Histo Flashcards
what do neutrophil polymorphs indicate
acute inflammation
what do lymphocytes indicate
chronic inflammation
lymphocytes + neutrophils =
acute on chronic
what is the loss of surface epithelium +/- lamina propria with muscularis in tact
erosion
what is the loss of surface epithelium with depth of tissue loss beyond the muscularis mucosae
ulcer
ulcer with element of fibrosis
chronic ulcer
what is dysplasia
cytological and histological features of malignancy, basement membrane in tact
what are the two roads to GI cancer
metaplasia-dysplasia pathway (oesophageal)
adeno-carcinoma pathway (colorectal cancer)
features of adenocarcinoma
gland forming
mucin secreting
features of squamous cell carcinoma
make keratin
inter-cellular bridges
what is the squamo-columnar junction called in oesophagus
Z line
what subtype of barrett’s oesophagus carries greater risk
goblet cell positive(intestinal type columnar epithelium)
stain to highlight intestinal type columnar epithelium
methylene blue
most common oesophageal malignancy worldwide
upper/mid oesopahgeal SCC
alcohol/ cigarettes
most common oesophageal malignancy UK
distal adenocarcinoma (columnar epithelium transformation)
GORD/ oesophagitis
oesophageal varices cause
portal HTN: cirrhosis, portal vein thrombosis, IVC obstruction
oesophageal varices presentation
upper gi bleed, melaena
oesophageal varices management
fluid resuscitate, terlipressin, scope, PPI infusion
should goblet cells be seen in stomach?
NO - indicates intestinal type metaplasia
what do chief cells produce
pepsin
what do parietal cells produce
intrinsic factor
HCl
causes of acute gastritis
alcohol consumption, NSAIDs, H. pylori, stress
causes of chronic gastritis
autoimmune (pernicious anaemia), H. pylori, bile reflux, NSAIDs, CMV if immunosuppressed, crohn’s
H. pylori eradication therapy
PPI
clarithromycin
amoxicillin or metronidazole
h pylori under microscope
gram negative curved rod
what is H pylori associated with
MALT, B cell marginal lymphoma
what is the main type of gastric cancer
adenocarcinoma (95%)
other 5% are SCC, lymphoma, GIST
what are the two types of gastric adenocarcinoma
intestinal - well-differentiated, mucin producing, gland forming
diffuse - sinlge-cell architecture, no gland formation, signet-ring cells
what are signet ring cells associated with
diffuse type gastric adenocarcinoma
usual type of stomach cell
columnar epithelium
most common cause of duodenal ulcers
H pylori
coeliac disease changes on biopsy
villous atrophy, crypt hyperplasia
lymphocytic duodenitis villous structure
NORMAL
examples of non-neoplastic polyps
hyperplastic polyps
inflammatory pseudo-polyps
hamartomatous polyps
examples of neoplastic polyps
tubular adenoma
tubulovillous adenoma
villous adenoma
polyps with increased risk of cancer
higher villous component, dysplastic features
pathology of liver fibrosis
kupferr cells activated
stellate cells activated –> myelofibroblasts
basement membrane secreted
collagen in space of disse
features of liver cirrhosis
whole liver fibrosis with nodules of regenerating hepatocytes and distortion of vascular architecture
alcoholic hepatitis features
ballooning of cells
mallory denk bodies
apoptosis
pericellular fibrosis
hypoxic zone 3
relatively irreversible
most common cause of liver cancer
secondary metastatic disease
primary tumours of the liver
hepatocellular carcinoma
hepatoblastoma
cholangiocarcinoma
haemangiosarcoma
peri-ductal injury in acute pancreatitis suggests what cause
obstructive cause
peri-lobular injury in acute pancreatitis suggests what cause
vascular cause
acute pancreatitis pathology
reflux enzymes –> acinar necrosis –> release of more enzymes
release of lipases –> fat necrosis –> soaponification with calcium
acute pancreatitis complications
haemorrhagic pancreatitis
hypoglycaemia, hypocalcaemia
pesudocyst, abcess
chronic pancreatitis features
fibrosis, duct strictures, loss of paenchyma
main cause = alcohol
main type of pancreatic carcinoma
ductal (85%)
other type = acinar
other types of pancreatic cancer
cystic neoplasms: - serous cystadenoma
- mucinous cystic neoplasm
neuroendocrine tumours
pancreatic neuroendocrine tumour features
associated with MEN1 (pituitary, pancreas and parathyroid)
most commonly in tail
most commonly non-secretory
most common type if secretory = insulinoma
pancreatic ductal carcinoma features
95% associated with K-ras mutations
most common in head (60%)
nephrotic syndrome triad
hypoalbuminaemia
proteinuria
oedema
primary causes of nephrotic syndrome
minimal change disease
membranous glomerular disease
focal segmental glomerulosclerosis
membranoproliferative glomerulonephritis
secondary causes of nephrotic syndrome
SLE
diabetes
amyloidosis
minimal change disease on electron microscopy
loss of podocyte foot processes
minimal change disease management
oral prednisolone
most common cause of adult nephrotic syndrome
membranous glomerular disease
membranous glomerular disease auto-antibody
anti-phospholipase A2 receptor
membranous glomerular disease light microscopy
diffuse GBM thickening
membranous glomerular disease electron microscopy
loss of podocyte foot processes
spikey subendothelial deposits
membranous glomerular disease management
ACEi/ ARB, Bp control
focal segmental glomerulosclerosis light microscopy
focal and segmental scarring, hyalinosis
focal segmental glomerulosclerosis electron microscopy
loss of podocyte foot processes
focal segmental glomerulosclerosis management
ACEi/ ARB, BP control
50% respond to steroids
nephritic syndrome features
proteinuria
haematuria
azootemia (high urea and creatinine)
red cell casts
oliguria
HTN
nephritic syndrome causes
acute post-infectious GN
IgA nephropathy (berger’s disease)
rapidly progressive GN (cresentic)
Alport’s syndrome (hereditary nephritis)
thin basement membrane disease (benign familial haematuria)
acute post infectious GN features
1-3 weeks after strep throat or impetigo
acute post infectious GN bloods
high antistreptlysin O titer (ASOT)
low C3
acute post infectious GN light microscopy
increased cellularity of glomeruli/ mesangium
acute post infectious GN electron microscopy
subendothelial humps
acute post infectious GN immunofluorescence
granular deposition of IgG + C3
acute post infectious GN management
supportive
IgA nephropathy features
most common cause of GN worldwide, east/ south asian patients
days after URTI/ GI infection
frank haematuria
deposition of IgA immune complexes
can progress to ESRF
IgA nephropathy bloods
high igA
IgA nephropathy immunofluorescence
granular deposition of IgA and C3 in mesangium
IgA nephropathy rule of thirds
1/3 asymptomatic
1/3 CKD
1/3 progressive ckd –> dialysis/ transplantation
rapidly progressive GN features
ESRF within weeks, most aggressive GN
rapidly progressive GN type 1 association
anti-GBM antibody
rapidly progressive GN type 2 association
immune complex mediated
rapidly progressive GN type 3 association
ANCA associated, pauci-immune
alport’s syndrome features
type 4 collagen mutation
nephritic syndrome
sensorineural deafness
eye disorders (lens dislocation, cataracts, macular retinal flecks)
alport’s syndrome inheritance
x linked
thin basement membrane disease features
asymptomatic microscopic haematuria
renal function normal
excellent prognosis
autosomal dominant
most common type of ovarian cancer, with columnar epithelium and psammoma bodies on histology
serous cystadenoma
ovarian cancer with mucin secreting cells, NO psammoma bodies. epithelium may resemble GI or endocervical epithelium
mucinous cystadenoma
ovarian cancer with tubular glands on histology, with endometriosis as a risk factor
endometroid carcinomas
ovarian cancer with clear cells, and hobnail appearance on histology. strong association with endometriosis, poor prognosis
clear cell carcinomas
most common ovarian cancer in young women, usually benign
dysgerminoma
tumour with differentiation into mature tissues e.g. skin, teeth, hair, bone, cartilage
cystic teratoma (aka dermoid cyst)
tumour type that secretes hCG and mimics pregnancy
choriocarcinoma
ovarian sex cord tumour that secretes oestrogen
symptoms include post-menstrual/ intermenstrual bleeding, endometrial/ breast cancer, breast enlargment
granulosa/ theca cell tumours
ovarian sex cord tumour that secretes androgens
symptoms include virilisation, breast atrophy, hirsuitism, enlarged clitoris
sertoli-leydig cell tumours
sex cord tumour that doesn’t secrete any hormones
benign, 50% associated with meig’s syndrome (r sided pleural effusion, ascites)
fibroma
high risk hpv strains
16, 18
most common type of cervical cancer
SCC (80%)
other 20% = adenocarcinoma
red painful breast, tender to touch, hot. neutrophils present on cytology
acute mastitis
multiparous 40-60 y/o smoker with greeny brown nipple discharge. cytology shows proteinaceous material and inflammatory cells, histology shows duct dilation, proteinaceous material inside the duct and periductal inflammation.
duct ectasia
obese middle aged woman with a painless, firm breast mass after surgery. cytology shows empty fat spaces, histiocytes, multinucleated giant cells. can cause nipple retraction
fat necrosis
breast cancer that is almost always found incidentally. no microcalcifications, so doesn’t show up on USS or mammography. NO necrosis
lobular carcinoma in situ
breast cancer with areas of calcification seen on mammography and with necrosis
ductal carcinoma in situ
features of invasive breast carcinoma
peau d’orange, tethering, paget’s disease of breast (eczema on nipple), nipple retraction, lymphadenopathy, ulceration, bloody discharge
most important prognostic factor for breast cancer
status of axillary lymph nodes
ER/PR receptor positive breast cancer prognosis/ treatment
good prognosis
tamoxifen
HER2 receptor positive breast cancer prognosis/ treatment
poor prognosis
herceptin
breast lumpiness, cyclical (related to menstruation), very common
fibrocystic disease
20-30 yo with a freely mobile breast lump, changes in size with menstrual cycle. histology shows stromal and glandular tissue
fibroadenoma
enlarging fibroepithelial mass in woman >50. Histology shows leaf-like fronds/ artichoke like appearance, glandular and stromal proliferation, overlapping cells
phyllodes tumour
benign cause of bloody nipple discharge in 40-60 yos. cytology shows branching papillary groups of epithelium. histology shows a papillary mass within a dilated duct, papillary mass tends to have fibrovascular core
intraductal papilloma
central zone of scarring surrounded by radiating zone of proliferating glandular tissue. stellate mass on mammogram (resembles carcinoma)
radial scar
benign bone tumour in woman <30 affecting proximal femur/ ribs/ tibia/ skull.
xray shows soap-bubble osteolysis, shepherd’s crook deformity if femur affected.
histology - chinese letters (marrow replaced by fibrous stroma and rounded trabecular bone
fibrous dysplasia
benign bone tumour in men aged 10-20 at the ends of longs bones
most common benign bone tumour
x ray shows bony protuberance with cartilage cap - ‘mushroom’
osteochondroma
benign bone tumour with risk of malignant transformation. Affects fingers and hands of middle aged, can cause pathological fractures.
xray shows popcorn/ cotton wool calcification, o ring sign
echondroma
benign bone tumour causing dull pain at night in tibial diaphysis, proximal femur, adolescent boys. pain relieved by aspirin
osteoid osteoma
most common primary bone cancer. men aged 10-30 with bone forming at end of long bones, most commonly knee. causes pain and a mass.
xray shows elevated periosteum (Codman’s triangle), mixed sclerotic and lytic lesions, cortical breach, sun-burst appearance
histology shows malignant mesenchymal cells, stain for ALP is positive
osteosarcoma
malignany bone tumour that is cartilage producing in axial skeleton, proximal femur/tibia, pelvis, pts aged >40
xray shows lytic lesions with fluffy calcification
chondrosarcoma
malignant bone tumour of under 20s, at the diaphysis/ metaphysis of long bones or pelvis.
xray shows onion skinning of periosteum, lytic lesions +/- sclerosis
histology shows sheets of small round cells, CD99 positive, ALP negative
Ewing’s sarcoma
malignant bone tumour of 20-40 yo women, at knee epiphyses with extension into metaphysis
xray shows lytic appearance, soap-bubble appearance
histology shows giant multinucleate osteoclasts
giant cell tumour
RA features
periarticular erosions, osteopenia, soft tissue swelling, subluxations
osteoarthritis features
loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis
what condition is associated with bamboo spine
ankylosing spondylitis
psoriatic arthritis features
new fluffy bone
nail changes - onycholysis, nail pitting
reactive arthritis features
seronegative
HLA-B27 associated
sacroiliac and knee joints
associated keratoderma, blennorrhagica, circinate balanitis, enthesitis of achilles tendon
psoriasis features
parakeratosis - nuclei within stratum corneum, thick keratin layer, silvery scales
loss of stratum granulosum - auspitz sign
purple, pruritic, papules and plaques on inner surface of wrists. white lacy appearance in mouth (wickam striae)
lichen planus
ulcer due to underlying disease (colitis, leukaemia, sclerosing cholangitis)
pyoderma gangrenosum
pigmented, cauliflower like lesion with a stuck on appearance. histology shows horn cysts and orderly proliferation of epidermis
seborrhoeic keratosis
pre-malignant lesion with warty, sandpaper like texture in sun exposed areas. histology shows solar elastosis, parakeratosis, atypia/ dysplasia, inflammation
actinic keratosis
superficial skin blisters that easily rupture leading to raw red surface. nikolsky’s sign is positive. acantholytic cells on biopsy, mucosal involvement
pemphigus vulgaris
antibodies associated with pemphigus vulgaris
desmoglein 1 and 3
elderly patient, with tense bullae on flexor surfaces that do not easily rupture
bullous pemphigoid
antibodies associated with bullous pemphigoid
anti-hemidesmosome
excoriated red area (bullae rupture too easily to see intact), less severe course than pemphigus vulgaris
pemphigus foliaceus
initial salmon pink lesion (herald patch) –> multiple oval macules in fir tree distribution
follows an URTI
pityriasis
rolled pearly edge with central ulcer and fine telangiectasia in a sun exposed area in an elderly person, does not metastasise
BCC
most common type of amyloidosis
AL amyloidosis
associated with paraproteins (e.g. multiple myeloma)
AA amyloidosis
associated with chronic infection/ inflammation (RA, crohn’s)
sarcoidosis features
non-caseating granulomas, lungs most commonly affected, high ACE
associations - erythema nodosum, hypercalcaemia, uveitis
fontana stain
positive for melanin, melanoma
congo red stain with apple green birefringence under polarised light
amyloidosis
rhodanine stain
golden brown against blue background = copper (Wilson’s disease)
prussian blue stain
blue = iron, haemachromatosis
perl’s stain
positive = iron, haemachromatosis
cytokeratin is used for
epithelial marker, carcinoma
cd45 is used for
lymphoid marker, lymphocyte
ziehl-neelson stain
red against blue background = TB
auramine stain
bright yellow fluorescence = TB
gomori’s methanamine silver stain
flying saucer shaped cysts = pneumocystis jiroveci
modified kinyoung acid fast stain
cryptosporidium parvum
india ink stain
yeast cells surrounded by halos = cryptococcus neoformans
giemsa stain
cytoplasmic inclusions = chlamydia psittaci
fite stain
mycobacterium leprae
what is aflatoxin from aspergillus a risk factor for
hepatocellular carcinoma
chronic bronchitis histology
mucus gland hypertrophy, goblet cell hyperplasia/ metaplasia
microscopic polyangitis features
small vessel vasculitis, immune complexes
affects skin, heart, brain, kidneys
pANCA association
condition with a thickened aortic arch, leading to no palpable pulses, reduced blood pressure in arms and hands
takayasu arteritis
inclusion bodies deposited in alpha-synuclein neurons
parkinsons
features of subdural haemorrhage
between dura and arachnoid due to tear in bridging vein
caused by trauma
raised ICP
haematoma development takes 48hrs
conditions associated with SAH
polycystic kidney disease, aortic coarctation, fibromuscular dysplasia, Berry aneurysm, HTN
features of an extradural haemorrhage
middle meningeal artery rupture from pterion fracture
lucid interval
intracerebral haemorrhage
HTN –> hyaline arterioscleorsis, charcot-bouchard aneurysms
crohn’s disease extra-intestinal manifestations
artheritis
ankylosing spondylosis
stomatitis, uveitis
derm lesions (pyoderma gangrenosum, erythema nodosum)
crohn’s disease features
transmural inflammation, skip lesions, fistulae
non-caseating granulomas
haemachromatosis features
autsomal recessive
cirrhosis, diabetes, bronzed skin, cardiomyopathy, gondal atrophy, impotence
primary biliary cirrhosis features
jaundice, xanthelasma, pruritis
raised ALP, GGT, IgM, cholesterol
associated with sjogren’s
what is adenocarcinoma of the bile ducts called
cholangiocarinoma
cholangiocarcinoma risk factors
primary sclerosing cholangitis
parasitic liver fluke infection
exposure to imaging contrast media
alpha1-antitrypsin deficiency features
emphysema
cirrhosis
primary sclerosing cholangitis features
periductal fibrosis
concentric onion ring fibrosis
symptomatic individual with a fasting glucose over what number indicates diabetes
7
most common type of lung cancer in uk
adenocarcinoma
hepatobiliary pathology associated with pANCA
primary sclerosing cholangitis
mallory denk bodies on liver biopsy
alcoholic hepatitis
chemo for CLL increases risk of which type of kidney stone
uric acid
keratin pearls in which cancer
squamous cell carcinoma
what do pancreatic delta cells produce
somatostatin
positive anti-mitochondrial antibody, hepatobiliary disease with granulomas
primary biliary cirrhosis
most common cause of chronic renal failure in UK
diabetes
MODY inheritance
autosomal dominant
IBD with non-caseating granulomas
crohn’s
18 year old man with nephritic syndrome, cataracts and sensorineural deafness
Alport’s
honeycomb lung
interstitial lung disease
stain for iron
prussian blue
pancreatic cancer marker
ca 19-9
stool marker for IBD
calprotectin
wilson’s disease treatment
zinc
trientine
ECG leads 2,3 and aVF represent which region of heart
inferior wall
positive male pregnancy test
testicular cancer
kimmelstiel wilson nodules on renal biopsy
diabetes
epigastric pain that worsens after eating is which kind of peptic ulcer
gastric
renal cancer with neoplastic cells with transparent cytoplasm. cells are arranged in nests with interveneing blood vessles
clear cell cancer
acute rheumatic fever criteria
jones criteria
IBD with transmural inflammation
crohn’s
oat shaped cells on biopsy
small cell lung cancer
infective endocarditis criteria
dukes criteria
lucid interval
extradural
bronchoconstriction, flushing and diarrhoea
carcinoid syndrome
waxy casts in urine
CKD
epithelial casts in urine
acute tubular necrosis
fatty casts in urine
nephrotic syndrome
