Breast and Genitourinary Flashcards by Michael McMahan

7 cm mass at 
superior pole of 
right kidney
Metastases:
• Retroperitoneal 
lymph node 
conglomerate
12 cm
• Bilateral adrenal 
glands
• T12 vertebral 
body
• Right 12th rib
• Pleura

Stage IV Renal Cell Carcinoma

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• Structurally complex - 0.4% of body weight, but filters 25% of blood through glomeruli
• Excretes nitrogenous waste products of metabolism - cleans the blood –turns 1.5 L
into urine
• Regulates body water and electrolytes
• Maintains appropriate acid-base balance
• Endocrine organ –secretes hormones
– Renin: blood pressure
– Erythropoietin –proliferative effect on bone marrow to make RBCs

Kidney

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_______ in
wall of afferent arteriole
– Sensor for blood
pressure

Juxtaglomerular cells

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______ in wall of
distal convoluted tubule
– Sensor for sodium

Macula densa

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• Elevation of blood urea nitrogen and creatinine levels
• Usually related to reduced glomerular filtration rate (GFR)
• Associated with many primary renal disorders
• May also be associated with extra-renal disorders
– Pre-renal: hypoperfusion of the kidneys decreases GFR in
the absence of parenchymal damage
– Post-renal: urine flow obstructed below the level of the
kidney

azotemia

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• Progression of azotemia to produce clinical manifestations and systemic 
biochemical abnormalities
• Failure of renal excretory function
• Metabolic and endocrine alterations
• Secondary involvement of organ systems
– Uremic gastroenteritis
– Peripheral neuropathy
– Uremic fibrinous pericarditis
– Uremic stomatitis

Uremia

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Clinical Manifestations of __________
• Nephrotic syndrome (glomerular syndrome): heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria
• Nephritic syndrome (glomerular syndrome): acute onset of grossly-visible
hematuria, mild-to-moderate proteinuria, azotemia, edema and hypertension
(classic presentation - acute post-streptococcal glomerulonephritis)
• Acute renal failure: May result from glomerular injury or acute tubular necrosis
• Chronic renal failure: prolonged symptoms and signs of uremia. the end result of
all renal disease
• Urinary tract infections: bacteriuria and pyuria. symptomatic or asymptomatic.
kidney (pyelonephritis) or bladder (cystitis)
• Nephrolithiasis: kidney stones - colic, hematuria
• Urinary tract obstruction
• Renal tumors

Renal Diseases

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• Glomerular syndrome
– non-specific disorder in which the kidneys are 
damaged, causing them to leak large amounts of 
protein from the blood into the urine
– Heavy proteinuria
– Hypoalbuminemia
– Severe edema
– Hyperlipidemia
– Lipiduria

Nephrotic syndrome

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• Glomerular syndrome
• A non-specific disorder in which the kidneys are damaged, causing them 
to leak protein and red blood cells from the blood into the urine.
• Acute onset
• Grossly-visible hematuria
• Mild-to-moderate proteinuria
• Azotemia
• Edema
• Hypertension

Nephritic syndrome

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\_\_\_\_\_\_ syndrome
• Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia / hyperlipiduria

Nephrotic syndrome

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\_\_\_\_\_\_\_ syndrome
• Hematuria
Oliguria
Azotemia
Hypertension

Nephritic syndrome

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__________: an immune mediated disease of the renal glomeruli
– Treated with steroids

Glomerulonephritis

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• ________: an infection of the kidney (not the glomerulus) usually
caused by bacteria and of retrograde origin
– Treated with antibiotics

Pyelonephritis

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• Acute onset of nephritic syndrome in 9-14 days following Streptococcal
infection
• Type III immune injury (Immune complex-mediated inflammation)

Post strep glomerlunephritis

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What is the most common pathway of renal infection?

Ascending infection

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What is the least common pathway of renal infection?

Hematogenous dissemination: least

common

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• Common
• May cause obstruction
• Pain
• Ascending infection
• Hematuria
• Pyuria
• Lithotripsy
• May be associated with 
hypercalcemia:
– hyperparathyroidism, 
metastatic skeletal disease, 
multiple myeloma

Kidney Stones (Nephrolithiasis) Urolithiasis

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• Arises from renal tubular
epithelium
• Often silent
• May grow into renal vein

Renal cell carcinoma

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• Nephroblastoma
• Children under 5 years
• Abdominal mass
• Chronic low-grade fever
• Histopathology: resemble abortive 
glomeruli or skeletal muscle
• Better than 90% 5-year survival

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Wilm’s tumor (Nephroblastoma)

• Arises from the urinary tract  
lining epithelium (transitional 
epithelium)
• Bladder most common site
• Painless hematuria
• Cigarette smoking, industrial 
solvents (beta-naphthlylamine), 
chronic cystitis, schistosomiasis, 
drugs (cyclophosphamide)
• Clinical significance depends on 
histologic grade, differentiation 
and depth of invasion

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Urothelial Carcinoma

Condyloma
• Venereal wart - sexually-
transmitted disease
• Multiple, clustered lesions 
common
• Sessile, pink exophytic mass, 
larger than squamous papilloma
• HPV sub-types 6 and 11
Herpes Simplex Type 2
• Multiple coalescing vesicles and 
ulcers
• Genital region

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HHV-2

• Protein present in the serum at low levels (nl: < 4 ng/mL)
• Physiologic functions
– Liquefy semen, allowing sperm to swim freely
– Dissolution of cervical mucous cap
• Increased levels may suggest the presence of prostate cancer
• Elevated in prostatitis
• Velocity of change significant

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Prostate specific agent

• Acute bacterial disease

treated with antibiotics

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Prostatitis

• 70% of men develop prostate cancer by 70-80 
years of age
• Digital prostate examination
• Biopsy –multiple cores
• Wide variation in clinical behavior
• Gleason grading

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Adenocarcinoma of prostate

• Absence of one or both testes in the scrotum • Failure of testis to descend from an abdominal position through the inguinal canal into the scrotum (“undescended” testes) • Infertility • Increased risk for neoplasia • Orchiopexy: surgical correction

Cryptorchidism

* Most common germ cell tumor of testis * Young adults (15-34 years) * Surgery plus radiation therapy and chemotherapy * One of the most treatable and curable cancers * Over 95% long-term survival in early stages

Seminoma

``` Complications of _______: • Complications rare in the young and more common in older individuals • Orchitis, oophoritis, mastitis, meningitis, thyroiditis, pancreatitis • Sterility, hearing loss ```

Mumps

``` • Benign smooth muscle neoplasm • “Fibroids” • May cause irregular bleeding (metrorrhagia), painful intercourse (dyspareunia) ```

Uterine leiomyoma

``` • Endometrial tissue outside the uterine cavity • Ectopic endometrial tissue influenced by hormonal changes • Recurring pelvic pain • Symptoms depend on the site involved and worsen with the menstrual cycle ```

Endometriosis

Risk factors for _______: • Age –most common in the 55 to 65 age group • Obesity –greater synthesis of estrogen in body fat • Infertility –women who are nulliparous are at increased risk of endometrial carcinoma

Endometrial carcinoma

``` • Exfoliative cytologic screening for early detection (Papanicolau smear) • Squamo-columnar junction • High risk HPV sub-types: 16, 18 • Vaccination ```

Cervical squamous cell carcinoma

``` • A tumor containing tissues from all three germ layers • Most tumors are derived from one cell layer –ectoderm, endoderm, mesoderm • Generally arise in gonadal tissues • Most commonly seen in the ovary • “Dermoid cyst” of the ovary –a benign cystic teratoma –may contain a variety of tissues including hair, teeth, bone, cartilage, thyroid, etc ```

Teratoma

* Neisseria gonorrhea * “Mother nature’s birth control” * Pelvic inflammatory disease * Tubal scarring * Ectopic pregnancy

Gonorrhea

``` • Most common benign neoplasm of breast • Discrete, usually solitary, moveable nodule • Young women (third decade) ```

Fibroadenoma

``` ______ cancer: • Lobules • Ducts • Lobules - lobular carcinoma – Lobular carcinoma-in-situ – Invasive lobular carcinoma • Ducts - ductal carcinoma – Ductal carcinoma-in-situ – Invasive ductal carcinoma ```

Breast cancer

Risk factors in _______: Well-established risk factors – Age: uncommon < 30 y – Genetics and family history - p53, BRCA1/2 genes – Menstrual history –early menarche (<12y), late menopause (>55y) – Length of reproductive life – No children: having children is protective – Geographic variation Other risk factors – Exogenous estrogens –postmenopausal hormone replacement therapy – Oral contraceptives –newer formulations of balanced, low doses of estrogen and progestin safe – Ionizing radiation during breast development • Less well-established risk factors – Alcohol consumption – High fat diet – Obesity – Cigarette smoking

Breast cancer

_____ changes in breast cancer • Familial syndromes – Li-Fraumeni Syndrome –germ-line mutations in p53 – Cowden Syndrome –germ-line mutations in PTEN – Ataxia-telangiectasia gene –DNA repair genes – BRCA1/BRCA2 –germ-line mutations• HER2/NEU proto-oncogene – Epidermal growth factor receptor – Amplified in 30% of breast cancers – Overexpression associated with poor prognosis – Therapeutic intervention –Herceptin (trastuzumab) • Amplification of RAS and MYC (proto-oncogenes) • Mutations of Rb and p53 (tumor suppressor genes) • Estrogen receptor positivity – Therapeutic intervention - Tamoxifen • Progesterone receptor positivity

Genetic changes

• Precursor lesion to invasive carcinoma • When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same breast. • Treatment –surgery and radiation • Tamoxifen –antiestrogenic if estrogen receptor + (blocks estrogen receptor) • Aromatase inhibitors –post-menopausal women (blocks estrogen formation) • Good long-term prognosis

Ductal carcinoma in situ

• Clinical variant of DCIS • Extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple • Crusting exudate over the nipple and areolar skin • Underlying invasive carcinoma in 50%

Paget disease

• One-third of women with LCIS develop invasive carcinoma • The invasive carcinoma may arise in either breast • is a marker of increased risk for developing breast cancer in either breast • Bilateral prophylactic mastectomy may be performed

Lobular carcinoma in situ

• Most breast carcinomas (70-80%) • Term used for all carcinomas that cannot be sub-classified into a specific type (not discussed) • Does not imply that the tumor specifically arises from the duct system • Carcinoma of “no special type” or “not otherwise specified” (NOS) are synonyms for invasive ductal carcinoma

Invasive ductal carcinoma

• • Stage ____ breast cancer–tumor <2 cm, without nodal involvement, no metastases

Stage 1

• • Stage ____ breast cancer- tumor <5 cm with <3 nodes and no distant metastases (or more than 5 cm without nodes)

Stage 2

• • Stage ____ breast cancer –* many categories, any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases

Stage 3

• Stage ____ breast cancer –any cancer with disseminated metastases

Stage 4

``` • Enlargement of male breast may occur in response to estrogen • Hyperestrinism in male – Cirrhosis of liver –inability to metabolize estrogens – Klinefelter syndrome – Estrogen-secreting tumors – Estrogen therapy • Bilateral –rule-out hormonal • Unilateral –rule out tumor ```

Gynecomastia

Breast and Genitourinary Flashcards

(46 cards)