Pathology of effusions and cytopathology Flashcards
CASE HISTORY
i) what are the 5Fs of abdominal distention?
ii) name three types of neoplasia assoc with swollen abdomen
iii) name two inflammatory causes
iv) which bacteria can cause it?
i) flatulence, faeces, foetus, fluid, fat
ii) ovarian, uterine, GI, pancreatic, peritoneum
iii) peritonitis and vasculitis
iv) mycobacteria
CLINICAL FEATURES
i) what are caput medusae?
ii) why do CM occur?
i) swollen veins in the abdominal wall
ii) collateral circulation needs to be established due to portal hypertension - blood not getting to liver so needs a different route to the venous circulation
HOMEOSTASIS OF FLUID IN LARGE BODY CAVITIES
i) name three spaces that contain fluid
ii) how many L per day are filtered out of the circulation? what % os reabsorbed?
iii) how much reaches the circulation as lymph fluid?
iv what does Qf equal? (filtration/reabsorption rate)
i) pleural space, abdominal space and pericardial space
ii) 20L per day are filtered out of the circulation - 90% is reabs
iii) 2L reaches circ as lymph fluid
iv) Qf = Peff (filtration pressure) x Kf (filtration coefficient)
PATHOPHYSIOLOGY OF FLUID - Qf = Peff x Kf
i) what is Peff? what two things affect it?
i) what is Kf? what two things affect it?
i) Peff (diff bet hydrostatic/blood pressure minus oncotic pressure)
- aff by change in hydrostatic pressure (BP) and change in oncotic pressure of blood (from albumin(
ii) Kf (permeability x exchange area)
- aff by change in perm of vessel (leakiness) and change in exchange area
SEROUS MEMBRANES
i) name four serous membranes
ii) what type of tissue makes up serous membranes? what type of cells are they lined by?
iii) why are they highly vascularised?
iv) can effusions be physiological?
i) pericardium, pleura, peritoneum and tunica vaginalis of testes
ii) made up of connective tissue lined by mesothelial cells
iii) highly vascularised as there is close proximity between the mesothelial layer and the blood
iv) effusions are always pathological
EFFUSIONS
i) how are the two types seperated?
ii) do transudates have high or low protein content? what two pressures are affected to produce one?
iii) do exudates have high or low protein content? what two changes produce them?
iv) which type of effusion is unfiltered? which is a plasma filtrate?
i) seperated by their protein content
ii) transudates have a low protein content
- changes in hydrostatic or oncotic pressure which no change in vasc permeability
- hydrostatic process therefore protein cant exit therefore low prot cont
iii) exudates have high protein content
- changes in vasc permeability or exchange area
- exit of both fluid and protein as the permeability of the vessel changes
iv) exudate are unfiltered and transudates are filtered
ASCITES
i) what is it aka?
ii) what three broad things can cause it?
iii) what is the most common cause of portal hypertension? what type of change occurs here?
iv) what change does hypoalbumuria cause? why does this cause ascites?
v) what two things does peritoneal disease cause? name two things that cause peritoneal diease
i) aka intra-abdominal effusion
ii) infection, portal hypertension and malignancy
iii) 80% of PH is caused by liver cirrhosis (blood cant get to liver)
- hydrostatic change
iv) hypoalbuminura causes oncotic changes
- decreased oncotic pressure in vascular system which causes fluid to move into the abdo cavity
v) peritoneal disease causes change in permeability and exchange area
- caused by malignancy, carcinomatosis, infection
WHAT IS THE CAUSE OF THE ASCITES?
i) what score is used to assess ascites? (serum albumin - ascites albumin)
ii) what does a score of >1.1 indicate?
iii) what does a score of <1.1 indicate?
i) Serum albumin ascites gradient (SAAG)
ii) >1.1 indicates cause is portal hypertension
iii) <1.1 - not portal hypertension (more likely to be malignancy, infection, inflam)
APPEARANCE OF ASPIRATE
i) what type of effusion will be pale yellow watery? name two things that can cause this
ii) what appearance will chylous effusion from thoracic duct obstruction cause?
iii) what colour will psydochylous effusion caused by cholesterol from TB/rheumatoid/old effusion
iv) what causes green aspirate?
v) name a type of cancer that causes gelatinous aspirate?
i) transudate from CCF/cirrhosis
ii) milky white/green
iii) milky green with silky sheen
iv) bile from biliary tract disease or ruptured bowel
v) mesothelioma (hyaluronic acid)
MESOTHELIAL CELLS
i) what is found on their cell surface?
ii) what do they form when grouped together?
iii) what features may they have which look malignant? (2)
iv) which feature will not be seen if there are malignant cells eg mesothelioma
v) name two things vacuoles may contain
i) microvili
ii) form windows when group together
iii) large nuclei and multi nucleated
iv) if malignant - wont have windows
v) glycogen, fat
OTHER CELLS FOUND IN ASPIRATE
i) which cells can be difficult to seperate from mesothelial cells and do not have windows between them?
ii) which cells most frequently occur in long standing effusions and are associated with obstructed circulation through LNs/TB/lymphoma
iii) which cells may be degenerated if there is infection present but well preserved if not?
iv) which cells are mostly found in the pleura and are stimulated by air (increased with repeated aspiration)
v) which cells can be found in lupus and produce effusions?
vi) which body is found in asbestosis?
i) macrophages
ii) lymphocytes
iii) neutrophils
iv) eosinophils
v) LE cells
vi) ferruginous body
FEATURES OF MALIGNANT CELLS
i) what can be checked for to see if its mesothelial?
ii) name three characteristics of adenocarcinoma cells
iii) in which organ may malignant cells be dispersed single cells but may form papillae/acinae?
iv) which organ may have papillary/acinar aggregates, tall columnar cells and nuclear palisading
i) are there windows
ii) proliferation spheres, intracytoplasmic lumina that may dilate to look like signet ring, microvilli, mucin
iii) stomach
iv) colorectum
MALIGNANT MESOTHELIOMA
i) which type rarely causes effusions?
ii) what type of tumour are many asbestos related tumours that are not mesothelioma?
iii) name three features of mesothelioma that allow it to be differentiated from the histological subtype above?
i) sarcomatous rarely causes effusion
ii) many asbestos related tumours are adenocarcinomas
iii) mesothelioma has diffuse nodular pleural thickening, often unilateral (adeno is bilateral), thicking of fissues (adeno has intra parenchymal nodules)
IMMUNOHISTOCHEMISTRY
i) what needs to be done to cells to allow IHC to be done?
ii) what does IHC allow in relation to an aspirate
iii) name a positive marker found in adenocarcinoma?
i) need to do cytospin (compress into a pellet)
ii) IHC allows diganosis
iii) adenocarcinoma is positive for AE1/3, cytokeratin
FINE NEEDLE ASPIRATION
i) name three pros for the patient
ii) name three pros for clinical management
iii) name three pros for the pathologist
i) minimal pain/post procedure discomfort, minimal anaesthesia req, outpatient procedure
ii) easily repeated allowing sampling of several areas, confirms malignancy but leaves lesion in tact, therapeutic for cysts, quick feedback
iii) equipment simple and cheap, good cell preservation due to rapid fixation, fresh tissue for microbiol/genetic analysis
