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Flashcards in Benign tumors Deck (129):
1

What are seborrheic keratoses?

Round, flat, coin-like plaques that vary in diameter

2

seborrheic keratoses are rare before what age?

30

3

What is the treatment for seborrheic keratoses?

Surgery
Chemical peeling agents
Electro or cryotherapy

4

true or false: seborrheic keratoses are generally well circumscribed, unlike melanomas

True

5

True or false: seborrheic keratoses usually occur as a single lesion, unlike melanomas

Double false-- seborrheic keratoses occur in multiples, and melanomas occur as singletons

6

What is the Leser-Trelat sign, and what might it indicate?

the explosive onset of multiple seborrheic keratoses[1] (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome

7

What are the histological findings of seborrheic keratoses?

Well defined papillations of keratin confined to the epidermis, with microcysts within them

8

What are the histological findings of *pigmented* seborrheic keratoses?

Same as seborrheic keratoses, but with a lot of pigment within the keratinocytes

9

What defines the difference in pigmentation between people

Difference in pigmentation in the keratinocytes--NOT in the number of melanocytes

10

True or false: the number of melanocytes does not vary much between people

True

11

What are fibroepithelial polyp acrochordon? What usually causes these?

-Polyps on the skin that have a fibrovascular core, covered by a benign epithelium
-Chronic rubbing of the skin

12

Polyps on the skin that have a fibrovascular core, covered by a benign epithelium = ?

Fibroepithelial polyp-acrochordon

13

What are the four major types of epithelial cysts?

-Epidermal inclusion cysts
-Pilar or trichilemmal cysts
-Dermoid cysts
-Steatocystomas

14

What is the classic appearance of epidermoid cysts?

Deep nodules with a central punctum

15

Deep nodule with a central punctum = ?

Epidermoid cysts

16

What is a follicle?

a small secretory cavity, sac, or gland, in particular.

17

What is an infundibulum?

a funnel-shaped cavity or structure.

18

What are epidermoid cysts filled with?

Loose Keratin

19

Sebaceous cysts = ?

Epidermoid cysts

20

What are trichilemmal cysts?

a common cyst that forms from a hair follicle. They are most often found on the scalp. The cysts are smooth, mobile and filled with keratin

21

What are dermoid cysts?

a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands

22

What is the classic presentation of a dermoid cyst?

Single SQ nodule present at birth on the lateral aspect of the upper eyelid

23

What are the histological characteristics of a dermoid cyst?

Like epidermoid cyst, but with dermal tissue components

24

What are steatocystomas?

AD mutation in keratin 17, resulting in multiple cysts on the body, usually in the sternal, axillae, and groin

25

What are the histological characteristics of steatocystomas?

Jagged area of keratin, with sebaceous structures attached to it

26

What are trichilemmomas?

a benign cutaneous neoplasm that shows differentiation toward cells of the outer root sheath

27

What is Cowden's disease?

AD mutation in PTEN gene that predisposed for breast and thyroid CA. Presents are multiple, hamartomas, as well as trichilemmomas

28

Multiple trichilemmomas = what disease?

Cowden's disease

29

What are the characteristics of trichilemmomas?

Lighter, clear sheets of cells with a thick BM

30

Lighter, clear sheets of cells with a thick BM = ?

Trichilemmomas

31

What are pilomatricomas? Where are they most commonly found on the body?

Benign skin tumor derived from the hair matrix
-head (cheek) and neck region, but also on UE and trunk

32

What genetic disease is associated with pilomatricomas?

Turner's syndrome

33

What is the genetic mutation associated with pilomatricomas?

APC mutation, resulting in high beta catenin

34

What are the histological features of pilomatricomas?

anucleate squamous cells (called "ghost cells"), benign viable squamous cells and multi-nucleated giant cells. The presence of calcifications is common.

35

What percent of pilomatricomas occur before age 20?

60%

36

anucleate squamous cells (called "ghost cells"), benign viable squamous cells and multi-nucleated giant cells = ?

Pilomatrixoma

37

What is Birt-Hogg-Dube syndrome? Genetic cause?

AD mutation to BHD gene on chr 17, which encodes the protein folliculin.
-Causes susceptibility to a wide variety of cancers, and fibrofolliculomas

38

What are fibrofolliculomas? What syndrome are they seen in?

2 to 4 mm in diameter, dome-shaped, yellowish or skin-colored papules usually located on the head, neck, and upper trunk. They are characteristically seen in Birt–Hogg–Dubé syndrome

39

What are the two diseases in particular that Birt-Hogg-Dube syndrome is associated with?

-Renal tumors
-Spontaneous pneumothorax

40

What are the gross characteristics of fibrofolliculomas?

Small white papules, usually located along the face

41

What are the gross characteristics of trichodiscomas?

Small white papules, usually located along the face

42

What are the histological characteristics of fibrofolliculomas?

Abortive and squeezed off follicular structures surrounded by fat cells

43

Abortive and squeezed off follicular structures surrounded by fat cells = ?

Fibrofolliculomas

44

What are the two skin lesions associated with Birt-Hogg-Dube syndrome?

Fibrofolliculomas
Trichodiscomas

45

What is a nevus sebaceous? Where on the body is it usually found? What age? Which gender?

-A congenital, hairless plaque that typically occurs on the face or scalp.
-Present at birth, affecting males and females of all races equally. The condition is named for an overgrowth of sebaceous glands in the area of the nevus.

46

What is the prognosis for nevus sebaceous?

In itself is benign, but secondary tumors may arise from it--usually BCC

47

True or false: all nevi are melanocytic proliferaitons

False--nevus sebaceous is not

48

What are the gross findings of nevus sebaceous?

Localized area of alopecia, with a waxy, papule

49

What are the histological findings of nevus sebaceous?

Abortive hair follicles, with a whole bunch of sebaceous glands attached to them

50

Localized area of alopecia, with a waxy, papule + Abortive hair follicles, with a whole bunch of sebaceous glands attached to them on histology = ?

Nevus sebaceous

51

How common is sebaceous hyperplasia? What causes it? What is it often misdiagnosed as?

Common on faces of adults from sun damage that is usually misdiagnosed as BCC

52

What are the gross characteristics of sebaceous hyperplasia?

Yellowish dome shaped papules

53

What are the histological characteristics of sebaceous hyperplasia?

Tons o' sebaceous glands

54

Yellowish dome shaped papules with a central punctum + tons o' sebaceous glands on histology = ?

Sebaceous hyperplasia

55

What are sebaceous adenomas? What condition are they associated with? Where on the body are they usually found?

-Rare, benign tumor of sebaceous glands
-Muir–Torre syndrome
-face and scalp of old people

56

What is Muir–Torre syndrome? What is the genetic defect and inheritance pattern? What skin findings are associated with it?

a rare hereditary, autosomal dominant cancer syndrome that is thought to be a subtype of HNPCC.
-Individuals are prone to develop cancers and skin lesions, such as keratoacanthomas and sebaceous tumors.
-The genes affected are MLH1, MSH2, which are involved in DNA mismatch repair and microsatellite stability.

-Sebaceous adenomas

57

What are the histological characteristics of sebaceous adenomas?

Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated

58

Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated = ?

Sebaceous adenomas

59

What are sebaceomas? What does it look like grossly?

A sebaceous structure that is intermediate in malignancy, that appears as a yellow or orange papule

60

What are the histological characteristics of sebaceomas?

Somewhat differentiated sebaceous glands

61

What are the cutaneous findings of MTS?

Sebaceous tumors:
-Adenomas, sebaceomas
-Keratoacanthomas

62

What are the visceral malignancies associated with MTS?

-Colon
-Bladder
-Endometrium
-Breast

63

What is the immunostaining technique used to diagnose MTS? What is an abnormal result?

Stain for MLH1 and MSH2
Loss of stain = pathologic

64

What are cylindromas? Where do they most often occur on the body? What is the F:M?

-Sweat gland tumors that appear as pink/red nodules
-head and neck
-9:1

65

What is Brooke-Spiegler syndrome? What are the tumors that can grow with this condition?

a condition involving multiple skin tumors including growths called spiradenomas, trichoepitheliomas, and cylindromas.

66

What is the genetic inheritance and mutation of Brooke-Spiegler syndrome?

AD CYLD gene on chr 16

Causes NF-kappa-B pathway overactivation

67

What are the histological findings of cylindromas?

Jigsaw puzzle

68

Jigsaw puzzle histology = ?

Cylindromas

69

What are xanthomas?

Benign aggregate of histiocytes with cytoplasmic lipids

70

What are the five main clinical types of xanthomas? Which is the only one that has normal serum lipid levels?

-Eruptive
-Tendinous
-Tuberous
-Planar
-**Disseminated**

71

What are xanthogranulomas? What age do they typically arise? What conditions are associated with this?

yellow/brown papules or nodules on the head and neck region that usually arise within the first 5 years of life
-CML and NF

72

What is the prognosis for xanthogranulomas?

They themselves are benign and spontaneously regress within several years, but may indicate underlying visceral pathology

73

What are histological findings of xanthogranulomas?

Histiocytes in the dermis and Touton giant cells

74

Histiocytes in the dermis and Touton giant cells = ?

JXG

75

What is the age and gender that is typically affected with reticulohistiocytomas?

Middle aged females

76

What are the two forms of reticulohistiocytomas?

Solitary
Multicentric

77

What are the histological findings of reticulohistiocytomas?

Ground glass histiocytes

78

Ground glass histiocytes = ?

reticulohistiocytomas

79

What are the associations of reticulohistiocytomas?

CT diseases
Vasculitis

80

What is the acute generalized form of LCH (letterer-Siwe disease), and who does it affect? How aggressive is it?

A rapidly progressing disease in which Langerhans Cell cells proliferate in many tissues, including internal organs. It is mostly seen in children under age 2, and the prognosis is poor: even with aggressive chemotherapy, the five-year survival is only 50%

81

What is the multifocal chronic form of LCH (Hand-Schuller-Christian disease)? Who is it usually seen in? S/sx?

Seen mostly in children, multifocal unisystem LCH is characterized by fever, bone lesions and diffuse eruptions, usually on the scalp and in the ear canals. 50% of cases involve the pituitary stalk, leading to diabetes insipidus.

The triad of diabetes insipidus, exophthalmos, and lytic bone lesions is known as the Hand-Schüller-Christian triad. Peak onset is 2–10 years of age.

82

What is the classic triad of symptoms for multifocal chronic LCH?

-Lytic skull lesions
-DI
-Proptosis

83

What is the treatment for multifocal LCH?

XRT and chemo

84

What is the unifocal version of LCH (eosinophilic granuloma)?

A slowly progressing disease characterized by an expanding proliferation of Langerhans Cells in various bones. It is a monostotic (involving only one bone) or polyostotic (involving more than one bone) disease. It typically has no extraskeletal involvement, but rarely an identical lesion can be found in the skin, lungs, or stomach.

85

What is the prognosis for unifocal LCH (eosinophilic granuloma)? Treatment?

most benign--relative good prognosis

Treatment = Excision or XRT

86

What are the LM and EM findings of LCH?

LM = Dermal infiltration of monocytes and giant cells. Crinkled appearance to nuclei
EM = Birbeck granules

87

What is the immunostain for LCH?

CD1a

88

What is benign fibrous histiocytoma (dermatofibroma)?

Benign, tan-brown papules, with size varying over time. Related to dermal neoplasms of fibroblasts and histiocytes

89

What are the histological findings of dermatofibromas?

Spindle cells appearance that trap collagen bundles ("doughnut sign")

90

What is the most common CT tumor?

Lipomas

91

What are pyogenic granulomas?

Hemangiomas

(This name is misleading as it is not a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype which is the reason they are prone to bleeding.[4] Additionally, it is also not truly pyogenic, ("pus producing") as the cause is hormonal or traumatic and has no association with infection or pus production.)

92

What are cavernous hemangiomas?

Big vessel proliferation

93

What are arteriovenous hemangiomas?

Mix of thin and thick walled vessels

94

What are traumatic neuromas? S/sx?

A type of neuroma which results from trauma to a nerve, resulting in a disorderly proliferation of bundle of peripheral nerves
-Usually painful nodule
-

95

What are the histological characteristics of traumatic neuromas?

haphazard neuron proliferation

96

What is Morton's neuroma? S/sx?

A benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve.

-The main symptoms are pain and/or numbness that is exacerbated by walking.

97

True or false: Morton's neuroma usually present with a large, palpable mass

False--usually no mass is palpable

98

what are the three diseases of MEN1?

-Pituitary adenomas
-Pancreatic tumors
-Parathyroid

99

What are the three diseases of MEN2a?

-Medullary thyroid CA
-Parathyroid hyperplasia
-Pheochromocytoma

100

What are the three diseases of MEN2b?

-Medullary thyroid CA
-Mucosal neuromas
-Pheochromocytoma

101

What are the histological findings of mucosal neuromas?

Mucosal nodules with tiny nerve-lets

102

what are palisaded encapsulated neuromas? what age range are they usually found in?

Solitary, painless nodules that are commonly found on the face.

middle aged to old

103

What are schwannomas? Where on the body are they more prevalent?

a benign nerve sheath tumor composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves.

104

Is there an association of schwannomas with NF?

Per him, no, but in reality, yes.

105

What is the usual presentation of schwannomas? How often do they recur?

Solitary, painless SQ mass

Little capacity of recurrence

106

What is the antoni A type of schwannomas?

Cellular with nuclear palisading (verocay bodies)

107

What is the antoni B type of schwannomas?

Schwann cells, but hypocellular, with a myxoid matrix

108

Why are the blood vessels prominent with schwannomas?

Thick hyaline walls

109

Cellular with nuclear palisading (verocay bodies)

Antoni A

110

Schwann cells, but hypocellular, with a myxoid matrix

Antoni B

111

What are the characteristics of neurofibromas?

Solitary polypoid or nodular lesion with a wide distribution

112

What are the histological characteristics of neurofibromas?

Circumscribed, but unencapsulated, with a sheet like wavy nerve cells

113

Circumscribed, but unencapsulated, with a sheet like wavy nerve cells = ?

neurofibroma

114

What are plexiform neurofibromas?

a benign tumor of peripheral nerves (WHO grade I) arising from a proliferation of all neural elements, pathognomonic of neurofibromatosis type 1 (NF1). It involves single or multiple nerve fascicles that arises from major nerve branches.

115

plexiform neurofibromas = what disease

NF1

116

What are granular cell tumors?

a tumor that can develop on any skin or mucosal surface, but occurs on the tongue 40% of the time.

117

what are the histological characteristics of granular cell tumors?

Proliferation of cells with granular pink cytoplasm

118

Which gender usually gets granular cell tumors?

Females

119

Are granular cell tumors fast of slow growing? Recurrence rate? Treatment?

Slow growing
Low recurrence
Excise

120

What are the two versions of leiomyomas?

Pilar
Angio

121

What are giant cell tumors of the tendon sheath?

Uncommon and usually benign lesions that arise from the tendon sheath

122

Where are giant cell tumors of tendon sheaths usually found?

hand, feet, wrists, knees and other small joints

123

What is the prognosis for giant cell tumors of the tendon sheath? Treatment?

Benign, but can recur

excise

124

What are the histological findings of GCTTS?

Giant cells with PMNs in the background

125

What are ganglion cysts? Where are they usually found? What causes them? S/sx?

-Myxoid degeneration of a joint capsule, usually found in the wrist, hand, foot, and ankle.
-Caused by overuse
-Pain or weakness

126

What are the histological characteristics of ganglion cysts?

pseudocysts-no epithelial lining

Cystic space ling by histiocytes and granulation tissue with moderate inflammation

127

Cystic space ling by histiocytes and granulation tissue with moderate inflammation = ?

Ganglion cysts

128

What are superficial fibromatosis? (hand, plantar, penis)

Proliferation of spindle cells in tissue of various sites:

Hand = dupuytren's contracture

Plantar = Ledderhose dz

Penile = peyrones disease

129

True or false: superficial fibromatosis usually has beta catenin mutaitons

False