1. What are the basic principles of nomenclature of benign and malignant processes?
2. Describe the morphologic changes associated with poorly differentiated tumors; define and understand the usage of the terms anaplasia, pleomorphism, nuclear atypia, loss of polarity, abnormal mitoses, tumor giant cells.
3. What is the clinical significance of invasiveness and metastasis?
4. Describe the concept of a dominant oncogene.
5. Compare and contrast the different mechanisms of oncogene activation (point mutation, over-expression, gene amplification).
6. Compare and contrast clinical features of cancer in patients with an inherited predisposition versus sporadic cancer in terms of multiple primary tumors, age of onset, and oncogene alterations.
7. Compare and contrast the kinetics of tumor growth with the kinetics of tumor cell cycle progression, and how this relates to tumor growth fraction.
8. List some of the host factors (angiogenesis factors, hormones) that affect tumor cell growth and how they might be used as targets for therapeutic intervention.
9. Be familiar with the general principles, value and applications of biopsy, exfoliative and aspirative cytology, and frozen section, including the procedures used to obtain specimens.
10. List some examples of special markers used to diagnose cancer by immuno-histochemistry and flow cytometry.
11. Define tumor grade and clinical stage.
12. Define paraneoplastic syndrome, and know examples of tumors associated with endocrinopathies, osseous changes, and vascular and hematologic changes (selected from (Robbins 5th Ed., Table 7-9, p. 296) or (Robbins 6th Ed., Table 8-11, p. 321).
1. (Robbins 5th Ed., Chapter 7, p. 241-252, 254-257, 259-265,
272-279, 284, 295-300; Chapter 24, p. 1097-1109) or (Robbins 6th Ed.,
Chapter 8, p. 260-271, 275-276, 277-294, 298-305, 319-325; Chapter
25, p. 1104-1117)
2. Images in Neoplasia case studies folder: Case 2
A 41-year-old woman presents with a mass in her left breast. The patient initially noticed a tiny nodule during a self examination, which doubled in size during the last two months before presentation. Family history is significant for a maternal aunt who died of breast cancer at the age of 59; no other cancer-affected relatives are noted. The patient has two daughters.
Physical exam reveals a mass in the left breast, which is non-fixed. No signs of edema or nipple changes are evident. A single palpable axillary lymph node is also found, which is mobile. Mammography confirmed the presence of a mass 2.5 cm in diameter. CT scans of the chest and abdomen revealed no masses in the lungs, liver, adrenals, kidneys, spleen, or ovaries. A bone scan was negative as well. Serum calcium is elevated at 12.5 mg/dL, without specific signs or symptoms, and parathyroid hormone (PTH) is slightly low.
The patient underwent a modified-radical mastectomy to remove the tumor, including axillary lymph node dissection. Of the 14 lymph nodes removed, one was completely replaced by tumor cells and three others showed microscopic involvement. Immunostaining of the tumor for von Willebrand factor is shown in the computer case study file. The tumor was also stained for the estrogen and progesterone receptors, both were positive; in addition staining for c-Erb2 was also strongly positive. Viable tumor cells were dispersed and analyzed by flow cytometry for DNA content, revealing a relatively high proliferative index without aneuploidy. Based on clinical staging, the patient was given adjuvant radiation therapy to the left breast and axilla.
Ten months later the patient presented with complaints of headaches and blurred vision. Cerebrospinal fluid was analyzed.