Pathology - 2nd half
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What is a choristoma?
ectopic tissue resting in normal tissue (e.g. panc tissue in stomach). NOT a neoplasm
Define what a carcinoma, sarcoma, and blastoma are
- carcinoma: malignant tumor of epithelial structures
- sarcoma: malignant tumors of mesenchymal tissues
- blastoma: malignant tumors of cells resembling developing organ cells (e.g. pulmonary blastoma)
What are the rules involved in naming a tumor?
- 1) cell of origin
- 2) benign/malignant nature
- 3) the appearance
Differentiate benign vs malignant WRT: differentiation, anaplasia, rate of growth, local invasion, metastisis
What are some nuclear features looked for in anaplasia
- -nuclear enlargement
- -nuclear shape abnormalities
- -nuclear membrane thickening
- -chromatin usually coarse
- -prominent nucleoli
- -abnormal mitosis
- -altered architectures and cellular abnormalities are confined to a geographic area are CONFINED TO WITHIN THE BASEMENT MEMBRANE
- -considered a preneoplastic change
- -not all dysplasias progress to cancer
- -looking for this in pap smears
Describe the colouring in malignant and benign tumors
growth of fibrous or connective tissue
What is a metastisis?
successful transplantation of a tumor to a new site
Describe the pathway of metastasis
- -local infiltration: extension into adjacent normal tissue
- -seeding of body cavities: peritoneal, pleural, pericardial
- -lymphatic spread: usually for carcinoma, look for sentinel LN
- -hematogenous spread: usually venous
- -Iatrogenic spread: e.g. fine needle aspiration tract spreading cancer
What are the most/least common sites of metastatic spread?
- most: LNs, lung, liver, brain, bone
- least: muscles, gonads, speen
Describe the steps in the metastatic cascade
- 1) detachment of cancer cells from site of origin
- 2) attachment to BM
- 3) BM invasion
describe paraneoplastic syndroms (systemic effects of growths) and a few examples
- -at this stage the cells start producing abnormal proteins
- -distant systemic feature relatively specific to a neoplasm but having lots of other causes as well
- -ectopic hormone secretion by tumor cells of an unknown origin
- -often the first sign of malignancy
- -acanthosis nigricans (black armpit due to lung or stomach cancer)
- -fliting thrombophlebitis (pancreas carcinoma)
what is pre-neoplastic?
early stage of cancer where there are mass lesions with dysplasia
list some of the systemic features of neoplasms and some examples
- -weight loss
- -cachexia (muscle wasting and fat loss)
- -night sweats
- -features due to specific tumor products:
- -hypercoagulable state (leukemia)
- -amyloidosis (multiple myeloma, lymphoma)
What are the seven warning signs
- -Change in bowel or bladder
- -A sore throat that does not heal
- -Unusual bleeding or discharge
- -Thickening of lump in breast
- -Indigestion or difficulty swallowing
- -Obvious change in wart or mole
- -Nagging cough or hoarseness
Describe the biology of tumor growth
- 1) normal cell to transformed cell (calle transformation
- 2) transformed to cell to clinical detection (1cm or gm) (about 30 doublings)
- 3) clinical detection to fatal load (1 kg) (10 doublings)
- 4) aquire more aberrancy and subclones
What are the categories of genes involved in carcinogenesis?
- -proto-oncogenes (growth)
- -tumor suppressor genes (growth)
- -apoptosis genes (survival)
- -DNA repair genes (genomic stability)
- -Other genes (invasion, metastasis, angiogenesis, drug resistance, etc)
difference between caretaker and gate keeper genes
- caretaker genes: DNA repair
- gatekeeper: specific to a specific organ
What is the most important prognostic factor?
- TNM - tumor (size, stage), nodes, mets
Name 4 prognostic factors
- -Tumor site
- -histological type/grade
- -Stage (incorporates size)
- -performance status of the patient (can they achieve daily activities of living?)
List 3 hormonally-dependent cancers
- Breast (estrogen)
- prostate (androgen)
- thyroid (TSH)
Why are world wide cancer rates increasing?
- population increase
- increased urbanization
- -urban lifestyle
- -environmental exposures
- decreased infectious disease
- increases in child survival
- better diagnostic techniques
What is a hemorrhage?
Extravasion of blood from vessels.
What are the different types of hemorrhage?
- 1) hematoma: external or accumulate in a tissue (e.g. hemothorax, hemoparicardium, hematemesis, others)
- 2) petechiae: minute hemorrhages in the skin
- 3) purpura: 3-5 mm hemorrhages
- 4) Eccymoses: 1-2 cm hematomas
What is the difference between a thrombus and a blood clot?
- thrombus: solidification of blood components within intact vessels
- blood clot: can only happen ex vivo or post mortem. Have lines of Zahn.
What are the components of Virchow's Triad.
endothelial injury, stasis or turbulent blood flow, hypercoagulability
What are the fates of a thrombus?
- 1) propagation: either complete occlusion or embolism
- 2) dissolution: newly formed thrombi are responsive to fibrinolysis
- 3) Organization and recanalization: older thrombi may create conduits to reestablish blood flow.
What is an embolism?
intravascular solid, liquid, or gas that is carried by the blood to a site distant from its point of origin.
List 5 types of embolisms
- -pulmonary thromboembolism
- -systemic thromboembolism
- -fat embolism
- -air embolism
- -amniotic fluid embolism
What is an infarction?
area of ischemic necrosis caused by an occlusion of the vascular supply to the affected tissue
What are the types of infarction?
- 1) red: venous occlusions, loose tissues, when flow is re-established, hemorrhage
- 2) white: arterial occlusions, wedge shaped infarcts, heart, spleen, kidneys often, ischemia
What are the factors influencing the damage caused by an infarct?
- 1) anatomy of vascular supply (is there dual supply?)
- 2) rate of occlusion (slower growing ones have time to develop another blood supply)
- 3) tissue vulnerability to ischemia
- 4) blood oxygenation levels
Diff between precision and accuracy
- precise: close clustering, reproducibility
- accurate: close to the bullseye
What are the ten steps in ordering and processing a test request?
- 1) MD writes order
- 2) Nurse reviews
- 3) clerk writes requisition
- 4) lab prepares tube
- 5) phlebotomist draws blood
- 6) transport to lab
- 7) log in specimen
- 8) lab separates serum
- 9) storage until analysis
- 10) prepare worksheets
Describe the additives (if any) and the use of each of the following color tubes: red, blue, brown, green, lavendar, grey
- red: no additive; general biochem
- blue: no additive; for trace metal analysis
- brown: heparin; trace metal analysis
- green: heparin; prevents clotting
- lavendar: EDTA; chelating agent preserves cellular constituents in blood
- grey: oxalate; used for blood glucose
Define sensitivity and specificity
sens = frequency of correct results in patients with diseas
spec = frequency of correct results in patients without disease
When do you want a high sensitivity test?
- -serious disease you don't want to miss
- -treatable disease
- -false positive results won't harm the patient
When do you want to use a high specificity test?
- -disease is serious, but not treatable or curable
- -knowledge that disease is absent has value
- -false positive leads to emotional or economic trauma
- -e.g. MS
When do you want a high PPV?
When treatment of a false positive may have serious consequences.
when do you want an efficient test?
- -disease is serious but treatable
- -false positive and false negative results are equally damaging
- - e.g. MI
What are the 4 phases of acetaminophen toxicity
- 1) 0 to 24 hrs. Asymptomatic/nausea/vomiting/malaise/others
- 2) 18-72 hrs. RUQ pain, decreasing phase 1 symptoms, rising liver enzymes (ALT and AST)
- 3) 72-96 hrs. Centrilobular hepatic necrosis, abd pain, jaundice, vomiting, renal failure, fatality
- 4) 4 days to 3 weeks. complete resolution of organ function and symptoms
What is the antidote for APAP (acetaminophen) poisoning?
- -prevents the formation and accumulation of NAPQI by increasing glutathione stores and increasing sulphate conjugation
- -also an anti inflammatory
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