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143 Cards in this Set
- Front
- Back
Most common primary tumor of respiratory system?
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Bronchogenic cancer
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Most common tumors that metastasize to lungs?
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- Sarcomas (osteo-)
- Colon - Prostate - Wilm's - Bladder - Breast - Kidney - Neuroblastoma |
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List the most typical benign tumors of upper respiratory tract?
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- Single or multiple papillomas
- Hemangiomas = Nosebleeds - Angiofibroma (in childhood - regress) |
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Most typical malignant tumors of upper respiratory tract?
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- Bronchioalveolar cancer
- Bronchial carcinoid - Hamarthomas - Tumors of nasopharynx - Tumors of larynx |
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What is bronchioalveolar cancer?
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Adenocarcinoma of columnar mucosal producing cells, without any destruction of alveolar walls, but patient cough up a lot of mucus
President Havel had this condition, good prognosis:) |
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What is carcinoid?
Where do they arise? How are they classified? What syndrome may they produce? |
Malignant tumor composed of neuroendocrine cells.
The carcinoids can arise in both respiratory tract and GI tract. They are divided into: 1. Typical carcinoids = low grade 2. Atypical carcinoids = intermediate grade (higher mitotic rate) May produce carcinoid syndrome and sometimes they are part of MENS |
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What is bronchial carcinoid?
How is the growth patterns? |
A bronchial carcinoid of so-called Kulchitsko neuroendocrine cells
Grow either as: 1. Obstructing polypoid of bronchial lumen 2. A mucosal plaque penetrating bronchial wall out in the peribronchial tissue = Collar-button lesion |
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What is the spectrum of increasing agressivity of neuroendocrine tumors of lung - measured in survival over 10 years?
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1. Typical carcinoids - 85%
2. Atypical carcinoids - 50% 3. SCLC - 5%! |
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What is the location of the most typical hamarthoma in the body?
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Lung
Liver bile ducts |
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What is a hamarthoma?
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A mass of disorganized tissue, native to that place. It is often seen as the middle point between developmental malformation and a neoplasm
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Characteristics of a lung hamarthoma?
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It is a nodule composed of islands of cartilage, bronchial epithelium and blood vessels
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What are the most common laryngeal tumors?
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1. Vocal cord nodules
2. Papillomas 3. Squamous cell neoplasms |
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Tell me about the laryngeal vocal cord nodules?
What are they? What are they composed of? What are they associated with? How are they discovered? Where are typical locations? |
They are smooth protrusions, usually arising on the vocal cords.
Composed of fibrous tissue, covered by stratified squamous mucosa, often ulcerated due to mechanical trauma of the other vocal cord Associated with heavy smokers or singers (thus Singer's nodes) - suggesting chronic irritation (edema) Discovered by hoarseness Locations are commonest on true vocal cords |
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Tell me about laryngeal papillomas? :)
What are they and what are their composition? What is the difference between adult and children? |
They are benign finger-like neoplasms usually growing on true vocal cords
Composed of supporting fibrovascular core, with usually stratified squamous epithelium - which may ulcerate and cause hemoptysis Adults - Usually solitary Children - Often multiple, due to RRP (recurrent respiratory papillomatosis), caused by HPV 6 and 11. But now with vaccination of mother things are better |
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Laryngeal carcinoma
- What type is most common? - Where do they grow? - What are they associated with? - Any gender predominate? - What age? - How is their grading? - How discovered? |
1. Squamous cell carcinoma, often keratinizing, is the most common (95%) - less common is the adenocarcinoma
2. They most commonly grow on the true vocal cords (glottic) - where they are early discovered, but may grow supraglottic and subglottic where there are much worse prognosis since they are not discovered 3. Associated with Smoking, alcohol and asbestos exposure 4. Logically, men predominate quite lot - and usually it arises not before age of 40y. 5. Grading is usually quite nice, well differentiated squamous cell carcinomas - although all grades may be seen 6. Discovered by hoarseness. |
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What is the definition of lung cancer?
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Carcinoma of the bronchus (bronchogenic carcinoma)
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What are the symptoms of bronchogenic carcinoma?
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Cough, hemoptysis, chest pain
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What are the 4 types of lung cancer according to histological picture? Also add the frequency in %
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1. Adenocarcinoma (40%)
2. Squamous cell carcinoma (30%) 3. Large cell carcinoma (10%) (these are NSCLC) And then 4. Small cell lung cancer (SCLC) / Oat carcinoma |
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Why is it important to distinguish between NSCLC and SCLC?
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Since SCLC is treated by chemotherapy, and has worse prognosis
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How does carcinomas of lung usually begin?
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1. Small mucosal grey lesions
2. Grow as intraluminal masses - invade bronchial mucosa 3. May undergo central necrosis and cavitation if it grows too fast |
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Location and pathogenesis of squamous cell carcinoma of lungs?
What is usually the risk factor? |
Location
- Usually centrally in major bronchi Pathogenesis 1. Squamous metaplasia or dysplasia of bronchial epithelium 2. Carcinoma in situ - may last for years 3. Slowly growing and invading local tissues Risk factor is smoking |
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Location and pathogenesis of adenocarcinoma?
What are the different types? What people is it more common in? What is the most typical growth pattern? |
Location
- More peripherally of the lung, often related with scarring Pathogenesis - Grow slowly as smaller masses, metastasize in early stage! Types of adenocarcinomas - Acinar (gland forming) - Papillary - Mucinous - Solid types (intracellular mucin production) More common in females and non-smokers! Growth pattern - Growing along the alveolar walls - called 'Lepidic' - sticking to alveoli - like butterflies sitting on a fence :) |
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What is thought to be the precursor of adenocarcinoma?
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Atypical adenomatous hyperplasia (AAH) - which progress to adenocarcinoma in situ (AIS)
(Formerly known as bronchioloalveolar adenocarcinoma) |
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What is AIS of lung and what is the key features?
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AIS = adenocarcinoma in situ
Key features - 3cm or less diameter - Growth along pre-existing structures - Preservation of alveolar architecture |
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What is large cell carcinoma of lung?
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Most likely a extremely poorly differentiated squamous cell or adenocarcinoma.
Otherwise, large cells, large nuclei, prominent nucleoli and quite a lot of cytoplasm |
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If the lung tumor obstruct the bronchial lumen - what may occur?
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1. Collapse as a atelectasis
2. Consolidation with retention pneumonia |
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What is small cell lung carcinoma? (SCLC) What is it associated with?
What cell does it consist of? How do they look? Where is typical location? How is it's growth, agressiveness and metastasis? |
It is a carcinoid tumor of late stage, often associated with smoking
Made of neuroendocrine cells, which may or may not have a hormonal production They look like oats, about 2x the size of resting lymphocytes. Hyperchromatic. Grow centrally of lungs (close to bronchi) Grow very agressively, and metastasize quickly. This may often be first symptom: Metastasis to brain. |
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5 ways of local spreading of lung cancers?
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1. Central tumors often invade surrounding lung parenchyma or vessels
2. Peripheral often involve the pleura 3. Hilar lymph nodes are involved, sometime mediastinal 4. Spread to pericardium 5. May compress or involve nerve plexuses in apical tumors |
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Invasion of large blood vessels may lead to?
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Hemoptysis - severe hemorrhage
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Pleural involvement may lead to?
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Hemorrhagic effusion
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Pericardial involvement may lead to?
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Pericardial effusion - and eventually involvement of myocardium
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What is a Pancoast tumor - and what is it's typical manifestations?
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A apical tumor of lung - which involve structures of head and neck - leading to pancoast syndrome
Often destroy 1-2nd ribs It usually involves - Brachial plexus --> Sensory and motor symptoms - Cervical sympathetic chain --> Horney's syndrome |
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What is Horner's syndrome?
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A triad of:
1. Ptosis of eyelid 2. Miosis of eye 3. Ipsilateral enophtalmos 4. Anhydrosis |
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What happens if lung cancer spread to mediastinum?
Name 3 diseases (1 compression and 2 nerves) |
May grow and compress structures like:
- SVC => SVC syndrome - Recurrent laryngal => Vocal cord paralysis - Phrenic => Diaphragmatic paralysis |
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What ways may the lung cancer metastasize, most commonly?
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1. Hematogenous via invasion of pulmonary veins
- Liver - Bone - Brain - Adrenal 2. Lymphatic - Cervical nodes, and typically Virchow's node |
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It is typical that lung cancer (SCLC) is paraneoplastic. Which hormones or hormone-like substances are most common?
And what do each of them lead to? |
1. ACTH
- Adrenal hyperplasia --> Increased cortisol --> Cushing 2. ADH (SIADH) - Retention of water --> Dilutional hypernatremia 3. PTHrP - Hypercalcemia (parathyroidhormone related peptide) 4. Serotonin (carcinoid) |
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What are the 5 developmental stages of lung tumors and their characteristics?
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I - Small tumor with no node
II - Lymph node and pleural III - Parietal pleura + ipsialteral node IV - Mediastinal organs V - SVC syndrome |
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Tell me about malignant mesothelioma?
Risk factors Symptoms |
It's a malignant tumor of pleura
Almost always after some asbestos exposure, it might be only a brief one, and may be latent for 40y without symptoms The symptoms are dyspnea, chest pain etc... |
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Mesothelioma
- Grossly? How does it spread? - Histological? (3 growth patterns) |
Grossly
- Begin localized, and spread by continuous growth or seeding - Lung may be covered by this yellow, gelatinous tumor that obliterate pleural space Histology = biphasic, so: - Give rise to pleural lining cells + underlying CT! So it can form 3 patterns: 1. Epithelial with cuboidal cells 2. Sarcomatous with spindle cells 3. Biphasic (both) |
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Most common benign tumor of oral cavity?
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Squamous cell papilloma - although I guess most other mesenchymal and epithelial tumors may arise
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What are the precancerous lesions of oral cavity?
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- Leukoplakia
- Erythroplakia - Oral submucosal fibrosis - Actinic cheilitis |
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What is leukoplakia?
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Epithelial thickening + hyperkeratosis (thickening of stratum corneum, the outermost layer of epidermis)
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How is the leukoplakia in EBV infection?
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Progressive verrucous leukoplakia (warty lesions)
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How is leukoplakia in immunosuppresion?
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Oral hairy leukoplakia
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What is erythroplakia?
What is it associated with? |
Atrophy and dysplasia of tounge
Associated with - Smoking - Candidiasis |
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What is oral submucosal fibrosis?
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A complex irreversible precancerous condition with inflammation, and the inflammatory process leads to progressive fibrosis of the submucosal tissues - leading to rigid jaws and eventually unable to open mouth!
Associated with tobacco chewing and several types of nuts :P |
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What is actinic cheilitis?
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Similar to solar keratosis of skin
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Squamous cell papilloma of oral cavity - is highly associated with HPV virus.
Tell me about it: - Grossly - Koilocytes? - Low or high risk variants? - Differential diagnosis from? |
Very common benign tumor of oral cavity, with HPV etiology
Grow like cauli-flower projections, with some hyperkeratosis There are NO koilocytic changes, and might be misdiagnosed for condyloma acuminatum (!) - but this HPV virus is a low risk variant, so it stays benign |
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What are the typical locations of squamous cell carcinoma of oral cavity?
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1. Base of cavity
2. Lower lip 3. Base / lateral of tounge 4. Soft palate |
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What precancerous lesion may lead to lower lip sq. cell carcinoma?
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Actinic cheilitis
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What is problematic with squamous cell carcinoma of tounge?
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Very bad prognosis, it metastasizes in the deep head and neck lymph nodes!
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What is problematic with tonsillar squamous cell carcinoma?
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It consume the whole tonsil, and spread metastaticaly to cervical LN, since tonsil is full of lymphatic vessels
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Risk factors of oral squamous cell carcinoma?
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Alcohol
Tobacco UV light (lower lip) HPV 16 |
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HPV 16 is specific for what oral squamous cell carcinoma?
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Waldeyer's tonsillar ring carcinoma
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Name 4 special types of oral squamous cell carcinomas?
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1. Verrucous carcioma = Ackermans tumor
2. Keratoxanthoma 3. Basal cell carcinoma (both cutaneous) 4. Small cell carcinoma (neuroendocrine) |
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What is the primary etiological factor of nasopharyngeal carcinoma?
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EBC
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3 types of nasopharyngeal carcinoma?
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1. Squamous cell carcinoma
2. Keratinizing carcinoma 3. Lymphoepithelial carcinoma All may be well or poorly differentiated |
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Name 2 benign mesenchymal tumors and pseudotumors of nasopharynx?
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1. Epulides
2. Granular cell tumor |
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What are epulides?
Nb! It lays in the word…. 3 types! |
Epulides = "in the gingiva"
It is benign tumors of the oral gingiva. The types: 1. Fibrous epulis 2. Giant cell epulis 3. Granuloma fissuratum |
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What is granuloma fissuratum?
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A benign proliferative lesion of oral gingiva due to a poorly fitting tooth
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Name all the benign tumors of nasopharynx?
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- Epulides
- Granular cell tumors - Angiofibroma - Pyogenic granuloma |
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What is a angiofibroma, in who do it occur and how may a angiofibroma lead to death?
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A tumor composed of vessels of connective tissue
Only occur in men Arise form nasopharynx 1. Destroy surrounding tissue 2. Perforate base of skull 3. Spread to meninges 4. Meningitis & death |
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What is a pyogenic granuloma?
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A vascular lesion, protruding with a botryoid shape, typically on the gums or skin.
Associated with irritation, trauma or hormonal factors like in pregnancy |
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What is granular cell tumor?
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A benign proliferation of cells most likely from Schwann cell or nerve sheath origin - it can arise anywhere on or in the body
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What are the most common malignant mesenchymal tumors of nasopharynx?
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1. Myofibroblastic sarcoma of tounge
2. Rhabdomyosarcoma 3. Kaposi sarcoma in HIV 4. Angiosarcoma 5. Liposarcoma |
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What is a myofibroblast?
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A cell which is between fibroblast and myocyte in it's differentiation
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What are the 2 pseudotumors of salivary glands called?
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1. Mucocele
2. Ranula |
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What is an oral mucocele?
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A benign cyst, caused by a swelling of connective tissue filled with mucus, due to a rupture of a salivary gland duct - usually due to local trauma
If the duct is obstructed, we call it a 'mucus retention cyst' |
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What is a ranula?
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It is a type of mucocele - just of the oral cavity - due to a rupture of salivary gland duct
Confined to the floor of oral cavity Although Dr. Kamaradova said it was a cyst of thyreoglossus duct remnant. |
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What are the cells of salivary glands - and what does that mean for tumor development?
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1. Acinar cells
2. Ducts - Intercalated cells - Striated cells 3. Myoepithelial cells 4. Precursor cells => Therefore there is extremely many types of salivary tumors!! |
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What are the most common benign tumors of salivary glands?
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1. Pleomorphic adenoma
2. Warthin tumor 3. Myoepithelioma 4. Canalicular and basal cell adenoma |
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Ok… But what is the most common salivary gland tumor?
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Pleomorphic adenoma - and hence the name - there are many different ways it may look
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What is pleomorphic adenoma?
Which cell is the precursor? What is a satellite? Are they dangerous? |
A benign tumor, also called 'myxochondroepithelioma' with proliferation of glandular cells and myoepithelial cells - and a common precursor cell!
A satellite, I think, is also a pleomorphic adenoma, but they are found at location outside the salivary gland itself. But they are not an invasion. Only satellites. |
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Why is a pleomorphic tumor also called myxochondroepithelioma?
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Since it has different types of cells like:
- Epithelium - Myxoid CT - Islands of chondroid (resembling cartilage) |
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What is a Warthin's tumor?
How may it grow? |
A adenolymphoma, a entirely benign growth of lymhpoid tissue, without malignant potential
May grow: - Cystic - Papillary |
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What is a canalicular adenoma?
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A benign tumor of salivary glands, commonly of upper lip, in older people
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What is a basal cell adenoma?
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A benign tumor of salivary glands, looking like pleomorphic adenoma, but more closely they resemble 'basaloid' cells - cells resembling the basal layer of epidermis
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What are the 3 most common malignant salivary gland tumors?
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1. Acinar cell carcinoma
2. Adenoid cyst carcinoma 3. Mucoepidermoid carcinoma |
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Tell me about acinar cell carcinoma of salivary glands?
What is morphology? How do we know that they're acinar cells? Does it metastasize? |
1. Has morphology of acinar cells
2. Zymogenic granules are PAS positive 3. Metastasize to lymphnodes or hematogenous (bad prognosis) |
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What is PAS?
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Periodic acid schiff stain
Method used to detect polysaccharides like glycogen, GAG's, glycoproteins, glycolipids etc... |
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Tell me about mucoepidermoid carcioma? :D
Which glands is most typical? What 3 types of cells is there? |
Occurs in large salivary glands
Cells are - Mucus secreting cells - Squamous cells - Intermediate cells Good prognosis for low grade, bad prognosis for high grade May occur at more sites, like lacrimal glands |
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Tell me about adenoid cystic carcinoma?
What is it also called? What is it composed of? |
Rare type of cancer, at many sites like breast, lungs, lacrimal glands, but often in salivary glands
Also called cylindroma Composed of - Ductal cells - Modified myoepithelium |
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What are the most common (but extremely uncommon) benign tumors of esophagus?
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- Leiomyoma
- Hemangioma - Squamous cell papilloma - Granular cell tumors (scwhannoma) |
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What are the 2 most common malignant tumors of esophagus? With %
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Squamous cell carcinoma - 90%
Adenocarcinoma - 10% |
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Risk factors for squamous cell carcinoma?
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Male
Smoking Alcohol Bad diet, low fibers |
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Risk factors for adenocarcinoma?
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GERD
Tobacco Obesity |
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Complications of esophageal squamous cell carcinoma?
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Achalasia
Chronic esophagitis (not BE!) |
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3 growth patterns of squamous cell carcinoma of esophagus?
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1. Polypoid
2. Ulcerating 3. Infiltrative |
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How is microscopy of squamous cell carcinoma of esophagus?
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Poorly differentiated, grade 1-3
Sometimes keratinized |
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Staging of sq.cell ca of esophagus?
T1 T2 T3 T4 Tell how deep in mucosa it goes on each |
T1 - submucosa
T2 - Adventitia T3 - Subserosa (outside esophagus) T4 - Infiltration of other structures |
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Prognosis of esophageal cancers:
1. Squamous cell carcinoma 2. Adenocarcinoma |
1. 35% 5y, but only 5% with metastasis
2. 20% 5y |
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What is the most common underlying cause of adenocarcinoma of esophagus?
What is it? How does it develop? What is risk of adenocarcinoma with this? |
Barretts esophagus
A interchange of squamous epithelium by functional columnar epithelium with goblet cells: So intestinal metaplasia - and its a 40 times higher risk of adenocarcinoma Develops in 5 stages: 1. Erosions 3. Erosinos + leukoplakia 5. Barretts esophagus with intestinal metaplasia |
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What are the most common benign tumors of stomach?
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Polyps:
- Hyperplastic polyp - Fundic gland polyp - Adenomatous polyps - Hamartomatous polyp |
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What is a hyperplastic polyp?
How do you distinguish it from intestinal polyp? |
Small nice polyp, 1 cm, with an inflammatory origin
Distinguish it from colonic, since colonic are serrated lesions |
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What is a fundic polyp, where does it grow and what is it associated with?
What is usually the genetic mutation here? |
A polyp growing from oxyntic glands (the parietal cells = oxyntic cells) - which produce HCl.
It is associated with PPI treatment, Zollinger-Ellison syndrome and H.pylori infection So likely it origins from increased gastrin secretion - but they are luckily benign Genetic mutation - In gene coding for E-cadherin |
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Where do we find oxyntic / parietal cells in stomach?
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Body and fundus
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What are adenomatous polyps?
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Normal adenomas - with some malignant potential if they undergo dysplasia
May be areas of intestinal metaplasia |
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What are the 3 most common malignant tumors of stomach?
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1. Gastric adenocarcinoma (more or less all)
2. GIST 3. Lymphomas - B-cell MALT type - associated with H.Pylori (can regress with eradication of HP!) 4. Leiomyosarcoma (rare) |
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What are the most important risk factors for gastric adenocarcinoma?
Malignant neoplasm of the glandular epithelial cells |
1. Dietary - spicy foods - japan - wasabi
2. Genetic factors - FAP patients have APC mutation (HPCC) - so increased risk of intestinal type gastric cancer - Blood group A |
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What diseases are predisposing for gastric adenocarcinoma?
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1. Adenomatous polyp
2. HP gastritis 3. Chronic atrophic gastritis 4. Intestinal metaplasia 5. Duodenal reflux 6. Post gastrectomy |
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1. What are the most typical growth patterns for gastric adenocarcinoma and where are they located?
2. What are the 2 types of histologies? 3. Where does gastric adenocarcenoma spread to? |
1.
- Exophytic - fundus - Ulcerative - antrum (rolled edged ulcers, biopsy of rolled edge!) - Diffuse - entire gastric wall is thickened => Linitis plastica 2. - Intestinal, where malignant cells are arranged in acini through muscle of stomach wall! - Diffuse - typical in linitis plastica - where they have signet rings (globules of mucin push nucleus to side) 3. Virchow's supraclavicular lymph node |
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What is Krukenberg tumor?
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Gastric adenocarcinoma metastasis to ovaries
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What is the most common mesenchymal tumor of stomach?
Tell me about it :D |
GIST - gastrointestinal stromal tumor
Origins form the pacemaker cells of the stomach, called Interstitial cells of Cajal Grows like solitary well circumscribed mass, submucosally - with spindle shaped cells Cause hemorrhage |
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What are the most typical neoplasms of small intestine?
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1. Mesenchymal sarcomas
2. Lymphomas and MALTomas 3. Neuroendocrine carcinoids 4. Carcinomas = extremely rare |
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What are the most common benign mesenchymal tumors of small intestine?
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- Lipoma
- Leiomyoma - Schwannoma - Lymphangioma - GIST - MALTomas |
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Most common malignant mesenchymal tumors of small intestine?
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- Leiomyosarcoma
- Lymphomas - Kaposi sarcoma |
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What are the most common lymphomas of GIT? Nb! Non-hodgkin lymphomas
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1. MALT lymphoma
2. Diffuse large B-cell lymphoma |
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What is the neuroendocrine carcinoid tumors of GIT?
Where is most commonly located? What do they produce? How do they look in LM? |
They are tumors of enteroendocrine cells, called Kulchitski tumor
Located mostly in appendix Producing serotonin, leading to carcinoid syndrome LM: Pale regular cells... |
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What is carcinoid syndrome?
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Hyperseretoninemia
1. Bronchiconstriction 2. Flush of face 3. GIT hypermobility --> Diarrhea 4. Endocardial fibrosis of right heart - valvular lesions Nb! Occurs only in high grade carcinoid! Low grade carcinoid - serotonin is sufficiently broken down by liver |
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What are the most common benign tumors of appendix?
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1. Hyperplastic polyp
2. Sessile serrated lesions / adenomas |
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Most common intermediate tumors of appendix?
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1. Neuroendocrine carcinoids
2. Mucocele of appendix |
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What is mucocele of appendix?
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A appendix filled of mucin, most likely due to
1. Obstructed appendix full of mucin 2. Mucinous cystadenoma or mucinous cystadenocarcinoma |
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What is pseudomyxoma peritonei - in association with mucocele of appendix?
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If it ruptures, like in mucinous cystadenocarcinoma (or adenoma) - it lead to intraperitoneal seeding whole abdomen is filled with semi-solid mucin
|
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What is linitis plastica?
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It is the diffuse gastric adenocarcinoma, which undergo so-called desmoplastic changes
So it leads to a hardening of the gastric wall, feeling like thick pargement |
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What are the most common malignant tumors of appendix?
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Adenocarcinomas
Mucinous cystadenocarcinomas |
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What is the main classification of colonic polyps?
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1. Non-neoplastic
2. Neoplastic |
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What are the types of non-neoplastic polyps and their syndromes?
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1. Juvenile polyps = Juvenile polyposis syndrome
2. Peutz-Jegher polyp = Peutz-Jeghers syndrome 3. Hyperplastic polyps 4. Inflammatory polyps |
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What is a juvenile polyp? How does it look?
Risk of malignancy? What is a inflammatory polyp? |
Juvenile polyp:
A hamartoma A globular protursion of rectal mucosa, may be ulcerated and inflamed With a small risk of malignancy Inflammatory polyp: Polyps arising in inflammatory bowel diseases, like ulcerative colitis and Chron's disease |
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1. What is a Peutz-Jegher polyp? How does it look?
2. What is a hyperplastic polyp? How does it look? |
1. Peutz-Jegher polyp:
A hamartoma, but more branches like a tree with also branching smooth muscle from muscularis mucoisae 2. Hyperplastic polyp: A small sessile nodule, which do not become malignant. They may look very similar to serrated adenomas - which have malignant potential like all other adenomas |
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How do we morphologically divide neoplastic polyps?
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1. Conventional adenomas (low & high grade)
2. Serrated lesions |
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Which are the serrated lesions?
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Can be just a hyperplastic polyp (benign) or sessile serrated adenoma
|
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What are the 4 types of polyp shapes?
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1. Tubular
2. Tubulovillous 3. Villous (like small intestine) 4. Sessile / serrated |
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What are the most important polyposis syndromes?
|
1. FAP (familial adenomatous polyposis)
2. Gardner syndroem 3. Peutz-Jegher syndrome 4. Serrated polyposis (?) |
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Which gene is mutated in FAP and gardner syndrome?
What is the risk of adenocarcinoma with this mutation? |
APC gene - increase the chance of developing polyps - it's a tumor suppressor gene
|
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Gardner syndrome is also called?
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Familial colorectal polyposis (FCP)
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Gardner syndrome is characterized by multiple polyps in colo-rectum. But it also increases risk of what extracolonic neoplasms?
|
1. Osteomas of skull
2. Thyroid carcinoma 3. Desmoid tumors (like in NF) |
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What is a desmoid tumor?
|
Benign, slow-growing musculoaponeurotic tumors (Desmoid = tendon-like in greek) - without malignant potential.
However, in agressive neurofibromatosis, they can be locally agressive. Most cases sporadic, but some are associated with FAP, gardner syndrome and agressive neurofibromatosis |
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What extracolonic events is likely to occur in Peutz-Jegher syndrome?
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1. Perioral hyperpigmentation
2. Extraintestinal malignant tumors of e.g. pancreas |
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What are the most common malignant tumor of colon?
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Colonic carcinoma -
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How is the difference in colon carcinomas in right and left colon? And how is it connected to size of bowel and time of detection?
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Right (ascending colon and caecum)
- Polypoid carcinoma - Very small which are very difficult to discover (And hard to get to with colonoscope) - The lumen is wide + liquid feces, so there is no obstruction and symptoms do not present before it's often too late Left (descending and sigmoid) - Stenosing carcinoma - So it quickly obstructs + feces is more solid - More quicker symptoms |
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What are the typical symptoms of right colon carcinoma?
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1. Blood loss & anemia
2. Abdominal mass 3. Liver metastases Due to reasons mentioned above |
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What are the typical signs of left colon carcinoma?
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They are obstructing, so changed bowel movements, obstructions and rectal bleedings
|
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What chromosome does the APC gene lie on?
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Chromosome 5
|
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So what are the 5 types of colorectal carcinoma - how they may look?
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1. Exophytic (polypoid)
2. Ulcerating 3. Obstructing 4. Infiltrative 5. Stenosing Or combinations! |
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How do the colorectal carcinoma usually look in LM?
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More or less always a adenocarcinoma
|
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In staging - what is T4 characteristics?
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Infiltration of bowel wall. In pedunculated polyps - the stalk is always infiltrated first!
|
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What is lynch syndrome? What is it also called?
What other cancers are you in increased risk of? What is the underlying cause of this increased risk? |
Also called hereditary non-polypose colorectal cancer (HNPCC) - a autosomal dominant condition where you have increased risk of colon cancer!
A cancer without polyps! Other cancers: - Endometrial (these 2 are most common) - Stomach, ovary, bladder etc.. (Less common) Cause - Mutation in MMR (mismatch repair genes) |
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What is the 'Amsterdam criteria'?
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Diagnostic criteria to identify families with higher chance of Lynch syndrome
1. 3 or more 1st degree relative with colorectal cancer (with FAP excluded) 2. Over 2 successive generations 3. At least one of them before 50 years |
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What are the most typical mesenchymal tumors of large bowel?
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- Leiomyoma
- Schwannoma - GIST - Kaposi sarcoma |
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What are the 2 most common GIT lymphomas occurring?
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B-cell/T-cell non-HD lymphomas:
1. MALT lymphoma 2. DLBCL |
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What is Troisier's sign?
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Spread of gastric adenocarcinoma to Virchow's supraclavicular lymph node
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Most typical sites of spread of gastric adenocarcinoma?
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1. Lymphatics to Virchow's
2. Hematogenous to liver 3. Transcoelomic to ovaries (Krukenberg) 3. Late to lungs |
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Which blood group is familial more common with gastric carcinoma?
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Blood group A
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