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69 Cards in this Set
- Front
- Back
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what is the definition of pseudomyxoma peritonei
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a clinicopathologic correlation of gelatinous ascites and peritoneal deposits of mucinous tumor; corresponding pathologic term is metastatic mucinous adenoca or mucinous carcinoma peritonei - most frequently arises from appendiceal origin
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what histologic fx makes a pseudomyxoma peritonei high grade
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signet ring morphology (not macrophages!), complex/cribriform architecture, sheets of tumor
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what can help but is by no means diagnostic in separating appendiceal vs. ovarian origin of a mucinous tumor in peritoneum
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CDX2 - positive in appx but also positive in intestinal-type ovarian mucinous tumors (as opposed to endocervical)
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can ca125 be positive in mesotheliomas
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yes, some so pitfall when distinguishing btwn peritoneal or ovarian origin for a serous carcinoma
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if you see involvement of paratesticular structures in a testicular tumor, what should you think of
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lymphoma
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what is the primary testicular neoplasm in the elderly
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priamry testicular lymphoma, DLBL type
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what is oct3/4 good for
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germ cell tumors
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if one sees a bilateral testicular tumor, what should be in the differential
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primary testicular lymphoma, DLBL type
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in children, what types of testicular lymphoma should one with think of
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secondary involement by Burkitt or ALL
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if there is PRIMARY involvement of the testis by lymphoma in prepubertal boys, what would it be
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primary follicular lymphoma - excellent prognosis, grade 3 fx, unusual IHC phenotype of bcl2 (-), bcl6 (+) adn variable CD10
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if primary testicular lymphoma in adults, what is the most likely type
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DLBL
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identify the ihc staining patterns of the two types of primary testicular lymphoma, DLBL and why we care
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nongerminal center B cell like: CD10-, bcl6-, MUM1+, bcl2+, aggressive behavior, shortened survival
germinal center B cell like: CD10+, bcl6+, MUM1-, beter prognosis, can be related to HIV |
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name 4 ihc markers positive in seminoma
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PLAP+, OCT3/4+, D240+, CD117+
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name four ihc markers positiive in embryonal ca
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PLAP+, OCT3/4+, ck+, CD30+; note negative for D240 and CD117, which are positive in seminomas
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four ihc markers and 1 histochemical stain for myeloid lineage
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anti-myeloperoxidase, CD117, CD68, CD31 and histochemical stain: myeloperoxidase
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histologic fx of malignant phyllodes (5)
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marked stromal hypercellularity, marked cellular pleomorphism, numerous mits (>10/10hpf), marked stromal overgrowth, heterologous elements can occur
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what is the primary distinction between an endometrial stromal nodule and an endometrial stromal sarcoma
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presence or absence of an infiltrative border
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what is the primary distinction between a low grade endometrial stromal sarcoma and an undifferentiated uterine sarcoma (its high grade form)
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shouldn't really have trouble distinguishing - low grade ESS looks like proliferative endometrium; the undifferentiated uterine sarcoma doesn't look like endometrium
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main ihc marker to distinguish between endometrial stromal sarcoma and leiomyosarcoma (and what are the pitfalls)
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h-caldesmon (positive in majority of leiomyosarcomas, neg in ESS)
pitfalls are: nearly half of leiomyosarcomas are CD10+ and rare ESS can be desmin positive |
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recurrent czomal translocation in endometrial stromal sarcomas with gene product
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t(7;17)(p15;q21) with formation of chimeric gene JAZF1-JJAZ1
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most common primary renal malignancy
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clear cell RCC
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origin of clear cell RCC
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proximal tubule
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classic demographics for person with clear cell RCC
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older than 40, male
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what makes a clear cell RCC clear
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loss of lipids and glycogen during processing
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ihc markers for clear cell RCC
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vimentin, EMA, RCC, CD10
also low molecular weight ck: 8, 9, 19, keratin AE1, cam 5.2 |
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what cytokeratins are usually negative in clear cell RCC
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ck7-, ck20-
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what critical czomal abnormality is seen in clear cell RCC and what gene is affected
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3p deletions, VHL at 3p25
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two ihc markers for papillary rcc vs. clear cell rcc
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papillary rcc: positive for AMACR (P504S) and CK7
clear cell rcc: negative for AMACR (P504S) and CK7 |
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three common czomal alterations in papilalry rcc
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trisomy 7, 17 and loss of Y
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describe histologic fx of clear cell papillary renal cell ca
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renal carcinomas with papillary structures proliferating within cystic spaces lined by cells with clear cytoplasm; distinctive cytogenetics of papillary rcc or clear cell rcc were absent.
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who gets renal carcinomas associated with Xp11.2 translocations
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children adn young adults
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histologic fx of renal carcinomas with Xp11.2 translocations
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cells with abundant celar to faintly eosinophilic cytoplasm arrnaged in nests and papillary structures; psammoma bodies seen
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what ihc marker indicates the characteristic czomal translocation in renal carcinomas with associated Xp11.2 translocations
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nuclear staining for TFE3
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what is the prognosis of multilocular cystic renal cell carcinoma
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excellent, no solid components (be aware the cysts are lined by cells with clear cytoplasm and separated by septa of variable thickness)
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if there is sucutaneous fat necrosis in a acinar cell carcinoma of the pancreas, what does that suggest
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liver met
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is the survival from acinar cell carcinoma of the pancreas good or poor
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poor - 5 year is 6%
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can you get acinar cell carcinoma of the pancreas in children
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yes, generally better prognosis
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where in the pancreas does acinar cell carcinoma of the pancreas occur
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anywhere (no site predilection)
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do acinar cell carcinoma of the pancreas stain with PAS
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yes, the zymogen granules are PAS positive and resistant to diastase
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ihc for acinar cell carcinoma of the pancreas
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trypsin, chymotrypsin; can see focal neuroendocrine
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is ca125 elevated in endometrial adenoca of the ovary
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yes in ~80% of cases
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ihc for papillary thyroid ca (3 positives, two negatives)
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positive: CK19, TG, TTF-1
negative: c/s |
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what is the most common thyroid malignancy in children
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papillary thyroid ca
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name two syndromes in which papillary thyroid ca is seen
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Cowden's, FAP
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common genetic alterations in papillary thyroid ca
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RET/PTC, TRK, RAS, BRAF, beta-catenin
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name four architectural variants of papillary thyroid carcinoma that have the same prognostic signficance of classical PTC
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follicular, clear cell adn oncocytic types; (diffuse sclerosing variant has aggressive course in children but mortality that is similar to classical PTC)
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architectural variants of papillary thyroid carcinoma that have a better prognosis than classical PTC
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papillary microcarcinoma (1 cm or less)
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name 3 architectural variants of papillary thyroid carcinoma that have a worse prognosis than classical PTC
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solid variant (sheets with intervening fibrous stroma), tall cell and columnar cell variants (cell length of these two variants is three times the width)
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what can the cribriform-morula variant of papillary thyroid ca be identified in association with
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FAP or gardners
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histologic criteria for separating macronodular and micronodular cirrhosis
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3mm
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what is alpha 1 antitrypsin
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glycoprotein produced in liver that functions asn an inhibitor of serine proteases
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genetics of alpha 1 antitrypsin deficiency
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mutations in the SERPINA1 gene on czome 14q31-32.3, inherited in an autosomal recessive pattern - results in protein misfolding, retention of polymerized form in hepatocytes adn low serum levels of AAT: normal is PiM, variants are PiS and PiZ
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what two organs are affected by alpha 1 antitrypsin deficiency
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lungs and liver (be aware there can be other systemic diseases associated with alpha 1 antitrypsin deficiency including GN, aneurysms, etc.)
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associated complications of alpha 1 antitrypsin deficiency
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lungs: panacinar emphysema (unopposed destruction of alveoli by neutrophil elastase); can get bronchitis, etc.
liver: cirrhossi, HCC |
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most important histologic feature for alpha 1 antitrypsin deficiency in liver and EM appearance
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large eosinophilic cytoplasmic globules; on EM, proteinaceous material within dilated ER, pools surrounded by an electron-lucent halo
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5 hematolymphoid processes with predominately white pulp involvement (with or without extension into red pulp)
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most of the small B-cell lymphomas - including CLL/SLL, follicular lymphoma, mantle cell, splenic marginal zone, lymphoplasmacytic lymphoma
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3 hematolymphoid processes with predominately red pulp involvement
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hairy cell leukemia, large granular lymphocytic leukemia, myeloproliferative disorders, including CML and chronic idiopathic myelofibrosis
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2 hematolymphoid processes with nodular, random pattern
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large cell lymphoma and Hodgkin lymphoma
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name three hematopoietic cell types (normal or neoplastic) that are CD10+
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germinal center B cells, follicular lymphoma, burkitt lymphoma (NOTE: mantle cells are negative)
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what does bcl6 positivity mean
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germinal center b-cell origin
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where does bcl-2 stain in a reactive LN
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mantle zone and T cells anywhere
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what does CD21 highlight in a LN
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meshwork of follicular dendritic cells
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what does CD23 highlight in a LN
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highlights follicular dendritic cells, but not as specific as CD21, as CD23 also can stain some mantle B cells too
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can you find macrophages in the mantle zone of a reactive LN
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not usually
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what does CD57 stain in a germinal center of a reactive LN
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T cells and NK cells
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what are interdigitating dendric cells
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similar to follicular dendritic cells (FDC) except that they present antigens to T-cells
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expectations for mantle cell lymphoma for the following IHC markers: CD5, CD10, CD19, CD20, cyclin-D1
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CD5+, CD10-, CD19+, CD20+, cyclin-D1+
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FISH for mantle cell lymphoma
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cyclin-D1-IgH fusion gene
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demographics of mantle cell lymphoma
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older men, most common in LN but also spleen, GI, Waldeyer's ring
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