Pr.Dr. Magdy Ismael Ahmed

neutrophils lymphocyte

Plasma cell macrophage

Mast cell eosinophil

Giant cellFibroblast

Collagen fibers

Inflammation Acute inflammation :-e.g Acute suppurative appendicitis.Chronic inflammation :-e.g Ch.inflammation of skin.

Repair Myocardial scarring

Appendicitis

Definition :- Inflammation of appendix ( either acute or chronic)Etiology :- Predisposed by:-1-Obstruction of its lumen or hyperplasia of lymphoid follicles.2- Fibrosis of the wall Excited by infection with Strep.E.coli or staph.

Pathology-: 1-Acute catarrhal appendicitis (edema,congestion ,serous fluid)

2-Acute suppurative appendicitis(filled by pus) 3-Acute gangrenous appendicitis(black in colour and offensive).

Complications-: 1-Perforation septic peritonitis (diffuse or localized)

2-Appendicular mass :-Fibrosis and adhesion with intestine and omentum

3-Appendicular abscess4-Sinus & fistula

5-Portal pyemia

Pathology-: Gross picture Comment -The appendix slightly enlarged ,congested and edematous .-The lumens are filled by inflammatory exudate-The serosa show dark spots of hemorrhages

Diagnosis: Acute suppurative appendicitis.

Slide (1):-Slide (1):-Acute suppurative Acute suppurative

appendicitisappendicitis Naked eyeNaked eye :-Circular structure with bluish wall :-Circular structure with bluish wall Organ :-Organ :-T.S. of an appendixT.S. of an appendix Comment :-Comment :-

1-Lumen1-Lumen :- :-Necrotic debris,intact and dead Necrotic debris,intact and dead PNLs,PNLs,

2-Mucosa :-2-Mucosa :-Intact and ulcerated areasIntact and ulcerated areas 3-Submucosa :-3-Submucosa :-Edema ,dilated and congested Edema ,dilated and congested

blood vessels , hyperplastic lymphoid follicles blood vessels , hyperplastic lymphoid follicles and PNL,s may extends to musculosa or serosa and PNL,s may extends to musculosa or serosa

Diagnosis Diagnosis :- :- Acute suppurative Acute suppurative appendicitis appendicitis

Slide (2):- Slide (2):- Chronic inflammationChronic inflammation

OrganOrgan ::- Section in the skin- Section in the skin Comment :-Comment :- 1-Epidermis1-Epidermis :- :- Thickened epidermis and keratinThickened epidermis and keratin 2-Dermis 2-Dermis :-:- -Arterioles :- Thickened and narrowed (EAO)-Arterioles :- Thickened and narrowed (EAO) -Peri-vascular cuffing by (lymphocytes ,plasma -Peri-vascular cuffing by (lymphocytes ,plasma

cellscells and macrophages)and macrophages) -Increased fibroblasts and collagen. -Increased fibroblasts and collagen.

Diagnosis :- Diagnosis :- Chronic inflammation in Chronic inflammation in

skin skin

Slide(3):-Myocardial scarring OrganOrgan :- Section in heart:- Section in heart

Comment :-Comment :- Intact cardiac musclesIntact cardiac muscles :- Running in different directions :- Running in different directions

Infarction areaInfarction area :- Pale pink,fibrous tissue :- Pale pink,fibrous tissue area ,composed of wavy collagen,few fibroblasts and area ,composed of wavy collagen,few fibroblasts and few dilated thin walled capillariesfew dilated thin walled capillaries

Diagnosis:- Diagnosis:-

Myocardial scarring Myocardial scarring

Cell injury (degeneration)Water accumulation :-e.g Cloudy swelling of kidney Fat accumulation :-e.g fatty change of liver

Cloudy swelling :- Reversible cell damage characterized by mild

accumulation of water inside cells. Oragns affected :-Proximal convoluted tubules of

kidney ,liver and heartPathogenesis:-swollen mitochondria is fragmented

with resultant decreased production of ATP and consequent distrubed Na/K pump retention of Na and H2O inside cells .

Pathology Grossly :- The organ size :- Increased Colour :- Pale Consistency:- Soft

Cloudy swelling of kidney

Section in the kidney :-Section in the kidney :- Glomeruli :-Glomeruli :- Normal Normal Tubules :-Tubules :-

--LumenLumen :- Narrowed and star shaped:- Narrowed and star shaped

--Lining epithelial cells Lining epithelial cells

*Swollen*Swollen

*Conical (pyramidal ) shaped.Its apex *Conical (pyramidal ) shaped.Its apex directed directed

inward.inward.

*Pink and granular cytoplasm *Pink and granular cytoplasm (mitochondrial(mitochondrial

damage. damage.

*Intact rounded nuclei .*Intact rounded nuclei .

Diagnosis Diagnosis :- :- Cloudy swelling of the kidneyCloudy swelling of the kidney

Fatty change ,liverA condition characterized by accumulation of

triglyceride inside hepatocytesCauses:-1-Toxins->diphtheria 2-Chemicals as phosphorus

and CCL4Etiology:-1-Increased entrance of FFAheptocytes2-Increased synthesis of FA and decreasd its

oxidation 3-Increased estrification of FA4-Decreased formation of phospholipids5-Decreased excretion of phospholipids.

Specimen :- Section of liver Size :- enlargedSurface :-SmoothCapsule :-Thin ,stretched easilyStrepedColour :- YellowishBorders :- RoundedConsistency:- Soft

D13

Section in liver :-Section in liver :- Liver cells :-Liver cells :-

CytoplasmCytoplasm :- Contain large clear :- Contain large clear vacuolesvacuoles

Nuclei :-Nuclei :-Peripheral located Peripheral located nuclei(signetnuclei(signet

ring appearance.ring appearance.

Some intact liver cellsSome intact liver cells are seen. are seen.

Diagnosis :- Fatty changes of liver.Diagnosis :- Fatty changes of liver.

Slide(5):-Fatty changes of liver

Naked eyeNaked eye :-Rounded structure with intra-luminal :-Rounded structure with intra-luminal thrombus (2thrombus (2ndnd rounded structure) rounded structure)

Section in blood vessel :- Section in blood vessel :- 1- The lumen of blood vessel :- 1- The lumen of blood vessel :-

-Filled by thrombus mass attached to the vessel-Filled by thrombus mass attached to the vessel

wall at one point (head of the thrombus ) wall at one point (head of the thrombus )

2-The thrombus mass containing :-2-The thrombus mass containing :-

pale pink lines radiating from the head (pale pink lines radiating from the head (lines of Zahnlines of Zahn) and ) and contain in between meshwork of fibrin ,RBC,s and contain in between meshwork of fibrin ,RBC,s and WBC,s.WBC,s.

Diagnosis :- Diagnosis :- Recent thrombus Recent thrombus

Slide(6):-Recent thrombus

2nd of circular lesions

Naked eyeNaked eye :- 3 :- 3rdrd rounded structure rounded structure Section in an artery :-Section in an artery :-

IntimaIntima :- Degenerated and elevated :- Degenerated and elevated

SubintimaSubintima :- Fibro-fatty mass containing :- Fibro-fatty mass containing , needle like crystals of , needle like crystals of cholesterol. and haylinized C.T ± cholesterol. and haylinized C.T ± calcification calcification

Elastic laminaElastic lamina :-Fragmented :-Fragmented

Media opposite the lesionMedia opposite the lesion :- Atrophic . :- Atrophic .

DiagnosisDiagnosis :- :- Atherosclerosis of an Atherosclerosis of an arteryartery

Slide(7):-Slide(7):-AtherosclerosisAtherosclerosis

Atheroma

Calcification

Media

crystals

Section in lung tissueSection in lung tissue :- :- Alveolar wall :-Alveolar wall :- -Thickening of the alveolar wall.-Thickening of the alveolar wall.

-Dilated congested blood capillaries-Dilated congested blood capillaries

Alveolar space:-Alveolar space:- -Fibrin mass entangling ,RBC,s,WBC,s and large -Fibrin mass entangling ,RBC,s,WBC,s and large

numbers of macrophages numbers of macrophages

-A retraction space is found separating the mass-A retraction space is found separating the mass

from the alveolar wall. from the alveolar wall.

Diagnosis :-Diagnosis :-Lobar pneumonia grey Lobar pneumonia grey hepatization hepatization

Slide(8):-Lobar pneumonia (grey

hepatization)

Fibrin mass

PNL,s

Retraction space

Lobar pneumonia grey hepatization

Section in nasal polyp :-Section in nasal polyp :- The polyp composed of fibro-vascular C.T core The polyp composed of fibro-vascular C.T core

covered by epitheliumcovered by epithelium . .

*The covering epithelium ;-*The covering epithelium ;- -Pseudostratified columnar ciliated epithelium,with -Pseudostratified columnar ciliated epithelium,with

focal areas of ulceration or squamous metaplasia .focal areas of ulceration or squamous metaplasia .

*The core show :-*The core show :- -Stromal edema-Stromal edema -Thin dilated blood vessels-Thin dilated blood vessels -Mixed inflammatory cellular infiltrates -Mixed inflammatory cellular infiltrates

(PNL,s ,lymphocytes ,plasma cells ,macrophages and (PNL,s ,lymphocytes ,plasma cells ,macrophages and eosinophils)eosinophils)

-Hyperplastic mucus secreting glands .-Hyperplastic mucus secreting glands .

Diagnosis :- Diagnosis :- Nasal polyp Nasal polyp

Slide(9):-Nasal polyp

Blood vessels

Edema

Eosinophil

Squamous metaplasia

Slide(10):-Bronchogenic carcinoma Section in lung :-Section in lung :- The lung tissue show :-The lung tissue show :- -Area of intact lung tissue -Area of intact lung tissue -Infiltration of lung tissue by malignant cells are -Infiltration of lung tissue by malignant cells are

disposed in one of three patterns . disposed in one of three patterns .

1-Squamous cell carcinoma1-Squamous cell carcinoma :-Nests of malignant :-Nests of malignant squamous epithelium ± keratin pearls (squamous epithelium ± keratin pearls (cell nestscell nests) )

2- Or Adenocarcinoma2- Or Adenocarcinoma with well formed malignant with well formed malignant aciniacini

3-Or Aot cell carcinoma3-Or Aot cell carcinoma :- Malignant ,darkly :- Malignant ,darkly stained small sized cells with rounded ,oval or stained small sized cells with rounded ,oval or spindle shaped hyper-chromatic nuclei and scanty spindle shaped hyper-chromatic nuclei and scanty cytoplasm. cytoplasm.

Diagnosis :-Diagnosis :- Bronchogenic carcinomaBronchogenic carcinoma

Squamous cell carcinoma

Fibrous septae

Aot cell carcinoma

Lung tissue

Bengin tumorsA-Tumors arise from the epithelium 1-Surface epithelium :- Squamous cell papilloma

2-Glandular epithelium :- a-Adenoma of intestine b-Fibroadenoma of the

breast (intracanalicular and pericanalicular )

B-Tumors arises from mesenchymal tissue 1-Fibroma

2-Leiomyoma 3-Chondroma 5-Lipoma

Slide (11) Slide (11) Squamous cell papillomaSquamous cell papilloma

DefinitionDefinition :- benign tumor of surface epithelium. :- benign tumor of surface epithelium. SitesSites :- Skin –lips –oral mucosa –cervix -pharynx - :- Skin –lips –oral mucosa –cervix -pharynx -

vagina and anal canal .vagina and anal canal . Gross picture Gross picture :- Small sessile or pedunclated :- Small sessile or pedunclated

projection projection Microscopic picture Microscopic picture :- :- The coreThe core:- Composed of fibro-vascular connective :- Composed of fibro-vascular connective

tissue tissue The coverThe cover:-Composed of hyperplastic :-Composed of hyperplastic stratified squamous epithelium showing:-stratified squamous epithelium showing:-

--HyperkeratosisHyperkeratosis:- Increased keratinous layers:- Increased keratinous layers --ParakeratosisParakeratosis:- Nucleated keratin:- Nucleated keratin --AcanthosisAcanthosis:- Increased number of prickle cell :- Increased number of prickle cell

layerlayer

Squamous cell papilloma

Squamous cell papilloma

Squamous cell papilloma

Slide (12) Slide (12) AdenomaAdenoma

DefinitionDefinition :- :- A benign tumor of endocrine and A benign tumor of endocrine and exocrine glands and mucosal glands of GIT and exocrine glands and mucosal glands of GIT and endometrium.endometrium.

Gross picture Gross picture :- A well –defined capsulated ovoid :- A well –defined capsulated ovoid mass mass

cut section : solid ,cystic or papillary cystic cut section : solid ,cystic or papillary cystic

Microscopic picture Microscopic picture :- Proliferated glands lined :- Proliferated glands lined by cuboidal or columnar epithelium separated by a by cuboidal or columnar epithelium separated by a dense fibro-vascular connective tissue stroma (colon dense fibro-vascular connective tissue stroma (colon adenoma ) adenoma )

Adenoma

Adenoma

Slide (13) Slide (13) Fibroadenoma of the breastFibroadenoma of the breast

DefinitionDefinition :- :- Mixed benign tumor composed Mixed benign tumor composed of glandular and fibrous tissue elementsof glandular and fibrous tissue elements

Gross picture Gross picture :- Well circumscribed :- Well circumscribed capsulated tumor mass .capsulated tumor mass .

Cut section :- Grayish white, firm and lobulated Cut section :- Grayish white, firm and lobulated massmass

Microscopic picture Microscopic picture :- Proliferated :- Proliferated fibrous tissue stroma and glandular tissues.The fibrous tissue stroma and glandular tissues.The ducts are lined by double cell layers of benign ducts are lined by double cell layers of benign ductal epithelial cells .ductal epithelial cells . - -Pericanalicular Pericanalicular fibroadenoma fibroadenoma :-The ducts are :-The ducts are Patent Patent Intracanaliclar Intracanaliclar fibroadenoma fibroadenoma :-The ducts are closed .:-The ducts are closed .

Pericanalicular fibroadenoma

Intracanalicular Fibroadenoma

Benign mesenchymal tumorsFibroma Leiomyoma Lipoma Chondroma

Origin: arise from the fibrous tissue.Sites: Fibrous tissue stroma of organs (breast ,ovary and kidney) , intermuscular septa, submucosa,Grossly: capsulated, oval, soft (cellular) to hard and Cut section :- Whorly bundles grayish white (hard) or pinkish –white(cellular) in colour .Microscopically: bundles of mature fibroblasts, collagenous tissue, and few capillaries. If excess collagenhard fibroma,if excess fibroblastssoft fibroma. Types: -Pure fibroma.-Mixed fibroma, with glandsfibroadenoma, with muscles fibromyoma

Slide (14) : Slide (14) : Fibroma

Slide (14) : Slide (14) : Leiomyoma

Origin: from smooth muscles.Sites: uterus is the most common (fibroid) GIT, bladder.Grossly: non capsulated (false capsule) , single or multiple, rounded, firm . C.S whorled pattern, composed of pinkish and whitish interlaced bundles . Microscopically: interlacing bundles of smooth muscle fibers separated by fibrovascular stroma.

Slide (15) : Slide (15) : lipomalipoma Origin:Origin: from fatty tissues.from fatty tissues. Sites:Sites: Subcutaneous tissues of the Subcutaneous tissues of the

arm, back, submucosa and arm, back, submucosa and retroperitoneum.retroperitoneum.

Grossly:Grossly: capsulated, round or oval, capsulated, round or oval, lobulated soft mass lobulated soft mass

C.S:-Bulging,pale- yellow and greasyC.S:-Bulging,pale- yellow and greasy Microscopically:Microscopically: capsulated, with fine capsulated, with fine

trabeculae dividing the tumor into trabeculae dividing the tumor into lobules that contain clusters of adult lobules that contain clusters of adult fat cells { clear cytoplasm with fat cells { clear cytoplasm with peripheral (signet ring) nuclei} and peripheral (signet ring) nuclei} and fewer clusters of embryonic fat cells fewer clusters of embryonic fat cells ( granular eosinophilic cytoplasm with ( granular eosinophilic cytoplasm with central nuclei..central nuclei..

Slide (16) : Slide (16) : ChondromaChondroma Origin: Origin: Benign tumors of cartilageBenign tumors of cartilage.. Sites:Sites: Short bones (hands & feets) , flat bones Short bones (hands & feets) , flat bones

(sternum ,ribs ,scapula) and ends of long bones (sternum ,ribs ,scapula) and ends of long bones ..

Grossly: Grossly: Capsulated, rounded or oval, Capsulated, rounded or oval, solitary or multiple mass .Cut section :- Sharp solitary or multiple mass .Cut section :- Sharp borders , lobulated bluish and translucent .borders , lobulated bluish and translucent .

Microscopically: Microscopically: The fibrous capsule The fibrous capsule sends trabeculae that divide the tumor into sends trabeculae that divide the tumor into lobules .Each lobule composed of lobules .Each lobule composed of chondrocytes (vacuolated cytoplasm with chondrocytes (vacuolated cytoplasm with central nuclei in lacunae) are arranged singly central nuclei in lacunae) are arranged singly or in groups .The stroma is pale blue hyaline or in groups .The stroma is pale blue hyaline matrix .matrix .

Chondroma

Malignant tumors Malignant epithelial tumors :- Carcinoma of surface epithelium :-

1-Squamous cell carcinoma 2-Basal cell carcinoma

Carcinoma of glandular epithelium :- 1-Adenocarcinoma 2-Mucoid adenocarcinoma

Malignant mesenchymal Fibrosarcoma

Slide 17 :- Slide 17 :- Squamous cell Squamous cell carcinomacarcinoma

Definition :- Definition :- Malignant tumor of stratified Malignant tumor of stratified squamous epithelium squamous epithelium

Epidermis:-Epidermis:- Intact or partially ulcerated Intact or partially ulcerated stratified squamous epithelial covering stratified squamous epithelial covering

Dermis :- Dermis :- Groups of malignant squamous Groups of malignant squamous epithelial (prickle) cells with pale pink ill defined epithelial (prickle) cells with pale pink ill defined cytoplasm ,large size vesicular nuclei with cytoplasm ,large size vesicular nuclei with prominent nucleoli .With or without central prominent nucleoli .With or without central keratin pearls (cell nests) .Few chronic keratin pearls (cell nests) .Few chronic inflammatory cells in between the nests.inflammatory cells in between the nests.

Hemorrhage and necrosis may be Hemorrhage and necrosis may be found.found.

SCC

Cell nests Keratin pearls

Lymphocytes

Slide 18 Slide 18 : : Basal cell carcinomaBasal cell carcinoma (Rodent ulcer) (Rodent ulcer)

Def:Def: - - Locally malignant tumor arising from the basal cell layer Locally malignant tumor arising from the basal cell layer of epidermis in face skin exposed to sun rays of epidermis in face skin exposed to sun rays Gossly:- Gossly:- starts as a firm reddish papule starts as a firm reddish papule nodule nodule finally finally

ulcerate .It erodes surrounding structures through its spread ulcerate .It erodes surrounding structures through its spread ( rodent ulcer) .It characterized by( rodent ulcer) .It characterized by Margin : rounded or oval margin Margin : rounded or oval margin

Edge: raised inverted (rolled in ) .Edge: raised inverted (rolled in ) . Floor: rough and necrotic .Floor: rough and necrotic . Base: indurated .Base: indurated .

Histologically:Histologically: invasion of the dermis by variable sized invasion of the dermis by variable sized masses formed of malignant basaloid cells that form palisade masses formed of malignant basaloid cells that form palisade appearance at the periphery. The surrounding stroma is appearance at the periphery. The surrounding stroma is retracted from them leaving spacesretracted from them leaving spaces

Basaloid cells

Palisading

Retracted stroma around the malignant masses

Slide 19 :Slide 19 :AdenocarcinomaAdenocarcinoma Origin: Origin: glandular tissue.glandular tissue. Sites:Sites: endocrine, exocrine glands, mucus endocrine, exocrine glands, mucus

membranes, GIT, endometrium.membranes, GIT, endometrium. Gross: Gross: in solid organsin solid organsirregular infiltrative growth,irregular infiltrative growth,in hollow organsin hollow organsfungating, infiltrating or ulcerating fungating, infiltrating or ulcerating

growth.growth. Microscopically: Microscopically: The malignant glands are: The malignant glands are: 1-irregular in size and shape. 1-irregular in size and shape. 2- They are lined by malignant cells . 2- They are lined by malignant cells . 3-They are present in abnormal location (in 3-They are present in abnormal location (in

submucosa ,musculosa even reach serosa) submucosa ,musculosa even reach serosa) 4-The glandular lumina are irregular or absent.4-The glandular lumina are irregular or absent. Grading: Grading: depends on architecture and cellular depends on architecture and cellular

differentiation.differentiation.

Adenocarcinoma colon

Normal mucosa

Malignant glands

Adenocarcinoma colon

Normal mucosa

Malignant glands

Slide 20 Slide 20 :Mucoid carcinoma:Mucoid carcinoma Origin:Origin: from glandular epithelium producing from glandular epithelium producing

mucin.mucin. Sites: Sites: mostly in GIT (stomach & colon).rare in mostly in GIT (stomach & colon).rare in

breast ,gall bladder and bronchi.breast ,gall bladder and bronchi. Grossly:Grossly: appears as soft gelatinous massappears as soft gelatinous mass.. Microscopicaly:Microscopicaly:

Mucoid (colloid) carcinomaMucoid (colloid) carcinoma: : adenocarcinoma adenocarcinoma rupture of cells rupture of cells release release of large amount of extra-cellular of large amount of extra-cellular mucinmucinPools of mucin containing floating Pools of mucin containing floating malignant cells.malignant cells.

Signet cell carcinomaSignet cell carcinoma: cells are distended : cells are distended with intracellular mucinwith intracellular mucin Signet ring cells Signet ring cells with minimal extracellular mucin.with minimal extracellular mucin.

Mucoid carcinoma, colon

Normal mucosa

Mucus pools

Slide 21 :Fibrosarcoma Definition : malignant tumor of fibrous tissueSites : subcutaneous,intermuscular and periosteal

tissuesGross picture :Large ,grayish white mass with foci

of hemorrhage and necrosis.Microscopic picture:- Fasicles of malignant

spindle cells separated by collagen (Herring –bone pattern)

Herring bone

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