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Meded Path Lectures > Histopathology > Flashcards

Histopathology Flashcards

1
Q

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

A

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

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2
Q

What would be a typical presentation of minimal change disease?

A

Child presenting with:

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

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3
Q

What would be a typical presentation of membranous glomerular disease?

A

Nephrotic Syndrome in an adult

Anti-Phospholipase A2 Receptor

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4
Q

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

A

Light = Diffuse glomerular basement membrane thickening

Electron: Loss of podocyte foot processes, spikey subepithelial deposits

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5
Q

Spikey subepithelial deposits on electron micrscopy

A

Membranous Glomerular Disease

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6
Q

How would focal segmental glomerulosclerosis typically present?

A

Afro-Carribean

Nephrotic Syndrome

Light = Focal and segmental scarring, hyalinosis

Electron = Loss of podocyte foot processes

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7
Q

Which symptoms characterise nephritic syndrome?

A

PHAROAH

Proteinuria 
Haematuria 
Azootermia (AKI) 
Red Cell casts 
Oliguria 
Hypertension
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8
Q

How would acute post-infectious GN typically present?

A

Post-strep/ Post impetigo

1-3 weeks post infection

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9
Q

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

A

Light = Increased cellularity

Electron - Subendothelial humps

Immunofluorescence - Granular deposition of IgG and C3 in BM

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10
Q

How would IgA nephropathy typically present?

A

Berger’s DIsease

Frank Haematuria days after URT/GI Infection

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11
Q

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

A

Immunofluorescence - Granular deposition of IgA and C3 in mesangium

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12
Q

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

A

1/3 asymptomatic

1/3 ckd

1/3 severe ckd needing dialysis/transplant

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13
Q

How does rapidly progressive (crescentic) glomerulonephritis typically present?

A

GN rapidly progressing to end-stage renal failure within weeks

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14
Q

What are the main types of crescentic GN?

A

Type 1 = Anti-Glomerular basement membrane antibody

Type 2 - Immune Cimplex Mediated

Type 3 -
Pauci-Immune, associated with ANCA

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15
Q

What is Alport’s Syndrome?

A

Type 4 Collagen mutation

X-Linked

Nephritic Syndrome + Sensorineural Deafness + Eye disorders

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16
Q

What is Thin basement membrane disease?

A

AD type 4 collagen mutation leading to asymptomatic microscopic haematuria

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17
Q

What are the main complications of PID?

A

Fitz-Hugh-Curtis Syndrome

Subfertility

Ectopic pregnancy

Tubo-ovarian Abscess

Peritonitis

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18
Q

What causes ‘Violin Strings around your liver’?

A

Fitz-Hugh-Curtis Syndrome

Peri-hepatic adhesions

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19
Q

Chronic Pelvic Pain

PR Bleeding

Immobile Uterus

A

Endometriosis

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20
Q

Bulky Uterus

Chronic Pelvic Pain

A

Adenomyosis

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21
Q

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

A

Powder Burn Spots

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22
Q

What is the most common form of ovarian cancer?

A

Serous Cystadenoma

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23
Q

What is serous cystadenoma?

A

Ovarian Cancer

Can see columnar epithelium and psammamoma bodies on histology

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24
Q

What are psammoma bodies?

A

Concentric Laminated Calcifications

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25
Q

What can be seen on histology of a mucinous cystadenoma?

A

Mucin secreting cells

No psammoma bodies

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26
Q

What is the main risk factor for endometroid carcinoma?

A

Endometriosis

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27
Q

What can be seen on histology of endometroid carcinoma?

A

Tubular Glands

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28
Q

What can be seen on histology of clear cell carcinomas?

A

Clear Cells (Abundance of glycogen)

Hobnail Appearance (bulbous nucleus and nuclear projections into the cytoplasm)

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29
Q

What are the types of epithelial ovarian cancers?

A

Serous
Mucinous
Endometroid
Clear Cell

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30
Q

What are the main types of germ cell ovarian cancers?

A

Dysgerminoma

Dermoid Cyst/Cystic Teratoma

Choriocarcinoma

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31
Q

What is the most common ovarian cancer in younger women?

A

Dysgerminoma

Benign, sensitive to radiotherapy

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32
Q

What is the most common type of germ cell tumour?

A

Cystic Teratoma

Mature tissues eg. hair, bone

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33
Q

Which ovarian tumour may mimic pregnancy by secreting BHcG?

A

Choriocarcinoma

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34
Q

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

A

Granulosa/Thecal Cell

Sertoli-Leydig Cell

Fibromas

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35
Q

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

A

Granulosa/Thecal Cell Tumour

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36
Q

Ovarian tumour which secretes androgens, leading to virilisation, defeminisation

A

Sertoli/Leydig Cell Tumours

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37
Q

What are 50% of ovarian fibromas associated with?

A

Meig’s Syndrome

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38
Q

What is Meig’s Syndrome?

A

R sided pleural effusion

Ascites

Fibroma

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39
Q

Which proteins are implicated in cervical cancer development?

A

E6 and E7, produced by HrHPV 16 and 18

40
Q

What is CIN?

A

Histological observation of increased nucleo-cytoplasmic ratio -> dyskaryosis

41
Q

What are the main types of inflammatory breast conditions?

A

Acute Mastitis

Duct Ectasia

Fat Necrosis

42
Q

How does Acute mastitis typically present?

A

Red, painful, hot, tender breast

Neutrophils on Cytology

43
Q

How does duct ectasia typically present?

A

Multiparous 40-60yo

Smoker

Greeny-brown nipple discharge

44
Q

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

A

Duct dilation

Proteinaceous material inside the duc t

Periductal inflammation

45
Q

How does fat necrosis typically present

A

Inflammation post-trauma/surgery

Painless, firm breast mass

46
Q

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

A

Empty fat spaces

Histiocytes

Multinucleated Giant Cells

47
Q

What are the main types of breast cancer?

A

Carcinoma in situ -> Lobular or ductal

Invasive Breast Carcinoma

48
Q

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

A

Lobular -> Doesn’t show up on uss/mammography well

Ductal -> Necrosis seen on uss/mamography

49
Q

How does invasive breast carcinoma typically present?

A

Nipple changes

Peau d’orange, tehtering, Paget’s, nipple retraction, lymphadenopathy, ulceration, nipple dishcarge

50
Q

How does treatment for invasive breast carcinoma differ?

A

EP/PR +ve = Tamoxifen

HER2 Positive = Herceptin

Prognosis = axillary lymph nodes

51
Q

Hormone responsive breast lumpiness in premenopausal women

A

Fibrocystic Breast Disease

52
Q

20-30yo

Freely mobile lump (like a breast mouse)

Hormone-responsive

A

Fibroadenoma

53
Q

What would be seen on histological analysis of a breast fibroadenoma

A

Stromal and glandular tissue

Multinodular Mass

Expanded intralobular tissue

54
Q

‘Leaf-Like’ enlarging fibroepithelial mass in women over 50

A

Phyllode’s Tumour

55
Q

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

A

Leaf-like fronds

Artichoke like appearance

Glandular and stromal proliferation
Overlapping cells

56
Q

Bloody nipple discharge with central papillomas

40-60yo

A

Intraductal Papilloma

57
Q

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

A

Cyt ->. Branching Papillary Groups of epithelium

Histology -> Papillary Mass within a dilated duct, fibrovascular core

58
Q

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

A

Radial Scar

59
Q

What would be seen on mammogram of a radial scar?

A

Stellate Mass

60
Q

How would fibrous dysplasia of the bone typically present?

A

Young Female

Proximal Femur/Rib disease

61
Q

What would you see on x ray of fibrous dysplasia

A

soap-bubble osteomyelitis, shepherd’s crook deformity

62
Q

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

A

Marrow replaced by fibrous stroma

Rounded trabecular bone (Chinese letters?)

63
Q

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

A

Bony Protuberance

Cartilage Cap ‘Mushroom Sign’

64
Q

What is an enchondroma?

A

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

65
Q

What would be seen on x ray of an enchondroma?

A

Popcorn/Cotton Wool Calcification

O ring sign

Expansile

66
Q

How would an osteoid osteoma typically present?

A

Adolescent male

Dull pain at night relived by aspirin

Tibia Diaphysis/ Proximal Femur

67
Q

How would osteosarcoma typically present?

A

Young

End of long bones

Pain & Mass

68
Q

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

A

Elevated Periosteum (Codman’s triangle)

Sub-burst appearance

69
Q

What would be seen on histology of an osteosarcoma?

A

Malignant mesenchymal cells which stain for ALP +ve

70
Q

What is a chondrosarcoma?

A

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

71
Q

What would be seen on x ray of a chondrosarcoma?

A

Lytic lesions with fluffy calcifications

72
Q

Where does Ewing’s Sarcoma typically affect?

A

Diaphysis/Metaphysis of long bones/pelvis

73
Q

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

A

Onion Skinning of periosteum

Lytic Lesions +/- sclerosis

74
Q

What can be seen on histology of ewing’s sarcoma

A

Sheets of small round cells CD99 +ve

75
Q

Where do giant cell bone tumours primarily affect?

A

Knee

76
Q

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

A

Lytic appearance

Soap-Bubble appearance

77
Q

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

A

Giant multinucleate osteoclasts on a background of spindle/ovioid cells

78
Q

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

A

Vulgaris = intra-epidermal

Bullous = Sub-epidermal

Foliaceus = Intra-epidermal

79
Q

Which antibodies cause pemphigus vulgaris?

A

Desmoglein 1 and 3

Attack Cadherin proteins

80
Q

Which antibodies are implicated in Bullous Pemphigoid?

A

Anti-hemidesmosome

81
Q

In which type of pemphigus do blisters easily burst?

A

Pemphigus Vulgaris

82
Q

What would be seen on biopsy of pemphigus vulgaris?

A

Acantholytic Cells

83
Q

What is the Auspitz Sign in Psoriasis?

A

Loss of the stratum granulosum

Dots of bleeding when trauma to arm

84
Q

How does lichen planus present?

A

purple, pruritic papules and plaques

White lacy appearance in mouth = wickam striae

85
Q

What is pyoderma gangrenosum?

A

A form of vasculitis, not gangrene

Forms ulcers due to underlying disease eg. colitis, leukaemia, sclerosing cholangitis

86
Q

How does Seborrheic Keratosis present?

A

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

87
Q

What would be seen on histology of seborrheic keratosis?

A

Horn Cysts, Orderly proliferation of epidermis

88
Q

How does actinic keratosis present?

A

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

89
Q

What can be seen on histology of actinic keratosis?

A

Solar Elastosis
Parakeratosis
Atypia/dysplasia
Inflammation

90
Q

How does a sebaceous cyst present?

A

Smooth, non-mobile, smelly, punctum

91
Q

How does pityriasis rosea presenr?

A

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

Post URTI

92
Q

How does a BCC present

A

Rolled pearly edges with a central ulcer and fine telangiectasia

93
Q

What is the difference between AL and AA amyloidosis?

A

AL = paraproteins eg. myeloma

AA = Secondary to chronic disease, especially autoimmune

94
Q

What is sarcoidosis?

A

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

95
Q

What marker is high in Sarcoidosis?

A

ACE

Meded Path Lectures (15 decks)

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