ICL 7.3: Neoplasia III

Question 1

how biopsies would you do confirm that something is a benign neoplasm?

Answer 1

options:
1. fine needle aspiration biopsy (FNAB): non-invasive, allows for preoperative planning and saves OR time

2. core needle biopsy: guided with ultrasound
3. excision of lump = lumpectomy

Question 2

what are the microscopic features of a benign neoplasm?

Answer 2

1. expansile growth rather than infiltrative
2. well demarcated from surrounding tissue; smooth edges
3. well differentiated = closely resembles normal tissue
4. lacks malignant nuclear features
5. not fixed to the tissue so it can move around

Question 3

what is a fibroadenoma?

Answer 3

the most common benign solid breast lump in women from 15-30 years

Question 4

what’s the treatment for fibroadenoma?

Answer 4

they’re benign

so most times treatment isn’t necessary but you have to follow-up to make sure there’s no changes in size or appearance

Question 5

what are uterine leiomyomas?

Answer 5

aka fibroids

they’re the most common benign tumor of the uterus and originate from smooth cells of the myometrium

they can occur within the myometrium (intramural), just beneath the endometrium (submucosal), or beneath the serosa (subserosal)

Question 6

what are submucosal leiomyomas?

Answer 6

benign uterine tumors just beneath the endometrium

they’re most often associated with abnormal bleeding from the expansile pressure of the tumor on the mucosal surface

Question 7

what populations are associated with uterine leiomyomas?

Answer 7

most common neoplasm in females, specifically African American

smooth muscle cels of the myometrium respond to estrogens so most of these tumors arise during reproductive years –> they’re almost never found in prepubertal girls and post-menopause

Question 8

is someone with a uterine leiomyoma at risk for uterine malignancy?

Answer 8

no

malignant transformation of leiomyomas is really rare

leiomyosarcomas are malignany smooth muscle tumors of the uterus and they’re rare neoplasm that arise de novo, unrelated to preexisting leiomyomas

Question 9

what does desmoplasia mean?

Answer 9

refers to tumor-induced proliferation of non-neoplastic fibrous connective tissue

it’s commonly seen in adenocarcinomas of the breast, prostate and pancreas

Question 10

break down the word “adenocarcinoma”

Answer 10

adeno = forming glands

carcinoma = arising from epithelial cells

Question 11

how can you predict the consistency of a tumor based on the stroll appearance?

Answer 11

if there’s extensive collagen in the tumor, it’s consistency would be hard or scirrhous

Question 12

what type of stain would you use for a breast tumor?

Answer 12

a marker for estrogen

if a tumor is positive for estrogen, this is a good prognostic sign and this can be exploited in treatment

antibodies are used to stain the tumor and the stain shows that basically all the tumor cells express estrogen receptor protein and they stain brown

Question 13

how is estrogen receptor expression involved in the development of a breast tumor?

Answer 13

estrogen may bind to the receptors on the tumor cells and promote their growth!!

estrogen is not mutagenic so it’s a tumor promoter, NOT tumor initiator

Question 14

in breast tumors that have estrogen receptors, how can this be exploited therapeutically?

Answer 14

since tumor cells can proliferate by binding estrogen, three therapeutic strategies are used to interrupt this process:

1. interrupt the binding of estrogen to its receptor (tamoxifen)
2. prevent estrogen production (aromatase inhibitors)
3. deplete the supply of estrogen (oophorectomy) –> this is done a lot with patients who have BRCA1 or BRCA2 mutations

Question 15

which drug interrupts the binding of estrogen to its receptor?

Answer 15

tamoxifen

Question 16

which drug prevents estrogen production?

Answer 16

aromatase inhibitors

Question 17

what depletes the supply of estrogen?

Answer 17

oophorectomy

Question 18

how does immunohistochemical staining done?

Answer 18

it requires an antibody against the target protein to be detected

the antibody is conjugated to an enzyme that converts a colorless compound into a chromogen

this lets us visualize any antibody binding to the tissue

Question 19

what are some characteristics of dysplasia cells?

Answer 19

• hyperchromic
• irregular nuclear outlines
• increased nuclear to cytoplasmic ratio

Question 20

what is the difference between carcinoma in situ and invasive carcinoma?

Answer 20

CIS is confined to the epithelium and doesn’t go beyond the basement membrane

invasive carcinoma goes through the basement membrane into the underlying stroma

Question 21

which virus is associated with cervical dysplasia?

Answer 21

HPV

high risk = HPV 16 & 18

low risk = HPV 31, 33 and 35

Question 22

how can HPV lead to neoplasia?

Answer 22

the proteins encoded by the E6 and E7 genes high risk risk HPV disable important tumor suppressor proteins that regulate the cell cycle like p53 (E6) and RB (E7)

Question 23

what is pleomorphism?

Answer 23

when the nuclei of a cell vary in size and shape

Question 24

why is it important to know that a tumor has invaded into the muscle layer of the esophagus but not beyond it?

Answer 24

important in determining tumor stage!

staging of cancers is based on the size and extent of the primary lesion, the extend of spread to regional lymph nodes and the presence or absence of distant metastasis

staging is important to the clinician in determining the best course of therapy (more important than grading!)

Question 25

what is grading?

Answer 25

tumor grading is based on the level of differentiation and the number of mitoses with the tumor

the grade of the cancer is presume to correlate with the neoplasm’s aggressiveness

Question 26

what is metaplasia?

Answer 26

replacement of one mature epithelium with another mature epithelium in response to stress

Question 27

what is Barrett’s esophagus?

Answer 27

patients usually have a history of heartburn or burning substernal chest pain especially after eating

there’s columnar metaplasia with goblet cells in the tissue samples

after many years, a dysplasia can arise in Barrett’s mucosa and from that an adenocarcinoma can arise

dysplasia in Barrett’s esophagus is regarded as the precursor of invasive malignancy

Question 28

what environemal causes could lead to lung carcinoma?

Answer 28

smoking

Question 29

what environmental cause could lead to mesothelioma?

Answer 29

asbestos

it’s a tumor of the tissue that lines the lungs, stomach, heart, and other organs

Question 30

what environmental cause could lead to endometrial carcinoma?

Answer 30

estrogen

Question 31

what environmental cause could lead to hepatic angiosarcoma?

Answer 31

vinyl chloride

Question 32

what cancers could radiation exposure lead to?

Answer 32

bone cancer

leukemias

thyroid cancer

Question 33

what happens to most people with a malignant neoplasm?

Answer 33

weight loss = cancer cachexia

if someone is gaining weight then it suggest a paraneoplastic syndrome!

the carcinoma could be secreting ACTH-like substances that is leading to increased glucocorticoid production and Cushing’s syndrome which would cause easy bruising, hypertension, glucose intolerance and truncal obesity

Question 34

what are some characteristics of Cushing’s syndrome?

Answer 34

caused by the tumor secreting excess ACTH

ACTH hormone regulates steroid levels

characteristics = high BP, thin arms and legs but truncal obesity, moon face, red cheeks, buffalo hump, each bruising, red stretch marks, poor wound healing

Question 35

how do sarcomas spread?

Answer 35

they tend to spread via the bloodstream

it’s less common that they spread via the lymphatic system