Module 4 Path-Continued Flashcards
Benign tumors have a suffix of oma after tissue type . what are the exceptions to the oma rule?
Malignant: melanoma, lymphoma
What is an adenoma?
Benign tumor that forms a gland or originates from a gland
What is a cystadenoma?
An adenoma with cystic areas (fluid filled)
what is a papilloma?
Benign tumors with finger like projections
What is a polyp?
Elevated mucosal lesion of tumor; bump in the mucosa
What is a lipoma?
Slow growing benign tumor of adipose (mesenchymal origin)
Well differentiated, well demarcated and smooth borders
(no hemorrhage, necrosis or ulcerations)
Lipoma Has a TRUE CAPSULE
What is the etiology of a lipoma?
Unknown and painless
What is the most common site for a lipoma?
Most common in back
most common in makes
f-breast fibroadenoma
How does a benign lipoma appear on histological slide?
Mature white fat cells without pleomorphism
Will a benign become malignant ever?
Nope! 0% chance of malignant transformation
What is a hemangioma?
Encapsulated aggregates of closely packed thin wall capillaries separated by scant CT
Flattened endothelium
How does a hemangioma appear on histological side?
Disorganized blood vessels
What age group of individuals is a hemangioma most common in?
Children
What is the classic appearance of a hemangioma?
Strawberry raised lesion (usually on buttcheek of newborn)
Would you do a biopsy of a hemangioma?
nope!
Is there a change of a hemangioma ever becoming malignant?
0% chance of malignant transformation
What is a chorisotoma?
Normal tissue in an abnormal palce
aka: ectopic or heterotopic rest
Meckel’s Diverticulum (gastric and pancreatic tissue in the ileum)
What are the two types of hemangioma?
Capillary and Cavernous (larger vessels)
What is a leiomyoma (uterine fibroid)
Benign smooth muscle uterine muscle
What is the pathogenesis for a leiomyoma?
Fast growing benign tumors in myometrium (Smooth muscle-mesenchymal)
no necrosis or hemorrhage; clear demarcation, localized and pseudocapsule
What is the etiology and symptoms for leiomyomas?
Unknown
Asymptomatic
No chance of malignancy
What is the most common population for these leiomyomas?
Nulliparous African American Women (never had children)
What is the presentation for leiomyomas?
- Heavy periods (menorrhagia) –> iron deficiency anemia –> left ventricular hypertrophy –> left ventricular failure–> pulmonary edema –> at 2 weeks hemosiderin laden macrophages in alveolar space with alveolar fibrosis (due to collagen)
- Uterus grows big and presses on bladder (urinary urgency/frequency) and presses on rectum (constipation)
What does the histological slide of a leiomyoma look like?
Well differentiated -whorling bundles smooth muscle cells
What are some complications of leiomyomas?
–Estrogen makes the fibroids grow bigger but does not cause them (pregnancy and oral contraceptives cause the fibroids to grow bigger) (menopause causes the fibroids to grow smaller)
What happens if the leiomyomas become too big for the blood supply?
They undergo coagulative necrosis and then a red infarct
What is a sarcoma?
Malignant tumor of mesenchymal origin
retroperitoneal soft tissues: bone, muscle, fat
-disseminate haematogenously in blood
-vimentin (Cytoskeleton protein)
What is a carcinoma?
Malignant tumor of epithelial origin
- disseminate via lymph
- cytokeratin
What is a mixed tumor?
Can either be benign or malignant (mesenchymal or epithelial origins)
1 germ layer with different types of cells and divergent differentiation
A Benign mixed tumor of parotid gland is a pleomorphic (mixed benign) adenoma of salivary gland. What is the etiology and pathogenesis?
Etiology -> Unknown
Pathogenesis: arises from 1 germ layer that undergoes divergent differentiation; monoclonal origin
How does a benign mixed tumor of the parotid gland present?
Painless lumpy mass in the jaw
What are the complications of a benign mixed tumor of the parotid glands?
Small change of malignant transformation –> metastasize –> compression of the facial nerve –> Bell’s Palsy
High chance of recurrence
For investigation of a benign mixed tumor of the parotid gland, what do you see?
See both mesenchymal (amorphous fibromyxoid stroma) and epithelial cells (Serous acini)
–both are benign
What is a polyp?
An outgrowth of mucosal tissue
(can be pednuculated –has visible stalk or sessile–flat with not stalk
What is Familial Adenomatous Polyposis (FAP)?
Genetic, tubular adenoma, numerous benign polyps (>100) on left side of colon (sigmoid descending) (diameter on left colon is smaller than right –>easier to obstruct)
Benign tumor with dysplastic cells and hence can become cancer
What is the gene involved in FAP?
APC (tumor suppressor gene) which requires 2 hits –> inherit 1 bad hit and get second hit later in life –> POLYPS –> mutation in KRAS (one hit) and p53 (two hits) –> adenocarcinoma
(hence never born with polyps because your only born with one hit)
What are symptoms for FAP?
Asymptomatic-screen with sigmoidoscopy (Screen at age 12) if family has a history of left sided colon cancer at a young age
What are some complications of FAP?
Can bleed and give iron deficiency anemia –> left heart failure
What is HNPCC?
No benign polyps; cancer on right side of colon
HNPCC is due to a DNA mismatch of what repair genes?
MLH1, MSH2 and MSH6 and PMS2
At what age do you start screening for HNPCC?
Microsatellite instability
start at age 25 with colonoscopy
What is Lynch syndrome?
Family history of cancers in breast, right sided colon, endometrium and ovaries
(mutations in DNA mismatch repair genes)
Colon Cancer is mostly what?
Sporadic
What are predisposing factors to colon cancer?
FAP, high fat diet, low fiber, rich in refined carbs, low in vitamins A,C, and E, UC and Crohns
What is the etiology for colon cancer?
Unknown
What are the symptoms for colon cancer?
Left side –> bright red blood in stool, mucus, intestinal obstruction and LLQ pain
Right side –> initially no symptoms (b/c occult bleeding) –> iron deficiency anemia due to chronic blood loss
If an older male presents with iron deficiency anemia, what is the most likely diagnosis?
Right sided colon cancer
What is the tumor maker to check for followup after being treated for Colon cancer?
Carcino-Embryonic Antigen (CEA) –useful for followup to treatment
What immunohistochemical stain is used for colon cancer?
Cytokeratin
What is the spread of the cancer from colon?
Lymph –> liver –> lung
So if a patient presents to you with a family history of left sided colon cancer at an early age (before 50), what is the first thing you should thing of?
FAP!
present with bright red blood in the stool
What kind of polyps do you see in FAP?
Pedunculated, they have a stalk and found in the sigmoid colon. totally benign (does not cross basement membrane)
What is the chance FAP will become colon cancer?
100% chance, all you need is one polyp to turn into cancer. so you are going to get colon cacner
What treatment are patients offered by doctors, who are found to have these polyps?
Prophylactic colectomy
better to take it out now then before it turns into cancer
take out the left side, the sigmoid colon
