Pathology Fa Mnemonics & Facts

Front 1

Apoptosis

Back 1

ATP required; activation of caspases; DNA laddering 180-bp; no inflammation

Intrinsic--Bcl-2 prevents cytochrome c release; dec IL-2 after completed immunological rxn triggers apoptosis

Extrinsic--FAS or T-cell release of perforin & granzyme
*FAS mutation-->autoreactive lymphocytes-->autoimmune disease

Front 2

Hypoxic ischemic encephalopathy

Red neuron

Back 2

Affects pyramidal cells of hippocampus and purkinje cells of cerebellum

Red neuron: a neuron responding to irreversible injury, typically evident 12-24 hrs after injurious event; eosinophilic cytoplasm, pyknotic nucleus, loss of nissl substance

Front 3

Areas susceptible to ischemia:
Brain
Heart
Kidney
Liver
Colon

Back 3

B: ACA/MCA/PCA boundary areas
H: subendocardium
K: PCT and thick loop
L: zone III (area around central vein)
C: splenic flexure, rectum

**CNS & neurons most susceptible; ischemia causes liquefactive necrosis and cystic astroglial scar

Front 4

Dystrophic versus Metastatic calcification

Back 4

Dy: localized calcium deposition in tissues secondary to necrosis; pancreatic saponification, breast trauma; pts are normally normocalcemic!!

Me: widespread deposition of calcium secondary to hypercalcemia; favors kidney, lungs, and GI due to increased pH; pts are hypercalcemic

Front 5

Axonal rxn~chromatolysis

Back 5

Seen in neural cell body following axonal injury-->increased protein synthesis and repair

Round cellular swelling
Displacement of nucleus to periphery
Dispersion of Nissl substance throughout cytoplasm

Front 6

Leukocyte extravasation
Margination
Tight-binding
Diapedesis
Migration

Back 6

Occurs at postcapillary venule

M: endothelial selectin interacts with leukocyte sialyl-lewisX protein; essentially speed bumps

T: interaction btw endothelial ICAM/VCAM and leukocyte CD18/integrin/LFA-1

D: actually exits blood vessel; PECAM to PECAM

M: C5a, IL-8, LTB4 are main chemotactic products

Front 7

Free Radicals Pathologies

Radiation tx

Back 7

Retinopathy of prematurity
Bronchopulmonary dysplasia
Iron overload (hemochromatosis)
Reperfusion injury (ypac post tPA tx)
**Acetaminophen OD (fulminant hep, renal papillary necrosis)
**CCl4-->RER swelling (free radical damage)->dec protein synthesis->dec apolipoproteins-->fatty liver necrosis

RTX: induces dsDNA break and forms free radicals

Front 8

Wound healing mediators
PDGF
FGF
EGF
TGF-b
Metalloproteinases

Back 8

PDGF: secreted by activated platelets and M0's; vascular remodeling and smooth muscle recruitment

**FGF: stimulates all aspects of angiogensis

EGF: stimulates cell growth via tyrosine kinase

TGF-b: angiogenesis, fibrosis, cell cycle arrest

**Metalloproteinases (collagenase, hydrolase): degrades collagen during tissue remodeling; **also used by invasive Ca to invade basement membrane

Front 9

Granulomatous disease

Back 9

TH1 cells secrete IFN-g to activate M0's. TNF-a from M0's maintains granuloma formation.

Anti-TNF drugs can cause granuloma breakdown-->disseminated disease. Always screen for latent TB before starting anti-TNF tx

Front 10

ESR elevation

Common causes

Back 10

Products of inflammation (fibrinogen) coat RBCs and cause aggregation--RBCs group (rouleax) and fall at faster rate

Anemia, infection, inflammation, cancer, pregnancy, autoimmune disorders

Front 11

Iron poisoning
Mechanism
Sx's
Tx

Back 11

Iron kills cells by peroxidation of membrane lipids

n/v, gastric bleeding

chelation (deferoxamine) and dialysis

Front 12

Amyloidosis
AL (primary)
AA (secondary)
Dialysis-related
Heritable
Organ-specific

Back 12

Due to misfolded proteins; stains congo red, apple green birefringence
AL--Ig Light chain; common in multiple myeloma or other plasma cell disorder
AA--acute phase reactant, seen in chronic conditions like RA
D: b2-microglobulin; may present as carpal tunnel syndrome
H: often due to transthyretin gene mutation-->cardiac amyloidosis and restrictive CM
O: amyloid-b protein in alzheimer; amylin in DM type II

Front 13

P-glycoprotein

Back 13

AKA multidrug resistance protein 1 (MDR1)

Expressed by some cancer cells to pump out toxins & chemotherapeutic agents. One mechanism of resistance to CTX.

Front 14

Tumor Grade versus Stage

Back 14

G: determined by degree of cellular differentiation and mitotic activity; low grade (well differentiated), high grade (anaplastic)

S: based on site and size of primary lesion, spread to lymph nodes and mets

Front 15

Cachexia

Back 15

Weight loss, muscle atrophy, and fatigue that occur in chronic disease (Ca, AIDS, CHF, TB). Mediated by TNF-a, IFN-g, and IL-6.

Front 16

PSaMMoma bodies

Back 16

Laminated, concentric, calcific spherules

Papillary thyroid carcinoma
Serous papillary cystadenocarcinoma of ovary
Meningioma
Malignant mesothelioma

Front 17

Carcinogens--
Alfatoxins (aspergillus)
Alkylating agents
Aromatic amines (naphthylamine)
Asbestos
CCL4
Cigaretter smoke

Back 17

Alf: liver-HCC
Alk: blood-leukemia, lymphoma
Aro: bladder-transitional cell carcinoma
Asbestos: lung-bronchogenic>mesothelioma
CCL4: liver-centrilobar necrosis, fatty change
Cigs: transitional CC; esophagus-squamous & adenocarcinoma; RCC; larynx-squamous; lung-squamous & small CC; pancreas-adenocarcinoma

Front 18

Carcinogens--
Ethanol
Ionizing radiation
Nitrosamines (smoked foods)
Vinyl chloride

Back 18

Eth: liver-HCC
Ion: thyroid-papillary thyroid carcinoma
Nit: stomach-gastric Ca
Vin: liver-angiosarcoma

Front 19

Oncogenic Microbes
HBV, HCV
H. pylori
Liver fluke (Clonorchis sinensis)
Schistosoma haematobium

Back 19

HBV, HCV--HCC
H. pylori--gastric adenocarcinoma & MALT lymphoma
Clonorchis--cholangiocarcinoma, pigmented gall stones; tx praziquantel
Schistosoma--bladder Ca (squamous), painless hematuria, snails are host; tx praziquantel

Front 20

Oncogenes--
BCR-ABL
bcl-2
BRAF
c-kit
c/n/l myc
Her2-neu (c-erbB2)
ras
ret

Back 20

Cause gain of fxn; need to damage only 1 allele

BCR-ABL--TK; CML & ALL
bcl-2--anti-apoptosis
BRAF--melanoma
c-kit--GIST GI stromal tumor
c/n/l myc--transcription factor; burkitt, lung tumor, neuroblastoma
Her2-neu (c-erbB2)--TK; breast, ovarian
ras--GTPase; colon, lung, pancreatic Ca
ret--TK; MEN 2A & 2B

Front 21

Tumor suppressor genes--

APC
DCC
NF1
NF2
p53
Rb

Back 21

Loss of fxn; both alleles must be lost--two hits
Loss of heterogeneity--"first hit"

APC: colorectal Ca (associated w/FAP)
BRCA1/2: DNA repair protein
DCC: deleted in colon Ca
NF1: RAS GTPase activating protein
NF2: merlin protein
p53: Li-Fraumeni syndrome; TF for p21; blocks G1 to S
Rb: retinoblastoma, osteosarcoma; inhibits E2F, blocks G1 to S

Front 22

Tumor markers
Alkaline phosphatase
AFP
b-HCG
CA-19-9
CA-125
CEA
S-100
TRAP

Back 22

ALP: mets to bone, liner, paget disease of bone, seminoma (placental ALP)
AFP: HCC, yolk sac tumor, testicular cancer, mixed germ cell tumors; normally made by fetus (commonly elevated due to underestimation of gestational age)
b-HCG: hydatidiform moles & choriocarcinomas
CA-19-9: pancreatic adenocarcinoma
CA-125: ovarian cancer
CEA: nonspecific; colorectal, pancreatic Ca
S-100: neural crest origin (melanomas, neural tumors, schwannomas), langerhans cell histiocytosis (tennis racket)
TRAP: Tartrate-Resistant Acid Phosphatase; hairy cell leukemia (B-cell neoplasm)

Front 23

Tumor nomenclature
Carcinoma versus Sarcoma
Method of spread & exceptions

Back 23

C: implies epithelial origin
S: implies mesenchymal origin

Carcinomas typically spread via lymphatics, while sarcomas spread via blood

Notable exceptions: RCC (renal vein); HCC (hepatic vein); follicular carcinoma of thyroid, and choriocarcinoma