2. Lecture no 1
Dr NUDRAT FAYYAZ
ASSOCIATE PROFESSOR
FCPS CHEMICAL PATHOLOGY
3.
4.
5. Be on TIME…..maximum relaxation will be 10
minutes
Each student should have his/her own pen
and a paper(don’t forget to write your roll
number on it, that will be your attendence)
My every lecture has some task that you all
have to do…
6. At the end of this lecture students should be
able to
Describe neoplasia
Describe basic components of neoplastic
tumor.
Describe Nomenclature of neoplasia
8. Neoplasm means
a)Disordered growth
b)New growth
c)Poor growth
d)Rapid growth
e)Slow growth
Correct answer???
b) new growth
9. Neoplasia means “new growth,”
Defined as a disorder of cell
growth that is triggered by a series of
acquired mutations affecting a single cell and
its clonal progeny.
10. An abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with that
of normal tissues and persisit in the same
excessive manner after cessation of stimuli
which evoked the change.
12. All tumors have two basic components:
(1) Neoplastic Cells----- tumor parenchyma
(2) Reactive Stroma---- connective tissue,
blood vessels, and variable numbers of cells
of the adaptive and innate immune system.
14. WHICH OF THE FOLLOWING IS NOT TRUE
REGARDING BENIGN TUMORS?
a) amenable to local surgical removal
b) innocent
c) localized
d) Well demarcated
e) will spread to other sites
CORRECT ANSWER??
e) will spread to other sites
15. A tumor is said to be benign when
gross and microscopic appearances are
considered relatively innocent,
localized,
will not spread to other sites,
amenable to local surgical removal
Well demarcated
16. Which one of the following is true about
malignant tumors?
a) amenable to local surgical removal
b) innocent
c) localized
d) Well demarcated
e) will spread to other sites
CORRECT ANSWER??
e)will spread to other sites
17. A tumor is said to be malignant when
gross and microscopic appearances are
abnormal
Not localised
Spread to distant sites
Poorly demarcated
20. How to name a tumor????
name of the cell type from which the tumor
originates
suffix -oma .
21.
22. Fibroma originates from
a) Adipose tissue
b) Blood vessels
c) Cartilaginous tissue
d) Fibrous tissue
e) Glandular tissue
Correct answer??
d) fibrous tissue
23.
24. Benign tumor of cartilage is called
a) Chondroma
b) Fibroma
c) Leiomyoma
d) Lipoma
e) Osteoma
correct answer?
a) Chondroma
25. Benign tumor of smooth muscle is called
a) Chondroma
b) Fibroma
c) Leiomyoma
d) Lipoma
e) Osteoma
correct answer?
c)Leiomyoma
26. Benign tumor of fat cells is called
a) Chondroma
b) Fibroma
c) Leiomyoma
d) Lipoma
e) Osteoma
correct answer?
d)lipoma
27. Benign tumor of bone is called
a) Chondroma
b) Fibroma
c) Leiomyoma
d) Lipoma
e) Osteoma
correct answer?
e)Osteoma
28. If a tumor is benign and glandular in origin,what is
it called
a) Adenoma
b) Fibroma
c) Leiomyoma
d) Lipoma
e) Osteoma
Correct answer:
a)adenoma
29.
30. If tumor is benign and squamous in
origin,what would it be called:
a) Adenoma
b) Fibroma
c) Leiomyoma
d) Osteoma
e) Papilloma
CORRECT ANSWER
e)papilloma
31. What is the difference between papilloma and
polyp?
32. What is the difference between papilloma and
polyp?
papilloma polyp
Microscopic/ macroscopic Always macroscopic
Finger like projections
above Epithelial surface
Projections above mucosal
surface in gastric or
colonic lumen
33.
34.
35. What is Papillary cystadenoma?
Mass produce papillary patterns that protrude
into cystic spaces
36. What is Adenomatous polyp?
If the polyp has glandular tissue
37.
38. Benign tumor originating from blood vessels?
a) Adenoma
b) Fibroma
c) Hemangioma
d) Lipoma
e) Osteoma
Correct answer
Hemangioma
39. Benign tumor of glandular origin with the gross
appearance of cystic mass is labelled as
a) Cystadenoma
b) Fibroma
c) Leiomyoma
d) Osteoma
e) Papilloma
correct answer
a)Cystadenoma
44. At the end of this class,you should be able to
1. Enlist the benign and malignant tumors
2. Differentiate between sarcoma and
carcinoma
3. Describe nomanclature of benign and
malignant tumors.
47. Sarcoma arise from
a) Blood-forming cells
b) Mesenchymal tissues
c) Epithelial tissues
d) Lymphocyte
e) Endothelium
Correct answer?
mesenchymal tissues
48. What is meant by mesenchymal tissue?
Connective tissue
osteoblasts
chondrocytes
myocytes
adipocytes
49.
50. Malignant tumor of epithelial tissue origin is
called
a) Carcinoma
b) Lymphoma
c) Melanoma
d) Meningioma
e) Sarcoma
Correct answer:
a)Carcinoma
51. Epithelial tissue
derived from any of the three germ
layers.
1. ectodermally derived epidermis,
2. mesodermally derived renal tubules/lining
of body cavities.
3. endodermally derived lining of the
gastrointestinal tract
53. A 40 year old female presented to the out
patient department with the complaint of
hard lump with the scaly top on the right
hand. Lump was excised and sent for
histopathology. Histopathology revealed
neplastic tissue containing stratified
squamous epithelium . What is the most likely
carcinoma this patient is having?
Squamous cell carcinoma of skin
55. A 50 year old male,smoker presented to the
medical ward with complaint of hemoptysis.
On complete examination, lung carcinoma
was diagnosed. Histopathology of lung tumor
showed neoplastic epithelial cells that were
arrranged in glandular pattern. Which type of
lung carcinoma this patient was having?
Adenocarcinoma lung
57. What is the difference between lymphoma
and leukemia?
58. Origin Affected cells Diagnosis
Lymphoma Immune
system(lymph
node)
Lymphocyte
(B cell, Tcell)
Complete
blood count
Leukemia Bone marrow Neutrophils
Eosinophils
Monocytes
basophils
Biopsy of
affected organ
59. What is the difference between sarcoma and
carcinoma?
Origin
Sarcoma---- mesenchymal tissue
Carcinoma--- epetheilial cell
60. Which of the following tumor is benign
Chondrosarcoma
Osteochondroma
Ewings sarcoma
Chondroblastoma
Seminoma
Correct answer
Osteochondroma
61. Which of the following is malignant?
a) Hydatiform mole
b) Immature teratoma
c) Osteochondroma
d) Squamous cell papilloma
e) Transitional cell papilloma
Correct answer:
Immature teratoma
63. Tumor containing tissues derived from all the
three germ layers is called
a) Sarcoma
b) Carcinoma
c) Hemartoma
d) Teratoma
e) Choristoma
correct answer
Teratoma
64. Totipotential germ cells give rise to which type of
tumor?
a) Sarcoma
b) Carcinoma
c) Hemartoma
d) Teratoma
e) Choristoma
CORRECT ANSWER??
TERATOMA
65.
66. Contains recognizable mature or immature
cells or tissues belonging to more than one
germ cell layer (and sometimes all three).
ORIGEN--- totipotential germ cells that are
normally present in the ovary and testis,
67. Components of teratoma:
Bone
Epithelium,
Muscle
Fat,
Nerve
.
68. A 65 year old female came to the doctor with the
complaint of dull pelvic pain for the last 1 year.
Physical examination showed right adnexal mass
that was later surgically excised. On gross
examination there was presence of hair, tooth
and skin tissue inside the cystic space.
What is the most likely diagnosis?
a) Choriocarcinoma
b) Leiomyoma
c) Serous cyst adenoma
d) Teratomas
e) Yolk sac tumors
TERATOMA
69. Disorganized benign masses composed of cells
indigenous to the involved site.
Example
Site of tumor:
Lung
Tissue involved:
endothelium, fibrous tissue, cartilage
Nature of mass:
Disorganised
70. Heterotopic rest of cells.
{normal tissue at abnormal site}
Example
Site of tumor:
GUT
Tissue involved:
PANCREATIC TISSUE
Nature of mass:
Organised/ Well developed.
71. A 65 years old female patient came to medical department for
the workup of lump in the breast. On radiography along with the
lump in breast an incidental finding was observed in the right
bronchus that showed a nodule measuring 1cmx1cm in size.
Biopsy of the nodule was taken and sent for histopathology. The
histopathological examination revealed poorly organized
collection of cartilaginous tissue along with fat cells and blood
vessels.
What is the most likely neoplasm this patient is suffering from?
a) Adenoma
b) Choristoma
c) Hamartoma
d) Sarcoma
e) Lymphangioma
HEMARTOMA
72. A 15 year old male patient presented to the medical
department with complaints of abdominal fullness and
regurgitation of food. Upon investigating the case
ultrasonography was done that revealed a nodule of 1.5
cm in diameter in the first part of duodenum. Nodule was
excised and sent for histopathology. Histopathological
examination revealed presence of normal well organized
pancreatic tissue.
What is the most likely neoplasm that this patient is
having?
a) Adenoma
b) Choristoma
c) Hamartoma
d) Sarcoma
e) Lymphangioma
Choristoma
73. A 40 year old woman had a firm palpable mass on the
dome of her uterus which was discovered six years
ago on the routine physical examination. The mass
has slowly increased in size and is now about twice
the size it was when first discovered.She remains
asymptomatic. Which of the following neoplasm is
she most likely to have?
a) Adenocarcinoma
b) Hematoma
c) Leiomyoma
d) Leiomyosarcoma
e) Rhabdomyoma
correct answer:
Leiomyoma
74.
75.
76. Write down the origins of following neoplasms.
1. Choriocarcinoma
2. Wilms tumor
3. Teratocarcinoma
4. Nevus
5. Benign fibrous tumor
6. Hemangioma
Write down the names of benign and malignamt tumors
arising from the following tissues?
1. Blood vessels
2. Testicular epithelium
3. Brain coverings
4. Placental epithelium
5. Urinary tract epithelium
6. Skeletal muscle
77. Names of malignant tumors that end with –
oma.
Difference between sarcoma and carcinoma
Difference between hemartoma and
choristoma
81. Write down the origins of following neoplasms.
1. Choriocarcinoma
2. Wilms tumor
3. Teratocarcinoma
4. Nevus
5. Benign fibrous tumor
6. Hemangioma
Write down the names of benign and malignamt tumors arising
from the following tissues?
1. Blood vessels
2. Testicular epithelium
3. Brain coverings
4. Placental epithelium
5. Urinary tract epithelium
6. Skeletal muscle
82. Write down the origins of following neoplasms.
Choriocarcinoma
Placenta
Wilms tumor
Renal tissue
Teratocarcinoma
Ttotipotential germ cells
Nevus
melanocyte
Benign fibrous tumor
mesothelium
Hemangioma
blood vessels
83. Write down the names of benign and
malignamt tumors arising from the following
tissues?
1. Blood vessels
2. Testicular epithelium
3. Brain coverings
4. Placental epithelium
5. Urinary tract epithelium
6. Skeletal muscle
85. At the end of this lecture students should be
able to
Differentiate between benign and malignant
tumor
Describe metaplasia and dysplasia
Describe carcinoma in situ
86.
87.
88.
89. WHICH OF THE FOLLOWING IS HALLMARK OF
MALIGNANCY?
a) ANAPLASIA
b) DIFFERENTIATION
c) HYPERPLASIA
d) HYPERTHROPHY
e) PLEOMORHISM
CORRECT ANSWER??
ANAPLASIA
90. Differentiation extent to which neoplastic
parenchymal cells resemble the
corresponding normal parenchymal cells,
both morphologically and functionally;
92. Pleomorphism —variation in size and shape
Abnormal nuclear morphology
i. Nuclear-to-cytoplasm ratio--- 1 : 1 instead of
the normal 1 : 4 or 1 : 6.
ii. Nuclear shape-- variable and often irregular
iii. Chromatin-- coarsely clumped and distributed
along the nuclear membrane, more darkly
stained than normal(hyperchromatic).
iv. Nucleoli ---Abnormally large
93. Mitoses---reflect the high proliferative activity
of the parenchymal cells.
Morphologic feature of malignancy--- atypical,
bizarre mitotic figures, (tripolar, quadripolar,
or multipolar spindles)
94. Loss of polarity---Sheets or large masses of
tumor cells grow in an anarchic, disorganized
fashion
Ectopic Secretion of hormones
Ectopic production of ADH from lung
cancer
95. A 25 year old women presents to her physician with a
lump in her left breast. She has no family history of
cancer. On examination she has 2cm round freely
mobile mass. Needle biopsy showed fibroadenoma.
Which of the following characteristics was most likely
seen on the sample?
a) Anaplastic cells
b) Cellular hyperplasia with glandular architecture.
c) High quantity of cells with mitotic spindle .
d) High nucleus to cytoplasmic ratio.
e) Loss of glandular archetecture.
Cellular hyperplasia with glandular architecture.
96.
97.
98. Metaplasia is defined as the
replacement of one type of cell with another
type in association with tissue damage,
repair, and regeneration.
99. Gastroesophageal reflux
Damages the squamous epithelium of the
esophagus
replacement by glandular (gastric or intestinal)
epithelium (more suited to an acidic
environment.)
100. A 70 year old man presents with a complaint of a change
in bowel habits,alternating constipation and diarrhea. A
stool sample reveals occult blood.Digital rectal
examination reveals palpable mass. A biopsy was
performed. Of the following microscopic findings, which of
the following is most likely to indicate that the neoplasm is
malignant?
a) Atypia
b) Increased nucleus to cytoplasmic ratio
c) Invasion of surrounding tissue
d) Necrosis
e) Pleomorphism
Increased nucleus to cytoplasmic ratio
101.
102. At the end of this lecture,students should be
able to:
Describe dysplasia
Describe carcinoma in situ
Enlist common cancers in pakistan
Enumerate the environmental factors causing
malignancy
Enlist acquired predisposing factors leading
to malignancy.
103.
104. Disordered growth
loss in the uniformity and architectural
orientation of the individual cells
pleomorphism
Abnormal nuclear morphology
105. You receive a cytopathology report on a PAP
smear from 40 year old patient that states
‘minimal dysplasia’ is present in ectocervical
epithelium. Which of the following statements
about minimal dysplasia is correct?
a) Hyperplasia precedes this lesion
b) This lesion is irreversible
c) There is no risk of more aggressive lesion.
d) The cells are poorly differentiated than normal.
e) There is increased risk for benign neoplasm.
The cells are poorly differentiated than normal.
106.
107. dysplastic changes
marked
involve the full thickness of the epithelium
does not penetrate the basement membrane
Once the tumor cells breach the basement
membrane, the tumor is said to be Invasive.
108. Earliest change at microscopic level for the
malignamt transformation of neoplasm is
a) Carcinoma in situ
b) Dysplasia
c) Hyperplasia
d) Hypertrophy
e) Metaplasia
Metaplasia
110. Which of the following features would best
indicate that the adrenal cortical neoplasm
was malignant?
a) Cellular atypia
b) Desmoplasia
c) Dysplasia
d) Metastasis
e) Presence of mitosis
Metastasis
111. Which of the following is true regarding
malignant tumors?
a) Always contain tumour giant cells
b) Rarely metastasise
c) Well differentiated
d) When arising from epithelial cells are called
sarcoma
e) When arising from glandular cells are called
adenocarcinoma.
Correct answer:
When arising from glandular cells are called
adenocarcinoma.
112. The most common tumors
Men
prostate, lung, and colon/rectum.
Women
breast, lung, and colon/rectum
113. Enlist the environmental factors that
contribute to malignant transformation???
114. Infectious agents--- human papilloma virus
Cervical carcinoma
Smoking:
lung cancer,
cancer of the mouth, pharynx, larynx,
esophagus, pancreas,bladder,
.
118. Reproductive history:
--- lifelong cumulative exposure to estrogen
stimulation, particularly if unopposed by
progesterone, increases the risk of cancers of
the breast and endometrium,
120. The common neoplasms of infancy and
childhood
Neuroblastoma,
Wilms tumor,
Retinoblastoma,
Acute leukemias
Rhabdomyosarcomas.
The rising incidence of cancer with age is
likely explained by the accumulation of
somatic mutations associated with
122. Precursor lesions
Barrett esophagus (gastric and colonic metaplasia of the
esophageal mucosa in the setting of gastric reflux)
Squamous metaplasia of the bronchial mucosa (in
response to smoking)
Bladder mucosal metaplasia (in response to
schistosomiasis infection)
Colonic metaplasia of the stomach (in the setting of
pernicious anemia and chronic atrophic gastritis)
Endometrial hyperplasia, which is caused by sustained
estrogenic stimulation of the endometrium.
Leukoplakia---squamous carcinoma.
123. Germline mutations in a tumor suppressor
gene—breast cancer risk in females who
inherit mutated copies of the BRCA1 or
BRCA2 tumor suppressor genes is almost
threefold higher.
