pathology_20140626210953 Flashcards
Term: when a tumor results in a meningitis-like picture
carcinomatous meningitis
What is the gold standard for dx of carcinomatous meningitis
detection of tumor cells in CSF
Carcinomatous meningitis occurs in ___% of patients with solid cancers.
1-5%
What are the MC non-hematologic cancers that metastasize to the CNS?
lung, breast, melanoma
What is the MC organism found in brain abscesses?
streptococcus
What leads to paretic syphilis?
widespread parenchymal invasion by spirochetes
What leads to tabes dorsalis?
damage to sensory nerves in dorsal roots -> ataxia, loss of pain sensation and proprioception
Meningovascular syphilis frequently involves what area of the brain?
base of the brain -> CN palsies
What is the MC presentation of meningovascular meningitis ?
stroke syndrome in a younger adult involving middle cerebral artery or branches of the basilar artery
Paretic syphilis occurs ___ after initial exposure to T. pallidum.
20-30 years
What is the MC symptoms seen in paretic syphilis?
personality change
Which type of neurosyphilis is characterized by tissue invasion with spirochetes, chronic perivascular and meningeal inflammatory changes and meningeal fibrosis?
paretic syphilis
Tabes dorsalis involves what areas and what occurs in these areas?
posterior columns (demyelination)posterior roots (inflammatory change w/ fibrosis)
What is a common pathologic finding in neurosyphilis?
gumma
Gumma
Meningeal granulomassoft, non-cancerous growth from 3˚ stage of syphilis
Where can gummas be found?
liver MCalso heart, skin, bone, testis
What is the name of the febrile reaction that can occur several hours after treatment of early stage syphilis?
Jarisch-Herxheimer reaction
Progressive multifocal leukoencephalopathy (PML)
rare progressive demyelinating disease that results in the loss of oligodendrocytes
Gross: PML
irregular areas of granularity in the white matter
What is a rare complication of measles (rubeola) that can develop 1-20 years after initial measles infection?
subacute sclerosing panencephalitis (SSPE)
Histology: subacute sclerosing panencephalitis (SSPE)
perivascular cuffing patchy demyelinizationgliosiseosinophilic inclusion bodies
What is the only change in CSF profile in SSPE?
elevation of Rubeola IgG antibody
Gross: SSPE
white matter hemorrhage and gliosis (both hemispheres and brainstem)
Poliomyelitis
RNA virus transmitted via oral-fecal route
Pathophysiology: poliomyelitis
viremia -> virus becomes neurotropic, destroying motor neurons in anterior horn and brainstem -> flaccid paralysis
Post-polio syndrome
recurrent bouts of muscle weakness that can appear 20-50 years after infection
Reye’s syndrome
often fatal encephalopathy characterized by fatty infiltration of liver and swelling of kidneys and brain
Magnesium ammonium phosphate stones
Assoc. w/ UTIs dt urea-splitting bacteria (proteus)Assoc. with increased urine pH (less acidic)Assoc. w/ larger size (staghorn calculi)
What is the MC type of renal stone?
calcium oxalate 75%triple phosphate 15%uric acid 5-6%cystine 1%
What is the MC cz of hypothyroidism in the world?
iodine deficinecy
MC sites for METS to the pituitary
Breast CALung CAProstate CA
Histology: craniopharyngiomas
oil-filled cysts, which mb seen grosslylamellations of “wet” keratin
Labs: seminoma tumor
Placental alklaline phosphatase (PLAP) in 50%elev. Human chorionic gonadotropin (hCG)Normal serum alpha fetoprotein
Histology: gonococcal urethritis
gram- diplococciintracellular and extracellular bacteria, PMNs
If bladder CA is related to schistosomiasis, it is more likely what type of CA?
squamous cell carcinoma (70%)
Risks: bladder CA
cigarette smoking (esp. in men)analgesics (long-term)radiation to areaexposure to benzenesschistosomiasis
Cystitis as a result of chemotherapy or radiation therapy can result in ___
hemorrhagic cystitis
Histology: malakoplakia
foamy histiocytes w/ round basophilic inclusions (Michaelis-Gutmann bodies)
Malakoplakia
slightly raised mucosal plaques of the bladder lining
Histology: chronic cystitis
chronic inflammatory cells (esp. lymphocytes) in lamnia propria of the bladderlymphocytes may form germinal centers
Men with prostatic enlargement are at an increased risk for ___
acquired bladder diverticuli
Patients with congenital exstropy of the bladder have an increased risk for ____.
bladder adenocarcinoma
What is the MC type of ureteral malignancies?
transitional cell carcinomas
Morphology: Ureteritis follicularis
fine granular appearance
Ureteritis follicularis
increased lymphocytes in subepithelial region dt chronic localized inflammation
Most islet cell antibodies in DM1 are directed against ___
glutamic acid decarboxylase (GAD) within beta cells
Histology: DM type 1
lymphocytic infiltration in islets of Langerhans
Histology: DM type 2
hyalnization, amyloid deposits in islet cells
What histological feature of DM2 is also seen in normal aging?
amyloid deposits
Male patients with diabetic neuropathy are at an increased risk for ___
impotence
What are the first histological changes that are noted in patients with diabetic nephropathy?
thickened capillary walls within glomerulus
MC location for tumors (MEN1)
parathyroid gland (90%)pancreas (gastrinoma - 50%, insulinoma - 20%)pituitary gland (66%)
MC location for tumors (MEN2A)
medullary thyroid carcinoma (100%)pheochromocytoma (50%)parathyroid gland (50%)
MC location for tumors (MEN2B)
medullary thyroid carcinoma (85%)pheochromocytoma (60%)mucosal neuroma (100%)marfanoid body habitus (80%)
What is the MC and often initial manifestation and of MEN1?
1˚ hyperparathyroidism
What are the MC ant. pituitary tumors seen in MEN1 patients?
prolactinomas
Histology: medullary thyroid cancer
multiple areas of amyloid deposition+ staining for calcitonin
Both MEN2A and MEN2B have an increased risk of ___
intestinal aganglionosis and Hirschsprung dz
PTH1 receptors are found in the highest concentration where?
bone, kidney
PTHrP is MC secreted in which types of cancers?
breast, lung CA
What is often the first sign of malignancy in paraneoplastic syndromes?
PTHrP-related hypercalcemia
What is the 2nd MC form of 1˚ hyperparathyroidism?
parathyroid hyperplasia
What is the least common form of 1˚ hyperparathyroidism?
parathyroid carcinoma
What is the MC cz of 2˚ hyperparathyroidism?
renal failure
Cells of the adrenal medulla produce ___
EPI (80%)NE (20%)Dopamine (small amt)
What area of the adrenal produces aldosterone?
zona glomerulosa (outermost layer)
What area of the adrenal produces cortisol?
zona fasiculata (middle layer)
What area of the adrenal produces sex steroids?
zona reticularis (innermost layer)
Etiology: Primary hyperaldosteronism (Conn’s syndrome)
MC functional adrenal adenoma
MC Etiology: Cushing’s syndrome
long-term glucocorticoids
What is the MC tumor associated w/ paraneoplastic production of ACTH?
carcinoma of the lungs
1˚ Addison’s dz is often associated with what AI conditions?
DM1Hashimoto’s thyroiditisVitiligo
Addison’s disease is a result of insufficient ___ production.
cortisol
Waterson-Frederickson syndrome
Type of 2˚ Addison’s disease Adrenal gland failure dt hemorrhage into adrenals (hemorrhagic necrosis)MC dt severe bacterial infx (meningococcal infx)
SSx: 21-hydroxylase deficiency
Females: virilization, abn menses, infertility Males: precocious sexual development
What is the MC solid, extra-cranial malignancy in infants and children?
neuroblastoma
Histology: neuroblastoma
rosettes, pale-staining neurofibrils
What is the MC type of thyroid CA?
Papillary carcinoma
What is the 2nd MC type of thyroid CA?
follicular carcinoma
What is the 3rd MC type of thyroid CA?
medullary carcinoma
XR: Paget’s dz of bone
cotton ball appearance
Patients with Paget’s dz of bone have an inc. risk for ___
development of malignant neoplasms, esp. osteosarcoma