Other

Question 1

Appendiceal mucinous neoplasm

Answer 1

LAMN (epithelium on fibrous tissue or non-destructive through wall)

HAMN (same as LAMN with HG cytology)

mucinous adenocarcinoma (destructive invasion and desmoplasia)

NB: report whether epithelial cells present in extraappendiceal mucin

Question 2

neuroendocrine tumours of appendix

Answer 2

carcinoid

goblet cell carcinoid

mixed GCC-adenocarcinoma (MANEC)

Question 3

staging appendiceal neoplasm

Answer 3

three tier grading (as per CAP)

non-mucinous: glands (50% and 95% cutoffs)

mucinous: G1-3, signet rings = G3

Question 4

When is HR HPV tested in NZ?

Answer 4

Used in 3 situations:

1. triage of ASCUS and LSIL in 30+ (if +ve=colp, if -ve=rpt in 12 months)
2. test of cure after tx of HSIL
3. discordant colposcopy

Question 5

What is pathogenesis of squamous intraepthelial lesions

Answer 5

LG: viral infection

HG: virus integrates into genome, E6/E7 part of viral genome expressed

Question 6

How is HR HPV tested in NZ?

Answer 6

PCR-based amplification

ThinPrep or Surepath samples

detects L1 region of HPV genome

14 HR types (incl 16, 18, 31, 33)

Question 7

benefits and drawbacks of hrHPV as primary screening

Answer 7

benefit: more sensitive, overall more cervical ca found, can be self-sampled, not dependent on cytologist experience/skill, not affected by obscuring artefact
drawback: less specific, some will have infection but no lesion

Question 8

what are plans for cervical screening in NZ?

Answer 8

Primary prevention:

HPV Immunisation (2 doses 6mo apart, male and female, age 9-26, 7 HR and 2LR HPVs (Gardasil-9))

Secondary Prevention:

Screening tests

Currently LBC cytology every 3 years

2018: hrHPV Testing with partial genotyping and cytology triage every 5 years

Question 9

explain use and rationale of p16 in cervical specimens

Answer 9

normal protein that switches off cell proliferation

function disrupted by E7 on HPV, allows uncontrolled proliferation

p16 levels increase in nucleus and cytoplasm

–> surrogate marker for HPV integration

Question 10

preparation of an LBC cervical sample (Thin Prep)

Answer 10

collected: 5x around os, rinsed in fixative
processed: cells dispersed, vacuum used to collect cells on a membrane, transfered onto slide

stained (nuclear stain, blue and orange stains) and mounted

imaged and reviewed

Question 11

How are sarcomas graded?

Answer 11

FNCLCC grading system, based on:

tumour differentiation

mitotic count (10 and 20/10HPF cutoffs)

necrosis (0% and 50% cutoffs)

Question 12

grading mucoepidermoid ca

Answer 12

AFIP, points for:

cystic component (>20%)

neural invasion

necrosis

>4 mit/10HPF

anaplasia

Question 13

Neuroblastoma vs GNB/GN

Answer 13

stroma-rich (>50%) = GN or GNB vs stroma poor (<50%) = NB

nodules of NB: none (GN), microscopic (GNB intermixed), macroscopic (GNB nodular)

Question 14

How are neuroblastomas graded?

Answer 14

no ganglion cells, no neuropil = undiff NB

<5% ganglion cells + neuropil = poorly diff NB

>5% ganglion cells + neuropil = differentiating NB

favourable and unfavourable prognosis based on:

age (1.5 and 5 year cutoffs)

MKI (2 and 4% cutoffs)

Question 15

definition of gastric vs GOJ cancer

Answer 15

if involves GOJ and centre is within 2cm, call GOJ

if doesn’t involve GOJ (incl within 2cm), call gastric

nb: AJCC 7th ed uses 5cm cutoff
nb: GOJ = upper limit of gastric rugae or peritoneal reflection