Because of the alcohol

extraction of lipids necessary

for the technical procedures
(deparaffinization) for H-E
staining, hepatocytes show
optically empty vacuoles
.
The nuclei of the hepatocytes
are often displaced to the
periphery and cells are called
signet ring cells (20). Lipids
are proved if fresh frozen,
unfixed or fixed in formalin
tissue is stained in Sudan III in
orange color
.

1. Degeneratio
adiposa hepatis

2. Anthracosis pulmonis
In lung parenchyma is found
anthracotic pigment as small,
black granules. Some of the
pigment is found into alveolar
macrophages lying in the
alveolar space and released
with sputum.
The pigment is located in
peribronchial and perivascular
spaces.

*
*

3. Haemosiderosis
pulmonis H-E
In chronic left ventricular failure are
seen: 1.Multiple hemorrhages per
diapedesin, which cause
Hemosiderosis of lungs and
2. Diffuse interstitial fibrosis.
Macroscopically Induratio fusca
pulmonum.

Walls of the alveoli are

thickened and they are
filled with cells sideroblasts
and siderophages, loaded
with plenty of brown pigment:
hemosiderin from
phagocytosis of erythrocytes
.

4.Haemosiderosis pulmonis Perls reaction

Van Gieson is used for

staining of collagen fibers and
proving of fibrosis.
Perls reaction is used for
obtaining of Berlin blue, which
stains hemosiderin granules in
blue- green color.

5. Icterus hepatis

In mechanical jaundice the

retained bile is seen as yellowbrown thrombi in dilated bile
capillaries and bile ductules
in portal spaces
.
Yellow- brown granules of
direct bilirubin are found in the
cytoplasm of hepatocytes and
Kupffer cells
( 20) .

6. Icterus renis
In mechanical or severe
parenchymal jaundice urine
becomes darker ("like beer").
Direct ("connected") bilirubin passes
through the glomerular filter. It is
found as yellow-green (to brown)
"cylinders
in convoluted
tubules and Henle loop.
It causes sever degenerative
changes in the tubular epithelium, to
the degree of acute renal failure
(so-called "hepato-renal syndrome"
or cholemic nephrosis").

7. Naevus pigmentosus
Tumor- like lesion of cells,
spread during embryogenesis
from neural crest.
Pigment producing oval
melanocytes
are
clustered in nests and strands
in epidermis,dermo-epidermal
or in derm. They are proven
by immunohistochemistryHMB-45 or S100 protein( also
in achromatic forms).

Mucoid degeneration is an
early stage of disorganization of
connective tissue in rheumatism,
resulting in redistribution of
glycosaminoglycans on the
surface of collagen fibers. It is
well expressed in perivascular
connective tissue in myocardium
and cuspid valve.
Tissue is basophilic (H-E bluish color) and shows
metachromasia in staining with
Toluidin blau: change of the basic
color of the stain, depending on
the chemical composition of the
tissue (from blue in red color).

8. Degeneratio
mucoidea
Toluidin blau

9. Corpus albicans
ovarii
White bodies of ovaries are
round pale structures with wavy
surface. Pigment hemosiderin can
be found peripherally.
Hyalinosis of Graaf folicles is
physiological involution process:
extracellular accumulation of
eosinophilic homogenous
substance with scattered single
fibrocytes.
In adults hyaline is
deposited in the walls of ovarian
arterioles.

10.Nephrosclerosis
arteriolosclerotica
Arteriolohyalinosis in hypertensive
disease affects primarily afferent
arterioles of glomeruli. Because of their
winding they can be seen several times
in the plane of histological cut.
Their walls are thickened, homogenously
pink and lumen is obliterated
( 20).
Later are hyalinised also their glomeruli
(pink globules) and efferent arterioles
( 10). Due to lack of blood flow in rete
mirabilis the entire nephron atrophies.
However, single intact glomeruli
hypertrophy in order to compensate the
function.

20
10

11. Hyalinosis
arteriolarum cerebri
Prolonged vasospasm in arterial
hypertension leads to narrowing of
the lumen and thickening and
homogenization (hyalinosis) of the
walls of the cerebral vessels.
They accumulate basal membrane
material and plasma proteins.
Myoelastofibrosis occurs: smooth
muscle cells proliferate, elastic
membranes thicken and look like
flakes of onion
.
Around vessels are seen clear
spaces- perivascular edema.
Ganglion cells show degenerative
changes (pyknotic nuclei).

12. Amyloidosis renis

Glomeruli are homogeneous,
enlarged, with decreased
number of nuclei
.
Stained in homogenous pink
substance is deposited in
mesangium, in the walls of
blood vessels and basal
membranes of renal
tubules. Some of them are
cystically dilated and contain
protein cylinders- expression
of proteinuria.

13. Amyloidosis renis

Congorot
In staining with
Congo rot is seen
metachromasia: change
of the color of stain
(from brownish to
orange) due to the
chemical composition of
tissues.

...

14. Amyloidosis lienis

( )
In local form amyloid is deposited in white
pulp at the periphery of lymph follicles of
spleen and in the walls of central arterioles
( 10).
Lymphocytes in follicular centers are
reduced ( 20).
Sago is a starch mash of grains of
sago palm tree.

20

10

15. Tophi urici

Pale pink aggregates of
urate crystals
and surrounding
inflammatory reaction of
fibroblasts and giant cells
type foreign body .
Surrounding tissues ( soft
tissues, synovia ) show
hyperplastic fibrosis
.

16. Necrosis coagulativa lienis

(Infarctus anaemicus lienis)
Organ diagnosis is determined
by the presence of
Malpighian bodies lymph
follicles with centrally located
arterioles
.
The area with coagulative
necrosis is eosinophilic- in pink
color, without nuclei.
Only outlines of trabecules
and walls of blood vessels can
be seen, which are also
eosinophilic, acellular and
without nuclei.

17. Necrosis colliquativa cerebri

(Infarctus ischaemicus cerebri)
The specimen is an example for
liquefactive necrosis of the brain in
encephalomalacia.
Necrotic area consists of foamy cells
among disintegrated brain
substance.
Foamy cells have macrophagic
origin. Their cytoplasm has vacuoles
because of phagocytosis of lipids,
obtained from the necrosis of
ganglions cells (detail).
After 2-8 weeks is formed cavity,
covered with glia- pseudocyst ( its
wall is not covered with epithelium).

18. Steatonecrosis
pancreatis
In specimen of pancreas is found
area of liquefactive necrosis of fat
tissue, due to activation of pancreatic
enzymes.
The fat cells of the fat tissue
are showing only outlines of their cell
membranes, while the cytoplasm
looks structureless and purple
resembling tobacco smoke
.
Basophilic appearance is due to
deposition of sodium, calcium and
potassium (saponification).
Nearby are found hemorrhages and
secondary inflammatory reaction.

19. Hyperplasia mucosae uteri glandularis

cystica
Benign hyperplasia of the
endometrium is diffuse cystic
proliferation, due to estrogenic
stimulation after 2- week proliferative
phase. The extended glands are
scattered
,there are
hemorrhages in their lumen
and in the stroma
.
They are well demarcated and have
preserved basal membranes. Some
glands are covered with more than
one line epithelium without cellular
atypia. Increased number of normal
mitoses can be seen in the
epithelium and in the stroma.

20. Hyperplasia glandulae prostatae

Hormonally induced nodular benign
prostatic hyperplasia includes
epithelial acini and ductules, smooth
muscle cells and stromal fibroblasts:
glandular, myomatous and
adenomyofibromatous hyperplasia.
Papillary epithelial proliferations
are
double- lined: high cylindrical and basal
cells. In acini are found eosinophilic
lamellar protein precipitates
corpora amylacea (with
microcalcifications
), and in stromaround cell infiltrations.

Nodular hyperplasia is developed

periurethrally (in prostatic center) and
causes atrophy of the glands in
subcapsular areas.

21. Atrophia fusca

hepatis
On lower magnification there
are thinning of liver columns
and dilatation of sinusoids. On
higher magnification (20) are
seen decreased in size
hepatocytes with deposits of
golden- brown pigment
granules of lipofuscin.

22. Cyanosis hepatis

In initial venous congestion
mainly centrilobular
sinusoids and central veins
are dilated. They are filled
with erythrocytes
.
The columns of hepatocytes
are separated. Architecture of
liver cell is unchanged and
they are without degenerative
changes. This first stage of
congestion in liver is
reversible.

23. Hepar muschatum

In advanced chronic venous
congestion in the centers of lobules
can be seen only blood lakes.
(1). Sinusoids are dilated and
hyperemic. (2). Hepatocytes in
intermediate area show fat
degeneration and look like signet
ring cells (3). Peripherally
hepatocytes are pressed and
atrophic. (4). The variety of colors
emphasizes the lobular
structure
.
In hepar muschatum adiposum
are saved only the cells in
periportal areas, while in reverse
type (typus inversus) they also
show fat degeneration.

2
1

24. Haemorrhagiae punctatae cerebri

Spot hemorrhages per
diapedesin are seen in
hypertensive crises and in
trauma.
They are scattered in white
brain substance. Free
erythrocytes can be found
around vessels with unchanged
walls. Between them
and
the the vessel is included brain
tissue (annular form) or they
are confluent (discoid form)
Surrounding ganglion cells
are necrobiotic.

25. Oedema cutis

In edema of skin
multilayered flat keratinizing
epithelium of the epidermis
is preserved () , but
fibrous structures of derma

are separated

Between them are found

pale pink precipitates and

around vessels- light areas

.

26. Oedema pulmonis

Air

Edema of lungs occurs in acute

left ventricular failure and in
exogenous or endogenous
intoxications, which cause
increased permeability of the
walls of pulmonary capillaries.
Alveolar spaces are filled
with precipitated homogenous
pink fluid transudate
.
Capillaries in alveolar septi are
dilated and filled with
erythrocytes
. In alveolar
cavities and in the lumen of
bronchi and bronchioles can be
seen airy bubbles as round,
optically empty spaces (A).

A
A
A

Air

Air

27. Thrombus
mixtus
The lumen of the vein is partially
occluded (RL) by a laminar formation,
composed of formed elements of the
blood and fibrin (hrombus).
Its place of insertion (PI) is located in
areas with destruction of the
endothelium.
Pink streaks (aggregated platelets
and fibrin fibers) alternate with orange
accumulations of erythrocytes. Among
them are seen groups of leucocytes.
Clustering of formed elements
distinguishes thrombus from
postmortem clot.

hrombus

Residual
lumen

28. Infarctus
anaemicus renis
On small magnification is seen
eosinophilic area of necrosis (1),
surrounded by blue rim, rich of
inflammatory cells (2) and thin
peripheral streak, infiltrated with
erythrocytes ( hyperemichemorrhagic area) (3).
20: In area of coagulative
necrosis nuclei are missing or
pyknotic, and cytoplasm is
granular. Basal membranes of
glomeruli and tubules are partially
preserved and look like shadows.

1
3

29. Infarctus
haemorrhagicus
pulmonis
Necropsy: At 24th hour of symptoms of
severe dyspnoea and haemoptoe,
alveoli are filled with hemolyzed
erythrocytes and the alveolar walls are
hyperemic (1). Peripherally is seen
leucocytic infiltration (2). The
surrounding preserved alveoli are filled
with edematous fluid and
hemosiderophages, their walls are
thickened and fibrosed.
Hemorrhagic infarction occurs in
pulmonary embolism, which is preceded
by brown induration of lungs
(hemosiderosis + alveolar fibrosis).
Brown induration of lungs is an
expression of chronic left ventricular
failure.

30. Pericarditis
fibrinosa
On the epicardium is seen fibrin
layer with rough net- like
structure, composed of
intertwined fibrin fibers
.
Among them are included
lymphocytes, plasma cells and
leucocytes. Capillaries of
epicardium () are dilated and
hyperemic (inflammatory
hyperemia).

E
p
i
c
a
r
d
i
u
m

31. Leptomeningitis
purulenta
Purulent leptomeningitis
affects brain convexity.
Leptomeninges
are
infiltrated with great number of
neutrophil leucocytes
.
Thrombosis of venous vessels
and local hemorrhages can be
found.
In cerebral cortex is seen
pericellular
and
perivascular
edema.

32. Appendicitis
phlegmonosa
Specimen of transversal
section of appendix lumen,
filled with purulent exudate.
(PE).
Epithelium of mucosa
and
glands is with desquamative
changes (primary affect)
.
Lymph follicles
are
hyperplastic, with light
germinal centers. The whole
wall of appendix from
mucosa to serosa is infiltrated
with leucocytes
.
Subserous vessels shows
hyperemia and on serosa is
found pink fibrin exudate.

Purulent
exudate

33. Myocarditis
acuta abscedens
Among myocardium are
found cavities, filled with
purulent exudateabscesses
.
Segmented leukocytes,
macrophages, detritus
mass (D) and bacterial
colonies
can be found.
Adjacent cardiomyocytes are
with severe degenerative
changes.

34. Granulatio
Granulatio is fresh connective
tissue, rich in cells, blood vessels
and tender argyrophilic fibers.
Capillaries ( C ) are covered with
plump endothelial cells, with oval
nuclei, prominent into the
lumen. In their lumen are seen
erythrocytes (
).
Cell content includes
lymphocytes(1), plasma cells(2),
macrophages, segmented
leucocytes, eosinophils,
fibroblasts and fibrocytes (3).

Increased mass of nasal polyp

is due to severe edema of tunica
propria ( 20).
In some places ciliated
epithelium is hyperplastic, with
hypersecretion
, in othersdesquamated or even with
metaplasia in squamous
epithelium
.
In stroma are found hyperplastic
sero- mucinous glands
,
infiltrates of lymphocytes and
plasma cells (subepithelial and
around vessels)
, eosinophils
(allergic diathesis), mast cells
and fibroblastic proliferation.

35. Polypus nasalis

36. Granuloma typus

corporis alieni
Stereotypical nodular proliferative
reaction against hardly absorbable
particles (projectiles, necrotic
fragments, implants, etc.).
Often occurs around surgical
sutures : zone of polygonal
multinucleated giant cells type
"foreign body
from macrophagic
origin. Their small, rich in chromatin
nuclei are eccentrically clustered. In
granuloma participate fibroblasts,
which later lead to its fibrosing.

37. Echinococcus
hepatis
Echinococcosis most commonly affects
the liver, because scolexes are
transported by the blood in v. ortae from
gastro- intestinal tract to the liver.
Germinate membrane is seen as
basophilic streak (1).
Scolexes are not seen, but chitin
membrane is pathognomonic: thick
multilayered acellular streak, which look
like cigarette smoke(2). Between it and
liver tissue (3) is located fibrous capsulerich in collagen connective tissue (4), in
which are included single bile ducts and
foci of lymphoid inflammatory reaction.

2
1

38. Lymphadenitis
tuberculosa
Lymph nodule is recognized by
the presence of lymphoid tissue in the
periphery. Its structure is destroyed
by tubercles nodules with lamellar
structure.
In the center of granuloma is seen pink
structureless caseous necrosis(1).
Around it is found area of uniform light
polygonal cells, resembling stratum
spinosum of multilayered flat
epithelium. They have macrophagic
origin (from blood monocytes), but are
called epitheloid cells(2). Among them
are seen giant multinucleated cells of
Langhans with numerous light oval
peripherally located nuclei as
horseshoe, opened to necrosis(3).
Peripheral area of tubercle consists of
lymphocytes and less plasma cells.
There is no capillaries in and around the
tubercle.

2
3

2
3

39.Mesaortitis luetica
Luetic mesaortitis is developed 20
and more years after the primary
infection. Most strongly affects tunica
media, which is markedly
vascularized. Lumens of vessels are
occluded due to proliferation of
endothelial cells (endarteriitis
obliterans)
. Around vessels are
seen infiltrates of lymphocytes,
plasma cells, fibroblasts and single
epitheloid cells
. They tear the
elastic fibers, which are replaced by
connective tissue. Similar changes
are found in tunica adventitia.
Thickened intima is predisposed to
severe atherosclerosis.

40. Actinomycosis
Typical bacterial colonies druses are with dark blue
color (1) and pink periphery
( 2 corona radiata). They
are surrounded by purulent
exudate with the presence
of macrophages with one or
more nuclei and foamy
cytoplasm foamy cells(3).
Around granuloma is found
fibrous connective tissue(4).

3
1

3
4

41. Cycatrix myocardii

Scarring is a result of
maturation 8 weeks after
myocardial infarction.
Among pale pink, rich in
collagen connective tissue
(red staining in Van Gieson)
are found fibroblasts, single
hyperemic blood vessels and
scattered cardiomyocytes.
Most of them are atrophic, but
peripherally are seen also
hypertrophic cardiomyocytes
.

42.Struma lymphomatosa
(Thyreoiditis Hashimoto)
In autoimmune thyroiditis
the tissue of thyroid gland is
infiltrated and replaced by
lymphocytes, plasma cells and
macrophages. At some places
are formed lymph follicles with
light germinal centers
.
Surrounding thyroid follicles are
destroyed, but some of them
are with hypertrophic
eosinophilic epithelium- cells of
Ashkenazy.

43. Papilloma
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 in infiltrate the
surrounding tissue.

44. Carcinoma
basocellulare
Under destroyed epidermis
are seen branches and nests
of spindle cells with moderate
polymorphism, scanty
cytoplasm, hyperchromic nuclei
and some mitoses (1).
Tumor nests are solid or cystic
with palisade arranged cells in
the periphery (2). Nests
infiltrate deep layers of derma.
In adjacent connective tissue is
found stromal reaction of
lymphocytes and plasma cells.
Macroscopic metaphor:
ulcus rodens (cankerous ulcer).

45.Carcinoma planocellulare
(spinocellulare) keratodes
Tumor is composed of nests
or
anastomosing branches
, which
remind structure of multilayered
squamous epithelium, from which they
originate. In periphery of nests epithelial
cells remind cells of basal layer (1).
Inside are located polygonal cells with
bright cytoplasm and hyperchromic
nuclei - squamous cells(2).
Synonym of tumor squamous cell
carcinoma.
In highly differentiated types in center
of nests is seen accumulation of pink
stained keratin substancecancer pearls,
and inside them- dystrophic
calcification
.

2
2
1

46. Adenoma pleomorphe (Tumor mixtus)

glandulae parotis
Diverse (pleomorphic)
structure. Tumor cells form
ductules with pink secretion (1),
acini, streaks and branches,
and have cubic to spindle
shape. They are integrated in
the stroma, in which are found
islands as hyaline cartilage
(precipitation of mucus and
myxoid transformation of
connective tissue 2) and rarely
bone.
Immunohistochemically is
proved that cell variety has
myoepithelial origin.

1
1

47. Adenocarcinoma
ventriculi
On background of chronic
gastritis with colonic metaplasia
(10,
) hyperchromic tumor
glands destroy mucosal surface
and infiltrate lamina propria
mucosae and submucosa ( 20).
They are irregular, with destroyed
basal membranes and pathological
mitoses. Epithelium is multilayered,
atypical
.
In PAS reaction in cytoplasm is
proved mucin (red staining).
In stroma are found infiltrates of
lymphocytes and plasma cells
and in lumens of glands- leucocytes
.

48. Lipoma
Encapsulated

nodular

formation of optically empty

lipocytes without cellular atypia.

Lipids are extracted during
deparaffinisation (in frozen sections

+ Sudan red staining).

Vacuoles displace nuclei in the
periphery and signet ringcells
occur ( 20,

). Below capsule

are seen cells with foamy

cytoplasm lipoblasts.
Stroma consists of vessels and

connective tissue

49. Haemangioma
cavernosum hepatis
Among liver tissue
is found tumor without
capsule, but well
distinguished from the
surrounding tissue. Tumor is
composed of large vascular
spaces, resembling corpora
cavernosa of penis
.
Their walls consist of
fibrous septi, covered by
endothelial cells. Inside are
found erythrocytes and
hemolyzed blood.

50. Hemangioma
capillare labii oris
Below multilayered squamous
epithelium are found
transversal and obliquely cut
capillaries, covered with
plump endothelium. Some of
their lumens contain
erythrocytes.
Stroma is hyalinized.
Benign vascular tumors have
no capsule.

51. Leiomyoma uteri

Leiomyomas have no capsule and
their cellular composition is one and the
same as the surrounding myometrium,
but they are well distinguished because
of their fascicular structure
.
The structure is expression of tissue
atypia, while cellular atypia and
infiltration are not seen. Tumor has
expansive growth. It is composed of
smooth muscle cells, crossing in different
directions. Transversal cut nuclei have
ound shape, while obliquely cut spindle.
Leiomyomas differ from neurinoma by
the absence of palisade structure and
from fibroma by the absence of collagen
synthesis (Van Gieson staining).

52. Leiomyosarcoma uteri

The entire specimen is
engaged of tumor tissue and
organ diagnosis is not possible.
Neoplasm consists of spindle
cells, forming chaotic bundles.
Cellular atypia is seen ,
presented by hyperchromasia
polychromasia and
polymorphism of nuclei
.
There are monstrous cells
(giant multinucleated cells with
increased ratio
nucleus /cytoplasm
and a
lot of mitoses.

Malignant tumor of pigment

tissue with cellular atypia.
Epithelium is destroyed
Tumor parenchyma
is
represented by large, pale,
polygonal or spindle cells,
arranged in nests, trabeculae
or acini. There are giant cells
and mitoses. A sign for
differentiation is the presence
of melanocytic granules in the
cytoplasm
. In cases with
total lack of pigment tumor is
called achromatic melanoma.

53. Melanoma
malignum

54. Teratoma adultum

Mature teratomas often occur in ovaries.
They have cystic structure and are filled with
yellow fat tissue and hairs.
In their walls are included elements from
different germinal layers. Cyst may be covered
by multilayered squamous epithelium
and in its wall are seen hair follicles and
sebaceous glands
. Squamous epithelium
can transverse in multilayered ciliated cylindrical
epithelium
and below is found hyaline
cartilage
and sero- mucinous (bronchial)
glands
. Fat and lymphoid tissue, elements
of thyroid tissue, brain substance and even teeth
can also be found.