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Flashcards in Repro - Pathology Part 2 Deck (115):
1

What tumor marker would you order on a patient if you suspect an endodermal sinus (yolk sac) tumor?

α-Fetoprotein

2

What is the most common type of germ cell tumor in women?

Teratoma (more than 90% of tumors); mature teratomas are the most common benign ovarian tumors in women

3

Is there a difference in the prognosis of a patient with an immature teratoma compared to a mature teratoma?

Yes; immature teratomas are malignant whereas mature teratomas or dermoid cysts are benign

4

What kind of tumor contains cells from two or three germ cell layers?

Teratoma

5

A woman presents with palpitations, sweating, weight loss, and a low thyroid-stimulating hormone level; what ovarian pathology could be responsible?

Struma ovarii, in which functional thyroid tissue within a teratoma can cause symptoms of hyperthyroidism

6

Which benign non-germ cell ovarian tumor is frequently bilateral and has a fallopian tube-like epithelium?

Serous cystadenoma, which compose 20% of non-germ cell tumors

7

Which malignant non-germ cell tumor represents 50% of ovarian tumors and is frequently bilateral?

Serous cystadenocarcinoma

8

Which benign non-germ cell tumor has multilocular cysts lined with mucus-secreting epithelium?

Mucinous cystadenoma; this can often look like intestinal tissue

9

Which malignant ovarian non-germ cell tumor can progress to pseudomyxoma peritonei?

Mucinous cystadenocarcinoma

10

What is pseudomyxoma peritonei?

An intraperitoneal accumulation of mucinous material from an ovarian or appendiceal tumor

11

Which benign ovarian non-germ cell tumor resembles bladder epithelium?

Brenner tumor (remember: Brenner is Benign and looks like Bladder)

12

Which benign ovarian non-germ cell tumor contains bundles of spindle-shaped fibroblasts and can cause Meigs' syndrome?

Ovarian fibroma

13

What triad is associated with Meigs' syndrome?

Ovarian fibroma, ascites, and hydrothorax

14

A patient with an ovarian non-germ cell tumor has small follicles filled with eosinophilic secretions on histopathology. What are these called and what tumor do they signify?

Call-Exner bodies, indicative of granulosa cell tumors

15

How can the presentation of a granulosa cell tumor differ based on age?

Granulosa cell tumors secrete estrogen; in childhood, this can result in precocious puberty, whereas adults may see abnormal uterine bleeding, endometrial hyperplasia, or carcinoma

16

What is the most important risk factor for ovarian cancer?

Family history, since there is a strong genetic component to development of the disease

17

What histologic appearance is seen in a Krukenberg tumor of the ovary?

Signet cell adenocarcinoma, which produces mucin

18

Krukenberg tumor is an ovarian tumor that has its origin in what organ system?

Gastrointestinal system, usually as gastric cancer

19

What serum marker would you follow in a patient with any form of ovarian cancer?

CA-125 is a general marker for ovarian cancer

20

Name two genetic risk factors for developing ovarian tumors with a non-germ cell origin.

Being positive for BRCA-1 mutation or HNPCC(hereditary nonpolyposis colorectal cancer) genes

21

What vaginal cancer develops secondary to cervical carcinoma?

Vaginal squamous cell carcinoma develops from cervical squamous cell carcinoma

22

Diethylstilbestrol exposure can lead to what type of vaginal carcinoma?

Clear-cell adenocarcinoma

23

A girl younger than 4 years of age has a vaginal mass that shows spindle-shaped tumor cells positive for desmin staining; what is the diagnosis?

Sarcoma botryoides; a variant of rhabdomyosarcoma

24

A sexually active female presents with vaginal pain, and on exam you note a tender mass in the labia majora; this is suspicious for what disorder?

Bartholin's gland cyst, a rare lesion that may be a result of a prior infection

25

Sarcoma botryoides is a variant of what type of malignancy?

Rhabdomyosarcoma

26

What is the most common breast tumor among women younger than 25 years of age?

Fibroadenoma, a benign tumor

27

A 20-year-old woman has a small, mobile, firm breast mass with well-defined borders; what is the most likely etiology?

Fibroadenoma, the most common tumor in women younger than 25 years of age

28

A 24-year-old woman notes a breast mass that becomes more tender during menstruation and asks you if this means she has breast cancer; what is your reply?

The age and description of the breast tenderness are consistent with a fibroadenoma, which is a benign breast mass

29

What neoplasm would be likely in a woman with serosanguinous discharge from her nipple but without a palpable breast mass?

Intraductal papilloma, which grows in the lactiferous ducts, often below the areola

30

What is the relationship between an intraductal papilloma and the development of breast cancer?

There is a small increase in the risk of carcinoma (1.5-2 times increased risk)

31

What is the likely diagnosis of a breast mass removed from a 55-year-old woman that is a large, bulky tumor composed of connective tissue and cysts with leaf-like projections?

Phyllodes tumor (remember: phyllodes means leaf-like)

32

What is the prognosis of a woman with a phyllodes tumor of the breast?

Although typically regarded as a benign breast tumor, some may become malignant

33

What are the two types of breast tissue from which breast carcinoma can arise?

Mammary duct epithelium or lobular glands

34

Which cellular markers that affect both treatment and prognosis should you test for in a patient with a new diagnosis of breast cancer?

Hormone receptor expression (estrogen, progesterone receptors) and erb-B2 or HER-2, an epidermal growth factor receptor

35

What is the single most important prognostic factor in malignant breast cancer?

Axillary lymph node involvement

36

Name four risk factors for breast malignancies.

Increased estrogen exposure, obesity (which also results in increased estrogens), increased number of total menstrual cycles, and advanced age at the first live birth

37

What type of breast carcinoma should you suspect if a biopsy shows ductal tissue filling the lumen that does not cross the basement membrane?

Ductal carcinoma in situ, an early malignancy that arises from ductal hyperplasia

38

What type of breast carcinoma should you suspect if you note a rock-hard mass on exam and a biopsy shows a fibrous mass with small, interspersed, glandular, duct-like cells?

Invasive ductal carcinoma

39

What type of malignant breast tumor is most invasive and has the worst prognosis?

Invasive ductal carcinoma; it is also the most common (75% of breast malignancies)

40

How can a comedocarcinoma be distinguished from ductal carcinoma in situ?

Comedocarcinoma is a subtype of ductal carcinoma in situ, notable for caseous necrosis within the duct

41

A woman presents to your office and on breast exam you note that she has a mass and the overlying skin looks like an orange peel; what is the cause of these dermatologic findings?

This is inflammatory breast carcinoma with the classic peau d'orange appearance, caused by malignant involvement of the dermal lymphatics

42

Which type of breast carcinoma should you suspect in a woman with bilateral masses when biopsy reveals orderly rows of cells?

Invasive lobular carcinoma, which is often bilateral and multiple

43

Which histologic type of breast carcinoma is a fleshy tumor with lymphocytic infiltration and a good prognosis?

Medullary

44

A woman presents to your office complaining of a chronic nonhealing eczematous patch on her nipple; what do you expect to see on biopsy?

Paget cells (large epidermal cells with a clear halo around the nucleus) on biopsy; she has Paget's disease of the breast

45

What work-up should be done in a patient with Paget's disease of the nipple?

Work-up for underlying carcinoma of the breast

46

Name four histologic types of fibrocystic breast disease.

Fibrotic, cystic, sclerosing adenosis, and epithelial hyperplasia

47

Which form of fibrocystic breast disease increases the risk of breast carcinoma?

Epithelial hyperplasia when atypical cells are present; otherwise, there is no increased risk of carcinoma

48

A patient notes that she has several breast masses that have been causing her pain and that seem to change in size during her menstrual cycle; what is the most likely diagnosis?

Fibrocystic disease of the breast, the most common cause of breast lumps in woman between 25 years of age and menopause

49

How does the fibrotic type of fibrocystic disease appear on histopathology?

Hyperplasia of the breast stroma

50

What is the gross appearance of cystic-type fibrocystic breast disease?

Fluid-filled, blue dome cysts

51

How does sclerosing adenosis appear on histopathology in fibrocystic breast disease?

Increased acini and intralobular fibrosis; calcifications can also be seen

52

What is the histologic appearance of the epithelial hyperplasia subtype of fibrocystic breast disease?

The terminal ductal tissue has an increased number of epithelial cell layers

53

A breastfeeding woman presents with a fluctuant breast mass that is hot and tender and she is febrile; what is the diagnosis?

Acute mastitis that has progressed to form an abscess

54

What organism most commonly causes acute mastitis?

Staphylococcus aureus, which enters through cracks in the nipple (common during breastfeeding)

55

What diagnosis should you suspect in a woman who presents with a painless breast lump following trauma to her chest?

This is likely fat necrosis, a benign process that occurs after trauma (although 50% of patients may not recall an injury)

56

Name five conditions that can cause gynecomastia in males due to hyperestrogenism.

Puberty, old age, testicular tumors, cirrhotic liver disease, estrogen therapy

57

Name a genetic abnormality that can result in gynecomastia.

Klinefelter's syndrome

58

Name nine drugs or substances that cause gynecomastia.

Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole (remember: Some Drugs Create Awesome Knockers) along with marijuana, estrogen, heroin, and psychoactive drugs

59

What physical examination would be useful in an older male who has symptoms of pain, increased frequency and urgency on urination, and lower back pain?

A rectal/prostate exam; this patient has symptoms suggestive of prostatitis

60

What species is the most common etiology of bacterial prostatitis?

Escherichia coli

61

Is chronic prostatitis most commonly bacterial or abacterial?

Abacterial

62

What role do circulating hormones play in the pathogenesis of benign prostatic hyperplasia?

Age-related increases in estradiol and greater sensitivity to dihydrotestosterone are thought to cause prostate hyperplasia

63

A 65-year-old man presents with increased frequency of urination, nocturia, and difficulty starting and stopping his urine stream. What common benign urologic condition is high on the differential diagnosis?

Benign prostatic hyperplasia

64

Looking at a prostate specimen in a patient with benign prostatic hyperplasia, what is notable about the lobes of the prostate and the prostatic urethra on gross pathology?

The lateral and middle periurethral lobes are hyperplastic, and the urethra is compressed into a vertical slit

65

Name a vasoactive class of drugs effective in treating benign prostatic hyperplasia.

a1-Blockers like terazosin and tamsulosin; these relax the smooth muscle in the prostate and reduce urinary symptoms

66

What serious complications can arise in a patient with benign prostatic hyperplasia?

Distention or hypertrophy of the bladder, hydronephrosis, and urinary tract infection

67

Prostate-specific antigen can be elevated in men with what two conditions?

Benign prostatic hyperplasia and prostate cancer

68

Prostatic adenocarcinoma is common among men in what age group?

50 years

69

Benign prostatic hyperplasia is often more likely located in the _____ (periurethral/posterior) lobe, whereas prostatic adenocarcinoma is more likely located in the _____ (periurethral/posterior) lobe.

Periurethral; posterior

70

What is the most common way to diagnose prostatic adenocarcinoma?

Digital rectal exam (hard nodule) and biopsy

71

Name two useful tumor markers for prostatic adenocarcinoma.

Prostatic acid phosphatase and prostate-specific antigen

72

An elderly male has lower back pain and a hard nodule on prostate exam; what should you suspect if he has elevated prostate-specific antigen and alkaline phosphatase levels?

Prostate adenocarcinoma with metastases to bone causing osteoblastic lesions

73

How can benign prostatic hyperplasia be distinguished from prostatic adenocarcinoma using the prostate-specific antigen test?

Generally, benign prostatic hyperplasia has an elevated free prostate-specific antigen, whereas adenocarcinoma has an elevated total prostate-specific antigen with a decreased free prostate-specific antigen fraction

74

On a male newborn exam, you fail to palpate testicles in the scrotum; name two potential complications of this condition.

This child has cryptorchidism and may develop infertility or testicular (germ cell) cancer

75

Why does cryptorchidism cause infertility?

The increased temperature of the testes when they are close to the body leads to a lack of spermatogenesis

76

Name a risk factor for cryptorchidism.

Premature birth; because cryptorchidism occurs when the testicle does not fully descend

77

What type of testicular tumor is more common: germ cell tumors or non-germ cell tumors?

Germ cell tumors make up 95% of testicular tumors; non-germ cell tumors account for 5%

78

What is the most common testicular tumor?

Seminoma

79

A 25-year-old male presents with a painless testicular mass that on biopsy has lobules of large cells with a fried egg appearance; what is his prognosis?

Seminoma, which in spite of being malignant has an excellent prognosis and only metastasizes late in its course

80

What treatment can be used in a patient with seminoma?

Radiation therapy; this tumor, mostly affecting males aged 15-35 years, is extremely radiosensitive

81

What malignant testicular germ cell tumor typically has glandular histopathology and can differentiate to other tumors?

Embryonal carcinoma

82

In males, seminoma presents with a _____ (painful/painless) testicular mass, whereas embryonal carcinoma presents with a _____ (painful/painless) mass.

Painless; painful

83

What tumor markers are elevated in a patient with embryonal carcinoma?

α-Fetoprotein and human chorionic gonadotropin

84

What germ cell tumor should you suspect if the histopathology indicates Schiller-Duval bodies?

Yolk sac (endodermal sinus) tumors; Schiller-Duval bodies, which resemble primitive glomeruli, are found in these tumors

85

What tumor marker is associated with yolk sac (endodermal sinus) tumors?

Increased α-fetoprotein

86

A testicular germ cell tumor has disordered syncytiotrophoblastic and cytotrophoblastic elements on histopathology; what serum marker should you check?

Human chorionic gonadotropin; these findings are consistent with choriocarcinoma, which has an elevated human chorionic gonadotropin

87

Most germ cell tumors of the testicle are _____ (benign/malignant) whereas non-germ cell tumors are usually _____ (benign/malignant).

Malignant; benign

88

In men, mature teratomas are _____ (benign/malignant) and in women, mature teratomas are _____ (benign/malignant).

Malignant; benign

89

What benign testicular non-germ cell tumor is associated with Reinke's crystals?

Leydig cell tumor

90

What symptoms would you expect to see in a child with a testicular Leydig cell tumor? An adult?

This androgen-producing tumor will result in precocious puberty in boys and often causes gynecomastia in adult men

91

How can you distinguish between testicular cancer and most tunica vaginalis lesions on exam of a patient who has felt a lump?

A lesion of the tunica vaginalis will transilluminate whereas a testicular tumor will not

92

What is the most common testicular cancer among older men?

Testicular lymphoma

93

What is a varicocele?

A dilated vein in the pampiniform plexus

94

When performing a testicular exam on a patient you note that there is a bag of worms quality to the scrotum; what long-term complication should you warn your patient about?

Infertility; this is consistent with a varicocele, which can lead to infertility

95

What embryologic abnormality causes a hydrocele?

Incomplete fusion of processus vaginalis resulting in retention of fluid within the tunica vaginalis

96

What is a spermatocele?

A dilated epididymal duct

97

What diagnosis is likely in a 45-year-old male who presents with a gray, crusty plaque on the scrotum or shaft of the penis?

Bowen's disease, most common in men in their fifth decade

98

What may occur if Bowen's disease is left untreated?

Squamous cell carcinoma, which occurs in 10% of untreated lesions

99

What diagnosis is likely in a male patient who presents with red, velvety plaques on the glans of the penis?

Erythroplasia of Queyrat

100

Name two risk factors associated with an increased rate of penile squamous cell carcinoma.

Lack of circumcision and human papillomavirus infection

101

Geographically, where is penile squamous cell carcinoma most common?

The condition is uncommon in Europe and the United States and more common in Asia, Africa and South America

102

What condition results in a bent penis due to an acquired fibrous tissue formation?

Peyronie's disease

103

What type of penile pathology is characterized by multiple papular lesions in younger men that generally do not become invasive?

Bowenoid papulosis

104

Which chromosomal disorder is marked by testicular atrophy, eunuchoid body shape, long extremities, gynecomastia, and female hair distribution?

Klinefelter's syndrome(XXY), which has an incidence of 1:850

105

When looking at a blood smear of a male patient you note a small dumbell-shaped extension on a cell nucleus that you identify as a Barr body; what does this represent and what is the condition?

This is an inactivated X chromosome, normal in women but indicative of Klinefelter's syndrome (XXY) in men

106

Which chromosomal disorder is marked by short stature, webbing of the neck, and coarctation of the aorta in a female?

Turner's syndrome (XO) (remember: "Hugs and Kisses"; [XO] from Tina Turner[female])

107

What is the most common cause of primary amenorrhea?

Turner's syndrome (XO)

108

Which chromosomal disorder is implicated in men who are phenotypically normal although very tall with severe acne and are known for antisocial behavior (in 1% to 2% of cases)?

Double Y males (XYY), which has an incidence of 1:1000

109

True or False? Double Y males are infertile.

False, double Y males have normal fertility

110

What happens to the levels of follicle-stimulating hormone and luteinizing hormone in a patient with Turner's syndrome?

Because ovarian failure results in a decrease in estrogen, follicle-stimulating hormone and luteinizing hormone levels are elevated due to lack of negative feedback

111

How many Barr bodies are seen when the cells of a patient with Turner's syndrome are examined under the microscope?

None

112

What happens to follicle-stimulating hormone levels in a patient with Klinefelter's syndrome?

Due to dysgenesis of the seminiferous tubules levels of inhibin are reduced; with no negative feedback follicle-stimulating hormone is increased

113

What happens to luteinizing hormone levels in a patient with Klinefelter's syndrome? What effect does this have on sex hormones?

Patients with Klinefelter's syndrome have abnormal Leydig cell function, resulting in low testosterone levels and thus increased luteinizing hormone; increased luteinizing hormone stimulates an increase in estrogen levels

114

What gonadal tissue is present in a patient with true hemaphroditism?

Both ovarian and testicular tissue is present

115

What are the two possible karyotypes of true hemaphroditism?

46, XX and 47 XXY are the possible karyotypes of this very rare disorder

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