Malignant Neoplastic Diseases Flashcards
Characteristics of malignant neoplasms
hypoechoic halo
multiple solid, hypoechoic liver masses
high velocity Doppler/hypervascularity
lymphadenopathy
malignancy of connective tissue origin
sarcoma
malignancy of epithelial tissue origin
carcinoma
most common type of malignancy
adenocarcinomas
high risk factors for malignant neoplasms
viruses
family history/genetics
environmental exposures
hormone imbalances
most common primary malignant liver neoplasm
HCC
HCC, aka
hepatoma
hepatoma, aka
HCC
most common malignant neoplasm, overall
secondary metastases
gender prevalence of HCC
males>females
three forms of HCC
solitary focal, multiple focal, diffuse infiltration
risk factors for HCC
alcoholism, cirrhosis, Hep B or C, toxic metabolites, metabolic disorders (e.g. GSD)
GSD
glycogen storage disease
symptoms of HCC
RUQ pain
weight loss
abdominal swelling/ascites
hepatomegaly
appearance of HCC
often solitary, usually hypoechoic, anechoic halos
size of HCC
less than 5 cm
common site of invasion for HCC
portal and hepatic veins
DDx for hyperechoic presentation of HCC
hemangioma, adenoma, lipoma
lab values indicative of HCC
elevated AFP (most reliable, 70% present) and LFT’s (ALP, AST, ALT)
liver hemangiosarcoma, aka
liver angiosarcoma
liver angiosarcoma, aka
liver hemangiosarcoma
age prevalence of liver hemangiosarcoma
60-80 yrs old
environmental risk factors for liver hemangiosarcoma
exposure to arsenic, PVC (industrial chemicals), or thorotrast (xray contrast)
appearance of liver hemangiosarcoma
large, mixed echogenicity, necrotic or fibrotic areas due to rapid growth
appearance of epitheloid hemangioendothelioma
multiple, hypoechoic, inward retraction of hepatic capsule over the lesion
Identify: large, mixed echogenicity mass in liver, with necrotic or fibrotic areas due to documented rapid growth
liver hemangiosarcoma/angiosarcoma
Identify: multiple, hypoechoic liver lesions, causing inward retraction of hepatic capsule over the lesion
epitheloid hemangioendothelioma
age prevalence of hepatoblastoma
children under 5 yrs old
most common primary liver malignancy in children
hepatoblastoma
Which primary liver malignancy is associated with Beckwith-Wiedemann syndrome?
hepatoblastoma
lab values indicative of hepatoblastoma
elevated AFP
appearance of hepatoblastoma
singular, solid, large, mixed echogenicity, poorly defined walls, calcifications
symptoms of splenic hemangiosarcoma
anemia (70% presentation)
common site of metastasis for splenic hemangiosarcoma
liver
appearance of splenic hemangiosarcoma
variable - similar to splenic hemangioma:
hyperechoic, homogeneous and solid; or complex with cystic degeneration
symptoms of Hodgkin’s lymphoma
fever, weight loss, ANEMIA
painless enlarged cervical and clavicular LN’s
age prevalence of Hodgkin’s lymphoma
younger
gender prevalence of Hodgkin’s lymphoma
male>female
prognosis of Hodgkin’s lymphoma
high survival rate
prognosis of non-Hodgkin’s lymphoma
poor
age prevalence of non-Hodgkin’s lymphoma
older
prevalence of para-aortic lymphadenopathy in Hodgkin’s lymphoma
25%
prevalence of para-aortic lymphadenopathy in non-Hodgkin’s lymphoma
50%
symptoms of non-Hodgkin’s lymphoma
fever, weight loss, NIGHT SWEATS
painless enlarged cervical and clavicular LN’s
common site of metastasis for lymphoma
liver, spleen
appearance of splenic metastases caused by lymphoma
splenomegaly with solid, anechoic/hypoechoic, homogeneous, lobulated or scalloped mass
5 F’s of likelihood to acquire gallstones
family hx female fat forty's fertile (fair, flatulent)
symptoms of gallbladder carcinoma
RUQ pain, fatty food intolerance, occasional nausea and vomitting
jaundice, itchiness
clinical DDx for GB carcinoma, based on symptoms
chronic cholecystitis
gender prevalence of GB carcinoma
females>males
age prevalence of GB carcinoma
60’s-70’s
common site of metastasis for GB carcinoma
liver, LN’s
primary adenocarcinoma of the GB
GB carcinoma
icterus
jaundice
pruritis
itchiness
appearance of GB carcinoma
polypoid intraluminal lesion, irregular borders, GB wall thickening
normal GB wall dimension
under 3 mm
common site of invasion for GB carcinoma
adjacent liver tissue and GB fossa
primary adenocarcinoma of the bile ducts
cholangiocarcinoma
gender prevalence of cholangiocarcinoma
males>females
age prevalence of cholangiocarcinoma
50’s-60’s
risk factors for GB carcinoma
gallstones
risk factors for cholangiocarcinoma
chronic biliary stasis and inflammation, history of choledochal cyst or Caroli’s disease
symptoms of cholangiocarcinoma
vague - dyspepsia, fatigue
jaundice
pruritis
lab values indicative of cholangiocarcinoma
elevated serum bilirubin and ALP
most common type of cholangiocarcinoma
Klatskin’s (hilar region, diffuse intrahepatic duct dilatation)
three types of cholangiocarcinoma
intrahepatic (isolated ducts)
distal (CBD)
Hilar/Klatskin’s (diffuse, bilobar)
appearance of Klatskin’s cholangiocarcinoma
diffusely dilated intrahepatic ducts,narrowing of lumen, low level intraluminal echoes, solid mass at porta hepatis, normal CBD
location of Klatskin’s cholangiocarcinoma
liver hilum/porta hepatis, where CHD is formed by joining of R and L hepatic ducts
most common primary pancreatic malignancy
primary pancreatic adenocarcinoma
lab values indicative of pancreatic adenocarcinoma
elevated lipase
typical location of pancreatic adenocarcinoma
pancreas head
age prevalence of pancreatic adenocarcinoma
60-80 yrs old
risk factors of primary pancreatic adenocarcinoma
smoking, alcoholism, diabetes
symptoms of primary pancreatic adenocarcinoma
weight loss PAINLESS jaundice nausea and vomitting change in stools epigastric pain radiating into back
What is PAINFUL jaundice indicative of?
biliary obstruction
What is PAINLESS jaundice indicative of?
malignancy
appearance of primary pancreatic adenocarcinoma
ill-defined, solid, hypoechoic, variable echotexture
size of primary pancreatic adenocarcinoma
greater than 2 cm
Identify: solid mass at porta hepatis, normal CBD, dilated intrehepatic ducts with low level intraluminal echoes and narrowing lumen
Klatskin’s cholangiocarcinoma
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)
Identify: polypoid intraluminal GB lesion, irregular borders, GB wall thickening, hx of gallstones
primary GB carcinoma
Identify: ill-defined, solid, hypoechoic, homo/heterogeneous mass in pancreatic head
primary pancreatic adenocarcinoma
indirect signs of pancreatic adenocarcinoma
double duct sign, Courvoisier’s GB/sign
double duct sign
both the CBD and pancreatic duct are dilated, likely due to obstruction at the pancreatic head
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)
gender prevalence of cystic pancreatic neoplasms
women>men
age prevalence of cystic pancreatic neoplasms
middle aged - older population
appearance of macrocystic pancreatic neoplasms
large, encapsulated, may be uni- or multilocular
macrocystic pancreatic neoplasm, aka
pancreatic mucinous cystadenoma
pancreatic mucinous cystadenoma, aka
macrocystic pancreatic neoplasm
size of macrocystic pancreatic neoplasms
larger than 2 cm
typical location of macrocystic pancreatic neoplasms
pancreatic tail
name a malignant pancreatic neoplasm that is often found in the tail
macrocystic pancreatic neoplasm
name a benign pancreatic neoplasm that is often found in the head
microcystic pancreatic neoplasm
name a malignant pancreatic neoplasm that is often found in the head
primary pancreatic adenocarcinoma
Identify: large, encapsulated cystic area in the pancreatic tail, may be uni- or multilocular
macrocystic pancreatic neoplasm
Identify: small, echogenic, well defined cystic area in the pancreatic head
microcystic pancreatic neoplasm
normal distended GI wall thickness
3 mm
normal non-distended GI wall thickness
5 mm
echogenicity of gut signature from inner to outer
collapsed lumen - hyper mucosa - hypo submucosa - hyper muscularis - hypo serosa - hyper
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
appearance of thickened bowel
target pattern, pseudokidney appearance, loss of tissue layer differentiation, hypoechoic wall with hyperechoic centre
What is increased peristalsis indicative of?
early stage obstruction and inflammation
What is decreased peristalsis indicative of?
end stage obstruction, inflammation, and paralytic ileus
signs and symptoms of GI neoplasms
pain, anemia, anorexia, palpable, blood in stool, internal bleeding
most common primary malignant GI neoplasm
GI adenocarcinoma
gender prevalence of primary GI adenocarcinoma
males>females
common sites of primary GI adenocarcinoma in the stomach
prepyloric, antrum, lesser curvature
common sites of primary GI adenocarcinoma in the small bowel
ileum
Which area of the bowel is associated with developing adenocarcinoma with Crohn’s disease?
ileum/small bowel
common sites of polypoid GI adenocarcinoma in the colon
cecum and ascending colon
common sites of annular GI adenocarcinoma in the colon
descending and sigmoid colon
What presentation of primary GI adenocarcinoma is found commonly found in the cecum and ascending colon?
polypoid GI adenocarcinoma
What presentation of primary GI adenocarcinoma is found commonly found in the descending and sigmoid colon?
annular GI adenocarcinoma
appearance of primary GI adenocarcinoma
large, hypoechoic, target pattern or pseudokidney due to thickened gut wall
most common malignant GI tract neoplasm in children under 10 yrs old
GI lymphoma
appearance of GI lymphoma
hypoechoic solid nodules, target pattern lesion, enlarged mesenteric LN’s
renal cell carcinoma, aka
hypernephroma
hypernephroma, aka
renal cell carcinoma
most common malignant renal neoplasm in adults
renal cell carcinoma
symptoms of RCC
flank pain, gross hematuria, palpable, weight loss, HTN
gender prevalence of RCC
men>women
age prevalence of RCC
50-70 yrs old
Which malignant renal neoplasm is associated with Hippel-Lindau disease and Tuberous Sclerosis?
renal cell carcinoma
Hippel-Lindau disease
inherited disease characterized by the formation of multiple tumors (both benign & malignant)
common sites of invasion for RCC
IVC, renal veins, para-aortic LN’s, contralateral kidney
appearance of RCC
variable echogenicity, hypoechoic halo, possible calcifications
most common malignant renal neoplasm in children
nephroblastoma/Wilm’s tumour
nephroblastoma, aka
Wilm’s tumour
Wilm’s tumour, aka
nephroblastoma
age prevalence of nephroblastoma
3-4 yrs
symptoms of nephroblastoma
fever, hematuria, anemia, HTN, palpable
appearance of nephroblastoma
large, well defined, solid, unilateral, variable echotexture
typical size of presentation for nephroblastoma
around 12 cm
DDx: large pediatric tumour on kidney
primary neuroblastoma of the adrenal gland
Identify: variable echogenicity adult renal parenchymal mass with hypoechoic halo, possible calcifications
renal cell carcinoma
location of TCC
sinus of kidney - urinary collecting system (calyces, pelvis, ureters, bladder)
location of renal cell carcinoma
renal parenchyma
gender prevalence of TCC
men>women
TCC
transitional cell carcinoma
RCC
renal cell carcinoma
DDx x 3 for TCC
blood clots, fungal balls, sloughed papilla from pyramid apex
clinical presentation of renal pelvis TCC
painless hematuria
clinical presentation of bladder TCC
painless hematuria, urinary frequency, dysuria, suprapubic pain
appearance of renal pelvis TCC
ill-defined, hypoechoic mass
appearance of bladder TCC
focal, non-mobile mass or thickening
location of bladder TCC
trigone, lateral or posterior bladder walls
