Histopathology Flashcards
Caseating necrosis
TB
What type of epithelium has intercellular bridges?
Squamous
What type of epithelium has keratin?
Squamous
Stain used for amyloid
Congo Red (stains amyloid bright red)
Amyloid under polarised light looks like…
Apple green birefringence
Villous atrophy and crypt hyerplasia
Coeliac
Antibodies in Coeliac
Anti-EMA and anti-TTG (endomysial and tissue transglutaminase)
Skin complication of coeliac
Dermatitis herpetiformis (“blistering rash on elbow/knees”)
Pancreatic calcifications
Chronic pancreatitis (diagnostic)
What cancer type is “mucin-secreting glands set in desmoplastic stroma”
Adenocarcinoma
Rosette Cells
Neuroendocrine tumours
Rokitansky-Aschoff sinus
Chronic Cholecystitis
• Diverticula in gall bladder (due to obstruction)
o Gallbladder pumps harder to get rid of obstruction
o –> Increases pressure inside gallbladder
o –> Rokitansky-Aschoff sinus:
Liver with lots of nodules
Cirrhosis (nodules = regenerating hepatocytes)
Liver biopsy shows nodular hepatocyte with collagen cuff around it
Cirrhosis
Spotty necrosis and interface hepatitis
Acute hepatitis (Spotty necrosis = foci of inflammation and apoptosis-> happens in all acute hepatitis) (Interface hepatitis = can’t see where hepatocytes end and portal tract begins = T cell destruction of hepatocytes)
Ballooning of hepatocytes
Alcoholic hepatitis (most important feature – shows that they are apoptosing)
Bowel disease where don’t pass meconium in first 24 hrs
Hirschsprung’s Disease
Pericellular fibrosis around hepatocytes
Alcoholic hepatitis
Liver disease causing itchy skin
Primary Biliary Cholangitis (bile acids escape to circulation)
Test for Primary Biliary Cholangitis
Anti-mitochondrial antibodies
Gut disease occurring in “watershed zones” (splenic flexure and rectosigmoid)
Ischaemic Colitis (watershed zones are far from gut’s blood supply)
ERCP: “beaded appearance”
Primary Sclerosis Cholangitis
Chocolate brown liver
Haemachromatosis
What stain used for iron in Haemachromatosis?
Prussian Blue (brown iron stained blue)
What stain used in Wilson’s Disease?
Rhodamine stain
Eye sign in Wilson’s Disease
Kayser-Fleischer rings (brown ring around edge of iris)
Very steroid responsive liver disease
Autoimmune hepatitis
Hirschsprung’s Disease associated with which congenital disease?
Down Syndrome
Mallory-Denk Bodies
Alcoholic hepatitis (hepatocyte damage)
Liver disease with increased gamma globulin
Primary Sclerosis Cholangitis
IBD: Whole GI tract affected (mouth to anus)
Crohn’s
IBD: Only large bowel affected = moves upwards from anus
Ulcerative Colitis
IBD: Inflammation confined to mucosa (not though wall)
Ulcerative Colitis
IBD: Cobblestone mucosa
Crohn’s
IBD: Crypt abscess
Ulcerative Colitis
IBD: Transmural inflammation
Crohn’s
Lip and mouth complications of Crohn’s
Cheilitis = inflammation of lips (look dry and cracked) Stomatitis = mouth ulcers
Extra-intestinal complication of Ulcerative Colitis
Primary Sclerosing Cholangitis
Skin complication of Crohn’s
Erythema multiforme/nodosum
Dangerous bowel complication of Ulcerative Colitis
Toxic megacolon
Ulcerative Colitis increases risk of which cancer?
Bowel Adenocarcinoma
Mouth ulcers in which GI condition?
Crohn’s
Familial Adenomatous Polyposis involves mutation in which gene?
APC tumour suppressor gene (chromosome 5q21)
Colorectal cancer in very young person. What disease do they have?
Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
- poorly differentiated and mucinous carcinomas
- often carcinomas proximal to splenic flexure
Brain biopsy shows piloid “hairy” cell with Rosenthal fibres
Pilocytic Astrocytoma
Heterogeneous and enhancing brain tumour
Glioblastoma Multiforme
Brain tumour with long history of neuro signs/seizures
Oligodendrogliomas
Co-deletion is specific for which brain tumour?
Oligodendrogliomas (co-deletion of 1p/19q)
Cystic cerebellar lesions
Pilocytic Astrocytoma
Whorl pattern (spirals) on brain biopsy
Meningioma
Brain cells look like fried eggs (round cells with clear cytoplasm)
Oligodendrogliomas
Small blue round cell brain tumour, with Homer-Wright Rosettes
Medulloblastoma
Brain tumour in patient who had lobectomy 5 years ago
Brain mets (lobectomy = previous cancer)
Medulloblastoma expresses this neuronal marker
Synaptophysin
Can’t see gyrae on brain MRI
Cerebral Oedema (can’t see gyrae because tightly compressed)
T2-weighted brain MRI shows “target sign”
Cavernous Angioma
Head injury with runny nose and ears
Skull fracture (esp hairline fracture = extend into base of skull)
Beta-amyloid plaques in Hippocampus
Alzheimer’s Disease
What protein accumulates in Parkinson’s?
Alpa-synuclein (forms Lewy Bodies)
Balloon Neurones
Pick’s Disease
Cortical atrophy on brain MRI (Widening of sulcae, shrinkage of gyrae)
Alzheimer’s Disease (lose brain tissue)
Frontotemporal atrophy on brain MRI
Pick’s Disease
Amyloid lines cerebral vessel walls
Alzheimer’s Disease
Tau protein
Alzheimer’s Disease
Pick Bodies in hippocampus
Pick’s Disease
What genetic condition increases risk of kidney cancer?
Von Hippel Lindau
Cancer with frond-like growths (like a leaf)
Non-Invasive Papillary Urothelial Carcinoma
Testicular cancer which can differentiate into other cancer types (e.g. lung)
Post-Pubertal Teratoma
Schiller-Duval Body
Yolk Sac Tumour (testicular cancer in <3yrs)
Testicular cancer presenting with precocious puberty
Leydig Cell Tumour (releases hormones)
Skin disease which is Nikolsky’s Sign Positive
Pemphigus Vulgaris (slight rubbing detaches upper epidermis from lower epidermis)
Skin bubbles which do not easily rupture
Bullous Pemphigoid
Skin disease with hyperkeratosis
Contact Dermatitis (epidermis thicker after scratching)
Silvery plaques on extensor surfaces
Plaque Psoriasis
Skin disease with white lines in mouth
Lichen Planus
Horn cysts
Seborrhoeic Keratosis (entrapped keratin- surrounded by proliferating epidermis)
Skin bubbles which easily rupture
Pemphigus Vulgaris
Skin lesion with smooth surface, non-mobile, central punctum
Sebaceous Cyst
Skin lesion with rolled pearly white border, central ulceration
Basal Cell Carcinoma
Crusty, non-healing ulcer with everted edge on sun-exposed areas
Squamous Cell Carcinoma
Weird horns growing on skin
Bowen’s Disease = Early Form of SCC
Rodent Ulcer
Basal Cell Carcinoma
Stain for melanin
Fontana stain
Herald Patch
Pityriasis Rosea (salmon-pink, scaly –> rash on trunk)
Skin cancer which does NOT metastasise
Basal Cell Carcinoma
Skin viral infection which causes target lesions
Pityriasis Rosea = HHV6/7 (get URTI before rash)
Low-risk HPV types
HPV 6 and 11
High-risk HPV types
HPV 16 and 18
Bone disease with mottled rarefaction (bone thinner) and lifting of periosteum
Osteomyelitis
Bone biopsy contains multinucleated Langerhans-type Giant cells
TB Bone Disease
Joint disease with osteophytes
Osteoarthritis
Joint disease with spares the distal interphalangeal joint
Rheumatoid Arthritis
Grimley-Sokoloff cells in biopsy
Rheumatoid Arthritis (multinucleated giant cells specific for RA)
Bone X-Ray shows “onion-skinning” of periosteum
Ewing’s Sarcoma
Bone disease with Codman Triangle on X-Ray
Osteosarcoma - see in kids
Bone X-Ray is lytic with fluffy calcification
Chondrosarcoma
Joint disease with subcondral sclerosis and subcondral cyst
Osteoarthritis
Bone disease with sheets of small round blue cells on biopsy
Ewing’s Sarcoma
Lung disease with Curschmann’s Spiral
Asthma
Lung infection which does not have consolidation on CXR, but shows patchy changes. Terminal event which kills off old person.
Bronchopneumonia
Central lung tumour
Squamous Cell Carcinoma
Lung cancer containing “large cells”
Large Cell Carcinoma
Oat-shaped lung cells on biopsy
Small Cell Lung Cancer
Cancer which causes pleural thickening
Mesothelioma
Peripheral lung tumour
Adenocarcinoma
Ovarian cancer type which is strongly associated with endometriosis
Clear Cell Carcinoma
Ovarian cancer which causes virilisation
Sertoli-Leydig Cell tumour: makes androgens
Ovarian cancer which differentiates into all types of human tissue (teeth, hair, brain)
Mature Teratoma (germ cell tumour)
Painful red breast, very tender on palpation
Acute Mastitis
Hard, firm breast lump
Fat Necrosis
Lumpy breast
Fibrocystic Disease
Breast lump which shows leaf-like throngs of stroma on biopsy
Phyllodes Tumour (Phyllodes means leaf)
Breast lump which shows 3D cluster of cells on biopsy
Intraductal Papilloma
Stellate masses on mammogram (incidental finding)
Radial Scar
Breast cancer causing eczema around nipple
Ductal Carcinoma in Situ
Paget’s Disease of the Nipple = because DCIS goes along ducts–> can arise at nipples= where all ducts lead to…
Breast cancer which has “India File pattern” on biopsy
Lobular Carcinoma
Breast cancer with sheets of atypical cells with lymphocytic infiltrate
Basal-Like Carcinoma
Breast cancer recognised as microcalcifications on mammogram
Ductal Carcinoma in Situ
Most important prognostic marker in breast cancer
Spread to axillary lymph nodes
Autoimmune condition with Libman-Sacks cardiac sign
Systemic Lupus Erythematosus
Libman-Sacks = non-infective endocarditis
Antibodies for diffuse systemic sclerosis
Anti-topoisomerase antibodies
Antibodies for limited systemic sclerosis
Anti-centromere antibody
Gottron’s Papules on fingers
Dermatomyositis
“Wire-looping” of glomeruli on biopsy
SLE
(thickened glomerular capillary loops
due to immune complex deposition in basement membrane surrounding capillaries)
Anti-Smith used in which autoimmune condition?
SLE
Small arteries look like onion skins on biopsy
Systemic Sclerosis (intimal thickening of small arteries --> hypertensive crisis)
Autoimmune condition with lupus pernio (ring splodgy lesion at bottom of nose)
Sarcoidosis
Palpable purpuric rash
Vasculitis
Erythema rash of palms & soles–> desquamation (peeling)
Kawasaki’s Disease
“Rosary sign” on angiogram
Polyarteritis Nodosa (Small aneurysms strung along arteries)
Antibody in Wegener’s (Granulomatosis with polyangiitis)
C-ANCA against proteinase 3
Antibody in Churg-Strauss (Eosinophilic Granulomatosis with polyangiitis)
P-ANCA against myeloperoxidase
Vasculitis after chest infection in child
Henoch-Schonlein Purpura (HSP)
Autoimmune condition with ENT, lung and kidney problems
Wegener’s (Granulomatosis with polyangiitis)
Statins inhibit this enzyme
HMG-CoA Reductase
Which protein can cause restrictive cardiomyopathy?
Amyloid
Palpable spleen with notch, and microscopic haematuria
Subacute bacterial endocarditis
slowly develops, due to friendly bacteria like strep viridans
Hurthle cells
Hashimoto’s
thyroid epithelial cells are enlarged, filled with eosinophils
Psammoma Body
Papillary Thyroid Carcinoma
Which thyroid cancer produces amyloid?
Medullary Thyroid Carcinoma
A 46 year old women presents to A&E out of breath and with severe chest pain. On examination a mid systolic click late systolic murmur is revealed.
Myxomatous mitral valve
causes mitral valve prolapse
Cystic tumour lined by epithelium
Cystadenoma
A 38 year old female with Rheumatoid Arthritis presents with a single episode of malaena. Investigations reveal erosions through out the stomach and a neutrophilic infiltrate in the superficial mucosa
Acute Gastritis
Which ulcer is relieved by meals, and which is worsened?
Duodenal ulcer relieved by meals
Gastric ulcer worsened by meals
Positive CLO test
Duodenal ulcer
A jejunal biopsy showed periodic acid-Schiff (PAS)-positive macrophages
Whipple’s disease
‘Leather bottle stomach’ (infiltration into all layers of the gastric wall)
Signet ring cells on biopsy
Adenocarcinoma
Sarcoidosis has raised levels of which enzyme?
ACE!
Stomach looks like a leather bottle, and contains signet-ring cells
Gastric carcinoma
Carcinogen which directly causes hepatocellular carcinoma
Aflatoxin (made by Aspergillus- seen in cereals and nuts)
Mobile breast lump which grow during menstrual cycle
Fibroadenoma (oestrogen causes to grow)
Breast disease with peau d’orange, Paget’s Disease of Breast, nipple retraction
Infiltrating Ductal Carcinoma (arise from DCIS)
Inverted U loop of bowel
Sigmoid volvulus
Constipated with abdo pain that is relieved by pooing
Diverticular Disease
Cauliflower-like mass covered by dysplastic columnar epithelium in the rectum
Villous adenoma
Widespread itching, plethoric and hepatosplenomegaly
Polycythaemia rubra vera
Green-brown discolouration at the peripheries of her corneas
+confusion and tremor (in young person)
Wilson’s Disease
Old man with palpable mass in right loin, and hypercalcaemia
Renal Cell Carcinoma
hypercalcaemia = humoral hypercalcaemia of malignancy
Old man with dysuria, frequency and red urine
Bladder Cancer (red urine = FRANK haematuria)
Ovarian cancer containing different cell types (thyroid, hair, teeth)
Cystic Teratoma
Antibody used to diagnose CREST
Anti-centromere
T2DM drug which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel
Acarbose
leaves undigested sugar in the bowel giving wind as a side effect
Bone biopsy reveals sheets of cells with small, primitive nuclei and scanty cytoplasm. A positive immunoreactivity is seen with the MIC2 (CD99) antibody.
Ewing’s sarcoma
Mottled rarefaction and lifting of the periosteum are seen on X-ray
Osteomyelitis
Lung cancer subtype with bilateral ptosis and proximal weakness in the limbs which improves on repeated testing
Small cell carcinoma
Young person with thyroid lump and high thyroglobulin = what type of thyroid cancer?
Papillary carcinoma
Hyperthyroid, then hypothyroid, then euthyroid (with fever)
De Quervain’s
Largest ovarian neoplasm (90% benign)
Mucinous Tumour
Ovarian cancer: fibrous tissue containing spindle cells and lipid
Thecoma
Ovarian cancer: malignant cells surrounded by serous fluid and Psammoma bodies
Serous cystadenocarcinoma
Ovarian cancer: malignant signet ring cells containing mucin
Krukenberg tumour
Painful ulceration of the vulval skin. Intraepithelial blisters, intranuclear viral inclusions and eosinophilic cytoplasmic swelling
HSV
Pap smear taken from a chronic granulomatous ulcer shows a necrotic centre, periarteritis and endarteritis obliterans and an intense peripheral cellular infiltrate consisting mainly of mononuclear cells and giant cells.
Treponema pallidum (syphilis)
Vaginal irritation – silver stain reveals fungi within the keratin layer and superficial epithelium
Candida albicans
The metaplasia that occurs in the transformation zone involves which cell-types?
Glandular to squamous epithelium
Anti-topoisomerase antibody
Diffuse Scleroderma (needs involvement of one internal organ)
Anti-centromeres antibody
Limited scleroderma (skin manifestations and CREST)
H. Pylori affects which part of the stomach the most?
Pyloric antrum
HLA associated with Type 1 DM
HLA DR3 and DR4
Pain in femur/hip
X-Ray: “soap bubble” appearance (osteolysis) and Shepherd’s Crook Deformity
Biopsy: irregular trabeculae of woven bone - looks like Chinese letters
Fibrous Dysplasia = lesions containing fibrous and bone tissue
Most common cause of lobar pneumonia
Strep pneumoniae = 95% lobar pneumonia!
- Central lung tumour
2. Peripheral lung tumour
- Squamous Cell Carcinoma
2. Adenocarcinoma
“Spares the distal interphalangeal joint”
Rheumatoid Arthritis
Bamboo spine (fusion of spine)
Ankylosing Spondylitis
White cell casts in urine
Acute pyelonephritis
Red cell casts in urine
Glomerulonephritis
Eosinophils in urine
Tubulointerstitial Nephritis
ANCA and vasculitic rash – what type of glomerulonephritis?
Pauci-immune crescentic glomerulonephritis
IBD: “rubber hose” gut wall
Crohn’s Disease
Early bowel cancer, with adenomata in large bowel
Familial Adenomatous Polyposis (FAP)
-autosomal dominant (mutation in FAP gene on Chr5)
Early bowel cancer, with no adenomata in large bowel
Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
-autosomal dominant
Breast biopsy shows necrosis with multinucleated giant cells –> fibrosis
Fat Necrosis
Pepperpot skull
Primary Hyperparathyroidism
Raindrop skull
Multiple myeloma
Blood-stained nipple discharge –> lump has branching fibrovascular cores covered by cytologically bland epithelium
Duct Papilloma
Hard, calcified lump –> cells have pleomorphic nuclei and that the lump has a necrotic centre
Ductal Carcinoma in situ
Multifocal lumps in young person
Lobular Carcinoma in situ
Nipple retraction
Invasive Carcinoma
Firm palpable mass with signs of tethering. 4-month history of back pain
Invasive Carcinoma
What causes galactorrhoea in hypothyroidism?
Increased TRH
Tender bump, but contains inflammatory cells and proteinaceous debris only. A few weeks after giving birth
Duct Ectasia
Firm breast lump – histology: long clefts with myxoid cellular stroma
Phyllodes Tumour
Back and neck pain which improves with exercise.
Spinal X-rays show ‘bony bridges’ between the vertebrae.
Ankylosing Spondylitis
Arthritis, urethritis and conjunctivitis – after GI/STI infection
Reiter’s Syndrome = Reactive Arthritis (“can’t see, pee or bend their knee”)
Pemphigus vulgaris has antibodies against what?
Desmoglein-1 and 3 (cadherins in epidermis)
Hep B associated with this vasculitis
Polyarteritis nodosa (immune complexes deposit in vessels –> necrosis –> aneurysms)
Acantholytic cells on skin biopsy
Pemphigus vulgaris – acantholytic = separation of keratinocytes due to loss of cadherin connections
Antibodies against hemidesmosomes of skin basement membrane
Bullous pemphigoid
Causes “backwash ileitis”
Ulcerative Colitis (backwash of poo into ileum –> ileitis)
Liver tumour in woman taking COCP
Hepatic Adenoma –> need to avoid pregnancy
Biliary brush cytology shows cellular discohesion and a high nuclear/cytoplasmic ratio
Cholangiocarcinoma
Visit tropical country –> malabsorption and thickened small bowel loops on imaging
Tropical sprue
Thyroid cancer associated with RET mutation
Medullary
Calcitonin staining used in this thyroid cancer
Medullary
Thyroid cancer = cystic lesion with papillary architecture and clear cytoplasm
Papillary carcinoma
Bone pain and low calcium in someone who has kidney problems
Renal Osteodystrophy (kidneys can’t convert D3 to calcitriol)
Pins and needles in legs in osteoporosis
Vertebral Collapse
X-Ray hand: small resorptive lesions in the bones of the 4th and 5th digits
Hyperparathyroidism
Widened epiphyseal plates
Osteomalacia
Troisier’s Sign +ve
Virchow’s node enlargement (abdo cancer)
Loss of ganglion cells in the myenteric plexus
Achalasia = increased tone in oesophagus
Perforation of the oesophagus due to rise in internal oesophageal pressure while vomiting e.g. alcoholism, bulimia
Boerhaave Syndrome
Bloody discharge from nipple –> mammogram does not show any lesions
Intraductal Papilloma (need galactogram)
Collapse suddenly while exercising. Echo shows asymmetrical thickening of septum
Hypertrophic Cardiomyopathy
Endocarditis with SLE
Libman-Sacks Endocarditis
Young man with SOB/palpitations – have narrowing of left ventricular outflow tract
Hypertrophic Cardiomyopathy
Psammoma bodies found in which type of ovarian cancer?
Serous
Vitamin deficiency causing Subacute Combined Degeneration of Cord
B12
Vitamin deficiency causing dry skin, dry eyes (and immature retinas)
A
Anti-ANA and anti-RNP
Mixed connective tissue disease
Head CT shows crescent-shaped lesion (in alcoholic)
Subdural haemorrhage
Deletion of APC gene
Familial Adenomatous Polyposis
Pancreatic tumour with KRAS mutation
Pancreatic Ductal Carcinoma
Most common autoantibody in SLE
Anti-ANA
Tumour marker in papillary and follicular thyroid cancer
Thyroglobulin
Ca 19-9 tumour marker
Pancreatic and biliary
Ca 15-3 tumour marker
Breast
hCG and LDH tumour markers
Testicular
Symmetrical, erythematous lesions – with “central clearing”, and some have overlying vesicles/bullae
Erythema multiforme (Type IV Hypersensitivity)
Many lytic lesions in epiphysis of knee –> soap-bubble appearance
Gaint Cell Tumour
This feature is diagnostic of chronic pancreatitis
Pancreatic calcifications
Most common pancreatic cancer
Ductal carcinoma – more common in head
Pancreatic cancer found in tail of pancreas
Neuroendocrine
Mutation found in pancreatic cancer
K-Ras
Composition of radiolucent gallstones
Cholesterol
Iron-storage complex (found in haemachromatosis, stained by Prussian Blue)
Haemosiderin
Commonest liver tumour
Haemangioma = benign
Commonest malignant liver tumour
Mets!
Old man with colicky abdo pain relieved by pooing
Diverticular Disease (low fibre diet)
Most common bowel cancer type
Adenocarcinoma 98%
This disease predisposes to pilocytic astrocytoma
Neurofibromatosis 1
Cancer that astrocytomas always become
Glioblastoma
This makes CSF
Choroid plexus
Commonest cause of coma in brain injury
Diffuse Axonal Injury
Causes Tau -ve Pick’s Disease
Progranulin mutation
Type of kidney stone in proteus infection
Magnesium ammonium phosphate (Struvite)
Most common renal cancer (“golden yellow tumour”)
Clear Cell Renal Carcinoma
Triphasic renal tumour
Nephroblastoma (Wilm’s)
Amplification of this is used to show if tumour is testicular germ cell tumour
i12p
Most common testicular cancer
Seminoma
Composition of inorganic bone
Calcium hydroxyapatite
Bone tumour caused by t(11;22)
Ewing’s Sarcoma
Ovarian cancer that makes oestrogen
Granulosa Cell
Thyroid cancer containing amyloid
Medullary (calcitonin broken down to amyloid)
+ve CLO test
H. pylori
Periodic acid-Schiff (PAS)-positive macrophages
Whipple’s Disease
