Neoplasia Flipped

Question 1

T or F: Benign Leiomyomas can cause abnormal menstrual bleeding, and may appear at more than one spot in the uterus

Answer 1

True, they can appear at more than one spot as long as they are well circumscribed and pearly white in appearance

Question 2

What features help you to differentiate between a leiomyoma and a malignancy on GROSS inspection?

Answer 2

Malignant Tumors will often Have:

• Myometrial Invasion - Often into multiple areas
• Necrosis (Yellow Color) - Gelatinous feel
• Hemorrhage (Red)

Question 3

Why does a malignant Uterine Tumor appear red often times?

Answer 3

Synthesis of Leaky Vessels and Rapid growth

Question 4

What kind of tissue forms spindle cell lesions?

- are these lesions benign or malignant?

Answer 4

Smooth Muscle forms Spindle Cell Lesions

**These can be BENIGN OR MALIGNANT

Question 5

If you take a sample from a enlarged Lymph node and there is a kappa to lamda ratio that is much larger than 3:1 or is flipped 1:3 what should you should you suspect?

Answer 5

• Possibly some monoclonal expansion occurring indicative of cancer
• Polyclonal expansion would tend to maintain the kappa to lamda 3:1 ratio

Question 6

What marker is used for Immunohistochemical staining of Plasma Cells?

Answer 6

CD138

Question 7

• *You get a 13 year old kid with a monoclonal population of B cells in his lymph node. What is your differential?
• how would you find an answer to this?

Answer 7

Either:

• EBV virus - “mono”
• B cell Lymphoma

Also,
- An immunologic reaction to a single antigen can produce a monoclonal proliferation that is NOT AUTONOMOUS therefore NOT NEOPLASTIC

*Molecular Diagnostics can be used to differentiate these potential diseases

Question 8

T or F: incidence of cancer increases with age?

Answer 8

True, while this is true the possibilities of some cancers happening plains off with age (like breast and prostate cancer - if you don’t have it by the time your 75 or 80, you probably aren’t going to get it)

Question 9

T or F: most people clear HPV without ever being symptomatic

Answer 9

True

Question 10

How do you expect Adenocarcinomas to spread?

Answer 10

These typically spread via the lymphatics

Sarcomas may spread by the blood or lymphatics, but are typically associated with blood metastatsis

Question 11

Where do you typically see metastatic spread of Osteosarcomas occuring?

Answer 11

Often go to the lung (you see this in children most often)

Question 12

What Features are you looking for histologically in an osteosarcoma?

Answer 12

1. Osteoid Production - even a little osteoid present and you should call it osteosarcoma (unless its a teratoma)
2. Spindle Cells

Question 13

In what kind of cancer are psammona bodies often seen?

Answer 13

Ovarian

• *These can be found in vessels
• • Don’t confuse them with Squamous Pearls

Question 14

If a patient with metastatic ovarian cancer develops nausea and vomiting, what can you can assume is happening?
- differentiate this from nausea and vomiting associated with a GI bleed

Answer 14

Obstruction of Bowels by Cancer

• GI bleed Hematemesis (bloody vomit)

Question 15

T or F: TNF, Hepatic Metastastes, and Tumor necrosis often cause nausea but rarely vomiting.

Answer 15

True

Question 16

Describe the Growth of a Benign Tumor.

Answer 16

• Autonomous Growth
• Slowly progressive
• Pressure and Atrophy can cause some Necrosis with Fibrosis filling in these dead spots

Question 17

What are your ABCDE’s or telling the difference between a nevus and melanoma?

Answer 17

A - Asymmetry 
B - Border (smooth vs. irregular) 
C - Color (single vs. multiple shades of brown) 
D - Diameter
E - Evolving

Question 18

What is Pseudopalicading Necrosis?

- type of tumor this is associated with?

Answer 18

• Tumor Cell surrouding Necrotic Tissue

- Glioblastomas often have pseudopalisading necrosis

Question 19

Just by looking at a head CT how can you tell that a cancer is not metastatic?

Answer 19

If you only see one lesion in the brain then is likely not metastatic

Question 20

How does p53 halt the cell cycle in order for DNA repair to occur?

Answer 20

p53 GOES TO THE NUCLEUS and drives transcription p21 (CDK1A) with inhibits Cyclin D/CDK4,6 as well as Cyclin E/CDK2

Question 21

What is the principle way by which we grade lung cancer?

- what is the precursor to pulmonary lung cancer called?

Answer 21

• Typically graded by the SIZE

Precursor - AAH - Atypical Adenomatous Hyperplasia

Question 22

T or F: oropharygeal cancer is often caused by HBV

Answer 22

False, its often caused by HPV which has proteins that bind p53 preventing cell apoptosis

Question 23

What type of cancer is most often associated with radon?

Answer 23

LUNG - common cause of cancer in people who have never smoked

Question 24

Would you expect to see a mesothelioma in a younger person?

- why or why not?

Answer 24

No, this is a slow growing cancer that is seen most often in older people that have been exposed to asbestos

Question 25

What is the normal order of gene mutations that lead to Cancer in the epithelium (carcinoma)? - Give Pathway and Mutated Gene - Tissue Classification with each

Answer 25

Normal Epithelium: WNT pathway altered (APC) ---> Early Ademona/Dysplastic Crypt: EGFR signaling Activation (KRAS) ---> Intermediated Ademoma: TGF-ß Response inactivation (Smad 2/4) ---> Late Adenoma: Loss of p53 ---> Carcinoma