Pathology Flashcards
(198 cards)
1
Q
Give an account on the types of intracranial hemorrhage
A
Extradural: Rapid accumulation of blood between skull & dura due to acute severe trauma severing MMA
Subdural: Mild traumatic injury to veins crossing subdural space produces chronic venous blood accumulation
Intracerebral: may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Can increase ICP and cause cerebral herniation
2
Q
Enumerate the causes of Hydrocephalus and discuss its types
A
a) Obstruction in the normal flow of CSF
b) Problems with resorption of CSF into the venous system
c) Excessive production of CSF.
Communicating: The whole ventricular system is dilated caused by impaired absorption of CSF. The most common causes are post hemorrhagic or post-inflammatory changes
Non communicating: hydrocephalus develops from a block in CSF pathways.
3
Q
Increased intracranial tension (3, last one has 5 subgroup)
A
An increase in the amount of CSF.
Cerebral edema.
Space occupying lesions:
* Tumors
* Hemorrhage
* Hematoma
* Infarction (with Hemorrhage &edema)
* Infections (localized abscess).
4
Q
Causes of cerebral infarction
A
Cerebral artery occlusion due to thrombus or embolus
5
Q
Complications of acute meningitis (4)
A
1- Spread of infection to the brain: brain abscess.
2- Phlebitis may cause venous occlusion and hemorrhagic infarction of the brain.
3- Septicemia resulting in DIC and suprarenal hemorrhage leading to acute adrenal insufficiency
4- Fibrosis in the subarachnoid space leads to:
- Obstructive hydrocephalus.
- Cranial nerve palsies (paralysis).
- Epilepsy
6
Q
Route of spread of Brain abscess
A
o Septic emboli: from acute bacterial endocarditis produce multiple pyaemic abscesses
o Hematogenous spread: from chronic pulmonary infections.
o Direct spread: from otitis media which produces mastoiditis and infection is transmitted to the temporal lobe. In paranasal sinusitis a frontal lobe abscess occurs.
o Trauma: producing an abscess at site of injury.
7
Q
Complications of brain tumors (5)
A
1- Increased intracranial pressure:
* Pressure on vital centers due to medullary herniation.
* Brain atrophy which is responsible for paralysis or dementia.
2- Invasion and brain tissue destruction.
3- Cerebral edema.
4- Irritation effects in the form of seizures or epileptic fits.
5- Obstructive hydrocephalus.
8
Q
Etiology & pathogenesis of Hashimoto’s thyroiditis
A
Ø It is an autoimmune disease directed against thyroid antigens.
Ø Autoimmune injury is mediated by circulating Abs to thyroglobulin & thyroid peroxidase.
Ø Thyroid autoimmunity is accompanied by:-
1-progressive follicular cell loss.
2-fibrosis.
9
Q
Etiology & pathogenesis of Subacute thyroiditis
A
a) It is attributed to a viral infection or post viral inflammatory process, resulting in cytotoxic T-cell-mediated follicular epithelial damage.
b) Because the immune response is virus initiated, it is self-limited.
10
Q
Grave’s disease (definition and pathogenesis)
A
Definition: It is an autoimmune disorder characterized by thyrotoxicosis. (thyroid storm)
A) Production of autoantibodies to TSH receptor :
1- Thyroid stimulating immunoglobulin (TSI) à binds to the (TSH ) receptor and mimics the action of TSH, leading to T3 and T4 release.
2- Thyroid Growth Stimulating I.G (TGI) is directed against (TSH ) receptor but these autoantibodies induce thyroid follicular epithelium proliferation.
B) T-cell mediated autoimmunity: Ophthalmopathy.
11
Q
Definition and complications of goiter
A
is a non-inflammatory, non-neoplastic enlargement of the thyroid gland.
- Cosmetic effects of a large neck mass.
- Airway obstruction .
- Dysphagia .
- A hyper functioning nodule may develop within a long-standing goiter resulting in hyperthyroidism.
12
Q
Follicular adenoma (Gross and microscopic)
A
Gross: Solitary, spherical,& average about 3 cm in diameter, encapsulated, gray-white to red-brown
well demarcated from the surrounding parenchyma. with fibrosis, hemorrhage, or calcification
Microscopic : Follicles: Compact, small lined by cubical calls, surrounded by a fibrous capsule .
13
Q
Complications of diabetes
A
Microangiopathy: Retinopathy, nephropathy, neuropathy
Hyaline atherosclerosis
Accelerated atherosclerosis—>angina pectoris, myocardial infarction, diabetic gangrene
Increase susceptibility to infections due to lowering of immunity
14
Q
Enumerate the thyroid tumors
A
Follicular adenoma
Follicular carcinoma
Papillary carcinoma
Anaplastic carcinoma
Medullary carcinoma
15
Q
Define lymphadenopathy
A
Enlargement of lymph nodes secondary to disease. It may be localized in one group or generalized
16
Q
Causes of lymphadenopathy (7)
A
- Reactive lymphoid hyperplasia.
- Lymphadenitis: Acute /chronic inflammatory inflammation.
- Sarcoidosis.
- Lymphoma: Primary neoplasm of lymphoid tissue.
- Metastasis: Metastatic carcinoma in lymph nodes (more common than lymphoma)
- Blood diseases; mainly leukemia.
- Some metabolic storage disease.
17
Q
Enumerate Types of lymphoid Hyperplasia
A
Reactive lymphoid hyperplasia:
follicular hyperplasia
paracortical hyperplasia
reticular hyperplasia
Lymphadenitis: acute and chronic lymphadenitis
18
Q
Enumerate Types of RS cells
A
Classic RS
Mononuclear variant
Lacunar variant
Lymphohistiocytic variant
19
Q
Enumerate subtypes of Hodgkin’s Lymphoma
A
1- Classical Hodgkin lymphoma:
Nodular sclerosis type
Mixed cellularity type
Lymphocyte-rich type
Lymphocyte-depletion type
2-Nodular lymphocyte predominant type
20
Q
comparison between low and high grade non Hodgkin’s lymphoma
A
21
Q
Complications of Plasma cell tumors 7
A
- Pathological fracture.
- Replacement of the marrow by tumor cells, resulting in pancytopenia
- Hypercalcemia, and metastatic calcification
- Increased levels of Immunoglobulins (secreted by plasma cells) in the blood and/or in the urine causing renal failure
- Amyloidosis: Deposition of secreted abnormal protein in the tissues
- Renal changes : secondary to blockage of tubules and pyelonephritis
- Spread: direct & early blood producing plasma cell leukemia.
22
Q
Causes of splenomegaly (5)
A
- Inflammations & Infections:
* Bacterial: TB
* Parasitic: Malaria -Bilharziasis.
* Viral: Infectious mononucleosis. - Circulatory disturbances:
* Rt. Sided Heart failure & systemic venous congestion (CVC).
* Portal hypertension.
* Recent infarction. - Blood disorders:
* Leukemia-polycythemia.
* Hemolytic anemia-thrombocytopenia. - Tumors: Lymphoma & Leukemia.
- Metabolic disorders:
23
Q
causes of bone fracture (2, last one has 4)
A
A. Traumatic.
B. Pathological:
1. Osteomyelitis.
2. Osteoporosis.
3. Tumors: primary and secondary tumors.
4. Bone cyst.
24
Q
Factors delaying healing of fractures
A
- Inadequate immobilization: slows tissue union. If this continues, movement will prevent bone formation and collagen will be laid down instead giving rise to fibrous union and false joint at fracture site.
- Soft tissue interposition: will prevent healing and if not removed will lead to non-union.
- Infection: will delay healing.
- Pre-existing bone disease: If the bone is broken due to a disease in the bone, it is called pathological fracture. Example of pathological fracture is fracture due to metastatic carcinoma.
25
Complications of osteomyelitis
1. Spread of infection: Direct spread causing arthritis, myositis and neuritis; or blood spread as toxemia, septicemia, and pyemia.
2. Pathologic fracture.
3. Amyloidosis.
4. Malignancy: Squamous cell carcinoma in the sinus tract, bone osteosarcoma.
26
What is Pott’s disease and enumerate its characteristics
It is vertebral tuberculosis
Characterized by:
Kyphosis
Cold abscess
Paraplegia
27
Compare between Osteoid osteoma and osteoblastoma
-Osteoid Osteoma: Benign bone tumor that commonly occurs in the shafts of long bones of adolescents and young adults, who complain of persistent pain, worse at night, often relieved by aspirin.
-Osteoblastoma: is uncommon solitary tumor that involves vertebrae and, to a lesser extent, the long bones of the extremities. It is similar to osteoid osteoma histologically, but is larger and not accompanied by nocturnal pain
28
Osteochondroma
It affects patients under 20 years and both sexes are affected. Osteochondromas commonly develop in the metaphyseal region (near the growth plate) of long bones, especially near the knee.
Gross: Lesions are mushroom-shaped surface protrusions, covered by a cap of hyaline cartilage with surface perichondrium.
29
Gross and microscopic of Fibrous dysplasia
Gross: Lesions are well-circumscribed, intramedullary masses that are tan-white, gritty, and variable in size.
Microscopic: Lesions are composed of curvilinear trabeculae of woven bone with no osteoblastic rim (likened to Chinese letters) separated by richly vascularized fibrous stroma. Mature lamellar bone is not formed and lesions do not enlarge after puberty. This suggests that the lesion represents an arrest of bone maturation at the woven bone stage.
30
Define Rheumatoid Arthritis and discuss the pathogenesis. Enumerate the extraarticular manifestations
Definition: Chronic systemic inflammatory disease of autoimmune origin that principally attacks joints, producing a non-suppurative proliferative synovitis that progresses to joint destruction and ankylosis. Most patients have an increased level of anti Ig antibody (rheumatoid factor)
a. Rheumatoid skin nodules over bony prominences.
b. Heart: Rheumatoid nodule in valves & pericardium with a lympho-plasmacytic & histiocytic infiltrate.
c. Lung rheumatoid nodules.
d. Arteritis but may also cause phlebitis.
e. Lymphadenopathy & splenomegaly
f. Amyloidosis.
31
Define Tenosynovial giant cell tumor and discuss its types
group of closely related benign neoplasms involving synovial membranes, tendon sheaths, and bursae.
1- Diffuse type: typically presenting in the knee (80%) with pain, “locking", and swelling; range of motion is decreased and aggressive lesions erode into the bone and adjacent soft tissue.
2- Localized type (giant cell tumor of the tendon sheath):, commonly manifesting as a solitary painless mass involving the tendon sheaths of the wrist and fingers.
32
* Gross picture of melanocytic Nevus and melanoma
-Most nevi arise in childhood and adolescence. Common melanocytic nevi are tan to brown, uniformly pigmented small papules. After many years, nevi gradually lose their pigmentation, decrease in size and disappear.
-Melanomas have an irregular border and marked variation in pigmentation including shades of black, brown, red and dark blue. They are usually larger than nevi. Tumor development shows two phases: radial (in situ not metastatic yet) and vertical growth phase (metastatic)
33
Define fibromatosis and discuss its two types of
A group of fibroblastic proliferation which are cytologically benign but grow in an infiltrative fashion , and can recur after surgical excision but do not metastasize.
a. Superficial fibromatoses: Palmar fibromatosis, in the palmar fascia, Plantar fibromatoses, Penile fibromatosis (Peyronie disease).
b. Deep fibromatoses: Abdominal desmoid tumor, arises from the rectus abdominis muscle in post- partum women or in scars of abdominal surgery.
*Extra-abdominal desmoid arises from the shoulder or pelvic girdle muscles.
*Retroperitoneal fibromatosis.
34
Enumerate vascular tumors and tumor like conditions. 7
VASCULAR ECTASIA
HEMANGIOMAS
LYMPHANGIOMAS
GLOMUS TUMOR
HEMANGIOENDOTHELIOMA
KAPOSI SARCOMA
ANGIOSARCOMA
35
Discuss the pathological stages of lobar pneumonia
Congestion (24h): The lung is edematous, red and heavy. The capillaries are hyperemic and the alveoli are filled in protein rich exudates
Red hepatization (few days): The lung is red, solid and airless, and consistency resembles fresh liver. The alveoli shows fibrin and massive accumulation of polymorphs and macrophages.
Grey hepatization (few days): The lung is gray show more accumulation of fibrin § Lysis of red blood cells.
Resolution (8-10 days):The lung returns to normal. Liquefaction and absorption of the exudate, and enzymatic digestion of inflammatory debris
36
Mention 4 complications of lobar pneumonia
1 - failure of resolution-----> Carnification
2- Toxemia: on 9th day acute heart failure due to toxic myocarditis
3- Spread: Direct or by blood
4- Post pneumatic lung abscess
37
Discuss the morphology of bronchopneumonia (septic bronchopneumonia)
Gross: Usually bilateral lower lobe affection
* Patchy areas of yellow consolidation.
* Pleurisy.
* Enlarged hilar lymph nodes (lymphadenitis).
Microscopic:
§ Suppurative exudation filling bronchi, bronchioles, and alveoli.
§ Alveoli: The alveoli are full of pus
38
Predisposing factors of bronchopneumonia
* It occurs most commonly in extreme of age: infants and old age.
* Commonly in patients with debilitating diseases such as : diabetes, cancer and cardiac failure.
* It may complicate viral infections as viral bronchitis.
39
Complications of bronchopneumonia 7
1) Death, especially in debilitated patients.
2) Post pneumonic lung abscess & gangrene.
3) Spread: to the pleura causing pericarditis, mediastinitis.
4) Toxemia causing toxic myocarditis.
5) Septicemia causing meningitis, arthritis, osteomyelitis and infective endocarditis.
6) Fibrosis is common, due to tissue destruction by suppuration.
7) Bronchiectasis: healing of bronchial walls by fibrosis, results in weakened walls and permanent dilatation of the lumen
40
Discuss the types of abscesses (5)
Aspiration lung abscess: due to blood or vomitous or foreign body. These locations represent the more direct course for the aspirated material from the trachea. The abscess wall is irregular and congested. The lining is shreddy yellow and the contents of cavity is yellow pus.
Post pneumonic abscess: in lobar or bronchopneumonia
Bronchial obstruction with bronchogenic carcinoma: aspiration of blood and tumor fragments contribute to the development of lung abscess.
Pyemic abscess: Septic emboli from septic thrombophlebitis of systemic veins.
Direct traumatic punctures or spread of infection from adjacent Organs.
41
Fate and complications of acute lung abscess (6)
1) Small size: Resolve with proper treatment
2) Rupture into a bronchus: results in hemoptysis & cough of purulent sputum
3) Rupture into a pleural cavity: results in empyema and pyopneumothorax.
4) Lung gangrene: ( the cavity is irregular with a necrotic lining but black in color & has a foul odor).
5) Embolization of septic material to the brain results in meningitis and brain abscess.
6) Chronic lung abscess: Well-defined cavity with a thick fibrous wall. The lining is smooth & the contents are inspissiated (thick pus).
42
Enumerate obstructive lung diseases and restrictive lung diseases.
1) Emphysema.
2) Chronic bronchitis.
3) Bronchiectasis.
4) Bronchial asthma.
1) Chest wall disorders in the presence of normal lungs.
Eg. : severe obesity, diseases of the pleura,
2) Chronic interstitial lung diseases:
Eg . pneumoconiosis and interstitial fibrosis.
43
Define emphysema and give an account on their types
Permanent over distention of air spaces distal to the terminal bronchioles, with destruction of their walls
Centriacinar: The lesions are more common and severe in the upper lobes. This type is common in cigarette smokers & coal workers
Panacinar: Occurs more commonly in the lower lung zones. It is the type of emphysema that occurs with alpha 1 antitrypsin deficiency.
Distal acinar: It occurs adjacent to areas of pulmonary scarring. It is usually in the upper half of the lung, and forms multiple adjacent dilated air spaces, some forming bullae.
44
Enumerate the complications of emphysema (3)
1) Pulmonary hypertension and right sided heart failure
2) Respiratory failure from defective ventilation, perfusion & diffusion of gases
3) Rupture bullae containing air into pleura producing pneumothorax
45
Define chronic bronchitis
Chronic bronchitis is defined clinically as persistent productive cough for at least 3 consecutive months, for 2 consecutive years.
46
Define bronchial asthma and enumerate its types
It is a chronic inflammatory disorder of the airways, characterized by paroxysmal reversible bronchospasm due to smooth muscle hyper-reactivity and increased mucus production
Atopic (allergic) asthma: it is caused by a type I hypersensitivity reaction (Ig E- mediated) triggered by environmental antigens
Non-atopic asthma: Hyper-reactivity of airways can be triggered by respiratory tract infections, chemical irritants
Aspirin induced asthma: exact mechanism unknown
47
Discuss the gross picture of bronchial asthma
Lungs are overinflated
Bronchial wall is thick, swollen & red.
Bronchial lumen contains large amounts of thick mucus plugs
48
Discuss the microscopic picture of bronchial asthma
Bronchial lumen: Occlusion of bronchi and bronchioles by mucus plugs which contain whorls of shed epithelium known as Curschmann spirals.
Numerous eosinophils are also present.
Bronchial wall
§ mucous gland hypertrophy.
§ smooth muscle hypertrophy,
§ thickening of basement membrane
49
Discuss the etiology of Bronchiectasis
1) Congenital:
-Kartagener’s syndrome: Structural abnormalities of the cilia impair mucus clearance in the airways resulting in persistent infections
-cystic fibrosis: A hereditary disease associated with thick mucus in exocrine glands, respiratory, gastrointestinal and reproductive tracts.
2- Septic bronchopneumonia particularly in children.
3- Bronchial obstruction (e.g., by tumor or foreign body).
50
Discuss the pathogenesis (mechanism) of Bronchiectasis
Two processes are involved: obstruction and chronic persistent infection.
In septic bronchopneumonia: Severe persistent suppurative inflammation in bronchi or bronchioles
causes:
- loss of cough reflex and accumulation of secretions,
- inflammation of the wall and weakening of the wall by fibrosis
In case of obstruction: caused by foreign body or lung cancer:
- There is accumulation of secretions which favor infection,
- Infection damages the bronchial walls leading to their weakening
- The obstruction causes collapse of lung parenchyma , and the week bronchial wall are exposed to the negative intrathoracic pressure with each inspiration leading to its dilatation.
51
Discuss the gross picture of Bronchiectasis
Medium sized bronchi & bronchioles: Airways can be dilated up to four times the normal size.
The bronchi appear thickened, with suppuration of their lining.
The pleura is thickened , fibrotic with adhesions
-There ;are 3 types of dilatation
Saccular dilatation: involves a part of the circumference of a segment sac like dilatation
Fusiform dilatation involves the whole circumference of a segment of the bronchus
Cylindrical :dilatation involves the whole circumference of the whole length of the bronchus.
52
Give an account on the microscopic picture of bronchiectasis
Bronchi
§ Lumen: filled with pus & blood.
§ Lining respiratory epithelium shows areas of ulceration.
§ Wall shows intense acute and chronic inflammatory cells and fibrosis.
Alveoli
§ Adjacent alveoli undergo fibrosis.
§ Patches of compensatory emphysema
Pleura
§ Fibrosis and adhesions.
53
Enumerate the complications of bronchiectasis 6
a. Hemoptysis with,yellowish red sputum (pus + blood).
b. Lung abscess- gangrene.
c. Spread of infection (see septic bronchopneumonia).
d. Bilateral lung fibrosis , pulmonary hypertension & right sided heart failure (cor pulmonale).
e. Secondary amyloidosis (chronic destructive condition).
f. Squamous metaplasia (due to chronic irritation) which may lead to squamous cell carcinoma.
54
Define atelectasis and give its types
Atelectasis is failure of expansion of the lung or collapse of previously inflated lung, affecting part or all of one lung,
Resorption atelectasis :Occurs with complete airway obstruction e.g. mucus plugs postoperatively or with bronchial ashma, and foreign bodies in children causing collapse of alveolia.
Compression atelectasis :Is associated with accumulation of fluid, blood or air in the pleural cavity, which compress and collapse the lung.
55
Enumerate microscopic types of lung carcinoma
1. Squamous cell carcinoma.
2. Adenocarcinoma.
3. Large cell carcinoma.
4. Small cell carcinoma.
56
complications of lung cancer
A) Spread:
Direct:
-to the pericardium, mediastinum and esophagus.
- Pleural seeding especially in adenocarcinoma.
Lymphatic: To the hilar and mediastinal lymph node.
.
Blood spread: To the brain, bones, liver, adrenals or other lung.
B) Hemoptysis.
C) Obstruction leading to collapse, secondary infection, bronchiectasis or lung abscess.
D) Paraneoplastic syndrome: 3-10% of patients with lung cancer develop clinical paraneoplastic syndrome due to secretion of polypeptide hormones.
-It presents in one or more of the following forms:
Hypercalcemia.
Cushing syndrome.
Myasthenia gravis.
Excess ADH.
57
Gross and microscopic picture of mesothelioma
Mesothelioma is usually unilateral, starting as small nodules on the visceral pleura and extends to cover the whole lung and obliterate the pleural cavity. The tumor is yellowish white.
Microscopic:
Epithelioid type: Cuboidal cells forming papillae and acini (looks like adenocarcinoma)
Sarcomatoid type" sheets of spindle malignant cells (looks like sarcoma)
Mixed type (biphasic): Epithelial + sarcomatous
58
Enumerate: Four causes of endometrial hyperplasia.
Prolonged estrogen stimulation
Estrogen secreting tumors
Prolonged estrogen therapy
Obesity
59
Four causes of uterine bleeding caused by local organic lesion
Pregnancy disorders: abortion
Benign tumors: endometrial polyp
Malignant tumors: carcinoma of endometrium
Inflammations: endometritis
60
Causes of dysfunctional uterine bleeding 4
Anovulatory cycle
Endocrine disorders
Estrogen producing ovarian tumors
Inadequate Luteal phase
61
Predisposing factors of uterine cervical carcinoma.4
1. Early age of sexual activity
2. Females with multiple sexual partners
3. Male partner with multiple previous sexual partners
4. Chronic cervicitis
62
Complications of endometriosis 3
Dysmenorrhea: Painful menstruation due to intrapelvic bleeding.
Dyspareunia: painful intercourse
Infertility: Adhesions around the tubes
63
Complications of puerperal sepsis. 4
severe toxemia and septicemia
Spread of infection to the tubes -> salpingtis.
spread of infection to peritoneum --> peritonitis
Healing of infected tubes--> fibrosis and infertility
64
Mention differences between partial and complete hydatiform moles.
Complete: diploid, fertilization of empty ovum by two sperm, fetal parts absent and rarely progress to carcinoma
Partial: triploid, fertilization of ovum by two sperms, fetal part present and very rarely progress to carcinoma
65
Give an account on duct ectasia (periductal mastitis) (definition, etiology, gross and microscopic pictures).
marked dilatation of mammary ducts containing inspissated Secretions
unknown etiology
Gross: firm tender greyish white mass with large dilated ducts
Micro: dilated ducts contain foamy macrophages and are surrounded by granulomatous inflammation
66
Complications of puerperal sepsis. 5
1. Severe toxemia and septicemia.
2. Septic thrombophelipitis may cause pyemia.
3. Spread of infection to the parametrium, and tubes causing salpingitis.
4. Spread of infection to peritoneum may cause localized (in the pelvis) or diffuse peritonitis.
5. Healing of salpingitis causes fibrosis and infertility.
67
Complications of uterine leiomyomas. 3
1. Uterine bleeding.
2. Infertility
3. Multiple leiomyomas may cause marked uterine enlargement and pressure on nearby organs and pelvic veins.
68
Complications of pelvic inflammatory disease 4
1. Spread of infection to the peritoneum; peritonitis.
2. Toxemia.
3. Chronic PID and chronic tubo-ovarian abscess.
4. Infertility.
69
Complications of ovarian mucinous cystadenoma. 3
1. Pressure effects on nearby organs.
2. Torsion of the pedicle causing, hemorrhage, shock.
3. Malignant change.
70
Complications of vesicular (Hydatidiform) mole 3
1. Bleeding
2. 10% of complete mole are invasive
3. 2-3% give rise to choriocarcinoma.
71
* Three theories explaining endometriosis
and
*Four common sites of endometriosis
1. The regurgitation theory: (more accepted).
Proposes menstrual backflow through the fallopian tubes with subsequent implantation.
2. The metaplastic theory: Proposes endometrial metaplasia of serosal cells covering ovaries or fallopian tubes.
3. Lymphatic :Used to explain extra pelvic endometriosis.
Sites: Pelvic structures, ovaries, Peritoneal cavities and fallopian tubes
72
Cause of acute salpingitis.
Inflammation of fallopian tube, most commonly sexually transmitted due to chlamydia and gonorrhea.
73
* Types of benign ovarian surface epithelial tumors and describe one of them.
serous cystadenoma
mucinous cystadenoma
Serous cystadenoma is often unilocular. The outer surface and the lining are smooth. The inner surface may show papillary projections
74
* Types of ovarian teratoma and describe the most common form
Benign, Malignant and specialized teratoma.
Benign teratoma shows mature ectodermal, endodermal and mesodermal structures such as teeth and hair.
75
Define Endometriosis.
It is the presence of endometrial glands and stroma in a location outside the inner lining of the uterus.
76
Define Adenomyosis.
It is a down growth of endometrium and its entrapment deep within the myometrium
77
Define Dysfunctional uterine bleeding
It is abnormal uterine bleeding caused by hormonal dysfunction without organic (anatomic) cause
78
Gross and microscopic picture of chronic non-specific cervicitis.
There is eversion of the ectocervix with hyperemia, edema and granular surface. Nabothian cysts may be visible as pearly white vesicles.
Microscopic: The cervix shows inflammatory cellular infiltrate; rich in plasma cells, lymphocytes and histiocytes, with fibrosis.
* Often some of the mucous glands are obstructed and dilate to form mucus- filled cysts called Nabothian cysts (follicles).
* The surface epithelium may show squamous metaplasia.
79
Pathology and complications of Female Gonorrheal infection. 6
1. Urethritis: Hyperemic mucosa covered by purulent exudate.
2. Paraurethritis: inflammation of paraurethral glands.
3. Bartholin gland inflammation: This may lead to abscess (Bartholin abscess). Obstruction of the gland duct may lead to cyst formation (Bartholin cyst).
4. Cervicitis (see before).
5. Vaginitis and endometritis (rare).
6. Salpingitis
80
Microscopic picture and grading of cervical intra-epithelial neoplasia (CIN).
It shows proliferated squamous epithelium with cellular atypia and loss of polarity, without basement membrane invasion.
CIN 1 (mild dysplasia): Cellular atyia in lower 1/3 of epithelium
CIN 2 (moderate dysplasia): Cellular atypia in lower 2/3 of epithelium
CIN 3 (severe dysplasia): Cellular atypia involves the full epithelial thickness without surface maturation.
81
Gross picture of endometriosis.
* Endometriosis contains functional endometrium which undergoes cyclic bleeding, so they appear as red brown foci or nodules.
* In the ovaries blood filled cysts are formed. By time the blood becomes brown in color and are called chocolate cysts.
* Organization of the blood occurs leading to fibrosis and adhesions around the fallopian tubes, and ovaries.
82
Gross and microscopic picture of adenomyosis.
Gross: Enlarged uterus with thick myometrium showing trabeculations and haemorrhagic foci.
Microscopic: The myometrium shows foci of endometrial glands and stroma with hemorrhage
83
Microscopic types of endometrial hyperplasia.
1. Non-atypical hyperplasia:
* An increase in the gland-to-stroma ratio.
* The glands show variation in size and shape and may be crowded with back- to- back glands. Cystic change may be present.
* The glands are lined with tall columnar cells which show stratification.
2. Atypical hyperplasia:
* The glands are commonly back-to-back and often have complex outlines due to branching of the glands.
* Individual cells are rounded and lose the normal perpendicular orientation to the basement membrane. In addition, the nuclei have open chromatin and nuclear atypia.
84
Types of endometrial carcinoma.
a. Endometrioid type (80%) which resembles the normal endometrial glands.
■ It is the most common and arises in the setting of endometrial hyperplasia.
■ This type associated with (1) obesity, (2) diabetes (3) hypertension, (4) infertility, and (5) unopposed estrogen stimulation.
■ It occurs around the menopause.
b. Serous type of endometrial carcinoma (20%) arises in the setting of endometrial atrophy in older menopausal women.
85
Enumerate Non-neoplastic ovarian cysts. 5
1. Follicular cysts
2. Polycystic ovaries
3. Corpus luteum cyst
4. Theca-lutein cysts
5. Chocolate cysts
86
Ectopic pregnancy (Definition, sites, predisposing factors).
* Ectopic pregnancy is fetal implantation at any site other than normal intrauterine cavity.
* The most common site is within the fallopian tubes (about 90%), other sites include ovary and abdominal cavity.
* Most important predisposing factor is prior pelvic inflammatory disease resulting in fallopian tube scaring or fibrosis.
87
Give an account on ovarian granulosa cell tumor.
Gross: Well defined solid and cystic tumors and may be hemorrhagic.
Microscopic: The tumor is composed of granulosa cells which mostly have grooved nuclei. Cells are arranged in micro follicular pattern
Effects: The tumor may be functional and produce estrogen.
88
Mention causes of liver abscess
Solitary abscess: amoebic abscess, infected hydatid cyst, cholecystitis, traumatic injury
Multiple abscesses: Amoebic abscess, pyemic abscess, actinomycosis
89
5 causes of liver cirrhosis
Post hepatitis Cirrhosis
Alcohol/Nutritional cirrhosis
Post- Necrotic Cirrhosis
Primary biliary cirrhosis
Cirrhosis related to circulatory disorders
90
5 complications of gall bladder stones
Predisposes to cholecystitis
Stones migrate to common bile duct and may cause obstruction
Acute pancreatitis
Distention of gall bladder
Predispose to carcinoma
91
Three predisposing factors for hepatocellular carcinoma
Cirrhosis
Chronic viral hepatitis C
Hepatocarcinogen alfatoxins
92
Three types of gall bladder stones
Cholesterol stones: yellowish-white; cannot be seen by X-ray
Pigmented stones: very dark and small; opaque on X-ray
Mixed stones: most common, faceted, different colors
93
5 causes of hepatomegaly.
Inflammatory diseases
Degenerative diseases
Metabolic disorders as glycogen storage disease
Neoplastic diseases
Some types of Cirrhosis
94
List Clinco-pathological syndromes of viral hepatitis
Acute asymptomatic infection with recovery
Acute symptomatic infection with recovery
Fulminant hepatitis
Chronic hepatitis
Carrier state
95
Define acute hemorrhagic pancreatitis
a severe and potentially life-threatening inflammation of the pancreas characterized by the presence of hemorrhage, or bleeding, within the pancreatic tissue
96
Acute viral hepatitis microscopic picture.
1. Liver cell injury:
* ballooning of hepatocytes.
* Apoptosis of individual cells, resulting in acidophil bodies
* Focal necrosis , leaving collapsed reticulin network behind.
* In severe cases, necrosis occurs, commonly centrilobular, or even central-portal bridging necrosis.
2. Cholestasis: Accumulation of bile in the liver cells and bile canaliculi Kupffer cells engulf bile and undergo hyperplasia.
3. Portal tract inflammation: In the form of mild mononuclear cell infiltration.
97
Chronic hepatitis (definition and etiology).
Chronic hepatitis is defined by the presence of symptomatic, biochemical, or serologic evidence of continuing or relapsing hepatic disease for more than 6 months, with histologically documented inflammation and necrosis.
Etiology:
* Viral etiology (most common): HBV (+HDV) or HCV. Mixed infection may occur.
* Autoimmune: Caused by autoantibodies as antinuclear antibodies & anti actin antibodies.
* Drug induced: Isoniazid, methyl dopa
Metabolic diseases as: antitrypsin deficiency.
98
Microscopic picture of Chronic Viral Hepatitis
Microscopy:
1) Inflammation :
* Portal inflammation: Expansion of the portal tracts by chronic inflammatory cells, Bile duct walls may be inflamed
* Lobular inflammation
2) Piecemeal necrosis: This is inflammation with destruction of the liver cells at the limiting plates of liver lobules. The liver cells become detached.
3) Fibrosis: Portal fibrosis, bridging fibrosis, accompanied by regeneration nodules (cirrhosis).
4) Other Features: Steatosis of hepatocytes
* Hepatocellular dysplasia (precancerous)
99
Complications of Chronic Viral Hepatitis
1. Post hepatitic cirrhosis.
2. Liver failure.
3. Hepatocellular carcinoma.
100
Enumerate Liver abscesses. 3
Amoebic liver abscess
Ascending cholangitic abscesses
Pyemic Abscesses
101
Causes of portal hypertension 5
Portal vein thrombosis: Tumor and Infection
Portal tract fibrosis: Schistosomiasis, Sarcoidosis, Biliary cirrhosis
Cirrhosis
Veno-occlusive disease
Hepatic vein thrombosis
102
Complications of acute cholecystitis 4
1. Gangrene
2. Perforation resulting in septic peritonitis
3. Adhesions and fistulous tract between gall bladder and duodenum leading to passage of gall stone to the intestine. Large stones can lodge in the ileo cecal valve and lead to gallstone ileus.
4. Chronic cholecystitis.
103
Etiology of acute pancreatitis 6
Pancreatic necrosis, hemorrhage and inflammation may be due to:
1- Obstruction of ampulla of Vater by gall stone. Thus bile passes into pancreatic duct and activates trypsinogen into trypsin which digests the pancreatic tissue.
2- Excess alcohol abuse may lead to increased secretion of pancreatic juice and contraction of sphincter of oddi leading to rupture of pancreatic duct.
3- Accidental surgical injury of pancreas.
4- Hyperparathyroidism.
5- Polyarteritis nodosa.
6- Viral and bacterial infection.
104
complications of chronic pancreatitis 3
1- Malabsorption.
2- Diabetes mellitus.
3- Pseudocysts.
105
Mention the predisposing factors of gastric carcinoma
H.pylori gastritis; as there is sequence of events of atrophy, intestinal metaplasia and dysplasia
Smoked food and canned food have carcinogenic substances
Autoimmune gastritis type A through atrophy
Genetic factors
106
Mention the microscopic picture of Crohn's disease
Segmental inflammation and ulceration rich in neutrophils affecting the whole thickness of the wall
Fibrosis
107
Mention the microscopic picture of ulcerative colitis
Active phase: Mucosal ulcers, diffuse infiltration by inflammatory cells, crypt abscess formation, degenerative changes in the surface epithelium, severe mucosal edema
Chronic phase: mucosal crypt distortion, mucosal atrophy and submucosal fibrosis, epithelial dysplasia
108
Five Complications of peptic ulcer disease.
Bleeding from eroded vessels
Penetration into solid viscera as pancreas
Pyloric obstruction in ulcers
Perforation of peritoneal cavity
Malignant transformation does not occur
109
Six causes of acute pancreatitis.
Obstruction of Ampulla of Vater by gall stone
Excess alcohol abuse
Accidental surgical injury
Viral infection
Bacterial infection
Hyperparathyroidism
110
Six causes of acute intestinal obstruction
Paralytic ileus
Strangulation hernia
Adhesion of healed peritoneal inflammation following surgery
Lumen obstruction
Volvous: completely twisting of bowel loop
embolism of mesenteric artery
111
Five complications of acute suppurative appendicitis
Rupture with septic peritonitis
Gangrene
Chronicity (Chronic appendicitis)
Pus formation
Mucocele of appendix
112
Five of the pathological features gross pictures of ulcerative colitis
Rectosigmoid commonly affected by multiple superficial ulcers
Pseudo polyps which are small elevations
Fibrosis in prolonged disease
It involves the rectum and extends proximally retrograde to colon
113
Four non neoplastic colonic polyps
Bilharzial polyps
Hyperplastic polyps
Pseudo polyps
Hamartomas polyps
114
List the complications of gastric carcinoma 5
Melena
Hematemesis (bloody vomiting)
Pyloric obstruction
Anemia
Spread: direct, lymphatic spread and blood spread
115
Discuss pathogenesis and gross picture of chronic duodenal ulcer (Peptic Ulcer Disease)
Pathogenesis: hyperacidity and failure of mucosal defense mechanism
Gross picture: peptic ulcers are four times more common in the duodenum than in the stomach. Are usually solitary, round or oval in shape. The floor is smooth and base is firm
116
Define acute hemorrhagic pancreatitis
a severe and potentially life-threatening inflammation of the pancreas characterized by the presence of hemorrhage, or bleeding, within the pancreatic tissue
117
Define ulcerative colitis
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulcers in the colon and rectum,
118
Define dysentery
Dysentery is a term used to describe a group of gastrointestinal disorders characterized by inflammation of the intestines, particularly the colon, and accompanied by symptoms such as severe diarrhea, abdominal pain, and the presence of blood and mucus in the stool
119
Define Liver cirrhosis.
Liver cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions
120
Discuss the gross picture of cirrhosis
1. The liver is decreased in size and weight due to loss of liver tissue & fibrous tissue shrinkage.
2. The surface and cut section are nodular. According to size of regeneration nodules, cirrhosis is classified
3. The color is :
- Yellow in cases of nutritional or alcoholic cirrhosis
- Green in case of biliary cirrhosis.
4. Consistency is firmer than normal, edges are sharp & retracted cut section (due to fibrosis).
121
Discuss the microscopic picture of cirrhosis
1. Regeneration nodules:
- Regenerating hepatocytes are arranged in collections trying to simulate a liver lobule but the sinusoids are irregular. These masses of regenerating hepatocytes are totally surrounded by fibrous bands.
- Liver cells proliferate haphazardly so that the liver cell plates are more than two cell thick
- Other changes that may be observed according to the cause: necrotic foci, fatty change, hydropic changes,
2. Fibrosis: in the form of bands of collagen encircling the regenerating nodules involving the portal areas. According to the presence or absence of inflammatory cells within the fibrous septae, cirrhosis is either active or inactive.
3. The portal tracts are widened by the fibrosis, the inflammatory cells & show proliferating bile ducts
122
Define leukoplakia
It is a clinical descriptive term for a white mucosal patch which cannot be attributed to any specific disease . It cannot be removed by rubbing.
Microscopically, It is squamous hyperplasia with hyperkeratosis. It is a precancerous lesion in the oral cavity.
123
Define diverticular disease of colon
Diverticulae are acquired herniations of mucosa and submucosa into the wall of the intestine. It is a disease of old age.
124
Gross picture of pleomorphic adenoma
* Benign tumor with an incomplete capsule.
* Lobulated outer surface.
* Bluish white in color.
* Soft, gelatinous consistency.
* Cut section: Bulging with rounded borders & cystic areas.
125
Microscopic picture of pleomorphic adenoma
* Epithelial glands.
* Myoepithelial cells in solid groups.
* Myxoid, hyaline, (pseudocartilage) or osseous stroma.
126
Esophageal varices etiology and complications
Etiology:
In case of liver fibrosis or cirrhosis : the blood flow through the liver is impaired leading to portal hypertension & opening of porto-systemic anastomosis.
Complications: Hematemesis- as the varices are easily traumatized by food and it can be fatal.
127
Give an account of Barrett esophagus
■ Barrett's esophagus is a complication of long standing GERD characterized by foci of intestinal metaplasia in the esophageal squamous mucosa.
■ By endoscopy: It appears as salmon-colored tongues replacing the pearly white squamous epithelium of the esophagus.
■ Patients with Barrett’s esophagus have a higher risk of developing esophageal adenocarcinoma than the general population.
128
Complications of reflux esophagitis 5
Ulceration
hematemesis
melena
stricture
Barrett esophagus.
129
Complications of Meckel’s diverticulum
1. It may contain heterotropic gastric epithelium, which may secrete acid & pepsin resulting in peptic ulcer.
2. Acute intestinal obstruction: Meckel’s diverticulum can result in abnormal twisting of a loop of intestine on itself (volvulus) causing acute intestinal obstruction.
3. May get inflamed and present as acute abdomen mimicking acute appendicitis.
130
Complications of bacillary dysentery and amebic Dysenetry 6
■ Local
1- Hemorrhage.
1- Perforation.
2- Rectal prolapse from frequent motions & straining.
3- Intussusception due to frequent motions with abnormal peristalsis.
4- Healing by fibrosis with stricture formation.
■ General toxic manifestation:
Myocarditis, arthritis, peripheral neuritis.
131
Complications of Colonic carcinoma 5
1- Intestinal obstruction: Mechanical obstruction of lumen by tumor.
2- Intussusception
3- Hemorrhage from ulceration or tumor necrosis.
4- Perforation leads to septic peritonitis & trans-coelomic spread.
5- Spread: - Direct: Malignant fistula formation.
- Lymphatic spread.
- Blood spread mainly to the liver.
132
Autoimmune gastritis pathogenesis
* Destruction of parietal cells is the major pathogenic mechanism by cell mediated autoimmunity.
* Autoantibodies to parietal cells & intrinsic factor are also present in the serum.
* Parietal cell destruction leads to defective gastric acid secretion (achlorhydria).
* Reduced intrinsic factor production impedes B12 absorption & causes pernicious anemia.
133
Morphology (patterns) of H.Pylori gastritis
1. The gastritis is predominantly antral and is associated with high acid production (which makes the mucosa of gastric body hostile to H pylori). Individuals with this pattern of gastritis are at increased risk of duodenal ulcer.
2. Another pattern is diffuse involvement of antrum and body (pangastritis) with multifocal glandular atrophy and fibrosis, and decreased acid output. Patients with this pattern are at increased risk of gastric ulcer and carcinoma.
134
complications of H.Pylori gastritis
1. Severe cases usually proceed to atrophy with intestinal metaplasia which is precancerous, and can lead to adenocarcinoma.
2. H. pylori infection is also a risk factor for peptic ulcer disease, & gastric lymphoma.
135
Hirschsprung’s disease (etiology and gross).
Etiology: Congenital absence of the ganglionic cells in the myenteric plexus of the intestine at the recto-sigmoid junction. Peristalsis stops at the affected site resulting in functional obstruction leading to chronic intestinal obstruction.
Gross: The ganglionic segment is narrow markedly dilated colon proximal to it (Megacolon). The intestinal wall is thickened due to hypertrophy of the muscle wall.
136
Gross picture of acute and chronic intestinal obstruction.
Acute: The proximal segment is markedly dilated, edematous wall. The mucosa is congested with loss of its folds (stretched), with accumulation of fluid & gas in the lumen . The distal segment is collapsed.
Chronic:
Proximal segment: Above obstruction there is dilatation, hypertrophy of wall. The lumen contains accumulating liguefied food & gases.
* Distal segment: Below obstruction: the segment is collapsed .
137
Complications of ulcerative colitis 5
1- Hemorrhage.
2- Perforation & septic peritonitis.
3- Dysplasia & adenocarcinoma.
4- Amyloidosis.
5- Extra-intestinal manifestations as liver and biliary damage.
138
Complications of Crohn's disease 4
1- Hemorrhage.
2- Malabsorption.
3- Fistulae & healing by fibrosis with strictures. 4- 2ry amyloidosis.
139
3 neoplastic colonic polyps
1. adenomatous polyp
2. papillary adenoma.
3. Tubulo-villous adenoma.
140
Predisposing factors of colonic adenocarcinoma 5
1- Adenomas: All adenomas. Villous adenomas are more likely to show invasion
2- Diet: high fat & low fiber
3- Ulcerative colitis with dysplasia
4- Familial adenomatous polyposis.
5- Hereditary Non-polyposis Colorectal Cancer
141
Discuss the etiology of piles (hemorrhoids) 4
1- Portal hypertension.
2- Congenital weakness of vessel walls.
3- Obstruction of lumen by tumor in rectum.
4- Chronic right sided heart failure with systemic venous congestion
142
What is meant by acute pyelonephritis? Enumerate the predisposing factors.
common suppurative inflammation affecting kidney and pelvis caused by bacterial infection
> Diabetes (++) susceptibility to infection
> Immune suppression and immunedeficiency
> short UTI
143
Define Crescentic glomerulonephritis and enumerate the causes
> rapid progressive loss of renal function
> histological formation of cresents + Severe oliguria
1- Post infectious: after acute diffuse proliferative GN in adults
2- With systemic diseases as PAN, SLE, good pasture syndrome
3- idiopathic
144
Define pyonephrosis?
Mention two causes?
Dilatation and distension of renal pelvis and calyces with pus---------> progressive atrophy of the kidney due to total complete obstruction of high urinary tract
Hydronephrosis
Chronic pyelonephritis
145
List Prerenal Causes of Hematuria
1. hypertension
2. Leukemia, purpura
3. vitK,C deficiency
4. Anticoagulation drugs
146
Enumerate six 6 post-renal causes for hematuria
1- Congenital bladder diverticulum
2- Trauma: catheterization
3- Bilharziasis
4- Cystitis, urethritis
5- kidney stones
6- Urinary bladder tumors
147
Renal causes of hematuria
Renal trauma
Glomerular nephritis
Kidney stones
Renal vascular diseases
148
Enumerate types of renal calculi
1. calcium oxalate: > 75%
2. triple phosphate: 10%
3. uric acid: 6-9%
4. cysteine stone (rare)
149
Mention complications of cystitis
* Ascending infection -> pyelonephritis
* Stones
* Chronic fibrosed contracted bladder
* Hematuria
150
Give short account on etiology and pathogenesis of acute diffuse proliferative glomerulonephritis (acute post streptococcal GN)
Exogenous: certain strains of B-hemolytic streptococci or Other infections: as mumps, measles, chickenpox
Endogenous: systemic lupus erythematosus (SLE)
PATHOGENESIS:
During latent period between infection and nephritis, antibodies against streptococcal antigens are formed in serum the Immune complex deposit between GBM and epithelial cells -> subepithelial granular deposits -> complement activation -> glomerular damage
151
Give the clinical manifestation of Nephritic syndrome
Acute onset of gross hematuria hypertension, mild proteinuria, edema
152
Give the clinical manifestation of Nephrotic syndrome
heavy proteinuria, severe edema, hyperlipidemia and lipiduria
153
Define chronic pyelonephritis and give its causes
Chronic tubulointerstitial inflammation and scarring associated with deformity
Causes: obstruction and reflux of UTI with congenial vesicoureteral reflux.
154
Enumerate four causes of urinary tract obstruction (Obstructive uropathy)
Congenital anomalies
Tumors
Pregnancy
Benign prostatic hypertrophy
155
Define Hydronephrosis and give 3 complications
Dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to partial obstruction to the outflow of urine
Secondary infection
Chronic renal failure
Hypertension
156
Define pyonephrosis and give 2 causes
Dilation and distension of the renal pelvis and calyces with pus associated with progressive atrophy of the kidney due to total or almost complete obstruction of the outflow urine.
Hydronephrosis
Chronic pyelonephritis
157
Enumerate the types of stones
Calcium oxalate
Triple phosphate stones
Uric acid stones
Cystine stones
158
Enumerate factors (pathogenesis) that cause calculi formation in urine
Increase urinary concentration of the stones constituents: increased urinary concentration of calcium, increased uric acid in urine, dehydration
Change in pH of urine: infection by urea splitting organism and decrease acidity
Lack of substances in urine which inhibit precipitation of crystals
159
Discuss the complications of renal calculi
Migration of stones from pelvicalyceal system to ureters resulting in colics and obstructive uropathy
Obstruction produces hydroureter and hydronephrosis
Infection: cystits
Squamous metaplasia, dysplasia. squamous cell carcinoma and carcinoma insitu
160
Enumerate the tumors of the kidney
Benign tumors: Renal papillary adenoma, angiomyolipoma, oncocytoma, squamous cell papilloma
Malignant tumors: renal cell carcinoma, Wilm's tumor, Urothelial carcinoma
161
Give the causes of acute renal failure
Pre-renal causes: hemorrhage
Renal causes: acute diffuse GN, Acute pyelonephritis, acute tubular necrosis
Post renal causes: Sudden complete obstruction of ureter by stone
162
Enumerate the causes of chronic renal failure 6
Chronic glomerulonephritis
Chronic bilateral pyelonephritis
Polycystic kidney disease
Bilateral hydronephrosis
Diabetes mellitus
Essential hypertension
163
Enumerate the predisposing factors of carcinoma in the bladder 3
Schistosoma haematobium infection
Cigarette smoking
Industrial carcinogens
164
Discuss the types of carcinoma found in the bladder 3
Urothelial carcinoma: are either papillary or non papillary. Papillary are superficial and can be removed while non papillary are more invasive and likely yo infiltrate lamina propria of bladder.
Squamous cell carcinoma: associated with chronic bladder infection and irritation
Adenocarcinoma: fungating mass that invades the bladder wall and ulcerates the mucosa
165
List four renal causes of hematuria
Trauma
Tumors of kidney
Nephritic syndrome
Polycystic kidneys
166
List complications of gonorrhea?
Spread: to seminal vesicles or prostate
Sexual transmission to female partner
Chronicity
Fibrosis-----> obstructive uropathy
167
List the germ cell tumors of the testis?
Seminoma
Non seminomatous: Embryonal carcinoma, yolk sac tumor, teratoma, mixed germ cell tumors
168
Define hematocele and mention 2 causes for it?
Def: collection of blood in tunica vaginalis
Causes: traumatic, malignancy tumors of testis, hemorrhagic blood disease
169
Effects and complications of benign prostatic hyperplasia?
Gradual hypertrophy of bladder musculature--> diverticula and dilation of bladder
Hydroureter, hydro nephrosis
Cystic
Bladder calcunli
170
List 4 complications for adult polycystic kidney disease?
Hematuria
secondary infections
hypertension
chronic renal failure
171
List 3 causes for rapidly progressive glomerulonephritis
1) Post infectious; follow acute diffuse proliferative GN, especially in adults.
2) In association with systemic disease as polyarteritis nodosa (PAN), SLE & Goodpasture syndrome.
3) Idiopathic.
172
List 4 systemic diseases associated with glomerular lesions
SLE.
Bacterial endocarditis.
Diabetic glomerulosclerosis.
Amyloidosis.
173
Types and causes of acute tubular necrosis
1. Toxic ATN:
* Heavy metals
* Organic solvents (carbon tetrachloride, chloroform)
* Therapeutic substances: Antibiotics, anaesthetics.
* Pesticides
2. Ischemic ATN: Shock due to various causes as trauma, burns and infections, leading to hypoperfusion of the peritubular circulation.
174
Mention 4 complications for renal stones
1. Migration of stones from pelvicalyceal system to ureters resulting in colics and obstructive uropathy
2. Obstruction produces hydroureter and hydronephrosis.
3. Infection: cystitis, pyelonephritis, pyoureter, pyonephrosis.
4. Injury of mucosa especially in oxalate stones resulting in hematuria.
175
Define hydrocele and mention 4 causes for it
Definition: Accumulation of serous fluid in the tunica vaginalis.
Causes:
1. Idiopathic
2. Secondary to:
a) Inflammations of epididymis or testes e.g gonorrhea or TB.
b) Filariasis of the spermatic cord
c) Torsion of the testis
d) Tumors of testis
176
Causes of acute pyelonephritis
* Mostly caused by the gram-negative bacilli
1. Ascending infection: From the lower urinary tract is the most common cause of clinical pyelonephritis.
2. Hematogenous infection: Through the blood stream. Less common and results from seeding of the kidneys by bacteria from distant foci e.g.in the course of septicemia.
177
Fate and complications of acute pyelonephritis 5
1. Mild cases: Recovery.
2. Repeated attacks may lead to chronic pyelonephritis.
3. Pyonephrosis (if associated with obstruction)
4. Papillary necrosis: Occurs mainly in diabetics and with urinary tract obstruction. There is necrosis of the tips of the renal pyramids. It may lead to acute renal failure.
5. Perinephric abscess develops in severe cases
178
Types and causes of cystitis
1. Acute cystitis:
* Bacterial suppurative cystitis: Caused by E.coli, Proteus, Klebsiella mostly through ascending infections. It is a common cause of acute pyelonephritis.
* Hemorrhagic cystitis in patients treated by
antitumor drugs
2. Chronic cystitis:
* Bilharzial cystitis (see general).
* Chronic tuberculous cystitis:
Organism spreads transluminally from tuberculous infection of kidney. Multiple ulcers with undermined edges form which heal by fibrosis and the bladder becomes thickened and contracted.
179
Pathogenesis of glomerulonephritis
A. Immune mechanisms: Antibody mediated injury is the most common type of glomerular injury as glomerular deposits of immunoglobulins and complement are detected in more than 70% of cases.
Two forms of antibody mediated injury have been established:
1. The antibodies react directly with intrinsic tissue antigens (Anti GBM nephritis) or planted antigens (IgA nephropathy).
2. Deposition of circulating antigen antibody complexes in the glomeruli.
B. Non-immune Mechanisms:
1. Loss of glomerular polyanion as in minimal change disease.
2. Hemodynamic changes as in focal segmental glomerulosclerosis.
180
Define rapidly progressive GN (crescentic GN) and discuss its etiology
It is a clinicopathologic syndrome characterized by:
-Rapid & progressive decline in renal function.
-Histologically; formation of crescents.
Etiology:
1) Post infectious; follow acute diffuse proliferative GN, especially in adults.
2) In association with systemic disease as polyarteritis nodosa (PAN), SLE & Goodpasture syndrome.
3) Idiopathic.
181
Discuss the microscopic picture of rapidly progressive GN (crescent GN)
-The glomeruli are enlarged, hypercellular showing proliferation of endothelial, mesangial and epithelial cells as well as leucocytic infiltration. Usually there is glomerular necrosis and may be glomerular capillary thrombosis.
-Crescents are formed in the Bowman space and compressing the tufts. They are formed of proliferating parietal epithelial cells, fibrin and migrating monocytes and leucocytes.
182
Discuss the fate of rapidly progressive GN (crescentic GN)
Course: Rapidly fatal due to:
Acute renal failure.
Hypertension.
Pulmonary hemorrhage in Goodpasture syndrome.
183
Discuss the pathogenesis of urolithiasis
1. Increased urinary concentration of the stone’s constituents:
* Increased urinary concentration of calcium.
a. This can occur in cases of hypercalcemia or b. Without hypercalcemia: attributable to defect in tubular reabsorption of calcium, or increase calcium absorption from the gut.
* Increased uric acid in urine , with or without with hyperuricemia.
* Increased oxalates in urine: may be primary hereditary or due to intestinal overabsorption.
* Dehydration.
2. Change in ph of urine
* Infection especially by urea splitting organisms e.g.proteus vulgaris increase the ph leading to precipitation of triple phosphate stones.
* Acidity leads to uric acid and cystine stones formation.
3. Lack of substances in urine which inhibit precipitation of crystals, as pyrophosphates and citrates.
184
Describe the morphology of urothelial carcinoma
a) 80% of bladder carcinomas are papillary tumors:
* They are formed of delicate fronds of vascular connective tissue core covered by urothelium.
* Most are superficial and can be treated by cystoscopic resection, with follow up for recurrence in the same area or different area of the bladder.
* When these tumors become invasive, they may superficially infiltrate the lamina propria or extend deeply into underlying muscle. The extent of invasion at the time of initial diagnosis is the most important prognostic factor.
b) 20% of tumors are solid (flat, non-papillary) and invasive at presentation and infiltrating the muscle. Such lesions are preceded by a carcinoma in situ. CIS is a flat lesion showing highly atypical cells.
185
Microscopic picture of acute diffuse proliferative GN 4
1. All the glomeruli are enlarged and hypercellular due to proliferation of endothelial, mesangial and epithelial cells as well as due to infiltration by neutrophils and monocytes. There may be crescent formation.
2. The tubules show hydropic degeneration and may contain red cell and granular casts. The interstitium is edematous and may be infiltrated by neutrophils.
3. By immunofluorescence microscopy, there are granular deposits of IgG in GBM
4. By electron microscopy there is subepithelial electron dense deposits (humps).
186
Causes of acute renal failure
a- Pre-renal causes: Shock with decreased renal blood flow as in hemorrhage, crush injuries,
b- Renal causes:
1- Acute diffuse GN.
2- Acute pyelonephritis.
3- Acute tubular necrosis.
4- Malignant nephrosclerosis.
c- Post- renal causes: Sudden complete obstruction of the ureter by a stone (calculous anuria)
187
Clinical manifestations of glomerular disease 5
1. Nephritic Syndrome: It is dominated by acute onset of gross hematuria, hypertension, mild/ moderate proteinuria, edema and oliguria. It is the presenting feature of acute post streptococcal glomerulonephritis
2. Nephrotic Syndrome: The syndrome is fundamentally the result of excessive glomerular permeability to plasma protein and thus heavy proteinuria is its prime characteristic, hypoalbuminemia, severe edema, hyperlipidemia and lipiduria.
3. Asymptomatic hematuria or proteinuria or combination of both.
4. Acute renal failure (ARF): dominated by oliguria or anuria (no urine flow).
5. Chronic renal failure (CRF): characterized by prolonged symptoms and signs of uremia.
188
Urinary bladder diverticula (Def, types and complications)
Definition: Outpouchings of the bladder wall.
1. Congenital diverticula: Caused by focal failure of development of the normal musculature or due to some urinary tract obstruction during fetal development. It is usually single and all the layers of the wall are present.
2. Acquired diverticula: Mostly associated with prostatic enlargement. It is usually multiple and only formed of mucosal outpouch.
Complications:
1. Inflammation: Diverticulitis (as they are sites of urinary stasis).
2. Formation of bladder calculi.
189
Non renal causes of hematuria 4
b. Hypertension.
c. Blood diseases e.g. leukemia and purpura.
d. Vitamin C and K deficiency.
e. Drugs as anticoagulants.
190
Varicocele def and types
Definition: Elongation, dilation and tortuosity of pampiniform plexus of veins of the spermatic cord.
Types:
1. Primary varicocele: commonest type. Occurs in young adults. May be to defective venous valves.
2. Secondary varicocele: due venous obstruction
191
Microscopic types of breast carcinoma
A. Noninvasive (In situ carcinoma).
1- Lobular carcinoma in situ (LCIS)
2- Ductal carcinoma in situ (DCIS).
B. Invasive carcinoma.
1- Invasive ductal carcinoma
2- Invasive lobular carcinoma.
3- Special types (Medullary, tubular, mucinous, cribriform....).
192
Paget's disease of the breast microscopic picture
The epidermis is infiltrated by large-sized neoplastic cells with clear cytoplasm and large hyperchromatic nuclei. These cells are called Paget’s cells.
193
Breast abscess (Etiology & morphology).
Etiology:
* occurs during lactation
* causative organism: staphylococcal infection
* route: cracks in nipple with bad hygiene
Gross: Diffuse, swollen, edematous, red, tender breast inflammation then localized-->acute abscess.
-If untreated -->chronic abscess may be clinically mistaken for a neoplasm
Microscopic: Infiltration by neutrophils Central cavity filled with neutrophils and secretion, surrounded by inflamed & fibrotic breast parenchyma
194
Paget's disease of the breast features and gross appearance
Mammary carcinoma: Intraduct or invasive (of any pattern).
Eczema of the nipple: due to transductal intraepidermal spread
Gross:
The nipple is red, ulcerated and scaly
Microscopic:
The epidermis is infiltrated by Paget's cells
195
Benign tumors of the breast. 3
1. Fibroadenoma.
2. Phylloides tumor.
3. Duct papilloma.
196
Two types of ductal carcinoma in situ (DCIS) and their microscopic appearance.
Comedo DICS: The ducts are enlarged and lined by several layers of high grade malignant cells with expanding central necrosis.
Non-Comedo DCIS
197
Breast duct papilloma (definition & morphology)
Benign neoplasm from major lactiferous ducts
serous or bloody nipple discharge
Gross:
It is polypoid intraductal mass < 3 cm, soft and Hemorrhagic.
Microscopic: Complex arborizing papillae formed of fibrovascular cores covered by Ductal epithelium & myoepithelial cells.
198
Duct ectasia (Definition, etiology & morphology).
* marked dilatation of mammary ducts containing inspissated Secretions
* surrounded by chronic inflammation rich in plasma cells.
* above the age of 40 years
* unknown Etiology
