By\King of pathology( Legand – Hazem

)
Histopathology
General items
General Rules :
Examination :ناحتملا
• in the form of spots……… 5 jars and 5 slides
• the time of each spot is 5 minutes
• the degrees are 8 degrees for each spot total 80 degrees
• the answer inludes :
!" diagnosis صيخشت
#" desription فصو
• Almost always, No fixed slides
$se of mirosope :
• ou should start with screening of the slide !y na"ed eye ( not to diagnose it #
• ou should !e sure that the o%er of the slide faes up ward
• $he following powers are present in any microscope :
%& low power : '(
)& intermediate power : ' %0&)0
*& high power : ' (0&(5
• &ou should start 'y the low power then intermediate then high if needed
1
• (lmost all the slides an 'e diagnosed 'y low power except # slides:
!) Hodg*in+s lymphoma
#) ,eminoma
• ou should start with the periphery of the slide then mo%e to the enter
• -ratie ma*es perfet ) 
Best .ishes
/omment on 0ain points in the slide: ( desription # فصولا
!" type of tissue
#" site of the lesion ( reation ) in the tissue
1" type of the lesion ( reation )
A- inflammatory
B- degenerative
C- neoplasti
!- ot"ers
2nflammatory reations
2
2" (ute inflammation : 1 omponents :&
a" aute inflammatory ells : neutrophils + multilo!ed nuclei # and macrophages
+ "idney shaped nuclei, irregular cytoplasmic !orders# e3ept in typhoid  no neutrophils
'" dilated ongested 'lood %essels : containing ,-./ and 0-./
" e3udate ( ontaining fi'rin # : appear in the tissue as either :&
♦ pale pin" areas
♦ separation of .$ fi!ers1
22"/hroni inflammation:
("4on speifi :
* components:
a" hroni inflammatory ells : plasma cells, lymphocytes, macrophages and fi!ro!lasts
 peri2ascular arrangement
'" thi* walled 'lood %essels 5 end arteritis o'literans (6(7#: proliferation of su!intimal
.$ thic"ening of the wall 3 narrowing of the lumen + !ecomes irregular instead of o2al&
rounded #
" 8i'rosis : fi!ro!lasts secrete collagen fi!ers then !ecome resting cells + fi!rocytes #
B",peifi : + granuloma #4 collection of histiocytes: 63amples:"
!" Bilharzial granulomatous reation :
!" Bilh) reation around worms or o%a w5 are rounded in 9), , o%al in L), , with a spine1
#" 9he o%a may ta*e one of 1 olors :
%& #$! if li2ing and contain miracidium 1
3
)& Bl%e if dead and calcified 1
*& &ello'is" )ro'n  d1t !ilhar6ial pigment
1& $sually there is refratile shell all a round )
:" 9he reation onsists of : collection of histiocytes 7 eosinophils 7 lymphocytes 78&giant cells 7
angiomatoids5 small %asular spaes ( in li%er only ) ; fi!rosis
#" 9u'erulosis :
9he granuloma is either :
!" *on aseating : well formed rounded pale pin" granulomas consist of:
(" Giant ells : + fused epithelioid ells # :&
• +anger"an,s type :
− 9n center of tu!ercle
− Nuclei are peripheral and may !e :&
: ;orse&shoe li"e
: -ipolar
: 0ing form
• *on-+anger"an,s type -
− Nuclei in the center of cytoplasm
B" 6pithelioid ells : ( marophages ontaining 9B 'ailli ) :"
• Cytoplasm: <arge swollen , pale pin" e5 ill&defined !order
• *%le%s : 2esicular , eccentric
/" Lymphoytes ; 8i'rosis around the granuloma)
#" Caseating :
4
9he ,ame 'ut little +ang"an,s ells s%rro%nding entral aseation w< is pin*= homogenous =
strutureless areas
1" Rhinosleroma
!" 0i*uliz ell : ( marophage engulfed 'ailli hydropi degeneration )
♦ ytoplasm : =oamy , 2acuolated with well&defined cell !orders
♦ nuleus : small, rounded , central or eccentric
#" Russell 'ody : ( intraellular hyalinosis in a dead plasma ell )
♦ ytoplasm : hyalini6ed 1
♦ nuleus: small , eccentric 1
9umors
− ."e ells s"o' riteria of malignany / atypia 0 -- 123
!) pleomorphism + cellular and nuclear#
#) 77 nucleocytoplasmic ratio +N8. ratio#::: e3ept in hypernephroma
1) A!normal mitosis
:) >iant cell formation
>) <oss of polarity
?) nuclei : large , hyperchromatic, with irregular nuclear chromatin and clumped chromatin
@) nucleoli : large, multiple, eosinophilic
4)B :
#eed 4tern)erg giant ell 5#46 ell / in 7odg8in,s lymp"oma 0-
5
(" typial R,G :
♦ large, !inucleated, e5 !asophilic cytoplasm
♦ # nulei : large 2esicular, mirror image , "idney&shaped with central eosinophilic large
nucleoli
B" R,G %ariants :
♦ <acunar cell
♦ ?opcorn cell
♦ 0ononuclear ;odg"in@s cell
♦ 0ultinucleated
Aegenerations
: Hyaline material : pin", homogenous, glassy , refractile , structureless
: (myloid material : the same !ut you should add special stains of amyloid
( /ongo red= metahromati stains )
,*in slides :"
♦ 4lides ontaining epidermis
/"in scar
6
!" atrophi epidermis + thinning 7 straight !asement mem!rane # 1
#" ('sent s*in appendages : + hair follicles 7 se!aceous glands 7 sweet glands#
1" Replaement of the dermis !y collagen !undles + A2ascular granulation tissue # which
are parallel to each other and to epidermis and separated !y fi!rocytes
.apillary hemangioma
♦ 6pidermis atrophic
♦ Aermis : show  non capsulated lesion formed of lo!ules of capillary&si6ed spaces
separated !y fi!rous tissue septa :&
(" lo'ules of small apillary sized spaes + rounded, o2al or irregular& some contain !lood
others not& lined !y endothelial cells resting on !asement mem!rane + ?A/ 72e#
B" fi'rous tissue in 'etween)
Aadura foot + actinomycosis if no epidermis #
!" 6pidermis : hyper"eratosis
#" Aermis : suppurati2e granulomas formed of :&
• .enter : yellowish !rown fungus colonies w are formed of clu!s and hyphae 1
• ?eriphery : neutrophils 7 pus cells 7 macrophages 7 lymphocytes 7 fi!rous tissue
• some types of fungi may stain !lue and red !y ;3E
• common fungus stain called 6roott
sBuamous cell papilloma
'ranhed papilloma : are finger&li"e projections + exophytic # formed of ore 7 o%er
♦ /ore : !ranched .1$
♦ /o%er : hyperplastic str1sB1 epithelium , shows:
%1 -asal cell hyperplasia
)1 Acanthosis : 77 stratification of pric"le cell layers
7
*1 ?ara"eratosis : nucleated "eratin 1
(1 ;yper"eratosis1
Bg melanoma 5 *ev%s
Non capsulated lesion formed of :&
♦ 6pidermis : atrophic
♦ Aermis : groups of -enign pigmented melanocytes :&
9-Bg :elanoytes : monotonous + no pleomrphism #
 9n upper dermis : polyhedral e5 rounded 2esicular nuclei
 9n lower dermis : spindle e5 o2al nuclei
;- :elanin pigments : !rownish , present in
 Aelanocytes1
 Aacrophages1
 =ree
:alignant melanoma
♦ 6pidermis : ulcerated
♦ Aermis : groups of mg pigmented melanocytes infiltrate deep dermis :
!" mg melanoytes : show criteria of malignancy <=>ت and may !e:
 melanocarcinoma : polyhedral cells
8
 melanosarcoma : spindle cells
#" melanin pigment : 777 in amount , dar" , present in
 melanocytes
 free
s?%amo%s ell arinoma
♦ 6pidermis : ulcerated
♦ Aermis : infiltrated + endophytic # !y irregular sheets of mg sBuamous epith1 .ells which
show criteria of malignancy <=>ت and arranged layers :
%& outer dar*ly stained ells : loo"&li"e N !asal cell layer of epidermis
)& polyhedral ells e5 a!undant pin" cytoplasm
*& enter formed of concentric "eratin layers 4 cell nest <ي@2AB CB
Basal ell arinoma
6pidermis : ulcerated
Aermis : infiltrated + endophytic # !y sheets of mg !asaloid cells
!" sheets : irregular , 2aria!le si6ed with peripheral palisading + outer layer of cells are
columnar and parallel , while inner cells are polyhedral#
#" /ells : ha2e scanty , !asophilic cytoplasm 7 + criteria of malignancy <=>ت (
Caverno%s "emangioma
non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa
9
! "9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat endothelium
3 ontain intat = hemolysed RB/s)
#" septa : .1$
4)B: it may 'e attahed to li%er tissue ( ommonest site of a%) Hemangioma is li%er)
Caverno%s lymp"angioma
non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa
!" 9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat
endothelium 3 ontain homogenous pin* material + lymph #
#" septa : .1$
1" lymphoytes either in septa or inside the lymph
Kidney
Cloudy swelling kidney
proDimal onvol%ted t%)%les s"o' --
!" 9he tu'ular epithelial ells :
♦ .onical in shape1
♦ /wollen1
♦ ,ith granular cytoplasm1
♦ Normal nuclei1
;- l%mens-
♦ Narrowed, /tellate in shape1
♦ .ontain epithelial casts 1
1" 9he interstitial apillaries are ompressed 'y swollen ells
10
C"roni Eyelonep"ritis
t"e lesion is pat"y affetion of -
!"9he interstitial tissue : shows characters of chronic inflammation + قبس امم فصوت#
#"9he olleting tu'ules :
♦ /ome atrophic + d1t fi!rosis #, others show compensating hypertrophy 1
♦ $hey contain hyaline casts 3 inflammatory cells casts 1
1 " B glomeruli :
♦ Affected late , )ry to tu!ulo&interstitial lesion
♦ ?eriglomerular fi!rosis sclerosis + بلت #
Amyloid 8idney
$he lesion is diffuse deposition of amyloid material in : + amyloid , staining 3 properties فصو! #
!" (fferent arterioles :
thic"ening of the wall 3 narrowing of the lumen1
#" Glomerular apillaries :
Amyloid deposit in C !asement mem!rane
1" /olleting tu'ules :
♦ Amyloid deposit in C !asement mem!rane1
♦ ;yaline casts in C tu!ular lumen1
.FB Eyelonep"ritis
11
%&&$he cortico&medullary junction : shows $1- granulomas <=>ت ( aseating and non aseating )
)& $he rest of renal tissue shows:
♦ =i!rosis1
♦ .ompensatory tu!ular hypertrophy
Gilms, t%mor 5 nep"ro)lastoma
Ag tumor formed of * elements + all are mg criteria of malignancy <=>ت #:
!" ('orti%e glomeruli and tu'ules : lined !y cu!ical cells with no !asement mem!rane
#" ,troma : sarcomatous stroma formed of !undles of o2al to spindle shaped cells which
show metaplasia, forming : muscles, !one , cartilage , myxomatous tissue…1etc
1" Blastema ells : undifferentiated , arranged in aggregate , small , lymphocyte&li"e cells
with dar" nuclei and little cytoplasm
7ypernep"roma 5 #enal ell arinoma
A& tumor formed of : cords 3 groups of mg epithelial cells separated !y delicate fi!rous stroma
the tumor cells are either :
!" lear ell type : cells are large polyhedral with 2acuolated cytoplasm + d1t dissol2ed fat
during preparation + cells show few malignant characters #
#" granular ell type : the same !ut with granular eosinophilic cytoplasm1
1" spindle ell type1
-& Areas of necrosis 3 hge1
Respiratory slides
4ose
Allergi nasal polyp
"inge#$like %#o&e'(ion )o#*ed o) 'o#e + 'o,e#
12
!"9he o%er : pseudo stratified columnar ciliated epithelium + respiratory epithelium# with areas
of sBuamous metaplasia1
#" 9he / )9 ore : 2ascular 3 edematous + edema leads to  pallor of tissue 3 separation of
.$ fi!ers# which appears as homogenous pale pin" material 9t contains :
♦ proliferated mucous glands
♦ inflammatory cells : eosinophils, lymphocytes, plasma cells, macrophages1
#"inosleroma
"o#*ed o) e%i(-eliu* + su.e%i(-eli/l (issue
♦ 6pithelium : stratified sBuamous epithelium + metaplastic#
♦ ,u'epithelial tissue shows : dense inflammatory cells 7 fi!rosis 7 ) important cells :
!" Aic"ulic6 cells : (s 'efore HIJت
#" 0ussell !odies : (s 'efore HIJت
Lung
$mp"ysema
 2nter al%eolar septa :
thinned , containing compressed capillaries  rupture  lea2ing a spur projecting inside the
al2eoli
 9he al%eoli :
13
due to rupture of the septa they decrease in num!er , 77 in si6e and !ecome distorted in shape
 2nterstitium shows :
!" hroni 'ronhitis + chronic inflammatory reaction فصوK 7 hyperplastic mucous glands
#" hroni 'ronhiolitis +chronic inflammatory reation فصوK 7 go!let cell metaplasia#
C"roni veno%s ongestion 5 )ro'n ind%ration
 2nter al%eolar septa :
thic"ened !y Edema + transudate # 3 fi!rosis1 contain dilated congested capillaries
 9he al%eoli : .ontains
− Drange + intact 3 hemoly6ed 0-.s#,
− !rown + hemosidrin granules 3 heart failure cells#
− pin", homogenous +transudate#1
9he heart failure ells :
>roups of <arge, rounded , phagocytic cells engulfing !rown hemosidrin granules 3 red cells
 2nterstitium shows :
$he !ronchial mucosa : edematous
.FB l%ng
%& caseating and non caseating tu!ercles ) ( LMN 2OP فصوت )
*& al2eoli contain :
E homogenous pin" inflammatory exudate1
E others show compensatory emphysema1
14
Qat ell arinoma
lung (issue is in)il(#/(ed .y / */lign/n( (u*o# (issue )o#*ed o) 0
!" groups and sheets of /mall, rounded, o2al or spindle malignant cells + Dat cells # with
scanty cytoplasm + lymphocyte& li"e #1 $hey are arranged in groups separated !y fi!rous
stroma1
#" (reas of hemorrhage + orange # and necrosis + pin"# are seen
1" 9umor ells show all malignant characters1 + قبس امم فصوت#
,mall intestine
4erofi)rino%s peritonitis / small intestine 0
!" 9he muosa= su'muosa and musulosa : normal
#" serosa shows :
− $he serosal cells are sheded
− serosal .1$ is thic"ened, shows C characters of acute inflammation) ( LMN 2OP فصوت #
7 fi!rin networ" of entangling C acute inflammatory cells
Rntestinal lymp"oma / *on 7odg8in S4 lymp"oma 0
!" -art of the wall of small intestine infiltrated + mucosa 7 su!mucosa 7 muscle 7 serosa# !y
malignant tumor tissue causing extensi2e ulceration of the mucosa 3 destruction of the wall
#" 9he tumor formed of :
− Aiffuse malignant lymphoytes whih are :
Fniform, <arge cells showing <arge deeply stained nuclei with irregular nuclear mem!rane and
some prominent nucleoli 3 thin rim of cytoplasm around1
15
− areas of nerosis C hge are seen1
large intestine
Bil"arTiasis Colitis
♦ -ilhar6ial o2a are deposited mainly in C su!mucosa 3 then  mucosa muscle serosa
♦ some worms1
All surrounded !y !ilhar6 reaction ( LMN 2OP فصوت #
Col%mnar ell papilloma
!"9he muosa shows exophytic 12ب3 45ا6growth in C form of 2illous projections +finger&li"e#
#" 9hese proDetions are formed of core 7 co2er
♦ /)9 ore : delicate fi!ro2ascular .$1
♦ /o%er : o2ercrowded columnar secretory cells with areas of dysplasia
Adenoarinoma / olon 0
9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor
tissue formed of malignant aini + cells arranged around a lumen # and sheets lined !y
malignant epithelial cells
♦ 9he malignant aini are :
16
− Garia!le in si6e and shape
− <ined !y dar" malignant cells + showing malignant criteria فصوت1#
♦ (reas of nerosis + in and Dut side the acinar lumena# 7 hemorrhage
♦ Au*e+s pathologial staging :
A tumor infiltrates mucosa, su!mucosa
- H H H H H H muscle 3 serosa
.H H H H H H Hpericolic lymph node1
:%oid Adenoarinoma / olon 0
9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor
tissue formed of muin pools in which malignant cells فصوت swim inside or line the pools
the cells may !e arranged in the form of :
♦ acini + cells arranged around a lumen #
♦ fragment of an acinus
♦ cords
♦ indi2idual cells
some cells are distended with pale mucin  pushing the nucleus at one side + eccentric #
( ,ignet ring appearane )
Li%er slides
Bil"arTial periportal fi)rosis of liver
♦ -reser%ed li2er architecture
♦ Bilharzial reation >K 27 7 fi!rosis 7 angiomatoid reaction in portal tract which may !e:
%& small  fine
17
)& large coarse
♦ *upffer ells are distended !y !ilhar6ial pigments + !rown#
Uatty "ange liver 5 / fatty degeneration V fatty infiltration 0
♦ -reser%ed li2e architecture
♦ hepatoytes show: empty 2acuoles in cytoplasm of hepatocytes fuse together
signet ring appearance
♦ signet ring appearane is due to fat accumulation  large 2acuole  push the nucleus to
one side which !ecome flattened and eccentric
♦ in H C 6 : 2acuoles appear empty as fat was dissol2ed during preparation !y xylol and
alcohol
♦ in frozen setion : fat 2acuoles are stained !y + orange > & osmic acid & sudan 999 #
Cirr"osis
$ loss o) li,e /#'-i(e'(u#e .y #egene#/(ing nodules se%/#/(ed .y )i.#ous (issue se%(/
(" Regenerating nodules : 2aria!le in si6e and shape 3 show:
♦ .entral 2ein eccentric
Iou!led
a!sent
♦ $ra!eculae : ) cell thic" + N1 4 % cell thic"#
♦ ;epatocytes : 2aria!le in si6e and shape
%& /ytoplasm : show fatty change
)& 4ulei : show normal mitosis
B" 8i'rous tissue : surround and separate the nodules 3 contains:
♦ ?roliferated !ile ducts
♦ ?roliferated capillaries 3 <ymphocytes
18
7epatoma / "epatoell%lar arinoma 0
$ 8oss o) li,e /#'-i(e'(u#e .y 9/lign/n( nodules se%/#/(ed .y )i.#ous (issue se%(/
(" malignant nodules : infiltrate the surrounding cirrhotic tissue 3 formed of:
♦ thic" tra!eculae +J ) cell thic"# , acini, or sheets of malignant hepatocytes
♦ criteria of malignancy <=>K
B" fi'rous tissue septa)
$ /#e/s o) -ge : ne'#osis
$ #es( o) li,e# (issue s-ows 'i##-osis
metastati adenoarinoma in t"e liver
Normal li2er tissue is infiltrated !y adenoarinoma :"
malignant tumor tissue formed of malignant aini + cells arranged around a lumen # and sheets
lined !y malignant epithelial cells
♦ 9he malignant aini are :
− Garia!le in si6e and shape
− <ined !y dar" malignant cells + showing malignant criteria فصوت1#
Breast
Ui)roadenoma )reast
$rue mixed tumor , well capsulated formed of ) elements :
!"8i'rosis : excess fi!rous issue replacing the fat
#"(denosis : proliferating !reast ducts lined !y ) layers of epithelial cells 123 WK2XYل
( inner u'ial and outer flat myoepithelial )
9ypes :
2" 2ntraanaliular: 22" perianaliular
&?roliferated ducts, compressed ,
in2aginated !y excess .1$ gi2ing which
gi2e a false impression that fi!rous tissue is
inside C ducts1
& Iucts are elongated, /tar shaped with
Narrow lumen
&proliferated ducts are surrounded !y delicate
fi!rous tissue
&Iucts are rounded or o2al in .8/ with patent
lumen1
19
Ui)roysti disease of Z )reast
!" 8i'rosis : excess fi!rous tissue replacing the fat
#" (denosis : 9ncrease in num!er of C ducts + lined !y ) l
ayers of epithelial cells , inner cu!ical and outer flat myoepithelial
1" 6pitheliosis : focal proliferation of C cells lining the ducts forming papillary processes
:" /yst formation : E some ducts !ecome cystically
dilated , may contain some secretions
>" (porine metaplasia of B lining ells  !ecome tall 3 acidophilic granular cytoplasm
?" /hroni inflammatory ells in the stroma
Rntrad%t arinoma / )reast 0
!" Large duts with intact !asement mem!rane + 123 # lined !y malignant epithelial cells
showing Ag criteria <=>ت
#" 9he duts may 'e :
♦ /omedo type : ducts lined !y many layers of malignant cells with central pin" necrosis
♦ ,olid type : ducts occluded completely !y malignant cells
♦ /ri'riform type : malignant cells are arranged around many regular lumena
♦ -apillary type : malignant cells projecting into the lumen as papillary structures
20
♦ /linging type : single layer of malignant cells line the ducts
Rnfiltrating d%ts arinoma
%& Non capsulated , malignant tumor tissue infiltrate the surrounding tissue
)& 9t is formed of sheets, cords of malignat epithelial cells surrounded !y fi!rous tissue
*& $he cells show malignant criteria ( LMN 2OP فصوت)
Grading of 2A/ :
!" Histologial grading :
♦ necrosis + 77 necrosis  high grade#
♦ tu!ular formation + no tu!ular formation high grade#
#" 4ulear grading : according to nuclear pleomorphism1
spleen
7yaline spleen
;y/line */(e#i/ls < %ink= gl/ssy = #e)#/'(ile > /#e de%osi(ed in
♦ /apsule
♦ 9ra'eulae
♦ /entral arteriole of B lymph folliles + Ieposition of hyaline material in C su!endothelial .1$
of C intima 3 media $he wall is thic"ened with narrow lumen  ischemia of lymphoid
follicles  !ecome small and atrophic
?n)#/'(ion s%leen
21
$hree successi2e 6ones :&
!" Eone of normal : contain lymph follicles, red pulp, !l1 2essels 3 tra!eculae1
#" Eone of ongestion : shows congested !lood 2essels and acute inflammatory cells, and
early granulation tissue formation
1" Eone of Reent infart + .oagulati2e necrosis # shows:
& ghosts of normal structure with nuclear fragments 1
& $he capsule opposite C infarct area shows : fi!rous thic"ening1
@AB s%leen
%& .aseating and non caseating tu!ercles <=>ت
Lymph node
=ollicular hyperplasia + <1N #
&enlarged lymph node
&nodal architecture is preser2ed
&the cortex shows numerous large folliles which are
♦ 2aria!le in si6e 3 shape
♦ each formed of :
!" 7uter dar* mantle zone : ?eripheral rim of small lymphocytes1
#" 2nner pale Germinal enter + lymphocytes, immuno!lasts, histiocytes #
$arly .FB lymp" node
22
& Enlarged <1N
& Nodal architecture is preser2ed
& many 4on aseating tu'erles among C lymphoid tissue1 LMN 2OP فصوK
+ate .FB lymp" node
& Enlarged <1N
& Aost of C su!stance of C node is replaced !y many aeating tu'erles LMN 2OP فصوت
7odg8inSs lymp"oma / +F* 0
& Enlarged <1N
& <ost nodal architecture
& $he <1N is diffusely infiltrated !y:
!" typial Reed",tern'erg giant ells C its %ariants LMN 2OP فصوت
#"inflammatory ells inlude:
♦ mature lymphocytes
♦ eosinophils
♦ histiocytes
♦ plasma cells
♦ neutrophils
♦ fi!ro!lasts
1" (reas of nerosis= hge C fi'rosis
:etastati arinoma / +F* 0
& Enlarged <1N
23
& <1N sinuses and su!stance are in2aded !y malignant tissue either sheets ( from infiltrating
dut arinoma فصوت or aini + Adenocarcinoma # فصوت
& $he malignant cells show all C malignant characters1 + LMN 2OP فصوت#
Bone (nd artilage
Qsteo"ondroma -
Con '/%sul/(ed -/*/#(o*/(ous lesion )o#*ed o) D 'o*%onen(s 0
!" /ap of hyaline artilage : normal chondrocytes arranged perpendicular to the
perichondrium 1 surrounded !y chondroid matrix 1
#" /anellous 'one : !one tra!eculae separated !y !one marrow 1
C"ondrosaroma
Con '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$
& ;igh num!er of malignant hondroytes in a hondroid matri3 with areas of hemorrhage and
necrosis
$he cells show the criteria of malignancy LMN 2OP فصوت 1 they are either :
♦ /pindle + undifferentiated #
♦ 0ounded inside lacunae + well differentiated #
6iant ell t%mor / Qsteolastoma 0
8o'/l 9g (u*o# )o#*ed o) 0$
!" ,tromal ells : + 0ounded K o2al K sphindle # 7 + criteria of Ag # 27Eت
#" Reati%e osteolast li*e giant ells : distri!uted large cells 1 contain up to %00 small
nuclei
1" ,anty fi'ro%asular stroma)
Qsteosaroma
Con '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$
& indi2idually arranged malignant osteo!lasts in osteoid matrix with areas of hemorrhage and
necrosis
24
&the matrix may !e also cartilaginous or fi!rous
&the cells exhi!it the criteria of Ag LMN 2OP فصوت
/u!types :
on%entional : descri!ed
parosteal : the same 7 chondroid areas
anaplasti : -i6arre cells 7 few osteoid
6ndometrium C$terus
Eroliferative endometri%m
!" 6ndometrial glands :"
• /mall, 0ounded + $8/ # or tu!ular + <8/ # 1
• Fniform in si6e, shape 3 distri!ution1
• <ined !y rowded tall columnar epithelial cells with .entral o2al nuclei show few mitosis
#" 9he stroma is ompat and formed of :"
♦ /phindle shaped cells e5 dar" nuclei 1
4eretory endometri%m
!" 6ndometrial glands :"
• large, $ortuous showing ( saw tooth appearane )
• Not uniform
• <ined !y one layer of cu!ical cells with rounded nuclei w5 contain secretory 2acuoles1
25
#" 9he stroma is loose and formed of :"
♦ rounded stromal cells with a!undant cytoplasm
♦ spiral arterioles
♦ hge
♦ stromal granulocytes1
Cysti $ndometrial "yperplasia
!" 6ndometrial glands :"
•9ncreased in num!er1
•Garia!le in si6e 3 shape
•<ined !y o%errowded columnar cells which may from papillary processes1
•/ome glands are lined !y flattened cells with cyst formation1
#" 9he stroma is ompat and formed of :"
•/pindle shaped cells with dar" nuclei
•areas of necrosis, hge 3 infiltration !y ?1A1Ns, lymphocytes1
1" 8reFuent mitosis in glandular epithelium C stroma ells
Adenomyosis
9slands 5FGof Endometrial glands 3 stroma present inside the myometrium without any
connection with surface endometrium + J *mm from C !ase of C endometrium#
leiomyoma
He'(ion in I u(e#us s-ow well 'i#'u*s'#i.ed = '/%sul/(ed */ss )o#*ed o) 0
& 9nterlacing -undles 3 whorls JاماKL of smooth muscle cells alternating with fi!ro!lasts in
collagenous matrix1
♦ musle ell : spindle with rounded !oth ends of cytoplasm , containing elongated nuclei
with rounded ends
♦ 8i'ro'last : spindle shaped cell with pointed !oth ends of cytoplasm, containing elongated
nucleus with pointed ends
26
Gonads
4eminoma
"ew se*ine)e#ous (u.ules /#e seen in)il(#/(ed .y / (u*o# (issue )o#*ed o) 0$
!" sheets of malignant ells w< are :
• <arge rounded or polyhedral cells
• cytoplasm is pale stained, 2acuolated +due to its lipid 3 glycogen content#1
• nuclei are large, 2esicular, with rounded central nucleoli1
#" stroma :is infiltrated !y lymphocytes1
M#e/s o) -e*o##-/ge /nd ne'#osis
.eratoma
!" 0any ysti struture lined 'y :"
• 0espiratory epithelium1
• /Buamous epithelium1
• 9ntestinal epithelium1
#" Heterogeneous tissues present 'etween B ysts inlude strutures deri%ed from all 1 germ
layers:
• endoderm li2er, glands + thyroid ,mucous, serous…#
• ectoderm s"in 3 !rain tissue
• mesoderm  Auscle, !one, cartilage
1" 4o immature elements)
plaenta
[esi%lar mole
27
Nnl/#ged '-o#ioni' ,illi )o#*ed o) 0 'o#e : / 'o,e# 0$
• 9he o%er : tropho!lastic epithelium with focal hyperplasia1
• /)9 ore : A2ascular edematous .$ with hydropic degeneration
C"orioarinoma 5اO3ا بP3
He'(ion in (-e *yo*e(#iu* s-ows 0
• ,heets of malignant cyto and syncytiotropho!lasts infiltrating the myometrium
• 4eroti musles infiltrated !y polymorphs 3 pus cells
• Large area of hge)
 $ropho!lastic cells + show criteria of malignancy# <=>ت are:
• /yto : polygonal cells with rounded nuclei
• ,ynytio : protoplasmic masses containing scattered spindl nuclei with no cell !orders
Bil"arTiasis \rinary )ladder
!" 7%a are deposited mainly in the lamina + most 2ascular#3 to a lesser extent other layers
#" 7%a are surrounded !y - reaction1 ( LMN 2OP فصوت #
1" 6pithelial hanges inlude :
28
 ulceration
 Atrophy
 ;yperplasia: hyperplastic transitional epithelium dips down in C su!mucosa forming
+ -runnLs nests# central cells degenerate to form a cyst lined !y transitional
epithelium and contain serous fluid + cystitis cystica#  glandular metaplasia of lining
epithelium , !ecome columnar and secrete mucous + cystitis glandularis #
 sBuamous metaplasia
Rounded strutures ( ontain lumen )
#eent t"rom)%s
!" ,etion in a %ein show distended lumen !y a throm!us + solid mass of !lood elements#
#" 9he throm'us formed of :
•;ead : the attached part to the endothelium
•$ail : the free end
•-ody which contains:
!"Lines of Eahn : columns of fused platelets forming homogenous structureless pale pin" lines
#" fi'rin meshwor* Between B lines : entangling ,-.s 3 0-.s1
/ompliated throm'us :
&calcification 3 infection 3 hyalinosis
A%te !iff%se 4%pp%rative Appendiitis
 <umen contains pus :
&dead and ali2e !acteria
&dead + pus cells# and ali2e neutrophils
&exudate
29
 .olonic mucosa : partly ulcerated
 $he whole wall : is diffusely affected !y acute inflammatory reaction ( LMN 2OP فصوK#
C"roni non speifi "oleystitis
• 9he muosa : hyperplastic or ulcerated1
• 4o su'muosa)
• 9he fi'romusular coat : shows chronic 9nflammation + LMN 2OP فصوت)
Goiter C prostate
4imple nod%lar goiter
%& Garia!le si6ed nodules separated !y fi!rous septa
)& Each nodule contain 2aria!le si6ed thyroid follicles
•6ah follile shows :
& Iistended lumen !y homogenous colloid1
& <ined !y flat cu!oidal epithelium
•9he stroma : compressed .1$ !etween follicles
•4ormal %asularity of B gland)
4enile prostati "yperplasia
%& Garia!le si6ed nodules separated !y fi!rous septa
)& Each nodule shows hyperplasia 3 hypertrophy of !oth elements of the prostate
+ stroma 3 parenchyma#
9he stroma + fi!romuscular # is increased and shows chronic inflammation
9he parenhyma + acini # :
♦ 9ncreased in num!er1
30
♦ Garia!le in si6e 3 shape
A- ."e lining of aini -
•lined !y one or more layers of columnar cells, may form papillae1
•/ome are cystically dilated with flat lining1
B-."e l%men of aini ontains -
•/heded epithelium1
•?rostatic concretions
•corpora amylaceae
,lides *nown 'y pathology ( no normal tissue attahed)
+ipoma
!" /apsulated tumor tissue !y fi!rous capsule , sending .$ septa + con2eying !l1G $o tumor
cells# di2iding the tumor into lo!ules of mature fat cells+ lipocytes #
#" 8at ells are :
• uniform in si6e and shape ,
• appear 2acuolated due to dissolution of fat !y xylol and alcohol1
• nuclei are compressed against C mem!rane + /ignet ring appearance #
1" 8at should 'e stained !y fat stains in a fro6en section to !e 2isi!le :
( orangeG – 7smoi aid – ,udan 222 )
6ran%lation tiss%e
Q$ Re%/i# (issue )ollowing /'u(e in)l/**/(ion o# /sso'i/(es '-#oni' in)l/**/(ion /nd )ollowed
.y )i.#osis
D$ ?( is )o#*ed o) 0
a"0any new apillaries lined !y swollen endothelial cells without a !asement mem!rane
+ ?A/ negati2e # 4 unli"e capillary hemangioma
31
'"8i'ro'last ells appear !etween C capillaries, it is spindle shaped cells
with tapering end 3 scanty cytoplasm with 2esicular spindle nuclei
" 9he ground su'stane !etween the capillaries and around fi!ro!lasts shows
• homogenous, pale pin" exudate
• collagen fi!ers +type 999# transforms to !undles + type 9 #1
• Aixed acute and chronic inflammatory cells1
7ydatid ysts
He'(ion in w/ll o) -yd/(id 'ys( s-ow 0
!" 7uter fi'rous layer + compressed tissue of C organ affected #
#"2ntermediate laminated layer of structureless pin" +ali2e# or 2iolet + dead and calcified# tissue
of the parasite
1"2nner germinal layer : where scolics project1
*e%rilemmoma 5 4"'annoma
!" /apsulated tumor tissue attached to a ner2e 1
#" /apsule di2ide the tumor !y .$ septa into lo!ules formed of :
- B%ndles of %niform spindle s"aped ells : separated !y delicate fi!rillary !ac"ground
- ."e n%lei are rod shaped and arranged parallel to each other  forming nulear palisading
1" 9he tumor tissue shows :
• .ellular areas + Antony type 9 #
• <oose areas + Antony type 99 #
+ cells are uniform , no pleomorphism , no mitosis…#
32
:eningioma
!" /apsulated tumor tissue attached to the meninges
#" 2t is formed of whorls and !undles of uniform meningothelial cells w5 are :
0ounded &o2al cells with 2esicular nuclei , eosinophilic cytoplasm with ill&defined !orders in
fi!rous tissue matrix
1" Garieties :
:eningot"elial meningioma : discussed
Ui)ro)lasti meningioma : !undles of fi!ro!last&li"e cells
.ransitional meningioma : meningothelial 7 fi!ro!lastic
Esammomato%s meningioma : when center of the whorle contain calcified , laminated
!odies
Atypial meningioma 0 when there is cellular malignant criteria
:alignant meningioma : when there is infiltration of !rain tissue
By\King of pathology( Legand – Hazem )
33