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Pathology 1 Block 2 > Immunopathology 2 > Flashcards

Immunopathology 2 Flashcards

1
Q

Autoimmunity can arise from these 3 factors?

A

Genetic

Environmental

Immunity

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2
Q

Name 4 autoimmune disorders:

A
  1. SLE
  2. Rheumatoid arthritis
  3. Sjogren
  4. Scleroderma
  5. Dermatomyositis
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3
Q

SLE damage is caused by what?

A

mostly due to deposition of immune complexes

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4
Q

what is noticible in this picture?

A

SLE (Class IV): deposits thickening capillary walls and thrombi (blue arrows)

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5
Q

SLE is what type of hypersensitivity?

A

Hypersensitivity type 3

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6
Q

what disease is this?

what are the arrows pointing at?

A

Lupus nephritis (class 4 lupus)

arrows point at wire loop lesions

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7
Q

what disease causes this?

A

SLE

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8
Q

what is being shown here? (arrows)

what disease causes this?

A

Libman-Sacks endocarditis of the mitral valve in lupus erythematosus. The vegetations attached to the margin of the thickened valve leaflet are indicated by arrows. Non-bacterial verrucous

SLE causes this

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9
Q

what disease is this?

what is the name for this symptom?

A

SLE

malar rash

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10
Q

in what disease we see this?

what is being shown here?

A

SLE class 4

narrowing of glomerular capillaries by mesangial and endocapillary proliferation. Wire-loop deposits and hyaline thrombi are segmentally distributed

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11
Q

what is the cell being shown by the arrow?

This characteristic appearace is found in what body parts or areas?

A

Pleural fluid. A neutrophil with an ingested large nucleus (nucleophagocytosis) (arrow) compressing the nucleus of the neutrophil (asterisk).

This appearance is characteristic of the L-E cell found in the blood, marrow, or serous effusions in patients with lupus erythematosus

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12
Q

what disease causes this?

A

Rheumatoid arthritis

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13
Q

In rheumatoid arthritis, what joint is usually spared? In what other disease is this joint not spared?

A

distal interphalangeal joint (DIP) unlike in osteoarthritis.

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14
Q

what disease causes this?

what is going on in this picture?

A

Rheumatoid Arthritis

subsynovial tissue containing a dense lymphoid aggregate is seen

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15
Q

what disease is this?

what is being seen in this picture?

A

Rheumatoid arthritis

Low magnification reveals marked synovial hypertrophy with formation of villi.

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16
Q

what disease causes this?

What is being shown here?

A

Rheumatoid arthritis

A fibrinoid nodule = fibrinoid necrosis encapsulated by eptitheloid cells (granuloma formed)

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17
Q

what is the clinical feature of rheumatoid arthritis?

A
  • small joints of hands and feet
  • early morning stiffness
  • anything attached to the wrist will be affected
    • ulnar deviation
    • flexor tendon tendosynovitis (hallmark)
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18
Q

what is this?

what disease?

A

swann neck deformity

rheumatoid arthritis

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19
Q

what disease?

what is it?

A

rheumatoid arthritis

boutonnière deformity

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20
Q

what disease causes this?

what is it?

A

rheumatoid arthritis

popliteal (Baker) cyst develops posteriorly and inferiorly to the knee as a distention of a local bursa

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21
Q

what are the hematologic findings of rheumatoid arthritis?

A

Anemia of chronic disease (ACD)

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22
Q

What will be the lab findings of rheumatoid arthritis?

A
  • Rheumatoid Factor (RF): most common is IgM
  • Normal to increased serum C3
  • C3 levels are low in synovial fluid
  • Synovial fluid analysis: presence of white cells
  • RF can be detected in synovial fluid
  • *antibodies to cyclic citrullinated peptides (anti-CCPs)
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23
Q

what can be expected in radiological labs for rheumatoid arthritis?

A

Plain X-ray, USG, MRI

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24
Q

what is Sjögren Syndrome?

A

chronic, slowly progressive autoimmune disease characterized by lymphocytic infiltration of exocrine glands

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25
Q

what are the main symptoms seen in Sjögren Syndrome?

A

xerostomia dry mouth

dry eyes (keratoconjunctivitis)

dental caries

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26
Q

why do you see decrease in tears and saliva (sicca syndrome)?

A

lymphocytic infiltrate and fibrosis of lacrimal and salivary gland

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27
Q

what cells are mostly predominate the inflammation?

A

CD4+ helper T-cells predominate the inflammation, along with B cells, and plasma cells

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28
Q

what other anti-bodies can be found in inflammation during Sjögren Syndrome? which are the most important?

A

also antinuclear antibodies such as rheumatoid factor , and other are present

most important:

SS-A (Ro)

SS-B (La)

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29
Q

Sjögren Syndrome is associated with what two HLA genes?

A

HLA association: HLA-B8, HLA-DR3

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30
Q

in Sjögren Syndrome, what do we find in the salivary glands?

A

periductal and perivascular lymphocytic infiltration

lymphoid follicles with germinal centers may appear

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31
Q

in Sjögren Syndrome, how do the ducts look? what does this lead to later?

A

ductal lining cells show hyperplasia, this leads to obstruction

later there is acinar atrophy, fibrosis, and hyalinization

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32
Q

where is this?

In what disease can we see this?

what is the left circle?

what is the right circle?

A

salivary gland

sjogren disease

gland

duct

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33
Q

what can we see in this picture?

in what disease can we expect this?

A

Note: dense lymphocytic inflammation, fibrosis

Sjogren syndrome

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34
Q

what can we find in the labs for sjogren syndrome?

A

antibodies in serum: SS-A(Ro), SS-B(La)

positive RF

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35
Q

patients with sjogren syndrome are at risk of what cancer?

A

lymphoma of marginal zone

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36
Q

what is Systemic Sclerosis (scleroderma)?

A

chronic inflammation (autoimmune),

2) widespread damage to small blood vessels, and
3) progressive interstitial and perivascular fibrosis in skin (hardening of skin (it stretches)) and multiple organs

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37
Q

in scleroderma, why is there autoimmunity?

A

CD4+ T cells responding to unknown antigen in skin

this activates inflammatory cells and fibroblasts

cytokines from T-cells (TGF-β, IL-13)

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38
Q

why is there vascular damage in scleroderma?

A

intimal proliferation, endothelial activation, and injury

39
Q

why is there fibrosis in scleroderma?

A

due to activated macrophages,fibrogenic cytokines

40
Q

in scleroderma, where does the sclerotic atrophy start? where does it go after?

A

begins with fingers and distal regions of upper extremities,

later involves neck and face

41
Q

what will be seen in the histology of scleroderma?

A
  • edema, perivascular infiltrates (CD4+ T cells)
  • swelling and degeneration of collagen (eosinophilic staining)
  • capillaries and small vessels show thickened basal lamina, endothelial damage, and partial occlusion
42
Q

what are the clinical symptoms of scleroderma?

A

C: calcinosis cutis

R: Raynaud’s phenomenon

E: esophageal dysfuntion

S: sclerodactly (tapered fingers, claw-like)

T: telangiectasia

CREST

43
Q

what changes do we see in the skin during scleroderma?

A
  • increasing fibrosis of dermis, tightly bound to subcutaneous structures
  • increase in compact collagen, and thinning of epidermis, loss of rete pegs
44
Q

what disease is this?

what is being shown here?

A

scleroderma

Sclerodactyly with dermatogenous contractures

45
Q

what disease is this?

what is being shown here?

A

scleroderma

Microstomia (radial furrowing around the mouth) with the typical frenulum sclerosis.

46
Q

What disease causes this?

what is being shown here?

A

scleroderma

Skin hardening/thickening proximal of the metacarpophalangeal-joints

47
Q

what disease causes this?

what is being shown here?

A

scleroderma

Scleroderma-typical facial physiognomy with hypermimia, microstomia, telangiectasias and a beaked nose

48
Q

in what disease do we see this?

what is this?

A

scleroderma

Digital ulcerations at the fingertips

49
Q

what disease causes this?

what is this?

A

scleroderma

Digital ulcerations and necrosis of the fingertips

50
Q

what disease causes this?

what is seen here?

A

Scleroderma

Severe calcifications with deposition of subcutaneous masses.

51
Q

what disease cause?

what is seen here?

A

scleroderma

Multiple ulcerations at bone protuberantes with inflammation in the surrounding sclerotic skin.

52
Q

what do you see here?

In what disease do we see this?

A

perivascular mononuclear cell infiltrate at the early stages of disease. Perivascular changes are shown at high power in the left panel.

scleroderma

53
Q

what disease is this?

what do we see here?

A

Later stage disease show skin sclerosis, a low density of blood vessels, and absence of inflammatory cells.

At this stage, there may be associated epidermal changes with thickening and loss of secondary skin structures, including hair follicles and sweat glands. Absence of the rete ridges is also characteristic at the later stages

54
Q

What is Raynaud’s phenomena?

what areas does it affect?

A
  • type of systemic scleroderma
  • episode of vasoconstriction in the fingers and toes that occurs in virtually every patient with scleroderma

• affect the tip of the nose and earlobes

55
Q

in Raynaud’s phenomena, what triggers the changes seen?

A

exposure to cold, a decrease in temperature, emotional stress, and vibration

56
Q

what changes are seen in raynaud’s phonemenon?

the 3 color changes reflect the pathogenesis are…

A

skin changes to pale, cyanotic and erythematous

vasoconstriction, ischemia, and reperfusion

57
Q

what is this disease?

A

Raynauds phenomena

58
Q

what changes do we see in scleroderma in the GI?

A

progressive atrophy

collagenous fibrous replacement of the muscularis may develop

*at any level of the gut but are most severe in the esophagus

  • lower two thirds of the esophagus often develops a rubber-hose–like inflexibility
  • metaplasia can occur
    • ​leads to GERD
59
Q

What changes are seen in Scleroderma in the Musculoskeletal system?

A
  • synovium show inflammation, hypertrophy & hyperplasia
  • unlike Rheumatoid Arhtritis, no joint destruction
60
Q

SLE immune complexes will target what areas of the body?

A

skin,

joints,

kidney,

serosal membrane

61
Q

SLE incidence is higher in what sex?

A

women

62
Q

what is the fundamental defect in SLE?

A

Inability to maintain self-tolerance

63
Q

What is the genetic component found in SLE?

A
  1. higher incidence among family members
  2. higher incidence among monozygotic twins
  3. HLA association
64
Q

What locus in the HLA gene leads to SLE?

A

HLA-DQ

65
Q

the HLA gene is associated with SLE because of what?

A

because it is responsible for the formation of autoantibodies:

  1. anti-double stranded DNA (ds)
  2. anti- Smith (Sm)
  3. antiphospholipid antibodies
66
Q

What does the immunological factor that is found in SLE do?

A
  • leads to persistence and uncontrolled activation of self-reactive lymphocytes
67
Q

what 2 reasons cause the immunological factor in SLE?

A
  1. defective elimination of self-reactive B cells in bone marrow or defect in peripheral tolerance
  2. CD4+ helper T cells specific for nucleosomal antigens also escape tolerance and contribute to production of auto antibodies
68
Q

What environmental factor contributes to SLE?

A
  1. UV ray exposure:

cells exposed to UV rays undergo apoptosis, which illicit an immune response, activate keratinocyte who release IL-1 and induce inflammation

  1. Estrogen

stimulate B cells to produce antibodies directed against DNA

69
Q

How do immune complexes cause damage in SLE?

A
  • immune complexes formed initiates inflammatory response in organs/tissue and anti DNA complexes go to glomeruli & small blood vessels (in other words they get tagged)
  • autoantibodies look for these tags and opsonize WBC/RBC/Platelets that are damaged (they expose the nucleus to antinuclear antibodies)
70
Q

what is another name for LE cells?

What is a LE cell?

A

hematoxilin bodies

LE cell is any phagocytic leukocyte that has engulfed denatured nucleus of an injured cell

71
Q

what can we see in blood vessels with SLE?

A

acute necrotizing vasculitis

• presence of fibrinoid necrosis

72
Q

what can we see in the kidneys with SLE?

A
  • deposition of immune complexes
  • six (6) Classes are recognized.
73
Q

What are the 6 classes of kidney SLE?

A

Class 1

  • minimal mesangial lupus nephritis

Class 2

  • mesangial proliferative lupus nephritis

Class 3

  • focal lupus nephritis

Class 4

  • diffuse lupus nephritis

Class 5

  • membranous lupus nephritis

Class 6

  • advanced sclerosing lupus nephritis
74
Q

what can we see in the skin with SLE?

A

erythema: butterfly rash (malar) in 50%
* caused by sun exposure

75
Q

what is the most common class of kidney SLE? and the least?

A

Class I

Class 4

76
Q

What pericardial changes can we expect to see with SLE?

A

Libman-Sacks endocarditis

Libman-Sacks endocarditis = Non-bacterial verrucous endocarditis (fibrinous)

77
Q

In a quick summary, how do we detect a diagnosis of SLE using symptoms only?

A
  • malar rash (butterfly rash)
  • photosensitivity
  • recurrent spontaneous abortions
78
Q

how do we confirma a diagnosis of SLE?

A
    • for Anti-nuclear antibodies
  • high titer of IgG to dsDNA
  • antibodies agains Sm
    • LE cell
  • proteinuria
79
Q

how do you confirm a diagnosis of scleroderma with labs?

A
    • anti-Scl 70
  • anti-centromere antibody
80
Q

what is dermatomyositis?

A

genetically determined autoimmune disorder that target the skeletal muscle or the skin

81
Q

what is the general pathogenesis of dermatomyositis?

A
  1. damage to small blood vessels
  2. muscle injury
  3. telangiectasia (dilated capillary loops)
82
Q

what body structures do we find affected by dermatomyositis?

A

nail folds, eyelids, and gums

83
Q

In dermatomyositis, if a biopsy is done of the affected structures (muscle of skin), what will we find?

A

deposits of complement: C5b-9

84
Q

what are the antibodies are associated with the gottron papules seen in dermatomyositis?

A

anti-Mi2

85
Q

what are the antibodies are associated with the interstitial lung disease, non-erosive arthritis, skin rash seen in dermatomyositis?

A

Anti-Jo1 antibodies

86
Q

what are the antibodies are associated with the paraneoplastic & juvenile cases of dermatomyositis?

A

Anti-P155/P140 antibodies

87
Q

what type of atrophy will be expected in a muscle with dermatomyositis?

if a immunohistochemistry is done of this biopsy, what is expected to be seen?

A

perifasicular atrophy of muscle

inflammatory cells stain positive for CD4+ T-helper cells, and deposition of C5b-9 in capillary vessels

88
Q

in what disease can we expect to see this?

what is happening here?

A

dermatomyositis

gottron sign (violaceous erythema, over the mcp/icp joints of the hand and fingers.

89
Q

what is happening in the outlined area?

A

perifascicular atrophy

90
Q

what are the clinical signs we need to see in order to diagnose dermatomyositis?

A
  • muscle weakness
  • lilac colored discoloration of upper eyelids
  • Gottron papules = scaling erythematous eruption or dusky red patches over knuckles/elbows/knee
91
Q

what sign of dermatomyositis can be found in a lab report?

A

elevated Creatine kinase

92
Q

what is Mixed connective tissue disorder?

A

disease with clinical features that are a mixture of the features of SLE, systemic sclerosis, and polymyositis

93
Q

what is characteristic of mixed connective tissue disorder?

A

characterized serologically by high titers of antibodies to ribonucleoprotein particle-containing U1 ribonucleoprotein

94
Q

what is the clinical presentation of mixed connective tissue disorder?

A
  • synovitis of the fingers,
  • Raynaud phenomenon
  • mild myositis,

Pathology 1 Block 2 (8 decks)

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