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Pathoma > Chapter 3: Neoplasia > Flashcards

Chapter 3: Neoplasia Flashcards

1
Q

Importance of Glucose-6-phosphate enzyme isoforms?

A

Clonality can depict neoplasm. Normally you inherit a G6PD isotype from each parent. The ratio of each type should be 1:1. If it’s asymmetrical you have a monoclonal growth that can indicate a neoplastic growth. Theoretically any X-linked isoform would work, so if androgen receptors have isotypes you could use those instead. X-linked and thus ONLY WORKS ON WOMEN

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2
Q

B cell clonality determined by Ig light chain phenotype

A

Ig has 2 heavy, 2 light chains each b cell expresses light chains that are either kappa or lambda
the NORMAL ratio is 3:1 kappa to lambda
any extreme asymmetry from this ratio could indicate neoplasm

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3
Q

3:1 ratio represents?

A

kappa to lamda KAPPA TO LAMDA KAPPA TO LAMDA 3-1 KAPPA LAMDA

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4
Q

Enlarged lymph node DDx

A

Metastatic Cancer
Reactive hyperplasia due to infection
Lymphoma

DIAGNOSTIC FOR LYMPHOMA is a Kappa to Lamda ratio that is NOT 3:1

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5
Q

Lamda to Kappa ratio of 3:1 and enlarged lymph node

A

LYMPHOMA

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6
Q

Kappa to Lamda ratio of 3:1 and enlarged lymph node

A

NORMAL

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7
Q

Aflatoxin

A

hepatocellular carcinoma, derived from Aspergillus which can contaminate stored grains

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8
Q

history with a grain silo

A

Aspergillus, can make aflatoxins which cause hepatocellular carcinoma

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9
Q

Alkylating agents

A

Leukemia/lymphoma this can be a side effect of chemotherapy

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10
Q

Squamous cell carcinoma of oropharynx and upper esophagus

A

alcohol

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11
Q

pancreatic carcinoma

A

alcohol

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12
Q

MCC of hepatocellular carcinoma

A

alcohol

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13
Q

Carcinogens in cigarette smoke

A

Polycyclic Hydrocarbons, Arsenic, Naphthylamine

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14
Q

Squamous cell carcinoma of skin risk factor

A

Arsenic

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15
Q

lung cancer can be caused by this chemical in cigarettes

A

arsenic

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16
Q

Lung carcinoma

A

Asbestos This is MORE LIKELY than mesothelioma after asbestos exposure

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17
Q

Mesothelioma

A

asbestos

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18
Q

Most carcinogenic chemical in cigarette smoke?

A

polycyclic hydrocarbons

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19
Q

Cigarette smoke causes…

A

Carcinoma of oropharynx, esophagus, lung AND kidney, bladder due to hyperconcentration of carcinogens in urine.

Also, increases likelihood of cervical cancer.

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20
Q

History of eating large amount of smoked foods with Japanese descent

A

Think Nitrosamines Stomach cancer, Intestinal type, NOT diffuse

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21
Q

Urothelial carcinoma of bladder

A

Naphthylamine(cigarette smoke derivative)

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22
Q

What symptom would you expect to see from occupational exposure to Polyvinyl chlorides such as those used to make PVC pipes?

A

Angiosarcoma of the liver caused by the vinyl chloride exposure

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23
Q

Occupational exposure to Nickel, chromium, beryllium or silica

A

Lung cancer

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24
Q

Chinese male or indigenous african presenting with neck mass

A

Nasopharyngeal carcinoma secondary to EBV

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25
Cancer associated with EBV
Burkitt's lymphoma and CNS lymphoma in AIDS patients and nasopharyngeal carcinoma
26
Older eastern european male and you see a papular erythematous lesion
Kaposi Sarcoma caused by HHV-8 Can also afflict AIDS patients, transplant patients
27
Which hepatitis viruses preclude hepatocellular carcinoma?
Hep B and Hep C Hep B = HepadnavirusHep C = Flavivirus
28
HTLV-1
HTLV-1 is a retrovirus that predisposed to Adult T-cell leukemia/lymphoma
29
HPV high risk? low risk?
High risk = 16, 18, 31, 33 (Squamous cell carcinoma of lower GU tract. Also ADENOcarcinoma of cervix) Low Risk = 6, 11 (condyloma acumulatum)
30
A worker during the japanese nuclear meltdown is predisposed to
ionizing radiation causing AML, CML and papillary carcinoma of the thyroid
31
What is the malignant cell in AML
myeloblast
32
What is the MOA of ionizing radiation
generation of hydroxyl free radicals
33
MOA of non-ionizing radiation
pyrimidine dimers are created which are normally excised by restriction endonucleases
34
non-ionizing radiation(UVB light) predisposes to.... a/w?
Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin A/W Xeroderma Pigmentosum where base excision is broken.
35
Most common cancers of INCIDENCE
breast/prostate lungs colorectal
36
Most common cancers of MORTALITY
lung breast/prostate colorectal
37
Mammography looks for which cancer?
DCIS, ductal carcinoma in situ
38
Where does prostate cancer generally present?
posterior periphery
39
Describe the RAS pathway
ras-GDP associated with GF in an inactive state Receptor binding causes GDP to be replaced with GTP activating ras ras sends growth signals to nucleus ras inactivated itself by cleaved GTP to GDP. This is overseen by GTPase activating protein NOW ABNORMALA mutated ras inhibits GTPase activating protein, resulting in its constitutively activation
40
Describe role of p53 in DNA repair
p53 is the cell cycle cop It stops a cell in G1 going to S and checks the DNA. If its crappy DNA, it'll say to go get fixed. If it can't get fixed, p53 euthanizes the cell via the Bcl pathway. p53's thug, BAX breaks the Bcl2 that stabilizes the mitochondrial membrane, and thus cytochrome c leaks out and activates apoptotic pathways
41
Li-Fraumeni syndrome
germline mutation of one p53 gene
42
Rb's role in cell cycle regulation
Rb is bound to E2f, this keeps the cell cycle in G1. When CDK comes over and phosphorylates Rb, E2f falls off and gives the green light for S phase and parties like its 1939. If Rb is mutated, then it is NEVER attached to E2f and the cell ALWAYS has the greenlight to party. That's bad
43
Germline retinoblastoma is A/w?
osteosarcoma
44
What gene is overexpressed in follicular lymphoma?
Bcl2. This overstabilizes the mitochondrial membrane, which isn't usually a problem except in the thymus, where you need negative selection to get rid of autoreactive t-lymphocytes. Also B-cells that would undergo apoptosis during somatic hypermutation...don't. This leads to lymphoma, which is probably polyclonal
45
Follicular lymphoma is associated with what translocation?
t(14;18) moves Bcl2(18) to the Ig heavy chain locus(14) making it constitutively active
46
Describe the process of tumor invasion
TUMOR INVASION!! 1. ) downregulation of cadherins, which normally keep cells buddy-buddy all attached to each other, causes...well, detachment. 2. ) Tumor cells then find a new friend to screw with, laminin, and in the process destroy the basement membrane(type IV collagen) with a collagenase 3. ) Bored with laminin, tumor cells attach to fibronectin in the ECM and spread locally until they get tired of THAT. 4. ) They find a blood or lymph vessel so they can go explore the world and party....like its 1939.
47
Sarcoma's generally spread...
haemotogenously
48
Breast cancers generally spread...
lymphatically(axillary breast node first hit)
49
omental caking
ovarian carcinoma. Commonly seeds body cavities, like the peritoneum
50
Hematogenous spread cancers...
Renal cell carcinoma(invades renal vein) Hepatocellular carcinoma(invades hepatic vein) follicular carcinoma of the thyroid choriocarcinoma(placental malignancy) sarcoma's...DUH
51
Keratin stains
epithelium
52
vimentin
mesenchyme
53
Desmin
muscle
54
GFAP
neuroglia
55
neurofilament
neurons
56
neurons IMF
neurofilament
57
neuroglia IMF
GFAP
58
muscle IMF
desmin
59
Mesenchyme IMF
vimentin
60
Epithelium IMF
Keratin
61
S-100
Melanin
62
What do you look for to be positive in melanoma's?
S-100
63
Chromogranin
Small cell carcinoma of lung and carcinoid tumors both of those are neuroendocrine tumors
64
Neuroendocrine tumors
Small cell carcinoma of lung and carcinoid tumors | stains Chromogranin
65
Absolute definition of benign neoplasm
Will never metastatize
66
CA-125
ovarian cancer, NON-specific test
67
Single most prognostic indicator?
metastasis
68
Grade or Staging more important?
Staging -- TNM
69
Staging or Grade more important?
Staging -- TNM
70
PDGFB mutation a/w?
overexpression, autocrine loop that can lead to an astrocytoma
71
breast carcinoma's can sometimes express this receptor
ERBB2[HER2/Neu] amplification of receptors expressed.
72
Common treatment for ERBB2 cancers
Trastuzumab
73
RET function
neural growth factor receptor
74
RET A/W
MEN 2A, MEN 2B, sporadic medullary carcinoma of thyroid
75
KIT function?
Stem cell growth factor receptor
76
KIT A/W
gastrointestinal stromal tumor
77
RAS gene family A/W
Carcinomas, melanoma and lymphoma
78
ABL
Tyrosine kinase
79
ABL A/W
CML and some types of ALL(poor prognosis) | t(9;22) with BCR. Abl starts on 9, but swaps with BCR which is on 22
80
c-MYC A/W | what translocation?
Burkitt Lymphoma transcription factor t(8;14) involving IgH which is always on. So when MYC gene on chromosome 8, which is a transcription factor is ALWAYS on, problems arise. In the party factory
81
N-MYC
amplification mutation leading to Neuroblastoma
82
L-MYC
Small cell lung carcinoma
83
CCND1(Cyclin D1) | What translocation?
Mantle cell lymphoma t(11;14) involving IgH which is always on. So when cyclin, which regulates cell cycle is ALWAYS on, the cops never roll that party.
84
CDK4 mutation
Melanoma
85
Growth Factor Receptors
ERBB2[HER2/neu] RET KIT
86
Signal Transducers
RAS gene family - GTP binding protein | ABL - Tyrosine Kinase
87
Nuclear Regulators
c-MYC N-MYC L-MYC they're all transcription factors
88
Cell Cycle Regulators
CCND1(Cyclin D1) | CDK4

Pathoma (7 decks)

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