Week 4 Female GU and Breast Flashcards

Question

Answer 1

Endometrial stromal sarcoma Group of tumors from endomtrial stroma Diffuse worm-like pattern

Answer 2

Umbrella term for group of diseases including hydatidiform mole, and malignant tumors e.g. choriocarcinoma (tumour of trophoblasts) Hydaditiform mole **Complete** - empty egg fertilised by one/two sperm 46 chromosomes Enlarged oedematous villi Circumferential trophoblastic proliferation Increased risk of choriocarcinoma **Partial** - normal egg fertilised by two sperm 69 chromosomes Oedematous villi Partial trophoblastic proliferation Minimal risk choriocarcinoma

Answer 3

Covered by flat, coelomic epithelium Cortex: follicles containing occytes, stroma Medulla: blood vessels, nerves, hilar cells In follicle, oocyte surrounded by granulosa cells, and theca cells (outer) LH acts on theca cells to secrete androgens FSH acts on granulosa cells to convert androgens to oestrogen

Answer 4

Corpus albicans - scarring left when corpus luteum degenerates, if an egg is not fertilised Shows patient has finished menstrual cycle but is peri- menopause, as no follicles

Answer 5

Includes symptoms of **annovulation** (oligomenorrheoa - few periods) and **increased androgen levels** (hirsutism, infertility) Typically in young, obese women Pathophysiology: **Gonadotropins:** Increased LH - supports theca cells - makes more androgens Decreased FSH (less conversion of androgens to oestrogen) Leads to degeneration of follicles forming mulitple sub-cortical cysts **Inreased androgens:** - Due to theca cells producing androgens - Decreased steroid hormone binding globulin (produced in liver, binds testosterone so won't be active) **Insulin resistance:** Inuslin stimulates theca cells, reduces SHBG, increased androgens Increased risk of endometrial carcinoma Treatment: Weight loss, metformin, clomifene (anti-oestrogen, leading to increased FSH due to negative feedback)

Answer 6

1. Coelomic epithelium 2. Germ cells 3. Sex cords/stromal cells (cells which support oocyte e.g. granulosa, theca cells Clinical presentation: Aymptomatic, pain, irregular menstruation, hirsutism, ascites (bloated abdomen) Investigations: physical examination, bloods: CA-125, ultrasound

Answer 7

Benign - cystadenoma (cystic) or cystadenofibroma (without solid stromal component) Borderline - has malignant potential but better prognosis Malignant - cystadenocarcinoma (cystic) or solid adenocarcinoma Carcinomas can be high grade serous, low grade serous, mucinous, endometrioid (assoc. with endometriosis), clear-cell (assoc with endometriosis), High grade serous: BRCA1/2 genes, p53 Low grade serous: KRAS

Answer 8

Benign: women 30-40yrs. Large, bilateral, smooth, shiny covering. Cysts are filled with serous fluid, lined by single columnar epithelium. Some cells cilaited. Borderline: cellular atypia, no stromal invasion Malignant: older women. Anaplasia (lack of differentiation) of cells. Stromal invasion. Psammoma bodies (pic) - concentric calcifications, in papillae of serous tumours. (Also in papillary thryoid carcinoma)

Answer 9

Tumour consists of mucin secreting cells Most benign. Borderline. Malignant. Krukenberg tumours - Cancer from GI metastases to ovary. Can mimic primary ovarian mucinous tumour (usually unilateral) Morphology: large, no psammoma bodies, cysts lined with mucinous cytoplasm

Answer 10

Malignant mucinous ovarian tumour Nuclei more atypical, lost polarity, mitotic figures, irregular shaped glands, cells contain mucus

Answer 11

Histologically characterised by appearence of tubular glands, resembles normal endometrium Usually malignant (though can be benign, malignant) Arises from endometriosis Some have ovarian tumour and endometrium carcinoma (due to loss of PTEN tumour supressor gene)

Answer 12

Young women Found as ovarian mass or incidentally on abdominal scans 95% are mature cystic teratomas (dermoid cysts) - **benign** Germ cells differentiate into 3 germ cells layers: ectoderm (skin, hair), mesoderm (muscle, fat), endoderm (GI, respiratory epithelium) Morphology - smooth, hair, teeth, bone, GI epithelium **Malignant:** 5% immature cystic teratomas (Immature tissue - neuroectoderm) 1%: tissue elements e.g. skin can become malignant. Skin - squamous cell carcinoma Cystic teratomas prone to torsion Yolk sac tumour, choriocarcnioma (placental tissue) rare

Answer 13

Resemble normal sex cord stromal tissue of ovary (granulosa, theca, cells, fibrous tissue, Sertoli, Leydig cells) Granulosa and theca cell tumours: secrete oestrogen Sertoli-Leydig cell tumours - secrete androgens Granulosa cell tumours - not rare. Post-menopausal women. Can lead to endometrial hyperplasia, endometrial carcinoma Fibroma - benign tumour of fibroblasts Meigs syndrome - fibroma, ascites and pleural effusion Ovarian tumour with ascites - usually carcinoma

Answer 14

Mixed surface epithelium-stromal tumour Benign, unilateral, yellowish Contains urothelium (transitional epithelial cells) with fibrous stroma

Answer 15

Ciliated columnar epithelium Plicae Layers of smooth muscle

Answer 16

Endometriosis Uterine fibroids (leiomyomas) Uterine cancer Clinical presentation: pain, post menopausal bleeding

Answer 17

Clinical presentation: heavy periods, pain, pressure, anaemia

Answer 18

Derived from milk line (imaginary line from axilla down to vulva) Terminal duct lobular unit: functional unit All ducts (grandular tissue) and lobules are lined by: inner luminal cells and myoepithelial cells (contractile function) Adolescent breast - ducts in a dense stroma After puberty - lobules develop, breast expands Pregnancy - hyerplasia, TDLU enlarged Lactating - epithelial secretory activity (cytoplasic vacuoles) Menopause - Atrophy -of TDLU. Ducts are dilated.

Answer 19

Tubo-ovarian abcess: pelvic pain, increased CRP/WCC, temperature Ectopic pregnant: pelvic pain, bHCG increased, missed periods

Answer 20

Ectopic breast tissue - commonest congenital breast abnormality, usually on milk line Brest hypoplasia - assoc. with Turner's syndrome

Answer 21

Infectious: Acute mastitis - cellulitis of breast, assoc. with breast feeding. Bacteria (S.aureus) enters through cracked nipple - presents as warm, red breast with purulent discharge - can form abscess Non-infectious/inflammatory: Granulomatous inflammation of breast can occur in systemic diseases e.g. sarcoidosis, TB Idiopathic granulomatous mastitis: Non-necrotising granulomatous inflammation centred on loubles. Distinct, hard mass. Usually parous (previously pregnant). May repsond to steroids. - Need to exclude TB, sarcoid, vasculitis Periductal mastitis - inflammation of subaerolar ducts, leading to dilation of sub-aerolar ducts. Assoc. with smoking. Presents as sub-aerolar mass and nipple retraction (due to granulation tissue which contains myofibroblasts which pull in skin). Multiparous post menopausal women. Ductal ectasia - Inflammation of duct leading to dilatation of duct. Duct becomes blocked. Debris leads out leading to, peri-aerolar mass with green/brown nipple discharge. Fat necrosis: related to trauma. Benign. Presents as mass or **calcification** on mammogram. Biopsy shows necrotic fat with calcifications and giant cells.

Answer 22

Most common breast condition Development of fibrosis and cysts Presents as bilateral, diffuse breast lumpiness Includes: Fibrosis (increased fibrous stroma) Cystic Adenosis (increased glandular tissue) (can show calcifications on MMG) Apocrine metaplasia (large, epithelial cells with granular eosinophilic cystoplasm and apical projections) Sclerosing adenosis - benign proliferation of glandular tissue. Can show **microcalcifications** on US. **2x risk of br. ca** Radial scars - sclerosing lesions, with fibrotic and elastic core \>10mm. Myoepithelail cells present (whereas tubular carcinoma doesn't) ``` Epithelial hyperplasia (ductal, lobular) - **2x risk of br. ca** Epithelial hyperplasia with atypia - **4x risk of br. ca** ``` Papillomas also included

Answer 23

Papillary lesion: finger like projection with epithelial lining Papillary growth (benign) into a large duct, lined by epithelal and myoepithelial cells with fibrovascular core Multiple papillomas (papillomatosis) - assoc. with malignancy Presents as **bloody discharge in pre-menopausal** (benign) If malignant (papillary carcinoma) - has no myoepithelial cells (more common in post-menopausal women)

Answer 24

Tumour of fibrous tissue and glands. Characteristically, proliferation of epithelium and mesenchyme. Most common benign tumour of breast Most common tumour in pre-menopausal women Well circumscribed, mobile, marble-like mass Hormone-sensitive - can shrink during menopasue Juvenile adenomas can be very large No increase risk of cancer

Answer 25

Fibroadenoma-like tumour with overgrowth of fibrous stroma Overgrowth pushes out "leaf-like" projections Post-menopausal women Can be malignant Needs to be surgically excised with margin

Answer 26

Pure adenomas: Tubular or lactating, lack prominent stroma of fibroadenomas

Answer 27

Nipple adenomas: Presents as erosive lesion on nipple +/- nipple discharge - Benign but can mimic Paget's disease of the nipple (malignant) Paget's disease of nipple: Ductal carcioma in situ that has gone up to skin of nippple - Presents as red, scaly rash on nipple (like eczema) , and darker area surrounding nipple. Can be a sign of breast cancer

Answer 28

Discrete, smooth, painless mass of glandular, fatty, fibrous tissue

Answer 29

Most common cancer in women Usually 40-70 yrs Risk factors: Earlier menarche, late menopause, obesity, OC use, HRT, alcohol, BRACA1/2, Li Fraumeni Syndrome (p53), pTEN. nulliparity, first child after 30 yrs. Symptoms: new lump, altered shape/size skin changes - peau d'orange (resembles skin of an orange, due to lymphatic infilitration), rash nipple changes - inversion, ezcema-like rash (Paget's) Investigations: Clinical examination MMG, US (microcalcification often present in invasive carcinoma) FNA Core biospy, excisional biopsy UK women invited from 50-70 every 3 yrs Treatment Local excision and radiotherapy Mastectomy Sentinel node biopsy Axillary clearence - if sentinel node positive. However, can cause limitation of arm movement, lymphoedema

Answer 30

Hard, palpable lump. Radily enlarging mass with skin changes. Premenopausal Dense stroma lined with channels lined by myofibroblasts Differential: angiosarcoma

Answer 31

Tamoxifen: ER (oestrogen receptor) antagonist (80% breast cancers overexpress oestrogen and progesterone receptors) However, has agonist activity in endometrium so can cause increase risk of endometrial cancer Aromatase inhibitors - Letrazole (prevents conversion of androgens to oestrogen) - only for post-menopausal women Transtuzumab (Herceptin) - Those who express HER2 have worse prognosis. Transtuzumab has improved survival Chemotherapy

Answer 32

Size, grade (based on tubules, pleomorphism, mitoses) and lymph node Type does not add much if take grade into account Hormone receptor status - important in repsonse to certain treatment

Answer 33

Estimates prognosis, and determines treatment Grade of tumour - Grade 1 = 1 pt, Grade 3 = 3 pts Nodes - 0 nodes = 1 pt, 1-3 nodes = 2 pts, 4+ nodes = 3 points Size (size x 0.2cm) Higher, poor prognosis

Answer 34

Malignant epithelial proliferation within basement membrane Has not expanded into breast stroma Has not communication with blood vessels, lymphatics No possibility of metastases

Answer 35

Need to US axilla in all invasive carcinoma Sentinel node biopsy - SN (first node which the cancer will spread to from primary tumour). If neg, suggests cancer has not spread to lymph nodes or other organs. Inject blue dye, assess first lymph nodes Axillary clearence - if SN postive

Answer 36

Malignant proliferation of cells in ducts within basement membrane Most commonly shows calcification on MMG Presents as lump, nipple discharge, Paget's disease of breast (DCIS which extends up ducts to skin of nipple) 10x increased risk of breast ca Histologically - necrosis dystrophic calcificaiton in centre Treatment Complete excision Local excision and radiotherapy Mastectomy+/-reconstruction

Answer 37

Forms duct-like structures Most common invasive carcinoma Presents as mass detected by physical examination or MMG May show nipple retraction, skin dimpling Biopsy: ductal like structures with desmoplastic stroma

Answer 38

Tubular carcinoma - produces tubules. Desmoplastic stroma (connective tissue which grows with tumour so very dense). No myoepithelial cells Mucinoid carcinoma - malignant cells flooded in pool of mucus. Usually over 75 yrs. Both have good prognosis

Answer 39

Malignant proliferation of cells in lobules, within basement membrane Usually detected incidentally, no mass or calcification Bilateral, multi-focal Dyscohesive cells (not stuck together), loss of E-cadherin Management: Follow up (as low risk of become invasive) Bilateral mastectomy

Answer 40

No duct formation, grows in single file (signet ring cells)

Answer 41

Blood and Richardson Grade 1-3 (Grade 1: **well differentiated,** slow growing, Grade 3: **poorly differentiated,** fast growing) Tubules (less no. of cells that form tubule, worse) Pleomorphism Mitoses

Answer 42

**Alkylating agents: cross-links DNA between one strand, and across two strands** - Nitrogen mustards: Melphalan, Cyclophosphamide - Cysplatin - Busulphan - Lomustine **Antimetabolites: interferes with DNA/nucleotide synthesis** - Methotrexate Nucleotide analogues: - Pyrimidine analogues: Flouro-uracil - Purine analogues: Mercaptopurines - Cytarabine (inhibits DNA polymerase) **Cytotoxic antibiotics: acts by direct action on DNA as intercalators** - Dactinomycin: disrupted RNA polymerase - Doxorubicin: impairs RNA/DNA synthesis Vincristine - Microtubule inhibitors - Disrupts cell division **Steroid hormones:** Prednisolone - supresses lymphocyte growth **Hormone antagonists:** Tamoxifen - oestrogen antagonist Flutamide - testosterone antag Prostap - LH release inhibitors

Answer 43

Salpingitis: Inflammation of fallopian tubes Part of inflammtory pelvic disease Due to bacteria e.g. Chalmydia trachomatis, mycoplasma, coliforms Fever, low abdo pain, pelvic mass if tube distended with exuate Complications: tubo-ovarian abcess (adherence of tube to ovary), damage of tube leading to infertility, tubal ectopic pregnancy

Answer 44

Papillary serous carcinoma BRCA1 mutations

Answer 45

Hard palpable lump Premenopausal Presents as rapidly expanding mass with skin changes

Answer 46

Ill-defined hard mass Assoc with TMD1 \<30 yrs Keloid like stroma

Answer 47

Abscess: neutrophils (soft, tender) Cyst: macrophages (doesn't appear solid on US) Lipoma: mature fat cells (soft to palpate, less mobile than fibroadenoma)

Answer 48

Cell which nucleus is pushed to side due to mucin Lobular carcinoma of breast Gastric adenocarcinoma (diffuse)

Answer 49

DICS that has extended up ducts to kin of nipples Red, scaly rash

Answer 50

That the breast cancer is ER positive (when oestrogen binds to receptor, moves to nucleus) Brown colour is positive Progesterone would look similar

Answer 51

Breast cancer which is Her2+ (Her2 receptor on cell surface) Brown colour is positive

Answer 52

Fx history Pre-menopausal age Mulitple tumours

Answer 53

Colposcopy: Looking at the cervix LETZ Biospy (loop excision of transformation zone)

Answer 54

Tumour size or depth N - spread to regional lymph nodes Metasteses - distant metastasis (most important factor)

Week 4 Female GU and Breast Flashcards

(78 cards)