Pathology - 2nd half

ectopic tissue resting in normal tissue (e.g. panc tissue in stomach). NOT a neoplasm

• carcinoma: malignant tumor of epithelial structures
• sarcoma: malignant tumors of mesenchymal tissues
• blastoma: malignant tumors of cells resembling developing organ cells (e.g. pulmonary blastoma)

• 1) cell of origin
• 2) benign/malignant nature
• 3) the appearance

• -nuclear enlargement
• -nuclear shape abnormalities
• -nuclear membrane thickening
• -chromatin usually coarse
• -prominent nucleoli
• -abnormal mitosis

• -altered architectures and cellular abnormalities are confined to a geographic area are CONFINED TO WITHIN THE BASEMENT MEMBRANE
• -considered a preneoplastic change
• -not all dysplasias progress to cancer
• -looking for this in pap smears

growth of fibrous or connective tissue

successful transplantation of a tumor to a new site

• -local infiltration: extension into adjacent normal tissue
• -seeding of body cavities: peritoneal, pleural, pericardial
• -lymphatic spread: usually for carcinoma, look for sentinel LN
• -hematogenous spread: usually venous
• -Iatrogenic spread: e.g. fine needle aspiration tract spreading cancer

• most: LNs, lung, liver, brain, bone
• least: muscles, gonads, speen

• 1) detachment of cancer cells from site of origin
• 2) attachment to BM
• 3) BM invasion

• -at this stage the cells start producing abnormal proteins
• -distant systemic feature relatively specific to a neoplasm but having lots of other causes as well
• -ectopic hormone secretion by tumor cells of an unknown origin
• -often the first sign of malignancy
• -examples:
•   -acanthosis nigricans (black armpit due to lung or stomach cancer)
•   -fliting thrombophlebitis (pancreas carcinoma)

early stage of cancer where there are mass lesions with dysplasia

• Features
•   -fever
•   -anorexia
•   -weight loss
•   -cachexia (muscle wasting and fat loss)
•   -night sweats
•   -features due to specific tumor products:
•     -hypercoagulable state (leukemia)
•     -amyloidosis (multiple myeloma, lymphoma)

• -Change in bowel or bladder
• -A sore throat that does not heal
• -Unusual bleeding or discharge
• -Thickening of lump in breast
• -Indigestion or difficulty swallowing
• -Obvious change in wart or mole
• -Nagging cough or hoarseness

• 1) normal cell to transformed cell (calle transformation
• 2) transformed to cell to clinical detection (1cm or gm) (about 30 doublings)
• 3) clinical detection to fatal load (1 kg) (10 doublings)
• 4) aquire more aberrancy and subclones

• -proto-oncogenes (growth)
• -tumor suppressor genes (growth)
• -apoptosis genes (survival)
• -DNA repair genes (genomic stability)
• -Other genes (invasion, metastasis, angiogenesis, drug resistance, etc)

• caretaker genes: DNA repair
• gatekeeper: specific to a specific organ

• stage.
• TNM - tumor (size, stage), nodes, mets

• -Tumor site
• -histological type/grade
• -Stage (incorporates size)
• -performance status of the patient (can they achieve daily activities of living?)

• Breast (estrogen)
• prostate (androgen)
• thyroid (TSH)

• population increase
• increased urbanization
•   -virus
•   -urban lifestyle
•   -environmental exposures
• decreased infectious disease
• increases in child survival 
• better diagnostic techniques

Extravasion of blood from vessels.

• 1) hematoma: external or accumulate in a tissue (e.g. hemothorax, hemoparicardium, hematemesis, others)
• 2) petechiae: minute hemorrhages in the skin
• 3) purpura: 3-5 mm hemorrhages
• 4) Eccymoses: 1-2 cm hematomas

• thrombus: solidification of blood components within intact vessels
• blood clot: can only happen ex vivo or post mortem. Have lines of Zahn.

endothelial injury, stasis or turbulent blood flow, hypercoagulability

• 1) propagation: either complete occlusion or embolism
• 2) dissolution: newly formed thrombi are responsive to fibrinolysis
• 3) Organization and recanalization: older thrombi may create conduits  to reestablish blood flow.

intravascular solid, liquid, or gas that is carried by the blood to a site distant from its point of origin.

• -pulmonary thromboembolism
• -systemic thromboembolism
• -fat embolism
• -air embolism
• -amniotic fluid embolism

area of ischemic necrosis caused by an occlusion of the vascular supply to the affected tissue

• 1) red: venous occlusions, loose tissues, when flow is re-established, hemorrhage
• 2) white: arterial occlusions, wedge shaped infarcts, heart, spleen, kidneys often, ischemia

• 1) anatomy of vascular supply (is there dual supply?)
• 2) rate of occlusion (slower growing ones have time to develop another blood supply)
• 3) tissue vulnerability to ischemia
• 4) blood oxygenation levels

• precise: close clustering, reproducibility
• accurate: close to the bullseye

• 1) MD writes order
• 2) Nurse reviews
• 3) clerk writes requisition
• 4) lab prepares tube
• 5) phlebotomist draws blood
• 6) transport to lab
• 7) log in specimen
• 8) lab separates serum
• 9) storage until analysis
• 10) prepare worksheets

• red: no additive; general biochem
• blue: no additive; for trace metal analysis
• brown: heparin; trace metal analysis
• green: heparin; prevents clotting
• lavendar: EDTA; chelating agent preserves cellular constituents in blood
• grey: oxalate; used for blood glucose

sens = frequency of correct results in patients with diseas

spec = frequency of correct results in patients without disease

• -serious disease you don't want to miss
• -treatable disease
• -false positive results won't harm the patient

• -disease is serious, but not treatable or curable
• -knowledge that disease is absent has value
• -false positive leads to emotional or economic trauma
• -e.g. MS

When treatment of a false positive may have serious consequences.

• -disease is serious but treatable
• -false positive and false negative results are equally damaging
• - e.g. MI

• 1) 0 to 24 hrs. Asymptomatic/nausea/vomiting/malaise/others
• 2) 18-72 hrs. RUQ pain, decreasing phase 1 symptoms, rising liver enzymes (ALT and AST)
• 3) 72-96 hrs. Centrilobular hepatic necrosis, abd pain, jaundice, vomiting, renal failure, fatality
• 4) 4 days to 3 weeks. complete resolution of organ function and symptoms

• -NAC
• -prevents the formation and accumulation of NAPQI by increasing glutathione stores and increasing sulphate conjugation
• -also an anti inflammatory