By\King of pathology( Legand Hazem )

Histopathology
General items
General Rules :
Examination :
in the form of spots 5 jars and 5 slides
the time of each spot is 5 minutes
the degrees are 8 degrees for each spot total 80 degrees
the answer inludes :
!" diagnosis
#" desription
Almost always, No fixed slides
$se of mirosope :
ou should start with screening of the slide !y na"ed eye ( not to diagnose it #
ou should !e sure that the o%er of the slide faes up ward
$he following powers are present in any microscope :
%& low power : '(
)& intermediate power : ' %0&)0
*& high power : ' (0&(5
&ou should start 'y the low power then intermediate then high if needed
1
(lmost all the slides an 'e diagnosed 'y low power except # slides:
!) Hodg*in+s lymphoma
#) ,eminoma
ou should start with the periphery of the slide then mo%e to the enter
-ratie ma*es perfet )
Best .ishes
/omment on 0ain points in the slide: ( desription #
!" type of tissue
#" site of the lesion ( reation ) in the tissue
1" type of the lesion ( reation )
A- inflammatory
B- degenerative
C- neoplasti
!- ot"ers
2nflammatory reations
2
2" (ute inflammation : 1 omponents :&
a" aute inflammatory ells : neutrophils + multilo!ed nuclei # and macrophages
+ "idney shaped nuclei, irregular cytoplasmic !orders# e3ept in typhoid no neutrophils
'" dilated ongested 'lood %essels : containing ,-./ and 0-./
" e3udate ( ontaining fi'rin # : appear in the tissue as either :&
pale pin" areas
separation of .$ fi!ers1
22"/hroni inflammation:
("4on speifi :
* components:
a" hroni inflammatory ells : plasma cells, lymphocytes, macrophages and fi!ro!lasts
peri2ascular arrangement
'" thi* walled 'lood %essels 5 end arteritis o'literans (6(7#: proliferation of su!intimal
.$ thic"ening of the wall 3 narrowing of the lumen + !ecomes irregular instead of o2al&
rounded #
" 8i'rosis : fi!ro!lasts secrete collagen fi!ers then !ecome resting cells + fi!rocytes #
B",peifi : + granuloma #4 collection of histiocytes: 63amples:"
!" Bilharzial granulomatous reation :
!" Bilh) reation around worms or o%a w5 are rounded in 9), , o%al in L), , with a spine1
#" 9he o%a may ta*e one of 1 olors :
%& #$! if li2ing and contain miracidium 1
3
)& Bl%e if dead and calcified 1
*& &ello'is" )ro'n d1t !ilhar6ial pigment
1& $sually there is refratile shell all a round )
:" 9he reation onsists of : collection of histiocytes 7 eosinophils 7 lymphocytes 78&giant cells 7
angiomatoids5 small %asular spaes ( in li%er only ) ; fi!rosis
#" 9u'erulosis :
9he granuloma is either :
!" *on aseating : well formed rounded pale pin" granulomas consist of:
(" Giant ells : + fused epithelioid ells # :&
+anger"an,s type :
9n center of tu!ercle
Nuclei are peripheral and may !e :&
: ;orse&shoe li"e
: -ipolar
: 0ing form
*on-+anger"an,s type -
Nuclei in the center of cytoplasm
B" 6pithelioid ells : ( marophages ontaining 9B 'ailli ) :"
Cytoplasm: <arge swollen , pale pin" e5 ill&defined !order
*%le%s : 2esicular , eccentric
/" Lymphoytes ; 8i'rosis around the granuloma)
#" Caseating :
4
9he ,ame 'ut little +ang"an,s ells s%rro%nding entral aseation w< is pin*= homogenous =
strutureless areas
1" Rhinosleroma
!" 0i*uliz ell : ( marophage engulfed 'ailli hydropi degeneration )
ytoplasm : =oamy , 2acuolated with well&defined cell !orders
nuleus : small, rounded , central or eccentric
#" Russell 'ody : ( intraellular hyalinosis in a dead plasma ell )
ytoplasm : hyalini6ed 1
nuleus: small , eccentric 1
9umors
."e ells s"o' riteria of malignany / atypia 0 -- 123
!) pleomorphism + cellular and nuclear#
#) 77 nucleocytoplasmic ratio +N8. ratio#::: e3ept in hypernephroma
1) A!normal mitosis
:) >iant cell formation
>) <oss of polarity
?) nuclei : large , hyperchromatic, with irregular nuclear chromatin and clumped chromatin
@) nucleoli : large, multiple, eosinophilic
4)B :
#eed 4tern)erg giant ell 5#46 ell / in 7odg8in,s lymp"oma 0-
5
(" typial R,G :
large, !inucleated, e5 !asophilic cytoplasm
# nulei : large 2esicular, mirror image , "idney&shaped with central eosinophilic large
nucleoli
B" R,G %ariants :
<acunar cell
?opcorn cell
0ononuclear ;odg"in@s cell
0ultinucleated
Aegenerations
: Hyaline material : pin", homogenous, glassy , refractile , structureless
: (myloid material : the same !ut you should add special stains of amyloid
( /ongo red= metahromati stains )
,*in slides :"
4lides ontaining epidermis
/"in scar
6
!" atrophi epidermis + thinning 7 straight !asement mem!rane # 1
#" ('sent s*in appendages : + hair follicles 7 se!aceous glands 7 sweet glands#
1" Replaement of the dermis !y collagen !undles + A2ascular granulation tissue # which
are parallel to each other and to epidermis and separated !y fi!rocytes
.apillary hemangioma
6pidermis atrophic
Aermis : show non capsulated lesion formed of lo!ules of capillary&si6ed spaces
separated !y fi!rous tissue septa :&
(" lo'ules of small apillary sized spaes + rounded, o2al or irregular& some contain !lood
others not& lined !y endothelial cells resting on !asement mem!rane + ?A/ 72e#
B" fi'rous tissue in 'etween)
Aadura foot + actinomycosis if no epidermis #
!" 6pidermis : hyper"eratosis
#" Aermis : suppurati2e granulomas formed of :&
.enter : yellowish !rown fungus colonies w are formed of clu!s and hyphae 1
?eriphery : neutrophils 7 pus cells 7 macrophages 7 lymphocytes 7 fi!rous tissue
some types of fungi may stain !lue and red !y ;3E
common fungus stain called 6roott
sBuamous cell papilloma
'ranhed papilloma : are finger&li"e projections + exophytic # formed of ore 7 o%er
/ore : !ranched .1$
/o%er : hyperplastic str1sB1 epithelium , shows:
%1 -asal cell hyperplasia
)1 Acanthosis : 77 stratification of pric"le cell layers
7
*1 ?ara"eratosis : nucleated "eratin 1
(1 ;yper"eratosis1
Bg melanoma 5 *ev%s
Non capsulated lesion formed of :&
6pidermis : atrophic
Aermis : groups of -enign pigmented melanocytes :&
9-Bg :elanoytes : monotonous + no pleomrphism #
9n upper dermis : polyhedral e5 rounded 2esicular nuclei
9n lower dermis : spindle e5 o2al nuclei
;- :elanin pigments : !rownish , present in
Aelanocytes1
Aacrophages1
=ree
:alignant melanoma
6pidermis : ulcerated
Aermis : groups of mg pigmented melanocytes infiltrate deep dermis :
!" mg melanoytes : show criteria of malignancy <=> and may !e:
melanocarcinoma : polyhedral cells
8
melanosarcoma : spindle cells
#" melanin pigment : 777 in amount , dar" , present in
melanocytes
free
s?%amo%s ell arinoma
6pidermis : ulcerated
Aermis : infiltrated + endophytic # !y irregular sheets of mg sBuamous epith1 .ells which
show criteria of malignancy <=> and arranged layers :
%& outer dar*ly stained ells : loo"&li"e N !asal cell layer of epidermis
)& polyhedral ells e5 a!undant pin" cytoplasm
*& enter formed of concentric "eratin layers 4 cell nest <@2AB CB
Basal ell arinoma
6pidermis : ulcerated
Aermis : infiltrated + endophytic # !y sheets of mg !asaloid cells
!" sheets : irregular , 2aria!le si6ed with peripheral palisading + outer layer of cells are
columnar and parallel , while inner cells are polyhedral#
#" /ells : ha2e scanty , !asophilic cytoplasm 7 + criteria of malignancy <=> (
Caverno%s "emangioma
non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa
9
! "9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat endothelium
3 ontain intat = hemolysed RB/s)
#" septa : .1$
4)B: it may 'e attahed to li%er tissue ( ommonest site of a%) Hemangioma is li%er)
Caverno%s lymp"angioma
non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa
!" 9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat
endothelium 3 ontain homogenous pin* material + lymph #
#" septa : .1$
1" lymphoytes either in septa or inside the lymph
Kidney
Cloudy swelling kidney
proDimal onvol%ted t%)%les s"o' --
!" 9he tu'ular epithelial ells :
.onical in shape1
/wollen1
,ith granular cytoplasm1
Normal nuclei1
;- l%mens-
Narrowed, /tellate in shape1
.ontain epithelial casts 1
1" 9he interstitial apillaries are ompressed 'y swollen ells
10
C"roni Eyelonep"ritis
t"e lesion is pat"y affetion of -
!"9he interstitial tissue : shows characters of chronic inflammation + #
#"9he olleting tu'ules :
/ome atrophic + d1t fi!rosis #, others show compensating hypertrophy 1
$hey contain hyaline casts 3 inflammatory cells casts 1
1 " B glomeruli :
Affected late , )ry to tu!ulo&interstitial lesion
?eriglomerular fi!rosis sclerosis + #
Amyloid 8idney
$he lesion is diffuse deposition of amyloid material in : + amyloid , staining 3 properties ! #
!" (fferent arterioles :
thic"ening of the wall 3 narrowing of the lumen1
#" Glomerular apillaries :
Amyloid deposit in C !asement mem!rane
1" /olleting tu'ules :
Amyloid deposit in C !asement mem!rane1
;yaline casts in C tu!ular lumen1
.FB Eyelonep"ritis
11
%&&$he cortico&medullary junction : shows $1- granulomas <=> ( aseating and non aseating )
)& $he rest of renal tissue shows:
=i!rosis1
.ompensatory tu!ular hypertrophy
Gilms, t%mor 5 nep"ro)lastoma
Ag tumor formed of * elements + all are mg criteria of malignancy <=> #:
!" ('orti%e glomeruli and tu'ules : lined !y cu!ical cells with no !asement mem!rane
#" ,troma : sarcomatous stroma formed of !undles of o2al to spindle shaped cells which
show metaplasia, forming : muscles, !one , cartilage , myxomatous tissue1etc
1" Blastema ells : undifferentiated , arranged in aggregate , small , lymphocyte&li"e cells
with dar" nuclei and little cytoplasm
7ypernep"roma 5 #enal ell arinoma
A& tumor formed of : cords 3 groups of mg epithelial cells separated !y delicate fi!rous stroma
the tumor cells are either :
!" lear ell type : cells are large polyhedral with 2acuolated cytoplasm + d1t dissol2ed fat
during preparation + cells show few malignant characters #
#" granular ell type : the same !ut with granular eosinophilic cytoplasm1
1" spindle ell type1
-& Areas of necrosis 3 hge1
Respiratory slides
4ose
Allergi nasal polyp
"inge#$like %#o&e'(ion )o#*ed o) 'o#e + 'o,e#
12
!"9he o%er : pseudo stratified columnar ciliated epithelium + respiratory epithelium# with areas
of sBuamous metaplasia1
#" 9he / )9 ore : 2ascular 3 edematous + edema leads to pallor of tissue 3 separation of
.$ fi!ers# which appears as homogenous pale pin" material 9t contains :
proliferated mucous glands
inflammatory cells : eosinophils, lymphocytes, plasma cells, macrophages1
#"inosleroma
"o#*ed o) e%i(-eliu* + su.e%i(-eli/l (issue
6pithelium : stratified sBuamous epithelium + metaplastic#
,u'epithelial tissue shows : dense inflammatory cells 7 fi!rosis 7 ) important cells :
!" Aic"ulic6 cells : (s 'efore HIJ
#" 0ussell !odies : (s 'efore HIJ
Lung
$mp"ysema
2nter al%eolar septa :
thinned , containing compressed capillaries rupture lea2ing a spur projecting inside the
al2eoli
9he al%eoli :
13
due to rupture of the septa they decrease in num!er , 77 in si6e and !ecome distorted in shape
2nterstitium shows :
!" hroni 'ronhitis + chronic inflammatory reaction K 7 hyperplastic mucous glands
#" hroni 'ronhiolitis +chronic inflammatory reation K 7 go!let cell metaplasia#
C"roni veno%s ongestion 5 )ro'n ind%ration
2nter al%eolar septa :
thic"ened !y Edema + transudate # 3 fi!rosis1 contain dilated congested capillaries
9he al%eoli : .ontains
Drange + intact 3 hemoly6ed 0-.s#,
!rown + hemosidrin granules 3 heart failure cells#
pin", homogenous +transudate#1
9he heart failure ells :
>roups of <arge, rounded , phagocytic cells engulfing !rown hemosidrin granules 3 red cells
2nterstitium shows :
$he !ronchial mucosa : edematous
.FB l%ng
%& caseating and non caseating tu!ercles ) ( LMN 2OP )
*& al2eoli contain :
E homogenous pin" inflammatory exudate1
E others show compensatory emphysema1
14
Qat ell arinoma
lung (issue is in)il(#/(ed .y / */lign/n( (u*o# (issue )o#*ed o) 0
!" groups and sheets of /mall, rounded, o2al or spindle malignant cells + Dat cells # with
scanty cytoplasm + lymphocyte& li"e #1 $hey are arranged in groups separated !y fi!rous
stroma1
#" (reas of hemorrhage + orange # and necrosis + pin"# are seen
1" 9umor ells show all malignant characters1 + #
,mall intestine
4erofi)rino%s peritonitis / small intestine 0
!" 9he muosa= su'muosa and musulosa : normal
#" serosa shows :
$he serosal cells are sheded
serosal .1$ is thic"ened, shows C characters of acute inflammation) ( LMN 2OP #
7 fi!rin networ" of entangling C acute inflammatory cells
Rntestinal lymp"oma / *on 7odg8in S4 lymp"oma 0
!" -art of the wall of small intestine infiltrated + mucosa 7 su!mucosa 7 muscle 7 serosa# !y
malignant tumor tissue causing extensi2e ulceration of the mucosa 3 destruction of the wall
#" 9he tumor formed of :
Aiffuse malignant lymphoytes whih are :
Fniform, <arge cells showing <arge deeply stained nuclei with irregular nuclear mem!rane and
some prominent nucleoli 3 thin rim of cytoplasm around1
15
areas of nerosis C hge are seen1
large intestine
Bil"arTiasis Colitis
-ilhar6ial o2a are deposited mainly in C su!mucosa 3 then mucosa muscle serosa
some worms1
All surrounded !y !ilhar6 reaction ( LMN 2OP #
Col%mnar ell papilloma
!"9he muosa shows exophytic 123 456growth in C form of 2illous projections +finger&li"e#
#" 9hese proDetions are formed of core 7 co2er
/)9 ore : delicate fi!ro2ascular .$1
/o%er : o2ercrowded columnar secretory cells with areas of dysplasia
Adenoarinoma / olon 0
9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor
tissue formed of malignant aini + cells arranged around a lumen # and sheets lined !y
malignant epithelial cells
9he malignant aini are :
16
Garia!le in si6e and shape
<ined !y dar" malignant cells + showing malignant criteria 1#
(reas of nerosis + in and Dut side the acinar lumena# 7 hemorrhage
Au*e+s pathologial staging :
A tumor infiltrates mucosa, su!mucosa
- H H H H H H muscle 3 serosa
.H H H H H H Hpericolic lymph node1
:%oid Adenoarinoma / olon 0
9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor
tissue formed of muin pools in which malignant cells swim inside or line the pools
the cells may !e arranged in the form of :
acini + cells arranged around a lumen #
fragment of an acinus
cords
indi2idual cells
some cells are distended with pale mucin pushing the nucleus at one side + eccentric #
( ,ignet ring appearane )
Li%er slides
Bil"arTial periportal fi)rosis of liver
-reser%ed li2er architecture
Bilharzial reation >K 27 7 fi!rosis 7 angiomatoid reaction in portal tract which may !e:
%& small fine
17
)& large coarse
*upffer ells are distended !y !ilhar6ial pigments + !rown#
Uatty "ange liver 5 / fatty degeneration V fatty infiltration 0
-reser%ed li2e architecture
hepatoytes show: empty 2acuoles in cytoplasm of hepatocytes fuse together
signet ring appearance
signet ring appearane is due to fat accumulation large 2acuole push the nucleus to
one side which !ecome flattened and eccentric
in H C 6 : 2acuoles appear empty as fat was dissol2ed during preparation !y xylol and
alcohol
in frozen setion : fat 2acuoles are stained !y + orange > & osmic acid & sudan 999 #
Cirr"osis
$ loss o) li,e /#'-i(e'(u#e .y #egene#/(ing nodules se%/#/(ed .y )i.#ous (issue se%(/
(" Regenerating nodules : 2aria!le in si6e and shape 3 show:
.entral 2ein eccentric
Iou!led
a!sent
$ra!eculae : ) cell thic" + N1 4 % cell thic"#
;epatocytes : 2aria!le in si6e and shape
%& /ytoplasm : show fatty change
)& 4ulei : show normal mitosis
B" 8i'rous tissue : surround and separate the nodules 3 contains:
?roliferated !ile ducts
?roliferated capillaries 3 <ymphocytes
18
7epatoma / "epatoell%lar arinoma 0
$ 8oss o) li,e /#'-i(e'(u#e .y 9/lign/n( nodules se%/#/(ed .y )i.#ous (issue se%(/
(" malignant nodules : infiltrate the surrounding cirrhotic tissue 3 formed of:
thic" tra!eculae +J ) cell thic"# , acini, or sheets of malignant hepatocytes
criteria of malignancy <=>K
B" fi'rous tissue septa)
$ /#e/s o) -ge : ne'#osis
$ #es( o) li,e# (issue s-ows 'i##-osis
metastati adenoarinoma in t"e liver
Normal li2er tissue is infiltrated !y adenoarinoma :"
malignant tumor tissue formed of malignant aini + cells arranged around a lumen # and sheets
lined !y malignant epithelial cells
9he malignant aini are :
Garia!le in si6e and shape
<ined !y dar" malignant cells + showing malignant criteria 1#
Breast
Ui)roadenoma )reast
$rue mixed tumor , well capsulated formed of ) elements :
!"8i'rosis : excess fi!rous issue replacing the fat
#"(denosis : proliferating !reast ducts lined !y ) layers of epithelial cells 123 WK2XY
( inner u'ial and outer flat myoepithelial )
9ypes :
2" 2ntraanaliular: 22" perianaliular
&?roliferated ducts, compressed ,
in2aginated !y excess .1$ gi2ing which
gi2e a false impression that fi!rous tissue is
inside C ducts1
& Iucts are elongated, /tar shaped with
Narrow lumen
&proliferated ducts are surrounded !y delicate
fi!rous tissue
&Iucts are rounded or o2al in .8/ with patent
lumen1
19
Ui)roysti disease of Z )reast
!" 8i'rosis : excess fi!rous tissue replacing the fat
#" (denosis : 9ncrease in num!er of C ducts + lined !y ) l
ayers of epithelial cells , inner cu!ical and outer flat myoepithelial
1" 6pitheliosis : focal proliferation of C cells lining the ducts forming papillary processes
:" /yst formation : E some ducts !ecome cystically
dilated , may contain some secretions
>" (porine metaplasia of B lining ells !ecome tall 3 acidophilic granular cytoplasm
?" /hroni inflammatory ells in the stroma
Rntrad%t arinoma / )reast 0
!" Large duts with intact !asement mem!rane + 123 # lined !y malignant epithelial cells
showing Ag criteria <=>
#" 9he duts may 'e :
/omedo type : ducts lined !y many layers of malignant cells with central pin" necrosis
,olid type : ducts occluded completely !y malignant cells
/ri'riform type : malignant cells are arranged around many regular lumena
-apillary type : malignant cells projecting into the lumen as papillary structures
20
/linging type : single layer of malignant cells line the ducts
Rnfiltrating d%ts arinoma
%& Non capsulated , malignant tumor tissue infiltrate the surrounding tissue
)& 9t is formed of sheets, cords of malignat epithelial cells surrounded !y fi!rous tissue
*& $he cells show malignant criteria ( LMN 2OP )
Grading of 2A/ :
!" Histologial grading :
necrosis + 77 necrosis high grade#
tu!ular formation + no tu!ular formation high grade#
#" 4ulear grading : according to nuclear pleomorphism1
spleen
7yaline spleen
;y/line */(e#i/ls < %ink= gl/ssy = #e)#/'(ile > /#e de%osi(ed in
/apsule
9ra'eulae
/entral arteriole of B lymph folliles + Ieposition of hyaline material in C su!endothelial .1$
of C intima 3 media $he wall is thic"ened with narrow lumen ischemia of lymphoid
follicles !ecome small and atrophic
?n)#/'(ion s%leen
21
$hree successi2e 6ones :&
!" Eone of normal : contain lymph follicles, red pulp, !l1 2essels 3 tra!eculae1
#" Eone of ongestion : shows congested !lood 2essels and acute inflammatory cells, and
early granulation tissue formation
1" Eone of Reent infart + .oagulati2e necrosis # shows:
& ghosts of normal structure with nuclear fragments 1
& $he capsule opposite C infarct area shows : fi!rous thic"ening1
@AB s%leen
%& .aseating and non caseating tu!ercles <=>
Lymph node
=ollicular hyperplasia + <1N #
&enlarged lymph node
&nodal architecture is preser2ed
&the cortex shows numerous large folliles which are
2aria!le in si6e 3 shape
each formed of :
!" 7uter dar* mantle zone : ?eripheral rim of small lymphocytes1
#" 2nner pale Germinal enter + lymphocytes, immuno!lasts, histiocytes #
$arly .FB lymp" node
22
& Enlarged <1N
& Nodal architecture is preser2ed
& many 4on aseating tu'erles among C lymphoid tissue1 LMN 2OP K
+ate .FB lymp" node
& Enlarged <1N
& Aost of C su!stance of C node is replaced !y many aeating tu'erles LMN 2OP
7odg8inSs lymp"oma / +F* 0
& Enlarged <1N
& <ost nodal architecture
& $he <1N is diffusely infiltrated !y:
!" typial Reed",tern'erg giant ells C its %ariants LMN 2OP
#"inflammatory ells inlude:
mature lymphocytes
eosinophils
histiocytes
plasma cells
neutrophils
fi!ro!lasts
1" (reas of nerosis= hge C fi'rosis
:etastati arinoma / +F* 0
& Enlarged <1N
23
& <1N sinuses and su!stance are in2aded !y malignant tissue either sheets ( from infiltrating
dut arinoma or aini + Adenocarcinoma #
& $he malignant cells show all C malignant characters1 + LMN 2OP #
Bone (nd artilage
Qsteo"ondroma -
Con '/%sul/(ed -/*/#(o*/(ous lesion )o#*ed o) D 'o*%onen(s 0
!" /ap of hyaline artilage : normal chondrocytes arranged perpendicular to the
perichondrium 1 surrounded !y chondroid matrix 1
#" /anellous 'one : !one tra!eculae separated !y !one marrow 1
C"ondrosaroma
Con '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$
& ;igh num!er of malignant hondroytes in a hondroid matri3 with areas of hemorrhage and
necrosis
$he cells show the criteria of malignancy LMN 2OP 1 they are either :
/pindle + undifferentiated #
0ounded inside lacunae + well differentiated #
6iant ell t%mor / Qsteolastoma 0
8o'/l 9g (u*o# )o#*ed o) 0$
!" ,tromal ells : + 0ounded K o2al K sphindle # 7 + criteria of Ag # 27E
#" Reati%e osteolast li*e giant ells : distri!uted large cells 1 contain up to %00 small
nuclei
1" ,anty fi'ro%asular stroma)
Qsteosaroma
Con '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$
& indi2idually arranged malignant osteo!lasts in osteoid matrix with areas of hemorrhage and
necrosis
24
&the matrix may !e also cartilaginous or fi!rous
&the cells exhi!it the criteria of Ag LMN 2OP
/u!types :
on%entional : descri!ed
parosteal : the same 7 chondroid areas
anaplasti : -i6arre cells 7 few osteoid
6ndometrium C$terus
Eroliferative endometri%m
!" 6ndometrial glands :"
/mall, 0ounded + $8/ # or tu!ular + <8/ # 1
Fniform in si6e, shape 3 distri!ution1
<ined !y rowded tall columnar epithelial cells with .entral o2al nuclei show few mitosis
#" 9he stroma is ompat and formed of :"
/phindle shaped cells e5 dar" nuclei 1
4eretory endometri%m
!" 6ndometrial glands :"
large, $ortuous showing ( saw tooth appearane )
Not uniform
<ined !y one layer of cu!ical cells with rounded nuclei w5 contain secretory 2acuoles1
25
#" 9he stroma is loose and formed of :"
rounded stromal cells with a!undant cytoplasm
spiral arterioles
hge
stromal granulocytes1
Cysti $ndometrial "yperplasia
!" 6ndometrial glands :"
9ncreased in num!er1
Garia!le in si6e 3 shape
<ined !y o%errowded columnar cells which may from papillary processes1
/ome glands are lined !y flattened cells with cyst formation1
#" 9he stroma is ompat and formed of :"
/pindle shaped cells with dar" nuclei
areas of necrosis, hge 3 infiltration !y ?1A1Ns, lymphocytes1
1" 8reFuent mitosis in glandular epithelium C stroma ells
Adenomyosis
9slands 5FGof Endometrial glands 3 stroma present inside the myometrium without any
connection with surface endometrium + J *mm from C !ase of C endometrium#
leiomyoma
He'(ion in I u(e#us s-ow well 'i#'u*s'#i.ed = '/%sul/(ed */ss )o#*ed o) 0
& 9nterlacing -undles 3 whorls JKL of smooth muscle cells alternating with fi!ro!lasts in
collagenous matrix1
musle ell : spindle with rounded !oth ends of cytoplasm , containing elongated nuclei
with rounded ends
8i'ro'last : spindle shaped cell with pointed !oth ends of cytoplasm, containing elongated
nucleus with pointed ends
26
Gonads
4eminoma
"ew se*ine)e#ous (u.ules /#e seen in)il(#/(ed .y / (u*o# (issue )o#*ed o) 0$
!" sheets of malignant ells w< are :
<arge rounded or polyhedral cells
cytoplasm is pale stained, 2acuolated +due to its lipid 3 glycogen content#1
nuclei are large, 2esicular, with rounded central nucleoli1
#" stroma :is infiltrated !y lymphocytes1
M#e/s o) -e*o##-/ge /nd ne'#osis
.eratoma
!" 0any ysti struture lined 'y :"
0espiratory epithelium1
/Buamous epithelium1
9ntestinal epithelium1
#" Heterogeneous tissues present 'etween B ysts inlude strutures deri%ed from all 1 germ
layers:
endoderm li2er, glands + thyroid ,mucous, serous#
ectoderm s"in 3 !rain tissue
mesoderm Auscle, !one, cartilage
1" 4o immature elements)
plaenta
[esi%lar mole
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Nnl/#ged '-o#ioni' ,illi )o#*ed o) 0 'o#e : / 'o,e# 0$
9he o%er : tropho!lastic epithelium with focal hyperplasia1
/)9 ore : A2ascular edematous .$ with hydropic degeneration
C"orioarinoma 5O3 P3
He'(ion in (-e *yo*e(#iu* s-ows 0
,heets of malignant cyto and syncytiotropho!lasts infiltrating the myometrium
4eroti musles infiltrated !y polymorphs 3 pus cells
Large area of hge)
$ropho!lastic cells + show criteria of malignancy# <=> are:
/yto : polygonal cells with rounded nuclei
,ynytio : protoplasmic masses containing scattered spindl nuclei with no cell !orders
Bil"arTiasis \rinary )ladder
!" 7%a are deposited mainly in the lamina + most 2ascular#3 to a lesser extent other layers
#" 7%a are surrounded !y - reaction1 ( LMN 2OP #
1" 6pithelial hanges inlude :
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ulceration
Atrophy
;yperplasia: hyperplastic transitional epithelium dips down in C su!mucosa forming
+ -runnLs nests# central cells degenerate to form a cyst lined !y transitional
epithelium and contain serous fluid + cystitis cystica# glandular metaplasia of lining
epithelium , !ecome columnar and secrete mucous + cystitis glandularis #
sBuamous metaplasia
Rounded strutures ( ontain lumen )
#eent t"rom)%s
!" ,etion in a %ein show distended lumen !y a throm!us + solid mass of !lood elements#
#" 9he throm'us formed of :
;ead : the attached part to the endothelium
$ail : the free end
-ody which contains:
!"Lines of Eahn : columns of fused platelets forming homogenous structureless pale pin" lines
#" fi'rin meshwor* Between B lines : entangling ,-.s 3 0-.s1
/ompliated throm'us :
&calcification 3 infection 3 hyalinosis
A%te !iff%se 4%pp%rative Appendiitis
<umen contains pus :
&dead and ali2e !acteria
&dead + pus cells# and ali2e neutrophils
&exudate
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.olonic mucosa : partly ulcerated
$he whole wall : is diffusely affected !y acute inflammatory reaction ( LMN 2OP K#
C"roni non speifi "oleystitis
9he muosa : hyperplastic or ulcerated1
4o su'muosa)
9he fi'romusular coat : shows chronic 9nflammation + LMN 2OP )
Goiter C prostate
4imple nod%lar goiter
%& Garia!le si6ed nodules separated !y fi!rous septa
)& Each nodule contain 2aria!le si6ed thyroid follicles
6ah follile shows :
& Iistended lumen !y homogenous colloid1
& <ined !y flat cu!oidal epithelium
9he stroma : compressed .1$ !etween follicles
4ormal %asularity of B gland)
4enile prostati "yperplasia
%& Garia!le si6ed nodules separated !y fi!rous septa
)& Each nodule shows hyperplasia 3 hypertrophy of !oth elements of the prostate
+ stroma 3 parenchyma#
9he stroma + fi!romuscular # is increased and shows chronic inflammation
9he parenhyma + acini # :
9ncreased in num!er1
30
Garia!le in si6e 3 shape
A- ."e lining of aini -
lined !y one or more layers of columnar cells, may form papillae1
/ome are cystically dilated with flat lining1
B-."e l%men of aini ontains -
/heded epithelium1
?rostatic concretions
corpora amylaceae
,lides *nown 'y pathology ( no normal tissue attahed)
+ipoma
!" /apsulated tumor tissue !y fi!rous capsule , sending .$ septa + con2eying !l1G $o tumor
cells# di2iding the tumor into lo!ules of mature fat cells+ lipocytes #
#" 8at ells are :
uniform in si6e and shape ,
appear 2acuolated due to dissolution of fat !y xylol and alcohol1
nuclei are compressed against C mem!rane + /ignet ring appearance #
1" 8at should 'e stained !y fat stains in a fro6en section to !e 2isi!le :
( orangeG 7smoi aid ,udan 222 )
6ran%lation tiss%e
Q$ Re%/i# (issue )ollowing /'u(e in)l/**/(ion o# /sso'i/(es '-#oni' in)l/**/(ion /nd )ollowed
.y )i.#osis
D$ ?( is )o#*ed o) 0
a"0any new apillaries lined !y swollen endothelial cells without a !asement mem!rane
+ ?A/ negati2e # 4 unli"e capillary hemangioma
31
'"8i'ro'last ells appear !etween C capillaries, it is spindle shaped cells
with tapering end 3 scanty cytoplasm with 2esicular spindle nuclei
" 9he ground su'stane !etween the capillaries and around fi!ro!lasts shows
homogenous, pale pin" exudate
collagen fi!ers +type 999# transforms to !undles + type 9 #1
Aixed acute and chronic inflammatory cells1
7ydatid ysts
He'(ion in w/ll o) -yd/(id 'ys( s-ow 0
!" 7uter fi'rous layer + compressed tissue of C organ affected #
#"2ntermediate laminated layer of structureless pin" +ali2e# or 2iolet + dead and calcified# tissue
of the parasite
1"2nner germinal layer : where scolics project1
*e%rilemmoma 5 4"'annoma
!" /apsulated tumor tissue attached to a ner2e 1
#" /apsule di2ide the tumor !y .$ septa into lo!ules formed of :
- B%ndles of %niform spindle s"aped ells : separated !y delicate fi!rillary !ac"ground
- ."e n%lei are rod shaped and arranged parallel to each other forming nulear palisading
1" 9he tumor tissue shows :
.ellular areas + Antony type 9 #
<oose areas + Antony type 99 #
+ cells are uniform , no pleomorphism , no mitosis#
32
:eningioma
!" /apsulated tumor tissue attached to the meninges
#" 2t is formed of whorls and !undles of uniform meningothelial cells w5 are :
0ounded &o2al cells with 2esicular nuclei , eosinophilic cytoplasm with ill&defined !orders in
fi!rous tissue matrix
1" Garieties :
:eningot"elial meningioma : discussed
Ui)ro)lasti meningioma : !undles of fi!ro!last&li"e cells
.ransitional meningioma : meningothelial 7 fi!ro!lastic
Esammomato%s meningioma : when center of the whorle contain calcified , laminated
!odies
Atypial meningioma 0 when there is cellular malignant criteria
:alignant meningioma : when there is infiltration of !rain tissue
By\King of pathology( Legand Hazem )
33