General Pathology Flashcards

8/20/2019 General Pathology Flashcards

1/23

www.natures.ir More Free USMLE , MCCEE , MCQe and AMQ Flashcards

Apoptosisaka

Programmed cell death.

Apoptosis

characteristics

cell shrinkage, chromatincondensation, membrane blebbing,

andformation of apoptotic bodies, whichare then phagocytosed.

Apoptosiswhen

- embryogenesis, hormone -induction(menstruation), -immune cell–

mediated death,- injurious stimuli (e.g., radiation,

hypoxia),

-atrophy.

Enzymatic degradation of a cellresulting from exogenous injury.

Necrosis

Characterized by enzymatic digestionand protein denaturation, with release

ofintracellular components.

Necrosis

http://www.natures.ir/http://www.natures.ir/


2/23

Necrosisdifferent types and there locations

Morphologically occurs as-coagulative (heart, liver, kidney),

-liquefactive (brain),

-caseous (tuberculosis),-fat (pancreas),

-fibrinoid, or gangrenous (limbs, GItract).

Cell injuryreversible or irreversible

Cellular swelling?Reversible


Nuclear chromatin clumping?Reversible


Decreased ATP synthesis?Reversible

Cell injuryreversible or irreversibleRibosomal detachment?

Reversible


Glycogen depletion?Reversible


Plasma membrane damage?Irreversible


3/23


Lysosomal rupture?Irreversible

Cell injuryreversible or irreversibleCa2+ influx → oxidative

phosphorylation?

Irreversible


Nuclear pyknosis, karyolysis,karyorrhexis?

Irreversible


Mitochondrial permeability?irreversible

Inflammation5 features

Characterized by-rubor (redness),

-dolor (pain),-calor (heat),

-tumor (swelling)-functio lassa (loss of function).

cells in acute InflammationNeutrophil, eosinophil, and antibody

mediated

cells in chronic Inflammation Mononuclear cell mediated:


4/23

Phases of Inflammation

Fluid exudationLeukocyte activation

Fibrosis AcuteChronic

Resolution

What happens in different phases ofInflammation?Fluid exudation

Increased vascular permeability,vasodilation, endothelial injury

What happens in different phases of

Inflammation?Leukocyte activation

Emigration (rolling, tight binding,diapedesis)

Chemotaxis (bacterial products,complement, chemokines)Phagocytosis and killing

What happens in different phases ofInflammation?

Fibrosis

Fibroblast emigration and proliferationDeposition of ECM


Acute

Neutrophil, eosinophil, and antibodymediated


Chronic

Mononuclear cell mediated:

Characterized by persistentdestruction and repair

Granuloma—nodular collections ofmacrophages and giant cells


5/23


Resolution 5 different outcomes

-Restoration of normal structure

-Granulation tissue—highlyvascularized, fibrotic

-Abscess—fibrosis surrounding pus

-Fistula—abnormal communication

-Scarring—collagen depositionresulting in altered structure and

function

Leukocyteextravasation

what mediatesRolling?

E-selectin on vascular endothelium

binding to Sialyl-LewisXon the leukocyte.

Leukocyteextravasationwhat mediatesTight binding?

ICAM-1 on vascular endotheliumbinding to LFA-1 on

the leukocyte.

Stages of Leukocyteextravasation

1. Rolling2. Tight binding3. Diapedesis4. Migration

Leukocyteextravasationwhat mediates

migration?

chemotactic signals (e.g., cytokines).

What is Diapedisis ––leukocyte travels between

endothelial cells and exits blood

vessel.


6/23

Free radical injurywhat initiates it

Initiated viaradiation exposure,

metabolism of drugs (phase I), redoxreaction,

nitric oxide,transition metals,

leukocyte oxidative burst.

Free radical injurywhen is it a big problem

reperfusion after thrombolytic therapy.

Free radical injurywhat are the antioxidants

(vitamins E and A).

• Abnormal proliferation of cells withloss of size, shape, and

orientation ––dysplasia

• Normal cells with basal → apicaldifferentiation

Normal cells

• Cells have increased in number– hyperplasia

• Neoplastic cells have not invadedbasement membrane

• High nuclear/cytoplasmic ratio andclumped chromatin• Neoplastic cells encompass entire

thickness

• In situ carcinoma


7/23

• Cells have invaded basementmembrane using collagenases and

hydrolases• Can metastasize if they reach a

blood or lymphatic vessel

Invasive carcinoma

-plasia definitionsHyperplasia

–– ↑ in number of cells (reversible).

-plasia definitions

Metaplasia

––1 adult cell type is replaced by

another (reversible). Often 2°

-plasia definitionsDysplasia–

–abnormal growth with loss of cellularorientation, shape, and size incomparison to normal tissue

maturation; commonly preneoplastic(reversible).

-plasia definitions Anaplasia

––abnormal cells lackingdifferentiation; like primitive cells of

same tissue, oftenequated with undifferentiated

malignant neoplasms.

-plasia definitionsNeoplasia

––a clonal proliferation of cells that isuncontrolled and excessive.

Tumor grade vs. stagedescribe

Grade = histo apperance, often basedon the mitoses per high pwer field

number

Stage = ammount of spread based onsite and size


8/23

Tumor grade vs. stagewhich is usually more prognostic

Stage

TNM staging system:T = size of Tumor

N = Node involvementM = Metastases

The term ?????? implies epithelialorigin, whereas sarcoma denotes

???????origin. Both terms imply?????.

carcinoma

sarcoma

malignancy

The term carcinoma implies ???????origin, whereas sarcoma denotes??????origin. Both terms imply

?????.

epithelial

mesenchymal

malignancy

Tumor nomenclatureBenign tumor of

Mesenchyme

Blood cells = There isn't one

Blood vessels = Hemangioma

Smooth muscle = Leiomyoma

Skeletal muscle = Rhabdomyoma

Bone = Osteoma

Fat = Lipoma

Tumor nomenclatureBenign vs malignant tumor of

Epithelium

Adenoma, papilloma

Adenocarcinoma, papillary carcinoma


9/23

Tumor nomenclatureBenign vs malignant tumor of

> 1 cell type

benign = mature teratoma

malignint = Immature teratoma

Tumor nomenclaturemalignant tumor of

Mesenchyme

Blood cells = Leukemia, lymphoma

Blood vessels = Angiosarcoma

Smooth muscle =Leiomyosarcoma

Skeletal muscle =Rhabdomyosarcoma

Bone = Osteosarcoma

Fat = Liposarcoma

What is the Neoplasm/s associatedwith Down syndrome?

ALL (we ALL fall Down), AML

What is the Neoplasm/s associatedwith Xeroderma pigmentosum,

albinism?

Melanoma and basal,squamous cell carcinomas

of skin

What is the Neoplasm/s associatedwith Chronic atrophic gastritis,

pernicious anemia,postsurgical gastric remnants?

Gastric adenocarcinoma

What is the Neoplasm/s associated

with Tuberous sclerosis?

Astrocytoma and cardiac

rhabdomyoma


10/23

What is the Neoplasm/s associatedwith Actinic keratosis?

Squamous cell carcinomaof skin

What is the Neoplasm/s associatedwith Barrett’s esophagus?

Esophagealadenocarcinoma


with Plummer-Vinson syndrome?

Squamous cell carcinoma

of esophagus

What is the Neoplasm/s associatedwith Cirrhosis (alcoholic, hepatitis B or

C)?Hepatocellular carcinoma

What is the Neoplasm/s associatedwith Ulcerative colitis?

Colonic adenocarcinoma

What is the Neoplasm/s associatedwith Paget’s disease of bone?

2° osteosarcoma andfibrosarcoma

What is the Neoplasm/s associatedwith Immunodeficiency states?

Malignant lymphomas


11/23

What is the Neoplasm/s associatedwith AIDS?

Aggressive malignantlymphomas (non-Hodgkin’s)

and Kaposi’s sarcoma

What is the Neoplasm/s associatedwith Autoimmune diseases?

Benign and malignantthymomas


with Acanthosis nigricans?

Visceral malignancy

(stomach, lung, breast,uterus)

What is the Neoplasm/s associatedwith Dysplastic nevus?

Malignant melanoma

Oncogene or Tumor suppressorand what is the associated tumor

abl

Oncogenes

CML


c-myc

Oncogenes

Burkitt’s lymphoma


bcl-2

Oncogenes

Follicular and undifferentiatedlymphomas (inhibits apoptosis)


12/23


erb-B2

Oncogenes

Breast, ovarian, and gastriccarcinomas


ras

Oncogenes

Colon carcinoma


L-myc

Oncogenes

Lung tumor


N-myc

Oncogenes

Neuroblastoma


ret

Oncogenes

Multiple endocrine neoplasia (MEN)types II and III


Rb

Tumor suppressor

Retinoblastoma, osteosarcoma


BRCA1 and 2

Tumor suppressor

Breast and ovarian cancer


13/23


p53

Tumor suppressor

Most human cancers, Li-Fraumenisyndrome


p16

Tumor suppressor

Melanoma


APC

Tumor suppressor

Colorectal cancer


WT1

Tumor suppressor

Wilms’ tumor


NF1

Tumor suppressor

Neurofibromatosis type 1


NF2

Tumor suppressor



DPC

Tumor suppressor

Pancreatic cancer


14/23


DCC

Tumor suppressor

Colon cancer

Tumor markers

PSA

Prostate-specific antigen. Prostaticcarcinoma.

Tumor markers

CEA

Very nonspecific but

colorectal and pancreaticcancers; also others

Tumor markers

α-fetoprotein

Hepatocellular carcinomas.

yolk sac tumor

Tumor markers

β-hCG

Hydatidiform moles,Choriocarcinomas,

Gestational trophoblastic tumors.

Tumor markers

CA-125Ovarian, malignant epithelial tumors.

Tumor markers

S-100

Melanoma, neural tumors,astrocytomas.


15/23

Tumor markers

Alkaline phosphatase

-Metastases to bone,-obstructive biliary disease, -Paget’s

disease of bone.

Tumor markers

Bombesin

Neuroblastoma, lung and gastriccancer.

Tumor markers

TRAP

Hairy cell

leukemia––a B-cell neoplasm.

Tumor markers

CA-19-9Pancreatic adenocarcinoma.

what is TRAPTartrate-resistant acid phosphatase.

Hairy cellleukemia––a B-cell neoplasm.

Oncogenic virusesname the tumor associated with

HTLV-1

Adult T-cell leukemia


HBV, HCV

Hepatocellular carcinoma


16/23


EBV

Burkitt’s lymphoma, nasopharyngealcarcinoma


HPV

Cervical carcinoma (16, 18),penile/analcarcinoma


HHV-8

Kaposi’s sarcoma, body cavity fluid B-

celllymphoma

Types of HPV that cause CIN 16, 18

Cancer caused by

AflatoxinsLiver (hepatocellular carcinoma)

Cancer caused by

Vinyl chlorideLiver (angiosarcoma)

Cancer caused by

CCl4

Liver (centrilobular necrosis, fattychange)


17/23

Cancer caused by

NitrosaminesEsophagus, stomach

Cancer caused by

Cigarette smokeLarynx, lung, ...

Cancer caused by

Asbestos

Lung (mesothelioma and

bronchogenic carcinoma)

Cancer caused by

ArsenicSkin (squamous cell carcinoma)

Cancer caused by

Naphthalene (aniline) dyesBladder (transitional cell carcinoma)

Cancer caused by

Alkylating agentsBlood (leukemia)

Paraneoplastic effects of tumorsneoplasm and Mech

Cushing’s syndrome

Small cell lung carcinoma

ACTH or ACTH-like peptide


18/23


SIADH

Small cell lung carcinoma andintracranial neoplasms

ADH


Hypercalcemia

Squamous cell lung carcinoma,renal cell carcinoma, breast

carcinoma, multiplemyeloma, and bone

metastasis (lysed bone)

PTH-related peptide, TGF-β, TNF-α,IL-1


Polycythemia

Renal cell carcinoma,hemangioblastoma

Erythropoietin


Lambert-Eaton syndrome

Thymoma, small cell lungcarcinoma

Antibodies against presynaptic Ca2+channels at neuromuscular junction


Gout, urate nephropathy

Leukemias and lymphomas

Hyperuricemia due to excess nucleicacid

turnover (i.e., cytotoxic therapy)

1° tumors that metastasize to brain

Lots of Bad Stuff Kills Glia.

Lung,Breast,

Skin (melanoma),Kidney (renal cell carcinoma),

GI.


19/23

approximately ??%of brain tumors are from metastases.

50

??????the most common sites ofmetastasis after the regional lymph

nodes.

liverand

Lungs

tumors that metastasize to the liver

mne: Cancer Sometimes PenetratesBenign Liver.

Colon > Stomach > Pancreas > Breast> Lung.

most common Liver cancer Metastasis

These 1° tumors metastasize to bone

P. TT. Barnum Loves Kids.

PROSTATE, Thyroid, Testes,BREAST, Lung, Kidney.

Features of 1° tumors thatmetastasize to bone

Lung = Lytic.Prostate = blastic.

Breast = Both lytic and blastic.

Most common Bone Tumors Mets from (esp Prostate or Breast)


20/23

Cancer epidemiology

Most common cancers inMen

..deaths in men

Prostate (32%)Lung (16%)

Colon and rectum (12%)..

Lung (33%)Prostate (13%)

Cancer epidemiology

Most common cancers inwomen

..deaths in women

Breast (32%)Lung (13%)

Colon and rectum (13%)...

Lung (23%)Breast (18%)

1st and 2nd leading killers in the U.S.

heart disease

cancer

Changes in lung cancer deathsDeaths from lung cancer have

plateaued in males butcontinue to ↑ in females.

Retinoblastoma, osteosarcoma

GeneChromosome

andOncogene or Tumor suppressor

Rb

13q

Tumor suppressor

Breast and ovarian cancer (BRCA)

GeneChromosome


BRCA1 and 2

17q, 13q

Tumor suppressor

Most human cancers, Li-Fraumenisyndrome

GeneChromosome


p53

17p

Tumor suppressor


21/23

Melanoma

GeneChromosome


p16

9p

Tumor suppressor

Colorectal cancer

GeneChromosome


APC

5q

Tumor suppressor

Wilms’ tumor

GeneChromosome


WT1

11q

Tumor suppressor


GeneChromosome


NF1

17q

Tumor suppressorNeurofibromatosis type 2

GeneChromosome


NF2

22q

Tumor suppressor

Pancreatic cancer

GeneChromosome


DPC

18q

Tumor suppressor

Colon cancer

Gene

Chromosomeand

Oncogene or Tumor suppressor

DCC 18q Tumor suppressor

and

ras Oncogenes


22/23

CML

GeneChromosome


abl

9:22

Oncogenes

Burkitt’s lymphoma

GeneChromosome


c-myc

8:14

Oncogenes

Follicular and undifferentiatedlymphomas

GeneChromosome


bcl-2

14:18

Oncogenes

Breast, ovarian, and gastriccarcinomas

GeneChromosome


erb-B2

Oncogenes

Colon carcinoma

GeneChromosome

and

Oncogene or Tumor suppressor

ras

OncogenesLung tumor

GeneChromosome


L-myc

Oncogenes


23/23

Neuroblastoma

GeneChromosome


N-myc

Oncogenes

Multiple endocrine neoplasia (MEN)types II and III

GeneChromosome


ret

Oncogenes

Gastrointestinal stromal tumor (GIST)

GeneChromosome


c-kit

Oncogenes

Documents

General Pathology Flashcards