TUMORS Flashcards
Q35. EXOCRINE PANCREAS TUMORS
WHAT ARE THEY?
Bng (adenomas, cystadenomas)
1. Serous cystadenoma
- female, 70yrs+
- cyst lined by glycogen rich cuboidal cells w. clear fluid inside
- non-specific pain, curative by resection
2. Mucinous cystadenoma
- female, body or tail of pancreas
- cysts lined w columnar-mucinous ep filled w thick mucin, thick cellular stroma
- bng, border-line or mlg
(similar to intraductal papillary mucinous neoplasm - men, head of pancreas, lack cellular stroma)
Mlg - pancreatic carcinoma
- high mortality rate, worst prognosis
- elderly >60yrs
- adenoCa arising from duct!
- strong association w smoking, chronic pancreatitis, DM
- progressive accum of genetic changes from non-neopl.–> non-invasive –> invasive
- majority head (60%) -obstructive jaundice, blocks bile duct; body (15%), rarely in tail - may remain silent, late symptoms, worse prognosis
‘Ductal adenoCa’ - most typically found
- poorly dif., aggressive, infiltrative, dense fibrotic desmoplastic stroma
- early and extensive invasion into peripancreatic tissue
- may extend to retroperitoneum
- symptoms silent until compress on sur structures e.g. spleen, adrenals etc.
- entraps adj nerves –> stomach pain etc. -pain = primary symptom
- metastasis to lungs, bone
anorexia, weakness, weight loss
Trosseau sy =migratory thrombophlebitis
Q37. KIDNEY TUMORS
CLASSIFY
Bng:
- adenomas
- angiomyolipomas
- oncocytoma
Mlg:
- Renal Cell Ca
- Clear cell ca
- Papillary cell ca
- Chromophobe renal ca - Nephroblastoma/ Wilm’s tu (children 2-4yrs)
- Renal pelvis ca
Q38. TUMORS OF URINARY COLLECTING SYSTEM
- Bng papilloma
- Urothelial (transitional) cell Ca
Bladder = most common, others- ureter, pelvis (not so much)
Others = sq cell Ca, adenoCa (more rare)
Q39. Testicular tumors
firm, painless enlargement of testes, 20-40yrs
Germ cell tumors (95%):
- Seminomas (55%) - better prognosis, metastasize late
- classic type (most common germ cell tu)
- spermatocytic seminoma - Non-seminomas (45%) - early metastasis, worst prognosis
- embryonal adenoCa (20-30yrs)
- yolk sac tu (<3yrs)
- choriocarcinoma (20-30yrs)
- teratoma (any age)
- mixed tu - mostly
Stromal/sex-cord tumors (5%):
- leydig tu
- sertoli tu
Other tumors - mlg. lymphomas, adenomatoid tu.
Q40. Prostate carinomca
Also know prostatitis (acute, chronic) and BPH (nodular hyperplasia..)
- prostate adenoCa
- elderly 65-75yrs
- periphery, posterior side
- unknown cause - genes, env, hormones plays a role
- DRE - palpation of firm protruding mass, (size, surface, consistency).
- macro = firm, yellowish-white mass
- micro = diffuse, solid nests w varying anaplasia, poorly dif gls, distorted gls; tu cells - enlarged nuclei, dark cytoplasm.
- if suspect –> transrectal biopsy (thin needle cytology/ thick needle biopsy) - microscopy, grading
- Gleason grading system based on differentiation
- PSA elevations >10ng/dL
- early stages maybe silent, metastasis can be first manifestation - later urethral obstruction - micruturtion disorders, back pain etc.
- one lobe affected –> second lobe too –> breaks through capsule –> invade seminal vesicles, metastasize to pelvic LNs, bones - osteoblastic (esp. L,Th vertebra), lungs liver etc.
- advance = hard, fixed prostate