Exam #2: Neoplasia II Flashcards Preview

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Flashcards in Exam #2: Neoplasia II Deck (32):
1

What are the four criteria used differentiate between a benign and malignant neoplasm?

1) Rate of growth
2) Differentiation and anaplasia
3) Local invasion
4) Metastasis

2

When does growth occur in normal tissues? How does this compare to malignant tissues?

In normal tissue, growth occurs in response to damaged tissues & is limited

In neoplasms, growth is not damage induced & it is limitless and there is:
1) Evasion of host control over growth
2) Limitless replication potential
3) Loss of contact inhibition

3

What is the difference between normal cells, benign tumors, and malignant cells that are in s-phase?

Generally, there is an increase in cells in s-phase.
>1%= Normal
1-10%= Benign
20-80%= Malignant

4

What are the factors that determine increased growth rate?

1) Doubling time
2) Faction of tumor cells in proliferative pool i.e. % of cells in s-phase
3) Cell production vs. cell loss

5

What is double time? What are the important clinical aspects of doubling time?

Doubling time= the time that it takes a cell population to divide and become twice its original size
- Takes roughly 30x to become a detectable mass ~1g
- 10x more doubling times= 1kg, maximum size compatible with life

6

What is the difference between the submicroscopic stage and later stages in terms of growth?

- Submicroscopic stage= early stage & higher growth fraction
- Later stages= low growth faction

7

How do growth rates of benign tumors compare to malignant tumors?

Benign= slow
Malignant= rapid

8

Microscopically, what are the indications of cell proliferation?

- Mitotic cells= i.e. mitotic figures are indicative of proliferation
- Atypical mitotic figures= proliferation & malignant

*****Mitotic figures= loose and expanded nuclei

9

What are Ki-67 & PCNA? How are they used?

PCNA= Proliferating cell nuclear antigen--a marker of proliferation

Ki-67= a second marker for proliferation

*****Increased amounts of these indicate cell proliferation and are used to calculate the Proliferating Cell Nuclear Antigen Score

10

What is the clinical significance of different growth rates in tumors?

Cells within the cell cycle are susceptible to chemo and/or radiation therapy

*Slow growth= surgery

11

What is differentiation?

Cells or tissue resemble their normal progenitors, both morphologically and functionally

12

How does differentiation compare between benign & malignant tumors?

Benign= low proliferating activity but cells & tissues are differentiated

Malignant= many cells/ tissues do NOT resemble the cells or tissue of origin

13

What is the difference between a well-differentiated, moderately differentiated, poorly differentiated, and undifferentiated/ anaplasic tumor?

Anaplastic or undifferentiated= complete lack of differentiation & HIGHLY MALIGNANT

The other terms describe the spectrum of differentiation. The more differentiated, the better.

14

How do the cells of the normal thyroid gland & thyroid adenoma?

Normal= well formed follicles & colloid

Thyroid adenoma= resembles normal thyroid but has an encapsulated thyroid mass

15

How do a well differentiated, poorly differentated, and anaplastic carcinoma of the thyroid gland compare?

Well-differentiated= resembles normal thyroid gland but shows invasion

Poorly-differentiated= little resemblance to normal thyroid w/ few follicles & scant colloid-->has metastatic potential

Anaplastic= no resemblance to normal thyroid tissue-->high metastatic potential

16

How are poorly differentiated and anaplastic neoplasms differentiated?

1) Expression of cell markers
2) Cytological findings

17

What is the term "loss of polarity" referring to?

- Normally, cells are well organized and have an inherent polarity
- A loss of this inherent organization & polarity is a marker of malignancy

18

What is cellular atypia?

Generally, cells within the same tissue with different morphology

- Cellular pleomorphism= cells that vary in size & shape
- Nuclear pleomorphism= different sizes & shapes of nuclei
- Nuclear hyperchromiticity i.e. increased DNA content indicated by darker stanining
- Nucleolar pleomorphism
- Increased nucleus to cytoplasm ratio

19

What is cellular atypia indicative of?

Pre-malignancy & malignancy

20

What is the difference between nuclear pleomorphism & hyerchromasia?

Pleomorphism= variation in size & shape of cells/ nuclei

Hyperchromasia= abundant DNA that is extremely dark staining

21

What is the normal N/C ratio? What N/C ratio is indicative of malignancy?

1:5 is normal

1:1= malignancy

22

What are the cytologic features of anaplasia?

1) Nuclear & cellular pleomorphism
2) Hyperchromatic nucleus
3) Increased N/C ratio
4) Prominent nuclei
5) Abundant + atypical mitoses
6) Bizarre tumor giant cells

23

What are tumor giant cells? What is the significance of tumor giant cells?

- Single huge polymorphic nucleus or more than 2 nuclei; hyperchromatic nuceli
- Represent anaplasia

24

What is the clinical significance of recognizing anaplasia?

- Indication of poorly differentiated
- More aggressive & poorer prognosis

25

What are the most prominent features of neoplasms at high magnification?

Atypical mitoses

26

What is desmoplasia?

Hyperplasia of activated fibroblasts that leads to an abundance of collagenous stroma

*****This makes the tissue hard & is seen in female breast cancer & "cholangiocarcinoma"

27

What color does collagen stain with trichrome staining?

Blue i.e. blue stroma= collagen & "desmoplasia"

28

What does a tumor cell require to grow in size?

Angiogenesis & adequate blood supply

29

What are the two most important factors in tumor angiogenesis?

VEGF
FGF

30

List three pro-angiogenic factors?

VEGF
bFGF
HIF

31

List the anti-angiogenic factors.

Thrombospondin-1
Angiostatain
Endostatin
Tumstatin

32

Why do malignant tumors show central necrosis?

Tumors outgrow its blood supply & areas of ischemic necrosis appear