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Skin cancer (epithelial tumors) is divided into 4 groups:
· Intraepidermal cancer (cancer in situ): Bowen’s disease, erythroplasia of Queyrat.
· Basal cell carcinoma (BCC, basalioma)
· Epidermoid cancer
· Skin appendage cell carcinoma: Paget’s disease
Basal cell carcinoma (basalioma) is malignant; the tumor is characterized by slow growth (sometimes for years), locally destructive invasive growth without metastases and frequent recurrences. The tumor is of polymorphous structure derived from the epidermis and skin appendages. The most prevalent location is the face, neck and scalp. Gradually increasing in size, they can form a large plaque or node with ulcerative depression in the center and elevated borders. It has the appearance of a flat well-defined reddish, round or oval-shaped spot or plaque.
Preventive examination of a patient revealed an enlarged lymph node of metastatic origin on the medial wall of the left axillary crease Specify the most likely localization of the primary tumour:
Metastases of breast cancer is either local or distant. Local metastases is usually to the lymphatic nodes of breast base, axilla, subclavicular, parasternal nodes. Distant metastases are hematogenic ones, 40-50% to the bones, lungs, and liver.
Cancer of any of the following will metastasize locally through:
Submandibular salivary gland – submandibular nodes
Thyroid gland – deep anterior cervical nodes
Stomach – celiac nodes
Lungs – visceral thoracic lymph nodes
Lipoma is a benign tumor of fatty tissue. It is the most frequent soft tissue tumor, arising in subcutaneous regions at any site but most commonly on the back, shoulder and neck. It may develop in every site where there is fat tissue. Lipomas are encapsulated, usually small yellow node with distinct (clear) borders.
Liposarcoma and fibrosarcoma are malignant with no distinct borders. Angioma is tumor of vessels; Fibroma and Fibrosarcoma are tumors of connective tissue.
A 39 year old man who had been operated for the stomach ulcer died 7 days after the surgery. Autopsy revealed that peritoneal leaves were dull, plephoric, covered with massive yellow-greenish films, the peritoneal cavity contained for about 300 ml of thick yellow-greenish liquid. What pathologic process was revealed in the peritoneal cavity?
Fibrinopurulent peritonitis: Supurative or purulent inflammation is characterized by the production of large amounts of pus. The cellular inflammatory response in peritoneal cavity is composed primarily of dense collections of neutrophils and fibrinopurulent debris that coat the visceral and abdominal wall. Serous peritonitis – thin fluid (not pus); Hemorrhagic peritonitis - hemorrhage.
Autopsy of a 17 year old girl who died from pulmonary failure revealed a small area of caseous necrosis in the inferior lobe of the right lung, and occurrences of caseous necrosis in the bronchopulmonary, bronchial and bifurcational lymph nodes. What is the most probable postmortem diagnosis?
Types of tuberculosis:
o Primary tuberculosis
o Post primary tuberculosis: - secondary tuberculosis
- Hematogenous tuberculosis
Primary tuberculosis is the infection of an individual who has not been previously infected or immunized. Also called Ghon’s complex or childhood tuberculosis. The primary complex in lungs is usually located in the lower part of the right upper lobes or the upper part of the lower lobes in segments 3,8,9,10. (NB: 8,9,10 segments are in the inferior lobe of the lungs). Primary complex or Ghon’s complex consists of 3 components: pulmonary component; lymphatic vessel component and lymph node component.
Secondary tuberculosis mainly affects the upper lobes of the lungs.
The Mantoux skin test should be read between 48 and 72hrs after administration. The basis of reading is the presence or absence of induration, which may be determined by inspection and by palpation. A record should also be made of formation of vesicles, bullae, lymphangitis, ulceration and necrosis at the test site. The formation of vesicles, bullae or necrosis at the test site indicates positive result. A negative mantoux result usually signifies that the individual has never been exposed to Mycobacterium tuberculosis i.e. absence of cell mediated immunity to tuberculin.
Mantoux test is a type IV Hypersensitivity reaction (HSR), which involves macrophages,T-lymphocytes and lymphokines(cytokines). Mononuclear cells (lymphocytes,monocytes,macrophages).
A 38 year old man died all of a sudden. Autopsy revealed myocardial infarction in the posterior wall of the left ventricle. What are the most likely alterations in myocardiocyte structure that can be revealed microscopically in the infarction focus?
In myocardial infarction there is necrosis. Nuclear changes in necrosis observed microscopically (light microscope) includes:
· Karyopicnosis: at first nucleus shrinks and becomes dense.
· Karyorrhexis: characterized by rupture of nuclear membrane and fragmentation of nucleus. Nucleus is decomposed into small granules.
· Karyolysis: develops when nucleus dissolves
At electron microscope level, in addition to the above nuclear changes, disorganization and disintegration of the cytoplasmic organelles and severe damage of the plasma membrane are seen.
Histologic analysis of uterus mucous membrane revealed twisting glands, serrated and spinned, they were extended by stroma growth with proliferation of its cells. Formulate a diagnosis:
Hyperplasia of endometrium is classified into 3 types:
· Simple hyperplasia (cystic glandular hyperplasia)
· Adenomatous hyperplasia (complex hyperplasia without atypia)
· Atypical hyperplasia (complex hyperplasia with atypia)
Simple hyperplasia (cystic glandular hyperplasia) is characterized by the presence of large and cystically dilated varying-sized glands, which are lined by atrophic epithelium.
Bacterioscopy of nasopharyngeal mucus taken from a 2,5 year old child with nasopharyngitis revealed gram- positive diplococci looking like coffee grains. What organs of the child are most likely to be affected if these microorganisms penetrate the blood?
Neisseria diplococcic are gram negative cocci that resemble paired kidney beans/coffee grains. The genus Neisseria contains two important human pathogens: Neisseria meningitides and Neisseria gonorrhoeae. Portal of entry is respiratory and genital tracts respectively. Meningococcal infection is an acute infectious process which has 3 main forms: nasopharyngitis; purulent meningitis and meningococcemia.
Meningitis is an acute or chronic inflammatory process chiefly affecting the pia and arachnoid mater (brain tunics) and cerebrospinal fluid. Meningococcal meningitis is characterized by the hyperemia of the pia mater, saturated with dull serous exudates during the first days of the disease.
Autopsy of a man who died from ethylene glycol poisoning revealed that his kidneys are a little bit enlarged, edematic; their capsule can be easily removed. Cortical substance is broad and light-grey. Medullary substance is dark- red. What pathology had this man?
Acute tubular necrosis/Necrotic nephrosis/Necronephrosis involves the death of tubular epithelial cells that form the renal tubules of the kidneys. Most common cause of acute renal failure. It can be ischemic or nephrotoxic.
· Ischemic acute tubular necrosis occurs due to hypoperfusion of the kidneys.
· Nephrotoxic acute tubular necrosis occurs as a result of direct damage to tubular cells by ingestion, injection or inhalation of a number of toxic agents. Toxic agents causing nephrotoxic acute tubular necrosis includes mercuric chloride, ethylene glycol, carbon tetrachloride etc.
Macroscopically, the kidneys are enlarged and swollen (edematous). On cut section, the cortex is pale, while the medulla is slightly darker than normal. The capsule can be easily removed.
Autopsy of a man who had tuberculosis revealed a 3x2 cm large cavity in the superior lobe of the right lung. The cavity was interconnected with a bronchus, its wall was dense and consisted of three layers: the internal layer was pyogenic, the middle layer was made by tuberculous granulation tissue and the external one was made by connective tissue. What is the most likely diagnosis?
Secondary tuberculosis usually results from reactivation of dormant, endogenous tubercle bacilli in a sensitized patient who has had previous contact with the tubercle bacillus. Reactivation typically begins in the apical or posterior segments (often 1st and 2nd segments) of one or both upper lobes (“simon’s foci”), where the organisms were seeded during the primary infection. There are 8 forms or stages of the secondary tuberculosis: Acute local tuberculosis; Fibrous local tuberculosis; Infiltrative tuberculosis; Tuberculoma; Caseous pneumonia; Acute cavernous tuberculosis; Fibrous cavernous tuberculosis; Cirrhotic tuberculosis.
Fibrous cavernous tuberculosis is the most frequent form. Macroscopically, the lesions are spherical and cavitary (cavity can contain blood and blood clots); the so-called coin lesions. Microscopically, the outer wall of cavity shows fibrosis or sclerosis. Internal surface may be connected with bronchus. The wall of cavern has 3 membranes:
· Internal membrane occurs by necrotic tissue
· Middle membrane occurs by special granular tissue
· External membrane occurs by connective fibrous tissue
During examination of a 6-year-old child a doctor revealed greyish films on the pharyngeal tonsils. Their removal provoked moderate haemorrhage. Bacterioscopy revealed gram-positive clublike bacteria. What symptoms will develop in this child within the next few days if no specific treatment is provided?
There are two types of fibrinous inflammation: croupous and diphtheric fibrinous inflammation. Usually croupous inflammation develops on the columnar epithelium. In this case the fibrinous membranes unfix easily, without any effort. Diphtheric fibrinous inflammation develops on the squamous or intermediate epithelium and the fibrinous membranes unfix with difficulties and may even bleed when trying to unfix it.
“their removal provoked moderate hemorrhage” – Diphtheric inflammation. General changes in diphtheria are accompanied by toxinemia and appear as toxic lesions to myocardium, nerves (peripheral nervous system) adrenal glands, kidney (interstitial nephritis) and liver.
Autopsy of a woman with cerebral atherosclerosis revealed in the left cerebral hemisphere a certain focus that is presented by flabby, anhistic, greyish and yellowish tissue with indistinct edges. What pathological process is the case?
Stroke is sudden loss of blood circulation to an area of the brain resulting in a corresponding loss of neurologic function. Types:
· Ischemic (70-80% of cases):
- Atherosclerotic (thrombotic): most common type
· Intracerebral hemorrhage
· Subarachnoid hemorrhage
· Lacunar stroke
Atherosclerotic (thrombotic) stroke: Ischemic type of stroke is commonly caused by platelet thrombosis that develops over a disrupted atherosclerotic plaque. Characteristics: it usually develops at the periphery of the cerebral cortex, swelling of brain, loss of dermacation between gray and white matter, breakdown of myelin, pale infarct; Cystic area develops after 10days to 3weeks due to liquefactive necrosis.
A 38-year-old man died in the attempt of lifting weight. He had collaptoid state. Autopsy revealled an extensive aneurism rupture of thoracic aorta. He suffered from visceral syphilis during his lifetime. What pathological process caused weakness of aortic wall, its dilatation and rupture?
The main forms of syphilis are Gumma; syphilitic aortitis; neurological syphilis. In syphilitic aortitis, the aorta is affected by an infiltration of lymphocytes and plasma cells beginning around the vasa vasorum and extending into the media, causing weakening due to focal destruction (windowing) of the specialized elastic tissues. There is compensatory irregular thickening of the intima (tree-bark appearance), but the important effect is expanding aneurysm formation because the elastic fibers are destroyed.
Microscopical examination of an enlarged cervical lymph node revealed blurring of its structure, absence of lymphoid follicles; all the microscopic fields showed cells with roundish nuclei and thin limbus of basophil cytoplasm. It is known from the clinical data that other groups of lymph nodes are also enlarged as well as spleen and liver. What disease might be suspected?
Lymphoid leukosis is a type of malignant neoplasm characterized by the proliferation of cells native to the lymphoid tissues; that is - lymphocytes, histiocytes and their precursors and derivatives. It is characterized by an enlarged liver due to infiltration of cancerous lymphoid cells. In addition, other abdominal organs are also affected.
A worker of a cattle farm fell acutely ill and then died from the progressing intoxication. Autopsy revealed enlarged, hyposthenic spleen of dark-cherry colour when dissected; excessive pulp scraping. At the base and fornix of brain pia maters are edematous, soaked with blood, dark-red (\"scarlet hat\"). Microscopic examination revealed serous haemorrhagic inflammation of brain tissues and tunics along with destruction of small vessel walls. What is the most likely diagnosis?
There are two medically important Bacillus species: Bacillus anthracis and Bacillus cereus. Bacillus anthracis causes anthrax.
Human disease occurs in 3 main forms: cutaneous, pulmonary (inhalation) and gastrointestinal. Humans are most often infected cutaneously at the time of trauma to the skin, which allows the spores on animal products such as hides, bristles and wool to enter. Spores can also be inhaled or when contaminated meat is ingested. After being inhaled, the organism moves rapidly to the mediastinal lymph nodes and causes hemorrhagic mediastinitis. Pathogenesis is based on the production of two exotoxins (Anthrax toxin) – edema factor and lethal factor. Hemorrhagic mediastinitis, septic shock hemorrhagic meningitis and death are severe life-threatening complications. In fatal cases, the organism may affect the spleen, liver, intestines, kidneys, adrenal glands and meninges.
A man with a wound of his limb that had been suppurating for a long time died from intoxication. Autopsy revealed extreme emaciation, dehydration, brown atrophy of liver, myocardium, spleen and cross-striated muscles as well as renal amyloidosis. What diagnosis corresponds with the described presentations?
Chronic sepsis (chroniosepsis): this form of sepsis is characterized by durably availability, not healing of primary septic focus that progress into a chronic one. In organs and tissues, there is atrophy and dehydration are expressed. Brown atrophy is found in the liver, myocardium and striated muscles. The spleen is decreased.
Metaplasia is a reversible change of one type to another type of adult epithelial or mesenchymal cells, usually in response to abnormal stimuli and often reverts back to normal on removal of stimulus. Types (2):
· Epithelial: *Squamous metaplasia: in bronchus (chronic smokers), cervix
*Columnar metaplasia: there is transformation to columnar epithelium.
· Mesenchymal metaplasia: osseous and cartilaginous.
Hyperplasia: ↑number of cells; Hypertrophy: ↑in size.
Microscopic examination of the enlarged neck gland of a 14 year old girl revealed destruction of the tissue structure of the node, absence of the lymph follicles, sclerotic areas and necrosis foci, cell constitution of the node is polymorphous, lymphocytes, eosinophils, big atypical cells with multilobular nuclei (Beresovsky-Sternberg cells) and mononuclear cells of the large size are present. What is the most likely diagnosis?
Hodgkin’s disease or lymphogranulomatosis is a disorder involving primarily the lymphoid tissue. It is separated from non-hodgkin lymphoma because:
First, it is characterized morphologically by the presence of distinctive neoplastic giant cells called Reed-sternberg’s (RS) cells, admixed with a variable inflammatory infiltrate.
Secondly, it is often associated with distinctive clinical features, including systemic manifestations such as fever.
Reed-sternberg cell: classically, it is a large cell, most often binucleate or bilobed, with two halves often appearing as mirror images of each other. Its identification is essential for the histologic diagnosis. The origin of Hodgkin’s lymphoma is unknown.
Silicosis is a lung disease that is caused by inhaling tiny bits of silica. Silica is a common mineral that is part of sand, rock and mineral ores like quartz. People who work in jobs where they could breathe in these tiny silica bits like sandblasting, mining, construction etc; are at risk for silicosis. The silica dust can cause fluid buildup and scar tissue in the lungs that cuts down the ability to breathe. Silicosis cannot be cured, but you can prevent it if you take specific steps to protect yourself.
The middle (medial) cerebral artery arises from the internal carotid artery and enters the lateral sulcus. There, it gives branches that supply the greater portion of the superolateral surface of the cerebral hemisphere; including the frontal, parietal, temporal lobes and the insula.
Anterior cerebral artery supplies the medial surface of hemisphere.
Posterior cerebral artery supplies the inferior surface of temporal lobe and the inferior and medial surfaces of the occipital lobe
Basilar artery gives the following branches: posterior cerebral arteries, anterior inferior cerebellar artery, superior cerebellar artery, pontine arteries.
Only the middle (medial) cerebral artery supplies the right and left parietotemporal region of brain.
Autopsy of a man with a malignant stomach tumour who had died from cancer intoxication revealed in the posteroinferior lung fields some dense, grayish-red irregular foci protruding above the section surface. Microscopic examination revealed exudate containing a large amount of neutrophils in the lumen and walls of small bronchi and alveoles. Such pulmonary alterations indicate the following disease:
Bronchopneumonia (focal pneumonia) is marked by patchy exudative consolidation of lung parenchyma. Bronchopneumonia often is a complication of other disease (complication of stomach cancer). Initially bronchi are affected. Then, inflammation spreads to parenchyma of lungs with accumulation of exudates in the alveoli. Grossly, the lungs show dispersed, elevated, focal areas of palpable consolidation and suppuration. Histological features consist of acute (neutrophilic) suppurative (purulent) or mixed exudates filling airspaces and airways, usually around bronchi and bronchioles.
Autopsy of a 1,5-year-old child revealed haemorrhagic skin rash, moderate hyperaemia and edema of nasopharyngeal mucous membrane, small haemorrhages in the mucous membranes and internal organs; dramatic dystrophic alterations in liver and myocardium; acute necrotic nephrosis; massive haemorrhages in the adrenal glands. What disease are these alterations the most typical for?
Morphologically, meningitis can be: meningococcal nasopharyngitis, meningococcal meningitis, meningococcemia. In meningococcemia, changes on the organs are characterized by generalized damage of microcirculation, skin rash, changes in the joints, vascular membrane of the eyes, adrenal glands and kidneys. Changes in the serous layers of the pericardium are observed. The rash is hemorrhagic, star-like, located mainly on the buttocks, lower extremities, eyelids and scleras. Focal necrosis 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.
A 46-year-old man had a bulging dark macula on skin that caused no discomfort. With time it began to increase in size and became painful. It turned dark brown and there was a nodule on palpation. Histological examination of tissues revealed spindle and polymorphous cells with multiple mitoses. Their cytoplasm contained brown pigment. What tumour is it?
Melanoma is strongly linked to acquired mutations caused by exposure to ultraviolet (UV) radiation in sunlight. Melanomas show striking variations in colour, appearing in shades of black, brown, red, dark blue and gray. The borders of melanomas are irregular and often notched, unlike the smooth, round and uniform borders of melanocytic nevi. The positive DOPA reaction indicates the presence of melanocytes. Melanoma arises in the skin, meninges, uvea of the eye.
Autopsy of a 58 year old man revealed that bicuspid valve was deformed, thickened and unclosed. Microscopically: foci of collagen fibrilla are eosinophilic, react positively to fibrin. The most probably it is:
Due to the positive fibrin reaction and eosinophilia of the collagen fibers, it is better to choose fibrinoid swelling since there is no record of any inflammatory reaction or cells. Fibrinoid swelling changes is a stromal vascular proteinous degeneration. The main signs are revealed microscopically: the bands of collagen fibers are homogenous, impregnated with plasma proteins.
Histological examination of the biopsy material obtained from the lower third of the esophagus of a 57-year-old male with the symptoms of continuous reflux revealed the change of the stratified squamous epithelium to the single-layer columnar glandular epithelium with signs of mucus production. Specify the pathological process in the mucous membrane:
*Columnar metaplasia: there is transformation to columnar epithelium.
Microscopy of the bronchial wall revealed atrophy of the mucosa, metaplastic change from columnar to squamous epithelium, an increase in the number of goblet cells, diffuse infiltration of the bronchial wall with lymphoplasmacytic elements with a large number of neutrophilic granulocytes, pronounced sclerosis. Specify the morphological form of bronchitis:
Pronounced sclerosis indicates a chronic condition. The diffuse infiltration of bronchial wall with lymphoplasmocytic elements with a large number of neutrophils indicates a purulent inflammation. Bronchial wall – bronchitis
Microscopy of the myocardium of a patient who had died from heart failure revealed foci of fibrinoid necrosis located diffusely in the interstitial stroma, and often around the vessels. Such foci were surrounded by lymphocytes, macrophages, histiocytes. Pericardium was found to have signs of sero-fibrinous pericarditis. What is the most likely diagnosis?
Rheumatic fever has 4 stages:
· Mucoid swelling: edema of connective tissue; they undergo swelling, fraying, fragmentation and disintegration.
· Fibrinoid changes: the affected areas take on a deeply eosinophilic appearance resembling fibrin – fibrinoid degeneration or necrosis.
· Cellular reactions: infiltration by lymphocytes, plasma cells, histiocytes and fibroblasts. Pathognomonic focal inflammatory nodules called Aschoff bodies are the most characteristic in the heart. In its early phase, they constitute a foci of fibrinoid necrosis, initially surrounded by lymphocytes, macrophages and a few plasma cells.
· Sclerosis: Aschoff bodies or diffuse inflammatory cellular infiltration are slowly replaced by fibrous scar mainly around the vessels.
The microscopic findings are basically describing the Aschoff bodies and the 3rd and 4th stages of rheumatic fever.
A 65-year-old male suddenly lost the vision in one eye due to the retinal detachment. The patient underwent enucleation. Histological examination of the removed eye retina and choroid revealed clusters of atypical cells with marked polymorphism of cells and nuclei, with a moderate number of mitoses including the pathological ones. The cell cytoplasm and intercellular medium contained brown pigment giving a positive DOPA reaction. Perls’ reaction was negative. What is the most likely diagnosis?
At the post-mortem examination the stomach of a patient with renal failure was found to have a yellow-brown coating on the thickened mucosa.The coating was firmly adhering to its surface and had significant thickness. Microscopy revealed congestion and necrosis of mucosal and submucosal layers, fibrin presence. What is the most likely diagnosis?
Fibrinous inflammation is an inflammatory response of mucous surface (oral, respiratory, bowel) to toxins of diphtheria or irritant gases. As a result of denudation of epithelium, plasma exudes on the surface where it coagulates and together with necrotized epithelium, forms false membrane that gives this type of inflammation its name. Histologically, fibrin appears as an eosinophilic network of threads or sometimes as an amorphous coagulum.
The epidermis of skin is composed of stratified squamous epithelium. It is nonkeratinizing because it is growing into the underlying tissue. It probably would have being keratinized if it is growing out of the tissue.
Autopsy of a man who died from chronic cardiovascular collapse revealed \"tiger heart\". Sidewards of endocardium a yellowish-white banding can be seen; myocardium is dull, dark-yellow. What process caused this pathology?
Intracellular accumulations (parenchymal degeneration or dystrophies). Intracellular fatty degenerations are the abnormal accumulations of triglycerides within parenchymal cells. The liver, heart, kidneys are damaged the most frequently. Fatty degeneration of the heart – Tiger’s heart; fatty degeneration of the liver – Goose liver; fatty degeneration of the kidney – large white kidney.
Psammoma bodies are laminated concentric spherules with dystrophic calcification. PSaMMoma bodies are seen in:
· Papillary carcinoma of thyroid
· Serous papillary cystadenocarcinoma of ovary
· Malignant mesothelioma
Meningioma is the only one in the options given.
Autopsy of a patient who suffered from croupous pneumonia and died from pneumococcal sepsis revealed 900 ml of turbid greenish-yellow liquid in the right pleural cavity. Pleural leaves are dull, plephoric. Name the clinicopathological form of inflammation in the pleural cavity:
Complications of croupous or lobar pneumonia includes empyema, gangrene, carnification, abscess formation, bacteremic spread which leads to purulent meningitis, bacterial endocarditis, arthritis, pericarditis and other organs. Empyema is a purulent inflammation of serous membranes (empyema of pleura, empyema of gall bladder and urinary bladder etc). Purulent or suppurative inflammation is characterized by the production of large amounts of pus or purulent exudates (liquids) consisting of a lot of neutrophils, necrotic cells and edema fluid.
A patient died from progressive heart failure. Autopsy revealed that the heart was enlarged in diameter, flabby. The muscle section exhibited irregular blood supply. Histological study of myocardium revealed hyperemia, the stroma was found to have lymphohistiocytic infiltrates with degeneration of cardiomyocytes. The revealed morphological changes are indicative of:
Hyperemia and lymphohistiocytic infiltrates indicates inflammation. It is not myocardial infarction nor cardiosclerosis because no necrosis is involved. No fatty infiltration, therefore it is not cardiomyoliposis. Therefore, the best answer is Non-purulent interstitial myocarditis.
A patient underwent biopsy of the soft palate arches for a suspected tumor (macroscopy revealed an ulcer with a dense floor).Study of the biopsy material revealed mucosal necrosis with infiltration of lymphocytes, epithelioid cells, plasma cells, single neutrophils in the submucosa. There were also apparent signs of endovasculitis and perivasculitis. The described changes are typical for:
Primary syphilis: the chancre develops at the site of inoculation in 10-90days (average 21 days) and has a characteristic “luetic vasculitis” (endovasculitis and perivasculitis). The chancre is a slightly elevated, firm, reddened papule that erodes to create a clean-based, shallow ulcer. Histologically, the chancre contains an intense infiltrate of plasma cells, with scattered macrophages and lymphocytes and an obliterative endarteritis. The regional lymph nodes are usually enlarged and may show nonspecific acute or chronic lymphadenitis, plasma cell-rich infiltrates or focal epitheloid granulomas. The combination of chancre, lymphangitis and lymphadenitis is called – primary syphilitic complex.
Hyalinosis (hyaline changes): transparent, glass-like, usually refers to an alteration within cells or in the extracellular matrix which gives a homogenous, glassy, pink appearance. It can be classified according to its localization (vascular and connective tissue hyalinosis) and propagation (generalized and localized). It is localized because it has a diameter of 1.5cm; it did not affect a large portion or the whole stomach wall.
A diseased child has a high fever, sore throat, swelling of submandibular lymph nodes. Objectively: pharyngeal mucosa is edematous, moderately hyperemic, the tonsils are enlarged, covered with grayish membrane tightly adhering to the tissues above. Attempts to remove the membrane produce the bleeding defects. What disease are these presentations typical for?
Diphtheria is an acute infectious disease characterized by fibrinous inflammation in the focus of primary fixation of the causative agent and general intoxication due to exotoxin absorption. Causative agent – Corynebacterium diphtheria. Local changes in Diphtheria in the pharynx: gray or white patches of exudates appear on the pharyngeal mucosa, usually over the tonsils. These enlarge and coalesce and with the accumulation of blood, become gray or black. The lymphoid tissues both in regional lymph nodes and systematically (as in the spleen) undergo hyperplasia with the development of prominent germinal centers that are often centrally necrotic. The epithelial surface becomes necrotic and easily adherent to the overlying membrane; this adherence explains why raw bleeding points are exposed when the membrane is forcibly removed. The soft tissue of the neck is swollen. In severe toxic forms, the edema is considerable and can involve the anterior surface of the chest.
14 days after quinsy a 15-year-old child presented with morning facial swelling, high blood pressure, \"meat slops\"urine. Immunohistological study of a renal biopsy sample revealed deposition of immune complexes on the basement membranes of the capillaries and in the glomerular mesangium. What disease developed in the patient?
Peritonsillar abscess also known as quinsy ( a complication of tonsillitis) caused by both aerobic and anaerobic bacteria (streptococcus, staphylococcus and haemophilus).
Atherosclerosis of aorta is the most common form of atherosclerosis in which the aorta aneurysm usually develop. Most common aneurysm associated with atherosclerosis is the saccular aneurysm (sacciform protrusion). Wall of aorta – stone-like density as a result of scarring from Atherosclerosis.
Study of the biopsy material revealed a granuloma consisting of lymphocytes, plasma cells, macrophages with foamy cytoplasm (Mikulicz cells), many hyaline globules. What disease can you think of?
Microscopic examination of specific granulomas:
* In Rhinoscleroma of nose, the granuloma (scleroma) consists of plasma cells, epitheloid cells, lymphocytes and hyaline sphere. Large macrophages with light cytoplasm containing klebsiella rhinoscleromatis (Mikulicz’s cells), sclerosis and hyalinosis takes place.
* In TB, the granuloma is reffered to as a tubercle and is classically characterized by the presence of central necrosis surrounded by epitheloid cells, lymphocytes, plasma cells and giant langhance cells. In contrast, caseous necrosis is rare in other granulomatous diseases.
* The syphilis granuloma is calle Gumma. Gumma consist of a central area of fibrinoid or caseous necrosis surrounded by mononuclear inflammatory cells, mostly plasma cells, lymphocytes, epitheloid cells and seldom-giant langhance cells. Around gumma forms the granulation tissue and endovasculitis.
* In Tuberculoid Leprosy, the epidermis contains confluent granulomas composed of macrophages, plasma cells and leprous Virchow’s cells – Leprous Virchow’s cells (or Leprous cells) refer to large foamy macrophages within fatty vacuoles containing leprous mycobacterium.
* Actinomycosis caused by Actinomyces. It occurs rarely in human but rather frequently in cattle. Characterized by the formation of painful abscess. Infected man often have poor oral hygiene or recent dental work. Does not form granulomas.
Tuberculin (Mantoux) skin test: this test is done by intradermal injection of tuberculoprotein (tuberculin), purified protein derivative (PPD). Type IV hypersensitivity reaction.
Immunization against tuberculosis is induced by injection of attenuated strains of bovine type of tubercle bacilli, Bacilli Calmette Guerin (BCG).
At autopsy the occipital lobe of brain was found to have a cavity 2,5x1,5 cm large filled with a transparent liquid. The cavity had smooth brownish walls. What process had developed in the brain?
Cyst cavity contains transparent fluid, blood, tissue or tumor cells; Abscess cavity contains pus. Both are with a distinguishable wall.
A male patient is 28 years old. Histological study of a cervical lymph node revealed a change of its pattern due to the proliferation of epithelioid, lymphoid cells and macrophages having nuclei in form of a horseshoe. In the center of some cell clusters there were non-structured light-pink areas with fragments of nuclei. What disease are these changes typical for?
When tubercle bacilli are introduced into the tissue, they are ingested by the alveolar macrophage. Macrophages undergo changes resembling epithelial cells – EPITHELOID cells. Some of the macrophages form MULTINUCLEATED GIANT cells by fusion of adjacent cells (langerhan’s or foreign body type). The giant cells may have 20 or more nuclei. These nuclei may be arranged at the periphery like HORSE-SHOE, RING or clustered at the poles or they may be present centrally (foreign body giant cells). Lymphocytes, plasma cells and fibroblasts surround the epitheloid cells and giant cells (hard tubercle- no central necrosis). Within 10-14 days, the centre of the cellular mass begins to undergo caseation necrosis – soft tubercle. This is the hallmark of tuberculous lesions.
During the hematogenous spreading, the most serious immediate complication is MILIARY tuberculosis. The name miliary derives from its resemblance to millet seeds. Lesions of miliary tuberculosis consist of small granulomas, with a central necrotic portion. Organs often affected are lung, spleen, liver, kidney, meninges and bone marrow.
Gonorrhea is caused by Neisseria gonorrhoeae. Its often intracellular (within neutrophils), gram-negative diplococci. It is sexually or perinatally transmitted.
Syphillis is caused by Treponema pallidum(spirochetes), Chancroid is caused by Haemophilus ducreyi. Trichonomoniasis is caused by trichomonas vaginalis. Veneral lymphogrnaulomatosis is caused by Chlamydia trachomatis (L1-L3). They are all sexually transmitted. Specific identification of the gonococcus can be made either by its fermentation of glucose (but not maltose) or by fluorescent-antibody staining.
Diffuse – multiple whitish layers of connective tissue
Cardiosclerosis – Atherosclerotic calcified plaques
A 7-year-old boy got ill with diphtheria. On the third day he died of asphyxiation. At autopsy the mucosa of the larynx, trachea and bronchi had thickened, edematous, lustreless appearance and was covered with gray films which could be easily removed. Specify the type of laryngeal inflammation:
A child with suspected tuberculosis was given Mantoux test. After 24 hours the site of the allergen injection got swollen, hyperemic and painful. What are the main components that determine such response of the body?
Mantoux test is a type IV Hypersensitivity reaction (HSR), which involves macrophages,T-lymphocytes and lymphokines (cytokines). Mononuclear cells (lymphocytes, monocytes, macrophages).
Remember,it is antibody independent (i.e does not involve antibodies).
Undifferentiated carcinoma: tumor is composed exclusively of undifferentiated cells with deeply stained pleomorphic nuclei and scanty cytoplasm, with no evidence of differentiation toward squamous carcinoma or adenocarcinoma. Pure undifferentiated carcinoma of the gastric cardia is rarely seen.
Scirrhous carcinoma: in this pattern, the stomach wall is thickened due to extensive desmoplasia. Therefore, we have scirrhous undifferentiated carcinoma.
A 10-year-old child was found to have a congenital hypoplasia of the left kidney. Ultrasound examination revealed that the right kidney was markedly enlarged and had regular shape. No functional disorders were revealed. Specify the process that developed in the right kidney:
Pathological hypertrophy (hyperplasia) types: neurohumoral; working; compensatory reparative; vicarious (substitutional); hypertrophic vegetations
* Vicarious (substitutional) hypertrophy: following nephrectomy (or congenital hypoplasia) on one side in a young patient, there is compensatory hypertrophy as well as hyperplasia of the nephrons of the other kidney.
* Working hypertrophy: cardiac muscle develop hypertrophy at some cardiac diseases such as systemic hypertension, aortic stenosis or insufficiency; skeletal muscles (e.g. biceps) in athletes. ↑ work load → hypertrophy
A 35-year-old female patient has undergone biopsy of the breast nodules. Histological examination has revealed enhanced proliferation of the small duct and acini epithelial cells, accompanied by the formation of glandular structures of various shapes and sizes, which were located in the fibrous stroma. What is the most likely diagnosis?
Adenoma: benign epithelial tumor from the epithelium of the glands and glandular organs. More often they can be found in the breast, thyroid gland, liver, ovaries, prostate gland, GIT. In the question, it is located in the fibrous stroma – FIBROADENOMA.
A 54-year-old female was brought to the casualty department after a car accident. A traumatologist diagnosed her with multiple fractures of the lower extremities. What kind of embolism is most likely to develop in this case?
Embolism is occlusion of a vessel by material travelling in the circulation.
* Fat/Adipose embolism: obstruction of arterioles and capillaries by fat globules constitutes fat embolism. It may occur following severe fracture trauma to bones, inflammation of bones and soft tissues, fatty liver
* Thromboembolism: a detached thrombus or part of thrombus which may arise in the arterial or venous circulation.
* Gas embolism: two main forms of gas embolism are air embolism and decompression sickness. Air embolism is usually due to accidental pumping of air into the venous circulation during intravenous (IV) injection or transfusion ( bubble – air escaped).
Tissue embolism: fragments of tissue.
There are cortical and medullary substances separated by connective tissue layer in the endocrine gland specimen. Parenchyma cells make up three zones in cortical substance, with rounded masses in the superficial zone, parallel chords in the middle one, reticular structure of cell chords in the deep one. What gland is it?
The adrenal gland (suprarenal gland) has a secretory parenchymal tissue organized into cortical and medullary regions. Adrenal cortex (derived from mesoderm; steroid-secreting portion) and medulla (derived from neural crest; catecholamine-secreting portion). The adrenal cortex is divided into 3 zones on the basis of arrangement of its cells:
* Zona glomerulosa (15%): arranged in closely packed ovoid clusters; secretes aldosterone.
* Zona fasciculata (80%): large and polyhedral; arranged in long straight cords; secretes cortisol.
* Zona reticularis (5-7%): cells are arranged in anastomosing cords separated by fenestrated capillaries; secretes androgens.
Chronic abscess has internal pyogenic membrane; middle – granulation tissue; external – fibrous tissue membrane. Acute abscess basically has only a pyogenic membrane no fibrous tissue membrane. Phlegmon: diffuse purulent inflammation which occurs along muscular fibers, tendons, fascias etc. Empyema is a purulent inflammation of serous membranes (e.g. empyema of pleura). Both phlegmon and empyema does not involve the formation of cavity (“cavitary lesion”).
Autopsy has revealed shrunken kidneys weighing 50 mg, with fine-grained surface and uniformly thinned substance. Microscopic investigation has shown the thickening of arteriole walls due to accumulation of homogeneous anhistic pink-coloured masses in them. Glomerules were undersized, sclerotic, with atrophied tubules. What disease are these changes characteristic of?
Primary shrunken kidney is a renal form of essential hypertension. It is characterized by chronic arteriolosclerotic nephrosclerosis. Macroscopically, both kidneys are affected equally and are reduced in size and weight. The surface of the kidney is finely granular. The cut surface shows firm kidney and narrowed cortex. Microscopically, there is variable degree of atrophy of parenchyma; these include glomerular shrinkage, deposition of collagen in Bowman’s space, periglomerular fibrosis.
Secondary shrinkage of kidneys is found in chronic glomerulonephritis.
On the 24th day since the onset of disease, a male patient diagnosed with typhoid fever and undergoing treatment in an infectious diseases hospital has suddenly developed clinical presentations of acute abdomen leading to the death of the patient. During autopsy peritonitis has been revealed, with numerous ulcers covering the colon mucosa and reaching as deep as muscular and, in places, serous tunic. The ulcers have smooth edges and even floor. The intestinal wall is perforated. What stage of typhoid fever has the lethal complication arisen at?
The changes in typhoid fever can be local and generalized. Local changes: has 5 stages. Each stage takes approximately one week.
* medullar swelling
* necrosis (7-10 days)
* ulcer formation (unclear, dirty ulcers)
* clean ulcer
* healing (recovery)
Clean ulcers has regular shape without necrotic tissue. In this stage the perforation can develop.
An HIV-positive patient’s cause of death is acute pulmonary insufficiency resulting from pneumonia. Pathohistological investigation of lungs has revealed interstitial pneumonia, alveolocyte desquamation and their methamorphoses: alveolocyte enlargement, large intranuclear inclusions surrounded by lightly-colored areas. Transformed cells resemble owl’s eye. Name the pneumonia causative agent:
Cytomegalovirus (CMV) causes congenital infection, mononucleosis, pneumonia, retinitis. Infected cells have characteristic “owl-eye” inclusions. Transmitted congenitally and by transfusion, sexual contact, saliva, urine, transplant. Interstitial pneumonia is mainly caused by viruses or mycoplasma. CMV is responsible for the most common viral opportunistic infection in persons with HIV infection.
A 37-year-old male patient developed pseudoarthrosis after a closed fracture of the femur. Specify the type of regeneration in the patient:
A patient with suspected tumor of lung had been admitted to the oncological department. Examination revealed localised pathology in the inferior lobe of the left lung. How many bronchopulmonary segments does this lobe have?
The inferior lobe of left lung has 5 segments: superior, medial basal, anterior basal, lateral basal, posterior basal segments.
Chronic pyelonephritis: microscopic changes involve predominantly tubules and interstitium. Tubules show atrophy and hypertrophy diffusely or dilatation. Dilated tubules may be filled with colloid crystals producing thyroidisation of tubules (thyroid-like). There is chronic interstitial inflammatory reaction, chiefly composed of lymphocytes, plasma cells, and macrophages with pronounced interstitial fibrosis. Renal pelvis and calyces are dilated and show marked chronic inflammation and fibrosis.
Autopsy of a 50-year-old male who had tuberculosis revealed a dense gray-white nidus in form of a nodule 2 cm in diameter in the subpleural portion of the upper right lobe. The pleura in this region was thickened, in the pleural cavity there was a small amount of serous hemorrhagic fluid. Histological study of the region revealed some glandular structures with signs of cellular atypia and abnormal mitoses, which were found within the fibrous connective tissue. What other pathology had developed in the lungs?
Glandular structures – ‘adeno’. Adenocarcinoma is an invasive malignant epithelial tumor with glandular differentiation or mucin production by the tumor cells. The lesions are usually peripherally located. Tumors (≤3cm) with a small invasive component (≤5mm) associated with scarring and a peripheral lepidic growth pattern are called microinvasive adenocarcinoma. Adenocarcinoma is one of the most common malignancies associated with tuberculosis.
A 10-year-old child has painful swallowing, neck edema, temperature rise up to 39, 0oC, the whole body is covered with bright-red petechial rash. Back of the throat and tonsils are hyperemic, the tongue is crimson-colored. Tonsillar surface is covered with isolated grayish-colored necrosis nidi. What disease is it?
Scarlet fever is an acute infectious disease accompanied by local inflammatory changes mainly in the pharynx and typical generalized rash.
* Local changes: primary scarlatnic affect/complex – catarrhal or necrotic tonsillitis. Catarrhal tonsillitis: hyperemia of pharynx (flaring pharynx or burning faucet). Necrotic tonsillitis: coagulative necrosis and ulceration.
* General changes are first of all RASH. The face is also involved, but usually a small area about the mouth (nasolabial triangle) remains relatively unaffected to produce a circumoral pallor. Tongue is beefy red/crimson red and glistening, strawberry tongue.
The dominant lymphatic drainage from the right upper lobe flowed into the superior mediastinal nodes. The sternal or parasternal nodes is one of the superior mediastinal nodes.
A young woman suddenly developed fever up to 39oC accompanied by a strong headache. Examination revealed marked nuchal rigidity. Spinal puncture was performed. Gram-stained smear of cerebrospinal fluid contained many neutrophils and Gram-positive diplococci. What bacteria could be the cause of this disease?
Gram negative diplococcic are Neisseria meningitides and N. gonorrhoeae.
N. meningitidis cause meningitis, meningococcemia (nuchal rigidity is a sign of meningitis).
N. gonorrhoeae causes gonorrhea, septic arthritis. Sexually transmitted or perinatally.
Papillomas are benign epithelial neoplasms producing microscopically or macroscopically visible fingerlike or warty projections from epithelial surfaces. Polyp: when a neoplasm – benign or malignant produces a macroscopically visible projection above a mucosal surface and projects, for example, into the gastric or colonic lumen. Fibroma: benign, node of differentiated connective tissue. Angioma and angiofibroma are related to vessels.
During autopsy approximately 2,0 liters of pus have been found in the abdominal cavity of the corpse. Peritoneum is lustreless and has grayish shade, serous tunic of intestines has grayish-colored coating that is easily removable. Specify the most likely type of peritonitis in the patient:
Fibrinopurulent peritonitis: Supurative or purulent inflammation is characterized by the production of large amounts of pus. The cellular inflammatory response in peritoneal cavity is composed primarily of dense collections of neutrophils and fibrinopurulent debris that coat the visceral and abdominal wall. Serous peritonitis – thin fluid (not pus); Hemorrhagic peritonitis - hemorrhage; Tuberculous peritonitis – the patient must have TB, before there can be an extrapulmonary TB.
Autopsy of the dead patient who died from pulmonary edema revealed a large yellow-grey nidus in the myocardium, and a fresh thrombus in the coronary artery. What is the most likely diagnosis?
The macro- and microscopic changes in the Myocardial Infarction (M.I.) correspond to the age of the infarct.
* first 24hrs: No gross changes; coagulative necrosis
* 1-3days: pallor of infracted tissue
* 3-7days: red granulation tissue surrounds area of infarction
* 7-10days: necrotic area is bright YELLOW
* first 2 months: infarct is replaced by white, patchy, noncontractile scar
During autopsy the following has been revealed: the meninges of the upper cerebral hemispheres are extremely plethoric, of yellow-green color and are soaked with purulent effluent. What kind of meningitis is characterised by such clinical presentations?
Meningococcal meningitis is characterized by hyperemia of pia mater (extremely plethoric), by the end of the 2nd – 3rd day the exudate becomes thicker, green-yellow, purulent (yellow-green cap). Dull-serous exudates during the first days of the disease.
Chronic osteomyelitis: most common causative agent is staphylococcus aureus. Characterized by bone necrosis (sequestrum formation), low-grade inflammation, persistent and progressing infection. Also characterized by low-grade clinical presentations.
A 40-year-old female patient has undergone thyroidectomy. Histological study of thyroid gland found the follicles to be of different size and contain foamy colloid, follicle epithelium is high and forms papillae, there is focal lymphocytic infiltration in stroma. Diagnose the thyroid gland disease:
Basedow’s disease (Grave’s disease, diffuse toxic goiter, primary hyperplasia): prismatic epithelium turns into cylindrical, epithelium proliferation with formation of papillae, colloid vacuolization (foamy colloid), formation of lymphoid follicles with germ centers are observed.
Hashimoto’s thyroiditis is devoid of colloid.
Extensive thromboembolic infarction of the left cerebral hemispheres, large septic spleen, immunocomplex glomerulonephritis, ulcers on the edges of the aortic valves, covered with polypous thrombus with colonies of staphylococcus were revealed on autopsy of the young man who died in coma. What disease caused cerebral thromboemboly?
Septic (bacterial) endocarditis is the form of sepsis, for which septic lesion of valves of the heart is characteristic. The most often causative agents are staphylococcus albus, staphylococcus aureus, streptococcus viridian and enterococcus. Polypous-ulcerative endocarditis develops on both sclerotic and intact valves. Large thromboembolic polyp-shaped plaques appear on sclerotic valves. The spleen is enlarged due to prolonged pulp hyperplasia (“septic spleen”). Immune-complex diffuse glomerulonephritis develops in the kidneys, foci of softening and hemorrhages are observed in the brain due to vascular changes (vasculitis, aneurysm) and thromboembolism.
A 45 year old male died from disseminated tuberculosis. On autopsy the symptoms of tuberculosis were confirmed by both microscopical and histological analyses. All the affected organs had epithelioid cell granulomas with caseous necrosis in the centre. What kind of hypersensitivity reaction underlies the process of granuloma development?
Type I (Immediate, Anaphylaxis, Reagin): IgE (immunoglobulin E)-dependent activation of mast cells/basophils, usually accompanied by eosinophilia e.g. urticaria (hives), hay fever, asthma (wheezing), rhinitis and conjunctivitis (stuffy nose and itchy eyes; usually seasonal)
Type II (cytotoxic): antibody dependent reactions e.g. Goodpasture syndrome, Myasthenia gravis, Graves disease, ABO hemolytic disease of newborn etc.
Type III (immune-complex): deposition of antigen-antibody complexes e.g. systemic lupus erythromatous (SLE), Arthus reaction, serum sickness, poststreptococcal glomerulonephritis etc.
Type IV (cell mediated, delayed): antibody-independent T-cell mediated reactions e.g. positive mantoux reaction (tuberculin test), hashimoto’s thyroiditis or transplant rejection etc.
A patient with high-titer antinuclear antibodies died from progressing renal impairment. Autopsy revealed mesangioproliferative glomerulonephritis and abacterial polypous endocarditis. There was periarterial bulbar sclerosis in spleen and productive proliferative vasculitis in skin. What is the most likely diagnosis?
Systemic lupus erythematous (SLE, Libman-sacks disease) is the classic prototype of the multisystem disease of autoimmune origin, characterized by a bewildering array of autoantibodies, particularly antinuclear antibodies. It is characterized principally by injury to the skin, joints, kidney, and serosal membranes. Antinuclear antibody is directed against several nuclear antigens and can be grouped into 4 categories:
· Antibodies to DNA
· Antibodies to histones
· Antibodies to nonhistone proteins bound to RNA
· Antibodies to nuclear antigens.
SLE is a type III hypersensitivity reaction with formation of immune complexes. It can cause diffuse proliferative glomerulonephritis seen under the light microscope as “wire loop” of capillaries and granular under the immunofluorescence microscopy.
A 50 year old patient underwent resection of tumour of large intestine wall. Microscopically it presents itself as fascicles of divergent collagen fibers of different thickness and form and some monomorphous fusiform cells that are irregularly distributed among the fibers. Cellular atypia is not evident. What tumour is it?
Fibroma is a benign connective (fibrous) tissue tumors. It can be hard (dense) or soft fibroma. Hard fibroma has fibrous connective tissue (e.g. collagen fibers) prevail over the cellular elements. Soft/loose fibroma has more cells than the connective tissue component.
In the question; fascicles of divergent collagen fibers with SOME fusiform cells irregularly distributed among the fibers i.e. fibers > cells (fibers dominate). Fibers are greater than cells.
Septicemia is a form of sepsis. Hemorrhagic syndrome is well pronounced (petechial rash, hemorrhages to the serous and mucus membranes and internal organs, DIC). Hyperplasia of lymphoid and hemopoietic system is typical. Proliferation of lymphoid and reticular cells as well as accumulation of mature and immature blood cells are found in the spleen and lymph nodes. Interstitial inflammation develops in the parenchymal organs (heart, liver, kidneys). Septicemia can lead to septic shock. DIC – disseminated intravascular coagulation
Acute renal impairment caused death of a bleeding patient. Autopsy revealed enlarged kidneys with a broad pale pink cortical layer expressively demarcated from dark red renal pyramids. Macroscopic examination revealed lack of epithelial nuclei of convoluted tubules, tubulorrhexis, phlebostasis. The cell nuclei of choroid glomus and straight tubules were present. What pathology is it?
Examination of a bronchial tissue sample revealed atrophy of mucous membrane, cystic degeneration of glands, focal metaplastic changes of lining prismatic epithelial cells into multilayer squamous cells; increase in goblet cell number; in some parts of bronchial wall and especially in the mucous membrane there was marked cellular inflammatory infiltration and growth of granulation tissue bulging into the bronchial lumen in form of a polyp. What is the most likely diagnosis?
The hallmark and earliest feature of chronic bronchitis is hypersecretion of mucus in large airways and is associated with hypertrophy of the submucosal glands in the trachea and bronchi. As chronic bronchitis persists, there is also a marked increase in goblet cells of small airways leading to excessive mucus production that contributes to airway obstruction. Histological features of the small airways:
· Goblet cell metaplasia with mucus plugging of the lumen.
· Inflammatory infiltration
· Fibrosis of bronchiolar wall (granulation tissue)
· Atypical metaplasia and dysplasia of the respiratory epithelium, providing a possible soil for cancerous transformation.
Autopsy of a 75 year old patient who had been suffering from disseminated atherosclerosis and died under chronic cardiac failure revealed constriction and deformation of coronary arteries, tuberous intima whose section appeared to be white and petrosal. Specify the stage of atherosclerosis morphogenesis:
Stages of atherosclerosis.
* Pre-lipid stage: mucoid swelling of intima, destruction of endothelium, elastic & collagen fibres of intima’s basal membrane.
* Stage of fatty stripes (lipidosis): Fatty stripes appear on intima. Macrophages that have accumulated lipid in their cytoplasm appear as csantomic or foam cells.
* Stage of liposclerosis: Lipid accumulates not only in macrophages but also in smooth muscle cells. In areas of lipidosis (lipid core), a young CT grows & forms a fibrous cap/plaque.
* Stage of atheromatosis: Necrosis of central part of fibrous cap, with formation of atheromas. Atheromas consist of amorphous lipid-rich material & are soft.
* Stage of ulceration: Break of fibrous cap cover & ulceration with small hemorrhage into plaque.
* Stage of atherocalcinosis: Deposition of calcium in ulcerative plaque. Calcification of vessels leads to hardening of arteries, which appears white & petrosal.
Dysentery refers to bloody diarrhea with mucus. It refers to diarrhea with abdominal cramping and tenesmus in which loose stools contain blood, pus and mucus. Bacillary dysentery is caused by shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei. Morphology: it has 4 stages namely: catarrhal colitis; fibrinous colitis; ulcer formation (ulcerative colitis); healing of the wound. Complications of dysentery include perforation, intraintestinal hemorrhage and eventually death may result from intestinal or extraintestinal complications.
A 46-year-old man complains of difficulties with nasal breathing. Mikulicz’s cells, accumulation of epithelioid cells, plasmocytes, lymphocytes, hyaline balls were discovered in the biopsy material of the thickened nasal mucosa. What is the most likely diagnosis?
A young man has a painless formation without marked borders in the soft tissues of his thigh. On the tissue bioptate the formation looks like flesh of fish and consists of immature fibroblast-like cells with multiple mitosis growing through the muscles. What is the most likely diagnosis?
Macroscopically, sarcoma looks like “fish flesh”. Fibrosarcoma occurs in deep soft tissue sites, showing increased fibroblastic cells, anaplasia and abundant mitotic figures. It looks like node or encapsulated formation.
Autopsy of a man ill with severe hypothyroidism revealed that connective tissue, organ stroma, adipose and cartilaginous tissues were swollen, semi- transparent, mucus-like. Microscopic examination of tissues revealed stellate cells having processes with mucus between them. What type of dystrophy is it?
Stromal vascular carbohydrate degenerations develop due to disturbance of glycosaminoglycans and glycoproteids metabolism. When glycoproteid metabolism is disturbed, chromotropic substances are released from the protein bonds. They accumulate in the main substance of the connective tissue. Collagen fibers change into mucus-like mass. Connective tissue mucin is associated with:
· Mucoid or myxoid degeneration in some tumors (myxomas)
· Neurofibromas, soft tissue sarcomas etc
· Myxomatous change in the dermis in myxedema
· Myxoid change in the synovium in ganglion on the wrist.
The condition results in colliquative necrosis with formation of cavities filled with mucus.
We have acute, subacute and chronic glomerulonephritis. Subacute glomerulonephritis does not necessarily follow acute attacks. It is usually characterized by the general symptoms of glomerulonephritis like proteinuria, hematuria, edema and azotemia persisting for many days and even weeks. Renal changes include those of rapidly progressive and membranoproliferative glomerulonephritis. “DEMILUNE”
A 6 year old child was delivered to a hospital. Examination revealed that the child couldn’t fix his eyes, didn’t keep his eyes on toys, eye ground had the cherry-red spot sign. Laboratory analyses showed that brain, liver and spleen had high rate of ganglioside glycometide. What congenital disease is the child ill with?
Tay- sachs disease is a progressive neurodegeneration, developmental delay, “cherry-red” spot on macula, lysosomes with onion skin, no hepatosplenomegaly. It is an autosomal recessive disease, caused by the deficiency of hexosaminidase A resulting in the accumulation of GM2 ganglioside in organs of the body (e.g. brain, liver, spleen).
A 20 year old patient died from intoxication 8 days after artificial illegal abortion performed in her 14-15th week of pregnancy. Autopsy of the corpse revealed yellowish colour of eye sclera and of skin, necrotic suppurative endometritis, multiple pulmonary abscesses, spleen hyperplasia with a big number of neutrophils in its sinuses. What complication after abortion was developed?
Septicopyemia is a form of sepsis, main attributes of which are purulent processes in the entrance of infection and bacterial embolism with formation of abscesses in many organs and tissues. At the dissection, there is primary septic focus, it is usually in the entrance of infection with purulent lymphangitis and lymphadenitis. At first metastatic abscesses appear in the lungs, then in the liver, kidneys (apostematous nephritis), spleen is septic, hyperplastic processes in blood – creating lymphatic tissues.
Leprosy (Hansen’s disease) is a chronic generalized infectious disease, which involves mainly the ectoderm components (the skin, mucous membranes and the peripheral nervous system), lymphatic nodes, liver, spleen, bones and endocrine glands. The causative agent is acid proof and alcohol-resistant Mycobacteria leprae. Three types of leprosy are distinguished: lepromatous; tuberculoid; undifferentiated (the first 2 are the main forms). In tuberculoid leprosy, the epidermis contains confluent granulomas composed of macrophages, plasma cells and leprous Virchow’s cells. Leprous Virchow’s cells (or leprosy/hansen’s cells) refer to large foamy macrophages within fatty vacuoles containing leprous mycobacterium.
Examination of a young woman revealed a tumour up to 3 cm in diameter in form of a knot localized along the acoustic nerve. The tumour is homogenous, soft and elastic, of pink-and-white colour. Microscopically the tumour contains clusters of cells with oval nuclei. Fibrous cell clusters form regular structures made up by parallel rows of regularly oriented cells arranged in form of a palisade. Zones between the rows of cells are acellular and homogenous (Verocai bodies). What tumour is it?
Neurinoma or Schwannoma is a benign tumor of peripheral nervous system. It is formed of spinder-like cells with rod-shaped nuclei. The cells and fibers form rhythmical structures. An acoustic neurinoma is a benign tumor that may develop on the hearing and balance nerves (CNVIII vestibulocochlear nerve) near the inner ear. The tumor results from an overproduction of Schwann cells – small sheet-like cells that normally wrap around nerve fibers like onion skin and help support the nerves.
A section of the left lung was found to have an area of dense red tissue. The area was cone-shaped, stood out distinctly from the healthy tissue, with its base directed to the pleura. The dissected tissue was granular, dark-red. What is the most likely diagnosis?
Infarction is an area of ischemic necrosis within a tissue or an organ, produced by occlusion of either its arterial supply or its venous drainage. Infarction of the lungs: embolism of the pulmonary arteries may produce pulmonary infarction, though not always. The pulmonary infarcts are classically wedge-shaped or cone shaped with base on the pleura (periphery) hemorrhagic, variable in size and most often in the lower lobes. Cut surface is dark purple or red and it may show the blocked vessel near the apex of the infracted area. Old organized and healed pulmonary infarcts appear as retracted fibrous scars. The characteristic feature is coagulative hemorrhagic necrosis of the alveolar walls.
Myocarditis is inflammation of the heart myocardium. Microvascular plethora and diffuse stroma infiltration with lymphocytes and histiocytes are indicative of an inflammatory process taking place in the heart. Heart failure, dilated heart cavities are complications of myocarditis.
Acute appendicitis is the most common acute abdominal condition requiring surgery. Clinico-morphological classification of acute appendicitis includes:
· Simple appendicitis
· Superficial appendicitis
· Destructive forms: phlegmonous appendicitis; phlegmonous-ulcerative appendicitis; apostematous appendicitis and gangrenous appendicitis.
Acute phlegmonous appendicitis occurs with diffuse infiltration of leukocytes (especially neutrophils) in the wall of appendix. Gross appearance: appendix is increased, swollen, tense and markedly congested and covered by fibrinous exudates (yellowish-green films).
Erosion of the cervix is a defect in the epithetlium covering the vaginal portion of the cervix. It is usually caused by inflammation of the mucous membrane of the cervical canal or less frequently, of the vagina. Irritation by cervical leucorrhea results in maceration and scaling of the epithelium with the formation of small superficial ulcers, bright red in colour that bleed when touched – True erosion. 7 – 10days later, columnar (cylindrical) epithelium growing out of the cervical canal gradually covers the ulcerous surface; the resulting “pseudoerosion” may persist with recurrences for many years.
Amyloidosis is the term used for a group of diseases characterized by extracellular deposition of fibrillar proteinaceous substance called amyloid. Systemic amyloidosis contain amyloid associated (AA) protein. It occurs as a complication of chronic infectious or noninfectious inflammatory conditions associated with tissues destruction such as tuberculosis, bronchiectasis, chronic osteomyelitis, chronic pyelonephritis etc. It is typically distributed in solid abdominal organs like liver, spleen, kidneys and adrenals. Morphologically, the kidneys may be normal-sized, enlarged or terminally contracted due to ischemic effect of narrowing of vascular intima. Cut surface is pale waxy and translucent.
Autopsy of a 50-year-old man revealed the following changes: his right lung was moderately compact in all parts, the dissected tissue was found to be airless, fine-grained, dryish. Visceral pleura had greyish-brown layers of fibrin. What is the most likely diagnosis?
Anthracosis also known as Coal workers’ pneumoconiosis or black lung disease; it is caused by lung exposure to coal dust. It is common in coal miners and others who work with coal. Inhaled coal dust progressively builds up in the lungs and is unable to be removed by the body; this leads to inflammation, fibrosis and in worse cases necrosis.
Colonoscopy of a patient with dysentery revealed that the mucous membrane of the large intestine was hyperemic, edematic, and its surface was covered with grey-and-green layerings. What morphological form of dysenteric colitis is it?
Morphology of dysenteric colitis has 4 stages: catarrhal colitis; fibrinous colitis; ulcer formation (ulcerative colitis); healing of the wound. During the stage of fibrinous colitis, within the course of 24hours, a fibrinosuppurative exudate first patchily, then diffusely covers the mucosa and produces a dirty grayish pseudomembrane, consisting of necrotic mucosa, neutrophils, fibrin and erythrocytes. Sloughed pseudomembrane, together with blood-tinged mucus, comprises the characteristic dysenteric stool.
An 8-year-old child was admitted to the infectious department with fever (up to 38oC ) and punctuate bright-red skin rash. The child was diagnosed as having scarlet fever. Objectively: mucous membrane of pharynx is apparently hyperaemic and edematic, the tonsils are enlarged and have dull yellowish-grey foci with some black areas. What inflammation is the reason for the pharynx alterations?
Scarlet fever is one of the forms of streptococcal infection. It is an acute infectious disease accompanied by local inflammatory changes mainly in the pharynx and typical generalized rash. A punctuate erythematous rash that is most abundant over the trunk and inner aspects of the arms and legs manifests exanthema. The face is also involved, but usually a small area about the mouth (nasolabial triangle) remains relatively unaffected to produce a circumoral pallor. Primary scarlatinic affect is characterized by catarrhal or necrotic tonsillitis:
· Catarrhal tonsillitis is manifested by hyperemia of pharynx (flaring pharynx or burning faucet) with involvement of oral cavity and tongue. It presents a strawberry appearance because of the erythematous papillae that project from a gray-coated background. When peeling occurs, the tongue becomes beefy or crimson red and glistening.
· Necrotic tonsillitis is characterized by coagulative necrosis and ulceration. Microscopically, there is a characteristic acute, edematous, neutrophilic (purulent) inflammatory reaction within the affected tissues, mostly affecting the soft palate, pharynx, auditory tube.
While examining a patient an otolaryngologist noticed hyperaemia and significantly edematous tonsils with a grayish film upon them. Microscopical examination of this film revealed some gram-positive bacilli placed at an angle with each other. What disease might be suspected?
Diphtheria bacteria (Corynebacterium diphtheria) is Gram positive, pleomorphic, often club-shaped rods and are arranged in palisades or in V (at an angle) or L-shaped formations. Media used for isolation are Tellurite agar & Lὄffler medium. Lὄffler nutrient medium consists of coagulated serum & nutrient broth. Selective indicator medium containing tellurite are used in selective culturing. K tellurite is used to inhibit the accompanying flora.
Examination of a patient revealed a dense, movable skin tumour that is standing out distinctly from the surrounding tissues. Its section is found to be white and composed of fibrous tissue. Microscopic examination revealed interlacing collagen fibers and few cells. What tumour is it?
In the question; fascicles of divergent collagen fibers with SOME fusiform cells irregularly distributed among the fibers i.e. fibers > cells (fibers dominate).
Spirochetes are thin-walled, flexible, spiral rods. Three (3) genera of spirochetes cause human infection: Treponema (syphilis and the nonvenereal treponematoses); Borrelia (lyme disease and relapsing fever); Leptospira (leptospirosis). Treponema pallidum are thin, tight, spirals seen by darkfield illumination, silver impregnation or immunofluorescent stain.
Syphilis (lues) is a sexually transmitted disease of mankind caused by the spirochete – Treponema pallidum. Stages of syphilis are: primary (chancre); secondary (disseminated) and Tertiary (with lesions of deep organs following a latent period of 2 – 20 years or more).
The chancre develops at the site of inoculation in 10 – 90 days (average 21 days) and has a characteristic “luetic vasculitis” (endovasculitis, perivasculitis) in which endothelial cells proliferate and swell and the walls of the vessels become thickened by lymphocytes and fibrous tissue. Syphilis can also produce fibrinoid or caseous necrosis (gumma).
A patient who has been abusing tobacco smoking for a long time has got cough accompanied by excretion of viscous mucus; weakness after minor physical stress, pale skin. The patient has also lost 12,0 kg of body weight. Endoscopic examination of biopsy material his illness was diagnosed as squamous cell carcinoma. Name a pathological process that preceded formation of the tumour:
*Columnar metaplasia: there is transformation to columnar epithelium.
A 33 year old man died from uraemia. Autopsy revealed enlarged kidneys weighing 500,0 each and consisting of multiple cavities 0,5-2 cm in diameter. The cavities were full of light-yellow transparent liquid. Renal pelvis and ureters had no peculiarities. What renal disease caused uraemia?
Adult polycystic disease is inherited as an autosomal dominant trait, generally becoming clinically manifest in adult life. Cysts develop and progressively enlarge over a number of years, but remain asymptomatic until the number and size of the cysts is so great that the patient becomes aware of abdominal masses. At about the same time, the replacement and compression of functioning renal parenchyma by the cysts leads to slowly progressive impairment of renal function and patients develop chronic renal failure (uremia) and hypertension.
Bilateral – both kidneys
Cyst – a cavity that may be filled with gas, liquid or solid
A patient died from acute cardiac insufficiency, among clinical presentations there was gastrointestinal haemorrhage. Examination of mucous membrane of stomach revealed some defects reaching myenteron; their edges and bottom were mostly even and loose, some of them contained dark-red blood. What pathological process was revealed?
Ulcer is a local defect on the surface of an organ produced by inflammation. Morphogenesis and morphology of peptic ulcer disease includes: erosions, acute ulcer and chronic ulcer.
Acute ulcer is characterized by loss of tissue penetrating into the submucosa. It is a single or multiple lesions through the stomach and duodenum. It is circular and small, less than 1cm in diameter. Inflammatory reaction is absent initially but develops secondarily. Massive hemorrhage may be fatal. This type of ulcer usually heals without a visible scar.
Chronic ulcers are characterized by fibrinoid necrosis and granulation tissue with plasma cell and lymphocytic infiltration, also scarring. But there is no granulation tissue or fibrous tissue mentioned in the question.
Examination of a 66 year old patient revealed a lytic tumour in the locus of pathological rib fracture. Histologically this tumour consists of atypical plasmoblasts. Further examination revealed osteoporosis in the bones of vertebral column and pelvis. These changes are typical for:
Multiple myeloma is a monoclonal plasma cell (“fried egg” appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%). It is the most common primary tumor arising within bone in people >40 – 50 years old. It is characterized by hypercalcemia; renal involvement; anemia; bone lytic lesions (osteoporosis); back pain. MM: monoclonal M protein spike.
Cholera is an acute gastrointestinal infectious quarantinic disease and is characterized by diarrhea and exicosis. It has 3 clinical-morphological stages: choleric enteritis, choleric gastroenteritis and choleric exicosis (algid). Choleric gastroenteritis is characterized by the hard diarrhea, vomit and increase of dehydration. The loss of sodium and water causes severe diarrhea called “rice-water stool.” Fluid loss may exceed 1 liter per hour. Death occurs in algid period and is caused by dehydration, coma, uremia and intoxication.
Autopsy of a 5 year old child revealed in the area of vermis of cerebellum a soft greyish-pink node 2 cm in diameter with areas of haemorrhage. Histologically this tumour consisted of atypical monomorphous small roundish cells with big polymorphous nuclei. What tumour is it?
Medulloblastoma is a tumor made by immature cells, medulloblasts; therefore it is highly malignant. It is localized in the vermis of cerebellum. Macroscopically, it is pinkish-gray. Microscopically, medulloblastoma consists of homogenous small cells with dark round or oval nucleus and poorly seen rim of cytoplasm. The cells are located close to each other. Rosette is typical. Mitoses are numerous. Vessels are not numerous. Metastasis spread through the liquor routs.
Pulmonary embolism is the most common and fatal form of venous thromboembolism in which there is occlusion of pulmonary arterial tree by thromboemboli. Pulmonary emboli are more common in hospitalized or bedridden patients. The majority of emboli arise from the deep veins of the lower extremities; most of the fatal ones arise from the ileofemoral veins. Consequences of thromboembolism include pulmonary infarction in which pyramidal segments (or ‘triangular’ segments) of hemorrhagic infarction are seen at the periphery of the lung. Detachment of thrombi from the thrombophlebitis site in the lower limbs produces a thromboembolus that flows through venous drainage into the large veins draining into the right side of the heart and then to the pulmonary circulation where they embolize.
A 4 year old child complained of pain during deglutition, indisposition. Objectively: palatine arches and tonsils are moderately edematic and hyperemic, there are greyish-white films up to 1 mm thick closely adhering to the subjacent tissues. What pathological process are these changes typical for?
Fibrinous inflammation or pseudomembranous inflammation is an inflammatory response of mucous surface (oral, respiratory, bowel) to toxins of diphtheria or irritant gases. There are 2 types of fibrinous inflammation: croupous and diphtheric fibrinous inflammation. Local changes of diphtheric inflammation in the pharynx is characterized by small gray or white patches of exudates which appear over the pharyngeal mucosa, usually over the tonsils. The epithelial surface becomes necrotic and easily adherent to the underlying membrane. Attempts to remove this necrotic membrane may expose raw bleeding points. The soft tissues of the neck are edematous.
A patient has been suffering from diarrhea for 5 day. On the fifth day colonoscopy revealed that membrane of rectum was inflamed, there were greyish-green films closely adhering to the subjacent tissue. What is the most probable diagnosis?
Fibrinous colitis stage produces a dirty grayish pseudomembrane (film). Catarrhal colitis stage produces edema (inflamed) and hyperemic mucosa.
48 hours after tuberculine test (Mantoux test) a child had a papule 10 mm in diameter on the spot of tuberculine injection. What hypersensitivity mechanism underlies these changes?
6 months after labour a woman had uterine hemorrhage. Gynaecological examination of uterine cavity revealed a dark-red tissue with multiple cavities resembling of a \"sponge\". Microscopic examination of a tumour revealed in blood lacunas atypic light epithelial Langhans cells and giant cells of syncytiotrophoblast. What tumour is it?
Chorioepithelioma or choriocarcinoma or gestational choriocarcinoma is a malignant neoplasm of trophoblastic cells derived from a previously normal or abnormal pregnancy. NB: trophoblast differentiates into 2 layers (cytotrophoblast and syncytiotrophoblast) in the 2nd week of development of an embryo. Chorioepithelioma is a soft, fleshy, yellow-white tumor that usually has large pale areas of necrosis and extensive hemorrhages. Histologically, it does not produce chorionic villi and consists entirely of proliferating syncytiotrophoblasts and cytotrophoblasts.
A 30 year old man had been suffering from acute respiratory disease and died from cardiopulmonary decompensation. Autopsy revealed fibrinous-haemorrhagic inflammation in the mucous membrane of larynx and trachea, destructive panbronchitis, enlarged lungs that look black due to the multiple abcesses, haemorrhages, necrosis. What is the most probable postmortem diagnosis?
Influenza is an acute respiratory viral infection. The clinical-morphological forms of influenza are slight influenza, mild influenza and severe influenza. The histopathologic features of mild influenza include a necrotizing tracheitis and bronchitis; diffuse hemorrhagic necrotizing pneumonitis with pulmonary edema. Pulmonary complications in severe influenza: lungs are dark and firm with interstitial emphysema (enlarged lungs); necrotic foci; abscesses; lungs appear as “large variegated (motley) influenza lung.” Obliterating bronchitis, bronchiolitis, bronchiectasis and other chronic lung diseases can develop.
Autopsy of a man who died from burn disease revealed brain edema, liver enlargement as well as enlargement of kidneys with wide light-grey cortical layer and plethoric medullary area. Microscopic examination revealed necrosis of tubules of main segments along with destruction of basal membranes, intersticium edema with leukocytic infiltration and haemorrhages. What is the most probable postmortem diagnosis?
Examination of coronary arteries revealed atherosclerotic calcified plaques closing vessel lumen by 1/3. The muscle has multiple whitish layers of connective tissue. What process was revealed in the myocardium?
A 22 year old patient from the West Ukraine complains of laboured nasal breathing. Morphological examination of biopsy material of nasal mucous membrane revealed lymphoid, epitheliod, plasma cells as well as Mikulicz’s cells. What is the most probable diagnosis?
Desmoid fibroma is a benign connective tissue tumor. It a kind of dense fibroma and characterized by infiltrating growth and relapses. It is composed of banal, “tame-loking” fibroblasts that do not metastasize. More often it is located on the anterior abdominal wall.
The liver puncture biopsy of a patient with hepatocellular insufficiency revealed hydropic and ballooning degenerationof hepatocytes, necrosis of certain cells, presence of Kaunsilmen’s bodies. Portal and lobular stroma were infiltrated mostly with lymphocytes and macrophages as well as with a small number of polymorphonuclear lymphocytes. What is the most likely diagnosis?
The morphologic changes in acute viral hepatitis are virtually the same regardless of the causative agent and can be mimicked by drug reactions. Grossly, the liver is slightly enlarged. Histologically, the major finding is hepatocellular injury characterized by necrosis of scattered hepatocytes; isolated liver cells or small cell clusters appear as eosinophilic rounded-up cells (apoptotic bodies, councilman’s bodies). Degenerated hepatocytes may also appear ballooned. Macrophages may phagocytize the necrotic hepatocytes and may accumulate clumps of lymphocytes and macrophages. Confluent necrosis may lead to bridging necrosis connecting portal-to-portal, central-to-central or portal-to-central regions of adjacent lobules, signifying a more severe form of acute hepatitis.
A patient with tuberculosis died from progressing cardiopulmonary decompensation. Autopsy in the region of the right lung apex revealed a cavity 5 cm in diameter communicating with lumen of a segmental bronchus. On the inside cavity walls are covered with caseous masses with epithelioid and Langhans cells beneath them. What morphological form of tuberculosis is it?
Acute cavernous tuberculosis develops due to lyses of caseous necrosis and characterized by formation of the round cavity.
Tuberculoma consists of focus necrosis surrounded by fibrous capsule. Size of tuberculoma may be near 2-5cm.
A 70-year-old male patient died from acute coronary insufficiency. He had knee joint swelling, gonycampsis and gonalgia during his lifetime. Pathomorphologic examination of the deformed joints and synovial membranes revealed membrane hyperemia with multiple perivascular inflammatory infiltrations made by lymphocytes, plasmocytes and macrophagocytes. There was an accumulation of organized fibrin covering some areas of synovium membrane and looking like rice grains in the articular liquid. What is the most likely diagnosis?
Rheumatoid (atrophic) arthritis is a chronic progressive inflammatory arthritis of unknown origin involving multiple joints and characterized by disorganization of connective tissue of the synovial membrane and articular cartilage and development of their deformation. Disorganization of the connective tissue cause increase in proteoglycans and glycosaminoglycans (GAGs) concentration in blood. Proteoglycans and GAGs are responsible for the physical properties of ground substance. Main morphological appearance of rheumatoid arthritis is synovitis. It has 3 stages: in the first stage, it is characterized by an acute inflammatory reaction with development of edema, hyperemia and infiltration of lymphocytes, plasma cells and macrophages. Small areas of superficial necrosis or superficial erosions are covered by fibrinoid deposits. Not infrequently 2-3mm “rice bodies” (rice grains) composed of fibrin, fibronectin, collagen and immunoglobulin are present in joint cavities of seropositive patients.
A patient died from cardiopulmonary decompensation. Histological examination revealed diffused pulmonary affection along with interstitial edema, infiltration of tissue by limphocytes, macrophages, plasmocytes; pulmonary fibrosis, panacinar emphysema. What is the most likely diagnosis?
Fibrosing alveolitis is also known as interstitial pneumonia. It is characterized by progressive scarring of both lungs. The scarring (fibrosis) involves the supporting framework (interstitium) of the lung. There are patchy or lobar areas of congestion without the consolidation of bacterial pneumonias. A predominance of interstitial pneumonitis with widened, edematous alveolar walls containing a mononuclear inflammatory cell infiltrates. Interstitial pneumonia is the most common form of interstitial fibrosis.
Medical examination of a 20-year-old woman revealed a dense incapsulated node 1 cm in diameter that was palpated in the mammary gland. The postoperative biopsy revealed connective tissue overgrowth around the mammary ducts and glandular components of different diameter that didn’t make lobules and bore no signs of cellular abnormality. What diagnosis will be made?