Pathology: Neoplasia Lab

Question 1

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Answer 1

Benign fibroadenoma in the breast. CT capsule confining tumor, no hemorrhaging, no necrosis, no angiogenesis and shiny surface (lack of dense collagen in tumor)

Question 2

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Answer 2

Malignant breast tumor. Note hemorrhage site from previous tumor biopsy, that is where the carcinoma is. White part is normal breast tissue, dull, yellowish portion is the malignant part.

Question 3

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Answer 3

Normal breast with ducts, tubes and uniform organization

Question 4

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Answer 4

Breast benign fibroadenoma. Note pale stroma, elongated/branching glands that are self-contained and widely separated in the stroma.

Question 5

Where do breast tumor cells originate from?

Answer 5

Stromal cells in the lobules

Question 6

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Answer 6

Note two cell layers: myoepithelial cells and inner glandular epithelial layer.

Question 7

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Answer 7

Malignant breast tumor. Note mass of cells with little tendency to form glands, poor differentiation, infiltrating border and large purple nuclei.

Question 8

You look at a slide and note the cells forming glands, hyperchromatic and giant cells. What information is the oncologist looking to get from the pathologist?

Answer 8

Tumor grade. The doctor wants to know how differentiated the tumor is.

Question 9

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Answer 9

Higher power image of malignant breast tumor. Note large and deep staining hyperchromatic nuclei.

Question 10

How can you decide whether something is an adenocarcinoma or not?

Answer 10

Mucin production and attempts to form glands

Question 11

An oncologist wants you to determine how far the tumor has invaded into surrounding tissue, if it has metastasized to lymph nodes or to different organs. What does she want?

Answer 11

Tumor staging.

Question 12

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Answer 12

Malignant breast tumor with highly pleomorphic cells and mitoses.

Question 13

A patient comes to your office for a routine gynecology exam. What test might you do that allows you to look at cells apart from their normal architecture?

Answer 13

Pap smear. This test is an example of cytological analysis.

Question 14

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Answer 14

Normal cervix, notice squamous epithelium in cervix and glandular columnar epithelium of endocervix that meet at the squamo-columnar junction. Note apical pyknotic layer with no mitoses and pyknoses and basal cuboidal layer

Question 15

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Answer 15

Normal pap-smear. Small round dark staining nucleus.

Question 16

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Answer 16

Normal pap smear of columnar epithelium from endocervix. Note evenly spaced and uniform nuclei.

Question 17

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Answer 17

Moderate dysplasia. Note the nuclei remain large more than halfway up into the cervix before they start to flatten out. Also note metaplasia in the lower endocervix that has spread from the cervix.

Question 18

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Answer 18

Carcinoma in situ. Note lack of differentiation all the way to the apical layer and in tact basement membrane.

Question 19

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Answer 19

Abnormal pap smear. Note increase in nuclei:cytoplasm ration, clumpy hyperchromatic nucleus, and notches/irregularities in the nucleus.

Question 20

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Answer 20

Cervical carcinoma with large polypoid mass coming from the ectcervix

Question 21

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Answer 21

Invasive cervical squamous carcinoma. Note pleomorphic cells with large hyperchromatic nuclei.

Question 22

You are pathologist and look at a carcinoma with cells that are connected by desomsome with pink staining cytoplasm. What type of carcinoma are you looking at?

Answer 22

Squamous cell carcinoma. Pink stain comes from keratin produced by these cells.

Question 23

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Answer 23

Malignant colon adenocarcinoma. Note necrosis, ulceration, “heaped up” border from infiltration of wall and narrowing of lumen.

Question 24

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Answer 24

Note tumor infiltration of wall and narrowing of lumen.

Question 25

What are the different shapes and sizes of tumors?

Answer 25

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Question 26

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Answer 26

Polypoid fungating mass in the right side of the colon.

Question 27

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Answer 27

Colon with adenocarcinoma. Note uniform goblet cells, separated one from another by CT in center; but dark-staining mass of large nuclei and shared glands in the tumor in the upper left

Question 28

Back to back glands

Answer 28

Indicative of adenocarcinoma.

Question 29

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Answer 29

Invasion of muscularis propria of the colon. Note central necrosis surrounded by neoplastic cells.

Question 30

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Answer 30

Metastasis of adenocarcinoma from the colon in the lymph node. Note sheets of lymphocytes.

Question 31

Dukes A tumor

Answer 31

Partial invasion of muscle wall

Question 32

Dukes B tumor

Answer 32

Goes into entire wall and serosal fat

Question 33

Dukes C tumor

Answer 33

Lymph nodes are affected by metastasis

Question 34

Dukes D tumor

Answer 34

Metastasis to distant organs

Question 35

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Answer 35

Liver with metastatic liver cancer. Note tumors with dark center area of necrosis.

Question 36

What is the difference between a cirrhotic liver and a cancerous liver?

Answer 36

Cirrhotic liver does not have any normal areas. Cancerous liver had nodules spread throughout the tissue.

Question 37

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Answer 37

Bone cancer which was a metastasis from the prostate. Note cancer infiltration of bone.

Question 38

A patient has cancer of the bone but doesn’t know it. What symptoms may he/she present with in clinic?

Answer 38

Hypercalcemia and pathological fractures

Question 40

A male comes to your office complaining of testicular pain. Suspecting testicular cancer, you put in for a test testing for a certain tumor marker. What marker would this be?

Answer 40

hCG

Question 41

Before referring a patient to have a tumor excised from his colon, you want to estimate his prognosis with a particular tumor marker. What marker might you test for?

Answer 41

CEA (Carinoembryonic Antigen)

Question 42

A patient presents to your office with jaundice and cachexia. You order a test to rule out cancer. What will the test be analyzing?

Answer 42

AFP (alpha-Fetoprotein)

Question 43

A patient comes to your clinic complaining of back pain and vaginal bleeding. You order a blood test for CA-125. What might the cytologist see if the CA-125 came back positive?

Answer 43

Ovarian Cancer

Question 44

A patient presents with typical CRAB symptoms (Calcium, Renal failure, Anemia, and Bone lesions). What test might you run to rule out myeloma in this patient?

Answer 44

Immunoglobulin test to see if there is an extraordinarily high level of a single Ig in the blood being produced by possibly cancerous WBCs.

Question 45

A young patient presents to your office with blood in his stool. Various relatives have had similar symptoms. What tumor marker might you test for in his case?

Answer 45

APC. It is tumor repressor and regulates beta-catenin in the WNT signaling pathway.

Question 46

Females with this syndrome have nearly 100% lifetime risk of developing some cancer. How would you test to see if a patient had this rare disease?

Answer 46

Genetic testing for a p53 mutation resulting in LiFraumeni Syndrome.

Question 47

Through genetic testing, you diagnose a patient with a mutated NF1 gene resulting in neurofibromatosis type I. What signaling pathway component causes neurofibromatosis?

Answer 47

RAS. NF1 codes for neurofibromin which is a negative regulator of RAS. Without this protein, RAS stays active.

Question 48

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Answer 48

Benign tumor of the thyroid. Note CT capsule separating it from the normal thyroid parenchyma.

Question 49

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Answer 49

Normal thyroid parenchyma on the left, benign tumor on the right.

Question 50

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Answer 50

A good shot of the capsule separating a benign thyroid tumor from the thyroid parenchyma. Note prominent blood vessels within tumor.

Question 51

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Answer 51

Benign thyroid tumor. Note the cuboidal thyroid follicular epithelium with little or no colloid within the follicles.

Question 52

What would the lung look like of a 65 year old female that has smoked for 25 years? She came to your clinic complaining of a cough and Cushingoid features.

Answer 52

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