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Block 4 Found Sci > VII- Neoplasia > Flashcards

VII- Neoplasia Flashcards

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1
Q

definition of neoplasm

A

clonal proliferation of cells that is uncontrolled and excessive
-irreversible change in cell type (metaplasia) and structure (dysplasia)
-benign or malignant

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2
Q

two components of neoplasm

A
  1. parenchyma - the monoclonal neplatic cells themselves, decides biological behavior of tumor
  2. stroma - CT/blood vessels/macrophages/lymphocytes that determine growth, spread, and mass consistency
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3
Q

hard mass = what stroma

A

abundant collagenous stroma

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4
Q

soft mass = what stroma

A

scant stroma
-tumor soft and fleshy

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5
Q

if benign @ epithelial tissue

A

ademoma
papilloma - finger like projections

if cavity or cyst then cystadenoma

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6
Q

features of benign tumors

A
  1. slow growth
  2. capsule present
  3. non invasive, non metastatic
  4. well differentiated
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7
Q

tumor-like conditions

A
  1. choristoma
  2. hamartoma
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8
Q

monoclonality of tumors

A

ALL TUMORS ARE MONOCLONAL so og from single precursor cell
-both benign and malignant

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9
Q

rubbery mass = what stroma

A

b/t soft and hard stroma status

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10
Q

if malignant @ epithelial tissue

A

carcinoma

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11
Q

if benign @ mesenchymal tissue

A

add -oma suffix

EXCEPTIONS: melanoma, lymphoma, seminoma, hepatoma, astrocytoma

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12
Q

if malignant @mesenchymal tissue

A

add -sarcoma suffix

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13
Q

polyp definition

A

club shaped growth projecting from mucosal surface into lumen of hollow viscus/organ
-bengin epithelial or hyperplasia

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14
Q

hematopoietic cell tumors

A

leukemia
-malignant from bone marrow stem cells
-CLL common for adults and ALL for peds

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15
Q

teratoma definition

A

tumor of 1+ parenchymal cell type so from more than one germ layer
-BUT all cells arise from single clone that can produce multi cell types

i.e. totipotent cells in gonads

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16
Q

non neoplastic lesions with -oma

A

granuloma
hematoma
choristoma

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17
Q

features of malignant tumors

A
  1. rapid growth
  2. no capsule
  3. invasive and metastatic potential
  4. range from well differentiated to poorly
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18
Q

features of sarcomas

A
  1. mesenchymal origin
  2. less common incidence vs carcinoma
  3. hematogenous initial spread
  4. poor prognosis
  5. early presentation

i.e. leiomyosarcoma (smooth m) or rhabdomyoSA (striated m)

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19
Q

features of carcinomas

A
  1. epithelial cell orgin
  2. more common than sarcomas
  3. lymphatic spread initially
  4. better prognosis
  5. late presentation

i.e. squamous cell CA, adenocarcinoma

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20
Q

carcinomas that spread hematogenously

exceptions to normal

A
  1. follicular CA of thyroid
  2. choriocarcinoma
  3. renal cell CA - invades renal vein
  4. hepatocellular CA invades hepatic vein

Four Carcinomas Route Hematogenously

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21
Q

choristoma

A

ectopic rest of normal tissue OR normal tissue in foreign location

ex. pancreatic tissue in mucosa of stomach

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22
Q

hamartoma def

A

disorganized benign mass of indigenous cells to invovled site
-developmental malformation

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23
Q

peutz-jeghers syndrome

A

hereditary intestinal polyposis syndrome aka autosomal dom
-polyps in GI tract and hyperpigmented macules @ lips and oral mucosa

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24
Q

determining B cell clonality

A

by Ig light chain phenotype

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25
Q

determining clonality of other cells

A
  1. glucose 6 phosphate dehydrogenase isoforms
  2. androgen receptor isoforms
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26
Q

pro-angiogenic factors

A
  1. VEGF
  2. bFGF
  3. HIF

-all are direct, indirect are Ras and myc by promoting

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27
Q

anti-angiogenic factors

A
  1. thrombospondin-1
  2. angiostatin
  3. endostatin
  4. tumstatin
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28
Q

rate of growth malignant

A

-rapid growth cancers highly susceptible to chemo

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29
Q

differentiation benign

A

-well differentiated bc only 1-10% are in cell cycle
-usually resemble normal mature cells/tissue

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30
Q

differentiation malignant

A

20-80% are in cell cycle so the rest of cells can differentiate varying
-may not resemble normal tissues

anaplasia (no resemblence to normal tissue) hallmark of high grade malignant tumor

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31
Q

indicators of tumor cell growth

A
  1. Ki-67
  2. PCNA
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32
Q

significance of mitotic figures

A

the more abnormal the mitotic figures (not metaphase, anaphase, prophase) the more likely malignancy

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33
Q

desmoplasia examples

A
  1. diffuse stomach cancer linitis plastica
  2. breast cancer
  3. prostate cancer
  4. cholangiocarcinoma
34
Q

desmoplasia definitions

A

hyperplasia of activated fibroblasts + production of abundant collagen in stroma

35
Q

recognizing cellular atypia

A
  1. cellular pleomorphism - vary in size and shape
  2. nuclear changes/pleomorphism
  3. inc ratio of nucleus:cytoplasm (1:1 instead of normal 1:5)
36
Q

atypia definition

A

structural abnormality in a cell
-only in premalignant conditions and malignant tumors

37
Q

cellular polarity

A

spatial diffs in shape, structure, function of cells
-if lost then can’t tell up from down of cell

38
Q

P53 normally

A
  1. inhibits VEGF
  2. promotes thrombospondin-1
39
Q

recognizing cellular atypia

A
  1. cellular pleomorphism - vary in size and shape
  2. nuclear changes/pleomorphism
  3. inc ratio of nucleus:cytoplasm (1:1 instead of normal 1:5)
40
Q

role of invasion benign

A

tumors cells stay attached by adhesion molecules like E. cadherin

41
Q

steps of invasion

A
  1. detachment of tumor cells from each other bc no E-cadherin
  2. attachment to matrix by laminin
  3. degradation of ECM by tumor cells, fibroblasts, inflamm cells, collagenase/MMP for type IV BM collagen
  4. migration of tumor cells by binding fibronectin and secreting motility factor
42
Q

metastatic cascade

A
  1. invasion of BM
  2. movement thru ECM
  3. vascular dissemination
  4. homing
43
Q

role of metastasis malignant

A

unequivocally marks a tumor malignant
-CD44 !!! favors metastasis

44
Q

tumor grading mechanisms

A
  1. conventional - degree of differentiation with H and E stain, mitotic index
  2. uptake of BrdU - higher uptake higher grade tumor
45
Q

TNM tumor staging

A

T = size of primary tumor
N = nodal involvement
M = distant metaastases

46
Q

cancer incidence

A

2 cause of death (heart dz is 1)

  1. prostate or breast
  2. lung
  3. colon
47
Q

primary tumors that metastasis to brain

A

LUBMECK
-lung > breast > melanoma/colon/kidney

48
Q

primary tumors that metastasis to liver

A
  1. colon
  2. stomach
  3. pancreas
49
Q

primary tumors that metastasis to bone

A
  1. prostate (blastic) and breast (mixed)
  2. lung, thyroid, kidney (all lytic)
50
Q

4 grades

A
  1. well differentiated
  2. moderately
  3. poorly
  4. nearly aplastic
51
Q

cervical dysplasia grading

A
  1. mild - confined to basal 1/3 of epi
  2. moderate- confined to basal 2/3 of epi
  3. severe - more than 2/3 but less than 3/3
  4. carcinoma in situ - full thickness dysplasia
52
Q

4 common acquired pre-cancerous conditions

A
  1. oral leukoplakia
  2. barret esophagus
  3. chornic ulcerative colitis
  4. hep B and C
53
Q

gene translocation CML

A

abl from 9 > bcr on 22
bcr-abl hybrid inc tyrosine kinase activity
-philadelphia chromosome

54
Q

gene translocation Burkitt lymphoma

A

c-myc from 8 > Ig heavy chain on 14
-inc myc protein

55
Q

gene translocation follicular B cell lymphoma

A

14 > 18

BCL-2 genes prevent mitochondrial leakage of cytochrome c (so no apoptosis)

56
Q

BRAF oncogene

A

inc serine/threonine kinase
-non hodgkin lymphoma, melanoma

57
Q

oral leukoplakia

A

starts as hyperlasia/hyperkeratosis
leads to mild-severe dysplasia
ends with squamous cell carcinoma

58
Q

Barretts esophagus progression

A

glandular metaplasia in lower esophagus > dysplasia > adeoCA of esophagus

59
Q

chronic ulcerative colitis progression

A

to dysplasia then adenoCa of colon

60
Q

hepatitis infection progression

A
  1. B or C
  2. macronodular cirrhosis
  3. hepatocellular carcinoma
61
Q

HER2 oncogene

A

inc receptor tyrosine kinase
-breast and gastric carcinoma

62
Q

MYC- L1 oncogene

A

inc transcription
-lung tumors

63
Q

N-MYC oncogene

A

inc transcription
-neuroblatomas

64
Q

RET oncogene

A

inc receptor tyrosine kinase
-medullary thyroid cancer

65
Q

APC

A

colorectal cancer
-normally downregs B-catenin to prevent accumulation
-pathologic by WNT signalling

66
Q

p53

A

most human cancers
-activates p21 to block G1 to S phase so apoptosis by BAX
-also inhibited by E6 and E7 from HPV

67
Q

VHL

A

von hippel lindau dz aka renal carcinomas + hemangioblastomas (benign), renal cysts
-normally tumor suppressor gene that inhibits HIF-1a

68
Q

RB

A

retinoblastomas, osteosarcoma, soft tissue sarcoma
-blocks G1 to S phase
-both alleles inactivated for cancer

69
Q

telomerase role in cancer

A

telomere shortening and loss of function can activate p53
-expression can be inc by E6

70
Q

psammoma body

A
  1. papillary thyroid carcinoma
  2. papillary renal cell carcinoma
  3. serous papillary cystadenocarcinoma ovary
  4. meningioma
  5. malignant mesothlioma

concentric spherules with calcification

71
Q

two steps of chemical carcinogenesis

A
  1. initiation by chemicals, perm DNA damage irreversible
  2. promotion - induces tumors but not affect DNA itself

chems can be direct without transformation or indirection need metabolism

72
Q

UVB and skin cancer

A

UVB causes DNA damage from pyrimidine dimers
-if defective repair enzymes then esp susceptible

73
Q

viral carcinogens

A
  1. HBV encodes HBx that activates growth promoting genes and inhibits p53, also chronic liver injury regen hyperplasia
  2. HCV gives chronic liver cell injury and regen
  3. EBV = burkitts, hodgkin, nasopharyngeal
  4. HPV 16, 18, 31
  5. HTLV1 via tax gene
  6. HIV
  7. HHV-8 kaposi sarcoma
74
Q

bacterial carcinogens

A

H pylori via CagA cytotoxin
-gastric lymphoma MALT, gastric carcinoma

75
Q

key paraneoplastic syndromes

A
  1. cushing syndrome - ACTH, small cell lung carcinoma
  2. SIADH - ADH, small cell lun carcinoma
  3. polycythemia- EPO, renal cell carcinoma, hepatocellular carcinoma, leiomyoma
  4. hypercalcemia - PTHrP, squamous cell carcinoma lung/head/neck
76
Q

IHC markers

A
  1. thyroglobulin = thyroid cancer
  2. CD10/CALLA = acute lymphobalstic leukemia
  3. placental alkaline phosphatase = seminoma
  4. vWF, CD31 = vascular neoplasms
77
Q

epithelial cell markers

A

cytokeratin or keratin or epithelial membrane antigen (EMA)

78
Q

hormonal carcinogens

A

estogren
contraceptive hormones
anabolic steroids

79
Q

mesenchymal origin markers

A

vimentin or desmin or muscle specific actin

80
Q

neuronal tumor origin markers

A

neuron specific enolase NSE
chromogranin
synaptophysin

NSE also stains for small cell carcinoma lung and carcinoids

Block 4 Found Sci (67 decks)

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