A1 - ACUTE MENINGITIS

Gross :

Acrylic jar mounted, formalin fixed specimen of whole BRAIN, measuring about 20 ˣ 10 ˣ 10 cm.
Meninges are seen on the top of the brain. Infiltration of leptomeninges & CSF within subarachnoid
space.
Loss of normal lustier and translucency of the normal meninges.
Purulent material deposited beneath the meninges.
Severely congested meningeal vessels.
It also shows grayish white exudates.
Tb meningitis : Cob web formation

Microscopy :

Neutrophilic infiltration.
Entire subarachnoid space is filled with neurophils in severe cases of meningitis.

A1 – Acute meningitis
Slide 14 – Acute meningitis
Gross:

1. Enlarged

2. In terminal stages of the disease, there is contraction due to ischaemic effect of narrowing of
vascular lumina

3. Cut surface is pale, waxy and translucent

4. Sectioned surface shows loss of cortico-medullary distinction

Diagnosis:

1. Congo-red staining- red pink colour

2. Polarising microscopy- apple green birefringence

 B6 - Fibrosarcoma Bone

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of BONE, measuring about 10 ˣ 6 ˣ 2 cm.
The specimen shows outer & inner cut surfaces of the bone.
Cut surface shows a grey-white, firm, lobulated & characteristically circumscribed mass.
Cut surface of the tumour is soft, fish-flesh like with foci of necrosis & haemorrhage.
The tumour is fibrosarcoma. It is malignant tumour & common in lower limbs especially thighs &
knee.
Microscopy :
The tumour is composed of uniform, spindle-shaped fibroblasts arranged in intersecting fascicles.
Such areas produces herring-bone pattern.

B6 - Fibrosarcoma Bone
Slide 40 - Fibrosarcoma Bone
Papillary Urothelial (Transitional Cell) Carcinoma

Gross:

1. Most commonly located in the lateral walls, followed by posterior walls and trigone area.

2. These papillary tumours have fern-like arrangement with a broad or narrow pedicle.
It is the classic breast cancer and is the most common histologic pattern of breast cancer(80%). This
is the pattern of cancer, for which Hippocrates coined the terms “cancer” and “carcinoma”.

Gross:

1. Most commonly found in the left breast in the upper outer quadrant.

2. Retraction of nipple may be seen

3. Peau de orange appearance may be seen

4. The tumor mass is irregular, hard, cartilage-like mass.

5. The cut surface of tumor is grey-white to yellowish with chalky streaks.

Bronchiestasis is defined as abnormal and irreversible dilatation of bronchi and bronchioles(greater
than 2mm in diameter) following inflammatory weakening of bronchial walls.

The most characteristic finding is persistent cough with expectoration of copious amounts of foul-
smelling, purulent sputum.

Causes:

1. Cystic Fibrosis

2. Immotile cilia syndrome, i.e., Kartagener’s syndrome (Triad of Bronchiectasis, situs inversus and
sinusitis[and infertility in males due to immotile sperms])

3. Endobronchial obstruction due to foreign bodies, tumours, enlarged hilar lymph nodes and post-
inflammatory scarring, eg. in healed TB.

4. As a secondary complication of Necrotizing pneumonias as in TB, Staphylococcus suppurative

pneumonia(esp by CA-MRSA strains)

Gross:
1. The pleura is usually fibrotic(carnification) and thickened with adhesions to the chest wall.

2. The dilated airways can be of 4 diff types, namely, Cylindrical, Fusiform, Varicose, Saccular.

3. Cut surface of the affected lobes(mainly the lower lobes) shows characteristic honey-combed
appearance.

Other conditions in which honeycombed lung appearance is present:

Other conditions in which honeycombed lung appearance is present:
a) Pulmonary TB
a) Pulmonary TB
b) Primary lung abscess (due to aspiration)
b) Primary lung abscess (due to aspiration)
c) Secondary lung abscess
c) Secondary lung abscess
d) Aspergillosis, Mucormycosis
d) Aspergillosis, Mucormycosis
e) Actinomycosis, Nocardiosis
e) Actinomycosis, Nocardiosis
f) Pneumoconiosis, eg., Coal workers’ pneumoconiosis, Asbestosis, Silicosis
f) Pneumoconiosis, eg., Coal workers’ pneumoconiosis, Asbestosis, Silicosis
g) Bronchogenic CA
g) Bronchogenic CA
h) Metastatic Lung CA
h) Metastatic Lung CA
i) Idiopathic Pulmonary Fibrosis
i) Idiopathic Pulmonary Fibrosis
j) Wegener’s granulomatosis
j) Wegener’s granulomatosis

4. The bronchi are extensively dilated, their walls are fibrotic and thickened, and the lumina is filled
with mucus or mucopus.

Complications:

1. Amyloidosis

2. Clubbing of the fingers

3. Cor Pulmonale

4. Metastatic abscesses (especially to the brain)

The tumor arises from the respiratory epithelium lining the bronchi or bronchioles or even alveoli.

Etiologic Factors:

1. Smoking

2. Radiation exposure

3. Atmospheric Pollution

4. Occupational causes: Asbestosis, Berylliosis, Arsenic etc

5. Vitamin A deficiency

Gross:

2 types-

1. Hilar type: More common, cancer arises from the main bronchus or one of its segmental branches
in hilar parts of the lungs, more on the right side. The tumor begins as a small roughened area on the
bronchial mucosa at the bifurcation. The tumor is a friable nodular, spherical mass narrowing and
occluding the lumen. The cut surface of tumor is yellowish-white with foci of necrosis and
haemorrhages and this produces cavitary lesions resembling honey-combed appearance.

2. Peripheral type: Seen in adenocarcinomas and bronchioalveolar carcinomas. There is pneumonia

like consolidation. Cut surface is greyish and mucoid.

5 Histologic types:

a> Squmaous cell CA

b> Small Cell CA
c> AdenoCA (most common)
d> Large cell CA
e> Adenosquamous CA
Bronchopneumonia or Lobular pneumonia is infection of the terminal bronchioles that extends into
the surrounding alveoli resulting in patchy consolidation of lung. It mainly occurs at extremes of
age(infancy and old age), in patients suffering from chronic lung diseases, and as secondary infection
following viral respiratory infections such as influenza, measles etc.

Causative Bacteria: Staphylococcus, Streptococcus pyogenes, Pneumococcus, Klebsiella pneumonia,

Haemophilus influenza, E. coli, Pseudomonas.

Gross:

1. Patchy areas of red or grey consolidation affecting one or more lobes.

2. Mostly bilateral

3. Mostly found in the lower lobes due to gravitation of the secretions.

4. On cut section, these areas are dry, granular, firm, red or grey in colour, slightly elevated over the
surface and are often centred around a bronchiole.

Complications: Same as Lobar Pneumonia.

Acrylic jar mounted, formalin fixed cut open section of aorta.

Serosal , intimal surfaces.

Intimal surface shows irregular hard, yellow white lesions in the form of elongated beaded
streaks, raised above the surface.

Few have ulcerated surface and dystrophic calcification.

These are atheromatous plaques.

Hence this is a specimen of complicated atherosclerosis of aorta.

 C1 - Fibrinous Pericarditis

Gross :
Acrylic jar mounted, formalin fixed specimen of HEART, measuring about 10 ˣ 10 cm.
Its shows the outer surface of heart with fibrinous ulceration of pericardium.
The pericardium is rough & adherent.
Whitish granular exudates appear on the pericardial surface of the heart.
It measures about 5 to 6 cm.
Bread and butter appearance
Microscopy :
Pericardium is covered with pink serofibrinous exudates.
The serosal layers shows dense infiltration by neutrophils.

C1 - Fibrinous Pericarditis
Slide 55 - Pericarditis
Acrylic jar mounted, formalin fixed specimen of heart.

Pericardium appears pale, rough, with loss of its normal lustre and translucency and it is
adhered to the heart . it shows fibrinous exudates that gives it a characteristic ‘bread and
butter’ appearance.

Hence this is a specimen of fibrinous pericarditis.

 C2 - Brown Atrophy of Heart

Gross :
Acrylic jar mounted, formalin fixed specimen of HEART, measuring about 8 ˣ 6 ˣ 4 cm.
The heart is small, shrunken & brown coloured.
The coronary vessels on the heart are congested & tortuous..
The brown colour is due to Lipofuscin or Lipochrome pigment
.
Microscopy :
The Lipofuscin pigment is seen in atrophied cells of old age & hence the name wear & tear pigment.
The pigment is golden brown in colour & accumulates in the central part of the cells around nuclei.
There is wasting of cardiac muscle which is known as brown atrophy of heart.

C2 - Brown Atrophy of Heart

Slide 13 - Brown Atrophy of Heart
Acrylic jar mounted, formalin fixed specimen of heart.

The heart is small, shrunken with tortuous, congested blood vessels. Hence it is not
paediatric heart.
 C3 - Atherosclerosis Complicated

Gross :
Acrylic jar mounted, formalin fixed cut open specimen of AORTA, measuring about 15 ˣ 7 cm.
Its shows intimal surface & adventitial surface.
Intimal surface shows white to yellowish-white patches along with ulcerations.
These lesions are raised on the surface.
Atheromatous plaques are 1 – 2 cm in diameter.
Cut section of the plaque shows fibrous cap & central core.
Microscopy :
Superficial part of fibrous cap is covered by endothelium & consists of smooth muscle cells,
Beneath the fibrous cap, there is cellular area consisting macrophages, foam cells, lymphocytes etc.
Central soft core consists of lipid material, cholesterol clefts, fibrin & necrotic debris.

C3 - Atherosclerosis Complicated
Slide 53 - Atherosclerosis Complicated
 C3 - Syphilitic Aortitis

Gross :
Acrylic jar mounted, formalin fixed cut open specimen of AORTA.
It is a part of Thoracic Aorta measuring about 10 to 12 cm.
It shows outer surface and inner surface.
Internal surface is rough and thick. It also shows some elevated areas.
It is called Tree Bark appearance.
(Tree bark appearance isn’t seen in Atherosclerosis. In Atherosclerosis multiple yellowish plaque
spots are observed on the inner surface.)

Microscopic :
Syphilis starts in tunica media and spreads into tunica intema.
Syphilitic aneurism can be observed with vasa vasorum obliteration.
There are 3 stages of syphilis : Primary, Secondary, Tertiary.

C3 - Syphilitic Aortitis
Slide 24 - Syphilitic Aortitis
Acrylic jar mounted, formalin fixed cut open section of aorta.

Cut section shows a bulge and thrombus formation. There is intimal tearing 3-4 cm long and
the thrombus separates the intima and inner twothird of media from the outer one third
meida and adventitia.

The aneurysm is saccular in appearance.

Hence this is a specimen of aortic aneurysm with thrombus.

 C4 (i) - Aneurysm with Thrombus - Aorta

Gross :
Acrylic jar mounted, formalin fixed cut open specimen of AORTA, measuring about 4 ˣ 3 ˣ 1 cm.
The specimen shows intimal surface & adventitial surface.
Aorta is dilated & walls are thickened.
In the dilated part of aorta, grayish-brown thrombus is seen measuring about 4 ˣ 3 cm.
Cut section of thrombus is attached to the aortic wall.
Alternative lines of Zahn are observed in the thrombus.
Microscopy :
Eosinophilic area with conversation of normal cells into their tombstones i.e. outline of the cells are
retained but the nuclear details are lost. Cells are swollen & more eosinophilic.

C10 - Myocardial Infarction with Aneurysm

 C5 - Organizing Thromus

Gross :
Acrylic jar mounted, formalin fixed specimen of cut open specimen of AORTA, measuring about 15 ˣ
5 ˣ 2 cm.
The specimen shows intimal surface & adventitial surface.
The intimal surface is degenerated & disrupted.
On the upper side, there are grayish-brown mural & occlusive thrombi measuring about 3 ˣ 3 cm & an
atheroma on the lower aspect measuring 2 ˣ 2 cm.
The thrombus is firmly attached to the vessel wall.
Cut surface shows lines of Zahn.
Microscopic :
Eosinophilic area with conversation of normal cells into their tombstones i.e. outline of the cells are
retained but the nuclear details are lost. Cells are swollen & more eosinophilic.

C5 - Organizing Thrombus
Slide 29 - Organizing Thrombus
 C7 - Dry Gangrene

Gross :
Acrylic jar mounted, formalin fixed specimen of part of left FOOT.
The specimen shows blackish discoloration of 4th finger.
It resembles with the foot of mummy.
The black color is due to formation of FeS from H2S and Haeme.
There is well defined line of demarcation between necrosed part & viable tissue.
Remaining part of the foot shows normal appearance.
Causes of dry gangrene : Arterial occlusion, ischaemia, arteriosclerosis, Burger’s disease, Raynaud’s
disease, trauma, ergot poisoning.

C7 - Dry Gangrene
 C9 - Myocardial Infarct

Gross :
Acrylic jar mounted, formalin fixed specimen of transverse section of HEART, measuring about 6 ˣ 5
ˣ 2 cm.
The specimen shows left & right ventricles with Interventricular Septum (IVS).
The specimen shows ventricular hypertrophy & dilatation.
The left ventricular wall shows an old healed subendothelial infarct area measuring about 3 ˣ 1 cm.
The infarct is replaced by a thin gray-white, hard, shrunken, fibrous scar compared to adjacent gray-
brown uninvolved myocardium.
Causes of myocardial infarct : Coronary artery thrombosis.
This is coagulative type of necrosis which is commonly seen in heart, kidney & spleen due to
ischaemia.
Microscopy :
Normal syntitial structure of cardiac muscles is lost. Nuclei are absent & pyknotic changes are seen.

C9 - Myocardial Infarct
Slide 28 - Myocardial Infarct
 C10 - Myocardial Infarction with Aneurysm

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of HEART, measuring about 15 ˣ 10 cm.
The specimen shows left & right ventricles with left atrium.
The myocardial wall is thin with dilatation of left ventricle.
In the myocardium, there is grayish-white infarct measuring 5 ˣ 0.5 cm.
This is the specimen of myocardial infarction with dilatation of ventricle i.e. aneurysm.
Microscopy :
Normal syntitial structure of cardiac muscles is lost. Nuclei are absent & pyknotic changes are seen.

C10 - Myocardial Infarction with Aneurysm

Acrylic jar mounted, formalin fixed longitudinal cut section of heart.

Demonstrate Pericardium , ventricles.

There are calcific deposits over the valve leaflets.

There are fibrous adhesions of mitral commissures and fusions and shortening of chordate
tendinae.

Hence this is a specimen of mitral valve stenosis.

Acrylic jar mounted, formalin fixed longitudinally cut section of heart.

Demonstrate pericardial surface and opened up chambers.

The mitral valve shows thickening and loss of translucency.

There are tiny vegetations or verrucae on the margins of valves so the free margins of
leaflets appear irregular and rough. They are firmly attached , not likely to get detached to
form emboli, unlike the friable vegetations of infective endocarditis.

The chronic healed mitral valve is a characteristic ‘fish mouth’ or ‘button hole’ in
appearance.

There is thickening, shortenin, fusion of chordate tendinae.

Hence this is a specimen of rheumatic endocarditis.

 C13 - Bacterial Endocarditis

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of HEART, measuring about 15 ˣ 10 cm.
The specimen shows left & right ventricles with part of aorta.
Pericardium is rough, opaque & hazy.
Mitral valve shows grey-tawny to greenish irregular vegetations.
These vegetations are typically febrile & the D/D is ‘bacterial endocarditis.’
There are 2 types of bacterial endocarditis : 1. Acute BE 2. Subacute BE.
Microscopy :
Outer layer or cap consists of eosinophilic material.
Below this layer is basophilic zone containing colonies of bacteria.
Deeper zone contains non-specific inflammatory reaction.

C13 - Bacterial Endocarditis

Acrylic jar mounted, formalin fixed longitudinal cut section of heart.

Demonstrate pericardial surface and opened up chambers.

There are irregular , soft, greyish white tawny, friable vegetations on the superior (atrial)
surface of mitral valve.

Hence this is a specimen of bacterial endocarditis.

Chronic Glomerulonephritis or End Stage Kidney or Chronic Kidney Disease

Gross:
1. Small and contracted kidneys

2. Capsule is adherent to cortex.

3. The cortical surface is diffusely granular.

4. The cortex is narrow and atrophic while medulla is unremarkable.

Causes:
1. RPGN

2. MGN

3. MPGN
4. FSGS

5. IgA Nephropathy

6.Acute PSGN

Clinical Features:
1. Hypertension

2. Uraemia

a) Primary uraemic(renal) manifestations: Metabolic Acidosis-[compensatory Kussmaul

Breathing, hypercalcemia, hyperkalemia], Hyperkalaemia-[Cardiac arrhythmias, weakness,
nausea, intestinal colic, diarrhoea, muscular irritability, flaccid paralysis], Sodium and water
retention-[Hypervolaemia, circulatory overload with CHF], Azotaemia-[elevation of urea,
creatinine, phenols and guanidines in blood]

b) Secondary uraemic(extra-renal) manifestations: Anaemia(due to decreased

erythropoietin), Uraemic frost on facial skin, Sallow-yellow colour of skin due to deposition
of urinary pigment urochrome, CHF, Pulmonary congestion and pulmonary edema, Uraemic
pneumonitis(Central, butterfly pattern of oedema and congestion in chest radiograph),
Azotaemia directly induces mucosal ulcerations in the lining of stomach and intestines;
subsequent bleeding can aggravate anaemia; further GIT irritation may cause nausea,
vomiting and diarrhoea, Renal osteodystrophy-[Osteomalacia and Osteitis Fibrosa Cystica]

3. Progressive deterioration of renal function

Etiopathogenesis:

1. Reflux nephropathy

2. Obstructive nephropathy

Gross:

1. Small, contracted kidney

2. But with unequal reduction.

3. Surface of the kidney is irregularly scarred; these scars show U-shaped depressions on cortical
surface.

4. Capsule can be stripped off with difficulty due to adherence to scars.

5. Calyectasis: Blunting and dilatation of the calyces( along with the renal pelvis).
Complications:

1. Chronic renal failure(CRF)

2. Hypertension
 D3 - CVC Lung

Gross :
Acrylic jar mounted, formalin fixed specimen of left LUNG, measuring about 12 ˣ 8 cm.
The specimen shows pleural surface and hilar surface.
The lung is large, voluminous & firm in consistency.
Cut surface is rusty brown in color, hence the name Brown Induration of lung.
The browny induration is due to pigmentation & fibrosis.
Rupture of dilated & congested capillaries causes release of RBCs.
Breakdown of RBCs causes liberation of haemosiderin pigment which is taken up by alveolar
macrophages i.e. heart failure cells.
CVC lung occurs due to left heart failure, especially rheumatic mitral stenosis.

D3 - CVC Lung
Slide 11 - CVC Lung
 D4 - Pyaemic Abscess of Lung

Gross :
Acrylic jar mounted, formalin fixed specimen of cut surface of left lobe of LUNG.
It measures about 15 ˣ 10 ˣ 7 cm.
The specimen shows pleural surface & cut surface.
Pleural surface shows white spots measuring about 0.2 to 0.5 cm.
Cut surface shows well demarcated numerous whitish grey spots measuring about 0.5 cm

D4 – Pyemic abscess of Lung

 D7 - Lung Infarct

Gross :
Acrylic jar mounted, formalin fixed specimen of slice of LUNG, measuring about 15 ˣ 8 cm.
The specimen shows pleural surface & cut surface.
Pleural surface shows chronic pleuritis.
Cut surface shows pale brownish area measuring about 3 ˣ 2 cm which is more firm than rest of the
lung.
This area is haemorrhagic infarct or red infarct.

D7 - Lung Infarct
 D12 - Tb Ghon’s Complex Lesion

Gross :
Acrylic jar mounted, formalin fixed specimen of part of LUNG (Pediatric Lung).
It measures about 7 ˣ 5 cm.
It shows pleural surface and cut surface.
Pleural surface shows yellowish small sub pleural foci. These are Ghon’s foci.
These foci measure about 0.5 to 0.8 cm.
Enlarged lymph nodes with caeseous necrosis are observed.
Ghon’s foci with enlarged lymph nodes and caeseous necrosis form Ghon’s complex.

D12 - Tb Ghon’s Complex Lesion

 D13 Tb Primary Complex
Pediatric Heart & Lungs

Gross :
Acrylic jar mounted, formalin fixed specimen of LUNGS and HEART.
The specimen is of a child. (can be recognized by small size)
The lung shows pleural surface.
Multiple yellowish small lesions of 0.2 to 0.5 cm are seen on the pleural surface.
Apical part of the lung shows cavity.
Heart is pale in appearance.
Enlarged lymph nodes are seen (also called matted lymph nodes).

D13 - Primary Tb complex - Pediatric Heart and Lungs

 D14 - Miliary Tb Lung

Gross :
Acrylic jar mounted, formalin fixed specimen of part of LUNG.
It measures about 10 ˣ 8 cm.
It shows pleural surface and cut surface.
Multiple small yellowish lesions of 0.2 to 0.8 cm are seen on both the surfaces.
These lesions are millet shaped, hence the name Miliary tuberculosis.

Microscopic :
Millets are the small seeds. Small multiple lesions are seen in the slide.
Epitheloid cells, Langhan’s giant cells are observed.
Ghon’s complex can be observed in the slide.

D14 - Miliary Tb Lung

Slide 20 - Miliary Tb Lung
 D15 - Fibrocaeseous Tb Lung

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of LUNG.
It measures about 10 ˣ 8 cm.
It shows pleural surface and cut surface.
Whitish pale appearance is seen on the upper part of lower lobe and lower part of apical lobe.
Tuberculous cavity is spherical with thick fibrous wall surrounded by yellowish caeseous necrosis.
Around the wall, foci of consolidation are seen.
D/D is Tuberculosis with Pneumonia i.e. Fibrocaeseous Lung.

Microscopic :
Eosinophilic, granular, necrotic material are observed in the slide.
Epithelioid cells, Langhan’s cells are observed.
Cavitations are seen. Lesions are filled with fibrocaeseous material.

D15 - Fibrocaeseous Tb Lung

Slide 21 - Fibrocaeseous Tb Lung
 D16 - Fibrocavitatory Tb Lung

Gross :
Acrylic jar mounted, formalin fixed specimen of part of LUNG, measuring about 10 ˣ 8 cm.
It shows pleural surface and cut surface.
Pleural surface is thickened and whitish in colour.
Cut surface shows small whitish/yellowish lesions.
Cavity at apical region is observed.
It measures about 2-3 cm in diameter.

D16 - Fibrocavitatory Tb Lung

WHO has defined Pulmonary Emphysema as combination of permanent dilatation of air spaces distal
to the terminal bronchioles and the destruction of walls of the dilated air spaces. (To differentiate it
from overinflation of lungs, we should know that in Overinflation, there is dilatation of air without
destruction or damage to the septal walls as in emphysema.)

Gross:

1. The lungs are voluminous, pale with little blood.

2. The edges of the lungs are rounded.

3. Dilatation of air spaces in mild cases. In advanced cases, there is subpleural bullae and blebs
bulging outwards from the surface. (Above one is a mild case.)

Bullae are air-filled cysts larger than 1 cm in diameter formed by rupture of adjacent air spaces.

Blebs are formed when alveoli rupture directly into the subpleural interstitial tissue.

These two are common causes of Spontaneous Pneumothorax.

5 types:

1. Centriacinar/Centrilobular: Respiratory bronchiole is affected. It coexists with Chronic Bronchitis.

It is predominantly seen in smokers and in coal miners’ pneumoconiosis. It is more common and
more severe in the upper lobes. (CU)

2. Panacinar/Panlobular: All portions of acinus (resp bronchiole+alveolar duct+alveoli) affected. It is

most often associated with alpha-1 antitrypsin deficiency in middle-aged smokers. It involves lower
lobes of lungs more frequently and more severely.

3. Paraseptal/Distal Acinar: Distal part of acinus is affected. So it is present along the pleura and
along the perilobular septa(boundary between two resp lobules). It involves upper parts of lungs
more frequently and more severely. It is the most common cause of spontaneous pneumothorax in
young adults.

4. Irregular/Para-Cicatricial: Most common form of emphysema. It is seen surrounding scars from

any cause, eg., TB. It is mostly asymptomatic.

5. Mixed: Characteristically seen in lungs of an elderly chronic smoker at autopsy, Centriacinar

emphysema in upper lobes, Panacinar emphysema in lower lobes and Paraseptal emphysema in
subpleural region.

Complications:

1. Spontaneous Pneumothorax

2. Cor Pulmonale

3. Pulmonary Hypertension
 F3 - Leiomyoma Uterus

Gross :

Acrylic jar mounted, formalin fixed specimen of UTERUS, measuring about 8 ˣ 4 ˣ 3 cm.
The specimen shows serosal surface, mucosal surface & endometrial cavity.
Serosal surface shows sharply circumscribed, nodular, round, firm, fibroid.
The fibroid is grayish-white whorled in appearance & measures about 2.5 ˣ 1.5 ˣ 1 cm.
The tumour is malignant & known as wandering tumour.

Microscopy :

Whorled bundles of smooth muscles cells are seen.

Nuclei are cigar-shaped with rounded ends.

F3 - Leiomyoma Uterus
Slide 62 - Leiomyoma Uterus
 F4 - Cervical Carcinoma

Gross :
Acrylic jar mounted, formalin fixed specimen of CERVIX & UTERUS, measuring about 9 ˣ 4 ˣ 3 cm.
It may be present in 3 types : Fungating, ulcerating & infiltrating.
Endocervical canal is disrupted.
Grayish-white tumour is pushing endocervical canal towards one side.
The cervical cancer is invasive type.
Distant metastasis occurs in the lungs, liver, bone marrow & kidney.
Microscopy :
The slide shows dysplastic epithelial cells, hence it is squamous cell carcinoma.
Keratin pearls are observed with polygonal epithelial cells.

F4 - Cervical Carcinoma
Slide 61 - Cervical Carcinoma
 F5 - Mature Cyst Teratoma - Ovary

Gross :
Acrylic jar mounted, formalin fixed specimen of OVARY, measuring about 6 ˣ 4 ˣ 2 cm.
It may be present in 3 types : Mature, immature, monodermal.
The outer wall is thin & blackish brown in colour.
Inner surface shows unilocular cyst measuring about 10 cm in diameter.
It is clinically termed as Dermoid cyst.
The cyst has hairs & tooth at one side.
Ovarian teratoma is benign tumour containing predominantly ectodermal elements.
Microscopy :
The most prominent feature is lining of the cyst wall by stratified squamous epithelium.
Some structures such as sebaceous glands, sweat glands & hair follicles are seen.
Some mesodermal & endodermal structures are observed.
Kaleidoscopic pattern is produced in the specimens.

F5 - Mature Cyst Teratoma - Ovary

Slide 61 - Mature Cyst Teratomas - Ovary
It is a benign tumor of fibrous and epithelial elements of breast. It is the most common benign tumor
of the female breast. It commonly occurs in the age group 15 to 30 years.

Gross:

1. Small, solitary, well encapsulated, spherical or discoid mass.

2. The cut surface is firm, grey-white and may show slit-like spaces formed due to compressed ducts.

Note: In fibrocystic disease, there can be multiple fibroadenomas in the breast, this condition is
termed fibroadenomatosis.

Microscopically 2 types of patterns:

1. Intracanalicular pattern: Compressed, narrow, slit-like ducts.

2. Pericanalicular pattern: Patent dilated ducts

Variants:

1. Tubular adenoma
2. Lactating adenoma

3. Juvenile fibroadenoma
Causes mnemonic:

We Hate PSM

W- Wegener’s granulomatosis

H- Henoch Schonlein Purpura

P- PSGN

S- SLE, Syndrome of GoodPasture, Subacute Bacterial Endocarditis(SABE)

M- Malignant Hypertension, Malignant Nephrosclerosis

Acute PSGN

Gross:

1. Kidneys are symmetrically enlarged.

2. Cortical as well as sectioned surface show petechial haemorrhages.

Acrylic jar mounted, formalin fixed specimen of stomach.

Serosal surface, muosal suface.

Gastric rugae present.

There is a perforation few mm in diameter, present on the upper part. The perforation has
involved the whole stomach wall. The margins of perforation are punched out.

The mucosal folds converge towards the ulcer.

Hence this is a specimen of perforated/chronic peptic ulcer.

 G3 - Wet Gangrene of Intestine

Gross :
Acrylic jar mounted, formalin fixed specimen of SMALL INTESTINE measuring about 15 – 20 cm.
The specimen shows serosal surface & mucosal surface.
Serosal surface is grayish black showing mesentery.
Mucosal folds are absent or thinned out.
The specimen is probably of Wet gangrene.
The black color is due to formation of FeSO4 from combination of H2S and Haeme.
The cause of wet gangrene is : Venous occlusion

G3 - Wet Gangrene of Intestine

acrylic jar mounted, formalin fixed specimen of stomach .

serosal, mucosal surface.

Upper part of the mucosal surface shows a flat, infiltrating, ulcerative growth with an
irregular necrotic base and raised margin.

There is loss of rugae in the affected area.

Hence this is a specimen of carcinoma stomach (ulcerative carcinoma)

 G5 - Typhoid Ulcer

Gross :
Acrylic jar mounted, formalin fixed cut specimen of INTESTINE, measuring about 10 cm.
It shows serosal surface and mucosal surface.
Serosal surface appears pale.
Mucosal surface shows ulcerated areas with dimensions about 1.5 to 3 cm.
Ulcerated areas are elongated, round or oval, parallel to the long axis of the intestine. (Main feature)
These areas appear pale brownish in colour.
Complications : Perforation (more common), haemorrhage.
Microscopy :
Ulcerated mucosa is seen in the microscope as dense eosinophilic areas.
Characteristic feature – Erythrophagocytosis
Note : Peptic ulcers are more common in stomach and duodenum. Peptic ulcers are
perpendicular to the long axis of the intestine. There are 4 zones of ulcerations.
1. Superfitial necrotic zone
2. Zone of inflammatory exudates
3. Zone of granulation
4. Fibrosis
Complications – Perforation, haemorrhage, pyloric stenosis etc.

G5 – Typhoid ulcer of intestine

Slide 17 – Typhoid ulcer of intestine

1.
Acrylic jar mounted, formalin fixed cut open specimen of small intestine.

Serosal surface is pale. Mucosal surface shows mucosal folds and multiple ulcers which are
deep and flask shaped with narrow neck and broad base containing necrotic tissue and
undermined margins.Hence this is a specimen of amoebic ulcer.

Amoebic ulcer is due to infection caused by Entamoeba histolytica. Infection occurs from
ingestion of cyst form of the parasite. The cyst wall is dissolved in the small intestine from
where liberated amoebae pass into large intestine,

invading the epithelium of mucosa, reaching the submucosa and producing characteristic ‘flask-
shaped’ ulcers
 G7 - Tuberculous Ulcer

Gross :
Acrylic jar mounted, formalin fixed cut open specimen of part of INTESTINE.
It measures about 8 to 10 cm.
It shows mucosal surface and cut surface.
Mucosal surface shows ulcers which are transverse to the long axis of the intestine.
These ulcers measure about 3 to 4 cm in length.

Microscopic :
Slide shows deep foci to serosa – Ulcers and granulations.
Necrotic debris is seen in the slide.
Breech in the continuity of the epithelium is observed.
Epithelioid cells, Langhan’s giant cells, caeseous necrosis are seen in the slide.

G7 - Tuberculous Ulcer
Slide 22 - Tuberculous Ulcer of Intestine
Acrylic jar mounted, formalin fixed cut open section of large intestine.

Serosal surface- appears pale.

mucosal surface: mucosal folds are present. There is a large ulcer transverse to the long axis
of the intestine with caeseous necrosis. The ulcer has developed stricture. The wall of
intestine in the area of narrowed lumen is thickened. Hence this is a specimen of intestinal
T.B. : secondary t.b (in primary t.b., Ghon’s focus will be seen as enlarged lymph nodes with
matting and caeseation: ‘tabes mesenterica’)
Acrylic jar mounted, formalin fixed cut open specimen of colon.

Serosal, mucosal surface.

The wall of colon is thickened and shows ulceration with caesous necrosis. The lumen of
intestine is obliterated The thickening resembles a carcinoma.

Hence this is a specimen of hyperplastic caecal t.b. which occurs secondary to pulmonary
t.b.
 G10 - ACUTE APPENDICITIS

Gross:
Acrylic jar mounted, formalin fixed cut specimen of APPENDIX.
It measures about 5 cm. (Normal - 3 to 5 cm)
The Specimen shows two surfaces : 1.Serosal and 2. Mucosal
Serosal surface is enlarged, reddish and shows congested blood vessels.
Mucosal surface shows irregularity of the size of the lumen, constriction of lumen.
Serosal surface shows swollen, dull, granular and reddish appearance signifies acute appendicitis.
Mucosa is lacerated.
3 stages of acute appendicitis : 1. Early stage – swollen, dull, granular, reddish appearance
2. Later stage – covered with fibrinous exudates
3. Gangrenous stage
Causes : 1. Obstructive causes – faecolitis, gall stones, certain tumors
2. Non obstructive causes – any vascular change

Microscopy :
PMN cells are seen in the muscular layer of the appendix. It confirms the acute appendicitis.

G10 – Acute appendicitis

Slide 15 – Acute appendicitis
Acrylic jar mounted, formalin fixed cut open specimen of colon.

Wall of colon is thickened.

Serosal, surface is pale.

Mucosal surface shows a large, cauliflower like, friable mass, projecting into the lumen.

Hence this is a fungating polypoid carcinoma: right sided colonic growth . the differences
between right and left colonic growths are due to liquid nature of colonic contents in the
ascending colon, leaving space for luminal growth on the right side, and more solid contents
of left colon, causing spread of growth into the bowel wall.
Acrylic jar mounted, formalin fixed cut open specimen of large intestine.

Serosal surface : appearing pale.

Mucosal surface : mucosal folds present. There is a solitary polyp in the lower part of
mucosa measuring less than 1 cm, pedunculated, with irregular surface.

Hence this a specimen of large intestinal polyp.

 H1 - Hyaline Change of Spleen

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of spleen.
It measures about 10 ˣ 8 cm.
It shows capsular surface and cut surface.
Capsular surface is thickened.
It shows pink amorphous depositions or foaming granules measuring about 0.1 to 0.5 cm.
It is also called Sugar-coated spleen.

H1 – Hyaline Change of Spleen

Slide 6 - Hyaline Change of Spleen
 H2 - Spleen Infarct

Gross :
Acrylic jar mounted, formalin fixed specimen of slice of SPLEEN, measuring about 12 ˣ 5 cm.
The specimen shows capsular surface & cut surface.
Cut surface shows two pale areas measuring about 4 ˣ 4 cm & 3 ˣ 2 cm.
These areas are characteristically wedge shaped infarcts.
Causes of spleen infarct : Thromboembolic phenomenon, Sickle cell disease
This is coagulative type of necrosis which is commonly seen in heart, kidney & spleen due to
ischaemia.

H2 - Spleen Infarct
Slide 8 - Spleen Infarct
 H4 - Calcified Miliary Spleen

Gross :
Acrylic jar mounted, formalin fixed specimen of SPLEEN.
It measures about 8 ˣ 6 ˣ 5 cm.
The spleen is enlarged.
It shows cut surface and capsular surface.
Cut surface shows small whitish spots measuring about 0.2 to 0.5 cm.
Capsular surface shows multiple whitish nodules measuring about 0.2 to 1 cm.
This is calcification.

H4 - Calcified Miliary Spleen

 H10 - Tb Lymph Node

Gross :
Acrylic jar mounted, formalin fixed specimen of LYMPH NODES.
The specimen shows matted group of lymph nodes measuring about 1 - 4 cm.
Lymph nodes are grayish brown in color.
Cut surface of a lymph node shows map-like cheesy area of caeseous necrosis.
Hence the specimen indicates tuberculosis.
Adhesion causes sticking of lymph nodes giving them matted appearance.
Microscopy :
Area of caeseous necrosis shows Langhan’s giant cells with multiple nuclei, slipper shaped epitheloid
cells and infiltrate of PMNs.

H10 - Tb Lymph Node

Slide 23 - Tb Lymph Node
Hashimoto’s thyroiditis/Autoimmune thyroiditis/Chronic Lymphocytic thyroiditis/Diffuse
Lymphocytic thyroiditis/ Struma Lymphomatosa/ Goitrous Autoimmune thyroiditis has the
following salient features:

1. Diffuse goitrous enlargement of the thyroid gland

2. Most common cause of goitrous hypothyroidism in regions where iodine supplies are adequate.

3. Lymphocytic infiltration of thyroid gland.

4. Occurence of thyroid autoantibodies(Microsomal, Thyroglobulin, TSH receptor autoantibodies).

5. 10-fold female preponderance

6. Age range: 30 to 50 years

7. Seen more often in HLA-DR3 and HLA-DR5 subtypes

8. If there is hyperthyroidism, it is called Hashitoxicosis.

9. Increased risk of developing Malignant lymphoma.

10. Presence of degenerated follicular epithelial cells called Hurthle/Askanazy/Oxyphil cells.

Gross:

2 variants: Classic form(90%) and Fibrosing variant(10%)

1. In the classic form, the gland is- Diffusely and symmetrically enlarged, having firm and rubbery
texture.

2. The cut surface appears fleshy with accentuation of normal lobulations.

3. Normal shape of the gland is retained.

4. In fibrosing variant, there is compression of the surrounding tissues.

Gross:
1. Kidneys have moderate enlargement.

2. Initially, there is extrarenal hydronephrosis characterized by dilatation of renal pelvis.

3. As obstruction persists, there is progressive dilatation of the renal pelvis and calyces. And
pressure atrophy of renal parenchyma.

4. Eventually, the dilated pelvicalyceal system extends deep into the cortex so that a rim of
renal cortex is stretched over the dilated calyces and the external surface assumes a
lobulated appearance.

5. This advanced stage is called Intrarenal Hydronephrosis.

Causes:
For unilateral:

1. Calculus in ureter or pelvis. Eg. Staghorn calculi

2. Congenital Pelvic-ureteric junction obstruction

3. Trauma, Neoplasm of ureter or bladder

4. Inflammatory stricture. Eg. TB

5. Ureter atresia

For bilateral:

1. Prostatic enlargement due to prostatic carcinoma or prostitits

2. Bladder tumour involving both ureteric orifices

3. Phimosis

4. Bladder neck stenosis

5. Inflammatory or traumatic urethral stricture

 I 1 - Leprosy Skin

Gross :
Acrylic jar mounted, formalin fixed specimen of flap of SKIN.
It measures about 15 ˣ 10 cm.
It shows hypopigmented patch of skin.
The patch measures about 5 ˣ 3 cm.
D/D for the hypopigmented patch of skin -
1. Localized - Burns, Leprosy, Trauma etc
2. Generalized - Albinism etc

Microscopy :
In tuberculoid leprosy slide, there are 3 characteristic features of the slide -
1 Epithelial cell granuloma
2. Granuloma surrounding peripheral nerve
3. Granuloma reaching to epidermis
In lepromatous leprosy slide, Lepra cells/ Virchow cells are observed.
Grenz’s zone is the feature of lepromatous leprosy.

I 1 - Leprosy Skin
Slide 25 - Leprosy Skin
 I 2 - Madura Foot

Gross :
Acrylic jar mounted, formalin fixed specimen of part of right FOOT.
It measures about 6 ˣ 6 ˣ 2 cm.
It shows dorsal surface and plantar surface.
Dorsal surface shows multiple lesions, measuring about 0.2 to 0.3 cm, which are discharging sinuses
filled with whitish/yellowish material.
Plantar surface shows multiple lesions, measuring about 0.2 to 0.3 cm, which are discharging sinuses
filled with whitish/yellowish material.
Discharging sinuses are the sulfur granules containing colonies of bacteria.
This is the case of Actinomycosis.

I 2 - Madura Foot
 I 7 - Squamous Papilloma

Gross :
Acrylic jar mounted, formalin fixed specimen of SKIN, measuring about 6 ˣ 5 cm.
The specimen shows papillary growth.
Many small nodular masses are seen.
This is a benign tumour of skin.
Microscopy :
The slide of papilloma shows finger-like projections separated by fibrovascular septa.
Stroma is fibrovascular & lined by squamous epithelium.

I 7 - Squamous Papilloma
Slide 32 - Squamous Papilloma
 I 10 - Squamous Cell Carcinoma

Gross :
Acrylic jar mounted, formalin fixed specimen of EAR & RETROBULBAR region, measuring about 6
ˣ 6 cm.
The specimen shows an ulcerated growth with elevated & indurated margin.
The growth is polypoid or cauliflower looking.
There is exophytic or external growth of cells.
The carcinoma is Squamous cell carcinoma & it is malignant.
Microscopy :
There is irregular downward invasion of epidermal cells into the dermis & subdermis.
Squamous cell carcinoma has whorled arrangement of malignant squamous cells forming horn pearls.
At the centre, laminated keratin material called keratin pearls are observed.
The malignant cells are polygonal. They show hyperchromatism with altered nuclei & have high
mitotic activity.

I 10 - Squamous Cell Carcinoma

Slide 38 - Squamous Cell Carcinoma
 I 11 - Basal Cell Carcinoma

Gross :
Acrylic jar mounted, formalin fixed specimen of SKIN, measuring about 12 ˣ 10 cm.
The specimen shows small nodules which have undergone central ulceration with pearly, rolled
margins.
The tumour is called Rodent tumour because it destroys the neighboring tissue like a rodent.
This is a malignant tumour of skin.
Microscopy :
The characteristic feature is the proliferation of basaloid cells (resembling basal layer of epidermis).
The dermis is invaded by mass of basaloid cells with peripheral palisaded appearance.

I 11 - Basal Cell Carcinoma

Slide 39 - Basal Cell Carcinoma
 I 12 - Malignant Melanoma

Gross :
Acrylic jar mounted, formalin fixed specimen of FOOT, measuring about 10 ˣ 8 cm.
The specimen shows dorsal surface & plantar surface.
Plantar surface shows a tumour measuring 4 ˣ 3 cm which is grayish-black in colour.
The tumour is malignant & the black is colour is due to melanin pigment.
It appears as slightly elevated naevus which has variegated pigmentation & irregular borders.
The specimen of SKIN also shows the same gross features with black pigmentation in the area
measuring 5 ˣ 3 cm.
Microscopy :
The malignant melanoma cells are enlarged & have epitheloid or spindle-shaped appearance.
The blackish-brown melanin pigment is observed in the form of uniform fine granules.

I 12 - Malignant Melanoma
Slide 72 - Malignant Melanoma
 I 13 - Lipoma

Gross :
Acrylic jar mounted, formalin fixed specimen of cut slice of FAT, measuring about 15 ˣ 10 ˣ 3 cm.
The specimen shows encapsulated smooth capsule.
The cut surface is soft, lobulated, yellowish greasy in appearance
Lipoma is the commonest soft tissue tumour which is soft, movable & painless.
Common sites for lipoma are neck, back & shoulder.
Microscopy :
The tumour is composed of lobules of mature adipose cells separated by delicate fibrous septa.
A thin capsule is observed.

I 13 - Lipoma
Slide 35 - Lipoma
 K2 - Large White Kidney

Gross :
Acrylic jar mounted, formalin fixed specimen of bisection of KIDNEY.
It measures about 7 ˣ 5 ˣ 4 cms. It is slightly enlarged and swollen.
It shows subcapsular surface and cut surface.
Subcapsular surface is smooth and pale.
Cut surface shows pale appearance and cortico-medullary junction is blurred.
D/D of Large white kidney –
1. Cloudy/Hydropic/ Hyaline/ degeneration
2. Toxemia in pregnancy
3. Early stages of amyloidosis, SLE, diabetes
4. Rapid Progressive Glomerulo nephritis
5. Chronic membranous glomerulo nephritis
6. Early stage of Malaria
7. Constructive pericarditis
8. Irradiation nephritis
9. Post chemotherapy

K2 - Large White Kidney (Hydropic change)

Slide 4 - Large White Kidney
 K3 - Kidney Infarct

Gross :
Acrylic jar mounted, formalin fixed specimen of section of KIDNEY, measuring about 7 ˣ 5 ˣ 3 cm.
The specimen shows subcapsular surface & cut surface.
Outer surface shows pale infarct area with zone of hyperaemia.
On the cut surface there is wedge shaped pale infarct are with apex towards medulla & base towards
cortex.
This is coagulative type of necrosis which is commonly seen in heart, kidney & spleen due to
ischaemia.
Microscopic :
Eosinophilic area with conversation of normal cells into their tombstones i.e. outline of the cells are
retained but the nuclear details are lost. Cells are swollen & more eosinophilic.

K3 - Kidney Infarct
Slide 8 - Kidney Infarct
 K4 - Pyaemic abscess of Kidney

Gross :
Acrylic jar mounted, formalin fixed specimen of cut section of KIDNEY, measuring about 9 ˣ 7 cm.
It shows subcapsular surface & cut surface.
On the subcapsular surface multiple abscesses are seen. The abscesses are pale in appearance.
Grossly yellow exudates are seen in the kidney.
The cut surface is pale.

Microscopy :
In early stages, neutrophilic infiltration is limited only to interstitium. There is collection of PMN
cells. In later stages, destruction of tubules is seen.

Note : In pyogenic abscess, there is a single focus of abscess. In pyaemic abscess, there are
multiple foci. Pyaemic abscess is seen in solid organs such as kidney.

K4 – Pyaemic abscess of Kidney

Slide 16 - Pyaemic abscess of Kidney
 L1 - Amoebic Abscess - Liver

Gross :
Acrylic jar mounted, formalin fixed specimen of LIVER, measuring about 15 ˣ 10 cm.
The right lobe shows abscess which are solitary.
The approximate size of the abscess is 7 ˣ 5 cm.
The centre of abscess contains large necrotic area having reddish-brown thick pus.
This resembles with anchovy or chocolate sauce.
The abscess wall consists of irregular shreds of necrotic liver tissue.

L9 - Amoebic Abscess of Liver

Slide 47 - Amoebic Abscess of Liver
 L2 - Liver Cirrhosis

Gross :
Acrylic jar mounted, formalin fixed specimen of section of LIVER, measuring about 10 ˣ 5 cm.
Externally the liver is small, distorted & irregularly scarred.
Margins of the liver are rounded.
The specimen shows outer or serosal surface and cut surface.
Serosal & cut surfaces show grayish brown multiple nodules measuring from 3mm to a few
centimeters.
Hence, these are macronodules.
On the cut surface, macronodules are separated by grayish white fibrous septae.

L4 - Liver Cirrhosis
Slide 45 - Liver Cirrhosis
 L4 – Fatty Liver

Gross :
Acrylic jar mounted, formalin fixed specimen of section of LIVER, measuring about 8 ˣ 7 cm.
The liver is enlarged somewhat yellowish in colour.
Margins of the liver are rounded.
The specimen shows outer surface and cut surface.
Outer surface is smooth and pale.
Cut surface is cheesy.
Fatty alteration of liver can be seen.

L4 – Fatty Liver
Slide 5 - Fatty Liver
 L5 – Haemochromatosis
Prussian Blue Reaction

Gross :
Acrylic jar mounted, formalin fixed specimen of section of normal LIVER & pigmented LIVER,
measuring about 15 ˣ 8 cm.
The liver is enlarged & margins of the liver are rounded.
The specimen shows bluish brown discoloration due to +ve Prussian Blue reaction.
It indicates deposits of Ferritin & Haemosiderin which appear as golden brown pigments in
cytoplasm.
Other organs affected are - pancreas, heart, endocrine glands, synovium, testes, skin.

L5 - Haemochromatosis or Prussian Blue Reaction

 L6 - Liver Haemangioma

Gross :
Acrylic jar mounted, formalin fixed specimen of slice of LIVER, measuring about 10 ˣ 6 ˣ 3 cm.
The specimen shows Parenchymal surface & subcapsular surface.
On upper lobe, there is a blackish-brown mass measuring 4 ˣ 3 cm.
Haemangiomas appear as solitary or multiple & circumscribed lesions.
It is a benign tumour of liver of cavernous type.
Microscopy :
Haemangioma of liver shows large cavities i.e. cavernous spaces filled with blood.

I 13 - Liver Haemangioma
Slide 35 - Liver Haemangioma
 L7 - CVC Liver

Gross :
Acrylic jar mounted, formalin fixed specimen of LIVER, measuring about 8 ˣ 7 cm.
The liver is enlarged & tender.
The margins of liver are rounded.
The specimen shows serosal surface & cut surface.
Serosal surface shows tense capsule.
Cut surface shows characteristic Nutmeg appearance, dark & light areas corresponding to congested
centers of lobules & fatty peripheral zone respectively.
CVC Liver occurs in right heart failure & occlusion of IVC & hepatic vein.

L7 - CVC Liver
Slide 26 - CVC Liver
 L9 - Hepatocellular Carcinoma

Gross :
Acrylic jar mounted, formalin fixed specimen of LIVER, measuring about 15 ˣ 10 cm.
The liver is enlarged.
Margins of the liver are rounded.
The right lobe shows a single, large yellow-brown mass measuring about 6 ˣ 5 cm with irregular
borders & a central area of necrosis.
Rest of Hepatic parenchyma shows scattered multifocal masses measuring 3 ˣ 2 cm owing to
coexistent macronodular (post necrotic) cirrhosis.

L9 - Hepatocellular Carcinoma
Slide 48 - Hepatocellular Carcinoma
Metastatic tumours in the liver are more common than the primary hepatic tumours. Most
frequently, these are blood-borne metastases. Most frequent tumours metastasizing to the liver, in
descending order of frequency are Stomach -> Breast -> Lungs -> Colon -> Oesophagus etc

Gross:

1. Multiple spherical nodular masses of variable size.

2. Liver is enlarged.

3. Tumor masses are well-demarcated and haemorrhagic.

4. The surface of the tumor shows characteristic umbilication due to central necrosis of tumor
masses.
Causative Bacteria: S. pneumoniae, S. aureus, S. pyogenes, Haemophilus influenza, Klebsiella,
E.coli, Pseudomonas, Proteus.

Staging: 4 sequential pathological stages according to Laennec-

1. Stage of Consolidation: Initial Phase(1 to 2 days)

The affected lobe is heavy, enlarged, dark red and congested. Cut section exudes blood-stained
frothy fluid.

2. Red Hepatisation: Early Consolidation(2 to 4 days)

Affected lobe is red, firm and consolidated. The cut surface is airless, red-pink, dry, granular and has
liver-like consistency. It is accompanied by serofibrinous pleurisy.

3. Grey Hepatisation: Late Consolidation(4 to 8 days)

The affected lobe is firm and heavy. The cut surface is dry, granular, and grey in appearance with
liver-like consistency. The change in colour from red to grey starts at the hilum and spreads to the
periphery. It is accompanied by fibrinous pleurisy.
4. Resolution(Starts at 8th/9th day if no chemotherapy is administered and is completed in 1 to 3
weeks. Antibiotic therapy induces resolution on about 3rd day.)

The previously solid fibrinous constituent is liquefied by enzymatic action, eventually restoring the
normal aeration. The process of softening starts at the hilum and spreads to the periphery.

Complications:

1. Organisation. The exudates undergoes organisation instead of resolution. There is ingrowth of

fibroblasts from the alveolar septa resulting in fibrosed, tough, airless leathery lung tissue. This type
of post-pneumotic fibrosis is called carnification.

2. Pleural Effusion

3. Empyema. Encysted pus in the pleural cavity

4. Lung abscess

5. Metastatic Infection. To the pericardium and heart causing purulent pericarditis, myocarditis,
bacterial endocarditis.
 M2 - Seminoma Testis

Gross :
Acrylic jar mounted, formalin fixed specimen of TESTIS along with epididymis, measuring about 5 ˣ
4 ˣ 2 cm.
The specimen shows capsular surface & cut surface.
Outer surface is nodular in appearance.
On the cut surface, upper pole shows lobulated homogenous yellowish-white tumour.
The tumour is replacing whole the testis.
It is closely lobulated.
Seminoma is most common tumour of testis with good prognosis.
Microscopic :
Seminoma cells are arranged in sheet like pattern or nested pattern.
They are separated by fibrous septae.
These fibrous septae are infiltrated with lymphocytes.
Seminoma cells have clear cytoplasm, round or oval nuclei & prominent nucleoli.

D2 - Bronchopneumonia
Slide 49 - Bronchopneumonia
 M3 - Benign Prostatic Hyperplasia

Gross :
Acrylic jar mounted, formalin fixed specimen of cut sections of PROSTATE, measuring about 6 ˣ 4 ˣ
3 cm.
The specimen is enlarged & shows grayish-white appearance.
The cut surface is lobular, with prominent cystic appearance.
The external surface is nodular.
The cut surface shows nodules with spongy viable tissue of prostate.
Microscopy :
Glandular proliferation is observed with dilatation of glands.
Corpora amylacea is the characteristic finding.

M3 - Benign Prostatic Hyperplasia

Slide 30 - Benign Prostatic Hyperplasia
Nodular goitre/Multinodular goitre/Adenomatous goitre is the end stage of long-standing simple
goitre. Most cases are in a euthyroid state but about 10% cases may develop thyrotoxicosis resulting
in toxic nodular goitre or Plummer’s disease. It has female preponderance and affects older
individuals since it is a late complication of Simple goitre.

Gross:

1. Thyroid gland shows asymmetric enlargement.

2. Multinodularity with poor or incomplete encapsulation.

3. Haemorrhages

4. Cystic degeneration

5. Fibrous scarring

6. Focal calcification
Giant cell tumour or Osteoclastoma has uncertain histogenesis(probably of mesenchymal origin).
Most common sites of involvement are lower end of femur and upper end of tibia, lower end of
radius and upper end of fibula. It occurs in the age group 20-40 years. Radiologically, it gives a Soap
Bubble appearance.

Gross:

1. Eccentrically located in the epiphyseal end of a long bone which is expanded.

2. Tumor mass is well circumscribed and covered by a thin shell of subperiosteal bone.

3. Cut section of tumour is characteristically haemorrhagic, necrotic and honey-combed due to focal
areas of cystic degeneration.
1. Infection begins in the metaphyseal end of the marrow cavity which is largely occupied by pus.

2. The tension in the marrow cavity is increased due to pus and results in spread of infection along
the marrow cavity into the endosteum, and into Haversian and Volkmann’s canal causing
periosteitis.

3. The infection may reach the subperiosteal space forming subperiosteal abscess.

4. Combination of suppuration and ischaemia in the cortical bone results in thinning, erosion and
infarction necrosis of the cortex called Sequestrum.

5. In late stages, there is reactive bone formation beneath the periosteum over the infected bone.
This forms an encasing sheath around the necrosed bone and called Involucrum.

6. If too much neo-osteogenesis is present, there is a dense sclerotic pattern of osteomyelitis called
Chronic Sclerosing nonsuppurative osteomyelitis of Garre.

7. If acute osteomyelitis is contained in a localised area and walled off by fibrous tissue and
granulation tissue, it is called Brodie’s abscess.
Complications:

1. Septicaemia

2. Acute bacterial Arthritis

3. Pathological fractures

4. Squamous cell Carcinoma

5. Secondary amyloidosis

6. Vertebral collapse, Paravertebral abscess, Spinal cord compression, Neurologic deficitis

Most common primary malignant tumor of the bone. It is called osteogenic because the tumor is
characterised by bone or osteoid or both formation directly by sarcoma cells. The tumor arises from
primitive osteoblast-forming mesenchyme. It is of two types: Central and Surface osteosarcoma.

The above specimen shows Central/Medullary Osteosarcoma. It occurs in young patients; age group
10-20 years. It arises in the metaphysis of long bones. Most common sites are Lower end of
femur>Upper end of tibia>Upper end of Humerus>Pelvis>Upper end of femur [Rarely in Jaw bones,
vertebrae and skull].

Gross:

1. The tumor appears as a grey-white bulky mass at the metaphyseal end of a long bone of the
extremity(sparing the epiphyseal cartilage atleast in the initial stages).

2. Codman’s Triangle is a type of periosteal reaction between elevated periosteum and surface of
the cortex; with aggressive lesions, the periosteum does not have time to ossify with shells of new
bone, so only the edge of the raised periosteum will ossify. This creates a triangular lip of new bone.
It is seen both radiologically and marcoscopically.
3. Cut surface shows foci of necrosis and haemorrhages.

4. Radiologically there is Sunburst pattern due to bone formation within the tumour mass.

Clinical features:

1. A palpable mass which may be warm and tender.

2. Decreased joint movement.

Complications:

1. Hearing loss (due to Cisplatin)

2. Fever and Neutropenia

3. And other complications due to anticancer drugs like immunosuppression.

Renal Cell Carcinoma/Adenocarcinoma of Kidney/Hypernephroma/Grawitz Tumour

It is associated with von Hippel-Lindau disease; having germline mutations of tumor suppressor VHL
gene located on chromosome 3p.

It is of 6 types: 1> Clear cell type 2> Papillary type 3> Granular cell type
4>Chromophobe type 5>Sarcomatoid type 6>Collecting duct type

Gross:

1. Arises mostly from the upper pole of the kidney

2. Solitary and 99% unilateral

3. Tumor mass is large, golden yellow, circumscribed

4. Cut section shows large areas of ischaemic necrosis, cystic degeneration and haemorrhages.

5. Like in Wilm’s tumor, there is frequent presence of tumor thrombus in renal vein which may
extend upto the inferior vena cava.

Clinical Features: Palpable abdominal mass, Gross Haematuria, Flank Pain

Paraneoplastic Syndromes: Polycythaemia(by erythropoietin), Hypercalcemia( by PTH and PGs),
Hypertension(by Renin), Feminisation or Masculinization(by Gonadotropins) and Cushing’s
Syndrome( by glucocorticoids)
Most common abdominal malignant tumour of young children; seen between the ages of 1 to 6
years.

Also called Nephroblastoma; it is derived from primitive renal epithelial and mesenchymal
components. Associated with WAGR syndrome and Beckewith-Weidemann Syndrome.

Gross:

1. Tumor mass is quite large, spheroidal, replacing most of the kidney.

2. On cut-section, there is variegated appearance, soft, fish-flesh like grey-yellow tumour.

3. With foci of necrosis and haemorrhages.

4. Grossly identifiable myxomatous and cartilaginous elements are also seen.

Clinical Features:

Palpable Abdominal mass, Haematuria, Pain, Fever, Hypertension