Histopathology Flashcards by Elliot Colman

How would you investigate proteinuria in a patient presenting with frothy urine?

PCR (Protein: Creatinine ratio) >300mg/mmol

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What would be a typical presentation of minimal change disease?

Child presenting with:

Frothy Urine
Oedema
No changes on light microscopy
Loss of podocyte foot processes on electron microscopy

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What would be a typical presentation of membranous glomerular disease?

Nephrotic Syndrome in an adult

Anti-Phospholipase A2 Receptor

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What would be seen on microscopy of a biopsy of a patient with membranous glomerular disease?

Light = Diffuse glomerular basement membrane thickening

Electron: Loss of podocyte foot processes, spikey subepithelial deposits

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Spikey subepithelial deposits on electron micrscopy

Membranous Glomerular Disease

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How would focal segmental glomerulosclerosis typically present?

Afro-Carribean

Nephrotic Syndrome

Light = Focal and segmental scarring, hyalinosis

Electron = Loss of podocyte foot processes

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Which symptoms characterise nephritic syndrome?

PHAROAH

Proteinuria 
Haematuria 
Azootermia (AKI) 
Red Cell casts 
Oliguria 
Hypertension

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How would acute post-infectious GN typically present?

Post-strep/ Post impetigo

1-3 weeks post infection

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What can be seen on a biopsy of post-infectious glomerulonephritis?

Light = Increased cellularity

Electron - Subendothelial humps

Immunofluorescence - Granular deposition of IgG and C3 in BM

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How would IgA nephropathy typically present?

Berger’s DIsease

Frank Haematuria days after URT/GI Infection

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What would be seen on biopsy of a patient with Berger’s Syndrome?

Immunofluorescence - Granular deposition of IgA and C3 in mesangium

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What is the rule of thirds with regards to berger’s disease?

1/3 asymptomatic

1/3 ckd

1/3 severe ckd needing dialysis/transplant

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How does rapidly progressive (crescentic) glomerulonephritis typically present?

GN rapidly progressing to end-stage renal failure within weeks

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What are the main types of crescentic GN?

Type 1 = Anti-Glomerular basement membrane antibody

Type 2 - Immune Cimplex Mediated

Type 3 -
Pauci-Immune, associated with ANCA

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What is Alport’s Syndrome?

Type 4 Collagen mutation

X-Linked

Nephritic Syndrome + Sensorineural Deafness + Eye disorders

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What is Thin basement membrane disease?

AD type 4 collagen mutation leading to asymptomatic microscopic haematuria

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What are the main complications of PID?

Fitz-Hugh-Curtis Syndrome

Subfertility

Ectopic pregnancy

Tubo-ovarian Abscess

Peritonitis

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What causes ‘Violin Strings around your liver’?

Fitz-Hugh-Curtis Syndrome

Peri-hepatic adhesions

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Chronic Pelvic Pain

PR Bleeding

Immobile Uterus

Endometriosis

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Bulky Uterus

Chronic Pelvic Pain

Adenomyosis

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What can be seen upon diagnostic laparoscopy of a patient with endometriosis?

Powder Burn Spots

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What is the most common form of ovarian cancer?

Serous Cystadenoma

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What is serous cystadenoma?

Ovarian Cancer

Can see columnar epithelium and psammamoma bodies on histology

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What are psammoma bodies?

Concentric Laminated Calcifications

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What can be seen on histology of a mucinous cystadenoma?

Mucin secreting cells No psammoma bodies

What is the main risk factor for endometroid carcinoma?

Endometriosis

What can be seen on histology of endometroid carcinoma?

Tubular Glands

What can be seen on histology of clear cell carcinomas?

Clear Cells (Abundance of glycogen) Hobnail Appearance (bulbous nucleus and nuclear projections into the cytoplasm)

What are the types of epithelial ovarian cancers?

Serous Mucinous Endometroid Clear Cell

What are the main types of germ cell ovarian cancers?

Dysgerminoma Dermoid Cyst/Cystic Teratoma Choriocarcinoma

What is the most common ovarian cancer in younger women?

Dysgerminoma Benign, sensitive to radiotherapy

What is the most common type of germ cell tumour?

Cystic Teratoma Mature tissues eg. hair, bone

Which ovarian tumour may mimic pregnancy by secreting BHcG?

Choriocarcinoma

What are the main types of sex-cord ovarian tumour?

Granulosa/Thecal Cell Sertoli-Leydig Cell Fibromas

Ovarian tumour that secretes oestrogen, leading to pmb, imb, endometrial and breast cancer and breast enlargement

Granulosa/Thecal Cell Tumour

Ovarian tumour which secretes androgens, leading to virilisation, defeminisation

Sertoli/Leydig Cell Tumours

What are 50% of ovarian fibromas associated with?

Meig's Syndrome

What is Meig's Syndrome?

R sided pleural effusion Ascites Fibroma

Which proteins are implicated in cervical cancer development?

E6 and E7, produced by HrHPV 16 and 18

What is CIN?

Histological observation of increased nucleo-cytoplasmic ratio -> dyskaryosis

What are the main types of inflammatory breast conditions?

Acute Mastitis Duct Ectasia Fat Necrosis

How does Acute mastitis typically present?

Red, painful, hot, tender breast Neutrophils on Cytology

How does duct ectasia typically present?

Multiparous 40-60yo Smoker Greeny-brown nipple discharge

What would be seen on histology of a patient with duct ectasia?

Duct dilation Proteinaceous material inside the duc t Periductal inflammation

How does fat necrosis typically present

Inflammation post-trauma/surgery Painless, firm breast mass

What would be seen on cytology of a sample of fat necrosis

Empty fat spaces Histiocytes Multinucleated Giant Cells

What are the main types of breast cancer?

Carcinoma in situ -> Lobular or ductal Invasive Breast Carcinoma

How would you distinguish between the types of carcinoma in situ?

Lobular -> Doesn't show up on uss/mammography well Ductal -> Necrosis seen on uss/mamography

How does invasive breast carcinoma typically present?

Nipple changes | Peau d'orange, tehtering, Paget's, nipple retraction, lymphadenopathy, ulceration, nipple dishcarge

How does treatment for invasive breast carcinoma differ?

EP/PR +ve = Tamoxifen HER2 Positive = Herceptin Prognosis = axillary lymph nodes

Hormone responsive breast lumpiness in premenopausal women

Fibrocystic Breast Disease

20-30yo Freely mobile lump (like a breast mouse) Hormone-responsive

Fibroadenoma

What would be seen on histological analysis of a breast fibroadenoma

Stromal and glandular tissue Multinodular Mass Expanded intralobular tissue

'Leaf-Like' enlarging fibroepithelial mass in women over 50

Phyllode's Tumour

What would be seen on histological analysis of a phyllode's tumour?

Leaf-like fronds Artichoke like appearance Glandular and stromal proliferation Overlapping cells

Bloody nipple discharge with central papillomas 40-60yo

Intraductal Papilloma

What would be seen on cytology and histology of a sample of intraductal papilloma

Cyt ->. Branching Papillary Groups of epithelium Histology -> Papillary Mass within a dilated duct, fibrovascular core

Breast lesion with central zone of scarring surrounded by a radiating zone of proliferating glandular tissue

Radial Scar

What would be seen on mammogram of a radial scar?

Stellate Mass

How would fibrous dysplasia of the bone typically present?

Young Female Proximal Femur/Rib disease

What would you see on x ray of fibrous dysplasia

soap-bubble osteomyelitis, shepherd's crook deformity

What would you see on histology of fibrous dysplasia of the bone?

Marrow replaced by fibrous stroma Rounded trabecular bone (Chinese letters?)

What would typically be seen on x ray of an osteochondroma?

Bony Protuberance Cartilage Cap 'Mushroom Sign'

What is an enchondroma?

Cartilaginous proliferation within bones, typically affecting the fingers/hands of middle aged people

What would be seen on x ray of an enchondroma?

Popcorn/Cotton Wool Calcification O ring sign Expansile

How would an osteoid osteoma typically present?

Adolescent male Dull pain at night relived by aspirin Tibia Diaphysis/ Proximal Femur

How would osteosarcoma typically present?

Young End of long bones Pain & Mass

What would be seen on X-ray of an osteosarcoma?

Elevated Periosteum (Codman's triangle) Sub-burst appearance

What would be seen on histology of an osteosarcoma?

Malignant mesenchymal cells which stain for ALP +ve

What is a chondrosarcoma?

Cartilage producing tumour affecting the axial skeleton, proximal femur/tibia and pelvis

What would be seen on x ray of a chondrosarcoma?

Lytic lesions with fluffy calcifications

Where does Ewing's Sarcoma typically affect?

Diaphysis/Metaphysis of long bones/pelvis

What can be seen on x ray of ewing's sarcoma?

Onion Skinning of periosteum Lytic Lesions +/- sclerosis

What can be seen on histology of ewing's sarcoma

Sheets of small round cells CD99 +ve

Where do giant cell bone tumours primarily affect?

Knee

What can be seen on x ray of a giant cell bone tumour

Lytic appearance Soap-Bubble appearance

What can be seen on histology of a giant cell bone tumour?

Giant multinucleate osteoclasts on a background of spindle/ovioid cells

Which layers of the skin do the three types of pemphigus affect?

Vulgaris = intra-epidermal Bullous = Sub-epidermal Foliaceus = Intra-epidermal

Which antibodies cause pemphigus vulgaris?

Desmoglein 1 and 3 Attack Cadherin proteins

Which antibodies are implicated in Bullous Pemphigoid?

Anti-hemidesmosome

In which type of pemphigus do blisters easily burst?

Pemphigus Vulgaris

What would be seen on biopsy of pemphigus vulgaris?

Acantholytic Cells

What is the Auspitz Sign in Psoriasis?

Loss of the stratum granulosum Dots of bleeding when trauma to arm

How does lichen planus present?

purple, pruritic papules and plaques White lacy appearance in mouth = wickam striae

What is pyoderma gangrenosum?

A form of vasculitis, not gangrene Forms ulcers due to underlying disease eg. colitis, leukaemia, sclerosing cholangitis

How does Seborrheic Keratosis present?

Benign, lesion of the elderly with a stuck on appearance, looks like a cauliflower

What would be seen on histology of seborrheic keratosis?

Horn Cysts, Orderly proliferation of epidermis

How does actinic keratosis present?

Rash with sandpaper-like texture, warty, relayed to sun exposure

What can be seen on histology of actinic keratosis?

Solar Elastosis Parakeratosis Atypia/dysplasia Inflammation

How does a sebaceous cyst present?

Smooth, non-mobile, smelly, punctum

How does pityriasis rosea presenr?

Salmon pink lesion (herald patch) with multiple oval macules in a fir tree distribution Post URTI

How does a BCC present

Rolled pearly edges with a central ulcer and fine telangiectasia

What is the difference between AL and AA amyloidosis?

AL = paraproteins eg. myeloma AA = Secondary to chronic disease, especially autoimmune

What is sarcoidosis?

Multi-system disease characterised by formation of non-caseating granulomas

What marker is high in Sarcoidosis?

ACE