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lecture 7 hughes

sx of lymphoma night sweats, weight loss, fever without obvious infection
general sx suggestive of ca unusual fatigue, obvious loss of appetite, loss of taste for food
ways malignancy can produce sx 1) direct mass effect with or without invasion // 2) metabolic derangement, release of hormones or other biologically active agents (paraneoplastic syndrome)
SVC syndrome usually secondary to lung ca, lymphoma or breast ca obstruction of SVC leads to collateral venous formation (azygous, internal mammary), thoracic and chest wall veins affected. sx: dyspnea, facial/arm swelling, cough, cyanosis
Horner's syndrome usually seen with high apical tumors of the lung that obliterate sympathetics traveling up towards head. sx: classic triad of miosis, anhidrosis and mild ptosis
hypocalcemia as metabolic derangement secondary to ca Ca levels drop due to tumor lysis syndrome and release of massive amts of phosphate into blood, which sinks serum Ca levels
#1 metabolic emergency in ca pts hypercalcemia, pattern of hyperthyroidism with increased serum Ca, decreased serum phosphate and increased urinary cAMP
humoral hypercalcemia of malignancy (non-small cell lung, breast, head/neck) primary tumor produces hormones released into circulation, causes indirect release of Ca from bone
PTH-RP parathyroid hormone-related protein that is released by ca cells, most common paraneoplastic cause of hypercalcemia
cytokines released with myeloma that cause local osteolytic hypercalcemia IL-1 and IL-6
dermatomyositis (inflammatory neuropathy) causes proximal muscle weakness, is diagnosed by electromyogram or nerve conduction studies, associated 10% of time with breast or lung malignancies
2 pathognomic physical exam findings of dermatomyositis pt heliotrope rash = violaceous erythema of eyelids; Gottron's papules = telangiectasis on knuckles
Eaton-Lambert syndrome 60% of time caused by small lung ca, proximal muscle weakness like myasthenia, Ab to presynaptic Ca channels blocks ACh release, improvement with repeated contraction
stains to be used to highlight glycogen, catecholamines, glandular differentiation in adenocarcinomas PAS stain, silver stain, mucin stain
keratin epithelial origin (carcinoma)
vimentin mesenchymal origin (fibroma, sarcoma)
LCA leukocyte common Ag, specific for leukocytes
UCHL1 specific marker for T cells
L-26 specific marker for B-cells
CEA carcinoembryonic Ag, specific for most adenocarcinomas
HCG, AFP specific for germ cell tumors
Created by: sirprakes