Dystrophies: parenchymal, stromal-vascular, and mixed
Parenchymatous dystrophies are represented by classic specimens. The liver in fatty liver disease (steatosis) is enlarged, firm, with a rounded anterior margin, and has a uniform, clay-like, yellow-brown appearance on cross-section. Leukoplakia of the tongue presents as firm, whitish hyperkeratotic plaques. Ichthyosis manifests as scales ranging from small and fine to large plates with fissures. Tiger heart: the myocardium is flabby; beneath the endocardium of the trabeculae and papillary muscles of the left ventricle, there is a transverse yellowish striation resembling a tiger's skin.
Stromal-vascular dystrophies: aortic atherosclerosis with yellow spots, streaks, and ulcerated plaques; hyalinosis of the splenic capsule ("glaze spleen") as white, shiny foci of induration; renal amyloidosis ("large greasy kidneys") where kidneys are enlarged, pale yellow-gray with a greasy luster; simple fatty heart with massive epicardial fat.
Mixed dystrophies: jaundice (bilirubin in the sclerae), acid hematin at the base of acute erosions, slate-black spleen in malaria, melanocytic nevus with a geographic contour, cutaneous melanoma.
Necrosis, gangrene, and infarctions
Wet gangrene of the intestine: thickened edematous walls, flabby consistency, black-red color, dull serosa with fibrin. Dry gangrene of the toes: reduction in size, gray-black color (iron sulfide), clear demarcation. Wet gangrene of the foot: edema, cyanosis, maceration, indistinct demarcation.
Infarction of the kidney and spleen has a regular triangular (conical) shape with the base facing the capsule, and a yellow-gray color with a hemorrhagic rim. Myocardial infarction is a yellowish focus of necrosis with an inflammatory border. Cerebral infarction is liquefactive necrosis with a grayish-white mushy tissue. Pulmonary infarction is a conical, dense, dark-red focus with its base facing the pleura.
Circulatory disorders, thrombosis, inflammation
Nutmeg liver: red-brown lobular centers alternating with a yellow periphery. Spleen in chronic venous congestion: enlarged, flabby, cyanotic-crimson. Cerebral hemorrhage: a collection of brownish-red clotted blood with destruction of brain tissue.
Coronary artery thrombosis: thrombotic masses intimately adherent to the vessel wall. Varicose veins of the leg, globular thrombus in the left atrium. Fibrinose pericarditis ("hairy heart") with gray strands and films of fibrin. Lung abscess: a rounded cavity resulting from the liquefaction of necrosis. Purulent meningitis: meninges are thickened, infiltrated with yellow-green pus, and sulci are smoothed out. Serous pleuritis, splenic sarcoidosis with whitish granulomas, miliary tuberculosis, nasal gumma.
Tumors and pre-tumor conditions
Intestinal polyp is a formation on a stalk or a broad base. Renal cell carcinoma: a variegated nodule with foci of hemorrhage and necrosis on a bright yellow background. Hepatocellular carcinoma: multiple light-yellow nodules disrupting the liver architecture. Lipoma is an encapsulated yellow nodule of elastic consistency; mesenteric liposarcoma annularly surrounds the bowel, causing obstruction. Osteosarcoma invades the cortical bone and soft tissues. Breast cancer presents as firm, gray nodules with indistinct borders.
Exophytic gastric cancer grows into the lumen as nodular polypoid masses; endophytic diffusely infiltrates the muscular layer with stenosis. Seminoma consists of white elastic nodules with necrosis. Paget's disease of the nipple presents with weeping, ulcers, and crusts. Hydatidiform mole features enlarged chorionic villi resembling a bunch of grapes.
Cardiovascular pathology and rheumatic diseases
Myocardial hypertrophy: heart of flabby consistency, thickening of the left ventricular wall, enlargement of trabeculae and papillary muscles. Aortic atherosclerosis with a mural thrombus, aortic aneurysm. Coronary heart disease: fibrinous pericarditis following infarction, hemopericardium upon rupture, myocardial rupture with a slit-like opening, chronic cardiac aneurysm as an out pouching of the thinned wall.
Acute warty endocarditis: mitral valve leaflets are thickened, edematous, with dark-red friable vegetations along the free margin. Recurrent-warty endocarditis with valvular defect formation: sclerosis, hyalinosis, calcification, and fusion of leaflets, with shortening of chordae tendineae. Rice bodies in the joint cavity in rheumatoid arthritis. Skin lesions in the form of a "butterfly" rash in SLE.
Organ diseases, infections, and tuberculosis
Gastrointestinal tract: hemorrhagic gastric erosions with a black-brown base; chronic ulcer with firm edges and convergence of folds; acute ulcer with soft edges; phlegmonous appendicitis; portal (micronodular) and biliary (macronodular) liver cirrhosis.
Kidneys: "large variegated kidney" in acute glomerulonephritis, apostematous pyelonephritis, secondary shrunken kidneys, nephrolithiasis. Lungs: lobar pneumonia in the stage of gray hepatization, empyema of the pleura, focal bronchopneumonia.
Tuberculosis: primary Ghon complex includes the primary focus (Abrikosov's subpleural focus of caseous necrosis, most commonly in the III segment of the right lung), tuberculous lymphangitis, and caseous lymphadenitis. Miliary tuberculosis features diffuse millet-like tubercles. Caseous pneumonia presents as large confluent foci of caseous necrosis. Intestinal infections: medullary swelling of Peyer's patches in typhoid fever, diphtheritic colitis in dysentery, serous-hemorrhagic enteritis in cholera. Syphilis: hard chancre (primary ulcer) as a painless ulcer with a firm base; secondary syphilis manifests as macules, papules, pigmentation, and alopecia.
Key points
- Fatty liver disease and tiger heart are typical parenchymatous dystrophies characterized by a yellow-brown discoloration of the organs.
- Infarctions of the kidney, spleen, and lung have a conical shape with the base located at the capsule or pleura.
- Nutmeg liver and cyanotic induration of the spleen reflect chronic venous congestion.
- The primary Ghon tuberculous complex includes Abrikosov's focus, lymphangitis, and caseous lymphadenitis.
- Exophytic and endophytic gastric cancers differ in their growth direction and the nature of wall involvement.
- Acute warty and recurrent-warty endocarditis differ in the degree of sclerosis and valvular deformation.
- Portal cirrhosis is characterized by a micronodular liver, whereas biliary cirrhosis features a macronodular liver with a light pink surface.
- Dry gangrene is characterized by clear demarcation, whereas wet gangrene features edema and an indistinct border of necrosis.