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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
Metastases to & from: Parathyroid
To: Lung, liver, bone From: None
26
Metastases to & from: Pheochromocytoma
To: Bone (always need bone scan), liver From: N/A
27
Metastases to & from: Pleura
To: None From: Lung, breast, but really any organ
28
Metastases to & from: Prostate
To: Axial skeleton (via hematogenous spread of spinal cord venous plexus), lung, liver, adrenal.
29
Metastases to & from: RCC
To: Lung, bone, liver, brain, adrenal. From: Plasma cell myeloma?
30
Metastases to & from: Salivary gland
To: Lung
31
Metastases to & from: Skin
To: ?? From: Lung, breast, colon, melanoma, oral cavity, peds stuff
32
Metastases to & from: Stomach
To: Liver, peritoneum, especially **supraclavicular node, periumbilicus, and ovary** (Krukenberg)
33
Metastases to & from: Testis
To: Lung, liver, brain, bone (seminoma lymphatic, choriocarcinoma hematogenous)
34
Metastases to & from: Thyroid
To: Lung and bone (hematogenous) (Mdullary: Distant, especially miliary lung)
35
Metastases to & from: Soft tissue
To: Other soft tissue From: LUng, breast, RCC, aerodigestive tract, melanoma
36
What are the most common origins of malignant pleural effusions?
Lung, breast, lymphoma
37
What are the most common origins of peritoneal malignant effusions
Gyne (ovary, endometrium, cervix) GI (colon, rectum, stomach)
38
Where does neuroblastoma spread to?
Can spread to lymph nodes Commonly goes to liver, bone, ovary, and skin ("blueberry muffin")
39
To where does Wilms tumor spread?
**L**ymph nodes, **L**iver, **L**ung.
40
Where does clear cell sarcoma of kidney spread to?
Bone
41
Where do the following sarcomas metastasize to? 1. Alveolar soft parts sarcoma 2. Ewing sarcoma 3. PNET (bone) 4. Myxoid liposarcoma
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
What tumors are associated with the serum marker AFP?
HCC (except fibrolamellar variant) Yolk sac tumor
43
What tumors are associated with the serum marker b-HCG?
Choriocarcinoma, trophoblastic tumors
44
What tumors are associated with the serum marker CA125?
Ovary (non-specific, used for monitoring/following)
45
What tumors are associated with the serum markers CA19.9? CA27.29?
CA19.9: Pancreas (non-specific) CA27.29: Breast (non-specific)
46
What tumors are associated with the serum marker calcitonin?
Medullary thyroid carcinoma
47
What tumors are associated with serum catecholamines?
Pheochromocytoma (especially plasma metanephrines) Neuroblastoma (especially urine VMA/HVA)
48
What tumors are associated with the serum marker CEA?
Many; Colon, pancreas, medullary thyroid carcinoma
49
What tumors are associated with the serum marker chromogranin A?
Neuroendocrine neoplasms, as well as neuroendocrine-differentiated prostate cancer (follows after androgen deprivation)
50
What tumors are associated with serum hypercalcemia?
Lung SqCC (due to PTHrP) Ovarian small cell carcinoma hypercalcemic type ATLL
51
What tumors are associated with elevated serum lipase?
Acinar cell carcinoma (Schmid's triad: Widespread fat necrosis, polyarthritis, eosinophilia)
52
What hormones can SFTs secrete? Which form of carcinoid secretes serotonin?
Insulin Small bowel (uncommon in lung, thymus, pancreas...)
53
What is the clinical consequence of PNET secretion of the following hormones? 1. Insulin 2. Glucagon 3. Gastrin 4. Somatostatin 5. VIP
1. Hypoglycemia 2. Necrotizing migratory erythema, diabetes 3. Gastric ulcers 4. Diabetes, steatorrhea, alkalosis? 5. Watery diarrhea, hypokalemia
54
What hormones can be secreted by pituitary adenomas?
ACTH Prolactin Growth hormone TSH LH/FSH ADH
55
What tumors are associated with hypercortisolism?
Pitutiary adenoma Adrenocortical adenoma Small cell carcinoma, thymic carcinoid (ectopic ACTH)
56
What tumors can cause hyperestrinism?
Granulosa cell tumor, thecoma
57
What tumors can cause hyperandrogenism in women?
Sertoli-leydig and steroid cell tumors Adrenocortical tumors (via DHEA)
58
Describe the role of PSA in identifying prostate cancer.
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
What use is the serum marker thyroglobulin?
Can be used to monitor recurrence of a completely excised or ablated thyroid cancer. Beware, 15-20% have antithyroglobulin antibodies.
60
In what tumors is the RAS/RAF/MEK/ERK pathway active? What drugs target it?
Involved in many, many cancers. Too many to list. Multiple inhibitors in development (mostly unsuccessful so far)
61
In what tumors does the PI3K/AKT/mTOR/S6K1 pathway play a role? What drugs target it?
Many cancers, prominently glioma, melanoma, prostate, endometrioid, and RCC. Rapamycin analogs? mTOR inhibitors.
62
Describe the role and use of VEGF-inhibitors in cancer.
eg. Bevacizumab Pathway involved in many cancers; use confined to lung adenocarcinoma (risk of hemorrhage in pulmonary SqCC)
63
Summarize the epidemiology and management of EGFR-mutated lung adenocarcinomas.
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
Summarize the epidemiology and management of KRAS-mutated lung adenocarcinomas.
Usually smokers. Mucinous and solid histologic types? Negative predictor for response to TKIs.
65
Summarize the epidemiology and management of EML4-ALK rearranged lung adenocarcinomas.
Young, non-smoker, higher stage. Often with mucin and signet-ring cells. Requires FISH to identify rearrangements. Targetable with crizotinib.
66
Summarize the mutational and targeted landscape of colon adenocarcinomas.
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
Summarize the mutational landscape and treatment of melanoma.
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
Summarize the mutation landscape and treatment of GIST.
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
What role does VHL play in formation of RCC?
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
Summarize the mutational landscape and treatment of breast carcinomas.
ER/PR expression is targetable with tamoxifen (gold standard: IHC on FFPE sections) HER2 overexpression is targetable with trastuzumab or lapatinib+capecitabine
71
What tumors besides breast can be treated with trastuzumab?
Some gastric of GEJ adenocarcinomas can overexpress HER2. More common with intestinal histology.
72
What targeted therapy can be used to treat some PTCs?
BRAF inhibitors (mutated in 30-50%).

Quick Reference Handbook for Surgical Pathologists (9 decks)

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