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Goljan Path > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

Benign vs. malignant

A

Benign usually doesn’t metastasize. Malignant has the capacity to metastasize. Exceptions occur.

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2
Q

Leiomyoma - most common benign tumor in a woman

A

Tumor of smooth muscle. “Fibroids.” Don’t become leiomyosarcomas.

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3
Q

Most common benign tumor in a man

A

Lipoma.

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4
Q

Benign tumor of glands

A

Adenoma.

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5
Q

Tubular adenoma

A

Most common precursor for colon ca. Strawberry on a stick.

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6
Q

Carcinoma vs. sarcoma

A

Carcinoma is a malignancy of epithelial tissues (squamous, glandular, transitional). Squamous (Keratinous pearls, Adenocarcinoma (glands with things inside).

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7
Q

Melanoma

A

Melanocyte. Benign lesion = Nevus. APUD - neurosecretory origin. Have neurosecretory granules. S100 antigen. APUD (small cell carcinoma, melanoma, bronchiocarcinoid, carcinoid, neuroblastoma)

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8
Q

Sarcoma

A

Malignancy of mesenchymal tissue.

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9
Q

Osteogenic sarcoma

A

Sunburst

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10
Q

Bx of girl w/ mass coming out

A

vimentin neg, keratin neg, desmin positive. Embyronal myosarcoma - most common cancer of children.

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11
Q

Leiomyosarcoma vs. rhabdomyosarcoma

A

Smooth muscle vs. striated muscle sarcoma

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12
Q

Mixed tumor

A

Parotid gland. Pleomorphic adenoma. NOT teratoma b/c derived from SAME cell layer. 2 different types of tissues.

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13
Q

Teratoma

A

Germ cell tumors from all cell layers.

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14
Q

Leukemia vs. Lymphoma

A

Auer rod (AML). Hypersegmented neutrophils (B12-folate). Leukemia is a malignancy of stem cells of bone marrow. Malignant lymphomas come from lymph nodes (can metastases to bone marrow).

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15
Q

Most common site for lymphoma NOT in LN.

A

Stomach. H. pylori. 2nd most = Peyer’s patches in the Terminal ileum

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16
Q

Most common lymphoma

A

Follicular B-cell lymphoma. t(14;18) -> BCL-2 -> Inactivates apoptosis gene

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17
Q

Trophoblastic tumors

A

Hydatiform mole (bunch of grapes), PEC in 1 TM presentation w/ uterus is too large. (Mole = benign tumor of the chorionic villus.) Villi are lined by syncytial trophoblast [outside for o2 extraction] and cytotrophoblast, wharton’s jelly, vessel = umbilical vein (most o2 for fetus). Choriocarcinoma = malignancy of the LINING (syncytio and cytotrophoblast). Syncytiotrophoblast makes Beta-HCG and human placental lactogen.

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18
Q

Things that end in -oma are not necessarily benign or even a neoplasm.

A

Melanoma. lymphoma. Non-neoplastic –> Hamartoma = overgrowth of tissue in the place it SHOULD be. (e.g. bronchial hamartoma - coin lesion; polyp of Putz-Jegher’s syndrome). Choristoma = benign tissue in wrong place. e.g. Meckel’s diverticulum - gastric or pancreatic mucosa in small bowel bleed.

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19
Q

“Cancer”

A

Increased mitotic rate does NOT mean cancer. Atypical mitotic spindle is suggestive (aneupleid). Malignant = ability to metastasize. Longer cell cycle than cell that derived.

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20
Q

Doubling times before clinical detection

A

THIRTY. Tumor about 1 cm in size.

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21
Q

Tumor cells

A

LACK adhesion. Anaerobic metabolism. Lots of enzymes (protreases = breakthrough tissue; collagenase for BM breakdown)

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22
Q

Metastasis

A

Three types: lymphatic, hematogenous, seeding; Carcinomas usu. metasasize via LN’s (breast -> axillary) at the SUBCAPSULAR sinus. If they get through efferent to thoracic duct - > subclavian -> eventually hematogenous. Hematogenous = BAD. bone, liver. Sarcomas go straight through blood vessels and metastasize hematogenously (lungs and bones). Harder to detect. (e.g. radical dissection of breast isn’t need to angiosarcoma of breast). LOTS of exceptions.

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23
Q

Renal adenocarcinoma

A

Goes to renal vein directly.

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24
Q

HCC

A

Like to invade vessels.

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25
Q

Seeding

A

Cancers in cavities = ovarian cancer (b/c they’re mostly SURFACE-derived cancer. Omentum, pouch of douglas. Seeding in pleural cavity. Glioblastoma multiforme –> seed into spinal cord (leptomeningeal carcinomatosis).

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26
Q

Always asks if metastasis is more common than primary cancer?

A

Renal adenocarcinoma is an exception. Most common lung cancer is breast cancer metastasis. Most common cancer of bone is metastasis (breast cancer; BATSON venous plexus - venous from base of skull to sacrum has NO valves). For bone, vertebral column and head of femur are the most common locations.

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27
Q

Most common cancer of liver?

A

Lung and colon cancer.

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28
Q

Testicular cancer metastasize to?

A

Para-aortic LN’s (b/c descended).

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29
Q

Left supraclavicular node

A

VIRCHOW’s node = STOMACH. Visceral.

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30
Q

Lytic metastasis and blastic metastasis.

A

MM = PUNCH out lesions. Plasma cells have IL-1 (osteoclast-activating factor!) HyperCa. Osteoblastic response? Prostate cancer is osteoblastic. Release AlkPhos. Lytic = lucency. Blastic = entity. (on x-ray)

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31
Q

Multiple lesions on anything

A

THINK Metastasis.

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32
Q

Adrenal gland metastases

A

Lung cancer

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33
Q

Desmin stain

A

Muscle

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34
Q

Keratin

A

Carcinomas

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35
Q

EM is rare

A

APUT tumor for neurosecretory granules. Histiocytosis X tumor - Birbeck granules; CD1. Muscle = actin and myosin. Vascular = Weibell-Palade bodies? (Vwf)

36
Q

Oncogenesis steps

A

Initiation = mutation. Promoted = multiple copies of mutation. Progression = sub-specializing cells (invasion, metastasis, stay, resist chemo).

37
Q

Protooncogenes

A

Proto-oncogenes are normally regular cell-cycle stuff. Cis = makes growth factors. ERB-2=HER2 (breast cancer) - codes for a receptor. RET = MEN syndromes (1&2) = receptors. Messenger genes. RAS = GTP messenger (cell-membrane). ABL = cytosolic messenger system. Nuclear receptors that are transcription factors. N-myc (neuroblastoma) and C-myc (Burkitt’s).

38
Q

Proto-oncogenes

A

Proto-oncogenes are normally regular cell-cycle stuff. Cis = makes growth factors. ERB-2=HER2 (breast cancer) - codes for a receptor. RET = MEN syndromes (1&2) = receptors. Messenger genes. RAS = GTP messenger (cell-membrane). ABL = cytosolic messenger system. Nuclear receptors that are transcription factors. N-myc (neuroblastoma) and C-myc (Burkitt’s).

39
Q

Tumor suppressor genes

A

Rb and p53. ALL point mutations.

40
Q

Initiation

A

Mechanisms of mutations? Most common = POINT mutation (e.g. p53 and RAS). Amplification = multiple copies of gene (HER2). TRANSLOCATION

41
Q

Translocations

A

CML = translocation of ABL to BCR = t(9;22) = Phildaelphia chromosome. Burkit’s = EBV-associated where C-myc t(8;14); EBV receptor is CD21 on B-cells -> plasma cells. EBV stimulates divisions. t(14;18) = B-cell lymphoma. t(15;17) = Acute promyelocytic leukemia (tx = retinoic acid by maturing the cell into a benign one)

42
Q

Tumor suppressors

A

APC for FAM. NF. Wilms tumor. BRCA1/2 (DNA repair) - 1 is breast/ovarian and others.

43
Q

Etios of initiation

A

Chemicals, viruses, radiation. CHEMICALS is most common cause (e.g. smoking - polycyclic hydrocarbons)

44
Q

Papillary tumor of bladder

A

Smoking. Analine. Cyclophosphamide.

45
Q

Kaposi’s sarcoma

A

HHV-8.

46
Q

HCC

A

Aflatoxin B + HBV = Lots of HCC in Asia.

47
Q

HIV-associated cancers

A

Primary CNS lymphoma.

48
Q

HPV

A

Squamous cancers. Genes. E6 knocks off p53. E7 knocks off Rb.

49
Q

Radiation

A

Leukemia. CML is most. t (9;22) = ABL. Papillary carcinoma of the thyroid. Osteogenic sarcoma

50
Q

Non-ionizing radiation. UV B. B is Bad.

A

UV A = Wood’s light (dermatology - Shagreen’s patches, dermatopyosis). Basal cell carcinoma.

51
Q

Actinic keritosis

A

Solar keratosis —> Squamous cell carcinoma (3-4%). Scrapes off and comes back off. Arsenic (Bangladesh - angiosarcoma of liver, lung cancer, squamous cell carcinoma)

52
Q

Retinoblastoma

A

Chromosome 13. Sporadic (TWO HITS) and familial (1 HIT req.) White eye reflex (most common of this is congenital cataracts - e.g. rubella, CMV).

53
Q

Xeroderma pigmentosa

A

Nuclear. UV. Nuclear excision repair (not base).

54
Q

Scar cancers in lung

A

Adenocarcinomas not squamous (like in the skin - burns, keloids, draining sinus tracts)

55
Q

Helicobacter pylori associated cancers

A

Adenocarcinoma and low-grade malignant lymphomas

56
Q

Grade

A

Grade = what it looks like. Well-differentiated = LOW-grade. Most things that look weird = anapestic = High-grade

57
Q

Stage

A

TNM. T = tumor size. 2 cm generally cut-off. N = nodes. M = metastases outside of nodes; biggest prognostic factor.

58
Q

Most important host defense system?

A

CD8+. Look for MHC I changes. Perforin for caspases to apoptosize.

59
Q

Most common anemia of malignancy

A

Anemia of chronic disease.

60
Q

Most common anemia of malignancy

A

Anemia of chronic disease.

61
Q

Most patients with disseminated cancer are hyper-coagulable and thrombocytosis

A

Trousseau sign? Vascular problem in vein jumps from one to another. (Migratory thrombophlebitis)

62
Q

Most common cause of fever in malignancy

A

Gram NEG. E. coli (catheter), Pseudomonas (resp)

63
Q

Paraneoplastic syndromes

A

Signs +/- symptoms that might say that a cancer is present.

64
Q

Most common paraneoplastic syndrome

A

Hypercalcemia. PTHrP (acts like PTH)

65
Q

Multiple outcroppings of Seborrheic keratosis or Acanthosis nigricans (Leser-Trelat sign)

A

Is a gastric adenocarcinoma marker.

66
Q

Connective tissue disease associated with cancer

A

Dermatomyositis. Leukemia, lymphoma.

67
Q

Vegetations on MV. Sterile. Mucus-producing cancers (colon cancer)

A

Colon cancer. Marantic endocarditis.

68
Q

HypoNa OR Cushings

A

Small cell carcinoma. ADH and ACTH. APUT tumors. S100 +. Neural crest origin. Neurosecretory granules on EM

69
Q

HyperCA or 2 polycythemia.

A

Renal adenocarcinoma. PTHrP and EPO.

70
Q

Hypoglycemia or 2 polycythemia

A

HCC. EPO. Insulin-like factor.

71
Q

HypoCa or Cushings?

A

Medullary carcinoma of the thyroid. Calcitonin is the tumor marker.

72
Q

Two tumor markers with testicular cancer

A

Alpha-fetoprotein. HCG. AFP is a marker for yolk-sac tumor = endodermal sinus tumor. AFP is the albumin of a fetus. AFP is also associated with HCC. Open-neural tube (Folate). AFP is DOWN in DOWN’s.

73
Q

Marker for malignancy of bone associated with monoclonal spike

A

Bence-Jones protein. MM. BJ is light chain of immunoglobulin.

74
Q

Tumor marker for prostate cancer

A

PSH. Not specific b/c BPH. Sensitive but NOT specific.

75
Q

Breast cancer - surfaced derived

A

CEA-15-2

76
Q

Ovarian cancer

A

CEA-125

77
Q

Carcinoembryonic Ag (CEA)

A

For Colon cancer, small cell, and breast. CEA ic –> nephrotic syndrome = diffuse membranous glomerulonephritis

78
Q

Breast cancer - surfaced derived

A

CEA-15-2

79
Q

Ovarian cancer

A

CEA-125

80
Q

Carcinoembryonic Ag (CEA)

A

For Colon cancer, small cell, and breast. CEA IC –> nephrotic syndrome = diffuse membranous glomerulonephritis

81
Q

Trophoblastic tumor

A

B-HCG

82
Q

Primary tumor of the brain in kids

A

Cerebellar cystic astrocytoma (benign). Most common cancer is medulloblastoma (cerebellum)

83
Q

Most common childhood cancer

A

ALL.

84
Q

Incidence of cancer?

A
  1. Breast 2. lung 3. colon; men 1. prostate 2. lung 3. colon
85
Q

GYN Cancers

A

Most common = endometrial cancer (but BEST prognosis). 2. ovarian. 3. cervical (pap smears).

Goljan Path (9 decks)

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