Parotid Tumours 2 (25)

Question 1

What is the relation between breast cancer and pleomorphic adenoma?

Answer 1

Genetic (BRCA1 and BRCA2)

Question 2

55 years old female with Mastectomy done 5 years back and parotidectomy for pleomorphic adenoma 10 years back. Now presented by neck swelling (supra-clavicular LN swelling).

Investigation?

Answer 2

FNAC or Tru-Cut® biopsy

Question 3

What test to be done in FNAC?

Answer 3

Immunohistochemistry, receptor status

Question 4

What is the meaning of pleomorphic?

Answer 4

Varied or diverse in appearance

Question 5

Describe pleomorphic adenoma appearance?

Answer 5

Mixed tumor consisting of epithelial and mesenchymal elements

Question 6

After 10 years from resection patient develop neck swelling what this indicate?

Answer 6

Possible recurrence or metastasis

Question 7

After 10 years from resection patient develop neck swelling what this indicate

What other things do you consider? What is DD?

Answer 7

Differential diagnosis:
- Lymphoma
- Carotid body tumor
- Carcinoma

Question 8

If the metastasis from the erodes carotid artery it doesn’t stop bleeding, why?

Answer 8

Because of high blood flow

Question 9

What is fine needle aspiration cytology (FNAC)?

Answer 9

An operator-dependent procedure that may or may not be image-guided and involves passing a needle through a lesion while suction is applied to a syringe. The material thus obtained is expressed onto a slide and sent for cytological assessment.

Question 10

Other than FNAC, what types of tissue samples may also be obtained?

Answer 10

Core and Tru-Cut biopsy

Question 11

Define metastasis

Answer 11

The survival and growth of cells at a site distant from their primary origin

Question 12

List 5 pathological steps by which carcinoma spreads

Answer 12

• Direct or continuous extension
• Penetration into lymphatic, blood vessels, or body cavities
• Transport of the tumor cells into the circulation
• Arrest in the capillary beds of secondary sites
• Growth of the disseminated tumor cells in secondary sites

5 stages of metastasis- 1. detachment and migration from the primary tumour (cells need to undergo epitheal cell to mesenchymal cell transition by E cadherins). 2. Intravastation (enters the blood ciculation system). 3. Transport. 4. Extravasation (exciting blood circulation system). 5. Growth at the site of metastasis.

Question 13

What are the main routes of spread of malignant tumors?

Answer 13

• Lymphatic (permeation and lymph emboli)
  
  • Hematogenous
  • Trans-celomic (along the body cavity to peritoneal surface)

Question 14

How or what is the mechanism of lymphatic spread?

Answer 14

• Cancer cells and tumor-associated macrophages secrete growth factors such as VEGF-C and VEGF-D to induce lymph-angiogenesis in the primary tumor and in draining sentinel LN, thereby promoting LN metastasis.
• Primary tumors also release immunomodulatory molecules like exosomes that lead to immunosuppression.