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ITE > 2024 Spring ITE > Flashcards

2024 Spring ITE Flashcards

1
Q

List five subtypes of myeloproliferative neoplasms according to the 5th edition of WHO

A
  1. Chronic myeloid leukemia (CML)
  2. Polycythemia vera (PV)
  3. Essential thrombocythemia (ET)
  4. Primary myelofibrosis (PMF)
  5. Chronic neutrophilic leukemia (CNL)
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1
Q

List the three broad, major categories of myeloid neoplasms.

A
  1. Myeloproliferative neoplasms
  2. Myelodysplastic neoplasms
  3. Myelodysplastic/myeloproliferative neoplasms
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2
Q

List one genetic abnormality seen in acute myeloid leukemia with defining genetic abnormalities.

A

AML with RUNX1::RUNX1T1 fusion
AML with BCR::ABL1 fusion

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3
Q

List two most common anatomical sites involved by extramedullary hematopoiesis in primary myelofibrosis

A

Spleen
Liver

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4
Q

List two clinicopathologic variants of Langerhans cell histiocytosis (LCH).

A

Single-system LCH
Multisystem LCH

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5
Q

Subtypes of LCH

A

Eosinophilic granuloma
Letterer-Siwe disease
Hand-Schuller-Christian disease

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6
Q

Most common genetic alteration seen in LCH

A

BRAF V600E mutation

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7
Q

Other entities with BRAF V600E mutation

A

Melanoma
Papillary thyroid carcinoma
Anaplastic thyroid carcinoma
Papillary craniopharyngioma
Sessile serrated lesion
Borderline serous ovarian tumor
Hairy cell leukemia
Erdheim-Chester disease
Ameloblastoma
Metanephric adenoma

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8
Q

List three specific immunostains used for diagnosis of LCH

A

S100
CD1a
Langerin (CD207)

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9
Q

List one specific finding of LCH on electron microscopy

A

Birbeck granules

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10
Q

What is the characteristic clinical finding in IgA nephropathy?

A

Recurrent hematuria

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11
Q

What is the specific finding on immunofluorescence in IgA nephropathy?

A

Mesangial deposition of IgA antibodies within the glomeruli

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12
Q

List three histologic findings that can be seen in IgA nephropathy

A

Mesangial hypercellularity
Focal segmental endocapillary hypercellularity
Crescents
Tubular atrophy/interstitial fibrosis
Segmental sclerosis

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13
Q

What related (to IgA nephropathy) 1) clinical syndrome can occur in the pediatric population, and what 2) three extrarenal symptoms can be seen in these patients?

A

Henoch Schonlein Purpura (IgA vasculitis)

Palpable purpura
lower extremity arthralgia
abdominal pain/GI bleeding

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14
Q

List four risk factors for development of urothelial carcinoma

A

Genetic - Lynch syndrome, Costello syndrome
Aristolochic acid based herbal medicine
Radiation exposure
Schistosoma infection
Smoking
Medications: Cyclophosphamide, phenacetin

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15
Q

3 histologic variants of urothelial carcinomas

A

Micropapillary, nested, large nested, tubular, microcystic, plasmacytoid, sarcomatoid, lipid-rich, clear cell, giant cell, lymphoepithelioma-like, poorly differentiated

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16
Q

3 types of divergent differentiation of urothelial carcinomas

A

Squamous differentiation, glandular differentiation, trophoblastic differentiation, Mullerian differentiation

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17
Q

List three urothelial carcinoma variants associated with worse prognosis than conventional urothelial carcinoma

A

Micropapillary
Sarcomatoid
Clear cell
Poorly-differentiated

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18
Q

List two histologic findings on bladder biopsy/TURB that are associated with higher risk of progression in otherwise T1 urothelial carcinoma

A

High grade, pT1 stage:
1. tumor size > 30 mm
2. multifocality
3. association with CIS
4. LVI
5. variant histology (those with worse prognosis)

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19
Q

List five clinical manifestations seen in Birt-Hogg-Dube syndrome

A

Fibrofolliculomas
Trichodiscomas
Acrochordon
Pulmonary cysts
Oncocytic RCC
Chromophobe RCC

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20
Q

What gene is involved in the development of Birt-Hogg-Dube syndrome?

A

FLCN gene encoding for folliculin

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21
Q

List 1) one immunostain and 1) one histochemical stain most helpful in differentiating oncocytoma from chromophobe renal cell
carcinoma.

A

CK7 - positive in chromophobe RCC but not oncocytoma

Colloidal iron stain - diffuse/granular staining in chromophobe RCC

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22
Q

List two immunostains most helpful in differentiating oncocytoma from low-grade oncocytic tumor.

A

CK7: Low-grade oncocytic tumors typically show strong and diffuse positivity for CK7. In contrast, oncocytomas usually exhibit weak or focal staining for CK7 or may be negative.

CD117 (C-kit): Low-grade oncocytic tumors often demonstrate positive staining for CD117, whereas oncocytomas are typically negative for CD117.

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23
Q

List the three major parameters used in prognostication of gastrointestinal stromal tumors (GISTs).

A

Tumor size

Mitotic rate

Tumor location

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24
Q

List three patterns of KIT immunoexpression that can be seen in GISTs.

A
  1. Dot-like perinuclear staining
  2. Membranous pattern
  3. Cytoplasmic
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25
Q

What are the three most common molecular alterations found in GISTs?

A

KIT
PDGFRA
Wildtype GIST (SDH-deficient GIST)
BRAF mutation

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26
Q

List three syndromes associated with GISTs

A

Neurofibromatosis type 1 (NF1)
Familial GIST syndrome
Carney-Stratakis syndrome
Carney triad

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27
Q

List five subtypes of lung adenocarcinoma according to the fifth edition of WHO

A

Invasive non-mucinous adenocarcinoma of the lung
Invasive mucinous adenocarcinoma of the lung
Colloid adenocarcinoma of the lung
Fetal adenocarcinoma of the lung
Enteric-type adenocarcinoma of the lung

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28
Q

What are the two recognized precursor glandular lesions?

A

Atypical adenomatous hyperplasia of the lung
Adenocarcinoma in situ of the lung

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29
Q

List the three genes that should be tested in ALL advanced lung adenocarcinomas as per the updated molecular testing guidelines
provided by College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for
Molecular Pathology

A

EGFR

ALK

ROS1

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30
Q

Provide the diagnostic criteria for diagnosis of minimally invasive lung adenocarcinoma

A

A small (≤ 30 mm) lepidic-predominant adenocarcinoma with an invasive component ≤ 5 mm, solitary on a resection specimen that is completely sampled

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31
Q

List the five groups constituting the WHO classification of pulmonary hypertension

A

Group 1: Pulmonary arterial hypertension (PAH)
Group 2: PH due to left heart disease
Group 3: PH due to lung diseases and/or hypoxia
Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH)
Group 5: PH with unclear and/or multifactorial mechanisms

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32
Q

List three clinical signs or symptoms that can be found in patients with advanced idiopathic pulmonary hypertension

A

Dyspnea
Fatigue
Syncope
Chest pain
Cyanosis
Right ventricular hypertrophy

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33
Q

What is the most common gene mutated in familial pulmonary arterial hypertension?

A

Bone Morphogenetic Protein Receptor Type 2 (BMPR2 gene)

34
Q

Name 1) one macroscopic and 2) one microscopic finding that can be seen in pulmonary hypertension

A

Macroscopic - Atherosclerotic plaques in larger pulmonary arteries, Right ventricular hypertrophy, pulmonary emboli

Microscopic - Pulmonary arteries may have
medial smooth muscle hypertrophy
Intimal (“onion skin”) fibrosis ± adventitial thickening
Plexiform lesions

35
Q

List five causes of myocarditis.

A

Viral - coxsackie virus
Bacterial - Strep, Staph, Borrelia
Parasitic infections
Autoimmune - SLE
Toxic substances - cocaine
Allergic reactions
Sarcoidosis
Giant cell myocarditis
Connective tissue disease

36
Q

List the two histologic criteria required for diagnosis of myocarditis

A

Inflammatory infiltrate
Myocyte necrosis/degeneration

37
Q

Which form of myocarditis is associated with particularly bad prognosis?

A

Giant cell myocarditis

38
Q

Which form of cardiomyopathy can develop as a consequence of myocarditis?

A

Dilated cardiomyopathy

39
Q

Define quality assurance in pathology.

A

System/program that ensures the final result reported is as correct and accurate as possible and standard is met

40
Q

Define quality control in pathology.

A

Tools included in every test to help detect and correct defects in the system and control the quality of the service being output

41
Q

List three examples of quality control in pathology

A

Daily assessment of H&E staining

External control tissue in IHC slides

Verifying more than 2 patient identifiers in specimens

Periodic calibration of digital slide scanners

Daily checking of temperature and pH value of staining solution

42
Q

Define proficiency testing in pathology.

A

Process of evaluating the results of unknown specimens to a standard test

43
Q

List 1) the most common primary tumor of the adult heart and 2) one associated syndrome

A
  1. Cardiac myxoma
  2. Carney syndrome, McCune-Albright
44
Q

List 1) the most common primary tumor of the pediatric heart and 2) one associated syndrome

A
  1. Cardiac rhabdomyoma
  2. Carney complex, Gorlin syndrome, tuberous sclerosis
45
Q

Two genes associated with tuberous sclerosis

A

TSC1
TSC2

46
Q

List three most common causes of metastatic tumors to the heart.

A

Bronchogenic carcinoma
Hematologic malignancies
Breast cancer
Renal cell carcinoma

47
Q

Define amyloidosis.

A

Inherited inflammatory disorder characterized by the deposition of insoluble protein fibrils in various tissues of the body and causing damage.

48
Q

List two special stains that can highlight amyloid in tissue and specify the expected positive staining for each.

A
  1. Congo red - apple green birefringence under polarized light
  2. Crystal violet - metachromatic staining (purple/blue)
  3. Sirius red - rose red
49
Q

Give 1) one example of disease associated with systemic amyloidosis and 2) one example of disease associated with localized amyloidosis.

A

Systemic: Immunoglobulin light chain (AL) amyloidosis, multiple myeloma, monoclonal plasma cell proliferations, chronic inflammatory disorders, chronic kidney disease

Localized: Primary localized cutaneous amyloidosis - Macular, Nodular, anosacral amyloidosis, Alzheimer’s disease, type 2 diabetes mellitus

50
Q

What is 1) the major fibril protein in Alzheimer disease and 2) its chemically related precursor protein?

A
  1. beta-amyloid
  2. amyloid precursor protein (APP)
51
Q

List three indications for intraoperative evaluation of lymph nodes.

A

Triage for lymphoma protocol
Exclusion of metastatic malignancy
Exclusion of infectious process

52
Q

List five additional techniques that can be performed on fresh lymph node tissue during intraoperative consultation

A

B+ fixative (different fixative)
Imprints for cytogenetics
RPMI
Snap freeze for molecular analysis
Microbiology cultures

53
Q

List four main causes of error during intraoperative consultation

A

Sampling error
Insufficient/inappropriate clinical history
Technical errors
Interpretative errors

54
Q

Which among these is the most common cause of error during intraoperative consultation?

A

Sampling error
Interpretive error

55
Q

List three extramammary locations that can be involved by myofibroblastoma

A

inguinal/groin area, including in the vulva/vagina, perineum, and scrotum
trunk/axilla
extremities
abdominal cavity
retroperitoneum
viscera

56
Q

List the two most useful immunostains for diagnosis of myofibroblastoma.

A

Desmin
CD34

57
Q

List the two immunostains that can overlap between myofibroblastoma and invasive lobular carcinoma of the breast.

A

ER
PR

58
Q

List four entities to consider in the morphologic differential diagnosis of myofibroblastoma in the breast

A

Spindle cell lipoma
Pseudoangiomatous stromal hyperplasia
Solitary fibrous tumor
Nodular fasciitis
Invasive lobular carcinoma
Fibromatosis

59
Q

Define oral leukoplakia

A

white plaque/patch that cannot be scraped off and cannot clinically be characterized as any other disease

60
Q

How does erythroplakia differ from leukoplakia?

A

Erythroplakia is a thin slightly depressed red patch on the oral mucosa

61
Q

What is the most common predisposing factor to leukoplakia?

A

Tobacco

62
Q

List three possible histologic correlates of leukoplakia

A

Verrucous hyperplasia
Proliferative verrucous leukoplakia
Squanous hyperplasia
Hyperkeratosis
Squamous hyerplasia / dysplasia

63
Q

List two commonly used scoring systems for assessing PD-L1 immunohistochemical expression and the corresponding formula

A

Tumor proportion score = (# PDL1 positive tumor cells/total # of viable tumor cells) x 100

Combined positive score = (# of PDL1 positive tumor cells and tumor associated immune cells/total # viable tumor cells) x 100

64
Q

For each of the two scoring systems for PDL1, list one organ system where the specific scoring system is used

A

TPS - NSCLC

CPS - ENT (head and neck SCC), GU (urothelial), GI (gastric and esophageal ca), Gyne (cervical ca)

65
Q

List the two normal tissues that can be used as controls for PD-L1 immunohistochemistry

A

Tonsil
Placenta

66
Q

What is the minimum number of cases that would be required for validation of a new PD-L1 antibody within a laboratory?

A

40 cases

67
Q

Outline the seven categories in the classification of the epithelial tumors of the ovary according to 5th edition WHO.

A

Serous tumors
Mucinous tumors
Seromucinous tumors
Endometroid tumors
Clear cell tumors
Brenner tumor
Other carcinomas

68
Q

List three precursor lesions of mucinous carcinoma of the ovary.

A

Mucinous borderline tumors
Mature cystic teratoma
Brenner tumor

69
Q

List four pathologic features that favor ovarian involvement by metastatic carcinoma rather than a primary mucinous carcinoma of the ovary.

A

Bilaterality (metastatic are usually bilateral while primary are unilateral)
Smaller size
Surface involvement / hilar involvement
Infiltrative growth pattern
High grade cytology
Dissecting mucin

70
Q

List five immunostains that can be used to distinguish ovarian involvement by metastatic carcinoma versus a primary mucinous carcinoma of the ovary.

A

Things in the differential of mucinous neoplasm: breast, GI, ovary
PAX8
CK7
CK20
CDX2
SATB2
WT1
ER
PR
SMAD4
GATA3

71
Q

List the four most important points to include in a pathology report on salivary gland carcinoma.

A

Tumor histologic type and pattern
Anatomic site of origin / location, side
Tumor size
Tumor histologic grade (for mucoepidermoid carcinoma, adenocarcinoma, NOS, malignant mixed tumor, adenoid cystic carcinoma)
Tumor extension (intra or extraglandular), to adjacent structures
Status of resection margins
Vascular invasion
Perineural invasion
Lymph node involvement

72
Q

Name two specific salivary gland carcinomas for which histologic grading is pathologically relevant.

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Carcinoma exPA
Adenocarcinoma NOS

73
Q

List two risk factors for the development of salivary gland carcinoma.

A

Age
Sex - more common in males
Radiation
Tobacco chewing NOT smoking
EBV
Genetic predisposition
Nickel exposure
Chromium exposure

74
Q

In general, what is the single most important pathologic prognostic factor for carcinoma of the head and neck?

A

Lymph node status

75
Q

List three criteria of malignancy in conventional adrenocortical neoplasms in adult patients.

A

Weiss criteria: ≥ 3 for adrenal cortical carcinoma
1. Nuclear grade III or IV (Fuhrman)
2. > 5 mitotic figures/50 high power fields*
3. Atypical mitotic figures*
4. Clear or vacuolated cells ≤ 25% tumor
5. Diffuse architecture (> 33% of tumor)
6. Necrosis
7. Venous invasion* (of smooth muscle walled vessels)
8. Sinusoidal invasion
9. Capsular invasion

*= major criteria; 1 is required to diagnose adrenal cortical carcinoma

76
Q

List two immunostains useful in distinguishing adrenocortical adenocarcinoma from pheochromocytoma

A

SF1, α-inhibin - negative in pheochromocytoma
Melan A - negative in pheochromocytoma

Chromogranin - positive in pheochromocytoma
GATA3 - positive in pheochromocytoma

77
Q

List one adverse prognosis factor in adrenocortical adenocarcinomas

A

Angioinvasion
Advanced tumor stage
Lack of completeness of the tumor excision
Tumor functionality
High-mitotic tumor grade
High Ki67 proliferation index

78
Q

List five causes of adrenal insufficiency.

A

Primary Adrenal Insufficiency: caused by
1. Autoimmune diseases
2. Amyloidosis
3. Congenital Adrenal Hyperplasia
4. Adrenal bleeding due to trauma
5. Fungal infections

Secondary adrenal insufficiency:
1. Pituitary dysfunction
2. Long-term use of high-dose corticosteroids

79
Q

What is the definition of sudden unexpected death in epilepsy (SUDEP)?

A

Sudden unexpected death in epilepsy (SUDEP) is sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death, occurring in benign circumstances, in individual with epilepsy, ± evidence for seizure and excluding documented status epilepticus, in which postmortem examination does not reveal cause of death

80
Q

List five causes of death that can be seen in patients with epilepsy

A

SUDEP
Status epilepticus
Seizure-related injuries (head injury)
Suicide
Arrhythmia
Trauma
Drowning
Postictal asphyxia

81
Q

List two macroscopic findings in epileptic death.

A

foam cone
tongue biting
muscle rigidity
urinary incontinence
gastric aspiration

82
Q

What is the most common histologic finding in brain in epileptic death?

A

normal brain

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