GROSS SPECIMEN REVISION UG pathology.pptx

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1. GROSS SPECIMEN REVISION

2. FATTY LIVER Enlarged liver with tense glistening capsule. Rounded margin C/S – bulges and is pale yellow-yellow with greasy fat

3. STAGHORN CALCULUS Wet mount specimen of nephro-Ureterectomy specimen cut section shows dilated pelvicalyceal system. Renal cortex is thinned out. The dilated calyx; shows large impacted chalky white stone taking the shape of dilated duct

4. Q)What are the clinical symptoms of these patients? A)Fever, hematuria , flank pain, UTI Q)What are the chemical composition? A)Struvite(Magnesium, Phosphate and Ammonium) Q)Name any hereditary causes? A)Primary hyperoxaluria

5. GANGRENE INTESTINE Colectomy specimen show congested,dusky , blackish, thinned out colonic wall. The lumen shows thinned out mucosa with loss of mucosal folds No area appears spared No perforation/Lesion seen

6. Q)What are the different types of gangrene? A) Dry gangrene, wet gangrene and gas gangrene Q)Name any etiological factors? A) Clostridium perfringens Q)Name 2 other organs where such lesions can occur? A) Muscle and uterus

7. ACUTE APPENDICITIS Wet Mount Specimen of Appendix measuring 8x2cms. The surface shows prominent, Congested vessels No exudate seen No perforation/Gangrenous change noted.

8. Q)What are the 2 causes? A) -Obstructive- fecolith , calculi, tumor . -Non obstructive-vascular occlusion Q)What are the classical clinical presentation? A) Colicky pain(initially around the umbilicus later to the right iliac fossa), nausea, vomiting ,mild pyrexia Q)What is the peripheral smear findings in this case ? A)Neutrophilia / leukocytosis Q)What are the complications? A)appendix abscess (rupture of appendix), peritonitis

9. CVC SPLEEN Wet mounted splenectomy specimen shows enlarged dark spleen showing smoothening of contours with stretched out capsule. Cut section shows congested appearance

10. Q)Enumerate the causes? Right heart failure and portal hypertension from liver cirrhosis Q)Histological features of these lesions?

11. INFARCT SPLEEN Slice of a splenectomy specimen- Normal splenic tissue appears slate-grey in appearance. There is an abrupt change of appearance with a pale area which appears wedge-shaped with base towards the hilum . No grey white lesions seen.

12. TB LYMPH NODE Specimen shows well circumscribed 3 lymphnodes which appear matted. Cut surface shows grey white cheesy appearance, Granular and yellowish.

13. Q)What is Pott’s spine? A)Tuberculous spondylitis Q)What is Psoas abscess? A)Collection of pus in iliopsoas muscle compartment. Q)What is scrofula? A) A swelling of lymph node in the neck caused by bacterial infection. Q)What is type of hypersensitivity reaction seen in this case? A)Delayed/type IV hypersensitivity reaction is seen Q)What is the special stain used? A)AFB stain Q)Describe the histology? A)Giant multinucleated cells (Langerhans giant cell), T cell lymphocytes and few fibroblasts.

14. TB CAVITY LUNG Wet Mount specimen of lung S howing a cavitary lesion measuring 5x3cms Describe the wall and the base No necrotic material seen

15. Q1) Identify and describe the gross specimen. A) This is a wet mount specimen of lung showing a cavitary lesion. No necrotic material is seen. Q2) Name any four causes for the same. A) Tuberculosis, Aspergillosis, pulmonary abscesses, septic emboli Q3) What is the most common cause? A) Due to Mycobacterium tuberculosis infection Q4) What is the most common fungi seen in these lesions? A) Aspergillus fungi which are seen as a “fungus ball” in the cavity.

16. Causes of lung cavities

17. ATHEROSCLEROSIS Wet mount specimen of blood vessel showing yellowish atherosclerotic plaques.

18. MULTIPLE POLYPOSIS INTESTINE Wet mount colectomy specimen which shows no normal mucosa – carpeted by numerous (thousands) of polyps varying in size. Sessile and pedunculated. There is no ulcerative/malignant lesion seen.

19. Q1) Describe the gross specimen. A1) Wet mount colectomy specimen which shows no normal mucosa – carpeted by numerous (thousands) of polyps varying in size. Sessile and pedunculated . There is no ulcerative/malignant lesion seen. Q2) What is the minimum number of polyps required? A2) Minimum 100 polyps are required to make a diagnosis of FAP. Q3) What complications can develop? A3) The most important complication which can develop in an untreated case of FAP is adenocarcinoma, where the risk is 100% Q4) What prophylactic measures are taken once the case is diagnosed? A4) Once diagnosed, prophylactic colectomy is done if APC gene is detected. Q5) What is the type of polyp commonly seen in histology? A5) The most common type of polyp seen is the tubular type of polyp which is small and pedunculated (has a stalk). Q6) Name 2 associated syndromes. A6) The associated syndromes with FAP are Gardner’s and Turcot’s syndrome. Gardner syndrome is associated with osteomas and Turcot’s is associated with CNS tumors such as medulloblastoma.

20. CARCINOMA COLON wet mount specimen of a cut open colon measuring 10x8 cm shows an ulceroproliferative lesion with irregular edges that is 0.4 cm away from the distal resection margin. The adjacent colonic mucosa appears edematous .No other masses or polyps or diverticuli are seen

21. Q1) Identify and describe the specimen. A1) Wet mount specimen of a cut open colon measuring 10x8 cm shows an ulceroproliferative lesion with irregular edges that is 0.4 cm from the distal resection margin. The adjacent colonic mucosa appears oedematous. No other masses or polyps or diverticuli are seen. Q2) Describe the etiological factors. A2) Risk increases with increasing age, peaking in the 60-70 age group. Males are affected more than females. Dietary factors are associated with colon cancer, especially those on a low-vegetable fibre diet and high intake of carbohydrates are at increased risk. Q3) What are the differences between right-sided and left-sided lesions? A3) Right sided lesions present as exophytic, polypoid masses that extend along one wall of the large- caliber caecum and ascending colon and hence rarely cause obstruction. However, left sided colon cancer presents as annular lesions that produce “napkin ring” constrictions and luminal narrowing. Right sided colon cancers produce weakness, fatigue due to iron deficiency anaemia while left sided colon cancer causes occult bleeding, changes in bowel habits or cramping left lower quadrant discomfort. Q4) Name any two genetic mutations that can give rise to these lesions? A4) Mutation of the APC tumor suppressor gene (after “two-hit” hypothesis- 2 mutations)- KRAS and TP53, mutations of microsatellite repeats – BRAF mutation.

22. CIRRHOSIS LIVER wet mount specimen of an already grossed hepatectomy ( Explant liver) specimem consists of a liver that appears small and shrunken. The external surface appears nodular. The specimen on serial slicing shows multiple nodules that are diffusely arranged .No lesion is noted , no bile staining is seen

23. Q1) Describe the gross specimen. A1) Wet mount specimen of already grossed hepatectomy ( explant liver) specimen consisting of a liver that appears small and shrunken. The external surface appears nodular. The specimen on serial sectioning shows multiple nodules that are diffusely arranged. No lesion/bile staining is seen. Q2) Name any 4 causes for the same. A2) Alcoholism, intake of hepatotoxic medication such as anti-tubercular drugs, obesity, NAFLD etc. Q3) What special stain is used while reading the histology of these? A3) Masson’s trichrome stain and Reticulin stain for seeing the extent of fibrosis. Q4) Name any 2 complications of these lesions. A4) Liver failure, portal hypertension, development of hepatocellular carcinoma

24. CHRONIC CALCULOUS CHOLECYSTITIS Specimen shows an already cut open enlarged, distended gallbladder. There is loss of velvety mucosal appearance and is congested with blackish discoloration of fundus and body . Mucosa shows irregular granular appearance. The gall bladder wall appears thickened Stones seen in the container

25. Q)Enumerate the etiological factors? A) Cholelithiasis though severity of disease poorly correlates with stone burden. Risk factors correspond to those that increase risk of cholelithiasis: female sex, obesity, rapid weight loss, pregnancy, advanced age. Q)What are the common symptoms? A) Murphy sign: right upper abdominal pain with deep palpation Abdominal discomfort often related to fatty food ingestion Nausea, vomiting, bloating, flatulence

26. CARCINOMA LUNG Wet mount specimen of Irregular circumscribed grey white lesion of lungs. Soft to firm in consistancy . Cut surface shows grey white granular . pleura apperas uninvolved. Pleural invasion if present is usually assosiated with pleural puckering.Rest of the lung appears normal grossly with carbon deposits.

27. Q1) Identify and describe the gross specimen. A1) Wet mount specimen of irregular circumscribed grey white lesion of lung a few centimeters away from the bronchial cut margin. Soft to firm in consistency. Cut surface shows grey white granular appearance. Pleura appears uninvolved. Pleural invasion if present is usually associated with pleural puckering. Rest of the lung appears normal grossly with carbon deposit. Q2) Enumerate the etiological factors. Smoking-in small cell carcinoma and squamous cell carcinoma Genetic factors- EGFR mutations for adenocarcinoma . Other environmental factors- asbestos, arsenic, chromium, uranium dusts, radioactive ores etc. Q3) Classify these lesions. Lung carcinomas are classified into two broad groups- small cell and non-small cell (SCLC and NSCLC). Non-small cell carcinoma includes adenocarcinoma (with acinar , papillary, mucinous subtypes etc), large cell and squamous cell carcinoma. Other histological types are adenosquamous carcinoma, carcinoid tumour etc.

28. Q4) Name any two paraneoplastic syndromes caused by this lesion. Cushing syndrome is a paraneoplastic syndrome seen in small cell lung carcinomas due to ectopic secretion of ACTH by the tumour. Hypercalcemia is seen in squamous cell carcinoma of lung due to ectopic secretion of parathyroid hormone related peptide ( PTHrp ). Q5) What is Pancoast’s tumour? A5) Pancoast tumour is an apical lung neoplasm which may invade the brachial or cervical sympathetic plexus to cause severe pain in the distribution of the ulnar nerve to produce Horner syndrome- ptosis , anhidrosis , miosis , enopthalmos . They are commonly non-small cell tumours. It is often accompanied by destruction of first and second ribs and sometimes thoracic vertebrae. Q6) Which tumour resembles clinically and radiologically pneumonia? A6) Bronchioloalveolar carcinoma or adenocarcinoma in situ.

29. RENAL CELL CARCINOMA Wet mount specimen of the kidney with a clearly defined large, fungating yellowish mass, necrotic lesion on the upper pole

30. Q1) Describe the gross specimen. A1) Wet mount specimen of the kidney with a clearly defined large, black, necrotic lesion on the upper pole. Q2) What is the lesion? A2) Renal cell carcinoma- more specifically clear cell carcinoma. Q3) Name any 2 familial causes for the same. Q4) Describe the histology. A4) Microscopically, the tumour consists of large polygonal pale cells with abundant clear cytoplasm. The cells are arranged in solid nests, cords or tubules. The nuclei are vesicular, and have a prominent nucleolus. The cytoplasm is clear due to the presence of lipids and glycogen. The scanty stroma has abundant thin-walled blood vessels. Haemorrhage and necrosis may be seen. Q5) Name any 4 risk factors. A5) 1. Smoking 2. Hypertension 3. Obesity 4. Occupational exposure to cadmium 5. Patients who acquire polycystic kidney disease as a complication of chronic dialysis.

31. POLYCYSTIC KIDNEY Wet mount specimen showing cut section of kidney with loss of corticomedullary differentiation. Entire kidney is seen replaced by multiple cysts of varying sizes. With the normal reniform shape of kidney being maintained.

32. Q1) Describe the gross specimen. A1) Wet mount specimen of kidney with loss of corticomedullary differentiation. Entire kidney is seen replaced by multiple cysts of varying sizes, with the normal reniform shape of kidney being maintained. Q2) What is the mode of inheritance? A2) Autosomal dominant . Q3) Name any two symptoms of these patients? A3) Intermittent gross hematuria , flank pain or a heavy dragging sensation. Q4) What other associated lesions can be seen? A4) Saccular aneurysms of the circle of Willis are seen in 10-30% of cases and are associated with a high risk of subarachnoid haemorrhage.

33. SEMINOMA TESTIS Wet mount specimen of cut section of dissected half of testis with spermatic cord,shows a white homogenous patch on testicular parenchyma which is circumscribed .

34. LEIOMYOMA UTERUS A wet mount specimen of hysterectomy showing multiple grey white nodules in myometrium . Cut surface shows a well circumscribed, grey-white, whorle , firm lesion.

35. Q) 2 sites affected? A) retroperitoneum and the urinary bladder . Q)2 clinical presentation? A) Menorrhagia and pelvic pain Q)Malignant counterpart? A) Uterine leiomyosarcoma. Q)What are the degenerative changes that can occur? A) hyaline, cystic, myxoid, or red degeneration Q)Cell of origin of this lesion? A) These tumors are of monoclonal origin which arises from  the smooth muscle of the uterus . Q)Mention the different types? A) Submucosal leiomyoma. Intramural leiomyoma. Subserosal leiomyomas

36. CARCINOMA UTERUS Wet mount specimen of longitudinally cut uterus shows markedly thickened endometrium. No areas of hemorrhage or necrosis seen.

37. Q)Most common symptoms and age group affected? A) Unusual vaginal bleeding, spotting, or other discharge. Endometrial cancer affects mainly  post-menopausal women .(  between ages 55 and 64 years ) Predisposing factors? A) Obesity. Things that affect hormone levels, like taking estrogen after menopause, birth control pills, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnancy, certain ovarian tumors , and polycystic ovarian syndrome (PCOS)

38. TERATOMA OVARY Wet mount specimen shows smooth thin walled unilocular cystic lesion. Shows solid areas with dirty material- Rokitansky protuberance in the wall which contains teeth, bone and hair.

39. Q)What are the common sites of occurrence? A) The most common site of occurrence is in the  ovaries and testes Q)what is the cells of origin? A) germ cell origin . Q)What is struma ovarii ? A) It is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue. Q)Name any 2 malignant transformation that can occur? A)  squamous cell carcinoma, basal cell carcinoma,

40. SEROUS PAPILLARY CYSTADENOMA, OVARY Wet mount specimen of uterus shows cystic lesion of the ovary in which many nodular irregularities are seen with papillary projection.

41. Q)How are tumor in this organ classified?

42. Q)Name a tumor marker that can be tested in this case? A)CA125 Q)What is the lining epithelium in these tumors ? A) non-stratified or stratified cuboidal to columnar cells

43. FIBROADENOMA BREAST Wet mounted specimen of cut section of breast shows greyish white lesion with well defined margins. Cut surface shows vague nodules with slit like spaces between them.

44. Q)What is the common age group affected? A) It occurs most commonly in women  between the age of 14 to 35 years. Q)What is phyllodes tumor ? A) It is a   rare breast tumors that start in the connective (stromal) tissue of the breast, not the ducts or glands. Q)What is the common presentation? A)It is a painless, unilateral, benign tumor that presents as  a solid lump .

45. CA BREAST Wet mounted specimen of breast shows ill-defined lesion . Cut surface shows irregular grey white area.

46. Q)Enumerate etiological factor? A) Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as  BRCA1 and BRCA2,  are at higher risk of breast and ovarian cancer. Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer. Having dense breasts. Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical ductal hyperplasia or lobular carcinoma  in situ  are associated with a higher risk of getting breast cancer. Family history of breast or ovarian cancer.  Previous treatment using radiation therapy. Women who had  radiation therapy  to the chest or breas t.

47. Q)Name any 4 prognostic factors? A) Tumor size , nodal involvement, nuclear grade, hormone receptor status, measures of proliferation, and molecular markers such as HER2 overexpression Q)What is paget’s disease of nipple? A) It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola). It's usually a sign of breast cancer in the tissue behind the nipple. Q)What is paeu de orange? A) Peau d'orange (French for orange peel) is characterized by edema and pitting and results from blockage of lymphatic drainage with or without associated stromal infiltration. Q)Which is the common gene mutation associated with this? A)BRCA1 and BRCA2

48. MNG THYROID Wet mount specimen of thyroid showing enlarged lobe. Cut section shows region of hemorrhages and calcification. Cystic degeneration is present. Ares of necrosis can be visualised.

49. Q) Enumerate the cause? A) Iodine deficiency, female gender, increasing age and family history of multinodular goitre . Q)Name any 2 symptoms of this patient? A) A feeling of neck fullness or tightness. Difficulty swallowing. Difficulty breathing. Coughing. Changes in your voice. Q)What are hot nodules? A)   Some thyroid nodules produce thyroid hormone, similar to the thyroid gland, but do not respond to the body's hormonal controls .  Name any 2 degeneration that can occur? A) cystic degenerations, hemorrhagic degeneration

50. PAPILLARY CARCINOMA THYROID Wet mount specimen of thyroid showing multiple nodules

51. OSTEOSARCOMA Wet mount specimen of the lowe limb containing a long bone. It has a gritty appearance , exhibiting hemorrhagic and cystic degeneration.

52. OSTEOCLASTOMA Wet mount specimen of a long bone of the lower limb showing reddish brown lesion with cystic degeneration.

53. MALIGNANT MELANOMA Wet mont specimen of the skin showing ill defined nodular grey white lesion centre shows dark pigmentation.

54. Q1) Describe the gross specimen.? A1) The specimen shows a striking variation in pigmentation. The borders are irregular and often “notched”. Q2) What are the warning signs of these lesions? Rapid enlargement of a pre-existing nevus Itching or pain in a lesion Development of a new pigmented lesion during adult life. Irregularities of the borders of a pigmented lesion Variegation of color within a pigmented lesion Q3) What is meant by radial growth and vertical growth? A3) Radial growth describes the initial tendency of a melanoma to grow horizontally within the epidermis, often for a prolonged period. Later on, a vertical growth phase supervenes, in which the tumor grows downwards into the deeper dermal layers. Q4) Name any 4 sites where these tumours can occur? A4) The skin, the oral and anogenital mucosal surfaces, the esophagus , meninges and the eye.

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