CELL AND TISSUE INJURY
COURSE-I
YEAR II
PATHOLOGY LABORATORY
Assist. Prof. Dr. Ipek Erbarut Seven
Assoc. Prof. Dr. Pelin Bağcı
CHANGES IN THE SIZE,
CONSISTENCY, COLOUR&
COMPOSITION OF ORGANS
HD-l . HYPERTROPHY
ORGAN: Heart
Gross findings: The thickness of the ventricular wall is thickened.
NODULE
Normal size of
the prostate
HD-2 HYPERPLASIA
ORGAN: Prostate
Gross Findings: Two prostatic lobes are seen. They are enlarged, firm and nodular. The cut surfaces are also
nodular and contains some minute cysts. The size of nodules vary from 0.5 to 1.5cm.
Descriptive Notes: This increase in size is in response to hormonal changes that occurs with the aging process.
NODULE
HD-3: HYPERPLASIA
ORGAN: Thyroid (Nodular Hyperplasia)
Gross Findings: Thyroidectomy specimen with glistening, jelatinous, nodular surfaces is seen. At cut section you can discriminate fibrous bands
causing nodular structures.
Descriptive Notes: In the adult, the normal thyroid gland weighs 20 to 25 gm. The most common cause of the nodular hyperplasia is lack of
iodine in the diet resulting insufficient production of throid hormones. This cause increase the sythesis and release of TSH (thyroid stimulating
hormone), resulting in enlargement of the thyroid.
HD-4: LYMPHOMA
ORGAN: Spleen
Gross Findings: In the cut section of the spleen, you see numerous nodular masses(approximately 0.6-0.8 cm. in
dimension). This leads to diffuse enlargement of the spleen.
Descriptive notes: These nodular masses are formed by neoplastic proliferation of lymphocytes which are actually
local cells of the spleen.
NODULE
HD-4: LYMPHOMA
ORGAN: Spleen
Gross Findings: In the cut section of the spleen, you see numerous nodular masses(approximately 0.6-0.8 cm. in
dimension). This leads to diffuse enlargement of the spleen.
Descriptive notes: These nodular masses are formed by neoplastic proliferation of lymphocytes which are
actually local cells of the spleen.
Granulomatous foci
HD-5: MILLIARY TUBERCULOSIS
ORGAN: Lung
Gross Findings: There are multiple small (pin-point to a few millimeters), yellow white
distinct foci. This leads to diffuse enlargement of the lungs.
Descriptive notes: These foci are formed by granulomatous inflammation.
HD-7: ACUTE REJECTION
ORGAN: Kidney
Gross Findings: The kidney is larger,
harder,and paler than normal.
Descriptive Notes: Enlargement of the
kidney caused by edema, and diffuse
mononuclear cell infiltration. Result of
humoral rejection extensive renal
parenchymal necrosis seen.
HD-8: LINITIS PLASTICA
ORGAN: Stomach
Gross Findings: There is diffuse thickening of the gastric wall which has given rise to a term “leather-bottle”
stomach also called linitis plastica.
Descriptive Notes: Tumour cell infiltration to the gastric wall ends up with diffuse thickening of the gastric wall.
trabeculation
HD-9: HYPERTROPHY – DILATATION
ORGAN: Urinary Bladder
Gross Findings: This is a partial cystectomy spesimen. The bladder is turned inside out so that you can
see the pale mucosa. The cavity of the urinary bladder is enlarged. The bladder wall is thicker than
normal.
Descriptive Notes: Vesical obstruction caused hypertrophy of the muscle layer. Hypertrophy of the
muscle bundles produce trabeculation. Vesical obstruction caused dilatation of the bladder and
hypertrophy of the muscle layer. Hypertrophy of the muscle bundles produce trabeculation.
HD-11: FATTY CHANGE
ORGAN: Liver
Gross Findings: A slice of the liver is seen. Liver is enlarged, yellow, smooth, firmer than normal and greasy. The
capsule remains smooth and glistening.The lumina seen on the cut surface are the branches of the portal vein.
Descriptive Notes: the normal adult liver weighs 1400 to 1600 gms. Fatty change results from defective
oxidation of fatty acids and aberrant mitochondrial function.
HD-12: ANTHROCOSIS
ORGAN: Lung
Gross Findings: Accumulation of this
pigment blacken the tissue of the lung
Descriptive Notes: The most common
exogeneous pigment is carbon or coal
dust, which is a virtually ubiquitous air
pollutant of urban life.
HD-12: ANTHROCOSIS
ORGAN: Lung
Gross Findings: Accumulation of this pigment blacken the tissue of the lung.
Descriptive Notes: The most common exogeneous pigment is carbon or coal dust, which is a
virtually ubiquitous air pollutant of urban life.
LipidLIPID
plaque
PLAQUE
HD-13: ATHEROSCLEROSIS-CHOLESTEROL ACCUMULATION
ORGAN: Vessel Wall
Gross Findings: You see an opened vessel wall. On the inner surface there are elevated areas of different diameter in size, yellow-white in colour
and with irregular lipid plaques.Some plaques are calcified, these can be recognised with their white color and rigid appearance. The size of the
atheromatous plaques are varible and some show coalescence.
Descriptive Notes: Endothelial cell damage and increased total cholesterol and decreased HDL cholesterol cause atherosclerotic plaq formation.
HD-14: FATTY CHANGE
Gross Findings: The heart is enlarged and softened. It is yellow in colour.
You can also see atherosclerotic yellow lipid plaques in the opened
vessels.
HD-15: AMYLOIDOSlS
ORGAN: Kidney
Gross Findings; Kidney is enlarged ,
firm and have a waxy appearance.
Descriptive Notes: Extracellular
hyaline amorphous material is
accumulated in glomeruli and vessel
wall. Painting the cut surface with
iodine imparts a yellow colour is
transformed to blue violet.
HD-16: PASSIVE CONGESTION
ORGAN: Ovary
Gross Findings : The organ is diffusely enlarged, firm, and cyanotic.
Descriptive Notes: This is due to twisting of ovary that cause obstruction of venous return resulting in
intense congestion. Ovarian torsion is uncommon.
NUTMEG
HD-17: CHRONIC PASSIVE CONGESTION ORGAN: Liver
NUTMEG LIVER (normal adult liver weight is 1400-1600gm.)
Gross Findings: There is dusky red cyanosis and diffuse increase in liver size and weight. On the cut surface
the central congested areas appear darker than the pale peripheral portions of the lobules and thus compose
the so-called nutmeg pattern.
Descriptive Notes: Passive congestion of the liver results from right-sided heart failure or obstruction of the
inferior vena cava or hepatic vein. When you think about the normal circulation of the liver you will easily
understand why the central areas axe primarily affected. We see hemorrhagic necrosis in the pericentral
zones. Whereas the peripheral hepatocytes, suffering from less hypoxia, develop fatty change. This zonal
difference gives red [centre of the lobule) and yellow (periphery-of the lobuie) discoloration so-called
"nutmeg" liver to the organ.
NUTMEG
HD-17: CHRONIC PASSIVE CONGESTION ORGAN: Liver
NUTMEG LIVER (normal adult liver weight is 1400-1600gm.)
Gross Findings: There is dusky red cyanosis and diffuse increase in liver size and weight. On the cut surface the
central congested areas appear darker than the pale peripheral portions of the lobules and thus compose the socalled nutmeg pattern.
Descriptive Notes: Passive congestion of the liver results from right-sided heart failure or obstruction of the
inferior vena cava or hepatic vein. When you think about the normal circulation of the liver you will easily
understand why the central areas axe primarily affected. We see hemorrhagic necrosis in the pericentral zones.
Whereas the peripheral hepatocytes, suffering from less hypoxia, develop fatty change. This zonal difference gives
red [centre of the lobule) and yellow (periphery-of the lobuie) discoloration so-called "nutmeg" liver to the organ.
HD-18: PASSIVE CONGESTION
ORGAN: Testis (Torsion)
Gross Findings: Testis shows slight but diffuse enlargement. The organ is tense and
cyanotic.
Descriptive Notes: There is an impairment of venous return from the testis due to
the twisting of the spermatic cord resulting compression of testicle veins.
CEREBRAL LOBES
ENGORGED VESSELS
CEREBELLUM
HD-19: CONGESTION
ORGAN: Brain —> Meningeal Congestion
Gross Findings: The blood vessels of the meninges are engorged with dark red
blood. There is also diffuse increase in the size and weight of the organ due to
secondary edema formation.
HD-20: ABSCESS ORGAN: Spleen
Gross Findings: Spleen is enlarged. Acute inflammatory cell infiltration results
with a tissue defect (arrows) that you can notice on the cut section of the
spleen.
Descriptive Notes: Normally in the addult spleen weighs, about 150 gm and
measures 12 cm in lenght, 7 cm in width, and 3 cm in thickness.
HD-21: TUBERCULOSIS ORGAN: Apex of the Lung
Gross Findings: At the apex of the lung there is an intraparanchymal tissue defect (arrow)
.At the centre of the defect with a close inspection one can easily identify the necrosis.
Descriptive Notes: Mycobacterium cause tuberculosis.The type of the necrosis is called
caseification necrosis
NECROSIS
HD-21: TUBERCULOSIS
ORGAN: Lung
Gross Findings: At the apex of the lung there is an intraparanchymal tissue defect. There is
a caseification necrosis at the center.
Descriptive Notes: Mycobacterium cause tuberculosis.The type of the necrosis is called
caseification necrosis.
DILATED CALYCES
PARENCHYMAL
THINNING
HD-22: ATROPHY
ORGAN: Kidney
Gross Findings: The cut section of the kidney reveals dilatation and deformation of the
calyces, irregular loss of renal parenchyma with scarring. Its surface is granular with
depressed scars.
Descriptive Notes: Atrophy is due to progressive destruction and loss of renal parenchyma.
HD-23: HYPOPLASIA(congenital)
ORGAN: KIDNEY
The size of the kidney is diffusely decreased. Its surface is
smooth. There are some hemorhagic areas in cortex. The
number of renal lobes and pyramids is 6 or fewer (normal
kidney has about 12 pyramids).
Corcical thinning
calculi
HD-24: CHRONIC PYELONEPHRITIS WITH CALCULI
ORGAN: KIDNEY
The cortical surface of the kidney contains irregular, broad depressed area (scar formation) of
cortical fibrosis and atrophy leading to focal decrease in size of the organ. On cut section you see
dilatation of calyces with atrophy, calculi and scarring of the overlying cortex. Medullary and
perirenal fatt tissue is increased.
INFARCT
INFARCT
HD-25: INFARCTION ORGAN: SPLEEN
Gross Findings: On the cut section of the spleen you see multiple, pale, wedge shaped, well
deliniated infarcts beneath the capsule. The infarcts which are wedge shaped have their apex
pointing toward the focus of vascular occlusion. Since all the dependent tissue out to the
periphery of the organ is affected, the external aspect of the organ forms the base of the
wedge.
Descriptive Notes:This is an example of white infarct which is seen secondary to the arterial
occlusion of the solid organs.
INFARCT
HD-26: INFARCTION
ORGAN: Placenta
Gross Findings: On cut section of the placenta reveals a white-tan and firm area of necrosis.
It is also wedge shaped with apex at maternal surface.
Descriptive Notes: This is also an example of white infarct. It results from cessation of blood
supply to intervillous space and necrosis of villi .
HD-27: TRANSMURAL INFARCT ORGAN: Small bowel
Gross Findings: A segment of small bowel is seen. A large part of this segment is intensly
congested and dark purple. This discoloration fades gradually into the adjacent segments
of the normal bowel, that is the demarcation is not sharply defined.
Descriptive Notes: This is also an example of a red infarct. We see red infarct both in
arterial and venous occlusions of the small bowel due to the fact that it has rich in arterial
anastomoses.
Fibrous bands
HD-29: CIRRHOSIS
ORGAN: Liver
Gross Findings: The liver is harder than normal due to fibrosis. Its surface shows diffuse
nodularity that reflects nodular regeneration and scarring.
Descriptive Notes: Cirrhosis of the liver is the terminal sequel of repeated injury to the liver
parenchyma. The result is the formation of broad fibrous bands separating regenerative
nodules that do not have the normal achitecture of liver lobules.
HD-30: BRONCHOPNEUMONIA
ORGAN: Lung
Gross Findings: The lung shows patchy distributed firm and gray-red to yellow colour,
elevated nodular airless areas due to inflammatory infiltration.These nodules are distributed
along with the bronchioles so called bronchopneumonia.
Descriptive Notes: It results from aspiration of organisms causing inflammation and necrosis
of underlying parenchyma.
Cholesterol accumulation
HD-31: CHOLESTEROLOSIS
ORGAN: Gall bladder
Gross Findings: Its mucosal surface shows minute yellow patches due to cholesterol
accumulation . This is called as a "strawberry gallbladder".
Descriptive Notes: It is results from abnormal deposition of mixtures of cholesterol and
triglyceride in macrophages in the lamina propria of the gallbladder.
HD-32: FIBROMA
ORGAN: Ovary
Gross Findings: The tissue is harder and bigger than a normal ovary because of infiltration by
neoplastic cells arising in the ovarian strorna. The ovary appears as a white firm, mass
composed of interlacing bundles of fibers.
Descriptive Notes:It is a benign neoplasm of the ovary.