261. Intro to Neoplasia

Question 1

COLORECTAL CARCINOMA

Distinguish between hyperplastic polyps, tubular adenoma, invasive carcinoma

What is the tumorigenesis of colorectal carcinoma?

Answer 1

Hyperplastic polyps: benign lesions with NO risk of malignant transformation
Tubular adenoma: dysplastic clonal proliferations, precursor to invasive carcinoma, will need more frequent colonoscopic surveillance

Tumorigenesis: colon accumulates genetic abnormalities, particularly K-ras oncogene, DCC (deletion in colon cancer) adhesion molecule gene, p53 tumor suppressor gene are TOP THREE

Question 2

What is the TNM and AJCC staging of colorectal staging?

What is the most important histo feature in staging?

Answer 2

MOST important feature: Depth of INVASION

T - tumor invasion
T1: submucosal invasion
T2: muscularis propria invasion
T3: Pericolonic tissue invasion
T4: Invasion into/beyond visceral peritoneum

N - nodes
N1: Mets in 1-3 regional nodes
N2: Mets in 4+ nodes

M - metastasis
M1: distant metastasis

AJCC Staging
Stage 1: into submucosa
Stage 2: full submucosa and muscularis propria
Stage 3: beyond submucosa, muscularis propria and into serosa
Stage 4: spread to other organs

Question 3

What are the 3 ancillary studies done for colorectal carcinoma? What is their significance?

Answer 3

1. BRAF V600E mutation: if positive, predicts poor response to anti-EGFR tx
2. Micro-satellite Instability (MSI): mutation in DNA mismatch repair genes, if high, tx with 5-fluoro-uracil

Question 4

PROSTATE ADENOCARCINOMA

• what are 4 features of high grade prostatic intraepithelial neoplasia?
• risk of progression to invasive adenocarcinoma?

Answer 4

1. Neoplastic cells lining architecturally benign glandular spaces with nuclear enlargement
2. Prominent nucleoli
3. Rigidity of glandular lumens
4. Cytoplasmic Eosinophilia

Question 5

How is prostatic adenocarcinoma graded and staged?

What are the 3 most important histo considerations in PCa?

Answer 5

Grade: GLEASON GRADING = 1 through 5, sum of first and second predominant patterns

1: small uniform glands
2: more stroma b/w glands
3. distinctly infiltrative margins
4. irregular masses of neoplastic glands
5. only occasional gland formation

Histo

1. Unilateral vs. Bilateral
2. Extra-prostatic extension
3. Seminal Vesicle Invasion

TNM Staging
T1: not clinically apparent (incidental)
T2: confined to gland
T3: extraprostatic extension
T4: invaded adjacent organs
N1: spread to nearby LNs
M1: spread to distant LNs or beyond

Question 6

Breast Carcinoma

What are the features/differences of ADH and DCIS?

Answer 6

ADH: Atypical Ductal Hyperplasia
- hyperplasia/overgrowth of cells lining duct spaces

DCIS: Ductal Carcinoma in situ

• malignant, clonal proliferation of cells growing WITHIN basement membrane bound structures of breast
• NO evidence of invasion into surrounding stroma

Question 7

Breast - Invasive Carcinoma

• how is it graded? What 3 components are involved in grading? What are the three grades?
• what are the 3 most important histo considerations?
• what are the TNM staging?

Answer 7

Modified Bloom-Richardson grading system

• Architecture (tubule formation), mitotic rate, nuclear grade
• I (low, well-differentiated), II (intermediate, moderately-differentiated), III (high, poorly-differentiated)

Considerations

1. Tumor Size
2. Multifocality
3. LN Mets

Staging (T = tumor SIZE)
T1: <2cm
T2: 2-5cm
T3: >5cm
T4: chest wall or skin invasion
N1: mets in 1-3 nodes
N2: mets in 4-9 nodes
N3: mets > 10 nodes

Question 8

What are two ancillary tests done for breast carcinoma?

Answer 8

1. Hormone Receptors: ER/PR and Her2/neu testing for prognosis and therapy options (IHC or in-situ hybridization/FSH)
2. OncotypeDx: analyzes a panel of genes using RT-PCR (gives clinicians an idea of tumor behavior - estimate risk of local recurrence) helping to guide tx decisions