pathology tutorial Flashcards
describe the specimen
- Upper is more pale, loss of sulci, more opaque – pathological
- Lower half is normal brain matter - arachnoid matar is transparent
- meningitis
- Photophobia and neck stiffness – menigism (inflammation of meninges)
- Bacterial because exudate in subarachnoid space = the opacity
- exudate - neutrophils, necrotic cells, bacteria, fibrin
Ix for bacterial menigitis
- LP
- Leukocytes
- Acute inflammation – neutrophils and polymorphs
- Low glucose and high protein in bacterial menigitis.
- Sometimes see bacterial organisms
- Bloods
- raised WCC and CRP
- glucose, lactates.
- Cultures – identify organism and culture
Mx of bacterial menigitis
IV AB – Neisseria menigism, gp B streptococcus (strep pneumoniae) e coli less common
Microscopy of meningitis
neutrophils in the subarachnoid space
describe the specimen
Coronal Section of the brain showing a lesion
Lesion – well circumscribed, unencapsulated lesion, homogenous, no haemorrhage or necrosis.
Signs of benign.
Dx – meningioma of the brain – most common benign lesion of the brain.
most common malignant CNS tumour
glioblastoma
Ix for brain tumour
MRI or CT
MRI - see midline shift
Mx of meningioma
Surgical excision – slow growing might not cause severe sx so treat conservatively. If severe sx – surgery/radiotherapy
Conservative – watch and wait and monitor regularly with CT and change in sx/pressure effects.
Even if benign can be lethal because of the pressure sx
ddx
- Cancer
- Anaemia secondary to blood loss
- IBD
- Diverticulitis
- Haemorrhoids
But age and red flag – want to think colorectal ca
things o/e for colorectal ca
Palpate mass
Signs of anaemia
Virchows node
Low blood pressure and tachycardia from blood loss
DRE – see if blood and if you can feel a mass
what would you see on proctoscopy and biopsy
adenocarcinoma
or adenoma (benign polyp)
describe the specimen
Section of the colon
Transmural, luminal lesion
Circumferential = stenosis
Napkin ring lesion – cause narrowing of lumen and change in bowel
Irregular edge,
Looks malignant
sx and signs of colorectal adenocarcinoma
Obstruction – depend on how prox
- Distal – bowel and constipation
Bleeding
- ascending = anaemia fatigue, pallor, breathless.
- Rectum = blood in stool – haematochezia
Systemic sx – loss of weight
grading of colorectal carcinoma
well differentiated = well formed glands.
Poor = less are glandforming and just have solid sheets of cells
describe the specimen
Can see multiple large, pale, well circumscribed lesions. Centre is necrotic – soft and cheesy. High met load.
Wont be a candidate for curative treatment – need to include onchologists and see if palliative chemo
If one or 2 mets – metastasectomy
describe the specimen
Very red and haemorrhagic
Polypoid, raised
Lobulated but smooth
Doesn’t look like invading wall – could be pedunculated with stalk
Adenoma – benign polyp that is dysplastic
Have malignant progression if get larger
Very common
sx and sign of polup
Signs of obstruction
Blood in stool
Intusseption
No sx – 5-10mm
what is seen on this colonoscopy
Small polyp
Diverticulae in the bag
Tubular adenoma – benign polyp. Glands form test tube shape structures histopathologically.
ddx
Most sig sx – weight loss. Red flag. Malabsorption.
Ddx
- UC
- Crohn’s
ddx of mass in RIF
Ovarian cyst
Incisional hernia – more middle age problem
Ectopic pregnancy – difficult to palpate, see tenderness rather than lesion
Fallopian tube pathology
Dilated caecum or ileum
Appendicular mass
Yellow arrow – stricture – caecum and ascending colon is very narrow – dye is hardly making way through. Lumen very narrow.
Confirm the dx of crohn’s disease
Small bowel – barium filling and distending the bowel
describe the specimen
Ulceration
Flattening of the bowel wall – cobblestone appearance, areas where there are no folds. Sudden outpouching
Holes is where the pathologist has taken samples
Irregular mucosal appearance
Skip lesions – area in between lesions that are relatively normal eg terminal ileum
Fistula would be small
differentiate crohn’s and UC
UC - rectosigmoid colon
UC – pseudopolyps – appear similar to polyposis – regenerating mucosa in between path area
crohns - thick bowel wall because of oedema and fibrosis -> stricture and obstruction
crohn’s - creeping fat adhere to the serosal surface
crohn’s - non-caseating granulomas
ddx
Ddx
- Diverticulitis – fever, LLQ (region of sigmoid colon)
Fever not normal in IBS, mean there is some inflammation
