Module Five: Applied Clinical Pathology

Question 1

What are the 4 zones of the prostate?

Answer 1

Transitional zone
Central zone
Peripheral zone
Anterior fibromuscular stroma

Question 2

What is the normal histology of the prostate?

Answer 2

Epithelial cells
Basal cells
Stroma

Question 3

What are the theories of the cause of nodular hyperplasia?

Answer 3

Imbalance of oestrogen/testosterone/dihydrotestosterone

Question 4

What zone does Nodular Hyperplasia affect?

Answer 4

Tz - compresses the urethra => difficulty passing urine

Question 5

Symptoms of nodular hyperplasia

Answer 5

Frequency, nocturia, urgency and incontinence, slow and weak stream, difficulty initiating and stopping flow, dribbling

Question 6

Histopathology of nodular hyperplasia

Answer 6

Proliferation of epithelial cells of the glands and ductules

Proliferation of the smooth muscle cells and fibroblasts within the stroma

Question 7

Complications of Nodular Hyperplasia

Answer 7

Chronic obstruction
Hypertrophy of the bladder, urinary stasis, recurrent UTI’s
Back pressure if obstruction is prolonged, causing hydroureter, hydronephrosis, renal failure and death

Question 8

What is the most frequently diagnosed carcinoma in males?

Answer 8

Prostate adenocarcinoma

Question 9

Risk factors for prostate adenocarcinoma

Answer 9

Increasing rate with age
Racial differences: rare in Asian males, most common in black males
Family history: risk increases two fold when first degree relative diagnosed
Genetic factors: e.g. BRCA2
Obesity, high fat diet

Question 10

How do you screen for prostate cancer

Answer 10

Measure serum PSA levels

Question 11

Causes for elevated PSA

Answer 11

Nodular hyperplasia
Prostate carcinoma
Prostatitis
Perineal trauma

Question 12

What is melanoma?

Answer 12

Malignant tumour derived from melanocytes

Question 13

What are the risk factors for melanoma?

Answer 13

Family history 
Large numbers of benign or atypical naevi 
Previous melanoma 
Immunosuppressive
Sun sensitivity
Exposure to UV

Question 14

What are the clinical and histological features of a benign naevus?

Answer 14

Clinical: small, well circumscribed, even coloration
Histological: symmetrical, cells predominantly in nests, round to oval, nuclei, maturation as cells get deeper

Question 15

What are the common types of naevus?

Answer 15

Sptiz naevus

Blue

Question 16

Features of a dysplastic naevus

Answer 16

Less symmetrical 
Larger
Irregular borders 
Fibrosis in upper dermis 
Some larger darker nuclei

Question 17

Clinical features of melanoma

Answer 17

Asymmetrical 
Border irregularity 
Colour variability 
Diameter (>6mm)
Evolving

Question 18

Microscopic features of melanoma?

Answer 18

Asymmetrical 
Poorly circumscribed 
Single cells predominate over nests 
Growth in continuity from one rete ridge to another
Extension into upper levels of epidermis
Cytolological atypical

Question 19

What are the growth phases of melanoma?

Answer 19

Radial growth phase - lacks any significant metastatic potential

Vertical growth phase - implies capacity for metastatic spread

Question 20

What are the prognostic indicators?

Answer 20

Tumour thickness 
Level of invasion
Ulceration
Mitotic rate
Lymphovascular or perinureal invasion
Satellite lesions

Question 21

Mutations in melanoma that disrupt cell cycle control genes?

Answer 21

CDKN2A

CDK4

Question 22

Mutations in melanoma that activate pro-growth signalling?

Answer 22

BRAF
NRAS
KIT

Question 23

Melanoma mutations that activate telomerase?

Answer 23

TERT promoter mutations?

Question 24

Where is CDKN2 located?

Answer 24

Chromosome 9p21

Question 25

CDK2N encodes for:

Answer 25

P16INK4A

P14ARF

Question 26

BRAF is what?

Answer 26

Serine threonine kinase

Question 27

What is the common BRAF mutation

Answer 27

V600E substitution of Glutamate for valine