Slide review for Students.pdf

Slide review for Students Prof. Charles C Anunobi Dept. of Anatomic & Molecular Pathology CMUL  Basic information Identify and Make diagnosis Aetiological agents/risk factors/predisposing factors Common sites/cell or tissue of origin Clinical prese...

Slide review for Students Prof. Charles C Anunobi Dept. of Anatomic & Molecular Pathology CMUL  Basic information Identify and Make diagnosis Aetiological agents/risk factors/predisposing factors Common sites/cell or tissue of origin Clinical presentation Complications Atherosclerosis  Risk factors : aging, sex (males are much more prone to atherosclerosis), familial predisposition, hyperlipidemia, hypertension, cigarette smoking, diabetes mellitus, obesity, physical inactivity. Complications: ischaemic heart disease (angina, myocardial infarction), cerebrovascular disease, peripheral artery disease eg gangrene of the legs, of upper limbs, aneurysms. Prevention/Treatment : life styles changes eg exercise, non- smoking, healthy diet. Medication for the predisposing factors eg, for high cholesterol, for hypertension Hodgkin’s Disease  Types: (classical Hodgkin's lymphoma) – Nodular sclerosis Hodgkin's lymphoma – Mixed cellularity Hodgkin's lymphoma – Lymphocyte-depleted Hodgkin's lymphoma – Lymphocyte-rich classical Hodgkin's lymphoma Nodular Lymphocyte predominant Hodgkin's lymphoma  Clinical presentation – Asymptomatic lymphadenopathy – Unexplained weight loss, unexplained fever, night sweats – Chest pain, cough, shortness of breath – Pruritus – Splenomegally and hepatomegally  Reed-Sternberg cell is the cell of diagnostic importance The Ann Arbor staging is the staging system used most often for Hodgkin lymphoma Fibroadenoma (Gross) Fibroadenoma Fibroadenoma  FIBROADENOMA Benign tumour commonly found in women under 30 years of age Types: simple and complex fibroadenomata Symptom – Solid breast lumps that are firm, painless and mobile Methods of diagnosis – Ultrasonography – Mammography – Fine needle aspiration – Biopsy  Treatment : surgery Invasive Ductal Carcinoma  Invasive ductal carcinoma Risk factors – Genetic predisposition – Increasing age – Proliferative breast diseases – Radiation exposure – Length of reproductive life – Parity, commoner in nulliparous women – Obesity – Exogenous estrogen  Signs and symptoms – A painless, hard mass that has irregular edges – Swelling of all or part of a breast (even if no distinct lump is felt) – Skin irritation or dimpling – Breast or nipple pain – Nipple retraction (turning inward) – Redness, scaliness, or thickening of the nipple or breast skin  Diagnosis – Ultrasound – Mammography – Fine needle aspiration cytology – Biopsy Screening methods – Breast self examination – Ultrasonography – mammography  Histologic subtypes – Tubular, colloid, medullary, lobular, papillary, – Ductal carcinoma of no special type Treatment – Surgery – Radiotherapy – chemotherapy Benign Prostatic Hyperplasia.  Risk factors – Aging – Family history – Race/Ethnic background – Obesity Etiology – 5 alpha reductase type 2 acting on testosterone to reduce it to Dihydrotestosterone (DHT) leading to hyperplasia and accumulation of senescent cells  Symptoms – Urine dribbling : leaking of urine – Frequency – Nocturia – Dysuria – Urgency – hematuria  Complications – Acute urine retention – UTI – Urinary Bladder diverticulosis – Hydroureter – Hydronephrosis – Renal failure Methods of diagnosis : DRE (Digital rectal examination, Ultrasonography, biopsy) Treatment – 5 alpha reductase type 2 inhibitor – Surgery Adenocarcinoma of the prostate  Risk factors – Increasing age : rare below 40 years – Race/ethnicity: Prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races – Geography : most common in North America, Caribbean islands, Western Europe and Australia – Family history – High fat diet – obesity  Grading system – Gleason Screening methods – PSA – DRE – Ultrasonography Diagnosis – Histology  Treatment – Expectant management (watchful waiting) or active surveillance for well differentiated tumours. – Surgery. – Radiation therapy. – Cryotherapy – Hormone therapy. – Chemotherapy. Melanoma  Malignant tumour which commonly produces melanin Melanocyte is the cell of origin Possible primary sites : skin, oral and anogenital mucosal surface, adrenal medulla, oesophagus, uveal tract (eye), leptomeninges, choroid plexus  Risk factors – Exposure to sun (UV rays) – Number of skin moles – Family history – Fair skin colour – Weakened immune system  Normal vs Cirrhotic liver Normal liver  Most common cause of chronic liver ds Late complication of most liver disorders Liver cells form regenerative nodules Some of the areas are replaced by fibrous tissue which form bands in between the nodules Liver Cirrhosis Early Cirrhosis Early cirrhosis- fibrous tissue stains blue with Trichrome stain  Liver Cirrhosis Aetiological factors: Hepatitis B, C or D viral infection, biliary diseases, Wilson’s disease, haemochromatosis, alpha-1-anti-trypsin deficiency, alcoholic liver disease, Non alcoholic steatohepatitis, etc Presentation: ascites, obstructive jaundice, pruritus, features of chronic liver disease Complications: Portal hypertension, Liver failure, hepatic encephalopathy, hepatocellular carcinoma Pulmonary tuberculosis  Tuberculous lymphadenitis showing central caseous necrosis surrounded by granulomata  Aetiological agent- Mycobacterium tuberculosis Predisposing factors- immunosuppression Diagnosis- microscopy using Ziehl Neelsen stain to demonstrate acid fast bacilli, or culture Complications: – Miliary TB, TB arthritis, Endometritis, Oophoritis, Mastitis, TB epididymo-orchitis, Pott’s disease, etc Pulmonary tuberculosis Invasive well differentiated Squamous cell carcinoma  Invasive well differentiated squamous cell ca. Invasive well differentiated squamous cell carcinoma of the cervix. Predisposing factors – Human papiloma virus infections – Family history – Multiple sexual partners – Early sexual activity – Other sexually transmitted infections (STI) eg Chlamydia – Smoking – Weak immune system – Long term use of oral contraceptives  Invasive well differentiated squamous cell ca Symptoms : post coital bleeding, vaginal discharge Screening – Pap smear – HPV DNA testing – Visual inspection with Lugol’s iodine VILI – Visual inspection with acetic acid VIA – Colposcopy Diagnosis – Colposcopy – Biopsy  Cervical cancer Treatment – Surgery, – Radiotherapy, – chemotherapy Prevention: – HPV vaccine Ectopic tubal gestation  Ectopic (tubal) pregnancy Risk factors – Previous ectopic pregnancy – Pelvic inflammatory disease (PID) including Salpingitis – Fallopian tube with structural defect – Intrauterine Contraceptive Device (IUCD) – Smoking Symptoms : missed period, breast tenderness, nausea, light vaginal bleeding, pelvic pain, positive pregnancy test  Complications – Rupture – Massive intraperitoneal haemorrhage – Peritonitis – Shock Diagnosis – Positive pregnancy test (presence of human chorionic gonadotropin) – Abdominal four quadrant tap – Culdocentesis with presence of blood – Ultrasound Treatment : surgery Mature teratoma of the Ovary  Mature teratoma Benign tumour This teratoma has cartilage, adipose tissue, and intestinal glands at the right, while at the left is a lot of thyroid tissue. The cells arise from toti –potential cells in the gonads or in embryonic cell rests Common sites are-ovary, testes, mediastinum, sacrococcygium Uterine leiomyomata Uterine leiomyomata leiomyoma  Leiomyoma Cell of origin-smooth muscle cells; Commonest Site: myometrium; Oestrogen dependent Types based on uterine location: subserous, intramural, submucous Presentation: menorrhagia, abdominal swelling, dysmenorrhoea, pressure effects Complications: abnormal fetal lie, obstructed labour, pregnancy wastage (infertility), haemorrhage, degeneration (myxoid, hyaline, or cystic) ,infarction or dystrophic calcification. Acute Appendicitis Normal appendix Acute appendicitis Acute Appendicitis  Acute appendicitis Predisposing factors: foreign bodies, worms, faecolith, trauma Presentation: abdominal pain which later settles to RIF, nausea with vomiting, fever, abdominal tenderness with rebound, Full blood count shows elevated WBC with relative neutrophilia Complications: Rupture, gangrene, appendix abscess, peritonitis, septicaemia Pyogenic meningitis Pyogenic meningitis Pyogenic meningitis  Pyogenic meningitis Aetiological agents: infective(bacterial-) Neisseria meningitides, Strep. Pneumonia, Listeria Monocytogenes, Haemophilus Influenzae, E. Coli, Presentation: headache, fever, neck stiffness, Complications: Encephalitis, Brain infarction, brain abscess, arachnoid fibrosis , hydrocephalus, increased intracranial pressure, Water House Frederickson syndrome END STAGE RENAL DISEASE  ESRD Features - Global sclerosis of the glomeruli, interstitial fibrosis, thyroidization, dilatation of the tubules Causes: include diabetes mellitus, hypertension, Chronic glomerulonephritis, drug abuse, blockages in the urinary tract, chronic pyelonephritis.