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Flashcards in MoD Session 8 Deck (140):
0

What is neoplasm?

An abnormal growth of cells that persists after the initial stimulus is removed

1

What does cell growth become in neoplasm?

Autonomous

2

How is neoplasm distinguished from inflammation clinically?

Neoplasm is cold to touch

3

When would neoplasm not cause a lump?

In leukaemia

4

What is malignant neoplasm?

An abnormal growth of cells that persists after the initial stimulus is removed and which invades surrounding tissue w/potential to spread to distant sites

5

What must be present in cells to cause neoplasia?

Genetic alterations

6

What is a tumour?

Any clinically detectable lump or swelling

7

What two types of tumour can form?

Non-neoplastic
Neoplastic

8

What two types of neoplastic tumour are there?

Benign
Malignant

9

What is metastasis?

Malignant neoplasm that has spread from its original location to a new non-contiguous site

10

Why might removal of a primary malignant neoplasm not prevent spread of cancer?

Each secondary tumour has the potential to spread

11

Is tumour formation reversible?

Nope

12

What is dysplasia?

Pre-neoplastic alteration in which cells show disordered tissue organisation

13

Is dysplasia reversible?

Yes

14

How are benign neoplasms characterised?

Remain confined to site of origin
Do not produce metastases
Create a pseudocapsule

15

What does the danger of a benign neoplasm depend on?

What tissue it is pressing on

16

What characteristics do malignant neoplasms display?

Irregular outer margin and shape
Can show ulceration in centre due to inadequate blood supply formation
Have the potential to metastasise

17

What do the cells of a benign neoplasm closely resemble?

Parent tissue

18

How can the cells in a malignant neoplasm vary?

From well to poorly differentiated

19

What term is used to describe cells with no resemblance to any tissue?

Anaplastic

20

What examines tissue cells ex situ so there is no architecture surrounding them?

Cytology

21

How do poorly differentiated cells compare to sell differentiated cells?

Increased:
Nuclear size
Nucleus:cytoplasm ratio
Pleomorphism
Hyperchromasia
Mitotic figures

22

What is pleomorphism?

Variance in cell and nuclei size and shape

23

How may mitotic figures appear in poorly differentiated cells?

May be abnormal

24

How is the grading of neoplasm determined?

Grade 1-3 with decreased differentiation with each stage

25

What happens to mortality with each increase in neoplasm grade?

It increases by 40%

26

What indicates worsening differentiation?

Mild --> moderate --> severe dysplasia

27

At what point does dysplasia become neoplasia?

When the worsening differentiation becomes irreversible

28

How long can the development of dysplasia into neoplasia take?

Years

29

What three aspects does the Modified Bloom Richardson grading for breast cancer examine?

Tubules
Mitoses
Nuclear pleomorphism

30

What percentage of cancer risk is extrinsic?

~85%

31

What change is seen in skin which has undergone reversible dysplasia?

Decreased specialisation causing loss of keratin

32

What change is seen in skin which has undergone irreversible dysplasia?

Tripolar mitosis
Invasive carcinoma

33

What causes neoplasia?

Accumulated mutations in somatic cells

34

How are the 10 million opportunities for somatic cell mutation per second dealt with to prevent neoplasia?

Apoptosis
Cell senescence

35

What causes a cell to enter G0?

Oncogene

36

What two things are needed to cause neoplasia?

Initiators
Consistent promoters

37

What are the main initiatiors of neoplasm which can also act as promoters?

Chemicals
Infection
Radiation

38

What causes early onset of cancer by skipping the initiator/promoter step of neoplasm?

Inheritance of a germline mutation

39

What is progression?

Formation of a neoplasm by accumulating more mutations by subclonal expansion

40

What causes heterogenous cells to be present within a neoplasm?

Progression

41

Is a neoplasm formed from progression monoclonal?

Yes, from same founding cells

42

What is a monoclonal tumour?

Tumour which originates from a single founding cell

43

What can be studied to identify monoclonal tumours?

X-linked G6PD

44

How are different alleles of G6PD gene switched off during female embryogenesis?

Randomly by lyonisation

45

What expression of G6PD izoenzyme is seen in normal tissue?

Patchwork of cells expressing both heat stable and heat labile isoenzymes

46

What isoenzyme expression of G6PD is seen in neoplastic tissue?

Either only maternal or paternal isoenzyme expressed

47

What genetic alteration occurs in proto-oncogenes which favours neoplasm formation?

Abnormally activated oncogenes

48

Why does abnormal activation of a proto-oncogene only need activation of one allele?

It is positively acting

49

What is the effect of abnormal activation of proto-oncogenes?

Abnormally pushes cell through cell cycle

50

What happens to tumour suppressor genes to favour neoplasm formation?

Inactivation of growth factor
Cyclin inactivators
Inactivation of receptors

51

Why is deletion of both alleles of tumour suppressor genes needed to cause neoplasia formation?

Alleles have an inhibitory function

52

What words with the suffix -oma are not neoplasms?

Granuloma
Atheroma
Haematoma

53

What suffix do neoplastic blood disorders have?

-aemia

54

What are the two types of benign epithelial tumour?

Papilloma
Adenoma

55

What are papillomas?

Benign non-glandular/non-secretory epithelial tumours

56

What do adenomas consist of?

Glandular/secretory epithelium

57

What prefixes the papilloma/adenoma in benign epithelial tumours?

Name of specific cell type origin

58

What is a carcinoma?

A non-glandular malignant epithelial tumour

59

What is an adenocarcinoma?

A glandular malignant epithelial tumour

60

What is also included in malignant epithelial tumour names in addition to carcinoma/adenocarcinoma?

Name of tissue of origin - type of epithelial cell

61

What is the difference between in-situ and invasive carcinoma?

In-situ = no basement membrane penetration
Invasive = penetrated basement membrane

62

What are the four names of benign epithelial tumours?

Squamous cell papilloma
Transitional cell papilloma
Basal cell papilloma
Adenoma

63

What are the four names of malignant epithelial tumours?

Squamous cell carcinoma
Transitional cell carcinoma
Basal cell carcinoma
Adenocarcinoma

64

What are the eight types of benign mesenchymal tumours?

Leiomyoma
Rhabdomyoma
Lipoma
Angioma
Osteoma
Chondroma
Benign mesothelioma
Synovioma

65

What is a leiomyoma?

Benign smooth muscle tumour

66

What is a rhabdomyoma?

Benign striated muscle tumour

67

What are the eight types of malignant mesenchymal tumours?

Leiomyosarcoma
Rhabdomyosarcoma
Liposarcoma
Angiosarcoma
Osteosarcoma
Chondrosarcoma
Malignant mesothelioma
Synovial sarcoma

68

What is a cyst?

Fluid-filled space lined by epithelium

69

Are cysts neoplasms?

Some are, some are not

70

What five types of cyst are there?

Neoplastic
Congenital
Parasitic
Retention
Implantation

71

What is Burkitt's lymphoma?

B-cell lymphoma associated w/Epstein-Barr virus and malaria

72

Where is Burkitt's lymphoma endemic?

Certain parts of Africa

73

What is Ewing's sarcoma?

Malignant tumour of bone of uncertain histiogenesis

74

What is Hodgkin's lymphoma?

Malignant lymphoma characterised by the presence of Reed-Sternberg cells

75

What is Kaposi's sarcoma?

Malignant neoplasm derived from vascular endothelium

76

What is Kaposi's sarcoma commonly associated with?

AIDS
Human herpesvirus-8

77

What are harmatomas?

Tumour-like lesions lacking autonomy of true neoplasm

78

What are teratomas?

Neoplasms forming cells representing all 3 germ layers

79

Where are teratomas most common?

Gonads

80

How does the presence of teratoma in the ovaries compare to that in the testes?

Ovaries - usually benign
Testes - usually malignant

81

Why does a retinoblastoma form?

Inherited predisposition

82

Where does a retinoblastoma arise?

In the eye

83

Where does a nephroblastoma/Wilms' tumour arise?

In the kidney

84

Where does a neuroblastoma arise where it can mature into a harmless, benign ganglioneuroma?

Adrenal medulla
Nerve ganglia

85

Where do hepatoblastomas arise?

In the liver

86

What do mixed tumours exhibit?

Characteristic combination of cell types e.g. mixed parotid/fibroadenoma of breast

87

What is a neuroendocrine tumour?

Cells scattered diffusely in various epithelial tissues form hormone or carcinoid tumours

88

What is a carcinoid neuroendocrine tumour?

A neuroendocrine tumour which does not secrete a peptide hormone

89

Where are embryonal tumour almost exclusively seen?

In young

90

What do embryonal tumours have histiological resemblance to?

Embryonic form of organ

91

What types of tumour are embryonal?

Blastomas
Mixed
Neuroendocrine

92

What is the name given to a normal gene that is expressed inappropriately?

Oncogene

93

Give four characteristics of malignant tumours.

Purposeless
Atypical - cells are structurally and functionally abnormal in varying degrees
Autonomous
Aggressive

94

What is transformation in neoplasia?

Change of a normal cell to a malignant cell

95

What can be said about the nature of blastomas?

Tend to be very aggressive

96

What is the name of a club-shaped tumour dangling from a surface by means of a stalk?

Polyp

97

What do type of tissue do polyps grow out of?

Skin
Mucosa

98

What are sessile polyps?

Polyps that lack a stalk

99

What is the name given to an outgrowth from an epithelial surface which has long thin branches and resembles a cauliflower in cross-section?

Papilloma

100

Is myeloma malignant or benign?

Malignant

101

In what type of tissue is it very unlikely to see a benign tumour?

Lymphoid

102

What is odd about a ganglioneuroma?

It is a tumour of neurones which are meant to be non-dividing cells

103

What is a glioblastoma?

Malignant glial tumour

104

Where do tetaromas tend to arise?

Along the midline - base of the skull, anterior mediastinum, along aorta, in gonads

105

How do harmatomas develop during growth?

Present at birth and grow with the person

106

Where does the lump of tissue found in a harmatoma belong?

To the organ in which the lump was found

107

What are choristomas/ectopic tissue?

Lumps of normal tissue that do not belong in the organ where they are found

108

What is the likely method by which tumours contain cells which are less differentiated?

Contain undifferentiated stem cells whose progeny fail to mature

109

Why do tumour cells have increased cytoplasmic basophilia?

Increased RNA therefore more active protein synthesis

110

Why can the number of mitoses be used as a measure of malignancy?

Their number is proportional to the rate of growth

111

What tends to parallel the degree of aggressiveness?

Atypical

112

What causes a signet ring cell?

Abnormal mucus secretion causing it to be retained as a large droplet that distends the cell

113

Why might cells be seen floating in mucus in malignant cells?

Abnormal mucus secretion due to atypia

114

What properties do malignant cells possess?

Immortality
Loss of anchorage dependence
Loss of contact inhibition
Decreased requirement for growth factors

115

Why do malignant cells have decreased requirement for growth factors?

They supply their own by autocrine secretion

116

How do cancer cells move around, allowing their invasion?

Like amoebae

117

Between which cells is decreased adhesion seen in malignant cells?

Same type
Stroma

118

How can a tendency of malignant cells to shed surface molecules such as proteins, glycoproteins and enzymes help malignant cells to function?

Shedding enzymes e.g. collegenase helps them to invade through ECM
Tissue factor exaggerates clotting

119

How can surface molecules shed by malignant cells be useful clinically?

Some are found in blood (tumour markers) and can be used for diagnosis

120

What two components do all tumours consist of?

Neoplastic parenchyma
Non-neoplastic stroma

121

How do some benign tumours develop a fibrous capsule?

Laid down by surrounding tissues as a response to pressure

122

Why can some benign tumours such as fibroadenoma of the breast be 'shelled out' through a clear cut cleavage plane with little surrounding tissue?

They are surrounded by a fibrous capsule

123

What must be removed with malignant tumours?

Surrounding tissue

124

What type of tumours tend to become ulcerated?

Those that arise from a bacteria only containing tend surface

125

What is the formation of an ulcerated tumour in the gut thought to be secondary to?

Bacterial infection and digestive enzymes

126

How is a non-healing ulcer formed on a tumour?

Surface eroded by friction --> colonised by bacteria --> ulcer

127

What does an ulcer with a raised/rolled edge strongly suggest?

Ulcerated tumour rather than non-neoplastic ulcer

128

What is any ulcer on the skin present for more than 3-4 weeks a suspect for?

Malignancy

129

What are scirrhous carcinomas?

Tumours with lots of connective tissue stroma

130

How do melanomas, angiomas, hepatoma and most other tumours appear on cross section?

Melanomas = black
Angiomas = red with blood
Hepatomas = green with bile
Most others = white

131

What do foci of necrosis correlate with in malignant tumours where they are more commonly seen?

Poor prognosis

132

How can BV within the stroma of a tumour arise?

Incorporated by growing tumour
Newly developed by angiogenesis

133

How are tumour cells that are so undifferentiated they have lost identifying structural features recognised?

Usually retain some cell-specific antigen that can be recognised by a specific antibody

134

What secondary changes are seen in tumours?

Ulceration
Necrosis
Calcification
Torsion

135

When is necrosis seen in tumours?

Secondary to ischaemia in the centre of tumour
Can be due to impaired blood flow by high tissue pressures in the centre of the tumour

136

When is calcification of a tumour seen?

In dead cells or necrotic masses

137

What is used in breast screening by mammography to identify malignancy?

Calcification of tumours

138

What is torsion?

An accident seen in benign or malignant pedunculated tumours

139

What does torsion result in?

Veins compressed first --> congested tissue --> red infarct