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Medical Pathophysiology > week 5- histopathology and cytopathology > Flashcards

week 5- histopathology and cytopathology Flashcards

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USMLE® Step 1 flashcards
1
Q

what is histopathology

A

study of changes in tissue associated with disease

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2
Q

what is cytopathology

A

study of changes in cells associated with disease

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3
Q

What is the difference between histology and histopathology?

A

Histology is the study of tissues in general.
Histopathology is the study of tissues associated with disease.

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4
Q

What is the difference between cytology and cytopathology?

A

Cytology is the study of cells in general.
Cytopathology is the study of cells associated with disease.

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5
Q

what is histopathology and cytopatholgy used for

A

screening
diagnosis
treatment
determining prognosis

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6
Q

what is screening used for

A
  • highlight abnormalities in asymptomatic patients
  • benefits must outweigh harm
  • bowel/ breast cancer
  • cervical screening
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7
Q

what does diagnosis used for

A
  • look for abnormal cells
  • signs of inflammation
  • used alongside medical history and other methods
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8
Q

SLIDE 8-11

A
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9
Q

What is histopathology in brief?

A
  1. the tissue sample is enclosed within paraffin wax
  2. the paraffin wax block is cut into thin sections
  3. Section placed on microscope slide
  4. Slide is stained with dyes and then examined
  5. results sent to requesting clinician to follow up
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10
Q

what is histology process

A
  1. receipt/ booking in
  2. fixation
  3. dissection
  4. processing
  5. embedding
  6. microtomy
  7. staining
  8. immunohistochemistry
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11
Q

what is receipt/ booking in

A

specimen is taken from GP surgery, outpatient clinic or during surgery

it is labelled with atleast 3 forms of ID and pot and request form should match

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12
Q

what is fixation

A

often samples are stored and sent in formaldehyde
pre-filled pots and buckets are provided to drop sample in
samples may be frozen (study proteins)
- immunofluorescence
- biopsies for enzyme studies

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13
Q

what is formaldehyde - related to fixation

A

it preserves tissue, prevents autolysis, kills bacteria and viruses, forms cross-links with proteins thus preserving them
it is the most common fixative

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14
Q

What are artefacts - related to fixation

A

Artefacts are structures in a histological section that has come from outside sources.

Can result from ice crystals, insufficient / over fixation.

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15
Q

what is dissection

A

-transfer pieces of tissue into cassettes
- technique depends on sample size:
small- no dissection needed
intermediate/large - representative piece taken

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16
Q

what is processing

A
  • dehydrate tissue and infiltrate with molten paraffin wax
    -often automated- up to 600 cassettes per run (rapid processing= same-day diagnosis)
  • reagents: alcohol, xylene and paraffin
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17
Q

what is embedding

A
  • transfer tissue to wax block
  • paraffin embedding machine
  • samples picked ip from plastic cassette and soaked in liquid paraffin, then arranged in the middle of the mould
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18
Q

What is sample orientation - related to embedding?

A

The way you cut the paraffin wax with the tissue inside

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19
Q

what is microtomy

A
  • thin section of tissue from the wax block is sliced and mounted onto microscope slide
  • use a microtome
  • 3-4 microns (0.003-0.004 mm)
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20
Q

what is staining

A
  • haematoxylin and eosin
  • depth of colour related to time spent in dyes as well as structures
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21
Q

what is haemotoxylin

A

basic (alkali) dye which stains acidic structures such as DNA purple

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22
Q

what is eosin

A

acidic dye and stains basic structures pink

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23
Q

what is immunohistochemistry (ICH)

A

determines the location of an antigen in tissue using antigen
secondary antibody linked to enzyme

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24
Q

What things are important about the process of fixation in immunohistochemistry - IHC

A
  1. The fixation must be optimised
  2. If the sample is fixated too little or too much, it can lose signal
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25
Q

what is immunofluorescence (IF) - direct

A
  • rapid single- step staining
  • no signal amplification
  • antibodies can be from the same host, so long as have different fluorophore
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26
Q

what is immunofluorescence (IF) - indirect

A
  • 2 step protocol
  • signal amplified
  • requires primary antibodies from different hosts
  • can work out cheaper
27
Q

Describe how immunofluorescence is used when you have multiple targets?

A

It is used to assess the colocalisation ( 2 or more different targets in the same physical area) of antigens in tissue and cells

It is faster as you can look for multiple antigens in one sample

28
Q

How is histopathology used to detect cervical cancer/

A

Screening reduces incidence/mortality of cervical cancer by detecting and potentially pre cancerous areas of the cervix

29
Q

How is the cervix tested to detect cervical cancer?

A
  1. call and recall
  2. sample takers and primary care
  3. cytology and histology labs
  4. colposcopy
30
Q

How are abnormal cells detected in the cervix using Histopathology

A

The abnormal cells are detected using immunohistochemistry process

31
Q

What is neoplasia and dysplasia?

A

Neoplasia - new growth
Dysplasia - abnormal growth

32
Q

What are the stages of cervical cancer

A

CIN1
CIN2
CIN3
CIN4

33
Q

What happens in CIN1?

A

Only slightly abnormal cells
Usually caused by HPV infection
Isn’t camcer but can progress to cancer
Usually goes away on its own
It’s aka low-grade dysplasia

34
Q

What happens in CIN2?

A

Moderately abnormal cells
Usually caused by HPV infection
Still not cancer but can progress to cancer
Treated by cryotherapy, laser therapy
It’s aka high grade/moderate dysplasia

35
Q

What happens in CIN3?

A

Severely abnormal cells
Usually caused by HPV infection
Still not cancer yet but can become cancer if it isn’t treated
Treated by cryo/laser therapy, LEEP to remove abnormal tissue
It’s aka high grade/severe dysplasia

36
Q

What happens in CIN4?

A

This is when it becomes a cancer, it is known as invasive carcinoma

37
Q

What is a colposcopy/

A

it is a procedure used to examine the cervix

38
Q

What happens during a colposcopy and what do the results show/

A

Acetic acid is applied - normal areas won’t stain, abnormal cell growth will appear white

Iodine can be applied - abnormal cell growth areas won’t stain, normal cells will appear brown - this is because iodine is taken up by normal cells with high glycogen

39
Q

What is Large Loop Exercision of the Transformation Zone (LLETZ)

A

It is a treatment that can prevent the development of cervical cancer.
CIN is removed with a clear margin

40
Q

What is breast cancer screening?

A

It consists of a mammogram (low dose X ray)
Detects cancers too small to see or feel

41
Q

What are the lobules and ducts?
(anatomy of the breast)

A

Lobules - the glandular tissue that produces milk

Ducts - deliver milk to be expelled

Cancer can form in the lobules/lobes and the ducts

42
Q

What is the histology of ducts/lobules??????

A
43
Q

What are the different types of breast lumps

A

Lipoma - benign cancer, composed of adipose cells

Fibroadenoma - benign cancer, epithelial and stroll

Carcinoma - in the ducts/glands, malignant cancer, genetic 60+

Phyllodes tumour - usually benign, stromal origin

Cyst

Fat necrosis

44
Q

What is the histopathology like in a carcinoma?

A

You can see a loss of myoepithelial layer

Using IHC you can see there is a negative/reduced stain for p63

45
Q

what is p63 and what does it mean if there’s a reduced/negative stain for it?

A

p63 is involved in cellular differentiation - therefore, if there is reduced amounts it shows there is no differentiation — cancer cells are usually not differentiated !!!!!!!!!!!!!!!!!

46
Q

How is a diagnosis made?

A

You need a multi-disciplinary team meeting consisting of:
pathologists
surgeons
radiographers
Oncology nurses
MDT coordinator

You need all the input from these people to make a diagnosis

47
Q

What are the 3 assessments of testing for breast cancer?

A

Physical examination
Scan
Biopsy

48
Q

Why are biopsies useful?

A

Because they give information about the stage that the tumour is in

49
Q

What are the disadvantage of histopathology?

A

It requires fragments of tissue
Retrieving the tissue is invasive - may cause bleeding/trauma
More expensive
Longer procedure

50
Q

Learn Histopathology V cytopath

A
51
Q

What is exfoliative cytology?

A

This is where cells are shed by the body - via sputum, urine, other secretions

Or where cells are manually scraped/brushed - via a smear, skin scraped from inside nose/mouth

52
Q

What is aspiration cytology?

A

It uses a fine needle aspiration to take cells from swelling/lumps/cysts/nodules etc
Commonly used to test for cancer

53
Q

How is cytopathology of the urinary system carried out?

A
54
Q

What are other sources in the body used to take out cells for cytopathological uses?

A

Pleural body cavities - lungs, trachea
Pericardial body cavities - heart, liver
Peritoneal body cavities - stomach, live etc

55
Q

What is immunocytochemistry?

A
56
Q

What are targets for immunoCYTOchemistry?

A

Cytoplasmic
Nuclear
Membrane
Lipids
Proteins

57
Q

Learn more about immunocytochemistry

A
58
Q

What is apoptosis?

A

Programmed cell death

59
Q

What is necrosis?

A

Uncontrolled cell death resulting from injury/infection

60
Q

What is a urinary cast/

A

Small cylindrical structures generated by distal convoluted tubules in the kidney

They are found in the urine when you have certain diseases

61
Q

What are the types of urinary casts and what do they show?

A

Epithelial cast - shows there is a sign of damage to tubule cells in the kidney

\White b blood cell cast - shows a sign of infection/inflammation

Granular cast - shows degenerated cellular material

Red blood cell cast - Shows there is a small amount of bleeding in the kidney

CHECK DIAGRAM ON PP

62
Q

What is Strongyloides stercoralis/

A

It is a nematode that can infect human

KNOW WHAT A NEMATODE LOOKS LIKE

63
Q
A
64
Q
A

Medical Pathophysiology (11 decks)

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