pathology

Question 1

what is the type of mutation causes cholangiocarcinoma?

Answer 1

KRAS, BRAF, P53

Question 2

why extrahepatic cholangiocarcinoma has a better prognosis than intrahepatic?

Answer 2

because extrahepatic form jaundice which will appear early with other symptoms ut intrahepatic will. no cause symptoms until a large mass of the liver replaced by tumor

Question 3

which of the following routes of the spread of cholangiocarcinoma will spread to the abdomen?

Answer 3

by peribiliary nerve

Question 4

which of the following gall bladder tumors have a better prognosis and why?

Answer 4

papillary type because
1- it has less tendency to spread
2- formed of well-differentiated adenocarcinoma

Question 5

morphology of chronic cholecystitis?

Answer 5

1- contracted, thick, atrophied gall bladder 
2-cholestrolosis 
3- porcelain gall bladder 
4- aschoff - rokitansky sinusis 
5- xanthogranulumatous cholecystitis

Question 6

what are the associations of carcinoid tumor?

Answer 6

1- endocrine cell hyperplasia
2- chronic atrophic gastritis
3- ZE syndrome
4- MEN syndrome

Question 7

how carcinoid tumor can lead to bowel obstruction?

Answer 7

1- metastasis to the mesentery 
2- release vasoactive material  
3- stimulation of fibroblast and collagen 
4- desmoplastic reaction 
5-kinking 
6-obstriction

Question 8

that characteristic histochemical stains found in the carcinoid tumor is?

Answer 8

1- chromogranin A

2- synaptophysin

Question 9

characteristic morphology of carcinoid tumor?

Answer 9

sal and paper appearance

Question 10

what is the problem in Lynch syndrome?

Answer 10

defect in mismatched repair system (MSH2 , MLH1)

Question 11

What are the genetic mutations in colonic adenocarcinoma?

Answer 11

1- APC gene 
2- DNA mismatch repair system 
3- KRAS and P53
4- reactivation of telomerase
5- SMAD mutation

Question 12

numerate the pediatrics childhood lymphoma?

Answer 12

1- HL

2-NHL (lymphoblastoma , follicular, Burkitt’s, DLBCL, Anaplastic T cell)

Question 13

what are the complications of a patient with long-term HL treated with chemotherapy and radiotherapy?

Answer 13

1- development of 2nd hematologic cancer

2- solid cancers (lung, skin, stomach, breast, soft tissue

Question 14

what are the non-neoplastic complication of radiotherapy

Answer 14

1- pulmonary fibrosis

2- accelerated AS

Question 15

when do the fibrous septa in liver cirrhosis will be reversible or irreversible?

Answer 15

it will be reversible if the underlying disease is treated

irreversible if the underlying disease no treated or treated but associated with vascular shunt

Question 16

discuss the “ductular reactions” found in the periphery of most of the cirrhotic nodules?

Answer 16

source: stem cells adjacent to bile ductules and canal of herrings
mechanism:
when parenchyma meets damaged stroma
proliferation of endothelial cells and the presence of myofibroblast and inflammatory cells

Question 17

mention the 3 causes of Portal hypertension in cirrhosis

Answer 17

1/ fast flowing, narrow vascular channel
2/ shunt btw portal and hepatic artery
3/ hepatic nodules that compress the sinusoid => ↑the resistance.

Question 18

which of the following liver tumers maybe associated with fibropolycystic liver disease ?

Answer 18

when multiple von myenburg complexes present

Question 19

which of the following liver tumor have no risk of malignancy ?

Answer 19

focal nodular hyperplasia

Question 20

what are the clinical significance of hepatic adenoma?

Answer 20

1- may be mistaken by sever HCC
2- maybe rupture in pregnant women causing intraabdominal hemorrhage
3- may lead to HCC if b-catenin mutation involved

Question 21

write the microscopic picture of hepatic adenoma?

Answer 21

1- hepatocyte resemble the normal with few variations
2- absent portal tracts
3- prominent hepatic veins and arteries

Question 22

what are the microscopical features of nodular dysplasia in HCC?

Answer 22

1- large size
2- dysplastic hepatocyte
3- contain overly malignant submodules

Question 23

mention the etiologies associated with HCC?

Answer 23

1- HBV (Asian countries)
2- HCV (japan, central europ, western)
3- aflatoxin exposure 
4- alcoholic cirrhosis
5- NAFLD 
6- hemochromatosis 
7- alpha 1 antitrypsin deficiency, and tyrosinemia

Question 24

explain how aflatoxin comes and causes HCC?

Answer 24

fungus aspergillus => aflatoxins => bind covalently to cellular DNA => gene mutation as P53, found in moldy grains and peanuts

Question 25

what are the main 3 causes of hepatic adenoma?

Answer 25

1- biallelic inactivation
2- gain of function mutation
3- inflammation

Question 26

what are the prucesure lesions for HCC

Answer 26

1- hepatic adenoma (b-catenin)
2- chronic liver disease (cellular dysplasia + nodular dysplasia)
3- liver cirhosis

Question 27

write the gross picture of HCC

Answer 27

- patterns
1- unifocal 
2- multifocal 
3- diffuse
color
- white - yellow, some bile stain, may hemorrhage and necrosis
risks
 - may metastasize to the heart by vascular invasion invading portal vein to IVC => reaching the right heart.

Question 28

pseudocanaliculi present in which of the following diseases?

Answer 28

HCC

Question 29

explain why alpha-fetoprotein is not diagnostic in HCC?

Answer 29

• only useful in advanced cases in 50% of patients
• because it may be mistaken with yolk sac tumor, normal pregnancy, liver cirrhosis, massive liver disease, or chronic hepatitis

Question 30

how can we don the Clinical assessment of chronic hepatitis ?

Answer 30

by clinical data, serologic data, and histologic data :
1- grading: the degree of inflammation, and extent of hepatocyte injury
2- staging: progression of scarring

Question 31

what re the clinical feature of autoimmune hepatitis?

Answer 31

1- predominance in female
2- the absence of viral evidence
3- high IgG
4- the presence of other autoimmune diseases

Question 32

what are the genetic associations of autoimmune hepatitis?

Answer 32

HLADR3, HLADR4

Question 33

numerate the pathological classification of granulomatous diseases?

Answer 33

1- granuloma with cassation: TB
2-granuloma without cassation: IBD, BILH, sarcoidosis
3- suppurative granuloma: cat scratch, lymphogranuloma
4- foreign body granuloma: thread and silicone implant

Question 34

what is the microscopic picture of bilharzial granuloma?

Answer 34

1- ova in the center
2- epithelioid cell
3- multinucleated giant cell 
4- eosinophils 
5- lymphocytes

Question 35

discuss the fate of primary biliary cirrhosis

Answer 35

1- Patients develop prominent H.T, and nodular regenerative hyperplasia (nodularity with no scar)
2- Patient develop duct loss leading to cirrhosis and profound cholestasis (periportal/periseptal, associated with degeneration, marked by ballooned bile stained hepatocyte with Mallory denk bodies).