Neoplastic Study Guide Flashcards

Question

ephelis

Answer 1

freckles - most common pigmented lesions of childhood particularly common in light-skinned ppl often appear after sure exposure once present, fade and darken in a cyclic pattern during winter and summer

Answer 2

aka age spots small tan-brown macula's or patches do not darken upon exposure to sunlight

Answer 3

aka moles, common benign neoplasms acquired melanocytes nevi- most common type tan-brown to black, uniform pigmented well-defined round borders nests of round melanocytes with uniform nuclei - inconspicuous nucleoli, little to no mitotic activity grow in nests along the dermoepidermal junction (junctional nevus) grow in the dermis and dermoepidermal junction - compound nevus grow only in the dermis -intradermal nevus at the deepest point in there dermis the cells become less rounded and start to grow in fascicles that resemble neural tissue- neurotization, implies maturation/growth of nevus cells

Answer 4

present at birth or nearly infancy no associated with sun exposure have irregular borders may be hair bearing similar to acquired nevi on histology but grow along adnexal structure such as hair follicles

Answer 5

grossly and histology abnormal may give rise to melanoma larger than benign nevi irregular borders variability in pigmentation can e seen in both sun exposed and non sun exposed areas nests of enlarged nevus cells that fuse along the dermoepidermal junction - individual nuclei are enlarged and hyper chromatic with irregular borders

Answer 6

strongly linked to acquired mutations caused by UV radiation in sunlight vast majority arise in skin- other sites include oral mucosa, angogential mucosa, esophagus, meninges, uvea of eye

Answer 7

p16 and p14 lead to increased melancytic proliferation due to loss of cell cycle control p16 mutation prevent RB from arresting cells in the G1 phase of the cell cycle leading to uncontrolled cell growth p14 mutations enhance p53 activity leading to uncontrolled cell growth

Answer 8

BRAF mutations are seen in 40-50% of melanomas, ucontrolled cell proliferation TERT promoter mutations turn on telomerase- prevent cell senescence

Answer 9

A - asymmetry B- irregular borders C- color changes D- increasing diameter E- evolution over time

Answer 10

horizontal spread within the epidermal and superficial dermis

Answer 11

tumor cells invade deeper into the dermis Breslow depth - depth of invasion of melanoma measured from granular of epidermis to deepest point of invasion- measured mircroscopically , most important prognostic factor

Answer 12

individual cells are larger than those seen in benign nevi ## Footnote  Enlarged nuclei with irregular borde Characteristic prominent, cherry red nucleolus  Cells grow singly and in nests along the dermoepidermal junction (lentiginous growth) and extend down into the dermis  There is no evidence of maturation/neurotization as malignant cells extend into the dermis

Answer 13

thinner Breslow depth, less mitotic activity, brisk tumor infiltrating lymphocyte response

Answer 14

ulceration, lymph node metastases (even with few cells)

Answer 15

common in middle aged older individuals ## Footnote o Arise spontaneously o Activating mutations in **FGFR3** are thought to drive growth o **Leser-Trelat sign** – sudden appearance of large numbers of seborrheic keratoses  Paraneoplastic syndrome associated with GI malignancies o Round, flat, waxy plaques  Often appear **“stuck on”** o Sheets of small basal epithelial cells with exuberant keratin production  **Pseudohorn cysts** – invaginations of epithelium with abundant laminated keratin

Answer 16

scaly erythematous lesion seen in sun damaged skin ## Footnote Tan-brown, red, or flesh colored with a rough consistency o Dysplastic cells are present in the lowermost layers of the epidermis o Parakeratosis is seen in the superficial epidermis o Associated solar elastosis  Thickened, blue-grey elastic fibers  Result of sun damage o May progress to squamous cell carcinoma

Answer 17

related to DNA damage induced by exposure to UV light ## Footnote Tumor incidence is proportional to the degree of lifetime sun exposure o Other patients at particular risk for SCC: chronic immunosuppression, industrial carcinogens, chronic ulcers, draining osteomyelitis, old burn scars, arsenic, ionizing radiation, tobacco o DNA damage caused by UV radiation (sun exposure) gives keratinocytes increased susceptibility to infection with and transformation by oncogenic viruses such as human papillomavirus (HPV), particularly HPV types 16 and 18 o High incidence of TP53 mutations  p53 is not able to arrest the cells in G1 phase of the cell cycle for repair of DNA damage or elimination via apoptosis  DNA damage induced by UV radiation is passed on to daughter cells o SCC in situ – atypical cells are confined to the epidermis  Grossly appear as sharply defined, red, scaly plaques o Invasive SCC – lesions become nodular with variable keratin production  May ulcerate o Well differentiated tumors consist of atypical squamous cells with enlarged, hyperchromatic nuclei Large areas of keratinization  May be swirls of keratin – “keratin pearls” o As tumors become more poorly differentiated the tumor cells become larger and more irregularly shaped  Less and less keratinization may be present

Answer 18

Slow growing tumors o Rarely metastasize o **Nevoid basal cell carcinoma syndrome (aka Gorlin syndrome)**  Germline mutations of PTCH gene  Uncontrolled cell growth and survival o Pearly papules with prominent telangiectasias  Advanced lesions may ulcerate  Superficial BCCs may present as an erythematous, scaly, plaque o Tumor cells resemble normal basal cells of the epidermis  Polygonal with enlarged, hyperchromatic nuclei  Grow in nests/clusters that can extend along the epidermal surface or deep down into the dermis  Cells at the periphery of the clusters show peripheral palisading  Stromal clefting – stroma retracts from islands of tumor cells  Artifact of processing  Fairly specific for BCC

Answer 19

aka benign fibrous histocytoma firm tan brown papule benign spindle cells

Answer 20

well differentiated fibrosarcoma of the skin slow growing but locally agressive characteristic translocation t(17:22) firm nodule that my ulcerate storiform patter of fibroblasts

Answer 21

lymphoma of CD4 T cells that presents in the skin patch, plaque and nodular stages Sezary-Lutzner cell with characteristic hyperconvoluted/ceribriform nucleus