7.1 Benign vs Malignant

Question 1

Which of the following is true of the nomenclature of benign tumors generally, and most often tumors of mesenchymal cells?

A. Based on cell origin

B. Based on microscopic features

C. Based on macroscopic architecture

D. Cell type is given the suffix -oma

Answer 1

D. Cell type is given the suffix -oma

NOTE: A-C are true of benign tumors of epithelial cells

ex. of mesenchymal cells
- fibroma, chondroma, etc

Question 2

What is the name of epithelial neoplasms that are derived from glands or from glandular structures?

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

E. Polyps

Answer 2

Adenomas

Question 3

What is the name of epithelial neoplasms that produce microscopic or macroscopic finger-like projections from the epithelial surface?

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

E. Polyps

Answer 3

Papillomas

Question 4

Epithelial neoplasm that form cytic massess are called?

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

E. Polyps

F. None of the above

Answer 4

None of the above

NOTE: they’re called cystadenomas

Question 5

Tunors that produce papillary patterns that protrude into cystic spaces are called?

A. Papillomas

B. Adenomatous polyps

C. Papillary cystadenomas

D. Adenomas

E. Polyps

F. None of the above

Answer 5

Papillary cystadenomas

Question 6

A malignant or benign epithelial neoplasm that produces visible macroscopic projections that project above the mucosal surface are called what?

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

E. Polyps

F. None of the above

Answer 6

Polyps

Question 7

All neoplasms, whether benign or malignant, are called ______ if they produce a macroscopically visible projection that goes through the mucosa and contains glandular tissue.

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

E. Polyps

F. None of the above

Answer 7

B. Adenomatous polyps

NOTE: whether the prjecting tumor contains glandular tissue or not determines if its an adenomatous polyp or not

Question 8

A tumor is derived from renal tubular cellls that produce glandular cell clusters that are microscopically visible. What should this benign tissue be called?

A. Papillomas

B. Adenomatous polyps

C. Papillary cytadenomas

D. Adenomas

Answer 8

Adenoma

Question 9

All tumors have two basic components: Parenchymal and Stromal

Which component is associated with the biological behavior and classification of the tumor cells?

Which component is associated with the growth and mobility of the tumor cells?

Answer 9

Which component is associated with the biological behavior and classification of the tumor cells?

parenchymal

Which component is associated with the growth and mobility of the tumor cells?

stromal

NOTE: stromal refers to the blood vessels, connective tissue, and immune cells involved

Question 10

Malignant tumors arising in solid mesenchymal tissue are usually called what? What’s an example?

A. Carcinomas

B. Sarcomas

C. Leukemias or Lymphomas

D. None of the above

Answer 10

Sarcomas

Fibrosarcomas and Chondrosarcomas

Question 11

Malignant tumors arising from epithelial cells, which can be derived from any of the 3 germ layers are termed?

A. Carcinomas

B. Sarcomas

C. Leukemias or Lymphomas

D. None of the above

Answer 11

Carcinomas

NOTE: carcinomas can be further classified based on the epithelial cell the carcinoma resembles

ex. squamous cell carcinoma

NOTE: It can be even further classified based on tissue or organ origin

ex. bronchogenic squamous cell carcinoma

Question 12

Malignant tumors that arise in hematopoitic cells are called?

A. Carcinomas

B. Sarcomas

C. Leukemias or Lymphomas

D. None of the above

Answer 12

C. Leukemias or Lymphomas

Question 13

What is the name of a tumor, that arises from a salivary gland, and contains epithelial and myoepithelial cells thus allowing it to have epithelial components amongts myxoid stroma?

A. Adenoma

B. Carcinoma

C. Pleomorphic adenoma

D. Cystadenomas

Answer 13

C. Pleomorphic adenoma

NOTE: This is a mixed tumor

Question 14

Normally mixed tumors, while containing mixed elements, usually are made up of cells derived from 1 germ line. An exception to the mixed tumor rule, is a teratoma which originates from totipotent germ cells. A common example of a teratoma is the Ovarian Cystic teratoma. Which of the following correctly describes the ovarian cystic teratoma?

A. Composed of epithelial components scattered within a myxoid stroma containing bone and cartilage

B. Neoplasms differentiate along the mesodermal line to create a cystic tumor lined with skin, sebacceous glands, and teeth

C. Tumor cells differentiate along the endodermal line to create a cystic tumor lined with skin, sebacceous glands, and teeth

D. Neoplasms differentiate along the ectodermal line to create a cystic tumor lined with skin, sebacceous glands, and teeth

Answer 14

D. Neoplasms differentiate along the ectodermal line to create a cystic tumor lined with skin, sebacceous glands, and teeth

To say “ecto” you have to use your teeth, just like that ovarian cystic teratoma

Question 15

Name the 4 examples of malignant tumors that were given benign sounding terminologies. Hints included below

1. Malignant tumor of lymphoid tissue:
2. MAlignant tumor of melanocytes:
3. Maligenant tumor of mesothelium:
4. Malignant tumor of testicular epithelium:

Answer 15

1. Malignant tumor of lymphoid tissue: lymphoma
2. MAlignant tumor of melanocytes: melanoma
3. Maligenant tumor of mesothelium: mesothelioma
4. Malignant tumor of testicular epithelium: seminoma

Poorly named malignant tumors Lyft Me Spirits Mistakenly

Question 16

All of the following are useful discriminators when trying to distinguish between benign and malignant tumors, EXCEPT?

A. Anatomical features

B. Growth rate

C. Histological features

D. All the above are good discriminators

Answer 16

B. Growth rate

Question 17

Why are benign tumors are usually considered well differentiated?

What clues are available to help distinguish benign tumors?

Answer 17

The parenchymal cells of benign tumors tend to have little microscopic difference than their normal counterparts

Some clues can be found in the growth of the cells into masses

NOTE: In well-differentiated benign tumors mitoses are rare and cell divisions are of normal configuration

Question 18

Which of the following is a hallmark of malignancy?

A. Partial differentiation

B. Reversal of differentation

C. Complete differentiation

D. Lack of differentiation

E. All of the above

F. All except C

Answer 18

All except C

NOTE: D is the definition of anaplasia, and B is a direct translation of anaplasia

Question 19

Which of the following nuceli to cytoplasm ratios is characteristic of malignant anaplastic neoplasms?

A. 1:6

B. 1:5

C. 1:4

D. 1:1

Answer 19

D. 1:1

Thats right, the nuclei are often LARGEEEE, as well as often darkly stained

Question 20

Which of the following does mitoses absolutely indicate in a cell?

A. Malignancy

B. Rapid cell growth

C. Benign nature

D. All of the above

Answer 20

B. Rapid cell growth

Question 21

Which of the following is an important morphological figure of malignancy?

A. Mitoses

B. Atypical mitotic figures

C. Cells with tripolar, quadripolar, or multipolar spindles

D. All but A

E. None of the above

Answer 21

All but A

Question 22

Dysplasia means “disordered growth” and normally is encountered in what cell type?

Dysplasia includes a constellation of changes that include loss of what 2 things?

Answer 22

Epithelial cells

Loss of uniformity

Loss of architectural orientation

Question 23

Which of the following correctly characterizes the evolution of dysplasia in squamous epithelium?

A. Replacement of squamous epithelium with a stratified squamous that is more suited for the rough environment

B. Tall cells from the basal layer become flattened squames over time with an abundance of mitotic figures seen at the basal level

C. Tall cells with hypochromatic nuceli populate the surface with an abundance of mitotic figures seen at all cell levels

D. Tall cells with hyperchromatic nuclei populate the surface with an abundance of mitotic figures seen at all cell levels

Answer 23

D. Tall cells with hyperchromatic nuclei populate the surface with an abundance of mitotic figures seen at all cell levels

NOTE:

A is referring to metaplasia

B is refering to normal squamous epithelial growth

Question 24

Which of the following descriptions correctly describes Carcinoma In Situ?

A. The tumor has not yet breached the basement membrane but dysplastic changes can be seen in all layers of the epithelium

B. The tumor has breached the basement membrane and dysplastic changes can be seen in all layers of the epithelium

C. The tumor has not yet breached the basement membrane, and dysplastic changes can only be seen in the majority of the epithelial layers

D. Regardless of the level of dysplastic changes in the epithelial layers, the tumor has not yet invaded through the basement membrane

Answer 24

A. The tumor has not yet breached the basement membrane but dysplastic changes can be seen in all layers of the epithelium

NOTE: the left figure depicts a carcinoma in situ which is also called a pre-invasive neoplasm

Question 25

T/F: Like that of long time smokers and people with Barrets Esophagus, dysplasia often predates the appearance of cancer

Answer 25

True NOTE: although dysplasia is a precursor to malignant transformation, it does not always progress to cancer

Question 26

T/F: All dysplasia often occurs in metaplastic epithelium, but not all metaplastic epithelium is dysplastic

Answer 26

True

Question 27

Due to the slow growth of benign tumors, as a response to pressure and hypoxia, the tumors stromal cells release extracell matrix that encapsulates the growth in a fibrous capsule. All of the following are true of the affects of this capsule EXCEPT? A. Makes the tumor palpable B. Makes the tumor easy to remove surgically C. Makes the tumor mobile locally D. PRevents the tumor from growing further

Answer 27

D. Prevents the tumor from growing further NOTE: the exception to these influences is seen in hemangiomas, which are uncapsulated

Question 28

Histologically, pseudocapsulated masses always show a row of cell penetrating the margin and infiltrating adjacent structures in a crab-like growth pattern. Which of the following cells are we most likely to see pseudocapsulated masses? A. Rapidly growing benign tumors B. Rapidly growing malignant tumors C. Slow growing benign tumors D. Slow growing malignant tumors

Answer 28

D. Slow growing malignant tumors

Question 29

Next to metastases, what is the most reliable feature that differentiates cancers from benign tumors, and yields to the reason resection of malignant tumors are damn near impossible?

Answer 29

Invasivness

Question 30

In general, though there are many exceptions, the likilihood of metastes correlates with what 4 things?

Answer 30

Anaplasia (lack of differentiation) Agreesive invasion Rapid Growth Large Size *Metasteses are like a good basketball player. "If he's big, fast, an agressive penetrator, and not like other normal atheletes, then he's going places"*

Question 31

About 30% of solid tumors present with metastases, with the exception of what class of solid tumors? What is the exception that is highly metastatic in that class of solid tumors?

Answer 31

Skin cancers Melanoma

Question 32

What are the 3 potential pathways utilized by disseminated cancers? Which one is the most common pathway for initial dissemination of carcinomas? Which one is it more typical for sarcomas to use than carcinomas?

Answer 32

What are the 3 potential pathways utilized by disseminated cancers? **Open space/cavities, Lymphatics, Blood vessels** Which one is the most common pathway for initial dissemination of carcinomas? **Lymphatics** Which one is it more typical for sarcomas to use than carcinomas? **Blood vessels**

Question 33

Which of the following is true regardinf hematogenous spread of disseminated cancers? A. Arteries are more often penetrated vs. veins B. Venous spread only occurs if the tumor can pass through the pulmonary capillary beds C. Venous flow we often see the tumor cells rest at the first capillary bed they encounter D. Liver and lungs are the most frequent site of tumor travel destinations E. All except A F. C and D

Answer 33

C and D C. Venous flow we often see the tumor cells rest at the first capillary bed they encounter D. Liver and lungs are the most frequent site of tumor travel destinations

Question 34

Cancers of the upper quadrants like breast cancer are most often sent to axillary lymph nodes, while cancers of inner quadrants are sent to which of the following lymph nodes? A. LN along the internal mammilary arteries B. Perihilar Trachobronchial LNs C. Mediastinal LNs D. All except A E. A and B F. B and C

Answer 34

A. LN along the internal mammilary arteries NOTE: B and C are utilized by cancers of the lungs

Question 35

Look at this

Answer 35

Look at this too