Logan College Of Chiropractic Pathology Exam 4

Front 1

Define, recognize or use in context: T-lymphocytes

Back 1

Thymus derived cells direct the diverse elements of cellular immunity and are also essential for inducing the B cell—derived humoral immunity to many antigens. They make up 60-70% of lymphocytes. They can either directly lyse targets or orchestrate the anti microbial immune response of other cells by producing soluble protein mediators called cytokines.

Front 2

Define, recognize or use in context: Humoral immunity-

Back 2

antibody (immunoglobulins) related immunity

Front 3

Define, recognize or use in context: T-helper lymphocytes

Back 3

CD4+ T cells are “helper” T cells because they secrete soluble molecules (cytokines) that influence virtually all other cells of the immune system. CD4+ helper T cells respond to peptide antigens only in the context of class II MHC.

Front 4

Define, recognize or use in context: T-cytotoxic lymphocytes-

Back 4

CD8+ T cells are “cytotoxic” T cells which also secrete cytokines but they play a more important role in directly killing virus-infected or tumor cells. CD8+ cytotoxic T cells respond only to antigens associated with class I MHC.

Front 5

Define, recognize or use in context: B-lymphocytes

Back 5

differentiates into plasma cells and they secrete antibodies (immunoglobulins). They constitute 10 to 20% of the circulating peripheral lymphocyte population.

Front 6

Define, recognize or use in context: Dendritic cells

Back 6

They are widely distributed. They are found in lymphoid tissue and in the interstitium of many non-lymphoid organs, such as the heart and lungs. Similar cells within the epidermis have been called Langerhans’ cells. They are nonphagocytic cells that express high levels of MHC class II and costimulatory cells.

Front 7

Define, recognize or use in context: ADCC-

Back 7

This form of antibody-mediated injury involves killing via cell types that bear receptors for the Fc portion fo IgG; targets coated by antibody are lysed without phagocytosis or complement fixation. ADCC may be mediated by a variety of leukocytes, including neutrophils, eosinophils, macrophages, and NK cells. Although ADCC is typically mediated by IgG antibodies, in certain instances IgE antibodies are used.

Front 8

Define, recognize or use in context: Plasma cells

Back 8

secrete antibodies (immunoglobulins), IgG, IgA, IgM, IgE, IgD

Front 9

Define, recognize or use in context: Natural Killer cells

Back 9

They are larger than T and B lymphocytes, comprise 10-15% of peripheral blood lymphocytes, and they are sometimes called null cells. These cells contain abdunant azurophilic granules and are able to lyse a variety of tumor cells, virally infected cells, and some normal cells, without previous sensitization. These cells are classified as part of the innate immune system that is the first line of defense against neoplastic or virus-infected cells. They do not express TCR and are CD3-. NK cells may be identified by the presence of two cell-surface molecules, CD16 and CD56; CD16 is of particular functional significance. It is an Fc receptor for IgG and endows NK cells with the additional ability to lyse IgG-opsonized target cells, called antibody-dependent cell-mediated cytotoxicity.

Front 10

Define, recognize or use in context: Langerhans cells

Back 10

they are related to antigen presenting cells (APC)

Front 11

Define, recognize or use in context: CD3+ cells-

Back 11

The CD3 proteins are a group of proteins associated with the TCR and are used as a “marker” or means of identifying T-cells in-vitro. The CD3 proteins do not bind antigen but are involved in the transduction of signals into the T cell after it has bound the antigen.

Front 12

Define, recognize or use in context: CD3+, CD4+ cells-

Back 12

t helper cells

Front 13

Define, recognize or use in context: CD3+, CD8+ cells

Back 13

t suppressor cells or t cytotoxic cells

Front 14

Define, recognize or use in context: Class I MHC molecules

Back 14

they prevent lysis of normal cells by Nk cells. Theses molecules are coded by three closely loci designated HLA-A, HLA-B, and HLA-C. In general, they bind to peptides derived from proteins synthesized within the cell. Because they are present on virtually all nucleated cells, virally infected cells can be detected and lysed by cytotoxic T cells.

Front 15

Define, recognize or use in context: Class II MHC molecules

Back 15

These are coded by genes in the HLA-D region, where there are at least three subregions, DP, DQ, and DR. They are constitutively expressed mainly on APC (monocytes, macrophages, and dendritic cells) and B cells. In general, they bind to peptides derived from proteins synthesized outside the cell. This allows CD4+ T cells to recognize the presence of extracellular pathogens and to orchestrate a protective cytokine-mediated response.

Front 16

Define, recognize or use in context: Class III MHC molecules

Back 16

They include some of the complement components; genes for tumor necrosis factor (TNF) and lymphotoxin (TNF-β) are also encoded within the MHC. They do not act as histocompatibility.

Front 17

Define, recognize or use in context: IL-1

Back 17

Cytokine that mediates innate immunity. It affects cells systemically (endocrine effect) and also produces the acute-phase response during inflammation. It drives IL-6 synthesis. It can be produces by virtually any cell. It is redundant, meaning it has the same effects as other cells. It initiates nonspecific proinflammatory responses. Macrophages are the major source of this cytokine.

Front 18

Define, recognize or use in context: IL-2

Back 18

formed from T helper 1 cells

Front 19

Define, recognize or use in context: Type I Immune Response

Back 19

(anaphylactic type) - is a tissue response that occurs rapidly after the interaction of allergen with IgE antibody previously bound to the surface of mast cells and basophils in a sensitized host.

Front 20

Define, recognize or use in context: Type II Immune Response

Back 20

(antibody to fixed tissue antigen) - is mediated by antibodies directed against target antigens on the surface of cells or other tissue components. The response results from antibody binding followed by one of three different antibody-dependent mechanisms: Complement-dependent reactions, ADCC, and Antibody-mediated cellular dysfunction.

Front 21

Define, recognize or use in context: Type III Immune Response

Back 21

(immune complex disease) – mediated by the deposition of antigen-antibody (immune) complexes, followed by complement activation and accumulation of polymorphonuclear leukocytes. Immune complex-mediated injury can be systemic or localized. Systemic immune complex disease example is acute serum sickness. Local immune complex disease also known as the Arthus reaction.

Front 22

Define, recognize or use in context: Type IV Immune Response

Back 22

[cell-mediated (delayed) hypersensitivity] – mediated by specifically sensitized T cells and is divided into two basic types: Delayed-type hypersensitivity (DTH) initiated by CD4+ T cells and Direct cell cytotoxicity mediated by CD8+ T cells.

Front 23

Define, recognize or use in context: Penicillin reaction

Back 23

Type II immune response by complement-dependent reaction, specifically drug reaction, where hemolysis occurs after administration of penicillin.

Front 24

Define, recognize or use in context: Contact dermatitis

Back 24

is tissue damage caused by delayed-type hypersensitivity (type IV immune response) that is evoked by contact with pentadecylcatechol in a sensitized host and manifests as a vesicular dermatitis.

Front 25

Define, recognize or use in context: Serum Sickness

Back 25

Acute serum sickness is the prototype of a systemic immune complex disease. It was first described in humans when large amounts of foreign serum were administered for passive immunization (e.g., horse antitetanus serum). Type III immune response and systemic immune complex disease.

Front 26

Define, recognize or use in context: Neoplasia

Back 26

literally means “new growth.” A neoplasm is an abnormal mass of tissue the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after the cessation of the stimuli which evoked the change.

Front 27

Define, recognize or use in context: Erythroblastosis fetalis

Back 27

it is due to rhesus antigen incompatibility; maternal antibodies against Rh in a sensitized Rh negative mother cross the placenta and cause destruction of Rh-positive fetal red cells. Part of type II hypersensitivity complement-dependent reactions.

Front 28

Define, recognize or use in context: Lupus (SLE)

Back 28

is an autoimmune, multi-system disease of protean manifestations and variable behavior. Type III immune response

Front 29

Define, recognize or use in context: Tuberculosis

Back 29

Type IV immune response delayed-type hypersensitivity. The decreased CD4+ cells decreases host response for the pathogen M. tuberculosis can invade. The bacteria are engulfed by macrophages but are not killed and there is accumulation of unactivated macrophages poorly adapted to deal with the invading mircrobe.

Front 30

Define, recognize or use in context: Graves’ Disease

Back 30

In this disorder, antibodies against the thyroid-stimulating hormone (TSH) receptor on thyroid epithelial cells stimulate the cells, resulting in hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism. Graves’ disease is a form of autoimmune disorder that presents with symptoms of hyperthyroidism, diffuse enlargement of the thyroid gland, and exophthalmos (protuberant, staring eyes due to expansion of retro-orbital soft tissue, mainly expansion of adipose tissue). Symptoms include Female 20-40 years of age, Exophthalmos, Enlarged thyroid gland, Weight Loss, Nervousness, Fine tremor of the hands, Tachycardia, Increased sensitivity to heat, Increased T4, Decreased TSH, and Positive for TSI’s. The disease is due to the presence of an IgG antibody, (TSI) originally called LATS, which acts directly on thyroid follicle cells, stimulating them to divide (to produce increased cell numbers – hyperplasia) and to synthesize and secrete TH continuously, out of the control of TSH from the pituitary. There is a high incidence of the HLA antigen HLA-DR3 in patients with Graves’ disease.

Front 31

Define, recognize or use in context: Anergy-

Back 31

This refers to prolonged or irreversible inactivation of lymphocytes induced by encounter with antigens under certain conditions. During T cell activation, if the costimulatory signals are not delivered, the T cell becomes anergic.
Molecular mimicry- Some infectious agents share epitopes with self-antigens, and an immune response against such microbes will elicit similar responses to the cross-reacting self-antigen. It may also aply to T cell epitopes.

Front 32

Define, recognize or use in context: IgA

Back 32

major immunoglobulin in mucosal secretions and is thus involved in airway and gastrointestinal defense. Small amount in blood but large amount n secretions like tears, milk, saliva, mucus. They activate the complement system.

Front 33

Define, recognize or use in context: IgM

Back 33

monomers found on B cell surface (facilitate the recognition of antigen). Synthesized in the early portion of the immune response.

Front 34

Define, recognize or use in context: IgE

Back 34

They are also known as regains. They bind to basophils in the blood and mast cells in tissues. They are allergy related (immediate type). They are mostly seen on skin and body fluids and are low in the blood.

Front 35

Define, recognize or use in context: Histamine

Back 35

the most important primary (performed) mediators; causes increased vascular permeability, vasodilation, bronchoconstriction, and increased secretion of mucus. It is one of many that initiates the early events of type I hepersensitivity reactions.

Front 36

Define, recognize or use in context: Prostaglandin

Back 36

Prostaglandin D2 is the most abundant mediator generated by the cyclooxygenase pathway in mast cells. It causes intense bronchospasm as well as increased mucus secretion.

Front 37

Define, recognize or use in context: Interferon

Back 37

They are immune enhancers or stimulators

Front 38

Define, recognize or use in context: Arthus reaction

Back 38

may be defined as a localized area of tissue necrosis resulting from acute immune complex vasculitis. The reaction is produced experimentally by injecting an antigen into the skin of a previously immunized animal. Because of the initial antibody excess, immune complexes are formed as the antigen diffuses into the vascular wall. Arthus lesions evolve over a few hours and reach a peak 4-10 hours after injection, when the injection site develops visible edema with severe hemorrhage occasionally followed by ulceration.

Front 39

Define, recognize or use in context: Clonal anergy

Back 39

when you do not want your immune system working

Front 40

Define, recognize or use in context: Immune tolerance

Back 40

is a state in which an individual is incapable of developing an immune response against a specific antigen.

Front 41

Define, recognize or use in context: Self tolerance

Back 41

specifically refers to a lack of immune responsiveness to one’s own tissue antigens.

Front 42

Define, recognize or use in context: Rheumatoid Arthritis

Back 42

(136-139)- is a systemic, chronic inflammatory disease affecting multiple tissues but principally attacking the joints to produce a nonsuppurative proliferative synovitis that frequently progresses to destroy articular cartilage and underlying bone with resulting disabling arthritis. It may resemble SLE or scleroderma when extra-articular involvement develops.

Front 43

Define, recognize or use in context: Raynaud’s phenomenon

Back 43

a vascular disorder characterized by reversible vasospasm of the arteries. Typically the hands turn white on exposure to cold, reflecting vasospasm, followed by a blue color as capillaries and venules dilate and blood stagnates. Finally, the color changes to red as reactive vasodilation occurs.

Front 44

Define, recognize or use in context: Juvenile Rheumatoid Arthritis

Back 44

- refers to chronic idiopathic arthritis that occurs in children. It is not a single disease but a heterogeneous group of disorders, most of which differ significantly from the adult form of RA except for the destructive nature of the arthritis.

Front 45

Define, recognize or use in context: Sjogren’s syndrome

Back 45

is a clinicopathologic entity characterized by dry eyes and dry mouth resulting from immune-mediated destruction of the lacrimal and salivary glands.

Front 46

Define, recognize or use in context: CREST syndrome

Back 46

- A form of limited scleroderma. Most patients (90%) have anti-centromere antibodies. There is only minor involvement of internal organs. Typical features include: Calcinosis:deposition of calcium salts in body tissues, Raynaud’s phenomenon: intermittent attacks of pallor or cynaosis especially of the fingers, due to vasospasm, often precipitated by exposure to cold. Fingers are first white due to cold, then blue due to dilation and stagnation, then red due to vasodilation, Esophageal dysmotility: difficulty in swallowing due to fibrosis, Sclerodactyly: Scleroderma or fibrosis of the digits of the finger, Telangiectasia: dilation of the capillaries and formation of an angioma

Front 47

Define, recognize or use in context: AIDS

Back 47

(147-157)- caused by HIV virus that attacks T helper cells which leads to total immune system failure.

Front 48

Define, recognize or use in context: Selective IgA deficiency

Back 48

the most common of all the primary immunodeficiency diseases. Although most individuals with this condition are asymptomatic, weakened mucosal defenses predispose patients to recurrent sinopulmonary infections and diarrhea. There is also a significant association with autoimmune diseases. The pathogenesis of IgA deficiency appears to involve a block in the terminal differentiation of IgA-secreting B cells to plasma cells; IgM and IgG subclasses of antibodies are present in normal or even supra-normal levels.

Front 49

Define, recognize or use in context: Bruton’s Disease

Back 49

X-linked Agammaglobulinemia is one of the more common forms of primary immunodeficiency. It is characterized by the failure of pre-B cells to differentiate into B cells; as a consequence, there is a resultant absence of gamma globulin in the blood. In the disease, B cell maturation stops after the initial heavy-chain gene rearrangement because of mutations in a tyrosine kinase involved in pre-B cell signal transduction, called Bruton tyrosine kinase (BTK). It is responsible for continued B cell maturation.

Front 50

Define, recognize or use in context: DiGeorge’s Syndrome

Back 50

results from a congenital defect in thymic development with deficient T-cell maturation. T cells are absent in the lymph nodes, spleen, and peripheral blood. The disorder is a consequence of a development malformation affecting the third and fourth pharyngeal pouches—structures that give rise to the thymus, parathyroid glands, and portions of the face and aortic arch. In 90% of cases of the syndrome there is a deletion affecting chromosome 22q11.

Front 51

Define, recognize or use in context: Severe Combined Immuno-Deficiency

Back 51

- represents a constellation of genetically distinct syndromes all exhibiting defects in both humoral and cell-mediated immune responses. Hereditary immune system failure

Front 52

Define, recognize or use in context: Amyloidosis

Back 52

- is a group of diseases characterized by a deposition of amyloid in various organs

Front 53

Define, recognize or use in context: Hamartomas

Back 53

is a malformation that presents as a mass of disorganized tissue indigenous to the particular site.

Front 54

Define, recognize or use in context: Choristomas

Back 54

it is a congenital anomaly is better described as a heterotopic rest of cells

Front 55

Define, recognize or use in context: Dysplasia

Back 55

a term used to describe disorderly but non-neoplastic proliferation. It is a loss in the uniformity of the individual cells and a loss in their architectural orientation

Front 56

Define, recognize or use in context: Anaplasia

Back 56

literally means “to form backward.” It implies dedifferentiation, or loss of the structural and functional differentiation of normal cells. It is now known, however, that cancers arise from stem cells in tissues, so that failure of differentiation, rather than dedifferentiation of specialized cells, accounts for undifferentiated tumors.

Front 57

Define, recognize or use in context: Carcinoma

Back 57

it is malignant neoplasms of epithelial cell origin. It is evident that mesoderm may give rise to carcinomas and sarcomas.

Front 58

Define, recognize or use in context: Sarcoma

Back 58

it is malignant neoplasms arising in mesenchymal tissue or its derivatives. They are designated by their histogenesis.

Front 59

Define, recognize or use in context: Teratomas

Back 59

contain recognizable mature or immature cells or tissues representative of more than one germ-cell layer and sometimes all three. They originate from totipotential cells such as those normally present in the ovary and testis and sometimes abnormally present in sequestered midline embryonic rests.

Front 60

Define, recognize or use in context: Leiomyoma

Back 60

benign smooth muscle tumor

Front 61

Define, recognize or use in context: Rhabdomyoma

Back 61

striated muscle cell tumors

Front 62

Define, recognize or use in context: Cachexia

Back 62

Many cancer patients suffer progressive loss of body fat and lean body mass, accompanied by profound weakness, anorexia, and anemia.

Front 63

Define, recognize or use in context: Polyp

Back 63

- is a mass that projects above a mucosal surface, as in the gut, to form a macroscopically visible structure. Although this term commonly is used for benign tumors, some malignant tumors also may appear as polyps. Sometimes, especially in the colon, the term is applied to non-neoplastic growths that form polypoid masses.

Front 64

Define, recognize or use in context: Oncogenes

Back 64

are mutant alleles of protooncogenes. Genes that promote autonomous cell growth in cancer cells are called oncogenes. They are derived by mutations in protooncogenes and are characterized by the ability to promote cell growth in the absence of normal growth-promoting signals.

Front 65

Define, recognize or use in context: Protooncogens

Back 65

genes involved in normal growth control pathways in cells.

Front 66

Define, recognize or use in context: TNM System

Back 66

used in staging of cancers that is based on the size of the primary lesion (tumor), its extent of spread to regional lymph nodes, and the presence or absence of metastases. This assessment is usually based on clinical and radiographic examination, and in some cases surgical exploration. T1-T4 describes the increasing size of the primary lesion; N0-N3 indicates progressively advancing node involvement; and M0 and M1 reflect the absence or presence of distant metastases.

Front 67

What are the main differences between benign and malignant tumors?

Back 67

Differentiation and anaplasia
Rate of Growth
Local invasion
Metastases

Front 68

Which tumors metastasize through the lymphatics, and which ones metastasize hematogenously?

Back 68

Lymphatic spread is more typical of carcinomas.
Hematogenous route is favored by sarcomas.

Front 69

Which tumors spread primarily by seeding of body cavities?

Back 69

Carcinomas mainly ovarian and GI

Front 70

What is the difference between staging and grading of tumors?

Back 70

The grading of a cancer attempts to establish some estimate of its aggressiveness or level of malignancy base on the cytologic differentiation of tumor cells and the number of mitoses within the tumor.
The staging of cancers that is based on the size of the primary lesion (tumor), its extent of spread to regional lymph nodes, and the presence or absence of metastases. This assessment is usually based on clinical and radiographic examination, and in some cases surgical exploration.
When compared with grading, staging has proved to be of greater clinical value.

Front 71

What are the most common forms of cancer in men and women?

Back 71

Men- Prostate 30%
Women-Breast 31%

Front 72

What are the most common causes of cancer-related death?

Back 72

Men- Lung and bronchus 31%
Women- Lung and bronchus 25%

Front 73

List the important diseases that are associated with an increased incidence of cancer.

Back 73

Diseases-type of cancer
Solar keratosis of the skin- Squamous carcinoma
Cirrhosis- Hepatocellular carcinoma
Ulcerative colitis- Colic adenocarcinoma
Reflux esophagitis/Barrett esophagus- Esophageal adenocarcinoma
Atrophic gastritis- Gastric adenocarcinoma
Paget disease of bone- Osteosarcoma
Immunodeficiency disorders- Lymphoma
Gonadal dysgenesis- Germ cell tumors

Front 74

List important infectious diseases associated with an increased incidence of some cancers.

Back 74

Disease/pathogen-Type of cancer
Epstein-Barr infection- Burkitt lymphoma, nasopharyngeal cancer
Viral hepatitis B & C- Hepatocellular carcinoma
Human papilloma virus infection- Carcinoma of cervix
Human T cell lymphoma/leukemia virus- T cell lymphoma/leukemia
AIDS- Lymphoma, Kaposi sarcoma

Front 75

What are carcinogens?

Back 75

They are cancer-inducing factors that can be classified as: Physical agents (UV light, x-rays, and gamma radiation), chemicals, viruses, and endogenous oncogens.

Front 76

Explain and describe the Ames test.

Back 76

The Ames test uses the ability of a chemical to induce mutations in the bacterium Salmonella typhimurium. It is frequently used to screen chemicals for their carcinogenic potential. The bacterium used in the test is a strain of Salmonella typhimurium that caries a defective (mutant) gene making it unable to synthesize the amino acid histidine (His) from the ingredients in its culture medium. However, some types of mutations (including this one) can be reversed, a back mutation, with the gene regaining its function. These revertants are able to grow on a medium lacking histidine. A suspension of a histidine-requiring (His-) strain of Salmonella typhimurium is plated with a mixture of rat liver enzymes on agar lacking histidine. A disk of filter paper is impregnated with the chemical in question and placed on the culture.
Simply test for testing if mutation can occur. But know that if it cannot mutate that it doesn’t mean that it can’t cause cancer.

Front 77

Know the four classes of normal regulatory genes are the principal targets of genetic damage.

Back 77

Growth-promoting proto-oncogenes
Growth-inhibiting cancer suppressor genes (anti-oncogenes)
Those that control programmed cell death, or apoptosis
Those that regulate DNA repair

Front 78

List some important environmental carcinogens and neoplasms they may cause.

Back 78

Polycyclic aromatic hydrocarbons- found in tobacco smoke and tar. May cause lung cancer and skin cancer.
Aromatic azo dyes—urinary bladder cancer in workers in aniline dye industry.
Benzene—leukemia in chemical industry.
Aflatoxin B-1—toxin produced by Aspergillus flavus that grows on moldy grains and peanuts. Suspected as cause of liver cancer in underdeveloped countries.
Nickel—cancer of nasal cavity and lungs in mine workers.
Arsenic—skin cancer in vineyard workers.
Asbestos—mesothelioma in shipyard and insulation workers.

Front 79

Which tumors have been linked to viruses as a cause of human cancer?

Back 79

Human papilloma virus subtypes 16 and 18 are implicated in the pathogenesis of carcinoma of the cervix and the lower female genital tract
Epstein-Barr virus has been associated with Burkitt lymphoma and nasopharyngeal carcinoma.
Hepatitis virus B and C chronic liver disease has been associated with an increased incidence of hepatocellular carcinoma.
Herpes virus 8 has been isolated from cells of Kaposi sarcoma.

Front 80

Which tumors have been linked to exposure to x-rays and ionizing radiation?

Back 80

Skin cancer
Leukemia/lymphoma
Thyroid cancer
Osteogenic carcinoma
Lung cancer
Liver angiosarcoma

Front 81

Which cells act against tumor cells?

Back 81

Natural killer cells
Macrophages
Cytotoxic (CD8+) T lymphocytes
Antibodies

Front 82

What are tumor markers?

Back 82

Oncofetal glycoproteins found on tumor cells and fetal cells
Serum proteins
Enzymes
Hormones
Biogenic amines

Front 83

List clinically useful tumor markers.

Back 83

Alpha-Fetoprotein
Chorionic gonadotropin
Carcinoembryonic antigen
Calcitonin
Prostate-specific antigen.

Front 84

List local adverse & systemic adverse effects of tumors.

Back 84

Local adverse effects
Mass effect
Compression of normal tissue with loss of function
Pain due to compression of nerves
Destruction of normal tissue
Obstruction of hollow organ
Irritation and inflammation
Bleeding due to erosion of blood vessels
Necrosis
Systemic adverse effects
Nonspecific symptoms, such as loss of appetite, fatigue, and weakness
Cachexia and weight loss
Paraneoplastic syndromes

Front 85

What are paraneoplastic syndromes?

Back 85

They include signs and symptoms caused by remote tumor effects. Essential features of paraneoplastic syndromes are as follows:
Unrelated to the mechanical effects of the tumor mass or distant metastases
May result from substances released from tumor cells but not found in the normal cells from which the tumor has originated
May result from a series of immunologic and other host reactions to tumor
May have a complex and not fully understood pathogenesis