Test 1 Flashcards
]Cells adapt to change in 6 distinct ways, what are they?
○ Atrophy ○ Hypertrophy ○ Hyperplasia ○ Metaplasia ○ Dysplasia ○ Anaplasia
Whats the best example of Atrophy
■ Thymus undergoing involution
The best example of pathological Atrophy
■ Ischemic organs are typically small (kidneys involved in atherosclerosis)
The best physiologic example of Hypertrophy
■ Skeletal muscles in body builders due to weight training
The best pathologic example of Hypertrophy
■ Hypertrophy of the heart that occurs as an adaptation to increased workload
The best pathologic hyperplasia example
○ Endometrial hyperplasia due to estrogens
Best physiologic hyperplasia example
■ Physiologic hypertrophy of the uterine smooth muscle cells during pregnancy accompanied by hyperplasia
An adaptive change of one cell type for another to suit the environment
Metaplasia
Examples of adaptive change of one cell type for another to suit the environment
○ Squamous metaplasia of the bronchial epithelium due to smoking
○ Gastric or glandular metaplasia of the GE junction in Barrett’s esophagus
Disordered growth of tissues resulting from chronic irritation or infection
Dysplasia
The best example of Dysplasia
■ Cervical intraepithelial neoplasia or CIN based on PAP smears
Undifferentiated and uncontrolled growth of cells. The hallmark of malignant transformation!
Anaplasia or cancer
Other names for Anaplasia
○ Malignancy
○ Carcinoma
○ Cancer
○ Neoplasm
What are Microscopic hallmarks of anaplasia?
○ Cell and nuclei display marked cellular pleomorphism
■ Variation in size and shape
○ Nuclei are irregular and hyperchromatic
○ Extremely high nuclear/cytoplasmic ratio (N/C ratio)
■ About 1:1 instead of 1:4 or 1:6
○ Large nucleoli present within the nucleus
○ Large numbers of abnormal mitotic figures
Reversible Cell Injury characteristics
○ Swelling of the cytoplasm and it’s organelles due to malfunctioning ATP Na/K pump
○ Glycolysis takes over, PH decreases
○ If energy is restored the cell will survive and balance out.
condensation of the chromatin
■ Pyknosis
Fragmentation of the nucleus into small particles (nuclear dust)
■ Karyorrhexis
Involves dissolution of the nucleus and lysis of chromatin by enzymes
■ Karyolysis
Characteristics of irreversible cell injury
DNA in the Nucleus is damaged, cytoplasm is destroyed. Cells will release/leak enzymes into the ECF e.g… Hepatocytes release AST or LDH
What is coagulative cell necrosis?
■ The most common form of necrosis
■ Occurs when cell proteins are altered or denatured
■ Cell outlines are preserved and the cytoplasm appears finely granular
■ Occurs in solid internal organs
● Ex: heart, kidney, spleen, and liver
infarction
■ Appears white: dead myocytes and neutrophils that have infiltrated before the cells died
■ Most often caused by anoxia
● Ex: heart tissue undergoing a myocardial
■ Occurs in solid internal organs
● Ex: heart, kidney, spleen, and liver
infarction
coagulative cell necrosis
What is Liquefactive necrosis?
■ Refers to a process by which dead cells liquefy under the influence of certain cell enzymes
■ Occurs most often in the brain
● Brain cells lose their contours and liquify
● Typical of brain infarcts which are usually soft and are ultimately transformed into a fluid filled cavity
Liquefactive necrosis
What is caseous necrosis?
■ A form of coagulative necrosis in which a thick, yellowish, cheesy substance forms
■ Typically found in tuberculosis, characterized by the development of lung granulomas, inside of which can be found caseous necrosis
■ Can also be seen in some fungal infections
caseous necrosis
Fungi responsible for caseous necrosis in some infections
● Histoplasmosis
What is Fat necrosis?
■ A specialized form of liquefaction necrosis caused by the action of lipolytic enzymes
■ Limited to fat tissue, usually around the pancreas
What is one of the best example of fat necrosis?
● Enzymes are released into adjacent fat tissue after rupture of the pancreas (due to trauma, acute pancreatitis, etc) causing degradation of fat into glycerol and free fatty acids
What are Dystrophic calcifications?
○ Represents an extracellular deposition of calcium from the circulation into dead or dying necrotic tissue, often visible to the naked eye
The best example of Dystrophic calcification
■ Calcifications in atherosclerotic coronary arteries contributing to narrowing of vessels
Others
■ Calcifications of the mitral or aortic valves leading to impeded blood flow (stenosis)
■ Calcifications seen around breast cancers that can be visualized by mammography
■ Infact periventricular calcifications seen in congenital toxoplasmosis
What are Metastatic calcifications?
○ Reflects derange calcium metabolism, NOT cell injury, usually associated with increased serum calcium levels, leading to deposition of calcium in other locations
When do we see Metastatic calcification?
■ Hyperparathyroidism
■ Vitamin D toxicity
■ Chronic renal failure
calcium stones in gall bladder, kidney, and bladder are due to precipitation of salts from solution into tissues.
Have expansile growth and compress the normal surrounding tissue WITHOUT infiltration or invasion
Benign tumors
Characteristics of Benign Tumors
○ Histologically, composed of cells that resemble the tissue from which they have arisen
○ Cells are composed of a uniform population in which all the cells have the same features
■ Regularly shaped round or oval nuclei
■ All the same size with evenly distributed chromatin and normal nuclei
■ Well-developed cytoplasm
Histologically show prominent anaplasia
Malignant tumors
Spread of malignant cells occurs through three main pathways:
○ Lymphatics
○ Bloodstream
○ Direct extension of the primary tumor
A cancer that loves to spread through Lymphatics
Breast
A cancer that loves to spread through the Bloodstream
Many, Not sure which one’s best.
A cancer that loves to spread through Direct extension of the primary tumor
■ Usually by seeding of the surface of the body cavities
■ Renal cell carcinoma seeding to the adrenal
Tumors derived from the 3 germ cell layers are called:
○ Teratomas (benign)
○ Teratocarcinomas (malignant)
Not all tumors that end in “-oma” are benign, and the most important examples are?
○ Lymphomas
○ Melanomas
○ Astrocytomas
○ Seminomas
Malignant tumors of epithelial origin are called
carcinomas
eg..
○ Squamous cell carcinoma
○ Adenocarcinoma
○ Transitional cell carcinoma
The names for malignant tumors of connective tissue origin are coined from the root of the cell type and suffix
sarcoma
Malignant tumors composed of embryonic tissue are called.
Blastomas
e.g…
○ Retinoblastoma
○ Neuroblastoma
○ Medulloblastoma
What are the three grades of malignancy
○ Grade I: well-differentiated
○ Grade II: moderately differentiated
○ Grade III: poorly or undifferentiated
TMN Criteria takes into account…
○ Tumor size
○ Lymph node status
○ Distant Metastasis
What cancer(s) do Nitrosamine cause?
■ GI Tract cancers (especially esophageal and stomach cancers)
■ Nitrates (preservatives) may react with other dietary components to form nitrosamines
What cancer(s) do Polycyclic Aromatic Hydrocarbons cause?
○ lung cancer
○ skin, soft tissue, and breast cancers
○ angiosarcoma of the liver
dibenzanthracene cause cancer in…
implicated in skin, soft tissue, and breast cancers
Vinyl Chloride (plastics) implicated in cancer of?
angiosarcoma of the liver
Nature of Aflatoxin B1
■ Natural product of aspergillus flavus, among the most potent liver carcinogen
■ Contaminates produce in Africa and Asia
Effect of Aromatic Amines (Naphthylamina/ Azo Dyes)
■ Indirect action on urinary bladder and liver tumors
● Liver: due to metabolism
● Bladder: hydrolysis to hydroxylamine causing cancer
Effects of UV Light
● Enzyme activation ● Inhibition of cell division ● Mutagenesis ● Cell death ● Cancer (skin)
Most important effect of UV light is
Formation of pyrimidine dimers of DNA, not seen in any other carcinogen
Asbestos causes?
■ Mesothelioma
HPV virus causes?
■ DNA virus that induces lesions that progress to squamous cell carcinoma in the:
● Cervix
● Oropharynx
● Penis
● Anus
● VaginaHepatitis B causes?
development of hepatocellular carcinoma
Epstein-Barr Virus causes?
Causes Burkitt’s Lymphoma and Nasopharyngeal Carcinoma
● Burkitt’s in African children
● Nasopharyngeal in Africa and Asia
Human Herpesvirus 8 causes?
Kaposi Sarcoma which is a vascular neoplasm associated with AIDS patients
Mutated normal cellular genes (proto-oncogenes) that normally encode for proteins important to basic cell function regulating growth and differentiation
Oncogens
Proto-oncogenes are transformed into oncogenes by four basic mechanisms:
● Point mutations:
● Gene amplification:
● Chromosomal rearrangements:
● Insertion of the viral genome:
Two best known Tumor Suppressor Genes
retinoblastoma gene 1 (Rb-1) and p53
What is Barrett’s esophagus?
■ Glandular cell metaplasia in esophagus
■ Benign tumor of epithelial origin:
papilloma
■ Benign tumor of connective tissue
name of tissue “-oma”
■ Benign tumor of glandular:
adenoma
■ Malignant tumor of epithelial origin
Carcinoma
■ Malignant tumor of glandular origin
adenocarcinoma
■ Malignant tumor of connective tissue:
Sarcoma
■ Malignant tumor of placental origin:
Blastoma
The five exception to the benign “-oma” rule
■ Seminomas, lymphomas, mesothelioma, astrocytoma, melanoma
Differentiate necrosis from autolysis
○ Necrosis is in living cells, autolysis occurs after death
Who does the grading vs. who does the staging?
○ Pathologist→ grading
○ Oncologist→ staging
● Japan and Latin America (Chile), also Ireland
● 10x higher in these countries than in US
■ Stomach Cancer:
● Highest incidence in US (3-4x more common)
● High fiber diet in India, Japan, Africa, and Latin America decreases risk (US has high fat diet)
■ Colorectal Cancer:
