aquifer (@jppathpd) profile picture

Pathologist #PathKeys

Posts = my own opinion
Joined November 2022
Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)Photo by aquifer (@jppathpd)
Dx? mandible HE #Pathkeys 2025-1p-2 (etc)
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⭕Ameloblastoma (follicular and plexiform patterns) 🔬Epithelial islands with peripheral palisading of columnar cells and central stellate reticulum-like cells in a fibrous stroma ☢Well-defined radiolucency around the crowns of impacted molars with partial cortical resorption
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Image (pathology, panoramic radiograph): Gao X, et al. Front Oncol 2026;16:1801359 (CC BY 4.0) Ref: Gao X, et al. Front Oncol 2026;16:1801359
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Dx? pleura STAT6 #Pathkeys
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🧬NAB2-STAT6 fusion (intrachromosomal rearrangement on 12q) ☢️Well-circumscribed pleural-based mass, mostly attached to visceral pleura; may grow large enough to fill a hemithorax and displace the mediastinum
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Image (pathology): Paraschiv A, et al. Reports 2026;9:229 (CC BY 4.0) Image (CT): Paraschiv A, et al. Reports 2026;9:229 (CC BY 4.0)
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Dx? adrenal chromogranin A #Pathkeys
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🧬At least 30% hereditary: SDH genes (most common), NF1, VHL, RET, MAX, EPAS1, FH; SDHB IHC screens for SDH loss ☢️Marked T2 hyperintensity ("light bulb sign"); no signal drop on opposed-phase MRI, unlike lipid-rich adenoma
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Image (pathology): Zhang J, et al. Front Oncol 2026;16:1770384 (CC BY 4.0) Image (MRI): Tamayo Y, et al. Abdom Radiol 2026;51:3004-9 (CC BY 4.0)
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Dx? kidney HE #Pathkeys
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⭕oncocytoma 🔬Nests and tubules of cells with abundant granular eosinophilic cytoplasm and small round regular nuclei, floating in edematous stroma 🧪c-kit+; CK7- 🧬Loss of chromosome 1, 11q13 rearrangement, deletion of chromosome 14 ☢️Central scar may be seen on CT
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Image (pathology): Pagano D, et al. World J Surg Oncol 2018;16:123 (CC BY 4.0) Ref: Goldblum JR, et al. Rosai and Ackerman's Surgical Pathology, 11th ed. Elsevier; 2018
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To everyone who follows me: thank you, as always, for reading, liking, and reposting. This account posts one case a day, drawn mainly from diseases that have appeared on Japan's pathology board examination (every image cited comes from CC BY papers only).
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My aim is the sharpest possible diagnostic skill — reading an H&E image alone and "seeing through" it to what lies beyond the disease and to its genetics — and I will keep working toward it. Thank you all for your continued support.
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Dx? kidney Pt with dialysis #Pathkeys
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⭕ Acquired cystic disease-associated RCC 🔬 Arises in ACKD. Eosinophilic cells with prominent nucleoli and cytoplasmic vacuoles giving a sieve-like pattern; intratumoral calcium oxalate crystals. ☢️ small atrophic kidneys studded with cysts + heterogeneously enhancing solid mass
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Image (pathology): Zhou L, et al. Front Oncol 2024;14:1349610 (CC BY 4.0) Image (CT): Yang Y, et al. Front Oncol 2023;13:1187495 (CC BY 4.0) Ref: El-Zaatari ZM, Truong LD. Biomedicines 2022;10:657 Ref: Yang Y, et al. Front Oncol 2023;13:1187495
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Dx? kidney GATA3 #Pathkeys
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🧬KRAS mutation in most cases (~80–90%), clustered in exon 2 codon 12 (mainly G12V); no trisomy 7/17. Indolent behavior ☢️Small, round, well-defined renal mass with high attenuation on pre-contrast CT (arrow)
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Image (pathology): Mohanty SK, et al. Virchows Arch 2024;485:829 (CC BY 4.0) Image (CT): Lee HJ, et al. Jpn J Radiol 2024;42:1458 (CC BY 4.0) Ref: Marletta S, et al. Virchows Arch 2026;489:631 Al-Obaidy KI, et al. Mod Pathol 2022;35:1279
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