Histopathology Flashcards
1
Q
Basic anatomy of the kidney
A
Thick fibrous outer capsule
Then cortex - contains glomeruli
Internally is the medulla - tubules and collecting ducts that drain urine into pelvis and collects into ureter
2
Q
Micro anatomy of the kidney
A
Renal artery divided into branches - interlobar arteries This branches to arcuate arteries (run between vortex and medulla) End arteries (interlobular) run to kidney surface and give rise to afferent arterioles
3
Q
Fontana stain
A
Positive for melanin
4
Q
Congo red stain
Apple green birefringence
A
Amyloid
5
Q
Prussian blue stain
A
Positive for iron
Haemochromatosis
6
Q
Cd45 positive cells
A
Lymphoid cells
7
Q
Cytokeratin stain used for
A
Epithelial marker
8
Q
Complications of MI
A
Contractile dysfunction - cardiogenic shock
CCF - due to ventricular dysfunction
LV infarct - mitral regurgitation
Cardiac rupture of: ventricular wall (haemopericardium), septum (left to right shunt, VSD), papillary muscle (MR)
Ventricular aneurysm - usually 4 weeks after MI (causing persistent ST elevation)
Arrhythmia
VF (in first 24h) common cause of death
90% develop arrhythmia post MI
Pericardial
Early peri infarc associated pericarditis
Pericardial effusion +/- tamponade
Dressers syndrome - chest pain, fevers and effusion weeks-months after MI
Fibrinous pericarditis
Mural thrombus - embolization
9
Q
Chest pain, fevers and effusion week-months after MI
A
Dressler’s syndrome
10
Q
Post MI immediate histology
A
Normal
CK-MB also normal
11
Q
6-24 hours after MI histology
A
Loss of nuclei
Homogenous cytoplasm
Necrotic cell death
12
Q
Histology 1-4days after MI
A
Infiltration of polymorphs then macrophages (clears up debris)
13
Q
5-10 days after MI histology
A
Removal of debris
14
Q
1-2 weeks post MI histology
A
Granulation tissue
New blood vessels
MyoFibroblasts
Collagen synthesis
15
Q
Weeks-months post MI histology
A
Strengthening
Decellularising scar tissue
16
Q
Charcot Leyden crystals
Curshman spirals
Which condition
Where
What are they
Pathology
A
Asthma
Bronchus
Degenerating eosinophils
From shedding epithelium
SM hypertrophy
Excess mucus
Inflammation
17
Q
Dilation of the airways
Mucus gland hyperplasia
Goblet cell hyperplasia
Mild inflammation
What condition
Complications
A
Chronic bronchitis
chronic cough productive of sputum for at least 3 months over at least 2 consecutive yars
Repeated infections
Resp failure, reduced exercise tolerance
Increased lung cancer risk (independent of smoking)
Chronic hypoxia results in PULMONARY HTN AND RHF = aka cor-pulmonale - Peripheral oedema - Hepatosplenomegaly - Raised JVP
18
Q
Permanent dilation of the bronchi with scarring
Complications
A
Bronchiectasis
Recurrent infections
Haemoptysis
Pulmonary htn
Amyloidosis (as producing excessive amyloid A protein)
19
Q
Alpha - antitrypsin deficiency
Dyspnoea cough
Condition and histology
Other cause
A
Emphysema
Loss of alveolar parenchyma distal to the terminal bronchiole - honeycomb appearance
Due to smoking, (Centrilobular) Alpha-1 antitrypsin deficiency (panacinar)
Rarely IVDU, connective tissue
Complicatons:
Bullae - PNEUMOTHORAX
Resp failrue
Pulmonary HTN and RHF
20
Q
Causes of bronchiectasis
A
Inflammatory
- post infection
- immunodeficiency (hypogammoglbulinaeia) or secondary
- obstruction
- post inflammatory (aspiration)
- Secondary to bronchiolar disease and interstitial fibrosis
- systemic disease
- Asthma
Congenital
- CF
- primary ciliary dyskinesia
- hypogammaglobulinemia
- yellow nail syndrome
- young’s syndrome
21
Q
Rhinosinusitis
Azoospermia
Bronchiectasis
A
Young’s syndrome
22
Q
Honeycomb lung
A
Interstitial Lung disease
- all have at end stage
23
Q
FEV1/FVC <0.7
SOB
End inspiratory crackles
Cyanosis, pulmonary HTN and cor-pulmonale
A
Restrictive lung disease
24
Q
Broad categories of causes of interstitial lung disease
A
Fibrosis
Granulomatous
Eosinophilic
Smoking related
25
Collection of histiocytes, macrophages +/- multi-nucleate giant cells
Granuloma
26
What is extrinsic allergic alveolitis
Immune mediateevlung disorders caused by prolonged exposure to inhaled organic antigen —> widespread alveolar inflammation
27
Histology of extrinsic allergic alveolitis
Polyploid plugs of loose connective tissue within alveoli/bronchioles - granuloma formation and organising pneumonia
28
Male smoker
Proximal bronchi cavitating lesion seen in lungs. Pt has hypercalcaemia, haemoptysis and weight loss
What type of tumour
Histology
SCC (30-50%)
Histology: keratinisation, intercellular prickles (desmosomes)
29
Female non smoker. Hx of weight loss, dyspnoea and hemoptysis
Peripheral lesions seen on CXR and possible Mets.
Type of lung cancer
Histology
Adenocarcinima (20-30%)
Histology: glandular differentiation
Cytology: cells containing mucin vacuoles
Molecular: EGFR mutations
30
Smoker. Cushingoid. Proximal weakness. Lack of co-ordination.
Type of lung cancer
Associated conditions
Where does it arise from
Mutations
Small cell lung cancer (20-25%) - strong relationship to smoking
Ectopic ACTH
Lamberton-Eaton
Cerebellar degeneration
Arises from neuroendocrine cells
P53 and RB1 mutations
31
P53/ RB1 mutations
Lung cancer?
Prognosis and why
Small cell carcinoma
Poor prognosis as
- early Mets to adrenal, liver and brain
Despite chemo sensitive
32
4 weeks after MI
| Persistent ST elevation
Aneurysm
33
flushing, diarrhoeah, bronchoconsriction
carcinoid syndrome
serotonin neoplastic syndrome
- lung, ovary, testes, bowel tumours
34
EGFR mutation lung cancer
adenocarcinoma
| TK inhibitor therapy
35
What does a Kras mutation in lung cancer tell you
Adeno/squamous carcinoma
Poor prognosis
No response to TK inhibitor
36
What does a ERCC1 mutation in lung cancer tell you
Non small cell lung cancer
| Poorer response to cisplatin
37
Lung cancer staging
T(T1-4)
N(0-2)
M(0-1)
38
What is mesothelioma
Arising from parietal or visceral pluera and spreads widely in pleural space
Associated with extensive pleural effusion, chest pain and dyspnoea
- In asbestos related - long latent period of 25-45 years
39
Large pulmonary thrombo-embolism that straddles the main pulmonary arterial trunk at its bifurcation
- Name
- What does it lead to?
Saddle embolus
Acute cor pulmonale
Cardiogenic shock
Death
If >60% of pulmonary bed occluded
40
What is a wedge infarct
```
Pulmonary infarction (commonly after PE)
Repeated infarctions can cause pulmonar HTN
```
41
Non thrombotic emboli examples
BM, amniotic fluid, tumour, air, foreign body
42
PE cause
95% caused by DVT
43
Risk factors for PE/DVT
```
Female
Immobility
Cardiac disease
cancer
Primary and secondary hypercoaguable states
(Virchow's triad)
```
44
Define pulmonary HTN
Mean pulmonary arterial pressure of >25mmHg at rest
45
Pulmonary HTN classification
According to aetiology
1) PAH (idiopathic, hereditary, drugs, associated with congenital heart disease)
2) Pulmonary HTN associated with left heard disease
3) Pulmonary HTN due to lung disease
4) Chronic thromboembolic pulmonary HTN
5) Pulmonary HTN with unclear multifactoral mechanisms
46
Complications of Pulmonary HTN
RHF
Nutmeg liver
Peripheral oedema
47
What is nutmeg liver
Venous congestion of organs
| Due to pulmonary HTN
48
Intra alveolar fluid, iron laden macrophages
Pulmonary oedema
| - Cause is Left heart failure
49
Lung expanded, firm, plum-coloured , airless
Cause
Clinical presentation
Diffuse alveolar damage
ARDS adults - infection, aspiration, trauma
HMD (hyaline membrane disease) neonates - insufficient surfactant production in prems
50
Normal oesophagus histology
Proximal 2/3 squamous
Squamo-columnar junction/z-line
Distal 1/3 columnar
51
GORD histopath
Reflux of gastric acid content
```
Consequences
Ulceration (muscularis proposal)
- haemorrhage, perforation
Granulation tissue
- fibrosis, structures
Barretts oesophagus
```
52
Barrett oesophagus histopath
Stages
Columnar lines oesophagus
Re-epithelialisation by metaplastic columnar epithelium
1) gastric metaplasia
2) intestinal metaplasia (goblet cells too)
Can lead to adenocarcinoma:
Metaplasia - dysplasia - cancer
53
Adenocarcinoma oesophagus histopath
Invading basement membrane unlike dysplasia
Associated with Barrett
Risk factors: smoking, obesity
54
SCC of oesophagus
Associations
Where in oesophagus
Etoh and smoking
Afro carribean
Middle and lower oesophagus
Poor prognosis -early spread
55
Oesophageal varices define
Cause
Histology
Management
Engorged dilated veins
Cirrhosis/portal htn
Thrombosed variceal focus
Emergency endoscopy - sclerotherapy/banding
56
Acute gastrits causes
Aspirin/NSAIDs
Corrosives
Alcohol
Acute H pylori
57
Chronic gastritis causes
H pylori (Antral usually)
AI - pernicious anaemia
Smoking, etoh
58
Gastric ulcer
Symptoms
Risk factors
Complications
Breach through muscularis mucosa into submucosa
Worse with food (unlike duodenal
H.pylori
Smoking
NSAID
Elderly
Anaemia
Perforation (erect CX)
Malignancy
59
Investigating gastric ulcer
Biopsy for H.pylori status
60
Tumors of the stomach
95% adenocarcinoma
```
Rest
MALT
Neuroendocrine
SCC
GIST
```
61
H Pylori eradication
Triple therapy
PPI
Clarithromycin
Amox or metro
62
Gastric lymphoma
Chronic antigen stimulation - chronic inflammation by H.pylori
- B cell (marginal zone) lymphoma
H pylori eradication if limited to stomach
- will go away
63
Duodenitis, duodenal ulcer and H.pylori
Risk factors
Increased acid production spills into duodenum. Chronic inflammation and gastric metaplasia with helicobacter infefctoion. LOSS OF GOBLET CELLS = gastric metaplasis
Duodenal ulcer More common than gastric ulcer
Pain relieved by food, worse at night + WHEN STOMACH EMPTY
Biopsy: neutrophils
H.pylori, Smoking, NSAID, Young
Anaemia
Perforation (erect CX)
64
Duodenal disease
```
Ulcer
Immunosuppressive
- CMV
- cryptosporidisis
Giardia lamblia
Whippes disease
Coeliac - MALT (Tcell)
```
Paeds
- atresia
- Stenosis
- Hirschsprung
65
Coeliac histopath
Vilous atrophy
Crypt hyperplasia
Lymphocyte infiltration
10% get lymphoma
66
Cause of ischaemic colitis
arterial or venous occlusion
Small vessel disease
Low flow states
Obsruction
67
Typical areas of ischamic colitis
Splenic flexure: SMA to IMA transition
| Rectosigmoid IMA to internal ileac
68
Which type of IBD does smoking worsen?
Chron's
69
MZ twin conordance in IBD
Chron's 50%
| UC 15%
70
Histopath chron's
```
Mouth to anus
Skip lesions - cobblestone appearance
First lesion - aphthous ulcer - deep rosethorn ulcer
Non caseating granluomas
Transmural inflammation
Fistula/fissure common
```
71
UC histopath
Extends proximally from rectum continuously
Small bowel not affected unless 'backwash ileitis'
Mucosa only
No granulomas/fistulas/fissures/strictures
Can get pseudopolyps
72
IBD presentation
Chron's: Intermittent diarrhoea, pain and fever
| UC: More bloody diarrhoea, mucus. Crampy abdo pain relieved by defecation.
73
IBD extra-GI manifestations
Anaemia - stomatitis
Eyes: uveitis, conjunctivitis
Skin: erythema nodosum/multiforme, clubbing, pyoderma gangrenosum
Joints: Migratory polyarhropathy of large joints, sacroilitis, myositis, ankylosing spondylitis
Liver: PSC (UC), pericholangitis
74
Chron's complications
Fissures/fistula
Strictures (requiring resection)
Abscess
Perforation
75
UC complications
Severe haemorrhage
Toxic megacolon
30% require colectomy within 3 years
Adenocarcinoma (20-30X risk)
76
Chron's management
Mild: Pred
Severe attack: IV hydrocortisone, metronidazole
Additional: Azathioprine, methotrexate, infliximab
77
UC management
Mild: Pred + mesalazine (5ASA)
Moderate: Pred + mesalazine + steroid enema bd
Severe: Admit, nbm IV fluid, IV hydrocortisone, rectal steroids
For remission: All 5ASA (1st line), azathioprine (2nd line)
78
Carcinoid syndrome manifestations
Treatment
Bronchoconstriction
Flushing
Diarrhoea
Octreotride (somatostatin analogue)
79
Types of non-neoplastic polyps
```
Hamartamous polyp (juvenile, peutz jegher)
Hyperplastic - folds of mucosa grown to much - benign - seen at 50-60yo
Inflammatory - psuedopolyps in UC
```
80
Multiple polyps, hyperpigmentation, freckles around mouth, palms and soles
Condition
Management
Peutz-Jegher syndrome (AD)
Increased risk of intussusception and malignancy
- regular GI, pevlis and gonadal surveillance
81
Risk factors for colon/rectum cancer
Size >4cm
Proportion of villous component
Degree of dysplastic change
82
Colon adenoma
Symtoms
Benign dysplastic lesions
- precursors to most adenocarcinomas (most remain benign) - takes 10 years
Usually asymptomatic
Bleed/anaemia
83
1000 adenomatous polyps. Condition
Prognosis
Genetics
Familial adenomatous polyposis
>100polyps is diagnostic
100% develop cancer in 10-15yrs
APC tumour suppressor gene - Chr 5q21 in 70%
84
Condition similar to FAP
Differences
Gardner's syndrome
Extra intestinal manifestations too
- Osteomas of skull and mandible
- Epidermoid cysts
- desmoid cysts
- Dental caries
85
Young (<50yo) bowel cancer proximal t splenic flexure
Condition
Hereditary non-polyposis colorectal carcinoma/Lynch syndrome
Early age
AD mutations in DNA mismatch repair genes
Carcinomas usually in right colon
Extra-colonic cancers - endometrium, prostate, breast, stomach
86
Colorectal carcinoma
Type of cancer
Age
Location in bowel
Adenocarcinoma in 98%
60-79
45% in rectum
87
Colorectal carcinoma risk factors
Diet, lack of exercise, obesity, familial syndromes, IBD
NSAIDs protective (COX-2 overexpressed in 90%)
88
Investigation bowel cancer
Proctoscopy, sigmoidoscopy, colonoscopy, barium enema, bloods
CT/MRI
CEA (monitor disease)
89
Staging colorectal carcinoma
Dukes
A) Limited to mucosa (5yr survival >95%)
B1) Extending into muscularis propria
B2) Transmural invasion
C1) Extending into muscularis propria with lymph nodes
C2) Transmural invasion with lymph nodes
D) Distant metastasis (5yr survival <10%)
90
Right hemicolectomy for cancer located where
Caecum, ascending colon and proximal transverse
91
Extended right hemicolectomy for cancer located where
Transverse colon
92
Left hemicolectomy for cancer located where
Descending colon and distal transverse
93
Sigmoid colectomy for cancer located where
Sigmoid
94
Anterior resection for cancer located where
>1-2cm above anal sphincter
| - allows preservation of anal sphincter
95
Adomino-perinal resection for cancer located where
<1-2cm above anal sphincter
| - associated with permanent colostomy
96
Pancreatic carcinoma types
Location
Risk factors
```
Ductal adenocarcinoma (85%)
Also can have acinar cell cancers
```
Head of pancreas
Smoking, diet, FAP, HNPCC, diabetes, chronic pancreatitis
97
Painless jaundice, weight loss, steatorrhoea
Pancreatic carcinoma
| - Jaundice if obstructing common bile duct
98
Prognosis of pancreatic ductal carcinoma
5 year survival ~ 5%
99
Ca 19-9
Pancreatic tumour marker
100
Severe epigastric pain radiating to back
Relieved by sitting forward
Vomiting
Acute pancreatitis
101
Histology it acute pancreatitis
Coagulative necrosis
102
Complications of acute pancreatitis
Pseudo cyst, abscess
| Shock, hypoglycaemia, hypocalcaemia
103
Chronic pancreatitis causes
80% alcohol
Haemochromatosis
Duct obstruction: gall stones, CF, tumours
Autoimmune (IgG4) - gG4-POSITIVE PLASMA CELLS-->Tx with steroids
104
Epigastric pain radiating to back, weight loss, steatorrhoea, DM
Chronic pancreatitis
105
Histology chronic pancreatitis
Fibrosis and loss of exocrine tissue (atrophy of acinar cells)
- not of duct cells
Duct dilation, secretions, calcification
106
Complications of chronic pancreatitis
Pseudocyst
Diabetes
Pancreatic cancer
Malabsorption
107
Structural unit of the liver
Hepatic lobule - 1-2mm hexagon
In the centre are terminal branches of the hepatic vein (centrilobular vein)
Angles of hexagon formed by portal tracts
- bile duct
- portal vein
- hepatic artery
108
Significance of liver zones
1) near portal tract (periportal hepatocytes) have rich blood supply
2) hepatocytes grow up
3) centrilobular hepatocytes bear terminal hepatic vein - more metabolically active
109
Portal tract with no bile duct
Indicates bile duct disease going on
110
Liver functions
```
Metabolism
Hormone metabolism
Bile synthesis
Protein synthesis
Storage
Immune function
```
111
Metabolic function of the liver
Involved in glycolysis, glycogen storage, glucoses synthesis , amino acid synthesis, fatty acid synthesis makes, drug metabolism
112
Hormone metabolism by the liver
Activation of vit D
Conjugation and secretion of steroid hormones
Peptide hormone metabolism (GH, PTH, insulin)
113
Bile synthesis by liver
600-1000ml daily
114
Protein synthesis by liver
All proteins except gamma globulins
| - Notable albumin, fibrinogen and coagulation factors
115
Storage function of liver
Large amounts: Glycogen, vitA, D, B12
| Small amounts: Vit K, folate, iron and copper
116
Immune function of the liver
Antigens from gut arrive via portal circulation
| Phagocytosed by Kupffer cells
117
Liver cirrhosis definition
1) Whole liver hepatocyte necrosis
2) Fibrosis - deposition of collagen
3) Nodules of regenerating hepatocytes
4) Distortion of liver vasculature - intra and extra hepatic shunting
118
Extrahepatic shunting of blood through?
Oesophageal varices
Caput medusae
Retroperitoneal space
119
Causes of liver cirrhosis
3 main
1) Alcoholic liver disease
2) Non-alcoholic fatty liver disease
3) Chronic viral hepatitis (B+/-D and C)
Autoimmune, Biliary (PBC, PSC), Genetic, Drugs (methotrexate)
120
Genetic causes of liver cirrhosis
```
Haemochromatosis (HFE gene, Chr6)
Wilson disease (ATP7B gene Chr 13)
Alpha-1 antitrypsin deficiency (A1AT)
Galactosaemia
Glycogen storage disease
```
121
Cirrhosis classification
Micronodular (<3mm)
- caused by alcohol, biliary tracy disease
Macronodular (>3mm)
- caused by viral, Wilson, alpha-1 antitrypsin deficiency)
122
Causes of portal hypertension >10-12mmHg leading to venous system dilation and collateral vessel formation
1) pre-hepatic: Portal vein thrombosis (factor V leiden)
2) Hepatic
- Pre-sinusoidal - schistomsomiasis, PBC, Sarcoid
- Sinusoidal: Cirrhosis
- Post sinusoidal - Veno-occlusive disease
3) Post hepatic: Budd-Chiari syndrome, idiopathic, thrombophilia, OCP, leukaemia, compression by renal tumour, HCC, radiotherapy
123
Budd chiari syndrome
Abdominal pain
Ascites
Liver enlargement
124
Treatment of the collateral vessels formed by portal HTN
Thrombolytic
Treat underlying cause
TIPS (transjugular intrahepatic portosystemic shunt)
125
Alcoholic liver disease patterns and order
1) Fatty liver
2) Alcoholic hepatitis
3) Alcoholic Cirrhosis
126
What is fatty liver
Macroscopic features
Microscopic features
First stage of alcoholic liver disease
Large, pale, yellow and greasy liver
Steatosis - fat droplets in hepatocytes
Chronic exposure --> fibrosis
Fully reversible if alcohol avoided
127
What is alcoholic hepatitis
Macroscopic features
Microscopic features
Stage 2 of alcoholic liver disease
Large, fibrotic liver
In zone 3:
Hepatocyte ballooning and necrosis due to accumulation of fat, water and proteins
Mallory bodies
Fibrosis
Seen acutely after heavy drinking. Ranges from asymptomatic to fulminant liver disease
128
Alcoholic cirrhosis
Macroscopic features
Microscopic features
Last stage of alcoholic liver disease
Yellow-tan, fatty enlarged
Becomes shrunken, non fatty, brown organ
Micronodular cirrhosis
- small nodules and bands of fibrous tissue
129
What is non alcoholic fatty liver disease
Categories
Hepatic steatosis in non-alcoholics.
Due to raised BMI, Diabetes
1) Simple steatosis: fatty infiltration, relatively benign
2) Non-alcoholic steatohepatitis (NASH): steatosis and hepatitis (fatty infiltration and inflammation). Can progress to cirrhosis
130
Autoimmune hepatitis associated conditions
Genetic association
Epidemiology
Coelia, RA, SLA, thyroiditis, Sjogrens, UC
HLA-DR3
Females, young and postmenopausal
131
Types of autoimmune hepatitis
Treatment
Prognosis
1) ANA, anti-SMA, anti-actin
2) Anti-LKM
Immunosuppression until transplant
- but disease returns in 40%
132
What is PBC
Male or female predominant
Autoimmune destruction of intrahepatic bile ducts - granulomas = loss of bile ducts
- -> cholestasis
- -> slow development of cirrhosis
Female
Ursodeoxycholic acid treatment in early disease
133
Steatorrhoea, pruritus, fatigue, xanthelasma, arthropathy
High ALP, high cholesterol, hyperbillirubinaemia.
Anti-mitochondrial antibody +ve
What is the condition
Histology
Treatment
PBC
No bile duct dilation
Intrahepatic bile duct loss with granulomas
Ursodeoxycholic acid tx in early disease
- 25% remission
134
What is PSC
Male or female predominant
Inflammation and fibrosis of extrahepatic and intrahepatic bile ducts
- -> multifocal strictures
- -> dilation of preserved sements
Male
135
45yo male, UC
High ALP, high p-ANCA
Diagnosis
What will be shown on
US + ECRCP
At risk of
PSC
Bile duct dilation
Beading of bile ducts
Cholangiocarcinoma
136
Causes of hepatic granulomas
PBC + Drugs
Non specific: TB and sarcoid
137
Most common benign liver tumour
Others
Haemangioma
Liver cell adenoma
Bile duct adenoma
138
Rhodanine stain
Liver biopsy for dx of Wilson disease
139
Most common malignant liver tumour
METS
From Bowel, Breast, bronchus
140
Hepatic adenoma presentation
Management
Benign
Abdo pain/intraperitoneal bleeding
Resection if:
Symptomatic
>5cm
No shrinkage when stopping OCP
141
What is a cholangiocarcinoma
| Prognosis
Adenocarcinoma arising from bile ducts - intra or extra hepatic
Poor prognosis
142
Cholagiocarcinoma causes
```
PSC
Chronic liver disease
Parasites
Congenital liver abnormalities
Lyn snydrome type 2
```
143
HCC causes
Investigations
```
Hep B/C
Alcoholic cirrhosis
NAFLD
Aflatoxin
Androgenic steroids
```
Alpha feoprotein
US
144
What is alpha-fetoprotein
liver tumour marker (HCC)
145
Skin pathology
| - layers
Epidermis - renews every 15-30days
Dermis: vascular and nerves
Subcutaneous: fatty tissue
146
What is spongiosis
Intercellular edema
147
What is hyperkeratosis
Increase in S. Corneum/ keratin
148
What is parakeratosis
Nuclei in S.corneum
149
What is Acanthosis
Increase in S.spinosum
150
What is acantholysis
Decreased cohesion’s between keratinocytes
151
What is lentigenous
Linear pattern of melanocytes proliferation with epidermal nasal cell layer (reactive or neoplastic)
152
Salmon pink rash then oval macular in Christmas tree distribution. Had flu recently.
Management
Herald patch originally
Remits spontaneously
153
Intraepidermal bulla
Intercellular IgG deposits
Acatholysis
Pemphigus
Superficial
154
Suprapubic pain, fever, dysuria, increased frequency of urinating
Treatment
Trimethoprim
Or
Nitrofurantoin
155
Cystitis complications
Ascending infections causing pyelonephritis
156
Cyclophosphamide associated with Supra pubic pain, dysuria, low grade fever
Haemorrhagic cystitis
157
Painless haematuria, frequency, urgency
Bladder cancer
158
Types of bladder cancer
TCC (most common) - smoking, aromatic amines
SCC - schistosomiasis
Adenocarcinoma - rare
159
TCC bladder diagnosis
Complications
Cystoscopy and biopsy
Pyelonephritis or hydronephrosis if ureteral orifice involved
160
60yo man dysuria, nocturia, overflow dribbling
Cause
Treatment
BPH - dihydrotestosterone medicated hyperplasia of prostrate forming large nodules
TURP
5-alpha reductase inhibitors (tamsulosin)
161
Prostate cancer type
Spread
Adenocarcinoma in men over 50
Local to bladder and haematogenous to bone
162
Prostate cancer diagnosis
Hi, Exam, PSA >4ng/ml is suggestive
163
Risk factors for testicular cancer
Main type
Undescended testes
Low birth weight/SGA
Germ cell (95%)
- includes seminoma, yolk sac tumour, choriocarcinoma, teratoma
Vs
Sex cord - Stromal (5%)
164
Seminoma
Histology
Most common type of germinal tumour
Peak age: 30s
Radiosensitive
Clear cells with prominent lymphoid infiltrate
165
Teratoma testicular
Histology
Malignant when post-pubertal
Chemosensitive
Tumour trying to produce keratin
166
Lace like growth pattern - testicular biopsy
Yolk cell tumour
167
High grade, prominent nuclei
| Necrotic testicular biopsy
Embronal carcinoma
168
Choriocarcinoma
Histology
Subtype of germ cell cancer
Need both to diagnose:
1) cytotrophoblast cells - clear
2) Cynsitial trophoblastic cells - nucleated
169
Prognosis of testicular germ cell cancers
5yr 95% prognosis
170
Non germ cell testicular cancers
Lymohoma - older men, highly aggressive
Leydig cell - precocious puberty, usually benign
Sertoli cell - usually benign
171
Nephrotic syndrome
Proteinuria (>3g/day)
Hypoalbuminaemia + hyperlipidaemia
Odoema
Swelling
Frothy urine
172
Primary causes of nephrotic syndrome
1) Minimal change disease
2) Focal segmental glomerulosclerosis
3) Membranous glomerular disease
4) Diabetes
5) Amyloidosis
173
Child with proteinuria, hypoalbuminaemia and oedema
What is this syndrome
What is it most likely caused by
Treatment
Nephrotic syndrome
Minimal change disease
90% respond to steroids
174
Minimal change disease histology
Light micros: no changes
| Electron micros: loss of podocyte foot processes
175
Membranous glomerular disease histology
Light micros: diffuse glomerular basement membrane thickening
Electron micros: loss of podiatry foot processes, subepithelial deposits (spiked)
Immunofluorescence: Ig and complement granular deposits along GBM
176
Ig and complement deposits along GBM - what is this?
Response to steroids
Membranous glomerular disease
Poor
177
Focal segmental glomerular sclerosis histology
Light micros: focal and segmental glomerular consolidation and scarring, hyalinosis
Electron micros: loss of podocyte foot processes
Immunofluorescence: Ig and complement in scarred areas
178
Prognosis of glomerular membrane disease
Prognosis of focal segmental glomerulosclerosis
40% ESRF after 2-20 yrs
50% ESRF in 10yrs
179
Histology I’m diabetic nephrotic syndrome
Diffuse glomerular basement membrane thickening
Kimmelstiel Wilson nodules
Aka mesangial matrix nodules
180
Amyloid nephrotic syndrome histology
Apple green birefringence with Congo red stain
181
Nephritic syndrome clinical picture
What is nephritic syndrome
```
Proteinuria
Haematuria
Azootemia
Red cell casts
Oliguria
HTN
```
Manifestation of glomerular infiltration
182
Causes of nephritic syndrome
1) acute post infectious GN
2) IgA nephropathy
3) Rapidly progressive (crescentic) GN
4) Hereditary nephritis (Alport’s syndrome)
5) Thin basement membrane disease (benign familial haematuria)
183
Composition of bone
Inorganic: 65%
- Contains 99% Calcium, 85% Ph, 65% Na and Mg of body's total amounts
Organic: 35%
- Bone cells and protein matrix
184
Bone structure
Outside lined by periosteum, then cortex, then medulla.
Long bones comprised of diaphysis and then epiphysis (distal)
Metaphysis is in between where growth plates fuse
185
Types of bone and % of skeleton
Cortical - 80%
| Cancellous - 20%
186
What type of bone is long bone
Cortical: 80% of skeleton
- Appendicular
- Mainly mechanical and protective
- Long bones
- 80-90% calciufied
187
What type of bone is pelvis and vertebrae
Cancellous: 20% of skeleton
- Axial
- 15-25% calcified
- Mainly metabolic
- Large surface
188
Microanatomy of cortical bone
Micro column: has a central canal around which is
Concentric lamellae
- Between units is interstitial lamellae
Surrounding whole entity is circumferential lamellae
Deeper inside is trabecular lamellae
189
Types of bone cells and function
Osteoblasts: build bone by laying down osteoid
Osteoclasts: multinuclueate macrophage cells - reabsorb/chew bone
Osteocytes: Osteoblast like cells which sit in lacunae
190
Types of bone cells - histology
Osteoblast: Middle size, single nucleus
Osteoclast: Biggest bone cell - mostly pick with multiple purple nuclei
Osteocyte: Just a v small nuclei
191
What is Paget's disease
What is primarily affected
What are the phases
Disorder of bone turnover
Skull and vertebrae aka axial
1) Osteolytic
2) Osteolytic-osteosclerotic
3) Quiescent osteosclerotic
192
Huge osteoclasts + Mosaic lines characteristic histology of
Paget's disease
193
Many multinucleate giant cells on histology is characteristic of what
Brown's tumour
| In hyperparathyroidism
194
Fracture repair stages
1) Haematoma
2) Fibrocartilaginous callus
3) Mineralisation of fibrocatrilaginous callu
4) Remodelling of bone along weight-bearing lines
195
Causative organisms of osteomyelitis and bones affected
| Adults vs children
Adults: S. aureus.
- Vertebrae, jaw and toe (secondary to diabetic ulcers)
Children: H.influenza, Group B strep
- long bones
196
X-ray changes of osteomyelitis
10 days post onset usually
- Mottled rarefaction (reduced density) and lifting of perisosteum
>1 week: irregular sub periostal new bone formation called involucrum
10-14days: Irregular lytic estruction
3-6weeks: Areas of necrotic cortex may become detached - called sequestra
197
Histology shows large cell with nuclei arranged in a horseshoe-shaped pattern in the cell periphery
- What is this called
- In which conditions
Langhans-type giant cell
Granulomatous conditions e.g. TB bone
198
Target rash cause
Other symptoms common early and late
```
Borrelia burgdorefi (lyme disease)
Central sparing = chronicum migrans
```
Early: Muskoskeletal, heart, nervous system
Late: Arthritis
199
Nodes on DIPJ and PIPJ names and condition
DIPJ: Heberdens
PIPJ: Bouchards
Osteoarthritis
200
What is osteoarthritis?
X ray features
Degenerative joint disease mainly affecting vertebrae, hips and knees
Loss of joint spaces
Osteophytes (bone outgrowth)
Subchondral sclerosis
Subchondral cysts
201
Rheumatoid arthritis association with HLA
DR4 AND DR1
202
Rheumatoid arthritis characteristic deformities
Radial deviation of wrist, ulnar of fingers
Swan neck and Boutonniere deformity of the fingers
Z shaped thumb
Symmetrical, small joints of hand and feet (sparing DIPJ), wrists, elbows, ankles and knees
203
Histology rheumatoid arthritis
Proliferating synovitis with
1) Thickening of synovial mebranes
2) Hyperplasia of surface synoviocytes
3) Intense inflammatory cell infiltrate
4) Fibrin deposition and necrosis
Pannus formation
204
Adolescent x ray shows metaphyseal lytic, permeative, elevated periosteum.
Condition
Name of elevated periosteum
Osteosarcoma
Codman's triangle
Malignant mesenchymal cells - bone, cartilage and stroma
ALP+ve
Adolescents
Knee (60%)
205
50yo x ray shows lytic bone with fluffy calcification
Condition
Bones affected
Chondrosarcoma
Axial, pelvis, proximal femur, proximal tibia
206
Histology of chondrosarcoma
| Prognosis
Malignant chondrocytes
Cartilage-producing tumours in axial skeleton
- Age >40
- X-ray shows lytic lesions with fluffy calcification
- Ring and arc mineralisation
- Malignant chondrocytes - purple/blue - found in matrix
70% 5 yr survival
207
X ray shows onion skinning of periosteum
Condition
Age group affected
Location affected
Ewing's sarcoma
Under 20s
Diaphysis/metaphysis of long bones, pelvis
208
Histology of Ewing's sarcoma
Chromosome translocations
Sheets and sheets of small round cells
CD99+
t(11;22)
- Age <20y
- Joints of long bones but not in knees
- Onion skinning of periosteum
- Lytic lesions
- Sheets of small round blue cells
- CD99 +ve, MIC2 +ve, ALP -ve
209
Femus affected - histology showing chinese letters (misshapen bone trabeculae)
Condition
X-ray findings
Fibrous dysplasia - bening - 1st 3 decades of life
Soap bubble osteolyis
Shepherd's crook deformity (of femoral head)
Multiple often affected
210
Fibrous dysplasia associated with
Albright syndrome: cafe au lait spots, precocious puberty, polyostitic dysplasia
211
Cartilage capped bony outgrowth histology
Condition
Age group affected
Site affected
Osetochondroma: benign
Adolescent
Metaphysis of long bones near tendon attachment sites
212
Osteochondroma what is it?
| Features
Cartilage capped bony outgrowth - benign
Mushroom on bone
Most common benign bone tumour
Diaphyseal acelasis/hereditary multiple exostoses = multiple extososes + short stature + bone deformities
213
Endochondroma
Age affected
Site affected
Benign tumours of cartilage
Middle age
HANDS
214
X ray showing lytic lesion , Cotton wool calcification - expansile o ring sign
Endochondroma - benign tumour of cartilage
Middle aged
Hand affected
215
Knee epiphysis - lytic/lucent lesions right up to articular surface on x-ray
Condition
Age/gender affected
Giant cell (borderline malignancy)
Females more
20-40yrs
216
What is giant cell malignancy
Histology
Site affected
Borderline malignany
Osteoclast-type multinucleate giant cells on background of spindle/ovoid cells
knee/end of long bones
217
Immune cells involved in acute inflammation
Neutrophils
218
Cells associated with chronic inflammation
Lymphocytes
219
Bilobed nucelus and granular cell
Eosinophils
220
Eosinophil associated conditions
Allergy
Parasites
Tumours (Hodkins)
221
Keratin producing carcinoma with intercellular bridges
SCC
222
Mucin producing carcinoma from glands
Adenocarcinoma
223
Breast pathology shows: Dilation in one or more of the large lactiferous ducts
Name condition
Epidemiology
Cytology
Duct ectasia - inflammatory
Multiparous, 40-60yo women. Smokers
Nipple discharge cytology:Proteinaceous material, inflammat ory cells
224
Thick white nipple secretions
Name condition
Other symptoms
Duct ectasia - no increased risk of malignancy
| Mass, nipple retraction due to fibrosis
225
Lactating woman with painful red breast and fever
Name condition
Associated with
Acute mastitis - inflammation of breast - no risk of cancer
- due to cracked skin and stasis of milk
Complicates duct ectasia
Staph infection
226
Treatment of acute mastitis
Painful red breast and fever in lacting woman
| tx: Antibiotics + treatment of duct ectasia (drainage)
227
Painless breast lump after trauma, surgery, radiotherapu, nodular panniculitis
Epidemiology
Histology
Fat necrosis - inflammatory reaction to damaged adipose tissue (typically obese middle aged)
- Onset can be 10yrs after trauma
benign but can mimic cancer
Fat cells surrounded by inflammatory cells e.g. foamy macrophages, giant cells, lymphocytes and plasma cells
- Later: fibrosis and calcification
228
What is fibrocystic disease of breast
Risk of subsequent breast cancer
Group of alterations in breast which reflect normal but exaggerated response to hormones - benign
- Cystic change - often calcified
- Fibrosis secondaru to cyst rupture
- Adenosis - increased number of acinar per lobule (normal in pregnancy
Benign - no risk
229
Breast mouse
Name condition
Age of presentation
Management
Fibroadenoma - spherical, freely mobile, variable size and rubbery - benign. Fibrous epithelial tumour. Compressed slit like ducts
Any reproductive age, usually 20-30yrs
Shelling out is curative
230
Fibroadenoma histology
Stromal and fibrous cells
231
What is Phyllodes tumour
Arise from interlobular stroma (like fibroadenomas - can arise within existing or de novo), with increased cellularity and mitoses
In >50yo presents as a palpable mass
Low grade or high grade. Most benign but can be aggressive
232
Phyllodes tumoru cytology
Overlapping cells
| Leaf like frongs on histology
233
Bloody discharge form nipple
Ductal papilloma - benign papillary tumour arising within duct system of breast
NO LUMP, not seen on mammogram.
3D clusters on cytology
```
Central = from large lactiferrous ducts. May bleed
Peripheral = from terminal ducts
```
234
Ductal papilloma histology
3D clusters on cytology
235
What is radial scar
Management
Benign sclerosing lesion in breast - central scarring surrounded by proliferating glandular tissue in stellate pattern
Offer excision because of v small chance of malignancy in surrounding breast
236
Eczema around nipple and darkening of areola
Name of this
Condition associated
Paget's disease of the nipple
Breast cancer - 10% of ductal carcinomas in situ have this
237
Ductal carcinoma in situ detection
Prognosis
Classification
Appear as areas of microcalcification on mammography
Much increased risk of progressing to invasive breast Ca
Low, intermediate, high grade
238
Breast biopsy - punched out spaces that are regular and round, overlapping cells, calcified
Management
Ductal carcinoma in situ
Complete surgical excision with clear margins = curative
Higher grace DCIS - more likely to occur.
239
What is invasive breast carcinoma
Malignant tumours epithelial, which infiltrate teh breast and
Tumour gone out of BM and invaded the stroma
240
Mutation associated with breast cancer
BRCA 1 and BRCA 2
241
Breast histology (suspected cancer): Cells aligned in single file chains/strands
Invasive lobular cancer
242
Breast histology (suspected cancer): well formed tubules with low-grade nuclei. Rarely palpable as <1cm
Tubular carcinoma
243
Breast histology (suspected cancer): Sheets of atypical cells with lymphocytic infiltrate
Basal like carcinoma
Stain positive for CK5/6/14
Often associated with BRCA mutations
Cam spread to vascular invasion and distant metastatic spread
244
How are breast cancers graded
```
Core needle biopsy to assess nuclear pleomorphism, tubule formation and mitotic activity
Scored 3 for each
3-5: grade 1
6-7: grade 2
8-9: grade 3
```
245
Receptor status of breast carcinomas
Low grade tumours: ER/PR +ve and HER2 -ve
High grade tumours: HER2 +ve, ER/PR -ve
Basal like carcinoma: Triple negative
246
Prognostic factors breast cancer
Most important: axillary lymph nodes
But also: tumour type, histological type and grade
247
Age of breast cancer screening
50 to their 71st birthday every 3 years.
248
Breast histology male breast in gynaecomastia
Epithelial hyperplasia, finger like projections into ducts
249
SLE symptoms and signs
S: serositis
O: oral ulcers
A: arthritis
P: photosensitivity
B: blood disorders (AIHA, ITP, pancytopenia)
R: renal involvement
A: ANA+
I: Immune phenomena (dsDNA, anti-smith, anti-histone - drug related, anti-SM, antiphospholid)
N: Neuro symptoms
M: Malar rash
D: discoid rash
250
Skin histopathology in SLE
Lymphoycte infiltration of upper dermis, extravasation of RBC in upper dermis, vacules in basal dermis
Immunofluorescence: Immune complex deposition between dermis and epidermis
251
Renal histopathology in SLE
Thickening of capillary walls in glomerulus (thick pink wall) - wire loop
- because immune complex deposition in basement membrane
252
Cardiac histopathology in SLE
Non-infective endocarditis - vegetations on valves called Libman sacks
253
What is the definition of scleroderma
Fibrosis and excess collagen. (localised form is called morphea in the skin)
2 types:
Limited (CREST) - anticentromere ab
Diffuse - anti topoisomerase ab (aka scl70)
254
Anti-centromere antibody +
| Name condition + features
Limited scleroderma
Skin changes limited to face and distal to elbows and knees
```
Calcinosis
Raynauds
Eosophageal dysmotility
Sclerodayctyl
Telangectasia
```
Pulmonary HTN
255
Anti-topoisomerase ab +
| Name condition + features
Diffuse systemic scleroderma
Skin changes anywhere + CREST + Widespread organ involvement
Pulmonary fibrosis
256
HLA DR5 and DRw8 associated with
Both types of systemic scleroderma
257
Histology in scleroderma of skin
Excess collagen.
| Onion skin thinning of arterioles - obliteration of lumen
258
What is mixed connective tissue disorder
Overlap of SLE, scleroderma, Polymyositis, Dermatomyositis
259
SLE HLA association
DR3 or DR 2
260
Nucleolar pattern of ANA staining
Scleroderma
261
Speckled pattern of ANA testing
Mixed connective tissue disorder
262
Tender inflammed muscles, proximal muscle weakness
+
Erythematous rash over knucles name
Erythematous rash over eyes
Dermatomyositis
Gottron's paupules
Heliotrope rash
263
Lymphadenopathy, arthritis, erythema nodosum, bilateral hilar lymphadenopathy
Condition and other organs that may be affected
Sarcoidosis - non-caseating granulomas
Skin - lupus pernio (nose), skin nodules
Kidneys, eyes, Liver, heart, neuro
264
Asthma, eosinophilia and vasculitis
Diagnosis
Test to do
Eosinophilic granulomatosis with polyangitis (small vessel vasculitis)
pANCA (anti-MPO)
265
ENT, Lung, kidney involvement
Diagnosis
Test to do
granulomatosis with polyangitis
cANCA
266
What is sarcoid
Multisystem disease of non-caseating granulomas
- skin
- lung
- joints
- lymph nodess
267
Most common thyroid cancer
| Histology
Papillary - non-functioning, may get cervical lymphadenopathy mets
May be Psommoma bodies
Optically lear nuclei
Intranuclear inclusions
Prognosis good
268
Follicular carcinoma of thyroid metastasize to where
lung, bone, liver
269
Medullary carcinoma of thyroid histopathology
80% sporadic in 40-50yo, 20% MEN in younger
Derive from parafollicular C cells - produce calcitonin
This calcitonin broken down and deposited as amyloid - STAIN
270
Define cerebral oedema
Causes
Result
How is cerebral oedema reduced?
Excess accumulation of fluid in the brain parenchyma
1) vasogenic - disruption of blood brain barrier
2) cytotoxic - secondary to cellular injury aka hypoxia/ischaemia
Raised ICP
Brain reduces oedema itself by
- tightening tight junctions
- astrocytes actively effluxing water
- water going into ventricles
Steroids can also reduce oedema
271
Nephron filtration through various parts
1) PCT: Active reabsorption Na, also glucose, AA Phosphate, K
2) LOH
- D/thin limb: Only permeable to water
- Asc limb: Active reabsorption of Sodium and chloride
3) PCT:
- pH balance - active transport H+/HCO3-
- Na, K regulation - active transport (aldosterone)
- Calcium regulation (PTH, 1,25 vit D)
4) CD
- water reabsorption (ADH)
- pH regulation (proton excretion)
272
Polycystic kidney disease presentation
Genes
Associated conditions
HTN, haematuria, flank pain
PKD1, PKDS2
Liver cysts
Berry aneurysm
273
Asymptomatic haematuria causes
1) Thin basement membrane disease (benign familial haematuria) - hereditary defect in type IV collagen. Benign in most, may lead to scarring in few
2) IgA nephropathy (Berger disease)
- Commonest glomerulonephritis WW. IgA predominant deposition in glomeurli. Often macroscopic/microscopic haematuria. MAY cause proteinuria, AKI.
- Aetiology not well understood.
- Can be seen with HSP
Alport syndrome
274
Causes of acute renal failure
Pre-renal
- Failure of perfusion
Rena;
- Acute tubular injury (most common cause)
- Acute glomerulonephritis
- Thrombotic microangiopathy
Post-renal
- Obstruction to urine flow
275
Causes of ATN
Histopathology
Hypovolaemia
Nephrotoxins: aminoglycosides, NSAIDs, contrast, Hb, myoglobin, ethylene glycol
Necrosis of short segments of tubules
276
Benign renal tumours
1. Papillary adenoma
- Formed of papillary cells ± tubules
- <15mm by definition
- Trisomy 7, loss of chromosome Y
2. Renal oncocytoma
- PINK oncocytic cells
- Naked eye - mahogany brown with central scar
3. Renal angiomyolipoma
- Made of blood vessels, smooth muscle and fat
- Can be seen in tuberous sclerosis
- Remove if >4cm
277
Malignant renal tumours
1. Clear cell renal carcinoma
- Most common type - linked to vhl
- Clear cells = small round blue cells in capillary network
- LEIBOVICH RISK MODEL (risk progression index)
- Loss of Chr 3p
2. Renal papillary carcinoma
- Papillary cells FRIABLE FRAGILE BROWN
- >15mm by definition
- Loss of chromosome Y, trisomy 7
3. Chromophobe renal cell carcinoma
- Different coloured cells
- Distinct cell borders and thick vascular walls
4. Nephroblastoma
- Made of 3 layers of tissue: stromal, epithelial and blastoma
- Children
- Good prognosis
278
Bladder cancers
Transitional cell carcinomas
- Most common bladder cancer
- Associated with smoking and aromatic amines
- Painless haematuria
- 3 subtypes: Clear cell transitional carcinoma, Infiltrations transitional carcinoma and flat epithelial carcinoma in situ
SCC
- Associated with Schistosomiasis
Adenocarcinoma
- Rare
279
Prostate pathology
Benign Prostate Hyperplasia
- Increase in the numbers of cells in the prostate
- Very common, aetiology unknown
- Presents with LUTS
- Mx - alpha-blockers (tamsulosin), 5a=reductase inhibitors (finasteride), TURP
Prostate cancer
- Develops from prostate intraepithelial neoplasia
- Risk factors = smoking, FHx, red meat consumption
- Prognosis - GLEASON SCORE
280
What are the two layers of epithelium in breast tissue?
- Outer layer = myoepithelium
| - Inner layer = luminal cells
281
What's the terminal duct lobular unit?
Duct + acinar tissue
All breast cancers arise from here
282
Inflammatory breast disease
DUCT ECTASIA
- Inflammation and dilation of breast duct
- Smoking = biggest risk factor
- Lump with thick white nipple secretions
- There can be slit-like nipple retraction
- Cytology of nipple discharge = proteinaceous material, inflammatory cells
ACUTE MASTITIS
- Inflammation of breast tissue
- Associated with lactation(Staphyloccal infection)
- If not lacating - keratinising squamous metaplasia
- Painful tender breast
- Neutrophils
- Incision & drainage + Abx
FAT NECROSIS
- Inflammatory reaction to adipose injury e.g. radiotherapy
- PAINLESS breast lump
- Giant multinucleate cells
283
Benign breast disease
Fibrocystic breast disease
- Fibrous and cystic changes to breast tissue
- Changes with cycle
- Calcification may be seen
Fibroadenoma
- Fibrosis of stroma and glandular tissue
- Mouse
- Generally self-resolving
Phyllodes tumour
- Leaf-like
- Malignant potential
- Pink = benign, purple = malignant
Duct papilloma
- NO LUMP!!!
- Central papillomas - arise from large lactiferous ducts
- Perpheral papillomas - arise from small terminal ductules
- Central papillomas can give bloody discharge
Radial scar
- Central scarring surrounded by proliferating glandular mesenchyme
- Excise, because there can be malignancy at the edges
284
Proliferative breast disease
Usual epithelial hyperplasia
- Proliferation of the epithelial cells - 4-5cells thick into lumen
- No direct increase risk in malignancy (yes it is?)
- Serrated lumen
Atypical ductal hyperplasia
- Epithelial proliferation - multiple layers of cells
- Rounded lumen
- 4 x risk of cancer so remove
Atypical lobular hyperplasia
- Proliferation into the acinar space
- May not be able to see lumen
- 7-12x risk of cancer
285
Breast cancer - carcinoma in situ
30% of breast cancer
- Can be DUCTAL (DCIS) or LOBULAR (LCIS)
Lobular CIS
- Loss of E-adherin
Ductal CIS
- Areas of calcification
- Intraductal epithelial proliferation along the length of the duct
- Low-grade - cribriform appearance
- High-grade - larger cells, can't see lumen well, only one central lumen, containing necrotic material
286
Invasive breast cancer
- Invasion through the BM and INTO STROMAL TISSUE
- Associated with high lifetime oestrogen exposure and BRCA mutation
Types of invasive breast cancer
- Ductal - large pleomorphic cells, abnormal chromatin, invading into stroma
- Tubular - elongated tubules of cells
- Lobular - linear arrangement of cells in Indian file pattern
- Mucinous - lots of mucin production
- Basal like carcinoma - sheets of markedly atypical cells
287
Breast basal-like carcinoma
Sheets of atypical cells with predominantly lymphocytic infiltration
- Associated with BRCA mutations
- Positive staining for CK5/6, CK14
- Usually triple-negative
Propensity to invade vasculature and spread disstantly
288
Breast cancer screening
- All women aged 47-73, every 3 years
- Looks for masses and abnormal calcification
- If mammogram is abnormal, may need to be recalled for further investigation
- Triple assessment = examination + USS + FNA/core biopsy
289
Benign bone tumour
Osteochondroma
- Age 10-20, M>F
- Cartilagenous surface overlying the normal bone
- Affects knees and elbows
Endochondroma
- Cartilganeous proliferation within the bone
- Hands and feet
- X-ray - POPCORN CALCIFICATION
Giant cell tumour
- Borderline malignancy
- Malignant stromal cells
- Occurs in the epiphyses and can burst through the bone into surrounding tissue
- X-ray - lytic lesions
- Histology - osteoclasts, on a background of spindle cells
290
Malignant bone tumours
- Osteocarcoma :(
- Chondrosarcoma :)
- Ewing's sarcoma :/
291
Patterns of injury in acute pancreatitis
- Periductal injury - most common, usually secondary to obstruction
- Perlobular injury - necrosis at edges of lobules
- Panlobular injury - develops from periductal or perilobular injury
292
Pancreatic neoplasms
CARCINOMA
- 85% of all pancreatic cancers are ductal carcinomas
- Acinar carcinoma
CYSTIC NEOPLASMS - usually benign
- Seroud cystadenoma
- Mucinous cystadenoma
293
Pancreatic ductal carcinomas
Usually at head of pancreas
- K-RAS MUTATION!!
Ductal carcinoma arises from dysplastic ductal lesions in one of 2 pathways:
1. Pancreatic Intraductal Neoplasm (PanIN)
2. Intraductal Mucinous Papillary Neoplasm (IMP)
294
Chronic cholecystitis
1. Thickened GB wall
2. Rokitansky Acschoff sinuses
- Diverticula in the gallbladder
- Seen in chronic cholecystitis
- Occur with gallstones
295
Gastric cancer
- Intestinal - well differentiated
- Diffuse - poorly differentiated (linitis plastica, signet ring cell)
Signet ring cell - contains mucin which pushes nucleus to cell periphery
- Can metastasise to ovaries =Krukenburg tumour
296
Types of haemorrhage and bleed
Extra dural = middle meningeal artery. Trauma + lucid interval
Subdural = Communicating veins. Trauma
297
Endometrial cancer types
Endometrioid - perimenopausal, oestrogen sensitive, good prognosis
Non endometrioid - clear cell, older, bad, hobnail
298
Ovarian cancers
Ovarian sex cord tumours most common in post menopausal women
- Granulosa-theca cells (& therefore tumours) convert androgens to oestrogen
- Sertoli-Leydig - androgen
- Ovarian fibroma - Meig’s syndrome (ascites + pleural effusion)
Germ cell: teratoma, dysgerminoma, choriocarcinoma (secrete hCG)
Epithelial - most ovarian tumours
- Serous - most common, psammoma bodies
- Mucinous - mucin secreting cells
- Endometrioid - tubular glands
- Clear cell - hobnail
299
Alzheimer's
Cortical atrophy
Neurofibrilary tangles of tau
a B amyloid plaques
300
Rheumatic fever
Strep pyogenes. Mitral valve - antigenic mimicry
Histology: beady fibrous vegetations (veruccae)
- Aschoff bodies (small giant cell granulomas)
- Anitschov myocytes (regenerating myocytes)
```
2 major or 1 major + 2 minor
Cardititis
Arthritis
Sydenhams chorea
Erthema marginatum
Subcutaneous nodules
```
Minor: Fever, ESR/CRP, micgratory arthralgia, previous rheumatic fever, malaise, tachy
Vegetations are small and warty
TREATMENT = BEN PEN (Erythryomycin if allergic)
301
Cardiomyopathy
Restrictive
- Caused by sarcoid, amyloid, radiation
- HF due to diastolic dysfunction
- Pericardial constriction
Hypertrophic
- Caused by genetic, storage diseases
- HTN, AS
- HF due to diastolic dysfunction
Dilated
- Caused by: alcohol, genetic, myocarditis, haemochromatosis,
- HF due to systolic dysfunction
- IHD, valvular HD, HTN, congenital HD
302
Saddle shaped ST wave
Pericarditis
Chest pain relieved on sitting forward. Pericardial rub
303
Genetic defect in myofilament formation leading to huge mytoses
Hypertrophic cardiomyopathy
- often go on to develop dilated cardiomyopathy
- AD inheritance
HOCM is obstruction of outflow tract!! = sudden death
304
Who should do the MCCD
Reasons for referral to coroner
Last doctor to attend to the patient
Cause unknown
Not seen by a doctor during illness/last 14 days
During or within 12 months of pregnancy
Death in custody, while detained under Mental Health Act
Death due to suicide
Accident, trauma, industrial
Medical/surgical treatment
Abortion, anaesthetic care, lack of medical care, murder, self neglect
305
HTN in upper extremities
co-arctation of the aorta
306
Disease that affects the external caratid
GIANT CELL ARTERITIS
307
ground glass appearance of lungs in adult
Diffuse alveolar damage
Due to infection, aspiration, trauma, inhaled irritants, blood transfusion, DIC, drug overdose, pancreatitus, idiopathic
Exudative phase --> hyaline membranes --> organising phase (granulation sitting in alveolar spaces)
40% die
Some resolve, some have residual fibrous scarring
