MULTINUCLEATED CELLS

1.PAGET'S -> MULTINUCLEATED OSTEOCLASTS

2. giant cell tumors of bone
3. aneurysmal bone cyst
4. HSV ESOPHAGITIS -> squamous epithelial cells exhibit multinucleation and prominent
intranuclear inclusions
5. Neonatal hepatitis may be due to infection (cytomegalovirus, viral hepatitis B, rubella) or
unknown causes

GIANT CELLS
1. Urate crystals surrounded by infiltrates of lymphocytes, macrophages, and foreign body
giant cells
2. giant cell tumor of bone ( Lytic on X-Ray0
3. fat necrosis of the breast + foreign body giant cells
4. Temporal arteritis
5. Pott's disease of the vertebrae -> Langhans giant cell (TB)
6. Coccioides immitis -> Meninges : granulomatous with epithelioid cells and caseous necrosis
and a giant cell containing an organism. A couple of spherules of C. immitis are present in the
giant cell in the center. The spherule contains endospores. In the United States, C. immitis is
endemic to the southwest.

7. Reuhmatic carditis -> Aschoff giant cell

8. Foreign body giant cells -> This is subacute granulomatous thyroiditis (DeQuervain's
disease), which probably follows a viral infection and leads to a painful enlarged thyroid
9. Sarcomas, including leiomyosarcomas, often have very large bizarre giant cells along with
the spindle cells.
10. Crohn's disease is demonstrated here with epithelioid cells, giant cells, and many
lymphocytes
11. RSV -> Scattered giant cells with a scant mononuclear interstitial infiltrate are seen
12. Seen here is the major differential diagnosis of biliary atresia: this is neonatal giant cell
hepatitis.
13. Exogenous lipid pneumonia -> foreign body giant cells.
14. Aspirated content -> Foreign body giant cells
15.HIV -> Giant cells in the brain
16.Seminoma -> Giant cells
17.Measles -> Giant cells in the Lung
18.Giant cell granuloma of gingival. (Δ) Brown-tumors of Hyperparathyreoidism.

INCLUSIONS
1. Molloscum contagiosum -> lesion appears cup-shaped, with central "molluscum
bodies" which are the homogenous pink inclusions
2. Negri bodies (Rabies)
3. Spironolactone -> adrenal cortex -> The small eosinophilic laminated inclusions seen
by H&E are whorls of endoplasmic reticulum by electron microscopy and represent
spironolactone bodies.
4. HSV esophagitis  Microscopically, the squamous epithelial cells exhibit
multinucleation and prominent intranuclear inclusions. At high magnification, the
squamous mucosa at the margin of the herpetic ulcer shows pale pink "ground glass"
 inclusions within squamous epithelial cells. Some of the inclusions are clustered
together-- multinucleation is another common viral cytopathic effect.
5. Epidermal inclusion cysts in Gardner’s syndrome. (+POLYPOSIS-dominant/ osteomas
of the skull / 100%  Adenocarcinoma)
6. Howell-Jolly bodies, or inclusions of nuclear chromatin remnants (IN RBC)  Indication
of ABSENT SPLEEN.
7. CMV  inclusions (also in adrenal cortex in immunocompromised). Note the very large
cells that have large violet intranuclear inclusions with a small clear halo. / large CMV
inclusions in the renal tubular epithelium. /
8. Parvovirus, or "fifth disease" is a self-limited infection that can produce a "slapped
cheek" appearance of a rash in children, and often goes unnoticed in adults. The pink
intranuclear inclusions in the erythroid precursors seen here are
characteristic for parvovirus infection.
9. Mauve to pink homogenous intranuclear inclusions in the epithelial cells of the
epidermis. This is typical for Herpes simplex virus (HSV) infection.
10. The pink, rounded intracytoplasmic inclusion in the giant cell of the inset at the
upper right is typically seen with respiratory syncytial virus (RSV).
11. Placental villitis seen here is accompanied by a couple of enlarged cells with
mauve intranuclear inclusions typical for congenital cytomegalovirus infection. Such
inclusions may be difficult to find, and the inflammation can be focal, with
lymphocytes, plasma cells, and occasional neutrophils.
12. She has findings that suggest nemaline rod myopathy, one of several types
of congenital myopathy, some of which can be non-progressive. There are a variety of
inheritance patterns  Intracytoplasmic inclusions
13. Electron microscopy  Adrenoleukodystrophy : Adrenoleukodystrophy, adrenal
gland, with long parallel inclusions of long chain fatty acids.
14. CMV pneumonia / CMV inclusions in Liver. CMV can often be disseminated and
involve a variety of organs, though the degree of organ failure from such involvement
varies greatly
15. Dementia with Lewy bodies is a clinicopathological syndrome that may
account for up to 20% of all cases of dementia in older patients. Lewy bodies
are spherical, intraneuronal, cytoplasmic, eosinophilic inclusions comprising
abnormally truncated and phosphorylated intermediate neurofilament proteins, alpha-
synuclein, ubiquitin, and associated enzymes. Alpha-synuclein can also be found in
another neurodegenerative disease known as multiple system atrophy.
16. Pick's Disease. This is an uncommon cause for dementia, but it appear similar
to Alzheimer's disease. About 90% of cases are sporadic and the rest familial. The
cerebral atrophy with Pick's disease is lobar and typically involves the frontal and
temporal lobes. This atrophy is so striking that it is "knife-like" in appearance. This
atrophy may be asymmetrical. Microscopically, there is marked loss of cortical neurons
with gliosis. Pick bodies, cytoplasmic inclusions that are highlighted by silver
stain, are seen in the cortex.
17. Multiple system atrophy (MSA) has features that overlap striatonigral
degeneration, olivopontocerebellar atrophy, and Shy-Drager syndrome. Most patients
with MSA exhibit symptoms similar to Parkinson's disease. MSA is characterized
microscopically by the appearance of glial cytoplasmic inclusions.