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250 Cards in this Set
- Front
- Back
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What are the most common CNS neoplasms?
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Secondary metastases :) Got'ya!!
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Even benign tumors in brain may have fatal consequences - how?
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E.g. meningeoma - may compress vital brain centers and lead to death
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Every brain tumor have a consequence in common - what is it?
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1. Intracranial hypertension via:
- The mass effect - Obstruct CSF pathways |
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Even most malignant CNS tumors - where do they metastasize?
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Only within CNS pathways (CSF)
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Most common adult CNS tumors?
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- Glioblastoma
- Meningioma - Metastases |
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Most common children CNS tumors?
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Pilocystic astrocytoma
Pineoblastoma Medulloblastomas |
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Which cells in brain do usually become neoplastic?
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Usually glial cells - neurons are stable cells
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Somewhat a classification of CNS tumors?
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- Diffuse astrocytomas
- Oligdendroglioma - Ependymoma - Choroid plexus papilloma - Pineal neoplasms - Embryonal neoplasms - Meningeal neoplasms - Melanocytic lesions - Metastatic tumors |
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What is the spectrum of diffuse astrocytomas?
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From low grade astrocytoma to glioblastoma:
1. Low grade diffuse astrocytoma (II) 2. Anaplastic astrocytoma (II--> III) 3. Glioblastoma (IV) x. Pilocystic astrocytoma (different) |
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General negative characteristics of astrocytomas?
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1. Infiltrative, so hard to resect
2. Bad response to chemotherapy |
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According to what mnemonic do we grade the diffuse astrocytomas?
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According to AMEN:
A - nuclear atypia M - mitoses E - endothelial proliferation N - necrosis |
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Astrocytoma with only nuclear atypia is what?
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Low grade diffuse astrocytoma
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Astrocytoma with A & mitoses is?
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Anaplastic astrocytoma
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Astrocytoma with A, M and endothelial proliferation is?
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Glioblastoma IV
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How does a glioblastoma develop?
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From the bottom of the specter, develop according to the AMEN criteria
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Young adult with poorly demarcated tumor in subcortical white matter of cerebral hemisphere.
He has seizures and intracranial hypertension. LM show well differentiated fibrillary astrocytes with hyperchromatic nuclei, but no mitosis. What does he have? What is expected survival? |
He has a low grade diffuse astrocytoma.
Expected survival is 7-12 years |
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How is LM of low grade diffuse astrocytomas?
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- Astrocytes are well differentiated
- They have some nuclear atypia (e.g. hyperchromatic) - There is NO mitoses - There is a fibrillary background - so cytoplasm not visible |
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What is a special variant of low grade diffuse astrocytoma?
How does it look? |
Gemistocyte variant - with eccentrically placed nucleus and LOTS of cytoplasm
(they are reactive astrocytes to some acute injury - swollen. They decrease in size after some time) |
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Same guy comes in some years later, when he is 45 years old. Now LM shows higher cellularity - with not only atypia (A) but also mitoses (M).
What does he have? What is expected living time? |
Anaplastic astrocytoma
2-4 years |
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The patient refused treatment, and came back 4 years later. Now he had for 3 months suffered from
- Intracranial hypertension - Mental changes & seizures MRI showed - Large mass with central necrosis in left hemisphere - Peripheral rim of living tumor tissue - Ring enhancement on MRI What does he now have? What is expected survival time, even with treatment? |
All his AMEN criterias fulfilled. He better start praying, since he has glioblastoma.
Median survival is 12 months - and only 5% live 5 years. |
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How does glioblastomas arise?
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Either:
- De novo - Secondary from the 2 latter |
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If the glioblastoma infiltrates corpus callosum into contralateral hemisphere - what is it called?
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Butterfly glioma
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The doctors took a biopsy of the glioblastoma. How did it look in LM?
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- Hypercellular
- Nuclear atypia (A - hyperchromatic) - Coagulative necrosis, with pseudopallicading neoplastic cells - Endothelial hyperplasia (AMEN!) |
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What are the 2 forms of endothelial proliferations we can see in glioblastoma?
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1. Glomeroid masses of small vessels
2. Intraendothelial proliferations (more typical) |
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What is the most benign tumor of the astrocytomas - and why is it not classified in the specter of the others?
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Pilocystic astrocytoma - and not among the others since it's completely different! - Grade I
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Typical age group of development of pilocystic astrocytoma?
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Children and young adults
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Most common locations of pilocystic astrocytoma?
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Cerebellum
Optic nerve Brainstem |
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Clinical signs and prognosis of pilocystic astrocytoma?
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1. Slowly increased intracranial hypertension
2. Cerebellar and focal neurological deficits --> Good prognosis! |
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Morphology of pilocystic astrocytoma?
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Cystic and circumscribed (benign)
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What is the LM morphological pattern of pilocystic astrocytoma?
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Biphasic:
1. Compact areas 2. Loose areas |
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What are the compact areas in pilocystic astrocytoma - and what are those special fibers called?
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They are aggregation of proteins in astrocytic structures - and called Rosenthal fibers.
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Is rosenthal fibers specific for pilocystic astrocytoma?
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No - it just means aggregatinon of these proteins - it might as well occur in reactive lesions like gliosis (response to damage of CNS)
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What are the loose areas in pilocystic astrocytoma?
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Also aggregates of proteins - but of astrocytes with a few proceses. They are also called eosinophilic granular bodies
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So what are the 2 maybe diagnostic findings in pilocystic astrocytoma?
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1. Rosenthal fibers
2. Eosinophilic granular bodies |
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What is a oligodendroglioma?
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It is a low grade tumor (II / AM) of cells resembling oligodendrocytes (glial cells producing CNS myelin)
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Typical age, location, clinical signs and prognosis of oligodendroglioma?
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45 years
Cerebral hemispheres Seizures (cortical involvement) & ICHt Better prognosis than low grade astrocytoma |
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LM morphology of oligodendroglioma?
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- Infiltrative monomorphic cells with uniform round darker nuclei, with a perinuclear halo (fixation)
- Plexiform capillary network (chicken wire) |
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What is it called when oligodendroglioma infiltrate cerebral cortex?
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Perineuronal satellitosis (neoplastic cells surround glial cells in a satellite fashion)
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What is the signature of oligodendroglioma?
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Deletion of arms of chromsome:
1q (short) 19p (long) |
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What is ependymoma?
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A tumor of ependymal cells arising around brain ventricles or around spinal cord
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Age, clinical signs and prognosis of ependymoma?
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Any age
Clinical - Hydrocephalus - ICH Prognosis 50% 5 y - good |
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Gross morphology of ependymoma?
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Well circumscribed growing into ventricular lumen
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LM morphology of ependymoma?
What is the hallmark? |
Normal cellularity
Monomorphic nuclei Hallmark - Perivascular pseudo-rosettes - True ependymoma rosettes with central lumina |
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What are perivascular pseudorosettes?
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Ependymoma cells growing around vessels - and called pseudo since central part of rosette is not part of tumor
NB! See them in other tumors too |
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What is a true ependymomal rosette?
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They are ependymal cells surrounding a small empty lumen - thought to be the cells trying to create a new ventricle.
NB! They are specific to tumor, but not very sensitive - since they are rarely found. |
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What are 2 subtypes of ependymoma?
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1. Myxopapillary ependymoma (I)
2. Sybependymoma (II) |
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Special about myxopapillary ependymoma?
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Grow exclusively in the end of SC:
- Conus medullaris - Cauda equina - Filum terminale Composed of long cells in myxoid core |
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Special about subependymoma?
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Just a benign tumor growing slowly in the wall of the lateral ventricles - usually incidental finding
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2 types of choroid plexus tumors?
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1. Choroid plexus papilloma (I)
2. Choroid plexus carcinoma (III) |
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Tell me about choroid plexus papilloma?
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Benign tumor looking like normal choroid plexus growing as a cauliflower mass intraventricularly
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How does normal choroid plexus look then? :)
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Monolayer of cuboidal cells covering a fibrovascular cores
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What is the typical consequence of choroid plexus papilloma?
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Obstruction of CSF pathways - so ICH and hydrocephalus
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Tell me about choroid plexus carcinoma - how does it differ from papilloma counterpart?
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- Mitoses
- Hypercellularity - Not papillary pattern anymore - just solid sheaths - Areas of necrosis - Invasion of adjacent brain tissue |
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Prognosis of choroid plexus carcinoma?
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Moderate - 40% 5 years
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Can neurons be neoplastic?
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Maybe not differentiated neurons - but there are definitely neuron-looking tumors (from primitive cells)
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What are the neuronal and glioneuronal neoplasms?
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1. Ganglioneuroma (only neurons)
2. Ganglioglioma (neurons + glial cells) 3. Central neurocytoma (primitive neurons) |
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LM of ganglioneuroma and ganglioglioma?
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- Well differentiated multipolar neurons with dysplastic features
- Glial component resemble pilocystic astrocytoma or oligodendroglioma - Calcifications & perivascular lymphocytes |
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From which cells do the neuronal tumors arise from?
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Most likely from stem cells in brain - since adult neurons cannot divide
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What is the so-called dysplastic features seen in ganglioneuroma and ganglioglioma?
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Loss of organization and variations of size and shape of neurons
Some neurons are denucleated |
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Age, location, clinical and prognosis of central neurocytoma? (II)
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1. Young adults
2. Grow in lateral ventricles near foramen of Monroe 3. Block CSF - so cause hydrocephalus and ICH 4. Good prognosis |
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Neurocytoma look how grossly?
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Cauliflower mass growing into ventricles, near foramen of Monroe
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LM morphology of neurocytoma?
What are the cells called? |
1. Lots of small similar cells called neurocytes
2. Sheets of these neurocytes are interrupted by nuclei free areas of neuropil |
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What is neuropil?
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Its the collection of the processes of the neurons and the glial cells
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What is a neurocyte?
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It is some primitive form of neuron - NOT a adult one since they cannot differentiate
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What are the pineal neoplasms?
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1. Pineocytoma (I)
2. Pineoblastoma (IV) |
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Age, location and clinical signs of pineocytoma?
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Adults
Grow in the pineal gland (duh) Cause neuroopthalmological dysfunctions! |
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Gross morphology of pineocytoma?
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Slow growing demarcated tumor
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LM morphology of pineocytoma?
What are the neoplastic cells called? |
- Small cells with rounded nuclei called pineocytes
--> Form round large structures called pineocytomatous rosettes |
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Prognosis of pineocytoma?
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Very good - almost excellent
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What is a pineoblastoma and typical age of patient?
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Malignant counterpart of pineocytoma - typical children
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Gross morphology of pineoblastoma?
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Gross easily friable, poorly demarcated mass - with invasion of adjacent brain!
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LM morphology of pineoblastoma?
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- Hypercellular patternless growth of primitive looking cells (small nuclei and low cytoplasm)
- Pineocytomatous procesess lost - High mitotic activity |
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Prognosis of pineoblastoma?
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Very bad - children die in 2 years due to large CSF dissemintation
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What is the most important embryonal neoplasm of brain?
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Medulloblastoma
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Age and only location of medulloblastoma?
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Young kids - only located in cerebellum
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Clinical signs of medulloblastoma?
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1. Cerebellar ataxia
2. ICH |
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What is cerebellar ataxia?
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The loss of full control of body movements
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Malignancy of medulloblastoma?
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Veery malignant - but survival better now due to modern chemotherapy!
One of the biggest successes in modern neurooncology |
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LM morphology of medulloblastoma?
What is a very specific sign? (a type of rosette) |
- Densely packed primitive cells with round nuclei
- Cells of neuronal differentiation (very primitive) - Neuroblastic Homer-Wright rosettes! |
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How do we prove that these small monomorphic cells are primitive neurons?
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By synaptophysin identification (synaptic vesicle protein)
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How does the Homer-Wright rosettes look?
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Halo-tumor cells around a central core of neuropil, simply
=> Neuronal origin |
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2 grades of meningiomas?
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II - Atypical meningioma
III - Anaplastic meningioma |
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Typical age and gender of meningeomas?
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Middle aged women
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Cells of meningeomas derive from?
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Meningothelium = arachnoidal cells (of arachnoid mater)
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Typical location of meningioma?
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- Usually over cerebral hemispheres:
- Skull or spinal portion of dura - In orbit - Rarely outside CNS, e.g. lungs |
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Clinical presentation of meningiomas?
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Seizures
Compression of other structures |
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Survival rate of grade II & III of meningiomas?
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II = 95%
III = 60% |
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Gross appearance of meningiomas?
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1. Rubber-like nodule attached to dura mater
2. Sometimes grow like a flat surface on dura |
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Name of when meningioma grow like a flat mess on dura?
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Meningioma en plaque
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Invasiveness of meningioma?
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Quite high - invade dura so dura should be removed with broad rim
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LM of meningioma is very variable. What are the most important subtypes? (WHO = 12)
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1. Meningothelial
2. Fibrous 3. Transitional 4. Psammomatous 5. Clear cell |
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Which is the most common subtype of meningioma?
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Meningothelial meningioma
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LM of meningothelial meningioma?
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Uniform cells grow in lobules - divided by fibrous septa
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LM of fibrous meningioma?
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Elongated fibrous cells predominate with extracellular collagen
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LM of transitional meningioma?
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Whorls of neoplastic cells in onion-structure - which later will become psammoma bodies
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What are psammoma bodies?
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Concentrically calcified aggregates of cells
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Which meningoma subtype has worst prognosis?
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Clear cell meningioma
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LM of clear cell meningioma?
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- Clear looking cytoplasm
- May be confused with metastasis of renal cell carcinoma :P (!!!) Aha |
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How to diagnose a atypical meningoma? (II)
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1. More than 4 mitoses per 10 HPF or
2. 3 of 5: - Cellularity - Patternless growth - Necrosis foci - Small cells with high N/C ratio - Prominent nucleoli |
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Most important mesenchymal brain tumor which may be confused with meningioma?
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Hemangiopericytoma
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Where in CNS do we find melanocytes?
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In leptomeninges
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What are the 3 main melanocytic lesions?
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1. Melanocytoma
2. Diffuse melanocytosis / melanomatosis 3. Malignant melanoma |
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What is a melanocytoma?
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The leptomeningeal counterpart of pigmented nevus!
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Most typical location of melanocytoma?
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Well.
Most typical is eye. But of leptomeninges: - Cervical / thoracic spine |
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LM of melanocytoma?
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Uniform round shaped spindle cell nuclei
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What is diffuse melanocytosis?
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A diffuse proliferation of leptomeningeal melanocytes occuring in children
- May or may not show malignant features, even so, both have quite poor prognosis |
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Malignant melanoma of leptomeninges? Location, age, gross and LM?
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Typically in SC and posterior fossa
ADults, pigmented mass and LM like malignant melanoma elsewhere: - Mitosis - Invasion - Necrosis |
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Malignancy of malignant melanoma?
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Highly agressive, so poor prognosis (locally I thiiink)
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Malignant lymphoma in CNS occur typically in what patients?
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Immunosuppressed patients (AIDS , drugs)
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Gross morphology of malignant CNS lymphoma?
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Single or multiple nodular masses deep in cerebral hemispheres (in contrast to gliomas)
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Most of CNS lymphomas are of what cell type?
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B cell
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LM of malignant brain lymphoma?
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- Large lymphoid cells arranged around vessels
- Foci of necrosis |
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What are germ cell neoplasms of CNS?
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The same as in gonadal tumors - but appear in brain
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Where are germ cell neoplasms typically found?
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Pineal or suprasellar regions
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What are the types of germ cell tumors of CNS?
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The same as in testicles or ovaries so:
- Germinoma = seminoma / dysgerminoma - Teratomas - Yolk sac tumors … - Etc. |
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What is a craniopharyngioma?
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A benign tumor forming from the remnants of Ratke's pouch epithelium
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What is the Rathke's pouch?
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A depression in the roof of primitive oral cavity, which give rise to the anterior pituitary gland
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What are the clinical signs of a growing craniopharyngioma?
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1. Visual disturbances - since it compresses optic tracts in suprasellar region
2. Diabetes insipidus - since it compress hypothalamus 3. Maybe some behavioural changes |
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How does a craniopharyngioma look grossly?
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Usually large and lobulated, containing cysts with a fluid feeling like machinery oil
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How does a craniopharyngioma look in LM?
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Lobules of squamous cell epithelium - with peripheral palicading nuclei
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What is the most typical feature of craniopharyngioma?
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Presence of "wet keratin"
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Where in CNS does usually secondary metastases spread to?
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80% - hemispheres
15% - cerebellum |
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What are the most common tumor metastasis to brain?
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Lung carcinoma - especially small cell
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What are the other common tumor metastases to the brain?
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- Breast carcinoma
- Melanoma - Renal cell carcinoma - Colorectal carcinoma |
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What are the most common children tumors spreading to brain?
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- Leukemia
- Lymphoma - Osteosarcoma - Rhabdomyosarcoma - Ewing sarcoma |
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What are the 2 typical patterns of tumor metastasis to brain, besides the architecture of the tissue it comes from?
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1. Rounded circumscribed mass with central necrosis
2. Carcinomatous leptominingitis |
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What is carcinomatous leptomeningitis?
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Diffuse infiltration of leptomeninges of neoplastic cells - this is not inflammation!
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What are the peripheral nerve sheath tumors?
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- Schwannoma
- Neurofibroma - Malignant peripheral nerve sheath tumor |
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Another name for schwannoma?
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Neurilemmoma
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Gross morphology of schwannoma?
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Smooth nodulated lesion arising from peripheral nerve - and attached to it from the side
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LM morphology of schwannoma - 2 types of pattern? (biphasic)
Antoni A Antoni B |
Antoni A
- Compact areas with many uniform spindle cells - Grow in Verocay bodies Antoni B - Less cellular areas - Smaller cells |
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What are verocay bodies?
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Palicading nuclei around non-cellular core
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Which nerve does schwannoma often affect?
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Acoustic nerve (CN VIII)
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What is the neurofibroma?
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A benign tumor of peripheral nerves - attached to the nerve as a nodule
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Schwannomas can easily be resected from nerve without damaging the nerve (thus nerve sheath) - but how is this with neurofibromas?
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They must be resected with the nerve - so it may include a loss of innervation
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What cells does a schwannoma consist of?
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Schwann cells
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What cells does a neurofibroma consist of?
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Mixture of:
- Schwann cells - Fibroblasts of endoneurium - Perineural cells |
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LM morphology of neurofibroma?
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Spindle shaped cells with elongated nuclei - scattered in myxoid stroma
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Neurofibroma used to be called?
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Neurofibrosarcoma! but changed - it sounded too dramatic :)
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The malignant peripheral nerve sheath tumor is the malignant counterpart of what?
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Neurofibroma
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Typical age group and location for malignant neurofibroma?
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Adult
Locations: Major nerves of: - Neck - Forearm - Lower leg - Buttock |
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LM morphology of a malignant neurofibroma?
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Spindle cells:
- Hyperchromatic - atypical nuclei - Mitotic activity Areas look like stone marvel: - Some highly cellular, some low cellular |
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What is a Homer Wright rosette?
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Rosette seen in medulloblastoma:
- Primitive neurons surrounding a core of neuropil |
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What is a Flexner-Wintersteiner rosette?
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Rosette seen in retinoblastomas.
- Tumor cells surrounding central lumen of cytoplasmic extensions of tumor cells In EM you see they are primitive photoreceptor cells |
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What is a true ependymal rosette?
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Rosette seen in ependymoma:
- Tumor cells surrounding empty lumen - supposed to be their attempt to create new ventricle :) Aaww... |
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What is a perivascular pseudorosette?
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Rosette seen in ependymomas, medulloblastomas, PNET, central neurocytomas and glioblastomas (more or less all of them):
- Tumor cells surrounding a blood vessels. A pseudorosette since it does not have a true lumen made by the neoplastic cells! |
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Name the 5 stratums of the epidermis?
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1. Basale
2. Spinosum 3. Granulosum 4. Corneum 5. Lucidum |
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Why is it called stratum basale?
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It is the basal cells - with 1 layer of smaller & darker SC's
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Why is it called stratum spinosum?
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There are spines / bridges between the cells
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Why is it called stratum granulosum?
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They contain basophilic pre-keratin granules
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Why is it called stratum corneum?
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There is kertain (horny layer)
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What cells do we find between the keratinocytes in epidermis?
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Melanocytes - africans have more
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What is normal location of eccrine sweat glands?
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Border between dermis and subcutaneous tissue
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2 layers of dermis?
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1. Papillary top
2. Reticular below (thicker) |
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What is hyperkeratosis?
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Increased formation of horny layer in some diseases - showing like a white plate on the skin
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Examples of diseases with hyperkeratosis?
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- SLE
- Leukoplakia |
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What is parakeratosis?
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When we find nuclei in the horny layer - where there should be no nuclei!
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Examples of diseases with parakeratosis?
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Psoriasis
- Here you can also see hyperparakeratosis :) |
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What is dyskeratosis?
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Abnormal maturation of epidermal cells - with presence of small kreatine globules inside them
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What is akhantosis?
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Elongation of the epidermal papillae long and downwards to dermis - by hyperplasia of the cells
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What is papillomatosis?
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Elongation of the epidermal papillae - but this time upwars (opposite of akanthosis), like fingers of pedunculated papillary growths
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Typical locations of papillomatosis?
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Urogenital system
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Definition papilloma?
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Benign epithelial tumor arising from superficial epithelium
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Definition adenoma?
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Benign epithelial tumor arising from glandular epithelium
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What is acantholysis?
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Autoimmune destruction of the spines (desmosomes?) between the str. spinosum cells - leading to loss of cohesion
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In what diseases is acantholysis seen?
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Pemphigus vulgaris
(vulgaris = common) |
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What is pemphigus vulgaris?
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Autoimmunity against the interconnecting spines of cells in str. spinosum - leading to deadly intraepithelial blisters!
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What is pemphigoid?
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Disease with clinical appearance similar du pemphigus - but there is no loss of the connecting spines in str. spinosum
- There is antibodies against the BM - and a subepidermal location of blisters |
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What is potentially the mechanism of this blister formation?
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Spongiosis - a intERcellular edema, with accumulation of fluid - like a sponge
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Definition macula?
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Red spot
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Definition urtica?
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Blister caused by allergic reaction
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Definition papula?
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Elevated lesion
1. Inflammation 2. Intraepidermal edema 3. Subepidermal blisters (perphigoid) |
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Pustule?
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Infected and pus-containing papula
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3 way of developing pustule?
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1. Balloning (viral - herpes)
2. Spongiosis 3. Akantholysis |
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Definition erosion?
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Superficial defect of epidermis, not extending to dermis
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Definition exkoriation?
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Defect into dermis, but with remnants of papillaes
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Definition ulcus?
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Deeper - important for burns (depth decide how much that can be regenerated - or if skin transplant is needed)
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What are the most common benign tumors of skin?
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- Histiocytoma / dermatofibroma
- Seborrheic wart |
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What is a histiocytoma / dermatofibroma?
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A warty lesion composed of fibrous tissue - and should not be called dermatofibroma since it is not a tumor
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How is a histiocytoma created?
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It is a accumulation of histiocytes - as a reaction to some minor injury - and later it becomes fibrous
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Where do we usually ( and very rarely) find true fibromas?
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Ovary
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What is a seborrheic wart?
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It is a benign hyperplasia of the epidermis - with hyperkeratosis on the surface and horny balls in the epidermis
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What gives the seborrheic wart the brown color?
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Increased amount of melanin
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What gives the seborrheic wart the waxy character?
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The horny cysts / balls in the epidermis
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What age are usually affected by seborrheic warts?
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Old people - thus it was used to be called senile wart
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Does most skin malignancies develop de novo or from precancerous lesions?
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From precancerous lesions
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What is the main etiological factor for skin malignancies?
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UV light - therefore they appear more on UV exposed areas of body
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What are the most common & curios forms of precancerous lesions?
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1. Actinic (solar) keratosis
2. Cornu cutaneum 3. Morbus Bowen |
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What is actinic keratosis?
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A premalignant condition of hyperpigmented and or hyperkeratotic areas of skin - which is worsened by UV radiation
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How is actinic keratosis histologically?
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With hyperkeratosis and dysplastic changes in epidermis
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How to decide the degree of precancerousness in actinic keratosis?
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Use DIN: dysplastic intraepithelial neoplasia
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How long time does it take for a actinic keratosis to develop to a true carcinoma?
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Decades
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What is cornu cutaneum? (cutaneous horn)
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Hyperplastic extreme hyperkeratosis of skin - where the base of the lesion is precancerous - and if arising on head - you may look like the devil :D
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What is Morbus Bowen?
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Intraepidermal carcinoma in situ - going from:
1. Dysplasia 2. Bowen 3. Invasive carcinoma |
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Which malignancy does usually the precancerous lesions develop into?
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Squamous cell carcinoma (epidermoid carcinoma)
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What is the commonest among all cancers?
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Skin malignancies! But not so important - since they have mostly good prognosis due to simple resection
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What are the 3 most common skin malignancies?
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1. Squamous cell carcinoma (epidermoid carcinoma)
2. Basal cell carcinoma (basalioma) 3. Malignant melanoma |
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A third name for epidermoid carcinoma - and why?
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Spinalioma - since the cells come from stratum spinosum
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Gross appearance of epidermoid carcinoma?
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Non-healing ulcer with elevated margins
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Agressiveness of epidermoid carcinoma?
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Locally yes, but simple resection heal.
And metastasis occur in less than 2% - and in that case always to lymph nodes |
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What are the etiological factors for epidermoid carcinoma?
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- Precancerous lesions
- Chronic irritation - Old burn scars - Ionizing radiation - Chronic ulcers / fistulas - Varicose ulcers |
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Histology of a epidermoid carcinoma?
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Keratinizing squamous cell carcinoma
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Which 2 factors give better prognosis in general in skin tumors?
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1. Keratinization
Since it means cells are more differentiated 2. Good lymphocytic infiltrate - No idea why :)) |
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What is most common of epidermoid carcinoma and basalioma?
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Epidermoid = 30%
Basalioma = 60% Others = 10% |
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So what is the most frequent cancer in humans?
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Basal cell carcinoma!
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From which epidermal layer does basalioma arise from?
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Stratum basale :) - so smaller and darker cells are typical
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Typical histology of basalioma?
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1. Basophilic blue small cells
2. Growing in large sheats in upper dermis 3. Palicading cells around the sheat |
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What is typical location for basalioma?
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100% upper part of body - most on face:
- Nasolabial area (very typical) - Dorsum of nose - Eyelids - Ears |
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How is gross appearance of basalioma?
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Non-healing ulcer, but it is glossy and nodular compared to epidermoid carcinoma
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Late stage of basalioma appear as - and is called?
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Ulceration of skin with elevated margins (which 'roll' inwards) and make the margins go up.
It bites into the skin - and it is called ulcus rodents |
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Rodents mean?
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Something that is biting
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3 histological forms of ulcus rodents?
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1. Solid - most common
2. Cystic - if lesion become liquefied 3. Pigmented - if it contains more melanin |
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Why have the name basal cell carcinoma been changed to basalioma?
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Since it practically never metastasize
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What is the only potential danger of a basalioma?
What will one then die of? |
If it is infiltrative type:
- Forming subdermal lesions, which even with resection will recur and can grow into bone, orbit, skull etc. Will die of suppurative meningitis |
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Which generation is most affected by basalioma and epidermoid carcinoma?
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Older - due to accumulation of UV effect
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What is a pigmented nevi?
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It is a raised pigmented mole which we all have lots of
All types, raised, flat, brown, black hairy etc |
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Pigmented nevi arise from what cells?
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Melanocytes in stratum basale
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3 types of nevus?
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1. Junctional
2. Compound 3. Intradermal |
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Location and age of junctional nevus?
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Young age - in junction between dermis and epidermis
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What is a compound nevus?
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When some cells from a junctional nevus drop down into dermis
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Location and age of a intradermal nevus?
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Old age - entirely dermal
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If a pigmented nevi become malignant - it is always from?
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Junctional or compoud - intradermal is always benign!
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What are the 2 most dangerous nevuses?
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1. Atypical nevus
2. Giant nevus |
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What is a giant nevus?
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Nevus affecting large parts of the body - socalled bathing suit nevus
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How does a atypical nevus look?
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Usually larger and contain some part of junctional form
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What is a sign of malignant transformation in a preexisting nevus?
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Any change in size, color etc.
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Frequency of malignant melanoma among skin tumors?
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2%
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What is so bad about the malignant melanoma?
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It metastasizes very early, both lymphogenous and hematogenous
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3 types of malignant melanoma?
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1. Superficial spreading melanoma
2. Nodular malignant melanoma 3. Lentigomalignantmelanoma |
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What is a superficial spreading melanoma?
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Melanoma growing superficially - growing into epidermis
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What is a nodular malignant melanoma?
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Melanoma typically growing into dermis
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What is a lentigomalignant melanoma?
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More extensive, brownish spot - typically on face of old women
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A lentigomalignant melanoma can be regarded as 2 things?
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1. Dysplastic tumor
2. Premelanoma lesion |
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Another name for lentigomalignant melanoma?
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Hutchington's freckle
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Malignant melanoma arise usually from?
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Preexisting lesion - primary is very rare!!
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Name 1 other malignancy of skin?
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Mycoses fungoides
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What is mycoses fungoides?
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A T-cell lymphoma of skin :)) - The only (almost) T-cell lymphoma! The rest are usually B
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According to who do we stage malignant melanoma?
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According to Clark and Breslow
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Malignant melanoma staging according to Clark?
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Into which layer the lesion grow:
1 - Intraepithelial 5 - Subcutis Higher Clark, worse prognosis. But some malignant tumors do not grow deep, so Breslow was needed |
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Malignant melanoma staging according to Breslow?
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Measure absolute thickness of tumor layer - i.e. invasion
1 - Less than .75mm 5 - more than 5mm |
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What other organs than skin can malignant melanoma occur in?
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- Eye (retina)
- Leptomeninges - Inner ear - Heart - Bones ?? |
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What are the typical metastases of malignant melanoma?
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Spine
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What are the specific immunohistochemistry tumor markers of malignant melanoma?
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- Melan A
- HMB45 |
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Name 2 benign mixed tumors?
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- Fibroadenoma of breast
- Pleomorphic adenoma of salivary gland |
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Name 4 malignant mixed tumors?
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- Phyllodes tumor of breast (fibrous + epithelial / fibroadenoma)
- Malignant mixed tumor of salivary gland origin - Wilms tumor - Teratomas |
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What components does a Wilms tumor consist of?
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1. Primitive embryonal cells (nephrogenic blastema)
2. Epithelial kidney tubules 3. Mesenchymal structures (cartilage, muscles) |
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Definition of tumor multiplicity?
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Occurence of more than one primary tumor at the same time - and not necessarily the same type
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Examples of tumor multiplicity?
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- Breast carcinoma + ovarian carcinoma (BRCA)
- Colorectal cancer + prostate carcinoma (tumor duplicity) - Osteoma + colorectal cancer (FAP) - Multiple foci of urothelial carcinoma in urinary bladder |
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Name some hereditary syndromes with higher chance of tumor multiplicity?
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- Li-Fraumeni syndrome
- MENS - FAP syndrome - BRCA mutations - Neurofibromatosis |
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Another name for Li-Fraumeni syndrome?
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SBLA - sarcoma, breast, leukemia and adrenal gland carcinoma syndrome
A syndrome of unkown cause (maybe P53 mutation) leading to multiple tumors |
