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Tag Archives: Cancer
Warthin’s Salivary Gland Tumor
Warthin’s Tumor
Clinical features
• Second most common salivary gland neoplasm
• Almost always arises in parotid gland
• Occurs most commonly in males rather than females, usually in fifth to seventh decades of life
• 10% are multifocal; 10% are bilateral
• Smokers are have an 8-fold risk than non-smokers for developing these tumours
Cytologic features on fine-needle aspiration
• Mixed population of lymphocytes
• Sheets of oncocytes
• Granular background
Gross features
• Round to oval encapsulated lesions
• 2-5 cm in diameter
• Arise in superficial parotid gland where they are readily palpable
• Sectioning reveals pale gray surface punctuated by narrow cystic or cleft-like spaces filled with a mucinous or serous secretion
Prognosis
• Benign
• Recurrence rate is only 2% after resection
Posted in Salivary Gland
Tagged Cancer, Oncocytes, Oncocytic tumor, Parotid gland cancer, Parotid gland tumor, Salivary Gland, warthin tumor, warthin's tumor
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Cancer
Neoplastic complications of Iinflammatory Bowel Disease
Epithelial dysplasia in Ulcerative Colitis
Mod Path 2003 : 16(4): 347-358. by Robert Odze
Ulcerative colitis associated epithelial dysplasia
-incidence increases with duration of the disease
-risk is highest with ulcerative pan-colitis – the greatest extent
-presence of sclerosing cholangitis might also be a risk factor
- softer risk factors include: early age of onset, Family History of colon cancer, folate deficiency
- patients who have had Ulcerative Colitis for 7-8 years should be entered in a screening program
- systematic, multiple mucosal biopsies increase the rate of detection
- dysplasia lesions classified as either flat or raised (DALM – dysplasia associated lesion or malignancy).
- dysplastic epithelium further classified into low and high grade dysplasia
-Management guidelies depend on probabilities of 1. coexistant carcinoma and 2. progression onto carcinoma
DALM – dysplasia associated lesion or malignancy
-flat dysplasia , if low grade, is followed. If high grade, goes to colectomy.
-DALM – dysplasia associated lesion or malignancy – is broken down to adenoma-like polypoid sporadic ( isolated polypoid lesions similar in appearance to sporadic adenoma) , adenoma like polypoid dysplastic lesion related to the underlying IBD and non adenoma like . Polypoid sporadic is treated with polypectomy, and there is increasing evidence that polypoid IBD associate lesions can also be treated with polypectomy, provided there is no associated flat dysplasia.
-non adenoma like lesions are treated with colectomy
Crohn’s Disease Cancer
-increased risk of adenocarcinoma ( 4x-20x)
- adenocarcinoma may arise in a morpholocially normal bowel, in areas of stricture and within fistula tracts, making diagnosis difficult.
-multiple synchronous and metachornous adenocarcinomas may occr and involve large and small intestines
-overall mortality in Crohn’s from cancer is high -80%
well-differentiated tumors may extend from fistula tracts and may endoscopically be misinterpreted as adenoma
-symptomatically, adenocarcinoma may mimic a Crohn’s relapse – delay in diagnosis
-unlike in ulcerative colitis there is no standard surveillance strategy due to technical diffculties in surveying the bowel
-prophylactic resection ( for dysplasia) is not recommended because of risk of post op complications
Posted in Inflammatory Bowel Disease
Tagged , Cancer, Crohn’s Disease, dalm, dysplasia, dysplasia associated lesion or malignancy, epithelial, Inflammatory Bowel Disease, prophylactic colectomy, screening, Ulcerative Colitis
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Burkitt
Burkitt lymphoma
Burkitt Lymphoma Pathogenesis
Burkitt lymphoma is caused by the translocation of c-myc (on chromosome 8 ) to immunoglobulin gene locus allowing for upregulation of c-myc (increased transcription and translation). Translocation occurs to IgH locus t(8;14) or light chain locus t(2;8) or t(8;22). This is thought to occur during errors in class switching or during attempted V(D)J joining, or breaks generated during somatic hypermutation of Ig genes.
Additional mutation of p53, MDM, or p16 are needed for malignant transformation.
Burkitt Lymphoma Histology
Tissues involved by Burkitt lymphoma are effaced by a diffuse proliferation of intermediate-sized cells (10 to 25 um diameter; similar to nuclear size of benign macrophages within tumor), containing round or oval nuclei with coarse chromatin, several nucleoli, and a moderate amount of faintly basophilic to amphophilic cytoplasm. There is a high mitotic index and high rate of apoptotic cell death within the tumor. This is a requirement. Tingible body macrophages are diffusely scattered among the tumor cells imparting a “starry sky” appearance to the neoplasm.
Classification in the Working Formulation and the REAL classification
Working Formulation
- Classified under high grade lymphoma (small, noncleaved cells)
REAL Classification
- Classified as peripheral B-cell neoplasm
References:
Robbins Basic Pathology 7th ed, edited by Vinay Kumar, Ramzi S. Cotran, and Stanley J. Robbins, 873 pp, Philadelphia, Pa, Sounders, 2003.
Posted in Lymphoma
Tagged burkitt, burkitt lymphoma, Cancer, high grade lymphoma, lyphoma, peripheral b cell
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Kidney Cancer
Kidney Cancer
Renal Cell Carcinoma
85% of kidney cancers
found mainly in the age groups 60-70 years old
more common in males
in past called a hypernephroma due to clear appearing cells and yellow gross appearance
Causes of Kidney Cancer
Causes of renal cell carcinoma
tobacco
pipe and cigar smokers
hypertension
asbestos
heavy metals
petroleum
unopposed estrogen therapy
chronic renal failure
tuberous sclerosis
cystic diseases, acquired
Kidney Cancer Genetics
Most renal cancers are sporadic. Very few are familial. Familial renal cancers include Von Hippel Lindau syndrome, VHL. Von Hippel Lindau syndrome is characterized by renal cysts, renal cell carcinoma and cerebellum hemangioblastomas.
Clear Cell Renal Carcinoma
about 80% of all renal cell carcinomas
no papillary architecture
clear to granular cytoplasm
unifocal often
sporadic in 95% of cases
familial in 5% of cases, such as with Von Hippel-Lindau syndrome
associated with a loss of chromosome 3, p region, which carries the VHL gene
VHL gene encodes a uniquitin ligase complex which targets many proteins for degradation
HIL-1 is eleveated in renal clear cell carcinomas, as VHL protein is unable to traget it for destruction
HIL-1 increases the levels of the growth factor insulin-like growth factor-1, which promotes cell growth
HIF-1 increases the levels of VEGF and TGF-beta which are pro-angiogenic
Papillary Renal Cell Carcinoma
15% of renal cell carcinomas
papillary growth pattern
multifocal
associated with trisomies, mutated MET protooncogene, and PRCC oncogene
Chromophobe Renal Cell Carcinoma
5% of renal cell carcinomas
derived from intercalated cells of collecting ducts
have prominent cell membranes and pale eosinophilic cytoplasm
halo around nucleus often
many chromosome losses
Collecting Duct Carcinoma
1% renal cell carcinoma
appear as atypical cells within a distinct and prominent fibrotic stroma
found in the medulla often
many chromosome losses and chromosome deletions
Clinical Presentation of Kidney Cancer
Symptoms
costovertebral pain, low-back pain situated laterally
palpable mass
hematuria (most important) – can be intermittent, gross and/or microscopic
fever
weakness
weight loss
fatigue
Renal cell carcinoma can secrete many different peptides that can mimic the function of many hormones, producing many different paraneoplastic syndromes including polycythemia, hypercalcemia, hypertension, Cushing syndrome, amyloidosis and many more.
Kideny Cancer Metastasis
Renal cell carcinoma metastasizes very early and widely. Most common sites are the lungs and bones, followed by the lymph nodes and liver.
Prognosis of Kidney Cancer
Prognosis of kidney cancer is around 75%, with metastasis it drops to 45%, and with renal vein invasion or invasion into the perinephric fat, it drops to 15%.
Treatment of Kidney Cancer
Nephrectomy (removal of the kidney_
Partial nephrectomy to conserve kidney function
Posted in Cancer, Kidney
Tagged , Cancer, Causes of Kidney Cancer, Chromophobe Renal Cell Carcinoma, Clear Cell Renal Carcinoma, Clinical Presentation of Kidney Cancer, Collecting Duct Carcinoma, Kidney, kidney cancer, Kidney Cancer Genetics, Papillary Renal Cell Carcinoma, prognosis, renal cell carcinoma, symptoms, treatment
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Wilms Tumor
Wilms Tumor
Cancer Type Wilms Tumor
Wilms Tumor Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What is Wilms tumor? Wilms tumor is a disease in which cancer (malignant) cells are found in certain parts of the kidney. The kidneys are a matched pair of organs found on either side of the backbone. The kidneys are shaped like a kidney bean. Inside each kidney are tiny tubes that filter and clean the blood, taking out unneeded products, and making urine. The urine made by the kidneys passes through a tube called a ureter into the bladder where it is held until it is passed from the body. Wilms tumor is curable in the majority of affected children. If your child has symptoms, your child s doctor will usually feel your child’s abdomen for lumps and run blood and urine tests. The doctor may order a special x-ray called an intravenous pyelogram. During this test, a dye containing iodine is injected into your child’s bloodstream. This allows your child’s doctor to see the kidney more clearly on the x-ray. Your child’s doctor may also do an ultrasound, which uses sound waves to make a picture, or a special x-ray called a computed tomographic scan to look for lumps in the kidney. A special scan called magnetic resonance imaging, which uses magnetic waves to make a picture, may also be done. Chest and bone x-rays may also be taken. If abnormal tissue is found, your child’s doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. In Wilms tumor, how the cancer cells look under a microscope (histology) is also very important. The cancer cells can be of favorable histology or anaplastic histology. Anaplastic means the cancer cells divide rapidly and look very different from normal cells. Anaplastic tumors may be focal (in one area) or diffuse (spread widely throughout an area). Your child’s chance of recovery (prognosis) and choice of treatment depend on the stage of your child’s cancer (whether it is just in the kidney only or has spread to other places in the body), how the cancer cells look under a microscope (histology), tumor size, and your child’s age and general health. What Are Other Childhood Kidney Tumors? Clear cell sarcoma of the kidney, rhabdoid tumor of the kidney, and neuroepithelial tumor of the kidney are childhood kidney tumors unrelated to Wilms’ tumor. The treatment of these tumors is different from that of Wilms’ tumor but because of their location near the kidneys, they have been treated on clinical trials developed by the National Wilms’ Tumor Study Group.
Vulvar Cancer
Vulvar Cancer
Cancer Type Vulvar Cancer
Vulvar Cancer Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What is cancer of the vulva? Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman s vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal. Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough. If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for any lumps. The doctor may then go on to cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctor s office. The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vulva or has spread to other places) and the patient s general state of health.
Vaginal Cancer
Vaginal Cancer
Cancer Type Vaginal Cancer
Vaginal Cancer Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What is cancer of the vagina? Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the “birth canal.” The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina). There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30. Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage). A doctor should be seen if there are any of the following: Bleeding or discharge not related to menstrual periods. Difficult or painful urination. Pain during intercourse or in the pelvic area. Also, there is still a chance of developing vaginal cancer in women who have had a hysterectomy. A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain. If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs. The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient’s general state of health.
Urethral Cancer
Urethral Cancer
Cancer Type Urethral Cancer
Urethral Cancer Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What is cancer of the urethra? Cancer of the urethra, a rare type of cancer, is a disease in which cancer (malignant) cells are found in the urethra. The urethra is the tube that empties urine from the bladder, the hollow organ in the lower abdomen that stores urine. In women, the urethra is about 1 1/2 inches long and opens to the outside of the body above the vagina. In men, the urethra is about 8 inches long and goes through the prostate gland and then through the penis to the outside of the body. Cancer of the urethra affects women more often then men. There may be no symptoms of early cancer of the urethra. A doctor should be seen if there is a lump or growth on the urethra, or pain, bleeding, or other difficulty during urination If there are symptoms, a doctor will examine the patient and feel for lumps in the urethra. In men, a thin lighted tube called a cystoscope may be inserted into the penis so the doctor can see inside the urethra. If the doctor finds cells or other signs that are not normal, a small piece of tissue (called a biopsy) may be cut out and looked at under a microscope for cancer cells. The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread to other places) and the patient s general state of health.
Thyroid Cancer
Thyroid Cancer
Cancer Type Thyroid Cancer
Thyroid Cancer Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What is thyroid cancer? Thyroid cancer is a disease in which cancer (malignant) cells are found in the tissues of the thyroid gland. The thyroid gland is at the base of the throat. It has two lobes, one on the right side and one on the left. The thyroid gland makes important hormones that help the body function normally. Certain factors may increase the risk of developing thyroid cancer. Thyroid cancer occurs more often in people between the ages of 25 and 65 years. People who have been exposed to radiation or received radiation treatments to the head and neck during infancy or childhood have a greater chance of developing thyroid cancer. The cancer may occur as early as 5 years after exposure or may occur 20 or more years later. People who have had goiter (enlarged thyroid) or a family history of thyroid disease have an increased risk of developing thyroid cancer. Thyroid cancer is more common in women than in men. Asian people have an increased risk of developing thyroid cancer. A doctor should be seen if there is a lump or swelling in the front of the neck or in other parts of the neck. If there are symptoms, a doctor will feel the patient s thyroid and check for lumps in the neck. The doctor may order blood tests and special scans to see whether a lump in the thyroid is making too many hormones. The doctor may want to take a small amount of tissue from the thyroid. This is called a biopsy. To do this, a small needle is inserted into the thyroid at the base of the throat and some tissue is drawn out. The tissue is then looked at under a microscope to see whether it contains cancer. There are four main types of thyroid cancer (based on how the cancer cells look under a microscope): papillary follicular medullary anaplastic Some types of thyroid cancer grow faster than others. The chance of recovery (prognosis) depends on the type of thyroid cancer, whether it is in the thyroid only or has spread to other parts of the body (stage), and the patient s age and overall health. The prognosis is better for patients younger than 40 years who have cancer that has not spread beyond the thyroid. The genes in our cells carry the hereditary information from our parents. An abnormal gene has been found in patients with some forms of thyroid cancer. If medullary thyroid cancer is found, the patient may have been born with a certain abnormal gene which may have led to the cancer. Family members may have also inherited this abnormal gene. Tests have been developed to determine who has the genetic defect long before any cancer appears. It is important that the patient and his or her family members (children, grandchildren, parents, brothers, sisters, nieces and nephews) see a doctor about tests that will show if the abnormal gene is present. These tests are confidential and can help the doctor help patients. Family members, including young children, who don t have cancer, but do have this abnormal gene, may reduce the chance of developing medullary thyroid cancer by having surgery to safely remove the thyroid gland (thyroidectomy).
Thymoma
Thymoma
Cancer Type Thymoma
Thymoma Information on Symptoms, Diagnosis, Prognosis, Screening and Imaging
What are thymoma and thymic carcinoma? Thymoma and thymic carcinoma are diseases in which cancer (malignant) cells are found in the tissues of the thymus. The thymus is a small organ that lies under the breastbone. It makes white blood cells called lymphocytes that travel through the body and fight infection. Thymoma is usually a slow-growing tumor that does not spread beyond the thymus. Thymic carcinoma, however, is difficult to treat and generally spreads to other parts of the body. People with thymoma often have other diseases of the immune system, most commonly myasthenia gravis, a disease in which the muscles become weak. A doctor should be seen if a person has the following symptoms: A cough that won t go away. Pain in the chest. Weakness in the muscles. If there are symptoms, the doctor may take an x-ray of the chest. The doctor may also do a CT scan, a special x-ray that uses a computer to make a picture of part of the body. The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the thymus or has spread to other places), the types of cells found in the cancer, and the patient s general state of health.