Histopath of systemic disease

Question 1

name the sign seen on microscopy for cmv infections?

Answer 1

Nuclear Inclusion bodies - owls eye inclusions

Question 2

name some ivx and findings for CMV oesophagitis?

Answer 2

Endoscopy; oesophageal ulcers

slide; inclusion bodies

immunohistochem - cmv

Question 3

name some tumours associated with HIV and their causes

Answer 3

• Kaposi’s sarcoma: HHV-8

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

• Others:
Squamous cell carcinoma
Anus and cervix
HPV

Question 4

name some HIV Central Nervous System Disease

Answer 4

• Progressive encephalopathy = AIDS dementia complex

tumours
opportunitistic infections

Question 5

what is the pathological picture with Mycobacteria infection?

Answer 5

• Caseating granulomas / Granuloma with caseous necrosis

* Demonstration of acid fast bacilli

Question 6

which condition is characterised by:

Non-caseating granulomas
with a diagnosis of exclusion.

Answer 6

sarcoid

Question 7

characterise a sarcoid granuloma?

Answer 7

lymphocytes lining outside giant cells in lymphocyte layer

epithelioid cells in the middle

Question 8

characterise the extrapulmonary manifestations of sarcoid?

Answer 8

• Lung: scattered granulomas, heal with fibrosis
• Lymph nodes: usually hilar and mediastinal
• Skin: nodules, plaques or macules. ERYTHEMA NODOSUM
• Eyes: iritis, choroid retinitis, lacrimal glands . can cause blindness

Bones; arthritis

hepatomegaly, splenomegaly and more

Question 9

what is the aetiology of sarcoid?

Answer 9

1. genetics; hla-dr genes may be implicated if more than 1 family member has it
2. infectious agents include: mycobacteria, fungi, borrelia, and rickettsia
3. autoimmune

Question 10

what is IgG4 Related Disease?

Answer 10

Inflammation dominated by IgG4 antibody producing plasma cells

Fibrosis, obliteration of veins

Question 11

Name igg4 rleated disease in the different systems?

Answer 11

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

Question 12

what conditions can alcohol cause in the different systems?

Answer 12

• 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

Question 13

large consumption of alcohol is usually dangerous. list some benefits of small-moderate alcohol consumption?

Answer 13

lowers diabetes risk
increases insulin sensitivity

higher skeletal bone mineral density

increase hdl, increase coronary blood flow
reduced thrombosis
… so cardioprotective effects

Question 14

list some benefits of alcohol consumption regardless of the amount of intake?

Answer 14

reduced rheumatoid arthiritis

reduced chance of getting;

• gallstones
• kidney stones

Question 15

list the stages of alcoholic liver disease?

Answer 15

normal liver -> steatosis -> steatohepatitis ->

fibrosis -> cirrhosis -> hepatocellular carcinoma

Question 16

what is the systemic impact of fizzy drinks on the body?

Answer 16

obesity

bones - osteoporosis and density loss (caffeine and phosphoric acid)

kidneys - increase calculi RR 2x

teeth - corrosion

lungs - increase asthma & COPD risk

heart - increased risk of CVDs

GI - worsens IBS, caffeine -> diarrhoea constipation

Question 17

list the possible systemic impact of cystic fibrosis?

Answer 17

• 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

Question 18

what are the types of amyloid and which condition do they present in?

Answer 18

AA - derived from serum amyloid A e.g. Crohn’s Disease, Rheumatoid arthritis

• AL - derived from light chains
e.g. multiple myeloma, B Cell lymphoma

Question 19

name an ivx for amyloidosis and the result?

Answer 19

Stains with Congo Red dye

• This shows apple green birefringence under polarised light

Question 20

what is the clinical picture seen in amyloid?

Answer 20

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

Question 21

this patient has which condition;

A 79-year-old man presents with dyspnoea on exertion for 1 year and lower extremity oedema. As part of a cardiac work-up, the echo shows concentric left ventricular hypertrophy. Cardiac catheterisation shows normal coronary arteries and he is referred for further evaluation of non-cardiac dyspnoea.

Answer 21

amyloidosis

Question 22

this patient has which condition;

A 62-year-old man is referred for management of atypical multiple myeloma. He has a mild anaemia of 120 g/L (12 g/dL), a urinary protein loss of 2.2 g/day with a urinary immunofixation showing free lambda light chains. However, the bone marrow shows only 5% plasma cells and does not fulfil criteria for multiple myeloma.

Answer 22

amyloidosis

Question 23

which ‘types of amyloid’ are associated with the following;

• mutation
• peritoneal dialysis
• Alzheimer’s
• endocrine tumours

Answer 23

• Transthyretin e.g. mutation
• Beta2-macroglobulin – peritoneal dialysis
• Abeta2 protein - Alzheimer’s
• Insulin, calcitonin – endocrine tumours