Cancer Pathology

Question 1

describe the dysplasia-carcinoma sequence

applies to many common carcinomas eg breast, bowel, oesophageal, cervical

Answer 1

• Gradual accumulation of mutations
• Progression of tumour phenotype
• Becomes more aggressive - gains invasive and metastatic potential.

Cell w mutation -> hyperplasia -> dysplasia -> carcinoma in situ -> invasive carcinoma -> metastases

Question 2

Common histological features of dyplasia?

Answer 2

• Cellular pleiomorphism
• Nuclear pleomorphism
• Loss of differentiation
• Architectural disorder
• Hyperchromatic nuclei
• prominent nucleoli
• high N:C ratio
• frequent and atypical mitotic figures

Question 3

Features that help distinguish an invasive carcinoma?

Answer 3

• Breach of BM or muscularis mucosa
• Desmoplastic stroma (including fibrosis)
• Necrosis (due to outgrowing blood supply)
• LN involvement/distant metastases

Question 4

Name 2 histological features that

might help identify a squamous cell carcinoma and 1 that helps identify an adenocarcinoma

Answer 4

Sq cell carcinoma: keratin pearls; intracellular bridges

Adenocarcinoma: gland/acinar formation

Question 5

Which serovars of HPV confer the greatest risk of cervical cancer?

Answer 5

serovars 16 and 18

Question 6

What does a Pap smear involve?

Answer 6

Taking a sample of ecto and endocervical cells and performing a cytological analysis

Question 7

How are cervical cancers graded - cytological grading?

Answer 7

• HSIL (high-grade squamous intraepithelial invasion)
  = HPV infection, mild dysplasia, CIN I
  -LSIL (low-grade squamous intraepithelial invasion)
  = mild to moderate dysplasia, carcinoma in situ, CIN II/II

Question 8

How are cervical cancers graded - histological grading?

Answer 8

Reqs biopsy (colposcopy) to look at cellular histological architecture
CIN = cervical intraepithelial neoplasia

CIN I: mild dysplasia, atypical cells confined to lower 1/3 of epithelium
CIN II: moderate dysplasia, atypical cells in lower 1/2 of epithelium, upper 1/2 cells flattened
CIN III: severe dysplasia and carcinoma in situ, atypical cells in full thickness of epithelium

Question 9

Examples of important tumour suppressor genes?

Answer 9

p53
APC
BRCA1/2

Question 10

Examples of important proto-oncogenes?

Answer 10

RAS
RAAF
Bcr-Abl 
WNT
MYC
ERK

Question 11

Myeloid cells are those originating from a common myeloid progenitor.
Which cells are they?

Answer 11

Monocytes/macs
Neutrophils
Eosinophils
Basophils
Megakaryocytes/platelets
RBCs

Question 12

Lymphoid cells are those originating from a common lymphoid progenitor. Which cells are they?

Answer 12

B cells
T cells
NK cells

Question 13

What is a leukaemia?

Answer 13

• typically presents w diffuse bone marrow involvement

- often assoc w peripheral blood involvement

Question 14

What is a lymphoma?

Answer 14

-typically presents as a discrete tissue mass (esp lymph node)

Question 15

How can lymphoma and leukaemia overlap?

Answer 15

Uncommonly in leukaemia, a non-bone marrow collection can be the first presentation

Lymphomas can progress to have bone marrow/peripheral blood involvement like leukaemias

Question 16

ALL is the most common cancer of children (ave age 3 yrs).

How does it present?

Answer 16

Bone pain
Pancytopaenia 
Easy bruising 
Lymphadenopathy
Also freq infections/fever, fatigue dt anemia

Question 17

CLL is the most common leukaemia in adults (ave age 60 yrs). How does it present?

Answer 17

Non-specific, indolent presentation
Lymphadenopathy most common feature but often not present
Lymphocytosis of peripheral blood

Question 18

Typical histological features of CLL?

Answer 18

Many small atypical lymphocytes

“Smudge cells” - fragile cells collapse during film preparation

Question 19

Features of Hodgkin’s lymphoma?

Answer 19

• typically localised to a single axial group of LNs
• orderly pattern of contiguous spread, from one LN group to the next
• rarely involves mesenteric LNs, or Waldeyer’s ring
• rarely presents extra-nodally

Question 20

Features of non-Hodgkin lymphoma?

Answer 20

• usually involves multiple LNs at presentation, incl peripheral LNs
• non-contiguous pattern of spread
• often involves mesenteric LNs and Waldeyer’s ring
• extra-nodal presentation not uncommon

Question 21

Major histological feature of Hodgkin lymphoma?

Answer 21

Reed-Sternberg cells

large cells, multinucleated or mononuclear but multilobed

Question 22

Major histological feature of AML?

Answer 22

• Auer rods (in cytoplasm)

- cells w bilobed nuclei and granular cytoplasm also suggest AML

Question 23

What is the relation between Bcr-Abl and CML?

Answer 23

Bcr-Abl is a fusion protein created by a translocation bn chromosomes 9 and 22.
It is an unregulated tyrosine kinase -> incr signal transduction

Question 24

Blood smear findings in CML?

Answer 24

Recognisable, mature neutrophils

Question 25

Main parts/features of a lymph node?

Answer 25

Cortex - location of B cells
Paracortex - location of T cells
High endothelial venules - deliver
circulating lymphocytes and antigens into
LN
Follicles - site of stimulation, clonal expansion and maturation of B cells
Medulla - consists of a network of lymphatic sinuses which drain into the efferent lymphatics
Medullary cord - an expansion of cortical cells