Department of General and

Clinical Pathology
Medical Faculty - Sofia
General pathology

Examination histological images

1. Degeneratio Parenchymatosa Renis

Degeneratio Parenchymatosa Renis x 10

1. Degeneratio Parenchymatosa Renis

Degeneratio Parenchymatosa Renis x 20

 1. Degeneratio Parenchymatosa Renis

Degeneratio Parenchymatosa Renis x 40

The most significant changes are seen in the proximal tubules. The epithelial cells are swollen
with indistinct borders, due to accumulation of fluid, the lumen appears narrow, some of the
cells have no visible nuclei.
 2. Steatosis hepatis

Steatosis hepatis x 20

The whole cytoplasm of the affected hepatocytes is taken up by a single large vacuole,
that pushes the nucleus to the cell membrane. The lipid content of the vacuole has been
dissolved during the processing of the tissue causing it to appear empty. The fat can
microscopically be visualized on frozen sections with some special stains ( Sudan ІІІ ).
3. Atheromatosis aortae ( HE )

Atheromatosis Aortae HE x4
 3. Atheromatosis aortae ( HE )

Atheromatosis Aortae HE x4
The most severe changes are seen in the intima. The center of the atherosclerotic plaque
contains cholesterol clefts, foamy macrophages and cellular debris, surrounded by smooth
muscle cells and collagen cap. Sometimes a superimposed thrombus on the plaque may be
seen.
 4. Anthracosis pulmonis

Anthracosis Pulmonis x10

The inhaled carbon ( anthracotic ) pigment is engulfed by the macrophages and can be
seen free in the interstitium and regional lymph nodes, brought there by the lymphatic
vessels.
5. Icterus renis

IcterusRenis x10
 5. Icterus renis

IcterusRenis x20

Bilirubin (non - iron containing pigment) imparts the yellow-orange color of the epithelial cells
of the proximal tubules and also forms bilirubin casts in the lumens of the collecting ducts.
6. Naevus pigmentosus

Naevus Pigmentosus x4
 6. Naevus pigmentosus

Naevus Pigmentosus x10

The nevus cells are densely packed, forming nests surrounded by delicate bundles of connective
tissue. The cytoplasm contain dark brown pigment – melanin. Depending on the location of the tumor
cells, nevi may be intraepidermal, intradermal and compound.
6. Atrophia Fusca Hepatis

Atrophia Fusca Hepatis x20

 6. Atrophia Fusca Hepatis

Atrophia Fusca Hepatis x40

More lobules are seen at the low power, dilated sinusoids, centrilobular hepatocytes with
goldenbrown cytoplasmic pigment – lipofuscin.
7. Induratio fusca pulmonis (HE )

Induratio Fusca Pulmonis HE x10

 7. Induratio fusca pulmonis (HE )

Induratio Fusca Pulmonis HE x10

There are numerous distended capillaries in the interalveolar septa and blood
extravasation. The breakdown of Er leads to accumulation of hemosiderin in alveolar
macrophages ( hemosiderophages, heart failure cells) imparting to the rusty brown colour of
the lungs. There is also thickening of the interalveolar septa, due to collagen deposition.
8. Induratio fusca pulmonis (FE )

Induratio Fusca Pulmonis FE x10

 8. Induratio fusca pulmonis (FE )

Induratio Fusca Pulmonis FE x20

The iron containing pigment stains deep blue with Prussian blue reaction.
9. Hyalinosis arteriolarum renis

Hyalinosis arteriolarum renis x20

 9. Hyalinosis arteriolarum renis

Hyalinosis arteriolarum renis x20

Example of extracellular (insudation ) hyaline deposition in the walls of arterioles, that results in
thickening of the latter and narrowing of their lumen . Afferent arteriols are affected predominantely
in the case of arterial hypertension, both (afferent and efferent ) – in the case of diabetes.
10. Corpus Albicans Ovarii

Corpus Albicans Ovarii x4

 10. Corpus Albicans Ovarii

Corpus Albicans Ovarii x10

Corpus albicans appiers as large pale pink homogenous structure with irregular borders. It
is an example of physiologic extracellular accumulation of hyaline. Around those structures
is seen the ovarian stroma that appears dark purple.
 11. Amyloidosis renis (HE)

Amyloidosis renis (HE) x10

Amyliod appears as an eosinophilic homogenous acellular substance in glomeruli (
mesangial matrix, along the basement membrane). Amyloid also deposits in the small
arteries and arterioles, along the basement membrane of the renal tubules and in the
intersticium .
 12. Amyloidosis renis (MV, Congo red )

Amyloidosis renis (MV, Congo red ) x10

Some special stains are used to demonstrate amyloid microscopically. One of them is
metilviolet, that metachromatically stains amyloid dark purple. Congo red stains amyloid
vivid orange, while the uninvolved areas are pale yellow .
 13. Amyloidosis lienis (HE )

Amyloidosis lienis (HE ) x10

Two patterns of deposition may be seen. In one the lace-like pink amorphous deposits
are mainly limited to the splenic follicules, replacing their structure – that form is called
sago spleen. In the other pattern the deposits involve the walls of splenic sinuses ( red
pulp ), sparing the follicules – that form is called lardaceous spleen
14. Necrosis lymphonodi

Necrosis lymphonodi x4
 14. Necrosis lymphonodi

Necrosis lymphonodi x10

Preserved structure of the lymph node on the right and area of caseous necrosis
occupying the left and central part of the lymph node ( pink acellular substance ). In the
interface – specific granulation tissue , composed of epitheloid and gigant cells Langhans
type
15. Necrosis Myocardii

Necrosis Myocardii x10

 15. Necrosis Myocardii

Necrosis Myocardii x20

Area of coagulative necrosis : granular eosinophilic cytoplasm of myocardial cells, indistinct

cross striations, nuclei of the cells have disappiered. The necrotic region is demarcated
from the normal myocardium by an infiltrate of neutrophils and dilated blood vessels (
demarcation inflammation and hemorrhagic – hyperaemic zone ).
16. Necrosis cerebri

Necrosis Cerebri x10

 16. Necrosis Cerebri

Necrosis Cerebri x20

Loose appearance of the necrotic area compared to the vital brain parenchyma. At the rim
of the uninvolved brain one finds lipid-laden macrophages, hemosiderophages and red
neurons. At the later stages – glial proliferation( reactive astrocytosis) around the infarct.
 17. Necrosis Renis

Necrosis renis x10

Necrotic tissue is pale and eosinophilic and only ghosts of the normal structures may be
seen. There are no visible nuclei in the necrotic area. The latter is demarcated from the
surrounding vital parenchyma by neutrophils and more towards the uninvolved tissue – rim
of extravasated Er and distended capillaries ( hemorrhagic – hyperaemic zone).
 18. Oedema pulmonis

Oedema pulmonis x10

Capillaries of the alveolar walls are engorged with blood and become leaky due to
increased permeability. As a result fluid and little amount of proteins accumulate in the
interstitium first, then in the alveolar spaces.
 19. Cyanosis hepatis

Cyanosis hepatis x20

The changes are due to acute hepatic congestion. The hallmarks are distended with blood
central veins and sinusoids and mild disarray in the normally radial fashion of the hepatic
lamellae. The overall architecture of the lobules is preserved and the changes are
reversible.
20. Hepar moschatum

Hepar moschatum x4
 20. Hepar moschatum

Hepar moschatum x10

The changes are due to passive chronic congestion of the liver. Since the central portion
of the hepatic lobule is the last one to receive blood, there is loss of hepatocytes in that
area, congestion and hemosiderophages. The periportal better oxygenated hepatocytes only
develop fatty change.
21. Haemorrhagie punctatae cerebri

Haemorrhagie punctatae cerebri x4

21. Haemorrhagie punctatae cerebri

Haemorrhagie punctatae cerebri x10

 21. Haemorrhagie punctatae cerebri

Haemorrhagie punctatae cerebri x10

Pinhead hemorrhages in the white matter of the brain due to increased permeability of the
blood vessels and diapedesis. The structure of the blood vessel walls is unremarkable.
Many Er are seen around blood vessels arranged in discoid manner
 22. Thrombus mixtus

Thrombus mixtus x10

The thrombus attached to the blood vessel wall has apparent laminations ( lines of Zahn ).
They are composed of darker layers containing more red cells alternating with pale layers
composed of platelets admixed with fibrin. Both layers contain also leukocytes
 23. Thrombus organisatus

Thrombus organisatus x10

Thrombi may be invaded by inflammatory cells, fibroblasts , smooth muscle cells and
endothelial cells proliferating from the blood vessel wall – granulation tissue is formed with
many capillary channels that at least partly restore the patency of the blood vessel. The
process of conversion of thrombotic mass into granulation and fibrotic tissue is called
organization.
24. Infarctus haemorrhagicus pulmonis

Infarctus haemorrhagicus pulmonis x10

 24. Infarctus haemorrhagicus pulmonis

Infarctus haemorrhagicus pulmonis x20

The necrotic area appears as red hemorrhagic zone , flooded with Er and
hemosiderophages . The underlying lung structure is indistinct with only ghosts of alveolar
septa, bronchioles and blood vessels remaining.
25. Pneumonia lobularis

Pneumonia lobularis x10

25. Pneumonia lobularis

Pneumonia lobularis x10

25. Pneumonia lobularis

Pneumonia lobularis x20

 25. Pneumonia lobularis

Pneumonia lobularis x20

There are foci of inflammation in the alveoli around a bronchiole. The inflammatory exudate
has variable amount of cells mostly neutrophils and fibrin. In the nearby parenchyma areas
of edema , congestion and nearly preserved areas are seen - an overall polymorphous
picture in contrast to the case of croupous (lobar) pneumonia.
 26. Pneumonia lobaris

Pneumonia lobaris x20

The alveolar spaces are filled with exudate and due to the processing of the tissue and shrinkage of
the latter there is a clear space between the alveolar walls and the exudate. The interalveolar septa
are widened with congested capillaries . The effacement of the normal spongy structure of the lung
parenchyma gives one the erroneous feeling of looking at liver tissue ( hence the term hepatisation ).
 27. Pneumonia lobaris ( Weigert )

Pneumonia lobaris ( Weigert )

That stain gives the fibrin strands in the exudates deep blue colour.
28. Pericarditis fibrinosa

Pericarditis fibrinosa x4
28. Pericarditis fibrinosa

Pericarditis fibrinosa x10

28. Pericarditis fibrinosa

Pericarditis fibrinosa x10

 28. Pericarditis fibrinosa

Pericarditis fibrinosa x10

Over the unremarkable myocardium and subepicardial fat tissue there is thick layer of
eosinophilic fibrin intermixed with inflammatory cells , placed over the mesothelial surface.
Under the mesothelial lining there are dilated blood vessels. That slide is a classic
example of superficial fibrinous inflammation.
29. Leptomeningitis purulenta

Leptomeningitis purulenta x4
29. Leptomeningitis purulenta

Leptomeningitis purulenta x4
29. Leptomeningitis purulenta

Leptomeningitis purulenta x20

 29. Leptomeningitis purulenta

Leptomeningitis purulenta x10

The subarachnoid space is widened and filled with exudate composed primarily of
neutrophils that spreads over the brain surface ( phlegmonous inflammation ). The
leptomeningeal blood vessels are considerably congested. As for the underlying brain
tissue – it is spared of the inflammation.
 30. Appendicitis phlegmonosa

Appendicitis phlegmonosa

The whole thickness of the appendiceal wall is infiltrated by neutrophils ( phlegmonous

inflammation ). The lymphoid follicles of the submucosa are enlarged often with prominent
germinal centers. The lumen is filled with amorphous debris , the subsecosal blood vessels
are dileted.
31. Nephritis purulenta ( pyelonephritis acuta abscedens )

Nephritis purulenta ( pyelonephritis acuta abscedens ) x10

 31. Nephritis purulenta ( pyelonephritis acuta abscedens )

Nephritis purulenta ( pyelonephritis acuta abscedens) x20

Multiple small collections of neutrophils forming abscesses ( liquefactive necrosis ) are

scattered throughout the cortex of the kidney in the case of hematogenous spread of the
infection. Neutrophils can be found in the tubules also. In the case of intracanallicular
spread of the infection, the abscesses may be found in the two poles.
32. Granulatio

Granulatio x10
 32. Granulatio

Granulatio x20

Granulation tissue is composed of mixed cellular infiltrate and small capillary channels with
increased permeability that imparts the edematous appearing of the intercellular space. It is
part of the healing process. The fibroblasts produse collagen that gradually replaces the
granulation tissue – organization.
33. Granuloma corporis alieni

Granuloma corporis alieni x4

33. Granuloma corporis alieni

Granuloma corporis alieni x10

33. Granuloma corporis alieni

Granuloma corporis alieni x20

 33. Granuloma corporis alieni

Granuloma corporis alieni x20

The slide represents remnants of surgical sutures surrounded by inflammatory infiltration of

multinucleated foreign body type giant cells , lymphocytes and plasma cells , forming non-
necrotic granulomas. The latter are located in the dermis
34. Abscessus chronicus cerebri

Abscessus chronicus cerebri x4

 34. Abscessus chronicus cerebri

Abscessus chronicus cerebri x10

There is a basophilic area of necrosis , composed of many neutrophils and cellular debris.
That zone is surrounded by foamy macrophages ( contain lipids from the necrotic tissue) ,
followed outside by a layer of reactive glial cells and some fibrosis.
35. Cirrhosis hepatis ( HE )

Cirrhosis hepatis ( HE ) x4
 35. Cirrhosis hepatis ( HE )

Cirrhosis hepatis ( HE ) x10

There is complete transformation of normal lobular architecture , due to inflammation and

necrosis , followed by formation of thick fibrous septae and simultaneous regeneration of
hepatocytes. The fibrous septa divide the liver parenchyma into pseudolobules. These septa
are infiltrated by inflammatory cells and contain newly formed bile ducts.
36. Cirrhosis hepatis (VG)

Cirrhosis hepatis (VG) x10

36. Cirrhosis hepatis (VG)

Cirrhosis hepatis (VG) x20

 36. Cirrhosis hepatis (VG)

Cirrhosis hepatis (VG) x20

With this stain collagen septa appear in red , hepatocytes in yellow.

37. Cicatrices myocardii ( HE )

Cicatrices myocardii ( HE ) x10

37. Cicatrices myocardii ( HE )

Cicatrices myocardii ( HE ) x10

 37. Cicatrices myocardii ( HE )

Cicatrices myocardii ( HE ) x20

Pale pink area is seen that represents replacement of the normal myoradial tissue with
fibrous tissue ( cicatrix ). In the early stages it contains big thin-walled blood vessels that
disappear with time. At the periphery of the cicatrix cardiomyocytes with compensatory
hyperplasia may be seen.
38. Cicatrices myocardii (VG)

Cicatrices myocardii (VG) x4

 38. Cicatrices myocardii (VG)

Cicatrices myocardii (VG) x10

That dye stains collagen red , cardiomyocytes yellow.

39. TBC miliaris pulmonis

TBC miliaris pulmonis x4

39. TBC miliaris pulmonis

TBC miliaris pulmonis x10

 39. TBC miliaris pulmonis

TBC miliaris pulmonis x20

Scattered in the lung interstitium are rounded circumscribed granulomas with characteristic
structure. The center of these granulomas contains acellular pink caseous necrosis ,
surrounded by epitheloid cells and Langhans type giant cells. The outermost part of the
tubercle is composed of round cells , predominantly lymphocytes. Preserved blood vessels
are not seen.
40. Leptomeningitis tuberculosa

Leptomeningitis tuberculosa x4
40. Leptomeningitis tuberculosa

Leptomeningitis tuberculosa x10

 40. Leptomeningitis tuberculosa

Leptomeningitis tuberculosa x10

The typical granulomas may be found in the leptomeninges along with dileted blood
vessels. Arteries running through the subarachnoid space may show obliterative endarteritis
with intimal thickening and inflammatory infiltrates within their walls.
41. Mesaortitis luetica

Mesaortitis luetica x10

 41. Mesaortitis luetica

Mesaortitis luetica x10

Mononuclear inflammation composed of lymphocytes and plasma cells can be found

around vasa vasorum in adventicia. Another common event is vascularisation and
perivascular inflammation of the media, which leads to destruction of elastic fibers followed
by scarring.
 42. Actinomycosis

Actinomycosis

The pathogen appears as basophilic granules with radiating edges called sulfur granules,
enveloped by purulent exudates. Around the abscess cavity many foamy macrophages may
be seen and granulation tissue.
43. Struma lymphomatosa

Struma lymphomatosa x10

 43. Struma lymphomatosa

Struma lymphomatosa x20

The hallmark features are: mononuclear infiltrates in the parenchyma with development of
germinal centers, reactive epithelial cells with abundant pink cytoplasm ( Hürthle cells ) and
increased connective tissue.
 44. Polyarteritis nodosa

Polyarteritis nodosa

Transmural necrotizing inflammation of small and medium sized blood vessels. The
changes depend on the phase of the disease. In the acute phase there is dense
inflammatory infiltrate of mononuclear cells and neutrophils affecting the whole thickness of
the wall ( transmural ). The typical fibrinoid necrosis appears homogeneous and eosinophilic.
45. Emphysema Pulmonis

Emphysema Pulmonis x4
 45. Emphysema Pulmonis

Emphysema Pulmonis x10

Thinning and destruction of interalveolar septa due to loss of elastic fibers and reduction
of capillaries. Remnants of destroyed alveolar septa may be seen protruding into the
alveoli. Some of the alveolar spaces coalesce to form bigger air – filled cavities.
46. Atrophia Fusca Hepatis

Atrophia Fusca Hepatis x20

 46. Atrophia Fusca Hepatis

Atrophia Fusca Hepatis x40

More lobules are seen at the low power, dilated sinusoids, centrilobular hepatocytes with
goldenbrown cytoplasmic pigment – lipofuscin.
47. Hyperplasia mucosae uteri glandularis cystic

Hyperplasia mucosae uteri glandularis cystic x4

 47. Hyperplasia mucosae uteri glandularis cystic

Hyperplasia mucosae uteri glandularis cystic x10

Both glandular and stromal component are hyperplastic. Glands vary in size and shape,
some showing infoldings and outpouchings and some are cystically dilated. The stroma is
also hyperplastic and cellular, similar to proliferative endometrium.
48. Hyperplasia glandulae prostatae

Hyperplasia glandulae prostatae x4

 48. Hyperplasia glandulae prostatae

Hyperplasia glandulae prostatae x10

There is an increase in the glandular component ( adenomatous hyperplasia ) together with

an increase in smooth muscle and fibrous stroma ( fibroleiomyomatous hyperplasia ). The
lumen of the glands may contain pale eosinophilic secretions ( corpora amylacea ).
49. Struma colloides

Struma colloides x10

49. Struma colloides

Struma colloides x20

 49. Struma colloides

Struma colloides x60

Enlarged follicles are seen, lined by a single layer of flattend epithelial cells ( histologic
accommodation ). The lumen of follicles is filled with eosinophilic substance ( colloid ).
 50. Fibrocystic disease

Fibrocystic disease
The hallmark features are: 1. Adenosis – increased number of acini within the lobular units.
2. Cystically dilated ducts, some of them featuring apocrine metaplasia of the lining
epithelium ( epithelial cells with abundant eosinophilic cytoplasm ). 3. Fibrosis – increased
amount of dense pink collagen around ducts and lobules. 4. Proliferative changes - some
of the lining epithelium may show hyperplasia.
 51. Fibroadenoma glandule mammae

Fibroadenoma glandule mammae x4

Simultaneous proliferation of connective tissue stroma and glandular epithelium. The latter
is represented by ducts of variable shape and length – some of them have round well
visible lumen ( pericanalicular variant ) and in other the surrounding stroma is bulging into
the duct giving it a slit-like shape ( intracanalicular variant ). Both histologic types may be
present within one tumor.
 52. Cystadenoma papilliferum ovarii

Cystadenoma papilliferum ovarii x4

This tumor consists of fibrous capsule from which many papillary growths protrude into the
lumen. They have a core of connective tissue lined by a single row of cuboidal or
columnar epithelium which sometimes is ciliated, resembling tubal epithelium.
 53. Adenoma villosum recti

Adenoma villosum recti

Adenoma consists of tightly packed tubules and long finger-like projections ( villi ). This is
true neoplastic polyp because exhibits dysplasia of the epithelium: the lining epithelium is
composed of crowded cells with pseudostratified hyperchromatic nuclei and occasional
mitoses, basement membrane is well preserved.
54. Adenoma pleomorphae glandule parotis

Adenoma pleomorphae glandule parotis x10

 54. Adenoma pleomorphae glandule parotis

Adenoma pleomorphae glandule parotis x20

The essential feature is that the tumor is composed of variable proportions of both
epithelial and mesenchymal tissues ( hence the old name tumor mixtus ). The epithelial cells
form nests, cords , trabecular or duct-like structures surrounded by mucoid amorphous
ground substance. The latter may contain islands of cartilage or even bone.
55. Papilloma planocellulare lingue

Papilloma planocellulare lingue x4

 55. Papilloma planocellulare lingue

Papilloma planocellulare lingue x10

This tumor has papillary structure , composed of finger-like projections with central
fibrovascular core and lining squamous epithelium.
56. Carcinoma planocellulare keratodes

Carcinoma planocellulare keratodes x10

 56. Carcinoma planocellulare keratodes

Carcinoma planocellulare keratodes x20

This is the well-differentiated variant of squamous cell carcinoma. It consists of large nests
of cells with abundant pink cytoplasm resembling the cells of prickle cell layer. In the
center of those nests whorls of pink acellular keratinaceous material produced by the
tumor cells may be seen.
57. Carcinoma basocellulare

Carcinoma basocellulare x10

 57. Carcinoma basocellulare

Carcinoma basocellulare x20

The basal layer of the squamous epithelium is contiguous with nests in the dermis ,
composed of basophilic tumor cells reminiscent of the basal layer cells of the epidermis. At
the periphery of the nests there is typical radial orientation of the cells ( palisading ) and
detachment of the stroma from the nests with formation of clear spaces ( separation
artefacts ).
58. Carcinoma gelatinosum

Carcinoma gelatinosum x10

58. Carcinoma gelatinosum

Carcinoma gelatinosum x20

58. Carcinoma gelatinosum

Carcinoma gelatinosum alcian blue x10

 58. Carcinoma gelatinosum

Carcinoma gelatinosum x40

Tumor cells produce increased amount of pale amorphous mucin substance that forms lakes,
dissecting through the smooth muscle layer of the intestinal wall. Groups or single tumor cells may
be seen, some of them containing mucin in their cytoplasm (signet ring cells ).
Special stain for mucin is Alcian blue. It demonstrates intra- as well extracellular mucin light blue.
59. Adenocarcinoma ventriculi

Adenocarcinoma ventriculi x4
 59. Adenocarcinoma ventriculi

Adenocarcinoma ventriculi x20

Here is shown the intestinal type of gastric adenocarcinoma, demonstrating darker

appearing malignant glands with different form and shape and with cellular atypia, invading
through gastric submucosa and muscularis propria. The border between the neoplastic and
normal tissue is well visible.
60. Adenocarcinoma uteri

Adenocarcinoma uteri x10

 60. Adenocarcinoma uteri

Adenocarcinoma uteri x20

Here is demonstrated the endometrioid type of adenocarcinoma of the uterus. There are
many villous and glandular structures packed tightly „ back to back“, lined with malignant
epithelium, with almost none intervening stroma, invading through the myometrium.
61. Carcinoma renis

Carcinoma renis x10

61. Carcinoma renis

Carcinoma renis (hypernerhoma) x10

61. Carcinoma renis

Carcinoma renis (hypernerhoma) x20

 61. Carcinoma renis

Carcinoma renis x40

The tumor cells are large and rich in glycogen which dissolves in the course of
preparation of the slide, therefore their cytoplasm appears optically clear, similar to that of
plant cells. The nuclei are dark and centrally placed. Those cells are arranged in nests or
trabeculae with delicate intervening fibrovascular stroma. Necroses and hemorrhages are
common.
62. Carcinoma hepatocellulare

Carcinoma hepatocellulare x10

 62. Carcinoma hepatocellulare

Carcinoma hepatocellulare x20

The cells of well-differentiated tumor resemble hepatocytes, arranged most often in one or
multiple cells thick trabecular architecture. However they do not form lobules. The stroma is
sparse, portal spaces or bile ducts are not seen. Some of the tumor cells may contain bile
pigment or lipid vacuoles.
63. Seminoma testis

Seminoma testis x10

63. Seminoma testis

Seminoma testis x10

 63. Seminoma testis

Seminoma testis x20

Typical for classic seminoma are nests formed by round tumor cells with ample glycogen
containing pale cytoplasm with large vesicular nuclei. Those nests are enclosed in
connective tissue stroma, that shows characteristic lymphocytic infiltrate.
64. Choriocarcinoma

Choriocarcinoma x10
64. Choriocarcinoma

Choriocarcinoma x20
 64. Choriocarcinoma

Choriocarcinoma x20
Atypical proliferation of trophoblastic cells without stroma. The tumor is composed of two
cell types that are in direct contact with the surrounding blood: cytotrophoblastic cells –
mononuclear cells with pale cytoplasm and distinct cell borders; syncytiotrophoblastic cells –
large, multinucleated, with dense pink cytoplasm, forming invaginations, in which often Er are
situated.
65. Carcinoma papillare glandule thyreoideae

Carcinoma papillare glandule thyreoideae x10

65. Carcinoma papillare glandule thyreoideae

Carcinoma papillare glandule thyreoideae x10

 65. Carcinoma papillare glandule thyreoideae

Carcinoma papillare glandule thyreoideae x20

Typical are branching papillary structures with central fibrovascular core, lined by a layer of
differentiated cuboidal epithelium. The hallmark features of that epithelium, that are critical for the
diagnosis are: 1. Empty appearing nuclei ( ground glass nuclei ), 2. Invagination of the cytoplasm into
the nuclei ( „coffee bean nuclei” ) and 3. Overlapping of the nuclei. Sometimes concentrically
laminated structures are seen within the fibrovascular cores ( psammoma bodies ).
 66. Carcinoma ductale glandule mammae

Carcinoma ductale glandule mammae

Tumor cells are arranged in ductal structures with variable form and shape and are seen
to invade into the marginal fatty tissue. They are encased in usually dense fibrous stroma.
In some areas the stroma is so dense, that the tumor cells appear as single invading
cells and may be confused with the typical pattern in lobular carcinoma.
 67. Carcinoma lobulare glandule mammae

Carcinoma lobulare glandule mammae

Tumor cells invade as single cells forming “indian file “ due to lose of cohesiveness. They
are embedded in dense fibrous stroma. Indian files often grow around ductules or blood
vessels – the so called targetoid lesions. Both growth patterns are suggestive but not
entirely specific for invasive lobular carcinoma.
68. Metastases lymphonody

Metastases lymphonody x10

 68. Metastases lymphonody

Metastases lymphonody x20

In this case the residual lymphoid tissue is well recognized. It has a distinct border with
the metastasis, which is composed of considerably larger tumor cells, that stain lighter. The
latter invade and replace the normal lymphoid structure. Sometimes the tumor penetrates
the capsule and invades adjacent fat tissue.
 69. Lymphangiosis carcinomatosae pulmonis

Lymphangiosis carcinomatosae pulmonis

Multiple tumor emboli packed in distended lymphatic vessels subpleurally and in the lung
interstitium are seen. Some of them have central necrotic areas, composed of pink granular
acellular debris (comedonecrosis ).
70. Fibroma

Fibroma x4
70. Fibroma

Fibroma x10
 70. Fibroma

Fibroma x20

In the dermis bundles of fibrocytes ( cells with spindle shaped nuclei with pointed edges )
and collagen crossing in different directions are seen. If cellular elements predominate, the
term fibroma molle is applied, if collagen predominates – the term fibroma durum is in use.
The collagen stains red with Van Gieson.
71. Leiomyoma

Leiomyoma (HE) x10

71. Leiomyoma

Leiomyoma (VG) x10

 71. Leiomyoma

Leiomyoma (VG) x20

The tumor is well circumscribed, but not encapsulated and composed of bundles of smooth
muscle cells with cigar shaped nuclei. Collagen encases bundles of smooth muscle cells
that can be demonstrated with Van Geason stain.
72. Lipoma

Lipoma x4
 72. Lipoma

Lipoma x10

The tumor is composed of cells with empty looking cytoplasm due to dissolution of fat
during the processing of the biopsy. The fibrous capsule that surrounds the tumor sends
fibrous septa inside it, that divides it into lobules.
73. Chondroma

Chondroma x10
 73. Chondroma

Chondroma x20

Encapsulated tumor composed of groups of chondrocytes placed in matrix of ground

substance of acid mucopolysacharides. The tumor has blood vessels only along the fibrous
septa, which often leads to areas of necroses and cystic degeneration.
74. Haemangioma cavernosum hepatis

Haemangioma cavernosum hepatis x10

 74. Haemangioma cavernosum hepatis

Haemangioma cavernosum hepatis x10

Anastomosing fibrous septa that surrounds spaces lined with flat epithelium and filled with
blood. They are not true vessels, that doesn’t have elastic membrane. The tumor is not
encapsulated, but is well circumscribed from the surrounding liver parenchyma.
75. Fibrosarcoma

Fibrosarcoma x10
 75. Fibrosarcoma

Fibrosarcoma x20

Spindle shaped tumor cells forming bundles arranged at right angles ( herring-bone pattern
). Great nuclear pleomorphism, high mitotic count, necroses and hemorrhages are not
typical. Well differentiated variant retains its ability to produce collagen, that may be seen
between the cells using Van Geason stain.
76. Leiomyosarcoma

Leiomyosarcoma x20
 76. Leiomyosarcoma

Leiomyosarcoma x40

Tumor cells show ample pink cytoplasm and easily detectable nuclear and cellular
pleomorphism, that can be appreciated even at low magnification. Mitoses including
abnormal ones are readily seen. Typical are the giant tumor cells, areas of necrosis and
hemorrhages.
77. Liposarcoma

Liposarcoma x20
77. Liposarcoma

Liposarcoma
 77. Liposarcoma

Liposarcoma x40

Thick fibrous septa intersect the tumor, which are cellular and contain spindle or
polymorphous cells, seen even at low magnification. Lipoblasts may be seen – big cells with
multiple vacuoles, that indentate the nucleus.
78. Sarcoma osteogenes

Sarcoma osteogenes x4
78. Sarcoma osteogenes

Sarcoma osteogenes x10

 78. Sarcoma osteogenes

Sarcoma osteogenes x40

Proliferating osteoblast-like giant cells produce unmineralized matrix ( osteoid ) that appears
as pink lace-like substance. The tumor cells are scattered in between the osteoid
substance. They are higly pleomorphic and atypical mitoses frequently may be seen. In
some tumors fibrous, myxoid or cartilaginous substance may predominate.
79. Astrocytoma

Astrocytoma x10
 79. Astrocytoma

Astrocytoma x20

The tumor cells are stellate-shaped cells, resembling astrocytes. They have round dark
nuclei with mild pleomorphism. In fibrillary astrocytoma tumor cells have spider-leg
projections that form microcystic spaces. Necroses and hemorrhages are not seen.
80. Glioblastoma multiforme

Glioblastoma multiforme x20

 80. Glioblastoma multiforme

Glioblastoma multiforme x40

The tumor is more cellular compared to astrocytoma and tumor cells exibit increased
cellular and nuclear pleomorphism. The neoplasm contains foci of hemorrhages and
necroses, with tumor cells forming palisades around necrotic centers. A characteristic finding
is proliferation of endothelial cells in the capillaries ( glomeruloid structures ).
81. Meningioma

Meningioma x10
 81. Meningioma

Meningioma x20
Tumor cells are oval or spindle shaped and are arranged in nests separated by
connective tissue ( cyncitial grwth pattern ). In the center of those conglomerates of cells,
small concentrically laminated purple structures may be seen ( psammoma bodies ). When
psammoma bodies comprise more than 75% of the tumor – this is psammoma variant of
meningioma.
82. Neurinoma

Neurinoma x10
 82. Neurinoma

Neurinoma x20
Two types of growth pattern may be observed: Antoni A have fascicular architecture with
spindle cells forming parallel bundles. Their nuclei are lined in palisading manner like
solgers . The pink area formed by the cytoplasmic processes that is located between two
rows of nuclei is called Verocay body. Antoni B is composed of tumor cells placed in
loose, myxoid ground substance.
83. Melanoma malignum

Melanoma malignum x10

 83. Melanoma malignum

Melanoma malignum x20

The tumor cells may be seen infiltrating all three layers of the skin and ulcerating the
overlaying epidermis. They may be epitheloid ( with ample cytoplasm ) or spindle shaped (
elongated ). In some cases tumor cells produce excessive amount of brown pigment –
melanin that obscures the cellular features. In other cases there is no melanin production –
achromatic variants.
 84. CML – liver

CML – liver
In chronic myelogenous leukemia the hepatic lobules are diffusely infiltrated by abnormal
myelogenous precursor cells – mainly between the liver plates along the sinuses. The
neoplastic infiltrates are more polymorphous compared to the CLL , because in CML the
tumor cells are at various levels of differentiation.
 85. CLL – liver

CLL – liver

In chronic lymphocytic leukemia the infiltrates form circumscribed foci mainly in the portal
tracts. The cells of the infiltrates consists of lymphocytes with round , hyperchromatic nuclei
and thin rim of cytoplasm, that are morphologically indistinguishable from normal Ly.
86. Hodgkin lymphoma

Hodgkin lymphoma x40

 86. Hodgkin lymphoma

Hodgkin lymphoma x40

The normal architecture of the lymph node is effaced by an infiltrate of a mixed cell population
drown to the lymph node by the true neoplastic cells – Reed-Sternberg cells, that represent no
more than 1-2% of the cellullarity. In the nodular sclerosis type thick bundles of collagen divide the
lymph node into smaller sections. Tipycal here are lacunar RS cells. In the mixed cellularity group
tipycal are the lymphohistiocytes ( so called „ popcorn cells „).