bananas's version from 2015-07-05 18:44

Uterine cancer

Question Answer
Risk factors for endometrial hyperplasiaUnopposed estrogen (obese, PCOS, HRT)
PTEN mutation
Menstrual irregularities (meno/metrorrhagia)
Endometrial gland proliferationEndometrial hyperplasia
Is there a cancer risk with endometrial hyperplasia?YES! Endometrial adenocarcinoma
How do you treat endometrial hyperplasia?Progesterone, Hysterectomy
MC Gynecological malignancyEndometrial carcinoma
Peak age for endometrial adenocarcinoma55-65 y.o.
Excess unopposed estrogen is a risk factorEndometrial hyperplasia + Endometrial carcinoma
Rapid enlargement of uterus (post-menopause)Leiomyosarcoma
Unilateral proliferation of myometrial SMLeiomyosarcoma
What's the prognosis of LeiomyosarcomaMalignant! Aggressive mets to the lung, liver, abdomen. Hemorrhagic necrosis
Plasma cells in the endometriumChronic endometritis
Causes of Endometritis?Ascending infection: Retained products of conception, C section, IUD.
Treatment of EndometritisGentamycin + Clindamycin (usually polymicrobial)
Endometrial gland tissue outside the endometrium?Endometriosis
MC location of endometriosis?Ovaries! Usually bilateral
Chocolate cystEndometriosis in the ovaries
Gun-powder lesionEndometriosis
DyscheziaEndometriosis in the pooper (Pouch of Douglas)
Treatment of EndometriosisNSAIDs, OCP's, Progestins, Continuous GnRH
Is there a cancer risk with EndOmetriosis?YES! Carcinoma, especially Ovarian.
MC benign endometrial growth?Leiomyoma (aka fibroids)
Well-defined White Whorled massesLeiomyoma!!
Age group at risk for Leiomyoma20-40 y.o. aa.
Usually asymptomatic?Leiomyoma
Treatment for Leiomyoma?Hysterectomy
Cyclic pelvic pain +/- bowel or bladder symptoms?Endometriosis
Menorrhagia + nontender irregular uterus?Leiomyoma aka Fibroids
Memorrhagia + Tender, enlarged, globular uterusAdenomyosis
Endometrium in the myometrium?Adenomyosis

Ovarian cancer


Question Answer
MC group of ovarian cancer?Surface epithelial tumors
Surface epithelial tumorsCystadenoma (Serous and Mucinous), Cystadenocarcinomas (Serous and Mucinous), Endometrioid, Brenner's
Are germ cell tumors typically bilateral or unilateral?Bilateral
Which age group is affected in Epithelial tumors?40-60's
Which surface epithelial tumors are benign?Cystadenoma (Serous and Mucinous), Brenner
Which surface epithelial tumors are malignant?Cystadenocarcinoma (Serous and Mucinous), Endometrioid, Clear cell
Prognosis for surface epithelial tumors?Poor
MC ovarian cancer?Serous Cystadenoma/Cystadenocarcinoma
Fallopian tube-like epitheliumSerous Cystadenoma
BRCA-1Serous cystadenoma/cystadenocarcinoma
Multiloculated, huge mass?Mucinous cystadenoma (can be unilateral)
Chocolate cystEndometrioid
Associated with Endometrial CAEndometrioid (also Granulosa cell, Thecoma)
Bladder epithelium?Brenner tumor (Pale yellow-tan)
Coffee bean nuclei?Brenner tumor
Psammoma bodiesSerous cystadenocarcinoma!
[yo momma is a serious cystah]
Fallopian-tube like epitheliumSerous
Pseudomyxoma peritoneiMucinous cystadenocarcinoma: mucous collects in intraperitoneum (can be appendiceal)


Question Answer
Sex cord tumorsGranulosa cell, Sertoli-Leydig, Fibroma, Thecoma
What age group is affected with sex-cord?All
Sex cord tumors: unilateral or bilateral?Unilateral
Which sex cord tumors are benign?Thecoma, Fibroma
Which sex cord tumors are malignant?Granulosa, Sertoli
Prognosis of Sex-cord stromal tumors?Good! Tend to be found early
Ovarian tumor+Ascites+HydrothoraxMeig's syndrome: Fibroma
Meig's syndromeFibroma (benign)
Pleural effusion
Spindle shaped fibroblast bundlesFibroma (benign)
Precocious pubertyGranulosa cell tumor
Follicle-looking rosettes?Call-exner bodies: Granulosa cell tumor
Estrogen secretingGranulosa cell
- increased risk for Endometrial Carcinoma (Also Endometrioid)
Virilization (Hirsutism, Acne)Sertoli-Leydig
Estrogen secretingGranulosa and Thecoma
Reinke Crystals: Leydig tumor
Fibroma: spindle shaped fibroblasts
Call Exner bodies: Granulosa cell [Call your Grandma]


Question Answer
Germ cell tumorsCystic teratoma, Dysgerminoma, Yolk sac (endodermal sinus), Choriocarcinoma
What age group is affected with germ cell tumors?Teens to 20's
Germ cell tumors: unilateral or bilateral?Unilateral
Benign germ cell tumor?Mature teratoma
Malignant germ cell tumor?Immature teratoma, Dysgerminoma, Yolk sac, Choriocarcinoma
Prognosis of Germ cell tumorsExcellent response to chemo
Hyperthyroidism + ovarian massStruma ovarii: teratoma has functional thyroid tissue
Associated with Turner syndromeDysgerminoma
MC in adolescentsDysgerminoma
Fried egg cellsDysgerminoma
Tumor markers for Dysgerminoma?LDH
Cytotrophoblasts, syncytiotrophoblasts (without chorionic villi)Choriocarcinoma
Worst prognosisChoriocarcinoma: Hematogenous spread to the lungs
High B-hCGChoriocarcinoma
Embryonal carcinoma
MC in childrenYolk sac (endodermal sinus)
Glomeruloid bodiesSchiller-Duval bodies: Yolk sac tumor
AFPYolk Sac tumor
Schiller-Duval bodies: Yolk sac tumor
Dysgerminoma: fried egg


Question Answer
Bloody nipple dischargeIntraductal or Papillary
Phyllodes tumor:
- Fibrous overgrowth with leaf-like projections
Rubbery, mobile mass with sharp edgesFibroadenoma
Benign tumor that grows during pregnancyFibroadenoma
Milk productionNipple stimulation, Prolactinoma of anterior pituitary, Drugs (dopamine blockers)
Purulent nipple dischargeAcute mastitis from fissures. Most commonly staph aureus
Green/brown nipple dischargeMammary duct ectasia
Benign mass, post menopausal woman: Chronic inflammation and plasma cellsMammary duct ectasia
Lumpy breastFibrocystic change
Fluctuates with menstrual cycleFibrocystic change
Cysts or fibrosis that expand lobules and may cause painFibrocystic change
Changes that can occur with fibrocystic change?No risk: fibrosis, cystic, apocrine
2x Risk: Sclerosing adenosis
5x Risk: Atypical Hyperplasia
Nonlactational mastitis?Duct ectasia, fat necrosis, granulomatous mastitis (from TB or ruptured silicone implants), and inflammatory carcinoma
Trauma/injury to the breastFat necrosis
Abnormal calcification and soponofication on mammographyFat necrosis
Benign, painless lumpFat necrosis
Risks for malignant breast cancer?female gender, estrogen exposure, early menarche and late menopause, older age at first live birth, obesity, BRCA1 and 2 mutations, atypical hyperplasia, first degree relative with breast cancer
Dystrophic calcification on mammographyDCIS
Comedo type DCIS:
- central caseous necrosis and dystrophic calcification
Excematous patches on nipplePaget Disease. Extension of DCIS into the nipple
Paget cells: Large cells in epidermis with clear halo
- Underlying DCIS
Incidental benign findingLobular carcinoma in situ
Lack E-cadherinlobular carcinomas
Rock-hard mass with sharp marginsInvasive ductal carcinoma: Medullary
Stellate infiltrationInvasive ductal
Dimpled skin or nipple retractionInvasive ductal carcinoma or periductal mastitis
Tubular Invasive ductal carcinoma
- Duct-like structures invading stroma
Invasive lobular carcinoma
- Single file row of cells
Carcinoma with lymphocytic infiltrate and good prognosisMedullary (Invasive Ductal)
BRCA1 mutationsMedullary
Dermal lymphatic invasion with peau d'orange skininflammatory
Acute mastitis that is not responding to antibiotics?Inflammatory
Good prognosis:medullary, mucinous, tubular, papillary, pagets
MC Breast changeFibrocystic changes
MC malignant breast cancerInvasive ductal

Testicular cancer

Question Answer
Fried egg appearance Seminoma
MC testicular tumor Seminoma
MC Boys <3Yolk Sac (endodermal tumor)
Yellow, mucinous and aggressiveYolk Sac
Yolk sac
- Schiller Duvall bodies (primitive glomeruli)
PainfulEmbryonal Carcinoma: hemorrhagic mass
Glandular/papillary/Tubular morphologyEmbryonal Carcinoma
Teratoma in menMalignant! (but benign in kids)
Syncytiotrophoblast and cytotrophoblastsChoriocarcinoma
Hematogenous spreadChoriocarcinoma
Gynecomastia and hyperthyroidChoriocarcinoma
Older menTesticular lymphoma (metastatic, aggressive)
Leydig cell tumor: Reinke crystals
Gynecomastia in menLeydig cell tumors
High AFP- Yolk sac!
- Also teratomas
High HCG- Choriocarcinoma!
- Embryonal carcinoma
- Teratoma
High ALPSeminoma
Estrogen secretingSertoli cell
Testosterone secretingLeydig


Question Answer
What gene mutation is associated with FAP?AD mutation on Chromosome 5q leading to mutation of APC tumor suppressor
What is the pathogenesis of FAP?Adenoma-Carcinoma sequence:
Loss of APC → KRAS mutation →p53 mutation →DCC = Carcinoma
Thousands of rectal polyps arising after pubertyFAP (familial adenomatous polyposis)
FAP + bone/soft tissue tumors + supernumary teethGardner syndrome
FAP + CNS tumorTurcot syndrome
What tumor is associated with Turcot?Medulloblastoma
GI Hamartomas + Hyperpigmented lips, hands, genitalsPeutz-Jeghers
Is there risk associated with Peutz Jeghers?Yes! 50% will develop cancer: GI cancer
What gene mutation is associated with HNPCC?Autosomal dominant mutation of DNA musmatch repair genes
What is the pathogenesis of HNPCC?Microsatellite instability: DNA mismatch repair mutations accumulate and cause repeating segments of DNA
3-2-1 diagnosisLynch (HNPCC):
3 relatives with Lynch
2 generations
1 diagnosed before 50 y.o.
Which part of the colon is always involved in HNPCC?Proximal
How common is colorectal cancer?3MC incidence and death
Risk factors for colorectal cancer>50 y.o.
IBD, especially UC
Meat and low fiber
Which bacteria is associated with colorectal cancer?Strep bovis
How does right-sided colorectal cancer present?Iron deficiency anemia!
How does left sided colorectal cancer present?Thin poo, Hematochezia
Barium enema sign of colorectal cancerApple core lesion
Screening of colorectal cancerColonoscopy x10 years
Stool occult blood x1year
Barium enema
Colorectal tumor marker?CEA. Not specific but good for monitoring.

Brain Tumors

Question Answer
pseudopalisadingglioblastoma multiforme
butterflyglioblastoma (crosses corpus callosum)
crosses corpus callosumglioblastoma (butterfly)
GFAP +glioblastoma, oligodendrioma, pilocytic astrocytoma
from arachnoid cellsmeningioma
dural attachmentmeningioma
spindle cells in whorled patternmeningioma
psammoma bodiesmeningioma
surface of brainmeningioma
asymptomatic until presents with focal near signs or seizuresmeningioma
von hippel lindau associationhemangioblastoma
can cause polycythemiahemangioblastoma
produces EPOhemangioblastoma
thin walled capillaries closely arrangedhemangioblastoma
cerebellopontine angleschwannoma
NF2bilateral schwannoma
fried egg cellsoligodendroglioma
chicken wire capillary patternoligodendroglioma
prolactinomapituatary adenoma
bitemporal hemianopiapituitary adenoma
posterior fossapilocytic astrocytoma
rosenthal fiberseosinophilic corkscrew fibers in pilocytic astrocytoma
homer-write rosettessolid small blue cells in medulloblastoma
drop metastases to spinal cordmedulloblastoma
compress 4th ventricle and cause hydrocephalusependymoma and medulloblastoma
perivascular pseudorosettesrod shaped basal ciliary bodies near nucleus in ependymoma
only childhood tumor supratentoriumcraniopharyngioma
remnant of rathke pouchcraniopharyngioma
tooth-enamel likecraniopharygioma
Precocious puberty+ParinaudPineal germinoma in the superior colliculi
Paralysis of upward gazeParinaud syndrome. Pineal germinoma in the superior colliculi

Skin cancer

Question Answer
What is the most common skin cancer?Basal cell
Locally invasive but never metastasizesBasal cell
Pink, pearly nodules w rolled borders and central crusting or ulcerationBasal cell
Commonly with telangiectasiasBasal cell
nonhealing ulcers with infiltrating growthBasal cell
scaling plaqueBasal cell
Palisading nucleiBasal cell
Second most common skin cancerSCC
Arsenic exposureSCC
Commonly on face, lower lip, ears, and handsSCC
Maybe LNs, but rare metastasisSCC
Chronic draining sinusesSCC
Ulcerative red lesions with scalingSCC
Actinic keratosis is a precursorSCC
KeratoacanthomaSCC variant
- grows rapidly (4-6 weeks) and may regress spontaneously
Significant risk of metastasisMelanoma
Fair-skinned persons are at ↑ riskMelanoma
Depth of tumor correlates with risk of metastasisMelanoma
ABCDEs of melanomaAsymmetry
Border irregularity
Color variation
Diameter > 6mm
Evolution over time
Activating mutation in BRAF kinaseMelanoma
vemurafenibMelanoma in pts with BRAF V600E mutation
Which growth pattern increases the risk of melanoma metastasis?Active vertical growth (Down into the deep dermis)
Blue lesion under the nail, tender to touchGlomangioma (SM cell tumor)