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INTRODUCTION

Hallmark of acute inflammation: increase vascular permeability


Chronic inflammation: tissue destruction
Differentiation of Necrosis vs apoptosis
"LIFELESS" (since cells are
dead):
Differences are in:
Leaky membranes
Inflammatory response
Fate
Extent
Laddering
Energy dependent
Swell or shrink
Stimulus
CARDIO
anitschkow cells - aka CATERPILLAR CELLS! Pathognomonic cells of rheumatic fever

INFECTIVE ENDOCARDITIS HM- fribale bulky potentially destructive vegetation


Virchow's triad (thrombus formation): endothelial injury, stasis or turbulent blood flow,
hypercoagulability of blood
VIRchows triad
"VIR" venous thrombosis
Vascular trauma
Increased coagulability
Reduced blood flow (stasis)
Hallmark of infective endocarditis:
Friable, bulky, potentially destructive vegetations

Intimal tear - most common predisposing factor of thrombus formation n the arterial system

Prolonged immobility - common predisposing factor to lower extremity deep vein thrombosis
Two key processes in atherosclerosis
1. intimal thickening
2. lipid accumulation
CARDIO RHD

ASCHOFF BODIES- consist of:


-foci of lymphocytes (Tcells)
-plasma cells
-ANITSCHKOW CELLS (pathognomonic for RF) - macrophaes having abundant ytoplasm and
central round to ovoid nucle having a chromatin in a ceentral, slender, wavy ribbon (thus the
caterpillar cell name as well)
MITRAL VALVE (STENOSIS)-virtually the only cause
->Cardinal anatomic change:
leaflet thickening
commsural fusion and shortening
fusion of the tendinous cords
VERUCCAE- small vegetations visible along the line of clsure of the mitral vale leaflet.
MacCallum plaques- irregular thickenings (subendocardial lesion) usually in left atrium
CARDIO comparison of four major forms of vegetative Endocarditis
RHD small, warty vegetation along the lines of closure of the valve leaftlets
IE large, irregular masses on the valve cusps that extend onto the chordae.
NBTE small, bland vegetations usuall attached at the line of closure
LSE small or medium sized vegetations on either or both sides of the valve leaflets.
ARTERIAL THROMBOSIS WITH ORGANIZATION & RECANALIZATION
-thrombus develops usually in site of turbulence and endothelial injury
-sites affected in decreasing order: CORONARY, CEREBRAL, FEMORAL
-they are composed of friable platelet, fibrin, red cells and degeneration leukocytes
-LINES OF ZAHN:pale platelet and fibrin alternating with darker red cell rich layer; it signifies that
the thrombus originates from a FLOWING blood(living/antermortem)
RESPI MODULE
BRONCHOPNEUMONIA - patchy consolidation of lung
LOBAR PNEUMONIA - fibrinosuppurative consolidation of a large portion of a lobe or of an entire lobe

TB features
4C
Caseation
Calcification
Cavitation
Cicatrization
Calcium
Ammonium magnesium phosphate
Cystine
Uric acid

COPD:4types and hallmark


ABCDE
Asthma
Brochiectasis
Chronic bronchitis
Dyspnea [hallmark of group]
Emphysema
Alternatively: replace Dyspnea with D for decrease FEV
PATHO Tuberculosis
Mycobacterium tuberculosis for most cases
resorvoir humans w/ active TB
oropharyngeal and intestinal TB by drinking milk with M. bovis
rare in countries where milk is routinely pasteurized
EPIDEMIOLOGY
Infection w/HIV makes people susceptible to rapidly progressive TB
flourishes where there is poverty, crowding, chronic debilitating illness
dse of elderly, urban poor, people w/ aids
dse states that inc risk: DM, Hodgkin lymphomas, chronic lung dse (silicosis), chronic RF,
malnutrition, immunosuppression

INFECTION - presence of organisms w/c may or may not cause clinically significant dse
acquired by person-person, airborne
PATHO - INFLUENZA INFECTION
MORPHOLOGY
- MUCOSAL HYPEREMIA and SWELLING w/ predominantly LYMPHOMONOCYTIC and
PLASMACYTIC inflitration of submucosa accompanied by overprod of mucus secretion
- swollen mucosa may plug nasal channels, sinuses, or Eustachian tubes lead to SUPPURATIVE
SECONDARY BACTERIAL INFECTION
- virus induced tonsillitis w/ enlargement of lymphoid tissue w/in WALDEYER RING in children
- LARYNGOTRACHEOBRONCHITIS and BRONCHIOLITIS - vocal chord swelling and abundant mucus
exudation
-impairment of bronchociliary fxn invites bacterial super infection w/ more marked suppuration
-plugging of small airways may give rise focal lung atelectasis

-more severe bronchiolar involvement - widespread plugging of 2ndary and terminal airways by
CELL DEBRIS, FIBRIN, INFLAMMATORY EXUDATES when prolonged cause ORGANIZATION and
FIBROSIS resulting in obliterative bronchiolitis and permanent lung damage
LUNG CANCER
Lung CA - cauliflower like mass
Bronchiolveolar CA (adenocarcinoma)- lepidic growth pattern
Squamous CA - squamous pearls
Small cell CA - salt n pepper pattern, azzopardi effect
Large cell neuroendocrine CA -organoid nesting, trabecular, rosette-like and palisading pattern
RENAL MODULE
U/A
isovaleric acidemia & glutaric acidemia SWEATY FEET
maple syrup urine dse MAPLE SYRUP
methionine malab CABBAGE, HOPS
pku MOUSY
trimethylaminuria ROTTING FISH
tyrosinemia RANCID
POSTSTREP GN characteristic-enlarged hypercellular glomerulus
THYROID MODULE
GRAVE'S DISEASE
-most common cause of endogenous hyperthyroidism
Triad of:
-Hyperthyroidism
-Ophthalmopathy
-Dermopathy
Morphology
-Thyroid follicles:diffuse hyperplasia,hypertrophy; becomes crowded
-Colloid:pale "scalloped"margins;with papillary formation that LACKS fibrovascular core(in
contrast to papillary cancer)
-cut sections:soft, meaty appearance resembling normal muscles
-Ophthalmopathy:deposition of MPS+lymphocytic infiltration+fibrosis
-Dermopathy:dermal thickening+GAG deposition+lymphocytic infiltrates
CONGENITAL HYPOTHYROIDISM
-most often the result in ENDEMIC deficiency in the diet
PENDRED SYNDROME
-mutation of SLC6A4(PENDRIN)
-hypothyroidism+SENORINEURAL deafness

HASHIMOTO'S THYROIDITIS
-most common in iodine SUFFICIENT areas
-CTLA4 polymorphism
-HURTHLE CELL(eosinophilic,granular cytoplasm) + HETEROGENOUS population of lymphocytes is
a characteristic finding
-thyroid gland is diffusely enlarged+atrophic thyroid follicles
-CAPSULE IS INTACT
***FIBROUS VARIANT:severe follicular atrophy+keloid like fibrosis that does NOT go beyond the
capsule
SUBACUTE GRANULOMATOUS/DE QUERVAIN'S THYROIDITIS
-most common cause of thyroid PAIN
-viral induced and self limited
-iodine uptake is DIMINISHED
-can be unilaterally/bilaterally enlarged with intact capsule
-EARLY/INFLAMMATORY PHASE:disrupted/scattered follicles;replaced by neutrophils forming
microabscess
-LATE:lymphocytes,macrophage,plasma cells+multinucleate cells enclose naked pools
(GRANULOMATOUS)
-LATER:chronic inflammatory infiltrates+fibrosis
***Granulomatous/de Quervain-PAINFUL
***Lymphocytic-painless
SUBACUTE LYMPHOCYTIC THYROIDITIS
-painless;variant of hashimoto
-histology is the same with hashimoto EXCEPT it is mild & symmetrically enlarged and thyroid
appears normal; hurtle cel and fibrosis are NOT prominent
-Most specific finding:lymphocytic infiltration + hyperplastic germinal centers within the thyroid
parenchyma + patchy disruption+collapse of thyroid follicles
REIDEL THYROIDITIS
-extensive fibrosis involving the thyroid and
contiguous neck structures(extend beyond the capsule);HARD and FIXED thyroid mass,
simulating a carcinoma
OTHERS
DERMA:
basal cell ca:
Pearly papules with prominent, dilated subepidermal bld vessels (telengiectasia)
MSK:
paget disease:
Hm is mosaic pattern of lamellar bone