5.10 Paths of Spread Flashcards Preview

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Flashcards in 5.10 Paths of Spread Deck (38):
1

Pathways of spread

local invasion, seeding of body cavities, lymphatic metastasis, hematogenous metastasis

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seeding of body cavities

occurs in ovarian and abdominal tumors_.things of spreading seeds everywhere and the tumors growing

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lymphatic metastasis is used to

stage the tumor. In breast tumors they are usually in the upper outer quadrant and drained by the axillary LN, so if you have a positive biopsy you want to evaluate the LN and see if you do or don't need adjuvant threrapy

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after distant metastasis

surgery is not an option and all you have left is chemotherapy

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of patients with lung cancer

95% are smokers

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percent of smokers that develop lung cancer

20%.....but with emphysema and additional problmes there is an additional 40% occurance of cancer

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helpful diagnostic lesions in the liver

coin lesions_.they could be granulomas so you ned to biopsy, see lots of seeding though

8

histological diagnosis of malignancy

there is no single parameter which allows one to diagnose a malignant neoplasm. However a pattern of invasiveness, histologic or cytologic anaplasia, and evidence for metastasis are the criteria which are most generally useful

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for primary diagnosis look at

HE stain

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benign neoplasms

remain localized to tissue of oritin, encapsulated (pusing borders), lack of invasiveness, slow or arrested growth, well differentiated (resembles normal tissues)

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encapsulation

seen in benign tumors as the grow, pusing against surrounding tissue, resulting in formation of a fibrous cap

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leiomyomas

smooth muscle tumors - benign - seen in uterine fibroids - will look like normal smooth muscle but with a little more density in nuclei

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danger of benign neoplasms

depends on location

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sypmptoms of uterine fibroids

inability to become pregnant, pain

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benign neoplasms lack

metastases

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do benign neoplasms result in death

not usually, but it depends on location

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benign neoplasm that causes problmes

meningioma - if it grows fast and big enough it will kill you by mass effect (not metastasis, endocrine tumors can over secrete things like insuline resulting in death

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benign neoplasms can often be cured by

simple surgical excision

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malignant neoplasms and surgery

cannot always perform surger, tumors are usually not fully treatable by surgery, often need chemo too

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anaplasia

lac of differentiation

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anaplastic cells are seen in

malignant neoplasms

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anaplastic cells generally lack

cytoplasmic features of differentiation

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an anaplastic skeletal muscle tumor can lose

muscle differentiation

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an anaplastic secretory cell can lose

secretory product

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morphologically anaplastic cells have

higher nuclear to cytoplasmic ratios, nuclear hyperchromasia, clumped chromatin, prominent nucleoli

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nuclear hyperchromasia

dark staining nucleus

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clumped chromatin

this is seen in anaplastic cells bc cells are rapidly actively dividing and making things

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anaplastic tumors often exhibit

pleomorphism (nuclear and cytoplasmic), frequent and sometimes abnormal mitosis, tumor giant cells

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pleomorphism

different shape - seen in malignant cells

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tumor giant cells

these are NOT fused like when macs fuse, instead these cells are just messed up bc they grow multiple nuclei without being lined up with mitosis

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suspect malignancy if yous see

tissue that is not supposed to be there

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where should you see lung glands?

in the submucosal glands of the large bronchi, so if you see them in the periphery, or paranchyma of the lung_.you know they shouldn_t be there

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cell features you need to pay attention to

shapes of nuclei, sizes of cells

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squamous cell metaplasia happens in

heavy smokers, marker of damage, will lead to squamous cell carinomma

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diff btw a leiomyosarcoma and Leiomyoma

a leioymyosarcoma will have a larger nucleus to cell ratio

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stain showing invasion of lymphatics predicts

high number of draining LN that will stain positive

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perineural invasion indicates

malignancy

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Dysplasia

abnormal growth