Systemic Pathology

Question 1

What are the complications of HIV?

Answer 1

• Opportunistic Infections
• Tumours
• Central nervous system diseases

Question 2

How does symptoms change with CD4 and RNA over time?

Answer 2

Question 3

What are the HIV opportunistic infections?

Answer 3

Pneumocystis jiroveci: pneumonia
• CMV: especially retina and GIT
• Candida
• Tuberculosis and atypical mycobacteria
• Cryptococcus: meningitis
• Toxoplasma gondii: encephalitis and mass lesions
• JC papovavirus: progressive multifocal leukoencepalopathy
• Herpes simplex
• Cryptosporidium, Isospora belli, microsporidia: GIT

Question 4

What is this showing?

Answer 4

Endoscopy:
Oesophageal ulcer
CMV

Question 5

What is this?

Answer 5

(a) CMV nuclear inclusion
(b) Immunohistochemistry
for CMV

Question 6

What are the HIV associated tumours?

Answer 6

• Kaposi’s sarcoma:
HHV-8

• Lymphoma:
systemic, CNS or body cavity based
B cell lymphomas
EBV

• Others:
Squamous cell carcinoma
Anus and cervix
HPV

Question 7

How does a Kaposi sarcoma look Histologically?

Answer 7

A. The dermis is expanded by a solid
tumour.
B. Fascicles of relatively monomorphic
spindled cells, with slit-like vascular
channels containing erythrocytes.
C. The nuclei of the tumour cells
demonstrate immunoreactivity for
HHV-8.

Question 8

What CNS diseases does HIV cause?

Answer 8

• Progressive encephalopathy = AIDS dementia complex
• Plus opportunistic infections and tumours

Question 9

What does CNS HIV lymphoma look like?

Answer 9

Question 10

What is the pathology of mTB?

Answer 10

• Caseating granulomas
• Demonstration of acid fast bacilli
• Cavitating lesions

Question 11

What kind of granuloma is this?

Answer 11

Caseous

Question 12

Where can TB infect?

Answer 12

• Lung
• Lymph node
• Bone: e.g. vertebra- potts
• Heart: e.g. pericarditis
• GIT: e.g. peritonitis
• CNS: e.g. meningitis
etc.

Question 13

What are the extrapulmonary features of mTB?

Answer 13

Question 14

What is the pathology of sarcoidosis?

Answer 14

• Non-caseating granulomas
• A diagnosis of exclusion.

Question 15

What is this?

Answer 15

Sarcoidosis

Question 16

Where can sarcoid effect?

Answer 16

• Lung: scattered granulomas, heal with fibrosis
• Lymph nodes: usually hilar and mediastinal
• Spleen
• Liver
• Heart
• Joints
• Bone marrow
• Skin: nodules, plaques or macules
• Eyes: iritis, choroid retinitis, lacrimal glands
• CNS
• Salivary glands

Question 17

What is IgG4 related disease?

Answer 17

• Inflammation dominated by IgG4 antibody producing plasma cells
• Fibrosis, obliteration of veins

Question 18

What is this?

Answer 18

IgG4

Question 19

Where does IgG4 related disease effect?

Answer 19

• Salivary and lacrimal glands: Mikulicz syndrome
• Thyroid: Riedel thyroiditis
• Peritoneum: Retroperitoneal fibrosis
• Liver: Biliary obstruction
• Pancreas: Autoimmune pancreatitis
• Mass lesions: Inflammatory pseudotumour

Question 20

What can alcohol cause?

Answer 20

• Liver: fatty change (steatosis) , fatty liver hepatitis (steatohepatitis),
cirrhosis, liver cell cancer (hepatocellular carcinoma)
• GI Tract: acute gastritis, oesophageal varices
• Nervous system: peripheral neuropathy, Wernicke-Korsakoff
syndrome etc.
• Cardiovascular system: dilated cardiomyopathy, hypertension,
atheroma (and decreases it!)
• Pancreas: acute pancreatitis, chronic pancreatitis
• Fetal alcohol syndrome
• Cancer: oral cavity, pharynx. oesophagus, liver and breast

Question 21

What are the stages of ALD?

Answer 21

Normal
Steatosis
Steatohepatitis
Fibrosis
Cirrhosis
HCC

Question 22

10

Answer 22

10

Question 23

Where does CF present?

Answer 23

Pancreas: duct obstruction, exocrine atrophy
• Salivary glands: duct obstruction, atrophy
• Intestine: meconium ileus
• Liver: biliary obstruction, cirrhosis
• Lung: bronchial obstruction, superimposed infection with abscess
formation (Staphylococcus aureus, Haemophilus influenzae and
Pseudomonas aeruginosa)
• Male genital tract: infertility, absence of the vas

Question 24

What is amyloid?

Answer 24

Deposition of an abnormal proteinaceous substance in non branching
fibrils, 7.5-10nm diameter
• Always contains P component
• Beta-pleated sheet structure
• A variety of proteins can take on this conformation
• Resistant to enzymic degradation

Question 25

What is amyloid classification?

Answer 25

•AA - derived from serum amyloid A e.g. Crohn’s Disease, Rheumatoid arthritis •AL - derived from light chains e.g. multiple myeloma, B Cell lymphoma

Question 26

What types of amyloid causes certain diseases?

Answer 26

* Transthyretin e.g. mutation * Beta2-macroglobulin – peritoneal dialysis * Abeta2 protein - Alzheimer’s * Insulin, calcitonin – endocrine tumours

Question 27

What is the staining for amyloid?

Answer 27

Stains with Congo Red dye This shows apple green birefringence under polarised light

Question 28

What are the clinical features of amyloidosis?

Answer 28

• Proteinuria, renal failure • Restrictive cardiomyopathy, arrhythmias • Autonomic neuropathy • Carpal tunnel syndrome • Macroglossia • Bleeding on injury • Also deposited in blood vessels, endocrine organs, liver, spleen

Question 29

What are the causes of granulomas in the liver?

Answer 29

Sarcoidosis TB Drug induced Schistosomiasis Malignancy

Question 30

What are the different types of liver damage due to alcohol?

Answer 30

Steatosis Steatohepatitis Fibrosis Cirrhosis

Question 31

What type of amyloid is associated with multiple myeloma?

Answer 31

AL amyloid derived from light chain