🦆 PATHOLOGY 🦆

LAB REVIEW SESSION - SEC B

================== ANONYMOUS ANIMAL ZOO PARKING LOT ===================

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Slides Notes

“Items that I feel like will come up in the exam”

Barrett esophagus - remember “goblet”

- In barrett esophagitis goblet cells must be
present in order to diagnose (No goblet no
barrett!!!)
- Intestinal metaplasia characterized by
columnar cells w/ goblet cells (normal
histology = presence of goblet cells)
- Presence of dysplasia
- a term related to neoplasia.
- Microscopic finding wherein cells tend
to be disorganized, atypical cells
- (kung columnar dapat nasa base pero
in dysplasia = haphazardly arranged.)
- Hyperchromatic. more basophilic
- Increased nucleus to cytoplasm ratio
- (voluminous cytoplasm),
- coarse chromatin material, visibility to
prominence of the nucleoli unless in
tissue layer of actively dividing cells
(i.e stratum germinativum/basale)
- High level of mitotic activity in stratum
germinativum
- Salmon-colored area (affected by metaplasia)
- Always read the history first
Normal lining of the esophagus - Non-keratinized
Stratified Squamous epithelium

- Lined by Glands
- Glands: columnar (+) goblet cells
- Intestinal metaplasia, dysplasia
- Nuclei are stratified rather than basally
located
- Color is more basophilic
- Anisocytosis - variation in sizes of nuclei
- Some are pleomorphic
- Gastroesophageal reflux
- Drug: long-term use of steroids indicated in
px w/ autoimmune disease
--> can induce acid reflux
Barrett esophagus - in itself is not even carcinoma in
situ, no strong evidence of anaplasia. (malignancy =
anaplasia must be present)
- Columnar metaplasia → Can evolve into a
deadly adenocarcinoma

Most common location of adenocarcinoma →

DISTAL 3rd because it is the most common location
of intestinal metaplasia
Squamous cell Carcinoma → MIDDLE 3rd of the
esophagus
distal 3rd - adenocarcinoma
middle 3rd - squamous cell carcinoma
Bulky,
malignant
⇐Ulceration, necrosis, hemorrhage

Microscopic examination
- Orient 1st of what tissue you are looking
- Check history
- Gross > microscopic

Adenocarcinoma - malignant tumor composed of glands

- Glands
- Malignant epithelium??
Adenocarcinoma

Glands: normally located at the mucosa; (-)

muscularis propria, serosa

- 3rd image: supposed muscularis propria but

glandular cells are still present
(Hyperchromatic, increased N:C ratio cells →
cytoplasm not visible, prominent nucleoli)
Squamous cell CA:
- Non-neoplastic -squamous cells (R)

Squamous cell carcinoma

- Squamous cell must be present
- Right(image 2): non neoplastic
- left: cells are becoming atypical / neoplastic
and infact the mucosal line by glands. In this
case, the squamous cells have reached the
lamina propria.
- Lamina propria: (+) lympho-vascular units
- Complete histologic diagnosis:
well-differentiated squamous cell
carcinoma
- Present intercellular bridges more important
- keratin pearl: but in practice this is not
used as evidence
- (+) sheets of highly malignant
squamous cells
Chronic Benign Peptic Ulcer (Stomach)

History: Endoscopy of a 35 y/o complaining of

epigastric pain
- Smoker

Bases (benign):
- Punched out lesion: well defined border
- Clean base

Malignant
- Heaped up borders
- Jagged one
- Necrosis, hemorrhage

(2nd image) Depression = ulcerated portion

(3rd image) After the clean base you will see a layer
of granulation tissue.
- Found in Healing wound
- (+)small sized blood vessels, angiogenesis
- (+) fibroblasts
 -

Ulceration

Granulation tissue

GIST - gastrointestinal stromal tumor

- Misnomer (not from stroma)
- Came from interstitial cells of Cajal
- pacemaker cells of alimentary tract,
git motility/peristalsis
- ANS
- Helpful in conveying message

2nd image: cells appear spindly / wavy / fusiform

- Spindle cell tumors are similar in histology
- Clue: Saan ba galing?
- abdominal = GIST: most common
mesenchymal
- request: CD117 / c-KIT
- mutation:tyrosine kinase inhibitor

GIST - most common mesenchymal tumor in the abdomen

Adenocarcinoma intestinal type (Pylorus,
Stomach) - due to presence of glands lined by
Stomach:tumor split open malignant cells

Lauren’s Classification: Easier to use in histologic

typing of gastric cancer than WHO

Adenocarcinoma diffuse type (all over the

stomach): 3rd image
- No mass but with thickening – leathery and
rubbery
- leather bottle in appearance (linitis plastica)
- Several glands, hyperchromasia, inc N:C
ratio
- solid sheath/nest of tumor cells
no formation of distinct tumor -- diffused
“For adenocarcinoma, you should always see glands
lined by malignant cells.”
presence of glands

nest of tumor cells

Diffuse-type gastric adenocarcinoma (linitis
plastica)

Wala kang makikitang bukol, you only notice the

thickening and the leathery of the gastric wall

Examining it microscopically:
● 3rd image: These are the malignancy cells,
you don't see any formation of the gland. You
only see single cells infiltrating the gastric
wall. When you examine them closely, they
look erratic.

malignant cells; no formation of glands = no mass

single cells infiltrating the gastric wall

Signet Ring Cell Carcinoma

Another distinct type of diffuse-type is the signet-ring

cell carcinoma. It is a signet ring because the
malignant cells look like a signet ring.

Nucleus: pushed at the periphery

Cytoplasm: mucin which pushes the nucleus at the
 periphery

POOR PROGNOSIS
- Any type of diffuse-type gastric carcinoma is
considered aggressive, hence the poor
prognosis. Might not live up to 5 years

Q: If this is given in the practical exam, what type of

gastric carcinoma is this?
a. Diffuse-type
b. Intestinal-type

Meckel’s Diverticulum NO MASS formation

- small intestine
- Hx: 2/M, abdominal pain, blood-tinged stool
- Enrico: falls into Rule of 2’s of
Meckel’s

Microscopic examination:
● Most likely from small intestine due to the
presence of microvilli
● It looks like an outpouching
● 3RD IMAGE: Do you normally see these
groups of cells in the intestine?
○ Should not. This is an ectopic tissue in
the wall of the intestine → consider
Meckel’s Diverticulum

Q: Is Meckel’s Diverticulum, a true diverticulum or

not?
microvilli A: True. It contains all three layers of the bowel tract.
● False diverticulum – sigmoid diverticulum

When you have an ectopic tissue, it can tell you the

possible complication. If it’s gastric it can cause
ulceration? If pancreatic, then perforation may occur.

Rule of 2
outpouching ● 2 years old
● 2 feet from the ileocecal valve
● 2% of the population
● 2x more likely in males

MOST LIKELY WILL NOT APPEAR IN THE LAB

EVALUATION: Choristoma vs. Heterotopia

Choristoma: (+) obvious gross mass

→ in Merkel’s: (-) mass → heterotopia

Hamartoma: excessive, focal overgrowth of cells and

ectopic tissue tissues native to the organ in which it occurs;
disorganized but benign masses composed of cells
indigenous to the involved site. (Robbins 9th)
 Segmental hemorrhagic infarction of the ileum
● Most common etiology of a transmural
infarction of the intestine: blockage of SMA
(Superior Mesenteric Artery)
○ Cause of transmural infarction: Areas
do not get collateral or poorly
perfused area
○ Large intestine has other sources of
blood supply: SMA, IMA, “watershed”

2nd image:
● If mural, only up to submucosa
● If transmural, the whole layer of the intestine
is infarcted (Right)
● No mucosa
● Hemorrhage in the submucosa
● Outermost layer has inflammation

mural = up to submucosa
transmural = whole layer of intestine

normal
 complete necrosis of entire intestinal wall
TRANSMURAL INFARCTION

ILEOCECAL TB IS SKIPPED

“Magaling na kayo sa TB”

Lymphoma of the intestine will not be asked!!!!!!

 Tubular Adenoma, colon
● Why?
○ Tubular = tubules, because of the
tube-like lesions
○ Adenoma = neoplastic polyp of the
intestine
○ Polyp = true neoplasm = (+) dysplasia
■ Review characteristics of
dysplasia way above
● 3RD IMAGE: Villous = finger-like projections
○ Possesses the highest risk of
malignancy
● 4TH IMAGE: Tubulovillous = combination of
tubular and villous
○ Accd. to F2F session, surgery says
tubulovillous?? Pero Patho dept
follows villous as the highest risk.

*Tubular has the lowest risk of malignancy*

Tubulous - LOWEST risk for malignancy

NON-NEOPLASTIC POLYPS
- hyperplastic polyps
- juvenile polyp
- inflammatory polyp
- ??

Villous - HIGHEST risk for malignancy

Villous
Tubules Tubulovillous
Hyperplastic polyp
● Nuclei is basally located
● No stratification of the nuclei
● Cork-screw/serrated appearance due to piling
up/ crowding of nuclei creating a papillary
structure
● Non-neoplastic polyp due to absence of
adenomatous change or dysplastic change

Crohn’s disease
● IBD with Ulcerative colitis
● How to differentiate between UC and
Crohn’s?
○ Crohn’s: transmural
○ UC: exclusive to the colon; Toxic
megacolon
○ Both predispose to malignant
development if Crohn’s involves colon
● Skip lesions in Crohn’s disease
○ Lesions in UC are localized
○ Granuloma formation in Crohn’s that
is between normal tissue – skip
lesions
○ (3rd image) Gross: (+)Cobblestoning
Ulcerative colitis
● Debris, inflammatory infiltrates
● Where the ulcer is – more granulation tissue
Adenocarcinoma of the colon (well-differentiated)
● Well-differentiated because the tumor is
primarily composed of well-formed glands
● Prognostication:
○ Depth of invasion
○ Regional lymph node status
○ Size is important in adenoma: >
adenoma > chance of developing into
malignancy

Mucinous Carcinoma, colon

Cells floating in mucin

Memorize the image xD

 Appendicitis
- Most common etiology: obstruction of fecalith
- Anything that can increase pressure

Histo:
● Mucosa, submucosa, muscularis, which
layer? serosa
● Lymphoid follicles in the mucosa to
submucosa layer
○ In diagnosing acute suppurative
appendicitis: muscularis layer: inc
neutrophils

Kung nasa mucosa lang, we will not call it

APpendicitis

Hemorrhoids (Mixed)
● Varices
● Depending on the lining epithelium, that is
where you will base your diagnosis:
○ If columnar - internal hemorrhoid
○ If squamous - external hemorrhoids
○ If both glands/columnar and
squamous - mixed
● Not a neoplasm
○ Dilatation of network of veins, hence
they are like varicose veins

LIVER, PANCREAS, GALLBLADDER

Fatty Liver
● Grossly, yellowish and greasy
● Microscopically: you will see several fat
droplets
● Etiology:
○ Most common cause of fatty change
is chronic alcoholism
○ Malnutrition is also another common
cause
● Pathophysiology:
○ Accumulation of triglycerides in
hepatic parenchyma

Alcoholic Liver Disease

● Alcoholism
● Formation of pseudonodules
○ What is the normal arrangement of
hepatocytes? In trabeculae contained
in a plate
○ 2 layers in 1 plate, endothelial lining
■ HCC if w/o endothelial lining
● Near central vein
● Stroma → collagenous, sclerotic
prominence of stroma
 Hepatocellular Carcinoma (HCC)
● Look at the size of the tumor – bulky, almost
effacing the normal architecture of the liver
● (+) satellite nodules (2nd image)

3rd Image
● LEFT: tumor
○ THe cells are already haphazardly
arranged
○ Note the nuclear details – anaplastic
changes
● RIGHT: normal
● Tumor marker to request: AFP
○ G3 is sometimes requested
○

tumor

normal
hepatocyte
 normal hepatocyte

tumor cells

Metastatic gastric carcinoma in liver

● Stomach and intestine (colon) are common
sources of liver mets
 Chronic cholecystitis
● Histologically:
○ Mucosa
○ Muscularis
■ Diagnosis depends on
presence of mononuclear
infiltrates (lymphocytes) in this
layer
● It is not normal to see
Eosinophils, seeing
them might indicate
chronic inflammation
○ Serosa

Layers of the gallbladder (3)

- Walang submucosa

muscularis layer
mucosa

Gangrenous Cholecystitis
● Microscopic:
○ You will no longer appreciate the three
layers of gallbladder
○ You might see some remnant of
fibrotic tissue
 necrotic debris and remnant of fibrotic tissue

Acute Hemorrhagic Pancreatitis

● Most common etiology: alcoholism
● Where the hemorrhage is that is where the
necrosis and saponification process are
○ Lipase is more specific to the
pancreas over amylase
■ Saliva also contains amylase

pancreatic islets
Male Genital System/Tract

Condyloma Acuminata
● Benign condition caused by low-risk
oncogenic HPV (6, 11)
● Anogenital cancers, mostly in the form of
SCC are due to high-risk oncogenic HPV (16,
18, 31, 33)
● Microscopically:
○ Papillary projection
■ Supported by fibrovascular
cores
○ Koilocytic atypia
SCC of the Penis
● Keratin pearl
● Intracellular bridges

Cryptorchid, testis
● Fibrosis makes it smaller and hard
● Microscopically:
○ Arrest in the germ cell maturation
■ You will usually see
spermatids
○ Prominence of basement membrane
(seminiferous tubule)
○ Prominent Leydig cells
○ Increase in interstitial stroma
Seminoma
● All germ cell tumors are considered malignant
● Counterpart of (dysgerminoma) germinoma of
the ovary
● Radio-sensitive
● Bulky
● Microscopically (2nd image):
○ Tumor cells in sheaths separated by
delicate fibrous septa
○ Cytoplasm is clear
○ The nucleolus of a cell is very
prominent
○ Lymphocytic infiltration of the
background
● Tumor marker: Placental lactogen alkaline
phosphatase (PLAP)

Case:
20 yo with testicular tumor: seminoma

Choriocarcinoma AGGRESSIVE GERM CELL TUMOR

● High propensity for angioinvasion
● Metastasizes earlier than expected due to its
propensity for angioinvasion
○ Brain mets
● Many patients will present with seizure
● Microscopically:
○ Two distinct groups of cells:
■ Syncytiotrophoblast: look like a
multinucleated giant cell

■ Individually placed –
cytotrophoblast
 ● Normal to see extensive hemorrhage (image
3) due to its ability to invade blood vessels
● Tumor marker for diagnosis and monitoring:
○ hCG (human chorionic gonadotropin)

Nodular prostatic hyperplasia

● Usually arises from the transitional size,
whereas your prostatic carcinoma and
something else arise from the peripheral zone
● (+) nodularity
● Image: impingement of the urethra secondary
to the enlarged nodules
● (2nd image) Microscopically:
○ Increased number of cells in each
gland creating folds or papillary
projection (due to crowding, piling up)
● Pathophysiology: testosterone → elevated
DHT
○ 5-a-reductase
 SKIPPED PROSTATIC ADENOCARCINOMA
“Alam nyo na yan”

FGT 1 & 2

Bartholin cyst, vulva

● Pathophysiology:
○ Blockage of duct, expect infection
● Treatment: antibiotics, marsupialization
● Microscopically NO STICTHING
○ Transitional type lining epithelium
Gartner Duct Cyst
● Pathophysiology:
○ Patent wolffian duct that is now
obstructed
● Microscopically
○ Unlike Bartholin, the gartner is lined
by flattened or cuboidal epithelium
○ It also contains fluid (its only content)
○ Fluid-filled
Cervical Intraepithelial Neoplasia (CIN) 3
● Colposcopy, acetowhite
● CIN Grading (based on location)
○ Grade 1: lower 3rd
○ Grade 2: two 3rds is dysplastic
○ Grade 3: carcinoma in-situ
■ Full thickness dysplasia (see
image 2)
SCC of the cervix skipped
Adenocarcinoma of the cervix skipped

Endocervical Polyp
● Polypoid, fleshy
● Since this is an endocervical polyp, we
expect glands
○ Columnar, mucin-containing
● Microscopically
○ Blood vessels in the stalk
■ When removing the polyp, the
removal of the stalk should be
clean to prevent recurrence
Leiomyoma SMOOTH MUSCLE BENIGN TUMOR
● One of the favorite questions in the practical
exam
● Image: uterus split open
○ This uterus has multiple leiomyomas
(leiomyomata)
● Well-circumscribed, solid lesion
● Location could be intramural, subserosal,
submucosal
○ Submucosal leiomyoma – you can
see glands attached to it due to its
location
● Microscopically
○ You will see bundles of interlacing
fascicles of smooth muscle cells
■ Leio - smooth
■ Myo - muscle
■ Oma - benign tumor
● Leiomyosarcoma is the
malignant counterpart
(mesenchymal origin)
● The fact that the ‘bukol’ is in the myometrium,
that should signal you that it is made of
smooth muscle cells
Cystic Follicle
● Lined by Graafian follicles
● DIfferentiated from follicular cysts by its size
○ Cystic follicles are <3 cm whereas
your follicular cysts are > 3 cm
○ Histologically, they are the same
■ Lined by follicle

Corpus Luteum Cyst, Ovary

● Cystic space with yellowish wall
○ Wall is yellowish because wall is
luteinized
■ It is expected to be luteinized
during the proliferative phase
(surge of LH)

Papillary Serous Cystadenoma, Ovary

● We usually call it serous cystadenoma
● Benign tumor of the ovary
● Usually unilocular (one cyst, one locule) but
can also be multilocular
● The wall is smooth
○ Since benign
● You won’t see solid areas unlike in serous
carcinoma of the ovary where it is solid cystic
● Microscopically
○ Single layer of columnar with hair-like
projection
 Serous Cyst Carcinoma, Ovary
● Exophytic tumor
● Cystic part
● Microscopically
○

Mucinous Cystadenoma, Ovary

● Microscopically
○ HPO: columnar, mucin-containing
● Adenoma = benign
○ If columnar epithelium, we call it
glandular, if glandular we call it adeno
● Mucinous carcinoma is same except the cells
are more erratic/pangit

MULTILOBULATED THAN SEROUS CYSTADENOMA

 Mature (Benign)Teratoma, Ovary
● Cystic w hair → teratoma only, needs
microscopic findings to know if it is mature or
immature
● Microscopic
○ (2nd pic) Mature cartilage- Basophilc
○ (3rd pic) Mature Sweat glands,
sebaceous glands
○ (4th pic) Green arrow: look like mature
hair follicle
○ (5th)Squamous epithelium
○ All shows skin attributes = mature
teratoma

cartilage
sebaceous gland

sweat gland

hair follicle

hair follicle

squamous epithelium

Immature Teratoma, Ovary

● MOST IMPORTANT: Presence of
NEUROEPITHELIUM
● Malignant
● Age is most important biologic predictor
○ Sa elderly, even if its immature, the
management is still
children - benign behavior
elderly - malignant

solid cystic, hemorrhagic, uglier presentation, ketosis

 NEUROEPITHELIUM - most important

Dysgerminoma ovary is skipped

Yolk Sac Tumor, ovary

● Age of the px: infants, children <3yo
● Microscopically:
○ Schiller-Duval body
○ Pink circular, round structure –
hyaline globule
■ PAS positive
○ Cystic tumor
● Tumor markers:
○ AFP
Schiller-Duval body

cystic tumor

hyaline globule

Choriocarcinoma same sa choriocarcinoma ng testis

Fibroma, Ovary
● Monodermal germ cell lesion
○ Composed of fibrous tissue
● Meig’s syndrome
○ Characterized by pleural effusion,
ascites
Hydatidiform mole
● Sago-sago
● If with fetus → partial mole
● Microscopically:
○ Partial if there are only some areas
that are swollen
■ Proliferation of trophoblasts is
one-sided, incomplete, partial
■ Villous: incomplete
proliferation
- Complete if entire area is with
proliferating trophoblastic cells

Partial mole
 Placenta Accreta
● (-) decidium
○ Attachment of spiral arteries directly to
muscle, so it’s difficult to remove the
placenta → uterine inversion

Granulosa cell tumor – might not ask that since germ

cell tumor is more important
● Call-exner bodies

Call- exner bodies

Sertoli Cell Tumor

● Reinke crystals

Breast
Fibroadenoma, breast
● (-) leaf-like processes, (-)hypercellular, nuclei
are spaced out
● MOST COMMON TUMOR of the breast

Phyllodes tumor, low grade, breast

- Can respond to hormones
● Leaf-like processes
● Highly cellular: nuclei are very close to each
other

grows large, can replace entire tumor

both arise from intralobular stroma, can be responsive to

hormone

Invasive Ductal Carcinoma

● Malignant
● Microscopically:
○ dense , collagenous, fibrous
○ Haphazard arrangement
○ Desmoplastic reaction: stroma is
oriented towards the tumor
○ Tumor has reached the fat
● Lymphatic spread (bec. carcinoma)
○ Sarcoma= hemo spread
○ “Pag inoperahan ang pasyente, pati
kulane tanggalin”
 Mucinous Carcinoma, Breast
- Extracellular pool of mucin, - no supporting
stroma attached to the cells (floating)

Endocrine
Pituitary Adenoma
● Depends on the hormone secreted by the
tumor → diagnosis
○ GH-secreting = somatotroph adenoma
○ FSH/LH-secreting = gonadotroph
adenoma
○ TSH-secreting = thyrotroph
● Most common location is the sella turcica
○ Bilateral hemianopsia

Papillary Carcinoma of the Thyroid

Exam will show the papillary structure

(+) fibrovascular core supporting papilla
(+) orphan annie eye appearance (3rd image, green
arrow) chromatin is dispersed

Papillary carcinoma: nuclear details will give you

more accurate diagnosis. Hindi lang naman papillary
ang pwede mag sabi if papillary siya.

Chromatin dispersal

Consider Grave’s disease (?)

Triad of Graves disease
Follicular adenoma, Thyroid
- Neoplastic thyroid follicles
- well-demarcated, encapsulated
- Histologically
- examine carefully the capsule: should
be intact
- Microvascular invasion
- Hard to differentiate from follicular vs
Carcinoma
 Graves’ Disease
HISTORY
- Triad of Graves what is missing?
- Exophthalmos, dermopathy, ano daw yung
isa HAHA hyperthyroidism

Colloid → moth-eaten

Hashimoto’s Thyroiditis is skipped

RENAL

Renal Cell Carcinoma, Kidney

● Favorite question in the renal system
● Easy to diagnose in the exam since they will
show a kidney mass → RCC
● Always read history in the exam
● Microscopically
○ (3rd image)Thyroidization of the renal
tubules → chronic pyelonephritis
■ (+) lymphocytes
○ (4th pic)Tumor: the cytoplasm is clear
– renal clear cell carcinoma
■ RCC is understood as
clear-cell type
● Most common etiology of RCC:
○ SMOKING
■ Almost always
■ Also in urothelial carcinoma
normal tissue

RCC
Papillary Urothelial Carcinoma, Urinary bladder
● Low-grade:
○ Since the tumor arises from the
urinary bladder, you expect the lining
epithelium to be transitional
■ The normal number of cells in
the transitional epithelium is 7,
■ >7 → urothelial carcinoma/
malignancy is present
○ Low-grade = differentiated
■ The cells still resemble the
normal ones
● High-grade:
○ More erratic cells, you can’t
appreciate the transitional
arrangement anymore
■ Haphazard arrangement

low-grade
 Wilm’s Tumor, Kidney
● IMPORTANT: HISTORY
○ Pediatric, renal tumor
■ 5 y/o with abdominal
enlargement, UTZ revealed a
renal mass
● Microscopically
○ Different population of cells (3rd
image)
■ Tubule formation
■ solid sheath of tumor cells
■ Nephroblastoma (Wilm’s) is a
triphasic tumor: epithelial
(tubules), blastemal (sheath of
tumor cells), stromal
○

MSS
Fibrous Dysplasia
● “Chinese-character”
● Absence of osteoblastic rimming, unlike in
osteoid osteoma
●

Osteoid osteoma
● Similar sila ng Fibrous dysplasia
● Microscopically:
○ Osteoblastic rimming
○ (+) osteoblast

Liposarcoma
● History and appearance
● Histologically
○ Composed of fats
○ Look for osteoblasts: panget na
nucleus → consider it as lipoblast
Rhabdomyosarcoma
- “I dont think they will ask
Rhabdomyosarcoma”

Chondrosarcoma
● SKIPPED

Gout
● Microscopically
○ Uric acid crystals, tophi/tophus
■ In the practical exam, Hx: pain
in metatarsal area with
erythema, see the image
below and identify the
structure → tophi/tophus
■ Pain bc it becomes solid →
kaskas on bones
 Osteochondroma
● Microscopically
○ Mixed of cartilage and bony tissue
■ Cartilage cap (dark blue part)
overlying the osseous tissue

Osteosarcoma
● Several diagnostic features
○ Clinical: location, age, radiographic
findings, histology
● Most common in the lower extremities
specifically in the metaphysis
● Radiographic: Sunburst appearance,
Codman’s triangle
● Microscopically
○ Presence of osseous tissues
○ Tumor giant cells
○ Bony structures

CNS
Acute Pyogenic Meningitis

Infections
● Location of Exudates - leptomeninges
(cortical area) most possibly c_ area (staph,_
) if
●
● _ area (tuberculous) basal area
● Hydrocephalus and cranial nerve palsy

Glial Tumors
Grade 1: Pilocytic Astrocytoma
Grade 2 Oligodendroglioma
Grade 3:Anaplastic Astrocytoma
Grade 4: Glioblastoma
● wild type: aggressive type, common among
adults, poor prognosis
● Mutant type: less aggressive
● Secondary =adults
● Primary= children

Wild and mutant type

SecOndart mas common sa bata
Pangit ang wid type sa prognosis kaya WILD.

Glioblastoma
● Microscopucally:
○ Necrosis
○ Endothelial proliferation
○ Peripheral palisading around the
necrosis
Medulloblastoma IV/IV
● children, cerebellum
● Small round
● Monomorphic
● Homer-Wright rosettes
Meningioma
- Benign
- Psammomatous meningioma (+)

Pilocytic Astrocytoma
- corkscrew appearance eosinophilic

Acoustic Schwannoma (Neurilemmoma)

- Mapagkamalan na glioblastoma
- No necrosis
- No blood vessel proliferation
- Palisading of the tumor cells
- Hyperceullar = Antoni A
- Middle, pinkish = verocae
- Composed of neuropil
- Network of axons
- Anything without nerve sheath
- Exposed filaments / dendrites
- Communicate the stimulus
- Hypocellular = Antoni B

This was discussed by dra pascual during MSK module, use

2023 trans wala tayong trans for that

Intracerebral hemorrhage
● Most common location: (google)
Subarachnoid (basal area) *di namin narinig
sorry pu*
50 y/o with chronic hypertension that is poorly
controlled

2 types of stroke
 - Hemorrhagic - Aneurysm; deadlier because it
compromise the brain stem
- Thrombotic - infarction that leads to
thrombosis

Infarct can be converted to hemorrhage.

ER = establish first what type of stroke before
medication is given.

Hemorrhagic tas akala mo thrombotic binigyan mo

ng anti-thrombotic = mas lalong dudugo

“MOST LIKELY KUNG ANO LUMABAS DIYAN (REVIEW), AYON LALABAS SA EXAM”

- Doc Renan Navarro

P.S. Maligo daw kayo

Kami din doc malakas sa alcohol ;)

VOTE LENI ROBREDO + KIKO PANGILINAN

EASIER NA DAW ANG GUT 2 RETAKE TT__TT sana po talaga

TRUE AYAKO NA

Patho Pratical Exam - June 16 Thursday