A slide seminar on Clinical

Histopathology
 Chronic atrophic gastritis
• The most common inflammatory
disease of the stomach. 2 types –
superficial and profound.
•Microscopic findings :
nflammatory cells infiltrate (Ly,Pl)
in surface or/and in deeper layers of
the mucosa;
40x atrophy of the glands and
replacement with fibroconnective
tissue;
•metaplasia: Intestinal type in
antrum - replacement of foveolar
globet cell epithelium with intestinal mucous
metaplasia Goblet cell and Paneth cells)
Pseudopyloric type (replacement of
the body glandular chief and parietal
cells with mucus neck cells).

PAS 400x
atrophy of the epithelial elementes
 Large bowel
carcinoma
The most common malignant tumor of GIT is
adenocarcinoma – high, low and moderatly
differentiated. Irregular “back to back”
atypical glands composed of tall, columnar
cells, with large elongated polymorphic
nuclei with moderately condensed
chromatin. Secundary lumena are seen
100x inside the lumena of glands, due to
necrosis.

Tumor glands invade lamina propria of the

mucosa

Histological characteristics of a moderately

differentiated colonic adenocarcinoma
Tips
• use magnification 100-400x

400x
 Toxic necrosis of the liver
•3 types of necrosis:
• Diffuse: involve
zone 2
almost all the cells in
groups of lobules (in
acute viral hepatitis B
zone 1
and C, or drugs and
40x
toxicity).
• Zonal: centrilobular mostly in
zone 3, ischemic injury; midzonal,
in zone 2,
•Focal: involve small groups
irregulary (drugs, viral, tbc,
fungus).
100x
 Cirrhosis of the liver
micronodules • The normal microscopic structure of
the liver is impaired
• Liver parenchyma is organized in
fibrous septa
micronodules, devoid of central
Infiltrates lymphocytic
veins and having fibrous septa
dividing them.
Infiltrates lymphocytic
• Reactive bile duct proliferation in the
septa is present (arrows)
micronodules
• Inflammatory infiltrates
(lymphocytic) might be more or less
prominent

• Tips
• Use magnification 100-200x

bile duct proliferation

 Hepatocellular carcinoma
An organ specific malignant tumor
of the liver, originating from the
hepatocytes .

Microscopically it is presented by
400x trabecular growth pattern,
composed of cells resembling
hepatocytes with vesicular nuclei,
and prominent nucleoli.

The cytoplasm of the tumor cells is

eosinophilic to basophilic.

The pleomorphism varies, but

some times it is generally
40x significant and bizarre giant cells
may be present.
400x
 Lung emphysema – Centrilobular type

terminal
not involved bronchiole
alveoli
anthracosis

Ddistended
respiratory
Ddistended bronchiole
40x respiratory
bronchiole
• Distension of the respiratory bronchiole in
the centre of lobules.
• Surrounding alveoli are not distanded 400x
• The alveolar walls are thin and stretched.
• Spurs of broken septa are seen.
• Chronic inflammation in terminal spurs of broken septa
bronchioles
 Acute lung abscess
• An acute inflammatory
disease of lung.
•Destruction of lung parechyma
with suppurative exudate and
puss bodies in lung cavity.
• Acute inflammation around
cavity initially and later turns
into chronic inflammatory cells
(lymphocytes, plasma cells and
100x macrohages).

Bacterial colonies can be seen.

Fibroblastic proliferation forming fibrocollagenic wall in more

bacterial colonies chronic cases.(NOT IN THIS CASE!)

400x
 Silicosis of the lungs
Silica cristals

40x

Lung parenchyma with foci of severe

fibrosis – formed silicotic nodules,
composed of :
•Hyaline centre
•Concentric layers of collagen
•Fibroblasts and dust – laden
macrophages
•Silica crystals can be seen (on polarizing
400x
microscopy)
 Small cell lung cancer
The malignant tumor grows in aggregates,
cords and ribbons, often around small
blood vessels. It is composed of small,
uniform cells (larger than lymphocytes)
with round nuclei with diffuse chromatin
and sparse cytoplasm. The stroma is
scanty, presented only by thin-wall blood
vessels.

40x

400x
 Acute bacterial myocarditis
An acute inflammatory disease
of the heart. The findings are
predominated by exudate
composed of neutrophils with
some lymphocytes, plasma cells
and macrophages.
40x
Foci of myocardial damage
(swollen myocardiocytes without
exudate nuclei) are found
After careful examination,
bacterial
colonies
bacterial colonies might be seen .

400x
 Chronic pyelonephritis
A chronic inflammatory disease if the kidney. The pathological changes
are predominant in the interstitium of kidney :
1. Chronic interstitial inflammatory
reaction - lymphocytes, plasma cells
and macrophages (some prominent
aggregations of inflammatory cells are
designated with blue arrows) Single
inflammatory cells are evident almost
everywhere in the interstitium (see
small blue dots)
2. The tubules are seen with atrophy
and dilatation, some containing
eosinophilic proteinous casts (known
as thyroidisation of tubules -
designated with green arrows)
3. Glomerular hyalinosis and delicate
400x periglomerular fibrosis (designated
with arrow contours).
 Focal diabetic
glomerulosclerosis
Known as Intercapillary nodular
glomerulosclerosis (also called
Kimmellstiel – Willson lesion)

It is characterized by the presence of one

or more nodules in at least several
glomeruli (designated with arrow
contours)
100x
Each nodule is rounded, laminated,
compressed acellular , hyaline mass, situated within
capillaries

nodular
the glomerulus (see blue arrows).
deposits
The nodules are surrounded by
compressed capillaries and accompanied
by increased mesangial matrix (difficult to
distinguish).
Increased
mesangial
matrix

400x
 Subacute glomerulonephritis

Leucocytic infiltration

400x

40x
The light microscopy criteria include:
Presence of “crescents” pattern inside the
Bowman’s capsules of the glomeruli. The
“crescents” are composed of proliferated
polygonal or elongated parietal cells of
Bowman’s capsules.
Proliferation of endothelial and mesangial
cells might be present in the glomerular tufts
. Leucocytic infiltration is present in.
 Renal cell carcinoma
• A malignant organ-specific tumor of
kidney, originating from tubular cells.
normal kidney
• The presented case is a clear cell type –
the most common one.
• The tumor cells are with clear cytoplasm
(due to accumulation glycogen and lipids
40x
and removal of them from cytoplasm
during processing of tissues). The cellular
membranes are very well contoured.
• Tumor cells are arranged in several
different paterns - solid, trabecular and
tubular, separated by delicate
vascularised stroma.
use magnification 100-400x

400x
 Squamous cell carcinoma of penile

A malignant tumor of the skin of the

penile.
The tumor is formed by polygonal
squamous cells,
arranged in orderly lobules and nests
in the stroma.
40x The parenchyma of the tumor exhibit
numerous large zones of
keratinization with or without keratin
“pearls” (designated on the second
illustration with an arrow)
Tips
use magnification 40-400x
400x
 Seminoma of the testis
• A malignant organ-specific tumor of the
testis, the most common one.
• The tumor is presented by lobulated and
nested growth pattern – the lobules of
monomorphic tumor cells are separated by
delicate fibrous stroma containing thin-wall
blood vessels and lymphocytic infiltration –
a kind of stromal reaction (it can hardly be
noticed in the present case )
The characteristics of seminoma cells are:
40x • Fairly uniform and small in size
• With clear cytoplasm
• The nuclei are centrally located, large,
hyperchromatic and contain 1-2 prominent
nucleoli.

• Use magnification 100-400x

400x
 Benign prostatic hyperplasia
Predominantly glandular

A benign hyperplastic disease of the prostatic

gland .

glandular part Histological findings :

A glandular proliferation with an
Intra-glandular papillary infoldings with
fibrovascular cores.
40x
•The epithelium is divided in two layers:
- tall, columnar mucus –secreting with
indistinct margins (inner layer)
papillary - cuboidal with basal nuclei (outer layer)
infoldings
•Aggregate of spindle-shaped smooth muscle
cells can also be presented (fibro-myomatous
part)

100x
 Prostatic carcinoma
(relatively well –differentiated type)
100x
A malignant tumor of prostatic gland.
Histological findings :
Architectural changes are presented by:
back-to-back arrangement of the glands
and loss of intra-glandular papillary
convolutions
•Stroma – is invaded, scant, or no
stroma separates the tumor glands
•Pattern of the glands:
Small or medium –sized, lined by single
layer of tumor cells (in well –
differentiated tumors )
-Cribriform or fenestrated gland appearance (moderatly–
differentiated tumors) (not this one)
-Solid or trabecular pattern (poorly–differentiated tumors)
(not this one)
•Tumor cells – do not show usual sign
of malignancy May be clear, dark or eosinophilic
 CIN (cervical intraepithelial
A premalignant lesion of the neoplasia)
squamous nonkeratinising
epithilium of cervix of the The whole
uterus (PVCU). thickness of the
CIN: The dysplastic epithelium is
abnormalities are: affected (CIN III)
•crowding of cells
•pleomorphism
•high nucleo/cytoplasmic ratio 400x
(1/1)
•hyperchromasia - coarce,
irregular nuclear chromatin
•many mitoses
Koilocytes features :
Nuclear enlargement
Irregularity of the nuclear
membrane contour Koilocytes
Nuclear hyperchromasia , optic 100x
clear area around the nucleus
(perinuclear halo). 400x
 Invasive cervical carcinoma
nests of non-
keratinizing
squamous cell
cancer

panoramic picture 100x

You need to scan the whole slide!

The malignant tumor of the cervix is

composed of invasive nests of non-
keratinizing squamous cell cancer.
Pleomorphism is moderate, mitotic
figure are present, a moderate stromal
inflammation is observed.

400x
 Benign ovary mucinous
cystadenoma

• On histologic
examination, benign
mucinous tumors are
characterized by a lining
100x
of tall columnar epithelial
cells with apical mucin
and absence of cilia, akin
to benign cervical or
intestinal epithelia.
Tips
use magnification 100-400x

400x
 Serous papillary carcinoma of the
ovary
A malignant tumor of the ovaries.
Histological findings :

•Papillary formations with

fibrovascular core in the centre, lined
40x by multilayered malignant cuboidal
cells (arrows).

•Stromal invasion may be evident

•Psammoma bodies, concentric and

psammoma
calcified in the stroma.
400x bodies
 Teratoma of the
ovary
• A benign germ cell tumor
commonly composed of multiple
cell and tissue types, derived from
one or more of the 3 germ layers.
• microscopic view:
• skin (Squamous cell epithelium)
12 frames; 100x • sebaceous glands,
• smooth muscle cells
• mucinous gland
• Within normal ovary
parenchyma
Squamous cell
epithelium
sebaceous glands

100x
100x
 Simple fibrocystic change of the
breast
Sclerosing Dilation of ducts, adenosis
adenosis (enlargement, and increase in
the number of glands than
Not really?! :/
usual in the terminal ducto-
lobular unit) and fibroses of the
stroma
Mild epithelial hyperplasia in the
terminal ducts may be present (in cases
of proliferate fibrocystic changes). NOT IN
40x THIS CASE!

Apocrine metaplasia is
common in the ducts. It is
found in cystically dilated duct.
Notice the eosinophilic
Apocrine metaplasia epithelium that is covering the
duct.

400x
 Invasive NOS (ductal) carcinoma of
the breast
The most common female malignant organ-
specific tumor of the breast, known as
Carcinoma of no special type (NST) or not
otherwise specified (NOS)
Histological findings :

•Anaplastic tumor cells growing in nests,

glandular structures, cords.
40x
•Presence of fibrous (desmoplastic) stroma

•In some intraductal foci can be found – ductal

carcinoma in situ (DCIS)

Some larger
tumor nests
100x and glands
 Choriocarcinoma
A malignant tumor with origin
from placental villi.
•Absence of identifiable
placental villi
•The parenchyma of the
tumor is presented by masses
and columns of highly
anaplastic and bizarre
40x cytotrophoblastic and
syncytiotrophoblastic cells
which are intermixed.
• Invariable presence of
haemorrhages and necrosis.
•Invasion of the underlying
myometrium and other
structures, blood vessels and
lymphatics can be seen (not
present in this case)

400x
 Infant neonatal respiratory distress
syndrome

40x

The main histological characteristics

are of three types:
•atelectasis (presence of collapsed
alveoli)
•Necrosis of alveolar epithelium and
haemorrhages formation of hyaline membranes
•Oedema, congestion, haemorrhages.
400x
 Chronic lymphocytic leukaemia in liver
periportal space
central
vein
Histological findings :

The overall structure of the liver is preserved.

The periportal spaces are dilated and
100x diffusely infiltrated by malignant lymphoid
proliferation (lymphoblasts and lymphocytes
)
The sinusoids are relatively not involved .

400x
Chronic myelocytic leukaemia in liver

Histological findings :

• The overall structure of the liver is almost

preserved. The periportal spaces are
spared and free from cellular infiltration.

• The sinusoids are much dilated filled with

vast majority of myeloid cells of all
degrees of maturity.
 Malignant Hodgkin’s Lymphoma
Hodgkin's disease
lymphoid follicles
Defuse proliferation of tumor cells substitutes the
normal lymph node morphology.
On high magnification the histological findings
represent admixture of mature lymphocytes,
plasma cells, neutrophils, eosinophils, hystiocytes
and classic Reed- Sternberg – RS cells, small zones
of fibrosis and necrosis.
40x There are 4 morphological subtypes :
40x
1. lymphocyte-rich /lymphocyte predominance
2. nodular sclerosis
3. mixed-cellularity
4. lymphocyte depletion
The slide present mixed-cellularity type of
Hodjkin’s lymphoma.

400x Reed- Sternberg cells

 Macro and microfollicular goiter

Histological findings :
Hyperplastic stage)
•Tall columnar follicular epithelium with papillary infoldings and
formation of new follicles

40x •Large follicles distended by colloid and

covered by flattened follicular
epithelium (smaller follicles are also
present )

400x
 Toxic goiter in Graves` disease

Histological findings :

•Increased number of thyroid follicles

lined by high columnar cells with
formation of papillary infoldings and
100x heaps lumena of the follicles – “star-
like”view.
papillary infoldings

•The colloid is decreased in amount

,finely vacuolated and brightly stained
with H&E.

•The stroma is more vascularized and

may have lymphoid cell accumulation
400x
 Hashimoto thyroiditis
40x

Histological findings :

• Infiltration by lymphocytes, plasma

cells, immunoblasts and
macrophages, lymphoid follicles with
germ centers are found
lymphotd follicles with
germinal centres
•Decreased in number atrophic,
thyroid follicles

•Presence of Hurtle cells – follicular

epithelial cells in degenerated state
•Fibrous thickening of the stroma of
the thyroid gland

400x
 Papillary thyroid cancer
• A malignant tumor
presented by papillary
structure with central
fibrovascular stalks, covered
by single layer of overlaping
columnar tumor cells and
usually accompanied by
normal thyroid follicles.
• Tumor cells: characteristic
nuclear features (dispersed
chromatin imparting it ground
glass or optically clear
appearance – (Orphan Annie eyes).
•Psammoma bodies,
400x concentric and calcified are
found in the stroma.

Orphan Annie eyes http://voices.washingtonpost.com/comic-riffs/2010/05/comic_farewell_little_orphan_a.html

 Tuberculosis in lymph node
Tuberculous granuloma in lymph node
– identify the organ and describe a
typical tuberculosis granuloma:

• Central caseating necrosis - foci of

structureless, eosinophilic substance,
contain granular debris.

•Specific granulomatous inflammatory

100x
reaction is consisting of epitheloid cell
layer surounding the necrotic centre in
pallisade pattern, with interspersed
multinucleated giant cells of Langhans’
and peripheral mantle of T-cytotoxic
lymphocytes.
400x 400x
giant cells of Langhans’ caseosus necrosis
 Tuberculosis of the meninges
(like tuberculosis elsewhere)
giant cells of Langhans’ caseosus necrosis

400x 400x

panoramic picture 100x

Describe a typical tuberculosis
granuloma:
•caseating necrosis - foci of
structureless, eosinophilic
substance, contain granular debris.
•Specific granulomatous
inflammatory reaction consisting of
epitheloid cells, with interspersed
giant cells of Langhans’ and
peripheral mantle of lymphocytes.
100x
 Meningeoma
A benign tumor of CNS, originating from the
leptomeninges (arracnoidea and pia matter).
Meningeomas are divided into 5 subtypes
The present case represents a transitional
(mixed)
Meningioma
Combination of cells with syncytial
(predominant celular component) and
fibroblastic features with conspicuous whorled
pattern of tumour cells (large arrow) often
around central capillary – sized blood vessels.
Psamoma bodies (calcium deposits designated
with small arrows ) are present

Tips
100x •Use magnification 100-400x
 Neurinoma
A benign tumor of CNS arising from
Schwann cells. The tumor is
composed of fibrocellular bundles
forming whorled pattern. There are
areas of of densely cellularity (Antoni
A pattern), alternated with loose
100x
acellular zones (Antoni B ). Antoni A
pattern show palisaded parallel nuclei
called Verocay bodies.
Tips
use magnification 100-400x

400x
Used literature
1. Kumar, V., Abbas, A.K.
Pathologic Basis of
Disease (Robbins
)

Pathology) 8 Ed.
Saunders, Philadelphia,
2009.

2. MOHAN, H. Textbook of
Pathology 6 Ed. Jaypee
Brothers Medical
Publishers, New Delhi,
2010.