Soft Tissue Sarcomas and Lymphomas, C62 P464-468 Flashcards Preview

Section II General Surgery P203Surgical Recall Sixth > Soft Tissue Sarcomas and Lymphomas, C62 P464-468 > Flashcards

Flashcards in Soft Tissue Sarcomas and Lymphomas, C62 P464-468 Deck (63):
1

SOFT TISSUE SARCOMAS
What are they?
P464

Soft tissue tumors, derived from mesoderm

2

SOFT TISSUE SARCOMAS
Sarcoma means what in
GREEK?
P464

“Fish flesh”

3

SOFT TISSUE SARCOMAS
Sarcomas are more common
in upper or lower
extremities?
P464

50% of sarcomas are in the extremities
and are 3.5 more common in the
lower extremity (thigh)

4

SOFT TISSUE SARCOMAS
How common are they?
P464

0.6% of malignant tumors

5

SOFT TISSUE SARCOMAS
What is the median age at
diagnosis?
P464

55 years

6

SOFT TISSUE SARCOMAS
What are the risk factors?
P464

“RALES”:
Radiation
AIDS (Immunosuppression)
Lymphedema
Exposure to chemicals
Syndromes (e.g., Gardner’s/Li-Fraumeni)

7

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Fat
P464

Liposarcoma

8

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Gastrointestinal
P464

GIST (GastroIntestinal Stromal Tumor)

9

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Myofibroblast
P464

Malignant fibrous histiocytoma

10

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Striated muscle
P464

Rhabdomyosarcoma

11

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Vascular endothelium
P464

Angiosarcoma

12

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Fibroblast
P464

Fibrosarcoma

13

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Lymph vessel
P465

Lymphangiosarcoma

14

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Peripheral nerve
P465

Malignant neurilemmoma or
schwannoma

15

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
AIDS
P465

Kaposi’s sarcoma

16

SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Lymphedema
P465

Lymphangiosarcoma

17

SOFT TISSUE SARCOMAS
What are the signs/
symptoms?
P465

Soft tissue mass; pain from compression
of adjacent structures, often noticed after
minor trauma to area of mass

18

SOFT TISSUE SARCOMAS
How do most sarcomas
metastasize?
P465

Hematogenously (i.e., via blood)

19

SOFT TISSUE SARCOMAS
What is the most common
location and route of
metastasis?
P465

Lungs via hematogenous route

20

SOFT TISSUE SARCOMAS
What tests should be done
in the preoperative workup?
P465

CXR,  ± chest CT, LFTs

21

SOFT TISSUE SARCOMAS
What are the three most
common malignant sarcomas
in adults?
P465

Fibrous histiocytoma (25%)
Liposarcoma (20%)
Leiomyosarcoma (15%)

22

SOFT TISSUE SARCOMAS
What are the two most
common in children?
P465

Rhabdomyosarcoma (about 50%),
fibrosarcoma (20%)

23

SOFT TISSUE SARCOMAS
What is the most common
type to metastasize to the
lymph nodes?
P465

Malignant fibrous histiocytoma

24

SOFT TISSUE SARCOMAS
What is the most
common sarcoma of the
retroperitoneum?
P465

Liposarcoma

25

SOFT TISSUE SARCOMAS
How do sarcomas locally
invade?
P465

Usually along anatomic planes such as
fascia, vessels, etc.

26

SOFT TISSUE SARCOMAS
How is the diagnosis made?
P465

Imaging workup—MRI is superior to
CT at distinguishing the tumor from
adjacent structures
Mass 3 cm: incisional biopsy or core
biopsy

27

SOFT TISSUE SARCOMAS
Define excisional biopsy.
P466

Biopsy by removing the entire mass

28

SOFT TISSUE SARCOMAS
Define incisional biopsy.
P466

Biopsy by removing a piece of the mass

29

SOFT TISSUE SARCOMAS
What is the orientation of
incision for incisional biopsy
of a suspected extremity
sarcoma?
P466

Longitudinal, not transverse, so that the
incision can be incorporated in a future
resection if biopsy for sarcoma is positive

30

SOFT TISSUE SARCOMAS
Define core biopsy.
P466

Large-bore needle that takes a core of
tissue (like a soil sample)

31

SOFT TISSUE SARCOMAS
What determines histologic
grade of sarcomas?
P466

1. Differentiation
2. Mitotic count
3. Tumor necrosis
Grade 1 = well differentiated
Grade 2 = moderately differentiated
Grade 3 = poorly differentiated

32

SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage I
P466

Well differentiated (grade 1), any size, no
nodes, no metastases

33

SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IIA
P466

< 5 cm, grade 2 or grade 3

34

SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IIB
P466

> 5 cm, grade 2

35

SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage III
P466

Positive nodes or >5 cm and grade 3

36

SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IV
P466

Distant metastases

37

SOFT TISSUE SARCOMAS
What is a pseudocapsule and
what is its importance?
P466

Outer layer of a sarcoma that represents
compressed malignant cells; microscopic
extensions of tumor cells invade through
the pseudocapsule into adjacent
structures—thus, definitive therapy must
include a wide margin of resection to
account for this phenomenon and not
just be “shelled-out” like a benign growth

38

SOFT TISSUE SARCOMAS
What is the most important
factor in the prognosis?
P466

Histologic grade of the primary lesion

39

SOFT TISSUE SARCOMAS
What is the treatment?
P467

Surgical resection and radiation (with or
without chemotherapy)

40

SOFT TISSUE SARCOMAS
What surgical margins are
obtained?
P467

2 cm (1 cm minimum)

41

SOFT TISSUE SARCOMAS
What is the “limb-sparing”
surgery for extremity
sarcoma?
P467

Avoidance of amputation with local
resection and chemoradiation

42

SOFT TISSUE SARCOMAS
What is the treatment of
pulmonary metastasis?
P467

Surgical resection for isolated lesions

43

SOFT TISSUE SARCOMAS
What tests should be done
in the follow-up?
P467

Physical examination, CXR, repeat CT/
MRI of the area of resection to look for
recurrence

44

SOFT TISSUE SARCOMAS
What syndrome of lymphangiosarcoma
arises in chronic
lymphedema after axillary
dissection for breast cancer?
P467

Stewart-Treves syndrome

45

SOFT TISSUE SARCOMAS
What syndrome is associated
with breast cancer and soft
tissue sarcoma?
P467

Li-Fraumeni syndrome (p53 tumor
suppressor gene mutation)

46

LYMPHOMA
How is the diagnosis made?
P467

Cervical or axillary node excisional biopsy

47

LYMPHOMA
What cell type is associated
with the histology of
Hodgkin’s disease?
P467

Reed-Sternberg cells

48

LYMPHOMA
What are the four
histopathologic types
of Hodgkin’s disease?
P467

1. Nodular sclerosing (most common;
 ≈50% of cases)
2. Mixed cellularity
3. Lymphocyte predominant (best
prognosis)
4. Lymphocyte depleted

49

LYMPHOMA
What are the indications for
a “staging laparotomy” in
Hodgkin’s disease?
P467

Rarely performed
Most experts rely on CT scans, PET
scans, bone marrow biopsy, and other
directed imaging and biopsies

50

LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage I
P468

Single lymph node region (Think:
Stage 1 = 1 region)

51

LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage II
P468

Two or more lymph node regions on
the same side of the diaphragm
(Think: Stage 2 = >2 regions)

52

LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage III
P468

Involvement on both sides of the
diaphragm

53

LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage IV
P468

Diffuse and/or disseminated involvement

54

LYMPHOMA
What is stage A Hodgkin’s?
P468

Asymptomatic (Think: Asymptomatic 
stage A)

55

LYMPHOMA
What is stage B Hodgkin’s?
P468

Symptomatic: weight loss, fever, night
sweats, etc. (Think: Stage B = Bad)

56

LYMPHOMA
What is the “E” on the
staging?
P468

Extralymphatic site involvement
(E = Extralymphatic)

57

LYMPHOMA
What treatments are used
for low versus advanced
stage Hodgkin’s lymphoma?
P468

Low stage: radiotherapy
Advanced stage: chemotherapy

58

LYMPHOMA
What percentage of patients
with Hodgkin’s disease can
be cured?
P468

≈80%

59

GI LYMPHOMA
What is it?
P468

Non-Hodgkin’s lymphoma arising in the
GI tract

60

GI LYMPHOMA
What is the risk factor for
gastric lymphoma?
P468

Helicobacter pylori

61

GI LYMPHOMA
What are the signs/
symptoms?
P468

Abdominal pain, obstruction, GI
hemorrhage, GI tract perforation, fatigue

62

GI LYMPHOMA
What is the treatment of
intestinal lymphoma?
P468

Surgical resection with removal of
draining lymph nodes and chemotherapy

63

GI LYMPHOMA
What is the most common
site of primary GI tract
lymphoma?
P468

Stomach (66%) (see Maltoma, p. 281)