General Path - Slide Discussion | FARRE - Pathology Practicals | Dr. Ranjith

0:14 hey guys can you see me hear me hello everyone how are you am I audible am I visible if so say me a hi okay so uh I hope most of you must have completed your theory part of your University exam and I hope you must have done amazingly well so I'm going to have four series for pathology practicals I'm just going to be an extension of the same for everything what you have done so I'll be discussing gentle pathology slides today we have digital slides and also one or two points which is necessary for you to answer the exam that's one second tomorrow we'll have heraty classes the next day the third day we'll be having systemic pathology classes and the last day we'll be having gross specimen right because gross and

1:00 microscop is something which is a part and parcel of every practical exam I am 100% sure you know what is the diagnosis by looking at the label but still let's go and read the right way possible and try to answer a couple of questions I'll ask you since your theory is over I want you to answer few identification points for everything one or two leading questions which might be required to write in the Practical exam for everything right so if everything goes good let's start am I audible if so just give me a comment hi hello good evening okay so the first thing I'm going to just show you an simple slide of fatty liver right okay D I hope you did well for people who have not completed this might definitely help you over the period of time right okay I'm just going to show you the slide of FY liver can you see the faty liver so first thing if

1:47 you're able to see the slide please let me know yes so first question every time when a slide comes is there'll be a question like how did you identify it's a liver biopsy right so for a liver biopsy it's very very simple you have to go to the hexagonal architect and the most important thing in every liver biopsy is you look for this portal Triad the portal Triad and the central ve right so if you look for portal Triad and the central vein that will help us definitely say yes definitely a li biopsy right you can see the artery vein and the B radical here this a perfect portal TR right so once I know it's a portal TR it's undoubtedly for sure it's very very simple for to say it's a l b right if you look at this you have an epithelial lining here this is a portal B radical you have the artery here and you have a collapsible Venus structure here right there'll be more than one n

2:32 in a portal right so now I know it's a liver seed second fat in any place whatever part of the body what's the color of fat come on let's interact you guys know you are the fat end of the entire second year you must have definitely know this answer it is going to be clear in appearance right so if you look at the hepy here first I show you normal hepy then you look at a fat Lev part right this how a normal hepto will be right if you look at this you have a row of an heite then a CID again a row ofite then a cide again Rite then cide right this how normal liver will be normal liver cells will be pinkish in color it may have one or more than one of nuclear right so now if you go to this part in the cytoplasm per se right can you see that there are empty vules empty vacums in the cytoplasm empty

3:18 vacums that's a simplest and easiest description of fatty liver right so now since we know about fatty liver and just going to take few words which might come in an exam causes types there are two types of party liver one we call them microvesicular sosis the other is macro vesicular sosis if the question comes how do I differentiate micro and macro in a hisop right in microvesicular sosis the simplest one is the nucleus will be in the center of the cell in the macrovesicular sosis the nucleus will be pushed towards the corner of the cell if the nucleus in the corner of the cell the entire fat globul push the nucleus to the corner that's how it's macro and micro right so causes of fatty liver can anyone comment on at least one cause of fty liver fatty Li is multiple cause first I wanted to comment on Nash non-alcoholic St htis or nonalcoholic

4:04 fatty level disease nfld then obviously alcohol is one of the important cost if the questions on a pediatric population pediatric population the fatty liver costes PM protein energy malnutrition the qu marasmus where all the peripheral fat will be diverted into the liver that's the cause for Pediatric cause right okay now in the h& in a light microscopy obviously fat will be clear in appearance right definitely in a vaa this will come as a leading question why is fat clear anyone come on come on inter it's fine if you make a mistake it's not at all a problem right so the reason for fat being clear is fat will be cleared away during processing right so fat will be clear because it'll be washed away during processing so when I process the tissue it'll be washed away that's why I always need a frozen section or a no fixator for me to look

4:51 at the fat stains in microscopy right there should be no fixator or only when in a Frozen tissue I'll be able to look at it right so once once you're done and answering all these questions they might ask what are the special stains if you might know regarding fatty change or fatty liver there are two stains I want you to remember one is oil Red O where the fat will be reddish color and we have Sudan black you can call it Sudan black B Sudan black 4 any different thing but Sudan black is more than enough or SBB Sudan black B is a fat stain right so these are few things which might be required from an exam point of view this is what I'm going to do for every slide show the slide a few identification points why it is the normal thing and why it is abnormal and few leading questions which is more than enough for you to sail through the Practical exam right uh since you guys

5:37 are very very very silent audience this is the last day of this year right maybe my uh last day of the lecture here for this year right we'll have one more lecture tomorrow as well so slowly answer keep answering it's completely fine if you're wrong okay so I'm going to show you the next question next slide let's see if you can identify there two slides here both of them are acute inflammation let's go to the first slide I hope it opens I'll give the slide also for you so that you can easily appreciate them right can anyone tell me what organ is this it's a very simple organ if an entire organ is seen in a single slide that's an appendix it's a tubular structure with a lumen with all the lymphoid follicles here that's how an appendix looks fine perfect so if you look at the appendix I'm going to zoom here this is a normal slide or an epithelium of the appendix simple columi below that we have the P

6:24 patches or the lymphoid follicle atics if you know there's only one thing which can be coming in an exam which is acute appendicitis right so now how do I say it's acute appendicitis if your answer is saying that I'm having neutrals in the blood vessel it's not acute appen is in normal blood vessel also have neutr right the only way I can say it is go to the muscle layer this is my epithelium this is my sub mucosa this is muscle right so in this muscle layer if you zoom you will see neutrophils in between the muscle layer this a muscle neutr it's not there in the whistle it's there in the wall of the appenx that's the most important thing for me to call it an acute set is I need neutr are perfect neutr right you can see the bent nuclei right the perfect neutrals in the wall of the appendix then I can definitely call it an acute appendicitis right so

7:11 that's the best way for to call it acute apptis please don't go to blood vessel in blood vessel actually if you can see there's rolling going on in the blood vessel maybe it must have gone outside and must have infiltrated the entire wall of the appendix right okay that's how you're going to see append it is how do you know it's an appendix if you have a luminal structure in a slide right along with that you have the lymphoid follicle right lymphoid follicle tells this is definitely a lymphoid structure your intestinal structure and the entire Lum seen in the single SL has to be an appendicite second how do you know it's an acute appendicitis for me to call it an acute app it is you need neutrophils we'll have the bent nuclear neutrophils neutrophils will be in the wall of the appendix if you have neutrophils in the wall of the appendix that's a classical

7:57 finding for an acute append is f and you might have a leading question on events of a inflammation right okay rining s it's not the diagram I'm just having the slides here okay these are slides here good evening you have the epithelium you have the P patch and here in the wall of the entire appendix you have the neutr then I can fairly enough call it an acute appendic is fine okay perfect so events of acute inflammation can be a leading question you have to talk about margination right you have to talk a little bit about rolling the select and interaction and everything you have to talk about addition the integrant and your I cams and V cams and obviously about diapedesis they might ask you that right some of your colleges might have one more slide for acute inflammation

8:42 right I'm just coating slides from various colleges which students have given me right if I miss something do let me know okay uh Elite unknown Elite being right so see you soon after couple of years once you come to second year we'll learn about this fine okay now this is a simple slide of a lung biopsy how do I say it's lung if you zoom in you can see a beautiful alv here right actually it's not a normal alv obviously it's going to be a simple case of a Bronco pneumonia I'm sure most of your colleges might have this slides right so if you look at this this how the normal Alvi will be an empty space because Normal Al is filled with air right but if you look here can I say this entire Al is filled with neutrophils or inflammatory cells look at them entire Al is filled with

9:27 inflammatory cells right predominantly neuts right so this Alvi will it be breathing they will not be breathing because I have lots of cells here right so this must be most likely consolidate Al they have lots and lots of rbcs as well as wbcs most likely a stage of red hepatization if I'm right right but we have to look at the gross to answer it but this is how acute Bronco pneumonia looks like the entire Ali filled with neutrals right okay all the very best can anyone tell me any one organism which causes acute bronconeumonia right so second slide what we saw was an acute case of an Bronco pneumonia I cannot call it an acute Bronco or lobar because Bronco and lar are both based on your gross architecture I can just say that acute pneumonia right identification points to

10:12 say it's a normal lung I go for the Alvi second the entire Alvi will be filled with wbcs okay if it's filled with wbcs I can definitely say it's an acute Bronco pneumonia the other one is in chronic pneumonia the intertial pneumonia where the lympo will be then the interum here the alv is wbcs and predominant of them are neutrophils so I can definitely call it an acute Bronco pneumonia right CSA can cause stepto Cocos can cause stus can cause there are multiple acute BAC ponia causes I'm sure you must be aware of right so two slides for acute inflammation acute appendicitis and acute Bron pneumonia fine perfect let's go to next one it's a very simple slide this slide at least I want you to answer without looking at the label right okay let's go to the slide let's have a look at it

10:59 it's a lymph node right it's a lymph node here look at the lymph node can anyone tell me what structure is this you should not miss the structure right it's a beautiful beautiful granuloma in the center of the granuloma in this part exactly I'm having completely pink color right so this is the cous necrosis and if you can carefully look at this these are the elongated cells little bit of elongated maybe looking like a slipper shaped nuclear the epitheloid macro figures and the entire structure is in granum right definitely there'll be Jan cells we have to just scod for someone let's see if I can find any Jan cell here can I call this a Jan cell I'm having 1 2 3 4 five nuclear here that's a Jan cell right so that's a classical case of an necrotising or non

11:45 necrotising great necrotising not necrotising look at this that's a classical case of one necrotising right necrotising see there'll be non- necrotising Gros also in the same image but here predominantly I'm having necrotic areas in the center that's a classical case of a necrotising granuloma right so a necrotising granuloma in a lymph node what's your diagnosis it has to be tuberculosis that's all right so it's a classical case of a necrotizing groma so my first thought process TB lymphadenitis that's going to be my first thought process how do I say it's a lymph node the capsule is there the architecture is there that's what says a lymph node or the history will have a lymph node biopsy right cause of necrotising RMA the first and the foremost thing is tuberculosis otherwise very rarely I can have

12:30 histoplasmosis causing it right the principle cell of granuloma like sh said the modified macres or the M1 activated macres or then epitheloid macres right that's the principles of the granuloma there are two inter lucans which are very very important granuloma can anyone tell me what are those inter lucans there are two very important inter lucans which you have to learn with respect to a granula formation right one is interferon gamma interferon gamma helps the conversion of a normal macrofit to an M1 activated macro then interlukin 12 interin 12 converts T cells into th1 subtype because th1 subtype is the one which secretes interon gamma again helps in the formation of the granuloma right there might be two extra questions they might

13:17 ask you if you answer everything right right I just want you to tell me one answer I'll ask a leading question to the answer when you examine a patient of tuberculous lymphadenitis what's the characteristic of appearance of the TB lymph node the very characteristic appearance in case of a TB lymph node what is that is it like rubbery is it like mat what do you call it TB lymph has this characteristic finding come on guys you answer you can answer you know the answer please open the mode it's completely fine to make a mistake here it is mat lymph nodes right so mat lymph nodes is a characteristic finding of a TB lymphadenitis where all the lymph nodes will be merge together that's matter lyos right so why there's a matter lymphosis TB lymphadenitis does not involve the substance of the lymph node also TB also will have something an

14:05 periadenitis let's see if I we have the pertis in the slide which means this is the lymph node surrounding the lymph node also inflammation spreads that's why two three lymph nodes joins together and gives the mattered appearance right let's go to the slide if possible if we are able to appreciate the period in this let's see right okay let's go here see actually is are two lyph nodes this one this is the second one right so if you zoom in here if you zoom in here I have a little bit of capsule here but outside the capsule also I'm having inflammation same way I'm having a little bit of capsule here there's Gap very different Gap there's an inflammation this inflammation outside the capsule is what is causing the lymphadenitis right or the periadenitis again here see here is a capsule right

14:50 capsule is a capsule but when you go here little bit outside the capsule also inflammat cells are very well seen right so perintis is a very classical feature of tuberculous lympus that's the reason you have the matter lymph no this might come in a especially if you answer everything correctly right okay next amid Amo is a classical finding Amo is nothing but a is it starch or is it protein what does your take what's Amo they are perfect they are beta PL sheets okay they beta PL sheets non- branching beta PL sheets they are obviously proteins right good evening okay they obviously beta Che what will be the color of Amon and microscopy obviously in the normal light microscopy amod will be pink in color right I'm going to show you this classical case of amod I'm not sure what slide they showed you in your

15:37 college but I'm having a simple superb case of liver hepatic amod dois okay let's look at this generally amod gets deposit in and around the brick sorry in and around the vessels right amazing right it'll be deposited in and around the blood vessels right so if it get deposited in and around the blood vessels this is a beautiful case of a liver and classically see you have the hepto sites here the heyes here heyes in between the heyes we generally had cids here entire cuso of the liver is pink in color because it is per vascular the space of Dy the entire sinos is becoming pink in color all these extell asell deposits are nothing but amid here right so since it's pink in color most of the proteins are many

16:23 things are pinky color there are multiple subtypes a Al these subtypes alone at least please don't forget a for chronic inflammation Al for your multiple Mal related you if you answer well they might ask a beta beta2m microbin at and specific of your med cosmid and others right these are few things which I don't want you to forget stain there are multiple stains can anyone name at least one stain the common stain this is must know Conor is must know in addition to that you can answer thylin is a stain it's a protein pH will definitely be positive right Crystal Viet will be positive these are all stains used there are many many more stains as well that's not relevant in current break practice right for practice for me it's congored and

17:09 congored in a polarizing microscopy that will definitely be a leading question you have your apple green bence right when apple green bence it's a concept of light that's all right am is pink extra depos of protein surrounding the blood vessels abdomen fat of P of fat bioy is preferred because I have lots and lots of capillaries right types stains that's all okay next fat necrosis okay necrosis anywhere in the body what will be the color pink or blue necros will be pink in color necrotic tissue fat will be clear in appearance right so necroses we divide them into fat necros we divide them into traumatic and enzimatic traumatic fat necrosis happens in any fatter structure

17:54 like blast paren or the Glu region whenever you had trauma enzimatic fat necrosis happens in momentum and the peripancreatic fat in case of an acute pancreatitis right perfect now let's look at the slide okay fat necrosis also in microscopy will look pink in color only right see this is an momental biopsy okay can I call this fat adpost tissue definitely a simple normal adpost tisue this is how tisue looks like right now if you go a little bit higher up look at this I do have good amount of adipose tissue here but if you carefully look these places also must have been adipose tissue but it's been destroyed the trigly has been converted to free fatty acid and it's become pink in color right I'm just going to zoom out here all these pink areas here are nothing

18:41 but necrotic fat and all the clear areas in between the necrotic fat are still live tissue fat necrosis in microscopy also looks pink in color only it will not be clear in right the reason for pink color in case of fat necrosis the triglycerides and the fat will be converted to free fatty acid and that will obviously change the color from clear to Pink it will not be washed away it gives a pink appearance in microscopy obviously it be pink in color only that's a classical finding case of f fat necrosis can this fat necrosis give St to calcification that might be leading point because Robins talks about that and people want to hear this name somehow saponification right you will never forget this right soap formation calcium salt formation happens only in fat or every necrosis every chronic

19:26 necros happens especially in fat necrosis happens that's all fine okay next lipo fion okay first let's look at the theory part then we'll go to slide here just for a change what will be the color of lipop fion in a microscopy pink blue brown black brown okay when I say brown I know for a fact melanin is brown hos is brown there's one classical location of liposan which helps me to identify liosion what's the location is it perinuclear is it throughout the cell is it per membranas it is perinuclear a perinuclear brown pigment in an elderly person is generally a clue there are few places where lipop can be very commonly seen as heart liver

20:11 pancreas it can be seen in many many many tissues right cardiac muscle or any straighten muscle liver pancreas you can have it right yes SAR the calcification look blue in microscopy but the necros will obviously be big pink in microscopy right and as seen in any old age person young person also can have Li potion but generally in an exam old is age is the most important criteria for us to pick up li potion right this is a cardiac biopsy you look at the slide it's actually a postmortem cardiac biopsy just store for us to look at lipop okay let's Zoom can you guys see the liposan it's much better than the image what you saw on Robins right so many liposan perinuclear perinuclear perinuclear right

20:57 perinuclear okay okay has a classical perinuclear deposit right all these look at this look at this look at this perinuclear perinuclear right golden brown pigment a brown pigment perinuclear in location in an elderly heart which made it call as brown atrophy of heart and everything might be relevant from a VI point of question right it can the reason for lipo pigment is it's a pigment of cells aging it's also called as an we and tar pigment right it can be seen at the end of acute inflammation it's nothing but an injured cell where all the broken particle being just being contained back and the reason for lipo they nothing but autoag related autoptic losal remnance that's all right

21:43 autoag reason primar for Lipan Gran right so you know about lipovan as well okay let's go to a simple normal coagulated necrosis okay how do you identify necrosis coagulative necrosis one main difference between coagulative and leifa necrosis will it retain the architecture or there'll be no retained architecture coagulator will definitely have retained architecture right so coagulator the cros obviously first thing it'll be pink in color second thing I can say there'll be retained architecture of these cells okay if you have retained architecture or the ghost cells present right I can definitely call it an coag necrosis causes you know the answer by now right any solid organ in

22:30 fact any solid organ Ina will have coag necos can be cardiac can be kidney can be spleen anything any solid organ have in fact be coagul necrosis the mechanism of action of coagul necrosis is protein degradation as a main mechanism of action of necrosis okay now let's look at a slide this is the most likely slide you must have also got in your college but I'm not sure what they kept for C necrosis can you guys tell what was the slide which is kept for c necros for you okay it's open first tell me what tissue is this if you tell me what tissue is this then let's go to krosis what tissue is this what tissue is this that's a classical glomi tubule

23:16 right so this glom and tubule it is live Perfect Right GL tubule kidney because I can see the nucleus it is definitely live here right now let's go a little bit ahead let's go see this a beautiful area can I say this part is more pink definitely gone necrotic this part is light this part is pink let's go to the pink area is it retain cellular architecture definitely these are tubules but they are dead because it's completely pink in color pink in color retain cellular architecture I can definitely call it an coagulative necros right let's look at few of the necros GL if they are anything there look at this necros GL it's perfectly GL architecture is perfectly retain but there no cellular no cells at all no live tissue at all

24:01 that's a classical retain cellular architecture right so this entire part is necrotic if you go here we do have the life tissues here right it's necrotic and life tissue that's a classical case of an coagul necrosis right lcaor necrosis I cannot see this difference the entire architecture will be gone the mechanism of action is definitely an enzyme activation your brain infact absess formation anything with suppuration you'll have likea necroses fine okay then Chester loses identification points first it's a chronic condition in the gallbladder it's chronic gallbladder in infection or cholesterol or chronic kritis so here what I have is in the lamina proper of the galbladder I have lots of macres filled with cholesterol crystals cholesterol be clear in

24:46 appearance right lots of fat ladden macres they have lots of fat lad macres that's a classical finding for cholesterosis and in Gross can anyone tell me what's the name given for cholesterosis in Ross or a nak I want you guys to comment we look at the slide and let's come back to this here okay so how to say a g the mucosa the mucosa the wavy mucosa and not much of a thick wall and lots of pereral fat tells is a clear galbladder right and now let's go here the space immediately below the mucosa is your lamina propria right so in this this the mucosa here or the epithelium here below the epithelium have laminaria the entire Lino proprias filled with fat lad and mcroof fases or cholesterol lad and macrophases right so

25:33 the easiest way to differentiate cholesterol was is fat or triglyceride cholesterol will not be as clear as your fat it'll be like kind of bubbly it's this is how cholesterol looks right we saw fatty liver there is a completely clean we are the fat necrosis is completely clean cholesterol have little bit of tiny tiny tiny bubbles they're also clear but tiny tiny bubbles these are all cholesterol lad macroides and this gives in Gross ELO in color the red mucosa gives the appearance of strawberry gallbladder right look at this this is also lamino propria this is also lamino propria maybe not much of them here here again there a lamino propria full of cholesterol Laden macrophases right okay that's how cholesterol looks like it's also an accumulation of the fat okay in Gross you have a classical appearance of an strawberry gallbladder the yellow color

26:19 for the fat and the red color for the classical G bladder appearance okay great perfect next CVC liver first let tell me what the gross finding here we'll definitely look at the microscopic findings all of the whatever we you have read will definitely be seen in the slide gross you have the classical nutmeg liver CVC liver can also be called as called as cardiac sosis great Luffy op Luffy Luffy Luffy is a cartoon character right great great so cardiac sosis fine so cardiacos is the other name for it nutmeg liver is the finding is seen in Gross how do I identify in microscopies your fatty liver or sorry CVC liver or chronic winess of the liver

27:06 will definitely have congestion surrounding the third part third zone of the liver which is centry lobula right so here you have centry lobular hemorragic necrosis so centry lobular hemic crosis especially in the Zone 3 is classical for an CBC liver or chronic venness of the liver right causes anything above when you have a problem with the heart right heart failure most common cause of right heart failure is left heart failure any heart failure the back pressure kind of goes through the IVC goes to the hepatic ve goes to the central veight and comes and destroys the crya crya is nothing but surrounding the central vein of the liver right okay so it's hemorragic necros so you'll have hemorrage as well

27:52 as necrosis n liver reason is that the normal thing gives An Tan appearance of the liver and the hemorragic area will have reddish appearance in the liver so it has an alternate tan and reddish area which looks like an right let's see if we can find all the classical findings in this slide okay it's a Lev biopsy again how do I say it's a Lev biopsy I have to go to this guy the portal Trad right if you look at this there's a beautiful portal Trad here B radical compressed vein maybe an artery here right that's a portal TR and whatever see next to the portal is Zone one Zone one is relatively normal zone two is decent but when it come to zone three look at the amount of hemorrage here completely hemorrhagic right entire are is completely hemorragic so everywhere

28:38 portal TR again a portal TR a beautiful Port The Zone one zone 2 is normal Zone 3 is gone again a portal R zone one zone two is normal Zone 3 is gone right and here you can see a classical dilated Central let's Zoom this here A Central ve and lots of hemorrhage here and also the entire liver cells also dead right Hemorrhage death hemorragic necrosis goes to zone two it's decent goes to Zone one it might even look normal and your portal Dr right so that's a classical case of hemorragic necrosis or a CBC liver chronic weenus of the liver portal surrounding the area will be normal little bit far away from the P again hemorragic necr again hemorragic necr if you zoom out if you can imagine if you zoom out all these red red red areas will look the gives the nutmeg

29:24 appearance red pale red pale gives the classical nut make appearance or CVC liver right okay great thrombus thrombus I'm not sure if they have sh you or will they show you in exam but it's a very classical finding which you have to see how do I say it's a thrombus this can come in an exam how do I say it's a thrombus and not an embolus because more both of them has more or less the same appearance right so first let's look at the image and then let's come to the classical findings here it's a blood vessel classical blood vessel you can see though I am not able to differentiate intima media Advanta but this is a wall of the blood vessel right so now the most important characteristic feature for me to call it a thrombosis it has to be attached to the blood vessel wall embolus is moving

30:13 they will not be attached to the blood vessel wall if it's attached to the wall of the blood vessel it is a thrombus if it's moving it's an embolus okay that's the most classical finding here and if you look at this place can actually look at the I'm not sure it's not very well defined but definitely a redish area a pale area a redish area a pale area what is this colors maybe we'll look at the other area if it's much better maybe a decently better one right reddish pale reddish pale what are these lines colors we call them a lines of Z perfect sat right if you have the point of attachment to the blood vessel I can definitely call it a thrombus if it's not attached if it's floating I'm going to call it an embas these are the classical lines of zand please do remember

30:58 lines of Zan is seen both in arterial and Venus it'll be less evident in Venus but both of them will have lines of Zan present means it's an antim motm thrombus which means the blood is flowing when when the blood flows I can see the altering areas right the red areas here are the rbcs the pale areas here is the platelet and fibrin the platelet and fibrin the rbcs which is going form the L lines of Zan the lines of Zan grossly also has a different architecture different color because of that it's called an Coraline thrombus thrombus name Coraline thrombus it looks like a coral right it altering color it's called Coraline thrombus and that's the microscopic equivalent of

31:44 lines of right so identification the most important thing like Sak said the point of attachment to the vessel the biggest difference between a thrombus and embis is embas will not be attached to the blood vessel and thrombus obviously be attached to the blood vessel you might have EMAs of your fat embolism or an amniotic fluid embolism you might have cases I don't have a slide of fat or am flid embolism but this is how a thrombus looks like f okay just a simple finding in the same slide of thrombus I'm going to zoom into a different area that's all look at this area what is this anyone sorry what is this blackish pigment in a lymph node right

32:32 this is a perihilar lymph node this actually the pollary artery if you can look at this the cartilage and maybe the overl epithelium mucus this might be the bronal area and this is your pulmonary artery thrus and this your hlar lymph node a hilar lymph node having a black color it's a classical like sun said it's a carbon particle it's a classical carbon particle classical case of anthracosis right anthracosis the one place where in microscope you have black color is anthracosis it can be seen both in the lung as well as in the high L node it'll be completely black actually what is seen in microscope is black color pigment in the macro fases in worst cases it can also be seen in inia but most of the time it will

33:18 start with black color pigment in the macres that's a classical appearance of anthrose right antho B is classical and anthros is not an occupational lung disease there's a of cold workers neocis anthros you and me everyone can have have like anyone who's living in an urban area can have anyone who smok tobacco can have then they have simple cold workers neocon pneumoconiosis and we have complicated coal workers neosis those are the complications of the occupational lung disease this neither of us will have if you're not working in a coal mining industry I might not have this right okay hanga just few more slides I hope hanga also is a part of the in general pathology in the last chapter so I'm including it here okay two things capillary was

34:05 cavness how do I identify in a capillary it'll be very very difficult for you to identify the H structure you have very very very very tiny capillaries these capillaries might not be dilated it'll be almost similar to one granulation tissue granulation tissue and a capillary hanga is very very difficult to identify differentiate if you have an overlying ulcer or an inflammation it's a granan tissue because Gran tissue also have very high capillaries it'll be very similar right cavernas is sp cavernas even a low power you can identify there'll be Lakes of blood vessels there'll be huge areas filled with blood that's how the cavern looks like this Cavern is water you need not want anyone to say it's a cavern

34:52 look it's a low power image that's beautiful kava right superbly dilated vessels vascular spaces filled with blood little bit of in between intervening thick SEPTA all are classical of Anima you can see them in the skin subc liver anywhere right capillary on the other hand might be a bit difficult okay so here there are few dilated spaces here just because there are few dilated spaces don't call it cavernous the most important thing is in this part if I zoom in here zoom in here all these tiny tiny gaps all these are individual capillaries this how dense capillary hanga will be it might be like I said bit difficult to identify here one thing which comes handy is the slide number right look at the slide number because cap H is bit difficult these are

35:39 all all these empty space can you see the RPS here all the are direct cap right that's how cap Hama look but cavernas like I said is a spotter you cannot miss a Cav Hama cap Hama is bit difficult to identify so please please be careful about it okay leprosy the last slide here did they show leprosy slide for you in your college we have two different types of leprosy here one is your tuberculid leprosy tuberculosis like where the immunity is good right and we have leoas type of leprosy in lepomas type of leprosy the cell mediated immunity is poor in a tubercul leprosy it will form granulomas mostly non necrotising Gras especially

36:24 in on the NES you can have necrosis otherwise non necrotising Gras right in lepomas leprosy what I'll have is I'll have sheets of histiocytes histiocytes are the other name for macres filled with lepra light that's how that's how it looks in lepro lepry okay they not sh great Let's ignore it it was there in the nmc curriculum so I took it okay so if you look at this this is skin biopsy that all these things are macroides these are all macroides right classical macroides here classical macroides here one important finding is if they have shown you the slide which can easily appreciate here is the maccrage here never touches the epidermis the maccrage here the clusters of maccrage never will touch the epidermis this area is called as gzone gzone is area where the macras

37:11 or the Infectious organism will not go and touch the epidermis it will be totally different from the epidermis it's in the dermal space only and this space is called in gr Zone and these are the sheets of macroides with lepra right just since we are leprosy I'll add few more findings there's a stain fight faracos stain fight faracos stain is kind of an acid Bas stain which is done for lepra Bas in case of a biopsy right that's all with with regards to leine so we have seen quite a few slides here I think around 13 14 slides fatty liver we saw acute inflammation we had two slides uptis and Bronco pneumonia granulomas a perfect TB granuloma and also blood about tuberclosis amid a liver amidis fat necros simple normal momentum lipop

37:57 of cardiac tissue coagul necrosis of the acute tubular necros of the kidney Chester of gallbladder CVC liver a very classical slight thrombus of a pulmonary artery in the same image we also had an anotic lymph node we saw two types of Hanta cap and cavas and we ended with lepomas Leprosy right I'll share this PDF in the insta Channel or the PW telegram group this will also have the slides just whenever it's possible just have a quick go through of it right tomorrow's class I'll take same way little bit of cases from hematology the third day we'll have little bit of cases from systemic methology right it'll be great if you guys can ping me what are slides which comes in h syic path so I'll just concentrate on that alot right thank you Shina thank you SAR all the very best for practicals okay see you soon