BMS314 Practical Summaries

Practical 1 – Describing Lesions

Today’s Slides
Digital slide label
Glass slide #

Example # Normal tissue Lesion tissue

1 Slide 80 (080 Liver) Slide 43 (Path043)

2 Slide 56 (056 Kidney) Slide 4 (Path004)

3 Slide 36 (036 skinC) Slide 63 (Path063)

4 Slide 42 (042 Lung) Slide 12 (Path012)

Describing a Lesion
1. What tissue is it? 4. What is the nature of the change?
• Organ • Is it cellular?
• Location of the lesions (e.g. cortex, medulla) - uniform or mixed?
• Is it non-cellular?
2. Describe the distribution of the lesion? - pigmented – what colour?
• Diffuse - Granular?
• Focal
• Multi-focal 5. What is the size, shape, demarcation of
• Multifocal coalescing the lesion?
• Is it regular/ symmetrical in shape or is it
3. Estimate the severity of lesion irregular?
• Mild
• Is well demarcated or poorly demarcated?
• Moderate
• Estimate the size (in mm)
• Severe
• Mild-moderate 6. Timing?
• Moderate-severe • Acute?
• Estimate the % of tissue affected • Sub-acute?
• Chronic?
Example 1 – Slide 80 (080)
• Low magnification examination of Slide 80 is shown in Figure1.

• Can you recognise the tissue at low magnification? It is very

solid, and has holes of various diameter (blood vessels).

• Any tissues that it definitely is not? Obviously not lung, unless

fabulously consolidated, but you should be able to state examples of
what it is not, if you get stuck saying what it is! Revise last year’s
histology if it looks like you need to!

• Any tissues that it might be? Well, you should state an organ, as a
Fig 1. Slide 80 (H&E) x1.2 hypothesis, then try and think what the key identifying features would be,
to support your hypothesis. If you think it is kidney, you should see
glomeruli at modest magnification, but not naked eye, although you
would see renal cortex and medulla by naked eye.
Example 1 – Slide 80 (080)

• What features can you see? The tissue has overall a solid make-up,
plus a wedge shaped outline, a smooth surface (perhaps
visceral/mesothelial), the various diameter blood vessels, and the zonal
pattern, are all clues here. You can also see its zonal architecture which
will help to identify it

• For the tissue(s) you think it could be, what would you
expect to see at higher magnification that might confirm
your hypothesis?

Fig 1. Slide 80 (H&E) x1.2

Lets look at higher magnification!
Example 1 – Slide 80 (080)
• At higher magnification (fig. 2), can you
identify any specific structures or cell
types? This shows the portal region, with a bile duct,
lined by cuboidal epithelium. As well as portal vein (large
diameter and thin wall) and portal artery (small diameter,
thick wall.

• If you have a hypothesis that it is a certain

tissue, can you state what evidence
hepatic artery
supports your hypothesis? A well-demarcated
organ with the presence of portal triads and central veins
organised into lobules, with a regular dense pattern of
large cells resembling hepatocytes, supports the
conclusion that this is normal liver
Fig. 2 Slide 80 (H&E) x30
Example 1 – Slide 43 (Path043)
• What is the tissue? Should be easy now – liver!

• How might you describe the distribution and severity of the lesion?
Multifocal to coalescing, affecting approximately 50% of the liver or maybe a bit more
(moderate - severe).

• What is the nature of the change? Cellular. At greater magnifications, you

Fig.3 Slide 43 (H&E) x4 should be able to see that the lesion is cellular, and that it is a uniform cellular
change. We will see examples of mixed cellular changes later on. Lots of cells
present - a lesion due to a dense cellular infiltrate!

• This is an example we shall cover in more detail in the course, but for now, you
can see how it provides a clear example of one type of lesion.

• What do you think the uniform cellular change could indicate as a disease
process?
Fig.4 Slide 43 (H&E) x20
Example 2 – Slide 56 (Path056)
Fig. 5 Slide 56 (H&E) x20

• As always examine the section by naked eye and then low

magnification first.

• Can you identify the normal tissue and see any lesions with
naked eye or low magnification examination? kidney, good glomeruli
on images. Colour change is evident by naked eye alone
Fig. 6 Slide 4 (H&E) x20
• The lesion is clear, but how would you describe its distribution?
It seems to be in lines, curving or serpentiginous lines, often forming tubular
outlines, for example. It looks diffuse through the cortex, but more accurately
it is widespread and intracellular (epithelial cells)
Example 2 – Slide 56 (Path056)
Fig. 5 Slide 56 (H&E) x20

• Is there an anatomical basis for the pattern you can see?

Yes, the pattern follows the outlines of renal tubules, and also the Bowman’s
capsule in some places, and is intracellular.

Fig. 6 Slide 4 (H&E) x20 • Is the lesion due to extra cells being present? No, but the cells are
changed by being pigmented. This is an example of a lesion due to a deposit, in
this case an intracellular pigment.

This is actually haemosiderin pigment (could be confirmed by Perl’s Prussian blue

stain), an iron containing pigment derived from the break down of red blood cells.
Example 3 – Slide 63 (Path063)

• Tissue? Skin (haired), subcutis or hypodermis

• Distribution? Solitary focal or focally extensive?

• Severity? Severe within the hypodermis

• Nature of the change? Is the lesion due to extra cells? Yes
Fig. 9 Slide 63 (H&E) x1.25
• If so, are they uniform or mixed cell types? Mixed: Some
big and multinucleate, some small with dense dark round nucleus
(lymphocytes), maybe spindle shaped cells also (fibroblasts).

• Is there a non-cellular change? Yes. A basophilic (purple!),

irregular deposit, sometimes crystalline, sometimes granular
(mineralisation).

Fig. 10 Slide 63 (H&E) x40

Example 4 – Slide 12 (Path012)
• Tissue? Lung
• Distribution? Diffuse (this is an intravascular change).
Everywhere in the slide seems affected.

• Severity? Moderate to severe

• Nature of the change
• Is the lesion due to extra cells? Yes, extra red
blood cells (and some fluid)

• If so, where are they and what sort are they?

They are intravascular still (so not haemorrhage) and
are red cells.

• Is the lesion a non-cellular change? Where?

Fig.12 Slide 12 (H&E) x10
Yes, in addition to the extra red cells in blood vessels
(hyperaemia) there is also a lightly eosinophilic fluid in
the alveoli.
Example 4 – Slide 12 (Path012)

Type of change? Hyperaemia and fluid effusion

(vascular changes)

This is an example of a vascular change, in which fluids form

part of the lesion. A transudate, but with it being so pink,
probably means extra protein, so could be a modified
transudate (but not an exudate – we will cover this in more
detail later in the course).

Fig.12 Slide 12 (H&E) x10