Exam results are posted!

The scores for today’s exam are now posted on Canvas. You did REALLY well, as usual – the mean was 96%!

I can’t officially release final grades for the course until the evals are in – but in the meantime, you can figure out your grade by using the grading scale at the bottom of our About page.

Please let me know if you have any questions on the exam, or on anything else. It was really nice having you guys in class again! Wish we could be in person, but until then, we’ll make do with Zoom. Looking forward to seeing you in Systemic Path this fall!

Exam Details

Hi everyone – just wanted to give you some details on our upcoming exam.

Date/time. The exam will be open from 7:00 am until 11:00 am on Wednesday, July 15, and you’ll have 2 hours to complete it once you start. On the official Google calendar, the exam is scheduled from 9:05 – 11:00 on Wednesday – but since you have lab at 11:15 that day, I thought I’d extend the time frame a bit to give you a little flexibility (that way you don’t have to rush to get to your 11:15 lab).

Password. The assessment password is Summer2020.

Points/questions. The exam is worth a total of 48 points (I had estimated more like 60 points, but it wound up to be shorter).

Please note that Examplify makes it look like the exam only has 30 questions! The reason for this is because there are several matching questions on the exam – and instead of counting each item as a separate question, Examplify just assigns one question number to each group of items.

Here’s an a set of matching questions similar to those on the actual exam, so you can see what I mean:

Examplify would count this set of items as a single question, instead of four questions. Each of the items is worth one point, so it’s not a big deal in the end. It’s just kind of annoying that the number of questions shows up as 30 – and I wanted to explain why.

Exam breakdown. The exam point breakdown is as follows:

  • Cell injury (10 points)
  • Inflammation (6 points)
  • Wound healing (3 points)
  • Immunology (4 points)
  • Hypersensitivity reactions (2 points)
  • Autoimmune diseases (6 points)
  • Neoplasia 1 (2 points)
  • Neoplasia 2 (6 points)
  • Neoplasia 3 (2 points)
  • Neoplasia 4 (7 points)

That’s all I can think of! Please let me know if you have any questions, either about the material or about the exam itself.

Please check your quiz scores in Canvas!

After I posted the scores for quizzes 2 and 3 to Canvas yesterday, some of you noticed errors in your scores. I looked into it, and it turns out Canvas had a glitch that made some of the scores load incorrectly – so I fixed the issue and uploaded the scores again. It looks like that fixed the problem – but please check your scores when you have a moment just to make sure they look right to you. Thank you!

Canvas now up to date – plus a quick explanation of a quiz 3 question.

Just a quick update – all the scores for all three of our quizzes are now posted on Canvas.

I have a couple comments about quiz 3. First: please note that Quiz 3 ended up only having 10 points instead of 15 (so your score for that quiz is out of a total of 10 points).

Second: there was one question on Quiz 3 that was problematic for quite a few people because of a misleading lecture slide – so I made a grade adjustment, and I want to be sure that you understand the concept correctly.

Here’s the question:

4. When a tumor is “well-differentiated,” that means:
A. The tumor cells look very similar to their cell of origin
B. The tumor cells look very different from each other
C.  The tumor is benign
D. The tumor probably has a poor prognosis

The correct answer is A (The tumor cells look very similar to their cell of origin). “Differentiation” refers to how closely a tumor’s cells resemble their cell of origin. Well-differentiated tumors are composed of cells that closely resemble their cell of origin, whereas poorly-differentiated tumors are composed of cells that hardly resemble their cell of origin at all.

Quite a few of you answered C (The tumor is benign). That answer is incorrect – but I can see why you may have chosen that answer based on this slide (slide 8 from the Neoplasia I: Tumor Nomenclature ppt):

This slide is misleading, because it seems to be saying that benign tumors are always well-differentiated, and malignant tumors are always poorly-differentiated (which isn’t true).

What I was trying to do on this slide was to list the general characteristics of benign vs. malignant tumors (for example: benign tumors tend to grow slowly, whereas malignant tumors tend to grow quickly). And with regard to differentiation, benign tumors tend to be well-differentiated, and malignant tumors tend to be poorly differentiated. But those are just big-picture trends! In real life, benign tumors are occasionally poorly-differentiated, and malignant tumors are sometimes well-differentiated.

Back to the quiz question. Choice C is incorrect because while it’s true that benign tumors tend to be well-differentiated, you can also see well-differentiated malignant tumors too! So just because a tumor is well-differentiated, that doesn’t automatically mean it is benign. It kind of makes you think in that direction – but it’s just a general rule of thumb (not an absolute rule).

I hope that makes sense. If not, please shoot me an email and I’ll be happy to explain it further.

Given the misleading slide, I went in and added a point to the score of everyone who answered C ūüôā

Lenox Hill

Just got an email from one of you about this show, and I wanted to pass it along to the rest of the class in case anyone needs a new Netflix series. Here’s the scoop: It’s a documentary about the neurosurgery department at Lenox Hill Hospital but because of the surgeries they are doing they are constantly bringing specimens to the pathology department and talking about neoplastic tissue. In the first episode, they diagnosed an adenocarcinoma and glioblastoma. It was very fitting giving the recent lectures so if anyone is looking for a mindless way of ‘studying’ it’s a good way to kill some time!¬†

Good question about birth control pills and estrogen exposure

Q. I had a question about the increased estrogen exposure and increased risk for breast and endometrial cancer. Is birth control an increased estrogen exposure? Or does it simulate the hormones of being pregnant? Or something completely different.

A. Good question! No, birth control pills do not expose you to excess estrogen. In fact, they may actually decrease your overall estrogen exposure. 

There are many different types of oral contraceptive pills (OCPs) Рbut basically they boil down to two formulations: they either contain a combination of estrogen and progesterone, or they just contain progesterone. They prevent pregnancy by preventing follicle maturation and ovulation.

Here’s how they work. Progesterone inhibits the release of GnRH from the hypothalamus – which means that you’ll release less FSH and LH from your pituitary, which means that both follicular maturation (controlled by FSH) and ovulation (controlled by LH) are inhibited. This means that you’re also making less estrogen (follicles make estrogen as they develop; that’s what actually triggers the LH surge that leads to ovulation).

Estrogen has an inhibitory effect on FSH release – so that’s why some OCPs also have a little estrogen in them. But that little bit of estrogen in the pill doesn’t increase your overall estrogen exposure, because at the same time, you’re inhibiting your own estrogen production (by the follicles) – so the net effect is an estrogen deficit.

So that’s why OCPs don’t increase the risk of developing estrogen-related cancers like breast and endometrial cancer. In fact, they may even be protective against some cancers (ovarian cancer in particular), although this hasn’t been definitively proven yet.¬†

Fletch

So I couldn’t find the exact scene I wanted to show you guys (the one where Fletch says “He has melanoma…carcinoma…some kind of noma”), probably because it wasn’t nearly as funny as the rest of the film. But I did find a couple good clips, in case you need a laugh.

Dr. Rosenpenis

This is just silly, stupid humor, but actually, that’s exactly why I like it.

Autopsy assistant

This is great because it’s exactly how I felt at my first autopsy. I could tolerate the sight of the body, and even the sound (barely) of the bone saw – but the smell…that pathologist is right, you just never get used to the smell.

Differentiation vs. dysplasia

dysplasia

I wrote a post on differentiation and dysplasia for my website Pathology Student a while back, and I thought it might be useful, so I’m reposting it here.

Here are two words that can cause some serious headaches for pathology students: differentiation and dysplasia.

Both terms are graded on a scale. Cells can be anywhere from well-differentiated (pretty normal looking, and resembling the cells from which they originated) all the way down to poorly differentiated (“bad” looking, and not really resembling the cells from which they originated at all) or even anaplastic (which means that they don’t look anything at all like the cells from which they originated). Similarly, dysplasia is graded on a mild – moderate – severe scale.

The problem arises when you start talking about the actual characteristics of poorly-differentiated and severely dysplastic cells. Both types of cells have a lot in common:

  • Pleomorphism (the cells and nuclei vary a lot in size and shape)
  • Abnormal looking nuclei (really big nuclei, or nuclei with dark, “hyperchromatic” chromatin, or nucleoli)
  • Lots of mitoses, and some abnormal mitoses (especially tripolar ones)
  • Loss of architectural orientation (the cells are basically in a state of anarchy: they pile up on each other, they don’t respect their neighbor’s boundaries, and they don’t arrange themselves in the nice regular way that normal cells do).

So…what’s the deal? It seems like both concepts (differentiation and dysplasia) are talking about the same thing: the degree of abnormality or “ugliness” in a particular group of cells. So why have two words? Is this just some masochistic pathology terminology aimed at making us miserable?

It turns out that while the two terms/concepts are indeed getting at the same idea (how “ugly” the cells look), you use the terms in totally different contexts.

Differentiation is only used when talking about neoplastic cells. You would never say, “wow, that section of normal liver is really well-differentiated.” It’s only used to describe tumor cells, period. Also, you can use the concept of differentiation to describe tumor cells of any origin – epithelial, mesenchymal, whatever.

Dysplasia, on the other hand, is only used when talking about non-neoplastic cells – it’s never used to describe neoplastic cells. Also, you only use the word dysplasia when you’re talking about epithelial cells.

The classic example for illustrating dysplasia is cervical pap smears and biopsies. One good thing about cervical cancer is that it is always preceded by dysplastic changes. So the epithelial cells don’t just one day turn into malignant cells: they go through long stages of mild, moderate, and severe dysplasia.

It’s really important to know this, because you can catch cervical carcinomas before they even become carcinomas. If you see an area of severe dysplasia, you can remove those cells and thereby prevent carcinoma from developing in that area. You can see a pretty clear demarcation in the photo above between dysplastic cells (on the left) and normal cervical squamous epithelium (on the right).

So to summarize:

1. Both dysplasia and differentiation are words that get at the same concept: the degree to which cells look abnormal or “ugly.”

2. You only use “differentiation” when you’re talking about neoplastic cells (and they can be neoplastic cells of any type – epithelial or otherwise).

3. You only use “dysplasia” when you’re talking about non-neoplastic cells (and they have to be epithelial cells).

Question about a quiz 2 question

Hi everyone! Here’s a good question I got by email – thought I’d share it with you in case someone else had the same question.

Q. Hello, I was wondering if you could send me the question that had the answer “Type 2” hypersensitivity. I got it wrong and I think the reason behind it was because of the “platelet” term and I took it maybe too literal by thinking that in the illustration of Type 3 in your notes where there is platelet aggregation in the picture. I also factored Type 2 out because it only mentioned red blood cells under type 2 which I took maybe more literal once again because I didn’t see anything about platelets.

A. Yes! I’ll explain why type II hypersensitivity is the correct answer for that question…and then I’ll answer your questions specifically. Here’s the question you’re referring to from quiz 2 (I also posted a link to the Quiz 2 Kahoot on our Kahoots page):

This patient is making antibodies against her own platelets, and those antibodies are coating (opsonizing) her platelets, making the platelets yummy to macrophages. This is an example of type II hypersensitivity, because there are antibodies coating a cell, leading to problems (in this case, consumption by macrophages). Here’s the slide from lecture showing how this process works:

This is exactly what’s going on in the patient in this quiz question – you could just cross out “opsonized cell” in the diagram above and put “platelet” and that would be a diagram specific for this patient.

I hope that makes sense! Just for completeness, here’s your email, with my responses to your questions in bold:

Hello, I was wondering if you could send me the question that had the answer “Type 2” hypersensitivity. I got it wrong and I think the reason behind it was because of the “platelet” term and I took it maybe too literal by thinking that in the illustration of Type 3 in your notes where there is platelet aggregation in the picture. You’re right – there is platelet aggregation in the picture illustrating type III hypersensitivity! But in type III hypersensitivity, the patient has immune complexes floating around, lodging in vessels, and the platelets are there because of all the damage to the vascular endothelium. The platelets are kind of a secondary thing – they’re not coated with antibodies, or anything – they’re just showing up because of tissue damage. The patient in our quiz question, on the other hand, doesn’t have immune complexes – she has platelets¬†that are coated with antibodies! Here, the platelets aren’t just showing up because there is damage – they are actually being targeted by antibodies – so their role in this patient is very different. I also factored Type 2 out because it only mentioned red blood cells under type 2 which I took maybe more literal once again because I didn’t see anything about platelets. Oh – actually type II¬†hypersensitivity reactions aren’t limited to just red cells! They can target any cell – red cells, thyroid cells, platelets, neurons – literally any cell in the body!