Oncology Flashcards
What is the differential diagnosis for an anterior mediastinal mass?
Remember the 4 T’s!
- Thyroid neoplasm
- Thymoma
- Teratoma (including germ cell tumors)
- Terrible lymphoma
Diagnosis:
How can you differentiate between a seminoma and a nonseminomatous germ cell tumor?
Seminoma= high B-hCG and normal (usually) AFP Nonseminoma= high B-hCG AND high AFP
What are the four characteristics of a solitary pulmonary nodule (SPN)?
- Rounded opacity
2.
What is the next step in management for patients found to have a solitary pulmonary nodule on CT with:
A. Low malignancy risk
B. Intermediate malignancy risk
C. High malignancy risk
A. Follow up monitoring with serial CT scans
B. PET scan and/or biopsy depending on radiographic findings
C. Surgical excision
Diagnosis:
Elderly man with
- anemia
- renal failure
- hypercalcemia
Multiple Myeloma
Diagnosis:
Multiple Myeloma
serum immunoelectrophoresis
Note, bone scans are not helpful in diagnosis patients with MM. Bone scans are most useful in pathophysiological processes that undergo new bone formation. There is no new bone formation in MM. X-ray should be used to detect lytic lesions associated with MM.
What is the most common primary bone malignancy found in children and young adults?
Osteosarcoma
Boys 13-16 are at a higher risk. The metaphases of long bones are typically involved. Labs will show elevated alkaline phosphatase and lactate dehydrogenase due to turnover of damaged osteocytes. The higher these levels are the worse the prognosis.
Diagnosis:
X-ray of the proximal humerus shows:
- spiculated “sunburst” lesion in the metaphysis of the proximal humerus
- Codman triangle (periosteal elevation)
Osteosarcoma
How can you differentiate Chronic myeloid leukemia from a leukemoid reaction?
Leukocyte alkaline phosphatase (LAP) score will be high in a leukemoid reaction and low in chronic myeloid leukemia.
Treatment:
Hairy cell leukemia
Cladribine
Diagnosis:
- lymphocytes with hair-like irregular projections
- Tartrate-resistant acid phosphatase (TRAP) stain
Hairy cell leukemia
What is the first line treatment for hypercalcemia of malignancy?
Bisphosphonates (zoledronic acid, paidronate)
Treatment:
- Asympotmatic hypercalcemia of malignancy
- Mild hypercalcemia of malignancy
- Symptomatic moderate hypercalcemia of malignancy
- Severe hypercalcemia of malignancy
- Nothing
2. Nothing (mild= calcium 14 mg/dL)
What caveat should be considered when using the heterophile antibody test to diagnose infectious mononucleosis (IM) ?
The heterophile antibody test is very specific and sensitive, BUT it can be negative in early illness. It might be helpful to repeat it.
Clinical Manifestation:
Infectious Mononucleosis (IM)
- fatigue, malaise
- sore throat
- fever
- generalized maculopapular rash
- posterior cervical lymphadenopathy
- palatal petechiae
- splenomegaly
Diagnosis:
- IgM spike on electrophoresis
- Signs of hyperviscosity
Waldenstrom’s macroglobulinemia
Treatment:
Patient with a asymptomatic, soft lymph node approximately 1 cm in diameter
Observation
a lymph node > 2 cm would be suspicious for malignancy
What laboratory value can be used to differentiate CML from polycythemia vera or leukomoid reaction in patients with myeloproliferation disorders?
low levels of leukocyte alkaline phosphate activity suggests CML
What condition must be suspected in a patient with a history of malignancy (lung, breast, prostate, multiple myeloma) who develops back pain and presents with signs of myelopathy?
Epidural spinal cord compression (ESCC)
Treatment:
Epidural spinal cord compression (ESCC)
IV glucocorticoids (dexamethasone)
Patients should also be sent for an emergency MRI.
What are the late neurological sequelae of epidural spinal cord compression?
Bowel and bladder dysfunction
Treatment:
Chemotherapy-induced nausea and vomiting
Ondansetron; serotonin antagonists that block 5HT3 receptors
Diagnosis:
Hairy cell leukemia
tartrate-resistant acid phosphatase (TRAP) staining
May be worded as, “cytochemical testing reveals a strong acid phosphatase reaction that is not inhibited by tartaric acid.
Diagnosis:
Chronic lymphocytic leukemia (CLL)
Flow cytometry showing lymphocyte clonality
