Histopathology Flashcards
1
Q
neutrophils vs lymphocytes and inflammation
A
neutrophils = acute inflammation lymphocytes = chronic inflammation
2
Q
what does an eosinophil look like on microscope?
A
bilobed nucleus, red granules
3
Q
what are macrophages like in their current state vs chronic inflammatory conditions?
A
- natural state: phagocytic
- chronic inflammatory conditions: secretory
4
Q
cause of a caseating granuloma
A
TB
5
Q
characteristics of an SCC
A
keratin production
intracellular bridges
6
Q
characteristics of adenocarcinoma
A
mucin production
glands
7
Q
what is the stain for melanin?
A
fontana stain
8
Q
stain for iron overload?
A
prussian blue
9
Q
what antibody shows it is an epithelial origin?
A
cytokeratin Ab
10
Q
out to in structures of bone?
A
periosteum
cortex
medulla
11
Q
diaphysis and epiphysis
A
diaphysis: main part of bone
epiphysis: head
12
Q
what are the bone tumour-like conditions?
A
- fibrous dysplasia
- metaphyseal fibrous corticol defect/ non-ossifying fibroma
- reporative giant cell granuloma
- ossifying fibroma
- simple bone cyst
13
Q
what happens in fibrous dysplasia?
A
marrow replaced by fibrous stroma with rounded trabecular bone
14
Q
X-ray features of fibrous dysplasia
A
soap bubble appearance
femoral head = Shepherd’s Crook
chinese letters
15
Q
features of McCune Albright Syndrome
A
- polyostotic fibrous dysplasia
- endocrine problems
- cafe au lait spots
16
Q
cartilaginous benign bone tumours
A
- osteochondroma
- enchondroma
- chondroblastoma
17
Q
bone forming benign bone tumours
A
osteoid osteoma
osteoblastoma
osteoma
18
Q
features of osteochondroma
A
- end of long bones
- young males
- cartilaginous surface overlying normal trabecular bone
19
Q
features of endochondroma
A
- cartilaginous proliferation within bone
- most in hands
- popcorn calcification
20
Q
what is a borderline bone malignancy? where is it formed?
A
giant cell tumour
end of long bones, mostly around knee
21
Q
X-ray and histology of giant cell tumour
A
X-ray: lytic appearance
Histology: osteoclasts on background of spindle/ovoid cells
22
Q
what are the tumours that metastasize to bone?
A
breast prostate lung kidney thyroid
23
Q
what are the types of malignant bone tumours?
A
- osteosarcoma: forms bone
- chondrosarcoma: forms cartilage
- Ewing’s: undifferentiated mesenchymal tumour
24
Q
X-ray chondrosarcoma findings
A
lytic with fluffy calcification
25
what is Ewings? X-ray finding
small round cell tumour
| X-ray: onion skinning of periosteum, lytic +/- sclerosis
26
what are soft tissues tumours?
mesenchymal proliferation
| occur in extra-skeletal non-epithelial tissues of body (exc meninges + LR system)
27
types of soft tissue tumours
- liposarcoma: myxoid appearance
- spindle cell sarcoma
- pleomorphic sarcoma
28
bad prognostic sign in bone tumours
aneuploid/ hyperdiploid
| >5cm
29
down side of cytopathology
does not show tissue architecture
30
different cytopathology grades
```
C1: inadequate
C2: benign
C3: atypia, probably benign
C4: suspicious of malignancy
C5: malignancy
```
31
what stain do you use for breast pathology?
H+E
32
features of breast histology under H+E stain
- purple = glandular tissue
- pink = stroma around gland
- duct with acini around
- myoepithelial cells (help pump milk)
33
histology of duct ectasia
duct distended, proteinaceous material
| foamy macrophages
34
what is fibrocystic disease? histology?
exaggerated response to hormonal influence
| ducts dilated, may get calcified
35
what is a fibroadenoma
benign fibroepithelial neoplasm of breast
36
what is an intraductal papilloma?
benign papillary tumour, arising duct system
37
peripheral vs central papilloma
- peripheral papilloma: small terminal ductules (clinically silent)
- central papilloma: large lactiferous ductules (nipple discharge)
38
histology of intraductal papilloma
- large dilated duct, polypoid mass in middle
| - fibrovascular core
39
what is radial scar?
benign sclerosing scar
| central zone of scarring surrounded by radiating zone of proliferating glandular tissue
40
histology of radial scar
central stellate area
41
process of proliferative breast disease
1. usual epithelial hyperplasia
2. epithelial atypia/ atypical ductal carcinoma
3. in situ lobular neoplasia (within acinar unit)
42
DCIS on mammography
areas of calcification
43
histology of DCIS
- cribriform (punched out appearance)
- cells large, not many lumens left
- central lumen, full of necrotic material
44
2 distinct pathways to invasive breast cancer
1. Low grade: from low grade DCIS, 16q loss
| 2. High grade: high grade DCIS, complex karotypes
45
cell type of invasive DUCTAL carcinoma
large pleomorphic nucleated cells
46
cell type of invasive LOBULAR carcinoma
linear, monomorphic
| Indian file pattern
47
cell type of invasive TUBULAR carcinoma
elongated tubules
| invade stroma
48
cell type of invasive MUCINOUS carcinoma
empty spaces, filled with mucin
49
what is breast cancer grading based on?
tubule formation
nuclear pleomorphism
mitotic activity
50
what receptor status are basal like carcinomas?
triple -ve
51
what is the most important prognostic factor in breast cancer?
axillary LNs
52
what does mammogram screening go on?
47-73
53
different mammogram gradings
```
B1 = normal breast tissue
B2 = benign abnormality
B3 = lesion of uncertain malignant potential
B4 = suspicious of malignancy
B5 = malignant a/ DCIS b/ invasive
```
54
cells of anterior and posterior pituitary
```
anterior = epithelial cells
posterior = nerve cells
```
55
what is a non-toxic goitre and when is it common?
enlargement without overproduction of thyroid hormones
| common if impaired synthesis of thyroid hormones
56
how does a multinodular goitre form?
with time simple enlargement develops into multinodular pattern
hyperfunctioning nodule may develop
57
what is struma ovarii?
ovarian teratoma
| ectopic thyroid
58
Hashimotos histology
- lots of lymphoid cells within germinal centres
- epithelial cells become large, lots of eosinophillic cytoplasm
= Hurthle cell
59
histology of papillary carcinoma
optically clear nuclei
intranuclear inclusion
psommoma bodies
60
what can medullary carcinoma produce?
parafollicular C cells
calcitonin produced
deposited as amyloid
61
what is the problem in Cushing's disease?
PITUITARY
62
hormone levels in CAH
dec cortisol production
inc ACTH
adrenal stimulation and inc androgen synthesis
63
acute causes of primary adrenal insufficiency
- sudden withdrawal of corticosteroid therapy
- haemorrhage (neonates)
- sepsis with DIC (waterhouse-fridenston syndrome)
64
chronic causes of primary adrenal insufficiency
AI
TB
HIV
Metastastic
65
SLE SOAPBRAINMD
```
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood (all counts low)
Renal (proteinuria)
ANA
Immunologic (anti-dsDNA)
Neurologic (psych, seizures)
Malar Rash
Discoid Rash
```
66
auto-Abs in SLE
- anti-dsDNA
- anti-smith
- anti-histone
67
what drug can cause SLE?
hydralazine
| anti-histone
68
skin histology in SLE
- lymphocytic infiltration of dermis
- vascuolisation
- extravasation of RBCs = rash
- immune complexes at epidermal-dermal junciton
69
renal histology in SLE
wire loop capillaries (thickened = immune complex deposition)
70
what is Libman Sacks Endocarditis
- non-infective
- SLE associated
- vegetation: lymphocytes/neutrophils/fibrin stranfs
71
diffuse vs limited scleroderma
diffuse: involves trunk, anti-topoisomerase (Scl 70)
limited: does not involve trunk, anti-centromere
72
pattern of immunofluoresence in scleroderma
nucleolar
73
vascular histology seen in scleroderma
intimal proliferation = onion skin appearance
74
pattern of ANA and what is signifies
ANA = speckled pattern
| suggests mixed connective tissue disease
75
main feature of sarcoidosis
non-caseating granuloma
76
investigation results in sarcoidosis
hypergammaglobuloinaemia
raised ACE
hypercalacaemia
77
what are the 2 medium vessel vasculitis?
polyarteritis nodosa
| Kawasaki
78
features of polyarteritis nodosa
rosary bead appearance on angio
| associated with Hep B
79
temporal arteritis biopsy findings
lymphocytic infiltration of tunica media of temporal artery
80
triad seen in granulomatosis with polyangiitis (Wegner's)
1. ENT (nosebleeds, sinusitis, saddle nose)
2. Lungs (haemoptysis, SOB)
3. Kidneys (haematuria)
cANCA
81
cANCA directed against
proteinase 3
82
triad in Churg Strauss (eosinophillic granulo w/ polyangiitis)
1. asthma
2. eosinophillia
3. vasculitis
pANCA
83
pANCA directed against
myeloperoxidase
84
what is hydrosalpinx?
enlarged fallopian tube filled with fluid
85
what proteins are encoded by HPV and what do they bind to?
E6 and E7 = transforming genes
| bind to and inactivate 2 tumour suppressors (retinoblastoma, p53)
86
what does productive HPV look like on histology?
halo around nucleus (koilocyte)
87
CIN 1/2/3
1; lower 1/3
2. lower 2/3
3. entire epithelium
88
cervical smear programme
at 25y
25-49: 3 years
50-62: 5 years
89
histology of endometrial hyperplasia
increase in stroma and glands
| driven by oestrogen
90
type 1 endometrial carcinoma
85%
endometrioid
mucinous
secretory
91
type 2 endometrial carcinoma
serous
clear cell
arise in atrophic endometrium
92
what carriers a better prognosis in Endometrial Carcinoma?
diploidy
93
FIGO staging in EC
1. confined to uterus
2. spread to cervix
3. spread to adnexae, vagina, local lymph nodes
4. distant spread
94
complete mole and possible complications
fertilisation of empty egg
| can convert to invasive mole or malignancy
95
partial mole
normal ovum fertilised by 2 sperms
| none progress to malignancy
96
issue with choriocarcinoma
rapidly invasive
| wide mets
97
theory of endometriosis
metaplasia of pelvic peritoneum
98
what do ovaries consist of
surface epithelium
ovarian stroma
germ cells
99
types of ovarian epithelial tumours
type 1: low grade (low grade serous, endometrioid, mucinous, clear cell)
type 2: high grade (mostly serous, p53 mutation)
100
what are the benign ovarian tumours
- serous cystadenoma
- cystadenofibroma
- mucinous cystadenoma
- brenner tumour
101
tumours associated with endometriosis
- endometrioid (better prognosis than mucinous and serous)
| - clear cell (clear cytoplasm due to lots of glycogen)
102
types of germ cell tumours
dysgerminoma
teratoma
choriocarcinoma
endodermal sinus tumour (develop from extra embryonic tissue)
103
what are the steps of atherogenesis
1. endothelial injury
2. LDL enters intima, trapped in subintimal space
3. LDL converted oxidized LDL = inflammation
4. macrophages take up oxidized LDL via scavenger receptors
5. form foam cells
6. apoptosis of foam cells =inflammatio and cholesterol core of plaque
7. increase adhesion molecules on endothelium
8. more macrophages and T cells entering plaque
9. VSMC form fibrous cap
104
what is the earliest change in atherosclerosis?
fatty streak
105
what are the different acute plaque changes?
- rupture: exposes prothrombogenic plaque contents
- erosion: exposes prothrombogenic subendothelial BM
- haemorrhage into plaque: increase size
106
what is dilated cardiomyopathy?
progressive loss of myocytes
| = dilated hearts
107
causes of dilated cardiomyopathy
infective
toxic (alcohol)
hormonal (peripartum, thyroid)
genetic (haemochromatosis)
108
histology following an MI: under 6 hours
normal histology
| CK-MB normal
109
histology following an MI: 6-24 hours
loss of nuclei
homogenous cytoplasm
necrotic cell death
110
histology following an MI: 1-4 days
infiltration of polymorphs
| then macrophages to clear up debris
111
histology following an MI: 5-10 days
removal of debris
112
histology following an MI: 1-2 weeks
granulation tissue
new blood vessels
collagen synthesis
113
histology following an MI: weeks to months
strengthening
| decellularising scar
114
MI complications
contractile dysfunction (cardiogenic shock)
arrhythmia
myocardial rupture (free wall most common)
pericarditis
RV infarction
infarct extension (new necrosis adjacent to old)
infarct expansion (necrotic muscle stretches)
115
what is the cause of chronic ischaemic heart disease?
progressive HF due to ischaemic myocardial damage
116
what is the cause of sudden cardiac death?
due to ischaemia-induced electrical instability
117
cardiac failure histology
- dilated heart
- scarring/thinning of walls
- fibrosis and replacement of ventricular myocardium
118
what is the abnormality in Hypertrophic Cardiomyopathy?
abnormality in beta-myosin heavy chain
119
what is the problem in restrictive cardiomyopathy?
impaired ventricular compliance
| normal heart size = big atria
120
cause of chronic rheumatic valvular disease
immune cross reactivity with cardiac valves
| mitral
121
histology of chronic rheumatic valvular disease
- thickening of valve leaflet
- commissures fuse
- thickening/shortening/fusion of chordae tendinae
122
causes of aortic regurgitation
- rigidity (rheumatic, degenerative)
- destruction (microbial endocarditis)
- disease of aortic valve ring (Marfan's, AS, dissecting aneurysm)
123
true vs false aneurysm
true: all layers of wall dilate
false: extravascular haemotoma
124
describe the endothelium in liver
is discontinuous
| no tight junctions
125
what do stellate cells do normally? Vs when activated?
```
normally = store Vit A
activated = become myofibroblasts and lay down collagen
```
126
what is found in liver zone 3?
more metabolically active enzymes
127
what is the limiting plate?
ring of collagen around portal tract
128
what changes occur in liver injury?
- kupffer cells activated
- endothelial cells stick together = hard for blood to flow through
- BM-type collagens secreted into Space of Disse by activated Stellate cells
- hepatocytes lose microvilli
129
what happens in extrahepatic shunting?
blood never reaches liver
| backlogs into sites of porto-systemic anastomosis
130
what happens in intrahepatic shunting?
blood goes through liver
does not come into contact with hepatocytes
blood = unfused and toxic
131
what histology do you see in acute hepatitis?
spotty necrosis
132
what determines the grade and stage in chronic hepatitis?
- grade = severity of inflammation
| - stage = severity of fibrosis
133
what is interface hepatitis ?
AKA piecemeal hepatitis
| inflammation crosses limiting plate
134
how does fibrosis stain? what would be seen in intrahepatic shunting?
stains blue
| extends between portal tract and central vein
135
3 presentations of alcoholic liver disease
fatty liver
alcoholic hepatitis
cirrhosis
136
histology of alcoholic hepatitis
- ballooning of cells
- mallory denk bodies (pink deposits in cells)
- apoptosis
- pericellular fibrosis
137
why is zone 3 particularly vulnerable to damage?
hypoxic
| most metabolically active
138
PBC
bile duct loss
chronic inflammation
granulomas
139
PSC
periductal bile fibrosis
| leads to loss
140
Haemochromatosis gene
HFe gene on Chr 6
141
Wilsons Chromsome
Chr 13
142
where is the deficiency in A1AT?
deficiency in blood not hepatocytes
excess in hepatocytes, folds wrong and cannot leave = damage
hepatitis and emphysema
143
causes of hepatic granuloma
PBC
Drugs
TB
Sarcoidosis
144
exocrine and endocrine aspects of pancrea
exocrine: acini and ducts
endocrine: e.g. islets of Langherans
145
2 pathogenesis of acute pancreatitis
1. Duct Obstruction (gallstone and alcohol)
| 2. Direct Acinar injury (all other causes)
146
how gallstone causes acute pancreatitis?
reflux of bile up pancreatic duct
damage to acini
release of enzyme
147
how alcohol causes acute pancreatitis?
spasm/oedema of Sphincter of Oddi
148
how does acute pancreatitis cause hypocalcaemia?
lipases released from inflamed pancreas = fat necrosis
| Ca binds to free fatty acids = soaponification
149
what is a pseudocyst?
collection of fluid without epithelial lining
lined by fibrous tissue
rich in pancreatic enzymes/necrotic materal
150
IgG4 related disease (AI pancreatitis)
duct surrounded by loads of IgG4 expressing plasma cells
| n.b. normal polyclonal response = different IgGs
151
different tumours of pancreas
- carcinomas: ductal (85%), acinar
- cystic neoplasms: serous cystadenoma, mucinous cystic neoplasm
- pancreatic neuro endocrine tumours
152
what 2 types of dysplastic ductal lesions can ductal carcinoma arise from?
- pancreatic intraductal neoplasia (PanIN)
| - intraductal mucinous papillary neoplasm
153
ductal carcinoma mutation
K-Ras
154
pathology of ductal carcinoma
mucin secreting glands set in desmoplastic stroma (adenocarcinoma)
most commonly in head
155
cystic tumours features
serous/mucin secreting epithelium
156
2 different types of gallstone
- cholesterol (>50%): radiolucent (not seen on plain abdo X-ray)
- pigment: Ca salts of unconjugated bilirubin, radio-opaque
157
pathology of chronic cholecystitis
- chronic inflammation
- fibrosis
- diverticula: Rokitansky-Aschoff sinuses (gall bladder contracting against obstruction)
158
histology of body and fundus of stomach
- lined by gastric mucosa, columnar epithelium
- specialised glands in lamina propria (produce acids and enzymes)
- muscularis mucosa
159
which parts of the stomach are affected by H. pylori associated gastritis?
pyloric antrum/canal
160
how is the histology of antrum/pyloric canal different?
same histology except no specialised glands
161
are goblet cells normally seen in stomach?
goblet cells not normally seen in stomach
| sign of intestinal metaplasia
162
Barrett's oesophagus changes
squamous to columnar metaplasia
| if goblet cells visible = intestinal metaplasia = much higher risk of Cancer
163
SCC of oesophagus
| RFs and location
RFs: smoking, alcohol
| mid/lower oesophagus, invades submucosa
164
causes of acute gastritis
- chemical (aspirin, alcohol, corrosives)
| - infection (H. pylori)
165
causes of chronic gastritis (ABC)
- AI (anti-parietal cell)
- bacteria (H. pylori)
- chemical (NSAIDs, bile reflux)
166
what are the histological sign of MALT?
lymphoid follicles in stomach (not normal)
| H.pylori induces lymphoid tissue in stomach
167
which form of H.pylori is associated with more chronic inflammation?
Cag-A +ve H. pylori
168
what are the 2 pathways that lead to GI cancer?
metaplasia - dyplasia e.g. oesophageal
| adenoma-carcinpoma e.g. colon cancer
169
definition of ulcer
depth of tissue loss goes beyone=d muscularis mucosa into submucosa
170
gastric adenocarcinoma subtypes
1. intestinal: well differentiated, big glands, containing mucin
2. diffuse: poorly differentiated, no gland formation
171
types of diffuse adenocarcinoma
linitis plastica
| signal ring cell carcinoma
172
what is lymphocytic duodenitis?
inflammatory changes (inc IELs) without architectural changes
173
what is the effect of ageing on skin?
fragile skin
little epidermis
collagen/elastic fibres poor quality
174
different inflammatory reaction patterns
- vesiculobullous (forms bullous)
- spongiotic (becomes oedematous)
- psoriasiform (thickened)
- lichenoid (sheeny plaque)
- vasculitis (ass/ w. vasculitides)
- granulomatous
175
features of bullous pemphigoid
- flexor surfaces
- tense bullae
- IgG and C3 attack BM (dermo-epidermal junction)
176
features of pemphigus vulgaris
- flaccid blisters
- IgG
- damage occuring within keratinocyte layers
- acantholysis
177
what is definition of acantholysis?
loss of intraceullular connections
| = loss of cohesion between keratinocytes
178
features of pemphigus foliaceus
- thin bullae, not intact
- IgG mediated
- damage to outer layer of keratinocytes/stratum corneum
179
what is hyperparakeratosis?
thickening of skin on surface when you have been scratching
| epidermis gets thicker
180
histology of eczema
spongiotic
| oedema in between keratinocytes
181
plaque psoriasis histology
extensor silvery plaques
rapid turnover of cells = parakeratosis
no stratum granulosum = not enough time to form
Munro's microabscesses (neutrophils) in epidermis
182
lichen planus presentation in mouth
Wickham striae
183
what histological finding can be seen in lichen planus and mycosis fungoides
band like lymphocytic infiltrate under epidermis
184
seborrhoeic keratosis
stuck on
| horn cysts
185
what does BCCs arise from?
keratinocytes along bottom of epidermis
186
what is an SCC in situ called?
Bowen's disease
187
what is Pagetoid spread?
melanocytes migrating up through epidermis
188
3 forms of urinary calculi
75%: calcium oxalate (due to hypercalciuria)
15%: struvite
5%: uric acid
189
features of struvite calculi
```
proteus infection (urease production)
staghorn calculus
```
190
3 types of benign renal neoplasm
- papillary adenoma
- renal oncocytoma
- angiomyolipoma
191
types of renal cell carcinoma
- clear cell (70%)
- papillary (15%)
- chromophone (5%)
192
features of clear cell carcinoma
- lots of clear cells
- golden yellow tumour, haemorrhagic areas
- loss of Chr 3p
193
what are the cells that make up nephroblastoma?
malignant TRIPHASIC kidney tumour
- blastema = small round blue cells
- epithelial
- stromal
194
most common type of bladder carcinoma and RFs
transitional cell carcinoma
| RFs: smoking, aromatic amines
195
Gleason score
most common pattern + worst pattern
196
features of testicular germ cell tumours
arise from germ cell neoplasia in situ
| painless testicular lump
197
RFs for testicular germ cell tumours
undescended testes
| LBW
198
5 subtypes of testicular germ cell tumours
1. seminoma
2. embryonal carcinoma
3. post-pubertal teratoma
4. yolk sack tumour
5. choriocarcinoma (cytotrophoblasts + synctiotrophoblasts)
199
histology of seminoma
clear cells
| prominate lymphocytic infiltrate
200
Tx of testicular germ cell tumours
platinum based chemo
201
composition of bone
- inorganic (Ca hydroxyapatite)
| - organic (bone cells and matrix)
202
what is the location of the growth plates?
metaphysis
203
cortical bone features
long bones
| mechanical/protective
204
cancellous bone features
vertebrae/pelvis
| metabolic
205
osteocytes
osetoblast like cells
| sit in lacunae
206
what cell are osteoclast percursors derived from?
monocytes
207
what are the 3 categories of metabolic bone disease?
- non-endocrine (e.g. age related osteoporosis)
- related to endocrine abnormality (e.g. vit D/PTH)
- disuse osteopaenia
208
what are the 2 types of osteomalacia?
vitamin D def
| phosphate def
209
what is a brown cell tumour? associated with what?
hyperparathyroidism
| multinucleated giant cells
210
what is Paget's disease?
disorder of bone turnover
211
what re the stages of fracture repair?
1. haemotoma at site (pro-callus)
2. formation of fibrocartilaginous callus
3. mineralisation of fibrocartiaginous callus
4. remodelling of bone along weight bearing lines
212
what is salmonella osteomyelitis associated with?
SCD
213
x-ray changes in osteomyelitis
7 days: irregular subperiosteal new bone = involucrum
10-14 days: irregular lytic destruction
3-6 weeks: some areas of necrotic cortex detached = sequestra
214
lyme disease cause
tick bite from Ixodus dammini
| organism: Borrelia burgdorferi
215
some symptoms of lyme disease
multisystem illness
inflammatory arthropathy
erythema chronicum migrans
216
histology of osteoarthritis
- cartilage degeneration
- fissuring
- abnormal matrix calcification
- osteophytes
- synovium inflamed, infiltration of inflammatory cells
217
what is RA?
severe chronic relapsing synovitis
218
characteristic deformities in RA
- radial deviation of wrist
- ulnar deviation of fingers
- swan neck and Botonniere deformity
- Z shaped thumbs
219
histology findings of RA
- proliferative synovitis
- pannus formation
- Grimley-Sokoloff cells
220
X-ray and Histology in Osteosarcoma
X-ray: lytic, elevated periosteum (Codman's triangle)
| Histology: malignant mesenchymal cells
221
X-ray and histology in Chrondrosarcoma
- X-ray: lytic with fluffy calcifications
| - Histology: malignant chondrocytes
222
cause of Hirschsprung's
absence of ganglion cells of myenteric plexus
223
associated genetic abnormality of Hirschsprung's
RET proto-oncogene
224
secretory and exudative diarrhoea
- secretory: caused by toxin
| - exudative: invasion and mucosal damage
225
associated skin lesions in Chrons
pyoderma gangrerosum
erythema multiforme
erythema nodosum
226
when can other parts of the bowel by caused in UC?
backwash ileilitis
| terminal ileum inflamed
227
complications of UC
severe haemorrhage
toxic megacolon
adenocarcinoma
228
what are the tumours of colon/rectum?
- non neoplastic polyps
- neoplastic epithelial lesions (adenoma, adenocarcinoma, carcinoid tumour)
- mesenchymal lesions (stromal, lipoma, sarcoma)
- lymphoma
229
different non-neoplastic polyps
hyperplastic
inflammatory (pseudopolyp)
haemartomatous (jeuvenile, Peutz-Jeghers)
230
types of neoplastic polyp
tubular adenoma
tubulovillous adenoma
villous adenoma
231
RFs for cancer of a polyp
- size of polyp (>4cm)
- proportion of villous component
- degree of dysplastic change
232
familial syndromes characterised by polyps
- Peutz-Jeghers
- FAP (Gardner's, Turcot)
- HNPCC
233
mutation in FAP
APC tumour suppressor on CHr 5q21
234
gene mutation in HNPCC
DNA mismatch repair gene
| + extra colonic cancers (e.g. endometrium, prostate, breast, stomach)
235
Duke's staging
A: confined to bowel wall
B: through bowel wall
C: LN mets
D: distant mets
236
molecular mutation in lung adenocarcinoma
EGFR
| ALK-1
237
molecular mutation in melanoma
BRAF
238
molecular mutation in breast
BRCA1/2
| CERB-B2
239
molecular mutation in colon cancer
APC
| KRAS
240
extra-axial tumours
coverings
| tumours of bone, cranial soft tissue, meninges, nerves, metastatic deposits
241
intra-axial tumours
parenchyma
| normal cell population of CNS/other cell types
242
WHO grading of CNS tumours
I: benign, long term survival
II: death > 5 yrs
III: death < 5 yrs
IV: death < 1 year
243
what are glial tumours and the 2 types?
most common primary tumour of CNS
1. diffuse infiltration
2. circumscribed glioma
244
diffuse infiltration types and genetics
adults
astrocytoma or oligodendrogliomas
genetics: IDH 1/2 mutations
245
circumscribed glioma type and genetic
- children
- MAPK mutation (BRAF)
- pilocystic astrocytoma = most common
246
pilocystic astrocytoma unique features and MRI
NF1
often cerebellar
piloid (hairy cell), Rosenthal fibres
MRI: well circumscribed, cystic and enhancing
247
astrocytoma features and MRI
- malignant progression --> eventually gliobastoma
- de novo glioblastoma = most aggressive/frequent
MRI: non-enhancing
248
features of glioblastoma multiforme
type 4
| high cellularity and mitotic activity
249
features and histology of oligodenroglioma
long history of neuro signs
better prognosis than astrocytoma
histology: round cells with clear cytoplasm (fried eggs)
250
Meningioma features
MRI: extra-axial, contrast enhancing
| focal symptoms
251
what is a medulloblastoma
originates from neuroepithelial precursors of cerebellum
| small blue round cell tumour
252
which cancers metastasise to CNS? where are mets seen?
lung, breast, melanoma
| seen at grey-white junction
253
what are the 2 main types of cerebral oedema?
1. vasogenic: disruption of BBB
| 2. cytotoxic: secondary to cellular injury (hypoxia/ischaemia)
254
what is the flow of the CSF?
1. choroid plexus pumps out of CSF
2. goes into 3rd ventricle through intraventricular foramen
3. goes down cerebral aqueduct into 4th ventricle
4. down into medulla and central canal of spinal cord
255
how does CSF return back to systemic circulation?
CSF will circulate through subarachnoid space
| and via arachnoid granules returns to systemic circulation
256
what are the 2 forms of hydrocephalus?
- non-communicating: obstruction to flow of CSF (usually involving cerebral aqueduct)
- communicating: NO obstruction, problem with reabsorption of CSF into venous sinuses (e.g. infection)
257
what is the normal ICP?
7-15mmHg
258
what is subfalcine herniation?
cortex pushed under rigid falx cerebri
259
what is transtentorial (uncal) herniation?
herniation of median temporal lobe through tentorial notch
260
what is tonsillar herniation?
tonsils (cerebellum) pushed through foramen magnum
261
what causes intra-parechymal haemorrhage?
due to rupture of small intraparenchymal vessel
| usually due to HTN
262
what is a cavernous angioma?
closely packed vessels
| no parenchyma interposed between vascular space
263
cavernous angioma vs AVM
similar to AVM but no brain substance wrapped up amongst vessels
264
where are most SAH?
most at internal carotid bifurcation
265
what is a contusion?
when brain collides with internal surface of skull
| = bruising of surface
266
what is it called if pia mater is ruptures?
laceration
267
what is contrecoup damage?
rebound of brain after direct impact causes damage to opposite side of brain
268
what is the issue in prion protein?
prion protein change's host protein into pathological form
269
histology in prion disease
spongiform encephalopathy = lots of vacuoles
270
features of vCJD and its cause
- sporadiac neuropsych
- cerebellar ataxia, dementia
- link to BSE (mad cow disease)
271
neuropathology of Alzheimer's
- extracellular plaques (amyloid-beta)
- neurofibrillary tangles
- cerebral amyloid angiopathy (deposition of proteins in blood vessels)
- neuronal loss (cerebral atrophy)
272
how does tau cause Alzheimer's?
hyperphosphorylated tau
intracellular accumulation
cell death
273
histology of Parkinson's
- Lewy Bodies (alpha-synuclein)
- loss of dopaminergic cells from substantia nigra
- substantia nigra connects to basal ganglia
274
what staging system is used in Parkinson's and Alzheimer's?
Braak stages
275
3 main differentials for Parkinson's?
- multiple system atrophy
- corticobasal degeneration
- progressive supranuclear palsy
276
which of these are tauopathies?
corticobasal degeneration
| progressive supranuclear palsy
277
what is multiple system atrophy?
alpha-synucleinopathy
targets glial cell, tends to affect cerebellum
patient presents with fall
278
histology of Pick's disease
- gliosis and neuronal loss
- balloon neurones
- Tau +ve Pick bodies
279
what are the 2 species of Tau in our brain?
3R and 4R
280
what is ARDS?
diffuse alveolar damage
281
phases to ARDS
1. exudative phase (congested and leaky lungs)
2. hyaline membranes
3. organisation of exudates to form granulation tissue
282
acute histological changes in asthma
- bronchospasm
- oedema
- hyperaemia
- inflammation
283
chronic histological changes in asthma
- muscular hypertrophy
- airway narrowing
- mucus plugging
284
pathology in chronic bronchitis
- dilated airways
- mucus gland hyperplasia
- goblet cell hyperplasia
- mild inflammation
285
what is emphysema?
permanent loss of alveolar parenchyma distal to terminal bronchi
secondary to inflammation
286
emphysema in smoking vs A1AT
```
smoking = centrilobular damage
A1AT = panacinar (damage throughout lungs)
```
287
what is bronchiectasis?
permanent abnormal dilation of bronchi with inflammation and fibrosis
infection = most common cause
288
complications of bronchiectasis
recurrent infection
haemoptysis
pulmonary HTN
amyloidosis
289
CF genetics
Chr 7
CFTR gene
Delta F508
290
what are the affects of CF on the different organs?
- GI: mec ileus, malabsorption
- Pancreas: pancreatitis, malabsorption
- liver: cirrhosis
- male: infertility
291
organisms affecting lungs in CF patients
S. pneumoniae
H. influenzae
P. aeruginosa
B. cepacia
292
Gram -ve causes of HAP
Klebsiella
| Pseudomonas
293
Bronchopneumonia features
infection centred around airways
| low virulence organisms
294
histopathology of lobar pneumonia
1. congestive
2. red hepatisation
3. grey hepatisation
4. resolution
295
what is a granuloma?
collection of macrophages and mutli-nucleate giant cells
296
what is pneumonitis?
interstitial inflammation
297
with lung cancers are near the airways?
SCC
298
with lung cancers are near the peripheral alveolar spaces?
mainly adenocarcinoma
299
what are the non-small cell carcinoma?
SCC
Adenocarcinoma
large cell carcinoma
300
which lung cancers is smoking associated with?
SCC
| small cell
301
features of squamous cell carcinoma
- central
- arising from bronchial epithelium
- spreads locally, mets late
302
features of adenocarcinoma
- periphery
- glandular
- mets common and early
303
what is the pre-cursor lesion in lung adenocarcinoma?
atypical adenomatous hyperplasia
304
mutations in smokers
K-ras
DNA methylation issues
p53
305
mutations in non-smokers
EGFR
306
what are the features of large cell carcinoma?
poorly differentiated large cells
| poorer prognosis
307
small cell carcinoma features
central, near bronchi
advanced disease, poor prognosis
paraneoplastic syndrome
308
histology in small cell carcinoma
small poorly differentiated
| P53, RB1 mutation
309
adenocarcinoma main molecular changes
EGFR mutation
ALK translocation
Ros1 translocation
