SM_261b: Introduction to Neoplasia Flashcards
Hyperplastic polyps are ___
Hyperplastic polyps are benign lesions that arise throughout colon but especially common distally
- Not believed to harbor risk of malignant transformation
Tubular adenoma is ___
Tubular adenoma is dysplastic proliferation of colonic epithelium
- Can be pedunculated or sessile with variety of architectural patterns
- By definition contain low-grade dysplasia at baseline
This is ___

Normal colonic mucosa

This is a ___

Hyperplastic polyp

This is a ___

Tubular adenoma

This is ___
Tubular adenoma -> carcinoma

Describe progression from dysplasia to carcinoma in colon
Dysplasia to carcinoma in colon
- Normal colon
- Hyperproliferative epithelium: methylation abnormalities, APC / hMSH2 / hMLH1 inactivation
- Adenoma: K-ras mutation, DCC deletion, p53 deletion
- Carcinoma: further accumulation of genetic abnormalities

This is ___

Colorectal carcinoma

Describe treatment and staging for colorectal carcinoma
Colorectal carcinoma
- Surgical resection
- Histologic considerations: depth of invasion, lymphovascular invasion, margin status, lymph node metastases

Describe TNM staging for colorectal carcinoma
TNM staging for colorectal carcinoma
- Tumor
- T1: submucosal invasion
- T2: muscularis propria invasion
- T3: pericolonic tissue invasion
- T4: invasion into or beyond visceral peritoneum
- Nodes
- N1: mets in 1-3 regional nodes
- N2: mets in 4 or more regional nodes
- Metastases
- M1: distant metastases

____, ____, and ____ are ancillary studies for colorectal carcinoma
BRAF V600E mutation testing, microsatellite instability, and KRAS mutation testing are ancillary studies for colorectal carcinoma
Presence of ____ predicts negative outcome in anti-EGFR monoclonal antibody treatment of colorectal carcinoma
Presence of BRAF V600E mutation predicts negative outcome in anti-EGFR monoclonal antibody treatment of colorectal carcinoma
Microsatellite instability is caused by ____ and occurs in ____
Microsatellite instability is caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6) and occurs in Lynch syndrome
- Prognostic indicator for fluorouracil-based adjuvant chemotherapy in colon cancer
____ predicts negative outcome in anti-EGFR monoclonal antibody treatment for colorectal carcinoma
KRAS mutation predicts negative outcome in anti-EGFR monoclonal antibody treatment for colorectal carcinoma
Screening for prostate cancer involves ___ and ___
Screening for prostate cancer involves digital rectal exam and serum PSA levels
- Confirmation is done with prostate needle biopsy

This is ___

Normal prostate epithelium

This is ___

High grade prostatic intraepithelial neoplasia

This is ___

Prostatic carcinoma

Describe Gleason grading
Gleason grading
- Small uniform glands
- More stroma between glands
- Distinctly infiltrative margins
- Irregular masses of neoplastic glands
- Only occasional gland formation

This is ___ prostate carcinoma

Gleason Grade 3 prostate carcinoma

This is ___ prostate carcinoma

Gleason Grade 4 prostate carcinoma

This is ___ prostate carcinoma

Gleason Grade 5 prostate carcinoma

Describe treatment and staging of prostate carcinoma
Prostate carcinoma
- Surgical resection
- Histologic considerations
- Unilateral vs bilateral disease
- Lymphovascular and perineural invasion
- Extraprostatic extension
- Margin status
- Seminal vesicle invasion
- Lymph node metastases
- Volume of tumor involved
Describe TNM staging of prostate carcinoma
TNM staging of prostate carcinoma
- Tumor
- T1: tumor that is not yet clinically detectable
- T2: palpable tumor confined to gland
- T3: tumor that has grown beyond prostatic capsule
- T4: tumor that has grown directly into adjacent tissues
- Lymph nodes
- N1: tumor has spread to nearby lymph nodes
- Metastases
- M1: tumor has spread to distant lymph nodes or beyond
This is ___ of prostate carcinoma

Perineural invasion of prostate carcinoma

This is ___ of prostate carcinoma

Seminal vesicle invasion of prostate carcinoma

Prostate cancer is treated with ___
Prostate cancer is treated with surgical resection and adjuvant therapy

This is ___

Normal breast epithelium

Pre-neoplastic diseases of breast are ____, ____, and ____
Pre-neoplastic diseases of breast are atypical ductal hyperplasia, ductal carcinoma in situ, and lobular carcinoma in situ

This is ___

Atypical ductal hyperplasia

This is ___

Lobular carcinoma in situ

This is ___

Ductal carcinoma in situ

Invasive ductal carcinoma is treated with ___
Invasive ductal carcinoma is treated with excision with needle localization

Negative margins are when ___
Negative margins are when cancer cells do not touch the edge of the resection

Positive margins are when ___
Positive margins are when cancer cells touch the edge of resection

Describe invasive ductal carcinoma
Invasive ductal carcinoma
- Most common subtype of breast cancer
- Hard consistency and stellate appearance
- Histology: cords or solid nests of malignant cells invading into stroma
- Association with in situ carcinomas

Describe histologic grading of breast carcinoma
Histologic grading of breast carcinoma: modified Bloom-Richardson grading system
- Combines three components: architecture (tubule formation), mitotic rate, and nuclear grade
- Grades
- I: low grade, well differentiated
- II: intermediate grade, moderately differentiated
- III: high grade, poorly differentiated

Describe invasive lobular carcinoma
Invasive lobular carcinoma
- Bilaterality and multicentricity
- Histology: lack of cohesion, strands of infiltrating small tumor cells in form of a single file
- E-cadherin is absent
- Unusual metastatic sites: serosal surfaces, bone marrow, meninges

Describe treatment and staging of breast carcinoma
Breast carcinoma
- Surgical resection
- Histologic considerations
- Tumor size
- Multifocality
- Lymphovascular invasion
- Margin status
- Lymph node metastases
Describe TNM staging of breast cancer
TNM staging of breast cancer
- Tumor
- T1: tumor ≤ 20 mm in greatest dimension
- T2: tumor between 2-5 cm in greatest dimension
- T3: tumor > 5 cm in greatest dimension
- T4: tumor of any site attached to chest well or skin
- Nodes
- N1: metastases in 1-3 lymph nodes
- N2: metastases in 4-9 lymph nodes
- N3: metastases in > 10 lymph nodes
- Metastases
____ and ____ are ancillary studies for breast carcinoma
Hormone receptor status and OncotypeDx are ancillary studies for breast carcinoma
- Hormone receptor status: ER/PR/Her-2 immunohistochemistry, Her-2 amplification via FISH
- OncotypeDx: analyzes expression of 21 genes using RT-PCR, provides individual estimate of 10-year risk of local recurrence, used in women with ductal carcinoma in situ treated with local excision ± tamoxifen
