Histopathology Flashcards
How would you describe a sessile serrated lesion histologically ?
Histology:- serrated epithelium,
crypt base dilatation,
boot shaped glands,
horizontal glands
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
What are the histological features of necrobiosis lipoidica ?
Histology:-
necrobiotic collagen
pallisading granulomas
no normal dermis
plasma cells
involves subcutis
What are the clinical features of granuloma annulare ?
Ring shaped lesions on the hand and arm
self limiting and benign
What is the differential for a sessile serrated lesion ?
Hyperplastic polyp
What syndromes are associated with sessile serrated lesions ?
Serrated polyposis syndrome
Which side are sessile serrated lesions usually found on ?
The right side/ ascending/ proximal colon (seRRated= right side)
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
Where is necrobiosis lipoidica usually seen ?
on the legs
Which disease is associated with necrobiosis lipoidica ?
diabetes mellitus
rheumatoid arthritis
What is the histological appearance of granuloma annulare ?
pallisading granulomas
necrobiotic collagen
mucin (stains +ve alcian blue)
What is granuloma annulare associated with ?
Diabetes mellitus
Thyroid disease
malignancy
medication
trauma
infection
What are small intestine adenomas associated with ?
FAP (familial adenomatous polyposis)
What is recommended for small intestine adenomas ?
Full colonoscopy, risk of large intestine adenoma
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
What is the differential diagnosis for mucinous breast carcinoma ?
Other mucinous breast tumours
What is the hormone receptor profile for mucinous breast carcinoma ?
ER +ve
PR+ve
HER2-ve
What does mucinous breast carcinoma look like macroscopically ?
jelly like
glistening
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
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
What is the differential diagnosis for lobular carcinoma of the breast ?
LCIS
poorly differentiated ductal carcinoma
ductal carcinoma with lobular features
lymphoma
melanoma
plasmacytoma
What is the immunoprofile for lobular carcinoma ?
e-cadherin -ve
ER +ve
PR+ve
HER2-ve
CK7+ve
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
what are markers for a lesion of breast origin ?
CK7+ve
CK20-ve
GATA3+ve
GCDFP+ve
mammaglobin
ER+/-ve
PR+/-ve
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 ?
No
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.
