Path - Histopathology Flashcards
Which of the following is true of bullous pemphigoid?
A. It is indicated by the presence of Wickham’s striae in the buccal cavity
B. Bullae can be found on the extensor serfaces
C. It is an auto-inflammatory condition present in older patients
D. Tense bullae are produced
E. It is a Type III hypersensitivity reaction
D. Tense bullae are produced
Bullous pemphigoid is an autoimmune condition present in elderly patients characterised by the formation of tense bullae formed on the flexural surfaces. It is characterised as a type II hypersensitivity reaction as it is mediated by IgG against desmosomes (as are all pemphigus types). Wickham’s striae are a sign of lichen planus.
Which of the following conditions would cause mitotically active melanocytes to be seen on histopathology?
A. Squamous cell carcinoma B. Pregnancy C. Basal cell carcinoma D. Psoriasis E. This is a normal finding
B. Pregnancy
Mitotically-active melanocytes are usually a sign of melanoma. A notable exception is when this appearance is noted in a pregnant patient, as this is normal.
In melanoma, upwards migration of melanocytes towards the epidermis will be seen, and melanocytes will fail to decrease in size as they migrate.
Where does damage occur in pemphigus vulgaris?
A. Between the basement membrane and the bottom of the epidermis
B. Between keratinocytes in the epidermis
C. The surface of the epidermis
D. Between the dermis and epidermis
E. Subcorneal layer of epidermis
B. Between keratinocytes in the epidermis
Pemphigus is caused by antibodies against desmosomes. The type of desmosomes targeted determines which type of pemphigus will arise.
‘A’ describes the site of damage and separation in bullous pemphigoid, and’E’ refers to pemphigus foliaceous.
Match the appearances on immunofluorescence with the disease they are each most associated with
A. Homogenous
B. Speckled
C. Centromere pattern
D. Nucleolar pattern
- Diffuse cutaneous systemic sclerosis
- Limited cutaneous systemic sclerosis
- Mixed connective tissue disease
- SLE
A. Homogenous - 4. SLE
B. Speckled - 3. Mixed connective tissue disease
C. Centromere pattern - 2. Limited cutaneous systemic sclerosis
D. Nucleolar pattern - 1. Diffuse cutaneous systemic sclerosis
NB: None of these patterns are 100% specific e.g. SLE can give almost any of these appearances on immunofluorescence.
Homogenous pattern indicates Anti-dsDNA
Speckled pattern indicates Anti-Ro, La, and Sm
Nucleolar pattern indicates ANti-SCL70 (anti-topoisomerase)
A kidney biopsy shows thickened glomerular capillary loops (a wire loop appearance)
Which disease is this suggestive of?
A. SLE B. Scleroderma C. Sarcoidosis D. Goodpasture's disease E. GPA
A. SLE
The wire loop appearance is the classic appearance of lupus nephritis, and is caused by immune complex deposition in the glomerular capillary loops causing thickening.
Which vessels are most often affected by polyarteritis nodosa?
A. Coronary arteries B. Temporal and retinal arteries C. The aorta and its branches D. Renal and mesenteric arteries E. Vessels in the kidneys, lungs, and upper respiratory tract
D. Renal and mesenteric arteries
Polyarteritis nodosa is a necrotising arteritis affecting medium vessels. It most often affects the renal and mesenteric arteries, and causes a series of aneurysms in close proximity, creating the ‘rosary beads’ appearance on angiography. It is classically associated with hepatitis B infection.
What is the most common form of thyroid cancer?
Papillary
Though thyroid carcinomas are rare, within that group papillary thyroid cancer is the most common. They are especially associated with radiation exposure.
What form of thyroid cancer arises from parafollicular ‘C cells’?
Medullary
Medullary carcinoma makes up 5% of thyroid carcinomas. 80% are spontaneous, but 20% are associated with a MEN syndrome.
What is the most common type of pituitary adenoma?
A, Gonadotrophin-secreting B. ACTH-secreting C. Non-functioning D. Prolactinoma E. TSH-secreting
D. Prolactinoma
Prolactinomas make up 20-30% of pituitary adenomas, with the next most common adenoma being a non-functioning one.
Muscle weakness, hypertension, and congestive cardiac failure are all possible complications of adenomas secreting which hormone?
A. Somatotrophin B. Prolactin C. Somatostatin D. Gonadotrophin E. TSH
A. Somatotrophin
Muscle weakness, hypertension, T2DM, and congestive cardiac failure are all potential complications of acromegaly which is caused by excess somatotrophin (a.k.a. growth hormone).
What is the most common cause of goitre worldwide?
A. Iodine deficiency B. Hashimoto's thyroiditis C. Toxic multinodular goitre D. Graves' disease E. Papillary thyroid cancer
A. Iodine deficiency
Although very rare in the west because of iodine-fortified food, iodine deficiency is very common in parts of the developing world and so is still the commonest cause of goitre.
Which of the following statements about thyroid nodules is FALSE?
A. Solitary nodules are more often neoplastic than multiple nodules
B. Solid nodules are more likely to be neoplastic than cystic nodules
C. Nodules in younger patients are more likely to be neoplastic than those in older patients
D. Nodules in females are more likely to be neoplastic than those in males
E. Nodules that don’t take up radio-labelled iodine (cold) are more commonly neoplastic than hot nodules
D. Nodules in females are more likely to be neoplastic than those in males
What findings on microscopy would suggest a papillary thyroid carcinoma?
Optically clear nuclei, intranuclear inclusions, and psamomma bodies
Diagnosis of papillary carcinoma does not necessarily focus on the overall architecture, as the classic papillary shape may not be present. Instead the cell morphology is analysed.
The nuclei in papillary thyroid carcinomas are visibly empty, hence ‘optically clear nuclei’ is a sign.
Psamomma bodies are round foci of calcification that appear in many cancers, but the only thyroid cancer they appear in is papillary.
Which of the following is not a complication or sign of primary hyperparathyroidism?
A. Depression B. Pancreatitis C. Osteitis fibrosa cystica D. Paraesthesia E. Tetany
E. Tetany
All the other options are complications of hypercalcaemia, whereas tetany results from hypocalcaemia. Hyperparathyroidism causes hypercalcaemia as the excess PTH increases serum calcium beyond normal limits.In 80-90% of cases, primary hyperparathyroidism is caused by an adenoma, with 10-20% of cases being due to generalised parathyroid hyperplasia (which can be part of a MEN syndrome). Parathyroid carcinoma accounts for <1% of hyperparathyroidism cases.
Hyperparathyroidism may also be secondary, in which case chronic kidney disease is the most common cause, leading to insufficient 25-hydroxycholecalciferol hydroxylation (low active vitamin D).
Which pathogens are particularly associated with pelvic inflammatory disease after a woman has undergone a TOP?
A. Stapylococci B. Salmonella C. Gonococci D. Shigella E. Chlamydia
A. Staphylococci
Gram positive cocci (Staphylococci, Streptococci), coliform bacteria (E. coli, Klebsiella, Enterobacter etc.), and C. perfringens are particularly important causes of PID after a TOP.
Which of the following HPV types is most associated with cervical cancer?
A. 6 B. 9 C. 11 D. 18 E. 33
D. 18
16 and 18 are the most common cancer-causing sub-types. They have a strong association with cervical cancer, but may also cause vulval, vaginal, penile, and anal cancer.
6 and 11 are the most common low-risk, wart-causing HPV sub-types.
Describe the Cervical Screening Program for the following age brackets:
25-49
50-64
65+
25-49: 3 yearly
50-64: 5 yearly
65+: only if not screened since age 50 or recent abnormal tests
A woman undergoes surgery for resection of an endometrial carcinoma. During surgery the para-aortic lymph nodes are found to be involved, though not the pelvic. The primary tumour has spread into the fallopian tubes.
What is the correct FIGO staging of this cancer?
A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 E. Stage 5
C. Stage 3
Stage 1 – confined to uterus
Stage 2 – spread to cervix
Stage 3 – spread to adnexae (fallopian tubes, ovaries, potentially nearby ligaments), vagina, local lymph nodes (pelvic or para-aortic)
Stage 4 – other pelvic organs distant spread inc any other distant lymph node groups
NB: there is no stage 5
Which of the following is false?
A. Endometriosis may be associated with a variety of ovarian tumours especially clear cell carcinoma
B. Epithelial serous ovarian tumours are the most common type and are bilateral in 30-50% of cases
C. Endometriosis may lead to scarring and infertility
D. Most cases of ovarian cancer have a genetic component
E. Some germ cell tumours can grow teeth and hair
D. Most cases of ovarian cancer have a genetic component
A woman attends her GP for a cervical smear, having not been vaccinated against HPV and having not engaged with smear services before. The doctor notices a visible abnormality of the cervix, which is swabbed, and later biopsied. The biopsy shows a neoplasia of the cervical epithelial squamous cells which occupies 3/4 of the thickness of the cervix but has not breached the basement membrane.
Which of the following options best describes the biopsied lesion?
A. Cervical intra-epithelial neoplasia 1 B. Cervical intra-epithelial neoplasia 2 C. Cervical intra-epithelial neoplasia 3 D. Carcinoma E. Metastasis
C. Cervical intra-epithelial neoplasia 3
The staging system for a cervical intra-epithelial neoplasia is as follows:
CIN 1 - neoplasia occupies <1/3 of the thickness of the epithelium
CIN 2 - neoplasia occupies 1/3 - 2/3 of the thickness of the epithelium
CIN 3 - neoplasia occupies >2/3 of the thickness of the epithelium
Carcinoma - neoplasia has invaded the basement membrane
This is clearly not a metastasis as the biopsy shows the cells are from the cervical epithelium
Which of the following statements concerning HPV and cervical cancer is false?
A. 90% of HPV infections are cleared within 2 years
B. Most women over 65 are not invited to cervical screening
C. The HPV virus can inactivate both the p53 and Retinoblastoma tumour suppressor genes
D. Adenocarcinomas occur 4 times less often than squamous cell carcinomas
E. Non-productive infection of cells cannot be identified due to the lack of infective virions
E. Non-productive infection of cells cannot be identified due to the lack of infective virions
It’s true that non-productive infection does not produce infectious virions, and that infected cells do not display the cytological and histological changes associated with HPV infection. However non-productive infection can still be identified using molecular tests (e.g. PCR) as the HPV DNA still resides in the cells and is replicated along with the host cell.
Which of the following is true
A. Mucinous and secretory endometrial carcinomas have better prognoses than serous and clear cell types
B. Leiomyomas (fibroids) affect ~40% of women <35
C. Diabetes, obesity, and multiparity are risk factors for endometrial carcinoma
D. Leiomyosarcomas may result from fibroids, and have a positive prognosis
E. Endometrial cancers are rare among cancers in the developed world
A. Mucinous and secretory endometrial carcinomas have better prognoses than serous and clear cell types
Endometrial cancer can be divided into two types:
Type I - 80-85% of cases, presents younger, oestrogen dependent, low grade, less invasive, usually mucinous or low grade endometrioid/ serous
Type II - 10-15% of cases, presents older, less oestrogen dependent, high grade, more deeply invasive, feature worse mutations e.g. in p53 (serous carcinoma), usually high grade serous
A Leiomyoma is a benign smooth muscle tumour colloquially known as a fibroid. They occur in 20% of women <35, are the commonest type of uterine tumour, and usually occur in multiples.
Leiomyosarcomas are rare malignant smooth muscle tumours, but do not evolve from benign leiomyomas. They occur usually in post-menopausal women, and have a 5 year survival rate of 20-30%.
Endometrial carcinoma is the most common gynaecological malignancy in the developed world. Diabetes and obesity are indeed risk factors, but nulliparity, not multiparity, also increases the risk.
Describe the pathogenesis of atherosclerosis
- LDLs are deposited in the subintimal space of arteries and become oxidised by free radicals in the endothelium
- Macrophages are recruited to the site of inflammation, take up the LDLs and become foam cells
- Foam cells (along with platelets that adhere to the damaged endothelium) release factors that recruit vascular smooth muscle cells and stimulate them to lay down extracellular matrix within the plaque
- Smooth muscle cells also form the fibrous cap over the top of the plaque in response to endothelial damage
- Macrophages/ foam cells also release proteinases which eventually degrade the fibrous cap of the plaque, and tissue factor which makes the plaque contents thrombogenic
- Eventually the foam cells die and contribute to the lipid rich plaque core
Which of the following is the most significant independent risk factor for cardiovascular disease?
A. Hypertension B. Gender C. Age D. Family history E. Smoking
D. Family history
Why are the majority of myocardial infarctions not preceded by symptoms?
Because symptoms of arterial stenosis only occur at around 70% stenosis
Atheromatous plaques may rupture well before this stage, exposing their thrombogenic contents to the bloodstream and causing a coronary artery thrombosis
Why is ischaemia less well tolerated by the myocardium than pure hypoxia?
Because of the failure to remove toxic waste products from the myocardium in ischaemia
Give 5 complications of an MI
Arrhythmia Cardiac rupture Cardiogenic shock/ chronic heart failure Dressler syndrome Mural thrombi (e.g. causing bowel infarction)
What would a ‘nutmeg’ appearance of the liver indicate?
Venous congestion of the liver from right/ congestive heart failure
How does a complete hydatidiform mole form?
Either:
One sperm fertilises an empty egg and its DNA replicates to make a 46XX diploid cell
OR
Two sperm fertilise an empty egg to make either a 46XY or 46XX diploid cell
How does a partial hydatidiform mole form?
Either:
A normal egg is fertilised by 2 sperm to form a 69XXY, XXX, or XYY cell
OR
A normal egg is fertilised by a 46XY sperm resulting in a 69XXY cell
Remember: 69 isn’t full sex, it’s partial
NB: partial moles don’t become malignant
The findings of an OGD + biopsy are: a lesion in the mid-oesophagus, which on histopathology is seen to feature intercellular bridges.
Which of the following would you most expect to find in this patient’s history?
A. Previous episodes of gastritis B. Epigastric or chest pain worse on lying down C. A family history of malignancy D. High alcohol intake and smoking E. Dysphagia to liquids
D. High alcohol intake and smoking
This history suggests squamous cell carcinoma of the oesophagus, which is the commonest oesophageal cancer worldwide and is particularly linked to high alcohol intake and smoking. The most common cause of oesophageal cancer in the UK is adenocarcinoma, which is linked to GORD and progresses from Barrett’s.
NB: High keratin content and intercellular bridges are features of squamous cell carcinoma
Match each histological description to the appropriate disease:
A. PSC B. PBC C. Alcoholic hepatitis D. Acute hepatitis E. Cirrhosis F. Steatosis G. Chronic hepatitis
- Intrahepatic bile duct granulomatous inflammation, damage, and loss associated with anti-mitochondrial antibodies
- Interface hepatitis
- Ballooning of hepatocytes and Mallory-Denk bodies
- Bile duct scarring and concentric fibrosis within the liver
- Fatty pockets within the liver linked to acute alcohol intake or dietary factors
- Nodules of regeneration causing disruption of vascular architecture
- Spotty necrosis
A. PSC - 3. Bile duct scarring and concentric fibrosis within the liver
B. PBC - 1. Intrahepatic bile duct granulomatous inflammation, damage, and loss associated with anti-mitochondrial antibodies
C. Alcoholic hepatitis - 2. Ballooning of hepatocytes and Mallory-Denk bodies
D. Acute hepatitis - 7. Spotty necrosis
E. Cirrhosis - 5. Nodules of regeneration cause disruption of vascular architecture
F. Steatosis - 5. Fatty pockets within the liver linked to acute alcohol intake or dietary factors
G. Chronic hepatitis - 2. Interface hepatitis
Which of the following statements is false?
A. Acute pancreatitis may cause the formation of pseudocysts lined with necrotic and granulated tissue but not epithelium
B. Gallstones are the most common cause of pancreatitis and are usually made of radiolucent cholesterol
C. Cholecystitis is usually associated with gallstones
D. Pancreatic cancer rarely produces secretions
E. The most common form of pancreatic cancer is ductal adenocarcinoma
D. Pancreatic cancer rarely produces secretions
Ductal adenocarcinomas are the most common type of pancreatic cancer (85%), and secrete mucin.
Match each histological finding to the appropriate disease:
- A multinodular mass of expanded intralobular stroma and compressed, slit-like ducts
- A rapid-growing tumour with overlapping cells that have a leaf-like architecture
- Inflamed and dilated ducts filled with secretions
- Cysts and mild epithelial and stromal proliferation
- Polypoid mass with epithelial outside lining and fibrovascular core
- Sclerosing lesion with scarred centre surrounded by proliferating glandular tissue
A. Fibroadenoma B. Duct ectasia C. Phyllodes tumour D. Intraductal papilloma E. Radial scar F. Fibrocystic changes
A. Fibroadenoma - 1. A multinodular mass of expanded intralobular stroma and compressed, slit-like ducts
B. Duct ectasia - 3. Inflamed and dilated ducts filled with secretions
C. Phyllodes tumour - 2. A rapid-growing tumour with overlapping cells that have a leaf-like architecture
D. Intraductal papilloma - 5. Polypoid mass with epithelial outside lining and fibrovascular core
E. Radial scar - 6. Sclerosing lesion with scarred centre surrounded by proliferating glandular tissue
F. Fibrocystic changes - 4. Cysts and mild epithelial and stromal proliferation
