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a path 3 > HISTO: Systemic Pathology > Flashcards

HISTO: Systemic Pathology Flashcards

1
Q

Describe the course of viral load and CD4 count in HIV.

A
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2
Q

List 5 types of opportunistic infections present in HIV.

A
  • 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
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3
Q

What is shown in this patient with HIV? What is a cause?

A

Endoscopy: Oesophageal ulcer

CMV oesophagitis

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4
Q

What is shown in this CMV oesophagitis?

A

(a) CMV nuclear inclusion
(b) Immunohistochemistry for CMV

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5
Q

List some types of tumours and their cause in HIV.

A

Kaposi’s sarcoma = HHV-8

Lymphoma: systemic, CNS or body cavity based B cell lymphomas = EBV

Others: Squamous cell carcinoma; Anus and cervix = HPV

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6
Q

What is seen in this Kaposi’s?

A

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.

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7
Q

What CNS disease can occur in HIV?

A

Progressive encephalopathy = AIDS dementia complex

Plus opportunistic infections and tumours e.g. CNS lymphoma as below

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8
Q

Describe mycobacterial pathology.

A

Caseating granulomas

Demonstration of acid fast bacilli

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9
Q
A
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10
Q

Which parts of the body can be affected by TB?

A
  • Lung
  • Lymph node
  • Bone: e.g. vertebra
  • Heart: e.g. pericarditis
  • GIT: e.g. peritonitis
  • CNS: e.g. meningitis etc.
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11
Q

How do you diagnose sarcoid?

A

Non-caseating granulomas

A diagnosis of exclusion.

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12
Q

What is shown here in sarcoid?

A

Organised collection of macrophages

Giant cells are characteristic (this is several macrophages joint together)

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13
Q

Which parts of the body can be affected by sarcoid?

A
  • 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
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14
Q

Describe the pathology of IgG4 related disease briefly.

A

Inflammation caused by IgG4 antibody producing plasma cells (polyclonal but subclass specific)

Fibrosis, obliteration of veins

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15
Q

What is seen here in this liver slice of IgG4 related disease?

A

A lot of plasma cells witg dark nuclei due to golgi apparatus due to IgG4 production of these cells, inflammatory infiltarte is also seen

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16
Q

What parts of the body are affected by IgG4 related disease?

A
  • Salivary and lacrimal glands: Mikulicz syndrome
  • Thyroid: Riedel thyroiditis
  • Peritoneum: Retroperitoneal fibrosis
  • Liver: Biliary obstruction
  • Pancreas: Autoimmune pancreatitis
  • Mass lesions: Inflammatory pseudotumour
17
Q

Which parts of the body are affected by alcohol?

A
  • 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
18
Q

What are the differences between consequences of large vs small/moderate consumption of alcohol long term? (Slide only for reference)

A
19
Q
A
20
Q

What parts of the body are affected by CF?

A
  • 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
21
Q

What is the pathophysiology of amyloid deposition?

A
  • 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
22
Q

What is the classification of amyloid (the who types)?

A
  1. AA - derived from serum amyloid A e.g. Crohn’s Disease, Rheumatoid arthritis
  2. AL - derived from light chains of immunoglobulin e.g. multiple myeloma, B Cell lymphoma
23
Q

What are the other proteins which can give rise to amyloid?

A
  1. Transthyretin e.g. mutation
  2. Beta2-macroglobulin – peritoneal dialysis
  3. Abeta2 protein - Alzheimer’s
  4. Insulin, calcitonin – endocrine tumours
24
Q

How is amyloid deposition diagnosed?

A

Stains with Congo Red dye

This shows apple green birefringence under polarised light

25
Q

What parts of the body can be affected by amyloid?

A
  • Proteinuria, renal failure
  • Restrictive cardiomyopathy, arrhythmias
  • Autonomic neuropathy
  • Carpal tunnel syndrome
  • Macroglossia
  • Bleeding on injury
  • Also deposited in blood vessels, endocrine organs, liver, spleen
26
Q

What is seen in this kidney slice?

A

Congo red stain - apple green birefringence under polarised light

(without polarised light it looks red as below)

27
Q

Menti: 3 causes of granulomatous inflammation in the liver.

A
  1. Sarcoid
  2. TB
  3. PBC (primary biliary cholangitis)
  4. Drug induced disease
  5. Schistosomiasis
28
Q

Menti: What are the types of liver changes associated with alcohol?

A

Steatosis

Steatohepatitis

Fibrosis

Cirrhosis

Hepatocellular carcinoma

29
Q

Menti: what type of amyloid is associated with myltiple myeloma?

A

AL - light chain immunoglobulin

a path 3 (89 decks)

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