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Pathology > Histopathology Part 4- (p183-207- Breast, Cerebral, Neurodegenerative, Bone, Skin + Miscellaneous) > Flashcards

Histopathology Part 4- (p183-207- Breast, Cerebral, Neurodegenerative, Bone, Skin + Miscellaneous) Flashcards

1
Q

How does acute mastitis present?

A

Painful
Red breast
Fever
Either lactational or non-lactational

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2
Q

What causes lactational and non-lactational acute mastitis?

A

Lactational- staphylococcal infection (often polymicrobial)

Non-lactational- secondary to duct ectasia

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3
Q

Treatment of lactational acute mastitis?

A

Continued expression of milk + antibiotics +/- surgical drainage

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4
Q

Treatment of non-lactational acute mastitis?

A

Abx + treatment of duct ectasia

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5
Q

Who does mammary duct ectasia usually occur in?

A

Multiparous 40-60yo women

Smokers- biggest RF

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6
Q

How does duct ectasia present?

A

Poorly defined palpable periareolar mass with thick white nipple secretions

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7
Q

What is the pathophysiology of duct ectasia?

A

Dilatation in one or more of the larger lactiferous ducts, which fill with a stagnant brown or green secretion, which may discharge.
These fluids irritate surrounding tissue leading to periductal mastitis or even abscess and fistula formation

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8
Q

Which condition mimics the mammographic appearance of cancer?

A

Duct ectasia

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9
Q

What would you see on cytology for duct ectasia?

A

Proteinaceous material

Inflammatory cells

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10
Q

What is fat necrosis of the breast?

A

Inflammatory reaction to damaged adipose tissue (can be delayed 10y from trauma)

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11
Q

How does fat necrosis of the breast present?

A

Painless breast mass which can mimic carcinoma by displaying skin tethering or nipple retraction

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12
Q

What is fibrocystic disease/fibroadenosis?

A

Breast lumpiness
Common group of changes caused by exaggerated hormone response:
Cystic- small cysts form by dilation of lobules and contain fluid
Fibrosis- secondary to cyst rupture
Adenosis- increased number of acini per lobule

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13
Q

What would you see on histology for gynaecomastia?

A

Epithelial hyperplasia

Finger-like projections into ducts

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14
Q

What is a fibroadenoma commonly referred to as?

A

A breast mouse- spherical and freely mobile

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15
Q

What is the most common benign breast tumour?

A

Fibroadenoma

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16
Q

When do fibroadenomas usually occur?

A

Reproductive period- usually 20-30y

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17
Q

What has a strong influence over fibroadenomas?

A

Hormones- increase in size during pregnancy and calcify after menopause

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18
Q

What is a duct papilloma?

A

Benign papillary tumour within the duct system of the breast

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19
Q

How does duct papilloma present?

A

Bloody discharge

No lump

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20
Q

Where does breast cancer rank in the most common cancers in women?

A

Numero uno

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21
Q

Women’s lifetime risk of breast cancer?

A

1 in 8

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22
Q

In which age range is breast cancer more common?

A

75-80y

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23
Q

What are the risk factors for breast cancer?

A 
Susceptibility genes- BRCA1/2
Hormone exposure- early menarche, late menopause, OCP, HRT etc
Advancing age
FH
Race (Caucasian most likely)
Obesity
Smoking
Alcohol
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24
Q

How does breast cancer present?

A

Hard fixed lump
Paget’s disease (eczema of nipple then areola- normal eczema never affects the nips)
Peau d’orange
Nipple retraction

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25
What is the breast cancer screening programme in the UK?
47-73yo women are invited every 3y for mammography
26
What is breast carcinoma in situ?
Neoplastic epithelial proliferation limited to ducts (DCIS) or lobules (LCIS) by basement membrane
27
How is breast carcinoma histologically subcategorised?
Ductal- can't be classified into one of the others, most common Lobular- cells in single file chains/strands Tubular- well formed tubules with low grade nuclei Mucinous- abundant extracellular mucin
28
What is the triple assessment for breast cancer?
Examination Radiological exam- mammography/USS/MRI) FNA + cytology
29
What are all neoplastic breast lesions assessed for?
Oestrogen receptor, progesterone receptor and HER2 receptor status
30
How does ER/PR/HER2 receptor status influence prognosis?
ER/PR positive- good as responds to tamoxifen | HER2 positive- bad prognosis
31
What is tamoxifen's MOA?
Mixed agonist/antagonist of oestrogen at its receptor
32
What is herceptin/trastuzumab?
Monoclonal Ig to Her2
33
What is it important to monitor in herceptin treatment?
LVEF as it is toxic to myocardium
34
Where do phyllodes tumours arise from?
Interlobular stroma with increased cellularity and mitoses
35
What are the main differences between male and female breast cancer?
Lesions easier to find due to smaller breasts but lack of awareness may postpone treatment Presence of gynaecomastia may mask condition Diagnosis made later in males Lesions less contained as don't have to travel far to infiltrate Almost 1/2 of male b cancer patients are stage III or IV
36
What is an infarction?
An area of tissue death due to lack of oxygen
37
What is the most common cause of a cerebral infarction?
Cerebral atherosclerosis
38
RFs for strokes and TIAs?
Smoking, DM, HTN, FH, past TIAs, OCP, PVD, ETOH, hyperviscosity e.g. sickle cell or polycythaemia vera
39
Symptoms and signs of stroke?
``` Sudden onset FAST Numbness Loss of vision Dysphagia ```
40
Symptoms and signs of TIA?
<24h Amaurosis fugax- painless temporary loss of vision Carotid bruit
41
Commonest area affected in a stroke?
MCA
42
Investigations for stroke/TIA?
CT/MRI (infarct vs haemorrhage) for stroke Carotid US for TIA Vascular risk- BP, FBC, ESR, U+E, glu, lipids, CXR, ECG, carotid doppler
43
Stroke/TIA management?
Aspirin +/- dipyridamole Thrombolytics (if <3h) for stroke +/- carotid endarterectomy Long term- HTN, lipid reducing, anticoag
44
How would a stroke affecting the anterior cerebral artery (ACA) present?
Contralateral leg paresis Sensory loss Cognitive deficits (apathy, confusion, poor judgement)
45
How would a stroke affecting the MCA present?
Contralateral weakness and sensory loss of face and arm Cortical sensory loss Contralateral homonymous hemianopia or quadrantopia If dominant hemisphere- aphasia If non-dominant- neglect Eye deviation towards side of lesion and away from weak side
46
How would a stroke affecting the PCA present?
Contralateral hemianopia or quadrantopia Midbrain findings- CNIII and IV palsy/pupillary changes, hemiparesis Thalamic findings- sensory loss, amnesia, decreased level of consciousness Bilateral- cortical blindness or prosopagnosia
47
How would a stroke affecting the basilar artery present?
Proximal- impaired extraocular movement, vertical nystagmus, reactive miosis, hemi or quadriplegia, dysarthria, locked-in syndrome, coma Distal- somnolence (sleepy), memory and behaviour abnormalities, oculomotor impairment
48
What type of haemorrhages are commonly non-traumatic?
Intraparenchymal | Subarachnoid
49
What is the common site for intraparenchymal haemorrhage?
Basal ganglia
50
What are responsible for 85% of subarachnoid haemorrhages?
Ruptured berry aneurysms
51
How does a SAH present?
Thunderclap headache Vomiting LoC Usually in F <50
52
Patients with which conditions are at increased risk of SAH?
Polycystic kidney disease Ehler's Danlos Aortic coarctation pts
53
Which cerebral haemorrhages are usually due to trauma?
Extradural Subdural Traumatic parenchymal
54
Which artery is involved in an extradural haemorrhage?
Middle meningeal artery ruptures
55
How does a subdural typically present?
Prev history of minor trauma -> damaged bridging veins with slow venous bleed, often elderly/alcoholic, associated with brain atrophy and fluctuating consciousness
56
Six types of brain herniation?
``` Uncal Central- transtentorial Cingulate- subfalcine Transcalvarial Upward tonsilar ```
57
Which organism most commonly causes meningitis in newborns-3m olds?
Group B strep (90% in first 5 days) | E. Coli and Listeria monocytogenes as well
58
Which organisms most commonly causes meningitis in 1m-6y olds?
Neisseria meningitidis, streptococcus pneumoniae, haemophillus influenza type B
59
Which organisms most commonly causes meningitis in >6yo olds?
N. meningitidis, strep pneumoniae, mumps (pre-MMR vaccine)
60
Which viruses cause meningitis?
Enteroviruses (80%), CMV, Arbovirus, HSV (most common in adults)
61
What RFs are there for meningitis?
Young HIV Immunocompromised Environmental- crowding, poverty + close contact with affected individuals
62
What would you see in the CSF for bacterial/pyogenic meningitis (appearance, predominant cell, cell count, glucose, protein and presence of bacteria in smear or culture)?
``` Appearance- turbid Predominant cell- polymorphs e.g. neutrophils Cell count- 90-1000+ Glucose- low <40 Protein- high >250 Bacteria in smear and culture ```
63
What would you see in the CSF for TB meningitis (appearance, predominant cell, cell count, glucose, protein and presence of bacteria in smear or culture)?
``` Appearance- fibrin web Predominant cell- mononuclear e.g. lymphocytes Cell count- 10-1000 Glucose- low <40 Protein- high 50-500 Bacteria often not in smear ```
64
What would you see in the CSF for viral meningitis (appearance, predominant cell, cell count, glucose, protein and presence of bacteria in smear or culture)?
``` Appearance- clear Predominant cell- mononuclear e.g. lymphocytes Cell count- 50-1000 Glucose- normal Protein- normal or high <100 Bacteria often not in smear ```
65
Symptoms of viral encephalitis?
``` Drowsiness Seizures Behavioural changes Headache Fever ```
66
Viruses that cause viral encephalitis?
``` Enteroviruses HSV VZV Arboviruses Adenoviruses HIV Mumps Rubella Rabies ```
67
Are most brain tumours primary or secondary tumours?
Secondary
68
Which cancers are the most common primaries for secondary brain tumours?
Lung Breast Malignant melanoma
69
Commonest type of primary brain tumour?
Astrocytomas
70
Which familial syndromes are associated with CNS tumours?
Von Hippel Lindau- hemangioblastoma of cerebellum, brainstem and spinal cord Tuberous sclerosis- giant cell astrocytoma NF type 1- neurofibroma astrocytoma NF type 2- Meningioma, ependydoma, astrocytoma Li-Fraumeni- astrocytoma, primitive neuroectodermal tumour Turcot syndrome- glioblastoma multiforme, medulloblastoma, pineoblastoma MEN 1- pituitary adenoma
71
What is the common pathogenic mechanism behind neurodegenerative diseases e.g. dementia?
Accumulation of misfolded proteins (intra or extra-cellular
72
What are the four As of dementia?
Amnesia Aphasia- language disorder Apraxia- unable to do skills Agnosia- unable to recognise people, objects
73
What is the pathological misfolded protein in Alzheimer's disease?
Tau | Beta-amyloid
74
What is the pathological misfolded protein in Lewy body dementia?
Alpha-synuclein | Ubiquitin
75
What is the pathological misfolded protein in corticobasal degeneration?
Tau
76
What is the pathological misfolded protein in frontotemporal dementia linked to Chr 17?
Tau
77
What is the pathological misfolded protein in Pick's disease?
Tau
78
What changes occur to the brain during Alzheimer's
Generalised atrophy of the brain Widened sulci Narrowed gyri Enlarged ventricles (temporal and frontal especially) Senile plaques of beta-amyloid protein and neurofibrillary tangles of tau protein
79
How is Alzheimer's diagnosed?
Clinical diagnosis | PET and MRI may help
80
How is Alzheimer's treated?
Symptomatic: Anti-cholinesterases nAChR agonists Glutamate antagonists
81
How can Lewy Body Dementia be differentiated from Alzheimer's?
Psychological disturbances- visual hallucinations- small people or animals Day to day fluctuations Signs of Parkinsonism (very similar) Recurrent falls and syncope
82
What is the pathology of Parkinson's disease?
Death of dopaminergic neurones in substantia nigra -> reduced stimulation of the motor cortex by the basal ganglia
83
How does Parkinsons present?
``` TRAP Tremor Rigidity Akinesia Postural instability ```
84
What is the pathology of multiple sclerosis?
Autoimmune demyelinating disease with plaques
85
How does multiple sclerosis commonly present?
20-40yo, focal sx e.g. optic neuritis, poor coordination
86
Aetiology of osteoporosis?
Age-related or secondary to systemic disease/drugs
87
Disease features of osteoporosis?
Decreased bone mass- >2.5 SD below normal (1-2.5=osteopenia)
88
Symptoms of osteoporosis?
Low impact fractures- NOF or Colles' | Pain
89
RF for osteoporosis?
``` Age Smoking F Poor diet Low BMI ```
90
Changes of x ray for osteoporosis?
Usually none
91
Histology of osteoporosis?
Loss of cancellous bone
92
Biochemical changes of osteoporosis (Ca, PO4, ALP)?
All normal
93
Aetiology of osteomalacia/rickets?
Low dietary vit D low sunlight Malabsorption of vit D Genetic causes
94
What is osteomalacia/rickets?
Decreased bone mineralisation
95
Symptoms of osteomalacia?
Bone pain/tenderness | Proximal muscle weakness
96
Symptoms of Rickets?
``` Bone pain Bowing tibia Rachitic rosary Frontal bossing Pigeon chest Delayed walking ```
97
Changes of x ray for osteomalacia?
Looser's zones (pseudofractures) | Splaying of metaphysis
98
Histology of osteomalacia?
Excess of unmineralised bone
99
Biochemical changes of osteomalacia/Rickets (Ca, PO4, ALP)?
Ca- Normal or low Decreased PO4 Increased ALP
100
Aetiology of primary hyperparathyroidism?
Parathyroid adenoma Hyperplasia Carcinoma MEN
101
Disease features of primary hyperparathyroidism?
Excess PTH production -> Ca reabsorption and PO4 excretion | Bone changes of osteitis and fibrosa cystica
102
Symptoms of primary hyperparathyroidisim?
``` Hypercalcaemia- Moans, stones. bones and groans Depression Renal stones Bone pain and fractures Constipation Pancreatitis Polydipsia Polyuria ```
103
X Ray changes in primary hyperparathyroidism?
Brown's tumours Salt and pepper skull Subperiosteal resorption in phalanges
104
Histology of primary hyperparathyroidism?
Osteitis fibrosa cystica (aka brown tumour)
105
Biochemical changes of primary hyperparathyroidism (Ca, PO4, ALP)?
Increased Ca Decreased or normal PO4 Increased or normal ALP Increased PTH
106
Aetiology of Paget's?
Disorder of bone turnover
107
Disease features of Paget's?
Lytic and sclerotic lesions
108
Symptoms of Paget's?
``` Bone pain Microfractures Nerve compression Skull changes increase head size Deafness High output cardiac failure ```
109
RF for Paget's?
>50 + Caucasian
110
X ray changes in Paget's?
Mixed lytic and sclerotic Skull- osteoporosis circuscripta, cotton wool Vertebrae- picture frame, ivory vertebra Pelvis- sclerosis and lucency
111
Histology of Paget's?
Huge osteoclasts with >100 nuclei | Mosaic pattern of lamellar bone
112
Biochemical changes of Paget's (Ca, PO4, ALP)?
Normal Ca Normal PO4 Massively raised ALP
113
Aetiology of renal osteodystrophy?
All skeletal changes associated with CKD- osteitis fibrosa cystica, osteomalacia, osteosclerosis, adynamic bone disease, osteoporosis
114
Biochemical changes of renal osteodystrophy (Ca, PO4, ALP)?
Low Ca High PO4 Secondary hyperparathyroidism
115
What is the main way to differentiate between gout and pseudogout?
Gout has negatively birefringent crystals | Pseudogout has positively birefringent crystals
116
What are RFs of gout?
Increased dietary purine intake ETOH Diuretics Inherited metabolic abnormalities
117
What is the aetiology of pseudogout?
Idiopathic HyperPTH Hypothyroid Wilsons
118
Which joints are affected in gout?
Great toe- MTP, lower extremities
119
What are the clinical features of gout?
Hot swollen red and exquisitely painful joint | Tophus (s/c urate deposits) is pathognomic lesion
120
What is the crystal type in gout?
Urate crystals | Needle shaped
121
What is the crystal type in pseudogout?
Calcium pyrophosphate crystals | Rhomboid shaped
122
How do you manage gout?
Acute- Colchicine Long term- Allopurinol Conservative- reduce alcohol and purine intake e.g. sardines or liver
123
Management of pseudogout?
NSAIDs or intra-articular steroids
124
What causes osteomyelitis ?
Haematogenous spread or local infection e.g. post-trauma | Mainly bacterial and occasionally fungal
125
Which organism most commonly causes osteomyelitis in adults and which most commonly cause it in children?
Adults- S.Aureus | Children- haemophillus influenza, GBS
126
How does osteomyelitis present?
Pain, swelling and tenderness | General features of malaise, fever, chills + leukocytosis
127
In what condition would you see Heberden's and Bouchard's nodes?
Osteoarthritis Heberden's- DIPJ Bouchard's- PIPJ
128
X ray features of osteoarthritis?
``` LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts ```
129
How does rheumatoid arthritis present?
Slowly progressive | Symmetrical in small joints of hands and feet- spares DIPJ
130
Characteristic deformities of rheumatoid arthritis?
Swan neck and Boutonniere deformity of fingers Radial deviation of wrist and ulnar deviation of fingers Z shaped thumb
131
How can you differentiate benign and malignant bone disease on xray?
Benign- No periosteal reaction, thick endosteal reaction, well developed bone formation, intraosseous and even calcification Malignant- Acute periosteal triangle- Codman's triangle, onion skin, sunburst, broad border between lesion and normal bone, varied bone formation, extraosseous and irregular calcification
132
Name some malignant bone tumours?
Osteosarcoma Chondrosarcoma Ewing's sarcoma Giant cell
133
Who does osteosarcoma and Ewing's sarcoma affect?
Adolescents
134
Where is most commonly affected by osteosarcoma?
Knee- 60%
135
What is seen on histology of osteosarcoma?
Malignant mesenchymal cells | ALP +ve
136
What is the X-ray appearance of osteosarcoma?
Codman's triangle- elevated periosteum | Sunburst appearance
137
Which bones does chondrosarcoma affect?
Axial skeleton | Femur/tibia/pelvis
138
X-ray appearance of chondrosarcoma?
Lytic lesion with fluffy calcification
139
Which bones does Ewing's sarcoma affect?
Long bones | Pelvis
140
What is seen on histology of Ewing's sarcoma?
Sheets of small round cells CD99 +ve T 11:22 translocation
141
X-ray appearance of Ewing's sarcoma?
Onion skinning of periosteum
142
Who does giant cell malignancy tend to affect?
20-40y | F>M
143
Where in the body does giant cell malignancy commonly occur?
Knee- epiphysis
144
What is seen on histology of giant cell malignancy?
Osteoclast-type multinucleate giant cells on background of splindle/ovoid cells
145
X-ray appearance of giant cell malignancy?
Lytic/lucent lesions right up to articular surface
146
What benign bone tumours are there?
``` Osteoid osteoma Osteoma- Enchondroma Osteochondroma Fibrous dysplasia Simple bone cyst Osteoblastoma ```
147
Any knowledge about osteoid osteoma?
Adolescents M>F Affects tibia diaphysis/proximal femur Small benign bone forming lesion, night pain X-ray- Radiolucident NIDUS with sclerotic rim 'BULLS EYE'
148
Any knowledge about osteoma?
Middle age Head and neck Bony outgrowths attached to normal bone Gardner syndrome- GI polyps, multiple osteomas + epidermoid cysts
149
Any knowledge about enchondroma?
Often in HANDS Benign tumours of cartilage Ollier's syndrome- multiple enchondromas Maffuci's syndrome- multiple enchondromas and haemangiomas X-ray- Lytic lesion, cotton wool calcification
150
Which benign bone tumour is most common?
Osteochondroma- cartilage capped bony outgrowth
151
Where do osteochondromas commonly occur?
Metaphysis of long bones near tendon attachment sites
152
Any knowledge on fibrous dysplasia?
Femur Bit of bone replaced by fibrous tissue Chinese letters on histology- misshapen bone trabeculae X-ray- soap bubble osteolysis, Shepherd's crook deformity
153
Any knowledge on simple bone cyst?
Humerus or femur Fluid filled unilocular X-ray- Lytic and well defined
154
What is the stratum corneum?
Outermost layer of epidermis, consisting of keratinised cells
155
What is hyperkeratosis?
Increase in stratum corneum/keratin
156
What is parakeratosis?
Nuclei in stratum corneum
157
What is acanthosis?
Increase in stratum spinosum
158
What is acantholysis?
Decrease in cohesion between keratinocytes
159
What is spongiosis?
Intracellular edema
160
What is lentiginous?
Linear pattern of melanocyte proliferation within epidermal basal cell layer
161
5 layers of epidermis?
``` S corneum S lucidum- only in hands + feet S granulosum S spinosum S basale ```
162
What is dermatitis/eczema?
Terms used to describe a group of disorders with same histology and presenting with inflamed dry itchy rashes
163
What is the histology of all types of dermatitis/eczema?
``` DISCA Acute: Dilated dermal capillaries Inflammatory infiltrate in dermis Spongiosis ``` Chronic: Crusting, scaling Acanthosis
164
Different types of dermatitis?
Atopic Contact Seborrhoeic
165
Where does atopic dermatitis commonly affect in infants and older?
Infants- face and scalp | Older- flexural area
166
What type of hypersensitivity reaction is contact dermatitis?
Type IV
167
What causes seborrhoeic dermatits?
Inflammatory reaction to a yeast
168
What is psoriasis?
A common chronic inflammatory dermatosis with well-demarcated red scaly plaques- cells have increased proliferation rate
169
What is the commonest form of psoriasis?
Chronic plaque affecting extensor surfaces and scalp
170
What is Auspitz' sign?
Rubbing psoriatic plaques causes pinpoint bleeding
171
What is Koebner phenomenon?
Lesions form at sites of trauma
172
What is seen on histology for psoriasis?
Parakeratosis, loss of granular layer, clubbing of rete ridges giving test tubes in a rack appearance, Munro's microabscesses
173
Pathophysiology of chronic plaque psoriasis?
Type IV T cell hypersensitivty reaction
174
What are other forms of psoriasis and how do they typically present?
Flexural- seen in later life, groin, natal cleft and submammary areas Guttate- rain drop plaques, children, seen 2w post STREP Erythrodermic/pustular- severe widespread, systemic symptoms, can be limited to hands and feet (palmo-plantar)
175
What nail changes are seen in psoriasis?
Pitting Onycholysis Subungal keratosis
176
What are lesions like in lichen planus?
``` 6ps Pruritic Purple Polygonal Papules Plaques Pearl sheen White network on surface called Wickam's striae ```
177
Where is lichen planus usually seen?
On inner surface of wrists but can affect oral mucosa
178
Histology of lichen planus?
Hyperkeratosis with saw-toothing of rete ridges and basal cell degeneration
179
What lesions are seen in erythema multiforme and where?
Annular target lesions Most commonly on extensor surfaces of hands and feet Can be a combination of macules, papules, weals, vesicles, bullae and petechiae
180
Causes of erythema multiforme?
``` Infections- e.g. HSV, mycoplasma Drugs- SNAPP: Sulphonamides NSAIDs Allopurinol Penicillin Phenytoin ```
181
Which condition is dermatitis herpetiformis associated with (not herpes lol)?
Coeliac
182
Pathophysiology of dermatitis herpetiformis?
IgA Abs bind to basement membrane -> subepidermal bulla
183
Clinical features of dermatitis herpetiformis?
Itchy vesicles on extensor surfaces of elbows and buttocks
184
Histology of dermatitis herpetiformis?
Microabscesses which coalesce to form subepidermal bullae | Neutrophil and IgA deposits at tips of dermal papillae
185
Pathophysiology of pemphigoid?
IgG Abs bind to hemidesmosomes of basement membrane -> subepidermal bulla
186
Pathophysiology of pemphigus?
IgG Abs bind to desmosomal proteins -> intraepidermal bulla
187
How can you easily differentiate between pemphigoid and pemphigus?
PemphigoiD- Deep bullae | PemphiguS- Superficial bullae
188
Clinical features of pemphigoid?
Large tense bullae on erythematous base Often on forearms, groin and axillae Elderly Do not rupture as easily as pemphigus
189
Histology of pemphigoid?
Subepidermal bulla with eosinophils | Linear deposition of IgG along basement membrane
190
Clinical features of pemphigus?
Bullae are easily ruptured | Found on skin and mucosal membranes
191
Histology of pemphigus?
Intraepidermal bulla Netlike pattern of intracellular IgG deposits Acantholysis
192
What are seborrhoeic keratosis?
Benign rough waxy plaques with a 'stuck on' appearance
193
What is an actinic keratosis?
Rough sandpaper-like scaly lesion on sun-exposed area
194
Histology of actinic keratosis?
``` SPAIN Solar elastosis Parakeratosis Atypia/dysplasia Inflammation Not full thickness ```
195
What is a keratoacanthoma?
Rapidly growing dome shaped nodule which may develop necrotic crusted centre Grows over 2-3w and clears spontaneously
196
Histology of keratoacanthoma?
Similar to SCC- difficult to distinguish
197
Characteristics of Bowen's disease?
Intraepidermal squamous cell carcinoma in situ | Flat red scaly patches on sun-exposed areas
198
Histology of Bowen's disease?
Full thickness atypia/dysplasia | Basement membrane intact- not invading the dermis
199
When does Bowen's disease become an SCC?
When it invades the dermis
200
What is referred to as a 'rodent' ulcer?
BCC
201
Characteristics of a BCC?
Pearly surface often with teleangiectasia
202
Histology of BCC?
Mass of basal cells pushing down into dermis | Palisading
203
What is a mole?
A benign melanocytic naevus
204
Histology of melanoma?
Atypical melanocytes, initially grow horizontally in epidermis (radial growth phase) then vertically into dermis (vertical growth phase) which produces Buckshot appearance
205
Most important prognostic factor in melanoma?
Breslow thickness
206
Subtypes of melanoma?
Lentigo maligna melanoma- sun exposed area of elderly Superficial spreading malignant melanoma- irregular borders with colour variation Nodular malignant melanoma Acral lentiginous melanoma- palms, soles and subungal areas
207
How can you differentiate between Stevens Johnson syndrome and Toxic Epidermal Necrolysis?
Sheets of skin detachment- <10% BSA= SJS, >30%= TEN
208
What commonly causes SJS and TEN?
Drugs- Sulphonamide antibiotics, anticonvulsants
209
How does pityriasis rosea typically present?
Salmon pink rash appears first (Herald patch) followed by ovule macules in Christmas tree distribution Post-virus
210
What type of hypersensitivity reaction is involved in SLE?
Type III
211
RFs for SLE?
In pts with classical complement deficiencies Drug induced Afro-Caribbeans F>M
212
HLA association of SLE?
HLA DR3
213
Autoantibody involved in SLE?
ANA (95%) Anti dsDNA Anti-Sm Anti-histone
214
Histology of SLE?
``` LE bodies Kidney- CNS- small vessel angiopathy Spleen- onion skin lesions Heart- Libman-Sack endocarditis ```
215
Diagnostic criteria for SLE?
``` 4 of 11 ACR criteria- SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivity Blood disorders (AIHA, ITP, leucopenia) Renal involvement ANA +ve Immune phenomena Neuro symptoms Malar rash Discoid rash ```
216
HLA association of scleroderma?
HLA DR5 + DRw8
217
Autoantibody in limited and diffuse scleroderma?
Limited- anti-centromere Diffuse- anti-Scl70, fibrillarin, RNA pol I, II, III PM-Scl
218
Histology of limited scleroderma?
Increased collagen in skin and organs | Onion skin thickening of arterioles
219
Histology of diffuse scleroderma?
Inflammation within or around muscle fibres
220
Signs and symptoms of limited scleroderma?
Skin changes on face and distal to elbows and knees ``` Calcinosis Raynaud's Esophogeal dysmotility Sclerodactyly Telangiectasia ```
221
Signs and symptoms of diffuse scleroderma?
Skin changes can occur anywhere Widespread organ involvement Pulmonary fibrosis association
222
Autoantibody in polymyositis + dermatomyositis?
Anti Jo-1 (tRNA synthetase)
223
Signs and symptoms of polymyositis + dermatomyositis?
Proximal muscle weakness Increased CK + abnormal EMG DM has cutaneous features- heliotrope rash + Gottron papules
224
Name some large vessel vasculitides?
Takayasu's arteritis | Temporal arteritis
225
Name some medium vessel vasculitides?
Polyarteritis nodosa Kawasaki's Buerger's disease
226
Name some small vessel vasculitides?
Wegener's granulomatosis Churg Strauss Microscopic polyangiitis Henoch Schonlein Purpura
227
What is Takayasu's arteritis also referred to as?
Pulseless disease- absent pulse, bruits and claudication | Increased in Japanese women
228
Key features of temporal arteritis?
``` Elderly Scalp tenderness Temporal headache Increased ESR Overlap with polymyalgia rheumatica ```
229
Histology of temporal arteritis?
Granulomatous transmural inflammation + giant cells + skip lesions
230
Key features of polyarteritis nodosa?
Renal involvement main feature Spares lungs 30% have Hep B Microaneurysms on angiography
231
Key features of Kawasaki's?
``` Children <5 Fever>5d Rash- red palms and soles Conjunctivitis Inflammation of lips, mouth or tongue (STRAWBERRY) Cervical LNs Coronary arteries may be involved ```
232
Key features of Buerger's disease?
``` Heavy smokers usually men >35 Inflammation of arteries of extremities Pain Ulceration of toes, feet and fingers Angiogram- corkscrew appearance from segmental occlusive lesions ```
233
Key features of Wegener's granulomatosis?
Triad of URT- sinusitis, epistaxis, saddle nose LRT- cavitation, pulmonary haemorrhage Kidneys- crescentic glomerulonephritis cANCA +ve
234
Key features of Churg Strauss?
Asthma, allergic rhinitis Eosinophillia Later systemic involvement pANCA +ve
235
Key features of microscopic polyangiitis?
Pulmonary renal syndrome- pulmonary haemorrhage and glomerulonephritis pANCA +ve
236
Key features of Henoch Schonlein purpura?
``` IgA mediated vasculitis In children <10 Preceding URTI Palpable purpuric rash- lower limb extensors + buttocks Colicky abdo pain Glomerulonephritis Arthritis Orchitis ```
237
What is amyloidosis?
Multisystem disorder caused by abnormal folding of proteins that are deposited as amyloid fibrils in tissues. disrupting their normal function
238
What is the primary form of amyloidosis?
AL- deposition of amyloid L protein
239
Key features of AL amyloidosis
Most associated with plasma cell dyscrasias and with paraproteins e.g. MM Most have monoclonal Ig, free light chains in serum and urine (Bence Jones) and increased bone marrow plasma cells
240
What is the secondary form of amyloidosis?
AA amyloidosis- Amyloid A (an acute phase protein) secondary to chronic infection and inflammation e.g. autoimmune disease- RA, ank spond, IBD, chronic disease- TB, IVDU+ non-immune- RCC, Hodgkin's
241
Clinical features of amyloidosis?
Caused by amyloid deposits in various organs- Kidney- nephrotic syndrome (most common presentation) Heart- conduction defects, HF, cardiomegaly Liver/spleen- hepatosplenomegaly Tongue- macroglossia in 10% Neuropathies- inc carpal tunnel
242
How can amyloidosis be identified by staining?
Apple green birefringence with Congo red stain under polarised light (otherwise pink/red)
243
What is sarcoidosis?
A multisystem disease of unknown cause, commonly affecting young adults, characterised by non-caseating granulomas in many tissues
244
What is seen on histology of sarcoidosis?
Non-caseating granulomas, also get Schaumman and asteroid bodies (inclusion of protein and calcium)
245
How is sarcoidosis most commonly detected?
Routine CXR - bilateral hilar lymphadenopathy and pulmonary infiltrates leading to fine nodular shadowing in mid zones Most seek help with SOB, cough, chest pain + night sweats
246
Extrapulmonary manifestations of sarcoidosis?
Skin- erythema nodosum, lupus pernio, skin nodules LNs Joints- arthritis + bone cysts Eyes- anterior uveitis Liver/spleen- hepatosplenomegaly Blood- leukopenia/anaemia Hypercalcaemia/hypercalcuria -> renal calculi + nephrocalcinosis Heart- dysrhythmias, cardiomyopathy, conduction defects CNs Constitutional symptoms- FLAWS
247
How is sarcoidosis diagnosed?
Exclusion | Ix- Raised Ca, ESR + ACE, transbronchial biopsy

Pathology (13 decks)

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