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Questions and Answers
What is the most significant factor in determining the prognosis of a cancer patient?
Which method is NOT a typical path of metastasis for cancer cells?
In terms of tumour grade, what does a high grade indicate?
What is paraneoplastic syndrome primarily caused by?
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Which of the following symptoms is associated with cancer but not directly due to local cancer cell presence?
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Which essential alteration for malignant transformation involves cancer cells acquiring the ability to grow without external signals?
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What characteristic differentiates benign tumors from malignant tumors in terms of growth patterns?
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Which of the following statements about the microscopic features of malignant tumors is true?
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Which type of gene is primarily responsible for the inhibition of cell growth?
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Which level of carcinoma indicates that cells have the ability to invade but are still limited by the basement membrane?
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What is NOT a recognized cause of cancer?
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Which of the following features is commonly associated with a malignant tumor's macroscopic appearance?
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What is a key factor that influences the clinical behavior of a benign tumor?
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What process is involved when cancer cells spread from their original site to distant locations?
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Which characteristic is most related to the ability of malignant tumors to cause severe tissue destruction?
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What is the primary purpose of intra-operative consultation in surgical settings?
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Which of the following best describes cytopathology?
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What sequence of events characterizes pathogenesis?
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Which of the following is NOT a common cause of cell injury?
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Which technique is commonly used in molecular pathology for disease diagnosis?
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What describes the concept of metaplasia in tissue adaptation?
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In the context of apoptosis, what is an essential characteristic?
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Which type of autopsy is performed to understand unexpected deaths?
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What does tissue adaptation involve in response to injury or stress?
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Which of the following best captures the essence of necrosis?
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What is the role of HLA typing in hematopathology?
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Which structure does molecular pathology NOT analyze directly?
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Hypertrophy is characterized by which of the following?
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Which of the following best defines the term 'etiology' in pathology?
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Study Notes
Pathology Disciplines
- Hematopathology: Diagnoses and monitors blood, bone marrow, and lymph nodes for diseases. Manages blood transfusions and performs HLA typing.
- Medical Microbiology: Analyzes tissue and body fluids for microorganisms, diagnoses infectious diseases, and tests bacteria for antibiotic susceptibility/resistance. Crucial for infectious disease control.
- Medical Biochemistry: Diagnoses and monitors disease through examination of bodily fluids and tissues.
- Anatomical Pathology: Applies anatomy, histology, and pathology to make diagnoses and rule out diseases. It's the "gold standard" for cancer and cancer precursors diagnosis.
Autopsy Pathology
- Manner of Death: Suicide, homicide, accidental, natural, unknown.
- Cause: Underlying disease leading to death. (The change that precipitated death)
- Mechanism: Physiological derangement causing cessation of life.
Types of Autopsies
- Clinical Autopsies: Determined when manner of death is natural and the cause and mechanism are known, but more information is needed.
- Forensic (Medico-legal) Autopsies: Determine the cause and manner of death when death is unexpected, the manner isn't natural, or there are suspicious circumstances.
Surgical Pathology
- Focuses on biopsies and surgical resections.
- Involves gross and microscopic evaluation of tissues.
Surgical Pathology Test Process
- Biopsy: Tissue sample is taken and placed in formalin for fixation (minimum of 12 hours).
- Accessioning: Sample is delivered to the pathology lab for record keeping and identification.
- Grossing: Detailed description of the specimen is created, and tissues are prepared for further analysis.
- Processing: Fixed tissue is embedded in paraffin wax for storage and sectioning.
- Sectioning: Thin slices of tissue are prepared using a microtome.
- Staining: Slides are stained with hematoxylin and eosin for visualization under a microscope.
Intra-operative Consultation/Frozen Sections
- Provides rapid diagnosis during surgery.
- Uses: Identification of disease processes and assessment of surgical resection margins.
- Process: Tissue is frozen to harden it, then sections are stained and examined under a microscope.
Cytopathology
- Examines cells that are exfoliated or found in liquid suspensions.
- Diagnosis: Based on changes in cell morphology and nuclear features, without the benefit of tissue architecture.
Molecular Pathology
- Diagnoses disease through molecular analysis of organs, tissues, and body fluids.
- Techniques: PCR, DNA microarray, FISH, DNA-sequencing.
Pathology Concepts and Principles
Etiology
- Single Etiologic Agent: Less common; one specific cause.
- Multifactorial: More common; multiple contributing factors.
Pathogenesis
- Sequence of events in cell or tissue response to a causative agent.
Morphological Changes
- Structural Changes: Analyzed using physical examination, light microscopy, and electron microscopy.
Basics of Disease Morphology
- Tissue/cellular Response to Injury/Stress: How cells and tissues react to damage.
- Inflammation and Tissue Repair: Body's response to injury and the process of healing.
- Neoplasia: The uncontrolled growth of cells leading to tumors.
Tissue/cellular Response to Injury
- Homeostasis: Stable internal environment.
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Adaptations (Reversible): Structural and functional changes in response to injury, resulting in a new stable state. Cell or tissue survives.
- Hypertrophy: Increase in cell size due to increased cellular proteins.
- Hyperplasia: Increase in cell number, often resulting in increased tissue/organ mass.
- Atrophy: Reduced cell size and number, leading to reduced tissue size.
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Cell Death (Irreversible):
- Necrosis: Uncontrolled cell death caused by injury.
- Apoptosis: Programmed cell death.
Adaptations (In Detail)
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Hypertrophy:
- Physiologic: Uterus during pregnancy.
- Pathologic: Hypertrophic cardiomyopathy.
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Hyperplasia:
- Physiologic: Hormonal (breast glandular proliferation) or compensatory (partial hepatectomy).
- Pathologic: Endometrial hyperplasia, benign prostatic hyperplasia.
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Atrophy:
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Physiologic: Notochord and thyroglossal duct in fetal development, uterus post-partum.
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Pathologic: Skeletal muscle after spinal cord injury.
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Causes: Decreased workload, denervation, decreased blood supply, inadequate nutrition, loss of endocrine stimulation, pressure.
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Metaplasia
- Reversible transformation of one cell type into another.
- Example: Barrett's esophagus (squamous epithelium changes to columnar epithelium in response to GERD).
Cell Injury and Death Causes
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Oxygen Deprivation:
- Ischemia: Reduced blood flow.
- Inadequate Oxygenation of Blood: Low blood oxygen levels.
- Decreased Oxygen Carrying Capacity: Conditions like anemia.
- Blood Loss: Hemorrhage.
- Physical Agents: Trauma, temperature changes, pressure changes, radiation, electricity.
- Chemical Agents and Drugs: Exposure to toxins.
- Infectious Agents: Bacteria, viruses, fungi, parasites.
- Immunologic Reactions: Autoimmune diseases, hypersensitivity reactions.
- Genetic Derangements: Inherited or acquired genetic defects.
- Nutritional Imbalances: Deficiencies or excesses of essential nutrients.
Cell Death
- Necrosis: Uncontrolled death caused by injury.
- Apoptosis: Programmed cell death.
Cancer Cells
- Oncogenes: Growth-promoting genes.
- Tumor Suppressor Genes: Growth-inhibiting genes.
- Genes that Regulate Apoptosis: Control programmed cell death.
- Genes Involved in DNA Repair: Correct errors in DNA.
Essential Alterations in Cancer Cells
- Self-sufficiency in Growth Signals: Ability to grow without external signals.
- Insensitivity to Growth Inhibitory Signals: Ignore signals to stop growing.
- Evasion of Apoptosis: Avoid programmed cell death.
- Limitless Replicative Potential: Unlimited capacity to divide.
- Sustained Angiogenesis: Maintain blood supply for growth.
- Ability to Invade and Metastasize: Spread to other locations in the body.
- Defects in DNA Repair: Unable to repair damaged DNA.
Causes of Cancer
- Radiant Energy: Ultraviolet radiation, ionizing radiation.
- Chemical Carcinogens: Tobacco smoke, asbestos, certain pesticides.
- Oncogenic Viruses and Other Microbes: HPV, Epstein-Barr virus, Helicobacter pylori.
- Genetics/Hereditary Predispositions: Inherited mutations in tumor suppressor genes.
- Chronic Inflammation: Long-term inflammation can increase cancer risk.
Levels of Carcinoma
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Dysplasia: Abnormal cellular growth with increased proliferation but no invasion.
- Pre-cancerous: Mild dysplasia to severe dysplasia reflects increasing severity.
- In-situ Carcinoma: Malignant cells confined to the original location, not invading surrounding tissues.
- Invasive Carcinoma: Malignant cells have invaded beyond the basement membrane into surrounding tissue, signifying cancer.
Classification and Naming of Neoplasms
- Neoplasm: Abnormal tissue growth.
- Benign: Non-cancerous, generally slow-growing, and localized.
- Malignant: Cancerous, often rapidly growing, and able to spread to other locations.
- Low-malignant Potential: May have features suggestive of malignancy but lack key markers.
- Borderline Tumors: Don't fit clearly into either benign or malignant categories.
Tissue of Origin
- Epithelial and Secretory Tissue: Linings of internal organs and parenchymal tissues.
- Mesenchymal Tissue: Connective tissues such as bone, muscle, and blood vessels.
- Neuroectoderm: Brain and nerves.
- Hematopoietic and Lymphoid Cells: Bone marrow and blood cells.
- Germ Cells: Precursors of egg and sperm cells.
Nomenclature
- Adenoma: Benign epithelial tumor.
- Carcinoma: Malignant epithelial tumor.
- __oma: Benign connective tissue tumor (the blank space represents the specific tissue type, e.g., fibroma, chondroma).
- Sarcoma: Malignant connective tissue tumor.
Macroscopic Features
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Benign Tumors:
- Often smaller.
- Well-defined borders.
- Have a compressing effect on surrounding tissues.
- Often resemble the tissue of origin.
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Malignant Tumors:
- Often larger.
- Irregular, ill-defined borders.
- Invade surrounding tissues.
- Often heterogeneous, with areas of hemorrhage and necrosis.
Microscopic Features
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Benign Tumors:
- Non-invasive.
- Uniform cell size, shape, and arrangement.
- Normal nuclear morphology.
- Few mitoses (cell divisions).
- Usually no necrosis.
- Don't invade fat, nerve, lymphatics, or blood vessels.
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Malignant Tumors:
- Destructive invasion of surrounding tissues.
- Pleomorphism (variation in cell size and shape).
- Abnormal nuclear morphology.
- Increased mitoses, often with abnormal forms.
- Necrosis often present.
- Invasion of fat, nerve, lymphatics, or blood vessels.
Clinical Perspective
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Benign Tumors:
- Localized growth.
- Slow growth rate.
- Generally curable by local excision.
- Usually do not cause death unless located in a critical location.
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Malignant Tumors:
- Spread via lymphatics, blood vessels, and body cavities (metastasis).
- Often rapidly growing.
- Treatment often involves radical excision, chemotherapy, and radiation.
- Can often cause death.
Invasion and Metastasis
- Invasion: Cancer cells invade surrounding tissues and blood vessels.
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Metastasis: Cancer cells spread to distant locations via:
- Lymphatics: Through lymph nodes.
- Bloodstream: Travel through blood vessels.
- Body Cavities: Spread through fluid-filled spaces.
Prognosis
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Tumor Stage (Most Important): Reflects the extent of spread and is a key predictor of prognosis.
- Primary Tumor: Size and location of the original tumor.
- Extent of Spread: How far the cancer has penetrated into surrounding tissue.
- Lymph Node Involvement: Whether the cancer cells have spread to nearby lymph nodes.
- Metastases: Whether the cancer has spread to distant locations.
- Tumor Type: The specific kind of cancer.
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Tumor Grade: Represents the degree of differentiation of the tumor cells; how closely they resemble normal cells.
- Low Grade (Well Differentiated): Cells are more similar to normal cells.
- High Grade (Poorly Differentiated): Cells have a more abnormal appearance, indicative of more aggressive behavior.
Clinical Presentation
- Symptoms: Caused by impaired function or injury to the organ of origin.
- Mass Effects: Pressure on nearby organs or tissues.
- General Symptoms: Weight loss, loss of appetite, fever, fatigue, and general malaise.
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Paraneoplastic Syndromes: Disease or symptoms caused by a cancer but not by the local tumor itself.
- Causes: Release of cytokines or hormones by cancer cells or immune response to the cancer.
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Description
Explore the critical fields within pathology, including hematopathology, medical microbiology, medical biochemistry, and anatomical pathology. Delve into the specifics of autopsy pathology, examining manner, cause, and mechanism of death. This quiz will enhance your understanding of diagnosis and disease management.
