Pathology Enrichment Session - Cellular Pathology
A 23-year-old woman presents to her primary care provider with recurrent sinus infections, bronchiectasis, and infertility. Physical examination reveals that the heart sounds are on the right side. Which of the following mechanisms best describes the patient's condition?
A defect in microtubule organization
A 38-year-old alcoholic man is brought to the emergency department with severe upper abdominal pain and vomiting of forty minutes duration. The pain is located in the mid-epigastrium and radiates to the back. Physical examination reveals hypotension, tachycardia and marked epigastric tenderness. The patient dies in spite of all resuscitative efforts. An autopsy is performed and the pancreas with attached mesentery is shown in the attached image. Which of the following is the underlying mechanism of the cause of death in this patient?
Action of pancreatic enzymes on adipose tissue
An autopsy was performed on a 77-year-old woman who died of renal failure. A total occlusion of her left renal artery by an atherosclerotic embolus was identified. A section of her left kidney is shown in the attached image. Which of the following is the most likely pathomorphologic diagnosis?
Coagulative necrosis
A 44-year-old woman presents to her family physician with fever and recently exacerbated chronic cough with production of copious amount of mucus. The patient reports a 20-pack-year history of smoking. After failing treatment with antibiotics, she undergoes a bronchoscopic biopsy. Which of the following microscopic features will most likely be found under the microscope?
Hyperplasia of submucosal glands
A 10-year-old boy is brought to the orthopedic surgeon for a follow-up examination. Three months ago, he sustained a complex fracture of the left tibia, which required cast immobilization. The cast is removed. Examination shows that the circumference of the left calf is smaller than that of the right calf. Which of the following processes in this patient's myocytes is the most likely cause of these findings?
Increased protein degradation via the ubiquitin-proteasome pathway
A 41-year-old man presented to the primary care provider with chronic heartburn. An endoscopy and an esophageal biopsy were performed, and microscopic appearance of the esophageal mucosa is presented in the attached image. Which of the following terms best designates the shown findings?
Intestinal metaplasia
An 76-year-old woman is brought to the emergency department with very severe headache. She died a few hours later before any investigations could be performed. An autopsy was ordered to determine the exact cause of death. During the autopsy, it was found that the heart was small in size, weighing 250 grams, with prominent, tortuous blood vessels. Microscopic examination of the heart is most likely to reveal an accumulation of which of the following pigments?
Lipofuscin
A 76-year-old man in admitted to the hospital with clinical features of stroke of 6-hour duration. A head MRI reveals a cerebral infarction. 5 days after the onset of symptoms, the patient dies, and an autopsy is performed. Which of the following pathomorphologic changes are most likely to be found in the brain?
Liquefactive necrosis
A 45-year-old woman with a parathyroid adenoma and hyperparathyroidism undergoes a CT scan, which reveals extensive calcium deposits in the lungs and kidney parenchyma. Which of the following mechanisms best explains these radiologic findings?
Metastatic calcification due to deranged calcium metabolism
A pathologist examined a liver biopsy taken from a 35-year-old man under the light microscope. Histological findings are shown in the attached image. This is an example of which one of the following processes?
Steatosis
A 75-year-old woman dies a few days after an episode of severe chest pain. Postmortem examination reveals an occlusive thrombus in the circumflex artery and a 1-cm focus of yellowish tissue with a hemorrhagic border in the lateral wall of the left ventricle. Which of the following types of tissue damage will most likely be identified with microscopic examination of the affected myocardium?
coagulative necrosis
A 49-year-old man with a history of alcohol abuse has increasing abdominal girth. On examination his liver edge is firm. A liver biopsy reveals pronounced inflammatory response, and severe hepatocyte injury; individual hepatocytes contain globular eosinophilic inclusions. Which of the following structural elements are those intracellular globules most likely contain?
cytokeratin filaments
A 38-year-old man has a health screening examination. He has a routine chest x-ray that shows a 2 cm partially calcified nodule in the right lower lobe. The nodule is resected and the following microscopic examination reveals caseous necrosis with calcification. Which of the following processes explains the appearance of the calcium deposits?
dystrophic calcification
A 40-year-old woman has sudden onset of severe abdominal pain. Physical examination reveals diffuse tenderness in all abdominal quadrants, with marked guarding and muscular rigidity. Laboratory findings include serum AST- 43 U/L, ALT-30 U/L, LDH 630 U/L, and lipase 415 U/L. An abdominal CT scan reveals peritoneal fluid collections and decreased attenuation along with an enlarged pancreas. Which of the following cellular changes will most likely be identified in the per pancreatic tissues?
fat necrosis
A 35-year-old woman with a history of familial hypercholesterolemia is brought to the emergency department with crushing retrosternal chest pain of one-hour duration. Laboratory evaluations reveal elevated serum levels of CK-MB and troponins. Coronary angiography reveals an occlusive thrombus in the right coronary artery. A stent is placed in the right coronary artery with restoration of normal coronary blood flow. The patient's condition is not improved, and his serum levels of CK-MB and troponins are found to have increased. Which of the following best explains the pathogenesis of this phenomenon?
generation of ROS
Lou Ferrigno began lifting weights at the age of thirteen. As a body builder, he later became Mr. Universe and eventually played the role of The Hulk in the CBS television series "The incredible Hulk." As a body builder, his muscles have undergone which of the following changes?
hypertrophy
A 64-year-old woman presents to the primary care provider with regular heart burns of several year duration. She has treated herself with a histamine H2-receptor antagonist that provided only partial relief. Past medical history and physical examination are unremarkable. An upper GI endoscopy reveals irregular hyperemic areas in the distal 4 cm of the esophagus. An esophageal biopsy taken from one of those areas shows normal-appearing papillary intestinal-like mucosa. The described gross and microscopic findings are most likely consistent with which of the following morphologic diagnoses?
intestinal metaplasia
A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region. She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells through fragmentation of individual cell nuclei and cytoplasm. Over the next 2 months, the lymphoma decreases in size, as documented on abdominal CT scans. By which of the following mechanisms has the neoplasm primarily responded to therapy?
intrinsic pathway involving caspase 9
A 56-year-old woman presents to her family physician with fatigue, loss of weight and appetite, and hemoptysis that have been progressed over the past few months. She reports a 40-pack-year history of smoking. Chest x-ray reveals a 4-cm mass in the right hilar area and widening of the mediastinum. Laboratory findings are remarkable for elevated serum Ca++ and PTH-r peptide levels. Which of the following pathologic processes is most likely associated with the described biochemical findings?
metastatic calcification
In an experiment, a disease process is found, which leads to scattered loss of individual cells, formation of dense eosinophilic cellular fragments containing nuclear remnants. The overall tissue structure remains intact. This process is most typical for which of the following diseases?
viral hepatitis
An autopsy is performed on a 53-year-old woman who died in a vehicular accident. Examination of her medical records reveals that she had undergone radiation therapy for a laryngeal squamous cell carcinoma one month ago. Microscopic examination of the laryngeal tissues reveals scattered neoplastic cells with shrunken, markedly eosinophilic cytoplasm and pyknotic, fragmented nuclei. Which of the following proteins, if released into the cytosol, acts as a trigger for the described microscopic findings?
Cytochrome c
A 30-year-old woman is claiming in a civil lawsuit that her husband has abused her for the past year. A workup by her physician reveals a 2 cm left breast mass. There is no lymphadenopathy. No skin lesions are seen, other than a bruise to her upper arm. A needle biopsy of the breast mass is performed. The biopsy is taken and the following microscopic examination reveals anucleated adipocytes and calcium deposits. This biopsy result is most consistent with which of the following etiologies?
breast trauma
A lung specimen from an 81-year-old woman, a chronic smoker, is examined at autopsy. The gross appearance of the lung is shown in the attached image. Which of the following would most likely be found at histology?
carbon-carrying macrophages
