VISHNUTEERTH JAMBAGI

SNMC,BAGALKOT

LIST OF CHARTS

Sl. no Charts
1. Cytology: Malignant cells in Pap smear.
2. Body fluids-Pleural/ Ascitic (exudate/transudate)
-
3. CSF analysis for Meningitis Viral
4. CSF analysis for Meningitis - Bacterial
5. CSF analysis for Meningitis - Tubercular
6. Viral hepatitis- Acute phase
7. Viral hepatitis- Chronic phase
8. Viral hepatitis- Convalescent and recovery phases
9. Thyroid function test
10. Renal Function test- Acute renal failure
11. Renal Function test- Chronic renal failure
12. Autoimmune Hemolytic anaemia
13. Sickle cell anaemia
14. Thalassemia
15. Hereditary Spherocytosis
16. Hematolymphoid malignancies- AML
17. Hematolymphoid malignancies- ALL
18. Hematolymphoid malignancies- Multiple Myeloma
19. Lab diagnosis of Myocardial infarction.

Dave
 Pathology practical charts

A 10 Years Female presented with history of

high fever 2 days.
2
unconsciousness- days.
O/E- Neck rigidity +
Fever +

CSFfindings
Physical examination
-
Appearance Clear
-
Colour Colourless
- Pressure - 165 mm of water

Chemical examination
Sugar 40 mg%
- 100
Proteins mg%
Chlorides - 750mg %

Mieroscopy
Total leukocyte count - 80 cells / cumm
- -
Differential count 85% lymphocytes
-
15% monocytes

1. What is your diagnosis?

2. Mention the causative organism.
182 SECTION FIVE: Clinical Pathology

TABLE 45.1: CSF findings in health and various types of meningitis.

Feature Normal Acute pyogenic Acute lymphocytic Chronic
(bacterial meningitis) (viral meningitis) (tuberculosis meningitis)
1. Naked eye Clear and Cloudy or frankly Clear or slightly Clear of slightly turbid, forms
appearance colourless purulent turbid fibrin coagulum on standing
2. CSF pressure 60-150 mm Elevated (above Elevated (above Elevated (above 300 mm
water 180 mm water) 250 mm water) water)
3. Cells 0-4 lympho 1,000-100,000 10-100 100-1,000
cytes/ml neutrophils/ml mononuclears/ml mononuclears/ml
4. Proteins 15-45 mg/dl Raised Raised Raised
5. Glucose 50-80 mg/dl Reduced Normal Reduced
(usually less than 40 mg/dl) (usually less than 45 mg/dl)
6. Bacteriology Sterile Causative organisms Sterile Tubercle bacilli present
present

-
CSF analysis for Meningitis Viral
 S. NIJALINGAPPA MEDICAL COLLEGE, BAGALKOT-587 102
DEPT. OF PATHOLOGY

68 Yr/ M presented with backache and fatigue.

O/E pallor, sternal tenderness present. Radiograph
of
skull and bone marrow aspiration smear for interpretation.

Hematolymphoid malignancies- Multiple Myeloma

Bence Jones proleins ehcid in Uin

Monouytosis
Plasma cels in cSF
 A 45 year malepresented wvith
sudden onset of
retrosternal chest pain, nausea, vomiting and
sweating
On exanmination
-
Tachycardia
- Coolness
- B.P.
of extremities
90/60 mm of Hg

1) What is your diagnosis?

2) Write points in favour of your diagnosis?

Lab diagnosis of Myocardial infarction.

 S. NIJALINGAPPA MEDICAL COLLEGE, BAGALKOT-587 102
DEPT. OF PATHOLOGY

5 yr / M presented with mouth ulcers and aching join ts since 15

Lab inv- TC 1.33 lac / mm days.
-
Platelet count 24,000 / mm
PSfor interpretation.

Hematolymphoid malignancies- ALL

Pldelet J
Pedia C2-5)
gene Muh

Hyper dipb idy ch 50)

 SNIJALINGAPPA MEDICAL COLLEGE, BAGALKOT-587 102
DEPT. OF PATHOLOGY

33 Yr / M with nose bleeds. O/E patient

had purpura
and petechiae. PS for interpretation.

Hematolymphoid malignancies- AML

ypertosnopklia
bleeding
Platelet Pr
ap
Netbophw
 S. NIJALINGAPPA MEDICAL COLLEGE, BAGALKOT-587 102
DEPT. OF PATHOLOGY

D
Retealcyt
MCHCt
t
sahensyk

8 Yr/ M With pallor jaundice and splenomegaly. PS for interpretation.

heiluubin

Hereditary Spherocytosis
 S. NIJALINGAPPA MEDICAL COLLEGE, BAGALKOT 587102
DEPT. OF PATHOLOGY

Joly bodts
>Tarsget
Sskle cally

Coc
8 m/M baby with severe pallor and jaundice. PS for interpretation.

Sickle cell anaemia

pede
 CLINICAL PATHOLOGY CASE- 27

5 year Male

Present History: Yellowish discoloration of sclera.

Pain abdomen, generalised weakness and

Dyspnea on exertion-1 month.

Examination: Frontal bossing,crowding of teeths +.

Severe Pallor +, lcterus +
P/A: Splenomegaly ++

Investigations: Hb- 4 gm%, Sr Bilirubin- 4 mg%,

Direct bilirubin- 0.2 mg%

Indirect bilirubin- 3.8 mg%.

Urine urobilingen level
PS study-polychromatophilic cells, nRBC,
+ with
target cells] schistocytes
thrombocytosis.

QUESTIONS

1) What is your diagnosis and how willyou confirm it?

2) What are the causes of splenomegaly?

Autoimmune Hemolytic anaemia

 Chart
A 35 year old female patient complains of neck
swelling since 6 months. Patient gives history of
veight gain, cold intolerance and irregular
menstruation cycles in last 6months.

O/E
Diffuse swelling measuring 4X 3 cm, firm in
consistency moves with diglutition

Thyroid function tests

T3 – 60 ng/dl
T4-3.0 microgram/dl
TSH- 14.0 mIU/L

Questions
T4b(ss-1:)
1) Interpret Thyroid function
2) What is diagnosis?

Thyroid function tests

radioactive iodine uptake
(RAIU) 24-hr 5-30%
thyroxine (T) total Serum 5.4-11.7 ug/dl 70-151 nmol/L
triodothyronine (T,) total Serum 77-135 ng/d 1.2-2.1 nmol/L
thyroid stimulating hormone (TSH) Serum 0.4-5.0 U/ml 0.4-5.0 mU/L
Trononins cardiac (cTn)

Thyroid function test

 CLINICAL PATHOLOGY CASE-36

25 year Male
Present History: Yellowish discoloration in sclera -& days.
Upper abdominal pain more on right side

5 days.
Recurrent vomiting -1day
+
Examination :Severe Pallor
Icterus +
P/A: Tender hepatomegaly ++

Investigations :Hb-8 gm%

Serum Bilirubin- 4 mg%,
SGOT(AST)-100 IU/dl
SGPT(ALT)-120 1U/al

Vnal hepaths E
Bodey
D Counilman
Ballaning degrtn
QUESTIONS

What is your diagnosis ?

2) What are the causes of hepatomegalyR

Viralhepatitis- Acute phase

 üboraular Neningiis

A 12 Years male presented with history of high fever

and unconsciousness- 2 days
O/E- Neck rigidity +
Fever +

CSF findings
Physical examination
Appearance Slightly opalescent
-
Colour Straw colour
Pressure 160 mm of water
-Cobwebk Present

Chemical examination
Sugar 30 mg%
- 250 mg%
Proteins
-
Chlorides 500mg %

Microscopy
-
Total leucocyte count -350 cells/ cumm
- - 90%
Differential count lymphocytes
-
10% polymorphonuclear
cells

1. What is your diagnosis?

2. Mention the causative organism.

182 SECTION FIVE: Clinical Pathology

TABLE 45.1: CSF findings in health and various types of

meningitis.

Feature Normal Acute pyogenic Acute lymphocytic Chronic

(bacterial meningitis) (viral meningitis) (tuberculosis meningitis)
1. Naked eye Clear and Cloudy or frankly Clear or slightly Clear of slightly turbid, forms
appearance colourless purulent turbid fibrin coagulum on standing
2. CSF pressure 60-150 mm Elevated (above Elevated (above Elevated (above 300 mm
water 180 mm water) 250 mm water) water)
3. Cells 0-4 lympho 1.000-100,000 10-100 100-1,000
cytes/ml neutophils/mi mononuclears/ml mononuclears/ml
4. Proteins 15-45 mg/dl Raised Raised Raised
5. Glucose 50-80 mg/dl Reduced Normal Reduced
(usually less than 40 mg/dl) (usually less than 45 mg/dl)
6. Bacteriology Sterile Causative organisms Sterile Tubercle bacilli present
present
 A 15 Years male presented with histogaaftfnhigh Or
fever, vometting, headache and unconsciousness ac

2 days. History of ear discharge for which he has me

not taken any treatment (er

S. pneunoniae
O/E- Neck rigidity +
B-Streptococcus gr A
Fever +
a-Streptococcus not gr D
Ear discharge + Enterococcus
Other Streptococcus
CSF findings S. aureus.
Physical examination Coagulase-negative.
- Appearance - Turbid StaphylococcuS
- -
Grey white
K.
pneumoniae
Colour
- Pressure - 170 mm water aeruginosa.
of
Acinetobacter spp
CSalmonella
Chemical examination H. influenzae
-
Sugar
-
10mg% Other gram-negative bacilli
Proteins 600mg% Other gram-positive
Chlorides - 750mg % Mixed bacterial spp
Culture negative
Microscopy
- Total leukocyte count 2500 cells /cumm
- Differential count - 90% polymorpho
nuclear cells
- 10% Iymphocytes

1. What isyour diagnosis?

2. Enumerate the causative organisms.

CSF analysis for Meningitis - Bacterial

 LIST OF INSTRUMENTs
SI .no Instruments
1. Lumbar Puncture Needle
2. Liver Biopsy Needle
3 Bone marrow Aspiration Needle
4. Wintrobe's Tube
5 Westergren's ESR Tube
6. Urinometer
7 R.B.C Pipette
8
W.B.C Pipette
9 Sahli's Haemoglobinometer
10. Neubauer's Counting Chamber
11. Hb Pipette
12. EDTA Tube
13. Sodium Citrate Tube
14. Plain vaccutainer
15. Heparin tube
16. Blood collection bag
 nstruments

• Blood collection bag:

o Designed for çollection, processipg
and storage of whole blood and
blood components.
TERLMC PENPO
O
Acts as closed system to reduce the
BLOODBAG CPDA 35Om

chance of contamination.

te
P9-SCO3SAY 08-02-2020 07-02-2022 151.00

1TPORB3229 (000)08B20Y4

Blood collection Bag

 • Sodium Çitate Tube:
o4 mlvacutainer with(blue cap
6Used for coagulation studies.

Sodium Citrate Tube

Used for RBC, WBC, Eosinophil
And platelet count

•Neubauer's
counting chamber:
o
Contains two ruled areas
consisting
of 9 large squares, each square
measuring 1X1 mm
oDepth is 0.1 mm.

Depth 0 tmm
,0025mm
Neubauer
Improved

many
Feinoptik
Bad Blankerba

for laahing
Blood Cels

Neubauer's counting chamber

• Hb pipette:
o Straight tube with any bulb or
beads.
o Has
marking of 0.02 ml.

HB Pipette
 • WBC pipette:
oThe bulb has a white coloured bead
and white mouth piece.
olt has markings upto 11.
o The lumen diameter in the stem is
more than RBC pipette.
Pipete
lonen dia >RCB
slem

WBCPipette

Pipette with small bulb and white bead in it

Used for total WBC count
 • Sahil's
hemoglobinometer:
oUsed formanual estimation of Hb)
o
Consists ofgraduated goded
hemoglobulin tube and a
Comparator

Sahli's Haemoglobinometer

Used for haemoglobin estimation

 • RBC pipette:
o Markings upto 01
dBeach andmouth piece is redin
colour.

RBC Pipette

Pipette with a bulb and red bead in it

Used for total RBC count
 • Urinometer:

oHasmercury weight with readings)

oUrinometer kept in ameasuring
is

CViindeof 50 ml capacity

Urinometer

Used for urine specific gravity

Glass cylinder with bulb containing mercury a
 • Bone marrow aspiration needle:
o
Known asalah bone marrow
needle.
o
Parts:Cannula trocar and
adjustabte sicde guarda

Cannula

Adj side Crard

Bone marrow Aspiration Needle

Used for bone marrow aspiration

 • Lumbar puncture needle:
o
Consist of
spinal needle and stylet
oHypodermic needle used to assess
Subarachnoid space and collect
CSF.

Sub-Arochnoid
space

Lumbar Puncture Needle

Used to aspirate CSF

 Liler
5Vim Siherman Bx
• Liver biopsy needle:
o
Known asim silvernman biopsy
needle._
o Has a

abifid needlewith
and canula

Liver Biopsy Needle

 Wintrobe's tube:
o 110mm long tube, closed at one
end.
o Calibrated 0-10 cm onone side and
10-0 cm onother side with internal
bore diameter of 2.5 mm.

The tube holds approximately 1

ml.of blood. The uses
are 1.
Determination of Packed cell yolume (PCV) 2.
Determination of Erythrocyte sedimentation rate (ESR)

Wintrobe's Tube

Used to estimate ESR and PCV

 • Westergren's ESR tube:
o Straight pipette 30 cm long, open
on both ends.
o Calibrated 0-200 mm from top to
bottom with internal bore diameter
of 2.5 mm.

Westergren's Pipette

Used to estimate ESR

• Plain vacutainer:
o4 vacutainer with|red cap.
ml

oUsed for routine biochemical studies.

Yash
4 ml

ot Activa

Plain Vaccutainer
 Heparin tube:
o4 ml vacutainer with green cap.
oUsed for osmoticfragility test and
blood gas analysis.

eD Va

PS USP U

LOmL

Heparin Tube
 LIST OF SLIDES
SL. NO. Slides
1. Fatty liver
2. Monckeberg medial calcific sclerosis
3. Hyaline degeneration (leiomyoma)
4. Coagulative necrosis
5
Caseous necrosis
6
Acute appendicitis
7. Lobar pneumonia
8. Granulation tissue
9
TB lymph node
10. Actinomycosis
11. Rhinosporidiosis
12. CVClung
13. Lipoma
14. Hemangioma
15. Schwannoma
16. Squamous cell carcinoma
17. Basal cell carcinoma
18. Adenocarcinoma-colon
19. Hodgkin's lymphoma
20. Pleomorphic adenoma
21. Cirhosis of Liver
22 Chronic cholecystitis
23 Atherosclerosis
24 Myocardial Infarction

25 Chronic pyelonephritis
26 Renal cellcarcinoma
27 Seminoma
28 Benign prostatic hyperplasia
29 Leiomyoma
30 Hydatidiform mole
31 Serous cystadenoma/ Mucinous cystadenoma
32 Fibroadenoma
33 Osteoclastoma
34 Multinodular goitre
35 Hashimoto's thyroiditis
36 Papillary carcinoma thyroid
Hematology
1. Normocytic normochromic blood picture
2. Eosinophilia
3. Microcytic hypochromic anaemia
4. Dimorphic anaemia
5. Chronic lymphoid leukemia
6. Chronic myeloid leukemia
Vishnuteerth Jambagi

Slide discussion points

28. BENIGN PROSTATIC HYPERPLASIA

Glandular hyperplasia exaggerated intra-acinar

:
a)
cores.
papillary infolding with delicate fibrovascular

b) Glands are lined by two layers of epithelium.

Fibromuscular hyperplasia aggregates of spindle cells

:

c)
uterus.
giving an appearance similar to fibromyoma of the
25. CHRONIC PYELONEPHRITIS

a) The interstitium shows chronic inflammatory infiltrate and

interstitial fibrosis.

b) The tubules :atrophy, dilatation, colloid casts producing

thyroidisation of tubules.

c) The wall of dilated pelvicalyceal system shows marked

chronic inflammation and scarring.

some glomeruli
d) periglomerular fibrosis and hyalinisation of
21. CIRRHOSIS OF LIVER

a) Lobular architecture of hepatic parenchyma is

lost and
central veins are hard to find.

b) Fibrous septa divide the hepatic parenchyma into

nodules.
20. PLEOMORPHIC ADENOMA

Epithelial component ducts, acini, tubules, sheets and

:
a)
strands of monomorphic cells of ductal or myoepithelial
or
origin. These ductal cells are cuboidal columnar while
myoepithelial cells are polygonal or spindle-shaped.

b) Mesenchymal component myxoid, mucoid

:

chondroid matrix which simulates cartilage

(pseudocartilage).
18. ADENOCARCINOMA-COLON

a) infiltrating glandular pattern in the colonic wall with

varying grades of differentiation of tumour cells.

b) About 10% cases show mucin-secreting colloid

carcinoma with pools of mucin
17. BASAL CELL CARCINOMA

a) patterns- solid masses, nests, islands, strands,

keratotic masses, adenoid, etc.

b) the cells forming the periphery of tumour have parallel

alignment or show palisading (basaloid cells).

c) The tumour cells are basophilic with hyperchromatic

nuclei

d) Stroma: clefts from tumor cell nests

15. SCHWANNOMA

a) fibrocellular bundles forming whorled pattern.

b) areas of dense and compact cellularity (Antoni A

pattern) alternating with loose acellular areas (Antoni B
pattern).

c) Areas of Antoni A show palisaded nuclei called

Verocay bodies.

d) Areas of degeneration containing haemosiderin and

lipidladen macrophages are often present.
14. HEAMANGIOMA

a) CAPILLARY HAEMANGIOMA
capillary-sized, thin-walled, blood-filled vessels.

The vessels are lined by single layer of plump

endothelial cells surrounded by a layer of pericytes.

Some stromal connective tissue separates lobules

of

blood vessels.
13. LIPOMA

a) A thin fibrous capsule surrounds the periphery

b) lobules of mature adipose cells separated by thin

fibrovascular septa
11. RHINOSPORIDIOSIS

a) subepithelial loose oedematous connective tissue

containing mucous glands and inflammatory cells like
lymphocytes, plasma cells and eosinophils.

respiratory epithelium may show squamous

,
b)
metaplasia.

c) Large number of organisms of the size of erythrocytes

with chitinous wall are seen in the thick-walled sporangia.
on the surface of
Spores are also seen in the submucosa and
the mucosa.
9. TB LYMPH NODE

a) necrotic foci :structureless, eosinophilic and granular

debris which may contain foci of dystrophic calcification.
:
b) granulomatous inflammatory reaction slipper-shaped
,
epithelioid cells giant cells of Langhans' type and
peripheral mantle oflymphocytes.
) GREY HEPATISATIONSTAGE
The fibrin strands in the air spaces are dense

The lumina of alveoli contain disintegrated neutrophils

and many macrophages

A
clear space separates septal walls from the cellular
exudate
7. LOBAR PNEUMONA

a) ACUTE CONGESTION STAGE

There is dilatation and congestion of capillaries in the
alveolar walls

The air spaces contain pale eosinophilic oedema fluid

red cells and neutrophils are seen in the intraalveolar

fluid
5. CASEOUS NECROSIS

a) The necrotic foci : structureless,

granular debris & foci eosinophilicand
of dystrophic calcification
b) granulomatous inflammatory
reaction :slipper-shaped
epithelioid cells , giant cells
of Langhans' type and
peripheral mantle oflymphocytes
3. HYALINE DEGENERATION (LEIOMYOMA)

a) Smooth muscle fibres admixed with fibrous tissue are

arranged in a whorled pattern at many places.

b) Areas of hyaline change appear as pink, homogeneous

and acellular lying in the centre of the whorls or between
them.
2. MONCKEBERG MEDIAL CALCIFIC SCLEROSIS

a) Smooth muscle of media is replaced by acellular

hyalinised fibrous tissue

b) Fociof dystrophic calcification in media as basophilic

coarse granules
36. PAPILLARY CARCINOMA

a) Papillary pattern: Papillae composed of fibrovascular stalk

and covered by single layer of tumour cells

b) Tumour cells: ground-glass appearance or optically

clear
appearnace and clear or oxyphil cytoplasm.

c) Invasion: The tumour cells invade the capsule, and

intrathyroid lymphatics.

d) Psammoma bodies: Almost half of papillary carcinomas

show typical, small concentric calcified spherules in the stroma
35. HASHIMOTO'S THYROIDITIS

a) Extensive infiltration : lymphocytes, plasma cells,

immunoblasts and macrophages with formation of lymphoid
follicles having germinal centres

b) Decreased number of thyroid follicles, atrophic follicles

which are often devoid of colloid.

c) Hurthle's cells (oxyphil cells or oncocytes).

d) Variable amount of fibrous replacement of thyroid

parenchyma.
34. MULTINODULAR GOITRE

a) Partial or incomplete encapsulation

b) The follicles of varying size from small to large and lined by

flat to high epithelium

c) Areas of haemorrhages, haemosiderin-laden macrophages

and cholesterol crystals.

d) Fibrous scarring and calcification in the nodules. Cystic

degeneration.
33. OSTEOCLASTOMA
,
a) osteoclast-like giant cells regularly scattered
throughout the stroma.

b) Giant cells contain as many as 100 benign nuclei and

are similar to normal osteoclasts

c) Stromal cells are mononuclear cells and are the real

tumour cells.
32. FIBROADENOMA

a) Intracanalicular pattern :compressed ducts

,slit-like
clefts

b) lined by ductal epithelium and may appear as cords

of
epithelial elements surrounding masses of fibrous tissue.

c) Pericanalicular pattern is characterised by encircling

masses of fibrous tissue around the patent or dilated ducts.
**MUCINOUS CYSTADENOMA OVARY

c) The cyst is lined by a single layer of cells having basal

nuclei and apical mucinous vacuoles, resembling intestinal
mucosa.

d) There is no invasion or papillae formation.

31.SEROUS CYSTADENOMA OVARY

a) The cyst is lined by properly-oriented low columnar

epithelium

b) The lining cells may be ciliated and resemble tubal

epithelium
30. HYDATIDIFORM MOLE

a) Large, round oedematous chorionic villi

b) Hydropic degeneration and decreased vascularity of

villous stroma.

c) Trophoblastic proliferation as masses and sheets of both

cytotrophoblast and syncytiotrophoblast seen
circumferentially around the villi.
1. FATTY LIVER

a) Fat in cytoplasm of hepatocytes (micro/macro

vesicular). Nucleus is pushed to
periphery

b) In mild steatosis fat involves entire

centrilobular
hepatocytes

c) fatty cysts/ lipogranulomas may be seen

29. LEIOMYOMA

a) Smooth muscle cells in interlacing fascicles

b) Well circumscribed lesion

4. COAGULATIVE NECROSIS

a) Hallmark :architectural outlines may be

preserved
though all cellular details are lost

b) inflammatory reaction,initially by polymorphonuclear

cells but later macrophages, lymphocytes and fibrous tissue
predominate
6.
ACUTE APPENDICITS

a) neutrophilic infiltration of the muscularis propria.

b) Mucosa is sloughed and blood vessels in the wall are

thrombosed.

c) Periappendiceal inflammation is seen in more severe

cases.
b) RED HEPATISATION ST4GE
Air spaces contain strands of fibrin

There is marked cellular exudate of neutrophils and

extravasation of red cells

Neutrophils may show ingested bacteria

8.GRANULATION TISSUE
a) proliferating fibroblasts, neovascularization and mixed
inflammatory cell infiltrates.

b) Granulation tissue matures from below upwards and late

stage shows dense collagen, scanty vascularity and fewer
inflammatory cells
10. ACTINOMYCOSIS

a) granuloma with central suppuration.

b) chronic inflammatory cells, giant cells and fibroblasts.

c) The bacterial colony, sulphur granule, characterised by

basophilic radiating filaments with hyaline, eosinophilic,
club-like ends is seen in the centre of suppuration.
12. CVCLUNG

.
a) Vessels alveolar septa are dilated and congested.

b) minute intra-alveolar haemorrhages.

c) alveolar macrophages filled with yellow-brown

haemosiderin pigment, so called heart failure cells in the
alveoli
b) CAVERNOUS HAEMANGIOMA LIVER
thin-walled cavernous vascular spaces, filled partly or
completely with blood.

The vascular spaces are lined by flattened endothelial

cells.

The intervening stroma consists of scanty connective

tissue

Large spaces
containing blood

-Spaces lined by single

layer of endothelium

Hepatic parenchyma

ILOVE
PATHOLOGY

@VijayPatho
 16. SQUAMOUS CELL CARCINOMA

a) tumour cells invade through the basement membrane

into subepithelium or dermis.

b) Keratin pearls

c) The masses of tumour cells are separated by

Iymphocytes

Cavernous spaces Flattened endothelium Normal Iiver

tissue
208 SECTION SIX: Haematology

Leishman's, X1000 oil Leishman's, X1000 oil

FIGURE51.7 Eosinophila in PBF.
FIGURE 51.6 Monocytes in PBF.

TABLE 51.6: Causes of eosinophilia and eosinopenia.

Eosinophilia Eosinopenia TABLE 51.7: Basophilia.
1. Allergic disorders Steroid administration i. Chronic myeloid leukemia
i. Bronchial asthma
i. Polycythaemia vera
ii. Urticaria
i. Myxoedema
ii. Hay fever iv. Ulcerative colitis
iv. Drug hypersensitivity V. Hodgkin's disease
vi Urticaria pigmentosa
2. Parasitic infestations
i. Roundworm

i. Hookworm
ii. Tapeworm
iv. Echinococcosis
3. Skin diseases
i. Pemphigus
i. Dermatitis herpetiformis
ii. Erythema multiforme
4. Pulmonary diseases
i. Löeffler's syndrome
ii. Tropical eosinophilia

5. Haematopoietic diseases
i. Chronic myeloid leukaemia
ii. Polycythaemia vera
ii. Hodgkin's disease
iv. Pernicious anaemia

6 Miscellaneous conditions
i. Rheumatoid arthritis

i. Polyarteritis nodosa Leishman's, X1000 Oil

ii. Sarcoidosis PBF.
FIGURE 51.8 Basophil in
iv. Irradiation
22. CHRONIC CHOLECYSTITIS

a) RokitanskyAschoff sinuses

b) Variable degree of chronic inflammatory cells

(lymphocytes, plasma cells and macrophages) in the lamina
propria and subserosal layer.

c) Variable degree of fibrosis and thickening of

perimuscular layer.
23. ATHEROSCLEROSIS

a) fibrous cap,macrophages, foam cells and lymphocytes.

material.,
b) central soft core consists of extracellular lipid
cholesterol clefts, necrotic debris and lipidladen foam cells

necrotic
c) Calcium salts are deposited in the vicinity of
area and in the lipid pool deep in the thickened intima
24. MYOCARDIAL INFARCTION

a) dense fibrocollagenous tissue with foci of entrapped

groups of myocardial fibres

b) healed infarct : shows old granulation tissue seen by

infiltrate of some pigmented macrophages, Iymphocytes
and plasma cells and a few capillary sized blood vessels.
26. RENAL CELL CARCINOMA

a) patterns : solid, acinar, tubular, trabecular, cord and

papillary arrangements in a delicate fibrous stroma

b) Tumour cells Clear cells are large cells with well

: :

defined borders, abundant clear cytoplasm and regular

pyknotic nuclei.

c) Granular cells have similar features but have moderate

amount of pink granular cytoplasm.
 27. SEMINOMA

a) Tumour cells. cords, sheets or columns forming

lobules. The tumor cells are typically uniform in size with
clear cytoplasm and well-defined cellborders.

b) Stroma. The stroma is delicate fibrous tissue and

characteristic lymphocytic infiltration

Hematology
1. Normocyticnormochromic blood picture
2. Eosinophilia
3. Microcytic hypochromic anaemia
4. Dimorphic anaemia
5. Chronic lymphoid leukemia
6. Chronic myeloid leukemia
 Haematology slide discussion points

•Chronic myeloid
leukaemia:
o Marked leucocytosis,
with
moderate normocytic
normochromic anaemia.
o Platelets are mostly raised but can
be normal.
Metamyelocytes Myelocytes Eosinophil Basophil

Leishman, X1000 Oil

FIGURE 58.3 PBF findings in leucocyte count consisting

chronic myeloid leukaemia.There is rise in of
immature myeloid precursor
cells of various stages. It also shown prominent presence of eosinophils and basophils.
•Spherocytosis:
o
Characteristicmicrospherocytes
are seen.
O
Anemia with increase in
polychromatophils.
Haemolytic disease of new-born:
O Anemia seen of macrocytic

normochromictype.
o Nucleated RBC's and
polychromatophils are increased.
O Aniospoikilocytosis including few

spherocytes.
 • MicrocyticHypochromic Anaemia:
oRBC cells are smaller than
lymphocytes.
RBC's cells are different in size and
o

shape - Anisopoikilocytosis.

Microcytosis Lymphocytes Hypochromasia

8
Leishman, x1000 Oil
 Haematology:

• Normocytic Normochromic blood

picture:
o RBC cells normocytic
normochromic.
o Normal distribution of WBC.
o Normal number of platelets.
• Eosinophilia:
o
Increased in number of eosinophils.
oOndifferential count-eosinophils
>6%.
• Dimorphic Anaemia:
o RBC cells are both smaller and
larger in size.
o Severe anisopoikilocytosis.
• Sickle cell anaemia:
o Prominent sickle cells.
oOther cells like target cells and
are
presence of Howell jolly bodies
noted.
 • Acute lymphoid leukaemia:
WBC count- can
o
be decreased/
normal or increased with
lymphoblasts > 20%.
o Anemia and thrombocytopenia
almost always seen.
Lymphoblasts Prolymphocytes

Leishman, X1000 Oil

FIGURE 58.2 PBF findings in ALL showing agranular cytoplasm of lymphoblasts and reduced platelets.
 •Acute myeloid
leukaemia:
oLeucocytosis with increase in
myeloblasts >20%.
o Severe normocytic normochromic
anaemia and thrombocytopenia.

240 SECTION SIX: Haematology

Myelocyte Auer's rod Myeloblasts

Leishman, X1000 Oil

FIGURE 58.1 PBF findings in AML showing numerous myeloblasts, accompanyingmyeloid precursor cells and reduced platelets.
 • Chronic lymphoid
leukaemia:
o Marked leucocytotosis
with 90%
are mature small lymphocytes.
o Smudge cells or basket cells
(degenerated forms are seen).

Small lymphocytes Platelets Smudge cell

Leishman, X1000 Oil

FIGURE 58.4 chronic lymphocytic leukaemia. The white cell count is increased with predominance of small lymphocytes
PBF in
and a few degenerated forms which appear as bare smudged nuclei.
 LIST OFSPECIMENS
SI. No. Gross specimens
1. Fatty liver
2.
Gangrene
3. Infarct spleen
4. TB lymph node
5. Acute appendicitis
6. Lobar pneumonia
7. Madura foot
8. CVC liver
9. Lipoma
10. Squamous cell carcinoma
11. Adenocarcinoma colon
12. Enlarged spleen
13. Pepticulcer
14. Gastric carcinomna
15. Cirrhosis
16. Gall bladder with gall stones
17. Bronchiectasis
18. Emphysema
19. Carcinoma lung

20. Atherosclerosis
21. Myocardial infarction
22. Renal cell carcinoma
23. Chronic pyelonephritis
24. Renal stones with hydronephrosis
25. Carcinoma Penis
26. Seminoma testis
27. Leiomyoma
28. Teratoma
29. Serous/ Mucinous cystadenoma
30. Carcinoma Cervix
31. Fibroadenoma
32. Multinodular goitre
33. Papillary carcinoma thyroid
34. Osteoclastoma
35. Osteosarcoma
 Vishnuteerth Jambagi. SNMO
Gross Specimen discUSSion points

Seminoma testis
• Involved testis is
enlarged.
• Cutsection- Well demarcated
,homogenous,greywhite. Lobulations
present.
 Teratoma
• Cyst may contain
hat /eeth/atag
e/baoe/
material.
•Raised protuberance in cyst wall -
Rokitansky protuberancp

ROKITANSKY NODULE
•A raised protuberance projecting into the cyst cavity.
•Most of the hair typically arises from this protuberance.
When bone or teeth are present, they tend to be located within
this nodule
 Leiomyoma
• Wellcircumscribed ,grey
white
• Whorled appearance

IntramUrat

Sbsersal

omuasal

Leiomyomas uterus. A, Diagrammatic appearance of conmon

locations and characteristic whorled appearance bn
Cut section. B, Sectioned surface of the uterus shows multiple
circumscribed, firm nodular masses of variable sizes-submucosa
(white arrows) and intramural (black arrows) in location having
characteristic whorling. C, The opened up uterine cavity shows an
intrauterine gestation sac with placenta (white arrow) and a single
circumscribed, enlarged, firm nodular mass in intramural location
(black arrow) having grey-white whorled pattern.
CVCliver:
• Liver enlarged,firm.
• Cutsurface-Nutmeg appearance.e
alternating dark areas of congestion and
pale areas of fatty change.
Fibroadenoma
• Wellencapsulated, globular mass.
• Cutsection- Grey white, slit like spaces
noted.

Cm

SANIE-sINE 2 3
Bronchiectasis:
• Pleura is fibrotic and thickened
• Cutsection- honeycomb appearance
Renal cell carcinoma
• Commonly arise from a pole

• Bosselated, Wellcircumscribed mass

• Cutsection- hemorrhage, necrosis

,calcification and cystic changes.

FIGURE 30.2 Renal cell carcinoma. The upper pole of the

kidney shows a large and tan mass while rest of the kidney has
reniform contour. Sectioned surface shows irregular,
circumscribed, yellowish mass with areas of haemorrhages and
necrosis.The residual kidney shows compressed calyces and renal
pelvis.
3)Infarct spleen:
• Infarcts of spleen are pale ,multiple with
congested margin.

• Infarcts are of Wedge shape with base

lying on splenic capsule.
 4)T.B Lymphnode
• Matted lymphnodes.

• Lymph nodes are grayish white and have

cheesy caseous necrotic foci.

FIGURE 9.4 Caseous necrosis in tuberculous lymphadenitis.

Multiple lymph nodes are matted together and surrounded by
fat. Sectioned surface shows merging capsules of adjacent nodes
and large areas of yellowish caseation necrosis (arrow).
 Liver cirrhosis
•External surface
Micronodules(>3mm)/Macronodules(<3
mm).

• Cut surface- Gray brown nodules

separated by grey white fibrous septa.
Cirrhosis of the liver is one of the leading causes of death and
occurs following hepatocellular necrosis of varying etiology.
Hepatocellular carcinoma is the most common primary
malignant tumour of the liver, most often following cirrhosis
of varying etiology andexposure to chemical carcinogens.
Most common forms of gallbladder diseases are chronic
cholecystitis, gallstones, and gallbladder carcinoma.

Cirrhosis Liver
Cirrhosis of the liver is a diffuse disease having disorganised
lobular architecture and formation of nodules which are
separated from one another by irregular bands of fibrosis.
G/A Cirrhosis is morphologically categorised by the size of
nodules-micronodular, if the nodules are less than 3 mm
(Fig. 28.1), macronodular if the nodules are bigger than 3 mm
(Fig. 28.2), and mixed if both small and large nodules are seen.
Etiologically, common forms are postnecrotic, alcoholic, biliary
and others. On sectioned surface, the grey-brown nodules are FIGURE 28.1 Alcoholic cirrhosis, showing the typ
separated from one another by grey-white fibrous septa. micronodular pattern. The nodules are smaller than 3
M/EThe etiologic diagnosis of cirrhosis in routine microscopy diameter on the sectioned surface.
may not be possible. The salient features of cirrhosis are as
under:
i. Lobular architecture of hepatic parenchyma is lost and ii. Fibrous septa divide the hepatic parenchyma i

central veins are hard to find. nodules.

(106)
 Adenocarcinoma colon
• Tumor in Ascending colon- Fungating,

large,soft ,friable mass projecting into

lumen.

• Tumor Descending colon-Napkin ring

in
constriction, colonwall shows
circumferential thickening.

EXERCISE 26: Diseases of Appendix and Large Intestine 101

A, RIGHT-SIDED GROWTH B, LEFT-SIDED GROWTH

FIGURE 26.5 A,Right-sided colonic carcinoma. Thecolonic wall shows thickening with presence of a luminal growth (arrow).The
growth is cauliflower-like, soft and friable projecting into the lumen. B, Left-sided colonic carcinoma. Sectioned surface shows napkin
ring narrowing of the lumen while the colonic wall shows circumferential firm thickening (arrow).
 Peptic ulcer
• Small round to oval ulcer with punched

out edges.
• Mucosal fold converge towards the
ulcer.

FIGURE 25.4 • Benign chronic gastric ulcer. Partial gastrectomy

specimen is identified by thick muscular wall and irregular
mucosal folds.The luminal surface shows a punched out round
to oval ulcer, about 1 cm in diameter (arrow) and penetrating in
to muscularis layer.
 Chronic pyelonephritis
• Irregular scarred cortical
surface usually
at poles.
•dilated
and blunted calyces, dilated
ureter,distruction of papillae with 'U
shaped scar.

A B C

FIGURE 29.6 Short contracted kidney in chronic pyelonephritis. The kidney is small, contracted weighing less than normal.
A, (External surface): the capsule is adherent to the cortex and has irregular scars on the surface. B, (Sectioned surface): shows dilated
pelvicalyceal system with atrophied and thin peripheral cortex and increased hilar fat extending inside (arrow). C, Staghorn stone
(arrow) lying in dilated pelvicalyceal system.

ii. There is fine delicate fibrosis of the interstitial tissue and

Chronic Pyelonephritis
varying number of chronic inflammatory cells in the
interstitium (Fig. 29.5). Chronic pyelonephritis is a chronic tubulointerstitial disease
iv. Advanced cases associated with hypertension show resulting from repeated attacks of inflammation and scarring
conspicuous arterial and arteriolar sclerosis. due to infection.

Hyalinised glomerulus Periglomerular fibrosis Hyalinised vessel

Chronic Colloid cast Interstitial
inflammatory cells (Thyroidisation) fibrosis

H&E, X200
FIGURE 29.7 Chronic pyelonephritis. The tubules show atrophy of some tubules and dilatation of some others which contain
colloid-like casts (thyroidisation). The interstitium shows chronic inflammatory cells and fibrosis. The blood vessels are thick-walled
and the qlomerulishow periqlomerular fibrosis.
 Lipoma:
• Yellowish,encapsulated mass.

• Cutsection-yellow in color, lobulated.

(most sarcomas) to distant sites. Examples of metastases

discussed below are metastatic carcinoma in lymph nodes and
metastatic sarcoma in lung.

Lipoma
Lipoma is a common benign tumour occurring in the
subcutaneous tissues.
G/A The tumour is small, encapsulated, round to oval.
The cut surface is soft, lobulated, yellowish and greasy
(Fig. 20.1).

MIE
i. A
thin fibrous capsule surrounds the periphery.
ii. The tumour is composed of lobules of mature adipose FIGURE 20.1 Lipoma. The tumour shows a thin outer capsu
cells separated by thin fibrovascular septa (Fig. 20.2). Cut surface is soft, lobulated, yellowish and greasy.

(73)

74 SECTION TWO: General Pathology

Capsule Mature adipocytes

H&E, X100

FIGURE 20.2 Lipoma. The tumour composed of mature fat cells is enclosed by thin fibrous capsule.
 5)Acute appendicitis
• Appendix is swollen.

• Serosa is congested.

An important disease affecting the appendix is acute Acute Appendicitis

inflammation called acute appendicitis.
Both small and large bowel may be affected by Acute appendicitis is the most common acute abdominal
inflammatory bowel disease (IBD); here we discuss ulcerative condition confronted by the surgeon.
colitis as an example. Besides, while small intestine is affected
more often by obstruction, large bowel is more common site G/A The appendix is swollen and serosa is hyperaemic and
coated with fibrinopurulent exudate. The mucosa is ulcerated
for development of benign (e.g. colorectal polyps) and
and sloughed.
malignant tumours (e.g. adenocarcinoma).

Neutrophilic infltration
Congested vessels Necrotic mucosa in muscularis

H&E, X 100

FIGURE 26.1 Acute appendicitis. Microscopicappearance showing diagnostic neutrophilic infiltration into the muscularis layer.
The lumen of appendix shows exudates and sloughed mucosa.
(98)
 Squamous cell carcinoma
• Large exophytic growth with cauliflower

like appearance.

• Lesion can be exophytic/flat/ulcerated

with everted edges.

A B C
FIGURE 19.3 Squamous cell carcinoma. A, The skin surface on the sole of the foot shows a fungating and ulcerated growth
(arrow). B, Carcinoma oesophagus showing narrowing of the lumen and thickening of the wall (arrow). C, Carcinoma penis showing
fungating growth on the coronal sulcus (arrow).
Enlarged spleen
Increased measurement of spleen.
• Increased weight of spleen.
Myocardial infarction
• Infarcted area is replaced by thin
.greywhite, hard,shrunken fibrous scar.
 Fatty liver:
• Liver is enlarged with rounded

margins.

• Color-Yellow with tense .glistening

capsule.

EXERCISE 7: Intracellular Accumulations 27

Microvesicles Portal triad

Central vein Fat cyst Macrovesicles

H&E, X200
FIGURE 7.2 Fatty liver. Many of the hepatocytes are distended with large fat vacuoles pushing the nuclei to the periphery
(macrovesicles), while others show multiple small vacuoles in the cytoplasm (microvesicles).
Renal stones with hydronephrosis
• Dilated pelvicalyceal system.
• Dilated ureter.
 Osteoclastoma
• Tumor is eccentrically located in
epiphysis of long bones
• Well circumscribed,dark tan, honeycomb
appearance surrounded by thin shell of
subperiosteal bone.
G/A Osteochondromas have a broad or narrow base (i.e.
either sessile or pedunculated) which is continuous with the
cortex. They protrude exophytically as mushroom-shaped,
cartilage-capped lesions enclosing well-formed cortical bone
and marrow (Fig. 36.3).
M/E
i. The outer part consists of mature cartilage resembling
epiphyseal cartilage.
ii. The inner part is composed of mature lamellar bone
enclosing marrow spaces (Fig. 36.4).

Osteoclastoma
Osteoclastoma or giant cell tumour is a tumour arising in the
epiphysis of the long bones, more common in the age range of
20 to 40 years. Common sites of involvement are: lower end of
femur and upper end of tibia (i.e. about the knee), lower end
of radius, and upper end of fibula.
GIAGiant celltumour is eccentrically located in the epiphyseal FIGURE 36.5 Giant cell tumour (osteoclastoma). The end of
end of a long bone which is expanded. The tumour is well the long bone is
expanded in the region of epiphysis (white
circumscribed, dark-tan and covered by thin shell of arrow). Sectioned surface shows circumscribed, dark-tan and
subperiosteal bone. Cut surface of the tumour is characteri necrotic tumour.
stically haemorrhagic, necrotic and honey-combed (Fig. 36.5).

M/E iii. Stromal cells are mononuclear cells and are the real
i. Large number of osteoclast-like giant cells which are tumour cells and determine the behaviour of the tumour.
regularly scattered throughout the stroma. They are uniform, plump, spindle-shaped or round to
ii. Giant cells may contain as many as 100 benign nuclei oval but may have varying degree of atypia and mitosis
and are similar to normal osteoclasts. (Fig. 36.6).

Osteoclastic giant cells Stromal cells

X200
H&E,

FIGURE 36.6 Osteoclastoma. Thetumour shows spindle-shaped tumour cells. with uniformlv distributed osteoclastic aiant cells.
 Multinodular goiter
• Asymmetric enlargement of thyroid with
nodular surface
• Cut section- multiple nodules of varying
sizes
•Areas of hemorrhage,scarring and cysts
filled with brown colored coloid.
of the gland is fleshy with accentuation of normal lobulations.
The fibrosing variant has a firm enlarged gland with
compression of the surrounding tissues.
M/E
i. Extensive infiltration of the gland by lymphocytes, plasma
cells, immunoblasts and macrophages with formation of
lymphoid follicles having germinal centres.
ii. Decreased number of thyroid follicles, atrophic follicles
which are often devoid of colloid.
ii. Follicular epithelial cells are transformed into their
degenerated state termed Hurthle's cells (oxyphil cells or
oncocytes). These cells have abundant eosinophilic and
granular cytoplasm due to numerous mitochondria.
iv. Variable amount of fibrous replacement of thyroid
parenchyma (Fig. 35.1).

FIGURE 35.2 Nodular goitre. The thyroid gland is enlarged

Nodular Goitre and nodular (normal weight 15-40 gm). Cut surface shows
multiple nodules separated from each other by incomplete
Nodular goitre is regarded as end-stage of long-standing simple fibrous septa. Areas of haemorrhage and cystic change are also
(or diffuse or colloid) goitre. It presents with tumour-like seen.
enlargement of the thyroid gland that has characteristic
nodularity. M/E
i. Partial or incomplete encapsulation.
GIA The thyroid shows asymmetric and extreme enlargement
ii. The follicles of varying size from small to large and lined
weighing 100-500 gm (normal weight 15-40 gm). The
5 cardinal gross features are: nodularity with poor encapsu by flat to high epithelium.
iii. Areas of haemorrhages, haemosiderin-laden macro
lation, fibrous scarring, haemorhages, focal calcification, and
phages and cholesterol crystals.
cystic degeneration. Cut surface of the gland shows
iv. Fibrous scarring and calcification in the nodules.
multinodularity (Fig. 35.2). v. Cystic degeneration (Fig. 35.3).

Haemorrhage Scarring Partial capsule Calcification

Macropapilla Variable-sized Chronic
follicles inflammation

H&E, X100
FIGURE 35.3 Nodular goitre. The predominant histologic features are: nodularity, extensive scarring with foci of calcification,
areas of haemorrhages and variable-sized follicles lined by flat to high epithelium and containing abundant colloid.
 Papillary carcinoma thyroid
• Firm, greywhite
Cut section- May be encapsulated or
may showinfitrative margin
•Variable cysts,fibrosis,calcification.

Papillary Carcinoma
Papillary carcinoma is the most common type of thyroid
cancer comprising about 60% of cases, seen more frequently
in females.

G/A Papillary carcinoma may range from microscopic foci to

nodules up to 10 cm in diameter and is generally poorly
delineated. Cut surface of the tumour is greyish-white, hard to
scar-like (Fig. 35.6).
M/E
i. Papillary pattern: Papillae composed of fibrovascular
stalk and covered by single layer of tumour cells.
ii. Tumour cells: The tumour cells have overlapping pale
nuclei imparting it a ground-glass appearance or optically
clear appearnace and clear or oxyphil cytoplasm.
ii. Invasion: The tumour cells invade the capsule, and
FIGURE 35.6 Papillary carcinoma of the thyroid. Thethyroid
intrathyroid lymphatics.
iv. Psammoma bodies: Almost half of papillary carcinomas
gland is enlarged and nodular (normal weight 15-40 gm). Cut
surface shows a single nodule separated from the rest of thyroid show typical, small concentric calcified spherules in the
parenchyma by incomplete fibrous septa. The nodule on cut stroma (Fig. 35.7).
section shows grey-white soft papillary tumour (arrow).

Tumour cells Papillae Psammoma body

(having 'ground-glass' nuclei) Fibrovascular stalk

H&E, X200

FIGURE 35.7 Papillary carcinoma of the thyroid. Microscopy shows branching papillae having fibrovascular stalk covered by a
single layer of cuboidal cells having ground-glass nuclei. Colloid-filled follicles and solid sheets of tumour cells are also present.
 Osteosarcoma
Grey white bulky mass at metaphyseal
end of long bones
• Cut section- Grey white with areas is
hemorrhage and necrosis.
Osteosarcoma
Osteogenic sarcoma or osteosarcoma is the most common
primary malignant bone tumour. Classically, the tumour
occurs in young patients between the age of 10 to 20 years.
The tumour arises in the metaphysis of long bones, most
commonly in the lower end of femur and upper end of tibia
(i.e. around knee joint).

4
3

1
2
FIGURE 37.4 Osteosarcoma. The lower end of the femur
shows a bulky expanded tumour in the region of metaphysis
(1) sparing the epiphyseal cartilage (2). Sectioned surface of the
FIGURE 37.3 Ewing's sarcoma.The figure shows tumour cells tumour shows lifting of the periosteum by the tumour (3) and
containing scanty ill-defined cytoplasm having glycogen stained eroded cortical bone (4).Cut surface of the tumour is grey-white
positive with PAS. with areas of haemorhage and necrosis (5).

15

EXERCISE 37: Malignant Bone Tumours 143

Highly pleomorphic sarcoma cells

Osteoid Mitotic figure Tumour giant cells

H&E, X200

FIGURE 37.5 Osteosarcoma. The tumour cells show pleomorphic and polymorphic features with direct formation of osteoid by
tumour cells.
 2)Gangrene foot:
• Affected part of foot is dry,shrunken,
dark black.

•A line separation is seen at junction of

of

viable tissue and gangrenous part.

the entire thickness of the affected segment of the bo.
and exudate on the serosa.
i. Bacterial colonies may be identified in different layers of
the affected bowel.
ii. The blood vessels in the bowel wall may show thrombi.
iv. The line of demarcation between the viable and
gangrenous segment shows acute inflammatory cells
(Fig. 10.2).

Dry Gangrene Foot

The typical form of dry gangrene is seen in most distal part of
the foot when the arteries to the foot are obliterated, most
often from arteriosclerosis in old age.
GIA The affected part of the foot is dry, shrunken and dark
black resembling the foot of mummy. A line of separation is FIGURE 10.3 Dry gangrene of foot. The affected part is dry,
seen at the junction of viable tissue with gangrenous part shrunken and dark black. There is a well-delineated line of
(Fig. 10.3). demarcation between the unaffected and affected area (arrow).

40 SECTION TWO: General Pathology

Media (calcification) Intima (uninvolved) Lumen Adventitia

Inflammatory
cells

Necrosis

Thrombosed
vessel

H&E, X100 H&E, X200

FIGURE 10.4 •while

Drygangrene foot.There is coagulative necrosis
non
FIGURE 10.5 Monckeberg's arteriosclerosis (Medial calcific
of soft tissues the margin
with viable tissue shows sclerosis).There is calcification in the degenerated tunica media
specific chronic inflammation. and no inflammation.
 Emphysema
• Subpleural bullae/blebs
• Spaces are air filled cyst like or bubble
like structures.

complete, obstruction to the airflow at any level from the

trachea to the terminal airways. COPD includes 4 main
conditions: chronic bronchitis and bronchial asthma (both of
which are more of medical problems), emphysema and
bronchiectasis (both of which have major pathologic changes
in the lungs and are hence discussed here). Besides, pathology
of two major forms of bronchogenic cancer--squamous cell
and small cell carcinoma, are discussed here.

Emphysema
Emphysema is permanent dilatation of air spaces distal to the
terminal bronchiole resulting in destruction of the walls of
dilated air spaces.

GIA The lungs show varying-sized sub-pleural bullae and

blebs. These spaces are air-filled cyst-like or bubble-like
structures, 1 cm or larger in diameter (Fig. 24.1).

M/E FIGURE 24.1 Bullous emphysema of the lung. The lung is

i. There is dilatation of air spaces and destruction of septal expanded and has thin-walled cysts or bullae visible on the
walls of part of acinus involved. pleural surface. Sectioned surface of the lung shows many large
ii. Alveolar walls are ruptured with spurs of broken septa air-filled sacs, a few centimeters in diameter (arrow), located under
between adjacent alveoli. the pleura.
(90)

tahir99-VRG & vip persianss. ir

100/291

EXERCISE 24: Chronic Obstructive Pulmonary Diseases and Lung Cancer 91

Distended alveoli Spurs of broken septa

and alveolar duct
Thin and stretched alveolar walls

H&E, X40

FIGURE 24.2 Emphysema. There is dilatation of air spaces and destruction of septal walls.
Carcinoma penis
• Exophyticgrowth with cauliflower like
appearance.
• Lesion can be exophytic as well as
endophvtic

ca

COS

alb
CC
C ca-f
AFIP 10-38:
Fig B: cut section shows an exophytic neoplasm covering the entire glans and
extending to the foreskin; note the characteristic undulating appearance of the
neoplastic papillae; the base of the lesion is ragged and infiltrates the corpus
spongiosum
Fig C: the diagram shows the tumor in yellow, effacing the corpus spongiosum
(ca) and involving the coronal sulcus (cos), tunica albuginea (alb) and foreskin
(ca-f), but sparing the corpus cavernosum (cc)
Gastric carcinoma
• Mass lesion in stomach or ulcer
Or
• Diffuse rugal flattening and rigid
thickened wall
 Madura foot:
• Swollen foot.

• Sinuses-discharging black granules.

Abscess Brown granule Necrotic tissue

H&E, X200
 Mucinous cystadenoma
• Smooth surface, Multilocular
• Cyst contains thick and
gelatinous/mucinous fluid.

FIGURE 33.4 Mucinous cystadenoma of the ovary. Cut FIGURE 33.6 Benign cystic teratoma (dermoid cyst) of the
ovary. Cut surface shows a large unilocular cyst containing hair,
surface shows a large, multiloculated cyst without papillae. The
loculi contain gelatinous material. pultaceous material and bony tissue.

with paste-like sebaceous secretions and desquamated keratin where tissue elements such as tooth, bone, cartilage and other
admixed with masses of hair. The cyst wall is thin and opaque odd tissues are present (Fig. 33.6).
grey-white. Quite often, the cyst wall shows a solid prominence

Tall columnar lining Mucinous fluid Mucus vacuole

H&E, X20o

FIGURE 33.5 Mucinous cystadenoma of the ovary.The cyst wall and the septa are lined by a single layer of tall columnar mucin
secreting epithelium with basally-placed nuclei and large apical mucinous vacuoles.
 6)Lobar pneumonia
• Uniform involvement of whole lobe.

• Greyish brown color on cut surface-gray

hepatization.

A B

FIGURE 23.3 Grey hepatisation (late consolidation) (4-8 days). A, The pleural surface shows some serofibrinous exudate (arrow).
B, Sectioned surface of the lung shows grey-brown, firm area of consolidation affecting a lobe (arrow) while the rest of the lung is
spongy.

88 SECTION THREE: Systemic Pathology

Macrophages (some) PMNs (some)

Dense fibrin Clear space

H&E, X20o
FIGURE 23.4 Lobar pneumonia, grey hepatisation. Thecellular exudate is separated from septal wall by a clear space. The exudate
consists of neutrophils as well as macrophages.
 Atherosclerosis
• Fatty streaks are yellow, minimally
raised lesions
• Fibrousplaques are raised ,well
demarcated, white,firm areas.

Atherosclerosis is a form of thickening and hardening of

medium and large sized muscular arteries due to fibrofatty
plaques on the intima.
Majority ofbenign tumours ofblood vessels and lymphatics
are malformations or hamartomas which occur on the skin
and mucosal surfaces and less often in the deeper tissues. A
few common examples are described below.

Atheroma Aorta
A fully-developed atherosclerotic lesion is called atheromatous
plaque or atheroma. It is located most commonly in the aorta
(Fig. 21.1) and major branches of the aorta including
coronaries.
G/A The atheromatous plaque in the coronary is eccentrically
located bulging into the lumen from one side. The plaque
lesion is white to yellowish-white and may have ulcerated
surface. Cut section shows firm fibrous cap and central
yellowish-white soft porridge-like core. Frequently, there is
grittiness owing to calcification in the lesion.
M/E The appearance of plaque varies depending upon the age FIGURE 21.1 Fuly-developed atheroma. The opened up
of lesion. However, the following features are invariably aorta shows arterial branches coming out. The intimal surface
present: shows yellowish-white lesions, slightly raised above the surface.
i. The superficial luminal part offibrous cap is covered by A few have ulcerated surface. Many of these lesions are located

endothelium and is composed of smooth muscle cells, near the ostial openings on the intima, thus partly occluding
dense connective tissue and extracellular matrix. them.
(79)
 Carcinoma cervix
• Diffusely enlarged ,bulky
cervix
•Cut section- grey white lesion
• Cervical growth/ulcer

FIGURE 32.4 Invasive carcinoma of the cervix. Sectioned

surface shows normal uterine cavity while the cervix is replaced
by irregular grey-white friable growth (arrow) extending into
cervicalcanal as wellas distally into attached vaginal cuf.
 Serous cystadenoma
•Smooth,glistening surface
• Unilocular, contain watery
clear to pale
yellow (serous )fluid.

FIGURE 33.1 Papillary serous cystadenoma of

theovary.Cut
surface shows a large unilocular cyst containing numerous
papillary structures projecting into it (arrow).