Neoplasia 2

Question 1

how do all benign tumors grow?

Answer 1

they all grow as a cohesive expansile mass

• they develop a fibrous tissue capsule composed of compressed connective tissue

Question 2

can benign tumors infiltrate other tissues?

Answer 2

no

Question 3

how do benign tumors grow?

Answer 3

develop a fibrous tissue capsule composed of compressed connective tissue

Question 4

what is the only benign tumor that does not grow as an expansive cohesive mass and without a capsule?

Answer 4

hemangioma

Question 5

what is this?

Answer 5

hemangioma

Question 6

what is this?

Answer 6

hemangioma

Question 7

what is an example of a benign tumor that is encapsulated?

Answer 7

Uterine leiomyoma (fibroid)

Question 8

what is this?

Answer 8

Uterine leiomyoma (fibroid): note the well encapsulated masses

Question 9

what is this?

Answer 9

Benign, unencapsulated tumor (hemangioma)

Question 10

what is this?

Answer 10

Carcinoma uterine cervix with invasion of bladder wall

Question 11

how do malignant tumors grow?

Answer 11

they infiltrate and destroy the surrounding tissue

Question 12

can malignant tumors be easily demarcated?

Answer 12

no, they are poorly outlined

Question 13

what is this?

Answer 13

Carcinoma head of pancreas

note the infiltration of the ampulla, duodenal wall, & common bile duct/pancreatic duct. Absolutely no demarcation, which indicates an ill defined margin.

Question 14

what does it mean when a tumor metastasizes?

Answer 14

when a tumor spreads to another region different from the primary tumor

Question 15

what tumors metastasize?

Answer 15

malignant

Question 16

what are the only malignant tumors that do not metastasize?

Answer 16

gliomas and basal cell carcinomas

Question 17

what is this?

Answer 17

Lung showing multiple metastatic tumor deposits from a primary breast carcinoma

Question 18

what is this?

Answer 18

canon ball appearance, metastatic breast carcinoma

Question 19

What 3 ways do malignant tumors spread?

Answer 19

i) Seeding of body cavities and surfaces
ii) Lymphatic spread
iii) Hematogenous spread

Question 20

how does the seeding of body cavities and surfaces mechanism of spreading work?

Answer 20

malignant cells will exfoliate off the tissue and invade another foreign tissue

Question 21

What malignant tumors utilize the seeding of body cavities and surfaces in the peritoneal cavity?

Answer 21

ovaries, appendix (pseudomyxoma peritonei)

Question 22

What malignant tumors utilize the seeding of body cavities and surfaces in the subarachnoid space?

Answer 22

• acute lymphoblastic leukemia
• glioblastoma multiforme

Question 23

what is Pseudomyxoma peritonei?

Answer 23

• associated with primary mucinous tumor arising from appendix
• associated with mucinous ovarian tumor

Question 24

what is a Myxoma?

Answer 24

benign neoplasms that comes from primitive multipotent mesenchymal cells

Question 25

what are the most common 1ry tumor of the adult heart?

Answer 25

myxomas

Question 26

familial syndromes associated with myxomas have activating mutations in what genes?

Answer 26

GNAS1 gene which is for Gs alpha

Question 27

what region in the heart is the preferred area for origin site of myxomas?

Answer 27

fossa ovalis

Question 28

what form of the myxoma tumor of heart may cause intermittent obstruction of the atrioventricular valve opening?

Answer 28

pedunculated myxomas

Question 29

histologically, myxomas are composed of what?

Answer 29

stellate or globular myxoma cells embedded within an abundant acid mucopolysaccharide ground substance

Question 30

what is this?

Answer 30

Cardiac Myxoma note: the myxoid background and stellate cells

Question 31

what is the lymphatic spreading pathway?

Answer 31

- lymph node involvement - follows the natural routes of lymphatic drainage

Question 32

what is the most common pathway for initial spread for carcinomas and sarcomas?

Answer 32

lymphatic spread

Question 33

what is a Sentinel lymph node?

Answer 33

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

Question 34

what is an example of a malignant tumor that utilizes the lymphatic spread pathway? from what side of the area do these tumors arise and to what lymph node do these cells first go?

Answer 34

breast cancer arise from upper, outer quadrant of breas tumor cells go to axillary nodes

Question 35

what is this an example of?

Answer 35

lymphatic spread ## Footnote - Observe the presence of glandular elements in the lymph node - Metastatic lymph node - Primary malignancy from colon

Question 37

how do we detect malignant tumor cells of breast in lymph nodes?

Answer 37

using Technetium-99 (bad cells uptake it better)

Question 38

what are the 2 causes for Lymph node enlargement in cancer?

Answer 38

1. spread and growth of cancer cells 2. reactive hyperplasia * drainage of tumor cell debris or tumor antigen, or both

Question 39

what is this?

Answer 39

Reactive Hyperplasia of Lymph nodes note the follicular architecture is still preserved, however, there is sinusoidal reaction by macrophages (sinus histiocytosis)

Question 40

what is this?

Answer 40

Metastatic lymph node note, no follicular architecture. Glandular elements seen.

Question 41

what cancers use the hematogenous spread pathway?

Answer 41

carcinomas and sarcomas

Question 42

what vessels are involved in the hematogenous spread pathway of malignant tumors?

Answer 42

veins

Question 43

what organs are mostly involved in the hematogenous spread pathway?

Answer 43

liver and lungs

Question 44

what is an example of a malignant tumor that uses the hematogenous spread pathway? What vein is involved?

Answer 44

renal cell carcinoma renal vein

Question 45

what is this?

Answer 45

tumor in blood vessel in primary lung cancer

Question 46

what is this?

Answer 46

tumor in blood vessel in primary lung cancer

Question 47

what is this?

Answer 47

tumor in blood vessel in primary lung cancer

Question 48

what is a unusual pathway of malignant tumor spreading?

Answer 48

krukenberg tumor

Question 49

what is a Krukenberg tumor?

Answer 49

gastric tumors giving rise to tumor deposits on surface of ovaries (bilateral)

Question 50

what is this?

Answer 50

Krukenberg tumor Note: nodular tumor deposits on surface of both ovaries

Question 51

what is this?

Answer 51

Perineural invasion

Question 52

where can a perineural invasion happen?

Answer 52

pancreas malignancies prostate malignancies salivary gland malignancies

Question 53

what are the 2 non-hereditary predispositions?

Answer 53

1. Chronic inflammation and cancer 2. Precancerous conditions

Question 54

what are the examples of Nonhereditary predisposition conditions for chronic inflammation and cancer?

Answer 54

1. ulcerative colitis 2. crohn's disease 3. helicobacter pylori 4. viral hepatitis 5. chronic pancreatitis

Question 55

what are the examples of Nonhereditary predisposition conditions that are precancerous?

Answer 55

1. pernicious anemia, solar keratosis of skin 2. Sjorgen syndrome, Hashimoto’s thyroiditis 3. atypical hyperplasia of ductal epithelium (breast) 4. leukoplakia of oral cavity, vulva and penis 5. chronic irritation of sinus orifice (osteomyelitis) 6. Barrett’s esophagus, dysplastic nevus 7. myelodysplastic syndrome, regenerative nodules in cirrhosis, 8. villous adenoma rectum, complete hydatidiform mole: choriocarcinoma 9. endometrial hyperplasia, scar tissue in lung

Question 57

pernicious anemia will lead to what cancer?

Answer 57

atrophic gastritis of stomach

Question 58

solar keratosis of skin will lead to what cancer?

Answer 58

squamous cell carcinoma

Question 59

sjogren syndrome will lead to what cancer?

Answer 59

MALT lymphoma

Question 60

hashimoto thyroiditis will lead to what cancer?

Answer 60

MALT lymphoma

Question 61

leukoplakia of oral cavity will lead to what cancer?

Answer 61

squamous cell carcinoma

Question 62

barrett's esophagus will lead to what cancer?

Answer 62

adenocarcinoma of esophagus

Question 63

dysplastic nevus will lead to what cancer?

Answer 63

melanoma

Question 64

myelodysplastic syndrome will lead to what cancer?

Answer 64

AML

Question 65

regenerative nodules in cirrhosis will lead to what cancer?

Answer 65

hepatocellular carcinoma

Question 66

villous adenoma of rectum will lead to what cancer?

Answer 66

adenocarcinoma

Question 67

complete hyaditiform mole will lead to what cancer?

Answer 67

choriocarcinoma

Question 68

endometrial hyperplasia will lead to what cancer?

Answer 68

adenocarcinoma of endometrium

Question 69

scar tissue in the lung will lead to what cancer?

Answer 69

adenocarcinoma

Question 70

what type of patient is at increased risk of developing cancer?

Answer 70

those with immunodeficiencies, mostly with T cell deficiencies

Question 71

what is this?

Answer 71

atrophic gastritis note patchy areas of atrophic mucosa right is normal

Question 72

what is this?

Answer 72

epithelial hyperplasia in breast duct (Atypical ductal hyperplasia breast) right is normal

Question 73

what is this?

Answer 73

solar keratosis

Question 74

what is this?

Answer 74

Crohn's Disease note non-caseating granuloma in small bowel mucosa. \* there is dense inflammation

Question 75

what is this?

Answer 75

helicobacter pylori note: appear as curved structures. Highlighted by silver stain.

Question 76

why do familial cancers occur?

Answer 76

due to germline mutations in a tumor suppressor gene

Question 77

Give 5 examples of autosomal dominant familial cancers

Answer 77

1. retinoblastoma 2. familial adenomatous polyposis (FAP) 3. Li-fraumeni syndrome 4. Hereditary Non polyposis Colon Cancer 5. BRCA 1 and 2

Question 78

Give 5 examples of autosomal recessive familial cancers

Answer 78

1. Xeroderma Pigmentosum (XP) 2. Ataxia Telangiectasia 3. Bloom Syndrome 4. Fanconi Syndrome

Question 79

what 2 types of non lethal genetic damage may lead to cancer?

Answer 79

1. acquired: environmental (virus, chemicals, radiation) 2. inherited: germline mutations

Question 80

this term is used to describe a single cell that suffered genetic damage and may keep replicating

Answer 80

clonal expansion

Question 81

Genetic damage leading to cancer occurs due to what?

Answer 81

damage to normal regulatory oncogenes

Question 82

what regulatory genes get damaged leading to cancer?

Answer 82

1. Growth promoting protooncogenes 2. Growth inhibiting tumor suppressor genes 3. Genes that regulate apoptosis 4. Genes involved in DNA repair

Question 83

what are the steps malignant tumors go through? (steps of carcinogenesis)

Answer 83

* excessive growth * local invasion * spread

Question 84

why do we face a therapeutic challenge regarding cancer treatment?

Answer 84

mutations that appear in subsequent generation differs vastly.