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Pathology > Breast and Genitourinary > Flashcards

Breast and Genitourinary Flashcards

1
Q 
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
A

Stage IV Renal Cell Carcinoma

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2
Q

• 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

A

Kidney

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3
Q

_______ in
wall of afferent arteriole
– Sensor for blood
pressure

A

Juxtaglomerular cells

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4
Q

______ in wall of
distal convoluted tubule
– Sensor for sodium

A

Macula densa

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5
Q

• 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

A

azotemia

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6
Q 
• 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
A

Uremia

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7
Q

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

A

Renal Diseases

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8
Q 
• 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
A

Nephrotic syndrome

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9
Q 
• 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
A

Nephritic syndrome

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10
Q 
\_\_\_\_\_\_ syndrome
• Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia / hyperlipiduria
A

Nephrotic syndrome

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11
Q 
\_\_\_\_\_\_\_ syndrome
• Hematuria
Oliguria
Azotemia
Hypertension
A

Nephritic syndrome

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12
Q

__________: an immune mediated disease of the renal glomeruli
– Treated with steroids

A

Glomerulonephritis

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13
Q

• ________: an infection of the kidney (not the glomerulus) usually
caused by bacteria and of retrograde origin
– Treated with antibiotics

A

Pyelonephritis

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14
Q

• Acute onset of nephritic syndrome in 9-14 days following Streptococcal
infection
• Type III immune injury (Immune complex-mediated inflammation)

A

Post strep glomerlunephritis

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15
Q

What is the most common pathway of renal infection?

A

Ascending infection

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16
Q

What is the least common pathway of renal infection?

A

Hematogenous dissemination: least

common

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17
Q 
• Common
• May cause obstruction
• Pain
• Ascending infection
• Hematuria
• Pyuria
• Lithotripsy
• May be associated with 
hypercalcemia:
– hyperparathyroidism, 
metastatic skeletal disease, 
multiple myeloma
A

Kidney Stones (Nephrolithiasis) Urolithiasis

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18
Q

• Arises from renal tubular
epithelium
• Often silent
• May grow into renal vein

A

Renal cell carcinoma

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19
Q 
• Nephroblastoma
• Children under 5 years
• Abdominal mass
• Chronic low-grade fever
• Histopathology: resemble abortive 
glomeruli or skeletal muscle
• Better than 90% 5-year survival
A

Wilm’s tumor (Nephroblastoma)

20
Q 
• 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
A

Urothelial Carcinoma

21
Q 
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
A

HHV-2

22
Q

• 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

A

Prostate specific agent

23
Q

• Acute bacterial disease

treated with antibiotics

A

Prostatitis

24
Q 
• 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
A

Adenocarcinoma of prostate

25
Q

• 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

A

Cryptorchidism

26
Q
  • 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
A

Seminoma

27
Q 
Complications of \_\_\_\_\_\_\_:
• Complications rare in the young 
and more common in older 
individuals
• Orchitis, oophoritis, mastitis, 
meningitis, thyroiditis, 
pancreatitis
• Sterility, hearing loss
A

Mumps

28
Q 
• Benign smooth muscle 
neoplasm
• “Fibroids”
• May cause irregular 
bleeding 
(metrorrhagia), painful 
intercourse 
(dyspareunia)
A

Uterine leiomyoma

29
Q 
• 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
A

Endometriosis

30
Q

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

A

Endometrial carcinoma

31
Q 
• Exfoliative cytologic screening for 
early detection (Papanicolau 
smear)
• Squamo-columnar junction
• High risk HPV sub-types: 16, 18
• Vaccination
A

Cervical squamous cell carcinoma

32
Q 
• 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
A

Teratoma

33
Q
  • Neisseria gonorrhea
  • “Mother nature’s birth control”
  • Pelvic inflammatory disease
  • Tubal scarring
  • Ectopic pregnancy
A

Gonorrhea

34
Q 
• Most common benign 
neoplasm of breast
• Discrete, usually solitary, 
moveable nodule
• Young women (third decade)
A

Fibroadenoma

35
Q 
\_\_\_\_\_\_ cancer:
• Lobules
• Ducts
• Lobules - lobular carcinoma
– Lobular carcinoma-in-situ
– Invasive lobular carcinoma
• Ducts - ductal carcinoma
– Ductal carcinoma-in-situ
– Invasive ductal carcinoma
A

Breast cancer

36
Q

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

A

Breast cancer

37
Q

_____ 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

A

Genetic changes

38
Q

• 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

A

Ductal carcinoma in situ

39
Q

• 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%

A

Paget disease

40
Q

• 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

A

Lobular carcinoma in situ

41
Q

• 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

A

Invasive ductal carcinoma

42
Q

• • Stage ____ breast cancer–tumor <2 cm, without nodal involvement, no metastases

A

Stage 1

43
Q

• • Stage ____ breast cancer- tumor <5 cm with <3 nodes and no distant metastases (or more than
5 cm without nodes)

A

Stage 2

44
Q

• • Stage ____ breast cancer –* many categories, any cancer infiltration into skin and chest wall,
with nodes, without disseminated metastases

A

Stage 3

45
Q

• Stage ____ breast cancer –any cancer with disseminated metastases

A

Stage 4

46
Q 
• 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
A

Gynecomastia

Pathology (26 decks)

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