Pathology

Pneumonia lobaris

• Thickened Wall due to congestion and edema

• Accumulation of exudate (in alveolar space ) rich in fibrin, bacteria,
leucocytes, and erythrocytes. in 3rd stage exudate also includes
neutrophils and macrophages in order to get rid of fibrin
• Congestion, Red hepatization, Grey hepatization, Resolution.
• naturally drained by lymphatics and airway (productive cough)
• Macroscopy: affected lobe first red/ purple—> red brown and liver like
(hepatization) dry rough surface—> uniform grey with grey purulent
liquid draining.)
 Pneumonia lobularis

• Acute exudative suppurative inflammation of lungs -

consolidation (hardening )of lungs

• Macroscopic: Multiple foci of condensation white/

yellowing foci. w. normal parenchyma

• Microscopic:affected alveoli around bronchioles.

with suppurative exudate rich in neutrophils.
congested capillary in these alveolar walls.
 Pericarditis Fibrinous

• Macroscopic: Thick fibrinous Exudate on pericardial

surface. Epicardium infiltrated by fibrin deposits
network and on deeper level :leukocytes (neutrophils)
and inflammatory cells. Bread and butter
appearance.

• Microscopic: fibrin network over epicardium (fibrinous

exudate) with leukocytes (neutrophils) and inflammatory
cells. Can also see vascular congestion. with no
changes to myocardium.
• Thick layer of fibrin w. neutrophils
• granulation
• Fat
• muscle
 Leptomeningitis purulenta

• Macroscopy: Cloudy swelling of meninges. thick pus-like

exudate. only meninges inflamed.
• Microscopy: the leptomeninges (arachnoid and pia
matter) contain purulent exudate, consisting of;
leukocytes( neutrophils), fibrin, germs, protein, and
necrotic debris.
• blood vessels in subarachnoid space are congested —>
neutrophil margination (leukocyte interact with endothelial
cells).
• theses neutrophils accumulate mainly around dilated
vessels.
• the underlying grey matter vessels are dilated with round
cells and leukocytes
• Caused by: in infants under 2 months: Staph aureus.
• if Over 2 months: Homophiles influenza, meningococci,
 Appendicitis phlegmonosa

• Neutrophils infiltrate entire thickness of appendices wall.

mucosa (1), Submucosa (2), Muscular layer (3), And
serosa (4) with neutrophils.

• Enlarged lymphoid follicles with prominent germinal

centre.

• lumen filled with amorphous debris.

• with little pus

• Macroscopy: Fibrino purulent exudate on serosa

• Caused by: Myocardial infarction, rheumatic fever

trauma, infections
 Nephritis purulenta

• Inflammation of renal parenchyma and pelvis.

• Lots of neutrophils in interstitial tissue and

inside lumen of tubules.

• small collection of neutrophils —> forms

access scattered throughout cortex.

• Macroscopic: focal abcesses yellowish ,

wedge shaped areas of suppuration

• Caused by UTI, ascending infections or

obstructions
 Granulatio

• Macroscopic: granular appearance - from capillary wedge.

• Microscopic:1) growth of young connective tissue cells=

Fibroblasts. 2) neoplasms of capillary wedge.

• 1) fibroblasts- spindle shaped oval.

Neutrophils= segmented nuclei
lymphocytes- hypochromic nucelus
plasma cells- eccentric nuclei
epitheliod cells- oval
macrophages- large cells, abundant cytoplasm, oval/ kidney
shaped nucleus.
Giant cells- with foreign body inside them and multinucleate
• Nonspecific reaction to foreign bodies- endogenous
or extraneous(sutures)

• Productive inflammation, immediately surrounds and

entraps foreign body. young granulation tissue
proliferates and has capillaries, fibrocytes.. etc esp
lymphocytes and segmented nuclei and GIANT
CELLS- made up of many macrophages (
multinucleaded giant cells)

• IF foreign body can be absorbed granulation tissue

—> matures to mature fibrous tissue

• if not Foreign body stays encapsulated

 Abscesses Chronicus Cerebri

• Macroscopy: liquefactive necrotic centre. Encapsulated

with a collagen capsule and gliosis capsule

• Microscopy: 3 layers; 1) Pyogenic membrane-

nectroti tissue infiltrated by neutrophils and cell debris.

2) Then Zone of Foamy Macrophages; (contains lipids from

necrotic tissue) and some plasma cells lymphocytes..
etc.

3) Layer of reactive glial cells- and some fibrosis

 Cirrhosis hepatis

• Macroscopic: Nodules present on surface of different sizes.

with fibrous bands

• Microscopic: 1) Formation Of Scar Tissue- where hep. are

destroyed- distorts structure. with Fibrotic Septa

2) fibrous septa- infiltrated with lymphocytes and plasma cells

and inflam. cells. also proliferation of bile ducts in here.

3)Dystrophic changes to hepatocytes by either vacuoles or fatty

degeneration and necrosis

4) regeneration of hepatocytes—> which are larger, w light

cytoplasm and larger and darker nucleus.

Caused by Alcohol, viral hepatitis, idiopathic (autoimmune) wilsons

cancer sever cardiac cirrhosis
 Cirrhosis hepatis VG

• Van Giesan Stain- shows

presence of collagen in
connective tissue

• red and yellow is

remaining hepatic tissue
 Cicatrices Myocardi

• Scaring in myocardium = mature

connective tissue (consists of fibrocytes
fibroblasts and few blood vessels).

• Caused by Hypoxia or myocardial

infarction.

• H/E scar stains pale pink

 Cicatrices Myocardi VG

• In Van gieson staining- connective tissue scarring

turns pink-red due to presence of collagen

• and muscle tissue = yellow

 Tuberculosis miliaris pulmonis

• Is chronic Granulomatous TB.

• Macroscopy: tiny lesions white/yellow.

Microscopy: focal granuloma= caseous necrosis.

Around this focal granulose is a fence of Epithliod cells. and

some giant cells (Langhans cells) this and epithelial cells
togather= specific for TB granulosa.

Around epithelial cells are Shaft T Lymphocytes.

few blood vessels and plasma cells

 Leptomeningitis Tuberculosa

• Macroscopy: white granules scattered over

leptomeninges. And gleatinous/ fibrinous
exudate in subarachnoid space/ base of brain.

• Microscopy tubercles formed by central

caseous necrosis, surrounded by epithelioid
cells and giant Langhan cells.

• Caused by Mycobacterium TB
 Mesaortitis luetica

• Manifestation of 3rd stage of syphilis in thoracic ascending or transverse aorta. leads to

destruction of elastic tissue and dilation and aneurisms formation.

• Macroscopy: scars and wrinkles on outside.

• Microscopy: Dilation with grey plaques of calcium . Middle layer infiltrates with PLASMA
CELLS and FRAGMENTS of damaged ELASTIN tissue and new blood vessels.

• could damage valves, narrowing—> embolism (cerebral)

• Obliterates Vaso Vasorum due to necrosis and fibrosis.

 Actinomycosis

• Chronic purulent infection - and suppurative.

• Caused by Actinomyces isralii mostly for humans.

• Macroscopy: Sulfur granules-small yellow granules found in the abscess formed.

• Microscopy: Purulent inflammation surrounded by many segmented leukocytes and

macrophages (loaded with lipids from dead pagocytosed cells ).

• Could be in Cervicofacial, skin, pelvic, abdominal , pulmonary

 Hyperplasia mucosae uteri glandularis cystica

• Due to increased proliferation of endometrium due to increased oestrogen levels - hormonal imbalance -
menopause, drugs w high oestrogen, oestrogen producing tumors.

• leads to endometrial hyperplasia, hyperplasia of glands always accompanied by endometrial soma cells which
are compressed.

• also there is swollen pink liquid in centre.

• and glands are closely packed together back to back

• this condition is precancerous

 hypertropia glandulae prostatae

• due to hormonal deficiency- loss of gondola function.

• hyperplasia of glands and stromal structures- by proliferation.

• increased glandular components (adenamentous hyperplasia)

and increase in smooth muscle and fibrous stroma
 Struma collidis

• Macroscopy: firm with amber out surface. Or if multi nodular Goiter -is
large, cystic, hemorrhagic, brown gelatinous colloid nodules with focal
calcifications.

• Microscopy: Due to Increased size of thyroid gland enlargement of

follicles with a lot of colloid accumulation inside them- this accumulation
—> pushed on cuboidal epithelial cells—> flat —> atrophy.

• Causes: Sporadic, Drug induced e.g. sulphonamides—> inhibit

organification of iodine, or plumbers syndrome.
 Fibrocystic disease of breast

• Macroscopy: Clear or blue domed cysts. soft white fibrinous tissue.

• Microscopy: Adenosis (orange) increased number of acini in the lobular units.

cystically- dilated ducts

Fibrosis- increase in dense collagen around ducts in lobules

Causes: due to hormonal imbalance- increase oestrogen and less progesterone. menopause…
 Emphysema pulmonis

• Macroscopy: empty spaces with pigmentation (black) and enlarged air spaces.

• Microscopy: thin alveolar walls less elastic fibres, remnants of septa, less alveoli , less
capillaries. - process of destruction and dilation of airways distal to terminal bronchioles.

• Caused by: smoking, pollution, infection , genetic factors- Alpha 1 Anti trypsin deficiency.
 Struma lymphomatosa- Hashimoto thyroiditis

• Macroscopy: enlarged thyroid gland intact capsule, when cut -> lymph nodes yellow
colour. sometimes there is atrophy, fibrosis or nodes. no necrosis.
• Microscopy: Lymphocyte infiltration in germinal centre of follicles. mainly T - cells and
Plasma cells.
• Mononuclear infiltrates in parenchyma and development of germinal centres. with
Hurthle cells- atrophic lymph follicles in cells with abundant eosinophilic cytoplasm.
Struma lymphomatosa
 Polyarteritis nodosa

• Macroscopy: areas of focal inflammatory exudation ( due to fibrinoid necrosis) and palpable nodules
on medium sized arteries.

• Microscopy: Necrotising inflammation on small and medium sized arteries,( often at bifurcations)->
micro aneurism formation -> rupture-> haemorrhage-> thrombosis-> ischemia or infarction of organ.

• Acute phase has infiltrate of mononuclear cells and neutrophils.

• as inflam. lesions prolonged -> proliferation of media -> obstruction-> ischemia or infarction of organ.

• Causes : HEP B