An approach to microscopic interpretation
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An approach to microscopic interpretation






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An approach to microscopic interpretation Presentation Transcript

  • 1. Introduction to microscopic interpretation
    Dr. Santosh Rathod
  • 2. Have your eyes and mind open
    Processing the acquired visual information
    Arriving at a tentative diagnosis (ie, model building)
    Testing the preliminary diagnosis with further examination
    Confirming the diagnosis
    Correlating available clinical information
    Finalizing the diagnosis
  • 3. From where to start?
  • 4. Examination of the Slide with the Naked Eye
    To gain some appreciation of the size, number, and nature of the histologic sections on the slide
    The tinctorial properties (histochemical staining) also may provide clues to diagnosis;
    For example,bluish cellular aggregates or nodules suggest high nuclear-to-cytoplasmic ratios because of basophilic staining of nuclei and, as a result of processes such as basal cell carcinoma, small cell carcinoma, and infil- trates of small lymphocytes or calcium deposition.
  • 5. Examination of the MicroslideatScanning(2 X or 4X) Magnification
    Firstly, one should attempt to identify the type of specimen submitted
    Then, inspect the specimen with the idea of determining in general terms from what anatomic site the tissue was taken.
    Entire specimen (ie, epidermis, dermis, or subcutis) should be scanned
    - for the principal site of involvement by a disease process, if any, and
    - the nature of the process, whether inflammatory
    inflammatory and proliferative or
  • 6. Examination at IntermediateMagnification
    The tendency to go to higher magnification too soon should be resisted because one often will overlook a crucial feature, and thus, in effect, one “cannot see the forest for the trees.”
    The reasons for closer inspection of the specimen (with 10Xand 40X objectives) are to confirm particular features of pathologic processes
    For identification of specific cell types, such as lymphocytes or granulocytes
  • 7. Normal histology of skin
    St. Corneum
    St. Granulosum
    St. Spinosum
    St. Basale
    Pappilary dermis
    Reticular Dermis
  • 8. Identification of cells
    Type of cells normally present in epidermis :
    Majority are - Keratinocytes (90%)
    Minority population of – Langerhans cells
    Neuroendocrine(Merkel Cells)
    Unmyelinated axons
    Occasional Cells – Toker cells found in nipple epidermis in
    approximately 10% individuals
  • 9. s
    Granular keratinocyte
    Basal keratinocyte
  • 10. Langerhans cells
    Marrow derived
    Antigen presenting cells
    In H&E sections, appear as clear cells
    Special stains are generally required for their detection and enumeration
  • 11. melanocyte
    Melanin synthesizing dendritic cells
    Located within basal layer of epidermis, hair bulb, ORS
    In H&E stained section, dendritis are not visible, cell bodies can be seen dispersed in basal layer
    Contain round to oval, dark stained nuclei that are generally smaller than basal keratinocyte
  • 12. Dermis
    Cellular content :
    Dermal dendritic cells
    Mast cells
    Extra-cellular content :
    Elastic fibres
    Ground substance
  • 13. Dermal fibroblast
    Appear as inconspicuous bipolar spindle cells with elongated ovoid nuclei
    Can’t be reliable distinguished from other dermal spindle shaped and dendritic cells ( dermal dendrocytes)
    Synthesizes collagen
    IH stain – Vimentin
  • 14. Phagocytic macrophages
    Also, called Histiocytes
    Are of bone marrow origin, circulate in blood as precursors and enter tissue as monocytes
    Activated monocytes – macrophages
    Aggregation of activated macrophages – granulomas
    Macrophages that have ingested melanin- melanophages
    Macrophages that have ingested hemosiderin - siderophages
  • 15. Monocytes are indistinguishable by routine histology from lymphocytes as both have a small, dark, rounded nuclei with very scanty cytoplasm
  • 16. Macrophages are larger cells than monocyte and possess a vesicular, light staining, elongated nuclei with a clearly visible nuclear membrane
  • 17. Emigrant inflammatory cells
    Neutrophilic granulocytes
    Eosinophilic granulocytes
    Basophilic granulocytes
    Plasma cell
  • 18. Neutrophilic granulocyte
    Lobated “pop-corn” shaped nuclei within pale pink fairly granular cytoplasm
    Nuclear breakdown due to local necrosis or by autodigestion of nuclear lobes as in vasculitis results in “nuclear dust” of vasculitis
  • 19. Eosinophilic granulocyte
    Characterized by strongly eosinophilic granules in cytoplasm and a characteristically bilobed nuclei
    Although visible with routine stains, these granules stand out more clearly in brilliant red when stained with giemsa
  • 20. Plasma cell
    Have abundant cytoplasm that is deeply basophilic, homogenous and sharply defined
    Round eccentrically placed nuclei along its membrane it shows course, deeply basophilic, regularly distributed chromatin particles which gives “cart-wheel” appearance
  • 21. Methods of diagnosis in dermatopathogy
    Initial stage of pattern - by the process of hypothesis
    recognition by a “gestalt” generation and differ-
    based or instant recognition tial diagnosis
    Pattern recognition method by Ackerman
  • 22. Inflammatory Dermatopathology by Pattern and Algorithm
    Categorize the pattern
    Assess the inflammatory cell population
    Look for specific findings that direct the algorithm as far as it can be taken
    Correlate the histologic assessment with known clinical information
  • 23. Superficial PerivascularDermatitis
    Superficial and Deep Perivascular Dermatitis
    Nodular and Diffuse Dermatitis
    Folliculitisand Perifolliculitis
    IntraepidermalVesicular and Pustular Dermatitis
    Subepidermal Vesicular Dermatitis
  • 24. Thank you