General Principals

Question 1

every cell is dividing, reversible, regulated, polyclonal

Answer 1

Hyperplasia

Question 2

Monoclonal, unregulated, irreversible

Answer 2

Neoplasia

Question 3

Parenchymal component

Answer 3

Determines biological behavior and classification

Question 4

Stromal component

Answer 4

Determines growth and spread

Provides nutrition (blood vessels) and mechanical support

Question 5

Increase synthesis of collagen and extra cellular matrix. When you do a Masons trichrome test is stained blue.

Answer 5

Normally you see a pink color, but when you have desmoplasia the collage takes a blue color. The blue color is due to hardening of collagen.

Question 6

Name the test used for Desmoplasia ( infiltrating ductal carcinoma of breast)

Answer 6

Masson’s trichrome= blue staining for increase synthesis of collagen and ECM proteins

Question 7

Exceptions for benign neoplasm that ends with -oma

Answer 7

1. Hepatoma- liver
2. Melanoma- melanocytes
3. Mesothelioma- mesothelial
4. Seminoma- malignant germ cell testis

Question 8

What is polyp

Answer 8

Projects above a mucosal surface into the lumen of hollow viscera ( stomach, intestine, colon)

Question 9

Benign tumor for glandular tissue

Answer 9

Adenoma

Question 10

Nomenclature for epithelial tumor
Benign and malignant

Answer 10

Benign- oma
Malignant- carcinoma

Question 11

Nomenclature for mesenchymal tumor
Benign and malignant

Answer 11

Benign- oma
Malignant- sarcoma

Question 12

Malignant tumors
Endoderm, ectoderm, Mesoderm

Answer 12

Endoderm and ectoderm are carcinoma

Mesoderm is sarcoma

Question 13

Mixed tumors

Answer 13

Teratomas - derived from multiple germ layers
Example: ovarian germ cell tumor

Pleomorphic- multiple component but are derived from the same germ cell
Example- pleomorphic adenoma of the parotid gland

Question 14

Neoplasm ending in - “blastomas”

Answer 14

Neoplasms ending in -blastoma resemble primitive embryonic tissues

Examples:
Retinoblastoma
Neuroblastoma
Hepatoblastoma
Medulloblastoma

Question 15

Choristoma

Answer 15

Tumor like mass consisting of normal cell but in abnormal location (ectopic)

Example: pancreatic choristoma.
Normal pancreatic tissue located in the stomach or small intestine

Question 16

Hamartoma

Answer 16

Benign mass composed of mature cells that are naive to the tissue of origin but is abnormal tissue organization.

Is not ectopic they just have a different organization that is supposed to be.

Example: tuberous sclerosis ( cortical hamartoma)
Pulmonary hamartoma
Iris hamartoma

Question 17

Differentiation

Answer 17

Refers to the extend to which the neoplasm, RESEMBLE the corresponding normal parenchymal cell. Morphological and functional.

Two types: well differentiated and poor differentiated

Well differentiated- resembles the normal parenchyma cell. Benign neoplasm are always well differentiated

Poor differentiated- only slightly or no resemble. Highly to be malignant.

Question 18

Examples of well- differentiated tumors

Answer 18

Lipoma of the stomach ( the one with fat cell)
Leiomyoma of the uterus

Question 19

which are the morphologic changes of cancer cell poorly differentiated?

Answer 19

1. Pleomorphism- variation in size cell and shape. Appearance of tumor giant cell.
2. Abnormal nuclear morphology N:C, ratio is high (1:1 instead of 1:4/1:6) hyperchromic nuclei with prominent nucleoli.
3. Atypical mitotic figure- abnormal dividing cell. the newly created cell receive an unequal amount of DNA.

Question 20

Examples of Metaplasia

Answer 20

Metaplasia - Replacement of one type of cell to another type

Examples: In chronic smokers a normal pseudostratified ciliated columnar epithelial cell are replaced by squamous epithelial cell.

Barret esophagus the normal squamus epithelium is replace by glandular intestinal epithelium (goblet cells)

Question 21

Histological characteristics of Dysplasia

Answer 21

Pleomorphism - variation in size and shape

High N:C, hyperchromic nuclei

Increase mitotic activity

Question 22

Carcinoma in situ

Answer 22

Is when the entire epithelium is involve. In severe dysplasia is Irreversible. But mild dysplasia it can be reversible.

DO NOT penetrate the basement membrane

Question 23

Carcinoma

Answer 23

Is when the basement is broken and the cell cross into the inside.

Question 24

Factors promoting invasive carcinoma

Answer 24

1. Upregulation of Type 4 collagenases ( they break collagen), MMP (Matrix metalloproteinases- involve in tumor metastasis) and plasminogen activator (uPA (Urokinase-type plasminogen activator) - a degradation enzyme that is highly expressed in invasive cancer cells)
2. Downregulating of cadherins
   (E-cadherin) - disrupt of the intracellular adhesion between neighboring cell.
3. Increased attachment to ECM protein ( high Laminin and CD44/integrin receptor)

Question 25

Dysplasia vs invasive carcinoma

Answer 25

Abundant mitosis, disordered maturation, loss cell polarity, nuclear abnormalities, pleomorphism ALL are seen in BOTH dysplasia and Invasive carcinoma. But if dysplasia is mild to moderate it CAN be REVERSE when the causal factors are withdrawn.

Question 26

Benign vs Malignant Poor/well Differentiation

Answer 26

benign is Well differentiation malignant is poor differentiation

Question 26

Benign vs Malignant Macroscopy

Answer 26

Benign is well demarcated capsulated where necrosis is rare Malignant usually do not have capsule and it could have necrosis

Question 27

Benign vs Malignant invasion

Answer 27

Benign do not invade the surrounding Malignant is locally destructive and invasive

Question 27

Benign vs Malignant Growth

Answer 27

Benign is slow growth Malignant is unpredictable growth

Question 28

Benign vs Malignant Microscopy

Answer 28

Benign almost do not have any irregularities of cellular structures Malignant have Pleomorphism, high N:C ratio, hyperchromatic nucleus with prominent nuclei, abnormal mitotic figures

Question 29

Benign vs Malignant Metastasis and relapse

Answer 29

Benign do not metastasis and relapse is rare Malignant are potential to metastasis and relapses are common.

Question 30

Direct seeding of carcinomas

Answer 30

Any body cavity can be affected but the most common one is Peritoneal cavity. Examples: 1. Omental caking- ovarian carcinoma ( the most common) 2. Pseudomyxoma peritonei- appendiceal mucinous tumor

Question 30

Three pathways of metastasis routes

Answer 30

1. Direct seeding of body cavities or surfaces 2. Lymphatic spread- most common route for metastasis of carcinomas EXCLUDING- renal cell carcinoma, follicular thyroid carcinoma, hepatocellular carcinoma and choriocarcinoma ( they spread HEPATOGENOUSLY) 3. Hepatogenous spread- typical for sarcomas, venous dissemination is more common than arterial dissemination because of thin vein that facilitates invasion.

Question 31

which are the exclusions of lymphatic spread?

Answer 31

Most carcinomas are spread by lympatic route but there are 4 exceptions This are spread by hepatogenous 1. renal carcinomas 2. thyroid carcinomas 3. hepatocellular carcinoma 4. Chroriocarcinoma

Question 32

Lymphatic spread

Answer 32

Most common route for metastasis for carcinomas. The sentinel lymph node is the first lymph node to which cancer are most likely to spread from a primary tumor. Axillary lymph node with metastatic adenocarcinoma of the breast. Sentinel lymph node mapping- radiolabeled traces or colored dyes.

Question 33

Cancer arising near the vertebral column often embolize through...

Answer 33

The paravertebral venous plexus.

Question 34

Hematogenous Spread

Answer 34

Typical of sarcomas The liver and lungs are frequently involved because all PORTAL areas drain into the LIVER and all CAVAL drain into the lung. The liver is the most commonest site of metastasis of colorectal cancer.

Question 35

The liver is the most commonest site of metastasis of ?

Answer 35

colorectal cancer.