The Pathology Museum

Transcription

1 The Pathology Museum

2 Welcome Welcome to the museum. This museum contains images of items in the departmental museum. In addition it has links to articles regarding the specific lesion and photomicrographs of some of the lesions in the museum. Please go through the items and give us your comments. Dr.Moses Isyagi and Dr. Ian Munabi.

3 Acknowledgements We are grateful to the following: Professor Nelson Sewankambo, Associate Professor Bimenya, Dr. F.F. Tusubira and the staff of the DICTS and Department of Pathology for their support and encouragement in developing the e-path project. Julia Royal and the United States Library of Medicine for financial support to start the e-path project at Makerere Milan Boie for his voluntary technical advice on the photography Dr. Robert Lukande for slides on Burkitts lymphoma.

4 Instructions Study the images and read the accompanying notes Click on the links (Blue text) to go to websites that give current information on the lesions in this growing museum. Send your comments to They will be highly appreciated.

5 Diptheria A child 2 years old, cough and pyrexia. Diagnosis: Diptheria (Larynx). Note: Pseudomembrane in the larynx. Question: What other organs may be affected in the disease and by what mechanism?

6 Diptheria Note pseudomembrane in the larynx and upper trachea. What is a psuedomembrane? How does it form?

7 Trichuriasis of the colon. H130 B Clinical Male 30 year old with diarrhoea for some weeks Specimen: Multiple small round worms in lumen of colon Diagnosis Trichuris Trichuria of the colon. Note worms attached to the intestinal mucosa. How common is this condition in Uganda?

8 Schistosomiasis. H 123:A Clinical: A 30 year old African fisherman from West Nile. Colostomy done for what was thought to be polyposis coli. Specimen: Multiple mucosal polyps of the colon. Diagnosis: Schistosomiasis Question: What could have been the presenting symptoms? Note the granulomas on the intestinal mucosa.

9 Transitional Cell carcinoma of the Urinary bladder. Exophytic papillary mass arising from the bladder wall and filling the bladder wall. Aetiology of transitional cell carcinoma of the bladder.

10 Transitional cell carcinoma Note Papillary folds Histological variants of transitional cell carcinoma

11 Transitional cell carcinoma Vascular invasion What is the significance of the presence of tumour cells in the blood vessels?

12 Transitional cell carcinoma Islands of tumour cells in the capsule of the bladder. What is the histological grade of this tumour?

13 Fibrinous pericarditis What are the causes of fibrinous pericarditis?

14 Tuberculous pericarditis Note the thickenened constrictive pericardium and the ares of caseation in the thickened the thickened pericardium.

15 Constrictive Pericarditis This is a complication of fibrinous pericarditis What are he possible medical complications of this condition? Note thickened pericardium.

16 Constrictive Pericarditis Note the thickened pericardium.

17 TB Bronchopneumonia. G10: 002 A female Luo 35 years old. Productive cough for six months and she was grossly wasted. Diagnosis: tuberculosis bronchopneumonia. Note: Part of adherent pericardium. Consider this patient s pathophysiology of the respiratory system. Question: What are the ways in which a patient can get TB bronchopneumonia? Note the tubercles within the lung parenchyma

18 Alveolar cell carcinoma mimicking metastases to the lung. G18: 162 What is this organ? What are the lesions most likely to be? Where might they come from? 1) Lung 2) Pulmonary metastases 3) Liver, Breast, G.I. tract, kidney. Adult male presented with severe dyspnoea and haemoptysis. CXR revealed multiple rounded opacities in both lungs and a diagnosis of pulmonary metastases from a primary of uncertain origin was made. The patient died shortly after admission. Autopsy confirmed the presence of multiple lung tumour, but a careful search failed to reveal any obvious primary source. Histology showed the tumour to be adenocarcinoma and a final diagnosis of alveolar cell carcinoma. This is a rare lung tumour and is often confused with pulmonary metastases. Where may lung metastases arise from?

19 Carcinoma of the lung with bronchiectasis. G17:162 Clinical summary: A male 60 years old. Chronic cough for six months, sometimes producing blood stained sputum. X-ray of chest suggested lung cancer. Diagnosis: Carcinoma of lung and bronchiectasis. Note: Involvement of the pleura. Questions: Is this tumour common in Ugandan Africans? What systemic effect can carcinoma of the lung produce? What histological type can this tumour be? What do you know about the etiology of lung cancer?

20 Carcinoma of the tongue H141: B Clinical A male African, 50 years old. A mass growing on the tongue for some months. Specimen: A solid tumour on the left side of the tongue. Diagnosis: Carcinoma of tongue. Question: Which group of lymph nodes will first be involved by this tumour?

21 Carcinoma of the Oesophagus H 150 B Clinical: Male African, 50 year. Dysphagia for some time. On examination he was wasted and dehydrated. Specimen: large solid granular tumour filling the oesophagus Diagnosis: Carcinoma of the Oesophagus Questions: How does the tumour spread and what complications may arise? In which area of East Africa is this area commonly seen.

22 Carcinoma of the stomach H 151: A Clinical: An adult male presented with hepatomegaly and was grossly wasted. Specimen: A large raised carcinomatous ulcer of the upper end of the lesser curve o the stomach. Diagnosis: Carcinoma of stomach (Ulcerating type). Questions: What are the local effects of the tumour? Which part of the world has a high incidence of this tumour?

23 Carcinoma of the caecum H 153: B Clinical: A male patient presented with gross wasting and anemia (Hemoglobin 5 g/ml) Specimen: An irregular, rough polypoidal tumour of the caecum. Diagnosis: Carcinoma of the caecum Question: What is the mechanism of the anemia in this case?

24 Malignant lymphoma of the small intestine causing inussusception. H 200: B Clinical: A female African 40 years old. Abdominal paid for 3 weeks and palpable mass in the abdomen. Laparotomy done. Specimen: A solid white tumour at the apex of the intussusceptum has caused the intussusception. Diagnosis: Malignant lymphoma: intussusceptions. Question: What other lesions in the small intestine may lead to intussusceptions?

25 Carcinoma of the Rectum H154: B Clinical: A male 60 years old, constipation, blood per rectum, loss of weight. Specimen: An annular, ulcerated carcinoma, with dilatation of the rectum above the tumour. Diagnosis: Carcinoma of the lower rectum. Question: What other tumors may occur in this region?

26 Cirrhosis of the Liver. H 581: A Clinical: A 28 year old Muganda male. On admission, he had gross ascites. Enlarged spleen and was mentally confused. Specimen: A small liver with pale nodules of hepatic parenchymal tissue, surrounded by darker fibrous tissue. Diagnosis: Cirrhosis of liver. Question: What results may be expected on laboratory examination of this patient s ascetic fluid and serum?

27 Hepatocellular Carcinoma H 155: A Clinical: A 37 year old Rwanda male. Pain and swelling in the right hypochondria for six weeks. He had haematemesis on the day of admission. Specimen: A cirrhotic liver with large nodules (macronodular). A solid tumour of the right lobe is spreading to involve the left lobe. Diagnosis: Hepatocellular carcinoma and cirrhosis: Question: Any views of carcinogenesis?

28 Diverticular disease of the small intestine. H 578: A Clinical: An adult male had abdominal pain for some weeks before admission to the hospital. Specimen: Multiple diverticular on the mesenteric aspect of the small intestine. The upper specimen is congested and inflamed. Diagnosis: Diverticular disease of the small intestine. Questions: Is this disease common in Africans? What are the complications of the disease? What is known of the pathogenesis of the condition?

29 Mesenteric lymphatic cysts H 578: D Clinical: A female patient 36 years old presented with acute abdominal paid and floating tumour in abdomen. Specimen: Large thin-walled cysts of mesentery, close to the intestine. Diagnosis: Mesenteric lymphatic cysts Question: These cysts may twist and produce acute pain. Could this have occurred in this patient?

30 Benign Chronic Gastric Ulcer H540: B Clinical: A male Rwanda 40 years old had epigastric pain for some years. One morning he collapsed and was rushed to hospital. On examination: A pulse was rapid and thready, he was cold at the periphery of the blood and pressure was very low. Specimen: A large deep chronic ulcer high up on lesser curve of stomach. Eroded blood vessels in the base of the ulcer. Diagnosis: Benign chronic Gastric ulcer. Question: Why did he collapse?

31 Intussusception H 570: B Clinical: A male adult African with abdominal pain for four months and palpable mass in the right iliac fossa. Specimen: The congested mass is composed of intestine that has been turned inside out. Diagnosis: Intussusception. Question: Is this type of intussusception commonly seen in the local population?

32 Fish bone in the oesophagus H 930: P Clinical: A male African, 20 years old. Specimen: Congestion and ulceration of esophagus due to vertebra of fish. Diagnosis: Fish bone in the esophagus. Note the surrounding inflammatory reaction. Question: What are the possible complications of this disease?

33 Fish bone in the oesophagus

34 Burkitts Lymphoma Go to the following link to about Burkitts lymphoma Starry sky appearance

35 Burkitts Lymphoma Immunohistochemistry. CD20 positive CD20.What are cellular differentiation markers?

36 Burkitts lymphoma-immunohistochemistry. Ki67 The Ki-67 is a cellular marker for proliferation. It is strictly associated with ell proliferation. During the interphase Ki-67 antigen can be exclusively detected within the nucleus in mitosis most of the protein is relocated to the surface of the chromosomes. Ki-67 protein is present during all active phases of the cell cycle (G1, S, G2, and mitosis), but is absent from resting cells (G0). Ki-67 is used as a marker to determine the growth fraction of a given cell population. Does the growth fraction affect the prognosis of the tumour? How?