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AP RCPA VIVA > Random Lists of Common Questions > Flashcards

Random Lists of Common Questions Flashcards

1
Q

Viruses that Cause Cancer

A

HPV - SCC of anogenital tract, cervical adenocarcinoma oropharyngeal SCC, sinonasal HPV-related multiphenotypic carcinoma

HHV8 - Kaposi sarcoma, Primary effusion lymphoma

EBV - NPC, HL, BL, gastric carcinoma

Hep B / C - HCC

Merkle cell polyomavirus - Merkel cell carcinoma

HTLV-1 - adult T cell lymphoma / leukaemia

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2
Q

Sarcomas that Metastasise to Lymph Nodes

A

SCARE

Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma

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3
Q

Common Tumours that Metastasise to Bone

A

Breast
Lung
Thyroid
Kidney
Prostate

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4
Q

Tumours with Plasmacytoid Morphology

A

Plasma cell neoplasms (!) - myeloma, LPL

Lobular breast, diffuse gastric and urothelial (plasmacytoid variant)

Myoepithelial
Mesothelial
Melanoma
Osteoblastic

Rhabdoid tumours - INI1 / BRG1 lost

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5
Q

Subtypes of Amyloid

A

Amyloidosis refers to a heterogenous group of disorders characterised by extracellular deposition of non branching linear fibrils.

AL: Ig LC / Ig HC - plasma cell neoplasms

AA: Chronic infection or inflammation (e.g. autoimmune)
: Familial hereditary fever syndromes

ATTR: Hereditary or mutation associated
Non familial mutation form

B2 microglobulin: haemodialysis

A-Beta: Alzheimers disease, aging

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6
Q

Benefits of Synoptic Reporting

A

1) Standardised report that captures all the essential information required to stage, prognosticate and manage a patient. Acts as a checklist to remind pathologist of required elements and includes explanatory notes if needed.
2) Allows clear communication to the clinician / MDM.
3) Improved data capture for Cancer Registries etc. Data can used be re-purposed for cancer research & for population based research.
4) Evidence that structured reporting improves the quality of the pathology report and subsequently the delivery of adjuvant therapy and patient outcomes.

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7
Q

Define Quality Control and Quality Assurance

A

Quality Control (QC) refers to activities lab engages in to ensure that tests are working correctly and results are of high and reproducible standard. Aim = right test, for the right result, on the right patient, reported to the right doctor at the right time

External Quality Assurance/Assessment (EQA) aims to ensure that all laboratories testing the same sample will give the same result

Internal Quality Assurance (IQA) which monitors performance, drives improvement and supports collaborative on-going professional practice

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8
Q

Who are the ISO

A

International Organisation for Standardisation.

NGO. Integrated organisation composed of national standard bodies.

Lay down standards and protocols for laboratory practice (ISO 15189 for medical labs). Compliance with standards are assessed by IANZ and NPAAC.

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9
Q

Quality Control Measures at Cut up Bench

A

Cerebro system - QR codes and tracking of specimens

Correlation with clinical details and imaging

Checking three points of ID

One specimen on bench at a time

Alternate specimen types and use rotating system of biopsy inks for biopsy transfers

Rinsing instruments and cleaning board between specimens

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10
Q

Explain role of p57 in molar pregnancy

A

Poor interobserver variability between CHM, PHM and hydropic abortus on histology alone. Can use p57 IPX and FISH to distinguish these.

Partial mole:
p57 positive (nuclear expression in at least 10% of villous stromal cells and cytotrophoblasts)
NB: p57 also positive in normal fetus / hydropic abortus
FISH shows triploidy in partial mole

Complete mole:
p57 negative
FISH shows diploidy (diandric)

P57 negative in CHM because p57 is a paternally imprinted, maternally expressed gene and complete moles are diandric (dispermy, empty ova)

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11
Q

How to troubleshoot unexpected negative IPX

A

Double check you’ve stained the right block…

Look at controls on slide - check correct antibody has been used and that external and internal controls are working as expected.

If controls working then repeat IPX on different block.

If controls look iffy then IPX may have failed for technical reason: failure of fixation, failure of antigen retrieval, uneven dispersal across slide. Discuss with scientist and attempt on different block or consider alternate test.

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12
Q

Interpret MMR / BRAF in GIT

A

Loss of MLH1 / PMS2

  • somatic promoter hypermethylation or
  • germline loss of MLH1 (Lynch)
  • > if BRAF positive, almost always due to promoter hypermethylation
  • > if in doubt can request MLH1 promoter hypermethylation studies

Isolated loss of PMS2
Loss of MSH2 / MSH6
= both usually associated with germline loss / Lynch

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13
Q

Why is p16 overexpressed in HSIL?

A

HR HPV (subtypes 16 / 18) integrate into host genome

Production of viral oncoprotein E7 which binds to RB causing it to degrade

Without RB acting as a brake on the cell cycle, the CDKN2A gene can continue to produce p16 protein

When overexpressed p16 causes downstream effects on cellular proliferation and increased cell survival

NB: E6 viral oncoprotien binds to p53 with similar downstream effects

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14
Q

How to Decontaminate Cryostat

A

1) Speak to scientists - OHS for staff (should wear N95 for FZ, fill in incident form). Inform OT may be delay in results if only one cryostat.

2) PPE

3) Crytostat preparation - turn off to allow to warm to room temperature. Reomve everything (blades, knives, tools, sectionning debris etc.) disassemble anything with multiple components. Use isopropyl alcohol to clean.

4) Chemical disinfection once at room temperature. Follow manufacturers instructions. Some cryostats have UV disinfection built in.

5) Dry, lubricate, reassemble and then turn back. Don’t reuse until back at cold temperature.

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15
Q

Reasons for Performing Frozen Section

A
  1. Assess whether a structure is present or absent e.g. parathyroid gland
  2. Assess whether adequate lesional tissue is present for further assessment e.g. soft tissue incision biopsies
  3. To triage tissue for other studies e.g. microbiology, flow cytometry, tumour banking
  4. To change intraoperative management e.g. margin status H&N cancers, breast sentinel nodes

OPTIONS: just macroscopic assessment (+ / - surgeon), imprint or smear, freeze tissue

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16
Q

Reasons for Discordant Frozen Section Results

A
  1. Clinical details missing / unavailable
  2. Specimen labelling error
  3. Gross sampling error
  4. Technical issues in performing frozen section
  5. Misinterpretation of the frozen section - overcall, undercall or misclassify
  6. Frozen section negative, permanent sections from block positive
17
Q

How to Stain a Frozen Section

A

Frozen sections are stained using a rapid H&E technique

Performed by scientists in lab but protocol on wall and stations clearly labelled with instructions if needed

  1. FIX with ethanol / methanol (30 secs)
  2. HAEMOTXYLIN (30 secs, rinse with water)
  3. HCL (10 secs, remove excess haemotoxylin)
  4. BLUE haematoxylin with AMMONIA (10 secs)
  5. EOSIN (15 secs)
  6. ETHANOL to clean slide then wash in XYLENE

Then coverslip slide.

18
Q

Purpose of MDM

A
  1. A forum for communication
    - allows all the pertinent data regarding a patients disease to be collated and discussed in order to make management decisions
    - allows opportunity for dicussion between clinicians, radiologist, pathologists etc regarding challenging or unclear aspects of a case
  2. Quality Tool
    - provide an opportunity for internal audit of cases and to identify and discrepant or discordant findings
19
Q

SRBCT’s in Adults

A

Lymphoma

Small cell NE carcinoma

Merkle cell carcinoma

Small cell melanoma

20
Q

SRBCT’s in Young Adults / Some Children

A

DSRCT

Synovial sarcoma, poorly differentiated

Olfactory neuroblastoma

Small cell osteosarcoma

Mesenchymal chondrosarcoma

High grade myxoid liposarcoma

21
Q

SRBCT’s in Children / Some Young Adults

A

Lymphoblastic lymphoma

Ewing sarcoma

CIC and BCOR rearranged sarcomas

Myeloid sarcoma

Neuroblastoma

Blastema predominant Wilms tumour

Alveolar RMS, solid variant

Medulloblastoma

Retinoblastoma

Hepatoblastoma, small cell variant

22
Q

Most Common Metastases to Brain

A

Lung

Breast

Melanoma

Renal cell carcinoma

Colon

Thyroid

23
Q

Critical Values in Anatomic Pathology

A

1) Cases with immediate clinical comsequences:

  • crescents in >50% of gloms in kidney biopsy
  • uterine contents without villi or trophoblast
  • fat in endometrial curette or endoscopic polypectomy from colon
  • malignancy in SVC obstruction
  • neoplasms causing paralysis
  • mesothelial cells in cardiac biopsy
  • (acute) transplant rejection

2) Infections

  • bacteria / fungi in CSF
  • bacteria in heart valve / bone marrow
  • invasive fungi in an immunocompromised patient
  • HSV in cervical smear in a pregnant women

3) Unexpected / discrepant findings

  • unexpected diagnosis of malignancy
  • significant disagreement between frozen or prelim FNA and final diagnosis
  • significant disagreement between original path and outside review
24
Q

Common Laboratory Hazards

A

Blood, infectious agents, sharps

Falls, trips, slips, ergonomic injury

Chemical hazards and spills

Fire hazards

Electrical hazards

25
Q

Biologic Hazards in the Laboratory

A

Blood borne illnesses:

Hep B, Hep C, Hep D, HIV

Immunisation where possible, handwashing, cover cuts, PPE

BBA / Incident form if exposed - OHS will test staff and source (with consent) at time of incident and in 3/12

Other Infectious Agents:

Prions, TB, Covid

PPE (N95), open in biosafety cabinet, fix for > 48 hours

26
Q

Name some Chemical Hazards in the Laboratory

A

Acetone – flammable liquid

Acetic acid – combustible liquid

Concentrated acids (hydrochloric, nitric, sulfuric) - corrosive

Concentrated bases (sodium hydroxide, ammonium hydroxide) - corrosive

Dyes such as auramine O, basic fuchsin and Congo red - carcinogenic

Toluene - neurotoxic and carcinogenic

Ethanol – flammable liquid

Xylene - toxic and flammable

Formaldehyde - irritant and carcinogenic

27
Q

What is Contained in the Safety Data Sheets for Chemicals

A

Identification of Substance

Hazard(s) Identification

Composition/Information on Ingredients

First-Aid Measures

Fire-Fighting Measures

Accidental Release Measures

Handling and Storage

Exposure Controls/Personal Protection

Physical and Chemical Properties

Stability and Reactivity

Toxicological Information

Non mandatory: Ecological Information, Disposal Considerations, Transport Information, Regulatory Information

28
Q

How To Manage a Formalin Spill or Exposure

A

1) Report the incident to the person in charge of the laboratory, alert others and assist anyone who is contaminated.
2) For large chemical spills, consult the appropriate SDS or product label for specific measures, e.g. for a flammable liquid this may include:

Avoid breathing vapors

Remove all sources of ignition

Evacuate the area immediately

3) Arrange for the safe cleanup of the chemical

Smaller spills may be absorbed with paper towels while wearing gloves and other PPE. Decontaminate the area and wash hands. Larger spills need formal spill kit with absorbent material.

4) If exposed to chemical:

For contact exposure, flush copiously with water and remove any contaminated clothing.

If the eyes or mucous membranes are involved, flush with water for at least 10 minutes

If severe burns are involved, apply cold wet cloths, gauze, or paper towels, and immediately seek medical attention.

29
Q

What to Include on Label for Chemicals that have been Decanted or Newly Prepared

A

Name of reagent

Reagent concentration

Initials of person who prepared the reagent

Date of preparation

Expiration date

Special storage requirements

30
Q

Difference Between a Fume Hood and a Biosafety Cabinet

A

(Chemical) Fume Hood:

Used for dangerous chemicals

Protects the user

No HEPA filter

Exhausets air outside the building

Biosafety Cabinet:

Used for infectious biologic agents

Protect the user, the environment and the material

Has a HEPA filter

Does not exhaust air outside (without decontamination)

31
Q

Advantages and Disadvantages of Smear versus Frozen

A

Smear / Imprint

Uses less tissue

Quicker

No frozen section artefacts

But…. no architecture, can’t give size (e.g. breast metastasis)

Frozen Section

Can see architecture and relationships of structures

Can give size of deposits and measure distances

But... uses up more tissue for FFPE and frozen artefacts

32
Q

Viral Inclusions

A

Nuclear inclusions are generally associated with DNA viruses (HSV, CMV, JC, BK, adenovirus)

CMV also has cytoplasmic speckles.

RNA viruses don’t usually have inclusions (except measles)

Nuclear inclusions fall into two morphologic categories:

Cowdry A: eosinophilic owls’eye e.g. CMV

Cowdry B: smudge cells with ground glass chromatin e.g. HSV

Other viral effects:

Koilocytes in HPV

Warthin-Finkeldey giant cells in measles

33
Q

How to Calculate Area of Field of View

A
  1. Take eye piece field number (22) and divide by objective magnification (40x) to give diameter of field of view (0.55mm)
  2. Take diameter, halve it and then use π r2 to calculate FOV. area e.g 0.55mm field diameter gives a FOV area of 0.237 mm2
  3. To convert mm2 to HPF: X mm2 divided by FOV area = HPF. e.g. 2mm2 divided by 0.237 = 8.4HPF
34
Q

Types of Rosettes

A

Homer Wright Rosettes

Fibrillary processes point to centre, but no true lumen or vessel

Pathognomonic for neuroblastic tumours

Perivascular Pseudorosettes

Fibrillary processes point to centre containing a vessel

Seen in ependymomas

Luminal Type Rosettes

Polarise around a central lumen which is formed by apical borders of cells, e.g NET’s and Flexner-Wintersteiner rosettes seen in RB

35
Q

How to See if Specimen (or Floater) matches a Patient

A

Barr bodies (if different genders…)

A, B, H blood group antigen IHC

MSI PCR to see if profile matches

HLA antigen testing

AP RCPA VIVA (14 decks)

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