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Pathoma > Pathoma Chapter 3 Flashcards > Flashcards

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
Q

Cancer associated with EBV

A

Burkitt’s lymphoma and CNS lymphoma in AIDS patients and nasopharyngeal carcinoma

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26
Q

Older eastern european male and you see a papular erythematous lesion

A

Kaposi Sarcoma caused by HHV-8 Can also afflict AIDS patients, transplant patients

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27
Q

Which hep virus preclude hepatocellular carcinoma?

A

Hep B and Hep C

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28
Q

HTLV-1

A

HTLV-1 is a retrovirus that predisposed to Adult T-cell leukemia/lymphoma

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29
Q

HPV high risk? low risk?

A

High risk = 16, 18, 31, 33 (Squamous cell carcinoma of lower GU tract. Also ADENOcarcinoma of cervix) Low Risk = 6, 11 (condyloma acumulatum)

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30
Q

A worker during the japanese nuclear meltdown is predisposed to

A

ionizing radiation causing AML, CML and papillary carcinoma of the thyroid

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31
Q

What is the malignant cell in AML

A

myeloblast

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32
Q

What is the MOA of ionizing radiation

A

generation of hydroxyl free radicals

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33
Q

MOA of non-ionizing radiation

A

pyrimidine dimers are created which are normally excised by restriction endonucleases

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34
Q

non-ionizing radiation(UVB light) predisposes to….

a/w?

A

Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin A/W Xeroderma Pigmentosum where base excision is broken.

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35
Q

Most common cancers of INCIDENCE

A

breast/prostate
lungs
colorectal

36
Q

Most common cancers of MORTALITY

A

lung
breast/prostate
colorectal

37
Q

Common screening tools:

A

Pap smear: CIN
Mammography
PSA and DRE
Hemoccult test and colonoscopy

38
Q

Mammography looks for which cancer?

A

DCIS, ductal carcinoma in situ

39
Q

Where does prostate cancer generally present?

A

posterior periphery

40
Q

Describe the RAS pathway

A

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
Q

Describe role of p53 in DNA repair

A

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
Q

Li-Fraumeni syndrome

A

germline mutation of one p53 gene. Need two hits to get cancer.

43
Q

Rb’s role in cell cycle regulation

A

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
Q

Germline retinoblastoma is A/w?

A

osteosarcoma and bilateral retinoblastoma

45
Q

Somatic retinoblastoma

A

unilateral retinoblastoma

46
Q

What gene is overexpressed in follicular lymphoma?

A

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
Q

Follicular lymphoma is associated with what translocation?

A

t(14;18) moves Bcl2(18) to the Ig heavy chain locus(14) making it constitutively active

48
Q

Describe the process of tumor invasion

A

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
Q

Sarcoma’s generally spread…

A

haemotogenously

50
Q

Breast cancers generally spread…

A

lymphatically(axillary breast node first hit)

51
Q

omental caking

A

ovarian carcinoma. Commonly seeds body cavities, like the peritoneum

52
Q

Hematogenous spread cancers…

A

Renal cell carcinoma(invades renal vein)
Hepatocellular carcinoma(invades hepatic vein)
follicular carcinoma of the thyroid
choriocarcinoma(placental malignancy)
sarcoma’s…DUH

53
Q

Keratin stains

A

epithelium

54
Q

vimentin

A

mesenchyme

55
Q

Desmin

A

muscle

56
Q

GFAP

A

neuroglia

57
Q

neurofilament

A

neurons

58
Q

neurons IMF

A

neurofilament

59
Q

neuroglia IMF

A

GFAP

60
Q

muscle IMF

A

desmin

61
Q

Mesenchyme IMF

A

vimentin

62
Q

Epithelium IMF

A

Keratin

63
Q

S-100

A

Melanin

64
Q

What do you look for to be positive in melanoma’s?

A

S-100

65
Q

Chromogranin

A

Small cell carcinoma of lung and carcinoid tumors both of those are neuroendocrine tumors

66
Q

Neuroendocrine tumors

A

Small cell carcinoma of lung and carcinoid tumors

stains Chromogranin

67
Q

Absolute definition of benign neoplasm

A

Will never metastatize

68
Q

CA-125

A

ovarian cancer, NON-specific test

69
Q

Single most prognostic indicator?

A

metastasis

70
Q

Grade or Staging more important?

A

Staging – TNM

71
Q

PDGFB mutation a/w?

A

overexpression, autocrine loop that can lead to an astrocytoma

72
Q

breast carcinoma’s can sometimes express this receptor

A

ERBB2[HER2/Neu] amplification of receptors expressed.

73
Q

Common treatment for ERBB2 cancers

A

Trastuzumab

74
Q

RET function

A

neural growth factor receptor

75
Q

RET A/W

A

MEN 2A, MEN 2B, sporadic medullary carcinoma of thyroid

76
Q

KIT function?

A

Stem cell growth factor receptor

77
Q

KIT A/W

A

gastrointestinal stromal tumor

78
Q

RAS gene family A/W

A

Carcinomas, melanoma and lymphoma

79
Q

ABL

A

Tyrosine kinase

80
Q

ABL A/W

A

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
Q

c-MYC A/W

what translocation?

A

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
Q

N-MYC

A

amplification mutation leading to Neuroblastoma

83
Q

L-MYC

A

Small cell lung carcinoma

84
Q

CCND1(Cyclin D1)

What translocation?

A

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
Q

CDK4 mutation

A

Melanoma

Pathoma (2 decks)

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