Ne Oplasia Revi Ew Plu s

8/14/2019 Ne Oplasia Revi Ew Plu s

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NE OPLASIA REVI EWE OPLASIA REVI EW

Pluslu s9-18-20099-18-2009

T. DavisT. Davis


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1. A new test for prostate1. A new test for prostatecancer (PC) is developed.cancer (PC) is developed. 90%0% of menof men wi th PCi th PC test positive.test positive.80%0% of menof men without PCithout PC testtest

negative.negative.2. In a population of 1000 men,2. In a population of 1000 men,30% (300 men) have the30% (300 men) have the

disease (the prevalence is 30%).disease (the prevalence is 30%).Calculate sensitivity, specificityCalculate sensitivity, specificityand PPV.and PPV.


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Sen sit ivit y a nden sit ivit y a nd

speci ficit ypeci ficit y90% sensitivity90% sensitivity90% of 1000 or 90090% of 1000 or 900

would be thewould be the trueru e positivesositives10% of 1000 or 10010% of 1000 or 100would be thewould be the falsealseneg at iv eseg at iv es

80% specificity80% specificity80% of 1000 or 80080% of 1000 or 800

would be thewould be the trueru enega tivesega tives20% of 1000 or 20020% of 1000 or 200would be thewould be the falsealsepos it ivesos it ives


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PPVPV (predictive value of a +)(predictive value of a +)

with a prevalence of 30%with a prevalence of 30%410 men have a positive test: 270 TP410 men have a positive test: 270 TP(90%x300) and 140 FP (20%x700)(90%x300) and 140 FP (20%x700)

PPV= TP/FP+TPPPV= TP/FP+TPPPV= 270 / 270 + 140PPV= 270 / 270 + 140

270/410 or about 66%270/410 or about 66%


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Ca ncer P recu rsor L es ion sa ncer P recu rsor L es ion s

________ ________ Atyp. Hyp. Breast Atyp. Hyp. Breast

_______ _______ Endom. HyperplasiaEndom. Hyperplasia

_________ _________

Gastric metaplasiaGastric metaplasia(Helicobacter)(Helicobacter)

___________ ___________

Sq. Cell CA Sq. Cell CA __________ __________

Adeno CA colon Adeno CA colon ___________ ___________ Esoph. Adeno CA Esoph. Adeno CA

_____________ _____________

Adeno CA liver Adeno CA liver


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Actinic keratosis Actinic keratosis Atyp. Hyp. Breast Atyp. Hyp. BreastUlcerative ColitisUlcerative ColitisEndom. HyperplasiaEndom. Hyperplasia

Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)Gastric metaplasiaGastric metaplasia

(Helicobacter)(Helicobacter)

Sq. Cell CA Sq. Cell CA Ductal CA Ductal CA

Adeno CA colon Adeno CA colon Adeno CA endom. Adeno CA endom.

Esoph. Adeno CA Esoph. Adeno CA

Gastric Adeno CA Gastric Adeno CA




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Actinic keratosis Actinic keratosis

__________ __________ Ulcerative ColitisUlcerative Colitis __________ __________

Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)

___________ ___________

CirrhosisCirrhosis

___________ ___________

Ductal CA Ductal CA ___________ ___________ Adeno CA endom. Adeno CA endom.

_____________ _____________

Gastric Adeno CA Gastric Adeno CA __________ __________


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Actinic keratosis Actinic keratosis Atyp. Hyp. Breast Atyp. Hyp. BreastUlcerative ColitisUlcerative ColitisEndom. HyperplasiaEndom. Hyperplasia

Esoph. MetaplasiaEsoph. Metaplasia(Barretts)(Barretts)Gastric metaplasiaGastric metaplasia

(Helicobacter)(Helicobacter)

Sq. Cell CA Sq. Cell CA Ductal CA Ductal CA

Adeno CA colon Adeno CA colon Adeno CA Adeno CA

endom.endom.Esoph. Adeno CA Esoph. Adeno CA Gastric Adeno CA Gastric Adeno CA




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Precu rs or s ( 2)recu rs or s ( 2)

____________ ____________

Sq.Sq.Dysplasia/cervix,Dysplasia/cervix,lung/larynxlung/larynx

______________ ______________

Adeno CA Adeno CA

___________ ___________

Adeno CA colon Adeno CA colon


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Scar in lungScar in lung


Adenomatous Adenomatouspolyppolyp

Adeno CA Adeno CA

Ss. Cell CA Ss. Cell CA



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____________ ____________


____________ ____________


_____________ _____________


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Adeno CA Adeno CA




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Malig nan t Tu mo rs a ndalig nan t Tu mo rs a nd

En docrin op athiesn docrin op athies _________ _________ ___________ ___________

___________ ___________ ____________ ____________ Insulin/hypoglycemiInsulin/hypoglycemi

ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct

Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testis

SC CA/lungSC CA/lungMed CA/thyroidMed CA/thyroidIslet cellIslet cell

Small CellSmall CellRenal Cell,Renal Cell,Hepatocellular CA Hepatocellular CA


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En docrin op athiesn docrin op athies ACTH/Cushings ACTH/CushingsHCG/gynecomastiaHCG/gynecomastiaPTH/hyperCa++PTH/hyperCa++Calcitonin/hypoCa+Calcitonin/hypoCa+

Insulin/hypoglycemiInsulin/hypoglycemi ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct

Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testisSquaC CA/lungSquaC CA/lungMed CA/thyroidMed CA/thyroid

___________ ___________ __________ __________ _____________ _____________


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Insulin/hypoglycemiInsulin/hypoglycemi ADH/hypoNa+ ADH/hypoNa+Erythropeitin/>HctErythropeitin/>Hct

_________ _________ ___________ ___________ ____________ ____________ ___________ ___________

Islet cellIslet cellSmall CellSmall CellRenal Cell,Renal Cell,

Hepatocellular CA Hepatocellular CA


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_________ _________ _________ _________ ____________ ____________

Small Cell, Med. CA Small Cell, Med. CA ChorioCA/testisChorioCA/testisSquaC CA/lungSquaC CA/lungMed CA/thyroidMed CA/thyroid

Islet cellIslet cellSmall CellSmall CellRenal Cell,Renal Cell,

Hepatocellular CA Hepatocellular CA


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The f oll owi ng im ag e ishe f oll owi ng im ag e is

mos t c/w wh ic h ma lign anc yos t c/w wh ic h ma lign anc y

A. Medullary Carcinoma of Thyroid A. Medullary Carcinoma of ThyroidB. Small cell carcinoma of LungB. Small cell carcinoma of LungC. Sq. Cell Carcinoma of LungC. Sq. Cell Carcinoma of Lung

D. Metastatic melanomaD. Metastatic melanomaE. Renal Cell AdenocarcinomaE. Renal Cell Adenocarcinoma


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An s. C, SCC o f L ungn s. C, SCC o f L ung

These tumors frequently make aThese tumors frequently make aparathormone-like substanceparathormone-like substance


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Anaplasianaplasia = __ _____ ____ ______ __= __ _____ ____ ______ __

Anaplasia is considered a hallmark of Anaplasia is considered a hallmark of ______________ ______________ .. Anaplastic features include: Anaplastic features include:

- ?- ???

?

- Undi ffere nt iat ed, po orl y di ffere nti at ed,Undi ffere nt iat ed, po orl y di ffere nti at ed,high gradeig h gr ade


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Anaplasianaplasia = L ack of diffe rentia ti on= L ack of diffe rentia ti on

Anaplasia is considered a hallmark of Anaplasia is considered a hallmark of malignant transformation malignant transformation ..

Anaplastic features include: Anaplastic features include:- Cellular/nuclear pleomorphism- Cellular/nuclear pleomorphism

- Increased nuclear-cytoplasmic ratio- Increased nuclear-cytoplasmic ratio- Nuclear hyperchromasia (increased DNA content)- Nuclear hyperchromasia (increased DNA content)

- Large nucleoli- Large nucleoli

- Und iffer ent iat ed , po orly dif fer ent iat ed ,Undifferentiated, poorly differentiated,hig h g radeig h g rade


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GR AD ING TU MORSR AD ING TU MORS

__________ tumors only __________ tumors onlyLook at: ? And ?Look at: ? And ?

Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore __________)more __________)Important for some tumors: breast,Important for some tumors: breast,

prostate, endometrium, astocytomasprostate, endometrium, astocytomasDysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features


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Malignant tumors onlyMalignant tumors onlyDifferentiation and mitotic rateDifferentiation and mitotic rate

Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore anaplastic)more anaplastic)Important for some tumors: ?, ?, ?, ?Important for some tumors: ?, ?, ?, ?

Dysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features


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Malignant tumors onlyMalignant tumors onlyDifferentiation and mitotic rateDifferentiation and mitotic rate

Grades I-III/IV (higher grades areGrades I-III/IV (higher grades aremore anaplastic)more anaplastic)Important for some tumors: breast,Important for some tumors: breast,prostate, endometrium, astocytomasprostate, endometrium, astocytomasDysplasias of the cervix are graded Dysplasias of the cervix are graded Based on microscopic featuresBased on microscopic features


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SP

SP


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Squamous cell carcinoma with squamous pearls (SP)

SP

SP


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SP


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SP

Squamous Pearls (SP)


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*

*


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*

*

Intercellular bridges (*)


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Anaplastic rhabdomyosarcoma


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STAGI NG TU MORSTAGI NG TU MORS

How far has the tumor spreadHow far has the tumor spreadMalignant tumors onlyMalignant tumors only?, ?, ??, ?, ?Staging often involves: theStaging often involves: thePathologist, radiology or otherPathologist, radiology or otherimaging, lab tests (tumor markers)imaging, lab tests (tumor markers)CISIS is referred to asis referred to as __ ___ __ ____ ___ __ ___

TAGI NG TUMORS


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STAGI NG TUMORSTAGI NG TUMORS

How far has the tumor spreadHow far has the tumor spreadMalignant tumors onlyMalignant tumors onlyTumor size (Tumor size ( T), lymph node (), lymph node ( N))involvement, distant metastases (involvement, distant metastases ( M))Staging often involves: theStaging often involves: thePathologist, radiology or otherPathologist, radiology or otherimaging, lab tests (tumor markers)imaging, lab tests (tumor markers)CISIS is referred to asis referred to as Sta ge Zerota ge Zero


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METASTA SISETASTA SIS

LIVER: (portal circulation)LIVER: (portal circulation) ______________ ______________ LUNG: breast, stomach, sarcomasLUNG: breast, stomach, sarcomas

BONE: 3BONE: 3rdrd

most frequent site for ??;most frequent site for ??;lung, breast, prostate, kidney, thyroid;lung, breast, prostate, kidney, thyroid;PROSTATE to bone gives osteoblasticPROSTATE to bone gives osteoblasticlesions on Xray and high serumlesions on Xray and high serumalkaline phosphatasealkaline phosphatase

ADRENAL: most common ADRENAL: most common ____________ ____________

AS A S SETASTA SIS


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LIVER: (portal circulation) GI tractLIVER: (portal circulation) GI tractand pancreas; lung, breast,and pancreas; lung, breast,melanomasmelanomas

LUNG: ?, ?, ?LUNG: ?, ?, ?BONE: 3BONE: 3 rdrd most frequent site formost frequent site formetastases; ?, ?, ?, ?, ?; PROSTATE tometastases; ?, ?, ?, ?, ?; PROSTATE tobone gives _____________ on Xraybone gives _____________ on Xrayand high serum ______________ and high serum ______________

ADRENAL: most common endocrine ADRENAL: most common endocrinesitesite



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LIVER: (portal circulation) GI tractLIVER: (portal circulation) GI tractand pancreas; lung, breast,and pancreas; lung, breast,melanomasmelanomas

LUNG: breast, stomach, sarcomasLUNG: breast, stomach, sarcomasBONE: 3BONE: 3 rdrd most frequent site formost frequent site formetastases; lung, breast, prostate,metastases; lung, breast, prostate,kidney, thyroid; PROSTATE to bonekidney, thyroid; PROSTATE to bonegives osteoblastic lesions on Xray andgives osteoblastic lesions on Xray andhigh serum alkaline phosphatasehigh serum alkaline phosphatase

ADRENAL: most common endocrine ADRENAL: most common endocrine

sitesite


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Neop las ia Ca seeop las ia Ca se

A 38-y.o. male has a family history of A 38-y.o. male has a family history of colectomies performed between agescolectomies performed between ages

30 and 40. The slide shows the total30 and 40. The slide shows the totalcolectomy specimen from this patient.colectomy specimen from this patient.


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Familial polyposis


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Tubular adenomas (adenomatous polyps)


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AC


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Adenomatous Change (AC)

AC


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Carcinomain situ invasive


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CO LON CANC ERO LON CANC ER

Grading is helpful/not very helpfulGrading is helpful/not very helpfulSTAGING: predicts _________ STAGING: predicts _________ TNMTNMRobbins Table 17-11Robbins Table 17-11


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Grading is not very helpfulGrading is not very helpfulSTAGING: predicts clinical outcomeSTAGING: predicts clinical outcomeTNMTNMRobbins Table 17-11Robbins Table 17-11


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Tu mor Siz e ( T)u mor Siz e ( T)

Tis- ???Tis- ???T1- ____________ T1- ____________ T2- ___________ T2- ___________ T3- ___________ T3- ___________ T4- ______________ T4- ______________


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Tu mor Size ( T)u mor Size ( T)

Tis- insitu; not through the muscularisTis- insitu; not through the muscularismucosamucosa

T1- invades submucosaT1- invades submucosaT2- into but not through theT2- into but not through themuscularis propriamuscularis propria

T3- through muscularis propriaT3- through muscularis propriaT4- invades adjacent organsT4- invades adjacent organs


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??? Staging System


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TNM Staging System


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Lymph Nodes ( N)ymph Nodes ( N)

N0- ??N0- ??N1- ??N1- ??N2- ??N2- ??


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Lymph Nodes ( N)ymph Nodes ( N)

N0- no nodes involvedN0- no nodes involvedN1- 1-3 regional LNsN1- 1-3 regional LNsN2- 4+ regional LNsN2- 4+ regional LNs


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Dis tant Met astas es (M)is tant Met astas es (M)

M0- ??M0- ??M1- ??M1- ??

*note*noteTx, Nx, Mx- can/cannot be assessedTx, Nx, Mx- can/cannot be assessed


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Dis tant Met astas es (M)is tant Met astas es (M)

M0- no distant metastasisM0- no distant metastasisM1- distant mets presentM1- distant mets present

*note*noteTx, Nx, Mx- cannot be assessedTx, Nx, Mx- cannot be assessed


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An swer : C, in activ ationn swer : C, in activ at ion

of AP Cf APCThis disorder is autosomal dominantThis disorder is autosomal dominantwith the APC supressor gene onwith the APC supressor gene on

chromosome 5.chromosome 5.


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OTHER OTHER 50% of colorectal carcinomas show ?? 50% of colorectal carcinomas show ??

mutations; 50% of adenomas > 1cm showmutations; 50% of adenomas > 1cm show ________ mutations ________ mutations _________ can be used to follow patients _________ can be used to follow patientsafter surgery- tumor monitoringafter surgery- tumor monitoringDeeply infiltrating tumors causeDeeply infiltrating tumors cause_______________________ and ???? appearanceand ???? appearance


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OTHER OTHER 50% of colorectal carcinomas show ras 50% of colorectal carcinomas show ras

mutations; 50% of adenomas > 1cm alsomutations; 50% of adenomas > 1cm alsoshow ras mutationsshow ras mutationsCEA (carcinoembryonic Ag) can be used toCEA (carcinoembryonic Ag) can be used tofollow patients after surgery- tumorfollow patients after surgery- tumormonitoringmonitoringDeeply infiltrating tumors causeDeeply infiltrating tumors causedes mop la si aes mop la si a and apple core/ napkin-ring and apple core/ napkin-ring

appearanceappearance


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????

?????


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Normal

Adenocarcinoma


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Tumor: napkin ring lesionNormal, pretty!


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Na me th e m ost c om mo na me th e m ost c om mo n


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Na me th e m ost c om mo na me th e m ost c om mo nhuma n tum or su presso ruma n tum or su presso r

gen es a nd p ro to onc ogeneen es a nd p ro to onc ogene(RESPECTIVELY)RESPECTIVELY)

A. P53 and RB A. P53 and RBB. P53 and RASB. P53 and RAS

C. RB and RASC. RB and RASD. APC and P53D. APC and P53E. APC and RBE. APC and RB


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An swer : B, P 53 a nd R ASn swer : B, P 53 a nd R AS

P53 is the tumor supressor geneP53 is the tumor supressor genemutated in over 50% of humanmutated in over 50% of human

tumors. The mutation prevents DNA tumors. The mutation prevents DNA repair and inhibits apoptosis. The pointrepair and inhibits apoptosis. The pointmutation in the proto-oncogene RASmutation in the proto-oncogene RAS

allows cell proliferation (GTP signalallows cell proliferation (GTP signaltransduction) and is seen 30+% of transduction) and is seen 30+% of human tumorshuman tumors


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Wha t tu mo r m ar kers ar eha t tu mo r m ar kers ar e


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Wha t tu mo r m ar kers ar eha t tu mo r m ar kers ar eusef ul in ma na gement o fsef ul in ma na gement o f

colon cancer?olon cancer? A. CEA is used to monitor tumor A. CEA is used to monitor tumorrecurrencerecurrenceB. CEA is used as a screening test forB. CEA is used as a screening test forcolon cancercolon cancerC. CEA is used as a confirmation test if C. CEA is used as a confirmation test if the test for occult blood is positivethe test for occult blood is positive

D. High PSA in serum is diagnosticD. High PSA in serum is diagnosticE. High AFP in serum is diagnosticE. High AFP in serum is diagnostic

An swer : A, u sed ton swer : A, u sed to


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An swer : A, u sed to,mon it or t umoron it or t umor

recu rre nceecu rre nceCEA is not specific for colon cancerCEA is not specific for colon cancerand not a sensitive test. CEA levels areand not a sensitive test. CEA levels are

determined pre- and post-surgery. Thedetermined pre- and post-surgery. TheCEA level should fall to near zero. If CEA level should fall to near zero. If the level falls and then increases, thethe level falls and then increases, the

patient may receive chemotherapy forpatient may receive chemotherapy forthe recurrence.the recurrence.


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Tu mor Ma rk er su mor Ma rk er s

ManagementManagementDetection (staging)Detection (staging)

Diagnosis (screening)- PSA andDiagnosis (screening)- PSA andCA 125CA 125


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Markersarkers

? - colon, pancreas, stomach, lung,- colon, pancreas, stomach, lung,breast, (19% smokers, 3% gen. pop.)breast, (19% smokers, 3% gen. pop.)

?-- hepatocellular, germ cellhepatocellular, germ cell(>500ng/ml)(>500ng/ml)??-?- 80% non-mucinous80% non-mucinous ovarian CA ovarian CA

??- pancreatic CA (80%)??- pancreatic CA (80%)

M kk


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Markersarkers

CEAEA- colon, pancreas, stomach, lung,- colon, pancreas, stomach, lung,breast, (19% smokers, 3% gen. pop.)breast, (19% smokers, 3% gen. pop.)

AFP-FP- hepatocellular, germ cellhepatocellular, germ cell(>500ng/ml)(>500ng/ml)CA 125 -A 125 - 80% non-mucinous80% non-mucinous ovarianovarian

CA CA CA 19-9- pancreatic CA (80%)CA 19-9- pancreatic CA (80%)


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Marker s ( 2)arker s ( 2)

PSA- (?? ng/ml normal) (> ?? ng/mlPSA- (?? ng/ml normal) (> ?? ng/mlhighly suspicious); also ??? elevationhighly suspicious); also ??? elevation

in prostate CA assoc. with bonein prostate CA assoc. with bonemetastasis (osteoblastic)metastasis (osteoblastic)HCG- ?, ?HCG- ?, ?

M k ( 2)k ( 2)


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Marker s ( 2)arker s ( 2)

PSA- (0-4 ng/ml normal) (>10 ng/mlPSA- (0-4 ng/ml normal) (>10 ng/mlhighly suspicious); also AlkPhoshighly suspicious); also AlkPhos

elevation in prostate CA assoc. withelevation in prostate CA assoc. withbone metastasis (osteoblastic)bone metastasis (osteoblastic)HCG- gestational trophoblasticHCG- gestational trophoblastic

tumors, testicular tumorstumors, testicular tumors


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L


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Benign breast ducts and lobules

L


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Fibroadenoma


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Fibroadenoma of breast


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C

C

CN


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C

C

CN

Intraductal carcinoma with cribbiforming (C) and comedonecrosis (CN)


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Invasive CA


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Mammogram shows a mass and Ca**

Stellate

tumor

BR EA ST CAR CI NO MAR EA ST CAR CI NO MA


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BR EA ST CAR CI NO MAR EA ST CAR CI NO MAGRADINGRADING

Bloom and RichardsonBloom and Richardson

?? (1-3)?? (1-3)?? (1-3)?? (1-3)?? (1-3)?? (1-3)

Total score 3-5: Grade ITotal score 3-5: Grade ITotal score 6,7: Grade IITotal score 6,7: Grade IITotal score 8,9: Grade IIITotal score 8,9: Grade III



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BR EA ST CAR CI NO MAR EA ST CAR CI NO MAGRADINGRADING

Bloom and RichardsonBloom and Richardson

Tubules present (1-3)Tubules present (1-3)Nuclear atypia (1-3)Nuclear atypia (1-3)Mitoses (1-3)Mitoses (1-3)

Total score 3-5: Grade ITotal score 3-5: Grade ITotal score 6,7: Grade IITotal score 6,7: Grade IITotal score 8,9: Grade IIITotal score 8,9: Grade III


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STAGI NGTAGI NG

Stage 0 (in situ or CIS): 5-year 92%Stage 0 (in situ or CIS): 5-year 92%Stage I. (4 LN+): 5-year 46%Stage IV. Distant mets: 5-year 13%Stage IV. Distant mets: 5-year 13%


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Invasive (infiltrating) ductal carcinoma with lymphatic invasion


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OTHER OTHER Estrogen receptor (+): tumor is stimulatedEstrogen receptor (+): tumor is stimulatedby ?? and can be treated with the ?? This isby ?? and can be treated with the ?? This ispalliation.palliation.HER-2 Neu amplification: by immunostainingHER-2 Neu amplification: by immunostainingor FISH. If HER-2 Neu is amplified (20%),or FISH. If HER-2 Neu is amplified (20%),the patient can be treated with ?? This isthe patient can be treated with ?? This isvery expensive and tends to be used in highvery expensive and tends to be used in highgrade/high stage lesions that are ??grade/high stage lesions that are ??



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OTHER OTHER Estrogen receptor (+): tumor is stimulatedEstrogen receptor (+): tumor is stimulatedby estrogen and can be treated with theby estrogen and can be treated with the

anti-estrogen tamoxifen. This is palliation. anti-estrogen tamoxifen. This is palliation.HER-2 Neu amplification: by immunostainingHER-2 Neu amplification: by immunostainingor FISH. If HER-2 Neu is amplified (20%),or FISH. If HER-2 Neu is amplified (20%),the patient can be treated with Herceptin.the patient can be treated with Herceptin.This is very expensive and tends to be usedThis is very expensive and tends to be usedin high grade/high stage lesions that arein high grade/high stage lesions that areHER-2 Neu positive.HER-2 Neu positive.


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ER (+)


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HER-2 Neu (+)


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d l


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HPV an d Cer vica l Ca ncerPV an d Cer vica l Ca ncer

HPV DNA types ? And ?: condylomaHPV DNA types ? And ?: condylomaHPV ?, ?, ? others: carcinomaHPV ?, ?, ? others: carcinoma

Viral protein _____ acts via Viral protein _____ acts viaretinoblastoma gene proteinretinoblastoma gene protein

Viral protein E6 acts via ___________ Viral protein E6 acts via ___________

Proliferation is stimulated andProliferation is stimulated andapoptosis is inhibitedapoptosis is inhibited



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HPV DNA types 6 and 11: condylomaHPV DNA types 6 and 11: condylomaHPV 16, 18, 13 others: carcinomaHPV 16, 18, 13 others: carcinoma

Viral protein E7 acts via Viral protein E7 acts viaretinoblastoma gene proteinretinoblastoma gene protein

Viral protein E6 acts via to P53 (TP53). Viral protein E6 acts via to P53 (TP53).

Proliferation is stimulated andProliferation is stimulated andapoptosis is inhibitedapoptosis is inhibited


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Squamous metaplasia

Endocervical glands


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Normal epithelium shows maturation at the surface


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? ??

?? ??

koilocyte


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Normal Low Grade

Moderate Severe/CIS


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?

?


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Koilocytes (K)

K

K


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??


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Invasive squamous cell CA

Wha t i s the m ost s ensi ti veha t i s the m ost s ensi ti vete st f or hi gh gr ad ee st f or hi gh gr ad e


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te st f or hi gh gr ad ee st f or hi gh gr ad e

dy sp las ia of the c ervix ?y sp las ia of the c ervix ? A. Pap smear A. Pap smear

B. HPV DNA test for high risk typesB. HPV DNA test for high risk typesC. HPV test for DNA type 16C. HPV test for DNA type 16D. HPV test for DNA type 18D. HPV test for DNA type 18E. HPV serum antibodies to DNA typeE. HPV serum antibodies to DNA type1616

HP V DNA is m ost s ensi ti veP V DNA is m ost s ensi ti ve


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HP V DNA is m ost s ensi ti veP V DNA is m ost s ensi ti ve

te st f or Hi gh G ra dee st f or Hi gh G ra dedysplasiaysplasia

Pap smear 55%Pap smear 55%HPV DNA 95%HPV DNA 95%

LUNG CANCE RUNG CANCE R


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LUNG CANCE RUNG CANCE R

?, ?, and ?: can be cured by surgery if ?, ?, and ?: can be cured by surgery if caught early (


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Large cell carcinoma, adenocarcinomaLarge cell carcinoma, adenocarcinomaand squamous cell carcinoma: can beand squamous cell carcinoma: can becured by surgery if caught earlycured by surgery if caught early(


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Large cell carcinoma, adenocarcinomaLarge cell carcinoma, adenocarcinomaand squamous cell carcinoma: can beand squamous cell carcinoma: can becured by surgery if caught earlycured by surgery if caught early(


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Normal

CIS

Squamous CA


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??

??

?? ??


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keratin

Nuclear molding

Squamous Cell Carcinoma Small Cell Carcinoma

?? ??


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?? ??

Squamous CA Adeno CA


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Small cell undifferentiated carcinoma Large cell CA


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Small Cell Carcinoma


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??


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Normal esophagus


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??


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Barretts syndrome


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Para neop last icara neop lasticS dd


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Syndromesyndromes Acanthosis Acanthosisnigricansnigricans

Eaton-LambertEaton-LambertOsteoarthropathyOsteoarthropathySeborrheicSeborrheic

keratosiskeratosisMigratoryMigratorythrombophlebitisthrombophlebitis

(Tro ssea s)(Tro ssea s)

Adeno CA Adeno CA (gastric)(gastric)

Small Cell CA Small Cell CA Bronchogenic CA Bronchogenic CA Gastric CA Gastric CA

Pancreatic CA Pancreatic CA



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______________ ______________ OsteoarthropathyOsteoarthropathy

___________ ___________

MigratoryMigratorythrombophlebitisthrombophlebitis(Trousseaus)(Trousseaus)

_____________ _____________

Small Cell CA Small Cell CA ___________ ___________ Gastric CA Gastric CA

______________ ______________



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Eaton-LambertEaton-LambertOsteoarthropathyOsteoarthropathySeborrheicSeborrheic

keratosiskeratosisMigratoryMigratorythrombophlebitisthrombophlebitis

(T )(T )

Adeno CA Adeno CA (gastric)(gastric)

Small Cell CA Small Cell CA Bronchogenic CA Bronchogenic CA Gastric CA Gastric CA

Pancreatic CA Pancreatic CA

PARA NEO PLASTI CARA NEO PLASTI CSYNDROMESYNDROMES


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SYNDROMESYNDROMESSmall Cell CA Small Cell CA

__________ __________

Carcinoid tumorCarcinoid tumor(lung or liver(lung or liverusually)usually)

_________ _________

PTH-likePTH-like(Hypercalcemia)(Hypercalcemia)

_____________ _____________



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SYNDROMESYNDROMESSmall Cell CA Small Cell CA

Squamous cellSquamous cellCA CA hypercalcemiahypercalcemia

Carcinoid tumorCarcinoid tumor(lung or liver(lung or liverusually)usually)

ACTH ACTH(Cushings); ADH(Cushings); ADH(iADH)(iADH)PTH-likePTH-like(Hypercalcemia)(Hypercalcemia)

Serotonin,Serotonin,bradykininbradykinin(Carcinoid(Carcinoid

d )syndrome)



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SYNDROMESYNDROMES _____________ _____________

Squamous cellSquamous cellCA CA hypercalcemiahypercalcemia

____________ ____________

ACTH ACTH(Cushings); ADH(Cushings); ADH(iADH)(iADH)

__________ __________

Serotonin,Serotonin,bradykininbradykinin(Carcinoid(Carcinoid

d )d )


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Vir uses a nd Ca ncerir uses a nd Ca ncer(RNA)RNA)


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(RNA)RNA) _____________ _____________

HTLV-1HTLV-1

HepatocellularHepatocellular

____________ ____________



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(RNA)RNA)HCVHCV

HTLV-1HTLV-1


T-cell leukemia/T-cell leukemia/lymphomalymphoma


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(RNA)RNA)HCVHCV

HTLV-1HTLV-1


T-cell leukemia/T-cell leukemia/lymphomalymphoma

Vir uses a nd Ca ncerir uses a nd Ca ncer(DNA)DNA)


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(DNA)DNA) _________ _________

HBV (


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(DNA)DNA)EBV t(8;14)EBV t(8;14)

HBV (


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___________ ___________

____________ ____________ HPV 18 (E7/RB)HPV 18 (E7/RB)

___________ ___________

___________ ___________ Hepatocellular CA Hepatocellular CA

SC CA cervix, anusSC CA cervix, anus __________ __________ Kaposis sarcoma inKaposis sarcoma in

AIDS AIDS

Vir uses a nd Ca ncerir uses a nd Ca ncer(DNA)DNA)


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HBV (

Documents

Ne Oplasia Revi Ew Plu s