REGUB Data Images

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Kidney failure results in hypertensive heart disease
Concentric L.V.H. Common cause of death in CKD.
Mild interstitial fibrosis lowest zone
Severe fibrosis
Gross of ADPKD
Cut surface
Congenital cystic disease
Von Hippel Lindau Syndrome
Pus in Tubule Pyelonephritis
Pus in tubules + PMN’s in interstitium
Pus in several tubules Pyelonephritis
Cystitis and ascending acute pyelonephritis secondary to prostatic obstruction.
Possible role of BPH
Suppurative pyelonephritis
Renal TB Miliary haematogenous seeding of the kidney Pyelonephritis.
Chronic Pyelonephritis
Struvite Calculi complicate chronic pyelonephritis.
Xanthogranuloma – foamy macrophage [Link]
Tubular Interstitial Nephritis
Eosinophil rich inflammation drugs PPI, antibiotics, NSAIDS
Granulomatous TIN in sarcoidosis
P.U.J. obstruction (congenital)
Hydronephrosis
Hydronephrosis
Oxalate crystals (antifreeze ingestion)
Renal Calculi
Oxalate – Polarised light
Acute tubular necrosis. No inflammation
Granular cast (Mitochondria aggregates)
Tubular epithelial cell necrosis
Acute Glomerulonephritis
Crescentic GN Cellular crescent
Myoglobin casts obstructing tubule in, eg crush, muscle breakdown injury.
Severe toxic like acute tubular injury, gentamicin, contrast for x rays.
Patchy inflammation with tubule destruction
Cholesterol embolus in artery following Coronary angiography via femoral artery
This is vasculitis. Note difference from thrombotic lesions.
Transmural vasculitis is present here.
Red cell cast in urine
Direct Immunofluorescence for IgA GN
Sclerosed glomeruli and glomerulus enlarged increased mesangial cellularity
Segmental sclerosing lesion
Mesangial deposits in IgA GN
Thin membrane nephropathy
Alport’s syndrome (lamellation of BM)
Alport’s syndrome
Alport’s syndrome- lamellation of basement membrane.
ANCA (cystoplasmic or perinuclear)
Artery with vasculitis (ANCA vasculitis)
Crescent and fibrinoid necrosis
Pulmonary – renal syndromes ( pulmonary haemorrhage)
Lung haemorrhage in ANCA vasculitis
Anti GBM disease (linear IgG positivity)
Rupture of capillary loops
Minimal Change Disease Severe epithelial cell foot processes effacement
Focal and Segmental Glomerulosclerosis (FSGS)
Segmental sclerosis
Thickening of capillary loops in MGN
Granular positivity of IgG in MGN
Deposits on epithelial side of BM in MGN.
Note no inflammation
New BM forms between deposits. Note also foot process damage
Amyloid – waxy
Starch - like
Amyloid “deposited” throughout Glomerulus
Apple green birefringence
Amyloid fibrils on high power EM
Kimmelstiel Wilson micro - aneurysm
Severe arteriolar sclerosis
Streptococcal Pharyngitis
Facial oedema in acute nephritic syndrome
Global and diffuse glomerular hypercellularity
Subepithelial “hump” – like deposit - PIGN
Also many large subendothelial deposits - PIGN
Granular C3 on FM (“starry sky” distribution) - PIGN
Capillary loops become thickened -MPGN
Cryoglobulin deposits → MPGN
Large aggregated deposits (C3 on FM)
 Deposits

EM of MPGN case due to cryoglobulinaemia

Fibrinous pericarditis (“bread and butter”) can occur in CRF.
Butterfly rash in SLE
All immunoglobulins positive on EM in SLE
Segmental glomerular acute inflammation in SLE
Large subendothelial deposits in SLE
Gross photo of RCC
RCC with necrosis and haemorrhage
Renal vein invasion
ADPKD. Tumours can arise in cysts.
Von Hippel Lindau syndrome. Tumours will complicate renal cysts
High power. Histology showed early Renal Cell Carcinoma
Other kidney same patient. Also showed early Renal Cell Carcinoma
Retroperitoneal liposarcoma. Can mimic RCC clinically
 Graves’ Disease
• Macro
• Diffuse enlargement
• Micro
• Star shaped follicles
• Little colloid
• Increased lymphocytes
 Hashimoto’s Thyroiditis
Macro: Swollen in start, atrophy later

Micro:
Lymphocytic infiltration of
the stroma with reactive
germinal centres and
oxyphilic change of
follicular epithelium.
Thyroiditis – De Quervian
 Typical follicular adenoma

Other variants: Hurthle cell (oncocytic) adenoma

Papillary Carcinoma
 Variants of papillary
carcinoma
• Follicular variant
• Oncocytic variant
• Columnar variant
• Diffuse sclerosing variant
• Tall cell variant
• Papillary microcarcinoma
• <1cm
• Common
• Incidental finding
• ?Therapy

Tall cell variant

Anaplastic Carcinoma
Adrenal Hypercortisolism
Waterhouse-Friderichsen Syndrome
Adrenocortical Adenoma
Adrenocortical Carcinoma
Adrenal Myelolipoma

• Benign entity
• Fat and
haematopoietic cells
• Incidental findings
• May reach massive
proportions
Phaechromacytoma
Benign Prostatic Hyperplasia
Prostatism
Prostate Cancer
Benign Malignant
IHC: 34BE12/p63 cocktail
 Early change
Germ cell neoplasia in situ
Normal seminiferous tubule Germ cell neoplasia in situ

In-situ malignant (like dysplasia), cannot metastasise

Seminoma
 Combined tumour

Seminoma

Non-seminoma
(Embryonal carcinoma)
 Pancreas - islet of Langerhans

H&E stain of pancreas with islet (centre) containing endocrine cells of different types
(types can’t be distinguished by microscopy): alpha cells secreting glucagon, beta cells
secreting insulin etc. Surrounding tissue is normal exocrine pancreatic acini
 Insulitis

H&E stain showing lymphocytic inflammation in islet of Langerhans (‘insulitis’, centre)

surrounded by normal exocrine pancreatic tissue and suggesting autoimmune
damage. Insulin-secreting B cells selectively targeted. Compare with normal
histology. This slide from the pancreas of an
 Hyaline arteriolosclerosis

H&E stain showing random arteriole (from skin). Typical microvascular changes
associated with diabetes. “Hyaline” refers to the pink glassy quality to the staining
in the vessel wall, “sclerosis” to thickening of the wall and narrowing of the lumen.
Similar changes seen to a lesser degree in association with hypertension
 Diabetic nephropathy

H&E showing glomerulus with increased mesangial matrix (accumulation

of deep pink matrix within mesangium of glomerulus) as well as hyaline
arteriolosclerosis (arteriole with thickened wall due to deep pink hyaline
material, arrowed). Compare with normal glomerulus
 Diabetic nephropathy

H&E showing glomerulus with diffuse and nodular glomerulosclerosis. Kimmelstiel-

Wilson nodules characteristic of nodular glomerulosclerosis (marked as ‘N’). Compare
with normal glomerulus
Lichen Sclerosis - Vulva
Paget’s - Vulva
This is normal cervical non-keratinizing squamous
epithelium. The squamous cells show maturation from
basal layer to surface.
The normal cervical squamous epithelium at the left
transforms to dysplastic changes on the right. There is also
underlying chronic inflammation because abnormal epithelial
surfaces do not provide the same protective barrier as normal
epithelial surfaces do.
This is the gross appearance of a cervical squamous
cell carcinoma. The tumor is a fungating red to tan to
yellow mass.
Proliferative phase-endometrium
Early Secretory Endometrium, Day 2 post-ovulatory
Late secretory phase endometrium
Endometrial Polyp
Adenomyosis occurs when endometrial glands and stroma are
found in the myometrium
Endometriotic cyst ( chocolate cyst)
This is a focus of endometriosis. The lumen of the tube is at the right.
Endometriosis, wall of colon
Endometriosis, serosa of the uterus
Uterine leiomyomata
Leiomyoma
Leiomyosarcoma
Serous
Cystadenoma
Serous Cystadenoma
 FALLOPIAN TUBE
PRECURSOR LESION
Ovarian Tumours
MUCINOUS
TUMOURS
 ENDOMETRIOID
ADENOCARCINOMA
Germ Cell - Teratoma
Fat Necrosis - Breast
Fibrocystic changes
Ductal carcinoma in situ
(DCIS)
Paget’s Disease
Lobular Carcinoma In Situ
Invasive Ductal Carcinoma
Invasive Tubular Carcinoma
Invasive Mucinous Colloid Carcinoma
Invasive Medullary Carcinoma
Breast Carcinoma
Breast Carcinoma
Fibroadenoma
Phyllodes Tumour
Escherichia coli
Pseudomonas aeruginosa
Histology of acute pyelonephritis with
microabscesses (M)
(Mims Medical Microbiology, Mosby Press)
Syphilis – JH reaction
Neisseria Gonorrhoea
HSV
MRI in Prostate
Cancer
Paget’s disease of the nipple
Hyperthyroidism
GRAVES - Solitary Thyroid
Nodule
 Thyroid Carcinoma
Papillary
 Thyroid Carcinoma
Follicular

Follicular carcinoma at
base
 Thyroid Carcinoma
Medullary

Medullary carcinoma
 Thyroid Carcinoma
Anaplastic
 Thyroid Lymphoma

• Associated with
Hashimoto’s thyroiditis

Thyroid lymphoma
 BACKGROUND DIABETIC RETINOPATHY

• Microaneurysms
• Exudates
• Haemorrhages
– (dot and blot)
 PROLIFERATIVE RETINOPATHY

• New Vessels at Disc

(NVD)

• New Vessels Elsewhere

(NVE)

• Vitreal haemorrhage
Diabetic Nephropathy
 Urine Sediment Analysis

Hyaline cast Red cell cast

Granular Cast
 Types of Casts
TYPE OF CAST EXPLANATION
Hyaline casts In normal individuals especially in setting of:
Solidifed Tamm Horsfall mucoprotein Dehydration
Vigorous exercise
Larger numbers suggest proteinuria
Granular casts Acute tubular necrosis – muddy brown casts
Can form from the degeneration of Any of the causes of cellular casts
cellular casts

Red cell casts Glomerulonephritis, e.g. SLE, Anti-GBM disease,

ANCA vasculitis
Renal infarction
Subacute bacterial endocarditis
White cell casts Acute pyelonephritis
Acute interstitial nephritis
 Urine Crystal analysis

Calcium Phosphate crystals

Uric Acid Crystals Calcium Oxalate crystals Cysteine Crystals
 Urinary crystals
CRYSTAL CAUSE SIGNIFICANCE
Uric acid crystals Hyperuricosuria Renal stones
Acute uric acid nephropathy
Calcium oxalate crystals Hypercalciuria Renal stones
Hyperoxaluria Ethylene glycol intoxication
Calcium phosphate crystals Oral sodium phosphate Renal stones
Laxatives Phosphate nephropathy
Cholesterol crystals Marked proteinuria Nephrotic syndrome
Cystine crystals Cystinuria Renal stones
Crystals due to medications Drug overdose Obstructive uropathy
Sulfonamides, amoxicillin, In the setting of ATN due to precipitation of
ciprofloxacin, acyclovir, dehydration and/or crystals
indinavir, vitamin C hypoalbuminuria
Nephrotic Syndrome
 Glomerulonephritis

Normal Glomerulus Diffuse mesangial hypercellularity of IgA

Postinfectious GN
Hyperthyroid Eye Disease
Graves’ Dermopathy (pretibial
myxodema)
 Thyroid Acropachy

Thyroid acropachy. This is most marked in the index fingers and thumbs .
Iodine Deficiency Disorders: Goiter
End of Regub Images!

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