Rapid Revision Reignite Pathology: Question-Answer Format | PrepLadder

Cell Injury

Big Question 1: What is Caseous Necrosis and where is it seen?

Broad Answer: Caseous necrosis is a form of tissue necrosis with a cheese-like (caseous) gross appearance. It is most characteristically seen in tuberculosis and fungal infections. Microscopically, it shows amorphous, granular, eosinophilic debris surrounded by inflammatory cells.

Detailed Questions

Q1.1: What is caseous necrosis?

Answer: A combination of Coagulative Necrosis (more common) + Liquefactive Necrosis.

• Cheese-like, soft, white gross appearance.
• A type of necrosis with a cheese-like, soft, white gross appearance.

Q1.2: Where is caseous necrosis commonly seen?

Answer:

• Tuberculosis.
• Fungal infections(histoplasmosis, coccidioidomycosis)

Q1.3: What is the microscopic appearance of caseous necrosis?

Answer:

• Amorphous, granular, eosinophilic debris.
• Surrounded by a border of inflammatory cells.

Neoplasia

Big Question 2: How are neoplasms classified and what are their histological variants?

Broad Answer: Neoplasms are classified into benign or malignant tumors, with specific nomenclature patterns and structural features. Some tumors defy naming conventions, while others originate from multiple germ layers or show mixed components.

Detailed Questions

Q2.1: How are benign tumors named and what are exceptions to the naming rule?

Answer:

• Benign tumors usually end with the suffix "-oma”
• Exceptions (though malignant):
  • Lymphoma
  • Melanoma
  • Seminoma
  • Chloroma (AML in soft tissue like orbit)

Q2.2: What distinguishes carcinomas from sarcomas?

Answer:

• Both are malignant tumors
• Carcinomas: arise from epithelial tissue
• Sarcomas: arise from mesenchymal tissue

Q2.3: What is a teratoma and its types?

Answer:

• Tumor derived from 2 or more germ layers
• Types:
  • Mature teratoma: Benign
  • Immature teratoma: May be malignant
• Example: Dermoid cyst = Mature cystic teratoma

Q2.4: What is a mixed tumor and give an example?

Answer:

• Tumor with epithelial and mesenchymal components
• Example: Pleomorphic adenoma (benign mixed tumor)

Q2.5: What is a hamartoma?

Answer:

• Haphazard proliferation of native tissue
• Example: Pulmonary hamartoma

Inflammation

Big Question 3: What are NETs and Emperipolesis in inflammation?

Broad Answer: NETs (Neutrophil Extracellular Traps) and Emperipolesis are specialized processes in inflammation, involved in defense and unique cell interactions.

Detailed Questions

Q3.1: What are NETs and why are they called beneficial suicide?

Answer:

• NETs = nuclear chromatin released outside cell - traps bacteria
• Occur in severe infections (e.g., sepsis)
• Cell dies - “beneficial suicide”
• Amino acid involved: Arginine
• NETs -extracellular killing; phagocytosis - intracellular
• NETs - possible source of ANA - SLE

Q3.2: What is emperipolesis?

Answer:

• Cell-within-a-cell phenomenon (no killing)
• Seen in:
  • M - MDS/MPN
  • A - AIH
  • R -Rosai-Dorfman disease
  • C- CLL

Big Question 4 : What are the features and mechanisms of chronic inflammation and granulomas?

Broad Answer:

• Chronic inflammation involves macrophages, lymphocytes, and plasma cells, often forming granulomas with distinct cellular structures.
• Types of Cells:
  • Lymphocytes
  • Macrophages (most important)
  • Plasma cells

Q4.1: What are macrophage names in various organs?

Q4.2: What are the components of granuloma?

Answer:

• Caseous necrosis (at centre)
  • Present: Caseating granuloma
  • Absent: Non-caseating granuloma
  • Both caseating and non-caseating granuloma: TB (caseating more common), sarcoidosis (non-caseating more common)
• Lymphocytic collar (at periphery)
  • TH1 lymphocyte: IFNγ
  • Absent: Naked granuloma (sarcoidosis).
• Nuclei of cells surrounding caseous necrosis:
  • Round nucleus - Macrophages
  • Slipper-shaped nucleus - Modified macrophages or Epithelioid cells (most important cells of granuloma)
• MNGC or multinucleated giant cells.
  • Fusion of macrophages.

Q4.3: What are types of multinucleated giant cells?

Answer:

Q4.4: What special types of granulomas exist?

Answer: Stellate - cat scratch, LGV (lymphogranuloma venereum)

Doughnut - Q fever, allopurinol

Durck  -  Cerebral malaria (Plasmodium falciparum), Field stain (special stain)

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