Pathology AB_1202 Part II
Rya Riedweg
2021/22
VU Amsterdam
1
,Contents
Digestive tract ................................................................................................................................................................... 4
Pathology of the upper digestive tract ......................................................................................................................... 4
Esophagus ................................................................................................................................................................. 4
Stomach .................................................................................................................................................................... 5
Lower GI ........................................................................................................................................................................ 6
GI tumors .................................................................................................................................................................. 6
Relevant adenomas................................................................................................................................................... 8
Interstinal obstruction .............................................................................................................................................. 8
Vascular disorders of bowel ...................................................................................................................................... 9
Malabsorptive diarrhea............................................................................................................................................. 9
Infectious enterocolitis ............................................................................................................................................. 9
Inflammatory bowel disease ..................................................................................................................................... 9
Appendix ................................................................................................................................................................... 9
The lung........................................................................................................................................................................... 10
Anatomy/histology of normal lung ............................................................................................................................. 10
Tracheobronchial system ........................................................................................................................................ 10
Pathology .................................................................................................................................................................... 11
Examination ............................................................................................................................................................ 11
Different diseases ................................................................................................................................................... 11
Tuberculosis ............................................................................................................................................................ 14
The hematopoietic and lymphoid system....................................................................................................................... 16
Cells ......................................................................................................................................................................... 16
Pathology .................................................................................................................................................................... 16
Decrease.................................................................................................................................................................. 16
Increase ................................................................................................................................................................... 18
Neoplastic lymphoid disroders ................................................................................................................................... 19
Lymphoid cancer ..................................................................................................................................................... 20
Classification ........................................................................................................................................................... 21
Incidence and relative distribution of malignant lymphomas ................................................................................ 22
Different types ........................................................................................................................................................ 22
Thymic tumors ........................................................................................................................................................ 23
Cardiovascular pathology................................................................................................................................................ 24
Atherosclerosis........................................................................................................................................................ 24
Heart valves............................................................................................................................................................. 25
Atherosclerosis of coronary arteries....................................................................................................................... 25
Myocarditis ............................................................................................................................................................. 28
Cardiomyopathy ...................................................................................................................................................... 29
Tumors .................................................................................................................................................................... 30
Gynaecopathology .......................................................................................................................................................... 31
Anatomy .................................................................................................................................................................. 31
2
, Uterus...................................................................................................................................................................... 31
Endometrial carcinoma ........................................................................................................................................... 32
High risk HPV related cancers ................................................................................................................................. 34
Vulva........................................................................................................................................................................ 37
Ovaries .................................................................................................................................................................... 37
Neuropathology .............................................................................................................................................................. 38
Cell types in the CNS ............................................................................................................................................... 38
(Edema, herniation, hydrocephalus)....................................................................................................................... 38
CNS disorders .............................................................................................................................................................. 39
Cerebrovascular accidents ...................................................................................................................................... 39
Infections................................................................................................................................................................. 41
CNS tumors ............................................................................................................................................................. 41
Congenital malformations and perinatal brain injury............................................................................................. 42
Diseases of Myelin .................................................................................................................................................. 43
Neurodegeneration......................................................................................................................................................... 43
Alzheimer disease ................................................................................................................................................... 43
Frontotemporal lobar degeneration = FTLD ........................................................................................................... 45
Amyotrophic lateral sclerosis (ALS)......................................................................................................................... 45
Huntington disease ................................................................................................................................................. 45
Parkinson’s disease ................................................................................................................................................. 45
Prion disease – Creutzfeldt-Jakob Disease (CJD) .................................................................................................... 46
Spreading of misfolded proteins in neurodegenerative diseases .......................................................................... 46
3
, Digestive tract
Pathology of the upper digestive tract
Esophagus
Normal
Z line: junction of the esophagus towards the stomach
Different layers of the wall: squamous epithelium with lamina propria and muscularis mucosae
below (3 together form the mucosa) then submucosa with loose tissue (fat, fibers, blood vessels,
nerves), then circular and longitudinal muscular layer, outside adventitia (composed of mainly
fat)
o Squamous epithelium: cells stacked on top of each other, stem cells in the basal layer ->
proliferation -> differentiate and migrate towards surface -> then fall off (= cell
desquamation)
Development of carcinoma
Have very different behavior
Adenocarcinoma
Most prevalent, but squamous epithelium has to differentiate in glandular epithelum first (cylindrical) -> when we
have acid reflux from the stomach
o Forms goblet cells
o Causes for GERD: decreased lower esophagal sphincter tone, increase abdominal pressure
Reflux oesophagitis:
o Phase 1: inflammation -> Hyperemia (increase in
blood flow), granulocytes and in severe cases
ulceration
o Phase 2: Metaplasia and (chronic) inflammation ->
metaplasia: replacement of a differentiated cell
type by another differentiated cell type
Are normal cells in the wrong place,
intestinal metaplasia bc they are like
bowel cells (has glandular structures) -> Squamous epithelium is
replaced by intestinal type epithelium
Not dangerous yet, but can develop into dysplasia
Barrett oseophagus = intestinal metaplasia
o Endoscopy: Close to the junction to the stomage it is redish -> reflux oesophagitis
o Microscopy: epithelium looks like bowel epithelia
Contains goblet cells
o Increased risk to develop esophageal adenocarcinoma
Dysplasia
o Cytonuclear atypia:
Large nuclei
Irregular shape of nuclei
Coarse chromatin pattern
o Cells have changes in DNA but not yet adenocarcinaoma bc it is not invasive
To see if it is invasive you need a biopsy -> look under the microscope
Adenocarcinoma = barrett carcinoma
o Glands also inside the lower layers of the oseophagus
o Most common in distal third of the esophagus
4
Rya Riedweg
2021/22
VU Amsterdam
1
,Contents
Digestive tract ................................................................................................................................................................... 4
Pathology of the upper digestive tract ......................................................................................................................... 4
Esophagus ................................................................................................................................................................. 4
Stomach .................................................................................................................................................................... 5
Lower GI ........................................................................................................................................................................ 6
GI tumors .................................................................................................................................................................. 6
Relevant adenomas................................................................................................................................................... 8
Interstinal obstruction .............................................................................................................................................. 8
Vascular disorders of bowel ...................................................................................................................................... 9
Malabsorptive diarrhea............................................................................................................................................. 9
Infectious enterocolitis ............................................................................................................................................. 9
Inflammatory bowel disease ..................................................................................................................................... 9
Appendix ................................................................................................................................................................... 9
The lung........................................................................................................................................................................... 10
Anatomy/histology of normal lung ............................................................................................................................. 10
Tracheobronchial system ........................................................................................................................................ 10
Pathology .................................................................................................................................................................... 11
Examination ............................................................................................................................................................ 11
Different diseases ................................................................................................................................................... 11
Tuberculosis ............................................................................................................................................................ 14
The hematopoietic and lymphoid system....................................................................................................................... 16
Cells ......................................................................................................................................................................... 16
Pathology .................................................................................................................................................................... 16
Decrease.................................................................................................................................................................. 16
Increase ................................................................................................................................................................... 18
Neoplastic lymphoid disroders ................................................................................................................................... 19
Lymphoid cancer ..................................................................................................................................................... 20
Classification ........................................................................................................................................................... 21
Incidence and relative distribution of malignant lymphomas ................................................................................ 22
Different types ........................................................................................................................................................ 22
Thymic tumors ........................................................................................................................................................ 23
Cardiovascular pathology................................................................................................................................................ 24
Atherosclerosis........................................................................................................................................................ 24
Heart valves............................................................................................................................................................. 25
Atherosclerosis of coronary arteries....................................................................................................................... 25
Myocarditis ............................................................................................................................................................. 28
Cardiomyopathy ...................................................................................................................................................... 29
Tumors .................................................................................................................................................................... 30
Gynaecopathology .......................................................................................................................................................... 31
Anatomy .................................................................................................................................................................. 31
2
, Uterus...................................................................................................................................................................... 31
Endometrial carcinoma ........................................................................................................................................... 32
High risk HPV related cancers ................................................................................................................................. 34
Vulva........................................................................................................................................................................ 37
Ovaries .................................................................................................................................................................... 37
Neuropathology .............................................................................................................................................................. 38
Cell types in the CNS ............................................................................................................................................... 38
(Edema, herniation, hydrocephalus)....................................................................................................................... 38
CNS disorders .............................................................................................................................................................. 39
Cerebrovascular accidents ...................................................................................................................................... 39
Infections................................................................................................................................................................. 41
CNS tumors ............................................................................................................................................................. 41
Congenital malformations and perinatal brain injury............................................................................................. 42
Diseases of Myelin .................................................................................................................................................. 43
Neurodegeneration......................................................................................................................................................... 43
Alzheimer disease ................................................................................................................................................... 43
Frontotemporal lobar degeneration = FTLD ........................................................................................................... 45
Amyotrophic lateral sclerosis (ALS)......................................................................................................................... 45
Huntington disease ................................................................................................................................................. 45
Parkinson’s disease ................................................................................................................................................. 45
Prion disease – Creutzfeldt-Jakob Disease (CJD) .................................................................................................... 46
Spreading of misfolded proteins in neurodegenerative diseases .......................................................................... 46
3
, Digestive tract
Pathology of the upper digestive tract
Esophagus
Normal
Z line: junction of the esophagus towards the stomach
Different layers of the wall: squamous epithelium with lamina propria and muscularis mucosae
below (3 together form the mucosa) then submucosa with loose tissue (fat, fibers, blood vessels,
nerves), then circular and longitudinal muscular layer, outside adventitia (composed of mainly
fat)
o Squamous epithelium: cells stacked on top of each other, stem cells in the basal layer ->
proliferation -> differentiate and migrate towards surface -> then fall off (= cell
desquamation)
Development of carcinoma
Have very different behavior
Adenocarcinoma
Most prevalent, but squamous epithelium has to differentiate in glandular epithelum first (cylindrical) -> when we
have acid reflux from the stomach
o Forms goblet cells
o Causes for GERD: decreased lower esophagal sphincter tone, increase abdominal pressure
Reflux oesophagitis:
o Phase 1: inflammation -> Hyperemia (increase in
blood flow), granulocytes and in severe cases
ulceration
o Phase 2: Metaplasia and (chronic) inflammation ->
metaplasia: replacement of a differentiated cell
type by another differentiated cell type
Are normal cells in the wrong place,
intestinal metaplasia bc they are like
bowel cells (has glandular structures) -> Squamous epithelium is
replaced by intestinal type epithelium
Not dangerous yet, but can develop into dysplasia
Barrett oseophagus = intestinal metaplasia
o Endoscopy: Close to the junction to the stomage it is redish -> reflux oesophagitis
o Microscopy: epithelium looks like bowel epithelia
Contains goblet cells
o Increased risk to develop esophageal adenocarcinoma
Dysplasia
o Cytonuclear atypia:
Large nuclei
Irregular shape of nuclei
Coarse chromatin pattern
o Cells have changes in DNA but not yet adenocarcinaoma bc it is not invasive
To see if it is invasive you need a biopsy -> look under the microscope
Adenocarcinoma = barrett carcinoma
o Glands also inside the lower layers of the oseophagus
o Most common in distal third of the esophagus
4
