Path - Anatomy - Exam 3 Flashcards

Question

Define anaplasia

Answer 1

A condition of cells in which they have poor cellular differentiation, losing the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells.

Answer 2

Pleomorphism is a term used in histology and cytopathology to describe variability in the size, shape and staining of cells and/or their nuclei. It is a feature characteristic of malignant neoplasms, and dysplasia.

Answer 3

The development of secondary malignant growths at a distance from a primary site of cancer.

Answer 4

Malignant epithelial

Answer 5

Malignant neoplasm A tumour having the properties of anaplasia, invasiveness and metastasis.

Answer 6

Malignant mesenchymal

Answer 7

The enlargement of an organ or tissue by the proliferation of cells of an abnormal type, as a developmental disorder or an early stage in the development of cancer.

Answer 8

- Behavioural  - Histogenetic  - Descriptive  - Site of origin - Embryological – ecto, endo or mesodermal - Aetiological – usually not known - Molecular – emerging. I.e. HER 2, BRAF ALK positive

Answer 9

Benign – remains localized | Malignant – not localized. Can be primary or secondary

Answer 10

In hyperplasia, there is an increase in the number of cells in an organ or tissue that appear normal under a microscope. In dysplasia, the cells look abnormal under a microscope but are not cancer. Hyperplasia and dysplasia may or may not become cancer. Neoplasia is the development of a tumor, which means cell division is not being controlled.

Answer 11

- may have a capsule and be circumscribed - no invasion - uniform, less haemorrhagic - rarely necrotic - grows slower

Answer 12

- well differentiated - low nucleus: cytoplasm ratio - usually not pleomorphic (variability in size and shape of cells) (but exceptions) - low mitotic rate - no invasion (exceptions) - no metastasis

Answer 13

- tends not to have a capsule and may not be circumscribed - invasion - necrosis common - haemorrhage common - grows faster

Answer 14

- variable differentiation - high nucleos: cytoplasm ratio - pleomorphism - hyperchromasia - variable mitotic rate, abnormal mitosis - necrosis - invasion - vascular invasion - reaction to invasion (desmoplasia – growth of fibrous or CT)

Answer 15

1. Differentiation – benign is well 2. Rate of growth – benign is slow 3. Local invasion – none for benign 4. Metastases – no for benign

Answer 16

The extent to which neoplastic cells resemble comparable normal cells morphologically and functionally a) well differentiated – tumor cells resemble mature normal cells (benign) b) Intermediate – moderately differentiated c) Poorly differentiated/undifferentiated – poor or no resemblance d) Anaplasia – extreme lack of differentiation

Answer 17

High grade (poor, undifferentiated) vs low - differentiation - nuclear pleomorphism - mitotic rate - vascular proliferation - necrosis - others, i.e. proliferation index

Answer 18

- HER2 – breast, stomach - BRAF – melanoma, colon, rectum, thyroid - EGFR – lung - KRAS – colon, rectum, pancreas - ASLK positive – lung - Oestrogen and progesterone receptors – breast Allows for target therapy

Answer 19

Premalignant lesions are morphologically atypical tissue which appears abnormal under microscopic examination, and in which cancer is more likely to occur than in its apparently normal counterpart. - Either dysplasia or benign tumor. - Confined to the epithelium - Morphological expression of disturbance of growth regulation - Individual cells similar to malignant cells - Pre-neoplastic lesion - Low vs high grade - Carcinoma in situ – very severe dysplasia

Answer 20

- lesions are first localized, often asymptomatic - penetrate the basement membranes/capsules - movement through extracellular matrix - penetrate vascular channels (most cells don’t survive journey) - exit to new tissue - survival and growth as metastasis evoking angiogenesis

Answer 21

- local direct invasion - lymphatic dissemination - haematogenous dissemination - spread across cavities - intraepithelial spread - others – implantation, fine needle aspiration tract

Answer 22

- genetic - chemical - hormonal - radiation - microbial organisms - chronic diseases (i.e. ulcers) - immune system disorders

Answer 23

a) autosomal dominant inherited cancer syndromes b) Defective DNA repair syndromes and resulting DNA instability (lynch) c) Familial cancers (breast, colon etc)

Answer 24

1. Non neoplastic: - chronic atrophic gastritis - solar keratosis of the skin - ulcerative colitis - Barrett disease 2. Neoplastic: - benign neoplasms - dysplasia

Answer 25

a) chemical b) radiation i) UV – squamous and basal cell carcinoma melanoma ii) ionizing radiation c) oncogenic viruses and other microbes - HepB – liver cancer - EBV – Burkitt’s lymphoma, nasopgaryngeal carcinoma - HPV - carcinoma of cervix - H. pylori – gastric carcinoma and lymphoma

Answer 26

``` TNM cancer staging (site dependant): - T: tumor - size - extent of spread - N: Nodal status - number - groups - size etc - M: Metastasis Eg. T3N1M0 ``` Clinical staging: I, II, III, IV

Answer 27

5 leading primary tumor sites for cancer mortality: 1. lung (M+F) 2. colorectal (M) breast (F) 3. prostate (M) colorectal (F) 4. Melanoma (M) Pancreas (F) 5. Unknown primary

Answer 28

- local/pressure effects - abnormal functional activity - obstruction of vessels, tubes and ducts - bleeding, secondary infection by ulceration - rupture of blood vessels - pain - raised intracranial pressure Benign tumors are rarely responsible for death directly. Malignant can also: - metastasize - replace/destroy native tissue/organs by crowding or invasion - cachexia (wasting) - paraneoplastic syndromes - psychological effects - effects of therapy

Answer 29

1. strength of association 2. consistency of the observation (reproducibility) 3. specificity to a disease 4. temporality (cause before disease) 5. gradient (dose-response) 6. plausibility (biology)  7. coherence (with natural history of disease) 8. experimentation (with significance) 9. analogy (similar known causes)

Answer 30

- metabolic activation by ‘DNA adduct’ | - Direct DNA damage

Answer 31

- P53 mutation* - LRAS - PTEN

Answer 32

A. development of atherosclerotic changes - chronic inflammation - lipid abnormalities - endothelial dysfunction B. induction of hypercoagulable state

Answer 33

- carbon monoxide - asbestos - lead - UV radiation

Answer 34

- direct interaction with cells - reactive oxygen species – macrophages attempt to digest it - chronic inflammation

Answer 35

- Asbestosis (fibrosis) - Mesothelioma - Adenocarcinoma – massive risk increase with smoking

Answer 36

a) Acute - GIT pain (colic) - demyelination neutopathy (weakness) b) Chronic - decreased IQ - cognitive decline - renal dysfunction - anemia - hypertension

Answer 37

- ozone - sulfur dioxide - nitrogen dioxide Can lead to: - production of free radicals - airway reactivity - lung inflammation

Answer 38

- Hb has 200x greater affinity for CO than O2 | - CNS ischemia

Answer 39

- sunburn - collagen damage - carcinoma/melanoma

Answer 40

Core 41-42 degrees Consequences: - confusion - cardiac and respiratory dysfunction - vasodilation - oedema - clotting - acidosis - denaturation of cell proteins

Answer 41

Core 35 degrees Consequences: - confusion - loss of shiver response - diuresis - cardiac arrhythmia - pulmonary oedema

Answer 42

- burns - trauma - electrocution - ionizing radiation - nutritional: a) obesity b) malnourishment

Answer 43

Morphological study of cells by themselves 1. gynaecological (pap smears) 2. non- gynaecological 3. fine needle aspiration (FNA)

Answer 44

- cells from transformation zone of cervix obtained via spatula or brush - smeared onto slide, fixed and stained using papanicolaou method - +/- liquid based technique - diagnosis of inflammatory conditions - candida - trichomonas - Diagnosis of viral infections - HSV - HPV - Malignant lesions and their precursors - CIN 3 (cervical intraepithelial neoplasia) - squamous cell carcinoma

Answer 45

a) Fluids - pleural - peritoneal - pericardial - CSF - urine b) Brushings - bronchial - bile duct c) Washings - peritoneal - bladder - renal pelvis

Answer 46

Either If unfixed – should be refrigerated to prevent degeneration of cells If fixed – alcohol fixative (95% ethanol)

Answer 47

``` To diagnose: - inflammatory conditions - infections - malignancy To exclude malignancy ``` Example – haematuria (blood in urine) – urologist performs cystoscopy and sees tumor and takes biopsy.

Answer 48

``` Virtually any organ or mass Either direct (superficial and palpable) or under image guidance (ultrasound or CT) ``` How is a FNA sample produced? - material obtained smeared on slides - fixed and air-dried - cell block and be made for ancillary studies

Answer 49

The microscopic examination of tissue in order to study the manifestations of disease. a) Biopsies - skin, breast, GIT, liver, kidney, cervix, brain b) Surgical excisions - inflammatory/infectious/infarct - benign neoplasm - malignant neoplasm

Answer 50

1. Specimen received with request form: - patient details - specimen location - clinical info - requesting doctor 2. Specimen fixed in 10% neutral buffered formalin 3. Examined by pathologist 4. Required tissue selected and placed in cassettes 5. Processed overnight then embedded in paraffin wax 6. Paraffin block sectioned 7. Section transferred onto slide 8. H&E stain 9. Examination 10. Report issued

Answer 51

- inflammatory conditions - infections - benign neoplasms - malignant neoplasms

Answer 52

Fresh tissue required for organism culture and providing antibiotic sensitivities. - bacteria: gram stain - H. pylori: Toluidine blue - Giardia: giemsa stain - Fingi: silver stain - Mycobacteria: Ziehl Neelsen Also special stains for iron, mucin and elastin.

Answer 53

1. Carcinoma (epithelial tissue of skin of lining of internal organs) - squamous cell - adenocarcinoma - neuroendocrine 2. Sarcoma (CT or other non-epithelial tissue) 3. Melanoma (melanin forming cells) 4. Lymphoma (lymph nodes)

Answer 54

TUMORS. Uses antibodies to detect different antigens in the tissue sections. Used to: - differentiate between different tumor types - determine site of primary tumor in metastatic lesions - measure of proliferative activity in tumors - determine tumor response to treatment

Answer 55

Triple test: 1. clinical 2. radiology 3. histopathology - core biopsy - post surgical excision

Answer 56

1. tumor type and grade 2. invasive vs in situ 3. presence/absence of lymphovascular space invasion 4. adequacy of surgical excision 5. lymph node status

Answer 57

- oestrogen and progesterone receptors hormone therapy: tamoxifen and aromatase - HER2 staining therapy: herceptin

Answer 58

a) blood loss - GI - menstrual - other b) inadequate intake – vegetarian c) Inadequate absorption - coeliac disease - gastritis - calcium impairs absorption - ascorbic acid aids absorption d) Increased requirements - pregnancy - children

Answer 59

a) Hereditary - HFE haemochromatosis (type 1) - non-HFE haemochromatosis (type 2-5) b) Acquired c) Iron loading anemias - thalassaemia major - sideroblastic anemia - chronic haemolytic anemia

Answer 60

- Reduced to ferrous state – ferric reductase - Transport into enterocyte – divalent metal transporter 1 - Released – ferroporin + hephaestin - Hepatocytes – take up a) free iron b) transferrin-bound iron – via TR1 and TR2 - TR2 – sensor for circulating TBI – expression of hepcidin - Hepcidin – down regulates ferroportin-mediated release In intestine: - In the duodenal enterocyte (cell of the lining of the intestine), dietary iron is reduced to the ferrous state by duodenal ferric reductase. - Then transported into the cell by divalent metal transporter 1 - It is released by way of ferroporin, facilitated by hephaestin, into circulation In liver: - hepatocytes take up iron from circulation either as free iron or transferrin-bound iron(TBI) (if latter, it’s taken up via transferrin receptor 1 and 2) - TR2 may serves as a sensor of circulating TBI, thereby influencing expression of the iron regulatory hormone hepcidin - Hepcidin is secreted into circulation, where it down regulated the ferroportin-mediated release of iron from enterocytes, macrophages and hepatocytes.

Answer 61

Deficiency: - often asymptomatic - weakness - headache - irritability - fatigue - difficult exercising - brittle nails - delayed growth in infants and children - neurological sequelae Overload: - organ damage - cirrhosis - diabetes - cardiomyopathy - arthritis - testicular failure - bronzing of the skin

Answer 62

1. Ferritin – reflects iron stores. Low DOESN’T indicate iron deficiency and high doesn’t confirm overload. 2. Iron – low doesn’t indicate deficiency, and high doesn’t indicate overload 3. Transferrin – binds two iron molecules in circulation 4. %Transferrin saturation = iron/transferrin x 50% 5. Red Cell Indices: a) MCH – low = hypochromic b) MCV – low = microcytic 6. Soluble Transferrin Receptor (sTfR) – up-regulated in deficiency 7. HFE genotyping if suspecting overload If anemic, these will all be low. Low RBC indices could also mean frank anemia. If overload: - increased transferrin saturdation - +/- increased ferritin - HFE genotype - Signs of end organ damage from iron deposition, i.e. abnormal LFT.

Answer 63

Soluble Transferrin Receptor (sTfR) – up-regulated in deficiency

Answer 64

1. Ferratin 2. Iron 3. Transferrin 4. %Transferrin 5. HFE genotyping – also identifies those at risk 6. Signs of end organ damage

Answer 65

Any of a group of organic compounds which are essential for normal growth and nutrition and are required in small quantities in the diet because they cannot be synthesized by the body.

Answer 66

Vitamin A: - xeropthalmia - hyperkeratosis (abnormal thickening of outer layer of skin) - pruritis (severe itching of the skin) - growth retardation - susceptibility to infection Vitamin D: - rickets in children - osteoporosis in adults Vitamin E: - progressive sensory and motor neuropathy - ataxia – loss of control of bodily movements - retinal degeneration - haemolytic anemia Vitamin K: - bleeding Folate: - megaloblastic anemia - pregnancy – low birth weight premature, neural tube defects B1: (Thiamine) - Beriberi - Cardiomyopathy - Polyneuritis B2: (Riboflavin) - angular stomatitis (inflammation of mucous membrane in mouth) - glossitis (inflammation of the tongue) - dermatitis B3 (Niacin) - pellagra: B6: (pyridoxine) - nonspecific stomatitis - glossitis - neurological complications B12: - megaloblastic anemia - atrophic glossitis - neuropathy and demyelination of the CNS Vitamin C: - scurvy

Answer 67

Assays. Vitamin K not available. Supplementation may be easier, cheaper, quicker. B12: - assay of B12 levels in serum - BUT low normal reference interval may still be deficient, therefore measure ‘active B12’.

Answer 68

- carcinoma - adenoma - papilloma

Answer 69

Stratum corneum = mechanical barrier Disruption allows penetration of pathogens into deeper layers. Bacteria may penetrate into deeper layers via lymphatic’s Capillary plexus allows dissemination of pathogens. Also brings acute inflammatory cells and chemokines.

Answer 70

Also cause pyoderma Microbiological causes: Usually S. pyogenes Also other step and staph aureus. ``` Presenting symptoms and signs: - Itchy rash with red papules, plaques on arms, hands and face - painless lesions - well child - heal without scaring May be confused with herpes ``` Pathogenesis: Minor skin trauma allows entry (i.e. bite, scratch) Investigation: - skin swap Treatment: - topical antibiotics, i.e. fucidin - oral antibiotics, i.e. flucloxacillin

Answer 71

- tinea pedis – feet - tinea corpus – body, ring worm - tinea cruris – warm, moist, creases - tinea capitis – scalp - tinea (or pitriasis) versicolor – Malassezia furfur - tinea unguium – onchomycosis. Fungal nail infections. Nails thick, crumbly and discolored. Microbiological causes: Dermatophyte infection Most common: Trichophyton rubrum Pathogenesis: - fungi that invade epidermis and cause inflammation - invade keratinized tissues, hair follicles, nails - release proteinases and keratinases into skin - spread through stratum corneum Signs and symptoms: - burning, itching, tingling in toe space - annular lesions Investigation: - skin scrapings or nail clippings – fungus is active in the advancing margin of the lesion - microscopy and culture Treatment: - topical clotrimazole given twice daily - given until 2 weeks post resolution of skin lesions

Answer 72

Microbiological causes: - Usually staph aureus - can be oral flora, strep, gram –ve or anaerobes - candida albicans usually if chronic Pathogenesis: - breakdown of protective barrier between nail and nail fold - can result from nail biting, finger sucking, manicuring, artificial nail placement Presenting symptoms and signs: - soft tissue infection around fingernail - acutely painful, red, swollen fingernail Treatment: - warm water soaks 3-4 times a day - oral antibiotic, i.e. Augmentin or Clindamycin - if it progresses to an abscess, drain promptly - If chronic, keep dry, warm soaks and topical antifungal Chronic paronychia: - symptoms > 6 weeks - episodic inflammation, pain and swelling - usually after exposure to water: housekeepers, dishwashers, bartenders, swimmers - main cause: Cadida albicans

Answer 73

Microbiological causes: - usually GAS infection (group A strep = pyogenes) Pathogenesis: - finger suckers or nail biters Presenting symptoms and signs: - painful pustules on fingertips - sausage-shaped, painful swelling of fingers and toes

Answer 74

Microbiological causes: - staph aureus Pathogenesis: - SA produced toxins - Bullous impetigo if local spread - Generalized spread = staph scalded skin syndrome (SSSS) Presenting symptoms and signs: - fluid filled blisters - pop and leave sores

Answer 75

Microbiological causes: - staph: menstrual or non-menstrual related - strep – usually associated with deep GAS infection Pathogenesis: - due to release of toxins - cause rash and organ dysfunction - strep TSS: 50% mortality - staph TSS: 5% mortality Presenting symptoms and signs: - rash and organ dysfunction

Answer 76

Microbiological causes: - usually S aureus - hot tub folliculitis = pseudomonas aeruginosa - Candida, Malassezia furfur Presenting symptoms and signs: - spots - infection of hair follicles/apocrine glands Treatment: - local measures, i.e. saline compress - topical antibacterials and/or antifungalds Variations: - Folliculitis barbae – shaving bumps - Hot-tub Folliculitis

Answer 77

Microbiological causes: - usually S aureus Pathogenesis: - from preceding folliculitis - areas subject to friction/perspiration and contain follicles, i.e. neck, face, axillae, buttocks - Predisposing factors: obesity, diabetes mellitus, steroids, leukemia Presenting symptoms and signs: - a plague of boils - deep inflammatory nodule Treatment: - application of moist heat usually sufficient - +/- anti-staph antibiotics (if fever/cellulitis) Recurrent furunculosis: - relatively common and not associated with a defect - prophylaxis: - general skin care - care of clothing, bedding - staph decolonisation

Answer 78

Microbiological causes: - mainly S aureus Presenting symptoms and signs: - deep infection, contagious furnucles - cluster of boils - painful, discharging legions - unwell, i.e. fever - usually nape of neck, back or thighs - Complications: - cellulitis - bacteremia Treatment: - surgical drainage AND - antibiotics

Answer 79

Microbiological causes: - beta haemolytic strep (usually GAS) Pathogenesis: - involves cutaneous lymphatics - predisposing factors: - tinea - venous insufficiency - stasis ulcerations - skin disease, i.e. dermatitis - insect bite Presenting symptoms and signs: - superficial bacterial skin infection - involves cutaneous lymphatics - fiery red, indurated, tense plaque - clearly demarcated borders (as opposed to cellulitis – indiscreet margins) - face or extremities Treatment: - Penicillin

Answer 80

Microbiological causes: - causative pathogen rarely identified ``` Pathogenesis: Predisposing factors: - tinea pedis - chronic venous or arterial ulcers - primary skin diseases (eczema etc) - minor trauma, recent surgery - leg oedema, i.e. RH failure, venous incompetence, lymphedema. - Immunodeficiency ``` Presenting symptoms and signs: - acute bacterial infections of skin and soft tissues - presents as a diffuse, spreading erythematous rash - maybe fever and chills after rash - abscesses, bullae/vesicles may form - often lymphangitis, regional lymphadenopathy or lymphadentitis Investigation: - swab blister fluid - results may be misleading Treatment: - antibiotics directed at S aureus and B-haemolytic strep - flucloxacillin - 1st gen cephalosporins - clindamycin - IV if significant fever or systemic upset, facial cellulities lymphangitis, obesity - HITH therapy used commonly

Answer 81

Venous insufficiency causes pooling of blood

Answer 82

- lipodermatosclerosis – secondary to venous stasis - erythema nodosum - pyoderma gangrenosum

Answer 83

a) Moulds - characteristic structure – hypha – elongated filaments which may branch. Gives moulds velvety appearance. - mycelium – interconnected network of hyphae b) Yeasts - unicellular, spherical or egg shaped bodies c) dimorphic – may exist as mould or yeast form

Answer 84

1. Site of infection - superficial - cutaneous - subcutaneous - deep 2. Source and route of acquisition - exogenous - inhalation, through skin - endogenous - commensals 3. Level of virulence - virulence to cause disease in normal immune systems - opportunistic (immunodeficiency)

Answer 85

Epidermis Hair shafts and nails may be involved

Answer 86

``` Superficial: - pityriasis versicolor o no living tissue invaded o no inflammation o malassezia furfur o asymptomatic - cosmetic ``` - white piedra - black piedra o both hair shafts producing nodules ``` Cutaneous: - no living tissue - dermatophytosis (ringworm, tinea) o no living tissue invaded o inflammatory response in living epidermis o 3 causal fungal genera: - Trichophyton - microsporum - epidermophyton floccosum ``` - mucocutaneous candidiasis o invasion of living part of epidermis of mucosa o inflammation

Answer 87

- Annular lesion which spread centrifugally - May be sharply defines - Dry scaly skin in center - Slightly raised - Inflamed spreading margin - Tends to heal in centre - May itch and burn

Answer 88

- mainly exist in yeast form - reproduce by budding - in human tissue, they may be found in the form of yeasts, hyphae or pseudohyphae - most common pathogen: C. albicans - opportunistic fungus - Infection of skin and nails may occur when local or systemic immunity is impaired or the balance of normal bacterial flora is altered - Life threatening if systemic

Answer 89

Occurs in parts of body constantly moist: o vulva and mucous membrane of vagina o nappy area of babies o sweaty, intertriginous areas, i.e. beneath breasts

Answer 90

Classical discharge: - milky white - thick with curd-like chunks - inflamed, swollen mucosa - painful and itchy

Answer 91

- soil fungi - introduced into the skin by trauma - resulting infections typically chronic - rarely become systemic

Answer 92

- mycetoma (Madura foot) - sporotrichosis - chromoblastomycosis - pheohyphomycosis - hyalohyphomycosis - zygomycosis

Answer 93

Typically see: 1. tumefaction – tumor like swelling 2. draining sinuses 3. granules – small collections of mycelia in concrete matrix Lesions grow over months to years May be destructive to underlying fascia, bone, cartilage and muscle Most common species = Madurella

Answer 94

Caused by: Sporothrix schenckii Features: 1. a small papule on the periphery at the site of foreign body trauma 2. gradual development of an enlarging, non-healing ulcer 3. appearance of pus filled red swellings moving up the limb (following  lymphatic channels) 4. these swellings may discharge pus 5. the infection progresses over a number of months if untreated, and  gradually heals Chronic, localized infections Follows traumatic implantation, soil saprophytes

Answer 95

- lymphocutaneous - pulmonary - meningeal - osteoarticular - disseminated - other

Answer 96

- Development of a papule days-weeks after cutaneous injury - Usually ulceration of primary lesion, frainage not grossly purulent and no odour - Recurrence of similar nodular lesions with overlying erythema along the lymphatics proximal to the primary lesion - Mild pain and no systemic symptoms

Answer 97

Gold standard – culture Histopath: mixed granulomatous and pyogenic process 3-5mm diameter, oval-cigar shaped with multiple buds – flower like Aspirated material or biopsy of lesions

Answer 98

- itraconazole - continue 2-4 weeks after all lesions have resolved - success rate – 90-100% - rarely causes long term morbidity

Answer 99

Features: - small scaly nodule at the site of inoculation - spreads slowly as a scaly, whitish thickened plaque - over time becomes raised and warty - may develop into a large “cauliflower”-like lesion

Answer 100

Clinical features determined by immunological status of host. Typical in the normal host is cystic form. In immunocompromised – paranasal sinuses or the brain

Answer 101

``` - exposure to organism via: o shower floors o changing rooms o hotel, gymnasium carpets and rugs - enhanced by warm, moist conditions of skin - frequent washing with sop and inadequate rinsing - use of disinfectants - mechanical irritation ```

Answer 102

1. Infection of skin (stratum corneum):  - i. tinea cruris (inguinal),  - ii. tinea pedis (feet),  - iii. tinea manuum (hand) - typically the palms - iv. tinea imbricata (rare in Australia) 2. Infection of hair:  - i. tinea capitis (scalp),  - ii. tinea barbae (facial skin/hair), 3. Infection of nails: - i. Tinea unguium 4. Infection of the upper dermis:  - i. Majocchi's granuloma (rare; not covered here) 5. Miscellaneous - i. Piedra, tinea nigra & others (rare; not covered here)

Answer 103

- Trichophyton - microsporum - epidermophyton floccosum Most common human dermatophyte = Trichophyton rubrum

Answer 104

- infection starts at free edge, on side of underneath (sub-ungual) - nails become thick, crumbly and discolored, with varying degrees of oncholysis - often have fungal infections at other sites

Answer 105

a) DLSO - distal and lateral nail borders (most common) b) SWO – superficial white onychomycosis – upper surface of nail plate c) PSO – proximal subungual onychomycosis – nail invasion directly from nail fold

Answer 106

Cause: Trichophyton concentrcum - concentric of annular plaques - significant scale covering hairless skin surfaces - squamous plaques become thick and lamella – looks overlapping (imbricated) - like lace, fish scales or tiles Aetiology: - begins in childhood - tropics with high humidity, high poverty index, rural/remote, poor hygiene and overcrowding Treatment: - systemic and topical antifungal treatment - responses sub-optimal

Answer 107

Cause: Malassezia furfur - chronic, superficial - doesn’t penetrate into tissue - induced no cellular response - small hypo/hyper pigmented macules - trunks, shoulders, arms Diagnosis: - Skin scrapes - Dixon’s agar or olive oil supplements required to grow it

Answer 108

Cutaneous: - very common - usually invade keratinous structures - common in healthy individuals - management is topical +/- systemic antifungals Subsutaneous mycoses: - less common - environment fungi with inoculation injury - more common in immune system dysfunction - management is systemic antifungals +/- surgery

Answer 109

List the epithelial tumors of the skin * Epidermal and trichilemmal cysts * Verrucae (warts) * Molluscum contagiosum * Solar lentigo * Seborrheic keratosis * Basal cell carcinoma * Actinic keratosis * Squamous cell carcinoma * Keratoacanthoma * (Adnexal Neoplasms)

Answer 110

Usually derived from hair follicles a) Epidermal cyst: - 1-4cm - punctum (small opening on top) - rupture with keratin granuloma is common - secondary infection may occur b) Tricholemmal Cyst: - usually on scalp - no punctum - rare proliferating variant

Answer 111

Caused by HPV. ``` Clinical types: - verruca vulgaris - verruca plana - verruca plantaris (sole of foot) - condyloma acuminatum (genital) Usually regress You know it’s a wart if you see koilocytes = vacuolated keratinocytes. Means HPV ```

Answer 112

- umbilicated papules caused by poxvirus - spread by direct contact - children, young adults - infects follicular infundibula - typically resolves

Answer 113

- pigmented macules on sun-exposed skin - elongation of rete ridges - keratinocyte hyperpigmentation - variable minimal melanocytic proliferation - most important DDx is lentigo maligna

Answer 114

- typically multiple lesions (grampa) - develop middle age - predilection for trunk, forehead - sharly demarcated – ‘stuck on’ - waxy surface - lese-trelat sign (tate) - Common types of histological patterns: o Acanthotic (uniform cuboidal cells) o Papullomatous/hyperkeratotic o Reticular o May see pseudohorn cysts

Answer 115

- Red thing - Variable inflammatory changed - Reactive architectural/cytological change - True dysplasia rare – not pre-malignant

Answer 116

* About 70% of skin cancer  * Predominantly in sun damaged skin  * H+N>trunk>other sites  * High probability of subsequent lesions  * Rare genetic predispositions (e.g. Gorlin’s syndrome)

Answer 117

* Numerous histological types * Practically:  * Superficial * Nodular * Aggressive sub-types: * Infiltrating * Micronodular  * Sclerosing/Morpheic  * Metatypical/Basosquamous You might see cystic areas. (clear but granular large holes) You might get blue cells forming a little line like a fence.

Answer 118

* Dysplastic proliferation of keratinocytes (grampa) * Marker of solar damage and risk of skin cancer * Low rate of progression to SCC * Occur on:  * Sun exposed sites  * Fair skin  * Middle aged/Elderly * Common substrate for “keratin horn” (15% SCC) * Variants:  * Hyperkeratotic * Pigmented  * Actinic cheilitis (on lower lip) * Lichenoid  (inflammation) * Atrophic Will see orthokeratosis (Hyperkeratosis with no nuclei) but it doesn’t invade into lower tissue.

Answer 119

- Bowen’s disease - Erythematous plaque - Sun-exposed or protected skin - Acanthotic epiderm, i.e. pleomorphic mitotic figures - Adnexal colonization frequent

Answer 120

- Sun-damaged skin - Tenderness, thickness on palpitation - Generally low risk of metastasis High risk sites: - ear - lips - vilva and penis Other risk factors: - clinical size>2cm - >2mm thickness - clark level 4 or 5 - PNI - Poorly differentiatied

Answer 121

- rapidly growing crateriform lesion - usually involutes - clinically and histologically overlap with some types of SCC - generally managed as SCC - may see central erupting core of keratin

Answer 122

``` Wide variety of tumours benign and malignant: • Follicular • Apocrine  • Sebaceous  • Eccrine  • Mixed differentiation ```

Answer 123

1. Lichenoid - lichen planus 2. Psoriasiform - psoriasis 3. Spongiotic - atopic eczema 4. Vesiculobullous - bullous pemphigoid 5. Granulomatous - sarcoidosis 6. Vasculopathis - urticarial - leukocytoclastic vasculitis

Answer 124

1. epidermolytic hyperkeratosis 2. acantholytic dyskeratosis 3. cornoid lamellation 4. papillomatosis 5. acral angiofibromas 6. eosinophilic cellulitis with flame figures 7. transepidermal elimination

Answer 125

1. Superficial perivascular inflammation 2. Superficial and deep dermal inflammation 3. Folliculitis and perifolliculitis 4. Panniculitis (inflammation of subcutis)

Answer 126

- characterized by epidermal basal layer damage – it won’t be as clear as it should be and may have signs of inflammation (blue dots) - basal vacuolar change or cell death. Cells will be in holes. If dead – diskeratosis (pink bit of keratin left) - accompanying inflammatory infiltrate o lymphocytes o histiocytes o eosinophils

Answer 127

Lichen Planus. - also look for hyperkeratosis - wedged shaped hypergranulosis (thickened granular layer) - epidermal hyperplasia - band like lichenoid inflammatory infiltrate - basal vacuolar change with formation of colloid bodies and civatte bodies. (keratin) - May have subepidermal clefting - Direct immunofluorescence – cytoid bodies

Answer 128

- regular epidermal hyperplasia with elongation of the rete ridges - increased mitotic activity - associated inflammatory infiltrate o lymphocytes o polymorphs o histiocytes

Answer 129

Psoriasis. - regular epidermal hyperplasia - elongated clib shaped rete ridges - parakeratosis (retains nuclei) - mild spongiosis - superficial dermal perivascular lymphocytic infiltrate - thinning of supra-papullary plated - *neutrophilling infiltration

Answer 130

- intraepidermal and intercellular edema – fluid will push cells apart and you will see desmosomes - ‘eczematous reaction’ - associated inflammatory infiltrate

Answer 131

Eczema. | Wet, weaping rash.

Answer 132

- blisters - the presence of vesicles or bullae at any levels within the epidermis or at the dermo-epidermal junction o intracorneal and subcorneal o intraepidermal o suprabasilar o subepidermal o miscellaneous

Answer 133

Bullous pemphigoid. - Autoimmune disease characterized by the production of autoantibodies to the bullous pemphigoid antigen related to hemidesmosomes - subepidermal vesicle containing mainly eosinophils - lymphocytic and dense eosinophilic infiltrate - linear IgG and C3 localised to roof of vesicle - superficial dermal edema especially in pre-bullous lesions - clean break takes base off - fluorescence – line along base

Answer 134

- chronic dermal inflammation with infiltration of histiocytes or epithelioid histiocytes - a granuloma is an aggregate of epithelioid histiocytes o sarcoidal o tuberculoid o necrobiotic o suppurative o foreign bodies

Answer 135

``` Sarcoidosis. - tight and naked granulomatous inflammatory infiltrate - usually no necrosis - well circumscribed - various inclusion bodies – none of which are specific for this disease o asteroid vodies o schaumann bodies o calcium oxalate crystals o hamazaki-wesenberg bodies ```

Answer 136

Diseases of the blood vessels comprising 6 groups. I.e.: - urticaria - vasculitides (i.e. *leukocytoclastic vasculitis) - endothelial proliferation - endothelial damage o necrosis o nuclear dust o red cell extravasation o increased permeability - immune complex deposition - different to other tissue where acute/chronic inflammation is shown as neutrophilic/lymphocytic infiltration only

Answer 137

- nuclear dust, origin = leucocytes - also called hypersensitivity vasculitis - affects small vessels in the superficial dermis - fibrinoid necrosis – will see lots of fibrinogen - swollen endothelium - perivascular lymphocytic infiltrate, nuclear dust and red cell extravasation. - Clinically – palpable and purple

Answer 138

Non-neoplastic pigmentary disorders: - vitiligo - melisma - post-inflammatory pigment alteration - ephelis Neoplasms: - (solar lentigo) - lentigo simplex - melanocytic naevi - melanoma

Answer 139

- acquired loss of pigmentation due to inflammatory destruction of melanocytes - histology: loss of melanocytes within the epidermis

Answer 140

- symmetrical hyperpigmented patched, usually face - hyperfunctioning melanocytes reacting to sun - hormonal association

Answer 141

- occurs after a variety of inflammatory and traumatic processes - histology: melanophages in superficial dermis

Answer 142

- melanocytes producing more melanin than they should, but normal numbers of melanocytes - wax ad wane - histology: normal epidermal architecture with increased keratinocyte pigmentation.

Answer 143

- small, flay darkly pigmented macule - fewer than ephelides, more darkly pigmented and do not wax/wane - a true melanocytic proliferation Histology: - melanocytes still single, not in nests, but there are just more of them in epidermal ridges

Answer 144

Clinical: - small - well circumscribed - even coloration Histology: - symmetrical - cells predominantly in nests - round to oval, even nuclei - maturation as the cells get deeper - classified as junctional, compound, intradermal

Answer 145

a) spitz naevus – red dome often mistaken for melanoma b) blue naevus – dendritic melanocytes c) large/giant congenital naevus – risk of melanoma d) dysplastic naevus? (technically not benign)

Answer 146

Clinical: - larger than benign naevi (>6mm) - irregular borders - variable colouration Histological: - less symmetrical - more single cell growth - some larger, darker nuclei - fibrosis in the upper dermis - cytological atypia

Answer 147

A malignant rumor derived from melanocytes

Answer 148

Any one of ABCDE is cause for concern - Asymmetrical - Border irregularity – poorly circumscribed - Colour variability - Diameter - >6mm as guide - Evolving – i.e. changing

Answer 149

• Asymmetrical  • Poorly circumscribed  • Single cells predominate over nests  • Growth in continuity from one rete ridge to another • Extension into the upper levels of the epidermis – Pagetoid spread  – “buckshot” scatter • Cytological atypia  – Nuclear enlargment, hyperchromasia, irregularity – Prominent nucleoli

Answer 150

Growth within the epidermis – lacks metastatic potential

Answer 151

- growth within the epidermis (in situ) as well as microinvasion into the superficial dermis - microinvasion limited to single cells and small cell nests - lacks metastatic potential

Answer 152

- invasive melanoma within the dermis - dermal nests larger than the epidermal nests - mitotic figures - implies capacity for metastatic spread

Answer 153

- tumor thickness (Breslow thickness) - level of invasion (Clark level) - ulceration - mitotic rate - lymphovascular or perineural invasion - satellite lesions

Answer 154

- superficial spreading melanoma – most common - nodular melanoma – no/minimal intraepidermal component - lentigo maligna melanoma - elderly, predominantly single cell growth pattern - acral lentiginous melanoma - not associated with the sun - acral sites – hands and feet, maybe under nail

Answer 155

- lymphocytes - scarring - melanin-containing macrophages

Answer 156

Complete excision with 2mm margin. Partial biopsies: - are less accurate (different degrees in different zones) - carry a higher risk of misdiagnosis – under staged

Answer 157

BRAF - BRAF is a serine-threonine kinase - Mutations found in 66% of melanomas - BRAF mutations lead to activation of kinase activity – MAPK pathway (mitogen activated protein kinase) - Also common in naevi - Not alone sufficient for melanoma development - Specific BRAF inhibiting drugs have been developed which are selective for V600E mutation – used to treat patients with metastatic melanoma

Answer 158

Practically, they can be though of as non-epithelial, non-melanocytic, non-lymphomatous skin tumors.

Answer 159

- tumors of fat - tumors of fibrous tissue - tumors of blood vessels and lymphatics - tumors of muscle - tumors with nerve sheath differentiation

Answer 160

Name: lipomas Clinically Features: - age 40+ - associated with obesity - may be very large - bright yellow homogenous fat with fine fibrous capsule and trabeculae - greasy cut surface Histological features: - composed of mature adipocytes with uniform nuclei resembling normal white fat - small amounts of fibrous tissue - occasional blood vessels

Answer 161

These are benign tumors with similar macroscopic appearance but variable microscopic appearance. - spindle cell lipoma - chondroid lipoma - pleomorphic lipoma - angiolipoma - capillaries more prominent

Answer 162

Name: liposarcoma 3 main types: a) atypical lipotamous tumour/well differentiated liposarcoma b) myxoid/round cell liposarcoma c) pleomorphic liposarcoma Deep soft tissue

Answer 163

A biphasic tumor that includes an undifferentiated sarcomatous component.

Answer 164

Well-differentiated tumors.

Answer 165

a) Dermatofibroma b) Defmatofibrosarcoma protuberans (DFSP) c) Atypical Fibroxanthoma (AFX)

Answer 166

- benign - common site: legs of women 20-50 - recurrence not common Histology: - tumor is composed of fibroblastic and histiocytic cells arranged in sheets or intersecting fascicles - mixed population of cells – inflammatory cells consisting of lymphocytes, plasma cells and foamy histiocytes are also seen - the stroma contains delicate collagen fibers in between cells - mitotic activity not increased - cytologic atypia absent - no sharply defined borders - usually show entrapment of surrounding dermal collagen - overlying epithelial hyperplasia and hyperpigmentation

Answer 167

- well differentiated primary fibrosarcoma of the skin - slow growing, can be locally aggressive and recur, but rarely metastasize - firm, solid nodules mostly found on trunk Histology: - composed of fibroblasts arranged radially in a stroriform patter (irregular pattern denoting a straw mat) - mitoses present - often show deep extendion into subcutaneous fat - lace-like pattern

Answer 168

- the deep margin of DF usually shows limited infiltration into subcut tissues, whereas DFSP has more extensive infiltration. - DSFP has more homogenous population of tumor cells, lacks inflammatory cells, foamy histiocytes and giant cells - Stratiform pattern more pronounced in DFSP - Mitotic activity increased in DFSP - DF = factor 13a positive - DFSP = CD34 positive

Answer 169

- generally rapidly growing nodular lesions in sun exposed areas of older patients - rapid growth - usually polypoid without ulceration. - 1-6cm - local excisions usually curative and recurrence is rare Histology: - composed of atypical, pleomorphic spindle cells - storiform or fascicle pattern - abundant mitoses, but some mitotic figures atypical - use immunohistochemistry to exclude melanoma, spindled squamous cell carcinoma or leiomyosarcoma. AFX will be negative for S-100, melan A, desmin and cytokeratins. - overlying epidermis uninvolved

Answer 170

a) Juvenile Xanthogranuloma (JXG) | b) Fibroepithelial polyp/skin tag/acrochordon

Answer 171

- cutaneous histiocytic lesion usually seen in infancy and childhood - most patients develop lesions by 6 months - excellent prognosis – most regress spontaneously - yellow or brown Histology: - composed of sheets of histiocytes (eosinophilic cytoplasm) in dermis and extending to the flattened epidermis - hallmark = touton giant cell - inflammatory cells found in moderate numbers

Answer 172

- benign - middle aged and older people – trunk, face and interigous areas - soft flesh coloured tumor attached to skin by a slender stalk Histology: - fibrovascular cored covered in squamous epithelium

Answer 173

Leiomyoma = benign Subtypes based on location: - nipple or scrotum - pilar leiomyoma - angioleiomyoma Histology: - intersecting fascicles - cigar shaped nuclei - no atypia - no mitotic activity - no necrosis

Answer 174

Leiomyosarcoma = malignant a) Dermal: - arise from pilar muscles or genital smooth muscles - middle aged males - metastasis rare b) Subcutaneous: - arise from vascular smooth muscle - greater tendency for metastasis Compared to leiomyoma: - more cellular - cytological atypia - mitoses - necrosis

Answer 175

Haemangiomas a) capillary Haemangiomas – thin walled capillaries b) juvenile Haemangiomas c) cavernous Haemangiomas – large, dilated vascular channels d) lobular capillary Haemangiomas (‘pyogenic granuloma’) – polypoid, often ulcerate and bleed - will look like lobulated polyp, capillary sized vessels

Answer 176

1. Angiosarcoma | 2. Kaposi Sarcoma

Answer 177

- head and neck in eldery - associated with chronic lymphedema - post radiation therapy - slow growing but highly aggressive - metastasize to regional lymph nodes and organ

Answer 178

- vascular neoplasm caused by HHV8 and highly associated with AIDS - Four forms: o Classic (older men) o Endemic African o Transplant-associated o AIDS-associated - Cutaneous lesions progress from patched to plaques to nodular tumors Histology: - spindle cells forming slits with extravasated RBCs - hemosiderin laden macrophages - lymphocytes - fibrosis - minimal atypia

Answer 179

1. Neurofibroma (nerve sheath) 2. Neuroma (nerve fibers and schwann cells) Describe a neurofibroma. - benign nerve sheath tumour - mixture of schwann cells, perineural cells, fibroblasts, mast cells - sporadic or related to neurofibromatosis - 3 growth patterns o superficial cutaneous neurofibroma - pedunculated o diffuse neurofibroma – plaque like elevation of skin o plexiform neurofibroma – nerve roots or large nerves

Answer 180

- benign non neoplastic overgrowth of nerve fibers and schwann cells - usually post traumatic - painful - common subtypes: o amputation or traumatic neuroma o morton neuroma Histology of amputation neuroma: - irregular organization of nerve fibers immersed in scar tissue

Answer 181

Divided loosely into B cell and T cell proliferation. Examples: Mycosis fungoides = a cutaneous T cell Lymphoma Primary Cutaneous Follicle Centre Cell Lymphoma = a cutaneous B cell lymphoma

Answer 182

- a cutaneous T cell Lymphoma - elderly or adults - skin-homing CD4+ T helper cells - progression: patch, plaque, nodule/tumor - often misdiagnosed early as eczema - usually remains localized to skin for many years, but may evolve into generalized lymphoma Histology: - may look similar to dermatitis – increased lymphocytes - neoplastic lymphocytes form a band-like zone in upper dermis - convoluted nuclear membrane – this would be unusual for dermatitis

Answer 183

- presents with solitary or localized skin lesions on the scalp, forehead or trunk - erythematous plaques or nodules - nodular diffuse pattern

Answer 184

MESENCHYMAL TUMORS: 1. Fat Tumors: a. Lipoma = benign fat tumor i. spindle cell lipoma ii. chondroid lipoma iii. pleomorphic lipoma iv. angiolipoma b. Liposarcoma = malignant fat tumor i. atypical lipotamous tumour/well differentiated liposarcoma ii. myxoid/round cell liposarcoma iii. pleomorphic liposarcoma 2. Fibrous Tissue Tumors: a. Dermatofibroma b. Defmatofibrosarcoma protuberans (DFSP) c. Atypical Fibroxanthoma (AFX) 3. Histiocytic Tumors: a. Juvenile Xanthogranuloma (JXG) b. Fibroepithelial polyp/skin tag/acrochordon (benign) 4. Smooth Muscle Tumors: a. Leiomyoma (benign) b. Leiomyosarcoma (malignant) 5. Blood Vessel Tumors: a. Haemangiomas (benign) i. capillary Haemangiomas ii. juvenile Haemangiomas iii. cavernous Haemangiomas iv. lobular capillary Haemangiomas b. Angiosarcoma (malignant) c. Kaposi Sarcoma (malignant) 6. Neural Tumours: a. Neurofibroma (benign) b. Neuroma (benign) LYMPHOMAS: 1. T cell lymphoma: Mycosis fungoides 2. B cell lymphoma: Primary Cutaneous Follicle Centre Cell Lymphoma

Path - Anatomy - Exam 3 Flashcards

(209 cards)