Untitled Quiz

Pathology - Marrow Edition 8

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General Pathology

• Cell Adaptations: Covers cell injury, cell death, intracellular accumulations, acute inflammation, chronic inflammation, wound healing, tissue repair, hemodynamics.
• Neoplasia: Covers the basics of neoplasia, types of carcinogenesis, neoplasia hallmarks, lab diagnosis of cancer, tumour diagnosis, genetics: basics, Mendelian & Non-Mendelian modes & pedigrees.
• Genetics: Covers basics, Non-mendelian modes & pedigrees, chromosomal disorders, genetic disorders-diagnosis, hypersensitivity reactions, transplant pathology, immunodeficiency disorders, amyloidosis.
• Hematology: Covers RBC: introduction, peripheral smear examination, microcytic hypochromic anemia, megaloblastic anemia, hemolytic anemia, WBC: introduction, acute lymphoblastic leukemia, acute myeloid leukemia, myeloid disorders, chronic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma, plasma cell disorders, hemostasis, blood banking.
• Cardiovascular System: Covers blood vessels: sclerosis, blood vessels: vasculitis, vascular tumors, cardiovascular system, cardiovascular system (part 1 and 2).
• Genitourinary System: Covers kidney, nephritic syndrome, nephrotic syndrome, renal involvement in systemic diseases, kidney tumors.
• Gastrointestinal System: Covers esophagus, intestinal disorders, inflammatory bowel disease, colorectal polyps and cancer, liver pathology.
• Respiratory System: Covers obstructive lung diseases, restrictive lung diseases, granulomas and infections of lung, lung tumors.
• Endocrine System and Breast: Covers thyroid: non-neoplastic lesions, thyroid tumors, adrenal medulla, pituitary and Parathyroid gland, breast pathology.
• Skin and Musculoskeletal System: Covers dermatopathology, bone and soft tissue lesions.
• Nervous System Includes CNS non-neoplastic lesions and CNS tumors.
• Miscellaneous: Demonstration of instruments.

Cell Injury

• Causes: Hypoxia (most common), ischemia (reduced blood supply), physical agents (radiation), chemical agents, infectious agents, and immune factors.
• Cellular Response: Adaptation (reversible), reversible cell injury, and irreversible cell injury (necrosis or apoptosis).
• Nuclear changes: Pyknosis, karyorrhexis, and karyolysis (important morphological feature of irreversible cell injury).
• Free Radicals: Highly reactive molecules with unpaired electrons, causing cell damage through lipid peroxidation.
• Formation & Effects: Production of ROS from radiation, toxins and reperfusion and their effects (Membrane damage, Oxidative protein modifications, DNA damage, Mutations).
• Protective mechanisms: Exogenous/endogenous antioxidants.
• Misfolded Proteins: Accumulation of misfolded proteins in the endoplasmic reticulum, leading to diseases like cystic fibrosis, familial hypercholesterolemia, and Alzheimer's Disease.

Cell Death

• Types: Apoptosis, necrosis, pyroptosis, ferroptosis, and necroptosis.
• Mechanism: Necrosis: Enzymatic digestion of cells. Apoptosis: Genetically programmed cell death.
• Morphology: Densely eosinophilic cells (necrosis), glassy/shiny (necrosis) appearance, moth-eaten (necrosis).
• Types: Coagulative necrosis, Liquefactive necrosis, Caseous necrosis, Fat necrosis, Fibrinoid necrosis, Gangrenous necrosis.

Intracellular Accumulations

• Substances: Glycogen, lipids, proteins, water, hyaline, calcium, pigments.
• Conditions: Glycogen storage disorders, renal cell carcinoma, diabetic nephropathy, and others.

Wound Healing and Tissue Repair

• Tissue Regeneration: Dead cells replaced by same parenchymal cells (liver as an example).
• Tissue Repair: Involves infiltration by inflammatory cells (lymphocytes, macrophages), fibrosis, and neovascularization.
• Permanent Cells: Don't regenerate (neurons, cardiac & skeletal muscles).
• Stable Cells: Can regenerate under specific conditions (e.g., liver cells).
• Labile Cells: Continuously divide and can easily regenerate (e.g., epithelial cells).
• Healing by 1st intention: Apposed wound edges, minimal scarring; 2nd intention: Gap in wound edges, more scarring.

Hemodynamics

• Hyperemia: Increased blood flow to tissues (redness);
• Congestion: Reduced blood flow out of tissues.
• Thrombosis: Blood clot within a blood vessel.
• Embolism: Movement of blood clot or other material through the blood stream to a site distant from its origin.
• Infarction: Area of ischemic tissue death.
• Virchows Triad: 3 components: endothelial damage, blood flow abnormalities (stasis/turbulence) and hypercoagulability necessary for thrombus formation.

Blood Banking and Transfusion Medicine

• Blood Groups: ABO (A, B, O) and Rh (positive, negative).
• Blood components: Whole blood, packed red blood cells (PRBCs), fresh frozen plasma (FFP), cryoprecipitate, and platelets.
• Donation & storage methods: Methods for blood types and components as well as safety standards. Preservation & storage of different components.

Lab Diagnosis of Cancer

• Cytology: Examination of cells (FNAC).
• Biopsy: Excisional or incisional removal of tissue to study.
• IHC: Immunohistochemistry (Antibody markers to identify cells).
• Frozen section: Rapid microscopic examination to quickly determine the tumor type during surgery.
• Other investigations: Serum tests, x-rays for identifying abnormal markers in cancer.

Genetics: Basics and Mendelian Modes

• Gene: A segment of DNA that contains the code for a protein.
• Chromosome: A structure of DNA containing genes.
• Alleles: Different forms of a gene.
• Homozygous: Having two identical alleles for a gene.
• Heterozygous: Having two different alleles for a gene.
• Dominant: An allele that is expressed in the phenotype even if only one copy is present.
• Recessive: An allele that is only expressed in the phenotype if two copies are present.
• Inheritance pattern: Pattern of how genes are passed down from one generation to the next. Includes autosomal dominant, recessive, x linked, and non-mendelian (mitochondrial, trinucleotide repeat expansions).
• Mutations: Heritable changes in DNA.

Genetics: Non-Mendelian Modes and Pedigree

• Mitochondrial inheritance: Inherited through the maternal line.
• Gonadal mosaicism: A rare condition in which a mutation occurs in the germ cells of only one parent, resulting in a genetic characteristic that skips generations in the pedigree.
• Trinucleotide repeat expansion: Diseases in which a section of DNA is repeated multiple times affecting the offspring.

Genetics: Chromosomal Disorders

• Structural abnormalities: Insertion, deletion, inversion, translocation, and ring chromosomes.
• Numerical abnormalities: Trisomy, monosomy, and polyploidy.

Tumor Diagnosis

• Features: Well-differentiated, moderately differentiated, and poorly differentiated.
• Microscopic: Different types depending on what the tumor cells look like.
• Other investigations: Serum tests, X-rays, IHC, genetic analysis.

Other Mechanisms of Neoplasia

• Limitless replicative potential: Telomerase activity in cancer cells.
• Evasion of apoptosis: Resistance to programmed cell death.
• Sustained angiogenesis: Increased blood supply to facilitate tumor growth.
• Altered cellular metabolism: Warburg effect (increased glucose uptake and metabolism).
• Invasion and metastasis: Spreading and dissemination of tumors to other parts of the body.
• Escape of immune recognition Mechanisms for avoiding recognition and destruction by the immune system

Immunodeficiency Disorders

• Primary (Inborn): Defects in the development, activation, or maturation of immune cells.
• Secondary (Acquired): Immune deficiencies due to infections (HIV), malnutrition, or certain diseases.
• Common Variable Immunodeficiency (CVID): Defects in B cell maturation and antibody production, resulting in recurrent sinopulmonary infections, autoimmunity.
• Hyperimmunoglobulinemia M syndrome (HIM): Problems with specific antibody class switching.
• Isolated IgA deficiency: Most common primary deficiency Wiskott-Aldrich Syndrome (WAS): X-linked recessive
• Chronic Granulomatous Disease (CGD): The phagocytes do not kill microorganisms via an oxidative pathway.

Amyloidosis

• Description: Extracellular deposition of abnormal protein fibrils in various tissues and organs, creating a characteristic 'hyaline' staining.
• Pathogenesis: May be primary (from plasma cells), or secondary (associated with other conditions like chronic inflammation or malignancy).
• Types: AL and AA.
• Clinical Features: Kidney involvement is a common cause of death, other features include organomegaly and waxy appearance.
• diagnosis Use microscopy/stained using Congo red.

Hematology: RBC Introduction

• Size: Normal range, smaller (microcytic), or larger (macrocytic)
• Life Span: 120 days
• Shape: Biconcave, central pallor
• Components: Hemoglobin, spectrin
• Erythropoiesis: The process of making red blood cells (RBCS). Stages (Proerythroblast, early, intermediate, late normoblasts, reticulocytes).

Hematology: Peripheral Smear Examination

• Stains: Romanowsky stains (ie Leishman, Giemsa, Wright), used to visualize the cells and their contents.
• Reporting components: RBC, WBC, Platelets, and abnormal cell types. These are important to be able to observe and identify the components of the sample.

Hematology: Microcytic Hypochromic Anemia

• Causes: Iron deficiency, thalassemia, sideroblastic anemia, anemia of chronic disease.
• Iron requirements: Daily requirements, forms in body (haeme vs non-haeme).
• Absorption factors: Acidic pH, vitamin C
• Important proteins in iron metabolism: Transferrin (transport), Hepcidin (inhibitor)
• Investigations: CBC, serum iron studies, serum ferritin, TIBC (total iron-binding capacity), serum electrophoresis
• Stage of anemia: Iron deficiency, Iron-deficient erythropoiesis, Iron-deficiency anemia; Based on severity, using reticulocyte and serum iron profiles.

Hematology: Megaloblastic Anemia

• Causes: Vitamin B12 and folate deficiency affect cell maturation leading to megaloblastic anemia.
• Mechanism of absorption: Absorption of vitamin B12 involves intrinsic factor, and folate absorption is enhanced by presence of certain digestive enzymes.
• Presentation: Pancytopenia (reduction in RBCS, WBCs, and platelets), macrocytic RBCs, and morphological abnormalities in various cell types.

Hematology: Hemolytic Anemia (Part 1 & 2)

• Type/Causes: Hereditary defects (e.g., HS, elliptocytosis, G6PD deficiency, haemoglobinopathies).
• Acquired mechanisms: Immune-mediated (e.g., AIHA), non-immune mediated (e.g., mechanical injury, infections).
• Features (Intravascular vs Extravascular): Site of hemolysis, spleen involvement, presence of haemoglobinuria
• Investigations: Hemoglobin electrophoresis.
• Management: Treatment of the underlying cause, blood transfusions, splenectomy.

Blood Banking and Transfusion Medicine

• **Blood groups:**ABO and Rh.
• Blood components: Whole blood, packed RBCs (PRBC), FFP, and platelets.
• Pre-transfusion testing: Screen donor and recipient blood for antigens/antibodies; ABO compatibility.
• Transfusion protocol: Temperature, time, and type of tubing for blood/blood components during transfusion.
• Blood components storage: Storage requirements for each blood component.

Cardiovascular System: Part 1 & 2

• Blood circulation & layers of heart: Overview of circulation, layers of the heart (pericardium, myocardium, endocardium).
• Heart Failure: Types and Pathophysiology (Left vs right heart failure).
• Ischemic Heart disease: Features, diagnosis, and management/treatment.
• Cardiomyopathies: Types, causes, and clinical features.

Vascular Tumors

• Benign: Hemangioma, Lymphangioma, Glomus tumor
• Malignant: Hemangiopericytoma, Angiosarcoma.

Renal Cell Carcinoma

• Risk factors: Smoking, obesity, exposure to asbestos.
• Features: Flank pain, hematuria, palpable abdominal mass.
• Microscopic Features: Clear cells, granular/chromophilic, papillary.

Male Genital System: Penis and Prostate

• Penis: Condylomas, SCC, Bowen's disease.
• Prostate: BPH (benign prostatic hyperplasia), adenocarcinoma

Female Genital Tract: Vulva, Vagina, and Cervix

• Vulva: Paget's disease; condyloma acuminatum (genital warts).
• Vagina: Pre-malignant conditions: embryonal rhabdomyosarcoma
• Cervix: Cervical intraepithelial neoplasia (CIN)

Female Genital Tract: Uterus and Endometrium

• Endometriosis: Presence of endometrial glands outside the uterus.
• Endometrial Hyperplasia: ↑ in the ratio of endometrial glands: stroma.
• Endometrial Cancer: Types, clinical features, and risk factors.

Female Genital Tract: Ovaries

• Ovarian tumors: Surface epithelial, germ cell, and sex cord stromal tumors; Clinical features for each type.

Miscellaneous Topics:

• Organisms in foamy macrophages: May be associated with infections like TB (tuberculous), Whipple's disease (T. whipplei organism).
• Micro RNAs: Non-coding RNA molecules, affecting various cellular functions.
• Immunohistochemistry markers: Useful tools in identifying cell types and diagnosing tumors (e.g., using markers for epithelial cells, mesenchymal cells).
• Demonstration of instruments: Includes different types of vacutainers and bone marrow needles.

CNS: Non-neoplastic Lesions

• Glial cells: Types, functions, and response to injury/disease.

CNS Tumors

• Classification: Based on tissue of origin, differentiation, and associated genetic alterations/syndromes.
• Grading: Different grades associated with various cancer types.

Specific diseases and conditions covered in the notes:

• Important cancer types: Breast carcinoma (different types and associated genes), renal cell carcinoma, prostate cancer, lung cancer, and other malignancies.
• Inflammatory bowel diseases (IBD) Specifics about Crohn's and ulcerative colitis, including associated features.
• Important Hematological and other conditions discussed (e.g., various anemias, leukemias, lymphomas, immunodeficiencies, coagulation disorders).
• Important syndromes associated with specific conditions or cancers (mentioned in the various sections)