histology of liver disease

Question 1

describe neutrophils

Answer 1

polylobate nuclei - 3-5
key cells of acute inflammation - eg in appendicitis
this is reflected in the blood and in the tissue

Question 2

describe lymphocytes and plasma cells

Answer 2

have big nucleus - small cytoplasm
bigger than RBC
part of chronic inflammation
if lots of lymphocytes - think lymphoma

Question 3

when would you have lots of neutrophils and lymphocytes

Answer 3

when there is acute on chronic inflammation ie acute exacerbations

Question 4

appearance of lymphoma

Answer 4

Sheets of lymphocytes that all look the same = monoclonal proliferations – genetically identical
macrophages with debris inside are present

Question 5

describe eosinophils

Answer 5

o Bilobed

o Granules

Question 6

when would you see eosinophils

Answer 6

o Allergic rn – asthma, hayfever, drugs – eosinophil in tissue and eosinophilia
o Parasitic infections – because of T cell reaction, in tissue and in blood
o Tumours – hodgkins disease – has background of reactive cells, response to the disease – part of immune response to tumour

Question 7

describe eosinophilic oesophagitis

Answer 7

rings down oesophagus 
lymphocytes 
granulocytes with bilobed nuclei
form microabscess (in pic)
allergy to ingested ag 
treated by dietry modulation and steroids

Question 8

describe mast cells

Answer 8

granulated
large nuclei
sheet of uniform mast cells = allergic

Question 9

what can you see on the skin from condition with raised mast cells

Answer 9

Raised red, flat lesions – urticaria – kind of allergic rn

Question 10

describe macrophages

Answer 10

o Cells lots of cytoplasm
o Major func – phagocytosis, clear debris, ingest bacteria
o Late acute inflammation – clear debris
o Chronic inflamm – including granulomas

Question 11

how can you tell whether a sputum specimen is from the mouth or the bronchi

Answer 11

 Macrophages black – because carbon debris taken into lungs phagocytosed by macrophages
 If see them in sputum – know actual specimen – macrophage from alveoli

Question 12

summarise granulomas

Answer 12

cells are derived from macrophages
in chronic inflammation
driven by Th cells
macrophages become secretory - get more protein synthesising organelles (golgi and RER) = more cytoplasm = look like epithelial cells
therefore called epithelioid macrophages = epithelioid granuloma
giant cells
lymphocytes - chronic inflammation

Question 13

what are giant cells

Answer 13

have multiple nuclei
feature of granuloma
derived from macrophafes - fused together to form giant cells

Question 14

what are the necessary characteristics of granuloma

Answer 14

epithelioid macrophages

giant cells are extra - it is granuloma with or w/o them

Question 15

what is Ziehl Neelson

Answer 15

Acid fast stain

see acid fast bacilli in the granulomas

Question 16

what are the types of tumours

Answer 16

carcinomas 
sarcomas 
lymphoma 
melanoma 
etc

Question 17

types of carcinomas

Answer 17

squamous cell carcinoma

adenocarcinoma

Question 18

summarise squamous cell carcinoma

Answer 18

Keratin production (in moist env, eg oesophagus, the cells don't normally make keratin but they can)
Intercellular bridges - barrier cells

Question 19

sites of common squamous cell carcinomas

Answer 19

skin 
head and neck
oesophagus
anus 
cervix 
vagina

Question 20

summarise adenocarcinoma

Answer 20

tumour of the glandular epithelium - secrete and form glands
mucin production - if do mucin stain you can see the mucin production

Question 21

sites of adenocarcinoma

Answer 21

lung
breast 
stomach 
colon
pancreas

Question 22

summarise transitional cell ca

Answer 22

Ureter, bladder, prox urethra – in urinary tract

Question 23

summarise pigmented skin

Answer 23

melanocytes are scattered along the BM

Question 24

characteristics of malignant melanoma

Answer 24

irregular edge, raised, itchy, bleeding, grown

Question 25

how can you tell it is a pigmented tumour on biopsy

Answer 25

full of pigment

Fontana stain for melanin - +ve

Question 26

what are the 2 different types of stain

Answer 26

(Histo)Chemical

Immunohistochemical

Question 27

what are histochemical stains

Answer 27

dye
based on the chemical reaction between the stain and a specific component of the tissue
product of reaction has a specific colour or property that can be identified

Question 28

example of histochemical staining - cirrhotic liver

Answer 28

brown pigment – iron – genetic haemochromatosis – liver contains large amounts of iron = cirrhosis
histochemical stain - iron appears blue, also see that iron is present in connective tissue outside the liver nodules
V sensitive, specific and cheap stain

Question 29

stain for amyloid

Answer 29

congo red stain

Question 30

what does congo red stain do

Answer 30

dyes amyloid red - seen in chronic inflammation - eg RA, tumours of B cells

Question 31

what is Apple green birefringence

Answer 31

when you examine congo red under birefringent light = amyloid stains apple green

Question 32

summarise immunohistochemical stains

Answer 32

Based on using an antibody specific to an
antigen in the tissue.
monoclonal Ab find specific features - based on Ab specific to Ag in the tissue
• Need a detection system to make this binding
visible.

Question 33

summarise immunofluorescence

Answer 33

Have Ag that rabbit has already made Ab to, but rabit serum on the cells
wash it off and the Ab that bound to Ag A would stay
add detection system which is another Ab that is made by goat and is anti-rabbit - goat has florescent tag so we can recognise this easily
sensitive

Question 34

summarise immunoperoxidase

Answer 34

primary Ab
secondary Ab has a biotin attached (ie is a biotinylated Ab)
secondary binds to the primary Ab - add Avidin/Biotinylated enzyme complex (ABC)
then add substrate

Question 35

what do you do if you cant tell what type of cancer it is

Answer 35

stain it

Question 36

why is staining used in infections

Answer 36

Identification of aetiological agent

Question 37

histology of herpes

Answer 37

multinucleate cells, clear centres
ulcers on low power
immunohistochem stain

Question 38

why dont you just tag the primary Ab

Answer 38

o Goat will work with all anti rabbit, otherwise would need to tag all diff anti-rabbit
o More steps add, more sensitivity – can add strong or multiple tags – make the whole thing more sensitive