TUMORS

Question 1

Q35. EXOCRINE PANCREAS TUMORS

WHAT ARE THEY?

Answer 1

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

Question 2

Q37. KIDNEY TUMORS

CLASSIFY

Answer 2

Bng:

1. adenomas
2. angiomyolipomas
3. oncocytoma

Mlg:

1. Renal Cell Ca
   - Clear cell ca
   - Papillary cell ca
   - Chromophobe renal ca
2. Nephroblastoma/ Wilm’s tu (children 2-4yrs)
3. Renal pelvis ca

Question 3

Q38. TUMORS OF URINARY COLLECTING SYSTEM

Answer 3

1. Bng papilloma
2. Urothelial (transitional) cell Ca
   Bladder = most common, others- ureter, pelvis (not so much)
   Others = sq cell Ca, adenoCa (more rare)

Question 4

Q39. Testicular tumors

firm, painless enlargement of testes, 20-40yrs

Answer 4

Germ cell tumors (95%):

1. Seminomas (55%) - better prognosis, metastasize late
   - classic type (most common germ cell tu)
   - spermatocytic seminoma
2. 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.

Question 5

Q40. Prostate carinomca

Also know prostatitis (acute, chronic) and BPH (nodular hyperplasia..)

Answer 5

• 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