practical patho

Chronic Pyelonephritis

Q: What are the microscopic features of chronic pyelonephritis?

  • A:

    • Some glomeruli are totally sclerotic.

    • Tubules are atrophic and may show thyroidization (tubules resemble thyroid follicles)1.

Hydronephrosis

Q: What are the gross features of hydronephrosis?

  • A:

    • The kidney and ureter are enlarged.

    • The outer surface appears lobulated.

    • Renal calyces are dilated, forming thin-walled sacs of variable size and shape that communicate with each other and the renal pelvis.

    • The renal tissue between calyces is atrophied and appears as a thin rim1.

Pyonephrosis

Q: What are the gross features of pyonephrosis?

  • A:

    • The kidney is increased in size.

    • The capsule is thick and adherent, sometimes requiring decortication.

    • The outer surface is irregular.

    • The cut surface shows a thin atrophic cortex and dilated calyces communicating with each other and the dilated pelvis1.

Angiomyolipoma

Q: What are the components of an angiomyolipoma?

  • A:

    • Composed of blood vessels (angio), smooth muscle cells (myo), and fat tissue (lipoma)1.

Oncocytoma

Q: What are the main features of renal oncocytoma?

  • A:

    • Grossly, it is a large tumor with a central scar.

    • Microscopically, it is composed of benign oncocytes (cells with reddish granular cytoplasm rich in mitochondria)1.

Renal Cell Carcinoma (Hypernephroma)

Q: What are the gross and microscopic features of renal cell carcinoma?

  • A:

    • Grossly, one pole of the kidney is compressed, the other replaced by a mass with variable colors: golden yellow (lipid), brownish-red (hemorrhage), and whitish (fibrous tissue).

    • Microscopically, malignant cells are arranged in tubules and papillae, with clear cytoplasm due to lipid and glycogen content, and a thin vascular stroma1.

Wilm's Tumor (Nephroblastoma)

Q: What are the microscopic features of Wilm's tumor?

  • A:

    • Contains both sarcomatous (blastemal) and carcinomatous (abortive tubules and glomerulus-like structures) elements.

    • Spindle cell stroma and compressed normal parenchyma are seen1.

Testicular Germ Cell Tumors – Seminoma

Q: What are the microscopic features of seminoma?

  • A:

    • Sheets of spermatogenic cells with clear cytoplasm (due to glycogen).

    • Tumor cells are separated by fibrous septa rich in lymphocytes and plasma cells1.

Endocervical Polyp

Q: What are the features of an endocervical polyp?

  • A:

    • Finger-like projection covered by columnar mucin-secreting epithelium.

    • The core contains dilated endocervical glands and fibrous tissue1.

High-Grade Squamous Intraepithelial Lesion (HSIL) of Cervix

Q: What are the microscopic features of HSIL?

  • A:

    • Normal squamous epithelium is replaced by basaloid cells.

    • Loss of polarity, nuclear enlargement, irregularities, hyperchromasia, and increased mitosis1.

Adenocarcinoma In Situ of Cervix

Q: What are the microscopic features of adenocarcinoma in situ of the cervix?

  • A:

    • Part of the gland is replaced by neoplastic columnar cells with stratification, nuclear enlargement, and hyperchromasia1.

Endometrial Hyperplasia

Q: What are the features of endometrial hyperplasia?

  • A:

    • Increased gland-to-stroma ratio.

    • Proliferative glands of variable size and shape1.

Leiomyoma

Q: What are the gross features of leiomyoma?

  • A:

    • Well-circumscribed, whorled, grayish-white, fleshy cut surface with firm consistency1.

Ovarian Corpus Luteum Cyst

Q: What are the features of a corpus luteum cyst?

  • A:

    • Arises from cystic dilatation of corpus luteum that fails to regress.

    • Usually single, unilocular, with a yellow wall, filled with blood or serous fluid.

    • Composed of an inner luteinized granulosa cell layer and an outer theca cell layer1.

Chocolate Cyst (Endometriotic Cyst)

Q: What are the features of a chocolate cyst?

  • A:

    • Due to ovarian endometriosis, can be bilateral or unilateral, multiple small or single large cysts filled with dark brown fluid.

    • Contains endometrial glands, stroma, hemorrhage, and hemosiderin-laden macrophages1.

Serous Tumors of the Ovary

Tumor Type

Gross Features

Microscopic Features

Benign serous cystadenoma

Cyst with smooth lining, clear watery fluid, usually bilateral

Cyst lined by single layer of cuboidal/columnar (often ciliated) epithelial cells1

Low-grade serous carcinoma

-

Stromal invasion by isolated tumor cells, glands, or nests with minimal atypia, low mitotic activity, desmoplastic response, psammoma bodies1

High-grade serous carcinoma

-

Stromal invasion with marked atypia, increased mitotic activity, abnormal mitosis, desmoplastic response, psammoma bodies1

Mucinous Tumors of the Ovary

Q: What are the features of benign mucinous cystadenoma?

  • A:

    • Cyst with smooth lining, viscous mucoid fluid, usually unilateral.

    • Lined by a single layer of mucin-producing epithelial cells1.

Mature (Cystic) Teratoma

Q: What are the features of a mature cystic teratoma?

  • A:

    • Most common ovarian germ cell tumor.

    • Cystic, filled with greasy sebaceous secretion and hair, may contain teeth and bone.

    • Contains mature tissues from two or three germ layers: ectoderm (skin, CNS), mesoderm (muscle, bone), endoderm (respiratory/GI epithelium, thyroid)1.

Dysgerminoma

Q: What are the microscopic features of dysgerminoma?

  • A:

    • Most common malignant ovarian germ cell tumor.

    • Nests of large polygonal tumor cells with clear cytoplasm, central nuclei, prominent nucleoli, separated by fibrous stroma rich in lymphocytes1.

Fibrocystic Disease of the Breast

Q: What are the microscopic features of fibrocystic disease of the breast?

  • A:

    • Adenosis: increased number of ducts.

    • Fibrosis.

    • Cyst formation.

    • Epitheliosis: hyperplasia of duct lining.

    • Apocrine metaplasia: lining epithelium shows large polygonal cells with eosinophilic cytoplasm1.

Ductal Carcinoma In Situ (DCIS) of the Breast

Q: What are the patterns of DCIS?

  • A:

    • Solid: complete duct occlusion.

    • Comedocarcinoma: central necrosis.

    • Cribriform: tumor growth with multiple open spaces1.

Invasive Duct Carcinoma, Not Otherwise Specified (NOS)

Q: What are the features of invasive duct carcinoma (NOS)?

  • A:

    • Gross: ill-defined, greyish-white, hard mass, may have necrosis.

    • Microscopy: tubules and sheets of malignant cells separated by desmoplastic stroma1.

Invasive Lobular Carcinoma of the Breast

Q: What are the microscopic features of invasive lobular carcinoma?

  • A:

    • Cords of small, uniform, non-cohesive malignant cells with little pleomorphism, arranged in an "Indian file" pattern, separated by desmoplastic stroma1.

Fibroadenoma of the Breast

Q: What are the types and features of fibroadenoma?

  • A:

    • Mixed tumor of epithelial-lined ducts and fibrous tissue.

    • Pericanalicular: equal proliferation of epithelial and fibrous elements, ducts with patent lumens.

    • Intracanalicular: more fibrous tissue, ducts compressed and slit-like, lined by two cell layers1.

Benign (Senile) Prostatic Hyperplasia

Q: What are the microscopic features of benign prostatic hyperplasia?

  • A:

    • Hyperplasia of acini and fibromuscular stroma.

    • Glands are cystically dilated, increased in number, lined by double-layered epithelium (inner columnar, outer cuboidal).

    • Presence of corpora amylacea1.

Bilharziasis of the Urinary Bladder

Q: What is the microscopic reaction in bilharziasis of the urinary bladder?

  • A:

    • Granulomatous reaction with lymphocytes, plasma cells, macrophages, and eosinophils surrounding bilharzial ova1.