1. Pancreas
1.1. Pancreatic Adenomacarcinoma
1.1.1. 96% arise from ductal epithelium. Origin from the acinar cells are rare. Usually occurs in 70-80y/o. Located mostly at the head of the pancreas. Overall 5yr survival is 3%.
1.1.2. Pathogenesis: assoc w/ K-ras mutation and p16 and p53 mutations. Histology shows moderately differentiated adenocarcinoma. Well formed malignant glands and stromal fibrosis. Key feature: perineural invasion is present. Pancreatic cancer along a NERVE.
1.1.3. Patients present w/ epigastric pain accompanied by unintentional weight loss (90%). Common bile duct (CBD) obstruction leading to jaundice, Light colored stools (from absent Urobilli (UBG)), Palpable gallbladder (Courvoisier's Sign; 30%). Key Feature: Trousseau's Syndrome-Superficial migratory thrombophlebitis is assoc w/ pancreatic carcinoma. C19-9 is the gold standard marker.
1.1.3.1. Virchow's Node and Sister Mary Jospeh's Node
1.1.4. Dx: w/ C sign on CT (cancer pushed against the duodenum making the "C" shape on CT. Rx: Surgery- Whipple's procedure, radiation, and chemo.
1.2. Islet Cell Tumors
1.2.1. Isulinoma
1.2.1.1. Benign tumor of Beta islet cells; 80% assoc w/ MEN1 syndrome. Fasting hypoglycemia will cause mental status issues. increased serum insulin and decreased C-peptide. Rx: surgery
1.2.2. Glugagonoma
1.2.2.1. malignant tumor of alpha islet cells; hyperglycemia, rash (necrolytic migratory erythema) Rx: surgery; octerotide (somatostatin analogue).
1.2.3. VIPoma (pancreatic cholera)
1.2.3.1. malignant tumor w/ excessive VIP. Secretory diarrhea, achlorhydria. Hypokalemia, normal anion gap metabolic acidosis (loss of bicarb in stool). Rx: surgery; octerotide
1.2.4. Zollinger-Ellison (Gastrinoma) Syndrome
1.2.4.1. malignant islet cell tumor that secretes gastrin; Assoc. with MEN 1 (20-30% of cases). Peptic ulcers, diarrhea, maldigestion of food. Dx: serum gastrin (>1000pg/mL) Rx: PPIs, surgery; octreotide
1.2.5. Somatostatinoma
1.2.5.1. malignant tumor of delta islet cells; producing the inhibitory hormone somatostatin. Presents with achlorhydria, cholelithiasis and steatorrhea, and diabetes mellitus. Rx: Surgery; stretozotocin
1.2.6. General: Islet cell tumors are rare. Associated w/ 1. hyperinulism w/ hypoglycemia, 2. Zollinger-Ellison syndrome or ulcer and gstrinoma, 3. MEN syndromes. 70% of tumors are solitary adenomas, 10% are multiple adenomas, while another 10% metastasize. NOTE: malignancy is determined by the biological behavior and can't be predicted from histology
1.2.7. Histology: shows nests of malignant islet cells in the pancreas. The nest resemble the normal islets mostly; however, a large mass of tumor cells have a trabecular architecture that can be appreciated.
2. Kidney
2.1. Renal Cell Carcinoma
2.1.1. RCC accounts for 90% of all renal cancers in adults. Elderly men are at highest risk. Called hypernephroma/clear cell due the abundant clear cytoplasm. The tumors; however, grossly are yellow, grey, and white and bulge through the upper pole of the kidney. 5yr survival is 45-70% unless invasion into the renal vien (15%).
2.1.2. Histologically, a thin strip of fibrovascular connective tissue separates the normal kidney from the tumor. many polygonal cells with clear cytoplasm. The cells stain w/ PAS (w/ distase). Nuclei are round and regular. This cancer can metastasizes to the thyroid.
2.1.3. Presentation: hematuria, fever, weakness, and unintentional weight loss. Key feature: Associated w/ polycythemia. Early metastasis is common especially to lung and bone.
2.1.4. Associated w/ vonHippel Lindau Syndrome patients. (which have hemangioblastomas of the CNS and retina). 2/3 of the develop RCC due to male of the VHL gene function.
2.2. Angiomyolipoma
2.3. Wilms Tumor
2.4. Urothelial (transitional cell) carcinoma
2.5. Squamous Cell Carcinoma, Kidney
2.6. Adenocarcinoma, Kidney
3. Prostate
3.1. Adenocarcinoma, prostate
3.1.1. Usually occurs in the periphery of the prostate or in the subcapsular location. Common in the US esp among Black men. Precursor lesions are common (PIN; prostatic intraepithelial neoplasia).
3.1.2. Malignant glands are small (microacinar) and packed. All glands are lined by a single cell layer. Larger glands are hyperplasic, and nerves are prominent beneath the capsule. Perineural invasion is common. Cancer invades the NERVE.
4. Liver
4.1. Metastatic Prostate Cancer of the Liver
4.2. Metastatic Small Cell Lung Carcinoma of the Liver
4.3. Cavernous Hemangioma
4.4. Hepatocellular Carcinoma/ Hepatoma
5. Brain
5.1. Meningioma
5.2. Glioblastoma multiforme (grade IV astrocytoma)
5.3. Schwannoma
5.4. Oligodendroglioma
5.5. Pitutiary Adenoma
5.6. Childhood Tumors
5.6.1. Pilocytic (low-grade) astrocytoma
5.6.2. Medulloblastoma
5.6.3. Ependymoma
5.6.4. Hemangioblastoma
5.6.5. Carniopharyngioma
6. Skin
6.1. Nevus
6.2. Malignant Melanoma
6.3. Basal Cell Carcinoma
7. Heart
7.1. Rhabdomyoma
7.2. Myxoma
7.2.1. Benign mesenchymal tumor w/ gelatinous appearance and abundant ground substance.
7.2.2. Most common primary cardiac tumor in adults.
7.2.3. Usually forms a pedunculated mass in the left atrium that causes syncope due to obstruction of the mitral valve.
8. Soft Tissue
8.1. Rhabdomyosarcoma
8.2. Ewing's Sarcoma
9. Tumor Nomenclature
9.1. Definitions
9.1.1. Neoplasm: new growth that will no stop growing. Clonal proliferation of cells from one cell that went awry.
9.1.2. Metaplasia: change of one adult cell type to another adult cell type usually in response to injury.
9.1.3. Dysplasia: Disordered growth. Cells will not look as uniformed as the usual architecture of the tissue.
9.1.4. Desmoplasia: malignant cells invade and stimulate surrounding cells passing the basement membrane to secrete fibrin. It is blue in hue. I leads to fibrotic scar. (typical of adenocarcinomas).
9.1.5. Pleormorphism: variable cell/nuclear size and shape. This is an indicator of malignancy.
9.1.6. Monomorphic: cells/nuclei are the same shape and size.
9.1.7. Differentiated: the degree to which the cells within the neoplasm resemble the primary structure from wince it originated. If the cells of the neoplasm originated in the colon and the colonic features are still noted in the neoplasm then the neoplasm is considered to be "well" differentiated. However, if they neoplasm in colon was completely pleomorphic with no resemblance to tissue origin then it is poorly differentiated.
9.1.8. Undifferentiated: poorly differentiated. Cells have gone awry and it is difficult to determine their origin. Another name for undifferentiated cells is "anaplastic".
9.2. Lineage
9.2.1. Epithelium
9.2.1.1. Ademona, Adenocarcinoma
9.2.1.2. Papillom, Paillary Carcinoma
9.2.2. Mesenchyme
9.2.2.1. Lipoma, Liposcarcoma
9.2.3. Lymphocyte
9.2.3.1. Lymphoma, Leukemia
9.2.4. Melanocyte
9.2.4.1. Nevus (Mole), Melanoma
10. Vascular
10.1. Hemangioma
10.2. Angiosarcoma
10.3. Kaposi Sarcoma
11. Thyroid
11.1. Follicular Adenoma, Thryoid
11.2. Papillary Carcinoma, Thyroid
11.3. Medullary Carcinoma, Thyroid
11.4. Anaplastic Carcinoma, Thyroid
12. Adrenal Medulla
12.1. Pheochromocytoma
13. Gall Bladder
13.1. Gall bladder carcinoma
14. Eye
14.1. Retinoblastoma
14.2. Metastatic Melanoma to the Eye
15. Pediatric Neoplasia
15.1. leukemia
16. Germ-cell Tumors
16.1. Seminoma
16.1.1. Male germ cell tumors peak at ages 15-43 yrs. Mixtures of two or more histologic patterns are most common. Accounts for 30% of germ cell tumors and has a 90% cure rate. Radiosensitive.
16.2. Non-Seminoma
16.2.1. Embryonal Carcinoma, Testis
16.2.1.1. Testis w/ extensive hemorrhage and necrosis. Tumor cells form tubular, alveolar, papillary, and sheet like patterns. Nuclei are hyperchromatic w/ prominent nucleoli. Mitoses are also common. Pure embryonal carcinoma is very rare and most tumors show other elements such as yolk sac.
16.2.2. Teratoma, Ovary
16.2.3. Serous Cystadenoacarcinoma, Ovary
16.2.4. Yolk Sac (endodermal sinus) tumor
16.2.4.1. make AFP
16.2.5. Choriocarcinoma
16.2.5.1. make hCG
16.2.6. Teratoma, Testis
16.2.7. Mixed germ cell tumor
16.2.7.1. make hCG and AFP
16.2.8. Sex cord stromal tumors
16.2.8.1. Stromal tumor (benign)
16.2.8.2. Leydig cell tumor
16.2.8.3. Sertoli cell tumor
16.2.9. Lymphoma
16.2.9.1. most common cause of testicular mass in males >60 y/o; often bilateral. Usually Diffuse large B-cell type.
17. Bladder
17.1. Papillary Transitional Cell Carcinoma, Urinary Bladder
18. Larynx
18.1. Squamous Cell Carcinoma, Larynx
19. Lung
19.1. Small Cell Carcinoma, Lung
19.2. Non-Small Cell Carcinoma
19.2.1. Metaplasia, Dysplasia, Squamous Cell Carcinoma In Situ
19.2.2. Ewing's Sarcoma Metastasis to Lung
19.2.3. Metastatic Osteosarcoma, Lung
19.2.4. Brochogenic Squamous Cell Carcinoma, Lung
20. Bone
20.1. Benign
20.1.1. Giant cell tumor (osteoclastoma)
20.1.2. Osteochondroma
20.2. Malignant
20.2.1. Chrondrosarcoma
20.2.2. Metastatic Osteosarcoma
20.2.3. Ewing's Sarcoma
20.2.4. Ductal Carcinoma of Breast, metastatic to Femur
21. GI
21.1. Colon
21.1.1. Adenomatous Polyp, Colon
21.1.1.1. General
21.1.1.1.1. Tubular- small and pedunculated; most common polyp (60%). Usually found in the sigmoid colon. Looks like a mushroom, and it has branches of glands.
21.1.1.1.2. Villous- large and sessile more likely to be malignant. Usually found in the rectosigmod area. They secrete protein and potassium rich mucus. This can produce hypoalbuminemia and hypokalemia.
21.1.1.1.3. Cancer risk correlated w/ size, architecture, dysplasia
21.1.1.1.4. Tubulovillous- (20-30% of polyps) usually has a stalk, contains ademomatous and villous change that resembles small bowel vili.
21.1.1.2. Microscopic
21.1.1.2.1. The epithelial surface is focally elevated. Increased glands (adenomatous change). The crowed glands also show nuclear hyperchromicity and decreased mucin.
21.1.1.3. FYI
21.1.1.3.1. Ras gene is the most commonly observed oncogene in adenomas. Adenomas >2cm have a 40% risk for malignancy.
21.1.2. Familial Adenomatous Polyposis (FAP)
21.1.2.1. AD patients develop tubular adenomas and cancer. Polyps develop // 10 and 20 y/o. Caused by inactivation of adenomatous polyposis coli (APC) suppressor gene. Presents w/ malignant transformation // 35 and 40 y/o. All patients will develop colon cancer (100%) therefore, colectomy is recommended prophylactically. Unique: associated with congenital hypertrophy of the retinal pigment epithelium.
21.1.3. Adenocarcinoma, Colon
21.1.3.1. Risk Factors: Age>50y/o, smoking, obesity, heavy alcohol intake, Hereditary polyposis syndromes, HPNCC, Family cancer syndrome, first degree relatives with colon cancer. IBD (ulcerative colitis> Crohn's Disease), low fiber diet, increased saturated fats and reduced vegetable intake.
21.1.3.2. Mutations in APC, K-ras, and P53 (AKP mnemonic). 80% of sporatic cancers. Most commonly found in the rectosigmoid region (50%) of cases; however is found on all other areas of the large bowel. Screen with fecal occult blood test and colonscopy. Can be found on digital rectal exam in some cases.
21.1.3.3. Colonscopy is gold standard- start at age 50 if no risk factors. Every 3-5yrs if history of polyp removal. Begin at age 40 if first degree relative has polyps or colorectal cancer. TMN staging is the most important prognostic factor.
21.1.3.4. Left vs. Right sided Colon Cancer
21.1.3.4.1. Left Side: Tend to obstruct, lesions will have annular napkin ring appearance/ apple core lesion, constipation or diarrhea w/ or w/o bleeding, bright red blood (BRB) coating the stool, Uniquely Strept. Bovis endocarditis.
21.1.3.4.2. Right Side: Tend to bleed, more polypoid in appearance, blood mixed in w/ stool, iron deficiency is more likely than in left sided cancer of the colon.
21.1.4. Gardner's Syndrome
21.1.4.1. AD polyposis syndrome characterized by colon polyps and benign osteomas and desmoid tumors usually in the jaw bone.
21.1.5. Turcot's Syndrome
21.1.5.1. AR polyposis syndrome characterized by colon polyps and the finding of a malignant brain tumor (astrocytoma and medulloblastoma)
21.1.6. Hereditary Nonpolyposis Colorectal Cancer (HNPCC/ Lynch Syndrome)
21.2. Stomach
21.2.1. Adenocarcinoma, Stomach
21.2.1.1. is common in Japan, China, and South American, but rare in US&UK. 5yr survival 10%. Most commonly found on the lesser curvature of the antropyloric region. A variant of gastric carcinoma is Linitis Plastica (Brinton's Disease) w/ a diffuse cancer (leather bottle cancer) that has flattened rugae. Unlike most gastric cancers Linitis Plastica is NOT associated w/ H. Pylori infection; however, it is associated with an E-Cadherin mutation.
21.2.1.2. Histologically, shows normal gastric epithelium w/ area of ulceration surrounding the underlying adenocarcinoma. Tumor is diffuse w/ mucin secreting from the malignant glands causing "signet ring" morphology. These cells penetrate the muscularis propria. However, the morphologic type is not prognostic.
21.2.2. Leiomyoma, Stomach
21.2.3. Primary gastric malignant lymphoma
21.2.4. Metastatic Gastric Adenocarcinoma
21.3. Small Bowel
21.3.1. Carcinoid Tumor
21.3.1.1. most common small bowel malignancy. However, the small bowel is the least common site for primary malignancy in the entire GI tract. (So this tumor does not arise very often.) BRIGHT YELLOW TUMOR
21.3.1.2. Neuroendocrine tumor (salt&pepper chromatin), metastatic potential correlates w/ size and depth. Foregut and Hindgut invade but don't metastasize and midgut does both. Found on the vermiform appendix in most cases (40%). Commonly metastasize to liver at which the patient is then diagnosed w/ Carcinoid Syndrome. Key feature: This tumor produces serotonin and it is delivered to the liver via portal vein.
21.3.1.3. Presents: flushing of skin, diarrhea (>70%), intermittent wheezing and dyspnea, facial telangiectasia, tricuspid regurgitation and pulmonary stenosis (b/c serotonin causes increased collagen production in valves). Dx: increased urine Serotonin, CT scan of liver for mets. Rx:Avoid alcohol, resect the tumor, chemo, and somatostatin analogue.
21.3.2. Gastric Polyps FA12 p358
21.3.2.1. Hyperplastic
21.3.2.2. Juvenile
21.3.2.3. Peutz-Jeghers
21.4. Oral
21.4.1. Squmous Cell Carcinoma, mouth
21.5. Salivary Gland
21.5.1. Pleomorphic Adenoma, salivary gland
21.5.2. Warthin Tumor
21.5.3. Mucoepidermoid carcinoma
21.6. Esophagus
21.6.1. Barrett's Esophagus
21.6.2. Esophageal carcinoma
21.6.3. Squamous cell carcinoma, esophagus
22. Blood
22.1. Hodgkin's Lymphoma
22.2. Non-Hodgkin's Lymphoma
22.2.1. Burkitt's Lymphoma
22.2.2. Diffuse Large B-cell lymphoma
22.2.3. Mantle cell Lymphoma
22.2.4. Follicular lymphoma
22.2.5. neoplasms of mature T-cells
22.2.5.1. Adult T-cell lymphoma
22.2.5.2. Mycosis fungoides/ Sezary syndrome
22.3. Multiple Myeloma
22.4. Monoclonal Gammopathy of Undetermined Significance (MGUS)
22.4.1. monoclonal plasma cell expansion w/o the symptoms of multiple myeloma.
22.5. Leukemias
22.5.1. Lymphoid neoplasms
22.5.1.1. Small Lymphocytic lymphoma (SLL)/ Chronic Lymphocytic Leukemia (CLL)
22.5.1.2. Acute Lymphoblastic leukemia/lymphoma (ALL)
22.5.1.3. Hairy Cell Leukemia
22.5.2. Myeloid
22.5.2.1. Acute Myelogenous Leukemia (AML)
22.5.2.1.1. Acute Promyelocytic Leukemia (M3)
22.5.2.2. Chronic Myelogenous Leukemia (CML)
22.6. Langerhans Cell Histiocytosis (LCH)
23. Female
23.1. Uterus
23.1.1. Leiomyoma, Uterus
23.1.2. Endometrial Carcinoma, Uterus
23.1.3. Endometrial Poylp
23.2. Cervix
23.2.1. Severe Dyslasia, Cervix
23.2.2. Carinoma In Situ, Cervix
23.2.3. Cervical Carcinoma
23.3. Breast
23.3.1. Invasive Ductal Carcinoma, Breast
23.3.2. Infiltrative (Invasive) Lobular Carcinoma, Breast
23.3.3. Metastatic Breast Ductal Adenocarcinoma
23.3.4. Gynecomastia, male breast
23.3.5. Inflammation and Fat Necrosis, Breast
23.3.6. Fibroadenoma
23.3.7. Lobular Carinoma in Situ (LCIS)
23.3.8. [MALE]-breast cancer
23.3.8.1. subareolar mass in older males. High density of breast tissue under the nipple. may produce discharge. Most common histological subtype is invasive ductal carcinoma. Lobular is rare since men have very few lobules. Assoc w/ BRCA2 mutations and Klinefelters syndrome.
23.3.9. Ductal Carcinoma In-Situ
23.3.9.1. Can be treated by recsection unlike LCIS
23.4. Vulva
23.4.1. Condyloma
23.4.2. Vulvar Carcinoma
23.5. Vagina
23.5.1. Clear Cell Adenocarcinoma, vagina
23.5.2. Embryonal Rhabdomyosarcoma, vagina
23.5.3. Vaginal carcinoma
23.6. Ovary
23.6.1. Surface Epithelial Tumor
23.6.2. Endometrioid Tumor
23.6.3. Brenner Tumor