Histopathology Quiz on Tumors and Inflammation

Third Year Histopathology Revision

• The practical exam will assess students' knowledge of jars and histo samples.
• The practical exam is worth 33 marks.
• The data show exam has 7 stations, each worth 3 marks, and a total of 21 marks. Each station contains 3-4 questions: describe, diagnose, and one additional question. Alternative questions are diagnose and 2 additional questions.
• The microscopic exam covers 4 stations, each worth 3 marks, totaling 12 marks. Students only need to describe and diagnose.
• The system name will be mentioned at each station, regardless of whether it is a data show or microscopy station.

Revision Keywords and Examples

• The revision will cover keywords and examples from previous years' questions.
• It includes a data show scheme and a microscopy scheme with examples.

Histopathology

• The comment for a histology slide should include: description of the section, showing and diagnosis of the organ.
• Students should primarily diagnose slides using low power (red lens), as higher power can be more confusing.
• A scheme is essential for a good answer.

Notes

• Malignant Tumor: Comment on infiltration, arrangement, cell shape, features of malignancy, and if sarcoma, comment on the matrix.
• Benign Tumor: Comment on encapsulation, arrangement, cell shape, and stroma.
• Papillary Lesion (papilloma, papillary carcinoma, or polyp): The comment must include the core (fibrovascular tissue) and covering.
• Acute Inflammation: Comment on edema, congestion, neutrophils, and macrophages (and pus cells if applicable).
• Chronic Inflammation: Comment on lymphocytes, plasma cells, macrophages, and fibrosis.
• Bilharziasis: Comment on yellowish refractile shell ova, fresh ova showing pink miracidia, calcified ova (dark blue), and the surrounding bilharzial reaction (lymphocytes, plasma cells, macrophages, giant cells, eosinophils, and fibrosis).
• Glandular Hyperplasia: Increased gland number and size/shape variation are key points. Glands are lined by columnar cells (double cell layer or multiple layers/papillary processes), often with dilated glands and flattened cells lining the dilated portions; the stroma should also be commented on.

Respiratory System

• The exam will include 2 nasal lesions and 6 lung lesions.
• Some lesions can be evaluated from data show or glass slides.
• A few cases are data show-only.

Rhinoselceroma (Page 7)

• Chronic inflammation of the nasal mucosa.
• Key cells are Mickulicz cells (clear or foamy cytoplasm and small central nuclei).
• Lymphocytes and plasma cells, with Russell bodies (pink oval cells) and showing hyalinosis, are present also.

Nasal Polyp (Page 8)

• The polyp has pseudostratified columnar epithelium with squamous metaplasia in focal areas.
• Edema (homogenous pale pink fluid), proliferated mucous glands, and infiltration by plasma cells, lymphocytes, macrophages, and eosinophils are key features of this polyp.

Lung Lesions (Page 10, 11, 12, 13 - Note 10 shows descriptions of various lesion types, and pages 11–13 identify specific lung conditions)

• Descriptions of various lung conditions and their microscopic features for differing types of whole section lesions.

Infarction (page 15)

• Sections in lung that shows different zones: infarct area (atrophic alveolar walls, thin fibrous septa, and red blood cells).
• The remainder of the lung might show chronic venous congestion.
• Identifies the zone of congestion (red) and infarction (black) in slides.

Bronchogenic Carcinoma (Page 16)

• Infiltrative malignant tumor consisting of sheets (acinus) of malignant cells.
• Malignant cells vary in size and shape.
• Nucleus are large with hyperchromasia and prominent nucleoli.
• Mitosis is common.
• Lung tissue shows anthracosis.

Miliary Tuberculosis (Page 18)

• Presence of many small miliary tubercles scattered in the interstitial lung tissue, often around blood vessels.
• Composed of epithelioid cells, Langhan's giant cells, and lymphocytes.

GIT and Liver

• 8 slides focus on GIT lesions (mucus-secreting glands).
• 6 slides are allocated for hepatic lesions (large pink hepatocytes, no mucus-secreting glands).

H. Pylori Gastritis (Page 31)

• Section of stomach stained with Giemsa showing numerous Helicobacter pylori organisms.
• The organisms commonly appear within mucosal glands as small curved bacilli.
• Inflammatory cells are present in the stroma, outside the mucosal glands.

Acute Suppurative Appendicitis (Page 32)

• Transverse section in the appendix with partly ulcerated mucosal glands.
• The mucosa, submucosa, musculosa, and serosa show edema and congestion of capillaries.
• Dense acute inflammatory cellular infiltrate (exudate), especially by many polymorphs, pus cells, and macrophages.
• Lumen with fibrin network engulfing necrotic and shed mucosal cells, polymorphs, and pus cells.

Adenomatous Polyp/Intestine (Page 33)

• Proliferated acini (glands) of varying size and shape lined by columnar, mucin-secreting cells with basal nuclei
• Some acini have dysplastic epithelium.
• Stroma shows a vascular connective tissue with few inflammatory cells.
• Benign tumor, but can display precancerous features.

Bilharzial Polyp (Page 34)

• A central core of connective tissue has fresh, degenerated, calcified ova.
• Bilharzial reaction surrounds the ova (lymphocytes, plasma cells, macrophages, eosinophils, and fibrosis).
• Hyperplastic mucosa surrounds the glands. Ova and inflammatory cells are present.
• Not precancerous.

Bilharziasis (Page 36)

• Bilharzia ova are found in the colonic mucosa, with yellow-refractile shell, some fresh, showing pink miracidia, and others are calcified.
• Ova are surrounded by a bilharzial reaction.
• Not a precancerous lesion.

Stomach: Signet Ring Carcinoma (Page 38)

• Infiltrative malignant tumor composed of signet ring cells, which have clear cytoplasm and dark eccentric nuclei.
• These cells have their nucleus pushed to one side of the cell due to accumulated mucin inside the cytoplasm.

Adenocarcinoma (Page 39)

• Malignant tumor formed of irregular acini that infiltrate submucosa and musculosa.
• Malignant cells show variation in size and shape and have large, hyperchromatic nuclei.
• The malignant cells show loss of polarity with irregular arrangement. Mitotic figures are common.

Mucoid Carcinoma (Page 40)

• A malignant tumor formed of malignant irregular acini and solid groups.
• The malignant cells show variation in size and shape, with pale cytoplasm extending and pushing the nuclei to become eccentric and flattened (signet ring appearance).
• Nuclei are large and hyperchromatic.

Liver Cirrhosis (Page 50)

• Loss of normal lobular architecture, and replacement by regeneration nodules surrounded by fibrous septae.

• Regeneration nodules show proliferating liver cells with irregular sinusoidal patterns.

• Central veins are absent or eccentric in the regeneration nodules.

• Chronic inflammatory cellular infiltration and proliferating bile ducts are seen within the fibrous septae.

Hepatocellular Carcinoma (Page 51)

• Malignant tumor formed of infiltrating trabeculae and sheets of malignant hepatocytes separated by connective tissue stroma.

• Tumor cells are polygonal, variable in size and shape, and show hyperchromatic nuclei and mitosis.

• The rest of the liver tissue shows cirrhosis features.

Fibrinous Peritonitis (Page 53)

• The covering peritoneum displays shed serosal cells and a fibrin network.
• The subserosal connective tissue is edematous and shows congested capillaries and inflammatory cellular infiltrate (exudate) formed primarily by polymorphs and macrophages.

Other diagnoses, lesions, and schemes as noted throughout the presentation.

Test your knowledge of histopathology with this quiz focused on tumors, inflammation, and specific histological features. Questions cover cirrhosis, amyloidosis, renal cell carcinoma, and more. Perfect for medical students or anyone interested in pathology!