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Cancers Flashcards

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1
Q

Retinoblastoma

A

Most common ocular tumor of childhood
White pupillary reflex (leukocoria) in children less than 5 y.o
Sporadic or familial
Familial at risk of sarcomas later on in life especially osteosarcomas (vimentin is an intermediate filament foud within cells of mesenchymal origin)

Germline mutation that affects Rb tumor suppressor gene on chromosome 13

Two-hit hypothesis

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2
Q

Adenocarcinoma of the lung

A

Location: peripheral

Characteristics: most common lung cancer in nonsmokers and overall

Activating mutations include k-ras, EGFR, and ALK
ALK can form fusion protein with EML4 resulting in constitutive activation of TK (inhibited by crizotinib)

Associated with clubbing

Histology: glands and mucin with short plump villi (as opposed to mesothelioma)

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3
Q

Brnchioalveolar carcinoma

A

Location: peripheral
Subtype of adenocarcinoma (in situ)

Not related to smoking

Chest X Ray shows hazy infiltrates similar to pneumonia
Excellent prognosis

Histology: well differentiated dysplastic columnar cells +/- mucin

Grows along alveolar septa with no invasion leading to apparent thickening of alveolar walls

Copious amounts of watery sputum

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4
Q

Squamous Cell carcinoma

A

Location: Central

Characteristics: hilar mass arising from bronchus
Cavitation

Associated with smoking

Hypercalcemia (produces PTHrP)

Histology: keratin pearls and intercellular bridges

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5
Q

Small Cell carcinoma

A

Location: central

Characteristics: arises from basal layer of bronchial epithelium

Undifferentiated and very aggressive

May produce ACTH,ADH, or Lambert Eaton Syndrome

Amplification of myc oncogene common

Inoperable treat with chemotherapy

Neoplasm of neuroendocrine therefore neurofilament positive-enolase, chrmogranin, synaptophysin

Small dark blue cells (smaller than lymphocytes)

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6
Q

Large Cell Carcinoma

A

Location: peripheral

Characteristics: highly anaplastic undifferentiated tumor
poor prognosis

less responsive to chemotherapy, surgically removed

Histology: pleimorphic giant cells
Gynecomastia and galactorhhea

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7
Q

Bronchial carcionoid tmor

A

When central forms polyp like mass in bronchus

Excellent prognosis, metastasis rare

Symptoms due to mass effect and occasional carcinoid syndrome (flushing, diarrhea wheezing)

Histology: neuroendocrine cells positive for chromogranin A

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8
Q

Hamartoma of the lung

A

Incidentally found solitary coin lesion

Benign

Popcorn calcifiation, excessive growth of tissue native to the organ of involvement

Composed of hyaline cartilage, fat, smooth muscle, and clefts lined by respiratory epithelium

patients 50-60 y. o

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9
Q

Mesothelioma

A

Malignancy of pleura associated with asbestosis

Associations: insulation and shipbuilding

Results in hemorrhagic pleural effusions and pleural thickening
Lung parenchyma remains intact

Symptoms: dyspnea and chest pain

Psammoma bodies seen on histology
Cells joined by desmosomes

EM: slender microvilli and abundant neurofilaments (gold standard)

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10
Q

Pancoast tumor

A

Apical tumor of lung that can affect cervical sympathetic plexus

Complications: Horner syndrome (ipsilateral ptosis, anhydrosis, miosis),
SVC syndrome, sensorimotor deficits, and hoarseness (recurrent laryngeal)
Hemoptysis and chest pain
Invasion of brachial plexus leads to weakness and parasthesias of the arm
Severe shoulder pain that radiates to axilla and scapula and atrophy of hand muscles
Compression of subclavian vessels leads to edema of upper extremity
Extension into intervertebral foramina leads to spinal cord compression and paraplegia

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11
Q

Giant Cell Bone Tumor

A

20-40 years old
Epiphyseal of long bones

Locally aggressive benign tumor often around knee

Soap bubble appearance on X-Ray
Multinucleated giant cells

Imagine giant blowing bubbles (he’s locally aggressive but relatively benign)- a house goes up to his knee and you need epiphyseal growth to become giant

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12
Q

Osteochondroma

A

Most common benign tumor

Males

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13
Q

Osteosarcoma

A 
2nd most common malignant bone tumor (after multiple myeloma)
Bimodal distribution (10-20 y.o. and greater than 65)

Predisposing factors: paget disease of the bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome (p53 mutation)

Metaphysis of long bones around knee

Codman triange from elevation of periosteum or sunburst pattern on x-ray
Aggressive.

Treat with surgical resection and chemothreapy

After many months LIeutenant Dan (li fraumeni-knee cap in wheel chair) MET his son paget after sailing around the sunny OSean
(bimodal son and father)

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14
Q

Chondrosarcoma

A

Rare, malignant cartilaginous tumor
Men 30-60 y.o.

usually in pelvis, spine, scapula, humerus, tibia or femur

May be of primary origin from osteochondroma
Expansile glistening mass within medulllary cavity

After some time, Everyone thinks shroom kid will get aggressive with his schoolwork and get into med school

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15
Q

Pineal Germinoma

A

Precocious puberty in males caused by increased B-hCG production

Acqueductal compression by tumor leads to obstructive hydrocephalus

Parinaud syndrome due to compression of tectal area of midbrain (superior colliculus)

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16
Q

Glioblastoma multiforme

A

most common adult

highly malignant brain tumor with about a 1 year median survival
poorly differentiated, nuclear atypia and high mitotic acitivity

Found in cerebral hemispheres

Can cross corpus callosum

Stain atrocytes for GFAP

Pseudopalisaiding pleomorphic tumor cells-border central areas of necrosis and hemorrhage

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17
Q

Meningioma

A

Common adult benign

Occurs in convexities of hemispheres near surfaces of brain and parasagittal region

Arises from arachnoid cells
May have dural attachment

Often asymptomatic but may present with seizures or focal neurologica signs (change in personality)

resection or radiosurgery

Spindle cells concentricall arranged in a whorled pattern: psammoma bodies

Composed of menigoethelial cells

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18
Q

Hemagnioblastoma

A

Adult tumor of cerebellum most often

Associated with VHL with retinal angiomas

Can produce EPO leads to secondary polycythemia

Closely arranged thin-walled capillaries with minimal interleaving parenchyma

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19
Q

Schwannoma

A

usually found at cerebellopontine angle
Biphasic: increased cellular areas with myxoid and decreased cellular areas (interdispersing nuclear free areas)
Elongated regular oval nuclei, palisading patterns)

S-100+ (neural crest cell origin)

often localized to CNVIII

Treatment: resectable or with sterotactic radiosurgery

CNVII and V may also be affected due to compression but all except 2 can be affected (II is covered by oligodendrocytes)

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20
Q

Oligodendroglioma

A

Rare and slow growing adult tumor
Most often in frontal lobes

Chicken wire capillary pattern

Oligodendrocytes=fried eggs (round nuclei with clear cytoplasm)
Often calcified

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21
Q

CNS lymphoma

A

Immunocompromised patients
Dense cellular aggregates of uniform atypical lymphoid cells

Arise from B cells (diffuse large B cell most common)
CD20+ and CD79a+

Associated with EBV

mental status changes, seziures, and focal neurologic

High grade respond poorly to chemo

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22
Q

Pilocytic astrocytoma

A

Child tumor
Well circumscribed

Most often found in posterior fossa (cerebellum)

May be supratentorial

GFAP+ (arise from astrocytes)

Benign good prognosis

Rosenthal fibers-eosinophilc corkscrew fibers
spindle cells with hair like glial processes associated with microcysts
Cystic (black on MRI)+ solid (gross)-(white on MRI)

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23
Q

Medullablastoma

A

Highly malignant cerebellar tumor-child

Primitive neuroectodermal tumor

Can compress 4th ventricle casing hydrocephalus-moning headaches, vomiting, lethargy
gait instability and ataxia

ca send drop metastases to spinal cord

Homer wright rosettes
Solid gross (white on MRI)

Small blue cells on histology

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24
Q

Ependymoma

A

Child/adult tumor

Most commonly found in 4th ventricle in children, S.C of adults

Can cause hydrocephalus

Poor prognosis

Perivascular rosettes
Rod shaped belpharoplasts (basal ciliary bodies) found near nculeus

GFAP+?

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25
Craniopharyngioma
Benign childhood tumor-most common May be confused with pituitary adenoma (can also cause bitemporal hemianopia) Derived from remnants of Rathke pouch (ant pit from roof of mouth) Calcification is common Cystic lined by stratified squamous epithelium Cysts filled with yellow, viscous fluid rich in cholesterol Cranio, RatCes pouch, Calcifications, Cholesterol, Cystic, Ceratin
26
Basal Cell Carcinoma
Most common skin cancer Found in sun exposed areas of body-UPPER LIP Locally invasive but almost never metastasizes Pink, pearly nodules, commonly with telangiectasias, rolled borders and central crusting or ulceration BCCs also appear as nonhealing ulcers with infiltrating growth or as scaling plaque Palisading nuclei
27
Squamous cell carcinoma
Second most common skin cancer Associated with excessive exposure to sunlight, immunosuppression, and occasionally arsenic exposure Commonly appears on face, LOWER LIP, ears and hand Locally invasive, but may spread to lymph nodes and will rarely metastasize Ulcerative lesions with frequent scale Associated with chronic draining sinuses Histology: keratin pearls Actinic Keratosis precursor Keratoaconthoma-rapidly growing and then spontaneously regresses over months
28
Melanoma
Common tumor with significant risk of metastasis S-100 tumor marker Associated with sunlight exposure Fair skinned individuals at increased risk Depth of tumor correlates with risk of metastasis-can go to CNS and cause seizures A:Assymetry B: border irregularity C: color variation D: diameter greater than 6 mm E: evolution over time Histo: congregate in poorly formed nests, and are large with irregular nuclei, clumped chromatin, and prominent nucleoli Often driven by BRAF kinase mutation (protein kinase) NEURAL CREST CELL ORIGIN Primary treatment is excision with appropriately wide margins BRAF V600E mutation may benefit from vemurafenib (BRAF kinase inhibitor)
29
Prostatic Adenocarcinoma
Common in men greater than 50 Arises most often from posterior lobe of the prostate gland Diagnosed by increased PSA and subsetquent needle core biopsies Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increase total PSA and decreased fraction of free PSA) Osteoblastic metastases in bone may develop in later stages indicated by lower back pain and increase in ALP and PSA
30
Myxoma
Most common cardiac tumor in adults 90% occur in atria Ball valve obstruction in left atrium associated with multiple syncope episodes Mid diastolic rumbling heard at apex Composed of scattered cells with a mucopolysaccharide stroma Abnormal blood vessels and hemorrhaging Increased VEGF Increased IL-6 leads to constitutional symptoms, weight loss, fever Present with emboli
31
Rhabdomyomas
Most frequent primary cardiac tumor in children Associated with tuberous sclerosis
32
Renal Cell carcinoma
Originates from proximal tubules cells-polygonal clear cells filled wit lipids and carbohydrates (eccentric nuclei) most common in men 50-70 years old Increased incidence with smoking and obesity Manifests clinically with painless hematuria, palpable mass, secondary polycythemia, flank pain, fever and weight loss Invades renal vein then IVC and spreads hematogenously to lung and bone Yellow on macroscopic exam-increased glycogen and lipid Associated with gene deletion on chromosome 3 (VHL) Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP)-from neural crest cells Treatment: resection if localized resistant to chemotherapy and radiation therapy
33
Wilm's tumor
most common renal malignancy of early childhood Contains embryonic glomerular structures Presents with: huge, palpable flank mass and/or hematuria Loss of function of tumor supppressor genes WT1 or WT2 on chromosome 11 Denys drash syndrome: gondoalydysgenesis, eraly onset nephropathy leading to renal failure beckwith-wiedemann syndrome: organomegaly, macroglossia, hemihypertrophy, omphalocele, adrenal cytomegaly WAGR: wilms tumro, aniridia, genitourinary malformation and mental retardation
34
Transitional cell carcinoma
Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters and bladder) elderly man Painless hematuria suggests bladder cancer Arise from transitional epithelial lining mutlifocal sessile or papillary tumors pleomorphic and hyperchromatic nuclei Disrupted orientation and polarity malignancy based on invasion into bladder wall and adjacent tissues Associated with: phenacetin, smoking, aninline dyes and cyclophosphamide Rubber, plastics aromatic amine containing dyes, textiles, leather
35
Sqamous cell carcinoma of the bladder
Chronic irriation of urinary bladder leads to squamous metaplasia and dysplasia and sqaumous cell carcinoma Risk factors: schisstosoma hematobium infection, chronic cystitis, smoking and chronic nepholithiasis Presents with painless hematuria
36
Somatistatinoma
Hyper or hypoglycemia Steattorhea Gallbladder stones (decreased CCK release)
37
VIPomas
Copious watery diarrhea, hypokalemia and Achlorydria Inhibited by somatostatin (ocreotride)
38
Gastrinoma
gastrin secreting tumor that causes high levels of acid secretion and ulcers in jejunum refractory to medical therapy Diarrhea and abdominal pain Located in pancreas Treat with proton pump inhibitors Could be associated with MEN-1
39
Pleomorphic Adenoma of salivary gland
Generally benign and in parotid gland Most common Presents as painless, mobile mass Chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptures intraoperatively
40
Mucoepidermoid carcinoma
Most common malignant tumor of salivary gland Has mucinous and sqaumous components Presents as painless slow growing mass
41
Esophageal Cancer
Sqaumous: upper 2/3 Adenocarcinoma: lower 1/3 Presents: progressive dysphagia and weight loss Poor prognosis risk factors for both: achalasia, cigarettes, familial squamous only: alcohol, Zenker DIverticula, N-nitroso containing foodss (beetel nuts), esophageal web, hot liquids Adenocaricnoma: barrett, obesity, GERD
42
Stomach Cancers
Almost always adenocarcinoma early aggressive local spread and node/liver metastases Presents with acanthosis nigricans Intestinal: associated with H. pylori, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis Commonly on lesser curvature Gland atrophy and intestinal metaplasia Looks like ulcer with raised margins Nodular, polypid and well demarcated columnar or cuboidal cells Diffuse: not associated with H. pylori Signet rings Stomach wall grossly thickened and leathery Growth infiltrating into stomach wall
43
Virchow node
Involvement of left supraclavicular node by mestasis from stomach
44
Krukenberg tumor
Bilateral metastases to ovaries Abundunt mucus and signet ring cells
45
Sister Mary Joseph nodule
Subcutaneous peripumbilical metastasis
46
Adenomatous Colonic Polyp
Precancerous Malignant risk is associated with increase in size, villous histology, increased epithelial dysplasia Precursor to colorectal cancer More villous=more malignant Symptoms: lower GI bleed, partial obstruction, secretory diarrhea Tubular: dysplastic, colonic mucosal cells, that form tubular glands (pedunculated) Villous: dysplastic epithelium from villi make projections (sessile) Tubulovillous: mixture
47
Hyperplastic colonic polyp
Most common non-neoplastic polyp well differentiated mucosal cells that form glands and crypts
48
Juvenile colonic polyps
Most sporadic lesions in children less than five years old 80% in rectum If single, no malignant potential Juvenile polyposis syndrome-multiple juvenile polyps in GI tract, increased risk of adenocarcinoma
49
Hamartomatous colonic polyps (Peutz Jeghers syndrome)
AD multiple nonmalignant hamartomas throughout GI tract with hyperpigmented mouth, lips, hands, genitalia Associated with increase risk of colorectal cancer and other visceral malignancies Mucosal glands, smooth muscle and connective tissue
50
Familial adenomatous polyposis
AD Mutation of APC gene on chromosome 5q 100% progress to CRC unless colon is resected Thousands of polyps arise starting at a young age Pancolic-always involves the rectum
51
Heriditary nonpolyposis colorectal cancer
AD Mutation of DN mismatch repair genes Proximal colon always involved
52
Hepatocellular Carcinoma/Hepatoma
Patients with stable cirrhosis who suddenly decompensate should be evaluated Most common primary malignant tumor of the liver in adults Associated with Hep B and C, Wilson disease, hemochromatosis, a1 antitrypsin deficiency, alcoholic cirrhosis, and aflatoxin May lead to Budd Chiari syndrome Findings: jaundice, tender hepatomegaly, ascites and anorexia Spreads hematogenously Diagnosis: increased a-fetoprotein, ultrasound or CT
53
Cavernous hemangioma of the liver
Common, benign liver tumor-30-50 years old Collagenous scar or fibrous nodules seen in association with thrombosis Biopsy contraindicated because of risk of hemorrhage Enlarge by ectasia (Distension of tubular structure) Histo: cavernous blood filled vascular spaces of variable size lined by single epithelial layer
54
Hepatic adenoma
Rare, benign lier tumor often related to oral contraceptive or anabolic steroid use May regress spontaneously or rupture (abdominal pain and shock)
55
angiosarcoma of the liver
Malignant tumor of endothelial origin Associated with with exposure to aresenic, vinyl chlroide
56
Pancreatic Adenocarcinoma
Prognosis averages 1 year Very aggressive tumor arising from pancreatic ducts (disorganized glandular structure with cellular infiltration) Already metastasized at presentation, tumors more common in pancreatic head Associated with CA-19-9 (CEA less specific) Risk factors: tobacco use, chronic pancreatitis, Diabetes, 50 y.o, jewish and african american males, MEN syndromes, HNPCC and FAP Presents with: abdominal pain radiating to back, weight loss (malabsorption and anorexia), migratory thrombophlebitis (redness and tnederness on palpation of extremities), obstructive jaundice with palpable nontender gallbladder (pruritis, dark urine and pale stools) Treatment: Whipple procedure, chemotherapy, radiation therapy
57
Glucagonoma
Necrolytic migratory erythemia Erythematous papules/plaques on face and extremitiies Lesions enlarge and coalesce leaving bronze colored central indurated area with peripheral blistering and scaling Diabetes mellitus-hyperglycemia GI symptoms: diarrhea, anorexia, abdominal pain Diagnosis: elevated glucagon levels Tumor arises from alpha cells Also can affect mucus membranes leading to glossitis, chelitisi and blephartitis Anemia of chronic disease also present
58
Neuroblastoma
Most common tumor of the adrenal medulla in CHILDREN less than 4 years old Originates from neural crest cells Neuropril is pathognomonic Presentation: abdominal Distension and firm, irregular mass that can cross the midline (wilms tumor is smooth and unilateral) Homovanillic acid (breakdown product of dopamine) increased in urin Bombesin + Associated with overexpression of n-myc oncogene Clinical: hypertension (rare), anorexia, weight loss Nonrhythmic conjugate eye movements with myoclonus
59
Pheochromocytoma
Most common tumor of adrenal medulla of adults Derived from chromaffin cells (neural crest cells) 10% malignant, 10%, bilateral, 10% extra-renal, 10% calcify, 10% kids Symptoms: secrete epinephrine, NE, and dopamine causing episodic hypertension Increased Pressure, pain (headache), perspiration, palpitations, pallor Anxiety and orthostatic hypotension Associated with VHL, MEN 2A and 2B Findings: urinary VMA (breakdown product of NE and epinephrine) and plasma catecholamines are increased Treatment: irreversible a antagonists (phenoxybenzamine) and B-blockers followed by tumor resection a-blockade must be achieved before giving B blockers to avoid hypertensive crisis
60
Papillary Thyroid Carcinoma
Most common excellent prognosis Empty apperaing nuclei (finely dispersed chromatin-ground glass appearance) Psammoma bodies, nuclear grooves Increased risk with RET and BRAF mutations, childhood irradiation
61
Follicular Thyroid carcinoma
Good prognosis Thyroid capsule, uniform folllicles RAS mutations, Bcl-2
62
Medullary Thyroid Carcinoma
From parafollicular C cells Produce calcitonin-sheets of cells in an amyloid stroma-stain with congo red Associated with MEN 2A and 2B-Ret mutations Uniform polygonal or spindle shaped
63
Undifferentiated/anaplastic carcinoma
Older patients, invades local structures, very poor prognosis p53 mutations, markedly pleimorphic Giant cells biphasic spindle cells
64
Pituitary adenoma
Most commonly prolactinoma adenoma may hormone producing or non hormone producing Nonfunctional tumors present with mass effect-bitemporal hemianopsia, hypopituitarism Functional tumor presentation is based on hormone produced-prolactinoma: ammenorrhea, galactorrhea, low libido, infertility Somatotropic adenoma-acromegaly Treatment for prolactinoma-dopamine agonists
65
Insulinoma
Tumor of B cells of pancreas-overproduction of insulin leading to hypoglycemia Whipple triad of episodic CNS symptoms: lethargy, syncope and diplopia symptomatic patients have decreased blood glucose and increased C peptide levels Treatment: surgical excision
66
Carcinoid syndrome
Rare syndoem caused by carcinoid tumors (neuroendocrine cells) especially metastatic bowel tumors Secrete high levels of 5HT Not seen if tumor is limited to GI tract-5HT metabolized in liver Symptoms: recurrent diarrhea, cutaneous flushing, asthmatic wheezing, and right sided valvular disease (fibrous intimal thickening with endocardial plaques on tricuspid and pulmonary valves-serotonin and bradykinin broken down by pulmonary MAO-can lead to pulmonary stenosis and restrictive cardiomyopathy) increase of 5-hydroxyindoleacetic acid in urine, niacin deficiency (pellagra), telangiectasias and cyanosis histology: copmirsed of nests and glands Eosinophilic cytoplasm with oval round nuclei Minimal to no variation in shape and size of tumor cells Dense core granules in cytoplasm containing secretory products Most common appendicial tumors Treatment: resection, ocreotride
67
Zollinger Elliison syndrome
gastrin secreting tumor of pancreas or duodenum Acid hypersecretion causes ulcers in distal duodenum and jejunum Presents with abdominal pain (peptic ulcer disease, distal ulcers), diarrhea, Ulcers refractory to therapy and recur after acid reducing surgery may be associated with MEN 1
68
ACTH paraneoplastic
Cushing Small cell lung cancer and pancreatic cancer
69
ADH paraneoplastic
SIADH Small cell lung cancer and intracranial neoplasms (also carbamazepine for giggles)
70
Abs against presynpatic Ca channels
Lambert Eaton syndrome Small cell lung cancer
71
EPO
Polycythemia renal cell carcinoma, thymoma, hemagioblastoma, HCC, leiomyoma, pheochromocytoma
72
PTHrP
Hypercalcemia Squamous cell lung cancer, renal cell carcinoma, breast cancer
73
Anti-yo Anti-P/Q, Anti Ho Abs
Subacute cerebellar degeneration-reactions with purkinje neurons Small cell lung cancer, breast, ovarian and uterine cancer
74
Brain metastases
1. Lung 2. breast 3. genitourinary 4. ostosarcoma 5. melanoma 6. GI Multiple well circumscribed tumors at gray/white matter junction
75
Liver metastases
1. Colon 2. Stomach 3. pancreas
76
Bone metastases
1. Prostate and breast 2. lung 3. thyroid preidlection for axial skeleton prostate=blastic Breast=lytic and blastic

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