Presentation on theme: "Slackers Advanced Topics Pathology Fact Stack Mike Ori."— Presentation transcript:
Slackers Advanced Topics Pathology Fact Stack Mike Ori
Disclaimer These represent my understanding of the subject and have not been vetted or reviewed by faculty. Use at your own peril. I can’t type so below are common missing letters you may need to supply e r l I didn’t use greek letters because they are a pain to cut and paste in.
What are the three most important properties of a tumor that affect its prognosis
Tumor type Tumor grade Tumor stage
A quantification of the degree of differentiation of the tumor. Higher grades are less differentiated.
What is the relationship of grading between tumor types
Tumors are graded based on features that are prognostic to each tumor type. Often these prognostic features are the similar from one tumor to another but this is not always the case.
What are three common histologic features that are used in grading
Nuclear atypia Growth pattern Mitotic activity
Are grading systems objective or subjective
Somewhat subjective especially in the middle.
Define prognostic markers as they pertain to grading
These are substances that help determine the prognosis and sometimes possible effective treatments of a tumor but that are not used for diagnosis.
List several common prognostic markers
Measure area of highest intensity Nuclear – ER Percent showing any stain – PR Percent showing any stain – KI-67 Percent showing any stain Plasma Membrane – HER2/Neu Stain intensity (0-3)
The measure of how far advanced (far afield) a tumor is
What is the primary descriptive system used for staging
Explain the relationships of the TNM system between cancers
Each cancer uses its own rules for staging.
What does an X mean in the TNM system
X indicates that that aspect has not been evaluated. T1N0MX MX = Metastasis was not looked for so the status is unknown M0 = Metastasis was looked for and not found
Describe the staging of colon cancer
Defined by anatomical boundary crossed T1 = Muscularis mucosa T2 = Inner edge of muscularis propria T3 = Outer edge of MP T4 = Serosa surface (into adjacent structures)
List common environmental causes of esophageal cancer
Alcohol Tobacco Fungi and nitrosamine (common in Asia) Acid reflux/Barretts esophagus
List a common cause of stomach cancer
How does the environment contribute to colon cancer
Diet is a major factor in sporadic colon cancers.
What are the gene defects associated with FAP and HNPCC
Alcohol related Non-alcoholic fatty liver disease Reye syndrome Acute fatty liver of pregnancy Drug toxicity
Distinguish between alcoholic and non- alcoholic steatohepatitis
Alcoholic – Hx of alcohol M > F – Neutrophil infiltration – Mallory hyaline Non-alcoholic – M=F – Obesity, HLD, DMII
Describe Reyes syndrome
An underlying metabolic disorder is unmasked by a combination of viral illness and salicylates. Mitochondrial swelling. Massive microvesicular steatohepatitis
Describe fatty liver of pregnancy
Very similar in concept to reyes disease except that the fetus is the source of the toxic insult. Maternal hydroxylacyl CoA dehydrogenase deficiency cannot metabolize fetal hydroxylacyl metabolite. Massive microvesicular steatohepatitis
Describe the pattern of hepatocyte damage that occurs with toxic drug exposure
Damage can be periportal to centrilobular depending on the agent and the enzymes expressed within the region Acetaminophen is classically centrilobular necrosis
Describe the pattern of hepatocyte damage from common substances
What is the characteristic age range for osteogenic sarcoma, chondrosarcoma, and ewing sarcoma
Osteogenic – Teens and young adults – Adults over 60 in association with pagets Chondrosarcoma – Adults > 40 Ewing – Childhood – Young adulthood
What are the radiographic findings for osteogenic sarcoma
Spiculated mass about the knee
What are the radiographic findings of chondrosarcoma
Irregularly destructive lesion within bone Lytic areas Soft tissue extension with speckled calcifications
What are the radiographic findings of Ewing Sarcoma
Irregularly destructive, lytic lesions often with disproportionately large soft tissue mass relative to the bone involvement
Differentiate Osteogenic sarcoma, chondrosarcoma, and ewing sarcoma histologically
Osteogenic – Bone – Malignant osteoblasts Chondro – Cartilage Ewing – Small round blue cell tumor
What genetic change is characteristic of Ewing sarcoma
What are the common locations and age of presentation of the soft tissue sarcomas
Age Liposarcoma40+Retroperitoneum Deep tissues of the thigh RhabdomyosarcomaChildrenHead and neck Urogenital Deep soft tissues (adults) Synovial sarcomaAdults < 50 Lower extremity typically the knee Malignant fibrous histiocytoma 40+Lower extremity Angiosarcoma FibrosarcomaDeep soft tissues of extremities
Identify the histology of the soft tissue sarcomas
LiposarcomaFat in cells Myxoid variant = gelatinous Round cell variant similar to lymphoma and ewing RhabdomyosarcomaEmbryonal – round to oval cells suggestive of muscle Botryoid – small dark cells (usually in urogenital tract) Alveolar – dark cells arranged around fibrous trabeculae Pleomorphic – large, bizarre cells with abundant eosinophilic cytoplasm Synovial sarcomaGlandular epithelial cells mixed with spindle cells that may express cytokeratin Malignant fibrous histiocytoma Mixed spindle cells and polygonal cells Angiosarcoma FibrosarcomaCells arranged with nuclei parallel to each other in herringbone pattern
What are the gene transformations in Ewing, liposarcoma, and synovial sarcoma?
What are the important features for grading sarcomas
Degree of differentiation Cellularity Mitotic activity Pleomorphism Extent of necrosis
Differentiate wegener, goodpastures, and microscopic poly arteritis
All are vasculidities that can affect small vessels WegenerGoodpastureMicroscopic GranulomaYesNo Antibodiesc-ANCAAnti-GBMp-ANCA Affected areaKidney Lungs Upper respiratory tract Kidney lower respiratory tract Skin Others?
If vasculitis is suspected, why must a relatively long segment of affected vessel be biopsied?
Vasculitis often skips segments within an affected vessels so a short biopsy may not contain diagnostic information.
What is acute necrotizing vasculitis?
A rapidly destructive vasculitis that results from rejection in transplant patients
What is the target in temporal arteritis?
Giant cell destruction of the elastic lamina.
List several common markers used to localize liver injury
Hepatocyte damage – AST – ALT Bile duct damage – Alkaline phosphatase Bilirubin – Direct – Indirect Not yet conjugated by hepatocytes
What diseases cause microvesicular steatosis
Reye syndrome Fatty liver of pregnancy Also – Tetracycline – Aflotoxin
What antibody is associated with primary biliary cirrhosis?
What are he principle mechanisms by which hepatitis B is spread
Vertical Sexual contact IVDA/needle sharing
Why can disruption of hypothalamus function cause a rise in prolactin
Prolactin secretion is inhibited by dopamine (prolactin inhibitory factor) released from the hypothalamus. Removing this negative modulator allows prolactin secretion.
List several common causes of hypercalcemia
CHIMPS Cancer Hyperparathyroidism Intoxication with vitamin D Milk alkalai syndrome Pagets disease Sarcoidosis
Distinguish parathyroid hormone from parathyroid hormone related peptide
PTH is secreted by the parathyroid glands PTH-rp is secreted by cancers.
List several common cancers that may secrete PTH-rp
Squamous cell carcinoma – most common Adult T-cell leukemia Adenocarcinoma – Breast – Esophagus – Colon
Decreased renal blood flow will cause increases in what hormones
Renin Angiotensin I/II Aldosterone
Distinguish the gross pathology of a pheochromocytoma from a adrenal adenoma
Pheo – beefy red Adenoma – golden yellow due to steroids
What are the two types of malignant gliomas and what are their common ages of presentation
anaplastic astrocytoma (grade III), 45 year olds glioblastoma (grade IV), 64 year olds,
What is the only proven risk factor for malignant gliomas
What are symptoms of malignant glioma
increased intra-cranial pressure and mass effect – Headache – Mental status changes/behavior changes – Papilledema – Vomiting – Diploplia Focal – Motor deficits – Sensory deficits – Agnosia – Aphsia – Apraxia – Ataxia