Module 4 Path Continued

Question 1

What is a blastoma?

Answer 1

Tumor thought to arise in embryonic tissue

Question 2

Blastomas are most common in what age group?

Answer 2

children

Question 3

Blastomas are malignant in what three areas of the body?

Answer 3

1. Retinoblastoma-retina
2. Heptaoblastoma-liver
3. Neuroblastoma- neural origin

Question 4

When do patient normally develop retinoblastoma?

Answer 4

around age 2

Question 5

What is the pathogenesis of retinoblastoma?

Answer 5

Mutation in Rb tumor suppressor genes needs 2 hits

• Sporadic (unilateral) and Familial (bilateral)
• Familial type leads to osteosarcoma later in life

Question 6

What is the presentation of retinoblastoma?

Answer 6

Visual impairment (running into walls) 
Leukocoria (cats eye reflex) causes pupil to look white with pupillary light reflex

Question 7

On histological stain of a retinoblastoma what classic things are you going to find?

Answer 7

True Rosettes (malignant cells arrange around a central lumen)

Question 8

What is the treatment for retinoblastoma?

Answer 8

Take eye out and chemotherapy called enucleuation

if you dont take out the eye it will spread

Question 9

What condition are pseudorosettes: not arranged around central lumen seen in ?

Answer 9

seen in neuroblastoma

Question 10

which tumors have NO chance of malignancy?

Answer 10

Lipoma
Capillary Hemangioma
Leiomyoma

Question 11

What tumors have small chance of malignancy?

Answer 11

Salivary gland adenoma (mixed tumor)

Benign dermoid cyst (teratoma)

Question 12

What tumors have 100% change of malignancy?

Answer 12

FAP
HNPCC
Osteosarcoma 
Wilm's Tumor 
Retinoblastoma

Question 13

NOTE –> MORE INFO IN CHARTS ON CARCINOGENS

Answer 13

:)

Question 14

HNPCC is due to what?

Answer 14

DNA mismatch repair genes: MLH1, MSH2 and MSH6 and PMS2

micro-satellite instability

Question 15

What is the presentation for HNPCC?

Answer 15

Family history of right sided colon cancer at an early age

normally asymptomatic

Question 16

What should you do as a physician to screen for HNPCC?

Answer 16

Start screening with a colonoscopy at age 25 that again has a family history of right sided colon cancer at an early age

Question 17

How many polps do you see in HNPCC?

Answer 17

1 or 2 polyps on the right side

Question 18

What do you find in the stool of a patient with HNPCC?

Answer 18

Stool is getting formed and blood mixed with stool and patient never see it.
patients are going to have iron deficiency anemia because they never see the blood.

Question 19

What is the appearance of the polys in HNPCC?

Answer 19

Sessile polys (flat with no stalk)

Question 20

Colon cancer, what side in the most common?

Answer 20

Left side and sporadic

Question 21

What are the predisposing factors and etiology of colon cancer?

Answer 21

Predisposing factors: FAP, high fat diet, low fiber, rich in refined carbs, low in vitamins A,C,E and UC/Crohn’s
Etiology: unknown

Question 22

What are the signs of left sided colon cancer?

Answer 22

Napkin ring constriction
stools come out like a pencil
bright red blood in stool
mucus and more likely to obstruct because diameter of left side is way smaller then right

Question 23

What are the signs of right sided colon cancer?

Answer 23

Symptoms: occult bleeding and fatigue from iron deficiency anemia
older male with iron deficiency is right sided so you do colonoscopy
If you have anemia = LV failure and heart failure cells

Question 24

At what age do you start screening people for colon cancer that do not have a family history of colon cancer?

Answer 24

age 50

Question 25

What do you see on histology of colon cancer?

Answer 25

Dysplastic glands invading (Adeno)

Question 26

How do you monitor response to treatment?

Answer 26

CEA

remember P CLUBS

Question 27

How do you differentiate on gross specimen cancerous ulcer vs peptic ulcer?

Answer 27

Look for margins that are heaped up or raised and thats huge for cancer ulcer

Question 28

Site of Metastasis = brain, what is the site of primary cancer?

Answer 28

Lung 
Breast 
Skin (melanoma) 
Kidney (renal cell carcinoma) 
GI 
Lots of Bad Stuff Kills Girls

Question 29

Site of Metastasis=LIVER, what is the site of primary cancer?

Answer 29

Colon 
Stomach 
Pancreas
Breast 
Lung 
P CLuBS

Question 30

Site of metastasis=bone, what is the site of primary cancer?

Answer 30

Prostate

Breast