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Clues to 8 pathological conditions hidden in the photographs 

All pathologists should know the answer.

Dr Sampurna Roy MD                           

 

 


 

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A girl with a bronze complexion was sitting in the garden and eating popcorn and nutmeg flavoured food.

Her pet tabby cat was lying next to her. 

An adorable owl was perched on a tree branch. The owl's feather blend in with the colour of the surrounding tree bark.

The girl looked up at the beautiful starry sky and noticed a prominent asteroid.

What are the 8 pathological conditions hidden in the images?

 

Answer:

 

1) The Bronze-complexion: Patients with hemochromatosis classically manifest with bronze skin complexion.  

Visit: Pathology of Primary Hemochromatosis

2) Tabby Cat Heart:

Fatty degeneration of the heart seen in elderly patients.

There is subendocardial fat affecting the ventricular wall.

The myocytes are replaced by fat followed by fibrosis.

3) Nutmeg liver:  

In chronic venous congestion secondary to right heart failure the liver undergoes congestion and pigmentation around the central veins of its lobules.

The appearance resembles that of a nutmeg.

Microscopically, the liver cells at the periphery (left) of the lobule is normal.

Centrilobular zone (right) liver cells are full of fat and many are atrophic.

Sinusoids are distended.

Nutmeg pattern results from congestion around the central veins.

4) Lymphocyte Predominance Hodgkin's disease: "Popcorn" cells.

   

      

Scattered neoplastic cells are seen against the backround of an abnormal cellular infiltrate.

These cells are known as  'L and H' (Lymphocytic and Histiocytic) or "Popcorn" cells.

Most of these cells lie within large nodular areas made up of small lymphoid cells.

5)  Classical Reed-Sternberg cell in Hodgkin's disease is binucleate, each nucleus contains a prominent eosinophilic nucleolus with perinucleolar halos giving the cell an "owl-eye" appearance.

  

 

The classic binucleate Reed-Stenberg  cell was described by Carl Sternberg and Dorothy Reed.

The binucleation is an artifact created due to deep indentations and folds in the nuclear membrane.

6) Syphilitic Aortitis in the tertiary stage of syphilis is grossly featured by wrinkling and scarring of the intima -  "Tree-bark appearance".

 A)         B)

B) Credit: Wellcome Library, London Late syphilis (tertiary stage): histopathology of the aorta in cardiovascular syphilis.

This medium power view shows the effects of syphilitic aortitis in a section of aortic wall. The upper part of the picture shows tunica media and the lower part shows adventitia.

There is a mixed, chronic, inflammatory infiltrate, which is most pronounced across the centre of the picture (dark-staining). The infiltrate lies around the vasa vasorum within the tunica media and adventitia. This indicates periaortitis. In addition, there is adventitial fibrosis (bottom zone) and endarteritis obliterans of the central arteriole. H&E stain.

 

Histologically the characterisitic findings are adventitial thickening with endarteritis of the vasa vasorum and perivascular accumulation of plasma cells and lymphocytes, and destruction of the elastic tissue and smooth muscle cells of  media in a patchy fashion.

7) Burkitt's Lymphoma - "Starry Sky Appearance"

"Two things awe me most, the starry sky above me and the moral law within me." - Immanuel Kant "

This tumour is typically made up of medium sized B-cells with a high proliferation fraction, interspersed with macrophages containing cellular debris, giving the characterisitic "starry sky" appearance.

It may be difficult to distinguish with certainty from diffuse large cell lymphoma.

Immunophenotype is that of peripheral B cell, although CD10 is also often present, which has prompted suggestion that it derives from germinal center cells.

In most "endemic African cases Epstein-Barr viral DNA is found in malignant cells.

Histologically and phenotypically identical cases are also seen occasionally in the West.

These may arise in patients with AIDS , and the EB virus is detectable in less than quarter of these cases.

Almost all cases from whatever country, show a chromosomal translocation involving the MYC gene on chromosome 8 and the gene for Ig heavy chain or, less commonly, one of the two Ig light chain genes.

8) The asteroid body in Sporotrichosis is a characteristic structure.

Sporotrichosis is a chronic fungal infection.

Asteroid body is  characterized by the presence of radiating star-like asteroid or club-shaped eosinophilic material around spores.

Visit: Pathology of Sporotrichosis

 

" We are involved in technology development for, you know, missions that we hope to plan that would take us to an asteroid and eventually to Mars. Ellen Ochoa"

 

Visit: A story with images :Clues to 8 pathological diseases

Visit: Location of Brain Tumours - A new puzzle for Pathologists

 

 

 

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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)

   


 

 

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