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Pathology I > Pathologic and Laboratory Diagnosis of Cancer > Flashcards

Pathologic and Laboratory Diagnosis of Cancer Flashcards

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1
Q

Clinician and pathologist interaction discussion

A
  • Prior history of patient
  • Past or recent Dx procedures
  • Availability of Previous slides
  • Intraoperative frozen sections
  • Quantity of tissue required for Dx
  • Special processing requirements
  • Adjunctive pathologic analyses
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2
Q

Nomenclature of tumor types

A
  • Means by which pathologists communicate a diagnosis to other pathologists and clinicians
  • Specific tumor designations carry specific clinical implications
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3
Q

Intraductal Carcinoma of Breast

A
  • ER / PR +

- Sentinel node bx ; no evidence of tumor

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4
Q

Adenocarcinoma of Prostate Gland

A
  • Tumor present up to inked margin

- Perineural invasion

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5
Q

Considerations/practices for most tumors recognized at the macroscopic level

A
  • Adequate sample
  • Margins of excision are labeled with indelible ink
  • Specimen is opened
  • Sections collected (with a scalpel or sharp knife)
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6
Q

Pathologist notes for most tumors recognized at the macroscopic level

A
  • Consistency
  • Color
  • Extent of neoplastic growth
  • Photograph
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7
Q

Macroscopic examination of tissue specimens

A
  • Macroscopic Recognition
  • Label Margins
  • Open Specimen
  • Sections collection
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8
Q

Hematoxylin and Eosin (H&E) staining of sections

A
  • Sufficient to make the Dx with most malignant neoplasms and tissue biopsies
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9
Q

Factors confounding gross and microscopic interpretaiton

A
  • Stage of neoplastic lesion development
  • Radiation and/or chemotherapy treatments
  • Presence of crush or cautery artifact
  • Bordeling or minimal deviation malignancies
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10
Q

Stage of neoplastic lesion development (confounding factor)

A
  • Lacks diagnostic histologic features of malignancy
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11
Q

Radiation and/or chemotherapy treatments (confounding factor)

A
  • Alter the pathologic characteristics of the tissue
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12
Q

Presence of crush or cautery artifact (confounding factor)

A
  • Distort tissue histology
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13
Q

Hematoxylin and Eosin (H&E) staining of sections

A
  • Microscopic Interpretation of Biopsy or Resection Specimens
  • Special Stains
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14
Q

Special stains involved in the microscopic interpretation of biopsy of resection specimens

A
  • Features unique to specific tumors are stained to narrow differential or make diagnosis
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15
Q

Stains used in diagnosis

A
  • Alcian Blue
  • Periodic Acid-Schiff
  • Trichrome
  • Congo Red
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16
Q

Alcian Blue stain specificity

A
  • Acid muco-substances
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17
Q

Alcian blue stain sample uses and comments

A
  • Demonstration of stromal mucin production by mesotheliomas
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18
Q

Periodic Acid-Schiff stain specificity

A
  • Glycogen (with appropriate control)

- Neutral mucosubstances

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19
Q

Periodic Acid-Schiff stain sample uses and comments

A
  • Demonstration of mucus or glycogen production
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20
Q

Trichrome stain specificity

A
  • Nuclei
  • Cytoplasm
  • Collagen
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21
Q

Trichrome stain sample uses and comments

A
  • Nonspecific

- Often can demonstrate immature skeletal muscle cells (myoblasts) in poorly differentiated mesenchymal tumors

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22
Q

Congo red stain specificity

A
  • Amyloid
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23
Q

Congo Red stain sample uses and comments

A
  • Amyloid deposition in neuroendocrine tumors or plasma cell tumors
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24
Q

PAS stain (special stain)

A
  • Germ cell neoplasia of the testis

- Abundant PAS-positive glycogen is present in the cytoplasm of the tumor cells

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25
Tumor markers
- Substances that are produced by cancer cells - Most tumor markers are made by normal cells - Cancer cells produce much higher levels
26
Tumor marker distribution
- Blood - Urine - Stool - Tumor tissue - Bodily fluids
27
Most tumor markers are
- Proteins
28
Patterns of gene expression are classified at
- Tumor markers
29
DNA changes are classified as
- Tumor markers
30
Tumor marker use in cancer diagnosis and care
- Supports diagnosis of cancer (along with other test) - Reflects the stage (extent) of the disease - Reflect Prognosis
31
Tumor markers prognosis of cancer diagnosis and care
- Must take periodic measurements
32
Decrease in tumor marker levels indiactes
- Cancer is responding to treatment
33
Increase in tumor marker levels indicates
- Cancer is not responding or recurrence
34
Tumor markers (names)
- Alpha-fetoprotein (AFP) - Estrogen receptor (ER)/Progesteron receptor (PR) - CA19-9 - CA-125 - Carcinoembryonic Agent (CEA) - Cytokeratin Fragments 21-1
35
Alpha-fetoprotein (AFP)
- Cancer types: Liver cancer and germ cell tumors - Tissue analyzed: Blood - How used: diagnosis liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of germ cell tumors
36
Estrogen receptor (ER)/Progesteron receptor (PR)
- Cancer type: Breast cancer - Tissue analyzed: Tumor - How used: To determine whether treatment with hormonal therapy (such as tamoxifen) is appropriate
37
CA19-9
- Cancer types: Pancreatic cancer, gallbladder cancer, bile duct cancer, and gastric cancer - Tissue analyzed: Blood - How used: To assess whether treatment is working
38
CA-125
- Cancer type: Ovarian cancer - Tissue analyzed: Blood - How used: To help in diagnosis, assessment of response to treatment, and evaluation of recurrence
39
Carcinoembryonic Agent (CEA)
- Cancer types: Colorectal cancer and breast cancer - Tissue analyzed: Blood - How used: To check whether colorectal cancer has spread; to look for breast cancer recurrence and assess response to treatment
40
Cytokeratin Fragments 21-1
- Cancer type: Lung cancer - Tissue analyzed: Blood - How used: To help in monitoring for recurrence
41
Tumor marker use in immunochemistry (part 1)
- Prepared and applied directly to paraffin embedded sections - Based on an indirect, antibody-enzyme method (immunoperoxidase procedure) - Differentiate between 2 or more histologically similar neoplasms
42
Tumor marker use in immunochemistry (part 2)
- Categorization of undifferentiated malignant tumors - Determination of site of origin of metastatic tumors - Detection of molecules that have prognostic or therapeutic significance - Highlight distinguishing features of a tumor to aid in diagnosis - “Picking the needle out of the haystack”
43
Antigens (tumor markers) used in immunocytochemistry
- Cytokeratin - Epithelial membrane antigen (EMA) - Prostate-specific antigen (PSA) - Carcinoembryogenic antigen (CEA) - CA 19-9 - Estrogen and progesterone receptor (ER/PR) - Alpha-fetoprotein
44
Cytokeratin predominant distribution
- Epithelial cells
45
Cytokeratin common diagnostic uses
- Distinguish carcinoma from lymphoma or melanoma
46
Epithelial membrane antigen (EMA) predominant distribution
- Epithelial cells
47
Epithelial membrane antigen (EMA) common diagnostic uses
- Distinguish carcinoma from melanoma
48
Prostate-specific antigen (PSA) predominant distribution
- Prostatic epithelium
49
Prostate-specific antigen (PSA) common diagnostic uses
- Identification of metastatic prostatic CA
50
Carcinoembryonic antigen (CEA) predominant distribution
- Endodermally derived epithelium
51
Carcinoembryonic antigen (CEA) common diagnostic uses
- Identification of GI and lunch adenocarcinoma | - Distinguish adenocarcinoma from mesothelioma
52
CA 19-9 predominant distribution
- Alimentary tract epithelium
53
CA 19-9 common diagnostic uses
- Identification of GI and pancreatic cancer
54
Estrogen and progesterone receptor (ER/PR) predominant distribution
- Mammary epithelium
55
Estrogen and progesterone receptor (ER/PR) common diagnostic uses
- Identification of metastatic breast carcinoma | - Prediction of clinical response to hormonal therapy in breast cancer
56
Alpha-fetoprotein predominant distribution
- Neoplastic hepatocytes | - Selected germ cell tumors
57
Alpha-fetoprotein common diagnostic uses
- Identification of hepatocellular carcinoma, endodermal sinus tumor, and other germ cell tumors
58
Other molecules with prognostic or therapeutic significance
- Erb-B2 Oncoprotein (encoded by the HER2/neu oncogene) - Ki-67 - Estrogen (ER) and progesterone receptor (PR) - P53
59
Erb-B2 Oncoprotein (encoded by the HER2/neu oncogene) prognostic/therapeutic significance
- Metastatic breast cancer sensitive to herceptin (trastuzumab)
60
Estrogen (ER) and progesterone receptor (PR) prognostic/therapeutic significance
- Breast cancer responsive to tamoxifen
61
Ki-67 prognostic/therapeutic significance
- Proliferating cell nuclear antigen
62
P53 prognostic/therapeutic significance
- Over-expression = poor prognostic indicator | - Cells carrying mutant p53 resist this response to chemotherapy
63
Flow cytometry
- Rapid quantitative measurement of cell characteristics
64
Cell characteristics detected by flow cytometry
- Membrane antigens | - DNA of tumor cells
65
Identification and classification of neoplasms by flow cytometry
- T and B lymphocytes | - Mononuclear-phagocytic cells
66
In situ hybridization (fluorescence in situ hybridization - FISH)
- Technique for detecting and locating a specific DNA sequence on a chromosome - Exposing chromosomes to a small DNA sequence called a probe that has a fluorescent molecule attached - Probe sequence binds to its corresponding sequence on the chromosome
67
Fluorescent colors when reading FISH
- Green = ABL - Red = BCR - Yellow = Fushion gene
68
Polymerase chain reaction (PCR)
- Used to amplify DNA sequences - Primers to select the portion of the genome to be amplified - Enzyme directed DNA replication of target sequence - Billions of copies of the target sequence in a few hours
69
Examples of target gene sequences amplified by PCR
- KRAS - BRAF - Her2
70
Microarray analysis
- Examine how active thousands of genes are at any given time - Determine gene expression and activity in normal and tumor cells - Differences in gene activity between untreated and treated tumor cells
71
Medical implications of microarray analysis
- Design and tailor treatment strategies targeted directly to each specific type of cancer
72
Process of microarray analysis
- mRNA → RT PCR (normal and tumor cells) - Several cDNA copies (label with flourescent dye) - Combine cDNAs - Compete for binding to probe - Analyze binding
73
Microarray analysis interpretation
- T>N = red - N>T = green - N=T = yellow - Absent = black
74
Application of microarray analysis
- Malignant melanoma (gene mutations)
75
Gene mutations seen in malignant melanoma that can be detected by microarray analysis
- BRAF - MEK - PTEN
76
Trametinib (Mekinist)
- MEK inhibitor indicated for melanoma with BRAF mutations
77
Dabrafenib (Tafinlar)
- BRAF protein kinase inhibitor

Pathology I (9 decks)

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