Flashcards in Ch8: Surgical Diagnosis Deck (110):
1. Surgical pathology involves what types of studies?3
• Frozen sections
• Permanent sections
• Special studies
Tumor diagnosis is performed originally by who?
Tumor diagnosis is done by doing what?
Removing a mass
Two types of procedures for tumor diagnosis?
Lumpectomy: Benign lesion
Radical: Malignant lesion
With a frozen section, who looks at tissue first?
What determines whether an area will be examined for frozen section?
1. Tumor or not
2. benign or malignant
3. if margins need to be used
What is process of frozen section? 5
1. Tissue put on chuck and covered with OCT
2. Place in cryostat and freeze to -22 celscius
3. Then cut thin slices in cryostat
4. Stain with hematoxylin and eosin and cover slip
5. Examine microscopically and give diagnosis
What are three things difficult to do with frozen tissue?
1. margins of malignant melanoma
2. lymphoma assessment
3. degree of dysplasia
What are steps of permanent sections diagnosis? 11
1. Tissue entered and recorded
2. Gross examination occurs
4. Fixate with a fixative agent
5. Embed in paraffin
7. plass on glass slide
8. de paraffined
10. cover slipped
Most common fixative?
What else might be used?
B-5, bouin's, zencker
What is most common stain of tissues?
Hematoxylin and eosin
What will Oil Red O stain do?
Red dye that dissolves into triglycerides
What does silver stain do?
Precipitate silver into specific cells, or components of cell walls of fungi and bacteria
What is Grocott's or Gomori's methenamine silver stain used for?
What is Warthin-Starry silver stain used for?
What is BIelschowsky's silver stain used for?
What is reticulin stain used for?
Staining reticulin network in tissues
Reticulin is what type of collagen?
Where is it found?
In support of organs
Periodic Acid Schiff stain (PAS) is used for what structures? (4)
2. intestinal mucins
3. basement membranes
Giemsa stain is used for what? (2)
Congo red stain is used for what?
Trichrome stain is used for what? 3
Differentiating smooth muscle (red), CT (blue), and neural tissue (pink)
Two types of iron stains?
Prussian blue does what?
Stains tissue iron blue
Colloidal iron stains what blue?
Tissue gram stain does what?
Gram stains bacteria
What are the three myobacterial stains?
1. Ziehl neelson
2. fite stain
3. auromine O stain
What stains will you use for fungi? (2)
1. PAS or
What stain will you use for BM of glomerulus?
2. silver reticular
What are immunostains?
Monoclonal antibody stains that have marker substance.
What are immunohistochemical stains?
Chromagen catalyzed by an enzyme with antibody that results in color formation
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.
Polyclonal ab's come form what?
Animals that have been exposed to antigen of interest
Monclonal ab's come from what?
Are mono or poly ab's more specific?
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
What is cold ischemic time?
Time from when tissue is removed from body until it is fixed
What is fixation time?
Perfect amount of fixation as to not alter staining
Some antibodies need what to increase their sensitivity?
antigen retrieval is done by what? (4)
Detection of immuno stains requires what? 6
1. Add primary specific monoclonal antibody to slide
3. add secondary detector antibody (anti mouse) to slide
5. Enzyme solution added to catalyze reaction with chromagen
6. color forms and you can diagnose
What antigen classes are used for diagnosis and prognosis? 7
1. intermediate filament
2. cell surface markers
7. various cell proteins
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
Keratins are markers of what?
Vimentin is a marker of what?
Neurofilaments are markers of what?
Desmin demonstrates what?
Muscle differentiation between skeletal and smooth
Glial fibrillary signifies what? (2)
1. Glial fibrillary acidic protein (GFAP)
2. CNS glial cells (Astrocyes, ependymal)
Two main groups of cell surface markers?
1. CD markers on hematopoietic cells
2. Cell surface antigens
What are the T-cell CD's?
CD1 through CD8
What are the B cell CD's?
CD19 and CD20
Where is CD34?
Stem cell and blast marker
Where is CD45?
What is it known as?
LCA: Leukocyte common antigen
What are the CD's seen in chronic lymphocytic leukemia and small lymphocytic lymphoma? 4
WHat are the CD's seen in Pre-T cell acute lymphoblastic leukemias?
Epithelial membrane antigen is expressed where?
Glandular tissues and neoplasms
Carcinoembryonic antigen is what?
Expressed in adults where?
Fetal glycoprotein adhesion molecule
Adult malignant neoplasms such as colorectal adenocarcinoma
Placental alkaline phosphatase is found where? (2)
1. normal placenta
2. adult germ cell neoplasms
Thyroglobulin is in what?
Pancreatic hormone is in what?
Pancreatic islet clel neoplasm
Parathyroid hormone is in what?
Pituitary hormones are in what?
Calictonin is in what?
Medullary carcinoma of thyroid
The receptor Her2-Neu is found where?
Breast and esophageal/gastric malignancies
MUC1 mucin is used to differentiate what?
PSA can be used to do determine what?
Specific immunostains include? (3)
3. Thyroid transcription factor 1
Nonspecific imunostains include what? 4
Neuron specific enolase
What does pankeratin signify?
Epithelial neoplasms (carcinomas)
What does vimentin signify?
Mesenchymal neoplasms (sarcomas)
CD45/LCA signify what?
Hematopoietic neoplasms (leukemias and lymphomas)
Is there a malignant or cancer stain available?
Spindle cell squamous cell carcinoma will have what stain results? (2)
Spindle cell melanoma will have what stain results? 2
Atypical fibroxanthoma has what for stain results? (4)
1. Pankeratin -
Papillary thyroid carinoma has what for stain results? 3
Papillary renal cell carcinoma has what for stain results? 3
Ovarian papillary serous carcinoma has what for stain results? 3
Poorly differentiated carcinoma has what for stain results? 4
Melanoma has what for stain results? 4
Lymphoma has what for stain results? 6
Esophageal/gastric carcinoma has what for stain results? (3)
Metastatic lobular breast carcinoma has what for stain results? (3)
What is the prostate cocktail stain for prostate carcinoma?
p504s is what type of antibody?
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)
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
Basal cells are present in what?
But not what?
High grade PIN, but NOT prostate carcinomas
Estrogen and progesterone receptors are in what cancers?
If you are ER+ and PR+, what does that mean about your cancer?
Lower grade with good prognosis
ER+ neoplasms can be treated with what?
CD20 does what for the B cell?
Surface glycosylated phosphoprotein in B-cell maturation
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)
Her2-neu is expressed in what percentage of breast carcinomas?
If her2-neu is overexpressed, what can you use to treat?
Herceptin (anti-Her2-neu antibody)
Her2-neu positive neoplasms may benefit from what other therapy?
MIB-1 is an antibody against?
Where is Ki67 expressed?
On proliferating cells
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)
CD117 is seen where? (4)
mast cell disease
CD117 mutations can be treated by what?
What is in-situ hybridization?
Using complimentary nucleic acid probes to detect sequences.
What type of viruses can in-situ hybridization mark? (3)
In-situ can be used to find what mutations in cancers? (2)
Oligodendrogliomas are what type of cancers?
Where are the mutations?
CNS glial neoplasms
1p and 19q mutations
How is flow cytometry used in cancer?
Detect cancer cells using surface markers.
WHat is cytogenetics?
Cell replication with interruption of mitosis and assessment of individual chromosome numbers and structure after GIEMSA staining
Cytogenetics is used to assess what? (5)
Single nucleotide arrays are used to detect what?
SNP's which are single nucleotide alterations.