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Pathology Flashcards

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1
Q

Increase in size of cells

A

hypertrophy

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2
Q

Increase in number of cells

A

hyperplasia

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3
Q

decrease in tissue mass due to decrease in size

A

atrophy

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4
Q

reprogramming of stem cells which results in replacement of one cell type by another that can adapt to a new stress

A

Metaplasia

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5
Q

Disordered precancerous epithelial growth

A

Dysplasia

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6
Q

Apoptosis

A

ATP dependent programmed cell death with intrinsic and extrinsic pathways which activate caspases (cytosolic proteases) that cause cellular breakdown –> phagocytosed

deeply eosinophilic cytoplasm and basophilic nucleus. pyknosis or nuclear shrinkage, and karyorrhexis or fragmentation caused by endonuclease mediated cleavage

cell membrane intact without significant inflammation unlike necrosis

DNA laddering is a sensitive indicator of apoptosis

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7
Q

Intrinsic pathway of apoptosis

A

mitochondrial pathway

involved in tissue remodeling in embryogenesis and after exposure to injurious stimuli. occurs when a regulating factor is withdrawn from a proliferating cell population.

The intrinsic pathway is regulated by the Bcl-2 family of proteins. BAX and BAK (proapoptotic) form pores in the mitochondrial membrane which cause release of cytochrome C from inner mitochondrial membrane into the cytoplasm which activates caspases. Bcl-2 keeps the mitochondrial membrane impermeable and thereby preventing cytochrome C release

Bcl-2 ( antiapoptotic) can decrease caspase activation and cause tumorigenesis

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8
Q

Extrinsic pathway

A

Death receptor pathway

two pathways:

1) ligand receptor interactions
- Fas-FasL interaction (important for thymic medullary negative selection) or TNF alpha binding its receptor
- defect in Fas-FasL will incrase numbers of circulating self-reacting lymphocytes due to failure of clonal deletion and thus autoimmune lymphoproliferative syndrome

2) immune cell (cytotoxic T cell release of perforin and granzymes B)

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9
Q

Coagulative necrosis

A
  • due to ischemia or infarction; injury denatures enzymes and proteolysis blocked
    histology: preserved cellular architecure (cell outlines seen), but nuclei disappear. Increased cytoplasmic binding of eosin stain. The increase in eosinophilia gives it a red/pink color
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10
Q

liquefactive necrosis

A

-due to neutrophils release lysosomal enzymes that digest the tissue

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11
Q

caseous necrosis

A

-In TB or fungi. Due to lymphocytes and macrophages walling off the infecting microorganism –> cellular debris. Forming a granuloma

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12
Q

fat necrosis

A

-In acute pancreatitis or trauma. Damaged cells release lipase which breaks down TGs. Liberated FA bind calcium and saponify (appears blue on H&E stain)

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13
Q

Fibrinoid necrosis

A

Due to immune complexes that combine with fibrin –> vessel wall damage (type 3 hypersensitivity rxn).

on histology the vessel walls appear thick and pink

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14
Q

gangrenous necrosis

A

Dry: ischemia. Coagulative on histology
Wet: superinfection. liquefacive superimposed on coagulative (histology)

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15
Q

Watershed areas

A

i.e. splenic flexure

Watershed areas are borderzones that receive blood supply from most distal branched of 2 arteries with limited collateral vascualrity. These areas are susceptible to ischemia fromhypoperfusion

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16
Q

Red infarct

A

Hemorrhagic

occurs in venous occlusions and tissues with multiple blood supplies

reperfusion injury that is due to damage by free radicals

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17
Q

Pale infarct

A

Anemic

occurs in solid organs with a single (end-arterial) blood supply

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18
Q

Inflammation

A

Response to eliminate initial cause of cell injury, to remove necrotic cells resulting from original insult, and to initiate tissue repair

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19
Q

Cardinal signs of inflammation

A
  • Rubor/Redness and Calor/Warmth due to histamine, prostaglandins, and bradykinin
  • Tumor/swelling due to endothelial contraction/disruption (leukotrienes C4,D4, E4 and histamine and serotonin). Increase in vascular permeability causes leakage of protein-rich from postcapillary venules into interstitital space (exudate) which increases oncotic pressure
  • Dalor (pain) due to bradykinin and PGF2
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20
Q

Systemic/acute phase rxn of inflammation

A

Fever (pyrogens induce macrophages to release IL1 and TNF which increases COX activity in perivascular cells of hypothalamus which in turn increase PGE3 –> increases temperature set point)

Leukocytosis - elevation of WBC count.
Leukemoid reaction is a severe elevation in WBC (>40,000 cells)

Increase in plasma acute phase proteins. They are produced by the liver and notably induced by IL-6

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21
Q

Positive/upregulated Acute phase reactants

A

Ferritin - binds and sequesters iron
Fibrinogen - coagulation, ESR
Serum amyloid A- elevation leads to amyloidosis
Hepcidin - decreases iron absorption and iron release. Anemia of chronic disease
C-reactive protein(CRP)-opsonin; fixes complement and facilitates phagocytosis. Nonspecific sign of ongoing inflammation

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22
Q

Negative/downregulated acute phase reactants

A

Albumin -reduction conserves AA for positive reactants

Transferrin- internalized by macrophages to sequester iron

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23
Q

Erythrocyte sedimentation rate (ESR)

A

Products of inflammation (eg fibrinogen) coat RBCs and cause aggregation. The denser RBC aggregates fall at a faster rate within a pipette tube and thus higher ESR

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24
Q

Acute inflammation

A
  • neutrophils in tissue and edema
  • involves the innate immune system (first line of defense, i.e. skin etc)
  • Inflammasome- cytoplasmic protein complex which recognizes cell products of dead cells, microbial products, and crystals –> activates Il-1 and inflmmatory response
  • extravasation of leukocytes (mainly neutrophils) from postcapillary venules and accumulation in the focus of injury followed by leukocyte activation
  • macrophages dominate in the later stages
  • outcomes:
    1) resolution and healing due to Il-10 and TNF beta which attenuate immune response
    2) IL-8 can cause persisten acute inflammation
    3) chronic inflammation due to APCs activaing CD4+ Th cells
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25
Leukocyte extravasation
Postcapillary venules 1) margination and rolling: - E selectin is upregulated by TNF and IL-1 on the endothelium and binds sialyl-Lewisx - P selectin is released from weibel-palade bodies - GLYCAM-1,CD 34 which bind L-selectin 2) Tight binding and adhesion - ICAM-1(CD54) on endothelium binds leukocytes CD11/18 integrins (LFA-1. Mac-1) - VCAM-1 (CD106) binds VLA-4 integrin 3) Diapedesis (Transmigration) - PECAM-1(CD31) binds PECAM-1(CD31) 4) Migration - due to C5a,IL-8, LTB4,Kallikrein, plately activating factor
26
Leukoyte adhesion deficiency type 2
due to decrease in Sialyl Lewis x which normally binds E selectin or P selectin on endothelial cells of vasculature blocks leukocyte extravasation step of margination and rolling
27
Leukoyte adhesion deficiency type 1
Due to drop in CD18 integrin subunit on the leukocyte which normally binds ICAM-1(CD54) and is important for the tight binding/adhesion step of extravasation
28
Chronic inflammation
infiltration of tissue by mononuclear cells (dominant is macrophages which interact with T lymphocytes) Type 4 hypersensitivity rxn, autoimmune dz, prolong exposure to toxic agents or foreign material Th1 cells secrete IFN gamma --> macrophage classical activation Th2 cells secrete IL-4,IL-13 --> macrophage alternative activation (repair and anti inflammatory)
29
Granulomatous diseases
Granulomas are part of chronic inflammation composed of epithelioid cells with surrounding multinucleated giant cells and lymphocytes Associated with hypercalcemia due to calcitriol (1,25-OH2) or vit D3 production
30
Metastatic calcification
Calcification in degenerated or necrotic tissue localized and secondary to injury or necrosis blood serum is normocalcemic
31
Dystrophic calcification
Deposition of calcium salts in otherwise normal tissue because of elevated serum levels of calcium widespread and secondary to hypercalcemia or high calcium-phosphate levels predominately in tissues of kidney,lung, and gastric mucosa because these lose acid quickly and high h favors calcium deposition
32
Lipofuscin
yellow-brown wear and tear pigment associated with normal aging formed by oxidation and polymerization of autophagocytosed organellar membranes
33
_____ is NONCASEATING granuloma
Sarcoidosis
34
Pathway for granuloma formation
Th1 secretes IFN gamma which activated macrophages macrophages then release TNF alpha which induces and maintains granuloma formation It is important to always test for latent TB before starting anti TNF regimen because they cause granuloma breakdown --> disseminated disease
35
Free radical injury
free radicals damage cells via membrane lipid peroxidation, protein modification,and DNA breakage
36
Process of having nonregenerated cells replaced by CT
scar formation
37
Hypertrophic scar formation
increase in type 3 colalgen, parallel, confined to borders of original wound
38
Keloid scar
Great increase in disorganized types I and III collagen extends beyond borders of original wound earlobes, face, and UE mostly
39
Tissue mediators that stimulate angiogenesis
FGF, VEGF, TGF beta (also fibrosis)
40
Tissue mediators that induce vascular remodeling and smooth mm cell migration, fibroblast growth for collagen synthesis
PDGF secreted by activated platelets and macrophages
41
Tissue mediator for tissue remodeling
Metalloproteinases
42
Tissue mediator that stimulates cell growth via tyrosine kinases
EGF
43
Phases of wound healing
1) inflammatory - platelets, neutrophils, macrophages cause clot formation, increased vessel permeability and neutrophil migration to tissue 2) Proliferative- fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages cause deposition of granulation tissue and type II colalgen, angiogenesis, epithelial cell prolif, dissolution of clot, wound contration. This is delayed in Vit C or copper deficiency 3) REmodeling- fibroblasts cause type 3 collagen replacement with type 1 to increase tensile strength, type 3 is broken down by collagenase. This is delayed in zinc deficiency
44
Exudate vs transudate
exudate is cloudy while transudate is clear/hypocellular
45
Light criteria
Exudative if >or= 1 of the following criteria is met: 1) pleural effusion protein/ serum protein ratio >0.5 2) pleural effusion LDH/serum LDH ratio is >0.6 3) pleural effusion LDH > 2/3 of the upper limit of normal for serum LDH
46
Abnormal aggregation of proteins or their gragments into beta pleated linear sheets that form insoluble fibrils that result in cellular damage and apoptosis
Amyloidosis
47
Accumulation of AL fibril protein from Ig light chain
primary amyloidosis plasma cell disorders and multiple myeloma
48
Accumulation of serum amyloid A (AA)
secondary amyloidosis chronic inflammatory conditions
49
Accumulation of beta2-microglobulin
Dialysis-related amyloidosis end stage renal dz and or long term dialysis
50
Accumulation of beta amyloid protein
Alzheimer disease cleaved from amyloid precursor protein (APP)
51
Accumulation of islet amyloid polypeptide (IAPP)
Type II DM caused by deposition of amylin in pancreatic islet cells
52
Accumulation of Calcitionin (A cal)
medullary thyroid cancer
53
Accumulation of ANP
Isolated atrial amyloidosis normal aging increases risk of atrial fibrillation
54
Accumulation of normal (wild-type) transthyretin (TTR)
Systemic senile (age related) amyloidosis cardiac venricles mostly. cardiac dysfunction more insidious than in AL amyloidosis
55
Accumulation of mutated transthyretin (ATTR)
Familial amyloid cardiomyopathy ventricular endomyocardium deposition which causes restrictive cardiomyopathy and arrhythmias
56
Accumulation of mutated transthyretin (ATTR) due to transthyretin gene mutation
Familial amyloid polyneuropathies
57
_______ is a shift of glucose metabolism away from mitochondria towards glycolysis
Warburg effect
58
Invasive carcinoma
cells have invaded basement membrane using collagenases and hydrolases (metalloproteinases). cell-cell contacts lost by inactivation of E cadherin
59
Metastasis seed? soil?
Seed is thumor embolus | soil is the target organ that is often first encountered capillary bed
60
Origin of a carcinoma
Epithelial
61
Origin of sarcoma
mesenchymal origin
62
Disorganized overgrowth of tissues in native location
hamartoma
63
normal tissue in a foreign location
choristoma
64
Blood vessel benign and malignant tumors?
benign is hemangioma malignant is angiosarcoma
65
Smooth mm benign tumor and malignant
leiomyoma is benign | leiomyosarcoma is malignant
66
Tumor grade vs stage
Stage determines SURVIVAL (more important than grade)
67
Tumor grade
degree of cellular differentiation and mitotic activity on histology
68
Tumor stage
degree of localization/spread TNM staging system: T-tumor size/invasiveness N-Node involvement M-Metastases *N and M are most important
69
Paraneoplastic syndromes
Triggered by altered immune system response to a neoplasm
70
Progressive proximal mm weakness, gottron papules, heliotrop rash
paraneoplastic syndrome Dermatomyositis related to adenocarcinomas (esp ovarian)
71
Hyperpigmented velvety plaques in axilla and neck
paraneoplastic syndrome acanthosis nigricans related to gastric adenocarcinoma and other malignancies
72
Sudden onset of seborrheic keratoses
paraneoplastic syndrome sign of leser-trelat related to GI malignancy
73
Abnormal proliferation of skin and bone at distal extremities causing clubbing, arthalgias, joint effusions, periostosis of tubular bones
paraneoplastic syndrome hypertrophic osteoarthropathy related to adenocarcinoma of the lung
74
PTHrP secretion by a tumor that causes hypercalcemia
paraneoplastic syndrome SCC
75
Vitamin D3 secretion by a tumor that causes hypercalcemia
paraneoplastic syndrome lymphoma
76
Increased ATCH causing cushing syndrome related to
paraneoplastic syndrome sMALL CELL LUNG CANCER
77
Increased ADH related to hyponatremia (SIADH) caused by a tumor
paraneoplastic syndrome small cell lung cancer
78
Increased erythropoietin
paraneoplastic syndrome polycythemia caused by pheochromocytoma, renal cell carcinoma, HCC, hemangioblastoma, leiomyoma
79
Anemia with low reticulocytes causing ____ due to ____ tumor
paraneoplastic syndrome Pure red cell aplasia due to thymoma
80
Hypogammaglobulinemia due to ____Syndrome and ____ tumor
paraneoplastic syndrome | due to good syndrome and caused by a thymoma
81
Migratory superficial thrombophebitis
paraneoplastic syndrome trousseau syndrome due to adenocarcinomas (Esp pancreatic)
82
Deposition of sterile platelet thrombi on heart valves
paraneoplastic syndrome nonbacterial thrombotic endocarditis due to most adenocarcinomas of pancreas
83
Psychiatric disturbances, memory deficits, seizures, diskinesias, autonomic instability, language dysfunction
paraneoplastic syndrome anti-NMDA receptor encephalitis due to ovarian teratoma
84
Dancing eyes and ancing feet
paraneoplastic syndrome opsoclonus-myclonus ataxia syndrome due to neuroblastoma in childrena nd small cell lung cancer in adults
85
Antibodies against antigens in purkinje cells
paraneoplastic syndrome paraneoplastic cerebellar degeneration due to small cell lung cancer (anti hu), gyn and breast cancers (anti yo), hodgkins lymphoma (anti tr)
86
Antibodies against Hu antigens in neurons
paraneoplastic syndrome small cell lung cancer causing paraneoplastic encephalomyelitis
87
Antibodies against presynaptic Ca channels at NMJ
paraneoplastic syndrome Lambert-eaton myasthenic syndrome due to small cell lung cancer
88
Antibodies against postsynaptic Ach receptors at NMJ
paraneoplastic syndrome myasthenia gravis due to thymoma
89
Oncogenes
GOF mutation coverts proto-oncogene (normal) to onvogene needs damage to only one allele of a proto-oncogene
90
tumor suppressor genes
LOF increases cancer risk need both alleles of tumor suppressor gene to be lsot for expression of dz
91
What are psammoma bodies seen in
- papillary carcinoma of thyroid - serious papillary cystadenocarcinoma of ovary - meningioma - malignant mesothelioma
92
Serum tumor markers: Alkaline phosphatase
metastases to bone or liver paget disease of bone seminoma
93
Serum tumor markers: alpha feto protein
``` hepatocellular carcinoma endodermal sinus (yolk sac) tumor Mixed germ cell tumor Ataxia telangiectasia neural tube defects ```
94
Serum tumor markers: beta Hcg
produced by syncytiotrophoblasts of the placenta hydatidiform moles and choriocarcinomas testicular cancer mixed germ cell tumor
95
Serum tumor markers: CA 15-3/ CA 27-29
breast cancer
96
Serum tumor markers: CA 19-9
pancreatic adeocarcinoma
97
Serum tumor markers: CA 125
ovarian cancer
98
Serum tumor markers: calcitonin
medullary thyroid carcinoma
99
Serum tumor markers: CEA
colorectal and pancreatic cancers
100
Serum tumor markers: chromogranin
neuroendocrine tumors
101
Serum tumor markers: LDH
testicular germ cell tumors | ovarian dysgerminoma
102
Serum tumor markers: PSA
prostate cancer
103
Immunohistochemical stain
used to identify origin of metastatic tumor
104
Immunohistochemical stain: vimentin
Mesenchymal tissues
105
Immunohistochemical stain: S-100
neural crest cells
106
Immunohistochemical stain: Desmin
Muscle
107
Immunohistochemical stain: cytokeratin
epithelial cells
108
Immunohistochemical stain: GRAP
neuroglia
109
Immunohistochemical stain:neurofilament
neurons
110
Immunohistochemical stain: PSA
prostatic epithelium
111
Immunohistochemical stain: TRAP
tartrate resistant acid phosphatase
112
Immunohistochemical stain: chromogranin and synaptophysin
neuroendocrine cells
113
P-glycoprotein
multidrug resistance protein 1 (MDR1) classically seen in adrenocortical carcinoma used to pup out toxins (decreases chemotherapy effectiveness)
114
Cachexia
weight loss, muscle atrophy, fatigue due to chronic dz TNF, IFN gamma, IL1 and IL6
115
Most common cause of cancer related mortality in men? women? children?
Men: lung >prostate> colon/rectum Women: lung>breast>colon/rectum children: leukemia>CNS>neurblastoma
116
Most sarcomas spread via
hematogenously
117
Most carcinomas spread via lymphatics EXCEPT these 4 which are hematogenously
follicular thyroid carcinoma choriocarcinoma renal cell carcinoma hepatocellular carcinoma
118
Primary tumors that commonly met. to brain?
lung>breast>melanoma,colon, kidney
119
primary tumors that commonly met. liver
colon >> stomach> pancreas
120
primary tumors that commonly met. bone
prostate,breast>kidney,thyroid, lung
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