CELL AND TISSUE INJURY COURSE-II PATHOLOGY LABORATORY PATHOLOGY of INFECTIOUS DISEASES MICROSCOPY Rengin Ahıskalı Macroscopy samples are shown in the macroscopy presentations of the first two courses. Please check your syllabus and previous presentations.
E-63 TUBERCULOUS LYMPHADENITIS A 58 year - old smoker male patient, had a history of malaise, night fever and weight loss. On chest x-ray, he had a large hilar mass with central cavitation, and an apical cavity in his right lung. Mediastinal lymph nodes were enlarged. After a diagnosis of squamous cell carcinoma by bronchoscopic biopsy, he underwent pneumonectomy and mediastinal lymph node dissection. Lung harboured a central carcinoma and apical tuberculosis. The lymph node specimens had multiple variously sized graywhite foci on cut surface. Lymph node sections show several pinkish, round, nodular structures which are granulomas. Try to find Langhans type of giant cells and areas of caseation necrosis seen in the center of some of the granulomas. In some areas you will see large and confluent granulomas with extensive necrosis which appears as amorphous eosinophilic granular material with cellular debris. You can see many multinucleated plump histiocytic giant cells in the granulomas. Some have typical features of Langhans type of giant cells, some do not. On high magnification, examine epitheloid histiocytes which form the granulomas. They have cytoplasmic extentions contacting with others, indistinct cell borders, elongated nuclei.
E-63 TUBERCULOUS 1 Granulomas composed of epitheloid histiocytes 2 Lymphocytes 3 Caseation necrosis 4 Multinucleated giant cells LYMPHADENITIS
TUBERCULOUS LYMPHADENITIS Low magnification Medium magnification
TUBERCULOUS LYMPHADENITIS High magnification High magnification
E-62 BACTERIAL COLONIES, (Tongue) A 22 year old male patient a patient with a tounge mass which showed a slow but considerable growth over many years underwent partial glossectomy to remove the tumor. The tumor was a hemangioma. These sections are prepared from the surgical magrin of the specimen and do not contain any tumor. Due to poor oral hygene, the surface of the tongue are covered with bacterial colonies. You can see the squamous epithelium of tongue is thicker than normal and shows keratinization (appearing dark pink). On the surface of the papillae, you can see blue hazy material surrounding clumps of keratinized cells. Examine the blueish areas: these are bacterial colonies. On highest magnification you can differentiate cocci and thread-like filamentous bacteria (probably Actinomyces). You do not see inflammatory cells. You would expect to see polymorphonuclear leucocytes in a case of bacterial infection with cocci and/or Actinomyces. Why do you think we do not see any inflammation in these sections?
E-62 BACTERIAL COLONIES, 1 Tongue muscles 2 Squamous surface epithelium 3 Bacterial colonies 4 Keratin TONGUE
BACTERIAL COLONIES Low magnification Medium magnification
BACTERIAL COLONIES Medium -High magnification High magnification
E-4 MOLLUSCUM CONTAGIOSUM, (skin) These sections are prepared from one of the multiple skin colored pruritic papules with umbilicated centers on the trunk of a 6 year old boy. You can see a cup-shaped lesion with distinct edges in the epidermis. Adjacent to a hair follicle, hyperplastic epidermis has grown downward to dermis in lobules in the center of the lesion. In the stratum granulosum and stratum corneum (upper layers of epidermis), you see homogenous, red, large cytoplasmic inclusions which displace the nuclei of cells. These inclusions, called "molluscum bodies" are aggregates of virions. They are pathognomonic for molluscum contagiosum.
1 Epidermis E-4 MOLLUSCUM CONTAGIOSUM 2 Hyperplastic squamous epithelium growing downward to dermis in lobules 3 Hair follicle 3 Cytoplasmic inclusions (Molluscum bodies)
MOLLUSCUM CONTAGIOSUM Low magnification Medium magnification
MOLLUSCUM CONTAGIOSUM Medium-High magnification High magnification
E-64 ASPERGILLOSIS, middle ear These sections prepared from the middle ear of a patient who had a history of itching and pain in the left ear and hearing defect. He had external ear infection which perforated the tympanic membrane and involved the middle ear. As the keratinized squamous epithelium, keratin and exudate filled the middle ear, he had to undergo an operation to remove these. You see part of this material: squamous epithelium overlying inflamed and fibrotic mucosa, inflammatory exudate and masses of fungi. You can see the squamous epithelium is thick and shows keratinization (appearing darker pink). Underneath the epithelium you can see mostly mononuclear inflammatory infiltrate. Deeper areas of the tissue shows fibrosis and some foreign body type giant cells. On the surface, you can see dense clumps of hyphae and suppurrative exudate. Hyphae are cut at varios planes, but you can see the septations and acute angle branching in many of them. As these are the typical features Aspergillus, we can diagnose the infectious agent in this case.
E-64 ASPERGILLOSIS, middle ear 1 Squamous epithelium 2 Keratinized cells 3 Subepithelial inflammation & fibrosis 4 Inflammatory exudate 5 Fungal septate hyphae
ASPERGILLOSIS Low magnification Medium magnification
ASPERGILLOSIS Medium - High magnification High magnification
E-61 ECHINOCOCCUS GRANULOSUS INFECTION, peritoneum A 28 year old man with a history of ruptured hydatid cyst and current abdominal pain was found to have multiple fluid-filled masses. At the operation, multiple soft, white cysts found in the peritoneum removed. Cysts easily shelled out from the surrounding fibrotic tissue. They were filled with clear fluid, with a white sand-like material, which is called the hydatid sand (daughter cysts). You do not see fibrous reactive host tissue in the sections. You can only see the hydatid cyst. It is composed of a thick, multi-laminated, pink outer membrane - the cuticle, inner germinative membrane and daughter cysts. The thin cellular layer with tiny nuclei inside the cuticle is the germinative inner lining from which daughter cysts budd off into the lumen. Some daughter cysts remain attached to the germinative wall, some seem to be floating within the lumen. Daughter cysts are composed of germinative membrane surrounding scoleces. You can also see free floating scoleces. You can see the hooklets of some scoleces which they will use if they get the chance to develop into adult worms in the future.
E-14-a ECHINOCOCCUS GRANULOSUS INFECTION-LIVER 1 thick, multi - laminated outer membrane - the cuticle 2 germinative membrane 3 daughter cysts 4 scolices
ECHINOCOCCUS GRANULOSUS Low magnification Medium magnification
ECHINOCOCCUS GRANULOSUS Medium-High magnification High magnification