Systemic Pathology Flashcards
What are the complications of HIV?
- Opportunistic Infections
- Tumours
- Central nervous system diseases
How does symptoms change with CD4 and RNA over time?
What are the HIV opportunistic infections?
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 showing?
Endoscopy:
Oesophageal ulcer
CMV
What is this?
(a) CMV nuclear inclusion
(b) Immunohistochemistry
for CMV
What are the HIV associated 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
How does a Kaposi sarcoma look Histologically?
A. The dermis is expanded by a solid
tumour.
B. Fascicles of relatively monomorphic
spindled cells, with slit-like vascular
channels containing erythrocytes.
C. The nuclei of the tumour cells
demonstrate immunoreactivity for
HHV-8.
What CNS diseases does HIV cause?
- Progressive encephalopathy = AIDS dementia complex
- Plus opportunistic infections and tumours
What does CNS HIV lymphoma look like?
What is the pathology of mTB?
- Caseating granulomas
- Demonstration of acid fast bacilli
- Cavitating lesions
What kind of granuloma is this?
Caseous
Where can TB infect?
• Lung
• Lymph node
• Bone: e.g. vertebra- potts
• Heart: e.g. pericarditis
• GIT: e.g. peritonitis
• CNS: e.g. meningitis
etc.
What are the extrapulmonary features of mTB?
What is the pathology of sarcoidosis?
- Non-caseating granulomas
- A diagnosis of exclusion.
What is this?
Sarcoidosis
Where can sarcoid effect?
- 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 IgG4 related disease?
- Inflammation dominated by IgG4 antibody producing plasma cells
- Fibrosis, obliteration of veins
What is this?
IgG4
Where does IgG4 related disease effect?
- Salivary and lacrimal glands: Mikulicz syndrome
- Thyroid: Riedel thyroiditis
- Peritoneum: Retroperitoneal fibrosis
- Liver: Biliary obstruction
- Pancreas: Autoimmune pancreatitis
- Mass lesions: Inflammatory pseudotumour
What can alcohol cause?
• 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!)
• Pancreas: acute pancreatitis, chronic pancreatitis
• Fetal alcohol syndrome
• Cancer: oral cavity, pharynx. oesophagus, liver and breast
What are the stages of ALD?
Normal
Steatosis
Steatohepatitis
Fibrosis
Cirrhosis
HCC
10
10
Where does CF present?
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
• Beta-pleated sheet structure
• A variety of proteins can take on this conformation
• Resistant to enzymic degradation
What is amyloid classification?
•AA - derived from serum amyloid A
e.g. Crohn’s Disease, Rheumatoid
arthritis
•AL - derived from light chains
e.g. multiple myeloma, B Cell
lymphoma
What types of amyloid causes certain diseases?
- Transthyretin e.g. mutation
- Beta2-macroglobulin – peritoneal dialysis
- Abeta2 protein - Alzheimer’s
- Insulin, calcitonin – endocrine tumours
What is the staining for amyloid?
Stains with Congo Red dye
This shows apple green birefringence under polarised light
What are the clinical features of amyloidosis?
• Proteinuria, renal failure
• Restrictive cardiomyopathy, arrhythmias
• Autonomic neuropathy
• Carpal tunnel syndrome
• Macroglossia
• Bleeding on injury
• Also deposited in blood vessels, endocrine organs,
liver, spleen
What are the causes of granulomas in the liver?
Sarcoidosis
TB
Drug induced
Schistosomiasis
Malignancy
What are the different types of liver damage due to alcohol?
Steatosis
Steatohepatitis
Fibrosis
Cirrhosis
What type of amyloid is associated with multiple myeloma?
AL amyloid derived from light chain
