Pathology-Final MSK Review Flashcards Preview

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Flashcards in Pathology-Final MSK Review Deck (31)
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1
Q

What characteristics of this slide tip you off that this patient has a contact dermatitis

A

Spongiosis, intraepidermal blistering, and mononuclear infiltrate.

2
Q

What characteristic of keratinocytes tip you off when looking at a squamous cell carcinoma?

A

There will be desmosomes between the malignant cells.

3
Q

What is your diagnosis? What is causing this patient’s condition?

A

This is pemphigus vulgaris. Note the “tombstone” basilar cells that remain. It is an autoimmune reaction to desmoglein. This causes round acantholytic cells.

4
Q

What is the whole spectrum of this disease?

A

Skin (erythema multiforme from herpes infection), mucosal involvement (Stevens-Johnson from drug reaction), whole body involvement (toxic epidermal necrolysis).

5
Q

What is your diagnosis? What leads you to this decision?

A

This is psoriasis. Notice hyperkeratosis, parakeratosis, Munro microabscesses, acanthosis and rete ridges.

6
Q

What is this “wisdom disease”? How does it look clinically?

A

This is seborrheic keratosis. Note the flat top, broad and flat epidermis with little horn cysts.

7
Q

A patient presents to your clinic with this lesion. It dimples when you squeeze it. How deep do you need to go when excising this tumor?

A

This is dermatofibroma. You will have an increase in basal pigmentation and fibroblastic proliferation deep in the dermis traps collagen bundles…thus you need to cut it deep.

8
Q

What features about this lesion guide your diagnosis? How might this lesion look under a microscope?

A

A well circumscribed, ulcerating lesion with telangectasia directs your thoughts toward basal cell carcinoma. Notice no change in granular layer with palisading, small-nucleated cells that collect in the middle of the dermis.

9
Q

What is the most common carcinoma of the skin? What is the prognosis?

A

Basal cell carcinoma. They often occur in sun-exposed areas and are benign.

10
Q

A patient presents to your clinic with this lesion on his hand. How does this disease progress?

A

It starts as actinic keratosis to squamous cell carcinoma in situ (fully unmaturated cells localized to epidermis) to squamous cell carcinoma (breaks through basement membrane)

11
Q

What are the different benign nevi? How would you stain for these melanocytes?

A

Junctional, compound and dermal. You stain with S100 because it is specific for neural cells…which melanocytes differentiate into.

12
Q

What determines if these nevi are becoming a malignant melanoma?

A

Pagitoid spread of melanocytes, high nuclei to cytoplasm ratio, melanocyte infiltrate into dermis without differentiation, and Breslow level above 1mm as seen below.

13
Q

Why is it important to get his entire lesion?

A

It is an epidermal inclusion cyst, full of inflammatory cells.

14
Q

How would you stain this skin biopsy?

A

GMS (silver stain) or PAS (periodic acid shift) will show you fungi living in the intradermal layer of tinea corpus.

15
Q

What is your diagnosis?

A

Vulgaris. Notice hyperkeratotic and aconthotic layers of epidermis and dermis respectfully.

16
Q

What causes pseudo hypertrophy in this patient?

A

Note increase in connective tissue between muscle fibers in muscular dystrophy. This patient will have an absence of dystrophin.

17
Q

What cells are causing muscle destruction in these images?

A

Top = CD4+. Bottom CD8+

18
Q

Whats going on here?

A

Dennervation atrophy

19
Q

What immunohistochemical stain is used here?

A

Desmin. This is specific for tumor cells in rhabdomyosarcoma. This is necessary because it is in the family of small round blue tumors as seen below.

20
Q

This woman has osteoporosis. What is going on in this slide of her vertebra?

A

This is pro callus (clot) formation after a micro fracture.

21
Q

What do you expect to see histologically in this section?

A

Rough surface due to weakening and loss of cartilage (fibrillation). The cartilage can also break off into the joint to form joint mice. You may also see subchondral cysts.

22
Q

What is being made by the tumor cells in this lesion? What genes put you at higher risk for this condition?

A

This is osteosarcoma. Osteoid is being laid down by the osteoblasts in trabecullae. RB and p53 put you at higher risk.

23
Q

How would this lesion look microscopically? Where do these lesions normally occur?

A

This is a chondrosarcoma. Note hyper cellular and less cellular areas organized into lobules. Also note multiple chondrocytes in lacunae. The often occur in the axial skeleton.

24
Q

How does this lesion look radiographically? Histologically?

A

This is Ewing sarcoma. It will have onion skin layering because it is a slow growing tumor. Histologically you will see Homer-Wright rosettes (more common in PNET) and neural cells.

25
Q

What differentiates Ewing sarcoma from PNET?

A

PNET spreads into the soft tissue. They come from the same translocation and they both metastasize to the lung.

26
Q

What bone lesion is more common in females?

A

Giant cell tumor

27
Q

Why do you need to get serum Ca and PTH levels in this patient?

A

Note mononuclear and multinucleate cells. Histologically this looks like hyperparathyroidism, but is giant cell tumor and will not have increased Ca or PTH levels.

28
Q

Why are IV antibiotics necessary for a patient with this condition?

A

Septic infection can eliminate blood flow and create an optimal environment for bacterial growth.

29
Q

What do you worry about if you have an osteomyelitis with lots of active plasma cells?

A

Chronic osteomyelitis can lead to amyloidosis

30
Q

What is this lesion if it is greater than 2cm in size? What age of patient do these often occur?

A

Osteoblastoma (happens in older patients). If it is smaller it is an osteoid osteoma.

31
Q

What type of tumors are associated with Ollier’s and Maffuci Syndrome?

A

Enchondromas.