Ch8: Surgical Diagnosis Flashcards
(110 cards)
1
Q
- Surgical pathology involves what types of studies?3
A
- Frozen sections
- Permanent sections
- Special studies
2
Q
Tumor diagnosis is performed originally by who?
A
Surgeon
3
Q
Tumor diagnosis is done by doing what?
A
Removing a mass
4
Q
Two types of procedures for tumor diagnosis?
A
Lumpectomy: Benign lesion
Radical: Malignant lesion
5
Q
With a frozen section, who looks at tissue first?
A
pathologist
6
Q
What determines whether an area will be examined for frozen section?
A
- Tumor or not
- benign or malignant
- if margins need to be used
7
Q
What is process of frozen section? 5
A
- Tissue put on chuck and covered with OCT
- Place in cryostat and freeze to -22 celscius
- Then cut thin slices in cryostat
- Stain with hematoxylin and eosin and cover slip
- Examine microscopically and give diagnosis
8
Q
What are three things difficult to do with frozen tissue?
A
- margins of malignant melanoma
- lymphoma assessment
- degree of dysplasia
9
Q
What are steps of permanent sections diagnosis? 11
A
- Tissue entered and recorded
- Gross examination occurs
- Dissected
- Fixate with a fixative agent
- Embed in paraffin
- section
- plass on glass slide
- de paraffined
- stained
- cover slipped
- diagnosed
10
Q
Most common fixative?
What else might be used?
A
Formalin
B-5, bouin’s, zencker
11
Q
What is most common stain of tissues?
A
Hematoxylin and eosin
12
Q
What will Oil Red O stain do?
A
Red dye that dissolves into triglycerides
13
Q
What does silver stain do?
A
Precipitate silver into specific cells, or components of cell walls of fungi and bacteria
14
Q
What is Grocott’s or Gomori’s methenamine silver stain used for?
A
Fungi
15
Q
What is Warthin-Starry silver stain used for?
A
Bacteria/Spirochetes
16
Q
What is BIelschowsky’s silver stain used for?
A
Neural tissue
17
Q
What is reticulin stain used for?
A
Staining reticulin network in tissues
18
Q
Reticulin is what type of collagen?
Where is it found?
A
Type III
In support of organs
19
Q
Periodic Acid Schiff stain (PAS) is used for what structures? (4)
A
- fungi
- intestinal mucins
- basement membranes
- glycogen
20
Q
Giemsa stain is used for what? (2)
A
H. pylori
Parasites
21
Q
Congo red stain is used for what?
A
Amyloid stain
22
Q
Trichrome stain is used for what? 3
A
Differentiating smooth muscle (red), CT (blue), and neural tissue (pink)
23
Q
Two types of iron stains?
A
Prussian blue
Colloidal iron
24
Q
Prussian blue does what?
A
Stains tissue iron blue
25
Colloidal iron stains what blue?
Mucins
26
Tissue gram stain does what?
Gram stains bacteria
27
What are the three myobacterial stains?
1. Ziehl neelson
2. fite stain
3. auromine O stain
28
What stains will you use for fungi? (2)
1. PAS or
| 2. GMS
29
What stain will you use for BM of glomerulus?
1. PAS
| 2. silver reticular
30
What are immunostains?
Monoclonal antibody stains that have marker substance.
31
What are immunohistochemical stains?
Chromagen catalyzed by an enzyme with antibody that results in color formation
32
Immunofluorescent stains are different from immunostains how?
Still use mono Ab's but have a fluorescent tag attached, remain attached to antigen after slide rinse.
33
Polyclonal ab's come form what?
Animals that have been exposed to antigen of interest
34
Monclonal ab's come from what?
Mice
35
Are mono or poly ab's more specific?
Mono
36
Steps of making mono ab's? 4
1. Expose mouse to antigen
2. Remove splenic lymphocytes
3. fuse with mouse myseloma to make hybrid that produces Ab and has long cell life.
4. Culture hybridomas and harvest antibody
37
What is cold ischemic time?
Time from when tissue is removed from body until it is fixed
38
What is fixation time?
Perfect amount of fixation as to not alter staining
39
Some antibodies need what to increase their sensitivity?
Antigen retrieval
40
antigen retrieval is done by what? (4)
1. heating
2. EDTA
3. citrate
4. enzymes
41
Detection of immuno stains requires what? 6
1. Add primary specific monoclonal antibody to slide
2. rinse
3. add secondary detector antibody (anti mouse) to slide
4. rinse
5. Enzyme solution added to catalyze reaction with chromagen
6. color forms and you can diagnose
42
What antigen classes are used for diagnosis and prognosis? 7
1. intermediate filament
2. cell surface markers
3. hormones
4. receptors
5. enzymes
6. mucins
7. various cell proteins
43
Intermediate filament proteins are classified into what five classes?
1. Class 1 and 2: Keratins for epithelial differentiation
2. Class III: Vimentin, desmin, glial fibrillary
3. Class IV: neurofilaments
4. Class V: neurolamins
44
Keratins are markers of what?
Epithelial cells
45
Vimentin is a marker of what?
Mesenchymal cells
46
Neurofilaments are markers of what?
Neurons
47
Desmin demonstrates what?
Muscle differentiation between skeletal and smooth
48
Glial fibrillary signifies what? (2)
1. Glial fibrillary acidic protein (GFAP)
| 2. CNS glial cells (Astrocyes, ependymal)
49
Two main groups of cell surface markers?
1. CD markers on hematopoietic cells
| 2. Cell surface antigens
50
What are the T-cell CD's?
CD1 through CD8
51
What are the B cell CD's?
CD19 and CD20
52
Where is CD34?
Stem cell and blast marker
53
Where is CD45?
| What is it known as?
All leukocytes
| LCA: Leukocyte common antigen
54
What are the CD's seen in chronic lymphocytic leukemia and small lymphocytic lymphoma? 4
CD5+
CD20+
CD23+
CD3-
55
WHat are the CD's seen in Pre-T cell acute lymphoblastic leukemias?
```
CD34+
CD3+
CD8+
CD19-
CD20-
```
56
Epithelial membrane antigen is expressed where?
Glandular tissues and neoplasms
57
Carcinoembryonic antigen is what?
| Expressed in adults where?
Fetal glycoprotein adhesion molecule
Adult malignant neoplasms such as colorectal adenocarcinoma
58
Placental alkaline phosphatase is found where? (2)
1. normal placenta
| 2. adult germ cell neoplasms
59
Thyroglobulin is in what?
Thyroid neoplasms
60
Pancreatic hormone is in what?
Pancreatic islet clel neoplasm
61
Parathyroid hormone is in what?
Parathyroid neoplasm
62
Pituitary hormones are in what?
Pituitary neoplasms
63
Calictonin is in what?
Medullary carcinoma of thyroid
64
The receptor Her2-Neu is found where?
Breast and esophageal/gastric malignancies
65
MUC1 mucin is used to differentiate what?
Adenocarcinomas
66
PSA can be used to do determine what?
Prostate hyperplasia
67
Specific immunostains include? (3)
1. PSA
2. Thyroglobulin
3. Thyroid transcription factor 1
68
Nonspecific imunostains include what? 4
Pankeratin
Vimentin
CD45 (LCA)
Neuron specific enolase
69
What does pankeratin signify?
Epithelial neoplasms (carcinomas)
70
What does vimentin signify?
Mesenchymal neoplasms (sarcomas)
71
CD45/LCA signify what?
Hematopoietic neoplasms (leukemias and lymphomas)
72
Is there a malignant or cancer stain available?
No
73
Spindle cell squamous cell carcinoma will have what stain results? (2)
1. Pankeratin+
| 2. S100-
74
Spindle cell melanoma will have what stain results? 2
1. Pankeratin-
| 2. S100+
75
Atypical fibroxanthoma has what for stain results? (4)
1. Pankeratin -
2. S100-
3. CD10+
4. CD99+
76
Papillary thyroid carinoma has what for stain results? 3
1. Thyroglobulin+
2. TTF-1+
3. RCC-
77
Papillary renal cell carcinoma has what for stain results? 3
1. Thyroglobulin-
2. TTF-1-
3. RCC+
78
Ovarian papillary serous carcinoma has what for stain results? 3
1. Thyroglobulin-
2. TTF-1-
3. RCC-
79
Poorly differentiated carcinoma has what for stain results? 4
1. Pankeratin+
2. EMA+
3. S100-
4. CD45-
80
Melanoma has what for stain results? 4
1. S100+
2. Pankeratin-
3. EMA-
4. CD45-
81
Lymphoma has what for stain results? 6
1. CD45+
2. CD3+
3. CD20+
4. S100-
5. Pankeratin-
6. EMA-
82
Esophageal/gastric carcinoma has what for stain results? (3)
1. CK20+
2. CK7-
3. ER-
83
Metastatic lobular breast carcinoma has what for stain results? (3)
1. CK20-
2. CK7+
3. ER+
84
What is the prostate cocktail stain for prostate carcinoma?
1. p504s
| 2. p63
85
p504s is what type of antibody?
Alpha-methylacyl-CoA racemase
86
What does Alpha-methylacyl-CoA do?
Enzyme in beta oxidation of fatty acids and restricted to prostatic carcinoma and high grade prostatic intraepithelial neoplasia (PIN)
87
p63 is a protein found where? 4
1. Nuclei of basal epithelial cells of the prostate
2. Myoepithelial cells of breast
3. Urothelial cells
4. squamous cells
88
Basal cells are present in what?
| But not what?
High grade PIN, but NOT prostate carcinomas
89
Estrogen and progesterone receptors are in what cancers?
Breast carcinomas
90
If you are ER+ and PR+, what does that mean about your cancer?
Lower grade with good prognosis
91
ER+ neoplasms can be treated with what?
Estrogen inhibition
92
CD20 does what for the B cell?
Surface glycosylated phosphoprotein in B-cell maturation
93
If CD20 is present on a B cell non-hodgkin lymphoma and chronic lymphocyte lymphoma, what can you use to treat?
Rituxan (anti-CD20 antibodies)
94
Her2-neu is expressed in what percentage of breast carcinomas?
25%
95
If her2-neu is overexpressed, what can you use to treat?
Herceptin (anti-Her2-neu antibody)
96
Her2-neu positive neoplasms may benefit from what other therapy?
Adriamycin
97
MIB-1 is an antibody against?
Ki67
98
Where is Ki67 expressed?
On proliferating cells
99
CD117 is what type of protein?
| What is it labeled in oncology?
1. Tyrosine kinase protein known as mast/stem cell growth factor receptor
Proto-oncogene (if mutates --> proliferation)
100
CD117 is seen where? (4)
AML
Melanoma
mast cell disease
GIST
101
CD117 mutations can be treated by what?
Gleevec (imatinib)
102
What is in-situ hybridization?
Using complimentary nucleic acid probes to detect sequences.
103
What type of viruses can in-situ hybridization mark? (3)
1. EMV
2. CMV
3. HPV
104
In-situ can be used to find what mutations in cancers? (2)
1. K-RAS
| 2. Her2-Neu
105
Oligodendrogliomas are what type of cancers?
| Where are the mutations?
CNS glial neoplasms
| 1p and 19q mutations
106
How is flow cytometry used in cancer?
Detect cancer cells using surface markers.
107
WHat is cytogenetics?
Cell replication with interruption of mitosis and assessment of individual chromosome numbers and structure after GIEMSA staining
108
Cytogenetics is used to assess what? (5)
```
trisomies
monosomies
duplications
deletions
translocations
```
109
Single nucleotide arrays are used to detect what?
SNP's which are single nucleotide alterations.
110
Electron microscopy is mainly used for what?
Biopsies
