cne21th

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Criteria and diagnostic terms for uterine smooth muscle tumors (adapted from the work of Richard Kempson )

Coagulative necrosis

Mitotic count per 10 HPF

Atypia

Diagnosis

Present

Greater than 10

Moderate to severe (focal or diffuse)

Leiomyosarcoma

None to mild

Leiomyosarcoma

Equal or less than 10

Moderate to severe (focal or diffuse)

Leiomyosarcoma

None to mild

STUMP (1)

Absent

Greater than 10

Moderate to severe, focal

Leiomyosarcoma

Moderate to severe diffuse

STUMP (2)

None to mild

Mitotically active leiomyoma (up to 15 mitoses/10 HPF are allowed)

Equal or less than 10

Moderate to severe, focal

STUMP (3)

Moderate to severe diffuse

Leiomyoma (4)

None to mild

Leiomyoma

(1) Of the three tumors here placed in the STUMP category, this is the one most likely to behave in a malignant fashion. Actually, it is regarded as a probable leiomyosarcoma in Kempson's scheme. The alternative possibility of an infarction in a leiomyoma due to torsion or other factors should be considered.
(2) In Kempson's scheme, this is designated as STUMP if the mitotic activity is higher than 15.
(3) This is referred to as "atypical leiomyoma with low risk of recurrence" in Kempson's scheme.
(4) This is designated as "leiomyoma with limited experience" in Kempson's scheme.

 

Invasive lobular carcinoma & Lymphoma
When ER, PR, Her-2 negative (especial ER negative), 
The D.D. of lymphoma should be included !!!

Liver transplantation

REJECTION ACTIVITY INDEX (RAI)

Criteria which can be used to score liver allograft biopsies with acute rejection, as defined by the World Gastroenterology Consensus Document.

Category

Criteria

Score

Portal Inflammation

Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads

1

Expansion of most or all of the triads, by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils and eosinophils

2

Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and eosinophils with inflammatory spillover into the periportal parenchyma

3

Bile Duct Inflammation Damage

A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes such as increased nuclear:cytoplasmic ratio of the epithelial cells

1

Most or all of the ducts infiltrated by inflammatory cells. More than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity and cytoplasmic vacuolization of the epithelium

2

As above for 2, with most or all of the ducts showing degenerative changes or focal lumenal disruption

3

Venous Endothelial Inflammation

Subendothelial lymphocytic infiltration involving some, but not a majority of the portal and/or hepatic venules

1

Subendothelial infiltration involving most or all of the portal and/or hepatic venules

2

As above for 2, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis

3

Total RAI Score = _/9

Reference Anonymous. Banff Schema for Grading Liver Allograft Rejection: An International Consensus Document. Hepatology 1997;25(3):658-63.

 
 

Labial salivary gland biopsy in Sjögren's disease
Chisholm Mason scale

Grade

Lymphocytes per 4 sq mm of Salivary Tissue

0

Absent

1

Slight infiltrate

2

Moderate infiltrate or less than one focus

3

One focus

4

More than one focus

 

Focus = an aggregate of 50 or more lymphocytes and histiocytes

2008 WHO new classification of Plasma cell neoplasm
Symptomatic plasma cell myeloma
M-protein in serum or urine*
Bone marrow clonal plasma cells or plasmacytoma#
Related organ or tissue impairment @
(CRAB: hypercalcemia, renal insufficiency, anemia, bone lesion)