Random Lists of Common Questions Flashcards
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
Sarcomas that Metastasise to Lymph Nodes
SCARE
Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma
Common Tumours that Metastasise to Bone
Breast
Lung
Thyroid
Kidney
Prostate
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
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
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.
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
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.
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
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 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.
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
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 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.
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