Pathology 3

Thinning of the epidermis with superficial hyperkeratosis

Epithelial thickiningwith signigicant hyperkeratosis

• Thin, flat, moist anogenital warts associated with syphilis
• Not pre cancerous

• Papillary and elevated anogenital warts
• Not pre cancerous

• 3% of all genital tract cnacers in women
• 90% are squamous cell carcinoma's
• HPV 16 is present in 75-90% of cases

• pt c/o leukorrhea
• Common offenders: Candida albicans (most common), Trichomonas vaginalis (2d most common), Gardnerella vaginitis (bacterial)
• Stinks, fishy amine odor, CLUE CELLS under KOH

• Rare malignancy (usually >60)
• Mother's took DES during pregnancy to reduce risk of miscarriage

• Rare variant of rhabdomyosarcoma
• Children <5
• Multiple polypoid masses resembling "bunch of grapes" often protruding from the vagina

• Associated with mucopurulent or purulent vaginal discharge (leukorrhea)
• Not pre cancerous
• Most Important: Chlamydia trachomatis

• Major cause of cancer related deaths world wide
• PAP smear dramatically lowered incidence

• Pre cancerous lesions graded
• CIN I: Mild dysplasia_ BG: Low grade SIL
• CIN II: Moderate dysplasia_BG: High grade SIL
• CIN III: Severe dysplasia_BG: High grade SIL
• CIS: Carcinoma in Situ_BG: High grade SIL
• Classifided as Low/High grade_BG: High grade SIL

High risk: 16, 18

Low Risk: 6, 11

• Growth of the basal layer of the endometruim down into the myometruim.
• Uterine wall becomes thickened

Excessive bleeding at the time of the menstrual period

Painful mentruation or pelvic pain accompanying menstruation, sometimes a symptom of endometriosis

pain present just prior toor at the onset of menstruation

Irregular bleeding between the periods

• Occur at any age, generally at the time of menopause
• Significance lies inteh production of abnormal uterine bleeding and rare risk of developing into cancer

• MOST FREQUENT CANCER of the female genital tract
• Risks: Obesity, Diabetes, HTN
• Frequently arises from endometrial hyperplasia

• Referred to as "fibroids"
• Most common benign tumors in females
• Asymptomatic

• Arise from myometrium
• Usually a solitary lesion

• More important and adenomyosis
• Ofen causes infertility, dysmenorrhea, pelvic pain

Acute: usually limited to bacterial infections arising after delivery or miscarriage (retained products of conception)

Chronic: associated with chronic gonorrheal pelvic disease, TB, IUD's

Inflammation of the fallopian tubes-nearly always bacterial

• Chlamydia, Mycoplasma hominis
• Post Partum: Staph, Strep
• Infections often lead to blockage or scarring of the tubes

Most common cause of enlarged ovary

• Typcially 2x normal size
• Excessive LH, Low FSH
• Accompanies oligomenorrhea, hirsutism

• Implantation of a fertilized egg outside the endometruim
• 95% occur in the fallopian tubes
• Pt presents with severe lower quadrant pain

Fetus and placenta are completely expulsed and woman resumes normal menses

Cervical dilation and expulsion of some fetal parts with soem being retained.

Death of a fetus which remains in utero

Cervical bleeding but the cervix does not dilate and pregnancy may continue uneventfully.

• Occurs as a result of an abmornally functioning placenta or abnormal materno-placental interaction
• Pre-eclampsic if no seizures
• Eclampsic if seizures occur

• Congenital absence of the breast
• No breast tissue, nipple, or areola

Development of more than 2 breasts

• Breast tissue without nipples
• Occasionally found in the axilla

Additional breast along the milk line

Supernumerary nipples without glands

• Acute: Most common inflammatory disease of the breast
• Usually occurs during lactation - Staph/Strep from babies mouth
• Chronic: Rare, biopsy required to r/o cancer

• Most common benign tumor of the female breast
• Increased estrogen activity, usually in younger women

• Usually benign, may become malignant
• Much less common than fibroadenoma

• Neoplastic papillary growth within a duct, usually latiferous ducts or sinuses
• Serous/bloody discharge
• Rarely nipple retraction

• Second only to lung cancer as the leading cause of cancer death in women'
• Typically the left breast, Upper/Outer quadrant
• Usually metastisize to axillary lymph nodes
• BRCA1/2 are gene mutations associated with an increase risk of developing breast cancer

• Enlargement of the male breast
• Excess estrogen
• Usually caused by Cirrhosis-it's inability to metabolize the estrogen

Female, >30, white (esp. Jewish), nulliparity, late age of 1st pregnancy

• Adenohypophysis
• Secrete: GH, LH, FSH, ACTH, TSH, Prolactin
• Trophic hormones: stimulate other endocrine glands

• Neurohypophysis
• Secretes: Oxytocin, ADH
• No trophic fxn

• Prolactinomas
• Hyperprolatinemia, inihibits LH
• pt c/o: amenorrhea, galactorrhea (spontaneous milk secretion unrelated to pregnancy), infertility
• Men: decrease libido, impotence

• Gigantism: Oversecretion of hGH in children.
• Acromegaly: Oversecretion of hGH in adults
• Causes hyperglycemia, hypercalcemia

Produce ACTH that stimulates the adrenal gland resulting in Cushing's Disease

• Produce LH/FSH
• Generally middle aged men
• Causes hypogonadism

• Insufficient ADH secretion or Kidney tubule receptor problem
• The inablity of the kidney to reabsorb water and results in dilute urine
• Polyuria, polydipsia, + water deprivation test

• Hyperthyroidism, autoimmune response to TSH receptors on the gland
• Tachycardia, exophlamous, thyrotoxicosis
• Greatly reduced TSH, Increaded T4

• Defective synthesis of thyroid hormones, poor fxning of the parenchyma due to finflammation or surgical resection, cancer, inadequate secretion of thyrotropin
• Sensitivity to cold, myxedema, bradycardia, decreased SV, CO, cool pale extremities

• Most common cause of hypothyroidism in the US
• Autoimmune, females 6:1

• Most common cancer of the thyroid
• Radiation exposure or genetic cause most common
• Not aggressive, could metastisize to lungs and obstruct trachea

• 4 glands
• 4th branchial arch
• 40 mg in weight
• 4 mm in diameter

• Usually due to parathyroid adenoma
• Hypercalcemia, hypophosphatemia
• Increased risk of kidney stones

• Accidental removal is most common cause during thyroidectomy
• hypocalcemia, increased muscle excitability

• Cushing's Syndrome
• caused by administration of exogenous glucocorticoids
• Primary hypothalmic/pituitary diseases assoc. with hypersecretion of ACTH, primary adrenocortical hyperplasia/neoplasia, secretion of ACTH by non endocrine glands
• Early: Wt gain, HTN
• Later: Moon facies, buffalo hump, purple striae

• Chronic Adrenocortical insufficiency, progressive destruction of the adrenal cortex.
• GI disturbances common, hyperpigmentation of the skin, hyperkalemia, hyponatremia hypotension

Neoplasms composed of chromaffin cells, secreting excessive amounts of Epi/NorEpi

• Most common extracranial solid tumor of childhood.
• Occurs in first 5 years of life

• flat lesion measuring less than 2 cm
• not raised or depressed, primarily just a color change
• Freckle

Similar to a macule but larger than 2 cm

• Slightly elevated, small induration of the skin with a diameter of less than 1 cm
• Hallmark of eczema

Similar to a papule but larger 1-5 cm

Nodule with a diameter exceeding 5 cm

• Fluid filled elevation of the epidermis measuring less than 1 cm.
• Herpes

• Vesicles measure more than 1 cm in diameter
• Severe burns with large blisters

• Vesicle filled with pus
• Impetigo, bacterial infection of the skin usuall in children

Sharp edged defet in the dermis that extends into the deeper layers of teh skin

• Defect or erosion of the epidermis
• Syphilitic chancre

• A skin defect that iscovered with coagulated plasma or blood
• Scab

• Keratin layers that cover the skin in flakes or sheets that can be easily scraped away
• Dandruff

Superficial skin defect caused by scratching

• Autosomal Dominant
• Child born with large thick scale resembling fish skin

• term used to denote several skin disorders
• Formation of large bulla upon rubbing of the skin or minor trauma

• Port Wine Mark
• Aggregate of small blood vessels usually on the face

• The most common congenital skin anomaly
• Normal skin elemens arranged irregularly

• Bleeding intothe soft tussues due to a disruption of the blood vessels
• Bruise

• A superficial tearing away fo the epidermal cells
• Road rash

A jagged tear often seen with streching of the skin and or underlying tissue

• A clean cut by a sharp object
• Scalpel

Deep tubular wound produced by a sharrp thin object

• Penetrating: when puncture pierces tissues
• Perforating: when puncture transversesteh tissue to make an exit

• First: Superficial involvement (sun burn)-mildest
• Second: Partial thickness-vesicle/bulla formation
• Thirtd: Full thickness-charring of the skin

• Tussue injury resulting from prolonged exposure to non freezing cold and moisture
• Trench foot
• Skin necrosis with blisters/ulcers

Injury caused by subfreezing temperatures

Occur on apparently normal skin

• Complicate pre existing skin diseases, wounds and ulcers
• Significant concerns with nosocomial infections

Skin involvment is only one of the manifestations of a blood borne infection

• Supericial infection involving Strep/Staph
• honey colred scabs
• Often on the face of children
• Highly contagious

• Infection is limited to teh hair follicles
• Most often caused by Staph

• Involving the hair shaft and teh perifollicular tissue
• Referred to as Boil

• The original furuncle now involves multiple hair shafts and become much larger
• Head or neck
• Males

• Fungal pathogen called dermophytes
• Tend to live in dead tissue
• Tinea pedis, capitis, manum, unguium, corporis
• (Foot, scalp, hand, nail, body)

• Used to denote numerous inflammatory skin diseases (dermatitis)
• Non specific lesions, pruritic
• Exogenous eczema-enviromental
• Endogenous eczema-immune basis

• Pt c/o erythema, scaling, itching of skin
• Especially nasolabial folds, eyebrows, upper chest

• slightly elevated papules and patches
• Covered in silvery scale, covers most extensor surfaces (elbows and knees)
• Usually not pruritic
• Excasserbated by stress or trauma

These originate from surface epidermis, hair shafts, subaceous glans and various eccrine and aporcrine sweat glands

• Most common benign epidermal tumor
• bleed easily
• "Stuck on" appearance

• Most common malignant skin tumor of epithelial origin
• Doesn't usually metastisize

• Occurs most often in sun exposed area
• Small flat plaque, persistant ulcer or slightly elevated

• May preceede SCC in the sun exposed areas
• Considered pre cancerous

• A macule or patch of skin in which the melanocytes show hyperactivity to UV light
• Freckle

Sharply demarcated macule occupided by increase number of melanocytes unresponsive to UV

Developmental skin abnormality consisting of an overabundance of melanocytes

• Cancerous tumor originating fromthe melanocytes
• Signs: persistant non healing ulcer containing friable bleeding tissue, ulcer of irregular shape
• A-asymetry of the lesions B-Borders (irregular) C-Color (marked variations) D-Diameter of lesion (typically >6mm)

• Remains localized for 10-15 years then becomes invasive
• Elderly

70% of all malignant pigmentary tumors and teh most common form.

Rapidly growing and infiltrating variant of melanoma

• Brittle bone disease
• abnormal development of type 1 collagen (Most Autosomal Dominant)
• Will often have a blue sclera

• Marble bone disease
• Caused by deficient osteoclastic activity
• Both Autosomal Dominant/Recessive forms

• Impaired maturation of cartilage in teh developing growth plate
• Major cause of Dwarfism
• Most common disorder for growth plates

• Bacterial infection of bones-most notably Staph
• Most often originates in the Metaphysis (neck)
• Children: often associated with bacteremia
• Adults: Most often complication of bone fractures or surgery and IV drug users

• Skeletal disorder characterized by low bone mass and micro architectureal deterioration
• Most common bone disorder seen in clinic

• Appears to be genetic predisposition
• Decreased estrogen
• Aging
• Women with small frames
• Caucasions

• Chronic corticosteriod administration
• Malignancies
• Malabsorbion syndromes
• Certain chronic prescription drugs
• smoking/alcohol abuse
• Inadequate CA intake

• Softening of the bones due to inadequate mineraliazation of the bone matrix
• Kids: Rickets
• Result of inaequate Vit. D/phosphorus

• Osteitis Deformans
• Excessive resorption of bone that causes cracks and fissures followed by excessive disorganized bone formation
• Most often affects the cranium and the long bones of the lower extremities

• Primary are rare
• Secondary: 10:1, mostly breast, prostate, lung, kidney and thyroid

• Benign lesions of the bone
• Most common in the head and neck
• Not invasive

• Benign tumors of the cartilage
• Occasionally give rise to malagnant tumors

• Benign lesions of fibroblasts
• Space occupying lesion

• 4 Most common
• Osteosarcoma 10-25
• Chondrosarcoma 35-60
• Ewing's sarcoma 10-20
• Giant cell tumor 20-40
• More often in males

• Most common primary malignant bone tumor in children
• Most ofent involves the metaphysis of long bones
• 50% in the knee

• Most commonly found in the axial skeleton
• Insensitive to chemo

• Second most common tumor of bones in children
• Typically in diaphysis

• Degenerative Joint Disease (DJD)
• Most common form of joint disease
• Primary: Unknown
• Secondary: Normal wear/tear of articular cartilage
• Erosion of wt bearing joints and fingers, narrowing joint space, not inflammatory

• Chronic, SYMETRICAL inflammation of joints
• More common in women
• Proliferation of synovium, joint erodes and can be completely obliterated

• Borrelia burgdorferi, bacterial
• TX by deer ticks
• Migrating skin rash, target lesion, most often affects the knee

• Hyperuricemia, deposition of uric acid in tissues
• Mostly male, overproducers of uric acid
• Secondary: other diseases resulting in increased uric acid
• Most common is acute painfull swelling of the big toe metatarsalphalangial joint
• Chronic: Less inflammation, more deformaties, uric acid kidney stones

• Acquired autoimmune disease, muscular weakness
• Autoantibodies are direted against the acetylcholine receptors
• Eyelids show ptosis, "mask like" facies, death from paralysis of the diaphram

• The most common type of muscular dystrophy
• X linked recessive
• Avg. onset 3-5 yrs, initiall affects the pelvic girdle, mental retardation
• Die usually by 25

• Mild Duchenne's, X linked recessive
• Onset later, 5-10
• Deformaties and disablities progress slower

• Second most common genetic muslce disorder
• Autosomal Dominant
• Symptoms apprear in adulthood
• Frontal baldness, testicular atrophy, "Hatchet" face, ptosis of eyelids
• Muscles can contract but remain contracted for some time

• Generalized muscle weakness
• Floppy child syndrome
• Cerebral Palsy: Upper neuron disorder, most common muscle weakness disorder in children

• Malignant mesenchymal neoplasm that exhibitis skeletal muscle differentiation
• Most common sarcoma in the pediatric pop.

• Highly malignant
• Doesn't arise from synovial cells

Benign lesion that present as well defined mobile nodules in the dermis or subcutaneous tissue

Often involves dermis and subcutaneous tissue

• Most common Sarcoma of adults
• Aggressive soft tissue sarcoma

Benign, well circumscribed tumor consisting of well differentiated addipocytes

• Second most common sarcoma of adulthood
• Malignant fat cells

• Accumulation of blood between teh skull and the dura
• Ruptured meningeal artery from fractured temporal bone
• Could take hours for large hematoma to form
• Initial loss of conscienceness, short period of lucidity, followed by rapidly developing signs of cerebral compression

• Accumulation of blood between teh dura and the arachnoid
• Bridging VEINS between the dura and the arachnoid are torn
• Venous blood will clot faster
• Gradual signs occuring hours-days-weeks after injury

• Bleeding between the arachnoid membrane and the surface of the brain (pia mater)
• Often caused by traumatic contusion to the brain, blood vessels from base of brain leak into the potential space
• Ruptured congenital "berry" aneurysms of the circl of willis

• Small aneurysm's at the base of the brain in the cirlce of willis.
• Sudden severe HA, followed by coma
• Associated with polycystic kidney disease

• Usually confined to larger cerebral arteries (vertebral, basilar, internal corotid)
• Provides a site for a thrombus to form

• Contusion of the cortex of the brain with bleeding from the ruptured intracerebral vessels
• Common in all types of head trauma
• Common in Leukemia

• Most important manifestation is strokes
• Due to atherosclerosis of the cerebral arteries
• Eventual complete disruptionfo blood flow can result leading to an infarct

• Global: affects the entire brain due to lack of perfusion often during shock
• Regional: Usually caused by a throbosis in a cerbral artery (stroke or CVA) most commonly at the site of trifurcation of the middle cerebral artery

• Embolisms cause an abrupt cerebral dysfunction
• Thrombus cause gradual onset of symptoms
• Sudden onset of paralysis of portions of the contralateral side of the body, partial loss of vision in one eye, inabiliity to speak, drooping mouth, loss of conscienceness

Infection of CSF between the pia mater and arachnoid, usually caused by hematogenous spread

Infection of the dura mater ususally due to contiguous infection of the sinus or mastoids

• Most caused by Group B Strep and E coli (neonates)
• HIB
• Strep pneumo (most cases in older adults and young children)
• Neisseria Meningitides (older children, adolescents, young adults

• Pt. c/o HA, vomiting, + Kernigs, + Brudzinski,
• CSF: Cloudy, low glucose, high protien, neutrophils

• Usually due to coxsackie virus, echo virus, mumpus, EBV, HSV
• pt c/o HA, vomiting, fever
• +Kernigs, Brudzinski
• CSF-Clear, normal to eleveated protien, normal glucose, + lymphocytes

• TX by saliva of infected animal (carnivore), virus travels via peripherial nerve to CNS
• If reaches brain, fatal-brain stem inflammation then cerebellum and hypothalamus

• Most common CNS disease in the US
• Affects women more, rarely before puberty or after 50
• Demylinating disease of CNS
• Dx made by 2 seperate sets of CNS symptoms that occur in at least 2 episodes separated by a month or morept presents with parasthesia with tingling

• Form of dementia, result of deposits of beta amyloid wich form plaques in the cerebral cortex
• Gradual loss of memory and cognitive ability along with peronality changes

• Loss of pigmented neurons in the subsantia nigra of midbrain which control muscle activitiy
• Cogwheel rigidity found on PE
• pt has slowness of voluntary muscular movement and a resting tremor of the hands

• Autosomal Dominant neurodegenerative disorder
• Primarily affects striatal neurons and the cerebral cortex
• pt presents with involuntary gyrating movements of the trunk and limb (choreiform gait), postural instabliity
• pt deteriorates rapidly

• Near sighted
• Image is focused in front of the vision field

• Farsighted
• Image would be focused behind the vision field

• Irregular lens or cornea result in uneven refraction fo the light
• Most common eye problem

• Farsightedness of old age
• Thought to be loss of elasticity of lens

• "Lazy eye"
• The eye's don't align and focus on the same object
• Negatively affects the depth perception

• Pink eye-Highly contagious
• Infection fo the conjunciva lining the anterior side of the eye and the inside of the palpebrae

Inflammed and blocked tear duct

• Stye
• Infection of the hair follicle or sweat gland

Blockage of a hair follicle or sweat gland

Inflammation of the eyelids

When an infection extends into the cornea or when conjunctivitis presents as an ulcerating disease

• Conjunctivitis caused by Chlamydia trachomatis also vectored by a fly
• Leading cause of preventable blindness world wide

Opacity of the normally clear lens

• Infection of the outer ear
• Could be bacterial, viral, fungal

Often children suffering from atopic dermatitis

• Middle ear infetion usually from upper resp. infection causing edema of the eustachian tube and accumulation of fluid
• Chronic: May put tubes in

• Benign tumor, pearly white appearance
• Epidermal inclusion cyst

• Autosomal Dominant appearing in 30's-40's
• Bilateral hearing loss, worse in one ear
• Deposits bone on both sides of oval window encompasssing bones of the middle ear preventing movement

• Episodic vertigo
• Tinnitus

• Conductive: Assoc. with TM dysfxn, external/middle ear
• Sensory: Cochlear abnormalities, repetitive noise trauma,
• Neural: Least common, damage to the CN, MS, CVA