Path Flashcards
pleomorphic adenoma (test)
MOST COMMON salivary gland tumor
BENIGN
middle age female
SLOW growing, PAINLESS, MOVABLE, firm, round, well circumscribed
ductal/epithelial and myoepithelial cells: EPITHELIAL and MESENCHYMAL differentiation
epithelial, myxoid, hyaline, chondroid, osseous tissue
mucoepidermoid carcinoma (test)
salivary gland tumor KIDS: most common malignant PAROTID, SMALL SALIVARY glands mixture: MUCUS cells, SQUAMOUS cells, intermediate cells prognosis: depends on grade
warthin tumor (test)
salivary gland tumor BENIGN middle age MALE SMOKER painless, PAROTID, can be BILATERAL EPITHELIAL and LYMPHOID, CYSTIC MOTOR OIL
gastropathy
when inflammation is rare or absent
MALToma
B cell origin CD19, CD20, CD43 t (11;18) monoclonal: only kappa OR lambda light chains or clonal IgH Tx: H. pylori eradication
CD19
MALToma
CD20
MALToma
CD43
MALToma
t (11;18)
MALToma
Pathogenesis of ulcerative colitis leading to toxic megacolon
inflammatory mediators damage muscularis propria and disturb neuromuscular function
acute sialadenitis
Causes?
Most common infectious cause?
inflammation of salivary gland
infectious: S. AUREUS
non-infectious: Sjogren’s, sarcoidosis, radiation
Parotid: swollen painful, pus draining from duct
chronic sialdenitis
inflammation of salivary gland
due to: SIALOLITH
Sx: episodic pain and swelling at mealtime (if submandibular: persistent enlargement may occur)
Tx: remove stone or gland
hairy leukoplakia
LATERAL tongue
EBV
immunocompromised patients
BALLOON cells
leukoplakia
40-70 yrs
TOBACCO, MALE
white patch that cannot be scraped off or characterized as any other disease
PREMALIGNANT unless proven otherwise
erythroplakia
40-70 yrs TOBACCO, MALE red patch less common and worse than leukoplakia dysplasia, carcinoma in situ or minimally invasive CA
oral squamous cell carcinoma
MOST COMMON: head and neck CA
oropharynx: HPV: p16
TOBACCO
usually advanced when Dx
p16
HPV related oral squamous cell carcinoma
dentigerous cyst
cyst around crown of unerupted tooth IMPACTED TOOTH associated with: AMELOBLASTOMA radiograph: unilocular lesion Tx: removal
ameloblastoma
locally invasive tumor in mandible
radiolucent SOAP BUBBLE
odontogenic keratocyst (OKC or keratocystic odontogenic tumor)
MALE; 10-40 yrs
POSTERIOR MANDIBLE
radiograph: well-defined unilocular or multilocular radiolucencies
locally AGGRESSIVE
association: nevoid basal cell CA syndrome
Tx: removal
cholesteatomas (test)
middle and internal ear benign LOCALLY INVASIVE lined by KERATINIZING STRATIFIED SQUAMOUS EPITHELIUM associated with: CHRONIC OTITIS MEDIA
imperforate anus
MOST COMMON congenital intestinal atresia
failure of the cloacal diaphragm to involute
esophageal diverticulum
outpouching of mucosa through muscular layer of esophagus
Sx: asymptomatic, dysphagia, regurgitation, bad breath
Dx: barium swallow
Tx: rarely Sx
several kinds
Zenker (pharyngeal) diverticula
FALSE
posterior outpouching of mucosa and submucosa through the cricopharyngeal muscle
cause: incoordination btwn pharyngeal propulsion and cricopharyngeal relaxation
midesophageal (traction) diverticula
cause: traction from mediastinal inflammatory lesions or by motility disorders
epiphrenic diverticula
just above diaphragm usually accompany a motility disorder (achalasia, diffuse esophageal spasm)
diaphragmatic hernia
incomplete formation of diaphragm allows abdominal viscera to herniate into thoracic cavity
severe: can cause PULMONARY HYPOPLASIA
omphalocele
closure of abdominal musculature is incomplete and abdominal viscera herniate into a ventral amnioperitoneal membranous sac
Tx: surgically
many have other birth defects
gastrochisis
closure of all layers of the abdominal wall (peritoneum to skin) incomplete
inlet patch
ectopic gastric mucosa in upper third of esophagus
Can result in: dysphagia, esophagitis, Barret esophagus, adenocarcinoma
Where can ectopic pancreatic tissue be found?
esophagus or stomach
What can GI ectopia look like?
invasive CA
gastric heterotopia
small patches of ectopic gastric mucosa in small bowel or colon
Sx: occult blood loss due to peptic ulceration
meckel diverticulum
TRUE ileum: failed involution of VITELLINE DUCT 2 feet of ileocecal valve 2 inches long 2x common in males 2: age symptomatic
pyloric stenosis
MALE, 3-6 weeks
Sx: regurgitation, projectile NONBILLOUS vomiting after feeding; freq. demands of refeeding
OLIVE on physical exam (abdominal mass)
esophageal mucosal web
FEMALE, 40 yrs with GERD, chronic graft-vs-host or blistering skin disease
protrusion of mucosa that can obstruct, composed of fibrovascular connective tissue and overlying epithelium
Sx: nonprogressive dysphagia with incompletely chewed food
Plummer-Vinson syndrome (Paterson-Brown-Kelly)
esophageal webs
iron-def. anemia
glossitis
cheilosis
esophageal (Schatzki) rings
similar to webs but CIRCUMFERENTIAL, thicker
include: mucosa, submucosa, occasionally hypertrophic muscularis propria
OBSTRUCTION
Curling ulcer
ulcer in proximal duodenum associated with severe burns
Cushing ulcer
gastric duodenal and esophageal ulcers in person with intracranial disease
high incidence of perforation
gastric antral vascular ectasia
WATERMELON stomach
association: cirrhosis, systemic sclerosis
Sx: occult fecal blood, iron-def. anemia
rare cause of gastric bleeding
small bowel obstruction
- Sx
- most frequent cause worldwide
- most common cause in children younger than 2 yrs
- if had Sx
- other
- abdominal pain, distention, vomiting, constipation
- Hernia
- Intussusception
- adhesions
- volvulus
histo divisions of anal canal
- upper: columnar rectal epithelium
- middle: transitional
- lower: stratified squamous
anal carcinoma patterns and association
- glandular adenocarcinoma: HPV 18
2. squamous cell CA: HPV 16
mucocele
dilated appendix filled with mucin
can be due to: obstructed appendix containing mucin, mucinous cystadenoma, mutinous cystadenocarcinoma
appendix mucinous neoplasm
what can these be mistaken for in women?
can get intraperitoneal seeding
can be mistaken for mucinous ovarian tumors
Tx: debulking mucin: eventually fatal
pseudomyxoma peritonei
abdomen filled with tenacious, semisolid mucin
due to appendiceal mucinous neoplasm
menetrier disease
30-60 yrs body, fundus mucous cells Sx: hypoproteinemia, wt. loss, diarrhea associated with adenocarcinoma
zollinger ellison syndrome
50 yrs fundus parietal cells neutrophils Sx: peptic ulcers risk: MEN syndrome not associated with adenocarcinoma
HP
50-60 yrs mucous cells neutrophils and lymphs Sx: similar to chronic gastritis risk: H. pylori sometimes adenocarcinoma
FGP
50 yrs parietal and chief cells Sx: none risk: PPI, FAP if syndromic: associated with adenocarcinoma
gastric adenoma
50-60 yrs antrum more than body dysplastic, intestinal cells Sx: similar to chronic gastritis risk: chronic gastritis, atrophy, intestinal metaplasia associated with adenocarcinoma
liver: focal nodular hyperplasia
young to middle age adults
spontaneous mass lesion; well demarcated but poorly encapsulated
CENTRAL SCAR
hepatocellular adenoma
Benign develop from hepatocytes incidental or due to rapid growth rupture: Sx emergency HNF1-alpha, B-catenin activated association: ORAL CONTRACEPTIVES, anabolic steroids NO PORTAL TRACTS
hepatoblastoma
less than 3 yrs: most common liver tumor malignant WNT activation association: APC/familaial adenomatous polyposis FATAL without Tx Tx: chemo, Sx
hepatocellular carcinoma (HCC)
male
associations: Hep. B and C, chronic liver disease (cirrhosis is not mandatory); aflatoxin, alcohol
SYNERGISTIC effect
mutations: B-catenin activation, p53 inactivation
ALPHA-FETAL PROTEIN
deadly
cholangiocarcinoma (CCA)
biliary tree malignancy arise from bile ducts KLATSKIN tumors BilIN (-1 thru -3) liver FLUKES (Opisthorchis, Clonorchi) risk: chronic inflammation, cholestasis MUCIN
liver: nodular regenerative hyperplasia
incidental finding
liver entirely transformed into nodules
gross: similar to micro nodular cirrhosis (no fibrosis)
COMPRESSED CENTRAL VEIN
can lead to PORTAL HTN
associations: conditions affecting intrahepatic blood flow: renal or hematopoietic stem cell transplant, vasculitis
CHICKEN WIRE
What factor do both types of liver nodular hyperplasia (regenerative and focal) have in common?
focal or diffuse alterationions in hepatic blood supply
due to obliteration of portal vein and compensatory augmentation of arterial blood supply
HNF1-alpha inactivation
hepatocellular adenoma
no risk for malignant transformation
association: oral contraceptive, MODY-3
B-Catenin activation
hepatocellular adenoma
high risk for malignant transformation
hepatocellular carcinoma
inflammatory hepatocellular adenoma
high CRP and serum amyloid A (gp130 mutations)
some have B-catenin mutations
intermediate risk for malignant transformation
WNT activation
hepatoblastoma
p53 inactivation
hepatocellular carcinoma
Opisthorchis
liver fluke
cholangiocarcinoma
Clonorchi
liver fluke
cholangiocarcinoma
Klatskin tumor
perihilar tumor
see in cholangiocarcinoma
biliary intraepithelial neoplasia (BilIN)
premalignant lesion for cholangiocarcinoma
liver angiosarcoma associations
vinyl chloride
arsenic
Thorotrast
FATAL
liver epithelioid hemangioendothelioma
endothelial malignancy
prognosis: variable
hepatosplenic delta-gamma T cell lymphoma
young adult males
lives in SINUSOIDS
also seen in marrow
Hepatic lymphomas
rare associations?
most commonly?
second most common?
middle age men
association: Hep. B and C, HIV, PBC
most: diffuse B cell
second: MALT
cholestasis
systemic retention of bilirubin and other solutes eliminated in bile due to obstruction of bile channels or defect in bile secretion
gives rise to bile pigment in liver
Crigler Najjar Syndrome type 1
AR
unconjugated bilirubin
absent UGT1A1 activity
fatal in neonatal period
Crigler Najjar Syndrome type 2
AD with variable penetrance
unconjugated bilirubin
decreased UGT1A1 activity
generally mild, occasional kernicterus
Gilbert syndrome
AR
unconjugated bilirubin
decreased UGT1A1 activity
Dubin-Johnson
AR conjugated bilirubin impaired biliary excretion of bilirubin glucuronides mutation in MRP2 BLACK LIVER
Rotor syndrome
AR
conjugated bilirubin
decreased hepatic uptake/stroage?
decreased biliary excretion?
UGT1A1
Crigler Najjar Syndrome
Gilbert syndrome
MRP2
canalicular multi drug resistance protein 2
Dubin-Johnson
Top 2 causes of large bile duct obstruction
- gallstones
2. malignancy (biliary tree or pancreas)
Mallory-Denk bodies
alcohol induced liver disease, nonalcoholic fatty liver disease
if periportal: chronic biliary obstruction
biliary atresia
complete or partial obstruction of lumen of the extra hepatic biliary tree within the first 3 mo. of life
primary biliary cirrhosis
50 yrs, female autoimmune progressive association: Sjogren's, Scleroderma, thyroid disease normal radiology AMA also: ANCA, ANA duct: florid duct lesions, SMALL DUCT LOSS ONLY CK-7
primary sclerosing cholangitis
30 yrs, male autoimmune unpredictable but progressive association: IBD radiology: strictures, beading of large bile ducts, pruning of smaller ducts p-ANCA duct: inflammatory destruction of extra hepatic and large intrahepatic ducts; fibrotic obliteration of medium and small intrahepatic ducts BEADING: strictures
CK-7
primary biliary cirrhosis
choledochal cysts
younger than 10 yrs, female
congenital dilations of common bile duct
Sx: jaundice, abdominal pain
some have: cystic dilation of intrahepatic biliary tree (Caroli disease)
predispose to: stone formation, stenosis, stricture, pancreatitis
older patients: increased risk of bile duct CA
fibropolycystic disease of the liver
heterogeneous group of lesions in which abnormalities are congenital malformations of the biliary tree
Von Meyenburg complexes
single or multiple, intrahepatic or extra hepatic biliary cysts
increased risk for: cholangiocarcinoma
congenital hepatic fibrosis
AR
mutation: PKHD1
chromosome: 6
complications: portal HTN, bleeding varices
Budd-Chiari syndrome
portal HTN due to thrombosis of hepatic veins
acute: can be fatal
Sx: hepatomegaly, ascites, abdominal pain
due to: polycythemia vera/myeloproliferatie disease, pregnancy, OCP, abdominal CA
liver cell that regenerates in injury
hepatocyte (not stem cells)
hepatic stellate cell
- activated by?
- contraction of activated cell by?
- fibrosis stimulated by?
- chemotaxis to injury?
scar deposition in liver
lipid (vit. A) storing cell that is converted to myofibroblast in injury
1. PDGF, TNF
2. ET-1 (endothelin 1)
3. TGF-B
4. PDGF, MCP-1 (monocyte chemotactic protein-1)
Which zone is most susceptible to injury?
Why?
zone III (next to central vein) lowest O2 and nutrients
Type 1 autoimmune hepatitis
middle aged women
Ab: ANA, AMSA
Type 2 autoimmune hepatitis
children or teens
Ab: anti-LKM1
AMA
primary biliary cirrhosis
ANCA
primary sclerosing cholangitis
primary biliary cirrhosis
ANA
primary biliary cirrhosis
type 1 autoimmune hepatitis
AMSA
type 1 autoimmune hepatitis
anti-LKM1
type 2 autoimmune hepatitis
preeclampsia
maternal HTN, proteinuria, peripheral edema, coagulation abnormalities
HELLP syndrome
hepatic disease that may be primary manifestation of preeclampsia
hemolysis, elevated liver enzymes, low platelets
eclampsia
preeclampsia plus hyperreflexia and convulsions
acute fatty liver of pregnancy
RARE
Sx: subclinical to elevated LFTs to hepatic failure to coma to death
3rd trimester: usually mild
mitochondrial dysfunction in baby effects mom
Tx: termination of pregnancy
intrahepatic cholestasis of pregnancy
second leading cause of gestational jaundice (after viral hepatitis)
late pregnancy
estrogen may inhibit hepatocellular bile secretion
Sx: pruritis, dark urine, light stool, jaundice
lab: some: elevated serum bilirubin (conjugated), mildly elevated ALP
association: fetal distress, stillbirths, premature
mother at risk for: gallstones, malabsorption
Gaucher disease
genetic disorder in which glucocerebroside accumulates in cells
lysosomal storage disease
enlarged liver, spleen
if bone marrow involved trilineage decrease
glucocerebroside
Gaucher
sphingolipid
kernicterus
yellow in brain
due to unbound bilirubin
ascending cholangitis
stone blocks duct and get back up leading to infection of bile ducts
