Neoplasia Flashcards
Orange peel is seen on pt’s breast.
Mechanism and what dz is the cause
dermal lymphatic invasion by malignant breast carcinoma; blocked lymphatic drainage
invasive, inflammatory breast tumor
FA 591
Female presents with firm, fibrous, “rock-hard” mass on breast.
Grossly see “stellate” infiltration.
histopathology shows what?
Invasive ductal breast carcinoma.
small, glandular duct like cells.
FA 591, figure D
Most common breast CA
invasive ductal carcinoma
FA 591
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?
squamous cell carcinoma
hypercalcemia because it releases PTH-rP
FA 619
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?
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
Immature teratoma
characteristics
Malignant ovarian neoplasm
fetal tissue, teeth, skin, immature neural tissue
FA 587
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?
mature cystic teratoma (dermoid cyst) is releasing thyroid hormones.
has all 3 germ layers. FA 586
FA 327 sx of hyperthyroidism
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?
Keratin pearls
rarely metastasizes
actinic keratosis is scaly plaque, precursor to squamous cell carcioma FA 443
Pt presents with skinproblem. pink, pearly nodules with rolled borders and central crusting is seen on the rash.
What is seen on histo?
palisading nuclei
most common skin cancer
FA 443
Major causes of death in adults in US
1) cardiovascular disease
2) Cancer
3) Chronic respiratory disease
poma 24
Major causes of death in children
1) accidents
2) cancer
3) congenital defects
poma 24
Most common cancers by incidence in adults
1) Breast/prostate
2) Lung
3) Colorectal
poma 24
Most common causes of cancer mortality
1) lung (85% of lung cancer patients are smokers)
2) Breast/prostate
3) colorectal
Goal of the pap smear
to detect cervical intraepithelial neoplasia (CIN I, II, or III) which is cervical dysplasia before it becomes cancerous
Microcalcifications seen on mammogram
What did this arise from?
Ductal Carcinoma in situ FA 590
arises from ductal atypia
How to test for prostate cancer
where in prostate gland does it grow
digitial rectal exam, PSA levels
posterior lobe of peripheral zone
FA 594
Pt with cough, chest mass found. Has past exposure to asbesthos
What is likely diagnosis?
More likely bronchogenic carcinoma than mesothelioma
FA 238, poma 25
pt presenting with ulcerative red lesion with scaling on skin. Histopathology shows keratin pearls.
What can cause this
UV light exposure
immunosupression
arsenic as carcinogen FA 238
FA 443 squamous cell carcinoma
key carcinogens found in cigarette smoke
what cancers are particularly linked?
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
Asian presenting with gastric problems, eats a lot of smoked foods
carcinogen and type of stomach cancer?
nitrosamines; intestinal stomach cancer FA 360, 238
naphthylamine
urothelial carcinoma of the bladder
FA 238
arsenic
squamous cell carcinoma of lung
squamous cell carcinoma of skin
FA 238
Pt presents with hematuria. There is no reported pain. No casts are found in the urinalysis, and there is negative leukocyte esterase.
bladder cancer
transitional cell carcinoma vs squamous cell carcinoma of bladder
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?
EBV virus, HHV-4.
can cause burkitt lymphoma, hodgkin lymphoma, CNS lymphoma in patient with AIDS
FA 158, 237
Pt with HIV presents with dark purple skin spots, and nodules in mouth.
What virus is associated?
what is pathogenesis causing spots?
HHV-8 - kaposi sarcoma FA 159
neoplasm of endothelial cells, causing vascular proliferations
FA 625, 237,
Hepatitis B virus and Hepatitis C virus are associated with what cancer?
hepatocellular carcinoma
FA 237
HTLV-1 is an oncogenic virus that is associated with what cancer?
Adult T-cell leukemia/lymphoma
FA 237
ionizing radiation increases the risk for
papillary thyroid carcinoma, acute myelogenous leukemia, chronic myelogenous leukemia
FA 238
hallmarks of cancer
evasion of apoptosis growth signal self-sufficiency anti-growth signal insensitivity sustained angiogenesis limitless replicative potential tissue invasion metastasis. FA 232
What are the high risk human paillomaviruses?
what cancer do they cause?
HPV subtypes 16, 18.
cause squamous cell carcinoma of vulva, vagina, anus, and cervix
FA 584, 237
c-myc nuclear regulator is translocated from _____ to _____ chromosome.
what are symptoms
what is histopathology
endemic is swelling of jaw lesion in africa
sporadic is swelling in pelvis or abdomen
starry sky appearance
FA 400
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?
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
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?
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
What oncogene defines gastrointestinal stromal tumor?
c-kit, a cytokine receptor / growth factor receptor
FA 236
Burkitt lymphoma: what is the defining oncogene?
what is the mechanism of mutation?
what is seen on histopathology?
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
Older male presents with enlarged lymph node.
Histo shows expansion of the region next to the follicle.
What is the mechanism?
Mantle cell lymphoma
translocation of cycline D1 from 11 to Ig heavy chain in chromosome 14 t (11;14)
FA 400
HIV positive patient presents with confusion, trouble speaking.
MRI of head shows multiple ring enhancing lesions
toxoplasma gondii -> brain abscesses
vs
EBC which may be solitary, not multiple
FA 170
What is the mechanism of HPV 16 and 18 in causing dysplasia in situ in female cervix?
production of
E6 - inhibits p53 suppressor gene
E7 - inhibits RB suppressor gene
FA 584
Pap smear is done in patient with suspected cervical cancer.
What would be seen on histo if they had dysplasia in situ?
Koilocytes; nuclei liked wrinkled, raisinoid; clearning or pernuclear halo
FA 584, figure A
Bilateral retinoblastoma in child patient.
What other cancer is associated?
What is role of this gene product?
osteosarcoma
Rb binds E2F when hypophosphorylated
Cyclin D phosphorylates it to go from G1 to S
FA 236
Li-fraumeni syndrome
what tumor supressor gene is this seen in
p53, germline mutation of tumor supressor gene
>50% of all cancers have this mutation
FA 236
Follicular lymphoma
what gene product and what is mechanism
Bcl-2 overexpression, t 14;18
follicular b cells undergo somatic hypermutation and do not undergo apoptosis
Bcl2 gene translocation from _______ to cr _________.
what are findings
painless, waxing waning lymphadenopathy.
Nodular, small cells; cleaved nuclei.
follicular lymphoma; FA 400
what is the mechanism of immune survellaince of cancerous cells?
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,
DNA damage is too high for repair.
What is role of p53
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
role of cyclin D/Cyclin dependent kinase
phosphorylate Rb protein so it lets go of E2F
G1->S
p27
BRCA1/BRCA2 genes
encodes for what
what type of cancer
DNA repair enzymes
breast and ovarian cancer
FA 236
colorectal cancer - what tumor suppressor gene?
APC
FA 236
source of nonionizing radiation?
associated cancers?
pathogenesis?
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
Child presents with melanoma all over face of skin. Pt has genetic predisposition.
What is the enzyme deficiency?
What is pathophys?
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
UV light damage
pyrimidine dimers
repaired by nucleotide excision repair
FA 67
Pt with prostatic adenocarcinoma has Gleason Grading scale of 7.
What lab values could you find?
Increased alkaline phosphatase (ALP) and PSA because the cancer may have already metastasized to bone
osteoblastic metastasis
FA 594
Stored grains in African countries contains what carcinogen?
What type of cancer?
Aflatoxins from Aspergillus
hepatocellular carcinoma
FA 238
Histology of tumor shows keratin positive cells in breast tissue.
what route of metastasis?
Where will these cells end up?
lymphatic spread characteristic of carcinomas (epithelium)
Regional draining lymph nodes
axillary lymph nodes drain the breast
p28, FA 234
Biopsy shows desmin positive cells.
Where would these cells metastasize to?
closest blood vessels, e.g. lungs
smooth muscle sarcoma
sarcoma spread hematogenously
FA 234
Tumor marker CA 125 is elevated.
Psammoma bodies seen on histo.
Where would these neoplastic cells spread to?
body cavity
ovarian cancer spreads to omentum.
“omental caking” based on consistency when cut
p28, FA 586 (ovarian cancer)
Choriocarcinoma spreads via ______
why?
even though carcinoma, spreads hematogenously
trophoblastic neoplasm, these cells try to find blood vessels
p 28
Describe features of benign tumor
what is the distinguishing factor from malignant cancers?
slow growing, well circumscribed, mobile (movable because not invading surrounding tissue), well-differentiated and looks like surrounding tissue
cannot metastasize
p 29, FA 234
Chromogranin stain positive on histo
neuroendocrine cell
small cell carcinoma, carcinoid tumor
Cerebral hemangioblastoma, retinal hemangioblastoma, bilateral renal cell carcinomas, pheochromocytoma, several angiomatosis on skin (proliferation of capillaries)
what genetic defect? protein product?
VHL gene defect, inhibits hypoxia inducible factor 1a
FA 627, 491, 236
Hypoxia inducible factor 1a is uninhibited.
What genetic defect?
What is classical presentation and lab results?
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
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?
Acute myelogenous leukemia AML
t(15;17)
Auer rods, peroxidase + cytoplasmic inclusions seen in M3 AML.
Genetic sequencing shows t(15;17)
what is the treatment ?
What is seen on histology?
What could these patients present with?
If M3 AML, treat with all-trans retinoic acid (Vitamin A)
Auer rods on histology
Can present with DIC
FA 402
Philadelphia chromosome
CML (BCR-ABL hybrid)
t(9;22)
FA 402, 403
Risk factors for developing AML
Age of onset?
alkylating chemotherapy , chemoradiation (ionizing), Downs syndrome.
Median age onset is 65 years.
FA 238
Pt used to work on ship yards. Develops chronic cough, DOE, SOB.
What carcinogenic agent
Nickel, chromium, beryllium, or silica - all are occupational carcinogens that can cause lung carcinoma
p 25
Histo stain is done to look at cells of mesodermal origin.
What stain is used and what are some examples?
S-100
stains melanoma (443), schwannoma (492), or Langerhans cells histocytosis in skin (403)
p 29
VHL deletion on chromosome ____
what diseases
Renal cell carcinoma FA 545
von Hippel-lindau disease FA 491
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?
VHL deletion on cr 3, inhibits hypoxia inducible factor
could release EPO, ACTH, PTHrP paraneoplastically (238)
Proximal convoluted tubule cells
FA 545
Describe anaplastic cells
hyperchromatic, large nuclei, giant cells. lalignant neoplasm
loss of structural and functional differentiation; resemble the primitive cells of that tissue
FA 233
Tumor of adrenal medulla (kids)
what is seen on histo
Neuroblastoma, FA 639
Homer-Wright rosettes, FA 629
N-myc
neuroblastoma (adrenal medulla tumor in kids
RAS
gene product and associated cancer
GTPase (oncogen)
colon CA, lung CA pancreatic CA.
FA 236
translocation 12;21
what marker is positive
Acute lymphoblastic leukemia (ALL)
TdT+ (marker of pre-T and pre-B cells), CD10+ (pre B-cells)
FA 402
