Histopathology Flashcards
What happens when there is acute inflammation
neutrophil infiltration
what happens when there is chronic inflammation
Lymphocyte and plasma cell infiltration
What processes are eosinophilic
Allergic
parasitic
hodgkins lymphoma
sometimes myeloproliferative
eosinophilic oesaphagitis will give what sign
feline contractions
what types of process involve macrophages
late acute inflammation
chronic inflammation
What is a the cell origin of a carcinoma
epithelial cell
squamous- keratin, intercellular bridges
adeno-mucin secreting(mucin stain), glandular
What stain would one use for amyloid
congo red with apple green bifringence under polarised light
what stain would one use for iron
prussian blue
what does cytokeratin stain
epithelial cells
4 layers of the artery wall (outer to inner)
Tunica externa
tunica media
tunica interna
basement membrane
4 layers of the artery wall (outer to inner)
Tunica externa
tunica media
tunica interna
basement membrane
Name 4 modifiable risk factors for atherosclerosis
Diabetes mellitus, Hypercholesterolaemia, smoking, hypertenstion
~Name 3 non modifiable risk factors for atherosclerosis
Age, Gender(male), Fhx
Name 3 non modifiable risk factors for atherosclerosis
Age(40plus), Gender(male. Premenopausal women protected by hormones), Fhx
Give 4 features of a vulnerable plaque
clusters of inflammatory cells
thin cap
small amount of smooth muscle
lots of foam cells/lipid
likely contributors to rupture of a vulnerable plaque
stress - increased adrrenaline, vasocontriction to increase BP
getting up in a morning is a stressful event
Causes of acute pancreatitis, and how would you test for it?
I GET SMASHED Iatrogenic Gall stones 50% Ethanol 30% Trauma Steroids Mumps Autoimmune Scorpian venom Hypercalcaemia/hyperlipidaemia ERCP Drugs - thiazides
Serum amylase is raised transiently but serum lipase is much more sensitive
What is a pancreatic pseudocyst? how do you differentiate it from another tumour?
A pathalogical collection of fluid, rich in pancreatic enzymes and necrotic tissue lacks epithelial lining. - often associated with alcoholic pancreatitis. is a common complication of pancreatitis.
They are conected with the ducts.
It may have a riased amylase where a tumour may not and a lower viscosity where in a tumour may be raised
What are the common complications of acute pancreatitis?
Pseudocyst, abcess and haemorrhage(which has a 50% mortality rate)
What are the complications of chronic pancreatitis?
Pseudocyst, malabsorption, diabetes mellitus, cancer.
What are the causes of chronic pancreatitis
Haemochromatosis, alcoholism, CF, autoimmune, duct obstruction.
IgG4 sclerosing plasma cells
autoimmune pancreatitis
periductal inflammation is caused by what
obstruction.
may be due to stones or alochool
alcohol works by makind sphincter spasm and thicken secretions
What is seen on histology of acute and chronic pancreatitis?
Acute - Coagulative necrosiss
Chronic - fibrosis and loss of exocrine tissue. calcifications seen on xray. duct dilation with thick secretions.
Difference between them is the fibrosis which you get in chronic panc. and loss of acini and eventually endocrine cells too.
What is a rokitansky aschoff sinus
pseudodiverticulae of the gall bladder - associated with chronic cholecystitis
What is the most common type of pancreatic cancer
ductal adenocarcinoma - 85%
Rx - Smoking, diet, BMI, chronic pancreatitis, PanIN(k-ras mutation in 95%)
occurs at the head of the pancreas, appear gritty and grey - present earlier and therefore have a better prognosis.
Classical features of pancreatic cancer
painless jaundice.
weight loss and anorexia.
steattorhoea
diabetes
what is trousseaus SYNDROME
also known as trousseaus sign of malignancy.
recurrent superficial thrombophlebitis, often felt as a tender nodule.
associated with pancreas and lung cancer.
perilobular inflammation is caused by what?
due to acinar injury and is therefore associated with the other processes such as autoimmunity infection and drugs
Mucinous and serous cysts are what?
multilocular and unilocular respectively - panc ca
What is depositied in the kidneys in multiple myeloma?
amyloid light chain
amyloidosis causes AA chain - and sometimes in RA or TB too.
They cause nephrOtic sydrome.
What forms the fibrous white cap of atherosclerosis
vascular smooth muscle cells
what are the 6 common causes of heart failure
IHD myocarditis Arythmias hypertension valve disease dilated cardiomyopathy
What are the mechnical complications of MI
Mechanical:
contractile dysfunction - loss of muscle - arytnmia - high mortality
Congestive cardiac failure - loss of ventricular function
Cardiac rupture of ventricle wall - typically seen at 4-5 days when get granulation tissue and before collagen is layed down.
can get ventricular aneurysm which leads to mural thrombos formation and stroke/ bowel infarct
What are the arythmia complications of MI
Arythmias:
VF usually occurs in the first 24 hours and is common cause of death
Other arythmia - AF, long QT
What are the pericardial complications of MI
Pericardial:
pericarditis
Effusion - and tamponade
Dresslers syndrome - immune mediated pericarditis on 2nd or 3rd day v painful fevers and effusion
who has the worst prognosis in MI
Women, old, previous MI and diabetics
What is dilated cardiomyopathy
loss of cardiac myocytes leading to systolic dysfunction
what is restrictive cardiomopathy
big atria with normal size ventricles and a loss of diastolic function due abnormal relaxation. no filling.
when would you see myocyte dissarray
Hypertrophic cardiomyopathy
what valve is typically affected by rheumatic fever
mitral valve - but may affect mitral AND aortic
What is the pathogenesis behind rheumatic fever
2-4 weeks post group A streptococcal infection, the cell mediated immunity antibodies cross react in what is known as antigenic mimicry with cardiac antigens causing a pancarditis
aschoff bodies
small giant cell granulomas - rheumatic fever
anitschkov myocytes
regenerating myocytes - rheumatic fever
Anti streptolysin o titre
rheumatic fever - with raised ESR
how do you treat rheumatic fever
Ben pen or erythromycin. steroids.
what would you see on a rheumative heart valve
small warty vegetations found along the lines of closure. verruccae
roth spots
infective endocarditis
name 5 obstructive respiratory disease processes
Asthma Chronic bronchitis bronchiectasis Emphysema bronchiolitis - small airway disease
in what condition do you get centrolobular bullae
emphysema due to chronic smoking and is mainly in the upper airways.
alpha 1 antitrypsin deficiency cause panacinar bullae and is also in lower airway
what are heart failure cells
iron laiden macrophages that have mopped up blood
what happens to children who have hyaline membrane disease
go on to get bronchopulmonary dysplasia - scarring
curschmann’s spiral
asthma
charcot leyden crystals
asthma
codmans triangel
osteosarcoma
fluffy calcifications of the axial skeleton
chondrosarcoma - malignant chondrocytes - cartilage. occurs in over 40’s
t(11,22) translocation
ewings sarcoma - under 20’s
is a primative peripheral neuroectodermal tumour occuring in the diaphysis.
where do metaphysis diaphysis and epiphysis occur
E M D M E
cd99+ve mic-2
ewing’s sarcoma - under 20’s
is a primitive peripheral neuroectodermal tumour occuring in the diaphysis.
5 causes of an eosinophilia
asthma parastitic infection drug allergy lymphomas RA polyarteritis
which tumours of lung occur centrally?
small cell and squamous cell
Which lung tumours occur peripherally
adenocarcinoma
What is the most common lung cancer?
squamous cell and is closely associated with smoking. however small cell is literally always a smoker.
what is the most common lung cancer for a non smoker
adenocarcinoma (20-30%) and often have a predilection for women.
What is the problem with bevacizumab
can cause fatal haemorrhage. VEGF monoclonal ab
What 2 things would you see on histology of a squamous cell lung carcinoma
keratinisation
intercellular pickles
Also associated with hypercalcaemia and cavitation.
What staging is used in Lung cancers
TNM T1 - less than 3cm T2 - 3-7cm - partial atelectesis T3 - >7cm - total lobe atelectasis, mediastinal pleura T4 - mediastinal organs
N - which nodes involved 0-2
M - any mets? 0/1
What does ERCC1 - NSCLC predict
poor response to cisplatin
What does a Kras mutation mean in lung cancers
usually non response to TKIs
What does EML4 - ALK mean?
no benefit from TKI
solid signet ring pattern
What kind of tumour is small cell carcinoma of the lung?
derived from neuroendocrine cells, and is therefore associated with ectopic ACTH secretion and lambert eaton syndrome.
it is highly metastatic and has poor prognosis despite being chemo sensitive
What is the name of the EGFR tyrosine kinase inhibitor
ertlotinib
used typically in adenocarcinoma of the lung
What would you see on histology of a small cell carcinoma
oat cell
What type of rash is seen in lyme disease
erythema migrans - NOT marginatum - this is rheumatic fever
What is aflotoxin
produced by aspergillus and causes hepatocellular carcinoma
What is one of the worse types of mesothelioma
sarcomatoid
what is virchows triad
stasis, vessel wall damage, hypercoaguable state
What are the sequelae of a PE
wedge shaped infarcts, if a large one greater than 60% of pulmonary bed occluded, can cause death.
what is for pulmonale
right heart failure as a result of pulmonary pathology e.g PE causing increased vascular resistance
What staging is used in Lung cancers
TNM T1 - less than 3cm T2 - 3-7cm - partial atelectesis T3 - >7cm - total lobe atelectasis, mediastinal pleura T4 - mediastinal organs
N - which nodes involved 0-2
M - any mets? 0/1
What does ERCC1 - NSCLC predict
poor response to cisplatin
What does a Kras mutation mean in lung cancers
usually non response to TKIs
What does EML4 - ALK mean?
no benefit from TKI
solid signet ring pattern
How do you divide up pulmonary hypertension, and how is it defined?
Pre capilliary
capilliary
post capilliary
defined as >25mmhg at rest (pulmonary arterial pressure)
Which lung cancer is associated with RB1 mutation
small cell
which lung cancers are associated with p53 mutations
mainly squamous, and small cell
What are the risk factors for squamous cell carcinoma of the oesophagus
alcohol, smoking, plummer vinson syndrome, HPV
What would you see on histology of a SCC of the oesophagus
intercellular bridges and keratin.
found in middle 1/3 50% then 30% in lower and 20 in upper
How does an SCC of the oesophagus present
progressive dysphagia - solids then fluids, and then odynophagia.
where does h pylori tend to populate
antrum of the stomach
Histology of acute gastritis
neutrophils
Histology of chronic gastritis
lymphocytes and plasma cells
what is considered a gastric ulcer
when the muscularis mucosa has been breached and you are into submucosa
it can lead to intestinal metaplasia and therefore adenocarcinoma
which ulcer is better with food
duodenal - and milk
4 times more common than gastric ulcers due to stomach acid entering the duodenum. this can cause metaplasia (gastric)
it can cause iron deficiency anaemia
what is the triple therapy for H pylori
PPI, clarythromycin and amox/metro
Whcih HLA types predispose to coeliac disease?
HLA DQ2 DQ8
What is the main risk of untreated coeliac disease
10% get duodenal t cell lymphoma
What causes hirschsprungs disease and what is it associated with?
absence of ganglion cells in the myenteric plexus, 2% in downs patients
what does the histology of hirschsprungs disease show?
a rectal biopsy shows hypertrophied nerve fibres with no ganglia.
what is the treatment for hirschsprungs disease
remove the affected segment.
Where does ischemic colitis occur and why?
Occurs at the watershed areas such as the splenic flexure where SMA transitions to the IMA. and the rectosigmoid. arterial or venous occlusion
Peak age of Chrons
20’s
Peak age of UC
20-25
pathophysiology of chrons
Cobblestone appearance, skip lesions, transmural inflammation, non casseating granulomas, rosethorn and apthous ulcers.
extra - GI manifestations of IBD
Pyoderma gangrenosum, erythema nodosum, erythema multiforme, clubbing, uveitis. joint problems including ank spond,
PSC (UC>cd)
what is the main risk of UC
at 20-30 times risk of adenocarcinoma
toxic megacolon - dilation and perf
What is the twin concordence in IBD
50% in chrons, and 15% in UC
In which IBD is pain relieved on defecation
UC
What is carcinoid syndrome?
Paraneoplastic syndrome whereby there is production of 5-HT. enterochromaffin cell origin. usually found in bowel.
What are the symptoms of carcinoid syndrome
bronchoconstriction, flushing and diarrhoea
how do you test for and treat carcinoid syndrome
24hr urinary 5-HIAA main metabolite of serotonin
octreotide
what is an adenoma
bening dysplastic lesion - adenocarcinoma precursor
at what point do adenomas need surveillance?
3.4cm - 45% will become malignant.
what is the main gene involved in adenoma formation?
APC - people with FAP are born with a mutation in thi s gene.
others important mutations include Kras, p53, LOF
what are the systemic sequelae of a villous adenoma
hypoproteinemic hypokalaemia - leak protein and K
there are tubular types too which look likea row of test tubes
villous look like a little amoeba
What are the 3 layers of the GI mucosa
epithelieum
lamina propria
muscularis mucosa
what are the 3 layers below the mucosal layer of the GI tract
sub mucosa
muscularis propria
serosa
what is peutz jeugers syndrome
Characterised by hamartomatous polyps of the Gi tract often in the rectum and present with bleeding.
they also have pigmentation around the mouth (mucocutaneous)
increased risk of intuccusseption and malignancy
What is a pseudopolyp
scar tissue from IBD, from granulation tissue in repeated cycles of ulceration.
What type of cancer is colorectal cancer
98% are adenocarcinomas
what are the clinical features of a cloretal cancer
Left sided: change in bowel habit and LLQ pain
Right sided: FE def anaemia, weight loss
monitor CEA
What is Dukes staging?
GI cancers (5yr surv) A: confined to the mucosa (95) B1 - in the muscularis propria without nodes (67) B2: transmural without nodes (54) C1: muscularis propria with nodes(43) C2:transmural with nodes(23) D distant mets(<10)
where is the FAP gene
APC C5Q1 70% AD mutatoin
What is the mutation in HNPCC
DNA mismatch repair gene - autosomal dominant
what is secretin
Hormose released by s cells of the duodenum to stimulate pancreatic and liver enzyme reslease
what is high blood pressure
140/90
what is dislipidaemia
HDL <1 and a TG>2
what is cck
cholecystokinin - released form I cells of the dudenum.
what is the main symptom of a VIPoma
diarrhoea
MEN1
PPP
Parathyroid hyperplasia
Pancreatic endocrine tumour
pituitary adenoma
MEN2a
Parathyroid
what is a lymphocytosis
too may tylphocytes
what is the limiting plate
the border between the hepatocytes and the portal tract
what are the causes of micronodular chirrosis
<3mm nodules with uniform liver involvement
alcoholic hepatitis and biliary tract disease, and haemochromatosis
what are the causes of macro nodular cirrhosis
viral hepatitis, alpha 1 antitrypsin disease and wilsons disease
what are the complications of cirrhosis
portal hypertension
hepatic encephalopathy
hepatocellular carcinoma
spotty necrosis
acute hepatitis
in liver pathology what does grade mean
severity of inflammation
in liver pathology what does stage mean
extent of fibrosis
what are the 3 types of alcoholic liver disease
fatty liver (steatosis)(fully reversible) alcoholic hepatitis (mallory bodies+hepatocyte ballooning) alcoholic cirrhosis
HLA DR3
autoimmune hepatitis
what is the cause of NAFLD
insulin resistance i.e BMI and DM
what is the cause of PBC
loss of MEDIUM SIZED bile ducts due to autoimmune destruction.
Anti- mitochondrial antibodies are positive in >90%
what would be seen on PBC histology
bile duct loss with granulomas
what would be seen on histology of PSC
Onion skin fibrosis and scarring. multifocal strictures of intra and extrahepatic bile ducts.
what are you more likely to get with primary sclerosing cholangitis
cholangiocarcinoma
Is it true that men are more likely to get PBC and PSC
yes to PSC, but no to PBC - 10 times more in women
where is the iron in haemochromatosis
Parenchyma of the liver. hepatocytes.
also in heart pancreas adrneals skin jonts pituitary
what is the difference between haemosiderosis and haemochromatosis
haemosiderosis - iron in the macrophages and does not cause cirhosis or hepatititis
what stain is used for copper
rhadanine
what is seen on histology of wilsons disease
mallory bodies and fibrosis
leads to hepatitis, cirhosis and fulminant failure. also kayser fleisher rings
what would you find on the histology of alpha 1 antitrypsin deficinecy
intracytoplasmic inclusions of A1AT and stain with periodic acid schiff
what are the markers of autoimmune hepatitis
anti smooth muscle and ANA, anti actin and anti soluble liver antigen.
disease mediated by plasma cells -
What are the causes of granulomas in the liver
specific - PBC and drugs
general - sarcoid and tb
What is an endothelial cell tumour of the liver
haemangioma - very common
What happens to the body of the stomach in pernicious anaemia
becomes atrophic and there is mucinous change - intenstinal metaplasia
What carcinoma with h pylori?
adenocarcinoma - but also lymphoma.
What paraneoplastic syndromes are associated with renal cell carcinomas
polycythaemia, hypercalcaeima, HTN, cushings, amyloid.
What is the most common renal cancer and what mtation is it associated with
clear cell carcinoma - 3p loss von hippel lindau.
golden brown kidney with haemorrhagic areas
What gener is associated with wilms tumours
WT1 - white/tan mass in kidney
in what condition are you more likely to get angiomyolipomas of the kidney
tuberous sclerosis associated with gene TSC-2
in what condition are you more likely to get angiomyolipomas of the kidney
tuberous sclerosis associated with gene TSC-2
What are the risk factors associated with renal cell carcinomas
obesity hypertension unnopposed oestrogen VHL smoking heavy metals CKD
what is the most comon prostate cancer
adenocarcinoma - craggy prostate PSA high
what causes BPH
dihydrotestosterone of stromal and epithelial cells creating large nodules
how do you treat BPH
5 alpha reductase inhibitors - preenting testosterone to DHT. finasteride or dutaseride
alpha blockers are thought to be useful too such as doxazocin.
Name 3 types of testicular malignancy
Seminoma - most common - radiosensitive - 30yr olds
terratoma - germ cell tumours occur in any age from infancy. often present with painless enlargement. chemosensitive
Lymphoma - old men, aggressive and poor prognosis.
Name 2 benign neoplasms of the testis which are stromal (sex cord)
Leydig cell and sertoli cell tumours.
What causes acute prostatitis
usually from a UTI - similar bacteria such as E.coli, enterococcus or staph.
biggest risk factor for germ cell tumours of the testis?
cryptorchidism - or undescended testis
what is the most common type of kidney stone
calcium oxalate
what causes cystitis
infection - e.coli or proteus most common.
more at risk with bladder calculi
can cause ascending infection
How does proteus increase likelihood of stone formation - mainly magnesium stone
proteus makes urine more alkaline by secreting urease, hydrolysing urea to ammonia. can become very large and cause a staghorn calculus
What is the most common type of bladder cancer
transitional cell - invasive infiltraing or non ivaisve papillary
non invasive pappillary - often recurrent and occur at various points - carcinogen assocaited.
invasive just spread out
what causes calcium stone
absorption of too much calcium from gut. underlying predisposition.
What is a papillary adenoma
<5mm nodules of benign tumour
what is an oncocytoma
benign tumour of renal epithemium
What is an angiomyolipoma
benign mesenchymal tumour of renal cell - fat, smooth muscle and vessels shown in tuberous sclerosis
What cancer is associated with schistosomiasis
Squamous cell carcinoma
Adenocarcinoma of the bladder
intenstinal metaplasia associated
What is the complication of lichen sclerosus of the penis
phimosis
how is nephritic syndrome characterised
by red cell casts and haematuria(abnormal red cells)
how much protein do you need in urine to count as nephrotic syndrome
3g in 24 hours
what is the mesangium
connective tissue which supports the arterioles within bowmans space.
contaisn cells called mesangial cells which are like smooth muscle cells and they tether the corners of the capilliary loops to the mesangium.
What are the layers of the cells involved in filtration
fenestrated epithelium
basement membrane - type 4 collagen
podocytes
what type of immune complex depotision leads to nephrotic syndrome
subepithelial - in between podocyte and BM
What is the most serious immune deposition
subendothelial - because they are in contact with cells of the blood and have the abiity to recruit large amounts of inflammation which is very damamgin to structure.
what mutation causes adult polycystic kidney diseas
PKD1 and PKD 2
AD - 10% of CKD are PCKD+ve
cysts cause pressure and result in loss of noral funtion
Who gets aquired renal cysts
- people with CKD
Who gets aquired renal cysts
- people with CKD and they have a risk of tranforming to carcinoma 7% at 10 years
What is AKI
rapid loss of glomerular and tubular function. increased GFR and Creatinine and urea. HyperK. and acidosis.
Acidosis and what derangement of potassium go hand in hand
hypERkalaemia -
Acute glomerulonephritis is a cause of AKI, what are the others
Pre renal
renal
post rrenal
What is the commonest cause of AKI
ATN - caused by ischemia
what is the most common cause of CKD
diabetes 20% glomerulonephritis - 15% HTN and vascular disease - 15% chronic pyelonephritis 10% PCKD - 10%
What are the causes of ATN
dehydration, bburns, septicaemia, drugs.
in this disease there is damage to the tubular epithelial cells. necrosis of short segments of tubule. causes leakage of fluid into surrounding interstitium and disrupts flow to other tubular cells aswell.
casts block the lumen.
What is the difference between post strep glomerulonephritis and IgA nephropathy
Post strep GN - 2-3 weeks post group A alpha haemolytic strep. granular IgG deposits
IgA nephropathy - 1-2 days post URTI - frank haematuria.
what is crescentic GN
a break in the glemrular luft causes leakage and recruitment of inflammatory cells into bowmans space.
they present like nephritis syndrome however oliguria and renal failure are much more common.
3 types : Anti GBM, immune complex, non imune (wegeners or p anca)
What is lumpy bumpy deposition of immune complex
SLE, IgA nephropathy or post strep GN
Alports syndrome
collagen type 4 (alpha 5 chain) x linked dominant mutation. causes nephritic syndrome, senorineural deafness
Thin basement membrane disease
collagen type 4 (alpha 4 chain) AD defect.
normally asymptomatic haematuria. normal renal function.
Causes of asytmptomatic haematuria
TCC
Thin basement membrane disease
alports syndrome
IgA nephropathy bergers
kimmelsteil wilson nodules
secondary nephrotic syndrome due to diabetes.
diffuse basement membrane thickening which leads to microalbuminurea
proteinurea
where is the deposition in post strep GN
subendothelial humps
What are the 3 main causes of primary nephrotic syndrome
minimal change disease - kids - steroid sensitive
membranous glomerular disease
Focal segmental glomerulosclerosus (FSGS)
what is the pathophysiology of minimal change disease
loss of podocyte foot process
what is the pathophysiology of membranous glomerular disease
phospholipase a2 recepter autoantibodies cause Ig and compliment deposition in granuar form, with a thickening of the basememnt membrane, a loss of podocyte feet and subepithelial deposits
it may be secondary to SLE, infection, rugs, malig
the response to steroids is poor
What is the pathophysiology behind FSGS
loss of podocyte foot, with areas of focal and segmental scarring. Ig and compliment in these areas
occurs in afro caribbean population and may be secondary to HIV
50% response to steroids
what are the stages of lupus nephritis
stage 1 - mesangial - in the mesangium with no alteration to structure
stage 2 - mesangial proliferative - in the mesangium with some increase in mesangial cellularity
stage 3 - focal - active swelling and proliferation in less than half of the glomeruli
stage 4 - diffuse - active swelling and proliferation in more than half of the glomeruli
stage 5 - membranous - subepithelial complex deposition
stage 6 - advanced sclerosing - >90% of glomeruli completely sclrosed.
What is the more common APCKD
PKD1 mutation 85% encoding polycystin 1
what are the clinical features of APCKD
hamaturia, pain, UTI, ruptured cysts infection of cysts, haemoorhage of cysts.
leukocytic casts
pyelonephritis
reflux nephropathy
chronic scarring due to infections or blackages
what are the sequelae of MAHAs
HUS - renal failure
TTP - seizures and neuro sx
What is fitz hugh curtis syndrome
infection of the liver capsule from PID causing RUQ pain from perihepatitis.
gives violin string perihepatic adhesions.
what are the complications of PID
infertility increased risk of ectopic - (scarring) abcess chronic pain peritonitis
what is salpingitis
infection of the fallopian tubes. often comes from the vagina and has repercussions including fusion and scarring, which lead to infertitlity and extopic risk. there is a risk of a hydrosalpynx.
what are the macroscopic signs of endometriosis
chocolate cysts and powder burns - red blue to brown nodules.
3 types of leiomyoma
intramural, submucosal, subserosal
benign tumour of smooth muscle origin causing haevy bleeding and sometimes pain and pressure effects
what are the complications of fibroids
red/carneous degeneration of pregnancy which is caused by venous thrombosis of the vessels within the tumour resulting in
very small chance of becoming cancerous - leiomyosarcoma but normally arise de novo and have a poor prognosis.
what are the complications of fibroids
red/carneous degeneration of pregnancy which is caused by venous thrombosis of the vessels within the tumour resulting in
very small chance of becoming cancerous - leiomyosarcoma but normally arise de novo and have a poor prognosis.
what is adenomysosis
implantation of endometrial tissue in the myometrium
What are the 2 types of endometrial cancer
T1 - Endometriod 80%
related to unnoposed oestrogen and 85% of these are adenocarcinomas but may show some squamous differentionation.
RX. obesity and PCOS are big risk factors. tamoxifen. nulliparoty or early menarche.
T2 - Non - endometriod
papillary, serous or clear cell.
which mutation is assocaited with serous non endometriod cancers
p53
which mutation is associated with clear cell non endometriod cancers
PTEN
which mutation is associated with adenocarcinoma endometriod cancers
PTEN, Pi3KCA, KRAS
What is the FIGO staging in endometrial cancer
1 - confined to uterus
2 - cervix
3 local spread - adnexa nodes
4 distant spread
what is the most common type of ovarian carcinoma
serous epithelial. mimics tubular epithelium - columnar
contains psammoma bodies commonly
BRCA, Kras, BRAF
what are the 4 types of epithelial ovarian cancers
serous - psammoma
mucinous - no psammomo
endometriod - mimics endometrium - tubular glands
clear cell - hobnail appearance.
How do you differentiate pagets disease of the nipple and eczema
Intraductal carcinoma - pagets affects the nipple first wheras eczema affects the areola first. pagets may have lumps or other skin changes associated with breast cancer age in 60’s aerage.
what is fibrocystic change
fibroadenOSIS -
cystic change - small cysts form by lobular dilation. they contain fluid which is less proteinacious than duct ectasia
fibrosis - inflammation and scarring due to cyst rupture
Adenosis - increased number of acini per lobule
what is mammary duct ectasia
occurs in perimenopausal women, dilation of the large ducts, may cause thick white/ green discharge and granulomatous inflammation.
may have a poorly defined palpable areolar mass.
need to do cytology as mammography mimics cancer.
Which condition of the breast is closely associated with smoking and what would you expect to see on histology?
periductal mastitis - not associated with breast feeding and would show keratinising squamous epithelium extending deep into the nipple orifaces.
what would be seen on fibroadenoma histology
benign overproliferation of stromal cells squishing the surrounding ducts.
what is an intraductal papilloma
bloody discharge with no lump not seen on mammogram
benign papillary tumour arising in the ducts of the breast. may be central or perpheral.
What is a radial scar?
central scarring surrounded by proliferating glandular tissue - looks the same as a cancer on mamogram and carries a small risk of malignant transformation due to it proliferating. excision.
stellate pattern
radial scar?
what type of breast cancer do you get with BRCA
invasive
name 3 possible causes of a unilateral ptosis
Horners (myosis, ptosis, anyhdrosis)
Myasthenia gravis
3rd cranial nerve palsy -
What is c-anca actually against?
proteinase 3
what is p anca actually against
myeloperoxidase abs
raised AFP
cholangiocarcionma or HCC
where do berry aneurysms normally form and what do they predispose to
85% of subarachnoid haemorrhage and they usally occur at the internal carotid bifurcation
How does an extradural haemorrhage present?
usually knock to the head and rupture of the Middle meningeal artery. They are lucid initially and then LOC.
how does a subdural present?
slow venous bleed presents with slow decline, fluctuating conciousness
elderley or alcoholics
AV malformation
high pressure bleed.
22q12
Neurofibromatosis 2 - meningioma
3q25
Von hippel lindau
IDH1 mutation
oligodendroglioma most commonglial tumours: glioblastoma and astrocytoma most comon
are glial tumours infiltrative or commpressive
80% infiltrate
pilocytic astrocytoma
meaning hairy
compressive margins usually present erly in life , benign and slow growing
Medullablastoma
grade 4 present in cerebellar vermis in kids but in the hemishphere in adults. cerebellar signs
meningioma
outer layer and compressive
often incidental but may cause focal symptoms
Where do oligodendrogliomas present?
frontal and always supratentorial. IDH1
optic gliomas
NF1
NF2
vestibulocochlear nerve affected. 8
difference between sporadic and variant CJD
Variant young
sporadic OLd
Variant psych first - depresison
sporadic - rapid dementia and neuro signs
variant - tonsillar biopsy
sporadic csf 14,3,3
codon 129 - MM
susceptibility to prion disease
MV and VV are chill
Alzheimers brain protein deposits
beta amyloid and abnormaly agregated TAU
alpha synuclein and ubiquitin
demntia with lewy bdoides
proliferation of type 2 pneumocytes?
clara cells adenocarcinoma secreting cells
What 3 things exhibit koebnerfication
psoriasis
lichen planus
vitiligo
(SLE)
loosers zones
pseudofracures seen in osteomalacia
can be seen in pagets too
browns tumour
no matrix - seen in primary hyperparathyroidism
huge osteoclasts
pagets disease
what goes orange on tetracycline labelling
bone which is vit d deficient and unminerilised
bone resortpion in the phalanges
primary hyperparathroidsim
loss of cancellous bone -
osteoporosis this is the same as thin TRABECULAE.
mosaic pattern of lamellar bone
pagets
pagets disease symptoms
bone pain head change of shape (osteoporosis circumscripta) deafness nerve compresion micro fracturews
cut ofs for osteopenia
dexa - betwwen 1 and 2.5 standard deviations below the mean
what is pseudo vitamin d deficicney
due to loss of problems with 1 alpha hydroxylase in the kidney
pseudogout crystals
calcium pyrophosphate
langhans giant cells?
TB of the bone
positive bofringence?
pseudgout
negative bifringence
gout
treatment for pseudogout
NSAIDS and intraarticular steroids
treatment for gout
colchicine in acute, allopurinol long term
reduce intake of alchol and purine rich foods.
common causes of osteomyelitis in children
haemophilus, group b strep? but normally staph in adults.
testicular tumour secreting AFP
terratoma also secretes LDH and HCG is considered malignant after
what is renal osteodystrophy
bone pain and disorders due to inability to maintain proper calcium and phosphate levels. question may say dialysis
what cell sits in howships lacunae?
osteoclasts
causes of restrictive pericarditis
Sarcoid
amyloid
radiation
causes of dilated cardiomyopathy
Sarcoid
Haemochromatosis
Alcohol
Genetic
Myocarditis
Peripartum.
What 4 things characterise chirossis
Hepatocyte necrosis
fibrosis and scarring
nodules of regenerating hepatocytes
change in liveer architecture which causes shunting and the hepatocytes dont see the blood.
what is surrounding the nodules of regenrating hepatocytes
fibrous cuff
what are the other markers of PBC
high alp, high cholesterol, high IGM
what is auspitz sign?
bleeding on rubbing of psoriasis
What is the diagnostic criteria fr nephritic syndrome
Red and white cell casts, haematuria
They may also have some protein in the urine but not enough to warrant it being nephrotic syndrome
oliguria is likely and may be more severe still in crescenteric glomerulonephritis
urea and creatinine are raised
they have hypertension
What are the secondary causes of nephrotic syndrome
diabetes - kimmelsteil wilson nodules in the mesangial matrix
amyloid due to chronic inflammation
myeloma
Which breast lesions calcify
DCIS - can be either pre or post menopausal
Which breast cancers are bilateral
LCIS - 20-40% bilateral
these also are mainly in younger pre menopausal women
What is the difference between a phylodes tumour and a fibroadenoma
similar but phylodes usually bigger than 5cm, and can have malignant potentiol and is usually found in older women, wheras fibroadenoma is usually young (20-30)
which type of cancer usually presents with pagets disease of the breast?
IDC
also causes pea d;orange, tethering and pain.
