Pathology: Neoplasia

Front 1

What is an adenoma?

Back 1

An adenoma is a benign neoplasm of glandular epithelium.

Front 2

What is a papilloma?

Back 2

A papilloma is a benign neoplasm of squamous or transitional cell epithelium. Some benign glandular neoplasms may also be called papillomas, depending on morphology.

Front 3

What is a carcinoma?

What are the different types of carcinomas?

Back 3

A carcinoma is a malignant neoplasm of epithelial tissue.

Squamous cell carcinoma
Adenocarcinoma
Transitional cell carcinoma

Front 4

What is a lipoma?

Back 4

A lipoma is a benign mesenchymal neoplasm of adipose tissue.

Front 5

What does the suffix -oma indicate?

Back 5

Something ending in -oma is a benign mesenchymal neoplasm.

Front 6

What is a sarcoma?

Back 6

A sarcoma is a malignant neoplasm of mesenchymal tissue.

Front 7

Define anaplasia.

Back 7

Anaplasia describes de-differentiated cells that are characteristic of malignant neoplasms. Pleomorphism is usually present with anaplastic cells, and they also usually have large, darkly staining nuclei.

Front 8

What is the difference between atrophy and hypoplasia?

List the six causes of atrophy.

Back 8

Hypoplasia is a type of atrophy, as atrophy is defined as a decrease in the number or size of cells, and hypoplasia is a decrease in the number of cells.

The seven causes of atrophy are:
1. Disuse
2. Denervation
3. Loss of nutrients
4. Pressure
5. Loss of trophic hormones
6. Senile atrophy

Front 9

What is the difference between hypertrophy and hyperplasia?

List the two general categories of reasons for these conditions.

Back 9

Hypertrophy is increased cell size, while hyperplasia is increased cell number.

These conditions may be the result of changes in physiologic conditions, or pathological conditions.

Front 10

What is the difference between metaplasia and dysplasia?

Back 10

Metaplasia is an abnormality in cell differentiation where one mature cell type is replaced by another, which looks normal but is in the wrong location. It does not increase the risk of developing cancer unless it is accompanied by dysplasia. Squamous metaplasia (ie: in the lung) is the most common type.

Dysplasia is a state of abnormal differentiation and maturation of cells. It is characterized by nuclar abnormalities, cytoplasmic abnormalities, and increased rate of cellular multiplication.

Front 11

Categorize the following as hyperplasia, metaplasia, or dysplasia:
Premalignant lesion
Carcinoma in situ
Squamous intraepithelial lesion
Cervical intraepithelial neoplasia

Back 11

All are dysplasia

Front 12

What three factors are predictive of whether dysplasia will develop into cancer?

Back 12

1. Grade of dysplasia
2. Duration of dysplasia
3. Site (bladder > cervix)

Front 13

What distinguishes dysplasia from cancer?

Back 13

Dysplasia is not invasive- it does not penetrate the basement membrane. Dysplasia can also be reversible.

Front 14

What does the degree of differentiation describe, in relation to a neoplasm?

Back 14

The degree of differentiation describes the degree to which the neoplasm resembles normal tissue. Benign neoplasms are usually well-differentiated and malignant neoplasms may have any degree of differentiation.

Front 15

Name seven distinguishing histological features of a malignancy.

Back 15

1. Hyperchromism
2. High cell density
3. Irregular mitoses
4. High nuclear/cytoplasmic ratio
5. Frequent necrosis
6. Abnormal differentiation
7. Pleomorphism

Front 16

Can a neoplasm that has metastasized be benign?

Back 16

No!

Front 17

Name four types of germ cell neoplasms.

Back 17

1. Seminoma
2. Embryonal carcinoma
3. Choriocarcinoma
4. Teratoma

Front 18

What is special about a teratoma?

Back 18

A teratoma is a totipotent tumor that contains components of all three embryonic germ layers. They can be mature or immature.

Front 19

What is a blastoma?

Back 19

A blastoma is a pluripotent neoplasm of fetal type stem cells. It resembles an early embryonic organ occurs in childhood, and is malignant.

Front 20

What are the three types of carcinomas?

Back 20

1. Adenocarcinomas- from glandular epithelium
2. Transitional carcinomas- from transitional epithelium
3. Squamous carcinomas- from squamous epithelium

Front 21

How are mesenchymal neoplasms named?

What are the exceptions?

Back 21

Benign mesenchymal neoplasms are named with the cell type +"oma".
Malignant mesenchymal neoplasms are named with the cell type +"sarcoma".

Exceptions: lymphoma, plasmacytoma, melanoma, glioma, and astrocytoma are all malignant.
Eponyms: Hodkin's lymphoma, Kaposi's sarcoma, Ewing sarcoma

Front 22

Define hamartoma.

Back 22

A hamartoma is a non-continuously growing abnormal tissue group in an organ. It is not technically a neoplasm because its growth does not continue excessively.

Front 23

Define choristoma.

Back 23

A choristoma is a non-continuously growing tissue which arises from an abnormal site. It is not technically a neoplasm because its growth does not continue excessively.

Front 24

Which five cancers have the highest incidence in men in the United States?

Back 24

1. Prostate
2. Lung
3. Colorectal
4. Urinary
5. Leukemia/lymphoma

Front 25

Which five cancers have the highest incidence in women in the United States?

Back 25

1. Breast
2. Lung
3. Colorectal
4. Uterus
5. Leukemia/lymphoma

Front 26

Which cancers of non-sex-specific organs have different incidences between men and women?

Back 26

Higher in men: oropharynx, esophagus, stomach, bladder, lung

Higher in women: Gallbladder, thyroid, melanoma

Front 27

Name seven factors that affect cancer incidence.

Back 27

1. Gender
2. Age
3. Occupation
4. Social habits
5. Sexual/childbearing history
6. Geographic location
7. Family history

Front 28

Describe the clonal theory of cancer.

Back 28

The clonal theory is the idea that neoplastic changes occur in a single cell (clone) in a tissue. This cell then divides extensively to create the tumor, which is generally entirely descended from this single cell.

Front 29

Describe the "multifactorial origin of neoplasia".

Back 29

The multifactorial origin of neoplasia describes that hits to multiple genes must occur in order for cancer to occur.

Front 30

What are proto-oncogenes, c-oncogenes, and v-oncogenes?

Back 30

Proto-oncogenes are genes present in normal cells for upregulation of cell growth. If they are abnormally activated by a carcinogen, they are then known as cellular oncogenes (c-oncogenes). Viral oncogenes (v-oncogenes) are similar to c-oncogenes, but are viral in origin.

Front 31

Name the following genes as apoptosis regulators, DNA repair proteins, or proto-oncogenes:

abl, BRCA1/2, bcl, myc, ras, p53, Rb, wnt, src

Back 31

Apoptosis regulators: Rb, p53

DNA repair: BRCA1/2

Proto-oncogenes: myc, ras, wnt, src, abl, bcl

Front 32

Name five cancers associated with defects in DNA repair genes.

Back 32

1. Fanconi syndrome
2. Ataxia telangiectasia
3. Xeroderma pigmentosum
4. Breast cancer
5. Bloom syndrome

Front 33

Is geographic variation in cancer incidence thought to be a product of different genetic makeup or different environmental carcinogens?

Back 33

Different environmental carcinogens. The role of genetics is believed to be very small.

Front 34

Name two associations between cancer and polycyclic hydrocarbons.

Back 34

Lung cancer in smokers.

Scrotal cancer in chimney sweeps.

Front 35

Name an association between cancer and aromatic amines.

Back 35

Bladder cancer in workers in the leather or aniline dye industries.

Front 36

Name a fungal toxin that causes cancer and its origin.

Back 36

Aspergillus flavus produces aflatoxin on improperly stored food, causing mutations in p53. This can act synergistically with EBV.

Front 37

What common practice in Sri Lanka and India causes oral cancer?

Back 37

Betel leaf chewing

Front 38

What two types of cancer are associated with asbestos?

Back 38

1. Malignant mesothelioma
2. Bronchogenic carcinoma (doubles likelihood, increases likelihood 10-fold when combind with smoking)

Front 39

Name three industrial carcinogens associated with lung cancer.

Back 39

1. Nickel
2. Chromium
3. Cadmium

Front 40

With what cancer is arsenic associated?

Back 40

Skin

Front 41

With what cancer is PVC associated?

Back 41

Angiosarcoma of the liver

Front 42

Describe the two mechanisms by which RNA viruses cause cancer.

Back 42

RNA viruses cause cancer by producing a DNA copy of their genome which is inserted into the host genome. Sometimes this genome contains an oncogene, and sometimes the location of genome insertion activates a c-oncogene.

Front 43

Name three retroviruses that cause cancer.

Back 43

1. Human T Leukemia Virus Type I (HTLV-I) causes leukemia
2. HIV may cause B cell lymphoma
3. Hepatitis C virus is thought to account for 25% of liver cancer

Front 44

Name five DNA viruses that cause cancer.

Back 44

1. Human papilloma virus (types 16, 18, 31, and 33) causes cervical carcinoma. Types 6 and 11 cause benign lesions.
2. Epstein-Barr virus causes Burkitt lymphoma in Africa, nasopharyngeal carcinoma in the far east, and possibly Hodgkin's lymphoma.
3. Hepatitis B virus may have a role in up to 50% of liver cancers.
4,5. Human herpesvirus 8 and cytomegalovirus are associated with Kaposi's sarcoma, and some believe that HHV8 is causal.

Front 45

With what cancer is Helicobacter pylori associated?

Back 45

Gastric

Front 46

With what cancer is Schistosoma haematobium associated?

Back 46

Bladder

Front 47

Name some associations between hormones and neoplasms.

Back 47

1. Therapeutic estrogens are associated with endometrial hyperplasia>dysplasia>carcinoma.
2. High dose oral contraceptives carry a mildly elevated risk of breast cancer.
3. Diethylstilbestrol increases risk of vaginal adenocarcinoma in girls exposed as fetuses.
4. Oral contraceptives and anabolic steroids are rarely associated with benign liver cell adenomas.
5. Prostate cancer is almost always androgen-dependent.
6. Breast cancer is frequently estrogen and/or progesterone-dependent.

Front 48

On what chromosome is retinoblastoma protein encoded? Is retinoblastoma dominant or recessive, when inherited? What proportion of cases have hereditary origin?

Back 48

Chromosome 13 (not 14, Cliff Scheckter).

Recessive.

10%

Front 49

Name five cancers with Mendelian inheritance.

Back 49

1. Retinoblastoma
2. Wilm's tumor
3. Polyposis coli
4. Neurofibromatosis
5. Nevoid basal cell carcinoma syndrome

Front 50

Name, in order, the four genes mutated or deleted in the Vogelstein model.

Back 50

1. APC (adenomatous polyposis coli)
2. Kras
3. DCC (deleted in colon cancer)
4. p53

Front 51

Name as many as you can of the 15 diseases associated with increased risk of malignancy due to chronic inflammation and dysplasia.

Back 51

1. Down syndrome
2. Xeroderma pigmentosum
3. Gastric atrophy/pernicious anemia
4. Tuberous sclerosis
5. Cafe au lait skin patches
6. Actinic dermatitis
7. Barrett's esophagus
8. Dysphagia plus anemia/Plummer-Vinson syndrome
9. Cirrhosis
10. Ulcerative colitis
11. Paget's disease of bone
12. Immunodeficiency
13. AIDS
14. Autoimmune diseases
15. Dysplasias

Front 52

Name three changes in cell structure and function that are indicative of neoplasia.

Back 52

1. Appearance or loss of certain cell surface antigens: viral antigens, oncofetal antigens, unique antigens.
2. Karyotypic abnormalities: aneuploidy, polyploidy, marker chromosomes (Philadelphia chromosome), other translocations.
3. Tumor cell products: oncofetal antigens, enzymes, Igs, excess of normal hormone, ectopic hormone

Front 53

Describe well-differentiated, poorly-differentiated, and anaplastic neoplasms in terms of benign or malignant, and slow growing or aggressive.

Back 53

Well-differentiated: typically benign or slow-growing malignant

Poorly differentiated: malignant, aggressive

Anaplastic: Very aggressive and malignant

Front 54

What is a neoplasm called with it is intraepithelial?

Back 54

In situ

Front 55

Describe some paraneoplastic syndromes associated with cancer.

Back 55

Anemias, purpura (low platelets), myopathy, neuropathy, myasthenia gravis, gout, hormonal syndromes, pyrexia, non-infective endocarditis, cachexia