APCON 2008 Chennai
NATIONAL
PATHOLOGY QUIZ – 5
Answers
Q 1: Endometrioid Cystadenofibroma – Benign, Ovary
This was kept for eliciting the correct nomenclature of an epithelial ovarian tumor. Multiple factors go into the name of a surface epithelial ovarian tumor – The type of epithelial cells, degree of differentiation and presence of invasion, amount of stroma and whether cysts are seen grossly or not.
This is a partly cystic tumor with abundant fibrous stromal
component; so it is a ‘Cystadenofibroma’. The type of epithelium resembles
endometrium (Some have diagnosed this as endometriosis. But the stroma is not
endometrial) – so it is an ‘Endometrioid cystadenofibroma’. Finally, it is non
invasive without atypia – Hence ‘Endometrioid Cystadenofibroma – Benign’.
Correct answers: 35.7%
Links
1. Classification of
Ovarian tumors
Q 2: Herpes
Virus hepatitis wth Hemophagocytic syndrome.
Postmortem needle biopsies from the spleen and liver are provided. The splenic biopsy shows red pulp distended with macrophages, many showing distinct hemophagocytosis (red cells and leukocytes). The liver biopsy shows portal and lobular hepatitis. Many hepatocytes show somewhat smudgy intranuclear inclusions. They most probably belong to the Herpesvirus group. CMV is unlikely as there is no cytomegaly. I thought it was Herpes simplex hepatitis. Unfortunately, Immunohistochemistry was not done.
Herpes viruses (HSV, HHV-6, CMV) can be associated with hemophagocytosis.
Half mark for hemophagocytosis and half for saying it is hepatitis due to a herpes group virus (even CMV).
Correct answers: 45.2%
Links
Q 3: Lipid profile (LDL Cholesterol)
Multiple tumors arranged linearly on the extensor aspect of the hand – the location of extensor tendons. The patient also had swellings elsewhere on the body. The microscopy shows foam cells. Quite clearly they are tendinous xanthomas. The large number of these leads you to suspect a homozygous state. Indeed, this patient had LDL cholesterol levels of 720 mg / dl suggesting the diagnosis of homozygous familial hypercholesterolemia. You may recall that homozygotes of Autosomal dominant disorders can have extremely severe disease.
Correct answers: 71.4 %
Links
1. Autosomal dominant hypercholesterolemia
Q 4:
Cytoplasmic crystals of Alveolar soft part sarcoma (PAS stain)
Note the tumor with alveolar architecture and large cells. Elongated, rectangular structures that stain bright pink are the PAS positive crystals.
Some of you thought them to be lepra bacilli. But, aren’t they too big for bacteria?
Correct answers: 42.9%
Links
Q 5: Mother
The letters given obviously represent a nucleotide sequence. First you have to find out where it occurs. For this you can use the BLAST program at
http://blast.ncbi.nlm.nih.gov/Blast.cgi
Select ‘Human’ from the assembled genomes. Type in or copy/paste the sequence in the box and click ‘Begin search’ at the bottom.
In the next screen click ‘View report’
The source seen in the report is
‘Homo sapiens mitochondrion, complete genome’
So this is a sequence from the mitochondrial genome. You and I get it from our mothers!No one has got it completely correct. I have given marks for the close hits. I suppose most of you just Googled it and got a hit about the DNA microarray for Human ancestry. It is true that MtDNA has been a powerful tool for searching for our ancestry.By the way, try Googling it again. A new hit will appear. Guess what? ‘IAPM NATIONAL PATHOLOGY QUIZ APCON 2008 CHENNAI’!
Correct answers: 16.7%
Links:
1. BLAST
Q 6: Denis
Burkitt
Starry sky and high fiber food. Who else but Burkitt? Read about him in the link below. His high fiber theory of colon cancer has been tenuous at best. Did you know that another pet theory of his was about the beneficial effect of squatting during defecation? I suppose we Indians should be thankful to him.
Correct answers: 61.9%