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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
Q

Cancer associated with EBV

A

Burkitt’s lymphoma and CNS lymphoma in AIDS patients and nasopharyngeal carcinoma

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26
Q

Older eastern european male and you see a papular erythematous lesion

A

Kaposi Sarcoma caused by HHV-8 Can also afflict AIDS patients, transplant patients

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27
Q

Which hepatitis viruses preclude hepatocellular carcinoma?

A

Hep B and Hep C Hep B = HepadnavirusHep C = Flavivirus

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28
Q

HTLV-1

A

HTLV-1 is a retrovirus that predisposed to Adult T-cell leukemia/lymphoma

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29
Q

HPV high risk? low risk?

A

High risk = 16, 18, 31, 33 (Squamous cell carcinoma of lower GU tract. Also ADENOcarcinoma of cervix) Low Risk = 6, 11 (condyloma acumulatum)

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30
Q

A worker during the japanese nuclear meltdown is predisposed to

A

ionizing radiation causing AML, CML and papillary carcinoma of the thyroid

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31
Q

What is the malignant cell in AML

A

myeloblast

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32
Q

What is the MOA of ionizing radiation

A

generation of hydroxyl free radicals

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33
Q

MOA of non-ionizing radiation

A

pyrimidine dimers are created which are normally excised by restriction endonucleases

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34
Q

non-ionizing radiation(UVB light) predisposes to….

a/w?

A

Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin A/W Xeroderma Pigmentosum where base excision is broken.

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35
Q

Most common cancers of INCIDENCE

A

breast/prostate
lungs
colorectal

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36
Q

Most common cancers of MORTALITY

A

lung
breast/prostate
colorectal

37
Q

Mammography looks for which cancer?

A

DCIS, ductal carcinoma in situ

38
Q

Where does prostate cancer generally present?

A

posterior periphery

39
Q

Describe the RAS pathway

A

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
Q

Describe role of p53 in DNA repair

A

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
Q

Li-Fraumeni syndrome

A

germline mutation of one p53 gene

42
Q

Rb’s role in cell cycle regulation

A

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
Q

Germline retinoblastoma is A/w?

A

osteosarcoma

44
Q

What gene is overexpressed in follicular lymphoma?

A

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
Q

Follicular lymphoma is associated with what translocation?

A

t(14;18) moves Bcl2(18) to the Ig heavy chain locus(14) making it constitutively active

46
Q

Describe the process of tumor invasion

A

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
Q

Sarcoma’s generally spread…

A

haemotogenously

48
Q

Breast cancers generally spread…

A

lymphatically(axillary breast node first hit)

49
Q

omental caking

A

ovarian carcinoma. Commonly seeds body cavities, like the peritoneum

50
Q

Hematogenous spread cancers…

A

Renal cell carcinoma(invades renal vein)
Hepatocellular carcinoma(invades hepatic vein)
follicular carcinoma of the thyroid
choriocarcinoma(placental malignancy)
sarcoma’s…DUH

51
Q

Keratin stains

A

epithelium

52
Q

vimentin

A

mesenchyme

53
Q

Desmin

A

muscle

54
Q

GFAP

A

neuroglia

55
Q

neurofilament

A

neurons

56
Q

neurons IMF

A

neurofilament

57
Q

neuroglia IMF

A

GFAP

58
Q

muscle IMF

A

desmin

59
Q

Mesenchyme IMF

A

vimentin

60
Q

Epithelium IMF

A

Keratin

61
Q

S-100

A

Melanin

62
Q

What do you look for to be positive in melanoma’s?

A

S-100

63
Q

Chromogranin

A

Small cell carcinoma of lung and carcinoid tumors both of those are neuroendocrine tumors

64
Q

Neuroendocrine tumors

A

Small cell carcinoma of lung and carcinoid tumors

stains Chromogranin

65
Q

Absolute definition of benign neoplasm

A

Will never metastatize

66
Q

CA-125

A

ovarian cancer, NON-specific test

67
Q

Single most prognostic indicator?

A

metastasis

68
Q

Grade or Staging more important?

A

Staging – TNM

69
Q

Staging or Grade more important?

A

Staging – TNM

70
Q

PDGFB mutation a/w?

A

overexpression, autocrine loop that can lead to an astrocytoma

71
Q

breast carcinoma’s can sometimes express this receptor

A

ERBB2[HER2/Neu] amplification of receptors expressed.

72
Q

Common treatment for ERBB2 cancers

A

Trastuzumab

73
Q

RET function

A

neural growth factor receptor

74
Q

RET A/W

A

MEN 2A, MEN 2B, sporadic medullary carcinoma of thyroid

75
Q

KIT function?

A

Stem cell growth factor receptor

76
Q

KIT A/W

A

gastrointestinal stromal tumor

77
Q

RAS gene family A/W

A

Carcinomas, melanoma and lymphoma

78
Q

ABL

A

Tyrosine kinase

79
Q

ABL A/W

A

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
Q

c-MYC A/W

what translocation?

A

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
Q

N-MYC

A

amplification mutation leading to Neuroblastoma

82
Q

L-MYC

A

Small cell lung carcinoma

83
Q

CCND1(Cyclin D1)

What translocation?

A

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
Q

CDK4 mutation

A

Melanoma

85
Q

Growth Factor Receptors

A

ERBB2[HER2/neu]
RET
KIT

86
Q

Signal Transducers

A

RAS gene family - GTP binding protein

ABL - Tyrosine Kinase

87
Q

Nuclear Regulators

A

c-MYC
N-MYC
L-MYC

they’re all transcription factors

88
Q

Cell Cycle Regulators

A

CCND1(Cyclin D1)

CDK4

Pathoma (7 decks)

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