Microscopy and Gross

IDENTIFICATION POINTS AND IMAGES

Compiled by:
Sparsh Srivastava
Dry Gangrene
Specimen of amputated foot showing dry
shrivelled appearance with blackish discoloration
in the distal half.
Line of demarcation can be seen.
Wet Gangrene (Intestine)
Specimen of intestine shows putrid and
blackish discoloration.
Line of demarcation cannot be seen.
Fatty Liver
Sections from the liver show accumulation of
lipid in the form of cytoplasmic vacuoles in
hepatocytes (micro vesicular steatosis)
Displacement of the nucleus to one side is seen
representing macro vesicular steatosis.
Acute appendicitis
Specimen of appendix shows exernally congested
vessels and serosa coated with fibrin,
fibrinopurulent exudate and pus.
The appendix is enlarged and diluted lumen contain
pus, fecalith or both.
Acute appendicitis
Section from appendix shows ulcerated mucosa.
Acute inflammatory infiltrate is seen in all layers
of appendix
Tuberculous Lymphadenitis

Specimen shows a group of enlarged matted

lymph nodes.
Cut section shows necrotic areas with initial
cheesy material.
Tuberculous Lymphadenitis
Normal lymphoid architecture is replaced by
characteristic tubercular granulomas.
Granuloma is composed of central caseous
necrosis, epithelioid macrophages,
, lymphocytes, plasma
cells and fibroblasts.
Tuberculoid Leprosy
Sections shows normal epidermis.
Underlying dermis contain perineural and
peri adnexal non containing granuloma
which are composed of epithelioid cells,
multinucleate giant cells and
lymphocytes.
Madura Foot
Specimen of foot with discoloration is
seen.
Skin surfaces shows multiple discharging
sinuses.
Rhinosporidiosis
Sections shows ulcerated respiratory
epithelium with areas of squamous
metaplasia.
Submucosa shows multiple numerous
sporangia with endospores and a dense
inflammatory cell infiltration
Actinomycosis
Section shows tangled deposits of
basophilic filamentous organism
surrounded by eosinophilic Splendore-
Hoeppli material.
Surrounded by foreign body granuloma
and acute inflammatory infiltrate is
seen.
Filariasis
Section shows lymph node.
Cross section of worm is seen
surrounded by granuloma and dense
eosinophilic infiltrate.
Granulation tissue
Section shows numerous proliferating
thin-walled capillaries.
Capillaries are surrounded by fibroblasts
and mixed inflammatory infiltrate in an
edematous stroma.
Adenoma
Specimen of colon seen with a
pedunculated polyp seen arising from the
inner lumen.
Cut sections of the polyp show grey white
areas
Adenoma
Closely packed glands lined by dysplastic
tissue epithelium (nuclear
hyperchromasia, elongation,
stratification)
Decreased cytoplasmic mucin is seen
No invasion is seen
Lipoma
Cut sections shows well circumscribed
tumor.
The tumor shows lobulated yellow areas
Cavernous Hemangioma
Large cavernous blood vessels partly or
completely filled with blood with flattened
vascular epithelium.
Separated by fibrous septa composed of
moderate connective tissue stroma.
Squamous Papilloma
Section shows multiple finger-like
processes/papillae lined by stratified
squamous epithelium.
Central core of papillae is composed of
fibrovascular tissue
Adenocarcinoma Colon
Specimen shows a large irregular
fungating mass in the mucosa.
Infiltration into the underlying mucosa
is seen.
Adenocarcinoma
Lesion composed of branching, tubular
glands lined by malignant cells with loss
of polarity, vesicular nuclei and nuclear
stratification.
Invasion into underlying stroma is seen.
Squamous cell carcinoma- Oral cavity
Specimen of the mandible seen with teeth
and adjacent portion of the tongue.
The gingiva-buccal sulcus shows a
proliferative growth with irregular margin.
Squamous cell carcinoma
Nests and sheets of malignant polygonal
squamous cells with moderate to abundant
eosinophilic cytoplasm and atypical
enlarged, pleomorphic hyperchromatic
nuclei is seen.
Keratin pearls are also seen.
Metastasis to lung
Specimen of lung showing multiple
grey white nodules resembling cannon
balls.
Nodules are distributed throughout the
lung.
Metastasis to Liver
Specimen of liver is seen.
The cut section shows multiple nodular
areas with areas of hemorrhage and
necrosis.
Amyloid Kidney
Section from kidney shows proteinaceous
amorphous eosinophilic and hyaline
extracellular amyloid deposits primarily in
the glomerular basement membrane and
mesangium.
Deposition of amyloid is also seen around
the tubules and vessel walls.
Specimen shows a group of enlarged non
matted lymph nodes.
Cut section shows a homogenous grey
white fish flesh appearance.
CVC Liver (Nutmeg Liver)
Liver is enlarged and the capsule is tense.
Cut surface shows characteristic NUTMEG
liver due to red and pale-yellow areas.
CVC Liver (Nutmeg Liver)
Congestion of centrilobular sinusoids.
Degeneration of hepatocytes and central
hemorrhagic necrosis in centrilobular region
and peripheral hepatocytes show fatty
change.
CVC Lung
Specimen of lung showing rusty brown
discoloration.
The lung appears engorged and heavy.
CVC Lung
Section from the lung shows widened
alveolar septae which contain dilated,
congested blood vessels and focal
intraalveolar hemorrhage and fibrosis
Alveolar lumina and septae also show
numerous hemosiderin laden macrophages
called heart failure cells.
Mural thrombosis
Specimen of heart is seen.
A large grey white to black friable
material is seen attached to the inner
wall of the left atrium

O
Splenic Infarction
Specimen composed of cut section of
spleen.
Pale white, sharply demarcated, wedge-
shaped areas surrounded by normal
grey brown splenic parenchyma.
Atherosclerosis
Specimen of abdominal aorta seen cut open
which is branched into common iliac arteries.
The intimal surface shows numerous elevated
yellowish plaques, some with ulceration and
calcification.
Atherosclerosis
Presence of fatty streaks.
Intimal macrophage derived foam cells
Mitral Stenosis
Specimen of heart seen markedly narrowed
mitral valve opening.
Leaflets are thickened, annular calcification
and closure of commissure is seen, giving
fish mouth/button hole appearance.
Myocardial Infarction
Specimen of heart cut open.
Left ventricle shows a large pale infarct with an
overlying mural thrombus.
Pneumonia
Specimen of lung shows grey-white areas of
consolidation.
It involves the entire (almost) lower lobe of
the lung.
Bronchiectasis
Specimen shows lung with dilated bronchi
and bronchioles.
Bronchi appears cystic with thickened wall
and filled with mucopurulent secretions.
Tuberculosis Lung
Specimen of lung shows multiple grey
white areas of caseation.
Cavitation of lung parenchyma and dilated
bronchioles noted.
Carcinoma Lung
Specimen of lung shows grey white growth
occluding the main branches.
The growth Is seen to infiltrate the lung
parenchyma.
Peptic Ulcer
Specimen of stomach with an ulcer.
The ulcer has punched out margins
with radiating rugae.
Carcinoma Stomach- Polypoid type
Specimen of stomach seen with polypoid
growth.
The polypoidal growth is projecting into the
lumen and has an irregular surface
Carcinoma Stomach- Linitis plastica
Specimen of stomach seen with loss of
rugae and flattening of mucosa.
Wall is markedly thickened by an
infiltrating tumor.
Tuberculosis of intestine
Section from intestine showing all the
layers.
Caseating granulomas are seen in all layers
of intestine, composed of epithelioid cells,
with surrounding
lymphocytes
Ulcerative colitis
Specimen of colon shows continuous
involvement with superficial ulcers.
Surrounding regenerated mucosa shows
multiple pseudo polyps.
Carcinoma Colon
Specimen shows a large irregularly fungating
mass in the mucosa.
Infiltration into underlying muscularis seen.
Gall stones
Specimen of gall bladder is seen with
thickened wall.
The lumen contains multiple faceted
stones.
Cirrhosis
Specimen of liver shows a nodular surface.
Nodules of varying sizes and less than 1cm
in diameter.
Cirrhosis
Section of liver shows nodules of
regenerating hepatocytes.
The nodules are separated by fibrous
bands with inflammatory infiltrate.
Adult Polycystic Kidney disease
Specimen of kidney which is markedly
enlarged and has bosselated appearance.
Cross section shows multiple cysts filled
with serous fluid.
Chronic pyelonephritis
Section from kidney shows atrophic and
dilated tubules which are lined by
flattened epithelial cells filled with colloid
like casts (Thyroidisation)
Interstitium is inflamed and fibrotic.
Hydronephrosis
Specimen consists of kidney
Cut section shows dilated pelvic
calyceal system with compressed renal
parenchyma.
Renal calculus
Specimen consists of kidney with attached
ureter.
Cut section shows multiple renal stones.
Renal Cell Carcinoma
Specimen shows a well demarcated, solid,
variegated spherical mass.
Surface shows bright yellow - grey-white tumor
with necrosis and foci of haemorrhagic
discoloration.
Renal Cell Carcinoma

Section shows tumor composed of cells

arranged in solid pattern and large nests
separated by delicate fibrovascular stroma.
Cells are large, polygonal with clean
granular cytoplasm (due to deposition of
glycogen and fat) and centrally located
nuclei.
Wilms Tumor
Solitary, well circumscribed and round
mass.
Cut sections shows solid grey tall areas
and cystic changes.
Wilms Tumor
Section shows a triphasic tumor with
blastemal components, epithelial
components and stromal components.
Blastemal component- sheet of small
round blue cells
Epithelial component abortive tubules
or glomeruli
Stromal component- fibrocystic cells
Urothelial Carcinoma
Specimen shows a soft, greyish red papillary
mass involving the trigone of the bladder.
Cut section shows delicate papillary
structures superficially attached to mucosa
by a stalk.
Urothelial Carcinoma

Section shows tumor composed of few

fused papillary fronds with fibrovascular
cores.
Tumor cells showing loss of polarity with a
large hyper chromatic nuclei, prominent
nucleoli, mitotic figures and areas of
necrosis.
Seminoma Testis
Specimen of enlarged testis with intact capsule
and attached spermatic cord.
Cut section of testis shows normal parenchyma
replaced by homogenous grey white lobulated
areas, no areas of haemorrhage or necrosis.
Seminoma Testis
Sheets of uniform tumor cells demarcated
into lobules by delicate fibrous septa with
lymphocytic infiltration.
Tumor cells are large, polyhedral with
distinct cell membrane and clear cytoplasm
with large central nucleus and 1-2
prominent nucleoli.
Nodular prostatic hyperplasia
Individual nodules contain small to large
cystically dilated glands separated by
bland spindle shaped stromal cells.
Glands are lined by 2 layers of cells, inner
columnar secretory cell layer and outer
flattened basal epithelium and infoldings
of the glands produce a papillary
architecture.
Serous cystadenoma Benign
Loculated cystic swelling with smooth
external surface and intact capsule.
On cut section, serous fluid expressed and
smooth internal surface is seen.
Serous cystadenoma
Section from cyst wall are lined by a
single layer of ciliated to non ciliated
tall columnar , cuboidal cell with
bland ovoid nuclei.
The lining epithelium is focally
flattened.
Mucinous cystadenoma
Specimen of ovary with ovarian
parenchyma replaced by multilobulated
tumor with delicate septae.
Cyst are filled with mucin.
Mucinous cystadenoma
Cyst wall lined by tall columnar epithelium
with mucin filled cytoplasm & basally
placed nuclei.
No invasion into stroma or nuclear atypia.
Benign Cystic Teratoma
Specimen of ovary showing a unilocular
cyst.
Cut section shows thin walls lined by
opaque grey white wrinkled epidermis with
protruding hair shafts, tooth and areas of
calcification.
Carcinoma Cervix
Specimen shows uterus with cervix.
Cut sections shows grey-white
infiltrative growth in the cervix.
Hydatiform Mole
Specimen of uterus shows delicate, thin
walled translucent, cystic grape like
vesicles.
These structures consists of swollen
edematous villi.
Hydatiform Mole
Section of chronic villi with hydropic
change and central cistern formation.
There is marked circumferential
proliferation of cytotrophoblast and
syncytiotrophoblast.
 Leiomyoma
Cut section of uterus shows
numerous well circumscribed
tumors.
Tumors shows firm grey white
whorled appearance.

Transmural
leiomyoma
Mucosal leiomyoma
Serosal leiomyoma
Leiomyoma
Whorling bundles of smooth muscles
cells.
Bundles of uniform size spindle shaped
smooth muscle cells with elongated
fusiform nuclei.
 Fibroadenoma
Slit like pattern
Entire lobular structure is lost due to
proliferation of intralobular connective
tissue.
Distorted glands are lined by cuboidal cells
surrounded by fibrous tissue.

FNAC-
Biphasic tumor cells with epithelial and myoepithelial cells.
Benign epithelial cells typically arranged in antler horn pattern.
CA Breast
India file pattern- tubules cords and
sheets.

Malignant ductal epithelial cells are seen

arranged in tubules, cords and sheets.
Surrounding desmoplastic stromal areas
of necrosis are seen.
CA Breast (gross)

Specimen shows breast showing irregular

growth and calcification.
Cut section shows grey-white growth with
infiltrative margin surrounded by yellow
areas.
Basal Cell Carcinoma
Infiltrating tumor composed of
nodules of basaloid cells seen.
Nodules show peripheral palisading
and retraction cleft.
Malignant Melanoma
Specimen shows a blackish exophytic
lesion arising from the skin to the heel.
Cut section shows a blackish growth
arising from the skin & infiltrating deeper
structures.
Malignant Melanoma
Section shows squamous epithelium
overlaying a malignant tumour composed
of nests and sheets.
Cells are large with moderate cytoplasm,
pleomorphic nuclei, prominent
eosinophilic nucleoli & abundant melanin
pigment.
Osteomyelitis
Specimen consists of portion of long bone.
Bone is thinned out (sequestrum) with
jagged edges.
Osteoclastoma
Specimen of long bone shows an
exophytic tumor arising in the epiphysis.
The tumor is well circumscribed & shows
cystic areas with areas of haemorrhage &
necrosis.

N
Osteoclastoma

Section shows a tumor composed of

uniform multinuclear cells with oval nuclei,
along with the numerous scattered
osteoclast like giant cells with multiple
nuclei & abundant eosinophilic cytoplasm.
Areas of haemorrhage & haemosiderin
deposition noted.
Osteosarcoma
Specimen of shoulder joint seen with a
bulky tumor arising in the metaphysis of
humerous.
Tumor is grey white with areas of
haemorrhage & necrosis.
The tumour is seen infiltrating the cortex &
overlying soft tissue.
Osteosarcoma
Section shows a tumour composed of anaplastic
pleomorphic cells with hyperpigmented nuclei &
tumour giant cell.
B/w the tumour cells lace like osteoid matrix
formed by tumour cells noted.
Colloidal Goitre
c/s brown glassy translucent.
Diffuse asymmetric enlargement.
Colloidal Goitre
Section from the thyroid shows
various sized follicles lined by
flattened cuboidal cells. (micro and
macro follicle)
Follicles are filled with abundant
colloid material.
Papillary Carcinoma of
Thyroid
Solitary / multifocal.
Well circumcised, encapsulated into
infiltrated lesion.
c/s granular
Papillary Carcinoma of
Thyroid
Section from the thyroid shows branching
papillae lined by multiple layers of
cuboidal cells having fine optically clear
nuclear chromatin.
Central fibrovascular core with psammoma
bodies.
Meningioma
Specimen of skull bone with a well
circumscribed tumor is seen.
Cut section of tumor shows firm, solid areas
along with fibrous gritty areas.
Meningioma
Section shows tumor composed of whorled
clusters of spindle shaped cells.
Scattered psammoma bodies are also seen.