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| ===Diagnosis=== | | ===Diagnosis=== |
| {{hidden|Diagnosis|<center>BORDERLINE SEROUS TUMOR OF THE OVARY WITH MICROINVASION.</center> | | {{hidden|Diagnosis|<center>BORDERLINE SEROUS TUMOR OF THE OVARY WITH MICROINVASION.</center> |
| <br>The characteristic feature of borderline serous tumor is the hierarchical branching of the papillae, where the papillae progressively branch from larger ones to smaller one and finally into tufts of epithelial cells. The cells show only mild to moderate atypia. A cytadenofibroma may have similar proliferation, but by convention should be less than 5% of the tumor. Focal mucinous change may also occur. Papillary clear cell carcinoma simulating borderline tumor will show a WT1-ve, ER-ve, PR-ve immunoprofile in contrast to the positive profile of the serous tumor. Often clusters of cells with abundant eosinophilic cytoplasm are seen at the surface of papillae (star, image 2; oval image 3) or in lymphatic like spaces either as single cells or small papillary clusters. This theoretically represents microinvasion which is variably defined by different authors (<3 or 5 mm or 10mm2). However, recent evidence suggests that the two patterns of invasion have vastly different prognosis. The AEC (abundant eosinophilic cells) are p16 positive and reflect a terminally differentiated senescent phenotype. If invasion is exclusively composed of this cell type, then these do not portend a poor prognosis.(Am J Surg Pathol 2014;38:743–755). These cells are significantly more often seen in BRAF mutated tumors, and are perhaps associated with a better prognosis. (Am J Surg Pathol 2014;38:1603–1611) ( </center>}} | | <br>The characteristic feature of borderline serous tumor is the hierarchical branching of the papillae, where the papillae progressively branch from larger ones to smaller one and finally into tufts of epithelial cells. The cells show only mild to moderate atypia. A cytadenofibroma may have similar proliferation, but by convention should be less than 5% of the tumor. Focal mucinous change may also occur. Papillary clear cell carcinoma simulating borderline tumor will show a WT1-ve, ER-ve, PR-ve immunoprofile in contrast to the positive profile of the serous tumor. Often clusters of cells with abundant eosinophilic cytoplasm are seen at the surface of papillae (star, image 2; oval image 3) or in lymphatic like spaces either as single cells or small papillary clusters. This theoretically represents microinvasion which is variably defined by different authors (<3 or 5 mm or 10mm2). However, recent evidence suggests that the two patterns of invasion have vastly different prognosis. The AEC (abundant eosinophilic cells) are p16 positive and reflect a terminally differentiated senescent phenotype. If invasion is exclusively composed of this cell type, then these do not portend a poor prognosis.<ref name=pmid24441661>{{Cite journal | last1 = Maniar | first1 = KP. | last2 = Wang | first2 = Y. | last3 = Visvanathan | first3 = K. | last4 = Shih | first4 = IeM. | last5 = Kurman | first5 = RJ. | title = Evaluation of microinvasion and lymph node involvement in ovarian serous borderline/atypical proliferative serous tumors: a morphologic and immunohistochemical analysis of 37 cases. | journal = Am J Surg Pathol | volume = 38 | issue = 6 | pages = 743-55 | month = Jun | year = 2014 | doi = 10.1097/PAS.0000000000000155 | PMID = 24441661 }}</ref>. These cells are significantly more often seen in BRAF mutated tumors, and are perhaps associated with a better prognosis. (Am J Surg Pathol 2014;38:1603–1611) |
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| | ====References==== |
| | {{Reflist|1}} |
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Revision as of 18:23, 24 September 2015
Provided clinical history
42 year old woman with a 9 cm ovarian mass
Site
ZZZ
Primary image
Low magnification. H&E stain.
Differential diagnosis
Expand Differential diagnosis
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SEROUS CYSTADENOFIBROMA OR ENDOCERVICAL TYPE BORDERLINE MUCINOUS TUMOR OR PAPILLARY CLEAR CELL CARCINOMA SIMULATING BORDERLINE TUMOR
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Additional tests
More history
Expand More history
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MORE HISTORY HERE
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Ask a colleague
Expand Ask a colleague
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CONSIDER DOING IMMUNO STAINS ?
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Stains
ExpandAlcian blue/PAS to Bilirubin |
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Alcian blue/PAS | Expand Dr Torres would ask why! |
Alican blue pH 1.0 | Expand Dr Torres would ask why! |
Alcian blue pH 2.5 | Expand Dr Torres would ask why! |
Auramine | Expand Dr Torres would ask why! |
Bielchowsky | Expand Dr Torres would ask why! |
Bilirubin | Expand Dr Torres would ask why! |
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ExpandColloidal iron to Fontana-Masson |
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Colloidal iron | Expand Dr Torres would ask why! |
Congo red | Expand Dr Torres would ask why! |
Cresyl violet | Expand Dr Torres would ask why! |
Dieterle | Expand Dr Torres would ask why! |
Diff Quik | Expand Dr Torres would ask why! |
Fontana-Masson | Expand Dr Torres would ask why! |
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ExpandGallyas to Gremelius |
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Gallyas | Expand Dr Torres would ask why! |
Giemsa | Expand Dr Torres would ask why! |
GMS | Expand Dr Torres would ask why! |
Gomori's trichrome | Expand Dr Torres would ask why! |
Gram | Expand Dr Torres would ask why! |
Gremelius | Expand Dr Torres would ask why! |
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ExpandJMS to Mucicarmine |
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JMS | Expand Dr Torres would ask why! |
Jones | Expand Dr Torres would ask why! |
Kinyoun | Expand Dr Torres would ask why! |
Luxol fast blue | Expand Dr Torres would ask why! |
Masson trichrome | Expand Dr Torres would ask why! |
M-MAS | Expand Dr Torres would ask why! |
Movat | Expand Dr Torres would ask why! |
Mucicarmine | Expand Dr Torres would ask why! |
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ExpandOil red O to Prussian blue |
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Oil red O | Expand Dr Torres would ask why! |
Orecein | Expand Dr Torres would ask why! |
PAS | Expand Dr Torres would ask why! |
PASD | Expand Dr Torres would ask why! |
PASF | Expand Dr Torres would ask why! |
PTAH | Expand Dr Torres would ask why! |
Prussian blue | Expand Dr Torres would ask why! |
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ExpandReticulin to Ziehl-Neelsen |
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Reticulin | Expand Dr Torres would ask why! |
Sudan black B | Expand Dr Torres would ask why! |
Toluidine blue | Expand Dr Torres would ask why! |
Verhoeff | Expand Dr Torres would ask why! |
Von Kossa | Expand Dr Torres would ask why! |
Warthin-Starry | Expand Dr Torres would ask why! |
Ziehl-Neeslen | Expand Dr Torres would ask why! |
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IHC
ExpandAlpha-1 AT to Cathepsin K |
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alpha-1 AT | Expand Dr Torres would ask why! |
ACTH | Expand Dr Torres would ask why! |
AE1/AE1 | Expand Dr Torres would ask why! |
alpha-fetoprotein | Expand Dr Torres would ask why! |
Alk-I | Expand Dr Torres would ask why! |
AMACR | Expand Dr Torres would ask why! |
AR | Expand Dr Torres would ask why! |
ATRX | Expand Dr Torres would ask why! |
Beta2-microglobulin | Expand Dr Torres would ask why! |
B72.3 | Expand Dr Torres would ask why! |
Beta-catenin | Expand Dr Torres would ask why! |
BCL2 | Expand Dr Torres would ask why! |
BCL6 | Expand Dr Torres would ask why! |
BCLxL | Expand Dr Torres would ask why! |
C3 comp | Expand Dr Torres would ask why! |
CA9 | Expand Dr Torres would ask why! |
Calcitonin | Expand Dr Torres would ask why! |
Calponin | Expand Dr Torres would ask why! |
Calretinin | Expand Dr Torres would ask why! |
CAM5.2 | Expand Dr Torres would ask why! |
Cathepsin K | Expand Dr Torres would ask why! |
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ExpandCD10 to Chromogranin |
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CD10 | Expand Dr Torres would ask why! |
CD117 | Expand Dr Torres would ask why! |
CD138 | Expand Dr Torres would ask why! |
CD15 | Expand Dr Torres would ask why! |
CD1a | Expand Dr Torres would ask why! |
CD20 | Expand Dr Torres would ask why! |
CD21 | Expand Dr Torres would ask why! |
CD23 | Expand Dr Torres would ask why! |
CD3 | Expand Dr Torres would ask why! |
CD30 | Expand Dr Torres would ask why! |
CD31 | Expand Dr Torres would ask why! |
CD34 | Expand Dr Torres would ask why! |
CD35 | Expand Dr Torres would ask why! |
CD4 | Expand Dr Torres would ask why! |
CD43 | Expand Dr Torres would ask why! |
CD45 (LCA) | Expand Dr Torres would ask why! |
CD5 | Expand Dr Torres would ask why! |
CD56 | Expand Dr Torres would ask why! |
CD57 | Expand Dr Torres would ask why! |
CD68 | Expand Dr Torres would ask why! |
CD7 | Expand Dr Torres would ask why! |
CD79a | Expand Dr Torres would ask why! |
CD8 | Expand Dr Torres would ask why! |
CD99 | Expand Dr Torres would ask why! |
CDX2 | Expand Dr Torres would ask why! |
CEA-m | Expand Dr Torres would ask why! |
Chromogranin | Expand Dr Torres would ask why! |
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ExpandCK17 to Glypican 3 |
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CK17 | Expand Dr Torres would ask why! |
CK19 | Expand Dr Torres would ask why! |
CK20 | Expand Dr Torres would ask why! |
CK34betaE12 | Expand Dr Torres would ask why! |
CK5/6 | Expand Dr Torres would ask why! |
CK7 | Expand Dr Torres would ask why! |
CMV | Expand Dr Torres would ask why! |
c-MYC | Expand Dr Torres would ask why! |
Cyclin D1 | Expand Dr Torres would ask why! |
D2-40 | Expand Dr Torres would ask why! |
Desmin | Expand Dr Torres would ask why! |
DOG1 | Expand Dr Torres would ask why! |
EBV | Expand Dr Torres would ask why! |
EMA | Expand Dr Torres would ask why! |
ER and PR | Expand POSITIVE |
Factor VIII | Expand Dr Torres would ask why! |
Factor XIIIa | Expand Dr Torres would ask why! |
Fascin | Expand Dr Torres would ask why! |
FH | Expand Dr Torres would ask why! |
FSH | Expand Dr Torres would ask why! |
Gastrin | Expand Dr Torres would ask why! |
GATA3 | Expand Dr Torres would ask why! |
GCDFP-15 (BRST2) | Expand Dr Torres would ask why! |
GFAP | Expand Dr Torres would ask why! |
GH | Expand Dr Torres would ask why! |
Glucagon | Expand Dr Torres would ask why! |
Glypican-3 | Expand Dr Torres would ask why! |
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ExpandHBME-1 to IgM |
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HBME-1 | Expand Dr Torres would ask why! |
HBV core | Expand Dr Torres would ask why! |
HBV surface | Expand Dr Torres would ask why! |
H-caldesmon | Expand Dr Torres would ask why! |
HCG | Expand Dr Torres would ask why! |
Helicobacter | Expand Dr Torres would ask why! |
Hepatocyte | Expand Dr Torres would ask why! |
HER2/neu | Expand Dr Torres would ask why! |
HHV-8 | Expand Dr Torres would ask why! |
HMB-45 | Expand Dr Torres would ask why! |
HNF1beta | Expand Dr Torres would ask why! |
HPV | Expand Dr Torres would ask why! |
HSV-I | Expand Dr Torres would ask why! |
HSV-II | Expand Dr Torres would ask why! |
IDH-1 | Expand Dr Torres would ask why! |
Inhibin | Expand Dr Torres would ask why! |
INI1 (BAF47) | Expand Dr Torres would ask why! |
Insulin | Expand Dr Torres would ask why! |
Kappa | Expand Dr Torres would ask why! |
Ki-67 | Expand Dr Torres would ask why! |
Lambda | Expand Dr Torres would ask why! |
Leu 7 | Expand Dr Torres would ask why! |
IgA | Expand Dr Torres would ask why! |
IgG | Expand Dr Torres would ask why! |
IgM | Expand Dr Torres would ask why! |
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ExpandLH to PDGFR |
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LH | Expand Dr Torres would ask why! |
LIN28 | Expand Dr Torres would ask why! |
Lysozyme | Expand Dr Torres would ask why! |
mammoglobin | Expand Dr Torres would ask why! |
MAP2 | Expand Dr Torres would ask why! |
MCV | Expand Dr Torres would ask why! |
Melanin A | Expand Dr Torres would ask why! |
MHC class I | Expand Dr Torres would ask why! |
MITF | Expand Dr Torres would ask why! |
MUM1 | Expand Dr Torres would ask why! |
Myeloperoxidase | Expand Dr Torres would ask why! |
MYO D1 | Expand Dr Torres would ask why! |
Myoglobin | Expand Dr Torres would ask why! |
Napsin | Expand Dr Torres would ask why! |
NF | Expand Dr Torres would ask why! |
NKX3.1 | Expand Dr Torres would ask why! |
NSE | Expand Dr Torres would ask why! |
OCT3/4 | Expand Dr Torres would ask why! |
p16 | Expand Dr Torres would ask why! |
P501S | Expand Dr Torres would ask why! |
p53 | Expand Dr Torres would ask why! |
p57 | Expand Dr Torres would ask why! |
p63 | Expand Dr Torres would ask why! |
Pankeratin | Expand Dr Torres would ask why! |
PAX2 | Expand Dr Torres would ask why! |
PAX5 | Expand Dr Torres would ask why! |
PAX8 | Expand Dr Torres would ask why! |
PCNA | Expand Dr Torres would ask why! |
PDGFR | Expand Dr Torres would ask why! |
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ExpandPLAP to WT1 |
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PLAP | Expand Dr Torres would ask why! |
PNL-2C | Expand Dr Torres would ask why! |
Prolactin | Expand Dr Torres would ask why! |
PSA | Expand Dr Torres would ask why! |
PSAP | Expand Dr Torres would ask why! |
RCC | Expand Dr Torres would ask why! |
S-100 | Expand Dr Torres would ask why! |
SALL4 | Expand Dr Torres would ask why! |
Smooth muscle actin | Expand Dr Torres would ask why! |
Somatostatin | Expand Dr Torres would ask why! |
STAT6 | Expand Dr Torres would ask why! |
Synaptophysin | Expand Dr Torres would ask why! |
TdT | Expand Dr Torres would ask why! |
TFE3 | Expand Dr Torres would ask why! |
TFEB | Expand Dr Torres would ask why! |
Thyroglobulin | Expand Dr Torres would ask why! |
Toxoplasma | Expand Dr Torres would ask why! |
TSH | Expand Dr Torres would ask why! |
TTF-1 | Expand Dr Torres would ask why! |
Ubiquitin | Expand Dr Torres would ask why! |
UCHL1 (PGP9.5) | Expand Dr Torres would ask why! |
Ulex Europaeus | Expand Dr Torres would ask why! |
Vimentin | Expand Dr Torres would ask why! |
VIP | Expand Dr Torres would ask why! |
VZV | Expand Dr Torres would ask why! |
WT-1 | Expand POSITIVE |
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Molecular testing
Chromosomal translocations
ExpandTranslocations Chr 1-10 |
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t(1;13) PAX7-FKHR | Expand Dr Torres would ask why! |
t(2,13) PAX3-FKHR | Expand Dr Torres would ask why! |
t(8;14) MYC-IGH | Expand Dr Torres would ask why! |
t(9;22) BCR-ABL | Expand Dr Torres would ask why! |
t(9;22) CHN-EWS | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr 11-13 |
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t(11;14) CCND1-IGH | Expand Dr Torres would ask why! |
t(11;22) EWS-WT1 | Expand Dr Torres would ask why! |
t(11;22) FLI1-EWS | Expand Dr Torres would ask why! |
t(12;15) ETV6-NTRK3 | Expand Dr Torres would ask why! |
t(12;16) FUS-ATF1 | Expand Dr Torres would ask why! |
t(12;16) CHOP-TLS | Expand Dr Torres would ask why! |
t(12;22) EWS-ATF1 | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr 14-22 |
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t(14,18) IGH-BCL2 | Expand Dr Torres would ask why! |
t(15;17) PML-RARA | Expand Dr Torres would ask why! |
t(16;21) FUS-ERG | Expand Dr Torres would ask why! |
t(17;22) COLA1-PDGFB | Expand Dr Torres would ask why! |
t(21;22) EWS-ERG | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr X & Y |
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t(X;1) PRCC-TFE3 | Expand Dr Torres would ask why! |
t(X;17) TFE3-ASPL | Expand Dr Torres would ask why! |
t(X;18) SYT-SSX | Expand Dr Torres would ask why! |
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Other molecular tests
ExpandMolecular tests (A-B) |
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ALK sequencing | Expand Dr Torres would ask why! |
B cell clonality Southern / PCR | Expand Dr Torres would ask why! |
BCL2 PCR | Expand Dr Torres would ask why! |
BRAF sequencing | Expand Dr Torres would ask why! |
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ExpandMolecular tests (C-H) |
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EBV PCR | Expand Dr Torres would ask why! |
EGRF sequencing | Expand Dr Torres would ask why! |
H3F3A sequencing | Expand Dr Torres would ask why! |
HHV-8 PCR | Expand Dr Torres would ask why! |
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ExpandMolecular tests (K-Z) |
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KIT sequencing | Expand Dr Torres would ask why! |
LOH 1p/19q PCR | Expand Dr Torres would ask why! |
T cell clonality Southern / PCR | Expand Dr Torres would ask why! |
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Diagnosis
Expand Diagnosis
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BORDERLINE SEROUS TUMOR OF THE OVARY WITH MICROINVASION.
The characteristic feature of borderline serous tumor is the hierarchical branching of the papillae, where the papillae progressively branch from larger ones to smaller one and finally into tufts of epithelial cells. The cells show only mild to moderate atypia. A cytadenofibroma may have similar proliferation, but by convention should be less than 5% of the tumor. Focal mucinous change may also occur. Papillary clear cell carcinoma simulating borderline tumor will show a WT1-ve, ER-ve, PR-ve immunoprofile in contrast to the positive profile of the serous tumor. Often clusters of cells with abundant eosinophilic cytoplasm are seen at the surface of papillae (star, image 2; oval image 3) or in lymphatic like spaces either as single cells or small papillary clusters. This theoretically represents microinvasion which is variably defined by different authors (<3 or 5 mm or 10mm2). However, recent evidence suggests that the two patterns of invasion have vastly different prognosis. The AEC (abundant eosinophilic cells) are p16 positive and reflect a terminally differentiated senescent phenotype. If invasion is exclusively composed of this cell type, then these do not portend a poor prognosis.[1]. These cells are significantly more often seen in BRAF mutated tumors, and are perhaps associated with a better prognosis. (Am J Surg Pathol 2014;38:1603–1611)
References
- ↑ Maniar, KP.; Wang, Y.; Visvanathan, K.; Shih, IeM.; Kurman, RJ. (Jun 2014). "Evaluation of microinvasion and lymph node involvement in ovarian serous borderline/atypical proliferative serous tumors: a morphologic and immunohistochemical analysis of 37 cases.". Am J Surg Pathol 38 (6): 743-55. doi:10.1097/PAS.0000000000000155. PMID 24441661.
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Other cases
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| Number | |
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| Subspecialty (Difficulty) |
Autopsy pathology (jr,sr, f/e)
Breast pathology (jr,sr, f/e)
Cardiovascular pathology (jr,sr, f/e)
Cytopathology (jr,sr, f/e)
Dermatopathology (jr,sr, f/e)
Endocrine pathology (jr,sr, f/e)
Forensic pathology (jr,sr, f/e)
Gastrointestinal pathology (jr,sr, f/e)
Genitourinary pathology (jr,sr, f/e)
Gynecologic pathology (jr,sr, f/e)
Hematopathology (jr,sr, f/e)
Head and neck pathology (jr,sr, f/e)
Lymph node pathology (jr,sr, f/e)
Medical kidney pathology (jr,sr, f/e)
Molecular pathology (jr,sr, f/e)
Neuropathology (jr,sr, f/e)
Pediatric pathology (jr,sr, f/e)
Pulmonary pathology (jr,sr, f/e)
Placental pathology (jr,sr, f/e)
Soft tissue pathology (jr,sr, f/e) |
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| Difficulty | |
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|