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Flashcards in Breast & Male Deck (58)
1

Clonality of neoplastic cells

Monoclonal

2

Clonality of B-lymphocytes

Determined by Ig light chain
Kappa: lambda 3:1

Lymphoma light chain 20:1 (or inverted)

3

Adenoma cell origin

Epithelium

4

Lipoma/Osteoma/Chondroma/Angioma cell origin

Mesenchyme

5

Papilloma cell origin

Epithelium

6

Number of divisions in cancer b4 clinical sx arise

30

7

How do tumor cells spread?

1. Down regulation of E-cadherin
2. Attaches to laminin & destroys BM
3. Attaches to fibronectin --> spread --> vasc, lymph = mets

8

Carcinoma spread

Lymphatic
- breast

9

Sarcoma spread

Mesenchymal tissue --> lungs

Exceptions
- Renal cell --> renal vein
- HCC --> hepatic vein
- Follicular
- Choriocarcinoma

10

Ovarian carcinoma spread

Seeding into body cavity
"Omental caking"

11

Vimentin

Stains Mesenchyme

12

Desmin

Stains muscle

13

*Chromogranin*

Stains neuroendocrine cells (small cell lung, carcinoid)

14

ER stain

Breast epithelium

15

Single most important cancer prognostic factor

Metastasis (Stage)

16

Subareolar mass w/ nipple retraction in a smoker

Periductal mastitis

Smokers --> vit A deficiency --> squamous metaplasia --> blocking ducts

17

Periareolar mass w/ GREEN-brown discharge in multiparous post-menopasual women

Mammary duct ectasia (dilation) of subareolar ducts

18

Middle aged women, lumpy mass in upper outer quadrant with blue color

Fibrocystic change

#1 pre-menopasual change
BENIGN

19

Fibrocystic changes associated w/ B/L invasive breast carcinoma

Fibrosis, cysts, apocrine metaplasia - no cancer risk
Ductal hyperplasia, sclerosing adenosis - 2x
Atypical hyperplasia - 5x

20

Middle aged women with bloody nipple discharge with fibrovascular projections lined by epithelial and myoepithelial cells

Intraductal papilloma

Carcinoma = POST-menopausal women & NO myoepithelial cells

21

Most common benign tumor of the breast

Fibrous adenoma

22

Mobile, marble-like mass that grows with pregnancy and painful during menstrual cycle

Fibroadenoma

NO inc risk of cancer

23

Leaf-like projections w/ OVERGROWTH of fibrous component in older woman

Phyllodes tumor

24

Pre-menopausal breast changes

All benign
- fibrocystic
- fibroadenoma
- papilloma

25

Post-menopausal breast changes

All malignant (minus mammary duct ectasia)
- Carcinoma
- Phyllodes

26

Breast cancer risk factor

1. Early menarche/late menopause
2. Obesity --> inc estrogen
3. Atypical hyperplasia
4. Nulliparity

27

Calcification, proliferation of ductal cells w/ invasion of BM. Histology shows high-grade cells with necrosis and dystrophic calcification in the center of the duct

Ductal carcinoma in-situ - Comedo type

--> extends to skin of nipple = Paget disease

28

Paget disease cancer assoc

Underlying ductal carcinoma

29

Most common invasive breast cancer

Invasive ductal

30

Mass on breast exam, dimpling of skin or retraction of the nipple with duct-like structures in a desmoplastic stroma

Invasive ductal carcinoma

31

Subtypes of invasive ductal carcinoma

1. Tubular - tubules lack myopeithelial cells
2. Mucinous - carcinoma w/ abundant EC mucin
3. Medullary
4. Inflammatory

32

"Tumor cells floating in mucous pool"

Mucinous breast carcinoma
70+ y/o

33

Red inflamed, swollen breast that does not respond to antibiotics

Inflammatory invasive ductal carcinoma
- tumor cell in dermal lymphatics
- poor prognosis

34

High grade cells in sheets assoc w/ plasma cells and lymphocytes in the breast

Medullary invasive ductal carcinoma

***ASSOC W/ BRCA1***

35

Lobular carcinoma in-situ

Incidental finding in bx
***Discohesive - No E-cadherin***
Multifocal
B/L

Tx = tamoxifen to dec risk of progression to invasive

36

Invasive Lobular carcinoma

SINGLE FILE - lack of E-cadherin

37

Predict response to tamoxifen

Estrogen and Progesterone receptor

38

Predict response to trastuzumab

HER2/neu amplification
-GFR on SURFACE of cells

39

Triple negative breast carcinoma

African Americans
Poor prognosis

40

Hereditary breast cancer

1. 1st degree relative
2. Early age
3. Multiple
4. BRCA1 - female
5. BRCA2 - males

41

Male breast cancer

Invasive ductal
BRCA2
Klinefelter syndrome

42

BRCA1 cancers

Medullary carcinoma
Serous ovarian & fallopian
Breast in women

43

Failure of urethral folds

Hypospadias

44

Failure of genital tubercle

Epispadias
- bladder extrophy

45

Leukoplakia of penile shaft

Bowen disease

46

Erythroplakia of glans

Erythroplasia of Queyrat

47

Orchitis in older men

E. coli or PA

48

Most common type of testicular tumor

Germ cell
- cryptorchidism, klinefelter

49

Testicular mass with large cells with clear cytoplasm, central nuclei. Radiosensitive, homogenous

Testicular germ cell SEMINOMA

50

Testicular mass with immature cells with glands and areas of hemorrhage and necrosis, not radiosensitive, inc AFP, bhCG

Testicular germ cell Nonseminoma - embryonal carcinoma

51

Most common testicular tumor in kids

Yolk Sac/endodermal
- schiller-duval
- AFP

52

Most common testicular mass in men >60 y/o

Lymphoma
- B/L
- Large DIFFUSE type B-cell

53

Male with dysuria, pelvic or LBP, WBCs but cultures (-)

chronic prostatitis

54

BPH

Central/Periurethral zone
--> hydronephrosis, bladder diverticula
- PSA 4-10

55

BPH Tx

Terazosin - alpha1 blocker
Tamsulosin - alpha1-a blocker for normotensive
Finasteride - 5alpha reductase --> gynecomastia, sexual dysfxn

56

Prostate cancer

Peripheral zone
PSA >10
Hard, knobby
Inc alk phos, prostatic acid phosphatase (PAP) w/ mets

57

Prostate cancer risk factors

AA > White > asian
Age
High saturated fats

58

Prostate cancer Tx

Surgery
Leuprolide (GnRH)
Flutamide - androgen receptor inhibitor