MORBID ANATOMY PRACTICAL

REVISION FOR ‘O18 CLASS

COMPILED BY
EWUZIE ZIMAKOR
FOR
UNMSA EDITORIAL BOARD
Specimen container
Lab request form
 Is this request card properly filled? List
the possible errors identify in this card?
Ans; No, the card was not properly filled.
The possible errors identified in this card
include;
1. Age of the patient was erroneously written
as adult.
2. The patient ward was not written
3. The nature of the specimen was
erroneously written as bone and was not
described.
4. The provisional diagnosis was not written
 What is fixation? Why do histopathology
lab at UNTH fixates tissues?

Ans; fixation is a chemical process by which biological tissues are

preserved from decay, thereby preventing autolysis or putrefaction
. Fixation terminates any ongoing biochemical reactions, and may
also increase the mechanical strength or stability of the treated
tissues process.
• The purpose of fixation is:
– To preserve cells and tissue constituents in a condition identical to that
existing during life i.e., prevent autolysis and bacterial decomposition
– To coagulate the tissue as to prevent loss of easily diffusible substances:
fat, mucin, some antigens
– To fortify the tissues against the deleterious effects of processing:
dehydration, clearing, impregnation
– To facilitate subsequent staining of tissues.
– fixatives chemically alter the fixed material to make it less palatable
(either indigestible or toxic) to opportunistic microorganisms.
 List the fixatives commonly used in
histopathology Lab?
• The fixatives used here are:
– 10% buffered formalin (pH 7.0) This is the commonest
and the best
– 10% formal-saline (100ml of pure formalin + 900ml of
tap water + 3 teaspoonfuls of table salt)
• 10:1
Ratio of formalin to specimen must be at least
• Specimens must be immersed into the fixative
immediately after removal
• The speed of fixation/formalin penetration of a
specimen is 1mm per hour
• Organs become paler and firmer after fixation
 Specimen transportation involves?
• Sometimes tissue are not immersed in fixatives
for the following reasons:
– To take pictures
– Potting of museum specimens
– Special techniques: cytology, electron microscopy,
PCR, immunofluorescence
• In this situation they are transported quickly to
the Morbid Anatomy laboratory while immersed
in tap water or normal saline to prevent drying
• In the laboratory normal fixation should
commence without excessive delay
Adequate quantity of fixative
 Identify this instrument and state its
use?
Ans; tissue basket
Use; for storage and
packaging of tissue
cassettes.
Identify this machine and state its use?
 What do you understand by tissue processing and
describe the process involves in tissue processing?

• Ans; This is the preparation of the tissue for impregnation

with the embedding medium
• It is carried out in a machine called the tissue processor
• It involves the following processes:
– Dehydration: This is necessary because wax will not penetrate
tissues in the presence of water; specimens are passed through
70%, 95%, and absolute alcohol
– Clearing: Since alcohol is not miscible with paraffin wax it has
to be washed away with a fluid which is miscible with both
alcohol and wax – xylene
– Wax impregnation: Molten wax replaces water and alcohol in
the tissue
In one sentence, define wax embedding?
Having been completely impregnated
with wax, the tissue is now cast into a
mould of molten wax
On cooling (hardening) this gives rise to
the tissue embedded paraffin block
This paraffin block has a hard consistency
which can then be cut into thin sections
on the microtome
what is Microtomy?
The microtome is a special machine that
cuts out thin tissue sections from the
tissue embedded paraffin block
The thickness of the tissue section is 3 to
5microns
Identify this machine?
What is floating/ picking?
The tissue section is picked from the
microtome knife and floated over warm
water at 480C so that it stretches out
With a clean glass slide this section is
picked up
Staining and mounting: This is carried out on the staining rack.
Observe the staining basket which is used to transfer the
sections from one solution to another
CNS pathology
1.aIdentify this micrograph?

Ans- Myelomeningocoele in a 3-day-old neonate

B. Name the possible causative

agent?
Ans; folic and Vit.B12 deficiency
c. Is this compatible with life?
Give one reason?
Ans; yes; because brain tissue is
not involved
d. What is the prognosis? Ans;
good
e. What is the possible treatment?
Surgery for correction and
folic acid therapy.
2. Identify this speciemen?
Ans-Arnold-Chiari malformation:

b. briefly desribe the effect of this

lesion?

Ans; Sagittal section showing

herniation of the cerebellar tonsils
and medulla through the foramen
magnum. It is associated with
compressed 4th ventricle and
noncommunicating hydrocephalus.
3. Identify the specimen?

Ans; Meningoencephalocoele:

b. Is it compatible with life?

Give one reason?

Ans; No, because brain tissue

participates in the herniation
hence the prognosis is poor.

C. is the child alive or dead?

Ans; No, died in utero
4. Describe briefly the
specimen?

It is Meningocoele such
that the there is
herniation of cranial Brain
tissue was not seen
within this lesion; hence
the prognosis is good.

B. is it compatible with
life?

Ans; yes because brain

tissue was not involved.
IDENTIFY THE LESION

LIST 2 COMPLICATIONS
CONGENITAL HYDROCEPHALUS

HERNIATIONOF BRAIN MATTER

DEVELOPMENTAL DELAY
MENTAL RETARDATION
IDENTIFY THE LESION

IS THIS COMPATIBLE WITH

LIFE?
ANENCEPHALY

NO
Brain contusion and haemorrhage: This patient fell from a ladder
and hit his occiput against the ground (contra-coup)
Identify this specimen?

Brain contusion and haemorrhage

State 5 complications?

i. Loss of cerebral functions

ii. Intracranial haemorrhage
iii.Confusions
iv.Loss of ocular functions
v. Damage to nerve roots
vi.Sometimes lead to death of the subjects
1. What type of
lesion is this?
2. What blood
vessels are
involved.
Epidural haematoma: Note calvarium, brain, dura
Identifythe specimen?
Epidural haematoma

Discuss the pathogenesis of this lesion?

This involves severe trauma which maybe a car accident which is almost always associated
with skull fracture and correlates with site of impact. When such happens middle meningeal
artery is the main artery that is likely to get ruptured because of its course along the lateral
part of cranial vault in the middle cranial fossa with presentation quickly (within 24hrs).

List possible complications?

i. Loss of motor area

ii. Loss of auditory functions as haemorrhage may cause loss of contralateral
impaired hearing.
iii.Confusion and loss of coordination
iv.Headache due to raised intracranial pressure
v. Haemodynamic instability as a result of the haemorrhagic shock
vi.Death may occur if nothing is done within 24hrs.
1.What is the pointed
structure
2. What type of
hemorrhage is
associated with it.
3. Differentiate btw
epidural and
subdural
hemorrhage.
Epidural h. vs Subdural h.
Epidural h. Subdural h.
Trauma is usually severe May be minor

Almost always associated

Usually absent
with skull fracture

Correlates with site of impact No correlation

Usually presents quickly Delayed presentation (days

(within 24hrs) to weeks)

Arterial bleeding Venous bleeding

Identify this specimen? Uncal herniation
list possible complications? i. Loss of motor coordination, ii. dyskinesia, iii. loss of balance
and orientation
Non-traumatic haemorrhage involving the basal ganglia caused by
hypertension which damages the small penetrating arteries
1. What pathology
is this?
2. What is your
reason.
1. What lesion is
this?
2. What is it
associated with?
3. What possible
signs will it
present with?
CEREBELLAR TONSILLAR
HERNIATION

SOL

DEEPENING DROWSINESS
LOSS OF CONSCIOUSNESS
1. Identify the
lesion
2.what type of
missile would
have caused it
3. Briefly
describe the
mechanism of
wound formation
Blast effect

High velocity missile

A high velocity missile moves with

>2000Fps and travel with a centrifugal
force in front of it this causes massive
damage to tissues. With initial lacerations
and hemorrhage
1. A man fully
conscious who
presented to the
hospital with this
x-ray report is
likely to have
attained injury to
the brain stem
.T/F
False.
Though he obtained a penetrating injury it
didn't get to the brain stem where the centre
of counciousness lies
1. Identify the
type of
herniation
that has
occurred
2. Briefly
describe the
pathogenesis of
the duret`s
haemorrage
Uncal transtentorial herniation.

Duret hemorrhage has to do with stretching

of penetrating arterioles of the basilar artery
in the median and paramedian zones of the
mesencephalon and pons. The rupture of
these vessels lead to linear shaped
hemorrhages. It results in early
unconsciousness and death; decorticate
posture.
1.Identify the
lesion
2. What vessels
are likely to be
involved
Subdural hematoma.

Bridging cerebral veins.

1. What nerve is
usually affected
by this type of
herniation
2. What is the
clinical
presentation
Occulomotor nerve, Cranial nerve III

In this order,

Pupillary dilatation
Ptosis and Deviation of the eye to a down
and out position(ophthalmoplegia of the
occular muscles supplied by CN3)
1. Briefly
describe the
pathogenesis
this lesion of
The lesion came about due to a rise in intra
cranial pressure which results from a mass
occupying space within the cranial cavity(ie. A
SOL-blood,pus,a tumour).The brain is not
compressible and so the CSF,venous blood and
arterial blood leave the cranial circulation (in that
order)as the mass increases and thus brain tissue
is now forced to go through free spaces available
hence herniation. For the cerebellar tonsils
above,they herniate through the foramen
magnum.
DIGESTIVE SYSTEM
PATHOLOGY
Identify the
specimen
Describe
Clinical
features
Possible
causes
complication
s
 Liver
 The liver looks small in size due to extensive necrosis.it
also has a wrinkled capsular appearance
 Right upper quadrant pain,jaundice,ascites,bleeding
diatheses
 Viral hepatitis,drugs/toxins e.g
acetaminophen,aflatoxin,ischemia,hepatic vein
obstruction
 Liver cirrhosis,PLCC
Id the specimen
Describe it
Diagnosis
Causes
Clinical
features
Complications
Liver
Cirrhosis
Coarse surface granularity.
Circumscription of nodules by fibrous tracts.
Chronic hepatitis, alcoholism.
Caput meduse, bleeding diathesis,fetor
hepatis,pedal oedema, ascites, jaundice
Cut surface has the same nodular appearance
Fatty liver: note the yellowish, greasy cut
surface
Identify the specimen? Caput medusae: dilated
abdominal veins in patient with cirrhosis
Identify the
specimen
Describe
Diagnosis
Is it primary or
secondary?
Clinical features
The pot shows a secton of liver with
multiple whitish tumour nodules all over
the liver, that are fairly uniform in size
and have necrotic centres or show central
umbilication.
The tumours are metastatic.the nodules
are fairly uniform in size and have
necrotic centres.
HCC: Solitary tumour in the absence of cirrhosis; what
percentage of tumour occur without cirrhosis here?
Acute haemorrhagic pancreatitis: note the
haemorrhagic foci
Diagnosis? Associated factors?