Cancer Flashcards
malignant cells are large with abundant eosinophilic cytoplasm, large, vesicular nucleus
extends into the dermis
23 year old patient
enlarged lymph node in neck
fevers, weight loss, itchy skin, and alcohol induced pain
Hodgkin lymphoma
4 mechanisms monoclonal antibodies can induce tumor death
- activation of complement cascade
- binding allows interaction of NK cell with tumor cell (ADCC)
- bindings allows interaction with macrophage (phagocytosis)
- triggers direct apoptosis
Acral Lentiginous Melanoma
10% of all melanomas
most common in darkly pigmented individuals
located on plams, soles, and lips
Actin- immunohistochemical marker for?
leiomyosarcoma rhabdomyosarcoma
Actinic cheilitis
actinic keratosis of the lower lip
if not treated, progresses to SCC with higher rate of metastases
Actinic Keratosis
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
Aggressive Types of Basal Cell Carcinoma
micronodular, morpheaform, and infiltrative
ALK fusion protein
Anaplastic large cell lymphoma
Alveolar Rhabdomyosarcoma
translocation involving long arm of 13 and 1 or 2–> transcription factors involved subtype determined by histology worse outcome
AML Hyperleukocytosis treatment
Hydroxyurea
leukapheresis
Anaplastic Large Cell lymphoma
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
Basal cell carcinoma
Basal Cell Carcinoma
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
large basaloid island of tumor cells budding off epidermis
=Basal Cell Carcinoma
Bone marrow aspirate
increased plasma cells
Multiple Myeloma
starry sky= tingible body macrophages eating up the apoptotic debris
=Burkitt lymphoma
Burkitt lymphoma
endemic type
Burkitt Lymphoma Morphology
high rate of apoptosis (starry sky)
High rate of mitosis (Ki67 = 100%)
presents as a rapidly growing mass
c-MYC (chromosome 8)
translocation = Burkitt lymphoma most commonly t(8;14) cMYC is an oncogene; translocation results in overexpression thereby allowing continued cell growth
Carcinoma = ?
malignant from epithelial cells
CD10+ CD20+ Ki67 100% c-MYC
Burkitt lymphoma
CD117 (c-kit)
GIST
CD15+ / CD30+, EBV +
Hodgkin’s Lymphoma
CD19 + CD23 + CD5 +
CLL
CD19+ CD5+ CD23 -
Mantle cell lymphoma cyclin D +
CD99 +
Ewing Sarcoma
CDKN2a
Predisposition for Melanoma
Cerebriform T cells
Mycosis Fungoides
CH10 + bcl2 +
Follicular lymphoma
Chondroblastic osteosarcoma
cartilaginous matrix production with malignant spindle cells
CHOP
(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
Classical HL with best prognosis
Lymphocyte rich
40% EBV
Classical HL with worst prognosis
Lymphocyte depleted
90% EBV +, HIV patients, older patients
(usually associated with immunosuppression)
Classical Hodgkin Lymphomas
Nodular Sclerosing
Mixed Cellularity
Lymphocyte Depleted
Lymphocyte Rich
Clinical Presentation of Mantle Cell lymphoma
painless lymphadenopathy
mrrow involvement and circulating cells
extranodal sites
age 63 years
male
Clinical Presentation of Multiple Myeloma
hypercalcemia
bone pain
fracture risk
“punched out” lesions seen on xray
smudge cells
=CLL
cloverleaf multilobulated nuclei
adult T cell lymphoma
Common Malignant Primary Bone Tumors
osteosarcoma chondroblastoma Ewing sarcoma
Curative treatment for BCC
Mohs micrographic surgery
Cyclin D
promotes G1 to S phase
constituitively expressed in Mantle Cell
Desmin- marker for?
rhabdomyosarcoma or leiomyosarcoma sometimes MFH
Diagnosis of hyponatremia
look at serum osmolality
most commonly hypo or euvolemia
Diagnosis of Malignant Spinal Cord Compression
MRI of entire spinal cord
Diagnosis of Marginal Zone Lymphoma
diagnosis of exclusion
Diagnosis?
Basal cell carcinoma
Diagnosis?
Langerhans Cell Histiocytosis
birbeck granules on EM
Diagnostic test for Malignant Spinal Cord Compression
MRI of entire spinal cord
Large cells with huge nuclei, prominent nucleoli, marked variation
from one cell to the next
Diffuse Large B Cell Lymphoma
Disease caused by t(15;17)
APL acute promyelocytic leukemia
EBV associated neoplasms
Hodgkin, DLBCL, Burkitt, extranodal NK/T, PTLD
Embryonal Rhabdomyosarcoma
loss of heterozygosity at 11p resulting in increased IGF2 expression subtype determined by histology better outcome
Onion skinning
=Ewing sarcoma
example of cellular cancer immunotherapy
dendritic cells- vaccine given that contains dendritic cells that can recognize prostate cancer
CAR T cell therapy
Extranodal NK/T cell Lymphoma
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)
Factor VIII Related Antigen- marker for?
angiosarcoma kaposi’s sarcoma
Favorable karyotype for AML (chemotherapy)
t(8;21)
will respond to chemo
no transplant
Favorable sites for rhabdomyosarcoma
orbit, genitourinary (not bladder or prostate)
Fibroblastic osteosarcoma
high grade spindle cell stroma contains only focal osteoid production
Finding? Likely diagnosis?
Lytic lesions–> “punched-out” bone
Multiple myeloma
FLT3-ITD
AML
receptor tyrosine kinase is expressed on blasts
likely to relapse
focus on cell upper middle
Horseshoe morphology, large cells, lots of cytoplasm
= Anaplastic Large Cell lymphoma
Follicular Lymphoma
lots of neoplastic follicles (pale zone) crowding out normal nodal architecture
no mantle zone
Gastrointestinal stromal tumor (GIST)
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
GIST
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
Hairy cell Leukemia
Hairy Cell Leukemia
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
Heavy chain disease
deposit in tissues and may cause dysfunction
HHV8 associated neoplasms
DLBCL (primary effusion)
High Grade Non-Hogkin Lymphomas
Diffuse Large B Cell Lymphoma
Burkitt Lymphoma
High or Low WBC
Low Hemoglobin
Low Hct
Low Platelets
High lymphoblasts
ALL
High or low WBC
Low Hemoglobin
Low Hct
Low platelets
myeloblasts
AML
High WBC
Normal hemoglobin
Normal Hct
Normal Platelets
High lymphocytes
CLL
High WBC
Normal hemoglobin
Normal Hct
Normal Platelets
High neutrophils
CML
Hodgkin cell
Hodgkin vs. NHL
Hodgkin is usually localized, continguous spread, rarely has extranodal presentation, Reed Sternberg Cells, marked B symptoms such as fevers and night sweats
HTLV-1 associated with which cancer?
adult T cell lymphoma
Hypercalcemia associated with?
non small cell lung cancer, breast cancer, myeloma, NHL
Immune modulators
=IMIDs
Ex: thalidomide
active in multiple myeloma
ADR: cytopenias, thromboses, edema, fever, chills
Inherited causes of osteosarcoma
Li Fraumeni syndrome Retinoblastoma
Langerhans Cell Histiocytosis
neoplasm of macrophages and dendritic cells
multifocal (liver, spleen, bone, skin, lung, etc)
aggresive
usually in 1 system; commonly bone
pulmonary in adult smokers
Lentigo Maligna
melanoma
tan macule that expands peripherally
radial growth phase 10-20 years
chronic sun damaged skin
Li Fraumeni
germline loss of p53 tumor suppressor
loss of heterozygosity at 11p –> increase in IGF2
embryonal rhabdomyosarcoma
Low grade Non-Hodgkin Lymphoma
Follicular lymphoma
Small lymphocytic (SLL)
Mantle Cell Lymphoma
Marginal zone lymphoma
Lymphoma found in multiple sites, same side of diaphragm
Stage 3
Lymphoma located on both sides of the diaphragm
Stage?
Stage 3
Lymphoma often seen with chronic inflammatory conditions/disease
Marginal zone lymphoma or maltoma
Marker for lymphoid cells
Tdt
Marker for myeloid
MPO
Markers in a normal germinal center
CD20+ CD10+ Bcl 2 -
Markers in mantle zone
CD20+
Markers in normal paracortex
CD3+ CD5+
Melanoma
–> consumption of epidermis, spread of melanocytes, nest of melanocytes with variable size and shape, melanocytes within lymphovascular spaces, mitoses, ulceration
Diagnosis? pathogenesis?
Melanoma
tumors originate in the pigment producing cells in the basal layer of the epidermis
Melanoma prognosis
depends on the depth of invasion
most dangerous form of skin cancer
mesenchymal or de-differentiated chondrosarcoma
chemotherapy
MFH
malignant fibrous histiocytoma –> high grade undifferentiated pleomorphic sarcoma
MGUS
=”monoclonal gammopathy of uncertain significance”
asymptomatic
elevated monoclonal protein (M protein)
preneoplastic condition–> converts to myeloma at ~1%/year
Mixed cellularity Lymphoma
classical Hodgkin lymphoma
EBV + 70%
lots of eosinophils, etc. (IL-5)
Multiple myeloma
abnormal plasma cells–> 2 nuclei, many droplets of Ig
Morphology of Follicular Lymphoma
lymph nodes, spleen, liver, marrow
nodular aggregates of cells
cells are centroblasts and centrocytes (majority)
Morphology of Langerhans Cell Histiocytosis
langerhans cells- deeply grooved nuceli and abundant cytoplasm (coffee bean)
Birbeck granules on electron microscopy (tennis rackets)
Immunostain for S100 and CD1a
Most common cause of death for patients with Multiple Myeloma
infections
Most common location for STS
thigh, buttock, groin
Most common melanoma in dark individuals
acral lentiginous melanoma
Most common NHL
diffuse large B cell lymphoma
Most common non-GIST Soft Tissue Sarcoma
Liposarcoma
Most common primary malignancy of bone in kids
osteosarcoma
Most common sites for Rhabdomyosarcoma
Head/neck- orbital, parameningeal genitourinary extremity
Most common type of ALL
B-ALL
Most common type of Classical Hodgkin’s Lymphoma
nodular sclerosing
Most common type of melanoma
superficial spreading
Multiple Myeloma
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
Multiple Myeloma staging
CRAB= end organ damage
C- hypercalcemia
R- renal failure
A- anemia
B- bone lesions
Mutation that disrupts RAR (retinoic acid receptor)
t(15;17)
Mycosis Fungoides
malignant T helper cells infiltrate the skin, forming plaques and tumors
“cerebriform’ T cells
only involves nodes and marrow in late phase
Myoglobin- immunohistochemical marker for?
rhabdomyosarcoma
popcorn cell
=Non classical Hodgkin lymphoma
Onion peeling/skinning of xray
Ewing Sarcoma
Osteoblastic osteosarcoma
abundant osteoid production around tumor cells
Osteosarcoma
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
Osteosarcoma- clinical features
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
sunburst pattern
osteosarcoma
“owl eye” cells
Reed-Sternberg cells = Hodgkin’s lymphoma (classical)
Peripheral T cell Lymphoma
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
Plasma Cell Myeloma/Plasmacytoma
solitary marrow based lesion (lytic lesion of bone)
increased marrow plasma cells
elevated M component
Tear drop cells
= Primary myelofibrosis (PMF)
Post-remission therapy for ALL
consolidation
intensification (high dose chemo or transplant)
CNS prophylaxis: radiation, intrathecal chemotherapy, high dose methotrexate
Maintenance for 2 years
Post-remission therapy for AML
consolidation (repeat chemo)
intensification (either high dose cytarabine or allogenic transplant)
Potential curative therapy for Soft Tissue Sarcoma
surgical resection
Potential curative therapy for STS
surgical resection
Presentation of Malignant Spinal Cord Compression
pain
weakness
paresthesias
ataxia
bladder/bowel dysfunction
Presentation of osteosarcoma
localized pain
soft tissue mass
elevated phos and LDH
Prevention of Neutropenic fever
prophylactic G-CSF or GM-CSF
Prevention of Tumor Lysis Syndrome
Allopurinol
hydration
monitor electrolytes, uric acid, calcium, phosphorous
Primary amyloidosis
light chains deposited as amyloid
Prognosis for t(8;21)
AML that will likely respond to chemo and not require transplant
Remission induction chemotherapy for AML
Cytarabine C (Ara-C) and Daunorubicin (anthracycline)
Remission induction for ALL
chemotherapy (if CD20+ give rituximab)
+ imatinib if Ph+
Rhabdomyosarcoma
Special type of STS
one of the top three pediatric solid tumors
two subtypes: a) embryonal b) alveolar
S-100 protein- immunohistochemical marker for?
melanoma, leiomyosarcoma, rhabdomyosarcoma, liposarcoma, chondrosarcoma
Sarcoma = ?
malignant from mesenchymal cells
Sclerosing liposarcoma- sign that what?
recurrent disease
Sezary Syndrome
malignant T helper cells infiltrate the skin
do not form discrete tumors
essentially more aggressive form of mycosis fungoides –> involves blood
Smoldering myeloma
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
Smudge cells on peripheral blood smear
CLL
squamous cell carcinoma
Squamous Cell Carcinoma
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
Stage 1 Lymphoma
found in single location
Stage 2 Lymphoma
multiple sites, same side of diaphragm
Stage 4 lymphoma
diffuse involvement of nonlymphoid organs
Stage of G1 or G2 soft tissue sarcoma
typically stage 1 or 2
Stage of this HL
Stage IIIB
no bone marrow involvement, but both sides of diaphragm
B symptoms
Standard of care for chondrosarcoma
surgery
Standard therapy for Hodgkin lymphoma
ABVD (Adriamycin= doxorubicin, bleomycin, vinblastine, dacarbazine)
+radiation for bulky disease
NO role for surgery
Starry sky H&E
Burkitt lymphoma
“Starry sky in Africa”
Sunburst/codman’s triangle
= osteosarcoma
Superficial spreading
70% of melanomas
less inclined to be on sun exposed skin
horizontal growth phase 1-5 years
variation in color
Synovial Sarcoma
most sensitive sarcoma to chemotherapy biphasic SSX1 has better prognosis than monophasic
t(11;14)
Mantle cell Cyclin D1
t(12:16) TLS-CHOP
myxoid round cell liposarcoma
t(14;18)
Follicular lymphoma bcl2+
t(8;14)
Burkitt lymphoma
t(X;18)
Synovial sarcoma
Tennis racket granules
Langerhans cell histiocytosis
Transformation of chromosome 22
Ewing Sarcoma
translocation long arm 13 and 1 or 2
alveolar rhabdomyosarcoma
Treatment for actinic keratosis
liquid nitrogen cryotherapy
if diffuse or patient immunosuppressed: laser, IMID topical, or oral retinoids
Treatment for advanced stage follicular lymphoma
allogeneic stem cell transplantation
Treatment for AML with either FLT3-ITD or complex karyotype
induction chemotherapy followed by transplant and/or clinical trials
Treatment for APL? How does it work?
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
Treatment for Essential Thromobocythemia
hydroxyurea
interferon
Treatment for Follicular Lymphoma
watch and wait
high rate of transformation to DLBCL
Treatment for GIST
imatinib
Treatment for GIST
Imatinib
Treatment for metastatic STS
resect or radiate if local treatment not possible, use chemotherapy
Treatment for mycosis fungoides
topical therapy
Treatment for osteosarcoma
excision
adjuvant chemotherapy
Treatment for Polycythemia Vera?
hydroxyurea
interferon
Jak 2 inhibitor
Treatment for Primary Myelofibrosis
JAK2 inhibitor
clinical trials
Treatment for Rhabdomyosarcoma
combination chemotherapy and surgical resection residual disease following surgery treated with radiation
Treatment for T cell NHL
CHOP
transplantation
Treatment of malignant spinal cord compression
start dexamethasone (corticosteroid) when dx is suspected
radiotherapy
surgery laminectomy
chemotherapy for underlying cancer
Treatment of MDS
demethylating agents– cytosine analogs
azacitidine or decitabine
Treatment of Multiple Myeloma
IMIDs (thalidomide) and proteasome inhibitors (bortezomib)
Treatment of tumor lysis syndrome
rasburicase
hydration
Types of STS
liposarcoma
synovial sarcoma
leiomyosarcoma
fibrosarcoma
angiosarcoma
rhabdomyosarcoma
GIST
Vimentin- immunohistochemical marker for?
sarcomas some carcinomas
Waldenstrom macroglobulemia
high IgM levels
large IgM
hyperviscosity of blood
LAD
visual and neurologic deficients
bleeding
Way to differentiate between ALL and AML?
Tdt = ALL
Way to prevent death of CAR T cells
co-stimulatory domains
most common melanoma in darker individuals
acral lentiginous melanoma
2 y/o with nasal polyps
workup should involved?
test for CF
possible complication of radiation to the neck
hypothyroidism
develops in 30-40% of patients
What must be done before starting a patient on Trastuzumab?
Echo to check cardiac function
trastuzumab can cause a decrease in EF
2 most common causes of MSCC
lung and breast
what are these shapes called?
diagnosis?
Keratin pearls
–> Squamous cell carcinoma
Name of mole found at DEJ and dermis
compound nevi
Melanoma type that skips to vertical growth phase
Nodular
Diagnosis
Rouleaux formation–> multiple myeloma
