Path 425

Main Table       

Lobar pneumoniaPulmonaryH & EMale age 30. Upper respiratory infection followed by tempature of 39 C and right-sided pleuritic pain. Restriction of movement right chest, dullness to percussion, diminished breath sounds and bronchial breathing. Sputum culture - pneumococci.At autopsy, the right lung was heavier than normal. There was a fibrinous exudate on the pleura of right lower lobe. The lower lobe was firm and, on section, the parenchyma was mottled reddish grey.Alveolar spaces are filled with exudate containing numerous polymorphonuclear leucocytes and occasional histiocytes, fine threads and clumps of brightly eosinophilic fibrin, and red cells. Alveolar capillaries are markedly congested. This is equivalent to what was previously termed "red hepatization".

BronchopneumoniaPulmonaryH & EMale, age 68. Confined to bed. Developed cough, thick sputum culturing Staphylococcus aureus, dullness and rales both lung bases. Temperature 38.5 C, WBC 18,000 per cu. mm. Sputum culture - Staphylococci.At autopsy, the lungs were heavier than normal. There was no pleural exudate. On section, fluid could be expressed and there were nodular, firm, reddish grey areas 1 cm. in diameter throughout both lower lobes.Alveolar capillaries are dilated and congested with red blood cells. Note the pale pink homogenous edema fluid in the alveoli, which contains polymorphonuclear inflammatory cells. Colonies of bacteria (purple granular masses) surrounded by an intense acute cellular exudate of polymorphs may be seen if postmortem bacterial growth has occurred. The characteristic pattern of bronchopneumonia - patchy, bronchocentricity - is not seen here and is best seen in the gross.

Lung abscessPulmonaryH & EFemale, age 75. Hospitalized for fractured hip. Two weeks later, cough, yellow chunky sputum culturing Staphylococcus aureus. Rales in chest. Swinging fever. WBC 12,000.At autopsy, the lungs were heavy, congested, edematous. There were palpable, firm, greyish-red nodules throughout. Several nodules had yellowish soft centres from which pus was expressed. The bronchi contained thick yellow purulent material.With the low objective, identify an abscess and distinguish it from bronchi containing pus (muscular wall and/or cartilage plates). In the centre of an abscess, there will be complete destruction of lung tissue and a massive accumulation of pus cells (polymorphs in various stages of disintegration). At the periphery, there will be a zone of macrophages and some fibroblasts. Note bacterial colonies (purple clumps) in centre at necrotic area.

Aspiration pneumonitisPulmonaryH & EMale, age 85. Several month history of dyspnea and cough, productive of copious amounts of mucoid sputum.Two unrelated processes are evident on this slide. Alveolar spaces contain large numbers of polymorphonuclear leucocytes and numerous pale areas in the centre (between dots on slide; may be elsewhere). These seed fragments are indicative of aspiration. In addition, many alveolar spaces are lined by cuboidal to columnar cells with abundant mucin and nuclear pleomorphism. This is bronchoalveolar carcinoma and was widespread in both lungs.Both lungs had dense, adherent adhesions on the pleural surfaces. The cut surfaces showed patchy solidification by fluffy muco infiltrates.

TuberculosisPulmonaryH & EMale age 30. Weakness, weight loss, low grade fever noted 3 years previously. Productive cough, thick yellow sputum. Hemoptysis. Chest x-ray shows multiple soft densities throughout both upper lobes and cavitation right upper lobe. Treated with streptomycin and I.N.H. for 12 months. Right upper lobectomy performed when sputum became nagative for tubercle bacillus.There are areas of caseation necrosis, well circumscribed by collagen and cellular fibrous tissue. A light diffuse infiltrate of chronic inflammatory cells, focal collections of lymphocytes, and occasionally, giant cells may be noted on the surrounding collagen. The Ziehl-neelson stained slide (Slide number 22) shows occasional red bacilli in the area of necrosis.The right upper lobe was small, contracted and fibrotic with dense pleural adhesions on the surface. On section, there was increased resistance and smaller and larger nodules of yellowish cheesy caseation. Cultures and Ziehl-Neelsen's tissue stains were positive for acid-fast turbercle bacilli.

Miliary tuberculosisPulmonaryH & EFemale, age 25. Two weeks postpartum. Severely ill, temperature 38 to 39 C, productive cough. Chest x-ray nine months ago showed nodular, partly calcified lesion, right apex. Before death, x-ray showed multiple "snow flake" densities throughout both lung fields.Tubercles are composed of central areas of necrosis, surrounded by epitheliod histiocytes, and cellular fibrous tissue in which there are chronic inflammatory cells. Langhan's giant cells are found fairly frequently.The lungs were deeply congested and throughout both were small "millet seed" sized greyish nodules. Similar nodules were noted in the spleen, liver and kidneys.

Pneumocystis carnii pneumoniaPulmonaryH & EMale, age 35. Homosexual, developed herpes zoster infection. One month later, developed cough and pyrexia. Pneumocystis carinii pneumonia was diagnosed and , following initial improvement, gradually deteriorated and died one week after admission to hospital. H.I.V. positive.Both lungs weighed over 1000 gm. Diffuse, firm, white, alveolar infiltrate was present bilaterally.The lung architecture has been remodelled with a large amount of fibrosis. Some alveoli contain residual hyaline membranes - eosinophilic material at the periphery of the alveolar spaces. Within the characteristic exudate seen in P.C.P. The methanamine silver stain (Slide number 23) shows numberous cysts within this material - they stain black and are spherical or cup-shaped. The fibrosis and hyaline membranes represent organizing diffuse alveolar damage.

AspergillosisPulmonaryH & EFemale, aged 31. Developed Acute lymphocytic leukemia 6 years prior to death. Treated initially with chemotherapy and, upon relapse, given bone marrow transplant. She developed dyspnea and died 5 months following transplant.Notice, at low power, the patchy, dark-staining areas. At higher power, these dark areas are seen to be composed of radially-arranged hyphae invading blood vessels and, in some cases, bronchi (H & E stain). The hyphae are well demonstrated on Grocott stain (Slide number 24).The cut surfaces of both lungs showed scattered foci of consolidation with pale centres and hemorrhagic peripheries - i.e., "targetoid lesions".

SarcoidosisPulmonaryH & EMale, age 30. Increasing shortness of breath and cyanosis. Cor pulmonale. Enlarged hilar nodes, spleen and liver. Increased serum gamma globulin. X-ray chest - mottled fine densities; x-ray digits - punched out areas in phalanges. Cultures for tubercle bacillus - negative.At autopsy, both lungs were mottled with minute grey nodules and, in many areas, the jparenchyma was collapsed and fibrous. The hilar nodes were enlarged, firm and mottled grey with small nodules.Throughout the lung are small tubercle-like nodules composed of large pale staining epithelioid cells with no areas of central caseation. These nodules are discrete and are similar to those in the lymph nodes. Cultures - negative for all organisms.

AnthracosisPulmonaryH & EElderly man, inhabitant of smog bound Vancouver for twenty years.An incidental finding at autopsy. The pleural surfaces and cut surfaces of the lungs showed a mosaic pattern outlined by grey-black pigmentation of the alveolar septae and lymphatics. The regional lymph nodes were a mottled black-grey.The aggregation of black carbon particles, orginating from inhaled smoke, contained in macrophages which are obscured by the pigment, is typical.

SilicosisPulmonaryH & EMale, age 50. Hard rock miner for 20 years. Dry cough and dyspnea for past 5 years. Shortness of breath incapacitating for past 6 months. Bouts of congestive failure. X-ray chest showed mottled, diffuse denstities throughout lung fields. Heart enlarged.At autopsy, the lungs weighed twice normal weight. They were firm and fibrotic and cut with increased resistance revealing innumerable smaller and larger firm gritty nodular areas.Notice the whorled nodular lesions. Some are composed of dense hyalinized connective tissue, in which there are cleft-like spaces and fine brownish pigment. These nodules are surrounded by more cellular connective tissue in which there are also chronic inflammatory cells. Some nodules are composed only of the more cellular connective tissue and these are younger lesions. Some alveoli show mild emphysema, others pulmonary edema.

Bronchiectasis (CF)PulmonaryH & E35 year old male with end stage cystic fibrosis and bronchiectasis, treated by heart-double lung transplantation.Both lungs heavy with dilated, tortuous bronchial tree, filled with purulent debris.Bronchial mucosa partly eroded, wall thickened by inflamed granulation tissue, pus in lumen. Submucosal glands, muscle and cartilage partly destroyed by longstanding inflammatory process.

Recent hemorrhagic infart of lungPulmonaryH & EMale, age 60. Debilitated; bedridden; cardiac failure. Mild edema of right leg from thigh to foot. Suddenly short of breath, chest pain, died 4 hours later. Had a milder episode with blood-stained sputum 2 days previously.At autopsy, there was an embolus in the right pulmonary artery, which extended into all the branches. The embolus was firm and friable. This large pulmonary embolus was the immediate cause of death. In the periphery of the right lower lobe was a firm, wedge-shaped, hemorrhagic infarct; this was caused by a smaller embolus 2 days before death (see history).The alveoli are stuffed with red blood cells. The alveolar septa are, for the most part, intact; however, in some areas, they are becoming necrotic. With time, the blood will hemolyse and the area will gradually become fibrosed, leaving a scar.

Ususal interstitial pneumoniaPulmonaryH & E69 year old man with 4-year history of progressive dyspnea. Chest X-ray shows interstitial disease with basilar predominance. Lung function studies show hypoxia and restrictive disease pattern.Irregularly dispersed areas of fibrosis alternate with areas of near normal alveolar architecture. The scars contain smooth muscle and some show a mild mononuclear cell infiltrate. Minimal disease activity, in the form of intraalveolar histiocytes and alveolitis in the non-fibrotic areas, is present at this point.Both lungs show irregular fibrosis with bibasilar predominance, most severe in subpleural zones with relative sparring of central and hilar areas.

Hyaline membrane diseasePulmonaryH & E37-week gestation infant, who died the day after birth, as a result of congenital cardiac anomalies.The alveolated lung tissue is collapsed and shows eosinophilic material lining alveolar ducts and respiratory bronchioles. These are the hyaline membranes. There is focal interstitial and intra-alveolar hemorrhage. While not seen here, early in the course of H.M.D, necrotic bronchiolar epithelium may be present.The lungs were congested, heavy and more solid than normal.

Small cell bronchogenic carcinomaPulmonaryH & EMale, age 60. Noticed some malaise, chronic cough, weight loss, bone pain in spine. Fractured right hip when he fell during a dizzy spell. Admitted to hospital, developed pneumonia and died 6 days later. X-ray showed a large density in left upper lobe, metastatic lesions in vertebrae and pathological fracture of right hip.At autopsy, the left upper lobe of lung showed a greyish granular and friable tumor arising from a secondary bronchus. The hilar lymph nodes were involved. There were multiple metastases to brain, lung, bones, adrenal and liver.Small cell bronchogenic carcinoma is characterized by sheets of cells with scant, indistinct cytoplasm and somewhat oval, closely packed, deeply basophilic nuclei. The stroma is composed of fibrous tissue. In some areas, the tumor is necrotic.

Bronchoaveolar carcinoma (mucinous)PulmonaryH & EFemale, age 70. Cough productive of abundant mucoid sputum. Ill-defined infiltrate left lower lobe.Multinodular and confluent growth of tumor cells along alveolar walls. Tumor cells with bland basal nuclei and abundant mucinous cytoplasm.Multinodular, fluffy to mucoid infiltrates throughout the lobe. Lymph nodes normal.

Bronchoaveolar carcinoma (non mucinous)PulmonaryH & E

Bronchoaveloar carcinoma (non mucinous)PulmonaryH & E

Pulmonary exudate - malignantPulmonaryH & EThis patient had a right-sided pleural effusion. A diagnostic paracentesis was performed. The fluid withdrawn was blood-tinged.Clusters of malignant cells with large hyperchromatic nuclei are typical of centrifuged sediment from a paracentesis specimen in such a patient.

TuberculosisPulmonaryZiehl-NeelsonThis is the same as slide number 5, but stained with Ziehl-Neelson Stain.

Pneumocystis carnii pneumoniaPulmonaryMethanamine SilverThis is the same as Slide number 7, but stained with Methanamine Silver Stain.

AspergillosisPulmonaryGrocott stainThis is the same as Slide number 8, but stained with Grocott Stain.

Acute fibrinous pericarditisCardiovascularH & EThis was a case of Acute Rheumatic Fever with an acute fibrinous percarditis. The slide is used only to demonstrate an early fibrinous exudate and is to be compared with Slide #27, where the exudate is becoming organized.Amorphous deeply eosinophilic fibrin on the visceral pericardium is the hallmark of this lesion. Mesenchymal cells proliferate in the underlying pericardium during early healing.

Organizing Fibrinous pericarditisCardiovascularH & ETo demonstrate organization of a fibrinous exudate. The case is Acute Rheumatic Fever, in which the patient lived long enough for repair to have started.Fibrin is absorbed and infiltrated with plump fibroblasts growing out from the pericardial surface. Proliferation of new blood vessels and macrophages occurs. Early formation of collagen fibers can be seen in the vicinity of adult fibroblasts and eventually fibrous tissue adhesions will be formed.

Tuberculosis pericarditisCardiovascularH & ELong history of pulmonary tuberculosis; developed signs of fibrinous pericarditis; a friction rub could be heard. Severe intractable congestive heart failure ensued with death.Organization of the fibrinous exudate with many fibroblasts diffuse infiltration of lymphocytes and monocytes yields a very thick pericardium. While no good tubercle follicles may be seen, focal whorls, simulating early tubercle follicles, and yound giant cells can often be seen. Bacteriological examination proves conclusively that this is a tuberculous pericarditis.The heart was enlarged. The percardial surface was very thickened with fibrinous adhesions between the visceral and parietal layers. When the heart was sectioned, the visceral pericardium measured between 1/2 to 1 cm. in thickness; the outer layer showed a fibrinous exudate. There was obvious organization closer to the heart muscle. Cultures and smears from the pericardial surface revealed acid-fast bacilli.

Rheumatic myocarditis and pericarditisCardiovascularH & EFemale, age 30. Upper respiratory infections with group A streptococci. Prolonged elevation of sedimentation rate. Two weeks later, acute polyarthritis. Temperature 39 C, rapid pulse, severe prostration. Prolonged PR interval. Later, heart enlarged, friction rub, mitral systolic murmur. Dyspnea. Died of congestive heart failure, 2 months after onset of arthritis.Aschoff nodules, scattered in the loose connective tissue between muscle bundles, occasionally beside an arterioule, are typical. These nodules are ovoid, or elliptical, with a central zone of fibrin and collagen (fibrinoid necrosis), surrounded by scattered large cells with pale vesicular neclei and prominent nucleoli. Occasionally, these cells have more than one nucleus. The pericardium is typically covered by a layer of fibrin, which is eventually organized.The pericardial surfaces were covered by a greyish-red, shaggy fibrinous exudate. The heart chambers were dilated and the mitral valve incompetent. The leaflets were thickened and edematous. On the posterior aspect of the left auricle, the endocardium was thickened, grey and pebbled - forming the so-called "McCallum patch".

Rheumatic endocarditisCardiovascularH & ESame as for slide #29.In this disease, the valve leaflets are thickened and the collagen becomes deeply pink and fibrillary. The endocardium of the auricle is thick and the collagen shows a granular and fibrillar degeneration. There is extensive diffuse infiltration of the endocardium, with chronic inflammatory cells. The inflammatory cells tend to be palisaded, lying parallel to one another and at right angles to the surface of the endocardium. Here and there are foci of degenerated collagen, palisaded with inflammatory cells, many being "owl eyed" cells. There are usually Aschoff nodules in the myocardium, the latter showing cloudy swelling and edema.

Acute bacterial enodcarditisCardiovascularH & EMale, age 55. Difficulty with urination over past three years. Frequency, retention and prostate enlarged. A trans-urethral prostate resection was done and indwelling catheter was inserted. Four days later, developed fever, urine cultured Staphylococcus aureus. Severe prostration. One week later, changing mitral systolic murmur, swinging temperature and blood culture - Staphylococcus aureus. Died two weeks later.Identify the valve, vegetation and myocardium on gross inspection of the slide. The vegetation is irregular and composed of coagulated fibrin and platelets, in which many bacterial colonies are usually embedded. Fresh fibrin and a few inflammatory cells are usually seen on the surface of the vegetation. Deeper, there may be ulceration and destruction of the valve ring and ventricular endocardium. A well-marked acute inflammatory exudate, which forms small abscess in some areas occur in virulent infections.The heart was dilated, expecially the left auricle, the myocardium flabby. On the ventricular aspect of the posterior cusp of the mitral valve, there was a large fungating, friable, reddish-grey vegetation, which extended on to the ventricular endocardium.

Atheroma of the aortaCardiovascularOil Red OMale, age 65. Angina pectoris for 5 years. Heart slightly enlarged. No murmurs. Blood pressure 170/95. Pulse 80, regular. Died of pneumonia.The slide has been stained with Sudan IV by frozen section techniques. Notice the marked, irregular thickening of the intima in plaque-like fashion. As well, notice the red staining fat deposits in the thickened intima. In the more involved areas, the fat deposit is heavier and often extends into the media.The coronary vessels were tortuous, hard and calcified in some areas. Their lumens were irregularly narrowed by yellowish plaques of atheroma. In some areas, they were only pin-point in diameter. The myocardium showed numerous diffuse fine greyish scars, but no large areas of infarction. The aorta was moderately dilated. Throughout its extent, but more marked in the abdominal portion, there were irregular yellowish-grey elevated plaques projectiong into the lumen. Some plaques were firm, others were ulcerated with pultaceous material extruding.

Atheroma of the aortaCardiovascularVerhoff's elastic stainSame as for slide #32.The elastic tissue stains a bluish-black. The intima is irregularly thickened due to fibrosis. Note the lack of elastic tissue in this area. The elastic tissue of the media has been compressed and fragmented in the superficial layers. A plaque of calcification is seen in the intima.

Acute coronary thrombosisCardiovascularH & EMale, age 47. Sudden severe steady crushing retro-sternal pain, collapse, marked dyspnea, profuse sweating, pallor. Death in two hours.An atheromatous plaque, containing a few cholesterol crystals, can be seen. The intima of the artery is very fibrotic and attached to the intima is a thrombus, which often occludes the coronary artery completely.Gross-sections through coronary arteries revealed irregular narrowing due to atheroma. The left anterior descending branch was completely occluded by a fresh thrombus about 2 cm. beyond its origin.

Acute coronary thrombosisCardiovascularH & EMale, age 55. Angina pectoris on exertion for two years. After a meal, suffered from indigestion and then steady severe retrosternal pain of 4 hours duration. Pale, sweating, blood pressure 110/70, pulse 120, irregular, marked dyspnea. Treated in hospital by complete bed rest and sedation. Died 2 days later.This section is from the anterior descending branch of the left coronary artery. The lumen is occluded with a mixture of atheromatous material intermixed with fresh thrombus.

Acute myocardial infarctCardiovascularH & ESee slide #35.Muscle fibers are widely separated by an inflammatory exudate of edema fluid and many polymorphonuclears. The muscle fibers show early necrosis, being smudged and eosinophilic. Focal areas of more advanced necrosis may be seen, depending on the length of time since the infarction.The heart was moderately enlarged. Involving the apex and 1/3 of the interventricular septum and anterior left ventricle was a large area of yellowish dull myocardium, with a peripheral mottled yellow-red border. This area was friable. The coronary arteries were sclerotic and irregularly narrowed by atheroma. In the anterior descending branch of the left coronary, there was a yellowish-red thrombus.

Myocardial Infarct healedCardiovascularTrichromeFemale, age 60. Shortness of breath on exertion for 5 years. Two years ago, suffered severe retrosternal pain and was diagnosed as myocardial infarction. Increasing shortness of breath, nocturnal dyspnea, recurring bouts of congestive failure. Blood pressure 170/90, pulse 100, irregular. Died in congestive failure.This heart section has been stained by Masson's fibrous tissue stain. Fibrous tissueThe heart was slightly enlarged and the right auricle dilated. There was marked atherosclerosis of the coronary arteries and fibrotic occlusion with recanalization of the left anterior descending branch. There was an area of grey-white fibrosis in the interventricular spetum, anterior wall and apex of the heart. The wall here was thin, firm and sclerotic.

recent Thrombosis - veinCardiovascularH & EMale, age 60. Debilitated, bedridden, cardiac failure. Mild edema of right leg from thigh to foot. Was suddenly short of breath, chest pain and died 4 hours later. Had a milder episode with blood-stained sputum 2 days previously.At autopsy, the femoral vein was firm and, on opening, it was filled with dry, friable, mottled-grey-red thrombus, from which a large pulmonary embolus had arisen.The lumen of the large vein is almost completely occluded by a thrombus composed of pale staining eosinophilic amorphous platelets in which white blood cells are entrapped. Alternating with the bands of platelets are red blood cells. There is no evidence of organization and the thrombus is not firmly attached to the vein wall. Mild inflammation in the vein wall may be seen.

organized and recanalized thrombus of veinCardiovascularH & EFemale, age 34. History of thrombophlebitis accompanying pregnancy, followed by "postphlebitic" syndrome with chronic edema of leg.The lumen of the vein has been occluded by fibrous connective tissue. Notice the innumerable small vascular channels lined by endothelium lying in the connective tissue and a few hemosiderin-containing macrophages.Vein removed at operation. The lumen was not visible.

Thromboanginitis obliteransCardiovascularH & EMale, age. 35. Intermittent claudication, coldness lower extremities, migratory red tender skin areas. Finally developed gangrene of foot and ulcerations of skin of lower leg. Arterial pulses below the knee were absent. Amputation above the knee.The main arteries, veins and nerves were bound together by dense fibrous tissue. The arteries showed recanalization of their lumina and the veins showed recent thrombosis.Identify the large vein occluded by thrombus and the artery occluded by organized thrombus, by gross examination of the slide. Microscopically, the above vessels are surrounded by dense fibrous connective tissue. Smaller vessels and nerve fibers are embedded in the scar tissue and there are a few focal collections of lymphocytes. The large artery shows fibrous thickening of the adventitia. Replacement of media by fibrous tissue and vascularization has occurred. The interanl elastic lamina is prominent, intact and very wavy. The lumen is occluded by completely organized, poorly recanalized thrombus. There is both focal and diffuse infiltration of all coats with chronic inflammatory cells. The wall of the vein shows fibrosis replacing media and thickening the adventitia. The lumen is occluded by recent thrombus and is undergoing organization.

Thromboangitis ObliteransCardiovascularH & E

Syphilitic aortitisCardiovascularVerhoff's elastic stainMale, age 45. Primary chancre 20 years ago. Over past 5 years, increasing dyspnea and angina. Several episodes of acute pulmonary edema. Heart enlarged to left. Water hammer pulse. Died in acute pulmonary edema.At autopsy, the heart weighed 500 gm., the left ventricle being hypertrophied and measuring 2.5 cm. in thickness. The aortic valve was incompetent, the leaflets shrunken and thickened, the valve ring dilated and commissures widened, the ascending aorta dilated and the coronary orifices narrowed. The aortic wall was thickened, the intima finely scarred in stellate fashion and studded with small firm greyish plaques. The adventitia was widened.Elastic tissue stain used. Elastic tissue stains black. Extensive atheromatous changes, involving intima and superficial media, can be seen and markedly thickened adventitia can be identified. Notice, in particular, the fragmentation and focal loss of the elastic tissue in the narrowed media.

Fatty degeneration of the heartCardiovascularosmiumPatient had pernicious anemia. RBC 2,600,000. Hb. 40%.At autopsy, the heart was dilated, soft, flabby and greasy. Yellow streaks were noted in the subendocardium (thrush breast).This slide has been stained by the osmic acid method, in which fat droplets appear black. Note the dispersion of these droplets through the involved muscle fibres.

Normal KidneyUrinaryH & E

Acute glomerulonephritisUrinaryH & ETen year old boy. Streptococcal pharyngitis, followed in two weeks by fever, edema, headaches and smoky urine. The urine contained protein, red blood cells, white blood cells and many casts. The B.U.N. was 50 mg%, serum complement (C3) 50 mg% - (normal: 70-120 mg%). A renal biopsy was done after 3 weeks.This is an example of severe post-streptococcal glomerulonephritis. The immunofluorescent reactions on this biopsy were strongly positive for IgG and C3 in a granular, or lumpy pattern, indicative of immune complexes within all glomeruli. This young boy recovered.Almost all glomeruli are hypercellular and contain increased numbers of mesangial, or endocapillary cells, as well as many polymorphonuclear leukocytes. In a few glomeruli, there is proliferation of epithelial cells of Bowman's capsule forming small epthelial crescents. Many tubules contain a protein precipitate, in which can be recognized bibrin, red blood cells and debris. There is also a patchy interstitial infiltrate of mononuclear cells. Occasional blood vessels contain some fibrinoid necrosis.

Membranoproliferative glomerulonephritisUrinaryPASMale, age 20. Onset of nephritis, two years previously, with hematuria, proteinuria, cylinduria, mild azotemia and hypertension. Severe proteinuria with moderate hematuria persisted and death was caused by an acute interstitial pneumonia. The serum complement (C3) levels were consistently between 10-30 mg %.All glomeruli are strikingly hypercellular and there is a marked loss of patent capillary loops. Many polymorphonuclear cells are present, but there is also a proliferation of mesangial, or endothelial cells. These two cells cannot be distinguished from each other in the slide. Note that the entire glomerular tuft is equally involved - the changes are not segmental. There is sometimes a suggestion of lobulation. A few glomeruli show epithelial proliferation, with formation of " crescents" and tuft adhesions. Many tubules contain protein precipitates, or red blood cells. There is diffuse interstitial edema, infiltrates of mononuclear and polymorphonuclear cells and some fibroblast proliferation. Immunofluorescent stains were strongly positive for C3 complement component, but negative for C1 or C4. This disease seems to involve activation of the alternate complement pathway. It is seen most often in young adults and runs a slowly progressive course.The kidneys were slightly enlarged and pale.

Membranoproliferative glomerulonephritisUrinaryPAS / Hematoxylin

Membranoproliferative glomerulonephritisUrinaryH & E

Chronic glomerulonephritisUrinaryH & EMale, age 30. Frequent sore throats as a child, but no definite history of any renal disease. Weakness, pallor, easy fatigue. Frequency D/N 5/6. Dyspnea, headaches. Blood pressure 180/110, pulse 80, heart enlarged. Urinalysis: RBC 2+, protein +2, casts. B.U.N. 150 mg%. Hb. 60%. Patient deteriorated - nausea and vomiting, cardiac failure, uremic convulsions - died 6 months after initial symptoms.The glomeruli are closer together than normal. Many are hyalinized, almost acellular, and fused to a thickened Bowman's capsule. Epithelial crescents can occasionally be identified. The least affected glomeruli are distorted in shape, large, but are bloodless and show thickening of basement membranes. The majority of the tubules are atrophic; however, they are occasionally hypertrophied and dilated. There is marked interstitial fibrosis and a diffuse and focal infiltration, with chronic inflammatory cells. Many tubules contain casts. The larger arteries show intimal thickening and hyalinization. The arterioles are not abnormal.Each kidney weighed 95 gm. The capsules stripped with difficulty, revealing a finely pitted and granular surface. On section, the kidneys were firm, the cortex narrow, pale and irregular; the medulla was pale; cortico medullary differentiation was poor.

Chronic glomerulonephritisUrinaryH & E

Membranous glomerulonephritisUrinaryH & EMale, age 45. Insidious onset of weakness and edema involving legs and face. The urine contained 12 gm. Of protein in 24 hours. The serum albumin was 1.2 gm%. B.U.N. 15 mg%. A renal biopsy was done. Proteinuria persisted for 6 years, in spite of prednisone therapy. Death was caused by pneumococcal pneumonia.The P.A.S. reaction stains basement membranes a magenta color. Note that the basement membranes of all glomeruli are uniformly thickened. There is little, or no glomerular hypercellularity, but a few tuft adhesions and collapsed capillary loops can be seen. Occasional hyalinized glomeruli can be found. Tubules show patchy atrophy, associated with interstitial fibrosis. A few tubules contain precipitated protein (hyaline casts). This is fairly advanced membranous glomerulonephritis. The disease progresses by causing collapse of glomerular tufts and atrophy of the associated nephron until renal functional impairment develops. Immunofluorescent reactions are strongly positive for IgG, indicating glomerular deposits of immune complexes.The kidneys were enlarged and pale.

Diabetic GlomerulosclerosisUrinaryPAS / HematoxylinThis patient with longstanding diabetes developed the nephrotic syndrome.In the sections, many glomeruli have undergone complete hyalinization. Others show hyalinization and thickening of Bowman's capsule and a patchy, nodular, cannonball-like hyalinization of the glomerular tufts. This latter change is present to varying degrees. There is hyaline arteriolar sclerosis, involving both the efferent and afferent arterioles. A careful search for changes in both vessels is necessary and may not be evident in all slides. There is ischemic atrophy of some tubules and replacement interstitial fibrosis and hypertrophy of other less involved tubules. Protein casts can be seen. This slide demonstrates both the nodular and diffuse lesions of diabetic glomerulosclerosis. The nodular lesions (Kimmelsteil-Wilson lesion) is pathognomonic of diabetes, but does not cause clinical renal disease. The diffuse lesion (mesangial thickening and thickening of basement membranes) causes the nephrotic syndrome.The kidneys were larger than normal and pale, with a very fine granularity.

Diabetic nephrosclerosisUrinaryH & EThis is the same as Slide number 53, but stained with PAS.

Amyloid KidneyUrinaryCongo RedMale, age 40. Long standing case of tuberculosis. Emaciated. Enlarged, firm spleen and liver. Urine 4+ protein.Notice the extensive replacement of almost every glomerulus, with homogenous amyloid material. This becomes deposited in the basement memebranes of the capillaries, which gradually become thickened to the point seen in this section. Although thickened, they are "leaky" - this patient had 4+ proteinuria. Numerous protein casts can be seen in dilated renal tubules. Amyloid is also present in many of the arterioles and in some of the basement membranes of the tubules, though this is not prominent in this particular case.The kidneys were enlarged to almost twice the normal weight, firm and pale.

Benign arteriolar nephrosclerosisUrinaryH & EFemale, age 60. Mild occipital headaches, shortness of breath and precordial pain following stress. Blood pressure fluctuated between 180/110 and 160/90 for the past 5 years. During the last year, the blood pressure was maintained at 200/120, severe occipital headaches, shortness of breath and angina pectoris on exertion, several transient paresthesias and weakness of a limb. Urinalysis: Specific gravity 1010-1015, protein 2+, hyaline casts. B.U.N. 25 mg%. Heart enlarged to left. Retinal arterioles narrow. Patient collapsed Christmas shopping. Admitted to hospital with right hemiplegia, unconsciousness, respirations difficult. She died 12 hours later.The kidney shows generalized congestion. The glomeruli show minimal to extensive degrees of thickening of the capillaries, with narrowing of the lumina and thickening of Bowman's capsule. In some instances, the thickening involves a few loops in a tuft, in others, there is complete hyalinization of the tuft and Bowman's capsule. The afferent arterioles, where seen, show a hyaline, eosinophilic, eccentric thickening of their walls and narrowing of the lumen. Many of the larger arteries show fibrous thickening of intima, hyaline degeneration of media and reduplication of internal elastic lamina. The lumens are narrow. Some tubules are atrophic, others hypertrophied, or dilated, containing casts. The epithelium shows cloudy swelling in many areas, which for the most part, is postmortem autolysis. The interstitial tissues show edema and fibrosis and a mild chronic inflammatory cell infiltrate.The heart weighed 450 gm and left ventricle showed concentric hypertrophy. Massive left cerebral hemorrhage was the cause of death. The kidneys weighed 130 gm., the capsules stripped with slight difficulty, revealing a finely granular, mottled reddish surface. On section, the cortex was irregular, mottled reddish and cortico medullary differentiation was poor.

Benign arteriolar nephrosclerosisUrinaryH & E

Malignant arteriolar nephrosclerosisUrinaryH & EMale, age 40. At age 38, noted mild headaches, slight decrease in exercise tolerance, blood pressure 150/100. Urinalysis normal. Six months before death, abrupt onset of severe headaches, nausea, vomiting, visual disturbances. Blood pressure 225/150, heart enlarged to left, rales in chest. Exudates and hemorrhages in retina and 4+ papilloedema. Urinalysis: 2+ RBC to gross blood, 3+ protein, many casts, specific gravity 1010 fixed. B.U.N. 70 mg%. Patient deteriorated and terminally had acidosis, convulsions and coma, and died of uremia.Many of the glomeruli are large and show marked thickening and narrowing of the capillary loops. As well, many loops show patchy fibrinoid necrosis of their thickened walls and marked narrowing of the lumina. Some of the larger vessels show narrowing of lumina by intimal fibrosis. Some tubules are atrophic, others hypertrophied and dilated. Many contain red blood cells. The epithelium shows varying degrees of degeneration. There is extensive interstitial edema and hemorrhage, some fibrosis and also a mild inflammatory cell infiltrate.The heart showed left ventricular concentric hypertrophy and weighed 600 gm. There was a fibrinous uremic pericarditis and uremic ulcerations of the gastrointestinal tract. The kidneys each weighed 140 gm., and the capsules stripped easily, revealing a finely granular, greyish-red surface, dotted with pinhead sized hemorrhages - the so-called "flea-bitten" kidney. On section, there was poor cortico medullary differentiation and the surface was mottled reddish-grey.

Shock kidneyUrinaryH & EMale, age 29. Traffic accident, with fractured pelvis. Acute renal failure developed and death occurred 7 days later.Glomeruli are normal, although they appear collapsed and bloodless. Tubules are widely dilated with a thin epithelium and, in some tubules, the epithelium has undergone degeneration and has been desquamated into the lumen, forming granular debris. There is marked interstitial edema and a focal inflammatory infiltrate. Sometimes, the latter seems to surround partly destroyed tubules (tubulorrhexis lesion). These changes are typical of acute tubular necrosis (ATN), due to shock associated with tissue injury.The kidneys were enlarged, edematous, with a dark red congested medulla.

Acute pyelonephritisUrinaryH & EFemale, child age 7. Frequent bouts of fever, dysuria, albuminuria and pyuria. Two weeks before death, had swinging fever, pain in costovertebral angles, chills. Urine 4+ albumin, casts, 1+ RBC. Urine cultured antibiotic resistant Staphylococcus.On gross inspection of the slide, linear streaks of bluish color can be seen traversing cortex and medulla. Microscopically, these streaks are composed of inflammatory cells, polymorphs predominating. In some areas, there are abscess-like formations composed of degenerating polymorphs. The infalmmatory cells in many areas lie in tubules. The glomeruli and tubules outside these foci are relatively normal and the interstitial tissues show mild edema.Both kidneys were larger than normal. The capsules stripped with ease, revealing a mottled, yellowish, smooth surface. On section, there were yellow streaks running through the cortex and medulla. The pelvis and ureters were congested and slightly dilated.

Pyemic abscess of the kidneyUrinaryH & EMale, age 35. Suffered from repeated boils. Toxic, with temperature spiking to 39 C. WBC 15,000. Urine 4+ WBC, 1+ RBC.Note the many small, discrete abscesses scattered in the parenchyma of the kidney. The kidney tissue is destroyed in these areas of acute inflammatory cell infiltration. Numerous pus cells can be identified.Both kidneys were studded with innumerable small yellow abscesses, which were very prominent in the cortices.

Papillitis NecrotansUrinaryH & EFemale, age 60. Diabetic for years, with advanced atherosclerosis. Developed gangrene of left small toe, spreading to dorsum of foot and cellulitis. Two weeks later - lumbar region pain, left renal colic, swinging fever. Urinalysis: 4+ sugar and acetone, 4+ pus cells, 2+ RBC, 3+ protein. Urine became scant, B.U.N. rose to 150 mg%.On gross inspection of the slide, notice the linear, blue streaking of the cortex and medulla and the pale papilla separated from the remainder of the kidney by a bluish zone. Microscopically, the papilla shows coagulation necrosis, separated from viable parenchyma by a fairly wide zone, showing a marked inflammatory reaction. The remainder of the parenchyma shows edema and acute pyelonephritis.The kidneys weighed 150 gm., the capsules stripped with ease, revealing a mottled, red-yellow surface. On section, there were yellowish steaks in cortex and medulla. There were yellow-grey, friable, necrotic areas replacing the pyramids, surrounded by an area of hyperemia. Several pyramids had sloughed away and one was found in the bladder. The pelvis and ureters were congested.

Chronic PyelonephritisUrinaryH & EMale, age 65. Difficulty in urination, dysuria for ten years. Prostate enlarged, nodular and rubbery. Residual urine 30 cc. Frequency, pallor. Urinalysis: Specific gravity 1010 fixed, 3+ protein, 2+ pus, 4+ WBC, 1+ RBC. B.U.N. rising 50-150 mg%. Died in uremia.The parenchyma is shrunken and distorted. The glomeruli are very close together and, for the most part, completely hyalinized. The relatively normal glomeruli show marked thickening of Bowman's capsule. The tubules, for the most part, are atrophic and replaced by fibrous tissue, in which there is a massive, chronic, inflammatory cell infiltrate. The remaining tubules contain deeply eosinophilic casts. The renal arteries show marked intimal thickening.Both kidneys were small, contracted, granular kidneys, each weighing 50 gm. The capsule was thickened and stripped with difficulty, revealing a greyish, granular surface, with U-shaped depressions. On section, the parenchyma was firm, grey, with narrowing of the cortex and poor cortico medullary differentiation. The ureters and pelvis were thickened and grey and moderately dilated. The bladder was trabeculated and inflamed and the prostate markedly enlarged.

Tuberculosis of the KidneyUrinaryH & EEmaciated male, age 40. Productive cough of 3 years' duration. Bilateral lung densities by X-ray. Dysuria, frequency. Urinalysis: 4+ protein, 4+ pus, 3+ RBC, Specific gravity 1020. Routine cultures of urine - negative. Tender swelling of left epididymis, with fistulous tract to skin. Low grade fever.In this section, much of the renal cortex has been destroyed. Note the many tubercle follicles, consisting of pale, epithelioid cells, with giant cells. Only occasional tubercles show caseous necrosis. The intervening tissue shows a marked, chronic inflammation, with destruction and atrophy of tubules, heavy lymphocytic infiltration and periglomerular fibrosis in places. The papillae and pelvis show caseous necrosis, surrounded by a palisade of epithelioid cells. Tubercle bacilli were cultured from the unrine.The pelvis of the kidney had focal collections of shaggy, caseous-like material. The kidney substance was shrunken and there was poor differentiation between cortex and medulla. In the cortex, there were scars of a focal nature and small, yellowish tubercles could be identified.

Tuberculosis of the EpididimusUrinaryH & ESame as slide #63.There are large, confluent, tuberculous follicles, with large areas of caseous necrosis, epithelioid cell reaction, giant cells, and chronic inflammatory cells. The surface shows considerable fibrosis.There was a fistulous tract on the left side of the scrotum and the testis on this side was swollen. When removed and sectioned, the epididymis was greatly thickened, no normal structures could be seen; the whole area was caseous mass with fibrosis and a fistulous tract connected with it. The body of the testis was not involved.

Recent infarct of the kidneyUrinaryH & EThis patient, with arteriosclerotic heart disease, had episodes of auricular fibrillation for some months. He developed the symptoms of a cerebral embolus, with massive infarction of the right internal capsule area of the brain.At autopsy, the kidneys showed yellow, wedge-shaped areas, surrounded by a congested border. The emboli causing these infarcts had arisen from an auricular thrombus.There is an irregular-shaped area of coagulation necrosis, in which the kidney architecture can still be identified. Around the edge, there is bluish, necrotic kidney tissue, infiltrated with inflammatory cells and, surrounding this, there is an area of congestion. Thrombosis can be seen in some of the small arteries.

HypernephromaUrinaryH & EMale, age 65. Hematuria noted intermittently for 3 months. Weakness and loss of weight. "Cannonball" nodules in lungs by X-ray. Pathological fracture of right humerus. On examination, a mass palpable in left abdomen.Sections show the kidney parenchyma to be replaced by a clear cell carcinoma, in which there are areas of necrosis and hemorrhage. The cells are large with clear, vacuolated cytoplasm and large nuclei, with prominent nucleoli. There is an alveolar pattern reminiscent of tubular structures. The tumor is supported by a fine, connective tissue stroma and larger septa. Infiltration of parenchyma is prominent.The left kidney was distorted by a large, soft, tumor mass, measuring 6 cm. x 8 cm., occupying the upper pole. On section, the tumor was yellow and mottled, with areas of necrosis and hemorrhage. The tumor infiltrated into adjacent kidney substance, into pericapsular tissues and filled the pelvis and renal vein.

Wilm's tumourUrinaryH & EFemale child, age 1 year. Mother noted mass in abdomen of child at six months of age. The mass gradually enlarged and abdomen was protuberant. Child lost weight, deteriorated and died.At autopsy, the left kidney occupied most of the abdomen, measuring 10 x 18 x 9 cm., and weighing 600 gm. Replacing most of the kidney was an ovoid, lobulated, encapsulated tumor mass. On section, there was a greyish, fleshy surface, with cystic areas.Sections show a tumor replacing kidney. The tumor is composed of tubular structures, surrounded by a diffuse arrangement of undifferentiated cells. The epithelial cells have small amount of indistinct eosinophilic cytoplasm and large elongated, rather clear nuclei. Mitotic figures are numerous. The stroma is scant and composed of loose, cellular, fibrous connective tissue.

Papillary transitional cell carcinoma of the bladderUrinaryH & E

Infilitrating transitional cell carcinoma of the bladderUrinaryH & E

Metastatic calcification of the kidneyUrinaryVon KossaThis patient had an adenoma of the parathyroid with hyperparathyroidism and a raised blood calcium. Renal calculi were present, with pyelonephritis.Focal deposits of calcium (black) may be seen in many of the renal tubules.

Myeloma of the kidneyUrinaryH & ESee Slide #230. Note that the patient died in uremia and with a heavy proteinuria.Note the markedly dilated tubules, particularly in the cortex, containing massive protein casts. The glomeruli appear normal. The lining of the tubules is atrophied.The kidneys were enlarged and pale.

Childhood nephrosisUrinaryPASMale, age 6 years. Repeated episodes of the nephrotic syndrome for two years. Resistant to therapy with Prednisone. The child died of pneumococcal peritonitis.This slide has been stained with P.A.S. (Periodic Acid Schiff) reagent to demonstrate basement membranes. Note that many glomeruli show segmental sclerosis with increased amounts of P.A.S.-positive material. There are frequent adhesions between the tufts and Bowman's capsules. A few glomeruli have undergone hyalinization. The lesions are focal - they vary a great deal from one glomerulus to another and some glomeruli seem unaffected. Many tubules contain a protein precipitate. There is a diffuse interstitial sclerosis, with sparse infiltration of lymphocytes. Most cases of childhood nephrosis are of the minimal lesion type, showing no abnormalities in the light microscope. Less than 10% of cases of nephrosis in children will show segmental glomerulosclerosis. This form of the disease is usually resistant to steroid therapy and progresses slowly to renal insufficiency. The cause is unknown. Immunofluorescent stains are negative.The kidney's were large and pale with a yellowish color.

Papillary transitional cell carcinoma of the renal pelvisUrinaryH & EMale, age 50. In good health. Recent onset of gross and microscopic hematuria. Painless. On cystoscopy, blood was seen to be coming from the right ureteral orifice. Retrograde pyelogram showed a filling defect in the right renal pelvic. The right kidney and ureter were removed.A large piece of normal kidney is present, together with a portion of pelvis, which contains the tumor. The tumor is made of papillary structures and consists of fairly well-differentiated transitional epithelium. Mild cellular pleomorphism is present and there are occasional mitotic figures. There is no evidence of invasion. The submucosa has focal lymphocytic infiltrates.

Infiltrating transitional cell carcinoma of the renal pelvisUrinaryH & EMale, age 62. History of painless hematuria for 6 months. Intravenous pyelography showed filling defect in right renal pelvis.A portion of kidney and pelvis is present. The pelvic mucosa is replaced by a poorly differentiated tumor made of pleomorphic cells which have hyperchromatic nuclei. Many mitotic figures are present. There is only a trace of a papillary pattern. Tumor infiltrates into the submucosa of the pelvis, and, in some slides, it can be seen within vascular structures. Note that there is a very pronounced lymphocytic infiltrate - ? Immune response to tumor antigens.

Gastric UlcerGI-StomachH & EThese slides are from gastric ulcers of chronic nature and show various stages in healing by granulation tissue formation. The ulcer can readily be seen with the naked eye. There is active fibroblastic proliferation, with new capillary formation and collagen fibrils being formed in the base of the ulcer. Superficially, there is a zone of inflammatory cell reaction. The ulcer has interrupted the continuity of the muscular wall. Slide #76 is the same as Slide #75, but has been stained by the Masson method. In it, collagen stains green; muscle, epithelium, etc., pinkish-red. Examination of this slide with the naked eye readily shows the interruption of the muscular layer and the new formation of collagen in the base of the ulcer.

Gastric ulcerGI-StomachMasson's TrichromeThese slides are from gastric ulcers of chronic nature and show various stages in healing by granulation tissue formation. The ulcer can readily be seen with the naked eye. There is active fibroblastic proliferation, with new capillary formation and collagen fibrils being formed in the base of the ulcer. Superficially, there is a zone of inflammatory cell reaction. The ulcer has interrupted the continuity of the muscular wall. Slide #76 is the same as Slide #75, but has been stained by the Masson method. In it, collagen stains green; muscle, epithelium, etc., pinkish-red. Examination of this slide with the naked eye readily shows the interruption of the muscular layer and the new formation of collagen in the base of the ulcer.

Peptic ulcer of the DuodenumGI-Small IntestineH & EMale, age 40. Thin, asthenic type. Epigastric gnawing pain between meals. Occult blood in stool. Filling defect in duodenum demonstrated by barium meal. At operation, the lower half stomach and a portion of duodenum were removed. Just distal to the pylorus, there was an area of ulceration measuring 2 cm. in diameter. The base was red and granular and the edges punched out. The pancreas formed the base of the ulcer.The ulcer is obvious. It has interrupted the muscularis; the base is formed with rather dense collagen, in which can be seen blood vessels and a few nerves.

Acute EnteritisGI-Small IntestineH & EThis patient had received broad spectrum antibiotic therapy for a staphylococcal pneumonia. He developed diarrhea and was terminally in a shocked state.At autopsy, multiple shallow ulcers were scattered through the small and large bowel. In some areas, pseudomembrane formation was noted. Culture grew coagulase positive Staphylococci and the normal bowel flora did not grow.The ulcers involving the mucosa are readily seen. In their base are varying numbers of acute inflammatory cells with macrophages and varying degrees of congestion. The degree of inflammation varies somewhat from slide to slide.

Tuberculosis EnteritisGI-Small IntestineH & EFemale, age 10. Severely ill, emaciated, diarrhea with blood and mucus, abdomen distended and tender. WBC 6,000; 50% lymphocytes, 25% monocytes. Temperature 39 C.Only some of the sections show the ulcer at the edge. Scattered in the submucosa, muscularis and serosa are many typical tubercles, some with caseous centers.There were 800 cc. of ascitic fluid in the abdomen and the serosal surface of the bowel was studded with many small tubercles. In the ileum and ileocecal regions were scattered shallow ulcers with overhanging edges.

Regional IlieitisGI-Small IntestineH & EMale, age 38. Intermittent diarrhea, abdominal cramps for one year. Increasing symptoms, mass right lower quadrant. Malnutrition.Look at the slide grossly and notice the markedly thickened wall of the ileum. The thickening is due to congestion, edema and diffuse and focal infiltrations with chronic inflammatory cells throughout all coats. There is marked fibrosis of the submucosa and fibrous scars are seen in the muscle coats. In some areas, the focal collections of chronic inflammatory cells form granulomas. In some slides, there may be artefactual separation of the mucosa.At operation, 40 cm. of ileum was thickened and firm, like a "garden hose" and a small portion of cecum was involved. There was sharp demarcation between involved and uninvolved bowel. The mucosa was nodular with loss of the normal markings. The mesentery was thick and rubbery and the mesenteric lymph nodes enlarged.

Acute ApendicitisGI-AppendixH & EMale, age 35. Nausea, vomiting, generalized abdominal pain. Tenderness right lower quadrant. Temperature 38.5 C. WBC 15,000; 85% polymorphs. Sedimentation rate 30.The entire wall, including the peritoneal surface, is heavily infiltrated with acute inflammatory cells: the muscle layers are edematous. There is ulceration of the mucosa, with some pus lying free in the lumen.The appendix was swollen. The serosal surface was dull and had a yellowish exudate in patches. It was congested.

Chronic Ulcerative ColitisGI-Large IntestineH & EFemale, age 35. Emotionally unstable. Diarrhea increasing in severity. Loose watery stools, blood, pus, mucus. Abdominal cramps and tenderness. Fever, pallor and dehydration. Several previous similar episodes.There is extensive ulceration of the mucosa and a heavy, chronic, inflammatory infiltrate in the submucosa and here, as well, there is congestion of vessels. In some areas, the inflammatory cells infiltrate into the muscle coat. There is a pseudopolyp, composed of fairly normal musosa, in which there is a chronic, inflammatory, cell infiltrate and congestion.At operation, the large bowel was thickened and congested. There were innumerable irregular ulcerations, some shallow and others deep. The intervening mucosa was congested, edematous and polypoid.

Amebic DysentaryGI-Large IntestineH & EA soldier invalided home from the Far East. Ten to twelve loose, foul-smelling stools per day, with blood and mucus. Low grade fever. Mild weight loss. All symptoms increased in severity and he died.At autopsy, the whole colon was involved. There were many ragged, deep ulcers, with overhanging margins; the base was covered by necrotic tissue for the most part. There were a few small foci of more normal mucosa. Smears - trophozoites of Entamoeba histolytica.There is necrosis and deep ulceration, with undermining of the normal mucosa. Amebae are identified as large trophozoites and are mainly in the submucosa. The reaction is scant and mainly mononuclear, but, when secondary infection with intestinal bacteria occurs, a polymorphonuclear reaction results.

Acute PeritonitisGI-Large IntestineH & EMale, age 45. History of dyspepsia. Right upper quadrant pain for 36 hours, then generalized severe abdominal pain and rigidity. Temperature 39 C. WBC 16,000; 95% polymorphonuclears. Laparotomy revealed a perforated duodenal ulcer. This was closed and the abdomen drained. He became moribound and died 4 days later. The section is from the peritoneum.Sections are of diaphragm and peritoneum. The peritoneum is thickened, edematous and heavily infiltrated with acute inflammatory cells and variable amounts of fibrin and fibrinopurulent exudate. This is the typical appearance of an acute peritonitis, regardless of cause.

Mixed Tumour of the ParotidGI-Salivary GlandH & EMale, age 50. Painless swelling at the angle of the right jaw; nodular and firm and discrete; not attached to skin. At operation, there was a well circumscribed, encapsulated nodule, measuring 2 cm. in diameter, embedded in the parotid. The nodule was firm, rubbery and, on section, there was a glistening, translucent, grey-pink, cut surface.Normal parotid can be identified. The tumor is composed of a myxomatous stroma, in which there are clusters of cells with poorly circumscribed cytoplasm and ovoid nuclei. As well, there are tubular structures lined by 1, or 2, layers of cuboidal, or flattened, epithelium. Notice the capsule of fibrous tissue. In some areas, the stroma is almost acellular, somewhat resembling cartilage.

Squamous Cell Carcinoma of the EsophagusGI-EsophagusH & EMale, age 50. Anorexia. Weight loss, anemia. Difficulty swallowing solids at first and, later, liquids. A "barium swallow" revealed a filling defect and evidence of obstruction.At autopsy, there was a large ulcerating carcinoma, measuring 4 cm. in diameter, at the lower end of the esophagus. The edges were heaped up and the base friable. On section, greyish cellular tumor extended to the serosal aspect.The squamous cell carcinoma is seen to arise from the overlying mucosa. The carcinoma extends deeply into the wall. The individual cell nuclei are hyperchromatic, large and show mitoses. They are arranged in cords and sheets. Epithelial pearls are present. Edema and an inflammatory cell infiltrate are also present.

Gastric Carcinoma in situGI-StomachH & EAll of the mucosa is abnormal, except for some blocks, which may contain normal duodenum. There is a pronounced proliferation of epithelial cells, which have lost the ability to secrete mucin and show loss of nuclear polarity, some hyperchromatism, frequent mitoses and piling up of nuclei. These changes are marked in focal areas and are most conspicuous along the superficial parts of the mucosa. (Hence the name - superficial spreading carcinoma). There is no invasion. The tumor tends to spread along the surface and eventually it will infiltrate. This is not a common type of stomach carcinoma. Most gastric carcinomas invade early and metastasize.

Gastric AdenocarcinomaGI-StomachH & EMale, age 60. Anorexia, weight loss. Anemia. Enlarged nodular liver. Filling defect in pylorus. At operation (on the lesser curvature proximal to the pylorus), there was an area of ulceration 3 cm. in diameter. The base was necrotic and the edges overhanging. The wall beneath and around the ulcer was thick and, on section, it was granular, friable and grey. The tumor tissue extended throughout the wall to the serosa.The normal mucosa has been replaced and ulcerated by an adenocarcinoma, composed of ill-formed glands, cords and nests of atypical columnar epithelium. The individual cells are large, with fairly cytoplasmic borders, the nuclei are irregular and vesicular, with fairly numerous bizarre mitotic figures. The stroma is scant and infiltrated with inflammatory cells. The carcinoma infiltrates throughout all coats.

Papilloma of the colonGI-Large IntestineH & EMale, age 45. Occult blood in stool. Sigmoidoscopic examination revealed a raspberry-like polyp 1.5 cm. In diameter, attached to the mucosa by a distinct stalk. It was removed.The polyp can be readily seen with the naked eye. There is a fibrous tissue core, with blood vessels, surmounted by mucous-secreting, glandular epithelium, the superficial layers of which show hyperplasia and hyperchromatism of the nuclei. A few mitoses can be seen. There is no infiltration of the stalk.

Adenocarcinoma of the colonGI-Large IntestineH & EMale, age 50. Increasing constipation, occult blood in stool, weight loss. Intestinal obstruction, distention of abdomen. An operation was performed, consisting of a hemicolectomy.The origin of the tumor from the mucosa may not be seen in all the slides. However, an obvious infiltrating adenocarcinoma, involving the submucosa, muscularis and, in some areas, the serosa, is quite obvious. There is considerable fibroblastic reaction to the tumor; the latter is made up, for the most part, of fairly well outlined gland acini.In the descending colon was an annular constricting mass, with ulceration of the mucosa. Regional lymph nodes were enlarged.

Carcinoid of the AppendixGI-AppendixH & EFemale, age 30. Recurrent right lower quadrant pain. Appendix removed prophylactically. At operation, the distal end of the appendix was expanded and firm and, on section, there was a homogenous yellow nodule, measuring 1 cm. In diameter.The mucosa and submucosa have been completely replaced by islands, cords and nests of rather large cells, with poorly defined, pale, vacuolated cytoplasm and basophilic, regular, vesicular nuclei. There is a connective tissue stroma between the groups of cells.

Hepatic Necrosis due to Acute HepatitisGI-LiverH & EThis young male felt listless, with no appetite and with general malaise; developed jaundice; was nauseated and vomited; his stoos were pale and urine dark. He had some pain in the R.U.Q. He lapsed into coma and died 5 days after the jaundice appeared.The normal architecture is difficult to identify. There is diffuse necrosis of liver cells. Many of the viable liver cells show degenerative changes. In some areas, there is congestion of sinusoids. There is bile staining of the necrotic liver cells and bile plugs in canaliculi can occasionally be identified. In the portal areas, especially, there is easily identified inflammatory cell exudate, consisting mainly of mononuclears, lymphocytes, plasma cells and a few eosinophils and polymorphs.The liver was small, weighing 1100 gm. The external surface was grossly mottled reddish-yellow. On section, the parenchyma was soft and flabby and diffusely mottled with large areas of yellow and smaller areas of red (acute "yellow atrophy").
Chronic hepatitisGI-LiverH & EThis male patient had a severe attack of jaundice, due to infectious hepatitis. The jaundice continued waning and waxing; the liver was enlarged and palpable. He continued to have episodes of anorexia, with some vomiting. A liver needle biopsy showed a continuing hepatitis. He pursued a gradually downhill course and died 120 days after the onset of his acute illness.The liver architecture is markedly disturbed. There are large areas, from which liver parenchymal cells have disappeared. Here, bile duct proliferation can be seen, with some fibrosis and a sprinkling of chronic inflammatory cells. These zones inter-link surrounding nubbins of irregular liver tissue, the cells of which are still viable, though the normal columnar architecture of the lobules is missing. Small islands of viable liver tissue can be seen in some of the fibrous bands. These are the features of a chronic hepatitis (a further extension of this process would lead to postnecrotic cirrhosis. Here, regeneration of liver cells would occur and the intersecting fibrous tissue scars would be more prominent).The liver was firm, slightly enlarged and very slightly granular on its surface. On cut section, it had a mottled, yellow-red appearance, without the characteristic distribution of a so-called "nutmeg" liver.
Coagulation Necrosis of the LiverGI-LiverH & EFemale executive, age 32. Cleaning clothes with carbon tetrachloride, inadvertently drank the CCl, which was in a tumbler. Three hours later, was hospitalized with headache, nausea, vomiting, diarrhea, drowsiness. Forty-eight hours later, severe vomiting, jaundice, ecchymosis, hematuria, oliguria, coma, convulsions and death.There are areas of hepatic necrosis, involving almost every lobule and situated, for the most part, in the cintrilobular zone. There are many confluent areas of necrosis and here it is difficult to define the zone affected. There is an infiltration of inflammatory cells, mainly neutrophils, into the necrotic areas. The nuclei of many necrotic cells can be indentified, although many are undergoing pyknosis or karyorrhexis.The liver was small, weighing 1000 gm. And the capsule was wrinkled. The external and cut surfaces were a diffusely mottled yellow-red. The consistency was soft and flabby.
Fatty Degeneration of the LiverGI-LiverH & EThis patient was a chronic alcoholic, with and enlarged liver.At autopsy, the liver was large, the surface pale, yellow and smooth. On section, the parenchyma was greasy and yellowish.In routine preparation of paraffin-embedded slides, the fat is dissolved out by the fat solvents used, hence, in H. & E. sections, accumulations of fat appear as clear spaces.
Laennec's CirrhosisGI-LiverH & EMale, age 50. Chronic alcoholic, with little respect for an adequate dietary intake. Previous admission with anorexia, edema, ascites. Treated with adequate diet and vitamin therapy. Returned to hospital moribund, edema, ascites, jaundice, coma - death.There is marked, fatty degeneration of the liver, almost all the cells being represented by large globules of fat. In many areas, the liver cells have collapsed and the condensed reticulin can be seen as thin strands, uniting portal tracts to portal tracts, and others to central vein areas, thus dissecting the liver. This is a very early stage in the development of a portal cirrhosis. Eventually, the areas of condensed reticulin will form collagen bands, as seen in Slide #106.The liver was large and pale yellow, weighing 1800 gm. The surface showed a fine granularity. On section, there was a greasy, pale yellow, soft surface.
Laennec's CirrhosisGI-LiverMallory's TrichromeHere, the connective tissue stains blue. One can readily see a more advanced phase of Laennec's Cirrhosis, with dense, fibrous bands intersecting the liver tissue. The liver lobules and nodules show extensive fatty change. Most of these nodules are regenerated liver tissue, which have undergone a secondary fatty change.
Postnecrotic CirrhosisGI-LiverH & EMale, age 39. Following an accident, he had a blood transfusion. Three months later, low grade fever, pain in the right upper quadrant, slight icterus. Hospitalized one week; then discharged to work. One year later, he again had R.U.Q. pain, anorexia, mild icterus. Liver palpable 6 cm. Below costal margin, tender. Biopsy revealed cirrhosis. Carried on with work. Two years later, entered hospital with edema, jaundice, marked ascites and anorexia. Liver palpable 8 cm. Below costal margin, spleen palpable. A/G - 2.6/3.5; bilirubin -8 mg/100ml; alkaline phosphatase elevated. Three weeks later - died suddenly from ruptured esophageal varices.The liver parenchyma is intersected with broad bands of cellular fibrous tissue, with several wide scars present. The nodules of liver parenchyma are large, some are compsed of regenerated liver cells; others of masses of liver tissue, containing one to several lobules. Most of the nodules, however, have haphazardly arraned liver cell cords without any lobular architecture. In the fibrous tissue, excessive bile ducts can be seen, together with chronic inflammatory cells.The liver weighed 1040 gm. It was coarsely nodular. The left lobe of liver was atrophic. The right lobe was markedly distorted by broad bands of fibrosis, separating large areas of nodular liver parenchyma.
Postnecrotic CirrhosisGI-LiverMallory's TrichromeThis slide is from the previous case (#107). It has been stained by the Mallory method to demonstrate the marked fibrosis. The fibrous tissue is stained blue.
Obstructive Biliary CirrhosisGI-LiverH & EFemale, age 40. Previous cholecystectomy for chronic cholecystitis and cholelithiasis. Repeated bouts of obstructive jaundice for three years. Stones removed from common duct. Developed a stricture, with recurring episodes of jaundice, which, over the past year, has been persistent and increasing. Dark urine, light stools. Died five years after initial trouble.The liver was large, weighing 1800 gm., bile-stained, firm and granular. The common bile ducts and hepatic ducts were dilated and filled with bile. There was a stricture of the common bile duct 2 cm. From the ampulla of Vater.There is marked fibrosis in the portal tract areas, with proliferation of bile ductules and mild chronic inflammatory cell reaction. From the fibrosed portal tract areas, strands of fibrous tissue sweep into the surrounding liver parenchyma, tending to surround lobules, one portal tract being joined to neighbouring ones by the fibrous tissue bands. Some of the large bile ducts are plugged with bile and some bile lakes, with destruction of liver cells, can be seen. There is central necrosis in many of the liver lobules and here, bile staining is prominent. Dilated cnanliculi, containing inspissated bile, can also be identified.
Hemochromatosis of the LiverGI-LiverPrussian BlueMale, age 50. Bronzing of skin. Epigastric pain, ascites, enlarged liver and spleen. Hyperglycemia and glycosuria.Hemosiderin is stained bright blue. The pigment is found in hepatic cells, Kupffer cells and macrophages. There is a well-defined, portal cirrhosis.The liver large, tan, firm and slightly granular, the cut surface was "rusty" and the lobules prominent. The gross Prussian blue reaction was positive.
Chronic Venous Congestion of the LiverGI-LiverH & EFemale, age 55. Rheumatick heart disease at age 10, residual mitral stenosis. Episodes of congestive heart failure, increasing dyspnea, with occasional hemoptysis. Mitral diastolic murmur, rales in chest, enlarged liver, edema of legs to sacrum.The central veins and neighbouring sinusoids are dilated and deeply congested, with blood forming reddish foci, scattered throughout the liver section. (The blackish pigment in some of these zones is artefact, caused by a deposit in formalin fixation). In many of the congested central congestion and associated anoxia, when prolonged, can lead to marked centrilobular necrosis. In some cases, there is extensive fatty change of the viable tissue remaining about the portal tract areas, hence the red and yellow, mottled, gross appearance.The liver was enlarged and tense on section. The lobular architecture was accentuated by central reddish areas, alternating with slight yellowish zones, the so-called "nutmeg liver" of chronic venous congestion, caused by chronic right heart failure.
Amyloidosis of liverGI-LiverH & EMale, age 40. Long standing case of tuberculosis. Emaciated. Enlarged firm spleen and liver. Urine - 4+ protein.At autopsy, the liver was of normal contour, but enlarged, with firm sharp edges. On section, there was a very firm, waxy surface.The cords of liver cells are atrophic and distorted due to compression by acellular, eosinophilic amyloid material, lying between them. In some areas, the liver cells have completely disappeared and here, masses of amyloid may be seen.
Cavernous HemangiomaGI-LiverH & EAn incidental finding in liver at routine autopsy.There is a well demarcated tumor, composed of large endothelial-lined, vascular channels, filled with blood. The endothelial cells are normal and regular.The liver was normal, except for a well-circumscribed, deep red, spongy nodule, measuring 1.5 cm. In diameter.
HepatomaGI-LiverH & EChinese male, age 60. Anorexia, indigestion, weight loss and weakness. Developed pain in right upper quadrant, nausea, vomiting, dyspnea and fever. On examination, liver enlarged and nodular, spleen palpable, massive ascites. Spider nevi on skin. Rapidly deteriorated and died.At autopsy, the liver was firm and large, weighing 3000 gm. The surface was nodular, composed of small and larger yellowish nodules. On section, the surface was tawny and finely nodular, due to cirrhosis, and, as well, there were larger and smaller nodules of greyish-yellow and greyish-pink, friable, tumor tissue distributed throughout the organ.There is a well-defined, active, portal cirrhosis. Areas of liver cell degeneration and necrosis can be seen and there may be plugging of small bile canaliculi and bile staining of liver cells in some sections. The hepatoma is composed of circumscribed nodules of tumor. The cells resemble atypical liver cells, characterized by indistinctly outlined, bluish-pink cytoplasm and hyperchromatic nuclei, with prominent nucleoli. The cells are arranged in clumps and cords.
Choangiocarcinoma of the LiverGI-LiverH & EThis patient had chronic jaundice, which was first thought to have been due to a carcinoma of the head of the pancreaas. At laparotomy, however, the pancreas was normal and a firm mass could be felt, involving the liver, in the region of the porta hepatis. A biopsy of the latter revealed a primary carcinoma of the liver of the cholangioma type. The jaundice continued to deepen and he eventually died of bronchopneumonia.At autopsy, the liver was enlarged, olive-green in color, a large grey, firm tumor mass, measuring 6 cm. x 7 c. extended into the liver in the region of the porta hepatis and involved the intrahepatic bile ducts. Beyond the tumor mass, the intrahepatic bile ducts were dilated and filled with bile. There was some nodularity of the liver tissue.In some slides, the tumor mass is largely necrotic. Where it is viable, one can recognize an adenocarcinoma, the small acini resembling bile ducts. This is the appearance of a primary bile duct carcinoma, or so-called cholangioma. The neighboring liver tissue shows some of the features of an obstructive biliary cirrhosis.
Metastasis in Liver from Adenocarcinoma of the StomachGI-LiverH & EMale, age 60. Anorexia, nausea and vomiting. Weight loss, anemia, occult blood in stool. Filling defect in pyloric region of stomach by x-ray. Liver nodular.The metastases in the liver are quite obvious. In some areas, the tumor is poorly differentiated and it would be difficult, on histological grounds alone, to be sure of its primary source. For the most part, the tumor is made up of cords of neoplastic cells, with scattered, poorly formed acini. In conjunction with the known presence of a primary carcinoma of the stomach, one can accept these nodules as being netastatic from that source.There was a primary carcinoma of the stomach. The liver was enlarged and studded with many distinct tumor nodules.
Chronic CholecystitisGI-Gall BladderH & EFemale, age 50. Four children. Recurrent biliary colic and right upper quadrant pain. Intolerance to fatty food, belching. X-ray showed gall stones and non-functioning gall bladder. At surgery, the gall bladder was enlarged, the serosa thickened. The wall measured up to 0.8 cm. In thickness and was firm and sclerotic. The mucosa was trabeculated and the lumen contained numerous mixed stones, one of which was impacted in the cystic duct. The bile was dark and viscid.The wall is markedly thickened by fibrosis. There is both a focal and a diffuse chronic inflammatory cell infiltrate throughout all coats. The hemorrhage on the serosa and congestion of blood vessels are due to operative trauma.
Carcinoma of the Gall BladderGI-Gall BladderH & EFemale, age 60. Dyspepsia with fatty foods for years. Two or three attacks of acute cholecystitis during the past twenty years. Noted anorexia, weight loss, and developed a boring, persistent pain in right upper quadrant. Jaundice developed. X-ray showed gall stones present.The wall of the gall bladder is markedly thickened by fibrosis. The lining, in some areas, consists of normal-appearing columnar epithelium. However, in most areas, the lining has been either lost by erosion and ulceration, or is composed of atypical polyhedral, or columnar, malignant epithelial cells, with dark pleomorphic nuclei. In some areas, the cells are diffusely arranged, in others, there are attempts at acinar formation, and in others, well-formed acini can be identified. Tumor can be seen deep in the wall and, in some slides, extending to the serosal aspect.At operation, the gall bladder was firm, fibrotic and contracted. The wall was markedly thickened and, in the region of the neck, was very firm. The mucosa here was ulcerated and friable, greyish-white tumor tissue infiltrated the wall and into the liver bed. The serosal aspect of the gall bladder showed a roughened, shaggy appearance. Enlarged lymph nodes were pressing on the common duct. These nodes were infiltrated with greyish tumor.
Acute Pancreatic NecrosisPancreaseH & EMale, age 40. Sudden severe upper abdominal agonizing pain. Later pain was referred to back, chest and lower abdomen. Restless, pale, perspiring. Blood pressure 90/60. Nausea and vomiting. W.B.C. 10,000. Hematocrit 60%. Serum amylase and lipase elevated. Patient developed paralytic ileus and died sixty hours later. Serum calcium had dropped to 8 mg/100 ml.At autopsy, the peritoneum was studded with yellowish opaque plaques of fat necrosis. The pancreas was swollen and tense and, on section, there was firm, hemorrhagic, swollen surface, with many greyish, soft areas of necrosis.Often very little normal pancreas is seen. Most show degenerative changes and there are many areas of necrosis. In the areas of necrosis, and in the areolar tissue surrounding the pancreas, there is usually a heavy, acute, inflammatory cell response. In some areas, fat necrosis is present. Some vessels may show eosinophilic necrosis of their walls.
Fibrocystic Disease of the PancreasPancreaseH & EThis 10 year old boy had failed to thrive normally as an infant and developed frequent respiratory tract infections, with bouts of pneumonia. A diagnosis of congenital fibrocystic disease of the pancreas was made and he was then treated with pancreatic granules and antibiotics. However, he eventually succumbed to a Staphylococcal pneumonia.Smaller interlobular and intralobular ductules and gland acini are typically dilated and contain plugs of thick, strongly eosinophilic secretion. There is an increased interstitial fibrosis, separating the gland acini. The islets of Langerhans are normal.The pancreas was slightly smaller and firmer than normal. Very careful examination revealed small cystic spaces, just descernible to the naked eye. The lungs showed a severe, suppurative bronchopneumonia, with thick mucopurulent exudate in the bronchi.
Hyalinization of the Islets of LangerhansPancreaseH & EMale, age 28. Diabetes mellitus since age 10. Treated by diet and insulin. Difficult to control and had innumerable bouts of diabetic coma and hypoglycemia. Developed hypertension and diabetic retinitis at 20 years of age. Later, peripheral neuritis. During the past year, massive albuminuria, edema and died of uremia. Blood pressure 210/120.The glandular parenchyma is relatively normal, but Islets of Langerhans have undergone varying degrees of hyalinization. Well marked hyaline arteriolosclerosis of arterioles is frequently noted.The pancreas was of normal size and consistency, with normal lobulations. The kidneys were enlarged and pale. On section, there was a pale cut surface and poor corticomedullary differentiation.
Carcinomoa of the PancreasPancreaseH & EMale, age 50. Anorexia, weight loss, constipation for six months. Gradually developing persistent, increasing jaundice. Boring pain in mid-back, aggravated by supine position. Intense pruritis, alcoholic stools, dark urine. Serum bilirubin 30 mg/100 ml. Alkaline phosphatase 35 K.A. units. Empirical liver function tests normal. Albumin/globulin ratio 2/1. Rapidly deteriorated and died.At autopsy, the body was a deep greenish-brown hue. The head of the pancreas was stony hard and enlarged. On section, there was a greyish firm tumor mass, involving the head, which had compressed the common bile duct and completely occluded it. The proximal bile ducts were dilated, as was the gall bladder.Adencarcinoma of the pancreas is most frequently scirrhous, but may be more cellular. The cells may be cuboidal to columnar in type, with pleomorphic dark nuclei. Invasion of the bile duct may be extensive. There are usually areas of necrosis and hemorrhage in the tumor.
Infarct, recentNervous SystemH & EAn 84 year old man died of arteriosclerotic heart disease. His right leg had to be amputated for thrombosis of arteries. He became confused before death.There are well-demarcated foci of ischemic necrosis. At the edges, macrophages are beginning to accumulate and there is some vascular proliferation.The cerebral arteries were severely sclerotic. The left occipital lobe and left cerebellar hemispheres contained wedge-shaped well-demarcated yellow areas, measuring about 2.5 cm. in diameter.
Infarct, OldNervous SystemH & EThis 75 year old man died of a brain contusion after a fall at home. He had a history of right hemiplegia for three years.The cystic area in the region of one pyramidal tract can be seen with the naked eye. Under the microscope, it is seen to contain many macrophages.The pons contained a cystic lesion in the left pyramidal tract, about 1/2 cm. In diameter. The pyramid in the medulla was grey and shrunken (see #132).
AnoxiaNervous SystemH & EThis 65 year old woman had left scleral buckle procedure for a detached retina. She developed bronchospasm and a cardiac arrest. A tube passed at first into the esophagus instead of the trachea. She was anoxic for 2 1/2 minutes and remained unconscious until her death of bronchopneumonia five weeks later.A linear infarct involves the entire cerebral cortex. The middle layer is collapsed and filled with macrophages. The deep and superficial layers of cortex contains many gemistocytic astrocytes with a plump pink cell body.The cerebral and cerebellar cortex was very thin and yellowish. The central muclei were shrunken.
Acute MeningitisNervous SystemH & EThis 50 year old alcoholic woman was found unconscious on the floor of her room in a boarding house. Her temperature was 40, her pulse 140. She was in a position of decerebrate rigidity, with slight opisthotonus and fixed dilated pupils. Lumbar puncture yielded cloudy fluid, with 400 mg% of protein, 420 R.B.C., and 20 polymorphs per and gram-positive diplococci on smear. She died the next day.The subarachnoid space is filled with an exudate of polymorphonuclear leukocytes. The vessels are engorged. The underlying brain is normal.The lungs were consolidated by a lobar pneumonia, the liver was fatty. The brain was covered by a purulent exudate in the subarachnoid space.
Chronic Brain AbcessNervous SystemMasson's TrichromeThis 45 year old man ruptured a berry aneurysm 9 years previously, which was clipped and coated with plastic. The patient lived hemiplegic in a nursing home and had repeated infections in the area, which culminated in multiple, contiguous abscesses of the brain. One of these was removed, but he succumbed to the remaining ones.The section is stained with Masson's trichrome, which stains collagen green. This shows well the dense fibrous wall of the abscess. On the inside is a layer of chronic inflammatory cells, including macrophages and, in the centre, fluid, debris and polymorphs. Bacteria are present, but difficult to see.
Tuberculosis MeningitisNervous SystemH & EA 4 1/2 year old native Indian child developed fever and anorexia, followed by a stiff neck. CSF: 40 lymphocytes, protein 70. She was, at first, treated with ampicillin, but became comatose 10 days later. Antituberculous treatment and a shunt for hydrocephalus were of no avail and she died 3 months after onset. Tubercle bacilli were grown from the C.S.F.This shows the cauda equina, with cross sections of the nerve roots. The subarachnoid space is solid, with an exudate composed of chronic inflammatory cells and pale epithelioid cells. Foci of caseation necrosis are present. There are no giant cells. The inflammation has spread through the dura to the extradural space, where occasional giant cells are seen.A tremendously thick exudate covered the base of the brain and the spinal cord, making access of antibiotics to the bacteria impossible. The hilar lymph nodes were tuberculous.
Tabes DorsalisNervous SystemLuxol Fast Blue H&EThis 66 year old man contracted syphilis 40 years before and, about 15 years later, was found to be confused, with an unsteady widespread gait, a positive Romberg's test, loss of sense of position, and pupils that reacted to accommodation, but not to light. He drank heavily and was terminally admitted for hematemesis, but actually died of heart failure, due to a syphilitic aortitis and widening of the aortic valve ring.Cervical spinal cord, luxol fast - H. & E. stain. The dorsal columns are flat and demyelinated. Compare with #142 and #144.The frontal convolutions of the cerebral hemispheres were atrophic. In the spinal cord, the dorsal columns were flat and grey.
Herpes Simplex EncephalitisNervous SystemH & EA 73 year old woman was admitted to hospital after two grand mal seizures. She had no neurological findings, but had fever of 39 C. Two days later, she became drowsy, then lapsed into coma and died one week after onset of her illness.The slide shows necrotic, hemorrhagic brain tissue, with many macrophages, closely resembling an infarct. There is, however, also lymphocytic cuffing around blood vessels, with some extension into adjacent tissue, also some polymorphonuclear leucocytes, indicating an inflammatory element. There are intranuclear eosinophilic viral inclusions, particularly in oligodendroglia, in adjacent, apparently uninvolved, brain tissue. Watch for nuclei with condensed chromatin at the margin and a pink droplet in the centre. They are not numeroous and difficult to recongnize, don't worry if you don't find them. The pale blue round structures are not viral inclusions, but corpora amylacea, hyaline deposits in the processes of aging astrocytes.A hemorrhagic, softened area ran along the undersurface of the right temporal lobe. Microscopically, much wider involvement of the brain, with inflammation and inclusion bodies, was found.
Amyotrophic Lateral SclerosisNervous SystemLuxol Fast Blue H&EA year before death, this 66 year old painter complained of weakness of his right arm and hand. Examination showed weakness and wasting with fasciculations, but no sensory loss of the right upper extremity and hyperreflexia of the right leg with a Babinski response. He deteriorated rapidly and, on his terminal admission 2 1/2 months before death, he had weakness and wasting in all extremities, bilateral dorsiflexor plantar reflexes, dysphagia, dysarthria and a hyperactive jaw jerk. He died with bronchopneumonia.Microscopically, widespread loss of neurons was present in ventral horns, 12th nerve nucleus and nucleus ambiguus, and degeneration of the corticospinal tracts as high as the pons. This slide of cervical spinal cord is stained with luxol fast H. & E. There is distinct pallor in the crossed pyramidal tracts in the lateral columns and one direct tract in the anterior column. The majority of the ventral horn cells have disappeared.The brain and spinal cord were unremarkable grossly.
Alzheimer'sNervous SystemBielschowskiA 53 year old woman, over the course of 2 years, became forgetful, disoriented and finally demented. She vegetated for another 2 years.This section of frontal lobe has been impregnated with silver. The senile plaques are round, cloud-like structures, often with amorphous centre of amyloid and a ring of nerve proscesses. Many nerve cells are filled with dense bundles of argyrophilic fibres, the neurofibrillary tangles.There was severe atrophy of the brain, which weighed only 1050 grams (normal 1200-1300 grams).
Subacute Combined Degeration of the Spinal CordNervous SystemLuxol Dast Blue Cresyl VioletThis man was diagnosed, at the age of 58, as suffering from pernicious anemia. He responded well to liver extract, but then for some years preferred no treatment to the suggested therapy of eating hog's stomach. Ten years later, he had not only pernicious anemia, but also lightning pains, diarrhoea, loss of knee and ankle jerks and gross ataxia, with loss of position and vibration sense. He died at the age of 81 years of pneumonia, after a fracture of the hip.The stain is luxol fast blue - cresyl violet. The posterior and lateral columns are degenerated, therefore are demyelinated and pale.The spinal cord was small and grey.
SyringiomyeliaNervous SystemH & EAt 17 years of age, this woman developed pins and needles and weakness of all her extremities. Over the next years, her right arm and leg became completely paralyzed, her left side was weak. Sensation to pain, touch and position and vibration sense were diminished on the left. Despite her disabilities, she got married and carried a pregnancy to term, but had to use crutches and, eventually, a wheelchair. She died of organizing pneumonia at the age of 43 years.This is a section of cervical spinal cord. It contains a large, flat cleft, partly lined by ependyma, which extends across the cord and backwards into the dorsal horns.The spinal cord showed a large transverse central cavity, running through the spinal cord to the L2 level. Slits ran from the floor of the 4th ventricle into the medulla, indicating syringobulbia.
AstrocytomaNervous SystemH & EA 9 year old girl developed, over a period of a few weeks, nausea, vomiting, headaches, vertigo and blurring of vision. She had papilloedema, hypotonia and slight incoordination of the right extremities. A brain scan showed a lesion in the posterior fossa and ventriculogram showed forward displacement and obstruction of the aqueduct.This shows the mural nodule. It is fibrillar, vascular, microcystic tumor, composed of well-differentiated astrocytes, often bipolar (spindled).At craniotomy, a cyst containing 30 cc. of straw-colored fluid was found in the midline and right side of the cerebellum. The cyst contained a 3 cm. Gelatinous, grey, mural nodule. The cyst and nodule were removed. The patient was discharged asymptomatic.
Gioblastoma MultiformeNervous SystemH & EThis 75 year old woman was admitted to hopital with a sudden onset of dysphasia, two months previously, which gradually deepened to complete aphasia. She also developed weakness of the right arm and became confused. Twitching of the face occurred and gradually she lapsed into coma and died, about four months after onset of her symptoms.This is a cellular tumor. Some of the cells are spindled, others are recognizable as gemistocytic astrocytes. The tumor is extremely vascular. Areas of necrosis, often with palisading of the cells around them, are prominent.The left cerebral hemisphere was severely swollen and contained a 5 cm. Variegated tumor, surrounded by edema.
OligodendrogliomaNervous SystemH & EThis 46 year old man had a 12 year history of focal, at first, then generalized seizures, only poorly controlled by anticonvulsants. During the last three months, he developed memory loss, personality disorders, nominal aphasia, partial acalculia and right-sided, hyperactive reflexes. X-ray demonstrated a shift of the pineal to the right and flecks of calcium in the left hemisphere. A craniotomy was done and large quantities of tumor were removed. He died 12 hours later.This shows a poorly demarcated tumor, made up of small uniform cells with round nuclei, surrounded by a clear "halo". There are many thin-walled vessels. A portion of fairly acellular tumor is heavily calcified.The brain was swollen, particularly the left hemisphere, with uncal and subfalcine herniation. A hematoma occupied the operative site. Pressure hemorrhages were present in the brain stem. The lungs showed hemorrhagic pulmonary edema.
EpendymomaNervous SystemH & EA 38 year old woman, with a one year history of headaches, periodic blackouts, dizziness, gradual deterioration of vision, nausea and vomiting. Recently, irritable and unsteady on her feet, papilloedema, rotating nystagmus. Ventriculograms showed a calcified 4th ventricle tumor.This is a lobulated, fibrillar, partly calcified tumor. Ependymal cells, round and regular, lie in small groups in the stoma.A huge, firm, grey tumor was removed from the 4th ventricle. There was only a tiny area of attachment to the floor. The patient was discharged improved.
MedulloblastomaNervous SystemH & EAn 8 year old girl developed occipital headaches, following a fall on the back of her head, unsteady gait, vomiting and head tilting. The right limbs were hypotonic and incoordinated. A brain scan indicated a lesion in the right posterior fossa.This is a very cellular tumor, composed of sheets of fairly uniform cells, with hyperchromatic nuclei and poorly defined cytoplasm and a moderate amount of mitoses.A 3 cm. firm tumor was shelled out from the right cerebellar hemisphere. X-ray therapy was given, resulting in loss of hair. Symptoms had disappeared and the child was back at school.
MeningiomaNervous SystemH & EOne year previously, this 60 year old woman developed pain in the legs and prickling in the toes. She had two lumbar laminectomies and disc removals, but failed to improve; developed difficulty in micturition and was unable to walk because of the pain. Her back movement was limited, the legs were weak, the leg reflexes hyperactive, and there was loss of sensation to pinprick to T10 level. A myelogram demonstrated a complete block at T3.The tumor cells are uniform and are arranged in groups, or whorls. Occasional calcified psammoma bodies are present. The tumor mimics arachnoid granulations.A 1 1/2 cm. firm, white tumor, with flecks of calcification, attached to the dura, was removed from the subdural space. Following this, the bladder symptoms resolved and leg pain slowly improved.
SchwannomaNervous SystemH & EA 35 year old woman, with a 2 1/2 year old history of progressive hearing loss in the right ear, later tinnitus, then numbness in the right cheek and staggering to the right; finally headaches. A posterior fossa myelogram demonstrated a lesion in the region of the right acoustic meatus and cerebellopontine angle; vestibular tests showed a dead labyrinth. Skull x-rays were normal. Cerebrospinal fluid protein was elevated to 126 mg/100 ml.The tumor cells are spindled Schwann cells, with ill-defined cytoplasm. They are arranged in streaming bands. The nuclei are sometimes palisaded in rows.An encapsulated tumor, about 3 cm. in diameter, overlaying the internal auditory and jugular foramina, obliterating the 7th and 8th nerves and stretching against the 5th nerve, was resected piecemeal. The tumor was firm and yellowish. Postoperatively, the patient had a 7th nerve paralysis, which was later repaired by spinal accessory to 7th nerve anastomosis.
Cerebral MetastisisNervous SystemH & EThis 69 year old man presented with a 6 month history of headaches, poor vision and a tendency to veer to the left. He had a dense, left, homonymous hemianopia. Chest x-rays demonstrated a lesion in the left upper lobe and scans showed multiple lesions in the brain and liver. His brain was irradiated, but he quickly dteriorated and died.A largely necrotic adenocarcinoma extends into the subarachnoid space.A bronchogenic adenocarcinoma of the left upper lobe had widely metastasized. The brain was markedly swollen and contained several well-defined, firm, white metastases, about 3 cm. in diameter. The lesion responsible for the initial symptoms was a metastasis in the right parieto-occipital region.
Normal BreastBreastH & EMost of this slide consists of normal breast tissue. However, in one focus, the acinar units of a breast lobule are replaced by apocrine epithelium. In some of the acini, the apocrine epithelium is papillary. Several of the involved acini are cystic. Nearby are several small ducts which contain foamy histiocytes in their lumen and are surrounded by lymphocytes (periductal mastitis).
Lactating BreastBreastH & ENote that, in contrast to the normal breast tissue (slide #156), the lobules in this case of lactating breast are expanded with an increased number of acinar units. The lumina of the acini contain secretion and the cells lining the acini are vacuolated. The ducts are somewhat dilated and filled with secretion.
Cystic lobular hyperplasiaH & E
FibroadenomaBreastH & EThe tumor is composed of ducts, which are lined with hyperplastic, but regular, benign epithelium. The ducts, for the most part, are rather large and dilated. They are supported by a fine cellular connective tissue stroma, which, in some areas, resemble myxomatous tissue.
Intraductal PapillomaBreastH & EThis 47 year old woman noted bleeding from her nipple for 6 months. On examination, a blood drop could be expressed from the nipple, the breast was ropy in consistency, but no definite nodule was palpated. Surgery was done and a lobule removed.The section shows part of a cystically dilated duct, filled with a papillary structure, which can be seen to arise from the wall of the duct. The papillary fronds are composed of a fibrous tissue core, which, in some areas, is hyalinized. The surmounting epithelium is benign, retains its polarity, but, in some areas, shows hyperplasia. In other areas, the epithelium is atrophic and flattened.Underlying the areola, there were dilated ducts in one lobule and a firm granular, raspberry-like nodule, filled a cystically dilated large duct, filled with serosanguinous fluid.
Intraductal and Invasive Ductal CarcinomaBreastH & EThis slide is an example of invasive ductal carcinoma and ductal carcinoma in situ (intraduct carcinoma). Most of the large ducts in the specimen are filled with malignant cells, growing in solid and cribriform patterns. There is focal necrosis within some of the ducts, which is an important sign of malignancy. The invasive ductal carcinoma takes the form of small nests, gland-like structures and cords of cells infiltrating the stroma in an irregular fashion and inciting a fibroblastic scirrhous response.
Lobular Carcinoma in situ and Invasive Lobular CarcinomaBreastH & EThis slide shows small foci of lobular carcinoma in situ and extensive areas of invasive lobular carcinoma. The lobular carcinoma in situ can be seen to involve a number of lobules and small ducts, which are filled with, and distended by, a relatively uniform population of small malignant cells. The invasive component infiltrates the breast stroma widely and is composed of tumor cells similar to those seen in the in situ component growing predominantly in an Indian file pattern. In some cases, the invasive tumor cells encircle normal ductules, producing the so-called "targetoid" pattern. The tumor also has a fibroblastic stroma similar to that seen in the invasive ductal carcinoma (Slide #161).
Paget's Disease of the NippleBreastH & EThis 65 year old woman had a weeping, crusting, eczematoid lesion on the right nipple, which gradually increased in area to involve the areola. On examination, there was a reddish, granular, moist area, measuring 3 cm. in diameter and oozing serous fluid. Biopsy diagnosis was made and a radical masectomy was performed. A small duct carcinoma 1.5 cm. in diameter was found in the breast tissue.The section is from the areola and nipple. The epithelium is irregular in depth and scattered in it one can see many large, pale, sometimes vacuolated "Paget cells", which have large nuclei and prominent nucleoli. In many instances, there is a clear halo surrounding these cells. The ducts are enlarged and dilated and lined by regular epithelium and some contain secretion. Papillary folds are sometimes seen in the ducts. The duct carcinoma is not seen in this section.
Invasive Squamous Carcinoma of the VulvaFemale ReproductionH & EThis slide shows a typical invasive squamous cell carcinoma of the vulva. At the edge of the tumor, the surface epidermis is mildly dysplastic. The invasive tumor is a wall differentiated, keratinizing, squamous cell carcinoma, which invades deeply into the underlying subcutaneous tissue.
Proliferative EndometriumFemale ReproductionH & E
Secretory EndometriumFemale ReproductionH & E
Endometrial Hyperplasia, curettageFemale ReproductionH & EThis is a curettage specimen in a postmenopausal woman, who complained of vaginal bleeding. There are multiple fragments of endometrium, admixed with blood. The endometrial fragments contain an increased number of glands which are crowded together and show variability in size and shape. The cells lining the hyperplastic glands, however, are not atypical. This would therefore be an example of simple hyperplasia.
Endometrial PolypFemale ReproductionH & EThis is a section of endometrium and underlying myometrium. Most of the endometrium is atrophic and composed of cystic glands. There is a polypoid mass arising from the endometrium, which consists of atrophic cystic glands embedded in a dense connective tissue stroma with the typical appearance of a benign endometrial polyp. At the base of the polyp appears to be some smooth muscle within its stroma which is a somewhat unusual finding.
Endometrial CarcinomaFemale ReproductionH & EThis section of uterus shows a poorly differentiated, endometrial adenocarcinoma, which is invading the myometrium. The surface of the tumor is very necrotic. Within the tumor, the cells grow predominantly in solid sheets, although focally there is some gland formation by the tumor cells, indicating a poorly differentiated adenocarcinoma. In some sections, the tumor cells invade myometrial vascular spaces and lymphatics.
Invasive Squamous Carcinoma of the CervixFemale ReproductionH & EThis slide shows a nodule of invasive squamous cell carcinoma, which, on one side, is bordered by benign endocervical columnar epithelium and, on the other side, by normal ectocervical squamous epithelium. The tumor invades approximately 5 mm. into the cervical stroma and is associated with non-keratinizing type. Focally, the overlying epithelium shows grade III CIN, or squamous cell carcinoma in situ.
Leimyoma of the UterusFemale ReproductionH & EThis is a section of outer myometrium with some serosal surface. There is some normal myometrium present, but most of the slide consists of a fairly well circumscribed proliferation of benign smooth muscle cells growing in intersecting fascicles. The leiomyoma is somewhat more cellular than the surrounding myometrium.
Leiomyocarcoma of the UterusFemale ReproductionH & EThis very cellular tumor is composed of interlacing bundles of plump, spindle-shaped cells of smooth muscle origin. The nuclei are irregular in size and shape, many are pyknotic. Tumor giant cells are present. Some areas of tumor necrosis may be seen.
Hydatidiform MoleFemale ReproductionH & EThis 35 year old woman gave a history of amenorrhea for three months. On examination, the uterus was enlarged almost to the umbilicus and suggested a 6 months pregnancy, but no fetal movements could be felt. There was a brownish discharge containing small pieces of tissue, or blood clot, expelled on several occasions. The pregnancy test was positive. X-ray showed no fetal parts. Finally, the patient had lower abdominal crampy pain and passed a multicystic mass, which was composed of stringy tissue, in which there were innumerable smaller and larger, thin, cystic structures.Compare this tissue with the villi in #178. In this tissue, many of the villi are large and cystic, with central cysternae, and the connective tissue of the villus stroma condensed to the margins. Few fetal vessels remain. The covering trophoblast is often hyperplastic, and lacunae are sometimes seen in the clumps of proliferating syncytiotrophoblast. Occasional islands of trophoblast alone are seen, but it is probable that they are arising from villi not in the plane of section. It is the combination of cystic dilatation of the villi with trophoblast proliferation that makes this lesion a hydatidiform mole. This lesion represents the pattern of a complete mole, that pattern which is cytogenetically androgenic, i.e. all the chromosomes are paternal in origin. The swelling of the villi occurs because the embryo dies very early and there is no fetal circulation to carry away the fluid that is transported into the villi by the trophoblast, which continues to function after embryonic death.
Carcinoma of the UterusFemale ReproductionH & EThis 30 year old woman, para III, had an abortion of a three months pregnancy. Intermittent uterine bleeding continued for one month. On examination, the uterus was enlarged, soft and boggy. The Pregnancy Test remained strongly positive. Curettings were done, followed by a hysterectomy.The myometrium is invaded by sheets of anaplastic trophoblast. Both cytotrophoblast and syncytiotrophoblast are seen, but cytotrophoblast predominates. The cells are large, with enlarged and often bizarre nuclei..No villi are formed by the malignant trophoblast, and important diagnostic point. These tumors are often necrotic and hemorrhagic, as seen in this slide, with some reactive inflammation.The uterus was moderately enlarged. In the fundus was a shaggy friable hemorrhage area, involving the endometrium and extending deeply into the myometrium.
Acute and Chronic SalpingitisFemale ReproductionH & EThe section of the fallopian tube shows almost complete destruction of the mucosa, only a few gland spaces being visible. The entire tube is heavily infiltrated with an acute and chronic inflammatory cell reaction with edema.
Ectopic (Oviductal) PregnancyFemale ReproductionH & EThe sections are from the fallopian tube, although it is difficult, in most areas, to recognize it. In the remaining lumen, there is a large hemorrhagic mass and, in it, one can identify occasional chorionic villi. In addition, there are proliferating trophoblastic cells, but only a very feeble decidual cell reaction can be seen. Hemorrhage extends into the wall, which, in one area, has ruptured, leading to the pelvic hemorrhage.
Follicle Cyst of OvaryFemale ReproductionH & EIdentify the various stages in follicle development and regression.
Dermoid Cyst of the OvaryFemale ReproductionH & EThe cyst lining is epidermis, with skin appendages.
Serous Tumour of Boderline MalignancyFemale ReproductionH & EThis section is from a cystic ovarian tumor which, upon opening, grossly visible papillary structures projecting into the cyst lumen were seen. The slide from the lining of the cystic tumor shows the papillary fronds, which are covered by atypical multilayered epithelial cells, some of which are ciliated. The stratification of the epithelial cells in some areas appear as cellular buds which appear to be free floating within the cyst lumen. Note there is no invasion of the underlying fibrous stroma by the neoplastic epithelial cells.
Mucious Tumour of Boderline MalignancyFemale ReproductionH & EThis tumor consisted of multiple locules filled with thick gelatinous mucous. The histologic section shows the cyst to be lined by columnar cells with abundant pale mucin-rich cytoplasm. The neoplastic mucinous cells are in multiple layers and show variable degrees of nuclear atypia. However, the stromal component of the tumor is not invaded.
Serous CystadenomaFemale ReproductionH & EThis ovarian tumor was predominantly solid and fleshy with areas of hemorrhage and necrosis. On histological examination, the tumor is a poorly differentiated adenocarcinoma with the very anaplastic tumor cells growing in solid sheets, small glands, and forming irregular papillae.
Endometriosis of the Fallopian TubeFemale ReproductionH & EThis section of fallopian tube shows, on the serosal aspect of the fallopian tube, a small focus of endometrial glands and stroma (endometriosis). Note the numerous pigment laden histiocytes within the tubal epithelium, a common finding in endometriosis.
AdenomyosisFemale ReproductionH & EThis section of uterus shows some endometrial glands and stroma extending into the myometrium, warranting a diagnosis of adenomyosis.
Normal ProstateMale ReproductionH & ENotice, in particular, the sling of collagen around and between the glands.
Squamous Metaplasia of the ProstateMale ReproductionH & EMale, age 60. Difficulty with urination, retention. Carcinoma of prostate diagnosed one year ago, treated with estrogens.This section is from an area of the prostate not involved by the carcinoma. Almost all the prostate acini are lined, in part, by stratified squamous epithelium and, in part, by prostatic epithelium.
Benign Nodular Hyperplasia of the ProstateMale ReproductionH & EMale, age 60. Dribbling, difficulty starting stream, burning. Enlarged, palpable, lobulated, rubbery prostate. Urine 1+ R.B.C.; 2+ protein. Suprapubic prostatectomy done.Careful naked eye examination shows a distinct nodule. It consists of hyperplastic acini, some of which are dilated and contain secretion. The cells and nuclei are regular. Each acinus is surrounded by a sling of collagen. The fibro-muscular stroma shows increased fibrous elements and muscle elements. There is a moderate infiltration, with chronic inflammatory cells, mainly lymphocytes.The prostate gland weighed 80 gm. The lateral lobes were enlarged and, on section, there was a lobulated, nodular, moist, greyish-ping, cut surface. Small cystic structures could be identified. The median lobe was enlarged and globular and formed a ball valve type of obstruction.
Carcinoma of the ProstateMale ReproductionH & ENotice, in particular, the sling of collagen around and between the glands.
Normal TestisMale ReproductionH & E
Atrophy of TestisMale ReproductionH & EMale, age 80. The testis was small, due to senile atrophy and, on section, the testis cut with increased resistance.Notice the numerous, atrophic tubules and marked increase in interstitial connective tissue. All tubules show marked thickening of their basement membranes and markedly decreased to absent spermatogenesis. Interstitial cells can be identified.
Testis, TeratomaMale ReproductionH & EMale, age 25. Noted gradual enlargement of right testis for 6 months. The mass became painful. He noted weight loss and anorexia. Examination revealed midline, posterior, abdominal masses. The testis was removed at operation.The sections may vary from box to box. There is a variety of mature and immature tissues. Primitive mesenchyme can be identified, cartilage, cystic spaces lined by columnar epithilium and other by flattened epithelium, or endothelium and melanin pigment.The testis was enlarged and partially replaced by a tumor, composed of cystic spaces, filled with gelatinous fluid. Interspersed between the cysts were areas of firm, translucent cartilage. The tumor had infiltrated the tunica and distorted the contour of the testis.
SeminomaMale ReproductionH & EMale, age 45. Noticed painless enlargement of left inguinal testis of 6 months' duration. Weight loss, weakness. Pain developed in low back region. Examination revealed symmetrically enlarged, firm, left testis; enlarged, palpable, periaortic lymph nodes. Metastases to lungs and vertebra by X-ray. The testis was removed and he was treated by irradiation.Sections show a monotonous, diffuse arrangement of large cells, with clear cytoplasm and very large, darkly-staining nuclei, with prominent nucleoli. The stroma consists of fine, and also broad, bands of connective tissue, in which there is a mild, diffuse infiltrate of lymphocytes.On section, the testis was largely replaced by a lobulated, discrete, greyish tumor, measuring 4 cm. in diameter. There were small areas of yellow necrosis. Tumor nodules were noted in the vas.
Focal Infarct of the Pituitary GlandEndocrineH & EThis 30 year old pregnant woman had premature separation of the placenta. She was in severe shock and was treated with supportative therapy, but died from pulmonary embolism.At autopsy, there was a small area of pale necrosis in the anterior lobe of the pituitary. No vascular occlusion could be identified.There is focal area of fairly recent ischemic coagulation necrosis in the anterior lobe of the pituitary.
Chromophobe Adema of the Pituitary GlandEndocrineH & EThis 60 year old man noticed progressive loss of vision in the left eye during the past five to ten years and transient misty vision of the right eye in recent months. For two years he noted increasingly frequent left frontal headaches. On examination, the left pupil was dilated and fixed, fundus pale and no vision. The right eye showed papilledema. There was limited upward movement of both eyes. X-ray showed erosion and enlargement of the sella turcica. At operation, a portion of the pituitary tumor was removed. The tumor was very large and there was excessive hemorrhage, hindering the complete removal of the tumor. The patient died the following day.The adenoma is composed of polygonal chromophobe cells, with round to ovoid nuclei. In some areas, the cells are diffusely arranged. In other areas, there are small cords and nests of cells, separated by sinusoids and fine connective tissue, a so-called "alveolar arrangement". Hemorrhagic extravasation is seen in some slides.The pituitary gland was smooth and ovoid and measured 7.5 x 5.5 x 3 cm. and weighed 95 gm. The tumor was soft, greyish-pink and cellular. Extensive hemorrhage had occurred into the tumor. The tumor compressed the left internal carotid artery and left optic nerve, the latter showing marked atrophy. The sella turcica was enlarged, measuring 3.5 cm. in length, 2.5 cm. in width and 3 cm. in depth. The overlaying brain showed compression.
Amyloidosis of the Adreanl GlandEndocrineH & ESee slide #112It is difficult to recognize this structure as adrenal gland. The cortex is almost completely replaced with amyloid, which is present between the cortical and adrenal cells and can be recognized as homogeneous, pink-staining material. The cortical cells are broken up into small groups, many are very atrophic. All the nuclei present belong to the cortical cells; the cytoplasm, where visible, is foamy and pale. The amyloid also extends into the medulla, but this is not involved to the same extent as the cortex.Both adrenals were slightly enlarged and firm. Cross-section showed a poor distinction between the cortex and medulla. The cut surface was homogeneous, firm and pale.
Nueroblastoma of the Adrenal GlandEndocrineH & EThis newborn baby had respiratory difficulty, was cyanotic, hypotonic and required continuous oxygen from birth. The liver was enlarged. She died 9 hours after birth.The tumor cells have round to ovoid nuclei and practically no discernible cytoplasm. They resemble large lymphocytes. The architecture is diffuse, in some areas, however, in most areas, there is a characteristic circular grouping of cells into pseudo-rosettes, the groups being separated by fine trabeculae and vascular sinusoids. In some areas, the tumor can be seen arising from medulla. The cortex is invaded by the tumor.The cause of death was atelectasis, due to subdural hematoma, which was due to a tear of the tentorium cerebelli. The left adrenal was ovoid, measuring 3.5 cm. in diameter. It was almost completely replaced by a greyish-pink, soft, circumscribed tumor, arising in the medulla. There was a rim of narrowed cortex surrounding the tumor. The right adrenal was of normal size and, on section, there were several greyish-pink nodules in the medulla. The liver was enlarged and was riddled with metastases.
Metastatic Carcinoma of the Adrenal from BronchiogenicEndocrineH & EThis 45 year old man had a cough and hemoptysis and, by X-ray, a mass in the left lung. At autopsy, there were multiple secondary nodules in many organs, including the adrenal "oat cell".There is a nodule of undifferentiated cancer cells of "oat cell" type in the adrenal gland.
Multinodular GoiterEndocrineH & E63 year old woman. Mass in the left lobe of the thyroid gland. A slight deviation of the trachea to the right was noted.The histologic picture of a nodular goitre has a heterogeneous appearance. The goitre is composed of many nodules of different sizes. Some nodules are encapsulated; most are not. Within the nodules, the follicles are dilated, filled with colloid and lined by cuboidal, or flattened, follicular cells. Other areas are more cellular; the follicles are crowded and the follicular cells appear taller and more active. Areas of fibrosis are also present.The resected lobe of the thyroid was enlarged and replaced by many nodules, varying from a few mm. to 2 cm. in diameter. The cut surface showed pink, soft areas (representing colloid-filled follicles), dry, white streaks (representing fibrosis) and some cystic areas.
Grave's Diseas of the ThyroidEndocrineH & EThis 30 year old woman, for the past six months, noted easy fatigue, weakness, irritability, palpitations, intolerance to heat and loss of weight, despite a good appetite. Her skin was moist; there was a fine tremor of the outstretched hands. The eyes held an anxious expression, there was lid lag and weakness of convergence. The thyroid gland was diffusely enlarged, smooth and soft. Basal metabolic rate +43, pulse 100. Subtotal thyroidectomy was performed.The acini are closely packed and vary in size and shape. The epithelium is hyperplastic, in many areas being thrown into papillary folds. There is no loss of polarity. The acini occasionally contain pale-staining colloid, which is vacuolated at the periphery. In some slides, there are focal collections of lymphocytes.The portion of right and left lobe weighed together 50 gm. The external aspect was smooth. On section, there was a homogeneous, firm surface.
Grave's Disease of the Thyroid, with Pre-op treatmentEndocrineH & E
Follicular AdenomaEndocrineH & EFemale, age 25. Noticed a lump in left side of her neck for several years. Sudden onset of pain, tenderness and increase in size. Examination revealed a large, soft nodule in the left lobe of the thyroid. At operation, the nodule and a portion of normal thyroid were removed.The adenoma is composed, for the most part, of small acini, lined by cuboidal, or flattened epithelium and containing colloid. The acini, in some areas, are separated by an eosinophilic matrix. Hemorrhagic extravasation can be seen, in some areas.The nodule was 5 cm. in diameter, well encapsulated, soft and sluctuant. On section, there was homogeneous, greyish-pink surface, except where extensive hemorrhage had occurred. In a few areas, there were yellowish spicules of calcification.
Hashimoto's ThyroiditisEndocrineH & EFemale, age 45. Uniform enlargement of thyroid gland present for many months. Basal metabolic rate -15. Some compression of the trachea noted.Note the extensive diffuse lymphocytic infiltrate and prominent lymphoid follicles; plasma cells are also seen. Follicles are atrophic, colloid is scant, or absent and the follicular cells have oxyphilic cytoplasm.Diffusely enlarged , lobulated, rubbery gland; capsule intact, no adhesions. Cut section yellowish-brown and the colloid appearance was lost.
Papillary carcinoma of the thyroidEndocrineH & EFemale, age 24. Developed an enlarging nodule of thyroid gland over several years.Papillary fronds, covered by neoplastic epithelium, showing hyperchromatism, pleomorphism and some loss of polarity. Some irregular follicles have been formed and contain colloid. (The regional nodes contained metastatic tumor).A firm nodule, 2 cm., with indistinct margins, situated in right lobe of thyroid. Regional lymph nodes are enlarged.
Parathyroid AdenomaEndocrineH & EThis patient, at 14 years of age, noticed listlessness, loss of weight and developed flat feet. At age 15, both hips and knees began aching and knock-knees developed. X-rays showed typical osteitis febrosa cystica, slipped epiphyses, bone rarefaction and demineralization. Blood calcium 16 mg/100 ml, phosphorus 2.6 mg/100 ml. Phosphatase 20 K.A. units. Later, crampy loin pain was noted and X-ray revealed renal calculi. Urinary calcium excretion was increased.The adenoma is composed of chief cells, which are large cells with abundant pale cytoplasm and large vesicular nuclei. There is no particular arrangement of cells. The stroma is scant and here and there are cystic spaces. The adenoma is well-encapsulated by fibrous tissue.At operation, a smooth, encapsulated nodule, measuring 2.8 x 1.8 x 1.4 cm. was removed from the posterior surface of the left lobe of the thyroid. On section, a greyish-pink, homogenous cut surface bulged from the retracted capsule. Here and there were minute cysts.
Chronic Suppurative OsteomyelitisBoneH & EMale, age 40. Deep penetrating wound of great toe. After unsuccessful treatment, it was necessary to amputate toe.There is bone destruction, with an acute inflammatory exudate, which also involves the adjacent connective tissues. At the periphery, new bone formation can be seen with osteoblastic activity.
Tuberculosis of SpineBoneH & EMale, age 12 years. Pain and tenderness in spine for many months, with gradual deformity and also increasing fatigue. Bone destruction shown by X-ray.Bone destruction and caseous necrosis can be seen. About this, there is a Tb. Granulation tissue, with poorly formed tubercle follicles and an occasional Langhan's giant cell.
Tuberculosis SynovitisBoneH & EThis 25 year old man complained of pain in his right knee of six months duration. He also noted increased fatigue and weakness. Later, he noticed swelling and stiffness of the knee. On examination, the joint was tender to passive movements, which were also restricted. There was bulging and boggy sensation about the joint space.Tuberculous granulation tissue involves the thick synovium.An operation was performed. The joint was filled with serous fluid and small joint mice. The synovial membrane was thickened and shaggy and was covered with minute greyish areas and tags of yellowish tissue.
Paget's DiseaseBoneH & EThis 60 year old man had noted loss of stature, enlargement of head and difficulty in walking, gradually increasing over the past five years. Lately, he noted tenderness and redness over the anterior lower legs and difficulty with vision and hearing. On examination, there were multiple deformities, bowing of tibia, kyphosis and waddling gait. X-rays revealed a "moth-eaten appearance" of skull, bowing of long bones and increased density and thickness of their cortices. Alkaline phosphatase elevated. Serum calcium 10mg/100ml. Serum phosphorus 4.5/100 ml.The trabeculae are irregular in size and shape. Some trabeculae are very thick. Notice the smaller and larger notches and depression on the surface of the trabeculae. These are the areas where bone resorption has been, or is, going on and also the areas wherenew bone is, or will be, there are osteoblasts and, as well, giant cells (osteoclasts). The pathognomonic feature of Paget's disease is the mosaic pattern of the irregular cement lines. These bluish cement lines mark the sites of the irregular bone resorption and subsequent repair, as described above.The involved bones could be sectioned with a knife, in most areas. In older, more advanced areas, the bones were more difficult than normal to saw. The cortices were thick, in some areas, and thinned in others. Many of the trabeculae were thicker than normal.
Osteitis Fibrosis CysticaBoneH & EAs for slide #217Sections show the marrow spaces to be replaced by cellular fibrous tissue, in which there are occasionally macrophages containing hemosiderisn from old hemorrhage. There are spicules of poorly calcified bone, around which are numerous osteoclasts and osteoblasts.A biopsy of the mandible was taken from an area of rarefaction.
Eosinophilic Granuloma of BoneBoneH & EThis 19 year old boy complained of low back pain for three years. The pain was intermittent and did not hinder labor. The pain became more severe and he was admitted to hospital. There was tenderness on deep pressure over the lumbar vertebral spines. X-ray showed osteolytic lesions involving Th. 12, L.1&2, left scapula, both iliums and the neck of the left femur. Biopsy of the ilium was performed.There is a diffuse distribution of cells, consisting of many eosinophils, monocytes, plasma cells, reticulum cells and, here and there, giant cells. The tissue is well vascularized. In some slides, there are spicules of dead (necrotic) bone.Several small, curetted fragments were received. They were soft and greyish-pink.
Giant Cell Tumour of BoneBoneH & EThis 25 year old woman complained of increasing pain in her right knee region on weight bearing and movement. Later, she noted swelling of the lower end of the femur. X-ray examination showed an expanded destructive lesion of the epiphyseal region of the lower end of the femur with a characteristic "soap bubble" appearance. The cortex was thin, but intact. The lesion was curetted.The giant cell tumor has replaced bone and also is present between trabeculae. The cells of the tumor are pleomorphic. There are giant cells supported by a wall vascularized and cellular stroma, that is comprised of spindle and oval shaped cells. 0.01 ml. Of this anti-serum was injected intradermally in the rat, forming a small wheal, and biopsies were taken 6, 24 and 48 hours after the injection. Study the next 3 slides in sequence and observe the cellular reaction that is occurring in the subepidermal tissues, where the antibody had been injected. Identical reactions could have been produced by non-immune methods, such as using bacterial toxins, etc.
Osteogenic Sarcome of BoneBoneH & EThis 18 year old boy developed pain in the region of the right knee, made worse by weight bearing and walking. Swelling was noted three months later. On examination, there was a fusiform enlargement of the lower end of the femur. X-ray revealed an irregular mass in the metaphysis of lesser dinsity than the surrounding bone. There was a typical "sunburst" appearance and "Codman's triangle" was present. There were nodular densities in both lung fields. Alkaline phosphatase was 20 K.A. units.Sections show an osteogenic sarcoma. There are pleomorphic osteoblasts, surrounded by an abundant osteoid matrix. The cells are sometimes hyperchromatic, large and bizarre, and form clusters surrounded by osteoid. Tumor giant cells are present, in some areas. There are vascular sinusoids throughout. Here and there are spicules of bone, some viable, some dead.In sagittal section, the metaphyseal area of the femur was replaced by an irregular tumor mass, which obliterated the medullary cavity and invaded the cortex, epiphysis and adjacent soft tissues. The tumor was variegated, some areas soft and fleshy, some areas hemorrhagic, others firmer, with spicules of bone apparent. Spicules of bone were lined up in sunburst fashion, radiating out from the medulla at right angles to the shaft.
Ewing's tumour of boneBoneH & EThis 12 year old by complained of pain in the right upper arm. On examination, there was tenderness in the mid-humerus, leukocytosis, fever and general malaise. X-ray showed expansion of the medullary cavity and thickening of the cortex, with reactive periosteal bone deposited in parallel layers - "onion skin appearance". Radiation therapy was given and, three months later, there were metastases to skull, lungs and to vertebrae.Sections show a monotonous array of fairly regular, round to ovoid cells, with dark nuclei and indistinct cytoplasm. The stroma is composed of fairly well-vascularized fibrous tissue. In some areas, the cells are arranged around blood vessels; in other areas, there is necrosis.The tumor was greyish, soft and cellular, and completely replaced the cancellus bone.
Mulitple myelomaBoneH & EThis 50 year old man complained of malaise and generalized aches and pains, and was thought to be a hypochondriac. Later, he noted bruising, weakness, shortness of breath and intense generalized bone pain. Investigation revealed multiple osteolytic lesions in many bones, "punched out areas" in the skull and collapse of Th.12. Hb 50%. Marked rouleaux formation. Sedimentation rate 100 mm/hr. Plasma globulins 4 gm.% Bence-Jones proteinuria. Sternal marrow 70% abnormal plasma cells. Albuminuria 4+. B.U.N. 80 mg/100 ml. He died of uremia.There is a diffuse array of neoplastic plasma cells (myeloma cells) of varying sizes and shapes. The stroma is scant. No other cells of the normal hematopoietic series can be identified.The multiple areas of bone involvement were comprised of soft greyish to reddish, gelatinous tissue, replacing the medulla and, in some areas, the bony cortex.
metastatic carcinoma of prostate involving boneBoneH & EAs for slide #195There is a typical adenocarcinoma replacing the bone marrow. The trabeculae are increased and thicker than normal.The vertebral column, when sectioned, was found to be sclerotic and contained diffuse metastatic tissue.
Rheumatoid arthritisInflammationH & ESee slide #240. This specimen is a biopsy from the patient's knee joint.Note the classical villus formations involving the synovial tissues; the blood vessels are markedly dilated and congested. There is a diffuse and focal infiltration of lymphocytes and plasma cells.
Acute inflammatory response 6 hour biopsyInflammationH & ENote the focal collections of acute inflammatory cells (polymorphonuclear leukocytes - granulocytes) lying in the deeper layers of the dermis on both sides of the muscle layer. The majority of the inflammatory cells are collected about the small blood vessels from which these cells have emigrated. There is also active hyperemia and considerable edema of the connective tissues, which has separated the collagen fibrils. There are some degenerative changes in the muscle, presumably the result of the trauma of injection and one can see some collections of acute inflammatory cells in such areas.
Acute inflammatory response 24 hour biopsyInflammationH & EThis shows a more diffuse infiltration of polymorphonuclear leukocytes, which have moved through the connective tissue. There is still some acute edema, though this is not as marked as in the former phase. Note that the smaller vessels are still quite dilated and congested. Many of the inflammatory cells are now of the mononuclear type (histiocytes, etc). This indicates how quickly the population of inflammatory cells can change, at least in this form of tissue damage caused by an antigen-antibody reaction.
Acute inflammatory response 48 hour biopsyInflammationH & EThe inflammatory reaction is now entirely cellular and of the so-called "chronic" type. The majority of the cells are mononuclears (histiocytes), together with some lymphocytes, swollen, plump fibroblasts, and a rare granulocyte or eosinophil. In this particular inflammatory reaction, edema and polymorphonuclear emigration characterized the early phases 6-24 hours after its initiation; at about 24 hours, the cell population has changed to the histiocytic, mononuclear cell groups, while at 48 hours, the reaction is obviously "chronic", i.e. mononuclear cells, lymphocytes, fibroblasts with few granulocytes.
Foreign body granuloma (oil)InflammationH & EThe patient had received multiple injections of an oily suspension of penicillin in the buttock. Subsequently, a firm, tender nodule developed in the area. This was biopsied.The tissue is heavily infiltrated by round cells and by foreign body giant cells. These contain multiple nuclei, irregularly distributed throughout the cytoplasm. There are also clear spaces of varying size within the tissue and these represent oily material, which has been injected.
Rheumatoid noduleInflammationH & EThis 35 year old woman had gross deformities from rheumatoid arthritis, which began at the age of 25. There were nodular subcutaneous swellings over both olecranon processes.The nodule is poorly demarcated. There are varying sized areas of fibrinoid necrosis, surrounded by spindle to oval shaped cells, arranged in palisading fashion.One of the nodules was removed. It was not attached to skin, but to deep structures. The nodule measured 1 cm. x 0.5 cm. and was firm and rubbery. On section, there was a greyish, firm surface, with foci of yellowish, necrotic material.
Gouty tophusInflammationH & EMale, age 50. Recurrent attacks of acute arthritis in right great toe. Slowly enlarging subcutaneous nodules (tophi) over dorsum of first metatarsal joint. Similar tophi on ears. Serum uric acid - 8 mg./100 ml.There are islands of brownish crystalline sodium urate, surrounded by "hyaline" connective tissue. As well, there is a reaction of foreign body giant cells and chronic inflammatory cells.At operation, the nodules
Molluscum contagiosumSkinH & EThis patient developed a small nodule 5 cm. in diameter on the anterior chest. It had a central crater, from which a little whitish material occasionally exuded. It was excised surgically.There is marked squamous cell hyperplasia (acanthosis) arranged in a cup-like configuration. Toward the surface, the cytoplasm of squamous cells becomes partially, then completely, replaced by variably staining homogeneous material, which is viral in origin.
Basal cell carcinoma of skinSkinH & EFemale, age 55. Small nodule 0.3 cm. in diameter on right temple.The dermis is partially replaced by irregularly-shaped masses of deep blue ovoid cells resembling basal cells of epidermis. The tumor cells are palisaded at the periphery of the tumor masses.
Squamous cell carcinoma of skinSkinH & EMale, age 54. Raised non-healing ulcerated nodule 2 cm. in diameter on back of hand with edges of ulcer raised, rolled and white. Present for six months.There is a fairly abrupt transition from relatively normal epidermis to cords of malignant squamous epithelium, which extend deeply into the dermis, infiltrating between collagen bundles. Study the nuclear changes and compare with the normal.
Capillary hemangioma of skinSkinH & EFemale, age 3. Raised raspberry red elevation on skin of forearm since birth. Blanched on pressure. At surgery, the subcutaneous tissue was replaced by a spongy, reddish, soft area, measuring 3 cm. in diameter.Lobulated, fairly well-circumscribed islands of varying sized vascular channels, lined by endothelium, occupy much of the dermis. Some channels contain red blood cells. The endothelial cells are regular in size, shape and staining quality.
XanthomaSkinH & EThis diabetic patient, with hyperlipemia and hypercholesterolemia, had several raised, yellow plaques in the eyelids.There is a rather irregular, pale-staining area in the dermis, composed of masses of finely vacuolated, lipid-laden histiocytes. These are xanthoma cells.One of these plaques was removed. On section, a circumscribed, bright yellow nodule was seen beneath the epidermis.
Malignant melanoma from junction nevusSkinH & EFemale, age 35. "Oil slick", brownish area on plantar surface of foot, present since birth; gradually enlarging and becoming darker brown. Surface ulcerated and bleeding.There is ulceration of the epidermis, with underlying malignant melanoma. The tumor cells show variations in size and shape (pleomorphism), some being plump and oval, while others are spindle-shaped. Mitoses are present and there is melanin pigment. Adjacent to the malignant melanoma, there are nests of nevus cells within the epidermis. This is junction nevus and the malignant melanoma has arisen from malignant transformation of similar nests of cells within the epidermis.
Malignant melanomaSkinH & EFemale, age 40. "Oil slick", brownish area left forearm for many years. Gradually increasing in size, becoming darker, ulcerated and bleeding.The epidermis is ulcerated, with underlying infiltrating malignant melanoma. Again, there is considerable pleomorphism and some melanin is present. The amount of melanin in malignant melanomas is highly variable and of no prognostic significance. In the epidermis, lateral to the tumor, are scattered abnormal nevus cells.
Malignant melanoma, eyeSkinH & EMale, age 50. Weight loss, malaise, enlarged nodular liver. Gradually deteriorated and died.At autopsy, there were large and small black nodules in the massively enlarged liver. Tumor nodules were noted in the adrenals. The right eye was enucleated and, in the posterior chamber, there was a nodule measuring 1 cm. in diameter. On section, the surface was black.Notice the brownish-yellow pigment present in the normal choroid cells. There is, as well, a tumor composed of plump, spindle cells. Many of these cells contain melanin.
FibrosarcomaConnective TissueH & EFemale, age 25. Soft tissue mass right thigh. On section, there was a large mass of greyish, soft "fish flesh", mottled red from hemorrhage. The tumor infiltrated surrounding structures.This malignant tumor of connective tissue origin consists of criss-crossing bundles of mailgnant fibroblasts. These cells are spindle-shaped with large pleomorphic hyperchromatic nuclei and with many bizarre mitoses.
Healing by primary union 24 hoursInflammationH & EThe next three slides demonstrate three stages in the healing of a surgical incision made in the skin of mice. The same changes pertain to healing of wounds in the human.Identify the incision. Note that it extends through a muscle layer; there is a polymorphonuclear exudate in the upper portion of the incision. Note the marked activity of primitive mesenchymal cells, mainly fibroblasts, in the neighboring connective tissues. The blood vessels at the margins and in the base of the wound are dilated and hyperemic. There are also some days, the wound will fill with fibrin, the fibroblasts will migrate into the wound area, along with capillaries and eventually collagen will be formed.
Healing be primary union 4 daysInflammationH & EEpithelium has already covered the incision, which is now filled with new capillaries and many fibroblasts, which are commencing to line up parallel to the surface. Note that the fibroblastic proliferation extends down through the incision that has interrupted the muscle layer.
Healing by primary union 8 daysInflammationH & EIt is now difficult to identify the incision; however, the interruption of the muscle layer is obvious and there is a depression of the epithelium overlaying it. There is still considerable fibroblastic proliferation, but collagen is now being formed and the wound has solidly united. Note an absence of skin appendages in the immediate incision itself. The degree of vascularity has already considerably decreased; epithelialization is practically normal. The sequence of events in the human are similar, but are probably slightly slower. However, between 7 and 10 days, the usual surgical incision in human skin is also healed.
Stasis ulcerInflammationH & EA middle-aged female, who had had previous venous thrombosis, with subsequent incompetence of veins and varicosities of others. Skin over anterior surface of lower extremity was pigmented and a chronic ulcer developed, which failed to heal in spite of a variety of therapy. This is a biopsy from the lesion.Note the ulcer, with non-specific, chronic, inflammatory cell reaction. The base of the ulcer is made up of dense, sclerotic collagen. Deep in the section, one can see thick-walled veins, with fibrotic and vascularized walls, indicating former chronic thrombo-phlebitis. No thrombi are in this section. There is no evidence of malignancy. In some of these ulcers, the epithelium at the edge becomes very hyperplastic and may simulate a cancer (pseudo-epitheliomatous hyperplasia).
Normal Lymph nodeImmuneH & EReview the normal histology. Note the lymphoid follicles and also the medulla.
Tuberculosis LymphadenitisImmuneH & EMale, age 15. Cervical lymph nodes enlarged and firm. Low grade fever. At operation, the lymph nodes were large and matted together. On section, there was a yellow-grey, cheese-like, mottled surface. Cultures were positive for Tb. Bacillus.The tubercles are prominent. Some are collections of epithelioid cells and giant cells, others show extensive caseation necrosis. The tubercles are confluent, in some areas.
Radiation effect - Lymph NodeImmuneH & EThis patient with leukemia was receiving extensive radiation therapy for the leukemia and died of the latter condition.Compare this lymph node with the normal. Note the extensive loss of lymphoid cells. No recognizable lymphoid follicles are seen. There is a background of reticulum cells, fibroblasts and other cells, difficult to accurately identify. The slide demonstrates the extensive "lympholysis" that occurs with radiation.
Radiation effect Bone MarrowImmuneH & ESame case as Slide #262.This section from red bone marrow shows complete loss of recognizable marrow cells. There is hemorrhage present. Again, this demonstrates the very marked destructive effect that radiation can have on bone marrow tissue. The normal bone marrow, as well as the leukemic tissue, has been destroyed.
Amyloidosis of SpleenImmuneH & EMale, age 34. Enlarged, matted, firm, superficial lymph nodes, enlarged hilar nodes; weakness, fatigue, lassitude. Spleen enlarged and palpable.The follicles have been completely replaced by rose-colored, homogeneous, amyloid deposit. The arteriolar walls, as well, are thickened by amyloid.The spleen was large and firm, the borders sharp. On section, there was a very firm, waxy, cut surface. The amyloid areas were pale and translucent against the red background of the remainder of the spleen - the so-called "sago spleen". When treated with iodine, these nodules stained mahogany brown.
Gaucher's Disease of SpleenImmuneH & EMale, age 30. Moderate weight loss and anemia. Dragging sensation left upper quadrant and some pain. Spleen enlarged to pelvis. Liver just palpable, superficial lymph nodes slightly enlarged. At operation, the spleen weighed 2500 gm. The surface and cut surface were a mottled grey-red.The splenic architecture cannot be identified. It has been replaced by very large, pale pink cells, whose cytoplasm is vacuolated. The nuclei are eccentric. These altered reticulo-endothelial cells are called "Gaucher cells", which contain "kerasin", a cerebroside.
Sarcoidosis of lymph nodeImmuneH & ESee slide #9At autopsy, both lungs were mottled with minute grey nodules and, in many areas, the parenchyma was collapsed and fibrous. The hilar lymph nodes were enlarged, firm and mottled grey, with small nodules.The lymph node architecture has been completely replaced by the sarcoid lesions. There are many small tubercle-like areas, composed of epithelioid cells; the centres show no necrosis. Notice the large pale giant cells and relative lack of lymphocytes. The lesions are both discrete and confluent.
Metastatic squamous cell carcinoma involving lymph nodeImmuneH & EMale, age 50. Developed a chronic ulcer on dorsum tongue, near the right margin. Painless, occasional bleeding. Gradually increasing in size. Cervical lymph nodes shotty. At operation, there was an area of ulceration 1 cm. in diameter. The base was necrotic and the edges firm. On section, there was greyish, friable tissue infiltrating into muscle. This specimen was one of the enlarged cervical lymph nodes.Note the sheets and cords of malignant squamous cells invading the lymph node.
Metastatic Adenocarcinoma involving lymph nodeImmuneH & EThis patient had a papillary adenocarcinoma of the colon. The regional mesenteric lymph nodes were grossly involved with metastatic tumor.Note the irregular gland acini lined by malignant columnar epithelium invading the lymph node.
LymphosarcomaImmuneH & EMale, age 50. Weakness, anemia, weight loss. Enlarged superficial and hilar lymph nodes. At operation, a node from the axilla was removed. It was very large and pulpy and, on section, there was a moist, greyish surface.The lymph node architecture has been completely replaced by small mature dark blue lymphocytes, which are diffusely arranged throughout the node. The picture is monotonous in regularity.
Hodgkin's Disease of LymphnodeImmuneH & EMale, age 34. Enlarged, matted, firm, superficial lymph nodes, enlarged hilar nodes. Weakness, fatigue, lassitude. Spleen enlarged and palpable.At autopsy, all lymph nodes were enlarged, firm and matted together. The spleen weighed 500 gm. On section, the nodes were fleshy and the cut surface of the spleen was firm and fibrotic and mottled with yellowish homogeneous areas - ("suet bodies").Normal lymph node architecture is lost. There are areas of necrosis and also fibrosis. The polymorphous cellular infiltrate extends throughout the lymph node and invades the capsule. There are plasma cells, histiocytes and numberous eosinophils. In addition, there are large cells with pale cytoplasm, sharply marginated vesicular nuclei, with deep read necleoli. Some of these are multinucleated and these are the characteristic Hodgkin giant cells (Reed-Sternberg cells).
Hodgkin's Disease of SpleenImmuneH & ESame as slide #270Nodules of "Hodgkin's tissue" are scattered in the pulp. These form the so-called "suet bodies" seen on gross examination.