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USMLE pathologgy > neoplasia > Flashcards

neoplasia Flashcards

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USMLE® Step 1 flashcards
1
Q

What does monoclonal mean in neoplasia?

A

Neoplastic cells are derived from a single mother cell.

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2
Q

How is clonality historically determined?

A

By analyzing glucose-6-phosphate dehydrogenase (G6PD) enzyme isoforms.

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3
Q

What is the normal ratio of G6PD isoforms in polyclonal tissues?

A

1:1

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4
Q

What is the difference in G6PD isoform ratio between hyperplasia and neoplasia?

A

Hyperplasia is polyclonal (1:1 ratio), while neoplasia is monoclonal (only one isoform).

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5
Q

How is B lymphocyte clonality determined?

A

By analyzing the immunoglobulin (Ig) light chain phenotype (kappa or lambda)

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6
Q

What is the normal kappa to lambda light chain ratio in B cells?

A

3:1.

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7
Q

How does the kappa to lambda ratio change in lymphoma?

A

The ratio becomes >6:1 or is inverted (e.g., 1:3), indicating monoclonality.

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8
Q

What distinguishes benign tumors from malignant tumors?

A

Benign tumors: Localized, do not metastasize.
Malignant tumors: Invade locally and can metastasize

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9
Q

What determines tumor nomenclature?

A

The lineage of differentiation (type of tissue) and whether the tumor is benign or malignant.

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10
Q

How many cell divisions occur before the earliest clinical symptoms of cancer?

A

Approximately 30 divisions.

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11
Q

What does a Pap smear detect?

A

Cervical dysplasia (CIN) before it becomes carcinoma

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12
Q

What does mammography detect?

A

In situ breast cancer (e.g., DCIS) before it invades.
Invasive carcinoma before it becomes clinically palpable

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13
Q

What are carcinogens?

A

Agents that damage DNA, increasing cancer risk (e.g., chemicals, viruses, radiation)

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14
Q

What are proto-oncogenes?

A

Genes essential for cell growth and differentiation. Mutations form oncogenes, leading to unregulated cellular growth.

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15
Q

What are the categories of oncogenes?

A

Growth factors (e.g., PDGFB in astrocytoma)
Growth factor receptors (e.g., HER2/neu in breast cancer)
Signal transducers (e.g., ras)

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16
Q

What cancer is associated with aflatoxins?

A

Hepatocellular carcinoma
Derived from Aspergillus, which can contaminate stored rice and grains.

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17
Q

What cancer is caused by alkylating agents?

A

Leukemia/lymphoma.
Side effect of chemotherapy

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18
Q

Name three cancers associated with alcohol.

A

Squamous cell carcinoma of oropharynx and upper esophagus
Hepatocellular carcinoma

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19
Q

What cancers are linked to arsenic exposure?

A

Squamous cell carcinoma of skin
Lung cancer
Angiosarcoma of the liver
Arsenic is present in cigarette smoke.

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20
Q

What cancers are associated with asbestos?

A

Lung carcinoma
Mesothelioma
Exposure to asbestos is more likely to lead to lung carcinoma than mesothelioma.

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21
Q

What cancer is caused by naphthylamine?

A

Urothelial carcinoma of the bladder.
Derived from cigarette smoke.

22
Q

What cancer is linked to nitrosamines?

A

Stomach carcinoma.

23
Q

What cancer is caused by naphthylamine?

A

Urothelial carcinoma of the bladder

24
Q

What cancer is associated with vinyl chloride?

A

Angiosarcoma of the liver.
Occupational exposure; used to make PVC for pipes.

25
Q

What cancers are linked to exposure to nickel, chromium, beryllium, or silica?

A

Lung carcinoma.

26
Q

What cancers are associated with EBV (Epstein-Barr Virus)?

A

Nasopharyngeal carcinoma
Burkitt lymphoma
CNS lymphoma in AIDS

27
Q

What cancer is linked to HHV-8?

A

Kaposi sarcoma.

28
Q

What cancer is linked to HTLV-1?

A

Adult T-cell leukemia/lymphoma.

29
Q

Which high-risk HPV subtypes are associated with cancer?

A

Subtypes 16, 18, 31, 33.
Causes squamous cell carcinoma of vulva, vagina, anus, and cervix; adenocarcinoma of the cervix.

30
Q

What cancers are associated with ionizing radiation?

A

AML (Acute Myeloid Leukemia)
CML (Chronic Myeloid Leukemia)
Papillary carcinoma of the thyroid
Generates hydroxyl free radicals.

31
Q

What cancers are linked to non-ionizing radiation (e.g., UV sunlight)?

A

asal cell carcinoma
Squamous cell carcinoma
Melanoma of the skin
Results in the formation of pyrimidine dimers in DNA, normally excised by restriction endonuclease.

32
Q

What is the inactive state of ras?

A

Ras is associated with growth factor receptors in an inactive GDP-bound state.

33
Q

How is ras activated?

A

Receptor binding causes GDP to be replaced with GTP, activating ras.
Activated ras sends growth signals to the nucleus.

34
Q

How does ras return to its inactive state?

A

Ras inactivates itself by cleaving GTP to GDP; this process is augmented by GTPase activating protein.

35
Q

What happens in ras mutations?

A

Mutated ras inhibits the activity of GTPase activating protein, prolonging the activated state of ras and increasing growth signals

36
Q

What is the role of cyclins and cyclin-dependent kinases (CDKs)?

A

Cyclins and CDKs form a complex that phosphorylates proteins, driving the cell through the cell cycle.

37
Q

Give an example of a cyclin-CDK complex and its function.

A

The cyclin D/CDK4 complex phosphorylates the retinoblastoma (Rb) protein, promoting progression through the G1/S checkpoint.

38
Q

What is the role of tumor suppressor genes?

A

Tumor suppressor genes regulate cell growth and decrease the risk of tumor formation

39
Q

Name two classic tumor suppressor genes.

A

p53 and Rb (retinoblastoma).

40
Q

What is the function of p53?

A

p53 regulates the progression of the cell cycle from G1 to S phase.

41
Q

What is the function of PDGFB and its associated tumor?

A

Function: Platelet-derived growth factor.
Mechanism: Overexpression, autocrine loop.
Associated Tumor: Astrocytoma.

42
Q

What tumor is associated with ERBB2 (HER2/neu) and its mechanism?

A

Function: Epidermal growth factor receptor.
Mechanism: Amplification.
Associated Tumor: Subset of breast carcinomas.

43
Q

What is the role of RET and its associated conditions?

A

Function: Neural growth factor receptor.
Mechanism: Point mutation.
Associated Tumors: MEN2A, MEN2B, and sporadic medullary carcinoma of the thyroid.

44
Q

What type of tumor is linked to KIT and its mechanism?

A

Function: Stem cell growth factor receptor.
Mechanism: Point mutation.
Associated Tumor: Gastrointestinal stromal tumor.

45
Q

What are the key features of the RAS gene family?

A

Function: GTP-binding protein.
Mechanism: Point mutation.
Associated Tumors: Carcinomas, melanoma, and lymphoma.

46
Q

What is the significance of ABL in oncogenesis?

A

Function: Tyrosine kinase.
Mechanism: t(9;22) translocation with BCR.
Associated Tumors: Chronic myeloid leukemia (CML) and some types of acute lymphoblastic leukemia (ALL).

47
Q

What tumor is associated with c-MYC, and what is the genetic alteration?

A

Function: Transcription factor.
Mechanism: t(8;14) involving IgH.
Associated Tumor: Burkitt lymphoma

48
Q

What tumor is associated with N-MYC?

A

Function: Transcription factor.
Mechanism: Amplification.
Associated Tumor: Neuroblastoma.

49
Q

What tumor is associated with L-MYC?

A

Function: Transcription factor.
Mechanism: Amplification.
Associated Tumor: Small cell lung carcinoma.

50
Q

What is the function of CCND1 (Cyclin D1) and its associated cancer?

A

Function: Cyclin.
Mechanism: t(11;14) involving IgH.
Associated Tumor: Mantle cell lymphoma.

51
Q

What tumor is associated with CDK4 and its mechanism?

A

Function: Cyclin-dependent kinase.
Mechanism: Amplification.
Associated Tumor: Melanoma.

USMLE pathologgy (10 decks)

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