Other AP Flashcards
3 types of cytosolic fibers in the cytoskeleton?
The cytoskeleton consists of 3 types of cytosolic fibers: microfilaments (actin filaments), intermediate filaments, and microtubules.
Adjuvant, neoadjuvant, induction, consolidation, maintenance, first line, second line chemotherapy?
Adjuvant chemo is given to destroy leftover (microscopic) cancer that may be present after the known tumor is removed by surgery (primary therapy). Is given to prevent a possible cancer recurrence. If known disease is left behind at surgery, further treatment is technically not adjuvant. Neoadjuvant chemo is given prior to the surgical procedure in an attempt to shrink the tumor so that the surgical procedure may not have to be as extensive. Induction chemo is given to induce a remission. The term is commonly used in the treatment of acute leukemias. Consolidation chemo (also called intensification therapy) is given once remission is achieved. The goal is to sustain the remission. The term is commonly used in the treatment of acute leukemias. Maintenance chemo is chemo given in lower doses to assist in prolonging a remission. Is used only for certain types of cancer, MC ALLs and APLs. First line chemo (also called standard therapy) is chemo that has been determined to have the best probability of treating a given cancer. Second line chemo (also called salvage therapy) is chemo that is given if a disease has not responded or has recurred after first line chemo.
Describe intracytoplasmic inclusions found in sarcoidosis.
ASTEROID BODIES: Small, eosinophilic, star-shaped structures. SCHAUMANN BODIES: Calcium and protein inclusions inside of Langerhans giant cells as part of a granuloma; basophilic, concentrically laminated, calcified, rounded chonchoidal structures. If numerous or large, they may be extruded into extracellular space.
CALCIUM OXALATE CRYSTALS: may serve as a nidus for deposition of calcium leading to formation of Schaumann bodies. HAMAZAKI-WESENBERG BODIES: PAS-positive inclusions which may be giant lysosomes containing lipofuscin or hemolipofuscin. Although H-W bodies may occur as inclusions, they are also found extracellularly in the sinusoids of lymph nodes in sarcoidosis. Are oval or spindle-shaped, range up to several microns in size, and appear yellow-brown with H&E. Stain with acid-fast and silver stains (may be mistaken for fungus). ADDITIONAL POINTS: Schaumann bodies and calcium oxalate crystals are birefringent and must not be mistaken for foreign (exogenous) material.
Although intracytoplasmic inclusions are a frequent finding in sarcoidosis, they may also be found in other granulomatous diseases, including TB, nontuberculous mycobacterial infection, leprosy, hypersensitivity pneumonitis, berylliosis, fungal infection, Crohn’s disease, foreign body granuloma (however, foreign material in sarcoidal granulomata does not exclude the diagnosis of sarcoidosis).
Examples of cell-specific intermediate filaments?
Major types of intermediate filaments are distinguished by their cell-specific expression: CKs in epithelial cells, GFAP in glial cells, desmin in skeletal/visceral/certain vascular smooth muscle cells, vimentin in cells of mesenchymal origin, and neurofilaments in neurons.
GFAP and vimentin in astroglial cells.
GFAP and vimentin form intermediate filaments in astroglial cells and modulate their motility and shape. In particular, vimentin filaments are present at early developmental stages, while GFAP filaments are characteristic of differentiated and mature brain astrocytes.
Oncotype DX (Genomic Health Inc.), MammaPrint (Agendia), Mammostrat (Clarient). How do they work?
Oncotype DX is a real-time RT-PCR assay measuring RNA expression in 16 cancer-related genes and five reference genes, using paraffin-embedded tissue. Results are given as a recurrence score between 0 and 100, which are translated as low risk (a score of 18 or lower), medium risk (19 to 30), or high risk (31 or above). MammaPrint microarray measures expression of 70 genes in fresh or FFPE tissue; it categorizes patients as either high risk, (a so-called poor signature), or low risk (a so-called good signature) for recurrence. Mammostrat is an IHC test measuring five markers: p53, HTF9C, CEACAM5, NDRG1, and SLC7A5. The results are combined into a quantitative risk index: low, moderate, and high. Oncotype DX and MammaPrint are send-out tests, with TATs of 10-14 days, while results from the IHC-based Mammostrat, also a send-out test, are available to local pathologists within 48-72 hours. As of 3/2014, only MammaPrint has FDA clearance.
Solid organ transplant-associated acute graft-versus-host disease.
The occurrence of an immunologically mediated and injurious set of reactions by cells genetically disparate to their host is known as GVHD. Acute GVHD is most commonly associated with hematopoietic stem cell transplantation (35-50%). With solid organs, the highest occurrence is with small intestine transplantation (5.6%), followed by liver transplantation (1-2%). Cases have also been reported after kidney, pancreas, heart, lung, and multivisceral transplants. The clinical presentation of solid organ transplant-associated GVHD includes skin rash (red to violet maculopapular rashes which may coalesce) and diarrhea (green, mucoid, watery, sometimes bloody), and most cases quickly advance to become a multisystem disease affecting bone marrow and other nontransplanted solid organs. The patient often dies of bleeding and infection from bone marrow failure. The mortality rate of solid organ transplant-associated GVHD ranges from 30 to >75%. In the rare reported cases after lung or pancreas transplant, the mortality rate reaches 100%. The diagnosis is based on clinical symptoms, characteristic histopathologic findings on biopsied tissues, and evidence of microchimerism of donor T cells. Solid organ transplant-associated GVHD often occurs between 2-6 weeks after liver transplantation, although this is variable with late-onset cases seen in other transplant settings.
Small intestinal bacterial overgrowth.
SIBO is a common cause of chronic diarrhea and malabsorption. It results from colonization of the proximal small bowel by gram-negative aerobic and anaerobic bacteria that are normally restricted to the colon or, less frequently, from overgrowth of oropharyngeal flora. A predisposition to SIBO exists in diverse conditions where there is altered anatomy from prior surgery (eg, blind loop syndrome) or stricture or where there is impaired gut motility and prolonged orocecal transit time. The gold standard for diagnosis is a small intestinal aspirate culture showing growth of at least 10^5 colony-forming units of bacteria per milliliter (CFU/mL) of duodenal or jejunal fluid. Cultures of small-bowel mucosal biopsies can be substituted when there are inadequate luminal secretions. Histologically, mild or moderate villous blunting is the only change seen, and this is seen in only ~50% of symptomatic pts with the culture diagnosis of SIBO. The high rate of histologically “normal” biopsies does not negate the pathogenic role of bacterial overgrowth in symptomatic pts. It has been hypothesized that excess colonic flora within the small intestine can impede fat digestion by deconjugating bile acids and hindering the formation of micelles, that these bacteria can induce vitamin B12 deficiency, and that they can result in osmotic or secretory diarrhea through the production of organic acids. All of these proposed mechanisms can coexist with microscopically health small bowel mucosa.
Splendore-Hoeppli phenomenon?
AKA asteroid bodies. The in vivo formation of intensely eosinophilic material around microorganisms or biologically intert substances.
What are general categories of disorders that show Mendelian inheritance and non-Mendelian inheritance?
Mendelian inheritance: autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive.
Non-Mendelian inheritance: multifactorial disorders, disorders affected by genomic imprinting, trinucleotide repeat disorders, mitochondrial disorders, and chromosomal instability/breakage disorders.
What is desmin?
An intermediate filament protein that is characteristically found in cardiac, smooth, and striated muscle cells. The clones D33, DEB-5, and DER-11, are the 3 most used monoclonal antibodies to desmin.
What is the epithelial-mesenchymal transition (EMT)?
A phenomenon whereby epithelial cells dissemble their junctional structures, start expressing mesenchymal proteins, remodel their extracellular matrix, and become migratory. The EMT is observed in both physiologic (embryogenesis) and pathologic (carcinogenesis) settings.
How has the grading system for GI tract NECs changed from the 2004 to 2010 WHO?
The 2010 grading system emphasizes mitotic count and Ki-67 index (It is recommended that these parameters are assessed over 50 hpf.). Grade 1 NET: < or =2% Ki-67 index. Grade 2 NET: 2-20 mitoses/10 hpf and/or 3-20% Ki-67 index. Grade 3 NET: >20 mitoses/10 hpf and/or >20% Ki-67 index. Most notably, NE lesions of the GI tract are graded and staged separately in the 2010 system. The 2004 system incorporated metastasis, gross invasion, size, vascular invasion, mitotic activity and proliferative rate, which resulted in a change in terminology from “tumor” to “carcinoma” based on the presence of metastasis for tumors of identical grade. Now, NE “tumors” represent G1 and G2 lesions, regardless of the stage.
The granularity of oncocytes is due to __.
The granularity of oncocytes is due to an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm.
The diffuse cytoplasmic positivity of chromophobe renal cell carcinoma with Hale’s colloidal iron stain is due to __.
The diffuse cytoplasmic positivity of chromophobe renal cell carcinoma with Hale’s colloidal iron stain is due to staining of acid mucopolysaccharides.
In AJCC (7th edition) staging of lung cancer: What are the tumor sizes for T1a, T1b, T2a, T2b, and T3? Direct tumor invasion into an adjacent ipsilateral lobe (i.e., invasion across a fissure) is classified as __. Multiple tumor nodules in the same lobe are classified as __. Multiple tumor nodules in the same lung but a different lobe are classified as __. Malignant pleural and pericardial effusions are classified as __. Separate tumor nodules in the contralateral lung are classified as __. Distant metastases are classified as __.
T1a is ≤2.0 cm in size, T1b is >2.0 to ≤3.0 cm in size, T2a is >3.0 to ≤5.0 cm in size, T2b is >5.0 to ≤7.0 cm in size, T3 is >7 cm in size. Direct tumor invasion into an adjacent ipsilateral lobe (i.e., invasion across a fissure) is classified as T2a. Multiple tumor nodules in the same lobe are classified as T3. Multiple tumor nodules in the same lung but a different lobe are classified as T4. Malignant pleural and pericardial effusions are classified as M1a. Separate tumor nodules in the contralateral lung are classified as M1a. Distant metastases are classified as M1b.
In AJCC (7th edition) staging of lung cancer, what are definitions of PL0, PL1, PL2, and PL3?
PL0 is defined as tumor located within the lung parenchyma or only superficially invading in the pleural connective tissue, but not beyond the elastic layer of the visceral pleura (i.e., falls short of completely traversing the elastic layer). PL1 is defined as tumor invading into the visceral pleura beyond the elastic layer, and PL2 is defined as tumor invading to the visceral pleural surface. Either PL1 or PL2 status allows classification of the primary tumor as T2. PL3 is defined as tumor invading into the parietal pleura or the chest wall, and PL3 status categorizes the tumor as T3.
Clear cell meningiomas are classified as WHO grade __.
Clear cell meningioma is a variant of meningiomas classified as WHO grade II for its propensity to recur. Similar to atypical meningiomas, recurrence can be local or distant and may have a mortality rate of up to 23%.
What are sentinel events?
A sentinel event is an unexpected occurrence involving patient death or serious physical or psychological injury. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. In addition to patient events which fall within this definition, The Joint Commission has specifically defined the following events as Sentinel: Unanticipated death or major permanent loss of function unrelated to the natural course of the patient’s illness or underlying condition. Suicide of any inpatient or within 72 hours of discharge. Unanticipated death of a full-term infant. Abduction of an individual receiving care, treatment, or services. Discharge of an infant to the wrong family. Sexual abuse/assault including rape of any patient receiving care, treatment, or services. Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities. Invasive procedure, including surgery, on the wrong patient, wrong site, or wrong procedure. Unintended retention of a foreign object in an individual after surgery or invasive procedure. Severe neonatal hyperbilirubinemia (bilirubin >30 mg/dL). Prolonged fluoroscopy with cumulative dose >1500 rads to a single field or any delivery of radiotherapy to the wrong body region or >25% above the planned radiotherapy dose. Rape, assault (leading to death or permanent loss of function), or homicide of a staff member, licensed independent practitioner, visitor, or vendor while on site at the healthcare organization.
Define: Advance care plan.
Advance care plan: An instructional document voluntarily executed by a competent patient authorizing the provision, withholding, or withdrawal of health care if the patient’s condition is irreversible and he/she lacks capacity. It may also be used to appoint a health care agent and/or to add special instructions or limitations including organ/tissue donation.
Define: Advance directive.
Advance directive: An individual instruction (oral or written) or a written statement voluntarily executed by a competent patient relating to the subsequent provision of health care for the individual.
Define: Agent, in the context of Advance Directives.
Agent: An individual designated in an Advance Directive to make a health care decision for the individual granting the power. The Agent may make any health care decision the patient could have made for him/herself while competent.
Define: Appointment of a health care agent.
Appointment of a health care agent: A written document voluntarily executed by a competent patient appointing another person (“Agent”) to make health care decisions in the event the patient lacks capacity.
Define: Capacity, in the context of Advance Directives.
Capacity: An individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision.
Define: Designated physician, in the context of Advance Directives.
Designated physician: A physician designated by an individual or the individual’s agent, guardian, or surrogate, to have primary responsibility for the individual’s health care or, in the absence of a designation or if the designated physician is not reasonably available, a physician who undertakes such responsibility.
Define: Durable power of attorney for health care.
Durable power of attorney for health care: A written document voluntarily executed by a competent patient appointing another person (“Agent”) to make health care decisions in the event the patient lacks capacity. While still a valid Advance Directive, TN law encourages use of the Appointment of a Health Care Agent.
Define: Living will.
Living will: A limited instructional document voluntarily executed by a competent patient authorizing the provision, withholding, or withdrawal of health care if the patient is in a terminal condition or permanently unconscious. While still a valid Advance Directive, TN law encourages use of an Advance Care Plan.
Define: Physician orders for scope of treatment (“POST”), in the context of Advance Directives.
Physician orders for scope of treatment (“POST”): A standardized form containing orders written by a physician who has personally examined a patient regarding his/her preferences for end of life care. The POST complements but does not replace an Advance Directive.
Define: Surrogate, in the context of Advance Directives.
Surrogate: An individual, other than a patient’s Agent or guardian, authorized to make a health care dicision for the patient. TN law recognizes a Patient-Designated Surrogate and a Physician-Designated Surrogate. Patient-Designated Surrogate: Patient’s oral or written designation, given directly to the Designated Physician, of an individual to make a health care decision for the patient. Physician-Designated Surrogate: An individual recognized by law to make health care decisions for a person who lacks capacity and who has not appointed an Agent or designated a Surrogate and does not have a guardian, or whose Agent, Surrogate, or guardian is not reasonably available.
If a test has high sensitivity, a negative result means ___.
If a test has high specificity, a positive result means ___.
If a test has high sensitivity, a negative result is used to rule out the disease/there is a low probability of disease.
If a test has high specificity, a positive result is used to rule in the disease/there is a high probability of disease.
SPIN and SNOUT are commonly used mnemonics which says: A highly SPecific test, when Positive, rules IN disease (SP-P-IN), and a highly ‘SeNsitive’ test, when Negative rules OUT disease (SN-N-OUT).
A small positive predictive value indicates that many of the positive results from this testing procedure are ___. Thus it will be necessary to follow up any positive result with a more reliable test to obtain a more accurate assessment. Nevertheless, such a test may be useful if it is inexpensive and convenient.
A small positive predictive value indicates that many of the positive results from this testing procedure are false positives. Thus it will be necessary to follow up any positive result with a more reliable test to obtain a more accurate assessment. Nevertheless, such a test may be useful if it is inexpensive and convenient.
What is lipofuscin?
Lipofuscin is the name given to finely granular yellow-brown pigment granules composed of lipid-containing residues of lysosomal digestion. It is considered one of the aging or “wear-and-tear”pigments, found in the liver, kidney, heart muscle, adrenals, nerve cells, and ganglion cells. It is specifically arranged around the nucleus, and is a type of lipochrome. Lipochrome is a form of pigment associated with amber and gold tones in the eyes of mammals. The term carotenoid is sometimes considered a synonym of lipochrome, but that term usually refers to specific molecules, while lipochrome refers to accumulations of varied molecules. Lipofuscin appears to be the product of the oxidation of unsaturated fatty acids, and may be symptomatic of membrane damage, or damage to mitochondria and lysosomes. Aside from a large lipid content, lipofuscin is known to contain sugars and metals, including mercury, aluminum, iron, copper, and zinc.
What is ceroid?
A golden, waxy (from cera, Latin for wax; eidos, Greek for form), alcohol-insoluble pigment. It is acid-fast and sudanophilic. It is a complex of oxidized polyunsaturated lipid pigment(s) (?polymer of oxidized lipid and protein?) resulting from the peroxidation of unsaturated lipids that are similar or identical to lipofuscin. Ceroid accumulates in macrophages of the heart, (cirrhotic) liver, GI tract, nervous system, muscles, and brain in the elderly and is thus termed “wear and tear” pigment.
IHC antibodies are classified as Class __ medical devices.
In 1998, the US FDA classified IHC antibodies as analyte-specific reagents. Within this defined group, most antibodies are deemed Class I medical devices, exempting them from premarket FDA notification, which entails providing evidence of safety and efficacy. A few IHC markers, including ER and PR, are Class II medical devices, meaning they have associated guidance documents. The rationale behind Class I categorization is that IHC results are just one part of the final diagnostic interpretation by the pathologist. The flexibility provided by such a designation can be credited with rapid development of new antibodies, but lends itself to divergent practices and inconsistent results among labs. CLSI guidelines require that individual labs validate each new antibody; however, the details are left to the laboratory director. Predictive markers, such as HER2/neu, whose results bear prognostic and treatment implications, have been the first target of standardization. In 12/2006, ASCO and CAP introduced guidelines for HER2/neu testing, which were published in 1/2007. Additional measures toward enhanced quality include guidelines for validation of hormone receptor assays (2010), and in 6/2009, the CAP LAP added new checklist items that probe documentation of new antibody validation and verification of new lots of antibody.
What does a screening mammogram consist of?
Screening mammograms consist of 2 views (mediolateral oblique view and craniocaudal view) of each breast for 4 images. In radiology, the standard convention is to label the view with the x-ray source first and the film location second. In an MLO view, the x-ray beam enters medially and the film is located laterally. In a CC view, the x-ray enters cranially and the film is located caudally. The MLO view is not orthogonal to the CC view but oriented 30 to 60 degrees to it. The oblique view is used to increase the quality of the image in the UOQ, which is where most breast cancers arise. In general, the film should be placed as close as possible to the lesion being examined to make the image as clear as possible. Screening is performed annually on asymptomatic women starting at 40 to 50 years.
In mammography, what is the difference between a mass and a density?
A mass is a lesion that is seen on more than one view. A density is seen only on one view. To determine whether an area of concern is a mass or a density, the radiologist will estimate or measure the distance of the lesion seen on one view from the nipple and look for a possible lesion the same distance from the nipple on the other view. The density may be a mass that is visible only on one view because of overlying shadows that obscure it on the other view. It could also be a summation shadow from normal structures that appear denser along one axis. If there is an apparent density, the radiology may order additional views to confirm or refute the presence of a mass or obtain short-term, followup imaging, depending on the level of suspicion.
What does a diagnostic mammogram consist of?
Diagnostic mammograms are used to confirm or refute the presence of a mass, parenchymal distortion, asymmetry, or microcalcification seen on a screening mammogram; to further characterize an abnormality seen on screening mammogram; to diagnose a patient with breast symptoms, such as a palpable mass, abnormal nipple discharge, or noncyclical localized pain; and to localize a nonpalpable mass. A diagnostic mammogram is more detailed than a screening mammogram but examines only the area of interest identified on the screening mammogram or by the physician. There are many different views that are considered for a diagnostic mammogram. One of the most common views ordered as part of a diagnostic mammogram is a spot compression view, with or without magnification.
What is the BIRADS score?
All mammograms are classified into 1 of 7 major categories to facilitate follow-up and treatment. This is called a Breast Imaging and Reporting Database System (BIRADS) score. It was created by the American College of Radiology to force radiologists to categorize mammograms into understandable categories, avoid unclear reports, reduce variability in reports, and standardize workup. (BIRADS score, interpretation, risk of cancer, and follow-up.) 0, needs more imaging, unknown, additional imaging. 1, normal, 0%, routine. 2, benign finding, 0%, routine. 3, probably benign, < or = 2%, 6-mo repeat or biopsy. 4a, suspicious, >2 to or = 10 to or = 90%, biopsy. 5, highly suspicious, > or = 90%, biopsy. 6, biopsy-proven cancer, 100%, treatment.
How is microvesicular steatosis defined?
In cellular pathology, steatosis (also called fatty change, fatty degeneration or adipose degeneration) is the process describing the abnormal retention of lipids within a cell. It reflects an impairment of the normal processes of synthesis and elimination of triglyceride fat. Excess lipid accumulates in vesicles that displace the cytoplasm. Microvesicular steatosis is defined by multiple small lipid droplets (liposomes) in the hepatocyte without nuclear dislocation, as compared with macrovesicular steatosis, which is usually composed of a large cytoplasmic lipid vacuole that displaces the nucleus peripherally.
What is peliosis?
The Greek word “pelios” means “discoloured by extravasated blood,” or “livid”. Peliosis is a pathological entity characterized by the gross appearance of multiple cyst-like, blood-filled cavities within parenchymatous organs. The classical pathoanatomical concept is based upon the opinion that peliosis exclusively develops in organs belonging to the mononuclear phagocytic system (liver, spleen, bone marrow, and lymph nodes). However, a paucity of studies indicates that other organs such as lungs, parathyroid glands, and kidneys may be affected too. Since the disease may culminate in spontaneous rupture of the affected organ and thus may mimic a violent death at autopsy, peliosis is far more than just another morphological curiosity.
Ki-67 protein and antibodies against it.
Antigen KI-67, also known as Ki-67 or MKI67 is a protein that in humans is encoded by the MKI67 gene. It is a nuclear protein that is associated with and may be necessary for cellular proliferation. Furthermore it is associated with ribosomal RNA transcription. Inactivation of antigen KI-67 leads to inhibition of ribosomal RNA synthesis. The Ki-67 protein (also known as MKI67) is a cellular marker for proliferation. It is strictly associated with cell proliferation. During interphase, the Ki-67 antigen can be exclusively detected within the cell nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. Ki-67 protein is present during all active phases of the cell cycle (G1, S, G2, and mitosis), but is absent from resting cells (G0). Ki-67 is an excellent marker to determine the growth fraction of a given cell population. The fraction of Ki-67-positive tumor cells (the Ki-67 labeling index) is often correlated with the clinical course of cancer. Ki67 and MIB-1 monoclonal antibodies are directed against different epitopes of the same proliferation-related antigen. The Ki-67 protein was originally defined by the prototype monoclonal antibody Ki-67; The name is derived from the city of origin (Kiel, Germany) and the number of the original clone in the 96-well plate.Whereas Ki67 works only on frozen sections, MIB1 may be used also on fixed sections. MIB-1 is used in clinical applications to determine the Ki-67 labeling index. One of its primary advantages over the original Ki-67 antibody (and the reason why it has essentially supplanted the original antibody for clinical use) is that it can be used on formalin-fixed paraffin-embedded sections, after heat-mediated antigen retrieval.
What is ecchordosis physaliphora?
A notochordal remnant usually found incidentally at autopsy. It is a small gelatinous hamartomatous lesion located in the intradural space and attached by a pedicle to the clivus. It has similar histological features of chordoma but does not destroy bone or invade tissues.
What are the four main autopsy techniques/methods for evisceration? What are some advantages and disadvantages for each?
Rokitansky technique (in situ dissection): Advantageous because it allows one to open and examine organs without removing them from the body, a condition somestimes mandated by a restrictive autopsy consent or severe time limitations. Virchow technique (removing organs one by one): Excellent for demonstrating pathologic changes in organs but sacrifices interorgan relationships and makes interpretation of regional disease more difficult. Ghon technique (en bloc-removing organs in regional and functional groups): Excellent preservation of the interrelationships of the various organs, their regional lymphatic drainage, and their vasculature. Is easier to perform without and assistant compared with the Letulle technique; however, the Ghon technique transects the esophagus and aorta at the diaphragm, a disadvantage in cases of aortic dissection, aneurysm, esophageal varices, or neoplasm. Letulle technique (en masse-removing all organ blocks as a single group): Excellent preservation of the interrelationships of the various organs, their regional lymphatic drainage, and their vasculature. Allows the most rapid preparation of the body for removal to the mortuary and, because there is less dissection within the confines of the body cavity, probably offers greater safety to the prosector. However, may be difficult to perform without an assistant and takes longer compared with the Virchow method.
Analysis of postmortem glucose, enzymes, and drugs shows significant differences between specimens taken from the right side of the heart, the left side of the heart, and the peripheral blood vessels. ___ or ___ specimens best approximate the antemortem values.
Analysis of postmortem glucose, enzymes, and drugs shows significant differences between specimens taken from the right side of the heart, the left side of the heart, and the peripheral blood vessels. Peripheral venous or peripheral arterial specimens best approximate the antemortem values.
What are the primary and secondary sites for obtaining blood for autopsy toxicologic studies?
The best samples for toxicologic analysis are obtained from the femoral artery or vein. The subclavian vessels serve as secondary collection sites.
What are filter blots obtained from autopsy cases used for?
300 uL of blood may be spotted on specialized filter papers. Several samples can be collected, dried overnight, wrapped in plastic wrap, and stored at -20 C. Such samples are useful for genotype and protein analyses available through commercial and academic laboratories. An example would be using tandem mass spectrometry on postmortem blood spotted on filter paper to detect specific enzyme defects. Filter blots of liver tissue, bile, and vitreous humor may also be used.
What is the best fluid for postmortem chemical analysis?
Vitreous humor provides one of the best samples for postmortem chemical analysis because it comes from a closed space and postmortem values often approximate the antemortem levels. Vitrous humor may not become contaminated after embalming, so it may still provide material for analysis in these cases. However, a sample of the embalming fluid should also be submitted to the laboratory as a control.
Postmortem determination of premortem glucose levels. Discuss.
Postmortem serum glucose decreases rapidly because of glycolysis, preventing detection of antemortem hypoglycemia. Even elevated levels of postmortem blood glucose require careful interpretation. Death from asphyxia, cerebral hemorrhage, CHF, electrocution, or terminal CPR may increase postmortem peripheral vascular glucose and falsely indicate hyperglycemia. Glycosuria, ketonuria, or elevated serum acetone can help confirm diabetic ketoacidosis. Blood samples taken from the right atrium or IVC may have a high glucose content because of glycogenolysis in the liver and subsequent diffusion of glucose into adjacent vessels. Thus, a low glucose level in blood from the right atrium and a positive test for ketones may support starvation. Vitreous humor provides more reliable data for determination of antemortem hyperglycemia. Glycolysis reduces the postmortem concentration of vitreous humor glucose; however, values greater than 200 mg/dL usually indicate that the decedent had uncontrolled diabetes.
List the four general patterns of postmortem vitreous humor concentrations of sodium, chloride, potassium, urea nitrogen, and creatinine, which allow some assessment of the terminal metabolic condition of the decedent.
- Dehydration pattern: Increased sodium and chloride concentrations. Moderate elevation of urea nitrogen levels. 2. Uremic pattern: No substantial increase in sodium and chloride values. Urea nitrogen and creatinine levels increased. 3. Low-salt pattern: Low sodium and chloride concentrations. Relatively low potassium level (20 mEq/L or 20 mmol/L).
What is the most stable postmortem chemistry blood constituent?
Urea nitrogen is perhaps the most stable blood constituent after death as it approximates premortem levels even after moderate decomposition. Urea nitrogen also remains stable in CSF, vitreous humor (even after embalming), and synovial fluid. In addition to their use in assessing renal function, urea nitrogen concentrations aid in the interpretation of hypernatremia. Similarly, creatinine levels in the blood remain stable after death, as they do in CSF and vitreous humor, making creatinine a valid postmortem marker of nitrogen retention and renal function.
What is the FNCLCC grading system for soft tissue sarcomas?
The 2 most widely used grading systems are the FNCLCC (Federation Nationale des Centre de Lutte Contre la Cancer) and NIH systems. The CAP recommends the French system over the NIH system for reasons of ease of use/reproducibility and perhaps slightly superior performance. The FNCLCC grade is determined by 3 parameters: differentiation (histology specific), mitotic activity, and extent of necrosis. Each parameter is scored: differentiation 1-3, mitotic activity 1-3, and necrosis 0-2. The scores are summed to designate grade: score of 2 or 3 = grade 1, score of 4 or 5 = grade 2, and score of 6-8 = grade 3. The tumor differentiation score is histology specific and is generally scored as follows: Score 1 is for sarcomas closely resembling normal, mature mesenchymal tissue. Score 2 is for sarcomas of definite histologic type. Score 3 is for synovial sarcomas, embryonal sarcomas, undifferentiated sarcomas, and sarcomas of unknown/doubtful tumor type.
WHO 2010 classification of neuroendocrine tumors in GI tract and pancreas.
Low grade (G1): 20 mitoses/10 HPF, OR >20% Ki-67 index.
How are neuroendocrine tumors graded in GI tract and pancreas, and for lung and thymus?
For GI tract and pancreas, WHO 2010 classification: Low grade (G1): 20 mitoses/10 HPF, OR >20% Ki-67 index. For lung and thymus, WHO 2004 classification: Low grade (G1): 10 mitoses/10 HPF.
What are the equations for calculating sensitivity and specificity?
Sensitivity is the probability that a person having a disease will be correctly identified (positive in disease). Sensitivity = TP/(TP+FN). Specificity is the probability that a person who does not have a disease will be correctly identified. Specificity = TN/(TN+FP).
What are the definitions of sensitivity and specificity in statistics?
Sensitivity is the probability that a person having a disease will be correctly identified (positive in disease). Sensitivity = TP/(TP+FN). Specificity is the probability that a person who does not have a disease will be correctly identified. Specificity = TN/(TN+FP).
How are positive predictive value and negative predictive value calculated?
Positive predictive value is the probability that an individual who tests positive has the disease. PPV = TP/(TP+FP). Negative predictive value is the probability that an individual who tests negative does not have the disease. NPV = TN/(TN+FN).
What are the definitions of positive predictive value and negative predictive value?
Positive predictive value is the probability that an individual who tests positive has the disease. PPV = TP/(TP+FP). Negative predictive value is the probability that an individual who tests negative does not have the disease. NPV = TN/(TN+FN).
How are incidence and prevalence calculated?
Incidence is the number of new cases of disease in the population over a given time. Incidence is generally calculated by: number of new cases/susceptible population. Prevalence is the total number of cases in a population at a given time. Prevalence is calculated by: TP+FN/(TP+FP+TN+FN) but generally calculated by: incidence x duration of disease.
