Histopathology (MedEd) Flashcards
what’s the difference between erosion & ulcer?
Both are loss of surface epithelium but in erosion it’s beyond the muscularis mucosae
difference between acute & chronic ulcers:
fibrosis in chronic ulcers
define dysplasia and give example
Cytological and histological features of malignancy but basement membrane intact
define metaplasia and give example
Change in one mature cell type for another
mature cell type (Reversible)
eg Barrett’s oesophagus (squamous epithelium to columnar epithelium)
what are 2 features of dysplasia?
-Mitotic figures
-Raised nuclear : cytoplasmic ratio
Difference in histology of adenocarcinoma and squamous cell carcinoma:
Adenocarcinoma
1. Gland forming
2. Mucin secreting
Squamous cell carcinoma
1. Make keratin (even in non-keratinised tissues)
2. Inter-cellular bridges
Difference between necrosis & apoptosis:
Necrosis
-Represents energy failure
-Non-energy dependent cell death
-Cell lysis due to loss of electro-ionic potential
-Pathological
Apoptosis
-Planned, energy dependent exit strategy
-Cell contents are not released
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
Acantholysis
what is the term for nuclei in S. corneum – thickening of skin when scratching it?
parakeratosis
what is the term for ↑ in S. spinosum
Acanthosis
what is the term for intercellular oedema between keratinocytes?
spongiosis
what is the term for the linear pattern of melanocyte proliferation within epidermal basal cell layer (reactive or neoplastic)
Lentiginous
what are the layers of the epithelium? mnemonic?
Corn Lovers Grow Some Bales
* Corneum
* Lucidum
* Granulosum
* spinosum
* basale
difference between bullous pemphigoid vs pemphigus vulgaris
Bullous pemphigoiD=Deep
pemphigus vulgariS= superficial
-Both IgG antibodies
-Pemphigus vulgaris: IgG Abs bind to desmosome proteins 1,3
-mucosal involvement
What is the typical chemotherapy regime used for non-resectable pancreatic cancer?
Management is generally palliative chemotherapy (FOLFIRINOX ie 5-FU: 5-fluorouracil based) or surgical Whipple’s procedure if curative intent
A 60 year old man has suffered from atrial fibrillation since his early 30s. He has undergone multiple failed cardioversions, the most recent of which was 10 years ago. Since then his symptoms have been well controlled with bisoprolol 10mg OD. His heart sounds are normal.
He says he has had high blood pressure for “years”.
His ECG is normal other than an irregularly irregular rhythm and large, bifid p waves.
What is the most likely abnormality that will be found on his echocardiogram to explain his permanent atrial fibrillation and poor success at cardioversion?
dilated left atrium
What liver enzyme may also be found in the heart and may rise in acute myocardial infarction?
Aspartate Aminotransferase (Hepatocytes + Heart + Muscle)
what are 5 types of nephritic syndrome?
BADPG
● Berger disease (IgA nephropathy: 1-2 days after strep pyogenes)
● Alport’s syndrome (aka Hereditary nephritis)
●Diffuse proliferative ( Rapidly progressive) glomerulonephritis in SLE
●Post-infectious (aka Post-streptococcal)
●Goodpasture syndrome
● Thin basement membrane disease (aka Benign familial haematuria)
● wegener’s granulomatosis: granulomatosis with polyangitis
●Henoch-schonlein purpura (HSP)
● Haemolytic uraemic syndrome
What is the typical inheritance pattern of hereditary haemochromatosis?
autosomal recessive
Complications of hereditary haemochromatosis (mnemonic)
HaemoChromatosis Can Cause Deposits Anywhere)
o Hypogonadism
o Cancer (hepatocellular)
o Cirrhosis
o Cardiomyopathy
o Diabetes mellitus
o Arthropathy
What liver enzyme may be measured in the blood and, if raised to a level >10x the upper limit of normal is suggestive of viral hepatitis?
ALT (alanine aminotransferase)
What tumour marker is associated with pancreatic cancer?
Carbohydrate Antigen 19-9 (CA 19-9)
What is the minimum random plasma glucose level (in mmol/L) that is required to diagnose diabetes in a symptomatic individual?
11.1
Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?
lipase
What is the main hormone produced by delta cells in the pancreas?
Delta cells: Produce somatostatin. Exhiibts a paracrine effect on alpha and beta cells, reducing secretion of glucagon and insulin
What histochemical stain would reveal the presence of iron in a liver biopsy with a patient with haemachromatosis?
Prussian blue
What histochemical stain would reveal the presence of melanin?
fontana
What is the inheritance pattern of Wilson’s disease?
autosomal recessive
What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?
Rhodanine
A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.
She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.
An ultrasound of the biliary tree shows no gross dilatation.
What is the likely diagnosis?
primary biliary cirrhosis
What is the first line treatment for severe haemachromatosis?
therapeutic phlebotomy (venesection)
triad of nephrotic syndrome:
- hypoalbuminaemia
- proteinuria
- oedema
electron microscopy of minimal change disease?
loss of foot processes
what is seen in light and electron microscopy of membranous glomerulonephropathy:
light: diffuse BM thickening
electron: spikey immune complex deposits
immunofluorescence:
triad of nephritis syndrome:
- hypertension
- haematuria
- peripheral oedema
investigations for post-streptoccus
ASOT titre ↑, C3 ↓
alport syndrome triad;
Nephritic syndrome + sensorineural deafness + eye disorders (lens dislocation,
cataracts): kidneys, ears, eyes
what inheritance is Alport syndrome
X-linked
casts in ATN vs acute interstitial nephritis:
ATN: brown cast
acute interstitial nephritis: white casts
symptoms of polycystic kidney disease:
MISSHAPES
Abdominal Mass
o Infected cysts & increased BP
o Stones
o Systolic hypertension
o Haematuria
o Aneurysms (Berry)/subarachnoid haemorrhage
o Polyuria & nocturia
o Extra-renal cysts e.g. liver(most common extrarenal manifestation) ovaries, pancreas, seminal vesicles
o Systolic murmur – due to mitral valve prolapse
lupus nephritis renal histology:
‘wire loop capillaries’ & lumpy-bumpy granular fashion.
Abs to phospholipase A2 receptor associated with which glomerulonephritis?
membranous
Goodpasture Ab:
Anti GBM membranes
characteristic histological finding in kidney of a patient with multiple myeloma:
Amyloid deposition (AL amyloidosis)
40 yr old with massive proteinuria. Renal biopsy=wire loop capillaries, immune complex deposition and sclerosis >95% of sample
end stage (advanced sclerosis), vs mesangial =early stage
(muddy) brown
acute tubular necrosis
acute tubular necrosis
functional unit of kidney
nephron
functional unit of liver
sinusoid
zones of liver
zone 1: most oxygenated
zone 3: least oxygenated
form portal triad–> central veins
acute hepatitis pattern of inflammation:
spotty necrosis
causes of chronic hepatitis:
Viruses (Hep B, C), drugs, PBC/PSC, wilson’s or haematochromatosis
pattern of inflammation in chronic nephritis
piecemeal necrosis/interface hepatitis
-bridging fibrosis from portal triad–> central vein: signals evolution to cirrhosis
micronodular causes:
alcohol
macronodular causes:
everything else, not alcohol
causes of acute hepatitis
Hep A, E or drugs
most common malignancy in liver;
metastasis
haemochromatosis inheritance pattern:
autosomal recessive
a1 antitrypsin inheritance pattern:
autosomal dominant
Wilson’s disease inheritance pattern:
autosomal recessive
most common exam finding in pt with portal hypertension:
splenomegaly (other: oesophageal varices, caput medusae, jaundice)
Answer: E. raised eosinophils
-schistosomiasis (parasitic infections); lake Malawi
-could also have deranged LFTs due to hepatomegaly
eosinophils granules colour
red granules
Answer: C : SCC
what’s the cause of squamous cells in urine;
contamination
oesophageal cancer most common types:
Adenocarcinoma is the most common type of cancer of the esophagus among White people
-squamous cell carcinoma is more common in African Americans
most cancers in histo:
adenocarcinomas
common transitional cell cancers (mnemonic)
KUB:
kidneys
-ureters/urinary tract
-bladder
Answer: none (under 6 hours–> normal, CK-MB creatine kinase isoenzyme MB=normal)
evolution of MI histological findings:
Answer: D. AD mutation in DNA mismatch repair gene
HNPCC (lynch syndrome)
FAP mutation/presentation:
AD mutation in APC gene, 100s/1000s polyps
calcitonin
MEN types (mnemonic)
3Ps–> 2Ps–> 1P
Gleason score: 8
3 +5 =8
what investigations can be done for wilson’s?
● ↓ serum caeruloplasmin
● ↓ serum copper
● ↑ urinary copper
treatment for wilson’s
lifelong penicillamine (heavy metal antagonist)
signs/symptoms of wilson’s
● Liver disease: acute hepatitis, fulminant liver failure or cirrhosis
● Neuro disease: parkinsonism, psychosis, dementia (basal ganglia involvement)
● Kayser Fleischer rings: copper deposits in Descemet’s membrane in cornea
mutation in wilson’s
Mutated gene ATP7B (Chr 13): Encodes copper transporting ATPase expressed on canalicular membrane therefore → ↓biliary Cu excretion and deposition in liver, CNS, iris.
Wegener’s granulomatosis triad:
1) necrotizing granlomatous inflammation of upper and/or lower respiratory tract
2) systemic or focal necrotizing vasculitis involving arteries and vein
3) focal segmental necrotizing crescentic gromerulonephritis.
most common cause of nephrotic syndrome in adults (& associations):
FSGS: focal segmental glomerulosclerosis (associated with diabetes, obesity & HIV)
2nd most common cause of nephrotic syndrome in adults
membranous glomerulonephritis
What is the underlying precipitant of DIC?
Increased Exposure to Tissue Factor
Which of the following is more associated with nephritic syndromes than nephrotic syndromes?
A. Proteinuria
B. Raised Creatinine
C. Oedema
D. Thrombosis
E. Onset in Childhood
B. Raised Creatinine (ie hypertension causing this)
what defect in TTP:
antibodies against ADAMTS13 lead to long strands of VWF which
act like cheese wire in the blood vessels, cutting up RBCs.
what does klebsiella typically cause/groups affected (mnemonic)
typical pneumonia (HADE): haemoptysis, alcoholics, diabetics, elderly.
-upper lobe cavitation, lung abscesses and empyemas
-negative rod, enterobacter
What type of emphysema is associated with smoking ?
centriacinar emphysema
What is the commonest cause of constrictive pericarditis in the developing world?
tuberculosis (vs developed: world. In the developed world, the most common cause of constrictive pericarditis is idiopathic or post-cardiac surgery. In some cases, radiation therapy or autoimmune diseases, such as lupus, may also cause constrictive pericarditis.)
What is the commonest cause of portal vein thrombosis?
Liver Cirrhosis (other causes=malignant, abdominal infection, IBD & inherited hypercoagulable states)
A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?
seminoma
Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?
Goblet cell
Commonest histological type of primary malignant breast cancer?
invasive ductal carcinoma (IDC)
What is the commonest cause of myocarditis?
– viral infections (coxsackievirus most common).
Other viral causes include adenovirus, cytomegalovirus, Epstein-Barr virus, parvovirus B19, and human herpesvirus 6. Bacterial, fungal, and parasitic infections, as well as autoimmune and idiopathic causes, can also lead to myocarditis.
Which virus characteristically causes encephalitis involving the temporal lobes?
Herpes simplex 1 (HSV1=encephalitis); also causes herpes labialis vs HS2: meningitis and genital herpes
restrictive vs obstructive impairment on spirometry causes
sarcoidosis extra-pulmonary manifestations:
hypercalcaemia due to ectopic 1a hydroxylase release by activated macrophages
-lymph nodes: lymphadenopathy, painless & rubbery
-skin: erythema nodosum
-eyes: anterior uveitis
-Heerfordt syndrome, or uveoparotid fever, occurs in 10% of cases and consists of a triad of parotid enlargement, uveitis, and seventh cranial nerve palsy
-ACE increased
-ESR increased
-Transbronchial biopsy: non-caseating granuloma
-Spirometry-restrictive pattern
erythema nodosum causes:
Heerfordt syndrome triad. seen in:
AKA: uveoparotid fever
- triad of parotid enlargement, uveitis, and seventh cranial nerve (facial) palsy
-sarcoidosis
What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
-This enzyme is produced by macrophages in the granulomas of sarcoidosis patients and converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, the active form of vitamin D. The excess production of 1,25-dihydroxyvitamin D leads to increased calcium absorption from the gut and bone resorption, resulting in hypercalcaemia.
what vasculitides is associated with anti-proteinase 3?
Wegeners glomerulonephritis (Granulomatosis with polyangiitis: GPA)
what drugs/conditions can cause erythema multiforme (mnemonic) ?
SNAPP:
○Sulphonamides
○ NSAIDs
○ Allopurinol
○ Penicillin
○ Phenytoin
encephalitis symptoms, common cause and management
- Sx: confusion, fluctuating consciousness
- Most commonly caused by HSV1
- Rx: IV acyclovir
encephalitis & paraneoplastic syndrome
Therefore, it is important to screen for cancer in patients whom you suspect may have an underlying tumour.
Particular associations:
- Anti-Hu: Small cell lung cancer
- NMDA receptor antibodies: Ovarian teratoma
- Anti-Yo: breast and ovarian tumours
A 30 year old woman has experienced a week of progressive retro ocular pain with a loss of visual acuity in the right eye. She does not wear glasses. There is a family history of Type 1 Diabetes.
On examination, there is a right relative afferent pupillary defect with reduced visual acuity. Fundoscopy and intraocular pressure is normal.
What investigation would be diagnostic?
An MRI Brain and Optic Nerves would be the best investigation to diagnose this patient because they are experiencing retro ocular pain with a loss of visual acuity in one eye, which could indicate optic neuritis, a common symptom of multiple sclerosis. The family history of Type 1 Diabetes may also increase the risk of developing optic neuritis.
