9a Pathology PDF
9a Pathology PDF
9a Pathology PDF
mucus plugs with Curschmann spirals and plasma cells; alveolar spaces are
(whorls of shed epithelium found in free of cellular exudate. This
mucus plugs) and Charcot-Leyden morphology points more to:
crystals (collections of crystalloids A localized area of suppurative Lung abscess
made up of eosinophil protein). necrosis within the pulmonary
Criteria for reversibility of airway FEV1 increase of parenchyma, resulting in the
obstruction diagnostic of bronchial >12% or 200 mL formation of one or more large
asthma. post cavities; most commonly occurs in the
bronchodilator right side, particularly in the posterior
segment of the upper lobe and apical
Permanent dilation of bronchi and Bronchiectasis segments of the lower lobe; most
bronchioles caused by destruction of common isolates are anaerobic
the muscle and elastic supporting bronchial dilation
necrotizing infection (exudate, mixed flora) bacteria.
tissue, resulting from chronic fibrosis
Tuberculosis
necrotizing infections; Form of tuberculosis that develops in Primary
morphologically, there is intense a previously unexposed, unsensitized tuberculosis
acute and chronic inflammatory person.
exudate within the walls, with mixed Implantation of the inhaled M. Ghon focus
flora often cultured; there is also tuberculosis bacilli in the distal
peribronchiolar fibrosis in chronic airspaces of the lungs, causes the
cases. formation of this 1-1.5 cm area of
Thickening of airway wall; sub- Airway remodeling gray-white inflammatory
basement membrane fibrosis; consolidation.
increased vascularity in submucosa; Ghon focus with involvement of the Ghon complex
increase in size of the submucosal hilar lymph nodes is called:
glands and goblet Radiographically detectable calcified Ranke complex
cell metaplasia of the airway Ghon complex is called:
epithelium; hypertrophy and/or
Pattern of disease that arises in Secondary or
hyperplasia of the bronchial muscle;
previously sensitized host to M. reactivation TB
are collectively called:
tuberculosis.
Occurs when TB bacilli drain through Miliary
the lymphatics into lymphatic ducts, tuberculosis
which eventually empty into the right
side of the heart and into pulmonary
circulation; individual lesions are
Diffuse pulmonary disease Restrictive lung
small, visible foci of yellow-white
characterized by reduced expansion diseases
consolidation scattered through the
of lung parenchyma accompanied by reduced lung parenchyma, dec FEV1, dec in FVC
-> normal to increased. FEV1/VVC parenchyma.
decreased total lung capacity;
Type of necrosis seen in tuberculosis. Caseous
spirometry findings: decreased FEV1,
Type of inflammation seen in Chronic
markedly decreased FVC, normal or
tuberculosis. granulomatous
increased FEV1/FVC; examples:
Type of hypersensitivity reaction in Type IV (Cell-
Chronic interstitial lung diseases
tuberculosis (including TST). mediated/Delayed)
Heterogeneous group of disorders Chronic interstitial
Cytokine responsible for formation of IFN-γ
characterized predominantly by lung diseases
granulomas in tuberculosis.
inflammation and fibrosis of the
pulmonary interstitium; follows
restrictive lung disease pattern; Histologic appearance of tuberculosis Macrophages filled
complications include cor pulmonale infection in the absence of an intact with bacilli
cell-mediated immunity.
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Most common form of Tuberculous Main consequences of gingivitis. Plaque and calculus
extrapulmonary TB. lymphadenitis Fibrous proliferative lesion usually Pyogenic
(scrofula) occurring in children, adults and granuloma
Most common affected segment in Ileum pregnant women (pregnancy tumor);
gastrointestinal TB (Note: GITB is histologically, characterized by
rare, due to decrease in consumption organizing granulation tissue (highly
of infected milk). vascular).
Tumors Most common oral fungal infection. Candidiasis
One of the two most common Squamous cell Characterized by vesicle formation; Herpetic
histologic types of lung cancer carcinoma histologically characterized by gingivostomatitis
associated with smoking; centrally ballooned cells with large eosinophilic
located in major bronchi; may range intranuclear inclusions (Cowdry Type
from poorly differentiated to well- A inclusion bodies).
differentiated with keratin pearl A white/red plaque that cannot be Leukoplakia/
formation; associated in general with scraped off; considered precancerous Erythroplakia
hypercalcemia, due to production of unless proven otherwise; the red
PTH related peptide (PTHrp). plaque is more associated with
Immunostains: p63, p40. malignancy than the white plaque;
The most common histologic type of Adenocarcinoma most common risk factor is cigarette
lung cancer; most commonly seen in smoking.
nonsmokers; peripherally located; Neoplasms
histologically, may show acinar Most common histologic type of oral Squamous cell
(glandular), papillary, mucinous, and cavity cancer. carcinoma
solid types. Immunostains: TTF-1 and Most common benign tumor of the Pleomorphic
napsin A. salivary gland; histologically adenoma
Most common histologic type of lung Small cell (Oat cell) characterized by epithelial elements
cancer associated with smoking; carcinoma arranged in ducts, acini, irregular
centrally located; with early nodal tubules, strands, or even sheets, in a
involvement; histologically, small, mesenchyme-like background of loose
round to fusiform cells with scant myxoid tissue containing islands of
cytoplasm and finely granular chondroid and rarely, foci of bone;
chromatin with numerous mitotic locally invasive.
figures are present; most associated The most common primary malignant Mucoepidermoid
with paraneoplastic syndromes, such tumor of salivary glands composed of carcinoma
as Cushing syndrome (ectopic ACTH), mucous and squamous cells.
Lambert-Eaton myasthenic syndrome, Most common epithelial odontogenic Ameloblastoma
and SIADH, among others; only type tumor that arises from odontogenic
not amenable to surgery; epithelium that does not demonstrate
Immunostains: chromogranin, extomesenchymal differentiation;
synaptophysin, CD57 and BCL2. locally invasive.
Lung carcinoma that typically has Large cell DISEASES OF THE UPPER AIRWAYS
large, prominent nucleoli, and a carcinoma Rare neoplasm with strong links to Nasopharyngeal
moderate amount of cytoplasm, with EBV and high frequency among the carcinoma
minimal glandular or squamous Chinese population. Characterized by
differentiation. Diagnosed when large epithelial cells having indistinct (Note: some types
immunostains for known histologic borders (syncytial growth) and of HL, and Burkitt
types of lung cancer are negative. prominent eosinophilic nucleoli. are also associated
DISEASES OF THE PLEURA with EBV)
A rare cancer seen in patients who Malignant A benign neoplasm usually on the true Laryngeal
work in shipyards, miners and mesothelioma vocal cords that forms a soft, papilloma
insulators; presents as lung raspberry-like excresence rarely more
ensheathed by a yellow-white, firm or (Note: Malignant then 1 cm in diameter; consists of
gelatinous layer of tumor that mesothelioma is multiple, slender, finger-like
obliterates the pleural space; lesion is commonly projections.
preceeded by extensive pleural associated with Most common symptom of laryngeal Persistent
fibrosis and plaque formation; may be asbestos, but the carcinoma. hoarseness
epithelial, sarcomatoid or biphasic in most common Common etiologic agents implicated Smoking, alcohol,
morphology. cancer asbestos in laryngeal carcinoma asbestos, radiation,
Immunostains: Epithelioid: Keratin, causes is still lung HPV
calretinin, WT-1, CK5,6, D2-40; cancer) Most common histologic type of Squamous cell
Sarcomatoid: usually Keratin(+) only. laryngeal carcinoma carcinoma (95%)
Most common location of laryngeal Glottic (60-75%)
CHAPTER 15: HEAD AND NECK carcinoma
QUESTION ANSWER EARS
ORAL CAVITY Most common cause of otitis media. Viral
Non-neoplastic conditions Most common primary bacterial S. pneumoniae, non-
Main cause of tooth loss before age Dental caries causes of acute otitis media. typeable H.
35. influenzae, M.
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catarrhalis metaplasia within the esophageal
Most common causes of chronic otitis P. aeruginosa, S. squamous mucosa; increased risk
media. aureus, fungus, of esophageal adenocarcinoma.
mixed Neoplasms
Complications of otitis media. Brain abscess and Esophageal carcinoma associated Adenocarcinoma
cholesteatoma with chronic GERD; usually occurs
NECK in the distal third of the esophagus;
True cyst arising from remnant of Branchial cleft cyst histologically characterized by
second branchial arch (most gland formation and mucin
common); clinically presents as upper production; premalignant lesion is
lateral neck mass along SCM. Barrett esophagus.
More common of the Squamous cell
histologicpatterns of esophageal carcinoma
cancer; associated with smoking,
alcohol, caustic injury, and frequent
consumption of very hot beverages;
Most common congenital anomaly of Thyroglossal duct usually occurs in the middle third
thyroid gland; arising from remnants cyst of the esophagus; premalignant
of thyroid gland descent; clinically lesion is squamous dysplasia.
present as a midline mass along the
track of descent of the thyroid gland;
treatment of choice is Sistrunk
procedure.
Neuroendocrine neoplasm associated Paranganglioma
with ANS; basically, an extra-adrenal
pheochromocytoma (histologically);
can be located paravertebral STOMACH
(sympathetic), or in aorticopulmonary Gastritides
chain (parasympathetic). Most common form of chronic H. pylori gastritis
SALIVARY GLANDS gastritis; most common cause of
Most common type of inflammatory Mucocele multifocal atrophic gastritis;
salivary gland lesion and the most characterized by the following:
common salivary gland lesion. predominantly antral, neutrophilic
Most common form of viral Mumps infiltrate with subepithelial plasma
sialadenitis; most common gland cells, serum gastrin normal to
involved: parotid. decreased; associated with
Most common gland involved in Submandibular hyperplastic/inflammatory polyps;
sialolithiasis. (+) for H. pylori antibodies;
Most common site of tumors Parotid gland sequelae includes gastric
regardless of behavior. lymphoma.
Most common tumor of the salivary Pleomorphic Most common form of gastritis in Autoimmune gastritis
gland; also the most common benign adenoma patients without H. pylori infection;
tumor. most common cause of diffuse
Most common primary malignant Mucoepidermoid atrophic gastritis; characterized by
tumor of the salivary gland; and the carcinoma the following: predominantly at the
second most common tumor. body, lymphocytic infiltrate with
Second most common benign tumor Warthin tumor macrophages, serum gastrin
of the salivary gland, with high (Papillary increased; associated with
association with smoking. cystadenoma neuroendocrine hyperplasia; (+)
lymphomatosum) for antibodies against parietal cells
Highly aggressive malignancy of the Adenoid cystic (proton pump and intrinsic factor);
salivary gland, with high propensity carcinoma clinically, patients present with
for perinueral invasion, and high achlorhydia (due to destruction of
occurrence of distant metastasis. parietal cells), and megaloblastic
anemia (due to Vitamin B12
deficiency).
CHAPTER 16: THE GASTROINTESTINAL TRACT
Peptic ulcer disease
ESOPHAGUS
Most common form of PUD. Antral or duodenal (H.
Non-neoplastic conditions
pylori)
Typical findings in significant Eosinophilic infiltrate
Histologic findings in PUD. NIGS: N: necrosis, I:
GERD. in mucosa with
acute inflammation,
neutrophils (if severe)
G: granulation tissue,
and Basal zone
S: fibrous scar (from
hyperplasia
superficial to deep)
Portocaval anastomoses involved Esophageal branch of
Neoplasms
in esophageal varices. left gastric vein and
azygos vein Most common gastric polyp. Inflammatory/
Hyperplastic (75%)
Complication of long-standing Barrett esophagus
GERD; characterized by intestinal The most common malignancy of Gastric
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the stomach (90%); has two types: adenocarcinoma disease. penetrated by blood
intestinal (bulky tumors with vessels)
gland-like structures Type of diverticulum in sigmoid False diverticulum
histologically); and diffuse (intense .diverticulosis.
desmoplasia leading to leather Neoplasms
bottle stomach (linitis plastic) with Polyps common in the left colon; Hyperplastic polyp
signet ring cells containing mucin characterized by serrated
histologically. (Lauren architecture limited to the upper
classification of intestinal and third of the crypt; no cytologic
diffuse is used); most common site: atypia and lateral growth; do not
Antrum, on the lesser curvature. have malignant potential.
Malignancy associated with H. Lymphoma/MALToma Polyps common in the right colon; Sessile serrated
pylori infection; most common site characterized by serrated adenoma
of occurrence is the stomach; architecture throughout the whole
eradication of H. pylori leads to length of the gland; no cytologic
tumor regression, except when it atypia but exhibits lateral growth
transforms to DLBCL. (elephant-feet glands); has
Tumors of neuroendocrine origin; Carcinoid malignant potential like
common site is small intestine; may conventional adenomas.
elaborate hormones that can lead Autosomal dominant syndrome of Peutz-Jeghers
to ZES (gastrin) or carcinoid hamartomatous polyps and syndrome
syndrome (serotonin); most mucocutaneous
important prognostic factor is hyperpigmentation, associated
location i.e. midgut tumors are with increased risk of visceral
often multiple and aggressive; malignancies; histologically
immunostains: Synaptophysin and characterized by arborizing
Chromogranin A. networks composed of smooth
Most common mesenchymal tumor Gastrointestinal muscle intermixed with lamina
of the abdomen; more than half of stromal tumor (GIST) propria.
cases occur in the stomach; Morphologic variants of colonic Tubular,
cytogenetic origin is interstitial adenomas. Tubulovillous, Villous
cells of Cajal (ICC); histologically The single most important Size (>4cm) (others:
composed of elongated spindle characteristic of adenomas that architecture (villous),
cells or plump epithelioid cells; correlates with malignancy. and severity of
Immunostains: KIT. dysplasia
Familial syndrome characterized Familial adenomatous
SMALL AND LARGE INTESTINES by early onset development of polyposis (FAP)
Intestinal obstruction numerous colonic polyps; main
Most common cause of intestinal Hernias pathology is mutations on the APC
obstruction. gene (Ch5); criterion is the
Most common cause of intestinal Intussusception presence of at least 100 polyps.
obstruction in children <2 years
old.
Ischemic bowel disease
Most common regions susceptible Splenic flexure and
to ischemia. rectosigmoid
Inflammatory bowel disease Familial syndrome characterized Hereditary
Inflammatory bowel disease Crohn disease by early development of colon nonpolyposis colon
characterized by the following: skip cancer and other visceral cancer
lesions, transmural bowel malignancies; main pathology is (HNPCC)/Lynch
involvement, and rectal sparing; mutations in genes of DNA repair syndrome
associated with development of (MSH2 or MLH1) that leads to
colonic adenocarcinoma if with microsatellite instability and
colonic involvement. subsequent development of colonic
Inflammatory bowel disease Ulcerative colitis adenocarcinoma.
characterized by the following: Most common malignancy of the Colonic
continuous lesions usually limited gastrointestinal tract; two adenocarcinoma
up to submucosa, with rectal pathways are recognized; the
involvement but disease is limited adenoma carcinoma sequence
to the colon only; associated with involving APC among others; and
toxic megacolon and development the microsatellite instability
of colonic adenocarcinoma. pathway (sessile serrated
Note: Make sure to study Table 14-5 in Robbins Basic adenoma-carcinoma sequence)
Pathology, 9th ed. p. 587 or Table 17-8 in Robbins and Cotran involving MSH2 or MLH1; clinically
Pathologic Basis of Disease 8th ed. p. 808 or Table 17-9 in characterized by different
Robbins and Cotran Pathologic Basis of Disease 9th ed. p. 797. symptomatologies depending on
Diverticular disease location: (Right colon: usually
Most common site of diverticular Sigmoid (in areas anemia from bleeding from the
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bulky nonobstructive masses; Left liver disease and portal hypertension hypertension
colon: usually presents with change due to excessive pulmonary vascular
in bowel habits due to napkin-ring remodeling; Clinically presents with
configuration of the lesion). exertional dyspnea and clubbing of
Two important prognostic factors Invasion and lymph the fingers.
in colonic adenocarcinoma. node status Clinical entity that occurs when Jaundice
Most common site of metastases of Liver retention of bilirubin leads to serum
colonic adenocarcinoma. levels of at least 2.0-2.5 mg/dL.
APPENDIX Most common cause of conjugated Hepatitis and intra-
The most common cause of acute Lymphoid hyperplasia hyperbilirubinemia. and extrahepatic
appendicitis in children and adults, and Fecalith, obstruction of bile
respectively. respectively flow
The most common tumor of the Carcinoid Most common cause of unconjugated Hemolysis
appendix. hyperbilirubinemia.
Hepatitides
CHAPTER 17: LIVER AND GALLBLADDER Note: Please study Table 15-5 of Robbins Basic Pathology, 9th
QUESTION ANSWER ed p. 613, or Table 18-3 of Robbins and Cotran Pathologic
LIVER Basis of Disease, 9th ed p. 836, for the detailed morphologies of
Clinical syndromes acute and chronic hepatitides.
Condition wherein there is 80-90% Acute liver failure The main differences in morphology Acute hepatitides
liver parenchymal loss in patient of acute and chronic hepatitides. have less
without pre-existing liver disease; inflammation and
clinically presents with more hepatocyte
encephalopathy and coagulopathy; death than chronic
occurs <26 weeks post initial insult. hepatitis
A clinical entity caused by severe loss Hepatic Which virus between HBV and HCV is HCV (most cases of
of hepatoceullular function and encephalopathy more associated with hepatocellular acute HBV infection
shunting of blood from portal to carcinoma? present with
systemic circulation, causing buildup subclinical disease
of toxins that cause neuronal and all of them
dysfunction (in acute cases); recover)
manifestations may range from Morphologic appearance of chronic Ground glass
subtle behavioral changes to deep Hepatitis B infection. hepatocytes
coma and death. Morphologic appearance of chronic Lymphoid follicles,
Syndrome heralded by a drop in Hepatorenal Hepatitis C infection. bile duct injury and
urine output and rising BUN and syndrome steatosis
creatinine; appears in severe liver Hepatitis characterized by early Autoimmune
failure; characterized by renal failure development of scarring after the hepatitis
in the setting of liver disease without initial wave of hepatocyte injury
primary renal abnormalities (versus viral hepatitides where
Common causes of chronic liver Chronic HBV and scarring usually happens years after
failure. HCV, Alcoholic liver the initial insult); associated with
disease, and NAFLD confluent necrosis, marked
Diffuse transformation of the liver Cirrhosis inflammation, plasma cell infiltrate,
into regenerating parenchymal and burned-out cirrhosis; has two
nodules, surrounded by dense bands types: Type 1 (in adults; associated
of scar, with variable degrees of with ANA and anti-SMA); and Type 2
vascular shunting. (in children; associated ithe Anti-
Common causes of death in chronic Complications of LKM1).
liver failure. acute liver failure Most common drug causing ALF. Acetaminophen
and hepatocellular Most common substance causing CLF. Alcohol
carcinoma Alcoholic and Non-alcoholic fatty liver disease
Amount of alcohol associated with 80 g/d
development of ALD.
Liver enzyme pattern unique to ALD. AST > ALT
Three morphological forms of Hepatocellular
Increased resistance to portal blood Portal hypertension alcoholic liver disease. steatosis; Alcoholic
flow that may be caused by Steatohepatitis; and
prehepatic, intrahepatic and Steatofibrosis
posthepatic causes; can cause dilation Hepatocyte ballooning, eosinophilic Alcoholic
of the portocaval anastomoses and intarcytoplasmic inclusion bodies Steatohepatitis
produce varices. composed of intermediate filaments
Severe arterial hypoxemia with Hepatopulmonary (Mallory-Denk bodies) and
dyspnea and cyanosis in patients syndrome neutrophilic infiltration are
with liver disease due to abnormal characteristic of:
intrapulmonary vascular dilatation
and increased pulmonary blood flow. Most common metabolic liver NAFLD
Pulmonary hypertension arising in Portopulmonary disease; usually occurs in patients
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consuming <20 g/week of ethanol; (histologically characterized by
associated with Type 2 DM, insulin multinucleated giant cells, and cannot
resistance, dyslipidemia, and be corrected, or even worsened with
hypertension. surgical intervention).
Most common outcome of NAFLD Isolated fatty liver
(>80%); most cases
do not progress to
NASH
Difference of non-alcoholic fatty liver Less prominent Complete or partial obstruction of the Extrahepatic biliary
disease from ALD. features of lumen of the extrahepatic biliary tree atresia
steatohepatitis within the first 3 months of life;
compared to ALD single most common cause of death
A rare disease characterized by Reye syndrome from liver disease in early childhood;
microvesicular fatty change in the most common is perinatal form;
liver and encephalopathy; treatment of choice is Kasai
microscopy of hepatocellular procedure.
mitochondria reveals pleomorphic Autoimmune cholangiopathies
enlargement and electron lucency of A chronic, progressive cholestatic Primary biliary
the matrices, with disruption of liver disease characterized by cirrhosis (PBC)
cristae and loss of dense bodies; nonsuppurative destruction of small
clinically suspected in a pediatric to medium-sized intrahepatic bile
patient who took Aspirin as ducts; associated with
antipyretic for a viral infection. antimitochondrial antibodies is 90%
Inherited metabolic diseases of cases; histologically, characterized
Triad of micronodular cirrhosis, Hereditary by destruction of interlobular bile
diabetes mellitus and abnormal skin Hemochromatosis ducts with lymphoplasmacytic
pigmentation; main pathology is infiltration with or without
extensive accumulation of body iron granulomas (florid duct lesions).
in the liver, pancreas and heart; most Chronic progressive fibrosis and Primary sclerosing
common form is autosomal recessive, destruction of extrahepatic and cholangitis (PSC)
involving mutations in HFE gene in intrahepatic bile ducts of all sizes;
Chromosome 6; associated with 200- patchy involvement gives rise to a
fold increased risk of HCC. beading appearance of ducts;
Extensive accumulation of toxic levels Wilson disease histologically characterized by onion-
of Copper in the liver, brain and eye; (Hepatolenticular skin lesion with an atrophic tubule on
(Kayser-Fleischer rings); autosomal degeneration) the center (small ducts) or acute on
recessive; main pathology is loss of chronic inflammation (large ducts);
function mutations in ATP7B gene in associated with an increased risk of
Chromosome 13 cholangiocarcinoma.
Autosomal recessive disorder α-1-antitrypsin Structural abnormalities of the biliary tree
characterized by panacinar deficiency Triad of choledochal cysts. Pain, jaundice,
emphysema and liver disease abdominal mass
secondary to accumulation of Choledochal cysts and fibropolycystic Cholangiocarcinoma
misfolded proteins; histologically diseases predisposes to this
marked by PAS-positive, diastase- particular kind of cancer.
resistant, cytoplasmic inclusions, Tumors
corresponding to mutant AAT; Most common benign tumor of the Cavernous
associated with increased risk of HCC. liver. hemangioma
Cholestatic liver diseases Most common liver tumor of early Hepatoblastoma
Most common cause of large bile duct Gallstones, biliary childhood.
obstruction in adults, and children, atresia A well-demarcated but poorly Focal nodular
respectively. encapsulated lesion, consisting of hyperplasia
Secondary bacterial infection of Ascending hyperplastic hepatocyte nodules with
biliary tree; clinically typified by cholangitis a central fibrous scar; carries no risk
Charcot triad: 1. fever, 2. jaundice, for malignancy.
and 3. RUQ pain. A benign tumor characterized by Hepatic adenoma
Intrehepatic gallstone formation Primary hepatocytes without portal tracts
(calcium bilirubinate) due to hepatolithiasis with prominent neovascularization;
repeated bouts of ascending harbors a risk for malignant
cholangitis and parenchymal transformation.
destruction; associated with Type of hepatocellular adenoma with β-catenin adenomas
increased risk of cholangiocarcinoma. the highest risk of malignant
transformation.
Prolonged conjugated Neonatal cholestasis Most common primary malignant Hepatocellular
hyperbilirubinemia in the neonate; tumor of the liver; commonly arises carcinoma
can either be caused by extrahepatic in the setting of chronic liver disease;
biliary atresia (can be corrected with may appear as unifocal, multifocal or
surgery), or neonatal hepatitis diffusely infiltrative; with strong
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propensity for vascular invasion; morphological changes: 1.
histologically, well-differentiated microvascular leak and edema; 2.
lesions may elaborate bile appearing enzymatic fat necrosis; 3. acute
as globules; tumor marker is AFP. inflammation; 4. destruction of
Most common site of hematogenous Lung pancreatic parenchyma; and 5.
metastases of HCC. destruction of blood vessels and
Most common tumor involving the Metastases interstitial hemorrhage.
liver. Most common causes of acute Alcoholism and
GALLBLADDER pancreatitis. biliary tract disease
Gallstones (80%)
Most common type of gallstones; pale Cholesterol stones Prolonged inflammation of the Chronic
yellow in color; radiolucent. (80%) pancreas associated with irreversible pancreatitis
Pigment stones derived from sterile Black pigment destruction of exocrine parenchyma,
gallbladder bile; 50-70% are stones fibrosis, and, in the late stages, the
radiopaque. destruction of endocrine parenchyma.
Pigment stones derived from infected Brown pigment Most common cause of chronic Long-term alcohol
gallbladder bile; radiolucent. stones pancreatitis. abuse
More common form of cystic disease Pseudocysts
Complication of cholelithiasis, Gallstone ileus in the pancreas.
wherein a large stone erodes directly (Bouveret Neoplasms
into adjacent small bowel. syndrome) Most common site of pancreatic Head (presents as
Most common form of acute Acute calculous adenocarcinoma. obstructive
cholecystitis. cholecystitis (90%) jaundice)
The gallbladder may be contracted, of Chronic acalculous Most common mutated oncogene in KRAS
normal size, or enlarged; presence of cholecystitis pancreatic adenocarcinoma.
stones in the absence of inflammation Most common mutated tumor p16
is diagnostic. suppressor gene in pancreatic
Most common form of chronic Chronic calculous adenocarcinoma .
cholecystitis; characterized by cholecystitis Strongest environmental risk factor Smoking
mononuclears in GB wall, with (>90%) for developing pancreatic
Rochitansky-Aschoff sinus. adenocarcinoma.
Tumors Two distinct features of pancreatic Highly invasive and
Most common malignant tumor of the Gallbladder ductal adenocarcinoma. intense
biliary tract; maybe exophytic (with carcinoma desmoplasia
mass) or infiltrating (with thickening Tumor marker for pancreatic CA19-9
of the wall; more common); most adenocarcinoma.
frequent histology is The usual sites of metastases of Liver and lungs
adenocarcinoma. pancreatic adenocarcinoma.
Most important risk factor for the Gallstones Paraneoplastic syndrome associated Trosseau syndrome
development of gallbladder with pancreatic adenocarcinoma,
carcinoma. characterized by migratory superficial
Second most common primary Cholangiocarcinoma thrombophlebitis, secondary to
malignant tumor of the liver; expression of pro-coagulant factors
malignant tumor of cholangiocytes; from the tumor or its necrotic
more common in extrahepatic bile products.
ducts; may develop in the hilum
(Klatskin tumor); risk factors include: CHAPTER 19: THE KIDNEY
NAFLD, PSC, fibrocystic diseases of QUESTION ANSWER
the biliary tree (choledocal cysts), Glomerular diseases
and infestation of Clonorchis sinensis Nephritic syndrome: 1. Hematuria (with dysmorphic RBCs
and Opistorchis viverrini; most and red cell casts indicating glomerular pathology); 2.
frequent histology is Oliguria and azotemia; and 3. Hypertension
adenocarcinoma. Most common cause of nephritic Acute
syndrome in children Postinfectious
CHAPTER 18: THE PANCREAS LM: diffuse hypercellularity (almost, if (Poststreptococcal)
QUESTION ANSWER not all glomeruli) Glomerulonephritis
Congenital anomalies EM: subepithelial humps on GBM (PSAGN)
What is the most common clinically Pancreatic divisum IF: granular deposits of IgG and
significant congenital anomaly of the complement within the capillary walls
pancreas? mesangium
Pancreatitides Rapidly progressing glomerulonephritis: syndrome of
Reversible pancreatic parenchymal Acute pancreatitis progressive loss of renal function, characterized by
injury associated with inflammation; nephritic syndrome often with severe oliguria; histologic
pathology is inappropriate release hallmark is presence of “crescents”, thus crescentic GN
and activation of pancreatic enzymes, Type of RPGN associated with anti- RPGN Type I
which destroy pancreatic tissue and GBM antibodies; associated with
elicit an acute inflammatory reaction; Goodpasture syndrome (glomerular
characterized by the following and pulmonary involvement);
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uninvolved segments shows no infected AV shunts tive
proliferation LM: Thickened split GBM (Tram track glomerulonephritis
EM: ruptures in the GBM appearance) (MPGN) Type I
IF: linear IgG and C3 deposits along EM: subendothelial electron-dense
the GBM deposits
Type of RPGN associated with RPGN Type II IF: Irregular granular C3 deposits,
immune complex deposition; usually a with IgG and early complement
secondary event of immune complex- components (C1q and C4)
mediated nephritides; uninvolved Formerly called MPGN Type II; Dense deposit
segment shows immune complex fundamental abnormality is excessive disease
deposition complement activation
EM: “lumpy bumpy” appearance of LM: Thickened split GBM (Tram track
GBM (due to deposits) appearance)
IF: granular deposition of Ig and EM: lamina densa and glomerular
complement in GBM capillary wall transformed into
Type of RPGN associated with ANCA; RPGN Type III irregular, ribbon-like, extremely
sometimes a component of ANCA electron-dense structure
vasculitides (Microscopic polyangiitis IF: Irregular chunky and segmental
and Wegener granulomatosis); linear foci of C3 deposits in GBM and
uninvolved segments shows no mesangium, without IgG and early
proliferation complement components (C1q and
EM: no detectable deposits C4)
IF: negative for Ig and complement Isolated glomerular abnormalities
An important cause of ESRD; grossly, Chronic One of the most common causes of IgA nephropathy
kidneys are symmetrically contracted, glomerulonephritis recurrent microscopic or gross (Berger disease)
surfaces are red-brown and diffusely hematuria; most common glomerular Note: Berger
granular; histologically, glomeruli are disease revealed by renal biopsy disease and
obliterated with marked interstitial worldwide. Henoch-Schonlein
fibrosis. LM: mesangial widening and purpura have the
Nephrotic syndrome: 1. Massive proteinuria (≥3.5g/dL; 2. segmental inflammation sam renal
Hypoalbuminemia (<3g/dL); 3. Generalized edema; 4. EM: mesangial electron-dense manifestations and
Hyperlipidemia and lipiduria deposits morphology, but
Most common cause of nephrotic Minimal change IF: mesangial deposition of IgA, often HSP involves
syndrome in children; responsive to disease/Lipoid with C3 and properdin and smaller systemic deposition
corticosteroids. nephrosis amounts of IgG or IgM of IgA, has
LM: none extrarenal
EM: uniform and diffuse effacement of symptoms
foot processes of the podocytes Nephritis associated with hearing and Alport syndrome
Most common cause of nephrotic Focal segmental visual defects; defect in Type IV
syndrome in adults; involves only glomerulosclerosis collagen synthesis; X-linked dominant
some glomeruli (focal), and only a (FSGS) pattern of inheritance
part of glomerulus (segmental) is LM: glomerulosclerosis, vascular
affected; associated with HIV and sclerosis, tubular atrophy, and
heroin abuse. interstitial fibrosis
LM: increased mesangial matrix, EM: thin GBM (early); irregular foci of
obliterated capillary lumina, and GBM thickening or attenuation (late);
deposition effacement of foot “basket-weave” appearance
processes of hyaline masses
(hyalinosis) and lipid droplets. Diseases of the Tubules and Interstitium:
EM: Tubulointerstitial nephritides
IF: nonspecific trapping of Clinicopathologic entity characterized Acute tubular
immunoglobulins, usually IgM, and clinically by acute renal failure and injury/necrosis
complement in the areas of hyalinosis. often, but not invariably, morphologic
Associated with infections (HBV, Membranous evidence of tubular injury, in the form
Syphilis, Schistosomiasis, Malaria), nephropathy of necrosis of tubular epithelial cells;
Malignant solid tumors (lung and has two forms: ischemic and toxic,
colon), SLE, Gold and Mercury, and which vary in terms of affected
drugs (Penicillamine, Captopril, segments of the nephron and
NSAIDs); distribution of necrosis.
LM: diffuse thickening of the capillary Most common cause of acute kidney Acute
wall injury; a common suppurative pyelonephritis
EM: subepithelial deposits along the inflammation of the kidney and renal
GBM (spike and dome appearance); pelvis caused by bacterial infection,
effacement of foot processes either by hematogenous spread or
IF: granular deposits of through ascending infection (more
immunoglobulins and complement common and more important mode);
along the GBM principal causes are Gram-negative
Associated with HBV, HCV, SLE, and Membranoprolifera enteric rods; grossly, there is discrete,