Histopathology Flashcards by Sachin Ananth

Caseating necrosis

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What type of epithelium has intercellular bridges?

Squamous

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What type of epithelium has keratin?

Squamous

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Stain used for amyloid

Congo Red (stains amyloid bright red)

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Amyloid under polarised light looks like…

Apple green birefringence

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Villous atrophy and crypt hyerplasia

Coeliac

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Antibodies in Coeliac

Anti-EMA and anti-TTG (endomysial and tissue transglutaminase)

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Skin complication of coeliac

Dermatitis herpetiformis (“blistering rash on elbow/knees”)

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Pancreatic calcifications

Chronic pancreatitis (diagnostic)

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What cancer type is “mucin-secreting glands set in desmoplastic stroma”

Adenocarcinoma

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Rosette Cells

Neuroendocrine tumours

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Rokitansky-Aschoff sinus

Chronic Cholecystitis
• Diverticula in gall bladder (due to obstruction)
o Gallbladder pumps harder to get rid of obstruction
o –> Increases pressure inside gallbladder
o –> Rokitansky-Aschoff sinus:

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Liver with lots of nodules

Cirrhosis (nodules = regenerating hepatocytes)

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Liver biopsy shows nodular hepatocyte with collagen cuff around it

Cirrhosis

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Spotty necrosis and interface hepatitis

Acute hepatitis
(Spotty necrosis = foci of inflammation and apoptosis-> happens in all acute hepatitis)
(Interface hepatitis = can’t see where hepatocytes end and portal tract begins = T cell destruction of hepatocytes)

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Ballooning of hepatocytes

Alcoholic hepatitis (most important feature – shows that they are apoptosing)

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Bowel disease where don’t pass meconium in first 24 hrs

Hirschsprung’s Disease

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Pericellular fibrosis around hepatocytes

Alcoholic hepatitis

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Liver disease causing itchy skin

Primary Biliary Cholangitis (bile acids escape to circulation)

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Test for Primary Biliary Cholangitis

Anti-mitochondrial antibodies

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Gut disease occurring in “watershed zones” (splenic flexure and rectosigmoid)

Ischaemic Colitis (watershed zones are far from gut’s blood supply)

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ERCP: “beaded appearance”

Primary Sclerosis Cholangitis

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Chocolate brown liver

Haemachromatosis

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What stain used for iron in Haemachromatosis?

Prussian Blue (brown iron stained blue)

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What stain used in Wilson's Disease?

Rhodamine stain

Eye sign in Wilson's Disease

Kayser-Fleischer rings (brown ring around edge of iris)

Very steroid responsive liver disease

Autoimmune hepatitis

Hirschsprung’s Disease associated with which congenital disease?

Down Syndrome

Mallory-Denk Bodies

Alcoholic hepatitis (hepatocyte damage)

Liver disease with increased gamma globulin

Primary Sclerosis Cholangitis

IBD: Whole GI tract affected (mouth to anus)

Crohn's

IBD: Only large bowel affected = moves upwards from anus

Ulcerative Colitis

IBD: Inflammation confined to mucosa (not though wall)

Ulcerative Colitis

IBD: Cobblestone mucosa

Crohn's

IBD: Crypt abscess

Ulcerative Colitis

IBD: Transmural inflammation

Crohn's

Lip and mouth complications of Crohn's

``` Cheilitis = inflammation of lips (look dry and cracked) Stomatitis = mouth ulcers ```

Extra-intestinal complication of Ulcerative Colitis

Primary Sclerosing Cholangitis

Skin complication of Crohn's

Erythema multiforme/nodosum

Dangerous bowel complication of Ulcerative Colitis

Toxic megacolon

Ulcerative Colitis increases risk of which cancer?

Bowel Adenocarcinoma

Mouth ulcers in which GI condition?

Crohn's

Familial Adenomatous Polyposis involves mutation in which gene?

APC tumour suppressor gene (chromosome 5q21)

Colorectal cancer in very young person. What disease do they have?

Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - poorly differentiated and mucinous carcinomas - often carcinomas proximal to splenic flexure

Brain biopsy shows piloid “hairy” cell with Rosenthal fibres

Pilocytic Astrocytoma

Heterogeneous and enhancing brain tumour

Glioblastoma Multiforme

Brain tumour with long history of neuro signs/seizures

Oligodendrogliomas

Co-deletion is specific for which brain tumour?

Oligodendrogliomas (co-deletion of 1p/19q)

Cystic cerebellar lesions

Pilocytic Astrocytoma

Whorl pattern (spirals) on brain biopsy

Meningioma

Brain cells look like fried eggs (round cells with clear cytoplasm)

Oligodendrogliomas

Small blue round cell brain tumour, with Homer-Wright Rosettes

Medulloblastoma

Brain tumour in patient who had lobectomy 5 years ago

Brain mets (lobectomy = previous cancer)

Medulloblastoma expresses this neuronal marker

Synaptophysin

Can't see gyrae on brain MRI

Cerebral Oedema (can't see gyrae because tightly compressed)

T2-weighted brain MRI shows "target sign"

Cavernous Angioma

Head injury with runny nose and ears

Skull fracture (esp hairline fracture = extend into base of skull)

Beta-amyloid plaques in Hippocampus

Alzheimer’s Disease

What protein accumulates in Parkinson's?

Alpa-synuclein (forms Lewy Bodies)

Balloon Neurones

Pick’s Disease

Cortical atrophy on brain MRI (Widening of sulcae, shrinkage of gyrae)

Alzheimer’s Disease (lose brain tissue)

Frontotemporal atrophy on brain MRI

Pick’s Disease

Amyloid lines cerebral vessel walls

Alzheimer’s Disease

Tau protein

Alzheimer’s Disease

Pick Bodies in hippocampus

Pick’s Disease

What genetic condition increases risk of kidney cancer?

Von Hippel Lindau

Cancer with frond-like growths (like a leaf)

Non-Invasive Papillary Urothelial Carcinoma

Testicular cancer which can differentiate into other cancer types (e.g. lung)

Post-Pubertal Teratoma

Schiller-Duval Body

Yolk Sac Tumour (testicular cancer in <3yrs)

Testicular cancer presenting with precocious puberty

Leydig Cell Tumour (releases hormones)

Skin disease which is Nikolsky’s Sign Positive

Pemphigus Vulgaris (slight rubbing detaches upper epidermis from lower epidermis)

Skin bubbles which do not easily rupture

Bullous Pemphigoid

Skin disease with hyperkeratosis

Contact Dermatitis (epidermis thicker after scratching)

Silvery plaques on extensor surfaces

Plaque Psoriasis

Skin disease with white lines in mouth

Lichen Planus

Horn cysts

Seborrhoeic Keratosis (entrapped keratin- surrounded by proliferating epidermis)

Skin bubbles which easily rupture

Pemphigus Vulgaris

Skin lesion with smooth surface, non-mobile, central punctum

Sebaceous Cyst

Skin lesion with rolled pearly white border, central ulceration

Basal Cell Carcinoma

Crusty, non-healing ulcer with everted edge on sun-exposed areas

Squamous Cell Carcinoma

Weird horns growing on skin

Bowen’s Disease = Early Form of SCC

Rodent Ulcer

Basal Cell Carcinoma

Stain for melanin

Fontana stain

Herald Patch

Pityriasis Rosea (salmon-pink, scaly --> rash on trunk)

Skin cancer which does NOT metastasise

Basal Cell Carcinoma

Skin viral infection which causes target lesions

Pityriasis Rosea = HHV6/7 (get URTI before rash)

Low-risk HPV types

HPV 6 and 11

High-risk HPV types

HPV 16 and 18

Bone disease with mottled rarefaction (bone thinner) and lifting of periosteum

Osteomyelitis

Bone biopsy contains multinucleated Langerhans-type Giant cells

TB Bone Disease

Joint disease with osteophytes

Osteoarthritis

Joint disease with spares the distal interphalangeal joint

Rheumatoid Arthritis

Grimley-Sokoloff cells in biopsy

Rheumatoid Arthritis (multinucleated giant cells specific for RA)

Bone X-Ray shows “onion-skinning” of periosteum

Ewing’s Sarcoma

Bone disease with Codman Triangle on X-Ray

Osteosarcoma - see in kids

Bone X-Ray is lytic with fluffy calcification

Chondrosarcoma

Joint disease with subcondral sclerosis and subcondral cyst

Osteoarthritis

Bone disease with sheets of small round blue cells on biopsy

Ewing’s Sarcoma

Lung disease with Curschmann’s Spiral

Asthma

Lung infection which does not have consolidation on CXR, but shows patchy changes. Terminal event which kills off old person.

Bronchopneumonia

Central lung tumour

Squamous Cell Carcinoma

Lung cancer containing "large cells"

Large Cell Carcinoma

Oat-shaped lung cells on biopsy

Small Cell Lung Cancer

Cancer which causes pleural thickening

Mesothelioma

Peripheral lung tumour

Adenocarcinoma

Ovarian cancer type which is strongly associated with endometriosis

Clear Cell Carcinoma

Ovarian cancer which causes virilisation

Sertoli-Leydig Cell tumour: makes androgens

Ovarian cancer which differentiates into all types of human tissue (teeth, hair, brain)

Mature Teratoma (germ cell tumour)

Painful red breast, very tender on palpation

Acute Mastitis

Hard, firm breast lump

Fat Necrosis

Lumpy breast

Fibrocystic Disease

Breast lump which shows leaf-like throngs of stroma on biopsy

Phyllodes Tumour (Phyllodes means leaf)

Breast lump which shows 3D cluster of cells on biopsy

Intraductal Papilloma

Stellate masses on mammogram (incidental finding)

Radial Scar

Breast cancer causing eczema around nipple

Ductal Carcinoma in Situ | Paget’s Disease of the Nipple = because DCIS goes along ducts--> can arise at nipples= where all ducts lead to…

Breast cancer which has "India File pattern" on biopsy

Lobular Carcinoma

Breast cancer with sheets of atypical cells with lymphocytic infiltrate

Basal-Like Carcinoma

Breast cancer recognised as microcalcifications on mammogram

Ductal Carcinoma in Situ

Most important prognostic marker in breast cancer

Spread to axillary lymph nodes

Autoimmune condition with Libman-Sacks cardiac sign

Systemic Lupus Erythematosus | Libman-Sacks = non-infective endocarditis

Antibodies for diffuse systemic sclerosis

Anti-topoisomerase antibodies

Antibodies for limited systemic sclerosis

Anti-centromere antibody

Gottron's Papules on fingers

Dermatomyositis

"Wire-looping" of glomeruli on biopsy

SLE (thickened glomerular capillary loops due to immune complex deposition in basement membrane surrounding capillaries)

Anti-Smith used in which autoimmune condition?

SLE

Small arteries look like onion skins on biopsy

``` Systemic Sclerosis (intimal thickening of small arteries --> hypertensive crisis) ```

Autoimmune condition with lupus pernio (ring splodgy lesion at bottom of nose)

Sarcoidosis

Palpable purpuric rash

Vasculitis

Erythema rash of palms & soles--> desquamation (peeling)

Kawasaki’s Disease

“Rosary sign” on angiogram

Polyarteritis Nodosa (Small aneurysms strung along arteries)

Antibody in Wegener's (Granulomatosis with polyangiitis)

C-ANCA against proteinase 3

Antibody in Churg-Strauss (Eosinophilic Granulomatosis with polyangiitis)

P-ANCA against myeloperoxidase

Vasculitis after chest infection in child

Henoch-Schonlein Purpura (HSP)

Autoimmune condition with ENT, lung and kidney problems

Wegener's (Granulomatosis with polyangiitis)

Statins inhibit this enzyme

HMG-CoA Reductase

Which protein can cause restrictive cardiomyopathy?

Amyloid

Palpable spleen with notch, and microscopic haematuria

Subacute bacterial endocarditis | slowly develops, due to friendly bacteria like strep viridans

Hurthle cells

Hashimoto's | thyroid epithelial cells are enlarged, filled with eosinophils

Psammoma Body

Papillary Thyroid Carcinoma

Which thyroid cancer produces amyloid?

Medullary Thyroid Carcinoma

A 46 year old women presents to A&E out of breath and with severe chest pain. On examination a mid systolic click late systolic murmur is revealed.

Myxomatous mitral valve | causes mitral valve prolapse

Cystic tumour lined by epithelium

Cystadenoma

A 38 year old female with Rheumatoid Arthritis presents with a single episode of malaena. Investigations reveal erosions through out the stomach and a neutrophilic infiltrate in the superficial mucosa

Acute Gastritis

Which ulcer is relieved by meals, and which is worsened?

Duodenal ulcer relieved by meals | Gastric ulcer worsened by meals

Positive CLO test

Duodenal ulcer

A jejunal biopsy showed periodic acid-Schiff (PAS)-positive macrophages

Whipple's disease

‘Leather bottle stomach’ (infiltration into all layers of the gastric wall) Signet ring cells on biopsy

Adenocarcinoma

Sarcoidosis has raised levels of which enzyme?

ACE!

Stomach looks like a leather bottle, and contains signet-ring cells

Gastric carcinoma

Carcinogen which directly causes hepatocellular carcinoma

Aflatoxin (made by Aspergillus- seen in cereals and nuts)

Mobile breast lump which grow during menstrual cycle

Fibroadenoma (oestrogen causes to grow)

Breast disease with peau d'orange, Paget's Disease of Breast, nipple retraction

Infiltrating Ductal Carcinoma (arise from DCIS)

Inverted U loop of bowel

Sigmoid volvulus

Constipated with abdo pain that is relieved by pooing

Diverticular Disease

Cauliflower-like mass covered by dysplastic columnar epithelium in the rectum

Villous adenoma

Widespread itching, plethoric and hepatosplenomegaly

Polycythaemia rubra vera

Green-brown discolouration at the peripheries of her corneas | +confusion and tremor (in young person)

Wilson's Disease

Old man with palpable mass in right loin, and hypercalcaemia

Renal Cell Carcinoma | hypercalcaemia = humoral hypercalcaemia of malignancy

Old man with dysuria, frequency and red urine

``` Bladder Cancer (red urine = FRANK haematuria) ```

Ovarian cancer containing different cell types (thyroid, hair, teeth)

Cystic Teratoma

Antibody used to diagnose CREST

Anti-centromere

T2DM drug which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel

Acarbose | leaves undigested sugar in the bowel giving wind as a side effect

Bone biopsy reveals sheets of cells with small, primitive nuclei and scanty cytoplasm. A positive immunoreactivity is seen with the MIC2 (CD99) antibody.

Ewing's sarcoma

Mottled rarefaction and lifting of the periosteum are seen on X-ray

Osteomyelitis

Lung cancer subtype with bilateral ptosis and proximal weakness in the limbs which improves on repeated testing

Small cell carcinoma

Young person with thyroid lump and high thyroglobulin = what type of thyroid cancer?

Papillary carcinoma

Hyperthyroid, then hypothyroid, then euthyroid (with fever)

De Quervain's

Largest ovarian neoplasm (90% benign)

Mucinous Tumour

Ovarian cancer: fibrous tissue containing spindle cells and lipid

Thecoma

Ovarian cancer: malignant cells surrounded by serous fluid and Psammoma bodies

Serous cystadenocarcinoma

Ovarian cancer: malignant signet ring cells containing mucin

Krukenberg tumour

Painful ulceration of the vulval skin. Intraepithelial blisters, intranuclear viral inclusions and eosinophilic cytoplasmic swelling

HSV

Pap smear taken from a chronic granulomatous ulcer shows a necrotic centre, periarteritis and endarteritis obliterans and an intense peripheral cellular infiltrate consisting mainly of mononuclear cells and giant cells.

Treponema pallidum (syphilis)

Vaginal irritation -- silver stain reveals fungi within the keratin layer and superficial epithelium

Candida albicans

The metaplasia that occurs in the transformation zone involves which cell-types?

Glandular to squamous epithelium

Anti-topoisomerase antibody

Diffuse Scleroderma (needs involvement of one internal organ)

Anti-centromeres antibody

Limited scleroderma (skin manifestations and CREST)

H. Pylori affects which part of the stomach the most?

Pyloric antrum

HLA associated with Type 1 DM

HLA DR3 and DR4

Pain in femur/hip X-Ray: "soap bubble" appearance (osteolysis) and Shepherd's Crook Deformity Biopsy: irregular trabeculae of woven bone - looks like Chinese letters

Fibrous Dysplasia = lesions containing fibrous and bone tissue

Most common cause of lobar pneumonia

Strep pneumoniae = 95% lobar pneumonia!

1. Central lung tumour | 2. Peripheral lung tumour

1. Squamous Cell Carcinoma | 2. Adenocarcinoma

"Spares the distal interphalangeal joint"

Rheumatoid Arthritis

Bamboo spine (fusion of spine)

Ankylosing Spondylitis

White cell casts in urine

Acute pyelonephritis

Red cell casts in urine

Glomerulonephritis

Eosinophils in urine

Tubulointerstitial Nephritis

ANCA and vasculitic rash -- what type of glomerulonephritis?

Pauci-immune crescentic glomerulonephritis

IBD: "rubber hose" gut wall

Crohn's Disease

Early bowel cancer, with adenomata in large bowel

Familial Adenomatous Polyposis (FAP) | -autosomal dominant (mutation in FAP gene on Chr5)

Early bowel cancer, with no adenomata in large bowel

Hereditary Non-Polyposis Colorectal Cancer (HNPCC) | -autosomal dominant

Breast biopsy shows necrosis with multinucleated giant cells --> fibrosis

Fat Necrosis

Pepperpot skull

Primary Hyperparathyroidism

Raindrop skull

Multiple myeloma

Blood-stained nipple discharge --> lump has branching fibrovascular cores covered by cytologically bland epithelium

Duct Papilloma

Hard, calcified lump --> cells have pleomorphic nuclei and that the lump has a necrotic centre

Ductal Carcinoma in situ

Multifocal lumps in young person

Lobular Carcinoma in situ

Nipple retraction

Invasive Carcinoma

Firm palpable mass with signs of tethering. 4-month history of back pain

Invasive Carcinoma

What causes galactorrhoea in hypothyroidism?

Increased TRH

Tender bump, but contains inflammatory cells and proteinaceous debris only. A few weeks after giving birth

Duct Ectasia

Firm breast lump -- histology: long clefts with myxoid cellular stroma

Phyllodes Tumour

Back and neck pain which improves with exercise. | Spinal X-rays show ‘bony bridges’ between the vertebrae.

Ankylosing Spondylitis

Arthritis, urethritis and conjunctivitis -- after GI/STI infection

Reiter's Syndrome = Reactive Arthritis ("can't see, pee or bend their knee")

Pemphigus vulgaris has antibodies against what?

Desmoglein-1 and 3 (cadherins in epidermis)

Hep B associated with this vasculitis

Polyarteritis nodosa (immune complexes deposit in vessels --> necrosis --> aneurysms)

Acantholytic cells on skin biopsy

Pemphigus vulgaris -- acantholytic = separation of keratinocytes due to loss of cadherin connections

Antibodies against hemidesmosomes of skin basement membrane

Bullous pemphigoid

Causes "backwash ileitis"

Ulcerative Colitis (backwash of poo into ileum --> ileitis)

Liver tumour in woman taking COCP

Hepatic Adenoma --> need to avoid pregnancy

Biliary brush cytology shows cellular discohesion and a high nuclear/cytoplasmic ratio

Cholangiocarcinoma

Visit tropical country --> malabsorption and thickened small bowel loops on imaging

Tropical sprue

Thyroid cancer associated with RET mutation

Medullary

Calcitonin staining used in this thyroid cancer

Medullary

Thyroid cancer = cystic lesion with papillary architecture and clear cytoplasm

Papillary carcinoma

Bone pain and low calcium in someone who has kidney problems

Renal Osteodystrophy (kidneys can't convert D3 to calcitriol)

Pins and needles in legs in osteoporosis

Vertebral Collapse

X-Ray hand: small resorptive lesions in the bones of the 4th and 5th digits

Hyperparathyroidism

Widened epiphyseal plates

Osteomalacia

Troisier's Sign +ve

Virchow's node enlargement (abdo cancer)

Loss of ganglion cells in the myenteric plexus

Achalasia = increased tone in oesophagus

Perforation of the oesophagus due to rise in internal oesophageal pressure while vomiting e.g. alcoholism, bulimia

Boerhaave Syndrome

Bloody discharge from nipple --> mammogram does not show any lesions

Intraductal Papilloma (need galactogram)

Collapse suddenly while exercising. Echo shows asymmetrical thickening of septum

Hypertrophic Cardiomyopathy

Endocarditis with SLE

Libman-Sacks Endocarditis

Young man with SOB/palpitations -- have narrowing of left ventricular outflow tract

Hypertrophic Cardiomyopathy

Psammoma bodies found in which type of ovarian cancer?

Serous

Vitamin deficiency causing Subacute Combined Degeneration of Cord

B12

Vitamin deficiency causing dry skin, dry eyes (and immature retinas)

Anti-ANA and anti-RNP

Mixed connective tissue disease

Head CT shows crescent-shaped lesion (in alcoholic)

Subdural haemorrhage

Deletion of APC gene

Familial Adenomatous Polyposis

Pancreatic tumour with KRAS mutation

Pancreatic Ductal Carcinoma

Most common autoantibody in SLE

Anti-ANA

Tumour marker in papillary and follicular thyroid cancer

Thyroglobulin

Ca 19-9 tumour marker

Pancreatic and biliary

Ca 15-3 tumour marker

Breast

hCG and LDH tumour markers

Testicular

Symmetrical, erythematous lesions -- with "central clearing", and some have overlying vesicles/bullae

Erythema multiforme (Type IV Hypersensitivity)

Many lytic lesions in epiphysis of knee --> soap-bubble appearance

Gaint Cell Tumour

This feature is diagnostic of chronic pancreatitis

Pancreatic calcifications

Most common pancreatic cancer

Ductal carcinoma -- more common in head

Pancreatic cancer found in tail of pancreas

Neuroendocrine

Mutation found in pancreatic cancer

K-Ras

Composition of radiolucent gallstones

Cholesterol

Iron-storage complex (found in haemachromatosis, stained by Prussian Blue)

Haemosiderin

Commonest liver tumour

Haemangioma = benign

Commonest malignant liver tumour

Mets!

Old man with colicky abdo pain relieved by pooing

Diverticular Disease (low fibre diet)

Most common bowel cancer type

Adenocarcinoma 98%

This disease predisposes to pilocytic astrocytoma

Neurofibromatosis 1

Cancer that astrocytomas always become

Glioblastoma

This makes CSF

Choroid plexus

Commonest cause of coma in brain injury

Diffuse Axonal Injury

Causes Tau -ve Pick's Disease

Progranulin mutation

Type of kidney stone in proteus infection

Magnesium ammonium phosphate (Struvite)

Most common renal cancer ("golden yellow tumour")

Clear Cell Renal Carcinoma

Triphasic renal tumour

Nephroblastoma (Wilm's)

Amplification of this is used to show if tumour is testicular germ cell tumour

i12p

Most common testicular cancer

Seminoma

Composition of inorganic bone

Calcium hydroxyapatite

Bone tumour caused by t(11;22)

Ewing's Sarcoma

Ovarian cancer that makes oestrogen

Granulosa Cell

Thyroid cancer containing amyloid

Medullary (calcitonin broken down to amyloid)

+ve CLO test

H. pylori

Periodic acid-Schiff (PAS)-positive macrophages

Whipple's Disease