Pathology Flashcards
What does VINDICATE stand for?
All problems must fit into one of these: Vascular Infectious/inflammatory Neoplastic Drugs/toxins Intervention/iatrogenic Congenital/developmental Autoimmune Trauma Endocrine/metabolic
Define hypertrophy
Increase in cell size e.g. muscle growth
Define hyperplasia
Increase in cell number e.g. BPH, thyroid, in response to a stimulus
Define dysplasia. Is it benign or malignant?
Presence of abnormal cell growth e.g. cervix, breast
Pre-malignant phase (not reached the basement membrane)
Define metaplasia
A reversible change from one mature cell type to another mature cell type in response to a stimulus
Define anaplasia
Poorly differentiated cells
Define neoplasia
Presence or formation of new, abnormal growth of tissue in the absence of a stimulus
There is a marked increase in cell number, large volume of glandular epithelium and low nucleus to cytoplasm ratio. What cell process is this?
Hyperplasia
Barret’s oesophagus is a metaplastic change. It represents the change from _______ epithelium to _____ epithelium.
Squamous cell epithelium
Columnar cell epithelium
What is Lynch syndrome?
Hereditary non-polyposis colorectal cancer (HNPCC) is a type of inherited cancer syndrome associated with a genetic predisposition to different cancer types, associated with mismatch repair and microsatellite instability
List clinical features pointing to a diagnosis of Lynch syndrome
Family history of endometrial cancer, colorectal cancer (usually right-sided) and bladder cancer
A post-menopausal women with a low BMI is likely to have endometrial hyperplasia. True/False?
False
She has low oestrogen which is a stimulus for endometrial hyperplasia
List risk factors for endomerial cancer
Age
Obesity
Exposure to unopposed oestrogen (early menarche, late menopause, low pariety, PCOS, HRT)
Lynch syndrome
23 year old female with heavy periods, occasional IMB with non-specific pelvic pain. Histology confirms a leimyoma. They are an example of a metaplastic/dysplastic/neoplastic change
Leiomyomas are an example of a neoplastic change.
Leiomyomas can become malignant. True/False?
True (but rarely)
Leimyomas can change into leimyosarcomas in 0.1% of case
24 year old female with post-coital bleeding. Smokes 30 a day and drinks regularly at weekends. What is CGIN?
Cervical glandular intra-epithelial neoplasia, a high-grade glandular abnormality
CIN 1 is a ___ grade squamous abnormality
CIN 1 is a low grade squamous abnormality
CIN 3 is a ___ grade squamous abnormality
CIN 3 is a high grade squamous abnormality
What is dyskaryosis?
Change of appearance in cells that cover the surface of the cervix
Outline the management of severe dykaryosis
Colposcopy
LLETZ (loop diathermy)
What is koilocyte?
A squamous epithelial cell that has been infected by HPV
How are CIN 1-3 classified?
Invasion of the basement membrane
CIN1 (basal third of epithelium), to CIN3 (full thickness invasion)
27 year old underwent appendectomy where an incidental ovarian cyst was identified, which was removed. What is the likely diagnosis?
An epithelial lesion
List types of ovarian tumours
Epithelial (mucinous, serous, endometriod, clear cell, transitional cell) Germ cell (dysgerminoma, teratoma, yolk sac, embryonal, yolk sac, choriocarcinoma) Sex cord/stromal (granulosa cell, fibroma, thecoma, leydig cell)
What is a trophoblastic tumour?
Germ cell tumour, known as a choriocarcinoma
A 39 year old female with spotting after insertion of an IUD. What type of inflammatory cell is most likely to be present?
Histiocyte (same as macrophage)
The uterus will shed and endometrial cells
State the tumour marker for choriocarcinoma
bHCG
State the tumour marker for yolk sac tumour
AFP
What is a complete mole?
Fertilisation of an empty ovum by a single sperm that undergoes duplication of chromosomes
What is a partial mole?
Two sperm fertilising a single ovum, forming a triploidy arrangement
What type of molar pregnancy is at risk of choriocarcinoma?
Complete molar pregnancy
57yo man with lump in left supraclavicular fossa. The lump is non-mobile, non-tender and feels irregular. He is a heavy smoker and has lost some weight. What is the most likely diagnosis?
Metastatic malignancy
The young are affected by neoplasms of…
Brain (medullablastoma)
Blood
Bone (osteosarcoma, Ewing’s sarcoma)
The old are affected by neoplasms of…
Carcinomas (derived from epithelium)
57yo man with lump in left supraclavicular fossa. The lump is non-mobile, non-tender and feels irregular. He is a heavy smoker and has lost some weight. What is the best management option for the GP?
Urgent referral to secondary care (ENT)
What is the lymphatic spread of colorectal carcinoma?
Lung
Liver
Brain
30yo man presents with a non-tender, irregular lump in the neck. He is a non-smoker and doesn’t drink. What is the likely diagnosis?
HPV associated malignancy
State the two most common causes of axilla metastases
Breast
Cutaneous (melanoma)
State the most common cause of paraortic metastases
Testes
State the most common cause of supraclavicular metastases
Gastric (Virchow’s node)
List cancers that metastases pretty much everywhere
Prostate
Small cell lung cancer
Melanoma
Biopsy of the lymph node shows poorly differentiated single cells, with a signet ring morphology and containing abundant intracytoplasmic mucin. What is the most likely histological diagnosis?
Adenocarcinoma
Signet cell carcinoma is a rare form of highly malignant adenocarcinoma that produces mucin (YING YANG SIGN)
What is a characteristic sign of melanoma on histological biopsy?
Brown staining
29 year old female with asymmetrical swelling in the mid-line of the neck. It is poorly circumscribed but moves on swallowing. Patient is otherwise aymptomatic. What is the most likely diagnosis?
Multinodular goitre
29 year old female with asymmetrical swelling in the mid-line of the neck. She has a multinodular goitre. Patient is otherwise aymptomatic. You do some blood tests. She has a high TSH, normal fT4 (low end), low haemoglobin, normal WCC. These results are consistent with?
Subclinical hypothyroidism
29 year old female with asymmetrical swelling in the mid-line of the neck, diagnosed as subclinical hypothyroidism, following blood tests. What is the next step in investigating the patient?
Ultrasound and fine needle aspirate as she has a neck lump
A FNA contains abundant colloid and scattered sheet and aggregates of thyroid follicular epithelial cells. Many of the cells exhibit oncocytic change. In the background abundant lymphocytes are present. What are the features in the report most likely to be describing?
Thyroiditis
What is the most common method of spread in follicular adenoma?
Haematological spread
What is the most common method of spread in papillary adenoma?
Lymphatic spread
What is meant by oncocytic change?
Abundant eosinophilic granular cytoplasm as a result of accumulation of altered mitochondria
List histological features of papillary thyroid carcinoma
Orphan annie nuclei (empty nuclei) Psammoma bodies (round calcified collection)
18 year old male presents with two day history of swelling in left lateral neck. It is soft and mildly tender. He has other small palpable masses on the contralateral side; What is the most likely pathological process?
Viral infection
18 year old male with two day history of swelling in the neck, presents two weeks later with a sore throat which has been getting worse and he now has difficulty swallowing. He is also jaundices and has some upper quadrant pain. What is the most likely diagnosis?
EBV virus causing glandular fever
List clinical features of CMV
Common in AIDS Fever Malaise Lymphadenopathy Diarrhoea Nausea and vomiting Visual floaters
An 18yo male with swelling in the neck is diagnosed with EBV virus. What would be the most appropriate management now?
Check EBV serology
FBC
Pen V
Advise rest
List clinical features of glandular fever
Fever Pharyngitis Cervical lymphadenopathy Abdominal pain (splenomegaly, hepatomegaly) Jaundice
What is the characteristic feature of infectious mononucleosis on biopsy?
Enlarged atypical lymphocytes
18 year old male with two day history of swelling in the neck, presents two weeks later with a sore throat which has been getting worse and he now has difficulty swallowing. He is also jaundices and has some upper quadrant pain. EBV testing comes back negative. What other important test should be done?
HIV (most important)
VDRL
Hep C serology
Hep B serology
Lymph node biospy contains numerous aggregates of epitheliod histiocytes many of which are forming granulomas. Areas of caseous necrosis are also present. What is the most likely diagnosis?
Mycobacterial infection (TB)
