⁨أسئلة المحاضرة التاسعة باثولوجي CVS (قبل التعديل) ⁩

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Questions and Answers

What is a common site for angiosarcomas?

Lungs

Skin (correct)

Brain

Kidneys

Which of the following best describes the clinical pattern of angiosarcomas?

They appear as large, painless lumps only in the abdomen.

They begin as small, sharply demarcated, asymptomatic red nodules. (correct)

They always present with severe pain and swelling.

They are typically discovered only after metastasis occurs.

What is the primary characteristic of angiosarcomas under microscopic examination?

Presence of lymphatic vessels only.

Complete absence of blood vessels.

High variability in differentiation with atypical endothelial cells. (correct)

Exclusively well-differentiated tumor cells.

What factor is typically associated with the development of lymphangiosarcoma following surgery?

Lymphedema following radical mastectomy. Signup and view all the answers

What is the usual age group affected by angiosarcomas?

Older adults. Signup and view all the answers

Which primary cardiac tumor is most frequently found in adults?

Myxomas Signup and view all the answers

What percentage of primary heart tumors do the five common types account for?

80% to 90% Signup and view all the answers

Where do most cardiac myxomas arise in the heart?

Fossa ovalis Signup and view all the answers

What is the most common primary malignant tumor of the heart?

Angiosarcoma Signup and view all the answers

What characterizes cavernous hemangiomas compared to capillary hemangiomas?

Composed of large, dilated vascular channels Signup and view all the answers

Which type of tumor is associated with tuberous sclerosis in children?

Rhabdomyomas Signup and view all the answers

What is a common feature of brain hemangiomas?

They can cause compression of adjacent tissue Signup and view all the answers

What is a common clinical manifestation of cardiac myxomas?

Fever and malaise Signup and view all the answers

What is the appearance of myxomas when examined grossly?

Soft and translucent Signup and view all the answers

Which statement is true regarding simple (capillary) lymphangiomas?

They consist of networks of endothelium-lined spaces Signup and view all the answers

What is the almost uniform treatment for cardiac myxomas?

Surgical resection Signup and view all the answers

What distinguishes cavernous lymphangiomas from other types?

They are poorly defined and unencapsulated Signup and view all the answers

What is the primary virus associated with Kaposi sarcoma?

Human herpesvirus-8 (HHV-8) Signup and view all the answers

What is the typical clinical significance of cavernous hemangiomas?

They are often of little clinical significance Signup and view all the answers

Where do simple (capillary) lymphangiomas primarily occur?

In the head, neck, and axillary subcutaneous tissues Signup and view all the answers

What feature is NOT commonly associated with cavernous hemangiomas?

They are fully encapsulated Signup and view all the answers

What is the appearance of lesions during the patch stage of classic Kaposi sarcoma?

Pink, red, or violaceous patches Signup and view all the answers

What type of cells are primarily found in the plaque stage lesions?

Plump spindle cells Signup and view all the answers

Which characteristic is common to the nodular stage of classic Kaposi sarcoma?

Extravasated red cells Signup and view all the answers

Where are the lesions primarily located during the plaque stage?

Located in dermis or subcutaneous tissues Signup and view all the answers

What are ‘spider cells’ primarily characterized by?

Numerous glycogen-laden vacuoles Signup and view all the answers

What additional features are more pronounced during the plaque stage?

Mitotic figures and extravasated red cells Signup and view all the answers

Which type of tumor is most commonly associated with the pericardium?

Teratoma Signup and view all the answers

What distinct cell type is commonly associated with the nodule stage lesions?

Plump spindle cells and chronic inflammatory cells Signup and view all the answers

Which statement about benign tumors is accurate?

They can be composed of vascular channels filled with blood cells Signup and view all the answers

What is a typical challenge when diagnosing the patch stage lesions?

They can be mistaken for granulation tissue Signup and view all the answers

What characterizes hemangiomas?

Most are present from birth and regress spontaneously Signup and view all the answers

Which of the following best describes the blood vessels during the patch stage?

Dilated, irregular, and angulated blood vessels Signup and view all the answers

What is the typical growth pattern of juvenile hemangiomas?

They grow rapidly for a few months then fade Signup and view all the answers

How can cardiac metastases occur?

By direct extension or intravascular means Signup and view all the answers

Which is the most common vascular tumor of the head and neck in infants?

Hemangioma Signup and view all the answers

What is the most common site for internal hemangiomas?

Liver Signup and view all the answers

What is the typical appearance of advanced angiosarcoma lesions?

Large, fleshy red-tan to gray-white masses with indistinct margins Signup and view all the answers

Which type of cardiac tumor is primarily associated with infants and children?

Rhabdomyomas Signup and view all the answers

Which microscopic characteristic can help identify poorly differentiated angiosarcoma tumors?

Staining for endothelial markers such as CD31 and von Willebrand factor Signup and view all the answers

What percentage of all primary heart tumors do the five most common benign types account for?

80% to 90% Signup and view all the answers

Where do most myxomas in adults commonly arise in the heart?

Fossa ovalis Signup and view all the answers

What condition often precedes the development of lymphangiosarcoma in patients?

Lymphedema after radical mastectomy Signup and view all the answers

Which age group is most commonly affected by angiosarcomas?

Older adults Signup and view all the answers

What is the primary method of treatment for cardiac myxomas?

Surgical resection Signup and view all the answers

What is a common clinical feature associated with advanced angiosarcomas?

Common development of necrosis and hemorrhage Signup and view all the answers

Which of the following is a characteristic appearance of myxomas when examined grossly?

Soft, translucent, villous lesions Signup and view all the answers

What is a common clinical manifestation of cardiac myxomas?

Fever and malaise Signup and view all the answers

Fibromas constitute which ranking of the most common types of primary cardiac tumors?

Second Signup and view all the answers

Which primary malignant tumor is most commonly found in the heart?

Angiosarcomas Signup and view all the answers

What is the primary characteristic of lesions during the patch stage of classic Kaposi sarcoma?

Composed of dilated, angulated blood vessels Signup and view all the answers

Which feature is commonly associated with the plaque stage of classic Kaposi sarcoma?

Interspersed chronic inflammatory cells Signup and view all the answers

What distinguishes the nodular stage lesions of classic Kaposi sarcoma from those in the earlier stages?

Prominent hemorrhage and hemosiderin deposition Signup and view all the answers

In the plaque stage of classic Kaposi sarcoma, what type of cells are commonly found?

Plump spindle cells Signup and view all the answers

What is the primary structural characteristic of 'spider cells' found in teratomas?

Large vacuoles filled with glycogen Signup and view all the answers

Which characteristic is NOT associated with the biopsy findings of the patch stage lesions in classic Kaposi sarcoma?

Obvious mitotic figures Signup and view all the answers

What is the incidence of benign tumors like hemangiomas in infants?

7% of all benign tumors of infancy and childhood Signup and view all the answers

During the nodule stage of classic Kaposi sarcoma, which component is typically present?

Accompanying nodal and visceral involvement Signup and view all the answers

What is a notable challenge in distinguishing patch stage lesions from other skin conditions?

Lesions resemble dermatitis Signup and view all the answers

How are cardiac metastases most commonly disseminated to the heart?

By direct extension from adjacent tissues Signup and view all the answers

What is a distinguishing feature of malignant tumors compared to benign tumors?

Increased cell proliferation and atypia Signup and view all the answers

Which feature is prominent in the plaque stage of classic Kaposi sarcoma compared to the patch stage?

Degree of hemorrhage and hemosiderin Signup and view all the answers

Which type of hemangiomas is extremely common in newborns and often fades after several years?

Juvenile hemangiomas Signup and view all the answers

What factors can contribute to the clinical presentation of hemangiomas?

Location and extent of the lesion Signup and view all the answers

What is a common characteristic of capillary hemangiomas under microscopic examination?

Thin-walled capillaries with scant stroma Signup and view all the answers

Which statement about the growth patterns of hemangiomas is accurate?

Many hemangiomas initially increase in size but later regress Signup and view all the answers

What distinguishes cavernous hemangiomas from capillary hemangiomas?

Cavernous hemangiomas are composed of larger blood-filled vascular spaces. Signup and view all the answers

Which of the following best describes the histologic appearance of cavernous hemangiomas?

Large blood-filled vascular spaces and connective tissue stroma. Signup and view all the answers

What is a notable clinical concern regarding brain hemangiomas?

They may cause symptoms from compression of neighboring tissues. Signup and view all the answers

What is the significance of the unencapsulated nature of cavernous lymphangiomas?

Surgical resection is complicated due to indistinct margins. Signup and view all the answers

Which of the following correctly describes the structure of simple (capillary) lymphangiomas?

Features networks of endothelium-lined spaces without blood cells. Signup and view all the answers

What is a primary characteristic of cavernous lymphangiomas?

They can grow significantly large and cause deformities. Signup and view all the answers

Which virus is predominantly associated with Kaposi sarcoma in patients?

Kaposi sarcoma herpesvirus (KSHV). Signup and view all the answers

What is a common complication of cavernous hemangiomas?

Cosmetic issues and risk of bleeding. Signup and view all the answers

Study Notes

Cardiac Tumors

Primary cardiac tumors are rare and mostly benign.
The most common benign cardiac tumors are myxomas, fibromas, lipomas, papillary fibroelastomas, and rhabdomyomas, accounting for 80-90% of all primary heart tumors.
Myxomas are the most frequent in adults, usually located in the left atrium.
Myxomas are composed of stellate cells embedded in an acid mucopolysaccharide ground substance.
Rhabdomyomas are the most common primary cardiac tumors in infants and children, frequently associated with tuberous sclerosis.
Rhabdomyomas appear as gray-white masses, characterized by large, rounded, or polygonal cells containing glycogen-laden vacuoles.
Cardiac metastases can occur by direct extension, bloodstream, lymphatics, and intracavitary diffusion.
Pericardial metastasis is the most common.

Pericardial Diseases

Hemangiomas are benign tumors composed of vascular channels filled with blood cells or lymph.
They are the most common vascular tumor of the head and neck in infancy.
Hemangiomas are typically present from birth and may eventually regress spontaneously.
Lymphangiomas are benign lymphatic counterparts of hemangiomas, occurring predominantly in head, neck, and axillary subcutaneous tissues.
Kaposi sarcoma, frequently observed in HIV patients, is a malignant endothelial neoplasm associated with Kaposi sarcoma herpesvirus (KSHV).
Kaposi sarcoma lesions progress through three stages: patch, plaque, and nodule.
Angiosarcoma is a malignant endothelial neoplasm of variable differentiation, ranging from well-differentiated tumors resembling hemangiomas to highly aggressive lesions.
Angiosarcoma predominantly affects older adults and can occur at any site, with a predilection for skin, soft tissue, breast, and liver.

Pericardial Diseases - Causes

Pericardial diseases can be caused by a variety of factors, including trauma, drugs, heart tumors, systemic lupus erythematosus (SLE), uremia, radiotherapy, and hypothyroidism.

Cardiac Myxoma

Most common primary tumor of the adult heart.
90% are atrial, 80% of those are in the left atrium.
Usually single.
Commonly found in the fossa ovalis (atrial septum).
Can be sessile or pedunculated.
Appears soft, translucent, villous, gelatinous.
Consists of multinucleated stellate cells embedded in an abundant acid mucopolysaccharide ground substance.
Clinically manifests as a "ball-valve" obstruction of the valves, embolization, or constitutional symptoms such as fever and malaise.
Surgical resection is curative in nearly all cases.

Rhabdomyomas

Most common primary heart tumor in infants and children.
Frequently discovered due to valvular or outflow obstruction.
Commonly found in patients with tuberous sclerosis.
Appear as gray-white masses up to several centimeters, protruding into ventricular chambers.
Characterized by large, rounded, or polygonal cells with numerous glycogen-laden vacuoles, separated by strands of cytoplasm running from the cell membrane to the nucleus, known as 'spider cells'.

Teratomas

Second most common cardiac tumor in infants.
Typically arise from the pericardium.
Usually benign.
Rarely recur.

Cardiac Metastasis

Can occur through:
- Direct extension.
- Bloodstream.
- Lymphatics.
- Intracavitary diffusion.
Pericardial metastasis is the most common.

Hemangiomas

Benign vascular tumor.
Common in infants and childhood.
Often regresses spontaneously.
Occurs in the head and neck, but can be more extensive (angiomatosis) and found internally.
1/3 of internal lesions are found in the liver.
Types:
- Capillary hemangiomas: most common, composed of thin-walled capillaries with minimal stroma.
- Juvenile hemangiomas: extremely common in newborns, often multiple, grow rapidly for a few months then fade by 1-3 years, completely regress by 7 years in most cases.
- Cavernous hemangiomas: large, dilated vascular channels, more infiltrative, frequently involve deep structures, don't spontaneously regress.

Lymphangiomas

Benign lymphatic counterpart of hemangiomas.
Types:
- Simple lymphangiomas: slightly elevated, up to 1-2 cm in diameter, common in the head, neck, and axillary subcutaneous tissue, composed of networks of endothelium-lined spaces.
- Cavernous lymphangiomas (cystic hygromas): fluid-filled sac in the neck or axilla of infants, large (up to 15 cm), composed of massively dilated lymphatic spaces lined by endothelial cells and separated by connective tissue stroma containing lymphoid aggregates.

Kaposi Sarcoma

Caused by Kaposi sarcoma herpesvirus (KSHV, or HHV-8).
Common in HIV patients.
Progresses through three stages:
- Patch stage: pink, red, or purple macules, confined to distal lower extremities.
- Plaque stage: larger violaceous patches, raised plaques.
- Nodular stage: accompanied by nodal and visceral involvement, plump proliferating spindle cells in the dermis or subcutaneous tissues.

Angiosarcoma

Malignant endothelial neoplasms.
Range from highly differentiated to anaplastic.
Most common in older adults.
No sex predilection.
Lesions occur anywhere, most common in skin, soft tissue, breast, and liver.
Aggressive, invasive, and metastasizes.
Can arise in the setting of lymphedema, classically after radical mastectomy.
Begins as small, asymptomatic red nodules, developing into fleshy, red-tan to gray-white masses, blending with surrounding structures.
Necrosis and hemorrhage are common.

Pericarditis Causes

Trauma.
Drugs.
Heart tumors.
Systemic lupus erythematosus (SLE).
Uremia.
Radiotherapy.
Hypothyroidism.

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