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Neoplasia > Neoplasia I-General Principles > Flashcards

Neoplasia I-General Principles Flashcards

1
Q

Uncontrolled cell proliferation due to abnormal regulation of cellular signaling pathways leading to a mass or nodule defines:

1) dysplasia
2) metaplasia
3) neoplasia
4) hyperplasia

A

Neoplasia.
Dysplasia is the presence of polymorphism (cells of different shape and size), disordered growth of epithelium, it is a precancerous condition.
Metaplasia is the tissue transformation from one type to another (Barret’s esophagus is due to metaplasia of squamous epithelium into columnar epithelium)
Hyperplasia is the increase in tissue size due to an increase in cell numbers

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2
Q

Tumour and neoplasia are synonymous. T/F

A

False.
Tumor = any type of lump or mass from any cause e.g. hematoma, abscess, scar, whereas neoplasm is the Uncontrolled cell proliferation due to abnormal regulation of cellular signaling pathways leading to a mass or nodule

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3
Q

what differentiates hyperplasia from neoplasia?

A

hyperplasia is controlled whereas neoplasia is uncontrolled by the immune system

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4
Q

define monoclonal vs polyclonal proliferation

A

Monoclonal-all cells are derived from one cell line (in leukemias all neoplastic cells are derived from 1 cell), whereas in polyclonal (for example an infection or inflammatory states) all cells are derived from different cells

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5
Q

what is autonomous proliferation?

A

Cells decide whether to grow and divide by integrating internal and external signals. Non-autonomous cell growth and proliferation occur when microenvironmental signals from neighboring cells, both physical and secreted, license this decision. Autonomy means that the cell does not require any external signal or growth factor to grow!!!!!. Autonomous replication of tumor cells seems to be an essential factor in the definition of the malignant tumor itself, although tumor cell proliferation is, in general, controlled by the host response including immunological reactions and microenvironment. The cause of the autonomy can hypothetically be classified into four categories as follow: (a) auto- and paracrine growth stimulation; (b) growth factor receptor abnormalities; (c) abnormal signal transduction; (d) self-incitement of ‘initiator-replicon’ system in DNA replication.

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6
Q

list 6 features of neoplastic proliferation.

A
  • Autonomous
  • Uncontrolled
  • Purposeless
  • Progressive
  • Parasitic
  • Monoclonal (derived from one mother cell)
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7
Q

what is the difference between benign and malignant tumors?

A

1) well-differentiated (resemble original tissue) vs poorly differentiated
2) slow growth vs rapid growth and high rate of cell division
3) no irregularities microscopically vs cellular atypia (polymorphism, polychromasia, mitotic figure)
4) no metastasis vs metastasis

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8
Q

what is the most important feature that differentiates benign and malignant tumours?

A

Ability to metastasize

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9
Q

malignant cells that arise from epithelium are termed?

A
  • carcinoma
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10
Q

list cancer with the highest mortality in males?

A

Lung 20%
Colon 15%
Prostate 14%

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11
Q

list cancer with the highest mortality in females?

A

Breast 25%
Lung 20%
Colon 15%

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12
Q

what is the most common cancer overall

A

Basal cells carcnioma, rarly metastasize, low mortality (vs melanoma)

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13
Q

do benign neoplasms have the ability of malignization?

A

Yes

For example adenoma of the colon

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14
Q

what are the macroscopic features of benign neoplasms?

A

– Well circumscribed(malignant have the ragged edge because they infiltrate into surrounding stroma)
– Often encapsulated
– Rarely hemorrhage
– Rarely necrosis

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15
Q

benign neoplasms are commonly encapsulated.

True/False

A

True

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16
Q

benign neoplasms commonly undergo necrosis and hemorrhage. True/False

A

False

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17
Q

why malignant neoplasms may show hemorrhage and necrosis?

A

The malignant cell grows rapidly so they outgrow their own blood supply (necrosis in the center getting least blood) + due to neovascularization— they are small, weak and fragile so easily break causing hemorrhages.

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18
Q

what is the key to the microscopic assessment of a neoplasm and malignancy?

A

nuclear features

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19
Q

list nuclear features of a malignant neoplasm.

A
  • pleomorphism (variability in size, shape, and staining of cells)
  • hyperchromasia (deep, dark staining chromatin)
  • increased mitotic activity
  • High Nuclear/Cytoplasmic ratio= 1:1 (nucleus is larger than normal, occupying more space in the cytoplasm) normal ratio is 1:4 or 1:6
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20
Q

what is the nuclear/cytoplasmic ration of malignant cells?

A

1:1, normally 1:4 or 1:6

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21
Q

loss of maturation is seen with benign neoplasms. True/False

A

False. They are well differentiated and resemble the original tissue

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22
Q

cytological features of the nuclei are used for?

A

to distinguish between:
–Normal cells/benign neoplasms
–Benign neoplasms and malignant neoplasms
– Grade malignant neoplasms

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23
Q

what feature is used to grade malignant neoplasms?

A

cytological features of nuclei

vs stage in which tumor metastasis are used, more clinically useful

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24
Q

what is a secondary tumor?

A

tumor due to metastasis

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25
Q

example of borderline neoplasia?

A 
ovarian.
General classification:
•	Benign
•	Borderline – very rare (mainly ovary)
•	Malignant:
    - Primary
    - Secondary (Metastasis)
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26
Q

what is the most common primary malignancy?

A

Carcinoma - 90%
Lymphoma - 3%
Sarcoma - 1%

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27
Q

papilloma is derived from?

1) Squamous epithelium
2) glandular epithelium
3) transitional epithelium

A

Squamous epithelium–papilloma
glandular epithelium–adenoma
transitional epithelium–transitional/urothelial papilloma

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28
Q

transitional papilloma arises where??

A

commonly bladder, urinary tract

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29
Q

sarcomas arise from what cells?

A

mesenchymal origin (cartilage, fat, muscle, bone). Is malignant. Chondrosarcoma, liposarcoma, osteosarcoma, fibrosarcoma

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30
Q

list benign tumors arising from mesenchymal tissue (connective tissue)

A

Lipoma (Fat)
Neuroma (Nerve)
Angioma (Vessel)
Chondroma (Cartilage

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31
Q

list few benign tumors arising from lymphoid tissue

A

Doesn’texist, always malignant-lymphoma (although end with ‘oma’ but are malignant). ? Lymph tissue already has access to the lymphatics-metastasize

32
Q

uterine fibromas are benign or malignant?

A

Benign, leiomyoma is the correct name, exceptionally low rate of malignization (<1%)

33
Q

a common benign neoplasm arising inside the skull?

A

meningioma, female>male, commonly estrogen receptor-positive, dural tale radiographically, commonly calcify

34
Q

An ovarian cyst is benign or malignant?

A

benign (cystadenoma), malignant one is called cystadenocarcinoma

35
Q

what are the main clinical features of benign tumors?

A

Due to mass effect pressure surrounding tissues leading to:
•Lump
•Bleeding, eg Hematemesis (Vomiting blood), Hemoptysis (Coughing of blood), Maelena (Black Stools)(bleeding through G.I. tract but by the time it reaches stool- it’s altered- black, can result in Fe Deficiency Anaemia
•Mass (Effect of)-Cerebral Stroke, GIT Obstruction, Prostatic Outflow Obstruction
• Pain

36
Q

benign neoplasms can spread locally to adjacent tissues.T/F

A

True

but do not metastasize

37
Q

what is the best treatment option for benign neoplasm?

A

surgery

38
Q

how adenoma of the colon become malignant?

A

Due to additional genetic alterations which facilitate invasion

39
Q

APC gene mutations lead to increased risk of

colon adenoma or colon adenocarcinoma

A

colon adenoma, as well as β-catenin gene and KRAS gene

40
Q

what is the Knudson’s hypothesis

A

also known as the two-hit hypothesis, is the hypothesis that most genes require two mutations to cause a phenotypic change. Knudson suggested that two “hits” to DNA were necessary to cause cancer. In the children with inherited retinoblastoma, the first mutation in what later came to be identified as the RB1 gene was inherited, the second one acquired.

41
Q

what gene mutation leads to colon adenoma malignization.

A

P53 which is the most important tumor suppressor gene

42
Q

why NSAIDs decrease the risk of colon adenoma malignization.

A

because Adenomas overexpress COX-2 which are inhibited by NSAIDs

43
Q

define borderline neoplasms

A

These are neoplasms that show some nuclear features that suggest malignancy but not enough to be certain that the neoplasm will behave like a malignant neoplasm.
Most commonly are ovarian neoplasms

44
Q

what are the steps for malignant cell metastasization?

A
  1. dissociate from one another and
  2. break down basement membrane and
  3. release enzymes to access capillaries and
  4. Attach to endothelial cells
  5. Become a clump of cells and then embolism
45
Q

why surgery is not always curative and chemotherapy may be required in malignant neoplasms?

A

because of the feature of metastasization

46
Q

how malignant neoplasm is differentiated from a benign one?

A

by evidence of invasion and/or microscopic nuclear features

47
Q

germ cell neoplasms commonly arise in?

A

Testis and Ovary

48
Q

neoplasms arising from non-neuronal cells in the brain are termed?

A

glial neoplasms (glioblastoma multiforme-very malignant)

49
Q

what defines carcinoma in situ?

A

No invasion beyond the basement membrane (the basement membrane separates the mucosa from the submucosa)

50
Q

do carcinoma in situ are capable to metastasize?

A

in situ carcinomas are not capable of metastases as they have no access to lymphatics or blood vessels when they are still in situ

51
Q

list the types of carcinoma

A

1) squamous cell carcinoma (SCC)
2) adenocarcinoma (glandular epithelium)
3) small cell carcinoma (in lung)
4) transitional/urothelial carcinoma-bladder, urinary tract
5) neuroendocrine carcinoma
6) Basal cell carcinoma (skin)
7) anaplastic carcinoma (not differentiated so does not resemlbe epitheium, very malignant)
8) mixed carcinoma

52
Q

classification of malignant neoplasms

A

1) carcinoma
2) lymphoma
3) leukemia
4) sarcoma
5) melanoma
6) carcinosarcoma
7) embryonic neoplasms
8) germ cell neoplasms
9) glial neoplasms

53
Q

classification of lymphomas

A

• Nodal
• Extranodal
Extranodal involves sites other than LN, spleen, thymus and pharyngeal lymphatic ring.
Extranodal lymphoma, by definition, involves sites other than lymph nodes, spleen, thymus, and the pharyngeal lymphatic ring. The involvement of the spleen in HD is considered as a nodal disease but in the case of non-Hodgkin lymphoma (NHL), the spleen is regarded as an extranodal site.

54
Q

example of extranodal lymphoma?

A

is gastric lymphoma – aggregates of lymphoid cells - MALT (if undergo a malignant transformation -MALToma)

55
Q

what is the difference between nodal vs extranodal lymphoma?

A

Extranodal involves sites other than LN, spleen, thymus and pharyngeal lymphatic ring

56
Q

lymphomas generally are classified as (except nodal vs extranodal)

A

Hodgkin’s lymphoma vs. Non-Hodgkin’s lymphoma

Hodgkin’s lymphoma has very specific factors and criteria (anything else– NHL)

57
Q

list a few important sarcomas?

A
  • Osteosarcoma (bone)
  • Chondrosarcoma (cartilage)
  • Angiosarcoma (vessel)
  • Neurofibrosarcoma (nerve)
  • Leiomyosarcoma (smooth muscle)
58
Q

what are the clinical effects of primary malignant neoplasm?

A 
•Mass e.g. Cancer of the breast
•Obstruction e.g. |Colon
•Bleeding   	- 
 -Hemoptysis
 -Hematemesis
 -Malaena
 - p.v. Bleeding
 -p.r. Bleeding
  -Fe deficiency anemia
•Loss of function e.g. fracture of a bone
59
Q

what are the clinical effects of metastasized neoplasm?

A

•Lump/Mass (in a distal site) e.g. Axillary nodal mass(metastasized lymph nodes from the breast)
•Obstruction e.g. of bronchus due to a metastasis
•Bleeding e.g.
-hemoptysis due to lung metastasis
•Loss of function e.g. Stroke due to metastasis in the brain

60
Q

what other clinical effects can have malignant tumors on the body?

A

1)Effects of hormone secretion
•ACTH from small cell carcinoma of the lung causing Cushing’s syndrome (when there is excess cortisol, regardless of cause)
Cushing disease is a condition in which the pituitary gland releases too much ACTH (due to pituitary tumor) leading to osteoporosis, moon facies, purple striae, hyperglycemia, depression/psychosis, gynecomastia.
•Estrogen from a testicular tumor causing gynaecomastia
2)constitutional signs
•Weight Loss
•Fatigue
•Anorexia
•Lassitude

61
Q

what are the features of Cushing syndrome?

A

osteoporosis, moon facies, purple striae, hyperglycemia, depression/psychosis, gynecomastia

62
Q

what is the paraneoplastic effect of the tumor?

A

Tumour-associated syndromes in which the symptoms are not directly related to the spread of tumour or to hormone effect indigenous to tumour tissue. Maybe due to immune reactions/certain cytokines.
•Peripheral neuropathy
•Dermatomyositis

63
Q

what are the ways to diagnose malignancy?

A 
•History
•Clinical examination
•Special tests
   -Radiology: CT, MRI, PET
   -Pathology: FNA, Bx, Aspirate, Resection
64
Q

Why is it important for the Pathologist to give the precise type of carcinoma in the Pathology Report?

A

1) To determine whether a primary Cancer or a metastasis

2) Different treatments may be available depending on the type of carcinoma

65
Q

in what areas of body squamous cell carcinomas occur?

A

Any area lined by squamous epithelium e.g. skin, mouth, esophagus, cervix.

66
Q

keratin production is the feature of what type of malignant neoplasm?

A

carcinoma, eg keratin pearl which is a concentric layer of epithelial cells, common in skin and lung SCC, helps pathologist to diagnose carcinoma

67
Q

in which organ adenocarcinomas occur?

A 
in the area lined with columnar/glandular epithelium
GIT
BREAST
THYROID
UTERUS
68
Q

mucin production is characterisitc to squamous cell carcinoma.T/F

A

False

It is a feature of adenocarcinoma which arise from glandular epithelium

69
Q

in what organ transitional cell carcinoma arise?

A

in organs lined with transitional/urothelial epithelium: pelvis of kidney, bladder, urethra, umbrella cells on histology

70
Q

which is the most aggressive carcinoma?

A

small cell (oat cell) carcinoma

71
Q

small cell carcinoma in lung is central or peripheral?

A

central

72
Q

what hormones can be secreted by small cell carcinoma?

A

secrete ADH or ACTH resulting in SIADH or Cushing syndrome respectively

73
Q

small cell carcinomas are neuroendocrine tumors. True/False

A

True.

Small/round, blue cells

74
Q

what mutations are commonly associated with small cell carcinoma?

A

p53, Rb or p16 mutations

75
Q

describe small cell carcinoma

A
  • Usually in the lung (but can be anywhere; if lung- centrally located)
  • High-grade neuroendocrine carcinoma (arise from neuroendocrine cells called Kulchitsky cells)
  • May be associated with hormonal effects(may secrete ADH or ACTH)
  • May be associated with paraneoplastic effects(peripheral neuropathy)
  • High frequency of p53, Rb or p16 mutations
76
Q

what does it mean anaplastic carcinoma?

A

No differentiating feature @ L.M. or E.M. So identified by immunohistochemistry-process of selectively identifying antigens (proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues.

Neoplasia (3 decks)

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