Oncology Flashcards
pathology associated with ovarian cancer and endometriosis
Hobnail cells characterist clear cell ovarian cancer (adenocarcinoma associated with endometriosis)
Hobnail cell “bulbous nuclei that protrude far into the cystic lumen, beyond the apparent cytoplasmic limits of the cell”
pathology grandulosa cell tumors
Call-Exner bodies, rosette arragnement of cell around an eosinophilic fluid space.
low grade malg, typically demonstrate indolent growth, unilateral 90%, likely found stage 1
pathology papillary serous tumors
psammoma bodies, extracellular round laminar dark eosinophilic collections of calcium
Leydig call tumors
crystals found, as cytoplasmic inclusionss
post menopauseal women
Yolk sac tumors
10-20% of all malignant ovarian germ cell tumors
dealist form
Schiller duval bodies as pathonomoic
Risk of endometrial cancer at time of hysterectomy with diagnosis of EIN.
- endometrial intraepithelial neoplasia
- 40%
- EIN is precursor into adenocarcinoma of the endometrium (increased estrogen)
- ideally diagnose EIN with hysteroscopy.
- HYST is diagnosis and treatment
EIN details
1) benign (benign endometrial hyperplasia),
2) **premalignant (endometrial intraepithelial neoplasia)
3) malignant (endometrial adenocarcinoma, endometrioid type, well differentiated)
EIN definition chart
pathology of choriocarcinoma
- plexiform patterns composed of an admixture of syncytiotrophoblast and cytotrophobloasts
patholgoy of immature teratomas
immature neural tissue with rosettes and tubules
pathology dysgerminomas
- germ cell tumor variant
- cytoplasmic glycogen demostrated wtih periodic acid-schiff stain is pathognomonic
complete molar pregnancy
- bilateral ovarian cysts (thecal lutein cysts)
- high bHGC
- HTN, PreE, hyperemesis, post molar gestational trophoblastic neoplasia
- p57 NEGATIVE (partial is positive)
- villous edema
- no fetal tissue
- diploid paternal origin
- uterus large for dates
- snow storm/swiss cheese appearance, “diffuse hydropic villi”
risk breast cancer with atypical ductal hyperplasia
5%
- pathologic finding of breast biopsies
- means substantial increased risk for breast cancer both ipsi and contralateral
Risk ovarian cancer with BRCA 1/2
BRCA 1 - 40%
BRCA 2 - 15%
most likely malignant component that could be present in mature dermoid (teratoma) cyst
- squamous cell carcinoma (skin)
partial molar pregnancy
- fetal parts
- focal cystic changes of the placenta
ratio fo transverse to anteroposterior dimension of gestational sac >1.5 (larger)
prognostic factor of invasive vulvar cancer
- lymph node mets
- squamous cell carcinoma
- vulvar lump on presentation and hx puritis
- dx via biopsy of dermis and connective tissue so you can evaluate depth of invasion
- spread via direct extension and hematogenous spread
vaginal cancer
- upper 2/3 of vagina
- lower 1/3
- lymph node spread
- upper 2/3 pelvic nodes
- lower 1/3 deep inguinal nodes
inflammatory breast cancer
- rare
- rapid onset of sx
- lymphatic involvement
- HPI: breast pain or rapidly growing
- erythema, edema, peau d’orange
- duration no more than 6 months
- occupies at least 1/3 of breast
- biopsy for dx
ovarian cancer
- transcoelomic spread
- clockwise spread through perintoneal fluid
- in addition to lympatic/hematogenous
- 1.5% overall lifetime risk
heredity breast and ovarian cancer is also assoicated with
- pancreatic, prostate, melaoma
lynch syndrome cancer types
- ovarian, endo, colon (gastric ureteral, pancreatic, glioblastoma, renal pelvis)
Li-Fraumeni cancer associated
- breast cancer
- colon cancer
- (other cancers: sarcomas, brain, adrenocortical
Cowden syndrome cancers associated
- breast, endo, colon (benign mucocutanesous lesions, thyoids, gastrointestinal harmartomes)
Peutaz-Jeghers associated tumors
- breast, ovarian, colon (cervical adenoma maligum, gastroinstentinal hamartomas, pancreatic, gastric, small bowel
Hereditary diffuse gastric cancer associated with
- breast cancer, gastric, colorectal
- Endometrial intraepithelial neoplasm risk cancer after hyst
- EIN definition
- 45%
- benign endometrial hyperplasia (non-neoplastic changes due to longer estrogen exposure, anovulation etc).
- EIN: endometrial precancer, epithelial crowding displaces stroma,
clear cell carcinoma quick path
hobnail cells
dysgerminoma quick path
sheets of lymphocytes/germ cells
endodermal sinus tumor quick path
schiller-duval bodies
grandulos cell tumor quick path
call-exner bodies
serous tumor quick path
psammoma bodies
brenner tumor quick path
wlthard nests, baldder epithelium
immature teratoma quick path
immature neuroepithelium
choriocarcinoma quick path
malignant cytotrophoblast/synchtiotrophoblast
embryonal carcinoma quick path
malignant cytotrophblast/syncytiotrophoblast
krukenberg tumor quick path
signet cells
most prognostic for survival in vulvar cancer (specific)
- inguinofemoral lymph node involvement
paget disease breast HPI
- red rash from nipple is the most common
ovarian cancer associated with endometriosis
- clear cell adenocarcinoma
- cured by surgery along
- 20% are advanced disease and platinum resistent
HPV strains
- 16: most commonly associated with cancer
- 18: also associated with cancer
- 6/11: genital warts
CA-125 increased for
- endometriosis, IBS, pancreatisis, pregnancy (inflammation)
- *not associated with cystitis
lifetime risk of ovarian cancer
1 in 75
MCC ovarian cancer
serous
HPV gene associated for cancer issue
p53
path findings for mature and immature teratomas
- mature: many types of differentiated cells
- immature: neuroectoderm
MCC endometrial cancer
adenocarcinoma
Best next step once GTN has been diagnosed with plateaued BETAs
- CXR next step
- no path sample because bleeds so much
Granulosa cell tumor
- path signs
- makes what output
- call exner bodies (rosette cells around eosinophilic fluid space most commonly associated with adult granulosa cell tumors
- make estrogen
sertoli leydig cell tumors path
- frank virilization in 35% of patients (another 10-15% with mild symptoms)
- cause menstrual disorders, virilization, non-specific symptoms resulting from an abdominal mass
- 50% report abdominal pain or abdominal mass
ovarian granulosa cell tumor path
sheets punctuated by small follicle like structures and coffee bean nuclei (call exner bodies)
yolk sac endodermal sinus tumor path
invaginated papillary structures with a central vessel (schiller duval bodies)
clear cell carcinoma path
hobnail cells
dysgerminoma path
sheets of lymphocytes/germ cells
brenner tumor path
walthard nests
krukenberg path
signet cells
immature teratoma path
immature neuroepthelium
choriocarcinoma path
malignant cryotrophoblstats/cyncytiotrophooblast
treatment stage 3 cervical cancer
cisplatin, radiation, brachytherapy
What do these secrete
chorio:
dysgerminoma:
Embryonal:
endodermal sinus (yolk sac):
epithelial:
Granulosa:
Mucinous:
chorio: hCG
dygerminoma: LDH
Embryonal: hCG, AFP
endodermal sinus (yolk sac): AFP
epethelial: CA-125
Granulosa: inhibit
mucinoous: CEA
treatment of placenta site trophoblastic tumor
actually hysterectomy (not chemo like chorio)
vaginal cancer spread pattern
distal 1/3: superficial and deep inguinal nodes»_space;femoral nodes
proximal 2/3: external, internal, and iliac notes
vulvar cancer type 1 risk factors
- cigarette smoking
- HPV
- younger age
- hx sexually transmitted infection
- Pre-existing vulvar intraepithelial neoplasia
Reasons for MRI to breast cancer
- history of cheat radiation therapy at age 24 for hodgkin lymphoma
- BRCA
- first degree relative of breast cancer genetic mutation carrier, but untested
- 20% lifetime risk of breast cancer
- radiation therapy to chest between ages 10-30 years
- age 25-29 years and known BRCA pathogenic variant
1A ovarian cancer popped in the abdomen
1C
ovarian cancer diagnosis FIGO score
Stage 3C
HPV independent vulvar cancer risk factors
- Older
- low association to HPV
- vulvur atypia
- keratinizing, squamous cell carcinoma
- seldom HPV positive
- vulvar inflammation, lichen sclerosus, squamous cell hyperplasia
- rarely with condyloma
- not associated with cigarette smoking
