1. EMR

2. Contents
• MNG
• Hashimoto’s Thyroiditis
• Graves Disease
• Papillary CA Thyroid
• Medullary CA Thyroid
• Mucinous Cystadenoma
• Serous Cystadenoma
• Dermoid Cyst
• Simple cystic endometrial hyperplasia
• Atypical endometrial hyperplasia
• Endometrial polyp
• Adenomyosis
• Leimyoma
• Leimyosarcoma
• H. mole
• Retained products of conception
• Dysgerminoma
• Cryptorchidism
• Fibrocystic Disease
• Fibroadenoma
• Invasive Ductal CA Breast

3. Multinodular
Goiter
Multinodular goiter-
colloid present in
follicles,
tall columnar cells lining
follicles, follicular
hyperplasia
Degenerating changes-
necrosis, hemorrhage, fi
brosis
Case:
Diffuse neck swelling, iodine
deficient diet, mostly
females, resident of hilly
areas, pressure symptoms-
dysphagia, dyspnea

4. Hashimoto’s
Thyroiditis
Extensive infiltration of
parenchyma by inflammatory
cells (lymphocytes and
plasma cells)
Atrophic thyroid follicles
Normal low cuboidal
epithelium replaced by
eosinophilic hurthle cells.
Case:
Woman with
hypothyroidism, thyroid
peroxidase antibodies
positive.

5. Graves’ Disease
1. Moth eaten appearance
of colloid
2. Crowding and
hypertrophy of tall
columnar cells
Case:
Woman with
exophthalmos, hyperthyroidi
sm symptoms, TSIs positive

6. Papillary CA
thyroid
Papillary CA thyroid-
Orphan Annie nuclei,
psammoma bodies
Case:
H/O radiation to
head/neck, mets to cervical
lymphnodes

7. Medullary CA
Thyroid
Polygonal cells forming
nests, follicles and
trabeculae.
A cellular amyloid deposits
derived from altered
calcitonin molecules secreted
by neoplastic cells.
Case:
Male, with familial MEN
Syndrome, mets present.

8. Mucinous
Cystadenoma
Ovary
Mucinous cystadenoma ovary
Mucin secreting cysts
Mucinous pleomorphic cells
Case:
U/L pelvic mass
Abdominal pain
Pseudomyxoma peritoneii
Gross specimen, increased
mucin production

9. Serous
cystadenoma
ovary
Serous cystadenoma ovary
Pleomorphic atypical
cells
Nests of tumor cells
Psammoma bodies
Tall columnar cells
Case:
B/L ovarian masses
Gross: smooth glistening
surface, septa

10. Dermoid Cyst
ID points:
1.Dermal appendages
2. Stratified squamous epithelium
Case:
Young girl, with pelvic
pain, radiological evidence
of calcification in pelvic
mass

11. Simple Cystic
Hyperplasia
ID points:
1. Dilated endometrial
glands
2. Increased gland to stroma
ratio
Case:
Woman with excessive
estrogen: PCOD, obesity
etc

12. Atypical
Endometrial
Hyperplasia
ID points:
1. Distorted endometrial
glands
2. Crowding of glands
3. Loss of cellular polarity
Case:
Woman < 40-50
yrs, obese, HRT, post-
menopausal, vaginal
bleeding

13. Endometrial
Polyp
Endometrial polyp
Endometrium
resembling basalis wih
small muscular arteries
Cystically dilated
endometrial glands
(finger like projections)
Case:
Woman with intermittent
vaginal spotting

14. Adenomyosis
ID points:
1. Endometrial glands in
myometrium
2. Reactive hypertrophy of
myometrium
Case:
Young female with enlarged
uterus, dysmenorrhea, m
enorrhagia

15. Leimyoma
Leimyoma
Whorls of smooth
muscle fibers
Spindle cells
Case:
Woman with
menorrhagia, increased
frequency, multipara

16. Squamous Cell
CA Cervix
Squamous cell CA cervix
Keratin pearls
Full thickness epithelium
involved
Neoplastic fragments in
stroma
Case:
Young woman, multiple
sexual partners, repeated
HPV infections, young age at
first intercourse, abnormal
Pap smear report

17. Leimyosarcoma
Leimyosarcoma
Cigar shaped cells
Increased mitotic figures
Necrosis
Hyperchromatic nuclei
Case:
Menorrhagia, mets, pelvic
adhesions leading to
symptoms

18. H. Mole
Hyaditiform mole
Swollen villi
Edematous avascular
stroma
Multinucleated
syncytiotrophoblasts
Case:
Pregnant lady with very high
HCG levels, large for date
gestation, passage of grape-
like clusters

19. Retained products
of conception
Retained products of
conception
Fetal RBCs
Chorionic villi
Case:
Incomplete abortion

20. Dysgerminoma
ID points:
polygonal uniform looking
seminoma cells, lymphocytic
infiltrate
Fibrous septa
Case:
Young male with hard
unilateral testicular
mass, localized to the
testes.

21. Cryptorchidism
Cryptorchidism
Interstitial fibrosis
Thickened tubular
basement membrane
Case:
Young male with empty
scrotal sac

22. Fibrocystic
Disease
Apocrine change in cells
lining ducts.
Dilation of ducts, normal
lining of ducts.
Case:
Asymptomatic woman with
U/L palpable breast mass.

23. Fibroadenoma
Fibroadenoma breast-
increased stroma,
star-shaped
intracanalicular ducts
Ducts lined by normal
cells
Case:
Young female, in
reproductive age
group, cyclical breast pain or
increase in mass size, freely
mobile mass, increases in size
during pregnancy/menstrual
cycle

24. Invasive Ductal
CA breast
Infiltrating ducts.
Ducts lined by single layer of
cells.
Pleomorphic nuclei.
Stroma shows dense
desmoplasia.
Case:
Woman with palpable breast
mass, nipple
discharge, peau’d orange
appearance of breast, axillary
lymphnodes +, mets present.

25. Invasive CA
breast
Breast CA-
Increased N/C ratio,
pleomorphic,
undifferentiated cells
Case:
Old woman, with mets,
axillary nodes palpable,
nipple retraction

31. KUB

32. Contents
• Kidney Necrosis
• Chronic pyelonephritis
• Membranous GN
• Crescenteric GN
• Glomerulonephritis
• Renal Cell CA
• Transitional Cell CA Bladder
• BPH
• Prostate CA

33. Kidney necrosis
Attenuation of epithelial cells
Presence of casts in lumina of
tubules and collecting ducts.
Interstitial edema.
Case:
Patient with ARF, drug
induced or shock-
induced, DIC

34. Chronic
Pyelonephritis
Hyaline like deposit in
glomeruli.
Abudant chronic
inflammatory cells.
Case:
Patient with recurrent kidney
infections, UTI, renal
scarring, chronic renal
failure, TIN.

35. Membranous
GN
Glomeruli are large.
Proliferation of mesangial
cells.
Glomerular capillaries show
tram track apperance.
Case:
Nephrotic Syndrome S/S

36. Crescenteric GN
Deposition of protein like
material in Bowman’s space.
Proliferation of cells in
parietal layer of Bowman’s
capsule.
Case:
Patient presenting with
ARF, with
Goodpasture’s, Wegener;s, SL
E etc.

37. Glomerolunephritis
Membranous
glomerulonephritis
Thickening of basement
membrane
Neutrophils
Case:
30-50 yr old male with
nephrotic syndrome

38. Focal Segmental
Glomerulosclerosis
Some glomeruli/part of
glomeruli show sclerosis.
Matrix proliferation.
Protein depostion.
Some glomeruli totally
sclerosed.
Case:
Nephrotic Syndrome S/S:
Hyperlipidemia, lipiduria,
proteinurea > 3.5 g/day,
children/adults. Not
responsive to steroids.

39. Renal Cell CA
Renal cell carcinoma
Vacuolated or lipid-
laden appearance of
cells (clear cells)
Scant stroma
Clear, granular
cytoplasm
Bizarre nuclei with giant
cells.
Case:
Painless hematuria, flank
pain, palpable mass

40. Transitional Cell
CA Bladder
Transitional cell carcinoma
Transitional cells are
arranged in 8-10 layers
Form papillae, having
fibrovascular core
Case:
Old man with painless
hematuria, working in
naphthylene/rubber industry

41. Benign Prostatic
Hyperplasia
Benign prostatatic
hyperplasia-
increased fibrous stroma,
double layers of cells lining
ducts, corpora amylasia
Case:
Old man with increased
hesitancy, frequency, poor
stream and smoothly
enlarged prostate on DRE

42. Prostate CA
Prostate CA-
single layer of cuboidal
cells lining ducts,
back to back
arrangement of glands
Case:
Old man with back
pain, mets, urinary
frequency, hesitancy, poor
stream

45. RES

46. Contents
• Nasal Polyp
• Nasopharyngeal CA
• Laryngitis
• Tonsillitis
• Pneumonia
• Granulomatous inflammation
• Bronchoalveolar CA
• Small Cell CA
• Sq. Cell CA

47. Nasal Polyp
Nasal polyp
Pseudostratified
columnar epithelium
Eosinophils and
fibroblasts
Case:
Patient of allergy, with
U/L nasal obstruction

48. Nasopharyngeal
CA
Nasopharyngeal CA
Large epithelial cells
with indistinct borders
Cells with prominent
eosinophilic nucleoli
Lymphocytes
surrounding syncytial
cells.
Case:
Chinese man with nasal
obstruction, cranial nerve
palsies, enlarged cervical
nodes

49. Laryngitis
Neutrophils
Congestion
Hyperemia
Stratified squamous
epithelium
Case:
High fever, hoarseness of
voice

50. Tonsillitis
Lymphnode lined by
stratified squamous
epithelium.
Proliferation of germinal
centers, infiltration of
reactive lymphocytes.
Case:
Child with sore
throat, cervical
lymphadenopathy, high grade
fever, odynophagia

51. Pneumonia
Alveolar architecture intact.
Distended alveolar spaces
Vascular congestion
Leukocytic infiltrate
Case:
Patient with
cough, sputum, high grade
fever, chest pain, crackles

52. Granulomatous
Inflammation
Epitheloid cells
Rim of fibroblasts
Multinucleated giant cells
Necrotic center
Case:
TB? (caseous necrosis)
Sarcoidosis? Cat-Scratch
Disease?

53. Alveolar Cell CA
Lung
Alveolar carcinoma
Atypical columnar
epithelial cells
Hobnailing of nuclei
Lining the alveoli
projecting towards the
lumen, intervening
stroma is not infilterated
by the tumor.
Case:
Non-smoker, usually
female, central mass

54. Small Cell CA
Lung
Small cell carcinoma of lung/
Oat cell CA
Undifferentiated
neoplasm of primitive
appearing cells
Cells are flat
shaped, with scant
cytoplasm
Their size is
approximately double to
that of a lymphocyte.
Case:
Paraneoplastic
syndrome, ACTH, Growth
hormone, ADH high related
symptoms

55. Squamous Cell
Ca Lung
Squamous cell carcinoma of
lung
Well-differentiated
squamous carcinoma of
the lung, shows keratin
pearl formation.
Cells show atypia and
loss of intercellular
junctions.
Case:
Smoker, male, central mass in
chest, late mets to
liver, bone, adrenals

56. GIT

57. Contents
• Pleomorphic Adenoma (Parotid)
• Barret’s esophagus
• Sq. Cell CA esophagus
• Gastritis
• H. Pylori (Chronic gastritis)
• Stomach CA (diffuse)
• Celiac Disease
• Crohn’s Disease
• Ulcerative Colitis
• Adenomatous Polyp
• Colorectal CA
• Carcinoid Tumor
• Acute appendicitis
• Chronic cholecystitis
• Cholestatis
• Fatty liver
• Chronic hepatitis
• Cirrhosis
• Hepatocellular CA

58. Pleomorphic
adenoma
Pleomorphic adenoma
Cartilage
Neoplastic acinus
Connective tissue &
adipose cells
Apparently encapsulated
Case:
Patient with swelling over
angle of jaw.

59. Barret’s
Esophagus
Squamous to columnar
(intestinal) metaplasia
Goblet cells
Chronic inflammatory cells.
Case:
Long standing GERD

60. Squamous CA
esophagus
Squamous cell CA esophagus
Keratin pearls
Stratified squamous epithelium
Case:
Patient of achalasia, with
weight loss, dysphagia to
solids, cough and formation
of tracheo-esopheal
fistulae, hemoptysis

61. Gastritis
Chronic gastritis
Plasma cells with
lymphocytes
Atrophy of epithelial
lining
Case:
Patient with retrosternal
burning, NSAID
use, hyperparathyroidism, ste
roid use

62. H. Pylori
Spiral rod shaped organism
seen in superficial cells of
stomach mucosa
Intestinal metaplasia
Chronic inflammatory cells
Case:
Patient not responding to PPI
regimen, fecal antigen
postive, urease breath test
positive, feco-oral
transmission

63. CA Stomach
(Diffuse)
Signet ring cells permeating
mucosa of stomach wall
Large mucin lobes
Case:
Long standing peptic ulcer
disease, weight
loss, anemia, supraclavicular
lymphnode (virchow’s
node), signs of
obstruction, hematemesis, m
elena

64. Celiac Disease
Celiac disease
Absence of microvilli
Intraepithelial
lymphocytes
Inflammatory infiltrate
Flattening of villi
Vascular degeneration of
epithelium
Crypt hyperplasia
Case:
Child with chronic diarrhea,
weight loss and intolerance
to wheat, rye, barley
products

65. Crohn’s Disease
Crohn’s disease
Granulomatous inflammation
Transmural damage
Linear ulcers
Case:
Male, melena, fistula
formation, mouth ulcers, can
involve any part of
GIT, mostly ileum

66. Ulcerative
Colitis
Ulcerative colitis
Mucosal ulceration
Inflammatory cells
Crypt abscesses
Epithelial metaplasia
Diffuse inflammatory
process limited to mucosa
and superficial submucosa.
Case:
Acutely sick
patient, melena, megacolon, j
oint pains, gallbladder
problems, commonly involves
colon, increased chances of
malignancy

67. Adenomatous
Polyp
Adenomatous polyp
Epithelial proliferative
dysplasia
Stalk covered by normal
epithelium
Neoplastic epithelium
forming branching
glands
Case:
Pt with melena, family
history of colorectal
problems, undergoing
colonoscopy. May present
with symptoms of
hypokalemia and
hypoalbuminemia.

68. Colorectal CA
Colorectal CA
(adenocarcinoma of colon)
Signet ring cells invading
bowel wall
Intracellular mucin
Neoplastic glands in
muscularis
Case:
Old man with
anemia, obstruction, melena,
altered bowel habits

69. Carcinoid Tumor
Carcinoid tumor
Solid nest of
monotonous appearing
cells with small uniform
nuclei
Cells with pink
cytoplasm and round-
oval stippled nucleus
Infrequent mitoses
Case:
Flushing, diarrhea, bronchosp
asm, mucoid stool

70. Acute
appendicitis
Acute appendicitis
Star-shaped lumen
Superficial ulceration
Neutrophils and pus
cells
Congested blood vessels
Hypertrophied muscles
Case:
Patient with tenderness in
RIF.

71. Chronic
cholecystitis
Chronic cholecystitis-
subserosal fibrosis,
lymphoplasmacytic
infiltrate
Case:
Female, forties, fat, flatulenc
e, bloating, fatty meal
intolerance

72. Cholestasis
Accumulation of bile pigment
in liver parenchyma
Dilated bile canaliculi
Foamy appearance (feathery
degeneration)
Apoptotic bodies visible.
Case:
Jaundice, pruritis, elevated
ALP, bilirubin

73. Fatty Liver
Small droplets of fat in
hepatocytes.
Perivenular and
perisinusoidal fibrosis
present.
Case:
Obese patient with long
standing diabetes, metabolic
syndrome, alcoholic, hyperlip
idemia

74. Chronic
Hepatitis
Chronic hepatitis-
collagen fibers, fibrous
tissue
inflammatory cells in
portal tracts
Steatosis
Liver architecture
preserved
Case:
K/C Hep B or
C, alcoholic, taking
hepatotoxic drugs

75. Cirrhosis
Cirrhosis
Bridging fibrous septa
Nodules
Total disruption of liver
architecture
Case:
Long standing liver
disease, alcoholic, encephalo
pathy, asterixis, spider
angioma, ascites

76. Hepatocellular
CA
Hepatocellular CA
Dilated sinusoidal space
Malignant hepatocytes
Case:
Patient of chronic liver
disease with signs of
decompensation and
worsening
ascites, melena, hemate
sis, bloody ascites etc.

80. Bones, Soft
Tissue & Skin

81. Contents
• Osteochondroma
• Osteosarcoma
• Sq. Cell CA Skin

82. Osteochondroma
Osteochondroma
Hyaline cartilage
Fibrous perichondrium
Case:
Patient with sudden onset of
pain in knee due to nerve
impingement

83. Osteosarcoma
Coarse lace like pattern of
neoplastic bone laid by
malignant cells.
Large hyperchromatic nuclei
of neoplastic cells.
Case:
Young boy with painful knee,
lung mets, Xray findings of
Codman’s triangle, sun burst
appearance.

84. Sq. Cell CA Skin
Lobules of squamous cells
with glassy cytoplasm
undergoing keratinization.
(keratin pearls)
Case:
Man with everted ulcer on
lip, face, arm (sun exposed
area) or everted ulcer
developing in long standing
scars (burns etc)

85. CVS

86. Atherosclerosis
Lipid core
Fibrous cap of atheromatous
plaque
Thickening of tunica media
Case:
Patient of HTN, IHD with
chest pain

87. HEM

88. Contents
• Iron deficiency Anemia
• Thalessemia
• Megaloblastic anemia
• Burkitt’s Lymphoma
• Hodgkin’s Lymphoma
• NHL

89. Iron Deficiency
Anemia
Iron deficiency anemia
Microcytic, hypochromic RBCs
Target cells distort into pencil cells
Case:
Pregnant female, child with
worm infestation, woman
with fibroids

90. Thalessemia
Thalessemia
Basophilic stippling
Nucleated RBCs
Microcytic, hypochromic
RBCs
Case:
Child- failure to
thrive, multiple transfusion
history, hepatosplenomegaly,
chipmunk facies, skull
showing hair on end
appearance on
xray, consanguineous
marriage

91. Megaloblastic
anemia
Megaloblastic anemia
Hypersegmented nuclei in neutrophils
Immature RBCs and WBCs
Case:
Adult woman, with C/O
peripheral neuropathy,
fatigue, psychiatric
disturbances, vegetarian or
post-op gastrectomy

92. Burkitt’s
Lymphoma
•Intermediate sized
lymphocytes with round to
oval nucleus
•Macrophages with clear
cytoplasm (starry sky
appearance)
Case:
African child with
mass/swelling in the jaw or
retroperitoneum

93. Hodgkin’s
Lymphoma
RS cells in a reactive
inflammatory background
consisting of
lymphocytes, eosinophils and
granulocytes.
Case:
Patient with multiple swelling
in neck and axillary region
associated with
malaisa, night sweats, low
grade fever

94. NHL Lymphoma
Lymphocytes
Case:
Patient with malaise, low
grade
fever, lymphadenopathy, hep
atosplenomegaly, in
contiguous involvement of
lymphnodes.