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Pathology > Ch 3 Pathoma - Neoplasia > Flashcards

Ch 3 Pathoma - Neoplasia Flashcards

1
Q

Neoplasia is new tissue growth that is ____, ______, and ______; these features distinguish it from hyperplasia and repair

A

unregulated, irreversible, monoclonal

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2
Q

______ was historically determined by glucose-6-phosphate dehydrogenase enzyme isoforms, which is present on which chromosome?

A

clonality; x chromosome

only 1 isoform is present in neoplasia, which is monoclonal

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3
Q

In addition to G6PD, clonality can also be determined by _________ isoforms (also present on x chromosome)

A

androgen receptor

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4
Q

Clonality of B lymphocytes is determined by __________.

A

Immunoglobulin (Ig) light chain phenotype

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5
Q

Normal kappa to lambda light chain ratio of B cells is _____. Ratio can be either ____ or ____ in lymphoma, which is monoclonal

A

3:1; >6:1 or 1:3

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6
Q

Changes in the normal ratio of G6PD isoforms or kappa:lambda light chains means there is ______.

A

Monoclonal proliferation = neoplasia

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7
Q

Most common cancers by incidence in adults are:

A

(1) breast/prostate
(2) lung
(3) colorectal

not including skin cancer

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8
Q

Most common cancers by morality in adults:

A

(1) lung
(2) breast/prostate
(3) colorectal

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9
Q

Approximately how many divisions must occur before the earliest clinical symptoms of neoplasia arise?

A

30 divisions - each division results in increased mutations (explains why cancers that are detected later have a poorer prognosis)

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10
Q

Screening seeks to catch ____ before it becomes carcinoma or carcinoma before ______.

A

dysplasia (precancerous change); clinical symptoms arise

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11
Q

Carcinogens are agents that ______, increasing risk for cancer. Important carcinogens include these three categories.

A

damage DNA; chemicals, oncogenic viruses, radiation

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12
Q

Aflatoxins are derived from _______. The associated cancer that develops is _____.

A

Aspergillus; hepatocellular carcinoma.

Aspergillum can contaminate stored rice and grains

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13
Q

______ agents in chemotherapy can cause leukemia/lymphoma as a side effect

A

Alkylating

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14
Q

Alcohol can predispose you for these types of cancer (4)

A

squamous cell carcinoma of oropharynx and upper esophagus; hepatocellular carcinoma; and pancreatic carcinoma

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15
Q

______ causes squamous cell carcinoma of the skin, lung cancer, and angiosarcoma of the liver

A

Arsenic (present in cigarette smoke)

Women in the fields used to put arsenic on their skin since it made it paler, to hide their tan

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16
Q

Cigarette smoke increases risk of these 6 cancers. _______ found in cigarette smoke are particularly carcinogenic.

A

Carcinoma of the oropharynx, esophagus, lung, kidney, bladder, and pancreas

Polycyclic hydrocarbons

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17
Q

______ are found in smoked foods and increase risk of stomach cancer (intestinal type)

A

Nitrosamines

responsible for high rates of stomach carcinoma in Japan

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18
Q

______ increases risk of urothelial carcinoma of bladder

A

Napthylamine (derived from cigarette smoke)

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19
Q

Vinyl chloride increases your risk of _______. Can occur due to occupational exposure. It’s used to make PVC pipes

A

angiosarcoma of liver

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20
Q

These four chemical agents increase your risk for lung carcinoma and exposure is often occupational.

A

Nickel, chromium, beryllium, silica

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21
Q

EBV increases your risk for these cancers (3)

A

Nasopharyngeal carcinoma (chinese male or african person), Burkitt lymphoma, and CNS lymphoma (in AIDS)

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22
Q

Kaposi sarcoma is a tumor of ______. Caused by which virus? Clinical presentation and 3 groups predisposed.

A

endothelial cells; HHV-8;

purplish raised lesions on skin - seen in older european males (excise it) and AIDS pts (treat with antiretorvirals - aka tx the virus), and transplant pts (decrease their immunosuppression slightly)

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23
Q

______ increases risk of adult t cell leukemia/lymphoma.

A

HTLV-1 (human t cell leukemia virus)

24
Q

High risk HPV (name 4 high risk subtypes) increases risk of these 5 cancers

A

16, 18, 31, 33

squamous cell carcinoma of vulva, vagina, anus, and cervix; and adenocarcinoma of cervix

25
Q

Ionizing radiation increases risk of these three cancers. Exposure occurs from ______ and it generates hydroxyl free radicals

A

AML, CML, papillary carcinoma of the thyroid

nuclear reactor accidents and radiotherapy

26
Q

Non-ionizing radiation increases risk of these three cancers. Exposure occurs from _____ which results in formation of _______ normally excised by _______.

A

Basal cell carcinoma, squamous cell carcinoma, melanoma of skin

UVB sunlight; pyrmidine dimers in DNA; restriction endonucleases (xeroderma pigmentosum has abnormal restriction endonucleases –> increased risk of skin cancer)

27
Q

______ are essential for cell growth and differentiation. Mutations form oncogenes that lead to unregulated cell growth

A

proto-oncogenes

28
Q

Name five categories of oncogenes

A

Growth factors, growth factor receptors, signal transducers, nuclear regulators, and cell cycle regulators

29
Q

_______ overexpression leads to astrocytoma. It does this in an autocrine fashion.

A

platelet derived growth factor

growth factors induce cellular growth

30
Q

Name three growth factor receptor oncogenes and the cancer they are associated with

A

1) ERBB2 (HER2/neu) = breast carcinoma
2) RET (neural GFR) = MEN2A/B and sporadic medullary carcinoma of the thyroid (MEN = multiple endocrine neoplasm
3) KIT (stem cell GFR) = GI stromal tumor

31
Q

Name two signal transducer oncogenes and the cancer they are associated with

A

1) RAS (GTP- binding protein) = Carcinomas, melanoma, and lymphoma
2) ABL (tyrosine kinase - 9:22 translocation with BCR) = CML and adult ALL

32
Q

Name three nuclear regulator oncogenes and the cancer they are associated with

A

1) c-MYC (t8:14 involving IgH) = Burkitt lymphoma
2) N-MYC = Neuroblastoma
3) L-MYC = Lung carcinoma (small cell)

They are all TF’s; IgH is normally overexposed so translocation causes oncogene in c-MYC

33
Q

Name two cell cycle regulators (proteins that assist mvmt through the cell cycle) and the cancer they are associated with

A

1) CCND1 (cyclin D1) (t11:14 involving IgH) = mantle cell lymphoma
2) CDK4 (cyclin dependent kinase) = melanoma

34
Q

____ is normally associated with GFRs in an inactive GDP bound state. Receptor binding causes GDP to be replaced with GTP activating it. Once it is activated, it sends growth signals to the nucleus. It inactivates itself by cleaving GTP to GDP, which is augmented by ____. Mutation of the first thing, inhibits activity of the second thing, prolonging the active state and increasing growth signals

A

RAS; GAP (GTPase activating protein)

35
Q

____ and ____ regulate progression from G1 to S phase and are classic tumor suppressor genes

A

p53; Rb

36
Q

In response to DNA damage, p53 slows the cell cycle and ______. If DNA repair is not possible, it induces apoptosis by up regulating _____, which disrupts Bcl2

A

upregulates DNA repair enzymes; BAX

p53 loss is seen in >50% of cancers

37
Q

Knudson two hit hypothesis

A

both copies of a tumor suppressor gene must be knocked out for tumor formation

38
Q

Li Fraumeni syndrome involves a _____ mutation in the ____ gene and is characterized by the propensity to develop multiple types of carcinomas and sarcomas

A

germline; p53

39
Q

Rb holds the ___ transcription factor, which is necessary for transition to the S phase. It is released when Rb is phosphorylated by the _____.

A

E2F; cyclinD/cyclin-dependent kinase 4 (CDK4) complex

mutation in Rb leads to constitutively free E2F allowing progression through the cell cycle

40
Q

Sporadic mutation (both hits are somatic) of Rb is characterized by ______. Germline mutation results in _______ (2nd hit is somatic) characterized by _____ and ____.

A

unilateral retinoblastoma; familial retinoblastoma; bilateral retinoblastoma; osteosarcoma

41
Q

Bcl2 is overexpressed in ______. There is a t14;18 that moves Bcl2 to the Ig heavy chain locus (on 14) resulting in increased Bcl2, and prevention of apoptosis.

A

follicular lymphoma

B cells that normally undergo apoptosis during somatic hypermutation in the LN germinal center accumulate –> lymphoma

42
Q

Other important features of tumor development - often you will see tumors with upregulated ____, which preserves telomeres; increased ___ and ___ which are needed for angiogenesis, and down regulation of _____ so tumor cells can evade immune surveillance

A

telomerase; FGF and VEGF (fibroblast FG and vascular endothelial GF); MHC class I

43
Q

For tumor invasion/spread, tumor cells downregulate ______ (a cellular adhesion molecule) –> dissociation of cells –> cells attach to _____ and destroy the basement membrane via collagenase. Cells then attach to _____ in the ECM, and spread locally. Entrance into ____ or _____ allows for metastasis

A

E-cadherin (normally attaches epithelial tumor cells to one another); laminin; fibronectin; vascular or lymphatic spaces

44
Q

_____ spread is characteristic of carcinomas and ____ spread is characteristic of sarcomas and some carcinomas (routes of metastasis)

A

Lymphatic; hematogenous

45
Q

Name the classic four carcinomas that spread hematogenously

A

RCC (invades renal vein); HCC (invades hepatic vein), follicular carcinoma of the thyroid; choriocarcinoma (placental tissue cancer)

46
Q

Seeding of body cavities is characteristic of ____, which often involves the peritoneum (omental caking)

A

ovarian carcinoma

47
Q

Clinical characteristics of benign tumors (4)

A

slow growing, well circumscribed, distinct, mobile

48
Q

Clinical characteristics of malignant tumors (4)

A

rapid growing, poorly circumscribed, infiltrative, fixed (to surrounding tissues and local structures)

49
Q

Classic histological features of benign tumors (6)

A

1) Organized growth; 2) Uniform nuclei; 3) Low nuclear:cytoplasmic ratio (lots of cytoplasm); 4) Minimal mitotic activity; 5) Lack of invasion; 6) No metastatic potential

tend to be well differentiated

50
Q

Classic histological features of malignant tumors (5)

A

1) disorganized growth (loss of polarity - poorly differntiated); 2) nuclear pleomorphism (many sizes) and hyperchromasia (dark blue nuclei); 3) high nuclear:cytoplasmic ratio (lots of nucleus); 4) high mitotic activity with atypical mitosis; 5) invasion (through BM or into local tissue)

51
Q

_____ is used to characterize tumors that are difficult to classify on histology. It involves taking an antibody for a target, labeling it with a brown stain, and seeing if it binds to cells –> helps identify proteins that could help sub classify the cell type

A

Immunohistochemistry

52
Q 
Intermediate filament immunohistochemical stain. Name the tissue type based on the IF type. 
Keratin
GFAP
Neurofilament
Desmin
Vimentin
A 
Epithelium
Neuroglia
Neurons
Muscle
Mesenchyme
53
Q 
Immunohistochemical stain. Name the tissue type based on the positive stained item listed below
Chromogranin
S-100
PSA
ER
Thyroglobulin
A

Neuroendocrine cell (small cell carcinoma of lung and carcinoid tumors)
Melanoma, Schwannoma and Langerhans cell histiocytosis
Prostatic epithelium
Breast epithelium (ER = estrogen receptor)
Thyroid follicular cells

54
Q

Serum tumor markers are useful for these 3 things. Elevated levels require ____ for diagnosis of carcinoma

A

Screening, monitoring response to treatment, monitoring recurrence

tissue biopsy

55
Q

______ (high/low grade) tumors resemble normal parent tissue and have a good/poor prognosis

A

well differentiated; low grade; good

56
Q

______ (high/low grade) tumors do not resemble parent tissue and have a good/poor prognosis

A

poorly differentiated; high grade; poor

57
Q

Staging of cancer is an assessment of both ___ and ___ of a cancer. The most important prognostic factor of TNM staging is ___.

A

size; spread; M - metastasis

Pathology (21 decks)

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