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Nashville Review 2024 > Nashville Pathology > Flashcards

Nashville Pathology Flashcards

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1
Q

Describe Warthin’s Tumor

A

PAPILLARY CYSTADENOMA LYMPHOMATOSUM: Salivary gland tumor with Male predominance, 7-8 decade, highly associated with smoking

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2
Q

Where are the majority of parotid neoplasms?

A

Parotid, but the majority are benign, most malignant tumors arise from palate and small glands

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3
Q

What is the most common salivary gland tumor?

A

Pleomorphic Adenoma, PLAG1 mutation in the superficial lobe, possible malignant transformation

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4
Q

What is the most common malignant salivary gland tumor?

A

MUCOEPIDERMOID CARCINOMA, most common place is the parotid (there is low grade and high grade)

5 year survival is 80 percent

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5
Q

Describe Adenoid Cystic Carcinoma

A

Malignant salivary glamnd tumor, 10 percent of all salivary gland malignancies, slow relentless progression of disease with skip lesions

Treatment is surgical resection and possible xrt; low 15 year survival

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6
Q

What is the treatment for neurofibromas and schwannomas?

A

Conservative excision

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7
Q

Do salivary gland tumors need a neck dissection?

A

Neck dissection if clinical or radiographic evidence of cervical metastasis.

If the risk of occult nodal disease is thought to be >15%, END is recommended as a staging procedure.

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8
Q

What tests should you order if you suspect a salivary gland tumor?

A

Perform imaging (neck ultrasound, computed tomography [CT] with intravenous contrast, and/or magnetic resonance imaging [MRI] of the neck and primary site) in patients with a suspicion of a salivary gland cancer

Perform a tissue biopsy (either fine needle aspiration biopsy [FNAB] or core needle biopsy [CNB]) to support distinction of salivary gland
cancers from nonmalignant salivary lesions

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9
Q

Which salivary tumors require post operative radiation?

A

Postoperative radiation therapy (RT) should be offered to all patients with resected adenoid cystic carcinoma (ACC)

Postoperative RT should be offered to patients with tumors with the following features: high-grade tumors, positive margins; perineural
invasion; lymph node metastases; lymphatic or vascular invasion; and T3-T4 tumors

Postoperative RT may be offered to patients with tumors with close margins or intermediate-grade tumors

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10
Q

For a parotid tumor that requires a neck dissection, which levels should be dissected?

A

Levels 1-4

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11
Q

What margins should you get for a pleomorphic adenoma?

A

1.0-1.5 cm, include periosteum and anything that includes the capsule

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12
Q

What are the margins for a mucoepidermoid carcinoma?

A

1cm for low grade, and hemimaxellectomy for high grade, treat nodal disease with neck dissection and rads

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13
Q

What are the margins for adenoid cystic carcinoma?

A

3cm margins, with hemi-maxillectomy

Complete extirpration to skull base due to skip lesions

Remember needs 6,000 - 7500 cGy and possible END

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14
Q

What causes an osteosarcoma?

A

Paget’s, Fibrous Dysplasia, or previous XRT, related to a loss of p53 or Rb tumor suppressor genes

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15
Q

What is the treatment for osteosarcomas?

A

Surgery is the mainstay of treatment, and achievement of wide free margins is the most important prognostic factor

Radiation therapy is indicated mainly for unresectable tumors or as an adjuvant treatment in cases with close or intralesional margins of resection.

The role of chemotherapy is debatable but new support for neoadjuvant therapy.

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16
Q

Whare are the chemotherapy drugs used to to treat osteosarcoma?

A

doxorubicin (Adriamycin)
vincristine
cyclophosphamide (Cytoxan) prednisone

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17
Q

What are the typical margins for osteosarcoma?

A

Bone 3cm

Overlying soft tissue 2cm

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18
Q

When should chemo start for osteosarcoma patients after resection?

A

6 weeks for tissue healing

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19
Q

What is kaposi sarcoma?

A

HHV8-driven endothelial proliferation (Kaposi sarcoma virus) associated with Immunosuppression or HIV/AIDS-associated

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20
Q

Describe VERRUCOUS CARCINOMA:

A

Non-ulcerated exophytic papillary growth

istologically bland - no evidence of cytologic atypia, prominent verrucoid hyperkeratosis, bulbous rete pegs that creates a pushing border but no invasion into underlying connective tissue

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21
Q

What is the treatment for verrucous carcinoma?

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A

Treatment is 0.5 to 1.0 cm margins

22
Q

What labs should you order for SCC patients?

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A

CBC, LFT, Electrolytes

23
Q

Describe the T classifcation for oral SCC

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A

T1: less than 2cm size and less than 5mm DOI

T2: greater than 2 and less than 4, with DOI less than 10

T3: greater than 4 cm or DOI greater than 10

24
Q

Describe N classifcation for

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A

N1: single node smaller than 3cm

N2: single node greater than 3cm but less than 6cm, or multiples nodes

N3: Larger than 6cm

A: ipsilateral, B: Multiple ipsilateral, and C: contralateral

25
How do you stage a tumor?
Stage 3 is N3 or higher, or Stage T4 Stage 4 is anything with metastasis
26
What are the margins for a squamous cell carcinoma resection?
1.5 cm If invades mandible, segmental resection is needed
27
Describe a radical neck dissection:
Classic procedure for entire removal of the cervical lymphatic chain from unilateral neck, includes level I – V, CN XI, internal jugular vein, SCM Used when SCM CN 9 or IJ are infiltrated
28
What is a modified neck dissection?
Removal of lymph nodes from levels I to V preserves SCM, CN 9 and IJ
29
Whats a supraomohyoid neck dissection?
Removal of levels I – III in the N0 neck in cases of oral cavity SCCa where there exists a > 20 % of occult neck disease; such as:
30
What are the indications for a supraomohyoid neck dissection?
Invasion of > 4mm for oral SCCa (DOI) Lymphovascular invasion (LVI) Performed on side of primary tumor except in lesions of midline such as floor of mouth that can metastasize bilaterally
31
What are the rules for prophylactic treatment of a cN0 neck?
The basic rule for prophylactic treatment of the N0 neck is to treat any patient whose risk of occult lymph node metastases is greater than 15-20% Areas such as the tongue base carry a risk as high as 55%
32
What are the indications for radiation for SCC?
Positive or near margins Significant lympho-vascular or perineural invasion Bone involvement Multiple nodal involvement or extracapsular spread Stage III or IV disease Dose is 6,000 cGy in divided doses after healing from surgery
33
What are the chemo drugs used to treat head and neck cancer?
Carboplastin-taxol Cisplastin + Docetaxel
34
What are the options for a tongue reconstruction?
Radial forearm, ALT, Skin Graft
35
Where do OKCs arise from?
Dental Lamina
36
Describe nevoid basal cell carcinoma:
Autosomal dominant (variable penetrance) PTCH1 gene micro-deletion 9q22.3 Numerous BCC of skin Multiple OKCs Palmar and plantar pits Ovarian fibromas, Medulloblastomas, Bifid ribs, Dural calcifications BCC and OKCs are less aggressive than the non-syndrome types but can occur in non-sun-exposed areas
37
What are the different subtypes of ameloblastoma unicystic form?
Intruminal Transmural Intramural
38
Describe OKC TREATMENT
Excision and peripheral ostectomy with adjuvant therapy provides the best chance to prevent recurrence (besides resection) Cryotherapy – thermal fixative, liquid nitrogen Decompression via marsupialization can be considered for larger lesions to attempt to shrink tumor, allow for consolidation of thin cortical walls 5-Fluorouracil application to bone
39
Describe treatment for ameloblastoma:
Resection is with 1.0-1.5 cm bony margins and one uninvolved anatomical barrier Recurrence rate is 70-85% for enucleation and curettage, due to incomplete removal cure rate is 98% for resection
40
Describe pathway for metastasizing ameloblastoma:
(embolus) Pterygoid plexus → Retromandibular vein → Internal jugular vein → Subclavian/Brachiocephalic vein → Superior vena cava → Right atrium → Right ventricle → Pulmonary artery → Tumor embolus wedges in lungs →. Tumor embolus clones in lungs
41
Ameloblastoma and Myxoma treatment:
Resection with 1-1.5cm margin and one uninvolved anatomic barrier
42
GOC treagtment:
Due to usual aggressive behavior and size, resection is sometimes needed
43
CEOT treatment:
Treatment varies ranging from enucleation/curettage for small lesions to resection with 1-1.5mm margins in bone and one uninvolved anatomic barrier
44
AFO/Odontoma treatment:
Not infiltrative nor adherent to bone, separates easily with enucleation and curettage, No grafting is usually needed, bone will regenerate in 9-12 months
45
AOT and COC treatment:
Treatment is enucleation, very rare recurrence
46
What is a central giant cell granuloma?
Benign proliferation of osteoclast-type multinucleated giant cells in a hypervascularized mesenchymal stroma
47
What are the two types of central giant cell granulomas?
Aggressive: >5cm rapid growth, tooth displacement, and cortical perforation Non-aggressive: < 5cm excise and curretage this
48
What are the adjuvant treatments for central giant cell granulomas?
Steroids: triamcinolone 10mg/ml 1cc for 1cm for 6 weeks CalcitoninL Sq 100 U for 18 months INFalpha: 3 mil units daily for 6 months Denosumab: 120 mg Subq for 3 weeks
49
What MRONJ stages?
Stage 1 =asymptomatic exposed bone Stage 2 = exposed bone that probes and is painful, and is necrotic with fistula Stage 3 = necrotic bone beyond the alveolus associated with a fracture or pathology
50
How does denosumab work?
Inhibits the receptor-activator of nuclear factor kappa-β ligand (RANKL) Decreases osteoclast activity, bone resorption, and skeletal related events
51
What is pemphigoid?
Autoantibodies against basement membrane molecules (BP180, BP230) leads to hemidesmosome failure
52
What is pemphigus?
Autoimmune attack against desmosomes’ proteins (Desmoglein 1 & 3)

Nashville Review 2024 (3 decks)

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