Important Pathological Stigmata

DISEASE	TYPICAL PATHOLOGICAL CHANGES
Gastroenterology
Barrett’s esophagus	Lower esophageal epithelium undergoes metaplasia to become gastric or intestinal-type epithelium
Coeliac disease	Total or subtotal villous atrophy in the small bowel Crypt hyperplasia with inflammatory cells in the mucosa
Crohn’s disease	Can affect any part of the gastrointestinal tract Macroscopically: skip lesions (ie lengths of normal bowel between diseased segments); cobblestone appearance with fissured ulcers Microscopically: thickened wall with trans-mural inflammation; granulomas
Ulcerative colitis	Affects large bowel only Affects mucosa and sub-mucosa only Crypt abscesses and superficial ulcers
Chronic cholecystitis	Chronic inflammatory changes Rokitansky–Aschoff sinuses
Hepatology
Acute viral hepatitis	Swelling of hepatocytes with spotty necrosis Councilman bodies
Alcoholic hepatitis	Fatty accumulation in cytoplasmic vacuoles, necrosis, Mallory hyaline material
Chronic active hepatitis	Piecemeal necrosis
Autoimmune hepatitis	Interface hepatitis, portal plasma cell infiltration
Hemochromatosis	Excessive hepatic iron (shows up blue on Perl’s stain)
Primary biliary cirrhosis	Portal hepatitis and granulomatous destruction of bile ducts. Later, periportal hepatitis and bile duct proliferation
Liver cirrhosis	Macroscopically: macro-nodular or micro-nodular Microscopically: fibrous tissue (shows up red on von Gieson stain)
Respiratory
Diffuse alveolar damage (DAD) which can lead to adult respiratory distress syndrome (ARDS)	Alveolar hyaline membranes and thickened alveolar walls
Previous asbestos exposure	Asbestos bodies in lung
Pulmonary fibrosis	Proliferation of type II pneumocytes with thickening of the alveolar walls
Nephrology
Malignant hypertension	Renal arteriole fibrinoid necrosis
Diabetic glomerulosclerosis	Kimmelstiel–Wilson nodules, thickened capillary basement membranes with hyalinisation of arterioles
Hematology
Hodgkin’s disease	Reed–Sternberg cells Abnormal lymph node architecture Nodular sclerosing type has fibrous tissue
Myelofibrosis	Bone marrow fibrosis secondary to fibroblast proliferation
Multiple myeloma	Plasma cell proliferation in bone marrow
Rheumatology
Temporal arteritis	Temporal artery biopsy may be normal Alternatively, plasma cells, lymphocytes and multinucleate giant cells can be present
Polymyositis	Muscle fiber necrosis Lymphocyte infiltration
Endocrinology
Pituitary tumors	Acromegaly is associated with acidophil macro-adenomas (somatotroph adenomas) Hyperprolactinaemia is associated with chromophobe adenomas ACTH excess is associated with basophil micro-adenomas (corticotroph adenomas)
Neurology
Alzheimer’s disease	Macroscopically: thinning of gyri Microscopically: neurofibrillary tangles; plaques
Parkinson’s disease and dementia with Lewy bodies	Lewy bodies (inclusions inside neurons)
Obstetrics and gynecology
Ovarian endometriosis	Macroscopically: chocolate cyst