Histopathology Flashcards
Breast composition?
2 main structures -> large ducts and terminal duct lobular unit
2 types of epithelial cells ->> luminal cells (inside) myoepithelial cells(on outside)
2 types of stroma - interlobular and intralobular stroma
Presentations of breast disease?
breast lump
on screening mammogram
Nipple discharge - evaluated with cytology -> papilloma is most common cause. weak cancer association particularly if discharge is bloody, or there is a mass
investigations for breast disease?
Physical examination.
Imaging- Sonography, mammography & MRI
Pathology (cytopathology and/or histopathology
Describe how cytopathology of breast lumps are coded
Aspirates of breast lumps are coded C1-5:
C1 = inadequate
C2 = benign
C3 = atypia, probably benign
C4 = suspicious of malignancy
C5 = malignant - KEY!
Inflammatory breast diseases
1. duct ectasia
2. acute mastitis
3. fat necrosis
3. galactocele
Acute Mastitis?
painful red breast
often seen in lactating women
staphylococcus
histology full of inflammatory cells - mainly neutrophils
Duct ectasia? (inflammation and dilation of large breast duct)
presents with nipple discharge
sometimes breast pain, masss, nipple discharge
histology -> large swollen duct, see pic
fat necrosis
Caused by trauma, surgery, radiotherapy.
Presents with a breast mass, late stages may show focal calcification.
histopathology - fat globules
Galactocele
Cystic dilation of a duct during lactation
Usually multiple ducts
Tender palpable nodules
Benign breast diseases
1. fibrocystic disease - breast lumpiness, hormonal responsiveness
2. fibroadenoma - well circumscribed breast lump
3. phyllodes tumours - enlarging mass in women aged over 50. increased stromal proliferation on histology
4. intraductal papilloma - nipple discharge or asymptomatic. proliferation/enlarged duct on histology
5. radial scar - MIMICs breast cancer!!
Proliferative breast diseases
1. Usual epithelial hyperplasia - may increase risk for invasive carcinoma
2. Fat epithelial atypia -> may increase risk of ductal carcinoma
3. in situ lobular neoplasia -> affects whole lobule
Malignant breast diseases (most important pathology but not most common)
1. Pagets disease - histology shows atypical large cells
2. ductal carcinoma in situ - 85% diagnosed as microcalcification on mammography. can be low or high grade
3. invasive breast carcinomas: breast lump presentation usually
- invasive ductal carcinoma. = MOST common!
- invasive lobular carcinoma
- invasive tubular carcinoma (teardrop histology)
- invasive mucinous carcinoma (clusters cells free floating in mucin)
- basal like carcinoma
Histological grading for breast cancers?
state the 3 parameters
assessing 1) tubule formation 2) nuclear pleomorphism, and 3)mitotic activity.
Each parameter is scored from 1-3 and the three values are added together to produce total scores from 3-9.
3-5 points = grade 1 (well differentiated).
6-7 points = grade 2 (moderately differentiated).
8-9 points = grade 3 (poorly differentiated).
most important prognostic factor in breast cancer?
status of the axillary lymph nodes.
Acute Esophagitis
- GORD is a RF
Barrets oesophagus
squamous to columnar metaplasia
without goblet cells - gastric metaplasia
with goblet cells - intestinal type metaplasia
adenonocarcinoma of eosophagus
reflux therefore lower eosophagus
developed countries
squamous carcinoma of eosophagus
developing countries
alcohol and smoking
middle 2/3
make keratin
oesophageal varices
liver disease RF
Gastritis
Acute - NSAIDS, alcohol, h pylori
chronic - ABC - autoimmune, bacteria, chemical - NSAIDS, bile reflux
other:
CMV, strongyloides
IBD (crohns)
Gastric cancer
Gatrointestinal stromal tumour
duodenitis
coeliac disease
endomysial antibodies
tissue transglutaminase antibodies
villous atrophy with increased intraepithelial lymphocytes
risk of duodenal MALT lymphoma
Acute pancreatitis
causes?
complications?
Duct obstruction -> e.g gallstones, trauma, tumours. periductal injury seen
Metabolic toxic - alcohol, drugs eg thiazides, hypercalcemia, hyperlipidemia
poor blood supply - perilobular injury seen
infection/inflammation
autoimmune - eg igG4 related disease
idiopathic
fat necrosis seen
complications - pseudocyst, abcess
chronic pancreatitis
metabolic/toxic - alcohol 80% AND most key to remember, hemachromatosis
duct obstruction - gallstones, cf
tumours
FIBROSIS - KEY Pathology in chronic pancreatitis vs acute. calcificication seen
complications; malabsorption, Diabetes, pseudocyst
Tumours of Pancreas
risk factors
Carcinomas - DUCTAL 85% (kras mutations in most cases, adenocarcinomas), Acinar cancers
Cystic neoplasms - serous cystadenoma, mucinous. usually benign
pancreatic endocrine neoplasms - usually non secretory, contain neuroendocrine marker CHROMOGRANIN. can be associated with MEN1. example = insulinoma
Gallstones and complications
chronic cholecystitis = THICKENED GALLBLADDER WALL
Gallbladder cancer - adenocarcinoma
obstructive jaundice
primary or secondary tumours more common?
secondary. but primary most common form in children
aetiology of CNS tumours
previous radiotherapy to head and neck - increases risk of Meningiomas
familial syndromes -> neurofibromatosis 1 (neurofibromas and astrocytoma)
nuerofibromatosis 2 (shwanomma, meningioma)
etc
Brain Tumour Polyposis syndrome 1-> malignant gliomas
Von Hippel Lindau -> hemangioblastoma
Gorlin Syndrome -> medulloblastoma
CNS symptoms based on location
supratentorial ->siezures, personality changes, focal neurological deficit
infratentorial -> ataxia, cranial nerve palsy
types of primary brain tumours
Astrocytoma
oligodendroglioma
epyndyoma
describe WHO grading system for primary brain tumours
grade 1 = benign e.g. meningiomas
grade 2 = more than 5 years
grade 3 = less than 5 years
grade 4 = less than a year eg GBM
mitotic activity determines grade:
<4 = grade 1
4-20 = grade 2
>20 = grade 3
Glial tumours
diffuse gliomas: astrocytomas, oligodendogliomas
circumbscribed gliomas: Pilocytic astrocytoma (grade 1)
Subependymal giant cell astrocytoma (grade1)
Ependymomas (usually)
pilocytic astrocytomas
BRAF Mutation
well circumbscribed
piloid hairy cells
rosenthal fibres
slow growing/who grade 1
MOST FREQUENT tumour in children
astrocytoma
cerebral hemispheres, point mutation in IDH1/1 = better prognosis
WHO 2-4
GBM
cerebral hemispheres, IDH1
most aggresive and common glioma.
WHO 1
High cellularity
Neoangiogenesis - very vascular
Necrosis
meningiomas
medulloblastoma
WHO grade 4, childhood cancer
4 different types?
most frequent brain tumour in adults?
metastatic deposits
mechanisms of cerebral oedema
vasogenic -> disruption of BBB
cytotoxic -> hypoxia, ischemia
hydrocephalus
non communicating -> blockage of cerebral aqueduct
communicating - problems with reabsorption
raised ICP
cause: space occupying lesion, oedema, both
can cause brain herniation:
1. subfalcine herniation
2. transtentorial herniaton
3. tonsilar herniation
Stroke
hemorrhage:
1. intraparenchymal hemorrhage (HTN, basal ganglia usually)
2. AVM (high pressure, massive bleeding)
3. Cavernous angioma (low pressure, recurrent bleeding)
4. subarachnoid hemorrhage (berry aneurysm rupture)
ischemic - learn ACA, MCA, PCA territories
traumatic brain injury?
non missile = acceleration/deceleration typically, usually car accidents
missile = penetrating
fractures - ottorrhea (skull base fracture) or rhinorrhea may occur
contusions
diffuse axonal injury - most common cause of coma when no bleed
What percentage of people with TIA will get an infarct within 5 years?
1/3
33%
Alzheimer’s disease
Extracellular plaques
Neurofibrillary tangles (hyperphosphorylated tau)
Cerebral amyloid angiopathy (CAA)
Hippocampal atrophy
Parkinson’s disease and Parkinson’s +
Idiopathic Parkinson’s disease
Drug-induced parkinsonism
- Multiple system atrophy (alpha synuclei!!found mainly glial cells not neuronal cells)
- Progressive supranuclear palsy (most common form of atypical parkinsons, no response to L-dopa. tau found!!!)
- Corticobasal degeneration (astrocytic plaques, neuropil threads. tau found!!)
Fronto-temporal lobar dementias
1. picks disease
Prion disease
general atrophy of brain
spongiform changes
no DNA or RNA, passed on through protein
Pick disease
Tau positive pick bodies
Must learn the ABC assessement for alzheimers e.g. A3B1C3 = low alzheimers risk
Hirschsprungs, volvulus, diverticular disease
diverticular disease can cause pain obstruction and importantly FISTULAS
Acute colitis causes
Infection
Drug/toxin (especially antibiotic)
Chemotherapy
Radiation
chronic colitis
chrons
ulcerative colitis
TB
infectious colitis
Viral e.g. CMV
Bacterial e.g. Salmonella
Protozoal e.g. Entamoeba hystolytica
Fungal e.g. candida
psuedomembranous colitis
Acute colitis with pseudomembrane formation
Caused by protein exotoxins of Clostridium difficile
Histology: Characteristic microscopic features on biopsy
Laboratory: C. difficile toxin stool assay
ischemic colitis
very red bowel contrast to remaining
Arterial Occlusion: atheroma, thrombosis, embolism
Venous Occlusion: thrombus, hypercoagulable states
Small Vessel Disease: emboli, vasculitis
Low Flow States: congestive cardiac failure, haemorrhage, shock
Obstruction: hernia, intussusception, volvulus, adhesions
chrons disease
- cobblestone mucosa with skip lesions
- transmural inflammation -FISTULA risk!
- granuloma formation
- crypt abscesses
extra intestinal: Arthritis
Uveitis
Stomatitis/cheilitis
Skin lesions
Pyoderma gangrenosum
Erythema multiforme
Erythema nodosum
ulcerative colitis
- starts in rectum
- mucosal inflammation
- crypt abscesses
extra intestinal:
Arthritis
Myositis
Uveitis/iritis
Erythema nodosum, pyoderma gangrenosum
Primary Sclerosing Cholangitis
complications:
Adenocarcinoma!! (severe risk compared to chrons)
severe hemorrhage
toxic megacolon
non neoplastic polyps
Hyperplastic polyps and Sessile Serrated Lesions (SSLs imaging different, architecual abnormality extends to base)
Inflammatory (“pseudo-polyps”) (pseudo because no epithelium, just granuloma)
Hamartomatous (Juvenile, Peutz Jeghers)
neoplastic polyps
Tubular adenoma
Tubulovillous adenoma
Villous adenoma
adenomas typically asymptomatic
congenital atresia
failure of bowel to form
can cause obstruction with dilation of proximal bowel
congenital duplication of bowel
can cause cyst like structure to form
risk factors for adenoma transformation to carcinoma
Size (bigger worse)
Proportion of villous component ( more worse)
Degree of dysplasia
Familial Adenomatous polyposis, FAP
minimum 100 polypsAPC tumour suppressor gene
virtually 100% will develop cancer within 10 to 15 years
Gardners syndrome?
FAP plus extra-intestinal manifestations e.g:
osteomas
desmoid tumors
Hereditary Non-polyposis Colorectal Cancer (HNPCC) = Lynch Syndrome
High frequency of carcinomas proximal to splenic flexure
Poorly differentiated and mucinous carcinoma more frequent
Multiple synchronous cancers
Presence of extracolonic cancers (endometrium, prostate, breast, stomach)
colorectal cancer
98% are adenocarcinoma
If < 50yrs consider familial syndrome
Change of bowel habit
Bleeding
Anaemia
Weight loss
Pain
describe the T1, T2, T3, T4 staging for colorectal cancers
hepatic stellate cells are activated by?
liver injury
cirrhosis classification
complications?
- according to size - micronodular or macronodular
- aetiology - alcohol/insulin resitance vs viral hepatitis
portal HTN, hepatic encephalopathy, liver cell cancer
Acute hepatitis
histopathology?
aetiology?
spotty necrosis
viral hepatitis, drugs, auto-immune
how is chronic hepatitis evaluated histologically
severity of inflammation = grade
severity of fibrosis = stage
Fatty liver disease
- risk factors such as obesity, type 2 diabetes, high blood pressure
Alcoholic hepatitis
Ballooning! +/- mallory denk bodies
apoptosis
pericellular fibrosis
cirrhosis
NAFLD and NASH
- histologically similar to alcoholic liver disease
- due to insulin resistance
Primary biliary cholangitis
- bile duct loss with chronic inflammation, chronic granulomas
- anti-mitochondrial antibodies = diagnostic
Primary sclerosing cholangitis
- periductal bile duct fibrosis
- associated with ulcerative colitis
- increased risk of cholangiocarcinoma
- bile duct imaging = diagnostic
hemachromatosis
Increased gut iron absorption
gene on chromosome 6 HFe
bronzed diabetes
hemosiderosis
accumulation of iron in macrophages
blood transfusion
Wilsons disease
accumulation of copper due to failure of excretion by hepatocytes into bile
chromosome 13 gene
kayser fleicher ring
rhodanine stain for copper
autoimmune hepatitis
anti-smooth muscle antibodies
alpha-1-antitrypsin deficiency
intra-cytoplasmic inclusions due to misfolded proteins
paracetamol toxicity
hepatic granulomas
PBC, drugs
TB, Sarcoid
benign liver tumours
1. liver cell adenoma
2. bile duct adenoma
3. hemangioma
malignant liver tumours
primary and secondary tumours
primary:
1. hepatocellular carcinoma
2. hepatoblastoma
3. cholangiocarcinoma (PSC, worms and cirrhosis association)
4. hemangiosarcoma
bone tumour presentation?
investigation?
management?
pain, swelling, deformity pathological fracture (in young adult, older think arthritis first)
history of trauma may be misleading
multiple lesions - may be a metastatic process or process involving bone marrow eg lymphoma
osteosarcoma - common around knee
associated disease - eg skin tumour at site or pagets disease
xray = 1st line to evaluate - solitary/,ultiple, extension into local tissue, fracture
specialist centre referral
confirmative diagnosis = needle biospy
core biopsy - irregular trabecular bone, infiltration with cartilage
possibly amputation, chemo
State 3 types of malignant bone tumours
most common?
Osteosarcoma - bone forming. most common - adolescents
Chondrosarcoma - cartilage forming - age 40 and over
Ewings Sarcoma (undifferentiated) - < age 20
osteosarcoma presentation?
xray findings?
metaohysis of long bones - knee common, lump, pain, fracture
elevated periosteum (Codmans Triangle)
or sunburst pattern on xray
Ewings Sarcoma presentation?
fusion protein associated with?
small blue cells
diaphysis of long bones, pelvis - black lesion on xray
fever leukocytosis -> differentials include osteomyelitis, lymphoma
t(11, 22)
Differentials for bone tumours?
(tumour like conditions)
- fibrous dysplasia!!!
- metaphyseal fibrous cortical defect/ non-ossifying fibroma
- reparative giant cell granuloma
- ossifying fibroma
- simple bone cyst
fibrous dysplasia presentation?
histological finding?
management
- affects any bone but proximal femur (shepherds crook deformity may occur) most common, rib (lump on chest)
- xray - soap bubble osteolysis - in more than one bone vs osteosarcoma 1 site unless metastatic
- endocrine association - MCcune Albright syndrome
histology- marrow replaced by pink fibrous stroma, rounded and curved trabecular bone
excision but no chemo as benign
classify and state the different types of benign bone tumours
most common?
Cartilaginous differentiation (produce cartilage)
1. osteochondroma - most common
2. enchondroma
3. chondroblastoma
Bone forming
1. osteoid osteoma
2. osteoblastoma
3. osteoma
osteochondroma site predilection?
x ray findings?
- end of long bones eg bump at top of humerus or around knee!!
- mimics formation of cartilage eg on femoral head
- flat or sessile (on a stalk)
xray may show outward projection of bone growth
enchondroma site predilection?
hands and feet - eg pathological fracture in finger
- may show popcorn calcification on x ray
giant cell tumour classification?
site predelection?
x ray findings
borderlign
benign but can metastize eg to lungs
benign sign - well demarcated
malignant sign - hemorrhage in lesion
end of long bones, mostly knee
histology - sheets of osteoclast giant cells
soap bubble appearance on x ray
top cancers that metastize to bone in adults?
breast, prostate, lung, kidney, thyroid
top cancers that metastize to bone in children?
neuroblastoma, wilms tumour, osteosarcoma, ewings sarcoma, rhabdomyosarcoma
metastatic disease is usually which parts of bone?
if you see lytic lesions in spine but chest xray is clear and the carcinoma is of an unknown primary, what could be differentials?, how would you investigate?
above elbow, above knee
multiple myeloma, but also just other parts of body
staining of malignant cells for identification
state some soft tissue tumours
liposarcoma
melanoma
rhabdomyosarcoma
histological classes (many fall under each):
spindle cell tumour
myxoid tumours
pleomorphic tumour
pituitary adenomas peak presentation time?
most common?
4th to 6th decade
prolactinoma
common causes of hypopituitarism?
manifestation of hypopituitarism?
non secreting pituitary adenoma
ischemic necrosis - sheehans, dic, sickle cell
ablation by surgery or radiaiton
children - growth failure
gonadotrophin deficiency - infertility, ammennorhea
hypothyroidism, hypoadrenalism
posterior pituitary hormones?
ADH oxytocin
causes of thyrotoxicosis not associated with thyroid?
struma ovarii - ovarian teratoma with ectopic thyroid
exogenous thyroid intake
Histology for Hashimotos thyroiditis?
lymphocytic infiltrate within germinal centres
hurtle cells -> epithelial cells enlarge and contain eosinophilic cytoplasm
Papillary thyroid carcinoma morphology?
optically clear nuclei
psammoma bodies - foci of calcifications
painless mass in neck
metastasize to cervcial lymph nodes
follicular thyroid carcinoma morphology?
Hematogenous spread!!! - metastasize to lungs bone!!!, liver
Medullary thyroid carcinoma origin? association?
histological finding?
parafollicular C cells
MEN syndrome - 20% cases associated with this and thus seen in younger patients
calcitonin broken down into AMYLOID - stains with congo red -> green colour under polarised light
anaplastic carcinoma?
very agggressive
most die within a year
causes of hyperparathyroidism?
symptoms of primary hyperparathyroidism?
solitary adenoma - most common
hyperplasia affecting all 4 glands - may be part of MEN
cancer <1%
normal parathyroid is 50% fat -> empty "cells"
bone changes can be seen in primary and secondary hyperparathyroidism
causes of hypoparathyroidism?
clinical manifestations?
surgical ablation
congenital absence
autoimmune
neuromuscular irritability
cardiac arrhythmias
fits
cataracts
what is secreted in each part of the adrenal gland?
most common endogenous causes of cushings syndrome?
pituitary - most common
adrenal - 30% adenoma or carcinoma, bilateral hyperplasia
ectopic acth - causes adrenals to show bilateral hyperplasia - contrast to exogenous cortisol ingesiton which causes atrophic adrenal glands!!
causes of hyperaldosteronism
manifestations?
bilateral adrenal hyperplasia - 60%
conns syndrome - 30%
HTN, hypokolemia
adrenal insufficiency causes?
primary:
- acute - abrupt stopping of steroids
- hemorrhage into adrenals in neonates
- sepsis with DIC - Waterhouse Friderichson Syndrome
- Addisons disease
secondary - pituitary lesion eg non-functioning adenoma
name 2 adrenal medulla tumours
pheaochromocytoma
neuroblastoma
what is the most common cause of thyroid cancer?
papillary carcinoma
causes of calcium oxalate kidney stones?
most common type of kidney stone
hypercalciuria:
- excessive gut ca absorption
- defective absorption ca in proximal tubule
- hyperparathyroidism - rare
cause of magnesium ammonium phosphate kidney stones (triple stone)? presentation?
infection with urease producing organisms eg proteus
staghorn calculi
cause of uric acid kidney stones?
believed hyperuricemia - gout, rapid cell turnover
most patients dont acc have hyperuricemia
kidney stones complications?
colic
large stones -- obstruction, infection, renal failure
state 3 benign renal neoplasms
1. papillary adenoma - incidental finding. Must be 15 millimeters or less. if not -> carcinoma
2. renal oncocytoma - incidental finding, brown with central are of scarring, nest of oncoytic cells
3. angiomyolipoma -associated with tuberous sclerosis, on histology you see blood vessel, muscle cells, big gat cells. when >4cm can hemmorrhage but typically asymptomatic
renal carcinoma
symptom?
state and describe different subtypes
most common?
Painless hematuria
1. clear cell renal carcinoma - golden yellow tumour, clear cells on histology - most common
2. papillary
3. chromophobe - look like clear cells, but have sharply defined borders, thickened vascular walls/network
Nephroblastoma (Wilms tumour) presentation ?
histology?
abdominal mass in a child aged 2-5
2nd most common malignancy in child
triphasic:
- small round blue cells
- epithelial component
- stomal component
Urothelial carcinoma (Transitional cell carcinoma) definition?
presentation?
3 main subtypes?
cancer arising in bladder, renal pelvis, ureters
hematuria
1. non-invasive papillary urothelial carcinoma - frond like growths
2. infiltrating urothelial carcinoma
3. flat urothelial carcinoma in situ - High grade lesion!! presents as red patch
BPH symptoms
lower urinary tract symptoms
can also present with urinary tract infection, acute urinary retention, renal failure
testicular germ cell tumor symptoms (typically malignant)
state different types and describe histology
treatment?
painless lump
10% mets signs - back pain, dyspnea, cough
1. Seminoma - clear cells, lymphoid infiltrate
2. embryonal carcinoma - necrotic, prominent nucleoli
3. teratoma - histology shows mix of keratin, cartilage etc, different tissues present - can be malignant vs benign ovarian carcinoma
4. yolk sac tumour
5. choriocarcinoma
chemo
state testicular non germ cell tumours
Leydig cell tumour - benign
sertoli cell tumour - benign
lymphoma - seen in older men - malignant
penile diseases
lichen sclerosis - causes phimosis
zoons blanitis - inflammatory disease causing red areas
condylomas
Pyeronie's disease - curving due to scarring and thickening of corpus cavernosum, painful erections
Penile carcinoma
scrotal diseases
epidermoid cyst, scrotal calcinosis
angiokeratomas
fourniers gangrene
squamous cell carcinoma - very rare
grading system for prostate cancer?
gleason score
Autosomal polycstic kidney disease symptoms?
HTN, flank pain, hematuria in adult
berry aneurysms
acquired cystic renal disease?
can occur in patients with end stage renal disease on dialysis -> risk of papillary renal cell carcinoma
Acute tubular injury/ ATN
causes
ischemia
toxins
drugs - eg NSAIDS
apoptosis and necrosis of tubular cells
Muddy brown casts
Acute tubulo interstitial nephritis
causes
infections and drugs eg NSAIDS
interstitial inflammatory infiltrate - eosinophils, granulomas
Hematuria (as it is a nephritis) and pyuria
Acute glomerulonephritis
erythrocytes, leucocytes casts
crescents in glomeruli - may be due to immune complexes(sle, igA nephropathy, post-infectious glomerulonephritis), pauci-immune (ANCA associated, scanty iG deposits), Anti-GBM(linear deposits of IgG on b membrane - leads to irreversible renal failure
Thrombotic microangiopathy risk factors?
MAHA
hemolytic uremic syndrome
nephrotic syndrome causes?
findings?
minimal change disease - effacement of foot processes on EM. no other changes. treat with immunosuppression
fsgs - scarred glomeruli, must exclude other causes of scarring
immune complex disease - membranous glomerulonephritis (subepithelial deposits on outside of gbm, antibody against PLA2R in 75%, autoimmunie usually, must exclude secondary causes)
systemic disease:
- diabetic nephropathy (nodular sclerosis, Kimmelstiel wilson lesion!! aka large nodules)
- amyloidosis - eg AA seen in chronic inflammatory states eg IBD or AL in which 80% patients have multiple myeloma. congo red stain - apple green birefringence
- SLE
2 common causes of microscopic hematuria?
- thin basement membranes - hereditary defect in type 4 collagen
- igA nephropathy - associated with HSP
how many classes of SLE nephropathy are there?
6
2 = mesangial pattern of injury
3 = cell proliferation in capillary loops, subendothelial deposits
5 = membranous pattern - subepithelial deposits
nephrotic syndrome is proteinuria of more than how many grams per day?
3.5g
IgA renal disease is scored using?
oxford classification system
most common cause of kidney failure requiring renal replacement therapy?
diabetes
lymphocytes and plasma cells are associated with which type of inflammation?
chronic - eg IBD
acute = neutrophils, eg in a FLARE of IBD
eosinophils are seen in?
allergic reactions
parasitic infections
Hodgkins lymphoma
eg rectal biopsy in child with eosinophils = cows milk intolerance? parasite?
eosinophilic oesophagitis - due to food allergens
features of squamous cell carcinomas?
keratin
intracellular bridges
adenocarcinomas features?
mucin production
glands
antibodies to what can be used to identify epithelium?
cytokeratin
even more specific eg
CK20+ AND CK7- from liver biospy = large bowel cancer primary
CD45 is a marker for?
lymphoid cells
Gilberts syndrome pathology?
presentation?
decreased activity of UDP glucoronyl transferase
increased bilirubin only (unconjugated - therefore doesnt enter urine as binds to albumin)
what is the best marker of liver function?
prothrombin (liver makes clotting factors)
alcoholic hepatitis biopsy findings?
treatment?
ballooned hepatocytes - white clear cells
mallory hyaline - pink bodies
swollen hepatocytes - bile accumulates in liver - raised bilirubin
stop alcohol
vitamins especially B1
ocassionally steroids
3 signs of portal hypertension?
caput medusae
spleenomegaly!!!
ascites
NOT hepatomegaly!
signs of chronic stable liver disease
spider neavi
palmar erythema
dupentryns contracture
signs of liver failure?
common causes of obstructive jaundice? how to differentiate?
gallstones - painful, non palpable gallbladder
pancreatic cancer - painless initially, palpable gallbladder
osteoporosis causes?
presentation?
investigationa?
post menopausal - eostrogen deficiency
steroids is a key risk factor
fractures - wrist hip, vertebral fractures may asymptomatic
serum calcium, phosophorus, alk phos, urinary calcium- typically normal
imaging
bone densitometry - cut off for osteoporosis vs osteopenia
Hyperparathyroidism bone findings?
osteitis fibrosis cystica
brown cell tumour - multinucleate cells seen on histology
what is renal osteodystrophy?
comprises all bone changes seen as a result of renal disease eg:
1. osteitis fibrosis cystica
2. osteomalacia
3. osteosclerosis
4. growth retardation
5. osteoporosis
osteomyelitis causative organism?
s aureus - 90%
salmonella - sickle cell
psuedomonas - IVDU
etc
xray findings usually appear only after about 10 days
new bone formation then lytic destruction (sequestrum)
what giant cells are seen in TB osteomyelitis?
name another rare cause of osteomyelitis
Langhans type Giant cells
syphilis
neuroendocrine tumour immunhistochemical marker?
chromogranin, synatophysin
can also stain for specific hormone it secretes - gastrin(eg zollinger ellison syndrome), insulin etc
staging for these tumours are site specific
HPV high risk strains? effect?
HPV 16 and 18 -> Can cause cervical cancer but als warts like low risk strains
squamous cell carcinoma - always HPV associated
adenocarcinoma - sometimes associated - 20% oof invasive cases
endometrial cancer
1. endometroid carcinoma
2. serous carcinoma
3. clear cell carcinoma
omentectomy lymphadenectomy + uterine removal if high grade
TCGA classification increasing for eec diagnosis
p53 mutation may be present - can be detected with staining
Endometriosis, ovarian cysts
Ovarian tumours
primary
1. epithelial - 65% of all, 95% of malignant - many subtypes eg serous, mucinous
2. sex cord - adult type(FOXL2) and juvenile granulosa cell
3. germ cell - 20%, 95% benign - mature teratoma, immature teratoma(malignant), dysgerminoma, yolk sac, embryonal carcinoma, choriocarcinoma
4. miscellaneous
- screen for BRCA1 AND BRCA2, HNPCC (lynch syndrome)
secondary
Lichenoid inflammation
lichen planus
erythema multiforme
Toxic epidermal necrolysis
basal cell damage, interface dermaittis
shiny, purple, flat, scaly
eczema
spongiotic reaction
atopic dermatitis, contact dermatitis, sebbohhreiac
psoriasis
epidermal hyperplasia
erythematous plaque with white silvery scales on extensor surfaces
vesticullobullous rash
blistering within or beneath the epidermis
antibodies attacking epidermis
- bullous pemphigoid - subepidermal blisters - > IF shows straight line
- pemphigoid vulgaris - intraepidermal bullae
malignant epithelial skin tumours
seborrheic keratosis -> benign, stuck-on appearance
Basal cell carcinoma - most common skin cancer -> does not metastize, ptch mutation
squamous cell carcinoma - actinic keratosis, bowens disease (scc in situ so full atypia of epidermis but basement membrane intact), SCC can occur in burns patients, immunocompromised
bening mole vs melanoma
melanoma staging based on breslow thickness
is urobilinogen present in normal urine?
true
obstructive jaundice signs
scratch marks from bile salts in skin
pale stools dark urine
must be able to recognise nutmeg liver specimen. what causes this?
right sided heart failure
how to identify granular deposits on electron micrograph
flourescence in whole glomerulus, following glomerular capillaries
nephrotic syndrome with
subepithelial deposits on electron micrograph
and granular deposits on imunofluroescence is most likely?
membranous glomerulonephritis
what happens in Acute tubular injury?
ischemia/toxins -> sloughing of cells into lumen -> blockage of tubules -> leaking into interstitium
what happens in acute tubulo interstitial nephritis?
immune injury. most commonly due to drugs
interstitial inflammatory infiltrate -> eosinophils, granulomas
can also be due to infection eg TB
different types of glomerulonephritis?
1. Immune complex -> SLE, IgA nephropathy, post infectious glomerulonephritis
2. anti GBM disease - linear deposition of IgG
3. pauci immune -> anti neutrophil cytoplasm antibodies. scanty immunoglobulins, no fluorescence
different types of nephrotic syndrome?
1.primary glomerular disease, no immune complex - minimal change, focal segmental glomerulosclerosis
2. primary renal disease, immune complex - membranous glomerulonephritis (subepithelial deposits, antibodies against PLA2R in 75% cases)
3. Systemic disease - diabetes(thickening of basement membrane and expansion of mesangium which progresses to nodular/kimettiel wilson lesions then scarring), amyloidosis, SLE
what are the 2 most common types of amyloid in the kidney in amyloidosis. describe classic presentation
AA amyloid -> derived from acute phase protein called SAA thus patients have chronic inflammatory state eg patient with IBD or recurrent infections
AL amyloid -> derived from immunoglobulin light chains. 80% have multiple myeloma
key EM finding in minimal change disease?
effacement of foot processes
nephotic syndrome is proteinuria of more than?
3.5g
IgA renal disease is scored using? associates with which vasculitis?
oxford classification/ MestC
HSP
most common cause of CKD?
diabetes
most common causes of isolated microscopic hematuria
thin basement membranes - eg alport Syndrome
igA nephropathy
hypertensive nephropathy histology findings?
shrunken kidneys
arteriolar hyalinosis, thickened arteries
benign kidney tumour features
1. papillary adenoma - max size is 15mm
2. renal oncocytoma - eosinophilic/pink cells
3. angiomyolipoma
renal cell carcinoma presentation?
subtypes (learn histology)?
painless hematuria
or incidental on imaging
1. clear cell renal carcinoma
2. papillary renal cell carcinoma
3. chromophobe renal cell carcinoma
malignant kidney tumour of childhood?
nephroblastoma
triphasic pattern
Urothelial Carcinoma (previously called transitional cell carcinoma)
1. non invasive papillary urothelial carcinoma
2. infiltrating urothelial carcinoma
3. flat urothelial carcinoma in situ - is high grade
BPH, Prostate cancer
cancer scored using gleason score
Testicular germ cell tumours
risk factors?
presention
subtypes
undescended testes, low birth weight
painless lump
back pain, cough, dyspnea with mets
1. seminoma - clear polygonal cells with prominent lymphoid infiltrate
2. embryonal carcinoma
3. post-pubertal teratoma
4. yolk sac tumour
5. choriocarcinoma - aggressive, hemorrhagic, necrotic
testicular non germ cell tumours
lymphoma
leydig cell tumours
sertoli cell tumours
