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Flashcards in Reproductive Pathology Deck (95):
1

What are the findings in Klinefelter syndrome? chrom abnorm? Lab findings? Mechanism?

47 XXY

Testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
Maybe developmental delay

Inactivated X chromosome (Barr body)

Dygenesis of semniferous tubules leads to decr. inhibin and incr. FSH
Abnormal leydig cell function leads to decr. testosterone, incr. LH, and thus incr. estrogen.

2

What is the chrom. abnorm in Turner syndrome? Findings? Lab findings? How does it come about? Is pregnancy possible?

45, XO or 45, XO/46, XX

Short stature
Ovarian dysgenesis
shield chest
bicuspid aortic valve
preductal coarctation
Lymphatic defects (webbed neck or cystic hygroma)
horseshoe kidney
menopause before menarche

No barr body
decr. estrogen leads to incr. LH, FSH

Mitotic or meiotic error

pregnancy possible in some cases (oocyte donation, exogenous estradiol and progesterone

3

Phenotype of double Y males? Cause? Associations?

Phenotypically normal, very tall
Normal fertility

Random non disjunction even (paternal meiosis II)

severe acne, learning disability, autism spectrum disorders.

4

What is true hermaphroditism?

AKA Ovotesticular disorder of sex development

46, XX or 47 XXY

Both ovarian and testicular tissue present
Ambiguous genitalia

5

What is a female pseudohermaphrodite like? Pathophys? Male?

Ovaries present
External genitalia virilized or ambiguous

Excessive and inappropriate exposure to androgenic steroids during early gestatio (CAH or exogenous admin of androgens during early pregnancy)


Testes present, but external genitalia are female or ambiguous.

Androgen insensitivity syndrome is most common cause.

6

What is pathophys of aromatase defic? Phenotype? How can it also present?

Inability to synthesize estrogens from androgens

Masculinization of female infants (ambiguous genitalia)
Incr. serum testosterone and androstenedione

Maternal virilization during pregnancy (fetal androgens cross placenta)

7

What is the phenotype of androgen insensitivity syndrome? Pathophys? Treatment? Lab findings?

Defect in androgen receptor resulting in normal appearing female (46, XY)

Female external genitalia with scant sexual hair rudimentary vagina
uterus and fallopian absent

Pts develop testes, often in labia majora which must be removed

Incr. testosterone, estrogen, LH

8

What is the pathophys of 5 alpha reductase defic? Phenotype? Lab findings?

Inability to convert testosterone to DHT

Ambiguous genitalia until puberty, when incr. testosterone causes masculinization/incr. growth of external genitalia
Internal genitalia are normal

Testosterone/estrogen levels normal

LH is normal or incr.

9

What is the pathophys of kallmann syndrome? Presentation? Lab findings?

Defective migration of GnRH cells and formation of olfactory bulb

Decr. synth of GnRH in hypothal
Infertility
Anosmia
Failure to complete puberty; hypogonadotropic hypogonadism

Decr. GnRH, FSH, LH, testosterone

10

Concerning diagnosing disorders of sex hormones, test and LH levels:

Incr; incr:
incr; decr:
decr; incr:
decr; decr:

Incr; incr: defective androgen receptor
incr; decr: testosterone secreting tumor, exog steroids
decr; incr: primary hypogonadism
decr; decr: hypogonadotropic hypogonadism

11

What is a hydatiform mole? Associations? Treatment? Compare and contrast complete mole and partial mole concerning karyotype pathophys, hCG levels, uterine size, choriocarcinoma risk? presence of fetal parts? Symptoms? Imaging findings?

Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast)

Theca-lutein cysts, hyperemesis gravidarum, hyperthyroidism

D&C + methotrexate; monitor beta hCG

COMPLETE
Karyo: 46, XX; 46, XY
pathophys: sperm enters enucleated egg then replicates
hCG level: heavily increased
Uterine size: incr.
ChorioCA: 2% risk
fetal parts: no
symptoms: first tri bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism
Imaging: Honeyocombed uterus or clusters of grapes; snowstorm on U/S

PARTIAL
Karyo: 69
pathophys: 2 sperm + 1 egg
hCG level: slightly incr.
Uterine size: normal
ChorioCA: rare
fetal parts: yes
symptoms: vaginal bleeding, abdominal pain
Imaging: fetal parts

12

Definition of gestational pregnancy? Treatment?

BP>140/90, after 20th week of gestation
No preexisting hypertension
no proteinuria or end organ damage

Antihypertensives (alpha methyl dopa, labetalol, hydralazine, nifedipine)
Deliver at 37-39 weeks

13

What is definition of preeclampsia? Progression? Complications? Pathophys? epid? Treatment?

New onset hypertension with either proteinuria or end organ dysfunction after 20th week of gestation (

14

What is eclampsia? Compications? Treatment?

Preeclampsia + maternal seizures

Maternal death due to stroke, ICH, or ARDS

IV magnesium sulfate
Antihypertensives
Immediate delivery

15

What is HELLP syndrome? Pathophys? Lab findings? Complications? Treatment?

Hemolysis
Elevated Liver enzymes
Low Platelets

Severe preeclampsia

Schistocytes

Hepatic subcapsular hematomas which rupture leading to severe hypotension

Immediate delivery

16

Pathophys of placental abruption? risk factors? Presntation?

Premature separation of placenta from uterine wall before delivery.

Trama, smoking, hypertension, preeclampsia, cocaine abuse

Presentation: abrupt, painful bleeding in third trimester, possible DIC, maternal shock, fetal distress. Life threatening for both.

17

Pathophys of placenta accreta/increta/percreta? Risk factors? How are they different? Presentation?

Defective decidual layer leads to abnormal attachment and spearation after delivery

Prior c-section
inflammation
placenta previa

Accreta; attaches to myoetrium
increta: penetrates myometrium
percreta: goes through myometrium, attaches elsewhere

U/S prior to delivery
No separation after delivery leads to postpartum bleeding (sheehan)

18

What is placenta previa? Risk factors? Presentation?

ATtachment of placenta to lower uterine segment internal os.

Multipartiy, prior c section

painless 3rd tri bleeding.

19

What is pathophys of vasa previa? Complications? Presentation? Treatment? Assocations?

Fetal vessels run over, or in close proximity to, cervical os.

Membrane rupture
painless vaginal bleeding
fetal bradycardia (no wharton jelly protection in travel to placenta

20

What are the risks of retained placental tissue?

Postpartum hemorrhage

Incr. risk of infection

21

Most common location of ectopic pregnancy? When should it be suspected? How is it confirmed? Risk factors?

Ampulla of fallopian tube

Amenorrhea, lower than expected rise in hCG based on dates, and sudden lower abdominal pain

U/S

History of infertility
PID (salingitis)
Ruptured appendix
Prior tubal surgery

22

What is polyhydramnios? Associations? Oligohydramnios? Assocations? Results?

too much amniotic fluid
Fetal malformations (duodenal atresia, anencephaly), maternal diabetes, fetal anemia, multiple gestations

Too little AF
Placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males)
Potter sequence

23

Incidence is u.s. of endometrial vs. ovarian vs. cervical tumors? prognosis?

endometrial, ovarian, cervical

Ovarian, cervical, endometrial

24

What are 3 vaginal tumors?

squamous cell carcinoma, clear cell adenoCA, sarcoma botryoides

25

What is etiology of vaginal SCC? Clear cell adenoCA? Epid of sarcoma botryoides? Histo? STaining? Presentation?

Secondary to cervical SCC

Exposure to DES in utero

Girls

26

What is cervical dysplasia? Where does it occur? How does it progress? What are the 3 types? What are they like? Pathophys? Progression? Presentation? Risk factors?

Disordered epithelial growth.

Transition Zone

Basal layer and extends outward
CIN 1=mainly basal
CIN 2=close to outer layer
CIN3=CA in situ, all layers

HPV 16 and 18: E6=p53, E7=RB.

May progress to invasive CA.

Typically asymptomatic (see at pap smear)
Abnormal vaginal bleeding (often postcoital)

Multiple sex partners
smoking
starting sex at young age
HIV infection

27

What type of cancer is invasive cervical CA usually? How can it be prevented? How is it diagnosed? Complications?

Squamous cell CA

Pap smear to catch dysplasia (koilocytes) before it becomes invasive

Colposcopy and biopsy

Lateral invasion can block ureters (renal failure)

28

What is premature ovarian failure? Presentation? Lab findings?

Premature atresia of ovarian follicles in women of repro age.

Menopause before 40.

Decr. estrogen
incr. LH and FSH

29

What are the most common causes of anovulation?

pregnancy, PCOS, obesity, HPO axis abnormal, premature ovarian failure, hyperprolactinemia, eating disorders, competitive athletes, cushing syndrome, adrenal insufficiency

30

What is the pathophys of PCOS? Presentation? Associations? Risks? Treatment?

hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response
Incr. LH/FSH ratio leads to incr. androgens from theca interna cells, decr. rate of follicular maturation, unruptured follicles (cysts) and anovulation. Subfertility

Enlarged, bilateral cystic ovaries
Amenorrhea/oligomenorrhea
Hirsuitism
acne
subfertility

Obesity

Incr. risk of endometrial cancer (unopposed estrogen from anovulatory cycles)

Weight reduction
OCPs
Clomiphene citrate
ketoconazole
spironolactone

31

What is a follicular cyst? Associations? Epid? What is a theca-lutein cyst? Cause? Association?

Distention of unrupture graafian follicle.

Hyperestrogenism, endometrial hyperplasia

Most common ovarian mass in young women


Often bilateral/multiple
Gonadotropin stimulation

ChorioCA and hydatiform moles

32

Epid of ovarian neoplasms? What cells do they arise from? What do the majority arise from? Which is most common? Risk factors? Types of genetic predisposition? What decreases risk? How does it present? How is it diagnosed? How is progression monitored?

Most common adnexal mass in women > 55
Benign or malignant

Surface epithelium (most common; serous cystadenoCA most common subtype), germ cells, or sex cord stromal tissue.

Risk incr. with age, infertility, endometriosis, PCOS, genetic predisposition (BRCA1 or BRCA2, HNPCC, strong family history)

Risk decr. with previous pregnancy, history of breastfeeding, OCPs, tubal ligation.

Adnexal mass, abdominal distention, bowel obstruction, pleural effusion.

Diagnose surgically

CA 125 levels

33

Epid of ovarian neoplasms? What cells do they arise from? What do the majority of malignant tumors arise from? Which is most common? Risk factors? Types of genetic predisposition? What decreases risk? How does it present? How is it diagnosed? How is progression monitored?

Most common adnexal mass in women > 55
Benign or malignant

Surface epithelium (most common; serous cystadenoCA most common subtype), germ cells, or sex cord stromal tissue.

Risk incr. with age, infertility, endometriosis, PCOS, genetic predisposition (BRCA1 or BRCA2, HNPCC, strong family history)

Risk decr. with previous pregnancy, history of breastfeeding, OCPs, tubal ligation.

Adnexal mass, abdominal distention, bowel obstruction, pleural effusion.

Diagnose surgically

CA 125 levelscyst

34

What is a serous cystadenoma like? Epid?

Lined with fallopian tube-like epithelium.
Often bilateral
Most common ovarian tumor.

35

What is a mucinous cystadenoma like?

multiloculated, large. Lined by mucus secreting epithelium.

36

What is an endometrioma like? Presentation? What is a chocolate cyst?

Endometriosis within ovary with cyst formation. Presents with pelvic pain, dysmenorrhea, dyspareunia; symptoms vary with cycle.
Chocolate cyst=endometrioma filled with dark, reddish-brown blood.
Complex mass on U/S

37

What is a mature cystic teratoma like? Origin? Epid? Presentation? What is struma ovarii?

Cystic mass containing elements from all 3 germ layers

Germ cell tumor

most common ovarian tumor in women 20-30

Pain secondary to ovarian enlargment or torsion

Tumor contains functional thyroid tissue leading to hyperthyroidism

38

What is Brenner tumor? Histo?

Looks like bladder
Solid tumor that is pale yellow-tan and appears encapsulated
Coffee bean nuclei on h&e stain

39

What is a fibroma? What is Meigs syndrome?

Bundles of spindle shaped fibroblasts

Triad of ovarian fibroma, ascites, and hydrothorax
Pulling sensation in groin

40

What is thecoma? Presentation?

Like granulosa cell tumor, may produce estrogen.
Abnormal uterine bleeding in a postmenopausal woman

41

What is an immature teratoma like? Kinds of tissue?

Aggressive, contains fetal tissue, neuroectoderm
Immature/embryonic like neural tissue

42

What is the epid of granulosa cell tumor? pathophys? Presentation? Histology?

Most common malignant stromal tumor
women in 50s

Produces estrogen and/or progesterone

Abnormal uterine bleeding
Sexual precocity
Breast tenderness

Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles

43

Location of serous cystadenoCA? Histo?

Bilateral. Psammoma bodies.

44

What type of tumor is a pseudomyxoma peritonei? What is it like?

Mucinous cystadenoCA

intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

45

Epid of dysgerminoma? Male homolog? Histo? Tumor markers?

Adolescents.
Seminoma
Sheets of uniform fried egg cells
hCG, LDH

46

What is a chorioCA? What is it made up of? What is not present? What does it incr. frequency of? How does it present? Spread? Treatment? Prognosis?

After pregnancy in mother or baby

Trophoblastic tissue, but no chorionic villi

Incr. frequency of bilateral/multiple theca-lutein cysts

abnormally incr. beta hCG, SOB, hemoptysis (hematogenous spread to lungs)

Very responsive to chemo.

47

What is a chorioCA? What is it made up of? What is not present? What does it incr. frequency of? How does it present? Spread? Treatment? Prognosis?

After pregnancy in mother or baby

Trophoblastic tissue, but no chorionic villi

Incr. frequency of bilateral/multiple theca-lutein cysts

abnormally incr. beta hCG, SOB, hemoptysis (hematogenous spread to lungs)

Very responsive to chemo.

48

What is another name for a yolk sac tumor? Staging? Location? Epid? Gross histo? Histo? Tumor marker?

Aggressive

Ovaries or testes (boys) and sacrococcygeal area in young children

Most common tumor in male infants

Yellow, friable (hemorrhagic), solid mass

50% have schiller-duval bodies (glomeruli)

AFP

49

What is a krukenberg tumor?

GI malignancy that metastasized to ovaries leading to mucin secreting signal cell adenoCA

50

What is a krukenberg tumor?

GI malignancy that metastasized to ovaries leading to mucin secreting signal cell adenoCA

51

What is a krukenberg tumor?

GI malignancy that metastasized to ovaries leading to mucin secreting signal cell adenoCA

52

What is an endometrial polyp?

Well circumscribe collection of endometrial tissue within uterine wall
May contain smooth muscle
Can extend into endometrial cavity in form of polyp

53

What is the epid of a leiomyoma? Another name? How does it often present? Other presentations? Grade/stage? What is it senstive to? implications? Prognosis? histo?

Most common tumor in females
More in blacks
age 20-40

Benign smooth muscle tumor
Malignant transformation (leiosarcoma) rare

Estrogen sens: larger in pregnancy and smaller with meno

Multiple discrete tumors
Asymptomatic
abnormal uterine bleeding
iron defic anemia
miscarriage

whorled pattern of smooth muscle bundles with well demarcated borders

54

What is adenomyosis? Cause? Presentation? Treatment?

Extension of endometrial tissue (glandular) into uterine myometrium.

Hyperplasia of basal layer of endometrium

Dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus

GnRH agonists
Hysterectomy

55

What is endometriosis? Location? Possible causes? Presentation/findings? Treatment?

Non neoplastic endometrial glands/stroma outside endometrial cavity.

Anywhere: ovary, pelvis, peritoneum

Retrograde flow, metaplastic transformation, transportation via lymph

Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defacation), infertility
Normal sized uterus.

NSAIDS, OCPs, progestins, GnRH agonists, danazol, laparoscopic removal

56

What is endometritis? Pathophys? Causes? Treatment?

Inflammation of endometrium

Retained material in uterus promotes infection y bacterial flora from vagina or intestinal tract

REtained products of conception following dleivery, miscarriage, abortion
Foreign body (IUD)

Gentamicin + Clindamycin with or w/o ampicillin

57

What is endometrial hyperplasia? Cause? Risks? Presentation? Risk factors?

Abnormal endometrial bgland prolif.

Excess estrogen stim.

Endometrial CA

Postmenopausal vaginal bleeding

Anovulatory cycles, HRT, PCOS, granulosa cell tumor.

58

What is endometrial hyperplasia? Cause? Risks? Presentation? Risk factors?

Abnormal endometrial bgland prolif.

Excess estrogen stim.

Endometrial CA

Postmenopausal vaginal bleeding

Anovulatory cycles, HRT, PCOS, granulosa cell tumor.

59

What is epid of endometrial CA? Presentation? Pathophys? Risk factors?

Most commmon gyn malig
55-65

Vaginal bleeding

Preceded by endometrial hyperplasia

Prolonged use of estrogen w/o progestins, obesity, diabetes, hypertension, nulliparity, late menopause, lynch syndrome.

60

What is epid of endometrial CA? Presentation? Pathophys? Risk factors?

Most commmon gyn malig
55-65

Vaginal bleeding

Preceded by endometrial hyperplasia

Prolonged use of estrogen w/o progestins, obesity, diabetes, hypertension, nulliparity, late menopause, lynch syndrome.

61

Describe the basic functional anatomy of the breast and the pathologies that occur in each location.

Nipple: paget disease, breast abscess
Lactiferous sinus: Intraductal papilloma, abscess, mastitis
Major duct: Fibrocystic change, DCIS, invasive ductal CA
Terminal duct: tubular CA
Lobules: Lobular CA
Stroma: Fibroadenoma, phyllodes tumor

62

What are the characteristics of a fibroadenoma? Epid? What is it sensitive to? Risk of malig? What is the location of an intraductal papilloma? Size? Symptoms? Risk of malig? What are the characteristics of a phyllodes tumor? Histo? Epid? Risk for malif?

Small, mobile, firm mass with sharp edges
Most common tumor in those

63

What are the characteristics of a fibroadenoma? Epid? What is it sensitive to? Risk of malig? What is the location of an intraductal papilloma? Size? Symptoms? Risk of malig? What are the characteristics of a phyllodes tumor? Histo? Epid? Risk for malif?

Small, mobile, firm mass with sharp edges
Most common tumor in those

64

What is proliferative breast disease? How does it present? What are fibrosis types like? What are cystic types like? What are sclerosing adenosis types like? ASsociations? What is it confused with? What is epithelial hyperplasia type like? Epid? risk of cancer for each?

Most common cause of breast lumps from age 25 to menopause
Premenstrual breast pain and multiple lesions, often bilateral.
Fluctuation in size of mass

Fibrosis: hyperplasia of stroma (no incr. risk of cancer)
Cystic: fluid filled, blue dome. Ductal dilation (no incr. risk)
Sclerosing adenosis: Incr. acini and intralobular fibrosis. Calcifications. Confused with cancer. Incr. risk (1.5-2x) of developing cancer.
Epthelial hyperplasia: incr. number of epithelial cell layers in terminal duct lobule. Incr. risk of CA with atypical cells. Women > 30.

65

What is the pathophys of mastitis? Most common pathogen? Treatment?

During BF, incr. risk of bacterial infection through cracks.

S. aureus

Dicloxacillin and continued breastfeeding

66

What is pathophys of breast fat necrosis? Presentation? Diagnosis?

Result of injury to breast tissue

Bening, usually painless lump
Abnormal calcification on mammography
necrotic fat and giants cells on biopsy

67

What is gynecomastia? What are some causes? When is it physiologic?

Breast enlargement in males
Hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter, drugs (spironolactone, digoxin, cimetidine, alcohol, ketoconazole)=Some drugs create awesome knockers

Birth, puberty, old age

68

When do malignant breast tumors usually occur? Where do they usually arise from? Mutations/characteristics? What characteristic makes it most aggressive? What is the single most important prognostic factor? Most common location? Risk factors?

Postmenopausal

Terminal duct lobular unit

Overexpression of ER/PR or HER-2 (EGFR) is common

Triple negative (ER-, PR-, Her2/Neu-) is aggressive

Axillary LN involvement

Upper outer quadrant

Incr. estrogen exposure
incr. total number of menstrual cycles
older age at first live birth
obesity (incr. estrogen expsure)
BRCA1 and 2
Afr. amer (incr. risk for triple neg)

69

What is ductal CA in situ? What does it arise from? mammography? What is a comedoCA?

Fills lumen but does not penetrate BM

Ductal atypia

Microcalcifications

DCIS with central necrosis

70

What is pathophys of paget? Presntation? Histo?

Underlying DCIS or invasive breast cancer

Eczematous patches on nipple

Large cells in epidermis with clear halo

extramammary on vulva does not suggest malignancy

71

What is the gross and micro histo of an invasive ductal breast CA? Prognosis? Epid?

Firm, fibrous, rock-hard mass with sharp margins and small glandular, ductlike cells.
Stellate infiltration grossly
Worst and most invasive
Most common

72

What is the histo/pathophys of invasive lobular breast CA? Location?

Orderly row of cells due to decr. E-cadherin expression
Bilateral with multiple lesions in the same location

73

What is medullary breast CA like? Prognosis?

Fleshy, cellular, lymph infiltrate

Good prognosis

74

What is pathophys of inflammatory breast cancer? Presentation? Prognosis? What can it be confused with?

Dermal lymph invasion by breast CA
Peau d'orange
50% survival at 5 years
mastitis or pagets.

75

What is peyronie disease? Association? Symptoms? Treatment? What is penile fracture?

Abnormal curvature of the penis due to fibrous plaque within tunica albuginea.

Erectile dysfunction

Pain, anxiety

Surgical repair once curvature stabilizes

Fracture=rupture of corpora cavernosa due to forced bleeding

76

What is priapism? Associations? How is it treated?

Painful erection > 4 hours

Trauma, sickle cell disease, medications

Corporal aspiration, intracavernosal phenylephrine, or surgical decompression

77

Epid of SCC of penis? Associations? What is bowen disease? Erythroplasia of queyrat? Bowenoid papulosis?

Asia, africa, and south america

PRECURSOR LESIONS
Bowen disease (in penile shaft, presents as leukoplakia)
Queyrat: cancer of glans, presents as erythroplakia
Bowenoid: CA in situ of unclear malignant potential, reddish papules

HPV, lack of circumcision

78

What is cryptorchidism? Symptoms? Hormone levels? Risk factors? Risks?

Undescended testis (one or both)

Impaired spermatogenesis

Decr. inhibin, incr. FSH, incr. LH
testosterone decr. in bilateral, normal in unilateral (leydig cells unaffected by temp)

Prematurity incr. risk

incr. risk of germ cell tumors

79

What is cryptorchidism? Symptoms? Hormone levels? Risk factors? Risks?

Undescended testis (one or both)

Impaired spermatogenesis

Decr. inhibin, incr. FSH, incr. LH
testosterone decr. in bilateral, normal in unilateral (leydig cells unaffected by temp)

Prematurity incr. risk

incr. risk of germ cell tumors

80

What is a varicocele? Pathophys? Symptoms? Signs? Diagnosis? Treatment?

Dilated veins in pampiniform plexus due to incr. venous pressure.

Left side due to incr. resistance to flow from left gonadal vein drainage into left renal vein.

Scrotal enlargement
Infertility (incr. temp)

bag of worms on palpation

U/S with doppler
Does not transilluminate

Varicocelectomy, embolization by interventional radiologist

81

Where do extragonadal germ cell tumors arise? In adults? Which is most common kind and locaion in young children?

Midline locations

RP, mediastinum, pineal, and suprasellar regions

Sacrococcygeal teratomas

82

What is pathophys/epid of congenital hydrocele? Signs? Acquired hydrocele? Spermatocele? Signs? What do they share in common?

Benign testicular masses that can be transilluminated

Common cause of scrotal swelling in infants, due to incomplete obliteration of processus vaginalis (transilluminating swellling)

Benign scrotal fluid collection secondary to infection, trauma, and tumor

Cyst due to dilated epididymal duct or rete testis (paratesticular fluctuant nodule)

83

Epid of testicular germ cell tumors? How might they present? Risk factors? Diagnosis?

95% of all testicular tumors

Young men

Cryptorchidism
Klinefelter syndrome

Mixed germ cell tumor

Testicular mass that does not transilluminate

84

Seminoma. Malignant or benign? Presentation? Epid? Histo? Lab findings? x ray? Prognosis?

Malignant

Painless
homogenous testicular enlargement

Most common testicular tumor
3rd decade, never infants

Large cells in lobules with watery cytoplasm and fried egg appearance

Incr. placental ALP

Radiosensitive

Late metastases, great prognosis

85

Histo of yolk sac tumor? Lab findings? Epid? Stage/grade?

Yellow, mucinous.
Schiller duvar bodies resemble primitive glomeruli

Aggressive.

Incr. AFP

Most common testic. tumor in

86

ChorioCA. malignant or benign? Histo? Spread? Possible presentations/complications? Lab finding?

Malignant

Incr. hCG

Disordered syncytiotrophoblastic and cytotrophoblastic elements.

Hematogenous spread to lungs and brain

Hemorrhagic stroke (bleeding into mets)
Gynecomastia
Symptoms of hyperthyroidism (hCG similar to LH, FSH, TSH)

87

Teratoma. Malignant? Lab findings?

In adult males, may be malignant
In children, no

Incr. hCG and/or AFP in 50% of cases

88

embryonal CA. Malignant? Gross path? Histo? Symptoms?In what form does it normally occur? Lab findings? Prognosis?

Malignant

Hemorrhagic mass with necrosis

Glandullar/papillary morph

Worse prognosis than seminoma

Pure embryonal CA is rare; most commonly mixed with other tumor types

Incr. hCG in pure
Incr. AFP when mixed.

89

embryonal CA. Malignant? Gross path? Histo? Symptoms?In what form does it normally occur? Lab findings? Prognosis?

Malignant

Hemorrhagic mass with necrosis

Glandullar/papillary morph

Worse prognosis than seminoma

Pure embryonal CA is rare; most commonly mixed with other tumor types

Incr. hCG in pure
Incr. AFP when mixed.

90

Epid of non-germ cell testicular tumors? Beningn or malignant? 3 types?

5%. Mostly benign

Leydig cell
sertoli cell
testic. lymphoma

91

HIsto of leydig cell tumor? Pathophys? Gross? What is a sertolli cell tumor? Epid of testic lymphoma? Pathophys? Stage?

Reinke crystals (eosinophilic cytoplasmic inclusions)
Androgens leading to gynecomastia in men, precocious puberty in boys
Golden brown color

Androblastoma from sex cord stroma

Most common testic cancer in older men.
Not a primary cancer, arises from metastatic lymphoma to testes
Aggressive

92

Epid of BPH? Gross/micro pathology? Risk of malignancy? Prsentation? Complications? Treatment? Lab findings?

Men > 50

Smooth, elastic, firm nodular enlargment (hyperplasia) of periurethral (lateral and middle lobes) lobes, which compress the urethra into a vertical slit.

Not premalignant

Incr. frequency, nocturia, difficulty starting and stopping, dysuria

Distention and hypertrophy of bladder
hydronephrosis
UTIs

Incr. free PSA

Alpha 1 antag (terazosin, tamsulosin)
5 alpha reductase (finasteride)
PDE-5 inhib

93

What are the symptoms of prostatitis? Acute causes? Chronic causes?

Dysuria, frequency, urgency, low back pain

Acute: bacterial (E. coli)
Chronic: bacterial or abacterial (most common)

94

Epid of prostatic adenoCA? Location? Diagnosis? Histo? Tumor markers? Late complications?

Men > 50

Posterior lobe of prostate gland

Incr. PSA then needle core biopsy
Small neoplastic glands with prominent nucleoli amid normal prostate stroma

Prostatic acid phosphatase (PAP)
PSA (incr. total with decr. fraction of free)

Osteoblastic metastases in bone; lower back pain and incr. serum ALP and PSA.

95

Epid of prostatic adenoCA? Location? Diagnosis? Histo? Tumor markers? Late complications?

Men > 50

Posterior lobe of prostate gland

Incr. PSA then needle core biopsy
Small neoplastic glands with prominent nucleoli amid normal prostate stroma

Prostatic acid phosphatase (PAP)
PSA (incr. total with decr. fraction of free)

Osteoblastic metastases in bone; lower back pain and incr. serum ALP and PSA.