PATHOLOGY
Neoplastic
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Define grade :
-?- grade is the histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation & number of mitoses per high-power field; character of tumor itself
Define stage :
-?- stage is based on site & and size of 1° lesion, spread to regional lymph nodes, presence of metastases; spread of tumor in a specific patient
Match condition to neoplasm
(not all items are used/no item used more than once)
-?- immunodeficiency states malignant lymphomas
-?- Barrett's esophagus esophageal adenocarcinoma
-?- acanthosis nigricans visceral malignancy
-?- actinic keratosis squamous cell carcinoma of skin
-?- Down syndrome acute lymphoblastic leukemia
-?- Paget's disease of bone 2° osteosarcoma & fibrosarcoma
-?- chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants gastric adenocarcinoma
-?- Plummer-Vinson syndrome squamous cell carcinoma of esophagus
-?- tuberous sclerosis astrocytoma & cardiac rhabdomyoma
-?- Xeroderma pigmentosum squamous cell & basal cell carcinomas of skin
Down syndrome
Xeroderma pigmentosum
chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants
tuberous sclerosis
actinic keratosis
Barrett's esophagus
Plummer-Vinson syndrome
cirrhosis
ulcerative colitis
Paget's disease of bone
immunodeficiency states
AIDS
autoimmune diseases
acanthosis nigricans
dysplastic nevus
Oncogenes
Match gene to the associated tumor
-?- L-myc lung tumor
-?- c-myc Burkitt's lymphoma
-?- bcl-2 follicular & undifferentiated lymphomas (inhibits apoptosis)
-?- ret multiple endocrine neoplasia (MEN) types II & III
-?- erb B2 breast, ovarian, and gastric carcinomas
-?- ras colon carcinoma
-?- N-myc neuroblastoma
c-myc bcl-2 erb B2 ras L-myc N-myc ret
Name tumor associated with gene & chromosome:
-?- retinoblastoma, osteosarcoma Rb, 13Q
-?- breast & ovarian cancer BRCA1 & 2, 17q, 13q
-?- most human cancers, Li-Fraumeni syndrome p53, 17p
-?- colorectal cancer APC, 5q
-?- Wilms tumor WT1, 11q
-?- neurofibromatosis type 1 NF1, 17q
-?- neurofibromatosis type 2 NF2, 22q
Name the tumor markers for the following:
-?- PSA prostate-specific antigen; prostatic carcinoma
-?- CEA carcinoembryonic antigen; very nonspecific but produced by ~ 70% of colorectal
& pancreatic cancers; also produced by gastric & breast carcinomas
-?- α-fetoprotein normally made by fetus; hepatocellular carcinomas; nonseminomatous germ cell
tumors of the testis (eg, yolk sac tumor)
-?- β-hCG hydatidiform moles, choriocarcinomas, & gestational trophoblastic tumors
-?- CA-125 ovarian, malignant epithelial tumors
-?- S-100 melanoma, neural tumors, astrocytomas
-?- alkaline phosphatase metastases to bone, obstructive biliary disease, Paget's disease of bone
-?- bombesin neuroblastoma, lung & gastric cancer
-?- TRAP tartrate-resistant acid phosphatase; hairy cell leukemia-a B-cell neoplasm
Matching: Oncogenic viruses
-?- HPV cervical carcinoma (16, 18), penile/anal carcinoma
-?- HTLV-1 adult T-cell leukemia
-?- HHV-8 Kaposi's sarcoma, body cavity fluid B cell lymphoma
-?- EBV Burkitt's lymphoma, nasopharyngeal carcinoma
-?- HBV, HCV hepatocellular carcinoma
HTLV-1
HBV, HCV
EBV
HPV
HHV-8
Matching: chemical carcinogens
-?- arsenick skin
-?- asbestos lung (mesothelioma & bronchogenic carcinoma)
-?- aflotoxins, vinyl chloride skin (squamous cell)
-?- nitrosamines esophagus, stomach
-?- naphthalene (aniline) dyes bladder (transitional cell carcinoma)
-?- CCI4 liver (centrilobular necrosis, fatty change)
aflotoxins, vinyl chloride
nitrosamines
asbestos
arsenick
CCI4
naphthalene (aniline) dyes
Matching: neoplastic, local effects of tumors
-?- seizures tumor mass in brain
-?- localized loss of sensory or motor function compression or destruction of nerve
-?- inflammation of serosal surface → pleural effusion, pericardial effusion, ascites
-?- hemorrhage from ulcerated area or eroded vessels
-?- mass tissue lump or tumor
-?- obstruction of left colon → constipation; of bronchus → pneumonia; of biliary tree → jaundice
-?- edema venous or lymphatic obstruction
-?- space-occupying lesion raised intracranial pressure with brain neoplasms; anemia due to bone marrow replacement
-?- nonhealing ulcer destruction of epithelial surfaces
-?- pain any site with sensory nerve endings; tumors in brain are initially painless
-?- perforation of ulcer inviscera → peritonitis, free air
-?- bone destruction pathologic fracture, collapse of bone
mass
nonhealing ulcer
hemorrhage
pain
seizures
obstruction
perforation
bone destruction
inflammation
space-occupying lesion
localized loss of sensory or motor function
edema
Prostatic adenocarcinoma:
Common in men > -?- 50
years of age; arises most often from the -?- posterior
lobe of the prostate gland and is most frequently diagnosed by digital rectal examination and prostate biopsy.
Skin cancer:
Squamous cell carcinoma is very common; associated with excessive exposure to
-?- sunlight and -?- arsenic exposure ;
locally invasive, but rarely
-?- metastasizes ; hitopathology:
keratin "-?- pearls ".
-?- basal cell carcinoma
most common in sun-exposed areas of body; locally invasive but almost never
-?- metastasizes ; gross pathology: pearly -?- papules .
Melanoma is a common tumor with significant risk of
-?- metastasizes ;
-?- depth of tumor correlates with risk of metastasis.
-?- Actinic keratosis
is a precursor to squamous cell carcinoma.
Basal cell tumors have "-?- palisading "
nuclei.
-?- Dysplastic nevus
is a precursor to melanoma.
Primary bone tumors:
-?- osteochondroma (exostosis) most common benign bone tumor
-?- giant cell tumor occurs most commonly at epiphyseal end of long bones
-?- osteosarcoma (osteogenic carcinoma) most common 1° malignant tumor of bone
-?- Ewings sarcoma anaplastic small blue cell malignant tumor
-?- chondrosarcoma malignant cartilaginous tumor
Matching: Primary brain tumors, adult peak incidence:
-?- oligodendroglioma relatively rare, slow growing, benign; most often in frontal lobes; "fried egg" cells
-?- pituitary adenoma prolactin secreting is most common form; bitemporal hemianopia &
hypopituitariasm are sequelae; derived from Rathke's pouch
-?- Schwannoma 3rd most common 1° brain tumor; often localized to 8th nerve; Antoni A loose pattern
-?- meningioma 2nd most common 1° brain tumor; most often occurs in convexities of
hemispheres & parasagittal region; psammoma bodies
-?- glioblastoma multiforme (grade IV astrocytoma) most common 1° brain tumor; prognosis grave; "pseudopalisading" tumor cells
glioblastoma multiforme (grade IV astrocytoma)
meningioma
Schwannoma
oligodendroglioma
pituitary adenoma
Matching: Primary brain tumors, childhood peak incidence:
-?- low-grade astroytoma (pilocytic astrocytoma) diffusely infiltrating glioma; in children, most often found in posterior
fossa; benign; good prognosis; Rosenthal fibers
-?- hemangioblastoma most often cerebellar; associated with von Hippel-Lindau syndrome when found
with retinoblastoma; foamy cells & high vascularity are characteristic
-?- medullo-blastoma highly malignant cerebellar tumor; a form of primitive neuroectodermal tumor
(PNET); can compress 4th ventricle, causing hydrocephalus; radiosensitive
-?- craniopharyngioma benign childhood tumore, confused with pituitary adenoma; calcification is
common; most common childhood supratentorial tumor
-?- ependymoma ependymal cell tumors most commonly found in 4th ventricle; can cause
hydrocephalus; rod-shaped blepharoblasts found near nucleus
low-grade astroytoma (pilocytic astrocytoma)
medullo-blastoma
ependymoma
hemangioblastoma
craniopharyngioma
Paraneoplastic effects of tumors:
NEOPLASM
CAUSES
EFFECT
Small cell lung carcinoma
-?- ACTH or ACTH-like peptide
Cushing's syndrome
-?- Small cell lung carcinoma & intracranial neoplasms
ADH or ANP
SIADH
Squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma & bone metastasis (lysed bone)
PTH-related peptide, TGF-α, TNF-α, IL-1
-?- Hypercalcemia
Renal cell carcinoma
-?- Erythropoietin
Polycythemia
Thymoma, brochogenic carcinoma
Antibodies against presynaptic Ca2+ channels at neuromuscular junction
-?- Lambert-Eaton syndrome (muscle weakness)
Various neoplasms
Hyperuricemia due to excess nucleic acid turnover (ie, cytotoxic therapy)
-?- Gout