Cancers Flashcards

1
Q

Hepatocellular Carcinoma

A

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

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2
Q

Cavernous hemangioma

A

common, benign liver tumor. 3-50yrs

no biopsy: risk of hemorrhage

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3
Q

Hepatic Adenoma

A

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

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4
Q

Angiosarcoma

A

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

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5
Q

Pancreatic Adenocarcinoma

A

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

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6
Q

Papillary Carcinoma of Thyroid

A

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

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7
Q

Follicular Carcinoma of Thyroid

A

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

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8
Q

Medullar Carcinoma of Thyroid

A

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

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9
Q

Anaplastic Carcinoma of Thyroid

A

Undifferentiated
older patients; invades local structures; aggressive
multinodular goiter

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10
Q

Lymphoma of Thyroid

A

Primary B-cell malignant lymphoma

associated with Hashimoto thyroiditis

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11
Q

Papillary and Medullary Thyroid Cancers

A

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

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12
Q

MEN1

A

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

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13
Q

MEN2A

A
Sipple syndrome
2 Ps: Parathryoid and Pheochromocytoma
AND Medullary thyroid carcinoma (secretes calcitonin)
Square
RET mutation
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14
Q

MEN2B

A
1P: Pheochromocytoma
AND Medullary thyroid carcinoma (secretes calcitonin) and oral ganglioneuromatosis (mucosal neuromas)
commonly see marfanoid habitus
RET mutation
Triangle (oral)
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15
Q

Renal Cell Carcinoma

A

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

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16
Q

Renal Oncocytoma

A

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

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17
Q

Wilms Tumor

A

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

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18
Q

Beckwith-Wiedemann Syndrome

A

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

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19
Q

Transitional Cell Carcinoma

A

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

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20
Q

Squamous Cell Carcinoma of the Bladder

A

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

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21
Q

WAGR complex

A

Wilms tumor, Aniridia, Genitourinary malformation, and mental Retardation

22
Q

Lung Mets (to lung)

A

Breast, colon, prostate, and bladder.

More common than 1˚ neoplasms

23
Q

Lung Mets (from lung)

A

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

24
Q

Adenocarcinoma of Lung

A

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)

25
Q

Bronchioalveolar Lung Cancer

A

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

26
Q

Squamous Cell Carcinoma (lung)

A

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

27
Q

Small Cell (Oat cell) Carcinoma Lungs

A

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

28
Q

Large Cell Carcinoma (lungs)

A

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

29
Q

Bronchial carcinoid syndrome

A

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

30
Q

Mesothelioma

A

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

31
Q

Myxoma

A

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

32
Q

Rhabdomyomas

A

1˚ cardiac tumor in children

associated with tuberous sclerosis

33
Q

Pyogenic Granuloma

A

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

34
Q

Cystic granuloma

A

cavernous lymphangioma of the neck

associated with Turners syndrome

35
Q

Glomus Tumor (Glomangioma)

A

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

36
Q

Angiosarcoma

A

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.

37
Q

Lymphangiosarcoma

A

Lymphatic malignancy associated with persistent lymphedema.

Post-radical mastectomy!

38
Q

Kaposi Sarcoma

A

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

39
Q

Neuroblastoma

A

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 +

40
Q

Pheochromocytoma

A

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.

41
Q

Intestinal Stomach Cancer

A

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
42
Q

Diffuse Stomach Cancer

A

Adenocarcinoma. Presents with acanthosis nigricans

  • NOT associated with H. pylori
  • signet rings cells
  • stomach wall grossly thickened and leathery (linitis plastica)
43
Q

Adenomatous Colonic Polyp

A

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

44
Q

Hyperplastic Colonic Polyp

A

Most common non-neoplastic polyp

Often in rectosigmoid colon

45
Q

Juvenile Colonic Polyp

A

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

46
Q

Hamartomatous Colonic Polyp

A

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

47
Q

Colorectal Cancer

A

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)

48
Q

Gardner Syndrome

A

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

49
Q

Turcot Syndrome

A

FAP + malignant CNS tumor

Turcot = Turban

50
Q

Lynch Syndrome

A

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

51
Q

Familial Adenomatous Polyposis

A

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

52
Q

Pathogenesis of CRC

A

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