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Neoplasia Flashcards

1
Q

Benign vs. malignant

A

Benign usually doesn’t metastasize. Malignant has the capacity to metastasize. Exceptions occur.

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2
Q

Leiomyoma - most common benign tumor in a woman

A

Tumor of smooth muscle. “Fibroids.” Don’t become leiomyosarcomas.

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3
Q

Most common benign tumor in a man

A

Lipoma.

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4
Q

Benign tumor of glands

A

Adenoma.

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5
Q

Tubular adenoma

A

Most common precursor for colon ca. Strawberry on a stick.

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6
Q

Carcinoma vs. sarcoma

A

Carcinoma is a malignancy of epithelial tissues (squamous, glandular, transitional). Squamous (Keratinous pearls, Adenocarcinoma (glands with things inside).

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7
Q

Melanoma

A

Melanocyte. Benign lesion = Nevus. APUD - neurosecretory origin. Have neurosecretory granules. S100 antigen. APUD (small cell carcinoma, melanoma, bronchiocarcinoid, carcinoid, neuroblastoma)

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8
Q

Sarcoma

A

Malignancy of mesenchymal tissue.

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9
Q

Osteogenic sarcoma

A

Sunburst

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10
Q

Bx of girl w/ mass coming out

A

vimentin neg, keratin neg, desmin positive. Embyronal myosarcoma - most common cancer of children.

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11
Q

Leiomyosarcoma vs. rhabdomyosarcoma

A

Smooth muscle vs. striated muscle sarcoma

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12
Q

Mixed tumor

A

Parotid gland. Pleomorphic adenoma. NOT teratoma b/c derived from SAME cell layer. 2 different types of tissues.

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13
Q

Teratoma

A

Germ cell tumors from all cell layers.

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14
Q

Leukemia vs. Lymphoma

A

Auer rod (AML). Hypersegmented neutrophils (B12-folate). Leukemia is a malignancy of stem cells of bone marrow. Malignant lymphomas come from lymph nodes (can metastases to bone marrow).

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15
Q

Most common site for lymphoma NOT in LN.

A

Stomach. H. pylori. 2nd most = Peyer’s patches in the Terminal ileum

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16
Q

Most common lymphoma

A

Follicular B-cell lymphoma. t(14;18) -> BCL-2 -> Inactivates apoptosis gene

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17
Q

Trophoblastic tumors

A

Hydatiform mole (bunch of grapes), PEC in 1 TM presentation w/ uterus is too large. (Mole = benign tumor of the chorionic villus.) Villi are lined by syncytial trophoblast [outside for o2 extraction] and cytotrophoblast, wharton’s jelly, vessel = umbilical vein (most o2 for fetus). Choriocarcinoma = malignancy of the LINING (syncytio and cytotrophoblast). Syncytiotrophoblast makes Beta-HCG and human placental lactogen.

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18
Q

Things that end in -oma are not necessarily benign or even a neoplasm.

A

Melanoma. lymphoma. Non-neoplastic –> Hamartoma = overgrowth of tissue in the place it SHOULD be. (e.g. bronchial hamartoma - coin lesion; polyp of Putz-Jegher’s syndrome). Choristoma = benign tissue in wrong place. e.g. Meckel’s diverticulum - gastric or pancreatic mucosa in small bowel bleed.

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19
Q

“Cancer”

A

Increased mitotic rate does NOT mean cancer. Atypical mitotic spindle is suggestive (aneupleid). Malignant = ability to metastasize. Longer cell cycle than cell that derived.

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20
Q

Doubling times before clinical detection

A

THIRTY. Tumor about 1 cm in size.

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21
Q

Tumor cells

A

LACK adhesion. Anaerobic metabolism. Lots of enzymes (protreases = breakthrough tissue; collagenase for BM breakdown)

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22
Q

Metastasis

A

Three types: lymphatic, hematogenous, seeding; Carcinomas usu. metasasize via LN’s (breast -> axillary) at the SUBCAPSULAR sinus. If they get through efferent to thoracic duct - > subclavian -> eventually hematogenous. Hematogenous = BAD. bone, liver. Sarcomas go straight through blood vessels and metastasize hematogenously (lungs and bones). Harder to detect. (e.g. radical dissection of breast isn’t need to angiosarcoma of breast). LOTS of exceptions.

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23
Q

Renal adenocarcinoma

A

Goes to renal vein directly.

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24
Q

HCC

A

Like to invade vessels.

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25
Seeding
Cancers in cavities = ovarian cancer (b/c they're mostly SURFACE-derived cancer. Omentum, pouch of douglas. Seeding in pleural cavity. Glioblastoma multiforme --> seed into spinal cord (leptomeningeal carcinomatosis).
26
Always asks if metastasis is more common than primary cancer?
Renal adenocarcinoma is an exception. Most common lung cancer is breast cancer metastasis. Most common cancer of bone is metastasis (breast cancer; BATSON venous plexus - venous from base of skull to sacrum has NO valves). For bone, vertebral column and head of femur are the most common locations.
27
Most common cancer of liver?
Lung and colon cancer.
28
Testicular cancer metastasize to?
Para-aortic LN's (b/c descended).
29
Left supraclavicular node
VIRCHOW's node = STOMACH. Visceral.
30
Lytic metastasis and blastic metastasis.
MM = PUNCH out lesions. Plasma cells have IL-1 (osteoclast-activating factor!) HyperCa. Osteoblastic response? Prostate cancer is osteoblastic. Release AlkPhos. Lytic = lucency. Blastic = entity. (on x-ray)
31
Multiple lesions on anything
THINK Metastasis.
32
Adrenal gland metastases
Lung cancer
33
Desmin stain
Muscle
34
Keratin
Carcinomas
35
EM is rare
APUT tumor for neurosecretory granules. Histiocytosis X tumor - Birbeck granules; CD1. Muscle = actin and myosin. Vascular = Weibell-Palade bodies? (Vwf)
36
Oncogenesis steps
Initiation = mutation. Promoted = multiple copies of mutation. Progression = sub-specializing cells (invasion, metastasis, stay, resist chemo).
37
Protooncogenes
Proto-oncogenes are normally regular cell-cycle stuff. Cis = makes growth factors. ERB-2=HER2 (breast cancer) - codes for a receptor. RET = MEN syndromes (1&2) = receptors. Messenger genes. RAS = GTP messenger (cell-membrane). ABL = cytosolic messenger system. Nuclear receptors that are transcription factors. N-myc (neuroblastoma) and C-myc (Burkitt's).
38
Proto-oncogenes
Proto-oncogenes are normally regular cell-cycle stuff. Cis = makes growth factors. ERB-2=HER2 (breast cancer) - codes for a receptor. RET = MEN syndromes (1&2) = receptors. Messenger genes. RAS = GTP messenger (cell-membrane). ABL = cytosolic messenger system. Nuclear receptors that are transcription factors. N-myc (neuroblastoma) and C-myc (Burkitt's).
39
Tumor suppressor genes
Rb and p53. ALL point mutations.
40
Initiation
Mechanisms of mutations? Most common = POINT mutation (e.g. p53 and RAS). Amplification = multiple copies of gene (HER2). TRANSLOCATION
41
Translocations
CML = translocation of ABL to BCR = t(9;22) = Phildaelphia chromosome. Burkit's = EBV-associated where C-myc t(8;14); EBV receptor is CD21 on B-cells -> plasma cells. EBV stimulates divisions. t(14;18) = B-cell lymphoma. t(15;17) = Acute promyelocytic leukemia (tx = retinoic acid by maturing the cell into a benign one)
42
Tumor suppressors
APC for FAM. NF. Wilms tumor. BRCA1/2 (DNA repair) - 1 is breast/ovarian and others.
43
Etios of initiation
Chemicals, viruses, radiation. CHEMICALS is most common cause (e.g. smoking - polycyclic hydrocarbons)
44
Papillary tumor of bladder
Smoking. Analine. Cyclophosphamide.
45
Kaposi's sarcoma
HHV-8.
46
HCC
Aflatoxin B + HBV = Lots of HCC in Asia.
47
HIV-associated cancers
Primary CNS lymphoma.
48
HPV
Squamous cancers. Genes. E6 knocks off p53. E7 knocks off Rb.
49
Radiation
Leukemia. CML is most. t (9;22) = ABL. Papillary carcinoma of the thyroid. Osteogenic sarcoma
50
Non-ionizing radiation. UV B. B is Bad.
UV A = Wood's light (dermatology - Shagreen's patches, dermatopyosis). Basal cell carcinoma.
51
Actinic keritosis
Solar keratosis ---> Squamous cell carcinoma (3-4%). Scrapes off and comes back off. Arsenic (Bangladesh - angiosarcoma of liver, lung cancer, squamous cell carcinoma)
52
Retinoblastoma
Chromosome 13. Sporadic (TWO HITS) and familial (1 HIT req.) White eye reflex (most common of this is congenital cataracts - e.g. rubella, CMV).
53
Xeroderma pigmentosa
Nuclear. UV. Nuclear excision repair (not base).
54
Scar cancers in lung
Adenocarcinomas not squamous (like in the skin - burns, keloids, draining sinus tracts)
55
Helicobacter pylori associated cancers
Adenocarcinoma and low-grade malignant lymphomas
56
Grade
Grade = what it looks like. Well-differentiated = LOW-grade. Most things that look weird = anapestic = High-grade
57
Stage
TNM. T = tumor size. 2 cm generally cut-off. N = nodes. M = metastases outside of nodes; biggest prognostic factor.
58
Most important host defense system?
CD8+. Look for MHC I changes. Perforin for caspases to apoptosize.
59
Most common anemia of malignancy
Anemia of chronic disease.
60
Most common anemia of malignancy
Anemia of chronic disease.
61
Most patients with disseminated cancer are hyper-coagulable and thrombocytosis
Trousseau sign? Vascular problem in vein jumps from one to another. (Migratory thrombophlebitis)
62
Most common cause of fever in malignancy
Gram NEG. E. coli (catheter), Pseudomonas (resp)
63
Paraneoplastic syndromes
Signs +/- symptoms that might say that a cancer is present.
64
Most common paraneoplastic syndrome
Hypercalcemia. PTHrP (acts like PTH)
65
Multiple outcroppings of Seborrheic keratosis or Acanthosis nigricans (Leser-Trelat sign)
Is a gastric adenocarcinoma marker.
66
Connective tissue disease associated with cancer
Dermatomyositis. Leukemia, lymphoma.
67
Vegetations on MV. Sterile. Mucus-producing cancers (colon cancer)
Colon cancer. Marantic endocarditis.
68
HypoNa OR Cushings
Small cell carcinoma. ADH and ACTH. APUT tumors. S100 +. Neural crest origin. Neurosecretory granules on EM
69
HyperCA or 2 polycythemia.
Renal adenocarcinoma. PTHrP and EPO.
70
Hypoglycemia or 2 polycythemia
HCC. EPO. Insulin-like factor.
71
HypoCa or Cushings?
Medullary carcinoma of the thyroid. Calcitonin is the tumor marker.
72
Two tumor markers with testicular cancer
Alpha-fetoprotein. HCG. AFP is a marker for yolk-sac tumor = endodermal sinus tumor. AFP is the albumin of a fetus. AFP is also associated with HCC. Open-neural tube (Folate). AFP is DOWN in DOWN's.
73
Marker for malignancy of bone associated with monoclonal spike
Bence-Jones protein. MM. BJ is light chain of immunoglobulin.
74
Tumor marker for prostate cancer
PSH. Not specific b/c BPH. Sensitive but NOT specific.
75
Breast cancer - surfaced derived
CEA-15-2
76
Ovarian cancer
CEA-125
77
Carcinoembryonic Ag (CEA)
For Colon cancer, small cell, and breast. CEA ic --> nephrotic syndrome = diffuse membranous glomerulonephritis
78
Breast cancer - surfaced derived
CEA-15-2
79
Ovarian cancer
CEA-125
80
Carcinoembryonic Ag (CEA)
For Colon cancer, small cell, and breast. CEA IC --> nephrotic syndrome = diffuse membranous glomerulonephritis
81
Trophoblastic tumor
B-HCG
82
Primary tumor of the brain in kids
Cerebellar cystic astrocytoma (benign). Most common cancer is medulloblastoma (cerebellum)
83
Most common childhood cancer
ALL.
84
Incidence of cancer?
1. Breast 2. lung 3. colon; men 1. prostate 2. lung 3. colon
85
GYN Cancers
Most common = endometrial cancer (but BEST prognosis). 2. ovarian. 3. cervical (pap smears).

Goljan Path (9 decks)

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