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Pathology > Grading and Prognostication > Flashcards

Grading and Prognostication Flashcards

1
Q

Breast carcinoma - MBR

A
  • Tubule formation:
  • -1 = > 75% tubules
  • -2 = 10-75% tubules
  • -3 = < 10% tubules
  • Mitoses: -counted per 10 HPF -dependent upon focal field
  • Nuclear pleomorphism
  • -1 = nuclei with mimimal variation in size and shape
  • -2 = nuclei with moderate variation in size and shape
  • -3 = nuclei with marked variation in size and shape
  • Final total: I = 3-5 II = 6-7 III = >7
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2
Q

Endometrioid endometrial carcinoma

A

% nonsquamous areas show solid growth and no glandular features Grade I = 50% solid

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3
Q

What are determinants of prognosis in seminoma?

A
  • pathologic stage - tumor size - rete testis invasion - intertubular growth > 3 high-power fields Note: LVI important prognostic factor in univariate analysis but not independent prognostic factor; Concept of “anaplastic” seminoma (> 3 mitoses per high-power field) is not accepted as separate entity and not adverse prognostic factor
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4
Q

Features of Leydig cell suggeseting malignancy

A
  • large tumour size (>5 cm) - infiltrative margins - vascular invastion - nuclear atypia - necrosis - high mitotic rate (> 3/10 hpf)
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5
Q

Urothelial carcinoma special subtypes

A

nested micropapillary microcystic with small tubules plasmacytoid carcinoma lymphoepithelioma-like carcinoma small cell sarcomatoid with rhabdoid features with osteoclast-like giant cells with clear cytoplasm with lipoid features large cell undifferentiated

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6
Q

What are the four histological types of neuroblastoma?

A

Neuroblastoma (Schwannian stroma-poor) Ganglioneuroblastoma, nodular (composite, Schwannian stroma-rich/stroma-dominant and stromapoor) Ganglioneuroblastoma, intermixed (Schwannian stroma-rich) Ganglioneuroma (Schwannian stroma-dominant)

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7
Q

Histological subtypes of melanoma

A

Superficial spreading melanoma Nodular melanoma Lentigo maligna melanoma Acral lentiginous melanoma Mucosal-lentiginous melanoma Desmoplastic/neurotropic melanoma Melanoma arising from blue nevus Melanoma arising from a giant congenital nevus Melanoma in childhood Nevoid melanoma Persistent melanoma Melanoma, not otherwise classified

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8
Q

Prognostic features for urothelial carcinoma

A

depth of invasion - stage histological variants LVI LN and distand mets associated CIS or multifocality

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9
Q

Poor prognostic histological types of urothelial carcinoma

A

Small cell micropapillary sarcomatoid undifferentiated carcinoma with rhabdoid features plasmacytoid carcinoma

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10
Q

Colorectal carcinoma

A
  • Low grade (grade 1): >95% glands (15-20% of all carcinomas)
  • Moderately differentiated (grade 2): 50-95% glands (60-70% of all carcinomas)
  • High grade (grade 3): < 50% gland formation (15-20% all of carcinomas
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11
Q

Nuclear grading of DCIS

A
  • nuclear size: 1 = <1.5 rbc, 2=1-2 rbc, 3 =>2.5 rbc
  • mitoses/10hpf: 1 = < 1, 2 = 1-2, 3 = >2
  • nuclear plemorphsm: mild = 1, moderate = 2, severe = 3
  • necrosis: 1 = none, 2 = central necrosis, 3 = comedonecrosis
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12
Q

Phyllodes grading

A
  • Benign:
    • mild stromal cellularity
    • minimal stromal pleomorphism
    • no infiltrative border
    • 0-1 mits/10HPF
  • Borderline
    • moderate stromal cellularity
    • mild stromal pelomorphism
    • may have infiltratrive border
    • 2-5 mits/10HPF
  • Malignant
    • marked stromal cellularity
    • marked stromal pelomorphism
    • stromal overgrowth (4X field full of stroma)
    • infiltratrive border
    • >5 mits/10HPF
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13
Q

Gleason Grading

A
  1. non-infiltrative nodule, round to oval nuclei with back to back glands
  2. well circumscribed nodule with minimal infiltration; more loosely arranged
  3. clearly infiltrative pattern with variable gland size and shape; all glands are distinct (circle around all glands)
  4. fused glands, poorly defined, cirbiform or glomeruloid
  5. solid sheets, rosettes, cords or single cells; comedonecrosis
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14
Q

Ruhrman nuclear grading of RCC

A
  • grading guidelines: worst area, applies to clear cell
  • nuclei
    • 1 - small, round and uniform
    • 2 - larger, crinkly nuclear membrane
    • 3 - large and very crinkly
    • 4 - pleomorphic, clumped chromatin
  • nucleoli
    • 1 - absent
    • 2 - absent to inconspicuous
    • 3 - conspicuous (visibla at 10X)
    • 4 - prominent
  • other
    • 4 - sarcomatoid features
    • sarcomatoid carcinoma = Grade 4
    • collecting duct = Grade 3-4
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15
Q

Criteria for anaplasia in Wilms Tumour

A
  • nucleomegaly (at least 3X)
  • nuclear hyeprchromasia
  • atypical mitoses

predicts resistance to chemomotherapy

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16
Q

Flat dysplasia vs flat CIS

A
  • dysplasia:
    • some features of CIS but fall short of threshold
  • CIS:
    • nucleomegaly (5X stromal lymphocyte or 2-3X normal urothelium)
    • pleomorphism
    • crowding
    • loss of polarity
17
Q

Classification of non-invasive papillary urothelial neoplasm

A
  • papilloma
    • < 7 layers
    • orderly, polarised, without crowding or disorganisation
    • no pleomorphism
    • no mits
    • no fusion or branching
  • PUNLMP
    • increased thickness
    • orderly, polarised, without crowding or disorganisation
    • no pleomorphism
    • rare basal mits
    • rare fusion or branching
  • LGTCC
    • increased thickness
    • minimal crowding or disorganisation
    • mild pleomorphism
    • occ mits at any level
    • occ fusion or branching
  • HGTCC
    • increased thickness
    • prominent crowding or disorganisation
    • moderate to severe pleomorphism
    • requent mits at any level
    • frequent fusion or branching
18
Q

Thyroid carcinoma grading by histolgoical type or features

A
  • well differentiated
    • papillary (caveat for high risk histology: tall cell, columnar or diffuse sclerosing)
    • follicular - widely invasive or encapsulated
  • moderatly differentiated
    • some place high risk PTC histo here but is controversial
  • poorly differentiated
    • insular, solid or trabecular + no PTC features + one of (convoluted nuclei, elevated mits > 2/ 10HPF or necrosis)
    • some groups use necrosis or mites > 3/10HPF
  • undifferentiated
    • minimal or no thyroid differentiation
    • squamoid, pelomrphicc/giant cell and spindled variants
19
Q

Mucoepidermoid AFIP grading

A
  • Point scale:
    • Low-grade 0-4
    • Intermediate-grade 5-6
    • High-grade >7
  • Features
    • 2 points - cystic componenet < 20%
    • 2 points - neural invasion
    • 3 points - necrosis
    • 3 points > 4 mits/10HPF
    • 4 points - anaplasia
20
Q

Autoimmune sialoadenitis in labial biopsy

A
  • focus = 50 lymphs, plasma cells or macrophages
  • Grade based on amount of inflammation
    • 0 - absent - ND
    • 1 - slight infiltrate - ND
    • 2 - moderate infiltrate ( <1 focus/ 4mm2) - ND
    • 3 - 1 focus/ 4mm2 - suggestive
    • 4 - > 1 focus/ 4mm2 - diagnostic
21
Q

Salivary gland neoplasm grading by histological type

A
  • Low-grade
    • acinic cell carcinoma
    • polymorphous low-grade adenocarcinoma
    • basla cell adenocarcinoma
    • epithelial-myoepitheilal carcinoma
  • Intermediate-grade
    • adenoid cystic carcinoma
    • myoepithelial carcinoma
  • High-grade
    • salivary duct carcinoma
    • large cell carcinoma
22
Q

Barrett’s esphagus grading

A
  • Negative for dysplasia
    • no architectural atypia
    • no cytological atypia
    • surface maturation present
    • inflammation variable
  • Indefinite for dysplasia
    • minimal architectural atypia
    • mild cytological atypia
    • surface maturation present
    • inflammation frequent
  • low-grade dysplasia
    • mild architectural atypia
    • moderate cytological atypia
    • surface maturation absent
    • inflammation minimal
  • high-grade dysplasia
    • prominent architectural atypia
    • severe cytological atypia with loss of polarity
    • surface maturation absent
    • inflammation minimal
23
Q

French system for soft tissue sarcoma grading

A
  • Final score:
    • Grade 1 = 2-3
    • Grade 2 = 4-5
    • Grade 3 = 6-8
  • Tissue differentiation
    1. closely resemble normal
    2. definite histologic type
    3. embryonal, poorly differentiated or uncertain histo
  • Mitoses (/10HPF)
    1. 0-9
    2. 10-19
    3. >19
  • Tumour necrosis
    1. no necrosis
    2. <50%
    3. >50%
24
Q

Pulmonary NET grading

A
  • neuroendocrine cell hyperplasia - <2 mm
  • carcinoid tumourlet - <5 mm
  • typical carcinoid
    • < 2 mits/10HPF
    • no necrosis
    • < 2% Ki-67 *
  • atypical carcinoid
    • 2-10 mits/10HPF
    • focal necrosis
    • < 20% Ki-67 *
  • NEC
    • >10 mits/10HPF
    • extensive necrosis
    • > 20% Ki-67 *
25
Q

GI/pancreatic NET grading

A
  • NET, Grade 1
    • < 2 mit/10HPF
    • < 3% Ki-67
  • NET, Grade 2
    • 2 - 20 mit/10HPF
    • 3 - 20% Ki-67
  • NEC, Grade 3
    • > 20 mit/10HPF
    • > 20% Ki-67

Must count 50 HPF for mitoses

Must count 500-2000 cells in hot spots for Ki-67

26
Q

Prognostic features for GI/pancreatic NET

A
  • Site:
    • poor: colon, esophagus
    • good: appendix, rectum
    • intermediate: small bowel, stomach
  • Clinical setting:
    • gastric NETs excellent if ZES, MEN1 or pernicious anemia vs sporadic which is worse
  • Size and depth of invasion
  • Type of hypersecretory syndrome in pancreas
    • insulinom - better
    • glucagonaom - worse
27
Q

Revised Shimada for Neuroblastoma

A
  • Stroma rich (> 50% schwannian stroma)
    • no microscopic nodules of NB cells; FH = ganglineuroma, maturing
    • microscopic nodules of NB cells; FH = ganglineurblastoma, intermixed
    • macroscopic nodules of NB cells; UH/FH = ganglioneuroblastoma, nodular
  • Stroma poor (< 50% schwannian stroma)
    • no ganglion cells; no neuropil; always FH (any age) - undifferentiated neuroblastoma
    • < 5% ganglion cells; neuropil present; UH if >1.5 y or MKI >4% otherwise FH = poorly differentiated neuroblastoma
    • >5% ganglion cells; neuropil present; UH if > 5 y or 1.5-5 y + MKI > 2%, or < 1.5 y + MKI > 4% = differentiating neuroblastoma
28
Q

Trophoblastic disease prognostic factors?

A
  • Overall score <7 low risk and 7 or greater is high risk
  • Factors:
  • age - <40 (0), > 40 (1)
  • antecedent pregnancy - mole (0), abortion (1), term preg (2)
  • months from antecedent - <4 (0), 4-<7 (1), 7-12 (2), >12 (4)
  • pretx bHCG - <1 000 (0), 1000 - 10 000 (1), 10^4-10^5 (2), >10^5 (4)
  • tumour size - < 3 cm (0), 3-5 cm (1), >5 cm (2)
  • met site - lung, (0), spleen/kidney (1), GI (2), liver/brain (4)
  • number of mets - 1-4 (1), 5-8 (2), >8 (4)
  • failed chemotx - single drug (2), multidrug (4)

Pathology (11 decks)

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