C2.3: Metastatic Malignant Neoplastic Diseases

Question 1

is lymphadenopathy often seen w/ mets

Answer 1

yes

Question 2

what is needed to determine the origin of mets tumors

Answer 2

biopsy

Question 3

most common sites for mets (BALL)

Answer 3

bone
adrenals
liver
lung

Question 4

are primary or secondary cancers the most common malignant tumor(s) of the liver

Answer 4

secondary

Question 5

does liver mets usually produce symptoms

Answer 5

no

Question 6

suggestice US appearance for liver mets

Answer 6

multiple lesions

hypoechoic halo

Question 7

signs and symp. of liver mets

Answer 7

hepatomegally
jaundice
pain
anorexia/nutritional wasting and muscle deterioration

Question 8

what lab values will be increase w/ liver mets

Answer 8

LFTs:
Alk phos
AST
ALT

Question 9

mets to which organs/areas of the body are rare

Answer 9

spleen
panc
GI tract
bladder

Question 10

is mets to the GB usually associated w/ gallstones

Answer 10

no (where as primary cancer of the GB are)

Question 11

typical US appearance of panc mets

Answer 11

small hypo mass

Question 12

is mets to the kidney common

from which organs?

Answer 12

yes

lung, breast, other kidney

Question 13

US appearance of metastatic lymphoma to the kidney

Answer 13

• non-specific renal enlargement and diffusely hypo kidney
• look for vessel/organ displacement due to enlarged nodes

appearance of other types of kidney mets are variable

Question 14

most common site for mets to the GI to occur

Answer 14

stomach, then Sm bowel, the colon

Question 15

Us appearance of GI mets

Answer 15

large, well defined, hypo mass w/ ring down

Question 16

which organ is the 4th most common site of mets

Answer 16

adrenal

know for registry

Question 17

which cancers usually mets to the adrenals

Answer 17

lung
breast
melanoma

Question 18

is adrenal mets usually bilateral

Answer 18

yes

Question 19

mets to the retroperitoneum typically occurs from which primaries

Answer 19

testicular

pelvic tumors

Question 20

mets to the abdo wall typically occurs from which primaries

Us appearance

Answer 20

melanoma

hypo mass w/ posterior enhancement (dont confuse w/ a cyst)

Question 21

what is peritoneal carcinomatosis

US appearance

Answer 21

diffuse metastatic spread to peritoneum

omental caking/thickening
hypo nodules or masses
ascites
mesenteric thickening or lymphadenopathy

Question 22

what is pseudomyxoma peritonei

Answer 22

gelatinous ascites that almost always originates from perforated appendiceal epithelial tumor

Question 23

prognosis for pseudomyxoma peritonei

Answer 23

variable

Question 24

US appearance of pseudomyxoma peritonei

Answer 24

complex ascites

non mobile bowel loops pushed centrally and posteriorly, creating the ‘starburst appearance’

Question 25

Acronym for all malignant and benign neoplasms that can have a variable US appearance

Answer 25

H[AL]L MARC

H - hemangioma of the spleen/hemangiosarcoma of the spleen
AL - abdo wall lipoma (varying degrees of echogenic)
L - lymphangioma of the spleen

M - mets to the liver
A - adenoma of the liver (often hyper but varies)
R - RCC (vairable ecogenicity)
C - cortical cancer

Question 26

Acronym for all malignant and benign neoplasms that are more common in women

Answer 26

FAD & HCG

F - FNH
A - AML & adenoma
D - Desmoid

H - Hemangioma
C - Cystic neoplasms of the panc
G - GB carcinoma

Question 27

Acronym for all malignant and benign neoplasms that are more common in men

Answer 27

MAAC HALL

M - Mesothelioma
A - Adenoma of the GI
A - Adenoma of the panc
C - Cholangiocarcinoma

H - HCC
A - Adenoma/oncocytoma of the kidney
L - Lymphoma (Hodgkins)
L - Lymphoma of the GI

All primary malignancies of the peritoneum (mesotheiloma and lyphoma of GI)
and ALL primary malignancies of the urinary tract (not included here)