Neoplasia

Question 1

Where is the most common benign tumor in women found? What is the most common tumor in males?

Answer 1

The uterus

Males: lipoma

Question 2

What are benign tumors of glands called?

Answer 2

Adenomas

Question 3

What disease can cause atrophy of the zona glomerulosa? What is a simple way to remember the three zones of the adrenal cortex?

Answer 3

Conn’s syndrome - tumor secreting mineralocorticoids

GFR = Glomerulosa, Fasciculata, Reticularis

Salty, Sweet, Sexy - gets sweeter as you go deeper

Question 4

What is the most common precursor lesion for colon cancer? What does it look like?

Answer 4

Adrenal adenoma - strawberry on a stick

Question 5

What is the definition of a carcinoma?

Answer 5

Malignancy of EPITHELIAL tissues - squamous, glandular(adenocarcinoma), transitional

Question 6

How do you recognize the three types of carcinoma?

Answer 6

Squamous - keratin pearls (small swirls of increased red brightness)

Glandular = ADENOCARCINOMA - glands containing stuff

Transitional - derived from BLADDER, RENAL PELVIS, AND URETER

Question 7

What are aput tumors?

Answer 7

S-100 Ag (+) Tumors that are of neurosecretory or neural crest origin (neurosecretory granules on EM)

e.g. MELANOMA, Small cell carcinoma of the lung, bronchial carcinoid, carcinoid tumor of the tip of the appendix, neuroblastoma

Question 8

A 2 year has many skin tumors that are S-100 (+) on biopsy.

Answer 8

Neuroblastoma - tumor from adrenal medulla that met’ed to the skin

Question 9

What does it mean when a tumor is S-100 (+)?

Answer 9

Aput tumor - neurosecretory derived tumor that usually contains neurosecretory granules

Question 10

What are sarcomas?

Answer 10

Malignancies of MESENCHYMAL tissue Smooth muscle - leiomyosarcoma
Striated muscle - rhabdomyosarcoma
Fat - liposarcoma
Bone - Osteogenic sarcoma

Question 11

What is the diagnosis for a necrotic mass protruding from the vagina of a small girl that is keratin (-) and desmin (+)? What is important about this disease?

Answer 11

Embryonal rhabdomyosarcoma - see STRIATIONS of muscle

MOST COMMON SARCOMA IN CHILDREN

Question 12

What is the most common salivary gland tumor? What tumor type should this not be confused with?

Answer 12

Mixed tumor - found in parotid gland and has TWO HISTOLOGIC TISSUE TYPES that are derived from THE SAME LAYER

Teratoma - DERIVED FROM ALL THREE LAYERS

Question 13

A 16 year old girl has a sudden onset of RLQ pain and you confirmed that this is not due to an acute abdomen.

Answer 13

Cystic teratoma of the ovaries - GERM CELL TUMOR

Question 14

Auer rod = ?

Answer 14

AML - Myeloblast

Question 15

What can cause a hypersegmented neutrophil?

Answer 15

B12 and folate deficiency

Question 16

What is the most common and second most common site in the body for a lymphoma to develop other than the lymph node?

Answer 16

1st = THE STOMACH
2nd = Payer's patches in TERMINAL ILEUM

Question 17

A follicular B cell lymphoma is due to what cellular problem?

Answer 17

bcl-2 is an anti-apoptotic regulatory protein

14;18 translocation that causes moves the bcl-2 gene close to the Ig heavy chain locus and causes the OVERPRODUCTION OF bcl-2 THAT INACTIVES THE APOPTOTIC GENE in B cells

Question 18

What is the most common polyp in the GI tract?

Answer 18

Hamartoma = hyperplastic polyp = NON-NEOPLASTIC WITH NO RISK FOR CANCER

Question 19

Do malignant cells typically have a shorter or a longer cell cycle than their parent cells? How many doubling times does it take to get a tumor that can be clinically detected?

Answer 19

LONGER CELL CYCLE

30 DOUBLING TIMES

Question 20

What enzymes are frequently found in many malignant cells and what type of metabolism do most go through?

Answer 20

Proteases to break through tissue and collagenases to break through the basement membrane

Anaerobic metabolism

Question 21

For a carcinoma to become hematogenously, it usually first had to do what? What tumor does not follow this route? What does this second route mean for course of action in establishing extent of spread? What carcinoma uncharacteristically follows the second route?

Answer 21

Carcinoma - usually spread to a lymph node

Sarcoma - typically spread hematogenously first (worse prognosis) -> DO NOT DO A RADICAL DISSECTION OF THE AXILLA FOR AN ANGIOSARCOMA OF THE BREAST

Follicular carcinoma of the thyroid, Renal adenocarcinoma, hepatocellular carcinoma - hemat. spread first

Question 22

In what organ is metastasis NOT the most common cancer?

Answer 22

Renal adenocarcinoma

Question 23

What is the most common cancer that metastasizes to the bone? Why? What are the most common bones that are metastasized? How should you image for bone mets?

Answer 23

Breast cancer due to the Batsom system of venous drainage from the base of the skull to the sacrum that doesn’t contain valves - this system sends tributaries to the vena cava and vertebral bodies before collecting around the spinal cord.

Most common - vertebral column
2nd most common - head of the femur

Imaging: radionucleide scan

Question 24

What is the source of the most common cancer of the liver?

Answer 24

The lungs (NOT THE COLON)

Question 25

Where are Virchow's nodes and what is the most common primary metastasis to them?

Answer 25

Left supraclavicular node - STOMACH = patient with weight loss and epigastric distress

Question 26

Why do myeloma patients get punched out lesions in their skull? What lab value will be elevated?

Answer 26

Malignant plasma cells have IL-1 in them = OSTEOCLAST ACTIVATING FACTOR AlkPhos will be elevated

Question 27

What is the most common overall location for mets? What image or gross presentation is most indicative for mets?

Answer 27

Most common location = Lumbar vertebrae Most indicative for mets = MULTIPLE LESIONS

Question 28

What is the most common primary site for brain cancer that is also the most common cancer that kills men and women? What is the most common primary site for the organ identified above? For the first organ identified, where else do its metastases love to travel that should be checked with a CT?

Answer 28

Most common brain cancer met source = lung Most common lung cancer met source = breast Lung = MOST COMMON MET SOURCE FOR ADRENAL GLANDS

Question 29

What is the best identifying stain for a carcinoma? For a sarcoma?

Answer 29

Keratin - carcinoma | Desmin - good stain for muscle -> rhabdomyosarcoma

Question 30

What is the first step in malignancy? Second step? Third step?

Answer 30

Initiation = mutation Promotion = make multiple copies of mutation Progression = sub-specializing

Question 31

What are some protooncogenes that code for receptors? What about those that code for messages sent from the cytosol to the nucleus? What about the genes that are stimulated by those messages in the nucleus? What are some suppressor genes that control the cell cycle?

Answer 31

``` Receptor Coding: erb-2 = breast cancer ret = MEN syndromes Message creating: ras = cell membrane located messenger abl = lives in the cytosol close to the nuclear membrane Stimulated by messages: n-myc = neuroblastoma c-myc = Burkitt's Lymphoma Suppressor genes that control the cell cycle: Rb suppressor gene p53 suppressor gene adenomatous polyposis coli (familial polyposis) neurofibromatosis (nfm) wilm's tumor gene BRCA1/2 ```

Question 32

Which protooncogenes are knocked out by point mutation? By amplification? By translocation?

Answer 32

Point mutation: p53 and ras Amplification: erb-2 Translocation: abl translocation on a Philly chromosome

Question 33

What genetic adjustment can sometimes be made by Epstein-Barr Virus and what can result? What receptor does EBV use to gain entry into plasma cells?

Answer 33

8;14 translocation that translocates myc from 8 to 14 -> BURKITT'S LYMPHOMA Receptor: CD21

Question 34

What cancer is associated with a 15;17 translocation and what can treat it?

Answer 34

Acute progranulocytic leukemia TREAT WITH VITAMIN A -> matures the blast and renders the malignant cell benign

Question 35

A patient with Wegener's granulomatosis develops hematuria with abnormal cells on cytology studies.

Answer 35

Cyclophosphamide prescribed to treat Wegener's causes transitional cell carcinoma

Question 36

A patient that works in the dye industry presents with dysuria and hematuria.

Answer 36

Papillary tumor of the bladder = transitional cancer caused by SMOKING

Question 37

What is the diagnosis for non-pruritic raised red lesions?

Answer 37

Kaposi's sarcoma caused by HHSV 8

Question 38

Aflatoxin B causes what? What disease can also cause this? What ethnicity most commonly gets this?

Answer 38

Hepatocellular carcinoma Hepatitis B Asian

Question 39

The rapidly increasing incidence of primary CNS lymphoma can be directly attributed to what?

Answer 39

HIV

Question 40

What virus can cause anal squamous cell cancer in homosexuals?

Answer 40

HPV

Question 41

What is the most common type of leukemia associated with radiation?

Answer 41

CML - 9;22 translocation of abl

Question 42

A patient was exposed to radiation in the head area and presents with non-tender, nodular masses in the cervical region. DDx?

Answer 42

Papillary carcinoma of the thyroid

Question 43

What metal is associated with skin cancer and what country has a high level of exposure through the water? What type of cancer?

Answer 43

ARSENIC - Bangladesh - squamous skin cancer

Question 44

What is the most common cause of white eye reflex in an infant?

Answer 44

Congenital cataract - NOT RETINOBLASTOMA