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Pathology > 6. Pathology Of The Male And Female Reproductive Tract And Breast - BP > Flashcards

6. Pathology Of The Male And Female Reproductive Tract And Breast - BP Flashcards

1
Q

What is the microscopic morphology of a seminoma?

A
  1. Large mononuclear cells with clear cytoplasm and fibrous septae with lymphocytes.
  2. Approx. 10-15% of seminomas have giant cells (syncytiotrophoblasts) –> hCG can be detected in the blood.
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2
Q

What is the clinical presentation of a seminoma?

A
  1. Painless testicular mass

2. Approx. 15% have metastasized to local lymph nodes at the time of diagnosis.

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3
Q

What is the prognosis of a seminoma?

A

Excellent, with cute rates close to 100% for stage I and stage II disease.

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4
Q

What is the age range of prostatic adenocarcinoma?

A

Males over 60

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5
Q

What is the location of prostatic adenocarcinoma?

A

Peripheral portion of gland - therefore palpated by digital rectal examination.

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6
Q

Where does prostatic adenocarcinoma metastasizes?

A

It is known for osteoblastic metastases to lumbar spine, proximal femur, and pelvis –> incr. alkaline phosphatase.

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7
Q

What is the genetic basis of prostatic adenocarcinoma?

A

Commonly has hypermethylation of glutathione S-transferase gene promoter (GSTP1) –> on chromosome 11q13.

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8
Q

What is the precursor lesion for prostatic adenocarcinoma?

A

High grade PIN

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9
Q

Describe Gleason grading system for prostatic adenocarcinoma.

A

Final grade is two numbers (e.g. 3+3) representing the dominant (first number) and the subdominant (second number) histologic appearance.

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10
Q

What is the gross morphology of prostatic adenocarcinoma?

A

Yellow discoloration involves the periphery of the gland first.

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11
Q

What is the low power microscopic morphology of prostatic adenocarcinoma?

A

Small glands back-to-back.

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12
Q

What are the symptoms of prostatic adenocarcinoma?

A
  1. Decreased urinary stream
  2. Decr. Urinary frequency
  3. Pain from osteoblastic metastases to lumbar spine.
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13
Q

What is the high power microscopic morphology of prostatic adenocarcinoma?

A
  1. Single cell layer (no basal cell layer as found in the normal prostate).
  2. Prominent nucleoli
  3. Crystals
  4. Blue mucin
  5. Known for perineural invasion
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14
Q

How is the diagnosis of prostatic adenocarcinoma made?

A

By physical examination plus prostatic biopsy.

Elevated PSA can help screen for, diagnose, and monitor prostatic adenocarcinoma.

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15
Q

What is the mutation involved in endometrial hyperplasia?

A

PTEN (phosphatase and tensin homologue).

Without PTEN, endometrial cells are more sensitive to estrogen stimulation.

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16
Q

What are the microscopic patterns in endometrial hyperplasia?

A
  1. Simple
  2. Complex
  3. Complex with atypia
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17
Q

What is the morphology in simple endometrial hyperplasia?

A

Cystic hyperplasia - very rare to progress to carcinoma.

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18
Q

What is the morphology of complex hyperplasia?

A

Crowded, back-to-back glands (>50% of tissue is glands)

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19
Q

What is the morphology of complex endometrial hypeplasia with atypia?

A

Crowded glands with nuclear pleomorphism and mitotic figures.
Difficult to separate from invasive endocarcinoma.

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20
Q

What are the symptoms of endometrial hyperplasia?

A

Vaginal bleeding, especially in a post menopausal woman.

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21
Q

What are the signs of endometrial hyperplasia?

A

Widened endometrial stripe on transvaginal ultrasound and endometrial or atypical glandular cells on PAP smear.

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22
Q

What is the MC endometrial carcinoma?

A

Endometrial adenocarcinoma

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23
Q

What is the age range of endometrial adenocarcinoma?

A

About 55 or older.

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24
Q

Mention an uncommon cause of endometrial hyperplasia/adenocarcinoma.

A

Granulosa cell tumors because they secrete estrogen.

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25
Q

What is the incidence of serous ovarian tumors?

A

MC type (30% of all ovarian tumors).
60% benign
15% borderline
25% malignant

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26
Q

What is important to keep in mind about serous ovarian tumors?

A

More likely to be unilocular, malignant, and bilateral.

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27
Q

What is the microscopic morphology of serous tumors?

A
  1. Lined by Fallopian tube-like epithelium - can have psammoma bodies.
  2. Incr. Solid areas, papillary projections and friable tissue within the tumor increase chance that a malignant component is present.
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28
Q

What is the incidence of mucinous ovarian tumors?

A

Represents 25% of all ovarian tumors.
80% are benign.
10 are malignant.

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29
Q

What is important to keep in mind about mucinous ovarian tumors?

A

More likely to be multilocular, benign, and unilateral.

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30
Q

What is pseudomyxoma peritonei?

A

An associated condition where patients have mucinous ascites, adhesions, and cystic peritoneal implants.
Can cause obstruction and death.

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31
Q

What is important to know about Brenner tumors?

A

Are almost always benign.

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32
Q

What is the microscopic morphology of Brenner tumor?

A

Fibrous stroma + clusters of transitional cell-like epithelium.

33
Q

What is the incidence of endometrioid tumor?

A

Represents 20% of all ovarian carcinomas.

34
Q

What is the microscopic morphology of endometrioid tumor?

A

Similar to endometrial adenocarcinoma.

35
Q

What is the struma ovarii?

A

Monodermal teratoma composed entirely of thyroid epithelium.

Can lead to hyperthyroidism.

36
Q

What is important to remember about granulosa cell tumor?

A

Most are benign.
However, 5-25% are malignant, not absolutely predicted by the histology, requires the presence of invasion and/or metastases to confirm diagnosis.

37
Q

What is the microscopy morphology granulosa cell tumor?

A

Have Call-Exner bodies (similar to ovarian follicle) + produce inhibin, which can be identified in serum and by immunohistochemistry.

38
Q

Give a basic description of a Krukenberg tumor.

A

Bilateral metastatic ovarian tumor composed of signet ring cells, usually from gastric carcinoma.

39
Q

Give a basic description of acute mastitis.

A

Bacterial infection of the breast occurring during lactation.

40
Q

What are the two forms of fibrocystic change?

A

Proliferative and non proliferative.

41
Q

What happens in non proliferative fibrocystic change?

A

No epithelial hyperplasia in ducts; no incr. risk for breast cancer.

42
Q

What happens in proliferative form of fibrocystic change?

A

Some ducts have epithelial hyperplasia. If the amount of hyperplasia is moderate to severe, patients have incr. risk for breast cancer.

43
Q

What is the morphology of fibrocystic change?

A
  1. Cysts and fibrosis

2. Proliferative version –> epithelial hyperplasia within ducts.

44
Q

What is the clinical presentation of fibrocystic change?

A

Pain that may be exacerbated by menstruation and chocolate or caffeine consumption; lumpy, irregular, breast texture, tenderness to palpation.
Classic blue domed cysts are seen at surgery.

45
Q

What is the importance of sclerosing adenosis?

A

Slightly incr. risk of breast cancer.

46
Q

What is the microscopic morphology of sclerosing adenosis?

A

Sclerosing (fibrosis) and duct proliferation (adenosis).

47
Q

What is the epidemiology of fibroadenoma?

A

Females <25

48
Q

Give a basic description of phyllodes tumor.

A

Similar to fibroadenoma, a stromal and glandular proliferation but with the stromal proliferation predominating, producing a leafy architecture.

49
Q

What is important to remember about phyllodes tumor?

A

Requires wide local excision or it can recur.

50
Q

What is the microscopic morphology of phyllodes tumor?

A

Leaf-like proliferation of glands with prominent stromal proliferation.

51
Q

What is important to keep in mind about intraductal papilloma?

A
  1. Produce bloody nipple discharge as a result of sloughing or necrotic tissue.
  2. Can produce non bloody discharge as a result of intermittent obstruction of duct.
  3. Occasionally malignant.
52
Q

What are the two types of CIN of the breast?

A
  1. Ductal

2. Lobular

53
Q

Is ductal carcinoma in situ detected as density on mammogram?

A

No. (Only if associated with clustered, or linear and branching calcification)

54
Q

How higher is the risk of breast carcinoma in patients with DCIS?

A

8-10 times.

55
Q

What is the microscopic morphology of DCIS?

A

Proliferation of cells within the duct. The collection of cells produce punched-out lumens (opposed to slit-like lumens in hyperplasia) + cells obey each other’s borders (opposed on hyperplasia).

56
Q

What is the microscopic morphology of high grade DCIS?

A

Comedo (has central necrosis)

57
Q

What condition is associated with DCIS?

A

Paget disease of the nipple.

58
Q

What is the gross morphology of Paget disease of the nipple?

A

Erythematous eruption with scaling crust.

59
Q

What is the microscopic morphology of Paget disease of the nipple?

A

Neoplastic cells in the epidermis.

60
Q

What is important to remember about Paget disease of the nipple?

A

Always associated with underlying DCIS which extends to the epidermis through the lactiferous ducts.

61
Q

What is the epidemiology of breast carcinoma?

A

Uncommon in females <30 years of age.
Rises towards menopause.
1% in men.

62
Q

Mention some risk factors for breast carcinoma.

A
  1. Age (70%)
  2. Family history
  3. Incr. Exposure to estrogen
  4. Inherited mutations (for <10%)
    BRCA1 (17q21.3)
    BRCA2 (13q12-13)
63
Q

Mention some major prognostic factors for breast carcinoma.

A

Invasive versus in situ –> 50% of invasive carcinom have metastases at diagnosis.
Distant metastases or lymph node metastases are poor prognostic factors.

64
Q

Discuss the prognosis of breast carcinoma in correlation with size of breast tumor.

A
  1. Node-negative patient with a 2cm tumor –> over 50% of patients will have lymph node metastases.
65
Q

Give a basic description of inflammatory breast carcinoma.

A

Not a specific type of breast carcinoma, but instead a term applied to a specific gross appearance of the breast due to certain microscopic findings.

66
Q

What is the gross morphology of inflammatory carcinoma?

A

Swollen, erythematous breast with thickening of skin and dimpling around hair follicles (peau d’orange).

67
Q

What is the microscopic morphology of inflammatory carcinoma?

A

Infiltration of subepidermal lymphatic ducts with neoplastic cells.

68
Q

What is important to remember about inflammatory breast carcinoma?

A

Has a 3-year survival rate of 3-10%.

69
Q

Mention some minor prognostic factors for breast carcinoma.

A
  1. Histologic type
  2. Histologic grade
  3. ER and PR positivity
  4. Her-2-Neu
  5. Lymphovascular invasion
  6. Proliferative rate
  7. DNA content
70
Q

What indicates a good prognosis for breast carcinoma?

A
  1. Size <2cm
  2. ER and PR positivity
  3. Her-2-Neu negativity
  4. Negative lymph nodes
71
Q

What indicates a poor prognosis in breast carcinoma?

A
  1. Size >2cm or >5cm.
  2. ER and PR negativity
  3. Her-2-Neu positivity
  4. Aneuploidy
  5. High proliferative rate
72
Q

What is the Her-2-Neu?

A

A proto oncogene expressed in >30% of breast cancers - an EGFR.

73
Q

What are the main types of breast carcinoma?

A
  1. Invasive ductal carcinoma
  2. Invasive lobular carcinoma
  3. Additional types –> colloid, medullary, and tubular. (Better prognosis)
74
Q

What is the microscopic morphology of invasive ductal breast carcinoma?

A

Ranges from neoplastic glands to sheets of neoplastic cells.

75
Q

What is the microscopic morphology of invasive lobular breast carcinoma?

A

Neoplastic cells occur in single-file. Can surround non-neoplastic glands (targetoid lesions).

76
Q

What is the microscopic morphology of medullary breast carcinoma?

A

Well circumscribed border; sheets of anaplastic cells associated with lymphocytic infiltrate.

77
Q

What is the microscopic morphology of colloid breast carcinoma?

A

Produce abundant mucin.

78
Q

What are the mutations found in breast carcinoma?

A

Deletion of 16q22.1 - cell adhesion molecules such as e-Cadherin and β-catenin.

79
Q

What are the locations of breast carcinoma metastases?

A
  1. To peritoneum
  2. Retroperitoneum
  3. Meninges
  4. GI
  5. Ovaries

Pathology (16 decks)

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