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Path 2022 > Histopath - Skin & Breast > Flashcards

Histopath - Skin & Breast Flashcards

1
Q

Pathophysiology of Pemphigus vulgaris

A 
IgG binds to desmosome proteins 1,3
Intraepidermal bullae (flaccid blisters)
  • Histology = acantholysis, suprabasal blistering
  • Direct immunofluorescence = chicken wire pattern of intercellular deposits of IgG ?
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2
Q

Invasive squamous cell carcinoma histology

A

Perineural invasion
Increased mitotic activity
Keratin ‘pearls’

Other:
Irregular aggregates of pink tumour cels
Infiltrative nests in dermis

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3
Q

Basal cell carcinoma histology

A

Basaloid tumour
Peripheral palisading
Clefting
Mitotic activity

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4
Q

Immunohistochemical stains for Malignant melanoma

A

Melan A
S100
HMB45

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5
Q

Vesicobullous inflammatory reaction pattern

A

Within epidermis

Forms bullae

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6
Q

Spongiotic inflammatory reaction pattern

A

Within epidermis

Becomes oedematous

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7
Q

Psoriaform inflammatory reaction pattern

A

Within epidermis

Becomes thickened

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8
Q

Lichenoid inflammatory reaction pattern

A

Within epidermis

Forms sheeny plaque?

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9
Q

Vasculitic inflammatory reaction pattern

A

Within dermis

Associated with vasculitis

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10
Q

Granulmatous inflammatory reaction pattern

A

Within dermis

Associated with (mainly non caseating) granuloma

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11
Q

Subcutis inflammatory reaction patterns?

A

Panniculitis e.g. erythema nodosum

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12
Q

Key histology of eczema / dermatitis

A

Acute = spongiotic pattern

  • fluid / oedema around keratinocytes
  • inflammatory infiltrate in dermis
  • dilated dermal capillaries

Chronic

  • acanthosis
  • hyper parakeratosis
  • T cells, eosinophils
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13
Q

Key histology of Lichen Planus

A

Flat epidermis
Basement membrane obscured by T cells
Colloid bodies (dead looking keratinocytes)

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14
Q

Koebner’s phenomenon

A

Psoriatic reaction at site of injury/irritation

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15
Q

Mechanism of psoriasis

A

Abnormally rapid turnover of epidermis (6 days vs 56 days normally)

Accumulation of thick scale over sites of frequent trauma/irritation

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16
Q

Key histology of psoriasis

A

Parakeratosis (remnants of nuclei indead keratinocytes - not time to be lost)

Hypogranulosis / Loss of stratum granulosum - no time for granular layer to form

Clubbing of rete ridges

Munro’s micro-abscesses (neutrophil recruitment) in stratum corneum

Dilated blood vessels

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17
Q

Pathophysiology of Dermatitis herpetiformis

A

Associated with coeliac disease

IgA abs bind to basement membrane –> sub epidermal bullae

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18
Q

Pathophysiology of Bullous pemphigoid

A
  • IgG binds to hemidesmosomes (of basement membrane)
  • Subepidermal large + tense blister (bullae)
  • Eosinophils - release elastase

Direct immunofluorescence: linear IgG along basement membrane
Indirect: raised serum IgG

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19
Q

Pathophysiology of Pemphigus foliaceous

A

IgG (/ IgE?) Ab against desmoglein 1 within desmosomes
Inter-epidermal blister - not intact, appear excoriated

  • Histology = acantholysis, subcorneal blistering
  • Direct immunofluorescence = chicken wire pattern of intercellular deposits of IgG ?
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20
Q

Seborrheic keratosis features

A

Keratin horns
Olderly proliferation
Acanthosis (thickening of epidermis)

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21
Q

Clinical features of Basal cell carcinoma

A

Pearly lesion
Rolled edge
Central ulceration

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22
Q

Cause of BCC

A 
PTCH mutation
Usually somatic (UV exposure), rarely inherited (Gallin syndrome)
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23
Q

Histology of actinic keratosis

A

atypia of epidermis (basal)
Abnormal stratum corneum (parakeratosis)
Basement membrane NOT lost

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24
Q

Bowen’s disease (SCC in situ) histology

A

Pleiomorphic cells
Hyperchromatic nuclei
Disorderd maturation
Increased mitotic activity, atypical mitotic figures

Full thickness atypia BUT basement membrane intact

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25
Q

Types of benign naevi (moles)

A

Junctional: melanocyte nests in epidermis, young people, well circumscribed, uniform pigment, flat.

Compound: nests of melanocytes within epidermis + dermis, can be very large, may need multiple excisions.

Intradermal: melanocytes within dermis, older patient.

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26
Q

Subtypes of melanoma

A

Lentigo maligna
Superficial spreading
Nodular
Acral lentiginous

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27
Q

Histology of melanoma

A

Atypical melanocytes

Cellular atypia in dermis

Pagetoid spread of melanocytes (ascend into epidermis)

Radial growth phase - horizontal in epidermis THEN vertical growth into dermis

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28
Q

Breslow thickness

A

Most important prognostic factor for melanoma

Measures from granular layer –> deepest abnormal melanocyte

<0.8mm = stage 1a

29
Q

C1 breast cytopathology - meaning

A

Inadequate sample

  • RBC, neutrophils
  • Debris
  • Cannot see cells clearly
30
Q

C2 breast cytopathology - meaning

A

Benign

Glandular proliferation

  • branching, staghorn clefts
  • possible benign tumour
31
Q

C3 breast cytopathology - meaning

A

Atypia, likely benign

32
Q

C4 breast cytopathology - meaning

A

Atypia, likely malignant

33
Q

C5 breast cytopathology - meaning

A

Malignant

34
Q

Current gold standard for diagnosing breast ca.

A

Histopathology

35
Q

Clinical features of duct ectasia

A

Nipple discharge
breast pain
mass
Nipple retraction

36
Q

Histology of duct ectasia

A

Duct distension - proteinaceous maternal inside

Foamy macrophages

37
Q

Cytology of fat necrosis

A

Fat cells surrounded by macrophages (histiocytes)

38
Q

Clinical features of acute mastitis

A

Painful, red breast

39
Q

Cytology of acute mastitis

A

Acute inflammatory cells - neutrophils

Foamy macrophages

40
Q

Usual causative organism of acute mastitis

A

Staphylococcus

41
Q

Usual epithelial hyperplasia - histological features

A

Increased cell proliferation causing multilayering
Clefts + empty spaces
Contained within duct

42
Q

Flat epithelial atypia / atypical ductal carcinoma - histology

A

Punched out margins

+/- calcification

43
Q

In situ lobular neoplasia - histology

A

Monomorphic

44
Q

Fibrocystic disease - histology

A

Dilated + calcified ducts

45
Q

Fibroadenoma - histology

A

Well circumscribed

Glands compressed

46
Q

Phyllodes’ tumour - histology

A

‘Leaf-like’ - broad based papillae, long clefts

High cellularity + Stromal overgrowth = more malignant

47
Q

Intraductal papilloma - histology

A

Dilated ducts
Polypoid mass in centre
Fibrovascular core
Blood vessels within stroma

48
Q

Radial scar - histology

A

2 distinct areas:

  1. central stellate scar
  2. peripheral proliferation of ducts/acini
49
Q

Tx of radial scar

A

Removal

Can contain malignant cells

50
Q

Tx of intraductal papilloma

A

Removal = curative

51
Q

Tx of Phyllodes’ tumour

A

Removal

Benign, borderline + malignant types

52
Q

What benign lesion can resemble ca. on imaging?

A

Radial scar

53
Q

mobile breast lump in 28 yo woman?

A

Fibroadenoma

54
Q

Most common ca. in women

A

Invasive breast carcinoma

  • ductal most common within this
55
Q

Features of low grade Ductal carcinoma in situ

A

Lumens compact + regular
calcification
overlapping clls

56
Q

Features of high grade ductal carcinoma in situ

A

Central lumen necrotic material

Pleiomorphic cells occlude duct

57
Q

RF for invasive breast carcinoma

A 
Early menarche
Late menopause
Increased BMI
EtOH
COCP
\+ve family Hx
58
Q

Malignant breast cancer that does not produce mammographic densities

A

Invasive lobular carcinoma

is picked up incidentally on biopsy

59
Q

Invasive ductal carcinoma - histology

A

Pleimorphic cells
Large nuclei, little cytoplasm
E-cadherin +ve

60
Q

Invasive lobular carcinoma - histology

A

Linear ‘Indian file’ pattern
Monomorphic
No calcification or stromal reaction?

61
Q

Invasive tubular carcinoma - histology

A

Elongated tubules invading stroma

Associated with radial scar

62
Q

Invasive mucinous carcinoma - histology

A

Nests of tumour cels

Extravasated mucin pools

63
Q

Basal like carcinoma - histology

A

Sheets of atypical cells
Prominent lymphocytic infiltrate
Central necrosis common
+ve for cytokeratins CK5/6 and 14

64
Q

Nottingham grading for breast ca.

A

Graded histologically looking at:

  • tubule formation
  • nuclear pleomorphism
  • mitotic activity

each scored 1-3 then totals added

65
Q

Receptors checked in breast ca.

A 
Oestrogen receptor (ER)
Progesterone receptor (PR)
Her2 status
66
Q

Receptor status of low grade tumours

A

ER/PR +

HER2-

67
Q

Receptor status of high grade tumours

A

ER/PR -

HER2+

68
Q

Receptor status of basal like carcinoma

A

Triple negative

ER-, PR-. HER2-

69
Q

Most important prognostic factor in breast ca

A

Axillary lymph node status

Path 2022 (12 decks)

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