Cellular Pathology of Cancer Flashcards
Define metaplasia
- A reversible change in which one adult cell type (usually epithelial) is replaced by another
What happens in gastric metaplasia?
- Stratified squamous epithelium → simple columnar epithelium
What characteristic feature can be seen histologically in intestinal metaplasia?
- You will see the metaplasia
- But you must see goblet cells to confirm its intestinal
Give one example of pathological metaplasia
- Barret’s oesophagus
- Gastro-oesophageal reflux causes oesophageal epithelium to change from squamous to columnar
- This is reversible if gastro-oesophageal reflux ceases
Give one example of physiological metaplasia
- In pregancy, the cervix opens up and this causes the more acidic uterine fluid to enter the endocervical canal
- This converts the columnar epithelium in the endocervical canal into squamous epithelium
- When the cervix closes up again, this effect is reversed
What is dysplasia and what features might you see in dysplastic tissue?
- Pre-invasive stage with intact basement membrane but showing signs of early cancerous properties
- Such as:
- Increased nucleo-cytoplasmic ratio
- Hyperchromatic nuclei
- Increased and abnormal mitoses / mitotic figures
- Pleiomorphy - loss of individuality
- Of course, INTACT BM
Give 6 sites that dysplasia is common in and why they occur here / in what conditions
- Cervix - HPV
- Larynx - Smoking
- Oesophagus - Barret’s oesophagus
- Colon - ulcerative colitis associated with IBD… UC → dysplasia → cancer
- Bronchus - smoking (psuedostratified columnar → squamous also occurs)
- Stomach - pernicious anaemia (chronic stomach inflammation)
This is a cervical biopsy - how can you tell the tissue is dysplastic here?
- Because on the left you see normal maturation with high cellular density towards the bottom and more spaced out lower density of cells layering towards the luminal side
- However on the right side, there is abnormal development - very dense towards the luminal side and dark, dense (hyperchromatic) nuclei can be seen
What is high grade and low grade dysplasia, and what are some histological differences between them?
- High grade dysplasia = likely to turn into cancer
- Low grade dysplasia = unlikely to turn into cancer
Histological differences:
- Larger nuclei : cytoplasmic ratio in high grade dysplasia
- Higher hyperchromaticity of nuclei
Define malignancy
- Abnormal, autonomous growth of cells that are unresponsive to normal growth mechanisms
Define neoplasia
- Any new growth, benign or malignant
What is a tumour?
- A swelling
What happens in endometrial hyperplasia?
- In the oestrogenic phase of the menstrual cycle, there is endometrial epithelia proliferation
- When oestrogen levels drop, the proliferation should start to stop
- In cancer, these endometrial epithelial cells have become autonomous of this mechanism and continue to proliferate despite the normal growth / proliferation signalling mechanism
Give 6 characteristic properties of benign tumours, that also make them different from malignant tumours
- DO NOT INVADE SURROUNDING TISSUE
- DO NOT METASTASISE
- Encapsulated
- Slow growing
- Well differentiated - i.e. they resemble the tissue they arise from
- Normal mitoses
Give 6 characterisitic properties of malignant tumours, these also make them different to benign tumours
- INVADE SURROUNDING TISSUE
- METASTASISE
- Rapidly growing
- Abnormal mitoses
- Poorly differentiated - i.e. do not resemble the tissue they arise from
- Unencapsulated
What could a benign tumour in the meninges cause?
Epilepsy
Give an example of a benign adenoma secreting something which is dangerous
- Insulinoma
- Secretes spikes of insulin which can cause dangerous hypoglycaemic episodes
How might benign tumours of the kidneys lead to infection?
- Because they obstruct the ureters and infection of the tumour and surrounding areas occurs
Why are liver adenomas quite dangerous?
- Because they can rupture and cause bad haemoperitoneum
Why can benign tumours in the stomach be dangerous?
- Bleeds
What can torted ovarian cysts (benign tumour form) cause?
- Ischaemic necrosis (infarction due to lost blood supply and thus cell death)
Define metastasis
- Discontinuous colony of tumour cells, at some distance from the primary site
What is a common metastasis of pancreatic carcinomas and what is the basis for this?
- Pancreatic carcinoma → liver metastasis
- Because the pancreas is drained by the splenic vein and into the hepatic portal vein so it can access the liver if a little cancerous tissue embolises from the primary site
1) What is the Duke’s staging system?
2) What does Duke’s A mean?
3) What does Duke’s C mean?
1)
- A system used to measure the prognosis for colon cancer
2)
- Cancer has remained stuck to the bowel wall - 90% survival prognosis
3)
- Cancer has metastasised via lymph node involvement - 30% survival prognosis
List 7 types of tumour
- Benign epithelial tumour (papilloma / adenoma)
- Malignant epithelial tumour (carcinoma)
- Benign soft tissue tumour
- Malignant soft tissue tumour (sarcoma)
- Leukaemias and lymphomas
- Teratomas
- Hamartomas
What type of tumour does a papilloma describe?
- Benign surface epithelial cell tumour = papilloma
- E.g. on the skin, bladder
What type of tumour does an adenoma describe?
- Benign glandular epithelial tumour
- E.g. on stomach, thyroid, kidney, pituitary, pancreas
What type of tumour does a carcinoma describe?
- Malignant epithelial tumour
What is a squamous cell carcinoma?
- Malignant epithelial tumour of skin / oesophagus
What is an adenocarcinoma?
- Malignant epithelial glandular tissue
What is a transitional cell carcinoma? Also what are transition cells and give a place they can be found
- Malignant epithelial tumour of transition cells
- Transition cells are stratified cell layers, the surface layer of which contains cell whose morphologies are dependent on the stretch they are exposed to
- E.g. in the bladder - useful for when the bladder fills with urine that there is a morphological change
What is a basal cell carcinoma?
- A malignant surface epithelial tumour of the skin
What are the 2 types of epithelia?
- Surface epithelia
- Glandular epithelia
What is the formula for naming benign soft tissue tumours?
- Like some sort of predictable stem
- Then immediately -oma (note other types of tumour end in -oma but not directly, they’re like set types of -omas like adenomas, whereas benign soft tissue tumours have the -oma suffix added directly on)
- E.g. Osteoma = benign soft tissue tumour of the bone
What is an osteoma?
- Benign soft tissue tumour of the bone
What is a chondroma?
- A benign soft tissue tumour of the cartilage of bone
What is a lipoma?
- Benign soft tissue tumour of fat
What is a leiomyoma?
- A benign soft tissue smooth muscle tumour
What is the suffix in the nomenclature for malignant soft tissue tumours?
- Sarcomas
What is a liposarcoma?
- Malignant soft tissue tumour of fat
What is an osteosarcoma?
- Malignant soft tissue tumour of bone
What is a chondrosarcoma?
- Malignant soft tissue tumour of the cartilage
What is a rhabdomysarcoma?
- Malignant soft tissue tumour of striated muscle
What is a lieiomyosarcoma?
- Malignant soft tissue tumour of the smooth muscle
What is a malignant soft tissue tumour of the nerve sheath called?
- Peripheral nerve sheath tumour
Outline what a teratoma is and where you can expect to find them
- A tumour derived from germ cells, which have the potential to develop into tumours of all 3 germ cell layers:
1. Ectoderm
2. Mesoderm
3. Endoderm - Gonadal teratomas are common in both male and females
Outline what a hamartoma is and give 2 examples of hamartomas
- Mostly benign but some malignant
- Localised overgrowth of cells and tissues native to the organ whose cells are mature but architecturally abnormal
- E.g:
- Bronchial hamartoma
- Bile duct hamartoma
When staging a tumour, how can you tell whether a particular tumour at a site is a primary or secondary tumour (i.e. if it originated there or is a metastasis)?
- Because there will be some evidence of function still in the primary tumours
- E.g. in adenocarinomas (malignant epithelial glandular tumours) there will still be mucin production
What is the grading system for breast cancer called?
Nottingham system
What is the grading system for prostate cancer called?
- Gleason system
What does grading a tumour describe?
- The degree of differentiation - higher grade = poor differentiation
What does staging a tumour describe?
- The degree of spread - higher stage = greater spread
What is more important, staging or grading in determining prognosis?
- Staging is more important than grading in determining prognosis
What is the TNM system?
- Tumour - extent of tumour involvement
- Node - extent of node involvement
- Metastasis - extent of metastasis
- TNM grading / staging system
Well-differentiated tumours are characterised by all of the following, except:
- A small numbers of mitoses
- Lack of nuclear pleomorphism
- A high nuclear-cytoplasmic ratio
- Relatively uniform nuclei
- Close resemblance to the corresponding normal tissue
- 3 - a high nuclear cytoplasmic ratio
