Term
| von Willebrand Factor is released from ____________ and acts to............. |
|
Definition
| Damaged endothelial cells and binds to exposed basement membrane to provide an adherent surface for platelets. |
|
|
Term
| ______ is a receptor on the platelet that binds vWF. |
|
Definition
GP1b
Bernard Soulier Syndrome is a defect in this receptor, thus the patient has prolonged bleeding times despite the PT and PTT being normal.
Slows the platelet to allowance adherence to ECM. |
|
|
Term
| Primary (temporary) hemostatic plug |
|
Definition
Platelets releasing ADP, serotonin, and thromboxane A2 causing more platelets to aggregate.
CANNOT occur in patients with thrombocytopenia. |
|
|
Term
| Secondary (permanent) hemostatic plug |
|
Definition
Endothelial cells produce tissue factor; coagulation cascade induces thrombin formation which then cleaves fibrinogen.
CANNOT occur in patients with hemophilia. |
|
|
Term
| Some of the ways in which endothelial cells block platelet aggregation...... |
|
Definition
1) Prostacyclin (PGI2)
2) NO
3) ADPase |
|
|
Term
| Some of the ways in which endothelial cells block the coagulation cascade...... |
|
Definition
1) Thrombomodulin- converts thrombin to an anticoagulant
2) Heparin- cofactor for anti-thrombin III which inactivates IXa and Xa. |
|
|
Term
|
Definition
| Catalyzes the conversion of prothrombin into thrombin. |
|
|
Term
| The release of alpha (larger) and delta (ADP) granules from platelets in controlled by..... |
|
Definition
CAMP levels.
A rise in CAMP inhibits release while a fall in CAMP triggers release. |
|
|
Term
| Role of calcium in hemostasis |
|
Definition
| Activates phospholipases to generate prostaglandins; also augments the coagulation cascade. |
|
|
Term
|
Definition
|
|
Term
| Both the intrinsic and extrinsic coagulation cascade converge at...... |
|
Definition
Activating IX --> IXa which then acts with VIIIa (with Ca present) to activate X --> Xa.
People with hemophilia have a mutation in VIII or IX. |
|
|
Term
| The conversion of prothrombin to thrombin is mediated by...... |
|
Definition
Xa, V, and platelet factor 3.
The clot is stabilized by XIII. |
|
|
Term
| Role of vitamin K in hemostasis |
|
Definition
Required by liver microsomal carboxylase that modifies VII, IX, X, and prothrombin.
Needed by protein C (activated by thrombin in the presence of thrombomodulin); Proteins C and S degrade Va and VIIIa which help out thrombomodulin. |
|
|
Term
| Prothrombin time measures the ________ pathway. |
|
Definition
| Extrinsic pathway.....normal time is 12 seconds. |
|
|
Term
| Most common cause of thrombocytopenia. |
|
Definition
| Platelets become aggregated by a virus or bacteria and get trapped in the spleen. |
|
|
Term
| _____ is a receptor on the platelet that promotes aggregation. |
|
Definition
GPIIb-IIIa
Thrombasthenia is a defect in this receptor leading to prolonged bleeding time despite the PT and PTT being normal. |
|
|
Term
| Hemophilia A versus Hemophilia B |
|
Definition
Defect in VIII versus IX; strangely, only PTT is affected.
Hemophilia is an X-linked recessive disorder. |
|
|
Term
| ______________ is the most common bleeding disorder. |
|
Definition
Von Willebrand Disease; affects both platelet plug formation AND coagulation (due to Factor VIII dependency); increased bleeding time and PTT.
No bleeding into joints (hemarthrosis) as in hemophilia though. |
|
|
Term
|
Definition
Factors that promote thrombosis:
1) Endothelial injury
2) Abnormal blood flow
3) Hypercoagulability |
|
|
Term
|
Definition
| Disseminated venous thrombosis in cancer patients; may be due to tumor releasing procoagulant factors. |
|
|
Term
|
Definition
| Thrombus is not mural and is almost being occluding; blood flow slows going around it; especially common in veins. |
|
|
Term
|
Definition
Greater than 50% of the pulmonary blood flow being blocked leading to acute right ventricular failure.
Slightly different than saddle embolus. |
|
|
Term
| The most common genetic cause of hypercoagulability is...... |
|
Definition
| Factor V mutation causing it not to be inactivated by protein C. |
|
|
Term
|
Definition
| Myocardial necrosis that traverses the entire ventricular wall; unlike a subendocardial infarction. |
|
|
Term
| After an acute myocardial infarct, the affected area is yellow at Day __ and red at Day __. |
|
Definition
| 3 (replacement of PMNs by macrophages).......10 |
|
|
Term
| Which type of bacteria cause rheumatic fever? |
|
Definition
| Beta-hemolytic streptococci; causes body to attack cardiolipin. |
|
|
Term
|
Definition
| Rheumatic endocarditis formed on the posterior wall of the left atrium. |
|
|
Term
| Mitral valve stenosis is marked by..... |
|
Definition
| Diastolic pressure higher in the left atrium than in the left ventricle; systolic output is affected. |
|
|
Term
| Acute endocarditis is caused by...... |
|
Definition
| Staph aureus (50% of cases); Strep viridans causes subacute endocarditis. |
|
|
Term
| While tricuspid valve involvement is rare in rheumatic heart disease, is may be involved in _______________. |
|
Definition
| Endocarditis of the carcinoid syndrome. |
|
|
Term
| Pulmonary valve involvement is most often seen in ________________. |
|
Definition
| Congenital malformations (ex. tetralogy of Fallot); also may be involved in the carcinoid syndrome. |
|
|
Term
| Congenital rubella syndrome |
|
Definition
| Link between rubella in mother in FIRST TRIMESTER and cardiovascular defects, microcephaly, cataracts, and growth/mental retardation. |
|
|
Term
|
Definition
| Most often presents as biventricular heart failure in young people with other heart problems; most often VIRAL. |
|
|
Term
| _____________ is the most frequently occuring cardiac tumor. |
|
Definition
| Myxoma of the left atrium. |
|
|
Term
| Right-sided CHF is most commonly caused by...... |
|
Definition
|
|
Term
|
Definition
1) Pulmonary infundibular or stenodid
2) Ventricular septal defect
3) Overriding aorta
4) Right ventricular hypertrophy |
|
|
Term
| The outer half of the tunica media is oxygenated by the ___________. |
|
Definition
|
|
Term
| Fibrofatty plaques begin in the tunica __________ and contain _____________. |
|
Definition
| Intima.........necrotic debris. |
|
|
Term
| Less oxygenation in a necrotic core of an atheroma can create _____________. |
|
Definition
|
|
Term
|
Definition
| Cylindrical; due to atrophy of the media; common in abdominal aorta |
|
|
Term
| During atherogenesis, ___________ occurs first and then _____________ follows. |
|
Definition
| Monocyte adhesion and immigration into intima...........entry of smooth muscle cells. |
|
|
Term
| _________ marks the stage for fatty streaks in atherosclerosis. |
|
Definition
| Oxidized LDLs which are chemotactic for monocytes among other things; also cause endothelial cells to express adhesion receptors; also cause macrophages to express "scavenger receptors" which bind modified LDL (not downregulated like LDL receptors). |
|
|
Term
| ____________ marks the stage for the fibrous plaque in atherosclerosis. |
|
Definition
| Smooth muscle cells secreting dermatan sulfate which preferentially binds extracellular LDL, thus contributing to its retention. |
|
|
Term
| Hyperlipidemia can increase the activity of ___________. |
|
Definition
|
|
Term
| Homocysteine levels can be returned to normal in patients with enzymatic defects using _________. |
|
Definition
|
|
Term
| Response to Injury Hypothesis of Atherosclerosis |
|
Definition
| Chronic injury to the endothelium induces release of cytokines (ex. heat shock proteins) which then induce inflammation or recruit WBCs (autoimmunity). |
|
|
Term
| Normotension is defined as...... |
|
Definition
|
|
Term
| Hypertension is defined as.......... |
|
Definition
|
|
Term
|
Definition
| The reflexive action of the vessel to narrow its lumen size to prevent hyperperfusion of sensitive tissues such as the CNS. |
|
|
Term
| Renal Rention Hypothesis of primary hypertension |
|
Definition
| Increase in Na retention in the kidney increases cardiac output which leads to autoregulation (bad). |
|
|
Term
| Vasoconstriction and Vascular Hypertrophy Hypothesis of primary hypertension |
|
Definition
| Increased peripheral resistance is the initiating event which eventually leads to smooth muscle cell proliferation in the vessels (mediated by Angiotensin II). |
|
|
Term
|
Definition
| Secondary hypertension during pregnancy; can be fatal, so ultimate treatment is to terminate the pregnancy. |
|
|
Term
| Hyaline arteriolosclerosis |
|
Definition
Occurs with aging in normal individuals, but is far more prevalent in people with primary benign hypertension.
Hyperplastic ateriolosclerosis is associated with malignant hypertension; marked by reduplication of the basement membrane (onion skinning); can also cause necrotizing arteriolitis. |
|
|
Term
| Systemic hypertensive heart disease |
|
Definition
| Left-sided heart failure; marked by left ventricular/atrial hypertrophy with reduced tissue perfusion (especially to the kidneys); therefore, patient develops azotemia. |
|
|
Term
| Grading scale for retinopathy caused by hypertension..... |
|
Definition
1) Generalized narrowing of arterioles
2) Grade I + focal arteriolar spasms
3) Grades I&II + flame-shaped hemorrhages and hard, waxy exudates
4) Grades I,II,&III plus optic disc edema (papilledema) |
|
|
Term
| Malignant nephrosclerosis |
|
Definition
Kidney has petechial hemorrhages; arterioles progress to fibrinoid necrosis; kidney activates renin/angiotensin which further exacerbates the problem.
Hyperplastic arteriolosclerosis is a new finding... |
|
|
Term
|
Definition
>220/>140
Often a complication of BENIGN hypertension; death is due to uremia, stroke, or cardiac failure; we see medial thickening associated with infiltration of plasma components leading to fibrinoid necrosis; endothelial cells proliferate giving an "onion skin" appearance.
These patients will present with headache, nausea, vomiting, and scotomas (spots before the eyes) due to swelling in the brain and retina. |
|
|
Term
| Atrial natriuretic factor |
|
Definition
| Gets the kidneys to secrete Na thus lowering the blood volume. |
|
|
Term
|
Definition
| Rare single-mutation genetic defect in sodium channel leading to Na retention. |
|
|
Term
| While the kidney is the major regulator of blood pressure, ___________ is the major responder. |
|
Definition
|
|
Term
| The most common problem with hypertension is......... |
|
Definition
| Atherogenesis resulting in thrombosis! |
|
|
Term
| Which part of the vasculature carries out the main functions of autoregulation? |
|
Definition
|
|
Term
| Evidence of clonal origin in uterine tumors...... |
|
Definition
| Uterine tumors express only one isozyme of G6PD unlike the mosaic in the normal uterus. |
|
|
Term
| All tumors have parenchyma and stroma (true/false). |
|
Definition
|
|
Term
| Benign tumors never express __________, _________, or ___________. |
|
Definition
Dysplasia, anaplasia, or atypical mitosis.
May see some metaplasia though. |
|
|
Term
|
Definition
| Benign smooth muscle tumor; rhabdomyoma is a benign skeletal muscle tumor. |
|
|
Term
| Sarcomas are of ___________ origin and include..... |
|
Definition
| Mesenchymal tissue........angiosarcoma and leiomyosarcoma. |
|
|
Term
| The "oma's" that are not benign..... |
|
Definition
1) Melanoma
2) Hepatoma = hepatocellular carcinoma
3) Mesothelioma
4) Seminoma = malignant germ cell tumor
5) Teratoma: can be epithelial or mesenchymal; always malignant in the testes but can be benign in the ovaries. |
|
|
Term
| ___________ derivatives are all epithelial in origin. |
|
Definition
Foregut derivatives; includes liver, pancreas, gall bladder, stomach, diaphragm, cystic duct, and bile duct.
Are all carcinomas! |
|
|
Term
| ___________ derivatives are of mesenchymal origin. |
|
Definition
| Neural crest; includes dorsal root ganglia, ANS, ganglia of cranial nerves V, VIII, IX, & X, Schwann cells, meninges of brain, melanocytes, adrenal medulla, head tissue, and tooth structures EXCEPT for enamel. |
|
|
Term
|
Definition
| Hamartoma is the development of deformed blood vessels or other tissue that belongs in the area; a choristoma is the development of tissue that does not belong in the area. |
|
|
Term
| Mixed tumors are derived from....... |
|
Definition
| One germ layer but give rise to different phenotypes due to divergent differentiation of the neoplastic stem cell; examples include fibromyxoid stroma and mixed tumors of salivary glands. |
|
|
Term
| Teratomas are derived from...... |
|
Definition
| More than one germ layer; rests of these cells (choristomas) are occasionally found in the midline giving rise to midline teratomas. |
|
|
Term
| Differentiation of a neoplasm refers to its (parenchyma/mesenchyma). |
|
Definition
| Parenchyma; determines the extent to which neoplastic cells resemble their forbears. |
|
|
Term
|
Definition
| The formation and proliferation of connective tissue in response to neoplastic growth; typical in breast and salivary tumors. |
|
|
Term
| ___________ is a hallmark of malignancy in a tumor. |
|
Definition
| Anaplasia; represents primitive, more aggressive cells; marked by pleomorphism, nuclear hyperchromatism, nuclear enlargement, and bizarrely-shaped nuclei. |
|
|
Term
| Direct extension is a common mode of spread in OSCC (true/false). |
|
Definition
|
|
Term
| What are two types of carcinomas that are prone to seeding in the peritoneal cavity? |
|
Definition
| Colon and ovarian carcinoma |
|
|
Term
| Sarcomas normally spread via _____________; these two organs are the common endpoints. |
|
Definition
Hematogenous spread affecting the liver and lungs; veins are the common route and arteries are rare.
Carcinomas are more likely to spread in the lymphatics. |
|
|
Term
| A tumor is first palpable once it contains ____ number of cells. |
|
Definition
| 10^9 cells weighing 1 gram. |
|
|
Term
| T staging for a primary tumor |
|
Definition
T0- no evidence of primary tumor
Tis- carcinoma in situ
T1- tumor <2cm
T2- tumor <4cm
T3- tumor >6cm
T4 (lip or oral cavity)- invasion of adjacent structures |
|
|
Term
|
Definition
N0- single ipsilateral lymph node
N1- " " <3cm
N2a- " " <6cm
N2b- multiple ipsilateral lymph nodes, but NONE >6cm
N2c- bilateral, contralateral lymph nodes <6cm
N3- any lymph node >6cm! |
|
|
Term
| If you have an N1, the lowest stage you can get is Stage __. |
|
Definition
| Stage III (only if T1 or T2); can have Stage II with T3 as long as there's no lymph node involvement. |
|
|
Term
| Melanoma has been associated with the gene __. |
|
Definition
|
|
Term
| Tumors have self-sufficiency in growth signals such as ____ in glioblastomas and ____ in sarcomas. |
|
Definition
PDGF.....TGF-alpha
TGF-beta is a soluble growth inhibitor, so cancer cells knock this gene out as well. |
|
|
Term
|
Definition
| Helps B-cells evade apoptosis in lymphomas. |
|
|
Term
| Cancer cells can avoid replicative senescence by mutating ____ or ___; they can avoid crisis by activating _____. |
|
Definition
| p53 or Rb.....activate telomerase |
|
|
Term
| Rho/Rac and MMPs aid in cancer's ability to..... |
|
Definition
|
|
Term
| Cachexia may be caused by..... |
|
Definition
| A cytokine elaborated by the tumor or the host. |
|
|
Term
| The telogen hypothesis proved that..... |
|
Definition
| The carcinogen needs to stay in contact with the area; we can't just wipe on and wipe off; latency would get in the way. |
|
|
Term
| Painting a second initiator on a newly formed papilloma can induce a carinoma (true/false). |
|
Definition
|
|
Term
| Genotoxic agents may be activated by __________ and antagonized by ____________. |
|
Definition
| Activated by CYP450 (a few are activated by Phase II metabolism)...........antagonized by reducing agents like glutathione, Vitamin C, and Vitamin E. |
|
|
Term
| Non-genotoxic carcinogens are generally good ___________. |
|
Definition
|
|
Term
| Radiation causes these diseases.... |
|
Definition
1) Leukemia- most common
2) Thyroid cancer
3) Glands, lungs, etc. |
|
|
Term
| Radiation causes these effects on DNA..... |
|
Definition
1) Cyclobutyl dimer (T-T dimers)- xeroderma pigmentosum
2) Deamination of cytosine producing uracil
3) Deletion of purinic sites- completely getting rid of adenine and a nucleotide pair on the new DNA |
|
|
Term
|
Definition
| Needed by cells to recognize unmethylated new DNA strands and perform mismatch repair on DNA damaged by UV radiation; here, the repair process actually causes the mutation (not the UV radiation). |
|
|
Term
|
Definition
Autosomal recessive syndrome of defective DNA repair caused by gamma radiation; affects genes that are involved in the signalling pathway to let cells know that DNA had been damaged and needs to be repaired.
Caused by mutations in ATM and hMre11 (less marked, later onset) genes. |
|
|
Term
| Fanconi's anemia is an autosomal recessive syndrome of defective DNA repair that interacts with the _________ gene. |
|
Definition
BRCA1
Ubiquinated protein D moves to the nuclear foci that contain BRCA1. |
|
|
Term
|
Definition
Autosomal recessive syndrome of defective DNA repair that involves defects in a series proteins (RecQ subset of DexH box containing DNA helicases -- unwinding DNA).
Patients have short stature, sun-sensitive facial lesions, increased susceptibility to infections, infertility, and mental retardation.
Ashkenazi Jews on chromosome 15 |
|
|
Term
|
Definition
| Another autosomal recessive syndrome of defective DNA repair; these people are not susceptible to skin cancer although UV radiation causes CSA and CSB to no longer perform "transcriptional repair". |
|
|
Term
| Radium can cause ______ and ______ cancer while uranium can cause ______ cancer. |
|
Definition
| Bone and nose cancer.........lung cancer. |
|
|
Term
| If the oncogene from a transducing virus replaces gag, pol, or env, ____________________ is necessary. |
|
Definition
| Co-infection with a wild-type (helper) virus. |
|
|
Term
|
Definition
Occurs in nature, but relies on "insertional mutagenesis"; can't transform a cell by itself like the Rous Sarcoma Virus.
May cause disease by activating c-myc from either end. |
|
|
Term
| __________ and _________ viruses are linked to a variety of animal tumors. |
|
Definition
|
|
Term
| Hepatitis B and C can cause hepatomas by...... |
|
Definition
| Acting as mitogens or perhaps by scrambling chromosomes. |
|
|
Term
| HTLV-I causes ____________ while HTLV-II causes _____________. |
|
Definition
| Epidemic leukemia in Japanese............hairy cell "leukemia" |
|
|
Term
|
Definition
| Maintain the transformed state of a cell and are encoded by oncogenes. |
|
|
Term
| What phenotype would be expected from a mutation in hMSH or hMLH? |
|
Definition
| Hereditary NonPolyposis Colon Cancer (HNPCC), Lynch syndrome II |
|
|
Term
| What would be the phenotype expected in mutations in uvrABCD genes? |
|
Definition
|
|
Term
|
Definition
| A genome that contains tat genes in addition to gag, pol, and env are tumorigenic; associated with HTLV viruses. |
|
|
Term
|
Definition
| C3 receptors on B cells; found in 100% of nasopharyngeal carcinomas! (8 to 14 translocation) |
|
|
Term
| HPV type __, __, and __ are associated with SCC in patients with epidermodysplasia verruciformis. |
|
Definition
|
|
Term
| Oncogenes show dominant transmission; only one aberrant copy is sufficient for mutation (true/false). |
|
Definition
|
|
Term
|
Definition
Codes for GTP-binding proteins (like p21); this causes cancer by point MUTATION at codon 12 or 61 which makes the GTP-bound state more persistent (p21 is mutated in 30% of all human cancers).
Harvey-Ras associated with bladder cancer and N-Ras associated with colon and pancreatic cancer. |
|
|
Term
|
Definition
abl (Chrom 9) translocates with bcr (Chrom 22); activates tyrosine kinase and causes CML.
Shorter break points in the translocation cause ALL though. |
|
|
Term
| What was the first virus to be associated with human cancer? |
|
Definition
|
|
Term
| Homogenous staining regions and double minutes are associated with...... |
|
Definition
| N-myc and neuroblastomas; HER-2/neu is a growth factor receptor that has a poor prognosis when amplified. |
|
|
Term
| ____ and ____ are growth factor proteins that are actually ligands. |
|
Definition
sis and hst
V-sis codes for a protein very similar to PDGF (normally C-sis produces true PDGF). |
|
|
Term
| ______________ is overexpressed in stomach cancer. |
|
Definition
| Fibroblast growth factor (FGF) |
|
|
Term
| _____________ and _____________ produce PDGF, whereas normal cells do not. |
|
Definition
| Glioblastomas and sarcomas |
|
|
Term
|
Definition
| An anti-cancer drug that prevents CML by binding where ATP normally would. |
|
|
Term
| ____ and ____ genes are nuclear regulatory proteins, and they need...... |
|
Definition
| C-myc and c-fas take the cell out of Go phase; need PDGF stimulation to undergo mitosis and then need EGF or IGF to take the cell through S-phase. |
|
|
Term
|
Definition
| Located on chromosome 17 and is the MOST COMMON genetic defect found in cancers; induced in response to DNA damage and prevents the cell from entering S-phase. |
|
|
Term
| Mutations in the tumor suppressor gene DCC causes ____________. |
|
Definition
Carcinomas of the colon and stomach.
Only one of multiple gene steps to cause colon cancer: need APC gene, K-ras, and possibly p53 as well. |
|
|
Term
|
Definition
| A tumor suppressor gene; mutations linked to childhood renal cancer. |
|
|
Term
|
Definition
| A putative tumor suppressor gene expressed ubiquitously in all tissues; mutations linked to Ewing's sarcoma, etc. |
|
|
Term
| Mutations in Bcl-2 are different that other proto-oncogenes because...... |
|
Definition
| Overexpression of Bcl-2 allows the cell to evade apoptosis. |
|
|
Term
| What other genes predispose women to breast cancer when mutated besides BRCA1 and BRCA2? |
|
Definition
1) p53 (Li-Fraumeni Syndrome)
2) CD1 (Cowden Syndrome)
3) ATM (ataxia telangectasia mutated) |
|
|
Term
| ________ is an oncogene that when activated causes a hereditary cancer. |
|
Definition
|
|
Term
| What qualifications does a cell need to cause oral cancer? |
|
Definition
1) eliminate Rb (heterozygous loss which normally inhibits E2F)
2) Disable p53
3) Activate telomerase (made up of proteins and RNA)
4) Acquire a growth-promoting mutation |
|
|
Term
| How is the APC tumor suppressor gene regulated? |
|
Definition
Normally, beta-catenin binds APC forming a "destruction complex"; when WNT binds to the cell, beta-catenin can translocate to the nucleus where it binds to TCF.
Causes Familial Adenomatous Polyposis |
|
|
Term
|
Definition
HNPCC; usually occurs on the RIGHT side of the colon; 50% chance of passing gene on to offspring; individual has an 80% chance of developing a malignant polyp at some point in life.
Controlled by the genes MSH2 and MLH1. |
|
|
Term
| Calcium susceptibility syndrome may affect (gatekeeper/caretaker) genes. |
|
Definition
|
|
Term
| Mutations in caretaker genes eventually results in....... |
|
Definition
Genomic instability leading to downstream mutations on gatekeeper genes.
Genomic instability is a big part of oral cancer. |
|
|
Term
| The patched gene is associated with which type of cancer? |
|
Definition
| Basal cell nevus syndrome |
|
|
Term
|
Definition
| A variant of familial adenomatous polyposis (both on Chromosome 5); an autosomal dominant mutation that causes osteomas of the skull, mandible, and long bones! |
|
|
Term
| __________ is associated with a rare type of male breast cancer. |
|
Definition
BRCA2
Women with a mutation in BRCA1 or BRCA2 have up to a 90% chance of developing breast cancer and a 60% chance of developing ovarian cancer. |
|
|
Term
|
Definition
| Are tumor suppressor genes located on chromosome 17(BRCA1) and 13(BRCA2)! |
|
|
Term
|
Definition
Loss of normal function of one allele of a gene in which the other allele was already inactivated; requires a two-step process.
Wilm's tumor is an example where it is always the allele on the maternal chromosome 11 that is lost. |
|
|
Term
| Why is chromosome 9p important in the development of oral cancer? |
|
Definition
Its mutation leads to p16 inactivation and hyperplasia (the first step to cancer).
Chromosome 3p goes next causing dysplasia along with p53 on chromosome 17. |
|
|
Term
| Do mutations in gatekeeper or caretaker genes have a greater effect on the development of oral cancer? |
|
Definition
Caretaker genes
TP53 (Li Fraumeni Syndrome) is the only gatekeeper gene that predisposes to oral cancer. |
|
|
Term
| _____ inactivation leads to carcinoma in situ finally becoming invasive. |
|
Definition
|
|
Term
| OSCC is more likely to present as a (leukoplakia/erythroplakia). |
|
Definition
|
|
Term
| Leukoedema is marked by intraepithelial edema in the ________ layer. |
|
Definition
|
|
Term
|
Definition
| Ectopic sebaceous glands usually found in older individuals. |
|
|
Term
| Geographic tongue has this histological appearance. |
|
Definition
Spongiosis and munro abscesses (PMNs in epithelium).
Looks identical to psoriasis in the skin. |
|
|
Term
| ___________ is the one epithelial lesion that probably doesn't warrant biopsy. |
|
Definition
| Linea alba; a variant of focal (frictional) hyperkeratosis |
|
|
Term
| Which leukoplakia has no risk for transformation into cancer? |
|
Definition
|
|
Term
| In papillomas, E6 causes ___________ while E7 causes _____________. |
|
Definition
p53 inactivation............Rb inactivation
Koilocytic changes are characteristically seen in HPV-associated lesions. |
|
|
Term
| Condyloma acuminatum differs from papillomas by....... |
|
Definition
| They are more broad-based and exclusively transmitted sexually. |
|
|
Term
|
Definition
Mutations in keratin 4 or 13 causing parakeratosis, epithelial acanthosis, and spongiosis.
A perinuclear eosinophilic halo is pathognomic! |
|
|
Term
| Hereditary Benign Intraepithelial Dyskeratosis (HBID) |
|
Definition
| Soft, asymptomatic white plaques; also forms foamy, gelatinous plaques of conjunctiva; epithelial acanthosis and edema with characteristic dyskeratotic cells in superior half of epithelium. |
|
|
Term
|
Definition
| Mutations in keratin 6, 16, or 17 usually involving the tongue; skin and nail changes are often seen. |
|
|
Term
|
Definition
Only inherited condition that can be autosomal dominant, recessive, or X-linked; mutations in telomerase gene causing skin and nail changes as well as affecting the tongue and buccal mucosa.
Risk to OSCC is increased. |
|
|
Term
| __% of erythroplakias are OSCC. |
|
Definition
| 50%; much more than the 3% of leukoplakias. |
|
|
Term
| For which type of lesion do we need to biopsy a piece of the adjacent tissue? |
|
Definition
|
|
Term
| Pigmented lesions are always pathologic (true/false). |
|
Definition
|
|
Term
| Smoking-Associated Melanosis |
|
Definition
| Cigarette smoke increases melanocyte activity particularly in anterior labial gingiva; females on birth control are more susceptible. |
|
|
Term
| Vascular lesions are pigmented (true/false). |
|
Definition
|
|
Term
|
Definition
Unknown origin but may represent post-inflammatory traumatically induced pigmentations.
Melanin incontinence (melanin in the connective tissue) may be seen. |
|
|
Term
| Systemic diseases associated with pigmentation..... |
|
Definition
1) Peutz/Jaghers syndrome (susceptible to intestinal polyposis)
2) McCune-Albright's syndrome
3) Neurofibromatosis
4) Addison's disease
5) Cushing's syndrome |
|
|
Term
| Progession of a nevus.... |
|
Definition
1) Junctional nevus
2) Compound nevus
3) Intramucosal nevus
Oral nevi present as flat or elevated, and are frequently non-pigmented. |
|
|
Term
| The three most common forms of skin cancer are..... |
|
Definition
|
|
Term
| What is the most common pigmented lesion of the oral mucosa? |
|
Definition
|
|
Term
|
Definition
| Hypoadrenalcorticism; recognized by increased ACTH levels; melanocyte-stimulating hormone (MSH) is part of the ACTH. |
|
|
Term
|
Definition
| Hyperadrenalcorticism; most causes are iatrogenic; only the ones that involve the pituitary gland cause pigmentation. |
|
|
Term
|
Definition
| Finger-like projections with pinpoint bleeding; there is a thickened granular cell layer. |
|
|
Term
| Histology of herpes simplex and varicella zoster viruses..... |
|
Definition
| Intraepidermal blister with acantholysis and multi-nucleated giant cells; nuclei have chromatic border with pale centers. |
|
|
Term
|
Definition
| Caused by the pox virus; small discrete skin-colored or pink papules with a central dell; endophytic epidermis with magenta-colored molluscum bodies. |
|
|
Term
| Tinea is caused by __________. |
|
Definition
Trichophyton sp. (a dermatophyte, not yeast).
KOH stain shows the hyphae. |
|
|
Term
|
Definition
| Epidermal thickening with neutrophils in the stratum corneum! |
|
|
Term
| North American Blastomycosis |
|
Definition
Deep fungal infection caused by blastomyces dermatitidis; has primary cutaneous, pulmonary, and systemic forms.
Shows pseudoepitheliomatous hyperplasia and granulomatous inflammation (giant cells have a fungal component). |
|
|
Term
| Differential diagnosis for Pseudoepitheliomatous hyperplasia.... |
|
Definition
1) Deep fungal infections
2) Halogenodermas (iodides, bromides)
3) Granular cell tumor (Schwannomas)
4) SCC |
|
|
Term
| Histology of impetigo.... |
|
Definition
| Subcorneal neutrophils; below the BM. |
|
|
Term
| Histology of leprosy..... |
|
Definition
| Granulomatous inflammation (as opposed to epidermal thickening in tinea); mycobacterium leprae present as well. |
|
|
Term
| Secondary syphilis is marked by...... |
|
Definition
| Lichenoid (WBCs at the dermal/epidermal junction) and perivascular inflammation; plasma cells and Warthin Starry stain. |
|
|
Term
|
Definition
Extremely common "barnacles" stuck on the skin that are often pigmented.
Histologically see a pseudohorn cyst filled with keratin. |
|
|
Term
|
Definition
| Looks like little papules in an arched line; histologically looks like seborrheic keratosis. |
|
|
Term
| Nevus Sebaceus of Jadassohn |
|
Definition
Yellow hairless plaque on face or scalp present at birth; histologically see epidermal thickening with aborted hair follicle.
Tumors can develop in this lesion! |
|
|
Term
|
Definition
| Most common! See telengiectasia; the head and neck are more commonly affected than the trunk and extremities. |
|
|
Term
|
Definition
| Pink patch; second most common; trunk and extremities are more commonly affected than the head and neck. |
|
|
Term
|
Definition
| Peripheral palisading and retraction artifact (characteristic). |
|
|
Term
| Which two forms of BCC have a high rate of recurrence? |
|
Definition
| Micronodular and morpheaform |
|
|
Term
| SCC has a ________ surface when on the skin. |
|
Definition
|
|
Term
|
Definition
| Clinically resembles SCC, but looks like a volcano histologically; treated the same as SCC. |
|
|
Term
|
Definition
1) in situ (Lentigo Maligna- due to chronic sun exposure)
2) in the papillary dermis
3) filling the papillary dermis
4) into the reticular dermis
5) into the subcutaneous fat |
|
|
Term
|
Definition
| Non-specific trauma can lead to formation of psoriasis in the area of irritation |
|
|
Term
|
Definition
| Epidermal thickening (acanthosis), parakeratosis with PMNs, and loss of granular cell layer. |
|
|
Term
|
Definition
| Erythematous scaly "greasy" patches with a "Seborrheic distribution"; more severe in HIV patients; may be caused by Pityrosporum. |
|
|
Term
|
Definition
| Vacuolar alteration with lymphocytes at dermal-epidermal junction; dermal mucinous ground substance. |
|
|
Term
|
Definition
| Depigmented area of skin; absence of melanocytes. |
|
|
Term
|
Definition
| Mucocele on the floor of the mouth; not a true cyst: surrounded by granulation tissue. |
|
|
Term
|
Definition
| A true cyst that occurs commonly on the palate due to salivary gland obstruction. |
|
|
Term
|
Definition
Inflammation of the major or minor salivary glands; atrophy of the glands and ductal dilation; may also see fibrosis.
There is no fever in chronic sialadenitis! |
|
|
Term
| Type of cheilitis glandularis |
|
Definition
1) Simple- red, tender
2) Superficial suppurative (Baelz's disease)
3) Deep suppurative
Only superficial suppurative and deep suppurative are infectious. |
|
|
Term
|
Definition
| Caused by Bartonella henselae; the gland itself is not affected; we see necrotizing lymphadenitis (liquefactive); use Warthin-Starry silver stain to identify the bacillus; erythromycin (first choice) and doxycyclin can treat it. |
|
|
Term
|
Definition
| Caused by a paramyxovirus infection; contagious until 14 days after clinical resolution; causes epididymoorchitis in males and spontaneous abortion in females who become pregnant during 1st trimester. |
|
|
Term
|
Definition
| Biopsy shows "owl eye" cells (pathognomic). |
|
|
Term
|
Definition
| Parotid enlargement, facial nerve palsy, uveitis (in eye), and fever associated with sarcoidosis. |
|
|
Term
|
Definition
Non-neoplastic, non-inflammatory enlargement of salivary glands; usually caused by underlying systemic diseases.
Diminished salivary secretions with increased K and decreased Na. |
|
|
Term
|
Definition
| Shows no evidence of fibrosis or destruction of architecture; Schirmer test identifies ocular involvement; anti-nuclear antibodies (anti-SS-A and anti-SS-B). |
|
|
Term
| Benign Lymphoepithelial Lesion |
|
Definition
Develops as a component of Sjogren's; dense infiltration of glands with lymphoid cells (parotid); surrounding myoepithelial cells become hyperplastic forming epimyoepithelial islands.
Increased risk for lymphoma. |
|
|
Term
|
Definition
Mutations in PLAG1 (tumor suppressor gene); forms a benign, encapsulated tumor of DOUBLE-LAYER ducts, plasmacytoid cells, and chondromyxoid tissue.
Warthin's tumors- only in major glands. |
|
|
Term
|
Definition
| Most frequent site is the upper lip; canalicular adenoma is a variant intraorally; can get severely deforming! |
|
|
Term
| Oncocytoma and myoepithelioma |
|
Definition
| Tumor made up of mainly mitochondria-rich tumor cells.........resembles pleomorphic adenoma except there are no double-layer ducts. |
|
|
Term
|
Definition
Most common malignant neoplasm in salivary glands; affects the palate and parotid glands the most; tumor produce mucus as well as contain squamous cells.
Low-grade=good prognosis High-grade=poor prognosis |
|
|
Term
|
Definition
| Affects all salivary glands equally, but the palate is the most common site intraorally; has a classic histologic "Swiss cheese" appearance; deceptively good 5-year prognosis with dismal 15-year prognosis. |
|
|
Term
| Polymorphous low-grade adenocarcinoma |
|
Definition
| Exclusively affects minor salivary glands |
|
|
Term
|
Definition
| Second most common salivary glands malignancy in children (behind mucoepidermal carcinoma). |
|
|
Term
|
Definition
| Pleomorphic adenoma that has become malignant. |
|
|
Term
| ____________ are the most common oral soft tissue growths. |
|
Definition
Fibromas
Giant cell fibroma has large, stellate-shaped fibroblasts with multi-nucleated cells. |
|
|
Term
| Neurofibromatosis type I (von Recklinghausen's disease) |
|
Definition
Caused by mutation in the tumor suppressor gene neurofibromin on chromosome 17; no significant sex predilection, and half of all cases are not associated with a family history.
Oral manifestations are common with half of all patients experiencing enlargement of the FUNGIFORM papillae of the tongue. |
|
|
Term
|
Definition
1) Six or more cafe au lait
2) Two or more neurofibromas or one plexiform neurofibroma
3) Crowe's sign (freckling in the inguinal or axillary regions)
4) Optic glioma
5) Two or more Lisch nodules (iris hamartomas)
6) A first-degree relative with NF1 |
|
|
Term
|
Definition
Caused by mutations in merlin tumor suppressor gene on chromosome 22 (associated with NF2); usually develop of solitary, non-pigmented lesions that are encapsulated and contain Antoni type A and B tissues as well as Verocay bodies.
Unlike neurofibromas, true nerve tissue is not found within these tumors. |
|
|
Term
|
Definition
Associated with MEN-2b; caused by mutations in the RET proto-oncogene; also causes cancers of the thyroid and adrenal glands.
Usually presents as an unencapsulated mass of irregular, convoluted nerve bundles within normal connective tissue. |
|
|
Term
| Pathognomonic evidence of mucosal neuromas |
|
Definition
Affects ocular and GI mucosa (GI bleeds); oral mucosa is almost always the first to be affected (mainly lips and tongue); high-arched palate and malocclusion.
BILATERAL NEUROMAS ON THE COMMISSURES! |
|
|
Term
| Hemangiomas are more common in (boys/girls). |
|
Definition
Girls
Capillary hemangioma is the most common form. |
|
|
Term
| Sturge-Weber Angiomatosis |
|
Definition
Non-hereditary defect of the vascular plexus around the cephalic portion of the neural tube; follows branches of the trigeminal nerve (port-wine stain or nevus flammeus).
Unique "tramline" calcifications of the ipsilateral brain! |
|
|
Term
|
Definition
Benign vascular lesions of lymphatic vessels; occur early in life; cavernous version is the most common; affects anterior 2/3 of tongue and posterior cervical triangle more frequently; cystic hygromas seen.
Recurrence is common. |
|
|
Term
| Histology of angiomyomas (variant of leiomyoma) |
|
Definition
Well-delineated nodules consisting of fascicles of smooth muscle cells surrounding thick-walled vascular channels.
Leiomyomas have cigar-shaped or blunt-ended nuclei. |
|
|
Term
|
Definition
Benign lesion that may be of neural origin; twice as common in women; poorly circumscribed infiltration of neoplastic cells; histologically see polygonal cells with pale, eosinophilic, granular cytoplasm; half of cases are associated with pseudoepitheliomatous hyperplasia.
Histologically, looks almost identical to the congenital epulis. |
|
|
Term
|
Definition
Indicates Schwann cell origin and helps to differentiate granular cell tumors from congenital epulis.
Also, congenital epulis NEVER shows pseudoepitheliomatous hyperplasia! |
|
|
Term
|
Definition
| Ill-defined, unencapsulated mass that exhibits fascicles of spindle cells with wavy or comma-shaped nuclei; occurs most commonly on the tongue intraorally. |
|
|
Term
|
Definition
| Occur almost always in female newborns; poorly circumscribed lesions that often show infiltration into surrounding tissues. |
|
|
Term
| Choritomas are frequently found....... |
|
Definition
| In the posterior 1/3 of the tongue near the foramen cecum (80%) with cartilage and/or bone. |
|
|
Term
|
Definition
| Classic form, endemic form, and AIDS-related form; not caused by translocations but by HHV8! Resembles hemangioma, pyogenic granuloma, and ecchymosis; has decreased due to HAART therapy. |
|
|
Term
| Rhabdomyomas occur more frequently than rhabdomyosarcomas (true/false). |
|
Definition
|
|
