APCON 2010
NATIONAL PATHOLOGY
Answers
Q 25: Paleopathology
Shown in the picture are the mummified remains of a human being and tibia with anterior thickening (saber shin) typical of treponemal diseases like yaws and syphilis. Seen in this context the third picture can be surmised to be an autolysed section of diseased blood vessel from animal or human remains.
Paleopathology is defined as "the science of diseases which can be demonstrated in human and animal remains of ancient times." It combines pathology with the disciplines of archeology and paleontology and is becoming ever more sophisticated by the introduction of molecular methods.
And indeed, we have come a long way. Rudolf Virchow had opined that the fossil bones recovered from the Neanderthal valley belonged to modern humans suffering from rickets and arthritis. And the great man was proved utterly wrong! A century and half on, Neanderthal man has been well characterized as our closest cousins on the evolutionary tree and the Neanderthal genome recovered from fossil bones has been sequenced.
Correct answers: 42.9%
Links
Q 26: Churg – Strauss
syndrome
A muscular blood vessel showing prominent inflammation of the wall. The infiltrate contains large number of eosinophils. Eosinophilic vasculitis is an uncommon condition and when combined with the very suggestive history, makes the diagnosis almost certain.
In pure bronchial asthma, you would not expect a vasculitis component.
Correct answers: 56.3%
Links
Q 27: Oral
mucocele (Mucus extravasation cyst)
This was a small cyst on the inner surface of the lower lip. It can be guessed that it is a mucous surface since there are no skin appendages. The cyst has no epithelial lining. Instead, it is surrounded by a broad band of tissue composed of macrophages (not epithelioid cells) and plenty of collagen. Inside the cyst there are macrophages and wisps of bluish material.
I saw this during routine reporting and it looked so neat and photogenic, and here it is. Maybe, a little bit of history was in order. My misjudgment.
Anyway, the outcome is quite egalitarian. No one got this right.
Correct answers: 0%
Links
Q 28: Inflammatory bowel
disease - pseudopolyps
Total colectomy specimen. The whole colon is diseased. There are polyps of varying sizes. They are not sharply demarcated as in adenomatous polyposis and there is no intervening normal mucosa. There is some edema in the last picture giving the appearance of cobblestone mucosa, which made some to call this Crohn disease. This was a case of ulcerative colitis. Anyone calling this UC or CD or IBD will get credit as long as the pseudopolyps are mentioned.
Correct answers: 58%
Links
1. Inflammatory bowel disease - Pathology
Q 29: Elastolytic giant
cell granuloma
An inflammatory lesion containing plenty of giant cells. They contain long slender light pink stained fibers, some of which seem to jut out of the giant cells. Actinic granuloma seems to refer to the same condition.
Here is a Verhoeff elastic tissue stain. See the dark elastic fibers within the giant cells.
The main differential would be Granuloma annulare. Absence of necrobiosis and plentiful giant cells exhibiting elastophagocytosis are the differentiating features.
The lesion is usually called Annular elastolytic giant cell granuloma; but the lesions need not always have an annular configuration.
Correct answers: 16.1%
Links
1. Annular Elastolytic Giant Cell granuloma
Q 30: Steato - cirrhosis
Trichrome stain shows nodules of liver tissue completely encircled by fibrous tissue and containing fat. The high power H&E picture shows Mallory hyaline in abundance. Cholestasis is also present.
Meant to be a spotter. Alcoholic cirrhosis is the most likely possibility. Non alcoholic steato-hepatitis may also lead to cirrhosis and then can have an identical appearance.
Correct answers: 45.5%
Links
Q 31: Extra-villous
trophoblast, decidua and uterine muscle
See the ordered structure of the tissue. There is the extravillous trophoblast (EVT) with its extracellular matrix above. This matrix is collagenous and not chondroid as some of you have suggested. Beneath the EVT is decidua, sitting atop the uterine muscle.
Extravillous trophoblast comprises various trophoblastic elements that are found outside of the chorionic villi. EVT cells are the ones apposed to the deciduas in most places including the site of implantation. ‘Intermediate trophoblast’ is an overlapping term for the same.
The key to recognition of the tissue lies in the decidual cells. Were they too small to be recognized. Here is a part of the same image at the same magnification but slightly enlarged.
Unfair? Sorry. But remember, ‘All’s fair in Love and Quiz’.
Correct answers: 1.8%
Links
Q32: a. Keratin
b. Rhinospodium
This one was for testing visual familiarity. You either get it or miss it. No scope for much discussion.
The first one is keratin, roughly shaped in ‘pearl’ formation. The giant cells are unsuccessfully trying to devour it. This was from a case of Squamous carcinoma mets in lymph node.
The second is a whole sporangium of Rhinosporidium. The only
organism which can be confused with this Coccidioides immitis. The spherules of
this organism usually measures 20-80 m.
Rhinosprial sprangia can be much larger; reaching upto 1000 m. In this case I would estimate the size to
be something like 200-300 m.
Correct answers: 9.8%
Links
1. A guide to the histological identification of fungi in tissues (free registration needed.)