100 Pathology Q/A Part 2

101 XXY = Klinefelter’s syndrome one of the most common causes of hypogonadism in males 
102 Approximately what percentage of brain tumors arise from metastasis? 
0.5 
103 Are basal cell carcinomas invasive? 
Locally invasive but rarely metastasize 
104 Are Ewing’s sarcomas likely to metastasize? 
Yes. They are extremely aggressive with early metastasis. However, they are responsive to chemotherapy. 
105 Are meningiomas resectable? 
Yes 
106 Are squamous cell carcinomas of the skin invasive? 
Locally invasive but rarely metastasize 
107 Are the majority of adult tumors supratentorial or infratentorial? 
Supratentorial 
108 Are the majority of childhood tumors supratentorial or infratentorial? 
Infratentorial 
109 Common histopathology often seen in squamous cell carcinomas of the skin? 
Keratin pearls 
110 Define anaplasia 
Abnormal cells lacking differentiation; like primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms. Tumor giant cells may be formed. 
111 Define dysplasia 
Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation. It is reversible but is often a preneoplastic sign. 
112 Define hyperplasia 
Increase in the number of cells (reversible) 
113 Define metaplasia 
One adult cell type is replaced by another (reversible). It is often secondary to irritation and/or environmental exposure (e.g. squamous metaplasia in the trachea and bronchi of smokers) 
114 Define neoplasia 
Clonal proliferation of cells that is uncontrolled and excessive 
115 Do oncogenes cause a gain or loss of function? 
Gain of function 
116 Do tumor suppressor genes cause a gain or loss of function? 
Loss of function. Both alleles must be lost for expression of disease 
117 Does a melanoma have a significant risk of metastasis? 
Very significant risk! The depth of the tumor often correlates with the risk of metastasis. 
118 From what cells do meningiomas most commonly arise? 
Arachnoid cells external to the brain 
119 Give 2 examples of a benign tumor of epithelial origin. 
1. Adenoma 2. Papilloma 
120 Give 2 examples of a malignant tumor of epithelial origin. 
1. Adenocarcinoma 2. Papillary carcinoma 
121 Give 2 examples of malignant tumors of blood cell (mesenchymal) origin. 
1. Leukemia 2. Lymphoma 
122 Give an example of a benign tumor of blood vessel (mesenchymal) origin. 
Hemangioma 
123 Give an example of a benign tumor of bone (mesenchymal) origin. 
Osteoma 
124 Give an example of a benign tumor of more than one cell type. 
Mature teratoma 
125 Give an example of a benign tumor of skeletal muscle (mesenchymal) origin. 
Rhabdomyoma 
126 Give an example of a benign tumor of smooth muscle (mesenchymal) origin. 
Leiomyoma 
127 Give an example of a malignant tumor of blood vessel (mesenchymal) origin. 
Angiosarcoma 
128 Give an example of a malignant tumor of bone (mesenchymal) origin. 
Osteosarcoma 
129 Give an example of a malignant tumor of more than one cell type. 
Immature teratoma 
130 Give an example of a malignant tumor of skeletal muscle (mesenchymal) origin. 
Rhabdomysarcoma 
131 Give an example of a malignant tumor of smooth muscle (mesenchymal) origin. 
Leiomyosarcoma 
132 Give an example of a neoplasm associated with Down’s Syndrome. 
Acute Lymphoblastic Leukemia (ALL) 
133 How are tumor markers used? 
Tumor markers are used to confirm diagnosis, to monitor for tumor recurrence, and to monitor the response to therapy. They should not be used as a primary tool for diagnosis. 
134 How is prostatic adenocarcinoma most commonly diagnosed? 
Digital rectal exam (detect hard nodule) or by prostate biopsy 
135 How often do primary brain tumors undergo metastasis? 
Very rarely 
136 In what population is osteochondroma most often found? 
Usually men under the age of 25 
137 In which age group is prostatic adenocarcinoma most common? 
Men over the age of 50 
138 Is malignant transformation in osteochondroma common? 
Malignant transformation to chondrosarcoma is rare 
139 Name 1 common tumor staging system. 
TNM system T= size of tumor, N=node involvement, and M=metastases 
140 Name 3 herniation syndromes that can cause either coma or death when the herniations compress the brainstem 
1. Downward transtentorial (central) herniation 2. Uncal herniation 3. Cerebellar tonsillar herniation into the foramen magnum 
141 Name 4 factors that predispose a person to osteosarcoma. 
1. Paget’s disease of bone 2. Bone infarcts 3. Radiation 4. Familial retinoblastoma 
142 Name 4 possible routes of herniation in the brain 
1. Cingulate herniation under the falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation into the foramen magnum 
143 Name 5 primary brain tumors with peak incidence in adulthood. 
1. Meningioma 2. Glioblastoma multiforme 3. Oligodendroglioma 4. Schwannoma 5. Pituitary adenoma 
144 Name 5 primary brain tumors with peak incidence in childhood. 
1. Medulloblastoma 2. Hemangioblastoma 3. Ependymomas 4. Low-grade astrocytoma 5. Craniopharyngioma 
145 Name 5 sites from which tumor cells metastasize to the brain. 
1. Lung 2. Breast 3. Skin (melanoma) 4. Kidney (renal cell carcinoma) 5. GI 
146 Name a common histopathological sign of basal cell carcinoma nuclei 
The nuclei of basal cell tumors have ‘palisading’ nuclei 
147 Name a population at a greater risk for melanoma. 
Fair-skinned people (blue eyes and red hair have also been considered as factors) 
148 Name the 5 primary tumors that metastasize to the liver 
1. Colon 2. Stomach 3. Pancreas 4. Breast 5. Lung 
149 Name two of the most common sites of metastasis after the regional lymph nodes 
The liver and the lung 
150 Name two presenting sequelae of a pituitary adenoma. 
1. Bitemporal hemianopsia (due to pressure on the optic chiasm) 2. Hypopituitarism 
151 On which chromosome is the p53 gene located? 
17p 
152 On which chromosome is the Rb gene located? 
13q 
153 On which chromosomes are the BRCA genes located? 
BRCA 1 is on 17q and BRCA 2 is on 13q 
154 Out of the 6 primary tumors that metastasize to bone, which two are the most common? 
Metastasis from the breast and prostate are the most common 
155 What 2 cancers are associated with EBV? 
1. Burkitt’s lymphoma 2. Nasopharyngeal carcinoma 
156 What 2 neoplasms are associated with AIDS? 
1. Aggressive malignant lymphomas (non-Hodgkins) 2. Kaposi’s sarcoma 
157 What 2 neoplasms are associated with Autoimmune disease (e.g. Hashimoto’s thyroiditis, myasthenia gravis, etc.)? 
Benign and malignant thymomas 
158 What 2 neoplasms are associated with Paget’s disease of bone? 
1. Secondary osteosarcoma 2. Fibrosarcoma 
159 What 2 neoplasms are associated with Tuberous sclerosis (facial angiofibroma, seizures, and mental retardation)? 
1. Astrocytoma 2. Cardiac rhabdomyoma 
160 What are 2 characteristic findings in carcinoma in situ? 
1. Neoplastic cells have not invaded the basement membrane 2. High nuclear:cytoplasmic ratio and clumped chromatin 
161 What are 2 characteristic findings of an invasive carcinoma? 
1. Cells have invaded the basement membrane using collagenases and hydrolases 2. Able to metastasize if they reach blood or lymphatic vessels. 
162 What are 2 neoplasms associated with Xeroderma pigmentosum? 
1. Squamous cell carcinoma of the skin 2. Basal cell carcinoma of the skin 
163 What are 3 disease findings associated with Alkaline Phosphatase? 
1. Metastases to bone 2. Obstructive biliary disease 3. Paget’s disease of bone 
164 What are 6 primary tumors that metastasize to bone? 
1. Kidney 2. Thyroid 3. Testes 4. Lung 5. Prostate 6. Breast 
165 What are a common histopathological finding of meningiomas? 
Psammoma bodies. These are spindle cells concentrically arranged in a whorled pattern. 
166 What are ependymomas? 
Ependymal cell tumors most commonly found in the 4th ventricle. May cause hydrocephalus 
167 What are the steps in the progression of neoplasia? 
1. Normal 2. Hyperplasia 3. Carcinoma In Situ/Preinvasive 4. Invasion 
168 What are two signs of bone metastases in prostatic adenocarcinoma? 
An increase in serum alkaline phosphatase and PSA (prostate-specific antigen) 
169 What are two useful tumor markers in prostatic adenocarcinoma? 
Prostatic acid phosphatase and prostate-specific antigen (PSA) 
170 What can be associated with the risk of melanoma? 
Sun exposure 
171 What cancer is associated with HBV and HCV (Hep B and C viruses)? 
Hepatocellular carcinoma 
172 What cancer is associated with HHV-8 (Kaposi’s sarcoma-associated herpes virus)? 
Kaposi’s carcinoma 
173 What cancer is associated with the HTLV-1 virus? 
Adult T-cell leukemia 
174 What cancers are commonly associated with HPV (human papilloma virus)? 
Cervical carcinoma, penile, and anal carcinoma 
175 What causes the local effect of a mass? 
Tissue lump or tumor 
176 What causes the local effect of a nonhealing ulcer? 
Destruction of epithelial surfaces (e.g. stomach, colon, mouth, bronchus) 
177 What causes the local effect of a space-occupying lesion? 
Raised intracranial pressure in brain neoplasms. Also seen with anemia due to bone marrow replacement. 
178 What causes the local effect of bone destruction? 
Pathologic fracture or collapse of bone 
179 What causes the local effect of edema? 
Venous or lymphatic obstruction 
180 What causes the local effect of hemorrhage? 
Caused by ulcerated area or eroded vessel 
181 What causes the local effect of inflammation of a serosal surface? 
Pleural effusion, pericardial effusion, or ascites 
182 What causes the local effect of obstruction in the biliary tree? 
Jaundice 
183 What causes the local effect of obstruction in the bronchus? 
Pneumonia 
184 What causes the local effect of obstruction in the left colon? 
Constipation 
185 What causes the local effect of pain? 
Any site with sensory nerve endings. Remember that tumors in the brain are usually painless. 
186 What causes the local effect of perforation of an ulcer in the viscera? 
Peritonitis or free air 
187 What causes the local effect of seizures? 
Tumor mass in the brain. 
188 What causes the localized loss of sensory or motor function? 
Compression or destruction of nerve (e.g. recurrent laryngeal nerve by lung or thyroid cancer causes hoarseness) 
189 What causes the paraneoplastic effect gout? 
Hyperuricemia due excess nucleic acid turnover (secondary to cytotoxic therapy of various neoplasms) 
190 What causes the paraneoplastic effect of Cushing’s disease? 
ACTH or ACTH-like peptide (secondary to small cell lung carcinoma) 
191 What causes the paraneoplastic effect of hypercalcemia? 
PTH-related peptide, TGF-a, TNF-a, IL-2 (secondary to squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma, and bone metastasis) 
192 What causes the paraneoplastic effect of Lambert-Eaton syndrome? 
Antibodies against presynaptic Ca2+ channels at NMJ (Thymoma, bronchogenic carcinoma) 
193 What causes the paraneoplastic effect of Polycythemia? 
Erythropoietin (secondary to renal cell carcinoma) 
194 What causes the paraneoplastic effect of SIADH? 
ADH or ANP (secondary to small cell lung carcinoma and intracranial neoplasms) 
195 What chemical carcinogen is commonly associated with the centrilobar necrosis and fatty acid change? 
CCL4 
196 What chemical carcinogen is commonly associated with the esophagus and stomach? 
Nitrosamines 
197 What chemical carcinogen is commonly associated with the lungs? 
Asbestos (Causes mesothelioma and bronchogenic carcinoma) 
198 What chemical carcinogen is commonly associated with the skin (squamous cell)? 
Arsenic 
199 What chemical carcinogen(s) are commonly associated with the liver? 
Aflatoxins and vinyl chloride 
200 What is a chondrosarcoma? 
Malignant cartilaginous tumor. 

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