PRACTICUM

ANATOMICAL PATHOLOGY
Dr. dr. Ni Wayan Winarti, Sp.PA, Subsp. URL(K)
Department of Anatomical Pathology
Faculty of Medicine, Udayana University
Prof. Dr. IGNG Ngoerah Hospital
 GLOMERULAR DISEASES
• Understanding pathogenesis of glomerular ds and for diagnostic
purposes
• Light microscopy → hyperplasia, thickening of basement membrane,
hyalinosis, sclerosis
• Hematoxyllin Eosin (HE)
• Periodic Acid Schiff (PAS)
• Masson Trichrome
• Methenamine Silver
• Immunofluorescence → immune deposits
• Electron microscopy → ultrastructure, including deposits
• Types of GNs
• Minimal change ds
• Membranous glomerulopathy
• Focal Segmental Glomerulosclerosis
• Acute Proliferative GN
• Crescentic GN
• Membranoproliferative GN
• Type I
• Type II (Dense deposit ds)
• IgA Nephropathy
• Chronic GN
Either primary or secondary
MINIMAL CHANGE DS

• LM : no abnormality
• IF : no deposit
• EM : no deposit; diffuse effacement of
foot processes of podocytes
MEMBRANOUS NEPHROPATHY
• LM :
• Basement membrane thickening (PAS)
• Spike (MS)
• IF : immune deposit → granular pattern
• EM : subepithelial deposit
FOCAL SEGMENTAL GLOMERULOSCLEROSIS
• Focal >< diffuse
• Segmental >< global

Hyalinosis and sclerosis in <50% of

glomeruli and <50% of glomerular
tuft of affected glomerulus
ACUTE PROLIFERATIVE GLOMERULONEPHRITIS
APS-GN

• LM : endocapillary proliferation
• IF : immune deposits → granular pattern
• EM : subepithelial hump
CRESCENTIC GN
LM : crescent formation
→ Extracapillary proliferation :
• Parietal cells >>>
• Visceral cells /podocytes
• Inflammatory cells
• Fibrin
MEMBRANOPROLIFERATIVE GN
- LM: Alteration of GBM, endocapillary proliferation
- EM : subendothelial deposit (Type I),
intramembranous (Type II)
IgA NEPHROPATHY

• LM: mesangial proliferation +/-

endocapillary proliferation
• IF : deposit IgA >>>
CHRONIC GN
• LM
• Glomerular sclerosis,
global/segmental
• Tubular atrophy + coloidization
• Interstitial fibrosis +
inflammation

• Sometimes it is difficult to
distinguish morphologically
with chronic kidney ds due to
other cause
LUPUS NEPHRITIS
• Secondary GN
• Circulating immune complex or/and in situ immune complex
deposition (planted Ag)
• Endogenous Ag (autoimmune ds)
• Morphology vary → class I-VI
• Lupus Nephritis → various
morphologic change → 6 classes
• Class I : normal
• Class II : mesangial proliferation and
expansion
• Class III : proliferative, focal
• Class IV : proliferative, diffuse
• Class V : membranous
• Class VI : global sclerotic
 TUBULO-INTERSTITIAL DS
• Acute Tubular Injury/Necrosis
• Pyelonephritis
• Drug-Induces Interstitial Nephritis
ACUTE TUBULAR INJURY/NECROSIS
• Epithelial cells necrosis →
occlusion of lumens by necrotic
cells
• Tubulorhexis (damage of tubular
basement membrane)
• DCT and CD → hyaline
cast/Tamm Horsfall cast
• Regenerative epithelial cells (flat
epithelial cells with enlarged
hyperchromatic nuclei)
• Edema and inflammatory cells at
interstitium
 PYELONEPHRITIS

- Tubular epithelial cells

necrosis
ACUTE PN - Leukocyte (PMN) casts
- Leukocytes infiltrate at
interstitial
- Edema

- Tubular pithelial cells

atrophy
CHRONIC PN - Hyaline casts
- MN cells infiltrate at
interstitial
- Fibrosis
DRUG-INDUCED INTERSTITIAL NEPHRITIS
• Inflammatory cells in tubular
and interstitial tissue
• Eosinophils
• Neutrophils
• Limphocytes
• Plasma Cells
TUMOR OF URINARY AND MALE GENITAL ORGAN
KIDNEY TUMOR

• The most frequent tumor of

kidney in adult:
Renal Cell Carcinoma (RCC)
• Clear cell RCC
• Papillary RCC
• Chromophobe RCC
Grade : ISUP I-IV based on nuclear
size and shape
Stage : pT (based on size,
capsular extension, LVI), pN, pM
• DD/ Xanthogranulomatous pyelonephritis
• Most frequent Renal tumor in children : Wilm’s tumor
BLADDER TUMOR
 BLADDER TUMOR
The most frequent tumor : Urothelial Carcinoma

Papillary, Non-invasive Invasive

 BLADDER TUMOR
The most frequent tumor : Urothelial Carcinoma

Low grade High grade

 PROSTATE CANCER
• Most frequent type : Acinar adeno carcinoma
• Other frequent pathology of prostate
• BPH
• Prostatitis
PROSTATITIS

Acute Chronic
BPH
PROSTATE CANCER
• Pattern
• Morphology
• Loss of basal cell
• Anaplastic changes of secretory cells
• Grade based on gleason pattern
• One tumor may composed of more than one Gleason pattern
• Gleason score = no 1 most frequent pattern + no 2 most frequent pattern
 PENILE CANCER
• The most frequent type : Squamous Cell carcinoma
• DD/ Condyloma acuminata
 Condyloma accuminata
Diffuse koilocytotic atypia, no stromal invasion
 Penile SCC
Anaplasia, koilocytotic atypia +/-, stromal invasion
Low grade High grade
 TESTICULAR TUMOR
• Mostly : Germ Cell Tumor
• Seminoma
• Non seminoma
• Endodermal Sinus Tumor
• Embryonal Carcinoma
• Choriocarcinoma
• Teratoma
• Etc
Seminoma Endodermal sinus tumor

Immature teratoma

Embryonal carcinoma Choriocarcinoma

• Tumor like mass : testicular TB