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34 Cards in this Set

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what is the most likely layer for neoplais to arise from?
epithelium, bc it divides most rapidly
what are the colorectal cancer screening guidlines?
colonoscopy ever 10 after 50
every 5, felixibel sigmoidoscopy barium enema or ct colongraphy
hamartomatous polyps including smooth muschle growth
peutz jeghers (less common than other types of polyps)
what is the most common type of polyp in western world?
neoplastic adenomas
what type of polyp is most commonly seen in colonoscopy?
hyperplastic poyps, usually samll left sided asymptomatic
saw tooth glands star shaped configuration
hypermature epithelium that doesnt shed
non neoplastic, but a lot could predispose for malignancies
goblet cell rich
hyperplastic polyps (serrated)
saw tooth edge star shpaed gland
flask shaped glands
inverted growth pattern (mimics malignancy)
Pre malignant!
larger, ridht sided
sessile serrated adenoma
jagged star shaped moprphology
eosinophilic scyotplasm
elngoated nuclei
rare
left sided, villiform
traditional serrated adenoma
older female pts
polyps around ampuularry region

large tumor: obstruction jaundice ag pain pancreatits
small bowel adenomatous polyps
50% of people after age 50 in west
family history and syndromes earlier
stong genetic and nutironal factors
oftern asymp, but may presen w/ occult bleed or iron defieincy anemia
large bowel adenomatous polyps
are all adenomas considered premalignant?
oh year
histology of subtypes of adenomatous polyps:
tubular
villous
tubulovillous

elongated nuclei
loss of polarity
increased mitosis
hyperchromatic nuclei, rounded cells, loss of polarity, mor mitosis
more inflammaiton and necrosis

cribriform growth pattern, invasion of stroma
high grade dysplastic adenomas
what are two molecular pathways for genoic insability of adenocarcinomas?
85% chromosomal insability
(mostly APC/beta catenin path

15% microsatelite instaily: altered size of repetitive DNA sequences and defectiv DNA mismatch repair enzymes
what is the adenoma carcinama preogression?
normal colon--> hit in germilne or tumor suppressor genes (APC or beta catenin)
mucosal has lost one allele for sumre suppp, other tummor supp allele gets hit through methylaiton of promoter -->complete loss of APC
upregulaiton or increased mutaiton of proto oncogenes K_RAS
adenoma
ACCUMULATION OF HITS OVER TIME LEAD TO CARCINOMA AND INVASION
what is the microsatelit adenmo carc progresion?
another tsg gets hit (MLH1 or MSH2)
loss of intial allele followed by lsos of 2nd
leads to sessile serrated adenomas and hyperplastic looking polyps
more mutations lead to invasive carcinomas
whar are some biloglical risk factos/protectors for colorectal carcinoma?
risk: meat consumption (nitrosamines and heterocyclic compounds) alcohol
protect: veggies, folate, fiber, nsaids hormomen replacement
where are colorect adenocarcinomas distributed
half cecum/ascending
half rectum sigmoid
apple core lession
adenocarcinoma: narrowed lumen, odd bowel habits
signet ring cell adenocarcinoma
poorly differentiated; easy to miss bc few cells in biopsy

eccentric nuclei, mucin droplets
poor prognosis
what is Familial adenomatous polyposis?
AD germ mutaiton of APC
>100 polyps
100% risk of cancer
osteomas
desmoid tumors
congenital hypertophy of renial pigme (Gardeners)
brain gliomas
extra intestinal manifestations of FAP
where does the FAP germ mut occur
5q21 (apc tummor suppressor)
what is the most common type of colon cancer (sporadic, genetic, etc.)
sporadci
highest and lowest survival rate locations of Neuro endocrin tumors?
highest: appendix
loswet colon
most common: SI
flushing, diarrhea, astham, tricuspid regurge
high circulat levels of hormones (serotonin)
mestastais to liver
carcinoid syndrome
how do you stage NET?
by mitotic count
morphology doesnt tell you how its going to act
middle aged older pts
rarely congenital
soft tissue tumor in stomach
GIST
what is the cell origin of GIST
ICC interstitial cels of cajal
what pathway is GIST related to?
cKit or platelet derived fowth facter recpeto alspha mutlation (a tyrosine kinase)
what are GIsT histological subtypes:
spindle cell morphology
epitheliod morphology
arise form lamina propira or muscularis mucosa
spindle cells perinuclear vacuoles
leiomyomas
like leiomyoma but more malignant: increase mitosis and necrosis
leiomyosarcoma
what is the most common type of hematopoetic neoplasm?
large B cell lymphoma verry aggressive