Beruflich Dokumente
Kultur Dokumente
Year 2
2009 - 2010
Pathology Laboratory Guide
CONTENTS
1
INTRODUCTION TO MICROSCOPIC EXERCISES
A considerable time of the Pathology Course is devoted to microscopic analysis of tissues.
This is not because we wish you all to become pathologists, but we believe that
understanding the cellular and structural changes in the tissues is essential for you to
understand the biological nature and the clinical expression of human diseases. Thus,
the laboratory material must be approached with this perpective.
Much of what you'll acquire in the way of histopathologic information will be self-taught.
You will utilize the microscope and the slide sets loaned to you for each laboratory
session. In the beginning of the year, a text syllabus will be supplied, by the
Department of Pathology. The laboratory sessions are intended to assist you in your
efforts to learn pathologic anatomy. The design of these sessions assumes a significant
effort on your part, before coming to class.
Coming to class without a reasonable study will ensure that your time in class will be
wasted. Ordinarily, if you've been staring at a given slide for 10-15 minutes to figure it
out, without any success, additional time spent will not be rewarded. Any additional time
you could spare would better be spent after discussion in lab, reviewing what you been
stumped by.
Experience has shown that a systematic approach to each slide works the best.
1. Familiarize yourself with the text and lecture material relevant to the condition under
consideration before studying the slide.
2. Inspect the slide carefully with the naked eye before putting it under magnification.
This will often enable you to spot the one focal area which is abnormal, an area which
might be missed under the microscope with its narrow field.
3. If you have not been told, begin the microscopic exercise by deciding what tissue is
represented on the slide (Is it a pancreas, brain, etc?). If you have been told, review the
features which would allow you to identify it. In either event, you should next look up to
the image of the tissue in your histology textbooks. It aids you in recognizing the normal
composition of the tissue you are examining.
4.Then, and only then, continue the exercise by examining the section for deviations
from that of normal.
a. Be systematic. Devise a personal system which ensures that you will cast an
eye over every bit of the section. Get into the habit for instance of sweeping back
and forth from top to bottom or up and down from left to right of the section
covering it completely.
b. Start with the lowest available magnification which provides the widest
field. When you recognize any abnormality under the lowest power, go after it at
higher magnification in order to figure it out,for instance, what kind of cells make
up that purple blotch. When you have figured it out, go back to the lowest
magnification to see it again. Before long, you'll be telling polys from plasma
cells with the low power scanning lens. As you get comfortable with the low
power, you'll be able to diagnose things by pattern recognization (which is how
you now recognize your friend's face in a crowd).
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c. Avoid to give any diagnosis, since it's often wrong for beginners. Instead
describe the abnormal elements to yourself one by one. For example vessels in
left field, fibroblasts in center field, and atypical pleomorphic cells in right field.
Then, try to put the elements together into a diagnosis. It works.
5. As questions appear in the syllabus, answer them carefully. They are desingned to
be helpful and freguently will give you insight into important clinical considerations.
Pathology practical examnation will be held in the multidisiplinary laboratory. This exam
contains multiple choice, open ended or an assay questions from slide presentation.
Students who do not fulfill the minimal required attendance limits, are not eligibal to participate
in the pathology practical exam.
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CELL AND TISSUE INJURY COURSE I
• IMPORTANT NOTE : In order to understand the pathologic findings, you have to know
the normal anatomic structure of the organs and tissues.
• In order to uderstand the underlying mechanism off these pathologic findings, you have
(to know the pathopysiological mechanisms of these pathologic processes that are going to
be examined.
• When examining the gross specimens, (try to answer the following
questions?
Is there any change in the size of the organ ?
If there is, is it diffuse or focal?
Is there any change in the color of the organ ?
If there is, is it diffuse or focal?
Is there any change in the consistency of the; organ ?
If there is, is it diffuse or focal?
Is there any tissue defect in the organ ?
If there is, is it superficial, intraparemchymal, or subepithelial
*hypertrophy
HYPERTROPHY - HEART
*hyperplasia
HYPERPLASIA - PROSTATE
NODULAR HYPERPLASIA - THYROID
* neoplasia
LYMPHOMA - SPLEEN ( Normal Spleen)
Non-local cells
*inflammatory cells
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MILIARY TUBERCULOSIS - LUNG GRANULOMATOUS INFLAMMATION
TESTIS ACUTE REJECTION – KIDNEY
*neoplastic cells (invasion / metastasis) LINITIS PLASTICA STOMACH
*dilatation
HYPERTROPHY -URINARY BLADDER
HIDROPS – GALLBLADDER
Focal
*Inflammatory
*Blood Accumulation
*Neoplastic
Decrease inSize
Diffuse
*atrophy RENAL ATROPHY ----> flbrosis
*hypoplasia
RENAL HYPOPLASIA
Local
*local atrophy
*scar formation
CHRONIC PYELONEPHRITIS
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CHANGES IN THE CONSISTENCY OF ORGANS
Softening
*destruction of the architecture of an organ (necrosis)
INFARCTION - SPLEEN
INFARCTION - MYOCARDIUM
TRANSMURAL INFARCTION - SMALL BOWEL
*decrease in ground substance
*edema, serous fluid accumulation
NASAL POLYP
HEMATOMA – SPLEEN
Hardening
Crispyness
*necrosis
TUBERCULOSIS - APEX OF THE LUNG
COAGULATION NECROSIS - KIDNEY - RENAL, CELL CARCINOMA
*decrease in substances giving elasticity to organs (osteogenesis imperfecta,
osteoporosis
DEGENERATIVE ARTRITIS
Darkening
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Paleness
Discoloration
*accumulation of pigments
ANTRACOSIS - LUNG
* accumulation of lipid
FATTY CHANGE - LIVER
NUTMEG LIVER
ATHEROSCLEROSIS - CHOLESTEROL ACCUMULATION FATTY CHANGE
- HEART AMILOIDOSIS - KIDNEY CHOLESTEROLOSIS - GALL BLADDER
HD-l . HYPERTROPHY
ORGAN: Heart
Gross Findings: This transverse slice from the heart displays prominent difference
between the diameters of ventricle walls. Notice a white area of flbrosis in one of the walls.
Descriptive Notes: Hypertrophies heart may achieve weights of 700 to 800 gr instead of
350gr.Normally the thickness of the wall of the right ventricle is 3 to 5 mm and that of the left
ventricle 1.3 to 1.5 cm. Greater weight or ventricular thickness indicates hypertrophy.
HD-2: HYPERPLASIA
ORGAN: Prostate
Gross Findings: Two prostatic lobes are seen. They are enlarged, firm and nodular. The
cut surfaces are also nodular and contains some minute cysts. The size of nodules vary from
0.5 to 1.5cm.
Descriptive Notes: This increase in size is in response to hormonal changes that
occurs with the aging process.
HD-3: HYPERPLASIA
ORGAN: Thyroid (Nodular Hyperplasia)
Gross Findings: Thyroidectomy specimen with glistening, jelatinous, nodular surfaces
is seen. At cut section you can discriminate fibrous bands causing nodular structures.
Descriptive Notes: In the adult, the normal thyroid gland weighs 20 to 25 gm. The
most common cause of the nodular hyperplasia is the of lack of iodine in the diet
resulting insufficient production of throid hormones. This cause increase the
sythesis and release of TSH (thyroid stimulating hormone), resulting in
enlargement of the thyroid.
HD-4: LYMPHOMA
ORGAN: Spleen
Gross Findings: In the cut section of the spleen, you see numerous nodular
masses(approximately 0.6-0.8 cm. in dimension). This leads to diffuse enlargement of the
spleen.
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Descriptive notes: These nodular masses are formed by neoplastic proliferation of
lymphocytes which are actually local cells of the spleen.
HD-12: ANTHROCOSIS
ORGAN: Lung
Gross Findings: Accumulation of this pigment blacken the tisues of the lung.
Descriptive Notes: The most common exogeneous pigment is carbon or coal dust, which is
a virtually ubiquitous air pollutant of urban life.
HD-15: AMYLOIDOSlS
ORGAN: Kidney
Gross Findings; Kidney is enlarged , firm and have a waxy appearance.
Descriptive Notes: Extracellular hyaline amorphous material is accumulated in
glomeruli and vessel wall. Painting the cut surface with iodine imparts a yellow colour is
transformed to blue violet.
HD-19: CONGESTION
ORGAN: Brain —> Meningeal Congestion
Gross Findings: The blood vessels of the meninges are engorged with dark red blood.
There is also diffuse increase in the size and weight of the organ due to secondary
edema formation.
HD-20: ABSCESS
ORGAN: Spleen .
Gross Findings: Spleen is enlarged. Acute inflammatory cell infiltration results with a
tissue defect that you can notice on the cut section of the spleen.
Descriptive Notes: Normally in the addult spleen weighs, about 150 gm and measures
12 cm in lenght, 7 cm in width, and 3 cm in thickness.
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HD-21: TUBERCULOSIS
ORGAN: Apex of the Lung
Gross Findings: At the apex of the lung there is an intraparanchymal tissue defect. At
the centre of the defect with a close inspection one can easily identify the necrosis.
Descriptive Notes: Mycobacterium cause tuberculosis.The type of the necrosis is
called caseification necrosis.
HD-22: ATROPHY
ORGAN: Kidney
Gross Findings: The cut section of the kidney reveals dilatation and deformation of
the calyces, irregular loss of renal parenchyma with scarring. Its surface is granular with
depressed scars.
Descriptive Notes: Atrophy is due to progressive destruction and loss of renal
parenchyma.
HD-23: HYPOPLASIA(congenital)
ORGAN: KIDNEY
Gross Findings:The size of the kidney is diffusely decreased. Its surface is smooth and
normal in appearance. The number of renal lobes and pyramids is 6 or fewer (normal
kidney has about 12 pyramids).
HD-25: INFARCTION
ORGAN: SPLEEN
Gross Findings: On the cut section of the spleen you see multiple, pale, wedge
shaped, well deliniated infarcts beneath the capsule. The infarcts which are wedge
shaped have their apex pointing toward the focus of vascular occlusion. Since all the
dependent tissue out to the periphery of the organ is affected, the external aspect of the
organ forms the base of the wedge.
Descriptive Notes:This is an example of white infarct which is seen secondary to the
arterial occlusion of the solid organs.
HD-26: INFARCTION
ORGAN: Placenta
Gross Findings: On cut section of the placenta reveals a white-tan and firm area of
necrosis. It is also wedge shaped with apex at the maternal surface.
Descriptive Notes: This is also an example of white infarct. It results from cessation of
blood supply to intervillous space and necrosis of villi .
HD-29: CIRRHOSIS
ORGAN: Liver
Gross Findings: The liver is harder than normal due to fibrosis. Its surface shows
diffuse nodularity that reflects nodular regeneration and scarring.
Descriptive Notes: Cirrhosis of the liver is the terminal sequel of repeated injury to the
liver parenchyma. The result is the formation of broad fibrous bands separating
regenerative nodules that do not have the normal achitecture of liver lobules.
HD-30: BRONCHOPNEUMONIA
ORGAN: Lung
Gross Findings: The lung shows patchy distributed firm and gray-red to yellow colour,
elevated nodular airless areas due to inflammatory infiltration.These nodules are distributed
along with the bronchioles so called bronchopneuonia.
Descriptive Notes: It results from aspiration of organisms causing inflammation and
necrosis of underlying parenchyma
HD-31: CHOLESTEROLOSIS
ORGAN: Gall bladder
Gross Findings: Its mucosal surface shows minute yellow patches due to cholesterol
accumulation . This is called as a "strawberry gallbladder".
Descriptive Notes: It is results from abnormal deposition of mixtures of cholesterol and
triglyceride in macrophages in the lamina propria of the gallbladder.
HD-32: FIBROMA
ORGAN: Ovary
Gross Findings: The tissue is harder and bigger than a normal ovary because of
infiltration by neoplastic cells arising in the ovarian strorna. The ovary appears as a white
firm, mass composed of interlacing bundles of fibers.
Descriptive Notes:It is a benign neoplasm of the ovary.
N- 18 FATTY CHANGE
Organ: Liver
PATHOLOGICAL FINDINGS
Gross findings: HD-15
Microscopic findings: This H&E stained slide is prepared from a grossly yellow
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colored enlarged liver. The parenchymal cells (hepatocytes) show marked fatty change.
Note the variable sized lipid vacuoles in the cytoplasm and peripherally displaced
nuclei. Remember that fat globules appear as empty spaces with routine H&E stain.
A-13 METAPLASIA
Organ: Cervix
PATHOLOGICAL FINDINGS
Microscopic findings: The section is prepared from uterine cervix. On one side there
is squamous, on the other side columnar epithelium is seen. You may easily see the
squamocolumnar junction where squamous epithelium changes to columnar
epithelium.called squamous metaplasia. There are glands in the endocervical portion
of the section, lined by similar columnar epithelium. When you look at the surface
epithelium closely you will see that some parts of the columnar epithelium transform to
squamous type of epithelium.
A-13B METAPLASIA
Organ: Stomach
PATHOLOGICAL FINDINGS
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Microscopic findings: The section is from a gastrectomy specimen. On the slides you
will see the gastric mucosa lined by columnar epithelial cells. At some parts the gastric
epithelium is replaced by intestinal metaplasia which is composed of goblet cells,
absoptive ‘brush border’ cells. On the other slide stained with PAS-Alcian Blue 2,5
normal gastric epithelium is bright pink (neutral mucin) and the intestinal metaplasia
areas are purple (acidic mucin) in color. There are goblet cells in these metaplastic
areas.Mark the difference.
P-22 HYPERPLASIA
Organ: Prostate
PATHOLOGICAL FINDINGS
Gross findings: HD-2
Microscopic findings: Examine both stromal and epithelial components. The
fibromuscular stroma and glands are proliferated. The glandular epithelium is generally
hyperplastic, some glands show cystic dilatation and contain corpora amylacea in the
lumina.
A-15 ANTHRACOSIS
Organ: Lymph node
Histology of the organ: A lymphoid stroma which contains lymphoid follicles some of
which have germinal center. The node is surrounded by a fibrous capsule beneath
which are found lymphatic sinuses.
CASE
Clinical history: A 78 year-old man underwent lobectomy and lymph node dissection
with diagnosis of lung cancer.
PATHOLOGICAL FINDINGS
Gross findings: HD-12(Antracosis in lung)
Microscopic findings: In the center of the lymph node lymphoid tissue is replaced by
a fibrotic stroma rich in blood vessels. This stroma is infiltrated by histiocytes which
contain black granules (carbon pigment). You may also see carbon pigment within the
extracellular space.
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A-7a HEMOSIDEROSIS
Organ: Ovary
Histology of the organ: A stroma composed of theca cells contains follicules lined by
granulosa cells, corpora lutea by luteinized theca cells.
CASE
Clinical history: A 30 year-old woman underwent partial oopherectomy due to an
ovarian mass.
PATHOLOGICAL FINDINGS
Microscopic findings: The slide is prepared from an ovary which has a focus of
endometriosis. Here we see an area of old bleeding. This area is mainly composed of
numerous hemosiderin-laden histiocytes. Try to identify intracytoplasmic bright yellow-
brown appearing tiny granules of hemosiderin within histiocytes. These cells are called
“siderophages”.
CASE
Clinical history: A 45 year-old woman underwent excisional biopsy for a pigmented
cutaneus lesion found in the dorsum of the wrist.
PATHOLOGICAL FINDINGS
Microscopic findings: A lesion composed of melanin containing melanocytes is seen
within the dermis. The lesion also contains some cells which don’t contain melanin.
These cells have plump nuclei.
C-3a CONGESTION
Organ: Spleen
Histology of the organ: A red pulp composed of red blood cells and white pulp
composed of lymphoid tissue is observed. The white pulp contains some lymphoid
follicles some of which have germinal centers. The organ is surrounded by a fibrous
capsule. Fibrous trabeculae extend from the capsule into the stroma. The red cells of
the red pulp pare within vascular structures called the splenic sinuses.
CASE
Clinical history: A 19 year-old man underwent splenectomy for rupture of spleen after a
road accident.
PATHOLOGICAL FINDINGS
Microscopic findings: The splenic sinuses are dilated and filled with red blood cells.
C-6e INFARCTION
Organ: Small intestine
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Histology of the organ: The gut wall consists of a mucous membrane, muscular coat
and a serous membrane. The mucous membrane has a lamina propria lined by surface
epithelium which exhibits villi. In the lamina propria glands are found.
CASE
Clinical history: A young man who had appendectomy 6 months ago presented with
symptoms of ileus. At operation intestinal adhesions and a strangulated segment of
ileum was found.
PATHOLOGICAL FINDINGS
Gross findings: HD-27
Microscopic findings: An intense congestion and silhouettes of intestinal villi are
seen. In some slides there is extensive red blood cell extravasation and necrosis of the
bowel.
C-4A, 4B THROMBOSIS
Organ: A: Artery, B: Vein
Histology of the organ: The artery is composed of an intima, muscular coat and an
adventitial fibrous tissue. In the vein these layers are not as prominent as in the artery.
CASE
Clinical history: The leg of a 70 year-old woman has been amputaded due to vascular
occlusion.
PATHOLOGICAL FINDINGS
Microscopic findings:
A: This slide illustrates artery occluded by thrombi. This is an organized thrombus.The
wall of the arteries is calcified.
B: In this section we see an enlarged vein in which the lumen is completely obliterated
by an organized thrombus.
B-6 ABSCESS
Organ: Skin
Histology of the organ: A dermis containing cutaneous appenages such as hair
follicles, sebaceous glands and sweat glands lined by an epidermis composed of
stratified squamous epithelium. Beneath the dermis begins the subcutaneous adipose
tissue.
CASE
Clinical findings: A 20 year-old young male underwent excision of a cutaneous abscess
wall.
PATHOLOGICAL FINDINGS
Microscopic findings: There is a area of liquefaction necrosis filled with neutrophils
intermingled with histiocytes and giant cells. The wall of the necrotic area is rich in
blood vessels.
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M-36a ACUTE INFLAMMATION
Organ :Appendix
Histology of the organ: The wall of the appendix is composed of a mucous layer rich
in lymphoid follicles with prominent germinal centers, a muscular coat and a serous
membrane.
CASE
Clinical findings: A 30 year-old female with severe abdominal pain underwent
appendectomy with a diagnosis of acute appendicitis.
PATHOLOGICAL FINDINGS
Microscopic findings: In this slide you see an inflamed appendix wall. Try to examine
each layer subsequently. There is a purulent exudate in the lumen. The continuity of
the mucous membrane is not maintained because of the erosion seen just beneath that
exudate. Note that the edematous wall is diffusely infiltrated by neutrophils.
CASE:
Clinical findings:A 50 year-old man underwent partial gastrectomy due to a chronic
peptic ulcer.
PATHOLOGICAL FINDINGS
Microscopic findings: On both sides of the slide you can see normal gastric tissue
and in the middle there is a local tissue defect. Here, epithelium is the ulcerated. The
surface of it contains an inflammatory exudate composed of necrotic tissue debris and
neutrophils. Beneath this try to see the granulation tissue which is surrounded by a thin
layer of fibrous collagenous tissue.
PATHOLOGICAL FINDINGS
Microscopic findings: In this section there is ruptured follicle cyst is seen. Around cyst
there is a foreign body granulation tissue composed of giant cells and lymphocytes.
Such foreign body giant cells have nuclei scattered haphazardly about the cell. There is
refractile hair shaft fragments in some of these giant cells.Remember the difference
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between foreign body giant cells and Langhan’s type giant cells that seen in
Tuberculosis infection.
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MACROSCOPY
M1 - RENAL TUBERCULOSIS
The kidney is slightly enlarged with irregular nodular cortex. The cut surface shows
multiple round yellowish to grey-white cavitary areas lined with soft friable material
(caseous necrosis) and walled off by white, solid fibrous tissue in the parenchyma. You
can see this material also filling the pelvis and calyces. Calyces and renal pelvis are
dilated.
M2 - SPERMATOCELE
You see a cystic mass with a thickened, fibrotic wall and a small compressed testis in
one pole. The internal surface is irregular, matte(dull) and yellowish to brownish color
due to accumulated cellular debris.
M4 - HYDATID CYSTS
This specimen is from a patient with a history of hepatic hydatid cyst rupture. You see
multiple, white colored, different sized cysts embedded in peritoneal fat tissue. These
are dense fibrous capsules enclosing true cysts. This membrane-like structure
represents the inflamed fibrous tissue, which is the result of host reaction. Some of
these capsules are opened and inside them you can see the semi - opaque, soft outer
layer of the hydatid cyst membrane (the cuticle). You can also see small, translucent
cysts - the daughter cysts.
S-8 FIBROADENOMA
This is from a young woman with a round, mobile brest mass. The mass is not
encapsulated but very well demarcated. Look at the slide macroscopically. You will see
its round homogenous appearance. Microscopically, this is a tumor composed of two
components: a fibrous component which looks like the ordinary odematous fibrous
tissue, and duct or cleft like structures lined by double layer of epithelial cells. Both the
fibrous and the epithelial components have bland, almost “normal” nuclei. You will see
compressed and atrophic breast acini around the tumor.
R-10 LEIOMYOMA
You have seen the macroscopic specimen. A 42 year old woman who had complaints
of irregular shedding and dysmenorrhoea, underwent hysterectomy. Uterus was
enlarged and irregularly nodular. Many firm, round, white nodules were found in the
myometrium. You see a section prepared from one of these nodules. You see no
capsule, but there is a well-defined border from the surrounding myometrium.
Tumour is composed of fusiform cells with elongated nuclei which form bundles running
at various angles( you can see some bundles in cross section, others in longitudinal
section). Normal myometrium is seen compressed around the tumour. The normal
myometrial cells are seen in more parallel bundles. The tumor cell bundles are seen in
a more haphazard fashion. Other than that, the tumor cells are very similar to normal
smooth muscle cells.Compare the nuclei of the tumour with that of the normal
myometrium. They seem very “normal” in appearance.
D-26 HAMARTOMA
This is a non-neoplastic lesion. The microscopic slide is prepared from a bulky mass
located in the hard palate of a young male patient. Note somewhat proliferated
keratinized squamous epithelium lining the surface of this particular mass. Beneath the
surface epithelium, there is abundant collageneous connective tissue containing
markedly proliferated but disorganized blood vessels in small diameter (capillaries).
The lumina of some capillaries are dilated but most of the remaining capillaries are
slitlike vascular structures lined with swollen endothelial cells. You may see
mononuclear inflammatory cell infiltrate, extravasated erythrocytes, and hemosiderin
laden macrophages around capillaries.
V-17 CHONDROSARCOMA
This a malignant tumor which produces cartilage. Your slide belongs to a 46 year old
woman who was admitted to the hospital with a complaint of a rapid growing mass
around her pelvic bone. Her roentgenogram demonstrated a large lobulated mass with
evidence of calcification. The mass appeared to arise from the wing of the left ilium.
Hemipelvectomy was performed. Macroscopically, the tumour was 12x8x7cm in size
and it invaded soft tissues. The cut surface was glistening and showed focal
calcification. In your slides you are going to see a tumor quite similar to a hyaline
cartilage tissue. If you look closely you will notice that the neoplastic cells which are
embedded within basophilic matrix are plump and in contrast to mature chondrocytes
two or three of them share the same lacunae. You may also notice the pleomorphism
of the neoplastic cells.
D-25 TERATOMA
This section is prepared from an ovarian tumour removed from a 32 year old woman.
This tumour had a smooth external surface and predominantly solid but partially cystic
white to tan in color and areas of cartilage could be recognized on its cut surface.
Microscopically you see various sized cysts and various tissues scattered among them.
Examine and differentiate variable types of tissues. They are all mature. You can see
hyaline cartilage, nests of squamous cells with foci of keratinization in the center,
glandular structures fibrous tissue, smooth muscle and nodular masses of mesencymal
tissue (abundant proliferation of spindle cells with fine chromatin and scanty
cytoplasm). Do you expect this tumor to behave in a benign or malignat fashion?
HYDATID CYSTS
This specimen is from a patient with a history of hepatic hydatid cyst rupture. You see
multiple, white colored, different sized cysts embedded in peritoneal fat tissue. These
are dense fibrous capsules enclosing true cysts. Some of these capsules are opened
and inside them you can see the opaque, soft outer layer of the hydatid cyst membrane
(the cuticle). You can also see small, translucent cysts - the daughter cysts.
PULMONARY TUBERCULOSIS
This surgical specimen, represents fibrocaseous tuberculosis. Lesion is located at lung
apex: a compressed cavity partially lined by yellow - gray caseous necrotic material
and walled off by white, solid fibrous tissue. Around the cavitary lesion, there are yellow
colored peribronchial infiltrates and yellow colored foci in the consolidated lung which
represent dissemination of infection (non - cavitary tubercules with caseous necrosis).
This is endobronchial dissemination of apical tuberculosis.
MILIARY TUBERCULOSIS
These specimens : lungs, heart, liver, spleen, and kidneys are from an infant who died
of disseminated tuberculosis. You can see multiple, small (usually pin - point to a few
millimeters), yellow - white, distinct foci disseminated in the organs. This miliary
seeding is especially prominent in the lungs and spleen. You can see fewer lesions in
kidneys and in liver but none in the heart. There is congestion in all of the affected
organs (dark red - brown color). [[ The dark colored areas on the costal surface of
lungs and on the cut surface of liver are fixation artifacts ]]
TUBERCULOUS PYELONEPHRITIS
The kidney is slightly enlarged with irregular nodular cortex. The cut surface shows
multiple round yellowish soft cavities in the parenchyma. These yellowish foci are
representative of caseous necrosis. See the soft friable material (caseous necrosis)
filling the pelvis and calyces.
MICROSCOPY
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HEMATOPOETIC SYSTEMS AND RELATED DISORDERS COURSE
HE-2 LYMPHOMA
ORGAN: Spleen
Gross Findings: In the cut section of the spleen, numerous white-tan colored, slightly
elevated nodular masses can be seen.(approximately 0.6-0.8 cm. in dimension). This
leads to diffuse enlargement of the spleen.
Descriptive notes: These nodular masses are formed by neoplastic proliferation of small
B lymphocytes .
HE-2: LYMPHOMA
ORGAN: Spleen
Gross Findings: In the cut section of the spleen, numerous white-tan colored, slightly
elevated nodular masses can be seen.(approximately 0.6-0.8 cm. in dimension). This
leads to diffuse enlargement of the spleen.
Descriptive notes: These nodular masses are formed by neoplastic proliferation of small
B lymphocytes .
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MUSCULOSKELETAL SYSTEM AND RELATED DISORDERS
NON-NEOPLASTIC DISEASES
V-23 OSTEOPOROSIS:
Osteoporosis is the increased porosity of the skeleton due to reduction in bone mass. It
is mostly seen in senile and postmenopausal patients. Your slide belongs to a 75 year-
old woman who admitted to hospital with a femur fracture. X-ray examination revealed
a fracture at the neck of the femur and osteoporotic changes. She had an operation
and a prosthesis was replaced in her hip.
Microscopic findings: You will easily notice that the bone trabecula is thinned and lost
their interconnections (which is the reason for the fractures). Also you will see that the
bone marrow is mostly replaced by fat tissue. This is not a feature of osteoporosis but a
finding of senility.
NEOPLASTIC DISEASES
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V-17 CHONDROSARCOMA:
This is a malignant tumor which produces cartilage. Usually seen over the age of 40.
your slide belongs to a 46 year-old woman who admitted to hospital with a complaint of
a rapid growing mass around her pelvis. Her X-ray demonstrated a large lobular mass
with evidence of calcification and ossification. The mass appeared to arise from the
wing of left ilium. Hemipelvectomy is performed.
Macroscopic findings: The size of the tumor was 12x8x7 cm and it invaded soft tissues.
The cut surface was glistening and showed focal calcification.
Microscopic findings: ın your slides you are going to see a tumor quite similar to a
hyaline cartilage tissue. If you look closely you will notice that the neoplastic cells which
are embedded witin basophilic matrix are plump and in contrast to mature
chondrocytes two or three of them share the same lacunae. You may also notice the
pleomorphism of the neoplastic cells.
OTHERS
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RESPIRATORY SYSTEM AND RELATED
DISORDERSCOURSE
INFECTIOUS DISEASES
PATHOLOGICAL FINDINGS
Microscopic findings:
You have seen this slide as edema. This section is prepared from a smooth, rounded,
pedunculated nodule removed from the vocal cord of a 32 year-old male. You see a
polipoid mucosal tissue covered by squamous epithelium. The stroma is composed of
loose connective tissue infiltrated by inflammatory cells and extravasated erythrocytes.
In some parts this stroma is dense, collagenous and stained deeply eosinophilic. This
eosinophilic amorphous deposit represents the protein and solutes of edema fluid
(exudate). But in some areas connective tissue cells seem to be forced apart by fluid
and inflammatory cells appear to be suspended in clear spaces. (Transudate).
K- 5 Pneumonia
Organ: Lung
CASE:A 52 year old man who complained of persistent cough, foul smelling sputum,
and shortness of breath, was admitted to our hospital. He was a heavy smoker of 36
years duration. He had dyspnea , mild cyanosis and fever. Despite treatment of a
variety of antibiotics, pneumonic infiltration of right lower lobe persisted and the patient
underwent lobectomy.
PATHOLOGICAL FINDINGS
Gross findings:HD-30 Macroscopic examination revealed patchy distribution of areas
of consolidation (slightly elevated, firm ,grayish-red and yellow poorly delimited areas).
Microscopic findings:This section is prepared from a consolidated area of this lobe. .
The walls of the bronchi are intensely infiltrated with inflammatory cells and their lumina
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are filled with pus. In addition to the features you see alveoli filled with pink
homogenous fluid with few erythrocytes and polimorphonuclear leucocytes in it. You
may also see alveolar histiocytes. Try to find areas where neutrophilic exudate is more
prominent.
K-6 Tuberculosis
Organ: Lung
CASE:50 years old male patient who complained of cough and night sweet. Chest x-
ray revealed bilateral shadow appeareance in the lung. He undervent lobectomy.
PATHOLOGICAL FINDINGS
Gross findings:HD-21 Macroscopically, lobectomy specimen has irregular, cystic
nodular area filled by cheesy material ( grey- white necrosis foci).
Microscopic findings: You’ll see several large granulomas with central caseification
necrosis. These granulomas are confluent, markedly surrounded with lymphocytic rim.
In high magnification you’ll recognize that granulomas are made of epithelioid
histiocytes and Langhans type multinucleated giant cells.
EZN staining demonstrated pink (ARB positive) mycobacterium bacilli in the necrosis
areas.
PATHOLOGICAL FINDINGS
Gross findings:
Macroscopic examination of the lower lobe revealed patchy distribution of areas of
consolidation (slightly elevated, firm ,grayish-red and yellow poorly delimited areas) and
on cut surface markedly distended bronchi producing an almost cystic pattern.
The lumina of the bronchi were filled with suppurative exudate. The lung parenchyma
showed patchy atelectasis , hemorrhage and areas of consolidation.
Microscopic findings: On microscopic examination you see markedly distended
bronchi which appear crowded together with compression of the intervening lung
parenchyma. The walls of the bronchi are intensely infiltrated with inflammatory cells
and their lumina are filled with pus. You may see desquamation of their lining
epithelium and in some areas necrotizing ulceration of the bronchial wall. Fibrosis of
the bronchial walls , hyperplasia of lymphoid follicles and hemosiderin laden
macrophages are other prominent features.
PATHOLOGICAL FINDINGS
Gross findings:
His lungs seemed somewhat smaller then normal size, solid airless and reddish purple
(liver-like).
Microscopic findings: On low power microscopic examination lung tissue has
apperance of solid tissue.You see small crumpled alveoli and over extended airways
with prominent type II pneumocytes or peripheral band of eozinophilic granular material
called hyaline membranes. The membrane are made up of fibrin and cell debris derived
from type II pneumocytes.
K - 14 SARCOIDOSIS
Organ: Lung
CASE:Shortness of breath, cough, and chest pain were the presenting symptoms of a
32-year old male to the hospital. Chest radiograph showed both bilateral hilar lymph
node enlargement and pulmonary infiltrates. During mediastinoscopy, tiny, white
nodules were determined on the surface of the visceral pleura.
PATHOLOGICAL FINDINGS
Microscopic findings: This section is prepared from the mediastinoscopic biopsy of
this patient. The lung architecture is partially replaced by multiple isolated or confluent
aggregates of well-formed granulomas. Please try to identify the distribution pattern of
the granulomas, that is along the lymphatic route. They are situated subpleurally,
along the septa and around the bronchovascular bundles. Epithelioid cells with a few
scattered multinucleated giant cells of Langhans and foreign body type form the largest
part of the granulomatous structures. Granulomas lack significant peripheral
lymphocytic rim but have abundant collagen deposits surrounding them. They are
tight, well formed and non-caseating.
NEOPLASTIC DISEASES
PATHOLOGICAL FINDINGS
Gross findings:
Macroscopically the tumor was an ulcerating, fungating friable mass that arose from left
vocal cord and extended centrifugally.
Microscopic findings: This slide is prepared from the outer border of the tumor. You
can see luminal surface lined by metaplastic squamous epithelium. The edematous
stroma beneath the epithelium is invaded by the tumor. Tumor has highly differentiated
areas where squamous cells with large eosinophilic cytoplasms form nests with horn
pearls in them In less differentiated areas neoplastic cells having pleomorphic,
hyperchromatic nuclei and scanty cytoplasm, invade the stroma forming small groups
and cords. Notice the infiltration of lymphocytes and plasma cells.
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K-8-c BRONCHIOLARALVEOLAR CARCINOMA
Organ: Lung
CASE:Chest X-ray of a 42-year old male revealed bilateral multiple masses in the
upper lobes of the lungs.
PATHOLOGICAL FINDINGS
Gross findings:On the gross examination of the lobectomy specimens soft, slightly
raised, yellowish multiple small nodules were seen.
PATHOLOGICAL FINDINGS
Gross findings: There is a necrotic, solid, white-tan colored, 5x4 cm. in diameter
tumoral mass in cental bronchus of the lobe. The other areas of the lung has patchy
black discoloration(antracosis) and mucin accumulation in the bronchioles.
RS-2 ADENOCARCINOMA
Organ: Lung
CASE:A-61-year old female admitted to the hospital with cough, weight loss. Chest x-
ray revealed coin lesion in the peripheral area of her right lobe. There is no smoking
history. Lobectomy was done.
PATHOLOGICAL FINDINGS
Gross findings: There is a solid, well delinieated,white-tan colored, 3x2 cm. in
diameter tumoral mass in periphery of the lobe.
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