Block 3 cancers
Upper GI
Squamous Cell Carcinoma of the Tongue
Usually older men who smoke, drink, have HPV, radiation
white or red, various forms, irregular
Big, hyperchromatic nuclei, keratin pearls
More posterior=worse prognosis.
EtOH causes TP53, p63, and NOTCH1 mutations, HPV causes p16
Salivary gland tumors
Pleomorphic Adenoma
Encapsulated, found in parotid. Gray-white with myxoid tissue
Fibromyxoid and chondoid tissue, glandular components
Treat with transection, recurs if you don't get it all. Careful of facial nerve.
Most often in women ages 20-50.
Warthin Tumor
Usually in men over 40 in parotid. Smoking is risk factor. Painless swelling of gland.
Tan with white fibrotic center
Cystic spaces lined with pink epithelium (onocytes) around lymphoid tissue w/ germinal centers
Mucoepidermoid carcinoma
20s-40s, no sex difference
11:19 translocation- MECT1-MAML2 gene
See mucocytes and epideromoid cells
Low grade cured by surgery, 90% survive 5 years. High grade 50%.
Esophageal cancer
Adenocarcinoma- weight loss and dysphagia, associated with Barrett's esophagus. Usually in distal 1/3 of esophagus
SCC- more often in middle. Usually polypoid, can be flat or excavated. Can obstruct or excavate to neighboring tissue
Very bad prognosis
Gastric Carcinoma
2 growth patterns
Prognosis depends on degree of infiltration.
Often seen in lesser curvature of antro-pyloric area, local spread
Intestinal
Diffuse
exophytic/excavated
Typical adenocarcinoma appearance
flat/infiltrative
signet-ring appearance
Risk factors- smoking, diet, SES, H. pylori
Krukenburg Tumor- met to ovary
Lower GI
Small Bowel Tumors
Adenocarcinoma is most common
Carcinoid tumor
Low-grade tumor of diffuse endocrine system
usually in deep mucosa/submucosa, often at appendix
secretes serotonin/somatostatin, get flushing, sweating, abd. pain, diarrhea, bronchospasm
Symptoms mean substances got past liver metabolism, means malignancy
See islands of uniform cells with scant pink cytoplasm and oval stippled nuclei
location important- foregut usually mild and resectable, midgut are aggressive and malignant, esp. ileum, hindgut usually incidental finding, proximal colon is rare but bad.
Colon cancer
Polyposis
FAP
Adenomas
Adenocarcinoma
FJP
Peutz-Jehgers
Tubular adenoma
Villous Adenoma
Tubulovillous adenoma
symptoms of cramping, hematochezia, and diarrhea. Almost always advances to malignancy.
hundreds of adenomatous polyps with stalks. Usual defect is APC gene
hyperchromatic cells with big nuclei
mucus-filled cysts composed of dilated glands lined by colonic columnar epithelium
leukocyte infiltration and granulation tissue
symptoms same as FAP, low risk of malignancy
Crowded, multiply branched villi or complex glandular formations are covered by a single layer of well-differentiated, tall, columnar epithelium.
smooth muscle in lamina propria
pigmentation around mucous membranes, 2-3% risk of adenocarcinoma
Polypoid lesion with raspberry like head
Closely aggregated long glands with dark lining cells w/ pseudostratified nuclei
90% in colon, can test with Guaic test
broad, sessile, involve whole mucosa
long villi with same dark cells with stratified nuclei
Has features of both
Left- obstruction, "napkin-ring"
Right- anemia, weight loss, abd. pain
Blood in stool is most common sign, may need guaiac test
back to back glands with nuclear crowding
HNPCC- MSH2, MLH1 mutations, stop mismatch repair.
Liver and Gallbladder
Liver Adenomas- associated with OCT, can turn malignant
HCC
Risk factors- HBV, HCV, alcohol, aflatoxin, NASH
well differentiated, see high AFP
Gallbladder carcinoma
Rare, seen in old ladies with porcelain gallbladder
Poor prognosis, usually adenocarcinoma
associated with couvoiser's sign
Pancreas
Benign
malignant potential, usually in women
Serous/mucinous cystadenoma
uncommon, usually in body or tail.
Adenocarcinoma
Risks- smoking, family history, chronic pancreatitis
See couviuser's sign, painless jaundice, Trousser's syndrome
usually in head, see glands in stoma, perineural invasion
Islet cell tumors
Rare, similar to carcinoid. Can be benign or malignant, functional or not
Insulinoma- usually benign, get hypoglycemia
Gastrinoma- 30s-60s, half are malignant
can lead to Zollinger-Ellison: high acid secretion leads to intractable peptic ulcer disease