patho(gross).pdf

Livor mortis - bluish-red discoloration of the
skin and organs
Result of the blood settling or pooling by gravity in
capillaries, which dilate following the cessation of
circulation
Back
Belly
it is absent where there is
pressure which prevents
dilation of capillaries
Livor due to hyopstasis ﬁrst 8-12Hrs
Livor due to imbibition after 8-12Hrs
(not moved)

Macerated foetus. Note the reddish discoloration of the skin. The epidermis
is detached from the dermis in large laminae.
Courtesy of Kaiser László, MD

Aspiration of gastric content caused obstruction of airways in the patient with deep
coma (lethal condition)
Trachea
Main bronchi

Anemic infarct of the heart: circumscribed yellowish lesion, the
margins are hyperemic

Hemorrhagic infarct of lung: wedge shaped, raised, dark-red
area

34
Hemorrhagic infarct of small bowels
due to arterial occlusion
and there is gas formation
in lumen

Brain infarct: the necrotic area is softened and pale
Internal capsule
Infarcted area
Caudate nucleus

Caseous necrosis
• Immune-mediated distinctive form of coagulative necrosis
in foci of tuberculous infection of the lung
• Grossly, caseous necrosis is white and cheesy

Necrotizing pancreatitis: the pancreas is swollen and displays
several yellowish foci of necrosis

Obstruction of the CSF flow leads to pressure atrophy of the
brain, with the enlargement of ventricles: hydrocephalus

Hydronephrosis: obstruction of the ureter (arrow) leads to sac-
like dilation of renal pelvis and calyces, and pressure atrophy of
parenchyma
TUMOR

Ischemic
atrophy of the
kidney
because the
supplying
renal artery
was
progressively
narrowed

Hypertrophy of heart, triggered by action of mechanical
stimuli ( workload) and vasoactive substances (e.g.,
angiotensin II). Free wall thickness: above 15 mm

Hypertrophy of the muscles of urinary bladder due to urethral
obstruction

Steatosis: the liver is enlarged, yellow and greasy,
resembles to goose liver
Courtesy of E. Kemény, SZTE Pathology
hypoxia-hepatotoxins
obesity-diabetes
alcohol-protein energy malnutrition

The hepatocytes are vacuolated; representing accumulations
of neutral lipids that have been removed by lipid solvents during
tissue processing
Frozen section, Oil Red O

Jaundice: yellowish discoloration of skin

Dystrophic calcification of aortic valves
(calcifying aortic stenosis) valsalva sinuses are rigid (Ca deposits)
which cause narrowing of aorta

7
Pulmonary edema: the lungs 2 to 3 times exceed their normal
weight; sectioning reveals a foamy mixture of air, edema fluid,
and RBCs
Trachea
Acute LHF

9
Hydrothorax in chronic right-sided HF
it should be almost colorless but blood
during autopsy changed the color
anthracosis

10
Increased hydrostatic pressure in the portal venous circulation
(portal hypertension) by cirrhosis of liver (shown) is an
important cause of ascites

14
Severe lymphedema of arm after mastectomy, surgical
dissection of the axillary lymph nodes and irradiation of the
axillary region because of breast cancer.
Post-mastectomy Lymphedema

Elephantiasis. The patient suffered from morbid obesity,
type 2 diabetes and congestive heart failure.

21
Hepatic congestion: hypoxic/fatty hepatocytes around central
veins are pale yellow, the better oxigenated portal parts are red.

24
Chronic left-sided HF  chronic pulmonary congestion:
brown induration of lungs

Cyanotic induration of the kidney in chronic right-sided heart failure
+Enlarged

Congestive splenomegaly. Weight: up to 500 gm, the organ is
firm, the capsule is thickened, the malphigian corpuscles are
indistinct

Peptic ulcer of the postpyloric duodenum that eroded the pancreaticoduodenal artery
(arrow) and caused lethal bleeding

Classification and nomenclature of hemorrhage
• Surface
- External, internal
• Enclosed within a tissue
Suffusion (2-dimensional)
Hematoma (3-dimensional); may be
- insignificant (bruise)
- lethal (retroperitoneal, subarachnoidal, intracerebral)
Subcutaneous suffusion due to trauma

33
Subarachnoidal
hematoma
rupture of cerebral a.
aneurysm

Basal ganglia hemorrhage as a result of long-standing hypertension
intracerebral
hemmorhage
(HTN crisis)

35
Petechiae: minute, 1-2 mm hemorrhages into skin,
mucous membranes or serosal surfaces, seen in
thrombocytopenia, defective platelet function or
clotting factor deficits

36
Purpura: slightly larger (>3 mm) hemorrhages, may
be associated with similar pathologies, as well as
vasculitis
Purpuras in
small vessel
vasculitis
Sándor Husz, MD,
SZTE Dermatology

39
Hemopericardium because of myocardial rupture (lethal)
blood is in the visceral layer
400 ml can be lethal

Hemocephalus: blood fills the lateral and third ventricles
(the ventricular drainage was unsuccesful)
Draining channel

Iatrogenic (adverse condition in a patient resulting from treatment)
hematoma around the carotid artery (CA) as complication of
catheterization
Internal CA
External CA
Common CA

9
Atherosclerosis of aorta with mural thrombi

Endocarditis. Thrombi on the leaflets

Aneurysms in the aorta filled with thrombi

Left ventricle.
Apical chronic aneurysm
with mural thrombus
(arrow)

17
Auricular thrombus (arrow) in a patient with atrial fibrillation

20
Auricular thrombus: grayish-red, lines of Zahn

Direction of blood flow
Venous thrombi (red or stasis thrombi)
Occur in a stagnating environment, and the thrombi contain more
enmeshed RBCs among sparse fibrin strands;
lAppear as long, red-blue cast of the vein lumen

26
Verrucous vegetations (arrows) on mitral valve composed of
platelets and fibrin. The patient had disseminated cancer.

34
Red thrombi in deep veins
Femoral artery

Saddle embolus (arrow) impacting the bifurcation of the pulmonary
Artery prevented the influx of blood into the lungs (lethal)
Aorta
Pulmonary
vein

Thromboembolism: hemorrhagic infarcts in the terrritory of
middle cerebral artery (hemorrhage due to reperfusion)
Caudate nucleus
Internal capsule
Putamen

55
Ruptured aneurysm of abdominal aorta leading to retroperitoneal
bleading and shock (the probe indicates the rupture)

Decreased perfusion may result in the necrosis of toes

Cardinal signs of bacterial inflammation: calor (warmth), rubor
(redness), tumor (swelling), dolor (pain), and loss of function
Dr. Sándor Husz, SZTE Dermatology

Unilateral bacterial inflammation of rat kidney induced by ligation of ureter
and i.v. injection of bacteria. The animal was sacrified on Day 2. The affected
kidney displayed inflammatory exudation-induced enlargement (“tumor”)

Gross features
Normally, the serous
membrane is smooth and
has a glistening surface.
In serous inflammation, it
becomes reddish and
opaque.
Shown: acute serous
pleurisy

Lethal acute serofibrinous peritonitis: the serosa of bowels is hyperemic;
the bowels adhere to each other with fibrin strands (right: normal serosa)
liver

Edema of larynx induced by
adverse (allergic) reaction
of an antihypertensive drug
administered intravenously in
hypertensive crisis.
Note marked swelling of
laryngeal mucosa which
caused upper airway
obstruction and death

Laryngal edema that caused airway obstruction

Blisters in chickenpox Superinfection with St. aureus:
the blisters are filled with pus
(pustula)
Courtesy of dr. Ildikó Kováts

Acute fibrinous pericarditis: intense hyperemia, fibrin strands

Left: fibrinous pericarditis, right: fibrinous pleurisy (parietal pleura). The thick strands of fibrin
will not not be removed by fibrinolysis, and adhesions develop between serous surfaces
Diaphragm
Thoracic
cage

Lobar pneumonia. Hepatisation: liver-like consistency because alveoli
are packed with fibrin
trachea

Lung: multiple abscesses as complication of pneumonia

Furuncle (boil)

Folliculitis on the nose; carbuncle on the face

Cellulitis: sharp, erythematous swelling of the skin
Courtesy of Erika Varga, MD, Department of Dermatology, SZTE

Empyema of thorax
Healing: granulation tissue  secondary calcification: callus of pleura

Purulent mediastinitis
(induced by descending
infection of the neck)
Aorta
Pulm. artery
Pulm.vein
Pericardium
Mediastinum
Mediastinum

Acute purulent peritonitis:
the abdominal cavity was filled
with more than 2000 ml pus

Acute purulent
meningitis
The exudate is
localized in the
subarachnoid space,
the meningeal
vessels are
engorged and
stand out
prominently

Acute purulent
tracheobronchitis
The exudate clogged the
airways and caused
widespread atelectasis
(collapse) of the alveoli
Note: tracheobronchial
toilet is necessary in
patients who cannot
cough actively

Purulent discharge in
Neisseria gonorrhoeae
infection
(sexually-transmitted
disease, termed
gonorrhoea)

Acute hemorrhagic
cystitis:
the bladder mucosa is
swollen, hyperemic and
displays focal hemorrhages

Pseudomembranous colitis induced by C. difficile: confluent
plaques of yellow fibrin and inflammatory debris adherent to a
reddened mucosa

Pseudomembranous enterocolitis: in severe cases the small
bowels are also affected

Amputated leg because of necrotizing fasciitis

Gas gangrene: necrotizing and gas-producing inflammation of the lower
extemity involving the abdominal wall, perineum and scrotum; the gas
bubbles detach the epidermis from the underlying tissues

Gas gangrene: the gas bubbles accumulated between the epidermis and
the underlying tissues

Acute necrotizing-hemorrhagic pancreatitis

Polyoma virions in the nucleus of an epithelial cell

Influenzavirus-induced
tracheobronchitis
Note intense mucosal
hyperemia

Comment
The influenza A virus subtype
H1N1 infection was lethal in this
young pregnant woman; she was
regrettably not vaccinated
Huge problem
If people refuse vaccination, herd
immunity does not develope
Safety concerns are based on
stories discovered in the media or
received from the acquaintaces

LM structure of chronic abscess
• The central cavity is filled with pus
• The wall of abscess has an inner pyogenic membrane
(granulation tissue rich in neutrophils) and an outer fibroblastic
rim
• Heals with fibrosis
Pus in the
cavity
Pyogenic
membrane
Fibroblastic
rim
Subpleural lung abscess (arrow)

Multiple chronic abscesses in the liver.
The patient suffered from common bile duct obstruction and
purulent cholangitis

Cirrhosis of liver: chronic inflammation of the liver  formation of
fibrous septa, which, in turn, form nodular pseudolobules 
impairment of venous flow through the liver.
Consequence: portal hypertension, hepatic failure

Cirrhosis of liver: nodular appearance of pseudolobules

Chronic glomerulonephritis-induced kidney shrinkage
Chronic inflammation of glomeruli  glomerular scarring
Grossly the kidneys are symmetrically shrunken, the surface is
granular (shown), and the cortex is thinned.
Consequence: chronic renal failure

Honeycomb lung: inflammation or
injury-induced widespread fibrosis in
alveolar septa culminate in grossly
evident lung fibrosis
Consequence: respiratory insufficiency
with hypoxemia and cyanosis
Alveolar septa are widened by deposition of
collagen (trichrome stain: blue).

Chronic peptic ulcer of the stomach

Venous ulceration of the leg due to poor venous drainage from
the lower leg

Decubital ulcer in the sacral region

Healing by
secondary
intention,
leading to
contracture
Courtesy of Prof. Dobozy Attila

Keloid
Raised hyperplastic scar
of the skin
due to accumulation of
great amount of collagen
in the dermis.
Common in Negroid/black
people.
Cosmetic problem.
Shown: keloid after
vaccination
Courtesy of Prof. Dobozy Attila

Laryngal edema causing airway obstruction
Edema of larynx induced by adverse allergic reaction of an anti-
hypertensive drug administered intravenously in hypertensive crisis

Pseudomembranous-ulcerative gastritis induced by Candida
Esophagus
Stomach

Kaposi’s sarcoma.
Tumorous nodules on the leg.
Autopsy case.

Benign tumors in the uterus: expansive growth, well-
defined borders, homogenous cut surface
leiomyoma

Malignant tumor (bronchial carcinoma): irregular infiltrative edges,
foci of necrosis, tissue destruction. Arrows: invasion of vessels

Cerebral metastasis of the bronchial carcinoma shown

Kaposi sarcoma.
Tumorous nodules on the leg.
Autopsy case.

Dermoid cyst of the ovary. Filled with hair, sebaceous
material, and desquamated squames.

Fungating tumor in the lip;
proved carcinoma
histologically
Courtesy of Prof. Sonkodi István, Faculty of Dentistry

Fungating carcinoma of the esophagus

Ulcerated carcinoma in the antrum of stomach:
irregular margins, crater-like raised borders

Annular (napkinring-like) growth in carcinomas of the distal
colon – obstructs the passage of bowel content

Papillomas of the skin
• Two types: basal cell
papilloma, and wart
Basal cell papilloma
(seborrheic keratosis)
• Very common
• In middle aged or older
individuals
• Most frequent on the trunk
• Dark brown lesion
with a granular surface
• Often multiple

Condylomas on the glans and prepuce
Prof. Attila Dobozy, Dermatology

Pedunculated polyp. LM: tubular adenoma; composed of tubular
glands with dysplastic features (elongated nuclei, nuclear
stratification, and architectural atypia)
Stalk
Bowel wall
Head
of the polyp

Resected bowel sample; histologically, the larger pedunculated polyp
proved to be tubular adenoma with malignant transformation
Head of the polyp
Polyp
Stalk

Unilocular serous cystadenoma of the ovary ranging more than 15 cm in
greatest dimension. The outer surface is smooth; the epithelial lining of the inner
surface exhibits small papillary projections.
Courtesy of Bence Nagy, MD, PhD, Department of Pathology, University of Szeged

Mucinous cystadenoma of the ovary: delicate septa form cysts;
mucinous material fills the cysts

Adrenal cortical adenoma: circumscribed, yellowish tumor deriving
from the adrenal cortex. The tumor was hormonally inactive.

Spontaneous hemorrhage of silent adenomas  blockade of
CSF flow  acute increase in liquor pressure  death

Scirrhous carcinoma of stomach (linitis plastica)
:

Signet-ring cc: tube-like thickening of the wall;
LM: the mucin in the cytoplasm pushes the nucleus to te periphery

Mucinous cystadenocarcinoma of the ovari. Foci of necrosis and
hemorrhage indicate malignant tumor. Invasion of ovarian surface →
dissemination in the peritoneal cavity → carcinosis of peritoneum

Special skin cancer:
basal cell cc (basalioma)
• Most frequent among cc-s
• Semimalignant
• Related to chronic sun exposure
• In the elderly; in the face, near
the eyes and nose
• Advanced lesion: ulcerated
(rodent ulcer)
Courtesy of Attila Dobozy, Bőrklinika

Excised breast cancer; infiltrative carcinoma with stellate
appearance; gray-white strands of tumorous tissue radiate into the
surrounding fat

Advanced breast carcinoma: invasion of the skin, with
extensive ulceration

Glioblastoma: continuous spread through corpus callosum
(butterfly tumour)

Renal cell carcinoma: continuous spread involving the cortex,
the medulla and the pelvic fat

Liver metastases of colon carcinoma

Seminal vesicle
Rectum
Carcinoma of the prostate; arrow: extension into the
paravertebral plexus

Vertebral metastases of prostatic carcinoma

Transcelomic spread: carcinosis
of the greater omentum
Greater omentum
Greater omentum

Peritoneally disseminated
ovarian carcinoma –
carcinosis of peritoneum
Greater
omentum
Stomach
Stomach
Liver

Enucleated eye because of retinoblastoma

ABCD of malignant
melanoma
Asymmetrical
lesion with
irregular borders
Bleeding:
spontaneous or
upon minor
trauma
Color: uneven
pigmentation
or change in color
Diameter: >6 mm
Korom Irma, SZTE Dermatology

Vertical growth from the
beginning: nodular melanoma
Gross: deepbrown nodule
LM: anaplastic tumour nests
Highly malignant:
hematogeneous metastases
very early
Korom Irma, SZTE Dermatology

Local effects
Benign tumors:
• Leiomyoma of the uterus: heavy menstrual bleeding, pelvic
pressure/pain, frequent urination, etc.
Uterine cavity
Body of the uterus

Multifocal destruction of vertebrae in multiple myeloma: pain +
pathological fracture

Fungating carcinoma in the lower third of the esophagus
caused progressive stenosis and dysphagia
Trachea
Esophagus Cardia

Left: napkinring-like spread of colonic cc led to stenosis  impaired the passage of
stool; the frequency of passing the stool and the consistency of the stool had changed

Ulcerated carcinoma of the stomach: irregular margins, crater-like raised borders:
iron-deficiency anemia and positive fecal occult blood test

Stenosing cancer of the ileocecal valve: the patient displayed
change in bowel habit and iron-deficiency anemia
Ileum
Coecum

Invasion of pelvis by renal cell carcinoma  painless microhematuria

Urinary bladder: ulcerated carcinoma on the lateral wall caused occult
painless microhematuria and iron deficiency anemia
Trigone

Bronchial cc. The non-tumorous bronchial mucosa (arrow) is
hyperemic, swollen indicating peritumoral bronchitis  caughing

Non-bacterial thrombotic endocarditis. Vegetations along the closure
line of the aortic valve cups. The patient suffered from bronchial
carcinoma

The vegetations
caused embolic
anemic infarction of
the kidney (arrow)
 hematuria

The vegetations caused embolic hemorrhagic infarction of the
small bowel  bloody stool

Sacral decubital ulcer in the bed-ridden patient wearing diaper. The patient
had brain infarction and hemiplegia (complete paralysis of the half of the
body)

Femoral vein thrombosis; pulmonary embolism
vein
artery
Pulm. artery
Embolus

Osteoporosis: severe loss of horizontal trabeculae in vertebral
bodies in the patient who suffered from brain-hemorrhage,
paralysis and prolonged bed rest

5) Ascending urinary tract infections in catheterized
patients: urethritis, cystitis, acute pyelonephritis (shown)

Lobectomy because of
bronchial carcinoma (arrow) in a
heavy smoker
Courtesy of B. Vasas, MD,
Dept. Pathology, Universitiy of Szeged
sq cc
destructed the bronchus

2) Induction of atherosclerosis
Absorbed into the blood, cigarette smoke causes increased
platelet aggregation and dysfunction of the endothelial layer of
aorta and large arteries  development of atheromatous
plaques

Emphysema (alveolar wall destruction, enlarged air spaces) in the non-tumoral areas
of the lobectomy specimen of the heavy smoker

Mucosal defects (erosions) in alcohol-abuse induced gastroduodenitis
Antrum
Duodenum

Hepatic steatosis: the liver is
enlarged (>2000 g), soft, yellow,
and greasy; LM: fat globules in the
hepatocytes; reversible

Pancreas: acinar cell injury (ethanol + heavy, fatty meal) 
acute necrotizing-hemorrhagic pancreatitis: high mortality rate

Micronodular cirrhosis of liver

Pancreas: chronic calcifying pancreatitis: atrophied, fibrotic
pancreas; irregularly dilated ducts obstructed with stones 
pain, malabsorption

Abnormally high deposition of visceral adipose tissue (thickness of subcutaneal
fatty tissue: 10 cm), fatty liver, elevated diaphragm

Obesity-related glomerulopathy: segmental scarring of the tufts

Osteophytes in spondylarthrosis limit movements of the
vertebral columns

Acute myocardial infarction
Most frequent cause of death in diabetes

Cerebral infarct involving the frontoparietal region, the internal capsule and
the striatum (caudate nucleus, putamen)  contralateral hemiparesis
Caudate
nucleus
Putamen

Diabetic retinopathy: new vessels, lipid-cholesterol deposits
Courtesy of Kolozsvári Lajos, SZTE Ophtalmology

Neuropathic diabetic foot ulceration: necrosis + phlegmon of
sole
Courtesy of R. Sipka, MD, Dept. Surgery, University of Szeged

Acute purulent pyelonephritis: several abscesses in the
cortex and medulla

Mucormycosis, with spread to the orbit and CNS
Courtesy of Szabó
Zsuzsanna, MD,
Szent László Kórház
lethal within days after
meninges involved

Myeloma: the tumorous plasma cell nodules destruct the bones;
death in 15% of patients due to consequences of AL-amyloidosis

The amyloid
deposition may not
be evident grossly.
In this case, the
heart weight was
580 gs (normal 350
gs)
LM evaluation
revealed amyloid
deposition

Cystic fibrosis of pancreas: fibrotic areas intermingle with cysts

Lungs of the patient who died of cystic fibrosis: purulent plugs obstruct the bronchi

The plugging of bronchi stem from obstruction and infection of the bronchi
secondary to the viscous mucus secretions

Bronchiectasis, purulent bronchitis and bronchopneumonia in
cystic fibrosis

Atheromatous plaque in the middle cerebral artery: raised
white-yellow lesion in the intima, protruding into the lumen
(formol-fixed brain)

Aorta: the plaques contain a yellow, grumous debris (arrow)

Structure of atheroma on LM
• Intimal lesion
• Central lipid core
• Fibrous ”cap” subendothelially

Coronary occlusion due ulceration of the plaque leading to
thrombosis

Cerebral infarct involving the internal capsule
 contralateral hemiparesis

Abdominal aorta: mural thrombi
Celiac artery Superior
mesenteric artery
Renal artery

24
Ruptured atherosclerotic aneurysm of the infrarenal abdominal aorta; the probe
indicates the communication between the lumen and the extraaortic retroperitoneal
space. The aneurysmal sac is filled with mural thrombus

Thrombosis of superior mesenteric artery: bowel infarction

Ruptured atherosclerotic aneurysm of abdominal aorta, leading to
retroperitoneal bleeding and shock (the probe indicates the rupture)
Iliac arteries

Saccular aneurysms in the thoracic aorta. Note mural thrombi

Degeneration of the tunica media: thinning and dilation of the aortic
root, and intimal tears

Resected ascending aorta because of dissection. By the time of surgery, the
process had not resulted in aortic rupture
Aortic
lumen
Dissecting
column of blood
Tear
Prepared by G. Nyári, MD, Dept. Pathology, Univ. Szeged

Dissection of aorta, hemopericardium
Intimal tears
Aortic valve

Hypertensive kidney disease
• Mild, symmetric shrinkage of kidneys (nephrosclerosis), weight:
120-120 g; the surface is granular

Hypertensive heart disease. Pressure overload-induced left
ventricular hypertrophy  arrhythmias, chronic left-sided heart failure

Vérzések retinopathia hypertonica-ban
Courtesy of Prof. Kolozsvári Lajos
Hypertensive retinopathy. Ophtalmoscopic examination reveals the
thickening of retinal small arteries; microhemorrhages can be present (fundus
hypertonicus)

Microaneurysms undergo rupture in hypertensive crisis 
massive hemorrhage of the basal ganglia

Destruction of the left putamen and internal capsule by fresh
hematoma

Slightly shrunken kidneys; finely granular surface

Heart weight 550 g; enlargement of the left ventricle

Kidneys: hyperplastic arteriolosclerosis
Gross changes
• Early changes: enlarged kidneys, pinpoint petechial
cortical hemorrhages + tiny infarcts
• Later, infarcts are replaced by vascular scars

Brain edema. The gyri are widened and flattened, the sulci are narrowed

Unilateral atrophy of
the kidney
Not shown: the
atherosclerotic
stenosis of the
orifice of the renal
artery

Takayasu arteritis, late phase.
Arrows indicate fibrous narrowing of arterial orifices
Aortic root
Brachioceph. a
Left common carotid a.
Left subclavian a.
Thoracic ao.

Clinical features in cranial GCA
• Fever, fatigue, weight loss; sedimentation rate >50 mm/h
• Palpable nodularity of the tortuous temporal artery

Brain infarcts with secondary hemorrhage in the patient who
died of PAN with kidney, heart, brain and muscle involvement

GPA: cavitation of lung parenchyma, due to necrosis of small
vessels and parenchyma

MPA, lungs: alveolar capillaritis
 bilateral air space
consolidation with relative apical
sparing corresponds to confluent
foci of alveolar hemorrhages
Courtesy of B. Radics, MD, Dept. Pathology, University of Szeged

Vasculitic purpuras
Prof. Husz Sándor, Bôrklinika

Clinical features
• Skin: purpuras, principally
in the lower extremities
• Bowels: abdominal pain,
bleeding
• Joints: arthritis and
arthralgia
• Kidneys: hematuria,
proteinuria and azotemia
Outcome
• Depends on the extent of
crescent formation; overall
prognosis is good

Esophageal varices
• In portal hypertension, the
submucosal veins of distal
esophagus undergo dilation
(portocaval shunt)
• Spontaneous rupture 
hemorrhagic shock 
exsanguination
• Autopsy: 2000-3000 ml-s of
fresh blood fills the stomach
and small bowels

Venous ulceration of the leg (varicose ulcer)

Thrombosis in deep leg veins
Most important consequence  pulmonary embolism
Femoral vein
Femoral artery

Photo: 54-year-old man.
Hemangiomas on his trunk

Cavernous hemangioma of the liver: the vascular channels
produce sponge-like structure

Angiosarcoma of the pulmonary artery; endoluminal spread
lead to occlusion

Morphologic features of concentric hypertrophy of the LV
• small lumen
• markedly increased wall thickness (> 20 mm)
• increased mass (> 500 g)
Septum
Posterior wall
Anterior wall
Lateral wall

Morphology of dilative hypertrophy of the LV: enlarged lumen,
enlarged size, slightly increased wall thickness, increased mass
Septum
Posterior wall
Anterior wall
Lateral wall

Pulmonary edema: lungs >1200 gs, congested and wet,
airways contain bubbly fluid

Brown induration of lungs; atheromatous plaques in pulmonary
arteries indicating sec. pulmonary hypertension
collagen in
alveolar septa

Morphology
RV hypertrophy (thickness › 6
mm) + dilation
and
manifestations of chronic
systemic congestion

Early phase: concentric hypertrophy of LV: wall thickness
> 20 mm; weight > 500 g
Septum
Posterior wall
Anterior wall
Lateral wall

Late phase: LV hypertrophy + dilation: wall thickness < 20 mm;
weight > 550 g

Occlusive thrombus (dissected with the scissor) on
atheromatous plaque (arrow)

MI: yellowish area of necrosis, hyperemic border

66
Hemopericardium due to rupture of the free wall of the LV
rupture

67
Rupture of the interventricular septum

Apical chronic aneurysm,
with mural thrombus

Septum
Posterior
RV
LV
Anterior
Reperfusion injury: hemorrhage in the septum, and
the anterior and posterior wall; angioplasty 12 hours after the onset of
symptoms

84
Chronic IHD: dilative hypertrophy, apical fibrosis
(arrow), dilated atrium, thrombus in the left auricle

Calcific aortic stenosis in congenitally bicuspid valves
Subendothelial calcific masses within sinuses of Valsalva

Mitral annular calcification: regurgitation + stenosis

Thinned and enlarged leaflets, elongated and attenuated
chordae tendineae, excentric LV hypertrophy

Rheumatic fever: acute verrucous endocarditis,
chordae tendineae are also involved
Dr. Tószegi Anna, SZTE Pathologia, 1972

Mitral stenosis: thickened leaflets, fused at the commissures;
thickened chordae tendinae, dilated LA

Large vegetations on the mitral valve

Nonbacterial thrombotic endocarditis of aortic valve from a patient
with adenocarcinoma of the tail of pancreas.
Histology ruled out infectious endocarditis

Mechanical valve: tilting disk
Bogáts Gábor SZTE Szívsebészet

Bioprothesis
Bogáts Gábor SZTE Szívsebészet

Dilated CM
The heart is
ball-shaped;
there is
pronounced
ventricular
chamber
dilation
The weight of
the heart
was 660 g

DCM in a 2-y-old child
• Extreme cardiomegaly 
lung compression
• Congestive hepatomegaly

HCM: hypertrophy of the septum and the free wall; the volume of the
LV is reduced; subaortic stenosis (arrow) is evident
Note: the thickened left
ventricular wall becomes
stiff, prevents diastolic
filling

Arrhythmogenic CM. Fibrofatty
near-transmural replacement of
ventricular myocardium; the
lesion affected the left ventricle
Courtesy of B. Radics, MD,
Dept Pathol, Univ Szeged
Posterior
wall
Septum

Diffuse mottling in myocarditis

Aorta
Septum
VSD
Ao valve
Anterior wall
Ventricular septal defect (VSD)
RC
LDA

Atrial septal defect (ASD)
90% secundum type: results
from deficient or fenestrated
fossa ovalis in the central
atrial septum
• RA and RV dilation
• RV hypertrophy
• Dilation of pulmonary artery
J.M. Kissane: Anderson’s Pathology, 1990

Ventricular septal defect
(VSD)
The most common congenital
cardiac anomaly
• Site (90%): membranous
part of the septum
• Dilative hypertrophy of RV
• Small defects may close
spontaneously

Patent ductus
arteriosus (PDA)
The ductus (just distal to
the left subclavian artery)
allows blood flow
between the aorta and
pulmonary artery during
fetal life. Normally closes
within 1 and 2 days of
life.
PDA is associated with
dilation of proximal
pulmonary arteries and
LV
LV and later RV
hypertrophy

Tetralogy of
Fallot (TOF)
• Dextraposed aorta
overriding
• VSD
• Pulmonary stenosis
• RV hypertrophy

Transposition
of the great arteries (TGA)
• Aorta arising from the
RV
• Pulmonary artery
arising from the LV
• A shunt (ASD or VSD
or PDA) for mixing of
blood

Postductal coarctation
(adult-type)
Distal to the obliterated
ductus arteriosus:
• LV hypertrophy
• Hypertension
proximal
and hypotension distal
to the narrowed
segment
• Asymptomatic until adult life

Preductal
coarctation
(infantile-type)
• Hypoplastic aorta
between the left
subclavian artery
and the d. arteriosus
• ASD
• Widely PDA
• Frequently lethal

Virus-induced acute serofibrinous pericarditis
The pericardium is hyperemic, covered by fibrin strands

Carcinosis of pericardium; primary tumor in the lung

Biopsy diagnosis of GN
• Via renal percutaneous biopsy evaluated by light
microscopy (LM), immunofluorescence (IF) and elecron
microscopy (EM)
• Mirrors the inflammatory events occurring in all glomeruli

Severe periorbital edema in a deceased man who had the
nephrotic sy

The kidney in nephrotic syndrome: the pale yellow cortex is due
to lipid accumulation in renal tubules (consequence of lipiduria)

Chronic sclerosing GN: symmetric shrinkage (80-80 g);
granular surface; on section, the cortex is thinned
Bleeding after biopsy

Gross features in advanced disease
• Diabetic nephrosclerosis: symmetrically shrunken kidneys with granular
surface
• Remember: diabetic nephrosclerosis, hypertensive nephrosclerosis, and
chronic glomerulonephritis all lead to symmetrically shrunken kidneys

Acute pyelonephritis: multiple abscesses

Necrotizing papillitis: necrosis of pyramids

Gross:“shock kidney” enlarged, swollen kidney (~ 200 g);
pale, bloodless cortex, dark medulla

The change of “shock kidney”
was photographed from a
deceased patient with
hemorrhagic shock induced
by the rupture of esophageal
varices (arrows)

• Normal ureteral insertion: acts as a valve that prevents
retrograde flow of the urine during micturition.
• Abnormal ureteral insertion: urine refluxes in the ureter and pelvis
during micturition (VUR)
• May be unilateral or bilateral
Kumar et al Pathologic
Basis of Disease, 2005.

Abscesses in the cortex and medulla; the pelvic mucosa is hyperemic
Pelvic mucosa

Confluent abscesses in the cortex of the kidney;
such severe cases result in urosepsis + death

Reflux-induced chronic pyelonephritis leading to kidney shrinkage

Coarse scars overlying blunted calyces in reflux-induced PN

The sharp edges of the stone incised the urothelium of ureter
during the travel  hematuria

Staghorn calculus: remains localized; leads to pyelonephritic
scar

Pyelonephritic scar due to stone in the calyx: obstruction +
infections are keyplayers in scar formation

Hydronephrosis: dilated calyces, atrophied
papillae (arrows), thinned parenchyma

55-y-o man with sepsis induced by intrarenal abscesses. Urgent nephrectomy saved
the life of the patient. The gross evaluation of the specimen revealed congenital
pyeloureteral stenosis (arrow), hydronephrosis, and intrarenal abscesses
Dilated pelvis
Ureter

Gross
Very large cystic kidneys (1000 to 4000 gs); cysts may be 3-4 cm
in diameter

Enourmously enlarged kidneys  elevation of the diaphragm;
pulmonary hypoplasia

The cysts cause spongelike appearance

Oligohydramnios; compression of fetus
By courtesy of L. Kaizer, MD, Dept Pathol, University of Szeged

Renal artery stenosis-induced atrophy of the left kidney.
Note multiple small cysts in the cortex of both kidneys

ESRD with several cysts; renal cell carcinoma in the walls of the
cysts (arrows)

Fresh infarct (arrow): wedge-shaped, yellow, preserved outlines

Embolism-induced vascular scars; thrombus was found in left
auricle during the autopsy of the patient with the history of atrial
fibrillation

End-stage kidneys: severe shrinkage (30 to 50 g each),
medulla and cortex do not separate from each other, and
multiple dialysis-associated cysts

Clear cell carcinoma
• Solitary spherical mass; greatest dimension 6 cm
• Bright yellow
necrosis

Papillary carcinoma
• Large solitary tumorous mass

Chromophobe carcinoma: well-circumscribed, tan-brown
necrosis

Local spread. RCCs invade the parenchyma, the adipose capsule, the pelvis,
the renal sinus, and the renal vein; may spread beyond the Gerota fascia

“Tumor thrombus” in renal vein (arrow), can extend into the
inferior caval vein

Bronchial carcinoma. Distal to the tumor, atelectasis-associated
pneumonia developes

ARDS, gross features: the lungs are heavy (1600-2000 gs),
diffusely firm, red, and boggy

The lungs are solid, airless, and reddish purple

Embolic occlusion of the major pulmonary branches of the
pulmonary artery

Pulmonary atherosclerosis in chronic LSHF

Emphysema: enlargement of alveolar spaces around terminal
bronchioli
Control lung

Emphysema
Pressure atrophy
of the liver where
the diaphragm
compressed it

Bullous E. Large subpleural blebs can develop (greater than 1
cm; usually apical). Risk of ptx!

Cylindrically dilated bronchi, which can be cut up to the pleural surface,
the lumina are filled with pus, the mucosa is hyperemic.
Note foci of associated bronchopneumonia (arrows)

Trachebronchitis
in H1N1 influenza:
markedly hyperemic mucosa.

Prototype
• Pneumococcal pneumonia
• Leads to the consolidation of an entire lobe (lobar
pneumonia) or patchy consolidation of the lobe
(bronchopneumonia)
JCE Undervood:General and Systematic Pathology,Third edition, 2000.

Lobar pneumonia, red hepatization.
The whole lobe is red, airless, with liver-like consistency.

Lobar pneumonia, gray hepatization. The whole lobe is greyish
and the cut surface is dry.

Lobar pneumonia, fibrinous pleuritis. Greyish-red fibrin on the
pleural surface.

Bronchopneumonia: gray-red patchy lesions slightly elevated from
the cut surface. Bronchi display features of chronic bronchitis

RS virus pneumonia in an infant. The lung is heavy and red.

Bronchial carcinoma: destruction of bronchial wall (arrow), infiltration of
hilar structures

Central tumor: invasion of hilum, pulmonary artery (p), and lung parenchyma;
metastases in hilar lymph nodes (n)
n
n
p

Carcinosis of pleura: grayish-white tumorous invasion of pleural
surface; arrow indicates propagation via lymphatic vessels

Metastases of bronchial carcinoma in vertebrae, suprarenal
glands and calvaria

Brain metastasis of bronchial carcinoma

Post-stenotic bronchiectasis
Chr purulent pneumonia
Large, central carcinoma
Consequences of bronchial obstruction

Adenocarcinoma. Peripheral (subpleural location), simulated pneumonia on X-ray
Courtesy of B. Vasas, MD, Department of Pathology, University of Szeged

Pancoast tumor. Apical tumor, infiltrated the first and second ribs.
rib
rib

METASTATIC TUMORS
Primary sites: tumors drained by the caval system: liver, kidneys,
adrenals, testis, thyroid, nasopharynx
Metastatic involvement
of the lungs: several
tumorous foci in all
lobes

Honeycomb lung. Fibrotic parenchyma surrounding the bronchi retract and
create cobblestone appearance of the pleural surface.

Honeycomb lung. The dense fibrosis causes the destruction of alveolar
architecture and formation of cystic spaces. Bronchi are dilated because of
traction bronchiectasis. Excised pieces of lung fixed in formol.
Traction bronchiectasis

Anthracosis
• Common, mild, asymptomatic, in urban inhabitants, tobacco
smokers
• Morphology: coal dust laden macrophages along
lymphatics and lymph nodes

Silicosis
Gross: small fibrotic nodules, dense scars

Goodpasture sy: anti-GBM autoantibodies crossreact with
alveolar basement membranes  severe lung hemorrhage and symptoms of
crescentic glomerulonephritis

Goodpasture syndrome
Punctuated hemorrhages in the
kidney
Fibrin a félholdban.
Crescentic glomerulonephritis;
fibrin in a crescent
Linear IgG along the GBM

Primary tuberculosis: Ghon complex (the inflammatory
process is asymptomatic)
asysmptomatic)
Subpleural
caseous necrosis
Caseous necrosis in
hilar lymph node
Courtesy of Prof. T. Mikó, Sydney, Australia

Bilateral caseating tuberculotic foci in the upper lobes

Apical lung cavernas in tbc, drained by bronchus
Caseous necrosis affects the the wall of bronchi, drainage of the
caseous debris results in cavity (caverna) formation.
Sputum (infective!!!!)

Miliary tuberculosis in lung. Cut surface of formaldehyde fixed
specimen: numerous small gray-white granulomas in the lung

Bilateral pneumothorax as complication of mechanical ventilation in a patient with
COPD – the lungs were collapsed, the venous return to the heart was impaired

63
Hydrothorax in chronic right-sided HF

Dense fibrous adhesions restrict pulmonary expansion

Empyema of thorax
Precipitation of the exudate
leads to septations of the
pleural space

Carcinosis of pleura: several tumorous nodules on the visceral
pleura. Past medical history: surgically treated breast cancer

Solitary fibrous tumor of the pleura: the cut surface is solid

Pseudomembranous
nasopharyngitis
Agent: Str. pyogenes
(strep throat)

Carcinoma of larynx: fungating tumor destructs the
vocal cords

Thyroid
cartilage
Thyroid
cartilage
The entire circumference of glottic mucosa can be
infiltrated by cancer

Supraglottic tumor: ulcerated carcinoma in the epiglottis

Cleft lip (cheiloschisis)
Unilateral Bilateral

Bilateral cleft lip
Prof. Füzesi Kristóf, SZTE Pediatrics

Terminated pregnancy
because of trisomy 13
(Patau’s sy):
severe clefting of the lip
and palate
Dr László Kaizer, SZTE Pathology

Robbins and Cotran Pathologic
Basis of Disease, 2006

Early complications
•Acute purulent pulpitis (severe toothache)
•Extension of infection throughout the pulp  necrosis of
pulp  loss of tooth
•Extension of infection into apical periodontium: acute apical
abscess  subperiosteal abscess  osteomyelitis 
drainage through the oral mucosa („gumboil”) or to the
adjacent facial skin

Late complications
• Periapical granuloma: necrotic tissue at the apex of the
root canal foramen, surrounded by granulation tissue
infiltrated by lymphocytes and plasma cells.
• Cystic degeneration and epithelialization of the granuloma
 radicular cyst

Recurrent aphthous
stomatitis (canker sores)
Aphtha (arrow)
shallow ulcer on the
inner surface of the lips,
buccal mucosa or the
tongue
surrounded by
hemorrhagic rim
Prof. Sonkodi István, SZTE Faculty of Dentistry

Oral candidiasis (thrush)
White pseudomembranes on
the lingual mucosa

Irritation fibroma
Pedunculated nodule on the apex of the tongue

Peripheral giant cell
granuloma (epulis) in
the gingiva
Prof. Sonkodi István, SZTE Fogászati Klinika

Leukoplakia on the
tongue - histology
revealed in situ cc in
the patient
Prof. Sonkodi István, SZTE Fac.
of Dentistry

Esophageal atresia and
tracheoesophageal fistula
Most common variant (C):
blind upper segment, and
fistula between the lower
segment and the trachea.
Feeding leads to aspiration
pneumonia

Esophageal atresia and
tracheoesophageal fistula
Blind upper segment (yellow
arrow and probe) and fistula
between the lower segment
and the trachea (red arrow)

Congenital
diaphragmatic
hernia.
Stomach, and
bowels and spleen in
the thoracic cavity.
The left lung is
hypoplastic (arrow)

Megaesophagus: dilation of the esophagus proximal to LES,
and also formation of a pulsion diverticulum

Esophageal varices
Tortuously dilated submucosal
veins of the lower esophagus
in response to portal
hypertension

Candidiasis (psuodemembranous esophagitis) in
agranulocytosis

Fungating carcinoma in the lower third of the esophagus
Cardia

Acute hemorrhagic-erosive pangastritis: hyperemic mucosa with
punctate hemorrhages and multiple brownish-black erosions.
Cardia

Acute ulcers in the postpyloric duodenum.

Acute hemorrhagic-erosive pangastritis probably induced by NSAID intake. The 65-y-old
patient with severe coronary atherosclerosis, and arthrosis of hip consumed NSAIDs to releave
pain. Massive gastric bleeding (hematemesis, melena) occurred which led to prolonged
hypotension and, in turn, subendocardial myocardial infarcts. The patient died of acute left-
sided heart failure.
Cardia

CNS trauma-associated acute stress ulcers in the postpyloric duodenum. The ulcers
led to hematemesis, weak pulse, tachycardia, hypotension; the patient ceased.
During the autopsy, 3000 ml blood was found in the intestines.

Large peptic ulcer on the lesser curvature of the stomach;
note round shape and sharp margins

Perforated antral ulcer (probe)

Autoimmune metaplastic atrophic gastritis (AMAG)-associated multiple hyperplastic polyps (P),
polyps with dysplasia (D), and carcinomatous transformation (Cc)
Courtesy of Bence Kővári, MD and Orsolya Oláh, MD, Dept. of Pathol, University of Szeged
P
P
P
D
D
Cc

Advanced gastric carcinoma: large fungating tumorous mass (line);
metastasis in the lymph nodes of greater omentum (M)
M
M
Courtesy of István Németh, MD, Dept. of Pathol, Univ. Szeged

Gastric carcinoma with two ulcer craters (arrow)

Antral gastric carcinoma infiltrating the mucosa and gastric wall
Courtesy of Prof. László Tiszlavicz and Levente Kuthi, MD; Dept. of Pathol, Univ. of Szeged

Linitis plastica (leather bottle stomach): the stomach wall is thicker and more
rigid because of cancerous infiltration
The stomach can’t hold as much and does not move as it should

Krukenberg tumor: bilateral ovarian metastasis of signet-ring cell carcinoma
Courtesy of András Vörös, MD, Dept. Pathol, Univ. Szeged

Perforated duodenal peptic ulcer: duodenal content irritated
the serosa and induced hyperemia

Purulent peritonitis: creamy exudate covers the bowels and
mesentery

Diffuse purulent
peritonitis caused by
perforation of acute ulcer
of the stomach
2000 ml of pus was
found in the abdominal
cavity
Diaphragm
E.Coli
Kleb. pneumo
Strep. pneumo

Carcinosis of omentum; the patient had pancreatic
carcinoma diagnosed during autopsy

Extreme large umbilical hernia

Invagination (intussusception)
The a ag a e ( e e c e ) he d a
loop, like the finger of an inverted glove

Volvulus-induced hemorrhagic infarction of the cecum and
ascending colon. Arrows: not affected colon and ileum

Border of the necrotized and non-necrotized ascending colon

Luminal cause of intestinal obstruction: gallstone ileus.
Proximal to obstruction, the small bowel is dilated

Consequences of intestinal
obstruction
The bowels proximal
to the obstruction
undergo dilation
their wall becomes
thinned
their lumen is filled
with large amount
of fluid and gas

Ileus due to
rectal carcinoma
X-ray of the
abdomen:
distended small
bowel loops
and stomach filled with
fluid and gas.
Note fluid levels.
Courtesy of Morvay Zita,
SZTE Radiology

Consequences of intestinal
obstruction
The bowels proximal
to the obstruction
undergo dilation
their wall becomes
thinned
their lumen is filled
with large amount
of fluid and gas
Elevation of the
diaphragm
+ Strangulation-induced
bowel infarction peritonitis

Thrombosis of superior mesenteric artery (not shown)
hemorrhagic infarction/gangrene of the small bowel +
generalized distension of bowels indicating vascular ileus
cecum
Asc.Colon
Transverse Colon
Small Bowels
Sup. Mes. a. thrombus --> Infarct
in Colon --> vascular ileus and
distention of Colon and SI

Shigella infection
Distal colonic inflammation with shallow ulcers
Colitis

Fulminant Clostridioides difficile colitis: the colon is
markedly distended, confluent pseudomembranes cover
the mucosa

Enteropathy-associated carcinoma

Pseudopolyps and broad-based ulcers in ulcerative colitis

Serpentine fissures and cobblestone-like mucosa in CD
(large bowel)

CD: Serpentine fissures and
cobblestone-like mucosa
CU: broad-based ulcers, pseudopolyps

Gross features that differ between CD and UC
C disease Ulcerative colitis
Bowel region Ileum + colon Rectum > distal colon >
entire colon
Distribution Skip lesions Continuous
Broad-based ulcers and
pseudopolyps
Not
characteristic
Yes
Serpentine fissures and
cobblestone appearance
Yes Not characteristic
Transmural stricture Yes Rare
Wall appearance Thick Thin
Fistulae Yes No

Diverticulosis. The mucosal surface is ridged due to hypertrophy of
the underlying muscle.
Mucosal hyperemia indicates diverticulitis.

Tubular adenomas
About half are found in
the rectosigmoid; may
be single or multiple
Usually <10 mm and
pedunculated
>10 mm: areas of
intramucosal carcinoma
can be present
(invasion of the lamina
propria with no
extension through the
muscularis mucosae
into the submucosa)

Two polyps. The smaller proved to be adenoma; the larger proved to be
adenoma with malignant transformation: stalk-invasive adenocarcinoma and
metastases in mesocolonic lymph nodes were observed
Mesocolonic LN

Villous adenomas
Most often in the
rectum; solitary,
sessile, diameter: up to
10 cm
Composed of villi
(finger-like protrusions
lined with dysplastic
columnar epithelium)
Adenocarcinoma
frequently arises in VA-
s > 4 cm

Villous adenoma with malignant transformation:
adenocarcinoma infiltrates the submucosa
Villous Adenoma
>4cm
Two points of
communication
between Mucosal
Dysplastic glands
and dysplastic
glands in
submucosa
creating the large
Adenocarcinoma

Familial adenomatous polyposis

Cc of the sigmoid bowel: annular (napkinring-like)
growth. Lymph node metastasis in mesocolic adipose
tissue
R. Colon --> Fungating
Into Serosa --> T3?

Carcinoma of the cecum: exophytic, fungous mass is
characteristic

Rectal cc leading to ileus:
extremely dilated colon
proximal to the
obstruction

Ca ci a f he ile cecal al e: he a ie a eak e
induced by iron-deficiency anemia
Ileum
Carcinoma

Neuroendocrine tumor in the ileum close to the
Bauchin valve
T a c L , SZTE Pa a

Mural tumor in the wall of the small intestine causing
subileus. Histology disclosed GIST

Ulcerophlegmonous appendicitis.
The peritoneal surface is covered by fibrinopurulent
exudate. Formol-fixed material

Congenital megacolon; before resection of the
aganglionic segment
P f. F e K f, SZTE Ped a c

Jaundice (icterus)
Yellow discoloration of the skin, sclerae, and mucous membranes due to
increased levels of bilirubin in circulation (> 40 umol/L)
Caused by cholestasis, hemolysis or genetic disease

Chronic hepatitis C virus infection led to cirrhosis of liver:
nodular alteration of the parenchyma

Alcoholic steatosis: the liver is enlarged, soft, yellowish,
the edges are rounded

Autopsy of an obese woman with type 2 diabetes, hypertension, dyslipidemia,
elevated ALT, AST, and bilirubin. Conversion of non-alcoholic steatohepatitis to
cirrhosis was found

Female patient with the medical history of 10 years of
primary sclerosing cholangitis. The normal lobular structure
was replaced by fibrosis.

Hemochromatosis. Fibrous pancreas and cirrhotic liver.
The brownish colour of organs is because of hemosiderin
deposition

Cirrhosis
Fiborus septa convert the normal liver architecture into structurally
abnormal nodules (pseudolobules)
HCV infection usually induces macronodular cirrhosis
5 cm
alcohol - micronodular

Esophageal varices
Dilated veins in submucosa
in the distal esophagus;
can rupture at any time

Focal nodular hyperplasia
In young women (no evidence of a relationship with oral
contraceptive use)
Nodule-forming hyperplastic response of hepatocytes to
focally increased blood flow
Uncapsulated tumorlike lesion with a central stellate scar

Cavernous hemangioma
Red-blue, soft nodules consist of endothelial cell
lined vascular channels and stroma
Blind percutaneous needle biopsy may cause
severe intra-abdominal bleeding

Morphology
Gross: usually in cirrhotic liver
Unifocal
Multifocal
Diffuse

Multifocal hepatocellular carcinoma in cirrhotic liver

Intrahepatic cholangiocarcinoma, multifocal variant
no cirrhosis + history adenocarcinoma = Largeduct iCCA

Metastases in the liver; the patient died of hepatic failure

Several metastatic foci in the liver

Cholesterol stones: from black to yellowish brown;
multiple; faceted surface owing to tight apposition
Gallbladder
Cystic duct
Hepatic duct
Common bile duct

Yellowish-brownish cholesterol stones

Pathogenesis
Crystallization of cholesterol (nucleation) can be
induced by
• Bile supersaturated with cholesterol
• Gallbladder hypomotility and/or defective
gallbladder emptying
• Hypersecretion of gallbladder mucus
Cholesterol can no longer remain dispersed and
nucleates into cholesterol monohydrate crystals

Cholesterol monohydrate crystals
Precipitation of Ca++-salts
Cholesterol stone

Ulcerophlegmonous cholecystitis: hyperemic
mucosa covered with multiple ulcers; the wall is
edematous

Thinned mucosa, thickened gallbladder wall, cholesterol stones

Hydrops: the gallbladder is markedly enlarged, the
muscular wall is thinned

Carcinoma developed in chronic calculous
cholecystitis. Note infiltrating growth pattern
Tumorous
Thickening
Of GB wall
Continuous spread to liver
parenchyma

Carcinoma of the gallbladder.
Hematogeneous metastases in the liver.
Liver Metastases with
spontaneous Necrosis

Muliple liver abscesses; the obstruction was managed by
stenting the common bile duct

Green liver in obstructive jaundice
The patient had carcinoma of the head of pancreas; the tumor
infiltrated and obstructed the common bile duct;
liver metastases

Carcinoma of the cystic duct, the hepatoduodenal
ligament and the hepatic duct (probe)
Diffusely inﬁltrating type
Liver, Nutmeg or
steatotic?

Stimulation
Secretion to the duodenum
Normal site of trypsinogen activation
Acinus
Calcium regulation
• Hypercalcemia
• Alcohol
Trypsin related mutations
• PRSS1+: activation of
trypsinogen
• CTRC+: ineffective
trypsin degradation
• SPINK1+: ineffective
blockade of active
trypsin
Duct
Duct cell secretion
• CFTR
Duct obstruction
• Gallstone
• Duct stones
• Tumor
• Mucus
Genetic and environmental factors that affect acinar cells or ducts
Modified from Muniraj et al. Disease-a-Month 60:530-550, 2014

Classification according to the severity of acute
pancreatitis
Clinically
• mild - morphologically acute interstitial pancreatitis:
interstitial (IS) edema + foci of enzymatic necrosis in the
acini by LM
• moderately severe - morphologically acute necrotizing
pancreatitis: IS edema and gross foci of enzymatic
necrosis
• severe - morphologically acute necrotizing-hemorrhagic
pancreatitis: the entire pancreas is involved; confluent
foci of necrosis and hemorrhage; foci of enzymatic fat
necrosis in the extrapancreatic collections of fat, such
as the mesentery of the bowel and the omentum

Moderately severe - acute necrotizing pancreatitis
IS edema and gross foci of enzymatic necrosis
I idiopathic
G Gallstones
E Ethanol
T Trauma
S Shock
M Mumps
A Autoimmune
S Scorpion Sting
H HyperTG/Ca
E ERCP
D Drugs

Severe - acute necrotizing-hemorrhagic pancreatitis. The
entire pancreas is involved; confluent foci of necrosis and
hemorrhage

Severe pancreatitis.
Foci of enzymatic fat necrosis in the mesentery of bowels
Duoddeno-Jejunal
Flexure

Complications in severe pancreatitis
• SIRS (systemic inflammatory response sy)-induced
shock
• Bacterial superinfection of necrotic pancreatic tissue
abscess(es) sepsis
• Disruption of large ducts can result in unilateral
pleural effusion, enlarging peripancreatic fluid
collection, or pancreatic ascites
• > 4 weeks: pseudocyst formation (1 to 15 cm): massive
liquefactive necrosis enclosed by granulation tissue; +
infection of pseudocysts pancreatic abscesses

Pathogenesis
Still not understood; TIGARO classification of risk factors
• Toxic-metabolic: chronic alcohol abuse (mostly in
middle-aged men), hypercalcemia, chronic renal failure,
etc.
• Idiopathic
• Genetic-induced: SPINK1 gene mutation or PRSS1
gene mutation or CFTR gene mutation (no
extrapancreatic manifestations of cystic fibrosis)
• Autoimmune
• Recurrent acute pancreatitis
• Obstruction of pancreatic duct by stone or tumor or
congenital abnormality (pancreas divisum [1 papilla
minor + 1 accesory duct])

Alcoholic chronic pancreatitis: atrophied, markedly fibrotic
pancreas, irregularly dilated ducts obstructed with Ca-
carbonate stones + pseudocysts (not present in this patient)
=Chr. Calcifying Pancreatitis

Carcinoma (cc) in the pancreatic head, infiltrating the papilla of Vater and the
common bile duct (cbd). Distal to the tumor, obstructive pancreatitis developed.
The Wirsungian duct is markedly dilated and tortuous
W
W
cc
cbd

Cc of the pancreas: hard, poor-defined
mass; difficult to distinguish from chronic pancreatitis

Hematogeneous metastases in the liver

Cystadenocarcinoma of pancreas

Immunopathology of severe SARS-CoV-2 lung disease
Inflammatory lung injury: impaired innate antiviral defense, overactivated innate immune response
Upper airways: evasion of IFN-I response → robust viral replication → infection extends to the lung
Uncurbed
viral
replication
Weak
IFN-I
response
Cytopathic damage to
pneumocytes,
endothelial cells → DAMPs
DAMPs overactivate
alveolar
macrophages
Weak
viral
clearance
Weak CD8+
cytotoxic T cell
response
Influx of activated
monocytes,
neutrophils
Alveolar edema,
hyaline membranes,
alveolar collapse
Progressive diffuse alveolar damage and ARDS + death
Adapted from
Med Res Rev 2020; 1-28

71-y-o male patient with
hypertension, chronic ischemic
heart disease and lethal SARS-
CoV-2 lung disease
Diffuse gray-white consolidation,
admixed with hemorrhage;
thrombi in pulmonary vessels
(arrows). Formol-fixed specimen.
Infected in nursing home 14 days
prior to death. Fracture of femur,
operated urgently 9 days prior to
death.
Fever and progressive ARDS
started 2 days prior to death.
Autopsy performed by B. Radics, MD,
Department of Pathology, University of
Szeged

Timeline of Covid-19
Modified from New Engl J Med 2020;383:2451-60
Onset of
symptoms
Median days
from infection
-5 8 13
-4 -3 -2 -1 0 1 6
5
4
3
2 7 9 10 11 12 14 15 16 17 18
Incubation period
Airways: viral
replication evades
IFN-I response and
extends to alveoli
Fever
Cough
Fatigue
Anorexia
Myalgias
Mild or moderate pneumonia, dyspnea
Severe pneumonia, ARDS, hypoxemia
+ hypercytokinemia, coagulopathy,
shock
19

Plasma
Water
92%
Proteins
7%
Albumin 58%
Globulins 37%
Fibrinogen 4%
Regulatory
proteins 1%
Other solutes
1%
Electrolytes (Na,
K, etc.)
Nutrients (glucose,
amino acids etc.)
Respiratory gases
Waste products
Red cells (erythrocytes)
4-5.5 million/ L
Buffy Coat
Platelets
(thrombocytes)
150.000-400.000/ L
White cells (leukocytes)
4.500-11.000/ L
Neutrophils (54-62%)
Lymphocytes (25-33%)
Monocytes (3-7%)
Eosinophils (1-3%)
Basophils (0-0.75%)
45%
55%
COMPOSITION OF BLOOD
Packed red cell volume: Hematocrit

BONE MARROW
Red marrow: active, blood cell forming
In adults: flat bones (pelvis), vertebrae
Yellow marrow: inactive, fatty tissue → it may turn red
again in cases of blood loss (adaptation), or in myeloid
neoplasias (leukaemias)

BONE MARROW
Top: in AML, the diaphysis is replaced by leukemic red bone marrow.
Bottom: normally, the diaphysis of femur is filled with yellow fatty bone marrow.
red tumorous bone marrow seen in aml and a l l it's a sign of bone
mineral haematopoiesis suppression leading to anemia
thrombocytopenia and sometimes granulocytopenia ( leukemic
leukaemia) JML has many subtypes one of them is PML associated with
translocation 15:17 between PML L Gene and rara play which could be
as viewed as a hey good prognostic sign since atra could be used with
arsenic trioxide to treat it and a special sign of the subtype is the dic due
to the procoagulant release while another subtype with differentiating
monocytic can cause leukaemia cutis

In certain diseases, the HSCs can travel in the blood from the bone marrow in one bone to another bone and
may settle in the liver and spleen (extramedullary hemopoiesis)

Aspiration of the bone marrow yields a bone
marrow cytological smear

Trephine (Jamshidi) biopsy to investigate
the constituents of bone marrow yields
a tissue core of bone marrow

Diseases of blood,
hematopoietic and
lymphoid system
Red blood cell
disorders
White blood cell
disorders
Coagulation
system disorders
Anemia Erythrocytosis
Leukopenia
Reactive
leukocytosis
Neoplasms
Thrombocytopenia
Thrombocytosis
Coagulopathies
Pancytopenia
(anemia, leukopenia,
thrombocytopenia
”Clot or bleed”

Pallor of skin
Pale Skin is a sign of Anemia
there are many causes of anywhere I like to think of them as as deficiency anaemia iron deficiency B12 B9 deficiency then we can talk
about the factory the bone marrow and diseases affecting the bone marrow such as aplastic anaemia tumor infiltration suppression by
irradiation then we can talk about the red blood cells themselves haemoglobin could be affected in thalassemia and sickle cell anaemia
the memory could be defective in spherocytosis and elliptocytosis enzyme deficiencies such as pyruvate kinase gcpd H deficiencies then
we can talk about hemolytic anemias such as autoimmune hemolytic anaemia malaria induced microscopic an geopathic hemolytic
anaemia ( TTP dic( and finally we can talk about blood loss which could be acute in case of traumatic injuries or chronic in case of
gynecology renal or GI pathologies

- Iron deficiency
- Anemia of chronic disease
- Thalassemias
- Sideroblastic anemia
Anemia
Microcytic Normocytic Macrocytic
Reticulocyte
count
Low High
- Megaloblastic anemia
* B12 deficiency
* Folate deficiency
- Non-megaloblastic
*Alcoholic liver disease
*Other liver diseases
Marrow failure
• Aplastic anemia
• Myelofibrosis
• Myelophthisis
• Marrow suppression (drugs,
chemotherapy, radiation)
Chronic renal failure
Anemia of chronic disease
Acute blood loss
Hemolytic anemias
• Sickle cell anemia
• G6PD deficiency
• Hereditary spherocytosis
• Autoimmune hemolitic
anemia

Acute
Massive bleeding from ruptured blood
vessels:
Traumatic wounds (eg.: car accidents)
Ruptured aortic aneurysm
Ruptured esophageal varices
Gastric or duodenal ulcer
Ectopic pregnancy
Etc.
Loss of intravascular volume (>20% loss of
blood) hemorrhagic shock and may lead to
death
If the patient survives hemodilution
(movement of fluid into the vascular space)
normocytic normochromic anemia
Tissue hypoxia EPO RBC production
with reticulocytosis normali ation within 3-4
weeks
Chronic
GI tract (ulcers, polyps, tumors,
IBD, angiodysplasias, hemorrhoids,
etc.)
Gynecological (heavy or frequent
menstrual bleeding, metrorrhagia
abnormal uterine bleeding)
Urological (kidney or bladder
cancer)
IRON DEFICIENCY
ANEMIA
ANEMIA OF BLOOD LOSS: HEMORRHAGE

• Iron in food (2 forms):
– Heme iron (bound to Hb and myoglobin – in meat) – Fe2+ (ferrous)
– Non-heme iron – free iron molecules in Fe3+ (ferric)
• Plant-based foods (spinach, beans, lentils)
IRON METABOLISM

IRON METABOLISM Fe
HCl
HEME IRON
NON-HEME
IRON
Fe3+
Fe2+
Fe2+
Ferri-reductases
Fe2+
Heme-transporter
Fe2+
DMT-1
HCl
Fe2+ Fe2+
Fe3+
Transferrin
(iron transporter)
Duodenal cell Blood
Target tissues
Ferroportin
Hephaestin
Erythropoiesis
Liver
Hepcidine
-
Storage of iron:
intracytoplasmic ferritin
and hemosiderin (eg.: in
macrophages)
Iron loss by
shedding of
epithelial cells
Transferrin-receptor
Stomach
Duodenum
Muscle
Ferritin
Intake: 10-20 mg/day

Gross morphology: yellow fatty marrow at sites of red bone marrow (sternum)

Petechial hemorrhages in severe thrombocytopenia

Myelophthisis: Prostate carcinoma metastases in spine and
femur (bottom: normal trabecular structure after formol fixation)
Lung, pancreas and Breast can also metastasise to bone

Hb Globin
Amino Acids
Heme
Biliverdin
Bilirubin
Heme oxygenase
Biliverdin reductase
Fe2+
A
Bilirubin / albumin complex
MACROPHAGE
I di ec bi i bi c j ga ed bi i bi
Stercobilin
Ha g bi
HEMOLYSIS
RBC c
F ee he g bi
Pink serum
<120 days
INTRA-
VASCULAR
EXTRA-
VASCULAR

CAUSES OF VITAMIN B12 DEFICIENCY
B12
Parietal
cell
Intrinsic
factor (IF)
B12-IF complex
IF receptor
Ileum
Stomach
Blood
Colon
Transcobalamin II
Target tissues
Storage in the Liver
a e B12
Vegeterians
Poor diet
absorption (malabsorption)
- production of IF
- Gastrectomy
- Pernicious anemia
- ileal absorption:
- Ileal resection
- Ileal inflammation: Crohn-
disease
- Consumption by intestinal
bacteria or tapeworms

PERNICIOUS ANEMIA
B12
Parietal
cell
Intrinsic
factor (IF)
B12-IF complex
IF receptor
Ileum
Stomach
Blood
Colon
Transcobalamin II
• Definition:
– A subtype of B12 deficiency
induced megaloblastic
anemia
• Cause:
– Autoimmune disease
against the parietal cells
and intrinsic factor
– IF B12 absorption
– Chronic atrophic corpus
gastritis with intestinal
metaplasia (AMAG)
risk of gastric cancer
Auto-
antibodies

CLASSIFICATION BASED ON NORMAL CELL LINES
• Myeloid neoplasms
– Acute myeloid leukaemias (AML)
– Chronic myeloproliferative neoplasms (MPN)
– Myelodysplastic syndromes (MDS)
• Lymphoid neoplasms
– Precursor lymphoid neoplasms (ALL)
– Mature lymphoid neoplasms
• Mature B-cell neoplasms
• Mature T- and NK-cell neoplasms
– Hodgkin lymphoma
• Histiocytic neoplasms

MYELOID NEOPLASMS: CLASSIFICATION
Maturation
arrest + ↑↑
replication
Defective
maturation
Proliferation of
terminally differentiated
myeloid cell lines
Secondary
maturation
arrest + ↑
replication
1) Acute myeloid leukemias
3) Chronic myeloproliferative neoplasms
3) Myelodysplastic syndromes
New
oncogenic
mutations

Grossly, the sites of yellow bone marrow are infiltrated by tumorous red bone
marrow.
Top: in AML, the diaphysis is replaced by leukemic red bone marrow.
Bottom: normally, the diaphysis of femur is filled with yellow fatty bone
marrow.

CML Polycythemia vera Essential thrombocytosis Primary myelofibrosis
Clinical features
Peak age 50-60 yrs 40-60 yrs 70 yrs 70 yrs
Splenomegaly Yes (Massive) Yes 30% (slight) Yes (Massive)
Bone marrow
Panhyperplasia
(predominantly
granulopoiesis)
Panhyperplasia
(predominantly
erythropoiesis)
Isolated megakarycytic
hyperplasia with large
megakaryocytes in clusters
Panhyperplasia with
fibrosis
Peripheral blood
Erythrocytes Mild anemia Erythrocytosis
(polycythemia)
Mild anemia Mild anemia
Granulocytes Markedly increased Norm.-mildly increased Normal (slightly increased) Normal to moderately
increased
Platalets Normal to moderately
increased
Normal to moderately
increased
Markedly increased (giant
thrombocytes)
Inreased to decreased
Genetics Philadelphia
chromosome (BCR/ABL
rearrangement)
JAK2 activating mutation JAK2 activating mutation;
MPL activating mutation
JAK2 activating mutation
MPL activating mutation

Myelofibrosis (right): osteosclerosis of the marrow spaces of
sternum. Left: normal sternum

Myelofibrosis
Note extreme splenomegaly
induced by extramedullary
hemopoiesis (myeloid metaplasia).
The arrow indicates spontaneous
infarction of the spleen
parenchyma.
The patient died of
consequences of transformation
to acute myeloid leukemia.
Liver
Spleen
Stomach

Non-Hodgkin lymphoma: enlarged lymph nodes, the cut
surface is homogeneous, grayish-white
lymphoma that could be Hodgkin's or non-Hodgkin's hodgkin's lymphoma is characterized by contiguous surprised
lymphadenopathy that is usually the cervical region it is characterised by symptoms such as fever night sweats and weight loss also
characterized by presence of certain cells such as reed-sternberg cells hodgkin's cells and lacunar cells it has Ford main subtypes
for the classical hodgkin's lymphoma the nodular sclerosing mixed hypercellularity lymphocyte rich and deleted while then non
Hodgkin lymphoma could be further classiﬁed based on whether the tumor is aggressive2 or indolent

Marginal zone lymphoma in the stomach and the regional
lymph nodes (formol-fixed specimen)
Pancreas
Stomach
this is a GI lymphoma most common GI landform what is the diffuse large b-cell lymphoma
and then the marginal zone lymphoma and then the celiac disease associated t-cell
lymphoma they are associated with chronic inﬂammation aka helicobacter pylori infection or
celiac disease they are highly aggressive

Marked enlargement of the hilar and paratracheal lymph nodes;
the disease was diagnosed as DLBCL during autopsy
Larynx
Trachea
Tongue

Superior vena cava sy caused by an agressive tumor;
autopsy revealed enlarged paratracheal, hilar and mediastinal
lymph nodes; T-cell lymphoma was confirmed

Erosions of cancellous bone of calvarium in myeloma

Erosions of cancellous bone of vertebrae in myeloma
myelomas are tumors arising from mature plasma cells that produce immunoglobulin light chain bence-jones protein that leads to renal failure
and gastric property and bence Jones proteinuria it is also associated with hypercalcemia due to the stimulation of osteoclast through cytokines
you can also cause anaemia and Bone defects presenting as pathological fractures the disease starts as monoclonal gammopathy of uncertain
signiﬁcance asymptomatic myeloma then symptomatic over to myeloma it is characterized by by m-protein Spike and the produced
immunoglobulins could act as autoantibodies and generally they are dysfunctional so we will have hypogammaglobulinemia

Toxoplasma-lymphadenitis
Ingestion of oocysts from cat feces; the protozoon
disseminates in the human body; the inflammatory
response, including lymphadenitis, destructs the
parasites).

Markedl enlarged pleen ( 1000 g) in ad l
Myelofibrosis
CML
CLL

Myelofibrosis.
Note extreme splenomegaly
induced by extramedullary
hemopoiesis (myeloid metaplasia).
The arrow indicates spontaneous
infarction of the spleen
parenchyma.
The patient died of
consequences of transformation
to acute myeloid leukemia.
Liver
Spleen
Stomach

Invasive thymoma:
The surgical resection margin (blue) is infiltrated by
the tumor

litterer siwe disease affect children, ﬁltration of skin spleen liver bone marrow can be lethal
third disease is is hand-schuler-christain having a triad of exopthalmus diabetes insipidus
calvarial bone defects

P of. Ba P l, Ne o ge
Diffuse brain
edema: ventricular
spaces are
severely
narrowed

1. Subfalcine herniation
Unilateral mass lesion
forces the ipsilateral
cingulate gyrus to be
compressed
underneath the falx
cerebri
focal necrosis and
hemorrhage in the
herniated tissue
+
compression of the
anterior cerebral artery
Kumar, Cotran, Robbins: Basic
Pathology 2003
Subfalcine
herniation

2. Transtentorial herniation
Transtentorial
herniation
• Expansion of the
hemisphere the uncal
gyrus of hippocampus is
herniated underneath the
free edge of the cerebellar
tentorium

2. Transtentorial herniation
Transtentorial
herniation
•The ipsilateral oculomotor
nerve undergoes
compression: ipsilateral
fixed pupil
• Posterior cerebral artery
compression occipital
infarction, cortical
blindness
• Cerebral peduncle
compression upper
motor neuron signs
• Brainstem compression
cardiorespiratory failure,
death

3. Tonsillar herniation
Tonsillar
herniation
Transtentorial
herniation
The cerebellar tonsils are
forced into the foramen
magnum and compress
the respiratory and
cardiac centers within the
medulla
cardiorespiratory failure,
death

Compression of cerebellar tonsils and medulla
oblongata by the foramen magnum
Green=Deep lesion
Red= Necrotic features

Striped hemorrhages in the pons in response to tearing
of small vessels(Duret hemorrhages)
Secondary hemorrhages to a space occupying leion
Can be seen in Tonsillar herniation

Hydrocephalus
Preparation of late
P of D . Gell Albe
SZTE Anatomy Department

Hydrocephalus: severe enlargement of the ventricles,
atrophy of the brain
Usually Atrophy of the brain leads to
ventricular enlargement
But in this case the enlargement of
the ventricles is huge so maybe the
ventricular enlargment (Primary
Hydrocephalus) preceeded and
cause pressure atrophy of the brain

Sec. (compensatory) hydrocephalus
The increase in
CSF volume
occurs following
brain atrophy:
HC ex vacuo
The intracranial
pressure is
normal

Fracture contusion with necrosis of GM and WM,
hemorrhage and brain oedema
Coup
Contre-coup

The branches of middle meningeal artery run between the dura
mater and the skull

Epidural hematoma
• Temporal bone fracture rupture of middle
meningeal artery accumulation of arterial blood
between the dura and the skull: EH
• Lucid interval followed by a rapid in intracranial
pressure
P of. Ba P l, Ne o ge

The bridging veins between the dura mater and the arachnoid membrane

The middle cerebral artery is the most frequent site
of occlusion in association with atherosclerosis

Thromboembolism: several infarcts with secondary reperfusion
hemorrhage in the territory of the middle cerebral artery
Caudate nucleus
Internal capsule
Putamen of
lentiform nucleus
Supplied by Ant.
cerebral a.
Midline shift is also present Cavity of Septum pallucidum
"Cavum Septi Pellucidi"
It is normaly present in fetuses
and closes on its own, ﬁnding it
in adults is not a pathologcal
ﬁnding per se, but rather an
antomical variation, sometimes
could be considered as a
marker of neural
maldevelopment.

Cerebral infarction: wedge-shaped softening of the parietal
lobe and the internal capsule
Caudate nucleus
Thalamus
infarction
Globus pallidus
infarction
Whitesh yellowish
necrotic area
with irregular
border and
surrounded by
edema
Blurring of WM and
GM on left side
compared to the well
demarcated right side
Caudate is infarcte
GP is spared

Hypertensive hemorrhage in the left hemisphere, lacunar state
in the right basal ganglia
Formol-fixed brain
Huge hemorrhagic
lesion "Apoplexy"

Hypertensive patient with psychomotor slowness:
bilateral lacunar infarcts in the deep WM focal myelin loss
From psychomotor
slowness it could
progress so vascular
dementia

Fresh hematoma distructs the putamen, the WM of parietal
lobe, and the internal capsule Midline shift

Hemocephalus in the fourth ventricle - lethal
Extension to subarachnoidal space
--> Subarachnoidal hemorrhage
Substantia Nigra could be
seen as a thin dark line
Maybe some signs of
Duret Hemorrhage

Multiple hemorrhages in blastic crisis

Berry aneurysm of the circle of Willis

Subarachnoid hemorrhage due to ruptured berry
aneurysm

Glioblastoma. Distortion of the temporal WM and thalamus,
note foci of necrosis, cystic change and hemorrhage
Heterogenous appearance
"Glioblastoma Multiforme"

Glioblastoma. Butterfly pattern of spread through the
corpus callosum

Cerebellar metastasis of breast carcinoma
(autopsy disclosed the primary tumour)
Well circumscribed
Lung cancer and melanoma are most likely to present with multiple metastasis, whereas breast,
colon, and renal cancers are more likely to present with a single metastasis
primary brain tumors could be pilocytic astrocytoma diffuse astrocytoma anaplastic
astrocytoma glioblastoma oligodendrogliomas ependymoma medulla blastoma
meningioma schwanoma and neuroblastoma

Parasagittal meningioma
Falx cerebri
Found incidentaly
Hard to excise since it is near the Falx cerebri
Tendency to recur

Gray-tan, firm plaques in the WM of brain and spinal cord; commonly beside
the lateral ventricles; optic nerve is frequently involved
Multiple Sclerosis "MS"

The plaques are located in the white matter: well-circumscribed,
glassy, gray-tan, irregularly shaped lesions
Multiple Sclerosis "MS"

Alzheimer disease. Cortical atrophy, characterized by
narrow gyri and widened sulci (meninges had been removed)

The medial structures of the temporal
lobe display marked atrophy.
Note compensatory ventricular
enlargement – HC ex vacuo
Sup. and Middle Temporal Gyrus
Atrophied
Cingulate Gyrus
Relatively preserved
Middle Frontal
Gyrus Atrophied

Gross: depigmentation of the substantia nigra and
locus coeruleus

Acute purulent meningitis of the brain and the
spinal cord
Engorged veins

Multiplex brain abscess, pyocephalus internus; the patient was hypertensive, the
reason why lacunar state was also observed
Pyocephalus internus
Lacunar infarcts
Abscess

Chronic abscess of the spinal cord

Anencephaly - lethal
• The calvaria and the
hemispheres are
absent
• The base of the skull is
covered by a mass of
vascular granulation
tissue (area
cerebrovasculosa)
D . Kai e L , SZTE Pa h g

Encephalocele
Malformed CNS
tissue extends
through a defect in
the cranium
Occurs in the
occipital region or
in the posterior
fossa
Lethal

Neuro - Fejlődési rendellenesség - Spina bifida
Myelomeningocele and rachischisis

Holoprosencephaly: incomplete separation of
hemispheres

Agenesis of corpus callosum

BC Screening
Before the advent of
breast cancer
screening programs
breast cancer was
mainly detected as a
symptomatic disease.
In the era of BC
screening many cases
are detected in an
asymptomatic (non-
palpable) stage; many
in the non-invasive or
in situ ha e

Carcinoma of cervix
Specimen removal termed:
Hysterectomy and salpingo-oopherectomy

Cervical cancer in advanced stage
causing hydronephrosis

Leiomyoma
Uterine Cavity
Solitary circumscribed leiomyoma
If located submucosaly they cause bleeding
If intrnurally then it can block/narrow lumen of fallopian tubes
Rarely they rise subserosaly bulging out of the contours of uterus

Serous cystadenocarcinoma
Cysts are visible on the cut surface
"Next image"

Serous cystadenocarcinoma Cysts with Papillary ingrowth pattern

Mucinous cystadenoma, multicystic
Gelatinous substance
remains in the cyst
after the cut Mucin ﬂowed out

DERMOID CYST
ﬁlled with hair,
sebaceuous material

Urolithiasis of the bladder
Note inflammatory hyperemia of
trigone
Ureter
Ureter

Autopsy case of multifocal, cauliflower-like exophytic bladder tumor (the 78-y-old patient had
iron deficiency anemia). Histologic evaluation revelealed nonmuscle-invasive papillary UCC.
Lateral wall
Posterior wall
Trigone
Ureter

Muscle invasive UCC: the layers of bladder (mucosa, submucosa,
muscularis propria) are invaded by the cancer
Detrusor muscle
Serosa
Mucosa

Slices of radical cystectomy specimen fixed in formol. Muscle-invasive UCC; the tumor has
invaded the perivesical fatty tissue (arrow)
Courtesy of F. Sükösd, SZTE Pathology

54-year-old, smoking male evaluated because of weakness.
Iron deficient anemia and microhematuria were found; abdominal ultrasound scans revealed
a tumorous mass in the renal pelvis. The symptoms were caused by papillary UCC (arrow),
evidenced by the pathological examination of the nephrectomy specimen
Courtesy of L. Kuthi, SZTE Pathology

UCC of the ureter: the exophytic tumor clogged the lumen and caused
hydronephrosis (next slide)

The tumor caused dilation of the ureter and hydronephrosis

Control of pregnancy by ultrasound
examination of the fetus.
Oligohydramnios, abdominal cyst?,
bilateral hydronephrosis were observed, and
the pregnancy was interrupted.
The autopsy identified the posterior urethral
valve and the extreme dilation of the bladder
as the consequence of urinary tract
obstruction developed in the fetus.
Courtesy of L. Kaiser, SZTE Pathology

Gonorrhoea
• 2-7 days after exposure: acute purulent
urethritis
• Complications: purulent prostatitis,
seminal vesiculitis, epididymitis
Late consequences:
• Urethral stricture  urinary tract
obstruction
• Fibrosis of the prostate
• Fibrosis of the epididymis; if bilateral:
obstructive azoospermia
Dr. Husz Sándor, Dermatology

Venereal ulceration of the glans penis
• Genital herpes: HSV2, HSV1 (increasing incidence due to practice of oral
sex); painful vesicles  ulcer + inguinal lymphadenitis
• Firm chancre: Treponema pallidum; painless firm ulcer + painless inguinal
lymphadenitis; heals with a subtle scar; 2 months later: secondary syphilis:
gen. lymph node enlargement, mucocutaneous lesions
• Soft chancre (chancroid): Hemophilus ducreyi; common in Africa and
Southeast Asia; painful soft ulcer + painful inguinal lymphadenitis with
central abscesses

Firm (luetic) chancre:
painless ulcer
at the site of
initial
inoculation
Dr. Husz Sándor, SZTE Dermatology

Phimosis
Abnormally small orifice in the foreskin; does not permit the retraction of the
foreskin over the glans penis
Füzesi Kristóf, SZTE, Pediatrics

Condyloma acuminatum (venereal wart). Cauliflowerlike lesions involving the
coronal sulcus, the glans, and inner prepuce

Penile intraepithelial neoplasia.
Plaques on the glans, prepuce and orifice.

Carcinoma of the penis

Partial penile
amputation
because of
invasive SCC of
preputium, coronal
sulcus and glans.
Formol-fixed
specimen.

62-y-old man with type 2 diabetes who
suffered from a large abscess of
prostate (arrow) and purulent cystitis
and died of urosepsis.
E. coli grew from the exudate.
L. Kuthi, Department of Pathology

Morphology
Gross
• Nodular enlargement
(60-100 g; normal: 20 g),
• The nodules have no
capsule

Frequent: the hyperplastic nodule elevates the trigone and compresses the internal urethral
meatus. Note trabecular hypertrophy and acute cystitis

Obstruction of urinary flow caused by hyperplastic nodule

Nodular hyperplasia of
prostate, obstruction of
urinary flow,
bilateral ureterectasis,
pyelectasis
and hydronephrosis.
The patient had renal
failure
Prostate
Bladder

Infection of residual urine in the bladder: acute cystitis, ascending pyelonephritis

Morphology
Gross
• PCCs arise
multifocally in the
peripheral posterior
zone of the prostate,
facilitating palpation
during rectal digital
examination
• Appear as multifocal
firm, grayish-
yellowish masses
(arrow)

Urinary bladder
Carcinoma invading the periprostatic tissues; the prostatic urethra is narrowed
(arrow).

Continuous spread: involvement of seminal vesicles.
Lymphatic metastases (arrow) along the iliac arteries
Rectum
Seminal
vesicle

Prostatic carcinoma: hematogeneous metastases in the spine
(retrograde venous spread)

Twisting of the spermatic cord  hemorrhagic necrosis of the
testis; orchiectomy had to be performed
Füzesi Kristóf, SZTE, Pediatrics

Varicocele (marked) and small seminoma were verified during the evaluation
of 26-y-old man with oligospermia

Seminoma invading the paratesticular structures:
homogeneous, lobulated cut surface

Non-seminomatous GCT
involving almost the entire testis,
invading the extratesticular structures,
and spread along the spermatic cord.
The heterogeneous cut surface
indicates extensive necrosis within
the tumor; the feature of NSGCTs

Non-seminomatous mixed GCT
(this case: seminoma + embryonal cc + teratoma)
T
E
S

BC Screening
• Before the advent of
breast cancer
screening programs
breast cancer was
mainly detected as a
symptomatic disease.
• In the era of BC
screening many cases
are detected in an
asymptomatic (non-
palpable) stage; many
in the non-invasive or
„in situ” phase

Malar rash
Erythema affecting the
facial butterfly (malar)
area (bridge of the nose
and cheeks);
upper eyelids and
nasolabial folds are
not involved
Husz Sándor, Dermatology

Photosensitivity
Dermatitis at sites
exposed to sunlight
Pokorny Gyula, Rheumatology

Angoinvasive aspergillosis
Angioinvasive aspergillosis

Confluent foci of lethal
pulmonary hemorrhage in
SLE, not verified clinically
23-year-old female. Coughs
for 2 weeks, dyspnoe,
weakness and pain in her
knees and shoulders. Low
grade fever.
Chest X-ray: bilateral patchy
opacities; left-sided pleural
effusion.
Proteinuria 2+, urinary
sediment: 25 RBCs,
se-creatinin 180 umol/L;
Hematocrit: 26

5 manifestations were present
simultaneously
Coughs, dyspnoe, bilateral
patchy opacities  pulmonary
hemorrhage
Weakness and pain in her
knees and shoulders 
polyarthritis
Low grade fever  active
disease
Left-sided pleural effusion 
pleurisy
Proteinuria 2+, urinary
sediment: 25 RBCs,
se-creatinine 180 umol/L 
lupus nephritis
Hematocrit: 26  anemia

Radiographic hallmark of RA: erosions in joints
Normal
joints

Fusiform swelling of the joints

Progressive pulmonary fibrosis
Cobblestoned pleural surface owing to the retraction of fibrosis
along the interlobular septa

Dermal fibrous thickening: prevents movements of fingers
Prof. Pokorny Gyula, Rheumatology
Scleroderma
Skin thickinenin of both hands extending
proximal to metacaropphalengeal joints

Prof. Pokorny Gyula, Rheumatology
Thickening and tightness of the
skin  mask-like face
c c

Raynaud’s phenomenon due to small vessel obliteration.
Gangraene of toes  autoamputation
Ondrik Zoltán, SZTE, Internal Medicine

Clinical syndromes of pituitary disease
Anterior pituitary
syndromes
Posterior pituitary
syndromes
- Nonfunctional adenomas / carcinomas
- Metastases
- Surgery, irradiation
- Inflammation
- Ischemic necrosis
- Pituitary haemorrhage (apoplexy)
- Hypothalamic diseases (rare)
Hyperpituitarism
Hypopituitarism
Local mass
effects
- Functional adenomas
- Functional carcinomas (very
rare)
- Hypothalamic diseases (rare)
Diabetes insipidus
ADH deficiency
Syndrome of
inappropriate ADH
secretion (SIADH)
ADH excess
↑ secretion of
trophic hormones
↓ secretion of
trophic hormones

Gross: Nonfunctional adenoma bulges from the sella (autopsy case)
Macroadenoma
more than 1 cm
Downward extension to inferior sella turcica

Cross section of the adenoma
Cavernous sinus
Carotid
Carotid Tumor
Tumor
Oculomotor nerve
Carotid
Carotid
Grayish tan with cystic degeneration
Necrosis and Hg can be seen
Irrguular shape
Inﬁltrate or compress neighbouring structures

patho(gross).pdf

Recomendados

Recomendados

Mais conteúdo relacionado

Semelhante a patho(gross).pdf

Semelhante a patho(gross).pdf (20)

Mais de bnvj

Mais de bnvj (11)

Último

Último (20)

patho(gross).pdf