Department of

General and Clinical

pathology

Histopathology
For Collecti
on
students of
Dental Training
medicine
 1. Hypertrophia
myocardii
Cardiomyocytes with
increased size.
The nuclei of the cells are also
enlarged, slightly
hyperchromatic, with “sharp”
edges (х 20).
There is insignificant fibrosis of
the interstitium and a little
increase in the number of
blood vessels.
2. Atrophia fusca hepatis
On low magnification there is
thinning of the liver plates
and dilatation of the
sinusoids.
On higher magnification (х20)
are seen decreased in size
hepatocytes with
accumulation of golden-
brown pigmented granules of
lipofuscin.
 In chronic pulmonary 3. Emphysema pulmonum
emphysema the alveolar walls
are thin and at some places
‘’disappeared’’ (1).
The alveolar ducts are dilated (2). 1
Usually, the walls of the bronchi
showed the morphological
picture of chronic bronchitis (3).
For that reason both diseases are
called Chronic Obstructive
Pulmonary Disease (COPD).
2 3

2
 4. Degeneratio adiposa hepatis
Because of the alcohol used in the
routine paraffin technique all Nucleus
Accumulation
lipids are extracted from the of lipids
cells. For that reason, on H-E
stain are seen only optically
empty vacuoles in the
cypoplasm of the hepatocytes.
The nuclei are displaced at the
periphery and these cells are
called ‘’signet ring cells’’(х20).
Lipids are proved by frozen
sections of unfixed or fixated in
formalin tissue and then stained
with Sudan 3 in orange colour .
 5. Anthracosis pulmonis
A big amount of anthracotic
pigment – small, black granules,
is seen in the lung parenchyma.
Some of the macrophages laden
with the pigment are found in
the alveoli and might be *
excreted by sputum.
*
The anthracotic pigment is
typically accumulated *
peribronchial (around bronchi)
and perivascular (around blood
vessels).
6. Haemosiderosis pulmonis – H-E; Perls
In chronic left-sided heart failure are seen:
1. Lots of spotty haemorrhagеs that caused
haemosiderosis of lungs.
2. Diffuse intersticial fibrosis.
This condition is grossly called – Induratio
fusca pulmonum (brown induration of
lungs).
The alveolar walls are thick and
marcophages laden with brown pigment
–haemosiderin, called siderophages, are
found in the alveoli or in the
interstitium.
Some special stain are used:
Van Gieson stain, for fibrous tissue –
collagen fibers are coloured in red.
Perls stain for haemosiderin – the pigment
is coloured in blue.
 7. Icterus hepatis
In mechanical jaundice the
retained bile is accumulated in
the lumens of bile canaliculi
and bile ductules in the portal
tracks as yellow-brown
‘’plug’’.
Brown-yellow granules of direct
bilirubin are found in the
cytoplasm of hepathocytes and
Kupffer cells (х 20) .
 8. Nephrosclerosis
Arteriolohyalonosis in Hypertensive disease arteriolosclerotica
affects firstly the afferent arterioles of the
glomeruli. Their walls are thickened,
homogenously pink without nuclei in the
muscular layer and lumens are reduced in
size. (х 20).
Later, an abnormal accumulation of hyalin is
also found in the glomeruli (pink
globules) and efferent arterioles.(х 10).
The decrease of blood flow in the glomerular
capillaries (rete mirabilis) caused the
atrophy of the whole nephron.
Some unaffected glomeruli undergo
hypertrophy to compensate the function
of the affected ones.
 9. Amyloidosis renis
The glomeruli are homogenous,
significantly enlarged with a
reduced number of nuclei . A
pink-stained substance is
deposited in the
mesangium, as well as in the
walls of the blood vessels and in
the basement membranes of the
tubules. Some of them are
cystically dilated and contain
protein cylinders –
presentation of proteinuria. There
is metachromasia in
Congo rot staining: a change of
the color of the stain (from
brownish into orange), due to the
chemical composition of the
tissue.
 10. Tophi urici
Pale-pink stained aggregates
from urate crystals,
accompanied by an
inflammatory reaction, in
which fibroblasts and giant
cells ‘foreign body’ type also
take part.
The surrounding tissues (
soft tissues, synovium ) exhibit
hyperplastic fibrosis.
 11. Necrosis lienis
The organ diagnosis is determined
by the presence of Malpighian
corpuscles – lymph follicles with
central arterioles .
The area with coagulative
necrosis is eosinophilic – pink
in color, without preserved nuclei.
There can be seen only contours
of trabeculae and blood vessel-
walls, which are also eosinophilic,
acellular and non-nucleated.
 12. Necrosis cerebri
This slide is an example of
liquefactive (colliquative) necrosis
in encephalomalacia. The necrotic
area is occupied by loosely arranged
foamy cells, without the presence of
brain tissue. They have macrophage
nature and are called
pseudoxanthomatous cells. Their
cytoplasm is vacuolated due to the
phagocytosis of lipids from the
necrotic ganglion cells (detail). A
cavity lined by glial cells –
pseudocyst (the wall is not lined by
epithelium), forms 2-8 weeks later.
 13. Steatonecrosis
pancreatis
In this slide from pancreas, there is an
area of, so to speak, liquefactive necrosis
of the fatty tissue, due to intra-organ
activation of the pancreatic enzymes.
The lipocytes are non-nucleated with
shadows of cell membranes and the
cytoplasm is substituted by a pale-
pinkish structureless material,
resembling cigarette smoke . The
basophilia is due to the formation of
potassium and calcium salts (
saponification of the fats ).
Nearby are found large hemorrhages and
secondary inflammatory reaction.
 14. Cyanosis hepatis
In the beginning, the venous
congestion causes dilation
mainly to the centrolobular
sinusoids and central veins,
which are filled with
erythrocytes .The hepatic
columns are apart. The
architecture of the hepatic lobule
is conserved and the hepatocytes
do not exhibit dystrophic
changes. This initial phase of
stagnation is reversible.
 15. Hepar muschatum
In advanced chronic venous
congestion, in the center of the lobule
are seen ‘blood lakes’ (1). The 3
sinusoids are dilated and hyperaemic
(2). The hepatocytes in the intermediate
zone undergo fatty degeneration and
resemble a signet ring (3). The
hepatocytes at the periphery are
compressed and atrophic (4). The
motley picture outlines the lobular 2
structure . 1
In hepar muschatum adiposum, only
the cells in the periportal space remain
conserved, while in the inverted type (
typus inversus), they also undergo fatty 4
degeneration.
 16. Oedema pulmonis
Air
Lung oedema occurs due to acute left-
sided heart failure and due to endo- or
exogenous intoxications, leading to
increased permeability of the pulmonary A
capillaries.
The alveolar spaces are filled with A
precipitated homogenous pink fluid – A
transudate .
The capillaries in the alveolar walls are
dilated and filled with
erythrocytes . The air bubbles in the Air
alveolar spaces and in the lumen of the
bronchi and bronchioles are seen as round,
optically empty spaces (A).
Air
 17. Haemorrhagiae
punctatae cerebri
Spot-like haemorrhages result
from per diapedesin
haemorrhage.
In the white brain matter we
find pericapillary erythrocyte
groupings.
These are with compact or
ring-like shape. In annular
leasions there is brain matter
between the ring and the blood
vessel. Its cells show
necrobiotic changes.
 18. Thrombus
mixtus At
ta
During lifetime the lumen of the c
venous vessel is partially filled (PF) by h
a layered structure which consists of m
blood cells and fibrin threads e
(Thrombus). nt
It is attached (A) to a place with
damaged endothelial lining. There is
alternation of pink stripes of
aggregated thrombocytes and Thrombus
interwoven fibrin fibrils and orange
stained erythrocyte clusters. Amidst
them are found groups of leucocytes.
Clustering of blood components Residual
lumen
helps to distinguish a thrombus from
postmortem clot.
19. Infarctus anaemicus
renis
At lower magnification is seen
wedge-shaped eosinophilic area of
necrosis (1), surrounded by a
bluish demarcation zone of
inflammatory infiltrate (2) and thin 1
peripheral band soaked with
erythrocytes (hyperemic- 3
haemorrhagic zone) (3).
Х 20: Coagulation necrosis is
devoid of nuclei or they are
picnotic and cell cytoplasm is
replaced by granular debris. Basal
membranes of glomeruli and 2
kidney tubules are partially spared
and they look like shadows.
 20. Infarctus
haemorrhagicus pulmonis
Postmortem: 24 hours after a heavy
bout of dyspnea with haemoptoe alveoli
are filled with hemolized erythrocytes
and alveolar walls are hyperemic (1).
Leucocytic infiltration is found at the
periphery (2). In the surrounding
relatively spared tissue alveoli are filled 1
with edema fluid, their walls are
thickened, fibrotic. Haemorrhagic lung
infarction follows moderate pulmonary
embolism and develops on the
background of brown induration of the 2
lungs (haemosiderosis + alveolar
fibrosis). It is the morphologic hallmark
of chronic left sided heart failure.
 21. Pericarditis
fibrinosa
Epicardium is covered by pink
stained rough fibrinous coating
which consists of dense
interlacing fibrilar network . E
Subepicardial fatty (SF) tissue is P
infiltrated by lymphocytes, I
C
plasmocytes and leucocytes; A
capillary vessels are engorged R
D
with erythrocytes (active I
inflammatory hyperemia). U
M
 22. Appendicitis
phlegmonosa
Purulent
exudate

Transverse section through

appendix filled with purulent
exudate (PEx). There are spotty
ulcerations of the mucous
membrane (primary affect) .
Lymphoid follicles are
hyperplastic, with light germinative
centers. The whole thickness of the
appendicular wall is lavishly
infiltrated by polymorphonuclear
leucocytes .
Subserous blood vessels are
very hyperemic; there is pink
fibrinous coating on the serosa.
 23. Myocarditis
acuta abscedens
Amidst the myocardium are
found zones of destruction
filled with purulent exudate –
abscesses . Except for
lavish polymorphonuclear
leucocytes, macrophages
and debris (D) one finds
bacterial colonies .
Cardiomyocytes in the vicinity D
of abscesses show heavy
degenerative changes.
 24. Granulatio
“Granulatio” is a young C
connective tissue rich in cells,
capillaries and delicate
argirophilic fibrils. Capillaries (C)
are lined by succulent
endothelial cells with oval or
round nuclei protruding into the
lumens. The latter ones contain
erythrocytes .Cellular C

component includes lymphocytes

(1), plasmocytes (2),
macrophages,
polymorphonuclear leucocytes,
eosinophils, fibroblasts and 1 2 3
fibrocytes (3).
 25. Lymphadenitis
tuberculosa
Lymph node is recognized because 3
of lymphoid tissue at its periphery. Its 3
structure is damaged by many 2
“tubercles” – specifically layered
nodules. At the center of granuloma is
3
2
found pinkish absolutely structerless
caseous necrosis (1). It is surrounded by
a layer of monomorphous clear cells.
Despite their macrophagic nature (of
1
monocytic origin) they are called 2
epitheloid cells (2) because of their
arrangement which mimics that of
epithelial cells. Amidst them are found
giant Langhans cells with multiple clear 3
oval nuclei at their periphery – 2
horseshoe like arrangement “opened” to
necrosis (3). Peripheral layer of 3 2
tubercle consists of lymphocytes and a
few plasmocytes. Tubercles lack
capillaries.
 26. Echinococcus hepatis
Most frequently Echinococcus hepatis
affects the liver because its scolexes
come from the gastrointestinal tract into
the blood stream of v. рortae. The 2
germinative membrane is presented as a
thin basophylic streak (1). 1
There are no scolexes but the chitin
membrane is pathognomonic: wide
multilayered structureless streak,
resembling “cigarette smoke” (2).
Between it and the liver tissue (3) is found 4
fibrous capsule - rich of collagen
connective tissue (4), which contents single
bile channels and focuses of lymphoid
inflammatory infiltration. 3
 27. Actinomycosis
hepatis
1
For actinomycosis is typical the
formation of druses, which are 2
dark blue in color (1) and have
pale pink periphery (2, corona
radiata). They are surrounded
3 3
by purulent exudate with large
1
mononuclear or multinuclear
macrophages and vacuolized
cytoplasm – pseudoxanthomic 3
cells (3). In the periphery is
found fibrous connective tissue
(4). 4
28. Carcinoma basocellulare
Under the ulcerous squamous
epithelium of the skin are found
cords and nests of spindle
cells with moderate
polymorphism, scanty 2
cytoplasm, hyperchromic nuclei
and some mitoses (1).
The nests are solid or cystic
with peripheral palisade
arrangement of the cells (2).
They infiltrate the dermis. In the 1
surrounding tissue is found
stromal reaction of
lymphocytes and plasma cells.
Macroscopic metaphor:
ulcus rodens (eroding ulcer).
29. Carcinoma spinocellulare
keratodes
The tumor consists of nests or
anastomosing cords , that resemble 2
the structure of the squamous
epithelium, from which they originate.
1 2
Peripherally the cells resemble the basal
layer (1) and inside they are polygonal
with thin bridges between them. The
cytoplasm is lightened and the nuclei are
hyperchromic – spinous cells (2).
Synonym: squamous cell carcinoma.
In the variant with high differentiation
centrally in the nests is found pink keratin 1 2
– cancer pearls and inside them – small
granules of dystrophic calcification .
 30. Haemangioma
capillare labii oris
Epidermis
In the dermis is found
unencapsulated tumor, poorly
defined from the surrounding
tissue, covered by epidermis
C
with parakeratosis (Е).
The tumor consists of
proliferating capillaries (C), C C
filled with erythrocytes. Some
capillaries do not have lumens
, because the endothelial C
cells have succulent
prominating nuclei.
 31. Haemangioma
cavernosum hepatis
Among the hepatic tissue is
found unencapsulated well
defined tumor .
The tumor consists of large
vascular spaces ,
resembling corpora
cavernosa of the penis. Their
walls consist of fibrous septa,
covered with endothelial cells.
Inside are found preserved
and hemolysed erythrocytes.
 32. Leiomyoma uteri
Even unencapsulated and resembling
the cells of the surrounding myometrium,
the myoma is well defined due to its
fascicular structure .
Only tissue atypism can be seen, there
are no cellular atypism or infiltration.
The tumor has expansive growth and
can reach large size. It consists of
smooth muscle cells, arranged in vortex-
like cords. The transversally cut nuclei
are rounded, obliquely cut – spindle and
longitudinally cut – stick-like.
Leiomyoma differs from neurinoma –
it does not have palisade arrangement –
and from fibroma, in which there is
collagen (Van Gieson staining) around
the cells and has taper nuclei.
 33. Leiomyosarcoma uteri
The section presents only
tumor tissue; the organ cannot
be recognized. The tumor
consists of spindle cells,
forming chaotically arranged
fascicules. Severe cellular
atypism, hyperchromasia,
polychromasia and
polymorphism of the nuclei .
Monstrous cells (giant
multinucleated cells with high
nuclear/cytoplasmic ratio )
and lots of mitoses are also
seen.
 34. Teratoma adultum

Mature teratomas are frequently found in the

ovaries. They have cystic structure and are filled
with yellowish fat and hairs. In their walls can be
found structures that originate from different
germ layers. The cyst can be covered with
squamous epithelium , and inside its wall can
be found hair follicles and sebaceus glands .
In another area the epithelium becomes
multilayered cilliated cylindrical , bellow it
there is hyaline cartilage and mixed sero-
mucinous (bronchial) glands . Fat and
lymph tissue, elements of thyroid, brain tissue or
even tooth germs can also be found.
 35. Glioblastoma Hemorrhage
multiforme
➢ Extremely moderate cellular
atypia!
➢ Various shapes - (round, polygonal,
star-like) and the largest tumor cells Necrosis
are located in a chaotic network of
cellular growths.
➢ There is plenty of monstrous giant
multicore cells.
➢ Stroma is rich in vessels.
➢ Common finding is bleeding and
areas of necrosis.
➢ About necrotic fields observed
"pseudopalisade" arrangement of
the tumor cells.
 36. Neurilommoma
(Schwanoma)
A benign tumor of the nerve sheathes origin
with a bundle (fascicular) structure. Tumor
cells have an elongated shape and unclear
borders. Their nuclei are gentle rod,
"cigarette-like" shape.
On places they are arranged in parallel lines,
like rug or "planks fence. " They are referred
to as palisades structures.

Areas with fresh and old haemorrhages can

be observed. In the presence of plenty
collagen fibers, the tumor reffers
as neurofibroma.

Regardless of the biological maturity,

because of its location in the rear cranial
fossa neurinoma of n. Statoscusticus can
cause death due to compression of the
medulla and cerebral swelling with cerebellar
herniating.
➢ Benign tumor composed of the
oval or slightly drained cell count, 37. Meningioma
which are arranged concentrically
like a bulb.

➢ Often at the center of these

structures reveals a hyalinization
court or deposition of calcium
salts. They are presented as
rounded laminated structures,
painted in dark blue-violet and are
called psammoma cells.

➢ The tumor is rich of the vessels

with the thick hyalinizated walls.
Malignant tumor of the
38. Melanoma
pigment tissue with marked malignum
cellular atypia. The lining
epithelium is ulcerated.
The tumor parenchyma is
represented by arranged in
nests or trabeculae acinae
consist of the large pale
rounded or drained cells.
There are also giant cells.
Mitoses are abundant.
There aremelanin granules in
the cytoplasm of the cells.

In the complete absence of the

pigment in the tumor is an
undifferentiated, and is called
achromatic melanoma.
➢ At the core of atherosclerotic plaque
(enlightened central zone) 39. Atherosclerosis
are scattered randomly situated optical
empty spaces that were postponed needle
aortae
cholesterol crystals.
They are derived in deparaffination of the
slices with alcohol. Sudan III is used to Mural mixed
demonstrate the lipid in the formalin thrombus
fixation of the tissue and cutting with a
freezing microtome. Stored lipid
deposits stained orange. Fibrotic cup

➢ In place of the endothelium roof over

fibrosis (CF) of the complicated plaque М
is a place of its end mixed mural
thrombus (CT). е
д
и
➢ The media is atrophic (M) and dark blue я
stripe on its border with lipid deposits is
a primary dystrophic calcification.
Medial leyer
40. Infarctus myocardii recens
➢ Among the fatty tissue of the epicardium Thrombus
is a branch of the coronary artery with Fibrotic
plaque
eccentric fibrous plaque (FP) and part of
mural thrombus (MT).
➢ There is a transmural coagulation
necrosis with deletion of nuclei and Coagulative
necrosis
transverse corrugations of
cardiomyocytes (N).
➢ Subendokcardial a necrotic cytoplasm is
resorbed (miocytolisis M), and over the Miocytolisis
andocardial surfase (ie ventricle) there is
secondary mural thrombosis (MT). Secondary mural
thrombosis

Клик !
Pathognomonic for reumatic
myocarditis are Aschoff’s 41. Myocarditis rheumatica
granulomas
Typically their location is around
blood vessels within the
myocardium. The center of the
granuloma is intensely pink and
structureless due to fibrinoid
necrosis. Around them there is a
proliferation of the T-lymphocytes,
plasma cells, fibroblasts, drained
giant mononuclear cells Anichkov
(chromatin, pleated like a caterpillar)
and multinuclear giant cells Aschoff.
Perivascular granulomas end with
scars that have spindle shape.
➢ Preparation of hypertrophic form
of chronic tonsillitis. 42. Tonsillitis
➢ Lymph follicles are numerous, chronica
greatly enlarged with bright germ
centers.

➢ Below them there are strips with

sclerosis .
➢ Lacunas are expanded,
they epithelium is desquamated, but
may form concentric deposits
("cholesteatomas" and in
dystrophic calcification -
concrements (amigdalolits).
➢ The tissue is infiltrated with
lymphocytes and plasma cells.
➢ Inflammatory infiltrate in
bronchial wall is composed by
lymphocytes and plasma cells (1). 43. Chronic bronchitis
➢ In their lumen are found
desquamated epithelial cells
(catarrhal inflammation) and in
case of exacerbation – catarrhal –
purulent exudate (2).
➢ In mucosa often occurs 3
metaplasia of cylindrical ciliated
epithelium into multilayered 1 2
squamous epithelium.
➢ Goblet cells are hyperplastic (3) ,
hyperplastic are also and 5
seromucinous glands in 4
submucosal layer(4).
➢ Muscularis mucosae is
hypertrophic (5).
 44. Acute abscessing
bronchopneumonia ♣
➢ Subpleural is found well distinguished
area of leukocytic infiltration, which ♣
destroys lung parenchyma and forms
abscesses Abscesses
➢ А .
♣
➢ In adjacent alveoli – exudate is composed
of leukocytes and desquamated ♣
pneumocytes (♣).
➢ At the periphery are found unaffected
alveoli, but they are pressed and collapsed
because of the compression (CA). The
perforation of an abscess in pleural cavity
leads to pyopneumothorax. Abscesses
➢ Pleura ( ) is covered by fibrinous – Collapsed
purulent exudate (F).
alveoli Fibrin
➢ This complication is typical for
staphylococcal pneumonia in infants (X –
ray designated as pneumonia– bullosa).
➢ In the stage of grey 45. Pneumonia
hepatization alveoli in all crouposa
visible areas are filled with
fibrin and leukocytes.
➢ Because of the artificial
phenomenon of fibrin
‘’retraction’’ in histological
specimen, the pale border
delimiting the exudate from
the alveolar wall is
pathognomonic .
➢ Fibrin fibrils are twisted like
braids and pass in adjacent
alveoli through the pores of
Cohn.
➢ Undifferentiated small cell 46. Undifferentiated small
carcinoma of the lungs is highly cell carcinoma of the lung
aggressive tumor with neuro-
endocrine activity.
➢ It is built by lymphocytic-like
cells with scant cytoplasm or
spindle shape cells resembling
‘’oat grains’’. Their nuclei are
hyperchromatic. Cells are
clustered in strands, the tumor
stroma is scant .
➢ Immunohistochemistry: pancytokeratin,
neuron-specific enolase, chromogranin
possitive stains.
 47. Caries dentis
➢ In middle caries the damages
affect the enamel and part of
dentin. The bottom of the
formed cavity contains
structureless ( detritic) material,
traces of food and
microorganisms (1). Deep in
the tooth there is a lighter area
(transparent dentin) (2) and an 2 1
area with dark and light lines (
substitution dentin) (3).

3
 48. Stomatitis candidosa
In oral candidosis the well outlined white
plaques are histologically presented as
pseudomembranes , composed by
numerous filamentary mycotic
organisms. Candida albicans creates
PAS-positive (red) covering, similar to
fuzz, that is poorly captured to the
liable inflammatory tissue. Filaments
are composed of tubular cells, from
which tiny, ovate yeast forms are
proliferated. Inflammatory process
leads to superficial ulceration of the
epithelium.
 49. Cysta radicularis
1
Periodontogenic cyst , a
complication of apical
granuloma consist of 1
multilayered squamous
epithelium without basement
membrane (1). 2
It originates from proliferative
epithelial cell - drags of
Mallase. Areas with necrosis
and granulation tissue are found
around (2), accumulation of
cholesterol esters (3, needle
vacuoles) and giant
multinuclear cells type “foreign
3
body”.
 50. Giant cell epulis
➢ Hyperplastic, tumor-like formation of the gum,
covered with multilayered squamous epithelium
with parakeratosis. It can be ulcerated with
granulation tissue below the epithelium.
➢ Epulis is composed of fibroblast-like cells and
giant multinucleated cells resembling the normal
osteoclasts. They are separated from the epidermis
by connective tissue .
➢ Giant cells are separated from the adjacent tissue
with a lighter area. They have a round shape and
basophilic (bluish) cytoplasm in which lie dozen
bright oval nuclei .
➢ Epulis is lavishly capillarized. At the periphery is
found hemosiderin – sign for old hemorrhages.
➢ Along with the most common giant cell epulis
there are also angiomatous and fibromatous
types.
➢ Mucosa of the oral cavity is covered
with multilayered squamous epithelium, 51. Leucoplakia
which is thickened with signs of :
➢ Hyperkeratosis – excessive
accumulation of keratin ;
➢ Parakeratosis - preserved nuclei of the
cells in stratum corneum and
➢ Acantosis – hyperplasia of stratum
basale and spinosum of epidermis with
enlarged papillae .
➢ Subepithelially is found mononuclear
inflammatory cell proliferation.
➢ Often behind the macroscopic
diagnostic of leucoplakia ( white plaque
) is hidden either dysplastic
(precancerous) or neoplastic process.
 52. Papiloma cavi
oris
Benign tumor of multilayered
squamous epithelium of oral
cavity with papillary
exophytic growth. Stroma is
dendriform branched .
Epithelial cells show no atypia
.
Superficially is seen
parakeratosis ( pyknotic
nuclei in stratum corneum ).
Tumor has no capsule and
does not infiltrate the
surrounding tissue.
 53. Amelloblastoma
(Adamantinoma)
➢ Locally destructive tumor, which
originates from the dental germ.
➢ In follicular variant the cells are
arranged in rounded or oval nest
structures among loose connective tissue.
➢ Peripherally cylindrical cells have
palisade arrangement and resemble
epithelial basal layer.
➢ Centrally they are loosely arranged and
have star-like shape .
➢ Between them there are small or larger
cysts with clear liquid .
➢ They crepitate when compressed during
examination.
 54. Adenoma pleomorphe (Tumor mixtus)
glandulae parotis
Marked pleomorphic structure.
Tumor cells form ductules 1
with pink secretion (1), acines, 1
streaks and have cubic or
spindle shape. The stroma has
islands with hyaline cartilage –
like appearance (precipitated
mucus and myxoid
transformation of the connective
tissue, 2) and rarely – bone. 2
The cellular origin is
immunohistochemically
proved as myoepithelial.
 55. Ulcus chronicum ventriculi exacerbata
➢ Sharply defined crater (2-4 cm),
which destroys the mucosa and reaches
tunica muscularis propria or even
serosa (perforation).
1
➢ Around it the gastric glands are
hypertrophic.
➢ The bottom of the ulcer is covered
with fibrinous-purulent exudate (1). 2
➢ Bellow it there is red destructive area 3
of fibrinoid necrosis (2). 4
➢ Under it – abundant granulation tissue
(3) .
➢ In depth- sclerotic area (4) (fibrous 3
connective tissue) with vessels with
highly thickened walls - endarteriitic
and endophlebitic changes and paddle-
like thickened peripheral nerves-
amputation neuromas .
➢ The surrounding mucosa has features
of chronic atrophic gastritis.
 56. Adenocarcinoma ventriculi
Tumor glands (1) are sharply
defined from the normal glands.
They consist of monomorphic
cylindrical cells. Their lumens are
enlarged, filled with mucus or
detritis ( ). Tumor cells form
one or two layers with impaired 1
polarity and hyperchromic
polymorphic nuclei.
There are lots of atypical mitoses
. Basement membranes are
destroyed.
Some atypical glands have
secondary lumens, others
infiltrate the muscular layer.
 57. Cirrhosis hepatis
➢ The structure of the liver is destroyed by micronodularis
diffuse growth of connective tissue
, which connects the portal spaces and
encircles one or several hepatic lobules.
➢ Differently sized (up to 5mm)
pseudolobules are formed.
➢ Some of them do not content central
veins.
➢ Some hepatocytes undergo fat
degeneration (small vacuoles
).
➢ The connective tissue is infiltrated with
lymphocytes and plasma cells .
➢ Among it there are blood vessels and
proliferated bile channels.
 The liver is involved in extramedular
neoplastic hemopoesis.
58. Myeloleucosis
➢ The lobular structure is depleted by
hepatis chronica
leucemic infiltrates which engage
diffusely the sinusoids (resembling
“streaks” of small hyperchromic cells).

➢ Blast cells are from the white

(granulocytic) blood line: from
myeloblasts and maturing myelocytes
to mature neutrofills
.
➢ Infiltrates in the portal spaces can
be found only during exacerbation of
the disease.
➢ Hepatocytes are thin, separated,
arranged like arcs (atrophy by
pression) and degenerative changes.
 Preserved lobular structure of the liver
59. Lympholeucosis
with abundant round-cell infiltrates, hepatis chronica
located perivascularly (around the
branches of a. hepatica and v. portae)
in the outlines of the portal spaces

.
➢ On higher magnification is found
that these cells are from the
lymphoid line, mainly lymphocytes -
with rounded hyperchromic nuclei with
scant cytoplasm and single
lymphoblasts – bigger cells with
lightened nuclei and slight
polymorphism.
 The normal structure of the lymph node is 60. Morbus Hodgkin –
destroyed by tumor cells and reactive смесен целуларитет
proliferation of cells that can be found in
granulation tissue: lymphocytes, plasma
cells, histiocytes eosinophils, neutrophils
and fibroblasts.
➢ Moderate capillarization and areas of
necrosis and fibrosis.
➢ Tumor cells are giant mononuclear cells
of Hodgkin with oval vacuolated nuclei
and centrally located nucleoli and
pathognomonic multinuclear giant cells of
Sternberg : binuclear («mirror image»
- like bean grain) and lacunar (with oval
nuclei one over another like a pile,
retraction and lightening of the cytoplasm).
➢ The capsule is fibrous, thickened and
infiltrated.
61. Lymphoma malignum
non-Hodgkin
➢ The normal structure of the lymph
node is destroyed by diffuse uniform
proliferation of atypical lymphoid
cells, which fill the sinusoids without
forming lymph follicles.
➢ Hyperhromic tumor cells infiltrate
the capsule and the surrounding fat
tissue and the lymph nodes form
packages.
➢ There are irregular mitoses.
➢ Malignant lymphomas are
immunohistochemically typified.
 62. Plasmocytoma
➢ In jelly-like mass, a curettage
from osteolytic bone lesion, is
found diffuse neoplastic
proliferation of mature plasma
cells (pear-like appearance: oval
cells with eccentric nuclei,
surrounded by lightened area and
contralateral basophilia), single
plasmoblasts – bigger cells with
dispersed chromatin and
multinuclear (binuclear) atypical
plasma cells.
➢ In 80% of the glomeruli are found
extracapillary “crescents” which engage 2/3 of
the Baumann capsule.
63.Rapidly progressive
➢ The process begins into the capillaries and has
glomerulonephritis
anti-basement membrane mechanism (10%) or
mechanism of deposition of circulating
immune complexes.
➢ After rupture of the glomerular basement
membrane is developed cellular proliferation in
the urinary space.
➢ The crescents are in a different stage of
maturing. They consist of blood monocytes,
parietal epithelium of the Baumann capsule,
fibroblasts from the cortical interstitium, fibrin
and erythrocytes.
➢ The process ends with global hyalinization of
the renal bodies.
➢ The tubular epithelium has severe
degenerative changes.
➢ Macroscopically: Big white kidneys.
 64. Pyelonephritis
acuta abscendens
➢ The cortical renal tissue is
focally destroyed by neutrophilic
infiltration , among which
can be found bacterial colonies
.
➢ The renal bodies, even these
located closely around the
abscesses, remain preserved for a
long time .
➢ In the renal tubules are formed
leucocytic cylinders.
 65. Pyelonephritis
Histological triad: chronica
In the interstitium, especially in the
border cortex/medulla, are found focal ¤
lympho-plasmocytic infiltrates .
The tubules are diluted and filled with
pink protein cylinders, resembling the
follicular structure of the thyroid gland -
strumization of the parenchyma .
Pericapsular glomerulosclerosis
Some renal bodies are completely sclerotic
.
In the interstitium there is diffuse
growth of connective tissue, the arterioles
are with thickened walls and narrowed
lumens due to secondary hypertension.
➢ The tumor cells have polygonal
shape and are arranged in nests, 66.Carcinoma renis
tubules or papillae.
➢ They have clear cytoplasm and
P
well distinguished cellular
S
membrane. The clear cytoplasm is
E
due to extraction of lipids and U
glycogen.
D
➢ Tumor cells infiltrate the vessel O
walls. C
➢ Among the tumor can be found A
necroses and hemorrhages. P
S
➢ The stroma is scant, with thin wall
U
vessels and scanty lymphoid
L
infiltrates.
E
➢ The tumor is well defined by
pseudocapsule: thick fibrous
connective tissue, which is
infiltrated by the tumor.
 67. Struma colloides
➢ “Struma” consists of cystic
dilated medium sized or small
thyroid follicles, containing dark C
pink thick colloid (C). In large
follicles it is located closely to the
flat one-layered epithelium
(histological accommodation due
to pressure ), while thyrocytes
of the microfollicles are cubic .
➢ In the interstitium can be found
secondary changes: hemorrhages,
fibrosis, degenerative calcification, C
ossification.
➢ Changed thyroid tissue with lobular 68.Struma Basedowiana
structure.
➢ The colloid is highly diluted, pale
pink, with multiple optically empty
(resorptive) vacuoles on its periphery
, with net-like appearance. In lots
of follicles it is completely depleted.
➢ The papillary proliferation of the
cylindrical thyrocytes with formation
of the so called “Sanderson pillows”
gives star-like shape of the thyroid
follicles.
➢ There are lots of blood vessels with
hyperemia.
➢ In the interstitium – lymphoid
infiltrates which do not form lymph
follicles with germinative centers.
 69. Glomerulosclerosis
diabetica
➢ Peripherally, in the urinary poles of
the renal bodies, are found some
intercapillary hyaline nodules .
➢ They can be seen on the background
of diffuse intercapillary
glomerulosclerosis (homogenic
dilation of the mesangial axis).
➢ Some glomeruli are completely
sclerotic.
➢ Simultaneously in the afferent and
efferent arterioles is found
lipohyalinosis (thickened hyalinized
walls) .
➢ The epithelium of the convoluted
tubules undergoes vacuolar
degeneration.
➢ Peribronchially are found 70. Tuberculosis miliaris
irregularly scattered granulomas
with size of millet grains pulmonis
(millium) .
➢ In some of them prevails caseous
necrosis, in others it is scanty and
surrounded by a layer of cells with
reniform vacuolized nuclei. Because
of the similarity with an epithelial
layer these macrophages are called
epithelioid cells.
➢ Between them are found giant
Langhans cells , with multiple
nuclei, arranged like horse shoe,
pointing the central necrosis.
➢ Peripherally – single lymphocytes
(L). There are no capillaries.