Ne Oplasia Revi Ew Plu s
Transcript of Ne Oplasia Revi Ew Plu s
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NE OPLASIA REVI EWE OPLASIA REVI EW
Pluslu s9-18-20099-18-2009
T. DavisT. Davis
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1. A new test for prostate1. A new test for prostatecancer (PC) is developed.cancer (PC) is developed. 90%0% of menof men wi th PCi th PC test positive.test positive.80%0% of menof men without PCithout PC testtest
negative.negative.2. In a population of 1000 men,2. In a population of 1000 men,30% (300 men) have the30% (300 men) have the
disease (the prevalence is 30%).disease (the prevalence is 30%).Calculate sensitivity, specificityCalculate sensitivity, specificityand PPV.and PPV.
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Sen sit ivit y a nden sit ivit y a nd
speci ficit ypeci ficit y90% sensitivity90% sensitivity90% of 1000 or 90090% of 1000 or 900
would be thewould be the trueru e positivesositives10% of 1000 or 10010% of 1000 or 100would be thewould be the falsealseneg at iv eseg at iv es
80% specificity80% specificity80% of 1000 or 80080% of 1000 or 800
would be thewould be the trueru enega tivesega tives20% of 1000 or 20020% of 1000 or 200would be thewould be the falsealsepos it ivesos it ives
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PPVPV (predictive value of a +)(predictive value of a +)
with a prevalence of 30%with a prevalence of 30%410 men have a positive test: 270 TP410 men have a positive test: 270 TP(90%x300) and 140 FP (20%x700)(90%x300) and 140 FP (20%x700)
PPV= TP/FP+TPPPV= TP/FP+TPPPV= 270 / 270 + 140PPV= 270 / 270 + 140
270/410 or about 66%270/410 or about 66%
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Ca ncer P recu rsor L es ion sa ncer P recu rsor L es ion s
________ ________ Atyp. Hyp. Breast Atyp. Hyp. Breast
_______ _______ Endom. HyperplasiaEndom. Hyperplasia
_________ _________
Gastric metaplasiaGastric metaplasia(Helicobacter)(Helicobacter)
___________ ___________
Sq. Cell CA Sq. Cell CA __________ __________
Adeno CA colon Adeno CA colon ___________ ___________ Esoph. Adeno CA Esoph. Adeno CA
_____________ _____________
Adeno CA liver Adeno CA liver
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Actinic keratosis Actinic keratosis Atyp. Hyp. Breast Atyp. Hyp. BreastUlcerative ColitisUlcerative ColitisEndom. HyperplasiaEndom. Hyperplasia
Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)Gastric metaplasiaGastric metaplasia
(Helicobacter)(Helicobacter)
Sq. Cell CA Sq. Cell CA Ductal CA Ductal CA
Adeno CA colon Adeno CA colon Adeno CA endom. Adeno CA endom.
Esoph. Adeno CA Esoph. Adeno CA
Gastric Adeno CA Gastric Adeno CA
Adeno CA liver Adeno CA liver
Ca ncer P recu rsor L es ion sa ncer P recu rsor L es ion s
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Ca ncer P recu rsor L es ion sa ncer P recu rsor L es ion s
Actinic keratosis Actinic keratosis
__________ __________ Ulcerative ColitisUlcerative Colitis __________ __________
Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)
___________ ___________
CirrhosisCirrhosis
___________ ___________
Ductal CA Ductal CA ___________ ___________ Adeno CA endom. Adeno CA endom.
_____________ _____________
Gastric Adeno CA Gastric Adeno CA __________ __________
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Actinic keratosis Actinic keratosis Atyp. Hyp. Breast Atyp. Hyp. BreastUlcerative ColitisUlcerative ColitisEndom. HyperplasiaEndom. Hyperplasia
Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)Gastric metaplasiaGastric metaplasia
(Helicobacter)(Helicobacter)
Sq. Cell CA Sq. Cell CA Ductal CA Ductal CA
Adeno CA colon Adeno CA colon Adeno CA Adeno CA
endom.endom.Esoph. Adeno CA Esoph. Adeno CA Gastric Adeno CA Gastric Adeno CA
Adeno CA liver Adeno CA liver
Ca ncer P recu rsor L es ion sa ncer P recu rsor L es ion s
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Precu rs or s ( 2)recu rs or s ( 2)
____________ ____________
Sq.Sq.Dysplasia/cervix,Dysplasia/cervix,lung/larynxlung/larynx
______________ ______________
Adeno CA Adeno CA
___________ ___________
Adeno CA colon Adeno CA colon
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Precu rs or s ( 2)recu rs or s ( 2)
Scar in lungScar in lung
Sq.Sq.Dysplasia/cervix,Dysplasia/cervix,lung/larynxlung/larynx
Adenomatous Adenomatouspolyppolyp
Adeno CA Adeno CA
Ss. Cell CA Ss. Cell CA
Adeno CA colon Adeno CA colon
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Precu rs or s ( 2)recu rs or s ( 2)
Scar in lungScar in lung
____________ ____________
Adenomatous Adenomatouspolyppolyp
____________ ____________
Ss. Cell CA Ss. Cell CA
_____________ _____________
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Precu rs or s ( 2)recu rs or s ( 2)
Scar in lungScar in lung
Sq.Sq.Dysplasia/cervix,Dysplasia/cervix,lung/larynxlung/larynx
Adenomatous Adenomatouspolyppolyp
Adeno CA Adeno CA
Ss. Cell CA Ss. Cell CA
Adeno CA colon Adeno CA colon
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Malig nan t Tu mo rs a ndalig nan t Tu mo rs a nd
En docrin op athiesn docrin op athies _________ _________ ___________ ___________
___________ ___________ ____________ ____________ Insulin/hypoglycemiInsulin/hypoglycemi
ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct
Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testis
SC CA/lungSC CA/lungMed CA/thyroidMed CA/thyroidIslet cellIslet cell
Small CellSmall CellRenal Cell,Renal Cell,Hepatocellular CA Hepatocellular CA
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Malig nan t Tu mo rs a ndalig nan t Tu mo rs a nd
En docrin op athiesn docrin op athies ACTH/Cushings ACTH/CushingsHCG/gynecomastiaHCG/gynecomastiaPTH/hyperCa++PTH/hyperCa++Calcitonin/hypoCa+Calcitonin/hypoCa+
Insulin/hypoglycemiInsulin/hypoglycemi ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct
Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testisSquaC CA/lungSquaC CA/lungMed CA/thyroidMed CA/thyroid
___________ ___________ __________ __________ _____________ _____________
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Malig nan t Tu mo rs a ndalig nan t Tu mo rs a nd
En docrin op athiesn docrin op athies ACTH/Cushings ACTH/CushingsHCG/gynecomastiaHCG/gynecomastiaPTH/hyperCa++PTH/hyperCa++Calcitonin/hypoCa+Calcitonin/hypoCa+
Insulin/hypoglycemiInsulin/hypoglycemi ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct
_________ _________ ___________ ___________ ____________ ____________ ___________ ___________
Islet cellIslet cellSmall CellSmall CellRenal Cell,Renal Cell,
Hepatocellular CA Hepatocellular CA
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Malig nan t Tu mo rs a ndalig nan t Tu mo rs a nd
En docrin op athiesn docrin op athies ACTH/Cushings ACTH/CushingsHCG/gynecomastiaHCG/gynecomastiaPTH/hyperCa++PTH/hyperCa++Calcitonin/hypoCa+Calcitonin/hypoCa+
_________ _________ _________ _________ ____________ ____________
Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testisSquaC CA/lungSquaC CA/lungMed CA/thyroidMed CA/thyroid
Islet cellIslet cellSmall CellSmall CellRenal Cell,Renal Cell,
Hepatocellular CA Hepatocellular CA
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The f oll owi ng im ag e ishe f oll owi ng im ag e is
mos t c/w wh ic h ma lign anc yos t c/w wh ic h ma lign anc y
A. Medullary Carcinoma of Thyroid A. Medullary Carcinoma of ThyroidB. Small cell carcinoma of LungB. Small cell carcinoma of LungC. Sq. Cell Carcinoma of LungC. Sq. Cell Carcinoma of Lung
D. Metastatic melanomaD. Metastatic melanomaE. Renal Cell AdenocarcinomaE. Renal Cell Adenocarcinoma
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An s. C, SCC o f L ungn s. C, SCC o f L ung
These tumors frequently make aThese tumors frequently make aparathormone-like substanceparathormone-like substance
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Anaplasianaplasia = __ _____ ____ ______ __= __ _____ ____ ______ __
Anaplasia is considered a hallmark of Anaplasia is considered a hallmark of ______________ ______________ .. Anaplastic features include: Anaplastic features include:
- ?- ???
?
- Undi ffere nt iat ed, po orl y di ffere nti at ed,Undi ffere nt iat ed, po orl y di ffere nti at ed,high gradeig h gr ade
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Anaplasianaplasia = L ack of diffe rentia ti on= L ack of diffe rentia ti on
Anaplasia is considered a hallmark of Anaplasia is considered a hallmark of malignant transformation malignant transformation ..
Anaplastic features include: Anaplastic features include:- Cellular/nuclear pleomorphism- Cellular/nuclear pleomorphism
- Increased nuclear-cytoplasmic ratio- Increased nuclear-cytoplasmic ratio- Nuclear hyperchromasia (increased DNA content)- Nuclear hyperchromasia (increased DNA content)
- Large nucleoli- Large nucleoli
- Und iffer ent iat ed , po orly dif fer ent iat ed ,Undifferentiated, poorly differentiated,hig h g radeig h g rade
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GR AD ING TU MORSR AD ING TU MORS
__________ tumors only __________ tumors onlyLook at: ? And ?Look at: ? And ?
Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore __________)more __________)Important for some tumors: breast,Important for some tumors: breast,
prostate, endometrium, astocytomasprostate, endometrium, astocytomasDysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features
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GR AD ING TU MORSR AD ING TU MORS
Malignant tumors onlyMalignant tumors onlyDifferentiation and mitotic rateDifferentiation and mitotic rate
Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore anaplastic)more anaplastic)Important for some tumors: ?, ?, ?, ?Important for some tumors: ?, ?, ?, ?
Dysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features
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GR AD ING TU MORSR AD ING TU MORS
Malignant tumors onlyMalignant tumors onlyDifferentiation and mitotic rateDifferentiation and mitotic rate
Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore anaplastic)more anaplastic)Important for some tumors: breast,Important for some tumors: breast,prostate, endometrium, astocytomasprostate, endometrium, astocytomasDysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features
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SP
SP
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Squamous cell carcinoma with squamous pearls (SP)
SP
SP
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SP
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SP
Squamous Pearls (SP)
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*
*
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*
*
Intercellular bridges (*)
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Anaplastic rhabdomyosarcoma
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STAGI NG TU MORSTAGI NG TU MORS
How far has the tumor spreadHow far has the tumor spreadMalignant tumors onlyMalignant tumors only?, ?, ??, ?, ?Staging often involves: theStaging often involves: thePathologist, radiology or otherPathologist, radiology or otherimaging, lab tests (tumor markers)imaging, lab tests (tumor markers)CISIS is referred to asis referred to as __ ___ __ ____ ___ __ ___
TAGI NG TUMORS
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STAGI NG TUMORSTAGI NG TUMORS
How far has the tumor spreadHow far has the tumor spreadMalignant tumors onlyMalignant tumors onlyTumor size (Tumor size ( T), lymph node (), lymph node ( N))involvement, distant metastases (involvement, distant metastases ( M))Staging often involves: theStaging often involves: thePathologist, radiology or otherPathologist, radiology or otherimaging, lab tests (tumor markers)imaging, lab tests (tumor markers)CISIS is referred to asis referred to as Sta ge Zerota ge Zero
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METASTA SISETASTA SIS
LIVER: (portal circulation)LIVER: (portal circulation) ______________ ______________ LUNG: breast, stomach, sarcomasLUNG: breast, stomach, sarcomas
BONE: 3BONE: 3rdrd
most frequent site for ??;most frequent site for ??;lung, breast, prostate, kidney, thyroid;lung, breast, prostate, kidney, thyroid;PROSTATE to bone gives osteoblasticPROSTATE to bone gives osteoblasticlesions on Xray and high serumlesions on Xray and high serumalkaline phosphatasealkaline phosphatase
ADRENAL: most common ADRENAL: most common ____________ ____________
AS A S SETASTA SIS
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METASTA SISETASTA SIS
LIVER: (portal circulation) GI tractLIVER: (portal circulation) GI tractand pancreas; lung, breast,and pancreas; lung, breast,melanomasmelanomas
LUNG: ?, ?, ?LUNG: ?, ?, ?BONE: 3BONE: 3 rdrd most frequent site formost frequent site formetastases; ?, ?, ?, ?, ?; PROSTATE tometastases; ?, ?, ?, ?, ?; PROSTATE tobone gives _____________ on Xraybone gives _____________ on Xrayand high serum ______________ and high serum ______________
ADRENAL: most common endocrine ADRENAL: most common endocrinesitesite
METASTA SISETASTA SIS
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METASTA SISETASTA SIS
LIVER: (portal circulation) GI tractLIVER: (portal circulation) GI tractand pancreas; lung, breast,and pancreas; lung, breast,melanomasmelanomas
LUNG: breast, stomach, sarcomasLUNG: breast, stomach, sarcomasBONE: 3BONE: 3 rdrd most frequent site formost frequent site formetastases; lung, breast, prostate,metastases; lung, breast, prostate,kidney, thyroid; PROSTATE to bonekidney, thyroid; PROSTATE to bonegives osteoblastic lesions on Xray andgives osteoblastic lesions on Xray andhigh serum alkaline phosphatasehigh serum alkaline phosphatase
ADRENAL: most common endocrine ADRENAL: most common endocrine
sitesite
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Neop las ia Ca seeop las ia Ca se
A 38-y.o. male has a family history of A 38-y.o. male has a family history of colectomies performed between agescolectomies performed between ages
30 and 40. The slide shows the total30 and 40. The slide shows the totalcolectomy specimen from this patient.colectomy specimen from this patient.
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Familial polyposis
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Tubular adenomas (adenomatous polyps)
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AC
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Adenomatous Change (AC)
AC
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Carcinomain situ invasive
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CO LON CANC ERO LON CANC ER
Grading is helpful/not very helpfulGrading is helpful/not very helpfulSTAGING: predicts _________ STAGING: predicts _________ TNMTNMRobbins Table 17-11Robbins Table 17-11
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CO LON CANC ERO LON CANC ER
Grading is not very helpfulGrading is not very helpfulSTAGING: predicts clinical outcomeSTAGING: predicts clinical outcomeTNMTNMRobbins Table 17-11Robbins Table 17-11
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Tu mor Siz e ( T)u mor Siz e ( T)
Tis- ???Tis- ???T1- ____________ T1- ____________ T2- ___________ T2- ___________ T3- ___________ T3- ___________ T4- ______________ T4- ______________
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Tu mor Size ( T)u mor Size ( T)
Tis- insitu; not through the muscularisTis- insitu; not through the muscularismucosamucosa
T1- invades submucosaT1- invades submucosaT2- into but not through theT2- into but not through themuscularis propriamuscularis propria
T3- through muscularis propriaT3- through muscularis propriaT4- invades adjacent organsT4- invades adjacent organs
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??? Staging System
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TNM Staging System
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Lymph Nodes ( N)ymph Nodes ( N)
N0- ??N0- ??N1- ??N1- ??N2- ??N2- ??
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Lymph Nodes ( N)ymph Nodes ( N)
N0- no nodes involvedN0- no nodes involvedN1- 1-3 regional LNsN1- 1-3 regional LNsN2- 4+ regional LNsN2- 4+ regional LNs
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Dis tant Met astas es (M)is tant Met astas es (M)
M0- ??M0- ??M1- ??M1- ??
*note*noteTx, Nx, Mx- can/cannot be assessedTx, Nx, Mx- can/cannot be assessed
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Dis tant Met astas es (M)is tant Met astas es (M)
M0- no distant metastasisM0- no distant metastasisM1- distant mets presentM1- distant mets present
*note*noteTx, Nx, Mx- cannot be assessedTx, Nx, Mx- cannot be assessed
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An swer : C, in activ ationn swer : C, in activ at ion
of AP Cf APCThis disorder is autosomal dominantThis disorder is autosomal dominantwith the APC supressor gene onwith the APC supressor gene on
chromosome 5.chromosome 5.
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CO LON CANC ERO LON CANC ER
OTHER OTHER 50% of colorectal carcinomas show ?? 50% of colorectal carcinomas show ??
mutations; 50% of adenomas > 1cm showmutations; 50% of adenomas > 1cm show ________ mutations ________ mutations _________ can be used to follow patients _________ can be used to follow patientsafter surgery- tumor monitoringafter surgery- tumor monitoringDeeply infiltrating tumors causeDeeply infiltrating tumors cause_______________________ and ???? appearanceand ???? appearance
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CO LON CANC ERO LON CANC ER
OTHER OTHER 50% of colorectal carcinomas show ras 50% of colorectal carcinomas show ras
mutations; 50% of adenomas > 1cm alsomutations; 50% of adenomas > 1cm alsoshow ras mutationsshow ras mutationsCEA (carcinoembryonic Ag) can be used toCEA (carcinoembryonic Ag) can be used tofollow patients after surgery- tumorfollow patients after surgery- tumormonitoringmonitoringDeeply infiltrating tumors causeDeeply infiltrating tumors causedes mop la si aes mop la si a and apple core/ napkin-ring and apple core/ napkin-ring
appearanceappearance
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????
?????
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Normal
Adenocarcinoma
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Tumor: napkin ring lesionNormal, pretty!
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Na me th e m ost c om mo na me th e m ost c om mo n
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Na me th e m ost c om mo na me th e m ost c om mo nhuma n tum or su presso ruma n tum or su presso r
gen es a nd p ro to onc ogeneen es a nd p ro to onc ogene(RESPECTIVELY)RESPECTIVELY)
A. P53 and RB A. P53 and RBB. P53 and RASB. P53 and RAS
C. RB and RASC. RB and RASD. APC and P53D. APC and P53E. APC and RBE. APC and RB
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An swer : B, P 53 a nd R ASn swer : B, P 53 a nd R AS
P53 is the tumor supressor geneP53 is the tumor supressor genemutated in over 50% of humanmutated in over 50% of human
tumors. The mutation prevents DNA tumors. The mutation prevents DNA repair and inhibits apoptosis. The pointrepair and inhibits apoptosis. The pointmutation in the proto-oncogene RASmutation in the proto-oncogene RAS
allows cell proliferation (GTP signalallows cell proliferation (GTP signaltransduction) and is seen 30+% of transduction) and is seen 30+% of human tumorshuman tumors
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Wha t tu mo r m ar kers ar eha t tu mo r m ar kers ar e
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Wha t tu mo r m ar kers ar eha t tu mo r m ar kers ar eusef ul in ma na gement o fsef ul in ma na gement o f
colon cancer?olon cancer? A. CEA is used to monitor tumor A. CEA is used to monitor tumorrecurrencerecurrenceB. CEA is used as a screening test forB. CEA is used as a screening test forcolon cancercolon cancerC. CEA is used as a confirmation test if C. CEA is used as a confirmation test if the test for occult blood is positivethe test for occult blood is positive
D. High PSA in serum is diagnosticD. High PSA in serum is diagnosticE. High AFP in serum is diagnosticE. High AFP in serum is diagnostic
An swer : A, u sed ton swer : A, u sed to
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An swer : A, u sed to,mon it or t umoron it or t umor
recu rre nceecu rre nceCEA is not specific for colon cancerCEA is not specific for colon cancerand not a sensitive test. CEA levels areand not a sensitive test. CEA levels are
determined pre- and post-surgery. Thedetermined pre- and post-surgery. TheCEA level should fall to near zero. If CEA level should fall to near zero. If the level falls and then increases, thethe level falls and then increases, the
patient may receive chemotherapy forpatient may receive chemotherapy forthe recurrence.the recurrence.
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Tu mor Ma rk er su mor Ma rk er s
ManagementManagementDetection (staging)Detection (staging)
Diagnosis (screening)- PSA andDiagnosis (screening)- PSA andCA 125CA 125
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Markersarkers
? - colon, pancreas, stomach, lung,- colon, pancreas, stomach, lung,breast, (19% smokers, 3% gen. pop.)breast, (19% smokers, 3% gen. pop.)
?-- hepatocellular, germ cellhepatocellular, germ cell(>500ng/ml)(>500ng/ml)??-?- 80% non-mucinous80% non-mucinous ovarian CA ovarian CA
??- pancreatic CA (80%)??- pancreatic CA (80%)
M kk
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Markersarkers
CEAEA- colon, pancreas, stomach, lung,- colon, pancreas, stomach, lung,breast, (19% smokers, 3% gen. pop.)breast, (19% smokers, 3% gen. pop.)
AFP-FP- hepatocellular, germ cellhepatocellular, germ cell(>500ng/ml)(>500ng/ml)CA 125 -A 125 - 80% non-mucinous80% non-mucinous ovarianovarian
CA CA CA 19-9- pancreatic CA (80%)CA 19-9- pancreatic CA (80%)
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Marker s ( 2)arker s ( 2)
PSA- (?? ng/ml normal) (> ?? ng/mlPSA- (?? ng/ml normal) (> ?? ng/mlhighly suspicious); also ??? elevationhighly suspicious); also ??? elevation
in prostate CA assoc. with bonein prostate CA assoc. with bonemetastasis (osteoblastic)metastasis (osteoblastic)HCG- ?, ?HCG- ?, ?
M k ( 2)k ( 2)
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Marker s ( 2)arker s ( 2)
PSA- (0-4 ng/ml normal) (>10 ng/mlPSA- (0-4 ng/ml normal) (>10 ng/mlhighly suspicious); also AlkPhoshighly suspicious); also AlkPhos
elevation in prostate CA assoc. withelevation in prostate CA assoc. withbone metastasis (osteoblastic)bone metastasis (osteoblastic)HCG- gestational trophoblasticHCG- gestational trophoblastic
tumors, testicular tumorstumors, testicular tumors
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L
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Benign breast ducts and lobules
L
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84/166
Fibroadenoma
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Fibroadenoma of breast
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C
C
CN
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C
C
CN
Intraductal carcinoma with cribbiforming (C) and comedonecrosis (CN)
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Invasive CA
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Mammogram shows a mass and Ca**
Stellate
tumor
BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
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BR EA ST CAR CI NO MAR EA ST CAR CI NO MAGRADINGRADING
Bloom and RichardsonBloom and Richardson
?? (1-3)?? (1-3)?? (1-3)?? (1-3)?? (1-3)?? (1-3)
Total score 3-5: Grade ITotal score 3-5: Grade ITotal score 6,7: Grade IITotal score 6,7: Grade IITotal score 8,9: Grade IIITotal score 8,9: Grade III
BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
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BR EA ST CAR CI NO MAR EA ST CAR CI NO MAGRADINGRADING
Bloom and RichardsonBloom and Richardson
Tubules present (1-3)Tubules present (1-3)Nuclear atypia (1-3)Nuclear atypia (1-3)Mitoses (1-3)Mitoses (1-3)
Total score 3-5: Grade ITotal score 3-5: Grade ITotal score 6,7: Grade IITotal score 6,7: Grade IITotal score 8,9: Grade IIITotal score 8,9: Grade III
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BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
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STAGI NGTAGI NG
Stage 0 (in situ or CIS): 5-year 92%Stage 0 (in situ or CIS): 5-year 92%Stage I. (4 LN+): 5-year 46%Stage IV. Distant mets: 5-year 13%Stage IV. Distant mets: 5-year 13%
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Invasive (infiltrating) ductal carcinoma with lymphatic invasion
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BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
OTHER OTHER Estrogen receptor (+): tumor is stimulatedEstrogen receptor (+): tumor is stimulatedby ?? and can be treated with the ?? This isby ?? and can be treated with the ?? This ispalliation.palliation.HER-2 Neu amplification: by immunostainingHER-2 Neu amplification: by immunostainingor FISH. If HER-2 Neu is amplified (20%),or FISH. If HER-2 Neu is amplified (20%),the patient can be treated with ?? This isthe patient can be treated with ?? This isvery expensive and tends to be used in highvery expensive and tends to be used in highgrade/high stage lesions that are ??grade/high stage lesions that are ??
BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
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BR EA ST CAR CI NO MAR EA ST CAR CI NO MA
OTHER OTHER Estrogen receptor (+): tumor is stimulatedEstrogen receptor (+): tumor is stimulatedby estrogen and can be treated with theby estrogen and can be treated with the
anti-estrogen tamoxifen. This is palliation. anti-estrogen tamoxifen. This is palliation.HER-2 Neu amplification: by immunostainingHER-2 Neu amplification: by immunostainingor FISH. If HER-2 Neu is amplified (20%),or FISH. If HER-2 Neu is amplified (20%),the patient can be treated with Herceptin.the patient can be treated with Herceptin.This is very expensive and tends to be usedThis is very expensive and tends to be usedin high grade/high stage lesions that arein high grade/high stage lesions that areHER-2 Neu positive.HER-2 Neu positive.
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ER (+)
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8/14/2019 Ne Oplasia Revi Ew Plu s
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HER-2 Neu (+)
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d l
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HPV an d Cer vica l Ca ncerPV an d Cer vica l Ca ncer
HPV DNA types ? And ?: condylomaHPV DNA types ? And ?: condylomaHPV ?, ?, ? others: carcinomaHPV ?, ?, ? others: carcinoma
Viral protein _____ acts via Viral protein _____ acts viaretinoblastoma gene proteinretinoblastoma gene protein
Viral protein E6 acts via ___________ Viral protein E6 acts via ___________
Proliferation is stimulated andProliferation is stimulated andapoptosis is inhibitedapoptosis is inhibited
HPV an d Cer vica l Ca ncerPV an d Cer vica l Ca ncer
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HPV an d Cer vica l Ca ncerPV an d Cer vica l Ca ncer
HPV DNA types 6 and 11: condylomaHPV DNA types 6 and 11: condylomaHPV 16, 18, 13 others: carcinomaHPV 16, 18, 13 others: carcinoma
Viral protein E7 acts via Viral protein E7 acts viaretinoblastoma gene proteinretinoblastoma gene protein
Viral protein E6 acts via to P53 (TP53). Viral protein E6 acts via to P53 (TP53).
Proliferation is stimulated andProliferation is stimulated andapoptosis is inhibitedapoptosis is inhibited
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-
8/14/2019 Ne Oplasia Revi Ew Plu s
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Squamous metaplasia
Endocervical glands
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112/166
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8/14/2019 Ne Oplasia Revi Ew Plu s
113/166
Normal epithelium shows maturation at the surface
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114/166
-
8/14/2019 Ne Oplasia Revi Ew Plu s
115/166
-
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116/166
-
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117/166
-
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118/166
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? ??
?? ??
koilocyte
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Normal Low Grade
Moderate Severe/CIS
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?
?
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Koilocytes (K)
K
K
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??
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8/14/2019 Ne Oplasia Revi Ew Plu s
125/166
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126/166
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Invasive squamous cell CA
Wha t i s the m ost s ensi ti veha t i s the m ost s ensi ti vete st f or hi gh gr ad ee st f or hi gh gr ad e
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te st f or hi gh gr ad ee st f or hi gh gr ad e
dy sp las ia of the c ervix ?y sp las ia of the c ervix ? A. Pap smear A. Pap smear
B. HPV DNA test for high risk typesB. HPV DNA test for high risk typesC. HPV test for DNA type 16C. HPV test for DNA type 16D. HPV test for DNA type 18D. HPV test for DNA type 18E. HPV serum antibodies to DNA typeE. HPV serum antibodies to DNA type1616
HP V DNA is m ost s ensi ti veP V DNA is m ost s ensi ti ve
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HP V DNA is m ost s ensi ti veP V DNA is m ost s ensi ti ve
te st f or Hi gh G ra dee st f or Hi gh G ra dedysplasiaysplasia
Pap smear 55%Pap smear 55%HPV DNA 95%HPV DNA 95%
LUNG CANCE RUNG CANCE R
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LUNG CANCE RUNG CANCE R
?, ?, and ?: can be cured by surgery if ?, ?, and ?: can be cured by surgery if caught early (
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Large cell carcinoma, adenocarcinomaLarge cell carcinoma, adenocarcinomaand squamous cell carcinoma: can beand squamous cell carcinoma: can becured by surgery if caught earlycured by surgery if caught early(
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Large cell carcinoma, adenocarcinomaLarge cell carcinoma, adenocarcinomaand squamous cell carcinoma: can beand squamous cell carcinoma: can becured by surgery if caught earlycured by surgery if caught early(
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-
8/14/2019 Ne Oplasia Revi Ew Plu s
134/166
Normal
CIS
Squamous CA
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135/166
-
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136/166
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137/166
-
8/14/2019 Ne Oplasia Revi Ew Plu s
138/166
-
8/14/2019 Ne Oplasia Revi Ew Plu s
139/166
-
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140/166
-
8/14/2019 Ne Oplasia Revi Ew Plu s
141/166
??
??
?? ??
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8/14/2019 Ne Oplasia Revi Ew Plu s
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keratin
Nuclear molding
Squamous Cell Carcinoma Small Cell Carcinoma
?? ??
-
8/14/2019 Ne Oplasia Revi Ew Plu s
143/166
?? ??
Squamous CA Adeno CA
-
8/14/2019 Ne Oplasia Revi Ew Plu s
144/166
Small cell undifferentiated carcinoma Large cell CA
-
8/14/2019 Ne Oplasia Revi Ew Plu s
145/166
-
8/14/2019 Ne Oplasia Revi Ew Plu s
146/166
Small Cell Carcinoma
-
8/14/2019 Ne Oplasia Revi Ew Plu s
147/166
??
-
8/14/2019 Ne Oplasia Revi Ew Plu s
148/166
Normal esophagus
-
8/14/2019 Ne Oplasia Revi Ew Plu s
149/166
??
-
8/14/2019 Ne Oplasia Revi Ew Plu s
150/166
Barretts syndrome
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8/14/2019 Ne Oplasia Revi Ew Plu s
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Para neop last icara neop lasticS dd
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152/166
Syndromesyndromes Acanthosis Acanthosisnigricansnigricans
Eaton-LambertEaton-LambertOsteoarthropathyOsteoarthropathySeborrheicSeborrheic
keratosiskeratosisMigratoryMigratorythrombophlebitisthrombophlebitis
(Tro ssea s)(Tro ssea s)
Adeno CA Adeno CA (gastric)(gastric)
Small Cell CA Small Cell CA Bronchogenic CA Bronchogenic CA Gastric CA Gastric CA
Pancreatic CA Pancreatic CA
Para neop last icara neop lasticS dd
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Syndromesyndromes Acanthosis Acanthosisnigricansnigricans
______________ ______________ OsteoarthropathyOsteoarthropathy
___________ ___________
MigratoryMigratorythrombophlebitisthrombophlebitis(Trousseaus)(Trousseaus)
_____________ _____________
Small Cell CA Small Cell CA ___________ ___________ Gastric CA Gastric CA
______________ ______________
Para neop last icara neop lasticS dd
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Syndromesyndromes Acanthosis Acanthosisnigricansnigricans
Eaton-LambertEaton-LambertOsteoarthropathyOsteoarthropathySeborrheicSeborrheic
keratosiskeratosisMigratoryMigratorythrombophlebitisthrombophlebitis
(T )(T )
Adeno CA Adeno CA (gastric)(gastric)
Small Cell CA Small Cell CA Bronchogenic CA Bronchogenic CA Gastric CA Gastric CA
Pancreatic CA Pancreatic CA
PARA NEO PLASTI CARA NEO PLASTI CSYNDROMESYNDROMES
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SYNDROMESYNDROMESSmall Cell CA Small Cell CA
__________ __________
Carcinoid tumorCarcinoid tumor(lung or liver(lung or liverusually)usually)
_________ _________
PTH-likePTH-like(Hypercalcemia)(Hypercalcemia)
_____________ _____________
PARA NEO PLASTI CARA NEO PLASTI CSYNDROMESYNDROMES
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SYNDROMESYNDROMESSmall Cell CA Small Cell CA
Squamous cellSquamous cellCA CA hypercalcemiahypercalcemia
Carcinoid tumorCarcinoid tumor(lung or liver(lung or liverusually)usually)
ACTH ACTH(Cushings); ADH(Cushings); ADH(iADH)(iADH)PTH-likePTH-like(Hypercalcemia)(Hypercalcemia)
Serotonin,Serotonin,bradykininbradykinin(Carcinoid(Carcinoid
d )syndrome)
PARA NEO PLASTI CARA NEO PLASTI CSYNDROMESYNDROMES
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SYNDROMESYNDROMES _____________ _____________
Squamous cellSquamous cellCA CA hypercalcemiahypercalcemia
____________ ____________
ACTH ACTH(Cushings); ADH(Cushings); ADH(iADH)(iADH)
__________ __________
Serotonin,Serotonin,bradykininbradykinin(Carcinoid(Carcinoid
d )d )
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Vir uses a nd Ca ncerir uses a nd Ca ncer(RNA)RNA)
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(RNA)RNA) _____________ _____________
HTLV-1HTLV-1
HepatocellularHepatocellular
____________ ____________
Vir uses a nd Ca ncerir uses a nd Ca ncer(RNA)RNA)
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(RNA)RNA)HCVHCV
HTLV-1HTLV-1
HepatocellularHepatocellular
T-cell leukemia/T-cell leukemia/lymphomalymphoma
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Vir uses a nd Ca ncerir uses a nd Ca ncer(RNA)RNA)
-
8/14/2019 Ne Oplasia Revi Ew Plu s
162/166
(RNA)RNA)HCVHCV
HTLV-1HTLV-1
HepatocellularHepatocellular
T-cell leukemia/T-cell leukemia/lymphomalymphoma
Vir uses a nd Ca ncerir uses a nd Ca ncer(DNA)DNA)
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(DNA)DNA) _________ _________
HBV (
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(DNA)DNA)EBV t(8;14)EBV t(8;14)
HBV (
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(DNA)DNA)EBV t(8;14)EBV t(8;14)
___________ ___________
____________ ____________ HPV 18 (E7/RB)HPV 18 (E7/RB)
___________ ___________
___________ ___________ Hepatocellular CA Hepatocellular CA
SC CA cervix, anusSC CA cervix, anus __________ __________ Kaposis sarcoma inKaposis sarcoma in
AIDS AIDS
Vir uses a nd Ca ncerir uses a nd Ca ncer(DNA)DNA)
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(DNA)DNA)EBV t(8;14)EBV t(8;14)
HBV (