Pathology Flashcards
Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue; classically seen in adolescent males
Presents with profuse epistaxis
Angiofibroma
Protrusion of edematous, inflamed nasal mucosa.
Usually secondary to repeated bouts of rhinitis; also occurs in cystic fibrosis and aspirin-intolerant asthma
NASAL POLYP
Aspirin-intolerant asthma is characterized by the triad of asthma, aspirin-induced bronchospasms, and nasal polyps; seen in 10% of asthmatic adults
Inflammation of the nasal mucosa;
Presents with sneezing, congestion, and runny nose (common cold).
Rhinovirus is the most common cause.
RHINITIS
Allergic rhinitis is a subtype of rhinitis due to a type I hypersensitivity reaction (e.g., to pollen), and is characterized by an inflammatory infiltrate
Malignant tumor of nasopharyngeal epithelium
Associated with EBV; classically seen in African children and Chinese adults.
Biopsy usually reveals pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a background of lymphocytes.
NASOPHARYNGEAL CARCINOMA
Often presents with involvement of cervical lymph nodes
Inflammation of the epiglottis; H influenzae type b is the most common cause, especially in non immunized children.
Presents with high fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor; risk of airway obstruction
ACUTE EPIGLOTTITIS
Inflammation of the upper airway; parainfluenza virus is the most common cause.
Presents with a hoarse, “barking” cough and inspiratory stridor
LARYNGOTRACHEOBRONCHITIS (CROUP)
Due to excessive use of vocal cords; usually bilateral.
Composed of degenerative (myxoid) connective tissue.
Presents with hoarseness; resolves with resting of voice.
VOCAL CORD NODULE (SINGER’S NODULE)
Nodule that arises on the true vocal cord
Benign papillary tumor of the vocal cord
Due to HPV 6 and 11; papillomas are usually single in adults and multiple in children.
Presents with hoarseness
LARYNGEAL PAPILLOMA
Full-thickness defect of lip or palate, due to failure of facial prominences to fuse.
During early pregnancy, facial prominences (one from superior, two from the sides, and two from inferior) grow and fuse together to form the face.
CLEFT LIP AND PALATE
C. Cleft lip and palate usually occur together; isolated cleft lip or palate is less common.
Painful, superficial ulceration of the oral mucosa that arises in relation to stress and resolves spontaneously, but often recurs.
Characterized by a grayish base surrounded by erythema
APHTHOUS ULCER
Recurrent aphthous ulcer is called Behcet syndrome
Recurrent aphthous ulcers, genital ulcers, and uveitis
Due to immune complex vasculitis involving small vessels. Can be seen after viral infection, but etiology is unknown
BEHCET SYNDROME
Vesicles involving oral mucosa that rupture, resulting in shallow, painful, red ulcers.
Primary infection occurs in childhood; lesions heal, but virus remains dormant in ganglia of the ______ nerve.
Stress and sunlight cause reactivation of the virus, leading to vesicles that often arise on the lips.
ORAL HERPES (Usually due to HSV-1)
trigeminal nerve
Malignant neoplasm of squamous cells lining the oral mucosa.
Tobacco and alcohol are major risk factors.
Floor of mouth is the most common location.
Oral leukoplakia and erythroplakia are precursor lesions.
SQUAMOUS CELL CARCINOMA
Erythroplakia and leukoplakia are often biopsied to rule out carcinoma.
_______ is a white plaque that cannot be scraped away; often represents squamous cell dysplasia.
Leukoplakia
It is distinct from oral candidiasis (thrush) and hairy leukoplakia.
_________ is a white, rough (‘hairy’) patch that arises on the lateral tongue. It is usually seen in immunocompromised individuals (e.g., AIDS) and is due to EBV-induced squamous cell hyperplasia; not pre-malignant
Hairy leukoplakia
________ is a white deposit on the tongue, which is easily scraped away; usually seen in immunocompromised states and is caused by fungi
Oral candidiasis
______ represents vascularized leukoplakia and is highly
suggestive of squamous cell dysplasia.
Erythroplakia (red plaque)
Infection resulting in bilateral inflamed parotid glands. Orchitis, pancreatitis, and aseptic meningitis may also be present.
- Serum amylase is increased due to salivary gland or pancreatic involvement.
- Orchitis carries risk of sterility, especially in teenagers.
MUMPS
Inflammation of the salivary gland. Most commonly due to an obstructing stone (sialolithiasis) leading to Staphylococcus aureus infection; usually unilateral
SIALADENITIS
Benign tumor composed of stromal (e.g., cartilage) and epithelial tissue; most common tumor of the salivary gland. Usually arises in parotid; presents as a mobile, painless, circumscribed mass at the angle of the jaw.
This tumor has high rate of recurrence; extension of small islands of tumor through tumor capsule often leads to incomplete resection.
PLEOMORPHIC ADENOMA
Rarely may transform into carcinoma, which presents with signs of facial nerve damage (facial nerve runs through parotid gland)
Benign cystic tumor with abundant lymphocytes and germinal centers (lymph node-like stroma); 2nd most common tumor of the salivary gland.
This tumor almost always arises in the parotid
WARTHIN TUMOR
Malignant tumor composed of mucinous and squamous cells; most common malignant tumor of the salivary gland.
Usually arises in the parotid; commonly involves the facial nerve.
MUCOEPIDERMOID CARCINOMA
A 6-year-old boy presents with painful sores on his upper
lip. He was seen for a fl u 1 week ago. The lesion appears as 0.2- to 0.4-cm vesicles with focal ulceration. Which of the following is the most likely histologic feature of this skin lesion?
(A) Acute arteritis
(B) Caseating granulomas
(C) Fungal hyphae
(D) Multinucleated epithelial cells
(E) Noncaseating granulomas
The answer is D: Multinucleated epithelial cells. Herpes labialis (cold sores, fever blisters) and herpetic stomatitis are caused by herpes virus type 1. Microscopically, the herpetic vesicle forms as a result of “ballooning degeneration” of the epithelial cells. Some epithelial cells show intranuclear inclusion bodies. At the edge of the ulcer are large, multinucleated, epithelial cells with “ground glass” homogenized nuclei, often exhibiting nuclear molding. The ulcers heal spontaneously without scar formation.
A 40-year-old woman is hospitalized because of a massive neck infection that developed over a period of 3 days after extraction of an impacted wisdom tooth. She has a high fever, and her lower jaw and entire neck are swollen, red, and painful. Throat culture reveals a mixed bacterial fl ora, containing both aerobic and anaerobic microorganisms. Which of the following is the most likely diagnosis?
(A) Actinomycosis
(B) Acute necrotizing ulcerative gingivitis
(C) Ludwig angina
(D) Pyogenic granuloma
(E) Scarlet fever
Ludwig angina is a rapidly spreading cellulitis, or phlegmon, which originates in the submaxillary or sublingual space but extends locally to involve both. The bacteria responsible for this infection originate from the oral flora. After extraction of a tooth, hairline fractures may occur in the lingual cortex of the mandible, providing microorganisms ready access to the submaxillary space. By following the fascial planes, the infection may dissect into the parapharyngeal space and, from there, into the carotid sheath. Actinomycosis (choice A) features branched, filamentous bacteria. Acute necrotizing ulcerative gingivitis (Vincent angina, choice B) does not extend to the neck. Pyogenic granuloma (choice D) is a focal, reactive vascular lesion.
A 16-year-old girl presents with a sore throat of 4 months in duration. She describes feeling a lump in her throat. Physical examination reveals a 1-cm cystic lesion at the base of the tongue. This developmental lesion most likely arises as a remnant of which of the following anatomic structures? (A) Auditory tube (B) Branchial arches (C) Facial fusion lines (D) Rudimentary thymus (E) Thyroglossal duct
The answer is E: Thyroglossal duct. During its normal development, the thyroid gland descends from the base of the tongue to its final position in the neck. Heterotopic functioning thyroid tissue or a developmental cyst (thyroglossal duct cyst) may occur anywhere along the path of descent. The most common location is at the foramen cecum of the tongue. Symptoms such as dysphonia, sore throat, and awareness of a mass in the throat often become evident during adolescence and pregnancy. The other choices do not present in this anatomic location. In particular, branched cleft cysts that originate from remnants of the branchial arches (choice B) occur in the lateral anterior aspect of the neck or in the parotid gland.
A 2-year-old girl was withdrawn from a day care center for excessive irritability. On physical examination, she has multiple, small superfi cial ulcers of the oral mucosa. The ulcerations heal spontaneously over the next 5 days. Which of the following is the most likely diagnosis? (A) Aphthous stomatitis (B) Candidiasis (C) Gingivitis (D) Ludwig angina (E) Pyogenic granuloma
Aphthous stomatitis describes a common disease that is characterized by painful, recurrent, solitary or multiple, small ulcers of the oral mucosa. The causative agent is unknown. Microscopically, the lesion consists of a shallow ulcer covered by a fibrinopurulent exudate. Candidiasis (choice B) features white plaques.
A 6-year-old boy presents with a painful sore in his mouth. Physical examination reveals a small, elevated, and focally ulcerated red-purple gingival lesion. A soft red mass measuring 1 cm in diameter is surgically removed. Histologic examination discloses highly vascular granulation tissue, with marked acute and chronic inflammation. What is the most likely diagnosis? (A) Acute necrotizing gingivitis (B) Aphthous stomatitis (C) Herpes labialis (D) Pyogenic granuloma (E) Tuberculosis
Pyogenic granuloma is a reactive vascular lesion that commonly occurs in the oral cavity. Usually some minor trauma to the tissues permits invasion of nonspecific microorganisms. In the oral cavity, pyogenic granulomas, ranging from a few millimeters to a centimeter, are most frequent on the gingiva. The lesion is seen as an elevated, red or purple, soft mass, with a smooth, lobulated, ulcerated surface. Microscopically, the nodule consists of highly vascular granulation tissue that shows varying degrees of acute and chronic inflammation. With time, pyogenic granuloma becomes less vascular and comes to resemble a fibroma. Choices A, B, and C are ulcerating lesions. Tuberculosis (choice E) features granulomatous inflammation.
A 60-year-old man, who is a chronic alcoholic, is referred
by a homeless shelter for facial ulcers. On physical examination, there are large ulcerations in the mouth and facial tissues with focal exposure of bone. A culture grows Borrelia vincentii. Which of the following is the most likely diagnosis?
(A) Acute necrotizing ulcerative gingivitis
(B) Apical granuloma
(C) Ludwig angina
(D) Periodontitis
(E) Pyogenic granuloma
Acute necrotizing ulcerative gingivitis (Vincent angina) represents an infection by two symbiotic organisms; one is a fusiform bacillus, and the other is a spirochete (B. vincentii). The fact that these organisms are found in the mouths of many healthy persons suggests that predisposing factors are important in the development of acute necrotizing ulcerative gingivitis. The most important element appears to be decreased resistance to infection as a result of inadequate nutrition, immunodefi ciency, or poor oral hygiene. Vincent infection is characterized by punched-out erosions of the interdental papillae. The ulceration tends to spread and eventually to involve all gingival margins, which become covered by a necrotic pseudomembrane.
A 4-year-old boy from Uganda presents for pre-school physical examination. His parents indicate that hearing loss in his right ear developed 3 years ago following an acute illness. If this child’s hearing loss was caused by a viral infection, which of the following was the most likely etiology? (A) Chickenpox (B) Epstein-Barr virus (C) Mumps (D) Rubella (E) Yellow fever
Mumps is the most common cause of deafness among the postnatal viral infections. The infection can cause rapid hearing loss, which is unilateral in 80% of cases. By contrast, prenatal infection of the labyrinth with rubella (choice D) is usually bilateral, with permanent loss of cochlear and vestibular function.
A 64-year-old man presents with sores on the gums. Oral
examination shows multiple, gingival abscesses adjacent to the teeth and excessive mobility of several teeth. Which of the following is the most likely diagnosis?
(A) Dental caries
(B) Hyperparathyroidism
(C) Osteitis deformans
(D) Periapical granuloma
(E) Periodontal disease
Periodontal disease refers to acute and chronic disorders of the soft tissues surrounding the teeth, which eventually lead to the loss of supporting bone. Chronic periodontal disease typically occurs in adults, particularly in persons with poor oral hygiene. However, many persons with apparently impeccable habits, but a strong family history of periodontal disease, manifest the disorder.
An 8-year-old boy presents with a 3-day history of fever and sore throat. His temperature is 38°C (101°F), pulse is 88 per minute, and respirations are 33 per minute. On physical examination, the tonsils are enlarged, boggy, and coated with a purulent exudate. A tonsillar swab is most likely to grow which of the following microorganisms? (A) Staphylococcus aureus (B) Staphylococcus epidermidis (C) Streptococcus pneumoniae (D) Streptococcus pyogenes (E) Streptococcus viridans
Streptococcus pyogenes. Acute tonsillitis may be caused by bacterial or viral infections. Streptococcus pyogenes (group A b-hemolytic streptococci, choice D) is the most common etiologic agent in acute suppurative tonsillitis.
Diagnosis: Tonsillitis, acute
A 70-year-old woman complains of gradual hearing loss.
Which of the following conditions is the most likely cause of conducting hearing loss in this patient?
(A) Acoustic trauma
(B) Chronic otitis media
(C) Labyrinthine toxicity
(D) Mastoiditis
(E) Otosclerosis
Otosclerosis refers to the formation of new spongy bone about the stapes and the oval window, which results in progressive deafness. This condition is an autosomal dominant hereditary defect and is the most common cause of conductive hearing loss in young and middle-aged adults in the United States
19 A 24-year-old man presents with right ear pain that he has had for 3 days. He recently returned from a scuba diving trip to the Caribbean. The patient is afebrile. Otoscopic examination reveals a bulging, right tympanic membrane. What is the most likely diagnosis? (A) Acute mastoiditis (B) Acute rhinitis (C) Acute serous otitis media (D) Acute sinusitis (E) Acute suppurative otitis media
Acute serous otitis media. Obstruction of the eustachian tube may result from sudden changes in atmospheric pressure (e.g., during flying in an aircraft or deep sea diving). This effect is particularly severe in the presence of an upper respiratory tract infection, an acute allergic reaction, or viral or bacterial infection at the orifice of the eustachian tube. Inflammation may also occur without bacterial invasion of the middle ear. More than half of children in the United States have had at least one episode of serous otitis media before their third birthday. It has become increasingly evident that repeated bouts of otitis media in early childhood often contribute to unsuspected hearing loss, which is due to residual (usually sterile) fluid in the middle ear.
A 34-year-old man complains of hearing loss. He has had multiple bouts of ear infections over the last 20 years and was recently diagnosed with chronic suppurative otitis media. Which of the following is the most likely complication of this condition in this patient? (A) Acoustic neuroma (B) Cholesteatoma (C) Chronic rhinitis (D) Chronic sinusitis (E) Squamous cell carcinoma
Cholesteatoma is a complication of chronic suppurative otitis and a rupture of the eardrum. Cholesteatoma is a mass of accumulated keratin and squamous mucosa that results from the growth of squamous epithelium from the external ear canal through the perforated eardrum into the middle ear. Microscopically, cholesteatomas are identical to epidermal inclusion cysts and are surrounded by granulation tissue and fibrosis. The keratin mass frequently becomes infected and shields the bacteria from antibiotics
Characteristics of Viral encephalitis include which of the following?
Perivascular cuffing
Neuronphagia
Abcesses
Glial nodules
Perivascular cuffing
Neuronphagia
Glial nodules
Which lobe of the brain would a herpes simplex virus infection causing encephalitis affect?
Adults have Temporal lobes that are affected and become swollen, hemorrhagic and necrotic
Children have general impact to cerebrum
Cowdry A intranuclear inclusions are most commonly found in what encephalitis causing disease?
Herpes simplex-1 infection causing encephalitis
Most cases of herpetic viral meningitis is caused by which type of herpes virus?
HSV-2
most cases of meningitis, not necessarily encephalitis
What is the name of the classic inclusion body seen in rabies?
Negri bodies in cytoplasm
These are small bullet-shaped eosinophilic cytoplasmic viral inclusion bodies seen in the hippocampus, brainstem, and cerebellar purkinje cells that will confirm a rabies diagnosis
Gial nodules with multinucleated giant cells in a perivascular location are characteristic of which type of encephalitis?
HIV encephalitis which is thought to be caused by monocytes carrying the infection into the CNS (trojan horse)
Remember, in general, viruses can cause glial nodules
Viral encephalitis caused bt the JC polyomavirus is called what? What type of cell does it preferentially infect?
Progressive multifocal lukoencephalopathy
Preferentially infects oligodendrocytes, therefore demyelination is its principal pathological effect
Disease occurs in immunosuppressed individuals
If you see a viral infection causing demyelination, what may be the dx?
progressive multifocal leukoencephalopathy
With fungal meningoencephalitis, which fungal infections are associated with vasculitis?
Mucor and aspergillus
Penetrate through vessel wall and cause inflammation
You really don’t see fungal brain infections unless immunocompromised
With fungal meningoencephalitis, which fungal infections are associated with brain invasion?
candida and cryptococcus (soap-bubble abscesses)
You really don’t see fungal brain infections unless immunocompromised
What fungal infection is commonly seen in people with poorly controlled diabetics?
mucor (mucormycosis)
You really don’t see fungal brain infections unless immunocompromised
The vast majority of adult/child tumors are supratentorial
Adult tumors are mostly supratentorial
A majority (though not vast majority) of child tumors are infratentorial, mostly cerebellum
Name this CNS tumor:
Malignant, high-grade tumor of astrocytes
Glioblastoma multiforme (GBM)
Name this CNS tumor:
The most common primary malignant CNS tumor in adults
Glioblastoma multiforme (GBM)
Name this CNS tumor:
Usually arises in the cerebral hemisphere and characteristically crosses the corpus callosum (butterfly lesion)
Glioblastoma multiforme (GBM)
Name this CNS tumor:
Characterized by regions of necrosis surrounded by tumor cells in a pseudopalisading manner with endothelial cell (Vascular) proliferation
Glioblastoma multiforme (GBM)
Name this CNS tumor:
Ring enhancing around a central area of necrosis
Glioblastoma multiforme (GBM)
How does IDH (isocitrate dehydrogenase) status predict prognosis for glioblastoma?
IDH mutation have increased survival and better prognosis compared to IDH wild-type
Younger patients are more likely to be IDH mutants than older patients
How does MGMT promoter methylation status predict prognosis for glioblastoma?
MGMT promoter methylation status is associated with a better response to chemotherapy with increased survival
Name this CNS tumor:
Benign tumor of arachnoid cells and the most common benign CNS tumor in adults
Meningioma
More commonly seen in women than men
Name this CNS tumor:
Imaging reveals a round mass attached to the dura.
Histology shows a whorled pattern
Meningioma
Name this CNS tumor:
Benign tumor of schwaan cells and involves CNVIII most frequently
Schwannoma
Tumor cells are S-100 positive
Name this CNS tumor:
malignant tumor of ologodendrocytes
oligodendroglioma
Name this CNS tumor:
Imaging reveals a calcified tumor in the white matter, usually involving frontal lobe and will have a “fried egg” appearance of cells on biopsy
oligodendroglioma
The fried egg appearance is also known as perinuclear halos
Name this CNS tumor:
Benign tumor of astrocytes
The most common CNS tumor in children
Pilocytic astrocytoma
Usually arises in the cerebellum, which is infratentorial
Name this CNS tumor:
Imaging reveals a cystic lesion with a mural nodule.
Biopsy shows Rosenthal fibers and eosinophilic granular bodies
Pilocytic astrocytoma
Rosenthal fibers are thick eosinophilic processes of astrocytes
GFAP postitive
Name this CNS tumor:
Malignant tumor derived from granular cells of the cerebellum (neuroectoderm), usually arises in children
Medulloblastoma
Name this CNS tumor:
Histology revelas small, round blue cells; Homer-Wright rosettes may be present
Poor prognosis; tumor grows and spreads rapidly via CSF
Medulloblastoma
Metastasis to the cauda equina is termed “drop metastasis”
Radiosensitive
Name this CNS tumor:
Malignant tumor of ependymal cells; usually seen in children
Most commonly arises in 4th ventricle and my present in hydrocephalus
Perivascular pseudorosettes on biopsy
Ependymoma
Name this CNS tumor:
Tumor that arises from the epithelial remnants of Rathke’s pouch, presenting as a supratentorial mass in a child or young adult
Craniopharyngioma
Name this CNS tumor:
May compress the optic chaism leading to bitemporal hemianopsia
Craniopharyngioma
Calcifications are commonly seen on imaging
Name this CNS tumor:
Often observed in patients with long term epilepsy, tumor not always obvious on imaging
Ganglioglioma: neoplastic, mature ganglion cells with neoplastic glial cells
Gangliocytoma: Neoplastic mature ganglion cells
Not all seizure foci are due to gangliogliomas
Immunosuppressed patients (e.g. recent organ transplant, HIV, MS) are at an increased risk for what type of CNS tumor?
Primary CNS lymphoma (B-cell most often)
Blood vessels surrounded by neoplastic cells…marked perivascular lymphocytic cuffing
Name this CNS tumor:
Dural neoplasm with a dural tail seen on imaging.
Lower grade has female skew, express progesterone receptor (in both genders) and meningiomas grow during preganacy
Meningioma
Radiation is a risk factor
What is the hereditary condition most commonly associated with bilateral schwannomas,
Neurofibromatosis Type 2 (NF-2)
An EEG with spike waves is pathognomonic for what neurodegenerative disease?`
Spongiform Encephalopathy due to prion proteins
Creutzfeldt-Jacob disease is the most common and patients present with rapidly progressive dementia associated with ataxia
Degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia, along with characteristic involuntary movements of all parts of the body and deterioration of cognitive function is associated with what neurodegenerative disorder?
Huntington Disease
autosomal dominant-Expansion of a trinucleotide repeat
Presents wit chorea that can progress to dementia and depression
Suicide is a common cause of death
_________ is a degenerative disorder of the cerebellum and spinal cord and is often associate with the development of cardiomyopathy
Friedreich Ataxia
Often seen with combined ataxia of both upper and lower limbs
Fracture to the temporal bone with a rupture of the middle meningeal artery; bleeding separates the dura from the skull and produces a lens shaped lesion on CT
Epidural hematoma-collection of blood between dura and skull (where MMA is located)
a lucid interval may precede neurologic signs
Due to a tearing of bridging veins that lie between dura and arachnoid and presents with a crescent-shaped lesion on CT. Increased rate of occurrence in elderly due to age-related cerebral atrophy which stretches the veins
Subdural hematoma
Presents with progressive neurologic signs
histology of brain tissue at autopsy shows spherical, eosinophilic inclusions in the cytoplasm composed of alpha-synuclein…what is the disease?
Parkinsons disease
describing lewy bodies that will be found in the substantia nigra
When deciding between viral and bacterial meningitis, which is more likely with neutrophils present in the CSF?
Neutrophils- go with bacterial
