Path Flashcards
1
Q
pleomorphic adenoma (test)
A
MOST COMMON salivary gland tumor
BENIGN
middle age female
SLOW growing, PAINLESS, MOVABLE, firm, round, well circumscribed
ductal/epithelial and myoepithelial cells: EPITHELIAL and MESENCHYMAL differentiation
epithelial, myxoid, hyaline, chondroid, osseous tissue
2
Q
mucoepidermoid carcinoma (test)
A
salivary gland tumor KIDS: most common malignant PAROTID, SMALL SALIVARY glands mixture: MUCUS cells, SQUAMOUS cells, intermediate cells prognosis: depends on grade
3
Q
warthin tumor (test)
A
salivary gland tumor BENIGN middle age MALE SMOKER painless, PAROTID, can be BILATERAL EPITHELIAL and LYMPHOID, CYSTIC MOTOR OIL
4
Q
gastropathy
A
when inflammation is rare or absent
5
Q
MALToma
A
B cell origin CD19, CD20, CD43 t (11;18) monoclonal: only kappa OR lambda light chains or clonal IgH Tx: H. pylori eradication
6
Q
CD19
A
MALToma
7
Q
CD20
A
MALToma
8
Q
CD43
A
MALToma
9
Q
t (11;18)
A
MALToma
10
Q
Pathogenesis of ulcerative colitis leading to toxic megacolon
A
inflammatory mediators damage muscularis propria and disturb neuromuscular function
11
Q
acute sialadenitis
Causes?
Most common infectious cause?
A
inflammation of salivary gland
infectious: S. AUREUS
non-infectious: Sjogren’s, sarcoidosis, radiation
Parotid: swollen painful, pus draining from duct
12
Q
chronic sialdenitis
A
inflammation of salivary gland
due to: SIALOLITH
Sx: episodic pain and swelling at mealtime (if submandibular: persistent enlargement may occur)
Tx: remove stone or gland
13
Q
hairy leukoplakia
A
LATERAL tongue
EBV
immunocompromised patients
BALLOON cells
14
Q
leukoplakia
A
40-70 yrs
TOBACCO, MALE
white patch that cannot be scraped off or characterized as any other disease
PREMALIGNANT unless proven otherwise
15
Q
erythroplakia
A
40-70 yrs TOBACCO, MALE red patch less common and worse than leukoplakia dysplasia, carcinoma in situ or minimally invasive CA
16
Q
oral squamous cell carcinoma
A
MOST COMMON: head and neck CA
oropharynx: HPV: p16
TOBACCO
usually advanced when Dx
17
Q
p16
A
HPV related oral squamous cell carcinoma
18
Q
dentigerous cyst
A
cyst around crown of unerupted tooth IMPACTED TOOTH associated with: AMELOBLASTOMA radiograph: unilocular lesion Tx: removal
19
Q
ameloblastoma
A
locally invasive tumor in mandible
radiolucent SOAP BUBBLE
20
Q
odontogenic keratocyst (OKC or keratocystic odontogenic tumor)
A
MALE; 10-40 yrs
POSTERIOR MANDIBLE
radiograph: well-defined unilocular or multilocular radiolucencies
locally AGGRESSIVE
association: nevoid basal cell CA syndrome
Tx: removal
21
Q
cholesteatomas (test)
A
middle and internal ear benign LOCALLY INVASIVE lined by KERATINIZING STRATIFIED SQUAMOUS EPITHELIUM associated with: CHRONIC OTITIS MEDIA
22
Q
imperforate anus
A
MOST COMMON congenital intestinal atresia
failure of the cloacal diaphragm to involute
23
Q
esophageal diverticulum
A
outpouching of mucosa through muscular layer of esophagus
Sx: asymptomatic, dysphagia, regurgitation, bad breath
Dx: barium swallow
Tx: rarely Sx
several kinds
24
Q
Zenker (pharyngeal) diverticula
A
FALSE
posterior outpouching of mucosa and submucosa through the cricopharyngeal muscle
cause: incoordination btwn pharyngeal propulsion and cricopharyngeal relaxation
25
midesophageal (traction) diverticula
cause: traction from mediastinal inflammatory lesions or by motility disorders
26
epiphrenic diverticula
just above diaphragm usually accompany a motility disorder (achalasia, diffuse esophageal spasm)
27
diaphragmatic hernia
incomplete formation of diaphragm allows abdominal viscera to herniate into thoracic cavity
severe: can cause PULMONARY HYPOPLASIA
28
omphalocele
closure of abdominal musculature is incomplete and abdominal viscera herniate into a ventral amnioperitoneal membranous sac
Tx: surgically
many have other birth defects
29
gastrochisis
closure of all layers of the abdominal wall (peritoneum to skin) incomplete
30
inlet patch
ectopic gastric mucosa in upper third of esophagus
| Can result in: dysphagia, esophagitis, Barret esophagus, adenocarcinoma
31
Where can ectopic pancreatic tissue be found?
esophagus or stomach
32
What can GI ectopia look like?
invasive CA
33
gastric heterotopia
small patches of ectopic gastric mucosa in small bowel or colon
Sx: occult blood loss due to peptic ulceration
34
meckel diverticulum
```
TRUE
ileum: failed involution of VITELLINE DUCT
2 feet of ileocecal valve
2 inches long
2x common in males
2: age symptomatic
```
35
pyloric stenosis
MALE, 3-6 weeks
Sx: regurgitation, projectile NONBILLOUS vomiting after feeding; freq. demands of refeeding
OLIVE on physical exam (abdominal mass)
36
esophageal mucosal web
FEMALE, 40 yrs with GERD, chronic graft-vs-host or blistering skin disease
protrusion of mucosa that can obstruct, composed of fibrovascular connective tissue and overlying epithelium
Sx: nonprogressive dysphagia with incompletely chewed food
37
Plummer-Vinson syndrome (Paterson-Brown-Kelly)
esophageal webs
iron-def. anemia
glossitis
cheilosis
38
esophageal (Schatzki) rings
similar to webs but CIRCUMFERENTIAL, thicker
include: mucosa, submucosa, occasionally hypertrophic muscularis propria
OBSTRUCTION
39
Curling ulcer
ulcer in proximal duodenum associated with severe burns
40
Cushing ulcer
gastric duodenal and esophageal ulcers in person with intracranial disease
high incidence of perforation
41
gastric antral vascular ectasia
WATERMELON stomach
association: cirrhosis, systemic sclerosis
Sx: occult fecal blood, iron-def. anemia
rare cause of gastric bleeding
42
small bowel obstruction
1. Sx
2. most frequent cause worldwide
3. most common cause in children younger than 2 yrs
4. if had Sx
5. other
1. abdominal pain, distention, vomiting, constipation
2. Hernia
3. Intussusception
4. adhesions
5. volvulus
43
histo divisions of anal canal
1. upper: columnar rectal epithelium
2. middle: transitional
3. lower: stratified squamous
44
anal carcinoma patterns and association
1. glandular adenocarcinoma: HPV 18
| 2. squamous cell CA: HPV 16
45
mucocele
dilated appendix filled with mucin
| can be due to: obstructed appendix containing mucin, mucinous cystadenoma, mutinous cystadenocarcinoma
46
appendix mucinous neoplasm
| what can these be mistaken for in women?
can get intraperitoneal seeding
can be mistaken for mucinous ovarian tumors
Tx: debulking mucin: eventually fatal
47
pseudomyxoma peritonei
abdomen filled with tenacious, semisolid mucin
| due to appendiceal mucinous neoplasm
48
menetrier disease
```
30-60 yrs
body, fundus
mucous cells
Sx: hypoproteinemia, wt. loss, diarrhea
associated with adenocarcinoma
```
49
zollinger ellison syndrome
```
50 yrs
fundus
parietal cells
neutrophils
Sx: peptic ulcers
risk: MEN syndrome
not associated with adenocarcinoma
```
50
HP
```
50-60 yrs
mucous cells
neutrophils and lymphs
Sx: similar to chronic gastritis
risk: H. pylori
sometimes adenocarcinoma
```
51
FGP
```
50 yrs
parietal and chief cells
Sx: none
risk: PPI, FAP
if syndromic: associated with adenocarcinoma
```
52
gastric adenoma
```
50-60 yrs
antrum more than body
dysplastic, intestinal cells
Sx: similar to chronic gastritis
risk: chronic gastritis, atrophy, intestinal metaplasia
associated with adenocarcinoma
```
53
liver: focal nodular hyperplasia
young to middle age adults
spontaneous mass lesion; well demarcated but poorly encapsulated
CENTRAL SCAR
54
hepatocellular adenoma
```
Benign
develop from hepatocytes
incidental or due to rapid growth
rupture: Sx emergency
HNF1-alpha, B-catenin activated
association: ORAL CONTRACEPTIVES, anabolic steroids
NO PORTAL TRACTS
```
55
hepatoblastoma
```
less than 3 yrs: most common liver tumor
malignant
WNT activation
association: APC/familaial adenomatous polyposis
FATAL without Tx
Tx: chemo, Sx
```
56
hepatocellular carcinoma (HCC)
male
associations: Hep. B and C, chronic liver disease (cirrhosis is not mandatory); aflatoxin, alcohol
SYNERGISTIC effect
mutations: B-catenin activation, p53 inactivation
ALPHA-FETAL PROTEIN
deadly
57
cholangiocarcinoma (CCA)
```
biliary tree malignancy
arise from bile ducts
KLATSKIN tumors
BilIN (-1 thru -3)
liver FLUKES (Opisthorchis, Clonorchi)
risk: chronic inflammation, cholestasis
MUCIN
```
58
liver: nodular regenerative hyperplasia
incidental finding
liver entirely transformed into nodules
gross: similar to micro nodular cirrhosis (no fibrosis)
COMPRESSED CENTRAL VEIN
can lead to PORTAL HTN
associations: conditions affecting intrahepatic blood flow: renal or hematopoietic stem cell transplant, vasculitis
CHICKEN WIRE
59
What factor do both types of liver nodular hyperplasia (regenerative and focal) have in common?
focal or diffuse alterationions in hepatic blood supply
| due to obliteration of portal vein and compensatory augmentation of arterial blood supply
60
HNF1-alpha inactivation
hepatocellular adenoma
no risk for malignant transformation
association: oral contraceptive, MODY-3
61
B-Catenin activation
hepatocellular adenoma
high risk for malignant transformation
hepatocellular carcinoma
62
inflammatory hepatocellular adenoma
high CRP and serum amyloid A (gp130 mutations)
some have B-catenin mutations
intermediate risk for malignant transformation
63
WNT activation
hepatoblastoma
64
p53 inactivation
hepatocellular carcinoma
65
Opisthorchis
liver fluke
| cholangiocarcinoma
66
Clonorchi
liver fluke
| cholangiocarcinoma
67
Klatskin tumor
perihilar tumor
| see in cholangiocarcinoma
68
biliary intraepithelial neoplasia (BilIN)
premalignant lesion for cholangiocarcinoma
69
liver angiosarcoma associations
vinyl chloride
arsenic
Thorotrast
FATAL
70
liver epithelioid hemangioendothelioma
endothelial malignancy
| prognosis: variable
71
hepatosplenic delta-gamma T cell lymphoma
young adult males
lives in SINUSOIDS
also seen in marrow
72
Hepatic lymphomas
rare associations?
most commonly?
second most common?
middle age men
association: Hep. B and C, HIV, PBC
most: diffuse B cell
second: MALT
73
cholestasis
systemic retention of bilirubin and other solutes eliminated in bile due to obstruction of bile channels or defect in bile secretion
gives rise to bile pigment in liver
74
Crigler Najjar Syndrome type 1
AR
unconjugated bilirubin
absent UGT1A1 activity
fatal in neonatal period
75
Crigler Najjar Syndrome type 2
AD with variable penetrance
unconjugated bilirubin
decreased UGT1A1 activity
generally mild, occasional kernicterus
76
Gilbert syndrome
AR
unconjugated bilirubin
decreased UGT1A1 activity
77
Dubin-Johnson
```
AR
conjugated bilirubin
impaired biliary excretion of bilirubin glucuronides
mutation in MRP2
BLACK LIVER
```
78
Rotor syndrome
AR
conjugated bilirubin
decreased hepatic uptake/stroage?
decreased biliary excretion?
79
UGT1A1
Crigler Najjar Syndrome
| Gilbert syndrome
80
MRP2
canalicular multi drug resistance protein 2
| Dubin-Johnson
81
Top 2 causes of large bile duct obstruction
1. gallstones
| 2. malignancy (biliary tree or pancreas)
82
Mallory-Denk bodies
alcohol induced liver disease, nonalcoholic fatty liver disease
if periportal: chronic biliary obstruction
83
biliary atresia
complete or partial obstruction of lumen of the extra hepatic biliary tree within the first 3 mo. of life
84
primary biliary cirrhosis
```
50 yrs, female
autoimmune
progressive
association: Sjogren's, Scleroderma, thyroid disease
normal radiology
AMA
also: ANCA, ANA
duct: florid duct lesions, SMALL DUCT LOSS ONLY
CK-7
```
85
primary sclerosing cholangitis
```
30 yrs, male
autoimmune
unpredictable but progressive
association: IBD
radiology: strictures, beading of large bile ducts, pruning of smaller ducts
p-ANCA
duct: inflammatory destruction of extra hepatic and large intrahepatic ducts; fibrotic obliteration of medium and small intrahepatic ducts
BEADING: strictures
```
86
CK-7
primary biliary cirrhosis
87
choledochal cysts
younger than 10 yrs, female
congenital dilations of common bile duct
Sx: jaundice, abdominal pain
some have: cystic dilation of intrahepatic biliary tree (Caroli disease)
predispose to: stone formation, stenosis, stricture, pancreatitis
older patients: increased risk of bile duct CA
88
fibropolycystic disease of the liver
heterogeneous group of lesions in which abnormalities are congenital malformations of the biliary tree
Von Meyenburg complexes
single or multiple, intrahepatic or extra hepatic biliary cysts
increased risk for: cholangiocarcinoma
89
congenital hepatic fibrosis
AR
mutation: PKHD1
chromosome: 6
complications: portal HTN, bleeding varices
90
Budd-Chiari syndrome
portal HTN due to thrombosis of hepatic veins
acute: can be fatal
Sx: hepatomegaly, ascites, abdominal pain
due to: polycythemia vera/myeloproliferatie disease, pregnancy, OCP, abdominal CA
91
liver cell that regenerates in injury
hepatocyte (not stem cells)
92
hepatic stellate cell
1. activated by?
2. contraction of activated cell by?
3. fibrosis stimulated by?
4. chemotaxis to injury?
scar deposition in liver
lipid (vit. A) storing cell that is converted to myofibroblast in injury
1. PDGF, TNF
2. ET-1 (endothelin 1)
3. TGF-B
4. PDGF, MCP-1 (monocyte chemotactic protein-1)
93
Which zone is most susceptible to injury?
| Why?
```
zone III (next to central vein)
lowest O2 and nutrients
```
94
Type 1 autoimmune hepatitis
middle aged women
| Ab: ANA, AMSA
95
Type 2 autoimmune hepatitis
children or teens
| Ab: anti-LKM1
96
AMA
primary biliary cirrhosis
97
ANCA
primary sclerosing cholangitis
| primary biliary cirrhosis
98
ANA
primary biliary cirrhosis
| type 1 autoimmune hepatitis
99
AMSA
type 1 autoimmune hepatitis
100
anti-LKM1
type 2 autoimmune hepatitis
101
preeclampsia
maternal HTN, proteinuria, peripheral edema, coagulation abnormalities
102
HELLP syndrome
hepatic disease that may be primary manifestation of preeclampsia
hemolysis, elevated liver enzymes, low platelets
103
eclampsia
preeclampsia plus hyperreflexia and convulsions
104
acute fatty liver of pregnancy
RARE
Sx: subclinical to elevated LFTs to hepatic failure to coma to death
3rd trimester: usually mild
mitochondrial dysfunction in baby effects mom
Tx: termination of pregnancy
105
intrahepatic cholestasis of pregnancy
second leading cause of gestational jaundice (after viral hepatitis)
late pregnancy
estrogen may inhibit hepatocellular bile secretion
Sx: pruritis, dark urine, light stool, jaundice
lab: some: elevated serum bilirubin (conjugated), mildly elevated ALP
association: fetal distress, stillbirths, premature
mother at risk for: gallstones, malabsorption
106
Gaucher disease
genetic disorder in which glucocerebroside accumulates in cells
lysosomal storage disease
enlarged liver, spleen
if bone marrow involved trilineage decrease
107
glucocerebroside
Gaucher
| sphingolipid
108
kernicterus
yellow in brain
| due to unbound bilirubin
109
ascending cholangitis
stone blocks duct and get back up leading to infection of bile ducts
