Flashcards in Reproduction Final Deck (121):
Name the 2 risk factors for cancer among the benign lesions of the Breast.
Atypical Epithelial Hyperplasia
Multiple Intraductal Papillomas
(underneath nipple in dilated lactiferous sinuses)
Who is more likely to get a Fibrocystic Change in the breast?
The pathogenesis of Fibrocystic Change in the breast is related to what?
*why improvement after menopause
Are Fibrocystic Changes to the breast generally bilateral or unilateral?
*symmetrical, usually affecting both breasts
Fibrocystic Changes of the breast are seen between what ages?
Onset of puberty to menopause
*Sex hormone related
How does the progesterone/estrogen imbalances that cause the pathogenesis in Fibrocystic breast changes affect the tissue?
What 3 areas are affected?
Stimulates proliferation of cells
Excretory ducts, Lobules, and Intralobular stroma
What is the only risk factor that occurs in Fibrocystic breast change that leads to cancer?
Atypical Epithelial Hyperplasia
*more atypical, greater risk
**Atypical = multilayered
The most constant feature of fibrocystic change in the breast is Fibrosis
10-15% women between 20-50 have fibrocystic change
What are the presenting clinical features of Fibrocystic changes to the breast?
Pain, nodularity, palpation sensitivity
Calcification (difficult to distinguish from cancer)
What is the most common presenting feature of Intraductal Papillomas?
Bloody/Serous nipple discharge
*secondarily sub-areolar mass
Non-pregnant woman with Bloody or Serous discharge from the nipple...
Multiple papillomas are associated with an increased risk of ________. ______ are benign.
What is the most common benign tumor of the breast?
A fibroadenoma is made up of what two components?
Fibroadenomas are well-encapsulated, spherical, and freely moveable (which distinguishes them from cancers).
Fibroadenoma is most often seen in what demographic?
Fibroadenoma is most often in what location?
(this is also the most common location for breast cancer)
Upper Outer quadrant
Fibrosis and Blue-Domed cysts are seen in _______, NOT ______.
What is the most common etiology behind fat necrosis of the Breast?
What is the term for male breast cancer?
Gynecomastia is a ductile cancer because what is absent?
What is Gynecomastia associated with?
Excess Estrogen (tumors/cirrhosis)
How does Gynecomastia present?
Fibrous cap under areola
Sex, Age, and Race are all risk factors for Breast Cancer
*peaks at 60
What ethnic bias does Breast cancer have?
Uncommon Japanese and Chinese, most common Caucasians and Jews
Other than Sex, Age, and Race, what are 5 risk factors for Breast Cancer?
Genetics (5-10 fold)
Hormonal (Estrogen - Tamaxaphen)
Other cancers (ovarian/endometrial)
Atypical Epithelial Hyperplasia/Multiple Intraductal Papillomas
Obesity, high fat diet, moderate EtOH consumption
What is the most common location for breast cancer?
Upper Outer quadrant (45%)
(25% central, under areola)
2/3 of Breast Cancers are of what type?
Invasive Ductal Carcinomas
*Desmoplastic rxn host response
What defines the difference between an In Situ lesion and and Invasive/Infiltrating lesion?
Breaching of Basement Membrane
90% of breast cancers metastasize via the lymphatics
Where does Breast cancer generally drain?
Distant breast metastases are common in what 5 areas?
Lumpectomy is limited to resection of the tumor and what?
Mastectomy removes the entire breast and what?
Surrounding fat tissue
Axillary lymph node resection
In a Mammography, aside from looking for a Mass, what else are we looking for?
Calcification around the mass
Where are the primordial germ cells?
In the wall of yolk sac near the allantois
After the primordial germ cells leave the yolk sac and migrate to the gonadal ridges and penetrate into the primitive gonad, what do they become?
Cells that create spermatagonia, and eventually, sperm cells.
The epithelium of the genital ridge proliferates and penetrates the underlying mesenchyme to form what?
Primitive Sex cords
In the presence of the SRY gene, the primitive sex cords differentiate into what?
Testicular seminiferous tubules
The medullary cords created from the Primitive Sex Cords further differentiate into what 4 structures?
Testicular seminiferous tubules
What fibrous connective tissue separates the testes cords from the epithelium?
What is the function and location of Sertoli cells?
Support, nutrition - between germ cells
Testosterone secretion - between seminiferous tubules
Mesonepheric Ducts aka...
Paramesonephric Ducts aka...
What type of epithelium histologically allows for the propulsion of sperm from the Efferent ducts > Epididymis > Vas Deferens?
Ciliated Pseudostratified Columnar Epithelium
*surrounded by smooth muscle
What is the term for the congenital malpositioning of the testes outside normal scrotal location?
(most important congenital abnormality relating to testes)
Descent of testes may stop at any point and 4% newborns have condition
*also unilateral common, 1/4 bilateral
In Cryptorchidism, what % arrest in the High Scrotal Sac?
% inguinal canal?
% abdominal cavity?
Most crytorchid children have testes descend within the 1st year, and condition in adults is less than 0.4%.
The decreased diameter of seminiferous tubules along with the decrease in germ cells can lead to Infertility in Cryptochidism
What 2 types of tumors are increased 10-35 times in untreated cryptorchidism?
(Germ Cell Tumors)
What are the 2 most feared complications of Cryptorchidism?
Germ Cell Tumors
Most testicular tumors are ______, and a small % are ______.
Malignant transformation into Seminomas or Embryonal Carcinomas can happen in what 2 cases/states of Cryptochidism?
Delayed normally descended testis
What is defined by male hypogonadism?
Klinefelter's Syndrome occurs when there is what pairing of chromosomes?
2 or more X
1 or more Y
**XXY most common
Klinefelter's is rarely diagnosed before puberty
Gynocemastia, lack of beard/body hair, female hips, long arms, testicular/penile atrophy, long legs, and lack of pubic hair all are physical characteristics of what?
*lack all secondary sex characteristics
**mean IQ somewhat lower, retardation uncommon
plasma FSH is increased and testosterone is decreased in Klinefelter's
What is the reproductive status of Klinefelters?
*testicular tubules totally atrophied with hyaline
What is the classic Karyotype of Klinefelter?
Results from paternal or maternal nondisjunction?
50/50 split maternal/paternal
Hydrocele, Spermatocele, and Hematocele are different flavors of what?
Cystic Scrotal Masses
A Hydrocele is a clear serous accumulation between what 2 layers?
Testis or Epididymis
Spermatocele is a cystic accumulation of semen in what 2 possible places?
Dilated efferent ductules
Ducts of rete testis
A Hematocele accumulates blood where?
Between Tunica Vaginalis layers
Histologically, what is the Spermatocele cyst lined with?
*contains spermatozoa in various developmental stages
What can result from testicular torsion, tumors, or infections?
Hydrocele can be either congenital or acquired, and the compression can lead to atrophy
If torsion of the Testes is severe enough, what can it cause?
Infarction (obstruction) of testicular Germ Cells
How doe testicular Torsion present?
Severe pain, usually a few hours after vigorous exercise
*once Tunica Albuginea black - amputation
Dysplastic lesions (Bowen Disease) on the glans and prepuce are known as what?
This occurs only in ______.
Erythroplasia of Queyrat
What is a major risk factor in penile cancer?
HPV 16 and 18
Since penile cancer is an extension of the skin, it is...
Squamous Cell Carcinoma
*presents as ulcerated hemorrhagic mass on glans/prepuce
What is the Etiology of Peyronie Disease?
*focal, asymmetric, penile curvature
*collagen slowly replaces muscle
What far advanced disease results in General Paresis (brain spirochetes), Gummas (granulomas), and Tabes Dorsalis (spirochetal damage to sensory nerves)
What are the 2 most common organisms that cause PID?
What are the 2 most common complications of PID?
Sterility and Ectopic Pregnancy
Why do many women get PID?
GC and Chlamydia are asymptomatic in women
What agar would one use to plate a GC swab?
Trichimonas vaginalis is only seen in a trophozoite form
**no cyst form
What type of organism is Trichomonas vaginalis?
Describe Trichomonas vaginalis
Pear shaped protozoan, anterior flagella
Who is most likely to get Trichomonas vaginalis?
Sexually active women
Herpes symplex I or II has what 2 characteristics?
Cytopathic effect (inclusion bodies)
Herpes simplex type I or II stains what color?
CMV stains what color?
Pink acidophilic nuclear inclusions
Basophilic/blue inclusion bodies
What is the homologue to Seminoma?
What is the homologue to the Yolk sac tumor?
Endodermal Sinus Tumor
Lobular Carcinoma In-Situ is a marker for what?
Invasive Ductal or Lobular carcinoma
What is the tumor marker for the Prostate?
What is the serologic marker for Seminoma?
Over 90% of testicular tumors are of what origin?
Is it the same in the ovary?
No - surface epithelial most common (75%)
4 Risk factors for Germ cell Tumors of the testes
Testicular Tumor on the opposite testis
When considering a Teratoma, what factor is most important in predicting whether it will be malignant or benign?
What is another name for Leydig Cell Tumors?
Interstitial Cell Tumors
What is the only Germ Cell Tumor that doesn't metastasize via the lymphatics?
How does it metastasize?
***this is if originate in either testes/ovaries
What is the most common tumor of the Urinary Tract?
Urinary Bladder tumors
What is the parasite that lays eggs in the Bladder?
What type of cancer does this cause?
Squamous Cell Carcinoma
What marker in used for both diagnosis and monitoring of Yolk Sac Tumors?
What is the most important risk factor (increases 4 fold) for Bladder Cancer?
What are some secondary risk factors?
Azo dyes, Drugs, Radiation to area
What does PSA stand for?
What is it?
How is it used as a tumor marker?
Prostate Specific Antigen
Antigen that is only released into blood by Tumor Cells (but made always)
If detectable after radical prostatectomy, metastasis persists
Explain Bone Alkaline Phosphate's relationship to Prostate Cancer
Marker that Prostate Cancer has metastasized to bone
*proliferation of osteoblasts increases Alk Phos in blood
Prostatic Cells produce Alkaline Phosphatase
*only osteoblasts produce
Prostate normally secretes PSA, but the tumor puts it in the bloodstream
BPH leads to Prostate Cancer
BPH doesn't lead to Prostate Cancer, but they are both under the influence of what hormone?
What does TURP stand for?
What is the surgical procedure?
Trans Urethral Resection of Prostate
Stent, Prostatic Chips
What does BPH stand for?
Benign Prostatic Hyperplasia
What ethnic group has the highest incidence of BPH in the US?
In what region of the world is it most common?
Asia (the orient?)
1/3 males over 65 have some degree of BPH, and 75% over 80 years have some degree of it.
Which cells are present in Acute Prostatitis?
Which are present in Chronic Prostatitis
E. coli with acute inflammatory infiltrate (PMN's, etc)
Lymphocytes, Plasma cells, Macrophage
How can Acute and Chronic Prostatitis be diagnosed?
Recovery organism on Urine Culture
What 2 organisms can cause granulomatous Prostatitis?
What % of the semen is secreted by the prostate?
30-50 tubuloalveolar glands are in the prostate and they each secrete into the urethra through its own duct
What histologically makes up the Prostate Gland?
Pseudostratified Columnar Cells
What is the classification of Prostate Cancers based on 5 histologic patterns of tumor gland formation and infiltration?
Each Gleason score is given a ______ pattern score and _____ pattern score.
What is the best Gleason Score?
What is the histologic state?
2 (1 for each)
What is the worst Gleason Score?
What is the histologic state?
10 (5 majority, 5 minority)