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Tissues > T24 - General Principles of Tumorigenesis > Flashcards

T24 - General Principles of Tumorigenesis Flashcards

1
Q

Define tumor.

A

swelling or mass

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2
Q

Does a tumor imply cancer?

A

No. The presence of a tumor indicates the possibility of a malignancy, but does not imply cancer.

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3
Q

What is a neoplasm?

A

biological process of cellular growth in which a group of cells grows faster than its neighbors

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4
Q

How would a neoplasm arise?

A

if a group of cells acquires somatic (i.e. not inherited) mutations that confer growth advantage

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5
Q

What is a precancer?

A

microscopic neoplasm that does not yet form a tumor

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6
Q

What is the precursor to cervical cancer?

A

cervical intraepithelial neoplasia (CIN), a microscopic neoplasm

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7
Q

What is a cancer?

A

neoplasm/neoplastic process in which cells have acquired ability to spread locally (invasion) or systemically (metastasis)

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8
Q

What is a synonym for cancer?

A

malignancy

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9
Q

Cells in a healthy liver do not divide very much. Under what conditions would cell proliferation increase in hepatocytes?

A

a partial resection (partial hepatectomy) would induce remaining hepatocytes to quickly proliferate and regrow the lost part of the organ

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10
Q

In the context of neoplasms, what is disequilibrium?

A

cell growth exceeds cell death, resulting in progressive (but not necessarily indefinite) growth

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11
Q

Explain why most malignant neoplasms have both increased cell growth and increased cell death. (2)

A

deregulated cell growth triggers apoptosis, and normal apoptotic checkpoints are only partially affected in cancer

however, rate of cell growth outpaces rate of cell death

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12
Q

What are the two defining features of neoplasia?

A

disequilibrium (cell growth > cell death)

uncoordinated growth

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13
Q

What is contact inhibition?

A

a physiological stimulus that places limits on cell growth

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14
Q

Explain the relationship between neoplasia and contact inhibition.

A

neoplasms are no longer responsive to physiological stimuli such as contact inhibition that place limits on their growth

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15
Q

What is hyperplasia? (2)

A

overgrowth of tissue in response to stimulus for growth

hyperplasia ends once stimulus ends

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16
Q

What are key differences between hyperplasia and neoplasia?

A

manner of growth:

hyperplasia = coordinated growth and normal architecture

neoplasia = uncoordinated growth and abnormal architecture

mutations vs. stimuli:

neoplasia = results from genetic mutations that allow it to bypass regulatory mechanisms

hyperplasia = impetus for growth arises externally (not internally)

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17
Q

Describe the relationship between neoplasia and hyperplasia.

A

hyperplasia provides fertile ground for neoplasia

long-standing hyperplasias can become neoplasia-like (but will have more ordered growth)

some neoplasms depend on stimuli

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18
Q

What is the relationship between neoplasia and metaplasia? (2)

A

metaplasia is also a fertile ground for neoplasia because of a carcinogenic stimulus or because of associated hyperplasia

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19
Q

Dysplasia refers to

A

abnormal cytoarchitecture and disarrangement of cells seen microscopically

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20
Q

Most cancers arise from which tissue of the body?

A

most cancers arise from epithelia

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21
Q

How is dysplasia recognized histologically?

A

loss of normal, progressive maturational sequence

cellular atypia

loss of normal tissue organization

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22
Q

What is cellular atypia?

A

atypical appearance of cells in a tissue section

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23
Q

What is the relationship between dysplasia and precancer?

A

dysplasias are a form of precancer (they can either progress into cancers or not)

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24
Q

What is carcinoma in situ?

A

lesion that histologically cannot be distinguished from cancer cell, but has not transgressed normal tissue boundaries

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25
Q

What is a Pap smear?

A

examination of exfoliated surface cells from cervical epithelium that can detect all grades of dysplasia

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26
Q

You perform a Pap smear on a patient. Histological analysis detects a dysplasia in situ. What happens next? (2)

A

recommend for minimally invasive surgery (the “cure”) to remove the tissue with dysplastic cells

minimally invasive surgery option applies as long as dysplasia remains in situ

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27
Q

Describe the reversibility of dysplasias.

A

dysplasias can regress spontaneously or progress into invasive cancer

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28
Q

Explain the relationship between epithelial dysplasia and neoplasia.

A

most forms of epithelial dysplasia are neoplasms confined to epithelium

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29
Q

What is histogenesis?

A

type of differentiation exhibited by tumor cells

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30
Q

What is the first/most basic distinction made in tumor classification?

A

whether the cells are of epithelial or mesenchymal histogenesis

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31
Q

What are adenomas?

A

benign tumors derived from glandular epithelium

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32
Q

(T/F) All adenomas, by definition, are benign.

A

False. Some types of adenomas are not truly benign.

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33
Q

Most adenomas are benign, but some are not. Give an example of an adenoma that is not truly benign.

A

colonic adenoma — example of dysplasia that tends to form a tumor (visible polyp), even though there is no stromal invasion

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34
Q

Differentiate between colonic dysplasia and cervical dysplasia in terms of how they are observed.

A

colonic dysplasia forms a grossly visible polyp

cervical dysplasia is invisible to the naked eye

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35
Q

Describe the basis of “mucinous cystadenoma of the ovary.”

A

adenoma of mucin-producing epithelial cells, where the ovary contains multiple large cysts filled with mucin

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36
Q

Describe the basis of the name “serous cystadenoma of the ovary.”

A

made up of non-mucinous cells that form cysts filled with watery fluid

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37
Q

What is an exception to the adenoma naming convention?

A

papillary glandular tumors are just called papillomas

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38
Q

True polyps are the result of

A

abnormal surface epithelial growth

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39
Q

What are polyps?

A

common neoplastic growth pattern in surface epithelia

attached through stalk

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40
Q

What is papillary architecture?

A

common pattern of abnormal growth in surface epithelia lining cavities and ducts characterized by complex branching

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41
Q

Give three examples of papillomas.

A

squamous cell papilloma of skin (a.k.a. skin tag)

transitional cell papilloma of bladder

intraductal papilloma of breast

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42
Q

What is a melanocytic nevus? (2)

A

benign tumor of dermal melanocytes

also called just a “nevus”

43
Q

Tumors that end in “-oma” can be benign or malignant. List two malignant variants.

A

mesothelioma

hepatoma = hepatocellular carcinoma

44
Q

Malignant epithelial tumors, in general, are known as

A

carcinomas

45
Q

Generally speaking, what are carcinomas?

A

malignant epithelial tumors

46
Q

Differentiate between carcinomas and adenocarcinomas.

A

adenocarcinomas are carcinomas (malignant epithelial tumors) that derive from glandular epithelium (breast, colon, prostate, endothelium)

47
Q

What happens to the term “adenocarcinoma” when it is modified by its tissue of origin?

A

when modified by tissue of origin, “adenocarcinoma” loses “adeno” part and is just called a “carcinoma”

48
Q

Give three examples of adenocarcinomas that lose the “adeno-“ prefix when modified by tissue of origin.

A

renal cell carcinoma

colon carcinoma or colon adenocarcinoma

hepatocellular carcinoma

49
Q

What is the naming convention for benign mesenchymal neoplasms?

A

names reflect histogenesis/cell of origin, followed by “-oma”

50
Q

What is a fibroma?

A

mesenchymal tumor with fibroblast differentiation

51
Q

Lipoma involves

A

fat

52
Q

Chondroma involves

A

cartilage

53
Q

Osteoma involves

A

bone

54
Q

Hemangioma involves

A

blood vessels

55
Q

Lymphangioma involves

A

lymphatics

56
Q

Leiomyoma involves

A

smooth muscle

57
Q

Rhabdomyoma involves

A

skeletal muscle

58
Q

Meningioma involves

A

meninges

59
Q

What is the naming convention for malignant mesenchymal tumors?

A

cell of origin + “-sarcoma”

60
Q

What are four exceptions to the tumor/neoplasm naming rules?

A

malignant peripheral nerve sheath tumor (MPNST) = malignant schwannoma

leukemia

lymphoma

invasive meningioma

[MILL]

61
Q

What is a malignant peripheral nerve sheath tumor, also known as a malignant schwannoma?

A

malignant tumor of Schwann cells in peripheral nerves

62
Q

What is leukemia?

A

tumor of white blood cells with circulating neoplastic cells

63
Q

What is a lymphoma? (2)

A

tumor of white blood cells that forms masses in lymph nodes

may have circulating neoplastic cells

64
Q

What is an invasive meningioma?

A

aggressive, invasive version of typically benign meningioma

65
Q

What are three tumors that cannot be categorized based on epithelial vs. mesenchymal origin?

A

seminoma

melanoma

carcinoid tumor

66
Q

What is a seminoma?

A

malignant tumor of germ cells (i.e. testicular cancer)

67
Q

What is a melanoma?

A

malignant tumor of melanocytes

68
Q

What is a carcinoid tumor?

A

a tumor derived from neuroendocrine cells that often arises in the gut

69
Q

What are mixed tumors?

A

tumors comprised of admixed epithelial and mesenchymal components

70
Q

What is a synonym for mixed tumor?

A

biphasic tumor

71
Q

On a cellular level, how do mixed tumors differ from monophasic tumors?

A

mixed tumors have two or more types of neoplastic cells, whereas monophasic tumors only have one type of neoplastic cell

72
Q

Give two examples of benign mixed tumors.

A

pleomorphic adenoma

fibroadenoma

73
Q

What is a pleiomorphic adenoma? (2)

A

tumor w/ neoplastic epithelial and stromal elements

found in salivary gland

74
Q

What is a fibroadenoma? (2)

A

tumor w/ neoplastic epithelial and stromal elements

found in breast

75
Q

Give four examples of malignant mixed tumors (with two cell types).

A

malignant mixed tumor of salivary gland (malignant version of pleomorphic adenoma)

Wilms tumor (kidney)

mixed mullerian tumor = carcinosarcoma of uterus

cystosarcoma phyllodes of breast

76
Q

What are teratomas?

A

tumors composed of 3 or more cell types

77
Q

Teratomas typically arise from

A

toti- or multi-potent cells — in other words, they arise from germ cell lineage

78
Q

In which tissue structure(s) are teratomas observed? (2)

A

most often, observed in gonads

but can arise in extragonadal locations due to aberrant migration in embryogenesis (i.e. brain, mediastinym)

79
Q

Give two examples of benign teratomas.

A

mature teratoma (cells resemble those in mature, adult tissues)

dermoid cyst

80
Q

What is a dermoid cyst?

A

mature teratoma characterized by keratinaceous debris formed from desquamating squamous epithelial cells

81
Q

Give an example of a malignant teratoma.

A

immature teratoma (cells resemble primitive cells in embryonic development)

82
Q

Define hamartoma.

A

malformation that resembles neoplasm but actually results form focal maldevelopment of that organ

83
Q

A hamartoma consists of

A

tissue elements normally found at that site

84
Q

What is a choristoma?

A

tumor formed by maldeveloped tissue not normally found at that site

85
Q

Give a common example of a hamartoma.

A

pulmonary hamartoma (typically composed of cartilage + bronchial epithelium)

86
Q

What is another name for a choristoma?

A

heterotropic rest

87
Q

Give an example of a choristoma/heterotropic rest.

A

adrenal rest

88
Q

What are adrenal rests?

A

harmless small masses of adrenal tissue found near ovary or kidney

89
Q

Are hamartomas and choristomas malignant?

A

No. By definition, both hamartomas and choristomas are benign.

90
Q

What is the primary difference and primary similarity between the terms “carcinoma” and “sarcoma?”

A

carcinoma = epithelial origin, whereas sarcoma = mesenchymal origin

both carcinoma and sarcoma imply malignancy

91
Q

(T/F) Hamartomas and choristomas are classified as neoplasms.

A

False. Hamartomas and choristomas are classified as non-neoplastic malformations.

92
Q

(T/F) Cancers do not have to metastasize to be lethal.

A

True.

93
Q

Give an example of contact inhibition that is commonly observed in laboratories.

A

fibroblasts can be cultured in a petri dish but will stop dividing after reaching a certain density

94
Q

What is the difference between neoplasia and hyperplasia in the context of the term “clonal?”

A

neoplasms derived from a single, genetically abnormal cell (monoclonal) — outgrowth of this abnormal cell

hyperplasias are polyclonal outgrowths of genetically normal cells

95
Q

Leukemias and lymphomas are derived from what kind of cell?

A

hematopoietic cells

96
Q

What is the most common type of germ cell tumor?

A

mature teratoma

97
Q

(T/F) Neoplasms are malignant.

A

False. Not all neoplasms are malignant.

98
Q

What is the “grey zone” between hyperplasia and neoplasia?

A

hyperplasia can lead to neoplasia because more growth means more opportunities for mutations

99
Q

MALT lymphoma is the result of

A

an H. pylori infection

100
Q

(T/F) Metaplasia is irreversible.

A

False. For example, you can treat Barrett’s esophagus if you catch it early enough.

101
Q

What is the relationship between carcinoma in situ and just a regular carcinoma?

A

carcinoma in situ means that the neoplasm has not crossed the basement membrane

102
Q

Differentiate between adenomas and papillomas.

A

adenomas = glandular and have a more blob-like shape

papillomas = non-glandular and have a finger-like shape

103
Q

Cystadenomas can produce what two products?

A

mucinous products

serous products

104
Q

What do HSIL and LSIL stand for?

A

high/low grade squamous intraepithelial lesion

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