1
Quick Review of Pathology
Microscopic Slides
CVS:
Early thrombus (Coronary A.):
There is a pink red recent thrombus (showing lines of Zahn which are the alternating
pale pink bands of platelets with fibrin and red bands of RBC's) occluding a narrowed
atherosclerotic coronary artery with numerous identifiable cholesterol clefts.
Atheroma with organized thrombus (Coronary A.) : The wall is showing a built up of an
atheromatous plaque, There is a thrombus (RBCs, platelets &fibrin) occluding the lumen
& undergoing organization by granulation tissue, and there is recanalization.
Atheroma with calcification (Coronary A.):
Artery with narrow lumen due to build-up of atherosclerotic plaque (with presence of
cholesterol clefts). There is calcification in part of atheroma.
Old MI (Heart): There is an area of pale white collagen in the interstitium between
myocardial fibres.
Respiratory Tract:
Allergic nasal polyp: Nasal mass covered by ciliated columnar epithelium having
edematous stroma & eosinophils infiltration .
Pneumonia: alveoli are filled with inflammatory cells (mainly neutrophils) and exudate
with congestion of alveolar wall.
Bronchiectasis: abnormally dilated bronchi with ulceration of mucosa, and infiltration
by inflammatory cells.
Emphysema: enlarged air spaces of respiratory acini with destruction of their walls.
Oat (Basal) cell Carcinoma: small round blue neoplastic cells packed in sheets (features
of malignancy)
2
GIT:
Pleomorphic adenoma of salivary gland: chondroid stroma with proliferated ducts &
glands & scattered myoepithelial cells
Adenocarcinoma in the stomach or colon: Irregular glands formation lined by
neoplastic cells (features of malignancy) invading the stroma.
Adenomatous polyp (tubular adenoma): a nodule, of proliferating glandular structure
with some cystic spaces, is connected to the mucosa by a stalk.
Villous adenoma: Multiple frond like projections (villi) that are directly connected to
underlying mucosa (sessile) lined by neoplastic columnar epithelium.
Acute appendicitis: extensive neutrophilic infiltration through the whole layers
(transmural) with area of mucosal ulceration & exudate with blood vessels congestion.
Liver:
Fatty change in liver (cell injury): accumulation of lipid vacuoles in the cytoplasm of
hepatocytes with the displacement of the nuclei to the periphery
Cirrhosis: loss of architecture of the liver, regeneration nodules which are separated by
fibrous septa.
Liver secondary (metastatic adenocarcinoma): There are numerous irregular variable in
size gland formation lined by neoplastic cells (features of malignancy) infiltrating in the
liver.
Renal:
Chronic Pyelonephritis: there is chroinc interstitial inflammation with fibrosis,
glomerular sclerosis, and dilated tubules having colloid casts (thyroidization).
Renal (clear) cell carcinoma: the neoplastic cells (features of malignancy) have clear
cytoplasm and are arranged in nests with intervening blood vessels.
Transitional cell carcinoma of the urothelium: frond-like papillary projections of fibrous
core covered by transitional neoplastic cells (features of malignancy).
3
Haematology:
Reticulocytosis: brilliant cresyl blue stain showing blue dots inside reticulocytes which
are increased in number.
Hypochromic Microcytic anemia: Increased central pallor in (hypochromic) and small
(microcytic) as well as anisopoikilocytosis.
Macrocytic anemia: large oval in shape RBC, and hypersegmented neutrophils.
B-Thalassemia major: Hypochromic microcytic, target cells, normoblasts, &
anisopoikilocytosis.
Sickle Cell anemia: normochromic normocytic with sickle-like cells , (target cells &
normoblasts may be seen) and anisopoikilocytosis.
Spherocytosis: normochromic small spherical RBCs.
Acute leukaemia:
WBC are increased in number with blastemia (blast cells are large cells with large N/C
and one or more nucleoli, with open (red chromatin).
Reduced platelets
Chronic Lymphocytic Leukaemia: Increased WBC count with increased mature
lymphocytes (absolute lymphocytosis)
Chronic myeloid leukaemia:
Increased WBC count with granulocytes at different stages of maturation (myelocyte ,
metamyelocyte , stab (band) cells ) & basophilia.
BM:
Multiple Myeloma: BM infiltration by plasma cells (at different stages of maturation)
which are oval cells with eccentric nucleus & perinuclear halo.
Note:
In hypochromic microcytic anemia , B-thalassemia major , sickle cell anemia , and
spherocytosis: WBC are mature and regular in number , platelets are adequate.
In Leukaemias : RBCs are normochromic normocytic (platelets may be adequate or
inadequate)
4
Lymphoreticular system:
Granulomatous inflammation (T.B.) (Chronic inflammation): Granuloma formation
which consists of epithelioid macrophages, Langerhans giant cell (with their nuclei
arranged at the periphery of the giant cell), and surrounded by a rim of lymphocytes and
fibroblasts.
Reactive Hyperplasia: preserved architecture of LN, follicles of different size & shapes
with prominent germinal center & prominent mantle zone, there are engorged blood
vessels with sinus catarrh
Hodgkin Lymphoma: Loss of LN architecture with large cell (Reed-Sternberg cell) having
abundant eosinophilic cytoplasm, large binucleated vesicular nuclei, & prominent
eosinophilic large nucleoli (mirror-image or owl-eye appearance) present in a
polymorphic cells in background.
Non Hodgkin Lymphoma: loss of LN architecture, with monomorphic neoplastic
lymphoid cells proliferation (features of malignancy)
LN secondary (Metastatic adenocarcinoma): Multiple irregular malignant glands
(features of malignancy) partially replacing LN.
Breast:
Breast Adenoma: small closely packed glands formation lined by a single layer of benign
cuboidal epithelium. It is surrounded by myoepithelial cells with scanty stroma.
Fibrocystic disease of the breast: There is adenosis, fibrosis, and cystic dilatation +/-
apocrine changes
Fibroadenoma: it has two histological components, the epithelial component (complex
branching gland like structure) & a stromal component with loose cellular fibrous
stroma compressing the glands
Invasive ductal carcinoma: neoplastic cells (features of malignancy)
which line the
ducts, with stromal invasion by irregular glandular malignant cells, with the desmoplasia
(stromal fibrosis) which contribute to the stony hard consistency to the tumor.
Endocrine:
Non-toxic goiter: The follicles are irregularly enlarged, with flattened epithelium,
consistent with inactivity.
5
Ameer Saadallah
(2011-2017) Batch No.53
Note: Features of malignancy are pleomorphism, hyperchromatism, high nuclear/cytoplasmic ratio,
abnormal mitosis & loss of polarity.
Muhadharaty.com/pathology
Female Genital Tract:
Cystic Endometrial Hyperplasia: the amount of endometrium is abnormally increased,
glands are enlarged dilated and irregular and lined by columnar cells.
Hydatidiform mole: large swollen avascular villi with central cistern and areas of
trophoblastic proliferation.
Leiomyoma of uterus: interlacing bundles of proliferating benign looking spindle cells,
and formation of pseudocapsule.
Teratoma (dermoid cyst): this teratoma has adult type of cartilage and intestinal glands.
(adipose tissue , sebaceous glands , and thyroid tissue may be found)
Male Genital Tract:
Nodular prostatic hyperplasia (NPH): involve both glands and stroma, here there is a
large hyperplasic nodules of gland lined by 2 cell layer of hyperplastic epithelium.
Skin & Subcutaneous tissue:
Granulation tissue (chronic inflammation): There are inflammatory cells infiltration,
fibroblast, collagen, & new blood vessels formation.
Scar (chronic inflammation):
Scar tissue is predominantly composed of fibrous tissue
made of collagen and is thicker, denser, and paler than surrounding tissues with
absence of skin appendages.
Basal cell carcinoma (neoplasia): dermal nodule of proliferating basaloid cells with
hyperchromatic round to oval nuclei, with peripheral palisading feature
Squamous cell carcinoma (neoplasia): cell nest with keratin pearls, the cell nest
composed of malignant squamous cells (features of malignancy).
Squamous cell papilloma (neoplasia): Finger like projections, lined by several layers of
benign looking squamous cells, with central fibrovascular core.
Lipoma (neoplasia): There is proliferation of mature fat cells
Cavernous Haemangioma (neoplasia): proliferation of blood vessels lined by
endothelial cells containing RBCs.