PathoHisto Flashcards
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invasive breast carcinoma
- Infiltrative growth- not well circumscribed.
- Desmoplasia.
- No myoepithelial cells seen in the tumorous glands= malignancy.
- The Nottingham histologic score is a scoring system to assess the grade, based on 3 different sub-scores (each given a grade from 1-3): structure (how many tumor cells form glands) + cytomorphology (nuclear atypia, polymorphism) + mitotic rate. Minimal grade:3, maximal: 9.
- Cytomorphology: 1. Carcinoma NST (Ductal): variable atypia. 2. Lobular: small, round tumor cells, usually slight/moderate polymorphism.
- Tumor cells form tubules, cribriform structures, nests and cords.
- In this slide- we can also see DCIS = Ductal carcinoma In Situ.
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Basal cell carcinoma, KROMPECHER TUMOR - SKIN
Most common skin malignancy. Semi malignant = Invasive but no distant metastasis. Peripheral Palisading (parallel organisation of nuclei on nest’s periphery. May contain melanin, surface often ulcerated, artifact reaction due to shrinkage of cells. May cause local bone destruction.
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Adrenocortical nodular hyperplasia
How can we see this is the Adrenal gland? It has an adipose capsule and cortex and medulla. The cortex is composed of Zona glomerulosa, Zona fasciculata, Zona reticularis, but here it is unorganized due to hyperplasia. Hyperplasia is typical for the prostate gland, and can also occur in uterus (pregnancy) and mammillary glands.
Kinds of Hyperplasia:
- Diffuse- thyroid gland.
- Nodular- parenchymal organs.
- Polyps- mucosal.
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thyroid follicular adenoma - THYROID
Complete fibrous capsule, Most common benign tumour of thyroid. Follicular structures. Low colloid content. Benign cytomorphology : Slight atypia/polymorphism can occur, but it does not indicate malignancy. Cytological evaluation of the cells in the case of thyroid follicular neoplasm cannot indicate whether the tumor is malignant or bening.
Criteria of malignancy:
a) infiltration of the capsule
b) vascular invasion.
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Non-Hodgkin lymphoma- extra nodal - stomach
Extra nodal disease refers to lymphomatous infiltration of anatomic sites other than the lymph nodes. Almost any organ can be affected by lymphoma, with the most common extra nodal sites of involvement being the stomach, spleen, Waldeyer ring, central nervous system, lung, bone, and skin.
This is a MALT lymphoma in the stomach, also DLBCL type. This tumor is related to H.Pylori infection. The stomach can be recognized via its normal gastric mucosa part, in the small part where it stayed intact. Most of the mucosal surface looks ulcerated. The tumor infiltrates all the way through the muscularis externa layer. Diffuse growth pattern in the stomach wall (DDG: diffuse type gastric cancer). The tumor cells show atypia characteristics (large, not cohesive, have large nucleoli) and look like blasts
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Extracellular protein accumulation in the Liver- Amyloidosis
To confirm the presence of Amyloid, we use Congo red stain + Polarization microscope = apple green color.
- The eosinophilic extracellular substance that surrounds the more basophilic cells (hepatocytes) is the Amyloid.
- Amyloidosis is caused by long term inflammation, hematogenic disorder, cancer, etc.
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fibroepithelial tumors - Skin
Both tumors here are benign, as the ducts are composed of 2 layers: intraluminal layer and an outer myoepithelial (clear cytoplasm) layer. If the myoepithelial layer disappears = malignancy.
• Fibroadenoma is the most common benign tumor of the breast (light pink). It is estrogen dependant, it has a fibrous troma + benign ductal epithelial proliferation.
Phyllodes tumor is rare (purple). It has a leaf like pattern, classified according to its mitotic rate, atypia of the stroma and stroma overgrowth. Hypercellular stroma with the same epithelium as in the fibroadenoma/
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Thyroid papillary carcinoma
Most common form of thyroid cancer, most often occurs in young adults (women).
- Good prognosis.
- Lymphogenic metastasis (cervical LN) – can develop early on, but can be treated surgically.
- Infiltrative growth.
- Contains papillary and follicular architecture in variable proportions.
- Branching papillae, having a fibrovascular stalk.
- Desmoplasia.
- Characteristic cytomorphology: special nuclei:
a) Orphan Annie eye (=chromatin clearing)
b) Nuclear grooves (=coffee bean nuclei)
c) intranuclear cytoplasmic inclusions (ICI) Nuclei are overlaping, arranged with long axes in parallel alignment.
• Psammoma body (laminated concentrically micro calcification in the stroma) may be seen.
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Liver Metastatic adenocarcinoma
Portal triads and hepatocytes can be seen. Fatty degeneration, Cholestasis (bile pigment in the cytoplasm). Basophilic area= tumor. It is well circumscribed = characteristic for metastases. Physiological liver does not contain glands. Zooming in the glands, we see malignant neoplastic cellular atypia = ADENOCARCINOMA. The primary tumor could be colorectal/ gastric/ breast/ lung for example.
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Serous cyst adenofibroma - UTERUS
Most common ovarian tumour, benign tumour is composed of cysts and stroma. The normal epithelial lining of the fallopian tube is composed of 3 cell types: ciliated, secretory and Peg cells. Cysts covered by single layer of tall, columnar, ciliated cells resembling normal tubal epithelium
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Endometrial typical hyperplasia
Thick endometrium (endometrium/myometrium ratio↑).
- Glands are dilated, cystic. The glands have pseudostratified epithelial lining, which mimics proliferative endometrium.
- Gland/stroma ratio is maintained- typical hyperplasia. (if it wasn’t maintained, and also the cells were atypical- then it would be called atypical).
- Endometrial hyperplasia occurs due to increased level of estrogen (obese) or low amount of progesterone (polycystic ovary disease)
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Necrosis of palatine tonsils
How do we know it is a tonsil?
- Stratified squamous nonkeratinized epithelium
- Crypts, lymph nodules can be identified
- Lymphatic tissue - lymphocytes nucleus is basophilic, and has invisible cytoplasm.
Diagnosis: This is a coagulative necrosis. We can see a homogenous loss of organization; the outline of the cell is seen and the nucleus is absent.
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active chronic gastritis
This is a specimen from a biopsy.
- There are no parietal or chief cells => this is the antrum of the stomach.
- Surface epithelium is ok, so no erosion or ulcer.
- In the lamina propria- many lymphocytes, plasma cells and eosinophils are seen. These are mainly cells of chronic inflammation. Also, neutrophils are seen which are the acute/active component of this inflammatory reaction.
- There is also an Intestinal metaplasia seen (goblet cells which are not usually found in the stomach). This happens due to the irritation.
- On macroscopy has Petechia hyperemic area, mostly the antrum is affected.
- Can be caused by over use of Aspirin or steroids.
- Counter measures: Proton pump inhibitors.
- Lack of vitamin b12 absorption due to lack of intrinsic factor.
- One of the agents that causes gastritis is helicobacter pylori causing chronic gastritis found on the surface of the mucosa, rod like bacteria. Can be seen with immunohistochemically reaction.
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Invasive squamous cell carcinoma of the Cervix
The normal cervical epithelium is not present here. The basement membrane of the epithelium was destroyed and hence this tumor is invasive. The tumor is also seen inside lymphatic vessels. Desmoplasia can be seen (Tumor induced stromal reaction characterized by collagen rich connective tissue). Broad epithelium polymorphism. Cells are not round, have prominent nucleoli. The epithelium is anaplastic (is a condition of cells with poor cellular differentiaton, losing the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells). This is a not well differentiated lesion (about grade 3)- aggressive tumor. Chronic inflammation infiltrate can be seen (lymphocytes).
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Granulation tissue
Granulation tissue is a new connective tissue with microscopic blood vessels that are formed on the surface of a wound during healing process. Characterization of granulation tissue:
- Rich vascularization (angiogenesis, cuboidal endothelial cells).
- Edematous interstitium, with fibroblasts (the main cells in the tissue, which will produce the collagen for the creation of a scar tissue).
- Chronic inflammatory cell infiltrate (macrophages, lymphocytes), in recent granulation tissue granulocytes as well. Their role is to phagocytose old or damaged tissues and protect the healing tissue from another infection.
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IRDS- infantile respiratory distress syndrome.
This is the lung of a pre-term baby. The alveoli are not completely open. This is an autopsy case. Hyaline membranes (protein rich exudate) are seen lining the alveoli. This is a new-born disease due to the lack of surfactant. Corticosteroids can be given to the mother to stimulate production of surfactant in the fetus.
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Non-Hodgkin lymphoma- nodal DLBCL - Lymph Node
Non-Hodgkin lymphoma can be due to neoplastic proliferation of either B or T cell (less common). It can be classified according to the B-cell size. 1. Small B-cells: follicular/mantle/marginal according to the regions of the secondary lymphatic follicles. 2. Intermediate B-cells: Burkitt lymphoma, associated with EBV. 3. Large B-cells: diffuse large B cell lymphoma (DLBCL)- most common, and seen in this slide. DLBCL is a diffuse large B-cell proliferation, present in late adulthood (>50) as an enlarging lymph node or an extra nodal mass. Diffuse growth pattern can be seen – the basic structure of the lymph node disappears (no distinct follicles seen). Centroblast, immunoblast-like tumor cells (ratio of tumor cells >90%) can be seen, that are large with prominent nucleoli. Many mitotic figures à high proliferation.
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Liquefactive necrosis of the brain
How do we know it is the brain? Fibrillar network with low cellularity (Neurons, axons, glial cells can be seen).
Diagnosis: This is a liquefactive necrosis. It is light eosinophilic and has irregular shape, we can see the loss of nuclei. The tissue is no longer compact, not homogenous, much paler. This is different from coagulative necrosis because we cannot see the cell outlines. This is a necrotic tissue that becomes liquified by enzymatic lysis of cells and proteins.
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nodular melanoma - SKIN Main types of melanoma: • SSM (most common) =superficial spreading melanoma= epidermal + dermal components. • Lentigo maligna: in situ melanoma of sun exposed skin. • Nodular melanoma (worst prognosis) = only dermal component. • Acral lentiginosus melanoma
Malignant tumor of melanocytes. Distant metastases can occur anywhere, liver usually affected.
- Mostly arises de novo. Mostly arises in the skin, other sites of origin include oral and anogenital mucosal surfaces, esophagus, and can also be intraocular and conjunctival.
- Atypical cells, variable cytomorphology (epithelioid/spindle cells), atypical mitoses.
- Asymmetric tumor with ulceration.
- Tumor cells look similar in the superficial and deeper layers, they do not show signs of maturation.
- Solar elastosis in dermis- an accumulation of abnormal elastin, which occurs as a result of the cumulative effects of prolonged and excessive sun exposure, a process known as photoaging. •
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alcoholic hepatitis
- Autopsy case.
- Fatty liver=yellowish liver parenchyma. In chronic cases may cause fibrosis or cirrhosis=grayish, firm liver parenchyma.
- Pattern of inflammation: Granulocytic infiltration between hepatocytes (not in portal spaces). Necrotic hepatocyte can be surrounded by granulocytes.
- Mallory-Denk body: hyaline deposits (eosinophilic) in hepatocyte’s cytoplasm (cytoskeletal degradation). These can be found as they are usually surrounded by neutrophils. These are not necessarily specific to alcoholic hepatitis.
- Fatty degeneration =fatty vacuoles in hepatocyte’s cytoplasm. • Congestion can also be seen here- sinusoids engorged with blood. • Centrilobular fibrosis (around central veins).
- Liver cell necrosis results fibrosis→ end stage=cirrhosis
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Squamous cell carcinoma- larynx
We can see hyaline cartilage, seromucous glands, and stratified squamous non keratinized epithelium. The tumor is seen infiltrating= malignant. Can also be seen in lymph vessels. We can also see cellular atypia (cellular and nuclear polymorphism, larger and euchromatic nuclei, atypical mitotic figures). The tumor has areas that are well differentiated, and areas that are poorly differentiated. keratin pearls can be seen (keratin production of tumor cells because of their epithelial origin). Surrounding the tumor nest, we can see a vast connective tissue stroma= Desmoplasia. Etiology: smoking, alcohol intake (HPV detected in small % of cases).
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signet cell carcinoma - Stomach
This is the body of the stomach. See the large gastric glands and parietal cells.
- There is no tumor mass. The tumor cells are very diffuse.
- The tumor cells are called signet ring cells and produce mucin (hence are positive for PAS staining).
- This tumor can be revealed by endoscopy. The tumor is not distinctively seen, but the thickness of the wall of the stomach can be measured. The thickening of the wall is called lintis plastica.
- This type of tumor occurs mainly stomach, but occasionally may occur in other GI organs, prostate, urinary bladder, breast.
- Usually advanced stage at the time of the diagnosis.
- Pas staining show signet ring cells all over the layer up to the serosa.
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peptic ulcer
This is the body of the stomach. See the large gastric glands and chief cells.
- This is an ulcer and not an erosion as the lesion reaches the submucosa.
- Intestinal metaplasia can be seen (goblet cells which are not usually found in the stomach). This happens due to the irritation.
- Peptic ulcer layers (from top):
- Necrosis with granulocytes and fibrin- looks eosinophilic.
- Granulation tissue- looks pale because it is edematous. This is edematous because the newly formed vessels of the granulation tissue are leaky.
- Scar tissue- connective tissue rich in collagen. In this slide it is not really seen, because the healing is not advanced enough.
- An ulcer can be acute (mostly in the stomach) or chronic (mostly in the duodenum or gastric antrum). The causes of an acute ulcer are hyperacidity, shock, stress. The causes of a chronic one are H.pylori, NSAID, smoking or alcohol.
- The consequences of an ulcer can be: Hemorrhage, perforation, scar formation.
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foreign body granuloma- anorectal region
There is a transition between stratified squamous keratinized epithelium (typical to the skin) and simple columnar colonic mucosa. So, this is either a stoma (an artificial permanent opening especially in the abdominal wall made in surgical procedure) or the anorectal transition.
- This is a subtype of chronic inflammation.
- Giant cells can be seen inside granulomas, with foreign material embedded in them (from stitches of a previous operation).
- Macrophages are stimulated by IFN-gamma (secreted by Th1) to become epithelioid histiocytes and giant cells.
- This is a surgical specimen (we can see the black ink).
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Metastasis of squamous cell carcinoma in lymph node
Encapsulated structure with secondary lymph follicles inside. Primary tumors can spread regionally, to form metastasis in nearby lymph nodes. For example: Bronchi tumor ---\>mediastinal lymph node. Uterine cervix tumor ---\> pelvic lymph node, Pharyngeal/laryngeal tumor ---\> neck region lymph nodes. Breast tumor ---\> axillary lymph nodes.
The metastases (pale area) are infiltrating the lymph node (darker, basophilic).
How can we know this tumor is of squamous cell origin? We can see keratin pearls, also no glands can be seen.
We can see the tumor as trabeculae surrounded by desmoplastic stroma.
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Chronic myocardial infraction
There is high variability in myocytes’ caliber and nuclear size, because of the simultaneous degeneration, atrophy and regeneration in this tissue. We can see tissue scarring- highly fibrotic hypocellular area with fibrocytes and wavy eosinophilic collagen fibers.
MI =\> granulation tissue =\> scar.
The large scarring is because of macro-infracts, and the small diffused scars are due to micro-infracts (can only be seen by microscope). We can also see some healthy tissue remnants
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Glioblastoma multiforme (GBM) - CNS/PNS
Gliomas are the most common group of primary brain tumors. these include astrocytomas oligodendrogliomas, and ependymomas. Infiltrative Gray Soft, hypercellular tumor. Differentiation: Grade I-IV. The presented slide contains glioblastoma multiforme (=grade IV). Solid tumor tissue, unorganized polymorphic cells (pseudopalisade arrangement around necrosis). Severe cytological atypia, frequent multinucleated giant cells. Necrosis & vascular proliferation
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Arteriolosclerosis (hyaline type)- Kidney
Hyalinization- deposition of protein =\> Dysfunctional arteriole =\> Nephrosclerosis.
Hyaline arteriolosclerosis is a common pathological lesion of arterioles and results in a thickening of the vessel wall, and decreasing lumen size.
The deposition of hyaline material begins as a focal process that eventually involves the entire circumference of the vessel. The hyaline material is composed of precipitated plasma proteins, a major component being the inactive form of complement C3b.
This is a process of normal aging. Can be caused by DM (involves both afferent and efferent arterioles) and hypertension (only efferent).
Can lead to atrophy of the tubules and glomeruli, surrounded by chronic inflammation =\> chronic renal failure.
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hepatocellular carcinoma (HCC)
Macroscopy: Solitary, rarely multifocal. Generally, well circumscribed nodules.
* Hepatocellular carcinoma is the most common tumor of the liver.
* portal/hepatic vein invasion → hematogenous metastasization.
* The basophilic (highly cellular) mass forming lesion is the tumor.
It shows: expansive growth, high cellularity, no desmoplasia. Loss of the hexagon unit and the trabeculae structure.
* Hepatocyte-looking tumor cells: large nucleus/cytoplasmic ratio, prominent nucleoli, bile secretion can occur. Forms rossete like formations. There might be hyaline (eosinophilic) bodies in the cytoplasm.
* Common necrosis/hemorrhage.
* Cirrhosis associated. We usually see cirrhosis when the tumor is a primary tumor and not a metastasis.
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acute myocardial infarction
You can see the hyperemic boarder (the infarct has a wavy shape) is very basophilic because of the large number of neutrophils going towards the infarct to infiltrate it.
It separates between the normal myocardium (broader part) and necrotic myocardium of the infarct (narrower part)- seen better at the bottom. You can see the difference between the normal myocytes and the ones inside the infarct which are necrotic (no nucleus, no striations, highly eosinophilic).
Contraction band necrosis can also be seen in the margins of the infarct- irreversibly damaged myocytes after reperfusion develop contraction band necrosis. These are intense eosinophilic bands of hypercontracted sarcomeres that are created by an influx of calcium across plasma membranes. Inside the blood vessels stasis and clots (fibrin + RBC) can be seen
31
HPV infection- condyloma (LSIL= low-grade squamous intraepithelial lesion)
This specimen is surgical. Cauliflower proliferation (papillary lesion with connective tissue core). Condyloma acuminatum most commonly in HPV 6, 11. Low-risk HPV associated benign tumor of squamous epithelium.
This is a benign papilloma, that can be recognized by: Parakeratosis (we can see nuclei in the stratum corneum) may occur in the epithelium, or even keratinization of single cells. Koilocytes can be seen. They have irregular nuclei (enlargement, hyperchromatic, multinuclear cells) and perinuclear halo.
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Atherosclerotic plaque atheromatous- coronary artery
The plaque has an outer fibrous layer (basophilic), and an inner core of cholesterol crystals, macrophages, calcification. This heart is taken from an autopsy case of a patient who had MI and so the coagulative necrosis (no nucleus stained, hyper-eosinophilic cells, no striations) is seen.
Near the remaining lumen, some new vascularization can be seen. Here we can see a soft unstable plaque that is prone to rupture and can cause emboli.
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chronic pancreatitis
This is a surgical case.
Chronic pancreatitis can mimic malignancy and this is why a surgery is usually done.
* May be caused by recurring inflammations with mild symptoms (alcoholic/ hereditary/ autoimmune/ obstructive).
* Loss of parenchyma (acinus atrophy). Islets of Langerhans remained. First the exocrine function of the pancreas is lost and only after the endocrine.
* Lymphocytic infiltration- chronic inflammation.
* Fibrosis can be seen. Perineural fibrosis causes a lot of pain.
* the ducts are dilated and filled with secretions due to backflow.
* In chronic pancreatitis, mucinous metaplasia can develop. Pancreatic intraepithelial neoplasia (PanIN) is a microscopic neoplastic lesion of the pancreas that can progress to invasive ductal adenocarcinoma
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clear cell renal cell carcinoma - Kidney
Most common malignant renal neoplasm.
* Mainly solitary. Often shows cystic degeneration, hemorrhage.
* High cellularity and vascularization, no Desmoplasia.
* Expansive growth pattern.
* Nesty/acinar structures .
* Clear cytoplasm (=glycogen and lipid rich), variable nuclear atypia and nucleoli (which determines the Fuhrman’s grade) no nucleoli visible with low magnification- low grade.
* Metastasis: most commonly hematogenous dissemination, direct tumor invasion to renal vein and vena cava =\> lung, brain, bone, suprarenal gland, liver.
* Highly associated with paraneoplastic syndrome.
* The symptoms are usually not clear.
Most typical: costovertebral pain.
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Leiomyosarcoma uteri - UTERUS
Endometrial normal glands and the myometrium can be seen. Malignant proliferation of smooth muscle from the myometrium, arising “de novo”. Highly basophilic. Old uterine tissue, post menopausal, atrophy can be seen. Glands are narrow and less numerous. Tumour is well circumscribed. Multinucleated giant tumorous cells can be seen. Expansive, infiltrative growth, apoptosis on edges.
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Squamous cell carcinoma of the lung
The cancerous cells are large, with a lot of cytoplasm. Have prominent nucleoli.
* Primary tumor centrally located (next to the bronchi). This may occlude the lumen and lead to repeating pneumonia.
* Tumor cell nests are surrounded by desmoplastic stroma.
* Keratin pearls can be seen, typical to squamous cell carcinoma.
* This has better prognosis than small cell carcinoma, and may sometimes be surgically removed.
* Antracotic, large, lymph node can be seen, with no definite metastatic signs in it.
* Large area of eosinophilia= necrosis.
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Ductal carcinoma in situ (DCIS) - Breast - BREAST Types according to morphology: comedo, cribriform, solid, papillary, flat., Types according to nuclear morphology: Low – Intermediate – High grade.
This is the breast of a post-menopausal woman, as we see increased fatty tissue and smaller amount of acini.
* Tumor cells are very similar to each other- might be misdiagnosed as benign.
* Microcalcification is characteristic (mammography can reveal it)- can help distinguish it.
* Macroscopically invisible or difficult to detect: the whole breast can be affected.
* It can be detectable by Comedo necrosis (area of necrotic cancer cells which builds up inside the tumor). Associated with high grade DCIS.
* Malignant cells proliferate within acini (in TDLUs) and in ducts.
* Myoepithelial cells and basal membrane present at the periphery of affected, distended acini and ducts.
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Hodgkin lymphoma- nodular sclerotizing type - LYMPH NODES There are 4 subtypes of Hodgkin lymphoma: 1. Nodular sclerosis-most common. Usually found in the cervical/mediastinal lymph nodes. Usually seen in young aged males. 2. Lymphocytes rich-good prognosis. 3. Mixed cellularity. 4. Lymphocytes depleted
Hodgkin lymphoma is a neoplastic proliferation of Reed-Sternberg cells, which are large B-cells with multi-lobed nuclei, that look like owl’s eyes, and are positive for CD15 and CD30. RS cells secrete cytokines that can attract lymphocytes, plasma cells, macrophages and mostly eosinophils, and can lead to fibrosis.
There are also Hodgkin’s cells, which are large mononucleated B-lymphocytes. In the nodular sclerosis type, there is accompanying sclerosis of the lymph node.
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Miliary tuberculosis of the lung
Fibrotic tissue around the granuloma with giant epithelioid cells (activated macrophages)
* Necrotizing granulomatous inflammation (eosinophilic necrosis in the middle, surrounded by fibrotic rim).
* Langhans giant cells (multinucleated giant cells, the nuclei are arranged in a semilunar or circular fashion)
* Mild congestion (capillaries are full with blood) .
* This specimen was taken from periphery of the lung (we can see the pleura + no cartilage or big bronchi).
* Identification of Mycobacterium tuberculosis in tissues: Ziehl-Neelsen stain (red rods)
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Adenocarcinoma in the colon
Atypical, variably polymorphic glandular neoplastic cells with atypical mitotic figures. Infiltrative pattern, all the way through, until the mesocolon sub-serosal fat =\> malignant. The tumor cells are forming atypical glands (so you can realize their glandular origin =\> well differentiated adenocarcinoma). There are some secondary lumina in the same crypt = cribriform structure. This is due to the proliferation of cells. Necrosis is seen filling the lumens of the glands (there is a lot of cell debris). Desmoplastic stroma is seen with lymphocytic infiltration
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Neuroblastoma of adrenal gland - ADRENALS
Neuroblastoma is a malignant tumor of neural crest cells, the cells that give rise to the sympathetic nervous system, which is observed in children. Commonly arises from adrenal gland and sympathetic system. Tumour is made out of cells and background (fibrillary material that looks like axons). The small round blue cells are the primitve cells of the tumour. HOMER-WRIGHT pseudorosettes can be seen.
42
Hemorrhagic Infarction in the lung
Hemorrhagic infarction (Red) is usually seen in the lung, testis, and bowel (more than one blood supply).
* Taken from autopsy case, from the periphery of the lung (we can see the connective tissue and the pleura).
* Alveolar structures disappear- Alveoli nuclei staining is lost (the nuclei that are seen- are of inflammatory cells), the alveoli space filled with blood, fibrin and neutrophils.
* Usually we can see fibrinous inflammation in the pleural surface of a hemorrhagic lung, but here we do not see it because the patient died before it developed.
* Anthracosis and emphysema can be seen as well.
* The reason of pulmonary thromboembolus is usually DVT. The cause of death here was probably cor pulmonale.
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mucinous cystadenoma - ovaries/uterus
Benign ovarian tumor.
* Can be large, multilocular structure (solid areas are suspicious for malignancy).
* Cystic wall is thin, lined with a single layer of columnar epithelium, without atypia.
* Malignant cystadenocarcinoma show: complex papillary proliferation, cellular atypia, invasion. There could also be borderline cystadenoma which shows: structural and cellular atypia, without invasion.
* If we have a doubt if this is a mucinous epithelium, PAS staining can be used.
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neuroendocrine tumor in the pancreas
Neuroendocrine tumors are common in the pancreas, GI and appendix. These were used to be called carcinoid tumors, but today only neuroendocrine lung tumors are called carcinoid. Most of them do not produce any hormones, but they might (insulin, glucagon, somatostatin, serotonin=carcinoid…)
* Neuroendocrine tumors can be detected via chromogranin A in the blood.
* Have malignant potential.
* Often associated with MEN-I syndrome (multiple endocrine neoplasia).
* Well circumscribed tumor.
* Homogenous cytomorphology, mostly monomorphic (mild atypia, round nuclei with salt & pepper chromatin).
* The grade of the tumor is decided according to its mitotic activity (number of mitoses/ Ki-67 index).
* The tumor has a fibrotic stroma with some amyloid.
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Adenoma colon
This tumor is not invasive (muscularis mucosae is not infiltrated with tumor cells). Benign colonic neoplasm of glandular origin. Colon low grade dysplasia. This is a tubulo-villous adenoma. This is a pre-malignancy. More basophilic due to a larger nucleus = neoplastic tissue. Mucin production is low. This is a polyp (a structure protruding into the lumen of an organ, that has a head and a stalk) removed by endoscopy. Non-neoplastic colonic epithelial cells have cytoplasm X6 bigger than nuclei. In the neoplastic cells, this ratio diminishes. The neoplastic epithelium looks stratified, but it is pseudostratified.
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Thrombus in a muscular artery (LAD)
Thrombus occludes the lumen. There seems to be a gap, but this is only because of shrinkage.
* A thrombus is a coagulation of blood within vessels/ heart chambers.
* A thrombus can be caused by:
1. endothelial injury (inflammation, hypertension, atherosclerosis).
2. Stasis or turbulence of blood flow.
3. Hypercoagulability.
* RBC & Fibrin can be seen inside the thrombus.
* This is an autopsy case because this is a fully occlusive thrombus of the Left Anterior Descending artery which probably caused MI.
* The tunica intima is thick= atherosclerosis.
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End stage kidney
* Irreversible destruction of renal function that leads to complete loss of renal function.
* The kidneys are shrunken.
* Can be caused by chronic inflammation, diabetes mellitus, hypertension.
* Interstitial fibrosis + lymphocytic infiltration (due to chronic inflammation).
* Glomerulosclerosis.
* Tubular atrophy + ”Thyreoidisation” (=tubular protein cylinders)
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Squamous cell metaplasia of the Cervix
How do we know this is the cervix?
According to the stratified squamous non keratinized lining, and endocervical glands. This is a surgical specimen taken from a uterus removal operation. The squamous epithelium part is filled with glycogen (normal)- cells look empty. Metaplasia in the uterus is a normal process seen in older women, also the Nabothian cysts seen are normal for older women.
We can see that the transition between the stratified squamous non keratinizing epithelium to the glandular epithelium is higher than it should have been. At the basophilic region of metaplasia- Squamous epithelium layer gets thicker with atypical cells within it (look like a combination between glandular and epithelial cells) in association with chronic inflammation (neutrophils and lymphocytes).
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embryonal carcinoma - Testicles
More aggresive than seminoma. Seen with necrosis and hemorrhage. Solid; pseudo glandular, papillary, alveolar areas. Primitive epithelial tumour cells, indistinct cell borders. Definitive nuclear polymorphism, prominent nucleoli, mitotic figures are frequently seen. Fibrotic septa are absent. Vascular invasion may be seen.
50
Lung edema\Acute Lung congestion
This is an autopsy specimen.
* We see no cartilage- so we are at the periphery of the lung.
* The alveoli are filled with an eosinophilic transudate fluid (edema).
* We can see in the vessels a lot of blood that increases the lumen of it.
* The reason for lung congestion is left heart failure (the heart cannot pump efficiently, so blood accumulates in the lung).
* We can also see emphysema (weak alveoli inner walls, causes larger air spaces instead of many small ones).
* We can see anthracosis (black debris eaten by macrophage).
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Sarcoidosis in a lymph node
This is the lymph node as the shape, capsule and lymphocytes indicate.
* Many small naked granulomas are seen (non-caseating).
* Granulomatous disease of unknown etiology.
Characteristically in young adults.
• Acute and chronic forms:
- Acute: Löffgren’s syndrome: fever, lethargy, severe pain in joints (ankle), erythema nodosum, BHL (bilateral hilar lymphadenopathy).
- Chronic: less symptoms, difficult diagnosis.
* Almost every organ can be affected, but most commonly present in the lungs (lymph nodes, skin, eyes).
* Type IV hypersensitivity reaction.
* The giant cells that are characteristic are asteroid bodies (star shape) and Schaumann bodies (lamellar appearance).
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Bronchopneumonia - Lung
Multiple, small foci of inflammation with one or more lobe is affected are seen in this autopsy case.
* In the lumen of bronchi, bronchioles and alveoli exudate is detectable which is rich in neutrophils.
* Edema and congestion may be seen in the alveoli.
* Anthracosis can be seen.
* Congestion, aspiration facilitate its development.
* Common microbes: Pneumococcus, Hemophilus influenzae.
* Less common microbes: Staphylococcus aureus, E.coli, Pseudomonas aeruginosa, Legionella pneumophilia, anaerobes (aspiration pneumonia)
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seborrheic keratoses
Benign tumor with exophytic growth.
* Symmetrical epithelial proliferation. Sharp dermo-epidermal interface.
* Widening of the basal cell layer (sometimes with pigmentation) without atypia.
* Hyperkeratosis (thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin)
* keratin inclusions.
* Basaloid cells with melanin.
* Keratin pseudocysts.
* Leser-Trélat sign: sudden onset of numerous seborrheic keratoses may indicate an underlying malignant visceral (usually GI) neoplasm (paraneoplastic syndrome)
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Brain metastasis - CNS/PNS
Metastatic brain lesions are more common than tumours originating from the brain. Metastatses from lung, breast, skin, kidney and gastrointestinal tract. Necrosis is seen, High cellular polymorphism and giant cells, all of these indicate that this is a high-grade malignancy. H&E stain doesn't allow differenciation (but may be carcinoma)
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Appendicitis purulent (acute)
Structure of the appendix is destroyed. Neutrophils and granulocytes infiltrate the wall, up to the serosal layer.
* Masses of granulocytes in all layers of the appendix.
* We know this is a purulent infection because we can see neutrophils and cell debris in the lumen (pus).
* Vasodilatation and edema.
* Ulceration of the mucosa (damaged, broken epithelium).
* Fibrin (eosinophilic) on the serosal surface.
* In this case- operation is needed, to avoid peritonitis.
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follicular cyst
Originate in unruptured Graafian follicles.
* Contains serous fluid.
* Granulosa or luteal cell lining.
* Dilated vessels.
* Cyst follicles are smaller than 1 cm. whenever they reach the size of 3 cm- they are called follicular cysts.
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prostatic adenocarcinoma
Third most common tumor and cause of death among men.
* 70-80% arise peripherally → urinary symptoms are less common, but can be detected by digital anal examination.
* Crowded small glands (structural atypia).
* Enlarged, hyperchromic nuclei with prominent, eosinophilic nucleoli.
* basal cell layer is absent.
* Perineural spread.
* Gleason grading is used to determine the therapy, taking into account the size and shape of the tumorous glands (the smaller, more fused are worse).
* Precancerous condition: PIN = prostate intraepithelial neoplasia.
* Metastasis: bone (can be both osteolytic and osteoblastic, through Batson venous plexus, mostly osteoblastic), lung, liver, pleura, adrenal glands, distant lymph nodes, brain.
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Squamous cell papilloma- larynx
Benign squamous cell tumor in the larynx. Is found in mucosal surface (stratified squamous non keratinized epithelium that can also be found in the mouth, pharynx), HPV associated (6,11) Often multiple (=papillomatosis). Exophytic, polypoid growth (there is a stalk with fibrovascular core). The tumor cells resemble the original non-neoplastic epithelium and this is a feature of benign tumors. Chronic inflammation is seen (a lot of lymphocytes). koilocytes may be present, and also parakeratosis.
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Leiomyoma uteri - UTERUS
Endometrial normal glands (Leiomyoma is soft tissue benign tumor of smooth muscle.
A storiform pattern is seen (characterized by loosely-arranged whorls of elongated, spindled fibroblast-like cells).
Common in women’s myometrium. Can be submucosal (bleeding disorder infertility), intramural or subserosal (pain can be felt).
Expansible growth: Compresses surrounding tissues. covering a wide area. Sharp circumscribed.
Multiple, Scattered, Small to large nodules, slightly more basophilic than the normal tissue (more cellular).
Fully differentiated smooth muscle cells that highly resemble normal smooth muscle cells. No or very few mitoses, no necrosis, no atypia.
There are extensive lines of hyaline material seen (due to necrosis).
No fibrous capsule (although usually benign tumors have).s- proliferative phase, with subcellular vacuoles) and the myometrium can be seen.
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Endometrioid carcinoma - UTERUS
## Footnote
Tumour is comprised of endometrial like glands with pseudostratified columnar epithelium. Lot of mitotic figures. Cribriform appearance (gland withing gland). Hemorrhage. Myometrium invasion (infiltrative growth). Usually patients presents post menopausal uterine bleeding.
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Seminoma - TESTICLES
Testicular germ cells tumour, malignant. Easily treatable. May produce HCG hormone. Large monomorphic cells with distinct cell borders and clear glycogen rich cytoplasm. Fibrotic septa with lymphocytic infiltration. Collagenous scar, sign of regression.
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Chronic lung congestion
We can see 2 kinds of macrophages
1. Anthracosis (black).
2. Brownish macrophages. Hemosiderin laden macrophages (heart failure cells). With Prussian blue the color of Hemosiderin is stained blue.
* Hemosiderin is an iron-storage complex produced by macrophages during the breakdown of phagocytosed hemoglobin (e.g., after red blood cell destruction). Its suffusion leads to its light gold color. These macrophages can occur systemically (the liver and dermis are examples).
* We can see emphysema as well.
* We can see in the vessels a lot of blood that increases the lumen of it.
* Some alveoli can have a thickened wall+ fibrosis, due to the chronic edema.
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Hashimoto’s thyroiditis
Lymphocytic aggregates with germinal centers,lots of plasma cells
• Destruction of follicular epithelium with oncocyte metaplasia =Hürthle cells.
Which stop to produced colloid which eventually causes fibrosis. The cytoplasm of the Hurthle cells gets acidophilic (increased number of mitochondria).
* Late stage: complete follicular atrophy and fibrosis (“burned out” inflammation).
* In Hashimoto thyroiditis thyroid neoplasms more frequently occur: follicular adenoma, follicular carcinoma, papillary carcinoma, B-cell lymphoma (MALToma).
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Atherosclerotic plaque calcified- coronary artery
Atherosclerosis is characterized by intimal lesions called atheromas that impinge on the vascular lumen.
Atheromatous plaques are raised lesions composed of soft lipid cores covered by fibrous caps. As they enlarge, atherosclerotic plaques may mechanically obstruct vascular lumina, leading to stenosis.
Plaques also are prone to rupture, may result in thrombosis and sudden occlusion of the vessel. The plaques in this slide, in the coronary arteries, caused chronic ischemic heart disease. We can see it in the fibrosis of the myocardium. Here we can see a fibrous stable plaque that has a high content of connective tissue and hence less dangerous.
At first- the lipid deposits are intracellular within foamy cells, and later accumulate extracellularly and form atheroma. The basophilic materials seen in the atheroma, are Ca+ depositions, that make the plaque rigid
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Mesothelioma - Lung - PLEURA Mesothelioma can have 3 variants: 1. Spindle cell variant=sarcomatoid. The least common cell type, sarcomatoid mesothelioma has less treatment options. Patients diagnosed with this cell type have the least favorable prognosis. 2. Epithelioid variant=epithelioid (solid/papillaris/pseudoglandularis) - Mesothelioma tumors made up of epithelioid cells are the most treatable. Patients with this cell type have the best prognosis. It’s the most common cell type. 3. Mixed type. Malignant pleural mesothelioma often presents with returning unilateral pleural effusions. To prevent recurrence of the Effusion, the pleural space can be obliterated through talc pleurodesis. The process involves introduction of talc or other chemicals into the pleural space through a chest drain. These resulting irritation leads to the adhesion of the two pleurae
Arises either from the visceral or the parietal pleura.
* Asbestos exposure related.
* Polymorphic tumor cells, that look like epithelial cells because of their round shape and relatively large amount of cytoplasm. IHC must be done to make sure this is mesothelioma and not carcinoma.
* On the pleural surface there are numerous cristals and foregin body giant cells
* This is a surgical specimen, with the black surgical margin seen.
* There are no remnants of the original lung tissue, so it is hard to distinguish it is in fact in the lung.
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Osteosarcoma - Bone
Malignant tumor arising from osteoblasts, due to pRb and p53 mutations. The most common primary bone cancer, primarily appears in men. 75% occurs in people under the age of 20. Frequent metastases from breast, prostate, lung, thyroid and kidney. Painful progressively enlarging masses with infiltrating margins. Elevated periosteum (Codman triangle in radiology). The dark eosinophilic area = remaining normal bone tissue of small amount. Amorphous strips of eosinophilic material = osteoid produced by tumor cells. Apoptotic bodies can be seen. The tumor cells show atypia (abnormal mitotic figures, polymorphisms, hyperchromatic…)
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high grade serous carcinoma (HGSC) - Ovaries/Uterus
This is the most common malignant ovarian tumor.
* Cortex of the ovary, and some covering epithelium can be seen.
* Lymphovascular invasions are seen.
* Tumor necrosis is seen.
* Polymorphic cells with prominent nucleoli, mitotic figures.
* complex papillary proliferation, solid growth, cellular atypia (usually high grade), psammoma bodies.
* Serous carcinoma is often bilateral.
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Fibrinous inflammation in the pericardium of the heart
Greater vascular permeability that allows large molecules (such as fibrinogen) to pass the endothelial barrier -\> extravascular fibrin.
* Eosinophilic material (=fibrin) on the surface of the pericardium.
* Thicker pericardium than normal.
* Mild inflammatory cells infiltrate (granulocytes, macrophages) around the pericardium.
* There is some granulation tissue near the subepicardial fat, as part of repair.
* What can lead to it? MI or uremia (kidney malfunction).
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Mature Teratoma - Embryo
Tumour which originates from all 3 germ layers. May contain epithelial and brain tissue from ectoderm, adipose and cartilage tissue from mesoderm and epithelial tissue from endoderm. May contain epithelial and brain tissue from ectoderm, adipose and cartilage tissue from mesoderm and epithelial tissue from endoderm.
They typically form in the ovary, testicle, or sacro-coccygeal area (typical for children). Original location can't be determined from the slide. Called mature because all tissues are mature, mature is benign while immature is cancerous
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thyroid multinodular hyperplasia (goiter)
This is a surgical resection biopsy (lobectomy).
* This is a multinodular goiter. Functionally, most commonly normo-functional. Sometimes some of the nodules are hyper-functional (toxic multinodular goiter – Plummer’s disease).
* There is also diffuse type goiter.
* Colloid nodule (hormonally inactive) = large dilated follicles colloid rich, flat epithelium.
* Adenomatous nodule (hormonally active) = small hyperplastic follicles, colloid poor, cuboidal vacuolized epithelium.
* Degeneration= hemosiderin + cholesterin accumulation, fibrosis, hyalinization, calcification.
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Acute purulent meningitis
Acute bacterial infection, Subarachnoid pus accumulation, mainly in gyri. Thickening of leptomeninges (pia + arachnoid).
* Granulocytic infiltration in the subarachnoid space.
* Brain edema can also be seen- extended perivascular spaces.
* Hyperemia can be seen (due to acute inflammation).
* Neonates: E. coli, Strep.agalctiae, H. influenzae.
* Young adults: N. meningitidis, Strep.pneumo
* Adults: Strep.pneumo, Listeria.
* Complication of meningitis is adhesions in the subarachnoid space that can lead to hydrocephalus.
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invasive lobular breast carcinoma
Tumor lacks glandular like structure due to lack of adhesion molecule E-cadherin. So, the tumor cells are infiltrating one by one, spreading in lines (“Indian file pattern”).
* Tumor cells are arranged around the lactiferous duct= targetoid arrangement.
* Monotonous small cells (no atypia).
* Multifocal usually (in the slide 1 mass).
* Only MRI can identify the tumor--\> hard to discover (many times we will find metastasis first).
* Grade determination: according to Nottingham grading as well.
* Develops from stem cell (can metastasize to unexpected sites like the GI & ovaries).
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Fibrocystic disease - Breast
Fibrocystic breast change is a condition of the breasts where there may be pain, breast cysts, and breast masses. The breasts may be described as "lumpy" or "doughy". Common among young women.
* Benign, not neoplastic but may be confused with malignancy.
* Usually bilateral although one breast may be affected more than the other.
* Either proliferative (adenosis, hyperplasia) or no proliferative (cysts).
* Fibrosis: increase of stroma / adipose tissue ratio.
* Alterations of the ducts: Cystic dilation of the ducts, apocrine metaplasia (special kind of metaplasia with no increased risk of dysplasia/ neoplasia), epithelial ductal hyperplasia.
* Alteration of TDLU (terminal duct lobular unit)- adenosis: enlarged lobules clumped together.
* Ruptured cysts can occur, with foamy macrophages.
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acute hemorrhagic necrotizing pancreatitis
This is an autopsy case.
* Most acute pancreatitis cases are edematous, only ~ 10% are hemorrhagic necrotizing. These cases are associated with high mortality.
* Some acini can be recognized, which are the remnants of the normal pancreas.
* Hemorrhage (vessels ruined because of activated pancreatic elastase) and hemorrhagic necrosis in the parenchyma.
* Granulocytic infiltration- acute inflammation.
* Fat necrosis=basophilic area with shade of adipocytes without nuclear staining. Saponification is seen in the peripancreatic fat tissue, with cholesterol crystals.
* Brownish pigment= hematoidin granules. These are the degeneration products of hemoglobin.
* Most common etiology: alcohol male drinkers. But can be also gallstones or genetic in kids.
* Local consequences can be peripancreatic edema, pseudocysts.
* Extra pancreatic consequences can be ARDS and DIC.
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HSIL (high grade squamous intraepithelial lesion) CIN3 (cervical intraepithelial neoplasia III) - CERVIX NABOTH CYST
Surgical specimen (the surgical staining can be seen at the edges + thermic eosinophilia). This was taken by a cone biopsy procedure (conization). Severe dysplasia (in situ carcinoma), caused by HPV 16,18. The basement membrane is still seen- not broken yet. The virus targets the transitional zone of the cervix which is usually very well demarcated. The dysplastic part is highly basophilic (because of the neoplastic big nuclei) and the basal cell layer cannot be seen distinctively. Several mitotic figures with abnormal location can be seen. The layering is abnormal. There is polymorphism. There is some involvement of the endocervical glands as well.
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nodular hyperplasia of the prostate
Hyperplasia of epithelial and stromal components- (hyperplasia adeno-myomatosa).
* Nodular structure (solid or cystic).
* The nodules cause obstruction of the urethra and the surrounding parenchyma.
* Usually located centrally in the gland, as opposed to prostate adenocarcinoma.
* Glands are lined by two layers of cells, basal cell layer and luminal columnar cells.
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follicular hyperplasia of the lymph node- reactive lymph adenopathy, non-specific
During inflammation or infection regional lymph nodes enlarge.
The basic structure of the lymph node is kept (cortex, paracortex and medulla), but we can see high number of lymphocytes.
Here we see a specific type of lymph adenopathy:
follicular hyperplasia (B dependent)- increase in the cells of the germinal center (centroblasts, centrocytes, dendritic cells and tingible body macrophages =\> creating a “starry sky pattern”).
We see an increase in both the size and the amount of the follicles. Some of the macrophages contain apoptotic debris of B lymphocytes. In the germinal center a lot of mitosis can be seen. Enlarged lymph nodes can be also due to metastasis and lymphoma.
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endometriosis in ovary
Endometriosis is endometrial glands and stroma found in an ectopic location.
* Fibrotic cyst wall in the ovarian parenchyma. When filled with blood- called chocolate cyst. The epithelial lining of the cyst is endometrial, and even endometrial glands can be seen.
* Endometrial stroma with hemosiderin. Hemosiderin accumulation (Prussian blue positive). The macrophages remove the bleeding debris from this endometrial tissue during menstruation.
* We can see transition from the columnar epithelium into other epithelium which has higher nuclear/cytoplasmic ratio and cellular atypia. This is called atypical endometriosis, and increases the risk for endometrioid carcinoma, and clear cell carcinoma.
* If the endometriosis spreads to the wall of the urinary bladder or the bowel, it is called deep infiltrating endometriosis. If spreads to the myometrium it is called adenomyosis.
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Ulcerative colitis
Active inflammation = crypts infiltrated by neutrophils= Cryptitis (severe form when the neutrophils inside the crypt= crypt abscess).
* Reactive epithelial atypia is present, dysplasia may develop later, and even carcinoma.
* Inflammation does not exceed submucosa.
* Erosion of the mucosa can be detected, leads to pseudopolyps appearance.
* Affects the colon continously. Usually starts in the recto-sigmoid region.
* There is basal plasma cytosis= presence of plasma cells between the base of the crypts and the muscularis mucosae. This is an early feature in the biopsies of IBD patients.
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diabetic nephropathy- PAS staining
kidney biopsy.
* PAS staining stains glycoproteins that are the result of diabetic non-enzymatic glycosylation.
* Thickening of the basement membrane around glomeruli, tubules and blood vessels (microangiopathy).
* Tubular atrophy, chronic interstitial inflammation and fibrosis.
* Glomerular sclerosis is seen and can be nodular (characteristic for diabetes) or diffused (more than 50%).
* Glomerular cellular crescent can be seen. A crescent is made up of proliferating epithelial cells that line the Bowman capsule and infiltrating macrophages.
* Kimmelstiel-Wilson syndrome is a kidney condition associated with long-standing diabetes. It affects the microvasculature in the glomerulus, which is critically necessary for the filtration of the blood
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Celiac disease - Duodenum
* Biopsy from the duodenum.
* Total atrophy (the surface of the mucosa is flat), the villi disappear, only crypts are seen in the mucosa. Normally, the villus/crypt ratio is 4-5/1.
As the disease gets more severe, the ratio diminishes, and in most severe atrophy the villi completely disappear.
* Marked lymphocytic infiltrate (T-cells that are CD3+) in the lamina propria and in the villous epithelium, T lymphocytes in the epithelium are called (IEL: intraepithelial lymphocytes).
* The disease severity is measured by MARSH grading (takes into account villi atrophy + amount of IEL).
* You can identify the organ (when villi are completely disappear ) by the presence of Brunner glands.
* Prolong gluten exposure can cause to enteropathy associated T cell lymphoma or adenocarcinoma in the small bowel.
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gastrointestinal stromal tumor (GIST) - Stomach
This is the body of the stomach. See the large gastric glands and parietal cells.
* The tumor can occur anywhere in the GI tract. Decreasing order of frequency: stomach-small bowel-colon-other.
* Arises from pacemaker cells (interstitial cells of Cajal), hence the tumor is located in the muscularis propria layer.
* This is a mesenchymal tumor. Usually spindle cells, less frequently epithelioid Polymorphism is low.
* The tumor cells are positive for CD-117 (tyrosine kinase growth factor receptor protein) and can be diagnosed that way.
* Expansive growth.
* Factors affecting the biological behavior: size + number of mitoses + localization .
* Difficult to assess if the tumor is malignant or benign (more frequently malignant in the small bowel).
* Mutation of the c-kit gene is characteristic.
* Better prognosis than adenocarcinoma.
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meningioma - CNS/PNS
Most common benign CNS tumor.
* Meningiomas are predominantly benign tumors of adults that arise from arachnoid meningothelial cells and are attached to the dura.
* Well-circumscribed.
* Some original brain tissue could be seen at the edge.
* Usually on the brain convexity- Compress the underlying brain.
* Rounded mass, well-defined from the brain parenchyma.
* Onion like growth.
* Numerous histological variants. Most common pattern is nesty tumor with fibrotic stroma.
* Cytomorphology: benign form shows monotonous Spindle cells without atypia or mitoses.
* Psammoma bodies (concentric calcifications) are typical (also seen in: thyroid papillary carcinoma + ovarian serous carcinoma)
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Intradermal pigmented nevus - SKIN Junctional nervus : consists of aggregates or nests of round nevus cells that grow along the epidermal junction. Compound nevus : nest in the epidermis and the dermis. Intradermal nevus : Epidermal nests are lost entirely.
Benign lesion, arises from dermo epidermal junction. Cell shows no atypia, no mitotic figures. Lesions are symetric. Superficial dermis : Nest formation, melanin secretion, larger cells. Deepre dermis: Confluent cords of smaller cells and dispersed population.
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ectopic pregnancy, extrauterine gravidity
Surgical specimen.
* Ectopic pregnancy in the fallopian tube (fimbriae seen, wall and epithelium of tubes).
* The pregnancy is recognized by Chorionic villi - cytotrophoblasts and syncitiotrophoblasts.
* Hemorrhage
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Intracellular fatty accumulation in the liver
How do we know this is the liver?
We can see cells with rounded nucleus (hepatocytes) and some portal triads.
* Taken from a core needle biopsy.
* Intracellular fat accumulation in the liver is caused by fatty degeneration of the liver.
* The origin of this can be from hypoxia, or toxic agents.
* Fatty degeneration is a reversible cell damage type and is the most common cell damage in the liver.
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Small cell carcinoma in the lung
The tumor cells very scant cytoplasm, oval shaped dark nuclei (no nucleoli). The cells are monomorphic.
* Numerous mitotic figures are seen, also necrosis.
* This is near the primary bronchus (cartilage and seromucous glands can be seen), hence called a central lung cancer.
* This is the primary tumor and not a metastasis.
* The pulmonary artery is seen and lymph nodes with black color (probably due to smoking).
* The bronchial wall consists of:
1. Respiratory epithelium.
2. Glands + muscles.
3. Cartilage.
* The most agressive of lung tumors. In smokers (99 %). Centrally located (hilar), surgical treatment is difficult. Bad prognosis. Systemic tumor.
* From neuroendocrine (Kulchitsky’s) cells (normally found in bronchial epithelium).
* Commonly associated with paraneoplastic syndromes (e.g.ACTH production).
* Widely metastasizing (bones, supr.glands, liver, brain)
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Anemic infarction in the kidney
Anemic infarction (pale) is caused by arterial occlusion (can be seen at the apex of the wedge) and usually seen in the heart, kidney and spleen (anemic infarction happens in organs with only one blood supply).
* Wedge shape hyperemic (basophilic) borders of infraction.
* Inside the infarction there is no nuclear staining- we see necrosis.
* This is taken from an autopsy case, we can also see autolysis (cellular outlines are not seen, but nuclei are) of the tubules, outside the hyperemic border.
* The origin of the thrombus can be thromboembolism from the heart.
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Crohn’s colitis
Inflammation with fibrosis: lymphocytes infiltrate all the layers of the bowel wall. In the mucosa the inflammation is less active than in Ulcerative Colitis.
* There is Granuloma formation (usually in submucosa). This is a more specific feature for Crohn’s colitis to distinguish it from UC.
* There are Knife like fissure that tunnel through the intestine and into the surrounding tissue, and may lead to Fistula formation. The content of the bowel may enter here and giant cells may interact with the foreign material from the bowel content. So, these scattered giant cells are of foreign body type.
* Macroscopically May present in any part of the GI tract.
Most common localization: terminal ileum-coecum.
The pattern is segmental=inflammed and normal segments alternate
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ductal adenocarcinoma of the pancreas
## Footnote
Most common tumor of the pancreas.
* This is a surgery case.
* Some remnants of normal pancreas can be seen- basophilic areas. Some remnants of the islets of Langerhans are seen even in the tumor area.
* Irregular infiltrative glandular structures (frequent perineural invasion), cribriform glands.
* These tumors have perineural invasion.
* Cellular atypia (polymorphism, hyperchromasia etc.) Preinvasive condition: PanIN (pancreatic intraepithelial neoplasia= dysplasia of the ductal epithelium).
* Prominent desmoplasia.
* Clinical features: elevation of pancreatic enzyme levels, Courvoisier sign (palpable non tender gallbladder), Trousseau phenomenon (migrating thrombophlebitis= paraneoplastic syndrome).
Tumor markers: CEA, Span-1, CA 19-9.
• Pancreatic cancers of the body and tail appear to have poorer survival compared with head lesions. This is because the head cancers are usually detected earlier, due to the blockage of the pancreatic duct that leads to jaundice.
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hepatitis cirrhosis
fibrotic septa result →”pseudolobules” (lobule formation without central vein).
* Ductular reaction: small bile duct-like proliferation, related to the liver regeneration, originating in the oval stem cells in Herring’s canal.
* Regenerative nodules→ increased cancer risk (HCC).
* Many lymphocytic aggregation, mainly of T-lymphocytes.
* Different etiologies cause different types of cirrhosis (example: alcohol-Laennec cirrhosis which is a micronodular form).
* Micronodular form: (alcohol, viral): \<= 3 mm sized nodules.
* Macronodular form: (rare, post necrotic regeneration: toxic, viral): variable \>3 mm sized nodules.
* Councilman bodies might be found here as well- indicative of reason of cirrhosis- viral hepatitis.
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infective endocarditis
Endocarditis is characterized by lesions, known as vegetations, which are masses of platelets, fibrin (eosinophilic) and microorganisms.
There is a risk that these vegetations will embolize. Bacterial clouds are seen basophilic. Neutrophilic infiltration is seen around the valve’s vegetations, and the beginning of granulation tissue (seen as small vascularization).
Fibrosis can also be seen in the myocardium (because of chronic ischemic heart disease).
Complications:
Valve destruction by inflammatory cells =\> heart failure. If the damage is fixed with scar tissue =\> valve rigidity =\> insufficiency =\> Chronic Heart Failure.
Infective Endocarditis is seen in the tricuspid valve in drug users’ patients
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viral hepatitis (chronic)
* Core needle biopsy. The hepatic Glisson capsule can be seen around the edges.
* When checking a liver biopsy, we have to look at:
1. Hepatocyte injury- necrosis, apoptosis, regeneration.
2. Sinusoidal reactive change, especially among Kupffer cells.
3. Portal tracts- inflammation/fibrosis.
* Viral hepatitis can be caused by hepatotropic viruses (hepatitis A-E) and other viruses (yellow fever).
* Viral hepatitis can be classified into acute and chronic.
To classify between the two, the cellular component has to significance (as it is mainly lymphocytes in both cases) but the location of the inflammatory cells can help us distinguish:
1. Acute: intraparenchymal inflammation- within the hepatic lobules and central veins.
2. Chronic: intraparenchymal inflammation + portal triad inflammation + fibrosis. In chronic hepatitis, the fibrosis has stages of severity. Periportal =\> bridging (portal-to-portal or portal-to-central veins) à cirrhosis. Here we a have a case of chronic hepatitis.
We can see here bridging necrosis between the portal triads. This will later turn into scar tissue and bridging fibrosis. Necrosis begins at the portal triads =\> goes over the limiting plate (first row of hepatocytes) =\> intralobular necrosis.
* There are collections of lymphocytes which are mainly T-cells. These aggregations are typical for HCV infection.
* Councilman body: apoptotic hepatocyte- eosinophilic cytoplasm. They are found in liver of individuals suffering from viral hepatitis.
* Degenerated “Balloon” hepatocytes may be seen.
* In case of hepatitis B infection, Ground glass hepatocytes can be seen. In these cells there is HBsAg (hepB surface antigen) accumulation within the endoplasmic reticulum of hepatocytes.
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Adenocarcinoma in the lung
## Footnote
LUNGS Can't see on H&E if it is primary tumour or metastatic. Lung adenocarcinoma can be metastatic from GI or breast adenocarcinoma.
Invasive adenocarcinoma- tumor cells form gland-like structures and are surrounded by desmoplastic stroma. • Lepidic spread (alongside the inner surface of the alveoli). If all the intra-alveolar space is filled with neoplasiathe tumor is called bronchoalveolar carcinoma. • The tumor cells have polymorphic nuclei, prominent nucleoli. • This is not a central tumor, but located in the periphery of the lung (no cartilage, nor large vessels are seen). • This is a subpleural mass forming lesion
