PATHOLOGY - AIM4PG

MANAGEMENT OF DIABETIC KETOACIDOSIS https://youtu.be/O9Enw3fzUt4 More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

A 38-year-old woman has a mobile lump in her breast. An FNAC was performed. The cytology image is shown below. Which of the following features on cytology do not favor a benign diagnosis? A. Bare bipolar nuclei B. Cohesive clusters of epithelial cells C. Absence of myoepithelial cells D. Stromal fragments DETAILED EXPLANATION Ans. C. Absence of myoepithelial cells • It's pap stained smear. You can see tightly cohesive papillaroid clusters. • In benign cases of breast , identification of myoepithelial cells are very important because if these are lost then it's a strongly suggestive feature of malignancy. • Benign bipolar nuclei are spread throughout the lesion in fibroadenoma breast • Up to 66% of fibroadenomas harbour mutations in the Exon (Exon 2) of the mediator complex subunit 12 (MED12) gene. In particular, these mutations are restricted to the stromal component For more notes www.aim4pg.com/study-group

RADIOLOGY POINTERS PART-1 https://youtu.be/6ibWOenFRAg More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

BRONCHIECTASIS https://youtu.be/Fmp08De_BcM More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

THORACOCENTESIS https://youtu.be/Az2cYrvKFCU More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes .

Pathology Important Notes For more notes join www.aim4pg.com/study-group

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Compare the normal astrocytes having dark nuclei to Alzheimer’s Type II astrocytes having pale edematous nuclei, prominent nucleolus and margination of chromatin Alzheimer’s Type II astrocytosis is seen in Hepatic Encephalopathy due to failure of the liver to clear ammonia Found in the lower layers of the cerebral cortex and basal ganglia

Plummer Vinson Syndrome/ Patterson Kelly Brown Syndrome • Iron deficiency Anemia • Esophageal webs in the upper 1/3rd post cricoid region • Atropic Glossitis C/F • Dysphagia – intermittently to solids • Aspiration • Weakness, fatigue, koilonychia, pallor, cheilitis due to anemia • Increased risk of Hypopharyngeal Cancers Diagnosis • CBC and iron studies might reveal Microcytic Hypochromic anemia • Barium swallow followed by lateral view x-rays for visualization of post-cricoid webs • Endoscopic visualization

esophageal web in Plummer Vinson Syndrome

Histoplasmosis Organisms present intracellularly within the macrophages Reason behind the name (Histoplasma capsulatum)- there is a clear zone surrounding the nucleus, so the cell membrane appears as a pseudo-capsule.

Ferruginous bodies seen in asbestosis. coated with iron and calcium. showing Prussian Blue staining positivity

Langerhans cell histiocytosis • Clonal proliferation of Langerhans cells. • Activating valine to glutamate substitution at residue 600 in BRAF (BRAF V600E) • Markers- CD 1a, Langerin, S-100 Histopath- • Cells having moderately abundant cytoplasm with grooved nuclei. (Coffee bean nucleus) Electron Microscopy- • Birbeck granules showing tennis racquet appearance Variants- Letterer-Siwe disease • Predominantly before 2 years • Presents with seborrheic eruptions involving the scalp, face, trunk and intertriginous areas • hepatosplenomegaly, lymphadenopathy • Osteolytic bone lesions. • Marrow infiltration leading to anemia, thrombocytopenia and neutropenia Hand-Schüller-Christian disease • 2-10 years • calvarial bone defects plus diabetes insipidus (due to infiltration of posterior pituitary) plus exophthalmos eosinophilic granuloma • 5-15 years • proliferation of Langerhans cells admixed with eosinophils. • Solitary calvarial lesion (button hole sequestra) and geographic skull. • Neurocognitive features producing seizures, vertigo and headache • Can involve other sites like vertebra, ribs and scapula • Osteolytic lesions of long bones leading to pathological fractures Pulmonary Langerhans cell histiocytosis • adult smokers • 3rd to 4th decade

birbeck granules in Langerhans cell Histiocytosis

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Sezzary cells- seen in Sezzary Syndrome(hematogenous form of cutaneous T cell lymphoma). showing cerebriform nucleus.

Hairy cell leukemia • Mature B-cell neoplasm • BRAF V600E mutation- valine to glutamate substitution at residue 600 PBS- • leukemic cells having fine hair like cytoplasmic projections, oblong nuclei, moderate pale blue cytoplasm • Best recognized under phase-contrast microscope Bone marrow biopsy- • shows massive infiltration with mononuclear cells that have a fried-egg appearance Dry tap on Bone marrow aspiration, as the cells are tightly enmeshed in extra cellular matrix (composed of reticulin) Markers- pan-B-cell markers CD19 and CD20, surface Ig CD11c, CD25, CD103, and Annexin A1. The mononuclear cells are TRAP positive (The red cytoplasmic staining) C/F • Infiltration of reticuloendothelial system- results due to expression of integrin receptor by the hairy cells that interact with the VCAM-1 found in bone marrow, liver and splenic stroma • Massive splenomegaly results in abdominal discomfort- most common finding • Pancytopenia- fatigue due to anemia, bleeding due to thrombocytopenia, fever and infections due to neutropenia • Hepatomegaly less commonly • lymphadenopathy is rare By: Dr Gudly For more notes join www.aim4pg.com/study-group

Hairy Cell Leukemia