Histopathology Flashcards
What are the layers of the epidermis
(superficial to deep)
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Basement membrane
What cells make up the epidermis
Keratinocytes
What is contained within the dermis
Collagen
Elastin
Glands
Vascular supply
What does hyperkeratosis mean
Increase in size of stratum corneum
Increased keratin
What does parakeratosis mean
Increased nuclei in the stratum corneum
They get retained there
What does acanthosis mean
Increase in the stratum spinosum
What does acantholysis mean
Reduced cohesions between keratinocytes
What is spongiosis
Intercellular oedema
What does actinic mean
Damaged by the sun
What is a benign derm neoplasm
Seborrheic Keratosis
What do seborrheic keratoses appear like
Rough pigmented plaques
Waxy and stuck on
Coin shaped
Who do seborrheic keratoses appear in
Middle age and elderly
What is the histology of seborrheic keratoses
Horn cysts
Orderly hyper-proliferation of epidermis
What are horn cysts seen in
Seborrheic keratosis
What are the premalignant derm neoplasms
Actinic keratosis
Keratoacanthoma
Bowens disease
How do actinic keratoses appear
Papule or plaque
Skin is red
White or yellow scaly crusts
What skin pathology is described as sandpaper like texture
Actinic keratosis
Histology of actinic keratosis
SPAIN
Solar elastosis
Parakeratosis
Atypia/dysplasia
Inflammation
Not full thickness
How does a keratoacanthoma appear
Dome shaped nodule with necrotic crusted centre
Histology of squamous cell carcinoma
Full thickness atypia/dysplasia throughout the epidermis spreading through basement membrane into dermis
Nuclear crowding
Histology difference between bowens disease and squamous cell carcinoma
SCC is bowens but it spreads through the basement membrane
How does bowens disease appear
Intra-epidermal squamous cell carcinoma
Flat
Red
Scaly patches
Stand alone
What are 2 precursors to SCC
Bowens disease
Actinic keratosis
Difference between actinic keratosis and bowens disease
Bowens disease is full thickness
How do basal cell carcinomas appear
Pearly surface
Telengiectasia
What is rodent ulcer
Basal cell carcinoma
Histology of BCC
Mass of basal cells pushing down into dermis
Palisading (alignment of nuclei in outermost layer)
Pathophysiology of amyloidosis
Excess proteins clumpb together to form beta sheets which make up fibrils
These then deposit in the EC space of tissues and cause damage
Why is AL amyloidosis called AL
Amyloid ‘light’- as excess light chains
What is a dyscrasia
Non specific term for disorder of blood
What is pathophysiology of AA amyloidosis
In chronic systemic inflammatory responses to infections, cancers and autoimmue conditions there is an excess of serum amyloid A which forms amyloid deposits in tissues
What is amyloid protein in AA amyloid
Serum amyloid A
What conditions cause AA amyloidosis
Infections- TB, osteomyelitis, IVDU skin infections, familial mediterranean fever
Autoimmine- IBD, RA, Ank spond
Cancer- Hodgkins lymphoma, Renal cell carcinoma
What is the most common form of familial amyloidosis
Familial mediterranean fever
Where is the amyloid deposition predominant in famial mediterranean fever
Kidney
Who does haemodialysis associated amyloidosis occur in
Chronic renal failure patients who are on especially peritoneal dialysis
What is the protein deposited in haemodialysis associated amyloidosis
Beta-2-microglobulin
What is most common presentation of amyloidosis
Nephrotic syndrome
Clinical features of amyloidosis
Carpal tunnel syndrome
Macroglossia
Hepatosplenomegaly
Restrictive cardiomyopathy
Nephrotic syndrome
Stain done for amyloidosis
Congo red stain under polarised light
Positive amyloid finding on congo red stain
Apple green birefringence- caused by beta pleated sheet configuration
What is negative congo red stain colour
Pink/red
When are neutrophils involved
Acute inflammation
When are macrophages involved
Late acute inflammation
Chronic inflammation like in granulomas
When are lymphocytes involved
Chronic inflammation
Lymphomas
When are plasma cells involved
Chronic inflammation
Myeloma
When are eosinophils involved
Allergic reactions
Parasitic infections
Hodgkins disease
When are mast cells involved
Allergic reactions
How do mast cells appear on histology
Lots of granules
Typical histological features of squamous cell carcinomas (not skin)
Keratin production
Intercellular bridges
Do not form glands
How do adenocarcinomas appear histologically
Form glandular epithelium
Form glands that can secrete substances
How do transitional cell carcinomas appear
Stretchy epithelium
Where do you get stretchy epithelium
Transitional cell carcinomas
What is the definition of histochemical stain
Result from the chemical reaction between stain and the tissue
What is the definition of immunohisto stain
Involves the antibodies against a specific antigen
What is lichenification
When skin becomes leathery and thick
What happens to skin if chronic atopic dermatitis
Lichenification
Acute histology of dermatitis
Spongiosis
Inflammatory infiltrate in the dermis (neutophils)
Dilated dermal capillaries
Chronic dermatitis histology
Acanthosis
Crusting
Hyperparakeratosis
T cells and eosinophil infiltrate
What is pathophysiology of seborrheic dermatitis
Inflammatory reaction to yeast infection- malassezia
What type of hypersentivity reaction is stevens johnsons syndrome
IV
What is the pathophysiology of SJS
Hypersensitivity reaction against the epidermis and mucosa which leads to necrosis of skin which can be wiped off
What determines if SJS or toxic epidermal necrolysis
<10% in SJS
>30% in TEN
What can cause SJS
Drugs- sulfonamides, carbamezapine
Infection- CMV, mycoplasma
How does chronic plaque psoriasis appear
Salmon pink well demarcated red plaques with silver scales
Where does chronic plaque psoriasis appear
Extensors of knees, elbows and scalp
What is auspitz sign
Rubbing plaque leads to pinpoint bleeding
What is the koebner phenomenam
Lesions form at site of trauma- seen in psoriasis
Histopathology of psoriasis
Parakeratosis
Loss of granular layer
Clubbing of rete ridges giving test tubes in rack appearance
Munros abscesses
Dilated blood vessels
Clubbing of rete ridges giving test tubes in rack
Psoriasis
What is pathophysiology of psoriasis
Type IV hypersensitivity reaction
When does guttate psoriasis present
Childhood
What triggers guttate psoriasis
Post strep throat 2 weeks ago
Typically in children
How does guttate psoriasis appear
Small spots
Rain drop plaque distribution
Over trunk and limbs
What is erythodermic psoriasis
Widespread disease with systemic symptoms
Where does pustular psoriasis affect
Hands and feet
How does pustular psoriasis appear
Red skin with white elevations of pus
What are the nail changes seen in psoriasis
Pitting
Onycholysis
Subungal hyperkeratosis
Who does flexural psoriasis occur in
Elderly
Where does flexural psoriasis occur
Creases in the skin
Groin
Submammary
Natal cleft
Histopathology of sarcoidosis
Non-caseating granulomas
Schaumann and asteroid bodies
CD4+
What are schaumann and asteroid bodies
Inclusions of protein and calcium
Blood findings of sarcoid
Hypercalcaemia
High ACE
High ESR
Anaemia
Leukopaenia
Skin findings in sarcoid
Erythema nodosum
Lupus pernio
Skin nodules
Eye manifestations of sarcoid
Anterior Uveitis
Posterior uveitis
Uveoparotid fever
Keratojunctivitis
Lacrimal gland enlargement
What happens in uveoparotid fever (heerfordt syndrome)
Bilateral uveitis
Parotid enlargement
Potentially facial nerve palsy
Joint manifestation of sarcoid
Arthritis
Bone cysts
Heart presentation of sarcoid
Cardiomyopathy
Conduction problems
Valvular disease
Pericarditis
What is the pathophysiology of bullous pemphigoid
IgG abs bind to hemidesmosomes which anchor epidermis to basement membrane
Leads to detachment of epidermis and formation of SUBdermal bullae
What is the pathophysiology of pemhigus vulgaris
IgG binds to desmoglein 1&3 which connect keratinocyes and between mucous membranes
Leads to breaking between layers of epidermis causing INTRAdermal bullae
What is difference in bullae between pemphigus vulgaris and bullous pemphigoid
Bullae in bullous pemphigoid are tense on erythematous base- DO NOT rupture
Bullae in pemphigus vulagris are easily ruptured which leads to a raw red surface
Nikolsky positive in pemphigus vulgaris
NB: Nikolsky +ve - the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender.
Histopathology of bullous pemphigoid
Subepidermal bulla with eosinophils
Linear deposition of IgG along basement membrane
Histopathology of pemphigus vulgaris
Acantholysis
Intradermal bulla
Netlike pattern of IgG
Complement deposition
What is the pathophysiology of dermatitis herpetiformis
IgA binds to basement membrane forming subepidermal bulla
What is dermatitis herpetiformis associated with
Coeliac
How does dermatitis herpetiformis appear
Itchy vesicles on extensors of elbows
Buttocks
Histology of dermatitis herpetiformis
Microabscesses which coalesce to form subepidermal bullae
Neutrophil and IgA deposits at tips of dermal papillae
How do lichen planus plaques appear
Hyperpigmented
Itchy
Polygonal
Papules
Plaques
Fine white network on the surface called wickams striae
Where is lichen planus normally found
Inner surface of wrists
Oral mucous membranes with lacy appearance
Histopathology of lichen planus
Hyperkeratosis
Saw toothing of rete ridges
Basal cell degeneration
What are wickhams striae
White network on top of plaques seen in lichen planus
What are annular target lesions seen in
Erythema multiforme
Where are erythema multiforme lesions seen
Extensor surfaces of hands and feet
How do erythema multiforme lesions develop
Can become pleomorophic so are anything from macules, papules, petechiae and bullae
Causes of erythema multiforme
Infections- HSV, mycoplasma
Drugs- SNAPP
SNAPP causes of erythema multiforme
Sulphonamides
NSAIDS
Allopurinol
Penicillin
Phenytoin
What causes pityriasis rosea
Appears after viral illness
Development of pityriasis rosea
Salmon pink rash apppears first called herald patch
Oval macules in xmas tree distribution then appear
What is a herald patch
Erythematous patch with white centre seen in pityriasis rosea
What is the scientific word for moles
Melanocytic naevi
Histology of melanomas
Atypical melanocytes
Initially radial growth phase then vertical phase
Buckshot appearance in vertical phase
Steps of atherogenesis
Endothelial injury
LDL enters subintimal space and gets trapped
LDL oxidised
Oxidised LDL gets taken up by macrophages via scavenger receptors becoming foam cells
Foam cells apoptose which causes cholesterol core
Increase in adhesion molecules on endothelium results in more macrophages and t cells
Vascular smooth cells form fibrous cap
What receptors take up oxidised LDL into macrophages
Scavenger
Why is abdo aorta more affected by atherosclerosis
Around the origins of major branches there is turbulent blood flow which has a low oscillatory shear stress
What are ostia
Origins of major arteries
Which blood flow is anti-atherogenic
Laminar
Turbulent is atherogenic
How long of severe iscahemia causes myocyte death
20-40 mins
Complications of an MI
DARTH VADER
D-death
A- arrythmia
R- rupture
T- tamponade
H- HF
V- valve disease
A- aneurysm of ventricle
D- dresslers syndrome
E- embolism
R- recurrence
What can rupture most MI
Due to necrosis:
- Septum causing left to right shift or VSD
- Papillary muscle causing MR
- Ventricular wall causing haemopericardium
What valve disease is common post MI
Mitral regurgitation from papillary muscle rupture or necrosis
What causes persistent ST elevation post MI
Ventricular aneurysm which can develop for over a month after
Difference between pericardial effusion and tamponade
Tamponade is when the fluid obstructs the contractility of the heart
What causes fibrinous pericarditis post MI
If MI extends to the epicardium
Pericardial complications of MI
Fibrinous pericarditis
Dresslers
Effusion/tamponade
Early infarct associated pericarditis
What is a mural thrombus
Clot that sticks to wall of heart
When are mural thrombi common
Ventricular aneurysm
What is nutmeg liver
The appearance of the liver due to chronic hepatic vein congestion
Long term what does nutmeg liver become
Cirrhosis aka cardiac cirrhosis
What are haemosedirin laden macrophages
Macrophages which have taken onto red blood cells in lungs after alveolar have burst
AKA heart failure cells
Histology post MI
- under 6 hours
- 6-24 hours
- 1-4 days
- 5-10 days
- 1-2wks
- weeks-months
- Normal by histology, CK also normal
- Loss of nuclei, necrotic cell death, homogenous cytoplasm
- Infiltration of polymorphs then macrophages
- removal of debris
- granulation tissue, new blood vessels, collagen synthesis, myofibroblasts
- decullarising scar tissue
Histology of heart in HF
Dilated heart with thin walls
Haemosiderin macrophages in lungs
Scarring
Fibrosis and replaced myocardium
Pathophysiology of rheumatic fever
Cell mediated immunity and antibodies to strep antigens cross react with myocardial antigens
Histology of rheumatic fever
Beady fibrous vegetations
Aschkoff bodies
Anitschow myocytes
Treatment for rheumatic fever
Benzylpenicillin
Diagnosis of rheumatic fever
Jones criteria
Group A strep infection and 2 major criteria
Group A strep infection and 1 major+ 2 minor
Major jones criteria
Carditis
Arthritis
Sydenhams chorea
Erythema marginatum
Subcut nodules
Minor jones criteria
Fever
Raised ESR or CRP
Migratory arthralgia
Malaise
Tachycardia
Prolonged PR interval
History of rheum fever
How does rheum fever affect the following
- heart
- joints
- skin
- - CNS
- endocarditis, pericarditis, mycocarditis
- arthritis, synovitis
- subcut nodules, erythema marginatum
- encephalopathy, sydenhams chorea
What is most common form of prostate cancer in over 50s
Adenocarcinoma
What is normal precursor of prostate cancers
Prostatic intraepithelial neoplasia
PIN
How is prostate cancer graded
Gleason
Rfs for RCC
Smoking
HTN
Obesity
Long term dialysis
Unopposed oestrogen
Heavy metals
3 types of malignant renal cancer
Renal cell carcinoma
Nephroblastoma
Transitional cell carcinoma
What group of people are nephroblastomas seen in
Childhood- is second most common childhood malignancy
Where do transitional cell carcinomas develop
Anywhere in urothelial tract- can be from renal pelvis to urethra
Most commonly in bladder
What are the types of renal cell carcinoma
Clear cell 70%
Papillary 15%
Chromophobe 5%
Difference in macroscopic appearance of renal cell carcinomas
Clear cell- golden yellow with haemorrhagic areas
Papillary- friable brown
Chromophobe- solid brown
Microscopic appearance of clear cell RCC
Nests of epithelium with clear cytoplasm
Microscopic appearance of papillary RCC
Papillary tubopapillary growth patter over 5mm
Microscopic appearance of chromophobe RCC
Sheets of large cells with distinct cell borders
Where do RCC appear from
Typically epithelial cells in the cortex of kidney
Microscopic appearance of nephroblastoma
Small round blue cells
Types of renal transitional cell carcinomas
Non-invasive papillary
Infiltrating urothelial carcinoma
Flat urothelial carcinoma in situ
How do non-invasive papillary urothelial carcinomas appear macroscopically
Frond like growths projecting from the walls
Often multifocal
How do non-invasive papillary urothelial carcinomas appear microscopically
The fronds which project are lined with urothelium
How do invasive urothelial carcinomas appear
Solid tumours stuck to pelvis
What are the 3 bladder tumours
Transitional cell 90%
Squamous cell carcinoma
Adenocarcinoma
What causes bladder squamous cell carcinomas
Schistomiasis
What causes bladder adenocarcinomas
Arise from intestinal metaplasia or urachal remnants
Location of the lung cancers
Proximal bronchi- small cell and squamous
Distal- adenocarcinoma
Histology of squamous cell lung cancer
Keratinisation
Intercellular prickles
Which lung cancer is associated with hypercalcaemia
Squamous cell carcinoma
PTHrp secretion
Histology of adenocarcinomas lung
G;andular differentiation- gland formation and mucin production
Which paraneoplastic syndromes are small cell carcinoma are associated with
SIADH
Cushing from ACTH
Lambert eaton
What cells does small cell lung cacner arise from
Neuroendocrine
Which lung cancers have high relationship to smoking
The S’s
Histology of small cell carcinoma
Small
Poorly differentiated
Oat cells
Histology of large cell carcinoma
Poorly differentiated
Large cells
Large nuclei
Prominent nucleoli
No glandular or squamous differentiation
How are tumours staged
TNM
Tumour- invasion
Nodes- lymph nodes involved
Mets
What are the 3 benign renal tumours
Papillary adenoma
Oncocytoma
Angiomyolipoma
Where are the renal papillae
Where collecting ducts enters the ureters
What are papillary adenoma
Renal epithelial tumours with a papillary structure
Less than 5mm
What is an oncocytoma
Benign renal epithelial tumour characterised by presence of oncocytes- eosinophillic cytoplasm
What are angiomyolipomas made up of
Mesenchymal tumour
Fat
Blood vessels
Muscle
What renal cell carcinoma is common in dialysis associated cystic disease
Papillary carcinoma
Management of nephroblastoma
Nephrectomy with pre or post op chemo
What is myocyte disarray seen in
HCM
Where does hypertrophy occur in HOCM
Interventricular septum
What is most common gene affected in HOCM
Beta myosin heavy chain
BMHC
Most common cause of restrictive CM
Amyloidosis
What is libmen sacks endocarditis
Cardiac complication of SLE and acute promyelocytic anaemia (APL) where get vegetations on endocardium
Characteristics of libmen sacks endocarditis vegetations
Warty vegetations that are sterile and platelet rich
Organisms which cause acute endocarditis
Staph aureus
Strep pyogenes
Organisms which cause sub-acute endocarditis
Strep viridans
Staph epidermis
HACEK
Coxiella
Mycoplasma
Candida
What organisms are in HACEK
Haemophilus
Aggregatibacter
Cardiobacterum
Eikenella
Kingella
Most common valvular problems in IE
Mitral and aortic regurg
Immune phenomena in IE
Roth spots- in eyes
Osler nodes- red painful nodes on hnads or feet
Haematuria from glomerulonephritis
Thromboembolic complications of IE
Janeway lesions
Septic abscesses
Microemboli
Splinter haemorrhages
Splenomegaly
How is IE diagnosed
Dukes criteria
- 2 major
- 1 major and 3 minor
- 5 minor
Major dukes criteria
Positive blood culture growing typical IE organism
Vegetations on echo/new regurg murmur
Minor dukes criteria
Risk factor
Fever
Thromboembolic phenomena
Immune phenomena
Positive blood cultures that dont meet major criteria
Tx for IE
Start broad spectrum abx then treat according to sensitivities
Abx for subacute IE
Benzylpenicillin and gentamycin
OR
Vancomycin
Abx for acute IE
Flucloxacillin for MSSA
Rifampicin, vancomycin and gentamicin for MRSA
What are 5 benign neoplastic breast conditions
Fibroadenoma- most common
Intraductal papilloma
Radial scar
Phyllodes tumour
Fibrocystic disease
What are fibroadenomas
Benign neoplasms of fibrous tissue and glandular tissue
What causes fibroadenomas to increase in size
Pregnancy as hormone responsive
Cytology of fibroadenoma
Branching sheets of epithelium in antler horn or honeycomb sheets
Bare nuclei and stroma
How do intraductal papillomas present
Bloody discharge or clear
Lump
Can be pain
Histology of intraductal papilloma
Papillary mass with a dilated duct lined by epithelia
What is a radial scar
A benign sclerosing lesion often found on histology
Called scar as what appears like under the microscope histologically
Histology of radial scar
Central fibrous stellate area
What are radial scars over 1 cm called
Complex sclerosing lesions
How does radial scar appear on mammography
Stellate area which can be confused for carcinoma
How do phyolldes tumours present
Palpable masses in over 50s
How does fibrocystic breast disease present
Lumpiness in breasts which changes according to cycle
Histology of fibrocystic breast disease
Fibrous tissue containing cysts with flattened and cuboidal epithelium
What are the breast proliferative cancers
A group of intraductal epithelial proliferations which are asymptomatic but can develop into a breast carcinoma
Usual epithelial hyperplasia
Flat epithelial atypia
In situ lobular neoplasia
What is the difference between the 3 breast proliferative conditions with regards to their histology
Usual type- growth of epithelial and glandular tissue protruding into lumen in fronds
Flat atypia- multiple layers forming a smaller but regular circular lumen
Intralobular neoplasia- solid proliferation of aplastic cells where can just see the lumen
What cancers does BRCA increase the risk of
Breast
Ovarian
Pancreatic
Prostate
Wht does pregnancy reduce the risk of breast cancer
There is differentiation of milk producing luminal cells which removes them from pool of potential cancer cells
What is pagets disease of the breast
Eczema of nipple then areola- never get eczema on nipple normally
What is the screening programme for breast cancer
47-73 year olds invited every 3 years for mammography
What is looked for on mammographyin breast cancer screening
Microcalcifications
What is difference in detection of lobular and ductal carcinoma in situ
Lobular- always on biopsy as no microcalcification
Ductal- appear as areas of microcalcifications on mammogram. Typically on screening unless get pagets
What do lobular breast carcinomas lack
Protein E-cadherin
Which breast cancer does pagets develop from
Ductal
Histology of ductal carcinoma in situ
Ducts filled with atypical epithelial cells
How are invasive breast carcinomas classified
Ductal
Lobular
Tubular
Mucinous
Histology of invasvie ductal carcinoma
Carcinoma which isnt classified into another group
Big pleiomorphic cells which invade into the stroma
Histology of invasive lobular carcinoma
Well formed tubules with low grade nuclei
Histology of breast mucinous carcinoma cells
Produce abundant amounts of extracellular mucin which dissect surrounding tissue
How are breast cancers investigated
Triple assessment
Exam, Mammogram, FNA and cytology
What receptors are tested for in breast cancer and which has best prognosis
HER2
ER/PR- very good prognosis as will respond to tamoxifen
Which drug is used to treat ER/PR positive cancer
Tamoxifen
Which drug is used to treat HER 2 positive cancer
Herceptin/trastuzumab- monoclonal Ig to Her2
What is problem of herceptin therapy
Direct toxic affect on myocardium
Must monitor LVEF
What is most significant prognostic factor in breast cancer
Axillary lymph node involvement
Histology of basal like carcinoma
Sheets of markedly atypical cells with lymphocyte involvement
What gene associated with male breast cancer
BRCA2- in familial cases at higher risk and not BRCA1
What are 2 benign liver lesions
Hepatic adenoma
Haemangioma- most common
What is main cause of hepatic adenoma
OCP
How do hepatic adenomas present
Abdo pain and intraperitoneal bleeding
What is the most common liver malignancy
Secondary metastases from GI tract, breast or lung
What are the 5 liver malignancies
Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
Secondary tumours
Haemangiosarcoma
What are cholangiocarincomas
Adenocarcinomas which arise from bile ducts
Causes of cholangiocarcinoma
PSC
Parasitic liver disease
Chronic liver disease
Congenital liver abnormalities
Lynch syndrome 2
Who do hepatoblastomas occur in
Children- they present with an abdo mass
What is most common site of pancreactic adenocarcinoma
Head of the pancreas
Risk factors for pancreactic adenocarcinoma
Smoking
Diet
HNPCC
FAP
BRCA
What is trousseaus syndrome
Superficial thrombophlebitis
Presentation of insulinoma
Hypoglycaemic attacks
Presentation of gastrinoma
Zollinger Ellison syndrome- high acid output so get recurrent ulceration of the stomach
Presentation of a vipoma
Diarrorhoea as VIP- vasoactive intestinal peptide
Presentation of glucagonoma
Necrolytic migrating erythema
How are neuroendocrine tumours classified
Function- symptoms of hormone excess
Non-function
Histology of pancreatic endocrine tumour
Cells arranged in nests or trabeculae with grannular cytoplasm
Epithelial anamtomy of oesophagus
Proximal 2/3 squamous epithelium (white)
Distal 1/3 columnar epithelium (pink)
Joined by the squamous columnar junction- Zline
GORD pathophysiology and what can lead to
Acid from stomach is refluxed up into oesophagus which causes oesophagitis and maybe- malaena, haemorrhage, haematemesis, stricture, barretts oesophagus
What is barrets oesophagus
After chronic GORD can get metaplasia in the oesophagus from squamous epithelia to columnar which have goblet cells
Get upwards movement of the SCJ
What are 2 oesophageal cancers
Adenocarcinoma
Squamous cell carcinoma
What is main risk factor for oesophageal adenocarcinoma
Barretts oesophagus
Can also be smoking, obesity and radiation exposure
Where do you get adenocarcinomas in the oesophagus
Distal 1/3 as associated with barrets oesophagus
Risk factors for squamous cell carcinoma of oesophagus
Smoking
Alcohol
Where are squamous cell carcinomas normally found in the oesophagus
Middle third
What antibiotics cause C.diff
3 C’s
Ciprofloxacin
Ceph
Clindamycin
What is diagnostic test for c diff
Stool assay for the toxin- PCR
Treatment for C diff
Oral vancomycin
What is diverticular disease
Low fibre diets cause high intraluminal pressure which causes outpouchings at weak points in the bowel walls
Complications of diverticular disease
Diverticulitis- can get peritonism, perofration, fistula, obstruction from fibrosis
Where do most outpouchings in diverticular disease occur
Sigmoid
What are carcinoid tumours cancers of
Enterochromaffin cells most commonly found in the bowel
Where can carcinoid tumours develop from
Most commonly the bowel
Lungs, ovaries and testes
What is carcinoid syndrome
Triad of;
Bronchoconstriction
Flushing
Diarrhoea
Caused by excess of serotonin (5-hydroxytryptamine)
What is diagnostic test for carcinoid syndrome
24hr urine 5-HIAA
5-hydroxyindoleacetic acid
Treatment for carcinoid syndrome
Octreotide- somatostatin analogue
What do you get in a carcinoid crisis
Life threatening vasodilation, hypotension, tachycardia, bronchoconstriction and hyperglycaemia
How to tell if sputum sample actually contains cells from the alveoli
Will contain macrophages
What is the stain for melanin
Fontana
What stain is used for haemochromatosis
Prussian blue
What is cytokeratin a marker of
Epithelial- if not positive then not a carcinoma
Describe the structure of hepatic lobule
In the shape of hexagon with each corner a portal triad. In the centre is a branch of the hepatic vein. Running from the portal triad to the central hepatic vein is a sinusoid
What is the structural unit of the liver
Hepatic lobule
In what direction does blood and bile run in a hepatic lobule
Blood runs towards the centrilobular vein
Bile runs towards to portal triad
How are liver endothelium different
Are spaces in between endothelium which allow for movement of molecules to hepatocytes across the space of disse
How are liver cells divided in the hepatic lobule
Zone 1- these are closest to the portal triad (periportal triad)
Zone 2- mid zone
Zone 3- perivenular hepatocytes
What are features of perivenular hepatocytes
Most mature and metabolically active
Which liver zone is most susceptible to iscahemia
Zone 3 nearest the hepatic vein as least oxygenated
Which liver zone is first affected by toxic substances and viral hepatitis
Zone 1
What is the immune function of the liver
Antigens from gut reach the liver and are phagocytosed by Kupffer cells
What is only protein the liver doesnt produce
Gamma globulins
First investigation if suspect pre hepatic jaundice
FBC and blood film
Which test determines the proportion of conj vs not bilirubin
Van der bergh
Direct reaction- measures conjugated
Indirect - measures unconjugated
What is inheritance of gilberts
recessive
What can confirm gilberts
fasting bilirubin
What is pathophysiology of gilberts
UDP glucuronyl transferase deficiency
Transmission of hep A
Farco oral
Can you get Hep A again
No
What are soider naevi, duputyrens contracture, palmar erythema etc all signs of
Chronic stable liver disease
What are the signs of portal hypertension
Distended veins
Ascites
Splenomegaly
Sites of porto-systemic anastamoses
Oesophageal varices
Rectal varices
Umbilical vein
Splen-renal shunt
What causes itching in liver disease
Urobilinogen and stercobilingoen
Which liver disease causes itching
Post hepatic
What is histopathology of acute hepatitis
Spotty necrosis concentrated around the portal triad
Where are stellate cells found in the liver
Space of disse
Which hepatitis infections can not cause chronic hepatitis
A and E
How is chronic hepatits staged and graded
Stage= fibrosis
Grade= inflammation
Histopathology of chronic hepatitis
Portal inflammation
Lobular inflammation
Interface hepatitis (piecemeal necrosis)
Bridging from portal vein to central vein
What is peacemeal necrosis/ interface hepatitis
Where can’t see border between portal tract and parenchyma due to inflammation
What is critical stage in hepatitis to cirrhosis interface
Bridging from portal vein to central vein
Histopathology of a cirrhotic liver
Hepatocyte necrosis
Fibrosis
Nodules of regenerating hepatocytes
Disturbance of vascular architecture
How can liver cirrhosis be classified
Based on the size of the regenerating nodules
- micronodular <3mm
- macronodular >3mm
What causes macronodular cirrhosis
Viral
Wilsons
Alpha 1 antitrpsin
What causes micronodular cirrhosis
Alcoholic hepatitis
Bilary tract disease
What is extrahepatic shunting
When blood backlogs into sites of portosystemic anastamoses
What is intrahepatic shunting
When blood goes through the liver but does not contact hepatocytes/not filtered
What is gene involved in haemochromatosis
HFE Chr 6
What is gene involved in wilsons
ATP7B chromosome 13
What is used to predict prognosis in liver cirrhosis
Child pughs score
Proper term for fatty liver
Hepatic steatosis
Histology of hepatic steatosis
Fat droplets in hepatocytes
Histology of alcohol hepatitis
Hepatocyte ballooning and necrosis
Mallory denk bodies
Pericellular fibrosis
Megamitochondria
Mainly seen in zone 3
What are mallory denk bodies
Filaments of collagen
What colour do mallory bodies stain
Blue- trichome
What is the most common cause of chronic liver disease in the west
NAFLD
Histology of NASH
Similar to alcohol hepatitis
Mallor denk bodies
Hepatocyte ballooning
What is steatosis versus hepatitis
Steatosis is fat accumulation whereas hepatitis is with inflammation
What is included in NAFLD
Simple steatosis
NASH
What are the antibodies in type 1 and type 2 autoimmune hepatitis
Type 1- anti-SMA, ANA
Type 2- Anti- LKM (liver kidney microsomal)
Blood findings of PBC
Raised ALP
Raised cholesterol
Raised anti-mitochondrial antibodies
What is US finding of PBC
No bile duct dilatation
Histology of PBC
Bile duct loss with granulomas
What is PSC
Inflammation and obliterative fibrosis of both intrahepatic and extrahepatic bile ducts
What is main association of PSC
UC
Blood findings of PSC
High ALP
High p-ANCA
US finding of PSC
Bile duct dilation
Dont see this in PBC
ERCP finding PSC
Beading of bile ducts
Histology of PSC
Onion skinning fibrosis- ocncentric fibrosis
What is PSC a main risk factor for
Cholangiocarcinoma
What is typical disease course when patients are infected with TB
Infection usually asymptomatic becomes latent in a Gohn focus then gets reactivated in times of immunosuppression to give post primary TB
Primary TB is when get symptoms on initial presentation
What is a ghon focus
Primary TB lesion in the pleura
Histology of TB
Caseating granulomas
Typical presentation of TB
Lung symptoms
Nights sweats etc
What are some less common presentations of TB
Mainly seen in immunocompromised patients
Potts disease
Miliary disease
Subacute meningitis
Tuberculoma
Main difference between male and female teratomas
Male are normally malignant
Where else can teratomas be found
Pineal gland
Base of skull
Mediastinum
Wherever germ cells have originated from
What is the main stain for NE tumours
Chromogranin
Can also do synaptophysin, CD56
Then can do individual hormones
Where are NE tumours normally found
Gut
Lung
THymus
Skin
How are NET graded
Ki-67 index
Where are Zollinger Ellison tumours normally found
Pancreas or duodenum
Secrete gastrin which drives acid production
Most common cancer in children
Brain tumours
How are brain tumours classified
Primary vs secondary
Intra-axial versus extra axial
Supratentorial tumour presentatoion
Focal neurology
Seizures
Personality changes
Infratentorial tumour presentation
Cerebellar ataxia
Long tract signs
Cranial nerve palsy
Where are diffuse gliomas found
Supra-tentorial
What brain tumour is found in childhood and is indolent
Pilocytic astrocytoma
How do pilocytic astrocytomas appear on MRI
Well circumcised
Cystic
Enhancing lesion
IN CEREBELLUM
Histology of pilocytic astrocytoma
Piloid hairy cells
Rosenthal fibres
Mutations seen in astrocytoma and oligodendromas
Point mtation in IDH1/2
Histology of astrocytoma
Low mitosis
No vascular necrosis or proliferation
IDH1 detected on immunohistochemistry
What are gliobastoma mutliforme
Most aggressive and frequent glioma Grade 4
MRI findings of glioblastoma multiforme
Heterogenous appearance
Where are secondary brain tumours normally seen
Grey/white matter junction
Where do medulloblastomas originate from
Neuroepithelial cells
Neuronal precurors of cerebellum
Most common brain tumour in children
Pilocytic astrocytoma
2nd- medulloblastoma
Difference in communicating vs non communicating hydrocephalus
Non- obstruction in passage of fluid
Communicating -obstruction into the venous sinuses
Common site of obstructing CSF flow
Cerebral aqueduct
Most common site of brain intra-parenchymal haemorrhage
Basal ganglia
Cause of intra parenchymal haemorrhage
HTN in over 50% of cases
What are lacunar infarcts
Bleeds which occur in the brain
What is a cavernous angioma
Well defined lesion composed of packed vessel with no parenchyma interposed between vascular spaces
Presents with low pressure bleeds- headahce, focal deficits, seizures
What is diangosis when target sign on imaging in brain
CAVERNOUS angioma
What causes SAH
Berry aneurysm in circle of willis
Most common site of berry aneurysm
Internal carotid artery bifurcation
What is global cerebral ischaemia
Systemic circulation failure
Causes of ischaemia in brain
Extracerebral thrombosis
Embolism from heart or carotid- most often seen in MCA
Histology of cerebral infarct
Tissue necrosis
Rarely haemorrhagic
Permenant damage in affeced area
No recovery
Histology of cerebral haemorrage
Bleeding
Dissection of parenchyma
Fewer macrophages
Limited tissue damage
Chance of recovery
What are common signs of brain fracture on examination
Straw coloured otorrhoea and rhinorhhoea
What is battles sign
Bleeding behind ear showing skull base fracture
What are contusions
Brain in collision with skull and get surface bruising
What is diffuse axonal injury
The long connecting fibers in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull
Usually causes a coma
What is chronic traumatic encephalopathy
Effects on brain of repeated trauma to head
Neuropathology of Alzheimers
Extracellular plaques of beta amyloid
Neurofibrillatory tangles of Tau
Cerebral beta amyloid angiopathy
Cerebral atrophy
Long term imaging finding of AD
Cortical atorphy
Widening of ventricles
Narrowed gyri
Widened sulci
How is staining for Tau done
Immunohistochemistry
Staging done for alzheimers
Braak
Pathophysiology of parkinsons
Reduced stimulation of cortex by basal ganglia due to dopaminergic loss in substantia nigra
Histology of lewy body dementia
Alpha synuclein
Ubiquitin
Lewy bodies
How does mutiple system atrophy differ to parksinsons
Alpha synuclein in the glial cells not neurones histologically
Histology of picks disease
Fronto-temporal atrophy
Marked gliosis and neuronal loss
Ballon neurones
Tau positive pick bodies
What is stained positively in frontotmeporal dementia linked to chr 17
Tau
Pathophysiology of frontotmeporal dementia linked to chr 17
Defect in tau generation
Only see atrophy unilaterally
What are 2 types of barretts oesophagus
Gastric metaplasia- without goblet cells
Intestinal type metaplasia- with goblet cells
Most common oesophageal cancer in developed world
Adenocarcinoma
Most common oesophageal cancer in developing world
SCC
What are 2 types of gastritis
Acute
Chronic
Acute gastritis causes
Aspirin
NSAIDS
Alcohol
Corrosives
Hpylori
Crohns
Chronic gastritis causes
Autoimmune- pernicious anemia
Bacteria- h pylori in antrum
Chemical- NSAIDS, bile reflux in antrum
Complications of H.pylori
Lymphoma
Metaplasia->adenocarcinoma pathway
Ulcers
Which Hpylori is most associated with chronic inflammation and ultimately cancer
Cag A
Nicher pathogenic causes of gastritis
CMV, strongyloides (threadworm)
Difference between gastritis and ulcer
Ulcers breach through muscularis mucosa into submucosa
Complications of ulcers in stomach
Bleeding- anamemia, shock
Perforation
Histology of gastric epithelial dysplasia
Cytological and histological features of malignancy but doesnt invade through BM
Most common cancer in stomach
Adenocarcinoma
How are gastric adenocarcinomas classifed
Intestinal- well differentiated
Diffuse- poorly differentiated
What are signet ring cells seen in
Diffuse gastric adenocarcinomas
Most common cause of gastric ulcer
Hpylori
What makes duodenum more vulnerable to H pylori
Increased acid production leaks into duodenum causing gastric metaplasia
Pathogens other than H pylori causing duodenal ulcer
CMV
Giardia lamblia- most important
Tropheryma whippeli
What causes whipples diseases
Tropheryma whippelii- causes duodenal ulcers and gastritis
Main cause of villous atrophy
Coeliac
Only if on gluten though, if not willbe normal
Diagnosing coeliac
Tisse transglutaminase ABs
Endomysial
Biopsy but patient must be off gluten
Biopsies of coeliac
Villous atrophy
Crypt hyperplasia
See flattened villi
Increased intraepithelial lymphocytes- normal range less than 20 lymphocytes/100 enterocytes
What else can present with villous atropy
Tropical sprue
Causes of chronic hepatitis
Viral
Drugs
Autoimmune
What is haemosiderosis
Accumulation of iron in macrophages from blood transfusions
Pathophysiology of alpha-1-antitrypsin
Failure to secrete it
Intra cytoplasmic inclusions due to misfolded protein
Causes hepatitis and pneumonitis
Causes of hepatic granulomas
PBC
Drugs
TB
Sarcoid
How is calcium stored in the bone
As calcium hydroxapatite
What are the types of bone
Cortical and cancellous
What is difference in distribution and function of cancellous versis cortical bone
Cortical
- long bones
- 80-90% calcified and mainly protective and mechanical
Cancellous
- vertebrae and pelvis
- 15-25% calcified
- mainly metabolic
What is metabolic bone disease
Disordered bone turnover due to imblalance of chemicals and hormones
Leads to osteopenia (loss of bone mass)
Whre is gold standard site for bone histology
Iliac crest
What is renal osteodystophy
Encompasses all of the bone changes seen in CKD
- osteomalacia
- osteosclerosis
- osteoporosis
- osteitis fibrosa cystica
Which viruses have been implicated in pagets disease
Parvomyxovirus
When are langhans giant cells seen
Granulomas
When does lyme disease affect bones
Very late
Get inflammatory arthropathy
What is tophus seen in
Gout
What are gout crystals
Negative birefringent needle shaped monosodium urate crystals
What are crystals in pseudogout
calcium pyrophosphate in knees
calcium phosphate in knees and shoulders
Rhomboid shaped and positively birefringent
Aetiology of pseudogout
Idiopathic
Metabolic- haemochromatosis, primary HPT
Hereditary
Traumatic
What are dermoid cysts
Mature cystic teratomas which contain teeth, hair etc from any lineage
Normally found on neck and head
Where and in who are primary bone tumours found
Around the knee
In young people and children
How can bone tumours present
Pain
Swelling
Deformity
Fractures easily
How to diagnose bone tumours
First investigation an XRAY
Desired diagnosis technique a needle biopsy with a jamshidi needle
Who does fibrous dysplasia occur in
Females more than men
First 3 decades
Where does fibroud dysplasia occur and what is x ray finding
Ribs and proximal femur
Soap bubble osteolysis and shepherds crook deformity if in proximal femur
What is fibrous dysplaia associated with
McUne albright syndrome (if polyostotic)- cafe au lait spots and endocrine problems
What is soap bubble osteolysis seen in
Fibrous dysplasia
Histology of fibrous dysplasia
Chinese letters
(misshapen bone trabeculae)
What do you see shephards crook deformity of femur in
Fibrous dysplasia
What is most common benign bone tumour
Osteochondroma
How do osteochondromas appear histologically and on x ray
Bony protuberance capped in cartilage- histology
Mushroom cap on bone- x-ray
Osteo (bone) chond (cartilage) roma
Where do you see osteochondromas
End of long bones
How do endchondromas appear histologically
Normal cartilage
What appears with cotton wool or popcorn calcifcation
Endochondromas
Where do endchondromas appear
“Ends”
Hands for example
Sheets of multi-nucleate giant cells on background of spindle cells taken from bone
Giant cell tumours (borderline malignancy)
What is most common malignant bone tumour
Metases however not at below elbow and knee
What are the 3 malignant bone tumours
Osteosarcoma
Chondrosarcoma
Ewings sarcoma (primitive peripheral neuroectodermal tumour)
Who and where do osteosarcomas occur
Adolescent
Normally around the knee
What is codmans traingle or elevated perisosteum seen in
Osteosarcoma
What are malignant mesenchymal cells seen in
Osteosarcoma
X ray finding of osteosarcoma
Elevated periosteum (Codmans triangle)
Sunburst appearnace
MOst common primay bnoe sarcoma
Osteosarcoma
Who are chondrosarcoma seen in and where are they
Middle age
Axial bones
Histology of chondrosarcoma
Malignant chondrocytes
What is fluffy calcification seen in
Chondrosarcoma
Who are ewings sarcoma seen in and where
Long bones and pelvis
Adolescents
Histology of ewings sarcoma
Sheets of small round cells
CD99+VE (MIC 2)
What is onion skinning of perisoteum seen in
Ewings sarcoma
Which bone tumour can be diagnosed genetically
Ewings sarcoma
T11:22 translocation
Difference in ALP staining between malignant bone tumours
Osteosarcoma- postive
Ewings sarcoma- negative
What is Radiolucent nidus with sclerotic
rim ‘Bull’s-eye’ seen in
Osteoid osteoma
Where are simple bone cysts appear and how do they appear
Humerus and femur
Lytic well defined small fluid fille dlesions
Skin findings of SLE
Malar rash
Photosensitive rash
Discoid rash with atrophic centre
What is a titre with regards to ANA
The titre is the highest dilution factor at which they are present within their serum
What are the autonatibodies in SLE
Anti-DsDNA
Anti-Smith (ribonucleoproteins)
Anti-histone
What is signifcance of anti-histone autoantibodies in SLE
That it is drug induced lupus from hydralazine etc
Most specific antibodie for SLE
Anti-smith (ribonucleoproteins)
Main histological finding with refgards to SLE
Immune complex deposition
SLE criteria
4 out of 11
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Photosenstivity
Blood disorders
Renal
ANA+ve
Immune phenomena (autoantibodies)
Neurological signs
Malar rash
Discoid rash
Pathophysiology of systemic scelrosis
Fibrosis and excess collagen deposition
Types of systemic sclerosis
Diffuse
Limited
Morphoea- if localised to 1 area
What is presentation of limited systemic scleorderma
CREST
Calcinosis
Raynauds
Esophageal dysmobility
Scleodactyly
Telengiectasia
What is histology of limited systemic scelrosis
Increased collagen deposition
Fibrosis
Arteriole onion skinning appearnace
Antibody difference between diffuse and limited systemic scelrosis
Diffuse- anti-scl-70 (anti-topoisomerase)
Limited- anticentromere
REMEMBER AS LACA
What is speckled immunofluorescence associated with in ANA testing
Mixed connective tissue disease
Differences between limited and diffuse systemic sclerosis
Limited- confined to face and distal aspects of limbs (distal to knee and elbow)- typically CREST
Diffuse- widespread including renal, cardio symptoms
Complication of limited is pulomanry htn whereas is pulm fibrosis in diffuse
What is pathophysiology of myositis’
Typically an underlying malignancy
Autoimmune condition agaisnt the muscle
Skin findings in dermatomyositis
Gottrons papules- callouses on knuckles
Heliotrope rash- reddening around eyes and face
CNS presentation of sarcoid
Meningitis
Cranial nerve palsy
What is the classfifcation of vasculitidies
Large vessel
- takayasu
- GCA
Medium vessel
- polyarteritis nodosa
- kawasakis
- thromboangiitis obliterans
Small vessel
- microscopic polyangiitis
- granluomatosis with polyangiitis
- IgA nephropathy
- eosinophillic granluomatosis with polyangiitis
Histology of GCA
Granulomatous transmural inflammation + giant cells +
skip lesions
Presentation of GCA
Over 50
Preceding polymyalgia rheumatica
eadache over eye
Vision difficulty
Presentation of takayasus arteritis
Japanese women
Cold hands
No pulse
Low BP
Claudication
Bruits
What is presentation of thromboangiitis obliterans
Heavy smoker and a young man
Feet ulcers
Arterial limb disease
Investigation for thromboangiitis obliterans and the findings
Angiogram
Shows corkscrew appearance from segmental occlusive lesions
Which vessels does polyarteritis nodosa normally affect
Renal and mesenteric
What condition is normally associated with polyarteritis nodosa
Hep B
Angiogram finding of polyarteritis nodosa
Microaneurysms on angiography (“string of pearls / rosary
bead appearance
Histology of polyarteritis nodosa
fibrinoid necrosis & neutrophil infiltration
Hallmarks of polyangiitis with granulomatosis
ENT- saddle nose, sinusitis, episatxis
Lung- pulm heamorrhage, cavitation
Renal- glomerulonephritis
AB in polyangiitis with granulomatosis
Cytoplasmic ANCA against proteinase 3
AB in eosinophilic polyangiitis with granulomatosis
Perinuclear- ANCA against myeloperoxidase
Presentation of eosinophilic polyangiitis with granulomatosis
Asthma
Eosinophilia
Allergic rhinits
Vasculitis evidence
Presentation of micropscopic polyangiitis
Renal and pulomary syndrome
AB in microsopic polyangiitis
Perinuclear- ANCA against myeloperoxidase
Main structure of breast and the 2 epithelial cells
Are large ducts with a termina ductal lobular unit
Luminal and myoepithelial cells
2 Most common breast lesions that presents with discharge
Papilloma
2nd- duct ectasia
How are aspirates of breast lumps coded
C1- inadequate
C2- benign
C3- atypia, probably benign
C4- suspicion of malignancy
C5- malignant
Presentation of duct ectasia
Older women
Multiparous
Green/wihte discharge
Usually discharge sometimes with breast mass and nipple retracition so easily mistaken for cancer
Cytology of duct ectasia discharge
Proteinaceous material and inflammatory cells
Histology of duct ectasia
Dilated duct
Inspissated secretions
Periductal and interstitial inflammation – granulomatous
Most common organism for acute mastitis
Staph
Presentation of fat necrosis
Breast mass
Late stages may show calcification
Preceded by trauma, surgery, radiotherapy as is inflam response to damaged adipose tissue
Histology of fat necrosis
Central focus of necrotic fat cells surrounded by lipid filled macrophages and neutrophilic infiltrates
What is a galactocele
Cystic dilation of a duct during lactaction
Presentation of galactocele
Multiple tender palpable nodules
Infection may convert these to acute mastitis or abscesss
Histology of pagets breast disease
Cells with abundant pale clear cytoplasm which contains mucin
Large and prominent nuclei
What is level of critical artery stenosis
70%
What causes prinzmetal angina
Coronary artery spasms
What is difference in name of tumour of large vs small nerve tumour
Small- neurofibroma
Larger (spinal cranial nerve)- schwannoma
What are gliomas
Tumours of non neuronal cells
Includes astrocytoma, ependymoma, o
ligodendromas etc
What is most common primary brain tumour in an adult
Mengioma- mainly occurs in elderly
What happens if pia mater torn when brain collides with the skull
Becomes a laceration not a contusion
What is name of stain done for copper
Rhodanine
Cases which promote coroner referral
o Unknown cause of death
o Sudden or unexpected death (inclusive of all deaths <24hours after admission to hospital)
o Deceased person not seen by a doctor within 14 days before death
o The death is considered suspicious/unnatural/violent
o The death may be due to an accident, self-neglect (i.e. drug-use death) or neglect on the behalf of others
o The death is/could be due to the deceased’s prior employment (including industrial disease)
o The death may be due to an abortion
o The death occurred during an operation or before recovery from anaesthetic
o The death occurred during or shortly after a period of police custody
o The death may be suicide (can only be confirmed by a coroner)
How do death certificates work in terms of cause of death
Section 1 is the cause of death can can have 1a, 1b, 1c
1a is the immediate cause
1b caused A
1c caused B etc
The last 1 letter is cause of death
Section 2 includes what lead may have contributed to death ie DM, HTN etc
Presentation of the connective tissue myositis’
Proximal muscle weakness
Can get SOB and arrythmias
How does wilsons present
Liver cirrhosis- often in kids
Neuro- dementia, seizures and parkinsons
Also seen in eyes, kidneys and heart
How can haemochromatosis present
Liver- cirrhosis
Heart- cardiomyopathy
Pancreas- DM
Gonads- atrophy and impotence
Blood finding of wilsons
Low caeruplasmin
What antibodies suggest that it is drug induced lupus
Anti-histone
Which infection of genital tract is associated with spontaneous abortion and chorioamnionitis
Mycoplasma
Pathogenesis of staph, strep, coliform bacteria and clostridium causing PID
Secondary to abortion
Start in lymphatics then spread by blood and lymph upwards
What is dyskaryosis
Change in the appearance of cells
How are HPV infections divided
Latent
- HPV resides in cells but does not produce infective virions
Productive
- DNA replication independant of cells own replication
How does HPV transform cells
Produces 2 proteins- E6 and E7 which inactivate tumour suppressor genes
E6- p53
E7- Rb
HPV vaccine schedule
Given between 12-13
2nd dose 6-24 months later
What tumour suppressor gene mutation is associated with serous endometrial carcinoma in 90% of cases
p53
What are the types of ovarian tumours
Epithelial
Sex chord stromal
Germ cell
Miscellaneous
Histology of serous cystadenoma
Columnar epithelium
Psammoma bodies
Histology of mucinous cystadenoma
Mucin producing cells
Which tumours are associated with pseudomyxoma peritonei
Mucinous ovarian adenomas
Appendicular tumours
Histology endometrioid ovarian tumours
Tubular glands mimicking the endometrium
Histology of clear cells ovarian tuours
Clear cells with clear cytoplasm
Hobnail appearance
What ovarian tumours are endometriosis associated with
Clear cell
Endometrioid
Difference between immature and mature teratomas in ovaries
Mature
- cystic
- differentiation into mature tissues like skin teeth etc
Immature
- solid
- embryonal tissue
- secrete AFP
Which ovarian tumours secrete AFP
Immature teratomas
What is most common malignant ovarian tumour in young women
Dysgerminoma (female counterpart to testicular seminoma)
What are the ovarian germ cell tumours
Dysgerminoma
Teratoma
Choriocarcinoma
What are the ovarian epithelial tumours
Serous
Mucinous
Endometrioid
Clear cell
What ovarian tumour secretes HcG
Choriocarcinoma
What are the sex chord tumours of ovaries
Granulosa-theca cells
Fibromas
Sertoli-Leydig
What do granulosa theca cells produce
E2
Signs include oestrogenic effects- irregular menstrual cycles, breast enlargement, endometrial/breast hyperplasia
What do sertoli leydig tumours produce
Androgens- look for signs of breast atrophy, clitoral enlargement, hirsutism, deep voice
Histology of granulosa theca cell tumours
Cal-exner bodies
Histology of krukenberg tumours
Mucin producing signet ring cells
Test for coeliac if IgA deficient
Straight to biopsy
What is stained for in parkinsons
Alpha synuclein
What do germ cell tumours secrete
AFP
LDH
bHCG
