APCON 2010 Hyderabad
NATIONAL PATHOLOGY QUIZ – 3
Answers
Q 17: Rabbit ear with squamous cell carcinoma experimentally produced by Katsusaburo Yamagiwa.
The exhibit is from the museum attached to St Bartholomew’s Hospital in London. It holds specimens of great historical interest, like the scrotal cancer in chimney sweeps described by Percival Pott and the bones from the first case of Paget’s disease.
Yamagiwa, born in 1863, obtained his medical degree in 1888 and chose a career in Pathology. He was sent by the Japanese government to Germany where he worked with Rudolf Virchow. Virchow’s ideas regarding chronic irritation as a cause of cancer were to influence his later work.
In 1915, he along with Koichi Ichikawa was successful in producing cancer on the inner part of the rabbit ear by repeated application of coal tar. A fan of Japanese Haiku poetry, he burst forth with the couplet
“Cancer was produced
Proudly I walk a few steps”
Yamagiwa and the Danish scientist Johannes Andreas Grib Fibiger were the main contenders for the 1926 Nobel prize in Physiology & medicine. Fibiger claimed to find an organism he called Spiroptera carcinoma that caused cancer in mice and rats. Fibiger was chosen for the Nobel prize. Yamagiwa's work went unrewarded.
Later, it was shown that Fibinger's specific organism was not the primary cause of the tumors. Yamagiwa and Ichikawa's seminal work went on to become one of the enduring models of experimental cancer and a foundation of future cancer research!
A noble error or just plain Eurocentrism? Take your pick.
Correct answers: 55.4%
Links
Q 18: Bronchiolo-alveolar carcinoma, Lung
I think the real challenge lay in identification of the organ. The gross picture shows lung tissue at the periphery, seen rather well in the first picture – or so I thought.
The cytology smears show tightly bound papillary clusters with psammoma bodies. The monolayers of rather uniform and somewhat benign looking nuclei would make you think of bronchioloalveolar carcinoma (BAC). A minority of these lesions can show distinct psammoma bodies. Indeed, the histology showed a non-invasive tumor with growth along the alveolar walls.
Papillary adenocarcinomas of higher grade would have more ominous nuclear features. Lower grades merge into BAC. Anyway, diagnosis of papillary adenocarcinoma, lung will fetch full credit.
Correct answers: 27.4%
Links
1. Bronchioloalveolar carcinoma
2. Cytology of Bronchioloalveolar carcinoma
Q 19: Cerebellar hemangioblastoma
The easy one in this quiz. Cystic tumor of the cerebellum seen on CT. Tumor full of rounded capillaries containing red cells. Outside of the capillaries are the stromal cells, many of which are vacuolated.
The only possible differential diagnoses are the very vascular gliomas – sometimes called Angiogliomas. These are gliomas associated with vascular malformations and may have astrocytoma or oligodendroglioma components. Lipidized angiomatous meningiomas would be ruled out by the location.
Correct answers: 66.7%
Links
1. Cerebellar hemangioblastoma
Q 20: Multiple splenic artery aneurysms
Spleen with a round mass in the hilum that is continuous with the winding tubular structure – the splenic artery. There is another bulge towards the distal end of the artery.
See the continuity of the aneurysm with the artery. Both aneurysms are filled with thrombi.
The splenic artery is the most frequent site of visceral arterial aneurysms. Large aneurysms as in this case always present the danger of rupture and shock.
Correct answers: 34.5%
Links
1. Case report and review of literature
Q 21: Pilonidal sinus
A sinus tract with a fibrous wall. Inside the cavity, there are inflammatory cells. A long hair shaft can be seen adjacent to the wall. On closer examination few small hair shafts can also be seen in the center of the cavity.
Correct answers: 33.3%
Links:
2. Pathology
Q 22: Acute promyelocytic leukemia
A genuine spotter; which in no way means it is easy.
It is a packed marrow mostly populated by a monomorphous population of cells with abundant cytoplasm, best described as purple pink. Many cells have eccentric nuclei which are vesicular and seem to contain nucleoli. Question is; what are these cells?
The responses have been many: eosinophil precursors, plasma cells, mast cells and Langerhans cells beside promyelocytes.
Cytoplasm of eosinophils would be more of reddish orange and that of plasma cells bluish. As far as I know ‘flame cell’ is a Romanowsky phenomenon. Langerhans cells would have more elongated and cleaved nuclei. Mast cells in systemic mastocytosis involving the bone marrow are almost always spindle shaped.
This patient had typical promyelocytes in the peripheral smear and was positive for the t(15:17) translocation.
Correct answers: 12.8%
Links:
1. Acute promyelocytic leukemia
Q 23: Basal cell adenocarcinoma, salivary gland
The gross specimen is that of a major salivary gland with a grey white neoplasm that seems to be at least in part poorly circumscribed, suggesting an invasive border.
The tumor itself has two distinct areas as seen in the scanner picture: basal cell adenoma like area and an obviously infiltrative portion.
The tumor cells are uniform and basaloid. Note the pink basement membrane material around the lobules in the last picture. Mitotic figures are seen. More important, the tumor infiltrates into the surrounding salivary gland.
Correct answers: 8.3%
Links:
2. Basal cell adenoma versus carcinoma
Q 24: Oral submucous fibrosis
The ubiquitous and deadly blue tin (name removed) matches perfectly with the thick blue band of fibrosis lying over the muscle of tongue in the Masson trichrome stain. Pan masala and Ghutka use is increasing all over – a definite cause for worry.
Correct answers: 78.6%
Links: