Pathology Flashcards
Give an account on the types of intracranial hemorrhage
Extradural: Rapid accumulation of blood between skull & dura due to acute severe trauma severing MMA
Subdural: Mild traumatic injury to veins crossing subdural space produces chronic venous blood accumulation
Intracerebral: may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Can increase ICP and cause cerebral herniation
Enumerate the causes of Hydrocephalus and discuss its types
a) Obstruction in the normal flow of CSF
b) Problems with resorption of CSF into the venous system
c) Excessive production of CSF.
Communicating: The whole ventricular system is dilated caused by impaired absorption of CSF. The most common causes are post hemorrhagic or post-inflammatory changes
Non communicating: hydrocephalus develops from a block in CSF pathways.
Increased intracranial tension (3, last one has 5 subgroup)
An increase in the amount of CSF.
Cerebral edema.
Space occupying lesions:
* Tumors
* Hemorrhage
* Hematoma
* Infarction (with Hemorrhage &edema)
* Infections (localized abscess).
Causes of cerebral infarction
Cerebral artery occlusion due to thrombus or embolus
Complications of acute meningitis (4)
1- Spread of infection to the brain: brain abscess.
2- Phlebitis may cause venous occlusion and hemorrhagic infarction of the brain.
3- Septicemia resulting in DIC and suprarenal hemorrhage leading to acute adrenal insufficiency
4- Fibrosis in the subarachnoid space leads to:
- Obstructive hydrocephalus.
- Cranial nerve palsies (paralysis).
- Epilepsy
Route of spread of Brain abscess
o Septic emboli: from acute bacterial endocarditis produce multiple pyaemic abscesses
o Hematogenous spread: from chronic pulmonary infections.
o Direct spread: from otitis media which produces mastoiditis and infection is transmitted to the temporal lobe. In paranasal sinusitis a frontal lobe abscess occurs.
o Trauma: producing an abscess at site of injury.
Complications of brain tumors (5)
1- Increased intracranial pressure:
* Pressure on vital centers due to medullary herniation.
* Brain atrophy which is responsible for paralysis or dementia.
2- Invasion and brain tissue destruction.
3- Cerebral edema.
4- Irritation effects in the form of seizures or epileptic fits.
5- Obstructive hydrocephalus.
Etiology & pathogenesis of Hashimoto’s thyroiditis
Ø It is an autoimmune disease directed against thyroid antigens.
Ø Autoimmune injury is mediated by circulating Abs to thyroglobulin & thyroid peroxidase.
Ø Thyroid autoimmunity is accompanied by:-
1-progressive follicular cell loss.
2-fibrosis.
Etiology & pathogenesis of Subacute thyroiditis
a) It is attributed to a viral infection or post viral inflammatory process, resulting in cytotoxic T-cell-mediated follicular epithelial damage.
b) Because the immune response is virus initiated, it is self-limited.
Grave’s disease (definition and pathogenesis)
Definition: It is an autoimmune disorder characterized by thyrotoxicosis. (thyroid storm)
A) Production of autoantibodies to TSH receptor :
1- Thyroid stimulating immunoglobulin (TSI) à binds to the (TSH ) receptor and mimics the action of TSH, leading to T3 and T4 release.
2- Thyroid Growth Stimulating I.G (TGI) is directed against (TSH ) receptor but these autoantibodies induce thyroid follicular epithelium proliferation.
B) T-cell mediated autoimmunity: Ophthalmopathy.
Definition and complications of goiter
is a non-inflammatory, non-neoplastic enlargement of the thyroid gland.
- Cosmetic effects of a large neck mass.
- Airway obstruction .
- Dysphagia .
- A hyper functioning nodule may develop within a long-standing goiter resulting in hyperthyroidism.
Follicular adenoma (Gross and microscopic)
Gross: Solitary, spherical,& average about 3 cm in diameter, encapsulated, gray-white to red-brown
well demarcated from the surrounding parenchyma. with fibrosis, hemorrhage, or calcification
Microscopic : Follicles: Compact, small lined by cubical calls, surrounded by a fibrous capsule .
Complications of diabetes
Microangiopathy: Retinopathy, nephropathy, neuropathy
Hyaline atherosclerosis
Accelerated atherosclerosis—>angina pectoris, myocardial infarction, diabetic gangrene
Increase susceptibility to infections due to lowering of immunity
Enumerate the thyroid tumors
Follicular adenoma
Follicular carcinoma
Papillary carcinoma
Anaplastic carcinoma
Medullary carcinoma
Define lymphadenopathy
Enlargement of lymph nodes secondary to disease. It may be localized in one group or generalized
Causes of lymphadenopathy (7)
- Reactive lymphoid hyperplasia.
- Lymphadenitis: Acute /chronic inflammatory inflammation.
- Sarcoidosis.
- Lymphoma: Primary neoplasm of lymphoid tissue.
- Metastasis: Metastatic carcinoma in lymph nodes (more common than lymphoma)
- Blood diseases; mainly leukemia.
- Some metabolic storage disease.
Enumerate Types of lymphoid Hyperplasia
Reactive lymphoid hyperplasia:
follicular hyperplasia
paracortical hyperplasia
reticular hyperplasia
Lymphadenitis: acute and chronic lymphadenitis
Enumerate Types of RS cells
Classic RS
Mononuclear variant
Lacunar variant
Lymphohistiocytic variant
Enumerate subtypes of Hodgkin’s Lymphoma
1- Classical Hodgkin lymphoma:
Nodular sclerosis type
Mixed cellularity type
Lymphocyte-rich type
Lymphocyte-depletion type
2-Nodular lymphocyte predominant type
comparison between low and high grade non Hodgkin’s lymphoma
Complications of Plasma cell tumors 7
- Pathological fracture.
- Replacement of the marrow by tumor cells, resulting in pancytopenia
- Hypercalcemia, and metastatic calcification
- Increased levels of Immunoglobulins (secreted by plasma cells) in the blood and/or in the urine causing renal failure
- Amyloidosis: Deposition of secreted abnormal protein in the tissues
- Renal changes : secondary to blockage of tubules and pyelonephritis
- Spread: direct & early blood producing plasma cell leukemia.
Causes of splenomegaly (5)
- Inflammations & Infections:
* Bacterial: TB
* Parasitic: Malaria -Bilharziasis.
* Viral: Infectious mononucleosis. - Circulatory disturbances:
* Rt. Sided Heart failure & systemic venous congestion (CVC).
* Portal hypertension.
* Recent infarction. - Blood disorders:
* Leukemia-polycythemia.
* Hemolytic anemia-thrombocytopenia. - Tumors: Lymphoma & Leukemia.
- Metabolic disorders:
causes of bone fracture (2, last one has 4)
A. Traumatic.
B. Pathological:
1. Osteomyelitis.
2. Osteoporosis.
3. Tumors: primary and secondary tumors.
4. Bone cyst.
Factors delaying healing of fractures
- Inadequate immobilization: slows tissue union. If this continues, movement will prevent bone formation and collagen will be laid down instead giving rise to fibrous union and false joint at fracture site.
- Soft tissue interposition: will prevent healing and if not removed will lead to non-union.
- Infection: will delay healing.
- Pre-existing bone disease: If the bone is broken due to a disease in the bone, it is called pathological fracture. Example of pathological fracture is fracture due to metastatic carcinoma.
Complications of osteomyelitis
- Spread of infection: Direct spread causing arthritis, myositis and neuritis; or blood spread as toxemia, septicemia, and pyemia.
- Pathologic fracture.
- Amyloidosis.
- Malignancy: Squamous cell carcinoma in the sinus tract, bone osteosarcoma.
What is Pott’s disease and enumerate its characteristics
It is vertebral tuberculosis
Characterized by:
Kyphosis
Cold abscess
Paraplegia
Compare between Osteoid osteoma and osteoblastoma
-Osteoid Osteoma: Benign bone tumor that commonly occurs in the shafts of long bones of adolescents and young adults, who complain of persistent pain, worse at night, often relieved by aspirin.
-Osteoblastoma: is uncommon solitary tumor that involves vertebrae and, to a lesser extent, the long bones of the extremities. It is similar to osteoid osteoma histologically, but is larger and not accompanied by nocturnal pain
Osteochondroma
It affects patients under 20 years and both sexes are affected. Osteochondromas commonly develop in the metaphyseal region (near the growth plate) of long bones, especially near the knee.
Gross: Lesions are mushroom-shaped surface protrusions, covered by a cap of hyaline cartilage with surface perichondrium.
Gross and microscopic of Fibrous dysplasia
Gross: Lesions are well-circumscribed, intramedullary masses that are tan-white, gritty, and variable in size.
Microscopic: Lesions are composed of curvilinear trabeculae of woven bone with no osteoblastic rim (likened to Chinese letters) separated by richly vascularized fibrous stroma. Mature lamellar bone is not formed and lesions do not enlarge after puberty. This suggests that the lesion represents an arrest of bone maturation at the woven bone stage.
Define Rheumatoid Arthritis and discuss the pathogenesis. Enumerate the extraarticular manifestations
Definition: Chronic systemic inflammatory disease of autoimmune origin that principally attacks joints, producing a non-suppurative proliferative synovitis that progresses to joint destruction and ankylosis. Most patients have an increased level of anti Ig antibody (rheumatoid factor)
a. Rheumatoid skin nodules over bony prominences.
b. Heart: Rheumatoid nodule in valves & pericardium with a lympho-plasmacytic & histiocytic infiltrate.
c. Lung rheumatoid nodules.
d. Arteritis but may also cause phlebitis.
e. Lymphadenopathy & splenomegaly
f. Amyloidosis.
Define Tenosynovial giant cell tumor and discuss its types
group of closely related benign neoplasms involving synovial membranes, tendon sheaths, and bursae.
1- Diffuse type: typically presenting in the knee (80%) with pain, “locking”, and swelling; range of motion is decreased and aggressive lesions erode into the bone and adjacent soft tissue.
2- Localized type (giant cell tumor of the tendon sheath):, commonly manifesting as a solitary painless mass involving the tendon sheaths of the wrist and fingers.
- Gross picture of melanocytic Nevus and melanoma
-Most nevi arise in childhood and adolescence. Common melanocytic nevi are tan to brown, uniformly pigmented small papules. After many years, nevi gradually lose their pigmentation, decrease in size and disappear.
-Melanomas have an irregular border and marked variation in pigmentation including shades of black, brown, red and dark blue. They are usually larger than nevi. Tumor development shows two phases: radial (in situ not metastatic yet) and vertical growth phase (metastatic)
Define fibromatosis and discuss its two types of
A group of fibroblastic proliferation which are cytologically benign but grow in an infiltrative fashion , and can recur after surgical excision but do not metastasize.
a. Superficial fibromatoses: Palmar fibromatosis, in the palmar fascia, Plantar fibromatoses, Penile fibromatosis (Peyronie disease).
b. Deep fibromatoses: Abdominal desmoid tumor, arises from the rectus abdominis muscle in post- partum women or in scars of abdominal surgery.
*Extra-abdominal desmoid arises from the shoulder or pelvic girdle muscles.
*Retroperitoneal fibromatosis.
Enumerate vascular tumors and tumor like conditions. 7
VASCULAR ECTASIA
HEMANGIOMAS
LYMPHANGIOMAS
GLOMUS TUMOR
HEMANGIOENDOTHELIOMA
KAPOSI SARCOMA
ANGIOSARCOMA
Discuss the pathological stages of lobar pneumonia
Congestion (24h): The lung is edematous, red and heavy. The capillaries are hyperemic and the alveoli are filled in protein rich exudates
Red hepatization (few days): The lung is red, solid and airless, and consistency resembles fresh liver. The alveoli shows fibrin and massive accumulation of polymorphs and macrophages.
Grey hepatization (few days): The lung is gray show more accumulation of fibrin § Lysis of red blood cells.
Resolution (8-10 days):The lung returns to normal. Liquefaction and absorption of the exudate, and enzymatic digestion of inflammatory debris
Mention 4 complications of lobar pneumonia
1 - failure of resolution—–> Carnification
2- Toxemia: on 9th day acute heart failure due to toxic myocarditis
3- Spread: Direct or by blood
4- Post pneumatic lung abscess
Discuss the morphology of bronchopneumonia (septic bronchopneumonia)
Gross: Usually bilateral lower lobe affection
* Patchy areas of yellow consolidation.
* Pleurisy.
* Enlarged hilar lymph nodes (lymphadenitis).
Microscopic:
§ Suppurative exudation filling bronchi, bronchioles, and alveoli.
§ Alveoli: The alveoli are full of pus
Predisposing factors of bronchopneumonia
- It occurs most commonly in extreme of age: infants and old age.
- Commonly in patients with debilitating diseases such as : diabetes, cancer and cardiac failure.
- It may complicate viral infections as viral bronchitis.
Complications of bronchopneumonia 7
1) Death, especially in debilitated patients.
2) Post pneumonic lung abscess & gangrene.
3) Spread: to the pleura causing pericarditis, mediastinitis.
4) Toxemia causing toxic myocarditis.
5) Septicemia causing meningitis, arthritis, osteomyelitis and infective endocarditis.
6) Fibrosis is common, due to tissue destruction by suppuration.
7) Bronchiectasis: healing of bronchial walls by fibrosis, results in weakened walls and permanent dilatation of the lumen
Discuss the types of abscesses (5)
Aspiration lung abscess: due to blood or vomitous or foreign body. These locations represent the more direct course for the aspirated material from the trachea. The abscess wall is irregular and congested. The lining is shreddy yellow and the contents of cavity is yellow pus.
Post pneumonic abscess: in lobar or bronchopneumonia
Bronchial obstruction with bronchogenic carcinoma: aspiration of blood and tumor fragments contribute to the development of lung abscess.
Pyemic abscess: Septic emboli from septic thrombophlebitis of systemic veins.
Direct traumatic punctures or spread of infection from adjacent Organs.
Fate and complications of acute lung abscess (6)
1) Small size: Resolve with proper treatment
2) Rupture into a bronchus: results in hemoptysis & cough of purulent sputum
3) Rupture into a pleural cavity: results in empyema and pyopneumothorax.
4) Lung gangrene: ( the cavity is irregular with a necrotic lining but black in color & has a foul odor).
5) Embolization of septic material to the brain results in meningitis and brain abscess.
6) Chronic lung abscess: Well-defined cavity with a thick fibrous wall. The lining is smooth & the contents are inspissiated (thick pus).
Enumerate obstructive lung diseases and restrictive lung diseases.
1) Emphysema.
2) Chronic bronchitis.
3) Bronchiectasis.
4) Bronchial asthma.
1) Chest wall disorders in the presence of normal lungs.
Eg. : severe obesity, diseases of the pleura,
2) Chronic interstitial lung diseases:
Eg . pneumoconiosis and interstitial fibrosis.
Define emphysema and give an account on their types
Permanent over distention of air spaces distal to the terminal bronchioles, with destruction of their walls
Centriacinar: The lesions are more common and severe in the upper lobes. This type is common in cigarette smokers & coal workers
Panacinar: Occurs more commonly in the lower lung zones. It is the type of emphysema that occurs with alpha 1 antitrypsin deficiency.
Distal acinar: It occurs adjacent to areas of pulmonary scarring. It is usually in the upper half of the lung, and forms multiple adjacent dilated air spaces, some forming bullae.
Enumerate the complications of emphysema (3)
1) Pulmonary hypertension and right sided heart failure
2) Respiratory failure from defective ventilation, perfusion & diffusion of gases
3) Rupture bullae containing air into pleura producing pneumothorax
Define chronic bronchitis
Chronic bronchitis is defined clinically as persistent productive cough for at least 3 consecutive months, for 2 consecutive years.
Define bronchial asthma and enumerate its types
It is a chronic inflammatory disorder of the airways, characterized by paroxysmal reversible bronchospasm due to smooth muscle hyper-reactivity and increased mucus production
Atopic (allergic) asthma: it is caused by a type I hypersensitivity reaction (Ig E- mediated) triggered by environmental antigens
Non-atopic asthma: Hyper-reactivity of airways can be triggered by respiratory tract infections, chemical irritants
Aspirin induced asthma: exact mechanism unknown
Discuss the gross picture of bronchial asthma
Lungs are overinflated
Bronchial wall is thick, swollen & red.
Bronchial lumen contains large amounts of thick mucus plugs
Discuss the microscopic picture of bronchial asthma
Bronchial lumen: Occlusion of bronchi and bronchioles by mucus plugs which contain whorls of shed epithelium known as Curschmann spirals.
Numerous eosinophils are also present.
Bronchial wall
§ mucous gland hypertrophy.
§ smooth muscle hypertrophy,
§ thickening of basement membrane
Discuss the etiology of Bronchiectasis
1) Congenital:
-Kartagener’s syndrome: Structural abnormalities of the cilia impair mucus clearance in the airways resulting in persistent infections
-cystic fibrosis: A hereditary disease associated with thick mucus in exocrine glands, respiratory, gastrointestinal and reproductive tracts.
2- Septic bronchopneumonia particularly in children.
3- Bronchial obstruction (e.g., by tumor or foreign body).
Discuss the pathogenesis (mechanism) of Bronchiectasis
Two processes are involved: obstruction and chronic persistent infection.
In septic bronchopneumonia: Severe persistent suppurative inflammation in bronchi or bronchioles
causes:
- loss of cough reflex and accumulation of secretions,
- inflammation of the wall and weakening of the wall by fibrosis
In case of obstruction: caused by foreign body or lung cancer:
- There is accumulation of secretions which favor infection,
- Infection damages the bronchial walls leading to their weakening
- The obstruction causes collapse of lung parenchyma , and the week bronchial wall are exposed to the negative intrathoracic pressure with each inspiration leading to its dilatation.
Discuss the gross picture of Bronchiectasis
Medium sized bronchi & bronchioles: Airways can be dilated up to four times the normal size.
The bronchi appear thickened, with suppuration of their lining.
The pleura is thickened , fibrotic with adhesions
-There ;are 3 types of dilatation
Saccular dilatation: involves a part of the circumference of a segment sac like dilatation
Fusiform dilatation involves the whole circumference of a segment of the bronchus
Cylindrical :dilatation involves the whole circumference of the whole length of the bronchus.
Give an account on the microscopic picture of bronchiectasis
Bronchi
§ Lumen: filled with pus & blood.
§ Lining respiratory epithelium shows areas of ulceration.
§ Wall shows intense acute and chronic inflammatory cells and fibrosis.
Alveoli
§ Adjacent alveoli undergo fibrosis.
§ Patches of compensatory emphysema
Pleura
§ Fibrosis and adhesions.
Enumerate the complications of bronchiectasis 6
a. Hemoptysis with,yellowish red sputum (pus + blood).
b. Lung abscess- gangrene.
c. Spread of infection (see septic bronchopneumonia).
d. Bilateral lung fibrosis , pulmonary hypertension & right sided heart failure (cor pulmonale).
e. Secondary amyloidosis (chronic destructive condition).
f. Squamous metaplasia (due to chronic irritation) which may lead to squamous cell carcinoma.
Define atelectasis and give its types
Atelectasis is failure of expansion of the lung or collapse of previously inflated lung, affecting part or all of one lung,
Resorption atelectasis :Occurs with complete airway obstruction e.g. mucus plugs postoperatively or with bronchial ashma, and foreign bodies in children causing collapse of alveolia.
Compression atelectasis :Is associated with accumulation of fluid, blood or air in the pleural cavity, which compress and collapse the lung.
Enumerate microscopic types of lung carcinoma
- Squamous cell carcinoma.
- Adenocarcinoma.
- Large cell carcinoma.
- Small cell carcinoma.
complications of lung cancer
A) Spread:
Direct:
-to the pericardium, mediastinum and esophagus.
- Pleural seeding especially in adenocarcinoma.
Lymphatic: To the hilar and mediastinal lymph node.
.
Blood spread: To the brain, bones, liver, adrenals or other lung.
B) Hemoptysis.
C) Obstruction leading to collapse, secondary infection, bronchiectasis or lung abscess.
D) Paraneoplastic syndrome: 3-10% of patients with lung cancer develop clinical paraneoplastic syndrome due to secretion of polypeptide hormones.
-It presents in one or more of the following forms:
Hypercalcemia.
Cushing syndrome.
Myasthenia gravis.
Excess ADH.
Gross and microscopic picture of mesothelioma
Mesothelioma is usually unilateral, starting as small nodules on the visceral pleura and extends to cover the whole lung and obliterate the pleural cavity. The tumor is yellowish white.
Microscopic:
Epithelioid type: Cuboidal cells forming papillae and acini (looks like adenocarcinoma)
Sarcomatoid type” sheets of spindle malignant cells (looks like sarcoma)
Mixed type (biphasic): Epithelial + sarcomatous
Enumerate: Four causes of endometrial hyperplasia.
Prolonged estrogen stimulation
Estrogen secreting tumors
Prolonged estrogen therapy
Obesity
Four causes of uterine bleeding caused by local organic lesion
Pregnancy disorders: abortion
Benign tumors: endometrial polyp
Malignant tumors: carcinoma of endometrium
Inflammations: endometritis
Causes of dysfunctional uterine bleeding 4
Anovulatory cycle
Endocrine disorders
Estrogen producing ovarian tumors
Inadequate Luteal phase
Predisposing factors of uterine cervical carcinoma.4
- Early age of sexual activity
- Females with multiple sexual partners
- Male partner with multiple previous sexual partners
- Chronic cervicitis
Complications of endometriosis 3
Dysmenorrhea: Painful menstruation due to intrapelvic bleeding.
Dyspareunia: painful intercourse
Infertility: Adhesions around the tubes
Complications of puerperal sepsis. 4
severe toxemia and septicemia
Spread of infection to the tubes -> salpingtis.
spread of infection to peritoneum –> peritonitis
Healing of infected tubes–> fibrosis and infertility
Mention differences between partial and complete hydatiform moles.
Complete: diploid, fertilization of empty ovum by two sperm, fetal parts absent and rarely progress to carcinoma
Partial: triploid, fertilization of ovum by two sperms, fetal part present and very rarely progress to carcinoma
Give an account on duct ectasia (periductal mastitis) (definition, etiology, gross and microscopic pictures).
marked dilatation of mammary ducts containing inspissated Secretions
unknown etiology
Gross: firm tender greyish white mass with large dilated ducts
Micro: dilated ducts contain foamy macrophages and are surrounded by granulomatous inflammation
Complications of puerperal sepsis. 5
- Severe toxemia and septicemia.
- Septic thrombophelipitis may cause pyemia.
- Spread of infection to the parametrium, and tubes causing salpingitis.
- Spread of infection to peritoneum may cause localized (in the pelvis) or diffuse peritonitis.
- Healing of salpingitis causes fibrosis and infertility.
Complications of uterine leiomyomas. 3
- Uterine bleeding.
- Infertility
- Multiple leiomyomas may cause marked uterine enlargement and pressure on nearby organs and pelvic veins.
Complications of pelvic inflammatory disease 4
- Spread of infection to the peritoneum; peritonitis.
- Toxemia.
- Chronic PID and chronic tubo-ovarian abscess.
- Infertility.
Complications of ovarian mucinous cystadenoma. 3
- Pressure effects on nearby organs.
- Torsion of the pedicle causing, hemorrhage, shock.
- Malignant change.
Complications of vesicular (Hydatidiform) mole 3
- Bleeding
- 10% of complete mole are invasive
- 2-3% give rise to choriocarcinoma.
- Three theories explaining endometriosis
and
*Four common sites of endometriosis
- The regurgitation theory: (more accepted).
Proposes menstrual backflow through the fallopian tubes with subsequent implantation. - The metaplastic theory: Proposes endometrial metaplasia of serosal cells covering ovaries or fallopian tubes.
- Lymphatic :Used to explain extra pelvic endometriosis.
Sites: Pelvic structures, ovaries, Peritoneal cavities and fallopian tubes
Cause of acute salpingitis.
Inflammation of fallopian tube, most commonly sexually transmitted due to chlamydia and gonorrhea.
- Types of benign ovarian surface epithelial tumors and describe one of them.
serous cystadenoma
mucinous cystadenoma
Serous cystadenoma is often unilocular. The outer surface and the lining are smooth. The inner surface may show papillary projections
- Types of ovarian teratoma and describe the most common form
Benign, Malignant and specialized teratoma.
Benign teratoma shows mature ectodermal, endodermal and mesodermal structures such as teeth and hair.
Define Endometriosis.
It is the presence of endometrial glands and stroma in a location outside the inner lining of the uterus.
Define Adenomyosis.
It is a down growth of endometrium and its entrapment deep within the myometrium
Define Dysfunctional uterine bleeding
It is abnormal uterine bleeding caused by hormonal dysfunction without organic (anatomic) cause
Gross and microscopic picture of chronic non-specific cervicitis.
There is eversion of the ectocervix with hyperemia, edema and granular surface. Nabothian cysts may be visible as pearly white vesicles.
Microscopic: The cervix shows inflammatory cellular infiltrate; rich in plasma cells, lymphocytes and histiocytes, with fibrosis.
- Often some of the mucous glands are obstructed and dilate to form mucus- filled cysts called Nabothian cysts (follicles).
- The surface epithelium may show squamous metaplasia.
Pathology and complications of Female Gonorrheal infection. 6
- Urethritis: Hyperemic mucosa covered by purulent exudate.
- Paraurethritis: inflammation of paraurethral glands.
- Bartholin gland inflammation: This may lead to abscess (Bartholin abscess). Obstruction of the gland duct may lead to cyst formation (Bartholin cyst).
- Cervicitis (see before).
- Vaginitis and endometritis (rare).
- Salpingitis
Gross and microscopic picture of adenomyosis.
Gross: Enlarged uterus with thick myometrium showing trabeculations and haemorrhagic foci.
Microscopic: The myometrium shows foci of endometrial glands and stroma with hemorrhage
Microscopic types of endometrial hyperplasia.
- Non-atypical hyperplasia:
* An increase in the gland-to-stroma ratio.
* The glands show variation in size and shape and may be crowded with back- to- back glands. Cystic change may be present.
* The glands are lined with tall columnar cells which show stratification. - Atypical hyperplasia:
* The glands are commonly back-to-back and often have complex outlines due to branching of the glands.
* Individual cells are rounded and lose the normal perpendicular orientation to the basement membrane. In addition, the nuclei have open chromatin and nuclear atypia.
Give an account on ovarian granulosa cell tumor.
Gross: Well defined solid and cystic tumors and may be hemorrhagic.
Microscopic: The tumor is composed of granulosa cells which mostly have grooved nuclei. Cells are arranged in micro follicular pattern
Effects: The tumor may be functional and produce estrogen.
Acute viral hepatitis microscopic picture.
- Liver cell injury:
* ballooning of hepatocytes.
* Apoptosis of individual cells, resulting in acidophil bodies
* Focal necrosis , leaving collapsed reticulin network behind.
* In severe cases, necrosis occurs, commonly centrilobular, or even central-portal bridging necrosis. - Cholestasis: Accumulation of bile in the liver cells and bile canaliculi Kupffer cells engulf bile and undergo hyperplasia.
- Portal tract inflammation: In the form of mild mononuclear cell infiltration.
Microscopic picture of Chronic Viral Hepatitis
Microscopy:
1) Inflammation :
* Portal inflammation: Expansion of the portal tracts by chronic inflammatory cells, Bile duct walls may be inflamed
* Lobular inflammation
2) Piecemeal necrosis: This is inflammation with destruction of the liver cells at the limiting plates of liver lobules. The liver cells become detached.
3) Fibrosis: Portal fibrosis, bridging fibrosis, accompanied by regeneration nodules (cirrhosis).
4) Other Features: Steatosis of hepatocytes
* Hepatocellular dysplasia (precancerous)
complications of chronic pancreatitis 3
1- Malabsorption.
2- Diabetes mellitus.
3- Pseudocysts.
Gross picture of pleomorphic adenoma
- Benign tumor with an incomplete capsule.
- Lobulated outer surface.
- Bluish white in color.
- Soft, gelatinous consistency.
- Cut section: Bulging with rounded borders & cystic areas.
Microscopic picture of pleomorphic adenoma
- Epithelial glands.
- Myoepithelial cells in solid groups.
- Myxoid, hyaline, (pseudocartilage) or osseous stroma.
Discuss the microscopic picture of rapidly progressive GN (crescent GN)
-The glomeruli are enlarged, hypercellular showing proliferation of endothelial, mesangial and epithelial cells as well as leucocytic infiltration. Usually there is glomerular necrosis and may be glomerular capillary thrombosis.
-Crescents are formed in the Bowman space and compressing the tufts. They are formed of proliferating parietal epithelial cells, fibrin and migrating monocytes and leucocytes.
Describe the morphology of urothelial carcinoma
a) 80% of bladder carcinomas are papillary tumors:
* They are formed of delicate fronds of vascular connective tissue core covered by urothelium.
* Most are superficial and can be treated by cystoscopic resection, with follow up for recurrence in the same area or different area of the bladder.
* When these tumors become invasive, they may superficially infiltrate the lamina propria or extend deeply into underlying muscle. The extent of invasion at the time of initial diagnosis is the most important prognostic factor.
b) 20% of tumors are solid (flat, non-papillary) and invasive at presentation and infiltrating the muscle. Such lesions are preceded by a carcinoma in situ. CIS is a flat lesion showing highly atypical cells.
Paget’s disease of the breast microscopic picture
The epidermis is infiltrated by large-sized neoplastic cells with clear cytoplasm and large hyperchromatic nuclei. These cells are called Paget’s cells.
Paget’s disease of the breast features and gross appearance
Mammary carcinoma: Intraduct or invasive (of any pattern).
Eczema of the nipple: due to transductal intraepidermal spread
Gross:
The nipple is red, ulcerated and scaly
Microscopic:
The epidermis is infiltrated by Paget’s cells
Two types of ductal carcinoma in situ (DCIS) and their microscopic appearance.
Comedo DICS: The ducts are enlarged and lined by several layers of high grade malignant cells with expanding central necrosis.
Non-Comedo DCIS
Breast duct papilloma (definition & morphology)
Benign neoplasm from major lactiferous ducts
serous or bloody nipple discharge
Gross:
It is polypoid intraductal mass < 3 cm, soft and Hemorrhagic.
Microscopic: Complex arborizing papillae formed of fibrovascular cores covered by Ductal epithelium & myoepithelial cells.
