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Robbins Pathology MOD2 (Chptr 7-10) > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

Migratory thrombophlebitis (trousseau syndrome) is associated with which cancers

A

Deep seated cancer, most often pancreas or lungs

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2
Q

What is the state of the antigenic markers of B cell lymphoma in immunosuppressed patients

A

Express LMP-1, EBNA-2 (both would be killed by CTL in immunocompetent pts) and lack MYC

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3
Q

Which conditions are fine needle aspirations used

A

Assessment of readily palpable lesions in sites such as breast, thyroid, and lymph nodes

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4
Q

How many layers are the majority of tumors composed of

A

Majority of neoplasms, even mixed, are composed of a single germ layer

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5
Q

Where do cancers of the inner quadrants of breast first disseminate

A

LN salong the internal mammary arteries

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6
Q

What is the common pattern see in the formation of ovarian cystic teratomas, aka Dermoid cysts

A

Along ectodermal lines composed of hair, teeth, and sebaceous glands)

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7
Q

What is the general nuclear morphology seen in tumor cells

A

Large nuclei compared to the size of the cytoplasm, and can approach a ratio of 1:1, rather than the normal 1:4 of 1:6

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8
Q

What is ATLL dues to HTLV-1 endemic

A

Japan, Caribbean basin, South America, and Africa

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9
Q

Why are biopsies of testicular masses never done

A

Iatrogenic spread on surgical equipment may occur

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10
Q

What is a pseudoencapsulated mass

A

In slow growing malignant tumors, masses develop rows of cells penetrating the margin and infiltrating

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11
Q

What is the definition of initiation with regards to a a neoplasm

A

Exposure of cells to a sufficient dose of carcinogenic agent, which alters the cell to have the potential to give rise to a tumor

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12
Q

When is a tumor said the be invasive

A

When it breaches the basement membrane

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13
Q

What Increases the risk of breast and endometrial cancers

A

Estrogen exposure, particularly if unopposed by progesterone

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14
Q

What areas is Burkitt’s lymphoma the most common childhood tumor

A

New Guinea and central Africa

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15
Q

What is seeding of body cavities

A

When a malignant neoplasm penetrates into a natural open cavity lacking barriers (most commonly the peritoneal, but includes, pleural, pericardial, subarachnoid, and joints)

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16
Q

How does LMP-1 in EBV work to allow cell proliferation

A

Acts as an activated CD40 receptor, leading to B cell lymphomas

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17
Q

What type of tumors are less likely to have specialized functional activity

A

Rapidly growing anaplastic tumors

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18
Q

Where do breast carcinomas preferably spread

A

To bone

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19
Q

How does the classification TNM system work

A

T for primary tumor (1-4, with 0 being in situ)
N for regional LN (1-3, 0 being no LN involvement)
M for metastasis (1-2, with 0 being no distant metastasis)

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20
Q

What is the effect of having a highly inducible CYP1A1

A

7 times increased risk of lung cancer in smokers than those without

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21
Q

Pathogenic strains of H. Pylori are known to contain which product and what is its function

A

-CagA (cytotoxin-associated A), which penetrates the gastric epithelium and can cause ulcers and other effects

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22
Q

Body cavity seeding is characteristic of which condition

A

Carcinomas of ovarian origin, which spread to peritoneal cavities.

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23
Q

What is a scirrhous tumor

A

Stony hard tumor, like in the breast

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24
Q

How is susceptibility to certain carcinogens polymorphic

A

Most are activated metabolically via CYP450s, which are polymorphic. So having a certain type may predispose to some carcinogens

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25
Q

Which strains of HPV are associated with genital warts

A

6,11

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26
Q

What is the only human retrovirus that is a carcinogen

A

Human T-cell leukemia virus 1 (HTLV-1)

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27
Q

What is the relationship between promoters and neoplasms

A

Promoters themselves are not carcinogenic and can not cause a tumor, as their effects do not change DNA and are reversible.They must follow an initiation event in order to cause a cancer

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28
Q

What are the most common cancers in adults and how does this compare to children

A
  • Carcinomas are most common in adults

- Lymphomas and leukemias most common in children

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29
Q

What is pseudomyxoma peritonei and what causes them

A

The peritoneal cavity is filled with a gelatinous neoplastic mass via a music secreting carcinoma, usually appendicular or ovarian in origin

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30
Q

Increased UV rays from the sun are associated with which conditions

A

Squamous cell carcinoma, basal cell carcinoma, melanoma of the skin

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31
Q

What is the antigenic levels in Burkitt lymphoma

A

Does not express LMP-1, EBNA-2 or other EBV proteins that drive proliferation

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32
Q

What is an ultimate carcinogen

A

The final product of an indirect carcinogen after it has been metabolized into its active form

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33
Q

What is the most common lung neoplasia associated with hypercalcemia

A

Squamous cell carcinoma

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34
Q

What is the strength of direct carcinogens

A

Very weak, but are used as cancer chemotherapy

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35
Q

What is the target of HTLV-1 and what is the result

A

Targets CD4 T cells, which is the major target of neoplasia

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36
Q

What is the potential result from a benign pancreatic islet tumor

A

production of insulin in an amount to produce hypoglycemia

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37
Q

Antibodies against which general cell structures are good for solid tumors

A

Abs against intermediate filaments

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38
Q

What is the example of neoplastic precursor lesion

A

Colonic villous adenoma, which will lead to cancer in 50% or patients

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39
Q

Where do virtually a precursor lesions arise

A

Epithelial surfaces

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40
Q

What are endocrinopathies

A

Paraneoplastic syndromes in which nonendocrine origin develop secretory activity known as ectopic hormone production

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41
Q

What is the result of tax in HTLV-1

A
  • increased pro growth signaling

- Increased genomic instability (increase aneuploid leukemias)

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42
Q

What is the most important substance in the case of malignant paraneoplasia causing hypercalcemia

A

Parathyroid hormone related protein (PTHRP), which is similar to PTH, but released from all tissues

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43
Q

What is the effect of E7 and HPV infections with cancer

A

All contribute to spending through the G1-S cycle checkpoint.

  • Binds to Rb-E2F and releases E2F to progress cell cycle
  • Binds and inhibits p21 and p27, which normally inhibit CDKs
  • activate cyclins A and E
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44
Q

What is cachectin

A

Aka TNF

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45
Q

Disseminated intravascular coagulation is associated with which cancers

A

Acute promyelocytic leukemia and prostatic adenocarcinoma

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46
Q

What are the characteristics of all carcinogenic and what are the properties of the substrates they bind to

A

All chemical carcinogenics are electrophiles and bind to nucleophilic sites in the cell

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47
Q

What are mitoses indicative in tumors

A

High proliferative activity of parenchymal cells

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48
Q

What is the path of hepatocellular carcinomas

A

Penetrate the portal and hepatic radicals then inotthe main venous channels

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49
Q

Where do bronchogenic carcinomas spread

A

Adrenals and the brain

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50
Q

Which conditions bode well for patients with oligodendrogliomas

A

Loss of chromosome 1p and 19q without EGF receptor amplification

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51
Q

Where do neuroblastomas spread

A

Liver and bones

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52
Q

What is the most common noninflammatory precursor lesions

A

Endometrial hyperplasia in response to sustained estrogen exposure

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53
Q

What is anaplasia

A

Lack of differentiation in tumor cells

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54
Q

What cancers are associated with H. Pylori

A

Gastric adenocarcinomas and gastric lymphomas

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55
Q

What percentage of newly diagnosed solid tumors present with metastasis

A

30%

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56
Q

How can you differentiate between Cushing syndrome caused by excess production of pituitary and endocrinopathies

A

Endocrinopathies from lung cancer will have pro-opiomelanocortin, while pituitary excess will not

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57
Q

What is a Choristoma

A

Heterotopic rest of cells (pancreatic neoplasm located in the stomach)

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58
Q

What is a hamartoma

A

Disorganized by benign mass composed of cells indigenous to the involved site

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59
Q

What is associated with intense intermittent UV exposure

A

Melanomas

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60
Q

What type of germ cells do teratomas originate from

A

Totipotent germ cells (normally found in ovaries and testis)

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61
Q

What is the risk in children with CT scans

A

2-3 CT scans have 3x risk of leukemia

5-10 CT scans have 3x risk of brain cancer

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62
Q

What is the most common pathway of initial dissemination of carcinomas

A

Transportation through lymphatics

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63
Q

B cell lymphomas due to H. Pylori can be cleared by what, and what is the reasoning

A

Cleared due to antibiotics, which kill the bacteria. This removes the antigen for T cells, which are required for the activation of the B cells

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64
Q

What is the long term effect of initiation process

A

It is permanent change to DNA and is irreversible

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65
Q

When and what are inducers of the change brought on by initiators

A

When there are promoters, such as phorbol esters, hormones, phenols, and drugs

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66
Q

How would brain cancers be targeted

A

PI3K

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67
Q

What is the process of HPV DNA integrating into the host

A
  • Integrations interrupts viral DNA writhing the E1/E2 reading frame
  • loss of viral E2 repressor
  • overexpression of E6 and E7 oncogenes
68
Q

How would breast cancers be targeted

A

HER2

69
Q

How would lung cancers be molecularly targeted

A

Mutated KIT

70
Q

What is the relationship between chronic inflammation and cancer

A

Chronic inflammation increases the risk of cancer

71
Q

What are the sources for aromatic and all dyes

A

Analine dye and rubber industries

72
Q

What are the most common cancers associated with EBV

A

Tumors derived from B cells and nasopharyngeal carcinomas

73
Q

Gastric lymphomas associated with H. Pylori are of what origin

A

B cell origin from normal Peyer’s patches and MALT structures

74
Q

What strains of HPV are high risk

A

16,18

75
Q

What is a immunohistochemical stain for ALK trying to identify

A

Lung cancers and lymphomas

76
Q

What is leukoplakia

A

Thinking of squamous epithelium on the vulva or penis or oral cavity that can give rise to squamous carcinoma

77
Q

How does tax in HTLV increase pro-growth signaling

A
  • Interacts with PI3K and AKT for cell survival
  • up regulates cyclin D2, and repressed the inhibitors
  • Upregulates NF-KB, which is activator for lymphocytes
78
Q

Which form of breast cancers have a better prognosis

A

Receptor positive breast cancers

79
Q

Where are the most common locations of cancer in US women

A

Lung, breast, colon/rectum

80
Q

What is the most common cancer that evolves from the precancerous stage “cancer in situ”

A

Carcinoma of the uterus (best illustrated), cancers of skin, breast

81
Q

What is the active product in many hydrocarbons and what is their effect

A

Forms epoxides, which form covalent adducts with Primarily DNA and RNA

82
Q

What type of tumor secrete the hormones characteristics of their origin

A

Benign tumors and carcinomas because they are still very well differentiated back to the tissue or origin

83
Q

What bodes poorly for patients with neuroblastoma

A

Amplification of NMYC and deletions of 1p

84
Q

What is the characteristic of benign tumors with regards to differentiation

A

Well differentiated, mitosis are rare, and are of normal configuration

85
Q

What are the common sites for neoplastic hypercalcemia

A

Breast, lung, kidney, ovary

86
Q

What condition is hypertrophic osteoarthropathy associated with

A

Cancer, as it is rarely seen in noncancer patients. 1-10% of lung carcinomas shows this condition

87
Q

What is the pathways used by LMP-1 in B lymphomas following EBV infection

A
  • Activated Jak-Stat and NF-kB (proliferation)

- activated BCL-2 (survival)

88
Q

What is the mutation in TP53 that is common in hepatocellular carcinoma (which can be induced by aflaxonB1)

A

G:C —> T:A tranversion at codon 249 (AA change from arginine to serine)

89
Q

What are the malignant cancers that regularly do not metastasize

A

Gliomas (malignant neoplasms of glial cells) and basal cell carcinomas

90
Q

What is a carcinoma in situ

A

Dysplasia changes are noted. And involve the full thickness of the epithelium, but the lesion does not penetrate the basement membrane

91
Q

What is the function of EBNA-2 in EBV

A

Encodes a nuclear protein that acts as a Notch receptor

92
Q

What condition is highly associated with developing EBV positive B cell tumors, and where do they develope

A

Immunosuppressive and in the CNS and gut

93
Q

What is desmoplasia

A

Formation of collagenous stroma

94
Q

What gives the measure of leukemia cells in treated patients with CML

A

BCR-ABL transcripts

95
Q

What are the three proteins carried by HTLV-1 that is common in all retroviruses, and what it the unique protein

A

All retrovirus: pol, gag, env

HTLV-1: tax

96
Q

What is the result of the Overexpression of E6 in HPV

A
  • Binds to p53 and mediates destruction

- stimulates TERT, which increases telomerase activity

97
Q

How is HTLV-1 transmitted

A

Sex, breast feeding, blood products

98
Q

What does HTLV-1 cause

A

Adult T cell leukemia/lymphoma (ATLL)

99
Q

What is the type of cancer associated with Cushing syndrome

A

50% have small cell lung cancer

100
Q

What is the rule of thumb for naming malignant tumors

A

Tissue of origin, followed by -sarcoma (ex:fibrosarcoma, chondrosarcoma

101
Q

What is the general rule of thumb for naming benign tumors

A

The type of tissue, followed by -oma. (Ex: Fibroma, chondroma,)

102
Q

What type of tumor is characteristic of anaplasia as its hallmark

A

Malignant tumors are anaplastic, aka not well differentiated

103
Q

What are the two basic components of all tumors

A
  • Neoplastic cells that constitute the tumor parenchyma

- Reactive stroma made up of connective tissues, blood vessels, and immune cells

104
Q

Virtually all of Burkitt lymphomas are associated with what

A

Translocation that activate the MYC oncogene.

-In particular, the translocation (8;14)

105
Q

What is associated with the total cumulative exposure to UV radios

A

Nonmelanoma skin cancers

106
Q

What is the most common endocrinopathy

A

Cushing syndrome

107
Q

Antibodies found on a tumor against cytokeratins would be indicative of which cell origin

A

Epithelial origin

108
Q

Lung cancer patients with Cushing syndrome have elevated levels of what

A

-pro-opiomelanocortin and corticotropin

109
Q

Where are the most common cancers in women worldwide

A

Breast, cervix, and lung

110
Q

What are the characteristics of acanthosis nigricans

A

Grey black patches of thickened hyperkeratic skin with a velvety appearance

111
Q

Miners of radioactive elements of Europe and Mocky mountains have an increased risk of what

A

10x increased risk for lung cancer

112
Q

Where do cancers of the vertebral column disseminate and which cancers are they associated with

A

Through the paravertebral plexus involved frequently with metastasis of thyroid and prostate

113
Q

What is the percentage of hepatocellular carcinomas caused by hep B and C

A

70-85%

114
Q

What are the 5 DNA viruses that have been identified to cause cancer in humans

A

-HPV, EBV, Hep BV, Markle cell polyoma virus, HHV-8

115
Q

What is a pleomorphic adenoma

A

A mixed tumor, in which the original clone is able to produce both epithelial and myoepithelial cells (contains cartilage/bone and epithelial components)

116
Q

What percentage of cancers worldwide are due to infectious agents

A

15%

117
Q

What is paraneoplastic syndrome

A

Distribution and elaboration of hormones that are indigenous to the tissue of origin

118
Q

What is the leading cancer killer in both men and women

A

Lung (28 and 26%)

119
Q

What is the large majority of cervical carcinomas and head/neck cancers caused by

A

HPV

120
Q

What are sources for polycyclic hydrocarbons

A

Burning animal fats, fossil fuels and tobacco combustion

121
Q

What tumors are characteristic of hematogenous spread, and which vessels are commonly involved

A

Typical of sarcomas, penetrate veins more commonly than arteries

122
Q

Where do breast carcinomas usually arise and where do they disseminate to

A

Commonly arise in the upper outer quadrant, so they disseminate first to the axillary LN

123
Q

How are most chemical carcinogens activated

A

Most are indirect, meaning they are activated metabolically via CYP-450

124
Q

What is the most common paraneoplastic syndrome

A

Hypercalcemia (more often related to cancer than hyperPTHism

125
Q

How does polymorphism play into the susceptibility of HPV infections and cancer

A

TP53 polymorphic at codon 72 (proline or arginine). Arg72 is more susceptible to degradation via E6

126
Q

What is the path of renal cell carcinoma

A

Invades the renal vein branches, then the renal vein, then up the IVC to the heart

127
Q

What is a common effect of using direct carcinogens as chemotherapy

A

Development of a secondary cancer, commonly acute myeloid leukemia

128
Q

What is acanthosis nigracans associated with

A

Cancer in 50% of patients, especially those over 40

129
Q

What do well differentiated squamous cells carcinomas secrete

A

Keratin

130
Q

Cancer cachexia is associated with which 3 things

A
  • Equal fat and muscle loss
  • Elevated BMR
  • Systemic inflammation and cytokines
131
Q

What are the characteristics of dysplasia

A

Disordered growth, principally in the epithelia with the loss of uniformity of individual cells and architectural orientation (pleomorphic, large nuclei)

132
Q

What do well differentiated hepatocellular carcinomas secrete

A

Bile

133
Q

Where are the most common sites of tumors in US men

A

Prostate, lung, colon/rectum

134
Q

What are papillomas

A

Benign epithelial neoplasms producing visible fingerlike projections, aka polyps

135
Q

What is the first bacteria classified as a carcinogen

A

H. pylori

136
Q

What are the two conditions commonly associated with hypercalcemia

A
  • osteolysis induced by cancer

- calcemic humoral substances by extraosseous neoplasms

137
Q

How would colon cancers be targeted

A

BRAF

138
Q

What do a high percentage of leukemias due to HTLV-1 express

A

FOXP3, which leads to immunosuppression and death

139
Q

What percent of which population has an highly inducible CYP1A1 and is more susceptible to benzo[a]pyrene

A

10% of the white population

140
Q

What is the source of aflatoxin B1

A

Certain strains of aspergillis

141
Q

What strains of HPV cause warts

A

1,2,4,7 cause benign squamous papillomas (aka warts)

142
Q

What occurs in osteolysis induced by cancer

A

Not considered a paraneoplastic condition

-primary in bone, such as myeloma, or metastatic to bone from a primary lesion

143
Q

What is Cushing syndrome caused by

A

Excess production of corticotropin and corticotropin like peptides

144
Q

How does cancer rank on the leading cause of death in the US

A

Second only to CV

145
Q

What is the correlation between EBV and nasopharyngeal carcinoma

A

100% of nasopharyngeal cancers contain EBV

146
Q

What is gene required for the metabolism of the polycyclic aromatic hydrocarbon benzo[a]pyrene

A

CYP1A1

147
Q

What is the titer levels in patients with nasopharyngeal cancer

A

Viral capsid antibodies are elevated, and appearance of IgA abs before the tumor ever shows

148
Q

When does arterial hematogenous spread occur

A

Tumor cells pass through the pulmonary capillary beds or pulmonary arteriovenous shunts

149
Q

What is a tumor capsule

A

IN benign tumors, there is a rim of compressed fibrous tissue that separates from the host tissue

150
Q

What is the tumor capsule compared of and what deposits it

A

Extracellular matrix that is deposited by stromal cells, which are activated by hypoxic conditions due to compression via the tumor

151
Q

What populations commonly develop nasopharyngeal cancers

A

Inuit people, southern China, Africa

152
Q

Which UV is responsible for cutaneous cancers

A

UVB

153
Q

What are the commonly hit locations first hit by hematogenous spread

A

Liver (via portal system) and lungs (caval system)

154
Q

What is dietary consumption of aflaxon B1 strongly correlated with

A

Hepatocellular carcinoma in Africa

155
Q

Where do carcinomas of the lung arising in the major respiratory passages metastasize first

A

Perihilar tracheobronchial and mediastinal LN

156
Q

Where are the most common cancers in men worldwide

A

Lung, stomach, and liver

157
Q

What is the most at risk location to radiation

A

Myeloid leukemias

158
Q

How would prostate cancers be targeted

A

EGFR

159
Q

What is the PCR product that is indicative of Ewing sarcoma

A

(11;22)(q24;q12) translocation

160
Q

What is the correlation between Burkitt lymphoma and EBV infections

A
  • 90% of Africans with Burkitt’s have EBV

- 100% have Abs against viral capsid proteins

161
Q

What is the prognosis of HER2 positive breast cancer and what is some treatment options

A

HER2 breast cancers have poor prognosis, but can be targets by Ab against HER2

162
Q

What is UVC not associated with cancer

A

It is blocked out by the ozone

163
Q

What is run to assess the presence or absence of metastatic lesion in lymph nodes during tumors

A

Biopsy of sentinel nodes (aka first node in the regional lymphatic basin that receives flow from the primary tumor)

164
Q

After initial dissemination, where do breast carcinomas spread

A

Supra and infraclavicular LN

165
Q

What do Direct carcinogens need to become carcinogenic

A

Nothing, they do not require metabolic conversion

Robbins Pathology MOD2 (Chptr 7-10) (4 decks)

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