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Step One Rapid Review > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

Small Cell Carcinoma

A 
poorly differentiated small cells
Kulchitsky (neuroendocrine)
Male smokers
Central
ADH/ACTH
Eaton-Lambert syndrome
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2
Q

Squamous Cell Carcinoma (Lung)

A

Keratin pearls, intracellular bridges
Most common tumor in male smokers
Central
PTHrP

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3
Q

Adenocarcinoma (Lung)

A

Glands or mucin
Most common tumor in nonsmokers and female smokers
Peripheral

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4
Q

Large Cell Carcinoma (Lung)

A

Poorly differentiated large cells
Smoking
Central or peripheral
Poor prognosis

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5
Q

Bronchioloalveolar Carcinoma

A

Columnar cells that grow along preexisting bronchioles and alveoli
Clara cells
No relation to smoking
Peripheral

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6
Q

Carcinoid Tumor

A

Well differentiated neuroendocrine cells, chromogranin positive
No relation to smoking
Low-grade malignancy, can cause carcinoid syndrome

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7
Q

Oral Squamous Cell Carcinoma

A

Floor of the mouth
leukoplakia and erythroplakia = precursors
Tobacco and alcohol are risk factors

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8
Q

Salivary pleomorphic adenoma

A

Most common tumor of salivary gland
Benign, parotid gland
mobile painless circumscribed mass at angle of jaw

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9
Q

Warthin Tumor

A

2nd most common salivary tumor (parotid)

Benighn, cystic, abundant lymphocytes

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10
Q

Mucoepidermoid carcinoma

A

Most common malignant tumor of salivary gland (parotid)
Mucinous and squamous cells
Commonly involves facial nerve

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11
Q

Esophageal carcinoma

A

Adeno = from Barrett’s (lower third), most common in west
Squamous = most common worldwide, upper or middle third, risks: ETOH, tobacco, very hot tea, achalasia, esophageal web
Presents late, progressive dysphagia
Nodes:
Upper 1/3 - cervical
Middle 1/3 - mediastinal/tracheobronchial
Lower 1/3 - celiac and gastric

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12
Q

Intestinal gastric carcinoma

A 
Large, irregular ulcer with heaped up borders
Risks: H. pylori, autoimmune gastritis, mitrosamines in smoked foods, blood type A
Periumbilical spread (Sister Mary Joseph nodule)
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13
Q

Diffuse type gastric carcinoma

A

Signet ring cells
Desmoplasia results in thickening of stomach wall
not associated with H pylori, intestinal metaplasia, nitrosamines
Spread to ovaries (Krukenberg)

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14
Q

Gastric Carcinomas

A

Present late, weight loss, abd pain, early satiety
Acanthosis nigricans or Leser-Trelat sign (explosive onset of seborrheic keratosis)
Spread can involve Virchow node

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15
Q

Familia Adenomatous Polyposis (FAP)

A

AD
APC mutation (Chr 5)
Gardner = FAP + soft tissue tumors and osteomas, hypertrophy of retinal pigment epithelium
Turcot = FAP + CNS (medulloblastoma and glial tumors)
Always involves rectum

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16
Q

HNPCC

A

Lynch syndrome
AD
DNA mismatch repair gene mutation
80% get CRC, always involves proximal colon

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17
Q

Colorectal Cancer

A

Includes FAP and HNPCC
Risks: IBD, tobacco, large villous adenomas, Peutz-Jeghers
Rectosigmoid>ascending>descending
“Apple core” lesion on barium enema x ray
CEA tumor marker for monitoring
2 molecular pathways:
>Microsatellite instability pathway (15%), DNA mismatch repair gene mutation: sporadic and HNPCC
>APC/B-catenin (85%):
Lose: APC, then K-RAS, then p53

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18
Q

Pancreatic Carcinoma

A

Adenocarcinoma
Risks: smoking and chronic pancreatitis, jewish and African american males
Painless jaundice
Migratory thrombophlebitis (trousseau’s sign)
Serum marker CA 19-9
Rw: whipple’s procedure

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19
Q

Gallbladder Carcinoma

A

Adenocarcinoma, glandular epithelium of bladder wall
Risks: gallstones, porcelain gallbladder
Cholecystitis in elderly woman

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20
Q

Hepatic adenoma

A

Benign tumor of hepatocytes
Assoc. oral contraceptives, regress with cessation
Risk of rupture/bleeding esp. with pregnancy (grow with Estrogens)

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21
Q

Hepatocellular carcinoma

A

Risks: Chronic hepatitis (HBV/HCV), cirrhosis (fatty liver, hemochromatosis, Wilson’s, Alpha1), Aflatoxins (from aspergillus)
Increases chance of Budd-Chiari
alpha fetoprotein is marker

HEMATOGENOUS spread

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22
Q

Renal Cell Carcinoma

A

hematuria, palpable mass, flank pain
Paraneoplastics: EPO, renin, PTHrP, ACTH
Abundant clear cytoplasm
Loss of VHL tumor suppressor, leads to increased IGF-1 and HIF transcription factor, increases VEGF and PDGF
Typically upper pole of kidney, risk factor is cigarette smok

HEMATOGENOUS spread to lungs and bone
retroperitoneal lymph nodes

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23
Q

Wilms Tumor

A

Most common malignant renal tumor if children (3 yo avg)
unilateral flank mass with hematuria and hypertension
blastema (immature kidney mesenchyme), glomeruli and tubules and stromal cells
WAGR, Denys-Drash & Beckwith-Widemann Syns

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24
Q

WAGR syndrome

A

Wilms tumor, Aniridia, Genital abnormalities, Retardation, assoc. with DELetion of WT1

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25
Q

Denys-Drash syndrome

A

Wilms tumor, progressive renal (glomerular) disease, male pseudohermaphroditism, assoc. with MUTations of WT1

26
Q

Beckwith-Wiedemann syndrome

A

Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (including tongue), assoc. with MUTations of WT2

27
Q

Transitional Cell Carcinoma

A

Urothelial cells, usually in bladder
Risks: cigarette smoke > napthylamine, azo dies, cyclophosphamide
Painless hematuria
2 pathways:
>flat - high grade flat tumor, early invasion, early p53 mut
>Papillary - low grade papillary tumor, late p53 mut

28
Q

Squamous Cell Carcinoma of the Bladder

A

or other lower urinary tract (Pelvis, ureter, bladder, urethra)
metaplasia -> dysplasia -> neoplasia
Risks: chronic cystitis, Schistosoma hematobium, nephrolithiasis

29
Q

Adenocarcinoma of the Bladder

A 
or other lower urinary tract
Urachal remnant (has glands), cystitis glandularis or extrophy (partial failure to form, exposed to outside)
30
Q

Extramammary Paget Disease

A

erythematous, pruritic, ulcerated vulva

Carcinoma in situ, no underlying carcinoma
Distinguish from melanoma:
Paget = PAS +, keratin +, S100 -
Melanoma = PAS-, keratin -, S100+

31
Q

Vaginal Clear Cell Adenocarcinoma

A

Complication of DES-associated vaginal adenosis

Glands with clear cytoplasm

32
Q

Embryonal rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle

bleeding, grape-like mass protruding from vagina or penis of child <5

cytoplasmic cross-striations
desmin+, myogenin+

33
Q

Vaginal carcinoma

A

Squamous epithelium
assoc. High Risk HPV (16, 18, 31, 33)
Lower 1/3 of vagina -> inguinal nodes
Upper 2/3 of vagina -> regional iliac nodes

34
Q

Cervical carcinoma

A

vaginal bleeding, post coital bleeding, cervical discharge in middle aged woman (40-50)

High risk HPV
Secondary risks: smoking, immunodeficiency
80% squamous, 15% adenocarcinoma

Hydronephrosis with postrenal failure is common cause of death (invades bladder, blocks ureters)

35
Q

Endometrial carcinoma

A

Postmenopausal bleeding
most invasive carcinoma of female genital tract

risks increase with estrogen exposure (early menarche/late menopause, nulliparity, infertility, anovulatory cycles, obesity)

Sporadic (25%), age is 70+, aggressive, p53 mut, psammoma bodies and serous papillary structures

36
Q

Leiomyoma

A

Most common tumor in females

Often multiple, enlarge in pregnancy, shrink after menopause
Well defined, white, whorled masses

37
Q

Leiomyosarcoma

A

malignant prolif of smooth muscle of myometrium
de novo in postmenopausal women
areas of necrosis and hemorrhage

38
Q

Dysgerminoma

A

markers: hCG, LDH

sheets of uniform cells, assoc with TURNER SYNDROME

39
Q

Ovarian Choriocarcinoma

A

hCG
Trophoblastic (placental) tissue, no chorionic villi
Assoc with Theca Lutein cysts
EARLY HEMATAGENOUS SPREAD

(placental tissue, programed to invade blood)

40
Q

Ovarian Yolk Sac tumor

A

AFP
Aggressive, yellow friable mass
50% have Schiller-Duval bodies (resemble glomeruli)

basically same for men, testicular yolk sac tumor

41
Q

Teratoma

A

90% of ovarian germ line tumors
Mature - dermoid cyst
Immature - aggressively malignant

Struma ovarii - functional thyroid tissue in teratoma can cause Hyperthyroidism

42
Q

Ovarian Serous Cystadenoma

A

CA-125
Benign, Bilateral
45% of ovarian tumors
fallopian tube epithelium

43
Q

Ovarian Serous cystadenocarcinoma

A

BRCA-1,-2, HNPCC
45% of ovarian tumors
Psammoma bodies

44
Q

Brenner tumor

A

Benign, unilateral ovarian tumor
Looks like Bladder
Coffee Bean nuclei on HE

Benign, Bladder, Bean, Brenner

45
Q

Granulosa cell tumor

A

Secretes estrogen
Precocious puberty in kids, endometrial hyperplasia/cariconoma in adults

Call-Exner bodies - small follicles with eosinophilic secretions

46
Q

Testicular seminoma

A 
malignant, painless enlargement, most common
Ages 15-35
Fried Egg cells
PLAP + (placental alk phos)
radiosensitive, excellent prognosis
47
Q

Testicular Choriocarcinoma

A

hCG
gynecomastia (hCG –> LH)
hematogenous met to lungs

48
Q

Testicular Embryonal Carcinoma

A

Malignant, painful, glandular/papillary, often mixed

49
Q

Leydig Cell

A

Reinke crystals, androgen producing, gynecomastia in men, precocious puberty in boys

50
Q

Testicular lymphoma

A

Most common in older men, metastasis from lymphoma, aggressive

51
Q

Thyroid Papillary carcinoma

A

Most common
Orphan annie eye nuclei
psammoma bodies
Good prognosis, spreads to cervical lymph nodes

Exposure to ionizing radiation in childhood is risk

52
Q

Thyroid follicular carcinoma

A

follicles in fibrous capsule with invasion THROUGH capsule

hematogenous spread

53
Q

Thyroid medullary carcinoma

A

Parafollicular C cells, neuroendocrine cells, secrete calcitonin –> increased renal calcium excretion –> hypocalcemia
Calcitonin deposits as amyloid locally

54
Q

Glioblastoma multiporme

A

Malignant, high grade, astrocytes
Most common primary mal of adults
cerebral hemispheres, crosses corpus callosum
regions of necrosis surrounded by pseudopallisading cancer cells
GFAP+

55
Q

Meningioma

A 
Benign, arachnoid cells
most common benign in adults (esp. women)
round mass attached to dura
whorled pattern on histology
psammoma bodies
56
Q

Schwannoma

A

benign, schwann cells
S-100+
involves CN VIII

57
Q

Oligodendroglioma

A

Malignant of oligodendrocytes
calcified tumor in white matter of frontal lobe
Fried egg cells

58
Q

Pilocytic astrocytoma

A

benign tumor of astrocytes
Most common CNS in Children, usually cerebellum
Cystic lesion with mural nodule
Rosenthall fibers (eosinophilic processes of astrocytes)
GFAP+

59
Q

Medulloblastoma

A 
Malignant granular cells of cerebellum
usually in children
small, round blue cells
Homer-wright rosettes
Poor prognosis, spreads via CSF ('drop metastasis' to cauda equina)
60
Q

Ependymoma

A

Malignant ependymal cells in ventricle
children
4th ventricle, presents with hydrocephalus
pseudorosettes

61
Q

Craniopharyngioma

A

epithelial rathke’s pouch
supratentorial mass, compresses optic chiasm (bitemporal hemianopsia)
Calcifications
benign, may recurr

Step One Rapid Review (8 decks)

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