Oncology Flashcards
(137 cards)
1
Q
Where to perform proximal humerus biopsy
A
through anterior third of deltoid
2
Q
What type of needle bx to do?
A
in general: core needle
if not enough: incisional bx
(avoid FNA)
3
Q
Doxorubicin side effect
A
CHF/cardiomyopathy
4
Q
Pazopanib mechanism
A
anti-VEGF
5
Q
well-differentiated liposarcoma (ALT) genetics
A
MDM2 amplification
6
Q
myxoid liposarcoma genetics
A
t(12;16), TLS-CHOP
7
Q
synovial sarcoma genetics
A
t(X;18), SYT-SSX
8
Q
ewing sarcoma genetics
A
t(11;22), EWS-FLI
9
Q
Rhabdomyosarcoma genetics
A
t(2;13), PAX-FKHR
10
Q
clear cell sarcoma genetics
A
t(12;22), EWS-ATF
11
Q
myxoid chondrosarcoma genetics
A
t(9;22), EWS-CHN
12
Q
Cytogenetic analysis determines…
A
translocation.
13
Q
Colorectal tumor marker
A
CEA
14
Q
Pancreatic tumor marker
A
CA-19-1
15
Q
Ovarian tumor marker
A
CA-125
16
Q
Breast tumor marker
A
CA-15-3
17
Q
HCC tumor marker
A
AFP
18
Q
Fibrous dysplasia is caused by…
A
activating missense mutation of Gs alpha protein (GNAS1 gene) which leads to increased cAMP production.
19
Q
Fibrous dypslasia classic xray
A
ground glass
20
Q
Fibrous dysplasia of the proximal femur leads to…
A
shepherd’s crook deformity
21
Q
McCune Albright
A
coast of Maine cafe au lait lesions, precocious puberty, polyostotic fibrous dysplasia
22
Q
Fibrous dysplasia histology
A
alphabet soup
fibroblasts surrounding islands of bone
NO osteoblastic rimming
23
Q
NOF histology
A
spindle cells in a storiform pattern
24
Q
mechanism of pain with osteoid osteoma
A
PGE2 and cycloxygenase
25
Common tumors of the posterior elements of the spine
osteoid osteoma, osteoblastoma, ABC
26
Histology of osteoid osteoma
woven bone, with osteoblastic rimming
27
Osteoblastoma is...
an osteoid osteoma > 1.5-2 cm that is more locally aggressive and less responsive to NSAIDs
28
An osteochondroma that has a cartilage cap that is...
greater than 2 cm poses risk for malignant transformation.
29
Multiple Hereditary Exostoses (MHE) genetics
autosomal dominant
EXT1 (most severe), EXT2, EXT3.
EXT is important in the synthesis of heparan sulfate.
30
What percent risk of malignant transformation does MHE have?
10% to chondrosarcoma (compared to 1% risk with solitary osteochondroma)
31
Traits of MHE
- short
- LLD
- long bone deformities
- subluxation of radiocapitellar joints
32
Treatment of MHE pt with loss of forearm fotation
marginal resection of the osteochondromas to improve rotation
33
Eosinophilic granuloma spine trait
vertebra plana
34
EG histology
Langerhan's cells with coffee bean nuclei, Birbeck granules
35
Hand-Schuller-Christian syndrome
- lytic skull lesions
- diabetes insipidus
- exophthalmos
- eosinophilic granuloma
36
Work-up of GCT
chest xray or CT to evaluate for lung mets
37
Most common spot for GCT
distal femur
38
The neoplastic cells in GCT are....
mononuclear stromal cells (pre-osteoblastic mononuclear cells), NOT multinucleated giant cells.
39
Treatment of GCT
Denosumab (RANKL inhibitor); curettage and bone graft or cement and adjuvant
40
Adjuvants for GCT
argon beam, liquid nitrogen, phenol, hydrogen peroxide, denosumab
41
Most common spot for UBC
central lytic lesion in the metaphysis of the proximal humerus
42
Over time, a UBC...
will get smaller and may spontaneously resolve.
43
Compared to a UBC, an ABC...
is eccentric and expands greater than the width of the physis w/ multiple septae separating blood-filled cavities.
44
Bone tumors common in the anterior tibia
adamantinoma and osteofibrous dysplasia
45
Adamantinoma
histology: nests of cells in palisading pattern
mets to the lungs
wide excision
46
Osteofibrous dysplasia (ossifying fibroma) histology
osteoblastic rimming
47
Work-up of osteosarcoma
xrays of the entire extremity, MRI, bone scan, CT chest, bx
48
Additional work-up of Ewing sarcoma
bone marrow bx
49
Metastasis of osteosarcoma is greater to...
lungs.
50
Risk factors for osteosarcoma
- Paget's
- retinoblastoma (Rb)
- p53
51
General Enneking presentation of osteosarcoma
-Stage IIB (high grade, extracompartmental)
52
MSTS (Enneking) Staging System
```
IA: low grade, intra-compartmental
IB: low grade, extra-compartmental
IIA: high grade, intra-compartmental
IIB: high grade, extra-compartmental
III: mets
```
53
Tx of osteosarcoma
chemo for 8-12 wks, surgery, chemo for 6-12 mos
54
There is improved overall survival of osteosarcoma if chemo is resumed within....
18-21 days after surgery.
55
Imaging of intramedullary osteosarcoma
sunburst, codman's triangle, metaphyseal
56
Imaging parosteal osteosarcoma
surface/juxtacortical on the posterior metaphysis of the distal femur (stuck-on)
57
Most common form of osteosarcoma
intramedullary
58
Tx of parosteal osteosarcoma
wide excision only (no chemo) since low grade
59
Periosteal osteosarcoma imaging
sunburst, codman's and diaphyseal
60
Imaging and histology of periosteal osteosarcoma
eccentric, lytic lesion
lakes of blood, like ABC but with more malignant features
61
Tx of Ewings
chemo-sx-chemo
62
Ewing's facts
CD99+
| elevated LDH is associated with worse tumor burden
63
Most common functional deficit after proximal femoral replacement is....
abductor weakness.
64
In the distal femur ES or OS, most durable reconstruction is...
rotationplasty.
65
Malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) is...
a malignant bone tumor similar to OS in clinical presentation and imaging.
66
Histology of MFH
pleomorphic spindle cells in storiform pattern (unlike osteo, no bone formation)
67
Secondary MFH/UPS may arise from...
chronic bone infarct, Paget's or post-radiation.
68
Treatment of MFH
chemo, sx, chemo
69
Multiple myeloma facts
- plasma cells w/ clock-face, eccentric nuclei
- SPEP (M spike): IgG >>> IgA heavy chains
- UPEP: kappa of lambda light chains (bence jones proteins)
70
Multiple myeloma CRAB
C: hyperCalcemia
R: renal insufficiency
A: anemia
B: bone lesions
71
What is responsble for punched out lesions in MM?
RANKL
72
Which diseases are cold on bone scan?
MM and thyroid carcinoma
73
Treatment for MM
bisphosphonates, chemo
(For pathologic fx, surgery, radiation and bisphosphonates).
74
MM solitary lesion
plasmacytoma
Tx: radiation
75
Lymphoma presents with...
B symptoms and diffuse, mottled, permeative lytic lesions.
76
Diagnosis of lymphoma done with...
flow cytometry and cytogenetic analsysis
| need unfixed fresh tissue
77
Histology of lymhpoma
small round blue cells
CD20+
CD45+
78
Treatment of lymphoma
chemo +/- radiation
79
An enchondroma is...
a benign cartialge tumor in the medullary cavity
80
Most common tumor in the hand
enchondroma
81
Histology of enchondroma
hyaline cartilage (uniform chondrocytes in lacunae)
82
Tx of symptomatic enchondroma
intralesional curretage and bone graft
83
Risk of malignant transfomration of enchondroma
1% to chondrosarcoma
84
Ollier's dz
multiple enchondromas
30% risk of malignant transformation
85
Maffucci's syndrome
multiple enchondromas, angiomas/hemangiomas, visceral malignancies
30% malignant transformation to chondrosarcoma but 100% lifetime risk of developing any malignancy (GI, astrocytoma, etc.)
86
X-ray of chondrosarcoma
cortical destruction, endosteal scalloping, periosteal rxn
87
X-rays of chondroblastoma
lytic lesion in epiphysis that may cross the physis with thin sclerotic rim
88
histology of chondroblastoma
chickenwire or cobblestone arragnement of chondroblasts
89
Where does chondroblastoma metastasize?
lung (get chest imgaging)
90
Tx of symptomatic chondroblastoma
curettage and bone graft
91
Periosteal chondroma
benign cartilage tumor on surface (juxtacortical) of long bones, most often proximal humerus
92
Imaging of periosteal chondroma
stippled calcification and scalloping of the cortex
93
Treatment of periosteal chondroma
observe if asymptomatic, marginal excision if symptomatic
94
Recurrence of chondrosarcoma is correlated with...
increased telomerase activity.
95
Clear cell chondrosarcoma location
epiphysis
96
Mesenchymal chondrosarcoma is responsive to...
chemo.
97
Dedifferentiated chondrosarcoma is...
an aggressive, bimorphic (low grade chondroid, high grade sarcoma).
98
Treatment of chondrosarcoma
wide excision, generally does not respond to chemoradiaiton (except mesenchymal chondrosarcoma)
99
Schwannoma (neurilemmoma) facts
- benign
- associated with NFII
- target sign on MRI
100
Histology of schwannoma (neurilemmoma)
```
S100+
Antoni A (hypercellular) and Antoni B (hypocellular) biphasic pattern
```
101
Treatment of symptomatic schwannoma
marginal resection
102
Malignant peripheral nerve sheath tumor (neurofibrosarcoma) arises from...
peripheral nerve of neurofibroma (NF1) --> increased PET-CT uptake suggests malignant transformation
Stains S100+
Tx w/ wide excision and radiation.
103
Most common solid tumor in children < 2 years old
neuroblastoma
104
Most common location of the neuroblastoma
adrenal gland
105
histology of neuroblastoma
small round blue cells arranged in a rosette pattern
106
In PVNS and GCTTS, there is an overexpression of...
CSF-1.
107
Common areas for desmoid tumor
paraspinal region and posterior distal femur (popliteal fossa)
108
Desmoid tumor is associated with...
gardner syndrome and familial adenomatous polyposis.
Consider colonoscopy.
Elevated beta-catenin, estrogen receptor Beta positive.
109
Treatment of desmoid tumor
estrogen receptor blockade (tamoxifen), wide resectiona dn radiation
110
Work up of soft tissue sarcoma
CT C/A/P, MRI and biopsy
111
Treatment of soft tissue sarcoma is generally...
wide excision and radiation.
112
The most common malignant sarcoma of the foot is...
synovial sarcoma.
113
synovial sarcoma is biphasic -->
spindle cells and epithelial cells
114
Synovial sarcoma stains for...
vimentin and epithelial membrane antigen.
115
Myxoid liposarcoma will metastasize to...
retroperitoneum and therefore needs a CT C/A/P.
116
Treatment of liposarcoma
well-differentiated (aka ALT): marginal resection
| other types: wide resection and radiation
117
Epithelioid sarcoma facts
- most common soft tissue sarcoma of the hand
- can cause overlying skin ulceration
- keratin +
118
Leiomyosarcoma is...
malignant sarcoma of smooth muscle.
| Bone leiomyosarcoma will show...lytic bone lesions with soft tissue extension.
119
Histology of leiomyosarcoma
spindle cells arranged in fascicles
| actin, vimentin positive
120
Risk factor for angiosarcoma
polyvinyl chloride exposure
121
Angiosarcoma stains positive for...
CD31.
122
Worst and best prognoses for metastatic cancer
lung worst
| thyroid best
123
Blastic lesions include...
prostate and breast due to endothelin-1.
124
SCARE
```
synovial cell
clear cell
angiosarcoma
rhabdomyosarcoma
epithelioid
```
125
most common sarcoma in children
rhabdomyosarcoma
126
For metastatic ppx fixation, single dose of radiation...
gives equivalent pain relief and lower cost compared to multifractional.
127
Fibrodysplasia ossificans progressiva
"stone man disease"
- diffuse, progressive HO
- mutation of activin A type I receptor (ACVR1) whichis a BMP receptor
128
Melorheostosis
dysplasia of cortial bone --> hyperostosis, flowing candle wax along cortical surface
129
PVNS facts
-hemosiderin deposits lead to low signal on both T1 and T2
130
Synovial chondromatosis
intra-articular loose bodies comprising synovium/cartilage. If symptomatic, treat with synovectomy and loose body removal.
131
Synovial chondromatosis histology
synovial metaplasia
132
Dermatofibrosarcoma protuberans
cutaneous soft tissue sarcoma
133
Glomus tumor histology
small round blue cells
134
Chordoma
malignant tumor of notochordal cells, most common in the sacrum/coccyx
135
Histology of chordoma
- physaliferous cells
- keratin +
- S100 +
136
Treatment of chordoma
wide resection (vertebrectomy w/ anterior and posterior reconstruction) +/- radiation
137
Tumoral calcinosis
dysfunction of phosphate regulation --> peri-articular calcinosis in extra-capsular soft tissues.
- more prevalent in african-americans
- mutations in FGF23
