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Histopathology > Histopathology 13 - Histopathology of Systemic Disease > Flashcards

Histopathology 13 - Histopathology of Systemic Disease Flashcards

1
Q

What can John cunningham virus infection in HIV positive patients lead to?

A

Progressive multifocal leukoencephalopathy

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2
Q

What is the most common opportunistic infection in HIV positive patients?

A

CMV

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3
Q

Which herpes virus causes kaposi sarcoma?

A

HHV8

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4
Q

What is the main histological finding in sarcoidosis?

A

Non-caseating granulomas

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5
Q

How does end-stage sarcoidosis appear on CXR?

A

‘Honeycomb’ lung

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6
Q

What is a granuloma made up of?

A

Lymphoid cells and giant cells

  • GRANULOMA- organised collection of activated epithelioid macrophages
  • Giant cells- formed by the fusion of macrophages
  • outside of granulomas, there will be lymphocytes
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7
Q

What colour does IgG4 stain when positive?

A

Brown

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8
Q

Recall 3 diseases caused by IgG4 inflammation

A

Riedel thyroiditis
Autoimmune pancreatitis
Inflammatory pseudotumours

others;

Billiary obstruction

retroperitoneal fibrosis

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9
Q

What is the structure of amyloid?

A

Beta pleated sheet that forms non-branching fibrils

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10
Q

What is the cause of AA amyloidosis?

A

Chronic inflammation

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11
Q

Which conditions are particularly implicated in the development of AA amyloidosis?

A

Crohn’s
Rheumatoid arthritis

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12
Q

What conditions can cause AL amyloidosis?

A

Myeloma
B cell neoplasms

**not MGUS and smouldering

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13
Q

What is the link between transthyretin and amyloidosis?

A

Transthyretin mutation can –> cardiac amyloid

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14
Q

What stain can be used for amyloid?

A

Congo red - gives green birefringence under polarised light

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15
Q

Where does CMV cause infection in HIV positvie patients?

A

CMV oesophagitis

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16
Q

Classical finding of CMV oesophagitis

A

Causes osopahgeal ulcers

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17
Q

Histopathological findings of CMV infection

A

CMV oeosphagitis - causes ulcers

Epithelial cells and coin like nuclear inclusions in nucleus (CMV inclusion)

Stains brown in immunohistochemistry

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18
Q

Which tumours do HIV positive patients get?

A
  1. Kaposi’s sarcoma
  2. Lymphoma - especially B cell lymphoma

EBV–> Burkitt’s lymphoma

  1. others:
  • HPV
    • Often high-risk variants 16 and 18
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19
Q

What CNS disease do HIV positvie patients get?

A
  1. Progressive encephalopathy - AIDS dementia complex
  2. Encephaitis/meningitis - opportunistic infections
  3. CNS lymphoma
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20
Q

Histology of Kaposi’s sacrcoma

A
  • elevated purple, pink, brown bumps on skin or in mouth and/or throat.
  • The mass is made up of spindle shaped cells with lots of space between them
  • Stained for HHV8 which is a marker for Kaposi’s sarcoma
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21
Q

Histology of CNS lymphoma

A

Tumour mass (pinky area of the brain slice) - rather than as disseminated disease which is usually the case

Perivascular lymphomatous infiltrate

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22
Q
A
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23
Q

Histopathology of myobacterial disease

A
  • caseating cheesy granulomas - collection of activated macrophages with. necrotic core
  • often seen in apices of the lungs
  • acid fast bacilli on ziehl neelson stain
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24
Q

Where do myobacterial diseases infect?

A
  • Lung
  • Lymph node: Disc damage and collapse
  • Bone- vertebra
  • Heart e.g. pericarditis
    • Calcifying pericarditis- almost always due to TB
  • GIT e.g. peritonitis
  • CNS: e.g. meningitis
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25
Features of mycobacterial disease in the lungs
1. miliary TB 2. Cavitating lesions
26
Sarcoid: pathology
* non-caseating grnaulomas * diagnosis of exlcusion - after TB has been excluded characteristic of sarcoid is granulomas- they are firm and solid (no caseating centre)
27
What is pathognemonic of granulomas?
Epithelioid macrophages collection of activated macrophages May see giant cells (langherhans cells) and lymphoid cells around the epithelioid macrophages
28
Clinical features of sarcoidosis
bilateral hilar lymphadenopathy hypercalcaemia:
29
30
What is IgG4 related disease?
* Inflammation dominated by plasma cells that make IgG4 antibody * Causes **fibrosis** and **obliteration of veins** → destruction of tissue * It is an inflammatory response but NOT infection
31
Examples of IgG4 related disease
32
5 stages of liver disease
* **fatty liver hepatitis (steatohepatitis)** – **progressive inflammation** characterised by neutrophils, ballooning- Mallory Denk bodies, fibrosis
33
Most common cause if cirrhosis in the UK
NAFLD
34
Diseases caused by alcohol in GI tract
* acute gastritis * oesophageal varices
35
Alcohol effects on neurological system
* peripheral neuropathy * wenircke's encephalopathy * Wernicke-Korsakoff syndrome
36
effect of alcohol in CVS
* dilated cardiomyopathy * hypertension * vascular disease - ATHEROMA: * NB some studies show moderate intake of wine can reduce risk of atherosclerosis
37
effect of alcohol in pancreas
* acute pancreatitis * chronic pancreatitis
38
effect of alcohol on foetus
foetal alcohol syndrome * **FIRST TRIMESTER increases risks to mother**: **miscarriage, still birth, prematurity** * Alcohol use **after first trimester** increases risk of abnormalities to foetus and developmental abnormalities growing up: * Microcephaly * Cardiac abnormalities- pan systolic murmur * Short palpebral fissures- small eye folds * Hypoplastic upper lip- thin * Learning disability * Absent philtrum * Reduced IQ * thin vermillion
39
alcohol and cancer
* oral cavity * pharynx and oeosphagus * liver * **breast cancer**
40
Effect of cystic fibrosis on pancreas
* duct obstruction by thick mucuous secretions * exocrine atrophy - inability to produce lipase, protease, amylase \>\>\> maldigestion and malabsorption this then leads to endocrine atrophy + chronic pancreatitis
41
effect of cystic fibrosis on salivary glands
* duct obstruction * atrophy
42
effect of cystic fibrosis on intestine
meconium ileus - infants Distal Intestinal Obstruction Syndrome (DIOS
43
effect of cystic fibrosis on liver
* biliary obstruction \>\> progressive billiary cirrhosis * hepatic steatosis all of this can cause portal hypertension + cirrhosis
44
effect of cystic fibrosis on lung
* broncial obstruction * superimposed infection with abscess formation * bronchiectasis
45
effect of cystic fibrosis on male genital tract
infertility
46
organisms associated iwth abscess formation in cystic fibrosis
Staph aureus Haemophilus influenzae psuedomonas
47
What component does amyloid contain?
P- component
48
What structure does amyloid protein have?
Beta pleated with non branching fibrils
49
Two main types of amyloid
**AA:** from serum amyloid A protein (Acute phase protein synthesised by the liver) - produced in inflammatory conditions **AL:** Also known as primary amyloidosis - derived from light chains on immunoglobulins - classically in multiple myeloma or b cell lymphoma
50
Where is serum amyloid protein produced?
Liver - it is an acute phase protein so it will be elevated in longstanding inflammatory disease eg crohn's disease, rheumatoid arthritis
51
52
Other minor causes of amyloid protein formation
1. transthyretin - happens due to mutation \>\> predisposes to cardiac amyloid 2. beta 2 macroglbulin - peritoneal dialysis patients 3. alpha beta 2 protein - alzheimer's disease 4. insulin, calcitonin - endocrine tumours, , medullary carcinoma of thyroid
53
Staining for amyloid Result under polarised light Result on electron microscopy
Congo red dye then examine under polarised light Apple green birefringence under polarised light electron microscopy - fibrillar structure
54
Clinical features of amyloidosis
55
What does amyloidosis cause in kidneys?
* Proteinuria * Renal failure
56
57
HIV: Opportunistic infections
* *Pneumocystis jiroveci*: pneumonia * CMV: especially **retina and GIT** * Retinitis * Oesophageal ulcerations * Candida * Can become invasive rather than being superficial * TB and atypical mycobacteria * Cryptococcus: meningitis * *Toxoplasma gondii*: encephalitis and mass lesions * JC papovirus: progressive multifocal leukoencephalopathy * HSV * *Cryptosporidium*, *Isospora belli*, *microsporidia*: GIT
58
in IgG4 related disease is it polyclonal and monoclonal
Polyclonal (proliferation of plasma cells is polyclonal) NOT monoclonal but sub specific.
59
summarise alcoohl and its complications in different organ systems
60
summarise complications of CF
61
can amyloid be broken down my enzymatic degradation
* **Resistant to enzymatic degradation**
62
causes of granulamtous inflammation in the liver
TB, mycobacterial infections, sarcoid, Primary biliary cholangitis, drug induced disease, malignancy

Histopathology (18 decks)

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