Seminoma tumour marker
Placental alk phosphate
BetaHCG
Uses of tumour markers (5)
Screening Diagnosis Monitoring response to treatment Monitor recurrence Severity of underlying disease
Types of transplant
Autograft: from one part of body to another part
Isograft: transplant between two genetically identical individuals
Allograft: from one person to another who are not genetically identical
Xenograft: between species
Cytological features of malignancy
- Increased mitotic index
- Hyperchromatism (dark nuclei due to more DNA)
- Pleomorphism
- Large nuclei (ie increased nucleus: cytoplasm ratio)
Histological features of malignancy
- Loss of normal tissue architecture
- Invasion of basement membrane into nearby structures
- Neovascularisation, necrosis and haemorrhage
Congenital causes of melanoma
(XAG)
Xeroderma pigmentosum
Albinism
Giant congenital pigments naevus
Acquired risk factors for melanoma
UV light exposure, childhood history of sunburn Redhead Fair skin Tendency to freckle High total number of naevi (>20) Immunocompromised
Four main types of melanoma
- Superficial spreading (>70%)
- Nodular
- Acral (nail, palms, usually in black and Asian patients)
- Amelanocytic
Mechanism of action of PPI
Inhibits H/K ATPase in gastric parietal cells
Factors that impede enterocutaneous fistula healing
F oreign body R adiation I nflammation/infection E pithelilisation N eoplasm D istal obstruction S hort tract (<2cm)
Malnutrition
High Output
Amyloidosis:
- Definition
- Microscopy findings
- 3 types
- Abnormal fibrillar protein in Extracellular space, Resistant to enzyme degradation
- Microscopy: bright pink hyaline
Congo red stain shows apple green birefringence under polarised light - AL- primary in myeloma and paraproteinaemia, clonal prolif of amyloidal monoclonal Ig
AA - secondary to inflammatory conditions
Familial - AD condition, mutation in transthyretin (transport protein produced by liver)
Places where isolated amyloid deposits can be found (4)
PULA
Pituitary
Urinary tract
Larynx
Aorta
(Also brain in Alzheimer’s and CAA)
Teratoma tumours markers
(ABC - Tetris, teratoma)
Alpha fetoprotein
Beta-HCG - can cause gynaecomastia
CEA
Seminoma
30-40y/o Lymphatic spread to paraaortic nodes Radiosensitive Monitor LDH Placental ALP
Teratoma & NSGCTs
20-30y/o
Haematogeous spread to lung, brain, liver
Chemo sensitive (platinum based chemo)
ABC (AFP, B-HGC, CEA)
Tissue formed from all 3 germ layers. Can be mature or immature, can contain malignant tissue from all layers
Sickle cell anaemia
Pathology and complications
Autosomal recessive
Amino acid substitute (glutamate to valine), homozygous = trait.
3 main complications:
Thrombosis (cold, infection, dehydration predispose)
Aplastic crisis (parvovirus infection causes reduced BM production)
Sequestration (acute hepatosplenomegaly with liver failure)
(Increased infection risk due to small spleen from multiple thrombi)
APC gene function
Facilitate beta catenin degradation. Beta catenin otherwise goes to nucleus and activates c-myc with transcription factors.
Crypt proliferation
P53 action
Arrests cell cycle
Mechanism of action of doxazocin
Alpha1-blocker
Relaxed internal bladder sphincter
Relaxes prostrate smooth muscle
MEN 2 tumours
Genetic defect
(PAT)
Parathyroids hyperplasia/adenoma
Adrenal (phaeo)
Thyroid (medullary Ca)
RET Proto-oncogene, autosomal dominant
MEN 1 tumours and genetics
Pituitary Parathyroids Pancreas (Adrenal hyperplasia) (Thyroid hyperplasia)
MEN 1 gene, TSG, autosomal dominant
Mechanism of calcium problems in chronic renal disease
- Glomerular damage cause phosphate retention
- Hyperphosphataemia inhibits calcium reabsorption
- Reduced 1,25-dihydroxycholecalciferol production, further reduce gut reabsorption of calcium
- Secondary and tertiary hyperparathyroidism mobilise calcium from bone
- Renal osteodysteophy and ectopic calcification
(Osteitis fibrosa cystica mainly from primary parathyroidism)
PTH-rP secreting tumours
Lung SCC
RCC
Bladder TCC
Commonest causes of hyperparathyroidism, and investigations
Single parathyroid adenoma (80%)
Diffuse hyperplasia
Carcinoma
(Primary, secondary, tertiary)
Ix: radioisotope scan (sestamibi), labelled with technetium-99m, persists longer in parathyroids, adenoma and carcinoma picked up.
