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In Service Exam > Pathology > Flashcards

Pathology Flashcards

1
Q

Oral cavity and oropharynx reactive and non-neoplastic lesions

A
  • Fibroepithelial polyp
  • Lobular capillary hemangioma (pyogenic granuloma)
  • Mucocele
  • Reactive lymphoid follicular hyperplasia (a benign proliferation of lymphoid follicles)
  • Necrotizing sialometaplasia
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2
Q

Fibroepithelial polyp histology

A

Common in the oral cavity and frequently occur in areas that are prone to trauma such as the tongue, buccal mucosa and lower lip. May be referred to as irritation or bite fibromas. The polyp is lined by an acanthotic, stratified squamous epithelium with a dense fibrovascular tissue stroma.

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3
Q

Lobular Capillary Hemangioma histology

A

Aka pyogenic granuloma. Proliferation of small capillary sized blood vessels in a lobular arrangement with a small feeder vessel and an inflammatory background.

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4
Q

Necrotizing sialometaplasia histology

A

Squamous metaplasia of minor salivary gland ducts in a lobular arrangement with many ducts obliterated by the metaplastic process with necrotic debris and neutrophils. Moderate chronic inflammatory cell infiltrate present in background with atrophy and destruction of the minor salivary gland acini.

Presents as an ulcerative lesion of the hard palate and may clinically simulate a carcinoma. Can mimic SCC is small biopsy specimens where the lobular arrangements of cells is difficult to appreciate. However, these lesions usually lack marked nuclear atypia and increased mitoses normally seen in SCC

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5
Q

Stain used for fungal organisms

A

methenamine silver stain

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6
Q

Stain used for TB

A

Ziehl Neelsen stain - used to identify acid fast organisms

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7
Q

Histoplasmosis histology

A

Used a periodic acid schiff (PAS) stain which shows foam macrophages with numerous small fungal spores in their cytoplasm surrounded by clear halos

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8
Q

Benign tumors of the oral cavity and oropharynx

A
  • Granular cell tumor
  • Lipoma
  • Spindle cell lipoma
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9
Q

Epithelial precursor lesions

A
  • mild epithelial dysplasia
  • Severe epithelial dysplasia/CIS
  • Verrucous hyperplasia
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10
Q

Malignant epithelial lesions

A
  • SCC (keratinizing and non keratinizing)
  • verrucous carcinoma
  • basaloid SCC
  • adenosquamous cell carcinoma
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11
Q

Granular cell tumor histology

A

Granular cells are cytologically bland large polygonal cells which contain abundant granular pink (oncocytic) fluffy cytoplasm and centrally located small dark nuclei. Granular cells react to antibodies to S100 protein and are thought to be of schwannian origin.

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12
Q

Lipoma histology

A

Lobules of mature adipose tissue separated by thick bands of fibrous tissue. Adipocytes are univacuolated with slender nuclei located at the periphery and often not apparent.

Nuclear atypia or marked variation in size might raise concern for malignancy.

Lipomas are usually solitary lesions in adults and commonly involve the oral cavity and larynx. Degree of cellularity and fibrosis is location dependent.

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13
Q

Malignant mesenchymal tumors of oral cavity/oropharynx

A

Kaposi sarcoma

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14
Q

Mild epithelial dysplasia histology

A

The architectural and cytologic features are confined to the lower one third of the epithelium

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15
Q

Severe epithelial dysplasia histology

A

Full thickness marked nuclear atypia

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16
Q

Define the term basaloid in histology

A

Cells show a high nuclear to cytoplasmic ration with small dense hyperchromatic nuclei, appear more blue than pink on histology

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17
Q

Basaloid lesions

A
  • Basaloid SCC
  • Adenoid cystic carcinoma
  • Salivary duct carcinoma
  • Nonkeratinizing HPV related SCC
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18
Q

Immune mediated lesions of the oral cavity/oropharynx

A
  • Pemphigus vulgaris (IgG autoantibodies directed again interepithelial desmosomes)
  • Pemphigoid (autoantibodies directed against the basement membrane)
  • Lichen planus
  • Sjogren syndrome
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19
Q

Minor salivary gland biopsy

A

Need at least 3-5 minor salivary glands for evaluation. Diagnosis if more than 50 lymphocytes are seen in one focus per 4mm2 of tissue.

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20
Q

Lesions of the osseous jaw

A
  • Osteomyelitis
  • ORN
  • Central giant cell granuloma
  • Osteoma
  • Osteosarcoma
  • Fibrous dysplasia
  • Ossifying fibroma
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21
Q

Benign epithelial odontogenic tumors

A
  • Solid/multicystic ameloblastoma
  • Calcifying epithelial odontogenic tumor
  • Adenomatoid odontogenic tumor
  • Keratocystic odontogenic tumor
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22
Q

Non neoplastic lesions of the larynx

A
  • Contact ulcer
  • Vocal cord polyp
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23
Q

Benign epithelial tumor of the larynx

A
  • Laryngeal papilloma
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24
Q

Malignant epithelial tumors of the larynx/hypopharynx

A
  • SCC
  • Papillary SCC
  • Spindle cell (sarcomatoid) carcinoma
25
Q

Mesenchymal tumors of the larynx

A

Chondrosarcoma

26
Q

Osteoma histology

A

Histologically classified into compact (cortical) and spongy (trabecular) types.

27
Q

Multiple osteomas are seen in the setting of what syndrome?

A

Gardner syndrome (autosomal dominant)
- Affects 10% of individuals with FAP
- characterized by GI polyps and skin and soft tissue tumors. GI polyps have a 100% risk of undergoing malignant transformation
- Osteomas of the head and neck can present in sinuses around early adulthood

28
Q

Ossifying fibroma histology

A

Dense fibrous tissue, short trabeculae of bone, numerous rounded psammomatoid (calcified psammoma body like) deposits

29
Q

Fibrous dysplasia histology

A

fibrous stroma and irregular trabeculae of bone said to resemble Chinese characters

30
Q

Periapical (radicular) cyst histology

A
  • An inflammatory odontogenic cyst seen at the apex of a non vital tooth
  • Lined by stratified squamous epithelium with Rushton (hyaline) bodies (eosinophilic curved glass structures)
  • Dense chronic inflammatory cell infiltrate is seen immediately beneath the cell lining.
31
Q

Amelioblastoma histology

A

Tumor shows a follicular growth pattern. Follicles are bordered by ameloblast like cells with reverse nuclear polarity. Center most areas often demonstrate cystic degeneration and are characterized by loosely connected cells, stellate reticulum like cells.

32
Q

Koilocytes

A

HPV induced cytopathic changes in mature squamous cells. May be binucleated and contain clear cytoplasm and wrinkled, rasinoid nuclei. Seen in laryngeal papillomas

33
Q

Papillary SCC histology

A

Exophytic papillary structure. Papillary fronds are covered by severely stratified squamous epithelium

34
Q

Epithelial and neuroepithelial tumors of the nose, sinuses and nasopharynx

A
  • Inverted papilloma
  • Schneiderian carcinoma
  • Nasopharyngeal carcinoma
  • Sinonasal undifferentiated carcinoma
  • Sinonasal adenocarcinoma
  • Olfactory neuroblastoma (esthesioneuroblastoma)
  • Sinonasal meningioma
35
Q

Mesenchymal lesions of the nose, sinuses and nasopharynx

A
  • Angiofibroma
  • Glomangiopericytoma
  • Chordoma
  • Rhabdomyosarcoma
36
Q

Synaptophysin

A

A marker of neuroendocrine cells. Synaptophysin is an integral membrane glycoprotein that occurs in presynaptic vesicles of neurons and in similar vesicles of the adrenal medulla

37
Q

Mucor hyphae

A

Nonseptated hyphae with 90 degree branch points. Often seen in invasive fungal sinusitis

38
Q

Aspergillus hyphae

A

Most common cause of isolated fungal ball and chronic fungal sinusitis. Culture on Sabouraud’s agar shows septated hyphae at 45 degree angles

39
Q

Rhinosporidiosis histology

A

Thick walled rounded variably sized cyst like structures (sporangia) filled with small spores. Caused by Rhinosporidium seeberi fungus endemic to South India and Sri Lanka. Usually presents as unilateral polypoid lesion

40
Q

Rhinoscleroma histology

A

Caused by klebsiella rhinoscleromatis. Histology shows foamy histiocytes (Mikuliz cells) and bloated plasma cells (Russell bodies)

41
Q

Inverted papilloma histology

A

Tumor exhibits an endophytic growth with islands of transitional type epithelium containing occasional mucus cells and small collections of neutrophils. Respiratory cells overlie the transitional epithelium. A distinct basal layer is observed and there is rarely atypia.

42
Q

What are almost all nonkeratinizing nasopharyngeal carcinomas positive for

A

Epstein Barr early mRNA

43
Q

Distinguishing histopathology of small round blue cell tumors

A

Melanoma: HMB45+, S-100+, MiTF +
SNUC: cytokeratin + , possibly neuron specific enolase +
Ewing sarcoma: neuron specific enolase +
Rhabdomyosarcoma: desmin +, myogenin+, myoglobin+, myoDI+
Esthesioneuroblastoma: neuron specific enoloase +, S-100+

44
Q

Olfactory neuroblastoma histology

A

Small cells with minimal cytoplasm suspended in eosinophilic fibrillary background. Nuclei are monomorphic and round with fine granular chromatin. Prominent nucleoli and mitotic figures are not seen.

45
Q

Angiofibroma histology

A

Tumor composed of variably sized blood vessels and moderately cellular fibrous tissue with bland spindled cells. Tumor is unencapsulated and composed of vascular tissue and fibrous stroma. Vessel walls lack elastic fibers and have incomplete or absent smooth muscle.

46
Q

Malignant salivary neoplasms

A
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Acinic cell carcinoma
  • Polymorphous low grade adenocarcinoma
  • Epithelial myoepithelial carcinoma
  • Carcinoma ex pleomorphic adenoma
  • Salivary duct carcinoma
47
Q

Physaliferous cells

A

Vacuolated cells seen in chordomas

48
Q

Wegner Granulomatosis histology

A

walls of blood vessels are destroyed by inflammatory process, fibrinoid/granular degeneration of collagen is seen

49
Q

Basal cell adenoma histology

A

Well circumscribed tumor composed of variably shaped nests of cytologically bland basaloid cells arranged in a jigsaw puzzle pattern. Tumor cell nests are surrounded by an acellular eosinophilic basement membrane like material. Nuclear palisading is noted at the periphery of the tumor cell nests. Distinguished from basal cell adenocarcinoma by lack of invasion.

50
Q

Pleomorphic adenoma histology

A

Well circumscribed tumor by a fibrous capsule. Consists of combination of myoepithelial cells and small ducts (blue) within a chondromyxoid stroma (pink). Myoepithelial cells can be spindled. epithelioid, plasmacytoid or have clear cytoplasm.

51
Q

Warthin tumor histology

A

Aka papillary cystadenoma lymphomatosum. A papillary projection protruding into a cystic space. Papillary projections are lined by a double layer of cuboidal to columnar epithelial cells, with ample pink, granular cytoplasm and nuclei with central prominent nucleuolus and an underlying lymphoid stroma

52
Q

Mucoepidermoid carcinoma histology

A

Low grade tumors are cystic with mucus and epidermoid cells. Higher grade show more epithelial cells and cellular atypia. Will see glandular component of cuboid mucus producing cells mixed with epithelial cells arranged in sheets amid a fibrous stroma.

Majority of cases show chromosomal translocation t(11;19)(q21;p13) which creates the MECT1/MAML2 fusion protein.

Mucicarmine stain is used to highlight goblet cells containing intracellular mucin

53
Q

Adenoid cystic carcinoma histology

A

Typically show a cribiform or swiss cheese pattern. Neoplastic myoepithelial cells with hyperchromatic small angulated nuclei surround rounded spaces containing acid mucoploysaccaridoses. Frequently have perineural invasion. Associated with amyloid deposition. Other patterns include tubular (grade 1), cribiform with less than 30% solid (grade 2) and cribiform with more than 30% solid (grade 3)

54
Q

Acinic cell carcinoma histology

A

Distinct acinar differentiation with neoplastic acinar cells having numerous blue purple zymogen secretory granules. Zymogen granules are periodic acid schiff+ and diastase resistant. Polyhedral cells with small dark eccentric nuclei, basophilic granular cytoplasm

55
Q

Paraganglioma histology

A

Paraganglioma is a type of neuroendocrine tumor that forms near certain blood vessels and nerves outside of the adrenal glands. On histology see well developed nests of epithelioid cells (Zellballen arrangement), surrounded by delicate vascular channels. A zellballen is a small nest of chromaffin cells or chief cells with pale eosinophilic staining. Numerous cytoplasmic granules. Zellballen are separated into groups by segmenting bands of fibrovascular stroma, and are surrounded by supporting sustentacular cells (which can be seen with S100 immunostaining). Paragangliomas are negative for epithelial markers such as keratin helping to distinguish them from neuroendocrine carcinomas.

56
Q

Common findings in papillary thyroid carcinoma histology

A

Nuclear inclusions and psammoma bodies (round collection of calcium)

57
Q

Medullary thyroid carcinoma histology

A

Nests of plasmacytoid cells associated with an acellular eosinophilic material (amyloid). Cells have round, eccentrically located nuclei with granular chromatin.

58
Q

What stain is used and what is seen for cat scratch disease

A

Warthin starry stain - coccobacilli

In Service Exam (16 decks)

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