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Millers > Tumor: Soft Tissue Lesions > Flashcards

Tumor: Soft Tissue Lesions Flashcards

1
Q

At what size should you 3D image soft tissue masses (vs directly excise)?

A

> 5cm body
1.5 hand/feet
Below this and looks like fat on imaging, can go to excisional biopsy

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2
Q

Next best step if you did an unplanned excision of malignant lesion

A
  1. Re-image the tumor bed
  2. Treat: radiate, wide excision

If superficial, wont need radiation - surgery only

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3
Q

MRI finding for soft tissue sarcoma

A

Dark T1 (aka not fat)
Bright T2 (doesn’t suppress like fat)

T1 shows normal anatomy
T2 shows disease

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4
Q

Imaging for synovial sarcoma

A

XR: mineralization
Ca2+ in soft tissues
Fluid (can look like hematoma)

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5
Q

Histo synovial sarcoma

A

Looks like synovium - that’s why named synovial sarcoma
Spindle cells

Glandular nests

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6
Q

Translocation / FISH synovial sarcoma

A

t(X:18)
SYT/SSX1
SYT/SSX2
Not heritable

XYZ = sYnovial X,18 SSX

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7
Q

Treat synovial sarcoma

A

STS: rads -> surgery

***Radiation

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8
Q

Atypical liposarcoma genetics

A

MDM2 amplification

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9
Q

Myxoid liposarcoma genetics and sites of metastasis

A

t(12;16)
Lungs
Bony spine
Retroperitoneum

Myx fat 12 and 16 times in the retroperitoneum

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10
Q

Treat liposarc

A

STS: rads, surg

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11
Q

Histo fibrosarcoma

A

Herringbone

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12
Q

RF MPNST

A

NF1, enlarging mass

Patient with a growing mass

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13
Q

Histo MPNST

A

Whirling pattern, S100

+S100

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14
Q

Treat MPNST

A

STS: rads + resection (entire nerve)

Surg - have to resect the nerve, make sure get clean margins

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15
Q

RF angiosarcoma
How does it present?

A

Stuart Treaves syndrome aka chronic lymphedema
Presents as a cutaneous bleeding growth

Hx breast cancer, radiation

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16
Q

What are the E-SARC (SCARE) tumors

A

Soft tissue tumors that also met to LN (lungs still most common)

  1. Epitheliod
  2. Synovial sarc
  3. Angiosarc
  4. Rhabdo
  5. Clear cell
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17
Q

Histo angiosarc

A

Epithelioid nests
Spindle cells
Trying to make rudimentary vessels (vs hemangio = mature BV)

18
Q

Treat angiosarc

A

STS: rads / surg

19
Q

Patient population rhabdomyosarcoma

A

KIDS

20
Q

Path (include translocation) rhabdo

A

Small round blue
+desmin
T(2;13)
PAX-FKHR

PA fucked ma to get 2 round 13 desmin boys

21
Q

Treat rhabdo

A

CHEMO -> surg
***Unusual STS

May not even need surg depending on response

22
Q

Location epithelioid sarcoma

A

Hand - confused for ulcerating granuloma

Younger patients

23
Q

Histo epithelioid sarcoma

A

+EMA (epithelial mutate antigen)
+cytokeratin
Lose INI1

Only 1 good hand for epitheliod pts!

24
Q

What are the names of versions of fibromatosis

A

Dupuy
Lederhosen
Peronie
FAP / extra-abdominal (get colonoscopy)

25
Q

Treat fibromatosis

A

Resection - high local recurrence

+/- adj rads if +margins

26
Q

Extra-abdominal fibromatosis (FAP) - histo and treat

A

+E receptor (why grow during pregnancy) - think like fibroids!!!
+IHC beta catenin
Surgery, but often don’t operate because so hard to get clear margins

27
Q

What is the difference between schwannoma and neurofibroma

A

Schwan - 1 nerve fiber eccentrically sitting on the rest of normal nerve - easy to resect
NF - deep, entire nerve involved - resect only if symptomatic bc bleed a lot

28
Q

Imaging Schwannoma vs NF

A

Schwan = egg on string, round mass
NF = bag of worms

NF: bag of worms

29
Q

Histo schwannoma

A

Antoni A and B
Antoni is a snake!

30
Q

Phlebolith is characteristic of what lesion

A

AVM/hemangioma

31
Q

Treat hemangioma

A

1: observe, compression
2: alcohol sclerotherapy
3: surgery

32
Q

Genetics PVNS/TGCT

A

CSF1 over expression

Recruit lots phagocytes

33
Q

Histo PVNS/TGCT

A

Giant cells matrix - spilled over choco cookies

34
Q

Treat PVNS/TGCT

A

Resect!
CSF1 I if recalcitrant (SE = albinism)

35
Q

What tumor is an example of metaplasia (reversible change in cell type)

A

Synovial chondromatosis
Synovial tissue -> cartilage
RICE BODIES
Metaplasia reverses after remove!

36
Q

What is tumoral calcinosis

A

Benign Ca deposits from a phosphate metabolism issue
EXTRA artic (why NOT synovial chondromatosis)

37
Q

What STS mimicker presents with regional LN involvement + treatment

A

Cat scratch disease
Bartonella henselae
Epitrochlear LN
Trt: doxycycline

38
Q

Imaging findings that differentiate infection vs STS

A

Infx - does not respect soft tissue planes

STS - has rind around it, central necrosis

39
Q

3 malignant lesions with Ca deposits in soft tissue

A

Synovial sarcoma
Liposarcoma
Angiosarcoma

40
Q

2 tumors characteristic to the foor

A

Clear cell sarcoma

Synovial sarcoma

41
Q

Tumor with MUC4 gene

A

Low grade myxofibrosarcoma

Remember fibrosarcoma herringbone pattern histo

42
Q

How stage STS

A

CT chest

Millers (29 decks)

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