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OITE Review Book > Oncology > Flashcards

Oncology Flashcards

1
Q

Where to perform proximal humerus biopsy

A

through anterior third of deltoid

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2
Q

What type of needle bx to do?

A

in general: core needle

if not enough: incisional bx

(avoid FNA)

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3
Q

Doxorubicin side effect

A

CHF/cardiomyopathy

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4
Q

Pazopanib mechanism

A

anti-VEGF

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5
Q

well-differentiated liposarcoma (ALT) genetics

A

MDM2 amplification

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6
Q

myxoid liposarcoma genetics

A

t(12;16), TLS-CHOP

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7
Q

synovial sarcoma genetics

A

t(X;18), SYT-SSX

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8
Q

ewing sarcoma genetics

A

t(11;22), EWS-FLI

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9
Q

Rhabdomyosarcoma genetics

A

t(2;13), PAX-FKHR

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10
Q

clear cell sarcoma genetics

A

t(12;22), EWS-ATF

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11
Q

myxoid chondrosarcoma genetics

A

t(9;22), EWS-CHN

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12
Q

Cytogenetic analysis determines…

A

translocation.

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13
Q

Colorectal tumor marker

A

CEA

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14
Q

Pancreatic tumor marker

A

CA-19-1

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15
Q

Ovarian tumor marker

A

CA-125

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16
Q

Breast tumor marker

A

CA-15-3

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17
Q

HCC tumor marker

A

AFP

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18
Q

Fibrous dysplasia is caused by…

A

activating missense mutation of Gs alpha protein (GNAS1 gene) which leads to increased cAMP production.

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19
Q

Fibrous dypslasia classic xray

A

ground glass

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20
Q

Fibrous dysplasia of the proximal femur leads to…

A

shepherd’s crook deformity

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21
Q

McCune Albright

A

coast of Maine cafe au lait lesions, precocious puberty, polyostotic fibrous dysplasia

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22
Q

Fibrous dysplasia histology

A

alphabet soup

fibroblasts surrounding islands of bone

NO osteoblastic rimming

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23
Q

NOF histology

A

spindle cells in a storiform pattern

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24
Q

mechanism of pain with osteoid osteoma

A

PGE2 and cycloxygenase

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25
Q

Common tumors of the posterior elements of the spine

A

osteoid osteoma, osteoblastoma, ABC

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26
Q

Histology of osteoid osteoma

A

woven bone, with osteoblastic rimming

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27
Q

Osteoblastoma is…

A

an osteoid osteoma > 1.5-2 cm that is more locally aggressive and less responsive to NSAIDs

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28
Q

An osteochondroma that has a cartilage cap that is…

A

greater than 2 cm poses risk for malignant transformation.

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29
Q

Multiple Hereditary Exostoses (MHE) genetics

A

autosomal dominant
EXT1 (most severe), EXT2, EXT3.

EXT is important in the synthesis of heparan sulfate.

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30
Q

What percent risk of malignant transformation does MHE have?

A

10% to chondrosarcoma (compared to 1% risk with solitary osteochondroma)

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31
Q

Traits of MHE

A
  • short
  • LLD
  • long bone deformities
  • subluxation of radiocapitellar joints
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32
Q

Treatment of MHE pt with loss of forearm fotation

A

marginal resection of the osteochondromas to improve rotation

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33
Q

Eosinophilic granuloma spine trait

A

vertebra plana

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34
Q

EG histology

A

Langerhan’s cells with coffee bean nuclei, Birbeck granules

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35
Q

Hand-Schuller-Christian syndrome

A
  • lytic skull lesions
  • diabetes insipidus
  • exophthalmos
  • eosinophilic granuloma
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36
Q

Work-up of GCT

A

chest xray or CT to evaluate for lung mets

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37
Q

Most common spot for GCT

A

distal femur

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38
Q

The neoplastic cells in GCT are….

A

mononuclear stromal cells (pre-osteoblastic mononuclear cells), NOT multinucleated giant cells.

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39
Q

Treatment of GCT

A

Denosumab (RANKL inhibitor); curettage and bone graft or cement and adjuvant

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40
Q

Adjuvants for GCT

A

argon beam, liquid nitrogen, phenol, hydrogen peroxide, denosumab

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41
Q

Most common spot for UBC

A

central lytic lesion in the metaphysis of the proximal humerus

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42
Q

Over time, a UBC…

A

will get smaller and may spontaneously resolve.

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43
Q

Compared to a UBC, an ABC…

A

is eccentric and expands greater than the width of the physis w/ multiple septae separating blood-filled cavities.

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44
Q

Bone tumors common in the anterior tibia

A

adamantinoma and osteofibrous dysplasia

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45
Q

Adamantinoma

A

histology: nests of cells in palisading pattern
mets to the lungs
wide excision

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46
Q

Osteofibrous dysplasia (ossifying fibroma) histology

A

osteoblastic rimming

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47
Q

Work-up of osteosarcoma

A

xrays of the entire extremity, MRI, bone scan, CT chest, bx

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48
Q

Additional work-up of Ewing sarcoma

A

bone marrow bx

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49
Q

Metastasis of osteosarcoma is greater to…

A

lungs.

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50
Q

Risk factors for osteosarcoma

A
  • Paget’s
  • retinoblastoma (Rb)
  • p53
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51
Q

General Enneking presentation of osteosarcoma

A

-Stage IIB (high grade, extracompartmental)

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52
Q

MSTS (Enneking) Staging System

A 
IA: low grade, intra-compartmental
IB: low grade, extra-compartmental
IIA: high grade, intra-compartmental 
IIB: high grade, extra-compartmental
III: mets
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53
Q

Tx of osteosarcoma

A

chemo for 8-12 wks, surgery, chemo for 6-12 mos

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54
Q

There is improved overall survival of osteosarcoma if chemo is resumed within….

A

18-21 days after surgery.

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55
Q

Imaging of intramedullary osteosarcoma

A

sunburst, codman’s triangle, metaphyseal

56
Q

Imaging parosteal osteosarcoma

A

surface/juxtacortical on the posterior metaphysis of the distal femur (stuck-on)

57
Q

Most common form of osteosarcoma

A

intramedullary

58
Q

Tx of parosteal osteosarcoma

A

wide excision only (no chemo) since low grade

59
Q

Periosteal osteosarcoma imaging

A

sunburst, codman’s and diaphyseal

60
Q

Imaging and histology of periosteal osteosarcoma

A

eccentric, lytic lesion

lakes of blood, like ABC but with more malignant features

61
Q

Tx of Ewings

A

chemo-sx-chemo

62
Q

Ewing’s facts

A

CD99+

elevated LDH is associated with worse tumor burden

63
Q

Most common functional deficit after proximal femoral replacement is….

A

abductor weakness.

64
Q

In the distal femur ES or OS, most durable reconstruction is…

A

rotationplasty.

65
Q

Malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) is…

A

a malignant bone tumor similar to OS in clinical presentation and imaging.

66
Q

Histology of MFH

A

pleomorphic spindle cells in storiform pattern (unlike osteo, no bone formation)

67
Q

Secondary MFH/UPS may arise from…

A

chronic bone infarct, Paget’s or post-radiation.

68
Q

Treatment of MFH

A

chemo, sx, chemo

69
Q

Multiple myeloma facts

A
  • plasma cells w/ clock-face, eccentric nuclei
  • SPEP (M spike): IgG&raquo_space;> IgA heavy chains
  • UPEP: kappa of lambda light chains (bence jones proteins)
70
Q

Multiple myeloma CRAB

A

C: hyperCalcemia
R: renal insufficiency
A: anemia
B: bone lesions

71
Q

What is responsble for punched out lesions in MM?

A

RANKL

72
Q

Which diseases are cold on bone scan?

A

MM and thyroid carcinoma

73
Q

Treatment for MM

A

bisphosphonates, chemo

(For pathologic fx, surgery, radiation and bisphosphonates).

74
Q

MM solitary lesion

A

plasmacytoma

Tx: radiation

75
Q

Lymphoma presents with…

A

B symptoms and diffuse, mottled, permeative lytic lesions.

76
Q

Diagnosis of lymphoma done with…

A

flow cytometry and cytogenetic analsysis

need unfixed fresh tissue

77
Q

Histology of lymhpoma

A

small round blue cells
CD20+
CD45+

78
Q

Treatment of lymphoma

A

chemo +/- radiation

79
Q

An enchondroma is…

A

a benign cartialge tumor in the medullary cavity

80
Q

Most common tumor in the hand

A

enchondroma

81
Q

Histology of enchondroma

A

hyaline cartilage (uniform chondrocytes in lacunae)

82
Q

Tx of symptomatic enchondroma

A

intralesional curretage and bone graft

83
Q

Risk of malignant transfomration of enchondroma

A

1% to chondrosarcoma

84
Q

Ollier’s dz

A

multiple enchondromas

30% risk of malignant transformation

85
Q

Maffucci’s syndrome

A

multiple enchondromas, angiomas/hemangiomas, visceral malignancies

30% malignant transformation to chondrosarcoma but 100% lifetime risk of developing any malignancy (GI, astrocytoma, etc.)

86
Q

X-ray of chondrosarcoma

A

cortical destruction, endosteal scalloping, periosteal rxn

87
Q

X-rays of chondroblastoma

A

lytic lesion in epiphysis that may cross the physis with thin sclerotic rim

88
Q

histology of chondroblastoma

A

chickenwire or cobblestone arragnement of chondroblasts

89
Q

Where does chondroblastoma metastasize?

A

lung (get chest imgaging)

90
Q

Tx of symptomatic chondroblastoma

A

curettage and bone graft

91
Q

Periosteal chondroma

A

benign cartilage tumor on surface (juxtacortical) of long bones, most often proximal humerus

92
Q

Imaging of periosteal chondroma

A

stippled calcification and scalloping of the cortex

93
Q

Treatment of periosteal chondroma

A

observe if asymptomatic, marginal excision if symptomatic

94
Q

Recurrence of chondrosarcoma is correlated with…

A

increased telomerase activity.

95
Q

Clear cell chondrosarcoma location

A

epiphysis

96
Q

Mesenchymal chondrosarcoma is responsive to…

A

chemo.

97
Q

Dedifferentiated chondrosarcoma is…

A

an aggressive, bimorphic (low grade chondroid, high grade sarcoma).

98
Q

Treatment of chondrosarcoma

A

wide excision, generally does not respond to chemoradiaiton (except mesenchymal chondrosarcoma)

99
Q

Schwannoma (neurilemmoma) facts

A
  • benign
  • associated with NFII
  • target sign on MRI
100
Q

Histology of schwannoma (neurilemmoma)

A 
S100+
Antoni A (hypercellular) and Antoni B (hypocellular) biphasic pattern
101
Q

Treatment of symptomatic schwannoma

A

marginal resection

102
Q

Malignant peripheral nerve sheath tumor (neurofibrosarcoma) arises from…

A

peripheral nerve of neurofibroma (NF1) –> increased PET-CT uptake suggests malignant transformation

Stains S100+

Tx w/ wide excision and radiation.

103
Q

Most common solid tumor in children < 2 years old

A

neuroblastoma

104
Q

Most common location of the neuroblastoma

A

adrenal gland

105
Q

histology of neuroblastoma

A

small round blue cells arranged in a rosette pattern

106
Q

In PVNS and GCTTS, there is an overexpression of…

A

CSF-1.

107
Q

Common areas for desmoid tumor

A

paraspinal region and posterior distal femur (popliteal fossa)

108
Q

Desmoid tumor is associated with…

A

gardner syndrome and familial adenomatous polyposis.

Consider colonoscopy.
Elevated beta-catenin, estrogen receptor Beta positive.

109
Q

Treatment of desmoid tumor

A

estrogen receptor blockade (tamoxifen), wide resectiona dn radiation

110
Q

Work up of soft tissue sarcoma

A

CT C/A/P, MRI and biopsy

111
Q

Treatment of soft tissue sarcoma is generally…

A

wide excision and radiation.

112
Q

The most common malignant sarcoma of the foot is…

A

synovial sarcoma.

113
Q

synovial sarcoma is biphasic –>

A

spindle cells and epithelial cells

114
Q

Synovial sarcoma stains for…

A

vimentin and epithelial membrane antigen.

115
Q

Myxoid liposarcoma will metastasize to…

A

retroperitoneum and therefore needs a CT C/A/P.

116
Q

Treatment of liposarcoma

A

well-differentiated (aka ALT): marginal resection

other types: wide resection and radiation

117
Q

Epithelioid sarcoma facts

A
  • most common soft tissue sarcoma of the hand
  • can cause overlying skin ulceration
  • keratin +
118
Q

Leiomyosarcoma is…

A

malignant sarcoma of smooth muscle.

Bone leiomyosarcoma will show…lytic bone lesions with soft tissue extension.

119
Q

Histology of leiomyosarcoma

A

spindle cells arranged in fascicles

actin, vimentin positive

120
Q

Risk factor for angiosarcoma

A

polyvinyl chloride exposure

121
Q

Angiosarcoma stains positive for…

A

CD31.

122
Q

Worst and best prognoses for metastatic cancer

A

lung worst

thyroid best

123
Q

Blastic lesions include…

A

prostate and breast due to endothelin-1.

124
Q

SCARE

A 
synovial cell 
clear cell
angiosarcoma
rhabdomyosarcoma
epithelioid
125
Q

most common sarcoma in children

A

rhabdomyosarcoma

126
Q

For metastatic ppx fixation, single dose of radiation…

A

gives equivalent pain relief and lower cost compared to multifractional.

127
Q

Fibrodysplasia ossificans progressiva

A

“stone man disease”

  • diffuse, progressive HO
  • mutation of activin A type I receptor (ACVR1) whichis a BMP receptor
128
Q

Melorheostosis

A

dysplasia of cortial bone –> hyperostosis, flowing candle wax along cortical surface

129
Q

PVNS facts

A

-hemosiderin deposits lead to low signal on both T1 and T2

130
Q

Synovial chondromatosis

A

intra-articular loose bodies comprising synovium/cartilage. If symptomatic, treat with synovectomy and loose body removal.

131
Q

Synovial chondromatosis histology

A

synovial metaplasia

132
Q

Dermatofibrosarcoma protuberans

A

cutaneous soft tissue sarcoma

133
Q

Glomus tumor histology

A

small round blue cells

134
Q

Chordoma

A

malignant tumor of notochordal cells, most common in the sacrum/coccyx

135
Q

Histology of chordoma

A
  • physaliferous cells
  • keratin +
  • S100 +
136
Q

Treatment of chordoma

A

wide resection (vertebrectomy w/ anterior and posterior reconstruction) +/- radiation

137
Q

Tumoral calcinosis

A

dysfunction of phosphate regulation –> peri-articular calcinosis in extra-capsular soft tissues.

  • more prevalent in african-americans
  • mutations in FGF23

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