The Pathology Museum

Welcome

Welcome to the museum. This museum contains images of items in the departmentalmuseum. In addition it has links to articles regarding thespecific lesion and photomicrographs of some of thelesions in the museum.

Please go through the items and give us your comments.

Dr.Moses Isyagi and Dr. Ian Munabi.

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 John Scot for the 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.

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 misyagi@med.mak.ac.ug. They will be highly appreciated.

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?

Diptheria

• Note pseudomembrane in the larynx and upper trachea.

• What is a psuedomembrane? How does it form?

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?

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.

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.

Transitional cell carcinoma

• Note Papillary folds• Histological variants

of transitional cell carcinoma

Transitional cell carcinoma

• Vascular invasion• What is the

significance of the presence of tumour cells in the blood vessels?

Transitional cell carcinoma

• Islands of tumour cells in the capsule of the bladder.

• What is the histological grade of this tumour?

Fibrinous pericarditis

• What are the causes of fibrinous pericarditis?

Tuberculous pericarditis

• Note the thickenened constrictive pericardium and the ares of caseation in the thickened the thickened pericardium.

Constrictive Pericarditis

• This is a complication of fibrinous pericarditis

• What are he possible medical complications of this condition?

• Note thickened pericardium.

Constrictive Pericarditis

• Note the thickened pericardium.

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 patho-physiology of the respiratory system.

• Question:– What are the ways in which a

patient can get TB bronchopneumonia?

• Note the tubercles within the lung parenchyma

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 metastases3) 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?

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?

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?

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.

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

Fish bone in the oesophagus

Burkitts Lymphoma

• Go to the following link to about Burkitts lymphoma

• Starry sky appearance

Burkitts Lymphoma Immunohistochemistry. CD20 positive

• CD20.What are cellular differentiation markers?

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?