Core Pathology Flashcards
Carcinoid tumour resection
Tumours greater than 2cm should have standard oncological resection
Lesions close to ICV should undergo a Right hemi
Carcinoid of appendix
Simple’s lesions (1-2cm) treated with simple Appendicectomy
Oesophageal cancer staging and lymph nodes
Abdominal wall lesions in patient with FAP
Desmond tumour (myofibroblasta) occur in up to 15% of patients with FAP
Pouts Jeghers syndrome screening
Small bowel evaluation is 3 yearly
In children if the index colonoscopy is normal, the. Repeat can be deferred until 18
Peutz - Jeghers Syndrome
Genetics - Autosomal Dominant, genes encodes serine threonine kinase LKB1 or STK11
Features- Hamartomatous pilots in GI tract. Pigmented lesions on lips, oral mucosa, face,palms and soles. Intestinal obstruction E.g intussusceptiob, GI bleeds
Management - Conservative unless complications develop.
Surveillance starts at 8 (OGD, colonoscopy and capsule endoscopy. Small bowel screening at 3yr. If index OGD/colon normal then defer till 18 (thereafter 3yrs)
Primary event in refeeding syndrome
The primary event in re-feeding following a period of starvation is that a carbohydrate load stimulates insulin release. This causes associated electrolyte shift of cations. Since these are often globally depleted in the starved state associated anion shifts may also occur. These can then lead to the consequences of re-feeding syndrome described below.
Which hepatitis virus is a DNA virus
Hep B
Liver lesions on contraceptive pill
Liver cell adenoma
What is heterotrophs
In heterotopia, the tissue type that is found in the abnormal location is present there from birth and does not migrate to that site subsequently or arise as a result of metaplasia. The tissue that lines a Meckels diverticulum is determined early in development.
Comman organisms with gas gangrene
Most cases of gas gangrene are due to Clostridium perfringens infection.
Diabetics may develop gas gangrene with Klebsiella but this is less common.
What proportion of breast cancers are Her-2 positive
25%
Warfarin treatment duration
Provided there are no other risk factors an above knee DVT is treated with warfarin to maintain an INR of 2.5 for 3 months.
For below knee DVT 6 weeks
Diabetic with hard, erythematous ans yellow centre ulcer
The appearances of necrobiosis lipoidica are very characteristic and the hard erythematous ulcer with a yellowish centre is a very classic descriptor. Whilst the condition can occur in non diabetics, the condition is most commonly encountered in the diabetic population.
Us features of liver cysts
Cavernous Haemangioma- well defined and hyperechoic
Liver cell adenoma - mixed echoity and heterogenous
Cystadenoma - large anechoic fluid filled areas with irregular margins.
What is the most common benign liver lesion
Haemangioma
Diffuse type Gastric cancer
Diffuse carcinomas have an equal sex distribution and younger average age at presentation. An endophytic (ulcerative growth pattern is usual).
Intestinal metaplasia and chronic atrophic gastritis are seen more commonly with intestinal type gastric carcinoma.
Lauren classification of gastric adenocarcinima
What is a Gohan Focus
A Gohn focus is the initial site of TB infection, this and the involvement of the draining lymph nodes quates to a Gohn complex. The lung is the most common site.
Duration if trastuzumab
1 year unless develops recurrence sooner
Antiphospholipid syndrome antibodies
Anti phospholipid syndrome= following antibodies
• Lupus anticoagulant
• Anti-cardiolipin
• Anti-B2-glycoprotein
How many lymph nodes should you aim to retrieve in colorectal cancer
12
Liver cell adenoma
• 90% develop in women in their third to fifth decade
• Linked to use of oral contraceptive pill
• Lesions are usually solitary
• They are usually sharply demarcated from normal liver although they usually lack a fibrous capsule
• On ultrasound the appearances are of mixed echoity and heterogeneous texture. On CT most lesions are hypodense when imaged prior to administration of IV contrast agents
• In patients with haemorrhage or symptoms removal of the adenoma may be required
• Asymptomatic adenomas > 5cm are usually excised
Breast cancer special types
Medullary carcinoma has a prognosis that is more favorable than conventional invasive ductal carcinoma. In contrast, invasive micropapillary carcinoma of the breast is a distinct and aggressive variant of breast cancer with marked lymphotropism, extensive axillary lymph node involvement, frequent local recurrence, and distant metastases.
This behavior seems independent of patient age, tumor size, location, histologic grade, and extent of the micropapillary growth pattern.
Blood films post splenectomy
Howell-Jolly bodies
Pappenheimer bodies
Poikilocytes (Target cells)
Erythrocyte containing siderotic granules
Heinz bodies
Stipple cells are found in lead poisoning or haemoglobinopathies
Signet cells on histology
With diffuse type cancers there is often excessive mucin production. This has the effect of pushing the nucleus towards the periphery of the cell. This produces a ‘signet cell’ appearance histologically.
Brown tumours of bone are associated with which of the following?
Brown tumors are tumors of bone that arise in settings of excess osteoclast activity, such as hyperparathyroidism, and consist of fibrous tissue, woven bone and supporting vasculature, but no matrix. They are radiolucent on x-ray. The osteoclasts consume the trabecular bone that osteoblasts lay down and this front of reparative bone deposition followed by additional resorption can expand beyond the usual shape of the bone, involving the periosteum thus causing bone pain. They appear brown because haemosiderin is deposited at the site.
Pathophysiology of AAA
in established aneurysmal disease there is dilation of all layers of the aneral wall and loss of both elastin and collagen. The primary event is loss of elassic fibres from the media with subsequent degradation of collagen fires.
Breast TNM
What is the most common location of intra-abdominal TB
Terminal ileal infection is the commonest site. Not infrequently the diagnosis is an intra operative one.
Most comman bacteria in Perianal abscess
Most ano rectal abscesses are the result of E-coli, the incidence of staphylococcal infections is rising but less prevalent than those derived from the gut lumen.
Management of small bowel adenocarcinoma
Most small bowel adenocarcinomas (which are relatively chemoresistent) should be treated with surgical resection as the primary (and only) treatment modality.
Carotid body tumours
Most sporadic carotid body tumours are benign
The incidence of malignancy is higher in familial cases (which present at a younger age)
Incidence of 5%
Carotid body tumour histology
Carotid body tumours in people from Western countries are usually sporadic lesions and are best described as paraganlionomas. These have a classical histological appearance of chief cells surrounded by sustentacular cells.
Merkel cell tumour
• Rare but aggressive tumour.
• Develops from intra epidermal Merkel cells.
• Usually presents on elderly, sun damaged skin. The periorbital area is the commonest site.
• Histologically these tumours appear within the dermis and subcutis. The lesions consist of sheets and nodules of small hyperchromatic epithelial cells with high rates of mitosis and apoptosis. Lymphovascular invasion is commonly seen.
• Pre-existing infection with Merkel Cell Polyomavirus is seen in 80% cases.
Histology of a rectal prolapse
Histological features of rectal prolapse:
Diamond shaped crypts
Sub mucosal elastic fibres
Hydatid cyst organism
Echinococcus granulosus is the only cestode found in the UK. Infection with oligarthrus and vogeli is seen in South America. Multiocularis infection is typically seen in many countries in the Northern Hemisphere.
Breast cancer Met site
Distant metastasis from breast cancer typically affects bone in the first instance. In patients dying from distant metastasis the lung is the commonest site of disease.
Nec Fasc bacteria
Monomicrobial infections of necrotising fasciitis are most likely to be due to Streptococcus pyogenes, other organisms may be responsible but are cultured in decreased frequency.
Colon cancer synchronous mets
Syncrhonous lesions are found in 5% of cases and it is for this reason that the whole colon be imaged pre-operatively. If the patient already has a tissue diagnosis then this can readily be achieved with CT colonography which has the advantage of simultaneous staging.
Which type of BCC has the highest risk of local recurrence
Morpheaform and micronodular BCC’s have the highest rates of local recurrence and should be considered for primary treatment with Mohs microsurgery
Oesophageal cancer survival rate
Factor 5 Leiden
Resistance to activated protein C occurs as a result of a point mutation affecting the synthesis of clotting factor V. This is otherwise known as factor V Leiden and is one of the most common genetic causes of deep vein thromboses.
Most likely underlying cause if amoebic liver abscess
Entamoeba histolytica
Although 10% of the global population are infected with Entamoeba histolytica, less than 10% of those affected develop symptoms.
Liver abscess is the most common extra intestinal manifestation of the condition.
Sarcoma
• Tumours of mesenchymal origin
• In adults; malignant fibrous histiocytoma is the commonest type
• Overall, sarcomas account for 1% of all malignancies
• The extremities are affected as the primary site in over 40% of cases
• Diagnosis of low grade lesions may be challenging and incomplete resection can result in high rates of local recurrence
• Most cases are treated surgically, resection with 2cm margins is the usual standard of care
• Visceral (primarily lung) blood borne metastasis are more common than lymphatic spread
• Adjuvant radiotherapy may be used to help in local control in patients with high grade, superficial lesions.
• Neoadjuvant chemotherapy is generally unhelpful, exceptions to this include Ewings and Rhadomyosarcomas (usually seen in children).
Associated syndromes - Li - fraumeni, VHL, radiotherapy, retinoblastoma
HIV
Features
• HIV is a RNA retrovirus
•. It may also be classified as a lentivirus (slow progression)
• Two variants - HIV-1 and HIV-2
• HIV-2 is more common in west Africa, has a lower transmission rate and is thought to be less pathogenic with a slower progression to AIDS
Structure
• gag gene - core proteins p24, p17, p15
• pol gene- polymerase/reverse transcriptase
• env gene - envelope proteins, gp120 and gp41
Insulinoma
• Insulin producing tumours of the pancreatic cells
• Incidence of 1 per 1,000,000 per year
• 90% of lesions are benign
• Most tumours less than 2cm in size
• Between 5 and 10% have MEN type 1
• 75% of patients with MEN 1 will develop pancreatic islet cell tumours
Buerger disease
Acute hypercellular occlusive thrombus
Hypercalcaemia
Clinical features
Stones, bones, abdominal groans, and psychic moans
High serum calcium levels result in decreased neuronal excitability. Therefore sluggis reflexes, muscle weakness and constipation may occur.
Causes of raised CEA
Heavy smoking
Chemo with 5FU
UC
Liver dysfunction
