Instructions:

• Answer 50 questions in 15 minutes.
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• Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Dysplasia
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Fibrous tissue formation in response to a neoplasm. Irreversible.
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'


2. Psammoma bodies
P rostate - T hyroid - T estes - B reast - L ung - K idney 'P.T. B arnum L oves K ids' Metastases from breast and prostate are mosot common.
Laminated - concentric - calcific spherules seen in: 1.) Papillary adenocarcinoma of thyroid 2.) Serous papillary cystadenocarcinoma of ovary 3.) Meningioma 4.) Malignant mesothelioma PS aMM oma: P apillary (thyroid) S erous (ovary) M eningioma M eso
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Liver (angiosarcoma)


3. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?

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4. Fluid exudation in inflammation
Melanoma - neural tumors - astrocytomas.
Esophageal adenocarcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Increase vascular permeability - vasodilation - endothelial injury.


5. Oncogenic viruses: HTLV-1 What is the associated cancer?
Assoc.: Breast and ovarian cancer
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.
Adult T- cell leukemia


6. Characteristics of irreversible cell injury
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Burkitt's lymphoma nasopharyngeal carcinoma


7. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
N euroblastoma
Liver (hepatocellular carcinoma)
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


8. Hypovolemic/cardiogenic shock
Bladder (transitional cell carcinoma)
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


9. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />
NF2
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
HHV-8


10. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Prostate carcinoma.
Amylin protein Derived from AE (AE = E ndocrine)
All (we All fall Down ) AML
Leukemias and lymphomas


11. Neoplastic progression: step 1 Hyperplasia/dysplasia

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12. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
AIDS
Degree of localization/spread based on site and size of 1' lesion - spread to regional LNs - presence of metastases; spread of tumor in a specific pt. S tage = S pread
Liver (centrilobular necrosis - fatty change)


13. Necrosis morphologies
Fibrous tissue formation in response to a neoplasm. Irreversible.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Increase in # of cells. Reversible.


14. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Dysplastic nevus
Xeroderma pigmentosum - albinism
Assoc.: Breast and ovarian cancer


15. Chemical carcinogens: Vinyl chloride What is the affected organ?
Malignant lymphomas
Liver (angiosarcoma)
T = size of T umor N = N ode involvement M = M etastases
Benign: -- Malignant: Leukemia - lymphoma


16. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
NF1
Assoc.: Breast and ovarian cancer


17. Melanoma - What is the tumor suppressor gene?
P 16
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Degree of localization/spread based on site and size of 1' lesion - spread to regional LNs - presence of metastases; spread of tumor in a specific pt. S tage = S pread
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma


18. Neoplastic progression: step 3 Invasive carcinoma

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19. tumor: Colon carcinoma What is the associated oncogene?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Fibrous tissue formation in response to a neoplasm. Irreversible.
Ras
EBV


20. breast cancer What is the tumor suppressor gene?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
BRCA2
Renal cell carcinoma - hemangioblastoma
P 16


21. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Hepatocellular carcinoma
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.
NF1
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


22. Dz: Paget's dz of bone What is the associated neoplasm?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Radiation exposure Metabolism of drugs (phase I) Redox rxtn Nitric oxide Transition metals Leukocyte oxidative burst *Reperfusion after anoxia induces free radical production (e.g. - superoxide) and is a major cause of injury after thrombolytic thera
Secondary osteosarcoma and fibrosarcoma


23. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Rb


24. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
APC
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
L ung tumor


25. Oncogene: L - myc Associated tumor?
Adult T- cell leukemia
L ung tumor
Beta -2 microglobulin Derived from MHC class I proteins.
Degree of cellular differentiation based on histologic appearance of tumor. Usually graded I- IV based on degree of differentiation and number of mitoses per high - power field; character of tumor itself.


26. Neoplastic progression: step 4 Metastasis

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27. Oncogene: ras Associated tumor?
Hepatocellular carcinoma
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Adult T- cell leukemia
Colon carcinoma


28. Dz: Immunodeficiency states What is the associated neoplasm?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Malignant lymphomas
HHV-8
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


29. Oncogene: N - myc Associated tumor?
Burkitt's lymphoma nasopharyngeal carcinoma
N euroblastoma
All (we All fall Down ) AML
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


30. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
C - kit
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
N - myc
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma


31. Dz: Dysplastic nevus What is the associated neoplasm?
Liver (angiosarcoma)
Malignant melanoma
Lung (mesothelioma and bronchogenic carcinoma)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


32. Primary tumors that metastasize to brain
P rostate - T hyroid - T estes - B reast - L ung - K idney 'P.T. B arnum L oves K ids' Metastases from breast and prostate are mosot common.
Malignant melanoma
Benign and malignant lymphomas
L ung B reast S kin (melanoma) K idney (renal cell carcinoma) G I L ots of B ad S tuff K ills G lia.


33. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Thymoma - small cell lung carcinoma
Hepatocellular carcinoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Lung cancer deaths have plateaued in males - but continue to Increase in females. Cancer is the 2nd leading cause of death in the USA (heart dz is 1st).


34. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Benign: hemangioma Malignant: Angiosarcoma
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Gain of fxn --< cancer. Need damage to only 1 allele.


35. Apoptosis (definition)
Radiation exposure
Usually stage < grade
Programmed cell death; ATP required. Mediated by caspases.
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']


36. Necrosis is characterized by...?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Immunodeficiency states
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
HPV


37. Neoplasm: Malignant lymphomas With what dz is this associated?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
BRCA1
Neuorblastoma - lung - and gastric cancer.
Immunodeficiency states


38. Leukocyte activation in inflammation
P 53
Abnormal cells lacking differentiation; like primitive cells of the same tissue - often equated w/ undifferentiated malignant neoplasms. Little or no resemblance to tissue of origin. Irreversible.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.


39. Metaplasia

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40. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: Leiomyoma Malignant: Leiomyosarcoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


41. Neoplasia
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Bcl -2
Paget's dz of bone


42. Apoptosis is characterized by...?
AIDS
Cell shrinkage - nuclear shrinkage and basophilia (pyknosis) - membrane blebbing - pyknotic nuclear fragmentation (karyorrhexis) - nuclear fading (karyolysis) - and formation of apoptotic bodies - which are then phagocytosed. No significant inflammat
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


43. Tumor markers: TRAP

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44. Male cancer epidemiology (incidence - mortality)
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Increase in # of cells. Reversible.
Assoc: Neurofibromatosis type 1
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


45. Tumor suppressor gene: Rb chromosome? Associated tumor?
N - myc
Assoc.: Retinoblastoma - osteosarcoma
Visceral malignancy (stomach - lung - breast - uterus)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


46. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Esophagus - stomach
Enzymatic degradation of a cell resulting from exogenous injury.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
P 16


47. Oncogenic viruses: EBV What is the associated cancer?

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48. Oncogene: abl Associated tumor?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
CML
Small cell lung carcinoma
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.


49. Oncogenes
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Small cell lung carcinoma
Gain of fxn --< cancer. Need damage to only 1 allele.


50. Metastasis to liver

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