lecture 7 hughes
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| sx of lymphoma | night sweats, weight loss, fever without obvious infection
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| general sx suggestive of ca | unusual fatigue, obvious loss of appetite, loss of taste for food
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| 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)
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| 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
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| 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
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| 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
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| #1 metabolic emergency in ca pts | hypercalcemia, pattern of hyperthyroidism with increased serum Ca, decreased serum phosphate and increased urinary cAMP
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| 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
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| PTH-RP | parathyroid hormone-related protein that is released by ca cells, most common paraneoplastic cause of hypercalcemia
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| cytokines released with myeloma that cause local osteolytic hypercalcemia | IL-1 and IL-6
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| dermatomyositis (inflammatory neuropathy) | causes proximal muscle weakness, is diagnosed by electromyogram or nerve conduction studies, associated 10% of time with breast or lung malignancies
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| 2 pathognomic physical exam findings of dermatomyositis pt | heliotrope rash = violaceous erythema of eyelids; Gottron's papules = telangiectasis on knuckles
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| 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
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| stains to be used to highlight glycogen, catecholamines, glandular differentiation in adenocarcinomas | PAS stain, silver stain, mucin stain
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| keratin | epithelial origin (carcinoma)
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| vimentin | mesenchymal origin (fibroma, sarcoma)
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| LCA | leukocyte common Ag, specific for leukocytes
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| UCHL1 | specific marker for T cells
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| L-26 | specific marker for B-cells
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| CEA | carcinoembryonic Ag, specific for most adenocarcinomas
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| HCG, AFP | specific for germ cell tumors
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