Pathology 2

Question 1

categories of pathology?

Answer 1

neoplasia
infection
trauma
allergy
drugs/toxins
idiopathic
iatrogenic
degenerative
developmental

Question 2

general principles of pathology in young vs old?

Answer 2

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

Question 3

which tumours can generally pop up everywhere?

Answer 3

prostate cancer

lobular breast cancer

Question 4

example of cancer with intuitive patters of spread?

Answer 4

testicular cancer > para-aortic nodes

Question 5

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?

Answer 5

adenocarcinoma

signet rings are seen due to the huge amount of mucin

Question 6

keratinisation indicates what type of cancer?

Answer 6

squamous cell carcinoma

keratinisaiton looks like dense pink area

Question 7

small monotonous cells with little cytoplasm indicates which type of cancer?

Answer 7

lymphocytoma

cells look like lymphocytes

Question 8

brown material on biopsy indicates which cancer type?

Answer 8

melanoma (brown material is melanin)

Question 9

mass which moves on swallowing indicates pathology where?

Answer 9

thyroid

Question 10

branchial cyst presentation?

Answer 10

swelling lateral in the neck at the angle of the mandible

congenital problem so presents at young age

Question 11

presentation of thyroglossal duct cyst?

Answer 11

swelling in midline
mobile
presents at young age
protrudes when patient sticks tongue out

Question 12

swelling in neck that moves on swallowing, high TSH and normal T4, whats the diagnosis?

Answer 12

subclinical hypothyroid

Question 13

next step investigating thyroid case?

Answer 13

subclinical hypothyroidism doesnt explain the lump so you need to still investigate the lump via FNA

Question 14

how does thyroid appear in hashimotos thyroiditis?

Answer 14

beefy swelling (not a discrete mass)

Question 15

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.

Answer 15

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

Question 16

what is oncocytic change?

Answer 16

type of metaplasia involving cellular enlargement characterised by an abundant eosinophilic granular cytoplasm as a result of the accumulation of altered mitochondria

Question 17

when does oncocytic change occur?

Answer 17

inflammatory disorders such as thyroiditis

Question 18

features of papillary thyroid cancer?

Answer 18

blackish broken substance (calcium)
pal nuclei with central clearing (orphan annie nuclei)
nuclear grooves and inclusions

Question 19

how are thyroid lumps generally investigated?

Answer 19

FNA
thy 1 = inadequate
thy 2 = benign
3 = atypia or follicular lesion
4 = atypia suspicious of malignancy
5 = malignant

Question 20

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?

Answer 20

viral infection
young with bilateral lymphadenopathy and unwell = viral
nodes can be painful too

Question 21

young male with bilateral lymphadenopathy, sore throat with difficulty swallowing, slight jaundice and some upper abdo pain
- what is the likely diagnosis?

Answer 21

EBV/glandular fever
(EBV can often cause hepatosplenomegaly)
pain is due to mild liver capsule distension

Question 22

how does EBV cause jaundice?

Answer 22

EBV infects reticuloendothelial system and causes some haemolysis

Question 23

next steps if EBV suspected?

Answer 23

EBV serology
check FBC (risk of haemolysis, thrombocytopenia etc)
give penicillin V
advise rest (risk of splenic rupture)
usually self limiting

Question 24

if EBV is suspected but test comes back -ve what other test should be considered?

Answer 24

HIV test