Path III Flashcards

1
Q

What is MS?

Resulting pathology?

A

Autoimmune inflammatory disease of the CNS

causes demyelination & variable axonal loss ; multiple lesions (plaques) involving brain & spinal cord

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2
Q

What are the genetic & environmental risk factors for MS?

A
  • Genetic
    • HLA-DR2
  • Environmental
    • temperate climate
    • viruses (?)
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3
Q

What pathology is shown in the provided image?

A

MS

wel circumscribed, tan, irregularly shaped plaque in periventricular white matter (demyelinating)

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4
Q

If the provided sample has been stained with Luxol-fast blue PAS, it is from what disease?

A

MS

unstained regions of demyelination

plaques (red arrows) seen around the 4th ventricle

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5
Q

What features of MS plaques are depicted in the provided schematic?

A
  • black solid arrows
    • sharp borders (to right is normal tissue)
  • white solid arrow
    • macrophages, both interstitial & perivascular
  • black open arrow
    • perivascular chronic inflammation
  • scattered large stellate reactive astrocytes complete the picture
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6
Q

What patholgy is shown in the provided images? This is suspicious of what conditin?

A
  • Left
    • perivascular lymphocytes (active MS)
  • Right
    • perivascular cuff of macrophages (suspicious demyelinating disease or infarct)
    • intraparenchmal phagocytes
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7
Q

If the provided sample has been stained with Luxol-fast blue PAS, it is from what disease?

A

sharp interface between lesion- demyelination - (left) and normal parenchyma (right)

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8
Q

What is ADEM?

It is associated with what conditions?

A

Acude Disseminate Encephalomyelitis

brief but widespread demyelinating disease in the brain & spinal cord (mainly in children)

post-infectious/post-vaccinial/allergic encephalomyelitis

usually follows URI

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9
Q

PML is cause by what virus?

A

JC polyoma virus

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10
Q

Describe the pathophysiology of PML

A

deadly demyelinating CNS disease due ot lytic infection of oligodendrocytes

  • infection acquired young age
  • virus lies dormant in kidneys & lympohoid
  • cellular immunity suppressed -> virus is reactivated

related to AIDS & immunosuppressive therapies

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11
Q

What pathology is shown im the provided images?

A

PML

  • Left
    • early lesions are ovoid, yellow-tan demyelinated foci along cortical gray-white junction (black arrows)
  • Right
    • older, tan-gray lesions coalesent and depressed (black arrows)
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12
Q

What pathology is shown in the provided images?

A

Advanced stage PML

large areas of cerebral white matter have depressed, cavitated areas w/ granular appearance (black open arrow)

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13
Q

What type of cells do see in this microscopic sample?

They are classic expression of what?

A

homogenized nuclei of oligodendrocytes

classic expression viral infections (ie. PML)

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14
Q

What is central pontine myelinolysis?

A

degeneration of a symmetrical midline portion of the basis pontis & portions of pontine tegmentum

loss of myelin w/ relative preservation of axons & neuronal cell bodies

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15
Q

Central pontine myelinolysis is most commonly seen in what situations?

A

rapid correction hyponatremia

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16
Q

What condition is seen in the provided image?

A

Central pontine myelinolysis

myelin loss without evidence of inflammation

all lesions appear at same stage of myelin loss & reaction

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17
Q

What pathology is shown in the provided image?

A

focal watershed infarct

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18
Q

What cause of infarct is shown in the provided image?

A

in situ thrombosis

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19
Q

Other than atherosclerosis, what are the other common causes of thrombosis?

A

Cardiac mural thrombi

Vasculitis (infectious & non-infectious)

20
Q

What pathology is shown in the provide image?

A

Hemorrhagic Infarct: shower emboli

21
Q

What pathology is happening in the two images?

A

Left - infarct

Right - reperfusion injury (d/t damaged vessel wall, they become leaky & you can get hemorrhage in the surrounding area)

22
Q

What pathology is shown in the provide image?

A

Acute Bland Infarct

12-48 hr

(w/o significant reperfusion injury)

23
Q

What is the general cause of bland infarct vs. red infarcts?

A
  • bland - in situ. thrombosis
  • red - emboli
24
Q

What is one of the earliest morphological findings of a bland infarct?

A

Edema & red neurons

clear spaces around red neurons that are starting to shrink

25
Q

What is the first thing that moves into the space after an acute bland infarct?

A

Neutrophils

to break down tissue & clean up mess

26
Q

What pathology is shown in the provided image?

This is at what time point after the initial injury?

A

Laminar necrosis after acute infarct (layered effect at grey/white junction)

48 hr - 10 days

27
Q

The shown microscopic sample are from what larger pathology?

Why does this happen?

A

Lamina necrosis (acute infarct)

cortex is divided into different layers & some of those cells in different layers are more susceptible to ischemia than other layers

28
Q

What do you see at 10-14 days after an infarct?

A

subacute infarct

phagocytosis of debris by macrophages & tissue begins to liquify

29
Q

What pathlogy is shown in the provided image?

A

Remote infarct

> 2 weeks (years later)

neurons do not regenerat & you are left with a cavity

30
Q

What pathology is shown in the provided image?

A

Remote infarct

> 2 weeks (years later)

neurons do not regenerat & you are left with a cavity filled with CSF

31
Q

What are the effects of hypertension on the brain?

A
  • lacunar infarcts
  • slit hemorrhages
  • acute hypertensive hemorrhages
  • Charcot-Bouchard microaneurysm
  • Acute hypertensive encephalopathy
32
Q

What pathology is shown in the provided image?

What is a commonly underlying cause of this pathology?

A

Lacunar infarcts in the caudate & putamen

underlying cause - arteriosclerosis

33
Q

What pathology is shown in the provided images?

A

Slit hemorrhages

34
Q

What pathology is shown in the provided image?

A

Massive hypertensive hemorrhage with rupture iinto a lateral ventricle

35
Q

What pathology is shown in the provided image?

A

Charcot-Bouchard Microaneurysm

small vessels (smaller than 250 microns)

36
Q

What condition can result from malignat hypertension?

A

Acute hypertensive encephalopathy - medical emergency

fibrinoid necrosis

thromosis of arterioles & capillaries results in microinfarcts & microhemorrhages

37
Q

What pathology is shown in the provided image?

A

Amyloid

  • left
    • congo red - light microscopy
  • right
    • congo red - polarized light
38
Q

What pathology is shown in the provided image?

They are most commonly found where in the body?

A

“Berry” aneurysms

commonly found in circle of willis

39
Q

Berry aneurysms typically affect what age group?

A

young adults (20s, 30s, 40s)

40
Q

What do you see at a microscopic level in Berry aneurysms?

A

hyalinzed fibrosis (weaker than native vessel from which it arose)

41
Q

What is the problem with arteriovenous malformations?

A
  • Do not have large capillary bed in between arteries & veins
  • veins become arteriolized because they are exposed to very high pressure - can be hard to differentiate arteris from veins
  • have a propensity to bleed
42
Q

What is a subarachnoid hemorrhage?

A

hemorrhage unde the arachnoid mater; may diffusely cover the brain

frequently fatal

43
Q

What are the common causes of subarachnoid hemorrhages?

A

secondary to rupture of berry aneurysms

A-V malformation

44
Q

What pathology is shown in the provided image?

A

Subarachnoid hemorrhage

looks like you need to “wash it off” but you cannot

45
Q

What pathology is shown in the provided images?

A

Cavernous hemangioma (venous malformation)

typically focal; often asymptomatic