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FRCPATH PART 2 > Histopathology > Flashcards

Histopathology Flashcards

1
Q

How would you describe a sessile serrated lesion histologically ?

A

Histology:- serrated epithelium,
crypt base dilatation,
boot shaped glands,
horizontal glands

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2
Q

Describe xanthalomatous chronic cholecystitis

A

Histology:-
Thickened gallbladder wall
cholesterol clefts
lipid laden macrophages
inflammatory cells
fibrosis

DDx:-
Chronic cholecystitis
gallbladder carcinoma
gallbladder cholesterolosis

Other information:-
Not common
Benign
Treated with cholecystectomy
Seen as hypoattenuated nodules on radiology

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3
Q

What are the histological features of necrobiosis lipoidica ?

A

Histology:-
necrobiotic collagen
pallisading granulomas
no normal dermis
plasma cells
involves subcutis

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4
Q

What are the clinical features of granuloma annulare ?

A

Ring shaped lesions on the hand and arm

self limiting and benign

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5
Q

What is the differential for a sessile serrated lesion ?

A

Hyperplastic polyp

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6
Q

What syndromes are associated with sessile serrated lesions ?

A

Serrated polyposis syndrome

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7
Q

Which side are sessile serrated lesions usually found on ?

A

The right side/ ascending/ proximal colon (seRRated= right side)

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8
Q

What is the differential for pallisading granulomas and necrobiotic collagen in skin ?

A

Necrobiosis lipoidica - plasma cells
Granuloma annulare - no plasma cells, ring shaped lesions
Rheumatoid nodule
epithelioid sarcoma

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9
Q

Where is necrobiosis lipoidica usually seen ?

A

on the legs

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10
Q

Which disease is associated with necrobiosis lipoidica ?

A

diabetes mellitus
rheumatoid arthritis

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11
Q

What is the histological appearance of granuloma annulare ?

A

pallisading granulomas
necrobiotic collagen
mucin (stains +ve alcian blue)

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12
Q

What is granuloma annulare associated with ?

A

Diabetes mellitus
Thyroid disease
malignancy
medication
trauma
infection

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13
Q

What are small intestine adenomas associated with ?

A

FAP (familial adenomatous polyposis)

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14
Q

What is recommended for small intestine adenomas ?

A

Full colonoscopy, risk of large intestine adenoma

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15
Q

Describe the histological appearance of mucinous breast carcinoma

A

Groups of tumour cells with irregular edges
floating in mucin
more than 90% of tumour is mucin

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16
Q

What is the differential diagnosis for mucinous breast carcinoma ?

A

Other mucinous breast tumours

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17
Q

What is the hormone receptor profile for mucinous breast carcinoma ?

A

ER +ve
PR+ve
HER2-ve

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18
Q

What does mucinous breast carcinoma look like macroscopically ?

A

jelly like
glistening

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19
Q

breast cancer staging

A

Tx- can not be assessed
T0- no tumour
TIS- in situ
T1- (2 comes after 1) tumour <2cm
T1a-c- (0.5+0.5=1, 1+1=2)
T1a- >0.1-<0.5cm
T1b- >0.5cm-1cm
T1c- >1cm-<2cm
T2-T3- (2,3, high five !!)
T2->2cm-<5cm
T3->5cm
T4- (when you are a four, size won’t bore)
T4- any size, extension to chest wall and skin
ABCD
adherent blisters C IgD
adeherent= adherent to chest wall
blisters= skin manifestations
C= see both of the above
IgD= inflammatory
T4a- adherence to chest wall
T4b- skin involvement
T4c- see both of the above
T4d- inflammatory

Tx
T0
TIS
T1,2
T 0.5+0.5, 1+1
T 2, 3, high 5!
T4- size won’t bore
T4a-c adherent blisters C IgD

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20
Q

What is the histological appearance of lobular carcinoma of the breast ?

A

cells lined up in a row in single file
non cohesive
no gland formation
no desmoplastic stroma

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21
Q

What is the differential diagnosis for lobular carcinoma of the breast ?

A

LCIS
poorly differentiated ductal carcinoma
ductal carcinoma with lobular features
lymphoma
melanoma
plasmacytoma

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22
Q

What is the immunoprofile for lobular carcinoma ?

A

e-cadherin -ve
ER +ve
PR+ve
HER2-ve
CK7+ve

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23
Q

Which syndrome is related to e-cadherin loss ?

A

Hereditary diffuse gastric cancer syndrome-

invasive lobular carcinoma
diffuse gastric carcinoma

mutation in epithelial cadherin gene
mutation in CDH1 gene

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24
Q

what are markers for a lesion of breast origin ?

A

CK7+ve
CK20-ve
GATA3+ve
GCDFP+ve
mammaglobin
ER+/-ve
PR+/-ve

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25
Q

what are aberrant plasma cell markers ?

A

CD10 +ve
CD20 -ve
CD38+ve
CD45-ve
CD56 +ve
CD117+ve
CD138+ve
cyclind1+/-
MUM1+ve

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26
Q

what are lymphoma markers ?

A
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27
Q

what are melanocytic markers ?

A

HMB45
MelanA
MITF
SOX10
S100

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28
Q

Describe the histological appearances of high grade urothelial carcinoma

A

Papillary
Complex architecture (fused and branched)
nuclear polymorphism
invasion into the lamina propria
mitoses

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29
Q

What is a risk factor for high grade urothelial carcinoma ?

A

smoking

30
Q

What is the immunoprofile for high grade urothelial carcinoma ?

A

ki67 >35%

31
Q

What needs to be considered with bladder biopsies in men ?

A

They could contain fragments of:-
a) bladder
b) prostate

32
Q

Which syndrome is urothelial carcinoma associated with ?

A

Lynch syndrome

33
Q

How do you distinguish low grade urothelial carcinoma from high grade urothelial carcinoma ?

A

low grade- ki67 <25%
high grade ki67 >35%

34
Q

What is the immunohistochemical profile for urothelial carcinoma ?

A

GATA3+ve
p63+ve
ck5/6+ve
PSA -ve
ck34betaE12+ve

35
Q

What is a clinical sign for urothelial carcinoma ?

A

haematuria

36
Q

Is urothelial carcinoma common ?

A

yes

37
Q

Describe the histological appearance of chromophobe renal cell carcinoma

A

Pale/ clear or eosinophillic cells
whispy eosinophillic material
perinuclear halo
koilocytic nuclei
plant wall like membrane

38
Q

What are the differentials for an eosinophillic renal tumour ?

A

chromophobe RCC, eosinophillic variant
Oncocytoma
clear cell RCC, eosinophillic variant
renal hybrid tumour (mixture of both oncocytic and chromophobe, seen in Birt-Hogg Dube syndrome)

39
Q

what is the immunohistochemical profile of a chromophobe RCC ?

A

CK7 +ve
CD117+ve
vimentin -ve
Colloidal iron +ve

40
Q

Which syndrome is chromophobe RCC associated with ?

A

Birt-Hogg-Dube syndrome

40
Q

How do you treat a chromophobe RCC ?

A

surgical removal

41
Q

How will you remember the details for chromophobe RCC ?

A

7 pink plants eaten by a pig with a halo and whiskers
CD7 and CD117 positive (all the 7s are positive)
pink = eosinophillia
plants= plant cell like membrane
pig= Hogg in Birt-Hogg, Dube
halo= perinuclear haloes
whiskers= whispy cytoplasm

42
Q

ISUP grading

A
43
Q

What are the features of an oesophageal inlet patch

A

This is gastric body type epithelium found outside of the expected location within the stomach.
It is commonly found in the proximal oesophagus
It is usually benign

44
Q

What features need to be commented on in an oesophageal biopsy ?

A

The presence of squamous epithelium
Is there glandular metaplasia ?
If so is it intestinal metaplasia ?
Is there dysplasia within the glandular metaplasia ?

45
Q

What needs to be commented on in a gastric biopsy ?

A

Type of epithelium
presence of acute or chronic inflammation
presence of h. pylori
presence of intestinal metaplasia

46
Q

What are the histological features of gallbladder cholesterolosis ?

A

abundant foamy macrophages in the lamina propria forming polyps
sometimes there is papillary hyperplasia

47
Q

What is a differential for gallbladder cholesterolosis ?

A

cholesterol polyp

48
Q

What is the macroscopic appearance of gallbladder cholesterolosis ?

A

strawberry like

49
Q

What is associated with gallbladder cholesterolosis ?

A

obesity
gallstones
chronic cholecystitis

50
Q

What is the presenting symptom of gallbladder cholesterolosis ?

A

biliary colic

51
Q

What is a pilar leiomyoma ?

A

Interesting fascicles of eosinophillic spindle cells containing plump cigar shaped nuclei within the dermis

52
Q

What are the histological features of pancreatic heterotopia ?

A

Very eosinophillic acini
No pancreatic ducts
No Islets of Langerhans

53
Q

What is pancreatic tissue positive for immunohistochemically ?

A

tryptase
lipase

54
Q

facts about pancreatic heteroptopia

A

found in GI tract
~20% of GOJ biopsies
associated with intestinal metaplasia

55
Q

which RCC does not require an ISUP grade ?

A

chromophobe

56
Q

Where is CD7 +ve in chromophobe ?

A

cell membrane (plant wall)

57
Q

where is CD7 +ve in oncocytoma ?

A

cytoplasm

58
Q

Grossly does a chromophobe RCC have a central scar ?

A

No

59
Q

What are langerhan cells ?

A

Immune cells in the mid epidermis of the skin
stain positively for CD1a and S100

60
Q

What are the histological features of a glomus tumour ?

A

perivascular tumour
formed of polygonal cells with clear, distinct borders
“cookie cutter appearance”
endothelial cells surrounding a slit like blood vessel (staghorn)

61
Q

Which syndrome is associated with glomus tumours ?

A

neurofibromatosis type 1

61
Q

which immunostains are positive in glomus tumours ?

A

SMA

61
Q

What is Birt-Hogg-Dube syndrome ?

A

A mutation in the folliculin gene
leading to manifestations in:-
skin
kidneys
lungs

61
Q

what are the skin manifestations of Birt hogg Dube syndrome ?

A
62
Q

What is the mutation associated with familial adenomatous polyposis ?

A

mutation in APC gene

63
Q

what is the grading for neuroendocrine tumours ?

A

grade 1, <2 mitoses, 3%ki67

grade 2, 2-20 mitoses, 3-20%ki67

grade 3, >20 mitoses, >20%ki67

64
Q

Which transcription factor is positive in cells of renal origin ?

A

PAX 2 or PAX 8

65
Q

Describe the histological appearance of nephrogenic adenoma

A

bland tubules lined by cuboidal cells with bland nuclei and punctate nucleoli.
hobnailing can also be seen.

66
Q
A

FRCPATH PART 2 (1 decks)

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