What do you need in gross description?
Organ: a … specimen + particular site
A: solitary lesion / multiple
Border: irregular, infiltrative
Cut-surface & Colour: homogenous / heterogenous
Dimension / size: exact size or with reference to neighbouring structures
Extension: layers of hollow organs / neighbouring structures
⇒ diagnosis
Marked nuclear atypia
- ↑ N/C ratio
- enlarged, pleomorphic, hyperchromatic nuclei
- prominent nucleoli
- frequent mitosis
ADC microscopic descrition
proliferation of tumour cells with glandular differentation
in a background a desmoplastic stroma +/- lymphovascular invasion
cells arranged in infiltrative, irregular, angular, complex glands
cells with marked nuclear atypia (…) with intracellular mucin
SCC description
proliferation of tumour cells with squamous differentiation
in a background desmoplastic stroma +/- lymphovascular invasion
cells arranaged in infiltraive sheets and nests of keratin pearls
polygonal cells with marked nuclear atypia (…) with intracellular bridges and keratinisation
HCC description
proliferation of tumour cells with hepatocytic differentation
in a desmoplastic stroma +/- lymphovascular invasion
tumour cells arranged in thickened trabeculae
cells with marked nuclear atypia (…)
What do you look for as a clinician in pathology report?
Procedure related:
- resection margin clearance
Grading:
- tumour grade
- histological subtype
Staging:
Tsize of tumour, depth of invastion, status of lymphovascular permeationNstage of nodal metastasis
Treatment indications:
- hormonal receptor / molecular status
- status of background
Ordinance for coroner report
Coroners Ordinance Cap 504
Metaplasia
reversible replacement of one differentiated cell type by another differentiated cell type
Dysplasia
reversible disordered growth and maturation of cells
Hamartoma
disorganised overgrowth of tissue indigenous to that site
Thrombus vs Embolus
blood clot forms locally inside a vessel
mass that floats freely in blood & travels along the bloodstream
What is target therapy?
a type of cancer treatment with drugs that specifically target on driver mutation for carcinogenesis / tumour growth, to precisely identify and attack cancer cells while minimally damage normal cells
Gross description of vessels with atherosclerosis
- fatty streaks (as flat yellow spots)
- multiple variable-sized raised atherosclerotic plaques
- confluent 匯合 in the aortic bifurcation
- more pronounced at locations of turbulence (i.e. opening of blood vessels into aorta / bifurcation)
- large plaques are complicated by ulceration with superimposed thrombus
- +/- aneurysmal dilatation at …
Microscopic appearance of atherosclerosis
Complicated atheroma
- Atheromatous plaque: fibrous cap + necrotic core
- Cells: SMCs, foam cells
- ECM: collagen, elastic fibers, proteoglycans
- Lipids
- Acute plaque changes
- Rupture, fissuring, ulceration or erosion of plaque
- Mural thrombus formation
- Haemorrhage into plaque
- Athero-embolism (ruptured plaque discharges debris into blood → microemboli)
- Aneurysm
Pathological definition of acute myocardial infarct
irreversible coagulative necrosis of the myocardium from ischaemia / reduction in coronary blood supply
Coronary arteries & their territory of supply
- Left anterior descending: anterolateral LV, anterior 2/3 of septum, apex
- Left circumflex: posterolateral LV, LA
- Right coronary: RA, RV, posterior 1/3 of septum
Gross description of MI
Specimen of a heart
- discolouration indicating transmural infarct
- pale to yellow infarcted myocardium in …
- patchy dark discoloration in …
- thrombus in … artery
- thickened left ventricular wall (left ventricular hypertrophy)
- +/- nearby fibrosis and thinning of the nearby myocardium
Miscroscopic features of MI
coagulative necrosis, wavy fibres, deeply eosinophilic cytoplasm, loss of myocyte nuclei & striation, neutrophil infiltration
infiltrate of lymphocytes, fibroblasts, macrophages
organising granulation tissues
irregular fibrous scar tissues
atherosclerotic plaque in coronary vessels
How does AMI lead to sudden death?
- Ischemia of conduction system → arrhythmia (especially VF)
- Ischemia of cardiomyocytes → Heart failure → Cardiogenic shock
- Rupture of ventricular wall → Hemopericardium → Cardiac tamponade
- Thromboembolism → Stroke
- Papillary muscle rupture → Valvular regurgitation
What are the pathological features of hypertension in kidney?
Benign nephrosclerosis
Gross: finely granular cortex
Microscopy:
- hyaline arteriosclerosis, predominantly at afferent arterioles
- tubular atrophy
- thickening of interlobular arteries
Malignant nephrosclerosis
Gross: petechiae on surface / “flea-bitten” appearance
Microscopy:
- Fibrinoid necrosis of arterioles
- Hyperplastic arteriolitis (onion skin lesion)
Gross pathology of aortic dissection
- presence of thrombus
- double lumen created to the aorta
- background: multiple atherosclerotic plaques
- longitudinal intimal tear
- blood propagate into the media
Gross features of bronchopneumonia
diffuse black deposition (smoker’s lung)
patchy, multiple foci of consolidation along small bronchi & bronchioles
foci of consolidation became confluent at the periphery
Histological features of pneumonia
- alveoli filled with RBCs, fibrin, polymorphs
- neutrophil infiltrates
- congestion of pulmonary capillaries
Classification of lung tumour
Primary
- Non-small cell lung carcinoma (NSCLC)
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
- Small cell lung carcinoma (SCLC)
- Others
- Carcinoid tumor
- Large cell neuroendocrine carcinoma
Secondary: metastasis
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Integrated Gross & Histological Pathology35
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Respiratory pathology60
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GI Pathology207
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Past paper58
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Bleeding, thrombosis, and transfusion109
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Renal Pathology123
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White cell disease95
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Gynaecological and breast pathology31
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Other topics40
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CVS Pathology50
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Red cell disease55
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CNS pathology92
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SAQ24
