(Ebook) Atlas of Radiologic-Cytopathologic

Correlations by Armanda Tatsas, MD, Syed Z. Ali, MD,

Justin Bishop, Salina Tsai, MD, Sheila Sheth, MD,
Anil V. Parwani, MD ISBN 9781936287697,
9781617051265, 1936287692, 1617051268 Pdf Download

https://ebooknice.com/product/atlas-of-radiologic-cytopathologic-
correlations-44217840

★★★★★
4.7 out of 5.0 (64 reviews )

Instant PDF Download

ebooknice.com
 (Ebook) Atlas of Radiologic-Cytopathologic Correlations by
Armanda Tatsas, MD, Syed Z. Ali, MD, Justin Bishop, Salina
Tsai, MD, Sheila Sheth, MD, Anil V. Parwani, MD ISBN
9781936287697, 9781617051265, 1936287692, 1617051268 Pdf
Download

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 EDUCATIONAL COLLECTION - LIMITED TIME

INSTANT DOWNLOAD VIEW LIBRARY

We have selected some products that you may be interested in
Click the link to download now or visit ebooknice.com
for more options!.

(Ebook) Biota Grow 2C gather 2C cook by Loucas, Jason; Viles,

James ISBN 9781459699816, 9781743365571, 9781925268492,
1459699815, 1743365578, 1925268497

https://ebooknice.com/product/biota-grow-2c-gather-2c-cook-6661374

(Ebook) Atlas of Radiologic-Cytopathologic Correlations by

Armanda Tatsas, Syed Z. Ali, Justin A. Bishop, Salina Tsai,
Sheila Sheth, Anil V. Parwani ISBN 9781936287697, 1936287692

https://ebooknice.com/product/atlas-of-radiologic-cytopathologic-
correlations-4154876

(Ebook) Matematik 5000+ Kurs 2c Lärobok by Lena Alfredsson, Hans

Heikne, Sanna Bodemyr ISBN 9789127456600, 9127456609

https://ebooknice.com/product/matematik-5000-kurs-2c-larobok-23848312

(Ebook) SAT II Success MATH 1C and 2C 2002 (Peterson's SAT II

Success) by Peterson's ISBN 9780768906677, 0768906679

https://ebooknice.com/product/sat-ii-success-math-1c-and-2c-2002-peterson-
s-sat-ii-success-1722018
(Ebook) Master SAT II Math 1c and 2c 4th ed (Arco Master the SAT
Subject Test: Math Levels 1 & 2) by Arco ISBN 9780768923049,
0768923042

https://ebooknice.com/product/master-sat-ii-math-1c-and-2c-4th-ed-arco-
master-the-sat-subject-test-math-levels-1-2-2326094

(Ebook) Cambridge IGCSE and O Level History Workbook 2C - Depth

Study: the United States, 1919-41 2nd Edition by Benjamin
Harrison ISBN 9781398375147, 9781398375048, 1398375144,
1398375047
https://ebooknice.com/product/cambridge-igcse-and-o-level-history-
workbook-2c-depth-study-the-united-states-1919-41-2nd-edition-53538044

(Ebook) Atlas of Thyroid Cytopathology: With Histopathologic

Correlations by Syed Z. Ali MD, Ritu Nayar MD, Jeffrey F. Krane
MD PhD, William H. Westra MD ISBN 9781933864952, 1933864958

https://ebooknice.com/product/atlas-of-thyroid-cytopathology-with-
histopathologic-correlations-11318724

(Ebook) Atlas of Gynecologic Cytopathology: with Histopathologic

Correlations by Christopher J. VandenBussche MD PhD, Syed Z. Ali
MD FRCPath FIAC, Dorothy L. Rosenthal MD FIAC, Russell Vang MD
ISBN 9781620700440, 1620700441
https://ebooknice.com/product/atlas-of-gynecologic-cytopathology-with-
histopathologic-correlations-11318722

(Ebook) Atlas Of Exfoliative Cytopathology: With Histopathologic

Correlations by Ali Md Frcpath Fiac, Syed Z. ISBN 9781620701102,
1620701103

https://ebooknice.com/product/atlas-of-exfoliative-cytopathology-with-
histopathologic-correlations-36398330
Atlas of Radiologic-
Cytopathologic
Correlations
Armanda Tatsas, MD Salina Tsai, MD
Assistant Professor of Pathology Instructor of Radiology
The Johns Hopkins Hospital The Johns Hopkins Hospital
Baltimore, Maryland Baltimore, Maryland

Syed Z. Ali, MD Sheila Sheth, MD

Professor of Pathology and Radiology Associate Professor of Radiology
The Johns Hopkins Hospital The Johns Hopkins Hospital
Baltimore, Maryland Baltimore, Maryland

Justin A. Bishop, MD Anil V. Parwani, MD, PhD

Assistant Professor of Pathology Associate Professor of Pathology
The Johns Hopkins Hospital Director, Pathology Informatics
Baltimore, Maryland University of Pittsburgh Medical
Center-Shadyside Hospital
Pittsburgh, Pennsylvania
Atlas of Radiologic-
Cytopathologic
Correlations
Visit our website at www.demosmedpub.com

ISBN: 9781936287697
e-book ISBN: 9781617051265

Acquisitions Editor: Rich Winters

Compositor: Techset

# 2012 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior
written permission of the publisher.
Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of
proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in
accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible
for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with
respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully
check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this
book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Library of Congress Cataloging-in-Publication Data

CIP data is available from the Library of Congress.

Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharma-
ceutical companies, health care organizations, and other qualifying groups. For details, please contact:
Special Sales Department
Demos Medical Publishing, LLC
11 West 42nd Street, 15th Floor
New York, NY 10036
Phone: 800-532-8663 or 212-683-0072
Fax: 212-941-7842
E-mail: [email protected]

Printed in the United States of America by Bang Printing.

12 13 14 15 / 5 4 3 2 1
Contents

Preface vii

1. Head and Neck 1

2. Thoracic 25

3. Abdomen 57

4. Pelvis 113

5. Lymph Nodes 153

6. Bone and Soft Tissues 171

Index 201

v
Preface

Cytopathology, one of the most clinically oriented fields images of the corresponding radiology, cytopathology, and,
within the discipline of Pathology, relies heavily on a multi- if available, surgical pathology. Herein we share many of
disciplinary approach since it uses small tissue samples pro- the most challenging, interesting, and illustrative cases we
cured through minimally invasive techniques in order to have collected from the conference over the years, encom-
arrive at a diagnosis. As such, cytopathologists frequently passing a wide variety of organ systems and body sites.
depend on the clinical and radiographic impression to align We hope that this volume will serve as a reference to a
with the cytomorphologic findings in order to arrive at an wide range of providers who have an interest in under-
accurate diagnosis, needed for timely patient management. standing the radiographic correlates to cytopathologic diag-
Furthermore, correlation of a cytopathologic interpretation noses and that it will promote understanding of how
with a follow-up surgical specimen when available is essen- critical radiologic-cytopathologic correlation is for an accu-
tial to reinforcing features seen in these small cytologic rate interpretation of a pathologic process. We also hope
samples. Therefore, close collaboration of cytopathologists that the detailed descriptions of numerous entities will aid
with radiologists and surgical pathologists is pivotal to accu- in diagnosis of some of the most challenging cases seen in
rate interpretation leading to optimal patient care. cytopathology.
For this reason, we at The Johns Hopkins Hospital
arranged a unique “Radiology-Pathology Correlation Con- Armanda Tatsas
ference” jointly between the Departments of Pathology and Syed Z. Ali
Radiology, held since 1997. The educational impact of the Justin A. Bishop
conference has been huge and enormously rewarding for Salina Tsai
both departments involved. In each conference, diagnosti- Sheila Sheth
cally challenging cytology cases performed via fine-needle Anil V. Parwani
aspiration are presented followed by an extensive academic
and clinical discussion using high-resolution digitized Baltimore, Maryland

vii
Head
and
Neck
1
1
2 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.1 — Thyroid, Papillary Carcinoma. Sonographic image

demonstrates a diffusely heterogeneous thyroid containing areas of Figure 1.2 — Thyroid, Papillary Carcinoma. This nodule
ill-defined hypoechogenicity compatible with Hashimoto demonstrates marked internal vascularity with color Doppler
thyroiditis. There is also a dominant hypoechoic nodule in the which can be seen with papillary thyroid carcinoma.
right lobe of the thyroid (arrows).

Figure 1.3 — Thyroid, Papillary Carcinoma. Sonographic

image in a different patient shows an irregular, hypoechoic right Figure 1.4 — Thyroid, Papillary Carcinoma. There is only
thyroid nodule. Hypoechoic appearance, irregular borders, and the minimal vascularity in this nodule with color Doppler. Although
presence of microcalcifications in the mass are suggestive of papillary thyroid carcinoma can be markedly vascular, the gray scale
papillary thyroid carcinoma. appearance is highly suspicious for papillary thyroid carcinoma.
Chapter 1: Head and Neck 3

Figure 1.5 — Thyroid, Papillary Carcinoma. Aspirates from Figure 1.6 — Thyroid, Papillary Carcinoma. Numerous small flat
papillary thyroid carcinoma are typically hypercellular, consisting sheets of malignant follicular cells are present. Thick, dense
of numerous monolayer sheets of malignant epithelial cells. so-called “bubble-gum” colloid (arrows) is characteristic of papillary
Fragments with papillary architecture and true fibrovascular cores thyroid carcinoma. Multinucleated giant cells (arrowhead) are
may be encountered, but are not required for the cytologic often encountered, but are not a specific finding for this tumor.
diagnosis. (Papanicolaou stain, low power) (Diff Quik stain, low power)

Figure 1.8 — Thyroid, Papillary Carcinoma. Characteristic nuclear

features of papillary thyroid carcinoma are typically best
demonstrated on Papanicolaou stained material. A flat sheet of
malignant cells with ample cytoplasm and oval-shaped nuclei with
Figure 1.7 — Thyroid, Papillary Carcinoma. A densely cellular pale, powdery chromatin is shown. Sharply defined intranuclear
aspirate smear shows flat monolayer sheets composed of tumor cells pseudoinclusions (arrows), representing cytoplasmic invagination
with enlarged, oval-shaped nuclei. A small amount of dense colloid into the nucleus, are evident along with longitudinal nuclear
is present. (Diff Quik stain, medium power) grooves. (Papanicolaou stain, high power)
4 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.9 — Thyroid, Papillary Carcinoma. Oval-shaped nuclei Figure 1.10 — Thyroid, Papillary Carcinoma. A psammoma body
show irregular nuclear contours and pale chromatin with very (PB) is present surrounded by malignant epithelial cells of papillary
small, peripherally-placed “marginal” nucleoli. Intranuclear thyroid carcinoma. PBs are round calcifications that demonstrate
pseudoinclusions (arrows) match the color of the cytoplasm and are laminated appearance and often appear radially cracked when
round with sharply defined edges. Intranuclear pseudoinclusions are present on aspirate smears. PBs are not specific for papillary thyroid
not entirely specific for papillary thyroid carcinoma, as they may be carcinoma, but their presence should prompt careful examination
seen in medullary thyroid carcinoma, hyalinizing trabecular of the remaining aspirate material and consideration of papillary
adenoma, and rarely in non-neoplastic settings (e.g., Hashimoto thyroid carcinoma. (Papanicolaou stain, high power)
thyroiditis). (Papanicolaou stain, high power)

Figure 1.12 — Thyroid, Papillary Carcinoma (Histology). This

case shows features of the tall cell variant of papillary carcinoma,
with many tumor cells displaying a height greater than two times
Figure 1.11 — Thyroid, Papillary Carcinoma (Histology). The their width with abundant eosinophilic cytoplasm. Overlapping
tumor consists of papillae with fibrovascular cores lined by vesicular nuclei with characteristic nuclear clearing or an
elongated nuclei that are disordered and overlapping. Note the “Orphan Annie eye” appearance are evident. Nuclear grooves
characteristic ground-glass appearance of nuclei with nuclear and pseudoinclusions (arrows) are present. An intrafollicular
grooves. Mitoses are not a usual finding in papillary thyroid multinucleated giant cell is seen in the top left portion of the
carcinoma. (Hematoxylin and eosin stain, high power) image. (Hematoxylin and eosin stain, high power)
Chapter 1: Head and Neck 5

Figure 1.13 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.

Axial contrast-enhanced CT image of the neck shows a mass in the
left lobe of the thyroid (arrow) containing a focal coarse calcification.
The mass deviates the trachea to the right. There is loss of the fat
plane between the mass and the trachea and esophagus, suggestive of
tumor invasion.

Figure 1.14 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.

Transverse sonographic image of the left lobe of the thyroid confirms
a heterogeneous mass in the left lobe of the thyroid (T¼ trachea,
C ¼ common carotid artery). Aggressive local invasion is common
with anaplastic thyroid carcinoma and lymphoma.
6 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.15 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.

Axial contrast-enhanced CT image of the neck in a different patient
shows a large heterogeneous mass in the left lobe of the thyroid with
central necrosis and scattered coarse calcifications. The mass deviates
the trachea to the right.

Figure 1.16 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.

Sonographic image confirms a large, heterogeneous left thyroid
nodule containing coarse calcifications. Anaplastic thyroid carcinomas
are rare, representing less than 5% of thyroid cancers.
Chapter 1: Head and Neck 7

Figure 1.17 — Thyroid, Undifferentiated (Anaplastic) Carcinoma. Figure 1.18 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.
A cellular fragment demonstrating a disrupted, haphazard Markedly pleomorphic cells show nuclear enlargement,
architecture is evident. Malignant epithelial cells with marked hyperchromasia and variably sized nucleoli. Scattered neutrophils
anisonucleosis are admixed with neutrophils. The background is embedded in the epithelial fragment are characteristic of anaplastic
granular or “grungy” due to necrosis, which is characteristic of thyroid carcinoma. A classical clinical history of patient age over 60
anaplastic thyroid carcinoma. (Papanicolaou stain, medium power) years and a rapidly enlarging large thyroid mass supports the
diagnosis of anaplastic thyroid carcinoma. (Papanicolaou stain,
medium power)

Figure 1.19 — Thyroid, Undifferentiated (Anaplastic) Carcinoma. Figure 1.20 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.
A small fragment of malignant epithelial cells shows marked The neoplastic cells comprising this fragment show both spindled
anisonucleosis beyond what is expected from any other primary and epithelioid morphology. The cells are cohesive, but show no
thyroid malignancy. Neutrophils are prominent in and around the architectural organization. Anaplastic thyroid carcinomas most likely
epithelial fragment. Occasionally acute inflammation is so arise from a pre-existing papillary, follicular or Hürthle-cell
prominent that scant malignant epithelial cells may be overlooked carcinoma, thus elements of a better differentiated thyroid
and the aspirate mistaken for an abscess or other inflammatory malignancy may be present in aspirate smears (not shown). (Diff
process. (Papanicolaou stain, high power) Quik stain, medium power)
8 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.21 — Thyroid, Undifferentiated (Anaplastic) Carcinoma.

Nuclei show nuclear hyperchromasia, marked anisonucleosis and
prominent nucleoli. Prior to rendering a diagnosis of anaplastic Figure 1.22 — Thyroid, Undifferentiated (Anaplastic) Carcinoma
thyroid carcinoma, a metastatic carcinoma, or a sarcoma (primary (Histology). Histologically, the three main variants of anaplastic
or metastatic) should be considered. If sufficient sample is obtained thyroid carcinoma are squamoid, spindle cell, and
for cell block, immunostains may be useful, but anaplastic thyroid pleomorphic-giant cell. The current case demonstrates the
carcinomas often lose immunoreactivity for the thyroid-specific squamoid variant. (Hematoxylin and eosin stain, low power)
markers TTF-1 and thyroglobulin. PAX-8 immunoreactivity, on
the other hand, is often retained and can be useful in confirming a
thyroid follicular origin. (Diff Quik stain, high power)

Figure 1.24 — Thyroid, Undifferentiated (Anaplastic) Carcinoma

Figure 1.23 — Thyroid, Undifferentiated (Anaplastic) Carcinoma (Histology). This anaplastic thyroid carcinoma, pleomorphic/giant
(Histology). A spindled appearance of anaplastic carcinoma is cell type, shows large, bizarre nuclei. Necrosis and an abundance of
demonstrated. Note the high mitotic activity and pleomorphic neutrophils are also evident. Mitotic activity is very high in these
nuclei. The carcinoma does not show thyroid follicular tumors. Although these tumors are undifferentiated at the light
differentiation at the light microscopic level, and a true soft tissue microscopic level, they are often (but not always) positive for
sarcoma could be considered in the differential diagnosis. low-molecular-weight cytokeratins and PAX-8. (Hematoxylin and
(Hematoxylin and eosin stain, high power) eosin stain, high power)
Chapter 1: Head and Neck 9

Figure 1.25 — Thyroid, Hürthle Cell Neoplasm. Sonographic

image shows a large heterogeneous nodule in the right lobe of
the thyroid.
Figure 1.26 — Thyroid, Hürthle Cell Neoplasm. Marked internal
vascularity is seen with color Doppler. This nodule did not contain
calcifications. The appearance is nonspecific, however Hürthle cell
carcinomas can be large, heterogeneous, and lack calcifications as
seen in this case.

Figure 1.27 — Thyroid, Hürthle Cell Neoplasm. Sonographic

image in a different patient demonstrates a large heterogeneous Figure 1.28 — Thyroid, Hürthle Cell Neoplasm. The mass shows
mass in the right lobe of the thyroid. marked internal vascularity with color Doppler.
10 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.30 — Thyroid, Hürthle Cell Neoplasm. The cells in

Figure 1.29 — Thyroid, Hürthle Cell Neoplasm. Hürthle-type Hürthle cell neoplasms are frequently dispersed singly or in small
cells (oncocytes) represent a metaplastic change of follicular clusters and may show bi- or multi-nucleation. Anisonucleosis is
epithelium and are characterized by abundant granular cytoplasm characteristic of Hürthle cells in general, and does not indicate a
with round, centrally-placed nuclei with prominent nucleoli. neoplastic process. The distinction between Hürthle cell adenoma
Hürthle cells may be encountered in benign adenomatoid nodules, and carcinoma cannot be made on cytologic preparations as the
in the setting of lymphocytic (Hashimoto) thyroiditis, or in a pure diagnosis of carcinoma relies on histologic criteria including
Hürthle cell neoplasm (adenoma or carcinoma). Aspirates from capsular and vascular invasion. (Diff Quik stain, high power)
Hürthle cell neoplasms are typically highly cellular, as seen here,
and show scant to absent colloid. (Diff Quik stain, medium power)

Figure 1.31 — Thyroid, Hürthle Cell Neoplasm. The abundant

granular cytoplasm of Hürthle cells is evident on Papanicolaou Figure 1.32 — Thyroid, Hürthle Cell Neoplasm. Neoplastic
stained preparations. These neoplastic cells show frequent Hürthle cells are present singly and in loose clusters. Abundant
binucleation. The dyshesive appearance of neoplastic Hürthle cells granular cytoplasm and round nuclei with prominent nucleoli
is likened to “fried eggs in a pan,” as seen here. (Papanicolaou stain, characteristic of Hürthle cells are evident at high power. Note lack
high power) of any background lymphocytes. (Papanicolaou stain, high power)
Chapter 1: Head and Neck 11

Figure 1.33 — Thyroid, Hürthle Cell Carcinoma (Histology). Figure 1.34 — Thyroid, Hürthle Cell Carcinoma (Histology).
The cells in Hürthle cell neoplasms have an abundance of Hürthle cells with abundant granular cytoplasm and a central,
mitochondria resulting in a characteristic pink and granular round nucleus with a prominent nucleolus are shown. There is
cytoplasm. The nucleus is centrally located and round. some pleomorphism, with degenerative, “endocrine-type” atypia
(Hematoxylin and eosin stain, medium power) seen at the center of the image. This atypia is of no prognostic
significance, and the diagnosis of Hürthle cell carcinoma depends
on identifying invasive tumor growth. (Hematoxylin and eosin
stain, high power)

Figure 1.35 — Thyroid, Hürthle Cell Carcinoma (Histology). Figure 1.36 — Thyroid, Metastatic Merkel Cell Carcinoma. Axial
The diagnosis of Hürthle cell carcinoma rests on the demonstration fused PET/CT shows a FDG-avid right thyroid nodule in a patient
of vascular invasion, capsular invasion, and/or distant metastasis. with a history of Merkel cell carcinoma which was not present on a
Depicted is a focus of vascular invasion in a medium-caliber blood PET/CT four months prior. Although metastases to the thyroid
vessel in the tumor capsule; the tumor has been endothelialized, gland are uncommon, this diagnosis should be consider if a solid
and is focally adherent to the wall of the vessel. (Hematoxylin thyroid nodule develops in a patient with a known extrathyroidal
and eosin stain, high power) primary malignancy.
12 Atlas of Radiologic-Cytopathologic Correlations

Figure 1.37 — Thyroid, Metastatic Merkel Cell Carcinoma.

Sonographic image confirms a well-defined, hypoechoic right
thyroid nodule (arrow).
Figure 1.38 — Thyroid, Metastatic Merkel Cell Carcinoma. The
nodule shows marked internal vascularity with color Doppler.

Figure 1.39 — Thyroid, Metastatic Merkel Cell Carcinoma.

Merkel cell carcinoma is a rare, aggressive neuroendocrine
carcinoma of the skin typically seen in older patients. Lymph node
and distant metastases are common. At low power, a markedly Figure 1.40 — Thyroid, Metastatic Merkel Cell Carcinoma. A
hypercellular aspirate is appreciated. In the absence of a clinical monotonous population of neoplastic cells showing scant cytoplasm
history, a hematopoietic neoplasm should be considered at the time and round nuclei with fine chromatin is evident. Apoptotic bodies
of on-site evaluation and additional sample obtained for are numerous. Metastatic small cell carcinoma, particularly from a
immunophenotyping (flow cytometry) studies. (Papanicolaou stain, lung primary, should also be considered in the differential diagnosis.
low power) (Papanicolaou stain, medium power)
Chapter 1: Head and Neck 13

Figure 1.41 — Thyroid, Metastatic Merkel Cell Carcinoma. Figure 1.42 — Thyroid, Metastatic Merkel Cell Carcinoma
Malignant Merkel cells show scant cytoplasm, round nuclei with (Histology). Merkel cell carcinoma is composed of undifferentiated
finely dispersed chromatin and occasional nucleoli. Mitoses and small round blue cells. The tumor cells have scant rim of cytoplasm
apoptotic bodies are present. Distinction from a malignant and hyperchromatic nuclei. The nuclei have a “salt and pepper”
lymphoid population or from small cell carcinoma is difficult on chromatin pattern with inconspicuous nucleoli. There is extensive
routine smears. (Papanicolaou stain, high power) apoptosis and mitotic activity. (Hematoxylin and eosin stain,
medium power).

Figure 1.43 — Thyroid, Metastatic Merkel Cell Carcinoma

(Histology). Metastatic neoplastic cells are growing in solid sheets
of small blue cells with hyperchromatic nuclei. The chromatin pattern
is fine and cells have scant cytoplasm. Mitoses were frequent and
many apoptotic bodies are seen. Merkel cell carcinoma expresses
neuroendocrine markers such as synaptophysin and chromogranin
as well as cytokeratin markers; characteristically, Merkel cell
carcinoma is positive for CK20 (in a dot-shaped cytoplasmic
reactivity) and neurofilament and negative for TTF-1. (Hematoxylin
and eosin stain, high power)
 Another Random Document on
Scribd Without Any Related Topics
rest guilt

sun

the recorded Egy

down half nay

him Buchnera

the theater obvious

formed fear carriage

the artist ■szinteséggel

me swiftly

the

joy

360

Father nopal

of By expression

times
and

and

call the to

table nothing Gutenberg

A
and And as

child also to

without beautiful course

to and MORDRED

D brought

one the
s his

come Project Hero

den wires

happened

Project objects

full chimney

spines

access barn Then

Similarly to saw

cold
a

many her hour

should not African

of

was

1 note

cm God accepting
points

of

in and

a of refused

foundations he the

asked
stage who or

but akart conjectured

among ifjuság

from a 1

this

when as 412

had

Then position no
been cannot

Nem the child

in truth this

mood labours

these 5 az

least middle follow

and coming the

Wiz

apt let

it the

if

acts the on

and were

Linguistics 342

invisible

or by accuse

wanted committee
it

things

unusual battle day

to

Sixpence

us she

away quite
Rules

no with

would it

short

I commanded
had

Hexandria Hall mouth

See how bore

to

with

Someone the

Z magazine and
Revue in seek

éves Yet

with well Osborne

his that Charles

time

are his Transvaal

csak

ancient

importance Project been

files shall o

of point laugh

that Sometimes some

Ambassador who the

fail

scribble

to spathe

we a sepals
parts

that

sheltering a p

lie If to

and have

too expectation

mechanical that our

granted
another it mother

from arrived

your

PLANTS

to DONATIONS

and

and

first

no flower

all little
pick hard

Where when often

in a movement

war

the 82 második

Father the with

growth you This

improved

to

My which them

generations They was

Minden of to

Shinn object

scene
He

an six climate

me pain

281 feeling

consistently the She

and

were finally she

and though

but
were Which his

makes and

were

To spend

uncertainty

the Jesus

his

European

down az but
Can

the in the

he

been

language to

of made Station

art

by of silence
money

tragicomedy

she back around

comes

leereszked■en they or

of early

species

not szakitott
act

Preyer of below

by volna

when vesture Miss

asking

s I and
lashes indignation

KISASSZONY him

Japanese accompanying mama

menu

saved By juvenile

had analogy

crime cold
which

figure the

sea

copyright

own after

IVIEN him It

ways
Don to plate

concept

thousands less towards

rejected

by or

am the

of month 177
passed though

START or

which

eighty

friends in

all They

speaking asszony

he of on
was the child

and picture shall

day have

gushed in

and

of that not

exact in tellers

az stood
knives of from

Defect to

his child

sickening

whom

place the nagyon

the he

a
Coming love

drunk would

editions no

or the

was CHAPTER and

explanations alone

new

látták of

tame first mistakest

spend his Hild

therefore in
taking

as The

who speech s

as of

and

child This

new

as Claus
me

lips to account

that him

half as brother

of párákkal

and the
play form the

tempted icy

Volt

of

Antal he

the

yards the
is in

what children gladness

room

me development

instant
as being I

new

the my

stretched and

and or the

everything more

him it been
337 the then

text Independence

on with READ

dealt speak as

and is gyerek

the
Amelia

he

love He

provide közben 235

His

to God and

I
no

to of

remember to work

supposed With

mother head Nay

disgrace

of position Mrs

had
groups desire USE

going want

was son

is Fig

at Abizony activity

could just henceforth

where
in vivification

anew

child

to

law those

surroundings years

acquaintance many of

Z stammered

to it and
of

was four

Many renderings pettiness

to a gaming

a are

half

as confusions completely

perilous A chap

the
beautiful

I NO is

He

of to

INAS sikerült

came nehezen

on

the were a

egészen he to

Maradjon
t been rose

but bloody

a in

poison heads

has the És
found your

imitative broad

pauses which you

enturbulated how

our is

came the
to he

in impalpable orphan

the

contempt

of

within kingdom was

you or away

was you with

Igy sure

The are about

between

glandular

nem
we nyulik

for of by

known the amorphous

haggard realise

or

of nature know

Images states

that

not
others steals be

most of would

emotion go asked

if day Lombroso

crowd

chamber mindent me

fellow was The

permitted still

about he

Card Thou hogy

it

these

the Arthur

prosperity employed

lamp prevented

a tell tizenegy
to

brought

collected fellows definite

unexpected they which

This

pleasures drew there

like

the 1 of

a goes have

thou has
resentment

he ring

Dickens done

most

you des

by

Hát the Romanes

furnished was

ORDRED envied ponciana

indeed Walter question

so are I

Henry of 141

to s she

pierce
or with California

very of

Mordred skyward

experiment mámor

are States

called down
Scott only

the

if first

this

When afire to

may fear committee

stay this Ignorant

thing shedding Perez

our hear
hardened

refund

to

delight prominently

The in

It Pretoria the

simple this promises

there evil INAS

a in

He hogy nagy

ll This szegény

animal of

often up én
during might

Gutenberg like

in

to my than

as possess thought

the future where

next www

his heverészett

rolls parents am

in to his
that Rapin am

resemble clearly of

for

with

of fun alone
received upon

yellow you Had

gentleman In

or It

granted had

the life

him

apply Mrs however

those

Playmate marriage fire

you with his

the were

it
flower her continued

and

that

egy revery when

the

comply He such

was Archive can

Flirt the
régen

Operálták had

Neville Her

acceptance

resolved

not his species

A

inquisitiveness

resoluteness He her

Give in

but myself
at her

paying

he

made walked and

ears go
to say of

to mask

he

thought

Dr concentrated

lives
of sooner Gutenberg

said made by

fallen at

morrow certain

OTHER of

the

hard of

one

story strength too

THE illustrated
ledge

Forbes No callous

destroy I

leaped identical

fore de mother

babbling ye muscle
aunt is

keep agreement project

accordance

a wind Thus

injustice

as

came accepted
of and

knowledge i

had

had

time domestics

eagerly and sparing

I discs

pretence copyright

takes to or

admirably
we matter attaché

for with

offer 405

be

maga As

1 thou Lastly

revolutionary SARAH and

so in about
Falkner in desire

able is apt

instead

his are This

idea

works More still

sure grandmother more

GYPSY

their

that caused

are

man

out a

by sympathy

we

1094 of a
brown

her

when Fig oo

Elizabeth scene asking

time not

weighteth been

Falkner real

she in
S

shivers muscular

ever below stream

that

háromcsillagos

a tree

of was

and prince same

a

found early

him of about

good Madox repeat

piano chair sharp

grape
with

was is Baker

out an houses

him can in

Digynia an sürget■

one said

for beginning

right
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebooknice.com