Pathoma - Chapter 3 - Neoplasia

Front 1

What does the word neoplasia mean?

Back 1

Neo means new
Plasia means growth

Front 2

What are some basic principles and important things to realize regarding neoplasia?

Back 2

(1) New tissue growth
(2) It is unregulated
(3) It is irreversible
(4) It is monoclonal

Front 3

What does "monoclonal" mean in the context of neoplasia?

Back 3

All the tumor cells (both benign and malignant) arise from one single progenitor/mother cell.

Front 4

What does it mean that G6PD ratio in a cell population is 1:1 in a female?

Back 4

It means that G6PD isoforms in a woman (from mom and dad) are equally distributed, telling us that this is a polyclonal proliferation of cells.

Front 5

How could we prove monoclonality in a female?

Back 5

Look at G6PD isoforms. It is expressed on the X-chromosomes. The tumor would originate from one cell, giving rise to a tumor cell population with only one isoform of G6PD, and not the normal mosaic of isoforms.

Front 6

The suffix -oma generally indicates a ____________.

Back 6

benign tumor

Front 7

Benign tumors of connective tissue origin derive from ________. Provide an example.

Back 7

mesoderm

Lipoma from adipose.

Front 8

What markers can be used to determine clonality in a tumor in a male?

Back 8

Androgen receptor isoform

Front 9

How could you determine the clonality of B-cells?

Back 9

It's determined by Ig light chains.

1. Ig is comprised of heavy and light chains.
2. Each B cell expresses light chain that is either kappa or lambda.
3. Normal kappa to lambda light chain ratio is 3:1.
4. This ratio is maintained in hyperplasia, which is polyclonal.
5. Ratio increases to > 6:1 or is inverted (e.g., kappa to lambda ratio = 1:3) in lymphoma, which is monoclonal.

Front 10

What are the three things that can cause a lymph node to grow?

Back 10

(1) Metastatic CA
(2) Reactive hyperplasia (due to infection)
(3) Lymphoma

Front 11

Compare benign and malignant and benign tumors.

Back 11

Benign tumors remain locally and do not metastasize.

Metastatic tumors (cancer) invade locally and have the potential to metastasize.

Front 12

What is an adenoma?

Back 12

Benign tumor of epithelium that creates glands.

Front 13

What is a papilloma?

Back 13

Benign tumor of epithelial origin that creates papillary finger-like structures (connective tissue core with blood vessel in the center, covered by epithelium)

Front 14

A benign tumor of melanocytes is called a __________, a malignant tumor of melanocytes is called a ___________.

Back 14

nevus (mole); melanoma

Front 15

Talk on the epidemiology of cancer.

Back 15

(1) 2nd leading cause of death in adults and chilldren.

(2) The leading causes of death in adults are (1) cardiovascular disease, (2) cancer, and (3) cerebrovascular disease.

(3) The leading causes of death in children are (1) accidents, (2} cancer, and (3) congenital defects.

Front 16

What are the most common cancers by incidence in adults? What are the most common causes of cancer mortality in adults?

Back 16

This is excluding skin cancers, because they rarely metastasize, are easily treated.

Front 17

How do you screen for lung cancer?

Back 17

You don't. There is no practical screening methodology. We can't pick up lung cancer early. That's why it usually presents late, with a poor prognosis (high on mortality list).

Front 18

What is the 5-year survival for lung cancers?

Back 18

Roughly 15%

Front 19

Cancer begins as a _____________.

Back 19

single cell

Front 20

How many divions have to occur before the average tumor reveals early clinical symptoms?

Back 20

Approximately 30 divisions must occur before the earliest symptoms arise.

Front 21

With each division of a cancer cell, there will be ____________.

Back 21

increased mutations

Front 22

Some tumors, such as ovarian tumors, have a large area to grow in before any clinical symptoms appear. Why is this dangerous?

Back 22

It means the tumor will have undergone more divisions and produced more mutations. Ovarian carcinoma generally has a poor prognosis. Pancreatic carcinoma and lung carcinoma as well.

Front 23

What's the goal of screening?

Back 23

(1) Catch dysplasia before it becomes cancer
(2) Detect CA before it produces clinical symptoms

Front 24

Well differentiated tumor means that the tumor ___________.

Back 24

resembles its parent tissue.

Front 25

What would be an example of a malignant tumor that is well differentiated or low grade?

Back 25

Example—produce keratin pearls or glandular lumens with secretions

Front 26

30 divisions of cancer cells is equivalent to?

Back 26

Equivalent to 10^9 cells, 1 g of tissue, volume of 1 mL.

Front 27

What cancer is increasing at the most rapid rate of all cancers?

Back 27

Malignant melanoma

Front 28

What is a preventive measure for colorectal cancer?

Back 28

Increase fiber/decrease dietary saturated animal fat.

Front 29

Inherited predisposition to cancer accounts for ____% of all cancers.

Back 29

5%

Front 30

What are some AD cancer syndromes?

Back 30

Retinoblastoma
• Inactivated RB on c13.
• Predisposed for osteogenic sarcoma in adolescence

FAP
• Inactivated APC (5q21) suppressor

Li-Fraumeni
• Inactivated P53 suppressor
• Increased risk for CA, SA and leukemias

HNCC (Lynch syndrome)
• Inactivated DNA mismatch repair genes
• Predisposed to colorectal cancer.

BRCA1/BRCA2 genes
• Inactivation lead to predisposition to breast & ovarian CA

Front 31

Lynch syndrome and FAP both produce colorectal CA, but what is one big difference in how these cancers appear?

Back 31

In Lynch syndrome (HNPCC), the colorectal CA arise WITHOUT previous polyps. In FAP there are many polyps.

Front 32

What are some AR cancer syndromes?

Back 32

Xeroderma pigmentosum
Chromosome instability syndromes
• Susceptible to dmg by ionizing radiation and drugs

Front 33

What are familial cancer syndromes?

Back 33

No defined pattern of inheritance, but cancers (e.g., breast, ovary, colon) develop with increased frequency in families; sometimes involves BRCA1 and BRCA2 genes.

Front 34

What ethnic group is at highest risk for cancer and death from cancer? Does it apply to all cancers?

Back 34

Blacks. All except malignant melanoma.

Front 35

Relative risk measure what? Provide example.

Back 35

The strength of a relationship between risk factors and a particular cancer. Compares risk of developing CA in individuals at risk with those that are not.

Male smokers have 23 times greater risk than male nonsmokers; relative risk is 23.

Front 36

Metastasis is often more common than a primary cancer in:

Back 36

a. Lymph nodes (e.g., metasiaiic breast and hmg cancer)
b. Lungs (e.g., metastatic breast cancer)
c. liver (e.g.. metastatic lung cancer)
d. bone (e.g.. metastatic breast cancer)
e. Brain (e.g.. metastatic lung cancer)

Front 37

The most common metastatic site in bone is? Why is this site such a common site?

Back 37

Vertebral column. Due to the Batson paravertebral venous plexus.

Front 38

How can breast, lung and prostate cancer metastasize to the brain?

Back 38

Internal vertebral-, external vertebral venous plexus and basivertebral vv. (connecting the two) surrounding the column communicate with dural sinuses and vv. of the thorax, abdomen and pelvis.

Front 39

Osteoblastic melastasis increases serum ________________.

Back 39

alkaline phosphatase

Front 40

What is seeding?

Back 40

Malignant cells exfoliate from a surface and implant and invade tissue in a body cavity.

Front 41

Give three examples of seeding.

Back 41

• Primary surface-derived ovarian cancers (e.g., serous cystadenocareinoma) commonly seed the omentum.
• Peripherally located lung cancers commonly seed the parietal and visceral pleurae.
• Glioblastoma multiforme commonly seeds the cerebrospinal lluid causing spread to the brain and spinal cord.

Front 42

The usual mechanism of dissemination of sarcomas is __________.

Back 42

hematogenous

Front 43

What are the first line of defense (forsvarslinje) against the spread of carcinoma?

Back 43

Regional lymph nodes. After architecture is destroyed, they enter efferent lymphatics.

Front 44

The usual mechanism of dissemination of carcinomas is _____________.

Back 44

lymphatic spread to lymph nodes

Front 45

Some tissues resist invasion. They are?

Back 45

• Mature cartilage
• Elastic tissue in arteries

Front 46

Benign tumors are usually enclosed by a ___________. An exception is __________.

Back 46

fibrous capsule; uterine leiomyomas do not have a fibrous capsule.

Front 47

What does telomerase do?

Back 47

Preserves length of telomeres.

Front 48

Malignant tumor have _________ (normal/increased) telomerase activity.

Back 48

increased

Front 49

These two are not tumors, but tumor-like "conditions". Give examples.

Back 49

1. Hamartoma
• Non-neoplastic overgrowth of disorganized tissue indigenous to a particular site
• Examples—bronchial hamartoma (contains cartilage), Peutz-Jeghers polyp

2. Choristoma (heterotopic rest)
• Non-neoplastic normal tissue in a foreign location
• Examples—pancreatic tissue in the stomach wall, parietal cells in Meckel
diverticulum
Properties of Benign

Front 50

Where do we see teratomas?

Back 50

• Ovaries
• Testes
• Anterior mediastinum
• Pineal gland

Front 51

What is a hamartoma? Provide examples.

Back 51

It's an overgrowth that is non-neoplastic, and the tissue is indigenous to its site.

Examples—bronchial hamartoma (contains cartilage). Peutz-Jeghers polyp

Front 52

What is a choristoma? Provide examples.

Back 52

It's a tissue that is non-neoplastic, and in a foreign location ("Normal tissue where it should not be").

Examples—pancreatic tissue in the stomach wall, parietal cells in Meckel diverticulum

Front 53

What is another term for choristoma?

Back 53

Heterotopic rest