Met histology

Question 1

Portal tract contents

Answer 1

Islands of connective tissue
Contain branches of the hepatic portal vein and hepatic artery
Also contain a bile duct

Question 2

Bile duct epithelium type

Answer 2

Simple cuboidal

Question 3

Hepatic lobule

Answer 3

Hexagonal shaped
Central vein (hepatic venue) in the muddle
Portal tracts at corners
Blood flows from corner –> centre

Question 4

Types of hepatic necrosis

Answer 4

Zonal = in one zone of the acinar unit 
--> haemodynamic changes
Bridging = forms bridge between portal tract and central vein 
--> severe hepatitis
Interface = around a portal tract 
--> autoimmune 
Apoptotic = single cells 
--> acute viral hepatitis

Question 5

Primary biliary cirrhosis

Answer 5

Autoimmune disease (anti-mitochondrial antibodies)
Infiltration of portal tracts 
Interface necrosis 
Granulomas around portal tracts
--> cirrhosis

Question 6

Collagen produced in cirrhosis

Answer 6

Types I and III

Question 7

Classification of nodules

Answer 7

Micro = <3mm --> alcoholic liver disease
Macro = >3mm --> greater risk of HCC

Question 8

HCC features

Answer 8

Cells resemble hepatocytes resting in nests
Central lumen
Bile may be secreted

Question 9

Pituitary cell types

Answer 9

Somatotrophs (50%) --> GH 
Mammotrophs (20%) --> PRL 
Corticotrophs (20%) --> ACTH
Thyrotrophs (5%) --> TSH 
Gonadotrophs (5%) --> FSH and LH

Question 10

Pituitary stalk contents

Answer 10

Pituicytes
Portal vessels
Hypothalamic neurone axons

Question 11

Thyroid follicle structure

Answer 11

Lined by simple cuboidal follicular cells –> release T3 and T4
Thyroid colloid in the middle containing thyroglobulin

Question 12

C cells

Answer 12

= parafollicular cells

Secrete calcitonin in response to high calcium levels

Question 13

Parathyroid cells

Answer 13

Chief cells --> PTH production 
Oxyphil cells (small central nuclei) --> function unknown

Question 14

ZG cells

Answer 14

Rounded clumps

• -> mineralocorticoids
• -> aldosterone

Question 15

ZF cells

Answer 15

Parallel cords of cells

• -> glucocorticoids
• -> cortisol

Question 16

ZR cells

Answer 16

Irregular cords of cells

• -> androgens
• -> testosterone

Question 17

Adrenal gland blood supply

Answer 17

Adrenal artery in capsule
Subscapular plexus in ZG 
Venous sinusoids through ZF 
Medullary plexus in ZR and medulla 
Adrenal vein drains from medulla

Question 18

Medulla blood supply

Answer 18

Blood from the cortex

Direct supply from vessels in the outer cortex

Question 19

Islet cell proportions

Answer 19

Alpha = 20% 
Beta = 70% 
Delta = 5-10% 
F = 1-2%

Question 20

Somatostatin release and function

Answer 20

From islet delta cells

Inhibits insulin and glucagon secretion

Question 21

Pancreatic polypeptide release and function

Answer 21

From F (pp) islet cells 
Inhibits pancreatic enzyme secretion

Question 22

Pituitary adenoma cell features

Answer 22

Uniform cells with large amounts of cytoplasm
Reduction in supporting network
Large areas stain positive for the same hormone

Question 23

Features of Grave’s disease

Answer 23

Thyrotoxic hyperplasia
Colloid scallopping
Follicular cells are taller with larger nuclei
Follicles themselves are smaller

Question 24

Renal cortex contents

Answer 24

Renal corpuscles
PCT
DCT 
Capillary network 
Medullary rays (some collecting ducts)

Question 25

Renal medulla contents

Answer 25

Loops of Henle Collecting ducts and tubules Vasa recta

Question 26

Bowman's capsule walls

Answer 26

``` Visceral = podocytes Parietal = simple squamous ```

Question 27

Glomerular filtration barrier

Answer 27

Podocytes Basement membrane Glomerulus endothelium

Question 28

PCT wall structure

Answer 28

Simple cuboidal Brush border Endocytotic vesicles + lysosomes Basolateral interdigitations

Question 29

Loop of Henle sections

Answer 29

Pars recta = same structure as PCT Thin descending limb = simple squamous Thin ascending limb = simple squamous Thick ascending = simple cuboidal with basal interdigitations

Question 30

Loop of Henle permeability

Answer 30

Thin descending = permeable to urea and water but not NaCl Thin ascending = permeable to NaCl but not water Thick ascending = active transport of NaCl

Question 31

DCT wall structure

Answer 31

Simple cuboidal Few microvilli and vesicles No brush border Basolateral interdigitations

Question 32

Collecting duct wall structure

Answer 32

Simple cuboidal | No interdigitations

Question 33

Juxtaglomerular cells

Answer 33

Specialised smooth muscle cells Around afferent (few in efferent) arterioles Secrete renin Beta1 receptors for SNS stimulation

Question 34

Macula densa cells

Answer 34

Taller and more densely packed than the rest of the DCT Sense the sodium concentration Communicate with JG cells via mesangial cells

Question 35

Lacis cells

Answer 35

Extraglomerular mesangial cells

Question 36

Urinary passageway mucosa

Answer 36

Transitional epithelium | Impermeable to urine

Question 37

Ureter muscle layers

Answer 37

``` Inner = longitudinal Middle = circular Outer = longitudinal ```

Question 38

Urinary passageway layers

Answer 38

Transitional epithelium Lamina propria/submucosa (no musculares mucosae) Muscularis (3 layers) Adventitia

Question 39

Glomerular response in GN

Answer 39

Swelling of endothelial cells Podocyte proliferation BM thickening Mesangial cell proliferation

Question 40

Histological patterns of GN

Answer 40

``` Diffuse = affects all glomeruli Focal = affect some glomeruli Global = entire glomerulus abnormal Segmental = only part of the glomerulus abnormal ```

Question 41

Minimal change GN

Answer 41

--> nephrotic syndrome Cell mediated immune response LM is normal EM shows flattened podocyte foot processes Children under 6 after respiratory infection Corticosteroid treatment

Question 42

Membranous GN

Answer 42

--> nephrotic syndrome Chronic immune mediated disease LM shows diffuse BM thickening EM shows deposition of electron dense immune complexes Occurs in adults Associated with infection, drugs, tumours and autoimmune disease

Question 43

Diabetic GN

Answer 43

--> nephrotic syndrome Caused by hyperglycaemia Capillary wall thickening, mesangial matrix expansion, BM thickening Kimmelstein-Wilson nodules (mesangial expansion)

Question 44

Acute proliferative GN

Answer 44

--> nephritic syndrome Diffuse glomerular hypercellularity --> proliferation of endothelial and mesangial cells --> neutrophil infiltration Occurs most commonly in children 1-4 weeks after Strep infection of pharynx or skin EM shows sub endothelial lumps (immune complex deposition)

Question 45

Nephrotic vs nephritis syndrome

Answer 45

Nephrotic = without inflammation Nephrotic --> proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia, lipiduria Nephritic --> haematuria, proteinuria, periorbital oedema, hypertension

Question 46

Renal cell carcinoma

Answer 46

Adenocarcinomas derived from tubular epithelial cells | 90% of primary kidney tumours

Question 47

Clear cell carcinoma

Answer 47

Derived from PCT cells | Tend to invade renal vein

Question 48

Transitional cell carinoma

Answer 48

Most common malignant bladder tumour Often have a papillary growth pattern May see large blood vessels

Question 49

Nephroblastoma

Answer 49

= small round blue cell tumour = Wilm's tumour Very rate Seen in very young children