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Pathology > Endo & Repro pathology > Flashcards

Endo & Repro pathology Flashcards

1
Q

Lichen sclerosis

A

Thinning of the epidermis and fibrosis of the dermis

Presents as leukoplakia with parchment-like vulvar skin

Post-menopausal women

Increased risk for SCC (unlike lichen simplex chronicus

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2
Q

Lichen simplex chronicus

A

Hyperplasia of the vulvar squamous epithelium

Presents as leukoplakia with thick, leathery vulvar skin

Associated with chronic irritation and scratching

No increased risk of SCC (unlike lichen sclerosis)

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3
Q

Extramammary paget disease

A

Malignant epithelial cells in the epidermis of the vulva

Presents as erythematous pruiritic ulcerated vulvar skin

Carcinoma in situ, WITHOUT underlying carcinoma (unlike Paget disease of the nipple that is almost always associated with underlying carcinoma)

Paget cells are PAS+ (mucus), keratin+ (intermediate filament in epithelial cells), and S100- (marker of melanoma) vs melanoma which is PAS-, keratin-, S100+

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4
Q

Effects of diethylstilbestrol (DES)

A

DES is an estrogen-like compound that was used to treat pregnancy-related complications.

In female infants, it caused adenosis (persistence of columnar epithelium in upper vagina), clear cell adenocarcinoma, and abnormal shaped uteri and fallopian tubes

In mothers, it increased risk of breast carcinoma

No effect on male infants

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5
Q

Tumors with psammoma bodies

A
  • Papillary carcinoma of the thyroid
  • Meningioma
  • Serous endometrial carcinoma
  • Mesothelioma
  • Serous cystadenocarcinoma (BRCA1)
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6
Q

Treatment of endometritis

A

Gentamicin + clindamycin +/- ampicillin

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7
Q

Brenner tumor

A

Benign ovarian tumor with bladder-like surface epithelium

Coffee-bean nuclei on H&E

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8
Q

Meigs syndrome

A

Triad of ovarian fibroma, ascites, and pleural effusion

Pulling sensation in the groin

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9
Q

Serous cystadenocarcinoma

A

Most common ovarian neoplasm. Frequently bilateral

Most commonly arises in postemenopausal women (cystadenomas are more common in premenopausal women)

BRCA1 mutation increases risk of serous carcinoma of the ovary and fallopian tube

Characterized by psammoma bodies

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10
Q

Pseudomyxoma peritonei

A

Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

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11
Q

Mature cystic teratoma (dermoid cyst)

A

Germ cell tumor that contains elements from all 3 germ layers; most common ovarian tumor in women 20-30 years old

Benign in women and children, malignant in men

Presents secondary to pain secondary to ovarian enlargement or torsion

hCG or AFP may be elevated

Struma ovarii - dermoid cyst that contains functional thyroid tissue

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12
Q

Immature teratoma

A

Malignant ovarian tumor; more aggressive than benign mature cystic teratoma (dermoid cyst)

Presence of immature tissue (fetal tissue, neuroectoderm) and somatic malignancy (SCC of skin) indicate malignant potential

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13
Q

Dysgerminoma

A

Most common malignant germ cell tumor

Composed of large cells with clear cytoplasm and central nuclei (resemble oocytes)

Equivalent to seminomas in males

Elevated LDH

Good prognosis, responds to radiotherapy

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14
Q

Yolk sac (endodermal sinus) tumor

A

Aggressive malignant ovarian/testicular neoplasm

Common in children (ovaries, testes, sacrococcygeal area)

Elevated AFP

Shiller-Duval bodies (glomerulus-like structures) characteristic

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15
Q

Choriocarcinoma

A

Malignant ovarian/testicular carcinoma consisting of cytotrophoblasts and syncytiotrophoblasts

Villi are ABSENT

Hemorrhagic tumor with early hematogenous spread to lungs (hemoptysis)

High beta-hCG (may lead to theca-lutein cysts, hyperthryoidism, gynecomastia)

Good response to chemo when it arises from gestational pathway (spontaneous abortion, normal pregnancy, hydratidiform mole); poor response to chemo when it arises from a spontaneous germ cell pathway

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16
Q

Krukenberg tumor

A

Metastatic mucinous signet cell adenocarcinonma that most commonly arises from diffuse subtype of gastric carcinoma

Differentiated from primary mucinous ovarian tumors by bilaterality of Krukenberg tumor

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17
Q

Preeclampsia

A

Usually arises in third trimester

Characterized by fibrinoid necrosis in vessels of placenta

HELLP - preeclampsia with thrombotic microangiopathy; characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets

Tx of HTN in pregnancy: alpha-methyldopa, labetolol, hydralazine, nifedipine

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18
Q

Kallman syndrome

A

Form of hypogonadotropic hypogonadism caused by defective migration of GnRH cells and defective formation of olfactory bulb

Results in decreased synthesis of GnRH and anosomia

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19
Q

Lymphogranuloma venereum

A

Necrotizing granulomatous inflammation of the inguinal lymphatics and LNs caused by Chalmydia (serotypes L1-L3)

Heals with fibrosis

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20
Q

Serotypes of Chlamydia trachomatis

A
  • A - C — cause trachoma: infection of the eyes, which can lead to blindness
  • D - K — cause urethritis, PID, ectopic pregnancy, neonatal pneumonia, and neonatal conjunctivitis
  • L1 - L3 — lymphogranuloma venereum
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21
Q

Bowen disease

A

In situ SCC of the penile shaft or scrotum

Presents as leukoplakia

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22
Q

Erythroplasia of Queyrat

A

In situ SCC of the glans fo the penis

Presents as erythroplakia

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23
Q

Bowenoid papulosis

A

In situ SCC that presents as multiple reddish penile papules

Unlike Bowen disease and Erythroplakia of Querat, it does not progress to invasive carcinoma

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24
Q

Orchitis

A

Inflammation of the testicle

Causes:

  • Chlamydia (types D-K), N. gonorrhea - young adults; also cause prostatitis
  • E. coli, Pseudomonas - older adults post-UTI; also causes prostatitis
  • Mumps virus
  • Autoimmune orchitis - granulomas involving seminiferous tubules
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25
Q

Risk factors for testicular germ cell tumors

A
  • Cryptorchidism
  • Klinefelter syndrome
26
Q

Seminoma

A

Most common testicular tumor; resembles dysgerminoma

Large cells with clear cytoplasm and central nuclei (“fried egg” appearance) that forms a homogenous mass without hemorrhage or necrosis

Increased placental ALP, rarely may produce beta-hCG

Responds well to chemo

27
Q

Embryonal carcinoma

A

Non-seminomatous testicular germ cell tumor

Painful hemorrhagic mass with necrosis. Immature primitive cells that may produce glands.

Aggressive with early hematongeous spread

Chemo may induce differentiation into another type of germ cell tumor (e.g. teratoma)

Increased beta-hCG or AFP may be seen

28
Q

Leydig cell tumor

A

Benign sex cord-stromal tumor of the testicle

Produce androgen, causing precocious puberty in children or gynecomastia in adults

Characteristic Reinke crystals on histology

29
Q

Sertoli cell tumor

A

Benign sex cord-stromal tumor of the testicle

Comprised of tubules, clinically silent

30
Q

Most common testicular mass in males > 60 years old

A

Lymphoma (diffuse large B-cell type), often bilaterally

31
Q

Treatment of prolactinoma

A

Dopamine agonists (bromocriptine, cabergoline)

32
Q

Treatment of GH-producing adenoma

A
  • Octreotide (somatostatin analog)
  • Pegvisomant (GH receptor antagonist)
33
Q

Nephrogenic diabetes insipidus (DI)

A

Collecting ducts respond poorly to ADH

Etiology: ADH receptor mutation, secondary to hypercalcemia, lithium, demeclocycline (ADH antagonist)

Findings: normal serum ADH, hyperosmotic volume contraction

No change in urine osmolarity after DDAVP (unlike central DI)

Tx: HCTZ, indomethacin, amiloride

34
Q

Symptoms of hyperthryoidism

A
  • Weight loss, heat intolerance, tachycardia
  • Arrhythmia (A-fib)
  • Staring gaze with lid lag
  • Diarrhea with malabsorption
  • Oligomenorrhea
  • Bone resorption with hypercalcemia
  • Hypocholesterolemia (increased LDL receptors)
  • Hyperglcyemia
35
Q

Symptoms of hypothyroidism

A
  • Cretinism (MR, short stature, enlarged tongue, umbilical hernia)
  • Myxedema (GAGs accumulate in skin and soft tissue due to increased TSH; result in deepening voice and large tongue)
  • Weight gain, cold intolerance, bradycardia
  • Oligomenorrhea
  • Hypercholesterolemia (decreased LDL receptors)
  • Constipation
36
Q

Hashimoto thyroiditis

A

Autoimmune destruction of thyroid gland; associated with HLA-DR5

Antithyroglobulin and antithyroid peroxidase antibodies are signs of thyroid damage (do not mediate disease)

Chronic inflammation with germinal centers and Hurthle cells (eosinophilic metaplasia of cells that line follicles)

Increased risk for marginal zone B cell lymphoma

37
Q

Subacute granulomatous (De Quervain) thyroiditis

A

Granulomatous thyroiditis following viral infection

Tender thyroid with transient hyperthyroidism

Rarely progresses to hypothyroidism

38
Q

Riedel fibrosing thyroiditis

A

Hypothyroidism with a “hard as wood” nontender thyroid gland

Extensive fibrosis of thyroid gland; may extend to local structures (airway) but do not confuse with anaplastic carcinoma of the thyroid

39
Q

Papillary carcinoma of the thyroid

A

Most common type of thyroid carcinoma

Risk factor: exposure to ionizing radiation in childhood

Increased risk with RET and BRAF mutations

Papillae lined by cells with clear “Orphan Annie eye” nuclei and nuclear grooves, and psammoma bodies

Often spreads to cervical LNs; excellent prognosis

40
Q

Follicular carcinoma of the thyroid

A

Malignant proliferation of thyroid follicles surrounded by a fibrous capsule with invasion through the capsule (distinguishes follicular carcinoma from follicular adenoma)

Metastasis occurs hematogenously

41
Q

Medullary carcinom of the thryoid

A

Malignant proliferation of parafollicular C cells (neuroendocrine cells that secrete calcitonin)

Biopsy reveals sheets of malignant cells in an amyloid stroma (consisting of calcitonin deposition)

Familial cases are often due to MEN 2A/2B (RET oncogene)

42
Q

Symptoms of hypocalcemia

A
  • Numbness and tingling (particularly circumoral)
  • Tetany - may be elicited with filling of BP cuff (Trousseau sign; tap the “tricep”) or tapping on facial nerve (Chvostek sign; tap the “cheek”)
43
Q

Diabetic nephropathy

A

Non-enzymatic glycosylation of arterioles leads to hyaline arteriosclerosis; involvement of renal arterioles leads to glomerulosclerosis

Preferential involvement of efferent arterioles leads to glomerular hyperfiltration injury that eventually progresses to necrotic syndrome; characterized by Kimmelstiel-Wilson nodules in glomeruli

Prevented by ACE inhibitors

44
Q

Gastrinoma (Zollinger-Ellison syndrome)

A

Treatment-resistant peptic ulcers

45
Q

Somatostatinoma

A

Achlorhydria (inhibition of gastrin)

Cholelithiasis with steatorrhea (inhibition of CCK)

46
Q

VIPoma

A

Watery diarrhea

Hypokalemia

Achlorhydria

47
Q

Thyroid storm

A

Stress-induced catecholamine surge in patients with hyperthyroidism

Presents with agitation, delirium, fever, diarrhea, coma, and tachyarrythmias

Tx (“3 P’s”): Propanolo, PTU, Prednisolone

48
Q

Pseudohypoparathyroidism

A

Albright hereditary osteodystrophy

Autosomal dominant unresponsiveness of the kidney to PTH

Results in hypocalcemia, shortened 4th/5th digits, short stature

49
Q

Carcinoid syndrome

A

Most common malignancy of the small intestine

Asymptomatic if tumor is limited to GI tract (5-HT undergoes first-pass metabolism in liver)

Presents with diarrhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease

Increased 5-HIAA in urine and niacin deficiency (pellagra)

Tx: resection and octreotide

50
Q

MEN 1 (Wermer syndrome)

A

Autosomal dominant

“Diamond”

  • Pituitary tumor (prolactin or GH)
  • Parathyroid tumors
  • Pancreatic tumor (Z-E syndrome, insulinoma, VIPoma, glucagonoma)

Commonly presents with kidney stones and stomach ulcers

51
Q

MEN 2A (Sipple syndrome)

A

Autosomal dominant

“Square”

  • Medullary thyroid carcinomas
  • Parathyroid hyperplasia
  • Pheochromocytoma

Associated with RET gene mutation

52
Q

MEN 2B

A

Autosomal dominant

“Triangle”

  • Oral/intestinal ganglioneuromatosis (mucosal neuromas)
  • Medullary thyroid carcinoma
  • Pheochromacytomas
  • Associated with marfanoid habitus

Associated with RET gene mutation

53
Q

High-dose dexamethasone

A
  • Suppresses ACTH production by pituitary adenoma
  • Does NOT suppress ectopic ACTH production (e.g. small cell carcinoma of the lung)

Low-dose dexamethasone fails to suppress cortisol in all causes of Cushing syndrome (only suppresses cortisol in normal patients)

54
Q

Pheochromocytomas

A

Tumor of chromaffin cells

Diagnosed by increased serum metanephrines (break-down product of epi) and increased 24-hour urine metanephrines and vanillylmandelic acid (break-down production of both epi and norepi)

Associated with MEN 2A/2B, von Hippel-Lindau disease, and NF type 1

55
Q

Neuroblastoma

A

Most common tumor of the adrenal medulla in children (

May occur anywhere along the sympathetic chain

Commonly presents with abdominal distension and a firm, irregular mass that can cross the midline (vs. Wilms tumor, which is smooth and unilateral)

Increased homovanillic acid (breakdown product of dopamine) in the urine)

Bombesin+

Associated with overexpression of N-myc oncogene

56
Q

Periductal mastitis

A

Inflammation fo the subareolar ducts

Usually seen in smokers (relative vitamina A deficiency results in squamous metaplasia of lactiferous ducts, producing blockage and inflammation)

Presents as subareolar mass with nipple retraction

57
Q

Mammary duct ectasia

A

Inflammation and dilatation (ectasia) of subareolar ducts

Classically arises in multiparous postmenopausal women

Presents as periareolar mass with green-brown nipple discharge

Chronic inflammation with plasma cells seen on biopsy

58
Q

Intraductal papilloma

A

Classically presents as bloody nipple discharge in premenopausal women

Fibrovascular projections lined by luminal (epithelial) and myoepithelial cells

Distinguished from papillary carcinoma by :age of onset (carcinoma more common in postmenopausal women) and presence of myoepithelial cells (absent in carcinoma)

59
Q

Klinefelter syndrome

A

XXY

Presents with testicular atrophy (hypogonadism), eunuchoid body shape, tall long extremities, gynecomastia, and female hair distribution.

Dysgenesis of seminiferous tubules leads to decreased inhibin and increased FSH

Abnormal Leydig cell function leads to decreased tesosterone, increased LH, and increased estrogen

Increased risk of germ cell testicular cancer and breast cancer

60
Q

Invasive ductal carcinoma

A

Most common type of invasive carcinoma in the breast

Duct-like structures in a desmoplastic stroma. Subtypes:

  • Tubular carcinoma - well-differentiated tubules that lack myoepithelial cells; good prognosis
  • Mucinous carcinoma - tumor cells floating in mucus pool; older women; good prognosis
  • Medullary carcinoma - large high-grade cells growing in sheets; higher incidence in BRCA1 carriers; lymphocytic infiltrate; good prognosis
  • Inflammatoy carcinoma - carcinoma in dermal lymphatics; mimics acute mastitis; poor prognosis
61
Q

Lobular carcinoma in situ

A

Dyscohesive cells lacking E-cadherin adhesion protein

Often multifocal and bilateral

Low risk of progression to invasive carcinoma

Tx: tamoxifen

62
Q

Invasive lobular carcinoma

A

Invasive carcinoma that characteristically grows in a single-file pattern; no duct formation due to lack of E-cadherin

May exhibit signet-ring morphology

Pathology (17 decks)

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