Third Year Histo Revision Answers PDF

THIRD YEAR HISTOPATHOLOGY REVISION BY DR. PASSANT ESSAM SHIBEL LECTURER OF HISTOPATHOLOGY CAIRO UNIVERSITY  PRACTICAL EXAM MARKS JARS AND HISTO Total: 33 marks DATA SHOW EXAM: 7 stations (jars > histo) X 3 mar...

THIRD YEAR HISTOPATHOLOGY REVISION BY DR. PASSANT ESSAM SHIBEL LECTURER OF HISTOPATHOLOGY CAIRO UNIVERSITY  PRACTICAL EXAM MARKS JARS AND HISTO Total: 33 marks DATA SHOW EXAM: 7 stations (jars > histo) X 3 marks = 21 marks Each station will have 3-4 questions (Describe, diagnose + 1 another question) or (diagnose and 2 questions). MICROSCOPIC EXAM: 4 stations X 3 marks = 12 marks Only describe and diagnose…. No questions System Name Will Be Mentioned At Every Station Whether Data Show Or Microscopy  THIRD YEAR HISTOPATHOLOGY REVISION - REVIEW, KEYWORDS AND EXAMPLES OF PREVIOUS YEARS QUESTIONS - DATA SHOW SCHEME - MICROSCOPY SCHEME WITH EXAMPLES  HISTOPATHOLOGY COMMENT includes: - Description: Section in ……. Showing: - Diagnosis: Diagnosis + organ. For glass slides, most of the slides are to be diagnosed by low power (red lens). Higher power usually confuses you. SCHEME is a MUST  NOTES: - While describing any MALIGNANT TUMOR: The comment includes infiltration by + arrangement of the cells + shape of the cells + features of malignancy + If sarcoma, comment on the matrix While describing any BENIGN TUMOR: The comment includes capsulated or not+ arrangement of the cells + shape of the cells + stroma. - While describing any PAPILLARY LESION (papilloma, papillary carcinoma or polyp): The comment includes core (fibrovascular tissue) and covering. - While describing any ACUTE INFLAMMATION: The comment includes edema, congestion, neutrophils, macrophages (+/- pus cells). While describing any CHRONIC INFLAMMATION: The comment mainly includes lymphocytes, plasma cells, macrophages and fibrosis. - While describing BILHARZIASIS: The comment includes bilharzia ova with yellowish refractile shell. Some are fresh showing pink miracidia and others are calcified (stained dark blue). Ova are surrounded by bilharzial reaction (lymphocytes, plasma cells, macrophages, giant cells, EOSINOPHILS and fibrosis). - While describing GLANDULAR HYPERPLASIA: The comment includes Increased number of the glands and variation in their size and shape. The glands are lined by columnar cells (if exocrine (prostate and breast) mention double cell layer), which might form multiple layers or papillary processes. Some glands are dilated and lined by flattened cells. + don’t forget to comment on the stroma RESPIRATORY SYSTEM - 2 Nasal lesions and 6 Lung lesions 3 can be Data show or glass slide 5 data show only. Diagnosis: Rhinoscleroma Describe. Chronic inflammation Section from the nasal mucosa showing: - Many Mickulicz cells have clear or foamy cytoplasm & central small nuclei. - Lymphocytes. - Plasma cells. Russel bodies may be seen. These are pink oval cells representing plasma cells showing hyalinosis. Name The Cells Pointed By The Arrow? Mickulicz cells Is this lesion neoplastic? No Diagnosis: Nasal polyp Describe. Polyp Section from a POLYP - covered by pseudostratified columnar ciliated epithelium with focal areas of squamous metaplasia. - The vascular core showed edema in the form of homogenous pale pink fluid, proliferated mucous glands and infiltrated by plasma cells, lymphocytes, macrophages and EOSINOPHILS. Is this lesion neoplastic? No  LUNG 6 lesions Whole section same appearance (3): - Alveolar wall - Alveolar space Section 2 halves (2). Scattered lesions (1). Diagnosis: Lobar pneumonia, Red hepatization Describe this picture. Acute inflammation DATA SHOW ONLY Section in the lung shows: - All the alveolar spaces contain a network of fibrin entangling many intact red blood cells and some intact polymorphs & macrophages. - The alveolar walls show edema and congested capillaries. TYPE OF INFLAMMATION? Acute non-suppurative fibrinous inflammation STAGES OF THIS LESION: Congestion, red hepatization, grey hepatization and resolution  Diagnosis: Emphysema, lung DATA SHOW ONLY Describe this picture. Section in the lung shows: - Widely distended alveolar spaces. - Thin alveolar walls focally ruptured and compressed capillaries. Types of this disease? Centri- acinar, distal acinar and pan-acinar  Diagnosis: Chronic venous congestion, lung Describe this picture. DATA SHOW ONLY Section in lung shows: - The alveolar walls are thickened due to interstitial edema and congested capillaries. - The alveolar spaces contain homogenous pink transudate entangling red cells, brown hemosiderin granules, and heart failure cells. - The HEART FAILURE CELLS are large rounded phagocytic cells engulfing brown hemosiderin granules. NAME THE BROWN CELLS?  ALVEOLAR WALL: ALVEOLAR WALL: ALVEOLAR WALL: Edema & congestion Edema & congestion Ruptured ALVEOLAR SPACE: ALVEOLAR SPACE: ALVEOLAR SPACE: Fibrin rich exudate, Transudate, RBCs and Wide RBCs and acute Heart failure cells inflammatory cells  DATA SHOW ONLY Diagnosis: Infarction, lung Describe this picture. Section in lung shows two zones: - The infarct, showing atrophic alveolar walls appearing as thin fibrous septa, and alveolar spaces containing many intact and haemolysed red blood cells and SHADOWS of heart failure cells. - The rest of the lung, showing the picture of chronic venous congestion (describe). Arrows (name or describe)? Red (zone of congestion) and black (zone of infarction)  Diagnosis: Bronchogenic carcinoma Describe: MALIGNANT TUMOR Section in the lung shows: - Infiltration by MALIGNANT TUMOR formed of sheets (or acini) of malignant cells separated by thin fibrous stroma. - The malignant cells vary in size and shape. Their nuclei are large, hyperchromatic with prominent nucleoli. Mitosis is frequent. - The lung tissue shows anthracosis. Diagnosis: Miliray tuberculosis, lung DATA SHOW ONLY Section in the lung shows: - Small many miliary tubercles scattered in the interstitial lung tissue usually perivascular. - Each tubercle is formed of epithelioid cells, langhan's giant cells and lymphocytes. Arrows? Tubercles DATA SHOW ONLY TAKE CARE MILIARY T.B. RHINOSCLEROMA  LUNG DATA SHOW Whole section same appearance: 3 slides (lobar pneumonia, emphysema and CVC). Comment on the alveolar WALL and alveolar SPACE. Slide is two halves: 2 slides (Bronchogenic carcinoma and lung infarction). Scattered lesions: 1 slide …. Miliary TB.  Respiratory Glass slides scheme (3 slides) Respiratory Epithelium, Edema with eosinophils and no Mickulicz cells: ALLERGIC NASAL POLYP Large clear cells (Mickulicz cells) with other inflammatory cells RHINOSCLEROMA Small part of normal lung with malignant irregular dark tumor BRONCHOGENIC CARCINOMA (By exclusion) Take care Not to be confused between pale edema in allergic nasal polyp and clear Mickulicz cells  RESPIRATORY GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled NASAL POLYP RHINOSCLEROMA BRONCHOGENIC CARCINOMA  GIT & liver 8 slides: GIT lesions (mucous secreting glands) 6 slides: hepatic lesions (large pink hepatocytes, no mucous secreting glands)  GIT 8 slides 4 Data Show And Glass Slides 4 Data Show Only  DATA SHOW ONLY Diagnosis: H.PYLORI GASTRITIS Describe this picture. Section in stomach, Giemsa stained, high power shows: - Many Helicobacter pylori organisms which are seen within the mucosal gland and appear as small curved bacilli. - Inflammatory cells are seen in the stroma outside the mucosal gland. ARROW? H. Pylori bacilli STAIN? Giemsa  ACUTE SUPPURATIVE APPENDICITIS. TRANSVERSE section in the APPENDIX: Acute suppurative inflammation The mucosal glands are partly partly ulcerated. The mucosa, submucosa, musculosa and serosa, show edema, congested capillaries and dense acute inflammatory cellular infiltrate (exudate) formed of many. polymorphs, pus cells and macrophages The lumen of the appendix contains a fibrin network entangling necrotic shedded mucosal cells, polymorphs and pus cells TYPE OF INFLAMMATION? Acute suppurative inflammation ARROW? Mucosal glands Diagnosis: Adenomatous polyp (adenoma), intestine Describe. POLYP / BENIGN TUMOR DATA SHOW ONLY Section in a benign tumor formed of : - Proliferated acini (glands) variable in size and shape and lined by columnar mucin secreting cells with basal nuclei. Some are lined by dysplastic epithelium shows mucin depletion, hyperchromatic, elongated pseudostratified nuclei. - A vascular connective tissue stroma is found between the glands showing few inflammatory cells. BENIGN OR MALIGNANT? Benign IS THIS LESION PRE-CANCEROUS? Yes  Diagnosis: Bilharzial polyp, colon Describe. POLYP + Bilharziasis Section in a POLYP shows: - A central core of vascular connective tissue showing fresh, degenerated and calcified ova (describe) surrounded by bilharzial reaction (lymphocytes, plasma cells, macrophages, eosinophils and fibrosis) - A hyperplastic covering mucosa (there is increased number of mucosal glands), also invaded by the ova and the inflammatory cells. ARROW? Bilharzial ova IS THIS LESION PRE-CANCEROUS? No  CORE: FIBROVASCULAR TISSUE COVERING: PROLIFERATED COLONIC GLANDS + OVA & BILHARZIAL + DYSPLASIA REACTION  Diagnosis: Bilharziasis, colon DATA SHOW ONLY Describe. Bilharziasis Section in Colonic Mucosa shows: - Many bilharzia ova with yellowish refractile shell. Some are fresh showing pink miracidia and others are calcified (stained dark blue). - Ova are surrounded by bilharzial reaction (describe) ARROW? Bilharzial ova IS THIS LESION PRE- CANCEROUS? No OVA (fresh and calcified) & BILHARZIAL REACTION (lymphocytes, plasma cells, macrophages, eosinophils and fibrosis)  Diagnosis: Stomach, Signet Ring Carcinoma Describe. MALIGNANT TUMOR DATA SHOW ONLY Section in stomach shows: - Invasion by MALIGNANT TUMOR composed of signet ring cells. These cells are poorly cohesive and have clear cytoplasm with dark eccentric nuclei. + Features of malignancy - The mucosal glands are destroyed due to invasion. Behavior? Malignant Arrow? Signet ring cells Gross Picture? Diffuse infiltrative pattern Cause For The Appearance Of The Cells? Due to cytoplasmic mucin pushing the nucleus to one side  Diagnosis: Adenocarcinoma, colon Describe MALIGNANT TUMOR Section in colonic wall shows: - A MALIGNANT TUMOR formed of irregular acini infiltrating the submucosa and muscle layer (musculosa). - The acini vary in size and shape and are lined by one or more layers of malignant columnar cells in irregular arrangement (loss of polarity). - The malignant cells vary in size and shape. Their nuclei are large, hyperchromatic. Mitotic figures are present. ARROWS (red: Normal mucosal glands and black: Malignant glands)? Behavior? Malignant  Diagnosis: Mucoid carcinoma, colon Describe MALIGNANT TUMOR Section in colonic wall shows: - A MALIGNANT TUMOR formed of malignant irregular acini and solid groups of malignant cells in pools of mucin, infiltrating the submucosa and muscle layer (musculosa). - The malignant cells vary in size and shape. The cytoplasm is distended with pale mucin which push the nucleus to become eccentric and flattened (signet ring appearance). The nuclei are large, hyperchromatic. Features of malignancy ARROWS (red: Normal mucosal glands and black: Malignant cells in pools of mucin)? Behavior? Malignant  INVASION by MALIGNANT tumor formed of - Mucin pools With - Irregular Glands - Dyscohesive glands, and groups - Mucin secreting - Signet Ring Cells - Signet Ring Cells columnar cells Don’t Forget Features Of Malignancy  GIT (Mucosal glands) Data show Blue colour (Giemsa stain): H pylori gastritis. Rounded section: Suppurative Appendicitis Mucosa With Polyp: Adenomatous polyp. Bilharzial ova: 2 slides (Bilharziasis and bilharzial polyp). Part mucosa and part tumor: 3 slides - With signet ring cells: Signet ring carcinoma, stomach. - With malignant glands: Adenocarcinoma, colon. - With Mucin: Mucoid carcinoma, colon.  LIVER 6 slides 2 Data Show And Glass Slides 4 Data Show Only Diagnosis: Fatty degeneration (steatosis), liver Describe this picture. DATA SHOW ONLY Section in the liver shows: - The hepatocytes are distended by cytoplasmic vacuoles which were occupied by fat that had dissolved during the preparation of the paraffin section. - The nuclei of some hepatocytes are flattened and pushed by the vacuole (accumulated fat) to one side against the cell membrane giving the cell a signet ring appearance. ARROW? Signet ring like hepatocytes. CAUSE FOR THE APPEARANCE OF THE CELLS? Due to cytoplasmic fat vacuoles that had dissolved during the preparation and pushes the nucleus to one side  Diagnosis: Chronic venous congestion, liver Describe this picture. DATA SHOW ONLY Section in liver shows: - The central veins and sinusoids are dilated and congested. - The liver cells in the center of the lobules are atrophic. - The liver cells in the periphery of the lobules show cloudy swelling and fatty degeneration. ARROWS: BLUE (portal tract)& BLACK (congested central vein)?  Diagnosis: Bilharzial periportal fibrosis Describe this picture: Bilharziasis DATA SHOW ONLY Section in the liver shows: - The portal tracts show wide fibrous expansion, Bilharzial ova surrounded by bilharzial reaction (lymphocytes, plasma cells, macrophages, eosinophils and fibrosis), newly formed capillaries, some of them are dilated (angiomatoids), and newly formed bile ducts - The liver lobules are normal. ARROW? Bilharzial ova Bilharzial OVA ( fresh and calcified ) with bilharzial REACTION Angiomatoids, bile Proliferated Glands ducts and normal hepatocytes Diagnosis: Liver cirrhosis Describe this picture. Section in the liver shows: - Loss of the normal lobular architecture which is replaced by regeneration nodules surrounded by fibrous septae. - The regeneration nodules are formed of proliferating liver cells with an irregular sinusoidal pattern. Central veins are absent or eccentric. - The fibrous septae show chronic inflammatory cellular infiltrate and proliferating bile ducts. ARROW (red: regeneration nodules and black: fibrous septa)? Diagnosis: Hepatocellular carcinoma Describe MALIGNANT TUMOR Section in the liver shows: - A malignant tumor formed of infiltrating trabeculae and sheets of malignant hepatocytes separated by connective tissue stroma and compressed liver cells. - The tumor cells are polygonal; vary in size, shape and arrangement. The nuclei are hyperchromatic and show mitosis. -The rest of the liver tissue shows the picture of cirrhosis (describe). BEHAVIOUR? Malignant NORMAL FIBRINOUS PERITONITIS Diagnosis: Fibrinous peritonitis, liver DATA SHOW ONLY Describe this picture. Acute inflammation Section in liver shows: - The covering peritoneum shows shedded serosal cells and a network of fibrin entangling acute inflammatory cellular infiltrate (exudate) formed of many polymorphs and few macrophages. - The subserosal connective tissue shows edema, congested capillaries, and acute inflammatory cellular infiltrate (exudate) formed of many polymorphs and few macrophages. ARROWS (blue: Subserosa, black: Fibrin network and red: Normal liver)? TYPE OF INFLAMMATION? Acute non-suppurative fibrinous inflammation  Digestive Glass slides scheme (5 slides) Rounded section: APPENDICITIS Mucin secreting GLANDS (3 slides) Hepatocytes (2 slides) (large pink cells) Dark irregular glands: = CIRRHOSIS ADENOCARCINOMA +/- HEPATOCELLULAR Pale mucin lakes with floating CARCINOMA (darker tumor cells: MUCOID irregular area) CARCINOMA. Bilharzial ova: BILHARZIAL POLYP  DIGESTIVE GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled  GLANDS APPENDICITIS ADENOCARCINOMA MUCOID CARCINOMA. BILHARZIAL POLYP COLONIC ADENOCARCINOMA MUCOID CARCINOMA BILHARZIAL POLYP  LIVER CIRRHOSIS HEPATOCELLULAR CARCINOMA ON TOP OF CIRRHOSIS. LIVER CIRRHOSIS HCC ON TOP OF LIVER CIRRHOSIS  UROGENITAL 5 Data Show And Glass Slides 3 Data Show Only Diagnosis: kidney, end stage. DATA SHOW ONLY Describe. Section of kidney showing: The GLOMERULI show complete fibrosis. The TUBULES show many changes including atrophy, degeneration and casts. The INTERSTITIAL TISSUE shows chronic inflammation and fibrosis. The ARTERIES AND ARTERIOLES are thickened. Arrows? Yellow: Fibrosed glomeruli and blue: Atrophic tubules with casts  DATA SHOW ONLY Diagnosis: Amyloidosis kidney. Describe the picture. Section from the kidney showing homogenous pink amyloid deposits seen in the basement membrane of: Arterioles which appear thickened with a narrowed lumen. The glomerular capillaries. Some glomeruli are partly or completely replaced by the pink amyloid deposit. The collecting tubules. Albumin casts are also detected in the tubular lumen. Special stain needed to document? Congo red stain Arrow? Glomerulus with amyloid deposits  GLOMERULI TUBULES (casts) ARTERIOLES (thickened) Diagnosis: Renal cell carcinoma (hypernephroma) Describe MALIGNANT TUMOR Section of kidney showing: MALIGNANT TUMOR formed of cords and groups of malignant rounded cells separated by delicate vascular connective tissue stroma. The cells are large polyhedral with pale vacuolated cytoplasm (due to high content of glycogen and lipids which had dissolved during preparation of the section). Their nuclei are small and deeply stained (Features of malignancy). Areas of necrosis and hemorrhage are seen. Behavior? Malignant Explain the appearance of the cells? Clear cytoplasm due to high content of glycogen and lipids which had dissolved during preparation Diagnosis: Wilm`s tumor (Nephroblastoma) Describe Section in kidney showing: A malignant tumor showing three components (triphasic): 1. Undifferentiated blastemal cells, small spindle, round or oval deeply stained cells with mitotic figures. 2. Epithelial cells, arranged in ribbons, imperfectly formed tubules, and imperfectly formed glomeruli (abortive glomeruli). 3. Mesenchymal elements, undifferentiated or differentiated into bundles of smooth and striated muscles, myxomatous tissue, bone, cartilage. Behavior? Malignant Age Group? Children Diagnosis: Seminoma DATA SHOW ONLY Describe MALIGNANT TUMOR Section in testicular tumor formed of : Groups of malignant cells separated by fibrous bands. The malignant cells are large round, their cytoplasm is abundant clear (due to its glycogen and lipid content), and their nuclei are large round with well demarcated nuclear membrane and 1-2 nucleoli. (features of malignancy) The STROMAL fibrous bands are always infiltrated by lymphocytes. The tumor shows thin walled vessels, areas of necrosis and hemorrhage. Arrows (red: Lymphocytes and black: Tumor cells?  - Groups - Polygonal cells. - Clear cytoplasm. - Features of malignancy. - Stroma (Delicate or lymphocytes) Diagnosis: Bilharziasis , urinary bladder Describe Bilharziasis Section from the urinary bladder wall: BILHARZIA OVA are deposited mainly in the submucosa and less in the other layers. The ova are surrounded by bilharzial reaction (lymphocytes, plasma cells, histiocytes, eosinophils and fibrosis). The UROTHELIUM shows areas of hyperplasia. The hyperplastic epithelium dips down into the submucosa forming epithelial nests (Brunn's nests). Some nests showing central degeneration leading to cyst formation (cystitis cystica). Can these lesions be precancerous? Yes Describe the changes in the smaller picture?  Bilharziasis Core + covering Angiomatoids, bile ducts + normal hepatocytes Submucosa + Urothelial changes Diagnosis: Transitional cell carcinoma Describe PAPILLARY MALIGNANT TUMOR Section in urinary bladder showing: A PAPILLARY MALIGNANT tumor arises from the mucosal surface. The papillae consist of vascularized connective tissue CORES COVERED by several layers of urothelial (transitional) cells showing pleomorphism, hyperchromasia with prominent nucleoli and frequent mitotsis (features of malignancy) Behavior? Malignant Another two types of malignant tumors at this site: Squamous cell carcinoma & Adenocarcinoma Diagnosis: Prostatic Hyperplasia Describe Glandular hyperplasia + exocrine Section in the prostate showing: Proliferation of both the acini and the fibromuscular stroma. The ACINI are lined by two or more layers of columnar cells with papillae, others are dilated and with flat lining. Their lumen shows round or oval homogenous pink corpora amylacea and inflammatory cells. The surrounding fibromuscular STROMA is increased and show lymphocytes and plasma cells infiltration. Arrows (red: Papillae and yellow: Corpora amylacea)? Is this lesion neoplastic: No? Urothelium: with papillae or with ova Kidney: full section or half kidney and half tumor Glands  GLASS Slide scheme 1) Glands with cystic forms ….. Benign Prostatic Hyperplasia. 2) Papillae (Finger like structures) …… Transitional Cell Carcinoma. 3&4) Kidney with TUMOR - Pale tumor……. RCC - Blue tumor….. Wilm’s tumor. 5) Search for the ova in a urinary bladder wall …. Bilharzial cystitis  GENITO-URINARY GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled BPH TCC WILM’S RCC Bilharzial cystitis  FEMALE AND BREAST All can be Data Show And Glass Slides except 1 (ductal carcinoma in situ) Data Show Only Diagnosis: Leiomyoma Describe? BENIGN TUMOR Section in BENIGN non- capsulated (pseudo- capsulated) TUMOR formed of - Interlacing bundles of smooth muscle cells surrounded by fibrous stroma. - The MUSCLE CELLS are spindle shaped cell with eosinophilic cytoplasm and rod shaped nucleus. There is no collagen in between the individual muscle cells. - The FIBROUS STROMA is formed of fibroblasts, short spindle shaped cells with spindle shaped nucleus. The cells are separated by pink collagen fibers. Behavior? Benign Is this tumor capsulated? No (pseudo-capsule) Diagnosis: CYSTIC ENDOMETRIAL HYPERPLASIA Describe? Glandular hyperplasia Section in endometrial curetting showing: Increased number of the GLANDS and variation in their size and shape. The glands are lined by columnar cells which might form multiple layers or papillary processes. Some glands are dilated and lined by flattened cells. The STROMA is very cellular formed of packed spindle cells with large dark nuclei. Mitosis is seen in the glandular epithelium and stromal cells Arrow? Cystically dilated endometrial glands Is this lesion neoplastic? No Diagnosis: FIBROCYSTIC DISEASE OF THE BREAST Describe? Glandular hyperplasia + exocrine Section in the breast showing : ADENOSIS : Increased number of the acini. EPITHELIOSIS: Proliferation of the lining cells of the ducts. The ducts are lined by two or multiple layers of cells and may show papillary processes. CYST FORMATION: Some ducts show cyst formation and become lined by cubical or flattened cells. APOCRINE METAPLASIA: Some ducts lined by acidophilic cells. FIBROSIS of the surrounding stroma. Is this lesion neoplastic? No Arrow? Cystically dilated breast ducts GLANDULAR HYPERPLASIA Diagnosis: Fibroadenoma, Pericanalicular BENIGN TUMOR Describe? Section in a capsulated benign tumor formed of: Proliferated DUCTS, rounded or oval in cut section with patent lumen, lined by two layers of cells, outer flattened and inner cubical. Delicate FIBROUS TISSUE containing blood vessels and few lymphocytes. Arrow? Round ducts with patent lumen Behavior? Benign Diagnosis: Fibroadenoma, Intracanalicular BENIGN TUMOR Describe? Section in a CAPSULATED benign tumor formed of Proliferated DUCTS, compressed (slit like obliterated lumen), lined by two layers of cells, outer flattened and inner cubical. Excess FIBROUS TISSUE giving the false impression that the epithelium surround the fibrous tissue in some areas. Arrow? Compressed ducts with slit like lumen Behavior? Benign  - Capsule - Ducts (Round or oval / Compressed) - Lumen (patent or slit like) - Cells (double cell lining). - Fibrous tissue stroma (Delicate or excess) IN GLASS SLIDE: - Capsulated - Ducts some are Round or oval with patent lumen, others are compressed with slit like lumen - Cells (double cell lining). Diagnosis: Intraduct carcinoma breast DATA SHOW ONLY Describe? Section in breast showing: - The ducts are dilated and distended by malignant cells and show necrosis of the central cells which appear granular and red (Comedo- type carcinoma). - Foci of micro-calcification in the necrotic area are seen. - The lining cells show the malignant characters: variation in size and shape, hyperchromatic nuclei and mitotic figures. Arrows? Black: Malignant cells, Yellow: Comedo necrosis and Red: micro-calcification Diagnosis: Infiltrating duct carcinoma, breast. Describe? MALIGNANT TUMOR Section in breast showing: A MALIGNANT TUMOR formed of infiltrating sheets of malignant epithelial cells separated by dense fibrous stroma. The malignant cells are rounded or polygonal and variable in size. Their nuclei are large, pleomorphic, hyperchromatic and may show prominent nucleoli. Mitotic figures present. (features of malignancy) Behavior? Malignant  GLASS Slides scheme 1) Spindle shaped cells (No glands)……. Leiomyoma. 2&3) Glands with cystic forms - Fibrous tissue stroma with FAT (No blue cells in stroma)……Fibrocystic disease of the breast. - Usually multiple fragments on the slide (Curetting) + Blue cells in the stroma…… Endometrial hyperplasia. 4) Regular glands (Slit like or round) with no solid groups and No fat….. Fibroadenoma. 5) Solid groups with irregular glands infiltrating into FAT …..Invasive breast Carcinoma FEMALE AND BREAST GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled Leiomyoma Endometrial Hyperplasia Fibrocystic Disease Of The Breast Fibroadenoma Invasive Breast carcinoma SKIN AND SOFT TISSUE 6 Data Show And Glass Slides 3 Data Show Only Diagnosis: Nevus Describe the lesion? Section in skin showing: Groups of small, round or polyhedral nevus cells (melanocytes) in the upper part of the dermis separated by collagen bundles. The cytoplasm is scanty and shows dark brown melanin pigment Free melanin inside histiocytes (melanophores) is also present due to rupture of the melanocytes. Name the pigment? Melanin Diagnosis: Malignant melanoma MALIGNANT TUMOR Describe? Section in skin showing: Dermal infiltration by groups of malignant cells which are rounded or polyhedral or spindle shaped arranged in bundles. The malignant cells show pleomorphism, hyperchromasia with prominent nucleoli, frequent mitotsis and cytoplasmic dark brown melanin pigment (features of malignancy). The stroma is scanty, vascular, and shows extracellular melanin deposits Behavior? Malignant Name the pigment? Melanin  - Section in skin - Dermis (upper in nevus) - shape and arrangement of cells. - Features of malignancy (only in melanoma). - Melanin in cells and stroma Diagnosis: Basal Cell Carcinoma Malignant tumor Describe? Section in skin showing: Masses (nests) of malignant epithelial cells, variable in size and shape infiltrating the dermis. The outer cells are columnar and parallel (palisade arrangement). The inner cells are polyhedral and rounded. The malignant cells show pleomorphism, hyperchromasia with prominent nucleoli, frequent mitotsis with scanty bluish cytoplasm (features of malignancy). Behavior? Locally malignant Diagnosis: Squamous cell carcinoma Describe this picture Section in skin showing: Malignant tumor Nests of malignant epithelial cells infiltrating the dermis. The tumor masses are variable in size and shape, their periphery show a layer of dark stained small basal like cells, inner to this are polyhedral cells and the central cells show a red stained keratin pearls (cell nest). The malignant cells show pleomorphism, hyperchromasia with prominent nucleoli, frequent mitotsis with abundant pink cytoplasm (features of malignancy). Behavior? Malignant, Name the structure pointed by the arrow? keratin pearl, Name the encircled structure? Squamous cell nest - Section in skin - Dermal infiltration - Nests (arrangement of cells). - Features of malignancy + Cytoplasm Diagnosis: Cavernous hemangioma Describe? BENIGN TUMOR Section in a non-capsulated benign tumor formed of Irregular wide vascular spaces lined by flat endothelium separated by connective tissue bundles and containing intact and hemolyzed red blood cells. Some spaces are inter-communicating. Is this lesion capsulated or not? No, Behavior? Benign, Arrow? Wide vascular spaces filled with blood Diagnosis: CAVERNOUS LYMPHANGIOMA Describe: BENIGN TUMOR DATA SHOW ONLY Section in a non-capsulated benign tumor showing Large irregular vascular spaces lined by flat endothelium and separated by delicate connective tissue. The spaces contain homogenous pink material (coagulated lymph) and few lymphocytes and red cells. Is this lesion capsulated or not? No, Behavior? Benign, Arrow? Wide vascular spaces filled with Lymph Diagnosis: Capillary hemangioma DATA SHOW ONLY Describe? BENIGN TUMOR Section in an non-capsulated benign tumor of skin: Tumor is formed of a large number of round, oval or irregular small vascular spaces lined by flat endothelial cells separated by delicate connective tissue stroma. Is this lesion capsulated or not? No, Behavior? Benign  - Benign Non-capsulated - Size of vascular spaces (large or small) - Containing (blood or lymph) - Lined by flat endothelial cells - Stroma (delicate fibrovascular) Diagnosis: Squamous cell papilloma Describe? PAPILLOMA Section in a benign tumor formed of Branching CORES of connective tissue showing blood vessels. COVERED BY a thick hyperplastic stratified squamous epithelium, showing basal cell hyperplasia, acanthosis (increased prickle cells), parakeratosis (nucleated surface keratin) and hyperkeratosis (excess surface keratin). Behavior? Benign Diagnosis: Fibrosarcoma DATA SHOW ONLY Describe? MALIGNANT TUMOR Section in a MALIGNANT TUMOR showing: The proliferated spindle CELLS ARRANGED in fascicles exhibiting herring bone pattern. The cells have dark elongated nuclei exhibiting high nucleocytoplasmic ratio and mitotic figures (features of malignancy). The background shows collagen. Behavior? Malignant  SKIN AND SOFT GLASS SLIDES SCHEME 1&2) Brown pigment: - Upper part of slide (upper dermis): Nevus. - Whole slide: Melanoma. 3) Blood filled spaces: Cavernous hemangioma. 4) Papillae (finger like structures): Squamous cell papilloma 5&6) Nests: - Red with keratin pearls: SCC. - Blue: BCC. SKIN AND SOFT TISSUE GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled Nevus Melanoma BCC SCC  TAKE CARE Cavernous hemangioma SCC Squamous cell papilloma BONE AND LYMPHOID 3 Data Show And Glass Slides 4 Data Show Only  Bone 2 Data Show And Glass Slides 1 Data Show Only Diagnosis: Chondroma BENIGN TUMOR Describe. Section in a BENIGN TUMOR The tumor is surrounded by a fibrous capsule at the periphery sending septa carrying thin walled blood vessels. The tumor is composed of cartilage cells surrounded by faint blue homogenous matrix. Cartilage cells are found singly or in groups of two, three or more. The cells are variable in size and shape. The cytoplasm is vacuolated due to dissolving of its content of glycogen and lipids. The nuclei are central and dark. Behavior? Benign  Diagnosis: Osteoclastoma (giant cell tumor of bone). Describe. Section in a malignant tumor formed of : Large number of MULTINUCLEATED GIANT CELLS, of the osteoclastic type containing up to 100 nuclei scattered all over the cytoplasm or grouped in the center. The nuclei are small, round or oval and vesicular. In between the giant cells, there are numerous SMALL, OVAL and fusiform CELLS having vesicular nuclei. The tumor shows areas of necrosis, degeneration and hemorrhage. Name the cell pointed by the arrow? Giant cell Behavior? Locally malignant Diagnosis: Osteosarcoma DATA SHOW ONLY MALIGNANT TUMOR Describe. Section in a MALIGNANT TUMOR showing: Irregularly arranged large, spindle, round or oval cells. The malignant cells show pleomorphism, hyperchromasia with prominent nucleoli, frequent mitotsis. The intercellular matrix between the tumor cells; may be osteoid, osseous, cartilaginous or fibrous. Behavior? Malignant  LOCALLY MALIGNANT BENIGN TUMOR MALIGNANT TUMOR TUMOR  Lymphoid 1 Data Show And Glass Slides 3 Data Show Only Diagnosis: Lymph node; Lymphoid follicular hyperplasia. Describe this picture. Section in lymph node showing: PRESERVED lymph node ARCHITECTURE with Patent subcapsular sinus The lymphoid follicles are variable in size and exhibit pale stained germinal centers. Arrow? Hyperplastic lymphoid follicles Is this lesion reactive or neoplastic? Reactive Diagnosis: Lymph node: Non Hodgkin lymphoma. DATA SHOW ONLY Describe. MALIGNANT TUMOR Section in lymph node showing: EFFACED ARCHITECTURE BY MALIGNANT TUMOR. The node is diffusely infiltrated by monomorphic population of lymphocytes showing round nuclei Is this lesion reactive or neoplastic? Neoplastic Diagnosis: Lymph node: Hodgkin lymphoma Describe. MALIGNANT TUMOR DATA SHOW ONLY Section in lymph node showing: EFFACED ARCHITECTURE BY MALIGNANT TUMOR. Infiltration by the characteristic Reed- Sternberg cells (RS) which are large neoplastic cells, with two mirror image nuclei containing large eosinophilic nucleoli. Surrounded by reactive lymphocytes. Name of the cell pointed by the arrow: Reed- Sternberg (RS) cells. Is this lesion reactive or neoplastic? Neoplastic - Lymph node - Effaced architecture - Infiltration  LIVER, CHRONIC LYMPHATIC LEUKEMIA. DATA SHOW ONLY Section in liver showing: Dense aggregates of small lymphocytes infiltrating portal tracts and sinusoids.  BONE AND LYMPHOID GLASS SLIDES SCHEME 1) Lymphoid tissue (blue small cells) with rounded Lymphoid follicles (dark outside and pale inside): LYMPHOID HYPERPLASIA 2) Chondroid matrix (usually blue) with cells in lacunae: CHONDROMA 3) Multinucleated cells (high power may be needed here): GIANT CELL TUMOR OF BONE BONE AND LYMPHOID GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled  ENDOCRINE AND NEURO 5…..ALL CAN BE DATA SHOW AND GLASS SLIDES  Endocrine 3…..ALL CAN BE DATA SHOW AND GLASS SLIDES Diagnosis: Toxic Goitre (Grave’s Disease). Describe Glandular hyperplasia Section in the thyroid gland shows: Hyperplastic follicles variable in size and shape, lined by cubical or columnar cells which may form intrafollicular papillary processes. The colloid is pale stained, scanty and vacuolated (scalloped) specially at the periphery, or absent. The stroma shows dilated congested capillaries and lymphocytic infiltration. Arrows? Red: Papillae and yellow: Peripheral scalloping? Is this lesion neoplastic? No Diagnosis: Colloid nodular goiter Section in thyroid showing: Variable-sized closely packed (minimal stroma) THYROID FOLLICLES lined by cuboidal epithelium The follicles are distended with pink colloid Is this lesion is neoplastic? No - Variable sized follicles - Lining cells - Colloid - Stroma Diagnosis: Papillary carcinoma, thyroid PAPILLARY MALIGNANT TUMOR Section of thyroid gland showing: A PAPILLARY MALIGNANT TUMOR formed of papillae have thin fibrovascular CORES COVERED BY multiple layers of malignant cells. Solid masses of malignant cells are also present. The CELLS are pleomorphic with large vesicular (open face) nuclei and frequent mitosis (features of malignancy BUT NO HYPERCHROMASIA). Is this lesion neoplastic? Yes, Behavior? Malignant  Neuro 2…..ALL CAN BE DATA SHOW AND GLASS SLIDES Diagnosis: Meningioma Describe BENIGN TUMOR Section in a BENIGN TUMOR. The tumor cells are arranged in a whorly pattern. They are oval with small vesicular nuclei The central cells of some whorls undergo hyalinosis and appear as homogenous pink rounded bodies which might undergo calcification and appear dark blue (psammoma bodies). Arrows ? Psammoma bodies, Behavior? Benign Diagnosis: Schwannoma Describe. BENIGN TUMOR Section in a benign nerve sheath tumor formed of: Proliferating SCHWANN CELLS. These cells are spindle with elongated nuclei arranged in bundles parallel to each other so that their nuclei placed side by side forming palisade pattern (Antoni type I) The BACKGROUND show pink stroma. Arrows ? Psammoma bodies, Behavior? Palisade pattern of nuclei Nuclear palisading - Arrangement - Cells  ENDOCRINE AND NEURO GLASS SLIDES SCHEME THYROID FOLLICLES: NO THYROID FOLLICLES: 1) Thyroid + papillae: Papillary 1) Whorls + Psammoma: thyroid carcinoma. Meningioma. 2&3) Thyroid only: 2) If Not (Spindle shaped - Colloid and Cells : Colloid goiter cells with palisading): Schwannoma - Colloid and Cells : Toxic goiter ENDOCRINE AND NEURO GLASS SLIDES EXAMPLES Copy Right Dr. Eman Khaled Papillary thyroid carcinoma Colloid goiter Toxic goiter Meningioma Schwannoma SUM UP  NOTES: - While describing any MALIGNANT TUMOR: The comment includes infiltration by + arrangement of the cells + shape of the cells + features of malignancy + If sarcoma, comment on the matrix While describing any BENIGN TUMOR: The comment includes capsulated or not+ arrangement of the cells + shape of the cells + stroma. - While describing any PAPILLARY LESION (papilloma, papillary carcinoma or polyp): The comment includes core (fibrovascular tissue) and covering. - While describing any ACUTE INFLAMMATION: The comment includes edema, congestion, neutrophils, macrophages (+/- pus cells). While describing any CHRONIC INFLAMMATION: The comment mainly includes lymphocytes, plasma cells, macrophages and fibrosis. - While describing BILHARZIASIS: The comment includes bilharzia ova with yellowish refractile shell. Some are fresh showing pink miracidia and others are calcified (stained dark blue). Ova are surrounded by bilharzial reaction (lymphocytes, plasma cells, macrophages, giant cells, EOSINOPHILS and fibrosis). - While describing GLANDULAR HYPERPLASIA: The comment includes Increased number of the glands and variation in their size and shape. The glands are lined by columnar cells (if exocrine (prostate and breast) mention double cell layer), which might form multiple layers or papillary processes. Some glands are dilated and lined by flattened cells. + don’t forget to comment on the stroma Malignant tumors Malignant tumors Two components Three components Benign tumors  Papillary lesions / polyps Papillary Carcinomas  Acute Inflammation Acute Both non-suppurative fibrinous Suppurative Inflammation Bilharziasis Glandular hyperplasia exocrine  Clear Cytoplasm Dissolved during preparation Mucin