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Pathology > Ch8: Surgical Diagnosis > Flashcards

Ch8: Surgical Diagnosis Flashcards

1
Q
  1. Surgical pathology involves what types of studies?3
A
  • Frozen sections
  • Permanent sections
  • Special studies
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2
Q

Tumor diagnosis is performed originally by who?

A

Surgeon

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3
Q

Tumor diagnosis is done by doing what?

A

Removing a mass

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4
Q

Two types of procedures for tumor diagnosis?

A

Lumpectomy: Benign lesion
Radical: Malignant lesion

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5
Q

With a frozen section, who looks at tissue first?

A

pathologist

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6
Q

What determines whether an area will be examined for frozen section?

A
  1. Tumor or not
  2. benign or malignant
  3. if margins need to be used
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7
Q

What is process of frozen section? 5

A
  1. Tissue put on chuck and covered with OCT
  2. Place in cryostat and freeze to -22 celscius
  3. Then cut thin slices in cryostat
  4. Stain with hematoxylin and eosin and cover slip
  5. Examine microscopically and give diagnosis
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8
Q

What are three things difficult to do with frozen tissue?

A
  1. margins of malignant melanoma
  2. lymphoma assessment
  3. degree of dysplasia
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9
Q

What are steps of permanent sections diagnosis? 11

A
  1. Tissue entered and recorded
  2. Gross examination occurs
  3. Dissected
  4. Fixate with a fixative agent
  5. Embed in paraffin
  6. section
  7. plass on glass slide
  8. de paraffined
  9. stained
  10. cover slipped
  11. diagnosed
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10
Q

Most common fixative?

What else might be used?

A

Formalin

B-5, bouin’s, zencker

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11
Q

What is most common stain of tissues?

A

Hematoxylin and eosin

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12
Q

What will Oil Red O stain do?

A

Red dye that dissolves into triglycerides

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13
Q

What does silver stain do?

A

Precipitate silver into specific cells, or components of cell walls of fungi and bacteria

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14
Q

What is Grocott’s or Gomori’s methenamine silver stain used for?

A

Fungi

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15
Q

What is Warthin-Starry silver stain used for?

A

Bacteria/Spirochetes

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16
Q

What is BIelschowsky’s silver stain used for?

A

Neural tissue

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17
Q

What is reticulin stain used for?

A

Staining reticulin network in tissues

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18
Q

Reticulin is what type of collagen?

Where is it found?

A

Type III

In support of organs

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19
Q

Periodic Acid Schiff stain (PAS) is used for what structures? (4)

A
  1. fungi
  2. intestinal mucins
  3. basement membranes
  4. glycogen
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20
Q

Giemsa stain is used for what? (2)

A

H. pylori

Parasites

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21
Q

Congo red stain is used for what?

A

Amyloid stain

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22
Q

Trichrome stain is used for what? 3

A

Differentiating smooth muscle (red), CT (blue), and neural tissue (pink)

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23
Q

Two types of iron stains?

A

Prussian blue

Colloidal iron

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24
Q

Prussian blue does what?

A

Stains tissue iron blue

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25
Q

Colloidal iron stains what blue?

A

Mucins

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26
Q

Tissue gram stain does what?

A

Gram stains bacteria

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27
Q

What are the three myobacterial stains?

A
  1. Ziehl neelson
  2. fite stain
  3. auromine O stain
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28
Q

What stains will you use for fungi? (2)

A
  1. PAS or

2. GMS

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29
Q

What stain will you use for BM of glomerulus?

A
  1. PAS

2. silver reticular

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30
Q

What are immunostains?

A

Monoclonal antibody stains that have marker substance.

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31
Q

What are immunohistochemical stains?

A

Chromagen catalyzed by an enzyme with antibody that results in color formation

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32
Q

Immunofluorescent stains are different from immunostains how?

A

Still use mono Ab’s but have a fluorescent tag attached, remain attached to antigen after slide rinse.

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33
Q

Polyclonal ab’s come form what?

A

Animals that have been exposed to antigen of interest

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34
Q

Monclonal ab’s come from what?

A

Mice

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35
Q

Are mono or poly ab’s more specific?

A

Mono

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36
Q

Steps of making mono ab’s? 4

A
  1. Expose mouse to antigen
  2. Remove splenic lymphocytes
  3. fuse with mouse myseloma to make hybrid that produces Ab and has long cell life.
  4. Culture hybridomas and harvest antibody
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37
Q

What is cold ischemic time?

A

Time from when tissue is removed from body until it is fixed

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38
Q

What is fixation time?

A

Perfect amount of fixation as to not alter staining

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39
Q

Some antibodies need what to increase their sensitivity?

A

Antigen retrieval

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40
Q

antigen retrieval is done by what? (4)

A
  1. heating
  2. EDTA
  3. citrate
  4. enzymes
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41
Q

Detection of immuno stains requires what? 6

A
  1. Add primary specific monoclonal antibody to slide
  2. rinse
  3. add secondary detector antibody (anti mouse) to slide
  4. rinse
  5. Enzyme solution added to catalyze reaction with chromagen
  6. color forms and you can diagnose
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42
Q

What antigen classes are used for diagnosis and prognosis? 7

A
  1. intermediate filament
  2. cell surface markers
  3. hormones
  4. receptors
  5. enzymes
  6. mucins
  7. various cell proteins
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43
Q

Intermediate filament proteins are classified into what five classes?

A
  1. Class 1 and 2: Keratins for epithelial differentiation
  2. Class III: Vimentin, desmin, glial fibrillary
  3. Class IV: neurofilaments
  4. Class V: neurolamins
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44
Q

Keratins are markers of what?

A

Epithelial cells

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45
Q

Vimentin is a marker of what?

A

Mesenchymal cells

46
Q

Neurofilaments are markers of what?

47
Q

Desmin demonstrates what?

A

Muscle differentiation between skeletal and smooth

48
Q

Glial fibrillary signifies what? (2)

A
  1. Glial fibrillary acidic protein (GFAP)

2. CNS glial cells (Astrocyes, ependymal)

49
Q

Two main groups of cell surface markers?

A
  1. CD markers on hematopoietic cells

2. Cell surface antigens

50
Q

What are the T-cell CD’s?

A

CD1 through CD8

51
Q

What are the B cell CD’s?

A

CD19 and CD20

52
Q

Where is CD34?

A

Stem cell and blast marker

53
Q

Where is CD45?

What is it known as?

A

All leukocytes

LCA: Leukocyte common antigen

54
Q

What are the CD’s seen in chronic lymphocytic leukemia and small lymphocytic lymphoma? 4

A

CD5+
CD20+
CD23+
CD3-

55
Q

WHat are the CD’s seen in Pre-T cell acute lymphoblastic leukemias?

A 
CD34+
CD3+
CD8+
CD19-
CD20-
56
Q

Epithelial membrane antigen is expressed where?

A

Glandular tissues and neoplasms

57
Q

Carcinoembryonic antigen is what?

Expressed in adults where?

A

Fetal glycoprotein adhesion molecule

Adult malignant neoplasms such as colorectal adenocarcinoma

58
Q

Placental alkaline phosphatase is found where? (2)

A
  1. normal placenta

2. adult germ cell neoplasms

59
Q

Thyroglobulin is in what?

A

Thyroid neoplasms

60
Q

Pancreatic hormone is in what?

A

Pancreatic islet clel neoplasm

61
Q

Parathyroid hormone is in what?

A

Parathyroid neoplasm

62
Q

Pituitary hormones are in what?

A

Pituitary neoplasms

63
Q

Calictonin is in what?

A

Medullary carcinoma of thyroid

64
Q

The receptor Her2-Neu is found where?

A

Breast and esophageal/gastric malignancies

65
Q

MUC1 mucin is used to differentiate what?

A

Adenocarcinomas

66
Q

PSA can be used to do determine what?

A

Prostate hyperplasia

67
Q

Specific immunostains include? (3)

A
  1. PSA
  2. Thyroglobulin
  3. Thyroid transcription factor 1
68
Q

Nonspecific imunostains include what? 4

A

Pankeratin
Vimentin
CD45 (LCA)
Neuron specific enolase

69
Q

What does pankeratin signify?

A

Epithelial neoplasms (carcinomas)

70
Q

What does vimentin signify?

A

Mesenchymal neoplasms (sarcomas)

71
Q

CD45/LCA signify what?

A

Hematopoietic neoplasms (leukemias and lymphomas)

72
Q

Is there a malignant or cancer stain available?

73
Q

Spindle cell squamous cell carcinoma will have what stain results? (2)

A
  1. Pankeratin+

2. S100-

74
Q

Spindle cell melanoma will have what stain results? 2

A
  1. Pankeratin-

2. S100+

75
Q

Atypical fibroxanthoma has what for stain results? (4)

A
  1. Pankeratin -
  2. S100-
  3. CD10+
  4. CD99+
76
Q

Papillary thyroid carinoma has what for stain results? 3

A
  1. Thyroglobulin+
  2. TTF-1+
  3. RCC-
77
Q

Papillary renal cell carcinoma has what for stain results? 3

A
  1. Thyroglobulin-
  2. TTF-1-
  3. RCC+
78
Q

Ovarian papillary serous carcinoma has what for stain results? 3

A
  1. Thyroglobulin-
  2. TTF-1-
  3. RCC-
79
Q

Poorly differentiated carcinoma has what for stain results? 4

A
  1. Pankeratin+
  2. EMA+
  3. S100-
  4. CD45-
80
Q

Melanoma has what for stain results? 4

A
  1. S100+
  2. Pankeratin-
  3. EMA-
  4. CD45-
81
Q

Lymphoma has what for stain results? 6

A
  1. CD45+
  2. CD3+
  3. CD20+
  4. S100-
  5. Pankeratin-
  6. EMA-
82
Q

Esophageal/gastric carcinoma has what for stain results? (3)

A
  1. CK20+
  2. CK7-
  3. ER-
83
Q

Metastatic lobular breast carcinoma has what for stain results? (3)

A
  1. CK20-
  2. CK7+
  3. ER+
84
Q

What is the prostate cocktail stain for prostate carcinoma?

A
  1. p504s

2. p63

85
Q

p504s is what type of antibody?

A

Alpha-methylacyl-CoA racemase

86
Q

What does Alpha-methylacyl-CoA do?

A

Enzyme in beta oxidation of fatty acids and restricted to prostatic carcinoma and high grade prostatic intraepithelial neoplasia (PIN)

87
Q

p63 is a protein found where? 4

A
  1. Nuclei of basal epithelial cells of the prostate
  2. Myoepithelial cells of breast
  3. Urothelial cells
  4. squamous cells
88
Q

Basal cells are present in what?

But not what?

A

High grade PIN, but NOT prostate carcinomas

89
Q

Estrogen and progesterone receptors are in what cancers?

A

Breast carcinomas

90
Q

If you are ER+ and PR+, what does that mean about your cancer?

A

Lower grade with good prognosis

91
Q

ER+ neoplasms can be treated with what?

A

Estrogen inhibition

92
Q

CD20 does what for the B cell?

A

Surface glycosylated phosphoprotein in B-cell maturation

93
Q

If CD20 is present on a B cell non-hodgkin lymphoma and chronic lymphocyte lymphoma, what can you use to treat?

A

Rituxan (anti-CD20 antibodies)

94
Q

Her2-neu is expressed in what percentage of breast carcinomas?

95
Q

If her2-neu is overexpressed, what can you use to treat?

A

Herceptin (anti-Her2-neu antibody)

96
Q

Her2-neu positive neoplasms may benefit from what other therapy?

A

Adriamycin

97
Q

MIB-1 is an antibody against?

98
Q

Where is Ki67 expressed?

A

On proliferating cells

99
Q

CD117 is what type of protein?

What is it labeled in oncology?

A
  1. Tyrosine kinase protein known as mast/stem cell growth factor receptor

Proto-oncogene (if mutates –> proliferation)

100
Q

CD117 is seen where? (4)

A

AML
Melanoma
mast cell disease
GIST

101
Q

CD117 mutations can be treated by what?

A

Gleevec (imatinib)

102
Q

What is in-situ hybridization?

A

Using complimentary nucleic acid probes to detect sequences.

103
Q

What type of viruses can in-situ hybridization mark? (3)

A
  1. EMV
  2. CMV
  3. HPV
104
Q

In-situ can be used to find what mutations in cancers? (2)

A
  1. K-RAS

2. Her2-Neu

105
Q

Oligodendrogliomas are what type of cancers?

Where are the mutations?

A

CNS glial neoplasms

1p and 19q mutations

106
Q

How is flow cytometry used in cancer?

A

Detect cancer cells using surface markers.

107
Q

WHat is cytogenetics?

A

Cell replication with interruption of mitosis and assessment of individual chromosome numbers and structure after GIEMSA staining

108
Q

Cytogenetics is used to assess what? (5)

A 
trisomies
monosomies
duplications
deletions
translocations
109
Q

Single nucleotide arrays are used to detect what?

A

SNP’s which are single nucleotide alterations.

110
Q

Electron microscopy is mainly used for what?

Pathology (36 decks)

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