Robbins Chapter 6 Morphology

Question 1

Principal morphologic manifestation of immune complex injury

Answer 1

acute vasculitis with necrosis of vessel wall and neutrophilic infiltration

Question 2

Fibrinoid necrosis

Answer 2

necrotic tissue and deposits of immune complexes, complement, and plasma proteins

Question 3

Fibrinoid necrosis morphology

Answer 3

smudgy eosinophilic area of tissue destruction

Question 4

Immune complex morphology in the kidney

Answer 4

granular lumpy deposits of immunoglobulin and complement in immunofluorescence
electron-dense deposits along glomerular basement membrane in electron microscopy

Question 5

Where are the most characteristic lesions from immune complexes deposited in SLE? (4)

Answer 5

blood vessels, kidney, skin, connective tissue

Question 6

Blood vessel response in SLE

Answer 6

acute necrotizing vasculitis of capillaries, small arteries, and arterioles

Question 7

What is arteritis characterized by in SLE

Answer 7

fibrinoid deposits in vessel walls

Question 8

Blood vessels in chronic stages of SLE

Answer 8

fibrous thickening with luminal narrowing

Question 9

Kidney response in SLE

Answer 9

glomerular lesions due to deposition of immune complex in basement membrane and glomerulus
6 patterns of glomerular disease in SLE

Question 10

Class I glomerular disease in SLE

Answer 10

least common
minimal mesangial lupus nephritis
immune complex deposition in mesangium

Question 11

Class II glomerular disease in SLE

Answer 11

Mesangial prolliferative lupus nephritis
characterized by mesangial proliferation
no involvement of glomerular capillaries

Question 12

Class III glomerular disease in SLE

Answer 12

Focal lupus nephritis
involvement of fewer than 50% of all glomeruli
affected glomeruli exhibit swelling and proliferation with leukocyte accumulation
focal necrosis and crescent formation
red cell casts in urine

Question 13

Class IV glomerular disease in SLE

Answer 13

Diffuse lupus nephritis - most common*
half or more of the glomeruli are affected
affected glomeruli show crescents that fill Bowman’s Space
thickening of capillary wall forming “wire loop”
proteinuria and hematuria

Question 14

Class V glomerular disease in SLE

Answer 14

Membranous Lupus Nephritis
characterized by diffuse thickening of the capillary walls form deposition of subepithelial immune complexes
severe proteinuria or nephrotic syndrome

Question 15

Class VI glomerular disease in SLE

Answer 15

Advanced sclerosing lupus nephritis

more than 90% of glomeruli are involved

Question 16

Skin response in SLE

Answer 16

“butterfly” rash- erythema affects the face along the bridge of nose and cheeks
involved areas show vacuolar degeneration of basal layer or epidermis
deposition of Igs and complement along dermoepidermal junction

Question 17

Joints response in SLE

Answer 17

nonerosive synovitis with little deformity

*makes it different from rheumatoid arthritis

Question 18

Pericarditis and Serosal Cavity in SLE

Answer 18

inflammation of serosal lining
can be acute with fibrinous exudate
can be subacute with thickened and opaque
can be chronic fibrous tissue

Question 19

Cardiovascular system response in SLE

Answer 19

valvular abnormalities of mitral or aortic valves

Libman-Sacks endocarditis and vegetations are large

Question 20

Spleen response in SLE

Answer 20

splenomegaly, capsular thickening, follicular hyperplasia

“onion skin” lesions

Question 21

Lungs response in SLE

Answer 21

pleuritis and pleural effusion

Question 22

What can be tested in the bone marrow when diagnosing SLE?

Answer 22

LE bodies (hemotoxylin)

Question 23

Morphology of Sjogren Syndrome

Answer 23

periductal and perivascular lymphocytic infiltration in salivary glands
ductal linings of epithelial cells show hyperplasia
can cause lymphoma

Question 24

Results of lack of tears in Sjogren Syndrome

Answer 24

drying of corneal epithelium which becomes inflamed, eroded, and ulcerated

Question 25

Results of lack of salvation in Sjogren Syndrome

Answer 25

oral mucosa may atrophy | inflammatory fissuring and ulceration

Question 26

What is the main changing area in systemic sclerosis?

Answer 26

skin, alimentary tract, musculoskeletal system

Question 27

Skin response in systemic sclerosis

Answer 27

diffuse, sclerotic atrophy begins in fingers and then extends proximally to upper trunk and head/neck atrophic changes in terminal phalanges

Question 28

Histological skin in systemic sclerosis

Answer 28

edema and perivascular infiltrates containing CD4+ increased fibrosis increased collagen

Question 29

Alimentary tract response to systemic sclerosis

Answer 29

progressive atrophy and collagenous fibrosis replacement of the muscularis of esophagus and guy Esophagus becomes like a "rubber-hose" inflexibility

Question 30

Musculoskeletal response to systemic sclerosis

Answer 30

early stages- inflammation of synovium from hypertrophy and hyperplasia later stages- fibrosis

Question 31

Kidney response to systemic sclerosis

Answer 31

vascular lesions - interlobular arteries show thickening and deposits of collagen proliferation of intimal cells

Question 32

Lung response to systemic sclerosis

Answer 32

pulmonary vasospasm | pulmonary fibrosis

Question 33

Heart response to systemic sclerosis

Answer 33

pericarditis with effusion, myocardial fibrosis and thickening of intramyocardial arterioles

Question 34

3 classifications of rejection reactions

Answer 34

hyperacute, acute, and chronic rejection

Question 35

Characteristics of hyperacute rejection

Answer 35

occurs within minutes or hours cyanotic, mottles, flaccid neutrophils accumulate

Question 36

Characteristics of acute rejection

Answer 36

occurs within days of transplant can be cellular mediated acute rejection can be humoral mediated acute rejection

Question 37

2 patterns of acute cellular (T cell mediated) rejection

Answer 37

``` tubulointerstitial patterns (type I)- tubulitis associated with tubular injury vascular patterns- endotheliitis- inflammation of vessels ```

Question 38

Characteristics of acute antibody-mediated rejection

Answer 38

damage to glomeruli and small blood vessels | deposition of C4d

Question 39

Characteristics of chronic rejection

Answer 39

4-6 months | dominated by vascular changes of intimal thickening, glomerulopathy, and peritubular capillaritis