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Bone Marrow

Biopsy Procedure and Processing of Specimen Trephine biopsy of the bone marrow has wide application in clinical medicine; its greatest utility is in the evaluation of patients with malignant lymphoma, acute leukemias, myeloproliferative neoplasms (MPNs), myelodysplastic syndromes (MDSs), metastatic tumor, granulomatous disorders, myelofibrosis, aplastic anemia, and plasma cell dyscrasias. It also serves as the most reliable method for assessing marrow cellularity following the administration of antineoplastic…

Spleen

Normal Anatomy The normal spleen serves as a lymphoid organ as well as a filtering organ. While fetal hematopoiesis occurs in the spleen, the spleen is not normally a hematopoietic organ after birth but may contain evidence of extramedullary hematopoiesis in a variety of settings. The splenic architecture largely reflects its functions. The splenic white pulp (or malpighian corpuscles) and the periarterial lymphoid sheaths constitute the…

Lymph Nodes

Normal Anatomy The lymph node is one of the major anatomic components of the immune system. The three major regions of a lymph node are the cortex , paracortex , and medulla ( Fig. 37.1A ). The cortex is situated beneath the capsule and represents the compartment where most lymphoid follicles reside and is composed of primarily B lymphocytes and follicular dendritic cells. The medulla, close…

Breast

Normal Anatomy The breast or mammary gland is covered by skin and subcutaneous tissue and rests on the pectoralis muscle, from which it is separated by a fascial layer. The morphofunctional unit of the breast is a complex branching structure that is topographically arranged into lobes and which is made up of two major components: the terminal duct–lobular unit (TDLU) and the large duct system .…

Ovary

Normal Anatomy The ovaries are paired pelvic organs located on the sides of the uterus close to the lateral pelvic wall, behind the broad ligament and anterior to the rectum. They are connected to the broad ligament by the mesovarium (a double fold of peritoneum), to the uterine cornu by the ovarian (or utero-ovarian) ligament, and to the lateral pelvic wall by the infundibulopelvic (or suspensory)…

Fallopian Tube

Normal Anatomy The fallopian tube or salpinx is a tubular hollow structure measuring 11–12 cm in length that runs throughout the apex of the broad ligament and spans the distance between the uterine cornus and the ovary. It is divided into four segments: intramural (inside the uterine wall), isthmus (2–3 cm, thick-walled), ampulla (a thin-walled expanded area), and infundibulum (a trumpet-shaped ending that opens into the peritoneal cavity…

Uterus: Corpus

Normal Anatomy The adult nulliparous uterus is a hollow, pear-shaped organ that weighs 40–80 g and measures 7–8 cm along its longest axis. It is divided into the cervix (discussed in Chapter 32 ) and the corpus . The portion of the corpus cephalad to a line connecting the insertion of the fallopian tubes is the fundus . The two lateral regions of the fundus associated with the…

Uterus: Cervix

Normal Anatomy The cervix is the lower portion of the uterus which connects this organ to the vagina through the endocervical canal. It is divided into a portion that protrudes into the vagina (portio vaginalis) and one that lies above the vaginal vault (supravaginal portion) . The outer surface of the portio vaginalis is known as the exocervix or ectocervix, and the portion related to the…

Vagina

Normal Anatomy The vagina is a tubular structure derived from the paired müllerian ducts that extend from the vestibule of the vulva to the uterus. It is composed of three main layers: mucosa, muscularis, and adventitia. The mucosa is composed of stratified squamous epithelium resting on loose connective tissue stroma. The squamous epithelium is responsive to steroid hormones, its appearance depending on the age of the…

Vulva

Normal Anatomy The vulva is composed of the following anatomic structures: mons pubis, clitoris, labia minora, labia majora, vulvar vestibule and vestibulovaginal bulbs, urethral meatus, hymen, Bartholin and Skene glands and ducts, and vaginal introitus. The labia majora are lined by keratinized skin containing all the cutaneous adnexa: hair follicles, sebaceous glands, apocrine glands, and sweat (eccrine) glands. The labia minora are covered by nonkeratinized stratified…

Adrenal Gland and Other Paraganglia

Normal Anatomy Adrenal Gland The adrenal gland is a composite of two endocrine organs, one mesodermally derived (cortex) and the other neuroectodermally derived (medulla). The function of the adrenal cortex is to secrete several steroid hormones known as corticosteroids, all of which are produced by a series of complicated enzymatic steps from cholesterol ( Fig. 29.1 ). They are classified into three groups—mineralocorticoids, glucocorticoids, and sex…

Penis and Scrotum

Penis Normal Anatomy The main anatomic components of the penis are the corpus (shaft), glans , and prepuce (foreskin). The corpus is composed of the corpora cavernosa (made up of a net of vascular spaces surrounded by the tunica albuginea) and the inferiorly located corpus spongiosus , in the center of which runs the penile urethra. All of these structures are covered by skin, a smooth…

Testis and Testicular Adnexa

Testis Normal Embryology and Anatomy The growth and development of the human testis can be divided into three major phases: (1) static, from birth to age 4 years; (2) growth, from age 4 to 10 years; and (3) developmental (maturation), from age 10 years to puberty. At birth, the seminiferous tubules are compactly filled with small undifferentiated cuboidal cells. Leydig cells are seen in the newborn…

Prostate and Seminal Vesicles

Prostate Normal Anatomy The prostate is a pear-shaped glandular organ that weighs up to 20 g in the normal adult male and that depends for its differentiation and subsequent growth on androgenic hormones synthesized in the testis, acting through a poorly understood mesenchymal–epithelial interaction. It is most commonly divided into the anterior fibromuscular stroma and three distinct glandular zones as described by McNeal: peripheral zone, transition zone,…

Bladder

Normal Anatomy The bladder is a hollow viscus with the shape of a four-sided inverted pyramid when empty and of a rounded structure when distended. It is divided into the following portions: superior surface (also known as dome , and covered by the pelvic parietal peritoneum), posterior surface (also known as base ), and the two inferolateral surfaces . The trigone is located at the base…

Kidney: Tumors and Tumorlike Conditions

Pediatric Tumors and Tumorlike Conditions Nephroblastic Tumors Wilms Tumor (Nephroblastoma) General Features Wilms tumor is also known as nephroblastoma (currently the preferred term). It constitutes the prototypical example of a neoplastic process that faithfully recapitulates embryogenesis at the morphologic and molecular levels. It is seen primarily in infants, 50% of the cases occurring before the age of 3 years and 90% before the age of 6…

Kidney: Non-Neoplastic Diseases

Renal Biopsy Renal biopsy is an important tool used in the evaluation of patients with renal disease. Utilizing this procedure, it is possible to establish an accurate diagnosis, obtain critical information on the evolution and prognosis of the disease process, and develop a rational approach to the treatment of a renal disorder. Even in advanced stages of kidney damage, a biopsy can provide clues regarding the…

Pancreas and Ampullary Region

Pancreas Normal Anatomy The pancreas forms from two separate buds or anlagen , which later rotate and fuse. The ventral bud, which appears as a part of the developing hepatic duct, forms the posterior and inferior parts of the head and the uncinate process; the larger dorsal bud, which develops from the other side of the foregut and extends into the dorsal mesentery, forms the body,…

Gallbladder and Extrahepatic Bile Ducts

Normal Anatomy The gallbladder is a pear-shaped sac that lies in a shallow depression on the inferior surface of the right hepatic lobe. In the adult, it measures up to 10 cm in length and 3–4 cm in width, and the normal wall thickness is 1–2 mm. The free surface is covered by serosa that is continuous with that on the hepatic surface, and the subserosal connective tissue of…

Liver: Tumors and Tumorlike Conditions

Hepatic Tumors and Tumorlike Conditions Surgical pathologists encounter a wide variety of nodules and tumors of hepatic origin, including both neoplastic and non-neoplastic lesions. Distinguishing between them can be challenging, but the distinction is critically important given the differing prognostic and therapeutic implications. Therefore, pathologists must understand the diagnostic criteria of these entities as well as the pitfalls inherent in interpreting small samples, such as core…