HISTO: Systemic Pathology Flashcards
Describe the course of viral load and CD4 count in HIV.
List 5 types of opportunistic infections present in HIV.
- Pneumocystis jiroveci: pneumonia
- CMV: especially retina and GIT
- Candida • Tuberculosis and atypical mycobacteria
- Cryptococcus: meningitis
- Toxoplasma gondii: encephalitis and mass lesions
- JC papovavirus: progressive multifocal leukoencepalopathy
- Herpes simplex
- Cryptosporidium, Isospora belli, microsporidia: GIT
What is shown in this patient with HIV? What is a cause?
Endoscopy: Oesophageal ulcer
CMV oesophagitis
What is shown in this CMV oesophagitis?
(a) CMV nuclear inclusion
(b) Immunohistochemistry for CMV
List some types of tumours and their cause in HIV.
Kaposi’s sarcoma = HHV-8
Lymphoma: systemic, CNS or body cavity based B cell lymphomas = EBV
Others: Squamous cell carcinoma; Anus and cervix = HPV
What is seen in this Kaposi’s?
A. The dermis is expanded by a solid tumour.
B. Fascicles of relatively monomorphic spindled cells, with slit-like vascular channels containing erythrocytes.
C. The nuclei of the tumour cells demonstrate immunoreactivity for HHV-8.
What CNS disease can occur in HIV?
Progressive encephalopathy = AIDS dementia complex
Plus opportunistic infections and tumours e.g. CNS lymphoma as below
Describe mycobacterial pathology.
Caseating granulomas
Demonstration of acid fast bacilli
Which parts of the body can be affected by TB?
- Lung
- Lymph node
- Bone: e.g. vertebra
- Heart: e.g. pericarditis
- GIT: e.g. peritonitis
- CNS: e.g. meningitis etc.
How do you diagnose sarcoid?
Non-caseating granulomas
A diagnosis of exclusion.
What is shown here in sarcoid?
Organised collection of macrophages
Giant cells are characteristic (this is several macrophages joint together)
Which parts of the body can be affected by sarcoid?
- Lung: scattered granulomas, heal with fibrosis
- Lymph nodes: usually hilar and mediastinal
- Spleen
- Liver
- Heart
- Joints
- Bone marrow
- Skin: nodules, plaques or macules
- Eyes: iritis, choroid retinitis, lacrimal glands
- CNS
- Salivary glands
Describe the pathology of IgG4 related disease briefly.
Inflammation caused by IgG4 antibody producing plasma cells (polyclonal but subclass specific)
Fibrosis, obliteration of veins
What is seen here in this liver slice of IgG4 related disease?
A lot of plasma cells witg dark nuclei due to golgi apparatus due to IgG4 production of these cells, inflammatory infiltarte is also seen
What parts of the body are affected by IgG4 related disease?
- Salivary and lacrimal glands: Mikulicz syndrome
- Thyroid: Riedel thyroiditis
- Peritoneum: Retroperitoneal fibrosis
- Liver: Biliary obstruction
- Pancreas: Autoimmune pancreatitis
- Mass lesions: Inflammatory pseudotumour
Which parts of the body are affected by alcohol?
- Liver: fatty change (steatosis) , fatty liver hepatitis (steatohepatitis), cirrhosis, liver cell cancer (hepatocellular carcinoma)
- GI Tract: acute gastritis, oesophageal varices
- Nervous system: peripheral neuropathy, Wernicke-Korsakoff syndrome etc.
- Cardiovascular system: dilated cardiomyopathy, hypertension, atheroma (and decreases it!)
- Pancreas: acute pancreatitis, chronic pancreatitis
- Fetal alcohol syndrome
- Cancer: oral cavity, pharynx. oesophagus, liver and breast
What are the differences between consequences of large vs small/moderate consumption of alcohol long term? (Slide only for reference)
What parts of the body are affected by CF?
- Pancreas: duct obstruction, exocrine atrophy
- Salivary glands: duct obstruction, atrophy
- Intestine: meconium ileus
- Liver: biliary obstruction, cirrhosis
- Lung: bronchial obstruction, superimposed infection with abscess formation (Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa)
- Male genital tract: infertility, absence of the vas
What is the pathophysiology of amyloid deposition?
- Deposition of an abnormal proteinaceous substance in non branching fibrils, 7.5-10nm diameter
- Always contains P component (important for identification)
- Beta-pleated sheet structure
- A variety of proteins can take on this conformation
- Resistant to enzymic degradation
What is the classification of amyloid (the who types)?
- AA - derived from serum amyloid A e.g. Crohn’s Disease, Rheumatoid arthritis
- AL - derived from light chains of immunoglobulin e.g. multiple myeloma, B Cell lymphoma
What are the other proteins which can give rise to amyloid?
- Transthyretin e.g. mutation
- Beta2-macroglobulin – peritoneal dialysis
- Abeta2 protein - Alzheimer’s
- Insulin, calcitonin – endocrine tumours
How is amyloid deposition diagnosed?
Stains with Congo Red dye
This shows apple green birefringence under polarised light
What parts of the body can be affected by amyloid?
- Proteinuria, renal failure
- Restrictive cardiomyopathy, arrhythmias
- Autonomic neuropathy
- Carpal tunnel syndrome
- Macroglossia
- Bleeding on injury
- Also deposited in blood vessels, endocrine organs, liver, spleen
What is seen in this kidney slice?
Congo red stain - apple green birefringence under polarised light
(without polarised light it looks red as below)
Menti: 3 causes of granulomatous inflammation in the liver.
- Sarcoid
- TB
- PBC (primary biliary cholangitis)
- Drug induced disease
- Schistosomiasis
Menti: What are the types of liver changes associated with alcohol?
Steatosis
Steatohepatitis
Fibrosis
Cirrhosis
Hepatocellular carcinoma
Menti: what type of amyloid is associated with myltiple myeloma?
AL - light chain immunoglobulin
