
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
- Inflammatory disorder:
- Acute viral Hepatitis
- Chronic hepatitis
- Autoimmune hepatitis
- Fulminant hepatitis
- Due to drugs and toxin induced
- Bacterial and parasitic infection:
Bacterial infection: S. aureus, salmonella typhi, Treponema pallidum
Parasitic infection: Schistosomiasis, Entamoeba histolytica, Liver fluke, Echinococcal infections.
- Cirrhosis of liver
- Alcoholic liver disease
- Non-alcoholic fatty liver disease
- Liver failure (Acute and Chronic)
- Drug and toxin induced liver injury
- Inherited metabolic disorder: Hemochromatosis, Wilson Disease, α1-Anti-Trypsin Deficiency
- Cholestatic liver disease: Cholestasis, Primary biliary cirrhosis, cholangitis
- Circulatory disorders:
- Impaired Blood Flow into the Liver: Portal Vein Obstruction and Thrombosis
- Impaired Blood Flow Through the Liver: Cirrhosis
- Hepatic Venous Outflow Obstruction: Hepatic Vein Thrombosis
- Nodules and tumors
Tumor of liver
- 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).
- 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
- Multicystic renal dysplasia
- Polycystic kidney disease
- Autosomal-dominant (Adult) polycystic disease
- Autosomal-recessive (Childhood) polycystic disease
- Medullary cystic disease
- Medullary sponge kidney
- Nephronophthisis
- Acquired (dialysis-associated) cystic disease
- Localized (simple) renal cysts
- Renal cysts in hereditary malformation syndromes (e.g., tuberous sclerosis)
- Glomerulocystic disease
- 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
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Tumors of the Urinary Bladder
A. Epithelial
- 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)
- Squamous cell carcinoma (5%)
- Adenocarcinoma
- Mixed carcinoma
- 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
- Congenital anomalies: Cryptorchidism, Synorchism
- Regressive changes: Atrophy and Decreased Fertility
- Inflammation: Orchitis [Syphilis, Gonorrhea, Tuberculosis, Mumps]
- Tumor of testis
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:
- Primary
- Bronchogenic carcinoma
- Mesenchymal origin
- Benign: Fibroma, Lipoma, Chondroma, Hemangioma, Leiomyoma
- Malignant: Fibrosarcoma, Leiomyosarcoma, etc.
- Lymphoma
- Secondary/Metastatic (Commonest 90-95%): From breast, GIT, Kidney
WHO histological classification of Malignant Epithelial Lung Tumor (Bronchogenic Carcinoma)
- Squamous cell carcinoma (25-40%)
- Adenocarcinoma (25-40%)
- Adeno-squamous carcinoma
- Small cell carcinoma
- Large cell carcinoma
- Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
- Carcinoma of salivary gland type
- Unclassified carcinoma
Neoplasm of salivary glands
A. Benign
- Pleomorphic adenoma (50%)
- Warthin tumor [WOOD]
- Oncocytoma
- Other adenomas
- Basal cell adenoma
- Canalicular adenoma - Ductal Papilloma
B. Malignant
- Mucoepidermoid carcinoma (15%)
- Adenocarcinoma (10%)
- Acinic cell carcinoma
- Adenoid cystic carcinoma
- Squamous cell carcinoma
- Malignant mixed carcinoma
- Other carcinomas
Esophagus
- Congenital anomalies: Atresia, Fistula (Tracheo-esopaageal fistula)
- Esophagitis (Barrett esophagus & Gastroesophageal Reflux Diseases - GERD)
- Esophageal varices
- Lesion associated with motor dysfunction: Achalasia cardia,
- 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
- Premalignant lesions
- Adenoma
- Intraepithelial neoplasia (dysplasia), low grade
- Intraepithelial neoplasia (dysplasia), high grade
- 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
- Benign: Hyperplastic polyps, Mucinous cystadenoma
- 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:
- Viral: Herpes Simplex Virus (commonly HSV -2), Human Papilloma Virus
- Fungal: Candida
- Protozoa: Trichomonas vaginalis
- 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
- Surface epithelial-stromal tumors (65-70%)
- Sex cord–stromal tumors (5-10%)
- Germ cell tumors (15-20%)
- 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:
- Physiological
- Follicular cyst
- Luteal cyst
- Pathological cyst: Non - neoplastic
- Polycystic ovarian diseases (PCOD)
- Chocolate cyst
2) Neoplastic
- Benign:
- Serous cyst adenoma
- Mucinous cyst adenoma
- Dermoid cyst
- 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
- Primary tumor
- Secondary tumor (Metastatic tumors from lungs, breast, skin, kidney and GIT)
Primary brain tumors are rare. Among primary tumor
- Glioma 50-60%
- Meningioma 25%
- Schwannoma 10%
Tumors of CNS:
A. Primary intracranial tumors | |
1. Tumors of neuroglia: (Glioma)
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Glioma:
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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:
- Meningothelial: Named for whorled, tight clusters of cells without visible cell membranes;
- Fibroblastic: Elongated cells and abundant collagen deposition;
- Transitional: Combine features of the meningothelial and fibroblastic types;
- Psammomatous: Presence of numerous psammoma bodies
- 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
- Infectious thyroiditis (Acute/Chronic)
- Hashimoto’s Thyroiditis
- Subacute granulomatous thyroiditis
- Subacute lymphocytic thyroiditis
- 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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