Pathology 1st Practical Exam :D

Created by: Jeffrey James Co Note: Hemo 1 and 2 (to follow)

Cellular Injury and Cell Death

Hydatiform Mole (Hydropic Change) UTERUS

Note that there is a edematous stroma :D

Cellular Swelling (Hydropic Change)

1. What are the 3 essential microscopic features of hydatiform mole? Answer: Chorionic villi are enlarged, extensive trophoblast proliferation, and extravillous islands of trophoblast 2. Among the 3 essential microscopic features, which is not seen in choriocarcinoma? Answer: No chorionic villi, mixed proliferation of syncytiotrophoblasts and cytotrophoblasts.

Fatty Change (LIVER)

Fat Vacuoles

Note the presence of FAT Vacuoles in the liver parenchyma (Hepatocytes)

NORMAL

ABNORMAL

Questions (REPHRASE IF COPIED):

1. What is the pathogenesis of fatty liver? Answer: Excess accumulation of triglycerides within the liver that may be due to chronic intake of Alcohol or defective metabolism and transport of lipids. 2. What organs are particularly vulnerable to fatty change? Answer: Heart and Liver

Fatty Change (Steatosis), Liver

1. Give the pathologic mechanism of the injury? Answer: Excess accumulation of triglycerides within the liver that may be due to excessive entry/intake (Alcohol) or defective metabolism and transport of lipids. 2. Give the most common etiology. Answer: Excess alcohol intake and Diabetes mellitus. 3. Reversible or Irreversible? Answer: Reversible

Tuberculosis Liver (Fatty Change)

Langhans Giant Cell (ALWAYS HORSESHOE IN APPEARANCE)

(+) Fatty Change Granuloma formation Langhans giant cells

Abnormal Liver

Normal Liver

Question (REPHRASE IF COPIED)

How does one distinguish caseation necrosis from coagulation necrosis histologically? Answer: Histologically, caseation necrosis appears pinkish with no prominent cellular structure. Coagulation necrosis appears to have an eosinophilic tombstone with preserve cellular structures
1.

Myocardial Infarction, Recent (Coagulation Necrosis)

Presence of neutrophils

Lost of striations Pyknotic nuclei

ABNORMAL CARDIAC MUSCLES

NORMAL CARDIAC MUSCLES

Myocardial Infarction, Recent

A. Identify the type of necrosis. Answer: Coagulation Necrosis. Retained cell structure. B. Recent or Old myocardial infarct? Answer: Recent

Neutrophilic infiltrations, Kaya recent! :D

Renal Infarction (Coagulation Necrosis)

Mononuclear infiltrates

Glomerular, Tubular, Ductular outlines discernible but lost the cellular details. (+) Pyknotic nuclei

ABNORMAL KIDNEY

NORMAL KIDNEY

Questions (REPHRASE IF COPIED)

1. What is the most common cause (etiology) of coagulation necrosis? Answer: Infarction caused by obstruction in a vessel that supplies different organ-tissues. 2. Explain the biochemical basis of the acidophilic tomb stone Answer: Increased eosinophilia is attributable to the loss of cytoplasmic RNA (binds to blue dyes) and to the denatured cytoplasmic proteins (binds to red dye) 3. Differentiate necrosis from apoptosis. Answer: Necrosis is mainly due to denaturation and enzymatic digestion of leaked lysosomal enzymes in injured cells that often lead to inflammation. In apoptosis, there is a systematical cascade of processes that serves to eliminate cells through the use of different caspases and cytochromes. The end phase usually leads to phagocytosis of the cell bodies. 4. Enumerate other organs prone to infarction. Answer: Kidney, Heart, Small and Large intestines and brain

Kidney

Identify the type of necrosis. Answer: Coagulation Necrosis What is the common cause of this type of necrosis? Answer: Renal Infarction.

Segmental Hemorrhagic Infarction, Ileum Necrotic Villi

Necrotic Blood Vessels

ABNORMAL ILEUM

NORMAL ILEUM

Questions: (Dont know the answer)

What are the usual causes of infarction of the bowel? Answer: Hernia, Embolus, Atrial and Venous Thrombosis, and Low Blood Pressure. 2. What are the most common causes of mesenteric vascular occlusion? Answer: Thrombus 3. What are the factors that determine whether infarction will occur or not in the presence of a vessel occlusion. Is it possible to have infarction in the absence of an acute occlusion? Answer: Degree of occlusion. Possible, transection of the superior mesenteric artery or hypovolemic shock 4. Explain why the small intestine is more prone to transmural infarction than the large intestine. Answer: Small intestine Is more dependent on the blood supply
1.

Liquefaction Necrosis (Ovarian Abscess)

Cellular Debris and Leukocytic infiltrates

ABSCESS

OVARY

Questions:
Explain the occurrence of liquefaction necrosis in bacterial infections. Answer: Liquefactive necrosis is characterized by digestion of the dead cells resulting into a liquid viscous mass. Bacterial infections can cause this because microbes stimulate the accumulation of leukocytes and the liberation of enzymes from these cells. 2. Enumerate 5 other organs or tissues where abscess formation is common. Answer: Skin, brain', lungs, and abdominal and anal abscess
1.

Liquefaction Necrosis

A. Define liquefactive necrosis. Answer: It is characterized by digestion of the dead cells, resulting in formation of tissue into a liquid viscous mass. B. Enumerate 5 other organs or tissues where abscess formation is common. Answer: Skin, brain', lungs, and abdominal and anal abscess

Acute Hemorrhagic Pancreatitis (Enzymatic Fat Necrosis)

Enzymatic Fat necrosis Abundance of adipose tissue

ABNORMAL PANCREAS

NORMAL PANCREAS

Enzymatic Fat Necrosis, Pancreas

1. Give the pathogenetic mechanism for the occurrence of the condition. Answer: The pancreatic enzymes leak out of acinar cells and liquefy the membranes of fat cells in the peritoneum. The leaked lipases split the triglyceride esters contained within fat cells.

Tuberculous Lymphadenitis (Caseous Necrosis)

ABNORMAL LYMPH NODE

NORMAL LYMPH NODE

Question:
Since other granulomatous diseases may affect the lymph nodes, how do you go about in arriving at the definitive diagnosis? Answer: Look for a granuloma surrounded by epitheloid cells and Langhans type giant cell. 2. What is the origin of epithelioid cells? Langhans giant cells? Answer: The epithelioid cells came from macrophages and the Langhans giant cells came from the fusion of epithelioid cells. 3. Enumerate at least 5 other diseases showing a granulomatous type of inflammation. Answer: Leprosy, Syphilis, Cat-scratch disease, Sarcoidosis, and Crohns disease
1.

Caseous Necrosis, Lymph Node

1. In what condition/ diseases is this type of necrosis most commonly encountered? Answer: Tuberculosis

2. Describe a granuloma. Answer: A granuloma is a focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells.

Acute Gangrenous Appendicitis (Gangrenous Necrosis)

Leukocytic Infiltrates in the lumen and no demarcations

ABNORMAL APPENDIX NORMAL APPENDIX

Questions:
Differentiate between dry and wet gangrene. Answer: Dry gangrene is typically a gangrenous necrosis without bacterial infection. While wet gangrene has superimposed bacterial infection which causes more liquefactive necrosis because of the degradative enzymes. 2. Enumerate 3 other organs which may develop gangrene. Answer: Lower limbs, Gallbladder, Small and Large intestines, and Appendix
1.

Gangrenous Necrosis, Vermiform Appendix

1. Give the pathogenetic mechanism of this condition. Answer: Lost of blood supply of the organ/tissue due to infarction or vasoocclusion. 2. Enumerate 3 other organs which may develop gangrene. Answer: Lower limbs, Bones and appendix.

Intracellular Acuumulations

Normal Cellular Accumulations

FATTY CHANGE (LIVER)

Normal Cellular Accumulations

FATTY CHANGE CORONARY ARTERY

Normal Cellular Accumulations

FATTY CHANGE AORTA

EXOGENOUS PIGMENTS

DUST (ANTHRACOTIC PIGMENTS)

ENDOGENOUS PIGMENTS

LIPOFUSCIN PIGMENTS

ENDOGENOUS PIGMENTS

MELANIN

Pigmented Epidermal Nevus

1. Identify the pointed cells. Answer: Nevi Cells. 2. Identify the Pigments. Answer: Melanin 3. Endogenous or Exogenous? Answer: Endogenous

ENDOGENOUS PIGMENTS

HEMOSIDERIN

ENDOGENOUS PIGMENTS

BILIRUBIN

Dystrophic Calcifications

Senile Uterus

Filariasis, Scrotum

Senile Uterus

Atherosclerotic Coronary Artery

PSAMMOMA BODIES

MENINGIOMA

Papillary serous cystadenocarcinoma, OVARY

Dystrophic Calcifications
Section taken from the wall of the uterus of 68 y.o. 1. Define Pathologic Calcification. Answer: It is the abnormal tissue deposition of calcium salts, together with smaller amounts of Fe, Mg, and other salts. 2. Enumerate and differentiate the type types of pathologic calcification. Answer: Dystrophic Calcification is encountered in areas of necrosis. Metastatic Calcification may occur in normal tissues whenever there is hypercalcemia. Dystrophic Calcification

HYALINE CHANGE

ACUTE PYELONEPHRITIS

Cellular Growth and Differentiation

Answer:
A. Nulligravid 50 grams

Primigravid 50-70 grams

Atrophic Endometrium, Less glands some glands are cystically dilated and there is an increase stroma to glandular ratio. Change from simple columnar to short columnar/squamous epithelium

Cigar-shaped nuclei

Hypertrophy of the Heart: 1. Define hypertrophy. Answer: Hypertrophy refers to an increase in size of cells, resulting in an increase in the size of the organ. 2. What are the microscopic changes evident in the pictomicrograph? Answer: Enlarged nuclei and the cardiac muscle cells are also larger in size. 3. Give other tissues/organs which can develop hypertrophy. Answer: Skeletal muscles and Uterus (Myometrium) 4. Explain the mechanism in hypertrophy. Answer: Increasing the amount of workload of the cells concomitantly triggers a linked actions of mechanical sensors that leads to producing more cellular proteins thus increasing the size of the cells Hypertrophy.

Hypertrophied Cardiac Muscle

Normal Cardiac Muscle

From simple columnar epithelium to squamous epithelium Section taken from the cervix of 30 y.o who went vaginal hysterectomy Metaplasia: 1. Define metaplasia. Answer: Metaplasia is a reversible change in which one differentiated cell type is replaced by another cell type. 2. Give other organs which may show metaplasia. Answer: Esophagus, Trachea, Retina

Normal Endocervix Metaplastic Endocervix

From 70 y.o male presenting with dysuria A. Define hyperplasia. Answer: Hyperplasia is the increase in number of cells in an organ or tissue. B. What is the normal weight of the prostate? Answer: Approx. 20grams C. What part/zone of the prostate is usually affected by hyperplasia? Answer: Transition zone

Hyperplasic with some atrophic prostate glands

Increase in number of glands and there is a decrease in gland-to-stroma ratio Normal number of glands with a prominent stroma

Fractional Cutterage Specimen: 70 y.o patient presenting with vaginal bleeding A. Describe microscopically. Answer: Hyperplastic endometrial glands and presence of blood in the vessels B. Enumerate the causes of pathologic hyperplasia. Answer: Excesses of hormones or growth factors and viral infections such as papillomaviruses.

Remember: 70 y.o. is most likely postmenopausal therefore the glands should be atrophic

Senile Uterus (Atrophic glands)

Uterus with pathologic hyperplasia

Neoplasia
x-(

45 year old male with colonic adenocarcinoma. CT Scan: Multiple Liver Nodules. 1. What feature of malignancy is best demonstrated in this pictomicrograph? Answer: Metastasis. 2. Diagnosis: Answer: Metastatic adenocarcinoma

A 32 y.o. female underwent an excision biopsy of the right cervical lymph node. 1. Identify the pointed structure. Answer: Reed-Sternberg cells 2. Give the diagnosis. Answer: Hodgkin Lymphoma 3. Benign or Malignant? Answer: Malignant

45 y.o. female presenting with early satiety. 1. Identify the organ Answer: Stomach 2. Benign or Malignant? Answer: Malignant 3. Describe the tumor cells morphologically. Answer: Erythematous with poorly delineated borders

Section taken from the liver in one of the autopsy cases. The mass is reddish blue and spongy measuring 2cm in widest diameter. A. Give the diagnosis. Answer: Cavernous Hemangioma B. Most likely, this neoplasm is Benign. C. Give the histogenetic origin. Answer: Mesenchymal

A. Identify the specimen. Answer: Uterus and cervix B. Describe the lesion/mass grossly. Answer: Ulcerated non-well delineated mass on the cervix C. Benign or Malignant? Answer: Malignant D. Identify the structure at the tip of the pointer. Answer: Keratin Pearls E. Give the complete histologic diagnosis. Justify your answer. Answer:Well-differentiated squamous cell carcinoma. Presence of the keratin pearl. F. What is the histogenetic origin of the neoplasm? Answer: Epithelial

A 70 yo male presented with bleeding per rectum and an enhancing abdominal mass on CT scan. A. Identify the organ. Answer: Colon B. Describe the mass grossly. Answer: Bloody with non-delineated borders, necrotic. C. Benign or Malignant? Answer: Malignant D. Give the complete histologic diagnosis. Answer: Well-differentiated adenocarcinoma E. Give the histogenetic origin of the neoplasm. Answer: Epithelial

Specimen: Right gluteal mass from two different patient. A. Describe A grossly and microscopically. Answer: Well delineated border and homogenous in color. Microscopically there is hyperplasia of adipose cells. B. Which among the two is benign neoplasm? Justify your answer. Answer: A. No variegation in color and the borders are distinct. C. Describe B. Answer: Pleomorphic cells, hyperchromatism, increase nuclei to cytoplasm ratio, and presence of nucleoli. D. Both are mesenchymal in histogenetic origin.

1. Identify the organ (A and B) Answer: Liver 2. Compare both masses by describing them grossly. Answer: A is well-demarcated and homogenous in color, B has irregular borders, variegated color, presence of necrosis, and infiltration of tumor cells. 3. Based on the gross features of both masses, which one is a malignant neoplasm? Justify your answer. Answer: B. Because of the irregular borders, variegated color and presence of necrosis. 4. What is the histogenetic origin of these neoplasm? Answer: Epithelial

Answers: 1. Variegated, irregular border, asymmetrical 2. Malignant

Answers: 1. Dysplasia 2. Carcinoma in situ 3. Carcinoma in situ

A. Uterus B. Well-delineated borders and homogenous in color C. Leiomyoma D. Benign E. Mesenchymal

A. Hemorrhagic, necrotic and bulky. Microscopically, presence of atypical and typical mitotic figures and pleomorphism B. Malignant. Presence of atypical and typical mitotic figures. C. Mesenchymal

A. Malignant B. Pleomorphism, hyperchromatism, increase nuclei to cytoplasm ratio

30 yo with ovarian mass: A. Benign or malignant? Justify. Answer: Benign. The teeth, sebum, hair follicles are matured B. Give the diagnosis. Answer: Matured Cystic Teratoma C. What is the histogenetic origin of this neoplasm? Answer: Derived from 3 germ cell layers.

A.Malignant B. Psammomma Bodies C.Branching papillary projections lined by columnar epithelial cells some showing a ground glass or Orphan Annie nuclei. D.Papillary Carcinoma

A.Clusters, singly nest of cords. B. Malignant. Invasion, pleomorphism, hyperchromatism, increase blah blah. C.Invasive ductal carcinoma

A.Malignant B. Pleomorphic, hyperchromatic and prominence of nucleoli

1. Papillomatosis 2. Squamous papilloma

1. Proliferation of fibrous tissue with no skin changes. 2. Dermatofibroma

Nodule on the face 1. Nevi cells 2. Pigmented intradermal nevus

1. Horn cyst 2. Seborrheic Keratosis

1. Papillomatosis, Hyperkeratosis, Acanthosis, Hypergranulomatosis 2. Human papilloma virus

1. Keratin material lined by keratinizing stratified squamous epithelium. 2. Epidermal Inclusion Cyst. 3. Proliferation of what layer? Answer: Hypergranulosis

1. Tumor giant cells, pleomorphism , hyperchromati sm, 2. Epidermal inclusion cyst

1. Tumor cells, hyperchromati sm, pleomorphism , prominent nucleoli and mitotic figures 2. Vertical and radial proliferation. Vertical is more aggressive than radial.

1. Composed of islands of malignant basaloid cells with peripheral palisading. 2. Basal cell carcinoma 3. Indolent

Note: Sure itatanong to :D

1. Keratin Pearl 2. Welldifferentiated squamous cell carcinoma. 3. Epithelial 4. Lymphatic

Note: Sure na itatanong rin :D

Diseases of the Head and Neck

Never daw tinanong :D

65 yo male complained of an ulcerated mass at the left lateral aspect of the tongue. Incisional biopsy was done. A. What are the histological criteria for making a diagnosis of poorly differentiated squamous cell carcinoma? Answer: Appearance of a pre-formed keratin pearl, undifferentiated structure B. Define dyskeratosis Answer: Abnormal, premature keratinization within cells below the stratum granulosum.

37 yo female has been having right-sided frontal headaches for about 2 years accompanied by right nasal obstruction and frequent sneezing. A. Give the diagnosis. Answer: Nasal Polyp B. Is this condition neoplastic or nonneoplastic? Answer: Non-neoplastic C. Describe the lesion microscopically. Answer: Edematous mucosa, stroma is infiltrated with inflammatory cells.

Remember the epithelium.. :D

Pseudostratified columnar epith Inflammatory cells, Lymphocytes.

A 50 yo male complained of painless right mandibular swelling. Incisional biopsy was done. A. Give the diagnosis. Answer: Odontogenic Ameloblastoma, Mandible B. What is the histogenesis of this tumor? Answer: Odontogenic epithelial cells C. Describe the neoplasm microscopically. Answer: Loose stroma with nests and islands of epithelium composed of stellate cells D. What is the characteristic behavior of the neoplasm? Answer: Indolent

Loose stroma Nests/Island (Stellate Cells)

Stellate Cells consists of a germinal center (w/ stellate reticulum-like spinous cells). Periphery is the presence of columnar cells on reverse polarity

A 10 yo boy had a mass bulging from the right lateral aspect of the neck. A. Give the diagnosis Answer: Branchial Cyst or Lymphoepithelial Cyst B. Describe microscopically. Answer: Lined by pseudostratified columnar with vascularized wall and scattered lymphoid tissue

Highly Vascular

Pseudostratified Columnar epith Lymphoid Follicle

Note: Pag may nag-iisang lymphoid follicle at katabi niya ay epithelium BRANCHIAL CYST agad un!

A 35 yo female complained of a mass at the right preauricular area. Excision biopsy was done. A. Give the diagnosis. Answer: Pleomorphic adenoma B. Benign or Malignant? Answer: Benign C. Describe the neoplasm microscopically. Answer: Loose myxoid tissue and islands of epithelial cells of round to oval cells that form cystic structures containing eosinophilic material D. Classify the neoplasm acc to its tumor composition. Answer: Mixed Tumor

Loose myxoid tissue

Eosinophilic material

A 5 yo presented with a mass at the right parotid area. A. Give the diagnosis Answer: Capillary Hemangioma B. Give the cell of origin. Answer: Blood vessels C. Give the histogenetic origin. Answer:Mesenchymal D. Benign or Malignant? Answer: Malignant

Capillary-sized vascular space with RBC.

Note: The red dots are RBCs