Simple Deck Flashcards
(146 cards)
1
Q
Autosomal dominant (adult) polycystic kidney disease
A
PKD-1 and 2 –> polycystin 1 and 2
tons of fluid filled cysts, irregular surface, organ enlargement
asymptomatic until 4th decade
Clinical: flank pain, loin heaviness, liver cysts
2
Q
Autosomal recessive (childhood) polycystic kidney disease
A
PKHD-1 –> fibrocystin
surface is smooth, radial arrangement
congenital hepatic fibrosis, too
3
Q
Glomerulonephritis
A
immune complexes kill glomeruli
hypercellularity, glomerular necrosis
patients present with nephritic syndrome
4
Q
Acute poststreptococcal glomerulonephritis
A
Strep Ag-Ab complexes kill glomeruli
IgG and C3 deposits
Subepithelial humps and lumps and humps and lumps
Red casts in the tubules
5
Q
Crescentic glomerulonephritis
A
Severe glomerulonephritis
anti-type IV collagen Ab
breaks in the BM, crescents formed by proliferated parietal cells
clinical: severe, rapid nephritic syndrome
6
Q
Goodpasture syndrome
A
Autoimmune disease that attacks collagen in the type IV collagen in the BM of lungs and kidneys, causes crescentic glomerulonephritis
7
Q
Acute tubular necrosis
A
causes: ischemia or toxins
straight PCT and thick Henle get jacked up
proteinaceous casts of Hb and proteins in DCT and CDs
8
Q
Acute pyelonephritis
A
cause: gram-negative bacteria; ascending or hematogenous
bacteria in urine: 100k/ml
focal lesions in kidneys
leukocyte casts in urine
9
Q
Wilms tumor
A
large kidney tumor in children
embryonal elements/mixed tissues
90% sporadic, 10% WT1 gene
10
Q
Renal cell carcinoma
A
malignant neoplasm of renal tubular or ductal epithelial cells
seen in older men
sporadic VHL mutation association
Clear Cell is common type: yellow-orange mass from lipid and glycogen
Clinical: hematuria, flank pain, palpable mass is the triad
11
Q
Urothelial carcinomas
A
cancer of the bladder - transitional epithelium
cigarette smoking might cause it
clinical: sudden hematuria, dysuria
most (85%) are confined to bladder
12
Q
GH/prolactin-secreting pituitary adenoma
A
Most common multi-hormone adenoma of the anterior pituitary
Amenorrhea, galatorrhea, loss of libido, infertility
Gigantism or acromegaly
13
Q
Prolactinoma
A
Adenoma of the anterior pituitary that causes amenorrhea, galactorrhea, loss of libido, and infertility in women.
14
Q
Somatotroph adenoma
A
Adenoma of the anterior pituitary that causes acromegaly or gigantism.
15
Q
ACTH-producing adenoma
A
Adenoma of the anterior pituitary that causes Cushing syndrome, hypercortisolism, hyperpigmentation.
16
Q
Craniopharyngioma
A
benign tumor from the remnants of Rathke’s pouch
17
Q
Sheehan syndrome
A
hypotension from postpatrum hemorrhage –> ischemic necrosis of the pituitary
18
Q
Cretinism
A
hypothyroidism at an early age
impaired skeletal and CNS development, coarse facial features, protruding tongue, umbilical hernia
19
Q
Hashimoto disease
A
Goiterous hypothyroidism without iodine deficiency; autoimmune - T cells kill the thyroid gland.
Gland is diffusely enlarged, firm. Cut surface is pale tan and flashy.
Clinical features typical of hypothyroidism
20
Q
Papillary carcinoma
A
Most common thyroid cancer type.
MAP kinase pathway activation, RET proto-oncogene mutated
Orphan Annie Eye nuclei, dense fibrovascular cores, psamonna bodies
21
Q
Hyperparathyroidism
A
Hypersecretion of PTH from various causes - often to correct for hypocalcemia.
Clinical: hypercalcemia, bone demineralization, urinary stones, bile stones, caridiac arrhythmias.
22
Q
Cushing syndrome
A
Adrenal hyperfunction –> lots of cortisol
Clinical: moon face, buffalo hump, skin striations
23
Q
Addison disease
A
Adrenal hypofunction caused by autoantibody attack, TB, AIDS, or metastatic cancers.
Clinical: weakness, weight loss, GI symptoms, hyperpigmentation
24
Q
Phaeochromocytoma
A
Neoplasm of the adrenal medulla –> tons of catecholamines
Most are sporadic, some associated with VHL disease, Multiple endocrine neoplasia (MEN)
Circumscribed nests of neoplastic cells (Zellballen).
Clinical: hypertension, tachycardia, nervousness. Dx made if catecholamines and vanillylmandelic acid are in urine.
25
Hereditary spherocytosis
Hemolytic anemia caused by defects in membrane proteins.
3/4 are autosomal dominant, 1/4 are AR
RBC lifespan is 10-20 days
Clinical: moderate to severe anemia, pigment stones, hemosiderosis, jaundice.
26
Sickle cell anemia
Hemolytic anemia due to single AA substitution in Hb B-globin chain.
Deoxy HbS --\> polymerization. Repeated oxy-deoxy cycles --\> calcification, destruction of RBCs.
Clinical: reticulocytosis, hyperbilirubinemia, hemosiderosis, gallstones, **autosplenectomy, acute chest syndrome, stroke**, **vaso-occlusive (pain) crises**.
Tx: **hydroxyurea** (increases HbF and NO)
27
Glucose-6-Phosphate dehydrogenase deficiency
X-linked recessive. Enzyme needed to protect RBCs against oxidation. More hemolysis occurs.
Stay away from antibiotics, large doses of aspirin, **antimalarials, moth balls (napthalene), fava beans**.
**Bite cells**, **Heinz bodies**.
28
Thalassemia
**Unbalanced** Hb a-**globin** or B-globin **synthesis**.
unpaired globins aggregate, kill cells
New bone formation due to marrow expansion --\> **crew cut** skull x-ray
29
Iron deficiency anemia
Microcytic-hypochromic anemia caused by blood loss, diet deficiency, or increased iron demands.
**Pencil/cigar-shaped cells**.
Low serum iron, ferritin, transferrin. High total iron binding capacity.
30
Pernicious anemia
Autoimmune attack on gastric mucosa --\> no intrinsic factor --\> no B12 absorption --\> impaired DNA synthesis --\> no more new blood cells
Macrocytic-hyperchromic RBCs. **CNS lesions, neuro problems** **(B12** only, **NOT** folate deficiency)
Atrophy of gastric fundic glands.
31
Polycythemia vera
**Primary** polycythemia: EPO-independent growth of RBC progenitors due to EPO receptor mutation (constitutive signaling)
Clinical: **viscous blood** impairs cardiac and peripheral flow, **dark red skin** (as with all polycythemias).
32
Chuvash polycythemia
**Secondary** polycytheima: **mutated VHL** increases HIF-1a stability.
Clinical: viscous blood impairs cardiac and peripheral flow, dark red skin (as with all polycythemias).
33
Prolyl hydroxylase mutations
The mutation causes **secondary** polycythemia somehow.
Clinical: viscous blood impairs cardiac and peripheral flow, dark red skin (as with all polycythemias).
34
Acute promyelocytic leukemia
Subtype of AML. Cancer of WBCs, causing accumulation of immature granulocytes that are **blocked from differentiation** due to a chromosomal translocation --\> abnormal **PML/RARA fusion protein**.
Tx with **all-trans retinoic acid**
35
Chronic myelogenous leukemia
Cancer of WBCs. Hyperproliferation of neoplastic myeloid progenitors that **retain the ability to differentiate**.
**Philadelphia** chromosome, **BCR/ABL** fusion --\> **tyrosine kinase** activation
36
Burkitt lymphoma
3-7 y.o, Central Africa
**MYC** translocation, **EBV** in endemic cases
large **facial tumors**
37
Acute lymphoblastic leukemia
**Most common childhood leukemia**. Proliferation of immature **B** lymphoblasts in bone marrow and peripheral blood.
38
Diffuse large B cell lymphoma
Most common lymphoma in adults.
Immunoblasts have prominent nucleoli.
**BCL6 and BCL2 gene** rearrangements.
39
Hodgkin lymphoma
monoclonal B lymphocyte neoplasm
**Reed-Sternberg** cells
staging is important
most **common** malignancy in Americans b/t 10-30 y.o.
40
Multiple myeloma
neoplasm of terminally differentiated B cells --\> **plasma cells**
infiltrates bone marrow --\> **punched out skull lesions**
dysregulation of **D cyclin**
**Bence Jones protein** is made (Ig component), gets to kidneys and kills kidneys --\> **renal failure**
41
Condyloma acuminatum
Genital warts
HPV 6 or 11
single or multiple
with (sessile) or without stalk (pedunculated)
hyperkeratosis, epidermal thickening
koilocytosis, **orderly maturation remains**
42
Bowen disease
carcinoma in situ of penis
HPV 16
single, thick, grey-white, opaque plaque
OR
reddish plaque on glans penis = **Erythoplasia of Queyrat**
no orderly differentiation, BM intact
43
Bowenoid papulosis
The other carcinoma in situ of penis
HPV 16
**multiple red-brown** lesions
**young**, sexually active men
doesn't develop into invasive carcinoma
44
Squamous cell carcinoma of the penis
Grey, crusted papular lesion on the glans penis or prepuce
infiltrates/invades the CT
25% have inguinal node involvement at Dx
5 yr survival rate is 70%
45
Cryptorchidism
undescended testicles
arrested germ cells
hyalinization and thickened BM
**prominent Leydig cells**
**higher risk for testicular cancer** even after Sx correction
46
Seminoma
Germ cell tumor of testis
most common testicular cancer; 30-40 y.o.
uniform **nests** and **sheets** of **polygonal cells** with central nuclei
lots of glycogen and lipid --\> clear staining
25% have **hCG + staining**
**90% cure rate**
47
Acute prostatitis
cause: UTI bacteria
**polys** (neutrophils) infiltrate stroma --\> microabscesses
**edema, congestion**
Clinical: dysuria, low back pain, pelvic pain, **PSA possibly elvevated**
48
Chronic prostatitis
**glandular injury, lymphocyte infiltrate**
fibroblastic proliferation
many WBCs present despite negative bacterial culture
clinical is the same as acute prostatitis: dysuria, pelvic, back pain, PSA elevated
49
Benign prostatic hyperplasia (BPH)
**transitional or central zones**
proliferation of epithelial (glandular) and stromal (fibromuscular) elements
**cut surface: well-circumscribed nodules**, dilated glands create cystic spaces
tall columnar cells and peripheral basal cells
**compression of uretrha**
50
Prostate cancer
**peripheral zone**
older folk
**no basal reserve cells**
**Gleason** grading
clinically silent, PSA may indicate but better used for recurrence indication. Metastasis to bones
51
Lichen sclerosus
White plaque like **leukoplakia**
**parchment/crinkled**, atrophic skin
monocyte infiltrate, hydropic degeneration, hyperkeratosis and fibrosis
Clinical: itching, dyspareunia, **1-5% --\> squamous carcinoma**
biopsy needed
52
Basaloid and warty carcinomas
**HPV** 16, 18
VIN (no maturation, atypia) --\> squamous carcinoma
**nests and cords** of **tightly packed** squamous cells
focal central necrosis possible
warty type grows outward and has koilocytic atypia
Clinical: itching, ulcers and secondary infection
lymph spread, hemato/lymph spread to other organs common
53
Keratinizing squamous cell carcinoma of the vulva
**NO HPV**
from lichen sclerosus or squamous hyperplasia
older folk
infiltrating but normal differentiation and maturation
**keratin pearls**
Clinical: itching, ulcers and secondary infection
lymph spread, hemato/lymph spread to other organs common
54
Cervical intraepithelial neoplasia
aka dysplasia
HPV 16, 18
classification: LSIL (1/3 of epi) or HSIL (2/3)
atypia, big nuclei, hyperchromic, **coarse chromatin granules**, koilocytes
10% LSIL --\> carcinoma
55
Squamous cell carcinoma of cervix
makes up **75%** of cervical cancers
**nests, tongues** of malignant squamous epi, keratinizing or non-keratinizing, invades underlying stroma
56
Endometriosis
**Abnormal** endometrial glands + stroma outside uterus
Yellow-red = blood breakdown, red in early form
**Powder burns, chocolate cysts**
Found on **ovaries** most often
Clinical: dysmenorrhea, dyspareunia, pelvic pain
**Adhesions, ectopic pregnancy**
57
Endometrioid adenocarcinoma aka type 1
Associated with **estrogen stimulation**, obesity, hypertension, diabetes
mutated **mismatch repair, PTEN tumor suppressor**
Well (grade 1), moderately (2), poorly (3) differentiated
58
Non-endometrioid adenocarcinoma aka serous carcinoma of the endometrium aka type 2
happens decade later than type 1
**NO estrogen** association
poor differentiation, always **grade 3**
**p53 mutation** in 90%
59
Leiyomyoma
**Very common benign** tumor of uterine smooth muscle
shrinks after menopause
Firm, pale-grey, circumscribed
Can be intramural or beneath the endometrium or serosa
**whorls of smooth muscle cells**, foci of fibrosis, calcification, necrosis, cystic degeneration, hemorrhage.
clinical: silent, metrorrhagia, menorrhagia
60
Leiyomyosarcoma
arises **de novo** from mesenchyme
uncommon
Variable morphology: bulky, polypoid lesions OR looks like leiomyoma. Variable histology.
**necrotic (is best Dx criteria)**, soft, hemorrhagic
recurrence and **lung metastasis** common
5-year survival 40%
61
Salpingitis
inflammation of fallopian tubes from lower genital tract infection
reinfection common
**acute**: polys, edema, congestion of mucosal folds
**chronic**: lymphocytes and plasma cells, **no edema or congestion**
**late**: pus and transudate distends tubes
Can lead to **PID, adhesion, abscesses, infertility, ectopic pregnancy**
62
Surface epithelial-stromal cell tumors
Ovarian neoplasm associated w/ **family Hx or nulliparity**
**HER2/NEU = poor prognosis**
includes three subtypes: serous tumors, cystadenomas, cystadenocarcinomas
63
Serous tumors of the ovary
Most frequent ovarian tumor. Large, spherical, can get huge (30-40cm)
64
Cystadenoma of the ovary
Benign cyst of ovary.
30-40 y.o.
25% are bilateral
single layer of tall columnar epithelium
65
Cystadenocarcinoma of the ovary
Malignant ovarian tumor
45-65 y.o.
Clinical: asymptomatic until huge, seeding, regional lymph spread common, NO distant metastasis
**CA-125 marker**
**Bad prognosis**.
66
Breast cancer
**Most common malignancy in women**, 2nd leading cause of cancer death
BRCA1, 2, p53 are hereditary factors but **most are sporadic**
**Hormonal status is big factor** (late/no pregnancy increases risk)
HER2/NEU = poor prognosis
67
BRCA2
found in 20% of hereditary breast cancer cases
carriers have 30-50% lifetime chance of getting breast cancer
**Ashkenazi Jewish Women**
Men are at increased risk for breast cancer, too
68
BRCA1
mutated in 1 in 200-400 peeps in US
60-85% lifetime risk of breast cancer, increases risk for
also found in 20% of hereditary cases (like BRCA2)
**not seen in sporadic cases**
69
Ductal carcinoma in situ (DCIS)
Most common in situ breast carcinoma - noninvasive
No BM penetration
Invades the shit out of ducts. Fills, distorts, unfolds lobules
Necrosis depends on subtype, calcifications
two subtypes: comedo, non-comedo
70
DCIS Non-comedo subtype
**No desmoplastic response** (hardening) = no palpable or radiologically detectable mass
Nipple discharge may develop
1/3 --\> carcinoma in the **same breast and quadrant**
**Excellent prognosis**
71
DCIS comedo subtype (high grade)
Aggressive DCIS: large, pleomorphic cells, abundant cytoplasm, irregular nuclei.
**Intraductal necrosis**, calcification can show up radiologically
**Desmoplastic** response
72
Lobar carcinoma in situ (LCIS)
2nd most common form of in situ breast carcinoma
BM intact
cells are smaller, uniform, round, regular nuclei, small nucleoli
cells don't pack up ducts as much as DCIS
**signet ring cells**
no calcification
1/3 --\> invasive carcinoma, used as breast cancer **marker**
73
Invasive ductal carcinoma
called this b/c they **can't be categorized**
associated with DCIS
irregular margins, lymph-vascular invasion, nerve invasion
**nipple dimpling and retraction**, nodules, breast inflammation
**paraneoplastic syndrome --\> hypercalcemia**
hard, palpable mass due to desmoplastic response
HER2/NEU is bad
74
PKD-1 and 2 --\> polycystin 1 and 2
tons of fluid filled cysts, **irregular surface**, organ enlargement
asymptomatic until 4th decade
Clinical: flank pain, loin heaviness, **liver cysts**
Autosomal dominant (adult) polycystic kidney disease
75
PKHD-1 --\> fibrocystin
**surface is smooth**, radial arrangement
congenital hepatic fibrosis, too
Autosomal recessive (childhood) polycystic kidney disease
76
immune complexes kill glomeruli
hypercellularity, glomerular necrosis
patients present with nephritic syndrome
Glomerulonephritis
77
Strep Ag-Ab complexes kill glomeruli
IgG and C3 deposits
Subepithelial **humps and lumps and humps and lumps**
Red casts in the tubules
Acute poststreptococcal glomerulonephritis
78
Severe glomerulonephritis
anti-type IV collagen Ab
**breaks** in the BM, **crescents** formed by proliferated parietal cells
clinical: severe, rapid nephritic syndrome
Crescentic glomerulonephritis
79
Autoimmune disease that attacks collagen in the type IV collagen in the BM of lungs and kidneys, causes crescentic glomerulonephritis
Goodpasture syndrome
80
causes: ischemia or toxins
straight PCT and thick Henle get jacked up
**proteinaceous casts** of Hb and proteins in DCT and CDs
Acute tubular necrosis
81
cause: gram-negative bacteria; ascending or hematogenous
bacteria in urine: 100k/ml
focal lesions in kidneys
**leukocyte casts** in urine
Acute pyelonephritis
82
large kidney tumor in children
embryonal elements/mixed tissues
90% sporadic, 10% **WT1 gene**
Wilms tumor
83
malignant neoplasm of renal tubular or ductal epithelial cells
seen in older men
sporadic VHL mutation association
Clear Cell is common type: yellow-orange mass from lipid and glycogen
Clinical: hematuria, flank pain, palpable mass is the **triad**
Renal cell carcinoma
84
cancer of the bladder - transitional epithelium
cigarette smoking might cause it
clinical: sudden hematuria, dysuria
most (85%) are confined to bladder
Urothelial carcinomas
85
Most common multi-hormone adenoma of the anterior pituitary
Amenorrhea, galatorrhea, loss of libido, infertility
Gigantism or acromegaly
GH/prolactin-secreting pituitary adenoma
86
Adenoma of the anterior pituitary that causes amenorrhea, galactorrhea, loss of libido, and infertility in women.
Prolactinoma
87
Adenoma of the anterior pituitary that causes acromegaly or gigantism.
Somatotroph adenoma
88
Adenoma of the anterior pituitary that causes Cushing syndrome, hypercortisolism, **hyperpigmentation**.
ACTH-producing adenoma
89
benign tumor from the remnants of Rathke's pouch
Craniopharyngioma
90
hypotension from postpatrum hemorrhage --\> ischemic necrosis of the pituitary
Sheehan syndrome
91
hypothyroidism at an early age
impaired skeletal and CNS development, coarse facial features, protruding tongue, umbilical hernia
Cretinism
92
Goiterous hypothyroidism without iodine deficiency; autoimmune - T cells kill the thyroid gland.
Gland is diffusely enlarged, firm. Cut surface is pale tan and flashy.
Clinical features typical of hypothyroidism
Hashimoto disease
93
Most common thyroid cancer type.
MAP kinase pathway activation, RET proto-oncogene mutated
**Orphan Annie Eye nuclei**, dense fibrovascular cores, psamonna bodies
Papillary carcinoma
94
Hypersecretion of PTH from various causes - often to correct for hypocalcemia.
Clinical: hypercalcemia, bone demineralization, urinary stones, bile stones, caridiac arrhythmias.
Hyperparathyroidism
95
Adrenal hyperfunction --\> lots of ACTH release
Clinical: **moon face, buffalo hump**, skin striations
Cushing syndrome
96
Adrenal hypofunction caused by autoantibody attack, TB, AIDS, or metastatic cancers.
Clinical: weakness, weight loss, GI symptoms, hyperpigmentation
Addison disease
97
Neoplasm of the adrenal medulla --\> tons of catecholamines
Most are sporadic, some associated with VHL disease, Multiple endocrine neoplasia (MEN)
Circumscribed nests of neoplastic cells (**Zellballen**).
Clinical: hypertension, tachycardia, nervousness. Dx made if catecholamines and **vanillylmandelic acid** are in urine.
Phaeochromocytoma
98
Hemolytic anemia caused by defects in membrane proteins.
3/4 are autosomal dominant, 1/4 are AR
RBC lifespan is 10-20 days
Clinical: moderate to severe anemia, pigment stones, hemosiderosis, jaundice.
Hereditary spherocytosis
99
Hemolytic anemia due to single AA substitution in Hb B-globin chain.
Deoxy HbS --\> polymerization. Repeated oxy-deoxy cycles --\> calcification, destruction of RBCs.
Clinical: reticulocytosis, hyperbilirubinemia, hemosiderosis, gallstones, **autosplenectomy, acute chest syndrome, stroke**, **vaso-occlusive (pain) crises**.
Tx: **hydroxyurea** (increases HbF and NO)
Sickle cell anemia
100
X-linked recessive. Enzyme needed to protect RBCs against oxidation. More hemolysis occurs.
Stay away from antibiotics, large doses of aspirin, **antimalarials, moth balls (napthalene), fava beans**.
**Bite cells**, **Heinz bodies**.
Glucose-6-Phosphate dehydrogenase deficiency
101
**Unbalanced** Hb a-**globin** or B-globin **synthesis**.
unpaired globins aggregate, kill cells
New bone formation due to marrow expansion --\> **crew cut** skull x-ray
Thalassemia
102
Microcytic-hypochromic anemia caused by blood loss, diet deficiency, or increased iron demands.
**Pencil/cigar-shaped cells**.
Low serum iron, ferritin, transferrin. High total iron binding capacity.
Iron deficiency anemia
103
Autoimmune attack on gastric mucosa --\> no intrinsic factor --\> no B12 absorption --\> impaired DNA synthesis --\> no more new blood cells
Macrocytic-hyperchromic RBCs. **CNS lesions, neuro problems** **(B12** only, **NOT** folate deficiency)
Atrophy of gastric fundic glands.
Pernicious anemia
104
**Primary** polycythemia: EPO-independent growth of RBC progenitors due to EPO receptor mutation (constitutive signaling)
Clinical: **viscous blood** impairs cardiac and peripheral flow, **dark red skin** (as with all polycythemias).
Polycythemia vera
105
**Secondary** polycytheima: **mutated VHL** increases HIF-1a stability (for angiogenesis).
Clinical: viscous blood impairs cardiac and peripheral flow, dark red skin (as with all polycythemias).
Chuvash polycythemia
106
The mutation causes **secondary** polycythemia somehow.
Clinical: viscous blood impairs cardiac and peripheral flow, dark red skin (as with all polycythemias).
Prolyl hydroxylase mutations
107
Subtype of AML. Cancer of WBCs, causing accumulation of immature granulocytes that are **blocked from differentiation** due to a chromosomal translocation --\> abnormal **PML/RARA fusion protein**.
Tx with **all-trans retinoic acid**
Acute promyelocytic leukemia
108
Cancer of WBCs. Hyperproliferation of neoplastic myeloid progenitors that **retain the ability to differentiate**.
**Philadelphia** chromosome, **BCR/ABL** fusion --\> **tyrosine kinase** activation
Chronic myelogenous leukemia
109
3-7 y.o, Central Africa
**MYC** translocation, **EBV** in endemic cases
large **facial tumors**
Burkitt lymphoma
110
**Most common childhood leukemia**. Proliferation of immature **B** lymphoblasts in bone marrow and peripheral blood.
Acute lymphoblastic leukemia
111
Most common lymphoma in adults.
Immunoblasts have prominent nucleoli.
**BCL6 and BCL2 gene** rearrangements.
Diffuse large B cell lymphoma
112
monoclonal B lymphocyte neoplasm
**Reed-Sternberg** cells
staging is important
most **common** malignancy in Americans b/t 10-30 y.o.
Hodgkin lymphoma
113
neoplasm of terminally differentiated B cells --\> **plasma cells**
infiltrates bone marrow --\> **punched out skull lesions**
dysregulation of **D cyclin**
**Bence Jones protein** is made (Ig component), gets to kidneys and kills kidneys --\> **renal failure**
Multiple myeloma
114
Genital warts
HPV 6 or 11
single or multiple
with (sessile) or without stalk (pedunculated)
hyperkeratosis, epidermal thickening
koilocytosis, **orderly maturation remains**
Condyloma acuminatum
115
carcinoma in situ of penis
HPV 16
single, thick, grey-white, opaque plaque
OR
reddish plaque on glans penis = **Erythoplasia of Queyrat**
no orderly differentiation, BM intact
Bowen disease
116
The other carcinoma in situ of penis
HPV 16
**multiple red-brown** lesions
**young**, sexually active men
doesn't develop into invasive carcinoma
Bowenoid papulosis
117
Grey, crusted papular lesion on the glans penis or prepuce
infiltrates/invades the CT
25% have inguinal node involvement at Dx
5 yr survival rate is 70%
Squamous cell carcinoma of the penis
118
undescended testicles
arrested germ cells
hyalinization and thickened BM
**prominent Leydig cells**
**higher risk for testicular cancer** even after Sx correction
Cryptorchidism
119
Germ cell tumor of testis
most common testicular cancer; 30-40 y.o.
uniform **nests** and **sheets** of **polygonal cells** with central nuclei
lots of glycogen and lipid --\> clear staining
25% have **hCG + staining**
**90% cure rate**
Seminoma
120
cause: UTI bacteria
**polys** (neutrophils) infiltrate stroma --\> microabscesses
**edema, congestion**
Clinical: dysuria, low back pain, pelvic pain, **PSA possibly elvevated**
Acute prostatitis
121
**glandular injury, lymphocyte infiltrate**
fibroblastic proliferation
many WBCs present despite negative bacterial culture
clinical is the same as acute prostatitis: dysuria, pelvic, back pain, PSA elevated
Chronic prostatitis
122
**transitional or central zones**
proliferation of epithelial (glandular) and stromal (fibromuscular) elements
**cut surface: well-circumscribed nodules**, dilated glands create cystic spaces
tall columnar cells and peripheral basal cells
**compression of uretrha**
Benign prostatic hyperplasia (BPH)
123
**peripheral zone**
older folk
**no basal reserve cells**
**Gleason** grading
clinically silent, PSA may indicate but better used for recurrence indication. Metastasis to bones
Prostate cancer
124
White plaque like **leukoplakia**
**parchment/crinkled**, atrophic skin
monocyte infiltrate, hydropic degeneration, hyperkeratosis and fibrosis
Clinical: itching, dyspareunia, **1-5% --\> squamous carcinoma**
biopsy needed
Lichen sclerosus
125
**HPV** 16, 18
VIN (no maturation, atypia) --\> squamous carcinoma
**nests and cords** of **tightly packed** squamous cells
focal central necrosis possible
warty type grows outward and has koilocytic atypia
Clinical: itching, ulcers and secondary infection
lymph spread, hemato/lymph spread to other organs common
Basaloid and warty carcinomas
126
**NO HPV**
from lichen sclerosus or squamous hyperplasia
older folk
infiltrating but normal diff and maturation
**keratin pearls**
Clinical: itching, ulcers and secondary infection
lymph spread, hemato/lymph spread to other organs common
Keratinizing squamous cell carcinoma of the vulva
127
aka dysplasia
HPV 16, 18
classification: LSIL (1/3 of epi) or HSIL (2/3)
atypia, big nuclei, hyperchromic, **coarse chromatin granules**, koilocytes
10% LSIL --\> carcinoma
Cervical intraepithelial neoplasia
128
makes up **75%** of cervical cancers
**nests, tongues** of malignant squamous epi, keratinizing or non-keratinizing, invades underlying stroma
Squamous cell carcinoma of cervix
129
**Abnormal** endometrial glands + stroma outside uterus
Yellow-red = blood breakdown, red in early form
**Powder burns, chocolate cysts**
Found on **ovaries** most often
Clinical: dysmenorrhea, dyspareunia, pelvic pain
**Adhesions, ectopic pregnancy**
Endometriosis
130
Associated with **estrogen stimulation**, obesity, hypertension, diabetes
mutated **mismatch repair, PTEN tumor suppressor**
Well (grade 1), moderately (2), poorly (3) differentiated
Endometrioid adenocarcinoma aka type 1
131
happens decade later than type 1
**NO estrogen** association
poor differentiation, always **grade 3**
**p53 mutation** in 90%
Non-endometrioid adenocarcinoma aka serous carcinoma of the endometrium aka type 2
132
**Very common benign** tumor of uterine smooth muscle
shrinks after menopause
Firm, pale-grey, circumscribed
Can be intramural or beneath the endometrium or serosa
**whorls of smooth muscle cells**, foci of fibrosis, calcification, necrosis, cystic degeneration, hemorrhage.
clinical: silent, metrorrhagia, menorrhagia
Leiyomyoma
133
arises **de novo** from mesenchyme
uncommon
Variable morphology: bulky, polypoid lesions OR looks like leiomyoma. Variable histology.
**necrotic (is best Dx criteria)**, soft, hemorrhagic
recurrence and **lung metastasis** common
5-year survival 40%
Leiyomyosarcoma
134
inflammation of fallopian tubes from lower genital tract infection
reinfection common
**acute**: polys, edema, congestion of mucosal folds
**chronic**: lymphocytes and plasma cells, **no edema or congestion**
**late**: pus and transudate distends tubes
Can lead to **PID, adhesion, abscesses, infertility, ectopic pregnancy**
Salpingitis
135
Ovarian neoplasm associated w/ **family Hx or no birth/\>35**
**HER2/NEU = poor prognosis**
includes three subtypes: serous tumors, cystadenomas, cystadenocarcinomas
Surface epithelial-stromal cell tumors
136
Most frequent ovarian tumor. Large, spherical, can get huge (30-40cm)
Serous tumors of the ovary
137
Benign cyst of ovary.
30-40 y.o.
25% are bilateral
single layer of tall columnar epithelium
Cystadenoma of the ovary
138
Malignant ovarian tumor
45-65 y.o.
Regional lymph spread, NO distant metastasis
**CA-125** marker
Clinical: asymptomatic until huge, seeding common
**Bad prognosis**.
Cystadenocarcinoma of the ovary
139
**Most common malignancy in women**, 2nd leading cause of cancer death
BRCA1, 2, p53 are hereditary factors but **most are sporadic**
**Hormonal status is big factor** (late/no pregnancy increases risk)
HER2/NEU = poor prognosis
Breast cancer
140
found in 20% of hereditary breast cancer cases
carriers have 30-50% lifetime chance of getting breast cancer
**Ashkenazi Jewish Women**
Men are at increast risk for breast cancer, too
BRCA2
141
mutated in 1 in 200-400 peeps in US
60-85% lifetime risk of breast cancer, increases risk for
also found in 20% of hereditary cases (like BRCA2)
**not seen in sporadic cases**
BRCA1
142
Most common in situ breast carcinoma - noninvasive
No BM penetration
Invades the shit out of ducts. Fills, distorts, unfolds lobules
Necrosis depends on subtype, calcifications
two subtypes: comedo, non-comedo
Ductal carcinoma in situ (DCIS)
143
**No desmoplastic response** (hardening) = no palpable or radiologically detectable mass
Nipple discharge may develop
1/3 --\> carcinoma in the **same breast and quadrant**
**Excellent prognosis**
DCIS Non-comedo subtype
144
Aggressive DCIS: large, pleomorphic cells, abundant cytoplasm, irregular nuclei.
**Intraductal necrosis**, calcification can show up radiologically
**Desmoplastic** response
DCIS comedo subtype (high grade)
145
2nd most common form of in situ breast carcinoma
BM intact
cells are smaller, uniform, round, regular nuclei, small nucleoli
cells don't pack up ducts as much as DCIS
**signet ring cells**
no calcification
1/3 --\> invasive carcinoma, used as breast cancer **marker**
Lobar carcinoma in situ (LCIS)
146
called this b/c they **can't be categorized**
associated with DCIS
irregular margins, lymph-vascular invasion, nerve invasion
**nipple dimpling and retraction**, nodules, breast inflammation
**paraneoplastic syndrome --\> hypercalcemia**
hard, palpable mass due to desmoplastic response
HER2/NEU is bad
Invasive ductal carcinoma
