MedEd Histopath Flashcards
How does HPV cause cervical cancer/
inhibits tumour suppressor genes (check)
E6 inactivates p53
E7 inactivates Rb gene
hypoechoic mass on USS
most likely cyst
Hyperplasua
increase in number of cells
e.g. parathyroid hyperplasmia
hypertrophy
increase in size of cells (HOCM, LVH)
Metaplasia
r
Dysplasia
Neoplasia
Vulval intraepithelial neoplasia
squamous epithelium on the outside
epithelial thickening
massive proliferation of epithelial cells
VIN types
usual and differentiated
VIN - differentiated type
derived from lichen sclerosis
more likely to develop into SSCC
hen is it not VIN anymore
when it invades the BM
Types of vulval and vaginal carcinoma
squamous cell carcinoma (95%)
clear cell carcinoma
What are CIN and VIN?
both are types of dysplasia
poorly differentiated cells
not cancer until invades the BM
cervical and vulval
buzz word for fibroids
purple bundles of smooth muscle cells
how common are fibroids?
common
present in 40% of women above 40 yo
How is endometrial tissue spread in endometriosis?
vascular or lymphatic dissemination of endometrial cells
powder burn
endometrial tissue is darker hence this appearance
Endometroid vs non-endometrioid carcinoma
endometriod more common
Endo: Sarah eats Meat (secretory, endometriosis, mucinous)
Non-endo: Paul Can’t stand (it) - papillary, clear cell, serous
buzz word for Fitz Hugh Curtis sundrome
‘violin strings’ peri hepatic lesions
Causes of ascending PID
n gonorrhea
c trachmoatic
causes of external contamination e.g. TOP PID
staph aureus?
what type of physiological cysts are common in early pregnancy ?
common in early pregnancy
corpus luteum may become filled with blood or fluid
most likely to present with intraperitoneal bleeds
Rokitansky protuberances are associated with…
How does milk travel through the breast?
made in lobules
travels through duct to the nipple
What is the single best prognostic indicator for breast cancer?
lymph node involvement
radiological buzzword for DCIS
microcalcifications
fibro… radiological finding
areas of microcalcifications in multiple areas in both breasts
4 classes of breast histopath
inflammatory
benign breast lump
proliferative
malignant breast lump
triple assessment
clinical hx and exam
imaging (USS in under 35, Mammography in over 35)
pathology/biospy
FNA vs core biopsy in breast cancer
FNA - used if you expect the content of a lump to be liquid, collect cells
CB - used when you expect the content of a lump to be solid and you get a portion of the tissue for histopath
types of mastitis
lactational (within 6w PP due to milk stasis, may have a cracked nipple)
non-lactational (not currently breast feeding)
acute mastitis - which cells may be found
neutrophils
Mx of mastitis
continue breast feeding bilaterally (can be due to obstruction)
analgesia
warm compresses
if unresolved after 12-24h
- medical - oral fluclox because S aureus is most common
abscess: IV abx and incision & drainage
Fat necrosis of the breast causes
trauma to the breassts
previous radiotherapy
unilateral masss?
histopath of breast fat necrosis
fat ?
fibroadenoma age group
20-40
buzzword for fibroadenoma
single
breast mouse
moves very mcuh
Mx of fibroadenoma
<3m -> convservative mx
> 3 cm -> surgical (or if v symptomatic)
phyllodes tumour
extremely rare
aggressive malignant fibroepithelial neoplasms
malignant version of fibroadenoma
2 in every 1 million
> 50 yo
artichoke appearance
frond-like
branching
Fibrocystic disesaseas
fluid-filled sacs in the breast
common - 7% of women, pre or perimenopausal
lumpiness of breasts
can be unilateral m bilateral, single or multiple, cyclical pain
well-demarcated, fluctuant, transilluminable, clear nipple discharge
histo: fluid filled cysts
red flags:
FNA is blood stained
core biopsy reveals complex cystic contents
bening duct ectasia - pathogenesis
blockage of milk ducts -> dilatation (proteinaceous immaterial inside the duct)
seen in peri-post menopausal women
benign duct ectasia- RFs
smokers
mass with yellow green discharge
sub areolar mass, nipple inversion
Intraductal papillome
benign
nodule wishin a duct
seen in peri and postmenopausal women
2 types:
1. peripheral -> small ductules affected
2. central -> large ductules affected -> blood or clear nipple discharge
Radial scar
bening sclerosing lesion caused by impaired healing post injury
radial scar buzz words
central, fibrous, stellate area
Proliferative breast conditions - pre-malignant
usual epithelial hyperplasia (1-2x) - good
flat epithelial atypic (4x) - medium
in situ lobular neoplasia (7-12x) - really baad
What is the commonest cancer in the UK
breast cancer
commonest cancer in the UK
affects 1/7 females
rare under 35, increasing with age
genetic of breast cancer
BRCA 1/2 (AD)
FH (br or ov ca)
Li Fraumeni syndrome
2 main types of breast ca
non-invasive (DCIS, LCIS)
invasive (IDC, ILC, Paget’s disease)
DCIS - how does it present
microcalcifications in asymptomatic women
most common non-invasive breast cancer
most common breast cancer
invasive ductal carcinoma (85%)
buzzwords breast cancer
Nottingham grading system
used for breast cancer
graded /3 for following criteria (total /9)
- nucelar pleomorphosms
- tubule formato
- mitotic activity
Grade 1: well diff
Grade 2:
Grade 3
grading for breast cancer
Nottingham grading system
Commonest brain cancer in childer
astrocytoma
stroke definition
focal neurological deficit of presumed vascular origin that lasts more than 24 h
Commonest cause of ischemic stroke
- atherosclerosis
- thromboembolic (e.g. AF)
commonest RD for hemorrhagic stroke
hypertension
single best modifiable RF for ALL strokes
hypertension
types of haemorrhagic strokes
traumatic
non-traumatic
non-traumatic hemorrhagic strokes
intraparenchymal haemorrhage (50% due ot HTN, common site: basal ganglia)
subarachnoid haemorrhage (85% from ruptured berry aneurysm, associated with PCKD = bilateral abdo masses and FH or SASH)
buzzword for SAH on CT
hyperattenuitaion around the circle of willis
xanthochromia
LP 12h post CT that was -ve for SAH
blood -> xanthochromia, confirms SAH
haemorrhagic strokes - traumatic
extradural haemorrhage (lemon shape - you are extra so you have lemon in your drink, rupture of MMA, post RTA or punch to temples)
subdural haemorrhage (prev hx of minor head trauma, banana/crescent shape, rupture of bridging veins)
alcoholics, anti-coal, elderly
What is the single largest cause of death in under 45s?
traumatic brain injiry
RED FLAGS post head injury
otorrhoea
rhinorrhoea
straw coloured fluid (CSF) from nose or ears
battle’s sign
What are contusions
collisions between brain and skull
coup: impact of brain on skull
countercoup: injury to the opposite side of the brain
e.g. whiplash
Commonest cells of the brain
astrocytes
what is the commonest type of brain cancer?
mets (lung, skin and breast)
- astrocytoma (primary) -> glioblastoma multiforme specifically
astrocytomas locations in the brain
intra-axial (within the brain parenchyma)
supratentorial
Do brain cancers use TNM?
no
grading vs staging
grading: how differentiated the tumour cells are compared with native
staging: how far the tumour has sprad
Range of astrocytomas
pilocytic ast rocytoma (G1) - 0-20yo, indolent, childhood
diffuse glioma (G2-G3) - 20-40 yo
Glioblastoma multiforme (G4) - 50+ years, most common! aggressive, primary tumour in adults
Brain cancer buzzwords slide
Medulloblastoma
mainly affects children
balance issues
squint
craaniopharyngioma vs pituitary
PT: superior bitemporaal hemianopia
more info here
5As of dementai
Amnesia
Apraxia
Aphasia
Agnosia
Anomia
commonest causes of dementia in order
- alzheimes
- vascular
- lewy body
- frontotemporal
theories for AD
- accumulate of beta amyloid plaques
- hyperphosphorylation of tau proteins
meidal temporal lobes and hippocampus most commonly affected in AD
global atrophy
BRAAK
used for staging AD
buzzwords for dementias
syndromes in parkisons
Flow of CSF
produced in choroid plexus within the ventricular system of the brain
drains through the inter ventricular foramen into 3rd ventricle
from 3rd to 4th via cerebral aqueduct
goes into the subarachnoid space
absorbed into sinuses and finally into the superior sagittal sinus
Different types of hydrocephalus
blockage: non-communicating
increased production/decreased absorption: communicating hydrocephalus
normal pressure hydrocephalus
aggregation of which protein in Parkinson’s disease
aloha synuclein
mccune albright syndroem
fibrous dysplasia
cafe au lait spots
precocious puberty
commonest bone cancer in adults
osteosarcoma
histological features of RA
osteomyelitis consequences
gout vs pseudogout
gout: needle shape -ve birefringent, rat bite erosions
pseudo gout: rhomboid shoe
benign bone cancer
osteisarcoma - commonest locations
knee (60%), tibia, femur
in teenagers
bone: fibrous dysplasia
seen in McCune Albright syndrome
bone is replaced by benign fibrous tissue
benign bone tumours
proliferation of which cell type is seen in RA
synoviocytes
anti CCP and RF binds to them
through B- and T-cell activation but you often don’t get proliferation of these cells
Layers of the epidermis
bullous pemphigoid
Pemphigus vulgaris
theories for eczemma
- inside out theory - automuune IgE sensitisation leads to skin barrier dysfunction
- outside in theory - allergen exposure leads to IgE dysfunction
eczema - mmutatiosn
filaggrin gene
hypersensitivity type - eczema
Type 1:
Type 2:
hsitpath of eczema
thickening of epidermis
spongiosis (fluid collection)
Psoriasis
t-cell hyperactivity
epidermal thickening
buzzword: parakeratosis (lots of keratin and keratinocytes)
Auspitz sign
associated with psoriasis
more info
types of psoriasis
bullous pemohigoid vs pemphigus vulgaris
bullous pemphigoid: IgG reaction to adhesion molecules
difficult to rub away because covered by epidermis
more in
pemphigus: bullae not that strong
pemphigus foliates
affects elderly populaation
detachment of superficial keratinocytes
commonest skin cancer
BCC (70%)
SCC (20%)
melanoma (10%)
most common type of melanoma
superficial spreading
