Benign tumors Flashcards
1
Q
What are seborrheic keratoses?
A
Round, flat, coin-like plaques that vary in diameter
2
Q
seborrheic keratoses are rare before what age?
A
30
3
Q
What is the treatment for seborrheic keratoses?
A
Surgery
Chemical peeling agents
Electro or cryotherapy
4
Q
true or false: seborrheic keratoses are generally well circumscribed, unlike melanomas
A
True
5
Q
True or false: seborrheic keratoses usually occur as a single lesion, unlike melanomas
A
Double false– seborrheic keratoses occur in multiples, and melanomas occur as singletons
6
Q
What is the Leser-Trelat sign, and what might it indicate?
A
the explosive onset of multiple seborrheic keratoses[1] (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome
7
Q
What are the histological findings of seborrheic keratoses?
A
Well defined papillations of keratin confined to the epidermis, with microcysts within them
8
Q
What are the histological findings of pigmented seborrheic keratoses?
A
Same as seborrheic keratoses, but with a lot of pigment within the keratinocytes
9
Q
What defines the difference in pigmentation between people
A
Difference in pigmentation in the keratinocytes–NOT in the number of melanocytes
10
Q
True or false: the number of melanocytes does not vary much between people
A
True
11
Q
What are fibroepithelial polyp acrochordon? What usually causes these?
A
- Polyps on the skin that have a fibrovascular core, covered by a benign epithelium
- Chronic rubbing of the skin
12
Q
Polyps on the skin that have a fibrovascular core, covered by a benign epithelium = ?
A
Fibroepithelial polyp-acrochordon
13
Q
What are the four major types of epithelial cysts?
A
- Epidermal inclusion cysts
- Pilar or trichilemmal cysts
- Dermoid cysts
- Steatocystomas
14
Q
What is the classic appearance of epidermoid cysts?
A
Deep nodules with a central punctum
15
Q
Deep nodule with a central punctum = ?
A
Epidermoid cysts
16
Q
What is a follicle?
A
a small secretory cavity, sac, or gland, in particular.
17
Q
What is an infundibulum?
A
a funnel-shaped cavity or structure.
18
Q
What are epidermoid cysts filled with?
A
Loose Keratin
19
Q
Sebaceous cysts = ?
A
Epidermoid cysts
20
Q
What are trichilemmal cysts?
A
a common cyst that forms from a hair follicle. They are most often found on the scalp. The cysts are smooth, mobile and filled with keratin
21
Q
What are dermoid cysts?
A
a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands
22
Q
What is the classic presentation of a dermoid cyst?
A
Single SQ nodule present at birth on the lateral aspect of the upper eyelid
23
Q
What are the histological characteristics of a dermoid cyst?
A
Like epidermoid cyst, but with dermal tissue components
24
Q
What are steatocystomas?
A
AD mutation in keratin 17, resulting in multiple cysts on the body, usually in the sternal, axillae, and groin
25
What are the histological characteristics of steatocystomas?
Jagged area of keratin, with sebaceous structures attached to it
26
What are trichilemmomas?
a benign cutaneous neoplasm that shows differentiation toward cells of the outer root sheath
27
What is Cowden's disease?
AD mutation in PTEN gene that predisposed for breast and thyroid CA. Presents are multiple, hamartomas, as well as trichilemmomas
28
Multiple trichilemmomas = what disease?
Cowden's disease
29
What are the characteristics of trichilemmomas?
Lighter, clear sheets of cells with a thick BM
30
Lighter, clear sheets of cells with a thick BM = ?
Trichilemmomas
31
What are pilomatricomas? Where are they most commonly found on the body?
Benign skin tumor derived from the hair matrix
| -head (cheek) and neck region, but also on UE and trunk
32
What genetic disease is associated with pilomatricomas?
Turner's syndrome
33
What is the genetic mutation associated with pilomatricomas?
APC mutation, resulting in high beta catenin
34
What are the histological features of pilomatricomas?
anucleate squamous cells (called "ghost cells"), benign viable squamous cells and multi-nucleated giant cells. The presence of calcifications is common.
35
What percent of pilomatricomas occur before age 20?
60%
36
anucleate squamous cells (called "ghost cells"), benign viable squamous cells and multi-nucleated giant cells = ?
Pilomatrixoma
37
What is Birt-Hogg-Dube syndrome? Genetic cause?
AD mutation to BHD gene on chr 17, which encodes the protein folliculin.
-Causes susceptibility to a wide variety of cancers, and fibrofolliculomas
38
What are fibrofolliculomas? What syndrome are they seen in?
2 to 4 mm in diameter, dome-shaped, yellowish or skin-colored papules usually located on the head, neck, and upper trunk. They are characteristically seen in Birt–Hogg–Dubé syndrome
39
What are the two diseases in particular that Birt-Hogg-Dube syndrome is associated with?
- Renal tumors
| - Spontaneous pneumothorax
40
What are the gross characteristics of fibrofolliculomas?
Small white papules, usually located along the face
41
What are the gross characteristics of trichodiscomas?
Small white papules, usually located along the face
42
What are the histological characteristics of fibrofolliculomas?
Abortive and squeezed off follicular structures surrounded by fat cells
43
Abortive and squeezed off follicular structures surrounded by fat cells = ?
Fibrofolliculomas
44
What are the two skin lesions associated with Birt-Hogg-Dube syndrome?
Fibrofolliculomas
| Trichodiscomas
45
What is a nevus sebaceous? Where on the body is it usually found? What age? Which gender?
- A congenital, hairless plaque that typically occurs on the face or scalp.
- Present at birth, affecting males and females of all races equally. The condition is named for an overgrowth of sebaceous glands in the area of the nevus.
46
What is the prognosis for nevus sebaceous?
In itself is benign, but secondary tumors may arise from it--usually BCC
47
True or false: all nevi are melanocytic proliferaitons
False--nevus sebaceous is not
48
What are the gross findings of nevus sebaceous?
Localized area of alopecia, with a waxy, papule
49
What are the histological findings of nevus sebaceous?
Abortive hair follicles, with a whole bunch of sebaceous glands attached to them
50
Localized area of alopecia, with a waxy, papule + Abortive hair follicles, with a whole bunch of sebaceous glands attached to them on histology = ?
Nevus sebaceous
51
How common is sebaceous hyperplasia? What causes it? What is it often misdiagnosed as?
Common on faces of adults from sun damage that is usually misdiagnosed as BCC
52
What are the gross characteristics of sebaceous hyperplasia?
Yellowish dome shaped papules
53
What are the histological characteristics of sebaceous hyperplasia?
Tons o' sebaceous glands
54
Yellowish dome shaped papules with a central punctum + tons o' sebaceous glands on histology = ?
Sebaceous hyperplasia
55
What are sebaceous adenomas? What condition are they associated with? Where on the body are they usually found?
- Rare, benign tumor of sebaceous glands
- Muir–Torre syndrome
- face and scalp of old people
56
What is Muir–Torre syndrome? What is the genetic defect and inheritance pattern? What skin findings are associated with it?
a rare hereditary, autosomal dominant cancer syndrome that is thought to be a subtype of HNPCC.
- Individuals are prone to develop cancers and skin lesions, such as keratoacanthomas and sebaceous tumors.
- The genes affected are MLH1, MSH2, which are involved in DNA mismatch repair and microsatellite stability.
-Sebaceous adenomas
57
What are the histological characteristics of sebaceous adenomas?
Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated
58
Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated = ?
Sebaceous adenomas
59
What are sebaceomas? What does it look like grossly?
A sebaceous structure that is intermediate in malignancy, that appears as a yellow or orange papule
60
What are the histological characteristics of sebaceomas?
Somewhat differentiated sebaceous glands
61
What are the cutaneous findings of MTS?
Sebaceous tumors:
- Adenomas, sebaceomas
- Keratoacanthomas
62
What are the visceral malignancies associated with MTS?
- Colon
- Bladder
- Endometrium
- Breast
63
What is the immunostaining technique used to diagnose MTS? What is an abnormal result?
Stain for MLH1 and MSH2
| Loss of stain = pathologic
64
What are cylindromas? Where do they most often occur on the body? What is the F:M?
- Sweat gland tumors that appear as pink/red nodules
- head and neck
- 9:1
65
What is Brooke-Spiegler syndrome? What are the tumors that can grow with this condition?
a condition involving multiple skin tumors including growths called spiradenomas, trichoepitheliomas, and cylindromas.
66
What is the genetic inheritance and mutation of Brooke-Spiegler syndrome?
AD CYLD gene on chr 16
Causes NF-kappa-B pathway overactivation
67
What are the histological findings of cylindromas?
Jigsaw puzzle
68
Jigsaw puzzle histology = ?
Cylindromas
69
What are xanthomas?
Benign aggregate of histiocytes with cytoplasmic lipids
70
What are the five main clinical types of xanthomas? Which is the only one that has normal serum lipid levels?
- Eruptive
- Tendinous
- Tuberous
- Planar
- **Disseminated**
71
What are xanthogranulomas? What age do they typically arise? What conditions are associated with this?
yellow/brown papules or nodules on the head and neck region that usually arise within the first 5 years of life
-CML and NF
72
What is the prognosis for xanthogranulomas?
They themselves are benign and spontaneously regress within several years, but may indicate underlying visceral pathology
73
What are histological findings of xanthogranulomas?
Histiocytes in the dermis and Touton giant cells
74
Histiocytes in the dermis and Touton giant cells = ?
JXG
75
What is the age and gender that is typically affected with reticulohistiocytomas?
Middle aged females
76
What are the two forms of reticulohistiocytomas?
Solitary
| Multicentric
77
What are the histological findings of reticulohistiocytomas?
Ground glass histiocytes
78
Ground glass histiocytes = ?
reticulohistiocytomas
79
What are the associations of reticulohistiocytomas?
CT diseases
| Vasculitis
80
What is the acute generalized form of LCH (letterer-Siwe disease), and who does it affect? How aggressive is it?
A rapidly progressing disease in which Langerhans Cell cells proliferate in many tissues, including internal organs. It is mostly seen in children under age 2, and the prognosis is poor: even with aggressive chemotherapy, the five-year survival is only 50%
81
What is the multifocal chronic form of LCH (Hand-Schuller-Christian disease)? Who is it usually seen in? S/sx?
Seen mostly in children, multifocal unisystem LCH is characterized by fever, bone lesions and diffuse eruptions, usually on the scalp and in the ear canals. 50% of cases involve the pituitary stalk, leading to diabetes insipidus.
The triad of diabetes insipidus, exophthalmos, and lytic bone lesions is known as the Hand-Schüller-Christian triad. Peak onset is 2–10 years of age.
82
What is the classic triad of symptoms for multifocal chronic LCH?
- Lytic skull lesions
- DI
- Proptosis
83
What is the treatment for multifocal LCH?
XRT and chemo
84
What is the unifocal version of LCH (eosinophilic granuloma)?
A slowly progressing disease characterized by an expanding proliferation of Langerhans Cells in various bones. It is a monostotic (involving only one bone) or polyostotic (involving more than one bone) disease. It typically has no extraskeletal involvement, but rarely an identical lesion can be found in the skin, lungs, or stomach.
85
What is the prognosis for unifocal LCH (eosinophilic granuloma)? Treatment?
most benign--relative good prognosis
Treatment = Excision or XRT
86
What are the LM and EM findings of LCH?
```
LM = Dermal infiltration of monocytes and giant cells. Crinkled appearance to nuclei
EM = Birbeck granules
```
87
What is the immunostain for LCH?
CD1a
88
What is benign fibrous histiocytoma (dermatofibroma)?
Benign, tan-brown papules, with size varying over time. Related to dermal neoplasms of fibroblasts and histiocytes
89
What are the histological findings of dermatofibromas?
Spindle cells appearance that trap collagen bundles ("doughnut sign")
90
What is the most common CT tumor?
Lipomas
91
What are pyogenic granulomas?
Hemangiomas
(This name is misleading as it is not a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype which is the reason they are prone to bleeding.[4] Additionally, it is also not truly pyogenic, ("pus producing") as the cause is hormonal or traumatic and has no association with infection or pus production.)
92
What are cavernous hemangiomas?
Big vessel proliferation
93
What are arteriovenous hemangiomas?
Mix of thin and thick walled vessels
94
What are traumatic neuromas? S/sx?
A type of neuroma which results from trauma to a nerve, resulting in a disorderly proliferation of bundle of peripheral nerves
-Usually painful nodule
-
95
What are the histological characteristics of traumatic neuromas?
haphazard neuron proliferation
96
What is Morton's neuroma? S/sx?
A benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve.
-The main symptoms are pain and/or numbness that is exacerbated by walking.
97
True or false: Morton's neuroma usually present with a large, palpable mass
False--usually no mass is palpable
98
what are the three diseases of MEN1?
- Pituitary adenomas
- Pancreatic tumors
- Parathyroid
99
What are the three diseases of MEN2a?
- Medullary thyroid CA
- Parathyroid hyperplasia
- Pheochromocytoma
100
What are the three diseases of MEN2b?
- Medullary thyroid CA
- Mucosal neuromas
- Pheochromocytoma
101
What are the histological findings of mucosal neuromas?
Mucosal nodules with tiny nerve-lets
102
what are palisaded encapsulated neuromas? what age range are they usually found in?
Solitary, painless nodules that are commonly found on the face.
middle aged to old
103
What are schwannomas? Where on the body are they more prevalent?
a benign nerve sheath tumor composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves.
104
Is there an association of schwannomas with NF?
Per him, no, but in reality, yes.
105
What is the usual presentation of schwannomas? How often do they recur?
Solitary, painless SQ mass
Little capacity of recurrence
106
What is the antoni A type of schwannomas?
Cellular with nuclear palisading (verocay bodies)
107
What is the antoni B type of schwannomas?
Schwann cells, but hypocellular, with a myxoid matrix
108
Why are the blood vessels prominent with schwannomas?
Thick hyaline walls
109
Cellular with nuclear palisading (verocay bodies)
Antoni A
110
Schwann cells, but hypocellular, with a myxoid matrix
Antoni B
111
What are the characteristics of neurofibromas?
Solitary polypoid or nodular lesion with a wide distribution
112
What are the histological characteristics of neurofibromas?
Circumscribed, but unencapsulated, with a sheet like wavy nerve cells
113
Circumscribed, but unencapsulated, with a sheet like wavy nerve cells = ?
neurofibroma
114
What are plexiform neurofibromas?
a benign tumor of peripheral nerves (WHO grade I) arising from a proliferation of all neural elements, pathognomonic of neurofibromatosis type 1 (NF1). It involves single or multiple nerve fascicles that arises from major nerve branches.
115
plexiform neurofibromas = what disease
NF1
116
What are granular cell tumors?
a tumor that can develop on any skin or mucosal surface, but occurs on the tongue 40% of the time.
117
what are the histological characteristics of granular cell tumors?
Proliferation of cells with granular pink cytoplasm
118
Which gender usually gets granular cell tumors?
Females
119
Are granular cell tumors fast of slow growing? Recurrence rate? Treatment?
Slow growing
Low recurrence
Excise
120
What are the two versions of leiomyomas?
Pilar
| Angio
121
What are giant cell tumors of the tendon sheath?
Uncommon and usually benign lesions that arise from the tendon sheath
122
Where are giant cell tumors of tendon sheaths usually found?
hand, feet, wrists, knees and other small joints
123
What is the prognosis for giant cell tumors of the tendon sheath? Treatment?
Benign, but can recur
excise
124
What are the histological findings of GCTTS?
Giant cells with PMNs in the background
125
What are ganglion cysts? Where are they usually found? What causes them? S/sx?
- Myxoid degeneration of a joint capsule, usually found in the wrist, hand, foot, and ankle.
- Caused by overuse
- Pain or weakness
126
What are the histological characteristics of ganglion cysts?
pseudocysts-no epithelial lining
Cystic space ling by histiocytes and granulation tissue with moderate inflammation
127
Cystic space ling by histiocytes and granulation tissue with moderate inflammation = ?
Ganglion cysts
128
What are superficial fibromatosis? (hand, plantar, penis)
Proliferation of spindle cells in tissue of various sites:
Hand = dupuytren's contracture
Plantar = Ledderhose dz
Penile = peyrones disease
129
True or false: superficial fibromatosis usually has beta catenin mutaitons
False
