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STEP 1 (1) > Repro- Pathology 2 > Flashcards

Repro- Pathology 2 Flashcards

1
Q

What is the most common BENIGN ovarian neoplasm?

A

a serous cystadenoma, which is often bilateral

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2
Q

What is an endometrioma?

A

Endometriosis (ectopic endometrial tissue) within the ovary that results in cyst formation

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3
Q

How might an endometrioma present? Benign or malignant?

A

Presents with pelvic pain (can be chronic), dysmenorrhea, and commonly dyspareunia

Benign

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4
Q

What is this?

A

This is endometriosis in the ovaries that produces a characteristic chocolate cyst which is filled with reddish-brown blood

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5
Q

What is a teratoma? benign or malignant?

A

This is a tumor/growth that consists of tissue from all three embryonic layers- endo, meso, and ectoderm

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6
Q

How common are ovarian teratomas?

A

These make up roughly 15-20% of all ovarian tumors and can be classified as mature (benign) or immature (malignant)

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7
Q

What is a clue that a mass in the ovaries might be a teratoma?

A

teratomas, especially mature ones, might present with mature tissue from other organs including hair, bone, and teeth

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8
Q

What is strauma ovarii?

A

This is a monodermal teratoma presenting in the ovaries that consists of ectopic thyroid functional tissue, seen in cases of hyperthyroidism

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9
Q

What is a Brenner tumor?

A

A benign ovarian tumor of the ovaries histologically presents as nests of urothelium like tissue and are often multicystic and benign

Brenner looks like bladder

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10
Q
A
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11
Q

What are fibromas?

A

These are BENIGN sex-stroma tumors of the ovaries comprised of spindle-shaed fibroblasts.

NOTE: Fibromas and thecomas (and fibrothecomas) are indistinguishable typically

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12
Q

What are some syndromes associated with ovarian fibromas?

A

Meigs syndrome which has the triad of hydrothorax, ascites, and fibromas and

Basal cell nevus syndrome

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13
Q

How do fibromas classically present?

A

with a ‘pulling’ sensation in the groin

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14
Q

How do thecomas behave?

A

These, like ovarian granulomas, may produce estrogen, and may present classically as abnormal uterine bleeding in a postmenopausal woman

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15
Q

What is the most common malignant stromal tumor of the ovaries?

A

granulosa tumors

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16
Q

When are granulomas common in women?

A

In older (50s) women

Granulomas in grannys

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17
Q

T or F. Granulomas are classically known for producing estrogen

A

T. So they might tend to grow during the follicular phase and pregnancy and not be as resposnibel post-menopause

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18
Q

What are these?

A

Call-Exner bodies seen in Granulomas tumors of the ovaries- these occur when granulosa cells arrange haphazardly around collections of eosinophilic fluid

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19
Q

What is the most common overall MALIGNANT neoplasm of the ovaries?

A

Serous cystadenocarcinomas

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20
Q

What is a good histo tip that something is a Serous cystadenocarcinomas?

A

Psoammoma bodies

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21
Q

What are the other malignant tumors of the ovaries besides granulosa cell tumors and serous cystadenocarcinomas?

A
  • mucinous cystadenocarcinoma
  • immature teratomas
  • dysgerminomas
  • Yolk sac tumor

Krukenberg tumor

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22
Q

Describe mucinous cystadenocarcinomas

A

These are MALIGNANT tumors that typically arise in the ovaries secondary to pseudomyxoma peitonei, a tumor of appendiceal origin

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23
Q

When are dysgerminomas most common?

A

adolescence (these are the equivalent to the male seminoma)

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24
Q

How do dysgerminomas appear histologically?

A

These tumors, like male seminomas, have a characteristic fried egg appearance

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25
Q

What are good tumor markers for dysgerminomas?

A

hCG and LDH

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26
Q

What is the most common testicular tumor of male infants?

A

Yolk sac tumor

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27
Q

What characterizes yolk sac tumors in males and females histologically?

A

Schiller-Duval Bodies

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28
Q

What is a good serum marker for yolk sac tumors?

A

AFP

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29
Q

What is a Krukenberg tumor?

A

This is a secondary tumor of the ovaries that mets from the GI and classically produces mucin-secreting signel cell adenocarcinoma

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30
Q

What are the most common tumors of the endometrial wall?

A
  • Endometrial polyps
  • Adenomyosis
  • Leiomyomas (fibroids)
  • Endometrial hyperplasia
  • Endometrial carcinoma
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31
Q

What is adenomyosis?

A

This is extension of the endometrium tissue down into the myometrium causing hypertrophy of the basal layer of the endometrium and a classic soft, **boggy***, enlarged uterus upon examination

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32
Q

What is the #1 most common tumor in females?

A

leiomyomas

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33
Q

What is a leiomyomas?

A

These are BENIGN tumors of the uterine smooth muscle that commonly appear in younger women (20-40)

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34
Q

Leiomyomas are more common in _____

A

AA

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35
Q

T or F. Leiomyomas are sensitive to estrogen

A

T. So they might enlarge during pregnancy and shrink after menopause

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36
Q

What are leiomyosarcomas?

A

These are the MALIGANT counterpart to benign leiomyomas

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37
Q

T or F. Most leiomyosarcomas arise from pre-existing leiomyomas

A

F. Malignant transformation is very rare

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38
Q

What causes endometrial hyperplasia?

A

This is most commonly associated with estrogen excess

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39
Q

What are some situations that might cause estrogen excess and lead to endometrial hyperplasia?

A
  • nullparity
  • obesity
  • anovulatory cycles
  • early age of menarche
  • granulosa cell tumor
  • PCOS
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40
Q

How is endometrial hyperplasia classified?

A

Based on the architechural complexity and the presence of cellular atypia

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41
Q

What is the most important indicator of potential to tranform endometrial hyperplasia into endometrial carcinoma?

A

cellular atypia

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42
Q

What is endometriosis?

A

Inflammation of the endometrium (can be acute or chronic)

43
Q

What things typically cause endometriosis?

A
  • retained products of conception (acute)
  • IUDs, TB, miscarriage
44
Q

What would you think of as the cause if chronic endometriosis presented due to IUDs?

A

Actinomyces

45
Q

How is endometriosis treated?

A

gentamicin+ clindamycin +- amplicillin

46
Q

What are the main suggested causes of endometriosis (i.e. ectopic endometrial tissue outside of the uterus)?

A
  • retrograde flow during menses
  • heme spread
  • totipotential formation
47
Q

Describe the anatomy of the breast lobular units?

A

Terminal duct lobular units surrounded by stroma filter into major ducts which lead to lactiferous ducts which expose to the surface of the nipple

48
Q

What are the breast tumors of the stroma?

A

fibroadenoma and phyllodes tumors

49
Q

What are the breast tumors of the terminal duct lobular units?

A

Fibrocystic changes

DCIS and LCIS

Ductal and Lobular carcinomas

50
Q

What are the breast tumors of the lactiferous ducts?

A

Intraductal papilloma

Paget disease

mastitis/abscess

51
Q

Describe fibroadenomas

A

These are BENIGN tumors most common in women under 35. They are biphasic and are composed of fibroblastic stroma and glands, but the stromal part is the only truly prolfierative part

52
Q

What is this?

A

Fibroadenoma marked by slitlike glands with stroma proliferation

53
Q

Do fibroadenomas carry any increased risk of carcinoma transformation?

A

No

54
Q

Describe fibrocystic changes

A

These are considered normal parts of female physiology and typically result from unrupture graafian follicles that occur mostly in repsonse to rising estrogen levels

55
Q

How do fibrocystic changes present?

A

These tend to worry women because they present as lumps that can grow during menstraul cycles (but then almost invaraibly shrink after) and can be associated with pain rarely

They are often bilateral and multifocal

56
Q

Note that fibrocystic changes are characterized as proliferative or non-proliferative based on their potential to cause malignant transformation. What are some things that mark non-proliferative fibrocystic change?

A

Again, these can be singular but typically present as multi-focal illdefined lumps of the breast that histologically are marked by a classic fluid, filled dilation witha blue dome

57
Q

What is another common finding associated with non-prolfierative fibrocystic change?

A

apocrine metaplasia, which is non malignant at all

58
Q

What are the types of prolfierative fibrocystic change?

A
  • usual ductal hyperplasia (below)
  • atypical ductal hyperplasia
  • atypical lobular hyperplasia
59
Q

What is sclerosing adenosis marked by? Benign or malignant?

A

swirling of the ductal units of the breast in the center and retention of circular formation on the periphery of the tumor with calcifications in the middle

These are BENIGN

60
Q

Can sclerosing adenosis turn into breast carcinoma?

A

Yes, there is about 1.5-2x increased risk

61
Q

What is a phyllodes tumor?

A

This is another BENIGN growth of the breast STROMA like fibroadenoma, except that this tumor is markedby more leaf-like epithelium (below) and increased stroma cellularity.

62
Q

Inflammation of the breast presents with localized pain and tenderness usually. What are some common causes?

A
  • Acute mastitis
  • Fat necrosis
  • Mammary duct estasia
  • Granulomatous mastitis
  • Lymphocytic mastitis
63
Q

What causes acute mastitis?

A

This typically presents as lateral breast pain in breastfeeding women most commonly caused by Staph aureus

64
Q

What drugs are associated with the formation of gynecomastia in men?

A

Spironolactone

Hormones (estrogens)

Cimetidine

Keotconazole

Some Hormones Create Knockers

65
Q

Describe malignant breast tumors

A

These typically arise postmenopausally from the terminal duct lobular unit. They most often arise in the upper outer quadrant of the breast

66
Q

What are the risk factors for breast carcinoma?

A

Most of the risk factors are related to increased levels of estrogen in the body, as in the case of obesity and several anovulatory cycles.

67
Q

What are the non-invasive malignant breast cancers?

A

-DCIS and LCIS

Comedocarcinoma

Paget disease

68
Q

Describe DCIS

A

These commonly arise from ductal hypertrophy and are marked by the loss of the myometrial layer of cells around the berast glands

They often present with microcalcifications which allow them to be caught early by mammography (note that LCIS are less likely to produce these and thus are harder to screen for)

69
Q

What is Paget disease of the breast?

A

This results from extension of DCIS from the terminal duct lobular unit to the lactiferous surface of the nipple and

70
Q

What is this?

A

Paget cells as seen in Paget disease of the breast

71
Q

What are the types of invasive carcinomas of the breast?

A
  • Invasive ductal and lobular carcinomas
  • medullary, tubular, and mucinous carcinomas
72
Q

Invasive ductal carcinoma is more likely to arise from what in situ carcinoma?

A

DCIS

73
Q

Invasive lobular carcinoma is marked by what?

A

Mutations in the CDH1 gene causing loss of cadherin-e causing to produce an ‘Indian-file’ orientation

74
Q

tubular carcinoma of the beast- look at how angular the glands are

A

Medullary carcinoma of the breast- look at how the glands almost synctiousize

75
Q

What is happening here?

A

Peau d-orange appearance of the breast, which commonly is associated with nipple retraction caused by an underlying invasive tumor causing tension on the supportive Copper ligaments of the breast

76
Q

Inflammatory breast cancer- dermal lymphatic invasion by breast carcinoma that BLOCK lymph drainage. prognosis?

A

Prognosis is very bad

77
Q

What is Peyronie disease?

A

This is the presence of unusual upward curvature of the penis during erection due to fibreous plaque within the tunica albuginea

78
Q

How should priapism be treated?

A

corporal aspiration, intracavernosal phenylephrine, or surgical decompression

79
Q

What are some precursor, in-situ lesions to a squamous cell carcinoma of the penis?

A
  • Bowen disease
  • erythroplasia of Queryat (cancer of glans)- below
  • Bowenoid papulosis
80
Q

What are the risk factors for squamous cell carcinoma of the penis?

A

-HPV, smegma, smoking

81
Q

How would cyrptochidism affect a pt?

A

Since the testes are undescended, they remain at a constant higher temp and thus spermatogenesis (via Sertoli cell function) will be impaired, but testosterone levels will be normal (Leydig cells unaffected by temperature)

this places a pt at risk for testicular cancer

82
Q

What cases congenital hydrocele?

A

incomplete obliteration of the processus vaginalis

remember: if it can be transilluminated, probably not a solid tumor

83
Q

What are the risk factors for testicular cancer?

A

Klinefelter, testicular dysgenesis, cryptochidism

84
Q

Describe seminomas

A

These are germ cell tumors of the testicle that present as a solid painless mass

85
Q

Histo of seminomas

A

classic ‘fried-egg’ appearance

86
Q

How do seminomas progress?

A

They tend to met late and have a very good prognosis

87
Q

What is a yolk sac tumor of the testes

A

an aggressive germ cell tumor most common in boys under 3 yo

88
Q

What histo clue is characteristic of yolk sac tumors?

A

Schiller-Duval bodies

89
Q

What serum markers are suggestive of a yolk sac tumor?

A

elevated AFP (and anti-trypsin a1)

90
Q

What is a choriocarcinoma?

A

This is a malignant non-seminoma germ cell tumor of the testes that is classically described as:

‘disordered synctiotrophoblast and cytotrophoblastic elements on a stroma of hemorrhage’ (below)

NOTE: These can arise from complete molar pregnancies

91
Q

Testicular teratomas

A

Unlike in females, mature teratomas in adult males may be malignant. Benign in children

92
Q

Where do choriocarcinomas like to MET to?

A

lungs and brain

93
Q

What serum marker would be suggestive of a choriocarcinoma?

A

elevated hCG

94
Q

How might a choriocarcinoma present?

A

potentially as gynecomastia OR
since hCG is stucturally anagalous to LH, FSH, and TSH, as signs of hyperthyroidism

95
Q

What is the most common testicular cancer in older men?

A

metastatic lymphoma to the testes- aggressive

96
Q

Buzzword for a leydig cell tumor of the testes

A

Reinke crystals (eosinophilic cytoplasmic inclusions)

97
Q

Describe BPH

A

This is characterized as smooth, firm nodular enlargement (hyperplasia not hypertrophy) of periurethral lobes, most commonly in men over 50.

98
Q

How might BPH present?

A

increased frequency of urination, nocturia, dysuria

99
Q

How would BPH be treated?

A

a1-antagonists (terazosin, tamsulosin, etc.)

100
Q

Describe prostatic adenocarcinomas

A

These arise more commonly in the peripheral zone (posterior lobe) of the prostate gland in men over 50

101
Q

How is prostatic adenocaricnoma diagnosed?

A

increased PSA (combined with DEcreased fraction of free PSA) and subsequent needle core biopsy

102
Q

What does prostatic adenocarcinoma classically like to do to nerve?

A

Wrap it self around nerve

103
Q

Where does prostatic adenocarcinoma like to MET to?

A

bone to produce BLASTIC lesions

STEP 1 (1) (28 decks)

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