Pathology

Cellular Changes & Adaptations

Cell swelling 1st manifestation of almost all forms of cell injury

Cell swelling pattern of reversible injury visible under light microscopy
Intact cellular components not a characteristic of cells undergoing apoptosis
Leukocytic infiltration not a morphologic finding in cells undergoing apoptosis
Necrosis a process involving intracellular destruction of protein & enzymatic cells
Inflammation produces exudates than transudates
Edema - accumulation of fluid in interstitium
Anasarca - severe generalized form of edema
Coagulation necrosis - most common type of necrosis occurring after ischemia
Pathogenesis - sequence of events in the dev t of disease
Nuclear pyknosis - does not represent an ultrastructural structure in reversible injury
Adenocarcinoma - most common malignant tumor in the stomach

Biology of Tumor Growth

Anaplasia absence of differentiation in a tumor

Dysplasia atypical proliferation of epithelial cells
Differentiation degree at which tumor cells resemble normal cells
Initiation step in chemical carcinogenesis wherein there is exposure of cells or tissues to an appropriate
dose of carcinogenic agent
Activation of independent NOT a feature of procarcinogen
Features of procarcinogen interact w/ DNA; mutagenic; require metabolic/enzyme conversion
p53 gene/protein known as tumor suppressor
Tumor angiogenesis factor produced by tumor that promotes vascularization
Development of fibrous capsule mechanism which does NOT favor invasion of cancer cells
Alkylating agents carcinogen known to be direct-acting
Cachexia wasting syndrome seen in terminal cancer patients
Reverse transcriptase produced by RNA virus leading to mutation in cancer development
Intact basement membrane qualifying feature of carcinoma-in-situ
Mutation effect of UV rays leading to cancer development
Cocarcinogenesis a condition of diverse oncogenic influences that act in concert to produce cell
transformation in cancer development
Teratoma tumor composed of more than 1 germ layer
Adenoma tumor of epithelial origin

Cancer Assessment & Evaluation

Cytologic involved in the examination introduced by Papanicolau for early diagnosis of cervical cancer
Grading assessment or evaluation of cancer based on cytologic differentiation
Staging assessment or evaluation of cancer based on extent of tumor spread

Tumor Marker
 CA 125 marker for ovarian surface epithelial tumors

Immunologic

Type I: Immediate hypersensitivity anaphylazis, allergies, bronchial asthma (atopic forms)

Atopy type I hypersensitivity
Type II: Ab-mediated hypersensitivity AIHA, Goodpasture syndrome
Type III: Immune Complex Acute poststreptococcal glomerulonephritis; SLE, Serum sickness; Arthus reaction
Type IV: Cell-mediated Contact dermatitis, multiple sclerosis, type 1 diabetes, transplant rejection, TB

Dermatologic

Melanocytes produce pigment that serves as endogenous screen

Langerhans cells dendritic histiocytic cells in epidermis
Langerhans cells epidermal cells that process antigenic signals
Keratinocytes epidermal cells responsible for biosynthesis of cytokines
Albinism lack of melanin due to defect in tyrosinase enzymes
Vitiligo skin lesion showing lack of pigmentation due to loss of melanocytes
Melasma mask-like facial hyperpigmentation seen in pregnancy
Dysplastic nevus precursor of malignant melanoma
Urticaria pigmentosa mastocytosis seen mostly in children
Vertical stage of growth in melanoma leading to development of nodule and has greater capacity
to metastasize
Epidermal inclusion cyst skin tumor NOT associated w/ sunlight exposure in its development
Skin tumor associated w/ sunlight exposure actinic keratosis, melanoma, squamous cell CA
Keratoacanthoma skin tumor w/ keratin filled epidermal crater; mimics well-differentiated squamous
carcinoma & may heal w/o treatment
Mycoses fungoides a type of cutaneous T-cell lymphoma
Trichofolliculoma adnexal tumor showing hair follicle differentiation
Melanin the only brown black pigment

Melanoma

Melanoma - skin neoplasm exhibiting polygonal cells, in cytoplasm abundant melanin pigments
Melanoma staged by Clark level

Squamous Cell CA

Squamous Cell CA - most common malignant neoplasm in skin

Squamous Cell CA can be associated w/ betel nut chewing

Basal Cell CA

Basal cell CA most aggressive type of tumor producing deep rodent ulcer
Basal cell CA shows characteristic palisading of nuclei at periphery of tumor
Basal cell CA - most common malignant skin lesion due to sun exposure
Basal cell malignancy rarely metastasize

Small Cell CA
 Small Cell CA commonly associated w/ ectopic hormone production

Clear Cell Adenocarcinoma

Clear cell adenocarcinoma hobnail nuclei, being pushed outward, abundant cytoplasm

Neurologic

Most common extracranial tumor in adulthood not true about neuroblastoma

Suprasellar - most common location of craniopharyngioma
> 200 mm H2O - ICP charac by CSF pressure
Microglial cells - principal cells for repair and scar formation in the CNS
Brain does not exhibit coagulation necrosis
Durette hemorrhages - secondary brainstem hemorrhage

Oral Cavity, Pharynx & Esophagus

Greatest importance is the development of SCCA not true of Barrets esophagus

Thyroid & Parathyroid

Anaplastic CA w/ sarcomatous appearance

Follicular CA diagnosis based on vascular & capsular invasion
Hashimotos thyroiditis histologic feature: polygonal cells w/ pink granular cytoplasm
Thyroid CA microscopic appearance: uniform appearing follicles containing colloid
Fibrovascular stalk histologic feature found in papillary CA but not in Graves disease
Amyloid component responsible for positive congo red stain in a thyroid tumor
Metastasis reliable criteria to parathyroid CA
Hot nodule nodule that takes up iodine 131 tracers on thyroid scan
Diffuse goiter autoimmune disease is usually associated w/ this type of lesion
Cystic follicle cyst w/ fibrous walls & granulose lining cells w/ outer theca cells

Papillary Thyroid Carcinoma

Papillary most common thyroid CA

Papillary tan-white nodule w/ areas of calcification; branching papillae w/ fibrovascular stroke
Papillary ground glass nuclei; psammoma bodies
Psamomma bodies papillary thyroid CA (Orphan-Anne appearance)

Struma Ovarii

Struma ovarii monodermal derived ovarian tumor composed entirely of thyroid follicles

Mammary Gland

Breast where most common malignancy arises among females

Breast - most common source of metastatic malignancy to the liver

Cardiovascular

Abdominal aorta - most common location of atherosclerotic aneurysm

 Vasa vasorum blood vessel that supplies the vessel wall
Heart failure cells seen in lungs in chronic massive congestion
Heart failure cells - seen not in the heart, as a result of HF such as CHF
Hypertrophic cardiomyopathy - most common cause of sudden death among athletes
Infective endocarditis - infection caused by invasion of heart valves caused by microbiologic agents
Lidmann sacks - endocarditis seen in SLE patients
Ankle & pedal edema hallmark of right-sided heart failure (RHF)
Mitral stenosis most important consequence of RF; 99 % cause of MS; fishmouth or buttonhole stenosis
Acute atherosis fibrinoid necrosis in the wall of blood vessels & some lipid-laden macrophages
Antithrombotic not a function of endothelial cell
Weibble palade bodies stores vWF seen in endothelium
Berry aneurysm - minute aneurysm development due to chronic HPN
Iliac - arterial embolus
Deep leg veins - most common source of venous thrombi

Rheumatic Fever & Rheumatic Heart Disease

Aschoff bodies - pathognomonic feature of RF

Anitskow cells - pathognomonic cell
Group A beta hemolytic - causative agent of RHD
Myocarditis prolonged PR interval in ECG of RHD patients

Atherosclerosis

Fatty streak - precursor of atherosclerotic plaque seen in childhood

Atherosclerosis - most common form of arteriosclerosis
Sequela of atherosclerotic plaque AOTA
Gromous central part - does not describe the atheromatous plaque

Hypertension

Hypertension - most important risk factor for coronary heart disease

Hypertension - most common cause of intracerebral hemorrhage

Hematologic

Hemoglobin laboratory test showing hemolytic anemia

Neutrophils group of phagocytes
Myelophthisic anemia hypocellular bone marrow
2:1 to 5:1 normal bone marrow myeloid-erythroid ratio (3:1)
Weibel-Palade Bodies stores vW factor (endothelial cells)
Serum ferritin good indication of the amount of storage iron
Vit. E deficiency predispose to high oxidative changes in RBC
Human T-cell Leukemia 1 NOT a DNA oncogenic virus
PT - this lab procedure will test the adequacy of extrinsic factor
Capillary fragility test - for patency of blood vessel wall; tourniquet test (most accessible)
Hemophilia A - bleeding d/o not associated with vessel wall
Ristocetin aggregation test - immunologic technique to assess VWF
 DIC - consequence of bleeding diathesis due to consumption of platelets
Vitamin C - deficiency results in vascular hemorrhages
Hypochromic normocytic - in chronic disease, morpholohy of RBC
Normochromic, normocytic - massive bleeding

Lymphatics

RS cell pathognomonic of Hodgkins lymphoma

Epstein-Barr associated w/ causation of Burkitts lymphoma

Pulmonary

Resolution stage of lobar pneumonia characterized by production of rusty sputum

Atypical pneumonia type of pneumonia showing alveolar thickening
Lungs - most common venous embolus will lodge in this area
Lungs - hepatocellular carcinoma 1st commonly metastasize to this organ
Emphysema - dilated air spaces seen

Tuberculosis

Primary stage Ghon complex seen

Mycobacterium tuberculosis infection causes chronic inflammation
Tuberculous infection langhans type of giant cells can be found

Gastrointestinal

Hirchsprungs disease absence of ganglion cells in the rectum

Diverticular disease associated w/ outpouching of the colon, most often located in the sigmoid colon
Megacolon a congenital disease where the distal colon lacks ganglion cells
Hemorrhoids variceal dilation of anal and perianal plexuses
Heaped up ulcer margin favors diagnosis of ulcerative gastric CA over diagnosis of gastric peptic ulcer
Helicobacter pylori associated w/ peptic ulcer
Dysplasia not a histologic feature of chronic gastritis
Dysplasia not a histologic feature seen in reflux esophagitis
Muscularis propria histologic findings of acute appendicitis are based on the presence of neutrophils
on this area
Astler Collers Staging guide to prognosis among patients w/ colon CA
Astler & Coller staging
Ascending colon & cecum common site of colon CA
Ulceration local effect of GI tumor leading to melena
Squamous cell CA - in esophagus
Adenocarcinoma usually in the background of this: barrets esophagitis
Large intestine, malignancy it is graded or classified by astler and coller
(depth of invasion & involvement of nodes)

Liver

Carvernous hemangioma - most common benign neoplasm of the liver

Metastatic carcinoma - most common malignant neoplasm of the liver
 Hepatocellular carcinoma - most common primary malignant neoplasm of the liver

Appendix

Neutrophilic infiltration of muscularis propria histologic criterion for diagnosis of acute appendicitis

Adrenal

urinary VMA confirms diagnosis of pheochromocytoma

Pheochromocytoma will give a positive result in a histochemical stain neuwon specific enolase
Catecholamine substance secreted if tumor is paraganglioma

Urinary

Kidney organ most commonly affected by ecclampsia

Acute tubular necrosis exhibited by kidney in cases of hypovolemic shock; seen indehydration
2+ protein in urinalysis patient w/ ecclampsia
Acute post-streptococcal GN presents as nephritic syndrome
Membranous proliferative GN dense deposits
Minimal change disease - loss of foot processes
Glomerulonephritis
Lipoid necrosis - Most common type of GN
Onion skinning - major morphologic characteristic of benign nephrosclerosis

Reproductive

Clue cells Gardnerella infection

Tzanck smear simple cytologic stain to diagnose herpes genitalis
Gonorrhea can cause female infertility
Endometrial stroma significant histologic changes in endometrial hyperplasia
Zonal necrosis not used to differentiate leiomyoma from leiomyosarcoma
Gardnerella vaginalis clue cells
Leiomyoma - most common benign mesenchymal derived tumor of the uterus
Hydatidiform mole gestational trophoblastic tumor
Mature cystic teratoma most common benign germ cell tumor
CA 125 epithelial derived tumor: serous papillary adenocarcinoma
Granulosa cell tumor - assoc. w/ hyperplasia of endometrium and may increased level of estrogen
Granulosa cell production of estrogen & progesterone
Proliferation & hyperplasia - estrogen effect to endometrium
Lactotroph - most common type of pituitary adenoma; px present w/ amenorrhea, infertility
Embryonal carcinoma px w/ solid ovarian tumor, level of hCG

Yolk Sac Tumor

Yolk sac tumor beta hCG

Yolk sac tumor central blood vessel enveloped by germ cells
Schiller duval bodies pathognomonic of yolk sac tumor or endodermal sinus tumor

Dysgerminoma
 Dysgerminoma - most common malignant germ cell tumor
Dysgerminoma polyhedral tumor cells w/ round nuclei & adjacent mononuclear inflammation
Dysgerminoma analogous to seminoma in the male testis
Dysgerminoma most radiosensitive, curable

Krukenberg Tumor

Krukenberg tumor PAS (+) epithelial cells w/ eccentrically located atypical nuclei & abundant clear cytoplasm

Endodermal Sinus Tumor

Endodermal sinus tumor AFP (+) intracellular & extracellular hyaline droplets
Schiller duvall bodies microscopic finding in endodermal sinus tumor

Serous Cystadenocarcinoma

Serous cystadenocarcinoma most common malignant ovarian tumor making up 40 % of all ovarian malignancy
Stromal invasion distinction bet. atypically proliferative serous tumor & serous cystadenocarcinoma

Cysts & Tumors

Fibroma most common benign solid tumor of the vulva

Fibroma most common benign, solid ovarian tumor
Leiomyoma most frequent pelvic tumor
Endometrial carcinoma most common malignancy of the genital tract
Ovarian carcinoma 2nd most common (endometrial > ovarian > cervix)
Inclusion cyst most common vaginal cyst, usually in posterior or lateral walls of lower 3rd of vagina
Nabothian cyst translucent or opaque-white retention cysts occurring where a tunnel or cleft was covered by
squamous metaplasia; considred a normal feature of adult cervix, no treatment needed
Follicular cyst most frequent cystic structure in normal ovary
Corpus luteum cyst triad: delayed menses followed by spotting, unilateral pelvic pain & a small tender
adnexal mass
Theca lutein cysts almost always bilateral w/ moderate to massive enlargement due to excessive
gonadotropin stimulation or sensitivity; associated w/ molar pregnancies & hypothyroidism
Benign cystic teratoma
- dermoid cyst, mature teratoma
- most common slow-growing ovarian tumor usually in prepubertal & teenage girls
- contains elements from all 3 germ layers
- torsion : most common complication
- rupture : most serious due to chemical peritonitis
Epithelial Stromal Tumors
- serous (most common), psammoma bdies, high grade, worse prognosis
- clear cell (mesonephroid) : glycogen rich cells, hobnail cells (nuclei protrude into glandular lumen)
Granulosa cell tumors Call-Exner Bodies (eosinophilic bodies surrounded by granulose cells, primarily
estrogenic)
Immature teratoma cyst wall composed predominantly of neuroepithelium
Mature teratoma unilocular cyst w/ stratified squamous wall & underlying skin adnexa
Mucinous cyst cyst wall w/ lining of tall columnar epithelial cells w/ basal nuclei
 Serous cyst lined by cuboidal to low columnar ciliated cells

HIV

Lymphocyte vehicle for HIV virus

Characteristic Appearance

Cannon Ball Appearance Choriocarcinoma

Snowstorm-like appearance Hydatidiform mole

Tumor Markers

CA 125 epithelial ovarian tumors

Serum LDH dysgerminoma
Alpha Feto Protein endodermal sinus tumor
hCG - chriocarcinoma