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
WAGR complex
Wilms tumor, Aniridia, Genitourinary malformation, and mental Retardation
Lung Mets (to lung)
Breast, colon, prostate, and bladder.
More common than 1˚ neoplasms
Lung Mets (from lung)
Adrenals, brain, bone (pathologic fracture), liver (jaundice and hepatomegaly)
Adenocarcinoma of Lung
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)
Bronchioalveolar Lung Cancer
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
Squamous Cell Carcinoma (lung)
Central
Hilar mass arising form bronchus
Cavitation, Cigarettes, and hyperCalcemia (produces PTHrP)
Keratin pearls and intercellular bridges
Small Cell (Oat cell) Carcinoma Lungs
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
Large Cell Carcinoma (lungs)
Peripheral
Highly anaplastic undifferentiated tumor; poor prognosis
Less responsive to chemo; surgery
Pleomorphic giant cells
Bronchial carcinoid syndrome
Good prognosis; mets rare
Nests of neuroendocrine cells (chromogrannin A + )
Symptoms due to mass effect: occasionally carcinoid syndrome(5-HT secretion –> flushing, diarrhea, wheezing)
Mesothelioma
malignancy of pleura associated with asbestosis
Results in hemorrhagic pleural effusions and pleural thickening
Psammoma bodies seen on histology.
Myxoma
1˚ heart tumor in adults in atria (left)
“ball valve” obstruction: associated with multiple syncopal episodes
scattered cells within a mucopolysaccharide stroma
Rhabdomyomas
1˚ cardiac tumor in children
associated with tuberous sclerosis
Pyogenic Granuloma
vascular tumor
Polypoid capillary hemangioma that can ulcerate and bleed.
associated with trauma and pregnancy
Cystic granuloma
cavernous lymphangioma of the neck
associated with Turners syndrome
Glomus Tumor (Glomangioma)
Benign, PAINFUL, red/blue tumor UNDER fingernails.
Arises from modified smooth muscle cells of glomus body.
Small, nonencapsulated neurovascular organs of dermis.
Angiosarcoma
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.
Lymphangiosarcoma
Lymphatic malignancy associated with persistent lymphedema.
Post-radical mastectomy!
Kaposi Sarcoma
Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and resp tract. Assocated with HHV8 and HIV
Neuroblastoma
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 +
Pheochromocytoma
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.
Intestinal Stomach Cancer
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
Diffuse Stomach Cancer
Adenocarcinoma. Presents with acanthosis nigricans
- NOT associated with H. pylori
- signet rings cells
- stomach wall grossly thickened and leathery (linitis plastica)
Adenomatous Colonic Polyp
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
Hyperplastic Colonic Polyp
Most common non-neoplastic polyp
Often in rectosigmoid colon
Juvenile Colonic Polyp
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
Hamartomatous Colonic Polyp
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
Colorectal Cancer
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)
Gardner Syndrome
FAP + osseous and soft tissue tumors; congenital hypertorphy of retinal pigment epithelium
benign proliferation of fibroblasts (skull and retroperitoneum)
Turcot Syndrome
FAP + malignant CNS tumor
Turcot = Turban
Lynch Syndrome
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
Familial Adenomatous Polyposis
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
Pathogenesis of CRC
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
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