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By\King of pathology( Legand – Hazem ) Histopathology

General items

General Rules :

Examination : المتح

• in the form of spots……… 5 jars and 5 slides

• the time of each spot is 5 minutes

• the degrees are 8 degrees for each spot total 80 degrees

• the answer inludes :

!" diagnosis تشخ

#" desription فصو

• Almost always, No fixed slides

$se of mirosope :

• ou should start with screening of the slide !y na"ed eye ( not to diagnose it #

• ou should !e sure that the o%er of the slide faes up ward

• $he following powers are present in any microscope :

%& low power : '(

)& intermediate power : ' %0&)0

*& high power : ' (0&(5

• &ou should start 'y the low power then intermediate then high if needed

1



• lmost all the slides an 'e diagnosed 'y low power except # slides:

! Hodg*in+s lymphoma

# ,eminoma

• ou should start with the periphery of the slide then mo%e to the enter

• -ratie ma*es perfet

Best .ishes/omment on 0ain points in the slide: ( desription #فصلا

!" type of tissue

#" site of the lesion ( reation ) in the tissue

1" type of the lesion ( reation )

A-inflammatoryB- degenerativeC-neoplasti!-ot"ers

2nflammatory reations

2



2" ute inflammation : 1 omponents :&

a" aute inflammatory ells : neutrophils + multilo!ed nuclei # and macrophages

+ "idney shaped nuclei, irregular cytoplasmic !orders# e3ept in typhoid no neutrophils

'" dilated ongested 'lood %essels : containing -./ and -./

" e3udate ( ontaining fi'rin # : appear in the tissue as either :&♦ pale pin" areas

♦ separation of .$ fi!ers1

22"/hroni inflammation:

"4on speifi :

* components:

a" hroni inflammatory ells : plasma cells, lymphocytes, macrophages and fi!ro!lasts

peri2ascular arrangement

'" thi* walled 'lood %essels 5 end arteritis o'literans (67 #: proliferation of su!intimal

.$ thic"ening of the wall 3 narrowing of the lumen + !ecomes irregular instead of o2al&

rounded #

" 8i'rosis : fi!ro!lasts secrete collagen fi!ers then !ecome resting cells + fi!rocytes #

B",peifi : + granuloma #4 collection of histiocytes: 63amples:"

!" Bilharzial granulomatous reation :

!" Bilh reation around worms or o%a w are rounded in 9, , o%al in L, , with a spine1

#" 9he o%a may ta*e one of 1 olors :

%& #$! if li2ing and contain miracidium 1

3



)& Bl%e if dead and calcified 1

*& &ello'is" )ro'n d1t !ilhar6ial pigment

1& $sually there is refratile shell all a round

" 9he reation onsists of : collection of histiocytes 7 eosinophils 7 lymphocytes 7&giant cells 7

angiomatoids5 small %asular spaes ( in li%er only ) ; fi!rosis

#" 9u'erulosis :

9he granuloma is either :

!" *on aseating : well formed rounded pale pin" granulomas consist of:

" Giant ells : + fused epithelioid ells # :&

• +anger"an,s type :

− 9n center of tu!ercle

− Nuclei are peripheral and may !e :&

;orse&shoe li"e

-ipolar

ing form

• *on-+anger"an,s type

− Nuclei in the center of cytoplasm

B" 6pithelioid ells : ( marophages ontaining 9B 'ailli ) :"

• Cytoplasm: <arge swollen , pale pin" e ill&defined !order

• *%le%s : 2esicular , eccentric

/" Lymphoytes ; 8i'rosis around the granuloma

#" Caseating :

4



9he ,ame 'ut little +ang"an,s ells s%rro%nding entral aseation w< is pin*= homogenous =

strutureless areas

1" Rhinosleroma

!" 0i*uliz ell : ( marophage engulfed 'ailli hydropi degeneration )

♦ ytoplasm : =oamy , 2acuolated with well&defined cell !orders

♦ nuleus : small, rounded , central or eccentric

#" Russell 'ody : ( intraellular hyalinosis in a dead plasma ell )

♦ ytoplasm : hyalini6ed 1

♦ nuleus: small , eccentric 1

9umors

− ."e ells s"o' riteria of malignany / atypia 0 - 123

! pleomorphism + cellular and nuclear#

# 77 nucleocytoplasmic ratio +N. ratio# e3ept in hypernephroma

1 A!normal mitosis >iant cell formation

> <oss of polarity

? nuclei : large , hyperchromatic, with irregular nuclear chromatin and clumped chromatin

@ nucleoli : large, multiple, eosinophilic

4B :

#eed 4tern)erg giant ell 5#46 ell / in 7odg8in,s lymp"oma 0

5



" typial R,G :

♦ large, !inucleated, e !asophilic cytoplasm

♦ # nulei : large 2esicular, mirror image , "idney&shaped with central eosinophilic large

nucleoli

B" R,G %ariants :

♦ <acunar cell

♦ ?opcorn cell

♦ 0 ononuclear ;odg"in@s cell

♦ 0 ultinucleated

Aegenerations

Hyaline material : pin", homogenous, glassy , refractile , structureless

myloid material : the same !ut you should add special stains of amyloid

( /ongo red= metahromati stains )

,*in slides :"

♦ 4lides ontaining epidermis

/"in scar

6



!" atrophi epidermis + thinning 7 straight !asement mem!rane # 1

#" 'sent s*in appendages : + hair follicles 7 se!aceous glands 7 sweet glands#

1" Replaement of the dermis !y collagen !undles + A2ascular granulation tissue # which

are parallel to each other and to epidermis and separated !y fi!rocytes

.apillary hemangioma

♦ 6pidermis atrophic

♦ Aermis : show non capsulated lesion formed of lo!ules of capillary&si6ed spaces

separated !y fi!rous tissue septa :&

" lo'ules of small apillary sized spaes + rounded, o2al or irregular& some contain !lood

others not& lined !y endothelial cells resting on !asement mem!rane + ?A/ 72e#

B" fi'rous tissue in 'etween

adura foot + actinomycosis if no epidermis #

!" 6pidermis : hyper"eratosis

#" Aermis : suppurati2e granulomas formed of :&

• .enter : yellowish !rown fungus colonies w are formed of clu!s and hyphae 1

• ?eriphery : neutrophils 7 pus cells 7 macrophages 7 lymphocytes 7 fi!rous tissue

• some types of fungi may stain !lue and red !y ;3E

• common fungus stain called 6roott

sBuamous cell papilloma

'ranhed papilloma : are finger&li"e projections + exophytic # formed of ore 7 o%er

♦ /ore : !ranched .1$

♦ /o%er : hyperplastic str1sB1 epithelium , shows:

%1 -asal cell hyperplasia

)1 Acanthosis : 77 stratification of pric"le cell layers

7



*1 ?ara"eratosis : nucleated "eratin 1

(1 ;yper"eratosis1

Bg melanoma 5 *ev%s

Non capsulated lesion formed of :&

♦ 6pidermis : atrophic

♦ Aermis : groups of -enign pigmented melanocytes :&

9-Bg :elanoytes : monotonous + no pleomrphism #

9n upper dermis : polyhedral e rounded 2esicular nuclei

9n lower dermis : spindle e o2al nuclei

;- :elanin pigments : !rownish , present in

elanocytes1

acrophages1

=ree

:alignant melanoma

♦ 6pidermis : ulcerated

♦ Aermis : groups of mg pigmented melanocytes infiltrate deep dermis :

!" mg melanoytes : show criteria of malignancy ت <=> and may !e:

melanocarcinoma : polyhedral cells

8



melanosarcoma : spindle cells

#" melanin pigment : 777 in amount , dar" , present in

melanocytes

free

s?%amo%s ell arinoma

♦ 6pidermis : ulcerated

♦ Aermis : infiltrated + endophytic # !y irregular sheets of mg sBuamous epith1 .ells which

show criteria of malignancy <=> ت and arranged layers :

%& outer dar*ly stained ells : loo"&li"e N !asal cell layer of epidermis

)& polyhedral ells e a!undant pin" cytoplasm

*& enter formed of concentric "eratin layers 4 cell nes t < @2

Basal ell arinoma

6pidermis : ulcerated Aermis : infiltrated + endophytic # !y sheets of mg !asaloid cells

!" sheets : irregular , 2aria!le si6ed with peripheral palisading + outer layer of cells are

columnar and parallel , while inner cells are polyhedral#

#" /ells : ha2e scanty , !asophilic cytoplasm 7 + criteria of malignancy <=> ت (

Caverno%s "emangioma

non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa

9



! "9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat endothelium

3 ontain intat = hemolysed RB/s

#" septa : .1$

4B: it may 'e attahed to li%er tissue ( ommonest site of a% Hemangioma is li%er)

Caverno%s lymp"angioma

non capsulated lesion formed of : <arge dilated 2ascular spaces separated !y fi!rous septa

!" 9he %asular spaes are : communicating , wide, irregular in shape1 <ined !y flat

endothelium 3 ontain homogenous pin* material + lymph #

#" septa : .1$

1" lymphoytes either in septa or inside the lymph

Kidney

Cloudy swelling kidney

proDimal onvol%ted t%)%les s"o' -

!" 9he tu'ular epithelial ells :

♦ .onical in shape1

♦ /wollen1

♦ ith granular cytoplasm1

♦ Normal nuclei1

;- l%mens♦ Narrowed, /tellate in shape1

♦ .ontain epithelial casts 1

1" 9he interstitial apillaries are ompressed 'y swollen ells

10



C"roni Eyelonep"ritis

t"e lesion is pat"y affetion of

!"9he interstitial tissue : shows characters of chronic inflammation + ب س م وصف #

#"9he olleting tu'ules :

♦ /ome atrophic + d1t fi!rosis #, others show compensating hypertrophy 1

♦ $hey contain hyaline casts 3 inflammatory cells casts 1

1 " glomeruli :

♦ Affected late , )ry to tu!ulo&interstitial lesion

♦ ?eriglomerular fi!rosis sclerosis + #

Amyloid 8idney

$he lesion is diffuse deposition of amyloid material in : + amyloid , staining 3 properties # !وصف

!" fferent arterioles :

thic"ening of the wall 3 narrowing of the lumen1

#" Glomerular apillaries :

Amyloid deposit in C !asement mem!rane

1" /olleting tu'ules :

♦ Amyloid deposit in C !asement mem!rane1

♦ ;yaline casts in C tu!ular lumen1

.FB Eyelonep"ritis

11



%&&$he cortico&medullary junction : shows $1- granulomas ت <=> ( aseating and non aseating )

)& $he rest of renal tissue shows:

♦ =i!rosis1

♦ .ompensatory tu!ular hypertrophy

Gilms, t%mor 5 nep"ro)lastoma g tumor formed of * elements + all are mg criteria of malignancy :# ت <=>

!" 'orti%e glomeruli and tu'ules : lined !y cu!ical cells with no !asement mem!rane

#" ,troma : sarcomatous stroma formed of !undles of o2al to spindle shaped cells which

show metaplasia, forming : muscles, !one , cartilage , myxomatous tissue…1etc

1" Blastema ells : undifferentiated , arranged in aggregate , small , lymphocyte&li"e cells

with dar" nuclei and little cytoplasm

7ypernep"roma 5 #enal ell arinoma

A& tumor formed of : cords 3 groups of mg epithelial cells separated !y delicate fi!rous stroma

the tumor cells are either :

!" lear ell type : cells are large polyhedral with 2acuolated cytoplasm + d1t dissol2ed fat

during preparation + cells show few malignant characters #

#" granular ell type : the same !ut with granular eosinophilic cytoplasm1

1" spindle ell type1

-& Areas of necrosis 3 hge1

Respiratory slides

4ose

Allergi nasal polyp

"inge#$like %#o&e'(ion )o#*ed o) 'o#e + 'o,e#

12



!"9he o%er : pseudo stratified columnar ciliated epithelium + respiratory epithelium# with areas

of sBuamous metaplasia1

#" 9he / 9 ore : 2ascular 3 edematous + edema leads to pallor of tissue 3 separation of

.$ fi!ers# which appears as homogenous pale pin" material 9t contains :

♦

proliferated mucous glands♦ inflammatory cells : eosinophils, lymphocytes, plasma cells, macrophages1

#"inosleroma

"o#*ed o) e%i(-eliu* + su.e%i(-eli/l (issue

♦ 6pithelium : stratified sBuamous epithelium + metaplastic#

♦ ,u'epithelial tissue shows : dense inflammatory cells 7 fi!rosis 7 ) important cells :

!" ic"ulic6 cells : s 'efore HIJ ت

#" ussell !odies : s 'efore HIJ ت

Lung

$mp"ysema

2nter al%eolar septa :

thinned , containing compressed capillaries rupture lea2ing a spur projecting inside the

al2eoli 9he al%eoli :

13



due to rupture of the septa they decrease in num!er , 77 in si6e and !ecome distorted in shape

2nterstitium shows :

!" hroni 'ronhitis + chronic inflammatory reaction فص K 7 hyperplastic mucous glands

#" hroni 'ronhiolitis +chronic inflammatory reation فص K 7 go!let cell metaplasia#

C"roni veno%s ongestion 5 )ro'n ind%ration 2nter al%eolar septa :

thic"ened !y Edema + transudate # 3 fi!rosis1 contain dilated congested capillaries

9he al%eoli : .ontains

− Drange + intact 3 hemoly6ed -.s#,

− !rown + hemosidrin granules 3 heart failure cells#

−

pin", homogenous +transudate#19he heart failure ells :

>roups of <arge, rounded , phagocytic cells engulfing !rown hemosidrin granules 3 red cells

2nterstitium shows :

$he !ronchial mucosa : edematous

.FB l%ng

%& caseating and non caseating tu!ercles (LMN 2OP فصت )

*& al2eoli contain :

homogenous pin" inflammatory exudate1

others show compensatory emphysema1

14



Qat ell arinoma

lung (issue is in)il(#/(ed .y / */lign/n( (u*o# (issue )o#*ed o) 0

!" groups and sheets of /mall, rounded, o2al or spindle malignant cells + Dat cells # with

scanty cytoplasm + lymphocyte& li"e #1 $hey are arranged in groups separated !y fi!rous

stroma1

#" reas of hemorrhage + orange # and necrosis + pin"# are seen

1" 9umor ells show all malignant characters1 + ب س م وصف #

,mall intestine

4erofi)rino%s peritonitis / small intestine 0

!" 9he muosa= su'muosa and musulosa : normal

#" serosa shows :

− $he serosal cells are sheded

− serosal .1$ is thic"ened, shows C characters of acute inflammation (LMN 2OP فصت #

7 fi!rin networ" of entangling C acute inflammatory cells

Rntestinal lymp"oma / *on 7odg8in S4 lymp"oma 0

!" -art of the wall of small intestine infiltrated + mucosa 7 su!mucosa 7 muscle 7 serosa# !y

malignant tumor tissue causing extensi2e ulceration of the mucosa 3 destruction of the wall

#" 9he tumor formed of :

Aiffuse malignant lymphoytes whih are :

Fniform, <arge cells showing <arge deeply stained nuclei with irregular nuclear mem!rane and

some prominent nucleoli 3 thin rim of cytoplasm around1

15



areas of nerosis C hge are seen1

large intestine

Bil"arTiasis Colitis

♦ -ilhar6ial o2a are deposited mainly in C su!mucosa 3 then mucosa muscle serosa

♦ some worms1

All surrounded !y !ilhar6 reaction (LMN 2OP فصت #

Col%mnar ell papilloma

!"9he muosa shows exophytic 3ب 12 45 6 growth in C form of 2illous projections +finger&li"e#

#" 9hese proDetions are formed of core 7 co2er

♦ /9 ore : delicate fi!ro2ascular .$1

♦ /o%er : o2ercrowded columnar secretory cells with areas of dysplasia

Adenoarinoma / olon 0

9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor

tissue formed of malignant aini + cells arranged around a lumen # and sheets lined !y

malignant epithelial cells

♦ 9he malignant aini are :

16



− Garia!le in si6e and shape

− <ined !y dar" malignant cells + showing malignant criteria 1#تصف

♦ reas of nerosis + in and Dut side the acinar lumena# 7 hemorrhage

♦ Au*e+s pathologial staging :

A tumor infiltrates mucosa, su!mucosa

- H H H H H H muscle 3 serosa

. H H H H H H Hpericolic lymph node1

:%oid Adenoarinoma / olon 0

9he oloni wall + mucosa , su!mucosa , muscle and serosa # are infiltrated !y malignant tumor

tissue formed of muin pools in which malignant cells swim inside or line the poolsتصف

the cells may !e arranged in the form of :

♦ acini + cells arranged around a lumen #

♦ fragment of an acinus

♦ cords

♦ indi2idual cells

some cells are distended with pale mucin pushing the nucleus at one side + eccentric #

( ,ignet ring appearane )

Li%er slides

Bil"arTial periportal fi)rosis of liver

♦ -reser%ed li2er architecture

♦ Bilharzial reation >K 27 7 fi!rosis 7 angiomatoid reaction in portal tract which may !e:

%& small fine

17



)& large coarse

♦ *upffer ells are distended !y !ilhar6ial pigments + !rown#

Uatty "ange liver 5 / fatty degeneration V fatty infiltration 0

♦ -reser%ed li2e architecture

♦ hepatoytes show: empty 2acuoles in cytoplasm of hepatocytes fuse together

signet ring appearance

♦ signet ring appearane is due to fat accumulation large 2acuole push the nucleus to

one side which !ecome flattened and eccentric

♦ in H C 6 : 2acuoles appear empty as fat was dissol2ed during preparation !y xylol and

alcohol

♦

in frozen setion : fat 2acuoles are stained !y + orange > & osmic acid & sudan 999 #

Cirr"osis

$ loss o) li,e /#'-i(e'(u#e .y #egene#/(ing nodules se%/#/(ed .y )i.#ous (issue se%(/

" Regenerating nodules : 2aria!le in si6e and shape 3 show:

♦ .entral 2ein eccentric

Iou!led

a!sent

♦ $ra!eculae : ) cell thic" + N1 4 % cell thic"#

♦ ;epatocytes : 2aria!le in si6e and shape

%& /ytoplasm : show fatty change

)& 4ulei : show normal mitosis

B" 8i'rous tissue : surround and separate the nodules 3 contains:

♦ ?roliferated !ile ducts

♦ ?roliferated capillaries 3 <ymphocytes

18



7epatoma / "epatoell%lar arinoma 0

$ 8oss o) li,e /#'-i(e'(u#e .y 9/lign/n( nodules se%/#/(ed .y )i.#ous (issue se%(/

" malignant nodules : infiltrate the surrounding cirrhotic tissue 3 formed of:

♦ thic" tra!eculae +J ) cell thic"# , acini, or sheets of malignant hepatocytes

♦ criteria of malignancy <=>K

B" fi'rous tissue septa

$ /#e/s o) -ge : ne'#osis

$ #es( o) li,e# (issue s-ows 'i##-osis

metastati adenoarinoma in t"e liver

Normal li2er tissue is infiltrated !y adenoarinoma :"

malignant tumor tissue formed of malignant aini + cells arranged around a lumen # and sheets

lined !y malignant epithelial cells

♦ 9he malignant aini are :

− Garia!le in si6e and shape

− <ined !y dar" malignant cells + showing malignant criteriaتصف

1#

Breast

Ui)roadenoma )reast

$rue mixed tumor , well capsulated formed of ) elements :

!"8i'rosis : excess fi!rous issue replacing the fat

#"denosis : proliferating !reast ducts lined !y ) layers of epithelial cells 123WK2XY ل

( inner u'ial and outer flat myoepithelial )

9ypes :

2" 2ntraanaliular: 22" perianaliular

&?roliferated ducts, compressed ,

in2aginated !y excess .1$ gi2ing which

gi2e a false impression that fi!rous tissue is

inside C ducts1

& Iucts are elongated, /tar shaped with

Narrow lumen

&proliferated ducts are surrounded !y delicate

fi!rous tissue

&Iucts are rounded or o2al in ./ with patent

lumen1

19



Ui)roysti disease of Z )reast

!" 8i'rosis : excess fi!rous tissue replacing the fat

#" denosis : 9ncrease in num!er of C ducts + lined !y ) l

ayers of epithelial cells , inner cu!ical and outer flat myoepithelial

1" 6pitheliosis : focal proliferation of C cells lining the ducts forming papillary processes

" /yst formation : some ducts !ecome cystically

dilated , may contain some secretions

>" porine metaplasia of lining ells !ecome tall 3 acidophilic granular cytoplasm

?" /hroni inflammatory ells in the stroma

Rntrad%t arinoma / )reast 0

!" Large duts with intact !asement mem!rane + 123 # lined !y malignant epithelial cells

showing g criteria ت <=>

#" 9he duts may 'e :

♦ /omedo type : ducts lined !y many layers of malignant cells with central pin" necrosis

♦ ,olid type : ducts occluded completely !y malignant cells

♦ /ri'riform type : malignant cells are arranged around many regular lumena

♦ -apillary type : malignant cells projecting into the lumen as papillary structures

20



♦ /linging type : single layer of malignant cells line the ducts

Rnfiltrating d%ts arinoma

%& Non capsulated , malignant tumor tissue infiltrate the surrounding tissue

)& 9t is formed of sheets, cords of malignat epithelial cells surrounded !y fi!rous tissue

*& $he cells show malignant criteria (LMN 2OP فصت )

Grading of 2A/ :

!" Histologial grading :

♦ necrosis + 77 necrosis high grade#

♦ tu!ular formation + no tu!ular formation high grade#

#" 4ulear grading : according to nuclear pleomorphism1

spleen

7yaline spleen

;y/line */(e#i/ls < %ink= gl/ssy = #e)#/'(ile > /#e de%osi(ed in

♦ /apsule

♦ 9ra'eulae

♦ /entral arteriole of lymph folliles + Ieposition of hyaline material in C su!endothelial .1$

of C intima 3 media $he wall is thic"ened with narrow lumen ischemia of lymphoid

follicles !ecome small and atrophic

?n)#/'(ion s%leen

21



$hree successi2e 6ones :&

!" Eone of normal : contain lymph follicles, red pulp, !l1 2essels 3 tra!eculae1

#" Eone of ongestion : shows congested !lood 2essels and acute inflammatory cells, and

early granulation tissue formation

1" Eone of Reent infart + .oagulati2e necrosis # shows:

& ghosts of normal structure with nuclear fragments 1

& $he capsule opposite C infarct area shows : fi!rous thic"ening1

@AB s%leen

%& .aseating and non caseating tu!ercles ت <=>

Lymph node

=ollicular hyperplasia + <1N #

&enlarged lymph node

&nodal architecture is preser2ed

&the cortex shows numerous large folliles which are

♦ 2aria!le in si6e 3 shape

♦ each formed of :

!" 7uter dar* mantle zone : ?eripheral rim of small lymphocytes1

#" 2nner pale Germinal enter + lymphocytes, immuno!lasts, histiocytes #

$arly .FB lymp" node

22



& Enlarged <1N

& Nodal architecture is preser2ed

& many 4on aseating tu'erles among C lymphoid tissue1 LMN 2OP فص K

+ate .FB lymp" node

& Enlarged <1N & ost of C su!stance of C node is replaced !y many aeating tu'erles LMN 2OP فصت

7odg8inSs lymp"oma / +F* 0

& Enlarged <1N

& <ost nodal architecture

& $he <1N is diffusely infiltrated !y:

!" typial Reed",tern'erg giant ells C its %ariants LMN 2OP فصت

#"inflammatory ells inlude:

♦ mature lymphocytes

♦ eosinophils

♦ histiocytes

♦ plasma cells

♦ neutrophils

♦ fi!ro!lasts

1" reas of nerosis= hge C fi'rosis

:etastati arinoma / +F* 0

& Enlarged <1N

23



& <1N sinuses and su!stance are in2aded !y malignant tissue either sheets ( from infiltrating

dut arinoma تصف or aini + Adenocarcinoma #فصت

& $he malignant cells show all C malignant characters1 + LMN 2OP فصت #

Bone nd artilage

Qsteo"ondroma on '/%sul/(ed -/*/#(o*/(ous lesion )o#*ed o) D 'o*%onen(s 0

!" /ap of hyaline artilage : normal chondrocytes arranged perpendicular to the

perichondrium 1 surrounded !y chondroid matrix 1

#" /anellous 'one : !one tra!eculae separated !y !one marrow 1

C"ondrosaroma

on '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$

& ;igh num!er of malignant hondroytes in a hondroid matri3 with areas of hemorrhage and

necrosis

$he cells show the criteria of malignancy LMN 2OP فصت 1 they are either :

♦ /pindle + undifferentiated #

♦ ounded inside lacunae + well differentiated #

6iant ell t%mor / Qsteolastoma 0

8o'/l 9g (u*o# )o#*ed o) 0$

!" ,tromal ells : + ounded K o2al K sphindle # 7 + criteria of g # 27E

#" Reati%e osteolast li*e giant ells : distri!uted large cells 1 contain up to %00 small

nuclei

1" ,anty fi'ro%asular stroma

Qsteosaroma

on '/%sul/(ed */lign/n( (u*o# in)il(#/(e (-e su##ounding (issue )o#*ed o) 0$& indi2idually arranged malignant osteo!lasts in osteoid matrix with areas of hemorrhage and

necrosis

24



&the matrix may !e also cartilaginous or fi!rous

&the cells exhi!it the criteria of g LMN 2OP فصت

/u!types :

on%entional : descri!ed

parosteal : the same 7 chondroid areas

anaplasti : -i6arre cells 7 few osteoid

6ndometrium C$terus

Eroliferative endometri%m

!" 6ndometrial glands :"

/mall, ounded + $/ # or tu!ular + </ # 1

Fniform in si6e, shape 3 distri!ution1

<ined !y rowded tall columnar epithelial cells with .entral o2al nuclei show few mitosis

#" 9he stroma is ompat and formed of :"

♦ /phindle shaped cells e dar" nuclei 1

4eretory endometri%m


• large, $ortuous showing ( saw tooth appearane )

• Not uniform

• <ined !y one layer of cu!ical cells with rounded nuclei w contain secretory 2acuoles1

25



#" 9he stroma is loose and formed of :"

♦ rounded stromal cells with a!undant cytoplasm

♦ spiral arterioles

♦ hge

♦ stromal granulocytes1

Cysti $ndometrial "yperplasia


• 9ncreased in num!er1

•Garia!le in si6e 3 shape

• <ined !y o%errowded columnar cells which may from papillary processes1

•/ome glands are lined !y flattened cells with cyst formation1

#" 9he stroma is ompat and formed of :"

•/pindle shaped cells with dar" nuclei

•areas of necrosis, hge 3 infiltration !y ?11Ns, lymphocytes1

1" 8reFuent mitosis in glandular epithelium C stroma ells

Adenomyosis

9slands 5FG of Endometrial glands 3 stroma present inside the myometrium without any

connection with surface endometrium + J *mm from C !ase of C endometrium#

leiomyoma

He'(ion in I u(e#us s-ow well 'i#'u*s'#i.ed = '/%sul/(ed */ss )o#*ed o) 0

& 9nterlacing -undles 3 whorls J ما KL of smooth muscle cells alternating with fi!ro!lasts in

collagenous matrix1

♦ musle ell : spindle with rounded !oth ends of cytoplasm , containing elongated nuclei

with rounded ends

♦ 8i'ro'last : spindle shaped cell with pointed !oth ends of cytoplasm, containing elongated

nucleus with pointed ends

26



Gonads

4eminoma

"ew se*ine)e#ous (u.ules /#e seen in)il(#/(ed .y / (u*o# (issue )o#*ed o) 0$

!" sheets of malignant ells w< are :

• <arge rounded or polyhedral cells

• cytoplasm is pale stained, 2acuolated +due to its lipid 3 glycogen content#1

• nuclei are large, 2esicular, with rounded central nucleoli1

#" stroma :is infiltrated !y lymphocytes1

M#e/s o) -e*o##-/ge /nd ne'#osis

.eratoma

!" 0any ysti struture lined 'y :"

• espiratory epithelium1

• /Buamous epithelium1

• 9ntestinal epithelium1

#" Heterogeneous tissues present 'etween ysts inlude strutures deri%ed from all 1 germ

layers:

•

endoderm

li2er, glands + thyroid ,mucous, serous…#• ectoderm s"in 3 !rain tissue

• mesoderm uscle, !one, cartilage

1" 4o immature elements

plaenta

[esi%lar mole

27



Nnl/#ged '-o#ioni' ,illi )o#*ed o) 0 'o#e : / 'o,e# 0$

• 9he o%er : tropho!lastic epithelium with focal hyperplasia1

• /9 ore : A2ascular edematous .$ with hydropic degeneration

C"orioarinoma 5 O3 ا P3

He'(ion in (-e *yo*e(#iu* s-ows 0

• ,heets of malignant cyto and syncytiotropho!lasts infiltrating the myometrium

• 4eroti musles infiltrated !y polymorphs 3 pus cells

• Large area of hge

$ropho!lastic cells + show criteria of malignancy# ت <=> are:

• /yto : polygonal cells with rounded nuclei

• ,ynytio : protoplasmic masses containing scattered spindl nuclei with no cell !orders

Bil"arTiasis \rinary )ladder

!" 7%a are deposited mainly in the lamina + most 2ascular#3 to a lesser extent other layers

#" 7%a are surrounded !y - reaction1 (LMN 2OP فصت #

1" 6pithelial hanges inlude :

28



ulceration

Atrophy

;yperplasia: hyperplastic transitional epithelium dips down in C su!mucosa forming

+ -runnLs nests# central cells degenerate to form a cyst lined !y transitional

epithelium and contain serous fluid + cystitis cystica# glandular metaplasia of lining

epithelium , !ecome columnar and secrete mucous + cystitis glandularis #

sBuamous metaplasia

Rounded strutures ( ontain lumen )

#eent t"rom)%s

!" ,etion in a %ein show distended lumen !y a throm!us + solid mass of !lood elements#

#" 9he throm'us formed of :

• ;ead : the attached part to the endothelium

•$ail : the free end

• -ody which contains:

!"Lines of Eahn : columns of fused platelets forming homogenous structureless pale pin" lines

#" fi'rin meshwor* Between lines : entangling -.s 3 -.s1

/ompliated throm'us :

&calcification 3 infection 3 hyalinosis

A%te !iff%se 4%pp%rative Appendiitis

<umen contains pus :

&dead and ali2e !acteria

&dead + pus cells# and ali2e neutrophils

&exudate

29



.olonic mucosa : partly ulcerated

$he whole wall : is diffusely affected !y acute inflammatory reaction (LMN 2OP فص K #

C"roni non speifi "oleystitis

• 9he muosa : hyperplastic or ulcerated1

• 4o su'muosa

• 9he fi'romusular coat : shows chronic 9nflammation + LMN 2OP فصت )

Goiter C prostate

4imple nod%lar goiter

%& Garia!le si6ed nodules separated !y fi!rous septa

)& Each nodule contain 2aria!le si6ed thyroid follicles

• 6ah follile shows :

& Iistended lumen !y homogenous colloid1

& <ined !y flat cu!oidal epithelium

•9he stroma : compressed .1$ !etween follicles

• 4ormal %asularity of gland

4enile prostati "yperplasia

%& Garia!le si6ed nodules separated !y fi!rous septa

)& Each nodule shows hyperplasia 3 hypertrophy of !oth elements of the prostate

+ stroma 3 parenchyma#

9he stroma + fi!romuscular # is increased and shows chronic inflammation

9he parenhyma + acini # :

♦ 9ncreased in num!er1

30



♦ Garia!le in si6e 3 shape

A- ."e lining of aini

•lined !y one or more layers of columnar cells, may form papillae1

•/ome are cystically dilated with flat lining1

B-."e l%men of aini ontains •/heded epithelium1

• ?rostatic concretions

•corpora amylaceae

,lides *nown 'y pathology ( no normal tissue attahed)

+ipoma

!" /apsulated tumor tissue !y fi!rous capsule , sending .$ septa + con2eying !l1G $o tumor

cells# di2iding the tumor into lo!ules of mature fat cells+ lipocytes #

#" 8at ells are :

• uniform in si6e and shape ,

• appear 2acuolated due to dissolution of fat !y xylol and alcohol1

• nuclei are compressed against C mem!rane + /ignet ring appearance #

1" 8at should 'e stained !y fat stains in a fro6en section to !e 2isi!le :

( orangeG – 7smoi aid – ,udan 222 )

6ran%lation tiss%e

Q$ Re%/i# (issue )ollowing /'u(e in)l/**/(ion o# /sso'i/(es '-#oni' in)l/**/(ion /nd )ollowed

.y )i.#osis

D$ ?( is )o#*ed o) 0

a"0any new apillaries lined !y swollen endothelial cells without a !asement mem!rane

+ ?A/ negati2e # 4 unli"e capillary hemangioma

31



'"8i'ro'last ells appear !etween C capillaries, it is spindle shaped cells

with tapering end 3 scanty cytoplasm with 2esicular spindle nuclei

" 9he ground su'stane !etween the capillaries and around fi!ro!lasts shows

• homogenous, pale pin" exudate

• collagen fi!ers +type 999#

transforms to !undles + type 9 #1

• ixed acute and chronic inflammatory cells1

7ydatid ysts

He'(ion in w/ll o) -yd/(id 'ys( s-ow 0

!" 7uter fi'rous layer + compressed tissue of C organ affected #

#"2ntermediate laminated layer of structureless pin" +ali2e# or 2iolet + dead and calcified# tissue

of the parasite

1"2nner germinal layer : where scolics project1

*e%rilemmoma 5 4"'annoma

!" /apsulated tumor tissue attached to a ner2e 1

#" /apsule di2ide the tumor !y .$ septa into lo!ules formed of :

- B%ndles of %niform spindle s"aped ells : separated !y delicate fi!rillary !ac"ground

- ."e n%lei are rod shaped and arranged parallel to each other forming nulear palisading

1" 9he tumor tissue shows :

• .ellular areas + Antony type 9 #

• <oose areas + Antony type 99 #

+ cells are uniform , no pleomorphism , no mitosis…#

32



:eningioma

!" /apsulated tumor tissue attached to the meninges

#" 2t is formed of whorls and !undles of uniform meningothelial cells w are :

ounded &o2al cells with 2esicular nuclei , eosinophilic cytoplasm with ill&defined !orders in

fi!rous tissue matrix1" arieties :

:eningot"elial meningioma : discussed

Ui)ro)lasti meningioma : !undles of fi!ro!last&li"e cells

.ransitional meningioma : meningothelial 7 fi!ro!lastic

Esammomato%s meningioma : when center of the whorle contain calcified , laminated

!odies

Atypial meningioma 0 when there is cellular malignant criteria

:alignant meningioma : when there is infiltration of !rain tissue

By\King of pathology( Legand – Hazem )

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