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P&T Block 2 > Cancer > Flashcards

Cancer Flashcards

1
Q
A

malignant cells are large with abundant eosinophilic cytoplasm, large, vesicular nucleus

extends into the dermis

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2
Q

23 year old patient

enlarged lymph node in neck

fevers, weight loss, itchy skin, and alcohol induced pain

A

Hodgkin lymphoma

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3
Q

4 mechanisms monoclonal antibodies can induce tumor death

A
  1. activation of complement cascade
  2. binding allows interaction of NK cell with tumor cell (ADCC)
  3. bindings allows interaction with macrophage (phagocytosis)
  4. triggers direct apoptosis
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4
Q

Acral Lentiginous Melanoma

A

10% of all melanomas

most common in darkly pigmented individuals

located on plams, soles, and lips

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5
Q

Actin- immunohistochemical marker for?

A

leiomyosarcoma rhabdomyosarcoma

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6
Q

Actinic cheilitis

A

actinic keratosis of the lower lip

if not treated, progresses to SCC with higher rate of metastases

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7
Q

Actinic Keratosis

A

precursor of SCC

rough, scaly, slightly raised

under 1 cm in diameter

sun exposed areas

when on lower lip= actinic cheilitis–> high rate of metastases

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8
Q

Aggressive Types of Basal Cell Carcinoma

A

micronodular, morpheaform, and infiltrative

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9
Q

ALK fusion protein

A

Anaplastic large cell lymphoma

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10
Q

Alveolar Rhabdomyosarcoma

A

translocation involving long arm of 13 and 1 or 2–> transcription factors involved subtype determined by histology worse outcome

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11
Q

AML Hyperleukocytosis treatment

A

Hydroxyurea

leukapheresis

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12
Q

Anaplastic Large Cell lymphoma

A

most common T cell lymphoma in children

often involves soft tissue

large anaplastic cells- cluster around vessels and lymphatics

may mimic carcinoma because cells are huge with lots of cytoplasm

ALK constituatively activated

histology- horseshoe morphology, lots of cytoplasm, large

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13
Q
A

Basal cell carcinoma

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14
Q

Basal Cell Carcinoma

A

uncontrolled growth arising from basal layer of epidermis

most frequent site is the face

waxy, pearly papule

may have central depression, erosion, or crust

telangiectasias (may bleed)

slow growth pattern

many subtypes

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15
Q
A

large basaloid island of tumor cells budding off epidermis

=Basal Cell Carcinoma

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16
Q

Bone marrow aspirate

A

increased plasma cells

Multiple Myeloma

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17
Q
A

starry sky= tingible body macrophages eating up the apoptotic debris

=Burkitt lymphoma

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18
Q
A

Burkitt lymphoma

endemic type

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19
Q

Burkitt Lymphoma Morphology

A

high rate of apoptosis (starry sky)

High rate of mitosis (Ki67 = 100%)

presents as a rapidly growing mass

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20
Q

c-MYC (chromosome 8)

A

translocation = Burkitt lymphoma most commonly t(8;14) cMYC is an oncogene; translocation results in overexpression thereby allowing continued cell growth

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21
Q

Carcinoma = ?

A

malignant from epithelial cells

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22
Q

CD10+ CD20+ Ki67 100% c-MYC

A

Burkitt lymphoma

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23
Q

CD117 (c-kit)

A

GIST

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24
Q

CD15+ / CD30+, EBV +

A

Hodgkin’s Lymphoma

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25
Q

CD19 + CD23 + CD5 +

A

CLL

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26
Q

CD19+ CD5+ CD23 -

A

Mantle cell lymphoma cyclin D +

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27
Q

CD99 +

A

Ewing Sarcoma

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28
Q

CDKN2a

A

Predisposition for Melanoma

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29
Q

Cerebriform T cells

A

Mycosis Fungoides

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30
Q

CH10 + bcl2 +

A

Follicular lymphoma

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31
Q

Chondroblastic osteosarcoma

A

cartilaginous matrix production with malignant spindle cells

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32
Q

CHOP

A

(C)yclophosphamide–> an alkylating agent which damages DNA by binding to it and causing the formation of cross-links

(H)ydroxydaunorubicin= doxorubicin–> topo II inhibitor

(O)ncovin (vincristine)–> binds tubulin in M phase and prevents mitosis

(P)rednisone

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33
Q

Classical HL with best prognosis

A

Lymphocyte rich

40% EBV

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34
Q

Classical HL with worst prognosis

A

Lymphocyte depleted

90% EBV +, HIV patients, older patients

(usually associated with immunosuppression)

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35
Q

Classical Hodgkin Lymphomas

A

Nodular Sclerosing

Mixed Cellularity

Lymphocyte Depleted

Lymphocyte Rich

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36
Q

Clinical Presentation of Mantle Cell lymphoma

A

painless lymphadenopathy

mrrow involvement and circulating cells

extranodal sites

age 63 years

male

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37
Q

Clinical Presentation of Multiple Myeloma

A

hypercalcemia

bone pain

fracture risk

“punched out” lesions seen on xray

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38
Q
A

smudge cells

=CLL

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39
Q

cloverleaf multilobulated nuclei

A

adult T cell lymphoma

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40
Q

Common Malignant Primary Bone Tumors

A

osteosarcoma chondroblastoma Ewing sarcoma

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41
Q

Curative treatment for BCC

A

Mohs micrographic surgery

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42
Q

Cyclin D

A

promotes G1 to S phase

constituitively expressed in Mantle Cell

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43
Q

Desmin- marker for?

A

rhabdomyosarcoma or leiomyosarcoma sometimes MFH

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44
Q

Diagnosis of hyponatremia

A

look at serum osmolality

most commonly hypo or euvolemia

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45
Q

Diagnosis of Malignant Spinal Cord Compression

A

MRI of entire spinal cord

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46
Q

Diagnosis of Marginal Zone Lymphoma

A

diagnosis of exclusion

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47
Q

Diagnosis?

A

Basal cell carcinoma

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48
Q

Diagnosis?

A

Langerhans Cell Histiocytosis

birbeck granules on EM

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49
Q

Diagnostic test for Malignant Spinal Cord Compression

A

MRI of entire spinal cord

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50
Q

Large cells with huge nuclei, prominent nucleoli, marked variation

from one cell to the next

A

Diffuse Large B Cell Lymphoma

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51
Q

Disease caused by t(15;17)

A

APL acute promyelocytic leukemia

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52
Q

EBV associated neoplasms

A

Hodgkin, DLBCL, Burkitt, extranodal NK/T, PTLD

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53
Q

Embryonal Rhabdomyosarcoma

A

loss of heterozygosity at 11p resulting in increased IGF2 expression subtype determined by histology better outcome

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54
Q
A

Onion skinning

=Ewing sarcoma

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55
Q

example of cellular cancer immunotherapy

A

dendritic cells- vaccine given that contains dendritic cells that can recognize prostate cancer

CAR T cell therapy

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56
Q

Extranodal NK/T cell Lymphoma

A

destructive mass of nasopharynx

invades vessels–> ischemic necrosis

strong association with EBV

more common in Asian ancestry

(think of Sketchy EBV–> asian made with crab pinching his nose)

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57
Q

Factor VIII Related Antigen- marker for?

A

angiosarcoma kaposi’s sarcoma

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58
Q

Favorable karyotype for AML (chemotherapy)

A

t(8;21)

will respond to chemo

no transplant

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59
Q

Favorable sites for rhabdomyosarcoma

A

orbit, genitourinary (not bladder or prostate)

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60
Q

Fibroblastic osteosarcoma

A

high grade spindle cell stroma contains only focal osteoid production

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61
Q

Finding? Likely diagnosis?

A

Lytic lesions–> “punched-out” bone

Multiple myeloma

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62
Q

FLT3-ITD

A

AML

receptor tyrosine kinase is expressed on blasts

likely to relapse

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63
Q

focus on cell upper middle

A

Horseshoe morphology, large cells, lots of cytoplasm

= Anaplastic Large Cell lymphoma

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64
Q
A

Follicular Lymphoma

lots of neoplastic follicles (pale zone) crowding out normal nodal architecture

no mantle zone

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65
Q

Gastrointestinal stromal tumor (GIST)

A

soft tissue sarcoma composed of spindle cells majority are CD117 positive (diagnostic) highly variable behavior- can be very aggressive or recur 20+ years later originate on cells of Cajal rarely metastases outside of abdomen mostly occurs in upper Gi tract with stomach being most common prognosis and response determined by KIT and PDGF-R mutations

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66
Q

GIST

A

gastrointestinal stromal tumor composed of spindle cells c-kit (CD117) positive; mutations in PDGF-R originates from intestinal cells of Cajal most commonly in stomach metastases outside abdomen are infrequent

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67
Q
A

Hairy cell Leukemia

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68
Q

Hairy Cell Leukemia

A

mature B cell

type of chronic leukemia

splenomegaly

dry tap with BM aspiration

absent LAD

can present with anemia and infections

Cells with hairlike projections

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69
Q

Heavy chain disease

A

deposit in tissues and may cause dysfunction

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70
Q

HHV8 associated neoplasms

A

DLBCL (primary effusion)

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71
Q

High Grade Non-Hogkin Lymphomas

A

Diffuse Large B Cell Lymphoma

Burkitt Lymphoma

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72
Q

High or Low WBC

Low Hemoglobin

Low Hct

Low Platelets

High lymphoblasts

A

ALL

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73
Q

High or low WBC

Low Hemoglobin

Low Hct

Low platelets

myeloblasts

A

AML

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74
Q

High WBC

Normal hemoglobin

Normal Hct

Normal Platelets

High lymphocytes

A

CLL

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75
Q

High WBC

Normal hemoglobin

Normal Hct

Normal Platelets

High neutrophils

A

CML

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76
Q
A

Hodgkin cell

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77
Q

Hodgkin vs. NHL

A

Hodgkin is usually localized, continguous spread, rarely has extranodal presentation, Reed Sternberg Cells, marked B symptoms such as fevers and night sweats

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78
Q

HTLV-1 associated with which cancer?

A

adult T cell lymphoma

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79
Q

Hypercalcemia associated with?

A

non small cell lung cancer, breast cancer, myeloma, NHL

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80
Q

Immune modulators

A

=IMIDs

Ex: thalidomide

active in multiple myeloma

ADR: cytopenias, thromboses, edema, fever, chills

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81
Q

Inherited causes of osteosarcoma

A

Li Fraumeni syndrome Retinoblastoma

82
Q

Langerhans Cell Histiocytosis

A

neoplasm of macrophages and dendritic cells

multifocal (liver, spleen, bone, skin, lung, etc)

aggresive

usually in 1 system; commonly bone

pulmonary in adult smokers

83
Q

Lentigo Maligna

A

melanoma

tan macule that expands peripherally

radial growth phase 10-20 years

chronic sun damaged skin

84
Q

Li Fraumeni

A

germline loss of p53 tumor suppressor

85
Q

loss of heterozygosity at 11p –> increase in IGF2

A

embryonal rhabdomyosarcoma

86
Q

Low grade Non-Hodgkin Lymphoma

A

Follicular lymphoma

Small lymphocytic (SLL)

Mantle Cell Lymphoma

Marginal zone lymphoma

87
Q

Lymphoma found in multiple sites, same side of diaphragm

A

Stage 3

88
Q

Lymphoma located on both sides of the diaphragm

Stage?

A

Stage 3

89
Q

Lymphoma often seen with chronic inflammatory conditions/disease

A

Marginal zone lymphoma or maltoma

90
Q

Marker for lymphoid cells

A

Tdt

91
Q

Marker for myeloid

A

MPO

92
Q

Markers in a normal germinal center

A

CD20+ CD10+ Bcl 2 -

93
Q

Markers in mantle zone

A

CD20+

94
Q

Markers in normal paracortex

A

CD3+ CD5+

95
Q
A

Melanoma

–> consumption of epidermis, spread of melanocytes, nest of melanocytes with variable size and shape, melanocytes within lymphovascular spaces, mitoses, ulceration

96
Q

Diagnosis? pathogenesis?

A

Melanoma

tumors originate in the pigment producing cells in the basal layer of the epidermis

97
Q

Melanoma prognosis

A

depends on the depth of invasion

most dangerous form of skin cancer

98
Q

mesenchymal or de-differentiated chondrosarcoma

A

chemotherapy

99
Q

MFH

A

malignant fibrous histiocytoma –> high grade undifferentiated pleomorphic sarcoma

100
Q

MGUS

A

=”monoclonal gammopathy of uncertain significance”

asymptomatic

elevated monoclonal protein (M protein)

preneoplastic condition–> converts to myeloma at ~1%/year

101
Q

Mixed cellularity Lymphoma

A

classical Hodgkin lymphoma

EBV + 70%

lots of eosinophils, etc. (IL-5)

102
Q
A

Multiple myeloma

abnormal plasma cells–> 2 nuclei, many droplets of Ig

103
Q

Morphology of Follicular Lymphoma

A

lymph nodes, spleen, liver, marrow

nodular aggregates of cells

cells are centroblasts and centrocytes (majority)

104
Q

Morphology of Langerhans Cell Histiocytosis

A

langerhans cells- deeply grooved nuceli and abundant cytoplasm (coffee bean)

Birbeck granules on electron microscopy (tennis rackets)

Immunostain for S100 and CD1a

105
Q

Most common cause of death for patients with Multiple Myeloma

A

infections

106
Q

Most common location for STS

A

thigh, buttock, groin

107
Q

Most common melanoma in dark individuals

A

acral lentiginous melanoma

108
Q

Most common NHL

A

diffuse large B cell lymphoma

109
Q

Most common non-GIST Soft Tissue Sarcoma

A

Liposarcoma

110
Q

Most common primary malignancy of bone in kids

A

osteosarcoma

111
Q

Most common sites for Rhabdomyosarcoma

A

Head/neck- orbital, parameningeal genitourinary extremity

112
Q

Most common type of ALL

A

B-ALL

113
Q

Most common type of Classical Hodgkin’s Lymphoma

A

nodular sclerosing

114
Q

Most common type of melanoma

A

superficial spreading

115
Q

Multiple Myeloma

A

multiple plasmacytomas

increased plasma cells in marrow

normal and abnormal plasma cells

elevated M component

monoclonal antibody

often have elevated IL-6 since it is a growth factor for plasma cells

116
Q

Multiple Myeloma staging

A

CRAB= end organ damage

C- hypercalcemia

R- renal failure

A- anemia

B- bone lesions

117
Q

Mutation that disrupts RAR (retinoic acid receptor)

A

t(15;17)

118
Q

Mycosis Fungoides

A

malignant T helper cells infiltrate the skin, forming plaques and tumors

“cerebriform’ T cells

only involves nodes and marrow in late phase

119
Q

Myoglobin- immunohistochemical marker for?

A

rhabdomyosarcoma

120
Q
A

popcorn cell

=Non classical Hodgkin lymphoma

121
Q

Onion peeling/skinning of xray

A

Ewing Sarcoma

122
Q

Osteoblastic osteosarcoma

A

abundant osteoid production around tumor cells

123
Q

Osteosarcoma

A

primary malignant tumor of bone

characterized by the production of osteoid

commonly during growth spurt and located at metaphysis of bone

sunburst pattern on xray; lifting of cortex

Bone scan preferred

124
Q

Osteosarcoma- clinical features

A

characterized by osteoid production or immature bone peak incidence during adolescent growth spurt occurs typically at metaphyseal ends of bones localized pain, soft tissue mass systemic symptoms usually absent 40% have elevated alkaline phosphate, 30% have elevated LDH

125
Q
A

sunburst pattern

osteosarcoma

126
Q

“owl eye” cells

A

Reed-Sternberg cells = Hodgkin’s lymphoma (classical)

127
Q

Peripheral T cell Lymphoma

A

diagnosis of exclusion

collection of several T cell lymphomas that don’t fit into any other category

effacement of lymph node architecture

mature T cells with one or more immunophenotypic abnormality

128
Q

Plasma Cell Myeloma/Plasmacytoma

A

solitary marrow based lesion (lytic lesion of bone)

increased marrow plasma cells

elevated M component

129
Q
A

Tear drop cells

= Primary myelofibrosis (PMF)

130
Q

Post-remission therapy for ALL

A

consolidation

intensification (high dose chemo or transplant)

CNS prophylaxis: radiation, intrathecal chemotherapy, high dose methotrexate

Maintenance for 2 years

131
Q

Post-remission therapy for AML

A

consolidation (repeat chemo)

intensification (either high dose cytarabine or allogenic transplant)

132
Q

Potential curative therapy for Soft Tissue Sarcoma

A

surgical resection

133
Q

Potential curative therapy for STS

A

surgical resection

134
Q

Presentation of Malignant Spinal Cord Compression

A

pain

weakness

paresthesias

ataxia

bladder/bowel dysfunction

135
Q

Presentation of osteosarcoma

A

localized pain

soft tissue mass

elevated phos and LDH

136
Q

Prevention of Neutropenic fever

A

prophylactic G-CSF or GM-CSF

137
Q

Prevention of Tumor Lysis Syndrome

A

Allopurinol

hydration

monitor electrolytes, uric acid, calcium, phosphorous

138
Q

Primary amyloidosis

A

light chains deposited as amyloid

139
Q

Prognosis for t(8;21)

A

AML that will likely respond to chemo and not require transplant

140
Q

Remission induction chemotherapy for AML

A

Cytarabine C (Ara-C) and Daunorubicin (anthracycline)

141
Q

Remission induction for ALL

A

chemotherapy (if CD20+ give rituximab)

+ imatinib if Ph+

142
Q

Rhabdomyosarcoma

A

Special type of STS

one of the top three pediatric solid tumors

two subtypes: a) embryonal b) alveolar

143
Q

S-100 protein- immunohistochemical marker for?

A

melanoma, leiomyosarcoma, rhabdomyosarcoma, liposarcoma, chondrosarcoma

144
Q

Sarcoma = ?

A

malignant from mesenchymal cells

145
Q

Sclerosing liposarcoma- sign that what?

A

recurrent disease

146
Q

Sezary Syndrome

A

malignant T helper cells infiltrate the skin

do not form discrete tumors

essentially more aggressive form of mycosis fungoides –> involves blood

147
Q

Smoldering myeloma

A

asymptomatic

elevated marrow plasma cells (>10%)

elevated serum M protein (myeloma levels)

–> higher levels of M protein and more plasma cells in BM than MGUS

148
Q

Smudge cells on peripheral blood smear

A

CLL

149
Q
A

squamous cell carcinoma

150
Q

Squamous Cell Carcinoma

A

originates from the keratinocytes squamous cell layer–> arises from epidermis and extends into the dermis

present as scaly, red patches and plaques, often tender, central depression and bleeding

easily spread and become disfiguring

caused by cumulative UVR

151
Q

Stage 1 Lymphoma

A

found in single location

152
Q

Stage 2 Lymphoma

A

multiple sites, same side of diaphragm

153
Q

Stage 4 lymphoma

A

diffuse involvement of nonlymphoid organs

154
Q

Stage of G1 or G2 soft tissue sarcoma

A

typically stage 1 or 2

155
Q

Stage of this HL

A

Stage IIIB

no bone marrow involvement, but both sides of diaphragm

B symptoms

156
Q

Standard of care for chondrosarcoma

A

surgery

157
Q

Standard therapy for Hodgkin lymphoma

A

ABVD (Adriamycin= doxorubicin, bleomycin, vinblastine, dacarbazine)

+radiation for bulky disease

NO role for surgery

158
Q

Starry sky H&E

A

Burkitt lymphoma

“Starry sky in Africa”

159
Q
A

Sunburst/codman’s triangle

= osteosarcoma

160
Q

Superficial spreading

A

70% of melanomas

less inclined to be on sun exposed skin

horizontal growth phase 1-5 years

variation in color

161
Q

Synovial Sarcoma

A

most sensitive sarcoma to chemotherapy biphasic SSX1 has better prognosis than monophasic

162
Q

t(11;14)

A

Mantle cell Cyclin D1

163
Q

t(12:16) TLS-CHOP

A

myxoid round cell liposarcoma

164
Q

t(14;18)

A

Follicular lymphoma bcl2+

165
Q

t(8;14)

A

Burkitt lymphoma

166
Q

t(X;18)

A

Synovial sarcoma

167
Q

Tennis racket granules

A

Langerhans cell histiocytosis

168
Q

Transformation of chromosome 22

A

Ewing Sarcoma

169
Q

translocation long arm 13 and 1 or 2

A

alveolar rhabdomyosarcoma

170
Q

Treatment for actinic keratosis

A

liquid nitrogen cryotherapy

if diffuse or patient immunosuppressed: laser, IMID topical, or oral retinoids

171
Q

Treatment for advanced stage follicular lymphoma

A

allogeneic stem cell transplantation

172
Q

Treatment for AML with either FLT3-ITD or complex karyotype

A

induction chemotherapy followed by transplant and/or clinical trials

173
Q

Treatment for APL? How does it work?

A

Tretinoin (all-trans-retinoic acid) binds receptor and causes the blasts to mature, thereby reducing the promyelocyte (leukemic) burden

Arsenic Trioxide produces free radicals and is cytotoxic

174
Q

Treatment for Essential Thromobocythemia

A

hydroxyurea

interferon

175
Q

Treatment for Follicular Lymphoma

A

watch and wait

high rate of transformation to DLBCL

176
Q

Treatment for GIST

A

imatinib

177
Q

Treatment for GIST

A

Imatinib

178
Q

Treatment for metastatic STS

A

resect or radiate if local treatment not possible, use chemotherapy

179
Q

Treatment for mycosis fungoides

A

topical therapy

180
Q

Treatment for osteosarcoma

A

excision

adjuvant chemotherapy

181
Q

Treatment for Polycythemia Vera?

A

hydroxyurea

interferon

Jak 2 inhibitor

182
Q

Treatment for Primary Myelofibrosis

A

JAK2 inhibitor

clinical trials

183
Q

Treatment for Rhabdomyosarcoma

A

combination chemotherapy and surgical resection residual disease following surgery treated with radiation

184
Q

Treatment for T cell NHL

A

CHOP

transplantation

185
Q

Treatment of malignant spinal cord compression

A

start dexamethasone (corticosteroid) when dx is suspected

radiotherapy

surgery laminectomy

chemotherapy for underlying cancer

186
Q

Treatment of MDS

A

demethylating agents– cytosine analogs

azacitidine or decitabine

187
Q

Treatment of Multiple Myeloma

A

IMIDs (thalidomide) and proteasome inhibitors (bortezomib)

188
Q

Treatment of tumor lysis syndrome

A

rasburicase

hydration

189
Q

Types of STS

A

liposarcoma

synovial sarcoma

leiomyosarcoma

fibrosarcoma

angiosarcoma

rhabdomyosarcoma

GIST

190
Q

Vimentin- immunohistochemical marker for?

A

sarcomas some carcinomas

191
Q

Waldenstrom macroglobulemia

A

high IgM levels

large IgM

hyperviscosity of blood

LAD

visual and neurologic deficients

bleeding

192
Q

Way to differentiate between ALL and AML?

A

Tdt = ALL

193
Q

Way to prevent death of CAR T cells

A

co-stimulatory domains

194
Q

most common melanoma in darker individuals

A

acral lentiginous melanoma

195
Q

2 y/o with nasal polyps

workup should involved?

A

test for CF

196
Q

possible complication of radiation to the neck

A

hypothyroidism

develops in 30-40% of patients

197
Q

What must be done before starting a patient on Trastuzumab?

A

Echo to check cardiac function

trastuzumab can cause a decrease in EF

198
Q

2 most common causes of MSCC

A

lung and breast

199
Q

what are these shapes called?

diagnosis?

A

Keratin pearls

–> Squamous cell carcinoma

200
Q

Name of mole found at DEJ and dermis

A

compound nevi

201
Q

Melanoma type that skips to vertical growth phase

A

Nodular

202
Q

Diagnosis

A

Rouleaux formation–> multiple myeloma

P&T Block 2 (4 decks)

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