Cancer Flashcards
(202 cards)
1
Q
A
malignant cells are large with abundant eosinophilic cytoplasm, large, vesicular nucleus
extends into the dermis
2
Q
23 year old patient
enlarged lymph node in neck
fevers, weight loss, itchy skin, and alcohol induced pain
A
Hodgkin lymphoma
3
Q
4 mechanisms monoclonal antibodies can induce tumor death
A
- activation of complement cascade
- binding allows interaction of NK cell with tumor cell (ADCC)
- bindings allows interaction with macrophage (phagocytosis)
- triggers direct apoptosis
4
Q
Acral Lentiginous Melanoma
A
10% of all melanomas
most common in darkly pigmented individuals
located on plams, soles, and lips
5
Q
Actin- immunohistochemical marker for?
A
leiomyosarcoma rhabdomyosarcoma
6
Q
Actinic cheilitis
A
actinic keratosis of the lower lip
if not treated, progresses to SCC with higher rate of metastases
7
Q
Actinic Keratosis
A
precursor of SCC
rough, scaly, slightly raised
under 1 cm in diameter
sun exposed areas
when on lower lip= actinic cheilitis–> high rate of metastases
8
Q
Aggressive Types of Basal Cell Carcinoma
A
micronodular, morpheaform, and infiltrative
9
Q
ALK fusion protein
A
Anaplastic large cell lymphoma
10
Q
Alveolar Rhabdomyosarcoma
A
translocation involving long arm of 13 and 1 or 2–> transcription factors involved subtype determined by histology worse outcome
11
Q
AML Hyperleukocytosis treatment
A
Hydroxyurea
leukapheresis
12
Q
Anaplastic Large Cell lymphoma
A
most common T cell lymphoma in children
often involves soft tissue
large anaplastic cells- cluster around vessels and lymphatics
may mimic carcinoma because cells are huge with lots of cytoplasm
ALK constituatively activated
histology- horseshoe morphology, lots of cytoplasm, large
13
Q
A
Basal cell carcinoma
14
Q
Basal Cell Carcinoma
A
uncontrolled growth arising from basal layer of epidermis
most frequent site is the face
waxy, pearly papule
may have central depression, erosion, or crust
telangiectasias (may bleed)
slow growth pattern
many subtypes
15
Q
A
large basaloid island of tumor cells budding off epidermis
=Basal Cell Carcinoma
16
Q
Bone marrow aspirate
A
increased plasma cells
Multiple Myeloma
17
Q
A
starry sky= tingible body macrophages eating up the apoptotic debris
=Burkitt lymphoma
18
Q
A
Burkitt lymphoma
endemic type
19
Q
Burkitt Lymphoma Morphology
A
high rate of apoptosis (starry sky)
High rate of mitosis (Ki67 = 100%)
presents as a rapidly growing mass
20
Q
c-MYC (chromosome 8)
A
translocation = Burkitt lymphoma most commonly t(8;14) cMYC is an oncogene; translocation results in overexpression thereby allowing continued cell growth
21
Q
Carcinoma = ?
A
malignant from epithelial cells
22
Q
CD10+ CD20+ Ki67 100% c-MYC
A
Burkitt lymphoma
23
Q
CD117 (c-kit)
A
GIST
24
Q
CD15+ / CD30+, EBV +
A
Hodgkin’s Lymphoma
25
CD19 + CD23 + CD5 +
CLL
26
CD19+ CD5+ CD23 -
Mantle cell lymphoma cyclin D +
27
CD99 +
Ewing Sarcoma
28
CDKN2a
Predisposition for Melanoma
29
Cerebriform T cells
Mycosis Fungoides
30
CH10 + bcl2 +
Follicular lymphoma
31
Chondroblastic osteosarcoma
cartilaginous matrix production with malignant spindle cells
32
CHOP
(C)yclophosphamide--\> an alkylating agent which damages DNA by binding to it and causing the formation of cross-links
(H)ydroxydaunorubicin= doxorubicin--\> topo II inhibitor
(O)ncovin (vincristine)--\> binds tubulin in M phase and prevents mitosis
(P)rednisone
33
Classical HL with best prognosis
Lymphocyte rich
40% EBV
34
Classical HL with worst prognosis
Lymphocyte depleted
90% EBV +, HIV patients, older patients
(usually associated with immunosuppression)
35
Classical Hodgkin Lymphomas
Nodular Sclerosing
Mixed Cellularity
Lymphocyte Depleted
Lymphocyte Rich
36
Clinical Presentation of Mantle Cell lymphoma
painless lymphadenopathy
mrrow involvement and circulating cells
extranodal sites
age 63 years
male
37
Clinical Presentation of Multiple Myeloma
hypercalcemia
bone pain
fracture risk
"punched out" lesions seen on xray
38
smudge cells
=CLL
39
cloverleaf multilobulated nuclei
adult T cell lymphoma
40
Common Malignant Primary Bone Tumors
osteosarcoma chondroblastoma Ewing sarcoma
41
Curative treatment for BCC
Mohs micrographic surgery
42
Cyclin D
promotes G1 to S phase
constituitively expressed in Mantle Cell
43
Desmin- marker for?
rhabdomyosarcoma or leiomyosarcoma sometimes MFH
44
Diagnosis of hyponatremia
look at serum osmolality
most commonly hypo or euvolemia
45
Diagnosis of Malignant Spinal Cord Compression
MRI of entire spinal cord
46
Diagnosis of Marginal Zone Lymphoma
diagnosis of exclusion
47
Diagnosis?
Basal cell carcinoma
48
Diagnosis?
Langerhans Cell Histiocytosis
birbeck granules on EM
49
Diagnostic test for Malignant Spinal Cord Compression
MRI of entire spinal cord
50
Large cells with huge nuclei, prominent nucleoli, marked variation
from one cell to the next
Diffuse Large B Cell Lymphoma
51
Disease caused by t(15;17)
APL acute promyelocytic leukemia
52
EBV associated neoplasms
Hodgkin, DLBCL, Burkitt, extranodal NK/T, PTLD
53
Embryonal Rhabdomyosarcoma
loss of heterozygosity at 11p resulting in increased IGF2 expression subtype determined by histology better outcome
54
Onion skinning
=Ewing sarcoma
55
example of cellular cancer immunotherapy
dendritic cells- vaccine given that contains dendritic cells that can recognize prostate cancer
CAR T cell therapy
56
Extranodal NK/T cell Lymphoma
destructive mass of nasopharynx
invades vessels--\> ischemic necrosis
strong association with EBV
more common in Asian ancestry
(think of Sketchy EBV--\> asian made with crab pinching his nose)
57
Factor VIII Related Antigen- marker for?
angiosarcoma kaposi's sarcoma
58
Favorable karyotype for AML (chemotherapy)
t(8;21)
will respond to chemo
no transplant
59
Favorable sites for rhabdomyosarcoma
orbit, genitourinary (not bladder or prostate)
60
Fibroblastic osteosarcoma
high grade spindle cell stroma contains only focal osteoid production
61
Finding? Likely diagnosis?
Lytic lesions--\> "punched-out" bone
Multiple myeloma
62
FLT3-ITD
AML
receptor tyrosine kinase is expressed on blasts
likely to relapse
63
focus on cell upper middle
Horseshoe morphology, large cells, lots of cytoplasm
= Anaplastic Large Cell lymphoma
64
Follicular Lymphoma
lots of neoplastic follicles (pale zone) crowding out normal nodal architecture
no mantle zone
65
Gastrointestinal stromal tumor (GIST)
soft tissue sarcoma composed of spindle cells majority are CD117 positive (diagnostic) highly variable behavior- can be very aggressive or recur 20+ years later originate on cells of Cajal rarely metastases outside of abdomen mostly occurs in upper Gi tract with stomach being most common prognosis and response determined by KIT and PDGF-R mutations
66
GIST
gastrointestinal stromal tumor composed of spindle cells c-kit (CD117) positive; mutations in PDGF-R originates from intestinal cells of Cajal most commonly in stomach metastases outside abdomen are infrequent
67
Hairy cell Leukemia
68
Hairy Cell Leukemia
mature B cell
type of chronic leukemia
splenomegaly
dry tap with BM aspiration
absent LAD
can present with anemia and infections
Cells with hairlike projections
69
Heavy chain disease
deposit in tissues and may cause dysfunction
70
HHV8 associated neoplasms
DLBCL (primary effusion)
71
High Grade Non-Hogkin Lymphomas
Diffuse Large B Cell Lymphoma
Burkitt Lymphoma
72
High or Low WBC
Low Hemoglobin
Low Hct
Low Platelets
High lymphoblasts
ALL
73
High or low WBC
Low Hemoglobin
Low Hct
Low platelets
myeloblasts
AML
74
High WBC
Normal hemoglobin
Normal Hct
Normal Platelets
High lymphocytes
CLL
75
High WBC
Normal hemoglobin
Normal Hct
Normal Platelets
High neutrophils
CML
76
Hodgkin cell
77
Hodgkin vs. NHL
Hodgkin is usually localized, continguous spread, rarely has extranodal presentation, Reed Sternberg Cells, marked B symptoms such as fevers and night sweats
78
HTLV-1 associated with which cancer?
adult T cell lymphoma
79
Hypercalcemia associated with?
non small cell lung cancer, breast cancer, myeloma, NHL
80
Immune modulators
=IMIDs
Ex: thalidomide
active in multiple myeloma
ADR: cytopenias, thromboses, edema, fever, chills
81
Inherited causes of osteosarcoma
Li Fraumeni syndrome Retinoblastoma
82
Langerhans Cell Histiocytosis
neoplasm of macrophages and dendritic cells
multifocal (liver, spleen, bone, skin, lung, etc)
aggresive
usually in 1 system; commonly bone
pulmonary in adult smokers
83
Lentigo Maligna
melanoma
tan macule that expands peripherally
radial growth phase 10-20 years
chronic sun damaged skin
84
Li Fraumeni
germline loss of p53 tumor suppressor
85
loss of heterozygosity at 11p --\> increase in IGF2
embryonal rhabdomyosarcoma
86
Low grade Non-Hodgkin Lymphoma
Follicular lymphoma
Small lymphocytic (SLL)
Mantle Cell Lymphoma
Marginal zone lymphoma
87
Lymphoma found in multiple sites, same side of diaphragm
Stage 3
88
Lymphoma located on both sides of the diaphragm
Stage?
Stage 3
89
Lymphoma often seen with chronic inflammatory conditions/disease
Marginal zone lymphoma or maltoma
90
Marker for lymphoid cells
Tdt
91
Marker for myeloid
MPO
92
Markers in a normal germinal center
CD20+ CD10+ Bcl 2 -
93
Markers in mantle zone
CD20+
94
Markers in normal paracortex
CD3+ CD5+
95
Melanoma
--\> consumption of epidermis, spread of melanocytes, nest of melanocytes with variable size and shape, melanocytes within lymphovascular spaces, mitoses, ulceration
96
Diagnosis? pathogenesis?
Melanoma
tumors originate in the pigment producing cells in the basal layer of the epidermis
97
Melanoma prognosis
depends on the depth of invasion
most dangerous form of skin cancer
98
mesenchymal or de-differentiated chondrosarcoma
chemotherapy
99
MFH
malignant fibrous histiocytoma --\> high grade undifferentiated pleomorphic sarcoma
100
MGUS
="monoclonal gammopathy of uncertain significance"
asymptomatic
elevated monoclonal protein (M protein)
preneoplastic condition--\> converts to myeloma at ~1%/year
101
Mixed cellularity Lymphoma
classical Hodgkin lymphoma
EBV + 70%
lots of eosinophils, etc. (IL-5)
102
Multiple myeloma
abnormal plasma cells--\> 2 nuclei, many droplets of Ig
103
Morphology of Follicular Lymphoma
lymph nodes, spleen, liver, marrow
nodular aggregates of cells
cells are centroblasts and centrocytes (majority)
104
Morphology of Langerhans Cell Histiocytosis
langerhans cells- deeply grooved nuceli and abundant cytoplasm (coffee bean)
Birbeck granules on electron microscopy (tennis rackets)
Immunostain for S100 and CD1a
105
Most common cause of death for patients with Multiple Myeloma
infections
106
Most common location for STS
thigh, buttock, groin
107
Most common melanoma in dark individuals
acral lentiginous melanoma
108
Most common NHL
diffuse large B cell lymphoma
109
Most common non-GIST Soft Tissue Sarcoma
Liposarcoma
110
Most common primary malignancy of bone in kids
osteosarcoma
111
Most common sites for Rhabdomyosarcoma
Head/neck- orbital, parameningeal genitourinary extremity
112
Most common type of ALL
B-ALL
113
Most common type of Classical Hodgkin's Lymphoma
nodular sclerosing
114
Most common type of melanoma
superficial spreading
115
Multiple Myeloma
multiple plasmacytomas
increased plasma cells in marrow
normal and abnormal plasma cells
elevated M component
monoclonal antibody
often have elevated IL-6 since it is a growth factor for plasma cells
116
Multiple Myeloma staging
CRAB= end organ damage
C- hypercalcemia
R- renal failure
A- anemia
B- bone lesions
117
Mutation that disrupts RAR (retinoic acid receptor)
t(15;17)
118
Mycosis Fungoides
malignant T helper cells infiltrate the skin, forming plaques and tumors
"cerebriform' T cells
only involves nodes and marrow in late phase
119
Myoglobin- immunohistochemical marker for?
rhabdomyosarcoma
120
popcorn cell
=Non classical Hodgkin lymphoma
121
Onion peeling/skinning of xray
Ewing Sarcoma
122
Osteoblastic osteosarcoma
abundant osteoid production around tumor cells
123
Osteosarcoma
primary malignant tumor of bone
characterized by the production of osteoid
commonly during growth spurt and located at metaphysis of bone
sunburst pattern on xray; lifting of cortex
Bone scan preferred
124
Osteosarcoma- clinical features
characterized by osteoid production or immature bone peak incidence during adolescent growth spurt occurs typically at metaphyseal ends of bones localized pain, soft tissue mass systemic symptoms usually absent 40% have elevated alkaline phosphate, 30% have elevated LDH
125
sunburst pattern
osteosarcoma
126
"owl eye" cells
Reed-Sternberg cells = Hodgkin's lymphoma (classical)
127
Peripheral T cell Lymphoma
diagnosis of exclusion
collection of several T cell lymphomas that don't fit into any other category
effacement of lymph node architecture
mature T cells with one or more immunophenotypic abnormality
128
Plasma Cell Myeloma/Plasmacytoma
solitary marrow based lesion (lytic lesion of bone)
increased marrow plasma cells
elevated M component
129
Tear drop cells
= Primary myelofibrosis (PMF)
130
Post-remission therapy for ALL
consolidation
intensification (high dose chemo or transplant)
CNS prophylaxis: radiation, intrathecal chemotherapy, high dose methotrexate
Maintenance for 2 years
131
Post-remission therapy for AML
consolidation (repeat chemo)
intensification (either high dose cytarabine or allogenic transplant)
132
Potential curative therapy for Soft Tissue Sarcoma
surgical resection
133
Potential curative therapy for STS
surgical resection
134
Presentation of Malignant Spinal Cord Compression
pain
weakness
paresthesias
ataxia
bladder/bowel dysfunction
135
Presentation of osteosarcoma
localized pain
soft tissue mass
elevated phos and LDH
136
Prevention of Neutropenic fever
prophylactic G-CSF or GM-CSF
137
Prevention of Tumor Lysis Syndrome
Allopurinol
hydration
monitor electrolytes, uric acid, calcium, phosphorous
138
Primary amyloidosis
light chains deposited as amyloid
139
Prognosis for t(8;21)
AML that will likely respond to chemo and not require transplant
140
Remission induction chemotherapy for AML
Cytarabine C (Ara-C) and Daunorubicin (anthracycline)
141
Remission induction for ALL
chemotherapy (if CD20+ give rituximab)
+ imatinib if Ph+
142
Rhabdomyosarcoma
Special type of STS
one of the top three pediatric solid tumors
two subtypes: a) embryonal b) alveolar
143
S-100 protein- immunohistochemical marker for?
melanoma, leiomyosarcoma, rhabdomyosarcoma, liposarcoma, chondrosarcoma
144
Sarcoma = ?
malignant from mesenchymal cells
145
Sclerosing liposarcoma- sign that what?
recurrent disease
146
Sezary Syndrome
malignant T helper cells infiltrate the skin
do not form discrete tumors
essentially more aggressive form of mycosis fungoides --\> involves blood
147
Smoldering myeloma
asymptomatic
elevated marrow plasma cells (\>10%)
elevated serum M protein (myeloma levels)
--\> higher levels of M protein and more plasma cells in BM than MGUS
148
Smudge cells on peripheral blood smear
CLL
149
squamous cell carcinoma
150
Squamous Cell Carcinoma
originates from the keratinocytes squamous cell layer--\> arises from epidermis and extends into the dermis
present as scaly, red patches and plaques, often tender, central depression and bleeding
easily spread and become disfiguring
caused by cumulative UVR
151
Stage 1 Lymphoma
found in single location
152
Stage 2 Lymphoma
multiple sites, same side of diaphragm
153
Stage 4 lymphoma
diffuse involvement of nonlymphoid organs
154
Stage of G1 or G2 soft tissue sarcoma
typically stage 1 or 2
155
Stage of this HL
Stage IIIB
no bone marrow involvement, but both sides of diaphragm
B symptoms
156
Standard of care for chondrosarcoma
surgery
157
Standard therapy for Hodgkin lymphoma
ABVD (Adriamycin= doxorubicin, bleomycin, vinblastine, dacarbazine)
+radiation for bulky disease
NO role for surgery
158
Starry sky H&E
Burkitt lymphoma
"Starry sky in Africa"
159
Sunburst/codman's triangle
= osteosarcoma
160
Superficial spreading
70% of melanomas
less inclined to be on sun exposed skin
horizontal growth phase 1-5 years
variation in color
161
Synovial Sarcoma
most sensitive sarcoma to chemotherapy biphasic SSX1 has better prognosis than monophasic
162
t(11;14)
Mantle cell Cyclin D1
163
t(12:16) TLS-CHOP
myxoid round cell liposarcoma
164
t(14;18)
Follicular lymphoma bcl2+
165
t(8;14)
Burkitt lymphoma
166
t(X;18)
Synovial sarcoma
167
Tennis racket granules
Langerhans cell histiocytosis
168
Transformation of chromosome 22
Ewing Sarcoma
169
translocation long arm 13 and 1 or 2
alveolar rhabdomyosarcoma
170
Treatment for actinic keratosis
liquid nitrogen cryotherapy
if diffuse or patient immunosuppressed: laser, IMID topical, or oral retinoids
171
Treatment for advanced stage follicular lymphoma
allogeneic stem cell transplantation
172
Treatment for AML with either FLT3-ITD or complex karyotype
induction chemotherapy followed by transplant and/or clinical trials
173
Treatment for APL? How does it work?
Tretinoin (all-trans-retinoic acid) binds receptor and causes the blasts to mature, thereby reducing the promyelocyte (leukemic) burden
Arsenic Trioxide produces free radicals and is cytotoxic
174
Treatment for Essential Thromobocythemia
hydroxyurea
interferon
175
Treatment for Follicular Lymphoma
watch and wait
high rate of transformation to DLBCL
176
Treatment for GIST
imatinib
177
Treatment for GIST
Imatinib
178
Treatment for metastatic STS
resect or radiate if local treatment not possible, use chemotherapy
179
Treatment for mycosis fungoides
topical therapy
180
Treatment for osteosarcoma
excision
adjuvant chemotherapy
181
Treatment for Polycythemia Vera?
hydroxyurea
interferon
Jak 2 inhibitor
182
Treatment for Primary Myelofibrosis
JAK2 inhibitor
clinical trials
183
Treatment for Rhabdomyosarcoma
combination chemotherapy and surgical resection residual disease following surgery treated with radiation
184
Treatment for T cell NHL
CHOP
transplantation
185
Treatment of malignant spinal cord compression
start dexamethasone (corticosteroid) when dx is suspected
radiotherapy
surgery laminectomy
chemotherapy for underlying cancer
186
Treatment of MDS
demethylating agents-- cytosine analogs
azacitidine or decitabine
187
Treatment of Multiple Myeloma
IMIDs (thalidomide) and proteasome inhibitors (bortezomib)
188
Treatment of tumor lysis syndrome
rasburicase
hydration
189
Types of STS
liposarcoma
synovial sarcoma
leiomyosarcoma
fibrosarcoma
angiosarcoma
rhabdomyosarcoma
GIST
190
Vimentin- immunohistochemical marker for?
sarcomas some carcinomas
191
Waldenstrom macroglobulemia
high IgM levels
large IgM
hyperviscosity of blood
LAD
visual and neurologic deficients
bleeding
192
Way to differentiate between ALL and AML?
Tdt = ALL
193
Way to prevent death of CAR T cells
co-stimulatory domains
194
most common melanoma in darker individuals
acral lentiginous melanoma
195
2 y/o with nasal polyps
workup should involved?
test for CF
196
possible complication of radiation to the neck
hypothyroidism
develops in 30-40% of patients
197
What must be done before starting a patient on Trastuzumab?
Echo to check cardiac function
trastuzumab can cause a decrease in EF
198
2 most common causes of MSCC
lung and breast
199
what are these shapes called?
diagnosis?
Keratin pearls
--\> Squamous cell carcinoma
200
Name of mole found at DEJ and dermis
compound nevi
201
Melanoma type that skips to vertical growth phase
Nodular
202
Diagnosis
Rouleaux formation--\> multiple myeloma
