Malignant Neoplasms pt. 2 Flashcards
What tissues can malignancy arises from?
epitheleal and connective
What are some high risk factors for malignancy?
viruses- HPV
familial tendencies- genetics
environment
hormones- estrogen
What sonographic signs would create suspicion of a malignant mass?
hypoechoic halo hypoechoic solid mass multiple liver masses high velocity signals hypervascular lesions lymphadenopathy
What is the most common primary malignant tumor?
hepatocellular carcinoma (HCC, Hepatoma)
HCC
males, 60yo
3 forms: focal solitary, focal multiple, diffuse
risk factors: cirrhosis, hep B + C, metabolic disorders
Signs and symptoms of HCC
RUQ pain, weight loss, ascities, hepatomegaly
What is the normal liver length midclavicular?
15.5cm
rt lobe: <17cm
Sono appearance of HCC?
variable, hypoechoic, anechoic halo, <5cm, portal venous invasion
What lab values are increased with HCC?
AFP increased in 70% of patients
Hemangiosarcoma
extremely rare but aggressive 60-80 metastisizes rapidly linked to arsenic, thorotrast, polyvinyl chloride exposure large mass, mixed echogenicity
Epitheloid Hemangioendothelioma
malignant vascular tumor, rare
multiple hypoechoic masses, Glisson’s capsule appears to e “pulled” in towards mass
What is the most common primary liver tumor in chidren?
hepatoblastoma
hepatoblastoma
<5 years of age, associated with beckwith-wiedemann, serum AFP elevated
sonographically: single, solid, large, mixed echogenicity, poorly defined
Hodgkin’s Lymphoma
fever, weight loss, anemia
15-24, males
painless lymph node enlargement
25% have para-aortic lymphadenopathy
Non-Hodgkin’s Lymphoma
arise from typhoid tissue of organs >55 50% have para-aortic lymphadenopathy mets to liver, spleen fever, weight loss, night sweats
Sonographic appearance of lymphoma
anechoic-hypoechoic, solid, homogenous
lobulated scalloped mass
splenomegaly
organ and vessel compression/displacement
Sonographic appearance of malignant node
round or oval (taller than wide)
area of buldging
narrow/absent hilum
Hemangiosarcoma
spleen, rare, similar appearance to cavernous hemangioma, mets to liver
What can be associated with gallstones?
adenocarcinoma
Gallbladder carcinoma
females, 60-70
RUQ pain, intolerance to fatty food, occasional nausea and vomiting
spread to liver and regional lymph nodes
jaundice occurs in later stages
Soon appearance of gallbladder cancer?
mass with irregular borders
focal/diffuse wall thickening
can invade adjacent liver
Cholangiocarcinoma
bile duct cancer, slow growing
males, 50-60
What are the risk factors for cholangiocarcinoma?
chronic biliary stasis & inflamm
choledochal cyst
caroli’s
What are the 3 forms of choleangiocarcinoma?
intrahepatic
distal
Hilar (Klatskins)
What lab value will be elevated with cholagniocarcinoma?
elevated serum bilirubin and ALP
Klatskins Tumor
most common
occurs at confluence of the right and left hepatic duct
poor prognosis
Soon appearance of Klatskins Tumour
Normal CBD
Dilated intrahepatic ducts
small solid mass at liver hilum
bulging duct walls
What is the most common malignancy of the pancreas?
adenocarcinoma
Adenocarcinoma of the pancreas
associated with smoking, alcohol, diabetes 60-70% located in pancreases head older males poor prognosis elevated lipase
Direct signs of adenocarcinoma?
ill defined, solid mass
hypo echoic, >2cm
homogenous/heterogenous
Indirect signs of adenocarcinoma?
Dilated pancreatic duct/bile duct dilation
dilated gb
Cystic neoplasms of pancreas
women, middle to older age
Microcystic (serous cystadenoma)
benign, well defined, small cysts <2cm, pancreases head
solid and echogenic due to multiple cyst interfaces (too many tubes)
Macrocystic (mucinous)
uncommon, malignant in pancreases tail
larger cysts <2cm
large, encapsulated, many septations
Normal thickness of the GB wall
distended 3mm, non distended 5mm
Benign wall thickness of GB
long segment involved
symmetric thickening
layers preserved
Malignant wall thickness of GB
short segment
asymmetric
wall layer destruction
Clinical presentation
pain
anemia
palpable abdominal mass
blood in stool
What is the most common malignant tutor of the GI tract?
adenocarcinoma
Adenocarcinoma
males
stomach: prepyloric, antrum, lesser curve
small bowel: ileum, increase chance of Crohn’s disease
Colon: very common, polypoid or annular
Soon appearance of adenocarcinoma
Large mass typically hypo echoic
thick ill defined wall
look for nodes or mets
What is the most common tutor of the GI tract in children <10?
lymphoma - non hodgkin’s
Lymphoma
hypo echoic, solid nodules
bowel wall may appear as a target lesion
mesenteric node involvement
Primaries of urinary tract
Renal cell carcinoma (RCC)
Nephroblastoma (Wilm’s Tumor)
Transitional cell carcinoma
Squamous cell carcinoma
What is another name for renal cell carcinoma?
Hypernephroma
What is the most common malignant renal tumor in adults?
Renal cell carcinoma
Hypernephroma
males 50-70
association with von Hippel-Lindau and tuberous sclerosis
What is the clinical triad of RCC
flank pain
gross hematuria
palpable mass
What should be checked for with RCC?
tumor invasion into IVC and renal veins
para-aortic nodes
contralateral kidney
Sonographic appearance of RCC
solid, variable echogenicity, possible calcifications, increased flow
Most common malignant renal tumor in children
nephroblastoma - Wilm’s tumor
Clinical presentation of nephroblastoma
fever, hematuria, hypertension, palpable mass, anemia
Sonographic appearance of nephroblastoma
large, well defined solid, unilateral heterogenous/homogenous lymphadenopathy metastatic extension
Transitional Cell Carcinoma
TCC - tumor of the collecting system
men, hematuria
Sonographic appearance of TCC
renal sinus: ill defined, hypoechoic mass
3 differentials of TCC
blood clots, fungal balls, sloughed papilla
TCC of the bladder
focal, non-mobile mass
trigone region
painless hematuria
What is needed to diagnose TCC of the bladder?
cystoscopy & biopsy
TCC of the ureter
hydronephrosis above mass
solid mass in ureter
Squamous Cell Carcinoma
rare, most aggressive, distant metastases
men
associated with chronic UTI’s, stones, strictures
Primaries of the prostate?
adenocarcinoma
What is the most common cancer diagnosed in men?
Adenocarcinoma of the prostate
Adenocarcinoma of the prostate
> 50, increase risk with age, diet, family hx
most develop in the peripheral zone and spreads towards the capsule
4 steps to evaluate adenocarcinoma of the prostate
DRE - digital rectal exam
PSA
TRUS - transrectal u/s
Biopsy - performed if TRUS is abnormal
Sono appearance of adenocarcinoma
small - hypoechoic
large - isoechoic, hyperechoic, mixed
loss of smooth contour
Is adenocarcinoma symptomatic or asymptomatic?
Asymptomatic
Primaries of the adrenal glands
adrenal cortical cancer - rare, typically adenocarcinoma
females - hyperfunction
males - non functioning
4 clinical presentations of adrenal gland tumors
Cushing’s syndrome
Conn’s Disease
viralization/feminization
precocious puberty - menstrating at young age
Sonographic appearance of adrenal gland tumor
well defined, solid mass, variable echogenicity
Neuroblastoma
highly malignant, 4-5 years old, adrenal medulla
presents with palpable mass, weight loss, failure to thrive
Soon appearance of neuroblastoma
solid, heterogenous, poorly defined, calcification, renal displacement, mets to liver
Primaries of the peritoneum
mesothelioma - asbestos exposure
peritoneal thickening, ascites
Lymphoma in the peritoneum
very rare, non Hodgkin’s, AIDS, hypoechoic focal masses along peritoneum
What are the routes a tumor can metastasize
blood
lymphatics
direct invasion
What are the most frequent sites for metastases?
lung, liver, bone, adrenal
What is the most common malignant tumor in the liver?
mets to the liver - multiple solid lesions, hypo halo - hepatomegaly, jaundice, pain (looks like cheetah)
What lab values are increased with mets to liver?
LFT’s elevated:
ALK PHOS
AST
ALT
T/F:
Mets to the gallbladder is not associated with gallstones.
True. Gallstones would be more susceptible to primary
Mets to pancreas
not commonly seen on u/s, usually seen in later stages - presents as small hypoechoic mass
Mets to kidney
common, lung, breast, contralateral kidney
Metastatic lymphoma to the kidney
nonspecific renal enlargement
hypoechoic diffusely
displacement of organs or vessels
How will mets to GI tract appear?
large, hypoechoic, well defined mass, ring down artifact
mets to adrenal
4th most frequent site
LUNG, breast, melanoma primaries
bilateral
solid, well defined, hypoechoic
mets to retroperitoneum
testicular or pelvic tutors most common
spread via lymph or blood
mets to abdominal wall
hypoechoic mass with posterior enhancement
What can mets to abdominal wall be mistaken as?
simple cyst - except this displays posterior enhancement
mets to peritoneum
peritoneal carcinomatosis
diffuse involvement
hypoechoic masses and wall thinking, ascites, lymphadenopathy
pseudomyxoma peritonei
mets to peritoneum: couples gelatinous ascites, rare variable prognosis
nearly always originates from perforated appendices epithelial tumor
starburst appearance
