CELL RESPONSE TO INJURY AND ADAPTIVE CELL REACTION

YEAR II

Assist. Prof. Dr. Ipek Erbarut Seven

Assoc. Prof. Dr. Pelin Bağcı

N-18 FATTY CHANGE ORGAN: LIVER

This H&E stained slide is prepared from a grossly yellow colored enlarged liver. The parenchymal cells (hepatocytes) show marked fatty change. Note the variable sized lipid vacuoles in the cytoplasm and peripherally displaced nuclei. Remember that fat globules appear as empty spaces with routine H&E stain.

N-18 FATTY CHANGE ORGAN: LIVER

This H&E stained slide is prepared from a grossly yellow colored enlarged liver. The parenchymal cells (hepatocytes) show marked fatty change. Note the variable sized lipid vacuoles in the cytoplasm and peripherally displaced nuclei. Remember that fat globules appear as empty spaces with routine H&E stain.

Lipid vacuole

A-1 COAGULATION NECROSIS ORGAN: PLACENTA

All of the section undergone coagulation necrosis. These areas are acidophilic. The cells have “tombstone” appearence that is nuclear detail is lost, only the basic cellular shape, the silhouette of the villi and cells are preserved. You can still recognise the cell outline and tissue architecture

necrosis

İntact villi

A-1 COAGULATION NECROSIS ORGAN: PLACENTA

All of the section undergone coagulation necrosis. These areas are acidophilic. The cells have “tombstone” appearence that is nuclear detail is lost, only the basic cellular shape, the silhouette of the villi and cells are preserved. You can still recognise the cell outline and tissue architecture.

silhouette of the villi

A-3 FAT NECROSIS Organ: Breast – fat tissue

Microscopic findings: The section is from an ill-defined mass in the breast present for 3 weeks. This section consists largely of fibrous tissue with scattered lymphocytes. Nearby there are islands of fat tissue which is replaced by histiocytes in some areas. Note that you can see the shadowy outlines of necrotic fat cells and they do not have nuclei.

histiocytes

B-8 FAT NECROSIS Organ:Breast

Microscopic findings: The section is from an ill-defined mass in the breast present for 3 weeks. This section consists largely of fibrous tissue with scattered lymphocytes. Nearby there are islands of fat tissue which is replaced by histiocytes in some areas. Note that you can see the shadowy outlines of necrotic fat cells and they do not have nuclei.

B-8 CASEIFICATION NECROSIS ORGAN: Lymph Node

Granuloma consist of epithelioid histiocytes (macrophages) surrounded by lymphocytes. You may see langhans type giant cells in some of them. In the center of a few of the granulomas, necrosis is seen. This is a special type of necrosis. The outlines of the cells are not preserved. Instead you see amorphous eosinophilic (pink) material which contains cellular debris.

B-8(2) CASEIFICATION NECROSIS ORGAN: Lung

Granuloma consist of epithelioid histiocytes (macrophages) surrounded by lymphocytes. You may see langhans type giant cells in some of them. In the center of a few of the granulomas, necrosis is seen. This is a special type of necrosis. The outlines of the cells are not preserved. Instead you see amorphous eosinophilic (pink) material which contains cellular debris.

necrosis

Lung

B-8(2) CASEIFICATION NECROSIS ORGAN: Lung

In this section of the lung, there are several round, nodular structures which are called granulomas. Each granuloma consist of epithelioid histiocytes (macrophages) ,surrounded by lymphocytes. You may see langhans type giant cells in some of them. This type of giant cells, nuclei arranged peripherally. In the center of a few of the granulomas, necrosis is seen. This is a special type of necrosis called caseification necrosis. The outlines of the cells are not preserved. Instead you see amorphous eosinophilic (pink) material which contains cellular debris.

Langhans type giant cell

necrosis

A-13 METAPLASIA Organ: Cervix The section is prepared from uterine cervix. On one side there is ectoservix lined by squamous epithelium and it continues with endoservix lined by columnar epithelium is seen. You may easily see the squamocolumnar junction where columnar epithelium changes to squamous epithelium called squamous metaplasia. There are glands in the endocervical portion of the section, lined by similar columnar epithelium. When you look at the surface epithelium closely you will see that some parts of the columnar epithelium transform to squamous type of epithelium.

ectoservix

Squamous metaplasia

Squamocolumnar junction

A-13B METAPLASIAOrgan: Stomach

The section is from a gastrectomy specimen. On the slides you will see the gastric mucosa lined by columnar epithelial cells. At some parts the gastric epithelium is replaced by intestinal metaplasia which is composed of goblet cells, absoptive ‘brush border’ cells

A-13B METAPLASIAOrgan: Stomach

PAS-Alcian Blue 2,5 staining: Normal gastric epithelium is bright pink (neutral mucin) and the intestinal metaplasia areas are purple (acidic mucin) in color.There are goblet cells in these metaplastic areas. Mark the difference.

Goblet cells

P-22 HYPERPLASIAOrgan: Prostate

Examine both stromal and epithelial components. The fibromuscular stroma and glands are proliferated. The glandular epithelium is generally hyperplastic, some glands show cystic dilatation and contain corpora amylacea in the lumina.

P-22 HYPERPLASIAOrgan: Prostate

The glandular epithelium is generally hyperplastic, some glands show cystic dilatation and contain corpora amylacea in the lumina.

Corpora amylacea

A-14 ATROPHY-NODULAR HYPERPLASIA Organ: Thyroid You see one of the nodules which has various sized follicles. These follicles have colloid in their lumen and their epithelial lining is cuboidal. Around some follicles a homogenous pink area of hyalinisation is noted. Surrounding the nodule fibrous tissue and atrophic thyroid follicules and granulomatous inflammation are seen. Atrophic follicles which are compressed are small and their epithelial lining is flattened.

nodules

colloid

A-14 ATROPHY-NODULAR HYPERPLASIA Organ: Thyroid

You see one of the nodules which has various sized follicles. These follicles have colloid in their lumen and their epithelial lining is cuboidal. Surrounding the nodule fibrous tissue and atrophic thyroid follicules and granulomatous inflammation are seen. Atrophic follicles which are compressed are small and their epithelial lining is flattened.

Atrophic follicles

Follicles in nodule

HEMODYNAMIC DISORDERS & ABNORMAL ACCUMULATIONSMORPHOLOGY OF ACUTE AND

CHRONIC INFLAMMATION

A-15 ANTHRACOSIS Organ: Lymph node

In the center of the lymph node lymphoid tissue is replaced by a fibrotic stroma rich in blood vessels. This stroma is infiltrated by histiocytes which contain black granules (carbon pigment). You may also see carbon pigment within the extracellular space.

Carbon pigment

A-15 ANTHRACOSIS Organ: Lymph node-high power

Stroma of the lymph node is infiltrated by histiocytes that contain black carbon pigment.

A-7a HEMOSIDEROSIS Organ: Ovary

The slide is prepared from an ovary which has a focus of endometriosis. Here we see an area of old bleeding. This area is mainly composed of numerous hemosiderin-laden histiocytes. Try to identify intracytoplasmic bright yellow-brown appearing tiny granules of hemosiderin within histiocytes(arrow). These cells are called “siderophages”.

N-17 MELANIN PIGMENT Organ: Skin

A lesion composed of melanin containing melanocytes is seen within the dermis. The lesion also contains some cells which don’t contain melanin. These cells have plump nuclei.

melanocytes

C-3a CONGESTION Organ: Spleen

The splenic sinuses are dilated and filled with red blood cells

C-6e INFARCTION Organ: Small intestine

An intense congestion and silhouettes of intestinal villi are seen. In some slides there is extensive red blood cell extravasation and necrosis of the bowel.

silhouettes of intestinal villi

C-4A THROMBOSISOrgan:Artery

This slide illustrates artery occluded by thrombi. This is an organized thrombus. The wall of the arteries is calcified.

calcification

thrombus

C-4B THROMBOSIS Organ: Vein

In this section we see an enlarged vein in which the lumen is completely obliterated by an organized thrombus.

thrombus

B-6 ABSCESSOrgan: Skin

Histology of the organ: A dermis containing cutaneous appenages such as hair follicles, sebaceous glands and sweat glands lined by an epidermis composed of stratified squamous epithelium. Beneath the dermis begins the subcutaneous adipose tissueMicroscopic findings: There is a area of liquefaction necrosis filled with neutrophils intermingled with histiocytes and giant cells. The wall of the necrotic area is rich in blood vessels.

M-36a ACUTE INFLAMMATION Organ :Appendix

In this slide you see an inflamed appendix wall. Try to examine each layer subsequently. There is a purulent exudate in the lumen. The continuity of the mucous membrane is not maintained because of the erosion seen just beneath that exudate. Note that the edematous wall is diffusely infiltrated by neutrophils.

Purulent exudate

M-10 PEPTIC ULCER Organ: Stomach

On both sides of the slide you can see normal gastric tissue and in the middle there is a local tissue defect. Here, epithelium is the ulcerated. The surface of it contains an inflammatory exudate composed of necrotic tissue debris and neutrophils. Beneath this try to see the granulation tissue which is surrounded by a thin layer of fibrous collagenous tissue.

ulcer

İntact epithelium

M-11 FOREIGN BODY REACTION Organ: Skin

In this section there is ruptured follicle cyst is seen. Around cyst there is a foreign body granulation tissue composed of giant cells and lymphocytes. Such foreign body giant cells have nuclei scattered haphazardly about the cell. There is refractile hair shaft fragments in some of these giant cells.Remember the difference between foreign body giant cells and Langhan’s type giant cells that seen in Tuberculosis infection.

Giant cell

Foreign body in giant cell