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عملى الصيدلة


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practical pathology

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عملى الصيدلة

  1. 1. Pr.Dr. Magdy Ismael Ahmed
  2. 2. neutrophils lymphocyte Plasma cell macrophage
  3. 3. Mast cell eosinophil Giant cell Fibroblast
  4. 4. Collagen fibers
  5. 5. Inflammation <ul><li>Acute inflammation :- </li></ul><ul><li>e.g Acute suppurative appendicitis. </li></ul><ul><li>Chronic inflammation :- </li></ul><ul><li>e.g Ch.inflammation of skin. </li></ul>Repair <ul><li>Myocardial scarring </li></ul>
  6. 6. Appendicitis Definition :- Inflammation of appendix ( either acute or chronic) Etiology :- Predisposed by:- 1-Obstruction of its lumen or hyperplasia of lymphoid follicles. 2- Fibrosis of the wall Excited by infection with Strep.E.coli or staph. Pathology :- 1-Acute catarrhal appendicitis (edema,congestion ,serous fluid) 2-Acute suppurative appendicitis(filled by pus) 3-Acute gangrenous appendicitis(black in colour and offensive). Complications :- 1-Perforation  septic peritonitis (diffuse or localized) 2-Appendicular mass :- Fibrosis and adhesion with intestine and omentum 3-Appendicular abscess 4-Sinus & fistula 5-Portal pyemia
  7. 7. Pathology :- Gross picture Comment -The appendix  slightly enlarged ,congested and edematous . -The lumens are filled by inflammatory exudate -The serosa show dark spots of hemorrhages Diagnosis: Acute suppurative appendicitis.
  8. 8. Slide (1):- Acute suppurative appendicitis <ul><li>Naked eye :-Circular structure with bluish wall </li></ul><ul><li>Organ :- T.S. of an appendix </li></ul><ul><li>Comment :- </li></ul><ul><li>1-Lumen :- Necrotic debris,intact and dead PNLs, </li></ul><ul><li>2-Mucosa :- Intact and ulcerated areas </li></ul><ul><li>3-Submucosa :- Edema ,dilated and congested blood vessels , hyperplastic lymphoid follicles and PNL,s may extends to musculosa or serosa </li></ul><ul><li>Diagnosis :- Acute suppurative appendicitis </li></ul>
  9. 10. Slide (2):- Chronic inflammation <ul><li>Organ : - Section in the skin </li></ul><ul><li>Comment :- </li></ul><ul><li>1-Epidermis :- Thickened epidermis and keratin </li></ul><ul><li>2-Dermis :- </li></ul><ul><li>-Arterioles :- Thickened and narrowed (EAO) </li></ul><ul><li>-Peri-vascular cuffing by (lymphocytes ,plasma cells </li></ul><ul><li>and macrophages) </li></ul><ul><li>-Increased fibroblasts and collagen. </li></ul><ul><li>Diagnosis :- Chronic inflammation in skin </li></ul>
  10. 12. Slide(3):- Myocardial scarring <ul><li>Organ :- Section in heart </li></ul><ul><li>Comment :- </li></ul><ul><li>Intact cardiac muscles :- Running in different directions </li></ul><ul><li>Infarction area :- Pale pink,fibrous tissue area ,composed of wavy collagen,few fibroblasts and few dilated thin walled capillaries </li></ul><ul><li>Diagnosis:- </li></ul><ul><li>Myocardial scarring </li></ul>
  11. 14. Cell injury (degeneration) <ul><li>Water accumulation :- </li></ul><ul><li>e.g Cloudy swelling of kidney </li></ul><ul><li>Fat accumulation :- </li></ul><ul><li>e.g fatty change of liver </li></ul>
  12. 15. <ul><li>Cloudy swelling :- </li></ul><ul><li>Reversible cell damage characterized by mild accumulation of water inside cells. </li></ul><ul><li>Oragns affected :-Proximal convoluted tubules of kidney ,liver and heart </li></ul><ul><li>Pathogenesis:- swollen mitochondria is fragmented with resultant decreased production of ATP and consequent distrubed Na/K pump  retention of Na and H2O inside cells . </li></ul><ul><li>Pathology </li></ul><ul><li>Grossly :- </li></ul><ul><li>The organ size :- Increased </li></ul><ul><li>Colour :- Pale </li></ul><ul><li>Consistency:- Soft </li></ul>
  13. 16. Cloudy swelling of kidney
  14. 17. <ul><li>Section in the kidney :- </li></ul><ul><li>Glomeruli :- Normal </li></ul><ul><li>Tubules :- </li></ul><ul><li>- Lumen :- Narrowed and star shaped </li></ul><ul><li>- Lining epithelial cells </li></ul><ul><li>*Swollen </li></ul><ul><li>*Conical (pyramidal ) shaped.Its apex directed </li></ul><ul><li>inward. </li></ul><ul><li>*Pink and granular cytoplasm (mitochondrial </li></ul><ul><li>damage. </li></ul><ul><li>*Intact rounded nuclei . </li></ul><ul><li>Diagnosis :- Cloudy swelling of the kidney </li></ul>
  15. 19. <ul><li>Fatty change ,liver </li></ul><ul><li>A condition characterized by accumulation of triglyceride inside hepatocytes </li></ul><ul><li>Causes:- </li></ul><ul><li>1-Toxins->diphtheria 2-Chemicals as phosphorus and CCL4 </li></ul><ul><li>Etiology:- </li></ul><ul><li>1-Increased entrance of FFA  heptocytes </li></ul><ul><li>2-Increased synthesis of FA and decreasd its oxidation </li></ul><ul><li>3-Increased estrification of FA </li></ul><ul><li>4-Decreased formation of phospholipids </li></ul><ul><li>5-Decreased excretion of phospholipids. </li></ul>
  16. 20. Specimen :- Section of liver Size :- enlarged Surface :-Smooth Capsule :-Thin ,stretched easily Streped Colour :- Yellowish Borders :- Rounded Consistency :- Soft D13
  17. 21. Slide(5):-Fatty changes of liver <ul><li>Section in liver :- </li></ul><ul><li>Liver cells :- </li></ul><ul><li>Cytoplasm :- Contain large clear vacuoles </li></ul><ul><li>Nuclei :- Peripheral located nuclei(signet </li></ul><ul><li>ring appearance. </li></ul><ul><li>Some intact liver cells are seen. </li></ul><ul><li>Diagnosis :- Fatty changes of liver. </li></ul>
  18. 23. Slide(6):-Recent thrombus <ul><li>Naked eye :-Rounded structure with intra-luminal thrombus (2 nd rounded structure) </li></ul><ul><li>Section in blood vessel :- </li></ul><ul><li>1- The lumen of blood vessel :- </li></ul><ul><li>-Filled by thrombus mass attached to the vessel </li></ul><ul><li>wall at one point (head of the thrombus ) </li></ul><ul><li>2-The thrombus mass containing :- </li></ul><ul><li>pale pink lines radiating from the head ( lines of Zahn ) and contain in between meshwork of fibrin ,RBC,s and WBC,s. </li></ul><ul><li>Diagnosis :- Recent thrombus </li></ul>
  19. 24. 2 nd of circular lesions
  20. 25. <ul><li>Naked eye :- 3 rd rounded structure </li></ul><ul><li>Section in an artery :- </li></ul><ul><li>Intima :- Degenerated and elevated </li></ul><ul><li>Subintima :- Fibro-fatty mass containing , needle like crystals of cholesterol. and haylinized C.T ± calcification </li></ul><ul><li>Elastic lamina :-Fragmented </li></ul><ul><li>Media opposite the lesion :- Atrophic . </li></ul><ul><li>Diagnosis :- Atherosclerosis of an artery </li></ul>Slide(7):-Atherosclerosis
  21. 26. Atheroma Calcification Media crystals
  22. 27. Slide(8):-Lobar pneumonia (grey hepatization) <ul><li>Section in lung tissue :- </li></ul><ul><li>Alveolar wall :- </li></ul><ul><li>-Thickening of the alveolar wall. </li></ul><ul><li>-Dilated congested blood capillaries </li></ul><ul><li>Alveolar space:- </li></ul><ul><li>-Fibrin mass entangling ,RBC,s,WBC,s and large numbers of macrophages </li></ul><ul><li>-A retraction space is found separating the mass </li></ul><ul><li>from the alveolar wall. </li></ul><ul><li>Diagnosis :- Lobar pneumonia grey hepatization </li></ul>
  23. 28. Fibrin mass PNL,s Retraction space Lobar pneumonia grey hepatization
  24. 30. Slide(9):- Nasal polyp <ul><li>Section in nasal polyp :- </li></ul><ul><li>The polyp composed of fibro-vascular C.T core covered by epithelium . </li></ul><ul><li>*The covering epithelium ;- </li></ul><ul><li>-Pseudostratified columnar ciliated epithelium,with focal areas of ulceration or squamous metaplasia . </li></ul><ul><li>*The core show :- </li></ul><ul><li>-Stromal edema </li></ul><ul><li>-Thin dilated blood vessels </li></ul><ul><li>-Mixed inflammatory cellular infiltrates (PNL,s ,lymphocytes ,plasma cells ,macrophages and eosinophils) </li></ul><ul><li>-Hyperplastic mucus secreting glands . </li></ul><ul><li>Diagnosis :- Nasal polyp </li></ul>
  25. 31. Blood vessels Edema Eosinophil Squamous metaplasia
  26. 33. Slide(10):- Bronchogenic carcinoma <ul><li>Section in lung :- </li></ul><ul><li>The lung tissue show :- </li></ul><ul><li>-Area of intact lung tissue </li></ul><ul><li>-Infiltration of lung tissue by malignant cells are disposed in one of three patterns . </li></ul><ul><li>1-Squamous cell carcinoma :-Nests of malignant squamous epithelium ± keratin pearls ( cell nests ) </li></ul><ul><li>2- Or Adenocarcinoma with well formed malignant acini </li></ul><ul><li>3-Or Aot cell carcinoma :- Malignant ,darkly stained small sized cells with rounded ,oval or spindle shaped hyper-chromatic nuclei and scanty cytoplasm. </li></ul><ul><li>Diagnosis :- Bronchogenic carcinoma </li></ul>
  27. 34. Squamous cell carcinoma Fibrous septae Aot cell carcinoma Lung tissue
  28. 35. Bengin tumors <ul><li>A-Tumors arise from the epithelium </li></ul><ul><li>1-Surface epithelium :- Squamous cell papilloma </li></ul><ul><li>2-Glandular epithelium :- a- Adenoma of intestine </li></ul><ul><li>b- Fibroadenoma of the breast (intracanalicular and pericanalicular ) </li></ul><ul><li>B-Tumors arises from mesenchymal tissue </li></ul><ul><li>1-Fibroma </li></ul><ul><li>2-Leiomyoma </li></ul><ul><li>3-Chondroma </li></ul><ul><li>5-Lipoma </li></ul>
  29. 36. Slide (11) Squamous cell papilloma <ul><li>Definition :- benign tumor of surface epithelium. </li></ul><ul><li>Sites :- Skin –lips –oral mucosa –cervix -pharynx -vagina and anal canal . </li></ul><ul><li>Gross picture :- Small sessile or pedunclated projection </li></ul><ul><li>Microscopic picture :- </li></ul><ul><li>The core :- Composed of fibro-vascular connective tissue The cover :-Composed of hyperplastic stratified squamous epithelium showing:- </li></ul><ul><li>- Hyperkeratosis :- Increased keratinous layers </li></ul><ul><li>- Parakeratosis :- Nucleated keratin </li></ul><ul><li>- Acanthosis :- Increased number of prickle cell layer </li></ul>
  30. 37. Squamous cell papilloma
  31. 38. Squamous cell papilloma
  32. 39. Squamous cell papilloma
  33. 40. Slide (12) Adenoma Definition :- A benign tumor of endocrine and exocrine glands and mucosal glands of GIT and endometrium. Gross picture :- A well –defined capsulated ovoid mass cut section : solid ,cystic or papillary cystic Microscopic picture :- Proliferated glands lined by cuboidal or columnar epithelium separated by a dense fibro-vascular connective tissue stroma (colon adenoma )
  34. 41. Adenoma
  35. 42. Adenoma
  36. 43. Slide (13) Fibroadenoma of the breast <ul><li>Definition :- Mixed benign tumor composed of glandular and fibrous tissue elements </li></ul><ul><li>Gross picture :- Well circumscribed capsulated tumor mass . </li></ul><ul><li>Cut section :- Grayish white, firm and lobulated mass </li></ul><ul><li>Microscopic picture :- Proliferated fibrous tissue stroma and glandular tissues.The ducts are lined by double cell layers of benign ductal epithelial cells . - Pericanalicular fibroadenoma :-The ducts are Patent Intracanaliclar fibroadenoma :-The ducts are closed . </li></ul>
  37. 44. Pericanalicular fibroadenoma
  38. 45. Intracanalicular Fibroadenoma
  39. 46. Benign mesenchymal tumors <ul><li>Fibroma </li></ul><ul><li>Leiomyoma </li></ul><ul><li>Lipoma </li></ul><ul><li>Chondroma </li></ul>
  40. 47. Origin : arise from the fibrous tissue. Sites: Fibrous tissue stroma of organs (breast ,ovary and kidney) , intermuscular septa, submucosa, Grossly: capsulated, oval, soft (cellular) to hard and Cut section :- Whorly bundles grayish white (hard) or pinkish –white(cellular) in colour . Microscopically: bundles of mature fibroblasts, collagenous tissue, and few capillaries. If excess collagen  hard fibroma, if excess fibroblasts  soft fibroma. Types: - Pure fibroma.-Mixed fibroma, with glands  fibroadenoma, with muscles  fibromyoma Slide (14) : Fibroma
  41. 50. Slide (14) : Leiomyoma Origin: from smooth muscles. Sites: uterus is the most common (fibroid) GIT, bladder. Grossly: non capsulated (false capsule) , single or multiple, rounded, firm . C.S whorled pattern, composed of pinkish and whitish interlaced bundles . Microscopically: interlacing bundles of smooth muscle fibers separated by fibrovascular stroma.
  42. 52. Slide (15) : lipoma <ul><li>Origin: from fatty tissues. </li></ul><ul><li>Sites: Subcutaneous tissues of the arm, back, submucosa and retroperitoneum. </li></ul><ul><li>Grossly: capsulated, round or oval, lobulated soft mass </li></ul><ul><li>C.S:-Bulging,pale- yellow and greasy </li></ul><ul><li>Microscopically: capsulated, with fine trabeculae dividing the tumor into lobules that contain clusters of adult fat cells { clear cytoplasm with peripheral (signet ring) nuclei} and fewer clusters of embryonic fat cells ( granular eosinophilic cytoplasm with central nuclei.. </li></ul>
  43. 56. Slide (16) : Chondroma <ul><li>Origin: Benign tumors of cartilage . </li></ul><ul><li>Sites: Short bones (hands & feets) , flat bones (sternum ,ribs ,scapula) and ends of long bones . </li></ul><ul><li>Grossly: Capsulated, rounded or oval, solitary or multiple mass .Cut section :- Sharp borders , lobulated bluish and translucent . </li></ul><ul><li>Microscopically: The fibrous capsule sends trabeculae that divide the tumor into lobules .Each lobule composed of chondrocytes (vacuolated cytoplasm with central nuclei in lacunae) are arranged singly or in groups .The stroma is pale blue hyaline matrix . </li></ul>
  44. 58. Chondroma
  45. 59. Malignant tumors <ul><li>Malignant epithelial tumors :- </li></ul><ul><li>Carcinoma of surface epithelium :- </li></ul><ul><ul><li>1-Squamous cell carcinoma </li></ul></ul><ul><ul><li>2-Basal cell carcinoma </li></ul></ul><ul><li>Carcinoma of glandular epithelium :- </li></ul><ul><ul><li>1-Adenocarcinoma </li></ul></ul><ul><ul><li>2-Mucoid adenocarcinoma </li></ul></ul><ul><li>Malignant mesenchymal </li></ul><ul><ul><li>Fibrosarcoma </li></ul></ul>
  46. 60. Slide 17 :- Squamous cell carcinoma <ul><li>Definition :- Malignant tumor of stratified squamous epithelium </li></ul><ul><li>Epidermis:- Intact or partially ulcerated stratified squamous epithelial covering </li></ul><ul><li>Dermis :- Groups of malignant squamous epithelial (prickle) cells with pale pink ill defined cytoplasm ,large size vesicular nuclei with prominent nucleoli .With or without central keratin pearls (cell nests) .Few chronic inflammatory cells in between the nests. </li></ul><ul><li>Hemorrhage and necrosis may be found. </li></ul>
  47. 62. SCC Cell nests Keratin pearls Lymphocytes
  48. 64. Slide 18 : Basal cell carcinoma (Rodent ulcer) <ul><li>Def: - Locally malignant tumor arising from the basal cell layer of epidermis in face skin exposed to sun rays </li></ul><ul><ul><li>Gossly:- starts as a firm reddish papule  nodule  finally ulcerate .It erodes surrounding structures through its spread ( rodent ulcer) .It characterized by </li></ul></ul><ul><ul><ul><li>Margin : rounded or oval margin </li></ul></ul></ul><ul><ul><ul><li>Edge: raised inverted (rolled in ) . </li></ul></ul></ul><ul><ul><ul><li>Floor: rough and necrotic . </li></ul></ul></ul><ul><ul><ul><li>Base: indurated . </li></ul></ul></ul><ul><li>Histologically: invasion of the dermis by variable sized masses formed of malignant basaloid cells that form palisade appearance at the periphery. The surrounding stroma is retracted from them leaving spaces </li></ul>
  49. 66. Basaloid cells Palisading Retracted stroma around the malignant masses
  50. 67. Slide 19 : Adenocarcinoma <ul><li>Origin: glandular tissue. </li></ul><ul><li>Sites: endocrine, exocrine glands, mucus membranes, GIT, endometrium. </li></ul><ul><li>Gross: </li></ul><ul><li>in solid organs  irregular infiltrative growth, </li></ul><ul><li>in hollow organs  fungating, infiltrating or ulcerating growth. </li></ul><ul><li>Microscopically: The malignant glands are: </li></ul><ul><li>1-irregular in size and shape. </li></ul><ul><li>2- They are lined by malignant cells . </li></ul><ul><li>3-They are present in abnormal location (in submucosa ,musculosa even reach serosa) </li></ul><ul><li>4-The glandular lumina are irregular or absent. </li></ul><ul><li>Grading: depends on architecture and cellular differentiation. </li></ul>
  51. 69. Adenocarcinoma colon Normal mucosa Malignant glands
  52. 70. Adenocarcinoma colon Normal mucosa Malignant glands
  53. 71. Slide 20 :Mucoid carcinoma <ul><li>Origin: from glandular epithelium producing mucin. </li></ul><ul><li>Sites: mostly in GIT (stomach & colon).rare in breast ,gall bladder and bronchi. </li></ul><ul><li>Grossly: appears as soft gelatinous mass . </li></ul><ul><li>Microscopicaly: </li></ul><ul><ul><li>Mucoid (colloid) carcinoma : adenocarcinoma  rupture of cells  release of large amount of extra-cellular mucin  Pools of mucin containing floating malignant cells. </li></ul></ul><ul><ul><li>Signet cell carcinoma : cells are distended with intracellular mucin  Signet ring cells with minimal extracellular mucin. </li></ul></ul>
  54. 73. Mucoid carcinoma, colon Normal mucosa Mucus pools
  55. 74. Slide 21 :Fibrosarcoma <ul><li>Definition : malignant tumor of fibrous tissue </li></ul><ul><li>Sites : subcutaneous,intermuscular and periosteal tissues </li></ul><ul><li>Gross picture :Large ,grayish white mass with foci of hemorrhage and necrosis. </li></ul><ul><li>Microscopic picture :- Fasicles of malignant spindle cells separated by collagen (Herring –bone pattern) </li></ul>
  56. 75. Herring bone
  57. 77. Thank you