Neoplasia 2

Question 1

Describe the differences between benign and malignant tumours

Answer 1

Benign:

• typically expand, compressing surrounding tissue
• well-differentiated (similar structure to tissue of origin)
• slow, progressive expansion
• no anaplasia
• little necrosis
• no invasion
• capsule
• no metastasis

Malignant:

• invade and spread (metastasise)
• poorly differentiated
• tissue of origin can be unclear
• anaplasia
• rapid growth
• frequent mitotic figures
• necrosis if poor blood supply
• local invasion
• infiltrative growth
• capsule often absent
• metastasis

Question 2

What is anaplasia and atypical cells?

Answer 2

• poorly differentiated cells

Question 3

What is Pleomorphism?

Answer 3

• variable appearance

Question 4

What is Anisocytosis?

Answer 4

• varied cell size

Question 5

What is Anisokaryosis?

Answer 5

• varied nuclear size

Question 6

What is Hyperchromasia?

Answer 6

• dark nuclei (condensation)

Question 7

What would increased nuclear to cytoplasmic ratio mean?

Answer 7

• increased nuclear content

Question 8

What is Karyomegaly?

Answer 8

• giant nucleus

Question 9

What are tumour giant cells?

Answer 9

• giant cells

Question 10

Multinucleate?

Answer 10

• more than 1 nuclei

Question 11

What is a prominent nucleoli?

Answer 11

• enlarged or conspicuous nucleolus

Question 12

What is bizarre mitoses?

Answer 12

• abnormal conformation

Question 13

What are all of these?

Answer 13

• cytological features of malignancy (learn together)

Question 14

What does this show and what features can you see?

Answer 14

• Liposarcoma
  
  • Anisokaryosis
  • anisocytosis
  • hyperchromasia
  • bizarre mitoses
  • tumour giant cells
  • poor differentiation - may be going anaplastic
  • multinucleate
  • haemorrhage- rbcs outside as endothelium

Question 15

What is this?

Answer 15

• bronchoalveolar carcinoma
  
  • anaplasia
  • increased nuclear to cytoplasmic ratio
  • hyperchromasia
  • bizarre mitsoses
  • arrow heads - cell death, necrosis, neutrophils (inflam)
  • multinucleation

Question 16

What are the morphological features of malignancy?

Answer 16

• loss of tissue organisation - effacement and disorganisation
• invasion - destruction of adjacent tissue
• no capsule or invasion of capsule - poorly demarcated
• vascular invasion - blood and or lymphatic invasion
• metastasis - spread from site of previous tumour
• necrosis - ischaemia and inflam
• haemorrhage - damage to vessels and angiogenesis

Question 17

What differences can you see between hyperplastic lymph node vs. lympoma (benign vs. malignant)

Answer 17

• hyperplastic lymph- large lymph nodes
  
  • normal architecture but boundaries are still present
• lymphoma - connective tissue not present so boundaries not present
  
  • haemorrhage due to necrosis and lack of blood supply
  • uncontrolled cell growth

Question 18

Is the showing a hyperplactic lymph node or lymphoma?

Answer 18

• hyperplastic lymph node

Question 19

What is this?

Answer 19

• lymphoma

Question 20

This is a squamous cell carcinoma- what features can you see?

Answer 20

• no keratin (SS ep usually produces)
  
  • keratin pearls present
  • still producing keratin- just dont care where they put it
• hyperchromasia
• bizarre mitoses

Question 21

What is the hallmark of neoplasia?

Answer 21

• uncontrolled proliferation
  
  • cell escapes all of its control mechanisms
  • escapes apoptosis
  • independent of external growth factors and regulations

Question 22

What are the genetic factors contributing to carcinogenesis?

Answer 22

• DNA mutations
  
  • point mutations
  • deletion
  • insertion
  • recombination
  • amplification
  • gene conversion
• Epigenetic changes
  
  • DNA methylation
  • imprinting
  • histone methylation
  • histone acetylation
• Chromosomal alterations
  
  • duplication
  • deletion
  • translocation
  • inversion

Question 23

What are telomeres?

Answer 23

• pieces of DNA at the end of chromosomes
• pieces are cut off at each cell division

Question 24

How to tumour cells avoid ageing/ apoptosis?

Answer 24

• add more telomeres to the end of chromosomes
• reactiavte telomerase
• are then immortal to aging

Question 25

How does a tumour form?

Answer 25

• one cell undegoes damage (initiated cell)
• transformation event - e.g. radiation
• the initiated cell enters a proliferative event
• the daughter cells will inherit the abnormalities
• evolves to a preneoplastic benign tumour after promotion
• then can progress to a malignant tumour

Question 26

What is p53?

Answer 26

• in all cells
• detect any damage
• tells the cell to stop dividing
• and undego apoptosis if DNA damage cannot be repaired
• with no p53 - more prone to tumours

Question 27

What substances does the tumour produce to communicte with the stroma?

Answer 27

• growth factors
• inflammatory mediators
• proteases
• tumour antigens

Question 28

What is the stromal response to a tumour?

Answer 28

1. Inflammatory cells
2. stromal fibroblasts
3. extracellular matrix (growth factors)
4. vascular endothelium

Question 29

What does this show?

Answer 29

• normal angiogenesis
  
  • stable
  • organised
  • limited permeability

Question 30

What does this show?

Answer 30

• tumour angiogenesis
  
  • unstable
  • disorganised
  • leaky

Question 31

What are the pink cells?

Answer 31

• pericyte