Histology Flashcards
What pelvic organ is covered by simple cuboidal epithelium?
ovary
Note: squamocolumnar junction
- endocervix, fallopian tube, uterus: simple columnar
- Ectocervix, vagina: stratified squamous non-keratinized
True cysts are lined by what?
Pseudocysts are lined by what?
True: epithelial cells
Pseudo: fibrous and granulation tissue
Note: pancreatic pseudocysts are a common complication of acute pancreatitis
What thyroid cancer? Large cells with nuclei containing finely dispersed chromatin with ground-glass appearance. Numerous inclusion bodies and grooves also seen
Papillary thyroid cancer (Orphan Annie Eye)
“Orphan wants Papa”
What thyroid cancer? polygonal to spindle-shaped cells with slightly granular cytoplasms that stains for calcitonin. Adjacent amyloid deposits typically seen
Medullary thyroid cancer
Arise from parafollicular c-cells
Component of MEN2A and 2B
What thyroid cancer? Pleomorphic cells, including irregular giant cells and biphasic spindle cells
Anaplastic cancer - aggressive and poor prognosis
Time after MI?
No visible change
0-4 h
Time after MI?
Myocyte hypereosinophilia with pyknotic (shrunken) nuclei
12-24h
Time after MI?
Wave fibers with narrow, elongated myocytes
4-12h
Time after MI?
Disintegration of dead neutrophils and myofibers
Macrophage infiltration at border areas
3-7 days
Time after MI?
Coagulation necrosis (loss of nuclei and striations)
prominent neutrophilic infiltrate
1-3 days
Time after MI?
Robust phagocytosis of dead cells by macrophages
Beginning formation of granulation tissue at margins
7-10days
Time after MI?
Well-developed granulation tissue with neovascularization
10-14 days
Time after MI?
Progressive collagen deposition and scar formation
2wk-2mo
Loose, foul-smelling stools that float and proximal small intestine with loss of villi (flat mucosa) - what is most likely dx?
Celiac disease
ischemia causes what type of necrosis?
Coagulative
Granulomatous infection causes what type of necrosis?
caseous
CNS repair: Microglia move to area of ischemic infarct.
Time after onset of ischemia?
3-5 days
CNS repair: Neutrophils move to area of ischemic infarct. Time after onset of ischemia?
24-48h
What type of IBD?
- rectum always involved
- inflammation is limited to mucosa and submucosa only
- mucosal damage is continuous
ulcerative colitis
What type of IBD?
- transmural inflammation
- perianal fistulae
- non-caseating granulomas
- skip lesions
crohns
Diffuse medium-sized lymphocytes and high proliferation index (high Ki-67 fraction approachin 100%) is classic for what?
Burkitt lymphoma (starry sky) - assoc with EBV
Thyroid FNA showing hypercellularity of lymphocytes (mononuclear parenchymal infiltration), well-developed GERMINAL CENTERS and minimal colloid is indicative of what?
hashimoto thyroiditis
Silver staining intracytoplasmic inclusion bodies in brain
Pick disease
Senile plaques and neurofibrillary tangles
Alzheimers disease
Lewy bodies
Parkinsons
Focal atrophy of caudate nucleus
Huntingtons
Acidophilic bodies, hepatocyte swelling and mononuclear infiltrates indicate what liver disease? MOA of liver damage?
Acute viral hepatitis - causes hepatocyte apoptosis and necrosis.
Acidophilic bodies = Councilman bodies/apoptotic bodies (nuclear fragments of shrunken apoptotic hepatocytes)
Endomysial inflammatory infiltration found on mm biopsy
Polymyositis
Endoneural arteriole hyalinization
Diabetes mellitus –> diabetic neuropathy
Endoneural inflammatory infiltration with multifocal demyelination
Guillain-Barre syndrome
Pap: Pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclaer halo-like clearing. Enlarged nucleus with raisinoid appearance
Koilocyte
Pap: squamous cells covered with rods to obscure normal epithelial margins
clue cells
Eosinophilic casts in tubular lumen of kidney in patient with back pain, elevated serum protein and azotemia
multiple myeloma
Bence jones proteins
MC benign liver tumor - cavernous, blood-filled vascular spaces of variable size lined by a SINGLE epithelial layer
Cavernous hemangioma
Note: Lack of structural support gives them a tendency to bleed.
If in the brain –> neuro deficits and seizures
Saccular aneurysms in contrast have a thickened intima due to myointimal hyperplasia
Lymphocytes with abundant pale blue cytoplasm and basophilic rim indented by surrounding RBC is classic for what?
EBV
atypical lymphocytes
Interstitial myocardial granulomas are associated with what condition?
Acute rheumatic fever (aschoff bodies)
What collagen is seen in MI scars? This collagen is also found where?
Type 1 - also in dermis, bone, tendons, ligaments, dentin, cornea, and blood vessels
CNS repair: red neurons (eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance) - Time after infarct?
12-24h
Acute irreversible damage
Thyroid FNA - mixed cellular infiltrate with occasional multinuclear GIANT CELLS
Subacute (de Quervain, granulomatosis) - typically present after viral URI with painful, tender thyroid gland and sx of hyperthyroidism
Pedunculated mass in the heart with scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging
atrial myxoma (LA)
target cells and spherocytes with microcytic anemia indicates what? Problem with what?
B-thal
B-globin mRNA formation d/t mutation- globin synthesis problem
Which gastric layer are parietal cells located in?
Upper glandular (superficial region of gastric glands under the simple columnar epithelial cells)
Transient myocardial ischemia causes myocardial cell to inc in size how?
Ion pump fails (lack ATP) –> inc intracellular Na and Ca2+ –> draws free water into cell –> swelling
Perivascular inflammation of small blood vessels within fibrinoid necrosis and predominance of neutrophils and fragmented neutrophilic nuclei
Cutaneous small vessel vasculitis - assoc with meds (PENICILLINS, cephalosporins)
Wound healing: excessive MMP and myofibroblast accum in the wound margins
Can cause CONTRACTURE
Wound healing: excessive collagenous scar tissue deposition by fibroblasts
Keloids
Transforming growth factor-B is critical for fibroblast migration, prolif and CT synthesis. Inc TGF-B is responsible for the hypertrophic/keloid scarrig
Histo for hep B infection
Large hepatocytes filled with finely granular, homgenous, pale pink cytoplasm. “ground glas” hepatocytes
MC subtype of RCC?
Clear cell carcinoma
Large, round or polygonal cells with clear cytoplasm
Follicular thyroid adenoma or follicular thyroid cancer?
Cant differentiate the two on FNA. Gene expression analysis can be useful
Metaplasia of:
Esophagus
Bronchi
Esophagus (GERD): squamous –> columnar
Bronchi (smoking): Columnar –> squamous (more resistant to irritation)
Differentiate the 2 morphological variants of gastric adenocarcinoma
Intestinal type - solid mass that projects into the stomach and is composed of glandular-forming cuboidal or columnar cells Diffuse type (linitis plastica) - infiltrates the stomach wall and displays SIGNET-RING cells
Patient with bladder outflow obstruction d/t BPH will have kidneys demonstrating what?
Parenchymal pressure atrophy
Urinary retention –> reflux nephropathy –> hydronephrosis and renal interstitial atrophy and scarring
Lung: Macrophages with Golden cytoplasmic granules that turn dark blue w/Prussian blue staining is assoc with what condition?
LV dysfunction (L-sided heart failure) Hemosiderin laden macrophages (Siderophages)
Destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation is characteristic of what?
Primary biliary cirrhosis.
Typically presents insidiously w/pruritus and fatigue in middle-aged women. Eventually dev signs of cholestasis and hypercholesterolemia
Compared to sporadic colorectal carcinoma, colorectal malignancy arising in a patient with UC would most likely exhibit what?
More likely to arise from:
- non-polypoid dysplastic lesions
- be multifocal in nature
- develop early p53 mutations and late APC gene mutations
- be of a higher histologic grade
Auer rods in AML stain positive for what?
Peroxidase (myeloperoxidase)
Major basic protein is found in eosinophil granules and helps to defend against what?
parasites
Tissue damage and resultant abscess formation in the lung is primarily caused by what?
lysosomal enzyme release from neutrophils and macrophages
Months to years after ischemic brain infarct, the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by what?
Astrocytes (glial scar)
Intestine histo: enterocytes with clear or foamy cytoplasm
Abetalipoproteinemia - cant synth apolipoprotein B (component of chylomicrons and VLDL). Lipids absorbed by the small intestine cannot be transported into the blood so they accum in the intestinal epithelium
Initiation of atherosclerosis
Note: Smooth mm cells are directly responsible for fibrous cap synthesis
- Endothelial cell injury (eg HTN, hyperlipidemia)
- Exposure of subendothelial collagen
- Inc permeability and monocyte, lymphocyte adhesion and migration into the intima
- Platelet adhesion
- GF from monocytes and platelets stim smooth mm cell migration and prolif in the intima
- LDL in the intima is phagocytosed by macrophages and SMCs –> foam cells (fatty streak)
- Chronic inflam –> foam cell necrosis –> fibrofatty atheroma (lipid debris core and fibrous cap)
Segmental vasculitis extending into contiguous veins and nerves
Buerger disease - vasculitis of medium and small-sized arteries assoc with smoking and common in Asians
Hypersensitivity to intradermal injections of tobacco extracts. Sx - eg calf pain and painful foot ulcers
Differentiate findings in chronic L heart failure versus acute pulmonary edema
Chronic LHF - hemosiderin-containing macrophages in alveoli
Acute pulm edema - inc filtration of plasma water and electrolytes into the lung interstium and alveoli (transudate)
Differentiate transudate and exudate in pleural effusions
Transudate - change (eg hydrostatic pressure, HF). No proteins leak out
Exudate - inflammatory (eg pneumonia). Fluid and proteins go out
Anal fissures are longitudinal tears in the mucosa usually due to passage of hard stool in patients with chronic constipation. Where do most fissures occur in reference to the dentate line?
Posterior midline distal to the dentate line - d/t poor perfusion of the posterior anal canal. Mucosa most sensitive to trauma and slows healing times.
Lobar pneumonia progression
- Congestion (24h) - red, heavy, boggy. Vascular dilation, exudate mostly bacteria
- Red hepatization (2-3d) - red, firm lobe. Exudate has erythrocytes, neutrophils, and fibrin
- Gray hepatization (4-6d) - gray-brown firm lobe. RBCs disintegrate, exudate has neutrophils and fibrin
- Resolution - normal architecture. Enzymatic digestion fo exudate
Differentiate gastric ulcers vs erosions
Ulcer - extend into the submucosal layer and muscularis propria (inner circumferential and outer longitudinal smooth mm layers)
Erosion - do NOT fully penetrate the muscularis mucosa
Note: layers of GI from inside out = mucosa, muscularis mucosa, submucosa, muscularis propria, serosa
Bronchioloalveolar carcinoma histo
<10% of all lung cancers
Well-differentiated dysplastic COLUMNAR cells (mucin-secreting) lining alveolar septa w/o vascular or stromal invasion.
Definition of anaplastic tumors.
pleopmorphic cells with large, hyperchromic nuclei that grow in a disorganized fashion - bear no resemblance to the tissue of origin
May also contain numerous, abnormal mitoses and giant tumor cells.
What is the only structure in the larynx with squamous cell lining?
Vocal cord. Any lesion of the vocal cord is SCC usually.
Cushings causes hypersecretion of ACTH leading to cortical hyperplasia or hypertrophy of the adrenal gland?
HyperPLASIA.
Patient with T1DM in DKA would have a pancreatic biopsy showing what?
Islet cells with cellular necrosis and lymphatic infiltration.
Muscle histo of a patient with polyarterhitis nodosa presenting with progressive proximal muscle weakness and myalgia?
Segmental ischemic necrosis
This vasculitis is a necrotizing vasculitis of multiple organs and spares the lungs
Patient with chronic alcoholism will show what on liver biopsy?
Mallory’s hyaline (Mallory body - damaged cytokeratin), also known as “alcoholic” hyaline is often seen in conjunction with chronic alcoholism
What features best explains the staining of amyloid in Congo red stain
Amyloids have been known to arise from many different proteins and polypeptides that generally form β-sheet structures
Note: prions are a type of amyloid, so they have beta pleating
Differentiate hyperplastic polyp vs tubular adenoma
Some types of polyps (called adenomas) have the potential to become cancerous, while others (hyperplastic or inflammatory polyps) have virtually no chance of becoming cancerous.
Note: adenomas usually are in the colon
Hyperplastic polyps are usually in the sigmoid/rectal area
What does the histo of prostate bone mets look like?
Pleomorphic epithelial cells forming duct-like structures
prostate cancer’s have ducts, so mets to the bone should look the same.
