pathology revision for ipe; shifa college of medicine
DESCRIPTION
TRANSCRIPT
EMR
Contents
• MNG• Hashimoto’s Thyroiditis • Graves Disease• Papillary CA Thyroid• Medullary CA Thyroid• Mucinous Cystadenoma• Serous Cystadenoma• Dermoid Cyst• Simple cystic endometrial hyperplasia • Atypical endometrial hyperplasia• Endometrial polyp• Adenomyosis • Leimyoma• Leimyosarcoma• H. mole• Retained products of conception• Dysgerminoma• Cryptorchidism• Fibrocystic Disease• Fibroadenoma• Invasive Ductal CA Breast
Multinodular GoiterMultinodular goiter-
colloid present in follicles, tall columnar cells lining follicles, follicular hyperplasiaDegenerating changes- necrosis, hemorrhage, fibrosis
Case:Diffuse neck swelling, iodine deficient diet, mostly females, resident of hilly areas, pressure symptoms- dysphagia, dyspnea
Hashimoto’s ThyroiditisExtensive infiltration of parenchyma by inflammatory cells (lymphocytes and plasma cells)Atrophic thyroid folliclesNormal low cuboidal epithelium replaced by eosinophilic hurthle cells.
Case:Woman with hypothyroidism, thyroid peroxidase antibodies positive.
Graves’ Disease1. Moth eaten appearance
of colloid2. Crowding and
hypertrophy of tall columnar cells
Case:Woman with exophthalmos, hyperthyroidism symptoms, TSIs positive
Papillary CA thyroidPapillary CA thyroid-
Orphan Annie nuclei, psammoma bodies
Case:H/O radiation to head/neck, mets to cervical lymphnodes
Medullary CA ThyroidPolygonal cells forming nests, follicles and trabeculae.A cellular amyloid deposits derived from altered calcitonin molecules secreted by neoplastic cells.
Case:Male, with familial MEN Syndrome, mets present.
Mucinous Cystadenoma OvaryMucinous cystadenoma ovary
Mucin secreting cystsMucinous pleomorphic cells
Case:U/L pelvic massAbdominal painPseudomyxoma peritoneiiGross specimen, increased mucin production
Serous cystadenoma ovarySerous cystadenoma ovary
Pleomorphic atypical cellsNests of tumor cellsPsammoma bodiesTall columnar cells
Case:B/L ovarian massesGross: smooth glistening surface, septa
Dermoid CystID points:1.Dermal appendages2. Stratified squamous epithelium
Case:Young girl, with pelvic pain, radiological evidence of calcification in pelvic mass
Simple Cystic HyperplasiaID points:1. Dilated endometrial
glands2. Increased gland to stroma
ratio
Case: Woman with excessive
estrogen: PCOD, obesity etc
Atypical Endometrial HyperplasiaID points:1. Distorted endometrial
glands2. Crowding of glands3. Loss of cellular polarity
Case:Woman < 40-50 yrs, obese,
HRT, post-menopausal, vaginal bleeding
Endometrial PolypEndometrial polyp
Endometrium resembling basalis wih small muscular arteriesCystically dilated endometrial glands (finger like projections)
Case:Woman with intermittent vaginal spotting
AdenomyosisID points:1. Endometrial glands in
myometrium2. Reactive hypertrophy of
myometrium
Case:Young female with enlarged
uterus, dysmenorrhea, menorrhagia
LeimyomaLeimyoma
Whorls of smooth muscle fibersSpindle cells
Case:Woman with menorrhagia, increased frequency, multipara
Squamous Cell CA CervixSquamous cell CA cervix
Keratin pearlsFull thickness epithelium involvedNeoplastic fragments in stroma
Case:Young woman, multiple sexual partners, repeated HPV infections, young age at first intercourse, abnormal Pap smear report
LeimyosarcomaLeimyosarcoma
Cigar shaped cellsIncreased mitotic figuresNecrosisHyperchromatic nuclei
Case:Menorrhagia, mets, pelvic adhesions leading to symptoms
H. MoleHyaditiform mole
Swollen villiEdematous avascular stromaMultinucleated syncytiotrophoblasts
Case:Pregnant lady with very high HCG levels, large for date gestation, passage of grape-like clusters
Retained products of conceptionRetained products of conception
Fetal RBCsChorionic villi
Case:Incomplete abortion
DysgerminomaID points:polygonal uniform looking seminoma cells, lymphocytic infiltrateFibrous septa
Case: Young male with hard unilateral testicular mass, localized to the testes.
CryptorchidismCryptorchidism
Interstitial fibrosisThickened tubular basement membrane
Case:Young male with empty scrotal sac
Fibrocystic DiseaseApocrine change in cells lining ducts.Dilation of ducts, normal lining of ducts.
Case:Asymptomatic woman with U/L palpable breast mass.
FibroadenomaFibroadenoma breast-
increased stroma, star-shaped intracanalicular ductsDucts lined by normal cells
Case:Young female, in reproductive age group, cyclical breast pain or increase in mass size, freely mobile mass, increases in size during pregnancy/menstrual cycle
Invasive Ductal CA breastInfiltrating ducts.Ducts lined by single layer of cells.Pleomorphic nuclei.Stroma shows dense desmoplasia.
Case:Woman with palpable breast mass, nipple discharge, peau’d orange appearance of breast, axillary lymphnodes +, mets present.
Invasive CA breastBreast CA-
Increased N/C ratio, pleomorphic, undifferentiated cells
Case:Old woman, with mets, axillary nodes palpable, nipple retraction
KUB
Contents
• Kidney Necrosis• Chronic pyelonephritis• Membranous GN• Crescenteric GN• Glomerulonephritis• Renal Cell CA• Transitional Cell CA Bladder• BPH• Prostate CA
Kidney necrosisAttenuation of epithelial cellsPresence of casts in lumina of tubules and collecting ducts.Interstitial edema.
Case:Patient with ARF, drug induced or shock-induced, DIC
Chronic PyelonephritisHyaline like deposit in glomeruli.Abudant chronic inflammatory cells.
Case:Patient with recurrent kidney infections, UTI, renal scarring, chronic renal failure, TIN.
Membranous GNGlomeruli are large.Proliferation of mesangial cells.Glomerular capillaries show tram track apperance.
Case: Nephrotic Syndrome S/S
Crescenteric GNDeposition of protein like material in Bowman’s space.Proliferation of cells in parietal layer of Bowman’s capsule.
Case:Patient presenting with ARF, with Goodpasture’s, Wegener;s, SLE etc.
Glomerolunephritis
Membranous glomerulonephritis
Thickening of basement membraneNeutrophils
Case:30-50 yr old male with nephrotic syndrome
Focal Segmental Glomerulosclerosis
Some glomeruli/part of glomeruli show sclerosis.Matrix proliferation.Protein depostion.Some glomeruli totally sclerosed.
Case:Nephrotic Syndrome S/S:Hyperlipidemia, lipiduria, proteinurea > 3.5 g/day, children/adults. Not responsive to steroids.
Renal Cell CARenal cell carcinoma
Vacuolated or lipid-laden appearance of cells (clear cells)Scant stromaClear, granular cytoplasmBizarre nuclei with giant cells.
Case:Painless hematuria, flank pain, palpable mass
Transitional Cell CA BladderTransitional cell carcinoma
Transitional cells are arranged in 8-10 layersForm papillae, having fibrovascular core
Case:Old man with painless hematuria, working in naphthylene/rubber industry
Benign Prostatic HyperplasiaBenign prostatatic hyperplasia-
increased fibrous stroma, double layers of cells lining ducts, corpora amylasia
Case:Old man with increased hesitancy, frequency, poor stream and smoothly enlarged prostate on DRE
Prostate CAProstate CA-
single layer of cuboidal cells lining ducts, back to back arrangement of glands
Case:Old man with back pain, mets, urinary frequency, hesitancy, poor stream
RES
Contents
• Nasal Polyp• Nasopharyngeal CA• Laryngitis• Tonsillitis• Pneumonia• Granulomatous inflammation• Bronchoalveolar CA• Small Cell CA• Sq. Cell CA
Nasal PolypNasal polyp
Pseudostratified columnar epitheliumEosinophils and fibroblasts
Case: Patient of allergy, with U/L nasal obstruction
Nasopharyngeal CA
Nasopharyngeal CALarge epithelial cells with indistinct bordersCells with prominent eosinophilic nucleoliLymphocytes surrounding syncytial cells.
Case:Chinese man with nasal obstruction, cranial nerve palsies, enlarged cervical nodes
LaryngitisNeutrophilsCongestionHyperemiaStratified squamous epithelium
Case:High fever, hoarseness of voice
TonsillitisLymphnode lined by stratified squamous epithelium.Proliferation of germinal centers, infiltration of reactive lymphocytes.
Case:Child with sore throat, cervical lymphadenopathy, high grade fever, odynophagia
PneumoniaAlveolar architecture intact. Distended alveolar spacesVascular congestionLeukocytic infiltrate
Case:Patient with cough, sputum, high grade fever, chest pain, crackles
Granulomatous InflammationEpitheloid cellsRim of fibroblastsMultinucleated giant cellsNecrotic center
Case:TB? (caseous necrosis) Sarcoidosis? Cat-Scratch Disease?
Alveolar Cell CA LungAlveolar carcinoma
Atypical columnar epithelial cellsHobnailing of nucleiLining the alveoli projecting towards the lumen, intervening stroma is not infilterated by the tumor.
Case:Non-smoker, usually female, central mass
Small Cell CA LungSmall cell carcinoma of lung/ Oat cell CA
Undifferentiated neoplasm of primitive appearing cellsCells are flat shaped, with scant cytoplasmTheir size is approximately double to that of a lymphocyte.
Case:Paraneoplastic syndrome, ACTH, Growth hormone, ADH high related symptoms
Squamous Cell Ca LungSquamous cell carcinoma of lung
Well-differentiated squamous carcinoma of the lung, shows keratin pearl formation.Cells show atypia and loss of intercellular junctions.
Case:Smoker, male, central mass in chest, late mets to liver, bone, adrenals
GIT
Contents
• Pleomorphic Adenoma (Parotid)• Barret’s esophagus• Sq. Cell CA esophagus• Gastritis• H. Pylori (Chronic gastritis)• Stomach CA (diffuse)• Celiac Disease• Crohn’s Disease• Ulcerative Colitis• Adenomatous Polyp• Colorectal CA• Carcinoid Tumor• Acute appendicitis• Chronic cholecystitis• Cholestatis• Fatty liver• Chronic hepatitis• Cirrhosis• Hepatocellular CA
Pleomorphic adenomaPleomorphic adenoma
CartilageNeoplastic acinusConnective tissue & adipose cellsApparently encapsulated
Case:Patient with swelling over angle of jaw.
Barret’s EsophagusSquamous to columnar (intestinal) metaplasiaGoblet cellsChronic inflammatory cells.
Case:Long standing GERD
Squamous CA esophagusSquamous cell CA esophagus
Keratin pearlsStratified squamous epithelium
Case:Patient of achalasia, with weight loss, dysphagia to solids, cough and formation of tracheo-esopheal fistulae, hemoptysis
GastritisChronic gastritis
Plasma cells with lymphocytesAtrophy of epithelial lining
Case:Patient with retrosternal burning, NSAID use, hyperparathyroidism, steroid use
H. PyloriSpiral rod shaped organism seen in superficial cells of stomach mucosaIntestinal metaplasiaChronic inflammatory cells
Case:Patient not responding to PPI regimen, fecal antigen postive, urease breath test positive, feco-oral transmission
CA Stomach (Diffuse)Signet ring cells permeating mucosa of stomach wallLarge mucin lobes
Case:Long standing peptic ulcer disease, weight loss, anemia, supraclavicular lymphnode (virchow’s node), signs of obstruction, hematemesis, melena
Celiac DiseaseCeliac disease
Absence of microvilliIntraepithelial lymphocytesInflammatory infiltrateFlattening of villiVascular degeneration of epitheliumCrypt hyperplasia
Case:Child with chronic diarrhea, weight loss and intolerance to wheat, rye, barley products
Crohn’s DiseaseCrohn’s disease
Granulomatous inflammationTransmural damageLinear ulcers
Case:Male, melena, fistula formation, mouth ulcers, can involve any part of GIT, mostly ileum
Ulcerative ColitisUlcerative colitis
Mucosal ulcerationInflammatory cells
Crypt abscessesEpithelial metaplasiaDiffuse inflammatory process limited to mucosa and superficial submucosa.
Case:Acutely sick patient, melena, megacolon, joint pains, gallbladder problems, commonly involves colon, increased chances of malignancy
Adenomatous PolypAdenomatous polyp
Epithelial proliferative dysplasiaStalk covered by normal epitheliumNeoplastic epithelium forming branching glands
Case: Pt with melena, family history of colorectal problems, undergoing colonoscopy. May present with symptoms of hypokalemia and hypoalbuminemia.
Colorectal CAColorectal CA (adenocarcinoma of colon)
Signet ring cells invading bowel wallIntracellular mucinNeoplastic glands in muscularis
Case:Old man with anemia, obstruction, melena, altered bowel habits
Carcinoid TumorCarcinoid tumor
Solid nest of monotonous appearing cells with small uniform nucleiCells with pink cytoplasm and round-oval stippled nucleusInfrequent mitoses
Case:Flushing, diarrhea, bronchospasm, mucoid stool
Acute appendicitisAcute appendicitis
Star-shaped lumenSuperficial ulcerationNeutrophils and pus cellsCongested blood vesselsHypertrophied muscles
Case:Patient with tenderness in RIF.
Chronic cholecystitisChronic cholecystitis-
subserosal fibrosis, lymphoplasmacytic infiltrate
Case:Female, forties, fat, flatulence, bloating, fatty meal intolerance
CholestasisAccumulation of bile pigment in liver parenchymaDilated bile canaliculiFoamy appearance (feathery degeneration)Apoptotic bodies visible.
Case:Jaundice, pruritis, elevated ALP, bilirubin
Fatty LiverSmall droplets of fat in hepatocytes.Perivenular and perisinusoidal fibrosis present.
Case:Obese patient with long standing diabetes, metabolic syndrome, alcoholic, hyperlipidemia
Chronic HepatitisChronic hepatitis-
collagen fibers, fibrous tissue inflammatory cells in portal tractsSteatosisLiver architecture preserved
Case:K/C Hep B or C, alcoholic, taking hepatotoxic drugs
CirrhosisCirrhosis
Bridging fibrous septaNodulesTotal disruption of liver architecture
Case:Long standing liver disease, alcoholic, encephalopathy, asterixis, spider angioma, ascites
Hepatocellular CAHepatocellular CA
Dilated sinusoidal spaceMalignant hepatocytes
Case:Patient of chronic liver disease with signs of decompensation and worsening ascites, melena, hematesis, bloody ascites etc.
Bones, Soft Tissue & Skin
Contents
• Osteochondroma• Osteosarcoma• Sq. Cell CA Skin
OsteochondromaOsteochondroma
Hyaline cartilageFibrous perichondrium
Case:Patient with sudden onset of pain in knee due to nerve impingement
OsteosarcomaCoarse lace like pattern of neoplastic bone laid by malignant cells.Large hyperchromatic nuclei of neoplastic cells.
Case:Young boy with painful knee, lung mets, Xray findings of Codman’s triangle, sun burst appearance.
Sq. Cell CA SkinLobules of squamous cells with glassy cytoplasm undergoing keratinization. (keratin pearls)
Case:Man with everted ulcer on lip, face, arm (sun exposed area) or everted ulcer developing in long standing scars (burns etc)
CVS
AtherosclerosisLipid core Fibrous cap of atheromatous plaqueThickening of tunica media
Case:Patient of HTN, IHD with chest pain
HEM
Contents
• Iron deficiency Anemia• Thalessemia• Megaloblastic anemia• Burkitt’s Lymphoma• Hodgkin’s Lymphoma• NHL
Iron Deficiency AnemiaIron deficiency anemia
Microcytic, hypochromic RBCsTarget cells distort into pencil cells
Case:Pregnant female, child with worm infestation, woman with fibroids
ThalessemiaThalessemia
Basophilic stipplingNucleated RBCsMicrocytic, hypochromic RBCs
Case:Child- failure to thrive, multiple transfusion history, hepatosplenomegaly, chipmunk facies, skull showing hair on end appearance on xray, consanguineous marriage
Megaloblastic anemiaMegaloblastic anemia
Hypersegmented nuclei in neutrophilsImmature RBCs and WBCs
Case:Adult woman, with C/O peripheral neuropathy, fatigue, psychiatric disturbances, vegetarian or post-op gastrectomy
Burkitt’s Lymphoma•Intermediate sized lymphocytes with round to oval nucleus•Macrophages with clear cytoplasm (starry sky appearance)
Case:African child with mass/swelling in the jaw or retroperitoneum
Hodgkin’s LymphomaRS cells in a reactive inflammatory background consisting of lymphocytes, eosinophils and granulocytes.
Case:Patient with multiple swelling in neck and axillary region associated with malaisa, night sweats, low grade fever
NHL LymphomaLymphocytes
Case:Patient with malaise, low grade fever, lymphadenopathy, hepatosplenomegaly, in contiguous involvement of lymphnodes.