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Pathoma Chapter 3 Flashcards

1
Q

Importance of Glucose-6-phosphate enzyme isoforms?

A

Clonality can depict neoplasm. Normally you inherit a G6PD isotype from each parent. The ratio of each type should be 1:1. If it’s asymmetrical you have a monoclonal growth that can indicate a neoplastic growth. Theoretically any X-linked isoform would work, so if androgen receptors have isotypes you could use those instead. X-linked and thus ONLY WORKS ON WOMEN

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2
Q

B cell clonality determined by Ig light chain phenotype

A

Ig has 2 heavy, 2 light chains each b cell expresses light chains that are either kappa or lambda
the NORMAL ratio is 3:1 kappa to lambda
any extreme asymmetry from this ratio could indicate neoplasm

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3
Q

3:1 ratio represents?

A

kappa to lamda KAPPA TO LAMDA KAPPA TO LAMDA 3-1 KAPPA LAMDA

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4
Q

Enlarged lymph node DDx

A

Metastatic Cancer
Reactive hyperplasia due to infection
Lymphoma

DIAGNOSTIC FOR LYMPHOMA is a Kappa to Lamda ratio that is NOT 3:1

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5
Q

Lamda to Kappa ratio of 3:1 and enlarged lymph node

A

LYMPHOMA

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6
Q

Kappa to Lamda ratio of 3:1 and enlarged lymph node

A

NORMAL

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7
Q

Aflatoxin

A

hepatocellular carcinoma, derived from Aspergillus which can contaminate stored grains

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8
Q

history with a grain silo

A

Aspergillus, can make aflatoxins which cause hepatocellular carcinoma

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9
Q

Alkylating agents

A

Leukemia/lymphoma this can be a side effect of chemotherapy

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10
Q

carcinogenic agent: Squamous cell carcinoma of oropharynx and upper esophagus

A

alcohol

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11
Q

carcinogenic agent: pancreatic carcinoma

A

alcohol

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12
Q

MCC of hepatocellular carcinoma

A

alcohol

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13
Q

Carcinogens in cigarette smoke

A

Polycyclic Hydrocarbons, Arsenic, Naphthylamine

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14
Q

carcinogenic agent: Squamous cell carcinoma of skin risk factor

A

Arsenic

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15
Q

lung cancer can be caused by this chemical in cigarettes

A

arsenic

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16
Q

carcinogenic agent: Lung carcinoma

A

Asbestos This is MORE LIKELY than mesothelioma after asbestos exposure

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17
Q

carcinogenic agent: Mesothelioma

A

asbestos

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18
Q

Most carcinogenic chemical in cigarette smoke?

A

polycyclic hydrocarbons

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19
Q

Cigarette smoke causes…

A

Carcinoma of oropharynx, esophagus, lung AND kidney, bladder due to hyperconcentration of carcinogens in urine.

Also, increases likelihood of cervical cancer.

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20
Q

History of eating large amount of smoked foods with Japanese descent

A

Think Nitrosamines Stomach cancer, Intestinal type, NOT diffuse

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21
Q

carcinogenic agent: Urothelial carcinoma of bladder

A

Naphthylamine(cigarette smoke derivative)

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22
Q

What symptom would you expect to see from occupational exposure to Polyvinyl chlorides such as those used to make PVC pipes?

A

Angiosarcoma of the liver caused by the vinyl chloride exposure

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23
Q

Occupational exposure to Nickel, chromium, beryllium or silica

A

Lung cancer

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24
Q

Chinese male or indigenous african presenting with neck mass

A

Nasopharyngeal carcinoma secondary to EBV

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25
Cancer associated with EBV
Burkitt's lymphoma and CNS lymphoma in AIDS patients and nasopharyngeal carcinoma
26
Older eastern european male and you see a papular erythematous lesion
Kaposi Sarcoma caused by HHV-8 Can also afflict AIDS patients, transplant patients
27
Which hep virus preclude hepatocellular carcinoma?
Hep B and Hep C
28
HTLV-1
HTLV-1 is a retrovirus that predisposed to Adult T-cell leukemia/lymphoma
29
HPV high risk? low risk?
High risk = 16, 18, 31, 33 (Squamous cell carcinoma of lower GU tract. Also ADENOcarcinoma of cervix) Low Risk = 6, 11 (condyloma acumulatum)
30
A worker during the japanese nuclear meltdown is predisposed to
ionizing radiation causing AML, CML and papillary carcinoma of the thyroid
31
What is the malignant cell in AML
myeloblast
32
What is the MOA of ionizing radiation
generation of hydroxyl free radicals
33
MOA of non-ionizing radiation
pyrimidine dimers are created which are normally excised by restriction endonucleases
34
non-ionizing radiation(UVB light) predisposes to.... a/w?
Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin A/W Xeroderma Pigmentosum where base excision is broken.
35
Most common cancers of INCIDENCE
breast/prostate lungs colorectal
36
Most common cancers of MORTALITY
lung breast/prostate colorectal
37
Common screening tools:
Pap smear: CIN Mammography PSA and DRE Hemoccult test and colonoscopy
38
Mammography looks for which cancer?
DCIS, ductal carcinoma in situ
39
Where does prostate cancer generally present?
posterior periphery
40
Describe the RAS pathway
ras-GDP associated with GF in an inactive state . Receptor binding causes GDP to be replaced with GTP activating ras . ras sends growth signals to nucleus . ras inactivates itself by cleaving GTP to GDP. This is overseen by GTPase activating protein. NOW ABNORMAL mutated ras inhibits GTPase activating protein, resulting in its constitutive activation --> growth signal
41
Describe role of p53 in DNA repair
p53 is the cell cycle cop It stops a cell in G1 going to S and checks the DNA. If its crappy DNA, it'll say go get fixed. If it can't get fixed, p53 induces apoptosis via the Bcl pathway. p53 upregulates BAX disrupting Bcl2 and cytochrome c leaks out of mitochondria and activates apoptotic pathways.
42
Li-Fraumeni syndrome
germline mutation of one p53 gene. Need two hits to get cancer.
43
Rb's role in cell cycle regulation
Rb is bound to E2f, this keeps the cell cycle in G1. When CDK comes over and phosphorylates Rb, E2f falls off and gives the green light for S phase and parties like its 1939. If Rb is mutated, then it is NEVER attached to E2f and the cell ALWAYS has the greenlight to party. That's bad
44
Germline retinoblastoma is A/w?
osteosarcoma and bilateral retinoblastoma
45
Somatic retinoblastoma
unilateral retinoblastoma
46
What gene is overexpressed in follicular lymphoma?
Bcl2. This overstabilizes the mitochondrial membrane, which isn't usually a problem except in the thymus, where you need negative selection to get rid of autoreactive t-lymphocytes. Also B-cells that would undergo apoptosis during somatic hypermutation...don't. This leads to lymphoma, which is probably polyclonal.
47
Follicular lymphoma is associated with what translocation?
t(14;18) moves Bcl2(18) to the Ig heavy chain locus(14) making it constitutively active
48
Describe the process of tumor invasion
TUMOR INVASION!! 1. ) downregulation of cadherins, which normally keep cells buddy-buddy all attached to each other, causes...well, detachment. 2. ) Tumor cells then find a new friend to screw with, laminin, and in the process destroy the basement membrane(type IV collagen) with a collagenase 3. ) Bored with laminin, tumor cells attach to fibronectin in the ECM and spread locally until they get tired of THAT. 4. ) They find a blood or lymph vessel so they can go explore the world and party....like its 1939.
49
Sarcoma's generally spread...
haemotogenously
50
Breast cancers generally spread...
lymphatically(axillary breast node first hit)
51
omental caking
ovarian carcinoma. Commonly seeds body cavities, like the peritoneum
52
Hematogenous spread cancers...
Renal cell carcinoma(invades renal vein) Hepatocellular carcinoma(invades hepatic vein) follicular carcinoma of the thyroid choriocarcinoma(placental malignancy) sarcoma's...DUH
53
Keratin stains
epithelium
54
vimentin
mesenchyme
55
Desmin
muscle
56
GFAP
neuroglia
57
neurofilament
neurons
58
neurons IMF
neurofilament
59
neuroglia IMF
GFAP
60
muscle IMF
desmin
61
Mesenchyme IMF
vimentin
62
Epithelium IMF
Keratin
63
S-100
Melanin
64
What do you look for to be positive in melanoma's?
S-100
65
Chromogranin
Small cell carcinoma of lung and carcinoid tumors both of those are neuroendocrine tumors
66
Neuroendocrine tumors
Small cell carcinoma of lung and carcinoid tumors | stains Chromogranin
67
Absolute definition of benign neoplasm
Will never metastatize
68
CA-125
ovarian cancer, NON-specific test
69
Single most prognostic indicator?
metastasis
70
Grade or Staging more important?
Staging -- TNM
71
PDGFB mutation a/w?
overexpression, autocrine loop that can lead to an astrocytoma
72
breast carcinoma's can sometimes express this receptor
ERBB2[HER2/Neu] amplification of receptors expressed.
73
Common treatment for ERBB2 cancers
Trastuzumab
74
RET function
neural growth factor receptor
75
RET A/W
MEN 2A, MEN 2B, sporadic medullary carcinoma of thyroid
76
KIT function?
Stem cell growth factor receptor
77
KIT A/W
gastrointestinal stromal tumor
78
RAS gene family A/W
Carcinomas, melanoma and lymphoma
79
ABL
Tyrosine kinase
80
ABL A/W
CML and some types of ALL(poor prognosis) | t(9;22) with BCR. Abl starts on 9, but swaps with BCR which is on 22
81
c-MYC A/W | what translocation?
Burkitt Lymphoma transcription factor t(8;14) involving IgH which is always on. So when MYC gene on chromosome 8, which is a transcription factor is ALWAYS on, problems arise. In the party factory.
82
N-MYC
amplification mutation leading to Neuroblastoma
83
L-MYC
Small cell lung carcinoma
84
CCND1(Cyclin D1) | What translocation?
Mantle cell lymphoma t(11;14) involving IgH which is always on. So when cyclin, which regulates cell cycle is ALWAYS on, the cops never roll that party.
85
CDK4 mutation
Melanoma

Pathoma (2 decks)

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