Carcinoma Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Carcinoma and links to relevant pages within the course.
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|Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome|
Thrombotic thrombocytopenic purpura (TTP) is an uncommon, but very serious consumptive platelet disorder. Its cause is unknown, but there are several possible precipitating factors including infection, carcinoma, and pregnancy. More women than men are affected by TTP. If left untreated, the mortality rate is in excess of 90% due to multiorgan failure. Hemolytic uremic syndrome (HUS) is also a platelet consumptive disorder. HUS is thought by some to be the same condition as TTP because both disorders have the same underlying pathology. However, HUS is more often associated with renal failure and TTP with neurological manifestations including visual impairment, weakness, headache, dizziness, disorientation. seizures, or coma. Microangiopathic hemolytic anemia, thrombocytopenia, and fever is associated with both TTP and HUS. The patient's condition can deteriorate rapidly while these symptoms are becoming evident. HUS is usually seen in children; it is the most common cause of acute renal failure in children. Patients may have bloody diarrhea and symptoms resembling colitis. Diarrhea-related HUS is usually associated with ingestion of undercooked beef contaminated with Ecoli O157:H7; it is the Shiga-like toxin from this serotype that causes the illness. Some patients may have long term kidney dysfunction as a result ofthis virulent infection. For patients who have experienced renal failure, dialysis may be required.
|It is important to establish a species identification of C. septicum in blood culture isolates because of its close association with carcinoma of the colon.||View Page|
Lorimer JW. Eidus LB.: Invasive Clostridium septicum infection in association with colorectal carcinoma. Canadian Journal of Surgery. 37:245-9, 1994 The association between invasive Clostridium septicum infection and colorectal carcinoma is examined by the presentation of three cases and a review of the literature. In the first two cases the patients presented with nontraumatic metastatic clostridial gas gangrene. In the third case a patient with chemotherapy-induced myelosuppression from concomitant multiple myeloma had a necrotizing transmural infection of the right colon. The apparent portal of entry of Clostridium septicum was an occult carcinoma of the ascending colon. The increasing evidence for a strong link between this organism and some cases of neutropenic enterocolitis is reviewed.
Kornbluth AA. Danzig JB. Bernstein LH.: Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature. Medicine. 68(1):30-7, 1989 We report 2 patients with myonecrosis due to Clostridium septicum and associated colon carcinoma and have reviewed the English language literature for all reported cases of atraumatic C. septicum infection. A total of 162 cases of C. septicum infection have been reported. Eighty-one percent of these patients had an associated malignancy. Thirty-four percent of all patients had associated colon carcinoma, while 40% had a hematologic malignancy. Thirty-seven percent of reported patients had an occult malignancy at the time of their infection with C. septicum. In many patients, the portal of entry was found in the large intestine. In a particularly lethal form (79% mortality) of C. septicum infection, known as "distant myonecrosis," infection metastatic from the initial site of infection causes severe myonecrosis, gangrene, and often death within hours of clinical detection. Overall, survival of patients with C. septicum infection is only 35%. Review of all cases of C. septicum infection suggests several conclusions. 1) Patients with malignancy, particularly colonic or hematologic, and patients with cyclic neutropenia who develop signs and symptoms of sepsis, especially with associated findings of abdominal pain or pain in an extremity, should be treated for possible clostridial infection. 2) C. septicum infection does not appear to be a result of a single specific defect in either humoral or cell-mediated immunity. Rather, it may occur in patients who are granulocytopenic and therefore prone to an enterocolitis. 3) Patients in whom an infection with C. septicum is found must undergo a vigorous search for malignancy.
|Match the species of anaerobes and frequently associated conditions.||View Page|
|Each of the following statements is true concerning Clostridium septicum infections EXCEPT:||View Page|
|A clinical condition often associated with Streptococcus anginosus ("milleri") is:||View Page|
|Serum calcitonin is typically elevated in which of the following conditions:||View Page|
|Prognosis and Mortality|
The major determinant of prognosis in cases of hereditary hemochromatosis (HH) is the degree of organ damage from iron overload at the point of diagnosis. The presence of liver cirrhosis reduces life expectancy. Damage that has occurred to tissues and organs is irreversible, but further damage can be halted with treatment. When there is no evidence of cirrhosis at time of diagnosis, life expectancy may be equal to that of persons without HH. With proper management of HH through treatment, affected individuals have good long-term outcomes. Hepatocellular carcinoma associated with cirrhosis, hepatic failure, and cardiac failure are the most common causes of death in persons with HH. Compared to the normal population, liver cancer is many times more prevalent as a cause of death in persons with HH. Cardiomyopathy, diabetes, and cirrhosis are all more common causes of death among persons with HH than among normal persons. The earlier HH is detected, before the onset of severe organ damage, the lower the risk of mortality.
|Which of the following is NOT a cause of death in patients with hereditary hemochromatosis (HH)?||View Page|
|HPV Vaccines; Gardasil and Cervarix|
GardasilGardasil HPV vaccine contains HPV types 6, 11, 16, and 18. Those vaccinated are protected against the two viral types (6 and 11) that cause about 90% of condolymas and against the two viral types (16, 18) that cause approximately 70% of cervical cancer. Gardasil vaccination is recommended for girls 11 and 12 years old. The vaccine can be given to girls as early as 9 years of age and catch-up immunization is recommended for women ages 13-26 years.CervarixCervarix HPV vaccine contains only two HPV types, 16 and 18. Infection with either of these types is responsible for the majority of cervical carcinoma. It is approved for vaccination of women and girls ages 10-25 years.
|Carcinogenesis of Cervical Cancer|
HR-HPV type viral infections, if left untreated, can convert normal cervical lining to cervical intraepithelial neoplasia (CIN). With a good immune response, the hyperplasia regresses and no carcinoma develops. This regression ocassionally occurs with CIN 2, but rarely occurs with CIN 3. If the CIN does not regress, high-grade squamous intraepithelial lesions (HSIL) develop. HSIL may progress to invasive carcinoma, typically in older individuals.
|Carcinogenesis of Cervical Cancer Continued|
Numerous genetic events occur over a relatively long period of time that lead to the development of cervical carcinoma. The protein products of tumor suppressor genes are the regulators of cell growth as discussed previously. Two intracellular protein products of tumor suppressor genes located within human cells are p53 and Rb. As noted earlier, protein products from HPV genes E6 and E7 bind to p53 and Rb, which results in unregulated cell growth. This unregulated growth prevents normal DNA repair, allowing for mutations to accumulate in the cell. As this process continues, it is postulated that a proto-oncogene becomes mutated, which in turn activates oncogenes.The E2 gene in HPV controls the production of E6 and E7 in the normal viral life cycle. When the viral genome is integrated into host cells, the E2 gene is disturbed and uncontrolled production of E6 and E7 protein products occurs. This leads to a greater interaction and disabling of host cell tumor suppressor gene products. The genes E6 and E7 of HPV Types 16 and 18 have a greater affinity for tumor suppressor gene products than other HPV types. This explains the greater virulence associated with Types 16 and 18 and their association with 70% of cervical cancer.
|Advantages of a Biopsy Specimen|
Examining the biopsy allows the structure of the marrow to be viewed as it exists in the body. It provides essential diagnostic information in conditions that disrupt the normal architecture, such as metastatic carcinoma, myelofibrosis, Hodgkin's lymphoma and granuloma. A biopsy may also be used to evaluate cellularity and identify acid-fast bacteria or fungi in less time than is needed for routine culture methods. One disadvantage of the tissue sections prepared from the biopsy sample is that morphologic detail is lost. For this reason, in many cases imprint slides or smears from the aspirated sample are also examined.
|Collection of Bone Marrow Biopsy|
A bone marrow biopsy involves removing a small portion of the bone marrow without destroying the architecture of the marrow. This type of biopsy is necessary when the marrow cannot be aspirated (dry tap) due to a disease process, and also provides additional information complementary to that derived from the aspirate: biopsy specimens are more accurate for assessing cellularity, and infiltrative processes, such as metastatic carcinoma, fibrosis, amyloid, and lymphoma. A biopsy specimen is processed as follows: touch preparation tissue section
|Transitional Epithelial Cells|
Another type of epithelial cell is a transitional epithelial cell, also known as a urothelial cell. It is smaller than a squamous epithelial cell and has a centrally located nucleus. Transitional epithelial cells can occur in spherical, polyhedral, and caudate (bottom image) forms. They originate from the bladder, ureters, and renal pelvis.
|Renal Epithelial Fragments||View Page|
|Schistosoma Haematobium Ova|
The third parasite which may be seen is the Schistosoma haematobium ovum. This parasite is considered an important factor in the etiology of carcinoma of the bladder. The ova are elongated and are 60 X 160 microns. They are a yellowish color, slightly transparent, and possess a delicate terminal spine.
|High-Risk Progression Groups|
The following persons are at high risk for progression from LTBI to TB disease: Persons infected with HIVPersons infected with Mycobacterium tuberculosiswithin the past two yearsPersons with untreated or inadequately treated TB diseaseInfants and children <4 years of agePersons with chronic medical conditions or immunocompromising conditions
|Match the letter representing the cell type with the condition in which increased numbers of the cell may be found in the peripheral smear.||View Page|
|The image shows a representative field from a peripheral blood smear. If similar blood cell morphology is seen throughout the smear, metastatic carcinoma should be considered.||View Page|