Path sci 2 term 2

Approximately what percentage of neoplasms are classed as malignant?

a. 25%

b. 45%

c. 60%

d. 10%

e. 5%

25%

Histology is a complex process, but which one of the below is not a step in the histology process?

a. Microtomy of tissues (sectioning)

b. Processing of the tissues

c. Spreading of tissue onto agar plates

d. Embedding of tissue

e. Grossing of specimens into cassette sized pieces

Spreading of tissue onto agar plates

Immunohistochemistry commonly employs panels of antibodies to identify cell and tissue characteristics to differentiate tumour types. If you were trying to differentiate between an adenocarcinoma & squamous cell carcinoma of the Lung using the following antibodies - P63, TTF1, CK5/6, Napsin A – what would the results for an adenocarcinoma show?

a. P63 negative – TTF1 positive – CK5/6 negative – Napsin A positive

b. P63 negative TTF1 negative -CD5/6 negative – Napsin A positive

c. P63 negative – TTF1 negative – CK5/6 positive – Napsin A negative

d. P63 positive – TTF1 negative – CK5/6 positive – Napsin A negative

e. P63 positive – TTF1 positive – CK5/6 negative – Napsin A negative

P63 negative – TTF1 positive – CK5/6 negative – Napsin A positive

Special Staining is a supportive diagnostic tool. Which of the following pathologies can be detected using this tool?

a. All of the above

b. Differentiation of tissue structures

c. Vascular Invasion

d. Detection of pathogens

e. Identification of minerals

All of the above

The transformation of one cell type into another cell type is a known as…

a. Dysplasia

b. Neoplasia

c. Apoptosis

d. Hyperplasia

e. Metaplasia

Metaplasia

To understand the severity of a tumour, staging must be considered. A commonly utilised approach is the TNM staging system. What does TNM stand for?

a. Tissue, Nodular, Migrating

b. Tissue, Nodes, Metastasis

c. Tumour, Necrosis, Metastasis

d. Tumour, Nodes, Margins

e. Tumour, Nodes, Metastasis

Tumour, Nodes, Metastasis

Which of the following features will a pathologist investigate when assessing for benign vs malignant differences?

a. Size

b. All of the above

c. Margins

d. Colour

e. Necrosis

All of the above

Which of the following processes does not produce Neoplasia?

a. Normal cell division/Decreased Apoptosis

b. All of the above

c. Normal cell division/Normal Apoptosis

d. Increased cell division/Normal Apoptosis

e. Increased cell division/Reduced Apoptosis

Normal cell division/Normal Apoptosis

Which one of the below is a malignant epithelial tumour?

a. Leiomyoma

b. Basal Cell Papilloma

c. Transitional Cell Papilloma

d. Chondroma

e. Squamous Cell Carcinoma

Squamous Cell Carcinoma

Which one of the below is a typical feature of a benign neoplasm?

a. Endophytic (grow inwards)

b. Fast growing

c. Poorly circumscribed

d. Remain localised (do not normally invade)

e. Necrotic hallmarks

Remain localised (do not normally invade)

Which surface appearance is associated with more aggressive tumour behaviour?

a. Annular

b. Polypoidal

c. Ulcerative

d. Sessile

e. Papillary

Ulcerative

Which type of differentiation is regarded as the most severe?

a. Well Differentiated

b. Moderately differentiated

c. Poorly Differentiated

d. Undifferentiated

e. Semi Differentiated

Undifferentiated

Adenosis is…

a. Scarring of tissue

b. An increase in the number of glands

c. A fluid filled gland

d. A change of one cell type to another cell type

e. Fewer but larger glands

An increase in the number of glands

ER, PR, and HER2 are prognostic markers commonly assessed together by immunohistochemistry (IHC) in breast cancer diagnosis. If a patient’s tumour is positive for the ER marker, this indicates…

a. The tumour cells have high progesterone levels

b. The tumour cells have low oestrogen receptor expression

c. The tumour cells have low progesterone levels

d. The tumour cells are positive for the HER2 gene

e. The tumour cells have high oestrogen receptor expression

The tumour cells have high oestrogen receptor expression

Fibroadenoma is a benign tumour. What histological hallmarks can be seen microscopically when using H&E stain?

a. Mitosis

b. All of the above

c. Percanalicular/Intracanalicular

d. Large nuclei

e. Poorly circumscribed stroma

Percanalicular/Intracanalicular

Fibrocystic disease is a benign non-cancerous condition which can be characterised by which morphological features?

a. Cysts

b. Apocrine Metaplasia

c. Adenosis

d. All of the above

e. Fibrosis

All of the above

Fine Needle Aspirate (FNA) is a diagnostic tool used to withdraw fluid containing cells from a lump of interest to identify malignant cells. What stain is commonly used on an FNA sample?

a. H&E

b. IHC

c. EVG

d. Alcian Blue

e. Giemsa

Giemsa

On H&E examination, what is the key microscopic hallmark of Ductal Carcinoma in Situ?

a. Tumour cells confined to the ducts

b. Tumour cells invading the stroma

c. Tumour cells confined to the lobules

d. Tumour cells present in both ducts and lobules

e. Tumour cells invading the nipple

Tumour cells confined to the ducts

HER2 is an important prognostic marker used within breast cancer – where patients are scored to assess their viability for treatment with Herceptin. But which HER2 score requires further analysis via in-situ hybridisation staining to identify gene amplification ensuring correct patients are treated with Herceptin.

a. 3+ score

b. 2+ score

c. 0 score

d. Any HER2 positive score required further analysis

e. 1+ score

2+ score

OSNA is a fast supportive diagnostic technique which provides information relating to metastatic disease by staging

a. Parasternal Lymph Node using CK5/6

b. Parasternal Lymph Node using CK19

c. Sentinal Lymph Node using CK5/6

d. Axillary Lymph Node using CK20

e. Sentinal Lymph Node using CK19

Sentinal Lymph Node using CK19

The histological feature “comedo” in ductal carcinoma in situ means…

a. Dysplasia Changes

b. Central Necrosis

c. Nuclear Pleomorphism

d. Ducts completely filled with malignant cells

e. Cell proliferation

Central Necrosis

Which of the following is a malignant invasive breast cancer?

a. Ductal Carcinoma In situ

b. Fibrocystic Disease

c. Ectasia

d. Infiltrating Ductal Carcinoma

e. Adenoma

Infiltrating Ductal Carcinoma

Which of the following structures are features of breast anatomy?

a. All of the above

b. Lobule

c. Acinus

d. Segmental Lactiferous Ductus/Lactiferous Sinus

e. Collecting Duct

All of the above

Which of the following H&E images shows and invasive infiltrating carcinoma?

a. Image A

b. Image B

c. Image C

d. Image D

e. Image E

Image C

The presence of abnormal cells is a known as…

a. Dysplasia

b. Neoplasia

c. Apoptosis

d. Hyperplasia

e. Metaplasia

Dysplasia

Increased cell production on normal tissue or organ is a known as…

a. Dysplasia

b. Neoplasia

c. Apoptosis

d. Hyperplasia

e. Metaplasia

Hyperplasia

Abnormal, uncoordinated and excessive cell growth is a known as…

a. Dysplasia

b. Neoplasia

c. Apoptosis

d. Hyperplasia

e. Metaplasia

Neoplasia

What is meant by differentation?

The degree to which the tumor looks like the cell of origin

Do all Neoplasias have a swelling?

No could be something like leukemia or myeloma

Programmed cell death is a known as…

a. Dysplasia

b. Neoplasia

c. Apoptosis

d. Hyperplasia

e. Metaplasia

Apoptosis

Is neoplasia always malignant?

No can be either benign or malignant

Neoplasia is the continuation of growth in the absence of physiological stimuli. True or false

True, even if there is a stimuli it will continue growing even when removed.

What are some of the stimuli that cause neoplasia?

Genetic

Metabolic

Environmental ( chemical, radiation, parasite, virus)

What are the hallmarks of benign neoplasms?

Localised

slow growing

Grows away from surface (Exophytic)

Well circumscribed

Closely resembles parent cell

Still can cause significant problems

Also though confined to the site of origin what clinical problems can benign neoplasms cause?

Pressure on tissues

Obstruction to flow

Hormone production

Transform to malignant

What do fibroblasts do for malignant neoplasms?

They provide nutritional elements and support.

What are the hallmarks of malignant neoplasms?

Invasive

Fast growing

Grows into surface (Endophytic)

Poorly defined

Doesn’t normally resemble parent cell

Mitotic figures

What are the morphology features of a malignant neoplasm?

Large nucleus size

Irregular cell size and shape

Prominent nucleoli

Scarce cytoplasm

Intensely coloured cells (nuclei)

Mitotic figures

Invasion

Differentiation

What are the 4 categories of differentiation?

Undifferentiated

Poorly differentiated

Moderately differentiated

Well differentiated

Which type of differentiation is regarded as the least severe?

a. Well Differentiated

b. Moderately differentiated

c. Poorly Differentiated

d. Undifferentiated

e. Semi Differentiated

Well Differentiated

What is the differentiation used for?

Very important for grading

Correlates strongly with prognosis/survival

Indicates appropriate treatment plan

What is special staining used for?

To identify

pathogens,

tissue structures,

minerals/products

vascular invasion

What does IHC stand for?

Immunohistochemistry

Immunohistochemistry commonly employs panels of antibodies to identify cell and tissue characteristics to differentiate tumour types. If you were trying to differentiate between an adenocarcinoma & squamous cell carcinoma of the Lung using the following antibodies - P63, TTF1, CK5/6, Napsin A – what would the results for an Squamous cell carcinoma show?

a. P63 negative – TTF1 positive – CK5/6 negative – Napsin A positive

b. P63 negative TTF1 negative -CD5/6 negative – Napsin A positive

c. P63 negative – TTF1 negative – CK5/6 positive – Napsin A negative

d. P63 positive – TTF1 negative – CK5/6 positive – Napsin A negative

e. P63 positive – TTF1 positive – CK5/6 negative – Napsin A negative

P63 positive – TTF1 negative – CK5/6 positive – Napsin A negative

What do mammary glands consist of?

Ducts and lobules

What are the three groups of lymphatics in the breast?

Axillary nodes

Parasternal nodes

Posterior intercostal nodes

What is the function of oestrogen in breast pathology?

It stretches ducts to produce channels

What is the function of prolactin in breast pathology?

Promotes production of progesterone preparing glands for milk

What is the function of progesterone in breast pathology?

Increases the number and size of lobules in preparation for breast feeding

What is the function of oxytocinin breast pathology?

helps release milk

What are types of fibrocystic disease?

Cysts

Fibrosis

Aprocrine metaplasia

Adenosis

What is stroma fibrosis?

When a cyst breaks the fluid escapes into stroma

cuases inflammation and recruitment of new fibroblasts

overtime leads to scarring known as fibrosis

Non cancerous

What is Aprocrine metaplasia?

When epithelial cells which line ducts in the breast change from columnar to apocrine

Non cancerous change

Apocrine cells look larger and pinker than normal cells

Normally seen in areola

What is Adenosis in breast pathology?

An increase in the number of glands

Non cancerous

Glands could be larger too

Often seen with columnar cell change and hyperplasia

What is mastitis?

Tissue surrounding ducts becomes inflamed and swollen

Can lead to bacterial infection

Ducts become narrowed

What is the classification of fibrocystic disease?

Benign proliferative disease

What is the classification of Fibroadenoma?

Benign tumor

What is the classification of Ductal Carcinoma Insitu?

Malignant Non Invasive breast carcinoma

What is the classification of Infiltrating Ductal?

Malignant invasive breast carcinoma

What percentage of malignant invasive breast carcinomas are infiltrating ductal?

20%

45%

60%

75%

80%

75%

ER, PR, and HER2 are prognostic markers commonly assessed together by immunohistochemistry (IHC) in breast cancer diagnosis. If a patient’s tumour is positive for the PR marker, this indicates…

a. The tumour cells have high progesterone levels

b. The tumour cells have low oestrogen receptor expression

c. The tumour cells have low progesterone levels

d. The tumour cells are positive for the HER2 gene

e. The tumour cells have high oestrogen receptor expression

The tumour cells have high progesterone levels

HER2 is an important prognostic marker used within breast cancer – where patients are scored to assess their viability for treatment with Herceptin. But which HER2 score means patients are instantly eligible to be treated with Herceptin.

a. 3+ score

b. 2+ score

c. 0 score

d. Any HER2 positive score required further analysis

e. 1+ score

3+ score

HER2 is an important prognostic marker used within breast cancer – where patients are scored to assess their viability for treatment with Herceptin. But which HER2 scorees means patients are neagtive?

a. 3+ score

b. 2+ score

c. 0 score

d. Any HER2 positive score required further analysis

e. 1+ score

0 and 1 scores

A pus-filled bump of the skin is …

a. Lichenfication

b. A rash

c. A papule

d. A macule

e. A pustule

A pustule

Dermatosis is a common condition affecting the skin, this is caused by…

a. All of above

b. Fungal

c. Bacteria

d. Virus

e. Autoimmunity

Al of the above

The epidermis consists of which cell type?

a. Melanocytes

b. Basal epithelial cells

c. All of the above

d. Langerhan cells

e. Squamous epithelial cells

All of the above

When observed macroscopically, which of the following skin diseases is characterised by a butterfly pattern on the face due to symmetry seen in this feature?

a. Tinea

b. Impetigo

c. Vitiligo

d. Lupus

e. Actinic Keratosis

Lupus

When observed macroscopically, which of the following skin diseases is characterised by white patches?

a. Vitiligo

b. Lupus

c. Acne

d. Tinea

e. Impetigo

Vitiligo

Which of the below is a morphological feature of the dermis?

a. Lacks nerves

b. Lymphatics

c. Shows stratification

d. Sitting on basement membrane

e. Avascular

Lymphatics

Which of the following can overcome the barrier functions of the skin to cause disease?

a. Parasitic

b. All of the above

c. Mechanical

d. Thermal

e. Chemical

All of the above

Which of the following H&E images shows Malignant Melanoma?

Image A

Image B

Image C

Image D

Image E

Image D

Which of the following is a key hallmark of a benign tumour?

a. Uneven shapes

b. Well defined borders

c. Ulcerative

d. Metastatic

e. Uneven colour

Well define borders

Which of the following terms is used to describe a thick discolouration of the skin?

a. Lichenfication

b. Vesicle

c. Plaque

d. Macule

e. Bullae

Lichenfication

Which of the statements below best describes the histological hallmarks seen within a H&E of Basal cell carcinoma?

a. Palisading cells – Atypical melanocytes – invasive locally

b. High nuclei to cytoplasm ratio – Atypical melanocytes - Great capacity to spread

c. Palisading cells – small basophilic cells – great capacity to spread

d. High nuclei to cytoplasm ratio – small basophilic cells – Great capacity to spread

e. Palisading cells – Small basophilic cells – invasive locally

Palisading cells – Small basophilic cells – invasive locally

What does palisading mean?

a rim or layer of cells who nuclei line up

Which panel of antibodies is important when differentiating basal cell carcinoma from malignant melanoma & squamous cell carcinoma?

a. Melan A – S100 – P63

b. BCL2 – EMA – P16

c. EMA – P16 – P63

d. BEREP4 – CD10 – BCL2

e. P63 – EMA – BCL2

BEREP4 – CD10 – BCL2

Which panel of antibodies is important when differentiating squamous cell carcinoma from malignant melanoma & basal cell carcinoma?

a. Melan A – S100 – P63

b. BCL2 – EMA – P16

c. EMA – P16 – P63

d. BEREP4 – CD10 – BCL2

e. P63 – EMA – BCL2

EMA – P16 – P63

What are some example of dermatosis?

Impetigo

Lupus

vitiligo

Acne

Tinea

Moles

Actinic keratinosis

What are the main points of pemphigus?

Intraepidermal (within epidermis)

effects middle age to elderly

high mortality

IgG attack intercellular junctions (desmosomes)

seperation above basement membrane

Is this Pemphigus or Pemphigoid?

Pemphigus

What are the main points of Pemphigoid?

Subepithelial (Below epidermis)

Effects elderly

Self-limiting

IgG attack basement membrane (hemidesmosomes)

separation at basement membrane

Is this Pemphigus or Pemphigoid?

Pemphigoid

Is basal cell papilloma malignant or benign?

Benign

Is basal cell carcinoma malignant or benign?

Malignant

is melanoma malignant or benign?

Malignant

What are the key hallmarks of benign skin tumors?

Do not metastasise

Well define borders

Slow growth

Non cancerous

What are the key hallmarks of malignant skin tumors?

Can metastasise

Irregular borders

uneven shapes

uneven colour

ulcerative

fast growth

What is basal cell papilloma also known as?

seborrhoeic wart

how common is basal cell papilloma?

common 90% of people over 60 get them

How common is basal cell carcinoma?

50%

60%

70%

80%

90%

80%

Most common form of skin cancer

What are the microscopic features of basal cell carcinoma?

Palisading cells

mitosis

small basophilic cells

ulceration

islands of basophilic tumor cells arising from basal layer of epidermis

What is Mohs surgery?

technique to remove skin cancer

usually for bsc scc

used intraoperatively

keep going until all neoplastic cells are free from margins

What is the prognosis on malignant melanoma dependent on?

Breslow score

The thickness of the lesion

What does the ABCDEF checklist stand for in malignant melanoma?

Asymmetry

Border irregularity

Colour

Diameter

Evolution

Funny looking

Fluid-filled cysts found within the mouth are called (a) …

a. Lipoma

b. Torus

c. Mucoceles

d. Schwannoma

e. Papilloma

Mucoceles

If you were using immunohistochemistry to differentiate salivary gland/duct carcinoma from other types of head and neck tumour, which of the following antibody panels would be most suitable?

a. S100 – CK8 – CK5/6

b. P16 – HMB45 – MelanA

c. Androgen Receptor – GCDFP15 – CK7 – GATA3

d. S100 – HMB45 – Melan A

e. P53 – CK8 – CK5/6 – P16

Androgen Receptor – GCDFP15 – CK7 – GATA3

If you were using immunohistochemistry to differentiate squamous cell carcinoma from other types of head and neck tumour, which of the following antibody panels would be most suitable?

a. S100 – CK8 – CK5/6

b. P16 – HMB45 – MelanA

c. Androgen Receptor – GCDFP15 – CK7 – GATA3

d. S100 – HMB45 – Melan A

e. P53 – CK8 – CK5/6 – P16

P53 – CK8 – CK5/6 – P16

If you were using immunohistochemistry to differentiate melanoma of the oral cavity from other types of head and neck tumour, which of the following antibody panels would be most suitable?

a. S100 – CK8 – CK5/6

b. P16 – HMB45 – MelanA

c. Androgen Receptor – GCDFP15 – CK7 – GATA3

d. S100 – HMB45 – Melan A

e. P53 – CK8 – CK5/6 – P16

S100 – HMB45 – Melan A

Tuberculosis (TB) develops gradually and is characterised histologically by formation of granulomas. What is the causative agent of TB?

a. HPV

b. Fungi

c. Cancer

d. HIV

e. Mycobacterium

Mycobacterium

What is the name given to the white patches seen within the mouth and tongue that are linked with oral cancer?

a. Difficulty swallowing

b. Leukoplakia

c. Sore

d. Erythroplakia

e. Ulcer

Leukoplakia