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Section II General Surgery P203Surgical Recall Sixth > Soft Tissue Sarcomas and Lymphomas, C62 P464-468 > Flashcards

Soft Tissue Sarcomas and Lymphomas, C62 P464-468 Flashcards

1
Q

SOFT TISSUE SARCOMAS
What are they?
P464

A

Soft tissue tumors, derived from mesoderm

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2
Q

SOFT TISSUE SARCOMAS
Sarcoma means what in
GREEK?
P464

A

“Fish flesh”

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3
Q 
SOFT TISSUE SARCOMAS
Sarcomas are more common
in upper or lower
extremities?
P464
A

50% of sarcomas are in the extremities
and are 3.5 more common in the
lower extremity (thigh)

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4
Q

SOFT TISSUE SARCOMAS
How common are they?
P464

A

0.6% of malignant tumors

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5
Q

SOFT TISSUE SARCOMAS
What is the median age at
diagnosis?
P464

A

55 years

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6
Q

SOFT TISSUE SARCOMAS
What are the risk factors?
P464

A 
“RALES”:
    Radiation
    AIDS (Immunosuppression)
    Lymphedema
    Exposure to chemicals
    Syndromes (e.g., Gardner’s/Li-Fraumeni)
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7
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Fat
P464
A

Liposarcoma

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8
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Gastrointestinal
P464
A

GIST (GastroIntestinal Stromal Tumor)

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9
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Myofibroblast
P464
A

Malignant fibrous histiocytoma

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10
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Striated muscle
P464
A

Rhabdomyosarcoma

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11
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Vascular endothelium
P464
A

Angiosarcoma

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12
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Fibroblast
P464
A

Fibrosarcoma

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13
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Lymph vessel
P465
A

Lymphangiosarcoma

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14
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Peripheral nerve
P465
A

Malignant neurilemmoma or

schwannoma

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15
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
AIDS
P465
A

Kaposi’s sarcoma

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16
Q 
SOFT TISSUE SARCOMAS
Name the following types of
malignant sarcoma:
Lymphedema
P465
A

Lymphangiosarcoma

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17
Q

SOFT TISSUE SARCOMAS
What are the signs/
symptoms?
P465

A

Soft tissue mass; pain from compression
of adjacent structures, often noticed after
minor trauma to area of mass

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18
Q

SOFT TISSUE SARCOMAS
How do most sarcomas
metastasize?
P465

A

Hematogenously (i.e., via blood)

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19
Q 
SOFT TISSUE SARCOMAS
What is the most common
location and route of
metastasis?
P465
A

Lungs via hematogenous route

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20
Q

SOFT TISSUE SARCOMAS
What tests should be done
in the preoperative workup?
P465

A

CXR, ± chest CT, LFTs

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21
Q 
SOFT TISSUE SARCOMAS
What are the three most
common malignant sarcomas
in adults?
P465
A

Fibrous histiocytoma (25%)
Liposarcoma (20%)
Leiomyosarcoma (15%)

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22
Q

SOFT TISSUE SARCOMAS
What are the two most
common in children?
P465

A

Rhabdomyosarcoma (about 50%),

fibrosarcoma (20%)

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23
Q 
SOFT TISSUE SARCOMAS
What is the most common
type to metastasize to the
lymph nodes?
P465
A

Malignant fibrous histiocytoma

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24
Q 
SOFT TISSUE SARCOMAS
What is the most
common sarcoma of the
retroperitoneum?
P465
A

Liposarcoma

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25
Q

SOFT TISSUE SARCOMAS
How do sarcomas locally
invade?
P465

A

Usually along anatomic planes such as

fascia, vessels, etc.

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26
Q

SOFT TISSUE SARCOMAS
How is the diagnosis made?
P465

A 
Imaging workup—MRI is superior to
    CT at distinguishing the tumor from
    adjacent structures
Mass 3 cm: incisional biopsy or core
biopsy
27
Q

SOFT TISSUE SARCOMAS
Define excisional biopsy.
P466

A

Biopsy by removing the entire mass

28
Q

SOFT TISSUE SARCOMAS
Define incisional biopsy.
P466

A

Biopsy by removing a piece of the mass

29
Q 
SOFT TISSUE SARCOMAS
What is the orientation of
incision for incisional biopsy
of a suspected extremity
sarcoma?
P466
A

Longitudinal, not transverse, so that the
incision can be incorporated in a future
resection if biopsy for sarcoma is positive

30
Q

SOFT TISSUE SARCOMAS
Define core biopsy.
P466

A

Large-bore needle that takes a core of

tissue (like a soil sample)

31
Q

SOFT TISSUE SARCOMAS
What determines histologic
grade of sarcomas?
P466

A
  1. Differentiation
  2. Mitotic count
  3. Tumor necrosis
    Grade 1 = well differentiated
    Grade 2 = moderately differentiated
    Grade 3 = poorly differentiated
32
Q 
SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage I
P466
A 
Well differentiated (grade 1), any size, no
nodes, no metastases
33
Q 
SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IIA
P466
A

< 5 cm, grade 2 or grade 3

34
Q 
SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IIB
P466
A

> 5 cm, grade 2

35
Q 
SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage III
P466
A

Positive nodes or >5 cm and grade 3

36
Q 
SOFT TISSUE SARCOMAS
Define the following
American Joint Committee
for Cancer Staging (AJCC)
Sarcoma Stages:
Stage IV
P466
A

Distant metastases

37
Q

SOFT TISSUE SARCOMAS
What is a pseudocapsule and
what is its importance?
P466

A 
Outer layer of a sarcoma that represents
compressed malignant cells; microscopic
extensions of tumor cells invade through
the pseudocapsule into adjacent
structures—thus, definitive therapy must
include a wide margin of resection to
account for this phenomenon and not
just be “shelled-out” like a benign growth
38
Q

SOFT TISSUE SARCOMAS
What is the most important
factor in the prognosis?
P466

A

Histologic grade of the primary lesion

39
Q

SOFT TISSUE SARCOMAS
What is the treatment?
P467

A

Surgical resection and radiation (with or

without chemotherapy)

40
Q

SOFT TISSUE SARCOMAS
What surgical margins are
obtained?
P467

A

2 cm (1 cm minimum)

41
Q 
SOFT TISSUE SARCOMAS
What is the “limb-sparing”
surgery for extremity
sarcoma?
P467
A

Avoidance of amputation with local

resection and chemoradiation

42
Q

SOFT TISSUE SARCOMAS
What is the treatment of
pulmonary metastasis?
P467

A

Surgical resection for isolated lesions

43
Q

SOFT TISSUE SARCOMAS
What tests should be done
in the follow-up?
P467

A

Physical examination, CXR, repeat CT/
MRI of the area of resection to look for
recurrence

44
Q 
SOFT TISSUE SARCOMAS
What syndrome of lymphangiosarcoma
arises in chronic
lymphedema after axillary
dissection for breast cancer?
P467
A

Stewart-Treves syndrome

45
Q 
SOFT TISSUE SARCOMAS
What syndrome is associated
with breast cancer and soft
tissue sarcoma?
P467
A

Li-Fraumeni syndrome (p53 tumor

suppressor gene mutation)

46
Q

LYMPHOMA
How is the diagnosis made?
P467

A

Cervical or axillary node excisional biopsy

47
Q 
LYMPHOMA
What cell type is associated
with the histology of
Hodgkin’s disease?
P467
A

Reed-Sternberg cells

48
Q 
LYMPHOMA
What are the four
histopathologic types
of Hodgkin’s disease?
P467
A 
1. Nodular sclerosing (most common;
    ≈50% of cases)
2. Mixed cellularity
3. Lymphocyte predominant (best
    prognosis)
4. Lymphocyte depleted
49
Q 
LYMPHOMA
What are the indications for
a “staging laparotomy” in
Hodgkin’s disease?
P467
A

Rarely performed
Most experts rely on CT scans, PET
scans, bone marrow biopsy, and other
directed imaging and biopsies

50
Q 
LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage I
P468
A

Single lymph node region (Think:

Stage 1 = 1 region)

51
Q 
LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage II
P468
A

Two or more lymph node regions on
the same side of the diaphragm
(Think: Stage 2 = >2 regions)

52
Q 
LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage III
P468
A

Involvement on both sides of the

diaphragm

53
Q 
LYMPHOMA
Define the stages (Ann Arbor)
of Hodgkin’s disease:
Stage IV
P468
A

Diffuse and/or disseminated involvement

54
Q

LYMPHOMA
What is stage A Hodgkin’s?
P468

A

Asymptomatic (Think: Asymptomatic

stage A)

55
Q

LYMPHOMA
What is stage B Hodgkin’s?
P468

A

Symptomatic: weight loss, fever, night

sweats, etc. (Think: Stage B = Bad)

56
Q

LYMPHOMA
What is the “E” on the
staging?
P468

A

Extralymphatic site involvement

E = Extralymphatic

57
Q 
LYMPHOMA
What treatments are used
for low versus advanced
stage Hodgkin’s lymphoma?
P468
A

Low stage: radiotherapy

Advanced stage: chemotherapy

58
Q 
LYMPHOMA
What percentage of patients
with Hodgkin’s disease can
be cured?
P468
A

≈80%

59
Q

GI LYMPHOMA
What is it?
P468

A

Non-Hodgkin’s lymphoma arising in the

GI tract

60
Q

GI LYMPHOMA
What is the risk factor for
gastric lymphoma?
P468

A

Helicobacter pylori

61
Q

GI LYMPHOMA
What are the signs/
symptoms?
P468

A

Abdominal pain, obstruction, GI

hemorrhage, GI tract perforation, fatigue

62
Q

GI LYMPHOMA
What is the treatment of
intestinal lymphoma?
P468

A

Surgical resection with removal of

draining lymph nodes and chemotherapy

63
Q 
GI LYMPHOMA
What is the most common
site of primary GI tract
lymphoma?
P468
A

Stomach (66%) (see Maltoma, p. 281)

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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