Introduction to Pathology

Cell Injury 1
Introduction: Anatomic Pathology work flow
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H&E staing+/-
Special
stains/IHC
How to identify the pathologic changes in tissue?

LOW POWER: Overall change in tissue composition or pattern.EX.

Normal Change?
b)HIGHER POWER: Details of the cells
(type & morphology) Example

Normal Change?
ILOs (Objectives) for the Practical Lab Course:
By the end of the practical lab course, you will be able to:

1.Identify & Describe the abnormal microscopic findings

in any given organ or lesion “in a photo” to reach a
diagnosis.

2.Identify the underlying type or nature of lesion.

3.Develop skills of observation, interpretation, and

integration needed to analyze basic clinical and
pathologic data to diagnose human disease
Learning Resources for lab lessons :
A. MAIN SOURCES:
1.Section attendance
2.MOODLE uploaded lab sections

B. HELPING RESOURCES:
Atlas of histopathology (please note to correlate with your
sections because book isn’t entirely aligned to current curriculum)
Adaptation
• Hyperplasia:
Increase size of the organ due to increase the
number of the cells
• Endometrial hyperplasia
• Benign prostatic
hyperplasia
• Nodular goiter
CASE1:
A female patient 50-year-old
complained of heavy
prolonged menses (menstrual
uterine bleeding) for the last 2
years. Pelvic ultrasound
revealed no organic lesions
(no masses) in the uterus.
Dilatation and curettage (D &
C) and endometrial biopsy
was done and revealed the
following figures.
Endometrial Hyperplasia
Clinical keynotes:
1- Usually elderly females
2- Exposed to ↑ unopposed E2→over stimulation
3- Presented usually by dysfunctional uterine
bleeding
4- RISK OF MALIGNANT TRANSFORMATION
-Glands & stroma
-Cellular stroma
-Cystically
dilated glands.
-Cuboidal lining
 Endometrial hyperplasia
Hypercellular stroma

Swiss cheese
appearance

Cystically dilated
glands

Nature of this lesion: Cellular adaptation-Hyperplasia

 Endometrial hyperplasia
Hyperplastic cellular stroma but overall increase glands/stroma ratio
Mitotic figure

Pseudostratified lining
Case 2:
A male patient 75-year-
old complained of dysuria
(difficulty in urination)
with intermittent
interruption of the urine
stream.
Trans-uretheral prostatic
resection (?) was done
which showed the
following figures
 Benign Prostatic Hyperplasia

Clinical keynotes:
1- Usually elderly males
2- 5 α-reductase enzyme: Testosterone
→ DHT
3- Presented usually by lower urinary tract
obstructive symptoms
4- DD with prostatic cancer BUT NOT
PRECANCEROUS
 Benign Prostatic Hyperplasia
• Stroma is
fibromuscular
• Glands relatively
large
• Lined by columnar
cells sometimes are
pale
• +/-corpora amylacea
 Benign Prostatic Hyperplasia

Fibromuscular
Stroma

Nature of the lesion: Cellular adaptation- Hyperplasia

 Benign Prostatic Hyperplasia

Proliferated glands & stroma

Lumena of some acini show Corpora Amylacea (laminated secretions)

Benign Prostatic Hyperplasia

Corpora
amylacea
papillary
infoldings
CASE3:
A 45-year-old man
observed an
enlarged mass in
the front of his
neck that moved
with deglutition.
Surgical removal of
the mass was done
and revealed the
following figures
 Nodular Goiter
Clinical keynotes:
1- Females> Males
2-Swelling in the neck midline (moves with
deglutition)
+/- pressure symptoms
+/- toxic symptoms
3- NOT PRECANCEROUS
 Nodular Goiter
• Glands& Stroma
• Very scanty fibrous
stroma
• Glands are filled
with colloid
Nodular Goiter
Nodules of thyroid acini separated by scanty
fibrous stroma
 Nodular Goiter

Nature
Nodules ofacini
of thyroid theoflesion:
variableCellular adaptation
size separated by delicate-fibrous
tissue septa showing few chronic inflammatory cells.
Hyperplasia
 Nodular Goiter
Colloid Acini show flat to cuboidal lining epithelium
 METAPLASIA
Change of mature cell type
to another mature cell type
with respect of histologic
boundaries.
CASE 4:
A 35 year old male
complained of burning
. in upper part of
pain
abdomen. Endoscopic
examination and biopsy
from esophagus were
done and revealed the
following figures.
Abnormal appearance
of the lower end of
esophagus
 Barrett's esophagus
Clinical keynotes:
1- History of acid
reflux (heartburn)
2- Preceded by reflux
esophagitis
4- Risk of
MALIGNANT
TRANSFORMATION
 Barrett's esophagus
Normal stratified squamous epithelium

Metaplastic intestinal epithelium with goblet cells

 Barrett's esophagus
Metaplastic intestinal epithelium with
goblet cells

Normal stratified
squamous
epithelium

Nature of the lesion: Adaptation- Metaplasia- Precancerous

3
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Time for
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Your Stations
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 Station 1
1-Diagnosis …………….

2-Type of lesion is:…………..

 Station 1
1-Diagnosis endometrial hyperplasia

2-Nature of lesion is:

Hyperplasia
 Station 2
1-Diagnosis …………….
2-Complete: Number of acini is ………..
3-Complete:The acini contain ……………

4-Nature of lesion is:

 Station 2
1-Diagnosis Multinodular Goiter
2-Complete: Number of acini is increased
3-Complete:The acini contain colloid

4- Nature of lesion is:

Hyperplasia
 Station 3
1-Complete: The proliferation involves
……….. and …………..
2-Complete:The lumen of some acini
contains ………………..

3- Nature of lesion is:

 Station 3
1-Complete: The proliferation involves
glands and stroma
2-Complete:The lumen of some acini
contains corpora amylacea
3- Nature of lesion is:
Hyperplasia
 Station 4
This esophageal biopsy shows
……………………..
 Station 4
This esophageal biopsy shows

Intestinal cell metaplasia with goblet

cells