High Yield Image Plates e-Book : By Marc Imhotep Cray, M.D.
Basic Medical Sciences Professor High Yield Image Plates e-Book University of South Carolina - Microbiology, Virology, Immunology, Bacteriology, Parasitology, Mycology Online University of Utah - WebPath University of Pennsylvania - Gram Stain Atlas Resources: GROSS PATHOLOGY, HISTOPATHOLOGY, MICROBIOLOGY AND RADIOGRAPHY http://ivms.blogspot.com/ IVMS 1999-2009 1
Streptococcus pneumoniae : Streptococcus pneumoniae Streptococcus pneumoniae. Sputum sample from a patient with pneumonia shows gram positive diplococci. IVMS 1999-2009 2
Mycobacterium tuberculosis : Mycobacterium tuberculosis (A) is characterized by caseating granulomas containing Langhans’ giant
cells, which have a “horseshoe” pattern of nuclei (see arrow).
Organisms (B) are identified by their red color on
acid-fast staining (“red snappers”). (A) (B) IVMS 1999-2009 3
Mycobacterium tuberculosis : Mycobacterium tuberculosis Miliary tuberculosis (C) is seen here with large caseous lesions at the left medial upper lobe and miliary lesions in the surrounding hilar node. This life-threatening infection is caused by bloodborne
dissemination of Mycobacterium tuberculosis to
many organs from a quiescent site of infection. (C) IVMS 1999-2009 4
Staphylococcus aureus : Staphylococcus aureus Sputum sample from another patient with pneumonia shows gram positive cocci in clusters IVMS 1999-2009 5
Neisseria gonorrhoeae : Neisseria gonorrhoeae Gram stain shows multiple gram-negative diplococci within polymorphonuclear
leukocytes as well as in the extracellular areas
of a smear from a urethral discharge. IVMS 1999-2009 6
Giardia lamblia : Giardia lamblia Giardia lamblia, small intestine, microscopic.
The trophozoite has a classic pear shape,
with double nuclei giving an “owl’s-eye” appearance. IVMS 1999-2009 7
Cytomegalovirus (CMV) : Cytomegalovirus (CMV) Cytomegalovirus (CMV). Renal tubular cells in a neonate with congenital CMV infection
show prominent Cowdry type A nuclear inclusions resembling owls’ eyes. IVMS 1999-2009 8
Coccidioidomycosis : Coccidioidomycosis Endospores within a spherule in infected lung parenchyma. Initial infection usually resolves spontaneously, but when immunity is compromised, dissemination to almost any organ
can occur. Endemic in the southwestern United States. IVMS 1999-2009 9
Cryptococcus neoformans : Cryptococcus neoformans Cryptococcus neoformans. The polysaccharide
capsule is visible by India ink preparation in
CSF from an AIDS patient with meningoencephalitis. IVMS 1999-2009 10
Candida albicans : Candida albicans KOH preparation showing branched and budding C. albicans. IVMS 1999-2009 11
Trichomonas vaginalis : Trichomonas vaginalis Trichomonas vaginalis demonstrating
trophozoites with flagellae IVMS 1999-2009 12
Herpes genitalis : Herpes genitalis Herpes genitalis. Ulcerating vesicles
associated with HSV-2. IVMS 1999-2009 13
Syphilis : Syphilis Syphilis. (A) Chancre associated with
primary syphilis. These ulcerative lesions are painless. (B) Primary syphilis. A dense infiltrate of plasma cells and dilated blood vessels can be seen. There is epidermal ulceration with crust; neutrophils are present within the predominantly plasmacytic infiltrate. (A) (B) IVMS 1999-2009 14
Syphilis : Syphilis (C) Tabes dorsalis resulting from progressive syphilis infection, thoracic spinal cord. Note degeneration of the dorsal columns and dorsal roots. IVMS 1999-2009 15
Bacterial vaginosis : Bacterial vaginosis Saline wet mount of clue cells. Note the absence of inflammatory cells. IVMS 1999-2009 16
Human papillomavirus : Human papillomavirus Human papillomavirus. Metaplastic epithelium at the cervical squamocolumnar junction, associated with HPV. IVMS 1999-2009 17
Herpes zoster : Herpes zoster Reactivation of virus spreads along the dermatomal distribution of infected nerves and can occur many years after initial infection. It is considered benign unless it affects an immunocompromised host or is a reinfection of the V1 branch of the trigeminal nerve with eye/cornea involvement. IVMS 1999-2009 18
Coxsackie exanthem (hand-footmouth disease) : Coxsackie exanthem (hand-footmouth disease) Diffuse eruptive vesiculopapules are
seen on the hand of a three-year-old child. IVMS 1999-2009 19
Pneumocystis carinii : Pneumocystis carinii Pneumocystis carinii. Special silver stain of lung epithelium shows numerous small, diskshaped organisms. IVMS 1999-2009 20
Target cells : Target cells Target cells. Due to an increase in surface area–to-volume ratio from iron deficiency anemia (decreased cell volume) or in obstructive liver disease (increased cell membrane) IVMS 1999-2009 21
Thalassemia major : Thalassemia major Thalassemia major. A blood dyscrasia
caused by a defect in ß-chain synthesis in hemoglobin. Note the presence of target cells. IVMS 1999-2009 22
Iron deficiency anemia : Iron deficiency anemia Iron deficiency anemia. Microcytosis
and hypochromia can be seen. IVMS 1999-2009 23
Sickle cell anemia : Sickle cell anemia (A) Sickle cell peripheral blood smear. Note the sickled cells as well as anisocytosis,
poikilocytosis, and nucleated RBCs.
(B) Splenic infarction. The splenic artery lacks collateral supply, making the spleen
particularly susceptible to ischemic damage. Coagulative necrosis has occurred in a wedge shape along the pattern of vascular supply. Individual sickle cells cause generalized splenic infarcts that result in autosplenectomy by adolescence. (A) (B) IVMS 1999-2009 24
Leukemia : Leukemia Acute lymphocytic leukemia, peripheral blood smear. Affects children less than 10 years of age.
(B) Acute myelocytic leukemia with Auer rods (arrows), peripheral blood smear. Affects adolescents to young adults. (A) (B) IVMS 1999-2009 25
Leukemia : Leukemia (C) Chronic lymphocytic leukemia, peripheral blood smear. In CLL, the lymphocytes are excessively fragile. These lymphocytes are easily destroyed during slide preparation, forming “smudge cells.” Affects individuals older than 60 years of age.
(D) Chronic myeloid leukemia, peripheral blood smear. Promyelocytes and myelocytes are seen adjacent to a vascular structure. Affects individuals from 30 to 60 years of age. (C) (D) IVMS 1999-2009 26
Multiple myeloma : Multiple myeloma (A) X-ray shows numerous punched-out lytic lesions (lucent areas) typical
of multiple myeloma. Note the generalized osteopenia
and multiple compression fractures (arrow).
(B) Classic bone lytic lesions seen in multiple myeloma. IVMS 1999-2009 27
Multiple myeloma : Multiple myeloma (C) Smears from a patient with multiple myeloma display an abundance
of plasma cells. RBCs will often be seen in rouleaux formation, stacked like poker chips. Multiple myeloma is associated with hypercalcemia, lytic bone lesions, and renal insufficiency due to Bence Jones(lightchain) proteinuria. IVMS 1999-2009 28
Burkitt’s lymphoma : Burkitt’s lymphoma The classic “starry-sky” appearance from macrophage ingestion of tumor cells can be seen. IVMS 1999-2009 29
Hodgkin’s disease (Reed-Sternberg cells) : Hodgkin’s disease (Reed-Sternberg cells) Binucleate RS cells displaying prominent inclusion-
like nucleoli surrounded by lymphocytes and other
reacting inflammatory cells. The RS cell is a necessary
but insufficient pathologic finding for the diagnosis of
Hodgkin’s disease. IVMS 1999-2009 30
Hemochromatosis with cirrhosis : Hemochromatosis with cirrhosis Hemochromatosis with cirrhosis.
Prussian blue iron stain shows hemosiderin in the liver
parenchyma. Such deposition occurs throughout the
body, causing organ damage and the characteristic darkening of the skin. IVMS 1999-2009 31
Metastatic carcinoma : Metastatic carcinoma Metastatic carcinoma to the liver.
The most common primary sites are the breast, colon,
and lung. Primary tumors of the liver are less common
than metastatic disease. IVMS 1999-2009 32
Fatty metamorphosis : Fatty metamorphosis Fatty metamorphosis (macrovesicular steatosis) of the liver, microscopic. Early reversible change associated with alcohol consumption can be
seen; there are abundant fat-filled vacuoles, but as yet there is no inflammation due to fibrosis of more serious alcoholic liver damage IVMS 1999-2009 33
Cirrhosis : Cirrhosis Micronodular cirrhosis of the liver, gross, from an alcoholic patient. The liver is approximately normal in size with a fine, granular appearance. Later stages of disease result in an irregularly shrunken liver with larger nodules, giving it a “hobnail” appearance.
(B) Cirrhosis, microscopic. Regenerative lesions are surrounded by fibrotic
bands of collagen (“bridging fibrosis”), forming the characteristic nodularity. (A) (B) IVMS 1999-2009 34
Cirrhosis : Cirrhosis (C) Gross natural color with macronodularity that is difficult to see. Hepatitis B surface antigen and core antigen negative.
(D) Chronic passive biliary congestion gives the liver a “nutmeg” appearance. (C) (D) IVMS 1999-2009 35
Colonic polyps : Colonic polyps Colonic polyps. Tubular adenomas
(A) are smaller and rounded in morphology and have less malignant potential than do villous adenomas
(B) , which are composed of long, fingerlike projections. (A) (B) IVMS 1999-2009 36
Diverticulitis : Diverticulitis Inflammation of the diverticula typically causes LLQ pain and can progress to perforation, peritonitis, abscess formation, or bowel
stenosis.
Note the presence of macrophages. Gut lumen is seen at the top of the photo. IVMS 1999-2009 37
Celiac sprue : Celiac sprue Celiac sprue (gluten-sensitive enteropathy).
Histology shows blunting of villi and crypthyperplasia. IVMS 1999-2009 38
Intussusception of infant gut, gross : Intussusception of infant gut, gross Intussusception of infant gut, gross IVMS 1999-2009 39
esophageal varix : esophageal varix Sclerosed esophageal varix.
Overlying esophageal mucosa is generally normal. IVMS 1999-2009 40
Pulmonary emboli : Pulmonary emboli Pulmonary thromboembolus (arrow), gross. Most often arises from deep venous thrombosis.
(B) Pulmonary thromboembolus in a small muscular pulmonary artery.
The interdigitating areas of pale pink and red within the organizing embolus form the “lines of Zahn” (arrow) characteristic of a thrombus. These
lines represent layers of red cells, platelets, and fibrin that are
laid down in the vessel as the thrombus forms. IVMS 1999-2009 41
Squamous cell carcinoma : Squamous cell carcinoma Squamous cell carcinoma of the lung, gross, from a patient with a long smoking history.
This tumor arises from the bronchial epithelium and is
centrally located. IVMS 1999-2009 42
Small (oat) cell carcinoma : Small (oat) cell carcinoma Small (oat) cell carcinoma in a pulmonary hilar lymph node. Almost all of these tumors are related to tobacco smoking. They can arise anywhere in the lung, most often near the hilum, and quickly spread
along the bronchi. IVMS 1999-2009 43
Acute respiratory distress syndrome (ARDS) : Acute respiratory distress syndrome (ARDS) Acute respiratory distress syndrome (ARDS). Persistent inflammation leads to poor pulmonary compliance and edema; note both alveolar fluid and hyaline membranes IVMS 1999-2009 44
Tension pneumothorax : Tension pneumothorax Tension pneumothorax. Note these
features:
1––Hyperlucent lung field
2––Hyperexpansion lowers diaphragm
3––Collapsed lung
4––Deviation of trachea
5––Mediastinal shift
6––Compression of opposite lung IVMS 1999-2009 45
Alzheimer’s disease : Alzheimer’s disease Alzheimer’s disease. Key histologic features include “senile plaques”
(A), a coronal section showing atrophy, especially of the temporal lobes A IVMS 1999-2009 46
Alzheimer’s disease : Alzheimer’s disease (B), and focal masses of interwoven neuronal processes
around an amyloid core (neurofibrillary tangles, arrow).
The remnants of neuronal degeneration
(C) are also associated with Alzheimer’s disease, the most common
cause of dementia in older persons. B C IVMS 1999-2009 47
Asbestosis : Asbestosis Asbestosis. Ferruginous bodies (asbestos
bodies with Prussian blue iron stain) in the lung,
microscopic. Inhaled asbestos fibers are ingested by
macrophages. IVMS 1999-2009 48
Subdural hemorrhage : Subdural hemorrhage Subdural hemorrhage. Note the hyperdense
extra-axial blood on the left side.
Concomitant subarachnoid hemorrhage.
1––subdural blood, layering;
2––skull;
3––falx;
4––subarachnoid blood;
5––shunt
catheter;
6––frontal sinus. IVMS 1999-2009 49
Epidural hematoma : Epidural hematoma Epidural hematoma from skull fracture.
Note the lens-shaped (biconvex) dense blood next to the fracture.
1––skull fracture;
2––hematoma in epidural
space;
3––temporalis muscle;
4––Sylvian fissure;
5––frontal sinus. IVMS 1999-2009 50
hypertensive hemorrhage : hypertensive hemorrhage Brain with hypertensive hemorrhage
in the region of the basal ganglia, gross. IVMS 1999-2009 51
Berry aneurysm : Berry aneurysm Berry aneurysm (A) located on the anterior cerebral artery. The small, saclike structure can easily rupture during periods of hypertension or stress.
The histologic section (B) at the origin of the aneurysm shows lack of internal elastic lamina. (A) (B) IVMS 1999-2009 52
Multiple sclerosis : Multiple sclerosis (A) Lumbar spinal cord with mostly random and asymmetric white-matter lesions.
(B) Brain with periventricular white-matter plaques of demyelination, gross. Demyelination occurs in a bilateral asymmetric distribution.
Classic clinical findings are nystagmus, scanning speech, and intention tremor. IVMS 1999-2009 53
Glioblastoma multiforme : Glioblastoma multiforme (A) extending across the midline of the cerebral cortex, gross.
(B) Histologyshows necrosis with surrounding pseudopalisading of malignant tumor cells. IVMS 1999-2009 54
Oligodendroglioma : Oligodendroglioma Gross natural-color coronal section of cerebral hemisphere with a large lesion ofthe left parieto-occipital white matter.
(B) Classic “fried egg” appearance with perinuclear halos and “chicken-wire” capillary pattern. IVMS 1999-2009 55
Left middle cerebral artery stroke : Left middle cerebral artery stroke Left middle cerebral artery stroke.
Large left MCA territory stroke with edema and mass effect but no visible hemorrhage. The patient experienced deficits in speech and in the right side of the face and upper extremities.
1––ischemic brain parenchyma;
2––subtle midline shift to the right;
3––the right frontal
horn of the lateral ventricle;
4––the left lateral ventricles
obliterated by edema. IVMS 1999-2009 56
Kayser-Fleischer ring in Wilson’s disease : Kayser-Fleischer ring in Wilson’s disease Kayser-Fleischer ring in Wilson’s disease.
This corneal ring (between arrows) was golden
brown and contrasted clearly against a gray-blue iris.
Note that the darkness of the ring increases as the outer
border (limbus) of the cornea is approached (right arrow). IVMS 1999-2009 57
Acute systemic lupus erythematosus : Acute systemic lupus erythematosus SLE Bright red, sharply defined erythema is seen with slight
edema and minimal scaling in a “butterfly pattern” on
the face (the typical “malar rash”). Note also that the patient
is female and young. IVMS 1999-2009 58
Scleroderma : Scleroderma Scleroderma. The progressive “tightening”
of the skin has contracted the fingers and eliminated
creases over the knuckles. Fibrosis is widespread and may
also involve the esophagus (dysphagia), lung (restrictive
disease), and small vessels of the kidney (hypertension). IVMS 1999-2009 59
Gout : Gout (A) Tophi within joints consist of aggregates of urate crystals surrounded by an inflammatory reaction consisting of macrophages, lymphocytes, and giant cells.
(B) Tophi affect the proximal interphalangeal (PIP) joints, knees, and elbows, growing like tubers from the bones. IVMS 1999-2009 60
Erythema multiforme, captopril induced : Erythema multiforme, captopril induced Erythematous macules, papules, vesicles, bullae, and erosions are seen. IVMS 1999-2009 61
Rheumatoid arthritis : Rheumatoid arthritis Rheumatoid arthritis. Note the swanneck deformities of the digits and severe, symmetric involvement of the PIP joints. IVMS 1999-2009 62
Arteriovenous malformation : Arteriovenous malformation Arteriovenous malformation. The markedly enlarged and distorted arm of a six-month-old boy with confluent erythematous papules and nodules. IVMS 1999-2009 63
Capillary malformation, port-wine type : Capillary malformation, port-wine type Irregular purple patches and plaques are seen on the neck and chest of the mother, and pink patches are seen on the cheek, lip, chin, neck, and chest of the daughter.
Both lesions were present at birth. IVMS 1999-2009 64
Scabies : Scabies Scabies. Adult female mite with egg
containing embryo within the epidermis. IVMS 1999-2009 65
Squamous cell carcinoma : Squamous cell carcinoma Malignant skin tumor involving the epidermal skin layer.
Note the presence of keratin pearls (arrows). IVMS 1999-2009 66
Malignant melanoma : Malignant melanoma (A) Lesion just beneath the epidermis with pigmented and nonpigmented cells.
The tumor cells are usually polyhedral but may be spindle shaped, dendritic, or ballooned or may resemble oat cells. Many but by no means all melanomas make melanin. Large nucleoli are common.
(B) A multicolored tan, red, and dark brown irregular plaque on the abdomen. The depth of the lesion is a prognostic indicator. A B IVMS 1999-2009 67
Basal cell carcinoma : Basal cell carcinoma Nests of basaloid cells are present within the dermis with peripheral palisading and prominent retraction artifacts. IVMS 1999-2009 68
Pemphigus vulgaris : Pemphigus vulgaris Pemphigus vulgaris. (A) Numerous crusted, denuded, and weepy erythematous plaques are seen on the chest, breast, abdomen, and arms.
(B) Vesicles on the gingiva. IVMS 1999-2009 69
Bullous pemphigoid : Bullous pemphigoid Erythematous plaques contiguous with large bullae. IVMS 1999-2009 70
Psoriasis : Psoriasis Psoriasis, fully developed plaque. IVMS 1999-2009 71
Acanthosis nigricans : Acanthosis nigricans (A) Extensive hyperpigmented plaques on the arms in a patient with congenital
lipodystrophy. This is an unusual distribution for acanthosis nigricans.
(B) Hyperkeratosis and papillomatosis. A B IVMS 1999-2009 72
Pancreas : Pancreas (A) Pancreatic acinar cell (EM). A condensing vacuole (C) is receiving secretory product (arrow) from the Golgi complex (G).
M––mitochondrion; RER––rough endoplasmic reticulum; S––mature condensed secretory zymogen granules.
(B) Pancreatic islet cells in diabetes mellitus type 1. In patients with diabetes mellitus type 1, autoantibodies against ß cells cause a chronic inflammation until, over time, islet cells are entirely replaced by amyloid. A B IVMS 1999-2009 73
Adrenocortical adenoma, gross : Adrenocortical adenoma, gross Adrenocortical adenoma, gross.
Cause of hypercortisolism (Cushing’s syndrome) or hyperaldosteronism (Conn’s syndrome). IVMS 1999-2009 74
Pheochromocytoma : Pheochromocytoma Pheochromocytoma. The tumor cells have numerous vacuolar spaces within the cytoplasm (pseudoacini). Most of the punctate blue-black granules of variable density are dense-core neurosecretory granules. IVMS 1999-2009 75
Cushing’s disease : Cushing’s disease Cushing’s disease. The clinical picture includes
moon facies and buffalo hump and
(B) Truncal obesity and abdominal striae. IVMS 1999-2009 76
Graves’ disease : Graves’ disease Graves’ disease. (A) Exophthalmos in a patient with proptosis and periorbital edema.
(B) CT shows extraocular muscle enlargement at the orbital apex. A B IVMS 1999-2009 77
Graves’ disease : Graves’ disease (C) Stimulation of follicular cells by TSH causes the normal uniform architecture to be replaced by hyperplastic papillary, involuted borders, and decreased colloid.
Typical medical therapy is propylthiouracil, which inhibits the production
of thyroid hormone as well as peripheral conversion of T4 to T3. C IVMS 1999-2009 78
Arteriolar sclerosis : Arteriolar sclerosis Arteriolar sclerosis showing masses of hyaline material in glomerular afferent and efferent arterioles and in the glomerulus. From a type 1 diabetic patient. IVMS 1999-2009 79
Papillary carcinoma : Papillary carcinoma Papillary carcinoma. The image shows the papillary architecture and classic nuclear features that are key in making the diagnosis, including
ground-glass or “Orphan Annie eye” chromatin, nuclear grooves, and intranuclear pseudoinclusions.
Psammoma bodies are not seen here but are often present. IVMS 1999-2009 80
Hydatidiform mole : Hydatidiform mole Hydatidiform mole. The characteristic gross appearance is a “bunch of grapes.” Hydatidiform moles are the most common precursors of choriocarcinoma.
Complete moles usually display a 46,XX diploid pattern with all the chromosomes derived from
the sperm. In partial moles, the karyotype is triploid or
tetraploid, and fetal parts may be present. IVMS 1999-2009 81
Prostatic adenocarcinoma : Prostatic adenocarcinoma Histology shows infiltrating glands lined by a single layer of cuboidal epithelium with enlarged nuclei and visible nucleoli.
Note the absence of the outer basal layer that is usually present in normal glands. IVMS 1999-2009 82
Seminiferous tubules : Seminiferous tubules IVMS 1999-2009 Seminiferous tubules. Sertoli cells play a supportive and protective role in spermatogenesis.
Note cells in various stages of differentiation, with spermatogonia
near the basal lamina and more mature forms near the lumen. 83
Histologic appearance of endometriosis : Histologic appearance of endometriosis IVMS 1999-2009 (A) Endometriosis of the ovary. (B) Endometriosis of the cervix. 84
Endocardial chronic ischemia : Endocardial chronic ischemia IVMS 1999-2009 Microscopic example of myocytolysis and coagulation necrosis beneath the endocardium. 85
Atherosclerosis : Atherosclerosis IVMS 1999-2009 Aorta with fibrous intimal thickening and foam cells dispersed throughout smooth muscle cells, micro. 86
Evolution of a myocardial infarction : Evolution of a myocardial infarction IVMS 1999-2009 Contraction band necrosis (arrow) is the first visible change, occurring in one to two hours (A). (B) (A) In the first three days, neutrophilic infiltration and coagulation necrosis occur (B). 87
Evolution of a myocardial infarction : Evolution of a myocardial infarction IVMS 1999-2009 By three to seven days, neutrophils have been replaced by macrophages, and clearing of myocyte debris has begun (C). Within weeks, granulation and scarring occur (D). (C) (D) 88
Left ventricular hypertrophy : Left ventricular hypertrophy IVMS 1999-2009 Heart with marked concentric left ventricular hypertrophy from hypertension, gross. 89
Acute bacterial endocarditis : Acute bacterial endocarditis IVMS 1999-2009 Acute bacterial endocarditis. Virulent organisms (e.g., Staphylococcus aureus) infect previously normal valves, causing marked damage (here, in the aortic valve) and potentially giving rise to septic emboli. 90
Calcified bicuspid aortic valve : Calcified bicuspid aortic valve IVMS 1999-2009 Calcified bicuspid aortic valve showing false raphe. The abnormal architecture of the valve makes its leaflets susceptible to otherwise ordinary hemodynamic stresses, which ultimately leads to valvular thickening, calcification, increased rigidity, and stenosis. 91
Aortic dissection with a blood clot : Aortic dissection with a blood clot IVMS 1999-2009 Aortic dissection with a blood clot compressing the aortic lumen. A tear in the intima allowed blood to surge through the muscular layer to the adventitia (may lead to sudden death from hemothorax).
Risk factors are hypertension, Marfan’s syndrome, pregnancy, Ehlers-Danlos syndrome, and trauma. 92
Aschoff body : Aschoff body IVMS 1999-2009 The Aschoff body, an area of fibrinoid necrosis surrounded by mononuclear and multinucleated giant cells, is pathognomonic for rheumatic heart disease.
The mitral valve is most commonly affected. 93
Carotid angiogram showing aneurysm : Carotid angiogram showing aneurysm IVMS 1999-2009 Note the path of the internal carotid artery through the neck and its major branches (ophthalmic artery, anterior cerebral artery, middle cerebral artery). The aneurysm is inferior to the terminal branches in this angiogram. 94
Bacterial endocarditis : Bacterial endocarditis IVMS 1999-2009 Bacterial endocarditis of the mitral valve. Vegetations can embolize and infect distant organ systems. 95
Left atrial myxoma : Left atrial myxoma IVMS 1999-2009 Left atrial myxoma. The most common primary cardiac tumor; known to produce VEGF
(vascular endothelial growth factor). 96
Acute pyelonephritis : Acute pyelonephritis IVMS 1999-2009 (A) is characterized by neutrophilic infiltration and abscess formation within the renal interstitium. Abscesses may rupture, introducing collections of white cells to the tubular lumen. In contrast, chronic pyelonephritis (B) has a lymphocytic invasion with fibrosis. 97
Transitional cell carcinoma : Transitional cell carcinoma IVMS 1999-2009 The image shows a papillary growth lined by transitional epithelium with mild nuclear atypia and pleomorphism. 98
Lupus erythematosus, kidneys : Lupus erythematosus, kidneys IVMS 1999-2009 Enlarged, very pale kidneys with “flea bite” or ectasia from a patient with nephrotic syndrome or subacute glomerulonephritis as a result of lupus erythematosus. 99
Normal glomerulus, microscopic : Normal glomerulus, microscopic IVMS 1999-2009 Normal glomerulus, microscopic, with (A) macula densa and (B) afferent and (C) efferent arterioles. 100
Minimal change disease : Minimal change disease IVMS 1999-2009 Minimal change disease (lipoid nephrosis) shows normal glomeruli on light microscopy but effacement of foot processes on EM (arrowhead).
The full arrow points to a normal foot process. Treatment
consists of corticosteroids. 101
Systemic lupus erythematosus : Systemic lupus erythematosus IVMS 1999-2009 Systemic lupus erythematosus, kidney pathology. In the membranous glomerulonephritic pattern, “wire-loop” thickening occurs as a result of subendothelial immune complex deposition. 102
Diabetic glomerulosclerosis : Diabetic glomerulosclerosis IVMS 1999-2009 Diabetic glomerulosclerosis. Nodular diabetic glomerulosclerosis is also known as Kimmelstiel- Wilson syndrome and is characterized by acellular ovoid nodules in the periphery of the glomerulus. 103
Polycystic kidney disease : Polycystic kidney disease IVMS 1999-2009 Abdominal CT shows multiple cysts in both kidneys. PKD is an autosomal-dominant disease and is often associated with aneurysm formation in the brain. The disease occurs bilaterally and presents with flank pain and hematuria. 104
Calcium oxalate crystals in the kidney : Calcium oxalate crystals in the kidney IVMS 1999-2009 Calcium oxalate crystals in the kidney, viewed with partially crossed polarizers.
Tubular failure in oxalate nephropathy can result from vitamin C or antifreeze abuse. 105
Renal cell carcinoma : Renal cell carcinoma IVMS 1999-2009 Gross. The kidney has been bivalved, revealing a nodular, golden-yellow tumor in the midkidney with areas of hemorrhage and necrosis.
(B) Histology shows polygonal cells with small nuclei and abundant
clear cytoplasm with a rich, delicate branching vasculature. A B 106
Osteogenesis imperfecta : Osteogenesis imperfecta IVMS 1999-2009 (A) Blue sclera caused by translucency of connective tissue over the choroid.
The optic nerve is on the right side of the image.
(B) Abnormal collagen synthesis results from a variety of gene mutations and causes brittle bones and connective tissue malformations. 107
Foot gangrene : Foot gangrene IVMS 1999-2009 The first four toes and adjacent skin are dry, shrunken, and blackened with superficial necrosis and peeling of the skin. A well-defined line of demarcation separates the black region
from the viable skin. 108
Slide 109 : IVMS 1999-2009 Bone fracture. New bone formation with osteoblasts. 109
Meningomyelocele : Meningomyelocele IVMS 1999-2009 Meningomyelocele. A neural tube defect in which the meninges and spinal cord herniate through the spinal canal; gross image of infant’s lower back. 110
Omphalocele in a newborn : Omphalocele in a newborn IVMS 1999-2009 Omphalocele in a newborn. Note that the defect is midline and is covered by peritoneum, as opposed to gastroschisis, which is not covered by peritoneum and is often not midline 111
Sarcoidosis : Sarcoidosis IVMS 1999-2009 Numerous tightly formed granulomas are seen on histology of a lymph node in a patient with sarcoidosis. 112
Amyloidosis : Amyloidosis IVMS 1999-2009 Congo red stain demonstrates amyloid deposits in the artery wall that show apple-green birefringence under polarized light. 113
Raynaud’s disease : Raynaud’s disease IVMS 1999-2009 The left hand exhibits a distal cyanosis compared to the right hand; it is seen especially well in the nail beds. Unilateral episodes such as this one may occur after contact with a cold object. 114
Colon cancer : Colon cancer IVMS 1999-2009 Note the circumferential
tumor with heaped-up edges and central ulceration. 115
Klinefelter’s syndrome (XXY) : Klinefelter’s syndrome (XXY) IVMS 1999-2009 Klinefelter’s syndrome (XXY).
Phenotype includes a female fat distribution
with male external genitalia. 116
Turner’s syndrome (XO) : Turner’s syndrome (XO) IVMS 1999-2009 Turner’s syndrome (XO). Phenotype includes short stature, webbing of the neck, and poorly developed secondary sex characteristics. 117
Marfan’s syndrome : Marfan’s syndrome IVMS 1999-2009 Patients are tall with very long extremities. The joints are hyperextensible, with slim bone structure and wiry muscles. 118
Simian crease : Simian crease IVMS 1999-2009 Simian crease. A characteristic feature of Down syndrome (trisomy 21). The palm has a single transverse crease instead of the normal two creases. 119
Hydatid cyst : Hydatid cyst IVMS 1999-2009 Hydatid cyst. Echinococcus eggs develop into larvae in the intestine, penetrate the intestinal wall, and disseminate throughout the body. The larvae form hydatid cysts in the liver and, less commonly, in the lungs, kidney, and brain. 120
Negri bodies : Negri bodies IVMS 1999-2009 Negri bodies are pathognomonic inclusions in the cytoplasm of neurons infected by the rabies virus. 121
Duodenal ulcer : Duodenal ulcer IVMS 1999-2009 Duodenal ulcer. The epithelium is ulcerated, and the lamina propria is infiltrated with inflammatory cells.
Necrotic debris is present in the ulcer crater. 122
Signet ring cell : Signet ring cell IVMS 1999-2009 Signet ring cell. Mucin expands the cytoplasm and pushes the nucleus to the periphery, creating the appearance of a signet ring. The diffuse type of gastric carcinoma is composed of widely infiltrative signet ring cells. 123
Photomicrograph of the small intestine : Photomicrograph of the small intestine IVMS 1999-2009 124
Coagulative necrosis of hepatocytes : Coagulative necrosis of hepatocytes IVMS 1999-2009 125
Crohn’s disease : Crohn’s disease IVMS 1999-2009 Crohn’s disease. Barium x-ray showing spicules, edema, and ulcers. 126
Inflammatory bowel disease : Inflammatory bowel disease IVMS 1999-2009 In Crohn’s disease (A), the juxtaposition of ulcerated and normal mucosa gives a “cobblestone” appearance. In acute ulcerative colitis (B), the intestinal mucosa is inflamed and edematous and has a pseudopolypoid appearance. Chronically, ulcerative colitis has a more atrophic appearance. B A 127
Multinodular goiter of the thyroid gland : Multinodular goiter of the thyroid gland IVMS 1999-2009 Multinodular goiter with hyperplasia and subsequent involution of the thyroid gland. The image shows follicles distended with colloid and lined by a flattened epithelium with areas of fibrosis and hemorrhage. 128
Ewing’s sarcoma : Ewing’s sarcoma IVMS 1999-2009 Ewing’s sarcoma. This malignant tumor of bone occurs in children and is characterized by the (11;22) translocation that results in the fusion gene EWS-FLI1. The tumor is composed of sheets of uniform small, round cells. 129
Bronchopneumonia : Bronchopneumonia IVMS 1999-2009 (A) Gross. Note the large area of consolidation at the base plus multiple small areas of consolidation (pale) involving bronchioles and surrounding alveolar sacs throughout the lung. A B (B) Bronchopneumonia with neutrophils in alveolar spaces, microscopic. 130
Small bowel obstruction : Small bowel obstruction IVMS 1999-2009 Small bowel obstruction on supine abdominal x-ray.
Note dilated loops of small bowel in a ladder-like pattern. Air-fluid levels may be seen if an upright x-ray is done. 131
Emphysema : Emphysema IVMS 1999-2009 Note the abnormal permanent enlargement of the airspaces distal to the terminalbronchiole. On microscopy, enlarged alveoli are seen separated by thin septa, some of which appear to float
within the alveolar spaces. 132
Squamous cell carcinoma : Squamous cell carcinoma IVMS 1999-2009 Squamous cell carcinoma in the right lower lobe. 133
Pneumonia : Pneumonia IVMS 1999-2009 Compare the diffuse, patchy bilateral infiltrates of “atypical” interstitial pneumonia (A) with the localized,dense lesion of lobar pneumonia (B) (A) (B) 134
Pulmonary edema : Pulmonary edema IVMS 1999-2009 Posteroanterior chest xray in a man with acute pulmonary edema due to left ventricular failure. Note the bat’s-wing density, cardiac enlargement, increased size of upper lobe vessels, and pulmonary venous congestion. 135
Anterior shoulder dislocation : Anterior shoulder dislocation IVMS 1999-2009 Note the humeral head inferior and medial to the glenoid fossa and fracture fragments from the greater tuberosity.
1––Acromion 4––Fracture fragments
2––Coracoid 5––Humeral head
3––Glenoid fossa 6––Clavicle 136
Multiple leiomyomas (fibroids) : Multiple leiomyomas (fibroids) IVMS 1999-2009 Multiple leiomyomas (fibroids) of the uterus. A common benign uterine tumor.
Fibroids beneath the endometrium may present with vaginal bleeding; they also develop subserosally or within the myometrium. 137
Teratoma (benign) : Teratoma (benign) IVMS 1999-2009 Teratoma (benign) of the ovary containing teeth and hair––an incidental finding during abdominal surgery. In females, teratomas are generally benign, whereas in males they account for roughly 30% of testicular tumors. 138
Atherosclerosis in a coronary vessel : Atherosclerosis in a coronary vessel IVMS 1999-2009 Calcified plaques have narrowed the lumen of the artery, increasing the risk for occlusion––i.e., myocardial infarction. 139
Breast mammogram : Breast mammogram IVMS 1999-2009 Breast mammogram diagnostic of breast cancer.
The upper half of the breast shows a dense, irregularly shaped mass with long, branching tentacles extending toward the nipple. Numerous tiny calcium deposits looking like grains of sand (microcalcifications) are seen both in the mass and in the surrounding tissue. 140
Subarachnoid hemorrhage : Subarachnoid hemorrhage IVMS 1999-2009 CT scan with contrast reveals blood in the subarachnoid space at the base of the brain. A B 141
Left ventricular hypertrophy : Left ventricular hypertrophy IVMS 1999-2009 Left ventricular hypertrophy (mediastinum wider than 50% of the width of the chest) from aortic valve stenosis. 142
Amiodarone toxicity : Amiodarone toxicity IVMS 1999-2009 Diffuse interstitial bilateral pulmonary markings in a reticular nodular pattern, most prominent in the lung bases and posteriorly, are evidence of pulmonary fibrosis. 143
Pneumothorax : Pneumothorax IVMS 1999-2009 The right lung is collapsed; the apparent straight line off the rightmost edge of the pleural space indicated by the arrow shows the edge of the collapsed lung. 144
Descending aortic dissection : Descending aortic dissection IVMS 1999-2009 Presents with severe chest pain. Type A is proximal to the subclavian artery and type B distal to the subclavian. 145
CT of the abdomen with contrast : CT of the abdomen with contrast IVMS 1999-2009 CT of the abdomen with contrast—
normal anatomy.
1––Liver 7––Splenic vein
2––IVC 8––Aorta
3––Portal vein 9––Spleen
4––Hepatic artery 10––Stomach
5––Gastroduodenal artery 11––Pancreas
6––Celiac trunk 146
Left adrenal mass : Left adrenal mass IVMS 1999-2009 147 Left adrenal mass.
1––Large left adrenal mass 7––Spleen
2––Kidney 8––Liver
3––Vertebral body 9––Stomach with air
4––Aorta and contrast
5––IVC 10––Colon–splenic
6––Pancreas flexure
Pancreatic adenocarcinoma : Pancreatic adenocarcinoma IVMS 1999-2009 148 A large, heterogeneously enhancing mass is visible at the neck of the pancreas, compressing the common bile duct, portal vein, splenic vein, superior mesenteric vein, and IVC. No liver metastases are apparent.
Acute pancreatitis : Acute pancreatitis IVMS 1999-2009 149 Acute pancreatitis, typically from alcohol abuse or gallstone obstruction of the pancreatic duct. No evidence of necrosis or fluid collection is seen.
Osteoarthritis : Osteoarthritis IVMS 1999-2009 150 Increased fibrosis of the joint and a decreased amount of cartilage are apparent.
Source of Image Plates : Source of Image Plates IVMS 1999-2009 Images from / Click Here 151