Pathology Slide List

Pathology Slide List Page 1 of 8

Slide Tissue Pathology Description Note normal respiratory mucosa with ciliated columnar epithelium. Normal tissue disrupted by a neoplastic mass of pleomorphic squamous cells with hyperchromatic and Squamous Cell 5 Larynx bizarre nuclei with eosinophilic cytoplasm. Identify keratin Carcinoma pearls associated with squamous cell CA. Most common laryngeal tumor, mostly 40y+ men, due to smoking and EtOH use. Benign neoplasm of breast. Collagenized stroma with breast ducts that are compressed and distorted by the proliferating stroma. Cells of both stroma and duct 16 Breast Fibroadenoma epithelium are bland and fairly easy recognizable. Nuceli normal. Most common breast tumor, mostly <25y Women. Generally painless, solitary, unilateral. Increased deposition of collagen representing end stage of healing. 1st – Epithelial cells migrate to cover surface. 2nd – Fibroblasts migrate in. Primitive CT deposited then 27 Skin Scar collage is made. Mature collage shows around 3 weeks. Keloid Scarring. More frequent in blacks, favors upper chest, back, shoulder. Thick whurling collagen in dermis. Endometrial atrophy – endometrium is thin and shows small, inactive glands with cystic dilatation. Compare to 30 Uterus Atrophy slide 153 with normal proliferative endometrium. Postmenopausal due to decreased estrogen or ovary removal. Thinning of vaginal mucosa and higher inf. risk. Cellular elements are present, granuloma has formed around the foreign body. Giant cells, macrophages, and lymphocytes present. Some foreign material has been 31 Skin Foreign Body phagocytosed (yellow material). Tumor, Rubor, Calor, Dolor, loss of function. Possible silicosis and asbestosis. Gross- Rounded areas are nodules of hyperplastic prostate gland. Micro- Closely spaced gland with papillary enfoldings. Dilated glands with large lumen are indicative 34 Prostate Hyperplasia of atrophy. Mostly 60y+ men, Nocturia, Polyuria, difficult micturition. TURP Procedure (transurethral resection) Diffuse infiltration of thyroid with lymphocytes and plasma cells, and formation of germinal centers. Follicular epithelium undergoes transformation to form small acinar structures composed of large granular cells (Hurthle or Hashimoto’s 39 Thyroid Askanazy cells). Cuboidal acinar cells = ↑Pink, Thyroiditis ↑Granules, ↓Size due to cytotoxic damage (Type II). Mostly older women, slow diffusely enlarged thyroid; cold intolerance, constipation, puffy face. Elevated TSH, Low T4. Pathology Slide List Page 2 of 8

Slide Tissue Pathology Description Mucosal ulceration (discontinuity). Notice large number of granulocytes in region. Note PMNs attached to endothelium of blood vessels in periappendiceal fat. 40 Appendix Acute Appendicitis PMNs on serosal surface causing abdominal tenderness. RLQ Pain, GI Symptoms (N/V/D). Antibiotic Tx early, or surgical excision. Rebound Tenderness on palpitation Malignant neoplasm of colon/rectum from glandular epithelium. Cells have variable nuclei (size, shape, chromatin pattern, nucleoli). Cells form recognizable 43 Rectum Adenocarcinoma glandular pattern around central lumen. INVASIVE. Most common malignancy. Tumor Cells produce CEA and CA-19-1 Markers. Poor, Mod, or Well Differentiated. CA characterized by sheets of large, irregular pink cells with abundant cytoplasm and anaplastic nuclei. This is moderately differentiated. Keratin pearls are not readily Squamous Cell 47 Lung found. Necrotic hilar nodes Carcinoma Arises from bronchial epithelium, more common in men, silent, therefore meta before detection, cachexia, hyporesonance, SOB. Note PMNs in alveolar space. Fibrin and other plasma proteins appear as threadlike eosinophilic strands in alveoli. Abscess is present due to necrosis. Sputum color due to PMN. Acute Pneumonia Focal consolidation (alveolar exudates with fibrin and inflammation). Note minimal tissue destruction relative to number of PMN. Septa are preserved. Inflammation exteds into adjacent alveolar spaces through Pores of 58 Lung Kohn. Bronchopneumonia follows bronchial tree and may expand out (confluence). Parasitic (eosinophils in wall), Viral (Lymphocytes in alv. wall), Bacterial (PMN in wall). Bronchopneumonia Red color = hemorrhagic, Blue color=PMN Infiltrate. Lobar Pneumonia confined to alveoli, bronchopneumonia is restricted to planes near bronchi. Abscess formation, SOB, Sputum (yellow-gray), CXR Whiteout. Malignant neoplasm of liver. Note similar architecture of normal and malignant cells. Malignant cells are more bluish in cytoplasm, mitotic bodies, high N:C ratio, fibrous Hepatocellular capsule, larger, and more vesicular (open) nuclear 60 Liver Carcinoma chromatin pattern with very large nucleoli. [hepatoma] Elevated α-FetoProtein AFP. More common in Males. Death within 6mo; GI/Esophageal Variceal Bleeding, Liver Failure. Sudden, worsening ascites, HBV associated. Pathology Slide List Page 3 of 8

Slide Tissue Pathology Description Note connective tissue septa staining blue-gray with criss- cross pattern breaking tissue into regenerative nodules. Nutritional Cirrhosis 63 Liver Steatosis present. ‘Alcoholic Cirrhosis’ Portal HTN  ascites, varices, caput medusa; jaundice, hypoalbuminemia, Clotting factor deficiencies. Usually located over extensor tendons in elbow or ankle. Central area of necrosis with fibrinoid material. Epithelioid cells are presence. Lymphocytes in Rheumatoid perivascular dermis of surrounding tissue. Compare with 73 Skin Arthritis TB necrosis. Increased euchromatin in macrophage  inactive, non-differentiated, immature macrophage. May appear to be granuloma but no giant cells. Present in 25% of RA pts. RF Factor, joint pain / stiff. Mixed tubular glands and villous fronds. Benign neoplasm. Villous adenoma is higher risk than tubular for 84 Colon Tubular Adenoma malignancy. Projects into lumen via stalk. Glands without mucous. Blood in stool, anemia, dx w/ colonoscopy, APC Gene. Malignant neoplasm of breast. Malignant cells are epithelial cells from breast duct. Neoplastic cells grow and infiltrate as cords and strands, destroy normal tissue, and are accompanied by collagenous reaction (desmoplasia). Pleomorphic, rough, angular shaped Infiltrating ductal 86 Breast cells. Necrotic region due to tumor growth faster than carcinoma angiogenesis. Elevated Estrogen/Prog receptors, Cathespin D, CA- 15-3, and c-erb B2 markers; most common breast CA. Firm on palpation. Low malignancy risk. Nodes involved= bad. Nodularity of lung tissue under normal light. Early granulomas =alveoli with PMN, Macrophage infiltrate and few epithelioid/giant cells. Mature granulomas have rim of epithelioid cells (mononuclear cells with ill-defined pink cytoplasm and elongated nuclei ~kidney shaped) Giant 92 Lung Coccidioidomycosis cells present, with caseous necrosis, red granular material. Cocci located in giant cells or necrotic region. Mature granulomas have fibroblast capsule. Caused by Spore inhalation, Endemic in SW and West (Vally Fever) Cough, fever, chills, CP, Skin Test-confirm. Brain tissue covered by Meninges. Subarachnoid space contains blood vessels and intense infiltrate of neutrophils. Expect PMN in CSF from LP. Acute Pyogenic 95 Meninges Pyogenic meningitis – note thickening due to edema Meningitis and PMN infiltrate. Creamy pus in SA space. Fever, stiff neck, ALOC, HA, High CSF Pressure, PMN in CSF, Milky white CSF fluid from LP. Pathology Slide List Page 4 of 8

Slide Tissue Pathology Description Granuloma against normal lung tissue. Granulomas are proximal to bronchovascular structures. Non-caseating necrosis; also nodal involvement. Clustered epithelioid cells with giant cells. Mature lymphocytes are present at Lung the periphery. Asteroid body – eosinophilic star-shaped 104 Sarcoidosis (ON EXAM) inclusion in giant cells, frequent in sarcoidosis. Multi-system disease, pulmonary infiltrates and hilar adenopathy, little resp dysfunction, fever, wt. loss. Also found in Liver and spleen. Lung and Node on Slide. DO NOT CALL THIS METASTATIC CANCER Disruption of normal liver architecture due to massive destruction. HBV may be visible with staining. Note lymphocytes, macrophages, responding to infection and cell necrosis. FEW POLYS. Councilman body (single Hepatitis B Viral necrotic/apoptotic cell). 106 Liver Infection Appears ‘Moth-eaten’. Relatively scant number of inflammatory cells present. Increased number of PMNs in Alcoholic Hepatitis (slide 251). Need stain for HepB differentiation. Trans via fluid exchange. Ch. liver cell loss and fibrosis  cirrhosis. Medicum sized arteries with inflammation around and extending through the vessel wall and fibrinoid necrosis. Muscle/ Necrotizing 120 NERVE = VASCULITIS until March. Inflammation can Nerve Vasculitis cause recanalization of vessel. Myocarditis / muscle pain, neuritis, immune mediated! Note parenchyma in hemorrhagic area Hemorraghic/ Coagulative Necrosis. Granular tissue with preserved architecture, except in hemorrhagic necrotic areas. 127 Lung Pulmonary Infarct Pulmonary infarcts are hemorrhagic due to its dual blood supply. CXR, V/Q Scan, Spiral CT, CP, SOB, PaHTN, Emboli commonly from DVT, saddle emboli=death. Contrast appearance of the post mortem clot with the Post Mortem thrombus in slide 132. Not attaced to vessel wall, 131 Lung Thrombus – ‘Clot’ homogenous appearance, no lines of Zahn. Not organized, post-mortem, two layer appearance. Look for the lines of Zahn in the thrombus (laminated layers of platelet-fibrin columns with RBCs). Attached to Pulmonary Artery vessel endothelium via fibroblasts. Recanalization 132 Lung Thrombus present. Formed in active blood flow areas, cause bruits, angiographic findings, may liquefy or become organized. Observe wedge-shaped pale area – this is the infracted portion. Example of coagulative necrosis due to ischemia. Note preserved architecture. Glomeruli and 134 Kidney Acute Renal Infarct tubules are still recognizable, but are anucleated. Zone of PMNs in remaining parenchyma surrounds the infarct. Renal Hypertension, Flank pain, proteinuria, hematuria Pathology Slide List Page 5 of 8

Slide Tissue Pathology Description Large granuloma is more mature than that in slide 92. Many cellular elements are gone; some epithelioid cells are present. Large central area of caseous necrosis Lung 139 Tuberculosis (yellow, friable, cavitating) and well defined periphery of (ON EXAM) fibrous tissue. Respiratory spread, fibrosis leads to restrictive lung disease, TB PPD +, Fever Night sweats Cough. Area of ulceration (flask shaped) are points of discontinuity of mucosa that stain pink, granular and necrotic cellular debris with inflammatory cells. Amoeba Acute Infection - located at base of ulcer (look like macrophages with 147 Colon Amoebiasis granular appearance, hypochromatic.) With trichrome stain, show nucleus and engulfed RBC (same size). Blood in stool, sepsis, diarrhea, Visible ulcers via colonoscopy. Note mature squamous cells within the pulmonary alveolar capillaries. Cells appear wrinkled, pale blue/gray Amniotic Fluid 149 Lung within the lumen. Numerous PMNs, may lead to DIC. Embolism Dysfunctional Labor, Respiratory Problems, 80% mortality, use up clotting factors. Cross section of fallopian tube affected by inflammation, dilated lumen, intact architecture. PMNs are seen in the folia (papillary fronds in lumen) and in lumen itself. Blood 154 Fallopian Tube Acute Salpingitis Vessel dilation. Compare to ureter and bile ducts. Usually bilateral º PID, women 15-25y, Mostly due to pyogenic Chlamydia then gonorrhea, Abd pain-esp. with cervix movement. Fever, cervical discharge. Tx w/ antib. Generalized thickening of myocardium, therefore increased volume of heart muscle is present. Hypertrophic changes of nuclei are visible where the 160 Heart Hypertrophy fibers have been cut longitudinally. Notice Box Car nuclei are enlarged and increased chromatin density. LV Damage has systemic effects (renal,hepato,spleen) CP, syncope, palpitations, sudden death. Systemic HTN. Hypertrophic synovium. Note papillary folds with Synovial cells infiltrated with T-cells. Type III Immune reaction occurs within the joint and PMNs mediate inflammation in Rheumatoid the joint. Aspiration shows PMNs and depleted 162 Synovium Arthritis complement components. Synovial cell proliferation. Pannus is a foci of necrosis and fibrinosis. RA Factor. Pannus = granulation tissue, painful, stiff joints, Type III Rxn. Ankylosis may occur. Irregular and variable enlargement, hyperchromasia of nucleus, and disordered arrangement of cells. No Squamous 172 Vulva evidence of invasion, no mitotic figures. Dysplasia Pap-smear, biopsy to determine malignancy, few early signs. Puritis, leukoplakia (white, patch-like lesion). Pathology Slide List Page 6 of 8

Slide Tissue Pathology Description Look for smaller than normal trabeculae with an irregular, ‘moth eaten’ edge. These are necrotic areas. Marrow is replaced by fibrous reparative tissue. Note areas of acute 176 Bone Osteomyelitis process (PMN) and subacute/chronic (Lymphocytes). No clasts, blasts, or cytes. May contain Bacteria º trauma/surgery, hemotogenous spread, bone pain, muscle spasm, guarded movement. Inflammed joint of RA pt. Bone is covered by distorted reticular cartilage with frond-like projections of synovium covering cartilage. Pannus = region of inflammatory destruction of cartilage. Increased lymphocytes and Rheumatoid angiogenesis. Cyst formation in bone. 179 Bone / Joint Synovitis (RA) Pannus has eroded the articular hyaline cartilage and exposed the bone. Fibrosis leads to loss of mobility and ankylosis of joint. Plasma cells may be present. HLA DR4 risks, Rheumatoid Factor, Joint pain / stiffness / deformity, ankylosis, vasculitis. Malignant neoplasm of bone from osteoblasts. Cells with irregular hyperchromatic nuclei forming bright-pink osteoid (non-mineralized matrix). Do not confuse with recent fx healing. Increased vascularization. Osteogenic 185 Bone Most common bone tumor, likes epiphyseal plates, Sarcoma common lung Meta. Young men infection, uremia, trauma, 2.5X increase in serum alkaline phosphatase. XR: irregular destruction, may break through cortex to soft tissues. Invasive, moderately- differentiated squamous cell carcinoma. Malignant cells arranged as sheets with fairly well defined cytoplasmic margins and abnormal nuclear configurations. Note KOILOCYTOTIC changes of HPV (wrinkled cells with cytoplasmic clearing and raisin like Squamous Cell nuclei on periphery.) Note changes of carcinoma in situe 189 Cervix Carcinoma along the surface. Lymphatic invasion causes small groups of malignant cells to have areas of clear space around them in the CT. Middle age women, most common cervical CA, DysplasiaCA in situinvasive CA. Pap Smear, vaginal discharge, HPV 16,18,31,33. Identify capsule, sinusoids and lymphocytes of the node. Loss of desmosomes at BM. One or more groups of cells Metastatic can be identified with in the lymph node with the 201 Lymph Node Squamous Cell differentiating features of squamous CA. Keratin pearls Carcinoma and intercellular bridges are helpful features to identify squamous differentiation. CA elsewhere, Lymphadenopathy, Malignant. Pathology Slide List Page 7 of 8

Slide Tissue Pathology Description Pure villous adenoma. Benign neoplasm with higher risk for malignancy than tubular adenoma. Broad-based 219 Colon Villous adenoma lesion with velvety surface. Cells have hyperchromatic stratified, CROWDED and elongated nuclei. Blood in stool, anemia, APC Gene, Colonoscopy Benign neoplasm of ovary with endoderm, mesoderm, and ectoderm cell layers. Skin, Respiratory epithelium, Benign Cystinc hair GI Glands, Cartialge, Brain, Teeth, etc. 223 Ovary Teratoma Generally benign in female, malignant in testis. ‘Dermoid Cyst’ Generally present as mass. Unilateral, may cause infertility, torsion. Mature=better, immature=bad. Fibrosis has altered lung architecture (compare to #178). Fibrosis is seen as bands or strands of eosinophilic Chronic fibrillar material. Fibroblasts are present. Septal walls Inflammation & are thickened in regions of preserved architecture. Lung 242 Lung Fibrosis skeleton is disorganized and simple. EMPHYSEMA (Idiopathic Pulm. LACKS THIS FIBROSIS. Monos>PMNs. Edema/Exudate Fibrosis) Respiratory difficulty º low O2 diffusion, hypoxia and cyanosis, hyporesonance, high respiratory rate. Well-circumscribed neoplasm with cells derived from islets of langerhans and show a trabecular (cord-like 244 Pancreas Islet Cell Adenoma pattern). Most commonly a beta cell tumor (insulinoma). Insulinoma, elevated C-Peptide, Hypoglycemia. Chronically inflamed liver from pt with EtOH abuse. Fibrous tissue extends between periportal areas dividing the liver into abnormal nodules. Cirrhosis = fibrosis with 251 Liver Cirrhosis regeneration of some cells. Increased PMN infiltrate = acute alcoholic hepatitis. Steatosis. Mallory Bodies. Jaundice, HTN, Hypoalbuminemia, hepatomegaly, micronodular (<3mm). Note anucleated cells in the lesion. (Pyknosis, Karyorrhexis, Karyolysis). Identify mural thrombus. Locate fibroblasts on thrombus / myocardium interface. Acute Myocardial 259 Heart Decreased contraction of heart leads to stasis and Infarct thrombosis. PMN Infiltrate. Ischemic Heart Disease, CP, Indigestion, ECG Changes, CK/CKMB/Trop I. Large vessels in Subarachnoid space show granulomatous infiltration within the vessel wall and Granulomatous 284 Brain epithelioid histocytes and well formed giant cells are angitis present. Also seen in temporal arteritis. 30-40y women, Temoral vessel lumps, WBCs in LP. Hyaline in vessel wall represents IgG, and leaked plasma IP 1&2 Vessels Allergic Vasculitis protein. Pathology Slide List Page 8 of 8

Note Processes – Pylonephritis: Infection and loss of architecture with pus and PMN infiltrate. If scattered foci, then hematogenous infection. If ascended from bladder, infection travels from renal pelvis  medulla  cortex.