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Fall Term 2021 > Malignant Neoplasms pt. 2 > Flashcards

Malignant Neoplasms pt. 2 Flashcards

1
Q

What tissues can malignancy arises from?

A

epitheleal and connective

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2
Q

What are some high risk factors for malignancy?

A

viruses- HPV
familial tendencies- genetics
environment
hormones- estrogen

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3
Q

What sonographic signs would create suspicion of a malignant mass?

A 
hypoechoic halo
hypoechoic solid mass
multiple liver masses
high velocity signals
hypervascular lesions
lymphadenopathy
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4
Q

What is the most common primary malignant tumor?

A

hepatocellular carcinoma (HCC, Hepatoma)

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5
Q

HCC

A

males, 60yo
3 forms: focal solitary, focal multiple, diffuse
risk factors: cirrhosis, hep B + C, metabolic disorders

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6
Q

Signs and symptoms of HCC

A

RUQ pain, weight loss, ascities, hepatomegaly

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7
Q

What is the normal liver length midclavicular?

A

15.5cm

rt lobe: <17cm

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8
Q

Sono appearance of HCC?

A

variable, hypoechoic, anechoic halo, <5cm, portal venous invasion

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9
Q

What lab values are increased with HCC?

A

AFP increased in 70% of patients

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10
Q

Hemangiosarcoma

A 
extremely rare but aggressive
60-80
metastisizes rapidly
linked to arsenic, thorotrast, polyvinyl chloride exposure
large mass, mixed echogenicity
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11
Q

Epitheloid Hemangioendothelioma

A

malignant vascular tumor, rare

multiple hypoechoic masses, Glisson’s capsule appears to e “pulled” in towards mass

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12
Q

What is the most common primary liver tumor in chidren?

A

hepatoblastoma

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13
Q

hepatoblastoma

A

<5 years of age, associated with beckwith-wiedemann, serum AFP elevated
sonographically: single, solid, large, mixed echogenicity, poorly defined

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14
Q

Hodgkin’s Lymphoma

A

fever, weight loss, anemia
15-24, males
painless lymph node enlargement
25% have para-aortic lymphadenopathy

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15
Q

Non-Hodgkin’s Lymphoma

A 
arise from typhoid tissue of organs
>55
50% have para-aortic lymphadenopathy
mets to liver, spleen
fever, weight loss, night sweats
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16
Q

Sonographic appearance of lymphoma

A

anechoic-hypoechoic, solid, homogenous
lobulated scalloped mass
splenomegaly
organ and vessel compression/displacement

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17
Q

Sonographic appearance of malignant node

A

round or oval (taller than wide)
area of buldging
narrow/absent hilum

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18
Q

Hemangiosarcoma

A

spleen, rare, similar appearance to cavernous hemangioma, mets to liver

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19
Q

What can be associated with gallstones?

A

adenocarcinoma

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20
Q

Gallbladder carcinoma

A

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

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21
Q

Soon appearance of gallbladder cancer?

A

mass with irregular borders
focal/diffuse wall thickening
can invade adjacent liver

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22
Q

Cholangiocarcinoma

A

bile duct cancer, slow growing

males, 50-60

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23
Q

What are the risk factors for cholangiocarcinoma?

A

chronic biliary stasis & inflamm
choledochal cyst
caroli’s

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24
Q

What are the 3 forms of choleangiocarcinoma?

A

intrahepatic
distal
Hilar (Klatskins)

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25
Q

What lab value will be elevated with cholagniocarcinoma?

A

elevated serum bilirubin and ALP

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26
Q

Klatskins Tumor

A

most common
occurs at confluence of the right and left hepatic duct
poor prognosis

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27
Q

Soon appearance of Klatskins Tumour

A

Normal CBD
Dilated intrahepatic ducts
small solid mass at liver hilum
bulging duct walls

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28
Q

What is the most common malignancy of the pancreas?

A

adenocarcinoma

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29
Q

Adenocarcinoma of the pancreas

A 
associated with smoking, alcohol, diabetes
60-70% located in pancreases head
older males
poor prognosis
elevated lipase
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30
Q

Direct signs of adenocarcinoma?

A

ill defined, solid mass
hypo echoic, >2cm
homogenous/heterogenous

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31
Q

Indirect signs of adenocarcinoma?

A

Dilated pancreatic duct/bile duct dilation

dilated gb

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32
Q

Cystic neoplasms of pancreas

A

women, middle to older age

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33
Q

Microcystic (serous cystadenoma)

A

benign, well defined, small cysts <2cm, pancreases head

solid and echogenic due to multiple cyst interfaces (too many tubes)

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34
Q

Macrocystic (mucinous)

A

uncommon, malignant in pancreases tail
larger cysts <2cm
large, encapsulated, many septations

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35
Q

Normal thickness of the GB wall

A

distended 3mm, non distended 5mm

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36
Q

Benign wall thickness of GB

A

long segment involved
symmetric thickening
layers preserved

37
Q

Malignant wall thickness of GB

A

short segment
asymmetric
wall layer destruction

38
Q

Clinical presentation

A

pain
anemia
palpable abdominal mass
blood in stool

39
Q

What is the most common malignant tutor of the GI tract?

A

adenocarcinoma

40
Q

Adenocarcinoma

A

males
stomach: prepyloric, antrum, lesser curve
small bowel: ileum, increase chance of Crohn’s disease
Colon: very common, polypoid or annular

41
Q

Soon appearance of adenocarcinoma

A

Large mass typically hypo echoic
thick ill defined wall
look for nodes or mets

42
Q

What is the most common tutor of the GI tract in children <10?

A

lymphoma - non hodgkin’s

43
Q

Lymphoma

A

hypo echoic, solid nodules
bowel wall may appear as a target lesion
mesenteric node involvement

44
Q

Primaries of urinary tract

A

Renal cell carcinoma (RCC)
Nephroblastoma (Wilm’s Tumor)
Transitional cell carcinoma
Squamous cell carcinoma

45
Q

What is another name for renal cell carcinoma?

A

Hypernephroma

46
Q

What is the most common malignant renal tumor in adults?

A

Renal cell carcinoma

47
Q

Hypernephroma

A

males 50-70

association with von Hippel-Lindau and tuberous sclerosis

48
Q

What is the clinical triad of RCC

A

flank pain
gross hematuria
palpable mass

49
Q

What should be checked for with RCC?

A

tumor invasion into IVC and renal veins
para-aortic nodes
contralateral kidney

50
Q

Sonographic appearance of RCC

A

solid, variable echogenicity, possible calcifications, increased flow

51
Q

Most common malignant renal tumor in children

A

nephroblastoma - Wilm’s tumor

52
Q

Clinical presentation of nephroblastoma

A

fever, hematuria, hypertension, palpable mass, anemia

53
Q

Sonographic appearance of nephroblastoma

A 
large, well defined
solid, unilateral
heterogenous/homogenous
lymphadenopathy
metastatic extension
54
Q

Transitional Cell Carcinoma

A

TCC - tumor of the collecting system

men, hematuria

55
Q

Sonographic appearance of TCC

A

renal sinus: ill defined, hypoechoic mass

56
Q

3 differentials of TCC

A

blood clots, fungal balls, sloughed papilla

57
Q

TCC of the bladder

A

focal, non-mobile mass
trigone region
painless hematuria

58
Q

What is needed to diagnose TCC of the bladder?

A

cystoscopy & biopsy

59
Q

TCC of the ureter

A

hydronephrosis above mass

solid mass in ureter

60
Q

Squamous Cell Carcinoma

A

rare, most aggressive, distant metastases
men
associated with chronic UTI’s, stones, strictures

61
Q

Primaries of the prostate?

A

adenocarcinoma

62
Q

What is the most common cancer diagnosed in men?

A

Adenocarcinoma of the prostate

63
Q

Adenocarcinoma of the prostate

A

> 50, increase risk with age, diet, family hx

most develop in the peripheral zone and spreads towards the capsule

64
Q

4 steps to evaluate adenocarcinoma of the prostate

A

DRE - digital rectal exam
PSA
TRUS - transrectal u/s
Biopsy - performed if TRUS is abnormal

65
Q

Sono appearance of adenocarcinoma

A

small - hypoechoic
large - isoechoic, hyperechoic, mixed
loss of smooth contour

66
Q

Is adenocarcinoma symptomatic or asymptomatic?

A

Asymptomatic

67
Q

Primaries of the adrenal glands

A

adrenal cortical cancer - rare, typically adenocarcinoma
females - hyperfunction
males - non functioning

68
Q

4 clinical presentations of adrenal gland tumors

A

Cushing’s syndrome
Conn’s Disease
viralization/feminization
precocious puberty - menstrating at young age

69
Q

Sonographic appearance of adrenal gland tumor

A

well defined, solid mass, variable echogenicity

70
Q

Neuroblastoma

A

highly malignant, 4-5 years old, adrenal medulla

presents with palpable mass, weight loss, failure to thrive

71
Q

Soon appearance of neuroblastoma

A

solid, heterogenous, poorly defined, calcification, renal displacement, mets to liver

72
Q

Primaries of the peritoneum

A

mesothelioma - asbestos exposure

peritoneal thickening, ascites

73
Q

Lymphoma in the peritoneum

A

very rare, non Hodgkin’s, AIDS, hypoechoic focal masses along peritoneum

74
Q

What are the routes a tumor can metastasize

A

blood
lymphatics
direct invasion

75
Q

What are the most frequent sites for metastases?

A

lung, liver, bone, adrenal

76
Q

What is the most common malignant tumor in the liver?

A

mets to the liver - multiple solid lesions, hypo halo - hepatomegaly, jaundice, pain (looks like cheetah)

77
Q

What lab values are increased with mets to liver?

A

LFT’s elevated:
ALK PHOS
AST
ALT

78
Q

T/F:

Mets to the gallbladder is not associated with gallstones.

A

True. Gallstones would be more susceptible to primary

79
Q

Mets to pancreas

A

not commonly seen on u/s, usually seen in later stages - presents as small hypoechoic mass

80
Q

Mets to kidney

A

common, lung, breast, contralateral kidney

81
Q

Metastatic lymphoma to the kidney

A

nonspecific renal enlargement
hypoechoic diffusely
displacement of organs or vessels

82
Q

How will mets to GI tract appear?

A

large, hypoechoic, well defined mass, ring down artifact

83
Q

mets to adrenal

A

4th most frequent site
LUNG, breast, melanoma primaries
bilateral
solid, well defined, hypoechoic

84
Q

mets to retroperitoneum

A

testicular or pelvic tutors most common

spread via lymph or blood

85
Q

mets to abdominal wall

A

hypoechoic mass with posterior enhancement

86
Q

What can mets to abdominal wall be mistaken as?

A

simple cyst - except this displays posterior enhancement

87
Q

mets to peritoneum

A

peritoneal carcinomatosis
diffuse involvement
hypoechoic masses and wall thinking, ascites, lymphadenopathy

88
Q

pseudomyxoma peritonei

A

mets to peritoneum: couples gelatinous ascites, rare variable prognosis
nearly always originates from perforated appendices epithelial tumor
starburst appearance

Fall Term 2021 (5 decks)

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