Histopathology Flashcards by Nesem Al-Ali

How would you describe a sessile serrated lesion histologically ?

Histology:- serrated epithelium,
crypt base dilatation,
boot shaped glands,
horizontal glands

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Describe xanthalomatous chronic cholecystitis

Histology:-
Thickened gallbladder wall
cholesterol clefts
lipid laden macrophages
inflammatory cells
fibrosis

DDx:-
Chronic cholecystitis
gallbladder carcinoma
gallbladder cholesterolosis

Other information:-
Not common
Benign
Treated with cholecystectomy
Seen as hypoattenuated nodules on radiology

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What are the histological features of necrobiosis lipoidica ?

Histology:-
necrobiotic collagen
pallisading granulomas
no normal dermis
plasma cells
involves subcutis

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What are the clinical features of granuloma annulare ?

Ring shaped lesions on the hand and arm

self limiting and benign

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What is the differential for a sessile serrated lesion ?

Hyperplastic polyp

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What syndromes are associated with sessile serrated lesions ?

Serrated polyposis syndrome

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Which side are sessile serrated lesions usually found on ?

The right side/ ascending/ proximal colon (seRRated= right side)

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What is the differential for pallisading granulomas and necrobiotic collagen in skin ?

Necrobiosis lipoidica - plasma cells
Granuloma annulare - no plasma cells, ring shaped lesions
Rheumatoid nodule
epithelioid sarcoma

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Where is necrobiosis lipoidica usually seen ?

on the legs

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Which disease is associated with necrobiosis lipoidica ?

diabetes mellitus
rheumatoid arthritis

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What is the histological appearance of granuloma annulare ?

pallisading granulomas
necrobiotic collagen
mucin (stains +ve alcian blue)

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What is granuloma annulare associated with ?

Diabetes mellitus
Thyroid disease
malignancy
medication
trauma
infection

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What are small intestine adenomas associated with ?

FAP (familial adenomatous polyposis)

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What is recommended for small intestine adenomas ?

Full colonoscopy, risk of large intestine adenoma

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Describe the histological appearance of mucinous breast carcinoma

Groups of tumour cells with irregular edges
floating in mucin
more than 90% of tumour is mucin

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What is the differential diagnosis for mucinous breast carcinoma ?

Other mucinous breast tumours

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What is the hormone receptor profile for mucinous breast carcinoma ?

ER +ve
PR+ve
HER2-ve

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What does mucinous breast carcinoma look like macroscopically ?

jelly like
glistening

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breast cancer staging

Tx- can not be assessed
T0- no tumour
TIS- in situ
T1- (2 comes after 1) tumour <2cm
T1a-c- (0.5+0.5=1, 1+1=2)
T1a- >0.1-<0.5cm
T1b- >0.5cm-1cm
T1c- >1cm-<2cm
T2-T3- (2,3, high five !!)
T2->2cm-<5cm
T3->5cm
T4- (when you are a four, size won’t bore)
T4- any size, extension to chest wall and skin
ABCD
adherent blisters C IgD
adeherent= adherent to chest wall
blisters= skin manifestations
C= see both of the above
IgD= inflammatory
T4a- adherence to chest wall
T4b- skin involvement
T4c- see both of the above
T4d- inflammatory

Tx
T0
TIS
T1,2
T 0.5+0.5, 1+1
T 2, 3, high 5!
T4- size won’t bore
T4a-c adherent blisters C IgD

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What is the histological appearance of lobular carcinoma of the breast ?

cells lined up in a row in single file
non cohesive
no gland formation
no desmoplastic stroma

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What is the differential diagnosis for lobular carcinoma of the breast ?

LCIS
poorly differentiated ductal carcinoma
ductal carcinoma with lobular features
lymphoma
melanoma
plasmacytoma

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What is the immunoprofile for lobular carcinoma ?

e-cadherin -ve
ER +ve
PR+ve
HER2-ve
CK7+ve

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Which syndrome is related to e-cadherin loss ?

Hereditary diffuse gastric cancer syndrome-

invasive lobular carcinoma
diffuse gastric carcinoma

mutation in epithelial cadherin gene
mutation in CDH1 gene

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what are markers for a lesion of breast origin ?

CK7+ve
CK20-ve
GATA3+ve
GCDFP+ve
mammaglobin
ER+/-ve
PR+/-ve

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what are aberrant plasma cell markers ?

CD10 +ve CD20 -ve CD38+ve CD45-ve CD56 +ve CD117+ve CD138+ve cyclind1+/- MUM1+ve

what are lymphoma markers ?

what are melanocytic markers ?

HMB45 MelanA MITF SOX10 S100

Describe the histological appearances of high grade urothelial carcinoma

Papillary Complex architecture (fused and branched) nuclear polymorphism invasion into the lamina propria mitoses

What is a risk factor for high grade urothelial carcinoma ?

smoking

What is the immunoprofile for high grade urothelial carcinoma ?

ki67 >35%

What needs to be considered with bladder biopsies in men ?

They could contain fragments of:- a) bladder b) prostate

Which syndrome is urothelial carcinoma associated with ?

Lynch syndrome

How do you distinguish low grade urothelial carcinoma from high grade urothelial carcinoma ?

low grade- ki67 <25% high grade ki67 >35%

What is the immunohistochemical profile for urothelial carcinoma ?

GATA3+ve p63+ve ck5/6+ve PSA -ve ck34betaE12+ve

What is a clinical sign for urothelial carcinoma ?

haematuria

Is urothelial carcinoma common ?

yes

Describe the histological appearance of chromophobe renal cell carcinoma

Pale/ clear or eosinophillic cells whispy eosinophillic material perinuclear halo koilocytic nuclei plant wall like membrane

What are the differentials for an eosinophillic renal tumour ?

chromophobe RCC, eosinophillic variant Oncocytoma clear cell RCC, eosinophillic variant renal hybrid tumour (mixture of both oncocytic and chromophobe, seen in Birt-Hogg Dube syndrome)

what is the immunohistochemical profile of a chromophobe RCC ?

CK7 +ve CD117+ve vimentin -ve Colloidal iron +ve

Which syndrome is chromophobe RCC associated with ?

Birt-Hogg-Dube syndrome

How do you treat a chromophobe RCC ?

surgical removal

How will you remember the details for chromophobe RCC ?

7 pink plants eaten by a pig with a halo and whiskers CD7 and CD117 positive (all the 7s are positive) pink = eosinophillia plants= plant cell like membrane pig= Hogg in Birt-Hogg, Dube halo= perinuclear haloes whiskers= whispy cytoplasm

ISUP grading

What are the features of an oesophageal inlet patch

This is gastric body type epithelium found outside of the expected location within the stomach. It is commonly found in the proximal oesophagus It is usually benign

What features need to be commented on in an oesophageal biopsy ?

The presence of squamous epithelium Is there glandular metaplasia ? If so is it intestinal metaplasia ? Is there dysplasia within the glandular metaplasia ?

What needs to be commented on in a gastric biopsy ?

Type of epithelium presence of acute or chronic inflammation presence of h. pylori presence of intestinal metaplasia

What are the histological features of gallbladder cholesterolosis ?

abundant foamy macrophages in the lamina propria forming polyps sometimes there is papillary hyperplasia

What is a differential for gallbladder cholesterolosis ?

cholesterol polyp

What is the macroscopic appearance of gallbladder cholesterolosis ?

strawberry like

What is associated with gallbladder cholesterolosis ?

obesity gallstones chronic cholecystitis

What is the presenting symptom of gallbladder cholesterolosis ?

biliary colic

What is a pilar leiomyoma ?

Interesting fascicles of eosinophillic spindle cells containing plump cigar shaped nuclei within the dermis

What are the histological features of pancreatic heterotopia ?

Very eosinophillic acini No pancreatic ducts No Islets of Langerhans

What is pancreatic tissue positive for immunohistochemically ?

tryptase lipase

facts about pancreatic heteroptopia

found in GI tract ~20% of GOJ biopsies associated with intestinal metaplasia

which RCC does not require an ISUP grade ?

chromophobe

Where is CD7 +ve in chromophobe ?

cell membrane (plant wall)

where is CD7 +ve in oncocytoma ?

cytoplasm

Grossly does a chromophobe RCC have a central scar ?

What are langerhan cells ?

Immune cells in the mid epidermis of the skin stain positively for CD1a and S100

What are the histological features of a glomus tumour ?

perivascular tumour formed of polygonal cells with clear, distinct borders "cookie cutter appearance" endothelial cells surrounding a slit like blood vessel (staghorn)

Which syndrome is associated with glomus tumours ?

neurofibromatosis type 1

which immunostains are positive in glomus tumours ?

SMA

What is Birt-Hogg-Dube syndrome ?

A mutation in the folliculin gene leading to manifestations in:- skin kidneys lungs

what are the skin manifestations of Birt hogg Dube syndrome ?

What is the mutation associated with familial adenomatous polyposis ?

mutation in APC gene

what is the grading for neuroendocrine tumours ?

grade 1, <2 mitoses, 3%ki67 grade 2, 2-20 mitoses, 3-20%ki67 grade 3, >20 mitoses, >20%ki67

Which transcription factor is positive in cells of renal origin ?

PAX 2 or PAX 8

Describe the histological appearance of nephrogenic adenoma

bland tubules lined by cuboidal cells with bland nuclei and punctate nucleoli. hobnailing can also be seen.