block 3 lab Flashcards
necrotizing enterocolitis (gas shadows because air in GI submucosa) it looks like rings
Hirschsprung disease (dilated air in GI lumen)
necrotizing enterocolitis (gas shadows because air in GI submucosa) it looks like rings
normal gi epithelium
Describe the symptoms of this condition
Neonatal Enterocolitis
- Abdominal distention of ileus & disintegrated villi (air in muscularis mucosa)
- Bloody mucosa (hemorrhagic necrosis)
Describe the condition and its features
The respiratory membranes (bronchioles, alveolar ducts, & alveoli) are made up of eosinophilic hyaline, fibrin, & cell debris with necrotic type pneumocytes
What’s the treatment of the following condition?
Surfactant
The respiratory membranes (bronchioles, alveolar ducts, & alveoli) are made up of eosinophilic hyaline, fibrin, & cell debris with necrotic type pneumocytes
Neonatal respiratory distress syndrome/ hyaline membrane disease
- Abdominal distention of ileus & disintegrated villi (air in muscularis mucosa)
- Bloody mucosa (hemorrhagic necrosis)
Neonatal Enterocolitis
(dilated air in GI lumen) what’s the condition?
Hirschsprung disease
(gas shadows because air in GI submucosa) it looks like rings
necrotizing enterocolitis
What is the condition?
Neonatal respiratory distress syndrome/hyaline membrane disease
Has ground glass opacities
What’s the condition
Ground glass opacities = Neonatal respiratory distress syndrome/hyaline membrane disease
Describe a hemangioma
A raised red lesion on the face, neck, or chest that’s caused by dilated vessels that are abnormally formed on the surface of the skin and mucosa
A raised red lesion on the face, butt, neck, or chest that’s caused by dilated vessels that are abnormally formed on the surface of the skin and mucosa
benign tumors affecting cutaneous blood vessels
Describe a hemangioma
Dilated thin blood vessels without interstitial tissues in-between the blood vessels
It disappears by age 6
Capillary hemangioma
Describe a capillary hemangioma
Dilated thin blood vessels without interstitial tissues in-between the blood vessels
It disappears by age 6
Dilated thin blood vessels without interstitial tissues in-between the blood vessels
It disappears by age 6
Capillary Hemangioma
What is the condition?
Hemangioma
Describe the condition
Cavernous hemangioma
Dilated blood vessels with stroma in-between the blood vessels that happens in the brain & liver
It doesn’t go away
What condition can cavernous hemangioma lead to
Von Hippel Lindau disease do a CT scan
How do you treat cavernous hemangioma
Ligating blood vessels
benign tumors affecting cutaneous blood vessels due to proliferating capillary endothelial cells that make flat-to-elevated, irregular, & blue masses
Hemangiomas
Can be capillary (disappears) or cavernous (persists)
Describe the condition
Lymphangiomas these tend to persist and the lymph accumulates in the neck
This may be a warning sign of turner syndrome
Describe the condition
Pulmonary Hamartoma, has coin-like lesions that contain hyaline cartilage and foci of adipose tissue surrounded by cleft-like spaces
Expect abnormal location of cells in the same organ tissue (Not malignant)
has coin-like lesions that contain hyaline cartilage and foci of adipose tissue surrounded by cleft-like spaces
Expect abnormal location of cells in the same organ tissue (Not malignant)
Pulmonary Hamartoma,
Describe the condition
Peutz-Jeghers syndrome these are mucocutaneous lesions which are causing hyperpigmentation in the mouth/buccal mucosa (they tend to disappear with time)
Describe the condition
Peutz-Jeghers syndrome, causing hamartomatous polyps in the GI tract
Describe the condition
Peutz-Jeghers syndrome causing
- Mucocutaneous lesions (hyperpigmented lesions that disappear with time)
- Hamartomatous polyps (GI tract)
Describe the condition
Choristoma
What is this?
Heteropic normal thyroid tissue (right side) in the liver
Describe the condition
Choriostoma
Describe the condition
Gastric Pancreatic choriostoma (submucosal mass)
Describe the condition
Fibroadenoma, usually a small lump that moves inside the breast (can be single or multiple)
Describe the features of this condition
Fibroadenoma of the breast, it grows in the acini of the breast and it’s compressed by growing fibrous tissue (fibrous capsule)
46-year-old woman with palpable finding in left breast that was determined to be benign
Phyllodes tumor
left = craniocaudal
right = lateromedial
isodense mass
Describe the condition
Phyllodes tumor (leaf like
stromal architecture with capsule)
A 46-year-old woman presents with left sided breast enlargement and skin dimpling consistent with
peau d’orange. She had received two courses of antibiotics without improvement. Presentation is suggestive of what condition?
Inflammatory breast cancer
Describe the condition
Mature cystic teratoma of the ovary; it has all 3 germ layers (ecto, endo, meso derms)
Describe the condition
Mature cystic teratoma of the ovary
Describe the condition
Benign Leiomyoma, the left is normal myometrium while the rights the neoplasm with bundles of smooth muscle interlacing the tumor mass
Describe the condition
Top left = normal cervix
bottom left & right = Carcinoma of the cervix
Cervical PAP smear looks for what cells
Cervical cells with large & darker staining nuclei with irregular shapes
Describe the features of VonHIPPEL-Lindau syndrome
- Hemangioblastoma
- Increased risk of renal cell carcinoma
- Pheochromocytoma
- Pancreatic lesions (cysts, cystadenomas, & neuroendocrine tumors)
- Eye lesions (retinal angiomas or hemangioblastomas)
Describe the features of capillary hemangiomas
-Found around eyelids, eye surface/orbit, face, neck, & upper chest
- Decreased vision (amblyopia)
- Drooping eyes
Describe the features of cavernous hemangiomas
- Found in blood vessels in the brain, lungs, and liver
- Presents with neurological deficits (speech & memory loss) and problems & seizures
- Need surgery to remove them
Dilated vascular channels, filled with many red blood cells
Hemangioma; Cavernous Hemangioma (image top left); Capillary Hemangioma (all other images)
Benign congenital malformations of the lymphatic vessels usually characterized by cystic and cavernous dilatation. The white gaps are the lymphatic vessels.
Lymphangioma
Always suspect_________, if this was the case, lymphangioma needs to removed.
testicular atrophy
malformation of lymphatic system composed of endothelium-lined cysts that contain lymphatic fluid. Or ovarian Torsion or something.
Lymphangioma –
Biopsy shows condensed tissue with a mixture of pale-staining immature myxomatous tissue, the most common type of BENIGN lung tumor. There is no malignancy shown, as that would be displayed by cellular atypia, mitosis and necrosis. Popcorn calcifications seen, round nodules lobulated with respiratory epithelium. IN THE PICTURE: nodules of hyaline cartilage are seen in the center mass, and then the left shows foci of adipose tissue, surrounded by entrapped airways.
Pulmonary Hamartoma
Elderly patient comes in for routine checkup, has coughing, SOB and minimal respiratory problems. There is no Past Medical History or anything extraordinary. Pulmonary nodule is seen on CT and X-ray scans.
Pulmonary Hamartoma
The biopsy shows presence of pancreatic lobules in the submucosa of gastric mucosa. The one on the right shows gallbladder mucosa with pancreatic lobules.
Gastric Pancreatic Choristoma/Choristoma
: (Female) patient shows up with recurrent pain in the right hypochondriac region. Barium x-ray is done, or endoscopy is done, which shows mass in gallbladder or stomach. Patient says they have a burning sensation during digestion. This is because there are pancreatic enzymes in the stomach. There is no further action that needs to take place.
: Gastric Pancreatic Choristoma/Choristoma
Different organ cells within the tissue
Choristomas are commonly found i
1) stomach 2) gallbladder 3) eye.
: Hemorrhagic necrosis beginning in the mucosa, and extends to involve the muscular wall. Intestinal villi are seen disintegrating, loss of nuclei and has reddish cytoplasm. The mucosal wall in the right slide shows pneuomatosis
Necrotizing Enterocolitis (NEC)
After being born, 2 weeks later the baby is brought back with symptoms of bloody stool and abdominal distention. Gas tracks are seen along the bowel wall, cystic “bubbly” collections. Air is collected in intestinal wall, but if it is intraluminal air accumulation 🡪 Hirshsprung’s
Necrotizing Enterocolitis (NEC)
There is hyperreactivity to bacteria which produces Toll-Like Receptors.
Mass is seen in duodenal area
Eonsinophilic Hyaline Membranes line the alveolar ducts and alveoli, made up of fibrin admixed with cell debris (necrotic type II pneumocytes) 🡪 Increased pulmonary vascular permeability, plasma leaks into the alveoli, which makes hyaline stain pink.
: Neonatal Respiratory Distress Syndrome / Hyaline Membrane Disease
: Neonate is presented with nasal flaring and grunting. This is due to surfactant deficiency, therefore need cortisol secretion (need to hit baby and starts crying, release of cortisol increased 🡪 Type II pneumocytes are responsible for secreting surfactant
Neonatal Respiratory Distress Syndrome / Hyaline Membrane Disease
Biopsy shows well circumscribed, uniformly hypercellular stroma, uniform distribution of glands and stroma. The mammogram shows a mass in the breast, that looks fibrous. Can see fibrous capsule covering benign adenoma, why it’s well demarcated.
Fibroadenoma of the Breast
Nontender, distorted shape of breast. Well-defined mobile mass. 25 y/o woman comes in and reports a distorted size of one breast.
No risk of developing into breast cancer, but has family Hx of breast cancer
TUMOR GROWS FROM FIBROUS TISSUE
Fibroadenoma of the Breast
: Biopsy shows all different types of layers: Ectoderm, Mesoderm, Endoderm, therefore we see blood vessels, sebaceous glands, smooth muscles (everything). Hair, teeth, sebaceous everything
Mature Cystic Teratoma of the Ovary/aka Dermoid Cyst
: Mostly asymptomatic, may have increased abdominal girth, urine frequency increased due to increased pressure, lower abdominal pain sometimes.
30 y/o female pt with hyperthyroidism, weight loss, palpitations, tachycardia. Lab findings: Increased T3/T4, decreased TSH
Mature Cystic Teratoma of the Ovary/aka Dermoid Cyst
Radio iodine test uptake 🡪 normally increased but comes back normal.
Next step: Ultrasound of the abdominal area
Lab findings: Increased T3/T4, decreased TSH
Differential Diagnoses:
- Graves Disease ~ Increased T3/T4, decreased TSH
- Confusion, Irritability, hallucinations 🡪 Lumbar puncture shows anti-NMDAR antibodies [autoimmune encephalitis]
- Ovarion Torsion
: Mature Cystic Teratoma of the Ovary/aka Dermoid Cyst
Describe the stage of cancer
Normal epithelium
Describe the stage of cancer
CIN1:
Rarely (~1%) develops into invasive cervical cancer
&
~20% progress to CIN2
Describe the stage of cancer
CIN2: 30% progress to stage CIN3
CIN3: 40% progress to cancer which usually develops post long term HPV 16 or 18 infection
poorly diff tumor (malignant)
mod diff tumor
well diff tumor (benign)
T1NOMO tumor grading
Stage 1: small low-grade tumor with NO metastasis or spread to regional lymph nodes
T4N3M1
Stage IV: Large, high-grade cancer that’s spread to regional lymph nodes and organs
SOB
Neck & face swelling
cough
hoarseness (worse with supination or bending forward)
Chest x-ray shows upper right sided mediastinal mass
Compressed phrenic & right recurrent laryngeal nerve
Superior vena cava syndrome due to squamous cell lung cancer and lymphoma.
leading cause in young adults is lymphoma
Describe the features of a Oncogenic activities of E7
The E7 protein binds to the RB protein and displaces the
E2F transcription factors that are normally sequestered by RB, promoting progression through the cell cycle. E7 also inactivates the CDK inhibitors p21 and p27 and also activate cyclins E and A.
effects of tumors on host
Location and impingement on adjacent structures
Functional activity (synthesis of hormones, cytokines)
Bleeding and infections
Rupture and infarction
Cachexia (wasting)
Lung cancer patients with Cushing syndrome have elevated_____________________________.
serum levels of both pro-opiomelanocortin and corticotrophin
Patients with pituitary disease induced Cushing syndrome only has excess _______________
serum corticotrophin.
Mostly associated with small cell lung carcinoma
Increased ADH–decreased urine output–decreased thirst–increased retention of water– the development of hyponatremia.
-altered mental status
-seizures
-coma and sometimes death
Overproduction of arginine vasopressin (antidiuretic hormone [ADH]) by a tumor causes syndrome of inappropriate ADH secretion (SIADH)
Benign epithelial neoplasms with macroscopically visible fingerlike or warty projections called
Papilloma’s
Describe the features of Papilloma’s
Benign epithelial neoplasms with macroscopically visible fingerlike or warty projections
Large cystic masses are called
Cystadenomas
Mixed tumors contain (Pleomorphic adenoma)
epithelial components scattered within a myxoid stroma that can have cartilage or bone (these arise from a single germ layer)
Describe the features of benign tumors
1) Well differentiated
2) Progressive & slow growth
3) Well demarcated masses that don’t invade surrounding normal tissues
4) No metastasis
1) Well differentiated
2) Progressive & slow growth
3) Well demarcated masses that don’t invade surrounding normal tissues
4) No metastasis
features of benign tumors
Describe the features of Malignant tumors
1) Poorly differentiated (anaplasia)
2) Erratic growth with mitotic figures
3) Locally invasive & infiltrates surrounding tissue
4) Metastasis
1) Describe the condition tumor of skeletal muscles
2) Marked cellular atypia
3) Nuclear pleomorphism
4) Hyperchromatic nuclei
5) Giant tumor cells
Rhabdosarcoma
Describe the features of Rhabdosarcoma
1) Describe the condition tumor of skeletal muscles
2) Marked cellular atypia
3) Nuclear pleomorphism
4) Hyperchromatic nuclei
5) Giant tumor cells
Describe the features of Leiomyoma
Benign & well-defined tumor
What’s the condition
Leiomyosarcoma
Describe the condition
Pseudomyxoma peritoni, a complication of appendiceal carcinomas & mucinous cystadenomas which fill peritoneal spaces with gel.
Leads to visceral organ failure
a complication of appendiceal carcinomas & mucinous cystadenomas which fill peritoneal spaces with gel.
Leads to visceral organ failure
Pseudomyxoma peritoni
What tumors are an exception and rarely metastasize?
Gliomas & skin carcinomas
Prostatic adenocarcinomas tend to metastasize to
Bone
Bronchogenic carcinomas tend to metastasize to
Adrenals & Brain
Neuroblastomas tend to metastasize to
Liver & Bone
Common methods of metastases for malignant tumors include
1) capillary beds
2) Batson paravertebral plexus (spine)
3) Tissues with specific chemokines receptors or chemoattractant similar to the primary tumor
Describe the condition
Kruckenberg tumor, an adenocarcinoma with signet-ring cytology that metastasizes to the ovary
Describe the condition
Virchow’s tumor, GI cancer that metastasizes to the supraclavicular lymph node via the thoracic duct
Any GI cancer that metastasizes to the supraclavicular lymph node via the thoracic duct
Virchow’s tumor
any adenocarcinoma with signet-ring cytology that metastasizes to the ovary
Kruckenberg tumor
Why are sentinel nodes very usefulness when assessing cancer?
They are the first place a primary tumor will metastasize so you can determine if the cancer is metastatic or local
Lung carcinomas tend to metastases to which nodes?
Peripheral tracheobronchial & mediastinal nodes
Breast carcinomas tend to metastases to which nodes
&
Inner quadrants breast cancers ten to spread to which nodes
reg breast = first axillary nodes
Inner quadrant breast = nodes along the mammary arteries
Normal nodal enlargement due to an immune response to tumor antigens is called
Reactive hyperplasia
N (0–3): degree of spread to regional lymph nodes
N0:
tumor cells absent from regional lymph nodes
N (0–3): degree of spread
N1:
regional lymph node metastasis present; (tumor spread to closest regional lymph nodes)
N (0–3): degree of spread
N2:
Tumor spread to an extent between N1 and N3 (N2 is not used at all sites)
N (0–3): degree of spread
N3:
N3: Tumor spread to more distant lymph nodes
