1. CELL RESPONSE TO INJURY AND ADAPTIVE CELL REACTION
YEAR II
Assist. Prof. Dr. Ipek Erbarut Seven
Assoc. Prof. Dr. Pelin Bağcı

2. 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. 

3. N-18 FATTY CHANGE ORGAN: LIVER
Lipid vacuole
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. 

4. A-1 COAGULATION NECROSIS ORGAN: PLACENTA
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

5. A-1 COAGULATION NECROSIS ORGAN: PLACENTA
silhouette of the 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.

6. A-3 FAT NECROSIS Organ: Breast – fat tissue
histiocytes
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.

7. 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.

8. 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.

9. 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.

10. B-8(2) CASEIFICATION NECROSIS ORGAN: Lung
Langhans type giant cell
necrosis
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.

11. A-13 METAPLASIA Organ: Cervix
ectoservix
Squamocolumnar junction
Squamous metaplasia
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.

12. A-13B METAPLASIA Organ: 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

13. A-13B METAPLASIA Organ: 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

14. P-22 HYPERPLASIA Organ: 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. 

15. P-22 HYPERPLASIA Organ: Prostate
Corpora amylacea
P-22 HYPERPLASIA Organ: Prostate
The glandular epithelium is generally hyperplastic, some glands show cystic dilatation and contain corpora amylacea in the lumina. 

16. A-14 ATROPHY-NODULAR HYPERPLASIA Organ: Thyroid
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. 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.

17. A-14 ATROPHY-NODULAR HYPERPLASIA Organ: Thyroid
Atrophic follicles
Follicles in nodule
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.

18. HEMODYNAMIC DISORDERS & ABNORMAL ACCUMULATIONS MORPHOLOGY OF ACUTE AND CHRONIC INFLAMMATION

19. A-15 ANTHRACOSIS Organ: Lymph node
Carbon pigment
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. 

20. A-15 ANTHRACOSIS Organ: Lymph node-high power
Stroma of the lymph node is infiltrated by histiocytes that contain black carbon pigment.

21. 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”.

22. N-17 MELANIN PIGMENT Organ: Skin
melanocytes
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.

23. C-3a CONGESTION Organ: Spleen
The splenic sinuses are dilated and filled with red blood cells

24. C-6e INFARCTION Organ: Small intestine
silhouettes of intestinal villi
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.

25. C-4A THROMBOSIS Organ:Artery
This slide illustrates artery occluded by thrombi. This is an organized thrombus. The wall of the arteries is calcified.
thrombus
calcification

26. C-4B THROMBOSIS Organ: Vein
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.

27. B-6 ABSCESS Organ: 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 tissue
Microscopic 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.

28. M-36a ACUTE INFLAMMATION Organ :Appendix
Purulent exudate
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. 

29. M-10 PEPTIC ULCER Organ: Stomach
İntact epithelium
ulcer
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.

30. M-11 FOREIGN BODY REACTION Organ: Skin
Giant cell
Foreign body in giant cell
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.