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Flashcards in Repro Cancers Deck (40):
1

Invasive cervical carcinoma

often squamous cell carcinoma

Pap smear can detect cervical dysplasia (koilocytes) before it progresses to invasive carcinoma

Lateral invasion can block ureters causing renal failure (hydronephrosis)-cause of death

Presents as poitcoital vaginal bleeding

2

Cervical Dysplasia and carcinoma in situ

Disordered epithelial growth

Begins at basal layer of sqaumocolumnar junction (transition zone)

Classification:
CIN I involves less than 1/3 the thickness of epithelium
CINII involves less than 2/3 the thickness of epithelium
CIN III involves slightly less than the full thickness of the epithelium

Associated with HPV 16 and 18 which produce E6 (p53 inhibitor) and E7 (RB suppressor)

May progress to invasive carcinoma

Typically asymptomatic (detected on Pap smear) or presents as abnormal vaginal bleeding (postcoital)

Risk factors: multiple sex partners, smoking, early sexual intercourse, HIV

3

Adenomyoma of uterus

Well circumscribed collection of endometrial tissue within the uteruine wall

may contain smooth muscle cells

Can extend into the endometrial cavity in the form of a polyp

Presents as abnormal uterine bleeding

Side effect of tamoxifen

4

Endometrial hyperplasia

Abnormal endometrial gland hyperplasia usually caused by excess estrogen stimuation

increased risk of endometrial carcinoma-dependent upon amount of atypia not hyperplasia

Manifests as postmenopausal bleeding

Risk factors: anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome and ganulosa cell tumor

5

Endometrial carcinoma

Most common gyneocologic malignancy

Peak occurrence at 55-65 years old

Clinically presents with vaginal bleeding (postmenopausal)

Typically preceded by endometrial hyperplasia
Sporadic pathway: atrophic endometrium with papillary structures-psammoma body formation-p53 mutation (aggressive)

Risk factors: use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause

Incraesed myometrial invasion decreases prognosis

6

Leiomyoma

Benign neoplastic proliferation of smooth muscle arising from mometrium

Most common tumor in females

Related to estrogen exposure: common in postmenopausal women, often mutiple

Enlarge during pregnancy, shrink during menopause

Gross: multiple, well-defined, white, whorled masses that may distort the uterus and impinge on pelvic structures

Usually asymptomatic but can present with abnormal uterine bleeding, infertility and pelvic mass (may have iron deficiency anemia)

7

Serous Cystadenoma

Benign ovarian neoplasm

Most common

Thin-walled uni-or multilocular

Line with fallopian like epithelium

Often bilateral

8

Mucinous cystadenoma

benign ovarian neoplasm

Multiloculated large

Lined by mucus secreting epithelum

9

Endometrioma

Benign ovarian neoplasm

Mass arising form ectopic endometrial tissue

Copmlex mass on ultrasoun

Presents with pelvic pain, dysmenorrhea, dysparenunia

10

teratoma

Mature cystic Germ cell tumor-benign ovarian neoplasm

Can contain elements from all 3 germ layers: teeth, hair, sebum, are common components

Can present with pain secondary to ovarian enlargment or torsion

Can also contain functional thyroid tissue (specific for mature)and present as hyperthyroidism

Immature teratoma is aggressive
Contains fetal tissue, neuroectoderm (specific for immature)

11

Brenner tumor

Benign ovarian neoplasm

Looks like bladder

Solid tumor that is pale yellow tan in color and appears encapsulated

Coffee-bean nuclei on H and E stain

12

Fibromas

Benign ovarian neoplasm

Bundles of spindle shaped fibroblasts

Meigs syndrom: triad of ovarian fibroma, ascites and hydrothorax

Pulling sensation in groin

13

Thecoma

Benign ovarian neoplasm

May produce estrogen

Present as abnormal uterine bleeding in a postmenopausal women

14

Granulosa cell tumor

Most common sex cord stromal tumor

Predominantly in women in their 50s

Often produce estrogen and progesterone
Leads to uterine bleeding, precocious puberty, breast tenderness
Endometrial hyperlasia (endometrial carcinoma)

Histology show Call-Exner bodies (eosinophilic excretions)

15

Serous Cystadenocarcinoma

Most common ovarian neoplasm

Frequently bilateral

Psammoma bodies

16

Mucinous Cystadenocarcinoma

Psuedomyxoma peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

17

Dysgerminoma

Most common in adolescents

large cells with clear cytoplasm and central nuclei (fried eggs)

(testicular counterpart is seminoma)

LDH may be elevated

18

Choriocarcinoma

Can develop during or after pregnancy in mother or baby
Also in males

Malignancy of trophoblastic tissue (cytotrophoblasts and syncytiotrophoblasts)

NO chorionic villi present

Increased frequency of theca-lutein cysts

Abnormal B-hCG, shortness of breath, hemoptysis (hematogenous spread to lungs)
May produce gynecomastia or hyperthyroidism (HCG has TSH and LH analog abilities)

Very responsive to chemo

19

Yolk sac tumor (endodermal sinus)

Agressive in ovaries and testes and scarococcygeal area in young children

Most common tumor of male infants

Yellow, friable (hemorrhagic) soild mass

Shiller Duval bodes (glomeruli-like)

AFP positie

20

Krukenberg tumor

GI malignancy that metastasizes to ovaries causing a mucin secreting signet cell adenocarcinoma

21

Vaginal Clear Cell Carcinoma

Malignant proliferation of glands with clear cytoplasm

rare but feared complication of DES associated vaginal adenosis

22

Embryonal rhabdomyosarcoma (sarcoma botryoides) of the vagina

Malignant mesenchymal proliferation of immature skeletal muscle

Prsents as bleeding and a grape like mass protruding from vagina or penis of a child less than 5 years old

Rhabdomyoblast exhibits cytoplasmic cross striations and positive immunohistochemical staining for desmin and myogenin

23

Vaginal carcinoma

Sqamous epithelium lining the vagina mucosa

usually related to HPV

Precursor si vaginal intraepithelial neoplasia

lower 1/3 goes to superficial inguinal
Upper 2/3 goes to regional external iliac, hypogastric, obturator

24

Fibroadenoma

Characteristics: small, mobile mass with sharp edges

Myxoid stroma that encircles epithelium lined glandular and cystic spaces
epithelium compressed by surrounding stroma

Increase in size and tenderness with increased estrogen (pregnancy, prior to menstruation)

25

Intraductal papilloma

Characteristics: small tumor that grows in lacteriferous ducts
Typically beneath areola

Fibrovascular projections lined by epithelial and myoepithelial cells (as opposed to papillary carcinoma that does not have myoepithelial cells)

Serous or blood nipple discharge
Slight increase in risk of carcinoma

Premenopausal=intraductal papilloma
Postmenopausal=papillary carcinoma

26

Phyllodes tumor

Characteristics: large bulky mass of connective tissue and cysts
Leaf-like projections

Most common in 6th decade

Some may become malignant

27

Ductal carcinoma in situ (breast)

Fills ductal lumen-no invasion of basement membrane

Arises from ductal atypia

Often seen as early microcalcifications on mammography

28

Comedocarcinoma

Ductal, caseous necrosis

subtype of DCIS

Chronic inflammation and periductal concentric fibrosis also found

Malignant clonal cell proliferation contained by ductal basement membrane

High grade pleiomorphic cells with central necrosis

29

paget disease

DCIS that extends up the ducts to involve the skin of the nipple

Eczematous patches on nipple

Paget cells: large cells in epidermis with clear halo

30

Invasive ductal carcinoma

Firm, fibrous rock hard mass with sharp margins and small glandular duct like cells

Grossly: stellate infiltration
may see retraction of nipple or dimpling of skin

Most invasive

31

Invasive lobular

Orderly row of cells
Found incidentally
Often bilateral with multiple lesions in same location

Lack of E-cadherin

32

Medullary invasive breast carcinoma

Fleshy, cellular, lymphocytic infiltrate

Good prognosis

increased incidence with BRCA1 mutations

33

Inflammatory breast carcioma

Dermal lymphatic invasion by breast carcinoma

Peau d'orange-pitting edema and thickening of skin around hair follicles
neoplastic cells block lymphatic drainage

Breast tenderness

rapidly progressive

34

Seminoma

Germ cell testicular tumor

Risk factors: cryptorchoridism, Klinefelter

Does not transluiminate

Malignant;
painless, Homogenous testicular enlargement
Never in infancy

large cells in lobules with watery cytoplasm and a fried egg apperance

Increased placental ALP

Radiosensitive
late metastasis but excellent prognosis

35

Testicular Teratoma

Germ cell testicular tumor

Risk factors: cryptorchoridism, Klinefelter

Does not transluiminate

mature teratoma can be malignant (adults)

Benign in children

Increased hCG and or AFP

36

Embryonal testicular carcinoma

Germ cell testicular tumor

Risk factors: cryptorchoridism, Klinefelter

Does not transluiminate
Malignant hemorrhagic mass with necrosis

Painful worse prognosis than seminoma

Often glandular/papillary morphology

Mixed with other cancers often

Increased hCG (increased AFP when mixed)

37

Leydig cell testicular tumor

non germ cell

Contains reinke crystals
Usually androgen producing-gynecomastia in men, precocious puberty in boys

Golden brown color

38

Sertoli cell testicular tumor

Androblastoma from sex cord stroma

39

Testicular lymphoma

Most common testicular cancer in older men

Not a primary cancer arises from lymphoma metastases to testes

Aggressive

40

Penile squamous cell carcinoma

More common in Asia, Africa and South America

Precursor in situ lesion: leukoplakia of penile shaft, erythorplasia of queryrat (cancer of glans), bowenoid papulosis (reddish papules)

Associated with HPV lack of circumcision