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Pathology
FA complete review Neoplasia Part 2
| Question | Answer |
|---|---|
| Uncontrolled, clonal proliferation of cells | Neoplasia |
| What are hallmarks of cancer? | 1. Evasion of apoptosis 2. Growth signal self-sufficiency, 3. Anti-growth signal insensitivity, 4. Warburg effect, 5. Sustained angiogénesis 6. Limitless replicate potential 7. Tissue evasion 8. Metastasis |
| What is Warburg effect? | Shift of glucose metabolism away from mitochondria toward glycolysis. |
| What is the polarity of normal cells? | Apical |
| What is carcinoma in situ? | Irreversible severe dysplasia that involves the entire thickness of epithelium but does not penetrate the intact basement membrane. |
| What is another term of carcinoma in situ? | Preinvasive |
| Definition of invasive carcinoma | Cells have invaded basement membrane using collagenases and hydrolases |
| Cell-cell contacts lost by inactivation of E-cadherin | Invasive carcinoma |
| What are the means of transport of metastasis? | Lymphatics or blood |
| A carcinoma implies _______________ origin. | Epithelial |
| A sarcoma denotes ______________ origin. | Mesenchymal |
| Description of benign tumors: | Well differentiated, well demarcated, low mitotic activity, no metastasis, and no necrosis. |
| Malignant tumors may show: | Poor differentiation, erratic growth, local invasion, metastasi, and decreased apoptosis. |
| What are terms of non-neoplastic malformation? | Hamartoma and choristoma |
| Disorganized overgrowth of tissues in their native location | Hamartoma |
| What is Choristoma? | Normal tissue in foreign location |
| What would be an example of choristoma? | Gastric tissue in distal ileum in Meckel diverticulum |
| What is malignant tumor of blood cells? | Leukemia, and lymphoma |
| What is benign tumor of smooth muscle? | Leiomyoma |
| What is the common benign melanocytic tumor? | Nevus/mole |
| What is differentiation? | Degree to which a tumor resembles its tissue of origin |
| What is the definition of Anaplasia? | Complete lack of differentiation of cells in a malignant neoplasm |
| Well-differentiated tumors are ________ aggressive. | Less |
| What is meant with grande in respect to tumor classification? | Degree of cellular differentiation and mitotic activity on histology. |
| Degree of localization/spread based on site and size of primary lesion, spread to regional lymph nodes, presence of metastases. | Stage |
| TNM staging system | T = Tumor size/invasiness N = Node involvement M = Metastases |
| Each TNM factor has ---> | Independent prognostic value |
| What are musculoskeletal and cutaneous paraneoplastic syndrome? | 1. Dermatomyositis 2. Acanthosis nigricans 3. Sign of Leser-Trélat 4. Hypertrophic osteoarthropathy |
| What are the associated tumors in Dermatomyositis? | Adenocarcinomas, especially ovarian |
| What are the most common associated tumors of Acanthosis nigricans? | Gastric adenocarcinoma and other visceral malignancies |
| Hypertrophic osteoarthropathy is seen with adenocarcinoma of the __________. | Lung |
| What is the description Hypertrophic osteoarthropathy? | Abnormal proliferation of skin and bone at distal extremities --> clubbing, arthralgia, joint effusions, periostosis of tubular bones. |
| Small cell lung cancer is associated with which Paraneoplastic syndromes? | Cushing syndrome and Hyponatremia (SIADH) |
| What are some common hematologic paraneoplastic syndromes? | Polycythemia, Pure red cell aplasia Good syndrome Trousseau syndrome Nonbacterial thrombotic (marantic) endocarditis |
| Thymoma is associated with which hematologic conditions? | Pure red cell aplasia and Good syndrome |
| What is the "Good syndrome" most significant clinical feature? | Hypogammaglobulinemia |
| Trousseau syndrome is most associated with ____________ (tumor). | Pancreatic adenocarcinoma |
| Associated tumors that produce Polycythemia | Pheochromocytoma, Renal cell carcinoma, HCC, Hemangioblastoma, and Leiomyoma. |
| List of Neuromuscular Paraneoplastic syndromes: | 1. Anti-NMDA receptor encephalitis 2. Opsoclonus-myoclonus ataxia syndrome 3. Paraneoplastic cerebellar degeneration 4. Paraneoplastic encephalomyelitis 5. Lambert-Eaton myasthenic syndrome 6. Myasthenia gravis |
| What neuromuscular paraneoplastic syndrome is associated with Thymoma? | Myasthenia gravis |
| Lambert-Eaton Myasthenic syndrome is associated with which tumor? | Small cell lung cancer |
| Antibodies against presynaptic Ca2+ channels at NMJ. Dx? | Lambert-Eaton Myasthenic syndrome |
| What is the cause of Myasthenia gravis? | Antibodies against postsynaptic ACh receptors at NMJ |
| What condition affects the PREsynaptic calcium channels at NMJ? | Lambert-Eaton Myasthenic syndrome |
| Which condition is seen with antibodies attacking the POSTsynaptic ACh receptors? | Myasthenia gravis |
| "Dancing eyes, dancing feet". Dx? | Opsoclonus-myoclonus ataxia syndrome |
| Which are the tumors associated with the development of Opsoclonus-myoclonus ataxia syndrome? | Neuroblastoma in children and Small cell lung cancer in adults |
| Antibodies against antigens in Purkinje cells. Dx? | Paraneoplastic cerebellar degeneration |
| What are the associated tumors of Paraneoplastic cerebellar degeneration? | 1. Small cell lung cancer (anti-Hu) 2. Gynecologic and breast cancers (anti-Yo) 3. Hodgkin lymphoma (anti-Tr) |
| Anti-Hu, anti-Yo, and anti-Tr. | Markers of tumors seen in the development of Paraneoplastic cerebellar degeneration |
| Ovarian teratoma often causes what neuromuscular paraneoplastic syndrome? | Anti-NMDA receptor encephalitis |
| List of Paraneoplastic syndromes associated with Small cell lung cancer: | 1. Hypertrophic osteoarthropathy 2. Cushing syndrome 3. SIADH 4. Opsonus-myoclonus ataxia syndrome 5. Paraneoplastic cerebellar degeneration 6. Paraneoplastic encephalomyelitis 7. Lambert-Eaton Myasthenic syndrome |
| Clinical signs include: Psychiatric disturbances, memory deficits, seizures, dyskinesias, autonomic instability, and language dysfunction. Associated with Ovarian tumor. Dx? | Anti-NMDA receptor encephalitis |
| Which are some of the tumors or neoplasms that produce Hypercalcemia (due to increased PTHrP) as Paraneoplastic syndrome? | 1. Squamous cell carcinoma of lung, head, and neck 2. Renal, bladder, breast, and ovarian carcinomas |
| EBV associated cancers: | 1. Burkitt lymphoma 2. Hodgkin lymphoma 3. Nasopharyngeal carcinoma 4. Primary CNS lymphoma (immunocompromised) |
| Burkitt lymphoma is often see with what kind of infectious agent? | EBV |
| What does Burkitt lymphoma, Nasopharyngeal carcinoma, and Primary CNS lymphoma have in common? | Associated with EBV infection |
| Which hepatitis infections are associated with HCC? | HBV and HCV |
| Associated cancer of HHV-8 infection? | Kaposi sarcoma |
| HPV ----> associated cancers? | Cervical and penile/anal cancers (types 16,18), head and neck cancer. |
| What infection is often associated to Gastric adenocarcinoma? | H. pylori |
| H. pylori infection is associated with which tumors? | Gastric adenocarcinoma and MALT lymphoma |
| HTLV-1 infections ----> Tumor? | Adult T-cell leukemia/lymphoma |
| What microbe is associated with Cholangiocarcinoma? | Liver fluke (Clonorchis sinensis) |
| Squamous bladder cancer is often described with preceding infection of: | Schistosoma haematobium |
| Aflatoxin exposure examples: | Stored in grains and nuts |
| What is the associated carcinoma of Aflatoxin exposure? | Hepatocellular carcinoma |
| What are examples of aromatic amine exposure? | 1. Textile industry (dyes) 2. Cigarette smoke (2-naphthylamine) |
| Aromatic amines cause ______________ cancer. | Bladder cancer |
| What kind of bladder cancer is seen with exposure to industrial textile dyes? | Transitional cell carcinoma of the bladder |
| Benzidine and 2-naphthylamine are examples of : | Aromatic amines |
| What are common Arsenic exposures examples? | Herbicides (vineyard workers), and metal smelting |
| Arsenic exposure causes damage to which organs? | Liver, Lung, and Skin |
| Associated cancer of arsenic exposures and affection to the liver | Angiosarcoma |
| Person with arsenic exposure. What is the cutaneous cancer association? | Squamous cell carcinoma of the skin |
| Which jobs are often associated with Asbestos exposure? | 1. Old roofing material 2. Shipyard workers |
| What organ is mostly affected by Asbestos exposure? | Lung |
| Which cancer is most common in Asbestos exposures? | Bronchogenic carcinoma |
| What are the two associated tumors/cancers with Asbestos exposure? | Bronchogenic carcinoma>>>> Mesothelioma |
| What type of bladder cancer is due to cigarette smoking? | Transitional cell carcinoma |
| Which are the associated cancers of the lung due to cigarette smoking? | Squamous cell and Small cell carcinoma |
| Cigarette smoking may cause what kidney cancer? | Renal cell carcinoma |
| What is the neoplastic manifestation of cigarette smoking and affection in the Esophagus? | Squamous cell carcinoma/adenocarcinoma |
| What organs are most affected by excessive ethanol consumption? | Esophagus and Liver |
| Ionization radiation to the Thyroid is associated with development of: | Papillary thyroid cancer |
| What is an important risk factor for development of Papillary thyroid carcinoma? | Ionizing radiation |
| What kind of toxin is presented with smoked foods? | Nitrosamines |
| Nitrosamine consumption is associated with ____________ cancer. | Gastric |
| What is the neoplastic relevant toxin found in material used to make PVC pipes? | Vinyl chloride |
| What kind of worker/job is most likely to be in exposures with Vinyl chloride (toxin)? | Plumber/plumbing |
| Vinyl chloride exposure affects the _____________ leading to development of __________________. | Liver ----> angiosarcoma |
| What are Psammoma bodies? | Laminated, concentric spherules with dystrophic calcification |
| What are conditions/cancers seen with Psammoma bodies? | Papillary carcinoma of thyroid Serous papillary cystadenocarcinoma of ovary Meningioma Malignant Mesothelioma |
| Why type of thyroid cancer is seen with Psammoma bodies? | Papillary carcinoma of thyroid |
| Which ovarian carcinoma is seen with Psammoma bodies? | Serous cystadenocarcinoma of ovary |
| Which type of asbestos-related cancer is seen with Psammoma bodies? | Malignant Mesothelioma |
| What is the most important/relevant histologic feature of Papillary thyroid carcinoma? | Psammoma bodies |
| What histological finding can further distinguish between Bronchogenic carcinoma and Mesothelioma? | Psammoma bodies in Mesothelioma |
| What should be the use of serum tumor markers? | Monitor tumor recurrence and response to therapy |
| What is used to monitor tumor recurrence and response to therapy? | Levels of serum tumor markers |
| What procedure should be the one used for definitive diagnosis of cancer? | Biopsy |
| What the important associations of Alkaline Phosphatase? | 1. Metastases to bone or liver, 2. Paget disease of the bone 3. Seminoma (placental ALP) |
| What is the common abbreviation for Alkaline Phosphatase? | ALP |
| Elevated placental ALP is seen in __________________. | Seminoma |
| Elevation in sumru tumor marker, ALP, is seen with metastases to ___________ or _________. | Bone or liver |
| How can ALP be distinguished or separated from hepatic origin? | Exclusion of hepatic origin by checking LFTs and GGT levels |
| Why are LFTs and GGTs levels often measured in cases of elevated ALP? | To exclude is ALP is of liver origin. |
| List of associations seen with elevated a-Fetoprotein: | 1. Hepatocellular carcinoma 2. Endodermal sinus (yolk sac) tumor 3. Mixed germ cell tumor 4. Ataxia-telangiectasia 5. Neural tube defects |
| Low levels of AFP are seen with? | Down syndrome |
| What kind of defects are seen with high levels of AFP? | Neural tube and abdominal wall defects |
| Which endodermal sinus tumor is seen with elevated AFP? | Yolk sac tumor |
| Elevated B-hCG is seen with: | - Hydatiform moles -Choriocarcinomas - Testicular cancer - Mixed germ cell tumor |
| Which tissue normally produces B-hCG? | Syncytiotrophoblasts of the placenta |
| Tumor markers for Breast cancer: | CA 15-3/CA 27-29 |
| Tumor marker of Pancreatic adenocarcinoma? | CA 19-9 |
| CA 125, is an _________________ cancer serum tumor marker. | Ovarian |
| What serum marker is used in Ovarian cancer? | CA 125 |
| What is the most common serum marker used for Medullary thyroid cancer? | Calcitonin |
| Which syndromes are seen with elevated Calcitonin? | MEN2A and MEN2B |
| What are the two major associations of CEA? | Colorectal and Pancreatic cancers |
| What are minor associations of CEA tumor marker? | Gastric, breast, and medullary thyroid carcinomas |
| CEA is the abbreviation for: | Carcinoembryonic antigen |
| What type of tumors use Chromogranin as a serum tumor marker? | Neuroendocrine tumors |
| LDH is a serum tumor marker for which cancers? | Testicular germ cell tumors Ovarian dysgerminoma |
| PSA is seen elevated in _____________ cancer. | Prostate |
| LDH is elevated in which ovarian cancer? | Ovarian dysgerminoma |
| Which testicular cancers result in elevated LDH leves? | Testicular germ cell tumors |
| Prostate-specific antigen is abbreviated ___________. | PSA |
| What other non-neoplastic conditions elevate PSA? | BPH adn prostatitis |
| Why are immunohistochemical stains important in cancerous processes? | 1. Determine primary site of origin for metastatic tumors 2. Characterize tumors that are difficult to classify |
| Immunohistochemical stains may have what important characteristic/ values? | Prognostic and predictive values |
| What is Vimentin's (stain) target? | Mesenchymal tissue |
| What stain is used to identify Mesenchymal tumors? | Vimentin |
| List of important immunohistochemical stains: | Vimentin, S-100 Desmin Cytokeratin GFAP Neurofilament PSA TRAP Chromogranin and synaptophysin |
| What is the target of S-100 stain? | Neural crest cells |
| What stain is used to identify neural crest cells? | S-100 |
| What are common (+) S-100 tumors? | Melanoma, Schwannoma, Langerhans cell histiocytosis |
| Melanoma and Schwannoma are both (+) for ___________. (stain) | S-100 |
| What is the most common immunohistochemical stain used for muscle tumors? | Desmin |
| What is stain/targeted by desmin (immunohistochemical stain)? | Muscle |
| What is Desmin? | Important immunohistochemical stain of muscles |
| What are common cells identified as (+) GFAP? | Astrocytes, Schwann cells, and Oligodendrocytes |
| What is the target of GFAP stain? | Neuroglia |
| What are the two most important (+) GFAP tumors? | Astrocytoma and Glioblastoma |
| What immunohistochemical stain can be used to ID Neurons and Neuronal tumors? | Neurofilament |
| Neuroblastoma is (+) for what immunohistochemical stain? | Neurofilament |
| What is the target for stain PSA? | Prostatic epithelium |
| Prostatic epithelium is stain by ____________. | PSA |
| Hairy cell leukemia is (+)___________. | TRAP |
| (+) TRAP. Dx? | Hairy cell leukemia |
| What are common tumors identified by (+) chromogranin and synaptophysin stains? | 1. Small cell carcinoma of the lung 2. Carcinoid tumor |
| What is another name for P-glycoprotein? | Multidrug resistance protein 1 (MDR1) |
| What is the function of P-glycoprotein? | Pump out toxins, including chemotherapeutic agents |
| Why is P-glycoprotein considered a "resistance" factor to chemotherapy? | It causes the pump-out of toxins, including those chemotherapeutic agents --> decreased response to therapy. |
| What is the most common cancer to show elevated levels of P-glycoprotein? | Adrenocortical carcinoma |
| What is cachexia? | Weight loss, muscle atrophy, and fatigue that occur in chronic disease. |
| What are the cytokines that mediate cachexia? | TNF, IFN-gamma, IL-1, and IL-6. |
| What is the most common cancer? | Skin cancer |
| What is the most common type of skin cancer? | Basal >Squamous >> melanoma |
| What is the highest incidence cancer in men? | Prostate |
| What is the top 3 cancer mortality in men? | Lung > Prostate > Colon/ rectum |
| What is the number 1 cancer incidence in women? | Breast |
| Leukemia is the cancer with highest incidence and mortality in ______________. | Children (0-14 years) |
| What is the 2nd leading cause of death in the United States? | Cancer |
| What is the leading cause of death in the USA? | Heart disease |
| What is the leading cancer mortality in men and women? | Lung |
| What are the top 3 cancer incidence and mortality in children? | Leukemia > CNS > Neuroblastoma |
| What are 50% of brain tumors? | Arise from metastases |
| What are the most common primary tumors that metastasizes to brain? | Lung > breast > melanoma, colon, and kidney. |
| What type of primary tumor metastases to liver the most? | Colon |
| What are the most common sites of metastasis after regional lymph nodes? | Liver and lung |
Created by:
rakomi
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