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Fundamentals 3- Heme > Tumor Classification and Growth > Flashcards

Tumor Classification and Growth Flashcards

1
Q

What is a tumor be classic definition?

A

Swelling or mass that could be:

  1. cancer
  2. hematoma
  3. abscess
  4. benign neoplasm

It can also be defined as a malignancy that does not cause a mass or swelling like leukemia.

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2
Q

What is a neoplasm?

What is the most typical cause of a neoplasm?

A

New biological, cellular outgrowth that can be a cancer OR a benign, nonlethal process.

They are typically caused by somatic mutation (non-germline) that confer growth advantage

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3
Q

What is a precancer?

What is a prime example?

A

It is a microscopic neoplasm that does not yet form a tumor.
CIN (cervical intraepithelial neoplasia) is a prime example. It does not extend beyond the basement membrane so it is not a cancer, but it is neoplastic growth reminiscent of a precancer

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4
Q

What is a cancer/malignancy?

What are the two ways they can spread?

A

They are neoplasms where the cells have the ability to invade or metastasize.
Local spread = invasion
Systemic spread = metastasis

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5
Q

Neoplasms can show disequilibrium in cell growth in what two ways?
Which is more characteristic of malignant neoplasms?

A
  1. increased cell growth, decreased cell death
  2. EXCESSIVE cell growth, slight increase in cell death

Malignant neoplasms increase cell growth and increase cell death because apoptotic checkpoints can still work, but the growth outpaces the death

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6
Q

What does it mean to say that neoplasms demonstrate uncoordinated growth?

A

They no longer respond to normal physiological stimuli that limit cell growth like contact inhibition
.
The cells have partial or complete autonomous growth (not dictated by physiological signal).

Growth is abnormal as is the architectural features of the tissue

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7
Q

Describe normal endometrium. How would this change in neoplastic endometrium?

A

Normal- coiled glands in loose stroma

Neoplastic= irregular glands in dense stroma

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8
Q

What is hyperplasia?

A

It is the overgrowth of tissue in response to growth stimulus (pathological or physiological).

Growth occurs within the framework of normal regulatory mechanisms and stops when the stimulus is removed.

Coordinated and normal architecture

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9
Q

What is the difference between hyperplasia and neoplasia?

A

Neoplasms arise as a consequence of genetic mutation producing a clonal outgrowth of abnormal cells.

Hyperplasia is polyclonal- the cells outgrow in response to growth stimuli, but are genetically normal

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10
Q

What does it mean that hyperplasia provides fertile ground for the development of neoplasms?

A

Because hyperplasia increases the number of cells, the chance for genetic mutation in one of those cells is increased. This can provide a chance for one cell to mutate and start monoclonal growth.
Also, increased rate of mitosis makes the DNA more prone to error

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11
Q

What is an example of when a long-standing hyperplasia actually continues after removal of a growth stimulus?

A

tertiary hyperthryroidism

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12
Q

What is an example of a neoplasm that relies on growth stimuli or hormones?
If they are dependent on growth factors, why are they considered neoplasms instead of hyperplasia?

A

uterine leiomyomata (fibroids)- are estrogen dependent and shrink down at menopause

They are benign outgrowths that are considered true neoplasms because they are genetically modified via translocations

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13
Q

What is a metaplasia?

A

The conversion of one cell type to another specialized cell type in response to noxious stimulus

They are:

  1. Adaptive
  2. Reversible
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14
Q

What are 2 common examples of metaplasia?

A
  1. Squamous metaplasia of bronchial epithelium in smokers

2. Barrett’s esophagus- squamous to columnar (intestinal type cells) in chronic gastric reflux

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15
Q

What is dysplasia?

What are the two main types?

A

Deranged growth with abnormal cytoarchitecture and missarranged cells.

  1. Developmental - malformation leads to abnormal arrangement like retinal dysplasia
  2. Neoplastic- cervical intraepithelial neoplasia (CIN)
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16
Q

What are the three main characteristics of epithelial dysplasia?

A
  1. loss of normal progressive maturation sequence
  2. cellular atypia (atypical appearance of cells)
  3. loss of normal tissue organization
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17
Q

Epithelial dysplasias are NOT thought to produce __________ but are true __________ meaning that they are at increased risk of progressing to invasive cancers via _____________________.

A

NOT tumor producing but are true PRECANCERS that progress to malignant cancer through the acquisition of genetic alterations

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18
Q

What are the two grades of cervical intraepithelial neoplasia?
Describe the changes seen in each.
Which is likely to progress to cancer?

A
  1. Low grade Squamous Intraepithelial Lesion (LSIL) which has more variation in cell size and shape of nuclei but will likely regress on its own
  2. High grade Squamous Intraepithelial Lesion (HSIL) which still hasn’t crossed the basement membrane but has loss of maturation, nuclear heterogeneity and increased immune response. It has a high risk of progression to cancer.
19
Q

What is meant by carcinoma in situ?

A

Lesion that histologically cannot be distinguished from cancer cells but the cells have not trangressed beyond the tissue boundaries (still BM in tact)

20
Q

What are the two purposes of the Pap Smear?

A
  1. detecting all grades of dysplasia
  2. screening method because CIN won’t cause cancer if it remains within the tissue boundaries and can be extracted by surgery
21
Q

How are tumors categorized?

What are the four major types?

A

By histogenesis- the type of differentiation exhibited by the tumor cell.

  1. epithelial
  2. mesenchymal
  3. mixed tumor
  4. teratoma
22
Q

What are benign epithelial tumors derived from glandular epithelium called?

A

adenomas

23
Q

What is an adenoma?
How is it typically named?
Give 3 examples.

A

epithelial tumor derived from glandular epithelium. They are benign.
They are named for the tissue of origin:

  1. Renal cell adenoma
  2. liver cell adenoma
  3. thyroid adenoma
24
Q

What is an example of an adenoma that is not truly benign, but is rather a precancer?

A

Colon adenoma are not benign because they have mutations characteristic of a precancer

25
Q

How can adenomas of the ovaries be further categorized?

A

By appearance:

  1. Serous cystadenoma- filled with watery fluid
  2. Mucinous cystadenoma- filled with mucin
26
Q

What are papillomas?

What 3 types of adenoma are they frequently associated with?

A

benign epithelial tumors that have a common pattern of abnormal growth in surface epithelia lining ducts and cavities. They have complex branching.

  1. intraductal papillomas of the breast
  2. squamous cell papilloma of the skin (tags)
  3. transitional cell papilloma of the bladder
27
Q

What is a polyp?

What adenoma are they frequently associated with?

A

The result of abnormal surface epithelial growth that is less complex than a papilloma. They have a stalk and bulb.
These are common in colon adenomas.

28
Q

What is the benign tumor of a dermal melanocyte called?

A

Nevus or melanocytic nevus

29
Q

What are the two malignant “omas”?

A
  1. mesothelioma

2. hepatoma (short for hepatocellular carcinoma)

30
Q

What is the nomenclature of malignant epithelial tumors?
What is the modifier when it is in glandular epithelia?
What is the modifier when the tissue of origin is known?

A

Carcinomas.
If they are derived from glands, they are referred to as adenocarcinomas

When the tissue of origin is known, you can lose “adeno”
ex. renal cell carcinoma, hepatocellular carcinoma

31
Q

How would you name a non-glandular malignancy found in the:

  1. skin (two)
  2. bladder (two)
  3. trophoblasts of the placenta
A
  1. squamous cell carcinoma or basal cell carcinoma
  2. transitional cell carcinoma or papillary transitional cell carcinoma
  3. choriocarcinoma
32
Q 
What is the nomenclature for benign mesenchymal tumors?
What would be the name for:
1. fibroblast 
2. fat
3. cartilage
4. bone
5. blood vessel
6. lymphatics
7. smooth muscle
8. skeletal muscle
9. meninges
A

The name of the cell/tissue of origin followed by “oma”.

  1. fibroma
  2. lipoma
  3. chondroma
  4. osteoma
  5. hemangioma
  6. lymphangioma
  7. leiomyoma
  8. rhabdomyoma
  9. meningoma
33
Q

What is the nomenclature for malignant mesenchymal tumors?

A

Cell/tissue of origin followed by “sarcoma”

34
Q

What 4 malignant mesenchymal tumors do not follow the “sarcoma” nomenclature?

A
  1. Malignant Schwannoma (in peripheral nerves)
  2. Leukemia- tumor of WBCs with circulating neoplastic cells
  3. Lymphoma- tumor of WBCs with masses in lymph nodes
  4. Invasive meningioma- aggressive version of a benign meningioma
35
Q

What three tumors do not fall in the “epithelial” or “mesenchymal” category?

A
  1. Seminoma- malignant in germ cells of testes
  2. Melanoma- malignant in dermal melanocytes
  3. Carcinoid tumor- neuroendocrine cells in gut, prostate and lungs
36
Q

What are tumors consisting of more than one neoplastic cell type calleD?

A

Mixed tumors. If two neoplastic cell types predominate, they are called biphasic.

37
Q

What cells typically make up a monophasic tumor? How does a monophasic tumor differ from a biphasic or mixed tumor?

A

Monophasic have the neoplastic cell, stroma, blood vessels, cells from the immune system, etc. Only one cell type, however, is neoplastic.

Biphasic and mixed tumors have atleast 2 types of neoplastic cells, stroma, blood vessels, cells of the immune system etc.

38
Q

What are two examples of tumors that have more than one neoplastic cell that are benign?

A
  1. Pleomorphic adenoma of salivary glands (epithelial and stromal neoplasms)
  2. Fibroadenoma- epithelial and stromal neoplasms
39
Q

What are 4 examples of mixed tumors that are malignant?

A
  1. malignant mixed tumor of the salivary gland
  2. Wilms tumor- children kidneys with epithelial and mesenchymal neoplasms
  3. Mixed Mullerian tumor- uterine
  4. Cystosarcoma phyllodes- malignant fibroadenoma of the breast
40
Q

What is it called when a tumor arises from more than one germ layer?
What 3 tissue types generally give rise to these tumors?

A

Teratomas- can arise from totipotent (ES) or multipotent (adult SC) germ cell lineages

  1. Gonads
  2. Mediastinum
  3. Brain
    (2 and 3 are because of aberrant migration during embryogenesis)
41
Q

What are examples of benign and malignant teratomas?

A

Benign:

  1. Mature teratoma
  2. Dermoid cyst- keritanous debris in the tumor from desquamating squamous epithelium (you can see teeth, hair, cartilage etc in the tumor)

Malignant:
1. Immature teratoma

42
Q

What is a hamartoma?
What does it consist of?
Give an example.

A

Malformation that resembles a neoplasm but actually results from focal maldevelopment of the organ.
Consists of tissue normally found at that site.
Ex. pulmonary hamartoma is cartilage and bronchial epithelium. NOT a neoplasm, but a maldevelopment

43
Q

What is a choristoma?

A

Tumor formed by maldeveloped tissue (not neoplasm) that is composed of components not normally found at that site.
AKA heterotopic rest
Ex. adrenal rest- adrenal tissue found in kidney or ovary

44
Q

What is the different between a hamartoma and choristoma?

A

they both are benign tumors derived from maldevelopment and NOT neoplasm.
Hamartoma- tissue that is from the same site (ex. pulmonary where there is bronchial epithelium malformation)
Choristoma- tissue from a different site (ex. adrenal rest where adrenal tissue is in the kidney or ovaries)

Fundamentals 3- Heme (19 decks)

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