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Lectur er s
Pathology Lab 2 Part 1 Exam 2
Surgical Pathologist
• The one who studies specimens, usually from a
o Glomerulus: bowman’s space is enlarged (A)
surgeon, and makes a diagnosis depending on
what they see from the specimen. They are also the o Tubules: normally found in spaces between
ones who specify if the lesion is benign or the glomeruli. In this picture, you see a
malignant. fibrous area which is almost devoid of
• They rely on what they observe directly from the tubules
o Blood Vessels – wall is thickened (B)
specimen itself and the clinical input coming from
the clinician or surgeon
• Specimen – may be a whole organ or a piece of
tissue
• Tissues are “fixed” by immersing them in formalin.
This prepares the tissue for slide processing.
Changes that may occur because of formalin include:
o Areas of the tissue with increased number of
cells per unit volume tend to become more white
compared to less cellular areas of the tissues
o Color of the tissues usually become lighter
ON High Power
o Inflammatory cells found on the slide (do you
see the lymphocytes below the glomerolus?)
o Thyroidization is present (boxed)
o Casts (Tamm-Horsefall protein) inside
tubules signify a long standing renal problem
with decreased urine flow.
o When the tubules are dilated, they usually
• Kidney: Organ is 5-6 inches in length, and form broad casts and the kidney damage is
covered with fat irreversible.
III. Angiomyolipoma
** visit
http://webpathology.com/case.asp?case=66
for nice pictures of renal cell cancer
• Light Microscope:
CUT section
o Multiple cysts on cut section
o May be due to proliferation of stromal
o Highly cellular tissue with no tubules
elements OR both stromal and glandular
o Notice the stroma (A), some gland like elements (when glandular elements
structures made by primitive cuboidal proliferate, they manifest as cystic spaces)
epithelial elements (B), and blastema (C -
dark staining cells) • Light Microscope:
** check
http://webpathology.com/case.asp?case=73 for
more histological pictures of wilm’s tumor
• ON High Power
o The picture shows a grade 5 lesion since no NtK from Robbins: Chronic Cystitis. The common etiologic
agents of cystitis are the coliforms: Escherichia coli, followed
glands are present in the field by Proteus, Klebsiella, and Enterobacter. Women are more
o This picture shows pleomorphic likely to develop cystitis as a result of their shorter urethras.
hyperchromatic nuclei Most cases of cystitis take the form of nonspecific acute or
chronic inflammation of the bladder. In gross appearance,
VI. Chronic Cystitis there is hyperemia of the mucosa, sometimes associated
with exudate.
Persistence of the infection leads to chronic cystitis, which
differs from the acute form only in the character of the
inflammatory infiltrate. There is more extreme heaping up of
the epithelium with the formation of a red, friable, granular,
sometimes ulcerated surface. Chronicity of the infection
gives rise to fibrous thickening in the muscularis propria and
consequent thickening and inelasticity of the bladder wall.
Histologic variants include follicular cystitis, characterized
by the aggregation of lymphocytes into lymphoid follicles
within the bladder mucosa and underlying wall, and
eosinophilic cystitis, manifested by infiltration with
submucosal eosinophils together with fibrosis and
occasionally giant cells. Most cases of eosinophilic cystitis
represent nonspecific subacute inflammation, although,
rarely, these lesions are manifestations of a systemic allergic
disorder. All forms of clinical cystitis are characterized by a
triad of symptoms: (1) frequency, which in acute cases may
necessitate urination every 15 to 20 minutes; (2) lower
Notice the ureter on the Right is dilated (probably abdominal pain localized over the bladder region or in the
suprapubic region; and (3) dysuria-pain or burning on
because of the presence of a stone impacted on
urination. Associated with these localized changes, there
the outlet) may be systemic signs of inflammation such as elevation of
temperature, chills, and general malaise. In the usual case,
Bladder also shows the bladder infection does not give rise to such a
areas of hemorrhage constitutional reaction.
WHO/ISUP Grades*
Urothelial papilloma
WHO Grades†
Urothelial papilloma
• Urinary bladder cut in half. Notice that the lesion
has occupied the whole bladder space Urothelial neoplasm of low malignant potential
• This lesion is malignant
Papillary urothelial carcinoma, Grade 1
• Upper area is normal Urinary Bladder mucosa –
has a smooth surface Papillary urothelial carcinoma, Grade 2
• Lower portion is stiff and nodular with thick walls -
lesion Papillary urothelial carcinoma, Grade 3
• Light Microscope:
• Light microscope:
o 3 glomeruli present in the field (encircled)
o Inflammatory cells in the interstitium
(lymphocytes) (A)
o Segmental sclerosis – collapsed lumen with
increased matrix (B)
o Thickened basement membrane signaling
Tubular atrophy ©
o Presence of hyaline cast inside some
tubules. The basement membrane of these
tubules are thinner because the cells have
sloughed off due to cell death/necrosis (D)
• Light microscopy: mesangial hypercellularity / ** the term hyalinization is used for blood
vessels and arterioles, while hyaline deposit
proliferation
is used for the glomerulus
• Light microscope:
o Thickening of the arterial wall (formation of
onion skin walls) sometimes leading to
• EM: numerous subepithelial deposits (arrows) obliteration of arterial lumen
o Hyperplasia of the wall leads to onion
Case 5 – Acute Tubular Necrosis skinning (feature of malignant HTN)
Twenty five year old man who had been stabbed with o Fibrinoid necrosis of arteries causing fibrin
a knife and shot with a gun clots
• ATN may progress to acute renal failure There is decrease of GFR
Leads to Ischemia (tubules are first bleed! Congrats sa lahat ng pumasa! now I
affected while the glomerulus is resistant believe when they say renal is the hardest! Damn
to ischemia) can’t wait for summer vacaction!!!
Greetings:
ADI: good luck sa exams next week! Lapit na
bakasyon yehey!!!