Reproductive - Pathology (Part 2) Flashcards Preview

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Flashcards in Reproductive - Pathology (Part 2) Deck (115)
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1
Q

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

A

α-Fetoprotein

2
Q

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

A

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

3
Q

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

A

Yes

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

4
Q

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

A

Teratoma

5
Q

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

A

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

6
Q

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

A

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

7
Q

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

A

Serous cystadenocarcinoma

8
Q

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

A

Mucinous cystadenoma; this can often look like intestinal tissue

9
Q

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

A

Mucinous cystadenocarcinoma

10
Q

What is pseudomyxoma peritonei?

A

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

11
Q

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

A

Brenner tumor

(remember: Brenner is Benign and looks like Bladder)

12
Q

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

A

Ovarian fibroma

13
Q

What triad is associated with Meigs' syndrome?

A

Ovarian fibroma, ascites, and hydrothorax

14
Q

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?

A

Call-Exner bodies, indicative of granulosa cell tumors

15
Q

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

A

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
Q

What is the most important risk factor for ovarian cancer?

A

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

17
Q

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

A

Signet cell adenocarcinoma, which produces mucin

18
Q

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

A

Gastrointestinal system, usually as gastric cancer

19
Q

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

A

CA-125 is a general marker for ovarian cancer

20
Q

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

A

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

21
Q

What vaginal cancer develops secondary to cervical carcinoma?

A

Vaginal squamous cell carcinoma develops from cervical squamous cell carcinoma

22
Q

Diethylstilbestrol exposure can lead to what type of vaginal carcinoma?

A

Clear-cell adenocarcinoma

23
Q

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?

A

Sarcoma botryoides; a variant of rhabdomyosarcoma

24
Q

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?

A

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

25
Q

Sarcoma botryoides is a variant of what type of malignancy?

A

Rhabdomyosarcoma

26
Q

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

A

Fibroadenoma, a benign tumor

27
Q

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

A

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

28
Q

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?

A

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

29
Q

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

A

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

30
Q

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

A

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

31
Q

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?

A

Phyllodes tumor (remember: phyllodes means leaf-like)

32
Q

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

A

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

33
Q

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

A

Mammary duct epithelium or lobular glands

34
Q

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

A

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

35
Q

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

A

Axillary lymph node involvement

36
Q

Name four risk factors for breast malignancies.

A

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
Q

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

A

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

38
Q

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?

A

Invasive ductal carcinoma

39
Q

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

A

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

40
Q

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

A

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

41
Q

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?

A

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

42
Q

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

A

Invasive lobular carcinoma, which is often bilateral and multiple

43
Q

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

A

Medullary

44
Q

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

A

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

45
Q

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

A

Work-up for underlying carcinoma of the breast

46
Q

Name four histologic types of fibrocystic breast disease.

A

Fibrotic, cystic, sclerosing adenosis, and epithelial hyperplasia

47
Q

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

A

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

48
Q

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?

A

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

49
Q

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

A

Hyperplasia of the breast stroma

50
Q

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

A

Fluid-filled, blue dome cysts

51
Q

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

A

Increased acini and intralobular fibrosis; calcifications can also be seen

52
Q

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

A

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

53
Q

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

A

Acute mastitis that has progressed to form an abscess

54
Q

What organism most commonly causes acute mastitis?

A

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

55
Q

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

A

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

56
Q

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

A

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

57
Q

Name a genetic abnormality that can result in gynecomastia.

A

Klinefelter's syndrome

58
Q

Name nine drugs or substances that cause gynecomastia.

A

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

59
Q

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

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

60
Q

What species is the most common etiology of bacterial prostatitis?

A

Escherichia coli

61
Q

Is chronic prostatitis most commonly bacterial or abacterial?

A

Abacterial

62
Q

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

A

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

63
Q

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?

A

Benign prostatic hyperplasia

64
Q

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?

A

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

65
Q

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

A

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

66
Q

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

A

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

67
Q

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

A

Benign prostatic hyperplasia and prostate cancer

68
Q

Prostatic adenocarcinoma is common among men in what age group?

A

50 years

69
Q

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.

A

Periurethral; posterior

70
Q

What is the most common way to diagnose prostatic adenocarcinoma?

A

Digital rectal exam (hard nodule) and biopsy

71
Q

Name two useful tumor markers for prostatic adenocarcinoma.

A

Prostatic acid phosphatase and prostate-specific antigen

72
Q

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?

A

Prostate adenocarcinoma with metastases to bone causing osteoblastic lesions

73
Q

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

A

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
Q

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

A

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

75
Q

Why does cryptorchidism cause infertility?

A

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

76
Q

Name a risk factor for cryptorchidism.

A

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

77
Q

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

A

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

78
Q

What is the most common testicular tumor?

A

Seminoma

79
Q

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?

A

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

80
Q

What treatment can be used in a patient with seminoma?

A

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

81
Q

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

A

Embryonal carcinoma

82
Q

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

A

Painless; painful

83
Q

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

A

α-Fetoprotein and human chorionic gonadotropin

84
Q

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

A

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

85
Q

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

A

Increased α-fetoprotein

86
Q

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

A

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

87
Q

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

A

Malignant; benign

88
Q

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

A

Malignant; benign

89
Q

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

A

Leydig cell tumor

90
Q

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

A

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

91
Q

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

A

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

92
Q

What is the most common testicular cancer among older men?

A

Testicular lymphoma

93
Q

What is a varicocele?

A

A dilated vein in the pampiniform plexus

94
Q

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?

A

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

95
Q

What embryologic abnormality causes a hydrocele?

A

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

96
Q

What is a spermatocele?

A

A dilated epididymal duct

97
Q

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?

A

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

98
Q

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

A

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

99
Q

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

A

Erythroplasia of Queyrat

100
Q

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

A

Lack of circumcision and human papillomavirus infection

101
Q

Geographically, where is penile squamous cell carcinoma most common?

A

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

102
Q

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

A

Peyronie's disease

103
Q

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

A

Bowenoid papulosis

104
Q

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

A

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

105
Q

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?

A

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

106
Q

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

A

Turner's syndrome (XO)

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

107
Q

What is the most common cause of primary amenorrhea?

A

Turner's syndrome (XO)

108
Q

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)?

A

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

109
Q

True or False? Double Y males are infertile.

A

FALSE

double Y males have normal fertility

110
Q

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

A

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
Q

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

A

None

112
Q

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

A

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

113
Q

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

A

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
Q

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

A

Both ovarian and testicular tissue is present

115
Q

What are the two possible karyotypes of true hemaphroditism?

A

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