Neoplasia Flashcards
Which of the following cancers occurs the most frequently in men in the UK? A) Bladder B) Large Bowel C) Lung D) Lymphoma E) Prostate
E) Prostate
In the UK the options are the 5 most frequently occurring cancers in men. The order of frequency is: 1) prostate 2) lung 3) large bowel 4) bladder 5) lymphoma
Which of the following cancers occurs most frequently in women in the UK?
A) breast B) large bowel C) lung D) ovary E) uterus
A) breast
The options are the 5 most frequently occurring cancers in women in the UK. The order of frequency is as follows:
1) breast
2) lung
3) large bowel
4) uterus
5) ovary
A 64 year old man presents with difficulty swallowing and feeling that food is sticking in his chest. He has lost 8kg over the last month.
An upper gastrointestinal endoscopy is performed and a tumour is seen in the patient’s mid oesphagus. This is biopsied. The histology shows nests of pale pink cells which show keratinisation in the centre of the nests. No glandular structures are present.
What type of cancer is it? A) adenocarcinoma B) leiomyoma C) leiomyosarcoma D) lymphoma E) squamous cell carcinoma
E) squamous cell carcinoma
All of these tumours can occur in the oesophagus although adenocarcinoma and squamous cell carcinoma are the commonest of the 5. They have a roughly similar incidence, although the incidence of adenocarcinoma is rising in Europe and the US.
Squamous cell carcinoma due to no glandular structures and nesting pale pink cells with keratinisation in the centre
Which of the following macroscopic features is most in keeping with a benign tumour?
A) endophytic growth B) exophytic growth C) irregular margin D) necrosis E) ulceration
B) exophytic growth
Of the options, only exophytic growth I.e. Growth out from a surface, is a common feature of benign neoplasms. Exophytic growth often indicates that the tumour is non-invasive.
The other options suggest malignancy.
- Endophytic growth suggests invasion into surrounding tissue as does an irregular tumour margin.
- Necrosis is seen when a tumour grows rapidly and out-strips its blood supply - usually a feature of malignant tumours
- Ulceration is a common feature of malignant neoplasms on skin or mucosal surfaces and may also be a consequence of poor blood supply to the centre of a tumour
Which of the following is a characteristic of sarcomas?
A) they are common
B) they arise from epithelial cells
C) they can develop from an in situ phase
D) they commonly metastasise via the blood stream
E) they usually occur in people over 50 years of age
D) they commonly metastasise via the blood stream
Unlike carcinomas, which tend to metastasise via the lymphatics, sarcomas usually metastasise by the blood stream and therefore often do not metastasise to lymph nodes but to other organs such as the lungs and brain.
- They are uncommon and usually develop in people less than 50 years old.
- They arise from connective tissue and not epithelial cells
- They do not arise from an in situ phase as there is no basement membrane beneath connective tissue as there is with epithelium.
A 68 year old woman presents with a rapidly growing mass in her neck. An ultrasound scan demonstrates that the mass is within the thyroid gland. A biopsy is taken and the report describes an anaplastic thyroid cancer.
What is an anaplastic tumour?
A) one that has disseminated around the body
B) one that has spread into surrounding tissues
C) one that is mitotically active
D) one that is very poorly differentiated
E) one that shows uncontrolled growth
D) one that is very poorly differentiated
- Anaplastic means very poorly differentiated.
- All neoplasms (both malignant and benign) show uncontrolled growth.
- Any dividing cells are mitotically active. Neoplasms tend to be more mitotically active than non-neoplastic tissues with malignant tumours generally more mitotically than benign tumours. However, the presence of mitosis alone does not indicate neoplasia.
- Dissemination around the body is metastasis and not anaplasia. Spread into surrounding tissues is invasion. Both metastasis and invasion are characteristics of malignant tumours but don’t give any information on differentiation.
Which of the following is a neoplasm?
A) atheroma B) glaucoma C) granuloma D) haematoma E) lipoma
E) lipoma
The suffix -Oma is generally used to indicate that the word is describing a neoplasm. However, there are notable exceptions, some of which are given here.
- The correct answer is lipoma which is a benign tumour of adipose tossing. None of the others are neoplasms (lesions which result from the autonomous abnormal growth of cells that persist in the absence of the initiating stimulus)
- Atheroma is the necrotic gruel-like material found in atherosclerotic plaques
- Glaucoma is a condition of the eye where there is increased pressure within the orbit
- A granuloma is a collection of epitheliod histiocytes.
- a haematoma is a collection of blood outside a vessel e.g. A bruise
A 32 year old man presents with a number of red-purple patches on his lower legs. A biopsy of one of the lesions shows dilated, irregular vascular spaces with associated chronic inflammatory cells and spindle-shaped cells. The man was found to be HIV positive 10 years ago but has refused treatment with antiretroviral therapy.
What is the diagnosis?
A) Burkett's lymphoma B) Ewing's sarcoma C) Hodgkin's lymphoma D) Kaposi's sarcoma E) Kruckenberg tumour
D) Kaposi’s sarcoma
Some tumours have eponymous names and don’t follow the usual pattern for naming of tumours. As such they just have to be learnt.
The correct answer is Kaposi’s sarcoma which is a vascular neoplasm caused by human herpes virus (HHV8). They usually occur in people who are HIV positive. Kaposi’s sarcoma is an AIDS-defining illness. The incidence of the tumour has fallen with the advent of aggressive anti-retro viral therapy. It is classed as a borderline tumour as early lesions have benign behaviour but older lesions have malignant features and can metastasise.
- Burkett’s lymphoma is a lymphoma associated with EBV infection and malaria
- Ewing’s sarcoma is a malignant tumour of bone that usually presents in childhood, adolescence or young adulthood.
- Hodgkin’s lymphoma is a lymphoma with Reed-Sternberg cells
- Kruckenberg tumour is a tumour metastatic to the ovary/ovaries. They usually arise from gastrointestinal primary tumours, often stomach cancers.
A 58 year old woman presents with a black nodule on her leg. A biopsy is performed and the histology report describes atypical cells showing polymorphism and with prominent nucleoli. The report gives the diagnosis as malignant melanoma.
What do prominent nucleoli indicate?
A) high rate of transcription of DNA
B) presence of condensed DNA
C) that genetic abnormalities are present
D) that the cell is about to undergo mitosis
E) that the cell is undergoing apoptosis
A) high rate of transcription of DNA
- the nucleolus is the site of formation of ribosomal RNA and for the formation of ribosomal subunits. Nucleoli are therefore prominent when there is a high rate of transcription of DNA as occurs in malignant cells.
- When DNA is condensed the nucleus appears hyperchromatic when stained with haematoxylin. This is also a feature of malignant cells.
- Although genetic abnormalities are present in malignant cells, the presence of a prominent nucleolus does not confirm this.
- Nucleoli do not become prominent when cells undergo apoptosis or mitosis.
A 71 year old woman presents with worsening constipation. She undergoes a colonoscopy and a biopsy is taken from a tumour in her sigmoid colon. The biopsy is reported as adenocarcinoma. She has a sigmoid colectomy and the tumour appears narrower in the middle.
Which of the following macroscopic descriptions best describes the tumour? A) annular B) exophytic C) papillary D) polypoid E) sessile
A) Annular
All of the options describe the macroscopic appearance of the tumours. The tumour is annular I.e. It is encircling the wall of the bowel like a napkin ring. These tumours are particularly associated with bowel obstruction.
- Exophytic tumours grow out from the surface and into the lumen of the bowel.
- The remaining three options are types of exophytic tumour:
- Papillary tumours have finger-like projections
- Polypoid tumours consist of an exophytic mass often on a stalk
- Sessile tumours are raised but flat
