Systemic Histopathology Flashcards
Name the systemic diseases?
- Cancer
- Connective tissue diseases
- Vascular diseases
- Infectious diseases e.g. HIV
- Non-infectious inflammatory diseases • Drugs/toxins
- Genetic
- Others
What are we concerned about it HIV?
- Opportunistic Infections
- Tumours
- Central nervous system diseases
Describe the timeline of HIs infection in terms of CD4+ lymphocytes and viral load.
Name the opportunistic infections in HIV.
- 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
WHAT IS THIS?
Endoscopy - oesophageal ulcer
Describe.
(a) CMV nuclear inclusion
(b) Immunohistochemistryfor CMV
What are the HIV tumours.
• Kaposi’s sarcoma: HHV-8
• Lymphoma:
systemic, CNS or body cavity based B cell lymphomas
EBV
• Others:
Squamous cell carcinoma Anus and cervix
HPV
Describe the pictures.
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.
What is a CNS disease in HIV?
- Progressive encephalopathy = AIDS dementia complex
- Plus opportunistic infections and tumours
Describe
A - Right ventricle is compressed by a SOL - tumour mass
B - Perivascular lymphomatous infiltrate
What pathology do we see in mycobacteria (particularly TB)
- Caseating granulomas
- Demonstration of acid fast bacilli
Describe.
Mycobacterial infection
Granuloma with caseous necrosis
Describe
C
Cavitating TB
What sites are affected by mycobacteria?
- Lung
- Lymph node
- Bone: e.g. vertebra
- Heart: e.g. pericarditis
- GIT: e.g. peritonitis
- CNS: e.g. meningitis etc.
Name the extra-pulmonary features of mycobacterial infection
What is sarcoid pathology?
- Non-caseating granulomas
- A diagnosis of exclusion.
Describe
Sarcoid granuloma
What are the sites of sarcoid?
- 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
What is the pathology of IgG4 related diseases?
- Inflammation dominated by IgG4 antibody producing plasma cells
- Fibrosis, obliteration of veins
Describe
Biopsy of liver
Plasma cell rich, inflammatory infiltrate
Immunohistochemistry for IgG4
What are the sites of igG4 Related Diseases?
- Salivary and lacrimal glands: Mikulicz syndrome • Thyroid: Riedel thyroiditis
- Peritoneum: Retroperitoneal fibrosis
- Liver: Biliary obstruction
- Pancreas: Autoimmune pancreatitis
- Mass lesions: Inflammatory pseudotumour
What are the sites of alcohol action?
- 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
What are the potential long term effects of Ethanol?
Name the stages of alcohol induced liver disease?
- Normal liver
- Steatosis - fatty change
- Steatohepatitis - ballooning inflammation + fatty change
- Fibrosis
- Cirrhosis
- Hepatocellular carcinoma
What are the sites affected in cystic fibrosis?
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
What is amyloid?
- 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
What are the types of amyloid?
• 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
What are the other proteins derived from amyloid?
- Transthyretin e.g. mutation
- Beta2-macroglobulin – peritoneal dialysis • Abeta2 protein - Alzheimer’s
- Insulin, calcitonin – endocrine tumours
What stain do we use to recognise amyloid?
- Stains with Congo Red dye
- This shows apple green birefringence under polarised light
What clinical features would you expect to see in amyloid?
- Proteinuria, renal failure
- Restrictive cardiomyopathy, arrhythmias
- Autonomic neuropathy
- Carpal tunnel syndrome
- Macroglossia
- Bleeding on injury
- Also deposited in blood vessels, endocrine organs, liver, spleen
Describe the picture
Accumulation of amyloid in kidney
Describe the picture
Amyloid in apple green birefringence
Describe the picture.
Electron microscopy in amyloid.
Causes of granulomatous inflammation in the liver
- Sarcoid
- TB
- PBC
- Drug-induced
- Malignancy
What are the different types of liver damage due to alcohol?
steatosis, steatohepatitis, cirrhosis, fibrosis and hepatocellular carcinoma
What type of amyloid is associated with multiple myeloma?
AL amyloid
