EXAM #3 (2-of-2)

Question 1

1. Cholelithiasis
   a. Afflict __-__% of adults

b. Main types:
i. _____ stones
ii. _____ stones (bilirubin)

c. Risk factors:
i. More common after age __
ii. __X as high in white women than men
iii. Geographic – more common in developed countries
iv. Hereditary
v. Environment – oral _____, _____, _____

d. Appearance:
i. Cholesterol – _____
ii. Pigment – _____

e. Clinically:
i. __-__% asymptomatic
ii. Symptoms: pain, empyema, perforation, fistulae, inflammation

Answer 1

1. Cholelithiasis
   a. Afflict 10-20% of adults

b. Main types:
i. Cholesterol stones
ii. Pigment stones (bilirubin)

c. Risk factors:
i. More common after age 40
ii. 2X as high in white women than men
iii. Geographic – more common in developed countries
iv. Hereditary
v. Environment – oral contraceptives, pregnancy, obesity

d. Appearance:
i. Cholesterol – yellow
ii. Pigment – black/brown

e. Clinically:
i. 70-80% asymptomatic
ii. Symptoms: pain, empyema, perforation, fistulae, inflammation

Question 2

2. Cholecystitis

a. Most cases due to _____
i. Causes _____ _____ which becomes toxic to gallbladder

b. Occurs as acute or chronic disease

c. Acute:
i. May present with _____ symptoms
ii. Gallbladder _____
iii. Filled with _____ – empyema of gallbladder
iv. _____ – large necrotic regions

d. Chronic:
i. Wall _____
ii. Mucosa can _____

Answer 2

2. Cholecystitis

a. Most cases due to cholelithiasis
i. Causes bile stasis which becomes toxic to gallbladder

b. Occurs as acute or chronic disease

c. Acute:
i. May present with intense symptoms
ii. Gallbladder swells
iii. Filled with pus – empyema of gallbladder
iv. Gangrenous – large necrotic regions

d. Chronic:
i. Wall thickens
ii. Mucosa can scar

Question 3

3. Choledocholithiasis
   a. Indicates presence of _____ in _____ _____

b. Can lead to:
i. Biliary _____
ii. _____
iii. _____
1. Inflammation of _____ _____
iv. Hepatic _____
v. Chronic _____ disease
vi. _____

Answer 3

3. Choledocholithiasis
   a. Indicates presence of calculi in biliary tree

b. Can lead to:
i. Biliary obstruction
ii. Pancreatitis
iii. Cholangitis
1. Inflammation of bile ducts
iv. Hepatic abscess
v. Chronic liver disease
vi. Cholecystitis

Question 4

4. Cholangiocarcionoma
   a. Adenocarcinomas – biliary differentiation
   b. Can be intra or extrahepatic

c. Extrahepatic _____ _____
i. At the _____ of the liver – _____ tumor
ii. Any where along the _____

d. Most are not symptomatic until _____ stages
e. Prognosis _____; most tumors _____

Answer 4

4. Cholangiocarcionoma
   a. Adenocarcinomas – biliary differentiation
   b. Can be intra or extrahepatic

c. Extrahepatic more common
i. At the hilum of the liver – Klatskin tumor
ii. Any where along the ducts

d. Most are not symptomatic until later stages
e. Prognosis poor; most tumors non-resectable

Question 5

5. Biliary Atresia
   a. Complete obstruction of _____ _____
   b. Destruction or absence of all or part of extrahepatic bile ducts

c. Leads to:
i. _____ and _____ of ducts
ii. Ultimate _____ of intrahepatic ducts
iii. _____

Answer 5

5. Biliary Atresia
   a. Complete obstruction of bile flow
   b. Destruction or absence of all or part of extrahepatic bile ducts

c. Leads to:
i. Inflammation and stricture of ducts
ii. Ultimate destruction of intrahepatic ducts
iii. Cirrhosis

Question 6

6. Pancreatitis
   a. Variable course ranging from _____ to _____ threatening disease

b. Acute Pancreatitis
i. _____ inflammation of the pancreas
ii. Mild to extensive _____ with _____
iii. Changes:
1. _____
2. _____ by lipases
3. Acute _____
4. Destruction of _____ _____ with _____
5. Possible sequela - _____
iv. Most common causes
1. _____ disease – i.e. gallstones with obstruction
2. _____
v. Clinically
1. Intense _____ _____, elevated _____ _____ in the blood stream

c. Chronic Pancreatitis
i. _____ standing inflammation and fibrosis
ii. Leads to long term _____ of exocrine pancreas; an _____ process
iii. Most common cause – _____ term alcohol abuse
iv. Clinically – variable
v. Some – _____, _____ _____, _____ and _____ pain
vi. Some silent until development of _____ _____
vii. High mortality – __% over __-__ years

Answer 6

6. Pancreatitis
   a. Variable course ranging from self-limited to life threatening disease

b. Acute Pancreatitis
i. Reversible inflammation of the pancreas
ii. Mild to extensive necrosis with hemorrhage
iii. Changes:
1. Edema
2. Necrosis by lipases
3. Acute inflammation
4. Destruction of blood vessels with hemorrhage
5. Possible sequela - pseudocysts
iv. Most common causes
1. Biliary disease – i.e. gallstones with obstruction
2. Alcoholism
v. Clinically
1. Intense abdominal pain, elevated pancreatic enzymes in the blood stream

c. Chronic Pancreatitis
i. Long standing inflammation and fibrosis
ii. Leads to long term destruction of exocrine pancreas; an irreversible process
iii. Most common cause – long term alcohol abuse
iv. Clinically – variable
v. Some – jaundice, GI symptoms, abdominal and back pain
vi. Some silent until development of diabetes mellitus
vii. High mortality – 50% over 20-25 years

Question 7

7. Cystic Neoplasms of Pancreas

a. Serous Cystadenoma
i. Most _____
ii. _____ _____ of benign cells which line simple cysts
iii. Contain thin _____ _____

b. Mucinous Cystic Neoplasm
i. Most occur in _____
ii. Usually located in _____ or _____
iii. Contain _____
iv. Occur in three forms based on malignant potential:
1. Benign – benign cells in benign arrangement that _____ the _____
2. Borderline – cytologic and architectural atypia – _____ _____ growth
3. Malignant - _____

c. Intraductal Papillary Mucinous Neoplasm
i. Similar in morphology to mucinous cystic neoplasms; but occur within the _____
ii. Also occur and _____, _____ or _____ lesions
iii. Other differences;
1. Occur more often in the _____ of the pancreas
2. Occur more frequently in _____

Answer 7

7. Cystic Neoplasms of Pancreas

a. Serous Cystadenoma
i. Most benign
ii. Single layer of benign cells which line simple cysts
iii. Contain thin clear fluid

b. Mucinous Cystic Neoplasm
i. Most occur in women
ii. Usually located in body or tail
iii. Contain mucus
iv. Occur in three forms based on malignant potential:
1. Benign – benign cells in benign arrangement that line the cysts
2. Borderline – cytologic and architectural atypia – no invasive growth
3. Malignant - invasion

c. Intraductal Papillary Mucinous Neoplasm
i. Similar in morphology to mucinous cystic neoplasms; but occur within the duct
ii. Also occur and benign, borderline or malignant lesions
iii. Other differences;
1. Occur more often in the head of the pancreas
2. Occur more frequently in men

Question 8

8. Pancreatic Carcinoma

a. Type that arises in gland
i. most are _____ _____

b. Most common site in pancreas
i. __% in head
ii. __% in body
iii. __% in tail
iv. __% diffuse involvement

c. _____ – growth of fibrous or connective tissue

Answer 8

8. Pancreatic Carcinoma

a. Type that arises in gland
i. most are ductal adenocarcinomas

b. Most common site in pancreas
i. 60% in head
ii. 15% in body
iii. 5% in tail
iv. 20% diffuse involvement

c. Desmoplasia – growth of fibrous or connective tissue

Question 9

1. Nephritic versus Nephrotic Syndromes

a. Nephrotic Syndrome
i. Results from _____ damage that alters _____ _____:
ii. Complex of:
1. Massive proteinuria
2. Hypoalbuminemia
3. Generalized edema
4. Hyperlipidemia and lipiduria
iii. Most common adult causes:
1. _____
2. _____
3. _____

b. Nephritic Syndrome
i. Characterized by diseases that cause _____ infiltration and proliferation of cells; damaging capillaries
ii. Complex of:
1. Hematuria
2. Oliguria
3. Hypertension
iii. Associated diseases:
1. Post infectious _____ – often _____-_____

Answer 9

1. Nephritic versus Nephrotic Syndromes

a. Nephrotic Syndrome
i. Results from glomerular damage that alters protein absorption:
ii. Complex of:
1. Massive proteinuria
2. Hypoalbuminemia
3. Generalized edema
4. Hyperlipidemia and lipiduria
iii. Most common adult causes:
1. Diabetes
2. Amyloidosis
3. Lupus

b. Nephritic Syndrome
i. Characterized by diseases that cause leukocyte infiltration and proliferation of cells; damaging capillaries
ii. Complex of:
1. Hematuria
2. Oliguria
3. Hypertension
iii. Associated diseases:
1. Post infectious Glomerulonephritis – often post-streptococcal

Question 10

2. _____ — an infection in any part of the urinary system, the kidneys, bladder, or urethra.
   a. Often an extension of urinary tract infection (UTI) – urinary bladder

Answer 10

2. Cystitis — an infection in any part of the urinary system, the kidneys, bladder, or urethra.
   a. Often an extension of urinary tract infection (UTI) – urinary bladder

Question 11

3. Acute pyelonephritis
   a. Inflammation of the _____ and _____ _____
   b. _____ – most often caused by bacteria
   c. Often an extension of urinary tract infection (UTI) – urinary bladder - cystitis
   d. Usually enteric bacteria – most common _____ _____

e. Two routes of infection
i. _____ – more common in females
ii. _____ – blood borne

f. Pathologic Changes:
g. Presence of yellow _____ within parenchyma
h. Supprative necrosis

i. Clinical risk factors:
i. Obstruction
ii. Instrumentation
iii. Vesicoureteral reflux
iv. Pregnancy
v. Sex and age
vi. Diabetes mellitus

j. _____ onset
k. _____
l. _____
m. _____
n. _____ with frequency and urgency

Answer 11

3. Acute pyelonephritis
   a. Inflammation of the kidney and renal pelvis
   b. Infectious – most often caused by bacteria
   c. Often an extension of urinary tract infection (UTI) – urinary bladder - cystitis
   d. Usually enteric bacteria – most common Escherichia coli

e. Two routes of infection
i. Ascending – more common in females
ii. Hematogenous – blood borne

f. Pathologic Changes:
g. Presence of yellow abscesses within parenchyma
h. Supprative necrosis

i. Clinical risk factors:
i. Obstruction
ii. Instrumentation
iii. Vesicoureteral reflux
iv. Pregnancy
v. Sex and age
vi. Diabetes mellitus

j. Sudden onset
k. Pain
l. Fever
m. Pyuria (pus in urine)
n. Dysuria (difficulty urinating) with frequency and urgency

Question 12

4. Chronic pyelonephritis
   a. Characterized by _____ _____
   b. Results in deformity of the _____ _____
   c. Ultimately leads to _____ _____

d. Two major associations
i. Chronic _____-_____ pyelonephritis (from repeated infections)
ii. Chronic _____ pyelonephritis

Answer 12

4. Chronic pyelonephritis
   a. Characterized by interstitial scarring
   b. Results in deformity of the renal pelvis
   c. Ultimately leads to renal failure

d. Two major associations
i. Chronic reflux-associated pyelonephritis (from repeated infections)
ii. Chronic obstructive pyelonephritis

Question 13

5. Adult versus Childhood Polycystic Kidney Disease

a. Adult Polycystic Kidney Disease:
i. Involves multiple expanding _____ of both kidneys which ultimately destroy _____
ii. Incidence: 1 in ___-___
iii. Kidneys become massively _____
iv. Complete involvement of parenchyma by cysts
v. Symptoms usually start in ___ decade
vi. End stage renal failure develops usually by age __; _____ progressive
vii. Also develop: hyertension and brain aneurysms

b. Childhood Polycystic Kidney Disease:
i. Occurs 1 in ___ births
ii. Perinatal, neonatal, infantile and juvenile subcategories exist based on time of presentation
iii. Result in numerous small cortical and medullary cysts giving _____ appearance
iv. Often accompanied by cysts in _____
v. Clinically: often proceed quickly to _____ _____; as well as congenital _____

Answer 13

5. Adult versus Childhood Polycystic Kidney Disease

a. Adult Polycystic Kidney Disease:
i. Involves multiple expanding cysts of both kidneys which ultimately destroy parenchyma
ii. Incidence: 1 in 500-1000
iii. Kidneys become massively enlarged
iv. Complete involvement of parenchyma by cysts
v. Symptoms usually start in 4th decade
vi. End stage renal failure develops usually by age 50; slowly progressive
vii. Also develop: hyertension and brain aneurysms

b. Childhood Polycystic Kidney Disease:
i. Occurs 1 in 20,000 births
ii. Perinatal, neonatal, infantile and juvenile subcategories exist based on time of presentation
iii. Result in numerous small cortical and medullary cysts giving sponge appearance
iv. Often accompanied by cysts in liver
v. Clinically: often proceed quickly to renal failure; as well as congenital cirrhosis

Question 14

6. Urolithiasis
   a. Definition: _____ formation at any level of system
   b. __% - calcium oxalate or calcium oxalate and calcium phosphate
   c. Predisposing factors
   d. _____
   e. __% - magnesium phosphate
   f. Predisposing factor
   g. Repeated UTI’s
   h. __ – __ % uric acid (gout) or cystine (genetic)
   i. Clinically
   j. May be asymptomatic (larger _____)
   k. Intense _____ (renal or ureteral colic)
   l. Predispose to bacterial infections

Answer 14

6. Urolithiasis
   a. Definition: calculus formation at any level of system
   b. 80% - calcium oxalate or calcium oxalate and calcium phosphate
   c. Predisposing factors
   d. hypercalciuria
   e. 10% - magnesium phosphate
   f. Predisposing factor
   g. Repeated UTI’s
   h. 6 – 9 % uric acid (gout) or cystine (genetic)
   i. Clinically
   j. May be asymptomatic (larger stones)
   k. Intense pain (renal or ureteral colic)
   l. Predispose to bacterial infections

Question 15

7. Hydronephrosis
   a. Definition: obstruction causes _____ of _____ _____ followed by _____ _____

b. Causes:
i. Congenital – atresia of _____, _____, aberrant _____ arteries, _____ of kidney with torsion
ii. Acquired – foreign bodies (_____), _____, _____ and _____, neurogenic causes

c. Clinically:
i. _____ – anuria
ii. _____ – more gradual

Answer 15

7. Hydronephrosis
   a. Definition: obstruction causes dilatation of renal pelvis followed by renal atrophy

b. Causes:
i. Congenital – atresia of ureter, valves, aberrant renal arteries, malpositioning of kidney with torsion
ii. Acquired – foreign bodies (stones), tumors, inflammation and scaring, neurogenic causes

c. Clinically:
i. Bilateral – anuria
ii. Unilateral – more gradual

Question 16

8. Renal Cell Carcinoma
   a. Derived from _____ _____ _____
   b. __-__% of primary renal tumors
   c. Located predominantly in _____

d. Risk factors:
i. _____
ii. _____
iii. _____
iv. Exposure to _____

e. Three most common forms:
i. _____ Cell (most common type, usually solitary)
ii. _____ Renal Cell
1. Frequently multifocal
iii. _____
1. Least common

f. Clinically:
i. Most present with hematuria
ii. _____
iii. _____ (abundance of RBC)
iv. _____ mass
v. Dull _____ pain

Answer 16

8. Renal Cell Carcinoma
   a. Derived from renal tubular epithelium
   b. 80-85% of primary renal tumors
   c. Located predominantly in cortex

d. Risk factors:
i. Smoking
ii. Hypertension
iii. Obesity
iv. Exposure to cadmium

e. Three most common forms:
i. Clear Cell (most common type, usually solitary)
ii. Papillary Renal Cell
1. Frequently multifocal
iii. Chromophobe
1. Least common

f. Clinically:
i. Most present with hematuria
ii. Fever
iii. Polycythemia (abundance of RBC)
iv. Palpable mass
v. Dull flank pain

Question 17

9. Wilms Tumor
   a. Almost exclusively in _____
   b. Comes from primitive cells of _____
   c. Also called _____
   d. Most present at __-__ years

Answer 17

9. Wilms Tumor
   a. Almost exclusively in children
   b. Comes from primitive cells of kidney
   c. Also called nephroblastoma
   d. Most present at 2-5 years

Question 18

10. Transitional Cell Carcinoma
    a. Can arise _____ along the collecting system
    b. Most common in the _____ _____
    c. Can be _____ to _____; _____ to _____; _____ of invasion key to prognosis

d. Clinically:
e. Painless _____ most common
f. Men affected __X more than women
g. Ages __-__
h. Risk factors – _____, chronic _____

Answer 18

10. Transitional Cell Carcinoma
    a. Can arise anywhere along the collecting system
    b. Most common in the urinary bladder
    c. Can be papillary to flat; invasive to non-invasive; depth of invasion key to prognosis

d. Clinically:
e. Painless hematuria most common
f. Men affected 3X more than women
g. Ages 50 -70
h. Risk factors – smoking, chronic cystitis

Question 19

11. Potter Syndrome - refers to the typical physical appearance and associated _____ _____ (limited lung development) of a newborn as a direct result of kidney failure, _____ (lack of amniotic fluid) and compression while in the uterus.
    a. _____ _____ - a condition in which a newborn is missing one or both kidneys

Answer 19

11. Potter Syndrome - refers to the typical physical appearance and associated pulmonary hypoplasia (limited lung development) of a newborn as a direct result of kidney failure, oligohydramnios (lack of amniotic fluid) and compression while in the uterus.
    a. Renal Agenesis - a condition in which a newborn is missing one or both kidneys

Question 20

12. Prune Belly Syndrome - rare disorder characterized by partial or complete absence of the stomach (abdominal) _____, failure of both _____ to descend into the _____ (bilateral cryptorchidism), and/or urinary tract _____
    a. _____ _____ obstruction

Answer 20

12. Prune Belly Syndrome - rare disorder characterized by partial or complete absence of the stomach (abdominal) muscles, failure of both testes to descend into the scrotum (bilateral cryptorchidism), and/or urinary tract malformations
    a. Renal outlet obstruction

Question 21

1. Cryptorchism
   a. Failure of _____ descent into the _____
   b. Descent from _____ to _____ cavity by _____ month of gestation
   c. Descent into _____ in last _____ months of intrauterine life; may not be complete by birth
   d. __% of males will have cryptorchism at __ year of age
   e. Most often _____
   f. Increases risk of _____ and _____ in both testicles
   g. Orchiopexy (permanently affixing testicle to scrotum) reduces but does not eliminate risk

Answer 21

1. Cryptorchism
   a. Failure of testicular descent into the scrotum
   b. Descent from abdominal to pelvic cavity by third month of gestation
   c. Descent into scrotum in last two months of intrauterine life; may not be complete by birth
   d. 1% of males will have cryptorchism at 1 year of age
   e. Most often unilateral
   f. Increases risk of infertility and malignancy in both testicles
   g. Orchiopexy reduces but does not eliminate risk

Question 22

2. Testicular neoplasms, general attributes of disease
   a. Incidence is 5 per ___ males
   b. Peak ages – __-__
   c. Can arise from either _____ cells or _____ chord/stromal cells
   d. __% are from germ cells
   e. Seminoma vs other germ cell tumors clinically

i. Seminoma - germ cell tumor of the _____ or, more rarely, the mediastinum or other extra-gonadal locations
1. __% of germ cell malignancies
2. _____ demarcated (distinguished) grey-white masses

ii. Seminomas:
1. Usually present as painless _____
a. Usually remain to confined to _____ for prolonged periods
b. Metastasis occurs mostly to regional _____ _____
c. Hematogenous spread usually occurs _____ in disease

2. Non-seminomatous lesions
   a. Tend to _____ sooner

Answer 22

2. Testicular neoplasms, general attributes of disease
   a. Incidence is 5 per 100,000 males
   b. Peak ages – 20-34
   c. Can arise from either germ cells or sex chord/stromal cells
   d. 95% are from germ cells
   e. Seminoma vs other germ cell tumors clinically

i. Seminoma - germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations
1. 50% of germ cell malignancies
2. Well demarcated (distinguished) grey-white masses

ii. Seminomas
1. Usually present as painless enlargments
a. Usually remain to confined to testicle for prolonged periods
b. Metastasis occurs mostly to regional lymph nodes
c. Hematogenous spread usually occurs late in disease

2. Non-seminomatous lesions
   a. Tend to metastasize sooner

Question 23

3. Nodular Hyperplasia of Prostate (_____ prostate cancer)
   a. Consists of hyperplasia of _____ and _____ components
   b. Arises in inner _____ and _____ zones of prostate most frequently
   c. Causes most likely alterations in _____ levels with aging
   d. Clinically – lower urinary tract _____ with frequency, urinary _____, _____ (pee often at night) and sometimes increased likelihood of _____

Answer 23

3. Nodular Hyperplasia of Prostate (benign prostate cancer)
   a. Consists of hyperplasia of glandular and stromal components
   b. Arises in inner transitional and central zones of prostate most frequently
   c. Causes most likely alterations in hormone levels with aging
   d. Clinically – lower urinary tract obstruction with frequency, urinary urgency, nocturia (pee often at night) and sometimes increased likelihood of infections

Question 24

4. Carcinoma of the Prostate
   a. Most _____ visceral malignancy in males
   b. Second most common cause of cancer death in males over __
   c. Peak incidence – __-__ years
   d. Incidence >__% in males over __; though latent disease
   e. __-__% arise in outer zones of prostate (less likely to cause obstruction than BPH)
   f. Microscopically – _____
   g. Prostatic intraepithelial neoplasia (PIN) often found with cancer

h. Common grading system – _____ system
i. Clinically:
i. Often clinically _____
ii. Incidental finding at autopsy in __% of males in __-__ age group
iii. Prostate specific antigen (PSA) used for screening
iv. _____ metastasis is common in later stage disease

Answer 24

4. Carcinoma of the Prostate
   a. Most common visceral malignancy in males
   b. Second most common cause of cancer death in males over 50
   c. Peak incidence – 65-75 years
   d. Incidence >50% in males over 80; though latent disease
   e. 70-80% arise in outer zones of prostate (less likely to cause obstruction than BPH)
   f. Microscopically – adenocarcinomas
   g. Prostatic intraepithelial neoplasia (PIN) often found with cancer

h. Common grading system – Gleason system
i. Clinically:
i. Often clinically silent
ii. Incidental finding at autopsy in 30% of males in 30-40 age group
iii. Prostate specific antigen (PSA) used for screening
iv. Bone metastasis is common in later stage disease

Question 25

5. Congenital malformations of the penis: a. Most common – abnormalities of the _____ of the distal urethral orifice b. Hypospadias: i. More _____ defect ii. 1 in ___ liver births iii. Urethral opening is located abnormally on _____ _____ c. Epispadias: i. Urethral orifice is located abnormally on the _____ _____ ii. Both may cause _____

Answer 25

5. Congenital malformations of the penis: a. Most common – abnormalities of the location of the distal urethral orifice b. Hypospadias: i. More common defect ii. 1 in 250 liver births iii. Urethral opening is located abnormally on ventral surface c. Epispadias: i. Urethral orifice is located abnormally on the dorsal surface ii. Both may cause obstruction

Question 26

6. Tumors of the Penis a. __% are squamous cell carcinomas b. Only __% of cancers in males c. Most commonly in uncircumcised patients >__ years of age d. Risk factors – _____, poor _____, _____ infection e. _____ disease – indicates in-situ disease (early form of skin cancer that's easily treatable)

Answer 26

6. Tumors of the Penis a. 95% are squamous cell carcinomas b. Only .4% of cancers in males c. Most commonly in uncircumcised patients >40 years of age d. Risk factors – smoking, poor hygiene, HPV infection e. Bowen’s disease – indicates in-situ disease (early form of skin cancer that's easily treatable)

Question 27

7. Epithelial Hyperplasias of Breast a. Orderly hyperplasias i. Epithelium is increased but maintains normal _____ and cellular _____ b. Atypical hyperplasias i. The architecture of the cells becomes _____. ii. The _____ of the cells are altered. iii. Can be found in _____ or _____ patterns. c. Cancer Risks i. Hyperplasia without atypia – slightly increased (__-__ times) ii. With atypia – significantly increased risk (__ times)

Answer 27

7. Epithelial Hyperplasias of Breast a. Orderly hyperplasias i. Epithelium is increased but maintains normal geography and cellular appearance b. Atypical hyperplasias i. The architecture of the cells becomes abormal. ii. The cytology of the cells are altered. iii. Can be found in ductal or lobular patterns. c. Cancer Risks i. Hyperplasia without atypia – slightly increased (1.5 -2 times) ii. With atypia – significantly increased risk (5 times)

Question 28

8. Fibroadenoma a. Most _____ _____ neoplasm of breast b. Peak incidence – ___ decade c. Usually _____ and _____ d. May _____ with menstrual cycle and during pregnancy

Answer 28

8. Fibroadenoma a. Most common benign neoplasm of breast b. Peak incidence – 3rd decade c. Usually solitary and discrete d. May enlarge with menstrual cycle and during pregnancy

Question 29

9. Breast Carcinoma a. Types: i. Non-invasive (has not invaded basement membrane into fat) 1. _____ _____ in-situ 2. _____ _____ in-situ ii. Invasive (invades out of ducts and lobules) 1. _____ _____ Carcinoma 2. _____ _____ Carcinoma 3. Less common: 4. _____ Carcinoma 5. _____ Carcinoma (mucinous) 6. _____ Carcinoma iii. _____ Disease of nipple – progress of DCIS (ducal carcinoma in-situ) into lactiferous ducts and skin of nipple iv. Inflammatory carcinoma – extensive invasive carcinoma throughout the breast with blockage of _____ – _____ swollen breast

Answer 29

9. Breast Carcinoma a. Types: i. Non-invasive (has not invaded basement membrane into fat) 1. Ductal carcinoma in-situ 2. Lobular carcinoma in-situ ii. Invasive (invades out of ducts and lobules) 1. Invasive Ductal Carcinoma 2. Invasive Lobular Carcinoma 3. Less common: 4. Medullary Carcinoma 5. Colloid Carcinoma (mucinous) 6. Tubular Carcinoma iii. Pagets Disease of nipple – progress of DCIS into lactiferous ducts and skin of nipple iv. Inflammatory carcinoma – extensive invasive carcinoma throughout the breast with blockage of lymphatics – large swollen breast

Question 30

o Wilms Tumor = ? o Testicular neoplasms = ? o Cholelithiasis = ? o Penis tumors = ? o Polycystic Kidney Disease = ? o Colorectal carcinoma = ? o Prostate carcinoma = ?

Answer 30

o Wilms Tumor = 2-5 o Testicular neoplasms = 20-34 o Cholelithiasis = 40 o Penis tumors = >40 o Polycystic Kidney Disease = 50 o Colorectal carcinoma = 60-70 o Prostate carcinoma = 65-75