WK5 - Pathology of Neoplasia

Question 1

What is a tumor?

Answer 1

= swelling or lump

= neoplasm

Question 2

What is neoplasm?

Answer 2

• abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the adjacent normal tissues
• the mass persists in the same excessive manner even after the stimulus or cause is removed
• neoplasms are named according to the type of normal tissue they most closely resemble
• neoplasm may be benign or malignant

Question 3

What is cancer?

Answer 3

• generic term for malignant neoplasms of all types
• cancers of different organs are different diseases
• they have a different etiology, pathology, clinical behavior and treatment
• cancers that spreads from one organ to another (metastasis) retains the biological characteristics of its primary cancer

Question 4

What is hypertrophy?

Answer 4

• an increase in the size of cells within an organ
• occurs in response to a stimulus
• when the stimulus is removed, the cells return to normal size
  Ex. bodybuilding

Question 5

What is hyperplasia?

Answer 5

• refers to an abnormal increase in cellular quantity
• hyperplastic growth in cell number usually results in organ enlargement or (benign) tumor formation
• may be due to a number of causes such as increased stress, chronic inflammatory response, or compensation for damage, etc.

Question 6

What is dysplasia?

Answer 6

• a pre-malignant change in cells (usually epithelium) characterized by disordered growth and morphologic changes in the cell nucleus

Question 7

Is there a difference between hyperplasia and dysplasia?

Answer 7

• hyperplasia cells are normal and usually benign

- dysplasia cells are not normal and are pre-cancer

Question 8

What is high grade dysplasia?

Answer 8

• synonymous with carcinoma-in-situ
• high-grade dysplasia has most of the cellular morphologic changes of cancer cells but is not invasive and cannot therefore metastasize
• by molecular analysis high-grade dysplasia has fewer mutations than invasive cancer

Question 9

What is atrophy?

Answer 9

• a reduction in either the size of cells or the number of cells within an organ
• this process is reversible when it represents part of a response to an external stimulus or it can be part of the normal aging process

Question 10

Is hypertrophy identical to hyperplasia?

Answer 10

hypertrophy is increase in size of cells within an organ while hyperplasia is increase in number of cells within an organ

Question 11

What is the composition of neoplasm?

Answer 11

1. proliferating neoplastic cells that consitute the parenchyma
2. supportive stroma made up of connective tissue and blood vessels. the stroma is not neoplastic. it is derived from normal host tissues that the tumor recruits for its own use
3. when large quantities of fibrous tissue are present in the supporting stroma the tumor is said to be scirrhous or desmoplastic and clinically the tumor is firm and shrunken

Question 12

Describe benign neoplasm.

Answer 12

• slow growing
• usually circumscribed
• a mass that pushes aside adjacent tissues
• does not infiltrate adjacent tissues
• do not metastasize
• histologically resemble the tissue of origin
• good prognosis
• can be cured by surgical removal
• can be a precursor for malignant neoplasm

Question 13

Describe malignant neoplasm.

Answer 13

• grow rapidly
• poorly circumscribed
• infiltrate and destroy adjacent tissues
• metastasize
• histologically may poorly resemble tissue of origin
• often fatal
• surgically cured only in the early stages

Question 14

How does malignant neoplasm grow/spread?

Answer 14

• direct: may infiltrate and destroy immediately adjacent structures
• lymphatic: invades lymphatics with spread to regional lymph nodes and beyond
• blood vessels: invades veins and spreads initially to lungs or liver then to more distant sites
• serosal surfaces: may spread across the pleura, pericardium or peritoneum

Question 15

What is differentiation referring to for neoplasms? How are they graded?

Answer 15

• refers to the extent to which the cells of a neoplasm resemble normal cells both morphologically and functionally
• Usually three grades recognized:
  1 = well differentiated (low-grade)
  2 = moderately differentiated (low-grade)
  3 = poorly differentiated (high-grade)

Question 16

How are neoplasms classified?

Answer 16

as a rule neoplasms are named for the type of normal tissue they most closely resemble:

• epithelial
• connective tissue (bone and soft tissue)
• lymphoid and hematopoietic
• CNS tumors (gliomas)
• germ cell tumors
• melanoma

Question 17

Name the following (benign and malignant) epithelial neoplasm:
squamous

Answer 17

benign: squamous papilloma
malignant: squamous cell carcinoma

Question 18

Name the following (benign and malignant) epithelial neoplasm:
glandular

Answer 18

benign: adenoma
malignant: adenocarcinoma

Question 19

Name the following (benign and malignant) epithelial neoplasm:
transitional

Answer 19

benign: transitional papilloma
malignant: transitional cell carcinoma

Question 20

Name the following (benign and malignant) epithelial neoplasm:
liver

Answer 20

benign: adenoma
malignant: hepatocellular carcinoma

Question 21

Name the following (benign and malignant) epithelial neoplasm:
skin

Answer 21

benign:
- papilloma
- nevus
malignant:
- squamous cell carcinoma
- melanoma
- basal cell carcinoma

Question 22

Name the following (benign and malignant) mesenchymal neoplasm:
bone

Answer 22

benign:
- osteoma
malignant:
- oasteosarcoma

Question 23

Name the following (benign and malignant) mesenchymal neoplasm:
fat

Answer 23

benign:
- lipoma
malignant:
- liposarcoma

Question 24

Name the following (benign and malignant) mesenchymal neoplasm:
cartilage

Answer 24

benign:
- chondroma
malignant:
- chondrosarcoma

Question 25

Name the following (benign and malignant) mesenchymal neoplasm:
smooth muscle

Answer 25

benign:
- leiomyoma
malignant:
- leiomyosarcoma

Question 26

Name the following (benign and malignant) mesenchymal neoplasm:
‘striped’ muscle

Answer 26

benign:
- rhabdomyoma
malignant:
- rhabdomyosarcoma

Question 27

Name the following (benign and malignant) mesenchymal neoplasm:
vessels

Answer 27

benign:
- angioma
malignant:
- angoisarcoma

Question 28

Name the following (benign and malignant) mesenchymal neoplasm:
fibrous tissue

Answer 28

benign:
- fibroma
malignant:
- fibrosarcoma

Question 29

Name the following hemopoietic/lymphoid neoplasm:

lymphocytes

Answer 29

malignant:

• lymphoma
• Hodgkin’s disease
• Non-Hodgkin’s disease

Question 30

Name the following (benign and malignant) hemopoietic/lymphoid neoplasm:
granulocyte

Answer 30

malignant:

- myeloid leukemia

Question 31

Name the following (benign and malignant) hemopoietic/lymphoid neoplasm:
marrow lymphocytes

Answer 31

malignant:

- lymphocytic lymphoma

Question 32

Name the following (benign and malignant) hemopoietic/lymphoid neoplasm:
plasma cells

Answer 32

malignant:

- multiple myeloma

Question 33

What is the role of apoptosis in cancer prevention?

Answer 33

cells that have undergone damage to their DNA may be eliminated by apoptosis before they can grow and form neoplasms

Question 34

What is the role of apoptosis in cancer progression?

Answer 34

• in some cancers the gene bcl-2 is upregulated and this reduces apoptosis and promotes tumor growth
• in other cancers the gene bax may be upregulated and this promotes apoptosis and may slow cancer growth

Question 35

How are tumors staged?

Answer 35

• staging of cancers is based on the size of the primary neoplasm, the extent of spread to regional nodes and the presence or absence of distal metastases
• TNM system and AJCC systems