Histopathology MedEd Flashcards
metaplasia
change in one mature cell type for another mature cell type
2 ways of cancer development
metaplasia –> dysplasia pathway
Adeno-carcinoma pathway
describe an adenocarcinoma
gland forming
mucin secreting
squamous cell carcionoma
make keratin - even in non-keratinsed tissue
inter-cellular bridges
define necrosis
represents energy failure
non-energy dependent cell death
cell lysis due to loss of electro-ionic pathway
z line
squamo-columnar junction
stricters of oesophagus
inflammation –> ulceration –> loss of surface epithelium –> repair –> replacement of useful cells with myofibroplasts –> scarring/strictures
oesophageal cancer pathway
inflammation –> metaplasia –> metaplasia withe goblet cells –> dysplasia –> cancer
two types of barratts
columnar metaplasia columnar metaplasia + goblet cells = intestinal type columnar --> greater risk of malignant transformation
cancers of oesophagus levels and causes
mid-distal - SCC - smoking and drinking
Distal - adenocarcinoma - GORD
what can cause oesophageal varices
any cause of portal hypertension
- cirrhosis
- portal vein thrombosis
- IVC obstruction
lining of stomach
columnar epithelium
specialised cells of the stomach
parietal cells - acid
P cells/chief cells - pepsin
causes of acute gastritis
NSAIDs, booze, H.pylori, stress
causes of chronic gastritis
autoimmune
bacteria - h.pylori
corrosives. e.g. acid
CMV( renal transplant) and crohns
complications of gastritis
cancer
perforation
ulceration
what bacteria is H.pylori?
Gram negative curved rod
hydrogenase: produce energy by oxidising molecular H2 +/- Cag pathogenicity island = poorer outcome
cancers associated with H.pylori
adenocarcinoma
lymphoma
MALT
Two types of adenocarcinoma of the stomach
intestinal - well differentiated, mucin producing, gland forming
diffuse - single-cell architecture, no gland formation, contain signet ring cell
Are goblet cells seen in the stomach?
NO
common cause of duodenal ulcers
H.pylori
anterior ulcers
perforation -> peritonitis
posterior ulcers
near gastroduodenal artery –> haemorrrhage
coeliac disease - affect malabsorption
villous atrophy
crypt hyperplasia
increased intraepithlial lymphocyes
cancer associated with coeliac disease
EATL
Lymphocytic duodenitis
increased epithelium lymphocytes
distinct condition from coeliac
ischaemic colitis causes
arterial occlusion venous occlusion small vessel disease low flow states obstruction
spotty necrosis with foci of inflammation
acute hepatitis
causes of acute hepatitis
drugs
Hep A and E
Bronzed diabetes
haemochromatosis
rhodanine stain
wilson’s disease copper
alcoholic hepatitis
ballooning of cells mallory denk bodies apoptosis pericellular fibrosis zone 3 - acetaldehyde highest and relatively hypoxic
NAFLD
metabolic syndrome
same process as alcoholic cirrhosis
common cause of liver cancer
metastatic
primary tumors of the liver
HCC - alcoholic hepatitis is risk factor
Hepatoblastoma
patterns of injury acute pancreatitis
peri-ductal - obstructive - acinar cells adjacent to the ducts undergo necrosis
peri-lobular - vascular cause - necrosis at the edges of the lobules
Pan-lobular -injury progressing in either
acute pancreatitis pathophysiology
reflux of enzymes –> acinar necrosis –> releasd of more enzymes –?> release of lipases –> fat necrosis –> soaponification with calcium
complications of acute pancreatitis
haemorrhage
metabolic disturbances
pseudocysts
abscess
management of acute pancreatitis
serum lipase
fluid - third spacing
abx are not needed unless there is sepsis or necrosis of more than 50%
electrolyte replacement
commonest causes of chronic pancreatitis
alcohol and gallstones
tumors of the pancreas
ductal - 85%
acinar - acinar ductal metaplasia - causes ductal cancer
cystic neoplasma - predispose to adenocarcinomas of the pancreas
ductal carcinoma common mutation
k-ras
peri-neural invasion very common
where are NETs most common?
tail of the pancreas
MEN1
PPP
Pituitary, pancreas and parathyroid
commonest secretory NET
insulinoma
50% of gallstones are?
CHOLESTEROL