A. Immunohistochemistry Practical (P3)-
Using a suitable panel of annotated images supported by informative legend(s), critically evaluate the outcome of your team’s staining results. You should consider the quality of both the immunocytochemical staining (distribution, contrast, specificity, background) and its Haematoxylin counterstain (colour, intensity, background). Find the practical results images using this link https://padlet.com/madgwia/CMP_P3 .
(250 words excluding labels and citations)
B. Case Study 1 – Cellular Pathology – Histopathology Case Study Report
The early lectures, associated reading, and formative practicals represented an integrating arc of learning leading to the first workshop (Investigating Cancer) where you will be introduced to an example of the histopathology work-up of a cancer case. It has been necessarily abbreviated to focus on the role of routine histopathology and immunohistochemistry in the reporting of the case. However, you should be aware of the pre-analytical events that precede the analytical and post-analytical summaries presented.
The case will illustrate the use of diagnostic prognostic and predictive tests to inform the future management of the patient by the oncology team.
Here we will look at the clinical and histopathological background to the case. As you should expect, and welcome, there will be some underpinning reading and research for you to do.
Clinical History
Patient A is a 68-year-old man who was referred by his GP after reporting seeing blood in his stools and having had a short history of needing to go to the toilet more often than usual. He reported that his stools had been looser for some time. He complained of feeling bloated after eating meals and that he had lost his appetite. The GP recorded that he had lost weight since his last visit. He was otherwise in good health.
This patient was investigated for “?(query)bowel cancer”. Clinical and imaging investigations suggested a moderately large mass in his distal colon. Imaging investigation of the thorax, abdomen and pelvis revealed a small lesion in his liver. This was found subsequently to map to a hot spot in a PET scan. A core biopsy was taken from this lesion.
The mass, along with its draining lymph nodes, was resected. Three of these nodes were found to be enlarged and firm.
The core biopsy from the liver was investigated using chromogenic immunohistochemistry. Anti-keratin 20 and anti-keratin 7 were included in the investigative panel.
The cellular pathology report suggested the presence of a poorly differentiated adenocarcinoma arising from within the mucosa. Two of the three lymph nodes contained histological evidence of the presence of tumour.
Materials
You are provided with a digital case study on colorectal adenocarcinoma in Westminster Slide Box. This consists of a number of whole slide images (WSIs) of sections from the patient’s tissue samples. These include a Haematoxylin and eosin (HE) stained section of the primary tumour (Image 1) and needle-core biopsy samples from the liver nodule stained for both routine HE (Image 2) and a short immunohistochemistry panel (Images 3 and 4). Note that these last images include control sections.
• Image 1 – tumour sample (HE)
• Image 2 – liver core biopsies (HE)
• Image 3 – liver core biopsies (anti-K20 IHC)
• Image 4 – liver core biopsies (anti-K7 IHC)
Using suitable technical language, describe the histopathology of the primary tumour in your case and discuss how the investigation was supported by the use of immunohistochemistry to suggest that the aberrant tissue morphology seen in the liver arose from the glandular epithelium of the colon.
Support your descriptions with two figures (for routine and IHC staining) including a panel of up to four suitably annotated images. Remember that you are highlighting changes from the normal presentation of the colon so avoid “trivial” labelling as discussed in P1.
(750 words excluding labels and citations)
C. Case Study 2 – Haematopathology
The case study below contains a brief clinical history relating to a rare case of acute lymphoblastic leukaemia and questions you are required to answer. This case will have been supported by the session on 21 February on the diagnosis and treatment of haematological malignancies.
Clinical history
Patient B was a 30-year-old female who presented with aches and pains affecting all parts of her body, mild fever, and complained of being tired all the time over the last four to five weeks. There was no history of any allergies and the patient was not on any medication at the time. Upon physical examination there was no lymphadenopathy. However, her spleen was slightly enlarged and palpable. The patient had no family history of diabetes, cancer nor any other major health conditions.
(a) Create a flow diagram to illustrate the haematology laboratory diagnostic algorithm to investigate this patient. Your diagram should not exceed two pages and should include:
• No more than five laboratory tests
• Accompanying text to justify the content
• Brief explanations of the expected findings for the patient
• No more than 400 words
(b) In the event of poor response to standard chemotherapy, critically evaluate two other suitable treatment strategies for this disorder and briefly discuss how they work. (600 words)
