Case # 1, Alcoholic liver cirrhosis

1. Alcoholic Micronodular cirrhosis of the liver:

This is a liver specimen with an irregular scarred capsular surface and
shows fine, diffuse, nodularity, the nodules varying from 1-3 mm in
diameter. Note also the yellowish-brown discoloration
* Hepatic cirrhosis is defined as a diffuse fibrosis, irreversible condition
characterized by hepatocellular injury leads to compensatory
hyperplasia (regenerative nodules) with disruption of the normal
architecture. Subclassified into 2 types on the basis of the size of
nodules;
Micro-nodular is less than 3 mm. and Macro-nodular is
larger than 3 mm. up to 5 cm.(is not value)
The most important classification of the cirrhosis is according to the
cause; 65% of the cases are due to alcoholic liver disease. The second
cause of the cirrhosis is chronic hepatitis B and C viruses.
* Complications: hepatic failure which leads to hepatic encephalopathy,
portal hypertension (with associated splenomegaly, ascites and
esophageal varices) and renal failure.

Case # 2, Budd-Chairi syndrome of the liver

 2.

Budd-Chairi syndrome of the liver:

This is a post-mortem liver specimen, at autopsy there were extensive

thrombosis within the efferent hepatic veins. The cut surface of the
liver shows irregular areas of intense congestion and mottling,
separated by rather pale, yellowish-brown parenchyma. Many of the
veins are visibly occluded by thrombus.
* Budd-Chairi syndrome results from occlusion of the major hepatic
veins, most often by thrombus, while many cases remain idiopathic,
recognized causes include any coagulopathy (particularly
polycythemia rubra vera), occlusion of major hepatic veins or inferior
vena cava by tumor, thrombophlebitis of the hepatic veins and various
drugs (e.g. birth control bills) or chemical toxins

Case # 3, Chronic active hepatitis & cirrhosis

3. Chronic Active Hepatitis and Cirrhosis of the Liver:

This is a post-mortem liver specimen, with the cut surface of the liver
shows an obvious irregular macronodular cirrhosis with evidence of
active hepatitis histologically by presence of piecemeal necrosis. *
Chronic hepatitis, which most often complicates hepatitis B or
hepatitis C
infection. Rare causes by drugs (such as methyl dopa) or autoimmune
hepatitis. *Chronic active hepatitis usually represents a particularly
aggressive host response to type B or C infection. Its significance lies
in the fact that changes in the lobular liver architecture leads to
cirrhosis in 50 % or more of patients.

Case # 4, acute fulminant viral hepatitis

 4. Acute Fulminant Viral Hepatitis of the Liver with massive

necrosis:
This is a post-mortem liver specimen of elderly man died from hepatic
failure after infection by acute viral hepatitis.
The cut surface of the liver is notably pale, enlarged in size (normally,
the liver in fresh state weighing only 670 gram = approximately 11/2
pound) and representing almost total necrosis with a few islands of
viable hepatic parenchyma remaining as brownish foci on the left.
*Microscopic finding : Multifocal areas of necrosis with lymphocytic
infiltrate, degeneration of hepatocyte cells, hyperplasia of Kupffer cells
and councilman bodies (fragmented, eosinophilic staining and
shrunken cells).
*Causes of the acute viral hepatitis include 5 types (please see the table
in page 101 of A Lecture Guide of Pathology II).
*Complications: Patients become carriers of infection or may develop
chronic hepatitis, cirrhosis or hepatocellular carcinoma

Case # 5 Hepatocellular carcinoma with cirrhosis

 5. Hepatocellular Carcinoma with Micronodular Cirrhosis of the

Liver:
This is a post-mortem liver specimen.
The cut surface of this liver shows a fine, uniform, micronodular
cirrhosis. A rounded, partly bile-stained tumor, measuring 6.5 cm in
diameter, arises near the diaphragmatic surface and appears wellcircumscribed. A similar tumor is apparent at the bottom right.
*Hepatocellular carcinoma is relatively uncommon in Caucasians but
appears increasing incidence in Asia and Africa. This tumor most
often affects adults between the ages of 40 and 60 with pre-existing
cirrhosis (This is the most common cause), also cirrhosis of chronic
active hepatitis B&C. A well-recognized environmental carcinogen, is
aflatoxin derived from a fungus (such as aspergillus flavus) in food.
* Prognosis is very poor with few patients surviving more than one
year.

Case # 6, Cholelithiasis of the gall bladder

 6. Cholelithiasis of the Gall Bladder:

These calculi were removed from a woman who had undergone
cholecystectomy.
The specimen consists of a very large number of yellowish-brown
calculi, ranging in diameter from 0.2 -2 cm. Many of the stones have
facetted surfaces, a result of their rubbing against one another in the
gall bladder.
Cholelithiasis is an extremely common condition, particularly with
advancing age, but is often asymptomatic. Females are affected twice
as often as males and recognized predisposing factors include obesity,
multiparity, diabetes mellitus, chronic hemolytic anemia, there is also
an increased familial incidence. * Types: cholesterol, bile pigment or
mixed type (the mixed type is the most common type).

Case # 7, Acute cholecystitis of the gall bladder

 7. Acute Cholecystitis of the Gall Bladder:

This specimen was excised from a woman, following a long history of
non-specific dyspepsia. No gall stones were found.
The gall bladder has been opened to show marked mucosal and
transmural congestion and edema, associated with a multifocal
fibrinopurulent exudate. Acute cholecystitis in the absence of
cholelithiasis is uncommon, but may be idiopathic or bacterial
infection

Case # 8, Acute hemorrhagic pancreatitis

 8.

Acute Hemorrhagic Pancreatitis of the Pancreas:

The pancreas is markedly swollen and extensive hemorrhagic necrosis,

particularly in the body. A small fragment of adjacent adipose tissue
(portion of the greater omentum) shows multiple foci of bright yellow
necrosis.
*Acute pancreatitis is very common, accounting for approximately 1 in
500 hospital admissions in the western world. 70% of the cases
associated with alcoholism and gall stone diseases.
*It results from the sudden onset of enzymatic autodigestion of the
pancreatic parenchyma and adjacent tissues. Activation of protease and
lipase leads to the destruction of the pancreatic tissue, blood vessel wall
(hence the hemorrhage) and adjacent adipose tissue.
*This extensive tissue damage, associated with loss of blood and body
fluids, may lead to the development of shock and renal failure.
*Prognosis : death in up to 10% 0f the cases.

Peritonitis due to acute pancreatitis

Case # 1, Horseshoe Kidney

 1. Horseshoe kidney:
Both kidneys with the aorta, renal arteries and ureters are shown. The
kidneys are enlarged and united at their lower poles by an isthmus of
renal tissue which leis over the aortic bifurcation.
*Renal fusion is not rare abnormality, being found in about 1 in 250
autopsies results from an embryological failure of ascent of
nephrogenic tissue. Associated abnormalities of the vascular supply
and ureters are common. This deformity is more common in males
than females

Case # 2, Adult polycystic disease

 2. Adult Polycystic disease with renal transplant:

These are post-mortem specimens from adult male who was found to
have polycystic disease 6 years before his death. Later he underwent
renal transplantation.
* The two diseased kidneys are grossly enlarged and the parenchyma is
replaced bilaterally by numerous cysts of varying size. The cysts are
smooth-walled and some contain gelatinous material. Hemorrhage is
apparent within a few of the cysts. The renal hemograft (center) is
normal in appearance and serves to demonstrate the size of the patient's
own kidneys.
* Adult polycystic disease is a common condition which has an
autosomal dominant inheritance.
Patients most often present in middle age, either hematuria,
hypertension or pyelonephritis. * Associated with other anomalies such
as liver cysts and Berry aneurysms in the circle of wills.
* Complications of hypertension (as MI), and chronic renal failure

Case # 3, Acute tubular necrosis

 3. Acute Tubular Necrosis:

This is a post-mortem specimen from a person who committed suicide
by taking drug (paracetamol). * The kidney shows pallor and swelling
of the cortex and intense congestion of the medulla.
* Acute tubular necrosis is an important cause of acute renal failure. *
It most often results from sever renal ischemia as seen in hypotensive or
hypovolemic shock , it may be nephrotoxic in origin, for example after
ingestion of heavy metals, antibiotic (aminoglycosides) and anesthetic.
* Prognosis: better prognosis with nephrotoxic than ischemic type.

Case # 4, Acute suppurative pyelonephritis

 4. Acute Suppurative Pyelonephritis:

This specimen was excised from a young woman who was acutely ill
with Escherichia Coli septicemia. Because of severe pain in the left
flank, ureteric catheter specimens of urine were examined and only that
on the left was infected. Nephrectomy was performed and the patient
mad a rapid recovery.
* The kidney has been sectioned to show numerous abscess, mainly in
the cortex, surrounded by zone of hyperemia, with thickened,
edematous renal pelvis
* Acute pyelonephritis is due to gram negative bacilli (E.coli or
Proteus) in the majority of the cases. Infection is most commonly
ascending in origin. In young adult females are most often affected,
while in older adults males predominate.
Common predisposing causes include urinary obstruction,
instrumentation of the urinary tract, pregnancy, vesicouretric reflux and
diabetes mellitus.
* Modern antibiotic therapy had led to greatly improved treatment of
these cases, nephrectomy is very rarely necessary.

Case # 5, Oxalate stones (nephrolithiasis)

 5. Oxalate Stones from Renal Pelvis:

The specimen on the left was removed from a person who had a
history of intermittent painless hematuria for long time, but no clinical
details on the right specimen.
Both stones have formed a cast of the renal pelvis and are covered with
small, sharp crystalline projections. While the one on the left is pale,
the right side stone is dark brown in color due to deposition of blood
pigment from pelvicalyceal hemorrhage caused by abrasion by rough
surface of the stone. * Calcium oxalate stones are the most common
type of the renal stones (urolithiasis).

Case # 6, Renal cell carcinma of the kidney

(Adenocarcinoma)

 6. Renal Cell Carcinoma of the Kidney (Adenocarcinoma,

previously known as Hypernephroma):
This is a nephrectomy specimen from old person who had suffered
intermittent hematuria for 7 years.
A section through the kidney shows virtual replacement of the
parenchyma by a tumor mass measuring 13 X 10 cm. It has the
characteristic appearance of a renal carcinoma, being predominantly
golden-yellow in color with area oh hemorrhage, fibrosis, necrosis and
cyst formation. The adjacent renal pelvis is compressed.
* Adenocarcinoma of the kidney is the most common primary renal
malignant tumor and predominantly occurs in older adults, affecting
males more than females.
*These tumors are derived from renal tubular epithelium and usually
arise in the cortex. Associated systemic manifestations are common
and include fever, hypercalcemia (due to parathormone), polycythemia
(due to erythropoietin) and hypertension (due to renin).
* Spread : local invasion, grow along renal vein (blood metastasis) to
the lungs and lymphatic to the periaortic lymph nodes.
* Treatment : surgery and radiotherapy

Case # 7, Cystitis of the urinary bladder

 7. Cystitis of the Urinary Bladder:

This is a post-mortem specimen from a person who suffered from
severe urine infection with foul-smelling of the urine.
The bladder has been opened to show intense congestion of the
posterior wall. On the left, the ostium of a small diverticulum is visible
just above the ureteric orifice and on the right, there are small flecks of
calcific material adherent to the urothelium.
* Acute infection of the urinary tract is most often due to E. Coli and
Proteus group.
* Predisposing factors include diabetes mellitus, radiation therapy,
instrumentation (catheter), neurogenic bladder and chemotherapy.

Case # 8, Papillary transitional cell carcinoma

of the urinary bladder

 8. Papillary Transitional Cell Carcinoma of the Urinary Bladder:

This papillary tumor, measuring 2 cm. in diameter, has been excised
from the bladder. It has been bisected to show the typical long,
branching villous processes. At the core is a small fragment of muscle
from the bladder wall which shows superficial invasion by tumor.
Unknown cause but carcinogenic chemicals (aniline dye) are high risk
to develop cancer.
* Transitional cell carcinoma is the most common primary malignant
tumor of the bladder, predominantly in males over the age of 50's.
While these tumors tend to be multiple, the trigone is the single
common site. Most of the patients present by painless hematuria.
* Metastasis by either local invasion or lymphatic spread.
* Prognosis: high incidence of recurrence and overall, 5 year survival
rate is 30%.

Case # 1, Maldescent of testis (cryptorchidism)

 1. Maldescent of Testis:
The left side of the scrotum was noted to be empty and the
corresponding testis was found in the left inguinal canal, at the head of
a hernial sac.
* Both testes have been sectioned to contrast the normal right testis
with the imperfectly descended left one, which is markedly atrophic
and appears fibrotic.
Incidence : is about 4 % in male neonates and about 1 % in all males
over the age of 1. The most common sites of arrest in the normal path
are high in the scrotum, the superficial inguinal pouch, the inguinal
canal or within the abdomen. If brought down into the scrotum by the
age of 4-6 years, such testes can retain normal function. If left, the
affected testis will fail to show spermatogenesis and there is an
increased risk of developing a testicular neoplasm, most commonly a
seminoma.

Case # 2, Seminoma of
the testis

 2. Seminoma of the Testis:

This specimen was excised from a man who had noticed gradual
enlargement of the testicle for 6 months.
The testicle has been sectioned to show a pale solid ovoid tumor, which
has replaced the entire body of the testis with nodularity than is usual.
The tunica vaginalis is closely adherent over most of the testis, the
remaining space containing some recent blood clot. Notice that the
tumor has invaded the epididymis. * Seminoma is the most common
primary malignant tumor of the testis and arises most often in patients
30-40 years of age. It is classically a well-circumscribed tumor of
uniform grayish-pink color, which occasionally shows foci of necrosis
but is rarely hemorrhagic.
It spreads largely by lymphatic. These tumors are very radiosensitive
such that 5-year survival is now at least 95 %.

Case # 3 malignant teratoma of the testis

 3. Malignant Teratoma of the Testis:

The specimen was excised from a young man who presented by a one
month history of a painless swollen testis. The testis is enlarged and
contains a well-defined tumor, composed largely of solid pale tissue
with cystic foci. There is a rim of residual normal testis at the upper
pole and the cord shows no evidence of invasion.
* Teratomas account for 30 % of primary testicular tumors and are
most common in the third decade. A very small proportion arise in
undescended testes. * Spread is both lymphatic and hematogenous.
Five-year survival has improved dramatically in recent years with the
addition of sophisticated chemotherapy to radiotherapy

Case # 4 Benign
Prostatic Hyperplasia
(hypertrophy)

 4. Benign Hypertrophy of the Prostate:

The bladder has been opened to show a symmetrically enlarged
prostate gland at its base, with a prominent 'middle lobe' which
projects into the trigone and obstructs the bladder neck. The prostate
shows marked nodularity and the bladder is trabeculated.
This is the typical appearance of benign, prostatic, nodular hyperplasia
which is increasingly with the age and is almost universal in men in the
8th and 9th decades. It results from proliferation of both the
connective tissue and glandular components, usually of the inner group
of glands in the middle and lateral lobes. It is thought to be due to an
imbalance in the androgen / estrogen ratio. The main complications
are those of urinary obstruction.
This condition does not predispose to carcinoma of the prostate.

Case # 5 Adenocarcinoma of the prostate

 5. Adenocarcinoma of the Prostate:

This is a post-mortem specimen of old man who had been treated for
carcinoma of the prostate. The enlarged prostate has been sectioned
transversely to show diffuse, irregular infiltration by pale, scirrhous tumor,
which extending into the adjacent soft tissue.
* Adenocarcinoma is much the commonest epithelial malignancy of the
prostate arising from major prostatic ducts. Adenocarcinoma, like benign
hyperplasia, is increasingly common with age .
* It principally affects the outer group of gland particularly the posterior
lobe and is often multifocal. It has a tendency to metastasize to bone,
giving rise to osteoblastic secondaries which elevates alkaline phosphatase
levels
* Etiology is unknown, but hormonal factors are thought to be important,
prostatic carcinoma is especially common in Western world.
Treatment: surgical by orchiectomy or medical by a new medicine
(Leuprolide)
Prognosis: Poor

Case # 1, Endometriosis at the umbilicus

 1. Endometriosis at the umbilicus:

This specimen was excised from a woman who noticed a pigmented
nodule at the umbilicus for 3 years. The nodule steadily increased in
size and bled at the menstrual periods.
The umbilicus has been sectioned to show a smooth, rounded, fibrous
nodule projecting from the surface. Numerous tiny cysts and foci of
brown discoloration are barely visible within the lesion.
Endometriosis is abnormal location of the endometrial tissue outside the
uterus and usually causes symptoms during the reproductive years due
to the normal cyclical changes that the ectopic tissue undergoes. Some
patients with endometriosis present with infertility but others are often
cured by undergoing a normal pregnancy. Very occasionally
endometriotic foci may develop hyperplasia or even carcinoma.

Case # 2, Endometrial
carcinoma of the uterus

 2. Endometrial Adenocarcinoma of the Uterus:

This specimen was excised from a nulliparous old woman in whom the
menopause had occurred 9 years previously and who presented with
postmenopausal bleeding.
The uterus has been sectioned in the sagittal plane to show a pale
neoplasm arising in the fundus and projecting into the uterine cavity
and widely infiltrating the muscle coat.
Endometrial carcinoma accounts for about 10 % of female malignant
disease. The majority of cases arise postmenopausal and known
associations include infertility, nulliparity, obesity and possibly
hypertension and diabetes mellitus.
Clinical manifestations: patient presents with vaginal bleeding in
postmenopausal women.
Prognosis: it is dependent upon tumor grade, depth of myometrial
invasion and clinical stage, but overall 5-year survival rate is of the
order of 85 %.

Case # 3, Leimyoma of
the myometrium
(Fibroid)

 3. Leiomyoma of the Myometrium ( Fibroid of the Uterus) :

This specimen was excised from a woman who presented with a 3 year
history of dysmenorrhea and metrorrhagia. Most recently she had
noticed an abdominal mass and she developed intermittent constipation
and urinary frequency.
This grossly enlarged and distorted uterus has been sectioned to show
multiple, well-circumscribed intramural and submucosal tumors which
have displaced and compressed the uterine cavity. The all lesions have
a typical whorled appearance except one on the left which has
undergone degeneration and dystrophic calcification.
*Leiomyomas, known as 'fibroid', are most common benign tumor of
uterine smooth muscle which arise only during the reproductive years.
They are often multiple and are thought to result from estrogenic
stimulation (enlargement is common during pregnancy or with the use
of oral contraceptive). Malignant changes are very rare.

Case # 4, Pyosalpinx of
the fallopian tube

 4. Pyosalpinx of the Fallopian Tube:

This specimen was excised from a middle age woman who presented
with infertility and dysmenorrhea. A bilateral salpingo-oophorectomy
and hysterectomy were done.
The fallopian tubes attached to the uterus and ovary are shown. There
are dense adhesions, the wall of the fallopian tube is thickened and
fibrotic and there are a series of abscesses within the tube.
Pyosalpinx is usually bilateral and represents the result of prolonged or
particularly severe bacterial salpingitis. The most common organisms
which responsible for this disease are chlamydia , gonococcus,
mycoplasma, ....etc. The predisposing factors include intrauterine
devices (IUDs), surgical instrumentation and abortion, but most cases
are sexually transmitted.

Case # 5, Squamous cell carcinoma of the uterine cervix

 5. Squamous Cell Carcinoma of the Uterine Cervix:

This specimen was excised from a 49-year old multiparous woman who
had noticed irregular bleeding for the last 3 months.
A sagittal section through the uterus and upper vagina shows a bulky,
polypoid tumor arising from the external cervical os and extending into the
vaginal vault. The surface of the tumor is extensively ulcerated.
Carcinoma of the cervix is common but has declined due to screening with
yearly pap smears.
It increased, particularly in younger women and most often in the 4th and
5th decades.
The most important risk factor is early age at first coitus, of which
promiscuity, early marriage or pregnancy, multiparity and lower social
class are co-variable.
Spread: Local spread causing ureteral obstruction and renal failure (which
is the most common cause of death in case of carcinoma of cervix ),
lymphatic and may be hematogenous spread to the lung and liver.
Prognosis: overall, 5-year survival chance is 60 %.

Case # 6, Fibrocystic disease of the breast

 6. Fibrocystic Disease of the Breast:

This specimen was excised from a woman who had noticed lumpiness
and pain in both breast for several years, which was aggravated during
menstruation.
The breast tissue shows numerous irregular cysts, some of which
contain creamy-white material, mixed with excessive connective
tissue.
* Fibrocystic disease, also known as cystic hyperplasia or cystic
mastitis, may affect up to 5 % of females and usually presents in the
age of 20 and 40, almost always before the menopause. It is thought
to result of hormonal imbalance with exaggeration and distortion of the
cyclic changes that normally occur in the menstrual cycle. The typical
histological changes of fibrosis, adenosis, cyst formation, apocrine
metaplasia and epitheliosis may each be present to a varying degree.

Case # 7, Fibroadenoma of the breast

 7. Fibroadenoma of the Breast:

This specimen was excised from a young woman who had noticed a
slowly growing lump in the right breast for 3 years. The mass was
tender during menstruation. Examination revealed a smooth, discrete
mass, which at operation was easily separated from the adjacent
compressed breast tissue.
* A rounded, coarsely lobulated benign
tumor, measuring 8 cm in diameter, is surrounded by a smooth fibrous
tissue.

Case # 8, Adenocarcinoma of the breast

 8. Adenocarcinoma of the Breast:

This specimen was from a 55-year old woman with a 3-month history of a firm
painless enlarging lump in the right breast. At presentation, firm axillary lymph
nodes were palpable.
A section through the breast shows an irregular, rounded tumor, measuring 4 cm in
diameter. The tumor is adherent to both the skin and pectoral fascia. At the top left
of the picture an enlarged lymph node replaced by metastatic tumor is seen.
* Carcinoma of the breast occurs in 1 out of every 10 woman in the United States,
the most common cancer in females and the second most common cause of death
due to cancer (lung is the first cause).
* The etiology remains uncertain but the following factors have been noted:
Family history, increasing age (uncommon before age 25), geographic influences
(more in United States), previous history of contralateral breast cancer, early
menarche, nulliparity, late menopause, obesity, low fiber and high fat diet,
endometrial cancer or history of irradiation therapy.
* Adenocarcinoma of the breast may be of lobular or ductal origin, the latter group
constituting at least 90 %. Up to 50 % of carcinoma develops in the upper, outer
quadrant of the breast, which therefore spread to axillary lymph nodes,
approximately 50 % of all cases show metastatic involvement of lymph nodes at
presentation. Spread by blood in late stage, to the lungs, liver, bone and adrenal.