Neoplasia

Question 1

What are the two components of tumors?

Answer 1

Parenchyma - neoplastic cells

Stoma - non-neoplastic supportive stroma

Question 2

What is a teratoma?

Answer 2

Tumor derived form >1 germ layer tha arises from totipotential germ cells in the ovaries and testes

Benign, malignant, or cystic

Question 3

What is a hamartoma?

Answer 3

Mass of disorganized but mature specialized cells indigenous to the particular site

E.g. bronchial hamartoma

Question 4

What is a choristoma?

Answer 4

Ectopic rest of normal tissue

I.e. normal pancreatic tissue found in the stomach

Question 5

What are the four features that distinguish benign and malignant tumors?

Answer 5

Degree of differentiation

Growth rate

Local invasiveness

Metastasis

Question 6

What is anaplasia?

Answer 6

Lack of differentiation

Hallmark of malignancy

Question 7

What is the difference in differentiation between benign and malignant neoplasms?

Answer 7

Benign - well differentiated

Malignant - rang from well differentiated to anaplastic

Question 8

What functional changes are associated with poor differentiation?

Answer 8

Well differentiated neoplasms retain functional capabilities

Poorly differentiated and anaplastic carcinomas are unable to perform their normal functions

Abnormal functions can emerge as well (e.g. production of proteins or hormones)

Question 9

How do benign tumors grow?

Answer 9

Cohesive expansile masses that remain localized to their site of origin

Can develop a capsule

Cause problems via impingement on other structures

Question 10

How do malignant tumors grow?

Answer 10

By infiltration, invasion and destruction of the surrounding tissue

Results in poor demarcation

Question 11

How is metastasis defined?

Answer 11

Spread of tumor to sites that are physically discontinuous with the primary tumor

Unequivocally marks a tumor as malignant

Question 12

What are the pathways of malignant spread?

Answer 12

Seeding of body cavities and surfaces

Lymphatic spread - most common

Hematogenous spread - typical of sarcomas

Question 13

What are the two phases of metastatic cascade?

Answer 13

Invasion of ECM

Vascular dissemination, homing of tumor cells and colonization

Question 14

How do malignant cancer cells dissociated from one another?

Answer 14

Down regulation of E-cadherin

This reduces the cells ability to adhere to each other

Question 15

What are four components of cellular invasion of the ECM?

Answer 15

Dissociation of cancer cells from one another

Degradation of the basement membrane and interstitial connective tissue

Attachment of tumor cells to ECM componenets

Migration and invasion of tumor cells

Question 16

What are three acquired predisposing conditions to cancer?

Answer 16

Chronic inflammation

Precursor lesions

Immunodeficiency states

Question 17

What is metaplasia?

Answer 17

Replacement of one cell type with another

Associated with tissue damage, repair, and regeneration

Question 18

What is cancer cachexia?

Answer 18

Progressive loss of body fat and lean body massa accompanied by profound weakness, anorexia and anemia

Equal loss of fat and muscle, BMR increased, systemic inflammation

Question 19

What are paraneoplastic syndromes?

Answer 19

Symptom complexes in cancer patients that cannot be readily explained by either the local or distant spread of tumor or by elaboration of hormones indigenous to the tissue in which the tumor arose

Question 20

What are common endocrinopathic paraneoplastic syndromes?

Answer 20

Cushing - small cell lung carcinoma

Hypercalcemia - breast, lung, kidney, ovary

Question 21

What are common neuromyopathic paraneoplastic syndromes?

Answer 21

Peripheral neuropathies

Cortical cerebellar degeneration

Polymyopathy

Myasthenia gravis syndrome

Question 22

What is hypertrophic osteoarthropathy?

Answer 22

Paraneoplastic syndrome associated with bronchogenic carcinoma

Periosteal new bone formation at end of long bones, metatarsals, metacarpals, proximal phalanges

Arthritis, clubbing

Question 23

What are some vascular and hematologic PNS?

Answer 23

Migratory thrombophlebitis

DIC

Nonbacterial thrombotic endocarditis

Question 24

Describe tumor grading?

Answer 24

Degree of differentiation, correlates with aggressiveness

Low grade/high grade (tiers)

Well, moderately, poorly, undifferentiated (I, II, III, IV)

Question 25

How are tumors staged?

Answer 25

Tumor size, extent of invasion, metastasis

For treatment and prognosis

Question 26

What is the TNM classification system?

Answer 26

T - primary tumor, size and local extent

N - regional lymph nodes, degree of involvement

M - metastasis, distant

Question 27

What are three methods of sampling for histologic/cytologic examination?

Answer 27

Excision or biopsy

Needle aspiration

Cytologic smears

Question 28

What are the uses for immunohistochemistry?

Answer 28

Categorization of undifferentiated or poorly differentiated tumors

Categorization of leukemias and lymphomas

Determiation of site of origin

Detection of prognosticc molecules

Question 29

What are the uses for flow cytometry?

Answer 29

ID of cell-surface antigens widely used in the classification of leukemias and lymphomas

Routine for specific diagnosis of lymphoma subtypes

Question 30

What are serum tumor markers?

Answer 30

Biochemical indicators of the presence of a tumor

Not primary modalities