B Flashcards
RCC
para neoplastic syndromes
Rare complication in males
Triad of symptoms
Difference between hereditary and sporadic types
B. Presents with classic triad of hematuria, palpable mass, and flank pain
1. All three symptoms rarcly occur together; hematuria is the most common
Paraneopplastictic syndrome (eg., EPO.Inc renin (HTN, inc ACTH (Cush
Inc PTHrp
3. Rarely may present with left-sided varicocele
Involvement of the left renal vein by carcinoma blocks drainage ofthe left spermatic vein leading to varicocele.
in. Right spermatic vein drains directly into the IC; hence, right-sided
varicoccle is not seen.
E. Tumors may be hereditary or sporadic.
both
1. Sporadic tumors classically arise in adult males (average age is 60 years) as a single tumor in the upper pole ofthe kidney; major risk factor for sporadic tumors is cigarette smoke!
2. Hereditary tumors arise in younger adults and are often bilateral,
i. Von Hippel-Lindau disease is an autosomal dominant disorder associated with inactivation of the VHL gene leading to increased risk tor hemangioblastoma of the cerebellum and renal cell carcinoma.
F. Staging
1, T based on size and involvement ofthe renal vein (oceurs commonly and increases risk of hematogenous spread to the lungs and bone)
Wilms tumor
Unilateral or bilateral
Symptoms
Associated with what condition a
III. WILMS TUMOR
A. Malignant kidney tumor comprised ofblastema (immature kidney mesenchyme)
primitive glomeruli and tubules, and stromal cells (Fig. 12.20J 1, Most common malignant renal tumor in children; average age is 3 years,
B. Presents as a large, unilateral flank mass with hematuria and hypertension (due t renin secretion)
C.
Associated with WTI mutation, especially in syndromic cases
V. WAGR syndrome- -Wilms tumor, Amiridia, Genital abnormalities, and ment and motor Retardation
2. Beckwith-Wiedemann syndrome- Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, and organomegaly (including tongue)
Urothelial carcinoma
What are the 2 types
Risk factors
Commonly affects wat organ
A. Malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra
I. Most common type of lower urinary tract cancer; usually arises in the bladder
B. Major risk factor is cigarette smoke: additional risk factors are naphthaylamine (found in cigarettes) .
, axodyes and long-term cyclophosphamide or phenacetin use.
C. Generally seen in older adults; classically presents with painless hematuria
D. Arises via two distinct pathways (Fig. 12.21)
I. Flat develops as a high-grade flat tumor and then invades; associated with early sta
p53 mutations
2,
Papillary develops as a low-grade papillary tumor that progresses to a high-grade papillary tumor and then invades; not associated with carly p53 mutations
Entire urothelial surface is mulated
E. Tumors are often multifocal and recur (“field detect”).
Squamous cell cancer of lower urinary tract
Risk factors
SQUAMOUS CELL CARCINOMA
A. Malignant proliferation ofsquamous cells, usually involving the bladder
B. Arises in a background ofsquamous metaplasia (normal bladder surface is not lined by squamous epithelium)
C. Risk factors include chronic cystitis (older woman). Schistosoma hematobium infection (Egyptian male), and long-standing nephrolithiasis.
Causes of. Adenocarcinoma of lower urinary tract
III. ADENOCARCINOMA
A. Malignant proliferation of glands, usually involving bladder
R, Arises from a urachal remnant (tumor develops at the dome ol the bladder), cystitis glandularis, or exstrophy (congenital failure to form the caudal portion ofthe anterior abdominal and bladder walls)
Bladder exposed to the outside environment
Which kidney stone is the only one that’s radiolucent( unable to be seen on X-ray )
Uric acid
The 2 types of vulvar cancer
HPV —>VIN dysplasia to squamous 40-50 got it in 20s so takes 10 years to become HPV caused squamous
or non HPV from lichen sclerosis in
70 y.o
Complications of DES in mom and female fetus
Des moms - if risk of breast cancer Since exposed to estrogen like compound
DES female baby - adenosis, clear cell adenocarcinoma, and miscarriages/infertility bc of uterine abnormalities
A. Focal persistence of columnar epithelium in the upper 1/3 ofthe vagina
I. During development, squamous epithelium from the lower 1/3 of the vagina (derived from the urogenital sinus) grows upward to replace the columnasr epithelium lining of the upper 2/3 ofthe vagina (derived from the Millerinans ducts)
Adenoma can lead to clear cell adenocarcinoma
Differentiate melanoma of vulva to extramamillary pager disease
.
D. Must be distinguished from melanoma, which rarely can occur on the vulva
Pas- stains mucus hence carcinoma
L,
Paget cells are PASt, keratint, and $100-.
2. Melanoma is PAS-, keratin-, and $100+.
Cervical cancer
What are the 2 types
Symptoms
Risk factor
Causes of death
Sq carcinoma or adeno both caused by
HPV
Presents as vaginal bleeding, especially postcoital bleeding, or cervical discharge
D. Key risk factor is high-risk HPV infection; secondary risk factors include smoking and immunodeficiency (e.g., cervical carcinoma is an AIDS-defining illness).
E. Most common subtypes of cervical carcinoma are squamous cell carcinoma (80% of cases) and adenocarcinoma (15% of cases). Both types are related to HPV infection.
Advanced tumors often invade through the anterior uterine wall into the bladder, blocking the ureters. Hydronephrosis with postrenal failure is a common cause of death in advanced cervical carcinoma.
Pathophysiology of Asherman
Basalis is the regenerative layer of endometrium when functionale layer is sloughed off during the menses
-basilica is stem cells
Aggressive d&c causes loss of basalis
Chronic endometritis
Causes
Interesting lab
Symptoms
B. Characterized by lymphocytes and plasma cells
Plasma cells are necessary for the diagnosis ofchronic endometritis given that lymphocytes are normally found in the endometrium.
C. Causes include retained products oficonception, chronic pelvic inflammatory discase (e.g. Chlamydia). IUD, and Tb)
D, Presents as abnormal uterine bleeding, pain, and infertility
Endometrial polyp can arise as a side effect of which medication
TAMOXIFEN
Endometriosis
Explain location of specific symptoms
Most commonly affected organ
Complication
Most common site of involvement is the ovary, which classically results in formation o fa ‘chocolate cyst
).
1. Other sites of involvement include the uterine ligaments (pelvic pain), pouch of Douglas (pain with defecation), bladder wall (pain with urination), bowel serosa (abdominal pain and adhosions), and fallopian tube mucosa (scarring increases risk for ectopic tubal pregnancy): implants classically appear as yellow-brown
“gun-powder’ nodules
There is an increased risk of carcinoma at the site of endometriosis, especially in the ovaries
Types of endometrial cancer
-hyperplasia (endometriod) cancer looks like normal endometrium: 50-60s
-sporadic- cancer from atrophic endometrium (serous histology with papillary strucfures). 70s, p53 mutation, finger like growths can necroses causing calcification afterwards/ps.ammommma bodies
Pcos
Pathophysiology
At risk of what cancer
Inc LH stimulates theca cell which produces androgens. Peripheral adipose cells converts androgens to estrone. Estrone inhibits GNRH and LH therefore degeneration of follicle to cyst.
Endometrial cancer
Surface epithelial ovarian tumors
What mutation is associated with it
Symptoms
Benign cystadenoma (mucus or serous
30-40
Malignant cyst adenocarcinoma mucus or serous
70s
Endometriod like endometriod endometrial cancer
Brenner tumors ( benign, bladder like epithelium
Brca1 ovarian and fallopian serious carcinoma
Sxs.
F. Surface tumors clinically present late with vague abdominal symptoms (pain and fullness) or signs oficompression (urinary frequency).
Germ cell tumor
Tetatoma -includes struma ovarii (hyperthyroidism) usually benign
Dysgerminona (LDH)
Endosermal sinus (mimics yolk sac so inc afp
Schiller duval bodies which is glomerular like
Choriocarcinoma - mimics trophoblasts of placenta so it acts like the placenta and seems blood (hematogenous spread) betahcg; May lead to thecAl cysts in ovary
Embryonal
Sex cord stromal tumors
B. Granulosa-theca cell tumor
1. Neoplastic proliferation of granulosa and theca cells
2. Often produces estrogen: presents with signs of estrogen excess
Prior to puberty precocious puberty
Reproductive age-menorrhagia or metrorchagia
lPostmenopause (most common setting of granulosa-theca cell tumors) endometrial hyperplasia with postmenopausal uterine bleeding
3. Malignant, but minimal risk for metastasis
C. Sertoli-L,eydigcell tumor
characteristic Reinke crystals
се
• 2. May produce androgen; associated with hirsutism and virilization
with
D. Fibroma
1, Benign tumor of fibroblasts (Fig. 13.16)
- Associated with pleural effusions and ascites (Meigs syndrome): syndrome resolves with removal oftumor.
What does the high blood pressure in preeclampsia result in
Fibrinoid necrosis of the placenta vessel
