Breast and Genitourinary Flashcards
7 cm mass at superior pole of right kidney Metastases: • Retroperitoneal lymph node conglomerate 12 cm • Bilateral adrenal glands • T12 vertebral body • Right 12th rib • Pleura
Stage IV Renal Cell Carcinoma
• Structurally complex - 0.4% of body weight, but filters 25% of blood through glomeruli
• Excretes nitrogenous waste products of metabolism - cleans the blood –turns 1.5 L
into urine
• Regulates body water and electrolytes
• Maintains appropriate acid-base balance
• Endocrine organ –secretes hormones
– Renin: blood pressure
– Erythropoietin –proliferative effect on bone marrow to make RBCs
Kidney
_______ in
wall of afferent arteriole
– Sensor for blood
pressure
Juxtaglomerular cells
______ in wall of
distal convoluted tubule
– Sensor for sodium
Macula densa
• Elevation of blood urea nitrogen and creatinine levels
• Usually related to reduced glomerular filtration rate (GFR)
• Associated with many primary renal disorders
• May also be associated with extra-renal disorders
– Pre-renal: hypoperfusion of the kidneys decreases GFR in
the absence of parenchymal damage
– Post-renal: urine flow obstructed below the level of the
kidney
azotemia
• Progression of azotemia to produce clinical manifestations and systemic biochemical abnormalities • Failure of renal excretory function • Metabolic and endocrine alterations • Secondary involvement of organ systems – Uremic gastroenteritis – Peripheral neuropathy – Uremic fibrinous pericarditis – Uremic stomatitis
Uremia
Clinical Manifestations of __________
• Nephrotic syndrome (glomerular syndrome): heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria
• Nephritic syndrome (glomerular syndrome): acute onset of grossly-visible
hematuria, mild-to-moderate proteinuria, azotemia, edema and hypertension
(classic presentation - acute post-streptococcal glomerulonephritis)
• Acute renal failure: May result from glomerular injury or acute tubular necrosis
• Chronic renal failure: prolonged symptoms and signs of uremia. the end result of
all renal disease
• Urinary tract infections: bacteriuria and pyuria. symptomatic or asymptomatic.
kidney (pyelonephritis) or bladder (cystitis)
• Nephrolithiasis: kidney stones - colic, hematuria
• Urinary tract obstruction
• Renal tumors
Renal Diseases
• Glomerular syndrome – non-specific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine – Heavy proteinuria – Hypoalbuminemia – Severe edema – Hyperlipidemia – Lipiduria
Nephrotic syndrome
• Glomerular syndrome • A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the blood into the urine. • Acute onset • Grossly-visible hematuria • Mild-to-moderate proteinuria • Azotemia • Edema • Hypertension
Nephritic syndrome
\_\_\_\_\_\_ syndrome • Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia / hyperlipiduria
Nephrotic syndrome
\_\_\_\_\_\_\_ syndrome • Hematuria Oliguria Azotemia Hypertension
Nephritic syndrome
__________: an immune mediated disease of the renal glomeruli
– Treated with steroids
Glomerulonephritis
• ________: an infection of the kidney (not the glomerulus) usually
caused by bacteria and of retrograde origin
– Treated with antibiotics
Pyelonephritis
• Acute onset of nephritic syndrome in 9-14 days following Streptococcal
infection
• Type III immune injury (Immune complex-mediated inflammation)
Post strep glomerlunephritis
What is the most common pathway of renal infection?
Ascending infection
What is the least common pathway of renal infection?
Hematogenous dissemination: least
common
• Common • May cause obstruction • Pain • Ascending infection • Hematuria • Pyuria • Lithotripsy • May be associated with hypercalcemia: – hyperparathyroidism, metastatic skeletal disease, multiple myeloma
Kidney Stones (Nephrolithiasis) Urolithiasis
• Arises from renal tubular
epithelium
• Often silent
• May grow into renal vein
Renal cell carcinoma
• Nephroblastoma • Children under 5 years • Abdominal mass • Chronic low-grade fever • Histopathology: resemble abortive glomeruli or skeletal muscle • Better than 90% 5-year survival
Wilm’s tumor (Nephroblastoma)
• Arises from the urinary tract lining epithelium (transitional epithelium) • Bladder most common site • Painless hematuria • Cigarette smoking, industrial solvents (beta-naphthlylamine), chronic cystitis, schistosomiasis, drugs (cyclophosphamide) • Clinical significance depends on histologic grade, differentiation and depth of invasion
Urothelial Carcinoma
Condyloma • Venereal wart - sexually- transmitted disease • Multiple, clustered lesions common • Sessile, pink exophytic mass, larger than squamous papilloma • HPV sub-types 6 and 11 Herpes Simplex Type 2 • Multiple coalescing vesicles and ulcers • Genital region
HHV-2
• Protein present in the serum at low levels (nl: < 4 ng/mL)
• Physiologic functions
– Liquefy semen, allowing sperm to swim freely
– Dissolution of cervical mucous cap
• Increased levels may suggest the presence of prostate cancer
• Elevated in prostatitis
• Velocity of change significant
Prostate specific agent
• Acute bacterial disease
treated with antibiotics
Prostatitis
• 70% of men develop prostate cancer by 70-80 years of age • Digital prostate examination • Biopsy –multiple cores • Wide variation in clinical behavior • Gleason grading
Adenocarcinoma of prostate
• Absence of one or both testes in the scrotum
• Failure of testis to descend from an abdominal position through the
inguinal canal into the scrotum (“undescended” testes)
• Infertility
• Increased risk for neoplasia
• Orchiopexy: surgical correction
Cryptorchidism
- Most common germ cell tumor of testis
- Young adults (15-34 years)
- Surgery plus radiation therapy and chemotherapy
- One of the most treatable and curable cancers
- Over 95% long-term survival in early stages
Seminoma
Complications of \_\_\_\_\_\_\_: • Complications rare in the young and more common in older individuals • Orchitis, oophoritis, mastitis, meningitis, thyroiditis, pancreatitis • Sterility, hearing loss
Mumps
• Benign smooth muscle neoplasm • “Fibroids” • May cause irregular bleeding (metrorrhagia), painful intercourse (dyspareunia)
Uterine leiomyoma
• Endometrial tissue outside the uterine cavity • Ectopic endometrial tissue influenced by hormonal changes • Recurring pelvic pain • Symptoms depend on the site involved and worsen with the menstrual cycle
Endometriosis
Risk factors for _______:
• Age –most common in the 55 to 65 age group
• Obesity –greater synthesis of estrogen in body fat
• Infertility –women who are nulliparous are at increased risk
of endometrial carcinoma
Endometrial carcinoma
• Exfoliative cytologic screening for early detection (Papanicolau smear) • Squamo-columnar junction • High risk HPV sub-types: 16, 18 • Vaccination
Cervical squamous cell carcinoma
• A tumor containing tissues from all three germ layers • Most tumors are derived from one cell layer –ectoderm, endoderm, mesoderm • Generally arise in gonadal tissues • Most commonly seen in the ovary • “Dermoid cyst” of the ovary –a benign cystic teratoma –may contain a variety of tissues including hair, teeth, bone, cartilage, thyroid, etc
Teratoma
- Neisseria gonorrhea
- “Mother nature’s birth control”
- Pelvic inflammatory disease
- Tubal scarring
- Ectopic pregnancy
Gonorrhea
• Most common benign neoplasm of breast • Discrete, usually solitary, moveable nodule • Young women (third decade)
Fibroadenoma
\_\_\_\_\_\_ cancer: • Lobules • Ducts • Lobules - lobular carcinoma – Lobular carcinoma-in-situ – Invasive lobular carcinoma • Ducts - ductal carcinoma – Ductal carcinoma-in-situ – Invasive ductal carcinoma
Breast cancer
Risk factors in _______:
Well-established risk factors
– Age: uncommon < 30 y
– Genetics and family history - p53, BRCA1/2 genes
– Menstrual history –early menarche (<12y), late menopause (>55y)
– Length of reproductive life
– No children: having children is protective
– Geographic variation
Other risk factors
– Exogenous estrogens –postmenopausal hormone replacement therapy
– Oral contraceptives –newer formulations of balanced, low doses of estrogen and
progestin safe
– Ionizing radiation during breast development
• Less well-established risk factors
– Alcohol consumption
– High fat diet
– Obesity
– Cigarette smoking
Breast cancer
_____ changes in breast cancer
• Familial syndromes
– Li-Fraumeni Syndrome –germ-line mutations in p53
– Cowden Syndrome –germ-line mutations in PTEN
– Ataxia-telangiectasia gene –DNA repair genes
– BRCA1/BRCA2 –germ-line mutations• HER2/NEU proto-oncogene
– Epidermal growth factor receptor
– Amplified in 30% of breast cancers
– Overexpression associated with poor prognosis
– Therapeutic intervention –Herceptin (trastuzumab)
• Amplification of RAS and MYC (proto-oncogenes)
• Mutations of Rb and p53 (tumor suppressor genes)
• Estrogen receptor positivity
– Therapeutic intervention - Tamoxifen
• Progesterone receptor positivity
Genetic changes
• Precursor lesion to invasive carcinoma
• When invasive carcinoma develops in a woman with a previous diagnosis of
DCIS, it is usually in the same breast.
• Treatment –surgery and radiation
• Tamoxifen –antiestrogenic if estrogen receptor + (blocks estrogen receptor)
• Aromatase inhibitors –post-menopausal women (blocks estrogen formation)
• Good long-term prognosis
Ductal carcinoma in situ
• Clinical variant of DCIS
• Extension of DCIS up to the lactiferous ducts and into
the contiguous skin of the nipple
• Crusting exudate over the nipple and areolar skin
• Underlying invasive carcinoma in 50%
Paget disease
• One-third of women with LCIS develop invasive carcinoma
• The invasive carcinoma may arise in either breast
• is a marker of increased risk for developing breast cancer
in either breast
• Bilateral prophylactic mastectomy may be performed
Lobular carcinoma in situ
• Most breast carcinomas (70-80%)
• Term used for all carcinomas that cannot be sub-classified into a specific
type (not discussed)
• Does not imply that the tumor specifically arises from the duct system
• Carcinoma of “no special type” or “not otherwise specified” (NOS) are
synonyms for invasive ductal carcinoma
Invasive ductal carcinoma
• • Stage ____ breast cancer–tumor <2 cm, without nodal involvement, no metastases
Stage 1
• • Stage ____ breast cancer- tumor <5 cm with <3 nodes and no distant metastases (or more than
5 cm without nodes)
Stage 2
• • Stage ____ breast cancer –* many categories, any cancer infiltration into skin and chest wall,
with nodes, without disseminated metastases
Stage 3
• Stage ____ breast cancer –any cancer with disseminated metastases
Stage 4
• Enlargement of male breast may occur in response to estrogen • Hyperestrinism in male – Cirrhosis of liver –inability to metabolize estrogens – Klinefelter syndrome – Estrogen-secreting tumors – Estrogen therapy • Bilateral –rule-out hormonal • Unilateral –rule out tumor
Gynecomastia
