Microscopically Yours:

A Glimpse at our Cells, in Sickness and in Health

Erna Sulistyowati

Modified from Nina C. Zanetti

Siena College
Department of Biology
• Is it cancer ??
• If it is… how serious
is it?
• Will I need
treatment? What
kind? http://1.bp.blogspot.com/_KkXx6fq12mU/Suvqkn-
xSpI/AAAAAAAAG3g/SClWSE4hgs0/s400/breast-self-exam.jpg
 Next step in the journey….
• “We need to look at
the tissues. We need
a biopsy.”
– Is it cancer or is it
benign ?
– Is it invasive?
– What treatments?

http://www.breastcancerlaw.com/counseling.jpg
 Histology will answer our
questions !
• Histology: study of normal tissues
• Pathology: study of diseased tissues
• Tissue:
– Building blocks of organs
– group of cells working together to carry out a
specific function
• Biopsy: small bit of tissue removed from
patient for examination with microscope
Histopathology

• Histopathology is the microscopic examination of

biological tissues to observe the appearance of diseased
cells and tissues in very fine detail.
• The word “histopathology” is derived from a combination
of the three Greek words:
• Histos meaning tissue
• Pathos meaning disease or suffering, and
• Logos which refers to study in this context
• Hence histopathology is the study of microscopic changes
or abnormalities in tissues that are caused as a result of
diseases.
Tissue:
•Building blocks of organs
•Group of cells working together to carry out a specific function
 From Biopsy to Pathology report

?
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http://img2.timeinc.net/health/images/journeys/brea
st-cancer/breast-cancer-interpreting-results-150.jpg
From Biopsy to Pathology report

?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Interpretation of slide  pathology report
(pathologist)
 From biopsy specimen to microscope slide:
HISTOTECHNIQUE

“why is it taking
so long?”

DIAGRAM: Kessel, Basic

Medical Histology, Oxford

Why “fix” and University Press.

Why thin section?
process ?

Why paraffin?
From biopsy specimen to microscope slide:
tissue fixation and processing
From biopsy specimen to microscope slide:
infiltrations and embedding
From biopsy specimen to microscope slide:
sectioning
From biopsy specimen to microscope slide:
staining

http://www.scuddlebutt3.co.uk/L_microscope_sli
de_mountant_1.jpg
From biopsy specimen to microscope slide:
The finished microscope slide

http://www.scuddlebutt3.co.uk/L_
microscope_slide_mountant_1.jpg
 Limitations of histotechnique
• Tissue is dead
• Only a slice: 2D
• Color artificial:
– Purple nuclei
– Pink cytoplasm
• Need to know “what is
normal”
 From microscopy slide to Pathology Report:
POWER of Histotechnique
Specimen:
Clinical History
49 year old female who was found to have a mass (or calcifications) on physical exam (or
mammography). Stereotactic core biopsy reveale malignancy.
Clinical Diagnosis: Right breast cancer

Microscopic Description
Slides A3- A4 consist of a portion of breast tissue in which is located an infiltrating ductal
carcinoma of the breast. The malignancy is characterized by infiltrating nests of malignant
cells in which there is only, focal tubule or glandular formation. The cells demonstrate a
moderate degree of nuclear pleomorphism, with some of the cells having central nucleoli.
However, the mitotic rate is less than 1 mitosis per 10 high power fields. Overall the carcinoma
is grade II. Adjacent to the carcinoma are areas of ductal carcinona in situ. Histologically the
tumor is 2 mm from the inked margin. No lymphatic invasion is appreciated.

Diagnosis Infiltrating ductal carcinoma of the breast, Grade II

Foci of ductal carcinoma in situ
Tumor is 2 mm from the inked margins
Metastatic cancer in 2/12 lymph nodes.
Markers The tumor is estrogen receptor positive
The tumor is Her-2 neu positive
From Biopsy to Pathology report

?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Microscope slide  Interpretation of
slide  pathology report (pathologist)
From microscope slide to Pathology
Report

?
“Reading”
the Slide
From microscope slide to
Pathology Report:

Interpreting
NORMAL Tissue structure
(Histology)
Four basic tissue types
• Epithelium
• Connective tissue
• Muscle tissue
• Nerve tissue
 Four basic tissue types
• Epithelium : the “lining” tissue
• Connective tissue : connects and supports
• Muscle tissue: movement
• Nerve tissue : communication
Epithelial tissue
 Characteristics of epithelial tissue:
• Where is it found?
– Lining spaces, covering surfaces
• How are cells arranged?
– Tightly packed, in layers
• Good at repair/regeneration?
• Polarity? Cells have different surfaces
• Functions? Protect, seal, secrete, absorb,
Connective tissue:
Characteristics of connective tissue:

• Where is it found?
– Connecting tissues and organs
• Cells + fibers + jellies
• How are cells arranged?
– Dispersed; fibers and jellies in between
• Variations?
Muscle tissue:
 Characteristics of muscle tissue:
• Where is it found?
– Where movement is needed.
• Cells: striped or dark pink “spindles”
• Variations?
– Yes - both structural and functional!
• Functions?
– Movement!
Nerve tissue:

neuron
 Characteristics of nerve tissue:
• Where is it found?
– Brain, spinal cord, other organs
• Special cells: neurons
• What do neurons look like?
– Large cell, extensions, owl-eye
nucleus
• Functions?
– Communication!
 Practice with normal histology:
• Epithelium:
– Lining
– cells in layers, tightly packed.
• Connective tissue
– Cells + fibers+ jellies
– Cells dispersed in matrix
• Muscle:
– striped or spindles
• Nerve:
– neurons with extensions and “owl eye” nuclei
 Practice with normal histology:  muscle ? 1
A B

C D
 Practice with normal histology: nerve ? 2
A B

C D
 Practice with normal histology: epithelium ? 3
A B

C
D
Practice with normal histology: connective tissue?
4
A B

C D
From microscope slide to Pathology
Report

?
“Reading”
the Slide
 From microscope slide to
Pathology Report:

Understanding Diseased Tissue

structure (Pathology)
 What can go wrong?

• Right cells in the wrong place

• Tissue injury: inflammation
• Good cells gone bad: cancer
Pathology: right cells in the wrong
place (Barret’s Esophagus)
 Pathology: right cells in the wrong
place (Barret’s Esophagus)

Small intestine, normal

epithelium

Esophagus, normal epithelium

 Pathology: right cells in the wrong place
Biopsy specimen
(Barret’s Esophagus)
Esophagus, normal

Small intestine, normal

 Pathology: Tissue injury
(inflammation)

Inflammation:
the body’s response
to injury
 lymphocyte monocyte

neutrophil eosinophil basophil

Cells of peripheral blood, human blood smear

 Cells of the inflammatory response

neutrophil

monocyte

lymphocyte
Neutrophils in acute inflammation, stomach
Lymphocytes in chronic inflammation, appendix
Pathology: Good Cells Gone Bad
CANCER
• Won’t stop dividing (mitosis)
• Weird nuclei
• Don’t stay at home
– Invade
– metastasize
 CANCER: Good Cells Gone Bad
Won’t stop dividing (mitosis)

Onion root tip cancer of uterus

 CANCER: Good Cells Gone Bad
Weird nuclei

Normal epithelium bladder cancer

 CANCER: Good Cells Gone Bad
Don’t stay at home

Normal epithelium Invasive breast cancer

Practice with pathology: which is normal
(bladder), which is cancer?
 Practice with pathology: which is normal
(uterus), which is cancer?

http://www.uoguelph.ca/~rfoster/repropath/surgicalpath/fe
male/cat/F%20fel%20uterus%20duplication%20YB13141
4%2003wl.jpg
• Is it cancer ??
• If it is… how serious
is it?
• Will I need
treatment? What
kind?
http://1.bp.blogspot.com/_KkXx6fq12mU/Suvqkn-
xSpI/AAAAAAAAG3g/SClWSE4hgs0/s400/breast-self-exam.jpg
The journey…. Waiting for the
Pathology Report
– Is it cancer or is it
benign ?
– Is it invasive?
– What treatments?

http://www.breastcancerlaw.com/counseling.jpg
From Biopsy to Pathology report

?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Interpretation of slide  pathology report
(pathologist)
Is it cancer?
Is it invasive?
 What kinds of treatment?
Are hormone receptors present?
 The journey continues….
– Is it cancer or is it
benign ?
– Is it invasive?
– Has it metastasized?
– What treatments?

http://www.breastcancerlaw.com/counseling.jpg
 Microscopically Yours:
A Glimpse at our Cells, in
Sickness and in Health
THANK YOU