histopathology Flashcards
1
Q
Rubor
A
Redness
Blood flow Injury
2
Q
Calor
A
Heat
Blood > heat
3
Q
Tumor
A
Swelling
Capillary > Sensory nerves
4
Q
Dolor
A
Pain
Pressure > Sensory nerves
5
Q
Functio laesa
A
Loss of function
Destruction of functional units
6
Q
Acute inflammation
A
Vascular & exudative
PMNs—(Tissue)—> Microphages
7
Q
Subchronic inflammation
A
Intergrade between acute & chronic
8
Q
Chronic inflammation
A
Vascular & fibroblastic
Monocytes—(Tissue)—> Macrophages
9
Q
Serous inflammation
A
Serum/secretions from serosal mesothelial cells (3P9s)
Pulmonary TB
10
Q
Fibrinous inflammation
A
Fibrinogen
Diphtheria, rheumatoid pericarditis
Early stage of pneumonia
11
Q
Catarrhal inflammation
A
Hypersecretion of mucosa
12
Q
Hemorrhagic inflammation
A
Blood + exudates
Bacterial infections & other infections
13
Q
Suppurative/purulent
inflammation
A
Pus: creamy fluid component of PMNs and necrotic tissue debris
Abcess : pus
Pustule: pus
14
Q
Aplasia
A
Incomplete/defective development of a tissue/organ
Ex. amastia (breast aplasia)
15
Q
Atresia
A
Failure to form an opening
16
Q
Hypoplasia
A
Failure of an organ to reach its matured size
17
Q
Agenesia
A
Complete non-appearance of an organ
18
Q
Physiologic atrophy
A
Natural
Thymus, brain, sex organs
19
Q
Pathologic atrophy
A
Vascular atrophy
Pressure atrophy
Atrophy of disuse
Exhaustion atrophy
Endocrine atrophy
20
Q
Brown atrophy
A
Lipofuscin
21
Q
Hypertrophy
A
Increased tissue size due to increased cell size
Physiologic: ·size of uterus
Pathologic: Systemic hypertension
22
Q
Hyperplasia
A
Increased tissue size due to increased cell number
Physiologic: Glandular proliferation of the female breast, ·size of uterus (preg.)
Pathologic: Skin warts due to HPV
23
Q
Compensatory hyperplasia
A
Ex. Enlargement of one kidney
24
Q
Pathologic hyperplasia
A
Ex. Endometrial hyperplasia
25
Congenital hypertrophy
Phenytoin-induced
26
Metaplasia
Reversible
One adult cell type ́ Another adult cell type
27
Dysplasia
Reversible
One type of adult cell ́ Changes in structural components
28
Anaplasia/
Dedifferentiation
Irreversible
Criterion toward malignancy
Adult cell More primitive cells (release tumor markers)
29
Neoplasia/tumor
Continuous abnormal proliferation of cells w/o control (no purpose/function)
Ex. Leukemia
30
Oncology
Study of neoplasm
31
Parts of a tumor
1. Parenchyma = active elements (tumor cells)
2. Stroma = CT framework
32
Types of tumor
1. Capacity to produce death:
- Benign (Ex. mole)
- Malignant
2. Histologic characteristics:
- Medullary = cells (parenchyma) > supporting tissues (stroma)
- Scirrhous = supporting tissues (stroma) > cells (parenchyma)
33
Benign
"-oma"
34
Malignant
"SaMe CarE"
<-sarcoma= = mesenchymal/CT
<-carcinoma= = epithelial tissues
35
Leukemia
Lymphoma
Malignant
36
Squamous cell papilloma
Benign
37
Squamous cell carcinoma
Malignant
38
Hepatoma/
hepatocarcinoma
Malignant
39
Melanoma/
melanocarcinoma
Malignant
40
Ectopic pregnancy
Fallopian tube pregnancy
41
Grading
Aggressiveness/level of malignancy
Differentiated cells = resemble normal cells
Undifferentiated cells = younger cells
42
Staging
Size, extent of spread to lymph nodes, +/- metastases
43
UICC
TNM classification
44
AJCS
Grading + staging
45
TNM system
Applicable to all forms of neoplasia
46
T
1' tumor
#: denotes the size of tumor and its local extent
Tis = carcinoma in situ
Ta = non-invasive
Tx = cannot be evaluated
T0 = free of tumor
T1 = lesion <2 cm (T1a = <0.5 cm | T1b = <1 cm | T1c = <2 cm)
T2 = lesion 2-5 cm (invasion in muscle)
T3 = skin and/or chest wall involved by invasion (T3a = deep muscle | T3b =
through organ)
T4 = tumor invasion/fixation (T4a = adjacent organ | T4b = fixation to bladder or
colonic wall, in breast, edema)
47
N
Regional lymph node involvement
High # denotes increasing extent of involvement
Nx = not evaluable
N0 = no axillary nodes involved
N1 = 1 mobile regional (axillary) node involved
N2 = multiple, mobile regional nodes involved
N3 = fixed regional lymph node involved
N4 = beyond regional lymph node involvement
48
M
Metastasis
M0 = no evidence of metastases
M1 = distant metastases are present
Mx = distant metastases not evaluable
49
Teratomas
Compound tumors
Greek: Monstrous tumors
May contain hair, teeth, bones
w/ heartbeat
50
Apoptosis
Programmed cell death (cellular suicide)
51
Necrobiosis
Physiologic cell death
Ex. normal sloughing off of skin cells
52
Necrosis
Pathologic cell death
53
Coagulation necrosis
Most common
Tombstone formation
54
Liquefaction/colliquative
necrosis
Pus formation
Brain & spinal cord
55
Caseous/caseation necrosis
Yellow, cheesy, crumbly material
TB, syphilis, tularemia, lymphogranuloma inguinale
56
Gangrenous necrosis
Sulfide gas production
a. Dry gangrene = arterial occlusion
b. Wet gangrene = venous occlusion
57
Fat necrosis
Chalky white precipitates
Pancreatic degeneration
58
Fatty degeneration
Liver
59
1' changes
During somatic death
"CRC" : circulatory, respiratory, CNS failure
60
2' changes
After somatic death
"ARLP DPA": Algor mortis, Rigor mortis, Livor mortis, Postmortem clotting,
Dessication, Putrefaction, Autolysis
61
Algor mortis (1st)
Postmortem cooling
62
Rigor mortis (2nd)
Stiffening
1st: neck & head (2-3 hrs)
Persists for 3-4 days
63
Livor mortis
Lividity/suggillations
Purplish discoloration
After 10-12 hrs, it does not blanch on pressure or shift when the body is moved
64
Disappears on pressure (reappears when pressure is
released)
Opposite of postmortem lividity
65
Oozing of blood (incision)
No oozing of blood (incision)
66
Postmortem Clot
Settling of RBCs from plasma
Chicken fat
Currant jelly
Assumes the shape of the vessel
Rubbery consistency
Dessication
Putrefaction
Autolysis
67
Antemortem Clot
Not readily detachable from the blood vessels
No chicken fat
No currant jelly
Seldom assumes the shape of blood vessels
Granular & friable
Drying & wrinkling of the anterior chamber of the eye
Invasion of intestinal microorganisms
Self digestion of cells
Lysosome: suicide sac of the cell, releases lysozyme
68
Exfoliative cytology
Desquamated cells
69
Pap smear stain method
Method of choice
70
Barr body
Females
71
3 anatomical sites
1. Upper lateral third of the vagina
2. Ectocervix
(Stratified Squamous Epithelium)
-------T zone: detect cervical cancer-------
(Simple Squamous Epithelium)
3. Endocervix
72
Fixation
♫ 50% alcohol = All types
50% alcohol = pleural & peritoneal
70% alcohol = sputum
95% alcohol = urine, bronchial & gastric
♫ Saccomanno9s fixative = 50% ETOH + 2% carbowax
73
Smear preparation
Fix immediately
2-3 slides/patient
a. streaking
b. spreading
c. touch preparation/impression
d. pull-apart
Never touch the bottom of the fixative container
74
Fixing smear
Equal parts of ethanol & ether = BEST (but highly flammable)
95% ethanol = commonly used
Spray fixatives = 1 ft away
75
Sputum
Saccomanno9s fixative
3 specimen
(+) alveolar macrophage = sputum
(-) alveolar macrophage = saliva
76
BAL
P. carinii/P. jiroveci
77
Jelly-like clots
Prevent by adding 300U heparin/100mL aspirate
78
GI specimen
If >1⁄2 hr delay of fixation digestion of cells
Fasting: 8 hrs
79
Urine
50mL = cytology
10-15mL = UA
2nd urine = preferred
80
Pap smear
Dr. George Papanicolau (1940)
Smears: prepared by rotary motion
1. Mailing of specimens
- air drying after 2 hrs fixation
- glycerin technique
2. Egg albumin = not recommended as adhesive agent (intensifies stain by Light
Green)
81
Adhesive agents
Pooled human serum/plasma
Celloidin ether alcohol
Leuconostoc culture
82
3 primary materials used
for obtaining specimen for
Pap smear
1. Speculum
2. Ayer9s spatula = rotate 3600
3. Cytobrush = Os
83
Strawberry cervix
T. vaginalis
84
Shift to the left
Parabasal cells
85
Shift to the right
Superficial cells
86
Shift to the midzone
Intermediate cells
87
Superficial cells
45-50μm
Pyknotic nucleus
True acidophilia
Estrogen
88
Intermediate cells
Folds/curls on edges
Progesterone
a. Navicular cells = boat-shaped
b.Pregnancy cell = nucleus pushed aside (glycogen)
89
Parabasal cells
15-30μm
Fried eggs w/ sunny side up
Menopausal women
90
Endometrial cells
Groups of 3 or more
1-10 days after menstruation ( RBCs, WBCs)
91
Endocervical glandular cells
Honeycomb appearance
Similar appearance to parabasal cells
92
Doderlein bacillus
L. acidophilus
Pap9s stain: blue to lavender
93
C. albicans
Diabetic patients
Sish kebab appearance
94
T. vaginalis
Pear-shaped, blue-gray to blue-green
Pigs on a scruff appearance
95
Leptothrix
Indicates T. vaginalis infection
96
G. vaginalis
Clue cells
97
Koilocytes
Wrinkled prune appearance
w/ perinuclear halo
HPV (LSIL)
98
Ferning
Formation of salt crystals
Estrogen
Early pregnancy
99
3 copies/report
1. Doctor
2. Patient = original copy
3. File
100
Reports
Surgical pathology report
Cytopathology report
Autopsy report
101
Signatories
Request forms = patient9s doctor
Result forms = pathologist
102
Turnover of results
Surgical pathology & cytology = 24 hrs
Frozen section = 5-15 mins
Autopsy report = 1 week (Autopsy procedure: 24 hrs)
103
Storage
Specimen (tissue) = 1 month to 1 year
Tissue blocks (paraffin) = 3 to 10 years
Slides = indefinite
104
Requisitions
2 years
105
QC
2 years
106
Instrument maintenance
2 years
107
BB QC
5 years
108
BB employee signatures
10 years
109
BB donor/recipient records
Indefinitely
110
Clinical pathology lab
reports
2 years
111
Surgical pathology (and
BM) reports
10 years
112
Cytogenetics reports
20 years
113
Autopsy forensic reports
Indefinitely
114
Technique of Virchow
Organs removed & dissected individually in the body
Most widely used metohd
115
Technique of Rokitansky
In-situ dissection in part combined w/ en bloc technique
♫ En bloc:
- By cavity
- Interrelated to each other
- Systemic dissection
- Ex. thoracic cavity (lungs, heart, diaphragm), respiratory system
116
Technique of Ghon
En bloc technique
117
Technique of Letulle
En masse technique
♫ En masse:
- All organs of thoracic, abdominal, & pelvic are removed at the same time
- Sweeping of all organs
118
Autopsy: Larynx > Rectum
Very popular, easy to do, convenient
Part of consent: organs should be retained completely or partially
Organs > set aside later
Body > undertaker of the body
119
Teasing/Dissociation
Tissue specimen > Watchglass (isotonic solution) > BF/PC microscope
120
Crushing/squash
preparation
Tissue (<1mm) > Sandwich bet. 2 slides/coverslip > Vital stain
121
Smear preparation
Spread lightly over a slide (wireloop/applicator)
122
Frozen section
(-) Fixative
123
Freezing of unfixed tissue
Best frozen section
124
Freezing of fixed tissue
To localize hydrolytic enzymes & other antigens
125
Formal (formol) calcium
Derivative of formaldehyde
Fix at 49C for 18 hrs
126
Commonly used methods of
freezing
Liquid nitrogen = most rapid
Isopentane cooled by liquid nitrogen
CO2 gas
Aerosol sprays
127
Staining methods
(frozen sections)
128
H & E
a. Progressive
- w/o decolorizer
- for frozen sections
b. Regressive
- w/ decolorizer (acid-alcohol)
- for routine histology staining
129
Freeze-drying
w/o use of any chemical fixative
♫ Quenching: rapid freezing (-1609C)
♫ Sublimation: removal of H2O in the form of ice (-409C) 3 vacuum
130
Freeze-substitution
Similar to freeze drying but:
Frozen tissue Rossman9s formula/1% acetone
Dehydrated in absolute alcohol
131
Cold knife procedure
Any microtome
Uses CO2
Knife: -40 to -609C
Tissue: 5 to -109C
Environment: 0 to -109C
132
Cryostat procedure
(Cold microtome)
Temperature: -18 to -209C
Cryostat: refrigerated cabinet w/ rotary microtome
133
O.C.T. (Optimal Cutting
Temperature)
Best mounting media for cryostat sections
134
Steps of tissue processing
"FDCIETS SMoL"
1. Fixation
(Decalcification)
2. Dehydration
3. Clearing/Dealcoholization
4. Impregnation/Infiltration
5. Embedding/Casting/Blocking
6. Trimming
7. Sectioning/Microtomy
8. Staining
9. Mounting
10. Labeling (slides)
135
Fixation of tissue
1st and most critical step
19 aim: preserve cell (life-like)
29 aim: harden & protect tissues
Most important: stabilization of proteins
136
pH of tissue
6.0-8.0
137
Microanatomical fixatives
General microscopic study of tissues
a. 10% Formol saline
b. 10% NBF
c. Heidenhain9s SuSa
d. Formol sublimate (formol corrosive)
e. Zenker9s solution
f. Zenker-formol (Helly9s)
g. Bouin9s solution
h. Brasil9s solution
138
Cytological Fixatives
Specific parts of the cell
a. Nuclear fixatives: w/ glacial acetic acid 3 destroys mitochondria & golgi
bodies (pH f4.6)
b. Cytoplasmic fixatives: w/o glacial acetic acid
c. Histochemical fixatives: preserves chemical constituents
139
Nuclear fixatives
140
Cytoplasmic fixatives
141
Histochemical fixatives
142
Paraformaldehyde
- White crystalline precipitates
- Due to prolonged standing
- Removed by: 10% METOH/filtration
143
Acid formaldehyde hematin
- Brown/black granular deposits that may obscure microscopic details
144
10% Formol saline
CNS
145
10% NBF
Best general tissue fixative
Best fixative for tissue containing iron granules
w/ double phosphate buffer
1 mm/hr = rate of tissue penetration
146
Formol-Corrosive
(formol sublimate)
w/ HgCl2
147
Glutaraldehyde
EM
148
Karnovsky's
paraformaldehyde-
glutaraldehyde
EM: electron histochemistry & electron immunocytochemistry
149
Acrolein
Mixture w/ formaldehyde
150
Fixative that has composition of Mercuric Chloride
Tissue photography
For Trichrome stain (excellent)
Produce black granular deposits except SuSa
151
De-zenkerization
Removal of mercuric deposits
H2O > I2 > H2O > Sodium thiosulfate > H2O
152
Chromate fixatives
153
Chromate pigments
Fine, yellow
154
Picric acid fixatives
Highly explosive when dry
Excessive yellow staining of tissues
Picrates Protein Ppt. (H2O soluble) Add 70% ETOH Insoluble
Never wash in H2O before dehydration
For glycogen (excellent)
a. Bouin9s = for embryos, Masson9s trichrome stain, glycogen
b. Brasil's alcoholic picroformol = less messy than Bouin's, glycogen (excellent)
155
Glacial acetic acid
Solidifies at 179C
Fixes & precipitates nucleoproteins, chromosomes, & chromatin material
Most commonly combined w/ other fixatives
156
Alcoholic fixatives
Disadvantage: polarization (glycogen granules > poles/ends of the cells)
157
Osmium tetroxide
(Osmic acid)
Inhibits hematoxylin
Produce black precipitate crystals (osmium oxide)
For lipids
a. Flemming9s = permanently fixes fat, for nuclear structures (excellent)
- Fixative & decalcifying agent (chromic acid)
b. Flemming9s w/o acetic acid = for mitochondria
158
Trichloroacetic acid
Precipitates proteins
Swelling effect counteract shrinkage by other fixatives
Weak decalcifying agent (softening effect)
159
Acetone
Recommended for H2O-diffusible enzymes (phosphatases, lipases)
Rabies
160
Heat fixation
Bacteriologic smears
Microwave: 45-559C
Underheating: poor sectioning
Overheating (>659C): vacuolation, overstained cytoplasm
161
2' fixation
Placing an already fixed tissue in a 2nd fixative
162
Post-chromatization
Primarily fixed tissue 2.5-3% K2CrO4 (mordant)
163
Washing out
Removing excess fixative
a. Tap H2O = remove excess chromates, formalin, osmic acid (NOT Bouin9s)
b. 50-70% alcohol = wash out excess picric acid (Bouin9s)
c. Alcoholic I2 = remove excess mercuric fixatives
164
EM fixatives
Glutaraldehyde
PtCl3
PtCl3 3 formalin (Zamboni9s)
AuCl
Osmium tetroxide
10% NBF = acceptable but not recommended
165
Stains (EM)
1. PTA = 1st general stain
2. Uranyl acetate = Best
3. Lead
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