Diseases and Tumors of Pathology

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Diseases and Tumor of Pathology

Diseases of Breast Disorder:

1. Developmental disorders:

  • Milk line Remnants: Supernumerary nipples or breasts
  • Accessory Axillary Breast Tissue
  • Congenital Nipple Inversion

2. Inflammatory disorders:

  • Acute mastitis
  • Periductal mastitis (Squamous Metaplasia of Lactiferous Ducts)
  • Duct ectasia
  • Fat necrosis
  • Lymphocytic mastopathy
  • Granulomatous mastitis

3. Benign epithelial lesion of breast

  • Non-proliferative breast changes (Fibrocystic changes).
  • Proliferative breast disease
  • Atypical hyperplasia
  • Atypical ductal hyperplasia
  • Atypical lobular hyperplasia

4. Tumor of Breast

A. Stromal tumor:

  • Intralobular stroma:
  • Fibroadenoma
  • Phyllodes
  • Interlobular stroma
  • Fibroma, Lipoma, Sarcoma.
  • Hemangioma, Angiosarcoma

B. Epithelial tumor of breast: Carcinoma of breast

 

Carcinoma of Breast

Greater than 95% of breast malignancies are adenocarcinomas, which are divided into in situ carcinomas and invasive carcinomas.

Histologic Types of Breast Carcinoma

Morphologic Type of Breast Carcinoma

I) Carcinoma In Situ of breast(15 - 30%)

  • Ductal carcinoma in situ (80%)
  • Lobular carcinoma in situ (20%)

II) Invasive Carcinoma of breast (70 - 85%)

  • No special type carcinoma (NST) (Invasive Ductal carcinoma) (79%)
  • Lobular carcinoma (10%)
  • Tubular/ cribriform carcinoma (6%)
  • Mucinous (colloid) carcinoma: 2%
  • Medullary carcinoma: 2%
  • Papillary carcinoma: 1%
  • Metaplastic carcinoma: <1%

Note: [NST = Invasive Carcinoma of No Special Type = Invasive Ductal Carcinoma]

 

 

Diseases of liver

  1. Inflammatory disorder:
    1. Acute viral Hepatitis
    2. Chronic hepatitis
    3. Autoimmune hepatitis
    4. Fulminant hepatitis
    5. Due to drugs and toxin induced
    6. Bacterial and parasitic infection:
      Bacterial infection: S. aureus, salmonella typhi, Treponema pallidum
      Parasitic infection: Schistosomiasis, Entamoeba histolytica, Liver fluke, Echinococcal infections.
  2. Cirrhosis of liver
  3. Alcoholic liver disease
  4. Non-alcoholic fatty liver disease
  5. Liver failure (Acute and Chronic)
  6. Drug and toxin induced liver injury
  7. Inherited metabolic disorder: Hemochromatosis, Wilson Disease, α1-Anti-Trypsin Deficiency
  8. Cholestatic liver disease: Cholestasis, Primary biliary cirrhosis, cholangitis
  9. Circulatory disorders:
    1. Impaired Blood Flow into the Liver: Portal Vein Obstruction and Thrombosis
    2. Impaired Blood Flow Through the Liver: Cirrhosis
    3. Hepatic Venous Outflow Obstruction: Hepatic Vein Thrombosis
  10. Nodules and tumors

 

Tumor of liver

  1. Secondary (Metastatic) tumor of liver: Commonest (The liver is the most common site of metastatic cancers from primary tumors of the colon, lung, and breast).
  2. Primary tumor of liver
Origin Benign Malignant
Hepatocyte Liver cell adenoma Hepatocellular carcinoma
Hepatoblastoma
Biliary Adenoma
Cystadenoma
 Cholangiocarcinoma
Cystadenocarcinoma
Vascular Haemangioma Angiosarcoma
Mesenchymal Lipoma Liposarcoma

 

 

Disease of gall bladder

1. Congenital: Congenitally absent, Double gall bladder, Aberrant locations.

2. Inflammatory: Cholecystitis

3. Cholelithiasis (Stone in gall bladder)

4. Tumors of gall bladder

  • Benign: Adenoma
  • Malignant: Adenocarcinoma (95%), Squamous cell carcinoma (Squamous metaplasia)

 

 

Diseases of kidney

Congenital Anomalies

  • Agenesis of the Kidney
  • Hypoplasia
  • Ectopic Kidneys
  • Horseshoe Kidneys

Cystic Diseases of the Kidney

  1. Multicystic renal dysplasia
  2. Polycystic kidney disease
  • Autosomal-dominant (Adult) polycystic disease
  • Autosomal-recessive (Childhood) polycystic disease
  1. Medullary cystic disease
  • Medullary sponge kidney
  • Nephronophthisis
  1. Acquired (dialysis-associated) cystic disease
  2. Localized (simple) renal cysts
  3. Renal cysts in hereditary malformation syndromes (e.g., tuberous sclerosis)
  4. Glomerulocystic disease
  5. Extraparenchymal renal cysts (pyelocalyceal cysts, hilar lymphangitic cysts)

Glomerular diseases of kidney

1. Primary glomerulopathies:

  • Acute proliferative glomerulonephritis
  • Post infectious
  • Others
  • Rapidly progressive (Crescentic) glomerulonephritis
  • Membranoproliferative glomerulonephritis
  • Membranous glomerulopathy
  • Minimal-change disease
  • Focal segmental glomerulosclerosis
  • IgA nephropathy
  • Chronic glomerulonephritis

2. Systemic Diseases with Glomerular Involvement

  • Goodpasture syndrome
  • Amyloidosis
  • Diabetes mellitus
  • Systemic lupus erythematosus
  • Microscopic polyarteritis/polyangitis
  • Wegener granulomatosis
  • Henoch-Schonleinpurpura
  • Bacterial endocarditis

3. Hereditary Disorders:

  • Alport syndrome
  • Thin basement membrane disease
  • Fabry disease

 

Tumor of the kidney:

Benign:

  • Renal Papillary Adenoma
  • Renal fibroma
  • Angiomyolipoma
  • Oncocytoma

Malignant:

  • Renal cell carcinoma
  • Wilm’s tumor
  • Urothelial carcinoma of renal pelvis

 

Histology Classification of Renal cell carcinoma

  • Clear cell carcinoma (70-80%)
  • Papillary carcinoma (10-15%)
  • Chromophobe renal carcinoma (5%)
  • Collecting duct (Bellini duct) (1%)



 

Tumors of the Urinary Bladder

A. Epithelial

  1. Urothelial (Transitional cell) tumors (90%)
  • Transitional cell papilloma (Exophytic papilloma, Inverted papilloma)   
  • Papillary urothelial neoplasms of low malignant potential (PUNLMP) 
  • Carcinoma in situ (CIS, or flat non-invasive urothelial carcinoma)
  • Transitional cell carcinoma (Low grade and high grade)
  1. Squamous cell carcinoma (5%)
  2. Adenocarcinoma
  3. Mixed carcinoma
  4. Small cell carcinoma

B. Mesenchymal: Sarcomas


Grading of Noninvasive Urothelial (Transitional Cell) Tumors

WHO/ISUP Grades (2016)

A. Flat Lesion 

  • Urothelial proliferation of uncertain malignant potential (Flat hyperplasia)
  • Urothelial dysplasia
  • Urothelial carcinoma in situ

 

B. Exophytic Papillary Lesions

  • Papilloma
  • Papillary hyperplasia (Urothelial proliferation of uncertain malignant potential)   
  • Papillary urothelial neoplasm of low malignant potential   
  • Papillary urothelial carcinoma, low grade   
  • Papillary urothelial carcinoma, high grade

 

 

Diseases of Male Genital System

 Diseases of Prostate

  • Prostatitis
  • Nodular hyperplasia
  • Prostatic carcinoma: Adenocarcinoma

 

Diseases of Testis & Epididymis

  1. Congenital anomalies: Cryptorchidism, Synorchism
  2. Regressive changes: Atrophy and Decreased Fertility
  3. Inflammation: Orchitis [Syphilis, Gonorrhea, Tuberculosis, Mumps]
  4. Tumor of testis

 

Testicular tumor:

Testicular tumor

 

 

Diseases of Respiratory System

A. Congenital Anomalies

  • Pulmonary hyperplasia
  • Foregut cyst
  • Atresia, Stenosis, Tracheo-esopharyngeal fistula

B. Pulmonary Infection

  • Pneumonia
  • Lung abscess
  • Pulmonary TB
  • Fungal Infection: Aspergillosis

C. Obstructive Pulmonary Disease

  • Chronic obstructive pulmonary diseases (COPD)
  • Emphysema
  • Chronic bronchitis
  • Bronchial asthma
  • Bronchiectasis

D. Restrictive Pulmonary Diseases

  • Fibrosing Diseases: Interstitial Lung Diseases (ILD)
  • Granulomatous Disease

E. Disease of vascular Origin

  • Pulmonary embolism & infraction
  • Pulmonary HTN

F. Others

  • Atelectasis (Collapse)
  • Pulmonary Edema
  • Acute Respiratory Distress Syndrome (ARDS)

G. Tumor like lesion

  • Hamartoma
  • Eosinophilic granuloma

H. Tumor of Lung:

  1. Primary
  • Bronchogenic carcinoma
  • Mesenchymal origin
  • Benign: Fibroma, Lipoma, Chondroma, Hemangioma, Leiomyoma
  • Malignant: Fibrosarcoma, Leiomyosarcoma, etc.
  • Lymphoma
  1. Secondary/Metastatic (Commonest 90-95%): From breast, GIT, Kidney

 

WHO histological classification of Malignant Epithelial Lung Tumor (Bronchogenic Carcinoma)

  1. Squamous cell carcinoma (25-40%)
  2. Adenocarcinoma (25-40%)
  3. Adeno-squamous carcinoma
  4. Small cell carcinoma
  5. Large cell carcinoma
  6. Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
  7. Carcinoma of salivary gland type
  8. Unclassified carcinoma

 

 

Neoplasm of salivary glands

A. Benign

  1. Pleomorphic adenoma (50%)
  2. Warthin tumor      [WOOD]
  3. Oncocytoma
  4. Other adenomas
     - Basal cell adenoma
     - Canalicular adenoma
  5. Ductal Papilloma

B. Malignant 

  1. Mucoepidermoid carcinoma (15%)
  2. Adenocarcinoma (10%)
  3. Acinic cell carcinoma
  4. Adenoid cystic carcinoma
  5. Squamous cell carcinoma
  6. Malignant mixed carcinoma
  7. Other carcinomas

 

Esophagus

  1. Congenital anomalies: Atresia, Fistula (Tracheo-esopaageal fistula)
  2. Esophagitis (Barrett esophagus & Gastroesophageal Reflux Diseases - GERD)
  3. Esophageal varices
  4. Lesion associated with motor dysfunction: Achalasia cardia,
  5. Tumor
  • Benign: Fibroma, Lipoma, Leiomyoma
  • Malignant: Squamous cell carcinoma, Adenocarcinoma

 

 

Diseases of Stomach

1. Congenital: Pyloric stenosis, Diaphragmatic hernia

2. Gastritis

  • Acute gastritis
  • Chronic gastritis

3. Ulcer

  • Peptic Ulcer Diseases (PUD)
  • Malignant Ulcer
  • Acute Gastric ulcer: Curling ulcer, Cushing ulcer, Stress ulcer, Drug induced

4. Tumor of stomach

  • Benign: Gastric polyps [Adenoma (Adenomatous polyps)], Leiomyoma, Lipoma
  • Malignant: Adenocarcinoma (90-95%), Lymphoma, Carcinoid

 

WHO classification of Gastric Tumor (2010)

A. Epithelial tumors

  1. Premalignant lesions
  • Adenoma
  • Intraepithelial neoplasia (dysplasia), low grade
  • Intraepithelial neoplasia (dysplasia), high grade
  1. Carcinoma
  • Adenocarcinoma
  • Papillary adenocarcinoma
  • Tubular adenocarcinoma
  • Mucinous adenocarcinoma
  • Signet ring cell carcinoma
  • Mixed adenocarcinoma
  • Squamous cell carcinoma
  • Adenosquamous carcinoma
  • Undifferentiated carcinoma

B. Mesenchymal tumors [LKGs]

  • Granular cell tumor
  • Gastrointestinal stromal tumor (GIST)
  • Leiomyoma
  • Leiomyosarcoma
  • Kaposi sarcoma
  • Schwannoma

C. Lymphoma

 

 

Tumors of Small Intestine & Colon

A. Non-Neoplastic Polyps (Tumor like lesion)

  • Hyperplastic polyps
  • Hamartomatous polyps (Juvenile polyps & Peutz-Jegher polyps)
  • Inflammatory polyps
  • Lymphoid polyps

B. Epithelial (Neoplastic) polyps

  • Benign: Adenoma (Adenomatous polyps)
  • Malignant: Adenocarcinoma, Carcinoid tumors

C. Mesenchymal Lesion

  • Gastrointestinal Stromal Tumor (GIST)
  • Lipoma, Leiomyoma, Leiomyosarcoma, Hemangioma, Kaposi sarcoma

D. Lymphoma

 

Tumor of Appendix

  1. Benign: Hyperplastic polyps, Mucinous cystadenoma
  2. Malignant tumor: Carcinoid tumor, Mucinous cystadenocarcinoma, Malignant stromal tumor

 

 

Diseases of the Female Genital Tract

  • Congenital
  • Infections
  • Tumors
  • Complications of pregnancy
  • Hormonally induced effects

 

A. Infection of the lower genital tract:

  1. Viral: Herpes Simplex Virus (commonly HSV -2), Human Papilloma Virus
  2. Fungal: Candida
  3. Protozoa: Trichomonas vaginalis
  4. Bacterial: Chlamydia trachomatis, Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis

 

B) Infections Involving Both Lower and Upper Genital Tract

  • Pelvic Inflammatory Disease (PID):

Neisseria Gonorrhoea (Gonococcus), Chlamydia infection, Staphylococci, Streptococci, Coliform bacteria, and Clostridium perfringens

 

C) Diseases of Vulva:

1. Bartholin cyst

2. Inflammatory dermatologic diseases: Psoriasis, eczema, and allergic dermatitis.

3. Benign exophytic lesions/Wart like lesion (Benign raised lesion)

  • Condyloma acuminatum/Genital wart (Papilloma Virus induced lesion - HPV 6, 11)
  • Condyloma latum (Syphilitic Lesion)
  • Fibroepithelial polyps or Skin tags
  • Squamous papilloma

4. Premalignant: Vulvar Intraepithelial Neoplasia (VIN)

5. Malignant Tumors

  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Malignant melanoma

 

D) Diseases of the Vagina:

1. Developmental anomalies

  • Septate or Double vagina
  • Vaginal adenosis
  • Mucous cyst
  • Gartner duct cysts

2. Inflammation: Vaginitis

3. Neoplastic

i. Benign:

  • Squamous papilloma, Stromal polyp
  • Leiomyoma
  • Haemangioma

ii. Premalignant: Vaginal Intraepithelial Neoplasia

iii. Malignant neoplasm

  • Squamous cell carcinoma
  • Embryonal rhabdomyosarcoma (Sarcoma botryoides)

 

E) Diseases of Cervix:

1. Inflammation: Acute and chronic cervicitis

2. Neoplasm

3. Benign: Endocervical polyp, Leiomyoma

4. Premalignant: Cervical Intraepithelial Neoplasia - CIN (Squamous Intraepithelial Lesion)

5. Malignant neoplasm:

  • Squamous cell carcinoma (80%)
  • Adenocarcinoma (15%)
  • Adeno-squamous carcinoma (5%)
  • Undifferentiated carcinoma

 

F) Diseases of Uterus:

  • Functional endometrial disorders (Dysfunctional endometrial bleeding)
  • Inflammation:
    • Acute endometritis,
    • Chronic endometritis: Chronic PID, IUCD, TB
  • Endometriosis and adenomyosis
  • Endometrial hyperplasia
  • Endometrial polyp
  • Malignant tumor of endometrium:
    • Endometrial carcinoma (Endometroid Adenocarcinoma)
    • Malignant mixed mullerian tumor
  • Tumor of myometrium:
    • Leiomyoma
    • Leiomyosarcoma

 

 

WHO Classification of Ovarian Neoplasms

  1. Surface epithelial-stromal tumors (65-70%)
  2. Sex cord–stromal tumors (5-10%)
  3. Germ cell tumors (15-20%)
  4. Metastatic cancer from nonovarian primary (5%): Colonic, appendiceal, Gastric, Breast

 

A. Surface Epithelial -Stromal Tumor (65 - 70%)

1) Serous tumors

  • Benign (cystadenoma)
  • Borderline tumors (serous borderline tumor)
  • Malignant (serous adenocarcinoma)

 

2) Mucinous tumors, endocervical -like and intestinal type

  • Benign (cystadenoma)
  • Borderline tumors (mucinous borderline tumor)
  • Malignant (mucinous adenocarcinoma)

3) Endometrioid tumors

  • Benign (cystadenoma)
  • Borderline tumors (endometrioid borderline tumor)
  • Malignant (endometrioid adenocarcinoma)

4) Clear cell tumors

  • Benign
  • Borderline tumors
  • Malignant (clear cell adenocarcinoma)

5) Transitional cell tumors

  • Brenner tumor
  • Brenner tumor of borderline malignancy
  • Malignant Brenner tumor
  • Transitional cell carcinoma (non-Brenner type)

6) Epithelial- stromal

  • Adenosarcoma
  • Malignant mixed müllerian tumor

 

B. Sex Cord–Stromal Tumors (5 - 10%)

  • Granulosa tumors
  • Fibromas
  • Fibrothecomas
  • Thecomas
  • Sertoli cell tumors
  • Leydig cell tumors
  • Steroid (lipid) cell tumors

 

C. Germ Cell Tumors (15 - 20%)

  • Teratoma
  • Immature
  • Mature
    • Solid
    • Cystic (dermoid cyst)
  • Monodermal or highly specialized (e.g., Struma ovarii: composed entirely of mature thyroid tissue, Carcinoid)
  • Dysgerminoma
  • Yolk sac tumor (endodermal sinus tumor)
  • Mixed germ cell tumors

 

 

Cyst of the ovary:

1) Non- neoplastic and functional cyst:

  1. Physiological
    • Follicular cyst
    • Luteal cyst
  2. Pathological cyst: Non - neoplastic
    • Polycystic ovarian diseases (PCOD)
    • Chocolate cyst

2) Neoplastic

  1. Benign:
  • Serous cyst adenoma
  • Mucinous cyst adenoma
  • Dermoid cyst
  1. Malignant
  • Serous cyst adenocarcinoma
  • Mucinous cyst adenocarcinoma

 

Dysfunctional uterine bleeding:

Causes: According to age group

1. Prepuberty: Precocious puberty (hypothalamic, pituitary, or ovarian origin)

2. Adolescence: Anovulatory cycle, coagulation disorders

3. Reproductive age:

  • Complications of pregnancy: abortion, trophoblastic disease, ectopic pregnancy
  • Organic lesions: leiomyoma, adenomyosis, polyps, endometrial hyperplasia, carcinoma
  • Dysfunctional uterine bleeding: Anovulatory cycle, Ovulatory dysfunctional bleeding

4. Perimenopausal:

  • Dysfunctional uterine bleeding: Anovulatory cycle
  • Organic lesions: carcinoma, hyperplasia, polyps

5. Postmenopausal:

  • Endometrial atrophy
  • Organic lesions: carcinoma, hyperplasia, polyps

 

 

CNS tumor

  1. Primary tumor
  2. Secondary tumor (Metastatic tumors from lungs, breast, skin, kidney and GIT)

Primary brain tumors are rare. Among primary tumor

  1. Glioma 50-60%
  2. Meningioma 25%
  3. Schwannoma 10%

Tumors of CNS:

A. Primary intracranial tumors  

1. Tumors of neuroglia: (Glioma)

  1. Astrocyte
  2. Oligodendrocytes
  3. Ependyma

Glioma:

  1. Astrocytoma
  2. Oligodendrogliomas
  3. Ependymomas
b. Tumors of neurons: Neuroblastoma, Ganglioneuroblastoma, ganglioneuroma
c. Tumor of neurons & neuroglia: Ganglioglioma
d. Tumors of primitive undifferentiated cells: Medulloblastoma
e. Tumors of nerve sheet cells: Schwannoma, Neurofibroma
f. Tumors of meninges Meningioma, Meningeal hemangiopericytoma, Meningeal sarcoma
g. Malformative tumors: Craniopharyngioma, Epidermal cyst
h. Tumors of pineal cells: Pineoblastoma
i. Others: Lymphoma, Germ cell tumor

 

B. Metastatic tumors: From lungs, breast, skin, kidney and GIT

 

Histologic patterns of Meningiomas:

  1. Meningothelial: Named for whorled, tight clusters of cells without visible cell membranes;
  2. Fibroblastic: Elongated cells and abundant collagen deposition;
  3. Transitional: Combine features of the meningothelial and fibroblastic types;
  4. Psammomatous: Presence of numerous psammoma bodies
  5. Secretory: Gland like spaces containing PAS-positive eosinophilic material.

 

 

Disease of bones:

1. Congenital:

  • Achondroplasia
  • Osteogenic imperfect

2. Metabolic:

  • Osteopenia
  • Osteoporosis
  • Rickets and osteomalacia

3. Osteomyelitis

4. Paget disease of bones

5. Fracture of bones

6. Tumors

 

 

Diseases of Thyroid gland

1. Congenital anomalies: Thyroglossal cyst

2. Thyroiditis

3. Thyrotoxicosis, Hypothyroidism

4. Grave’s disease

5. Goiter

  • Diffuse non-toxic goiter
  • Multi-nodular goiter

6. Tumors

 

Causes of thyroiditis

  1. Infectious thyroiditis (Acute/Chronic)
  2. Hashimoto’s Thyroiditis
  3. Subacute granulomatous thyroiditis
  4. Subacute lymphocytic thyroiditis
  5. Reidel thyroiditis

 

 

Tumor of Thyroid gland

Benign:

  • Adenoma
  • Dermoid cyst
  • Lipoma
  • Hemangioma
  • Teratoma

Malignant

  • Papillary carcinoma (75-80%)
  • Follicular carcinoma
  • Anaplastic carcinoma
  • Medullary carcinoma

 

 

Soft Tissue Tumor

1. Tumor of adipose tissue:

  • Benign (Lipoma)
  • Malignant (Liposarcoma)

2. Tumor of fibrous tissue

  • Benign (Fibroma)
  • Malignant (Fibrosarcoma)

3. Tumor of skeletal muscle

  • Benign (Rhabdomyoma)
  • Malignant (Rhabdomyosarcoma)

4. Tumor of smooth muscle

  • Benign (Leiomyoma)
  • Malignant (Leiomyosarcoma)

5. Vascular tumor

  • Benign (Hemangioma)
  • Malignant (Angiosarcoma, Hemangiopericytoma)

6. Peripheral nerve sheath tumor

  • Benign (Neurofibroma, Schwannoma)
  • Malignant (Malignant schwannoma)

 

 

Tumors of Skin

1. Benign epithelial tumors

  • Seborrheic keratosis
  • Acanthosis nigricans
  • Adnexal tumor
  • Keratoacanthoma

2. Pre malignant epidermal tumors

  • Actinic keratosis
  • Actinic cheilitis

3. Malignant epidermal tumor

  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Merkel cell carcinoma
  • Paget disease of skin

4. Tumors of dermis

  • Xanthoma
  • Benign fibrous histiocytoma
  • Dermal vascular tumor

 

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