Case 10

Carton, Daly & Ramani: Clinical Pathology - Case Studies
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10. Case 10

Case 10

Coronal slice through cerebral hemispheres

This is a coronal slice through the cerebral hemispheres of a 70-year-old female. This was removed during a hospital (medical interest) autopsy. Three space occupying lesions can be seen in this slice - one in the medial left parietal lobe, and two in the thalamic region of the brain. On histological examination these turned out to be deposits of metastatic tumour.

Question 1

Which of the following statements relating to this autopsy are true? (Tick all those that apply)

	a)	This must have been a death from natural causes.
	b)	After the autopsy a death certificate will be issued.
	c)	No tissue can be removed form the body following a hospital autopsy.
	d)	A hospital autopsy is only performed to find out the extent of a disease process.
Correct. The death must have been from natural causes, otherwise the autopsy would have been a Coroner's autopsy. The death certificate will have already been issued by the doctors caring for the patient before death. In a hospital autopsy, tissue can be removed from the body provided that the relatives have given specific consent for this to be done. A hospital autopsy can be requested for a variety of reasons, one of which may be to investigate the extent of a disease process. Other reasons for carrying out such an autopsy include investigation of the effects of any treatments, and investigation of co-morbidities. Page reference: 537-40 Incorrect. The death must have been from natural causes, otherwise the autopsy would have been a Coroner's autopsy. The death certificate will have already been issued by the doctors caring for the patient before death. In a hospital autopsy, tissue can be removed from the body provided that the relatives have given specific consent for this to be done. A hospital autopsy can be requested for a variety of reasons, one of which may be to investigate the extent of a disease process. Other reasons for carrying out such an autopsy include investigation of the effects of any treatments, and investigation of co-morbidities. Page reference: 537-40 Your answer has been saved.

Question 2

Regarding tumour metastasizing to the CNS, which of the following are true? (Tick all those that apply)

	a)	Of all cerebral metastases, the kidney is the most common primary site.
	b)	Ovarian tumours are notorious for their ability to metastasize to the brain.
	c)	Metastases to the brain tend to arise at the junction between the white and grey matter.
	d)	Metastases to the CNS are restricted to the brain.
Correct. Renal cell carcinomas can metastasize to the brain, but they constitute around only 5% of metastatic CNS neoplasms. It is very rare for ovarian carcinomas to metastasize to the brain. Cerebral metastases often arise at the junction between the white and grey matter; the rich capillary bed here appears to favour tumour deposition and growth. The spinal cord and meninges are other sites in the CNS that can be involved by metastatic tumour. Page reference: 442 Incorrect. Renal cell carcinomas can metastasize to the brain, but they constitute around only 5% of metastatic CNS neoplasms. It is very rare for ovarian carcinomas to metastasize to the brain. Cerebral metastases often arise at the junction between the white and grey matter; the rich capillary bed here appears to favour tumour deposition and growth. The spinal cord and meninges are other sites in the CNS that can be involved by metastatic tumour. Page reference: 442 Your answer has been saved.

This patient in fact had a primary breast tumour treated 10 years previously. The histology of the primary tumour showed that it was well differentiated. Histology of the metastases showed poorly differentiated tumour. She had been a life long smoker of cigarettes. One of her sisters had had breast cancer.

Question 3

Which of the following statements are true? (Tick all those that apply)

	a)	It is unusual for this lady to have developed metastases from her breast carcinoma so long after the original diagnosis.
	b)	It is unusual for the histological appearance of a metastatic tumour to be different from that of the primary tumour.
	c)	It is not surprising that this lady developed breast cancer, given her heavy smoking history.
	d)	If this lady's breast carcinoma was a case of hereditary/familial breast cancer, the most likely gene to be implicated would be the BRCA gene.
Correct. Recurrences of breast carcinoma may occur many years after the original diagnosis. Metastatic tumours can have a different morphology to that of the primary tumour; presumably because subclones of tumour cells develop their own mutations and appearance. Cigarette smoking is not associated with breast cancer. The BRCA1 and BRCA2 genes are the genes most commonly associated with hereditary breast cancer. Page reference: 291-4 Incorrect. Recurrences of breast carcinoma may occur many years after the original diagnosis. Metastatic tumours can have a different morphology to that of the primary tumour; presumably because subclones of tumour cells develop their own mutations and appearance. Cigarette smoking is not associated with breast cancer. The BRCA1 and BRCA2 genes are the genes most commonly associated with hereditary breast cancer. Page reference: 291-4 Your answer has been saved.

Carton, Daly & Ramani: Clinical Pathology - Case Studies

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Case 10

Question 1

Question 2

Question 3