Histopathology 1: Cellular Pathology

Question 1

What information does a report give you ?

Answer 1

Diagnostic information (e.g. tumour typing, classification of GN)
Prognostic information (e.g. staging, grading, biomarkers)
Other information regarding management (e.g. resection margins)
Feedback to imaging or other tests
Benefits / adverse effects of treatment
Incidental findings

Question 2

What should be included on the request form?

Answer 2

Full demographic details on the request form
Full demographic details on the specimen
 container
Relevant clinical history
Relevant available results
 (imaging, other investigations)
Your question
Contact details email or phone

Question 3

Give some examples of some stain types

Answer 3

Diastase Periodic Acid Schiff (DPAS) for mucin
EVG for elastin, fibrosis
Masson Fontana for melanin
Perl’s for iron
Von Kossa for calciumphosphate
Ziehl Neelsen for AFB
Giemsa for mast cells, HP

Question 4

What is a H&E stain?

Answer 4

haematoxylin and eosin stain

Question 5

What are the chnages that are seen in the cells if they are cancerous?

Answer 5

Increased N:C ratio Nucleoli
Irregular nuclear margin Atypical mitoses
Irregular distribution and texture of chromatin Hyperchromasia

Question 6

what is immunohistochemistry

Answer 6

Identifies specific proteins in tissue by using monoclonal antibodies

Question 7

what is used for fixation ?

Answer 7

10% neutral buffered formalin

Question 8

What colours does a H&E stain the different parts?

Answer 8

Cell membrane (eosin)
Cytoplasm (eosin)
Nucleus (haematoxylin)
Nucleolus (haematoxylin)
Basement membrane (eosin)
Extracellular matrix (eosin)

Question 9

what information can immunohistochemistry give?

Answer 9

Also gives prognostic information and informs treatment

Question 10

Describe how direct and indirect immunohistochemistry works

Answer 10

Direct = The primary antibody has a labelled enzyme or fluoresence which binds to the protein.

Indirect = an enzyme labelled secondary AB reacts with unconjugated primary AB bound to tissue antigen.

Question 11

What does S100+ bind to?

Answer 11

tumour of vulva

Question 12

What are the 6 tissues of origin?

Answer 12

Epithelium squamous or glandular, endothelium, mesothelium,
synovium, meninges
Connective tissue fat, fibrous tx, bone, vasculature, cartilage, ECM
Muscle skeletal or smooth or cardiac
Neural tissue Neurons, astrocytes, oligodendrocytes, microglia,
melanocytes
Germ line cells Reproductive cells (eggs, sperm)
Blood Erythrocytes, leucocytes, thrombocytes/platelets

Question 13

What are the 4 types of intermediate filaments ?

Answer 13

1. keratin (cytoplasmic)
2. vimentin (cytoplasmic)
3. neurofilaments (cytoplasmic)
4. nuclear lamins (Nuclear)

Question 14

what does AE1/3 + mean?

Answer 14

metastatic carcinoma

Question 15

what does CK7+ mean ?

Answer 15

breast, ovary, lung, endo, thyroid

Question 16

what does RCC+ mean?

Answer 16

Clear cell carcinoma of the kidney

Question 17

what does Pax8+ mean?

Answer 17

Clear cell carcinoma of the kidney

Question 18

give some examples of some prognostic biomarkers?

Answer 18

Breast	BRCA1 
Ovary	BRCA1
Breast	Her-2/neu (worse prognosis)
Colon	High frequency MSI (better prognosis)
NSCLC	K-ras (worse prognosis)
NSCLC	EGFR (worse prognosis)

Question 19

give some examples of predictive biomarkers

Answer 19

RCC CAIX (response to IL-2 therapy)
KIT GIST (response to imatinib/sunitinib)
NSCLC EGFR (response to gefitinib/erlotinib)
Breast ER (response to tamoxifen)
Breast Her-2/neu (response to trastuzumab)
Gastric Her-2/neu (response to multiagent ther.)
NSCLC K-ras (less response to EGFR therapy)
CRC K-ras (less response to EFGR therapy)
NSCLC p53 (response to cisplatin)
Breast PTEN (reduced effectiveness of trastuzumab)
Lymphoma CD20 (response to anti CD20 therapy)