Cellular pathology

This is homework in the past year .. If you did this homework for the past year perfectly .. I will make you answer the homework for this year.. my homework after the next week .. Please please avoid p lagiarism … There are two files on the lecture from the doctor tasked with summarizing the course .. also the homework file past year

Questions

 

There are 3 mandatory case studies. You must answer all three

 

Submit your answers in a single Word document, clearly indicating your name, student number, and each Case Study number and sub-section

 CASE STUDY ONE

A 32-year-old man presents to his GP with symptoms of productive cough and fever. He is a non-smoker and does not have any past medical history. He works as a civil engineer and he does not drink any alcohol. There is no history of any recent travel.

The patient looks unwell, his temperature is 37.9°C and stethoscope testing of his chest indicates pneumonia. Routine blood tests confirm infection. He is prescribed antibiotics.

The patient returns several weeks later with no significant improvement. The GP sends for some further blood tests. Liver function tests are still abnormal indicating an underlying liver pathology. The results are below:

 

Test	Result
Bilirubin	18
Aspartate aminotransferase	114
Alkaline phosphatase	196
Ferritin	1100
HIV	Negative
CMB	Negative
EBV	Negative
Hep A, B and C	Negative
Serum iron	30
Transferrin saturation	70%
Total iron binding capacity	40

 

The results indicate high levels of ferritin, indicative of haemochromatosis.

 

1. What type of tissue sample, would be taken to confirm this diagnosis? (2 marks)

 

 

1. List the special stains comprising a liver panel/set (6 marks) and explain how you would expect this panel to stain on a tissue sample from this patient and facilitate confirmation of the diagnosis of haemochromatosis (6 marks) NB 12 marks in total for part b)

 

 

1. There are two forms of haemochromatosis (primary and secondary). Explain the differences between these two types of haemochromatosis (5 marks)

 

 

1. Discuss the use of Cellular Pathology and Molecular techniques in the confirmation of primary haemochromatosis (6 marks)
2. What types of quality control measures would be applied in the Cellular Pathology laboratory in order to assure the quality of staining on the liver tissue sample? (5 marks)

CASE STUDY TWO

A 54-year-old male who is a long-term smoker presents with a history of worsening cough with haemoptysis. He confesses to a poor appetite and weight loss of over 5kg over the past 3 months. He works as a builder and is unable to say whether he may have been exposed to asbestos.

The patient appears emaciated. There is conjunctival pallor (indicative of anaemia) and digital (finger) clubbing. Examination of the chest reveals reduced breath sounds. Palpation of the abdomen and lymph nodes is unremarkable.

1. What is the most likely suspected pathological diagnosis in this case? (2 marks)
2. In terms of cellular pathology tests/techniques, how might this suspected diagnosis be confirmed? Your answer should include description of all steps from sample receipt to microscopy (16 marks)

Assuming that a malignant diagnosis is confirmed, below is a table of available antibodies:

 

CA125	CK14	NSE
CD10	CK20	P63
CDX2	ER	PR
Chromogranin A	GCDFP	Synaptophysin
CK5/6	Hep B	TTF1
CK7	HER2	Vimentin

 

1. Select those antibodies which could be used to distinguish between a final diagnosis of non-small cell adenocarcinoma and squamous cell carcinoma and explain your reasons for selection of each (14 marks)
2. If a diagnosis of NSCLC were confirmed, explain which additional Cell Path and /or molecular tests might be performed in terms of assessing patient prognosis/treatment options. Your answer should make reference to the 4 main altered genes which have been shown to be associated with the development of lung cancer (8 marks)

CASE STUDY THREE

 

A 55-year-old woman presents to the Emergency Department after slipping on an icy road and falling on her outstretched right hand. She complains of pain in her right wrist which has not responded to simple analgesia and has been unable to use her right hand since falling. She has a history of polymyalgia rheumatica though has not had a flare up for a couple of years. She is a non-smoker.

X-rays confirm she has a transverse fracture of the distal radius with minimal dorsal displacement of the wrist; there is also a fracture to the ulnar.

 

1. What type of sample could be taken for histopathological diagnosis? (2 marks)

 

 

 

1. There are three main reasons to obtain a bone biopsy. List the 3 reasons including an example of each. Interpret which would be pertinent to this case (4 marks)

 

 

 

1. Explain the difference between a genetic bone disorder (GBD) and a metabolic bone disease (MBD) (2 marks)

 

 

 

1. Describe how handling of this type of sample would be different from that described in Case Study 2 part b) (4 marks)

 

 

 

 

The following is a list of commonly used special stains for bone:

 

Alizarin Red	Aniline blue	Goldner’s trichrome
H&E	Masson Trichrome	PAS
Reticulin	Schmorl’s	Toluidine blue
Van Gieson	Von Kossa

 

1. Explain which of these you would choose to facilitate confirmation of a diagnosis of osteoporosis in a non-mineralised sample of bone (8 marks)
2. If two bone samples were received by the Cellular Pathology laboratory, and the request cards indicated that one was suspected as having osteoporosis and the other was suspected of bone cancer; what would be the implications of mixing these two samples up? Your answer should include impact on the patient and their diagnosis, as well as the measures in place in the laboratory which aim to prevent this happening (10 marks)

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