Clinical Pathology Flashcards
Define terms associated with cancer including, cancer, neoplasm, tumour, metastasis, carcinogen;
Cancer: an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasise.
Neoplasia: form of abnormal growth that is independent of the body’s normal homeostatic growth-regulating mechanisms, continues after the initiating stimulus is removed, and is purposeless.
example: neoplasmic lung cancer
Tumour: any abnormal swelling in or on a part of the body. Usually applied to abnormal growth of tissue which can be benign or malignant.
example: a non-neoplasmic tumour: nasal polyps
Metastasis: the spread of a malignant tumour from its site of origin.
Carcinogen: any substance that, when exposed to living tissue, may cause the production of cancer.
•Neoplasms may be either benign (remain localised) or malignant (invade locally and/or spread to distant sites).
Cancers are malignant neoplasms.
Hamartomas:
- These are localised benign overgrowths of one of more mature cell types e.g. in the lung.
- They represent architectural but not cytological abnormalities.
- For example: lung hamartomas are composed of cartilage and bronchial tissue.
Heterotopias
- These are normal tissue being found in parts of the body where they are no normally present.
- For example: pancreas in the wall of the large intestine.
Teratomas:
- These are tumours derived from germ cells and can contain tissue derive from all three for 3 germ cell layers.
- They may contain mature and / or mature tissue and even cancers.
Classification of neoplasms
•The primary description of a neoplasm is based on the cell origin (eg chondro) and the secondary description is whether it is benign or malignant (oma or sarcoma).
List features which distinguish benign from malignant tumours.
Classification of neoplasms
•The primary description of a neoplasm is based on the cell origin (eg chondro) and the secondary description is whether it is benign or malignant (oma or sarcoma).
photo (BM=basement membrane)
Benign tumours may become malignant - By which routes?
•Direct extension
This is associated with a stromal response to the tumour.
This includes fibroblastic proliferation (“ a desmoplastic response”), vascular proliferation (angiogenesis) and an immune response.
•Haematogenous
This is via blood vessels.
The blood vessels usually invaded are the venules and capillaries because they have thinner walls.
Most sarcomas metastasise first via the blood vessels.
- Lymphatic
- Transcoelomic
This is via seeding of body cavities.
The commonest examples are the pleural cavities (for intrathoracic cancers) and the peritoneal cavities (for intra-abdominal cancers)
•Perineural
This is via nerves.
This is an underappreciated route of cancer spread.
LO: List features of pathology which predict the prognosis in cancer.
How do we assess tumour spread?
- Clinically
- Radiologically
- Pathologically
How do we describe tumour spread (stage)?
T = Tumour: the tumour size or extent of local invasion
N = Nodes: number of lymph nodes involved
M = Metastases: presence of distant metastases
This is called the “TNM” system and the details are different for each kind of cancer
Grade and Stage
- Grade = how differentiated is the tumour (see Differentiation, above)?
- Stage = how far as the tumour spread (see TNM above)?
- In terms of tumour prognosis, Stage is more important than Grade.
Recall principles of cancer screening
AIM: detect cancer at either a pre-invasive or early stage
TEN Features of a Successful Screening Programme
- Condition is an important health problem
- Treatment is possible
- Facilities for diagnosis/treatment are available
- Recognisable latent or early symptomatic stage
- Suitable test or examination
- Test is acceptable to the population
- Natural history understood
- Agreed policy on which patients to treat
- Cost-effective
- Case-finding should be a continuoud process
Examples
- Cervical cancer
- Breast cancer
- Colorectal cancer
Recall examples of carcinogens and the cancers they may cause
ENVIRONMENTAL
- UV –> BCC, SCC and MM
- Ionising Radiation (e.g. CT) à leukaemia + solid tumours
- Asbestos à Mesothelioma
INFECTION
- EBV -> Burkitt’s Lymphoma
- HPV -> Cervical Cancer
- Hepatitis B Virus -> HCC
- HHV8 -> Kaposi Sarcoma
- H. pylori -> Gastric Cancer and Lymphoma
CHEMICAL
- Hydrocarbons
- Amines
- Nitrosamines
- Azo dyes
Explain the alignment of the earth sun and moon during a solar eclipse
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2’ break
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next up is autopsy
hehe have fun
Autopsy: list reasons for conducting an autopsy, explain the consent process, and recall cases that must be reported to the Coroner
Who is the Coroner?
An independent judicial officer of the crown who has a statutory duty to investigate the circumstance of certain categories of death for the protection of the public (what where how someone died)
Cases that must be reported to the Coroner
1) The cause of death is unknown
2) The deceased has not been seen by the certifying doctor either after death or within the 14 days before death
3) The death was violent, unnatural or suspicious
4) The death may be due to an accident (whenever it occurred for example boy with epilepsy dying 40 yrs lates)
5) The death may be due to neglect by self or others
6) The death may be due to an industrial disease or due to the deceased persons employment
7) The death may be due to an abortion
8) The death occurred during an operation or before recovery from the effects of an anaesthetic
9) The death may be a suicide
10) The death occurred during or shortly after detention in police or prison custody
11) The death may be related to poisoning
Reasons for hospital autopsy
1 ) Allows a very thorough examination of the deceased, the extent of their disease, their treatment and its effects
2) Audit – Major discrepancies between stated cause of death and actual cause of death
(main diagnosis missed in 15% of cases subsequently autopsied
Cameron et al 1980 )
3) Monitoring effectiveness of new treatments
Eg complex congenital heart disease
Teaching
Eg unrivalled clinic pathological correlation
4) Research
Eg knowledge of variant CJD relies heavily on study of post mortem brain tissue
Two types of Autopsy
1) Hospital:
- Consent must be obtained from next of kin
- With consent any material can be taken
2) Coroners
- No consent of next of kin needed (but their wishes should be considered)
- Material can only be taken if it bears upon the cause of death (with Coroners permission)
Autopsy findings: summarise causes of sudden unexpected death
The Death Certificate
Scrutinised and must be correct before registration of death possible
1a Immediate cause of death (must be filled in example: Gun shot wound to head, Haemopericardium, Myocardial infarction)
1b Predisposing factor
1c Predisposing factor
2 Other factors contributing to but not directly leading to death
Natural causes of sudden unexpected death
(in the community)
- Cardiovascular
- Coronary artery disease
75% (approximately) of deaths handled by medical examiners in USA - Cardiac Arrhythmia
- Severe coronary artery atherosclerosis: most common anatomical finding
- Hypertensive heart disease
- Cardiomyopathy/ Myocarditis
- Coronary artery disease
- Vascular
- Ruptured aortic aneurism
- Central Nervous system
- Non traumatic subarachnoid haemorrhage
- Intracerebral haemorrhage
- Epilepsy
- Respiratory System
- Pulmonary embolus
- Asthma
- Gastro intestinal tract (Not usually unexpected)
(not natural)
- Drugs and Alcohol
- Trauma
- Inherited Conditions
Define and recall possible mechanism of injury for traumatic features which may be found on an autopsy including, a bruise, an abrasion, a laceration, a cut and a stab
Bruise (aka contusion): An extravasated collection of blood which has leaked from damaged small arteries, venules and veins but not capillaries.
example: punch
Abrasion: A graze or a scratch. It is confined to the epidermis. Most superficial of blunt trauma injuries.
example: carpet burn
Laceration: A split in the skin due to blunt force trauma. Passes through the full thickness of the skin.
example: hit on the head with a batom
Cut: LENGTH of wound > DEPTH of wound. Caused by sharp object with clean edges to the wound.
example: knife
Stab: DEPTH of wound > WIDTH of wound. Caused by sharp object with clean edges to the wound.
example: knife
u’re welcome for the nice pic
