Category: Year 5

Syphilitic Aortic Aneurysm

Tertiary syphilis:
1. cardiovascular syphilis,
2. neurosyphilis (meningovascular syphilis, tabes dorsalis and general paralysis of the insane ).
3. “benign “tertiary syphilis.
After 5 years in 1/3rd of untreated patient

Cardiovascular syphilis
80% of cases of tertiary syphilis
Probably immune mediated
Endarteritis of the vaso vasorum leading to fibrosis of the media
Increasing dilatation of the aortic root (leading to aortic incompetence) and arch (leading to an aneurysm).
Also, obstruction of the coronary artery ostia leading to ischaemia

Other causes of aortitis:
1. Giant cell arteritis (>50).
2. Takayasu’s arteritis (<50).
Both may involve the eye.

Avraham Z. Cooper, MD @AvrahamCooperMD
“Pulsatile chest swelling ➡️ HUGE aortic aneurysm from tertiary syphilis.”

Answers to Questions Posted after Year 5 UGI Pathology Lecture

what are the key distinguishing factors that determine if a histological sample is dysplastic or cancer?
Invasion through the baseman membrane into the underlying connective tissue ( in the stomach that is into the lamina propria).

what causes squamous cell carcinoma? (ie you referenced it occurs more commonly in developing countries).
Smoking and/ or alcohol are important. HPV infection also has a role.

I think I missed it but what is CLO-IM?
Columnar Line Oesophagus- Intestinal Metaplasia

Is there such thing as chronic oesophagitis? Or does the inflammation just progress to Barrett’s over time?
These is, for example, with chronic gastro-oesophageal reflux. This will increase the risk of metaplasia

Are there any practical tests for determining cag-A status of H. pylori infections and are these tests used clinically at all?
The tests exist but are not used in routine clinical practice

How common is shock due to ulcer haemorrhage?
It depends how sever the haemorrhage is. Most bleeding from ulcers do not produce shock.

is there a genetic component? i.e. Japanese man migrating to England? (if that makes sense)
There is, and you give a good example, but environmental factors are also important. For example, even when people move they may take their diet with them.

why is there a high incidence in specifically in japan?
It is not only Japan that has a very high incidence: South Korea and Mongolia have even higher incidences. There are environmental as well as genetic factors but it is known that chronic gastritis with intesitnal metaplasia is commoner and more severe in these areas.

Can intestinal gastric cancer progress to diffuse?
I don’t think so but I know nothing published about this. Mixed intestinal and diffuse cancers are not uncommon.

are giardia and Whipple’s disease also associated with immunosuppression?
They are (as are almost all infections).

Answers to Questions Posted after Year 5 Pancreas and Gall Bladder Pathology Lecture.

How does Hyperlipidaemia result in pancreatitis? Good question, I had to look up the answer. There are 2 theories. The first is that the FFAs directly damage the pancreas and the second that chylomicrons cause increased plasma viscosity causing pancreatic ischemia,

how do these patients present? If you mean acute and/ or chronic pancreatitis, I refer you to any standard clinical textbook.

What’s the difference between a carcinoma and neoplasms? The term neoplasm includes both benign and malignant “new growths) A carcinoma is a malignant neoplasm of epithelial cells. It includes adenocarcinomas and squamous cell carcinoma.

On firms, someone presented a case where a patient had autoimmune pancreatitis, but with normal IgG4 plasma cell levels/serum IgG4 cells. Presumably this is not common, but is this likely to be related to the ‘IgG4 Related Diseases’ or another pathophysiology entirely? There are 2 types of auto-immune pancreatitis; type 1 is part of IgG4-RD and type 2 is not . It sounds like your case was an example of type 2.

What does the PAAN abbreviation stand for? I think you mean PanIN. This stands or Pancreatic Intra-epithelial Neoplasia.

Re Carcinoma of head of pancreas – does that mean they have better prognosis if diagnosed earlier? Or is timing irrelevant to prognosis? The earlier they present the less time there will have been for the cancer to spread. This will make it an earlier stage and early stage cancers have a better prognosis.

how do patients with igg4 related disease present? Wait until my lecture on Systemic Diseases! The pancreas is the commonest site but virtually any organ in the body can be involved.

Why are transplants not so successful in pancreatic cancer? Because they are an aggressive cancer and the immunosuppression for transplantation would mean the tumour would spread more quickly. The same is, of course, true for many other kinds of cancers.

Are thiazide diuretics directly noxious to pancreas or is it because they cause hypercalcaemia? Thiazides cause both hyperlipidaemia and hypercalcaemia either which can lead to pancreatitis

Where can I find your blog?

What textbooks would you recommend to be able to understand histopathology images better (and be able to know what we’re looking at). I think any of the standard undergraduate pathology textbooks would be fine. The latest edition of Muirs has just been published and is a good choice.

What practical do these diverticula have on management? Do you mean Rokitansky-Aschoff Sinuses in the gall bladder. If you do, then they have no impact on management – they are only identified when the gall bladder is removed.

Why is it so common in Chile? You are talking about gall bladder cancer The answer is, as ever, there are environmental (commoner as you go higher up the Andes) and genetic (commoner in the indigenous population).

Is alcohol not a drug? An interesting philosophical question. I think you are right but we tend to look at it separately as it very widely used, self-prescribed and not taken to treat disease.

paan is pancreatic atypical anaplastic neoplasia i’ve found out I am not sure that I understand this but see above. You can get anaplastic (undifferentiated) carcinomas in the pancreas as you can in any other organ,