Random Lists of Common Questions Flashcards by Linda Leys

Viruses that Cause Cancer

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

How well did you know this?

Not at all

Perfectly

Sarcomas that Metastasise to Lymph Nodes

SCARE

Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma

How well did you know this?

Not at all

Perfectly

Common Tumours that Metastasise to Bone

Breast
Lung
Thyroid
Kidney
Prostate

How well did you know this?

Not at all

Perfectly

Tumours with Plasmacytoid Morphology

Plasma cell neoplasms (!) - myeloma, LPL

Lobular breast, diffuse gastric and urothelial (plasmacytoid variant)

Myoepithelial
Mesothelial
Melanoma
Osteoblastic

Rhabdoid tumours - INI1 / BRG1 lost

How well did you know this?

Not at all

Perfectly

Subtypes of Amyloid

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

How well did you know this?

Not at all

Perfectly

Benefits of Synoptic Reporting

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.

How well did you know this?

Not at all

Perfectly

Define Quality Control and Quality Assurance

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

How well did you know this?

Not at all

Perfectly

Who are the ISO

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.

How well did you know this?

Not at all

Perfectly

Quality Control Measures at Cut up Bench

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

How well did you know this?

Not at all

Perfectly

Explain role of p57 in molar pregnancy

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)

How well did you know this?

Not at all

Perfectly

How to troubleshoot unexpected negative IPX

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.

How well did you know this?

Not at all

Perfectly

Interpret MMR / BRAF in GIT

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

How well did you know this?

Not at all

Perfectly

Why is p16 overexpressed in HSIL?

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

How well did you know this?

Not at all

Perfectly

How to Decontaminate Cryostat

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.

How well did you know this?

Not at all

Perfectly

Reasons for Performing Frozen Section

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

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

How well did you know this?

Not at all

Perfectly

Reasons for Discordant Frozen Section Results

Clinical details missing / unavailable
Specimen labelling error
Gross sampling error
Technical issues in performing frozen section
Misinterpretation of the frozen section - overcall, undercall or misclassify
Frozen section negative, permanent sections from block positive

How to Stain a Frozen Section

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

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

Then coverslip slide.

Purpose of MDM

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
Quality Tool
- provide an opportunity for internal audit of cases and to identify and discrepant or discordant findings

SRBCT’s in Adults

Lymphoma

Small cell NE carcinoma

Merkle cell carcinoma

Small cell melanoma

SRBCT’s in Young Adults / Some Children

DSRCT

Synovial sarcoma, poorly differentiated

Olfactory neuroblastoma

Small cell osteosarcoma

Mesenchymal chondrosarcoma

High grade myxoid liposarcoma

SRBCT’s in Children / Some Young Adults

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

Most Common Metastases to Brain

Lung

Breast

Melanoma

Renal cell carcinoma

Colon

Thyroid

Critical Values in Anatomic Pathology

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

Common Laboratory Hazards

Blood, infectious agents, sharps

Falls, trips, slips, ergonomic injury

Chemical hazards and spills

Fire hazards

Electrical hazards

Biologic Hazards in the Laboratory

_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

Name some Chemical Hazards in the Laboratory

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

What is Contained in the Safety Data Sheets for Chemicals

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

How To Manage a Formalin Spill or Exposure

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.

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

Name of reagent Reagent concentration Initials of person who prepared the reagent Date of preparation Expiration date Special storage requirements

Difference Between a Fume Hood and a Biosafety Cabinet

_(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)

Advantages and Disadvantages of Smear versus Frozen

**_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

Viral Inclusions

_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

How to Calculate Area of Field of View

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 r²to 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. 2mm²divided by 0.237 = 8.4HPF

Types of Rosettes

_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

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

Barr bodies (if different genders...) A, B, H blood group antigen IHC MSI PCR to see if profile matches HLA antigen testing