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Fall Term 2021 > Malignant Neoplasms pt. 2 > Flashcards

Malignant Neoplasms pt. 2 Flashcards

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1
Q

What tissues can malignancy arises from?

A

epitheleal and connective

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2
Q

What are some high risk factors for malignancy?

A

viruses- HPV
familial tendencies- genetics
environment
hormones- estrogen

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3
Q

What sonographic signs would create suspicion of a malignant mass?

A 
hypoechoic halo
hypoechoic solid mass
multiple liver masses
high velocity signals
hypervascular lesions
lymphadenopathy
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4
Q

What is the most common primary malignant tumor?

A

hepatocellular carcinoma (HCC, Hepatoma)

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5
Q

HCC

A

males, 60yo
3 forms: focal solitary, focal multiple, diffuse
risk factors: cirrhosis, hep B + C, metabolic disorders

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6
Q

Signs and symptoms of HCC

A

RUQ pain, weight loss, ascities, hepatomegaly

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7
Q

What is the normal liver length midclavicular?

A

15.5cm

rt lobe: <17cm

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8
Q

Sono appearance of HCC?

A

variable, hypoechoic, anechoic halo, <5cm, portal venous invasion

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9
Q

What lab values are increased with HCC?

A

AFP increased in 70% of patients

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10
Q

Hemangiosarcoma

A 
extremely rare but aggressive
60-80
metastisizes rapidly
linked to arsenic, thorotrast, polyvinyl chloride exposure
large mass, mixed echogenicity
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11
Q

Epitheloid Hemangioendothelioma

A

malignant vascular tumor, rare

multiple hypoechoic masses, Glisson’s capsule appears to e “pulled” in towards mass

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12
Q

What is the most common primary liver tumor in chidren?

A

hepatoblastoma

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13
Q

hepatoblastoma

A

<5 years of age, associated with beckwith-wiedemann, serum AFP elevated
sonographically: single, solid, large, mixed echogenicity, poorly defined

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14
Q

Hodgkin’s Lymphoma

A

fever, weight loss, anemia
15-24, males
painless lymph node enlargement
25% have para-aortic lymphadenopathy

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15
Q

Non-Hodgkin’s Lymphoma

A 
arise from typhoid tissue of organs
>55
50% have para-aortic lymphadenopathy
mets to liver, spleen
fever, weight loss, night sweats
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16
Q

Sonographic appearance of lymphoma

A

anechoic-hypoechoic, solid, homogenous
lobulated scalloped mass
splenomegaly
organ and vessel compression/displacement

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17
Q

Sonographic appearance of malignant node

A

round or oval (taller than wide)
area of buldging
narrow/absent hilum

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18
Q

Hemangiosarcoma

A

spleen, rare, similar appearance to cavernous hemangioma, mets to liver

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19
Q

What can be associated with gallstones?

A

adenocarcinoma

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20
Q

Gallbladder carcinoma

A

females, 60-70
RUQ pain, intolerance to fatty food, occasional nausea and vomiting
spread to liver and regional lymph nodes
jaundice occurs in later stages

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21
Q

Soon appearance of gallbladder cancer?

A

mass with irregular borders
focal/diffuse wall thickening
can invade adjacent liver

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22
Q

Cholangiocarcinoma

A

bile duct cancer, slow growing

males, 50-60

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23
Q

What are the risk factors for cholangiocarcinoma?

A

chronic biliary stasis & inflamm
choledochal cyst
caroli’s

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24
Q

What are the 3 forms of choleangiocarcinoma?

A

intrahepatic
distal
Hilar (Klatskins)

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25
What lab value will be elevated with cholagniocarcinoma?
elevated serum bilirubin and ALP
26
Klatskins Tumor
most common occurs at confluence of the right and left hepatic duct poor prognosis
27
Soon appearance of Klatskins Tumour
Normal CBD Dilated intrahepatic ducts small solid mass at liver hilum bulging duct walls
28
What is the most common malignancy of the pancreas?
adenocarcinoma
29
Adenocarcinoma of the pancreas
``` associated with smoking, alcohol, diabetes 60-70% located in pancreases head older males poor prognosis elevated lipase ```
30
Direct signs of adenocarcinoma?
ill defined, solid mass hypo echoic, >2cm homogenous/heterogenous
31
Indirect signs of adenocarcinoma?
Dilated pancreatic duct/bile duct dilation | dilated gb
32
Cystic neoplasms of pancreas
women, middle to older age
33
Microcystic (serous cystadenoma)
benign, well defined, small cysts <2cm, pancreases head | solid and echogenic due to multiple cyst interfaces (too many tubes)
34
Macrocystic (mucinous)
uncommon, malignant in pancreases tail larger cysts <2cm large, encapsulated, many septations
35
Normal thickness of the GB wall
distended 3mm, non distended 5mm
36
Benign wall thickness of GB
long segment involved symmetric thickening layers preserved
37
Malignant wall thickness of GB
short segment asymmetric wall layer destruction
38
Clinical presentation
pain anemia palpable abdominal mass blood in stool
39
What is the most common malignant tutor of the GI tract?
adenocarcinoma
40
Adenocarcinoma
males stomach: prepyloric, antrum, lesser curve small bowel: ileum, increase chance of Crohn's disease Colon: very common, polypoid or annular
41
Soon appearance of adenocarcinoma
Large mass typically hypo echoic thick ill defined wall look for nodes or mets
42
What is the most common tutor of the GI tract in children <10?
lymphoma - non hodgkin's
43
Lymphoma
hypo echoic, solid nodules bowel wall may appear as a target lesion mesenteric node involvement
44
Primaries of urinary tract
Renal cell carcinoma (RCC) Nephroblastoma (Wilm's Tumor) Transitional cell carcinoma Squamous cell carcinoma
45
What is another name for renal cell carcinoma?
Hypernephroma
46
What is the most common malignant renal tumor in adults?
Renal cell carcinoma
47
Hypernephroma
males 50-70 | association with von Hippel-Lindau and tuberous sclerosis
48
What is the clinical triad of RCC
flank pain gross hematuria palpable mass
49
What should be checked for with RCC?
tumor invasion into IVC and renal veins para-aortic nodes contralateral kidney
50
Sonographic appearance of RCC
solid, variable echogenicity, possible calcifications, increased flow
51
Most common malignant renal tumor in children
nephroblastoma - Wilm's tumor
52
Clinical presentation of nephroblastoma
fever, hematuria, hypertension, palpable mass, anemia
53
Sonographic appearance of nephroblastoma
``` large, well defined solid, unilateral heterogenous/homogenous lymphadenopathy metastatic extension ```
54
Transitional Cell Carcinoma
TCC - tumor of the collecting system | men, hematuria
55
Sonographic appearance of TCC
renal sinus: ill defined, hypoechoic mass
56
3 differentials of TCC
blood clots, fungal balls, sloughed papilla
57
TCC of the bladder
focal, non-mobile mass trigone region painless hematuria
58
What is needed to diagnose TCC of the bladder?
cystoscopy & biopsy
59
TCC of the ureter
hydronephrosis above mass | solid mass in ureter
60
Squamous Cell Carcinoma
rare, most aggressive, distant metastases men associated with chronic UTI's, stones, strictures
61
Primaries of the prostate?
adenocarcinoma
62
What is the most common cancer diagnosed in men?
Adenocarcinoma of the prostate
63
Adenocarcinoma of the prostate
>50, increase risk with age, diet, family hx | most develop in the peripheral zone and spreads towards the capsule
64
4 steps to evaluate adenocarcinoma of the prostate
DRE - digital rectal exam PSA TRUS - transrectal u/s Biopsy - performed if TRUS is abnormal
65
Sono appearance of adenocarcinoma
small - hypoechoic large - isoechoic, hyperechoic, mixed loss of smooth contour
66
Is adenocarcinoma symptomatic or asymptomatic?
Asymptomatic
67
Primaries of the adrenal glands
adrenal cortical cancer - rare, typically adenocarcinoma females - hyperfunction males - non functioning
68
4 clinical presentations of adrenal gland tumors
Cushing's syndrome Conn's Disease viralization/feminization precocious puberty - menstrating at young age
69
Sonographic appearance of adrenal gland tumor
well defined, solid mass, variable echogenicity
70
Neuroblastoma
highly malignant, 4-5 years old, adrenal medulla | presents with palpable mass, weight loss, failure to thrive
71
Soon appearance of neuroblastoma
solid, heterogenous, poorly defined, calcification, renal displacement, mets to liver
72
Primaries of the peritoneum
mesothelioma - asbestos exposure | peritoneal thickening, ascites
73
Lymphoma in the peritoneum
very rare, non Hodgkin's, AIDS, hypoechoic focal masses along peritoneum
74
What are the routes a tumor can metastasize
blood lymphatics direct invasion
75
What are the most frequent sites for metastases?
lung, liver, bone, adrenal
76
What is the most common malignant tumor in the liver?
mets to the liver - multiple solid lesions, hypo halo - hepatomegaly, jaundice, pain (looks like cheetah)
77
What lab values are increased with mets to liver?
LFT's elevated: ALK PHOS AST ALT
78
T/F: | Mets to the gallbladder is not associated with gallstones.
True. Gallstones would be more susceptible to primary
79
Mets to pancreas
not commonly seen on u/s, usually seen in later stages - presents as small hypoechoic mass
80
Mets to kidney
common, lung, breast, contralateral kidney
81
Metastatic lymphoma to the kidney
nonspecific renal enlargement hypoechoic diffusely displacement of organs or vessels
82
How will mets to GI tract appear?
large, hypoechoic, well defined mass, ring down artifact
83
mets to adrenal
4th most frequent site LUNG, breast, melanoma primaries bilateral solid, well defined, hypoechoic
84
mets to retroperitoneum
testicular or pelvic tutors most common | spread via lymph or blood
85
mets to abdominal wall
hypoechoic mass with posterior enhancement
86
What can mets to abdominal wall be mistaken as?
simple cyst - except this displays posterior enhancement
87
mets to peritoneum
peritoneal carcinomatosis diffuse involvement hypoechoic masses and wall thinking, ascites, lymphadenopathy
88
pseudomyxoma peritonei
mets to peritoneum: couples gelatinous ascites, rare variable prognosis nearly always originates from perforated appendices epithelial tumor starburst appearance

Fall Term 2021 (5 decks)

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