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Pathoanatomy Slides 3rd year

Pathoanatomy (Medical University-Pleven)

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Fibroadenoma (50) is the most common benign breast tumor, mostly in young women. It consists in two
components (epithelial and fibroblastic), estrogen-dependent, slowly growing.

Fibroadenoma is nodular and

encapsulated, included in breast. The
epithelial proliferation appears in a single
terminal ductal unit and describes duct-like
spaces surrounded by a fibroblastic stroma.
Depending on the proportion and the
relationship between these two
components, there are two main
histological features : intracanalicular and
pericanalicular. Often, both types are found
in the same tumor.

Serous papillary carcinoma cystadenoma of ovary (51)

Serous cystadenomas of the ovary are

thin-walled unilocular cysts that are lined
by ciliated pseudostratified cuboidal or
columnar epithelium (resembling that
lining the fallopian tube). Hobnail cells
may be present. The epithelium is
supported by variable amounts of spindle
cell stroma. Cytologic atypia is not seen.
Psammoma bodies are present in about
30% of cases.

The lining epithelium of mucinous cystadenomas usually

mucinous cystadenoma of ovary (51a)
consists of simple non-stratified columnar
cellsresembling gastric foveolar (shown here) or intestinal
epithelium. It may be thrown into folds or simple papillary
formations. Less commonly, it is endocervical type.

The intestinal epithelium is admixed with goblet cells, Paneth

cells, endocrine cells, as well as signet ring cells(rare
cases). The lining cells are capable of producing intestinal
enzymes (lipase, trypsin, and amylase) as well as peptide
hormones (serotonin, ACTH, gastrin, and somatostatin).

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Squamous Cell Carcinoma of skin (54)

In skin, tumor cells destroy the basement

membrane and form sheets or compact masses
which invade the subjacent connective tissue
(dermis). In well differentiated carcinomas,
tumor cells are pleomorphic/atypical, but
resembling normal keratinocytes from prickle
layer (large, polygonal, with abundant
eosinophilic (pink) cytoplasm and central
nucleus). Their disposal tends to be similar to
that of normal epidermis: immature/basal cells
at the periphery, becoming more mature to the
centre of the tumor masses. Tumor cells
transform into keratinized squames and form
round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The
surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes).

Basal Cell carcinoma (55)

Basal cell carcinoma is a malignant epithelial

tumor arising only in skin, from the basal
layer of the epidermis or of the
pilosebaceous adnexa. Tumor is represented
by compact areas, well delineated and
invading the dermis, apparent with no
connection with the epidermis. Tumor cells
resemble normal basal cells (small,
monomorphous) are disposed in palisade at
the periphery of the tumor nests, but are
spindle-shaped and irregular in the middle.
Tumor clusters are separated by a reduced
stroma with inflammatory infiltrate.

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Adenocarcinoma of large bowel (56)

Adenocarcinoma is a malignant
epithelial tumor, originating from
glandular epithelium of the
colorectal mucosa. It invades the
wall, infiltrating the muscularis
mucosae, the submucosa (photo)
and thence the muscularis propria.
(Notice the end-point of muscularis
mucosae. At left from this point,
muscularis mucosae is continuous.
At right from this point, muscularis
mucosae is destroyed by tumor
cells invasion.) Tumor cells
describe irregular tubular
structures, harboring stratification, multiple lumens, reduced stroma ("back to back" aspect). Depending
on glandular architecture, cellular pleomorphism and mucosecretion of the predominant pattern,
adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiate.

Teratoma of ovary (69)

Teratoma is a tumor which arises from

tutipotent germinal cells. Frequently, it is
localized in gonads (testis, ovary). It contains
a variety of tissues (derived from one, two or
three embryonic cell layers - mesoderm,
endoderm or ectoderm), tissues which
normally are foreign to the site of growth

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Seminoma of Testis (132)

Germ cell tumor of the testicle or, more rarely,

the mediastinum or other extra-gonadal locations.
Testicular seminoma originates in the germinal
epithelium of the seminiferous tubules.

Microscopic examination shows that seminomas are

usually composed of either a sheet-like or lobular
pattern of cells with a fibrous stromal network. The
fibrous septa almost always contain focal lymphocyte
inclusions, and granulomas are sometimes seen. The
tumour cells themselves typically have abundant clear to
pale pink cytoplasm containing abundant glycogen,
which is demonstrable with a periodic acid-Schiff (PAS)
stain.

Renal Cell Carcinoma (59)

Renal clear cell carcinoma (Grawitz tumor) is a

malignant epithelial tumor resulted from
proliferation of tubule cells. Tumor cells form
cords, papillae, tubules or nests, and are
atypical, polygonal and large. Because these cells
accumulate glycogen and lipids, their cytoplasm
appears "clear", lipid-laden, the nuclei remain in
the middle of the cells, and the cellular
membrane is evident. Some cells may be
smaller, with eosinophilic cytoplasm, resembling
normal tubular cells. The stroma is reduced, but
well vascularized. The tumor grows in large
front, compressing the surrounding parenchyma,
producing a pseudocapsule.

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Hepatocellular Carcinoma (59)

Hepatocellular carcinoma → developed

on liver cirrhosis. This malignant epithelial
tumor consists in tumor cells, discohesive,
pleomorphic, anaplastic, giant. The tumor
has a scant stroma and central necrosis
because of the poor vascularization. In
well differentiated forms, tumor cells
resemble hepatocytes, form cords and
nests, and may contain bile pigment in
cytoplasm.

Fibroma of Ovary (60b)

On microscopic examination, there are intersecting bundles of spindle cells producing collagen.

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Leiomyoma of the uterus (62)

Tumor cells resemble normal cells (uniform,

elongated, spindle-shaped, with a cigar-
shaped nucleus) and form bundles with
different directions (whirled). The tumor
may present areas of fibrosis, calcification
and / or hemorrhage. The tumor is well
circumscribed, but not encapsulated.

Lipoma (63)

Adenolipomas are lipomas associated with eccrine

sweat glands.

Angiolipoleiomyomas are acquired, solitary,

asymptomatic acral nodules, characterized
histologically by well-circumscribed subcutaneous
tumors composed of smooth muscle cells, blood
vessels, connective tissue, and fat.

Adenolipomas, Angiolipoleiomyomas,
angiolipomas, chondroid lipomas, Hebernomas,
Intradermal spindle cell lipomas, spindle cell
lipomas, pleomorphic lipomas

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Chondroma (64)

Chondroma is a benign cartilaginous

tumor, encapsulated, with a lobular
growing pattern. Tumor cells
(chondrocytes, cartilaginous cells)
resemble normal cells and produce the
cartilaginous matrix (amorphous,
basophilic material). Characteristic are the
vascular axes within the tumor, which
make the distinction with normal hyaline
cartilage.

Cavernous hemangioma of liver (65)

benign tumour of the liver

composed of hepatic endothelial
cells.

Typical hepatic haemangioma

Atypical hepatic haemangioma
Giant hepatic haemangioma
Flash filling hepatic
haemangioma – can account for
up to 16% of all hepatic
haemangiomas
Calcified hepatic haemangioma

Hyalinized hepatic haemangioma

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Osteosarcoma (68)

Malignant tumor whose neoplastic cells

present osteoblastic differentiation and form
tumor bone. Tumor cells are very pleomorphic
(anaplastic), some are giant and present
numerous and atypical mitotic figures. These
cells produce osteoid describing irregular
trabeculae (amorphous, eosinophilic/pink)
with or without central calcification
(hematoxylinophilic/blue, granular) - tumor
bone. Tumor cells are included in the osteoid
matrix. Cartilage may be present. Presence of
immature blood vessels (sarcomatous vessels
lacking endothelial cells) favors the
bloodstream metastasizing.

Leiomyosarcoma (62a)

malignant (cancerous) smooth muscle

tumor

tumors are usually hemorrhagic and

soft and microscopically marked by
pleomorphism, abundant (15–30 per
10 high power fields) abnormal
mitotic figures, and coagulative
tumor cell necrosis

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Neurinoma (74)

usually benign nerve sheath tumor composed of

Schwann cells, which normally produce the
insulating myelin sheath covering peripheral
nerves.
The tumor cells always stay on the outside of the
nerve, but the tumor itself may either push the
nerve aside and/or up against a bony structure
(thereby possibly causing damage). Schwannomas
are relatively slow-growing
Verocay bodies are seen histologically in
schwannoma

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Meningioma (75)

Slow-growing tumor that forms from the meninges,

the membranous layers surrounding the brain and
spinal cord.
Meningiomas arise from arachnoidal cells, most of
which are near the vicinity of the venous sinuses, and
this is the site of greatest prevalence for meningioma
formation.
Meningioma cells are relatively uniform, with a
tendency to encircle one another, forming whorls and
psammoma bodies (laminated calcific concretions). As
such, they also have a tendency to calcify and are
highly vascularized

Mallignant Melanoma (72)

Asymmetrical skin lesion.

Border of the lesion is irregular.
Color: melanomas usually have multiple colors.
Diameter: moles greater than 6 mm are more likely to be
melanomas than smaller moles.
Enlarging: Enlarging or evolving

Intradermal melanocytic nevus - a benign tumor in which

the tumor cells form nests in the dermis, are regular, round,
with central nucleus and single nucleolus. In the supreficial
dermis, some melanocytes may produce melanin pigment in the cytoplasm (dark-brown, granular).

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Dysplastic Change in Uterine Cervix (98)

most commonly occurs at the squamo-

columnar junction

The earliest microscopic change

corresponding to CIN is dysplasia of
the epithelial or surface lining of
the cervix, which is essentially
undetectable by the woman. Cellular
changes associated with HPV infection,
such as koilocytes, are also commonly
seen in CIN.

Urothenlian Carcinoma (112)

Arises from the transitional epithelium
Microinvasive

most common type of bladder cancer and

cancer of the ureter, urethra, and
urachus.

Superficial (pT1): some progress to pT2

disease and require cystectomy instead of
conservative management

Invasion of muscularis propria (pT2): 50%

have occult metastases at diagnosis,
usually becoming overt within 1 year.

Focal clear cells or choriocarcinomatous

Most urothelial carcinoma variants maintain urothelial areas may be present (rare)
immunophenotype (CK7+, CK20+, high molecular
May have spindle cells, osteoclasts,
weight cytokeratin/34ßE12+, p63+)
glandular or benign stromal elements,
plasmacytoid cells, lipid cells

May have focal pseudosarcomatous

stroma

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