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Histopathology > Systemic Histopathology > Flashcards

Systemic Histopathology Flashcards

1
Q

Name the systemic diseases?

A
  • Cancer
  • Connective tissue diseases
  • Vascular diseases
  • Infectious diseases e.g. HIV
  • Non-infectious inflammatory diseases • Drugs/toxins
  • Genetic
  • Others
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2
Q

What are we concerned about it HIV?

A
  • Opportunistic Infections
  • Tumours
  • Central nervous system diseases
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3
Q

Describe the timeline of HIs infection in terms of CD4+ lymphocytes and viral load.

A
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4
Q

Name the opportunistic infections in HIV.

A
  • Pneumocystis jiroveci: pneumonia
  • CMV: especially retina and GIT
  • Candida
  • Tuberculosis and atypical mycobacteria • Cryptococcus: meningitis
  • Toxoplasma gondii: encephalitis and mass lesions
  • JC papovavirus: progressive multifocal leukoencepalopathy • Herpes simplex
  • Cryptosporidium, Isospora belli, microsporidia: GIT
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5
Q

WHAT IS THIS?

A

Endoscopy - oesophageal ulcer

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6
Q

Describe.

A

(a) CMV nuclear inclusion
(b) Immunohistochemistryfor CMV

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7
Q

What are the HIV tumours.

A

• Kaposi’s sarcoma: HHV-8

• Lymphoma:
systemic, CNS or body cavity based B cell lymphomas
EBV

• Others:
Squamous cell carcinoma Anus and cervix
HPV

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8
Q

Describe the pictures.

A

Kaposi’s sarcoma

A. The dermis is expanded by a solid tumour.

B. Fascicles of relatively monomorphic spindled cells, with slit-like vascular channels containing erythrocytes.

C. Thenucleiofthetumourcells demonstrate immunoreactivity for HHV-8.

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9
Q

What is a CNS disease in HIV?

A
  • Progressive encephalopathy = AIDS dementia complex
  • Plus opportunistic infections and tumours
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10
Q

Describe

A

A - Right ventricle is compressed by a SOL - tumour mass

B - Perivascular lymphomatous infiltrate

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11
Q

What pathology do we see in mycobacteria (particularly TB)

A
  • Caseating granulomas
  • Demonstration of acid fast bacilli
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12
Q

Describe.

A

Mycobacterial infection

Granuloma with caseous necrosis

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13
Q

Describe

C

A

Cavitating TB

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14
Q

What sites are affected by mycobacteria?

A
  • Lung
  • Lymph node
  • Bone: e.g. vertebra
  • Heart: e.g. pericarditis
  • GIT: e.g. peritonitis
  • CNS: e.g. meningitis etc.
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15
Q

Name the extra-pulmonary features of mycobacterial infection

A
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16
Q

What is sarcoid pathology?

A
  • Non-caseating granulomas
  • A diagnosis of exclusion.
17
Q

Describe

A

Sarcoid granuloma

18
Q

What are the sites of sarcoid?

A
  • Lung: scattered granulomas, heal with fibrosis • Lymph nodes: usually hilar and mediastinal
  • Spleen
  • Liver
  • Heart
  • Joints
  • Bone marrow
  • Skin: nodules, plaques or macules
  • Eyes: iritis, choroid retinitis, lacrimal glands • CNS
  • Salivary glands
19
Q

What is the pathology of IgG4 related diseases?

A
  • Inflammation dominated by IgG4 antibody producing plasma cells
  • Fibrosis, obliteration of veins
20
Q

Describe

A

Biopsy of liver

Plasma cell rich, inflammatory infiltrate

Immunohistochemistry for IgG4

21
Q

What are the sites of igG4 Related Diseases?

A
  • Salivary and lacrimal glands: Mikulicz syndrome • Thyroid: Riedel thyroiditis
  • Peritoneum: Retroperitoneal fibrosis
  • Liver: Biliary obstruction
  • Pancreas: Autoimmune pancreatitis
  • Mass lesions: Inflammatory pseudotumour
22
Q

What are the sites of alcohol action?

A
  • Liver: fatty change (steatosis) , fatty liver hepatitis (steatohepatitis), cirrhosis, liver cell cancer (hepatocellular carcinoma)
  • GI Tract: acute gastritis, oesophageal varices
  • Nervous system: peripheral neuropathy, Wernicke-Korsakoff
  • syndrome etc.
  • Cardiovascular system: dilated cardiomyopathy, hypertension, atheroma (and decreases it!-little red wine)
  • Pancreas: acute pancreatitis, chronic pancreatitis
  • Fetal alcohol syndrome
  • Cancer: oral cavity, pharynx. oesophagus, liver and breast
23
Q

What are the potential long term effects of Ethanol?

A
24
Q

Name the stages of alcohol induced liver disease?

A
  1. Normal liver
  2. Steatosis - fatty change
  3. Steatohepatitis - ballooning inflammation + fatty change
  4. Fibrosis
  5. Cirrhosis
  6. Hepatocellular carcinoma
25
Q

What are the sites affected in cystic fibrosis?

A

Pancreas: duct obstruction, exocrine atrophy

Salivary glands: duct obstruction, atrophy

Intestine: meconium ileus

Liver: biliary obstruction, cirrhosis

Lung: bronchial obstruction, superimposed infection with abscess formation (Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa)

Male genital tract: infertility, absence of the vas

26
Q

What is amyloid?

A
  • Deposition of an abnormal proteinaceous substance in non branching fibrils, 7.5-10nm diameter
  • Always contains P component - can help identify it
  • Beta-pleated sheet structure
  • A variety of proteins can take on this conformation
  • Resistant to enzymic degradation
27
Q

What are the types of amyloid?

A

• AA - derived from serum amyloid A e.g. Crohn’s Disease, Rheumatoid

arthritis - acute phase protein - people with long standing inflammation at risk

• AL - derived from light chains (on immunoglobulin)

e.g. multiple myeloma, B Cell lymphoma

28
Q

What are the other proteins derived from amyloid?

A
  • Transthyretin e.g. mutation
  • Beta2-macroglobulin – peritoneal dialysis • Abeta2 protein - Alzheimer’s
  • Insulin, calcitonin – endocrine tumours
29
Q

What stain do we use to recognise amyloid?

A
  • Stains with Congo Red dye
  • This shows apple green birefringence under polarised light
30
Q

What clinical features would you expect to see in amyloid?

A
  • Proteinuria, renal failure
  • Restrictive cardiomyopathy, arrhythmias
  • Autonomic neuropathy
  • Carpal tunnel syndrome
  • Macroglossia
  • Bleeding on injury
  • Also deposited in blood vessels, endocrine organs, liver, spleen
31
Q

Describe the picture

A

Accumulation of amyloid in kidney

32
Q

Describe the picture

A

Amyloid in apple green birefringence

33
Q

Describe the picture.

A

Electron microscopy in amyloid.

34
Q

Causes of granulomatous inflammation in the liver

A
  • Sarcoid
  • TB
  • PBC
  • Drug-induced
  • Malignancy
35
Q

What are the different types of liver damage due to alcohol?

A

steatosis, steatohepatitis, cirrhosis, fibrosis and hepatocellular carcinoma

36
Q

What type of amyloid is associated with multiple myeloma?

A

AL amyloid

Histopathology (14 decks)

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