Test 1

Question 1

Ureter

Answer 1

Highly convoluted mucosa
Urothelium with multiple layers (3-6)
Dense, vascularised lamina propria 
Muscularis 
Adventitia

Question 2

Urethra

Answer 2

Urothelium
Lamina propria
Submucosa of fibroelastic tissue
May see sub urethral glands
Muscularis 
Adventitia

Question 3

Bladder

Answer 3

Urothelium (5-6 layers)
Lamina propria made up of fibroelastic tissue
Thin vascularised submucosa
Very thick muscularis layer (detrusor muscle)
Adventitia

Question 4

Vas Deferens

Answer 4

Pseudostratified columnar epithelium
Small lumen surface
Lamina propria rich in elastic fibres
Very thick muscularis layer (longitudinal, circular, longitudinal)
Adventitia

Question 5

Testes

Answer 5

Dense CT capsule (tunica albigunea)
Extends into the testes as septa
Seminiferous tubules
Surrounding seminiferous tubules are Leydig cells
Mucosa of seminiferous tubules made up of Sertoli cells
Flat cells on outside of seminiferous tubules are Myoid cell (smooth muscle cells)
CT framework throughout

Question 6

Seminal Vesicles

Answer 6

Tortuous glands
Lined by pseudostratified columnar epithelium
Thick CT capsule (tunica albuginea)
Lamina propria made up of elastic fibres
LP surrounded by smooth muscle

Question 7

Penis

Answer 7

Urethra in middle
Outer tunica albuginea
Urethra surrounded by erectile tissue known as corpus spongiosum
Corpus spongiosum = dense fibroelastic tissue with smooth muscle dotted throughout
Urethral glands may be present
Cavernous sinuses seen

Question 8

Benign Prostatic Hyperplasia

Answer 8

Proliferation of glands
Multilayered epithelium (usually only simple columnar)
Greatly thickened fibromuscular stroma
Corpora amylacia present (hyaline within glands)

Question 9

Urethra CIS

Answer 9

Loss of normal urothelium 
Cells have irregular nuclei and nucleoli
Ulceration of epithelial layer
Lamina propria with inflammatory cells
Epithelial cells exfoliating into lumen
No invasion into submucosa (basement membrane still intact)

Question 10

Prostate with Adenocarcinoma

Answer 10

Glandular architecture becomes tortuous and thickened
Cribriform arrangement
Invasion of tumour cells into the stroma

Question 11

Prostate

Answer 11

Glands lined with simple columnar epithelium
Fibromuscular stroma surrounding glands
Surrounded by thin layer of CT

Question 12

Ovary

Answer 12

Surface mesothelium of simple cuboidal epithelium
Dense CT tunica albuginea
Medulla made up of loose CT
Ovarian follicles seen

Question 13

Ovarian Follicle

Answer 13

Oocyte surrounded by layer of epithelial cells
Zona pelucida surrounding oocyte (dense glycoprotein)
Many layers of granulosa cells sitting on theca interna
Theca interna seen just outside the basal layer and is thick CT
Theca externa delicate CT and mixed with smooth muscle cells

Question 14

Fibroid Uterus

Answer 14

Mucosa normal
Blood vessels with very thick walls
Whirl like bundles of smooth muscle
Usually encapsulated with CT layer

Question 15

Endometrial Curretage

Answer 15

Fragmented specimen
Haemorrhage
You’re looking for normal structure (endometrial glands, simple columnar epithelium etc.)

Question 16

Uterus with Attached Placenta

Answer 16

Placenta:

• chorionic villi
• lacunae
• decidua is endometrial lining
• chorionic villi filled with vessels and capillaries

Question 17

Cervix

Answer 17

Stratified squamous epithelium (3 layers: basal, intermediate and superficial
Basal cells on basement membrane
CT stroma underneath BM
On PAS shows positive staining of squamous cells as they contain glycogen
Endocervical glands also stain positive on PAS (cystic lakes may also be seen staining positive)

Question 18

Fallopian Tube

Answer 18

Mucosa made up of complex folds
Ciliated columnar epithelium (not all ciliated)
Secretory peg cells seen within epithelium
CT framework that makes up the folds
Smooth muscle layer (circular and longitudinal) outside of mucosal folds

Question 19

Uterus

Answer 19

Simple columnar epithelium
Stratum functionale contains endometrial glands (thickness depends on stage of menstrual cycle)
Stratum basale seperating functionale and myometrium
Myometrium very thick muscular layer

Question 20

Uterus Adenocarcinoma

Answer 20

Loss of surface mucosa
Loss of normal architecture
Clusters of epithelial cells throughout
Evidence of haemorrhage
Tumour cells have eccentric nuclei due to mucin secreting vacuole
Mucin secreting vacuoles stain positive with the PAS stain

Question 21

Normal Lung

Answer 21

See bronci and bronchioles (bronchioles have low cuboidal epithelium and no cartilage)
Alveolar walls thin with type 1 and 2 pnuemocytes
CT septa seperates lobules
When staining with Masson’s Trichrome, shows blue staining for CT septa

Question 22

Trachea

Answer 22

Pseudostratified ciliated columnar epithelium
Lamina propria made of CT
Seromucinous glands seen
Loose CT surrounding hyaline cartilage
Goblet cells seen within epithelium
CT fibroblasts within LP
Adipose tissue before cartilage
Perichondrium surrounds cartilage (delicate CT)

Question 23

Bronchus

Answer 23

Pseudostratified ciliated columnar epithelium
Cartilage plates seen with smooth muscle bundles
Perichondrium surrounding hyaline cartilage
Essentially same as trachea

Question 24

Bronchiole

Answer 24

Loss of cartilage (replaced by smooth muscle)
Pseudostratified ciliated columnar epithelium/cuboidal
CT lamina propria

Question 25

Emphysema

Answer 25

Pleural bulli (holes in submucosa) Expanded alveolar spaces Fibrotic thickening in alveoli walls

Question 26

Lung Adenocarcinoma

Answer 26

Thickening of alveolar walls (much more thick) Shows lepidic growth pattern In alveolar spaces there are balls of tumour cells Tumour cells growing along the lumen of alveoli When staining with PAS, shows mucin targets and other small granules of residual glycogen

Question 27

Lung Small Cell Carcinoma

Answer 27

Crowded mass of tumour cells Poorly arranged, pleomorphic, hyperchromatic tumour cells with indistinct cytoplasm Can see nuclear moulding forming rows

Question 28

Normal Liver

Answer 28

Dense CT capsule known as Glisson's capsule Central vein surrounded by cords of hepatocytes Spaces between hepatocytes are called sinusoids See portal triad with accompanying bile ducts CT septa separating lobules With Masson's Trichrome, shows CT septa in blue With Gordon and Sweet's, shows reticulin fibres holding together hepatocytes With PAS, hepatocytes filled with glycogen

Question 29

Cirrhotic Liver

Answer 29

Normal architecture of liver is lost Degenerative hepatocytes Marked fatty lipid infiltrate (infiltrates hepatocytes, nucleus displaced to periphery) Normal loose CT septa replaced by more dense fibrotic CT Mallory bodies seen with regenerative hepatocytes With Masson's trichrome, see CT septa has been replaced by thick fibrotic CT and also losses normal structure, regenerative cells stain deep red With Gordon and Sweets, loss of reticulin fibres in the CT septa as well as hepatocytes that have been disrupted by lipid vacuole

Question 30

Gall Bladder

Answer 30

Surface mucosa folded Simple columnar epithelium CT LP Smooth muscle layer very close to mucosa Large external adventitia with BV, lympatics, collagen CT Can see Rokitansky Aschoff sinuses

Question 31

Metastatic Colon Carcinoma of Liver

Answer 31

Tumour shows gland formation Clearly separated from normal liver structure Tumour cells have high NC ratio and prominent nucleoli With PAS/AB, can see abundant lakes of acid mucin found inbetween tumour cells

Question 32

Normal Breast

Answer 32

Terminal Ductal Lobular Units (have 2 layers of cells: cuboidal/myoepithelial cells) Intralobular CT loose, interlobular CT dense Adipose tissue throughout Fibroblasts seen in stroma Myoepithelial cells seen surrounding ducts (flat cells) May also see nerve roots May see PAS positive material within ducts (note that the epithelial cells have no PAS positive staining - important when identifying adenocarcinoma)

Question 33

Fibroadenoma of Breast

Answer 33

``` Encapsulated by dense CT Complex extensions of ducts Tumour made up of dense CT Epithelium of ducts thicker (more than 2 layers) Increase in myoepithelial cells ```

Question 34

Fibrocystic Breast

Answer 34

Dilated ducts (with cystic deposit) Macrophages in ducts Stroma dense CT Complex gland formation

Question 35

Gynaecomastia

Answer 35

Fibrous stroma Some very simple mammory ducts Enlarge ducts with thickening of epithelial layer Increase in myoepithelial cells With PAS, staining in luminal epithelium (acid mucins on surface of epithelium)

Question 36

Ductal Cell Carcinoma in Situ (DCIS)

Answer 36

Some normal ducts May see cystic lakes Tumour encapsulated in normal ducts as BM is still intact Tumour cells hyperchromatic and pleomorphic Calcific material within ducts

Question 37

Adenocarcinoma of Breast

Answer 37

Stellate (star like) appearance Fibrous areas (lots of collagen) Tumour cells in small groups, no BM encasing them With PAS, mucin targets (nuclei on edge of cells), acid mucins produced by tumour cells

Question 38

Lobular Carcinoma

Answer 38

Lots of fibrosis Inflammation seen Solid in structure Interlobular stroma invaded by tumour cells (only invade stroma) Tumour cells form rows and many have vacuoles With PAS, tumour cells with vacuoles stain positive for neutral mucins (look like target cells) With Masson's Trichrome, lots of collagen (blue) surrounding tumour cells (red)