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Quick Reference Handbook for Surgical Pathologists > Chapter 9: Quick clinical references > Flashcards

Chapter 9: Quick clinical references Flashcards

1
Q

What carcinomas disseminate hematogenously?

A

Renal cell carcinoma

Follicular carcinoma of thyroid

Choriocarcinomas

Prostate (via spinal venous plexus)

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2
Q

Which sarcomas tend to spread to lymph nodes?

A

Clear cell sarcoma / melanoma of soft parts

Epithelioid sarcoma

Alveolar rhabdomyosarcoma

Synovial sarcoma

Malignant fibrous histiocytoma

Angiosarcoma

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3
Q

What tumors are known to have very late metastases?

A

Renal cellc arcinoma

Salivary gland carcinoma (especially ACC)

Breast cancer

Carcinoids

Melanoma

Granulosa cell tumor of the ovary

Sarcomas

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4
Q

In which organs are metastatic tumors more common than primary tumors?

A

Liver

Lung, pleura

Heart

Bone (in adults)

Brain

Adrenal

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5
Q

What four organs are the most common sites of metastasis?

A

Lung, liver, bone, brain

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6
Q

What are the four most common causes of metastatic disease in children?

A

Clear cell sarcoma of kidney

Rhabdoid tumor

Wilms tumor

Neuroblastoma

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7
Q

What organs of origin are most responsible for carcinomas of unknown primary?

A

Pancreaticobiliary

Lung

Gastric

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8
Q

What tumors tend to create the following pattern of lung metastases?

  1. Solitary nodule
  2. Lymphangitic
  3. Bronchioloalveolar
  4. Pleural seeding
  5. Miliary
A
  1. Sarcoma, melanoma, colorectal, germ cell
  2. Breast, sotomach, pancreas, lung, prostate
  3. Pancreticobiliary
  4. Lung, breast, ovary, thymoma
  5. Thyroid, RCC
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9
Q

Metastases to & from:

Adrenal

A

To: Liver, lung, peritoneal/pleural, bone

From: Lung, breast, kidney, stomach, pancreas

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10
Q

Metastases to & from:

Anus

A

To: Liver, lung

From: None

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11
Q

Metastases to & from:

Bone

A

To: None

From: Lung/thyroid/kidney (osteolytic), prostate (osteoblastic), breast (either)

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12
Q

Metastases to & from:

Bladder

A

To: Lung, bone, liver

From: None

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13
Q

Metastases to & from:

Brain

A

To: None

From: Lung, breast, melanoma, RCC, colon, thyroid

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14
Q

Metastases to & from:

Breast

A 
To: Lungs, bone, liver, brain, adrenal (IDC)
Unusual sites (ILC)

From: None

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15
Q

Metastases to & from:

Colon

A

To: Liver, peritoneum, lung, ovaries

From: None

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16
Q

Metastases to & from:

Carcinoids

A

To: Liver, then lung, then bone.

From: N/A

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17
Q

Metastases to & from:

Cervix

A

To: Lung

From: None

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18
Q

Metastases to & from:

Uterus

A

To: Lung, vagina, peritoneum

From: None

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19
Q

Metastases to & from:

Ovaries

A

To: Lungs, pleura, peritoneum (duh)

From: Colon?

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20
Q

Metastases to & from:

Liver

A

To: Lung, bone, adrenal (both HCC & cholangio)

From: Other GI, breast, lung, kidney, melanoma, peds stuff

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21
Q

Metastases to & from:

Lung

A

To: Adrenal, bone, brain

From: Any carcinoma, melanoma, sarcoma, germ cell tumors…

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22
Q

Metastases to & from:

Melanoma

A

To: Anywhere.

From: N/A

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23
Q

Metastases to & from:

Meninges

A

To: None (direct extension into brain?)

From: Melanoma, breast, leukemias

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24
Q

Metastases to & from:

Pancreas

A

To: Liver, peritoneum, lung (alveolar spread)

From: None

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25
Q

Metastases to & from:

Parathyroid

A

To: Lung, liver, bone

From: None

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26
Q

Metastases to & from:

Pheochromocytoma

A

To: Bone (always need bone scan), liver

From: N/A

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27
Q

Metastases to & from:

Pleura

A

To: None

From: Lung, breast, but really any organ

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28
Q

Metastases to & from:

Prostate

A

To: Axial skeleton (via hematogenous spread of spinal cord venous plexus), lung, liver, adrenal.

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29
Q

Metastases to & from: RCC

A

To: Lung, bone, liver, brain, adrenal.

From: Plasma cell myeloma?

30
Q

Metastases to & from:

Salivary gland

A

To: Lung

31
Q

Metastases to & from:

Skin

A

To: ??

From: Lung, breast, colon, melanoma, oral cavity, peds stuff

32
Q

Metastases to & from:

Stomach

A

To: Liver, peritoneum, especially supraclavicular node, periumbilicus, and ovary (Krukenberg)

33
Q

Metastases to & from:

Testis

A

To: Lung, liver, brain, bone

(seminoma lymphatic, choriocarcinoma hematogenous)

34
Q

Metastases to & from:

Thyroid

A

To: Lung and bone (hematogenous)

(Mdullary: Distant, especially miliary lung)

35
Q

Metastases to & from:

Soft tissue

A

To: Other soft tissue

From: LUng, breast, RCC, aerodigestive tract, melanoma

36
Q

What are the most common origins of malignant pleural effusions?

A

Lung, breast, lymphoma

37
Q

What are the most common origins of peritoneal malignant effusions

A

Gyne (ovary, endometrium, cervix)

GI (colon, rectum, stomach)

38
Q

Where does neuroblastoma spread to?

A

Can spread to lymph nodes

Commonly goes to liver, bone, ovary, and skin (“blueberry muffin”)

39
Q

To where does Wilms tumor spread?

A

Lymph nodes, Liver, Lung.

40
Q

Where does clear cell sarcoma of kidney spread to?

A

Bone

41
Q

Where do the following sarcomas metastasize to?

  1. Alveolar soft parts sarcoma
  2. Ewing sarcoma
  3. PNET (bone)
  4. Myxoid liposarcoma
A
  1. Usual (lung, brain, bone)
  2. Usual, never lymph nodes
  3. Usual (including other bones), rarely LNs.
  4. Other soft tissue sites, and lung
42
Q

What tumors are associated with the serum marker AFP?

A

HCC (except fibrolamellar variant)

Yolk sac tumor

43
Q

What tumors are associated with the serum marker b-HCG?

A

Choriocarcinoma, trophoblastic tumors

44
Q

What tumors are associated with the serum marker CA125?

A

Ovary (non-specific, used for monitoring/following)

45
Q

What tumors are associated with the serum markers CA19.9? CA27.29?

A

CA19.9: Pancreas (non-specific)

CA27.29: Breast (non-specific)

46
Q

What tumors are associated with the serum marker calcitonin?

A

Medullary thyroid carcinoma

47
Q

What tumors are associated with serum catecholamines?

A

Pheochromocytoma (especially plasma metanephrines)

Neuroblastoma (especially urine VMA/HVA)

48
Q

What tumors are associated with the serum marker CEA?

A

Many; Colon, pancreas, medullary thyroid carcinoma

49
Q

What tumors are associated with the serum marker chromogranin A?

A

Neuroendocrine neoplasms, as well as neuroendocrine-differentiated prostate cancer (follows after androgen deprivation)

50
Q

What tumors are associated with serum hypercalcemia?

A

Lung SqCC (due to PTHrP)

Ovarian small cell carcinoma hypercalcemic type

ATLL

51
Q

What tumors are associated with elevated serum lipase?

A

Acinar cell carcinoma

(Schmid’s triad: Widespread fat necrosis, polyarthritis, eosinophilia)

52
Q

What hormones can SFTs secrete?

Which form of carcinoid secretes serotonin?

A

Insulin

Small bowel (uncommon in lung, thymus, pancreas…)

53
Q

What is the clinical consequence of PNET secretion of the following hormones?

  1. Insulin
  2. Glucagon
  3. Gastrin
  4. Somatostatin
  5. VIP
A
  1. Hypoglycemia
  2. Necrotizing migratory erythema, diabetes
  3. Gastric ulcers
  4. Diabetes, steatorrhea, alkalosis?
  5. Watery diarrhea, hypokalemia
54
Q

What hormones can be secreted by pituitary adenomas?

A

ACTH

Prolactin

Growth hormone

TSH

LH/FSH

ADH

55
Q

What tumors are associated with hypercortisolism?

A

Pitutiary adenoma

Adrenocortical adenoma

Small cell carcinoma, thymic carcinoid (ectopic ACTH)

56
Q

What tumors can cause hyperestrinism?

A

Granulosa cell tumor, thecoma

57
Q

What tumors can cause hyperandrogenism in women?

A

Sertoli-leydig and steroid cell tumors

Adrenocortical tumors (via DHEA)

58
Q

Describe the role of PSA in identifying prostate cancer.

A

High levels are associated with prostate cancer (as well as BPH), especially PSA <10.

The PSA ratio is more specific for carcinoma.

Percent-free PSA correlates with BPH.

59
Q

What use is the serum marker thyroglobulin?

A

Can be used to monitor recurrence of a completely excised or ablated thyroid cancer.

Beware, 15-20% have antithyroglobulin antibodies.

60
Q

In what tumors is the RAS/RAF/MEK/ERK pathway active?

What drugs target it?

A

Involved in many, many cancers. Too many to list.

Multiple inhibitors in development (mostly unsuccessful so far)

61
Q

In what tumors does the PI3K/AKT/mTOR/S6K1 pathway play a role?

What drugs target it?

A

Many cancers, prominently glioma, melanoma, prostate, endometrioid, and RCC.

Rapamycin analogs? mTOR inhibitors.

62
Q

Describe the role and use of VEGF-inhibitors in cancer.

A

eg. Bevacizumab

Pathway involved in many cancers; use confined to lung adenocarcinoma (risk of hemorrhage in pulmonary SqCC)

63
Q

Summarize the epidemiology and management of EGFR-mutated lung adenocarcinomas.

A

Usually young, asian, women, non-smokers. Often a bronchioloalveolar histologic type. Exons 19 & 21.

Many TKIs available (gefitinib, erlotinib), but mutations can confer resistance (T790M?).

64
Q

Summarize the epidemiology and management of KRAS-mutated lung adenocarcinomas.

A

Usually smokers. Mucinous and solid histologic types?

Negative predictor for response to TKIs.

65
Q

Summarize the epidemiology and management of EML4-ALK rearranged lung adenocarcinomas.

A

Young, non-smoker, higher stage. Often with mucin and signet-ring cells.

Requires FISH to identify rearrangements. Targetable with crizotinib.

66
Q

Summarize the mutational and targeted landscape of colon adenocarcinomas.

A

KRAS mutations most common.

BRAF in 10% (predicts poor EGFR response)

EGFR overexpression otherwise targetable with cetuximab/panitumumab

UGT1A1 polymorphism may confer Irinotecan resistance

67
Q

Summarize the mutational landscape and treatment of melanoma.

A

Half are BRAF V600E mutated, targetable with BRAF/MEK inhibitors.

A minority are c-Kit mutated, targetable with imatinib. Usually in acral and mucosal sites.

68
Q

Summarize the mutation landscape and treatment of GIST.

A

Most are c-Kit mutated (target with imatinib). Some are PDGFRA mutated. A few are wild-type or have SDH1 mutations.

The response to imatinib is assessed by molecular testing for the type of KIT mutation.

69
Q

What role does VHL play in formation of RCC?

A

Mutations in VHL result in loss of degradation of HIF, in turn overexpressing CAIX, VEGF, and PDGF.

Maybe targetable with VEGF/PDGF and mTOR inhibitors.

70
Q

Summarize the mutational landscape and treatment of breast carcinomas.

A

ER/PR expression is targetable with tamoxifen (gold standard: IHC on FFPE sections)

HER2 overexpression is targetable with trastuzumab or lapatinib+capecitabine

71
Q

What tumors besides breast can be treated with trastuzumab?

A

Some gastric of GEJ adenocarcinomas can overexpress HER2. More common with intestinal histology.

72
Q

What targeted therapy can be used to treat some PTCs?

A

BRAF inhibitors (mutated in 30-50%).

Quick Reference Handbook for Surgical Pathologists (9 decks)

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