Disease - University of Arizona
Disease |Pathological Process |Microscopically | |Clinical Correlates | |
|Brain/ Meninges |
|Pyogenic Meningitis |Inflammatory |95 | |- classic triad of symptoms: fever, stiff |
| |Acute |- large vessels in subarachnoid space (between | |neck and headache (from traction on blood |
| | |arachnoid & pial) | |vessels) |
| | |- thickened meninges due to edema & neutrophils, | |- common complications: seizures, cerebral |
| | |does not breech arachnoid | |infarct |
| | |- large subarachnoid space | |- treat with IV or IM antibiotics |
|Granulomatous angitis |Inflammatory |284 | |- intellectual/ motor disturbances, seizures|
| |Granuloma |- large vessels in subarachnoid space | |or acute cerebral hemorrhage |
| | |-granulomatous infiltrate in vessel wall | |- treat with corticosteroids |
| | |-epithelioid cells (epithelial-like appearance; have| |- need Temporal Artery Biopsy |
| | |abundant, pale cytoplasm) | |- possible fever |
| | |-giant cells | | |
|Heart/ Arteries / Veins |
|Acute Myocardial Infarction |Circulatory, |259 – | |- chest pain, dyspnea, anxiety, N/V, |
|Heart |Inflammatory, acute |- Necrotic myocardium (nuclei loss, blurring & loss | |diaphoresis |
| | |of finely striated fiber structure) , | |- check troponin I (early) and creatine |
| | |- acute inflammatory infiltrate = neutrophils – some| |kinase MB (later) |
| | |degenerating with pyknosis (dense, shrunken nuclei) | |- treat with asa, nitroglycerin |
| | |& karyorrhexis (fragmenting & lysing nuclei), | | |
| | |- fibroblasts ( spindle shaped cells) between | | |
| | |thrombus & underlying heart tissue | | |
|Hypertrophy |Circulatory |160 – | |-causes: (L) HTN, aortic stenosis, |
| | |-↑ myocardial thickness | |aortic/mitral valve disease (R) L ventricle |
| | |- box car nuclei (squared off) | |failure, lung disease, mitral valve disease,|
| | |- enlarged nuclei | |L to R shunt |
| | |-↑ chromatin density | |- could have sudden death, arrhythmia, or |
| | | | |heart failure |
| | | | |- give antibiotic prophylaxis for minor |
| | | | |procedures (dental) |
|Post mortem clot |Circulatory |131 – | |-pt is dead |
| | |- no lines of Zahn | | |
| | |-homogenous appearance | | |
| | |-clot is not attached to vessel wall | | |
| | | | | |
| | | | | |
|Thrombus in pulmonary artery |Circulatory |132 – | | |
| | |- lines of Zahn (laminated layers of platelet-fibrin| | |
| | |alternating with RBCs) | | |
| | | | | |
|Lung |
|Abscesses of Lung |Inflammatory |180 – | |- Usu caused by fungi, Staphylococcus, |
| | |-Large abscess with tissue falling apart in center | |Nocardia |
| |(Liquefactive necrosis |-neutrophils | |- more common in elderly |
| |– neutrophils release | | |- treat with antibiotics (IV clindamycin) |
| |proteolytic enzymes | | |- possible symptoms: clubbing, low grade |
| |which digest tissue) | | |fever, gingival disease, ↓ breath sounds |
| | | | |- x ray shows irregular shaped cavity with |
| | | | |air-fluid level |
|Squamous Cell Carcinoma |Malignant neoplasm |47 – | |- associated with secretion of parathyroid |
| | |-sheets of large, irregular pink cells with abundant| |hormone like substances ( hypercalcemia |
| | |cytoplasm & aplastic nuclei; | |- 17% of lung neoplasms |
| | |-possible keratin pearls | |- cough, hemoptysis, dyspnea, weight loss, |
| | | | |low grade fever |
| | | | |- caused by smoking |
| | | | |- treat with chemotherapy |
|Broncho-pneumonia |Acute Inflammation |58 – | |- fever, hypothermia, cough, dyspnea, chest |
| | |- focal consolidation [in alveoli: exudate with | |discomfort, sweats, rigors |
| | |fibrin (fine, threadlike, eosinophilic strands/webs)| |- rales |
| | |& inflammatory cells – neutrophils], | |- yellow-gray, thick sputum resembling pus |
| | |- minimal tissue destruction, | |- chest x-ray shows parenchymal infiltrate |
| | |- pores of Kohn (inflammation extends from one | | |
| | |alveolar space to next) | | |
| | |- Other: abscess; other side shows gram staining for| | |
| | |coccal bacteria | | |
|Coccidioido- mycosis |Inflammatory |92 – | |-influenza-like symptoms: malaise, fever, |
| |Granuloma |-grossly: nodularity | |backache, headache, cough |
| | |-early granulomas (alveolar infiltrates of | |- chest x ray |
| | |neutrophils, macrophages, fibrin & few giant cells/ | |- symptomatic treatment |
| | |epitheliod cells) | | |
| | |-mature granulomas [rim of epitheliod cells (large | | |
| | |mononuclear cells with ill defined pink cytoplasm, | | |
| | |elongaged, folded nuclei with fine chromatin or | | |
| | |reniform nuclei) and giant cells] | | |
| | |- spherules of cocci (thick refractile wall with | | |
| | |basophilic matter inside) inside giant cells | | |
|Tuberculosis |Inflammation |139 – | |- fatigue, weight loss, fever, night sweats,|
| |Necrosis & Granuloma |- langerhan’s giant cell (multiple nuclei are | |cough |
| | |arranged in a horseshoe shape) | |- chest x ray shows pulmonary infiltrates |
| | |- large, mature granuloma with a few giant cells, | |(often apical) |
| | |epithelioid cells, lymphocytes | |- positive PPD |
| | |- large central area of caseating necrosis with | | |
| | |fibrous border at edge of granuloma | | |
|Sarcoidosis |Inflammation |104 – | |- incidence is high in North American blacks|
| |Granuloma |- granuloma near bronchovascular structures & | |and northern European whites |
| | |beneath pleura | |- malaise, fever, dyspnea |
| | |- epithelioid cells in center of granuloma | |- chest x ray |
| | |- lymphocytes at periphery | |- treat with corticosteroids |
| | |- asteroid bodies (common in sarcoidosis) in giant | | |
| | |cells | | |
|Chronic Inflammation & |Inflammation |242 – | | |
|Fibrosis |Chronic |- fibrosis (bands/strands of eosinophlic fibrillar | | |
| | |material) alters architecture | | |
| | |- fibroblasts (elongated cells) | | |
| | |- septal walls thickened | | |
|Pulmonary Infarct |Circulatory |127 – hemorrhagic area, coagulative necrosis | | |
| | | | | |
|Amniotic Fluid Embolism |Circulatory |149 – | |- tachypnea |
| | |- presence of mature squamous cells (wrinkled, pale | |- widened alveolar-arterial PO2 difference |
| | |blue or blue-gray structures) in pulmonary alveolar | |- dyspnea, chest pain, hemoptysis, syncope |
| | |capillaries | |- defects on ventilation-perfusion chest x |
| | | | |ray |
|Asthmatic Lung |Allergic |138 – | |- breathlessness, cough, wheezing, chest |
| | |- mucus plugs in bronchioles | |tightness |
| | |- hyperinflation of some alveoli | |- symptoms worse at night or in early |
| | |- hypertrophied submucosal glands | |morning |
| | |- hypertrophied bronchial SM, thickening of basal | |- pulmonary function test: limitation of |
| | |lamina | |airflow |
| | |-eosinophils in peribronchial tissue | |- corticosteroids, long acting |
| | | | |bronchodilators, leukotriene modifiers, |
| | | | |desensitization |
|Liver |
|Cirrhosis |Inflammation |251 – | |- 10th leading cause of death in USA |
| |Chronic |- fibrous tissue extending between periportal areas | |- asymptomatic for long periods |
| | |( abnormal nodules | |- symptoms: weakness, fatigability, |
| | |63 (nutritional) – | |disturbed sleep, muscle cramps, weight loss |
| | |- CT septa staining bluish gray crisscrossing the | |- hepatomegaly |
| | |liver cells ( nodules | |- increasing jaundice |
| | |-fatty change (fat vacuoles in hepatocytes) | | |
|Viral Hepatitis (B) |Inflammatory |106 – | |- prodrome of anorexia, nausea, vomiting, |
| |Chronic |- disrupted architecture | |malaise, aversion to smoking |
| | |- massive hepatocyte destruction, tissue appears | |- fever, enlarged/ tender liver, jaundice |
| |(hepatocytes are |“moth eaten” | |- abnormal liver tests |
| |attacked to kill virus |- macrophages with ingested debris | | |
| |inside) |- hepatocytes no longer attached to one another but | | |
| | |are loosely attached to CT matrix remnants | | |
| | |- lymphocytes | | |
|Hepatocellular carcinoma |Primary malignant |60 – | |-possible prevention by acyclic retinoid |
|(hepatoma) |neoplasm |- malignant cells (polygonal, arranged in trabeculae| |polyprenoic acid |
| | |(cords) bluish cytoplasm, larger/more vesicular | |-hepatomegaly |
| | |nuclear chromatin pattern, large nucleoli) | |- cachexia, weakness, weight loss, ascites |
| | | | |(bloody) |
| | | | |- cirrhosis is a risk factor |
| | |52 (for 8/12) | | |
|Pancreas |
|Fat Necrosis of Pancreas |Inflammatory |144 – | |- can be caused by trauma |
| |Acute |- Adipose intermingled with glandular units | |- erythematosus skin nodules |
| | |- necrotic fat cells (no nuclei, blurred cytoplasmic| |- 5cm may |
| |(Fat necrosis-Lipases, |contours, bluish-blue gray color due to Ca2+ + fatty| |liquefy within fibrotic capsule |
| |released from injured |acids = saponification) | | |
| |pancreatic cells, inure|- neutrophils | | |
| |fat cells) | | | |
|Islet Cell Adenoma |Neoplasm |244 – | |- most common type is beta cell tumor |
| |Benign |- well circumscribed with band around tumor | |(insulinoma) |
| | |- cells (lighter, redder color, trabecular pattern –| |- have fasting hypoglycemia (fasting blood |
| | |cord like pattern with intervening sinusoids); cells| |glucose < 40 mg/dL) associated with CNS |
| | |derived from islet cells | |dysfunction (confusion/ abnormal |
| | | | |behavior/diplopia) |
| | | | |- untreated, obesity can result from |
| | | | |overeating to relieve symptoms |
| | | | |- remove tumor ( if not possible- frequent |
| | | | |feedings) |
|Intestine |
|Tubular Adenoma of colon |Benign neoplasm |84, 219 – | |- colonoscopy |
| | |- mixed tubular glands & villous fronds | |- proximal colon: fecal occult blood, anemia|
| | |- also pure villous adenoma; | |- distal colon: change in bowel habits, |
| | |- no evidence of aggressive behavior | |hematochezia |
|Amoebiasis of colon |Inflammatory |147 – | |- blood in stool |
| | |- area of ulceration (point of discontinuity of | | |
| | |mucosa) with pink, granular, necrotic cellular | | |
| | |debris & neutrophils, | | |
| | |- amoebae (poorly visible nucleus, eats RBC) | | |
| | |52 (for 8/12) | | |
|Adenocarcinoma of rectum |Malignant neoplasm |43 – | |- colonoscopy |
| | |- derived from glandular epithelium of bowel mucosa;| |- proximal colon: fecal occult blood, anemia|
| | |highly variable nuclei (shape, size, chromatin | |- treat by resection |
| | |pattern, nucleoli size), | | |
| | |- cells form glandular patterns; | | |
| | |- invades bowel wall | | |
|Appendix |
|Acute Appendicidis |Inflammatory |40 – | |- abdominal tenderness |
| | |- mucosal discontinuity (ulcer) with missing glands,| |- anorexia, nausea and vomiting |
| | | | |- tenderness & localized rigidity at |
| | |- WBCs, | |McBurney’s point |
| | |- neutrophils in blood vessels (migrating through), | |- low grade fever & leukocytosis |
| | |- dilated vessels | | |
|Kidney |
|Infarction of the Kidney |Circulatory, |134 – | | |
| |Inflammatory, |- Grossly- pale wedge shaped area (infracted area) | | |
| |acute |- faint outlines of glomeruli & tubules with no | | |
| | |nuclei | | |
| |(coagulative necrosis –|- zone of neutrophils (many are degenerating – | | |
| |loss of blood supply) |karyorrhexis) at boundary of infarct reacting to | | |
| | |dead tissue | | |
| | |233 (for 8/12) | | |
| | | | | |
|Female Reproductive Systerm: Ovary, Fallopian Tubes, Uterus, Cervix, Vulva |
|Benign Cystic Teratoma of |Benign neoplasm |223 – | |- occur in childhood to post menopause |
|Ovary | |- composed of various cell lines & tissue types | |- 15% are bilateral |
| | | | |- no menstrual irregularity |
| | | | |- torsion can occur |
| | | | |- partial oopherectomy recommended |
|Acute Salpingitis fallopian |Inflammatory |154 – | |- lower abdominal pain/ pelvic pain |
|tubes | |-neutrophils in lumen and folia (papillary-like | |(constant and dull) |
|(Pelvic Inflammatory Disease) | |fronds protruding into lumen) | |- commonly have coexisting purulent vaginal |
| | |-dilated blood vessels in adventitia | |discharge |
| | |- neutrophils margination & migration | |- must give pregnancy test to r/o ectopic |
| | | | |pregnancy |
| | | | |- give parenteral antibiotics |
|Atrophy of Uterus | |30 – | |- |
| | |- endometrium is thin with small inactive appearing | | |
| | |glands (↓ cytoplasm, ↑ CT between glands, | | |
| | |discontinuous) some with cystic dilation (lost | | |
| | |communication with surface but still secrete matter)| | |
|Squamous Cell Carcinoma of |Malignant neoplasm |189 – | |- common symptoms: abnormal bleeding & |
|Cervix | |- malignant cells (well defined cytoplasmic | |discharge |
| | |clearing, twisted/wrinkled/dense/ raisin like nuclei| |- must be confirmed by a biopsy |
| | |often displaced to edge) arranged as sheets; | |- 5 year survival rate is 68% in white women|
| | |abnormal nuclei, abnormal maturation, disorganized | |in USA |
| | |growth pattern; | |- treat with total hysterectomy |
| | |- lymphatic invasion = small groups of malignant | | |
| | |cells with areas of clear space around them in CT | | |
| | |underneath the normal epithelium | | |
|Dysplasia of Vulva | |172 – | |- associated with HPV (sexually transmitted,|
| | |- nuclei: irregular, variable enlargement, | |manifested as venereal warts) |
| | |hyperchromasia (dark staining of nuclei caused by | |- excise lesion |
| | |increased DNA content) | | |
| | |- disordered cell arrangement | | |
| | |- no invasion | | |
|Breast |
|Fibroadenoma |Benign neoplasm |16 – | | |
| | |- abundant collagenized stroma with embedded breast | | |
| | |ducts (compressed & distorted) | | |
|Infiltrating Duct Carcinoma |Malignant neoplasm |86 – | | |
|“inflammatory” | |- malignant cells are epithelial (derived from | | |
| | |breast ducts) which grow and infiltrate as cords/ | | |
| | |strands | | |
| | |- accompanied by collagenous reaction | | |
|Male Reproductive System: Prostate, Testis |
|Hyperplasia of Prostate (BPH) | |34 – | |-most frequent cause of urinary tract |
| | |- grossly – rounded areas = nodules of hyperplastic | |obstruction (frequency, dysuria, hesitancy &|
| | |glands | |UTI |
| | |- closely spaced glands with proliferative | |-almost universal in older age group |
| | |appearance and well developed papillary enfoldings | | |
| | |- cystic dilation | | |
|Bone |
|Osteomyelitis of bone |Neoplasm |176 – | | |
| | |- bony spicules (trabeculae) are smaller than normal| | |
| |Necrosis |with irregular edges | | |
| | |- nuclei vacate lacunae (necrosis) | | |
| | |- marrow have been replaced by fibrous reparative | | |
| | |tissue | | |
|Osteogenic Sarcoma |Malignant Neoplasm |185 – derived from osteoblasts; | | |
| | |- cells with irregular, hyperchromatic nuclei | | |
| | |forming bright pink osteoid (nonmineralized bone | | |
| | |matrix) | | |
|Skin |
|Foreign Body Reaction in Skin |Inflammatory |31 – | | |
| | |- atypical granuloma; | | |
| | |- giant cells (with phagocytosed yellow fragments) | | |
| | |- mononucleated epitheliod cells | | |
| | |- lymphocytes | | |
|Scar | |27 – | |- treat with z-plasty (scar revision |
| | |- ↑ collagen deposition in reticular dermis | |technique) or m-plasty |
| | | | | |
|Other |
|Nasal Polyp |Inflammatory (Type I |15 – | |- difficulty breathing through nostril with |
| |hypersensitivity) |- edematous submucosal CT | |polyp |
| | |- many eosinophils (bilateral nuclei, eosinophilic | |- treat with topical nasal steroids or oral |
| | |granules) | |corticosteroids |
| | |- epithelium shows ↑ mucin production, | |- decreased sense of smell |
| | |- mucin filled cysts | |- in children: suggest CF |
|Hashimoto’s disease of thyroid|Inflammatory |39 – | |- more common in females |
| |Autoimmune |- diffuse infiltration of thyroid by lymphocytes & | |- cold, dry skin, alopecia, bradycardia |
| | |plasma cells forming germinal center | |- treat with thyroid hormone replacement |
| | |- residual follicular epithelium forms small acinar | | |
| | |structures formed of large glandular cells (Hurthle | | |
| | |or Askanazy cells) | | |
|Subcutaneous Rheumatoid nodule|Inflammatory |73 – | |- seen in 20-25% of RA pts |
| | |- central areas of necrosis with fibrinoid material,| |- usu located over extensor tendons in |
| | |surrounded by monocytic cells with palisading | |elbow/ankle |
| | |epithelioid appearance, | | |
| | |- perivascular infiltrates of lymphocytes | | |
|Hypertrophic synovium from pt |Inflammatory |162 – | | |
|with RA | |- papillary folds lined with synovial cells | | |
| |(immune complexes in |infiltrated with lymphocytes, neutrophils, | | |
| |synovial space IgM/G |lymphocytes, plasma cells, monocytic cells, deposits| | |
| |against IgG/A/E/D type |of fibrinoid, proliferation of synovial cells | | |
| |III rxn) | | | |
|Rheumatoid arthritis/synovitis|Inflammatory |179 – | |- joint pain & loss of joint mobility (due |
|joint | |-distorted reticular cartilage covering bone, | |to reactive fibrosis) can lead to ankylosis |
| |(IgM forms against |frond-like projections covered by synovial lining | | |
| |native IgG forming |cells (= hyperplastic synovial membrane), cellular | | |
| |complex which fixes |infiltrate; pannus has eroded & digested away the | | |
| |complement) |articular hyaline cartilage & exposed underlying | | |
| | |bone | | |
|Necrotizing vasculitis of |Inflammatory |120 – | | |
|muscle or nerve | |- focal changes; medium arteries with inflammation | | |
| | |around & extending through the vessel wall; | | |
| | |fibrinoid necrosis | | |
|Sickle Cell Anemia |Circulatory |279, 280, 296 – | | |
| | | | | |
|Cystic Fibrosis | |146 – | | |
| | | | | |
|Polycystic Kidney Disorder | |90 – | | |
| | | | | |
|Squamous Cell Carcinoma of |Neoplasm |5 – | | |
|Larynx | |- normal respiratory mucosa (ciliated columnar | | |
| | |epithelium) is disrupted by pleomorphic squamous | | |
| | |cells (hyprchromatic, bizarre nuclei, eosinophilic | | |
| | |cytoplasm), keritization, intracellular bridges | | |
|Metastatic Squamous Cell |Metastatic Neoplasm |201 – lymph node (capsule, sinusoids, lymphocytes, | | |
|Carcinoma of Lymph Node | |germinal centers) with large groups of squamous | | |
| | |carcinoma (keratin pearls and intercellular bridges)| | |
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