Revision notes: 7. Pathology Flashcards
Two substances responsible for initiating systemic acute phase response
Interleukin-1
TNF
Caseating granuloma
TB
Non-caseating granuloma
Sarcoidosis
Teratoma definition
Neoplasm containing more than one germ cell layer
HNPCC inheritance
Autosomal dominant
HNPCC risk of colorectal cancer
80% risk colonic cancer
What is factor V leiden
Variant of factor V that cannot be inactivated by protein C
Causes hypercoagulant state
Antiphospholipid triad
Recurrent miscarriage
Thrombosis - arterial & venous
Presence of antiphospholipid antibody
Ataxia telangiectasia important features
Autosomal recessive
Acute leukaemia
Lymphoma
Breast cancer
Fanconi anaemia important features
Autosomal recessive
Acute leukaemia
Xeroderma pigementosa
Autosomal recessive
Basal + squamous cell carcinoma
Malignant melanoma
Tuberous Sclerosis important features
Autosomal dominant
Hamartomas
Glial tumours
Neurofibromatosis important features
Autosomal dominant Gliomas of brain and optic nerve Acoustic neuromas Meningioma Phaeochromocytoma
Aflatoxin associated with which malignancy
Hepatocellular carcinoma
Nitrosamines and amides associated with which malignancy
Gastric CA
Arsenic associated with which malignancy
Skin cancer
aromatic amines and azo dyes which malignancy
Liver
Beta-naphthylamine which malignancy
Bladder
Pro-inflammatory mediator not inhibited by NSAIDs
Bradykinin
Tamm-Horsfall protein
glycoprotein secreted by renal tubular epithelial cells
Wound healing: re-epithelisation occurs when
24-48hrs post injury
Non-epithelial ovarian cancer makes up what percentage of ovarian cancer
10-15%
Brenner’s tumour is composed of
Transitional cells
These tumours secrete oestrogen
Meig’s syndrome triad
Ovarian fibroma
Hydrothorax
Ascites
RMI - how to calculate
Risk of malignancy index
CA-125 * USS findings * menopause status
Post-menopausal = 3 points
> 1 worrying ultrasound feature = 3 points
Schiller-Duval body
Cellular structure resembling glomerulus
Seen in endodermal sinus (yolk sac) tumours
Secrete AFP and A1-antitrypsin
Call-exner body
Fluid filled punched out spaces between granulosa cells
See in granulosa cell tumours
Sex cord stromal tumour presentation
Acute abdominal pain (tendency to rupture)
Iso-sexual precocious puberty
Menorrhagia
Irregular bleeding
Mucin-secreting signet-ring cells
Krukenberg tumour
GI cancer metastasing to ovary
Signet rings seen in stomach cancer
Inheritance pattern of Lynch syndrome
Autosomal dominant
Risk of endometrial cancer if u have lynch
Lifetime risk of endometrial cancer in pt with lynch is 40-60% compared to 3% risk in general population
Peutz-jeghers syndrome
Mutation in STK11
Autosomal dominant
Inc risk of sex cord stromal ovarian tumours and adenoma malignum of cervix
Serous ovarian cancers cell type
Resemble internal lining of fallopian tube
Mucinous ovarian cancer cell type
Resemble lining of endocervix or intestine
Clear cell tumours are linked to
endometriosis
Psammoma bodies
concentric lamellated calcified structures
Seen in:
papillary thyroid carcinoma
Meningioma
papillary serous cystadenocarcinoma of ovary
Endometrial epithelial cells becoming vacuolated, thrown into pseudo-papillary folds giving hyper-secretory impression
Evidence of decidualisation around spiral arteries and under surface of epithelium
Arias-stella reaction
Thickened polypoidal endometrium, straight endometrial glands, narrow columnar cells with basophilic cytoplasm, stromal hyperplasia and increase in glands
Ratio of glands to stroma is NORMAL
Hyperplasia without atypia.
Not pre-malignant
Associated wtih unopposed oestrogen stimulation with anovulatory cycles, oestrogen secreting tumours, oestrogen therapy
Increased ratio of glands:stroma, crowding of glands, back-to-back appearance
Various degrees of cellular pleomorphism and atypia
Increase in mitotic figures
Atypical hyperplasia
Risk of progression to endometrial carcinoma up to 50%
Endometrial SARCOMA - “homologous” vs “heterologous”
homologous if they contain endometrial tissue only (stromal or glandular)
heterologous if they contain extra-uterine tissue such as muscle or cartilage
Commonest site for endometriosis
ovary
elongated, spindle-shaped, with a cigar-shaped nucleus
FIBROID
Uterine leiomyoma
Most common fibroid degeneration type
Hyaline
Prevalence of sarcoma in pts undergoing hysterectomy or myomectomy for myometrial mass
1: 500
0. 2%
Dysgerminoma important facts
Most common malignant germ cell tumour
Female equivalent of seminoma
EXTREMELY RADIOSENSITIVE
Bilateral in 20%
Most common SOLID benign tumour of ovary
fibroma
Most common benign ovarian neoplasm in children
dermoid cyst
theca-lutein cyst features
simple cysts
lined with leutenised granulosa cells
2ndry to excessive gonadotrophic stimulation of ovaries - ovulation inducing drugs, molar pregnancy
Which ovarian tumour secretes AFP
endodermal sinus tumour
dermoid cyst lining
stratified squamous epithelium
serum inhibin is a marker for which ovarian tumour
granulosa cell tumour
In women using COCP, endometrium is characterised by
glandular atrophy
In women using copper coil, endo characterised by
mononuclear cell infiltrate
In women using mirena, endo characterised by
Decidual changes
acute endometritis - characterised by
Polymorphonuclear cell infiltration of the endometrial glands and stroma
Lymphocytic and plasma cell infiltration of the endometrial glands and stroma
Chronic endometritis
Diagnosis of endometriosis
Biopsy identifying haemosiderin-laden macrophages
average age of diagnosis of leiomyosarcoma
51 years old
ECM-1 antibodies have been detected in 60-80% of women with
Lichen Sclerosus
Pale, white atrophic areas on vulva
Fissuring
Stenosis of introitus
Lichen Sclerosus
Lichenoid inflammatory infiltrate in dermal-epidermal junction
Hyperkeratosis
Clefting
Lichen Sclerosus
Weak circulating basement membrane zone antibodies
Erosive lichen planus
Wickham’s striae
Lichus Planus
if it involves the vagina it cannot be
lichen sclerosus
Irregular saw-toothed acanthosis
Increased granular layer
Basal cell liquefaction
Lichen planus
Distal urethral prolapse
Pink exophytic lesion at urethral meatus
Urethral caruncle
Endocervical COLUMNAR epithelium visible at ectocervix, undergoes squamous metaplasia
cervical ectropion
Cervical intra-epithelial neoplasia associated with
HPV 16, 18, 31, 33
CIN I
Dysplastic cells confined to lower third of epithelium
CIN II
Dysplastic cells confined to lower two thirds of epithelium
CIN III
Entire thickness of epithelium involved
Risk factors for SCC cervix
Early age first sex Multiple partners Smoking Non-barrier contraception Immunosuppression
Risk of invasive vulval cancer in women with lichen sclerosus
4%
Diffuse CK20 positivity is suggestive of
secondary vulval paget’s disease
Spread of internal malignancy e.g. anorectal adenocarcinoma / urothelial carcinoma
Basaloid carcinoma of vulva
Associated with HPV Younger population (<65)
DES daughters at risk of
Clear cell adenocarcinoma of vagina
0.1% risk
Sulphur granules
Actinomycosis
Examples of granulomatous inflammation
1) TB and leprosy
2) Syphilis - gumma
3) Cat scratch disease
4) Schistosomiasis
5) Cryptococcus and coccidiodes infections
6) Sarcoidosis
7) Silicosis and berylliosis
HPV is a …. virus with ….. within genome
DNA virus
oncogene
MEN 1
Autosomal dominant
Adenoma of Pituitary, parathyroid, islet cell
MEN 2
Autosomal dominant
Medullary carcinoma thyroid
Phaeo
parathyroid
Neutrophils appear within …. at the margins of an incision
24 hours
Granulation tissue forms when in wound healing
3-5 days
Remodelled scar - main collagen
collagen 1
Protein involved in apoptosis
BCL-2
Granulosa cell tumour is a
Sex cord stromal ovarian cancer
Aflatoxin B1 causes
Hepatocellular carcinoma
What % of PEs are clinically asymptomatic
60-80%
Diffuse renal cortical necrosis
Abruption/septic shock
Irreversible renal failure
Anuria
Metastatic calcification occurs in
normal tissues in presence of hypercalcaemia
Dystrophic calcification refers to
Calcium deposition in tissues in presence of normal plasma calcium & phosphate
How to oncogenic viruses cause cancer
Cause cancer by integrating viral DNA into the host’s DNA
Mature cystic teratoma - risk of malignant transformation
1%
