Cellular Pathology Flashcards by Rama Jha

Define metaplasia

A REVERSIBLE change in which one adult cell (usually epithelial) is
REPLACED
by another adult cell type

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How is the change seen in metaplasia normally described?

ADAPTIVE
• i.e. in response to regurgitated stomach acid

• e.g. Barratt’s Oesophagus

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Give 2 types of metaplasia’s?

GASTRIC metaplasia
• columnar epithlium & NO goblet cells

INTESTINAL metaplasia
• columnar epithelium & goblet cells

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Define dysplasia

An ABNORMAL PATTERN of GROWTH in which the cellular & architectural features of malignancy are present

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How is the change seen in dysplasia normally described?

‘Pre-invasive’ changes
• intact BM
• can NOT spread
• loss of architecture & loss of uniformity of individual cells

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Features that can be seen in dysplasia?

Nuclei
• HYPERchromic
• enlarged

Mitotic figures (condensed DNA material)
• abundant
• abnormal (in places not normally found)

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Where is dysplasia common in?

CERVIX
• HPV infection

BRONCHUS
• smoking

COLON
• UC (ulceritive collitis)

LARYNX
• smoking

STOMACH
• pernicious anaemia

OESOPHAGUS
• acid reflux

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How can dysplasia be described?

HIGH-grade (darker nuclei)

vs.

LOW-grade

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Define neoplasia

An abnormal, AUTONOMOUS PROLIFERATION of cells UNRESPONSIVE to normal growth control mechanisms

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Difference of benign tumours compared to malignant tumours?

• Do NOT invade (do NOT metastasise)

• Encapsulated
- NOT always like this i.e. Leiomyomas are NOT but ARE benign

Usually well differentiated
Slow-growing
Normal mitotic figures

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Benign tumours are not often fatal unless?

• In a dangerous place
- i.e. pituitary

• Secretes dangerous chemicals
- i.e. insulinoma

• Gets infected
i.e. bladder infection from obstruction of ureter

• Bleeds
- i.e. stomach tumours

• Ruptures
- i.e. liver adenoma

• Torts (twisted)
- i.e. ovarian cyst (twists and cuts off own blood supply)

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Define metastasis

A DISCONTINOUS growing colony of tumour cells at SOME DISTANCE from the 1o cancer

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What does the occurrence of metastasis depend on?

Depends on
• local vascular supply
AND
• local lymphatic drainage

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What does it mean if lymph nodes are involved in metastasis?

Has a WORSE prognosis

e.g. Dukes A is a confined colon cancer with a 90% cure rate
vs.
Dukes C which metastasises and has a 30% cure rate

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Characteristics of malignant tumours?

Invade surrounding tissue
Metastasise
No capsule (BUT not always)

• Well –> poorly differentiated
- but tend to be poorly differentiated

Rapidly growing
Abnormal mitotic figures

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7 nomenclature of tumours?

Benign epithelial tumours
Carcinoma
Benign soft tissue tumours
Sarcoma
Leukaemia & lymphoma
Teratoma
Harartoma

BET (cancer type)

Benign Epithelial Tumours

• SURFACE epithelial

PAPILLOMA
e.g. skin, bladder

• GLANDULAR epithelial

ADENOMA
e.g. stomach, thyroid, colon, kidney, pituitary, pancreas

Define C (cancer type)

Carcinoma

A malignant tumour derived from epithelium

Different types of C (cancer type)

Carcinoma

• Squamous cell
- squamous cell malignancy

• Adenocarcinoma
- glandular epithelium malignancy

• Transitional cell carcinoma
- transitional cells line the URINARY tract

• Basal cell carcinoma
- arise from the skin

BSTT (cancer type)?

Benign Soft Tissue Tumours

e. g. Osteomas
i. e. just suffix -oma to the descriptor

Define S (cancer type)

Sarcoma

A malignant tumours derived from CT (mesenchymal) cells

Types of S (cancer type)?

Liposarcoma (fat derived)
Osteosarcoma
Chondrosarcoma (cartilage)

• Rhabdomyosarcoma
- striated muscle tumour

• Leiomyosarcoma
- smooth muscle tumour

• Malignant Peripheral Nerve Sheath Tumour
- nerve sheath tumour

Define L&L (cancer types)

Tumours of WBCs

Leukaemia
• malignant tumour of BONE MARROW-derived cells
• in the PERIPHERAL BLOOD

Lymphoma
• malignant tumour of LYMPHOCYTES (usually)
• in the LYMPH NODES

Define T (cancer type)?

Teratoma

Tumour derived from GERM CELLS, which have the potential to develop into tumours of all three germ cell layers

Ectoderm
Mesoderm
Endoderm

e.g. Dermoid cysts
• can contain anything such as teeth, bone, eyes etc.

Example of T (cancer type)?

Gonadal teratomas • in Males = all are malignant • in Females = most are benign

Define H (cancer type)?

Hamartoma Localised overgrowth of cells/tissues native to the organ e.g. Bile duct hamartoma

Features of H (cancer type)?

Cells are MATURE but architecturally abnormal | • i.e. expect to find the same types of tissues expected to grow in the organ BUT not in the right place in the organ

Within which cohort is H (cancer type) common in?

Common in CHILDREN | • but often stops growing when the child stops growing

A benign tumour of glandular tissue is...

1. An adenoma 2. A leiomyoma 3. An adenocarcinoma 4. A squamous papilloma 5. A lymphoma

A malignant tumour derived from soft tissue is a....

1. Carcinoma 2. Sarcoma 3. Teratoma 4. Lymphoma 5. Melanoma

Criteria for assessing differentiation of a malignant tumour?

1. Evidence of normal function is still present * i.e. production of keratin, mucin, etc. * e.g. an ectopic squamous cell cancer of the lung produces PTH-rp 2. If no evidence of normal function • high-grade or anaplastic carcinoma 3. If no evidence of differentiation • anaplastic carcinoma 4. Presence of abnormal mitoses • some tumours have a mitotic count • i.e. Tumour with 15 mitoses/mm2 behaves worse than one with 5 mitoses/mm2 5. Various grading systems • for cancer of breast, prostate & colon

What is the TNM?

Tumour, Node, Metastasis (TNM) system can be applied and individualised to tumour in all sites

Grade of a tumour?

Describes if DEGREE OF DIFFERENTIATION

Stage of a tumour?

Describes HOW FAR it has SPREAD

Which is more important - grade or stage of a tumour?

STAGE is more important in determining the prognosis Tumours of HIGHER GRADE (i.e. more poorly differentiated) tend to be of HIGHER STAGE (i.e. spread further)