Pathology II Flashcards
A 64-year-old woman is commenced on 5-fluorouracil following resection of a Dukes' C1 adenocarcinoma of the rectum. What is the mechanism of action of this agent? (Please select 1 option) Alkylating agent DNA polymerase inhibition Oestrogen receptor antagonism Thymidylate synthetase inhibition Topoisomerase II inhibition
Thymidylate synthetase inhibition
The active metabolites of 5-FU inhibit thymidylate synthetase through covalently binding to it. The drug is commonly used in the treatment of colorectal cancer usually with folinic acid. It is now often combined with oxaliplatin or irinotecan in advanced disease.
Methotrexate is a dihydrofolate reductase (DHFR) inhibitor.
Cytarabine used in acute myelogenous leukaemia (AML), is a DNA polymerase inhibitor.
Tamoxifen is an oestrogen receptor antagonist and irinotecan is an example of a topoisomerase II inhibitor.
A 74-year old male attends the emergency department complaining of back pain and an x ray suggests the presence of multiple metastases. Which of the following is the most likely site for the primary tumour? (Please select 1 option) Bladder Colorectal Lung Lymph glands Thyroid
Lung
There are five common primary sites that result in bone metastases. These are
Lung Breast Prostate Kidney Thyroid. Lung cancer is more common than thyroid cancer, so represents the most likely primary site in this case.
A 52-year-old lady presents to breast clinic with a 3 cm mass in her left breast. There are no skin changes and no evidence of fixation.
Imaging and pathology confirms that she has breast carcinoma.
According to the TNM staging system the tumour would be classified as which of the following?
(Please select 1 option)
T0
T1
T2
T3
T4
T12
The TNM classification of breast cancer is:
Tis - Ductal carcinoma in situ, Paget’s disease of the breast.
T1 Tumour diameter 2cm
T3 Tumour diameter >5cm
T4 Any size tumour with skin changes Fixation
A patient with AIDS is being counselled with regard to the risks of developing malignancies associated with retroviral infection. Which of the following malignancies characteristically occurs in patients with AIDS? (Please select 1 option) Anaplastic carcinoma of the thyroid Basal cell carcinoma of the skin B cell non-Hodgkin’s lymphoma Oesophageal squamous cell carcinoma Pancreatic adenocarcinoma
B cell non-Hodgkin’s lymphoma
Lymphoma (commonly a B cell non-Hodgkin’s lymphoma but also a T cell non-Hodgkin’s lymphoma)
Kaposi’s sarcoma
Squamous cell carcinoma of the skin and
Squamous cell carcinoma of the cervix and larynx
characteristically occur in patients with AIDS.
A 68-year-old male has recently undergone surgery for a tumour in his sigmoid colon.
Pre-operative investigations did not reveal any distant metastases. The pathology results confirm positive regional lymph nodes with tumour in the apical node.
What stage cancer does the patient have according to Dukes’ staging system?
(Please select 1 option)
A
B
C1
C2
D
C2
Dukes A involves lesions confined to the bowel wall, Dukes B reach the serosa. Dukes grade C1 has local nodes involved but apical nodes are spared. Dukes C2 involve the apical nodes and Dukes D with the worst prognosis have distant metastases.
Which of the following is an example of a tumour suppressor gene? (Please select 1 option) Int-2 Myc Ras Retinoblastoma gene (Rb) Sis
Retinoblastoma gene (Rb)
Retinoblastoma gene is the only tumour suppressor gene or growth inhibiting anti-oncogene.
The others are all growth promoting proto-oncogenes.
A 20-year-old male has been diagnosed with a testicular teratoma. Which tumour marker is most likely to be elevated? (Please select 1 option) Alpha-fetoprotein CA15-3 Calcitonin Placental alkaline phosphatase Prostate-specific antigen (PSA)
AFP
A tumour marker is a substance that is reliably found in the circulation of a patient with a neoplasm. It is directly related to the presence of the neoplasm.
Alpha-fetoprotein, ß-human chorionic gonadotrophin (ß-hCG) and carcinoembryonic antigen (CEA) are tumour markers associated with testicular teratomas.
In contrast, testicular seminomas are associated with placental alkaline phosphatase and sometimes ß-hCG.
You are in the weekly breast clinic and an anxious young lady whose mother is currently being treated for breast cancer in your unit asks you about the risk factors for developing breast cancer. Which of the following has been linked with a significantly increased risk of breast cancer? (Please select 1 option) Breast feeding Late menarche Late menopause Multiparity Oophorectomy
Late menopause
Risk factors linked to breast cancer include
Genetic factors (BRCA1/2, ataxia-telangiectasia, Li-Fraumeni)
Family history - x2 for 1 first degree and x5 for 2 first degree relatives
Proliferative benign breast disease with or without atypia
Early menarche
Late menopause
Nulliparity or late pregnancy
Chest radiation
Prolonged use of hormone replacement therapy.
You are carrying out an abdominal examination on a 30-year-old female.
The patient appears to have massive splenomegaly.
Which of the following is the most likely cause?
(Please select 1 option)
Amyloidosis
Autoimmune haemolytic anaemia
Infectious mononucleosis
Malaria
Rheumatoid arthritis
Malaria
The definition of ‘massive’ splenomegally is variable.
It can be a spleen
With any dimension greater than 20 cm
That weighs more than 1,500 gm or
Which reaches the iliac crest.
Except in infants, a spleen needs to be about twice normal size to be palpable.
The following conditions are associated with massive splenomegaly:
Malaria Chronic myeloid leukaemia Myelofibrosis Kala-azar, and Gaucher's disease. The other conditions listed may be associated with mild to moderate splenomegaly. There are, of course, exceptions to all rules.
A 35-year-old female presents to head and neck clinic with a small lump in the anterior triangle of her neck.
Which of the following is true?
(Please select 1 option)
Colloid fine needle aspirate is suspicious of malignancy
FNA can diagnose papillary carcinoma
FNA excludes malignancy
FNA revealing follicular cells indicates malignancy
The diagnosis of follicular carcinoma can be made with FNA
FNA can diagnose papillary carcinoma
FNA (fine needle aspiration biopsy) is a useful investigation for patients presenting with a solitary thyroid nodule. However, diagnosis depends on the material aspirated and there is a false negative rate of between 1 and 6%.
FNA is extremely accurate at diagnosing papillary carcinoma.
Follicular cells can be found with follicular adenoma and carcinoma. Therefore, the diagnosis of follicular carcinoma cannot be made with FNA.
Colloid and macrophages in the aspirate strongly suggest benign disease.
Your consultant suspects a patient on the ward might have amyloidosis. Which of the following tests would diagnose this disease? (Please select 1 option) Abdominal ultrasound ECG Echocardiogram Tissue or organ biopsy Urinalysis
Tissue or organ biopsy
Diagnosis of amyloidosis is based on finding amyloid deposits in organs or other body tissues.
Biopsies are typically taken from the rectum, abdominal fat or bone marrow under local anaesthesia.
Only bone marrow tests or biopsies of tissue can positively establish the diagnosis of amyloidosis and classify the type.
However, there may be abnormalities in the other tests listed above depending on the organs affected.
There has recently been a great deal of controversy relating to the use of Herceptin in breast cancer but how common is Her-2 over-expression? (Please select 1 option) 0-5% 5-10% 15-25% 40-50% 75-85%
Her-2 over-expression has a prevalence of between 15-25% in breast cancer.
A 62-year-old surgical patient has undergone anterior resection for a rectal mass.
The histology report describes a moderately differentiated adenocarcinoma which invades into the muscle, but not through the wall. One out of 13 lymph nodes is involved by metastatic tumour, but the high tie node is tumour free.
A liver biopsy from a suspicious lesion in the liver shows ‘no evidence of malignancy’.
What stage is this patient’s cancer?
(Please select 1 option)
Dukes’ A
Dukes’ B
Modified Dukes’ C1
Modified Dukes’ C2
Modified Dukes’ D
Modified Dukes’ C1
This patient has Dukes’ grade C1 carcinoma of the colon as local nodes are involved but apical nodes are spared.
Dukes’ A involve lesions confined to the bowel wall
Dukes’ B reach the serosa
Dukes’ C2 involve the apical nodes
Dukes’ D with the worst prognosis have distant metastases.
A 84-year-old man is admitted on the surgical intake complaining of jaundice, weight loss, dark urine and urticaria. He drinks 30 units of alcohol per week. On examination he is found to have a palpable gallbladder. Admission bloods include the following LFTs: Bilirubin 156 µmol/L (1-22) ALT 68 U/L (5-35) Alkaline phosphotase 1896 U/L (45-105) What is the most likely diagnosis from the list below? (Please select 1 option) Cholangiocarcinoma Cholecystitis Cholelithiasis Liver cirrhosis Pancreatic carcinoma
Pancreatic carcinoma This is the correct answerThis is the correct answer
This gentleman’s history suggests that he has obstructive rather than hepatocellular jaundice.
The liver function profile also has an obstructive pattern.
Courvoisier’s law states that, in the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones; rather carcinoma of the pancreas or lower biliary tree is more likely.
Pancreatic cancer is far more common than cholangiocarcinoma.
Concerning hamartomas, which of the following statements is correct?
(Please select 1 option)
Adenoma sebaceum seen in tuberous sclerosis is a type of hamartoma
Contains cells from all three germ layers
Contains metaplastic cell types
Does not predispose to malignancy
Usually develop in adolescents
Adenoma sebaceum seen in tuberous sclerosis is a type of hamartoma
The term hamartoma refers to an abnormal growth that consists of the same tissue from which it is derived. There may be variations in cellular numbers and cellular structure may be disorganised. Studies seem to indicate that a hamartoma occurs when the tissue in the growth did not develop completely.
They are usually present at birth.
Hamartomas may occur throughout the body, but are often found in the head and neck, particularly around the ears.
If hamartomas occur in multiple sites throughout the body, their presence is called Cowden disease.
By definition there is no metaplasia in hamartomata. There is evidence that polyps in Peutz-Jeghers, which are hamartomas, may progress to adenocarcinomas of the stomach, duodenum or colon and bronchial hamartomas may transform into carcinoma.
