Malignant Neoplastic Diseases Flashcards
1
Q
Characteristics of malignant neoplasms
A
hypoechoic halo
multiple solid, hypoechoic liver masses
high velocity Doppler/hypervascularity
lymphadenopathy
2
Q
malignancy of connective tissue origin
A
sarcoma
3
Q
malignancy of epithelial tissue origin
A
carcinoma
4
Q
most common type of malignancy
A
adenocarcinomas
5
Q
high risk factors for malignant neoplasms
A
viruses
family history/genetics
environmental exposures
hormone imbalances
6
Q
most common primary malignant liver neoplasm
A
HCC
7
Q
HCC, aka
A
hepatoma
8
Q
hepatoma, aka
A
HCC
9
Q
most common malignant neoplasm, overall
A
secondary metastases
10
Q
gender prevalence of HCC
A
males>females
11
Q
three forms of HCC
A
solitary focal, multiple focal, diffuse infiltration
12
Q
risk factors for HCC
A
alcoholism, cirrhosis, Hep B or C, toxic metabolites, metabolic disorders (e.g. GSD)
13
Q
GSD
A
glycogen storage disease
14
Q
symptoms of HCC
A
RUQ pain
weight loss
abdominal swelling/ascites
hepatomegaly
15
Q
appearance of HCC
A
often solitary, usually hypoechoic, anechoic halos
16
Q
size of HCC
A
less than 5 cm
17
Q
common site of invasion for HCC
A
portal and hepatic veins
18
Q
DDx for hyperechoic presentation of HCC
A
hemangioma, adenoma, lipoma
19
Q
lab values indicative of HCC
A
elevated AFP (most reliable, 70% present) and LFT’s (ALP, AST, ALT)
20
Q
liver hemangiosarcoma, aka
A
liver angiosarcoma
21
Q
liver angiosarcoma, aka
A
liver hemangiosarcoma
22
Q
age prevalence of liver hemangiosarcoma
A
60-80 yrs old
23
Q
environmental risk factors for liver hemangiosarcoma
A
exposure to arsenic, PVC (industrial chemicals), or thorotrast (xray contrast)
24
Q
appearance of liver hemangiosarcoma
A
large, mixed echogenicity, necrotic or fibrotic areas due to rapid growth
25
appearance of epitheloid hemangioendothelioma
multiple, hypoechoic, inward retraction of hepatic capsule over the lesion
26
Identify: large, mixed echogenicity mass in liver, with necrotic or fibrotic areas due to documented rapid growth
liver hemangiosarcoma/angiosarcoma
27
Identify: multiple, hypoechoic liver lesions, causing inward retraction of hepatic capsule over the lesion
epitheloid hemangioendothelioma
28
age prevalence of hepatoblastoma
children under 5 yrs old
29
most common primary liver malignancy in children
hepatoblastoma
30
Which primary liver malignancy is associated with Beckwith-Wiedemann syndrome?
hepatoblastoma
31
lab values indicative of hepatoblastoma
elevated AFP
32
appearance of hepatoblastoma
singular, solid, large, mixed echogenicity, poorly defined walls, calcifications
33
symptoms of splenic hemangiosarcoma
anemia (70% presentation)
34
common site of metastasis for splenic hemangiosarcoma
liver
35
appearance of splenic hemangiosarcoma
variable - similar to splenic hemangioma:
| hyperechoic, homogeneous and solid; or complex with cystic degeneration
36
symptoms of Hodgkin's lymphoma
fever, weight loss, ANEMIA
| painless enlarged cervical and clavicular LN's
37
age prevalence of Hodgkin's lymphoma
younger
38
gender prevalence of Hodgkin's lymphoma
male>female
39
prognosis of Hodgkin's lymphoma
high survival rate
40
prognosis of non-Hodgkin's lymphoma
poor
41
age prevalence of non-Hodgkin's lymphoma
older
42
prevalence of para-aortic lymphadenopathy in Hodgkin's lymphoma
25%
43
prevalence of para-aortic lymphadenopathy in non-Hodgkin's lymphoma
50%
44
symptoms of non-Hodgkin's lymphoma
fever, weight loss, NIGHT SWEATS
| painless enlarged cervical and clavicular LN's
45
common site of metastasis for lymphoma
liver, spleen
46
appearance of splenic metastases caused by lymphoma
splenomegaly with solid, anechoic/hypoechoic, homogeneous, lobulated or scalloped mass
47
5 F's of likelihood to acquire gallstones
```
family hx
female
fat
forty's
fertile
(fair, flatulent)
```
48
symptoms of gallbladder carcinoma
RUQ pain, fatty food intolerance, occasional nausea and vomitting
jaundice, itchiness
49
clinical DDx for GB carcinoma, based on symptoms
chronic cholecystitis
50
gender prevalence of GB carcinoma
females>males
51
age prevalence of GB carcinoma
60's-70's
52
common site of metastasis for GB carcinoma
liver, LN's
53
primary adenocarcinoma of the GB
GB carcinoma
54
icterus
jaundice
55
pruritis
itchiness
56
appearance of GB carcinoma
polypoid intraluminal lesion, irregular borders, GB wall thickening
57
normal GB wall dimension
under 3 mm
58
common site of invasion for GB carcinoma
adjacent liver tissue and GB fossa
59
primary adenocarcinoma of the bile ducts
cholangiocarcinoma
60
gender prevalence of cholangiocarcinoma
males>females
61
age prevalence of cholangiocarcinoma
50's-60's
62
risk factors for GB carcinoma
gallstones
63
risk factors for cholangiocarcinoma
chronic biliary stasis and inflammation, history of choledochal cyst or Caroli's disease
64
symptoms of cholangiocarcinoma
vague - dyspepsia, fatigue
jaundice
pruritis
65
lab values indicative of cholangiocarcinoma
elevated serum bilirubin and ALP
66
most common type of cholangiocarcinoma
Klatskin's (hilar region, diffuse intrahepatic duct dilatation)
67
three types of cholangiocarcinoma
intrahepatic (isolated ducts)
distal (CBD)
Hilar/Klatskin's (diffuse, bilobar)
68
appearance of Klatskin's cholangiocarcinoma
diffusely dilated intrahepatic ducts,narrowing of lumen, low level intraluminal echoes, solid mass at porta hepatis, normal CBD
69
location of Klatskin's cholangiocarcinoma
liver hilum/porta hepatis, where CHD is formed by joining of R and L hepatic ducts
70
most common primary pancreatic malignancy
primary pancreatic adenocarcinoma
71
lab values indicative of pancreatic adenocarcinoma
elevated lipase
72
typical location of pancreatic adenocarcinoma
pancreas head
73
age prevalence of pancreatic adenocarcinoma
60-80 yrs old
74
risk factors of primary pancreatic adenocarcinoma
smoking, alcoholism, diabetes
75
symptoms of primary pancreatic adenocarcinoma
```
weight loss
PAINLESS jaundice
nausea and vomitting
change in stools
epigastric pain radiating into back
```
76
What is PAINFUL jaundice indicative of?
biliary obstruction
77
What is PAINLESS jaundice indicative of?
malignancy
78
appearance of primary pancreatic adenocarcinoma
ill-defined, solid, hypoechoic, variable echotexture
79
size of primary pancreatic adenocarcinoma
greater than 2 cm
80
Identify: solid mass at porta hepatis, normal CBD, dilated intrehepatic ducts with low level intraluminal echoes and narrowing lumen
Klatskin's cholangiocarcinoma
81
Identify: splenomegaly with solid, anechoic/hypoechoic, homogeneous, lobulated or scalloped mass in spleen, enlarged cervical LN's, and night sweats vs anemia
lymphoma (non-Hodgkin's vs Hodgkin's)
82
Identify: polypoid intraluminal GB lesion, irregular borders, GB wall thickening, hx of gallstones
primary GB carcinoma
83
Identify: ill-defined, solid, hypoechoic, homo/heterogeneous mass in pancreatic head
primary pancreatic adenocarcinoma
84
indirect signs of pancreatic adenocarcinoma
double duct sign, Courvoisier's GB/sign
85
double duct sign
both the CBD and pancreatic duct are dilated, likely due to obstruction at the pancreatic head
86
Courvoisier's sign
non-tender, distended, palpable GB due to obstruction caused by malignancy of GB, bile ducts, or pancreatic head (not due to stones)
87
gender prevalence of cystic pancreatic neoplasms
women>men
88
age prevalence of cystic pancreatic neoplasms
middle aged - older population
89
appearance of macrocystic pancreatic neoplasms
large, encapsulated, may be uni- or multilocular
90
macrocystic pancreatic neoplasm, aka
pancreatic mucinous cystadenoma
91
pancreatic mucinous cystadenoma, aka
macrocystic pancreatic neoplasm
92
size of macrocystic pancreatic neoplasms
larger than 2 cm
93
typical location of macrocystic pancreatic neoplasms
pancreatic tail
94
name a malignant pancreatic neoplasm that is often found in the tail
macrocystic pancreatic neoplasm
95
name a benign pancreatic neoplasm that is often found in the head
microcystic pancreatic neoplasm
96
name a malignant pancreatic neoplasm that is often found in the head
primary pancreatic adenocarcinoma
97
Identify: large, encapsulated cystic area in the pancreatic tail, may be uni- or multilocular
macrocystic pancreatic neoplasm
98
Identify: small, echogenic, well defined cystic area in the pancreatic head
microcystic pancreatic neoplasm
99
normal distended GI wall thickness
3 mm
100
normal non-distended GI wall thickness
5 mm
101
echogenicity of gut signature from inner to outer
```
collapsed lumen - hyper
mucosa - hypo
submucosa - hyper
muscularis - hypo
serosa - hyper
```
102
characteristic presentation of benign vs malignant bowel
both - hyperemia and lymphadenopathy
benign - long segment involved, symmetric wall thickening, gut signature intact
malignant - short segment involving asymmetric wall thickening, loss of tissue layer differentiation, exophytic masses
103
appearance of thickened bowel
target pattern, pseudokidney appearance, loss of tissue layer differentiation, hypoechoic wall with hyperechoic centre
104
What is increased peristalsis indicative of?
early stage obstruction and inflammation
105
What is decreased peristalsis indicative of?
end stage obstruction, inflammation, and paralytic ileus
106
signs and symptoms of GI neoplasms
pain, anemia, anorexia, palpable, blood in stool, internal bleeding
107
most common primary malignant GI neoplasm
GI adenocarcinoma
108
gender prevalence of primary GI adenocarcinoma
males>females
109
common sites of primary GI adenocarcinoma in the stomach
prepyloric, antrum, lesser curvature
110
common sites of primary GI adenocarcinoma in the small bowel
ileum
111
Which area of the bowel is associated with developing adenocarcinoma with Crohn's disease?
ileum/small bowel
112
common sites of polypoid GI adenocarcinoma in the colon
cecum and ascending colon
113
common sites of annular GI adenocarcinoma in the colon
descending and sigmoid colon
114
What presentation of primary GI adenocarcinoma is found commonly found in the cecum and ascending colon?
polypoid GI adenocarcinoma
115
What presentation of primary GI adenocarcinoma is found commonly found in the descending and sigmoid colon?
annular GI adenocarcinoma
116
appearance of primary GI adenocarcinoma
large, hypoechoic, target pattern or pseudokidney due to thickened gut wall
117
most common malignant GI tract neoplasm in children under 10 yrs old
GI lymphoma
118
appearance of GI lymphoma
hypoechoic solid nodules, target pattern lesion, enlarged mesenteric LN's
119
renal cell carcinoma, aka
hypernephroma
120
hypernephroma, aka
renal cell carcinoma
121
most common malignant renal neoplasm in adults
renal cell carcinoma
122
symptoms of RCC
flank pain, gross hematuria, palpable, weight loss, HTN
123
gender prevalence of RCC
men>women
124
age prevalence of RCC
50-70 yrs old
125
Which malignant renal neoplasm is associated with Hippel-Lindau disease and Tuberous Sclerosis?
renal cell carcinoma
126
Hippel-Lindau disease
inherited disease characterized by the formation of multiple tumors (both benign & malignant)
127
common sites of invasion for RCC
IVC, renal veins, para-aortic LN's, contralateral kidney
128
appearance of RCC
variable echogenicity, hypoechoic halo, possible calcifications
129
most common malignant renal neoplasm in children
nephroblastoma/Wilm's tumour
130
nephroblastoma, aka
Wilm's tumour
131
Wilm's tumour, aka
nephroblastoma
132
age prevalence of nephroblastoma
3-4 yrs
133
symptoms of nephroblastoma
fever, hematuria, anemia, HTN, palpable
134
appearance of nephroblastoma
large, well defined, solid, unilateral, variable echotexture
135
typical size of presentation for nephroblastoma
around 12 cm
136
DDx: large pediatric tumour on kidney
primary neuroblastoma of the adrenal gland
137
Identify: variable echogenicity adult renal parenchymal mass with hypoechoic halo, possible calcifications
renal cell carcinoma
138
location of TCC
sinus of kidney - urinary collecting system (calyces, pelvis, ureters, bladder)
139
location of renal cell carcinoma
renal parenchyma
140
gender prevalence of TCC
men>women
141
TCC
transitional cell carcinoma
142
RCC
renal cell carcinoma
143
DDx x 3 for TCC
blood clots, fungal balls, sloughed papilla from pyramid apex
144
clinical presentation of renal pelvis TCC
painless hematuria
145
clinical presentation of bladder TCC
painless hematuria, urinary frequency, dysuria, suprapubic pain
146
appearance of renal pelvis TCC
ill-defined, hypoechoic mass
147
appearance of bladder TCC
focal, non-mobile mass or thickening
148
location of bladder TCC
trigone, lateral or posterior bladder walls
