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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
Q

Features of mycobacterial disease in the lungs

A
  1. miliary TB
  2. Cavitating lesions
26
Q

Sarcoid: pathology

A
  • 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
Q

What is pathognemonic of granulomas?

A

Epithelioid macrophages

collection of activated macrophages

May see giant cells (langherhans cells) and lymphoid cells around the epithelioid macrophages

28
Q

Clinical features of sarcoidosis

A

bilateral hilar lymphadenopathy

hypercalcaemia:

29
Q
A
30
Q

What is IgG4 related disease?

A
  • 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
Q

Examples of IgG4 related disease

A
32
Q

5 stages of liver disease

A
  • fatty liver hepatitis (steatohepatitis) – progressive inflammation characterised by neutrophils, ballooning- Mallory Denk bodies, fibrosis
33
Q

Most common cause if cirrhosis in the UK

A

NAFLD

34
Q

Diseases caused by alcohol in GI tract

A
  • acute gastritis
  • oesophageal varices
35
Q

Alcohol effects on neurological system

A
  • peripheral neuropathy
  • wenircke’s encephalopathy
  • Wernicke-Korsakoff syndrome
36
Q

effect of alcohol in CVS

A
  • dilated cardiomyopathy
  • hypertension
  • vascular disease - ATHEROMA:
    • NB some studies show moderate intake of wine can reduce risk of atherosclerosis
37
Q

effect of alcohol in pancreas

A
  • acute pancreatitis
  • chronic pancreatitis
38
Q

effect of alcohol on foetus

A

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
Q

alcohol and cancer

A
  • oral cavity
  • pharynx and oeosphagus
  • liver
  • breast cancer
40
Q

Effect of cystic fibrosis on pancreas

A
  • 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
Q

effect of cystic fibrosis on salivary glands

A
  • duct obstruction
  • atrophy
42
Q

effect of cystic fibrosis on intestine

A

meconium ileus - infants

Distal Intestinal Obstruction Syndrome (DIOS

43
Q

effect of cystic fibrosis on liver

A
  • biliary obstruction >> progressive billiary cirrhosis
  • hepatic steatosis

all of this can cause portal hypertension + cirrhosis

44
Q

effect of cystic fibrosis on lung

A
  • broncial obstruction
  • superimposed infection with abscess formation
  • bronchiectasis
45
Q

effect of cystic fibrosis on male genital tract

A

infertility

46
Q

organisms associated iwth abscess formation in cystic fibrosis

A

Staph aureus

Haemophilus influenzae

psuedomonas

47
Q

What component does amyloid contain?

A

P- component

48
Q

What structure does amyloid protein have?

A

Beta pleated with non branching fibrils

49
Q

Two main types of amyloid

A

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
Q

Where is serum amyloid protein produced?

A

Liver - it is an acute phase protein so it will be elevated in longstanding inflammatory disease

eg crohn’s disease, rheumatoid arthritis

51
Q
A
52
Q

Other minor causes of amyloid protein formation

A
  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
Q

Staining for amyloid

Result under polarised light

Result on electron microscopy

A

Congo red dye then examine under polarised light

Apple green birefringence under polarised light

electron microscopy - fibrillar structure

54
Q

Clinical features of amyloidosis

A
55
Q

What does amyloidosis cause in kidneys?

A
  • Proteinuria
  • Renal failure
56
Q
A
57
Q

HIV: Opportunistic infections

A
  • 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
Q

in IgG4 related disease is it polyclonal and monoclonal

A

Polyclonal (proliferation of plasma cells is polyclonal) NOT monoclonal but sub specific.

59
Q

summarise alcoohl and its complications in different organ systems

A
60
Q

summarise complications of CF

A
61
Q

can amyloid be broken down my enzymatic degradation

A
  • Resistant to enzymatic degradation
62
Q

causes of granulamtous inflammation in the liver

A

TB, mycobacterial infections, sarcoid, Primary biliary cholangitis, drug induced disease, malignancy

Histopathology (18 decks)

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