Neoplastic Growth Flashcards
How do we assess monoclonality in tumors?
G6PD iso-enzyme studies
HUMARA- human androgen receptor gene
Ig Light Chain studies- only kappa or only lambda= monoclonal
T-cell Receptor Gene analysis
What type of breast tumor is slow growing, freely mobile/not attached to skin or chest wall, firm mass, well-circumscribed, with fibrous capsule
Fibroadenoma
What type of breast tumor is rapid growing, poorly circumscribed with infiltrating margins, fixed to underlying tissues causing dimpling
Infiltrating Ductal Carcinoma
What kind of tumor will show atypical mitotic figures?
Malignant tumor
The following features are characteristic of \_\_\_\_? Pleomorphism Hyperchromasia Increased N/C ratio Irregular nuclear membrane Tumor giant cells
Cellular Atypia
What type of malignant tumor shows intracellular and extracellular KERATIN PEARLS?
WELL-DIFFERENTIATED squamous cell carcinoma
What type of malignant tumor shows intracellular keratin only?
Moderately-differentiated squamous cell carcinoma
What type of malignant tumor shows numerous mitoses but no keratin?
Poorly-differentiated squamous cell carcinoma
IHC stains ordered for a Carcinoma?
Keratin, cytokeratin
Epithelial Membrane Antigen (EMA)
IHC stain ordered for a Sarcoma?
Vimentin
IHC stains ordered for a Rhabdomyoma, Rhabdomyosarcoma?
Desmin
Muscle-specific Actin
IHC stain ordered for Leukemia, Lymphoma?
Leukocyte Common Antigen (LCA)
IHC stains ordered for Neuroblastoma, Carcinoid tumor, Small cell carcinoma?
Neuron-specific Enolase (NSE) Chromogranin Bombesin Synaptophysin S-100
IHC stains ordered for Melanoma?
S-100
Melanin
HMB-45
IHC stain ordered for a Glioma?
Glial Fibrillary Acidic protein (GFAP)
IHC stain ordered for suspected Thyroid cancer?
Thyroglobulin
IHC stain ordered for suspected Acute Lymphoblastic Leukemia
B-cell-CD10 (CALLA)
IHC stains ordered for suspected Seminoma?
Placental Alkaline Phosphatase (PLAP)
beta-HCG
IHC stain ordered for suspected Yolk Sac tumor?
Alpha-fetoprotein (AFP)
IHC stains ordered for suspected Vascular neoplasms?
vWF
CD31
EM studies of Squamous cell carcinomas will show what?
Tonofilaments
EM studies of an Angiosarcoma will show what type of structures?
Weibel Palade bodies
EM studies of a Small cell carcinoma will show what?
Neuro-secretory granules
EM studies of a Malignant melanoma will show what?
Melanosomes
EM studies of a Histiocytosis X tumor will show what?
Birbeck granules
Which factors/proteins induce angiogenesis in tumors?
VEGF, bFGF
Hypoxia inducible factor (HIF)- stimulates VEGF production
Name the two malignant tumors that DO NOT metastasize
Basal cell carcinoma (local invasion
Glioma (invasion and seeding)
During ECM invasion, loss of which molecule is required for detachment of tumor cells?
E-cadherin
During ECM invasion, which enzymes are released to degrade the basement membrane and connective tissue?
MMPs
Cathepsin D
Collagenase
During ECM invasion, increase of which proteins allow for attachment of tumor cells to the ECM?
Laminin
Fibronectin
Integrins
Which route of metastasis is more common in carcinomas?
Name the 3 exceptions
Lymphatic spread
Follicular carcinoma
Renal cell carcinoma
Hepato-cellular carcinoma
Which route of metastasis is more common in sarcomas?
Hematogenous spread
What is a common metastatic site for Stomach adenocarcinoma?
Virchow’s left supraclavicular node
What is a common metastatic site in breast cancer?
Lung
Bone
Common metastatic site in prostate cancer?
Bone
Common metastatic site in testicular tumor?
Para-aortic nodes
What will an X-ray likely show in a patient with PROSTATE CANCER?
OSTEOBLASTIC metastases (appear as radio-dense loci)
serum alkaline phosphatase indicates reactive bone formation
What will an X-ray likely show in a patient with BREAST CANCER?
OSTEOLYTIC metastases (appear as radio-lucent loci)
PGE2 and IL1 produced by tumor
What cytokine is responsible for the effects of Cancer Cachexia?
TNF-alpha
Autoimmune response at neuromuscular junction resulting in muscle weakness and periorbital heliotrope rash?
Eaton-Lambert syndrome (dermatomyositis)
Hyponatremia, cerebral edema, and neuro dysfunction are characteristic of what paraneoplastic syndrome?
SIADH
What is the underlying cancer and mechanism of Cushing syndrome?
Small cell carcinoma OF LUNG
ACTH
What is the underlying cancer and mechanism of SIADH?
Small cell carcinoma OF LUNG
ADH
What is the underlying cancer and mechanism of Eaton-Lambert syndrome?
Small cell carcinoma OF LUNG
Immunological/autoimmune
What is the underlying cancer and mechanism of Hypercalcemia?
Squamous cell carcinoma of lung
MOA:
PTH-related protein (PTHRP)
What is the underlying cancer and mechanism of Polycythemia?
Renal cell carcinoma
Erythropoietin
What is the underlying mechanism of Carcinoid syndrome?
Serotonin
What is the underlying cancer of Acanthosis nigricans?
Visceral malignancy, Gastric carcinoma
What is the underlying cancer of Hypertrophic osteoarthropathy?
Bronchogenic carcinoma. (associated with clubbing of distal phalanx)!
What is the underlying cancer of Trousseau phenomenon?
Pancreatic carcinoma (tumor products activate clotting)
What is the underlying cancer and mechanism of Hypocalcemia?
Medullary carcinoma of thyroid
Calcitonin
For adenocarcinoma, “well formed glands” and “mucin production” indicate what?
Grade 1 tumor (well differentiated)
For adenocarcinoma, “poorly formed glands” and “occasional glands” indicate what?
Grade 3 tumor (poorly differentiated)
For adenocarcinoma, “bizarre multinucleate giant cells” indicate what?
Grade 4 tumor (anaplastic/undifferentiated)
For squamous cell carcinoma, “keratin pearls” indicates what?
Grade 1 tumor (well differentiated)
For squamous cell carcinoma, “poorly formed squamous cells” indicates what?
Grade 3 tumor (poorly differentiated)
For squamous cell carcinoma, “bizarre multinucleate giant cells” indicates what?
Grade 4 tumor (anaplastic/undifferentiated)
If cancer is still near the place it started and has not invaded nearby tissues, what stage is it?
Stage 0
If cancer has not spread either to LNs or other parts of the body but has grown deeply into nearby tissues, what stage is it?
Stage I
If cancer shows distant metastasis, what stage is it?
Stage IV
What tumor marker will be present in prostate cancer?
Prostate-specific antigen (PSA)
What tumor marker will be present in Trophoblastic tumors such as Hydatidiform moles?
beta-hCG
What tumor marker will be present in carcinoma of the colon, pancreas, stomach, or breast?
Carcino-embryonic antigen (CEA)
What tumor marker will be present in Ovarian carcinoma?
Cancer antigen-125 (CA-125)
What tumor marker will be present in Hepatocellular carcinoma and Germ cell tumor of testes or ovary?
alpha-fetoprotein (AFP)
what are the two malignant tumors that do not metastasize?
1) Basal Cell Carcinoma
2) Glioma
what tumor marker is present for small cell carcinoma? and what is the cell of origin?
Neuron specific enolase (NSE)
neuro-endocrine
what tumor marker is present for medullary carcinoma of thyroid?
calcitonin
what tumor marker is present for colon or pancreatic cancer?
cancer antigen 19-9 (CA 19-9)
what tumor marker is present for breast carcinoma?
cancer antigen 15-3 (CA 15-3)
where does colorectal cancer metastasize to?
liver
where does melanoma commonly metastasize to?
liver, lung
where does renal adenocarcinoma metastasize to?
lung
where does lung cancer metastasize to?
adrenal, liver
what is a lab test marker for hepatocellular carcinoma?
alpha-fetoprotein
DON’T YOU FORGET THIS!
what are 3 examples of cancers that spread via “seeding” of body cavity
1) peritoneum (tumors of ovary)
2) pleural cavity (primary lung tumor)
3) sub-arachnoid (glioma)
most common site of bone metastasis?
1) vertebral column
2) proximal femur