Cancers Flashcards
Hepatocellular Carcinoma
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
Cavernous hemangioma
common, benign liver tumor. 3-50yrs
no biopsy: risk of hemorrhage
Hepatic Adenoma
OCPs or anabolic steroids; may regress spontaneously or rupture (abdominal pain and shock) –> intraperitoneal hemorrhage
– esp during pregnancy
Angiosarcoma
malignant tumor of endothelial origin; liver
exposure to arsenic or vinyl chloride
CD31+ (PECAM1): platelet endothelial cell adhesion molecule
Pancreatic Adenocarcinoma
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
Papillary Carcinoma of Thyroid
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
Follicular Carcinoma of Thyroid
invades thyroid capsule (UNLIKE follicular adenoma); uniform follicles. Hematogenous spread
Medullar Carcinoma of Thyroid
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
Anaplastic Carcinoma of Thyroid
Undifferentiated
older patients; invades local structures; aggressive
multinodular goiter
Lymphoma of Thyroid
Primary B-cell malignant lymphoma
associated with Hashimoto thyroiditis
Papillary and Medullary Thyroid Cancers
non diffuse enlargement of thyroid; no hyperthyroidism; no increased uptake of Iodine131
MEN1
Wermer Syndrome
3 Ps: Parathyroid, Pituitary, and Pancreatic tumors
panc: Zollinger-Ellison, insulinomas, VIPoma
Present with kidney stones and stomach ulcers
Diamond
MEN2A
Sipple syndrome 2 Ps: Parathryoid and Pheochromocytoma AND Medullary thyroid carcinoma (secretes calcitonin) Square RET mutation
MEN2B
1P: Pheochromocytoma AND Medullary thyroid carcinoma (secretes calcitonin) and oral ganglioneuromatosis (mucosal neuromas) commonly see marfanoid habitus RET mutation Triangle (oral)
Renal Cell Carcinoma
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
Renal Oncocytoma
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
Wilms Tumor
Nephroblastoma
children 2-4yrs; embryonic glomerular structures
Huge, palpable flank mass and/or hematuria.
WT1 or WT2 mutations (tumor suppressor genes) on Chr 11
Beckwith-Wiedemann Syndrome
Wilms Tumor, Neonatal hypoglycemia, muscular hemihypertrophy (one side of body bigger) and organomegaly (commonly tongue)
Transitional Cell Carcinoma
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
Squamous Cell Carcinoma of the Bladder
chronic irritation of urinary bladder –> squamous metaplasia –> dysplasia and squamous cell carcinoma
Risk: Schistosoma haematobium, chronic cystitis, smoking, and chronic nephrolithiasis
Painless hematuria