Praktikum MultiMedia

BMD Pathology
BLOCK BASIC MECHANISM DISEASE
2024

Departemen Patologi Anatomik

Fakultas Kedokteran dan Ilmu Kesehatan
Universitas Muhammadiyah Makassar
 OBJECTIVES
1. Hyperplasia 8. Fibrinoid Necrosis
2. Hypertrophy 9. Fatty liver
3. Atrophy 10. Hyalin drops
4. Metaplasia 11. Hydrophic degeneration
5. Coagulative necrosis 12. Pigment
6. Liquefactive necrosis 13. Inflammation
7. Caseous necrosis 14. Neoplasm
 1. HYPERPLASIA
(increase in the number of cells)
Normal Endometrium
 Hyperplasia
Gland

Endometrium Hyperplasia
cluster of glands with several back-to-back glands
NORMAL PROSTATE GLAND
 Nodul Prostate Hyperplasia.
Well-defined BPH nodules compress the urethra into a slitlike lumen.
 Nodul Prostate Hyperplasia.
Microscopic imaging revealed hyperplastic glandular nodules on both
sides of the urethra.
Gland Hyperplasia

Prostate Gland Hyperplasia

Diffuse adrenal hyperplasia
(bottom) contrasts with
normal adrenal glands (top).

This is the adrenal gland in a

patient with Cushing's
syndrome. Diffuse hyperplasia
of the adrenal glands was
seen.
NORMAL ADRENAL
ADRENAL CORTEX HYPERPLASIA
(NC: Normal Cell, H: Hyperplasia)
2. HYPERTROPHY
 Comparison between normal myocardial cells, adapting (reversible injury), and dead myocardial
cells. These heart sections were stained with triphenyltetrazolium chloride, an enzyme substrate
that colors normal myocardium magenta. The staining failed because the section lost the enzyme
after cell death.
 Physiological hypertrophy of the uterus during pregnancy.
A, Appearance of a normal uterus (right) and a gravid uterus (uterus operated on due to postpartum bleeding) (left).
B, Normal uterine muscle cells are spindle shaped, small in size
C, Large cells of the gravid uterus
3. ATROPHY
 Atrophy
A, Normal young adult brain
B, Brain atrophy in an 82 year old man suffering from cerebrovascular
atherosclerosis which resulted in a deficiency in blood supply. The substance of the
brain is reduced, the gyri are reduced, the sulci are widened.
4. METAPLASIA
 Metaplasia of columnar cells into squamous cells (flat cells)
A, Schematic picture
B, Metaplasia of columnar cells (left) into squamous cells (right) in the
bronchus
5. COAGULATIVE NECROSIS
 Morphology changes in reversible injury and necrosis.
A, Normal renal tubules. Normal epithelial cells are still alive.
B, In early ischemic injury (still reversible) epithelial cells appear to form bubbles,
the cytoplasm is more eosinophilic, edema cells.
C, Necrosis (irreversible injury) in epithelial cells. Epithelial cell nuclei are partially
lost, fragmentation cells and leaking cells.
 Coagulative necrosis.
A, Renal infarction is triangular (yellow). B, Microscopic picture, the left side is the normal
kidney (N) and the right side is the infarcted part (I)
 Liver infarction
A thrombus in the hepatic artery. The distal part of the liver appears pale
with areas of bleeding around it.
6. LIQUEFACTIVE NECROSIS
 Liquefactive Necrosis
Brain infarction that shows part of the brain is “melting”.
7. CASEOUS NECROSIS
 Pulmonary tuberculosis.
The upper surfaces of both lungs appear rough. The gray or white spots are
parts of caseous necrosis. It appears that some parts form cavitation
(cavities).
 Miliary tuberculosis of the spleen.
This cross-section shows many small white spots (tubercles).
 Caseous necrosis.
Pulmonary Tuberculosis. A large area of caseous necrosis was seen in the form of a
yellow-white necrotic mass.
 Tuberculosis morphological spectrum.
A. Low magnification.
B. The caseous necrosis is surrounded by epithelioid cells and giant cells/multinuclear datia cells.
Not all granulomas contain caseous necrosis.
C. Foamy macrophages (“foam cells”) contain many mycobacteria (shown by acid-fast bacteria
(BTA) staining in image D
Typical tuberculosis granuloma: in the form of central necrosis
surrounded by many Langhans datia cells, epithelioid cells and
lymphocytes.
 Granulomatous inflammation
This lymph node shows several granulomas, composed of epithelioid cells
groups and surrounded by lymphocytes. In the center of the granuloma
several multinucleated giant cells.
Foreign Body Granuloma
8. FIBRINOID NECROSIS
 Fibrinoid necrosis of the arterial wall.
A bright red area of necrosis appears accompanied by inflammation (a lot of
neutrophil nucleus dust appears).
 Fibrinoid Necrosis.
Segmental fibrinoid necrosis and occlusion of the arteriole lumen by
thrombus were seen. Note that the upper right portion of the blood vessel
wall (arrow) is still intact (not involved).
 Fibrinoid Necrosis.
Necrosis of blood vessel walls. Bright red fibrinoid material (jambon)
appears.
9. FATTY LIVER
 Fatty Liver.
Hepatosit cell nuclei are pushed to the edge by fat vacuoles.
 Histological features of non-alcoholic fatty liver.
Liver tissue showed macrovesicular steatosis (H&E).
Histological features of Nonalcoholic steatohepatitis (NASH) were stained
with trichrome staining. Perivenular and perisinusoidal fibrosis (blue
fibers) are visible.
 Foamy macrophages.
Cholesterol ladden macrophages (= foam cells, arrows)
 Atherosclerotic plaque rupture
Thrombus a. coronaria which occurs in atherosclerotic plaques that
rupture the fibrous cap and trigger myocardial infarction.
10. HYALIN DROPS
 Hialin Mass.
Periodic acid-Schiff (PAS) staining of liver tissue, showing red granules in the
cytoplasm of hepatocytes.
Reabsorption of protein droplets in renal tubule cells.
 Renal amyloidosis.
The glomerular architecture is almost completely blocked by amyloid
accumulation.
11. HYDROPHIC DEGENERATION
 Hydrophic Degeneration.
Mola hydatidosa. The uterus enlarges because it is filled with vesicular
choriales villi.
 Mola hydatidosa.
The villi are very wide, edematous, accompanied by proliferation of
trophoblast cells.
12. PIGMENT
Lipofuscin granules in heart muscle visible using a light microscope
Myocardial lipofuscin granules are viewed using an electron microscope
(location: intralysosomal, perinuclear).
Hemosiderin granules in liver cells. A fine, golden brown granular pigment
(H+E) appears.
Hemosiderin pigment in hereditary hemochromatosis. Dark brown iron
deposits can be seen in the liver cells. (H&E)
Hemosiderin pigment in hereditary hemochromatosis. Blue deposits of iron
are visible colored with Prussian blue staining.
13. INFLAMMATION
Characteristic features of acute inflammation.
A, Normal lungs. Blood vessels are visible (faintly) on the alveolar walls. There
are no cells in the alveoli.
B, Acute inflammation (vascular component). The vessels are dilated and
filled with erythrocytes due to congestion.
C, Acute inflammation (cellular component). It appears that the alveoli
contain many leukocytes (neutrophils).
Purulent inflammation.
A, Multiple lung abscesses in a case of bronchopneumonia (arrow).
B, The abscess contains neutrophils and cellular dust, and is surrounded by
congested blood vessels.
Serous inflammation
 Fibrinous Perikarditis
A, Fibrin deposits in the pericardium.
B, Fibrin meshwork (F) on the surface of the pericardum. (P).
Duodenal ulcer. Cross section of a duodenal ulcer shows inflammatory
cell exudate at the base of the ulcer.
Acute inflammation of the lungs (acute bronchopneumonia), neutrophils
fill the alveolar cavity and blood vessels appear congested.
Lung abscess due to Staphylococcus (Staphilococcus) shows very many
neutrophil cell infiltrates accompanied by destruction of the alveoli
 Limfosit cells in high
magnification

Chronic inflammation of the lung shows all three histological signs: (1) clusters of
chronic inflammatory cells (*), (2) destruction of the lung parenchyma (normal
alveolar walls replaced by cuboidal cells, arrowheads), and (3) replacement of fibrous
connective tissue (fibrosis, arrowheads).
 Chronic Appendicitis
Infiltration of chronic inflammatory cells (=Lymphocytes, arrows)
The inflammatory part shows a lot of eosinophil cell infiltration (blue arrows).
 Stages of bacterial pneumonia.
(A) Acute pneumonia. Septal capillaries become congested accompanied by
exudation of neutrophils into the alveoli. This corresponds to the initial stage of
red hepatization. The fibrin meshwork has not been repaired.
 Stages of bacterial pneumonia
(B) Initial organization of intra-alveolar exudate. Flow through the pores of Kohn
(arrows) is visible.
 Stages of bacterial pneumonia.
(C) Organization of late-stage pneumonia showing transformation of the exudate
into a fibro-myxoid mass infiltrated by macrophages and fibroblasts.
Contracture. Severe contractures in deep burns.
14. NEOPLASM
 MACROSCOPIC BENIGN VS MALIGNANT

Or capsulated
Polyps Colon Carcinoma Colon

(Arrow)
 MICROSCOPIC BENIGN VS MALIGNANT

Colon Polyps Adenocarcinoma Colon

 Microscopic Benign:
1. Strict lines
2. Encapsulated
3. Cells are monomorphic
and
4. Not atypical
5. Not invasive
6. Mitosis (–)
7. Necrosis (-)
High Magnification Colon Polyps
Microscopic Malignant:
1. There is a glandular and/or
papillary form/structure
2. Invasive/infiltrative growth
3. Atypical cells (not original), difficult
to recognize
4. Pleomorphic (varies in shape and
size of cells and nuclei)
5. Large nuclei, increased
nucleo-cytoplasmic ratio Nucleoli
clear
6. Mitosis ++
7. Necrosis +/-

High Magnification Adenocarcinoma Colon

 Malignant tumor (adenocarcinoma) of the colon. The structure of the glands is crowded, irregular in
shape and size, and does not resemble normal colonic glands. The tumor is still differentiating because it
still forms glandular structures. These malignant glands invade the muscularis layer of the colon.
 Benign tumor of the thyroid gland (adenoma).
Note the appearance of the thyroid gland follicles which are very similar to normal
glands (well-differentiated), containing colloid masses.
 Papillary Thyroid Carcinoma
The presence of true papillae defined as finger-like projection with a fibrovascular core
Macroscopic Benign tumour of breast Macroscopic Malignant tumour of breast

Microscopic Benign tumour of breast

Microscopic Malignant tumour of breast
 BENIGN VS MALIGNANT EPITHELIAL TUMOR OF
BREAST

Ductal adenoma of breast Invasive breast carcinoma

 BENIGN VS MALIGNANT STROMAL TUMOR OF BREAST

Benign phyllodes tumor with characteristic Marked stromal overgrowth displaces and
leaf-like epithelial pattern compresses epithelial structures in malignant
phyllodes tumor
Stromal cells in benign phyllodes tumor showing Mitotic figures, including atypical forms, are
minimal atypia, relatively low cellularity and common in malignant phyllodes tumor
inconspicuous mitosis
 MACROSCOPIC

Uterine Leiomyoma Uterine Leiomyosarcoma

 BENIGN VS MALIGNANT STROMAL TUMOR

Uterine leiomyoma Leiomyosarcoma

This benign smooth muscle tumor contains bundles of smooth Tumor cells are set in long intersecting fascicles parallel and
muscle cells that cross each other. Tumor cells are difficult to perpendicular to the plane of section, cells with pleomorphic
distinguish from normal tissue because they are well differentiated nuclei.
 MACROSCOPIC

Warts (verrucae) Squamous cell carcinoma

 Warts (verrucae) Squamous cell carcinoma
Low power view demonstrating papillomatous This view shows the transition from normal
epidermis within towing of rete ridges at edges of squamous epithelium into invasive carcinoma.
lesion.
 Well-differentiated squamous cell carcinoma.
It appears that the tumor cells show some similarities to the epidermis, having intercellular
bridges and keratinization structures (horn pearls, arrows).
 MACROSCOPIC

Lipoma Liposarcoma
 Lipoma Liposarcoma
Predominantly composed by mature adipose tissue, Mature adipocytes accompanied by both
with a pushy margin and homogeneous appearance, as spindle-shaped cells and multivacuolated lipoblasts.
well as adipocytes of roughly the same size.
 MACROSCOPIC

Osteoma Osteosarcoma
female with multiple bony hard This low grade central osteosarcoma arose in the distal femoral
swellings on the forehead metaphysis and invaded through the cortex and into the adjacent soft
tissue.
 Osteoma Osteosarcoma
Lamellar bone pattern with Haversian-like canals. Low grade central osteosarcoma containing bland spindle
cells and fibrous dysplasia-like bone.
Highly atypical spindle cells producing immature and
lace-like bone
 Chondroma Chondrosarcoma
Low power view showing lobules of cartilage with low There is obvious nuclear atypia and pleomorphism but
cellularity. the background is distinctly chondroid.
A, Macroscopic image of ovarian cystic teratoma. Note the presence of
hair, sebaceous material, and teeth.
B, Microscopic appearance of cystic teratoma. Visible skin components,
sebaceous glands, fatty tissue, and nervous tissue (arrows)
TERATOMA MATURE
 A, Carcinoma in situ. Low magnification show the entire epithelial layer has been replaced by dysplastic cells. No
normal squamous cell differentiation was seen. The basal membrane intact, no tumor elements were found in the
subepithelial stroma.
B, High magnification (from another part) there is clearly a failure of normal differentiation, the cells and nuclei are very
pleomorphic, there are many mitoses extending to the surface. The basal membrane is not visible in this image.
 Anaplastic tumor of skeletal muscle (rhabdomyosarcoma).
Tumor cells show highly pleomorphic cytoplasm and nuclei, hyperchromatic nuclei,
accompanied by several giant cells.
Anaplastic tumors that show variations in cells and nuclei, both in size and shape.
The cells in the middle show abnormal mitosis (tripolar).