10-MC TUMOUR, Tm MARKER, HPE, GENE, ROUTE OF SPREAD, PROGNOSTIC FACTOR

MC tm tm-World-ca lung, India-ca oropharynx(buccal mucosa> lip> ant tongue) tm mal World-incid,mort-ca lung> prostate> colon, preval-ca prostate tm mal India-incid,mort-ca lung, preval-ca oropharynx(buccal mucosa> lip> ant tong)> ca esoph tm fem-World,India-ca breast>cxChild solid tm neonat-sacrococcygeal teratoma(primitive streak) bn tm infancy-hemangioma bn tm infant spont regression-hemangioma malign infancy-neuroblastoma malign infant spont regression-neuroblastoma tm Down synd infant-M7AML(a/c megakaryoblastic leukemia) tm child-ALL> brain tm> neuroblastoma tm brain child best progn-astrocytoma bn tm child-hemangioma solid organ malign child-brain tm inherited tm child-retinoblastoma abd malign child-neuroblastoma abd malign old child-Wilms tm tm Down synd child-ALLAnal canal malign anal canal-epidermoid caAppendix tm appendix-adenocaBone tm bone-met bn bone tm-osteochondroma true bn bone tm-osteoid osteoma prim for bone met-mal-prostate> lung, fem-breast>lung, child-neuroblastoma osteoblastic met-mal-prostate, fem-breast osteolytic met-mal-lung, fem-breast

→ bone bone met-Ewing sarcoma> osteosarcoma prim malign bone-multiple myeloma> osteosarcoma prim tm bone <10ychild-Ewing sarcoma prim bone tm hand-enchondroma

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malign bone tm hand-chondrosarcoma malign bony chestwall-chondrosarcomaBrain tm brain-met prim tm brain-glioma> astrocytoma prim tm brain child-pilocytic astrocytoma prim tm brain adult-glioblastoma malign brain/CNS child-medulloblastoma prim malign brain/CNS adult-glioblastoma prim tm brain supratentorial-craniopharyngioma Midline cerebellar tm-Medulloblastoma tm CP angle-vest schwannoma post fossa tm-cerebellar astrocytoma tm pineal gld-germinomaBreast tm breast-fibroadenoma malign breast-duct[adenoca(scirrh ca)] malign breast mal-ductalCNS tm CNS-met prim for CNS met-lung prim tm CNS-glioma> meningioma> astrocytoma> oligodendroglioma tm CNS HIV-prim CNS lymphoma tm CNS with prim amenorrhoea-craniopharyngiomaDiaphragm prim tm diaphr-lipoma prim malign diaphr-fibrosarcomaEar vasc tm middle ear-glomus tmEndocrine endocrine tm-insulinoma endocrine tm mal-gastrinomaENT bn tm ENT-skull base osteomaEsophagus bn tm esoph-leiomyoma> GIST malign esoph-SCC lower esoph malign-adenoca tm Baretts esoph-adenoca prim for esoph met-melanomaEye intraocular prim malign-malign melanom> retinoblastoma intraocular tm child-retinoblastoma

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intraocular malign adult-met> choroidal melanoma(epitheloid) tm eyelid-BCC bn tm eyelid-sq papilloma tm lacrimal gld-lymphoid tm> inflamm pseudotm epith tm lacrimal gld-pleomorph adenoma malign cornea-SCC malign conjunctiva-SCC tm intrinsic CNII-glioma(juvenile pilocytic astrocytoma)GB prim tm GB-adenoca(scirrhous)Heart tm heart-met prim tm heart-myxoma(LA) prim malign heart-angiosarcoma prim tm heart child-rhabdomyosarcoma(LV) prim for heart met-ca breast> ca lung tm heart valve-papillary fibroelastoma tm tuberous sclerosis-rhabdomyoma tm pericardium-met prim tm pericardium-mesotheliomaKidney renal tm-RCC(adenoca-clear cell) renal bn tm-papillary adenoma renal malign infant-Wilms tm renal malign child-Wilms tm Wilms tm bone met-clear sarcomaLarge intestine malign GIT-ca colon(adenoca) bm tm rectum-adenoma(tubular) adenoma rectum with malign potential-villousLarynx tm larynx-SCC bn tm larynx-papillomatosis vasc tm larynx-hemangiomaLeukemia lymphoma-non Hodgkin> Hodgkin lymphoma Hodgkin lymphoma World-NS>MC Hodgkin lymphoma child-NS Hodgkin lymphoma India-MC Hodgkin lymphoma fem-MC Hodgkin lymphoma EBV+ve-risk-LD, incid-MC Hodgkin lymphoma EBV–ve-NS Hodgkin lymphoma HIV-LD

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non Hodgkin lymphoma-B(85%)> T(15%) BNHL-DLBCL> Burkitt lymphoma NHL skin,thymus,testis child-T> B lymphoma Nasal cavity-NK cell malign HIV-lymphoma(BNHL-DLBCL> Burkitt lymphoma)> Kaposi sarcoma lymphoma AIDS-immunoblastic lymphoma cause AIHA-BCLL/SLL tm LN-met leukemia adult-CLL leukemia child-ALL malign adolescence-lymphoma posttransplant lymphoma-BNHL(DLBCL> Burkitt) lymphoma Spleen-nonHodgkin(Small lymphocytic) malign a/w erythroderma-cut Tcell lymphoma malign Sweet synd-a/c myelogenous leukemia malign post heart transpl-post transpl lymphoproliferat ds> ca lung malign post lung transpl-<2y-post transpl lymphoproliferative ds, >2y-SCC skinLiver tm liver-met prim tm liver-cavernous hemangioma prim malign liver-HCC prim for hep met-ca colon> ca breast malign liver child-hepatoblastomaLung tm lung-met prim for lung met-brain> adrenal(most detected) prim malign lung-World,fem,nonsmoker,Asbestosis-Adenoca, India,mal,smoker,hypercalcem-SqCC, aggressive,paraneoplastic synd-SmCC tm pleura-metMediastinum mediast tm adult-neurogenic tm(23%)> thymoma mediast tm child-neurogenic tm tm ant mediast-thymoma tm middle mediast-lymphoma tm post mediast-neurogenic tm(neurofibroma, neurilemmoma)Mesentery bn tm mesentery-chylolymphatic cyst> lipoma malign mesentery-lymphoma> fibrosarcomNose bn tm nose-capillary hemangioma/blding polypus> inverted papilloma malign nose-SCC bn tm nasopharynx-angiofibroma ca nasopharynx-III

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Omentum solid tm omentum-metOral cavity malign lip-SCCOrbit bn tm orbit adult-cavernous hemangioma malign orbit adult-met> lymphoma prim for met orbit adult-breast> bronch> prostate> skin tm orbit chiLd-capiLL hemangioma> dermoid cyst malign orbit child-rhabdomyosarcoma prim for met orbit child-neuroblastoma tm periorbit area child-capill hemangioma periph n tm orbit-plexiform neurofibromaOvary tm ovary-serous cystadenoma malign ovary-serous cystadenoca tm ovary preg-dermoid cyst malign ovary preg-dysgerminoma tm ovary young fem-dysgerminoma tm ovary torsion-dermoid cyst GCT-dermoid cyst GC malign-immature teratoma GCT best progn-dysgerminoma GCT worst progn-endoderm sinus/yolk sac tm tm ovary a/w endometriosis-clear cell tm a/w dermatomyositis-ca ovaryPalate malign palate-adenocaPancreas tm pancr-adenoca bn tm pancr-insulinoma non fn pancr tm-parapolypeptidomaPenis malign penis-SCCPeritoneum tm peritoneum-metPituitary gld tm ant pituitary-prolactinomaPlacenta prim for met to placenta-melanomaPNS bn tm PNS-inverted papilloma malign PNS-SCC> adenoca

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Prostate malign prostate-adenoca malign mal >65y-adenoca prostateSalivary gld sal gld tm-pleomorph adenoma(mixed tm) sal gld malign-mucoepidermoid ca> medullary ca min sal gld tm-adenoid cystic ca min sal gld malign-mucoepidermoid ca parotid gld tm child-hemangioma> lymphangioma> mucoepidermoid caSkin malign skin-BCC(nodular) malign head&neck-SCC malign post kidn transpl-SCCskin+lip> cx melanoma-superf spreading melanoma black,Asian,hippanic-acral lentiginous melanom perineur invasion-desmoplasticSmall intestine bn tm SI-adenoma sympt bn tm SI-leiomyoma bn tm duod-adenoma malign SI-adenoca(polypoid)> carcinoid lymphoma GIT-DLBCL> Burkitt lymphoma malign GIT child-lymphoma enteropancr tm-gastrinomaSoft tissue soft ts tm-lipoma soft ts sarcoma adult-malign fibrous histiocytoma> liposarcoma soft ts sarcoma young adult-synovial cell sarcoma hemangioma-capillary soft ts tm child-hemangioma soft ts sarcoma child-rhabdomyosarcoma rhabdomyosarcoma-embryonal tm hand-ganglionSpinal cord spin cord tm-met prim spinal cord tm-nerve sheath tm intramedullary spinal cord tm-ependymomaStomach tm stom-leiomyoma bn tm stom-leiomyoma> adenoma malign stom-adenoca mesenchymal tm GIT-GIST mesenchymal tm stom-GIST(spindle)

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lymphoma stom-DLBCLTestis tm testis-mixed> seminoma(typical) tm undescend testis-gonadoblastoma malign undescend testis-seminoma tm testis child-yolk sac tm tm testis puberty-teratoma tm testis old age-lymphomaThyroid gld tm thy-papillary ca bn tm thy-follicular adenoma tm thy child-papillary ca tm thy a/w MEN II-Medullary ca tm thy a/w goitre-follicular ca tm thy a/w LN met-papillary ca tm thy a/w Cowden synd-papillary ca tm thy a/w Hashimoto thyroiditis-papillary ca tm thyroglossal cyst-papillary ca prim for thy met-breast>lungTonsil malign tonsil child-lymphoma malign tonsil aduld-mucoepidermoid caUB tm UB-transitional cell ca malign in ectopia vesicae-adenoca malign SChistosomiasis-SCC UB prim for UB met-melanomaUterus pelvic tm fem-leiomyoma/fibroid uterus tm uterus-leiomyoma(intramural> subserosal >submucosal) malign uterus-adenoca ca endom-endometrioid ca PTEN ass tm-ca endometrium type1 ca cx-SCC sarcoma uterus-leiomyosarcoma

tm—marker—HPE angiomyolipoma-HMB45-— angiosarcoma-CD34,31,fact VIIIa,XIIIa-— BCC skin-—-nuclear palisading bn fibrohistiocytoma-vimentin,CD68-— Brenner-—-Walthard cell nest,puffed Wheat nuclei ca breast-CEA,CA15-3,HER2neu-—

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ca breast lobular-—-Indian file ca colon-CEA,CA19-9,50,242-— ca lung SmCC-—-azzopardy effect ca meD thy-calcitonin,neuron sp enolase-amyloiD ca ovary-HER2neu-— ca pancr-CEA,CA19-9,50,242-— ca pap thy-thyroglobulin-Orphan Annei eye nucleus,Psammoma body ca prostate-acid phosphatase,PSA-— ca stom-CEA,CA19-9,50,72-4,125,242,βhCG,HER2neu-— ca UB-FGF-— carcinoid-5HIAA-— chordoma-—-physaliferrous cell ChorioCa-hCG-— clearcell/mesonephroid-—-hobnail cell Dermoid cyst-—-Rokitansky boDy dysgerminoma-LDH,AFP,hCG-— embryonal ca-βhCG+AFP-— epithelial(ca)-cytokeratin-— epith ovary ca-CA125-— epitheloid sarcoma-epith membAg(EMA)-— fibrolamellar ca liver-neurotensin-— fibroma-vimentin-— fibrosarcoma-vimentin-— GIST-CD117(C-KIT),CD34,DOG1(best),S100,SMA,BCL2,prot kinase Cθ-— GLioblastoma(WHO grade IV)-—-pseudopalisading,GLomeruloid vess glioma-GFAP(GlialFibrillaryAcidProt),VEGF-— granulosa cell tm-inhibin-Call Exner body HCC-AFP,HepPar1,arginase,PIVKA2,neurotensin,hepatocyteGF-— hemangioma-CD34,31,fact VIIIa,XIIIa-— hematolymphoid cell-CD45(common leucocyte Ag)-— hilus/Leydig cell tm-—-Reinke crystal Kaposi sarcoma-CD34,31,fact VIIIa,XIIIa-— Krukenberg tm-—-signet ring cell leiomyoma-sm m actin(SMA),desmin-— Medullary ca sal gld-—-Mucin,keratinising stratif sq epith melanoma-S100,HMB45-— meningioma-—-whorling,Psammoma body mesenchymal-vimentin-— mesothelioma-cytokeratin,calretinin-— mucinous CystadEnomA-CEA-— multiple myeloma-Ig-— myocyte(smooth/skeletal)-desmin-— myxoma heart-—-spider cell

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neuroblastoma-neuron sp enolase,HVA,VMA-— neurofibroma-S100-— nonseminomatous testis-hCG,AFP-— oligodendroglioma-—-fried egg app optic n glioma-GFAP-hair like projection,rosenthal fibre osteosarcoma-alk phosphatase-— pheochromocytoma-HVA,VMA-Zelballen pleomorph adenoma-—-chondromyxoid material rhabdomyosarcoma-desmin,myogenin,myoD1(best)-spider cell Schwannoma-S100-— serous cystadenom ovary-—-Psammoma body SqCC lung-CEA-keratin pearl,keratinization synovial sarcoma(unknown cell origin)-Mic2(CD99),cytokeratin,epith memb Ag(EMA)-epitheloid/spindle cell trophoblastic-hCG-— yoLksac/enDoDermaL sinus-AFP,LDH- Schillar Duval body

tm-gene Burkitt lymphoma-cmyc ca breast-BRCA1,2,PTEN ca breast mal-BRCA2 ca Colon-KRAS,Cmyc,PTEN ca endometrium(1)-PTEN ca esoph-p53 ca lung-KRAS ca SmCC Lung-Lmyc ca ovary-BRCA1 ca pancr-PTEN,P53,BRCA2,KRAS ca prost-PTEN,GSTP1,RASSF1A,AMACR ca stom-p16,53,cox2 ca thy folli-PTEN,p53,RAS,PAX8/PPAR1 ca thy mEd-RET GIST-ckit HCC-βcatenin hepatoblastoma-βcatenin melanoma-BRAF Neuroblastoma-myc RCC-HRAS

tm-route of spread BCC-transepith brochoalveolar ca-lepidic ca ovary-direct invasion into peritoneum

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ca thy follicular-bld ca thy papillary-lymph carcinoma-lymph chorioca-bld HCC-bld Krukenberg tm-transcoelomic, retrograde lymph malign melanoma-lymph medulloblastoma-drop met RCC-bld sarcoma-bld

PROGNOSTIC FACTORALLGood: age=2-10y hyperploidy TLC<5000/mm³ t(12;21) femBad: Black age<2y,>10y TLC>50000/mm³ pre Bcell ALL t(9;22),t(4;11),MLL-AF4 mal met-mening,testis LNpathy

AMLGood: age<40y t(8;21),t(15;17),i(16) TLC<25000/mm³ M2,3,4 blast cell with Auer rod leukemia without preceding MDSBad: extreme age<2y,>55y myeloid sarcoma i(3),t(3;3),t(6;9),t(6;11),t(10;11)t(9;22) monosomy5,7,20 11q23,3q21,3q26,FLT3,MDR1

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TLC>1lac/mm³ M0,6,7 leukemia with preceding MDS anticancer drug exposure

BCLL/SLLGood: ZAP>0

Burkitt lymphoma MiB1(Ki67) labelling index-proliferative index=100%

carcinomaBad: invasion(basement memb)

ca adrenal gld size

ca breast major prognostic criteria LN met/axillary LN status tm size distant met invasive ca in situ locally advanced ds inflammatory ca

good prog marker ER+ve PR+ve HER2neu–ve diploidy low cathepsin D tubular tm labelling index<3%

Nottingham prog criteria (0.2×size)+grade+LN

ca cx stage>LN

ca colonGood:

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rectal bldingBad: LN&stage age<30y colon obstruct mal rectum

ca endometrium histologic type

ca esoph TNM staging

ca GB depth of invasion

ca penis LN

ca stom depth of invasion>node

ca thy(MACIS) Age Met Completeness of resection Invasion Size

ca UB depth of invasion

CNS tm histologic grade

Ewing sarcomaBad: dist met↑ size

prox locat↑ fever,anem, TLC,ESR,LDH

↑ age

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mal

GISTBad: size>5cm met mitotic index>5/HPF cellular atypia necrosis ckit mutat

GTN/choriocaBad: age≥40y hCG≥10000IU/l full term preg duration≥12mth tm size>5cm met>8 site of met-liver&brain prev h/o multi agent CT

hairy cell leukemiaGood: age>60y

Hodgkin lymphomaBad: age>45y stage IV mal Hb<10.5g%(anem) WBC≥15000/mm³(15×10^9/l) ALC<600/μl,DLC<8% sr alb<4g/dl LDHL EBV+ve

malignant melanoma depth of invasion BrESlow(BESt)>Clarke

Multiple Myeloma

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β2 Microglobin level

NeuroblastomaBad: age>18mth Schwannian stroma,gangliocytic differ entiat-absent Nmyc gene absent TrkA-Absent TrkB-present telomerase-highly expressed 1p,11q,17q loss present near diploid stage-3,4 karyorrhexis mitosis index>200/5000

non Hodgkin lymphoma-International prog factorBad: Age>60y stage>II >1 extranodal organ involvem↑ sr LDH

performance status risk-high=4-5,interm=2-3,low=0-1

oral ca LN

pheochromocytomaBad: met invasion of surround ts

RCC Robson path stagingGood: chromophobe papillary type IBad: sarcomatoid

sarcomaBad: mitosis,necrosis

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soft ts sarcoma stage&grade

tm hollow visceral organ depth of invasion

Wilms tm stage&histology(Devita) LOH at 1P(CamPbell)

Abbreviations a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch, Bx-biopsy ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral, conc-concentration, cong-congenital, Cx-cervix d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis E-estrogen fem-female, fr-from gld-gland, glu-glucose h-hormone idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury lig-ligament, LL-lower limb, l/t-leading to m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor, mtx-methotrexate, Mx-management n-nerve, norm-normal P-progesterone, pl-plasma, prot-protein, pt-patient Rx-treatment SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure tm-tumour, ts-tissue UL-upper limb, u/l-unilateral vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume w-week, wt-weight Xr-X ray y-year #-fracture °-degree

-THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS. Aim

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