NEOPLASTIC CONDITIONS Flashcards
Upper limits of lymph nodes
10mm short axis
5 mm for mesenteric nodes is normal
Precursor lesion to SCC?
Actinic keratosis
MOST common type of cancer in head and neck?
Risk factors
Squamous cell carcinoma
alcohol and tobacco
HPV 16 in younger population
Hypopharynx SCC is relatively uncommon and more common in males except for which tumour which is more common in females?
posterior cricoid tumours with plummer vinson syndrome
MOST common location of SCC on tongue?
75% ON ANTERIOR 2/3rds
Non small cell carcinoma of the lung includes ?
adenocarcinoma of lung (MOST Common)
squamous cell carcinoma of the lung (Most common cause of pancoast tumour) - central
large cell carcinoma of the lung
What are the 4 subtypes of SCC of the lung?
Four subtypes are recognised 4:
papillary
clear cell
small cell (not to be confused with small cell lung cancer)
basaloid
SCC of the eosophgus is 4x more common in ? and occurs where in the eosphagus?
males
middle 1/3rd
MOST common cancer cell type of the bladder ?
TCC
Penile cancer - 95% are SCC what are the risk factors?
HPV
Uncircumscribed
Phimosis
group of primary neurogenic tumours that arise from nerve sheaths outside of the central nervous system.
Peripheral nerve sheath tumour
vast majority are benign, however, malignant transformation is seen particularly in large tumours and those associated with neurofibromatosis type 1 (NF1).
MOST common tumour of peripheral nerves, including cranial nerves.
by far the most commonly involved nerve is the?
Schwannoma
They arise eccentrically from their parent nerve, with the nerve fibres splayed along their surface (as distinct to neurofibromas which arise within the nerve).
vestibulocochlear nerve (CN VIII)
benign (WHO grade 1) peripheral nerve sheath tumours that are usually solitary and sporadic. There is, however, a strong association with neurofibromatosis type 1 (NF1) - most commonly plexiform
Neurofibroma
not encapsulated and infiltrate between the nerve fascicles, making resection difficult.
forms of peripheral nerve sheath tumours occurring either de novo or arising from pre-existing tumours (e.g. neurofibromas, schwannomas etc.). Approximately half of such tumours are seen in individuals with neurofibromatosis type I (NF1), in such cases arising from pre-existing neurofibromas.
Malignant peripheral nerve sheath tumours (MPNSTs)
classically located in the infrascapular regions, deep to the serratus anterior and latissimus dorsi musculature. Unilateral masses have a slight right-sided predilection, but up to 30% of elastofibromas are bilateral
Elastofibroma dorsi is a benign soft-tissue tumour with a characteristic location and imaging appearance.
Benign tumours of vascular origin, usually seen in early childhood. Though many types exist according to the ISSVA classification, the most common are by far infantile
Hemangioma
malignant neoplasm that arises from melanocytes
Melanocytes predominantly occur in what layer of the epidermis ?
Malignant melanoma
Basal
most common primary intraocular malignancy of the adult
Arises from ?
Malignant uveal melanomas
Ciliary body or choroid
MOST common extracranial solid childhood malignancy
third commonest childhood tumour after leukaemia and brain malignancies
Neuroblastoma
Tumours of neuroblastic origin. Although they may occur anywhere along the sympathetic chain, the vast majority arise from the adrenal gland.
What do they secrete?
Most common sites of origin
Neuroblastoma
Most of them secrete catecholamines: vanillylmandelic acid (VMA) and homovanillic acid (HVA)
Adrenal glands (35%)
Retroperitoneum (30-35%)
Posterior mediastinum (20%)
Classic feature of neuroblastoma on imaging
Most common place to metastesize?
What is a poor prognostic factor
Lies beneath the aorta and lifts it off the vertebral column.
encase vessels and may lead to compression
displaces adjacent organs
BONE
late age of onset >18 months and higher stage
Breast cancer can be seperated into 3 major groups
ER +/HER2 - (LUMINAL)
HER2 +/ER - or ER +
Triple negative
WHich breast cancer is the MOST common subtype in patients with germline mutations (TP53) Li Fraumeni syndrome
HER2 +
99% of breast cancers are ? and arise from the terminal duct lobular unit
ADENOCARCINOMA
MOST commone types of breast cancer
Invasive carcinoma of no special type
(40-75%)
DCIS (20-25%)
Invasive lobular carcinoma (5-15%)
MOST common orbital mass in children? where does it commonly occur
orbital dermoid cyst
along zygomaticofrontal and frontoethmoidal sutures
uncommon neuroendocrine tumours principally encountered in adults. They are divided into those arising from sympathetic paraganglia (primarily in the chest and abdomen, including phaeochromocytoma) and parasympathetic paraganglia (primarily in the head and neck).
Paragangliomas, previously sometimes called glomus tumours,
Head and neck paragangliomas are usually parasympathetic and non secretory - which cranial nerves are usually associated?
CN 9 and 10
What is the MOST common type of paraganglioma in the head and neck
Carotid Body (60-70%) and 10% are bilateral
Characteristic splaying of the ICA and ECA
Which paraganglioma erodes the floor of the middle ear?
Glomus jugulare
What is the MOST common middle ear tumour ?
Glomus tympanicum arising from Jacobsen nerve
Which paraganglioma occurs along pathg of vagus nerve and displaces the ECA and ICA anteriorly and IJV posteriorly
Glomus vagale
MOST COMMON brain tumours in children?
1 - High grade glioma
2 - Medulloblastoma
3 -
What is considered a long term epilepsy associated tumour ?
Ganglioglioma - most common presentation is temporal lobe epilepsy
Which tumour usually presents with rapidly increasing head circumference
Desmoplastic infantile ganglioglioma
<2yrs M>F
benign (WHO Grade 1) slow growing tumors arising from either cortical or deep grey matter. Vast majority are centered in cortical grey matter, arise from secondary germinal layers, and are frequently associated with cortical dysplasia (in up to 80% of cases). They characteristically cause intractable focal seizures (see temporal lobe epilepsy).
Dysembryoplastic neuroepithelial tumors (DNET)
rare tumor of the cerebellum appearing as thickening and increase in T2 signal of the cerebellar folia giving this lesion a characteristic striated appearance.
Dysplastic cerebellar gangliocytoma, perhaps better known as Lhermitte-Duclos disease
small “bubbly” indolent subcortical tumors that sometimes present with seizures.
Multinodular and vacuolating neuronal tumors (MVNT)
WHO grade 2 neuroepithelial intraventricular tumors with fairly characteristic imaging features, appearing as heterogeneous masses of variable size and enhancement within the lateral ventricle, typically attached to the septum pellucidum. They are typically seen in young patients and generally have a good prognosis provided a complete resection can be achieved.
Central neurocytoma
newly recognized IDH wildtype pediatric-type diffuse low-grade glioma included in the 5th Edition (2021) WHO brain tumor classification 1. It has a generally favorable prognosis and is often associated with seizures
Diffuse astrocytoma MYB or MYBL1 altered
represents the majority of diffuse intrinsic pontine gliomas. They are aggressive tumors with a poor prognosis and are considered WHO grade 4 tumors regardless of histological features.
Diffuse midline glioma, H3 K27-altered
most common spinal cord tumor overall, seen both in adult and pediatric populations.
Spinal ependymoma
variant type of ependymoma that occurs predominantly in the filum terminale and/or conus medullaris. They represent 13% of all spinal ependymomas and are the most common tumors of the cauda equina region.
Myxopapillary ependymomas
characterized by vividly enhancing masses, usually intraventricular. Hydrocephalus is common. cauliflower-like masses
Choroid plexus papillomas
Sympathetic paragangliomas occur below the level of the neck and secrete?
can be intra or extra-adrenal
Catecholamines
Where do extra adrenal paragangliomas occure?
Abdomen - organ of zuckerkandl
bladder base
thorax - paravertebral
Where do intra-adrenal paragangliomas arise from
Adrenal medulla
AKA PHEOCHROMOCYTOMA >10 HU on non contrast
What two types of cells are found in paragangliomas and what are they positive for on immunohistochemistry?
Type 1 - Chief cells
- NSE
- Chromogranin A
- Synaptophysin
Type 2- sustentacular cells
- s100
- GFAP
Demonstrate Zellballen - type 1 cells surrounded by single layer of type 2 cells
Organ of zuckerkandl paragangioloma is a small mass of chromaffin cells located along the aorta - where does it begin and extend to and where is the highest concentration?
begins cranial to SMA/renal arteries and extends to aortic bifurcation.
Highest concentration is at origin of IMA
Bladder base paraganglioma symptoms?
HTN and micturition attacks - transient loss of consciousness with voiding
What is the 10% rule of pheochromocytoma?
10% ARE EXTRA-ADRENAL
10% are bilateral
10% are malignant
10% are fnd in children
10% are NOT associated with HTN
10% contain calcification
what tests can be done to asses for pheochromocytoma?
24 hr urine for catecholamines
plasma metanephrines
MOST common type of germ cell tumour in women?
1) Mature teratoma (dermoid)
2) Yolk sack tumour
Germ cell tumour that occurs in adolescence and children - average age 14yrs. Solid ovarian mass and raised AFP or hcG ?
Embryonal carcinoma
MEN 1 PPP
Pitparapanc
Pituitary adenoma - prolactinoma most common
pancreatic neuroendocrine tumour - gastrinoma (>50%), insulinoma 4-6%, glucagonoma <3%
Parathyroid hyperplasia
MEN 2a
PMP
pheochromocytoma
medullary thyroid cancer
parathyroid hyperplasia
MEN 2b
PMMM
pheochromocytoma
medullary thyroid cancer
mucosal neuromas
marfinoid habitus
Hereditary cancer syndrome due to mutations in tumour suppressor gene TP53.
Li Fraumeni
WHat is the MOST common hereditary colorectal ca? and where in the bowel is it more common?
and MOST common cause of hereditary endometrial cancer
What gene is mutated?
HNPCC (Lynch syndrome)
5x more common than FAP
RIGHT side - 70% proximal to splenix flexure
** endometriod type**
DNA mismatch repair gene
What are the most common extracolonic malignancies associated with HNPCC
Endometrial cancer - endometrioid type
Prostate cancer
small bowel cancer - DUODENUM
HNPCC variant with sebaceous tumours and keratoacanthocytomas
Muir-Torre syndrome
Extra-adrenal paraganglioma
GIST
Pulmonary hamartoma
Carney Triad
Characterised by multiple hamartomas throughout the body and increased risk of which cancers?
COWDEN SYNDROME
breast 30-50%
Thyroid ca (5%) FOLLICULAR
Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease)
RAre MEN syndrome characterised by cardiac myxoma, skin pigmentation
Carney Complex
What condition increases risk of sympathetic and parasympathetic paragangliomas, pheochromocytoma, RCC and GIST
Succinate dehydrogenase gene germline mutation
SDHA, SDHB, SDHC, SDHD
SDH converts succinate to fumurate mutations result in mitochondrial dysfunction
