Pathology 2 Flashcards
categories of pathology?
neoplasia infection trauma allergy drugs/toxins idiopathic iatrogenic degenerative developmental
general principles of pathology in young vs old?
young = rarely carcinoma, only tumours in kids are of blood, bone and brain so likely to be something other than cancer old = carcinoma far more common and late presentation of developmental defects unlikely
which tumours can generally pop up everywhere?
prostate cancer
lobular breast cancer
example of cancer with intuitive patters of spread?
testicular cancer > para-aortic nodes
pathology report:
a lymph node largely replaced by a tumour. The tumour is poorly differentiatied consisting of single cells. Focally, cells with a signet ring morphology are present containing abundant intracytoplasmic mucin.
what is the most likely diagnosis?
adenocarcinoma
signet rings are seen due to the huge amount of mucin
keratinisation indicates what type of cancer?
squamous cell carcinoma
keratinisaiton looks like dense pink area
small monotonous cells with little cytoplasm indicates which type of cancer?
lymphocytoma
cells look like lymphocytes
brown material on biopsy indicates which cancer type?
melanoma (brown material is melanin)
mass which moves on swallowing indicates pathology where?
thyroid
branchial cyst presentation?
swelling lateral in the neck at the angle of the mandible
congenital problem so presents at young age
presentation of thyroglossal duct cyst?
swelling in midline
mobile
presents at young age
protrudes when patient sticks tongue out
swelling in neck that moves on swallowing, high TSH and normal T4, whats the diagnosis?
subclinical hypothyroid
next step investigating thyroid case?
subclinical hypothyroidism doesnt explain the lump so you need to still investigate the lump via FNA
how does thyroid appear in hashimotos thyroiditis?
beefy swelling (not a discrete mass)
what does the following report on the FNA sample indicate?
This aspirate contains abundant colloid and scattered sheets and aggregates of thyroid follicular epithelial cells. Many of the cells exhibit oncocytic change. In the background abundant lymphocytes are present.
thyroiditis
report talks about epithelial cells but theyre supposed to be there
oncocytic change isnt uncommon in thyroiditis (cells referred to hurthle cells)
lymphocytes shouldnt be there so indicate inflammation if present
what is oncocytic change?
type of metaplasia involving cellular enlargement characterised by an abundant eosinophilic granular cytoplasm as a result of the accumulation of altered mitochondria
when does oncocytic change occur?
inflammatory disorders such as thyroiditis
features of papillary thyroid cancer?
blackish broken substance (calcium)
pal nuclei with central clearing (orphan annie nuclei)
nuclear grooves and inclusions
how are thyroid lumps generally investigated?
FNA thy 1 = inadequate thy 2 = benign 3 = atypia or follicular lesion 4 = atypia suspicious of malignancy 5 = malignant
An 18 year old male presents to his GP in Dundee with a two day history of a swelling in the left lateral neck. It appears soft and is mildly tender. On further examination he has other small palpable masses on the contralateral side.
- what is the most likely pathological process?
viral infection
young with bilateral lymphadenopathy and unwell = viral
nodes can be painful too
young male with bilateral lymphadenopathy, sore throat with difficulty swallowing, slight jaundice and some upper abdo pain
- what is the likely diagnosis?
EBV/glandular fever
(EBV can often cause hepatosplenomegaly)
pain is due to mild liver capsule distension
how does EBV cause jaundice?
EBV infects reticuloendothelial system and causes some haemolysis
next steps if EBV suspected?
EBV serology check FBC (risk of haemolysis, thrombocytopenia etc) give penicillin V advise rest (risk of splenic rupture) usually self limiting
if EBV is suspected but test comes back -ve what other test should be considered?
HIV test
