25.5.2013(pathology gen,MGT,FGT,liver) 17 Flashcards by rakesh durai

Which is more commonly associated with congenital anomalies
Omphalocele
Gastroschisis

Omphalocele (50-60%)

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Most common site of gastrochisis

Right of umbilical cord

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Which is associated with mesenteric volvulus?
Omphalocele
Gastroschisis

Gastroschisis

Intestines are not fixed and have not undergone rotation

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Most common indication for Ileostomy

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Most common indication for colostomy

Colorectal cancer

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Normal human diploid fibroblasts stop proliferating after

50 doublings(hay flick phenomenon)

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Telomerase activity is expressed in

Germ cells
Cancer cells
Stem cells

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Apoptotic bodies

Councilman bodies
Civette bodies(lichen planus)
Tingible body macrophages(follicular lymphoma)

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Malignancies undergoing spontaneous regression

Neuroblastoma
Retinoblastoma
Melanoma
Choriocarcinoma

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Which of the following is an example of apoptosis
Mild hypoxia
Viral hepatitis
Neutrophil death in acute inflammation
All of the above

All of the above

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Hallmark of apoptosis

Chromatin condensation

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Nuclear changes in necrosis

Pyknosis
Karyohexis
Karyolysis

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Nuclear change in apoptosis

Fragmentation into nucleosome size fragments

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Phagocytic recognition of apoptotic cells is due to membrane expression of

Phosphatidyl serine(flips out from inner layer)
Thrombospondin

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Fas-fasl interaction is important for

Eliminating self reacting lymphocytes

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Action of TNF

Cell death or cell survival

Both!

Yin and yang action

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Apoptosis is induced by TNF through

TRADD(TNF receptor associated death domain)

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Cell survival is promoted by TNF through

NF kB

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Lysosomal enzymes effectively degrade all except
Starch
Carbohydrates
Protein
Fat

Fat

Lipofuschin

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Drug impairing lysosomal functions

Chloroquine(raises the internal pH of lysosomes)

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Oncocytomas arise from

Kidney
Salivary gland
Thyroid(Ashkenazy cells)
Parathyroid

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Renal tumor on cut section showing central scar and mahogany brown color

Oncocytomas

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Megamitochondria

Alcoholic liver disease
Nutritional deficiencies
Mitochondrial myopathies

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Amantia phylloids attacks

Thin filaments

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Thickest filament

Microtubules

Immuno marker of epithelial cells

Cytokeratin

Immunohistochemical marker for sarcoma

Vimentin

Drug preventing polymerisation of actin filaments

Cytochalazin B

Interleukin essential for hepatic cell regrowth

IL-6 | TNF

Stem cell niche in GIT

Isthmus of gastric glands | Crypts of small intestine

Permanent cells

Neurons | Cardiac and skeletal muscle cells

Stable cells

Hepatocytes Fibroblasts Osteoblasts

Labile cells

Bone marrow | Epithelial cells

The gene expressed in senescent cells

p21

``` All are effects of bradykinin except Vasoconstriction Pain Smooth muscle contraction Increased vascular permeability ```

Vasoconstriction

Increased vascular permeability is caused by which leukotrienes

LTC4 LTE4 LTD4 Except LTB4(powerful chemoattractant)

Platelet activating factor is released from

``` Platelets Basophils Mast cells Neutrophils Monocytes Macrophages Endothelial cells ``` Except: eosinophils

Action of PAF

Platelet activation Vasoconstriction Bronchoconstriction Mild doses: vasodilation

Priming of neutrophils is produced by

TNF

NOS3

Endothelial cells

NOS1

Brain

NOS2

Macrophages

PAF

Acetyl glyceryl ether phosphoryl choline

``` All are chemotactic except C5a Leukotrienes B4 Cytokines C3a ```

C3a

Anaphylotoxin chemoattractant

C5a

Coagulation factor secreted by macrophages is

Factor V

Chronic inflammation characterised by neutrophilic exudate

Actinomycetes Osteomyelitis Smoking

Pathognomonic feature of syphilis

Endarteritis obliterans

Acute inflammation not predominated by mononuclear cells after 24 hrs

Pseudomonas | Neutrophils persist for 2-4 days

Characteristic histologic appearance of granulation tissue

Angiogenesis(proud flesh)

Granuloma in cat scratch disease

Palisading/stellate

Granuloma in sarcoidosis

Naked granuloma | No lymphocyte cuffing

Naked granuloma seen in

Sarcoidosis Crohn Berylliosis

Lymphoma present with granuloma

Lennert(T cell lymphoma) | Hodgkin

Granuloma in toxoplasmosis

Microgranuloma

In langhans giant cells nuclei are arranged

Peripherally(horse shoe shaped)

Teuton giant cells(nuclei arranged around the circumference)

Juvenile xanthogranuloma

Lymphoid leukomoid reaction

Whooping cough

Myeloid leukomoid reaction

Any pyogenic infection | Tuberculosis!!

Lines of zahn are seen when thrombi form in

Heart | Aorta

Direction of growth of arterial thrombi

Retrograde direction from point of attachment

Thrombi applied to only one wall of underlying structure

Mural thrombi Not occlusive May embolise

Vegetations in libman sacks endocarditis

Verrucous

Vegetations in IE

Large friable

Descending order of arterial thrombi

Coronary Cerebral Femoral

Coagulative or red thrombi are formed in

Venous thrombi

Phlebothrombosis most commonly affects the

Deep calf veins

Characteristics of PM clot

Rubbery and gelatinous Current jelly and chicken fat appearance Not attached to underlying wall

Most common source of embolism

Thrombus Not atheromatous debris

Most common symptom of pulmonary embolism

They are clinically silent(60-80%)

Acute cor pulmonale occurs when pulmonary embolus obstructs how much of total pulmonary vasculature

60%

Systemic arterial emboli commonly arise from

Intracardiac mural thrombi | 2/3 from LV wall infarct

Most common site of arterial emboli

Lower limbs(75%) Brain only 10%

Caisson disease is

CHRONIC decompression sickness

Red infarcts occur in

``` Venous infarct(ovarian torsion) Loose tissues- lung Dual circulation-lung,small intestine Reflow into arterially occluded area Previously congested area ```

Shock occurring in anaesthetic accident

Neurogenic shock

Zonal lesions in shock

Subendocardial hemorrhages in heart | Contraction band necrosis

Organ resistant to hypovolemic shock

Lung

GIT lesion in shock

Hemorrhagic enteropathy

Septic shock is due to

GNB | GPB

Chemotactic interleukin

IL8

Type 3 Lepra reaction

Lucio phenomenon

Commonest immunodeficiency

Selective IgA deficiency

Free heavy chains in cytoplasm are found in

Bruton agammaglobulinemia Light chains are not rearranged

Type 3 reaction histologically

Neutrophilic Leukocytoclastic vasculitis

Type of hypersensitivity in RA

Type 4

Type of hypersensitivity in PAN

Type 3

Type of hypersensitivity in type 1 diabetes

Type 4

T cell zone of lymph node

Paracortex

Reactive T cell proliferation that mimics T cell lymphoma

``` Phenytoin Primadone Infectious mononucleosis Vaccine associated lymphadenopathy Dermatopathic lymphadenitis ``` Pseudolymphoma- para cortical widening

First site of lodgement of metastasis to lymphnode

Sub scapular sinus

Most severe pattern of renal involvement in SLE

Diffuse proliferative glomerulonephritis

Wire loop lesions

Class 4(more common) and 5

Type of hypersensitivity reaction to inhaled dusts

Type 1 with eosinophilia

Type of lymphoma In sjogren syndrome

Marginal zone lymphoma

Foamy exudate of lung is seen in which infection

PcP pneumonia

Best fungal stain

Gomorri methiamine stain

Major pathway in acute CELLULAR rejection

Direct pathway

Co stimulation of T cell activation is provided by

CD28(T cell) CD80 CD86 Found in APC

Major pathway in chronic cellular rejection

Indirect pathway

Central tolerance takes place in

Thymus | Bone marrow

Antigen sequestration is found in

Eye Brain Testis

Acute humoral rejection manifests as

Rejection VASCULITIS

Histological feature of cellular rejection

Interstitial mononuclear infiltrate

Class 3 HLA

Codes for components of complement Pathway

Fc receptor for IgG on NK cells

CD16

Receptor for EBV on B lymphocyte

CD21

ANCA associated vasculitis type of hypersensitivity

Type 2

Rheumatic fever - type of hypersensitivity

Type 2

Light chain seen in multiple myeloma amyloidosis

Lambda

In Ewing sarcoma the cells are rich in

glycogen

T cell area of spleen

Peri arteriolar sheath

Site of first appearance of amyloid in liver

Space of disse

Primary hemochromatosis iron deposition ,site

Within hepatocytes

Secondary hemochromatosis iron deposition site

Kuppfer cells

First site of amyloid deposition in kidney

Peri tubular capillaries in interstitium | Mesangium in glomeruli

Patients with Wiskott Aldrich syndrome develop which tumor

Lymphoma

Endothelitis is a feature of which type of graft rejection

Acute cellular rejection of kidney graft

Small vegetations confined to valve leaflets

Rheumatic endocarditis

Warty deposits on both sides of valves

LS endocarditis

Immunosuppressive therapy is beneficial in which myositis

Juvenile and adult dermatomyositis | Polymyositis

Pathology in SLE in spleen

Onion skin

Capsular drops and fibrin caps in kidney are seen in

Diabetic nephropathy

PAS positive and diastase sensitive

Glycogen

Flea bitten kidney

Malignant hypertension RPGN HUS IE

AIDS defining neoplasm

Kaposi B cell non Hodgkin lymphoma Primary CNS lymphoma Invasive Ca cervix

Most common fungal infection in immunocompromised

Oral candidiasis

Pattern of nuclear fluorescence diagnostic of SLE

Rim or peripheral staining

Homogenous or diffuse pattern

Ab to histones Chromatin Double stranded DNA

Rim or peripheral staining

Ab to double stranded DNA

Commonest pattern of fluorescence

Speckled

Speckled pattern

Non specific | Ab non-DNA nuclear constituents

Fluorescence pattern specific for systemic sclerosis

Nucleolar pattern

Ab against Nucleolar RNA

Hyperacute rejection is similar to

Arthus reaction

Most common Fungal infection in HIV patients

Oesophageal candidiasis

Contents of mast cell granules

``` Histamine Adenosine ECF NCF dermatin and heparin sulphate ```

Chief cytokine in type 4 hypersensitivity

IFN g

Chronic transplant glomerulopathy

Duplication of glomerular basement membrane

Cytokines that augument NK cell activity

IL2 and IL 15

Uniform tumor cells surrounded by lymphocytes | Genital tumor?

Seminoma/dysgerminoma

Germcell tumor that is extremely radio sensitive

Seminoma

Most common malignant germ cell tumor

Seminoma

Types of seminoma

Typical Anaplastic Spermatocytic

Seminoma variant that occurs in age >65

Spermatocytic seminoma

Histology of spermatocytic seminoma

3 populations of cells | Excellent prognosis

Germ cell tumor not associated with ITGCN

Spermatocytic seminoma Dermoid cyst Paediatric teratoma Yolk sac tumor

Ovaries with male external genitalia

Female pseudo hermaphrodite

Tumor marker for epithelial tumors of ovary

CA 125 | Osteopontin

CD 30 +

Hodgkin | Large cell lymphoma

Best marker for anaplastic large cell lymphoma

ALK

Reinke crystalloids seen in

Leydig cell tumor

Sarcoma botryoids

Rhabdomyosarcoma

Commonest sarcoma of children and adolescence

Rhabdomyosarcoma

Tadpole or strap cells

Rhabdomyosarcoma

IHC markers of rhabdomyosarcoma

MyoD1 Desmin Myogenin

Types of rhabdomyosarcoma

Embryonal Alveolar t 2;13, t 1;13 Pleomorphic

Site of embryonal rhabdomyosarcoma

Head and neck region

Site of alveolar rhabdomyosarcoma

Extremities

Tennis racket cells

Sarcoma botryoids

Cambium layer present in

Sarcoma botryoids

Saw toothed appearance of endometrial glands

Secretory phase

Gartner cyst derived from

Mesonephric duct

Most common malignant transformation of teratoma

SCC

Ovarian carcinoid arises from

Intestinal epithelium of teratoma

Proliferative endometrial glands

``` Tubular glands Columnar cells Mitosis++ Compact stroma Spindle cells ```

Secretory phase of endometrium

Basal secretory vacuols Edematous stroma Tortuous glands Spiral arterioles

Most common cause of bloody serous discharge from nipple

Large duct papilloma

Commonest tumor of ovary

Surface epithelial tumors(90%)

Major pathological change in eclampsia

Thrombosis of arterioles and capillaries

Serous cystadenocarcinoma | Unilateral/bilateral

Bilateral 65%

Majority of complete mole karyotype

46XX

Androgenetic mole

Complete mole

Partial mole

69XXY | 69XXX

Ovarian tumor showing combination of germ cell and sex cord stroma elements

Gonadoblastoma | Arise from dysgenetic gonads

Coffee bean nuclei are characteristic of

Granulosa cell tumor | Brenner tumor

Cerebriform nucleus

Sezary T cells

Flower/ clover leaf cells

HTLV induced lymphoma

Hallmark cells

Anaplastic large cell lymphoma

Commonest tumor of paratesticular region

Adenomatoid tumor

Adenomatoid tumor in females occurs in

Fallopian tube

Most common malignant paratesticular tumor

Rhabdomyosarcoma

Commonest malignant paratesticular tumor in adults

Liposarcoma

Commonest malignant germ cell tumor <3yrs

Yolk sac tumor

Yolk sac tumors contain

Alpha feto protein | Alpha 1 anti trypsin

Hyaline globules are seen in

Yolk sac tumor

Second common malignant tumor of germ cells

Yolk sac tumor

Causes of pseudomyxoma peritonei

Ovary Pancreas Appendix

Ovarian tumor common in Dysgenetic ovaries

Gonadoblastoma

Desmoplastic reaction is seen in which breast cancer

Ductal carcinoma

Red Indian file pattern

Infiltrating lobular carcinoma

Molecular defect in infiltrating lobular carcinoma

E cadherin mutation

Syntitium pattern

Nasopharyngeal Ca | Medullary carcinoma of breast

Most common type of breast Ca

IDC NST

Psammoma bodies

Papillary cystadenocarcinoma Pap ca of thyroid Meningioma Choroid plexus papilloma

Cutoff level of PSA

4ng/ml

Perineural infiltration

Adenoidcystic carcinoma Pancreatic Ca Prostate Ca

Most common tumor in undescended testis

Seminoma

Fixation is not needed for

Romanovsky stain

Ideal needle for FNAC

23-24 G

Stain used for vaginal hormonal cytology

Shorr stain

Stain for buccal smear(Barr body demonstration)

Aceto orcein stain

Most common benign GCT of ovary in premenopausal women

Benign cystic teratoma

Acute angle septate hyphae

Aspergillosis | Penicillium

Broad non septate hyphae

Mucormycosis

Infection associated with long standing IUD

Actinomycetes

Criteria for leiomyosarcoma

>10 mitosis in 10 high power fields

STUMP

Smooth muscle tumor of uncertain malignant potential

Submitting a tissue sample of mastectomy specimen of IDC for analysis by flow cytometry is useful for

Determination of aneuploidy

Basal like carcinoma of breast

Triple negative cancer

Triple negative cancer associated with what mutation

BRCA 1

Which teratomas are solid

Immature teratomas

Presence of which structure is only seen in immature teratomas

Neuroepithelial structures

Commonest site of cavernous hemangioma

Liver

Hemangiopericytoma is | Malignant/benign

Malignant

Grading system of breast

Tubule formation Nuclear pleomorphism Mitotic figures Bloom Richardson staging

Neoplasm originating from placental tissue

Chorangioma

Physaliferous cells

Cordoma

TCC like epithelial cell tumor of ovary

Brenner

Bilateral breast Ca

Invasive lobular

Increased risk for breast malignancy- histology

Florid epithelial hyperplasia Sclerosing adenosis Atypical epithelial hyperplasia Ductal papilloma Except: adenosis

Breast lesion associated with smoking

Periductal mastitis

Brenner tumor commonly associated with

Mucinous cystadenoma

Teratocarcinoma

A mixed germ-cell tumor Combination with embryonal carcinoma Choriocarcinoma Endodermal sinus tumor

The karyotype of all benign teratomas

46XX

Benign teratomas arise from

Meiotic germ cell

Icthyosis uterus

Extensive squamous metaplasia of endometrium

Biphasic pattern

Carcinosarcoma(uterus) malignant mixed mullerian tumor Synovial sarcoma Pleomorphic adenoma Mesothelioma

Demonstration of mast cells in synovial sarcoma

Toludine blue(metachromatic granules)

Most common malignancy ass with calcification in mammography

DCIS

mRNA arrays are used for

Predicting prognosis Predicting response to therapy Classifying hereditary Ca

Screening of breast cancer in young women

USG

Lobular carcinoma rarely metastasise to

Lungs!

Chr associated with lobular carcinoma

Chr 16

Vascular invasion is never seen in which type of breast Ca

Medullary carcinoma

Her2 neu over expression not seen in

Medullary Ca of breast | Lobular

Better prognosis despite high grading in bloom Richardson

Medullary carcinoma

Overexpression of adhesion molecules seen in which type of Ca breast

Medullary carcinoma

Protein involved in pathogenesis of paget disease of breast

Heregulin alpha

Soft fleshy breast Ca

Medullary Ca of breast

Proliferation indices

Ki-67 | MIB-1

Phylloids tumor arise from

Intralobular stroma

Breast tumor with increased epithelial cellularity and no stromal cellularity

Fibroadenoma Opposite for phyllodes

Most aggressive sarcoma of Breast

Angiosarcoma

Rye classification

Hodgkin

KEIL classification

Lymphoma

Key factor in development of endometrial carcinoma

Loss of PTEN expression

Follicular hyperplasia of lymph node seen in

Toxoplasmosis HIV early phase RA

Type of breast cancer in children

Secretory type

Breast Ca with excellent prognosis

Tubular Ca

Von brun nests are seen in

Bladder mucosa

Sites of paraganglioma

Carotid body Aortic arch Bladder Organ of zuckerkandl

Paragangliomas are chromaffin

Negative

60yr male Fluctuant parotid mass For 10 yrs No h/o pain,paralysis or growth

Warthin

Which choriocarcinomas have excellent response to chemotherapy

Gestational Not ovarian choriocarcinomas

Cytokines producing osteolysis

IL6 RANKL MIP1alpha

Most common primary for krukenberg tumor

Stomach

Cigarette smoking and OCP use are risk factors for

Cervical cancer

BRCA1 mutation in men increased risk for

Prostatic cancer

Premalignant vulval neoplasm

Squamous hyperplasia

Most common histologic type of Ca cervix

Large cell non keratinising SCC

Arias Stella reaction occurs in

Uterine ,ectopic gestation

Malignant potential of atypical hyperplasia of endometrium

25%

Most common germ cell tumor

Teratoma

Most aggressive germ cell tumor of ovary

Choriocarcinomas | Embryonal carcinoma

Chorionic villi are present in

Complete mole Partial mole Invasive mole Except: choriocarcinomas

Bilaminar pattern is seen in which malignancy

Choriocarcinoma Cytotrophoblast Syncytiotrophoblast

Area of liver lobule most sensitive to toxic injury

Zone 1

Mid zonal necrosis

Yellow fever

Most specific enzyme for liver cell injury

SGPT(ALT)

Mitochondrial liver enzyme

AST

AST is elevated in

Myocardial Skeletal muscle Renal Liver injuries

Bilirubin form elevated in convalescence phase

Delta bilirubin

Irreversibly conjugated bilirubin to albumin

Ground glass cytoplasm with sanded nuclei of hepatocytes

Hepatitis B

Genetic component of hep B responsible for carcinogenesis

HBxAg

Most sensitive marker for hep B infection

HBV DNA

stones generally not associated with chronic cholecystitis

Pigment stones

Color of stone in sterile gall bladder bile

Black stone

Neonatal jaundice that begins between 4-7 days

Breast milk jaundice

MRP2 mutation is seen in

Dubin Johnson syndrome Human canalicular organic anion transporter cMOAT

Black liver

Epinephrine metabolites | Dubin Johnson

Ab in PBC

E2 subunit of pyruvate dehydrogenase complex

Diffuse micro vesicular fatty change

Reyes Sod.valproate Tetracycline Jamaican vomiting sickness

Most common symptom of chronic hepatitis

Fatigue

CFTR is expressed by epithelial cells of

Large pancreatic ducts

Most common congenital anomaly of pancreas

Pancreas divisum

Gene mutated in hereditary pancreatitis

Cationic trypsinogen gene PRSS1 SPINK1 serine protein inhibitor kazal type 1

Effect of chronic pancreatitis on insulin secretion

Islets of langerhans are spared

Most frequently inactivated tumor suppressor gene in pancreatic Ca

P16 >95%

Factors responsible for trousseau sign

Pro coagulant factors | PAF

Post necrotic cirrhosis

Macro-nodular cirrhosis

Most common congenital anomaly of gall bladder

Phrygian cap

Characteristic histologic finding in fulminant hepatic failure

Confluent necrosis

Fulminant hepatic failure

Hepatic encephalopathy within 3 wks of onset of hepatic dysfunction

Ab in autoimmune hepatitis

ANA Anti smooth muscle antibody Anti LKM1 ab

Complications of caroli disease

Intrahepatic amyloidosis Cholangiocarcinoma Lithiasis

Caroli syndrome

Caroli disease+ congenital hepatic fibrosis

Schirrous tumors

Desmoplastic small round cell tumor Cholangiocarcinoma DCIS Fibrolamellar variant of HCC

Spread of cholangiocarcinoma

Lymphatic

Armani ebstein cells

PCT cells rich in glycogen in diabetic nephropathy

Extrinsic pathway of apoptosis | Initiator caspase in humans

Caspase 10

Lucio phenomenon

Lepromatous leprosy Ulcerative lesions mainly in lower limb Secondary infections may occur

Lucio phenomenon type of hypersensitivity reaction

Type 3

Marker for seminoma

Placental alkaline phosphatase

5 P s of compartment syndrome

``` Pallor Paresthesia Paresis Pulselessness Pain ```

Delta pressure

Diastolic pressure-compartment pressure

Immediate fasciotomy

Delta pressure30-40mm

Pauwel classification

Angle the fracture line forms with the horizontal 70

Anatomical classification of # NOF

Subcapital Transcervical Basal

Most widely used classification for # NOF

Garden | Angle btw primary compression trabeculae and axis of shaft

Rx #NOF age<65 yrs

ORIF

Rx #NOF age>65 | Without acetabular disease

Hemiarthroplasty

Rx #NOF age>65 | Acetabulum diseased

THR

Most common primary bone malignancy in age<10yrs

Ewing sarcoma

IHC stain for Ewing

MIC2

Histochemistry of Ewing sarcoma

PAS+ | reticulin-

Most common site of metastasis of Ewing

Lung

Poor prognostic factors for Ewing

``` Fever Increased WBC,ESR,LDH Increased age Male Anemia Aberrant P53 expression ```

Rx for Ewing

Radiosensitive

IHC stain for hemangiopericytoma

Factor VIII

PAS -,reticulin +

Lymphomas

Man lifted heavy weight from ground and experienced pain at back and radiating down lateral aspect of leg and big toe.diagnosis?

L4-L5 disc prolapse

Knee jerk is affected in

L4 lesion

Ankle jerk is affected in

S1 lesion

Sensory loss in L4 root compression

Posterolateral thigh Anterior knee Medial leg

Sensory loss in L5 lesion

Anterolateral leg Dorsum of foot Great toe

Sensory loss in S1 lesion

Lateral foot Lateral malleolus Heel Web of fourth and fifth toes

In acute ACL injuries the menisci torn is

Lateral menisci

The ACL band taut during flexion

Anteromedial band

Location of cruciate ligaments

Intracapsular | Extra synovial

Most sensitive test for acute ACL rupture

Lachman test

Mensicofemoral ligaments

Ligament of Humphrey (ant) | Ligament of wrisberg(post)

Dial test

Used to identify Posterolateral corner injury

25.5.2013(pathology gen,MGT,FGT,liver) 17 Flashcards

(334 cards)