This document summarizes ovarian sex cord-stromal tumors. It discusses that these tumors are clinically significant and heterogeneous, accounting for around 5% of ovarian cancers in women aged 15-24. They often present with hormonal manifestations or a pelvic mass. Histologic subtypes include granulosa cell tumors, Sertoli-Leydig cell tumors, and others. Recent studies have found associations between certain subtypes and genetic mutations like DICER1 mutations. Treatment typically involves surgery, with chemotherapy sometimes used for higher stages. Prognosis depends on stage and tumor characteristics. Further research is needed to better understand the epidemiology and develop targeted therapies for these rare tumor types.
Testicular microlithiasis (TML) refers to small calcium deposits within the seminiferous tubules of the testes that are typically detected on ultrasound. While TML was once thought to increase the risk of testicular cancer, more recent evidence suggests it does not increase risk in the absence of other risk factors or a testicular mass. For patients at high risk, such as those with infertility or genetic disorders, surveillance with ultrasound or consideration of biopsy may be warranted to check for early signs of cancer. Overall, reassurance can be provided to most patients with isolated TML and no other risk factors, with education on self-exam the most important factor. Management depends on risk stratification based on presence of masses
This document discusses ovarian tumors, specifically germ cell tumors. It provides information on the classification, histopathology, immunoprofile, and other characteristics of various types of ovarian germ cell tumors including dysgerminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, immature teratoma, and mature cystic teratoma. It also mentions other rare subtypes such as struma ovarii. The document aims to provide pathology residents with comprehensive information on diagnosing and classifying these tumor types.
This document discusses neuroblastoma and nephroblastoma (Wilms tumor). Neuroblastoma is the most common extracranial solid tumor in children, arising from the sympathetic nervous system. It presents heterogeneously from spontaneous regression to aggressive forms. The causes are largely unknown. Nephroblastoma (Wilms tumor) is the most common malignant renal tumor of childhood. Both tumors are diagnosed through imaging and urine/blood tests. Prognosis and treatment varies depending on tumor histology and staging. Aggressive forms of neuroblastoma and anaplastic Wilms tumor remain difficult to treat.
Primary Endometrial Stromal Sarcoma arising from Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides information about testicular pathology, including epididymitis, orchitis, and testicular tumors. It discusses the normal histology of the testis and epididymis. It describes the causes and pathology of epididymitis and orchitis, including non-specific, granulomatous, gonorrhea and tuberculosis types. It then covers the classification and features of testicular tumors, separating them into germ cell tumors and sex cord stromal tumors. Within germ cell tumors it discusses seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma and mixed germ cell tumors.
Neuroblastoma is a cancer of the sympathetic nervous system that most commonly affects infants and young children. It ranges in severity from tumors that spontaneously regress to very aggressive cases. Treatment involves surgery, chemotherapy, radiation, and stem cell transplants. Outcomes depend on risk factors like age and tumor stage, with low-risk cases having over 90% survival and high-risk cases having 25-35% long-term survival with intensive multimodal therapy. Stage 4S neuroblastoma in infants has an excellent prognosis often without treatment beyond symptom relief.
This document summarizes ovarian tumors. It notes that ovarian tumors are common in women and most are benign. Malignant tumors often spread beyond the ovaries at diagnosis. Risk factors for carcinoma include nulliparity and family history. Ovarian tumors are classified into surface epithelial tumors, germ cell tumors, sex cord stromal tumors, and other categories. Within sex cord stromal tumors are Sertoli-Leydig cell tumors and steroid cell tumors. Metastatic tumors from other organs like the stomach or colon can also involve the ovaries.
Testicular microlithiasis (TML) refers to small calcium deposits within the seminiferous tubules of the testes that are typically detected on ultrasound. While TML was once thought to increase the risk of testicular cancer, more recent evidence suggests it does not increase risk in the absence of other risk factors or a testicular mass. For patients at high risk, such as those with infertility or genetic disorders, surveillance with ultrasound or consideration of biopsy may be warranted to check for early signs of cancer. Overall, reassurance can be provided to most patients with isolated TML and no other risk factors, with education on self-exam the most important factor. Management depends on risk stratification based on presence of masses
This document discusses ovarian tumors, specifically germ cell tumors. It provides information on the classification, histopathology, immunoprofile, and other characteristics of various types of ovarian germ cell tumors including dysgerminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, immature teratoma, and mature cystic teratoma. It also mentions other rare subtypes such as struma ovarii. The document aims to provide pathology residents with comprehensive information on diagnosing and classifying these tumor types.
This document discusses neuroblastoma and nephroblastoma (Wilms tumor). Neuroblastoma is the most common extracranial solid tumor in children, arising from the sympathetic nervous system. It presents heterogeneously from spontaneous regression to aggressive forms. The causes are largely unknown. Nephroblastoma (Wilms tumor) is the most common malignant renal tumor of childhood. Both tumors are diagnosed through imaging and urine/blood tests. Prognosis and treatment varies depending on tumor histology and staging. Aggressive forms of neuroblastoma and anaplastic Wilms tumor remain difficult to treat.
Primary Endometrial Stromal Sarcoma arising from Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides information about testicular pathology, including epididymitis, orchitis, and testicular tumors. It discusses the normal histology of the testis and epididymis. It describes the causes and pathology of epididymitis and orchitis, including non-specific, granulomatous, gonorrhea and tuberculosis types. It then covers the classification and features of testicular tumors, separating them into germ cell tumors and sex cord stromal tumors. Within germ cell tumors it discusses seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma and mixed germ cell tumors.
Neuroblastoma is a cancer of the sympathetic nervous system that most commonly affects infants and young children. It ranges in severity from tumors that spontaneously regress to very aggressive cases. Treatment involves surgery, chemotherapy, radiation, and stem cell transplants. Outcomes depend on risk factors like age and tumor stage, with low-risk cases having over 90% survival and high-risk cases having 25-35% long-term survival with intensive multimodal therapy. Stage 4S neuroblastoma in infants has an excellent prognosis often without treatment beyond symptom relief.
This document summarizes ovarian tumors. It notes that ovarian tumors are common in women and most are benign. Malignant tumors often spread beyond the ovaries at diagnosis. Risk factors for carcinoma include nulliparity and family history. Ovarian tumors are classified into surface epithelial tumors, germ cell tumors, sex cord stromal tumors, and other categories. Within sex cord stromal tumors are Sertoli-Leydig cell tumors and steroid cell tumors. Metastatic tumors from other organs like the stomach or colon can also involve the ovaries.
Management of gynecological cancers in older womenSpringer
This chapter discusses the pathology of several gynecologic cancers that occur in older women, including endometrial cancer, ovarian cancer, and cancers of the cervix and vulva. For endometrial cancer, it reviews the main subtypes of endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated carcinoma, and carcinosarcoma. It discusses characteristics such as histology, molecular markers, risk factors like tamoxifen use, and association with Lynch syndrome. For ovarian cancer, it focuses on serous carcinoma and its link to BRCA abnormalities.
This document summarizes key information from a presentation on early diagnosis of cancer in neonates and young infants. It discusses how cancer can present non-specifically in infants, with symptoms like lethargy and feeding difficulties. Several common childhood cancers are mentioned, including neuroblastoma, Wilms tumor, retinoblastoma, and leukemia. Challenges in diagnosing and treating neonatal cancer are outlined, such as the need for specialized pathology expertise and reduced chemotherapy doses. The presentation concludes with acknowledgements and a call for improved early diagnosis and shared care models for childhood cancer.
Childhood abdominal tumors are difficult to detect but are a leading cause of cancer death in children. Common tumors include neuroblastoma, Wilms tumor, and rhabdomyosarcoma. Neuroblastoma originates from neural crest cells and most commonly presents as an abdominal mass in children under 2 years old. Histopathology shows small round blue cells with rosettes. Molecular markers include MYCN amplification and mutations in the ALK gene. Wilms tumor accounts for 90-95% of pediatric kidney tumors and has a mean age of diagnosis of 36 months.
Nephroblastoma also known as Wilms tumor, is the most common renal malignancy affecting one in 10,000 children <15 years old
Children with bilateral disease are diagnosed at an earlier age (median age, girls at 31 months and boys at 24 months): Patients with associated congenital anomalies are also diagnosed at an earlier age
Accounts for 6-7% of cases of childhood cancer in the developed world and 12% in South Africa
In Tanzania the prevalence is 6.7% ( Mgaya E et al., 2000), “third from leukemia and lymphoma” (Shakilu J, 2017)
The overall survival rate of nephroblastoma approaches 90% in the developed world but in developing countries the survival rates are much less and in some sub-Saharan countries it is only 40% at 8 months after diagnosis
These may occur in 1% of infantile kidneys but typically regress during childhood
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Has been associated with loss of function mutations of a number of tumor suppressor and transcription genes
These include mutations of the WT1, p53, FWT1, and FWT2 genes and at the 11p15.5 locus
Histologically, the classic favorable histology Wilms tumor is comprised of three cell types:
Blastemal cells – Undifferentiated cells
Stromal cells – Immature spindle cells and heterologous skeletal muscle, cartilage, osteoid or fat
Epithelial cells – Glomeruli and tubules
Grossly, Wilms tumors are usually well-circumscribed and have a pseudo-capsule
Histologically, Wilms is divided into "Favorable" and "Unfavorable" histologies
"Favorable" Histology: 90% of Wilms tumors will demonstrate "favorable" histology which generally has a better prognosis
Most children with Wilms tumor present with an abdominal mass or swelling without other signs or symptoms
The definitive diagnosis of Wilms tumor is made by histologic confirmation at the time of either surgical excision or biopsy
Stage I indicates the tumor was completely contained within the kidney without any breaks or spillage outside the renal capsule and no vascular invasion
Stage II would be a tumor that has grown outside the kidney
Stage IIIunresectable tumor
Stage IV-Metastasis
Stage V-bilateral kidney
Surgery is the main treatment
This document summarizes breast cancer risk factors, etiology, pathogenesis, classification, and carcinogenesis. It notes that breast cancer is most common in women over 30 and risk increases with age. The majority are estrogen receptor positive. Risk factors include family history, age of first birth, obesity, and hormone exposure. Cancers arise from genetic mutations in cells like luminal cells and can follow hereditary or sporadic pathways. Cancers are classified as either carcinoma in situ, confined to ducts/lobules, or invasive carcinoma penetrating the basement membrane. Carcinogenesis is a multi-step process as cells acquire mutations driving proliferation.
This document discusses testicular cancer, including:
- Risk factors include history of undescended testes, contralateral testicular tumor, or Klinefelter syndrome.
- Tumors are classified as germ cell tumors (most common), interstitial cell tumors, lymphoma, or other rare tumors.
- Seminoma and non-seminomatous germ cell tumors (NSGCT) are the main types of germ cell tumors.
- Diagnostic workup includes scrotal ultrasound, serum tumor markers, chest imaging and lymph node assessment to determine clinical stage according to the TNM system.
The document provides information on evaluating and managing solitary thyroid nodules. It discusses obtaining a detailed history, performing a physical exam focusing on the thyroid and lymph nodes, and using diagnostic tests like ultrasound, biopsy, and bloodwork. Fine-needle aspiration biopsy is the most important test, and can determine if a nodule is benign, suspicious, malignant, or nondiagnostic. Treatment depends on biopsy results and risk factors, and may include observation, surgery, radiation, or medication. The document outlines common thyroid cancers like papillary and follicular carcinoma.
This document discusses testicular cancer, including:
- Germ cell tumors account for 90-95% of testicular cancers and are divided into seminomas and non-seminomatous germ cell tumors.
- Tumor markers like AFP, HCG, and LDH help with staging, prognosis, and monitoring of disease.
- Testicular cancers typically spread through the lymphatic system to retroperitoneal lymph nodes.
- Ultrasound has near 100% sensitivity for detecting testicular tumors when combined with physical exam. MRI can also characterize tumors when ultrasound is equivocal.
1. cancer care.pdf medical surgical nursing 1akoeljames8543
This document provides an overview of cancer principles and concepts in Kenya. It discusses Kenya's health policy goals to address rising non-communicable diseases like cancer. Cancer arises due to uncontrolled cell growth and can spread through the body. Risk factors include genetics, behaviors, age, and environmental exposures. Diagnosis relies on tissue biopsy. Cancer management involves multidisciplinary teams. Prevention strategies include screening and avoiding risk factors. Genetic testing can assess cancer risk in families with predispositions. The cell cycle is important to understand cancer development.
This PPT presentation talks about osteosarcoma from the clinical point of view, summarizing the recent guidelines in diagnosis and treatment of osteosarcoma.
This document discusses ovarian cysts including their types, clinical presentation, diagnosis, and management. It covers the normal sizes of ovaries at different ages, types of benign cysts such as functional, inflammatory, and epithelial cysts. Diagnosis involves physical exam, ultrasound, and tumor markers. Small unilateral cysts without solid areas can often be observed. Suspicious cysts require surgery. Laparoscopy is preferred when possible for removal of benign cysts.
Solid tumors are abnormal masses of tissue that do not contain cysts or liquid areas. Over 85% of cancers are solid tumors, including cancers of the brain, breast, colon and other tissues. The pathogenesis of solid tumors involves multiple genetic mutations that cause cells to proliferate uncontrollably over several stages, eventually allowing malignant tumors to form and metastasize. Some key mechanisms in tumor development include changes to oncogenes and tumor suppressor genes, alterations in cancer cells that influence growth and structure, and invasion enabling spread through the bloodstream.
This document provides information on pediatric malignant solid tumors, including Wilms tumor (nephroblastoma), neuroblastoma, and rhabdomyosarcoma. It discusses the epidemiology, histology, clinical presentation, risk classification, diagnostic workup, and standard treatment approaches for each of these tumor types. Pediatric cancer is the second leading cause of death in children, though survival rates have improved to over 70% with modern multimodal therapy.
GROUP 1 Case 967-- A Teenage Female with an Ovarian MassCLI.docxgilbertkpeters11344
GROUP 1: Case 967-- A Teenage Female with an Ovarian Mass
CLINICAL HISTORY
A teenage female presented with secondary amenorrhea (https://www.healthline.com/health/secondary-amenorrhea#causes). The patient had 1 menstrual cycle 3 years ago and has had no menses since. Laboratory work-up was negative for pregnancy test, mildly increased calcium level (11.7 mg/dL, normal range: 8.5-10.2 mg/dL) and CA 125 (43 Units/ml, normal range: 0-20 Units/ml). Prolactin, TSH, AFP, Inhibin A, Inhibin B and CEA were normal. Imaging revealed a 13 x 11.8 x 8.6 cm, predominately cystic left pelvis mass, with multiple internal septations. Her past medical history was not contributory. Patient underwent left salpingo-oophorectomy (https://www.healthline.com/health/salpingo-oophorectomy), omentectomy (https://moffitt.org/cancers/ovarian-cancer/omentectomy/) and tumor debulking (https://en.wikipedia.org/wiki/Debulking) with intraoperative frozen section consultation.
GROSS EXAMINATION
The 930.9 g tubo-ovarian complex consisted of a 20.0 x 16.0 x 8.0 cm large mass, with no recognizable normal ovarian parenchyma grossly and an unremarkable fallopian tube. The cut surface was gray, "fish-flesh", soft with foci of hemorrhage and necrosis.
MICROSCOPIC EXAMINATION
Microscopically, the majority of main tumor was growing in large nests, sheets and cords with focal follicle-like structures and geographic areas of necrosis. It was predominantly composed of small cells with hyperchromatic nuclei, round to oval nucleus with irregular nuclear contour, inconspicuous to occasional conspicuous nucleoli and minimal cytoplasm. This component was variably admixed with a population of larger cells, which as the name implies composed of cells with abundant eosinophilic cytoplasm, with central or eccentric round to oval nuclei, pale chromatin and prominent nuclei. Both, the small and large cell components demonstrated brisk mitotic activity. All staging biopsies and omentectomy were composed of large cell component.
An extensive panel of immunohistochemical stains was performed. Overall, the staining pattern was strong and diffuse in small cell component compared to patchy weak staining pattern in the large cell component.
FINAL DIAGNOSIS
Small cell carcinoma (https://en.wikipedia.org/wiki/Small-cell_carcinoma) of the ovary, hypercalcemic type (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939673/)
DISCUSSION
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an aggressive and highly malignant tumor affecting the women under 40. It was first described as a distinct entity by Dickersin et al in 1982 (1). Fewer than 500 cases have been described in the literature and it accounts for less than 1% of all ovarian cancer diagnoses. Due to the initial consideration of epithelial origin, the term of SCCOHT has been used to distinguish this entity from its mimicker, the neuroendocrine or pulmonary type (2). In fact epithelial origin of SCCOHT was recently challenged as new imm.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
4. Diagnosis involves physical exam, ultrasound, tumor markers like AFP and H
Bilateral Gonadblastoma and Dysgerminoma in an 18-Year-Old Female Patient wit...Crimsonpublishers-IGRWH
This case report describes a rare case of an 18-year-old female patient with 46XY, SRY gene mutation who was found to have bilateral gonadoblastoma and dysgerminoma during a planned prophylactic gonadectomy. Additional imaging found no signs of metastasis. After multidisciplinary consultation, an expectant management approach was chosen without additional surgery or chemotherapy given the controversial need for these treatments and the ability to effectively treat recurrence with chemotherapy. During 1.5 years of follow-up so far, there have been no signs of recurrence. This case contributes limited data on managing this rare type of germ cell tumor.
The document discusses testicular tumors, providing details on:
1) Germ cell tumors (seminomas and nonseminomas) account for 95% of testicular tumors and can spread rapidly.
2) Sex cord-stromal tumors include Leydig cell and Sertoli cell tumors.
3) Risk factors for germ cell tumors include cryptorchidism, pesticide exposure, and genetic factors. Tumor markers like HCG, AFP, and LDH help diagnose and monitor these cancers.
This document discusses common malignancies in children and embryonal tumors specifically. It outlines four main embryonal tumors - Wilms tumor, retinoblastoma, neuroblastoma, and medulloblastoma. For each tumor, it describes the clinical presentation, cellular origins based on embryonic development, molecular pathology including key genetic drivers, and current treatment approaches. It concludes by noting certain genetic predisposition syndromes can increase the risk of developing cancer in childhood.
The document provides information on normal ovaries and ovarian masses. It discusses:
1. The typical size of normal ovaries and factors that can affect size.
2. Risks of ovarian neoplasms - a woman has a 5-10% lifetime risk of surgery for a suspected ovarian mass, of which 13-21% will be malignant.
3. Differential diagnosis of adnexal masses varies with age, with masses in pre-menarchal/post-menopausal women considered highly abnormal.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
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Management of gynecological cancers in older womenSpringer
This chapter discusses the pathology of several gynecologic cancers that occur in older women, including endometrial cancer, ovarian cancer, and cancers of the cervix and vulva. For endometrial cancer, it reviews the main subtypes of endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated carcinoma, and carcinosarcoma. It discusses characteristics such as histology, molecular markers, risk factors like tamoxifen use, and association with Lynch syndrome. For ovarian cancer, it focuses on serous carcinoma and its link to BRCA abnormalities.
This document summarizes key information from a presentation on early diagnosis of cancer in neonates and young infants. It discusses how cancer can present non-specifically in infants, with symptoms like lethargy and feeding difficulties. Several common childhood cancers are mentioned, including neuroblastoma, Wilms tumor, retinoblastoma, and leukemia. Challenges in diagnosing and treating neonatal cancer are outlined, such as the need for specialized pathology expertise and reduced chemotherapy doses. The presentation concludes with acknowledgements and a call for improved early diagnosis and shared care models for childhood cancer.
Childhood abdominal tumors are difficult to detect but are a leading cause of cancer death in children. Common tumors include neuroblastoma, Wilms tumor, and rhabdomyosarcoma. Neuroblastoma originates from neural crest cells and most commonly presents as an abdominal mass in children under 2 years old. Histopathology shows small round blue cells with rosettes. Molecular markers include MYCN amplification and mutations in the ALK gene. Wilms tumor accounts for 90-95% of pediatric kidney tumors and has a mean age of diagnosis of 36 months.
Nephroblastoma also known as Wilms tumor, is the most common renal malignancy affecting one in 10,000 children <15 years old
Children with bilateral disease are diagnosed at an earlier age (median age, girls at 31 months and boys at 24 months): Patients with associated congenital anomalies are also diagnosed at an earlier age
Accounts for 6-7% of cases of childhood cancer in the developed world and 12% in South Africa
In Tanzania the prevalence is 6.7% ( Mgaya E et al., 2000), “third from leukemia and lymphoma” (Shakilu J, 2017)
The overall survival rate of nephroblastoma approaches 90% in the developed world but in developing countries the survival rates are much less and in some sub-Saharan countries it is only 40% at 8 months after diagnosis
These may occur in 1% of infantile kidneys but typically regress during childhood
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Has been associated with loss of function mutations of a number of tumor suppressor and transcription genes
These include mutations of the WT1, p53, FWT1, and FWT2 genes and at the 11p15.5 locus
Histologically, the classic favorable histology Wilms tumor is comprised of three cell types:
Blastemal cells – Undifferentiated cells
Stromal cells – Immature spindle cells and heterologous skeletal muscle, cartilage, osteoid or fat
Epithelial cells – Glomeruli and tubules
Grossly, Wilms tumors are usually well-circumscribed and have a pseudo-capsule
Histologically, Wilms is divided into "Favorable" and "Unfavorable" histologies
"Favorable" Histology: 90% of Wilms tumors will demonstrate "favorable" histology which generally has a better prognosis
Most children with Wilms tumor present with an abdominal mass or swelling without other signs or symptoms
The definitive diagnosis of Wilms tumor is made by histologic confirmation at the time of either surgical excision or biopsy
Stage I indicates the tumor was completely contained within the kidney without any breaks or spillage outside the renal capsule and no vascular invasion
Stage II would be a tumor that has grown outside the kidney
Stage IIIunresectable tumor
Stage IV-Metastasis
Stage V-bilateral kidney
Surgery is the main treatment
This document summarizes breast cancer risk factors, etiology, pathogenesis, classification, and carcinogenesis. It notes that breast cancer is most common in women over 30 and risk increases with age. The majority are estrogen receptor positive. Risk factors include family history, age of first birth, obesity, and hormone exposure. Cancers arise from genetic mutations in cells like luminal cells and can follow hereditary or sporadic pathways. Cancers are classified as either carcinoma in situ, confined to ducts/lobules, or invasive carcinoma penetrating the basement membrane. Carcinogenesis is a multi-step process as cells acquire mutations driving proliferation.
This document discusses testicular cancer, including:
- Risk factors include history of undescended testes, contralateral testicular tumor, or Klinefelter syndrome.
- Tumors are classified as germ cell tumors (most common), interstitial cell tumors, lymphoma, or other rare tumors.
- Seminoma and non-seminomatous germ cell tumors (NSGCT) are the main types of germ cell tumors.
- Diagnostic workup includes scrotal ultrasound, serum tumor markers, chest imaging and lymph node assessment to determine clinical stage according to the TNM system.
The document provides information on evaluating and managing solitary thyroid nodules. It discusses obtaining a detailed history, performing a physical exam focusing on the thyroid and lymph nodes, and using diagnostic tests like ultrasound, biopsy, and bloodwork. Fine-needle aspiration biopsy is the most important test, and can determine if a nodule is benign, suspicious, malignant, or nondiagnostic. Treatment depends on biopsy results and risk factors, and may include observation, surgery, radiation, or medication. The document outlines common thyroid cancers like papillary and follicular carcinoma.
This document discusses testicular cancer, including:
- Germ cell tumors account for 90-95% of testicular cancers and are divided into seminomas and non-seminomatous germ cell tumors.
- Tumor markers like AFP, HCG, and LDH help with staging, prognosis, and monitoring of disease.
- Testicular cancers typically spread through the lymphatic system to retroperitoneal lymph nodes.
- Ultrasound has near 100% sensitivity for detecting testicular tumors when combined with physical exam. MRI can also characterize tumors when ultrasound is equivocal.
1. cancer care.pdf medical surgical nursing 1akoeljames8543
This document provides an overview of cancer principles and concepts in Kenya. It discusses Kenya's health policy goals to address rising non-communicable diseases like cancer. Cancer arises due to uncontrolled cell growth and can spread through the body. Risk factors include genetics, behaviors, age, and environmental exposures. Diagnosis relies on tissue biopsy. Cancer management involves multidisciplinary teams. Prevention strategies include screening and avoiding risk factors. Genetic testing can assess cancer risk in families with predispositions. The cell cycle is important to understand cancer development.
This PPT presentation talks about osteosarcoma from the clinical point of view, summarizing the recent guidelines in diagnosis and treatment of osteosarcoma.
This document discusses ovarian cysts including their types, clinical presentation, diagnosis, and management. It covers the normal sizes of ovaries at different ages, types of benign cysts such as functional, inflammatory, and epithelial cysts. Diagnosis involves physical exam, ultrasound, and tumor markers. Small unilateral cysts without solid areas can often be observed. Suspicious cysts require surgery. Laparoscopy is preferred when possible for removal of benign cysts.
Solid tumors are abnormal masses of tissue that do not contain cysts or liquid areas. Over 85% of cancers are solid tumors, including cancers of the brain, breast, colon and other tissues. The pathogenesis of solid tumors involves multiple genetic mutations that cause cells to proliferate uncontrollably over several stages, eventually allowing malignant tumors to form and metastasize. Some key mechanisms in tumor development include changes to oncogenes and tumor suppressor genes, alterations in cancer cells that influence growth and structure, and invasion enabling spread through the bloodstream.
This document provides information on pediatric malignant solid tumors, including Wilms tumor (nephroblastoma), neuroblastoma, and rhabdomyosarcoma. It discusses the epidemiology, histology, clinical presentation, risk classification, diagnostic workup, and standard treatment approaches for each of these tumor types. Pediatric cancer is the second leading cause of death in children, though survival rates have improved to over 70% with modern multimodal therapy.
GROUP 1 Case 967-- A Teenage Female with an Ovarian MassCLI.docxgilbertkpeters11344
GROUP 1: Case 967-- A Teenage Female with an Ovarian Mass
CLINICAL HISTORY
A teenage female presented with secondary amenorrhea (https://www.healthline.com/health/secondary-amenorrhea#causes). The patient had 1 menstrual cycle 3 years ago and has had no menses since. Laboratory work-up was negative for pregnancy test, mildly increased calcium level (11.7 mg/dL, normal range: 8.5-10.2 mg/dL) and CA 125 (43 Units/ml, normal range: 0-20 Units/ml). Prolactin, TSH, AFP, Inhibin A, Inhibin B and CEA were normal. Imaging revealed a 13 x 11.8 x 8.6 cm, predominately cystic left pelvis mass, with multiple internal septations. Her past medical history was not contributory. Patient underwent left salpingo-oophorectomy (https://www.healthline.com/health/salpingo-oophorectomy), omentectomy (https://moffitt.org/cancers/ovarian-cancer/omentectomy/) and tumor debulking (https://en.wikipedia.org/wiki/Debulking) with intraoperative frozen section consultation.
GROSS EXAMINATION
The 930.9 g tubo-ovarian complex consisted of a 20.0 x 16.0 x 8.0 cm large mass, with no recognizable normal ovarian parenchyma grossly and an unremarkable fallopian tube. The cut surface was gray, "fish-flesh", soft with foci of hemorrhage and necrosis.
MICROSCOPIC EXAMINATION
Microscopically, the majority of main tumor was growing in large nests, sheets and cords with focal follicle-like structures and geographic areas of necrosis. It was predominantly composed of small cells with hyperchromatic nuclei, round to oval nucleus with irregular nuclear contour, inconspicuous to occasional conspicuous nucleoli and minimal cytoplasm. This component was variably admixed with a population of larger cells, which as the name implies composed of cells with abundant eosinophilic cytoplasm, with central or eccentric round to oval nuclei, pale chromatin and prominent nuclei. Both, the small and large cell components demonstrated brisk mitotic activity. All staging biopsies and omentectomy were composed of large cell component.
An extensive panel of immunohistochemical stains was performed. Overall, the staining pattern was strong and diffuse in small cell component compared to patchy weak staining pattern in the large cell component.
FINAL DIAGNOSIS
Small cell carcinoma (https://en.wikipedia.org/wiki/Small-cell_carcinoma) of the ovary, hypercalcemic type (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939673/)
DISCUSSION
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an aggressive and highly malignant tumor affecting the women under 40. It was first described as a distinct entity by Dickersin et al in 1982 (1). Fewer than 500 cases have been described in the literature and it accounts for less than 1% of all ovarian cancer diagnoses. Due to the initial consideration of epithelial origin, the term of SCCOHT has been used to distinguish this entity from its mimicker, the neuroendocrine or pulmonary type (2). In fact epithelial origin of SCCOHT was recently challenged as new imm.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
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2. Abstract
2
Ovarian sex cord-stromal tumors are clinically significant heterogeneous tumors that include several
pathologic types. These tumors are often found in adolescents and young adults and can present
with hormonal manifestations as well as signs and symptoms of a pelvic mass. Serum tumor
markers may assist in preoperative diagnosis and surveillance. Several subtypes are associated
with genetic predisposition, including those observed in patients with Peutz-Jegher syndrome.
Recent studies have elucidated the relationship between Sertoli-Leydig cell tumors and DICER1
mutations. When classified as International Federation of Gynecology and Obstetrics stage Ia, most
subtypes may be treated with surgery alone. Higher stage or recurrent tumors have variable
prognoses that range from a usually rapid course in poorly differentiated Sertoli-Leydig cell tumor
to an often prolonged course in adult granulosa cell tumors. New understanding of the molecular
pathogenesis of these tumors may pave the way for novel therapeutics.
4. INTRODUCTION
Ovarian sex cord-stromal tumors are un-
common neoplasms that typically present
in the first two to three decades of life,
with the exception of adult granulosa cell
tu-mors, which typically present later,
with risk for development peaking at age
50 to 55 years.
In aggregate, these tumors ac-count for
approximately 5% of ovarian malignancies
in women age 15 to 24 years
5. CLINICAL PRESENTATION
Torsion
Distention
Abdominal
Pain
In contrast to epithelial and germ cell tumors, however, sex cord-stromal tumors
frequently present with signs of hormonal production, such as hir-sutism and
virilization, menstrual changes, or precocious puberty.
6. CLINICAL PRESENTATION
6
▰ Presence of precocious pu-berty or
delayed menarche, hyper pig-mented
macules that are suggestive of Peutz-
Jegher, or thyroid nodules that are
suggestive of DICER1 syndrome.
▰ Tumors are often large at diagnosis and
may rup-ture, which can result in an
acute pre-sentation with
hemoperitoneum.
7. PATHOLOGY
• These tumors are typically unilateral, 10 to 15 cm in
greatest dimension, and may vary from solid, firm, and
lobulated to soft and friable, often with hemorrhage
and/or necrosis.
These tumor
• are seen: adult granulosa cell tumor, juvenile granulosa
cell tumor, Sertoli-Leydig cell tumor, sex cord tumor with
annular tubules, and mixed forms, in-cluding
gynandroblastoma.
The following
histologic subtypes
8. FIG 1. Common histologic features of
juvenile granulosa cell tumors,
Sertoli-Leydig tumors, and
gynandroblastoma ovarian
neoplasms.
2tı
9. In one review of 72 pediatric patients with sex cord-stromal tumors, juvenile
granulosa cell tumors and Sertoli-Leydig cell tumors together accounted for
85% of such neoplasms in children and adolescents.
Almost two thirds of cases were juvenile granulosa cell tumors. Juvenile
granulosa cell tumors are characterized by polygonal cells with usually
abundant cytoplasm growing in nodules or diffusely.
Follicles of varying size and shape typically punctuate the tumor.
PATHOLOGY
10. Tumor cells are typically immature,
sometimes strikingly pleomorphic,
and are usually briskly mitotic.
The capsule of the ovary is intact in
most cases, which accounts, in
part, for the excellent out-come;
however, in tumors with rupture or
invasion beyond the capsule,
juvenile granulosa cell tumors can
pursue an aggressive clinical
course.
Adult granulosa cell tumor is un-
common in children just as juvenile
granulosa cell tumor is uncommon
in adults.
PATHOLOGY
11. 11
PATHOLOGY
Sertoli-Leydig cell tumors may be well differentiated with Sertoli cell tubules separated by
delicate stroma that contain clusters of Leydig cells, intermediately differentiated with lobules
of hyper-chromatic Sertoli cells that often grow focally as cords and tubules with stromal
Leydig cells, or poorly differentiated.
Approximately 20% of ovarian sex cord-stromal tumors in children are Sertoli-Leydig cell
tumors.
12. 12
MOLECULAR PATHOLOGY
Recent analyses have reshaped
our understanding of the
pathophysiology of some of these
tumor subtypes.
Mutations in DICER1, STK11,
and FOXL2 influence the
development of some of these
neoplasms.
13. DICER1 Sertoli-Leydig cell tumors and gynandroblastomas
are associ-ated with DICER1 mutation
DICER1 encodes an endo-nuclease that is critical for
microRNA processing.
DICER1 mutations are associated with pleuropulmonary blastoma, which is the most
common lung tumor of infancy and early childhood, as well as with embryonal
rhabdomyosarcoma of the uterine cervix, renal tumors, thyroid nodules and carcinoma,
nasal chondromesenchymal hamartoma, ciliary body medul-loepithelioma,
pineoblastoma, and pituitary blastoma
14. DICER1
The majority of
individuals with
DICER1 syndrome tu-
mors have germline
loss of function
mutations in DICER1.
Testing for DICER1
mutations may have
important impli-cations
for individuals and
familial tumor risk and
may facilitate diagnosis
of associated conditions.
Of importance, individuals with
tumor predisposition are at risk
for devel-opment of
contralateral, metachronous
ovarian tumors after the general
risk for recurrence has passed
and, thus, prolonged monitoring
is recommended in this setting.
15. 15
STK11
Sex cord-stromal tumors with annular
tubules may be asso-ciated with Peutz-
Jegher syndrome and specifically with
mutations in the STK11 gene.
Individuals with clinical findings of Peutz-
Jegher syndrome should undergo genetic
testing that includes screening for deletion
and/or duplication of STK11 and relevant
organ-specific screening.
16. Ollier disease includes
enchondromatosis, whereas
Mafucci syndrome includes
enchondromatosis and
hemangiomas.
Enchondromas may be associated
with bony deformities and
chondrosarcomas. Somatic mosaic
mutations in IDH1 and IDH2 may be
observed
Both Ollier disease and
Maffucci syndrome are
associated with an
increased risk of juvenile
granulosa cell tumor
16
Ollier Disease and Mafucci Syndrome
17. Nearly all adult granulosa
cell tumors are
characterized by missense
somatic point mutations
(402 C→G) in FOXL2, which
may be useful
diagnostically
This mutation may alter
antiproliferative pathways
and limit apoptosis, which
con-tributes to the
pathogenesis of adult
granulosa cell tumors
New analyses of FOXL2 and
clinical outcomes may alter
the clinical approach to
these generally indolent
tumors.
17
FOXL2
18. • Data from SEER suggest that the incidence of sex cord-stromal tumors is significantly
lower among white women compared with black women (0.18 v 0.35 per 100,000 person
years; relative risk, 0.53; 95% CI, 0.42 to 0.67).
• Unfortunately, many of these tumors, including higher stage juvenile gran-ulosa cell
tumors, are coded as benign or of uncertain ma-lignant potential by using the
International Classification of Disease–Oncology (ICD-O) coding system.
• Tumors thus classified are not collected by cancer registries; therefore, the incidence—
especially for tumors other than adult granulosa cell tumors—are underestimated by
cancer registry data.
• This underreporting limits our understanding of the epi-demiology of these tumors,
including the racial and ethnic predispositions.
EPIDEMIOLOGY
19. Conversely, juvenile pilocytic astrocytomas, although often considered benign, are coded as 9421/3
(malignant), and early endo-metrial carcinomas, which are largely curable with a benign course
when treated early, are coded as invasive malig-nancies
For instance, several CNS tumor types, including tumors of the brain and meninges, are reportable,
even with a behavior code of /0 or /1.
…EPIDEMIOLOGY
20. PREOPERATIVE EVALUATION
AND INITIAL TREATMENT
When an ovarian
sex cord-stromal
tumor is suspected,
levels of inhibin,
estradiol,
testosterone, and
AFP should be ob-
tained.
Inhibin levels may be
elevated in granulosa
cell tumors; inhibin B
may be more predictive
than inhibin A.
Granulosa cell tumors may
also present with elevated
estradiol, and Sertoli-Leydig
cell tumors may present
with elevated testos-terone
or, rarely, AFP.
21. PREOPERATIVE EVALUATION
AND INITIAL TREATMENT
Ultrasound is the most
common initial imaging
modality. A large mass is
commonly seen.
Cross-sectional imaging, either
computed tomography or
magnetic resonance imag-ing,
may show an adnexal mass with
a heterogeneous ap-pearance.
As in other ovarian
tumors, laterality may be
difficult to determine
from initial imaging and
is best de-termined
intraoperatively.
22. PREOPERATIVE EVALUATION
AND INITIAL TREATMENT
Women who are past reproductive age usually undergo total hysterectomy and bilateral salpingo-
oophorectomy.
Fertility-sparing surgery does not refer to ovarian cystectomy alone, but implies the complete removal
of the affected adnexa.
Fertility-sparing surgery is preferred in children, adoles-cents, and women of reproductive age as long
as the contra-lateral tube and ovary and the uterus are unaffected, which is usually the case.
23. PREOPERATIVE EVALUATION
AND INITIAL TREATMENT
Comprehensive staging includes sampling of
peritoneal fluid, examination of the contralateral
ovary, biopsies of the peritoneum and any
suspicious lesions, omental biopsy, and
palpation of lymph nodes, with re-section of any
lymph nodes that have concerning features upon
imaging or intraoperative examination.
Complete lym-phadenectomy is typically
excluded from the procedure, as the risk of nodal
metastasis with primary disease is low
24. 24
If confirmed as FIGO
stage Ia, most tumors
may be treated with
surgical resection alone.
Tumors that are staged
higher than Ia may
require chemotherapy
and/or additional sur-
gery.
Treatment with cisplatin,
etoposide, and
bleomycin over 5 days,
usually for four cycles, is
often administered to
children and adolescents
in the United States who
require chemotherapy.
In Europe, treatment
with cisplatin, etopo-
side, and ifosfamide is
more common.
PREOPERATIVE EVALUATION
AND INITIAL TREATMENT
25. Prognosis is heavily
dependent on
stage.
In pediatric pa-tients with juvenile
granulosa cell tumor, preoperative
rupture or malignant ascites may confer
a worse prognosis than intraoperative
rupture.
In Sertoli-Leydig cell
tumor, the level of
differentiation has major
prognostic significance
Prognosis
26. PREOPERATIVE EVALUATION AND
INITIAL TREATMENT
Recurrent disease
may be treated with
surgery, but other
modalities have
efficacy.
Radiation therapy
may be useful in
settings of recurrent
disease.
Combination therapy with
taxanes or cisplatin,
etoposide, and bleomycin
may be used,33 and
hormonal therapy with
leuprolide acetate may
demon-strate activity.
Bevacizumab has also
shown activity and
provides another option for
treatment, either alone or
in combination
27. 27
ONGOING STUDIES
The International Ovarian and Testicular Stromal Tumor Registry was established
in 2011 to study these rare tumors. Since that time, 140 patients have been
enrolled
In Europe, individuals with ovarian sex cord-stromal tumors can be registered
with the European Cooperative Study Group on Pediatric Rare Tumors.
International collaboration con-tinues to advance the understanding of these
tumors.
28. 28
ONGOING STUDIES
In addition, combined treatment with taxanes and bevacizumab is being investigated in
the recurrent setting in an ongoing trial in Europe
Thus far, the study has accrued 40 patients with plans to expand to a juvenile cohort.
The GOG 264 trial randomly assigned women with newly diagnosed and recurrent
chemonaive ovarian sex cord-stromal tumors to primary therapy with carboplatin and
paclitaxel versus cisplatin, etoposide, and bleomycin
29. SUGGESTIONS FOR FUTURE STUDY
Ovarian sex cord-stromal tumors are underreported but clinically significant
neoplasms.
As a result of coding and reporting issues, these tumors are often not reported to
state or national cancer registries.
These methodologic limitations do not reflect our current understanding of the
biology and clinical relevance of these tumors.
30. 30
In ad-dition, limitations in national reporting prevent an epi-demiologic understanding of these
tumors, including the risk for subsequent malignancies.
Referral to an oncology specialist for evaluation, possible treatment, surveillance, and a
discussion of potential genetic implications is recommended
A /1 ICD-O behavior code may result in underestimation of risks. For example, with Sertoli-
Leydig cell tumors, careful staging and assessment of level of differentiation is required to
determine whether ad-juvant therapy is needed.
SUGGESTIONS FOR FUTURE STUDY
31. 31
Reconsideration of the criteria for
the inclusion of these tumors in
national cancer registries would
allow for a more population-based
approach to the study of sex cord-
stromal neoplasms.
Benefits would include the ability
to calculate true incidence and
survival rates, which, given the
long interval to recurrence of these
tumors, is difficult to determine
from single-institution analyses.
Another benefit would be the
determination of any geographic
or racial and/or ethnic dif-ferences
in incidence.
SUGGESTIONS FOR FUTURE STUDY
32. 32
TREATMENT
Our understanding of the
pathophysiology of these tumors
continues to advance, yet, at this
point, this knowledge has not yet
been translated into novel
therapeutic approaches.
Currently, individuals with sex
cord-stromal tumors receive
treatment that is similar to that
in individuals with germ cell or
epithelial tumors.
As translational efforts advance,
it is likely that treatment will
evolve and that therapies
directed at the underlying genetic
aberrations may replace more
generic treatment.