29- Pathology Explains 1 Flashcards
What does the Dukes classification system determine?
The Dukes classification system determines the extent of spread of colorectal cancer.
What does Dukes A indicate?
Dukes A indicates that the tumor is confined to the bowel without extending beyond it, and there are no nodal metastases. This accounts for approximately 95% of cases.
What does Dukes B indicate?
Dukes B indicates that the tumor has invaded the bowel wall but there are no nodal metastases. This accounts for approximately 75% of cases.
What does Dukes C indicate?
Dukes C indicates the presence of lymph node metastases. This accounts for approximately 50% of cases.
What does Dukes D indicate?
Dukes D indicates the presence of distant metastases. This accounts for approximately 6% of cases (25% if the metastases are resectable).
Who is stereotypically affected by primary hyperparathyroidism?
Primary hyperparathyroidism is stereotypically seen in elderly females.
What are common symptoms of primary hyperparathyroidism?
Common symptoms include unquenchable thirst, an inappropriately normal or raised parathyroid hormone level, and it is most commonly due to a solitary adenoma.
What are the causes of primary hyperparathyroidism?
The causes of primary hyperparathyroidism are: 80% solitary adenoma, 15% hyperplasia, 4% multiple adenoma, and 1% carcinoma.
What are the features associated with primary hyperparathyroidism?
The features associated with primary hyperparathyroidism are often remembered by the phrase ‘bones, stones, abdominal groans, and psychic moans.’ These include polydipsia and polyuria, peptic ulceration, constipation, pancreatitis, bone pain/fracture, renal stones, and depression.
What are the associations of primary hyperparathyroidism?
Associations include hypertension and multiple endocrine neoplasia (MEN I and II).
What are the typical findings on investigations for primary hyperparathyroidism?
Typical findings on investigations include raised calcium levels, low phosphate levels, and the possibility of a raised or normal parathyroid hormone (PTH) level. A technetium-MIBI subtraction scan may also be performed.
What is the treatment for primary hyperparathyroidism?
The treatment for primary hyperparathyroidism is parathyroidectomy. If imaging suggests a target gland, a focused approach may be used.
What are the characteristics of adenomas that correlate with malignant potential?
Three characteristics of adenomas that correlate with malignant potential are increased size, villous architecture, and dysplasia.
What are the different types of polyps seen in colorectal cancer?
Polyps can be categorized as neoplastic polyps, adenomatous polyps, and non-neoplastic polyps.
What genetic changes accompany the transition from adenoma to carcinoma?
Genetic changes that accompany the transition from adenoma to carcinoma include APC, c-myc, K RAS mutations, and p53 deletions.
What is the transformation process from polyp to cancer called?
The transformation from polyp to cancer is described by the adenoma-carcinoma sequence.
What are some examples of non-neoplastic polyps?
Non-neoplastic polyps include hyperplastic, juvenile, hamartomatous, inflammatory, and lymphoid polyps.
Why should most polyps identified at colonoscopy be removed?
Most polyps identified at colonoscopy should be removed because they may have malignant potential.
What is the most common type of oesophageal cancer in the Western world?
In the Western world, the most common type of oesophageal cancer is adenocarcinoma.
What is a major risk factor for oesophageal adenocarcinoma?
Barrett’s oesophagus is a major risk factor for most cases of oesophageal adenocarcinoma.
What are some risk factors for squamous cell oesophageal cancer?
In other regions of the world, squamous cell oesophageal cancer is more common and is linked to smoking, alcohol intake, diets rich in nitrosamines, and achalasia.
Why is surveillance of Barrett’s oesophagus important?
Surveillance of Barrett’s oesophagus is important because it imparts a 30-fold increase in cancer risk. Early diagnosis of invasive malignancy may lead to a 5-year survival rate of approximately 85%.
What is the first-line test for the diagnosis of oesophageal cancer?
Upper GI endoscopy is the first-line test for the diagnosis of oesophageal cancer.
What imaging modality is used for staging oesophageal cancer?
CT scanning of the chest, abdomen, and pelvis is used for staging oesophageal cancer.
What surgical procedure is commonly performed for operable oesophageal cancer?
The most standard surgical procedure for operable oesophageal cancer is an Ivor-Lewis type oesophagectomy.
What is the biggest surgical challenge in oesophageal cancer surgery?
The biggest surgical challenge is anastomotic leak, which can result in complications such as mediastinitis.
Are patients with oesophageal cancer commonly treated with adjuvant chemotherapy?
Yes, many patients with oesophageal cancer will be treated with adjuvant chemotherapy in addition to surgical resection.
What are the risk factors for pancreatic adenocarcinoma?
The risk factors for pancreatic adenocarcinoma include smoking, diabetes, adenoma, and familial adenomatous polyposis.
In which part of the pancreas does pancreatic adenocarcinoma mainly occur?
Pancreatic adenocarcinoma mainly occurs in the head of the pancreas (70%).
Why is it important to differentiate carcinoma of the pancreas from other periampullary tumors?
It is important to differentiate carcinoma of the pancreas from other periampullary tumors because pancreatic carcinoma has a worse prognosis.
Where does pancreatic adenocarcinoma commonly metastasize to?
Pancreatic adenocarcinoma commonly metastasizes to the liver and spreads locally.
What are the clinical features of pancreatic cancer?
The clinical features of pancreatic cancer include weight loss, painless jaundice, epigastric discomfort, pancreatitis, and Trousseau’s sign (migratory superficial thrombophlebitis).
What is the surgical management for pancreatic cancer in the head of the pancreas?
Whipple’s resection is the surgical management for pancreatic cancer in the head of the pancreas.
What imaging modality is recommended for pancreatic cancer staging?
CT scanning (pancreatic protocol) is recommended for pancreatic cancer staging.
When is staging laparoscopy performed for pancreatic cancer?
Staging laparoscopy is performed to exclude peritoneal disease in pancreatic cancer.
What surgical procedure is performed for carcinoma in the body and tail of the pancreas?
For carcinoma in the body and tail of the pancreas, distal pancreatectomy is performed.
What is the usual treatment for resectable pancreatic cancer?
Resectable pancreatic cancer is usually treated with adjuvant chemotherapy.
What are oncoviruses?
Oncoviruses are viruses that can cause cancer.
Can oncoviruses be detected through a blood test?
Yes, oncoviruses can be detected through a blood test.
How can oncovirus-related cancers be prevented?
Oncovirus-related cancers can be prevented through vaccination.
Which oncovirus is associated with Burkitt’s lymphoma, Hodgkin’s lymphoma, post-transplant lymphoma, and nasopharyngeal carcinoma?
The Epstein-Barr virus is associated with these cancers.
Which oncovirus is associated with cervical cancer, anal cancer, penile cancer, vulval cancer, and oropharyngeal cancer?
Human papillomavirus 16/18 is associated with these cancers.
Which oncovirus is associated with Kaposi’s sarcoma?
Human herpes virus 8 is associated with Kaposi’s sarcoma.
Which oncovirus is associated with hepatocellular carcinoma?
Hepatitis B virus and hepatitis C virus are associated with hepatocellular carcinoma.
Which oncovirus is associated with tropical spastic paraparesis and adult T cell leukaemia?
Human T-lymphotropic virus 1 is associated with these conditions.
What is Paget’s disease?
Paget’s disease is a disease characterized by increased and uncontrolled bone turnover, resulting in architecturally abnormal bones.
Which cells are primarily involved in Paget’s disease?
Osteoclasts are primarily involved in Paget’s disease, leading to excessive bone resorption followed by increased osteoblastic activity.
What are the predisposing factors for Paget’s disease?
The predisposing factors for Paget’s disease include increasing age, male sex, living in northern latitudes, and having a family history of the disease.
What are the clinical features of Paget’s disease?
The clinical features of Paget’s disease include bone pain (e.g., pelvis, lumbar spine, femur), bowing of the tibia, bossing of the skull, and elevated alkaline phosphatase levels.
What are the indications for treatment in Paget’s disease?
Indications for treatment in Paget’s disease include bone pain, skull or long bone deformity, fractures, and periarticular involvement.
What are the commonly used treatments for Paget’s disease?
The commonly used treatments for Paget’s disease are bisphosphonates (oral risedronate or IV zoledronate). Calcitonin is less commonly used now.
What are the complications associated with Paget’s disease?
Complications of Paget’s disease include deafness (cranial nerve entrapment), bone sarcoma (1% if affected for > 10 years), fractures, skull thickening, and high-output cardiac failure.
What is the typical presentation of the skull on x-ray in Paget’s disease?
On x-ray, Paget’s disease of the skull may show a thickened vault and osteoporosis circumscripta.
Are calcium and phosphate levels typically affected in Paget’s disease?
No, calcium and phosphate levels are typically normal in Paget’s disease, although hypercalcemia may occur with prolonged immobilization.
What are the main processes that can lead to chronic inflammation?
The main processes that can lead to chronic inflammation include persisting infection with certain organisms (such as Mycobacterium tuberculosis), prolonged exposure to non-biodegradable substances (like silica or suture materials), and autoimmune conditions involving antibodies formed against host antigens.
What are the key differences between acute inflammation and chronic inflammation?
Acute inflammation involves changes to vascular structure, increased permeability of endothelial cells, and infiltration of neutrophils. It can resolve with suppuration, complete resolution, abscess formation, or progress to chronic inflammation. Chronic inflammation is characterized by angiogenesis, predominance of macrophages, plasma cells, and lymphocytes, and healing by fibrosis.
What is granulomatous inflammation?
Granulomatous inflammation is a type of chronic inflammation characterized by the formation of granulomas. Granulomas consist of a microscopic aggregation of macrophages, with epithelioid arrangement, and may have large giant cells at the periphery.
What are some mediators released by activated macrophages in chronic inflammation?
Some mediators released by activated macrophages in chronic inflammation include interferon, fibroblast growth factor, and other growth factors. These mediators can have systemic effects, leading to systemic symptoms and signs in individuals with long-standing chronic inflammation.
What is the significance of finding granulomas in the context of chronic inflammation?
The finding of granulomas is pathognomonic of chronic inflammation. Granulomas are characteristic microscopic structures seen in conditions such as colonic Crohn’s disease.
What are the main causes of hypercalcemia?
The main causes of hypercalcemia include malignancy (most common in hospital in-patients) and primary hyperparathyroidism (commonest cause in non-hospitalized patients).
What are some less common causes of hypercalcemia?
Less common causes of hypercalcemia include sarcoidosis (extrarenal synthesis of calcitriol), thiazides, lithium, immobilization, Paget’s disease, vitamin A/D toxicity, thyrotoxicosis, MEN (multiple endocrine neoplasia), and milk alkali syndrome.
What are the clinical features of hypercalcemia?
The clinical features of hypercalcemia are often summarized as “stones, bones, abdominal groans, and psychic moans.” This refers to the potential occurrence of kidney stones, bone pain or fractures, abdominal discomfort, and mood or mental changes.
How does high serum calcium levels affect neuronal excitability?
High serum calcium levels result in decreased neuronal excitability. As a result, individuals with hypercalcemia may experience sluggish reflexes, muscle weakness, and constipation.
What is the role of Helicobacter pylori in ulceration?
Helicobacter pylori infection is implicated in many cases of duodenal ulceration and up to 60% of patients with gastric ulceration.
Describe the characteristics of Helicobacter pylori.
Helicobacter pylori is a gram-negative, helical-shaped rod with microaerophilic requirements. It produces a urease enzyme that hydrolyzes urea, resulting in the production of ammonia.
How does ammonia affect the release of gastrin?
Ammonia, produced by Helicobacter pylori, stimulates the release of gastrin from antral G cells via a negative feedback loop.
What are the effects of Helicobacter pylori infection on the gastric mucous layer?
Once infection is established, Helicobacter pylori releases enzymes that disrupt the gastric mucous layer, leading to chronic inflammation of the gastric epithelium and the development of gastric ulcers.
What is the role of Helicobacter pylori in duodenal ulceration?
Although Helicobacter pylori cannot colonize the duodenal mucosa, it can induce a process of duodenal gastric metaplasia, where the duodenal mucosa changes to the gastric epithelial type. This metaplastic tissue can be colonized by Helicobacter pylori, leading to inflammation, duodenitis, and ulcers.
What are the risks associated with Helicobacter pylori colonization?
In patients who are colonized by Helicobacter pylori, there is a 10-20% risk of peptic ulcer, a 1-2% risk of gastric cancer, and a less than 1% risk of MALT lymphoma.
What is in situ disease in breast cancer?
In situ disease in breast cancer refers to cancer that has not yet invaded the basement membrane.
What are the subtypes of ductal carcinoma in situ (DCIS)?
The subtypes of DCIS include comedo, cribriform, micropapillary, and solid.
Which subtype of DCIS is most likely to form microcalcifications?
Comedo DCIS is most likely to form microcalcifications.
Which subtypes of DCIS are most likely to be multifocal?
Cribriform and micropapillary subtypes of DCIS are most likely to be multifocal.
What is the usual treatment approach for low nuclear grade DCIS?
Local excision of low nuclear grade DCIS typically produces satisfactory outcomes.
Are most DCIS lesions composed of a single subtype or multiple subtypes?
Most DCIS lesions are mixed and composed of multiple subtypes.
What is the association between high nuclear grade DCIS and malignant characteristics?
High nuclear grade DCIS is associated with more malignant characteristics, such as loss of p53 and increased erbB2 expression.
When is mastectomy usually required for DCIS?
Mastectomy is usually required for multifocal lesions, large lesions, and high nuclear grade lesions of DCIS.
How does lobular carcinoma in situ (LCIS) differ from DCIS?
LCIS is much rarer than DCIS and does not form microcalcifications. It usually has a single growth pattern and is often monitored rather than excised when it is low grade.
What is the benefit of whole breast irradiation in breast-conserving surgery for DCIS?
Whole breast irradiation improves locoregional control when breast-conserving surgery is performed for DCIS.
What is the difference in axillary nodal metastasis between LCIS and invasive foci found within DCIS?
When an invasive component is found in LCIS, it is less likely to be associated with axillary nodal metastasis than invasive foci found within DCIS.
Where is the spleen located?
The spleen is located in the left upper quadrant of the abdomen.
What are the typical dimensions of the adult spleen?
The typical adult spleen is 12.5cm long and 7.5cm wide.
Is the normal spleen palpable?
No, the normal spleen is not palpable.
What is the usual weight of the adult spleen?
The usual weight of the adult spleen is 150g.
What covers the spleen and adheres firmly to its capsule?
The spleen is almost entirely covered by peritoneum, which adheres firmly to its capsule.
How does the shape of the spleen change with gastric and colonic distension?
Gastric distension causes the spleen to resemble the shape of an orange segment, while colonic distension makes it more tetrahedral.
What ligaments connect the spleen to the posterior abdominal wall and stomach?
The spleen is connected to the posterior abdominal wall and stomach by two folds of peritoneum: the lienorenal ligament and gastrosplenic ligament.
What are the relations of the spleen?
Superiorly, it is related to the diaphragm. Anteriorly, it has a gastric impression. Posteriorly, it is related to the kidney. Inferiorly, it is related to the colon.
What structures are found at the hilum of the spleen?
At the hilum, you can find the tail of the pancreas and splenic vessels. The splenic artery divides here, and its branches pass to the white pulp, transporting plasma.
What is the function of the white pulp in the spleen?
The white pulp of the spleen has immune function. It contains a central trabecular artery and germinal centers supplied by penicilliary radicles.
What is the function of the red pulp in the spleen?
The red pulp of the spleen filters abnormal red blood cells and foreign bodies, such as bacteria.
What are the functions of the spleen?
The spleen functions in the filtration of abnormal blood cells and foreign bodies, immunity (IgM production, properdin, and tuftsin), haematopoiesis (up to the 5th month of gestation or in haematological disorders), platelet storage (40% storage), iron reutilization, and storage of monocytes.
What are some disorders of the spleen?
Disorders of the spleen include massive splenomegaly, myelofibrosis, chronic myeloid leukemia, visceral leishmaniasis (kala-azar), malaria, Gaucher’s syndrome, portal hypertension (secondary to cirrhosis), lymphoproliferative disease (e.g., CLL, Hodgkin’s), haemolytic anemia, infection (hepatitis, glandular fever, infective endocarditis), sickle-cell disease (majority of adult patients have an atrophied spleen due to repeated infarction), and rheumatoid arthritis (Felty’s syndrome).
Where are hydatid cysts endemic?
Hydatid cysts are endemic in Mediterranean and Middle Eastern countries.
What causes hydatid cysts?
Hydatid cysts are caused by the tapeworm parasite Echinococcus granulosus.
What is the composition of hydatid cysts?
Hydatid cysts have an outer fibrous capsule containing multiple small daughter cysts.
What type of hypersensitivity reaction do hydatid cysts precipitate?
Hydatid cysts precipitate a type 1 hypersensitivity reaction due to the allergens they contain.
Where do up to 90% of hydatid cysts occur?
Up to 90% of hydatid cysts occur in the liver and lungs.
When do hydatid cysts become symptomatic?
Hydatid cysts can be asymptomatic, but become symptomatic if they are larger than 5cm in diameter.
What are the potential complications of hydatid cysts?
Complications of hydatid cysts include cyst bursting, infection, and organ dysfunction (such as biliary, bronchial, renal, and cerebrospinal fluid outflow obstruction).
What is the classical triad seen in biliary rupture of hydatid cysts?
The classical triad seen in biliary rupture of hydatid cysts includes biliary colic, jaundice, and urticaria.
What does PSA stand for?
PSA stands for prostate specific antigen.
