grose pathology of human organ system.pptx

Hepatocellular carcinoma. A cross-section of a cirrhotic
liver, with a hepatocellular carcinoma that occupies the

Hepatocellular carcinoma is a highly aggressive
malignant neoplasm, but histologically may resemble its
cell of origin (i.e., the hepatocyte). Some hepatocellular

Cholangiocarcinoma (Tumor of the bile ducts) and
hepatocellular carcinoma in a cirrhotic liver. Sometimes, both
cholangiocarcinoma (arrowheads) and hepatocellular
carcinoma (arrows) developed in cirrhotic liver. An
antemortem biopsy of the liver was diagnosed as metastatic
adenocarcinoma, which is not unexpected since

Focal nodular hyperplasia. The well-circumscribed solitary
nodule in this non-cirrhotic liver has a central scar,
Central scar

Hemangioma of the liver. A cross-section of the
liver, with a large (10 cm) hemangioma. The white
tissue within the tumor mass is scar, associated with

Hemangioma .Large spaces filled with red blood cells,
divided by thin fibrous septae. This histology is consistent
with a cavernous hemangioma. In adults, most

Abscesses in liver may also occur with hematogenous
spread from other areas of the body with septicemia. Here
are seen many microabscesses in the liver in a patient with

Microscopically, a microabscess of liver contains numerous
neutrophils in the center. The beginning of an organizing

Acute cholecystitis and cholelithiasis. This gallbladder has
been opened, revealing a thick edematous wall and an
inflamed mucosa (acute cholecystitis). This inflammation is
due to the several calculi within the lumen of the
Calculi

Multiple yellow-tan faceted gallstones are seen in the
opened gallbladder pictured here. It is possible for a stone
to exit the gallbladder via the cystic duct. It may then
produce obstruction of cystic duct, or it may get into the
common bile duct and obstruct that. It may obstruct at the

A gallbladder has been opended, and to the left of the pale porcelain gallstones (averaging 1 cm
in size) is a fungating mass that extends into the gallbladder lumen and into the gallbladder wall.
This is a primary adenocarcinoma of gallbladder. Gallstones accompany such carcinomas in up to
90% of cases

At low power, the dysplastic epithelium can be seen at the left, and neoplastic glandular
structures are invading into the muscular wall. Adenocarcinoma of the gallbladder is more
common in the elderly and more frequently seen in women

At high magnifcation, this adenocarcinoma of the gallbladder is composed of columnar cells
forming glandular and papillary structures. The prognosis with adenocarcinoma of the
gallbladder is usually poor, because they have often invaded and metastasized by the time they
are discovered

Pseudomembranous colitis. Note the adherent green-tan
membranes focally present on the mucosa of this opened

This yellow-green exudate on the surface of an inflamed,
hyperemic (erythematous) bowel mucosa consists of many
neutrophils along with fibrin and amorphous debris from
dying cells
.

Entamoeba histolytica. This patient has colonic amebiasis.
Although some Entamoeba species are nonpathogenic, the
engulfment of red blood cells (arrow) by this amoeba

Celiac disease. A. Normal proximal small intestine shows tall
slender villi with crypts present at the base. B. Normal surface
epithelium shows an occasional intraepithelial lymphocyte as well as
an intact brush border. C. a mucosal biopsy from a patient with
advanced celiac disease shows complete loss of the villi with

Crohn disease. A. The terminal ileum shows striking
thickening of the wall of the distal portion. A longitudinal
ulcer is present (arrows). B. Another longitudinal ulcer is
seen in this segment of ileum. The large rounded areas of
edematous damaged mucosa give a cobblestone‌
Uninvolved
cobblestone
‌
longitudinal
ulcer

Crohn disease. Note the transmural nature of the
inflammatory infiltrate. Within the muscularis propria and
submucosa is a large cluster of lymphocytes associated with

A high-power view of one of the granulomas
with multinucleated giant cells

Ulcerative colitis. Prominent erythema and
mucosal ulceration of the colon
.

Ulcerative colitis. The mucosal nature of the inflammatory
infiltrate and the near complete loss of mucosa. The residual
mucosa is polypoid in appearance, but only because of the
pseudopolyp
loss of mucosa

The arrowhead indicates the loss of mucosa, and the arrow
indicates a pseudopolyp
.

INTUSSUSCEPTION
:
In this form of intraluminal small bowel obstruction a
segment of bowel (intussusceptum) protrudes distally into a
surrounding outer portion (intussuscipiens)
.
-
Intussesception usually occurs in infants or young children,
in whom it occurs without a known cause
.
-
In adults, the leading point of an intussusception is usually
a lesion in the bowel wall, such as diverticultion or a tumor
-
peristalsis drives the intussusceptum forward
.
A cross section through
the area of the
obstruction shows
telescoped‌ small

VOLVULUS
It is an example of intestinal obstruction in which a
segment of gut twists on its mesentery, kinking the bowel
and usually interrupting its blood supply
.
Red-black discolored segment of small intestine. The bowel is
twisted upon itself At the base of the red-black segment (a
volvulus). Often, the volvulus will compress the venous
drainage, but not the arterial circulation. Thus, blood

Intestinal ischemia. Note the red discoloration of the wall of
the ischemic segment of the colon (arrow). Colonic ischemia
can result from a variety of causes; in this case, the patient

Infarct of the small bowel. This infant died after an episode
of intense abdominal pain and shock. Autopsy demonstrated
volvulus of the small bowel that had occluded the superior
mesenteric artery. The entire small bowel is dilated,

Meckel diverticulum (arrow), a common incidental finding at
autopsy, is a true diverticulum (with all four layers of the
wall). Although usually asymptomatic, but a patient can have
ectopic gastric or pancreatic tissue and present with pain or

False diverticula
Common in the large intestine (e.g., rectum and descending
colon)
.
Complications
-
Can become infected (i.e., diverticulitis), which thickens the
wall of the bowel
.
-
Intestinal stenosis, and obstruction
-
Perforation, peritonitis, abscess and Gastrointestinal
bleeding
.
.
Diverticulosis
.
Note the diverticula
bulging outward from
the serosal surface of
this segment of colon
.

Diverticulosis. This segment of distal colon was
opened longitudinally, and all the spaces within the

Tubular adenoma. Note the dysplastic epithelial cells with a
tubular architecture. Tubular adenomas are less prone to

-Adenomas themselves are benign, but they are precursors
of malignancy.
-villous adenomas are more likely to progress to or contain
foci of invasive adenocarcinoma than are tubular
adenomas. If a villous adenoma is 4.0 cm in size, the risk of
a malignant neoplasm is greatly increased (i.e., 40%).
Villous adenoma.
Note the dysplastic
epithelial cells with
a villous (“finger-
like”) architecture.
Villous adenomas
are more likely than
tubular adenomas
to harbor an
invasive

Gross morphology of Familial adenomatous polyposis (FAP):
Colon has hundreds of adenomas.

Important points regarding colonic adenocarcinoma
■ Location is important for presentation
-Left-sided tumors present sooner by causing more of an
obstruction as fecal material is more solid at that point.
Right-sided tumors (i.e., cecal) present later because they do
not cause an obstruction and because fecal material is more
liquid at that point in transit.
- Adenocarcinoma is uncommon in the small intestine
Colonic adenocarcinoma
of cecum. In this opened
segment of terminal
ileum and cecum, note the
polypoid adenocarcinoma
in the cecum (green mass
at the top of the image).
Cecal adenocarcinomas
can often grow to a
greater size than rectal

Mucinous adenocarcinoma. In this image, the acellular,
myxoid material is mucous and only a few neoplastic cells
are present (arrow). The mucin produced by one of these
tumors can fill the peritoneum, causing a condition referred

Carcinoid tumors are low-grade neoplasms found within the
gastrointestinal system and bronchi. Their characteristic
histologic features are monotonous bland cells in nests.
The nuclei have a “salt and pepper” appearance to them.

Acute gastritis. The gastric mucosa is infiltrated by
inflammatory cells, including a prominent number of

Autoimmune gastritis.
A. Normal gastric
antrum.
B. In autoimmune gastiritis,
the gastric mucosa shows
chronic inflammation within
the lamina propria. The
diminished number of antral
glands indicates atrophy.

Intestinal metaplasia. As a complication of chronic
gastritis, the stomach can develop intestinal metaplasia. In
this photomicrograph of the stomach, note the intestinal-

Helicobacter pylori-associated gastritis. A. The
antrum shows an intense lymphocytic and plasma cell
infiltrate the superficial portions of the lamina propria. B.
The microorganisms appear on silver staining as small,

Peptic ulcers. The stomach is opened and laid flat,
revealing several large punched-out gastric ulcers.

A cross-section of a peptic ulcer. The four layers: fibrin
(black arrowhead), neutrophils (black arrow), granulation

Gastric ulcer. There is a characteristic sharp demarcation
from the surrounding mucosa, with radiating gastric folds.

Gastric ulcer. A. There is full-thickness replacement of the gastric
muscularis with connective tissue. B. Photomicrograph of a peptic

A duodenal peptic ulcer that has perforated the wall,
producing peritonitis. The liver is cirrhotic (an incidental

Duodenal ulcer. There are two sharply demarcated (circles)
duodenal ulcers surrounded by inflamed duodenal mucosa.
The gastroduodenal junction is in the mid portion of the
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Ulcerating gastric carcinoma. In contrast to the benign
peptic ulcer the edges of this lesion are raised and firm. Note
‫الرغوه‬ ‫مثل‬

Infiltrating gastric carcinoma.
A.Numerous signet ring cells (arrows) infiltrate the lamina
propria between intact crypts.
B. Mucin stains highlight the presence of mucin within the

Infiltrating gastric carcinoma (linitis plastica). Cross section
of gastric wall thickened by tumor and fibrosis.

Opened stomach with attached esophagus. The
gastroesophageal junction is indicated by the arrow. Note
that the mucosa of the stomach has no ulcer or polypoid
mass; however, the wall of the stomach is diffusely

A high-power view of the neoplasm. Note the characteristic
signet-ring cell ‫جنيت‬ ‫شوف‬ appearance of the neoplastic

Lowe power of Microscopic appearance of diffuse

High power of Microscopic appearance of diffuse (signet-ring cell) tumor
Signet-ring cell

Diffuse (signet-ring cell) tumor invaded the muscular layer of stomach. (low
muscular tissue

Diffuse (signet-ring cell) tumor invaded the muscular layer of
stomach. (high power)
muscular tissue
signet-ring cell

TRICHOBEZOAR 3 ‫زوار‬ ‫جوبي‬
This mass is a hairball within a gelatinous matrix, usually
seen in long-haired girls or young women who eat their own
hair as a nervous habit. Trichobezoars may grow by
accretion ‫ازدياد‬to form a complete cast of the stomach,
potentially reaching 3 kg.

Achalasia
Esophagus and upper
stomach of a patient with
advanced achalasia. The
esophagus is markedly
dilated above the
esophagogastric
junction, where the lower
esophageal sphincter is
located. The esophageal
mucosa is redundant and
has hyperplastic
squamous epithelium
.

Schatzki mucosal
ring. A contrast
radiograph illustrates
the lower
esophageal
narrowing
‫شط‬
‫زكي‬

Barrett esophagus A. The presence of the tan tongues of
epithelium interdigitating with the more proximal squamous
epithelium is typical of Barrett esophagus. B. The specialized
epithelium has a villiform architecture and is lined by cells

Barrett esophagus. A, Endoscopic view showing red
gastrointestinal-type mucosa extending from the
gastroesophageal orifice. Note paler squamous
esophageal mucosa. B, Microscopic view showing mixed
gastric- and intestine-type columnar epithelial cells in
‫كوز‬

Ruptured Esophageal
vein Varices

Esophageal carcinoma. A. Squamous cell carcinoma. There is a large
ulcerated mass present in the squamous mucosa with normal squamous
mucosa intervening between the carcinoma and the stomach. B.
Adenocarcinoma. There is a large exophytic ulcerated mass lesion just
proximal to the gastroesophageal junction. The well-differentiated
‫هع‬ ‫جعه‬

Mallory-Weiss syndrome (lacerations)
.
Between the arrowhead is a tear at

Scleral icterus. Note the yellow discoloration of this patient’s
conjunctivae. Scleral icterus is a manifestation of jaundice,
and can be seen in patients with elevated levels of bilirubin
.

Bile lake. In the center of the photomicrograph is a
yellowish pool of bile, which has displaced the

Bile plug. At the tip of the black arrow is a bile ductule
plugged with bile. This histologic feature is indicative of

Cirrhosis. This cross-section of the liver reveals
parenchyma that is effaced by innumerable

Complications of
cirrhosis
.
Congestive
splenomegaly. With
portal hypertension,
blood return through
the splenic vein is
impaired. Normally,
the spleen is about
one tenth the size of
the liver
In this photograph,
the spleen is about
one third the size of
the cirrhotic liver
.

Macronodular cirrhosis. The nodules seen here are larger
than 3 mm and, hence, this is an example of "macronodular"

This is an example of a micronodular cirrhosis. The
regenerative nodules are quite small, averaging less than 3
mm in size. The most common cause for this is chronic

Microscopically with cirrhosis, the regenerative nodules of
hepatocytes are surrounded by fibrous connective tissue
that bridges between portal tracts. Within this collagenous
fibrous connective
regenerative nodules of hepatocytes
lymphocytes

Cirrhosis due to hereditary hemochromatosis. In this
section, the hepatic parenchyma is divided into nodules by
fibrous septae. Within the fibrous septae are hemosiderin-

Fatty liver. Here, the fatty change seen in alcoholics
involved the entire liver (arrow) (diffuse fatty liver). Fatty
liver can also occur with other processes producing hepatic
steatosis, such as diabetes mellitus and obesity, and is

Macrovesicular steatosis and Mallory hyaline. Some of the
hepatocytes have macrovesicular steatosis (i.e., one large
fat vacuole in the cell). The ropy eosinophilic intracellular
accumulations at the tip of the arrowheads are Mallory
hyaline. Mallory hyaline is frequently associated with

Alcoholic hepatitis. This low power view of the liver
exhibits a prominent neutrophilic infiltrate, macrovesicular
steatosis, and Mallory hyaline (arrowheads), features that

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