Pathohisto pictures Flashcards
1
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Nephrosclerosis of the kidney
Hyalinization, interstitial fibrosis, necrosis, ischemia atrophy.
- Benign nephrosclerosis: due to hypertension or renal stenosis. Causes hyaline arteriolosclerosis which decreases perfusion and cause ischemia (all areas of the kidney show ischemic atrophy); symmetrical atrophy of kidneys with tubular atrophy, interstitial fibrosis, sometimes interstitial lymphocytic infiltrate, and glomerulosclerosis (fine diffuse granularity on the surface).
- Extra: the larger vessels (interlobar and arcuate arteries) show reduplication of internal elastic lamina along with fibrous thickening of the media (fibroelastic hyperplasia) and the subintima.
Gross: shrunken granular kidney (similar to chronic glomerulonephritis)
2
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Nodular goiter - Thyroid
- Mulitnodular goider (nontoxic goiter): Goiter = enlargement of the thyroid. Presents with a female predominance (Remember; endocrine disorders are more common in females in general). Frequently asymptomatic.
- Gross: enlarged thyroid gland with multiple colloid nodules
- Micro: nodules of varying sizes composed of colloid follicles. Sometimes, calcification, hemorrhage, cystic degeneration, and fibrosis.
- Lab: normal T4, T3 and TSH
- Plummer syndrome: development of hyperthyroidism (toxic multinodular goiter) late in the course. Nodule does not respond to TSH: autonomous secretion
3
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Lung congestion
- Fibrotic septae
- Heart failure cells filled with hemosiderin
- Congestion is a passive process due to imparied outflow.
4
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Cervical squamous cell carcinoma
- Halo around squamous cells = koilocytosis
- Mononuclear cells
- Invasive with some islands of keration
- HPV 16, 18, 31, 33
- CIN
- LKB1 mutation are common
- Other risk factors smoking and immunosupression (HIV)
- PAP smear do detect squmous cell carcioma (not adenocarcinoma)
5
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Ectopic pregnancy - Tubal/fallopian tube
- 1% of pregnancies
- Tubal gravity in 90% of cases
- Villi are present
6
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Prostatic adenocarcinoma
- Malignant proliferation of prostatic glands
- Most common cancer in men; 2nd most common cause of cancer death.
- Located at the posterior periphery of the prostate.
- Because is starts at the periphery it only gives urinary problems late in the course. Firm, yellow mass
- Gleason grading system: grade 1 to 5, most composed of two patterns, so their score are added (min 2, max 10). Based of architecture, not nuclear atypia.
- Spread to bone marrow!
7
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Melanoma of the skin
- Malignant neoplasm of melanocytes; most common cause of death from skin cancer.
- Breslaw thickness: predict metastases based on the depth of invastion
- Risk factors are based on UVB-induced DNA damage and include prolonged exposure to sunlight, albinism, and xeroderma pigmentosum;
- an additional risk factor is dysplastic nevus syndrome (autosomal dominant disorder characterized by formation of dysplastic nevi that may progress to melanoma).
- Presents as a mole-like growth with “ABCD”;
- Asymmetry
- Borders are irregular
- Color is not uniform
- Diameter> 6 mm
- Characterized by two growth phases.
- Radial growth horizontally along the epidermis and superficial dermis; low risk of metastasis
- Vertical growth into the deep dermis. Increased risk of metastasis; depth of extension (Breslow thickness) is the most important prognostic factor in predicting metastasis.
- Variants of melanoma include;
- Superficial spreading; most common subtype; dominant early radial growth results in good prognosis.
- Lentigo maligna melanoma; lentiginous proliferation (radial growth); good prognosis.
- Nodular melanoma; early vertical growth; poor prognosis
- Acral lentiginous; arises on the palms or soles, often in dark-skinned individuals; NOT related to UV light exposure
8
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Wilms tumor - nephroblastoma
- malignant kidney tumor comprised of blastema, primitive glomeruli, and tubules, and stromal cells (derived from mesoderm)
- Most common malignant renal tumor in children (3rd most common cancer in children under age 10 average age is 3 years.
- Good prognosis
- Presents with large, unilateral flank mass with hematuria and hypertension.
- Associated with WT1 mutation; especially syndromic cases
- WAGR syndrome and Beckwith-Wiedemann syndrome
- WAGR syndrome: Wilms tumor, aniridia, genital abnormalities, and mental and motor retardation.
- Beckwith-Wiedemann syndrome: Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (e.g. tongue)
9
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Ductal cancer in situ (DCIS)
- Malignant proliferation of cells in ducts with no invasion of the basement membrane. Often detected as calcification on mammography; DCIS does not usually produce a mass. Mammographic calcifications can also be associated with benign conditions such as fibrocystic changes (especially sclerosing adenosis) and fat necrosis.
- Most common breast cancer
- Biopsy of calcifications is often necessary to distinguish between benign and malignant conditions
- Histologic subtypes are based on architecture; comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
- Paget disease of the breast is DCIS that extends up the ducts to involve the skin of the nipple. Presents as nipple ulceration and erythema. Paget disease of the breast is almost always associated with an underlyingcarcinoma.
Invasive ductal carcinoma
- Invasive ductal carcinoma NST (No Special Type) / NOS (Not Otherwised Specified) (about 80% of the invasive cases).
- Invasive carcinoma that classically forms duct-like structures. Most common type of invasive carcinoma of the breast, accounting for > 80% of cases. Presents as a mass detected by physical exam or by mammography. Clinically detected masses are usually 2 cm or greater. Mammographically detected masses are usually 1 cm or greater.
- Advanced tumors may result in dimpling of the skin or retraction of the nipple. Biopsy usually shows duct-like structures in a desmoplastic stroma; special subtypes of invasive ductal carcinoma include;
- Tubular carcinoma: characterized by well-differentiated tubules that lack myoepithelial cells; relatively good prognosis.
- Mucinous carcinoma: characterized by carcinoma with abundant extracellular mucin (‘tumor cells floating in a mucus pool’). Tends to occur in older women (average age is 70 years). Relatively good prognosis
- Medullary carcinoma: characterized by large, high -grade cells growing in sheets with associated lymphocytes and plasma cells. Grows as a well-circumscribed mass that can mimic fibroadenoma on mammography. Relatively good prognosis. Increased incidence in BRCA1 carriers.
- Inflammatory carcinoma: characterized by carcinoma in dermal lymphatics. Presents classically as an inflamed, swollen breast (tumor cells block drainage of lymphatics)
10
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Hemiangioma of the skin
Benign tumor comprised of blood vessels. Commonly present at birth; often regresses during childhood. Most often involves skin (head and neck) and liver.
11
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GOT THIS SLIDE OM MY EXAM -> IT IS CELIAC DISEASE
Celiac disease: Or gluten-sensitive enteropathy is an immune-mediated damage of small bowel villi due to gluten exposure found in oat, rye, wheat and barley. Duodenum most commonly affected.
Blood tests for celiac disease include anti-gliadin, anti-tTG, and anti-endomysial (EMAs). Some patients can be IgA deficient.
Diagnosis are based on biopsy of duodenum. Show flattening or total loss of villi (villous atrophy), hyperplasia of crypts (deep crypts), pseudostratification of surface epithelium, and increased intraepithelial lymphocytes. This affects the absorption of nutrients, frequently leading to anemia. Damage is most prominent in duodenum; jejunum and ileum are less involved. See picture bellow.
Classic symptoms include gastrointestinal problems such as chronic diarrhea, abdominal distention, malabsorption, loss of appetite, and among children failure to grow normally.
Sometimes, dermatitis herpetiformis can be seen on the anterior abdominal wall due to IgA deposition at tips of dermal papillae à neutrophil infiltrate, inflammation and destruction of the connection between the epidermis and dermia à look like herpes like blisters, hence its name.
Increased risk for small bowel adenocarcinoma and T-cell lymphoma (enteropathy-associated T-cell lymphoma) present with refractory disease
12
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Clear cell carcinoma of the kidney
- Most common histological type (65% of renal cancers); composed of cells with clear cytoplasm.
- Depending of the amount of lipid and glycogen present, the tumor cells of clear cell carcinoma may appear almost vacuolated (lipid-laden) or may be solid.
- Thyroidzation of glomeruli -> end-stage kidney failure (nephrosclerosis - chronic pyelonephritis)
- Very often involves von Hippel-Lindau (VHL) gene (tumor suppressor gene), hence strongly associated with VHL disease; VHF causes high HIF-1 and hence high VEGF
- Associated with , HTN, smoking and dialysis (30x!)
- The cut surface of clear cell carcinoma is yellow to orange to gray-white, with prominent areas of cystic softening or of hemorrhage, either fresh or old. Margins of tumor is well defined. Stroma is highly vascular. At times, small processes projects into the surrounding parenchyma and small satellite nodules are found, proving the aggressiveness of these lesion.
- Clear cell carcinoma likes to fungate through the walls of the kidneys, often ending up in the renal vein (hematogenous spread!) where it grows as a solid column within this vessel, sometimes extending in serpentine fashion as far as the IVC and even the right side of the heart.
- Presents with classic triad of hematuria, palpable mass, and flank pain. And, renal hypertension
- Can present with fever, weight loss, or paraneoplastic syndrome (e.g. EPO (polycythemia!), renin, PTHrP (hypercalcemia), or ACTH)
- Rarely may present with left-sided varicocele. Spermatic vein is blocked by the left renal vein involvement of the tumor.
- Metastases to bone, brain and lung
- Other tumors of the kidney: angiomyolipoma, oncocytoma, RCC (clear cell, papillary, chromophobe), Wilms tumor
13
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Squamous cell carcinoma of the lung
- Squamous cell carcinoma (30%)
- Arise from squamous cell metaplaia
- Keratin perls or/and intercellular bridges + well-differentiated squamous islands. More common in men. Correlate well with smoking. Tend to arise centrally in major bronchi.
- Major risk factor is smoking
- Sometimes produce PTH-like hormones
14
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Testicular seminoma
- Malignant tumor of large polygonal cells with clear cytoplasm (glycogen-rich) and central nuclei arranged in small lobules, which are separated by fibrous septa.
- Soft, well demarcated gray-white tumors that bulge from the cut surface. Homogenous mass with no hemorrhage or necrosis (unless they are large; coagulative necrosis).
- Lymphocytes, granulomas, and giant cells may be seen.
- Rare cases may produce b-hCG.
- Good prognosis; responds to radiotherapy.
- Most common germ-cell tumor in adults age 15-35.
- Histologically equilivaent to dysgerminoma in females
- Spread to paraaortic LNs
- Risk factors: cryptorchidism, familiy history
15
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THIS MIGHT BE GASTRITIS! my examinator told me the “gastritis” slide was celiac, so it makes sense that this is gastritis.
Stomach gastritis
Neutrophils in lamina propria, some cross basement membrane, lymphoplasmocytic infiltrate in foveolar epithelium. Reactive atypia. Intestinal metaplasia
Micro: Congestion and edema of the lamina propria. Neutrophils within the surface and glandular epithelium. In acute erosive hemorrhagic gastritis à surface necrosis with hemorrhage
Cellular atypia = mitotic figures, enlarged cells, nucleoli
H. pylori -> Giemsa, urea breath test
Acute gastritis: Acid damage to mucosa due to imbalance between mucosal defenses and acidic environment. Stress erosions and ulcers, in shock, with burns, sepsis, trauma, surgery, intracranial injury.
Risk factors: Severe burns or trauma (Curling ulcer from hypovolemia à less BF to stomach), NSAIDs (decreased production of PGE2), smoking, heavy alcohol consumption, chemotherapy (decreased regenerative capacity of cells), ischemia, stroke, uremia, increased intracranial pressure (Cushing ulcer from increased vagal stimulation à acid production), and shock.
Damage results in inflammation with hyperemia, erosion (loss of epithelium), or ulcer (loss of mucosal layer)
Symptoms: Pain, vomiting, nauseas, hematemesis, melena, severe blood loss.
Gross: Hyperemia. In acute erosive hemorrhagic gastritis; erosions.
16
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Glioblastoma multiforme (GBM)
- Malignant, high-grade tumor of astrocytes (astrocytoma).
- Aggressive.
- Most common primary malignant CNS tumor in adults. Usually arises in the cerebral hemisphere; characteristically crosses the corpus callosum (‘butterfly’ lesion”).
- Characterized by regions of necrosis surrounded by tumor cells (pseudopalisading), pleiomorphic cells, large cells (!), hemorrhage and endothelial cell proliferation
- Tumor cells are GFAP positive.
- Poor prognosis
17
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Adrenal cortical adenoma
- No necrosis
- Encapsulated
- Slight polymorphism
- Lipid-rich -> pale cytoplasm
- Yellow-lipid rich masses
- Most adrenal tumors are non functional
18
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Cervical intraepithelial neoplasia
- Precursor leasion for squamous cell carcinoma
- CIN 1-3
- PAP-smear
- HPV 16, 18, 31, 33
- CIN1: dysplasia in lower 1/3 with some koliocytes
- CIN2: dysplasia up to middle/third. Some koiliocytes
- CIN3: total loss of maturation, variants in size, chromation heterogenety, oreientation loss, and mitosis. Changes in all layers. No koilocytes.
- Mabothian cyst: mucin-filled cyst formed when squamous epithelium prolifirate and cover columnar, blocking ducts
19
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Condyloma acuminatum
- Look for koilocytes
- Wart-like lesion of the vulva.
- HPV 6 and 11
20
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Uterus - endometrial hyperplasia
- Prolifiration of glands, they are also dilated with no glandular crowding
- Endometrial hyperplasia: hyperplasia of endometrial glands relative to stroma. Consequence of unopposed estrogen (not followed up by progesterone) = hormonal imbalance. Presents as postmenopausal uterine bleeding, menorrhagia
- Classified histologically: based on architectural growth and cellular atypia. Most important predictor for progression to carcinoma is cellular atypia.
- Can be simple or complex, and with or without atypia – see patho lecture
- Simple hyperplasia: increased number of cystically dilated glands with no glandular crowding
- Complex hyperplasia: increased number of dilated glandswith branching and glanduler crowding.
- Atypical hyperplasia: glanduler crowding and dysplastic epithelium. Greatest risk for endometrial cancer.
21
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Basal cell carcinoma of the skin
- Histology: resemble normal basal cell (basophilic), multifocal growth. Nodular leasion growing into dermis, look like vords/islands of basophilic cells in fibrotic stroma
- Peripheral tumor palisate (align), forming a cleft bewteen nodules and stroma
- Basal cell carcinoma: malignant prolifiration of basal cells of epidermis. Risk factors include prolonged exposure to sunlight (UVB), albuminism, and xeroderma pigmentosum (nucleotide-excission repair defect).
- Presents as an elevated nodule with a central, ulcerated crater surrounded by dilated (telangiectatic) vessels; ‘pink, pearl-like papule’
- Classic location is the upper lip
- Histology shows nodules of basal cells with peripheral.
- Treatment is surgical excision; metastasis is rare (which means good prognosis)
22
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Thrombus - Prostate (w/atrophy)
- Virchows triad
- Hypercoagulative state
- Endothelial damage
- Stasis or turbulent blood flow
- Can see fibrin (clot)
- Adhere to vessel wall
23
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Lymph node metastases - squamous cell carinoma
Some normal germinal centers and karatinization
24
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Seborrheic keratosis
- Seborrheic keratosis: benign squamous proliferation; common tumor in elderly.
- Histo: monotonous sheets of small cells resembling normal basal cells. Melanin pigmentation is present. Hyperkeratosis at surface. Deeper keratin filled cysts, “Horn cysts”
- Not related to UV-exposure
- Presents as raised, discolored plaques on the extremities or face; often has a coin-like, waxy, ‘stuck-on’ appearance. Characterized by keratin pseudocysts on histology.
- Leser-Trelat sign is the sudden onset of multiple seborrheic keratoses and suggests underlying carcinoma of the GI tract.
25
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Lobular invasive carcinoma of breast
- Indian-file
- Cells are monomorphic, with bland round nuclei, intraceullar mucan vacuoles common à signet ring. Usually form a single line; “indian-line”
- May exhibit signet-ring morphology
- No desmoplastic response
- No duct formation due to lack of E-cadherin
- Metastase to (special!): CSF, bone marrow, ovary, uterus, GI, serosal surfaces
26
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Hepatocellular carcinoma
- Likes to invade renal vein
- Histo: well-differentiated trabecular with pseudocanaliculi, or poorly differentiated with multinucleated anaplastic giant cells
- Most common primary malignant tumor in the liver
- Metastases to liver is more common than primary tumors
27
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Papillary transitional cell carcinoma
28
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Colon, polyp adenoma
- Sessile vs. pedunculated
- Villous adenoma
- Nuclear atypia
- Dysplastic
- Size of polyp correlate with malignancy
- Types of polyps
- Inflammatory
- Hamertamous
- Hyperplastic
- Adenomatous
29
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Chronic pyelonephritis
- Findings – atrophic tubules contain eosinophilic proteinaceous material reminiscent of thyroid follicles (“thyroidisation” of the kidney). Lymphocytes. Waxy casts may be seen in urine.
- Interstitial inflamation, fibrosis (scaring) and atrophy of tubules due to multiple bouts of acute pyelonephritis.
- Due to vesicourethral reflux (most common with superimposed UTI; often in children) or obstruction.
- Hallmark of chronic pyelonephritis is uneven scarring (benign nephrosclerosis from vascular stenosis and/or hypertension and chronic GNs have a more symmetrical fibrosis) involving the pelvis and calyces, or both, leading to papillary blunting and marked calyceal deformities. Leads to cortical scarring with blunted calyces. Scarring at upper and lower poles is characteristic of vesicoureteral reflux. Can end up in renal failure.
30
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Fibrocystic change of the breast
- Fibrocystic change: Development of fibrosis and cysts in the breast. Most common change in the breat, most commin in premenopausal age (age 20-50); thought to be hormone mediated.
- Presents as vague irregularity of the breast tissue (‘lumpy breast’), usually in the upper outer quadrant; may produce a palpable mass or nodularity. Cysts have a blue-dome appearance on gross exam.
- Heterogeneous group of morphologic patterns showing combinations of:
- Fibrosis: stromal change with increase in extralobular collagen
- Cysts: dilatation of the acini of the lobules (lobular architechture maintained); usually multifocal and bilateral; apocrine metaplasia often associated with cysts
- Adenosis: increase of number of acini per lobule. It is physiological during pregnancy and lactation, but can be focally present in nonlactating breasts.
- Benign, but some fibrocystic-related changes are associated with an increased risk for invasive carcinoma (increased risk applies to both breasts);
- Fibrosis, cysts, and apocrine metaplasia - no increased risk
- Ductal hyperplasia and sclerosing adenosis – 2x increased risk
- Atypical hyperplasia – 5x increased risk
31
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Chronic pancreatitis
- Fibrosis of pancreatic parenchyma secondary to recurrent acute pancreatitis and atrophy of parenchyma.
- Parenchymal fibrosis, acinar loss (chronic inflammation), fusion of langerhans islelets, dulated ducts with eosinophli calcified concreations
- Most commonly due to alcohol and CF, but many causes are idiopathic (many other causes; see lecture). Low mortality, but bad quality of life.
- Clinical features: Epigastric pain radiating to the back. Pancreatic insufficiency (steatorrhea, fat-soluble vitamin deficiency; A, D, E and K). Dystrophic calcification of pancreas. Jaundice. Secondary diabetes mellitus (in late stages; destruction of endocrine parts). Increased risk for pancreatic carcinoma. Low elastase in stool?
32
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Nutmeg liver - congestion
- Liver get a centrolobular necrosis with fibrotic progression (“cardiac fibrosis”) and a “nutmeg” appearance
- Causes: right ventricular failure (can cause “cardiac sclerosis”), intrahepatic obstruction, cirrhosis
- Combination of right sided heart failure and left sided hypoperfusion causes centrilobular hemorrhagic necrosis -> nut meg
33
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Bronchopneumonia
- Scattered patchy consolidation centred around bronchioles; often multifocal and bilateral. Caused by variety of bacteria. Fragile and breakable parenchyma. Purulent foci at multiple parts. Hyperemic parenchyma.
- Histo: purulet exsudate (neutrophils) fill the alveoli. Edeme
34
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Ovary - serous cystadenocarcinoma
- Borderline
- Psommona bodies
- BRCA 1 + 2
- Most are benign at the surface tumors
- Serous gland prolifiration
- Intact capsule
- Large, spherical cystic (30-40 cm).
- Benign: only one cell thick, columnar, ciliated epithelium
- Malignant: anaplasia, multicelllar papillae, nest of cancer cells
- Borderline: less atypia, no stromal invasion
35
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Embryonal carcinoma of the testis
- Malignant tumor of immature, large primitive cells with basophilic cytoplasm, indistinct cell borders and prominent nucleoli and large nuceli that may form glands.
- Hemorrhage mass with necrosis. Aggressive with early hematogenous spread, metastases to liver and lung
- Peak 20-30 years of age
- Chemotherapy may result differentiation.
- Increases AFP or b-hCG may be present.
36
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Peptic ulcer - Gastric ulcer
- Ulcer histologic components: necrotic debris, inflammation with a predominance of neutrophils, granulation tissue and fibrosis
- Solitary mucosal ulcer involving proximal duodenum (98%) or distal stomach (antrum at the lesser curvature). Male predominance.
37
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Foreign body granuloma - skin
- Granuloma around surgical thread
- Macrophages -> giant -> epitheloid cells
38
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Non-hodgkin lymphoma
- No normal structure of LNs. Big cells, mitosis, apoptosis.
- Types:
- Small cell lymphoma
- Follicular lymphoma
- Mantle cell lymphoma
- Diffuse large-cell lymphoma
- Burkitt lymphoma
39
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Adenocarcinoma of lung
- Precursor leasion - atypical adenomatous hyperplasia (AAH)
- Common with either EGFR or KRAS mutation
- Form glands
- Cellular atypia, large cells, mitotic figures, mononuclear infiltrate, big nucleoli
- Most common malignant lung tumor in nonsmokers and woman
40
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Liver cirrhosis
- Fibous septa, involves the whole liver, nodules (without central vein), with senescent and stem cell. Ductal reativ..
- Causes: alcohol, viral, toxic, autoimmune
41
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Breast - ductal carcinoma in situ
- Comodo necrosis
- Dilated ducts filled with luminal cells
- Have both basement membrane and myoepithelial layer intact.
- Radial scars
- IDC form tubular structures
- Can result in Paget disease of the brest and invasive ductal carcinoma
- Histological types
- Comodo = necroic center
- Solid = cancer cells compleately fills the ducts
- Papillary = papillary growth
- Cribiform
DCIS does not usually produce a mass.
- Histologic subtypes are based on architecture; comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
- Paget disease of the breast is DCIS that extends up the ducts to involve the skin of the nipple. Presents as nipple ulceration and erythema. Paget disease of the breast is almost always associated with an underlyingcarcinoma.
42
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Adenocarcinoma, colo-rectal
- Third most common cancer and cancer death
- Most common malignancy of GI-tract
- Invasive: no muscularis mucosae
- Dense stroma (desmoplastic responce), atypical glands, no goblet cells.
- Sessile/villous adenocarcinoma
- Villous: Sessile appearance. broad base, finger like projectons due to more dysplasia and with that, a higher risk for cancer (similar risk in tubular type was mentioned in Robbins)
APC -> KRAS -> P53 + COX
43
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Adenocarcinoma of the stomach
- Signet-cells (kruckenberg tumor)
- Linitis plastica
- Most common in Japan and eastern europe
- Cancer types
- Intestinal: grow along broad cohesive front and form ulcerative tumors. Apical mucous vacules
- Diffuse: infiltrative growth pattern, discohesice signet ting cells. Desmoplastic respone
44
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Melanocytic nevus(melanoma)
- Can be congenital or accuired
- Benign neoplasm
- Compound
- Superficial cells: large, pigmented, grow in nests
- Deeper cells: smaller, no pigment, grown in cords
- Deepest cells: fusiform, grow in fascicles
Nevus (mole): benign neoplasm of melanocytes.
- Congenital nevus is present at birth; often associated with hair (important to know as melanoma does not grow hair).
- Begins as nests of melanocytes at the dermal-epidermal junction (junctional nevus); most common mole in children
- Grows by extension into the dermis (compound nevus)
- Junctional component is eventually lost resulting in an intradermal nevus, which is the most common mole in adults
Characterized by a flat macule or raised papule with symmetry, sharp borders, evenly distributed color, and small diameter (< 6 mm)
Dysplasia may arise (dysplastic nevus), which is a precursor to melanoma.
45
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Acute pyelonephritis
- Always of bacterial origin. Infection of the interstitium, tubules and renal pelvis. Usually due to ascending infection (sepsis – hematogenous infection is the cause in a minor amount of cases); increased risk with vesicourethral reflux, urinary obstruction, female gender, pregnancy, urethral instrumentation, diabetes, benign prostatic hypertrophy.
- Presents with fever, flank pain, WBC casts (very important finding as is separated it from acute cystitis), and leukocytosis (neutrophils) in addition to symptoms of cystitis.
- Common suppurative inflammation of the kidney and the renal pelvis.
- Macro: One or both kidneys may be involved. The affected kidneys may be normal in size or enlarged.
- Characteristically, discrete, yellowish, raised abscesses are grossly apparent on the renal surface. If the pus is not drained it may end up with pus accumulation à pyonephrosis. Infrequently, necrosis of renal papilla occurs, papillary necrosis characterized by gray-white to yellow necrosis of the apical 2/3rd of the pyramids (coagulative necrosis with surrounding neutrophils on histo).
- Micro: liquefactive necrosis with abscess formation within the renal parenchyma
- Common pathogens: E. coli, Klebsiella, Proteus, Enterococcus faecalis and pseudomonas - In general; gram-negative enteric rods
46
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Adenocarcinoma metastases to liver
- More common with metastases to liver than primary tumors. Metastases to liver results in multiple nodules in liver. Clinically may be detected as hepatomegaly with nodular free edge of liver.
- Common to get metastases from colon, lung and breast
- They are normaly firm and well-circumscribed. White-grey. Often in the periphery
- Glandular structure, desmoplastia, well circumscribed, central necrosis
47
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Small cell carcinoma of the lung
- Small round of fusiform cells, scant cytoplasm, and finely granular chromation. Mitotic figures are commonly seen. Associated with smoking.
- Can look like lymphocytes
- Very little cytoplasm
- Respond to chemotherapy
*
48
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Squamous cell carcinoma of the esophagus infiltration stomach
- Invasive into submucosae
- Keratin perls
- Hyperchromatic cells
- Most typical in middle part
- Begins as squamous cell dysplasia
- Risk factors: smoking, hot beverage, vitmain A and C def, obesity, nitrosamines, male gender, black rase
49
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Neuroendocrine tumor - Ileum
- Carcinoid tumor: Malignant proliferation of neuroendocrine cells; low-grade malignancy.
- Positive chromogranin.
- Small round cells, “salt-and-pepper”. Yellow tan mass on macroscopy
- Can arise anywhere along the gut. Small bowel is the most common site.
- Grows as submucosal polyp-like nodule. Often secretes serotonin, 5-HIAA (metabolite) is excreted in the urine. Since it is formed in the small intestine it travels by the portal system and is metabolized in the liver by MAO, some due pass.
Only when you have metastasis to the liver you can get carcinoid syndrome since it bypasses the liver (bronchospasm, diarrhea and flushing of the skin). Symptoms can be triggered by EtOH or emotional stress. Carcinoid heart disease, right-sided valvular fibrosis. Leads to tricuspid regurgitation (“only” other cause of tricuspid changes is IV-drug use endocarditis) and pulmonary valve stenosis (unknown mechanism). Don’t get left sided carcinoid heart disease, lungs contain MAO and are able to degrade serotonin before it reaches the left side.
Morphology: Yellow tan solid tumor. Islands of monomorphic cells, vesicular nuclei with “salt and pepper” chromatin pattern.
Affects over 10% of patients with NET/NEC. Vasomotor disturbances (flushing, cyanosis). Intestinal hypermotility (diarrhea, vomiting). Bronchoconstriction (cough, wheezing). Systemic fibrosis (cardiac: pulmonary and tricuspid valve thickening, right ventricular fibrosis, retroperitoneal and pelvic fibrosis). Occurs in patients with metastatic disease. Serotonin (and histamine) production. More info above.
50
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Ulcerative colitis
- Starts in the rectum and ascends.
- Crypt abscesses (histological hallmark) with neutrophils.
- Pseudopolyps: islands of regeneration mucosa from these structures
- No granulomas
- Inflammation is limited to mucosae (and submucosa)
- Contineous with NO skiped leasion
- Can increase the risk of cancer and tocix megacolon
- Smoking protects. Screening endoscopy to check for areas of carcinoma and dysplasia. Associated with sclerosing cholangitis and p-ANCA.
- Most common at the age of 20-25 years, but may occur at any age.
51
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Metastatic melanoma to brain
- Metastatic tumors characteristically present as multiple, well-circumscribed lesions at the gray-white junction.
- Central area of necrosis: eosinophilic and anuclear
- Can see melanonic pigments
- Most common tumors to brain are
- Melanoma
- Breast
- Kidney
- GI
- Lung
*
52
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Crohns disease (picture looks like a “C” for Crohns disease)
- Granuloma (langerhans giant cells; non-caseating), fistula, inflammation of all layers.
- Crypt abcesses, ulcerations, neutrophils
- Transmural disease (knife-like fissures in the wall).
- Can affect all regions from the mouth to anus. Most common site is the terminal ileum, ileocecal valve and cecum (RLQ pain), while the least common is the rectum.
- Skipped discontinuous lesions. Cobblestone mucosa (healing of the mucosae with granulation tissue), myofibrocytes contract – patchy distribution of the inflammation, diseased areas are depressed.
- Creeping fat (mesenteric fat extends around serosa, stenosis and strictures (“strings-sign” on imaging).
- Aphthous ulcers may coalesce into serpentine ulcers along the axis of the bowel. Fissures, fistulae between loops, toward skin, vagina, urinary bladder etc.
- Develop most commonly at age 20-30 and 60-70.
- Non-caseating granuloma occur in some cases.
53
Q
A
Laryngeal squamous cell carcinoma
- HPV, smoking, alcohol
- dysplasia in mucosae
- desmoplasia
- 7:1 males-to-female
- 3/4 from vocal cord
- Starts off as in-situ lesions, evolving into plaques and ulcerations
- Symptoms: hoarseness
54
Q
A
Fibroadenoma of the breast
Tumor of fibrous tissue and glands. Most common benign neoplasm of the breast; usually seen in premenopausal women (under 35). Presents as a well-circumscribed, round, mobile marble-like mass.
- Macro: well-circumscribed, tan, rubbery mass with small, cleftlike spaces.
- Micro: proliferation of benign stroma, ducts and lobules. Mostly fibrous proliferation with some glandular (epithelial) proliferation
- Estrogen sensitive - grows during pregnancy and may be painful during the menstrual cycle.
- May regress and calcify after menopause.
- Benign, with no increased risk of carcinoma
55
Q
A
Pancreatic adenocarcinoma of the head with normal duodenum
- Gland formation
- Mucin secretion
- Perineural invasion
- Desmoplastic response
- Dense stromal fibrosis
- Moderate/poor diff.
56
Q
A
Old myocardial infarction
- Large thrombus, very common cause of MI after plaque rupture.
- Irreversible damage occurs after 20-30 minutes. Myocysis and coagulative necrosis.
- Complications arrythmias
- Macroscopy
- 18h > not visible
- 1-3 dayes - pale hyperemic edge
- 3-10 days - yellow
- 6 w - grey scar
- Early -> necrosis and neutrophils
- Late -> myocyte reorganization, scar tissue
57
Q
A
Hashimoto thyroiditis (chronic lymphocytic thyroiditis)
- Micro: lymphocytic inflammation with germinal centers. Epithelial “Hurthle cell” (large eosinophilic with granulated cytoplasm) changes.
- Characterized by immune destruction of the thyroid gland and hypothyroidism. Infiltration of lymphocytes. Most common noniatrogenic/nonidiopathic cause of hypothyroidism in the U.S.
- Clinical presentation: female predominance, age 40-65. Painless goiter. Hypothyroidism (late) and transient hyperthyroidism (initial)
- Antithyroid antibodies: antithyroglobulin and antithyroid peroxidase antibodies
- Gross: pale enlarged thyroid gland
May be associated with other autoimmune diseases such as SLE, RA, Sjogren syndrome.
Increased risk for the development of B cell non-Hodkin lymphoma
Complication: increased risk of non-Hodgkin B-cell lymphoma
58
Q
A
Lung tuberculosis
- Central zone of necrosis
- Casseating necrosis
- Granuloma with giant cells
- Ghon foci -> Ghon complex (nodal involvement)
- -> sencondary TB to apical lung and possible dissemination -> milliary TB
- Calcification -> Ranke complex
- Potts disease
59
Q
A
Pleomorphic adenoma of the parotid gland
- Nr 1 tumor (benign; 60%) of the salivary glands
- Encapsulated
- No epithelial dysplasia or mitotic figures
- Composed of stromal (e.g. cartilage) and epithelial tissue (e.g. glands).
- Overexpression of PLAG1
- Mobile, painless (because it does not affect the facial nerve), circumscribed mass at the angle of jaw.
- High rate of recurrence due to the irregularities of the mass; difficult for the surgeon to remove all the benign tissue. Extension of small island of tumour through tumour capsule often results in incomplete resection.
It rarely transforms into adenocarcinoma à presents with sign of facial nerve damage
60
Q
A
Fatty liver
- Micro and macrovesicles
- Fatty liver: Accumulation of fat in hepatocytes. Results in heavy (enlarged), greasy yellow liver; resolves with abstinence (reversible). Most common.
- Micro: Centrilobular macrovesicular steatosis (reversible. Eventual fibrosis around the central vein (irreversible). Steatosis around central vein.
- Histology: Mallory bodies à damage cytokeratin intermediate filaments in the hepatocytes (intracytoplasmic) à lymphocytes attack. Mainly central necrosis and perivenule fibrosis.
- Causes are alcohol, Reye syndrome (microvesicles), metabolic syndrome, obesity,
61
Q
A
Endometriosis of ovary
Histo: hemosiderin, endometrial stroma and glands
“Chocolate cyst”. Cyst wall are removed in small amounts. Corpus albicans. Hemosiderin loaded macrophages from bleeding.
Endometrioses: abnormal location of endometrial glands and stroma outside the uterine endometrial lining
62
Q
A
Uterus - adenocarcinoma
- Angiogenesis
- Invasion of myometrium
- Necrosis
- Desmoplasia
- Glandular structures
- Most common malignany in female genital tract
- Types
- Endometrioid (80%) - from endometrial hyperplasia
- Serous
64
Q
A
Leiomyoma of the myometrium of the uterus
- Benign proliferation of smooth muscle arising from myometrium. Most common tumor of the female genital tract. High incidence in African Americans. Related to estrogen exposure; tend to occur in pre-menopausal woman.
- Often multiple, rubbery, well defined white whorled masses which increase in size during pregnancy, and shrinks after menopause. Multiple nodules usually indicate a benign lesion; singular lesion is a sign of leiomyosarcoma (disease typical in postmenopausal woman).
- Location: subserosal, intramural (most common; inside the muscle), and submucosal
- Leiomyoma does NOT progress to leiomyosarcoma.
- Usually asymptomatic. When present symptoms include abnormal uterine bleeding, pelvic, back or suprapubic pain, infertility, and pelvic mass.
65
Q
A
Benign prostatic hyperplasia
- Nodular hyperplasia
- Basal layer is always intact -> not adenocarcinoma
- Granular papillary projections into lumen
- Hyperplasia of glands and fibromuscular stroma around_periutheral zone_.
- DHT dependent
