PATHOLOGY

Neoplastic

Click on the -?- to reveal/hide the answer.

Define grade: -?-grade is the histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation & number of mitoses per high-power field; character of tumor itself

Define stage: -?-stage is based on site & and size of 1° lesion, spread to regional lymph nodes, presence of metastases; spread of tumor in a specific patient

Match condition to neoplasm

(not all items are used/no item used more than once)
-?-immunodeficiency states malignant lymphomas
-?-Barrett's esophagus esophageal adenocarcinoma
-?-acanthosis nigricans visceral malignancy
-?-actinic keratosis squamous cell carcinoma of skin
-?-Down syndrome acute lymphoblastic leukemia
-?-Paget's disease of bone 2° osteosarcoma & fibrosarcoma
-?-chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants gastric adenocarcinoma
-?-Plummer-Vinson syndrome squamous cell carcinoma of esophagus
-?-tuberous sclerosis astrocytoma & cardiac rhabdomyoma
-?-Xeroderma pigmentosum squamous cell & basal cell carcinomas of skin
Down syndrome Xeroderma pigmentosum chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants tuberous sclerosis actinic keratosis Barrett's esophagus Plummer-Vinson syndrome cirrhosis ulcerative colitis Paget's disease of bone immunodeficiency states AIDS autoimmune diseases acanthosis nigricans dysplastic nevus

Oncogenes

Match gene to the associated tumor
-?-L-myc lung tumor
-?-c-myc Burkitt's lymphoma
-?-bcl-2 follicular & undifferentiated lymphomas (inhibits apoptosis)
-?-ret multiple endocrine neoplasia (MEN) types II & III
-?-erb B2 breast, ovarian, and gastric carcinomas
-?-ras colon carcinoma
-?-N-myc neuroblastoma
c-myc bcl-2 erb B2 ras L-myc N-myc ret

Name tumor associated with gene & chromosome:

-?-retinoblastoma, osteosarcoma Rb, 13Q
-?-breast & ovarian cancer BRCA1 & 2, 17q, 13q
-?-most human cancers, Li-Fraumeni syndrome p53, 17p
-?-colorectal cancer APC, 5q
-?-Wilms tumor WT1, 11q
-?-neurofibromatosis type 1 NF1, 17q
-?-neurofibromatosis type 2 NF2, 22q

Name the tumor markers for the following:

-?-PSA prostate-specific antigen; prostatic carcinoma
-?-CEA carcinoembryonic antigen; very nonspecific but produced by ~ 70% of colorectal & pancreatic cancers; also produced by gastric & breast carcinomas
-?-α-fetoprotein normally made by fetus; hepatocellular carcinomas; nonseminomatous germ cell tumors of the testis (eg, yolk sac tumor)
-?-β-hCG hydatidiform moles, choriocarcinomas, & gestational trophoblastic tumors
-?-CA-125 ovarian, malignant epithelial tumors
-?-S-100 melanoma, neural tumors, astrocytomas
-?-alkaline phosphatase metastases to bone, obstructive biliary disease, Paget's disease of bone
-?-bombesin neuroblastoma, lung & gastric cancer
-?-TRAP tartrate-resistant acid phosphatase; hairy cell leukemia-a B-cell neoplasm

Matching: Oncogenic viruses

-?-HPV cervical carcinoma (16, 18), penile/anal carcinoma
-?-HTLV-1 adult T-cell leukemia
-?-HHV-8 Kaposi's sarcoma, body cavity fluid B cell lymphoma
-?-EBV Burkitt's lymphoma, nasopharyngeal carcinoma
-?-HBV, HCV hepatocellular carcinoma
HTLV-1 HBV, HCV EBV HPV HHV-8

Matching: chemical carcinogens

-?-arsenick skin
-?-asbestos lung (mesothelioma & bronchogenic carcinoma)
-?-aflotoxins, vinyl chloride skin (squamous cell)
-?-nitrosamines esophagus, stomach
-?-naphthalene (aniline) dyes bladder (transitional cell carcinoma)
-?-CCI4 liver (centrilobular necrosis, fatty change)
aflotoxins, vinyl chloride nitrosamines asbestos arsenick CCI4 naphthalene (aniline) dyes

Matching: neoplastic, local effects of tumors

-?-seizures tumor mass in brain
-?-localized loss of sensory or motor function compression or destruction of nerve
-?-inflammation of serosal surface → pleural effusion, pericardial effusion, ascites
-?-hemorrhage from ulcerated area or eroded vessels
-?-mass tissue lump or tumor
-?-obstruction of left colon → constipation; of bronchus → pneumonia; of biliary tree → jaundice
-?-edema venous or lymphatic obstruction
-?-space-occupying lesion raised intracranial pressure with brain neoplasms; anemia due to bone marrow replacement
-?-nonhealing ulcer destruction of epithelial surfaces
-?-pain any site with sensory nerve endings; tumors in brain are initially painless
-?-perforation of ulcer inviscera → peritonitis, free air
-?-bone destruction pathologic fracture, collapse of bone
mass nonhealing ulcer hemorrhage pain seizures obstruction perforation bone destruction inflammation space-occupying lesion localized loss of sensory or motor function edema

Prostatic adenocarcinoma:

Common in men > -?-50 years of age; arises most often from the -?-posterior lobe of the prostate gland and is most frequently diagnosed by digital rectal examination and prostate biopsy.

Skin cancer:

Squamous cell carcinoma is very common; associated with excessive exposure to -?-sunlight and -?-arsenic exposure; locally invasive, but rarely -?-metastasizes; hitopathology: keratin "-?-pearls".

-?-basal cell carcinoma most common in sun-exposed areas of body; locally invasive but almost never -?-metastasizes; gross pathology: pearly -?-papules.

Melanoma is a common tumor with significant risk of -?-metastasizes; -?-depth of tumor correlates with risk of metastasis.

-?-Actinic keratosis is a precursor to squamous cell carcinoma.

Basal cell tumors have "-?-palisading" nuclei.

-?-Dysplastic nevus is a precursor to melanoma.

Primary bone tumors:

-?-osteochondroma (exostosis) most common benign bone tumor
-?-giant cell tumor occurs most commonly at epiphyseal end of long bones
-?-osteosarcoma (osteogenic carcinoma) most common 1° malignant tumor of bone
-?-Ewings sarcoma anaplastic small blue cell malignant tumor
-?-chondrosarcoma malignant cartilaginous tumor

Matching: Primary brain tumors, adult peak incidence:

-?-oligodendroglioma relatively rare, slow growing, benign; most often in frontal lobes; "fried egg" cells
-?-pituitary adenoma prolactin secreting is most common form; bitemporal hemianopia & hypopituitariasm are sequelae; derived from Rathke's pouch
-?-Schwannoma 3rd most common 1° brain tumor; often localized to 8th nerve; Antoni A loose pattern
-?-meningioma 2nd most common 1° brain tumor; most often occurs in convexities of hemispheres & parasagittal region; psammoma bodies
-?-glioblastoma multiforme (grade IV astrocytoma) most common 1° brain tumor; prognosis grave; "pseudopalisading" tumor cells
glioblastoma multiforme (grade IV astrocytoma) meningioma Schwannoma oligodendroglioma pituitary adenoma

Matching: Primary brain tumors, childhood peak incidence:

-?-low-grade astroytoma (pilocytic astrocytoma) diffusely infiltrating glioma; in children, most often found in posterior fossa; benign; good prognosis; Rosenthal fibers
-?-hemangioblastoma most often cerebellar; associated with von Hippel-Lindau syndrome when found with retinoblastoma; foamy cells & high vascularity are characteristic
-?-medullo-blastoma highly malignant cerebellar tumor; a form of primitive neuroectodermal tumor (PNET); can compress 4th ventricle, causing hydrocephalus; radiosensitive
-?-craniopharyngioma benign childhood tumore, confused with pituitary adenoma; calcification is common; most common childhood supratentorial tumor
-?-ependymoma ependymal cell tumors most commonly found in 4th ventricle; can cause hydrocephalus; rod-shaped blepharoblasts found near nucleus
low-grade astroytoma (pilocytic astrocytoma) medullo-blastoma ependymoma hemangioblastoma craniopharyngioma

Paraneoplastic effects of tumors:

NEOPLASM CAUSES EFFECT
Small cell lung carcinoma -?-ACTH or ACTH-like peptide Cushing's syndrome
-?-Small cell lung carcinoma & intracranial neoplasms ADH or ANP SIADH
Squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma & bone metastasis (lysed bone) PTH-related peptide, TGF-α, TNF-α, IL-1 -?-Hypercalcemia
Renal cell carcinoma -?-Erythropoietin Polycythemia
Thymoma, brochogenic carcinoma Antibodies against presynaptic Ca2+ channels at neuromuscular junction -?-Lambert-Eaton syndrome (muscle weakness)
Various neoplasms Hyperuricemia due to excess nucleic acid turnover (ie, cytotoxic therapy) -?-Gout
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