APCON 2008 Chennai
NATIONAL
PATHOLOGY QUIZ – 4
Answers
Q 1: Sarcoidosis
These grotesque disfiguring lesions of the arms and legs of a young male posed a great diagnostic problem. On biopsy, there were extensive granulomas in the subcutaneous tissue and muscle. Note the widespread edema of the skin.
The ACE levels were markedly elevated. The patient had renal stones since childhood and raised serum calcium.
Non caseating granulomas of the muscle are most common in sarcoidosis. In parasitic diseases the parasite and eosinophil infiltration are seen. Vasculitis accompanies Wegner’s granulomatosis. Primary granulomatous myositis is a disease of exclusion and it is extremely rare. Widespread diffuse involvement of the skin in addition to the muscle involvement is not expected in any condition other than sarcoidosis.
Virtually identical lesions have been described as ‘Cutaneous
childhood sarcoidosis’. Probably a better term
would be ‘Chronic Musculo-cutaneous sarcoidosis’.
Correct answers: 23.9%
Links
1. Granulomatous myositis – Pubmed abstracts
2. Cutaneous
childhood sarcoidosis
Q 2: Acute
Post-infectious glomerulonephritis superimposed on diabetic nodular
glomerulosclerosis.
Neutrophil exudation in the glomeruli is so prominent that there is no doubt regarding the diagnosis of acute glomerulonephritis. The glomeruli are solid due to endocapillary proliferation. In addition, there are eosinophilic hyaline nodules in the center of the lobules, well seen in the last two pictures. The sclerosed glomeruli attest to a chronic underlying process. Hyaline arteriolosclerosis can be well seen in the third picture. The patient was indeed a diabetic of long standing.
There were 3+ IgA deposits in the glomeruli on
immunofluorescence. This points to the recently
described condition - ‘IgA-dominant
acute poststaphylococcal glomerulonephritis complicating diabetic nephropathy’
as the most likely diagnosis.
A diagnosis of either AGN or Diabetic nephropathy alone would get you half credit.
Correct answers: 21.7%
Links
1. Acute glomerulonephritis complicating Diabetic nephropathy (page from Hepteinstall).
2. IgA-dominant acute post-infectious glomerulonephritis
Q 3: Mucinous cystadenoma of the Pancreas
A multilocular cystic lesion. The cyst contents have a glistening appearance. I thought the Pancreatic tissue hugging the intestine was well seen adjacent to the cyst.
Correct answers: 52.2%
Links
1. Differential diagnosis of Pancreatic cysts – Check out this nice site
Q 4:
Micrographia by Robert Hooke
Hooke coins the term 'Cell' in this seminal work because it
reminded him of a monk's quarters. Seeing the pictures of the cells in the cork
plant you can understand why. Correct answers: 54.3%
Links
1. Robert Hooke
Q 5: Imaging
Mass spectrometry
A new addition to the Pathologist’s ever increasing armamentarium. In the pictures you see images with the name of a protein and a value shown as m/z, which stands for mass to charge ratio.
Mass spectrometry is an analytical technique that identifies the chemical composition of a compound or sample based on the mass-to-charge ratio of charged particles. It can be modified to give the relative concentration of a protein in different areas of a tissue section which is what you see in the images.
Sounds confusing? Learn about it step by step by reading through the links provided.
Correct answers: 21.7%
Links:
1. How a mass
spectrometer works
2. Mass
spectra of organic compounds
Q 6: Enterobius
vermicularis (adult) amidst vegetable matter
Enterobius with its sharply pointed lateral alae. 0.25 marks will be reduced if vegetable matter is not mentioned.
Check out the atlas links provided.
Correct answers: 71.7%
- Enterobius vermicularis
- Home page of the atlas site shown above. (Bookmark it. It is really useful)