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106 Cards in this Set

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Normal cells
normal cells w/ basal -> apical differentiation
Hyperplasia
cells have increased in number
dysplasia
abnormal prolif of cells w/ loss of size, shape, and orientation
In situ carcinoma
- neoplastic cells have not invaded basement membrane
- high nuclear/cyto ratio
- clumped chromatin
- neoplastic cells incompas entire thickness
how do cells invade the basement membrane?
- via collagenases or hdyrolases
- will metastasize if it reaches blood or lymph
Normal Neoplastic Progression
normal cells w/ basal -> apical differentiation
Hyperplasia
cells have increased in number
dysplasia
- abnormal prolif of cells w/ loss of size, shape, and orientation
- commonly reversible (preneoplastic)
In situ carcinoma
- neoplastic cells have not invaded basement membrane
- high nuclear/cyto ratio
- clumped chromatin
- neoplastic cells incompas entire thickness
how do cells invade the basement membrane?
- via collagenases or hdyrolases
- will metastasize if it reaches blood or lymph
metastasis
- spread to distant organ
- must survive immune attack
- "seed or soil"
- seed = tumor embolus
- soil = target organ
metaplasia
- 1 adult cell type is replaced by another
- 2o to irritation or envorinment (think smokers)
anaplasia
- abnormal cells lacking differentiation
- seen w/ undifferentiation malignant neoplasms
- may form tumor giant cell
neoplasia
uncontrolled and excessive clonal prolif of cells
Tumor Grade
- histologic apperance (I-IV)
- based on degree of diff and # of mitoses
Tumor Stage
- based on 1o size and site
- more prognostic value
- grade w/ TNM - size of Tumor, Node involvement, Metastases
epithelium tumor, benign and malignant
B - adenoma, papilloma
M - adenocardinoma, papillary carcinoma
blood cell tumor, benign and malignant
B - none
M - leukemia, lymphoma
blood vessel tumor, benign and malignant
B - hemangioma
M - angiosarcoma
smooth muscle tumor, benign and malignant
B - leiomyoma
M - leiomyosarcoma
skeletal muscle tumor, benign and malignant
B - rhabdomyoma
M - rhabdomyosarcoma
bone tumor, benign and malignant
B - osteoma
M - osteosarcoma
fat tumor, benign and malignant
B - lipoma
M - liposarcoma
more than one cell type has a tumor, benign and malignant
B - mature teratoma
M - immature teratoma
Aflatoxin ass. w/
liver
vinly chloride ass. w/
liver
nitrosamines w/
esophagus, stomach
asbestos ass. w/
lung
arsenic ass. w/
skin
CCl4 ass. w/
liver
naphthalene (aniline) dyes ass. w/
bladder
tissue lump or tumor will cause
mass
destruction of epithelial surfaces will cause
nonhealing ulcer
from ulcerated area or eroded vessel
hemorrhage
any site w/ sensory nerve endings will cause
pain - tumors in brain are intitially painless
tumor mass in brain will cause
seizures
obstruction of brouchus will cause
pneumonia
obstruction of bilary tree will cause
jaundice
obstruction of left colon will cause
contstipation
perforation of ulcer in viscera will cause
peritonitis
bathologic fracture, collase of bone will cause
bone disturction
inflam of serosal surface will cause
pleural effusion, pericardial effusion, ascites
rasied intracranial pressure w/ bain neoplasm will cause
space-occupying lesion
anemia due to bone marrow replacement
space-occupying lesion
compression or destruction of nerve will cause
localized loss of sensory or motor function
venous or lymphatic obstruction will cause
edema
skin - squamous cell cancinoma
- very common - from exposure to sun
- usually on hands and face - locally invasive but rarly metastisizes
- see keratin pearls on slide
- actinic ketarosis is a precursor
skin - blast cell cancinoma
- most common in sun exposed areas
- localy invasive, almost never metastisizes -
- in gross path, will see pearly papules
- tumor cells have palisading nuclei
skin - melanoma
- significant risk fo metastasis
- ass. w/ sun exposure and fair skinned people
- depth of tumor corrlates w/ risk of metastasis
- dysplastic nevus is a precursor to melanoma
bone - osteochondroma (exoxtosis)
- most common benign bone tumor - usually in med < 25
- commonly originates from long metaphysis
- malignant tranformation to confrosarcoma is rare
bone - giant cell tumor
- occurs at epiphseal end of long bones - commonly in 20-40 years
- locally agressive but benign
- often around distal femur, prox tibial
- double bubble or soap bubble on x-ray
- on slide, spindle shaped nuclei w/ MN giant cell
bone - endochondroma
- benign catrilaginous neoplasm found in intramedullary bone
- usually distal extrimities
bone - osteosarcoma (osteogenic carcinoma)
- most common 1o malignant tumor - usally in men 10-20
- found in metaphysis of long bones
- ass w/ pagets disease of bone, bone infarcts, radiation, familial retinoblastoma
- codman's triangle (from elevated periosteum) on x-ray
bone - Ewings sarcoma
- anaplastic small blue cell malignant tumor - boys <15
- very aggressive w/ early mets, but responsive to chemo
- see onion skin in bone
- "going out for E-wings and onion rings"
- on diaphysis of long bones, pelvis, scapula, and ribs
- 11;22 translocation
bone - chondrosarcoma
- malignant cartilatinous tumor - mainly men 30-60
- usually in pelvis, spine, scapula, humerus, tibia, femur
- 1o origin from osteosarcoma?
1o brain tumors - general
- presentation due to mass effects (seizure, dementa, focal lesions)
- rarly mets - majority of supratentorial - majority of childrens infratentorial
glioblastoma multiforme (grade IV astrocytoma)
- mainly adults, most common 1o brain tumor
- <1 yr life expectancy
- found in hemisphere, can cross CC (butterfly glioma)
- pseudopalisading tumor cells border central areas of necrosis and hemorrhage
Menangioma
- mainly adults, 2nd most common 1o brain
- usually in convexities of hemispheres and parasagittal region
- arises from external arachnoid cells
- resectable
- spindle cells concentrically arraged in a whorled pattern - psammoma bodies (laminated caclifications)
schwannoma
- mainly adults, 3rd most common 1o brain
- schwann cell origin
- often localized to 8th nerve -> acousitc schwannoma
- bilateral found in neruofibromatosis type 2
- Antoni A is comact palisading nuclei
- Antoni B is loose pattern
oligodendroglioma
- mainly adults, pretty rare
- slow growing, often in frontal lobes
- fried egg cells w/ round nuclei and clear cyto - often calcified
pituitary adenoma
- mainly adults - prolactin secreting is common
- get bitemporal hemainopia due to pressure on optic chaism and hypopituatarism are sequelae
- see rathke's pouch
low grad astrocytoma (pilocytic astrocytoma)
- mainly in children - diffusely infiltrating glioma
- usually in posterir fossa
- benign w/ good prognosis
medulloblastoma
- mainly in children - very malignant cerebellar tumor
- from of primitive neruoectodermal tuomr (PNET)
- can compress 4th ventricle, causing hydrodcephalus
- rosettes or perivascular pseudorosette pattern - radiosensitive
ependymoma
- mainly in children - ependymal cell tumor
- commounly found in 4th ventricle, so can cause hydrodcephalus
- perivascular rosettes - rod shaped blepharoplasts (basal ciliary bodies) near nucleus
hemangioblastoma
- mainly in children - often cerebellar
- associated w/ hippel-lindau syndrome when found w/ retinal angiomas
- can produce ECO -> 2o polycythemia
- foamy cells and high vasularity
Craniopharyngioma
- mainly in children - benign - most common supratentorial
- counfused w/ bitemporal hemianopia
- dervied from remnants of rathke's pouch - calcification is common
Mets to brain
- Lots of Bad Stuff Kills Glia
- lung, breast, skin (melanoma) kidney (renal cell carcinoma) GI
- about 50% of brain tumors form mets
Mets to liver
- Mets >>> 1o liver
- Cancer Sometimes Penetrates Benign Liver
- colon > stomach > pancreas > breast > lung
small cell lung cancinoma
- causes
- effects
- ACTH or ACTH like peptide
- Cushings symdrome
small cell lung cancinoma and intracranial neoplasms
- causes
- effects
- ADH or ANP
- SAIDH
squamous cell lung , renal cell, breast carcinomas, multiple myeloma, and bone mets
- causes
- effects
- PTH related peptide, TGF-B, TNF-A, IL-1
- hypercalcemia
renal cell cancinoma
- causes
- effects
- EPO
- polycythemia
thymoma, bronchogenic cancinoma
- causes
- effects
- Abs against presynaptic Ca channels at NMJ
- Lambert-Eaton syndrome
leukemias and lymphomas
- causes
- effects
- hyperuricemia due to excess nucleic acid turnover (cytotoxic therapy)
- gout, urate nephropathy
Male cancer epi
- prostate incidence (32)
- lung incidence (16)
- colon incidence (12)
- prostate mortality (13)
- lung mortality (33)
female cancer epi
- breast incidence (32)
- lung incidence (13)
- colon incidence (13)
- breast mortality (23)
- lung mortality (18)
well differentiated neoplasm
a neoplasm that resembles the dissue of origin
poorly differentiated neoplasm
a neoplasm where there is little resemblance to the tissue of origin
trademarks of malignant cells
- pleomorphism
- hyperchomatism
- increased N:C ratio
- prominant nucleoli
carcinoma
- malignant tumor of epithelial origin
transitional cell carcinoma
carcinoma of epithelium of the bladder
adinocarcinoma
- carinoma of glandular epi
- GI mucousa, endometrium, urinary tract
- often associated w/ desmoplasion (tumor-induced prolif of non-neoplastic fibrous connective tissue) - esp in breast, pancrease, and prostate
sarcoma
- malignant tumor of mesenchymal origin
benign tumor characteristics
- well differentiated
- no mets, grow slowly
- tend to be ecapsulated
- suffix -oma (usually_
papilloma
- benign neoplasm from surface epi (skin, larynx, tounge)
- finger like epi process over a core of connective tissue
- may develop from transitional epi of bladderor renal pelvis
adenoma
- benign neoplasm of gladular epi
- a papillary cystadenoma is a papillary process extending into cytsic spaces (ovary)
- a febroadenoma has prolif of conncetive tissue (breast)
choristoma
- small, non-neoplastic area of normal tissue misplaced w/in another organ
hamartoma
non-neoplastic, disorganized tumor-like overgrowht of cell tupes regularly found in that organ - hemangioma (think of baby dana)
properties of neoplasms
- monoclonality
- invasion and mets
- cachexia and wasting
- endocrine abnormalities
monoclonality in B-cells
- b-cell malignancies have etiher kappa or lambda chain specificity, but not both
- also, neoplastic prolif results in a large number of cells all having the same Ig gene rearragement
monoclonality in T-cells
- malignanty T cells have large numbers of cells w/ the same surface markers
- they also have the same Ig rearragement
invasion vs mets
- invasion means its penetrated the basement membrane - doesn't mean mets
- mets is implantation in a distant site
mets steps
- growth and vascularization of tumor
- penetration of basement membrane (invasion)
- transport and survival in circulation
- arrest of tumor emboli
- overcoming target tissue defense
- developing sucessful metastatic implants
mets preferential routes
- carcinomas like lymph spread (except renal cell and hepato carcinomas)
- sarcomas like blood spread
mets target organs
- usually liver, lungs, brain, adrenal glands, LNs, BM
- rarely SkM or spleen
tumor progression
- characterized by accumulation of sucessive cytogenic or molecular abnormalities
- changes in APC, K-ras, DCC, and p53 genes go along w/ it
cachectin
- excess causes wasting in malignant tumors
- a product of macrophages that promotes catabolism of fatty tissue
pituitary abnormalities w/ malignant tumors
- prolacinoma -> amenorrhea, infertility, galactorrhea
- somatotropic (acidophilic) adenoma -> giantism in children and acromegally in adults
- cortictropic (basophilic) adenoma -> cushings disease
adrenocrotical abnormalities w/ malignant tumors
- adrenogenital syndrome, Conn syndrome, cushings syndrome
- all from adrenal cortical tumors
ovarian abnormalities w/ malignant tumors
- granulosa-theca cell tumor -> hyperesterinism
- sertoli-leydig cell tumor -> excess androgen production
endocrinopathies from malignancies
caused by ectopic production of hormones
- cushings - ACTH
- increasee antidiuretic - often SSC of lung
- hypercalicemia - bone
- hypoglycemia - from insulin like hormones from hepatocullular, mesothelioma
- polycythemia - inc EPO from renal tumors
- hyperthyroidism - via hydration moles, choriocarcinomas, some lung
cachectin
- excess causes wasting in malignant tumors
- a product of macrophages that promotes catabolism of fatty tissue
pituitary abnormalities w/ malignant tumors
- prolacinoma -> amenorrhea, infertility, galactorrhea
- somatotropic (acidophilic) adenoma -> giantism in children and acromegally in adults
- cortictropic (basophilic) adenoma -> cushings disease
adrenocrotical abnormalities w/ malignant tumors
- adrenogenital syndrome, Conn syndrome, cushings syndrome
- all from adrenal cortical tumors
ovarian abnormalities w/ malignant tumors
- granulosa-theca cell tumor -> hyperesterinism
- sertoli-leydig cell tumor -> excess androgen production
endocrinopathies
caused by ectopic production of hormones
- cushings - ACTH
- increasee antidiuretic - often SSC of lung
- hypercalicemia - bone
- hypoglycemia - from insulin like hormones from hepatocullular, mesothelioma
- polycythemia - inc EPO from renal tumors
- hyperthyroidism - via hydration moles, choriocarcinomas, some lung