Module 4 Path-Continued Flashcards by Nicole Pritchard

Benign tumors have a suffix of oma after tissue type . what are the exceptions to the oma rule?

Malignant: melanoma, lymphoma

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What is an adenoma?

Benign tumor that forms a gland or originates from a gland

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What is a cystadenoma?

An adenoma with cystic areas (fluid filled)

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what is a papilloma?

Benign tumors with finger like projections

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What is a polyp?

Elevated mucosal lesion of tumor; bump in the mucosa

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What is a lipoma?

Slow growing benign tumor of adipose (mesenchymal origin)
Well differentiated, well demarcated and smooth borders
(no hemorrhage, necrosis or ulcerations)
Lipoma Has a TRUE CAPSULE

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What is the etiology of a lipoma?

Unknown and painless

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What is the most common site for a lipoma?

Most common in back
most common in makes
f-breast fibroadenoma

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How does a benign lipoma appear on histological slide?

Mature white fat cells without pleomorphism

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Will a benign become malignant ever?

Nope! 0% chance of malignant transformation

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What is a hemangioma?

Encapsulated aggregates of closely packed thin wall capillaries separated by scant CT
Flattened endothelium

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How does a hemangioma appear on histological side?

Disorganized blood vessels

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What age group of individuals is a hemangioma most common in?

Children

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What is the classic appearance of a hemangioma?

Strawberry raised lesion (usually on buttcheek of newborn)

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Would you do a biopsy of a hemangioma?

nope!

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Is there a change of a hemangioma ever becoming malignant?

0% chance of malignant transformation

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What is a chorisotoma?

Normal tissue in an abnormal palce
aka: ectopic or heterotopic rest
Meckel’s Diverticulum (gastric and pancreatic tissue in the ileum)

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What are the two types of hemangioma?

Capillary and Cavernous (larger vessels)

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What is a leiomyoma (uterine fibroid)

Benign smooth muscle uterine muscle

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What is the pathogenesis for a leiomyoma?

Fast growing benign tumors in myometrium (Smooth muscle-mesenchymal)
no necrosis or hemorrhage; clear demarcation, localized and pseudocapsule

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What is the etiology and symptoms for leiomyomas?

Unknown
Asymptomatic
No chance of malignancy

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What is the most common population for these leiomyomas?

Nulliparous African American Women (never had children)

What is the presentation for leiomyomas?

Heavy periods (menorrhagia) –> iron deficiency anemia –> left ventricular hypertrophy –> left ventricular failure–> pulmonary edema –> at 2 weeks hemosiderin laden macrophages in alveolar space with alveolar fibrosis (due to collagen)
Uterus grows big and presses on bladder (urinary urgency/frequency) and presses on rectum (constipation)

What does the histological slide of a leiomyoma look like?

Well differentiated -whorling bundles smooth muscle cells

What are some complications of leiomyomas?

--Estrogen makes the fibroids grow bigger but does not cause them (pregnancy and oral contraceptives cause the fibroids to grow bigger) (menopause causes the fibroids to grow smaller)

What happens if the leiomyomas become too big for the blood supply?

They undergo coagulative necrosis and then a red infarct

What is a sarcoma?

Malignant tumor of mesenchymal origin retroperitoneal soft tissues: bone, muscle, fat -disseminate haematogenously in blood -vimentin (Cytoskeleton protein)

What is a carcinoma?

Malignant tumor of epithelial origin - disseminate via lymph - cytokeratin

What is a mixed tumor?

Can either be benign or malignant (mesenchymal or epithelial origins) 1 germ layer with different types of cells and divergent differentiation

A Benign mixed tumor of parotid gland is a pleomorphic (mixed benign) adenoma of salivary gland. What is the etiology and pathogenesis?

Etiology -> Unknown | Pathogenesis: arises from 1 germ layer that undergoes divergent differentiation; monoclonal origin

How does a benign mixed tumor of the parotid gland present?

Painless lumpy mass in the jaw

What are the complications of a benign mixed tumor of the parotid glands?

Small change of malignant transformation --> metastasize --> compression of the facial nerve --> Bell's Palsy High chance of recurrence

For investigation of a benign mixed tumor of the parotid gland, what do you see?

See both mesenchymal (amorphous fibromyxoid stroma) and epithelial cells (Serous acini) --both are benign

What is a polyp?

An outgrowth of mucosal tissue | (can be pednuculated --has visible stalk or sessile--flat with not stalk

What is Familial Adenomatous Polyposis (FAP)?

Genetic, tubular adenoma, numerous benign polyps (>100) on left side of colon (sigmoid descending) (diameter on left colon is smaller than right -->easier to obstruct) Benign tumor with dysplastic cells and hence can become cancer

What is the gene involved in FAP?

APC (tumor suppressor gene) which requires 2 hits --> inherit 1 bad hit and get second hit later in life --> POLYPS --> mutation in KRAS (one hit) and p53 (two hits) --> adenocarcinoma (hence never born with polyps because your only born with one hit)

What are symptoms for FAP?

Asymptomatic-screen with sigmoidoscopy (Screen at age 12) if family has a history of left sided colon cancer at a young age

What are some complications of FAP?

Can bleed and give iron deficiency anemia --> left heart failure

What is HNPCC?

No benign polyps; cancer on right side of colon

HNPCC is due to a DNA mismatch of what repair genes?

MLH1, MSH2 and MSH6 and PMS2

At what age do you start screening for HNPCC?

Microsatellite instability | start at age 25 with colonoscopy

What is Lynch syndrome?

Family history of cancers in breast, right sided colon, endometrium and ovaries (mutations in DNA mismatch repair genes)

Colon Cancer is mostly what?

Sporadic

What are predisposing factors to colon cancer?

FAP, high fat diet, low fiber, rich in refined carbs, low in vitamins A,C, and E, UC and Crohns

What is the etiology for colon cancer?

Unknown

What are the symptoms for colon cancer?

Left side --> bright red blood in stool, mucus, intestinal obstruction and LLQ pain Right side --> initially no symptoms (b/c occult bleeding) --> iron deficiency anemia due to chronic blood loss

If an older male presents with iron deficiency anemia, what is the most likely diagnosis?

Right sided colon cancer

What is the tumor maker to check for followup after being treated for Colon cancer?

Carcino-Embryonic Antigen (CEA) --useful for followup to treatment

What immunohistochemical stain is used for colon cancer?

Cytokeratin

What is the spread of the cancer from colon?

Lymph --> liver --> lung

So if a patient presents to you with a family history of left sided colon cancer at an early age (before 50), what is the first thing you should thing of?

FAP! | present with bright red blood in the stool

What kind of polyps do you see in FAP?

Pedunculated, they have a stalk and found in the sigmoid colon. totally benign (does not cross basement membrane)

What is the chance FAP will become colon cancer?

100% chance, all you need is one polyp to turn into cancer. so you are going to get colon cacner

What treatment are patients offered by doctors, who are found to have these polyps?

Prophylactic colectomy better to take it out now then before it turns into cancer take out the left side, the sigmoid colon