Disease



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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