Chapter 3.4 Clinical Characteristics

Question 1

Neoplasia can be divided into benign and malignant tumors. What are some clinical characteristics of benign tumors?

Answer 1

slow growing (mass that has grown slowly over many years)

Well circumscribed (very distinct and separate from adjacent tissue in which it is growing, ex breast mass)

mobile (if you try to move around, its easy; like a breast mass, tells you its not invading into local tissues, not attaching itself to chest wall in case of the breast

Question 2

Neoplasia can be divided into benign and malignant tumors. What are some clinical characteristics of malignant tumors?

Answer 2

Rapid growing (history of tumor that has grown within a year or months)

poorly circumscribed (can’t really separarate from adjacent tissue)

Infiltrative to local tissue

Fixed to surrounding tissues (fixed to chest wall in case of breast tissue)

Question 3

Sometimes benign tumors can have malignant characteristics and sometimes malignant tumors can have benign characteristics; what is the only way to actually diagnose a tumor as one class or the other?

Answer 3

biopsy or excision

required before a tumor can be classified with certainty (pathologist will make the diagnosis)

Question 4

What are some of the histological features of benign tumors (well differentiated)?

Answer 4

look very similar to tissue in which they are growing

usually have organized growth

uniform nuclei

low nuclear to cytoplasmic ratio

minimal mitotic activity

lack of invasion

no metastatic potential (won’t have ability to spread)

Question 5

What are some of the histological features of malignant tumors (usually poorly differentiated)?

Answer 5

disorganized growth (doesn’t really look like the tissue in which its growing)

nuclear pleomorphism (some nuclei small, some big) with hyperchromasia (nuclei v dark blue)

high nuclear to cytoplasmic ratio (indicates the nucleus is very active and open and is rapidly transcribing genes, etc)

high mitotic activity (rapidly dividing cells)

invasion into local structures

Question 6

Sometimes benign tumors can have malignant characteristics and sometimes malignant tumors can have benign characteristics; What is the absolute distinguishing feature between benign and malignant?

Answer 6

METASTATIC POTENTIAL

malignant have metastatic potential

benign do not have metastatic potential and never metastasize

Question 7

In context of neoplasia, immunohistochemistry may be used; when?

Answer 7

if v poorly differentiated cancer (looks nothing like normal tissue)

so patient has mass, get biopsy, cells are poorly differentiated, so; is this carcinoma (epithelial cells)?, lymphoma (cells lymphocytes)? sarcoma (derived from mesenchyme)? or is it melanoma?

take antibody against target, label that antibody w brown stain, place it on cells, if it binds the cells, that helps us identify proteins that may help us classify the subtype

Question 8

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for keratin. What does this indicate about the tumor? How can you classify it?

Answer 8

cells have a cytoskeleton and the cytoskeleton contains filaments; one subtype is intermediate filaments

Intermediate filaments vary depending on type of cell you’re dealing with

(if you are looking at tumor and can’t recognize if tumor cells are epithelial or something else; can do immunohistological stain for keratin and if the cells are keratin positive then that would indicate i’m dealing with a carcinoma (malignant epithelial tumors)

Question 9

What are the intermediate filaments present in epithelium?

Answer 9

keratin

Question 10

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for Vimentin; what does this indicate about the tumor? How can you classify it?

Answer 10

Vimentin is intermediate filament present in mesecnhymal cells (connective tissues cells)

so dealing with a SARCOMA (malignant tumor of mesenchyme tissue)

Question 11

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for Desmin; what does this indicate about the tumor? How can you classify it?

Answer 11

dealing w muscle

Question 12

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for GFAP; what does this indicate about the tumor? How can you classify it?

Answer 12

dealing w neuroglia cells

Question 13

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for neurofilaments; what does this indicate about the tumor? How can you classify it?

Answer 13

dealing w neurons

Question 14

Tumor is carcinoma; making glands. Describe a way to determine if it is from the prostate or another organ?

Answer 14

do immunohistological stain for PSA; if PSA positive it indicates these are prostatic epithelial cells and its a prostatic carcinoma

Question 15

If a patient has a metastatic carcinoma of lung and I’m worried about where that came from; what tests can I run? What would I look for?

Answer 15

do estrogen receptor (ER) stain; if estrogen expressed in those cells possible it came from a breast cancer

Question 16

What would a chromogranin positive immunohistological stain indicate?

Answer 16

indicates neuroendocrine cells (e.g. small cell carcinoma of lung and carcinoid tumors)

carcinoid-best
small lung cell carcinoma-worst

(both derived from both the same cell type; neuroendocrine cells)

Question 17

What is expressed in neuroendocrine cells that I can test for using an immunohistological stain?

Answer 17

Chromogranin

Question 18

After doing an immunological stain on a poorly differentiated tumor you see that the cells are positive for S-100; what does this indicate about the tumor? How can you classify it?

Answer 18

melanoma

Question 19

What are serum tumor markers?

Answer 19

proteins released by the tumor into the serum

can be useful for screening (PSA is protein released by prostate cancer into blood and we can detect in blood)

monitor response to treatment (cancer has prostate cancer and the PSA is 15; the surgeon removes the prostate along w the cancer, we’d expect the PSA to drop to near 0) if patient comes back in 2 years later with bone pain; if we did a PSA and PSA now high that would help prove the patient has a recurrence

Useful for screening, but elevated levels require tissue biopsy for diagnosis of carcinoma

Question 20

Patient comes in for screening and PSA is performed and PSA is markedly elevated; what’s the next step?

a. surgery
b. biopsy

Answer 20

STILL NEED TO BIOPSY THE SITE AND PROVE THAT IT IS TUMOR THAT IS CAUSING THE PSA

(other things can elevate the PSA, not only cancer)

Question 21

How is differentiation determined?

Answer 21

Grading of cancer is microscopic assessment of differentiation;

Look at architectural and nuclear features of the cell (like mitotic activity)

Does tumor look like the tissue in which its growing? The more it resembles the parent tissue, the more well differentiated it will be

poorly differentiated: does not resemble parent tissue

important for det. prognosis

Question 22

What is staging of cancer based upon?

Answer 22

based on size and spread

How far has cancer grown? What is its size or depth of invasion?

Question 23

What is the number one prognostic factor and when is it determined?

grade or staging?
biopsy or after resection?

Answer 23

staging is more important than grade

true staging is determined after resection of tumor

Question 24

What is TNM? Which is most important prognostic factor?

Answer 24

T- tumor size or depth of invasion

N- spread to regional lymph nodes; second most important prognostic factor

M-metastasis; single most important prognostic factor