APCON 2008 Chennai
NATIONAL
PATHOLOGY QUIZ – 2
Answers
Q 1: Nikolai Nikolaevich Anichkov
The clues were indeed effective since many have got this one
right. Aniichkov described the caterpillar nuclei when he worked in Aschoff’s
lab in
Much more important was his work on experimental Atherosclerosis in rabbits. Though subject to later criticism that it was cholesterolosis rather than Atherosclerosis that he and his undergraduate student Chalatov produced in the rabbits, there is no denying the fact that the study published by them spurred investigations that lead to our current knowledge.
Correct answers: 40.3%
Links
1. Nikolai
N. Anichkov and His Theory of Atherosclerosis
Q 2: Lhermitte-Duclos
disease
Didn’t think it would be so difficult. The composites in the first two panels show normal cerebellum and an abnormal area where the cerebellar folia can still be made out. The folia are enlarged mainly due to the much thicker granular layer. But this layer does not appear very granular because the tiny round neurons characteristic of this layer is very much diminished. The third picture shows a higher power of normal cerebellum with Purkinje cells at the interface between the two layers. The subsequent pictures are from the abnormal area. Purkinje cells are absent. Larger neurons are seen in the granular layer. The fibers in the molecular layer are coarser than normal because they are myelinated.
Dysplastic neurons and parallely arranged fibers in the molecular layer (not shown in the pictures originally supplied to you) are given below (Maybe more of you would have got this right with these pictures).
This was a case of sudden death in a young man. At autopsy a mass lesion was seen on one half of the cerebellum. Sudden death is known to occur in cases of Lhermitte-Duclos disease, usually due to respiratory arrest.
Lhermitte disease is now considered to be a hamartoma falling within the ambit of Cowden syndrome associated with abnormalities of the PTEN gene.
Correct answers: 6.5%
Links
2. Will the real Cowden syndrome please stand up: revised diagnostic criteria
Q 3: Hepatic adenoma with subcapsular
hemorrhage
Large well circumscribed mass in the liver of a young woman with a hematoma in the subcapsular region. The nodule is bile stained. This fact along with the age is against diagnosis of hepatoma. Focal nodular hyperplasia is associated with a central scar.
They are associated with a history of oral contraceptive use (as in this case) or in a setting of glycogen storage disorders. Large subcapsular tumors have a tendency to rupture causing intraperitoneal hemorrhage and shock.
Correct answers: 45.2%
Links
2. Hepatic Adenoma: MR Characteristics and Correlation with Pathologic Findings
Q 4:
Progressive transformation of germinal centers
A lymph node with many reactive follicles having clear cut, pale germinal centers. In addition, there are several large nodules several times the size of the reactive follicles. Germinal centers are not clearly seen in them though there are some paler areas. Higher power shows the nodules to contain mostly small lymphocytes and few centrocytes and centroblasts. It is actually an over-running of the germinal center by lymphocytes of the mantle layer. Absence of the typical popcorn cells distinguish this condition from Lymphocyte Predominant Hodgkin disease.
Correct answers: 43.5%
Links
1. Follicular
Hyperplasia, Follicular Lysis, and Progressive Transformation of Germinal
Centers
Q 5: Lichen
amyloidosis (Congo Red stain)
Simple spotter. The amyloid deposits are in the papillary dermis. The lesions present as raised papules or plaques in contrast to Macular amyloidosis which are flat discolored lesions. Histopathology in this case reveals hyperkeratosis and mild epidermal hyperplasia which favor lichen amyloidosis rather than Macular amyloidosis. Those offering the latter diagnosis will also get full credit. However, the diagnosis of Nodular amyloidosis will fetch only half credit since there no deposits of amyloid are seen beneath the papillary dermis.
Correct answers: 72.6%
Links:
Q 6: Deciduosis
peritonei
Common incidental finding in pregnant women subjected to surgery. Ectopic decidua can clinically mimick metastatic lesions. Rarely the deposits can be large enough to cause obstructive symptoms.
Correct answers: 30.6%
Links: