Ovarian Surface epithelium tumors (benign)
- Serous cystadenoma
- Mucinous cystadenoma
Most common ovarian neoplasm. Lined with fallopian tube–like epithelium. Often bilateral
Multiloculated, large. Lined by mucus-secreting epithelium
Ovarian Surface epithelium tumors (benign)
- Endometrioma
Endometriosis within ovary with cyst formation
pelvic pain, dysmenorrhea, dyspareunia; symptoms may vary with menstrual cycle
“Chocolate cyst”—endometrioma filled with dark, reddish-brown blood. Complex mass on ultrasound.
Ovarian Germ cell tumors (benign)
- Mature cystic teratoma (dermoid cyst)
most common ovarian tumor in females 10–30 years old. Cystic mass containing elements from all 3 germ layers
Can present with pain 2° to ovarian enlargement or torsion
A monodermal form with thyroid tissue (struma ovarii) uncommonly presents with hyperthyroidism
Ovarian Sex cord stromal tumor (benign)
- Fibroma
- Thecoma
Bundles of spindle-shaped fibroblasts. Meigs syndrome—triad of ovarian fibroma, ascites, hydrothorax.
Like granulosa cell tumors, may produce estrogen. Usually presents as abnormal uterine bleeding in a postmenopausal woman.
Ovarian Brenner tumor
Resembles bladder epithelium. Solid tumor that is pale yellow-tan and appears encapsulated. “Coffee bean” nuclei on H&E stain. Usually benign.
Ovarian Surface epithelium tumors (malignant)
- Serous cystadenocarcinoma
-
Most common malignant ovarian neoplasm, frequently bilateral. Psammoma bodies.
Ovarian Surface epithelium tumors (malignant)
- Mucinous cystadenocarcinoma
May be metastatic from appendiceal or other
GI tumors.
Can result in pseudomyxoma peritonei intraperitoneal accumulation of mucinous material.
Germ cell tumors (malignant)
- Dysgerminoma
in adolescents. Equivalent to male seminoma. 1% of all ovarian tumors; 30% of germ cell tumors
Sheets of uniform “fried egg” cells.
hCG, LDH = tumor markers.
Germ cell tumors (malignant)
- Immature teratoma
Commonly diagnosed before age 20. Typically
represented by immature/embryonic-like neural tissue.
Germ cell tumors (malignant)
- Yolk sac tumor (ovarian endodermal sinus tumor)
Aggressive, in ovaries or testes and sacrococcygeal
area in young children. Most common tumor in male infants.
Yellow, friable (hemorrhagic), solid mass. 50% have Schiller-Duval bodies (resemble glomeruli).
AFP = tumor marker.
Sex cord stromal tumors (malignant)
- Granulosa cell tumor
women in their 50s. Produces estrogen and/or progesterone.
Presents with postmenopausal bleeding, sexual precocity (in pre-adolescents), breast tenderness.
Shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles)
Krukenberg tumor
GI malignancy that metastasizes to ovaries mucin-secreting signet cell adenocarcinoma
Endometrial conditions
Pag. 630
Asherman syndrome
Adhesions and/or fibrosis of the endometrium.
Presents with infertility fertility, recurrent pregnancy
loss, abnormal uterine bleeding, pelvic pain
Endometrial
carcinoma
Most common gynecologic malignancy.
Peak occurrence at 55–65 years old. Presents with
vaginal bleeding
Breast Fibrocystic changes (< 35 years old)
- Sclerosing adenosis
- Epithelial hyperplasia
acini and stromal fibrosis, associated with calcifications. Slight (1.5–2 ×) risk for cancer.
cells in terminal ductal or lobular epithelium. risk of carcinoma with atypical cells.
*premenstrual breast pain or lumps; often bilateral and multifocal
Breast Inflammatory processes
- Fat necrosis
- Lactational mastitis
benign, usually painless, lump due to injury to breast tissue. Calcified oil cyst on mammography; necrotic fat and giant cells on biopsy.
risk of bacterial infection through cracks in nipple. S aureus is most common pathogen
Breast Benign tumors
- Fibroadenoma
< 35 years old. Small, well-defined, mobile mass.
inncrease size and tenderness with estrogen.
Breast Benign tumors
- Intraductal papilloma
small fibroepithelial tumor within lactiferous ducts, typically beneath areola.
Most common cause of nipple discharge (serous or bloody). Slight (1.5–2 ×) risk for cancer
Breast Benign tumors
- Phyllodes tumor
large mass of connective tissue and cysts with “leaf-like” lobulations.
Most common in 5th decade. Some may become malignant.
Gynecomastia
- Causes
Physiologic in newborn, pubertal, and elderly males.
Other causes:
cirrhosis, hypogonadism, testicular tumors, and drugs (Spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole)
Malignant breast tumors
Usually arise from terminal duct lobular unit.
triple negative (ER ⊝, PR ⊝, and Her2/Neu ⊝) more aggressive
Axillary lymph node involvement indicating metastasis is the most important prognostic factor in early-stage
disease
Non invasive breast cancer
- Ductal carcinoma in situ
- Comedocarcinoma
Fills ductal lumen. Arises from ductal atypia. Often seen early as microcalcifications on mammography.
Ductal, central necrosis. Subtype of DCIS.
Non invasive breast cancer
- Paget disease
Results from underlying DCIS or invasive breast cancer. Eczematous patches on nipple.
Paget cells = intraepithelial adenocarcinoma cells.
Invasive breasr cancer
- Invasive ductal carcinoma (most common)
Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.
Tumor can deform suspensory ligaments dimpling of skin. Classic morphology: “stellate” infiltration
Invasive breasr cancer
- Invasive lobular carcinoma
Orderly row of cells due to decreased E-cadherin expression
Often bilateral with multiple lesions in the same location
Invasive breasr cancer
- Medullary carcinoma
Fleshy, cellular, lymphocytic infiltrate.
Good prognosis.
Invasive breasr cancer
- Inflammatory breast cancer
Dermal lymphatic invasion by breast carcinoma. Peau d’orange. neoplastic cells block lymphatic drainage.
Poor prognosis (50% survival at 5 years). Often mistaken for mastitis or Paget disease.
Peyronie disease
Abnormal curvature of penis due to fibrous plaque within tunica albuginea. Associated with erectile dysfunction
Ischemic priapism
- Definition
- Causes
- Treatment
Painful sustained erection lasting > 4 hours.
Associated with sickle cell disease, medications (eg, sildenafil, trazodone).
Treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia.
Penile Squamous cell carcinoma
- Precursor in situ lesions:
- Bowen disease (in penile shaft, presents as leukoplakia),
- erythroplasia of Queyrat (carcinoma in situ of the glans, presents as erythroplakia),
- Bowenoid papulosis (carcinoma in situ of unclear malignant potential, presenting as reddish papules).
Cryptorchidism
associated with risk of germ cell tumors. Prematurity high risk of cryptorchidism
Testicular torsion
- Definition
- CLinical manifestations
- Treatment
Rotation of testicle around spermatic cord and vascular pedicle. Commonly presents in males 12–18 years old.
Characterized by acute, severe pain, high-riding testis, and absent cremasteric reflex
Treatment: surgical correction (orchiopexy) within 6 hours, manual detorsion
Varicocele
- Diagnosis
Standing clinical exam/Valsalva maneuver (distension on inspection and “bag of worms” on palpation; augmented by Valsalva) or ultrasound with Doppler A ; does not transilluminate.
Extragonadal germ cell tumors
Arise in midline locations.
In adults, most commonly in retroperitoneum, mediastinum, pineal, and suprasellar regions.
In infants and young children, sacrococcygeal teratomas are most common.
Congenital hydrocele
Common cause of scrotal swellingi n infants, due to incomplete obliteration of processus vaginalis.
Most spontaneously resolve by 1 year old.
Spermatocele
Cyst due to dilated epididymal duct or rete testis.
Paratesticular fluctuant nodule.
Testicular germ cell tumors
- Seminoma
Malignant; painless, homogenous testicular enlargement; most common testicular tumor. Does not
occur in infancy
Large cells in lobules with watery cytoplasm and “fried egg” appearance. ALP. Highly radiosensitive. Late metastasis, excellent prognosis
Testicular germ cell tumors
- Yolk sac tumor (testicular endodermal sinus tumor)
Yellow, mucinous. Aggressive malignancy. Schiller-Duval bodies resemble primitive glomeruli.
AFP is highly characteristic. Most common testicular tumor in boys < 3 years old.
Testicular germ cell tumors
- Choriocarcinoma
Malignant, hCG
Hematogenous metastases to lungs and brain. May produce gynecomastia, symptoms of hyperthyroidism
Testicular germ cell tumors
- Teratoma
Unlike in females, mature teratoma in adult males may be malignant. Benign in children
Testicular germ cell tumors
- Embryonal carcinoma
Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma. Often glandular /papillary morphology
hCG and normal AFP levels when pure (high AFP when mixed).
Testicular non–germ cell tumors (5% of all testicular tumors)
- Leydig cell tumor
Golden brown color; contains Reinke crystals.
Produces androgens or estrogens gynecomastia in men, precocious puberty in boys
Testicular non–germ cell tumors (5% of all testicular tumors)
- Sertoli cell tumor
Androblastoma from sex cord stroma
Testicular non–germ cell tumors (5% of all testicular tumors)
- Testicular lymphoma
Most common testicular cancer in older men. Not a 1° cancer; arises from metastatic lymphoma to testes. Aggressive
Benign prostatic hyperplasia
men > 50 years old
Enlargement of periurethral (lateral and middle) lobes.
Presents with frequency of urination, nocturia, difficulty starting and stopping urine stream, dysuria
Prostatitis
- Clinical presenation
- Acute bacterial prostatitis
- Chronic prostatitis
dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate.
in older men most common bacterium is E coli; in young males consider C trachomatis, N gonorrhoeae
either bacterial or nonbacterial (eg, 2° to previous infection, nerve problems, chemical irritation).
Prostatic adenocarcinoma
> 50 years old. Arises most often from posterior lobe (peripheral zone).
diagnosed by PSA and subsequent needle core biopsies.
Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and serum ALP and PSA.