Kidney Anatomy

Herpes Virus

Herpes Virus
- double stranded DNA ~ 70 proteins
- types
a. neutropic alpha-group viruses
HSV1, HSV2, VZV
b. lymphotropic beta-group viruses
CMV, HHV6, HHV7
c. gamma group viruses
EBV, HHV8 (Kaposi's Sarcoma)

HSV1, HSV2
- cause vesicular lesions of the epidermis
- infect neurons
- primary HSV infection in immunocompetent resolve in few weeks (VIRUS LATENT IN NERVE CELLS)

HSV morphology
- formation of large, pink to purple (Cowdry type A) intranuclear inclusions that contain intact and disrupted virions and push darkly stained host cell chromatins to the edge of nucleus
inclusion-bearing multinucleated syncitia

Manifest
- cold sore, fever blister
- gingivostomatitis
- genital herpes
- corneal lesions (herpes epithelial keratitis, herpes stromal keratitis)

Lymph Node, Spleen, Lymphoid Disorder

HODGKIN'S

MIXED CELLULARITY



NODULAR SCLEROSIS

A diagnostic (multi-nucleated) Reed-Sternberg cell lies dead-center. Just below it is a non-diagnostic, uninuclear cell that has been called a "Reed-Sternberg variant" or a "Hodgkin" cell. Although this cell is characteristic of hodgkin lymphoma, the pathologist who plays by the rules will scrutinize a node suspected of Hodgkin lymphoma involvement until a diagnostic cell is found.

Lacunar cells are a feature of nodular sclerosis Hodgkin lymphoma and are not found in other subtypes. In formalin-fixed tissue, the cytoplasm around Reed-Sternberg cell nuclei retracts, leaving a cleared space possibly spanned by a few shreds of cytoplasm. The nuclei are also contracted and have diminished nucleoli.

LYMPHOCYTE DEPLETED

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IMPORTANT PRINCIPLES REGARDING LYMPHOID NEOPLASM

- VAST MAJORITY(80~85%) B-CELL ORIGIN
REMAINDER ARE T-CELL, RARELY ARE NK OR HISTIOCYTIC ORIGIN
MAY REPRESENT CELLS ARRESTED AT AY STAGE OF DIFFERENTIATION
- AS TUMORS OF IMMUNE SYSTEM DISRUPTING NORMAL REGULATORY FUNCTION,
INCREASE SUSCEPTIBILITY TO INFECTION OR AUTOIMMUNITY
- ALL LYMPHOID NEOPLASMS DERIVED FROM A SINGLE TRANSFORMED CELL AND ARE MONOCLONCAL
- NEOPLASTIC B AND T CELLS TEND TO HOME IN AND GROW IN AREAS WHERE THEIR NORMAL COUTNERPARTS RESIDE
- HD SPREADS IN ORDERLY FASHION, NHL LESS PREDICTABLE






































































































ACUTE LYMPHOBLASTIC LEUKEMIA/LYMPHOMA (ALL)
- VERY IMMATURE CELLS WITH LARGE NUCLEOLI
- FEWER NUCLEOLI THAN DO MYELOBLASTS
- NUCLEAR CHROMATIN MORE CONDENSED
- CYTOPLASMIC GRANULES ABSENT


ACUTE MYELOBLASTIC LEUKEMIA (AML)
- VERY LARGE, IMMATURE MYELOBLASTS
- LINEAR RED, AUER ROD, COMPOSED OF CRYSTALLIZED GRANULES
- DELICATE NUCLEAR CHROMATIN
- PROMINENT NUCLEOLI
- FINE AZUROPHILIC GRANULES IN THE CYTOPLASM

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5 most common NHL



SMALL LYMPHOCYTIC LYMPHOMA (SLL, PROLYMPHOCYTES, BELOW: SMUDGE CELL)



FOLLICULAR LYMPHOMAS (TWO TYPES OF CELLS: CENTROCYTIC, CENTROBLASTIC)
a mixture of small lymphocytes with scanty cytoplasm and irregular nuclei (centrocytes) mixed with a population of larger lymphocytes with scanty cytoplasm with rounded nuclei and single or multiple small nucleoli (centroblasts).


DIFFUSE LARGE B-CELL LYMPHOMA(CELL SIZE 5 X A SMALL LYMPHOCYTE)



BURKITT LYMPHOMA(STARRY SKY DUE TO APOPTOSIS, MOST EXTRANODAL)
TWO TYPES, 1)AFRICAN(EBV), 2)NON-ENDEMIC

MANTLE CELL LYMPHOMA

- TOP: Note that the cells in the germinal center, which are not neoplastic, bear no resemblance to the small lymphocytes of the tumor.

- TWO PATTERNS, 1) MANTLE ZONE PATTERN, 2) DIFFUSE PATTERN
- REGARDLESS OF PATTERN, THE PROLIFERATION CONSISTS OF A HOMOGENOUS POP'N OF SMALL LYMPHOCYTES WITH ROUND TO IRREGULAR TO OCCASIONALLY DEEPLY CLEFTED(CLEAVED) NUCLEAR COUNTOURS

Ovarian, Uterine, Cervical, Vaginal Histologies

1. Ovary
- primary follicle(unilaminar -> multilaminar) -> secondary follicle (early vesicular -> vesicular) -> mature (Graafian follicle) -> rupture -> corpus luteum -> corpus albicans

theca externa, theca interna, basement membrane, granulosa cells, cumulus oophorus, corona radiata, Call-exner bodies (small cavities, vacuoles between follicuar cells), zona pellucida, oocyte

after rupture
corpus luteum
capsule of corpus luteum formed from theca externa
- theca lutein cells(smaller, dark staining cytoplasm, secrete estrogen) formed from theca interna
- granulosa lutein cells (larger, paler cytoplasm, secrete progesterone) formed from granulosa cells

2. oviduct (coming from ovary) - infundibulum -> ampulla -> isthmus -> interstitial segment
papillary projecting (fimbrae) mucosa, simple columnar
three layers : mucosa(epithelium; lamina propria), muscularis(inner circular; outer longitudinal), serosa(simple squamous, mesothelium)
the simple columnar mucosa has ciliated and nonciliated (secretory) cells

3. uterus
endometrium(stratum functionalis; stratum basalis), myometrium (stratum submucosum; stratum vasculare; stratum supravasculare; stratum subserosum), perimetrium(serosa)

stratum functionalis has stratum compactum and stratum spongiosum
proliferative phase from 3rd day (menstruation) to 14th day
- stratum functionalis grows from stratum basalis
- high level estrogen
secretory phase from 20th to 28th
- stratum functionalis secretes and then sloughes off
- hypertrophic uterine glands filled with secretion
- high level progesterone
- edematous stroma

4. Cervix has endometrium(mucosa), myometrium and perimetrium
- about 3 cm in length, external os to internal os
- endometrium (endocervix) has simple columnar epithelium, lamina propria devoid of spiral arteries, presence of cervical glands; mucosal folds longitudinal and transverse called "plicae palmate"
- endocervix does not slough off during menstruation
- portio vaginalis - portion of cervix that projects to vagina, covered with nonkeratinized stratifed squamous epithelium, constitute exocervix marked with no gland presence
- around time of ovulation, mucus secretion is thin and watery which allows the passage of sperm to uterine cavity
- around luteal(secretory) phase and pregnancy the mucus secretion is viscuous, preventing entry of microorganism and sperm to uterine cavity

5. Vagina: mucosa, muscularis and adventitia
- mucosa: nonkeratinized stratified squamous epithelium, basal cells stain darkly, intermediate cells with glycogen accumulation stale pale
- lamina propria has numerous elastic fibers in addition to collagen fibers and fibroblasts and a vaginal plexus(plexus venosus vaginalis); lamina propria penetrates into epithelium, forming "papillae"
- adventitia has large blood vessels and adipose cells

6. labia minora with thin keratinized stratified squamous epithelium and lamina propria(core)
- no hair follicles or adipose cells but numerous large sebaceous glands


Time Spent: 3 hrs?