histopathology Flashcards
pain relived by sitting forward, raised amylase. Inflammatory condition resulting in injury of the acinar cells to the pancreas
Pancreatitis
rare, mainly childhood, presents with abdo pain, emesis, jaundice
Pancreatoblastoma.
Cyst with the epithelial layer
cystadenoma
diarrhoea A 39 year old Nepalese man presents with severe watery diarrhoea.He is found to have hypokalaemia and, surprisingly, a metabolic acidosis. A RUQ mass is detected by contrast-enhanced spiral CT scanning. Stool bicarb is high and urine anion gap is negative.
vipoma
associatted with necrolytic migrating erythema
Glucaoma
recurrent ulceration, hematemesis, diarrhoea, multiple gastro duodenal ulcers, diarrhoea, non-responsive to omeprazole
zollinger ellison syndrome
Dilatation of the large breast ducts, menopause, tender lump around the areola +/- Thick, white nipple a green nipple discharge. secretions. Mimics mammographic appearance of cancer
Duct ectasia.
Mostly in smokers and not associated with lactation. Histologically, keratinizing squamous epithelium extends deep into nipple duct orifices.
Periductal mastitis
red breast, lactating, cracked skin - continue expressing + antibiotics
Mastitis
Very common. Group of changes caused by exaggerated normal response to hormones
Fibrocystic:
Local areas of epithelial proliferation in large mammary ducts, Hyperplastic lesions rather than malignant or premalignant. May present with blood stained discharge.
Duct papilloma
Proliferation of fibroepithelium and stromal tissue’ can arise with pre-existing fibroadenoma.
>50, potentially aggressive
○ Artichoke like tumor.
Phyllodes tumour
Incidence increased dramatically since development of mammography. Appear as areas of CALCIFICATIONS. 10% present with clinical symptoms. Much increased risk of progressing to invasive breast Ca. Cancer staged into low grade, intermediate, high grade
Ductal Carcinoma in Situ
loss of E-cadherin:
Invasive lobular
ALWAYS incidental finding on biopsy as no calcification 20-40% bilateral
LCIS
Most common type of invasive cancer:
DCIS
Woman with known breast cancer has a red and rough nipple:
Paget’s disease
Woman with breast lump, FNA shows C5 grading.
Invasive breast carcinoma
old, rectal bleeding, fever, LIF
Diverticulitis
left sided abdominal pain relived by defecation
diverticular disease
left sided abdominal pain relived by defecation plus fever
Diverticulitis
obstruction, constipation, vomiting
Sigmoid volvulus
patients after lung transplant are more likely to get adenocarcinoma of colon
CF
Pernicious anaemia, H pylori associated
Maltoma
Cancer due to Coeliac disease HLA B8 associated 10% would get primary lymphoma a of the gut if not properly treated
Enteropathy Associated T-cell Lymphoma
associated with pernicious anemia and gastric ulcer
Chronic gastritis
single episode of melana, erosion through the gastric wall and infiltrate
Acute Gastritis
well differentiated, progression from athropic gastritis to chronic, eldery male, same as Berret but in oesophagus
intestinal gastric cancer
Young women, associated with poor prognosis and lints plastic a and signet ring cells
diffuse gastric cancer
male with change in bowel habit, weight loss, bleeding PR
adenocarcinoma of the colon
hyperplastic polyps associated mutation
AFP
Seen at 50-60s years old, caused by shedding of the epithelium Polyps not associated with increased cancer risk
Hyperplastic
type of polyps associated with mucocutenous hyper pigmentation, freckles around the mouth. Focal malformation of mucosa and lamina proporoiat
Hamartomas Polyp
What mutation is associated with hamartomous polyps
AD - LKB1
Fe def, anaemia, weight loss
Right sided tumor
> 100 polyps seen, name the condition, and the mutaiton
70% Autosomal Dominant mutation in APC gene (Anaphase promoting Complex).
Change in bowel habit, crampy LLQ pain
Left sided bowel tumor
Bilateral pigmentation of the retina, bleeding per rectum, teenager, family history of colorectal cancer:
FAP
Associated with bilateral pigmentation on the retina, osteomas and dental carries:
Gardener Syndrome
Carcinoma in the right colon (Fe, anemia, weight loss), few polyps, fast progression to malignancy, AD mutations in mismatch repair genes
Hereditary non-polyposis colorectal cancer (Lynch syndrome)
What on surveillance would be an indication for colectomy in UC?
Dysplastic polyps
What would you see on histology in Crohn’s?
Non-Cesaiting Granulomas, Cobblestone
Intermittent diarrhea, pain and fever
diverticulitis
ring enhancing lesion HIV person
HIV Tuberculoma but I would say toxoplasmosis or brain abscess.
CSF shows. Oligoclonal Bands of IgG on, Electrophoresis.
Multiple Sclerosis
elderly person with insidious onset of neuro problems, ‘collapse at home’
Subdural
hit on side of head and lucid interval, car traffic accident
Middle meningeal/extradural bleed
Psychiatry symptoms first with young age of onset. Depression then CNS symptoms in young person.
young omnivore who had psychiatric symptoms then motor symptoms
Chorea-ataxia follow it x. Variant CJD
Neurosign’s first and presents later. Rapid progressive dementia with myoclonus.
Sporadic CJD
Optic nerve tumour excised and now lump on hand.
Neurofibromatosis type 1
1:5000 condition, mutation on Ch 17 which encodes neurofibrin. Associated with phaochromocytomas
Neurofibroblasotma
Epileptic with patch on back and lumps in brain
Tuberous sclerosis
adenoma sebaceum (angiofibromas):
Tuberous sclerosis
Capillary loops surrounded by epithelial cells, anywhere in the CNS, presenting between 2nd and 5th decade. Associated with headaches, seizures, focal neurological signs, rapid loss of consciousness.
AV Malformation
Presents from birth, anywhere in the CNS, usually 50+ of age. Well-defined malformation pf closely packed abnormal vessels with no parenchyma – vascular spaces that can leak, look like rasbery
Cavernous angioma
raised ICP symptoms for a while then became obtunded.
Herniation
Mass under dura mater compressing frontal lobe (usually). Check notes from David, also NF2.
Commonest brain tumour:
Meningioma
Highly vascular tumors and have a tendency to infiltrate. They have extensive areas of necrosis and hypoxia. As a rule, high-grade gliomas almost always grow back even after complete surgical excision, so are commonly called recurrent cancer of the brain
Gliomas
Patient with HIV, raised ICP, new onset epilepsy.
Cryptococcus: most common fungal infection of CNS.
Headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit.
Tuberculoma
Someone on dialysis with bone pain –
Renal osteodystrophy
Thin trabeculae, normal osteoid
Osteoporosis
The cell associated with howships lacunae, stimulated by IL-6 in myloma
Osteoclast
wide seams of osteoid and increased volume of osteoid
osteomalacia
where would you see fibrous osteodystrophy, Brown’s Tumor:
In primary hyperparathyroidism, renal osteodystophy
Unmerlised bone (osteoid) can be seen in
osteomalcia
Massive osteoclast are seen in which condition?
(Paget’s)
Mosaic pattern of lamellar bone
Pagets
Inferior cerebral artery – where does it rupture, what is the presentation
berry aneurysm, thunderclap headache
hit on side of head and lucid interval, car traffic accident
Middle meningea
On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat, von Hippel Laudau mutation VHL gene
Clear cell carcinoma – the most common renal problem
high EPO, high Hb,
renal masses, painless haematuria RCC
vomiting, white cell casts in the urine
pyelonephritis
Immensive pain, haematuria
Calculus
drug associated with focal glomerulonephritis
heroin
Patient with a cancer in their bladder following chronic schistosomiasis
squamous cell bladder cancer
Painless haematuria, frequency, urgency, pyelonephritis or hydronephrosis if ureteral orifice involved
Transitional Cell (Urothelial) Tumours
rare bladder cancer, arising from extensive intestinal metaplasia or from urachal Remnants
Adenocarcinoma
● The commonest cause of the– the most common cause of acute kidney injury, nephrotoxic drugs, RTA, hypovoloemia –
acute tubular necrosis
. If the patients has RTA there is myoglobin in his urine – generally rhabdomlylosis and muddy casts
acute tubular nephritis
All have loss of podocyte foot process
Nephrotic Syndrome
Adults, infection, malignant SLE non-responsive to steroids, membrane thickening, granular deposits (all SLE):
Membranous proliferative glomerulonephritis. PLA2 associated in 70% according to Meeran
Afro, Caribbean, scarring hylianosis, IgG complement in scarred areas. HIV drug users
Focal segmental glomerulonephritis
Somebody with bilateral oedema, oliguria and then we were given this insert (red cell casts).
Mixed Nepfritic/Nephrotic syndrome
may present as nephrotic syndrome, haematuria or proteinuria, Type 1 accounts for 90% of cases, subendothelial immune deposits of electron dense material resulting in a ‘tram-track’ appearance, cause: cryoglobulinaemia, hepatitis C
Mixed Essential Cryoglobuinaemia
(1-3) weeks post strep –infection coca-cola in the urine
Post-strep Glomerulonephritis
Frank haematuria, (1-2 days) following throat infection
IgA nephropathy (Berger Disease) proliferation of mesangial cells
Asian with slight change in renal function, sensorineural deafness + eye disorders
Alport syndrome
asymptomatic haematuria running in the families, Thin basement membrane disease
Thin basement membrane disease (benign familial hematuria )
RAPIDLY PROGRESSIVE Glomerulonephritis. What would you see on the electron microscopy?
CRESENTSS!!!! Like sailor moooon!!!
Q) What are three types of rapidly progressive glomerulonephritis?
Type 1: Anti-GBM antibody (Pulmonary-Renal syndrome) Goodpasture Collagen type IV. Linear deposition of complexes in the basement membrane
o LM: CRESCENT Type 2: Immune complex SLE, IgA nephropathy, post infectious GN, granular
o LM: CRESCENT Type 3: Lack of immune complex deposition, Pauci-immune / ANCA-associated (c-ANCA Wegner, p-Anca microscopic polyangitis). VASCULITIS
oncogene, poor prognosis, squamous and small cell
K-RaSS
Peripheral lesion of the lung plus non-small cell
Adenocarcinoma
peripheral lesion, Asian non-smokers, glandular, women. EGFR - good prognosis extremely good fucking response.
Adenocarcinoma
prickles, keratinisation, PTHrp secretion, smokers, central but not so much anymore
p53, c-myc mutation, most common, proximal bronchi
aggressive, responds to chemo, oat cells: p53 RB1
Small cell
not typical, hypertension, hyperglycaemia, Hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
ACTH
pre-synaptic voltage gated calcium channel in the peripheral nervous system: Features: repeated muscle contractions lead to increased muscle strength* (in contrast to myasthenia gravis)
Lambert-Eaton syndrome:
PTH is secreted by which cancers?
squamous and small cells
Thickened pleura on CT, extensive pleural effusion, chest pain, weight loss, dyspnoea
MesoThelioma
ship worker with pleural plaques
Asbestosis
⅓ due to infection, also CF, immunodeficiency, ABPA, aspiration
Bronchiectasis
A common cause of bronchiectasis
CF
pattern of lung injury associated with asthma
Eosinophilic inflammation
28 year old man with multiple fractures, on ward develops SOB and hypoxia:
fat embolism
occupational problem, finger clubbing, persistent weight loss (type IV)
EAA chronic
Inhalation of the dust in sensitized individual (type III, bird fancier lung). Cough after working on farm with mouldy hay
EEA acute
Patient who is a non-smoker, medically well has rusty coloured sputum cough
urine streptococcal antigen).
Homeless patient presents with dry cough and weight loss→ TB (in the question the options for this are either that you do induced sputum
- Sputum Fast Acid Bacilli (Ziehl-Nelson staining)
- NAAT test
c. Patient who is known to be an IVDU presents with dry cough. Chest X-ray shows bihilar interstitial shadowing,
silver stain PCP
CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation. May be normal
exercise-induced desaturation
bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)
perimenopausal, oestrogen sensitive, good prognosis
Endometroid
papillary serous. clear cell, older, bad, hobnail 80 year old lady which tumour
non-endometroid
most common, psammoma bodies
Serous
mucin secreting cells, pseudomyxoma peritonei(metastasis from appendix)
Mucinous
hobnail, malignant with poor prognosis
Clear cell
■ convert androgens to Oestrogen
Irregular menstrual cycles, breast enlarge, breast cancer.
Granulosa-theca cells (& therefore tumours)
defeminsation and virilsation (hirustuism, deepened voice, enlarged clitoris)
Sertoli-Leydig – androgen
Meig’s syndrome (ascites + pleural effusion)
Ovarian fibroma
○ (the most common in young females) radiotherapy sensitive
Dysgerminoma
Three germ layers (ecto, endo, meso)
teratoma (immature – AFP).
- secretes AFP
yolk sac tumors
(peripheral oedema and hepatosplenomegaly)
ALight chain in myeloma
Man undergoing treatment for chronic renal failure undergoes treatment and describes tingling in the hands
carpal tunnel syndrome) Dialysis associaciated amyloidosis = beta2 micorglobulin
Rash below the ankles, constipation followed by diarrhoea, pain in the joints- fever that is cyclical, IL-1
Familial Medeterian Fever
Cystic lesion with papillary architecture and clear cytoplasm, enlarged thyroid+ lymphadenopathy. Young females. The most common. Excellent prognosis.
Papillary carcinoma.
solitary nodule
Follicular
5% originates in par follicular cells – linked to MEN2 and Ret mutation!!!!!. Produce calcitonin
Medullary
Produced by par follicular cells in the thyroid:
calcitonin
calcitonin - what does it do?
lowers Ca by the action, opposes PTH
Rare. Elderly. Poor response to any treatment.
Anaplastic
Associated with vitiligo, type I diabetes mellitus:
Grave’s Disease. TSH, TPO antibodies. Treatment carbimozole SE=agranulocytosis
HIGH UPTAKE – 30% - 50%
toxic multinodular goitre.
HOT NODULE on isotope scan:
Toxic adenoma
Self-Limiting post-viral painful Goitre
Subacute DeQuervain’s thyroiditis
diffuse lymphocytic infiltration and atrophy – no goitre
no goitre Autoimmune
Amiodorane, Lithium: hypothyroidism
Drug Induced
20 year old with a lytic lesion in the diaphysis of his leg - pain alleviated by aspirin:
osteoid osteoma
Man goes deaf with bowed legs –
Pagets diseas, high ALP
Vertebral fracture, high paraprotein
Multiple Myloma
Young woman with symmetrical joint pain
Rheumatoid Arthritis
Rheumatoid arthritis + hepatosplenomegaly + low white cell count
Felty’s
radiolucent nidius with scleriotic rim
osteoid osteoma
Associated with Gardner syndrome and FAP
osteoma
Muliple swellings in the hands, cotton wool calcification
Enchodroma
Most common neoplasm in the skeleton, cartilage capped bony outgrowth
Osteochondroma
Bone replaced by the fibrous tissue, soap bubble osteolysis and shepards crook deformitiy.
Fibrous dysplasia
lytic, well defined lesions
Simple bone cysts
Sunburst apperence
Coldman Triangle
Osteosarcoma
Presents with fatigue, pruritus and abdominal discomfort. Progressive cholestasis, autoimmune associated with Sjorgen.
PBC
Features, cholestasis: jaundice and pruritus, RUQ fatigue. Intra and extrahepatic bile ducts
PSC
non-caseating granulomas; also get Schaumann and asteroid bodies, (inclusions of protein and calcium), lymphadenopathy, painless and rubbery
Sarcoidosis changes in the lymph nodes
Enzyme elevated in the sarcoidosis:
ACE, also 1 alpha hydroxolase
Patient had an appendectomy 1 week ago. What would you see in their scar collagen
Granulation tissue, fibrocytes and capillaries, primary wound healing
what enzyme is increased in acute MI?
AST
Alkaline phosphatese is secreated by?
osteoblasts
which one is increased in viral hepatitis?
ALT (marker of inflamttion)
which one is increased in viral hepatitis? (Hep A, Hep B)
ALT (marker of inflamttion)
Prostate cancer the most increased
acid phosphatase
Patient with funny tibia and a bit of bone pain. What tests are you going to order?
- ALP, liver function
What scan would you order for patient with Pagets?
TC biphosphonate scan
What are the complications of Paget’s?
Bone pain, osteosarcoma, fractures, deafness
Whats the treatmet for asyymptomatic patients with Pagets disease
- Asymptomatic (do nothing)
- Symptomatic biphosphonates
Whats the treatment for asymptomatic patients with Page’s disease
- Asymptomatic (do nothing)
- Symptomatic biphosphonates
Which enzyme is elevated in osteomalcia?
ALP because of the increased bone turnover and osteomalci, leading to increased ALP (secondary parathyroidism)
which one is low in primary hyperparathyroidism?
vitamin D
which enzymes rises in acute renal failure?
urea
which one is the marker of the chronic renal failure caused by a fall in GFR?
creatinine
which one is the marker of glucose control over the last three weeks?
fructosamine, has shorter life-time than Hba1c
what sort of information you would get from anion gap?
If there are any poisons sitting around the table , any lactate, any bicorbante
