(Fig. 17.3, A) : 3. Adenoma-Carcinoma Sequence Evolves From Pre-Existing Adenomas, Referred To As

Exam ticket no 1
Task. Patient R 60 years old went to the doctor with complaints about the appearance on the
lower lip of the focus of whitish-gray-spots. Microscopic examination of the biopsy of the mucous
membrane revealed significant keratin accumulation in the epithelium.
1. Name the pathological condition.

- Leukoplakia
2. Morphogenesis, classification, consequences.

leukoplakia may appear white, whitish-yellow, or red-velvety of more than 5 mm
diameter and variable in appearance. they are usually circumscribed, slightly elevated,
smooth or wrinkled, speckled or nodular.
leukoplakia is of 2 types:
1. Hyperkeratotic type is is characterised by an orderly and regular hyperplasia of

squamous epithelium with hyperkeratosis on the surface (Fig. 17.3, A).
2.Dysplastic type When the changes such as irregular stratification of the epithelium,
focal areas of increased and abnormal mitotic figures, hyperchromatism, pleomorphism,
loss of polarity and individual cell keratinisation are present, the lesion is considered as
epithelial dysplasia.
Task. At the autopsy of a 68year old man in the lumen of the colon there was a fungal tumor.
Numerous nodes from 1 to 2 cm in diameter of the white collar with clear borders are found in the
liver. Histological examination of the intestine and nodes revealed atypical glands, cell-
polymorphic, mutlitiple mitosis.

- Colon carcinoma with hepatic metastasis. (adenocarcinoma of colon)
3. Adenoma-carcinoma sequence evolves from pre-existing adenomas, referred to as

adenoma-carcinoma sequence (Fig. 18.48). thee following evidences are cited to support
this hypothesis:
i) In a case with early invasive cancer, the surrounding tissue often shows preceding
changes of evolution from adenoma hyperplasia dysplasia carcinoma in situ invasive
carcinoma.
ii) Incidence of adenomas in a population is directly propor- tionate to the prevalence of

colorectal cancer.
iii) e risk of adenocarcinoma colon declines with endoscopic removal of all identified
adenomas.
iv) Peak incidence of adenomas generally precedes by some years to a few decades the
peak incidence for colorectal cancer. v) e risk of malignancy increases with the following
adenoma-related factors:
a) Number of adenomas: familial polyposis coli syndrome almost certainly evolves into
malignancy.
b) Sizeofadenomas:large size increases the risk.
c) Type of adenomas: greater villous component associated with higher prevalence.
- Originates from the epithelium cell lining of the colon which most frequently is a result of
mutation, the mutation can be inherited or acquired.
I. COLORECTAL POLYPS
A. Non-neoplastic polyps
Hyperplastic (metaplastic) polyps Hamartomatous polyps
1. 2. (i) Peutz-Jeghers polyps and polyposis
3. 4. (ii) Juvenile (Retention) polyps and polyposis In ammatory polyps (Pseudopolyps)

Lymphoid polyps
B. Neoplastic polyps (Adenomas)
Tubular adenoma (Adenomatous polyp)
1. 2.
Villous adenoma (Villous papilloma)
3.
Tubulovillous adenoma (Papillary adenoma, villoglandular adenoma)
C. Familial polyposis syndromes
Familial polyposis coli (Adenomatosis) Gardner’s syndrome
1. 2.
Turcot’s syndrome
3. 4.
Juvenile polyposis syndrome
OTHER BENIGN COLORECTAL TUMOURS
II.
(Leiomyomas, leiomyoblastoma, neurilemmoma, lipoma and vascular tumours)
III. MALIGNANT COLORECTAL TUMOURS
A. Carcinoma
Adenocarcinoma
Other carcinomas
1. 2.
(Mucinous adenocarcinoma, signet-ring cell carcinoma, adenosquamous carcinoma,
undi erentiated carcinoma)
Other malignant tumours
B.
(Leiomyosarcoma, malignant lymphoma, carcinoid tumours)
IV. TUMOURS OF THE ANAL CANAL
A. Benign (viral warts or condyloma acuminata)
Malignant (squamous cell carcinoma, basaloid carcinoma, mucoepidermoid carcinoma,
B.
adenocarcinoma, undi erentiated carcinoma, malignant melanoma)
Colorectal polyps may be non-neoplastic and neoplastic.
! Non-neoplastic polyps are more common and include

hyperplastic, hamartomatous, and inflammatory polyps.
-Neoplastic polyps or adenomas are tubular, villous and tubulovillous adenomas. These
are more significant due
to their possible malignant change.
! Colorectal polyps may occur as a part of syndromes e.g.
familial polyposis, Gardener’s, Turcots
Task. Peptic ulcer.

- Purulent ulcerative

acute stress ulcers are multiple (more than three ulcers in 75% of cases). ey are more
common anywhere in the stomach, followed in decreasing frequency by occurrence in the
rst part of duodenum. ey may be oval or circular in shape, usually less than 1 cm in
diameter.
some inflammatory reaction depending upon the duration of the ulcers. ese ulcers
commonly heal by complete re- epithelialisation without leaving any scars. Complications
such as haemorrhage and perforation may occur.
classification; chronic and acute
PATHOGENESIS It is not clear how the mucosal erosions occur in stress ulcers because
actual hypersecretion of gastric acid is demonstrable in only Cushing’s ulcers occurring
from intracranial conditions such as due to brain trauma, intracranial surgery and brain
tumours. In all other etiologic factors, gastric acid secretion is normal or below normal. In
these conditions, the possible hypotheses for genesis of stress ulcers are as under:
1. Ischaemic hypoxic injury to the mucosal cells.

2. Depletion of the gastric mucus ‘barrier’ rendering the mucosa susceptible to attack by
acid-peptic secretions.
complications
duodenal ulcer: Commonly haemorrhage, perforation, sometimes obstruction; malignant
transformation never occurs
gastric ulcer: Perforation, haemorrhage and at times obstruction; malignant transformation in less
than 1% cases
Exam ticket no 2
Task. A patient with rheumatic fever, 55 years old. The autopsy revealed the deformed mitral valve
leaflets with slight thrombotic masses on the surface, in the left hemisphere of the brain -
ischemic necrosis.
- Rheumatic vascular endocarditis.
- Endocardial lesions of rheumatic fever may invoke the vascular end mural endocardium,
causing rheumatic vasculitis and mural endocarditis.
Task. A women 6 months after surgery due to a benign tumor of the anterior abdominal wall went
to the doctor with complaints about the appearance in the postoperative scar a tumour that is
constantly growing.

- Desmoid tumor (anterior abdominal wall), (Extra, intra -abdominal desmoids)
- Abdominal - Locally aggressive, infiltrating timor-like fibroblastic growth, often found in the
musculo- aponeurotic structures of the rectus muscle in the anterior abdominal wall in women
during or after pregnancy

- Solitary large grey-like. firm and unecncapsulated tutors infiltrating the muscle wall.
Classification.
a. (Extra, are more common in men and are widely distributed such as in the upper and lower
extremities, chest wall, back, buttocks, and head and neck region.
b. intra -abdominal desmoids) - present at the root of the small bowel mesentery are associated
with Gardner’s syndrome (consisting of bromatosis, familial intestinal polyposis, osteomas and
epidermal cysts).
Task A. A school-age child developed chills, fever rose to 39 degrees celsius, sharp headache,
agitation, anxiety, vomiting. Occipital rigidity was revealed. Diagnosis: meningococcal meningitis.
A few days later, a large-spotted rash appeared on the body, the involvement of the vascular
membrane of the eyes and acute adrenal insufficiency, which led to death.

-Meningococcemia- amage of microcirculation, skin rash, changes in the joints,
vascular membrane of the eyes, adrenal glands and kidneys.
Focal necroses and hemorrhages or bilateral massive hemorrhages with the

development of acute adrenal insufficiency(Waterhouse-Friderichsen syndrome)
are noted in the adrenals. Necrosis of nephrothelium of the tubules (necrotic
nephrosis) is observed in the kidneys. The changes of the microcirculation are
characterized by vasculitis and necrosis.
The death of the patients is caused by bacterial shock, its severity is aggravated
by hemorrhages to the adrenals, acute renal insufficiency is not so common (in the
adults). When the course of the disease is prolonged, the death occurs from septicemia
or purulent meningitis.
Exam ticket No 3 - ALSO TICKET 8
Task. A patient with rheumatic mitral stenosis died of chronic heart failure.
During life there was a cough with brown sputum.
-Rheumatic valvular endocarditis - leading to pulmonary edema.
Task. The patient was treated for three years for periodic increased blood
pressure. He was admitted to the neurological department with symptoms of
severe brain pathology from which he died. The section revealed a tumor of
the medullar-layer of the right adrenal gland and hemorrhage in the lateral
ventricles of the brain.
Histologically in the tissue of the tumor which is built of cells of the adrenal
medulla, signs of tissue atypism were detected.

- Pheochromocytoma
The patient is suffering from atherosclerosis and died of cardio vascular
Exam ticket No 4
Task. A patient with leukaemia under the influence of cytostatic drugs and radiation therapy had
constant complaints of joint pain. Objectively, there is a compaction of periarticular tissue, the
presence of ‘’lumps’’. In total blood test hyperuricemia was confirmed.

- (Gouty arthritis) - it’s a purine arthritis.
- Manifested by - increased serum uric acid, aggregated deposits of

Types:
- hyperuricaemia of metabolic origin - over production of uric acid
- hyperuricaemia of renal origin - decreased renal excretion of uric acid.
Morphological feautures- acute gouty arthritis
Task. The patient went to the clinic with complaints of a module appearance in the right breast.
The nodule appeared 2 years ago, the last six months is constantly increasing in size. On
examination - a node in size of a chicken egg fused with the surrounding tissues - the margins are
not clear. Enlarged supra-and subclavicular, axillary lymph nodes, but not painful.

- Breast cancer (malignant)

- Etiopathogenesis - hormonal & genetic.
- Hormonal - early menstruation and late menopause
Greater risks - ovarian tutors, long term use of contraceptives.
Genetic factors = BRCA 1gene, BRCA gene 2.
Classification
- Non-invasive carcinoma - introductal,lobular carcinoma
- Invasive carcinoma - tubular carcinoma, medullary, papillary, secretory, infiltrato carcinoma?
Task. The patient who suffered for 15 years from hypertension was examined and revealed
following: protein in the urine, a significant increase in blood creatinine. The patient died with
increasing symptoms of autointoxication from chronic renal failure.

Exam ticket No 7.
Task. During a traffic accident, the driver received a neck injury with broken glass. Bleeding from
the veins was stopped, but the victim died a few minutes later because of acute cardiovascular
failure.

- traumatic shock - shock resulting from trauma due to hypovolemia but even after haemorrhage
has been…..

stages of traumatic shock - compensated, progressive, irreversible.
Task. The uterus removed during the operation and is increased to 1-2 kg, the surface is tuberous
and on the section has many white coloured dense nodes of different size, generally sub-serous
localization.

-Uterine fibroid

- fibromyomes, most common uterine fibroids, unknown cause but possibly stimulates to their
proliferation of oestrogen
- there are mostly localised in the uterus usually multiple circumsied firmed nodular grey white
masses of variable size.
- stages: 1a(tumor limited to endothelium),
- 2a(endocervical glandular envolvement),
- 3a(tumor invades cerosa),
- 4a(tumor acts on bladder and bowel mucosa)
Task. The patient of a tall stature, disproportioned body composition, worried about headache,
increasing in the size of some bones and feet. X-rays revealed an increased in the size sella
turcica.
acromegaly. reason tumor adenohypophysis due to hormone secreting pituitary adenoma.
increase production of GH in adults following bone growth
Exam ticket No 9
Task. The lady who suffered from rheumatic fever for 25 years during the autopsy was found
following: in the heart - the fusion of mitral valve leaflets, the atrioventricular orifice is significantly
narrowed. Free fluid in the abdominal and pleural cavities. ‘’Nutmeg’’ liver, brown induration of the
lungs, cyanotic induration of the kidneys and spleen.
- Chronic right ventricular insufficiency
Task. The patient is 50 years old. Complains of an increase in the group of lymph nodes on the left
neck, weakness, weight loss, itchy skin, fever, ESR - 40 mm/h, there are no deviations in the
leukocyte formula. In the study of lymph node biopsy among the lymphoid elements found the
proliferation of atypical reticular cells, there are giant Berezovsky-Stenberg multinucleated cells,
foci of necrosis and sclerosis.
- Hodgkin’s disease/ lymphogranulomatosis.
Task. A 3 year old child suffering from primary tuberculosis, the following was found in the
section: sub pleural focus of caseous pneumonia in 3 segments up to 4 cm in size in the right
lung, enlargement and casenus necrosis of periphronchial, intrathoracic and cervical lymph
nodes, basal serous leptomeningitis.
1. Name the pathological condition
- Tuberculoma.
Exam ticket No 9
Task. Patient V for 10 years suffered from chronic lung abscesses and died of chronic renal failure.
On section the kidneys, liver, spleen are dense, increased in with iodine and sulphuric acid, the
surface of the kidneys turns blue.

- Secondary amyloidosis - due to greasy look
classification of amyloidosis:
- Systemic amyloidosis (primary, secondary, haemodialysis-associated, heredofamilial)
- Localised amyloidosis (senile cardiac, senile cerebral, endocrine, tumour-forming)
Task. Patient A, 20 years old at a rectoromanoscopy the tumor-like formation of a mucous

membrane with thin peduncle and a smooth surface. Microscopically, these formations are
represented by glands of irregular shape, consisting of high cylindrical epithelium with even
polarity of cells. Between the glands are thin connective tissue layers.

- Colon adenoma - due to tissue adenoma

Exam ticket No.5 - ALSO NR 8 (from another variant)
Task. A patient with coronary heart disease age-60 years, died because of acute heart failure. In
section the heart enlarged in size from the anterior wall of the left ventricle the focus is 2x3 cm,
irregular in shape. white-yellow with haemorrhages on the periphery. In the lumen of the left
coronary artery was found obstructive thrombus.

- Myocardial infraction.
Task. Necrotic tonsilitis was defined at the autopsy of an 11 year old child. The content of the
stomach has the colour of ‘’coffee-grains’’. In the intestine, the content of tar type on the mucous
membrane of the gastrointestinal tract petechial hemorrhages. Blood test- 20.0 thousand
leukocytes (45%- blast cells)

- Chronic peptic ulcer (stomach ulcer)
Task. At the autopsy bronchiectasis with the presence of abscesses with a pyrogenic membrane
was found in the lungs. Kidneys are dense the cutting surface has sebaceous appearance. In
addition ‘’hairy heart’’, fibrinous pleurisy, enterocolitis, pulmonary edema.

- Kidney failure. (secondary amyloidosis)
Exam ticket No 12
Task. A woman 70 years old after a fracture of the lower extremity was hospitalised in the trauma
department. On the 3rd day after the injury there was pain in the chest, shortness of breath,
cyanotic face, after which the patient died suddenly. At autopsy in the lungs, 2/3 of the vessels
are blocked by fat droplets, dense tray-red mass is found. Similar - formations are also found in
the lumen of the deep veins of the legs.

- Fat embolism -bone injuries when the fat is crushed and turned into emulsion;

- Due to trauma.
Following trauma fat is released directly from bone marrow to circulation due to trauma there is;
excerted pressure in the medulla cavity in bone marrow. The bone marrow releases fat globulins
into venous system supplying the bone. Thus there is obstruction in the fat embolus in the lung
capillaries.
If fat globules obstruct 80% of the lung capillary network, it all causes right heart failure which
results to death.
Classification
1. Trauma.
2. Non-tumatic
Concequences
1. Death
2. Brain damage
3. edema
4. Acute respiratory failure.
5. Stroke
6. alveolar haemorrhage
Signs & symptoms

1. Hypoxia.
2. Tacycardia
3. High temp
4. Unexplained anaemia
5. Mental status change
Task. A 63-year-old patient underwent surgery due to an enlargement prostrate and acute urinary
retention. Gladular structure of various size and also a large number of smooth muscle fibres are
histologically found in prostate tissue.
- Nodular hyperplasia of prostrate.
- Enlarged prostrate is; nodular, smooth, firm, weights 2-4 times.
1. Primary glandular BEP, Yellow pink soft, honey combed
2. Mainly fibromuscular - cut surface is firm, homogenous and cut surface is rm, homogeneous
and does not exude milky fluid.
3. Classification
Histologically, in every case, there is hyperplasia of all three tissue elements in varying
proportions—glandular, fibrous and muscular (Fig. 21.14):
Glandular hyperplasia predominates in most cases and is identified by exaggerated intra-

acinar papillary infoldings with delicate fibrovascular cores. e lining epithelium is two-
layered: the inner tall columnar mucus-secreting with poorly-de ned borders, and the
outer cuboidal to attened epithelium with basal nuclei.
Fibromuscular hyperplasia when present as dominant component appears as aggregates of

spindle cells forming an appearance akin to bromyoma of the uterus.
In addition to glandular and/or bromuscular hyperplasia, other histologic features

frequently found include foci of lymphocytic aggregates, small areas of infarction,
corpora amylacea and foci of squamous metaplasia.
4. Etiology - etiologic factors such as endocrinologic, racial, inflammation a n d

arteriosclerosis
Task. The patient has in the area of the left labia a painless ulcer with a copper-red smooth
bottom and cartilaginous edge. Inguinal lymph nodes on the left are enlarged, dense.
- Syphilis
- Sexually transmitted disease by spirochaetes
Classification:
-Primary syphilis, - Typical lesions appear on genital, 2-4 weeks after exposure to infection. Dense
infiltrate of mainly plasma cells proliferation of vascular endothelium .
- Secondary syphilis - in adequately primary syphilis developed into mucutaneous lesions in 2-3
months after exposure on the month, pharynx and vagina.
- Tertiary syphilis - Secondary lesions which appear about 2-3 years following the first exposure.
It has 2 main types.
a. Syphilitic gumma - It is a solitary, localised, rubbery lesion with central necrosis, seen
in organs like liver, testis, bone and brain.
ii) Diffuse lesions of tertiary syphilis the lesions appear following widespread
dissemination of spirochaetes in the body.
task 9
Answers: 1. Chronic general diseases of the connective tissue and vessels of the skin, internal organs
with marked autoimmunization.
2. a) diffuse, b) acute vemicous, c) recurrent verrucous, d) fibroplastic.
3. a) young, b) mature, c) old, 4, a) accumulation of muddy liquid,
b) growth ofvilli and destruction of the cartilage, c) development of fibrous
osteal ankylosis. 5, a) enlarged, b) flabby, c) stretched, with thrombotic
masses, d) motley. 6. Rheumatic disease. Stenosis of the orifice of the
mitral valve. Heart failure,
task 9 2.
• Hodgkin’s disease (HD) primarily arises within the lymph nodes and
involves the extranodal sites secondarily.
•
Morphogenesis:
most commonly a ected are the cervical, supraclavicular and axillary groups.
e sectioned surface of the involved lymph nodes or extranodal organ involved appears
grey-white and sh esh-like.
Nodular sclerosis type HD may show formation of nodules due to scarring while mixed
cellularity and lymphocyte depletion types HD may show abundance of necrosis.
Liver enlargement too may occur.
Constitutional symptoms (type B symptoms) are present in 25-40% of patients. e most

common is low-grade fever with night sweats and weight loss. Other symptoms include
fatigue, malaise, weakness and pruritus.
Exam ticket no 8 - ALSO TICKET 3
Task A. A patient with rheumatic mitral stenosis died of chronic heart failure. During life, there was
a cough with brown sputum.

- Rheumatic valvular endocarditis (leading to pulmonary edema)
Task. The patient was treated for three years for periodic increased blood pressure. He was
admitted to the neurological department with symptoms of severe brain pathology, from which he
died. The section revealed a tumor of the medullar layer of the right adrenal gland and
haemorrhage in the lateral ventricles of the brain.
Histologically in the tissue of the tumor, which is built of cells of the adrenal medulla, signs of
tissue atypism were detected.

- Pheochromocytoma
Exam ticket no 8 -ALSO TICKET 3
Task. A patient with rheumatic mitral stenosis died of chronic heart failure. During life, there was a
cough with brown sputum.

- (Mitral valve endocarditis.) Rheumatic valvular endocarditis - leading to pulmonary edema.
Task. The patient was treated for three years for periodic increased blood pressure. He was
admitted to the neurological department with symptoms of severe brain pathology, from which he
died. The section revealed a tumor of the medullar layer of the right adrenal gland and
haemorrhage in the lateral ventricles of the brain.
Histologically in the tissue of the tumor, which is built of cells of the adrenal medulla, signs of
tissue atypism were detected.

- Phenochromocytoma.
3rd- ischemia - Answer

Patient R 60 years old went to the doctor with complaints about the appearance on the
lower lip of the focus of whitish-gray-spots. Microscopic examination of the biopsy of the mucous
membrane revealed significant keratin accumulation in the epithelium.
- Leukoplakia
leukoplakia may appear white, whitish-yellow, or red-velvety of more than 5 mm
diameter and variable in appearance. they are usually circumscribed, slightly elevated,
smooth or wrinkled, speckled or nodular.
leukoplakia is of 2 types:
1. Hyperkeratotic type is is characterised by an orderly and regular hyperplasia of
squamous epithelium with hyperkeratosis on the surface (Fig. 17.3, A).
2.Dysplastic type When the changes such as irregular stratification of the epithelium,
focal areas of increased and abnormal mitotic figures, hyperchromatism, pleomorphism,
loss of polarity and individual cell keratinisation are present, the lesion is considered as
epithelial dysplasia
At the autopsy of a 68year old man in the lumen of the colon there was a fungal tumor.
Numerous nodes from 1 to 2 cm in diameter of the white collar with clear borders are found in the
liver. Histological examination of the intestine and nodes revealed atypical glands, cellpolymorphic,
mutlitiple mitosis.
- Colon carcinoma with hepatic metastasis. (adenocarcinoma of colon)
Microscopically, adenocarcinoma is characterized by atypia of epithelial cells(different shapes and

sizes) , hyperchromatic nuclei. Tumorous cells form abnormal gland formations of various sizes and
shapes that grow into the surrounding tissue and destroy it. The basal membrane disappears
According to structure adenocarcinoma may be
A. Acinar
B. Tubular
C. Papillary
The patient has been suffering from peptic ulcer of the stomach with seasonal exacerbation for a
long time. During the latest exacerbation accompanied by severe pain irradiating to under the
scapula, the patient performed gastroscopy demonstrated an ulcerative defect to 3 cm in diameter
with indistinct edges with yellowish-green membranes and constriction of the lumen in the
polyduodenal zone.
- Purulent ulcerative
acute stress ulcers are multiple (more than three ulcers in 75% of cases). They are more
common anywhere in the stomach, followed in decreasing frequency by occurrence in the
rest part of duodenum. They may be oval or circular in shape, usually less than 1 cm in
Diameter. Some inflammatory reaction depending upon the duration of the ulcers. These ulcers
commonly heal by complete re- epithelialisation without leaving any scars. Complications
such as haemorrhage and perforation may occur.
classification; chronic and acute
Complications
duodenal ulcer: Commonly haemorrhage, perforation, sometimes obstruction; malignant
gastric ulcer: Perforation, haemorrhage and at times obstruction; malignant transformation in less
than 1% cases
A patient with rheumatic fever, 55 years old. The autopsy revealed the deformed mitral valve
leaflets with slight thrombotic masses on the surface, in the left hemisphere of the brain -
ischemic necrosis.
Rheumatic vascular endocarditis.
3. Morphogenesis, classification, consequences
Depending on localization it can be valvular , chordal, parietal. Common ones are valvular
endocarditis. Classification of valvular endocarditiss :
1. Diffuse or valvulitis - diffuse damge of the valve cusps without endothelial changes and thrombotic
overlapping.
2. Acute warty - endothelial changes and warty thrombotic overlaps on the valve cups.
3. Fibroplastic - a reuslt of two forms with sclerosis and scarring.
4. Relapsing warty - endothelial changes and warty thrombotic overlaps on the valve cusps that
develops on the sclerosed and thickened valve.
A women 6 months after surgery due to a benign tumor of the anterior abdominal wall went
to the doctor with complaints about the appearance in the postoperative scar a tumour that is
constantly growing.
- Desmoid tumor (anterior abdominal wall), (Extra, intra -abdominal desmoids)
- Abdominal - Locally aggressive, infiltrating timor-like fibroblastic growth, often found in the
musculo- aponeurotic structures of the rectus muscle in the anterior abdominal wall in women
during or after pregnancy
- Solitary large grey-like. firm and unecncapsulated tutors infiltrating the muscle wall.
Classification.
a. (Extra, are more common in men and are widely distributed such as in the upper and lower
extremities, chest wall, back, buttocks, and head and neck region.
b. intra -abdominal desmoids) - present at the root of the small bowel mesentery are associated
with Gardner’s syndrome (consisting of bromatosis, familial intestinal polyposis, osteomas and
epidermal cysts)
A school-age child developed chills, fever rose to 39 degrees celsius, sharp headache,
agitation, anxiety, vomiting. Occipital rigidity was revealed. Diagnosis: meningococcal meningitis.
A few days later, a large-spotted rash appeared on the body, the involvement of the vascular
membrane of the eyes and acute adrenal insufficiency, which led to death.1. Name the pathological
condition.
- Meningococcemia- image of microcirculation, skin rash, changes in the joints,
vascular membrane of the eyes, adrenal glands and kidneys.
Focal necroses and hemorrhages or bilateral massive hemorrhages with the
development of acute adrenal insufficiency(Waterhouse-Friderichsen syndrome)
are noted in the adrenals. Necrosis of nephrothelium of the tubules (necrotic
nephrosis) is observed in the kidneys. The changes of the microcirculation are
characterized by vasculitis and necrosis.
The death of the patients is caused by bacterial shock, its severity is aggravated
by hemorrhages to the adrenals, acute renal insufficiency is not so common (in the
adults). When the course of the disease is prolonged, the death occurs from septicemia
or purulent meningitis.
A patient with rheumatic mitral stenosis died of chronic heart failure.During life there was a cough
with brown sputum.
-Rheumatic valvular endocarditis - leading to pulmonary edema.
The patient was treated for three years for periodic increased blood pressure. He was admitted to
the neurological department with symptoms of severe brain pathology from which he died. The
section revealed a tumor of the medullar-layer of the right adrenal gland and hemorrhage in the
lateral ventricles of the brain. Histologically in the tissue of the tumor which is built of cells of the
adrenal medulla, signs of tissue atypism were detected.
- Pheochromocytoma
Grossly, the tumor is usually less than 5cm in diameter. It has a pale creamy cut surface which
changes to dark brown with exposed to air.
A patient with leukaemia under the influence of cytostatic drugs and radiation therapy had
constant complaints of joint pain. Objectively, there is a compaction of periarticular tissue, the
presence of ‘’lumps’’. In total blood test hyperuricemia was confirmed.
- (Gouty arthritis) - it’s a purine arthritis.
- Manifested by - increased serum uric acid, aggregated deposits of
Types:
- hyperuricaemia of metabolic origin - over production of uric acid
- hyperuricaemia of renal origin - decreased renal excretion of uric acid
The tissues where the slats accumulate necrotize with agranulomatous reactions and accumulation of
giant cells around them. The process is followed by connective tissue growth with formation gouty
nodes.
The patient went to the clinic with complaints of a module appearance in the right breast.
The nodule appeared 2 years ago, the last six months is constantly increasing in size. On
examination - a node in size of a chicken egg fused with the surrounding tissues - the margins are
not clear. Enlarged supra-and subclavicular, axillary lymph nodes, but not painful.
- Breast cancer (malignant)
- Etiopathogenesis - hormonal & genetic.
- Hormonal - early menstruation and late menopause
Greater risks - ovarian tutors, long term use of contraceptives.
Genetic factors = BRCA 1gene, BRCA gene 2.
Classification
- Non-invasive carcinoma - intraductal,lobular carcinoma
- Invasive carcinoma - tubular carcinoma, medullary, papillary, secretory, infiltrative carcinoma

During a traffic accident, the driver received a neck injury with broken glass. Bleeding from
the veins was stopped, but the victim died a few minutes later because of acute cardiovascular
failure.
1. Name the pathological condition.-
Traumatic shock - shock resulting from trauma due to hypovolemia
stages of traumatic shock - compensated, progressive, irreversible
The uterus removed during the operation and is increased to 1-2 kg, the surface is tuberous
and on the section has many white coloured dense nodes of different size, generally sub-serous
localization.
-Uterine fibroid
- fibromyomes, most common uterine fibroids, unknown cause but possibly stimulates to their
proliferation of oestrogen
- there are mostly localised in the uterus usually multiple circumsied firmed nodular grey white
masses of variable size.
- stages: 1a(tumor limited to endothelium),
- 2a(endocervical glandular envolvement),
- 3a(tumor invades cerosa),
- 4a(tumor acts on bladder and bowel mucosa)
The patient of a tall stature, disproportioned body composition, worried about headache,
increasing in the size of some bones and feet. X-rays revealed an increased in the size sella
turcica.
acromegaly. reason tumor adenohypophysis due to hormone secreting pituitary adenoma.
increase production of GH in adults following bone growth
The lady who suffered from rheumatic fever for 25 years during the autopsy was found
following: in the heart - the fusion of mitral valve leaflets, the atrioventricular orifice is significantly
narrowed. Free fluid in the abdominal and pleural cavities. ‘’Nutmeg’’ liver, brown induration of the
lungs, cyanotic induration of the kidneys and spleen.
- Chronic right ventricular insufficiency
The patient is 50 years old. Complains of an increase in the group of lymph nodes on the left
neck, weakness, weight loss, itchy skin, fever, ESR - 40 mm/h, there are no deviations in the
leukocyte formula. In the study of lymph node biopsy among the lymphoid elements found the
proliferation of atypical reticular cells, there are giant Berezovsky-Stenberg multinucleated cells,
foci of necrosis and sclerosis.
- Hodgkin’s disease/ lymphogranulomatosis.

A 3 year old child suffering from primary tuberculosis, the following was found in the
section: sub pleural focus of caseous pneumonia in 3 segments up to 4 cm in size in the right
lung, enlargement and casenus necrosis of periphronchial, intrathoracic and cervical lymph
nodes, basal serous leptomeningitis.
1. Name the pathological condition
- Tuberculoma.
it is a specific variant of infiltrative tuberculosis development after resolving of inflammatory infiltrate.

It looks like encapsulated focus of caseous necrosis up to 5cm in diameter.
Patient V for 10 years suffered from chronic lung abscesses and died of chronic renal failure.
On section the kidneys, liver, spleen are dense, increased in volume on section have greasy look.
When the surface of the kidneys are covered with iodine and sulphuric acid, the surface of the
kidneys turns blue.
- Secondary amyloidosis - due to greasy look
Histochemically amyloud is stained reddish orange with congo red and background of surrounding
tissues is stained reddish brown. Microscopy shows amyloid accumulates around collagen or
recticular fibresas well as vascular wall. Grossly, the organs are enlarged and dense. They are fragile
and have sebaceous appearance on incision.
Patient A, 20 years old at a rectoromanoscopy the tumor-like formation of a mucous
membrane with thin peduncle and a smooth surface. Microscopically, these formations are
represented by glands of irregular shape, consisting of high cylindrical epithelium with even
polarity of cells. Between the glands are thin connective tissue layers.
- Colon adenoma - due to tissue adenoma
Tubular adenoma - there glandular cavities resembling tubes in the connective tissue with vessels.
Alveolar adenoma - numerous bubbles bedded with cylindrical or cubic epithelium are observed in
the connective tissue vessels. The epithelium is seperated from surrounding tissue by its own
membrane.
A patient with coronary heart disease age-60 years, died because of acute heart failure. In
section the heart enlarged in size from the anterior wall of the left ventricle the focus is 2x3 cm,
irregular in shape. white-yellow with haemorrhages on the periphery. In the lumen of the left
coronary artery was found obstructive thrombus.
- Myocardial infraction.
2. Morphogenesis, classification,
Necrotic tonsilitis was defined at the autopsy of an 11 year old child. The content of the
stomach has the colour of ‘’coffee-grains’’. In the intestine, the content of tar type on the mucous
membrane of the gastrointestinal tract petechial hemorrhages. Blood test- 20.0 thousand
leukocytes (45%- blast cells)
- Chronic peptic ulcer (stomach ulcer)
At the autopsy bronchiectasis with the presence of abscesses with a pyrogenic membrane
was found in the lungs. Kidneys are dense the cutting surface has sebaceous appearance. In
addition ‘’hairy heart’’, fibrinous pleurisy, enterocolitis, pulmonary edema.
- Kidney failure. (secondary amyloidosis)
- Localised amyloidosis (senile cardiac, senile cerebral, endocrine, tumour-forming
REFER TO PREVIOUS AMYLODOSIS
A woman 70 years old after a fracture of the lower extremity was hospitalised in the trauma
department. On the 3rd day after the injury there was pain in the chest, shortness of breath,
cyanotic face, after which the patient died suddenly. At autopsy in the lungs, 2/3 of the vessels
are blocked by fat droplets, dense tray-red mass is found. Similar - formations are also found in
the lumen of the deep veins of the legs.
- Fat embolism -bone injuries when the fat is crushed and turned into emulsion;
- Due to trauma.
Following trauma fat is released directly from bone marrow to circulation due to trauma there is;
excerted pressure in the medulla cavity in bone marrow. The bone marrow releases fat globulins
into venous system supplying the bone. Thus there is obstruction in the fat embolus in the lung
capillaries.
If fat globules obstruct 80% of the lung capillary network, it all causes right heart failure which
results to death.
Classification
1. Trauma.
2. Non-tumatic
Concequences
1. Death
2. Brain damage
3. edema
4. Acute respiratory failure.
5. Stroke
6. alveolar haemorrhage
Signs & symptoms
1. Hypoxia.
2. Tacycardia
3. High temp
4. Unexplained anaemia
5. Mental status change

A 63-year-old patient underwent surgery due to an enlargement prostrate and acute urinary
retention. Gladular structure of various size and also a large number of smooth muscle fibres are
histologically found in prostate tissue.
- Nodular hyperplasia of prostrate.
- Enlarged prostrate is; nodular, smooth, firm, weights 2-4 times.
1. Primary glandular BEP, Yellow pink soft, honey combed
2. Mainly fibromuscular - cut surface is firm, homogenous and cut surface is rm, homogeneous
and does not exude milky fluid
Classification Histologically, in every case, there is hyperplasia of all three tissue elements in varying
proportions—glandular, fibrous and muscular (Fig. 21.14):
Glandular hyperplasia predominates in most cases and is identified by exaggerated intraacinar

papillary in foldings with delicate fibrovascular cores. e lining epithelium is two layered: the inner tall
columnar mucus-secreting with poorly-de ned borders, and the outer cuboidal to attened epithelium
with basal nuclei.
Fibromuscular hyperplasia when present as dominant component appears as aggregates of
spindle cells forming an appearance akin to bromyoma of the uterus.
In addition to glandular and/or bromuscular hyperplasia, other histologic features
frequently found include foci of lymphocytic aggregates, small areas of infarction,
corpora amylacea and foci of squamous metaplasia.
Etiology - etiologic factors such as endocrinologic, racial, inflammation and Arteriosclerosis
The patient has in the area of the left labia a painless ulcer with a copper-red smooth
bottom and cartilaginous edge. Inguinal lymph nodes on the left are enlarged, dense.
- Syphilis
- Sexually transmitted disease by spirochaetes
Classification:
-Primary syphilis, - Typical lesions appear on genital, 2-4 weeks after exposure to infection. Dense
infiltrate of mainly plasma cells proliferation of vascular endothelium .

- Secondary syphilis - in adequately primary syphilis developed into mucutaneous lesions in 2-3
months after exposure on the month, pharynx and vagina.
- Tertiary syphilis - Secondary lesions which appear about 2-3 years following the first exposure.
It has 2 main types.
a. Syphilitic gumma - It is a solitary, localised, rubbery lesion with central necrosis, seen
in organs like liver, testis, bone and brain.
ii) Diffuse lesions of tertiary syphilis the lesions appear following widespread dissemination of
spirochaetes in the body.
The patient is 6 years old was admitted to the neurological department with complaints of
headache, vomiting, nausea, problems with coordination ataxia. CT shows a homogenous
formation in the cerebellum. On dissection the tumor is localized in vermis along midline of the
cerebellum. It has a soft texture, grayish-pink color
1. Medulloblastoma
2. Microscopically, consists of homogeneous small cells with dark round or oval nucleus and a poorly
seen rim of cytoplasm. The cells are located close to each other. Rosette so caed collonar structures
are typical. Mitoses are numerous but vessels are few.
1. Chronic venous congestion. General type
2. Increase filling with blood of an organ or tissue due to difficulties with blood outflow when blood
supply is changed or decreased.
3. Classification 1. local 2. General which divided into acute and chronic.
Prominent changes are to parenchymatous organ such as liver, lung, kidneys etc.
1. Chronic lymphoid leukemia
2. Lymph nodes of all regions are sharply enlarged and on cut are juicy and have whitish-pink color.
The bone marrow is red and the spleen and liver are enlarged. A characteristic feature is infitration of
liver along the portal tracts with leukemic cells.
Complications include bleeding, hemorrhages, insufficiency of inner organs, ulcero-necrotic processes

and anemia.

(Fig. 17.3, A) : 3. Adenoma-Carcinoma Sequence Evolves From Pre-Existing Adenomas, Referred To As

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Exam ticket no 1

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

1. Hyperkeratotic type is is characterised by an orderly and regular hyperplasia of

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

3. Adenoma-carcinoma sequence evolves from pre-existing adenomas, referred to as

ii) Incidence of adenomas in a population is directly propor- tionate to the prevalence of

3. 4. (ii) Juvenile (Retention) polyps and polyposis In ammatory polyps (Pseudopolyps)

! Non-neoplastic polyps are more common and include

Task. Peptic ulcer.

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

classification; chronic and acute

1. Ischaemic hypoxic injury to the mucosal cells.

1. Name the pathological condition.

- Rheumatic vascular endocarditis.

2. Morphogenesis, classification, consequences.

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

1. Name the pathological condition.

Focal necroses and hemorrhages or bilateral massive hemorrhages with the

Exam ticket No 3 - ALSO TICKET 8

2. Morphogenesis, classification, consequences.

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

The patient is suﬀering from atherosclerosis and died of cardio vascular

1. Name the pathological condition.

- Manifested by - increased serum uric acid, aggregated deposits of

2. Morphogenesis, classification, consequences.

- hyperuricaemia of metabolic origin - over production of uric acid

- hyperuricaemia of renal origin - decreased renal excretion of uric acid.

Morphological feautures- acute gouty arthritis

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

- Hormonal - early menstruation and late menopause

Greater risks - ovarian tutors, long term use of contraceptives.

Genetic factors = BRCA 1gene, BRCA gene 2.

- Invasive carcinoma - tubular carcinoma, medullary, papillary, secretory, infiltrato carcinoma?

1. Name the pathological condition.

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

1. Name the pathological condition.

2. Morphogenesis, classification, consequences.

- stages: 1a(tumor limited to endothelium),

- 2a(endocervical glandular envolvement),

- 3a(tumor invades cerosa),

- 4a(tumor acts on bladder and bowel mucosa)

1. Name the pathological condition.

acromegaly. reason tumor adenohypophysis due to hormone secreting pituitary adenoma.

2. Morphogenesis, classification, consequences.

increase production of GH in adults following bone growth

1. Name the pathological condition.

- Chronic right ventricular insuﬃciency

2. Morphogenesis, classification, consequences.

1. Name the pathological condition.

- Hodgkin’s disease/ lymphogranulomatosis.

2. Morphogenesis, classification, consequences.

1. Name the pathological condition