Cancers

Question 1

Hepatocellular Carcinoma

Answer 1

most common 1˚ malignant tumor of liver in adults.
Associations: HBV, HCV, Wilson, hemochromatosis, A1AT deficiency, cirrhosis, and carcinogens (aflatoxin form Aspergillus)
- spreads hematogenously
inc Alpha-fetoprotein

Question 2

Cavernous hemangioma

Answer 2

common, benign liver tumor. 3-50yrs

no biopsy: risk of hemorrhage

Question 3

Hepatic Adenoma

Answer 3

OCPs or anabolic steroids; may regress spontaneously or rupture (abdominal pain and shock) –> intraperitoneal hemorrhage
– esp during pregnancy

Question 4

Angiosarcoma

Answer 4

malignant tumor of endothelial origin; liver
exposure to arsenic or vinyl chloride
CD31+ (PECAM1): platelet endothelial cell adhesion molecule

Question 5

Pancreatic Adenocarcinoma

Answer 5

Aggressive; already metastasized at presentation
CA-19-9 tumor marker. (CEA too)
Painless jaundice (obstruction at pancreatic head)
Risk: smoking, chronic pancreatitis, diabetes, age
presents: wgt loss, abdominal pain to back, migratory thrombophlebitis (redness and tenderness of palpation of extremities: Trousseau syndrome)
Treat: Whipple: pancreatic head, neck and part of CBD

Question 6

Papillary Carcinoma of Thyroid

Answer 6

most common
Orphan Annie eyes (empty nuclei)
Psammoma bodies; nuclear grooves
Inc risk with RET and BRAF mutations; childhood irradiation
description: lymphatic invasion (cervical lymph nodes): branching
Does not affect thyroid function

Question 7

Follicular Carcinoma of Thyroid

Answer 7

invades thyroid capsule (UNLIKE follicular adenoma); uniform follicles. Hematogenous spread

Question 8

Medullar Carcinoma of Thyroid

Answer 8

from parafollicular C cells: produces calcitonin! (hypocalcemia possible; calcitonin converted to amyloid) sheets of cells in an amyloid stroma.
Associated with MEN 2A and 2B (RET mutations)
*spindle shaped cells forming nests

Question 9

Anaplastic Carcinoma of Thyroid

Answer 9

Undifferentiated
older patients; invades local structures; aggressive
multinodular goiter

Question 10

Lymphoma of Thyroid

Answer 10

Primary B-cell malignant lymphoma

associated with Hashimoto thyroiditis

Question 11

Papillary and Medullary Thyroid Cancers

Answer 11

non diffuse enlargement of thyroid; no hyperthyroidism; no increased uptake of Iodine131

Question 12

MEN1

Answer 12

Wermer Syndrome
3 Ps: Parathyroid, Pituitary, and Pancreatic tumors
panc: Zollinger-Ellison, insulinomas, VIPoma
Present with kidney stones and stomach ulcers
Diamond

Question 13

MEN2A

Answer 13

Sipple syndrome
2 Ps: Parathryoid and Pheochromocytoma
AND Medullary thyroid carcinoma (secretes calcitonin)
Square
RET mutation

Question 14

MEN2B

Answer 14

1P: Pheochromocytoma
AND Medullary thyroid carcinoma (secretes calcitonin) and oral ganglioneuromatosis (mucosal neuromas)
commonly see marfanoid habitus
RET mutation
Triangle (oral)

Question 15

Renal Cell Carcinoma

Answer 15

proximal tubule cells –> polygonal CLEAR CELLS (filled with lipids and carbs)
Triad: hematuria, palpable mass, and flank pain
risk: smoking and obesity
2˚: polycythemia, flank pain, fever, and wgt loss. Invades renal vein –> IVC –> hematogenous spread (+ variocele)
Mets to lung and bone

Question 16

Renal Oncocytoma

Answer 16

collecting duct cells
Benign epithelial cell tumor (well circumscribed)
Large eosinophilic cells with abundant mitochondria without perinuclear clearing (vs chromophobe renal cell carcinoma)
Painless hematuria, flank pain, and abdominal mall.
H&E: round to polygonal cells with granular eosinophlic cytoplasm and round nuclei

Question 17

Wilms Tumor

Answer 17

Nephroblastoma
children 2-4yrs; embryonic glomerular structures
Huge, palpable flank mass and/or hematuria.
WT1 or WT2 mutations (tumor suppressor genes) on Chr 11

Question 18

Beckwith-Wiedemann Syndrome

Answer 18

Wilms Tumor, Neonatal hypoglycemia, muscular hemihypertrophy (one side of body bigger) and organomegaly (commonly tongue)

Question 19

Transitional Cell Carcinoma

Answer 19

Urothelial carcinoma (tumor of urinary tract system: renal calyces, renal pelvis, ureters, and bladder)
Painless hematuria (no casts) suggests bladder cancer.
Causes: Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide
H&E: papillary growth lined by transitional epithelium with mild nuclear atypia and pleomorphism

Question 20

Squamous Cell Carcinoma of the Bladder

Answer 20

chronic irritation of urinary bladder –> squamous metaplasia –> dysplasia and squamous cell carcinoma
Risk: Schistosoma haematobium, chronic cystitis, smoking, and chronic nephrolithiasis
Painless hematuria

Question 21

WAGR complex

Answer 21

Wilms tumor, Aniridia, Genitourinary malformation, and mental Retardation

Question 22

Lung Mets (to lung)

Answer 22

Breast, colon, prostate, and bladder.

More common than 1˚ neoplasms

Question 23

Lung Mets (from lung)

Answer 23

Adrenals, brain, bone (pathologic fracture), liver (jaundice and hepatomegaly)

Question 24

Adenocarcinoma of Lung

Answer 24

Peripheral
Glands and mucus production!
Most common lung cancer in nonsmokers and overall
Activating mutations: k-ras, EGFR, and ALK
Associated with hypertrophic osteoarthropathy (clubbing)

Question 25

Bronchioalveolar Lung Cancer

Answer 25

Subtype of Adenocarcinoma: "in situ" Grows along alveolar septa --> "thickening of alveolar walls": underlying architecture is preserved. columnar cells Arise from Clara cells hazy infiltrates similar to pneumonia

Question 26

Squamous Cell Carcinoma (lung)

Answer 26

Central Hilar mass arising form bronchus Cavitation, Cigarettes, and hyperCalcemia (produces PTHrP) Keratin pearls and intercellular bridges

Question 27

Small Cell (Oat cell) Carcinoma Lungs

Answer 27

Central Undifferentiated: very aggressive Neoplasm of neuroendocrine (Chromogramin A + ) -- ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) Amplification of myc oncognees common Inoperable. Chemo only Kulchitsky cells: small dark blue cells

Question 28

Large Cell Carcinoma (lungs)

Answer 28

Peripheral Highly anaplastic undifferentiated tumor; poor prognosis Less responsive to chemo; surgery Pleomorphic giant cells

Question 29

Bronchial carcinoid syndrome

Answer 29

Good prognosis; mets rare Nests of neuroendocrine cells (chromogrannin A + ) Symptoms due to mass effect: occasionally carcinoid syndrome(5-HT secretion --> flushing, diarrhea, wheezing)

Question 30

Mesothelioma

Answer 30

malignancy of pleura associated with asbestosis Results in hemorrhagic pleural effusions and pleural thickening Psammoma bodies seen on histology.

Question 31

Myxoma

Answer 31

1˚ heart tumor in adults in atria (left) "ball valve" obstruction: associated with multiple syncopal episodes scattered cells within a mucopolysaccharide stroma

Question 32

Rhabdomyomas

Answer 32

1˚ cardiac tumor in children | associated with tuberous sclerosis

Question 33

Pyogenic Granuloma

Answer 33

vascular tumor Polypoid capillary hemangioma that can ulcerate and bleed. associated with trauma and pregnancy

Question 34

Cystic granuloma

Answer 34

cavernous lymphangioma of the neck | associated with Turners syndrome

Question 35

Glomus Tumor (Glomangioma)

Answer 35

Benign, PAINFUL, red/blue tumor UNDER fingernails. Arises from modified smooth muscle cells of glomus body. Small, nonencapsulated neurovascular organs of dermis.

Question 36

Angiosarcoma

Answer 36

Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. usually in elderly, on sun-exposed areas. Associated with radiation therapy and arsenic exposure. Very aggressive and difficult to resect due to delay in diagnosis.

Question 37

Lymphangiosarcoma

Answer 37

Lymphatic malignancy associated with persistent lymphedema. | Post-radical mastectomy!

Question 38

Kaposi Sarcoma

Answer 38

Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and resp tract. Assocated with HHV8 and HIV

Question 39

Neuroblastoma

Answer 39

Most common tumor of adrenal medulla in children. < 4 yrs old. Neural crest cell origin. Occurs anywhere along sympathetic chain. Abdominal distention and firm, irregular mass that can cross midline (Wilms tumor CAN NOT). N-myc oncogene HVA (homovanillic acid) from Dopamine in urine Bombesin +

Question 40

Pheochromocytoma

Answer 40

Tumor of adrenal medulla in adults. Derived form chromaffin cells (neural crest = PSNS origin) Secrete catecholamines (epi, norepi, and dopa) --> episodic HTN "spells" BOAS: benign, one sided, adrenal only, and sporadic 5 Ps: pressure (BP), Pain (headache), Perspiration, Palpitations, and Pallor Urinary VMA (vanillyl mandelic acid) breakdown of norepi and epi. Treat: phenoxybenzamine (irreversible alpha antagonist). Beta blockers. Then resection. Necessary to avoid hypertensive crisis.

Question 41

Intestinal Stomach Cancer

Answer 41

Adenocarcinoma. Presents with acanthosis nigricans - - associated with H. pylori infection, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis. - Commonly on lesser curvature; looks like an ulcer with raised margins

Question 42

Diffuse Stomach Cancer

Answer 42

Adenocarcinoma. Presents with acanthosis nigricans - NOT associated with H. pylori - signet rings cells - stomach wall grossly thickened and leathery (linitis plastica)

Question 43

Adenomatous Colonic Polyp

Answer 43

Precancerous! CRC malignant risk with inc size, villous histology, and inc epithelial dysplasia more villous the polyp, more likely it is to be malignant often asymptomatic, lower GI bleed, partial obstruction, secretory diarrhea

Question 44

Hyperplastic Colonic Polyp

Answer 44

Most common non-neoplastic polyp | Often in rectosigmoid colon

Question 45

Juvenile Colonic Polyp

Answer 45

children < 5 yrs old 80% in rectum if single, no malignant potential. Juvenile polyposis syndrome - multiple juvenile polyps in GI tract; inc risk of adenocarcinoma

Question 46

Hamartomatous Colonic Polyp

Answer 46

Peutz-Jeghers Syndrome! autosomal dominant multiple nonmalignant hamartomas throughout the GI tract, along with hyperpigmented mouth, lips, hands and genitals assoc with inc risk of CRC

Question 47

Colorectal Cancer

Answer 47

Rectosigmoid > ascending > descending Ascending: exophytic mass, iron deficiency anemia. wgt loss Descending: infiltrating mass, partial obstruction, colicky pain, hematochezia Apple core lesion on barium enema CEA tumor marker (for monitoring not screening)

Question 48

Gardner Syndrome

Answer 48

FAP + osseous and soft tissue tumors; congenital hypertorphy of retinal pigment epithelium benign proliferation of fibroblasts (skull and retroperitoneum)

Question 49

Turcot Syndrome

Answer 49

FAP + malignant CNS tumor | Turcot = Turban

Question 50

Lynch Syndrome

Answer 50

HNPCC: Hereditary Nonpolyposis Colorectal Cancer - AD mutation of DNA mismatch repair genes 80% progress to CRC proximal colon is always involved arises de novo: not from adenomatous polyps

Question 51

Familial Adenomatous Polyposis

Answer 51

AD: mutation of APC gene on chr 5q 2 hit hypothesis 100% progress to CRC unless colon is resected. Thousands of polyps arise starting at a young age

Question 52

Pathogenesis of CRC

Answer 52

AK-53: APC/beta-catenin pathway (chromosomal instability): sporadic cancer; COX-2 overexpression contributes to hyperproliferation loss of APC: decreased intercellular adhesion and increased proliferation K-RAS: unregulated intracellular signal transduction p53 and DCC (loss of tumor suppressor genes): increased tumorigenesis ---