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NBME 22 Answers

nbme22/Block 3/Question#24 (35.2 difficulty score)
An 84-year-old woman comes to the physician ...
Downregulation of E-cadherin🔍
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 +8 
submitted by d_holles(173),
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 +1 
submitted by imnotarobotbut(161),
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mcm94  UWORLD: Invasive tumor from carcinoma in situ includes the following: Tumor cells DETACH from surrounding cells in a process commonly determined by DECREASED adhesion molecules E-cadherin Tumor cells ADHERE to the basement membrane; this is facilitated by INCREASED expression of laminin Tumor cells INVADE the basement membrane via enhanced secretion of proteolytic enzymes (e.g, metalloproteinases) +2  



 +0 
submitted by naughtyegg(16),
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nwinkelmann  It makes sense that a tumor cell would increase their laminin, as opposed to decreasing, if attaching to laminin is what allows the cells to destroy the basement membrane. The more laminin, the more destruction possible. +  



 +0 
submitted by rajkamal17(0),
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ttPyer suer m’I gsimins gmiesohnt caisb reeh. hsiT swa SCC vandingi mbeetasn beenramm iectaiftdla by wath? hTe rnsaew is etoolnidrwngau of hreaEdci-n tbu I gutohht ’htats orf mattassssete AF( 81 yssa so .o)ot I ikcdte ddcaesree nanilim sertprceo )icnetroc(r zco ianmnli was fnodu ni bmeatsen eemnmbra. At salet ahtt wsa ym oen.agsinr yAn ehlp ried.tapapce hsnkT!a

naughtyegg  Downregulating E-cadherin is the first step cancer takes toward metastasis because low E-cadherin helps invade the basement membrane -> eventually leads to spread of cancer elsewhere. Laminin is also involved but according to pathoma, cancer will actually attach to laminin in order to destroy the basement membrane. Idk if receptor up/downregulation happens, that might be a stretch. +16  
nuket0wn  per medbullets, there are increased laminin and integrin receptors. Also upregulated MMPs (matrix metallo-proteinases) to breakdown the basement membrane. +1  
nwinkelmann  It makes sense that a tumor cell would increase their laminin, as opposed to decreasing, if attaching to laminin is what allows the cells to destroy the basement membrane. The more laminin, the more destruction possible. +  



 +0 
submitted by princesskrafna(0),
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