OSCE- Pathology

Phase IIIa

sienmingoat

Photo- PUD• Dx?

– Peptic ulcer disease

• 3 abnormalities?– Microscopic:

• Muscularis mucosa bleached• 4 zone: necrotic, non-specific inflam infiltration, granulation tissue, fibrosis/scarring

– Macroscopic:• Site: antrum, lesser curvature • Round to oval punch out ulcer, solitary• Little overhanging of edge• Puckering of surrounding, radiating folds

• 3 complications?– Hemorrhage– Stenosis– Penetration – Chronicity/malignancy

• 3 precipitating factors?– Smoking/alcohol– Helicobacter pylori infection– Drugs: steroids, NSAIDs– Stress– Diet: skipped meal, spicy, betel nut chewing

40yo man, hematuria

Removed kidney

Cross section: RCC• Describe?

– macroscopic• Upper lobe• Yellow/white mass, large, circumscribed • Hemorrhage/necrosis (patchy)

– microscopic• Sheets, tubules or cords of clear/granular cells• Polygonal-columnar cells with small round nuclei, abundant clear cytoplasm

(glycogen/lipid)

• Dx?– Renal cell carcinoma

• Mode of spread/metastasis?– Blood: liver, lung, bone– Lymphatic: regional, para-oartic– Direct: perinephric/adrenal

• 2 extra renal manifestation?– Polycythemia (erythropoietin)– Hypertension (renin)– Hypercalcemia (PTH-like hormones)– Metastasis (lung, bone)

Gross- Liver cirrhosis• Describe?

– Multinodular (micro <3mm, macro >2mm)– Irregular shape– Shrunken in size– Microscopic: parenchymal nodules separated by fibrous septa

• S&S?– Asymptomatic– Portal hypertension (caput medusae, anorectal varices)– Ascites , splenomegaly– Bleeding tendency– Infection (SBP)

• Causes?– Acquired:

• Alcoholic liver dz• Viral hepatitis (HBV)• Cryptogenic

– Congenital:• IEM (hemochromatosis)• Wilson’s dz• Alpha-1 antitrypsin deficiency

Male patient, A&E with abd pain & jaundice

Raw specimen- HCC• Describe?

– Loss of liver architecture – Main large nodule/mass over lower R lobe– Multiple/satellite nodules– Composed to gallbladder (swollen?)

• Dx/DDx?– Hepatocellular carcinoma– Liver abscess, adenoma/hemangioma?

• Causes?– Infection: viral hepatitis– Toxins: alcohol, drugs (methotrexate), aflatoxin– Biliary obstruction: PBC, stricture/stone – Metabolic: hemochromatosis, Wilson’s, alpha-1 AT deficiency– Hepatic venous congestion: Budd-chiari

• Ix?– Serum alpha-fetoprotein– Liver U/S, CT– Liver biopsy– LFT, clotting profile

Slide- fatty liver

• Describe + Dx?– Macro + micro vesicular/fatty degeneration

• 2 Clinical features?– Hepatomegaly– Vague abdominal symptoms: N&V, diarrhea– Chronic liver disease: parotid swelling, palmar

erythema, gynaecomastia, bruises etc

• 3 Causes?– Alcohol– Diabetes mellitus– Reye’s symptoms (aspirin)

Specimen- Ca colon• Describe?

– Diffuse infiltrating growth– Annular/papilliferous– Malignant ulcer

• Etiology?– Genetic

• Familial adenomatous polyposis• Hereditary non-polyposis colorectal Ca• Colorectal adenoma/polyps

– IBD (UC)– Diet: low fibre/Ca/vit D, high fat, smoking/alcohol

• Complication?– Intestinal obstruction (L side)– Perforation (peritonitis, pericolic abscess, fistulae)– Metastasis to liver (jaundice, hepatomegaly, ascites)

Cyst

Zoites

Picture- purple ball (toxoplasmosis)• Organism?

– Genus: Toxoplasma– Species: gondii– Stage: cyst

• Why hemiparesis?– Compression of cerebral abscess on internal capsule

(contra lateral)

• S&S?– Focal CNS signs, fits, confusion– Fever, headache, chorioretinitis

• Rx (2 drugs)?– Pyrimethamine, sulfadiazine, folinic acid (leucovorin)

Brain photo- hydrocephalus • Dx?

– Hydrocephalus

• 2 S&S?– Raised ICP: headache, vomit, papilloedema– Childhood: head enlargement, split suture, tense ant. frontanel,

sunset eyes

• Causes?– Primary-communicating

• Meningitis, SAH, head injury• Choroid plexus papilloma

– Primary- non communicating• Aqueduct stenosis• SOL/tumour/hemorrhage/vascular malformation• 4th ventricle foramina atresia

– Secondary• Brain shrinkage (compensation)

Photo- Ca breast• Describe?

– Ca breast with ulcer– Edematous, X retracted X discharge– Dilated superficial veins, forearm swelling

• Staging?– TNM staging

• Risk factors?– Age, gender, family hx, previous breast dz, radiation– Hormonal: early menarche, late menopause, nulliparious, X BF,

OCP/HRT

• 4 clinical types?– Tubular– Mucinous– Medullary– Invasive lobular– In situ (DCIS/LCIS)

59 yo male

Hemoptysis, dead

This is lung

Post-mortem section of lung

• Describe?– lower lobes (mainly) + haemorrhagic (dark red)– vary in size + wedge shaped with the apex pointing

towards the hilus of the lung

• Dx?– Pulmonary infarction 2nd to p. embolism

• Pathogenesis?– DVT, embolism, R heart, lungs vasculature, block

supply, infarct, respi distress, CO compromised

• If survived, 2 complications?– Pulmonary HPT– Cor pulmonale/R heart failure

Specimen- aortic valve vegetation

• S&S?– Bacteremia/vasculitis: fever, splenomegaly, clubbing,

splinter hemorrhage, Roth spot– Immune-complex: GN (hematuria), Janeway/Osler

lesion/node– Valvular dysfunction: murmur change, valve

destruction/perforation– Embolism: brain, kidney, intestine, pul vessel

• Complications?– CARDIAC: valvular destruction, CF/conduction

disturbance, abscess, perforation, pericarditis– EXTRA-CARDIAC: septic embolic, GN