misc Flashcards
Most common complication of a bone marrow biopsy
retroperitoneal hemorrhage; fatalities have been reported
technique for bone marrow biopsy
lateral angle towards the ipsilateral ASIS
avoid hitting the retroperitoneal vessels
Do you have to biopsy liver mets to establish a diagnosis of CRC?
No; CEA level and radiolgy are acceptable
treatment of pseudoaneurysm with pancreatic pseudocyst
need IR embolization first;
pseudoaneurysm is contraindication to an IR drain.
most common presentation of nasopharyngeal caner
painless neck mass
Three steps for missing parathyroid during 4 gland dissection
- resect thymus.
- divide middle thyroid vein to mobilization thyroid to expose the esophagus and trachea.
- Thyroid lobectomy is the last step before aborting
When should you perform median sternotomy for an ectopic parathyroid?
Should basically never happen; Would need clear imaging showing an intrathoracic gland preop.
Specific mutations for MEN 2a
RET exons 10, 11, 13, 14
Specific mutation for MEN 2b
RET codon 918
What is the most likely diagnosis in a thyroid nodule for <14 year old?
50% of thyroid nodules are malignant in children under 14 years
most common cancer still is papillary.
risk of cancer is highest in the young and old.
most common complication of percutaneous cholecystostomy:
Bile leak during placement or removal of the tube occurs in approximately 3% of patients. Many leaks are self-limited.
serum markers for medullary thyroid cancer
Carcinoembryonic antigen and calcitonin
Mucinous Cystic Neoplasms - pathology finding:
ovarian-type stroma (resect them all)
cholesterol polyp in a gallbladder - ultrasound features
pedunculated
hyperechoic
do not have posterior shadowing
initial management of hypercalcemia from bone metastasis
bisphosphonates and calcitonin
PTU mechanism
interferes with the uptake of iodine by the thyroid and preventing coupling of iodotyrosines that combine to produce thyroid hormone.
Feared side effect of PTU
agranulocytosis occurs in 0.1% to 0.04% of patients.
mechanism of lithium for management of hyperthyroid
reduces synthesis of thyroid hormone and blocks its release.
Adrenal operation if patient has had a previous contralateral adrenalectomy? (MEN2a/Pheo)
a partial (cortical-sparing) adrenalectomy (don't do if malignant tumor)
The virus associated with nasopharyngeal carcinoma and Burkitt`s lymphoma is:
Epstein Barr Virus
What other virus may play a role in Burkitts lymphoma in addition to Epstein Barr Virus?
Malaria
Burkitt’s Lymphoma in the US is most commonly associated with:
HIV
How do you perform a secretin stimulation test for ZE syndrome?
baseline gastrin level is drawn
2u/kg of secretin given iv
gastrin levels are drawn at q 5 minutes x6
increase in gastrin of more than 200pg/ml above the basal level supports the diagnosis of a gastrinoma.
A patient is undergoing distal, subtotal gastrectomy with D2 lymphadenectomy for gastric cancer. Preservation of which artery is required to assure adequate perfusion of the gastric remnant?
Left gastroepiploic
mechanisms of PTH
PTH has direct effects on skeletal muscle and the kidney with indirect effects on the gastrointestinal tract. PTH causes increase reabsorption of calcium by the kidney and inhibits the reabsorption of phosphate. PTH stimulates the hydroxylation of 25-hydroxy vitamin D and secretion of bicarbonate.
risks of rectal cancer with FAP
Patients who undergo total abdominal colectomy with ileorectal anastomosis have the risk for developing rectal cancer which has been shown to be 4%, 5.6%, 7.9%, and 25% at 5, 10, 15, and 20 years after resection.
cell of origin for MTC
calcitonin secreting para-follicular cells, or C-cells.
metabolic derangement from obstructive jaundice
Vitamin K deficiency
Biliary obstruction prevents intestinal formation of micelles necessary for absorption of the fat soluble vitamins A, D, E, and K.
what medicine has been studied with RCTs for malignant bowel obstruction?
octreotide
[find citations]
pseudohypoparathyroidism, definitions
Pseudohypoparathyroidism is characterized by target tissue resistance to parathyroid hormone (PTH), low serum calcium, elevated serum phosphate, and defect in skeletal growth and development.
pseudohypoparathyroidism, mutation
This is a rare familial disorder due to mutations in the GNAS1 gene.
pseudohypoparathyroidism mechanism
parathyroid hormone function itself is normal, but the kidney cannot respond to PTH stimulation. This results in hypocalcemia and hyperphosphatemia
What colostomy to perform if patient needs/getting RT?
End is preferred over a loop. Radiation may lead to contraction of the distal limb and disrupt the ostomy.
Most common cause of gastric outlet obstruction?
adenocarcinoma;
PUD is now rare.
What surveilance is needed after Ileoanal anastomosis for FAP?
anoscopy and upper endoscopy
Gastrinoma Triangle
. The gastrinoma triangle includes the area to the right of the superior mesenteric vessels (cystic and common bile ducts), in the head of the pancreas, or in the duodenal wall (2nd and 3rd portions of duodenum)
Percentage of gastrinomas that are associated with MEN-1
25%
What is adjuvant therapy for MALT lymphoma?
none required if localized disease completely excised.
Yuman Fong factors for CRC live metastasectomy prognosis?
a node positive primary disease-free interval of less than 1 year increasing number of metastasis largest metastasis greater than 5 cm serum CEA > 200.
Patients with all factors favorable -> five-year survival of 60%
How do you tell FNH from adenoma on liver sulfur colloid scan?
Unlike focal nodular hyperplasia, hepatic adenomas do not contain Kupffer cells and will appear cold on a sulfur colloid liver scan
Size cutoff to attempt discontinuation of OCPs for a hepatic adenoma
4 cm
The most common cause of primary adrenal insufficiency is:
autoimmune disease
How do you do a high dose dexamethosone suppression test?
2mg of dexamethasone is given orally q6 hours for two days. During this time, urine cortisol level is measured on the second day
dexamethosone supression result for a pituitary adenoma
urine free cortisol level should decrease by at least 50%. ACTH levels will also be suppressed in a pituitary adenoma by the end of the 2 days
dexamethosone result for ectopic ACTH secreting tumor
the high-dose dexamaethasone test will not cause a suppression of the ACTH nor urine free cortisol level.
formal test to diagnose exocrine pancreatic insuffieciency
> 20 g of fecal fat on a 24 hour stool collection
The three most common screening tests for cortisol overproduction are:
The three most common screening tests for cortisol overproduction are: 24-hour urinary free cortisol, low-dose dexamethasone suppression test, and late-night salivary cortisol.
Hounsfield unit cutoffs for adrenal tumors
An adrenal mass with HU of < 10 on noncontrast CT is 100% specific for a benign tumor. For tumors with a higher HU contrast washout of < 50% after 10 minutes is suspicious for malignancy. Other suspicious imaging features include tumor size > 4 cm, irregular borders, inhomogeneity and calcifications.
Cowden syndrome
Breast cancer
intestinal polyps
facial trichilemmomas, mucosal papillomas, and acral keratoses.
Frequency of Supernumerary parathyroid glands
five or more glands in ~13%,
only three parathyroids in ~3%.
Which locations results in the worst long-term functional outcome after curative operation and radiation therapy for squamous cell carcinoma of the oral cavity?
base of tongue
which sarcoma’s spread via lymphatics?
rhabdomyosarcoma,
epitheloid sarcoma,
clear cell sarcoma,
synovial sarcoma and vascular sarcoma.
criteria to diagnose a parathyroid carcinoma?
Marked mitotic activity
dense fibrous stroma
evidence of local invasion into the capsule or surrounding vessels
What is treatment for thyroid lymphoma?
excellent responses to CHOP unless significant compressive symptoms are present.
For diffuse large B-cell lymphoma, the therapy is CHOP (Cytoxan®, hydroxy doxorubicin, Oncovin®, Prednisone) followed by radiation.
Locations of apocrine sweat gland tumors
These glands are found primarily in the axillae, groin, and perineum
Neoplasms arising from eccrine glands are most commonly found
Neoplasms arising from eccrine glands are most commonly found on the palms of the hands and soles of the feet
trials for oncotype DX
NSABP B-14
NSABP B-20
TAILORx trial
Randomized mid-risk oncotype breast cancer patients to chemoendocrine therapy v endocrine therapy alone.
No chemo benefit for ER+PR+H2-, node–negative breast cancer who had a midrange 21-gene recurrence score
What do you do with a cystic duct margin that is positive for gallbladder cancer?
In the setting of a cystic duct margin that is positive, a bile duct resection with reconstruction is an appropriate operation.
What to do with a 2 cm solitary thyroid nodule in a 65 year old man?
Can go straight to excision for solitary nodule in man >60 years.
At colonoscopy for rectal bleeding, a 45-year-old man has a 1.0-cm submucosal lesion of the rectum. The biopsy diagnosis is granular cell myoblastoma. Pathologic examination of the specimen demonstrates positive margins. Appropriate management would be:
These are benign tumors, with fewer than 2% exhibiting malignant morphology. Thus, for colorectal lesions, colonoscopic excision is the procedure of choice.
Segmental colectomy is needed for malignant polyps with the following characteristics:
lymphovascular invasion poor differentiation less than 2mm margin piecemeal polypectomy invasion of the lower third of the submucosa central depression or ulceration.
PTU efficacy
Treatment with PTU has a 30% remission rate of hyperthyroidism at 18 months.
Management of thyroid FNA
“atypia of undetermined significance” (AUS)
“follicular lesion of undetermined significance” (FLUS)
In patients where malignancy risk is low, repeat FNA can be done. In patients with risk factors for malignancy (age >50, family history of thyroid cancer, personal history of irradiation, etc.), an aggressive approach to diagnosis is warranted
“book” cutoff value to start oral calcium supplementation after parathyroidectomy
> = 7.5 mg/dL
Colonoscopy scheduling
If a patient has a first-degree relative with colorectal cancer or polyps before age 60, or 2 first-degree relatives with colon cancer and/or polyps at any age, the patient should have screening colonoscopy starting at age 40, or 10 years before the earliest diagnosed family member, with subsequent colonoscopies every 5 years. If the patient has a first-degree relative with colorectal cancer or polyps at age 60 or older, or 2 second-degree relatives at any age, screening colonoscopy should be at 40 (or 10 years prior to earliest diagnosed family member), with subsequent colonoscopies at 10 year intervals. Patients with one second-degree or third-degree family member are considered average risk, and should have screening at age 50, at 10 year intervals (same recommendations for patients with no family history). Patients with known HNPCC should undergo their first screening colonoscopy at age 20-25 years (or 10 years prior to the earliest diagnosed family member), with subsequent colonoscopies every 1-2 years. In all scenarios, the time interval of subsequent colonoscopies may be shortened depending on the findings at the prior procedure.
dimensions on thyroid ultrasound that are concerning for malignancy.
Generally, dimensions that are “taller than they are wide” are suspicious for cancer. Benign lesions tend to grow more radially (outward) while cancers typically grow more vertically. If the cancer grows quickly, it can “mushroom” up from the thyroid surface, giving it an irregular appearance.
Worst pathological feature for a DFSP?
fibrosarcomatous change
Factors that predict MALT lymphoma treatment failure after H. pylori eradication alone:
transmural tumor extension
nodal involvement
transformation into a large cell phenotype
t(11;18) or nuclear BCL-10 expression.
The most common mutation in pancreatic cancer is:
kras
When do you perform segmental duodenectomy for adenocarcinoma?
For lesions amenable to segmental resection, segmental duodenal resection with regional lymphadenopathy is the procedure of choice.
Pancreaticoduodenectomy is reserved for those patients with lesions in the first and second portion of the duodenum.
A 35-year-old immunocompetent man is diagnosed with anal intraepithelial neoplasia, grade 1. What is the current recommended management for this lesion?
Observation with close surveillance is the best option for patients with low-grade dysplasia.
Topical treatments such as imiquimod and 5-fluorouracil have shown but not studied well enough for risks to outweigh benefits.
A 74-year-old woman presents to your clinic with a history of stage IB infiltrating ductal carcinoma of the left breast, which was treated with partial mastectomy and radiation 8 years ago. She now has an area of small, violaceous papules within the radiation field. Punch biopsy indicates cutaneous angiosarcoma. What is the best approach to treatment?
This is cutaneous angiosarcoma, manifested as a radiation-associated sarcoma.
Preoperative chemotherapy with a taxane is favored, followed by resection.
Level of evidence is retrospective.
60-year-old man with a bowel obstruction from jejunal mass with liver mets. He has a 6-month history of vague, crampy abdominal pain often associated with diarrhea and at times associated with sweating. Liver biopsy and en-bloc resection of the intussusception was performed with negligible blood loss. The patient became hypotensive and there was no response to increased fluids and catecholamines. What is the next step in management?
Give somatostatin analogue.
With no documented major blood loss, no response to additional fluids or to vasopressors, a carcinoid tumor must be strongly considered.
In a 55-year-old male with primary hyperparathyroid what medication is an indication for bilateral exploration as the primary surgery?
lithium-induced HPT are more likely to warrant a four-gland exploration since all four glands are exposed to the effects of lithium.
What non-skin cancer most commonly metastasizes to skin?
breast
management of mucinous carcinoma of the breast?
Needs a SLNB; has a better prognosis than typical ductal/lobular carcinomas.
APC mutation in colon cancer cells, does patient have APC?
Somatic mutations in APC are seen in more than 80% of sporadic colon cancers, and the presence of an APC mutation in tumor cells does not always indicate a familial cancer syndrome
prognosis of an APC mutation
The absence of an APC mutation may confer a worse prognosis than a single APC mutation
minimum length of a puestow
6 cm
A 65-year-old female with no family history of colon cancer presents to your clinic following right hemicolectomy for Stage III colon cancer. Her pathology results reveal a poorly differentiated tumor with signet-ring components. What is the most likely molecular marker associated with her tumor?
microsatellite instability (MSI)
A 36-year-old man presents for follow-up after excision of an internal anal lesion. The pathology showed a condyloma with anal intraepithelial neoplasia I. The most appropriate next step:
HIV testing
setting up a surveillance schedule
How do you perform a choledochotomy?
longitudinally
The most common genetic mutation associated with papillary thyroid cancer is:
BRAF-V600E
The most common genetic mutation associated with follicular thyroid cancer is:
PAX-8/PPARgamma
The most common genetic mutation associated with anaplastic thyroid cancer is:
p53
Components of Nigro protocol
5-fluorouracil
mitomycin C
50 Gy to the primary carcinoma/pelvis
35-45 Gy to pelvic inguinal lymph nodes.
enterochromaffin (Kulchitsky) cells at the base of the crypts of Lieberkuhn
carcinoid cell of origin
GIST cell of origin
interstitial cells of Cajal
3 most common locations for carcinoids in order:
A.I.R (Appendix, Ileum and Rectum)
A 72-year-old woman with a history of diverticulosis has a painless mass in the left lower quadrant of her abdomen. A CT scan of the abdomen shows an 8x8x9-cm cystic structure in the pelvis. On laboratory examination, her CA-125 level is 130 U/mL (N = < 35 U/ml). The next step in management should be:
operative exploration
A gallbladder fundal mass is noted during laparoscopic cholecystectomy. Frozen section biopsy shows involvement of the muscular wall by atypical cells and cystic spaces, “cannot rule out malignancy” - most likely diagnosis?
benign adenomyoma
A gallbladder fundal mass is noted during laparoscopic cholecystectomy. Frozen section biopsy shows involvement of the muscular wall by atypical cells and cystic spaces, “cannot rule out malignancy” - next step?
close and await final pathology
3 high risk pathologic features of a carcinoid
mucosal cellular origin
associated with mucin production
lymphovascular invasion
What is the most common radiographic finding on a patient with intussusception?
non-specific bowel obstruction
cutoff size for risk of malignancy of a gallbladder adenoma?
malignancy risk starts at ~1 cm
2-year follow-up after total thyroidectomy for a T1 N0 M0 papillary thyroid cancer. You note that her thyroglobulin has increased from undetectable (<0.1) to 1.1 within 1 year and similar TSH levels - next step
neck ultrasound
hyper-parathyroidism and radiation exposure?
A history of radiation exposure has been associated with four-gland hyperplasia. In this setting, it is prudent to perform a four-gland exploration.
A 40-year-old man with HIV and a previous history of genital warts is found to have an anal lesion consistent with anal intraepithelial neoplasia. What is the strongest risk factor for this diagnosis?
Human Pappiloma Virus
The most common benign tumor of the esophagus
leiomyoma
How to differentiate leiomyoma from GIST from leiomyosarcoma?
EUS with FNA
Most of the carcinoid tumors which produce the malignant carcinoid syndrome originate in the:
ileum
appendix is more common, but much less aggressive.
Best Radiology for a thigh mass:
Plain radiography and magnetic resonance imaging with contrast
Anal SCC with palpable inguinal nodes; what is next step?
FNA of nodes
Screening in Lynch Syndrome
colonoscopy at age 20 to 25 years (repeated every 1-3 years),
plus annual transvaginal ultrasound or endometrial aspiration (females) at age 20 to 25 years
A 35-year-old woman recovers after a suicide attempt involving ingestion of a large amount of lye. In outpatient follow-up, she inquires about the need need for further follow-up. What long-term follow-up, if any, is needed?
The risk of esophageal SCC is 2% after severe caustic ingestion.
The ASGE recommends endoscopic surveillance starting 15 to 20 years after the caustic ingestion.
What outcomes differ if a roux-en-y pouch is performed for reconstruction after a total gastrectomy
Roux-en-Y esophagojejunostomy results in less postoperative weight gain compared with Roux-en-Y pouch reconstruction
obstructing colorectal cancer unable to be scoped prior to resection: When should first post-op colonoscopy be?
in 6 months
When to do transplant for primary sclerosing cholangitis.
Liver transplantation should be considered soon after symptoms appear
A 44-year-old man has a total thyroidectomy for medullary thyroid carcinoma. The most sensitive postoperative screening test for residual or recurrent tumor would be:
pentagastrin-stimulated peak plasma calcitonin levels
Test to help decide when to do thyroidectomy for a MEN2 pediatric patient/
As children from families in whom the MEN2 syndrome has been identified approach puberty, pentagastrin-stimulated peak plasma calcitonin levels are helpful in deciding when total thyroidectomy should be performed.
adrenal mass (pheo) and ocular vascular malformations, what is the syndrome?
VHL
A 38-year-old man with Crohn’s disease for 15 years undergoes laparotomy and resection of a strictured portion of the distal ileum. In the area of the stricture, Crohn’s disease is confirmed, and a 2-cm small bowel mucosal neoplasm is noted. Which of the following is the most likely pathologic diagnosis?
adenocarcinoma
The highest cure rate by resection has been achieved in patients with gastrinomas located
in the duodenum
half life of CEA
15 days
half life of AFP
5 days
Definition of latency period
time from exposure to clinically detectable tumor
What is the most vulnerable stage of the cell-cycle for XRT
M stage
Three Rs of fractionated radiation
Allows normal cells to REPAIR
Allows tumor to REOXYGENATE
Allows cancer cell to REDISTRIBUTE in the cell cycle
Platinum alkylating agent that causes myelosupression
Carboplatin
microtubule inhibitor that causes myelosuppression
Vinblastine
Active metabolite of cyclophosphamide
acrolein
treatment for hemorrhagic cystitis (cyclophosphamide)
Mesna
Target of methotrexate
dihydrofolate reductase
Target of 5-FU
thymidylate synthesis
Leucovorin effect on methotrexate
rescue
leucovorin effect of 5-FU
increases effects (and toxicity)
mechanism of doxorubicin cardiotoxicity
O2 radicals
Side effect of GCSF
Sweet’s Syndrome - febrile neutropenic dermatitis
Embryologic precursor for melanocytes
Neural Crest Cells
what class of cancer is mesothelioma?
sarcoma
What are environmental risk factors for angiosarcoma?
PVC and arsenic
cell of origin for osteosarcoma?
metaphyseal cells
Most common location for supranumerary parathyroid glands
Supernumerary glands are most commonly found in the thymus.
What increases the likelihood of supranumerary parathyroid glands.
The likelihood of having a supernumerary gland is increased in patients with a familial/genetic component to their disease (for example, MEN-1 syndrome).
gene associated with parathyroid adenomas
PRAD-1
Chance of malignancy with a breast granular cell tumor?
benign; treat with WLE
Chance of malignancy in a breast fibromatosis
benign; treat with WLE
Chance of malignancy with radial scar
some chance of cancer: proceed to excision if found on core needle
Chance of malignancy with nipple adenomas
only a few case reports of malignancy; OK to not excise
Chance of malignancy with PASH
mimics inflammatory cancer and so excision is recommended, but does not contain cancer.
T staging of breast cancer
Tis (DCIS) – Ductal carcinoma in situ.
●T1 – Tumor ≤20 mm in greatest dimension.
●T2 – Tumor >20 mm but ≤50 mm in greatest dimension.
●T3 – Tumor >50 mm in greatest dimension.
●T4 – Tumor of any size with direct extension to the chest wall and/or the skin (ulceration or macroscopic skin nodules)*.
T4 subcatagories of breast cancer
- T4a – Extension to chest wall, not including only pectoralis muscle adherence/invasion.
- T4b – Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin, which do not meet the criteria for inflammatory carcinoma.
- T4c – Both (T4a and T4b).
- T4d – Inflammatory carcinoma**.
T1 subcatagories of breast cancer
- T1mi – Tumor ≤1 mm in greatest dimension.
- T1a – Tumor >1 mm but ≤5 mm in greatest dimension (round any measurement 1.0 to 1.9 mm to 2 mm).
- T1b – Tumor >5 mm but ≤10 mm in greatest dimension.
- T1c – Tumor >10 mm but ≤20 mm in greatest dimension.
Tis (Paget)
•Tis (Paget) – Paget disease of the nipple not associated with invasive carcinoma and/or DCIS in the underlying breast parenchyma. Carcinoma in the breast parenchyma associated with Paget disease is categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should still be noted.
Breast N staging
cN1 – Metastasis to movable ipsilateral level I, II axillary lymph nodes(s).
•cN1mi** – Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger than 2.0 mm).
●cN2 – Metastasis to ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted; or in ipsilateral internal mammary nodes in the absence of clinically evident axillary node metastases.
•cN2a – Metastasis to ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures.
•cN2b – Metastasis only in ipsilateral internal mammary nodes, and in the absence of clinically evident axillary node metastases.
●cN3 – Metastases in ipsilateral infraclavicular (level III axillary) lymph node(s) with or without level I, II axillary lymph node involvement; or in ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastases; or metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement.
myocutaneous flap reconstruction after APR is associated with:
lower wound complications.
limited internal sphincter involvement of CRC on MRI?
not an absolute contraindication to sphincter preserving surgery.
Rate of perforation with TEM
6=10%
typical features of parathyroids in MENI
typically hyperparathyroidism is 1st sign of the syndrome
have 4 gland disease
presents before age 30
have supranumerary glands
risk of malignancy in a symptomatic Meckels?
0.5-3%
Most common tumor in a Meckels?
carcinoid
Placement of a rectosigmoid stent for near obstructing cancer is associated with?
Higher lymph node harvest.
half the rate of ostomy formation
shorter hospitalizations
Cheung HY Arch Surg 2009
Which has better prognosis in CRC microsatellite instability or chromosomal instability?
MSI
Differences for patients with HIV and anal SCC
faster progression from AIN
younger at diagnosis
Anal SCC survival: HIV+ v HIV- patients:
OS is similar, but HIV+ patients more likely to die of SCC
Morbidity associated with HIV for SCC treatment
more skin toxicity and myelosuppression with Nigro protocol
more recurrences
more perineal complications at surgery.
COLOFOL study
multinational trial on follow-up of CRC (not resulted?)
Surrogate markers for portal hypertension when assessing a patient for liver resection?
platelets <100,000
splenomegaly
Efficacy of RFA v EtOH ablation for HCC
equivalent for <2 cm
RFA superior for 2-3cm
Timing of EtOH ablation for HCC
often requires multiple treatments.
Number of lymph-nodes associated with poor outcome after portal dissection for gallbladder cancer?
3 nodes
Effects of ASA of colon cancer risk?
Definitely decreases high risk lesions/polps in most studies and invasive CRC in some studies.
Latency of ASA on colon cancer risk reduction?
no effect until 10 years after treatment, and need to take continuously for 5 years.
dosage of ASA for CRC reduction?
no difference between 81mg and 325mg
onionskin appearing tumor on plain x-ray
Ewings
Starburst apprearance on plain x-ray
Osteosarcoma
amyloid on thyroid biopsy
Medullary Thyroid Cancer
Nuclear grooves and inclusions on thyroid biopsy
Papillary Thyroid Cancer
Oxyphilic cells on thyroid biopsy
Hurthle Cell Cancer
Calcitonin staining on thyroid biopsy
Medullary thyroid cancer
Diagnosis of Follicular thyroid cancer on FNA?
this is impossible; needs lobectomy to diagnose, and then completion thyroidectomy once diagnosed.
Diagnosis of Hurthle cell thyroid cancer on FNA?
Impossible
Appearance of Hurthle cells?
oxyphilic cells that appear pink and filled with mitochondria
Which thyroid cancers can be diagnosed on FNA?
PTC and MTC
Diagnostic stains for parafollicular c-cells (MTC)
chromogrannin A
CEA
Calcitonin
Bethesda Classification of thyroid nodules I-III:
I. Nondiagnostic or Unsatisfactory (10%) repeat biopsy
II. Benign - risk of cancer in this category is 0 to 3%.
III. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
repeat FNA in 6 weeks. Cancer risk 5 to 15%.
Bethesda IV-VI
IV. Follicular Neoplasm or Suspicious for a Follicular Neoplasm
Needs lobectomy. Cancer risk is 15 to 30%.
V. Suspicious for Malignancy
Total thyroid, except maybe nobule <1cm.
The risk of malignancy is 60 to 75%.
VI. Malignant
The risk of malignancy is 97 to 99%
Most common diagnosis after thyroid lobectomy for Bethesda IV
Most of these will turn out to be follicular adenomas which are benign.
