Atypical polypoid adenomyoma of the endometrium

These are two high power views of a highly unusual curetting specimen from a 38 yo patient. The total weight of these curettings was 37 gm, and it looked the same all over (I should have included a low power view). It is anticipated that a hysterectomy will be performed, possibly I will post a follow up.

Adenocarcinoma of the cervix uteri, endocervical type

This is a deeply infiltrating adenocarcinoma of the endocervix with typical characteristics of an endocervical type adenocarcinoma. It is characterized by cells with pale granular cytoplasm and basal nuclei resembling the cells of the normal endocervix. The tumor is papillary in part (right image).

"Funny" looking Brenner tumor

This is a sharply demarkated, unilateral, 3 cm Brenner tumor from a 52 yo patient. The histology appears odd because it contains large transitional cell nests that are also more frequent than usual. Only few microcysts. There is no cellular atypia, therefore it is a benign Brenner tumor. It is presented here to illustrate a somewhat more "active" but still benign variant of a Brenner tumor.

Mucinous borderline tumor of the ovary, endocervical type

These images were taken from a multicystic, 12 cm ovarian tumor in a 67 yo patient. After extensive sampling the diagnosis of a mucinous borderline tumor of the ovary, endocervical type was made.

Comment: Personally, I do not remember having encountered an endocervical type mucinous borderline tumor of the ovary, usually they are of intestinal type.

Malignant granulosa cell tumor of the ovary with heterogenous differentiation

This is an unilateral, 12 cm granulosa cell tumor of the ovary from a 65 yo patient. This case is presented here because of its unusual array of different kinds of histologic differentiation patterns. We called it "malignant" because of the presence of microscopic metastastases in the major omentum.

Virilizing hilus cell tumor of the ovary

This is a 2.8 cm steroid cell tumor of the ovary which was detected because of severe signs of virilization in a 37 yo patient. The tumor has all the characteristics of hilus cell tumor, but Reincke crystals were not identified (G-520/03). The patient is alive and well now two years after surgery.

My stuff for macro-photography

The task of taking good images of gross specimens in pathology is not easy. This post describes my selection of equipment that I am now using for routinely taking digital images of high quality. With this setup, each and every specimen can be documented, and it turns out to be very useful to have an image of what you have received and how you received it.

Although there is an enormously large array of digital cameras on the market that may be suitable for taking pictures in the lab, it turned out to be quite difficult to select equipment that meets the following requirements:

1. good lighting, no shadows, no color distortion
2. clean and neutral background
3. stationary setup of camera and lighting to eliminate the handling of the camera and the need for batteries
4. remote control of the camera and remote storage of the digital images on a computer or on a network
5. live display of a preview image on a computer to simplify setting up the image

When shopping for a camera, it turned out that the requirement for a live preview was the most difficult to meet. But after several weeks of research and a visit to the Photokina, I found a solution that meets all these requirements and allows taking and storing very high quality digital images in seconds. The cost of the whole setup was almost 6.000 Euros (camera, lighing, computer, monitor, and accessoires). It may be of interest to other pathologists, therefore the setup will be described here:

Lighting: The Just DTS/FS Compact Studio Light System is a heavyweight setup (91 kg!) with two large photostudio-type lamps and tubes to mount the camera and other equipment. It can be purchased e.g. at B+H Photo for 2500 USD. The lamps are very good, and there is also background illumination if you need that. The camera can be mounted at the vertical tubes with a "Super Clamp" from Manfrotto and a flexible camera arm, also from Manfrotto.	.
Camera: The Leica Digilux 2 has very good optics and can be fully remotely controlled on a PC, including live preview of the image. The zoom lens is adequate for the range of pictures to be taken, but it is good to have a 500D/77mm Canon close-up lens and the Leica E77 filter holder for close-ups. The camera is connected to any PC with an USB-2 cable. Viewing and shooting the image is done on the PC. There is no need for a flash memory in the camera, the images are stored on the computer.
Computer and Monitor: An old 500 MHz Pentium PC was used and fitted with an USB-2 card for connection to the camera. For the monitor, the 19 inch ViewSonic VP191 was selected because it has a very bright image and two VGA sockets. Because of this, both the microscope camera and the Leica camera can be connected to this monitor. The monitor was mounted on the wall using a Vogels EFW 1030 monitor arm.
Accessoires: It is important to securely fix the camera onto the lightening stand. A good solution is to use a "Super Clamp" and the articulate camera arm, or a flexible camera arm. All items are manufactured by Manfrotto.
Software: Although not directly relevant to this post, I use Picasa2 to manage all the images. This is a free software download from Google, and it nicely interacts with other tools that can be used to publish these pictures on the internet.