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MOD II Exam I > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

2 basic tissue components of benign and malignant neoplasms; which component typically gives rise to the neoplastic cells?

A

Parenchyma = generally gives rise to neoplatic cell component — this is what classification of tumors is based on

Reactive stroma = supportive tissue skeleton on which the parenchymal component resides - responsible for growth and spread

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2
Q

How is a mixed tumor of the salivary gland different from an adenoma of the colon?

A

Mixed tumor of salivary gland = pleiomorphic adenoma (benign) — contains more than one neoplastic cell type, usually derived from one germ layer

Adenoma of the colon = benign epithelial neoplasm derived from glands, may form adenomatous polyp

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3
Q

How is a cystic teratoma of the ovary fundamentally different from a mixed tumor of the salivary gland?

A

Primary difference is that teratomas may come from all 3 germ layers, while mixed tumors usually come all from same germ layer, even if different cell types are involved

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4
Q

Hallmark of malignancy characterized by lack of differentiation

A

Anaplasia

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5
Q

4 grades of differentiation

A

Well differentiated — closely resembles parent tissue

Moderately differentiated — features of the original tissue type identifiable but not in normal pattern, with additional atypia

Poorly differentiated — small minority of cell constituents allow ID of parent tissue; associated with cellular anaplasia

Undifferentiated — cannot discern parent tissue of origin; always associated with anaplasia

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6
Q

Histopathologic criteria used when classifying something as “anaplastic”

A

Pleomorphism

Abnormal nuclear morphology

High mitotic rate

Loss of polarity

Additional blood vessel formation with central areas of necrosis

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7
Q

Metaplasia vs. dysplasia

A

Metaplasia = replacement of one type of cell with another; found in association with tissue damage, repair, and regeneration

Dysplasia = disordered growth; encountered principally in epithelia, characterized by loss in uniformity of individual cells as well as loss in their architectural orientation

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8
Q

Define carcinoma in situ

A

Dysplastic changes are marked and involve full thickness of epithelium, but lesion does not penetrate the basement membrane

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9
Q

Carcinoma in situ is best characterized as ________

A

Pre-neoplastic (argument could be made for “benign” as well)

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10
Q

Most common histopathologic features used to assess rate of growth in a neoplasm

A

Slow growing cancers typically have capsule (rim of compressed fibrous tissue)

Malignant/rapidly growing tumors are typically poorly demarcated and lack well-defined cleavage plane; some have pseudoencapsulation (rows of cells penetrating margin and infiltrating adjacent structures)

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11
Q

Pathologic features that individually (and almost always in aggregate) distinguish malignant from benign tumors

A

Atypical structure with some lack of differentiation (anaplasia)

Erratic rate of growth; mitotic figures may be numerous and abnormal

Locally invasive, infiltrating surrounding tissue

Metastasis

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12
Q

2 examples of malignancies that rarely metastasize

A

Gliomas

Basal cell carcinomas

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13
Q

3 major pathways by which metastasis may occur

A

Direct seeding of body cavities or surfaces

Lymphatic spread

Hematogenous spread

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14
Q

Describe metastasis by direct seeding of body cavities/surfaces

A

May occur whenever a malignant neoplasm penetrates into a natural “open field” lacking physical barriers

Most often involves peritoneal cavity (can also be pleural, pericardial, subarachnoid, joint spaces, etc.)

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15
Q

Describe pattern of lymphatic spread in the metastasis of breast vs. lung cancers

A

Breast —> axillary nodes or internal mammary arteries

Lung —> perihilar tracheobronchial and mediastinal nodes

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16
Q

Carcinomas typically metastasize via lymphatic spread, however there are some exceptions. What are 4 carcinomas that tend to metastasize via hematogenous spread?

A

Renal cell carcinoma - via renal v. to IVC

Hepatocellular carcinoma - via hepatic v.

Follicular carcinoma of thyroid

Choriocarcinoma

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17
Q

First node in a regional lymphatic basin that receives lymph flow from the primary tumor

A

Sentinal node

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18
Q

The most common tumor of men in the US and most of developed world is prostate cancer, but in certain countries or regions (most located in developing world), cancers of the liver, stomach, esophagus, bladder, lung, oropharynx, and immune system rise to the top of the list.

Similarly, the incidence of breast cancer is generally much higher in women in developed countries than in most parts of the developing world.

What are some probable reasons for the difference in incidence in prostate and breast cancers?

A

Environmental influences likely underlie most differences in incidence:

Infectious agents like HPV
Smoking
Alcohol consumption
Diet
Obesity
Reproductive history
Environmental carcinogens
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19
Q

Occupational cancer associated with arsenic exposure (by-product of metal smelting, exposure to medications/herbicides/fungicides)

A

Squamous cell carcinoma of skin

Lung carcinoma

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20
Q

Occupational cancer associated with asbestos exposure (found in construction of older buildings, friction materials, roofing tiles, floor papers, etc)

A

Lung, esophageal, gastric, and colon carcinoma; mesothelioma

[note that lung carcinoma more commonly occurs than mesothelioma]

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21
Q

Occupational cancer caused by benzene exposure (component of light oil; used in dry cleaning, printing, paint, rubber, detergents)

A

Acute myeloid leukemia

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22
Q

Occupational cancer due to beryllium exposure (missile fuel, space vehicles, nuclear reactors)

A

Lung carcinoma

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23
Q

Occupational cancer due to cadmium exposure (yellow pigments and phosphors; found in solders, batteries, metal platings, coatings)

A

Prostate carcinoma

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24
Q

Occupational cancer due to chromium exposure (metal alloys, paints, pigments, preservatives)

A

Lung carcinoma

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25
Q

Occupational cancer due to exposure to nickel compounds (nickel plating, ceramics, batteries, byproduct of stainless steel welding)

A

Lung and oropharyngeal carcinoma

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26
Q

Occupational cancer due to exposure to radon + its decay products

A

Lung carcinoma

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27
Q

Occupational cancer due to vinyl chloride exposure

A

Hepatic angiosarcoma

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28
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Asbestosis, silicosis

A

Mesothelioma

Lung cancer

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29
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

IBD

A

Colorectal carcinoma

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30
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Lichen sclerosis

A

Vulvar squamous cell carcinoma

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31
Q

What type(s) of cancer are associated with chronic inflammatory states due to Sjogren syndrome or Hashimoto thyroiditis?

A

MALT lymphoma

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32
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Opithorchis, cholangitis (due to liver flukes)

A

Cholangiocarcinoma, colon carcinoma

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33
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

H. Pylori induced gastritis/ulcers

A

Gastric adenocarcinoma, MALT lymphoma

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34
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Hepatitis

A

Hepatocellular carcinoma

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35
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Osteomyelitis

A

Carcinoma in draining sinuses

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36
Q

What type(s) of cancer are associated with the following chronic inflammatory state:

Chronic cystitis d/t schistosomiasis

A

Bladder carcinoma

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37
Q

_______ = thickening of squamous epithelium that may occur in oral cavity, penis, or vulva, and give rise to squamous carcinoma

A

Leukoplakia

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38
Q

Benign neoplasm that, if left untreated, progresses to cancer in 50% of cases

A

Colonic villous adenoma

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39
Q

3 examples of benign neoplasms at extremely low risk for malignant transformation

A

Lipomas
Uterine leiomyomas
Pleomorphic adenomas

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40
Q

Inherited cancers are usually due to what type of mutation?

A

Germline mutation in tumor suppressor gene

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41
Q

Developmental attributes known as cancer hallmarks

A 
Self-sufficiency in growth signals
Insensitivity to growth-inhibitory signals
Altered cell metabolism
Evasion of apoptosis
Limitless replicative potential
Sustained angiogenesis
Ability to invade and metastasize
Ability to evade host immune response
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42
Q

PDGFB (platelet-derived growth factor) is a proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Overexpression —> Astrocytoma

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43
Q

ERBB2 [HER2/neu] is a proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Overexpression/amplification —> subset of breast carcinomas (important for therapeutic implications)

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44
Q

RET is a neural growth factor receptor and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Point mutation —> MEN2A, MEN2B, and sporadic medullary thyroid cancer

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45
Q

KIT is a stem cell growth factor receptor and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Point mutation —> GI stromal tumor

46
Q

The RAS gene family codes for GTP binding proteins that are known proto-oncogenes that undergo what type of mutation and is associated with what type of cancer?

A

Point mutation —> carcinomas, melanomas, lymphomas (many types)

47
Q

ABL is a tyrosine kinase and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

t(9;22) with BCR —> CML, some types of ALL (adult types)

48
Q

c-MYC is a transcription factor and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

t(8;14) involving Ig heavy chain locus (leading to massive production of MYC —> Burkitt lymphoma

49
Q

N-myc is a transcription factor and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Amplification —> neuroblastoma

50
Q

L-myc is a transcription factor and known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Amplification —> small cell lung cancer

51
Q

CCNDI (cyclin D1) is a known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

t(11;14) involving Ig heavy chain —> mantle cell lymphoma

52
Q

CDK4 is a known proto-oncogene that undergoes what type of mutation and is associated with what type of cancer?

A

Amplification —> melanoma

53
Q

Gatekeeper of colonic neoplasia

A

APC (adenomatous polyposis coli protein)

54
Q

When APC is mutated or absent, destruction of ______cannot occur - so it translocates to the nucleus and coactivates genes that promote entry into the cell cycle, and cells behave as if they are under constant stimulation by the ____ pathway

A

Beta-catenin; WNT

55
Q

Familial and sporadic cancers associated with APC

A

Familial: familial colonic polyps and carcinomas

Sporadic: carcinomas of stomach, colon, pancreas, melanoma

56
Q

____ is a regulatory gene that functions as an inhibitor of RAS/MAPK signaling; what types of cancers are associated with it?

A

NF1

Familial: neurofibromatosis type 1 - neurofibromas and peripheral nerve sheath tumors

Sporadic: neuroblastoma, juvenile myeloid leukemia

57
Q

_____ is a regulatory gene that functions in cytoskeletal stability and Hippo pathway signaling; what type of cancers is it associated with?

A

NF2 (merlin)

Familial: neurofibromatosis type 2 (acoustic schwannoma, meningioma)

Sporadic: schwannoma, meningioma

58
Q

____ is a regulatory gene that functions as an inhibitor of hedgehog signaling; what type of cancers is it associated with?

A

PTCH (patched)

Familial: gorlin syndrome (basal cell carcinoma, medulloblastoma, benign tumors)

Sporadic: basal cell carcinomas, medulloblastoma

59
Q

_____ is a regulatory gene that functions as an inhibitor of PI3/AKT signaling; what cancers are associated with it?

A

PTEN

Familial: Cowden syndrome - benign skin, GI, and CNS growths; breast, endometrial, and thyroid carcinoma

Sporadic: diverse cancers - particularly carcinomas and lymphoid tumors

60
Q

_____ is a regulatory gene that functions as a component of TGF-beta signaling pathway, repressor of MYC and CDK4 expression, and inducer of CDK inhibitor expression; what types of cancer is it associated with?

A

SMAD2, SMAD4

Familial: juvenile polyposis
Sporadic: frequently mutated in colonic and pancreatic carcinoma

61
Q

____ protein functions as an inhibitor of hypoxia-induced transcription factors (e.g., HIF1-alpha)

A

VHL

62
Q

Germline loss of function mutations in VHL protein cause VHL syndrome, and AD disorder associated with high risk of what cancers? What paraneoplastic syndrome?

A

Renal cell carcinoma
Pheochromocytoma
Cerebellar hemangioblastoma
Retinal angioma

Paraneoplastic syndrome = polycythemia (high RBC count) - due to the cerebellar hemangioblastoma

63
Q

_____ is an activator of AMPK family of kinases and functions in supression of cell growth when cell nutrient and energy levels are low; what cancers is it associated with?

A

STK11 (liver kinase B1 or STK11)

Familial: Peutz-Jeghers syndrome (GI polyps, GI cancers, pancreatic carcinoma)

Sporadic: diverse carcinomas

64
Q

Cancers associated with SDHB and SDHD which function in TCA cycle/oxphos

A

Paraganglioma, familial pheochromocytoma

65
Q

CDH1 (e-cadherin) functions in cell adhesion and inhibitor of motility; what cancers are associated with its dysfunction?

A

Gastric carcinoma, lobular breast carcinoma

66
Q

p53 may be inactivated by viral oncoproteins, such as ____ associated with HPV

Rb may also be inactivated by viral oncoproteins, such as ____ associated with HPV

A

E6

E7

67
Q

Therapeutic implications of a cancer associated with mutated TP53

A

Less likely to be killed by irradiation and conventional chemotherapy, because they mediate their effects by inducing DNA damage and subsequent apoptosis

68
Q

Rare syndrome in which patients inherit one defective copy of TP53 and have very high incidence of diverse cancers

A

Li-Fraumeni syndrome

69
Q

ALK is a growth factor receptor that may undergo translocation, fusion gene formation, or point mutation to contribute to what cancers?

A

Adenocarcinoma of lung, certain lymphomas, neuroblastoma

70
Q

BRAF is a proto-oncogene associated with RAS signal transduction that may undergo point mutations or translocations to contribute to what cancers?

A

Hairy cell leukemias, melanomas, benign nevi, colon carcinoma, and dendritic cell tumors

71
Q

Bcl2 is a regulator of apoptosis. What type of mutation does it undergo and what cancers is it associated with?

A

t(14;18) —> increased Bcl2 production —> apoptosis will not occur — this is normally not an issue EXCEPT in follicle, so it contributes to follicular lymphoma

72
Q

Warburg effect

A

Upregulation of glucose and glutamine uptake, which provide carbon sources of synthesis of nucleotides, proteins, and lipids

In cancers, oncogenic mutations involving growth factor signaling pathways and other key factors such as MYC deregulate these metabolic pathways

73
Q

Cancer cells acquire lesions that inactivate senescence signals and reactivate ______, which act together to convey limitless replicative potential

A

Telomerase

74
Q

Regulators of angiogenesis

A

p53 induces synthesis of angiogenesis inhibitor thrombospondin-1

RAS, MYC, and MAPK signaling all upregulate VEGF expresion

75
Q

Mechanisms by which tumors may avoid immune system detection

A

Selective outgrowth of antigen-negative variants

Loss or reduced expression of histocompatibility Ags

Immunosuppression mediated by expression of certain factors (e.g., TGF-beta, PD-1 ligand, galectins) by the tumor cells

76
Q

How do those with HNPCC syndrome end up with increased risk of colon cancer?

A

Defective DNA mismatch repair system — so their genome shows microsatellite instability, characterized by changes in length of short repeats throughout the genome

77
Q

Most known carcinogens are metabolized by what enzymes?

A

Cytochrome p450-dependent monooxygenases

78
Q

Aflatoxins are carcinogens produced by aspergillus mold and confer risk to what type of cancer?

A

Hepatocellular carcinoma

79
Q

Disorder associated with defects in nucleotide excision repair and thus increased risk of skin cancer in areas exposed to UVB light, due to inability to repair pyrimidine (typically thymidine) dimers

A

Xeroderma pigmentosa

80
Q

Cushing syndrome is a paraneoplastic syndrome related to what type(s) of cancer?

A

Small cell carcinoma of lung
Pancreatic carcinoma
Neural tumors

81
Q

SIADH is a paraneoplastic syndrome related to what type(s) of cancer?

A

Small-cell carcinoma of lung

Intracranial neoplasms

82
Q

Hypercalcemia is a paraneoplastic syndrome related to what type(s) of cancer?

A

Squamous cell carcinoma of lung
Breast and renal carcinomas
ATLL

83
Q

Hypoglycemia is a paraneoplastic syndrome related to what type(s) of cancer?

A

Ovarian sarcoma
Fibrosarcoma
Other mesenchymal sarcomas

84
Q

Polycythemia is a paraneoplastic syndrome related to what type(s) of cancer?

A

Renal carcinoma
Cerebellar hemangioma
Hepatocellular carcinoma

85
Q

Myasthenia is a paraneoplastic syndrome related to what type(s) of cancer?

A

Bronchogenic carcinoma

Thymic neoplasms

86
Q

Disorders of the CNS and PNS are paraneoplastic syndromes related to what type(s) of cancer?

A

Breast carcinomas

87
Q

Acanthosis nigricans is a paraneoplastic syndrome related to what type(s) of cancer?

A

Gastric carcinoma
Lung carcinoma
Uterine carcinoma

88
Q

Dermatomyositis is a paraneoplastic syndrome related to what type(s) of cancer?

A

Bronchogenic carcinoma

Breast carcinoma

89
Q

Hypertrophic osteoarthropathy and clubbing of the fingers are changes associated with a paraneoplastic syndrome that occurs with what type(s) of cancer?

A

Bronchogenic carcinoma

Thymic neoplasms

90
Q

Venous thrombosis (trousseau phenomenon) is a paraneoplastic syndrome related to what type(s) of cancer?

A

Pancreatic carcinoma
Bronchogenic carcinoma
Other cancers

91
Q

DIC is a paraneoplastic syndrome related to what type(s) of cancer?

A

Acute promyelocytic leukemia

Prostatic carcinoma

92
Q

Nonbacterial thrombotic endocarditis is a paraneoplastic syndrome related to what type(s) of cancer?

A

Advanced cancers

93
Q

Red cell aplasia is a paraneoplastic syndrome related to what type(s) of cancer?

A

Thymic neoplasms

94
Q

Definition of grading vs. staging of tumors

A

Grading based on degree of differentiation (cytologic appearance)

Staging based on size of primary lesion, extent of spread, and presence/absence of metastasis

95
Q

Utility of flow cytometry in cancer diagnosis

A

Mainly used to identify cellular antigens expressed by B and T cell lymphomas and leukemias as well as myeloid neoplasms

96
Q

HCG as tumor marker

A

Trophoblastic tumors

Nonseminomatous testicular tumors

97
Q

Calcitonin as tumor marker

A

Medullar carcinoma of thyroid

98
Q

Catecholamines as tumor markers

A

Pheochromocytoma

99
Q

ACTH or ACTH-like substances as tumor markers

A

Small-cell carcinoma of lung
Pancreatic carcinoma
Neural tumors

100
Q

ADH or ANP hormones as tumor markers

A

Small cell carcinoma of lung

Intracranial neoplasms

101
Q

PTHRP, TGF-alpha, TNF, or IL-1 as tumor markers

A

Squamous cell carcinoma of lung
Breast carcinoma
Renal carcinoma
ATLL

102
Q

Insulin as tumor marker

A

Ovarian carcinoma
Fibrosarcoma
Other mesenchymal sarcomas

103
Q

EPO as tumor marker

A

Renal carcinoma
Cerebellar hemangioma
Hepatocellular carcinoma

104
Q

Alpha-fetoprotein as tumor marker

A

Hepatocellular carcinoma

Nonseminomatous germ cell tumors of testes

105
Q

Carcinoembryonic antigen as tumor marker

A

Carcinomas of colon, pancreas, lung, stomach, and heart

106
Q

Neuron-specific enolase as tumor marker

A

Small cell cancer of lung

Neuroblastoma

107
Q

CA-125 as tumor marker

A

Ovarian cancer

108
Q

CA-19-9 as tumor marker

A

Colon cancer

Pancreatic cancer

109
Q

CA-15-3 as tumor marker

A

Breast cancer

110
Q

What type of cancer is associated with a t(15;17) translocation and is associated with DIC - indicated by fibrin split products and purpuric lesions?

A

Acute myeloid leukemia

MOD II Exam I (4 decks)

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