Pathoma (HIGH YIELD) Flashcards by Charles Shirley

Vulvar carcinoma etiologies

HPV (dysplasia, VIN) and non-HPV (longstanding lichen sclerosis)

How well did you know this?

Not at all

Perfectly

Extramammary Paget’s disease vs Melanoma differentiation?

Paget’s: PAS+, keratin +, S100-

Melanoma: PAS-, keratin-, S100+

How well did you know this?

Not at all

Perfectly

Vaginal carcinomas nodal metastasis pattern

Lower 1/3: inguinal nodes

Upper 2/3: iliac nodes

How well did you know this?

Not at all

Perfectly

High risk HPV proteins

E6 (destruction of p53), E7 (destruction of Rb)

How well did you know this?

Not at all

Perfectly

Cervical carcinoma risk factors

HPV (no 1), but smoking and immunodeficiency also important

How well did you know this?

Not at all

Perfectly

What malignancy is an AIDS-defining illness in a woman with HIV?

Cervical cancer

How well did you know this?

Not at all

Perfectly

Frequent cause(s) of mortality in Cervical cancer

“Local invasion” (e.g. invasion through bladder, hydronephrosis, renal failure)

How well did you know this?

Not at all

Perfectly

Limitations of Pap smear screening

Inadequate sampling of transition zone

- Decr. efficacy in screening adenocarcinoma

How well did you know this?

Not at all

Perfectly

Does HPV vaccination preclude the need for routine Pap smears? Why?

No; does not offer protection against HPV 31, 33

How well did you know this?

Not at all

Perfectly

Asherman syndrome cause

Progressive amenorrhea d/t loss of basalis (regenerative layer) and scarring

How well did you know this?

Not at all

Perfectly

Risk factor(s) for endometrial polyp(s)

Can arise as side effect of Tamoxifen

How well did you know this?

Not at all

Perfectly

Define adenomyosis

Endometriosis of myometrium

How well did you know this?

Not at all

Perfectly

Most important predictor for progression to carcinoma in Endometrial hyperplasia

Cellular atypia

How well did you know this?

Not at all

Perfectly

Leiomyosarcoma etiology

De novo (does not arise from leiomyoma)

How well did you know this?

Not at all

Perfectly

Describe normal endocrine regulation of ovulation in the ovary

LH acts on theca cells, which produce androgens, which are then converted to estradiol in the granulosa cells under the influence of FSH, eestradiol then causes egg maturation

How well did you know this?

Not at all

Perfectly

Most common germ cell tumor in children

Endodermal sinus tumor (type of yolk sac tumor)

How well did you know this?

Not at all

Perfectly

Endodermal sinus tumor lab findings

Elevated AFP

How well did you know this?

Not at all

Perfectly

Endodermal sinus tumor lab findings

Elevated AFP

How well did you know this?

Not at all

Perfectly

Defines Meigs syndrome

Ovarian fibroma (benign tumor of fibroblasts) plus pleural effusion, ascites

How well did you know this?

Not at all

Perfectly

What mutation incr. risk for serous carcinoma of the ovary and fallopian tube?

BRCA1

How well did you know this?

Not at all

Perfectly

What ovarian tumor usually contains urothelium?

Brenner tumor

How well did you know this?

Not at all

Perfectly

Choriocarcinoma response to chemo?

Good response for gestational pathway (i.e. from complete mole); poor response if germ cell pathway

How well did you know this?

Not at all

Perfectly

Hypospadias cause

Failure of urethral folds to close

How well did you know this?

Not at all

Perfectly

Penile SCC precursor lesions

Bowen disease (shaft)
• Leukoplakia on shaft of penis; has not invaded BM
Erythroplasia of Queyrat (glans)
Bowenoid papulosis (reddish papules)
• Not true Bowen’s disease b/c it does not usually progress to invasion

How well did you know this?

Not at all

Perfectly

Testicular torsion presentation

Adolescents with acute testicular pain and absent cremasteric reflex

Seminoma histopathology

No hemorrhage or necrosis

What type of testicular tumor may form glands?

Embryonal carcinoma

Most common testicular tumor in children

Yolk sac tumor (aka endodermal sinus tumor)

Possible clinical presentation of choriocarcinoma

Gynecomastia, hyperthyroidism (both d/t elevated b-HCG)

Leydig cell tumor characteristic histology

Reinke crystals

Leydig cell tumor characteristic histology

Reinke crystals

Are teratomas benign or malignant?

Benign in females; potentially malignant in males

Acute prostatitis on DRE

Tender and boggy

BPH occurs in this zone of the prostate (according to Pathoma)

What is the periurethral zone

Prostate adenocarcinoma characteristic histology

Small glands, nuclei contain dark nucleoli

Growth hormone adenoma presentation

Secondary diabetes is often present

Sheehan syndrome cause and symptoms

Pituitary growth during pregnancy d/t more blood flow incr. susceptibility to infarct during delivery; difficulty with lactation, pubic hair loss

Thyroglossal duct cyst presentation

Anterior neck mass

Lingual thyroid presentation

Mass at base of tongue

Cause of incr. BMR in hyperthyroidism

Incr. synthesis of Na+/K+ ATPase

Cause of incr. SNS activity in hyperthyroidism

Incr. expression of beta adrenergic receptors

Hyperthyroidism on a lipid panel

Hypocholesterolemia

Enzyme most often deficient in dyshormogenetic goiter

Thyroid peroxidase (causing pediatric hypothyroidism)

Haplotype associated with Hashimoto thyroiditis

HLA DR5

Histopathologic findings in Hashimoto thyroiditis

Abundant chronic inflammation with formation of germinal centers; Hurthle cells

Riedel fibrosing thyroiditis presentation

Hypothyroidism with "hard as wood" nontender thyroid

Subacute (deQuervain) granulomatous thyroiditis presentation

Transient hyperthyroidism with tender (particularly unique) thyroid

How is a thyroid biopsy usually performed and why?

FNA; thyroid is (very) vascular

Thyroid follicular adenoma histopathology

Benign proliferation of follicles surrounded by a fibrous capsule

4 types of thyroid carcinomas

Papillary medullary follicular anaplastic

Most important risk factor for papillary thyroid carcinoma

Exposure to ionizing radiation in childhood

Gross appearance of follicular thyroid carcinoma; what significance does this have with respect to thyroid bx?

Extension through capsule; cannot differentiate adenoma from follicular ca on FNA

Medullary thyroid cancer histopathologic appearance

Malignant cells within amyloid stroma

Medullary thyroid cancer genetics

Mutation in RET oncogene (mutations detected in RET always prompt prophylactic thyroidectomy)

PTH effect on bone

Incr. osteoblast activity, which in turn incr. osteoclast activity, crushing bone, leading to Ca++ and Phosphate release

Primary hyperparathyroidism GI sequelae

Acute pancreatitis (most important), PUD, constipation

Primary hyperparathyroidism urine labs

Incr. cAMP (PTH binds tubular cells of kidney, activates Gs protein thus activating adenylate cyclase, after which incr. cAMP leaks into urine)

Primary hyperparathyroidism serum labs

Incr. Alk phos, incr. Ca++, incr. Phosphate, incr. PTH

Cause of pseudohypoparathyroidism

Defect in Gs protein

Why is obesity implicated in type II diabetes?

Decr. number of insulin receptors

Which has a stronger genetic predisposition: type I or type II diabetes?

Type II diabetes

Pancreatic histopathology in diabetes

Amyloid deposition in islets

Diabetic neuropathy pathophysiology

Schwann cells can absorb glucose independent of insulin, then aldose reductase converts to sorbitol, leading to osmotic damage

How can Cushing syndrome lead to HTN?

Cortisol upregulates alpha-1 receptors (cortisol is "necessary for life" b/c it maintains vascular tone)

Causes of chronic adrenal insufficiency

- Autoimmune (most common in West) - TB (most common in developing world) - Bilateral metastatic disease (recall unique site of metastasis for lung ca)

Adrenal medulla cell composition (incl. embryologic origin)

Chromaffin cells (derived from NCCs)

Gross appearance of pheochromocytoma

Brown

Pheochromocytoma diagnostic requirements

Serum metanephrines (breakdown product of epinephrine), elevated 24-hr metanephrines and VMA (breakdown product of metanephrines and normetanephrines)

What medication is given before pheochromocytoma removal and why?

alpha-Phenoxybenzamine (irreversible alpha-1 blocker); intraoperative compression of pheo could release massive amount of catecholamines, causing HTN surge

Most common location (and presentation) of pheochromocytoma outside adrenal medulla

Bladder wall (hypertensive during urination)

Embryologic origin of breast tissue; why is this important?

Skin (modified sweat gland); breast tissue (incl. nipples, cancer) can develop anywhere along "milk line" (axilla to vulva)

Normal breast tissue epithelial composition

Lobules and ducts lined by 2 layers: myoepithelial cell layer and luminal cell layer

Highest density of breast tissue is located where?

Upper outer quadrant(s)

Mammary duct ectasia symptoms

Periareolar mass, green-brown nipple discharge

2 possible presentations of breast fat necrosis

Mass on exam; calcifications on mammogram (higher yield)

Fibrocystic breast histopathology that does NOT incr. risk of cancer (in either breast)

Fibrosis, cysts, apocrine metaplasia (one of a few metaplasias that do not incr. cancer risk)

Fibrocystic breast histopathology that DOES incr. risk fo cancer (in either breast)

Ductal hyperplasia, sclerosis adenosis (often calcified), atypical hyperplasia

Intraductal papilloma (breast) vs papillary carcinoma differentiation

Papillary carcinoma won't have myoepithelial cells

Phyllodes tumor (breast) histopathology

Fibroadenoma-like with overgrowth of fibrous component; leaf-like projections

Comedo type DCIS histopathology

High grade cells, necrosis, dystrophic calcifications (i.e. calcium in dead cells) in ductal lumen

Medullary carcinoma (of breast) histopathology

High grade malignant cells in background of inflammatory cells (especially plasma cells and lymphocytes)

Medullary carcinoma (of breast) genetics

BRCA1

Which breast neoplasms lack E-cadherin?

LCIS; invasive lobular carcinoma

Invasive lobular carcinoma (of breast) histopathologic feature

Grows in single file pattern

Most important part of TNM staging in breast cancer prognosis

Metastasis

Pathoma (HIGH YIELD) Flashcards

(85 cards)