Path Flashcards
Dyskeratosis
Abnormal keratinisation occurring prematurely in cells adjacent stratum corneum
Hyperchromasia
Dark staining nuclei due to increase DNA content and little cytoplasm
Architectural atypia
Dyskeratosis
Drop shape rete ridges
loss of basal cell polarity
Cytological Atypia
Hyperchromasia nuclear pleomorphism (abnormal nuclear size/shape) Cellular pleomorphism (abnormal cell size/shape)
Suprabasal Mitosis
Mitosis in the epidermis occurring in cells above basal layer
Dysplasia
Abnormal cell types and development
Atypical growth and differentiation
Grades of Dysplasia
Mild, Moderate, Severe, Carcinoma in situ
Mild Dysplasia
atypical features up to 1/3 thickness (lower epithelium)
Slight nuclear pleomorphism
Normal maturation and stratification of upper layers
Moderate Dysplasia
atypical features up to 2/3 thickness
Evident nuclear pleomorphism
Suprabasal mitosis
Severe Dysplasia
atypical features up to entire thickness
Loss of maturation and normal stratification
Abnormal Suprabasal mitosis
Carcinoma in Situ Dysplasia
atypical features covering entire thickness, but not perforation of basement membrane.
Preinvasive SCC but better prognosis
SCC
- CT invaded but no vascular
- Invasion of malignant keratinocytes beyond basement membrane into underlying CT
- Presence/integrity of encapsulation
- infiltrative cohesive invasion pattern
TNM
T= Size
N= Lymph nodes
M=Metastasis
T =
T1 = <2cm T2 = 2-4cm T3 = >4cm T4 = >4cm & invasion
N =
N0 = No nodes involved N1 = Ipsilateral palpable nodes N2 = Contra/bilateral palpable nodes N3 = Fixed palpable nodes
M =
M0 = No metastasis M1 = Metastastised
Stage 1 =
T1,N0,M0
>50% 5yr survival
Stage 2 =
T2,N0,M0
Stage 3 =
T3,N0,M0
Tany,N1,M0
15-20% 5yr survival
Stage 4 =
Tany,N2-3,M0
Tany,Nany,M1
<5% 5yr survival
Description of a Lesion
5S and 5C
5S =
Site Size Shape (Irregular, Ovoid, Lacy, Polypoid) Surface (ulcer, intact) Symptoms
5C =
Colour (Red, white, mixed) Contour (Sessile, pedunculated) Consistency (fluctuant, fixed) Circumscription (well defined borders/diffuse margins) Chronology
Pathologist to Surgeon
WEIDDVNCS
WEIDDVNCS
- What you think the lesion is? Is it benign or malignant?
- Encapsulation: even partial good, slow moving and easier surgical incision
- Infiltration: Daughter cells budding off. More=invasive
- Differentiation: Resemblance to parental cells. No resemblance = more aggressive
- Depth of lesion: lesion thickness, invaded surrounding tissues
- Vital structures: penetration into submucosa, bone, BV
- Necrosis
- Chronic Inflammatory cellular infiltrate surrounding invading front of lesion
- Surgical margins: +ve: lesion present at margins = lesion not fully removed
- ve: No lesion at margins = lesion removed.
White lesion
Developmental:
Leukodema
White Spongy Naevus
Infective
Oral Hairy Leukoplakia
Hyperplastic: Smokers keratosis Linear alba Chronic hyperplasic candidiasis Oral HPV Infection
Idiopathic
Leukoplakia
Red Lesion/Gum lumps
Developmental:
Geographic tongue/Migratory Glossitis (loss of filiform)
Haemangioma (vascular)- localised proliferation of endothelia cells
Infective:
Herpes Virus 8 (vascular, purple, bleeds easy)
Leprosy (red/purple, nodule/ulcer)
Acute and Chronic Atrophic Candidiasis
Hypertrophic Candidiasis ( yellow/white plaque - if remove=acute if not=chronic)
Atrophic candidiasis (symptomatic=acute, asymptomatic=chronic)
Hyperplastic:
Fibroepithelial polyp
Pyogenic Granuloma (Granulation tissue, very vascular)
Peripheral Giant Cell Granuloma (Vascular, multinucleated giant cells, surface ulcerations)
Calcifying Fibroblastic Granuloma
Inflammatory:
Lichen Planus
Erythroplakia (fixed red patch)
Ulcer
Aphthous:
Erythematous margins
