General Pathology Flashcards

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Apoptosis
aka
Programmed cell death.
Apoptosis
characteristics
cell shrinkage, chromatin

condensation, membrane blebbing,
and
formation of apoptotic bodies, which
are then phagocytosed.
Apoptosis
when
- embryogenesis, hormone -induction

(menstruation), -immune cell
mediated death,
- injurious stimuli (e.g., radiation,
hypoxia),
-atrophy.
Enzymatic degradation of a cell

resulting from exogenous injury.
Necrosis
Characterized by enzymatic digestion

and protein denaturation, with release
of
intracellular components.
Necrosis
Morphologically occurs as
-coagulative (heart, liver, kidney),
-liquefactive (brain),
Necrosis
different types and there locations
-caseous (tuberculosis),
-fat (pancreas),
-fibrinoid, or gangrenous (limbs, GI
tract).
Cell injury
reversible or irreversible
Cellular swelling?
Reversible
Cell injury
Nuclear chromatin clumping?
Reversible
Cell injury
Decreased ATP synthesis?
Reversible
Cell injury
Ribosomal detachment?
Reversible
Cell injury
Glycogen depletion?
Reversible
Cell injury
Plasma membrane damage?
Irreversible
Cell injury
Lysosomal rupture?
Irreversible
Cell injury
Ca2+ influx oxidative
phosphorylation?
Irreversible
Cell injury
Nuclear pyknosis, karyolysis,
karyorrhexis?
Irreversible
Cell injury
Mitochondrial permeability?
irreversible
Inflammation
5 features
Characterized by
-rubor (redness),
-dolor (pain),
-calor (heat),
-tumor (swelling)
-functio lassa (loss of function).
cells in acute Inflammation
Neutrophil, eosinophil, and antibody

mediated
cells in chronic Inflammation
Mononuclear cell mediated:
Phases of Inflammation
Fluid exudation
Leukocyte activation
Fibrosis
Acute
Chronic
Resolution
What happens in different phases of

Inflammation?
Fluid exudation
Increased vascular permeability,

vasodilation, endothelial injury

Inflammation?
Leukocyte activation
Emigration (rolling, tight binding,

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

Inflammation?
Fibrosis
Fibroblast emigration and proliferation

Deposition of ECM

Inflammation?
Acute
Neutrophil, eosinophil, and antibody

mediated

Inflammation?
Chronic
Mononuclear cell mediated:

Characterized by persistent
destruction and repair
Granulomanodular collections of
macrophages and giant cells
-Restoration of normal structure

-Granulation tissuehighly
vascularized, fibrotic
Inflammation?
Resolution 5 different outcomes
-Abscessfibrosis surrounding pus

-Fistulaabnormal communication
-Scarringcollagen deposition
resulting in altered structure and
function
Leukocyte
extravasation
what mediates
Rolling?
E-selectin on vascular endothelium

binding to Sialyl-LewisX
on the leukocyte.
Leukocyte
extravasation
what mediates
Tight binding?
ICAM-1 on vascular endothelium

binding to LFA-1 on
the leukocyte.
Stages of Leukocyte
extravasation
1. Rolling
2. Tight binding
3. Diapedesis
4. Migration
Leukocyte
extravasation
what mediates
migration?
chemotactic signals (e.g., cytokines).
What is Diapedisis
leukocyte travels between

endothelial cells and exits blood
vessel.
Free radical injury

what initiates it
Initiated via
radiation exposure,
metabolism of drugs (phase I), redox
reaction,
nitric oxide,
transition metals,
leukocyte oxidative burst.
Free radical injury

when is it a big problem
reperfusion after thrombolytic therapy.
Free radical injury

what are the antioxidants
(vitamins E and A).
Abnormal proliferation of cells with

loss of size, shape, and
orientation
dysplasia
Normal cells with basal apical

differentiation
Normal cells
Cells have increased in number
hyperplasia
Neoplastic cells have not invaded

basement membrane
High nuclear/cytoplasmic ratio and
clumped chromatin
Neoplastic cells encompass entire
thickness
In situ carcinoma
Cells have invaded basement

membrane using collagenases and
hydrolases
Can metastasize if they reach a
blood or lymphatic vessel
Invasive carcinoma
-plasia definitions
Hyperplasia
in number of cells (reversible).
-plasia definitions
Metaplasia
1 adult cell type is replaced by

another (reversible). Often 2
-plasia definitions
Dysplasia
abnormal growth with loss of cellular

orientation, shape, and size in
comparison to normal tissue
maturation; commonly preneoplastic
(reversible).
-plasia definitions
Anaplasia
abnormal cells lacking

differentiation; like primitive cells of
same tissue, often
equated with undifferentiated
malignant neoplasms.
-plasia definitions
Neoplasia
a clonal proliferation of cells that is

uncontrolled and excessive.
Tumor grade vs. stage

describe
Grade = histo apperance, often based

on the mitoses per high pwer field
number
Stage = ammount of spread based on
site and size
Tumor grade vs. stage

which is usually more prognostic
Stage
TNM staging system:
T = size of Tumor
N = Node involvement
M = Metastases
The term ?????? implies epithelial

origin, whereas sarcoma denotes
???????origin. Both terms imply
?????.
The term carcinoma implies ???????
origin, whereas sarcoma denotes
??????origin. Both terms imply
?????.
carcinoma
sarcoma
malignancy
epithelial
mesenchymal
malignancy
Blood cells = There isn't one
Blood vessels = Hemangioma
Tumor nomenclature
Benign tumor of
Mesenchyme
Smooth muscle = Leiomyoma

Skeletal muscle = Rhabdomyoma
Bone = Osteoma
Fat = Lipoma
Tumor nomenclature
Benign vs malignant tumor of
Epithelium
Adenoma, papilloma
Adenocarcinoma, papillary carcinoma
Tumor nomenclature
Benign vs malignant tumor of
> 1 cell type
benign = mature teratoma

malignint = Immature teratoma
Blood cells = Leukemia, lymphoma
Blood vessels = Angiosarcoma
Tumor nomenclature
malignant tumor of
Mesenchyme
Smooth muscle =Leiomyosarcoma

Skeletal muscle =
Rhabdomyosarcoma
Bone = Osteosarcoma
Fat = Liposarcoma
What is the Neoplasm/s associated

with Down syndrome?
ALL (we ALL fall Down),

AML

with Xeroderma pigmentosum,
albinism?
Melanoma and basal,

squamous cell carcinomas
of skin

with Chronic atrophic gastritis,
pernicious anemia,
postsurgical gastric remnants?
Gastric adenocarcinoma

with Tuberous sclerosis?
Astrocytoma and cardiac

rhabdomyoma

with Actinic keratosis?
Squamous cell carcinoma

of skin

with Barretts esophagus?
Esophageal
adenocarcinoma

with Plummer-Vinson syndrome?
Squamous cell carcinoma

of esophagus

with Cirrhosis (alcoholic, hepatitis B or
C)?
Hepatocellular carcinoma

with Ulcerative colitis?
Colonic adenocarcinoma

with Pagets disease of bone?
2 osteosarcoma and
fibrosarcoma

with Immunodeficiency states?
Malignant lymphomas

with AIDS?
Aggressive malignant
lymphomas (non-Hodgkins)
and Kaposis sarcoma

with Autoimmune diseases?
Benign and malignant

thymomas

with Acanthosis nigricans?
Visceral malignancy
(stomach, lung, breast,
uterus)

with Dysplastic nevus?
Malignant melanoma
Oncogene or Tumor suppressor

and what is the associated tumor
Oncogenes
abl
c-myc
bcl-2
CML
Oncogenes
Burkitts lymphoma
Oncogenes
Follicular and undifferentiated
lymphomas (inhibits apoptosis)

erb-B2
ras
L-myc
N-myc
ret
Rb
BRCA1 and 2
Oncogenes
Breast, ovarian, and gastric
carcinomas
Oncogenes
Colon carcinoma
Oncogenes
Lung tumor
Oncogenes
Neuroblastoma
Oncogenes
Multiple endocrine neoplasia (MEN)
types II and III
Tumor suppressor
Retinoblastoma, osteosarcoma
Tumor suppressor
Breast and ovarian cancer

p53
p16
APC
WT1
NF1
NF2
DPC
Tumor suppressor
Most human cancers, Li-Fraumeni
syndrome
Tumor suppressor
Melanoma
Tumor suppressor
Colorectal cancer
Tumor suppressor
Wilms tumor
Tumor suppressor
Neurofibromatosis type 1
Tumor suppressor
Neurofibromatosis type 2
Tumor suppressor
Pancreatic cancer

DCC
Tumor markers
PSA
Tumor suppressor
Colon cancer
Prostate-specific antigen. Prostatic

carcinoma.
CEA
Very nonspecific but

colorectal and pancreatic
cancers; also others
Tumor markers
Hepatocellular carcinomas.
-fetoprotein
yolk sac tumor
Tumor markers
Hydatidiform moles,
Choriocarcinomas,
Gestational trophoblastic tumors.
Tumor markers
-hCG
Tumor markers
Ovarian, malignant epithelial tumors.
CA-125
Tumor markers
S-100
Melanoma, neural tumors,

astrocytomas.
Tumor markers
Alkaline phosphatase
Tumor markers
Bombesin
Tumor markers
TRAP
-Metastases to bone,
-obstructive biliary disease, -Pagets
disease of bone.
Neuroblastoma, lung and gastric

cancer.
Hairy cell
leukemiaa B-cell neoplasm.
Tumor markers
Pancreatic adenocarcinoma.
CA-19-9
what is TRAP
Oncogenic viruses
name the tumor associated with
Tartrate-resistant acid phosphatase.

Hairy cell
leukemiaa B-cell neoplasm.
Adult T-cell leukemia
HTLV-1
Oncogenic viruses
HBV, HCV
Hepatocellular carcinoma
Oncogenic viruses
Burkitts lymphoma, nasopharyngeal

carcinoma
EBV
Oncogenic viruses
HPV
Oncogenic viruses
HHV-8
Types of HPV that cause CIN
Cervical carcinoma (16, 18),

penile/anal
carcinoma
Kaposis sarcoma, body cavity fluid Bcell

lymphoma
16, 18
Cancer caused by
Liver (hepatocellular carcinoma)
Aflatoxins
Cancer caused by
Liver (angiosarcoma)
Vinyl chloride
Cancer caused by
CCl4
Liver (centrilobular necrosis, fatty

change)
Cancer caused by
Esophagus, stomach
Nitrosamines
Cancer caused by
Larynx, lung, ...
Cigarette smoke
Cancer caused by
Asbestos
Lung (mesothelioma and

bronchogenic carcinoma)
Cancer caused by
Skin (squamous cell carcinoma)
Arsenic
Cancer caused by
Bladder (transitional cell carcinoma)
Naphthalene (aniline) dyes
Cancer caused by
Blood (leukemia)
Alkylating agents
Paraneoplastic effects of tumors

neoplasm and Mech
Cushings syndrome
Small cell lung carcinoma

ACTH or ACTH-like peptide

neoplasm and Mech
Small cell lung carcinoma and

intracranial neoplasms
SIADH
ADH

neoplasm and Mech
Hypercalcemia
Squamous cell lung carcinoma,

renal cell carcinoma, breast
carcinoma, multiple
myeloma, and bone
metastasis (lysed bone)
PTH-related peptide, TGF-, TNF-,
IL-1

neoplasm and Mech
Renal cell carcinoma,

hemangioblastoma
Polycythemia
Erythropoietin

neoplasm and Mech
Lambert-Eaton syndrome
neoplasm and Mech
Gout, urate nephropathy
Thymoma, small cell lung

carcinoma
Antibodies against presynaptic Ca2+
channels at neuromuscular junction
Leukemias and lymphomas
Hyperuricemia due to excess nucleic
acid
turnover (i.e., cytotoxic therapy)
Lots of Bad Stuff Kills Glia.
1 tumors that metastasize to brain
Lung,
Breast,
Skin (melanoma),
Kidney (renal cell carcinoma),
GI.
approximately ??%
of brain tumors are from metastases.
50
??????the most common sites of

metastasis after the regional lymph
nodes.
liver
and
Lungs
mne: Cancer Sometimes Penetrates
Benign Liver.
tumors that metastasize to the liver

Colon > Stomach > Pancreas > Breast
> Lung.
most common Liver cancer
Metastasis
P. TT. Barnum Loves Kids.

These 1 tumors metastasize to bone
PROSTATE, Thyroid, Testes,

BREAST, Lung, Kidney.
Features of 1 tumors that

metastasize to bone
Lung = Lytic.
Prostate = blastic.
Breast = Both lytic and blastic.
Most common Bone Tumors
Mets from (esp Prostate or Breast)
Cancer epidemiology
Most common cancers in
Men
..
deaths in men
Cancer epidemiology
Most common cancers in
women
..
deaths in women
Prostate (32%)
Lung (16%)
Colon and rectum (12%)
..
Lung (33%)
Prostate (13%)
Breast (32%)
Lung (13%)
Colon and rectum (13%)
...
Lung (23%)
Breast (18%)
heart disease
1st and 2nd leading killers in the U.S.

cancer
Changes in lung cancer deaths
Retinoblastoma, osteosarcoma
Gene
Chromosome
and
Breast and ovarian cancer (BRCA)
Gene
Chromosome
and
Most human cancers, Li-Fraumeni
syndrome
Deaths from lung cancer have

plateaued in males but
continue to in females.
Rb
13q
Tumor suppressor
BRCA1 and 2
17q, 13q
Tumor suppressor
p53
17p
Gene
Chromosome
and
Tumor suppressor
Melanoma
Gene
Chromosome
and
Colorectal cancer
Gene
Chromosome
and
Wilms tumor
Gene
Chromosome
and
Neurobromatosis type 1
Gene
Chromosome
and
Neurobromatosis type 2
Gene
Chromosome
and
Pancreatic cancer
Gene
Chromosome
and
Colon cancer
Gene
Chromosome
and
p16
9p
Tumor suppressor
APC
5q
Tumor suppressor
WT1
11q
Tumor suppressor
NF1
17q
Tumor suppressor
NF2
22q
Tumor suppressor
DPC
18q
Tumor suppressor
DCC 18q Tumor suppressor
and
ras Oncogenes
CML
Gene
Chromosome
and
Burkitts lymphoma
Gene
Chromosome
and
Follicular and undifferentiated
lymphomas
Gene
Chromosome
and
Breast, ovarian, and gastric
carcinomas
Gene
Chromosome
and
Colon carcinoma
Gene
Chromosome
and
Lung tumor
Gene
Chromosome
and
abl
9:22
Oncogenes
c-myc
8:14
Oncogenes
bcl-2
14:18
Oncogenes
erb-B2
Oncogenes
ras
Oncogenes
L-myc
Oncogenes
Neuroblastoma
N-myc
Gene
Chromosome
and
Multiple endocrine neoplasia (MEN)
types II and III
Oncogenes
Gene
Chromosome
and
Gastrointestinal stromal tumor (GIST)
Oncogenes
Gene
Chromosome
and
ret
c-kit
Oncogenes

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www.natures.

Programmed cell death.

cell shrinkage, chromatin

- embryogenesis, hormone -induction

Enzymatic degradation of a cell

Characterized by enzymatic digestion

cells in acute Inflammation

Neutrophil, eosinophil, and antibody

cells in chronic Inflammation

Mononuclear cell mediated:

What happens in different phases of

Increased vascular permeability,

What happens in different phases of

Emigration (rolling, tight binding,

What happens in different phases of

Fibroblast emigration and proliferation

What happens in different phases of

Neutrophil, eosinophil, and antibody

What happens in different phases of

Mononuclear cell mediated:

-Restoration of normal structure

-Abscessfibrosis surrounding pus

E-selectin on vascular endothelium

ICAM-1 on vascular endothelium

chemotactic signals (e.g., cytokines).

leukocyte travels between

Free radical injury

Free radical injury

reperfusion after thrombolytic therapy.

Free radical injury

(vitamins E and A).

Abnormal proliferation of cells with

Normal cells with basal apical

Cells have increased in number

Neoplastic cells have not invaded

Cells have invaded basement

in number of cells (reversible).

1 adult cell type is replaced by

abnormal growth with loss of cellular

abnormal cells lacking

a clonal proliferation of cells that is

Tumor grade vs. stage

Grade = histo apperance, often based

Tumor grade vs. stage

TNM staging system:

The term ?????? implies epithelial

Smooth muscle = Leiomyoma

benign = mature teratoma

Smooth muscle =Leiomyosarcoma

What is the Neoplasm/s associated

ALL (we ALL fall Down),

What is the Neoplasm/s associated

Melanoma and basal,

What is the Neoplasm/s associated

What is the Neoplasm/s associated

Astrocytoma and cardiac

What is the Neoplasm/s associated

Squamous cell carcinoma

What is the Neoplasm/s associated

What is the Neoplasm/s associated

Squamous cell carcinoma

What is the Neoplasm/s associated

What is the Neoplasm/s associated

What is the Neoplasm/s associated