Histopathology Flashcards
Features of nephrotic syndrome
Oedema +++ Proteinuria +++ Hyperlipidaemia More chronic No haematuria Hypertension
Features of nephritic syndrome
Haematuria +++ Oedema + More acute Variable proteinuria Azotaemia Oliguria
MNCS
Type of nephrotic syndrome
Damage only visible under electron microscope
Commonest type in children
Responds very well to steroids (despite no inflammatory cells being there…weird)
Membranous glomerulonephropathy
Deposition of GBM antibodies
Causes thickened GBM and subendothelial spikes
85% idiopathic
15% causes by malignancy, SLE, drugs, infection
Proliferation glomerulonephritis
Nephritic syndrome
Post-group A streptococcal infection
Infection –> over-repair (hence proliferative)
Major cause of acute nephritis in children
Membranoproliferative glomerulonephritis
Nephritic syndrome
Deposits in mesangium –> complement activation –> damage
Unlike membranous glomerulonephropathy, the mesangium (as well as the GBM) is thickened
When crescents are present, bad prognosis.
AKI definition in urine output
<400ml/day
Pathogenesis of AKI
Usually ATN
Desquamation causes blockage –> oliguria
In late stage it is so damaged that the blockage clears and the kidneys basically become useless at reabsorbing –> polyuria + protein etc
Reflux nephropathy infection pattern
Segmental
Infection pattern in bacteriaemia
Dotting
Inflammation pattern in pyelonephritis
Spares the glomeruli
Gross appearance of kidney in chronic pyelonephritis
Pseudobulging
Microscopic appearance of kidney in chronic pyelonephritis
Thyroidisation due to colloid filled tubules
Nephrosclerosis
Benign hypertensive kidney
Focal sclerosis of arterioles –> cortical scarring
Granular appearance
Malignant hypertension causes this to happen rapidly
Multicystic renal dysplasia
Congenital cause of cystic kidneys
Multiple cysts separated by dysplastic parenchyma
Most common cause of abdominal mass in newborn
Medullary sponge kidney
Cysts in the collecting ducts
Puts patients at increased risk of calculi
Prevalence of ADPKD
1 in 500
Prevelance of ARPKD
1 in 20,000
Extrarenal manifestations of ADPKD
40% have cysts in either: Liver Pancreas Spleen Lungs
10-30% have berry aneurysm in circle of Willis
Neonatal syndrome in ARPKD
Potter syndrome
‘Facies’ = low set ears, beaked nose, downward slanting eyes, prominent folds
Liver abnormalities
Causes death shortly after birth in severe forms
Stages of CKD
1 - >90 with evidence of kidney damage 2 - 60-90 3a - 45-60 3b - 30-45 4 - 15-30/ 5 - <15
Main causes of CKD
Diabetes 45%
Hypertension 30%
Glomerulonephritis 20%
Other (chronic pyelonephritis, PCKD) 5%
Acute renal failure definition in urine output
<0.5ml/kg/hr
Epidemiology of nephrolithiasis
20-30
5% prevalence
50% recurrence rate
M>F
Types of stone and frequency
Calcium oxalate 40% Calcium phosphate 25% Mixed calcium 10% Triple phosphate/struvite 15% Urate 5% Cysteine 1%
Molecular name for struvite
Magnesium ammonium phosphate
Infection associated with staghorn
Proteus, because it splits urea into ammonium
Wilm’s tumour presentation
Infants
Haematuria and abdominal mass
Pyrexia 50% of the time
Very responsive to treatment (surgery + radiotherapy)
Renal cell carcinoma origin
PTCs
Renal cell carincoma % of renal cancers
95%
RCC presentation
Painless haematuria Mass Hypertension Malaise Paraneoplastic effects (hypercalcaemia, polycythaemia, amyloidosis)
RCC risk factors
Smoking
Heavy metals
Von Hippel Lindau syndrome
Hypertension
RCC microscopy
Large round cells with clear cytoplasm and a clearly outlines membrane
TCC of renal pelvis presentation
Haematuria and backpain
Bladder tumours origin
90% TCC
10% SCC secondary to schistosomiasis haematobium
3 types of bladder tumour
Benign papillary adenoma
Papillary neoplasm with low malignant potential (PNLMP)
Urothelial carcinoma
RF for TCC bladder
Smoking Arylamines Job with chemicals Long term analgesic Cyclophosphamide
Survival of bladder cancer
98% @ 10 years
Most common benign liver neoplasm
Haemangioma = neoplastic proliferation of vessels
Rarely ruptures, incidental pickup
Benign liver neoplasm associated with the pill
Liver cell adenoma = benign tumour with glandular epithelial differentiation
Bening liver neoplasm picked up during surgery
Bile duct malformations, that look like metastases
HCC blood cell marker
AFP
Fibrolamellar HCC
A subtype of HCC that occurs in the young with no history of cirrhosis where there is collagen deposition
Most common place for cholangiocarcinoma to occur
Bifurcation of biliary tree
RF for cholangiocarcinoma
Things that cause chronic inflammation
Parasites
Primary sclerosis cholangitis
RFs for angiosarcoma
Arsenic
Anabolic steroids
Hepatoblastoma blood marker
Also AFP
Viral hepatitis from travelling
A
RF for HEV
Indochina
Pregnant women at BBQs
Serology of autoimmune hepatitis
ANA+
High IgG
High ALT
PSC common in what patients
UC
Progressive inflammation leads to fibrosis and strictures in the larger ducts. Diagnosed by MRCP/ERCP where you see beaded appearance
Primary biliary cholangitis patient group
Middle aged females
Pathophysiology of primary biliary cholangitis
Granuloma formation around smaller bile ducts in liver
Serology of primary biliary cholangitis
AMA+
Wilsons disease presentation
Children present with liver disease
Adults tend to present with neurological symptoms
Ch mutation in wilsons disease
Ch13
Haemochromatosis mutation
Ch6 AR mutation of HFE gene
Leads to increased absorption of iron
A1AT genetics
Autosomal codominant mutation of Ch14
Boundary between upper and lower respiratory tract
Lower larynx
Type of immunological reaction to TB
Type IV hypersensitivity A - allergic C - complement I - immune D - delayed
Histological changes in reflux œsophagites
Thickening of basal layer
Lymphocytes + eosinophilia infiltration
Vascular papillae come closer to surface
Cause of achalasia
Autoimmune destruction of myenteric ganglion cells
Leads to failure of smooth muscle fibres to relax
Food builds up in oesophagus –> chronic inflammation
Trypanosomiasis Africa
Testse fly –> sleeping sickness
Trypanosomiasis South America
Rejuvid bug –> Chagas disease (megaoesopagus, cardiomyopathy, megacolon)
Treatment for trypanosomiasis
Arsenic derivatives
GIST
Cancer of the interstitial cajal cells
Mesenchymal/connective tissue tumours
GIST treatment
Imatinib or surgery
TKI blocks the mutated KIT gene
Intestinal stomach cancer treatment
Hence-tin
Coealic histological changes
Flat mucosa
Crypt hypertrophy
Villous height: crypt ratio goes from 5:1 to <3:1
Complications of coealic
Refractory sprue (no response to gluten restriction)
Ulcerative jejunitis
Neoplasia (enteropathy associated T-cell lymphona EATL, adenocarcinoma)
Rate of perinatal mortality
7.4 per 1000
Markers for cancer detection in breast
cytokeratin 5/6
P63
Smooth muscle myosin
Stains for basement membrane
Laminin and collagen
Lymphocytic lobulitis
Middle aged diabetic females
Looks like cancer on radiograph
Lots of lymphocytes in a dense Stromae
Idiopathic granulomatous mastitis
Do not excise as you will cause a flare
Chalky white deposits
Fat necrosis
Radial scar
Sclerosis adenosis = a benign proliferative condition of the terminal duct lobular units. Manifests as multiple small firm tender nodules and microcysts in the breast.
Radial scars are benign but there is a 1% chance of it turning malignant, so you remove them anyways
Sarcoma
Malignant neoplasm with mesenchymal differentiation (bone, cartilage etc)
OI type that kills you
Type 2
Brittle bone disease
OI
Achondroplasia mutation
FGFR3
Incidence of achondroplasia
1 in 30,000
Symptoms in osteopetrosis
Brittle bones –> fractures
No space in medulla –> extramedullary haematopoesis –
> hepatosplenomegaly
Mosaic pattern in bone
Paget’s
Common age group for osteosarcoma
<25
Prevalence of IBD
1 in 250 total
UC = 1 in 400 Crohns = 1 in 630
Juvenile polyposis mutation
SMAD4 –> hamatomatous polyps
Peutz-Jegher’s syndrome mutation
AD mutation of STK11
Mesenchymal polyp example
Leiomyoma
Dukes staging and prognosis
A = not through muscularis mucosa B = through MM but not to lymph node C = lymph node spread D = distant metastasis
At 5 years A 95% B 80% C 50% D 5%
Stage that most people et diagnosed with colon cancer
2/3rds get diagnosed in stages C and D
Amsterdam criteria
For diagnosing HNPCC Lynch syndrome: Must have all the following: 3 first line relatives with CRC 2 different generations 1 person under 50 FAP is excluded
Inheritance of HNPCC
AD mutation of mismatch repair gene
FAP inheritance
AD APC mutation
Blood marker for progress/recurrence of CRC
CEA (Carcinoembryopnic antigen)
How many tubules are these in each testis
4 tubules in each of the 250 lobules
Androgen insensitivity is aka
Testicular feminisation
RFs for GCTs
Cryptorchidism
Testicular dysgenesis (Kleinfelter and testicular feminisation)
Changes in chromosome 12
Schiller Duval bodies
Yolk sac tumours
Present 50% of the time
Pathognemonic
Commonest GCT
Seminoma
Differentials for old man with tumour in testicle
Spermatocytes seminoma
Diffuse large B cell lymphoma
Lobes in prostate
5
Weight of prostate
20g normal
Up to 60-100g in BPH
Racial group susceptibility in prostate cancer
Black > white > asian
Dietary factors with prostate cancer
Fat increases
Tomatoes decrease
Sexual differentiation stage in embryo
6 weeks
Condyloma
Genital warts
HPV 6 and 11
HPV strains for cervical or anal cancer
HPV 16 and 18
Histological changes in HPV infection
Squamous cells are infected in zone of transformation
Perinuclear halo
Wrinkled nuclei
RF for not clearing HPV
Smoking
Krukenberg tumour
A tumour in the ovary from a distant metastasis
Classically a pyloric adenocarcinoma
Usually bilateral
Endometrial cancer staging
1 = confined to uterus 2 = into cervix 3 = beyond uterus, not beyond true pelvis 4 = beyond true pelvis
Most common type of ovarian tumour
Surface epithelial tumour
Chronic lymphocytic thyroiditis
A.k.a. Hashimotos
Types of thyroid cancer
Papillary - lymphatics - associated with radiation - 80%
Follicular - blood - 15%
Medullary - calcitonin producing parafollicular C cells - 3%
Anaplastic - 2%
Diagnosing medullary thyroid cancer
Measure blood calcitonin levels and/or biopsy and stain for C cells
3 main causes of primary hyperparathyroidism
Adenoma affecting one gland 90%
Hyperplasia affecting all 4 glands 10%
Carcinoma <1%
Main causes of secondary hyperparathyroidism
CKD
Vit D or calcium deficiency
Malabsorption
Low serum magnesium
Branches of LAD
Branches of circumflex
Diagonal
Obtuse marginal
Average risk fo stroke in someone with AF
1% per year
CF inheritance
AR CFTR gene
