09-PATHOLOGY

Hodgkin lymphoma
neopl:non neoplastic cell=1:100

in
classic-CD15+,30+,20–,45–(LCA), Pax5, Oct2, Prob1
NS
MC
LD(HIV+ve)-neopl:non neopl=1:10

s.
LR
LP-CD15–,30–,20+,45+

Reed-Sternberg cell(germinal centre Bcell) -Hodgkin lymphom

lacunar(owl eye nucleus)-NS
owL eye-cLassicaL HL
mononuclear-MC,LR
Popcorn-LP
Rx-ABVD regimen
iim
non Hodgkin lymphoma
neoplast>non neoplast cell
4a
staging-morphology of cell
Bcell
high grade
DLBCL
Burkitt lymphoma
mantle cell lymphoma
m

low grade
follicular
indolent
CLL(bone marrow,bld)/SLL(LN,Spleen)
Richter transformat-low grade→high
Ai

maltoma
Tcell
Anaplastic Large Cell Lymphoma(ALCL)
angiocentric lymphoma
angioimmunoblastic lymphoma
mycosis fungoides/Sezary synd(disseminated MF)
enteropathy(coeliac ds) associated Tcell lymphoma
 lineage marker
Bcell-CD10,19,21,22,23,79a, Pax5, Oct2, Prob1
T cell-CD2,3,4,5,7,8
NK cell-CD16,56
Plasma cell-CD38,138

lymphocyte sp marker
ALCL-CD30, EMA, ALK1

in
BCLL/SLL-CD5,23
Burkitt lymphoma-Bcl6, CD20
follicular lymphoma-Bcl2
hairy cell leukem-annexinA1, CD25,103, DBA44
mantle cell lymph-cyclinD1(Bcl1), CD5,CD23–

s.
morphology
ALCL-doughnut cell, halmark cell
BCLL/SLL-small cleaved/smudge cell
iim
Burkitt lymphoma-starry sky
follicular lymphoma-follicular cell, buttock cell
hairy cell leukemia-cell with hair like projection, fried egg app, TRAP+ve
mycosis fungoides-cerebriform nucl, Sezary cell, Pautriers abscess

genetic marker
ALCL-t(2;5)
4a
Burkitt lymphoma-t(2;18), t(8;14)/cmyc protooncogene, t(8;22)
DLBCL-cmyc
follicular lymphoma-t(11,18)
MCL-t(11,14)

plasma cell neoplasm

plasma cell leukemia
m

=MM+peripheral bld plasma cell> 20%(>2000/mm³)

multiple/plasma cell myeloma(MM)
=clonal proliferation of plasma cell+ M protein>30g/l+ end organ damage
C-hyperCalcemia
Ai

R-Renal insufficiency
A-Anaemia
B-Bone lesion
smouldering/asymptomatic myeloma
=MM–end organ damage
monoclonal gammopathy of undetermined significance
=plasma cell<10%+ M protein<30g/l+ no end organ damage
 multiple myeloma
Mott cell(grape like inclusion in cell)
flame cell(bluish)
Russel body
Dutcher body
starry sky app

myeloid neoplasm

in
myeloproliferative neoplasm
proliferation of mature myeloid cell
cytosis of affected lineage
cytopenia of other lineage
<20%blast

s.
CML, polycythemia vera, essential thrombocytosis, c/c neutrophilic leukemia, c/c
eosinophilic leukemia, mastocytosis
prim myelofibrosis-obliterat marrow fibrosis, collagen deposit in marrow,
leukoerythroblastosis, teardrop RBC(dacryocy te)
myelodysplastic synd iim
dysplasia in myeloid precursor
cytopenia of affected lineage
norm other lineage
hypercellular bone marrow
<20%blast
refractory cytopenia
4a
RCUD(unilineage dysplasia)
RCMD(multilineage)
RARS(ref anaem with ring sideroblast)
RAEB (ref anaemia with excess blast)
MPN/MDS/atypical CML
(BCR-ABL–ve, Ph chr 9-22–ve)
<20%blast
m

c/c myeomonocytic leukemia

JMML(Juvenile MyeloMonocytic Leukemia)
AML
>20%blast
Ai

<20%blast+t(8:21)/t(15:17)
WHO classific
AML with recur genetic abnorm
AML a/w MPN
AML a/w MDS
Down synd ass AML
therapy related AML
AML not otherwise specified
 M0-AML without differentiat
M1-AML without maturat
M2-a/c myeloblastic leukemia(MC)
M3-a/c promyelocytic leukemia-DIC, t(15:17)-good progn, multiple Auer rod(prim
granule), Rx-All transretinoic acid
M4-a/c myelomonocytic leukemia-gum infiltration, HSM
M4Eo-M4+eosinophilia-i(16)-good progn
M5-a/c monoblastic leukemia, gum hyperplasia

in
M6-a/c erythroid leukemia-glycophorin A, NSE–ve
M7-a/c megakaryoblastic leukemia-Down synd
Dx-myeloblast-abundant granular cytoplasm, multiple prom nucleoli, Auer rod,
azurophilic granule
promyelocyte-Faggot cell

s.
monoblast-abundant agranular cytoplasm, folded nucleus
lymphoblast-scanty agranular cytoplasm, no nucleoli

cell—special stain—CD marker

iim
myeloblast-myeloperoxidase,Sudan black-MPO,CD117
promyelocyte-MPO,Sudan black,weak NSE-MPO,CD117
monoblast-strong NSE-CD11,13,15,33, 64,lysozyme,NSE
erythroblast-PAS-glycophorin
megakaryoblast-esterase-CD41,42,61

myeloid/granulocytic sarcoma
4a
extramedull prolifer of blast
MPO>CD117

CML
Ph chr-22,tyrosine kinase
c/c phase
<10%blast
m

accelerat phase
10-20%blast
blast phase
≥20%blast
Ai

myeloid sarcoma

polycythemia vera
Hb(g%)-mal>18.5,fem>16.5
sr erythropoietin-↓
JAK2 mutat

essential thrombocytosis
 PLT>4.5lac/dl
bone marrow-↑↑megakaryocyte
JAK2 mutat

ALL
t(4;11)
L4-mature Bcell
Tcell lymphoblastic-mediastin mass

in
myeloid sp marker
CD4,11b,13,15,33,117,cMPO

CD marker-cell

s.
CD1a-thymocyte,Langerhans cell
CD3-panTcell
CD13,14,15,53-monocyte,macrophage
CD15,30-classical Hodgkin ds
CD16(ADCC),56-NK cell
CD19-panBcell
iim
CD20-lymphocyte predominant HL
CD21-EBV receptor
CD31(PECAM1)-diapedesis
CD34-aplastic anemia,rolling
CD38,138-plasma cell
4a
CD41-PLT
CD45-all leukocyte(leukoc comm Ag)
CD45RA-medullary(naive Tcell)
CD45RB-all leukocyte
CD45RC-subunit T medullar thymocyte, naive Tcell
CD45RD-subunit T cortical thymocyte, memory Tcell
CD55,59-PNH
m

CD95(FAS)-death recept domain, extrinsic pathway apoptosis

CD99-Ewing sarcoma
CD99(mic2)-ALL
CD117-GIST,granulocytic sarcoma
Ai

CD133-astrocytic glioma
CD271-p75 nGF receptor

bone marrow
fibrotic(dry tap)-myelofibrosis, hairy cell leukemia, megakaryoblastic leukemia
intensely hypercellular-leukem, lymphom
reduced cellularity-aplastic anemia, sickle cell anemia, radiation, trauma, HIV,
decompression sickness, TB, typhoid, SLE
 glioma-tm initiating capacity, ↑self renewal, undifferentiat cellular phenotype

amyloid tm
multiple myeloma
insulinoma
med ca thyroid
neuroendocrine tm

in
SmCC lung
chromogranin, synaptophysin, neuron sp enolase-nuclear moulding, Azopardy effect

palisading tm cell(ABCS)

s.
Adamantinoma
BCC
Craniopharyngioma
Schwannoma

self regression
hemangioma
melanoma
neuroblastoma
iim
retinoblastoma
4a
tm showing CSF dissemination
germ cell tm
ependymoma
choroid plexus tm
medulloblastoma
prim CNS lymphoma
high grade astrocytoma
m

sarcoma with high nodal met(RACES)

Rhabdomyosarcoma
Angiosarcoma
Ai

Clear cell sarcoma

Epithelioid sarcoma
Synovial sarcoma

tm showing Rosette(REMEN)
Retinoblastoma
Ewing sarcoma
Medulloblastoma
 Ependymoma
Neuroblastoma

chemoresistant tm
ca stomach
ca UB
SCC head&neck
soft ts sarcoma

in
sarcophagus
unfused phagosome in cytoplasm
lipofuschin-wear&tear pigment

s.
sk m hypertrophy
αmyosin→ βmyosin(less energy)

age—breast—uTerus
Puberty-hP-hP
preg-hp>ht-hT>hp
lact-ht-involutn
iim
menopause-atrophy-atrophy

metaplasia
sq metaplasia-resp tract,endocx
4a
Barett esoph-intest,columnar
Hurthl cell/oncocyt-Hashimoto thyroiditis
myositis ossificans-m→ bone

cell inj
cell Swelling(earlieSt), hydropic change, memb bleb
reversible-focal chromatin condensat, EM-small amorph densit
m

irreversib-cell memb damage, chromatin condensation(pyknosis),

fragmentation(karyorrhexis), dissolution(karyolysis), large amorphous density

apoptosis
Ai

intrinsic>extrinsic
Cytosol Cytochrome C+Apaf1(apoptosis activat fact1)→ ↑endonuclease,caspase
most CHaracteristic feature-CHromatim Condensation
hallmark in nucleus-internucleosomal fragmentation of chromosome
earlieSt change-cell Shrinkage
no lipase in apoptosis

caspase
 executioner-3,6,7
initiator intrinsic/mitoch pathw-9
initiator extrins/death recept path-8,10

p53
stimulat→ proapoptotic gene→ ↑memb permeability
proapoptotic gene
BAX,BAD,BID,BIM,BAK

in
antiapoptotic gene
BCl2,BClX

necroptosis=necrosis+apoptosis
RIPgene→ free radical→ mitoch damage→

s.
(↑permeability→ apoptosis)(↓ATP→ necrosis)

free radical
OH–(hydroxyl anion)-most potent

source
iim
O2–(superoxide anion)-least potent
cell component most sensitive to free radical inj-lipid

UV ray,ionising radiation
NADPH(phagocyte) oxidase(resp burst)
MPO
chemical/drug
4a
Heber Wiess rxn
Fenton rxn
xanthine oxidase
scavenger
vitA,C,E
mineral-Zn,Se,Mo,fenton
glutathione(Cys)
m

glutathione peroxidase
superoxide dismutase
Cu,Zn-Cytosol
Mn-Mitochondria
Ai

catalase(peroxisome)
health
immunity
fertilisation
ds
ageing
G6PD
Alz ds,Parkinson ds
 lipid peroxidation
PUFA→DNA damage
Fenton rxn
Fe++→Fe+++&free radical

calcification
dystrophic-γGandy body spleen, TB, lymphoma, neuroblastoma
metastatic-multiple myeloma, parathyr ca, SqCC lung, metastatic bone tm

in
necrosis
pseudolaminar-in cerebral neocortex-neuronal loss& gliosis are uneven
fibrinoid-malign HTN, PAN, a/c RF, RA, HSP, SLE, SABE, HBV, malign
fat-chalky white

s.
monocyte-αnaphthyl esterase

a/c inflammation
iim
transient vasoconstrict(1st sign)→ vasodilat→ ↑vasc permeabilit(hallmark)→ stasis
margination→
rolling(weak binding-selectin P,L,E)→
adhesion(strong bind-integrin-ICAM, VCAM, CD34)→
diapedesis(crossing-PECAM1/CD31)→
chemotaxis(chemotaxin-C3a,C5a, IL1, leukotrieneB4, TNFα, bact product, chemokine,
kallikrine)
4a
endothelial cell contraction=5-10min
endoth cell retract-aft 4-6h, persist-24h

chemokine
C-X-C
1AA separating 2cysteine-IL8(neutrophil)
m

C-C
βchemokine-eotaxin(eosinoph), MCP1, MIP1(macrophage), RANTES
C
lymphotaxin(lymphocyte)
Ai

C-X3-C
fractalkine(lymphocyte, monocyte)

leukotrieneB4-maj activator& chemotact agent for WBC, potentiate adhesion to

cellwall

bradykinin-↑vasc permeability
receding ds, maj basic prot-eosinophil
 5HT-vasoconstrictor

Pseudomonas-neutrophil
virus-lymphocyte
HSR-activat lymphocyte, macrophage, plasma cell
allergy-eosinophil

molecular carcinogenesis

in
↑proliferat
protooncogene mutat
protooncogene(norm-code for GF) mutat→ oncogene(abnorm)→ oncoprot-sis
signal transducer-RAS(K,H,N), tyrosine kinase
nuclear regulat prot mutat-myc(c,n,l), jun,fos

s.
tm suppress gene mutat-p53(molecular policeman), Rb, PTEN(Phosphatase TENsin
homologue)
↓death
inh of apoptosis

Cmyc-Cardiac hypertrophy

cell cycle
G0→G1→S→G2→M
iim
G1→S-cyclinD,CDK4
S→G2-cyclinA,CDK2
4a
G2→M-cyclinB,CDK1
G1→M-cyclinE,CDK6
G1=12h
S=4-6h(centriole self duplicat)
G2=5-6h
M=2h
tm cell total cell cycle time-↑/norm
m

cyclin-CDK
D-4,6
E-6,2
Ai

A-2
B-1

G1S checkpt-detect Preexisting mutat-P53> Rb

G2M checkpt detect Replication error-Rb> p53
p53-G1S>G2M
Rb-G1S>G2M
 p53→ ↑p21→ ↓cyclinD,CDK→ hypophosphorylat Rb→ ↓Rb binding to E2F

G1-l asparaginase(E coli), steroid(↓phospholipaseA2)

S(topoisomerase I)-antimetabolite, camptothecin, topoisomerase I inh(irinotecan,
topotecan)
G2(topoisomerase II)-bleomycin, epipodophyllotoxin(etoposide, teneposide)
M-vinka alkaloid(vincristin, vinblastine), taxan(paclitaxel, docitaxel), ixabepilon,
griseofulvin, estramustin, colchicine, erbulin

in
growth fraction
%of tm cell in cell cycle=15-20

labile cell

s.
continuously multiplying-all epith, bone marrow
quiescent cell
multiply if induced-hepatocyte, pancr,
nephron
permanent cell iim
postmitotic phase, cant multiply-myocyte, neuron

Kohler&Milstein hybridoma techniq Ab production-fusing Ab forming spleen cell with

myeloma cell

TNFα
4a
↑vasc permeability in a/c inflam
intrinsic Tyr kinase activity
replication hepatocyte
malign transf of norm cell
overexpres-HCC, astrocytoma, Menetrier ds

TNFBet
m

angiogenesis
antiinflamm
Bone morphogenic prot
chemotaxis
Ai

fibrogenic
growth inhiBitor for epith cell&WBC
invasion metast

IFNγ
convert activated macrophage→ epitheloid cell→ giant cell granuloma

nGF
 neuron
keratinocyte
memory B lymphocyte

TGF
antiinflammat
proliferat of fibrous ts
↓metalloproteinase

in
arachidonic acid metabolite
prostaglandin
lipoxin
leukotriene

s.
PG-Pain

PGI2(prostacycline)
vasodilat
↓PLT aggregat

PG-produce by
PGD2-mast cell
iim
PGE2-neutrophil,macrophage
PGI2-endothelial cell
4a
TXA2-PLT

pyrogen
exogen-bact tox
endogen-IL1,IL6, TNFα,INFα, ciliary neurotropic factor
→↑PGE2(hypothalam)→ ↑thermoregulatory set pt→ fever
m

ASSman focus-infraclav(lung apex) lesion of Sec TB

Ghon focus-lesion at lung(rt) perip+ LN in prim TB
cardiac polyp-PM fibrinous clot
Ai

a spare in atherosclerosis
radial a
ulnar a
renal a
mesenteric a

part of atherosclerotic plaque

fibrous cap-dense collagen, sm m
 shoulder-Tcell, macrophage, sm m
core-LDL, foam cell(macrophage, sm m engulf lipid)
extracellular hyaline change, Chlamydia pneum

microcytic hypochromic anem

Fe def anem, Pb poisoni, sideroblast anem, anem of c/c ds
microcytic
hereditary spherocytosis

in
Fe def anem
prelatent-↓sr ferritin(earliest,most sensit)
latent-↓sr total Fe, ↑TIBC
clinical-anisocytosis→ ↓MCV→ ↓MCH/Hb→ ↓RBC

s.
response to therapy
2d-↑sense of well being
4d-↑reticHb%
5-10d-↑retic count
iim
15d-regenerat of filiform papillae
2-3w-↑RBC→ ↑MCH→ ↑Hb%→ ↑MCV
2mth-nail,skin change
6mth-replenishment of store

hereditary spherocytosis
ankyrin
4a
band3
αspectrin
anion exchanger
pallidin
hereditary elliptocytosis
spectrin(biconcave shape)
glycophorin C
m

protein 4.1

Hb
βchain67(AGAL BMS)
Val→Asp-Bristol
Ai

Val→Glu-Milwaukee
Val→ALa-Sydney
HbC(Cooley Hbemia)-β6-Glu→Lys
HbD-β121-Glu→glutamine
HbE-β26-Glu→Lys
HbS-β6-Glu→ Val
 sickle cell anem
T→ A
GUG→GAG
Glu(β6)→VAl
electrophoresis(pH=8.6) mobility→ anode
Glu>Val,HbA>HbS
sickling agent-Na dithionate
↓sickling-Na cyanate

in
a/c chest synd in sickle cell anem-new pulm infiltrate on CXR, infn& infarction

Hb electrophoresis
+→–-CSFA

s.
Hb(FAASC)-elution time(min)
F=1
A=2.5
A2=3.5
S=4.5
C=5
iim
bone marrow-fat cell:RBC=1:1

AIHA(WoGayaCM)
Warm(IgG)
4a
Cold(IgM)

paroxysmal cold Hburia

cong syphilis, mumps, measles

Coomb test(IgG)
DCT-Ag detected(DoG)
m

ICT-Ab detected

hemolytic anem
Coombs+ve-SLE,Scleroderma
Ai

Coombs–ve-HSP,HUS,TTP

PNH
clonal stem cell disord→acq mutat PIGA gene→↓GPI anchor prot
MIRL(Memb Inhib Reactive Lysis)-CD59
decay accelerating factor-CD55
C8 binding prot
alkaline phosphatase
 AChsterase
↑altern pathw complem med intravasc lysis→ noct Hburia→ ↑CO2→ acidosis
complic-intravasc thromb, aplast anem, Budd Chiary synd
Ix-Ham test, glycerol lysis, sucrose lysis, ↑LDH
Mx-bld transfusion, stem cell transpl

bld grp
fucose-fucosal transferase-H gene(fnal), h gene(nonfnal-Bombay bld grp)

in
N acetyl galactose-NAG transferase-B
N acetyl galactosAmine-NAG Aminyl transferase-A

screening of inf before transfusion(5ds)

HIV(NACO), HCV, HBsAg, VDRL, malaria

s.
bld storage
RBC(sedimentation)
frozen(–65°C)-glycerol-10y
liquid(routine-+1-+6°C)iim
acid citrate(triNaCa chelater)dextrose-↓2,3DPG-↓O2 delivery-21d
ACD+NaH2PO4(↑2,3DPG)-21d
CPDA(adenine-↑ATP)-35d
CPD-SAGM(Saline Adenine Glycerol Mannitol)-42d
PLT
whole bld(+20-+24°C)-PLT life span=7d, used<5d, 1unit=6×WB
4a
single donor PLT-apheresis
FFP(ABO matching req)
whol bld→ (<8h)→ plasma→ all coag fact (–18°C)-1y
cryoppt
FFP→ centrifuge→ cryoppt(fact VIII=80 -120unit, 150mg fibrinogen, vWF,
factXIII)-–18°C-1y
liquid plasma
m

WB(1-6°C)→ (>24h-↓factVIII,V)→ plasma separate→ liquid plasma

transfusion related a/c lung inj-6h

Ai

clotting factor-name
I-fibrinogen(rouleaux format)
II-prothrombin
III-ts factor
IV-Ca
V-proaccelerin/heredit labile fact/activat globulin
VI-accelerin
VII-proconvertin/sr prothromb convers accelerator(SPCA)
 VIII-antihemophilic factor
IX-christmas fact/plasma thromboplastin component
X-Stuart factor
XI-plasma thromboplastin antecedent
XII-Hagemen factor
XIII-fibrin stabilizing factor/fibrinase
XIV-prekallekrein
XV-kallekrein

in
XVI-PLT factor

blding cascade
I-XII→XI→IX→VIII→X
E-VII→X

s.
C-X→II→(I→unstable fibrin)→XIII→stable clot

PT(Prothrombin Time-measured at<2h at room temp, <4h at 22-24°C)

ts thromboplastin
E-VII→X iim
aPTT(activat Partial Thromboplastin Time)
phospholipid, kaolin, silica
I-XII→→X
TT(Thrombin Time)
thrombin
X→fibrin
4a
reptilase time(modif TT)
reptilase-thrombin agonist(not antag by heparin)
norm-heparin toxicity
↑-afibrinogenemia

fact XIII def

PT-norm, aPTT-norm, TT-norm
m

urea lysis test-5Murea→ lysis of unstable clot

dry clot wt-stable>unstable

PLT fn disorder
aGGreGation-PLT→ PLT-Gp IIb,IIIa recept-ADP, collagen-Glanzman thrombasthenia
Ai

aDheSion-PLT→ enDoth-Gp Ib,IX recept-ristocetin-vWF, giant PLT-BernarD Soullier

synd

PLT aggregation
↑-ADP, TXA2, epinephrine, 5HT, vWF, fibrinogen, collagen, immune complex,
thrombin, thrombospondin
↓-PGI2, NO, endothelin, bradykinin
 PLT granule
α-fibrinogen, fibronectin, factV,VIII, PDGF, TGFβ, PLT fact4
δ(dense body)-ADP, Ca, histamine, 5HT, epinephrine

ITP
IgGanti GpIIb-IIIa/Ib-IX, spleen norm, ↑PLT destruct

in
spontan blding-PLT<20000/mm³

lysosomal granule
prim(azurophilic) granule
req high level of agonist to be released

s.
potentially more destructive
secrete-MPO, acid hydrolase, elastase, defensin, phospholipaseA2, nonsp
collagenase
sec(sp) granule
req low level agonist iim
secrete-lysozyme, lactoferrin, alk PO4ase, T4collagenase, phospholipaseA2

anticoagulant
EDTA-hematology
Li heparin-pl biochemistry, isolation of virus
plain-sr biochemistry
4a
Na Citrate(3.2%)-Coagulat assay
NaF-↓enolase→ ↓glycolysis(1-2%glu loss/h)
SPS(0.3%Na Polyanethal Sulfonate)-bld culture

ESR tube
Wintrobe-100mm,EDTA
Westergren-300mm,triNa citrate
m

modif Westergren-EDTA

cell-life span
neutrophil(in circulation)=4-8h
Ai

monocyte(in circulat)=1-3d
neutrophil(in ts)=2-5d
PLT=7-10d
lymphocyte(short lived)=3w
monocyte(in ts)=mth-y
RBC=120d
lymphocyte(long lived)=3y
 Lardaceous spleen-Red pulp, splenic Sinus(SaRLa)
sago spleen-white pulp, splenic follicle

opportunistic inf in AIDS-CD4 cell count

CMV<50
Cryptococcus<100
Pneumocystis jiroveci<200
Toxoplasma<200

in
Tuberculosis<400

neuronal migration disord

heterotop-grey matter fragm in abnorm locat brain
Lissencephaly-complete Lack gyri& sulci

s.
microgyri-multiple small gyri
pachygyria-coarse gyri

fixative
iim
electron microscope-2.5%glutaraldehyde
FNAC/pap smear-90%ethanol
HPE/Bx-10%neutral buffer formalin
immunofluorescence-frozen sample

bone
30%organic
4a
T1collagen(90%), prot, bone sialoprot, alk phosphatase
70%inorganic[hydroxyapatite-Ca5(PO4)3(OH)]
CaPO4,CaCO3,CaF2,Ca(OH)2,citrate

collagen(Gly-X-Y)n
fibrous prot,strength,flexibility
collagen molecule(tropocollagen)-3polypeptide chain
m

each chain-lt handed helix

twisted together-rt handed helix
helices are parallel
40nm gap b/n 2tropocollagen-hydroxyapatite deposit
Ai

most abundant prot=25%

protocollagen→ (lysyl hydroxylase, prolyl hydroxylase, vitC, molec O2, αKG→

hydroxylat of Pro&Lys)→ collagen

collagen(type28)—distribut ts—genetic disorder

I-ubiquitous in hard&soft ts, skin, tendon, bone, cornea(MC)-osteogenesis imperfecta
1,Ehlers Danlos synd7
 II-cartil, IVD, vitreous-achondrogenesis II
III-hollow organ, soft ts, healing, fetal skin, CVS, lung-vascul Ehlers Danlos synd4
IV-BM, glomerul, lens-Goodpasture synd(α3), Alport synd(α5)
V-soft ts, bld vess, placenta-classical Ehlers Danlos synd
VII-dermoepidermal jn-epidermolysis bullosa

angiofollicular LN hyperplasia-Castleman ds

in
HLA
6/6-total mismatch=85-90%survival
0/6-total match=92-97%survival

GVHD(Runt ds in animal)

s.
allogenic BMT, liver, unirradiated bld, not in skin
a/c-GIT, liver, skin
c/c-fibrosis-lung, musculoskeletal syst, kidn not involved

type of graft-donor iim

autogenous/autogenic/autograft-self
isologous/syngeneric/syn/isograft-twin
allogenic/homo/allograft-genetically unrelated member same sp
hetero/xenograft-diff sp
orthoptic-anat norm site
heterotopic-anat abnorm site
4a
interleukin
IL1-↑differentiat of T,B cell, pyrogenic, induce a/c phase prot, bone marrow proliferat,
pyroptosis(cell death in bact inf), ↑vasc permeability, ↑IL2 recept on Tcell, recruit
WBC, not Tcell IL
IL2-↑differentiat, growth of T,B cell, cytotoxicity of T,NK cell, secret of lymphokine
IL3-multiCSF
m

IL4-↑T,B cell, ↑IgG1,IgE production, class switching

IL5-↑eosinophil, ↑IgA,IgM production
IL6-↑B cell differentiat, IgG production, a/c phase protein, Stauffer synd, myeloma
cell proliferation, ↑osteoclast, ↓by E,Castleman ds
Ai

IL7-B&T cell GF
IL8-neutrophil chemotactic factor
IL9-T cell growth
IL10-↓IFN product&mononucl cell fn,UC
IL11-↑a/c phase prot
IL12-↑NK cell
IL13-↓mononuclear cell fn,↑mast cell
IL17-↑neutrophil,↑monocyte
 IL22-↑neutrophil,↑monocyte
antiinflam-IL4,10,13

prim lymphoid organ

bone marrow
thymus
sec lymphoid organ
Td(Tcell)

in
spleen(periarteriolar lymphoid sheath)
LN(paracortical area)
MALT
CLT
bone marrow

s.
Ti(Bcell)
spleen(cortex,medull,germinal centre)

Ag recognition molecule

TCR
MHC-I
MHC-II
iim
BCR(Bcell receptor)(valency=2)

Ag
Td(thymus dependent)
4a
exotoxin,soluble prot(more Agic)→ proc by APC→ stimulat Tcell→ stimulat Bcell
class switching+, affinit maturation+, memory+
Ti(thymus independent)
Ti1-LPS endotoxin
Ti2-capsule,struct prot
cant be proc by APC→stim Bcell directly
complement activat+
m

prot Ag-more immunogenic, Tcell depend, no tolerance, all type Ab, memory resp+,
req proces by Ag present cell, quickly metab
carb Ag-less immunogenic, Tcell indep, immunolog tolerance+, IgM,IgGAb,
Ai

memory–, no req processing, slow metab

cell
Tcell(70%)
CD4+,helper,class II restricted
CD8+,cytotoxic,class I restricted(produce perforin)
Bcell(10-20%)
NK cell(5-15%)
 large granular lymphocyte, azurophilic granulocyt, CD16-Fc tail recept to IgG, Ab
depend cytotoxicity

CD4+THcell
TH1-↑Bcell(IgG), ↑macrophage, ↑CD8+Tcell, IL2, IFNγ
TH2-↑memory cell, ↑Bcell(IgE), ↑eosinophil, ↑mast cell(T1HSR), IL4,5,6,13
TH17-↑neutrophil, ↑monocyte
initiate T4HSR

in
MHC
class I(A,B,C loci)
expression-on all nucleated cell& PLT, except RBC
restriction-CD8+Tcell

s.
fn-immun surveillance(self vs nonself), immunity against intracellular inf, graft
rejectn, GVHD, tm immunity
class II(DR,DQ,DP)
expression-on APC
restriction-CD4+Tcell iim
fn-prevent AI, GVHD, mixed leucocyt rxn
class III-C2,C4, proferdinB, chaperon, heat shock prot, TNFα,β

AgPresentingCell(bothMHC present)
professional-dendritic cell> macrophage> Bcell
nonprofess-glial cell, fibroblast, endoth cell ,thymic epith cell, thy follicular cell, pancr
4a
βcell
ocular dendritic cell-HLA2

+ve selection
thymic cortex-Tcell-self recognition, B cell-maturation
–ve selection
thymic medull-T,B cell-↑affinity for self MHC killed by apoptosis
m

B cell
no. of monomeric Ig(M,D) on Bcell surf =1.5×10^5
1IgM activate=5C1q
Ai

2IgG activate=1C1q
IgM,IgE-CH4
each domain=110 AA long
carbohydrate region
IgG,IgA,IgD-CH2
IgM,IgE-3
isotype-CH reg-class switching-germinal centre sec lymphoid organ
idiotype-VH,VL(CDR-complement determining reg) reg
 affinity
highest-IgG
least-IgM

IgA
pEpsin-cleave bEl hinge region-1f(ab)2
pApAin-cleav Abov hing reg-2f(ab)+1fc
seruM IgA-Monomer

in
secretory IgA-dimer, 2monomer join by Gly rich glycopeptide(J chain)

IgE
Praunitz Kustner rxn
cong def-Toxoplasma,Rubella,CMV

s.
RAST(Radio AllergoSorbent Assay)

complement system
fn
iim
opsonisation-C3b(MI)(↑×4000)
immunocomplex clearance-C3b
memb attack complex(MAC) mediated lysis-C5-9
chemotaxis-C5a
anaphylotoxin-C5a,3a,4a
adaptive/classical/lectin pathway
IgM/IgG+Ag bind C1q
4a
→C2→C2a,C2b
→C4→C4a,C4b→C4b2a→C3
alterNATive/inNATe pathway
free C3(bld)→C3a
→C3b→B→Ba,Bb→C3bBb→ C3
C3 convertase act on C3
complement glycoprot
m

intest-C1
macrophage-C2,4
spleen-C5,8
liver-C3,6,9
Ai

hapten<10kDa,unable to stimulate immune system

epitope-smallest unit of Ag
paratope-site on Ab that combin with Ag
idiotope-sp Ag determinant of paratope

Abbreviations
a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune
bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
 Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis
E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury

in
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment

s.
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year
#-fracture
°-degree
iim
THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG
ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS
BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.
4a
m
Ai