Fichas
Histopathology
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- 1Define cirrhosisIrreversible destruction of the liver architecture associated with fibrosis and nodule formation which may follow necrosis
- 22 RFs for liver cell adenoma1. Being female
2. OCP use - 3Often misinterpreted as metastasesbile duct malformations
- 4focal nodularhyperplasiatumour like malformation
central scar
more common in women - 5Causes of HCCcirrhosis
Hep b/c
ash/nash
autoimmune hepatitis
chronic biliary disease - 6Fibrolamellar HCC - differencesyounger patients
no background cirrhosis
better prognosis - 7angiosarcomamost common sarcoma of the liver
mostly in older men - 8Hepatoblastomachildren under 5
AFP often raised
lobulated appearance - 9Hep Ano carrier state
- 10Hep Btransmission via bodily fluids
Can lead to cirrhosis and HCC - 11Hep Cusually forms a chronic disease
often causes cirrhosis and can lead to HCC - 12Hep Efood/waterborne
severe in pregnant women - 13Autoimmune Hephigh ALT, IgG
ANA positive - 14Primary Sclerosing cholangitispresents in young/middle age males
common in patients with UC
inflammation of the large bile ducts
AMA neg, well recognised in children
Can be p-ANCA positive - 15Primary biliary cholangitispresents in middle aged females
AMA pos, IgM pos, Alk Phos raised
inflammation of the small bile ducts - 16Wilson's diseaseAutosomal recessive mutation on Chr 13
aberrant storage of copper in the liver
presents in childhood - 17HaemochromatosisAutosomal recessive mutation of HFE gene on Chr 6
increased iron absorption and storage in the liver
leads to cirrhosis and risk of HCC - 18A1AT deficiencymutation in A1AT gene on chr14
leads to accumulation in the liver - 19Secretory portion of the mammary glandsTDLU - terminal duct lobular units
- 20Markers used to identify myoepithelial cellsSMM
p63
CK5/6 - 21Fibrocystic changecommon in women 25-45
caused by hormonal changes
benign, not clinically significant - 22Fibroadenomamost common benign tumour between 25-30
increases in size during pregnancy
decreases in size with age - 23Breast carcinoma classification criteria2 criteria
invasion of basement membrane? yes - invasive, no - in situ
Morphology - Ductal or lobar - 24Breast carcinoma genetic factorsBRCA1 - chr17, also causes ovarian cancer
BRCA2 - chr13 - 25Phylloides tumourcomposed of mesenchymal and epithelial elements
mesenchymal component is malignant, metastasises through haematogenous route
recurrence is common - 26Breast lump Red flag symtomsTethered - carcinoma
bloody discharge - ductal papilloma/carcinoma
peau d'orange - carcinoma
microcalcification - DCIS - 27Coronary artery occlusionone or more lesions causing 75% reduction in CSA of at least one major epicardial artery
90% of patients with IHD - 28MITransmural - at least nearly full thickness of ventricular wall in distribution of one CA
Subendocardial - inner 1/3 or 1/2 at most of ventricular wall, can be beyond perfusion territiry of one CA
irreversible injury in 20-40mins - 29Detection of MICKMB test
Lactate
Troponin 1 and T
ECG, echo - 30Mitral annular calcificationcan lead to mitral regurg
source of throbi/emboli
prone to IE
women over 60 - 31Rheumatic heart diseaseoften occurs after Group A (beta haemolytic) streptococcal pharyngitis
chronic rheumatic valvular disease - most important consequence of RF, always involves mitral, often aortic - 32Bacterial Endocarditisforms friable vegetation in left heart valves, tricuspid in IVDUs
preventable using prophylactic antibiotics - 33Vascular supply of myocardiumLeft trunk: LAD - apex, ant wall of LV, ant 2/3 of VS
LCX - lateral wall of LV
RCA: RV, posterior1/3 of ventricular septum, post-basal wall of LV - 34Nephrotic syndromeAcute: haematuria, oliguria, azotemia, hypertension
- 35Minimal change glomerulopathymost common cause of NS in children
- 36membranous glomerulonephritismost common cause of nephrotic syndrome in adults
85% idiopathic - 37Glomerular nephritislarge deposition of immune complexes in glomerular wall
- 38Main cause of acute nephritis in children?acute proliferative glomerulonephritis
arises following group A beta-haemolytic streptococcal infection - 39presentation of combined nephritic-nephrotic picturemembranoproliferative glomerulonephritis
- 40Acute tubular necrosisfocal necrosis and desquamation of the cells into the tubular lumen
can lead to acute renal failure - 41UTI - patient RFs, symptoms and organismselderly, female, catheters, malformations
dysuria, frequency
e. coli and proteus - 42Acute Pyelonephritis - presentation, pathogenesisfever and raised creatinine (due to reduced eGFR)
inflammatory infiltrate into the interstitium and tubular lamina - 43Chronic pyelonephritis - appearance of the kidneysdepressed in scarred areas, pseudo-bulging in the intact parenchyma
symptoms present bilaterally but scarring is asymmetrical
a cut would show dilated, blunted or deformed calyces
dilated 'colloid' filled tubules are present - thyroidisation of the kidneys - 44Most common cause of abnormal mass in newbornmulticystic renal dysplasia
- 45ADPKDautosomal dominant
presents bilaterally in middle age - haematuria, UTI, abdo mass, HTN
can cause chronic renal failure
management - supportive, treat HTN, dialysis transplant when required - 46ARPKD (infantile)Large abdo masses at birth
associated with liver abnormalities
causes - CRF, HTN, PHTN, death shortly after birth if severe - 47CRF/CKDoften unrecognised or coexists with other conditions
Can be asymptomatic until end stage renal disease
Caused by: Diabetes and hypertension - 485 stages of CRF1 - GFR >90 with other evidence of damage
2 - GFR 60-89 with other evidence of damage
3 - A; GFR 45-59 with or without evidence of kidney damage, B; GFR 30-44 polyuria, anaemia, hypertension
4 - GFR 15-29 with or without other evidence of kidney damage
5- GFR <15 established renal failure - 49Acute renal failurerapid reduction in renal excretory function (within 48)
less than 0.5ml/kg urine output for >6hrs
presentation - metabolic acidosis, increased urea - 50Nephrolithiasisstone formation in the kidney or renal tract
recurrance 40-70%
75% calcium oxalate, hypercalcaemia, idiopathic calcuria - 51Renal cell carcinomaRFs: regular + heavy metals, von hippel lindau syndrome
presentation: paraneoplastic syndrome, referred back pain, haematuria, palpable masses - 52Urinary bladder tumours90% in urothelium
differential RF - industrial exposure to arylamines (dyes, aluminium) - 53Epithelial tumours of the bladder - red flag symptompainless haematuria
- 54Bronchopneumonia - patient, symptoms and organismsextremes of age
presents with flu like symptoms
Staph, haemophilus I, klebsiella - 55Lobar pneumonia - patients, symptoms and organismsyoung adults
high grade fever
Strep - 56TB - distinguishing featuresZN stain
- 57Oncogenes in bronchocarcinomaC-myc in small cell carcinoma
K-ras in adenocarcinoma - 58Clinical features for Bronchocarcinomasweight loss, non-productive cough
HAEMOPTYSIS, paraneoplastic syndrome from ectopic tumours:
ACTH & ADH - SmCC
PTH - SqCC - 59Causes of perinatal deathsSpontaneous pre-term delivery and hypertensive disorders (pre-eclampsia) 29%
prematurity - 62%
foetal abnormalities - 12% - 60Pre-eclampsia - clinical pres, autopsy findingsunexplained high maternal BP and proteinuria
IUGR and assymetrical growth
infarct on placenta - 61Acute choriomanionitisacute inflammation of foetal membranes
common after PROM
risk of ascending infection to mother - 623 layers of testistunica vaginalis/outer serosa
tunica albuginea
tunica vasculosa - 63Leydig cells - distribution and functionadjacent to SNTs
produce testosterone in presence of LH - 64Stages of development in germ cells1. spermatogonium
2. primary spermatocyte
3. secondary spermatocyte
4. spermatid
5. spermatozoon - 65germ cell tumour - presentation, RFsPainless unilateral testis enlargement, secondary hydrocele, symptoms from metastases - retroperitoneal mass, gynaecomastia
Cryptorchidism, genetic predisposition, testicular dysgenesis - 66Classification of GCTsIn situ - intratubular germ cell neoplasia
invasive - Seminoma, NSGCT, mixed - 67Subtypes of seminomaclassical - most common in 40s, mos
Spermatocytic - older age group, prognosis is better than classical - 68NSGCTs -4 subtypesembryonal carcinoma
Yolk sac tumour
Choriocarcinoma
Teratoma - 69Embryonal carcinoma20-30
usually associated with other GCT - 70Yolk sac tumourMost common GCT in <3yrs
in adults, associates with embryonal carcinoma
serum AFP is raised - 71Choriocarcinomahighly malignant
raised serum HCG levels - 72Teratomacan differentiate into any of the 3 germ layers
2nd most common in children
good prognosis
adult pure form is rare, treated as malignant as they have a high metastatic potential - 73Mixed GCT14% of all GCTs
treated as a NSGCT - 74Prognosis for testicular cancerType dependant - seminoma worse than NSGCT
staging:
1. contained within testicle, no spread. 1s means raised markers post surgery
2. nearby lymph nodes in abdo/pelvis. S1 raised markers
A- lymph nodes <2cm
B- 2-5
C- >5
3. A- distant lymph spread (collarbone, lumgs)
B- nearby/distant nodes with high markers S2
C- same as B but higher markers S3, OR spread to another organ
Size in seminoma - <40mm good, <40 bad
Invasion of the reti-testis
Vascular invasion - 75BPH - patient, symptoms, causesv common in men over 50
urinary retention
caused by androgens (DHT) - 76Prostate carcinoma - patient, etiologymen over 50
hormone androgen receptor
genes 1q24-25 and 1st degree relatives - 77Staging of prostate carcinomaA- non palpable
B- palpable
C- Extracapsular extension
D- metastatic - 78Diagnosis of prostate carcinomaRaised PSA level according to age:
50-59; >3
60-69; >4
70+; >5
digital PR exam
Imaging
Biopsy - 79Complications of reflux oesophagitisstricture - fibrosis of smooth muscle reduces compliance of oesophagus. can be caused by achalasia
Barretts - replaced lining with glandular mucosa due to reflux of stomach acid. Raises SCJ above GOJ - barretts distance
Neoplasia: SCC - 20% 3:1 m:f, poor prognosis
Adenocarcinoma - 80% good prognosis if early stage staged using TNM - 80TNM stagingT - tumour; depth of invasion
N - nodes; involvement of lymph nodes
M - metastases - 81Achalasiadestruction of myenteric ganglion cells
complication: SCC, stricture
immobilisation due to lack of peristalsis - 82Common UGI infectionsCandida - old age, immunosuppressed; cottage cheese in oesophagus
HSV - immunosuppressed, old age not enough
Chagas disease - reduviid bug from central/south america; causes pseudo-achalasia, cardiomyopathy - 83ABC classification for gastritisA- autoimmune
B- bacterial
C- chemical - 84Reactive gastritisChemical most common;
often caused by nsaids and alcohol;
look for vessel dilation in foveolar epithelium - 85HP gastritiscomplications: ulcer, MALT lymphoma and carcinoma
often present in antrum, moves in caudal direction as epithelium is destroyed - 86MALT lymphomaresult of chronic HP, treat by eradicating HP with PPI, Abx +/- bismuth
- 87Gastric carcinomamost common in antrum, with higher HP levels
HP is class 1 carcinogen - 88Adenocarcinoma of the stomachM:F - 3:1
RFs: poor diet, HP
if advanced - <20% 5yr survival
early - 90%
Intestinal or diffuse type
Diffuse can be treated with Her2 therapy
TNM staging - 89GISTcaused by mutations in tyrosine kinase genes (KIT)
treat with surgery and TKIs (imatinib)
Most common in stomach - 90Coeliac diseasecomplications: malabsorption - anaemia low albumin; ulcerative jejunitis; neoplasm - EATL, SIadenoC
pathology: flat micosa, reduction in vilous height to crypt depth ratio from 5:1 to 3:1 - 91GiardiasisMost common SI protozoal infection
Contaminated waterspread
immunocompromised patients
mucosa can be normal and inflamed - 92SI neoplasiaDuodenal in FAP
adenocarcinoma - rare; autoimmune conditions
Lymphomas - B&T cell, Burkitts (ilieum), EATL
Neuroendocrine tumours - SI has 5% 5 yr survival - 93HPV16&18 - malignancy
6&11 - genital warts
spontaneously clears unless immunosuppression - leads to chronic infection and progression to malignancy
brush smear to check for HPV - 94Cervical squamous cell carcinoma - causes, pathophysiologyoften begins with persistent HPV infection
high risk types integrate proteins e6&7 - inhibiting p53 and retinoblastoma, leading to dysplasia of squamous epithelium - 95Grading of CSCCCIN 1,2&3-
1. Mild, lower 1/3
2. moderate 2/3
3. severe whole thickness (Carcinoma in situ)
after CIN3 = invasive SCC - 96Treatment of CSCCif CIN1/2 then LLTx of transition zone (retain fertility)
if CIN3 or invasive, hysterectomy and pelvic lymph node resection (infertile)
if possible keep ovaries to prevent early menopause - 97Adenomyosis - pathogenesisendometrial tissue located within the myometrium - 'islands' of endometrium
causes smooth muscle inflammation and menorrhagia - 98Endometriosisendo tissue on serosa outside of the uterus
causes metaplasia of serosal cells to endometrial cells
causes 'chocolate cysts' due to no drainage for bleeding - 99Endometrial carcinoma - red flag and RFsPostmenopausal bleeding
normal + nulliparous, infertility - 1002 types of EC1. more common, endometrioid carcinoma
oestrogen excess; often obese without children
2. serous cell carcinomas
elderly with atrophic endometrium, tend to be higher grade, not related to oestrogen excess - 101Grading of endometrioid carcinomasSimple hyperplasia
complex hyperplasia - complex architecture
Atypical complex hyperplasia - glands increase in size and abnormal nuclear activity lining the glands
Carcinoma - cells lining glands show invasion - 102Grading of ECFIGO staging
1 confined to uterine body
2 invading cervix
3 not beyond true pelvis
beyond true pelvis +/- bladder/rectum - 103Fibroid leiomyomabenign SM tumour - subserosal, intramural, submucosal
often multiple
can produce abnormal bleeding, discomfort
growth stimulated by oestrogen exposure - 104Leiomyosarcomausually single
haemorrhage, frequent mitoses - 105Ectopic pregnancy - signs, treatment and RFpositive urine test but negative US;
salpingectomy;
Scarring or structural abnormality can predispose (chlamydia, gonorrhoea, PIV) although often no history - 106metastatic ovarian tumours - pathogenesisDirect spread from gastric carcinoma, haematogenous from breast
- 107types of ovarian tumourSurface epithelium - most common, can form different endothelial phenotypes, usually cystic, can be benign, malignant or borderline
germ cell - benign mostly, can form teratoma: totipotent, solid with cysts, often single component e.g. dermoid
Sex-cord stromal tumours - can be granulomas or fibromas - 108Crohns disease - epidemiology, pathologycommon in north america/europe
RR for siblings is 13-36x, most common 15-30yrs
both ileum and caecum in 40-50%
Skip lesions, cobblestone and crypt abscesses all characteristic - 109Crohns - complications and treatmentadhesions, perforation, perirectal disease, malabsorption, small bowel adenocarcinoma
5-asa, steroids, immunosuppression, monoclonal antibodies against tnf (infliximab), surgical resection - 110UCRR for siblings is 7-17x
max incidence 20-50, another peak at 60-70
histology is crypt abscesses with neutrophils in the crypt and gland branching - 111Toxic megacolon - presentation, cause, complications and treatmenthigh fever, tachycardic, diarrhoea;
paralysis of the motor function of the transverse colon
perforation, massive haemorrhage, colon cancer
5-asa, steroids, immunosuppression, surgery - 112inflammatory polypsseen in UC and CD
look like adenomas, microscopically inflammatory, hyperplastic mucosa - 113hamartomatous polypsbenign tumour like lesions
juvenile polyps - cystic glands with normal or inflamed epithelium, germ line SMAD4 mutation (18q21-22 in 25-30%), usually child less than 8; 80% in rectum, usually presents with bleeding or rarely prolapse
Peutz-Jegher - polyps and pigmentation of the oral mucosa, lips, palm, genitalia; autodom, can lead to intussusception and partial/complete obstruction. Can lead to adenoma/carcinoma - 114Neoplastic polypsAdenoma
premalignant- classification: tubular
tubulovillous - villi-elongated crypts
villous - more than 75% villous
Flat/depressed adenoma - high malignant potential, associated with a familial colon cancer (HNPCC) or FAP
malignant potential is proportional to villosity, size, degree of dysplasia - 115hyperplastic polypsmost common polyp in adults
asymptomatic, no mlaignant potential unless mixed types - 116Leimyomatous polypon muscularis mucosae
symptoms: anaemia, bleeding due to ulceration, epigastric pain - 117Colorectal cancer - site characteristicsright colon - polypoid, discomfort/anaemia
left colon - anular and obstructing, bleeding/mucus, colicky pain, change in bowel habit - 118Classification of CR cancersDukes:
A - into wall tissue, but not through
B - through muscularis propria into fat
C - 1 prsence in lymph nodes
2 involves apical node
D - metastases
TNM - 119TNM classificationT
1- invades submucosa
2- invades muscularis propria
3 - into subserosa/pericolic/perirectal tissues
4- invades other organs/structures and /or perforates visceral peritoneum
N
0 - no lymph node spread
1 - 1-3 regional lymph nodes
2 - 4+ regional lymph nodes
M
0 - no mets
1 - mets - 120Stage groupings1 - T1 or 2, N0, M0: begun to spread but within inner lining
2 - T3 or 4, N0, M0: spread to tissues near the colon/rectum, no lymph nodes
3 - any T, N1/2, M0: spread to lymoh nodes but not distant parts of the body
4 - M1: metastasised, mostly lung and liver - 121HNPCCautodom
carcinoma develops a lot younger
right sided, abnormalities in 4 repair genes - 122Amsterdam criteria for HNPCC3+ family members with cr cancer, at least 2 1st degree relatives
2 successive generations
1 must have occured before 50
FAP has been excluded - 123FAPwithout intervention all will develop colon cancer
multiple polyps throughout colon
none at birth, develop over time
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- 3rd year Fichas sobre Histopathology, creado por Rory Purves el 24/04/2017.
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- Rory Purves
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