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Pathological Processes > Session 8: Neoplasia 1 > Flashcards

Session 8: Neoplasia 1 Flashcards

1
Q

Definition of neoplasm.

A

An abnormal growth of cells that persists after the initial stimulus is removed. A neoplasm is a type of tumour.

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2
Q

Definition of malignant neoplasm.

A

Abnormal growth of cells that persists after the initial stimulus is removed AND invades surrounding tissue with potential to spread to distant sites.

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3
Q

Definition of tumour.

A

Any clinically detectable lump or swelling.

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4
Q

Definition of metastasis.

A

A malignant neoplasm that has spread from its original site (primary site) to a new non-contiguous site (secondary site).

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5
Q

Define dysplasia.

A

A pre-neoplastic alteration in which cells show disordered tissue organisation.

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6
Q

What is the main difference between neoplasia and dysplasia?

A

That dysplasia is reversible. Neoplasia is not.

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7
Q

Give examples of non-neoplastic tumours.

A

Absess and haematoma

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8
Q

What can neoplastic tumours be subdivided into?

A

Benign and malignant neoplasms.

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9
Q

What can malignant neoplastic tumours be subdivided into?

A

Primary or secondary (metastasis)

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10
Q

Benign and malignant neoplasms show different behaviours. Which?

A

Benign neoplasms remain confined to their site of origin and do not produce metastases.

Malignant noeplasms have the potential to metastatise.

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11
Q

How do benign and malignant neoplasms differ in appearance to the naked eye?

A

Benign: Tumours grow in a confined local area and so have a pushing outer limit. This makes them less dangerous.

Malignant: Tumours have an irregular outer limit and shape and may show areas of necrosis and ulceration.

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12
Q

How does the degree of differentiation differ in benign compared to malignant neoplasms?

A

Benign neoplasms are closely resembling the parent tissue meaning that they are well differentiated.

Malignant neoplasms range from well to poor differentiation and may not really resemble the parent tissue.

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13
Q

What are anaplastic cancers?

A

Cells with no resemblance to any tissue.

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14
Q

How does worsening differentiation show under the microscope?

A

Individual cells have an:

Increased size

Increased nuclear to cytoplasm ratio

Increased nuclear staining

More mitotic figures

Increasing variation in size and shape of cells + nuclei.

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15
Q

What is hyperchromasia?

What is pleomorphism?

A

Increased nuclear staining

Increased variation in size, shape of cells and of nuclei.

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16
Q

Clinicians use something called grade when referring to neoplasms.

What is grade?

What does a high grade indicate?

A

Grade is a term to indicate differentiation. Grade refers to how it looks under a microscope.

A high degree means the neoplasm is poorly differentiated.

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17
Q

Give the grades of the Modified Bloom Richardson grading for breast cancer.

What does each grade involve?

Is grade linked to survival rates?

A

G1: Tubules in histology

G2: Mitoses in histology

G3: Nuclear pleomorphism in histology

Survival rates fall as the grade increases.

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18
Q

How does grade relate to dysplasia?

A

Dysplasia also represents altered differentiation. There is mild, moderate and severe dysplasia which indicates worsening differentiation i.e. higher grade.

A high grade dysplasia means a higher risk of it developing into malignant neoplasia.

19
Q

What is neoplasia caused by?

A

An accumulation of mutations in somatic cells.

The mutations are caused by initiators which are mutagenic agents and promoters which cause cell proliferation.

20
Q 
X= Initiator
O = Promoter

Will the following combinations cause neoplasia?

1: X + X
2: O + O
3: X + O
4: X + X + O
5: X + O + O + O

A

1: No only initiators cannot cause neoplasia
2: No only promoters will have no mutagenic factor as a predecessor to act on
3: No, there is a need for prolonged exposure of promoters to promote proliferation.
4: No, there is no prolonged exposure of promoters.
5: Yes, there is a need of prolonged exposure to ensure neoplasia.

21
Q

What is a monoclonal population?

How does it come about?

Can a neoplasm arise from a monoclonal population?

A

A group of cells produced from a single ancestral cell.

A combination of initiators and promoters result in an expanded monoclonal population.

A neoplasm emerges from a monoclonal population through a process called progression. This is characterised by the accumulation of yet more mutations.

22
Q

Give example of main initiators.

A

Chemicals

Infections (e.g. oncogenic viruses)

Radiation

They can also act as promoters.

23
Q

If not through external mutagenic agents, how can neoplasms mutations come about?

A

Some neoplasms mutations are inherited.

24
Q

How do we know neoplasms are monoclonal?

A

Evidence that neoplasms are monoclonal came from the study of the X-linked gene for the enzyme G6PDH in tumour tissue from women.

Gene has several alleles encoding different isoenzymes.

Early in femal embryogenesis one allele will be randomly inactivated in each cell, this process is called lyonisation.

This means that in heterozygous women that happen to have one allele encoding a heat stable isoenzyme and one a heat labile isoenzyme -> this leads to normal tissue being a mixture of the both.

The problem comes to neoplastic tissue. It express only one isoenzyme which indicates a monoclonal group of cells.

25
Q

Genetic alterations can affect particular types of genes relating to neoplastic formation. Which?

A

There are two types of gene alterations which can favour neoplasm formation:

Proto-oncogenes and tumour suppressor genes.

26
Q

Explain what happens to proto-oncogenes in genetic alteration promoting neoplasm formation.

A

Proto-oncogenes become abnormally activated. These activated proto-oncogenes are now called oncogenes. Oncogenes favour neoplasm formation.

27
Q

Explain what happens to tumour suppressor genes in genetic alteration promoting neoplasm formation.

A

Tumour suppressor genes which normally suppress neoplasm formation become inactivated.

28
Q

How are neoplasms named?

A

Either by the organised system or the traditional system.

29
Q

Difference between the organised system and traditional system.

A

Organised follows rules

Traditional disobeys the rules.

The organised takes into account a neoplasm’s site of origin, whether it is benign or malignant, the type of tissue the tumour forms. Also sometimes the gross morphology.

30
Q

Give examples of promoters.

A

Oestrogen

Drugs

Chemicals

31
Q

What do benign neoplasms end in?

A

-oma

32
Q

What’s a carcinoma?

A

A malignant epithelial neoplasm.

33
Q

What is a stromal malignant neoplasm called?

A

It ends in -sarcoma

34
Q

There two main types of carcinomas. Which?

A

In-situ

Invasive

35
Q

What is an in-situ carcinoma?

What is an invasive carcinoma?

A

No invasion through epithelial basement membrane.

Penetration through the basement membrane.

36
Q

Leukaemia

A

Malignant neoplasm of blood-forming cells arising in the bone marrow.

37
Q

Lymphoma.

A

Malignant neoplasms of lymphocytes mainly affecting lymph nodes.

38
Q

Malignant neoplasm of plasma cells.

A

Myeloma

39
Q

Germ cell neoplasms.

A

Arise from pluripotent cells, mainly in the testis or ovaries.

40
Q

What are neuroendocrine tumours?

A

They areise from cells distributed throughout the body.

Like carcinoid tumours of various organs
Phaeochromocytoma of adrenal glands (Noradrenaline and adrenaline)
Small cell carcinoma of bronchii (ACTH and ADH)

41
Q

What are blastomas?

Main demographic for blastomas.

A

Formed from immature precursorcells like nephroblastomas.
They occur mainly in children.

42
Q

Zollinger Ellison syndrome

A

Neuroendocrine tumour from pancreatic and gastric regions. Causes an excess in gastrin production.

43
Q

Carcinoid syndrome.

Cause

Symptoms

A

Commonly seen with metastatic disease and caused by excess production of serotonin as well as other products like histamine, bradykinin and prostaglandins. These can be detected in blood and urine.

Symptoms

Flushing
Abdo pain
Diarrhoea
Nausea
Vomiting

Pathological Processes (14 decks)

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