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Muntasir Dhaka National Medical College Pathology

OSPE Question-Pathology

OSPE Question Pathology

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Specimen#1 Acute appenidicitis

This is a jar containing Specimen of Vermiform Appendix with Mesoappendix.It’s outer

surface is swallowen,Oedematous & congested subserosal vessel(& lumen contain exudate

External surface is lusterless),Probable diagnosis is Acute appenidicitis Confirmed by

Histopathology

What is the Complication of Appendicitis? 1. Appendicular lump

2. Appendicular abscess

3. Burst of appendix

4. Peritonitis

Hallmark of Diagnosis:Presence of Neutrophil in Muscle coat

Common Tumour:Carcinoid Tumour(Neuroendocrine Tumour)

Specimen#2 Chronic cholesystitis

This is a jar containing specimen of galbladder.It is swallowen, wall is Fibrosed &

thickened, probable diagnosis is chronic cholesystitis confirmed by Hystopathology

What is the Common Carcinoma of this viscera?

Adenocarcinoma

What are the Types of gallbladder Stone Cholesterol stone

Pigment stone

Mixed Stone

What is it’s Complication? Empyema

(Acute cholecystitis in the presence of bacteria-containing bile may progress to

suppurative infection in which the gallbladder fills with purulent material, a

condition referred to as empyema of the gallbladder)

Mycocele of Gallbladder

(Mucocele, or hydrops, of the gallbladder describes an overdistended gallbladder

filled with mucoid or clear and watery content)


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Specimen#3 Leiomyoma of Uterus

This is a jar containing a cut section of totally Resected Uterus.The Outer surface shows

multiple nodular greyish white lesion.My probable diagnosis is Leiomyoma of uterus

Confirmed by Histopathology

What’s it’s Malignant Counter part?

Leiomyosarcoma

What are the types of Leiomyoma?

1. Subserosal(Beneath the endometrium)

2. Intramural(Within the myometrium)

3. Submucosal(Beneath the Endometrium)

Specimen#4

Ca Cervix This is a specimen of totally receted uterus with both sided adnexi/Both sided fallopian

tube & ovary.The cut section shows an irregular greyish-white exophytic lesion.My

probable diagnosis is Ca Cervix Confirmed by Histopathology

What are the common Histological pattern?

Squamous cell carcinoma

Adenocarcinoma

Adenosquamous Carcinoma

Specimen#5 Carcinoma of Breast

This is a Jar containing Mastectomy specimen;which is partaily covered with skin

containing areola & nipple.Cut surface shows an irregular greyish-White tumourous

lesion.My probable diagonosis is Carcinoma of Breast Confirmed by Histopathology

What do you mean by Scirrhous Carcinoma?

It is one form of Desmoplasia of breast in which there is Greater extend of fibrosis which

forms a stony mass of breast

What do you mean by Comedo Carcinoma?

Dutctule carcinoma in situ with Central necrosis in situ

What is the Common Histologic Type?

Duct cell Carcinoma What’s Sentinile Lymphnod?What’s it’s significance


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The nearest lymphnode of a Neoplastic growth is called Sentinile Lymphnode

Significance:If sentinile Lymphnode is involved it is sign of malignancy What are the 4 prognostic criteria ?

1. Size

2. Involvement of Lymphnode & In situ

3. Invasiveness

4. ERPR

Specimen#6 Carcinoma of Colon

This is a Jar containing part of intestine.The mucosa shows a cauliflower/Fungative/ Exophytic growth.My probable diagnosis is carcinoma in colon confirmed by

histopathology

What are the common malignant tumour of this organ?

Adenocarcinoma

Carcinoid tunour

GIST(Gastrointestinal stromal tumour)

Lymphnode

What are the common Benigntumour of this organ?

Adenoma of colon

Specimen#7 Lymphnode

It is a jar containing decested section of Lymphnode showing-

Macroscopically it is Cheesy white material & Microscopically it shows Amorphous,

Granular, Eosinophilic cellular Debris my impression is tubercular granuloma confirmed

by Histopathology What’s Granuloma? A granuloma is a focus of chronic inflammation consisting of a microscopic aggregation

of epithelioid cell surrounded by a collar of mononuclear leukocytes & occationally

plasma cells. Older granulomas develop an enclosing rim of fibroblast & connective tissue What are the Gian cell?

physiological

SyncytoTrophoblast

MegaKaryoCyte

Oesteoblast

Pathological

Langhan’s Type of Giant cell

Foreign body giant cell

Tutan giant cell

Tumour giant

Reed-SteinBerg Giant cell


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Specimen#8 Renal Cell Carcinoma

This is a Jar containing Specimen of Resected Kidney.The cut section shows the upper pole with

large greyish-white Tumourous lesion.My probable diagnosis is Renal cell carcinoma confirmed

by histopathology

What are the Types of Renal cell carnoma?

1. Clear cell carcinoma

2. Papillary carcinoma

3. Chromophobe carcinoma

What are the common childhood tumour of this organ?

Wilm’s Tumour/Nephroblastoma

Specimen#9 Squamous cell carcinoma

This is a specimen of a peice of lung tissue.The cut surface shows greyish-white tumourous lesion at

base.My probable diagnosis is lung cancer

What are the common histologic type?


Small cell carcinoma

Adenocarcinoma

Largecell caecinoma

Carcinoid tumour

What is the most common aetiologic factor?

Smoking

Name the most common industrial factor?

Asbetosis

Specimen:10 Nodular goitre

This is jar containing a cut a cut surface of thyroid gland.This sliced specimen of thyroid tissue give

multipleee meaty nodular appearance.My probable diagnosis is nodular goitre confirmed by

histopathology

What’s the Most common malignant Type?

Papillary carcinoma

What do you mean by cold nodule? A nonfunctioning thyroid nodule/lump that does not concentrate radioactive isotopes in a thyroid

scan and may be indicative of cancer.


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Microscopic Slides Slide#1

Nodular goitre Section shows thyroid goitre.It reveals thyroid follicle of various sizes containing

Colloid.Follicle of various sizes containg colloid.Follicles are fibrosed, hyalinization &

evidence of haemorrhage-haemosiderin laden macrophage

No maignancy seen

My diagnosis:Nodular goitre of thyroid gland

What are causes/Types of goitre?

1. Colloid goitre,Simple goitre or, diffuse non-toxic goitre

2. Multinodular goitre

3. Diffuse toxic goitre(Grave’s disease)

4. Thyroiditis

5. Neoplasm

What are the nodular lesions of thyroid?

1. Mulinodular goitre

2. Adenomas

3. Carcinomas

4. Other

What are the autoimmuno thyroid disease?

Grave’s disease

Hashimoto’s thyroiditis

Primary myxoedema


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Slide#2 Granulomatous lymphadenitis

Section shows lympnode.It reveals many granulomas composed of area of Caesiation

necrosis surrounded by epithilioid cells, rim of lymphocyte, small number of plasma cells

& occasionally Langhan’s type of giant cells & surrounded by fibroblast.

Diagnosis:Granulomatous Lymphadenitis

What are the Gian cell?

physiological

SyncytoTrophoblast

MegaKaryoCyte

Oesteoblast

Pathological

Langhan’s Type of Giant cell

Foreign body giant cell

Tutan giant cell

Tumour giant

Reed-SteinBerg Giant cell


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Slide#3 Chronic Cholecystitis

Section shows wall of gallbladder.The wall has been invaded by many chronic

inflammatory celll.Inflammatory fibrosis is present in the peerimuscular coat &

Rocky-Tansky Aschoff sinus present

Diagnosis:Chronic cholecystitis

What is the Common Carcinoma of this viscera?

Adenocarcinoma

What are the Types of gallbladder Stone

Cholesterol stone

Pigment stone

Mixed Stone What is it’s Complication? Empyema

(Acute cholecystitis in the presence of bacteria-containing bile may progress to suppurative

infection in which the gallbladder fills with purulent material, a condition referred to as

empyema of the gallbladder)

Mycocele of Gallbladder

(Mucocele, or hydrops, of the gallbladder describes an overdistended gallbladder filled with

mucoid or clear and watery content)

Rockitansky-aschoff sinus


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Slide#4 Invasive Squamous cell carcinoma

Section shows a maignant tumour composed of anaplastic epithelial cell aranged in sheets

& nests.These cells have hyperchromatic nuclei, coarse chromatin & eosinophillic

cytoplasm.The tumour has invaded underlying stroma.Keratin pearl is also seen

Diagnosis:Invasive Squamous cell carcinoma grade-I

What are the common histologic type in case of Lung specimen?


Small cell carcinoma

Adenocarcinoma

Largecell caecinoma

Carcinoid tumour

What is the most common aetiologic factor of SSC of Lung?

Smoking

Name the most common industrial factor of SSC of Lung?

Asbetosis

Keratin pearl


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Slide#5 Adenocarcinoma

The section shows a malignant tumour composed of Anaplastic epithelial cells arranged in

clusters & glandular pattern.These cells have large nuclei with prominent nucleoli,coarse

chromatin & mild to moderate amount of cytoplasm.The tumour has invaded into the

muscle coat Diagnosis:Adenocarcinoma


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Slide#6 Fibroadenoma of breast

The section shows breast tissue.It reveals proloferation of ductular & fibrous tissue

elements.The ductules are compressed formiong slit like pattern.The background shows

myxoid stroma

No evidence of malignancy

Diagnosis:Breast fibroadenoma What are the Histologic types of fibroadenoma?

1. Pericanalicular fibroadenoma

2. Intracnalicular fibroadenoma What is the malignant counter part of it?

Adenocarcinoma


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Slide#7 Leiomyoma

Section shows interlacing bundle of smooth muscle fibre arranged in whorled bundle

pattern

No malignancy is seen

Diagnosis:Leiomymyoma

What’s it’s Malignant Counter part?

Leiomyosarcoma

What are the types of Leiomyoma?

1. Subserosal(Beneath the endometrium)

2. Intramural(Within the myometrium)

3. Submucosal(Beneath the Endometrium)


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Slide#8 Acute Appendicitis

The section shows appendix.The mucosa is partly disrupted.The muscle coat contains

infiltration of acute inflammatory cell mostly meutrophills.The muscle fibres are are

sperated due to inflemmatory exudate

Diagnosis:Acute appendicitis

What are the complication of Acute appendicitis?

5. Appendicular lump

6. Appendicular abscess

7. Burst of appendix

8. Peritonitis What are the Tumour of appendix?

1. Carcinoid tumour(Most common)

2. Adenocarcinoma


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Slide#9 Lipoma

Section shows nodules of mature adipose tissue partially covered by a capsule

No malignancy is seen

Diagnosis:Lipoma

What is the malignant Counterpart of It?

Liposacrcoma


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Slide#10 Nodular Hyperplasia of Prostate

Section shows multiple irregular fragmented piece of prostatic tissue.This revealed

hyperplastic gland & fibromusclular stroma arranged in nodules.The glands are lined by

multilayered epithelium projecting into the lumen.Some of the glands contains corpora

amylacea

What are the common carcinoma of prostate?

Adenocarcinoma Which age group is commonly affected?

50-60 age group


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Histophathology Diagnosis of diseases by examinating the tissues obtained by Biopsy or, surgically

resected specimen

Methods of histopathology 1. Paraffin section method

2. Frozen section method

Method of Specimen Collection 1. Biopsy

2. Surgical resection

Types of Collection of biopsy marterial-

Biopsy Example

1. Simple incisional biopsy

(Part of organ removed) Breast Lump

2. Excisional biopsy

(Whole organ removed) Lymph node

3. Wedge BIopsy Liver

4. Neddle biopsy Liver

5. Instrumental Biopsy Endoscopy, Colonoscopy

6. Truecut Biopsy From Liver & Kidney

7. CT Guided Biopsy From Lung

Common preservatives or, fixatives: 1. 10% formaline

2. Carnoy’s fixative

3. Bonin’s Fixative

4. Zenker’s fixative

Methods of Preservation(Why 10% formaline is most commonly used as preservatives) Prevention of autolysis

Maintainan tissue structure in life like manner

Maintain the architecture

Cut by-

Microtomein 3-5 µm thickness


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Staining Method

Stain Example Haematoxylin Eosin stain Haematoxylin:Basic & stains the Nucleus blue

Eosine:Acidic & stains the cytoplasm red

PAS(Periodic acid shift test) Mucin & glycogem. basemenst memberane of Blood vessel

Congo Red Amyloid fribils

Sudan IV & Oil Red-O Fat tissue

Masson’s Trichoma Muscle element

Geimsa Stain LD body for Kala-a-zar

Prussian Blue Iron Stain

Fite stain AFB bacilli

Frozen Section Method

It is histopathological method which mainly helps the surgeon in Determining the surgical

procedure to be applied to the pt.; by quick diagnosis of a specimen within 20 min while

the pt. is at OT bed.

Procedure

The Specimen comes from the Operation theatre to pathology

The pathologist then quickly paerforms the Frozen section method who is previously

informed for this procedure with a short history

Then the Specimen is cut with an instrument microtome into 3-5µm thick peices

The section is then placed into a freezer Cryostate which quickly freezes the section

into -20 to -30°C whinin 20 minute

Then the section is stained with HE stain & observed under microscope


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Cytopathology Study of individual cells for thedetection & diagnosis of cancerous or, precancerous lesion

of tissue Method of specimen collection

Method Example

1. Exfoliative Urine, Sputum

2. Abrassive

a) Scrapping In between the junction of Ecto & endocervix with

a spacula

b) Baloon A baloon is introduced Stomach then inflated & cell

is collected when it touches the stomach wall c) Touch imprint During brain surgery the specimen is collected from

the surgical instrument which came in touch with

the brain tissue a the cells are imprinted onto the

tissue

3. FNAC(Fine needle

aspiration cytology)

(With a 5-10cc syringe by creating

negative pressure)

Visible organ

eg.Breast,Thyroid

Invisible organ

eg.Intraabdominal, Intrathoracic organ

Stains used

Papanicolaou stain

Other stains

Geimsa stain

HE satin

PAS

Diff quick stain


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White blood Cell#1 Neutrophil

Identifying point

Mumerous, fine pinkish granules, uniformly distributed in the cytoplasm

Multinucleated(3-5)Lobes

Function

Phagocytosis

White blood Cell#2

Eosinophil Identifying point

Coarse fewer red granules in cytoplasm

Bilobednucleus

Function

Mediates allergic reaction

Kills certain parasite

White blood Cell#3 Lymphocyte

Identifying point

Large round violet Nucleus,almost completely occupying the cell

Bluish colored cytoplasm formed thin rim around the nucleus

Function

Mediates allergic reaction

Plays importance roll in immunity


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Instruments#1 Sahli’s Haemoglobinometer

Identifying point

It contains-

1. Colour matching

2. Haemoglobin pipette(with.02ml marking)

3. Graduated mixing tube

4. Dropper

5. Stirrer

6. Brush

Use-Estimation of haemoglobin by sahli’s Acid haematin Method

Name methods of Haemoglobin estimation.

1. Sahli’s Acid Haematin method

2. Alkaline haematin method

3. OxyHaemoglobin Method

4. Cyanmethhaemogllobin method

Which Method in is accurate?Why?

- Cyanmethhaemoglobin method.

Cause-

The result is accurate

No eye color variation(As in sahli’s Method)

Sulph-Hb, Carboxy-Hb etc. can be estimatd also

Calculation

Instruments#2 Wintrobe’s Haematocrit Tube

Identifying Point

Cylindrical Glass tube with one Open End

Marked from 0-10cm (Above downward-For ESR)& 10-0cm(Downward to above for

PCV)

Use-

Detrmenation of PCV by Wintrobe’s Method

Determination of ESR by Wintrobe’s Method

What is the PCV?its normal Value.

Male:.40-.54L/L(40%-50%)

Femlae:.37-.47L/L(37-47%)


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What are the Red cell indices?& their normal Values.

MCV(Mean Corpuscular Volume)-76-96fL

MCH(Mean corpuscular Haemoglobin)-27-32pg

MCHC(Mean corpuscular haemoglobin Concentration)-31-35gm/dl

Instrument#3

Westergren’s ESR Tube Identifying Point

Long Narrow glass tube

Open both ends

Marking from above to downward 0-200mm

Use-

Determination of ESR in Westergren Method

What’s the Importance of ESR?

1. It has Got no diagnostic importance

2. It is used to see the prognosis of disease

3. IT is helpfull to see the Efficacy of Treatment What are the cause of Sky high ESR?

Tuberculosis

Acute Rjeumatic Fever

Systmic Lupus Erythromatosus

Mutliple myeloma

Aplastic Anaemia

What are common Values of ESR?

Method Male Female

Westrgtren’s Method 0-10mm in first hour 0-20 in first hour

Wintrobe’s Method 0-8mm in first hour 0-10 in first hour

What’s the difference between westergren ESR tube & Wintrobe’s Haematocrit

tube?

Traits Westergren ESR tube Wintrobe’s Haematocrit tube

Length Longer Shorter

Open ends Both ends open One end Open

Marking 0-200mm from above to downward 0-10 from Above to downward

&downward to above


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Instrument#4 Haemocytometer

Identifying points-

RBC pipette

WBC pipette

Improved Neubauer’s counting chamber

Cover slip

Use-

TC of RBC

TC of WBC

Semen ananlysis

What’sTC of RBC?

4.5-5.5million/mm3

What’s the TC & DC of WBC?

TC of WBC 4000-7000/mm3

TC &DC of WBC- DC TC

Neutrophil 40-75% 2,000-7,500/mm3

Lymphocyte 20-50% 1,500-4,000/mm3

Eosinophil 2-10% 200-800/mm3

Monocyte 1-6% 40-400/mm3

Basophil 0-1% 0-100/mm3

Instrument#5 Spinocan needle

Identifying points

1. Trocar

2. Cannula

What are the Indication of lumber puncture?

1. Meningitis

2. Encephalitis

3. Subarachnoid haemorrhage

4. Brain Tumour

What are the contraindication of lumber puncture?

↑ICP


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Papillooedema

Head injury

What are the cause of increase Intracranial pressure?

Head injury

Hydrocephalus

Brain Tumour

Subdural haematoma

Instrument#6 Bone Marrow Aspiration Needle

Identifying Point

1. Trocar

2. Cannula

3. Gaurd

What are the indications of Bone Marrow Aspiration?

1. Aplastic Anaemia

2. Megaloblastic Anaemia

3. Leukaemia

4. Sublaeukaemic Acute Leukaemia

5. Multiple Myeloma

6. ITP

What are the Methods of Bone Marrow? 1. Wide bore method

2. Trephine Biopsy What are the site of Bone Marrow Aspiratoin?

1. Body of the Sternum opposite to 2nd to 3rd intrcostal space

2. Ilieac Crest

3. Medial Aspect of Upper pole of Tibia What are the contraindication of Bone Marrow aspiration?

1. Haemophillia

2. Other Coagulation Disorder What are the Common Complications of Bone Marrow Aspiration?

1. Suction Pain

2. Infection

3. Uncontrolled Bleeding

4. Injury to underlying Organ


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Instrument#7 Paraffin Block

Identifying Point

Whitish Cube made of Paraffin

How many Surface it has?

It has 6 surface

Which side is used for Which Purpose?

One side contain registration Number

The opposite site contain Tissue It is used For which Purpose?

For cutting the tissue evenly for Histopathologic Purpose

What are Stains Used for this Purpose?

1. HE stain

2. Congo Red

3. Sudan IV

4. Prussian Blue What are the methods of Histopathology?

1. Paraffin Block Method

2. Frozen Section Method Which instrument is used to cut the Paraffin Block?

Microtome

Instrument#8 Capillary Pipette

Identifying Point-

Micro Tube with capillary property which has 2 open or, patent ends

Why it is used?

To Measure the CT

Name the causes of increased CT.

Hemophillia

Other Coagulation dis order.eg.-Factor II, III, IV, V VII etc. defficiency

Name the causes of increased BT.

1. Thrombocytopenia

2. ITP

3. Dengue


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Procedure Station#1 Blood film Preparation

Two Slide is taken and made clean & greese-free with a cotton

¯ One slide is Fixed by left hand between thumb & index finger

¯ One Drop of Blood is added by right hand into the right side of the Slide

¯ Another Slide having smooth, even edge is taken as spreader

¯ The slide is Hold by right hand & place in the left side of Slide infront of the blood at

an angle 45°

¯ The spreader is slided towards right over the blood film & Wait untill the blood film is

spread Evenly over the edge of spreader

¯

Again Slide the spreader towards left & form an even blood smear


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Procedure Station#2 Sending Specimen for pathology First put the specimen into a clean Jar

¯ Then detect the Formalin filled jar by it’s disagreeable odour

¯ Then Pour the formalin into the Jar in such a manner so that, whole of the So

specimen/organ/Tissue is submerged into to formalin What information Should be given for sending the sending the sopecimen for

Histopathology?

Name of Pt.:........

Bed No.:.........

Reg. No.:........

Name of Specimen:......

Clinical Diagnosis:......

Advice:Histo/Cytology.......

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