Neoplasia Flashcards
Where is the most common benign tumor in women found? What is the most common tumor in males?
The uterus
Males: lipoma
What are benign tumors of glands called?
Adenomas
What disease can cause atrophy of the zona glomerulosa? What is a simple way to remember the three zones of the adrenal cortex?
Conn’s syndrome - tumor secreting mineralocorticoids
GFR = Glomerulosa, Fasciculata, Reticularis
Salty, Sweet, Sexy - gets sweeter as you go deeper
What is the most common precursor lesion for colon cancer? What does it look like?
Adrenal adenoma - strawberry on a stick
What is the definition of a carcinoma?
Malignancy of EPITHELIAL tissues - squamous, glandular(adenocarcinoma), transitional
How do you recognize the three types of carcinoma?
Squamous - keratin pearls (small swirls of increased red brightness)
Glandular = ADENOCARCINOMA - glands containing stuff
Transitional - derived from BLADDER, RENAL PELVIS, AND URETER
What are aput tumors?
S-100 Ag (+) Tumors that are of neurosecretory or neural crest origin (neurosecretory granules on EM)
e.g. MELANOMA, Small cell carcinoma of the lung, bronchial carcinoid, carcinoid tumor of the tip of the appendix, neuroblastoma
A 2 year has many skin tumors that are S-100 (+) on biopsy.
Neuroblastoma - tumor from adrenal medulla that met’ed to the skin
What does it mean when a tumor is S-100 (+)?
Aput tumor - neurosecretory derived tumor that usually contains neurosecretory granules
What are sarcomas?
Malignancies of MESENCHYMAL tissue Smooth muscle - leiomyosarcoma
Striated muscle - rhabdomyosarcoma
Fat - liposarcoma
Bone - Osteogenic sarcoma
What is the diagnosis for a necrotic mass protruding from the vagina of a small girl that is keratin (-) and desmin (+)? What is important about this disease?
Embryonal rhabdomyosarcoma - see STRIATIONS of muscle
MOST COMMON SARCOMA IN CHILDREN
What is the most common salivary gland tumor? What tumor type should this not be confused with?
Mixed tumor - found in parotid gland and has TWO HISTOLOGIC TISSUE TYPES that are derived from THE SAME LAYER
Teratoma - DERIVED FROM ALL THREE LAYERS
A 16 year old girl has a sudden onset of RLQ pain and you confirmed that this is not due to an acute abdomen.
Cystic teratoma of the ovaries - GERM CELL TUMOR
Auer rod = ?
AML - Myeloblast
What can cause a hypersegmented neutrophil?
B12 and folate deficiency
What is the most common and second most common site in the body for a lymphoma to develop other than the lymph node?
1st = THE STOMACH 2nd = Payer's patches in TERMINAL ILEUM
A follicular B cell lymphoma is due to what cellular problem?
bcl-2 is an anti-apoptotic regulatory protein
14;18 translocation that causes moves the bcl-2 gene close to the Ig heavy chain locus and causes the OVERPRODUCTION OF bcl-2 THAT INACTIVES THE APOPTOTIC GENE in B cells
What is the most common polyp in the GI tract?
Hamartoma = hyperplastic polyp = NON-NEOPLASTIC WITH NO RISK FOR CANCER
Do malignant cells typically have a shorter or a longer cell cycle than their parent cells? How many doubling times does it take to get a tumor that can be clinically detected?
LONGER CELL CYCLE
30 DOUBLING TIMES
What enzymes are frequently found in many malignant cells and what type of metabolism do most go through?
Proteases to break through tissue and collagenases to break through the basement membrane
Anaerobic metabolism
For a carcinoma to become hematogenously, it usually first had to do what? What tumor does not follow this route? What does this second route mean for course of action in establishing extent of spread? What carcinoma uncharacteristically follows the second route?
Carcinoma - usually spread to a lymph node
Sarcoma - typically spread hematogenously first (worse prognosis) -> DO NOT DO A RADICAL DISSECTION OF THE AXILLA FOR AN ANGIOSARCOMA OF THE BREAST
Follicular carcinoma of the thyroid, Renal adenocarcinoma, hepatocellular carcinoma - hemat. spread first
In what organ is metastasis NOT the most common cancer?
Renal adenocarcinoma
What is the most common cancer that metastasizes to the bone? Why? What are the most common bones that are metastasized? How should you image for bone mets?
Breast cancer due to the Batsom system of venous drainage from the base of the skull to the sacrum that doesn’t contain valves - this system sends tributaries to the vena cava and vertebral bodies before collecting around the spinal cord.
Most common - vertebral column
2nd most common - head of the femur
Imaging: radionucleide scan
What is the source of the most common cancer of the liver?
The lungs (NOT THE COLON)
Where are Virchow’s nodes and what is the most common primary metastasis to them?
Left supraclavicular node - STOMACH = patient with weight loss and epigastric distress
Why do myeloma patients get punched out lesions in their skull? What lab value will be elevated?
Malignant plasma cells have IL-1 in them = OSTEOCLAST ACTIVATING FACTOR
AlkPhos will be elevated
What is the most common overall location for mets? What image or gross presentation is most indicative for mets?
Most common location = Lumbar vertebrae
Most indicative for mets = MULTIPLE LESIONS
What is the most common primary site for brain cancer that is also the most common cancer that kills men and women? What is the most common primary site for the organ identified above? For the first organ identified, where else do its metastases love to travel that should be checked with a CT?
Most common brain cancer met source = lung
Most common lung cancer met source = breast
Lung = MOST COMMON MET SOURCE FOR ADRENAL GLANDS
What is the best identifying stain for a carcinoma? For a sarcoma?
Keratin - carcinoma
Desmin - good stain for muscle -> rhabdomyosarcoma
What is the first step in malignancy? Second step? Third step?
Initiation = mutation
Promotion = make multiple copies of mutation
Progression = sub-specializing
What are some protooncogenes that code for receptors? What about those that code for messages sent from the cytosol to the nucleus? What about the genes that are stimulated by those messages in the nucleus? What are some suppressor genes that control the cell cycle?
Receptor Coding: erb-2 = breast cancer ret = MEN syndromes Message creating: ras = cell membrane located messenger abl = lives in the cytosol close to the nuclear membrane Stimulated by messages: n-myc = neuroblastoma c-myc = Burkitt's Lymphoma Suppressor genes that control the cell cycle: Rb suppressor gene p53 suppressor gene adenomatous polyposis coli (familial polyposis) neurofibromatosis (nfm) wilm's tumor gene BRCA1/2
Which protooncogenes are knocked out by point mutation? By amplification? By translocation?
Point mutation: p53 and ras
Amplification: erb-2
Translocation: abl translocation on a Philly chromosome
What genetic adjustment can sometimes be made by Epstein-Barr Virus and what can result? What receptor does EBV use to gain entry into plasma cells?
8;14 translocation that translocates myc from 8 to 14 -> BURKITT’S LYMPHOMA
Receptor: CD21
What cancer is associated with a 15;17 translocation and what can treat it?
Acute progranulocytic leukemia
TREAT WITH VITAMIN A -> matures the blast and renders the malignant cell benign
A patient with Wegener’s granulomatosis develops hematuria with abnormal cells on cytology studies.
Cyclophosphamide prescribed to treat Wegener’s causes transitional cell carcinoma
A patient that works in the dye industry presents with dysuria and hematuria.
Papillary tumor of the bladder = transitional cancer caused by SMOKING
What is the diagnosis for non-pruritic raised red lesions?
Kaposi’s sarcoma caused by HHSV 8
Aflatoxin B causes what? What disease can also cause this? What ethnicity most commonly gets this?
Hepatocellular carcinoma
Hepatitis B
Asian
The rapidly increasing incidence of primary CNS lymphoma can be directly attributed to what?
HIV
What virus can cause anal squamous cell cancer in homosexuals?
HPV
What is the most common type of leukemia associated with radiation?
CML - 9;22 translocation of abl
A patient was exposed to radiation in the head area and presents with non-tender, nodular masses in the cervical region. DDx?
Papillary carcinoma of the thyroid
What metal is associated with skin cancer and what country has a high level of exposure through the water? What type of cancer?
ARSENIC - Bangladesh - squamous skin cancer
What is the most common cause of white eye reflex in an infant?
Congenital cataract - NOT RETINOBLASTOMA
