Male and Female Repro Flashcards
(285 cards)
1
Q
zones of prostate
A
peripheral
central
transitional
periurethral
2
Q
cell layers prostate
A
basal layer of low cuboidal epithelium
inner columnar secretory cells
3
Q
acute bacterial prostatitis etiology
A
same bacteria that cause UTI
E. coli, enterococci staph
implanted via reflux
4
Q
clinical presentation acute bacterial prostatitis
A
fever, chills, dysuria
prostate tender and boggy on DRE
leukocytes and bacterial cultures
5
Q
clinical presentation chronic bacterial prostatitis
A
mild symptoms or asymptomatic
history of recurrent UTI with same organism
leukocytes and bacterial cultures
6
Q
chronic abacterial prostatitis clinical presentation
A
most common form
same presentation as chronic bacterial
<10 leukocytes/HPF and bacterial culture negative
7
Q
etiology granulomatous prostatitis
A
from BCG in bladder to treat superficial bladder cancer
insignificant
8
Q
etiology BPH
A
increased number of epithelial cells
9
Q
role of DHT
A
testosterone to DHT by type 2 5 alpha reductase in stromal cells
binds androgen receptor on stromal and epithelial cells
increases proliferation of stromal cells and decreases death of epithelial cells
10
Q
morphology BPH
A
originates in transition zone (periurethral)
early nodules-stromal
later-epithelial
11
Q
microscopic BPH
A
lined by 2 layers
12
Q
work up BPH
A
do not do biopsy-nodules hard to appreciate
not premalignant lesion
13
Q
clinical presentation BPH
A
urethral obstruction-impinge on urethra
bladder hypertrophy and distension
sudden acute urinary retention
14
Q
treatment BPH
A
decrease fluids, caffeine, and alcohol
timed voiding
alpha blockers and 5 alpha reductase inhibitors
TURP
15
Q
most common cancer in men
A
prostate adenocarcinoma
16
Q
genetics prostate adenocarcinoma
A
BRCA2 mutations overexpression of ETS PTEN deletions MYC amplications alterations of GSTP1 (most common)
17
Q
risks for development of prostate adenocarcinoma
A
high fat diet
androgens
18
Q
prostate intraepithelial neoplasia
A
precursor lesion
seen in peripheral zone (same as cancer)
19
Q
morphology PIN
A
larger glands with branching and infolding
surrounded by patchy layer of basal cells and intact BM
20
Q
histology prostate adenocarcinoma
A
little or no stroma=back to back glands
single layer of cuboidal (outer basal layer absent)
mitotic figures uncommon
21
Q
local extension prostate adenocarcinoma
A
periprostatic tissues, seminal vesicles, base of bladder
22
Q
mets prostate adenocarcinoma via lymphatics
A
obturator nodes
para-aortic nodes
23
Q
mets prostate adenocarcinoma via blood
A
lumbar spine
osteoblastic lesions
24
Q
Gleason staging
A
scored by most prominent pattern and second most prominent
or most prominent and highest grade pattern
25
factors that elevate PSA
cancer, prostatitis, infarct, instrumentation of the prostate, ejaculation, UTI
26
use of PSA
organ specific
useful in diagnosis and management of prostate cancer
lacks specificity and sensitivity
27
refinements of PSA for screening
density
velocity
age specific reference ranges
bound to free (lower free in cancer)
28
treatment prostate adenocarcinoma
surgery
radiation
hormone manipulation-orchiectomy, LH-releasing hormone agonist
29
etiology of follicular and luteal cysts
unruptured Graafian follicle or one that immediately seals
30
histology follicular and luteal cyst
grnaulosal cell lining
| outer thecal cell
31
rim of yellow in luteal cyst
from corpus luteum
luteinized granulosal cells
may rupture and cause peritoneal reaction
32
clinical presentation polycystic ovaries
oligomenorrhea
obesity
hirsutism
virilism
33
risk factors ovarian tumors
nulliparity
| family history-BRCA1, BRCA2, p53, her2/neu
34
clinical presentation ovarian tumors
abdominal pain and distention
urinary and GI symptoms
bleeding
35
serous tumors origin
tubal epithelium
36
benign serous tumor gross morphology
cystic with few papillary projections
37
borderline serous tumor gross morphology
increasing papillary projections
38
malignant serous tumor gross morphology
solid with nodularity
39
benign serous histology
columnar cilia and intercalated cells
40
borderline serous histology
increased papillae with nuclear stratification and atypia
41
malignant serous cystadenocarcinoma histology
effacement of stroma and atypical nuclei
42
gross appearance mucinous tumors of ovary
filled with sticky, gelatinous material rich in glycoproteins
43
histology benign mucinous tumor
tall columnar with apical mucin and no cilia
44
histology borderline mucinous tumor
complex glanduar structures
45
histology malignant mucinous tumor
more solid growth with atypia and necrosis
46
pseudomyxoma peritonea
ovarian tumor with extensive mucinous ascites and cystic epithelial implants
can cause intestinal obstruction and death
also caused by appendiceal mucinous tumors
47
gross morphology endometrioid tumors
combination solid and cystic
48
histology endometrioid tumors
glands resembling endometrium
49
characteristics of clear cell adenocarcinoma
association with endometriosis
50
histology clear cell adenocarcinoma
looks like clear cell adenocarcinoma of endometrium
| large cells with abundant clear cytoplasm
51
Brenner tumor
adenofibroma with transitional type epithelium
52
histology Brenner tumor
fibrous stroma with nests of epithelium resembling urothelium with central mucinous cysts
53
cystadenofibroma
variant with proliferation of fibrous stroma
54
metastasis of surface epithelial tumors
regional nodes, liver, lungs and GI
55
screening for serous and endometrioid tumors
CA-125
56
gross morphology mature teratomas
unilocular containing hair and cheesy material
| areas of calcification
57
histology mature teratomas
mostly squamous epihtelium with underlying skin adnexae
58
specialized teratomas
most common struma ovarii and carcinoid
| can result in hyperthyroidism or carcinoid syndrome producing 5HIAA
59
immature malignant teratoma
resembles embryo
| found in adolescents and young women
60
gross morphology immature malignant teratoma
smooth external surface
| solid with areas of necrosis and hemorrhage
61
dysgerminoma
increased HCG
usually in childhood
can occur with gonadal dysgenesis
radiosensitive
62
gross morphology dysgerminoma
unilateral
| soft and fleshy
63
histology dysgerminoma
vesicular cell with well defined cell border
| fibrous stroma with lymphocytes
64
yolk sac tumor
rich in alpha fetoprotein and alpha 1 antitrypsin
children or young women
chemo has improved prognosis
65
histology yolk sac tumor
Schiller-Duval body (glomerular like)
66
choriocarcinoma histology
cytotrophoblasts and syncytiotrophoblasts
67
choriocarcinoma
invades blood vessels and mets to lungs, liver, bone and viscera
high levels HCG
unresponsive to chemo
68
histology granulosa-theca cell tumors
granulosal cells with many components (Call-Exner)
| theca are plump and spindled (stain Oil-Red-O)
69
clinical presentation of granulosa-theca cell tumors
large estrogen-precocious sexual development, endometrial hyperplasia or carcinoma, cystic breast
70
thecoma-fibroma
fibroblasts and thecoma (plump spindle cells with lipid)
71
Meigs syndrome
ascites, pleural effusion (right) and ovarian tumor
| thecoma fibroma
72
fibrosarcoma
increased mitosis and nuclear/cytoplasmic ratio
73
histology Sertoli-Leydig cell tumor
tubules of Sertoli cells with interspersed Leydig cells
74
Kruckenberg tumor
bilateral, mucin producing signet ring
| cancer of stomach
75
histology nipple and areola
stratified squamous epithelium
76
contractile cells of breast
myoepithelial
77
interlobular stroma
fibroconnective tissue with adipose
78
intralobular stroma
loose, myomatous stroma and lymphocyte
79
change to breast at menarche
terminal ducts give rise to lobules and interlobular stroma
80
milk line remnants
persistence of epidermal thickening along milk line
81
accessory axillary breast tissue
mastectomy may not remove all breast tissue
82
congenital inversion of nipple
nursing difficulties
| can be confused with inversion due to carcinoma or inflammation
83
acute mastitis
mostly staph aureus (abscess)
strep-spreading
in nursing mother, scarring and retraction of nipple
84
periductal mastitis
painful erythematous subareolar mass
85
morphology periductal mastitis
keratinizing squamous to abnormal depth
| keratin accumulates
86
risk of periductal mastitis
smoking
87
mammary duct ectasia
50s to 60s
| poorly defined mass, skin retraction, cheesy discharge
88
morphology mammary duct ectasia
ductal dilation
| periductal and interstitial chronic granulomatous inflammation
89
gross appearance fat necrosis
early hemorrhage
| late liquefaction necrosis
90
histology fat necrosis
central necrotic fat cells surrounded by lipid laden macrophages and intense neutrophilic infiltrate
later walled off by fibroblastic
91
etiology granulomatous mastitis
systemic granulomatous disease-Wegeners
infections
only affects parous women (HSR?)
92
morphology granulomatous mastitis
granulomas in lobular epithelium
93
lymphocytic mastopathy
single or multiple hard palpable masses
| collagenized stroma surrounding atrophic ducts and lobules
94
non-proliferative breast changes
peaks at menopause
| hormonal imbalance-increased estrogen or decreased progesterone
95
patterns non-proliferative breast changes
cyst
fibrosis
adneosis
96
cysts of breast
can calcify
| apocrine metaplasia-lining cells have abundant eosinophilic cytoplasm
97
fibrosis of breast
from rupture of cyst and release of contents resulting in inflammation
98
adenosis of breast
increase in number of acinar units per lobule
| calcifications can be seen
99
lactational adenomas
palpable masses in pregnant or lactating women
| exaggerated response to hormones
100
epithelial hyperplasia (w/o atypia)
more than 2 layers of hyperplasia
101
sclerosing adenosis
number of acini increased
| myoepithelial cells prominent
102
complex sclerosing adenosis
stellate with central nidus of entrapped glands
103
papillomas
branching fibrovascular cores
104
risk factors breast carcinoma
```
age
age at menarche
age at first birth
relative with breast cancer
breast biopsies
race (lower in AA)
```
105
other risk factors for breast carcinoma
estrogen exposure
radiation
carcinoma of contralateral breast or endometrial
geography
diet-decreased with B carotene, increase with alcohol
obesity-decrease at young age, increase at high age
exercise
breast feeding
organochloride pesticides
106
all carcinomas arise from
terminal duct lobular unit
107
ductal carcinoma in situ
limited to basement membrane
| myoepithelial cells can be present but decreased
108
comedocarcinoma
solid sheets of pleomorphic cells
109
non-comedocarcinoma
cribiform-cookie cutter spaces
solid
papillary
micropapillary
110
paget disease
unilateral erythematous eruption with scale crust
extension of DCIS into surface epithelium
can have underlying invasive carcinoma
111
lobular carcinoma in situ
lack E-cadherin
| small cells with oval or round nuclei
112
peau d'orange
larger carcinoma fixed to chest wall
| lymphatic involvement blocking skin drainage
113
NST invasive carcinoma
majority of carcinomas
| induce fibrotic reaction
114
invasive lobular carcinoma
seen in older women
115
morphology invasive lobular carcinoma
single infiltrating tumor cells
signet ring cell
concentric rings around normal ducts
116
mets invasive lobular carcinoma
peritoneum, retroperitoenum, leptomeninges, GI tract, ovaries, uterus
117
medullary carcinoma histology
large cells with vesicular nuclei and prominent nucleoli
frequent mitoses
pushing border
118
histology mucinous carcinoma
tumor cells as clusters of cells in lakes of mucin
119
clinical mucinous carcinoma
diploid
| better prognosis than invasive ductal
120
tubular carcinoma histology
tubules
| absence of myoepithelial cells
121
clinical tubular carcinoma
diploid
| excellent prognosis
122
major prognostic factors
```
invasive carcinoma
distant mets
lymph node mets
tumor size
locally advanced
inflammatory carcinoma
```
123
minor prognostic factors
```
histologic subtype
tumor grade
receptors
lymphovascualr invasion
proliferative rate
DNA content
```
124
fibroadenoma
fibrous clonal and epithelial is polyclonal
more common before age 30
hormonally responsive
125
phylloides tumor
in 60s
low grade that recurs
leaf like protrusions from nodules of proliferating stroma
126
diagnosis HSV
purulent exudate-CPE on culture
NAA test
anti-HSV antibodies
127
detection of antibodies to HSV
indicative of recurrent or latent infection
128
most common cause of molluscum contagiosum
MCV-2
| poxvirus
129
clincial appearance of molluscum contagiosum
pearly, dome shaped papules with dimpled center
| intracytoplasmic viral inclusions
130
risk factors candidiasis
diabetes, pregnancy, OCP
131
clinical presentation candidiasis
snow-ball to crotch
| vulvovaginal pruritis, erythema, swelling and curdlike vaginal discharge
132
clinical presentation trichomonas
from large ovoid protozoan with flagella
| vaginal discharge, fishy odor on exam, strawberry cervix
133
identification trichomonas
wet mount
pap smear
molecular test-more sensitive
134
presentation gardnerella
thin, gray-green, malodorous (fishy) vaginal discharge
135
causes follicular cervicitis, endometritis, slapingo-oophoritis
chlamydia trachomitis
136
causes PID
gonococci (most common)
chlamydia, enteric bacteria
D and C or surgical procedure
137
puerperal infection
PID following normal delivery
138
gonococcal infection leading to PID
begins in Bartholin glands
| inflammation confined to superficial mucosa and submucosa
139
spread non gonococcal infection leading to PID
lymphatics or venous channels
140
layers non gonococcal infection leading to PID
deeper layers
| causes acute suppurative salpingitis
141
complications non gonococcal infection
peritonitis, intestinal obstruction due to adhesions, bacteremia, infertility
142
presentation leukoplakia
white plaques
143
lichen sclerosis
parchment like white plaques on vulva and labial atrophy
more common after menopause
thinning of epidermis, dense dermal collagen
leads to atrophy, fibrosis, scarring
144
lichen simplex chronicus
non-specific
thickening of epidermis, hyperkaratosis, dermal inflammation
slight increased risk of cancer development
145
sites of HPV infection
vulva, vagina, cervix
146
condyloma acuminatum
wart like benign lesions
caused by HPV (6 and 11)
koilocytosis-halo around cell
147
basaloid and warty carcinomas
associated with high risk HPV (16, 18, 31)
preceded by VIN
presents as white patches
multicentric, lesions on vagina or cervix
148
keratinizing squamous cell carcinoma
from women with long standing lichen sclerosus or squamous cell hyperplasia
average age 76
149
extramammary paget disease
common in white postmenopausal women
pruritic red crusted lesion
not associated with cancer
150
morphology extramammary paget disease
intraepithelial growth pattern
| PAS or mucin stain
151
malignant melanom
6th and 7th decades
| may mimic paget disease
152
vaginal squamous cell carcinoma
most associated with HPV
| often results from spread of cervical lesion
153
vaginal adenocarcinoma
DES during pregnancy (babies from mothers who received this)
clear cell type
much more common association with vaginal adenosis
154
vaginal adenosis
red granular foci in vagina
| squamous replaced by columnar mucosa
155
embryonal rhabdomyosarcoma
child less than 5
malignant embryonal rhabdomyoblasts
project out of the vagina, grapelike mass
156
cervical change at menarche
increased estrogen causes increased glycogen uptake
| provides substrate for bacteria (drop in pH)
157
ectocervix histology
squamous epithelium
158
endocervix histology
columnar epithelium
159
endocervical polyp
can cause vaginal bleeding
soft, mucoid polypod mass
may protrude from os
160
testing of HPV in adolescents
may lead to over treatment
especially vulnerable
most are able to clear infections within 2 years
161
slow to clear
HPV 16
162
risk factor for development of cervical cancer
persistence of HPV
163
mode of infection HPV
infects immature basal cells
| especially immature metaplastic squamous cells at transformation zone
164
HPV in vulva and vagina
must have damage for HPV to have access to immature cells deep in epithelium
165
E6 and E7 in HPV
interact with tumor suppressor genes Rb and p53
166
test for primary HPV
cobas
| do HPV test first then pap
167
screening molecular tests for HPV
3 for DNA
| 1 for RNA
168
CIN 1
low grade dysplasia
| confined to lower 1/3 of epidermis
169
CIN 2
moderate dysplasia
more often associated with HPV
involves 2/3 of epidermis
170
CIN 3
most likely to progress to cervical cancer
| change to entire epidermal layer
171
squamous cell carcinoma
at 40-45 yo
| exophytic or infiltrative lesions
172
treatment of cervical dysplasia
excision-crypotherapy, laser vaporization, conization biopsy
173
treatment cervical cancer
complete hysterectomy with lymph node dissection
174
bleeding in older women
rule out endometrial hyperplasia or carcinoma
175
anovulatory cycles
most common cause of dysfunctional bleeding
| excessive estrogen stimulation without progesterone
176
inadequate luteal phase
corpus luteum does not put out adequate progesterone
increased bleeding, amenorrhea
biopsy-endometrium lags behind expected at date
177
causes of chronic endometritis
chronic PID
postpartum/postabortion
intrauterine contraceptive devices
patients with TB
178
histology chronic endometritis
plasma cells in endometrium
179
most common sites endometriosis
ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum
180
theories about endometriosis
regurgitation-retrograde menses spread to peritoneum
metaplastic-coelomic epithelium
lymphvascular-spread through pelvic vessels
181
morphology endometriosis
little red to brown nodules
powder burn marks
chocolate cyst in ovary
182
adenomyosis
endometrial glands within uterine wall
| nests are functional-hemorrhagic nests within the myometrium
183
two forms of endometrial polyps
functional endometrium-adjacent endometrium
| hyperplastic endometrium-mostly cystic
184
cause of endometrial hyperplasia
```
prolonged estrogen stimulation, unopposed estrogen
menopause
PCOS
excessive cortical function
prolonged estrogen replacement therapy
```
185
genetic alterations endometrial hyperplasia
inactivation of PTEN
186
non-atypical endometrial hyperpalsia
increased gland to stromal ratio
cystic formation
results from excessive estrogen stimulation
187
atypical endometrial hyperplasia
increased glands with crowding, enlargement and irregular shape
risk of adenocarcinoma
188
type 1 endometrial adenocarcinoma
most common
prolonged estrogen stimulation and endometrial hyperplasia
endometrioid carcinoma, PTEN associated
189
type 2 endometiral adenocarcinoma
may be asymptomatic
| thickened endometrium on ultrasound
190
malignant mixed mullerian tumors
malignant stromal differentiation with endometrial adenocarcinoma
highly malignant
191
leiomyomas
unique clonal neoplasm (most normal karyotype)
| most common tumor in humans
192
morphology leiomyomas
well circumscribed masses
white whorled cut surface
whorled bundles of smooth muscle
low mitotic index
193
clinical course leiomyomas
can cause abnormal bleeding, urinary frequency, pain, impaired fertility
malignant transformation rare
194
leiomyosarcoma
arise de novo from myometrium
| complex karyotypes with chromosomal abnormalities
195
morphology leiomyosarcoma
bulky fleshy mass iwthin myometrium or polypoid mass
| >10 mitoses per HPF
196
mets leiomyosarcoma
lungs, brain and bone
197
cause suppurative salpingitis
most often from gonococcus
198
primary adenocarinoma of fallopian tubes
watery discharge or bleeding
| associated with germline BRCA mutations
199
placenta composition
chorionic villi
| sprout from the chorion
200
outer cells of placenta
syncytiotrophoblast
201
inner cells of placenta
cytotrophoblast
202
spontaneous abortion causes
defective implantation and death of ovum or fetus
chromosomal abnormalities
trauma
infectious agents
203
predisposing factor for ectopic pregnancy
PID
204
most common location ectopic pregnancy
fallopian tube
205
presentation ectopic pregnancy
pain 6 weeks after normal menses
206
biopsy ectopic pregnancy
ill not show chorionic villi
207
rupture of tubal pregnancy
medical emergency
208
placenta accreta
adherence of placenta to myometrium due to partial or complete absence of deciduas
209
postpartum hemorrhage
sequela of placenta acreta
can result in hysterectomy
lack of placental separation
210
placenta previa
implants in lower uterine segment or cervix
antepartum bleeding and premature labor
can occur in women with previous c-section scar
211
two ova
dizygotic
212
one ova
monozygotic
213
dichorionic diamnionic
separate placentas or fused
214
twin twin transfusion syndrome
occurs in monochorionic-monoamionic placentas
| abnormal sharing of fetal circulatiosn
215
ascending pathway for infection
most common bacterial
sexual intercourse can enhance ascending infection
can cause premature rupture of membranes
216
hematogenous infection
spread of bacteria to placenta
| villi most often affected
217
most likely for pre-eclampsia
primiparas
218
pre-eclampsia
endothelial dysfunction, presents with HTN, proteinuria, and edema
219
eclampsia
seizures and DIC
220
placenta role in toxemia
endothelial dysfunction
vasoconstriction leading to HTN
increased permeability resulting in proteinuria and edema
221
abberations in toxemia
```
abnormal placental vasculaure-leads to shallow implantation and placental ischemia
endotheial dysfunction and imbalance of angiogenic and anti-angiogenic factors
hypercoagulable state (thrombosis in liver, kidneys, brain, pituitary)
```
222
morphology placenta toxemia
infarcts in wall of uterine vessels, decidual vessels show thrombosis and fibrinoid necrosis
223
hydatidiform mole
swelling of chorionic villi with trophoblastic proliferation
| uterus larger than due date in 4th or 5th month
224
complete mole
```
egg lost chromosomes-all paternally deerived
all villi are edematous
46XX or XY
rare fetal parts
uterine cavity-grape like structures
```
225
partial mole
some villi are edematous
69xxx,xxy
fetal parts more common
226
mole with elevated hcg
complete mole
227
invasive mole
penetrates and may even perforate the uterine wall
myometrium is invaded by hydropic chorionic villi
locally destructive and can embolize to liver and brain
228
clinical presentation invasive mole
vaginal bleeding and irregular uterine enlargement
elevated hcg
responds well to chemo
can result in uterine rupture/hysterectomy
229
morphology gestational choriocarcinoma
soft fleshy tumor with areas of necrosis
| proliferation of cytotrophoblasts and syncytiotrophoblasts
230
clinical course gestational choriocarcinoma
irregular spotting following miscarriage
| tumor mets by time of diagnosis-lungs, vagina, liver, kidney
231
treatment gestational choriocarcioma
chemo
232
hydrospadias
abnormal opening of the urethra along ventral aspect of penis
233
epispadias
abnormal opening of the urethra along the dorsal aspect of the penis
234
phimosis
orifice of prepuce too small for retraction
| predisposed to infection, carcinoma
235
balanoposthitis
infection of glans and prepuce
| non-specific and not sexually transmitted
236
Peyronie's disease
circumscribed fibrous thickening of connective tissue
painful curvature of penis toward lesion
may be related to chronic urethritis
237
condyloma acuminatum
HPV related
| histology-acanthosis, hyperkeratosis, koilocytosis
238
giant condyloma
large, cauliflower like
| usually in older individuals
239
dysplastic lesions of penis
associated with high risk HPV especially 16
240
Bowen's disease
lesion on skin of shaft, plaque like
| potential for malignant transformation
241
Bowenoid papulosis
seen in young
multiple papules
rare malignant transformation
242
cancer of penis, scrotum
squamous cell most common (related to HPV 16)
melanoma, soft tissue sarcomas, lymphomas
mets rare from GU
243
clinical course squamous cell carcinoma of penis
occurs in older
| circumcision confers protection, age of circumcision, hygiene
244
appearance squamous cell carcinoma
slow growing, plaque, ulceration or verrucous growth
245
mets squamous cell carcinoma
inguinal lymph nodes
246
cryptorchid testis
undescended testis
inguinal canal or abdomen
usually unilateral and idiopathic
increased risk of injury and cancer, bilateral-sterility
247
pathology of cryptorchid testis
increased hyaline deposition
failure of germ cell maturation
increased or normal Leydig cells
tubular atrophy-increases with age
248
causes of atrophy of testis
atherosclerosis, perivascular inflammation, cryptorchidism, malnutrition, hypo-pituitarism, obstruction, radiation, hormonal, Klinefelters
249
histology atrophic testis
increased interstitial scarring, tubular basement membrane thickening, loss of spermatogenesis, fibrosis, decreased or absent germ cells
250
gonorrhea in males
in epididymis
251
mumps in males
heavy mononuclear inflammation, edema
| neutrophils and abscesses
252
syphilis in males
testis first then epididymis
| gummas or diffuse inflammation of lymphocytes, plasma cells, obliterative endarteritis, perivascular cuffing
253
chronic orchitis
usually non-specific and chronic inflammation
254
tuberculosis in males
epididymis then testis
| caseating granulomas
255
torsion
twisting of spermatic cord and blockage of venous drainage
hemorrhagic infarction of testis
leads to acute pain and swelling
256
adenomatoid tumor
usually in epididymis, mesothelial in nature
cuboidal/flat cells in cords, cytoplasmic vacuole
benign
257
germ cell tumor origin
most from intratubular germ cell neoplasia
258
genetics intratubular germ cell neoplasia
12p
| germ cell tumors express OCT3/4 and NANOG
259
testicular dysgenesis syndrome
cryptorchidism, hydrospadias, poor sperm quality
| germ cell tumors association
260
seminomas genetics
25% KIT activation
261
AFP
elevated in yolk sac tumors
262
HCG
elevated in choriocarcinoma
263
characteristics of seminoma
average age 30
10% hcg+, PLAP+ 50%
radiosensitive, preceded by ITGCN, confined to testes
264
histology seminoma
thin septa, large cells, prominent nucleoli, sparse lymphocytes
265
histology spermatocytic seminoma
small cells, intermediate cells, large cells
266
characteristics spermatocytic seminoma
sarcomatous component-aggressive
seen in older population
never originates outside testes
267
characteristics embryonal carcinoma
more aggressive, 20-30 yo
tubular/alveolar/papillary pattern
large undifferentiated cells
PLAP+, CD30+
268
Schiller Duvall bodies
resemble primitive glomeruli
| seen in yolk sac tumor
269
characteristics yolk sac tumor
pure form in infants, young adults
positive for AFP
excellent prognosis
270
cells in choriocarcinoma
syncytiotrophoblast-large cells with irregular nuclei
| cytotorphoblast-small cells with clear cytoplasm
271
characteristics choriocarcinoma
malignant
mets to liver and lung
hemorrhage and necrosis common
hcg+
272
mature teratoma components
ectoderm-neural and epidermis
endoderm-GI, respiratory, mucous glands
mesoderm-bone, cartilage, muscle
273
common types of mixed germ cell tumor
teratoma, embryonal carcinoma, yolk sac
seminoma with embryonal
teratoma with embryonal
274
testicular lymphatic spread
retroperitoneal para-aortic nodes
275
testicular hematogenous spread
lungs, liver, brain, bones
276
characteristics of NSGCT
mets hematogenous
radioresistant
poorer prognosis
277
characteristics of SGCT
localized to testis longer
mets lymph nodes
radiosensitive
better prognosis
278
stage 1 testicular tumors
confined to testis, epididymis, or spermatic cord
279
stage 2 testicular tumors
retroperitoneal nodes below diaphragm
280
stage 3 testicular tumors
mets outside retroperitoneal nodes or above diaphragm
281
LDH serum marker
tumor burden/volume
282
characteristics Leydig cell tumor
20-60 yo
| may secrete androgens, may have gynecomastia
283
histology Leydig cell tumor
large, round, polygonal granular cytoplasm
| rod-shaped crystalloids of Reinke
284
histology Sertoli cell tumors
distinctive trabeculae with cordlike structures and tubules
| hormonally silent
285
testicular lymphoma
most common testicular neoplasm in men over 60
| diffuse large cell most common
