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Step 1 High Yields > Cancers > Flashcards

Cancers Flashcards

1
Q

Retinoblastoma

A

Most common ocular tumor of childhood
White pupillary reflex (leukocoria) in children less than 5 y.o
Sporadic or familial
Familial at risk of sarcomas later on in life especially osteosarcomas (vimentin is an intermediate filament foud within cells of mesenchymal origin)

Germline mutation that affects Rb tumor suppressor gene on chromosome 13

Two-hit hypothesis

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2
Q

Adenocarcinoma of the lung

A

Location: peripheral

Characteristics: most common lung cancer in nonsmokers and overall

Activating mutations include k-ras, EGFR, and ALK
ALK can form fusion protein with EML4 resulting in constitutive activation of TK (inhibited by crizotinib)

Associated with clubbing

Histology: glands and mucin with short plump villi (as opposed to mesothelioma)

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3
Q

Brnchioalveolar carcinoma

A

Location: peripheral
Subtype of adenocarcinoma (in situ)

Not related to smoking

Chest X Ray shows hazy infiltrates similar to pneumonia
Excellent prognosis

Histology: well differentiated dysplastic columnar cells +/- mucin

Grows along alveolar septa with no invasion leading to apparent thickening of alveolar walls

Copious amounts of watery sputum

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4
Q

Squamous Cell carcinoma

A

Location: Central

Characteristics: hilar mass arising from bronchus
Cavitation

Associated with smoking

Hypercalcemia (produces PTHrP)

Histology: keratin pearls and intercellular bridges

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5
Q

Small Cell carcinoma

A

Location: central

Characteristics: arises from basal layer of bronchial epithelium

Undifferentiated and very aggressive

May produce ACTH,ADH, or Lambert Eaton Syndrome

Amplification of myc oncogene common

Inoperable treat with chemotherapy

Neoplasm of neuroendocrine therefore neurofilament positive-enolase, chrmogranin, synaptophysin

Small dark blue cells (smaller than lymphocytes)

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6
Q

Large Cell Carcinoma

A

Location: peripheral

Characteristics: highly anaplastic undifferentiated tumor
poor prognosis

less responsive to chemotherapy, surgically removed

Histology: pleimorphic giant cells
Gynecomastia and galactorhhea

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7
Q

Bronchial carcionoid tmor

A

When central forms polyp like mass in bronchus

Excellent prognosis, metastasis rare

Symptoms due to mass effect and occasional carcinoid syndrome (flushing, diarrhea wheezing)

Histology: neuroendocrine cells positive for chromogranin A

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8
Q

Hamartoma of the lung

A

Incidentally found solitary coin lesion

Benign

Popcorn calcifiation, excessive growth of tissue native to the organ of involvement

Composed of hyaline cartilage, fat, smooth muscle, and clefts lined by respiratory epithelium

patients 50-60 y. o

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9
Q

Mesothelioma

A

Malignancy of pleura associated with asbestosis

Associations: insulation and shipbuilding

Results in hemorrhagic pleural effusions and pleural thickening
Lung parenchyma remains intact

Symptoms: dyspnea and chest pain

Psammoma bodies seen on histology
Cells joined by desmosomes

EM: slender microvilli and abundant neurofilaments (gold standard)

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10
Q

Pancoast tumor

A

Apical tumor of lung that can affect cervical sympathetic plexus

Complications: Horner syndrome (ipsilateral ptosis, anhydrosis, miosis),
SVC syndrome, sensorimotor deficits, and hoarseness (recurrent laryngeal)
Hemoptysis and chest pain
Invasion of brachial plexus leads to weakness and parasthesias of the arm
Severe shoulder pain that radiates to axilla and scapula and atrophy of hand muscles
Compression of subclavian vessels leads to edema of upper extremity
Extension into intervertebral foramina leads to spinal cord compression and paraplegia

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11
Q

Giant Cell Bone Tumor

A

20-40 years old
Epiphyseal of long bones

Locally aggressive benign tumor often around knee

Soap bubble appearance on X-Ray
Multinucleated giant cells

Imagine giant blowing bubbles (he’s locally aggressive but relatively benign)- a house goes up to his knee and you need epiphyseal growth to become giant

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12
Q

Osteochondroma

A

Most common benign tumor

Males

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13
Q

Osteosarcoma

A 
2nd most common malignant bone tumor (after multiple myeloma)
Bimodal distribution (10-20 y.o. and greater than 65)

Predisposing factors: paget disease of the bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome (p53 mutation)

Metaphysis of long bones around knee

Codman triange from elevation of periosteum or sunburst pattern on x-ray
Aggressive.

Treat with surgical resection and chemothreapy

After many months LIeutenant Dan (li fraumeni-knee cap in wheel chair) MET his son paget after sailing around the sunny OSean
(bimodal son and father)

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14
Q

Chondrosarcoma

A

Rare, malignant cartilaginous tumor
Men 30-60 y.o.

usually in pelvis, spine, scapula, humerus, tibia or femur

May be of primary origin from osteochondroma
Expansile glistening mass within medulllary cavity

After some time, Everyone thinks shroom kid will get aggressive with his schoolwork and get into med school

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15
Q

Pineal Germinoma

A

Precocious puberty in males caused by increased B-hCG production

Acqueductal compression by tumor leads to obstructive hydrocephalus

Parinaud syndrome due to compression of tectal area of midbrain (superior colliculus)

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16
Q

Glioblastoma multiforme

A

most common adult

highly malignant brain tumor with about a 1 year median survival
poorly differentiated, nuclear atypia and high mitotic acitivity

Found in cerebral hemispheres

Can cross corpus callosum

Stain atrocytes for GFAP

Pseudopalisaiding pleomorphic tumor cells-border central areas of necrosis and hemorrhage

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17
Q

Meningioma

A

Common adult benign

Occurs in convexities of hemispheres near surfaces of brain and parasagittal region

Arises from arachnoid cells
May have dural attachment

Often asymptomatic but may present with seizures or focal neurologica signs (change in personality)

resection or radiosurgery

Spindle cells concentricall arranged in a whorled pattern: psammoma bodies

Composed of menigoethelial cells

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18
Q

Hemagnioblastoma

A

Adult tumor of cerebellum most often

Associated with VHL with retinal angiomas

Can produce EPO leads to secondary polycythemia

Closely arranged thin-walled capillaries with minimal interleaving parenchyma

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19
Q

Schwannoma

A

usually found at cerebellopontine angle
Biphasic: increased cellular areas with myxoid and decreased cellular areas (interdispersing nuclear free areas)
Elongated regular oval nuclei, palisading patterns)

S-100+ (neural crest cell origin)

often localized to CNVIII

Treatment: resectable or with sterotactic radiosurgery

CNVII and V may also be affected due to compression but all except 2 can be affected (II is covered by oligodendrocytes)

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20
Q

Oligodendroglioma

A

Rare and slow growing adult tumor
Most often in frontal lobes

Chicken wire capillary pattern

Oligodendrocytes=fried eggs (round nuclei with clear cytoplasm)
Often calcified

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21
Q

CNS lymphoma

A

Immunocompromised patients
Dense cellular aggregates of uniform atypical lymphoid cells

Arise from B cells (diffuse large B cell most common)
CD20+ and CD79a+

Associated with EBV

mental status changes, seziures, and focal neurologic

High grade respond poorly to chemo

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22
Q

Pilocytic astrocytoma

A

Child tumor
Well circumscribed

Most often found in posterior fossa (cerebellum)

May be supratentorial

GFAP+ (arise from astrocytes)

Benign good prognosis

Rosenthal fibers-eosinophilc corkscrew fibers
spindle cells with hair like glial processes associated with microcysts
Cystic (black on MRI)+ solid (gross)-(white on MRI)

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23
Q

Medullablastoma

A

Highly malignant cerebellar tumor-child

Primitive neuroectodermal tumor

Can compress 4th ventricle casing hydrocephalus-moning headaches, vomiting, lethargy
gait instability and ataxia

ca send drop metastases to spinal cord

Homer wright rosettes
Solid gross (white on MRI)

Small blue cells on histology

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24
Q

Ependymoma

A

Child/adult tumor

Most commonly found in 4th ventricle in children, S.C of adults

Can cause hydrocephalus

Poor prognosis

Perivascular rosettes
Rod shaped belpharoplasts (basal ciliary bodies) found near nculeus

GFAP+?

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25
Q

Craniopharyngioma

A

Benign childhood tumor-most common

May be confused with pituitary adenoma (can also cause bitemporal hemianopia)

Derived from remnants of Rathke pouch (ant pit from roof of mouth)

Calcification is common
Cystic lined by stratified squamous epithelium
Cysts filled with yellow, viscous fluid rich in cholesterol

Cranio, RatCes pouch, Calcifications, Cholesterol, Cystic, Ceratin

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26
Q

Basal Cell Carcinoma

A

Most common skin cancer

Found in sun exposed areas of body-UPPER LIP

Locally invasive but almost never metastasizes

Pink, pearly nodules, commonly with telangiectasias, rolled borders and central crusting or ulceration

BCCs also appear as nonhealing ulcers with infiltrating growth or as scaling plaque

Palisading nuclei

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27
Q

Squamous cell carcinoma

A

Second most common skin cancer

Associated with excessive exposure to sunlight, immunosuppression, and occasionally arsenic exposure

Commonly appears on face, LOWER LIP, ears and hand

Locally invasive, but may spread to lymph nodes and will rarely metastasize

Ulcerative lesions with frequent scale

Associated with chronic draining sinuses
Histology: keratin pearls

Actinic Keratosis precursor
Keratoaconthoma-rapidly growing and then spontaneously regresses over months

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28
Q

Melanoma

A

Common tumor with significant risk of metastasis

S-100 tumor marker

Associated with sunlight exposure
Fair skinned individuals at increased risk

Depth of tumor correlates with risk of metastasis-can go to CNS and cause seizures
A:Assymetry B: border irregularity C: color variation D: diameter greater than 6 mm E: evolution over time

Histo: congregate in poorly formed nests, and are large with irregular nuclei, clumped chromatin, and prominent nucleoli
Often driven by BRAF kinase mutation (protein kinase)
NEURAL CREST CELL ORIGIN

Primary treatment is excision with appropriately wide margins
BRAF V600E mutation may benefit from vemurafenib (BRAF kinase inhibitor)

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29
Q

Prostatic Adenocarcinoma

A

Common in men greater than 50

Arises most often from posterior lobe of the prostate gland

Diagnosed by increased PSA and subsetquent needle core biopsies

Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increase total PSA and decreased fraction of free PSA)

Osteoblastic metastases in bone may develop in later stages indicated by lower back pain and increase in ALP and PSA

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30
Q

Myxoma

A

Most common cardiac tumor in adults

90% occur in atria

Ball valve obstruction in left atrium
associated with multiple syncope episodes

Mid diastolic rumbling heard at apex
Composed of scattered cells with a mucopolysaccharide stroma

Abnormal blood vessels and hemorrhaging
Increased VEGF
Increased IL-6 leads to constitutional symptoms, weight loss, fever

Present with emboli

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31
Q

Rhabdomyomas

A

Most frequent primary cardiac tumor in children

Associated with tuberous sclerosis

32
Q

Renal Cell carcinoma

A

Originates from proximal tubules cells-polygonal clear cells filled wit lipids and carbohydrates (eccentric nuclei)

most common in men 50-70 years old

Increased incidence with smoking and obesity

Manifests clinically with painless hematuria, palpable mass, secondary polycythemia, flank pain, fever and weight loss

Invades renal vein then IVC and spreads hematogenously to lung and bone

Yellow on macroscopic exam-increased glycogen and lipid

Associated with gene deletion on chromosome 3 (VHL)

Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP)-from neural crest cells

Treatment: resection if localized
resistant to chemotherapy and radiation therapy

33
Q

Wilm’s tumor

A

most common renal malignancy of early childhood

Contains embryonic glomerular structures

Presents with: huge, palpable flank mass and/or hematuria

Loss of function of tumor supppressor genes WT1 or WT2 on chromosome 11

Denys drash syndrome: gondoalydysgenesis, eraly onset nephropathy leading to renal failure

beckwith-wiedemann syndrome: organomegaly, macroglossia, hemihypertrophy, omphalocele, adrenal cytomegaly

WAGR: wilms tumro, aniridia, genitourinary malformation and mental retardation

34
Q

Transitional cell carcinoma

A

Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters and bladder)

elderly man

Painless hematuria suggests bladder cancer

Arise from transitional epithelial lining
mutlifocal sessile or papillary tumors
pleomorphic and hyperchromatic nuclei
Disrupted orientation and polarity

malignancy based on invasion into bladder wall and adjacent tissues

Associated with: phenacetin, smoking, aninline dyes and cyclophosphamide
Rubber, plastics aromatic amine containing dyes, textiles, leather

35
Q

Sqamous cell carcinoma of the bladder

A

Chronic irriation of urinary bladder leads to squamous metaplasia and dysplasia and sqaumous cell carcinoma

Risk factors: schisstosoma hematobium infection, chronic cystitis, smoking and chronic nepholithiasis

Presents with painless hematuria

36
Q

Somatistatinoma

A

Hyper or hypoglycemia
Steattorhea
Gallbladder stones (decreased CCK release)

37
Q

VIPomas

A

Copious watery diarrhea, hypokalemia and Achlorydria

Inhibited by somatostatin (ocreotride)

38
Q

Gastrinoma

A

gastrin secreting tumor that causes high levels of acid secretion and ulcers in jejunum refractory to medical therapy
Diarrhea and abdominal pain

Located in pancreas

Treat with proton pump inhibitors
Could be associated with MEN-1

39
Q

Pleomorphic Adenoma of salivary gland

A

Generally benign and in parotid gland

Most common

Presents as painless, mobile mass
Chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptures intraoperatively

40
Q

Mucoepidermoid carcinoma

A

Most common malignant tumor of salivary gland

Has mucinous and sqaumous components

Presents as painless slow growing mass

41
Q

Esophageal Cancer

A

Sqaumous: upper 2/3
Adenocarcinoma: lower 1/3

Presents: progressive dysphagia and weight loss
Poor prognosis

risk factors for both: achalasia, cigarettes, familial
squamous only: alcohol, Zenker DIverticula, N-nitroso containing foodss (beetel nuts), esophageal web, hot liquids
Adenocaricnoma: barrett, obesity, GERD

42
Q

Stomach Cancers

A

Almost always adenocarcinoma

early aggressive local spread and node/liver metastases

Presents with acanthosis nigricans

Intestinal: associated with H. pylori, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis
Commonly on lesser curvature
Gland atrophy and intestinal metaplasia
Looks like ulcer with raised margins
Nodular, polypid and well demarcated columnar or cuboidal cells

Diffuse: not associated with H. pylori
Signet rings
Stomach wall grossly thickened and leathery
Growth infiltrating into stomach wall

43
Q

Virchow node

A

Involvement of left supraclavicular node by mestasis from stomach

44
Q

Krukenberg tumor

A

Bilateral metastases to ovaries

Abundunt mucus and signet ring cells

45
Q

Sister Mary Joseph nodule

A

Subcutaneous peripumbilical metastasis

46
Q

Adenomatous Colonic Polyp

A

Precancerous

Malignant risk is associated with increase in size, villous histology, increased epithelial dysplasia

Precursor to colorectal cancer

More villous=more malignant

Symptoms: lower GI bleed, partial obstruction, secretory diarrhea

Tubular: dysplastic, colonic mucosal cells, that form tubular glands (pedunculated)
Villous: dysplastic epithelium from villi make projections (sessile)
Tubulovillous: mixture

47
Q

Hyperplastic colonic polyp

A

Most common non-neoplastic polyp

well differentiated mucosal cells that form glands and crypts

48
Q

Juvenile colonic polyps

A

Most sporadic lesions in children less than five years old

80% in rectum

If single, no malignant potential
Juvenile polyposis syndrome-multiple juvenile polyps in GI tract, increased risk of adenocarcinoma

49
Q

Hamartomatous colonic polyps (Peutz Jeghers syndrome)

A

AD

multiple nonmalignant hamartomas throughout GI tract with hyperpigmented mouth, lips, hands, genitalia

Associated with increase risk of colorectal cancer and other visceral malignancies

Mucosal glands, smooth muscle and connective tissue

50
Q

Familial adenomatous polyposis

A

AD

Mutation of APC gene on chromosome 5q

100% progress to CRC unless colon is resected

Thousands of polyps arise starting at a young age

Pancolic-always involves the rectum

51
Q

Heriditary nonpolyposis colorectal cancer

A

AD

Mutation of DN mismatch repair genes

Proximal colon always involved

52
Q

Hepatocellular Carcinoma/Hepatoma

A

Patients with stable cirrhosis who suddenly decompensate should be evaluated

Most common primary malignant tumor of the liver in adults

Associated with Hep B and C, Wilson disease, hemochromatosis, a1 antitrypsin deficiency, alcoholic cirrhosis, and aflatoxin

May lead to Budd Chiari syndrome

Findings: jaundice, tender hepatomegaly, ascites and anorexia
Spreads hematogenously

Diagnosis: increased a-fetoprotein, ultrasound or CT

53
Q

Cavernous hemangioma of the liver

A

Common, benign liver tumor-30-50 years old

Collagenous scar or fibrous nodules seen in association with thrombosis

Biopsy contraindicated because of risk of hemorrhage

Enlarge by ectasia (Distension of tubular structure)

Histo: cavernous blood filled vascular spaces of variable size lined by single epithelial layer

54
Q

Hepatic adenoma

A

Rare, benign lier tumor often related to oral contraceptive or anabolic steroid use

May regress spontaneously or rupture (abdominal pain and shock)

55
Q

angiosarcoma of the liver

A

Malignant tumor of endothelial origin

Associated with with exposure to aresenic, vinyl chlroide

56
Q

Pancreatic Adenocarcinoma

A

Prognosis averages 1 year

Very aggressive tumor arising from pancreatic ducts (disorganized glandular structure with cellular infiltration)

Already metastasized at presentation, tumors more common in pancreatic head

Associated with CA-19-9 (CEA less specific)

Risk factors: tobacco use, chronic pancreatitis, Diabetes, 50 y.o, jewish and african american males, MEN syndromes, HNPCC and FAP

Presents with: abdominal pain radiating to back, weight loss (malabsorption and anorexia), migratory thrombophlebitis (redness and tnederness on palpation of extremities), obstructive jaundice with palpable nontender gallbladder (pruritis, dark urine and pale stools)

Treatment: Whipple procedure, chemotherapy, radiation therapy

57
Q

Glucagonoma

A

Necrolytic migratory erythemia
Erythematous papules/plaques on face and extremitiies
Lesions enlarge and coalesce leaving bronze colored central indurated area with peripheral blistering and scaling

Diabetes mellitus-hyperglycemia
GI symptoms: diarrhea, anorexia, abdominal pain

Diagnosis: elevated glucagon levels
Tumor arises from alpha cells

Also can affect mucus membranes leading to glossitis, chelitisi and blephartitis

Anemia of chronic disease also present

58
Q

Neuroblastoma

A

Most common tumor of the adrenal medulla in CHILDREN less than 4 years old

Originates from neural crest cells

Neuropril is pathognomonic

Presentation: abdominal Distension and firm, irregular mass that can cross the midline (wilms tumor is smooth and unilateral)

Homovanillic acid (breakdown product of dopamine) increased in urin

Bombesin +

Associated with overexpression of n-myc oncogene

Clinical: hypertension (rare), anorexia, weight loss
Nonrhythmic conjugate eye movements with myoclonus

59
Q

Pheochromocytoma

A

Most common tumor of adrenal medulla of adults
Derived from chromaffin cells (neural crest cells)

10% malignant, 10%, bilateral, 10% extra-renal, 10% calcify, 10% kids

Symptoms: secrete epinephrine, NE, and dopamine causing episodic hypertension
Increased Pressure, pain (headache), perspiration, palpitations, pallor
Anxiety and orthostatic hypotension

Associated with VHL, MEN 2A and 2B

Findings: urinary VMA (breakdown product of NE and epinephrine) and plasma catecholamines are increased

Treatment: irreversible a antagonists (phenoxybenzamine) and B-blockers followed by tumor resection
a-blockade must be achieved before giving B blockers to avoid hypertensive crisis

60
Q

Papillary Thyroid Carcinoma

A

Most common excellent prognosis

Empty apperaing nuclei (finely dispersed chromatin-ground glass appearance)
Psammoma bodies, nuclear grooves

Increased risk with RET and BRAF mutations, childhood irradiation

61
Q

Follicular Thyroid carcinoma

A

Good prognosis

Thyroid capsule, uniform folllicles

RAS mutations, Bcl-2

62
Q

Medullary Thyroid Carcinoma

A

From parafollicular C cells

Produce calcitonin-sheets of cells in an amyloid stroma-stain with congo red

Associated with MEN 2A and 2B-Ret mutations

Uniform polygonal or spindle shaped

63
Q

Undifferentiated/anaplastic carcinoma

A

Older patients, invades local structures, very poor prognosis

p53 mutations, markedly pleimorphic
Giant cells biphasic spindle cells

64
Q

Pituitary adenoma

A

Most commonly prolactinoma

adenoma may hormone producing or non hormone producing

Nonfunctional tumors present with mass effect-bitemporal hemianopsia, hypopituitarism

Functional tumor presentation is based on hormone produced-prolactinoma: ammenorrhea, galactorrhea, low libido, infertility
Somatotropic adenoma-acromegaly

Treatment for prolactinoma-dopamine agonists

65
Q

Insulinoma

A

Tumor of B cells of pancreas-overproduction of insulin leading to hypoglycemia

Whipple triad of episodic CNS symptoms: lethargy, syncope and diplopia

symptomatic patients have decreased blood glucose and increased C peptide levels

Treatment: surgical excision

66
Q

Carcinoid syndrome

A

Rare syndoem caused by carcinoid tumors (neuroendocrine cells) especially metastatic bowel tumors

Secrete high levels of 5HT

Not seen if tumor is limited to GI tract-5HT metabolized in liver

Symptoms: recurrent diarrhea, cutaneous flushing, asthmatic wheezing, and right sided valvular disease (fibrous intimal thickening with endocardial plaques on tricuspid and pulmonary valves-serotonin and bradykinin broken down by pulmonary MAO-can lead to pulmonary stenosis and restrictive cardiomyopathy)

increase of 5-hydroxyindoleacetic acid in urine, niacin deficiency (pellagra), telangiectasias and cyanosis

histology: copmirsed of nests and glands
Eosinophilic cytoplasm with oval round nuclei
Minimal to no variation in shape and size of tumor cells
Dense core granules in cytoplasm containing secretory products

Most common appendicial tumors

Treatment: resection, ocreotride

67
Q

Zollinger Elliison syndrome

A

gastrin secreting tumor of pancreas or duodenum

Acid hypersecretion causes ulcers in distal duodenum and jejunum

Presents with abdominal pain (peptic ulcer disease, distal ulcers), diarrhea,

Ulcers refractory to therapy and recur after acid reducing surgery

may be associated with MEN 1

68
Q

ACTH paraneoplastic

A

Cushing

Small cell lung cancer and pancreatic cancer

69
Q

ADH paraneoplastic

A

SIADH

Small cell lung cancer and intracranial neoplasms (also carbamazepine for giggles)

70
Q

Abs against presynpatic Ca channels

A

Lambert Eaton syndrome

Small cell lung cancer

71
Q

EPO

A

Polycythemia

renal cell carcinoma, thymoma, hemagioblastoma, HCC, leiomyoma, pheochromocytoma

72
Q

PTHrP

A

Hypercalcemia

Squamous cell lung cancer, renal cell carcinoma, breast cancer

73
Q

Anti-yo Anti-P/Q, Anti Ho Abs

A

Subacute cerebellar degeneration-reactions with purkinje neurons

Small cell lung cancer, breast, ovarian and uterine cancer

74
Q

Brain metastases

A
  1. Lung
  2. breast
  3. genitourinary
  4. ostosarcoma
  5. melanoma
  6. GI

Multiple well circumscribed tumors at gray/white matter junction

75
Q

Liver metastases

A
  1. Colon
  2. Stomach
  3. pancreas
76
Q

Bone metastases

A
  1. Prostate and breast
  2. lung
  3. thyroid

preidlection for axial skeleton

prostate=blastic
Breast=lytic and blastic

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