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Neoplasia Flashcards

1
Q

Orange peel is seen on pt’s breast.

Mechanism and what dz is the cause

A

dermal lymphatic invasion by malignant breast carcinoma; blocked lymphatic drainage

invasive, inflammatory breast tumor
FA 591

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2
Q

Female presents with firm, fibrous, “rock-hard” mass on breast.
Grossly see “stellate” infiltration.
histopathology shows what?

A

Invasive ductal breast carcinoma.
small, glandular duct like cells.
FA 591, figure D

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3
Q

Most common breast CA

A

invasive ductal carcinoma

FA 591

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4
Q

Pt presents with cough, DOE, hypercalcemia, 2.3 cm lung mass in right middle lobe.
Broncoscopic biopsy of lung mass shows keratin pearls and intercellular bridges
What abnormal lab value finding would be found and why?

A

squamous cell carcinoma
hypercalcemia because it releases PTH-rP
FA 619

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5
Q

Pt presents with chronic cough, 7 lbs weight loss, DOE, truncal obesity.
Mass is found in left upper lobe. Cortisol levels are elevated.
Dexamethasone supression test shows no supression.
What will be seen on histo of biopsied lung mass? What is the treatment?

A

small cell (oat cell) carcinoma:

neoplasm of neuroendocrine kulchitsky cells -> small dark blue cells.
chromogranin A +
FA 619

Ectopic ACTH release, causing cushing syndrome FA 323

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6
Q

Immature teratoma

characteristics

A

Malignant ovarian neoplasm

fetal tissue, teeth, skin, immature neural tissue

FA 587

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7
Q

Pt presents with heat intolerance, pretibial myxedema, weight loss, and suprapubic mass significant for ovarian enlargement. TSH is low.
What benign neoplasm can be seen and why is TSH low?

A

mature cystic teratoma (dermoid cyst) is releasing thyroid hormones.
has all 3 germ layers. FA 586

FA 327 sx of hyperthyroidism

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8
Q

Farmer presents with ulcerating lesion on left cheek.
WHat will be seen on histopathology?
What can you tell the farmer in terms of its malignancy?
What was the precursor?

A

Keratin pearls

rarely metastasizes

actinic keratosis is scaly plaque, precursor to squamous cell carcioma FA 443

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9
Q

Pt presents with skinproblem. pink, pearly nodules with rolled borders and central crusting is seen on the rash.
What is seen on histo?

A

palisading nuclei

most common skin cancer

FA 443

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10
Q

Major causes of death in adults in US

A

1) cardiovascular disease
2) Cancer
3) Chronic respiratory disease
poma 24

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11
Q

Major causes of death in children

A

1) accidents
2) cancer
3) congenital defects
poma 24

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12
Q

Most common cancers by incidence in adults

A

1) Breast/prostate
2) Lung
3) Colorectal
poma 24

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13
Q

Most common causes of cancer mortality

A

1) lung (85% of lung cancer patients are smokers)
2) Breast/prostate
3) colorectal

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14
Q

Goal of the pap smear

A

to detect cervical intraepithelial neoplasia (CIN I, II, or III) which is cervical dysplasia before it becomes cancerous

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15
Q

Microcalcifications seen on mammogram

What did this arise from?

A

Ductal Carcinoma in situ FA 590

arises from ductal atypia

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16
Q

How to test for prostate cancer

where in prostate gland does it grow

A

digitial rectal exam, PSA levels
posterior lobe of peripheral zone
FA 594

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17
Q

Pt with cough, chest mass found. Has past exposure to asbesthos
What is likely diagnosis?

A

More likely bronchogenic carcinoma than mesothelioma

FA 238, poma 25

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18
Q

pt presenting with ulcerative red lesion with scaling on skin. Histopathology shows keratin pearls.
What can cause this

A

UV light exposure
immunosupression
arsenic as carcinogen FA 238
FA 443 squamous cell carcinoma

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19
Q

key carcinogens found in cigarette smoke

what cancers are particularly linked?

A

polycyclic hydrocarbons (and arsenic, naphthylamine)
lung cancer (small cell and squamous cell, FA 619)
urothelium lining urinary bladder, urethra, ureter is bathed in carcinogens
FA 238

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20
Q

Asian presenting with gastric problems, eats a lot of smoked foods
carcinogen and type of stomach cancer?

A

nitrosamines; intestinal stomach cancer FA 360, 238

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21
Q

naphthylamine

A

urothelial carcinoma of the bladder

FA 238

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22
Q

arsenic

A

squamous cell carcinoma of lung
squamous cell carcinoma of skin
FA 238

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23
Q

Pt presents with hematuria. There is no reported pain. No casts are found in the urinalysis, and there is negative leukocyte esterase.

A

bladder cancer

transitional cell carcinoma vs squamous cell carcinoma of bladder

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24
Q

Chinese male patient presents with neck mass and nasopharyngeal mass that is not ulcerating. Anti-ANA antibodies are negataive. Nasopharyngeal cancer is suspected. what can cause this?
what else can this microbe cause?
How about in patient with HIV?

A

EBV virus, HHV-4.

can cause burkitt lymphoma, hodgkin lymphoma, CNS lymphoma in patient with AIDS

FA 158, 237

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25
Q

Pt with HIV presents with dark purple skin spots, and nodules in mouth.
What virus is associated?
what is pathogenesis causing spots?

A

HHV-8 - kaposi sarcoma FA 159
neoplasm of endothelial cells, causing vascular proliferations

FA 625, 237,

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26
Q

Hepatitis B virus and Hepatitis C virus are associated with what cancer?

A

hepatocellular carcinoma

FA 237

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27
Q

HTLV-1 is an oncogenic virus that is associated with what cancer?

A

Adult T-cell leukemia/lymphoma

FA 237

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28
Q

ionizing radiation increases the risk for

A

papillary thyroid carcinoma, acute myelogenous leukemia, chronic myelogenous leukemia
FA 238

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29
Q

hallmarks of cancer

A 
evasion of apoptosis 
growth signal self-sufficiency 
anti-growth signal insensitivity 
sustained angiogenesis 
limitless replicative potential 
tissue invasion 
metastasis. 
FA 232
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30
Q

What are the high risk human paillomaviruses?

what cancer do they cause?

A

HPV subtypes 16, 18.
cause squamous cell carcinoma of vulva, vagina, anus, and cervix
FA 584, 237

31
Q

c-myc nuclear regulator is translocated from _____ to _____ chromosome.
what are symptoms
what is histopathology

A

endemic is swelling of jaw lesion in africa
sporadic is swelling in pelvis or abdomen
starry sky appearance
FA 400

32
Q

Pt presents having read an article that shows a new designer drug that is an antibody against a breast cancer growth factor.
What test should be done to test whether this drug would be appropriate for her?

A

Her2/neu
Treatment is monoclonal ab against Her-2, a tyrosine kinase receptor.
inhibits Her2-initiated cellular signaling and antibody-dependent cytotoxicity
Trastuzumab
FA 413, 220

33
Q

Pt presents with sweating and intermittent heart palpitations, and mucosal neuroma in mouth. Found to be hypertensive.
CT scan shows pheochromocytoma.
What is next appropriate test to do?

A

RET gene study; if patient is suspected to have MEN2B, to RET study.
if positive, remove thyroid prophylacticly because medullary thyroid carcinoma can kill (secretes calcitonin)
FA 337, 236

34
Q

What oncogene defines gastrointestinal stromal tumor?

A

c-kit, a cytokine receptor / growth factor receptor

FA 236

35
Q

Burkitt lymphoma: what is the defining oncogene?
what is the mechanism of mutation?
what is seen on histopathology?

A

c-myc: translocates from chromosome 8 to 14 into Ig heavy chain.
“starry sky”; lymphocytes with macrophages killing dying cells because they are growing so fast
FA 400, 236

36
Q

Older male presents with enlarged lymph node.
Histo shows expansion of the region next to the follicle.
What is the mechanism?

A

Mantle cell lymphoma
translocation of cycline D1 from 11 to Ig heavy chain in chromosome 14 t (11;14)
FA 400

37
Q

HIV positive patient presents with confusion, trouble speaking.
MRI of head shows multiple ring enhancing lesions

A

toxoplasma gondii -> brain abscesses

vs

EBC which may be solitary, not multiple
FA 170

38
Q

What is the mechanism of HPV 16 and 18 in causing dysplasia in situ in female cervix?

A

production of
E6 - inhibits p53 suppressor gene
E7 - inhibits RB suppressor gene
FA 584

39
Q

Pap smear is done in patient with suspected cervical cancer.
What would be seen on histo if they had dysplasia in situ?

A

Koilocytes; nuclei liked wrinkled, raisinoid; clearning or pernuclear halo
FA 584, figure A

40
Q

Bilateral retinoblastoma in child patient.
What other cancer is associated?
What is role of this gene product?

A

osteosarcoma
Rb binds E2F when hypophosphorylated
Cyclin D phosphorylates it to go from G1 to S
FA 236

41
Q

Li-fraumeni syndrome

what tumor supressor gene is this seen in

A

p53, germline mutation of tumor supressor gene
>50% of all cancers have this mutation
FA 236

42
Q

Follicular lymphoma

what gene product and what is mechanism

A

Bcl-2 overexpression, t 14;18

follicular b cells undergo somatic hypermutation and do not undergo apoptosis

43
Q

Bcl2 gene translocation from _______ to cr _________.

what are findings

A

painless, waxing waning lymphadenopathy.
Nodular, small cells; cleaved nuclei.
follicular lymphoma; FA 400

44
Q

what is the mechanism of immune survellaince of cancerous cells?

A

CD8+ t cells recognize aberrant proteins on MHC I of cancerous cells

cancerous cells evade by downreg MHC

immune suppression leads to risk of cancer
p 28,

45
Q

DNA damage is too high for repair.

What is role of p53

A

induce apoptosis by upregulating BAX
BAX disrupts Bcl2, which disrupts mitochondria membrane and cytochrome c leaks out
this joins apaf and cleaves caspases
p27, FA 222

46
Q

role of cyclin D/Cyclin dependent kinase

A

phosphorylate Rb protein so it lets go of E2F

G1->S
p27

47
Q

BRCA1/BRCA2 genes
encodes for what
what type of cancer

A

DNA repair enzymes
breast and ovarian cancer
FA 236

48
Q

colorectal cancer - what tumor suppressor gene?

A

APC

FA 236

49
Q

source of nonionizing radiation?
associated cancers?
pathogenesis?

A

UVb sunlight
basal cell carcinoma, squamous cell carcinoma, melanoma of the skin
formation of pyrimidine dimers in DNA, excised by restriction endonucleases

FA 443, p 25

50
Q

Child presents with melanoma all over face of skin. Pt has genetic predisposition.
What is the enzyme deficiency?
What is pathophys?

A

Xeroderma pigmentosum
lack of restriction endonucleases that repair pyrimidine dimers

UVb light -> pyrimidine dimers -> predisposition to sq cell carcinoma, basal cell carcinoma, melanoma
FA 67, 235, 443

51
Q

UV light damage

A

pyrimidine dimers
repaired by nucleotide excision repair
FA 67

52
Q

Pt with prostatic adenocarcinoma has Gleason Grading scale of 7.
What lab values could you find?

A

Increased alkaline phosphatase (ALP) and PSA because the cancer may have already metastasized to bone
osteoblastic metastasis

FA 594

53
Q

Stored grains in African countries contains what carcinogen?

What type of cancer?

A

Aflatoxins from Aspergillus
hepatocellular carcinoma
FA 238

54
Q

Histology of tumor shows keratin positive cells in breast tissue.
what route of metastasis?
Where will these cells end up?

A

lymphatic spread characteristic of carcinomas (epithelium)
Regional draining lymph nodes
axillary lymph nodes drain the breast
p28, FA 234

55
Q

Biopsy shows desmin positive cells.

Where would these cells metastasize to?

A

closest blood vessels, e.g. lungs
smooth muscle sarcoma
sarcoma spread hematogenously
FA 234

56
Q

Tumor marker CA 125 is elevated.
Psammoma bodies seen on histo.
Where would these neoplastic cells spread to?

A

body cavity
ovarian cancer spreads to omentum.
“omental caking” based on consistency when cut
p28, FA 586 (ovarian cancer)

57
Q

Choriocarcinoma spreads via ______

why?

A

even though carcinoma, spreads hematogenously
trophoblastic neoplasm, these cells try to find blood vessels
p 28

58
Q

Describe features of benign tumor

what is the distinguishing factor from malignant cancers?

A

slow growing, well circumscribed, mobile (movable because not invading surrounding tissue), well-differentiated and looks like surrounding tissue
cannot metastasize
p 29, FA 234

59
Q

Chromogranin stain positive on histo

A

neuroendocrine cell

small cell carcinoma, carcinoid tumor

60
Q

Cerebral hemangioblastoma, retinal hemangioblastoma, bilateral renal cell carcinomas, pheochromocytoma, several angiomatosis on skin (proliferation of capillaries)
what genetic defect? protein product?

A

VHL gene defect, inhibits hypoxia inducible factor 1a

FA 627, 491, 236

61
Q

Hypoxia inducible factor 1a is uninhibited.
What genetic defect?
What is classical presentation and lab results?

A

von Hippel-Lindau disease caused by VHL gene defect

will present with hemangioma in cerebrum, on skin, retina, renal cell carcinoma, pheochromocytoma, polycythemia, and elevated VEGF in blood serum.

FA 491, 236, 627

62
Q

Pt presents with elevated fibrin-split products, bleed from IV line, schistocytosis, elevated PTT and bleeding time.
Is due to malignancy. What is genetic sequencing show?
What is found on histology?

A

Acute myelogenous leukemia AML
t(15;17)
Auer rods, peroxidase + cytoplasmic inclusions seen in M3 AML.

63
Q

Genetic sequencing shows t(15;17)
what is the treatment ?
What is seen on histology?
What could these patients present with?

A

If M3 AML, treat with all-trans retinoic acid (Vitamin A)
Auer rods on histology
Can present with DIC
FA 402

64
Q

Philadelphia chromosome

A

CML (BCR-ABL hybrid)
t(9;22)
FA 402, 403

65
Q

Risk factors for developing AML

Age of onset?

A

alkylating chemotherapy , chemoradiation (ionizing), Downs syndrome.
Median age onset is 65 years.

FA 238

66
Q

Pt used to work on ship yards. Develops chronic cough, DOE, SOB.
What carcinogenic agent

A

Nickel, chromium, beryllium, or silica - all are occupational carcinogens that can cause lung carcinoma

p 25

67
Q

Histo stain is done to look at cells of mesodermal origin.

What stain is used and what are some examples?

A

S-100
stains melanoma (443), schwannoma (492), or Langerhans cells histocytosis in skin (403)
p 29

68
Q

VHL deletion on chromosome ____

what diseases

A

Renal cell carcinoma FA 545

von Hippel-lindau disease FA 491

69
Q

Pt presents with SOB, liver failure. 4cm mass in kidney. Nephrectomy reveals extension into renal vein.
What associated gene deletion?
How could this increase RBC count?
These cells originated from what?

A

VHL deletion on cr 3, inhibits hypoxia inducible factor
could release EPO, ACTH, PTHrP paraneoplastically (238)
Proximal convoluted tubule cells
FA 545

70
Q

Describe anaplastic cells

A

hyperchromatic, large nuclei, giant cells. lalignant neoplasm

loss of structural and functional differentiation; resemble the primitive cells of that tissue
FA 233

71
Q

Tumor of adrenal medulla (kids)

what is seen on histo

A

Neuroblastoma, FA 639

Homer-Wright rosettes, FA 629

72
Q

N-myc

A

neuroblastoma (adrenal medulla tumor in kids

73
Q

RAS

gene product and associated cancer

A

GTPase (oncogen)
colon CA, lung CA pancreatic CA.
FA 236

74
Q

translocation 12;21

what marker is positive

A

Acute lymphoblastic leukemia (ALL)
TdT+ (marker of pre-T and pre-B cells), CD10+ (pre B-cells)
FA 402

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