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ENRP > Exam 1 Path > Flashcards

Exam 1 Path Flashcards

1
Q

Vulvar lesions:

  • Cyst located in the posterior aspect of the vaginal introitus
  • Painful, warm and erythematous if infected
  • Histo: cyst lined with transitional epithelium
A

Bartholin cyst

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2
Q

Vulvar lesions:

  • Post menopausal woman with itchy white plaques of the vulvar and anogenital skin
  • Increased risk of TP53+ keratinizing SCC
  • Histo: thinning, edematous band, lymphocytic infiltrate
A

Lichen sclerosus

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3
Q

Vulvar lesions:

  • Thickened, reddened vulvar surface caused by habitual rubbing/scratching
  • Associated with lichen sclerosus, SCC
  • Histo: hyperkeratotic skin with epidermal acanthosis (thickening)
A

Squamous cell hyperplasia (Lichen Simplex Chronicus)

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4
Q

Vulvar lesions:

  • Skin colored exophytic papules and plaques
  • Histo: Papillary projections, Koilocytes with prominent perinuclear halos
A

Condyloma acuminatum (anogenital warts)

*HPV (6, 11)

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5
Q

Vulvar carcinoma: most are SCC

  • Age 60 (younger)
  • Caused by high risk HPV (16, 18)
  • Histo: full thickness atypia
A

Basaloid/warty SCC (classic VIN)

*contrast with keratinizing SCC

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6
Q

Vulvar carcinoma: most are SCC

  • Age 75 (older)
  • Caused by chronic irritation (lichen sclerosus or squamous hyperplasia)
  • assoc w/ TP53 mutations
  • Histo: basal/parabasal atypia +/- keratin pearls
A

Keratinizing SCC (differentiated VIN)

*contrast with basaloid/warty SCC

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7
Q

Other vulvar neoplasms:

  • Solitary, well circumscribed dermal or subcutaneous nodule
  • Arise from primitive milk line
  • Histo: Benign columnar and myoepithelial cells with apocrine gland differentiation
A

Papillary hydradenoma

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8
Q

Other vulvar neoplasms:

  • Itchy, ill defined, erythematous lesion +/- white crust
  • Intraepithelial adenocarcinoma
  • Histo: sweat gland and keratinocyte differentiation
A

Extramammary Paget Disease

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9
Q

Vaginal lesions:

  • Reproductive age woman
  • Submucosal cyst that arises in lateral vaginal wall
  • Can protrude from vaginal orifice
  • Histo: cyst with cuboidal lining
A

Gartner duct cyst (from wolffian/mesonephric duct)

*gartner/mullerian cyst: only difference is histo!

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10
Q

Vaginal lesions:

  • Reproductive age woman
  • Submucosal cyst that arises in lateral vaginal wall
  • Can protrude from vaginal orifice
  • Histo: cyst with tubal or endocervical lining
A

Mullerian cyst (from mullerian/paramesonephric duct)

*gartner/mullerian cyst: only difference is histo!

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11
Q

What exposue?

  • Daughter of treated mother develops VAGINAL adenosis
  • Eventual clear cell adenocarcinoma of the vagina
A

Diethylstilbestrol (DES) exposure

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12
Q

Vaginal neoplasm:

  • Infant or young girl
  • Protruding bulky, polypoid, grape like mass
  • Invasion can result in death
  • Histo: malignant embryonal rhabdomyoblasts
A

Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

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13
Q

Vaginal SCC LN spread?

  • develops from VAIN (precursor lesion)
  • caused by high risk HPV (16,18)
  • Located in lower 2/3 of vagina***
A

SCC in lower 2/3 of vag spreads to inguinal/femoral LNs

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14
Q

Vaginal SCC LN spread?

  • develops from VAIN (precursor lesion)
  • caused by high risk HPV (16,18)
  • Located in upper 1/3 of vagina***
A

SCC in upper 1/3 of vag spreads to iliac LNs

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15
Q

Cervical neoplasm eitiology:

Most are caused by high risk HPV (16, 18)

E6 viral oncogene function?

A 
Increase telomerase (no division limit)
Degrade p53 (tumor suppressor broke)
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16
Q

Cervical neoplasm eitiology:

Most are caused by high risk HPV (16, 18)

E7 viral oncogene function?

A

Inactivates p21 and RB (bypass G1 to S restriction)

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17
Q

Cervical Intraepithelial Neoplasia (CIN):

Mild dysplasia

A

CIN I / LSIL

more likely to regress, low chance to progress to HSIL

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18
Q

Cervical Intraepithelial Neoplasia (CIN):

Moderate dysplasia

A

CIN II / HSIL

more likely to persist, low chance to progres to carcinoma

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19
Q

Cervical Intraepithelial Neoplasia (CIN):

Severe dysplasia / Carcinoma in situ

A

CIN III / HSIL

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20
Q

Concerning observations for on colposcopy

A

acetowhite areas = concern for dysplasia

abnormal vessels = concern for carcinoma

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21
Q

Pap screening guidelines:

Start?
21-29?
30-65?
>65?

A

Start at 21
21-29 = q3y
30-65 = q5y
>65 = none if normal previously

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22
Q

HPV vaccination offered to?

A

boys and girls starting at age 11

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23
Q

Menstrual cycle histo:

tubular glands with pseudostratification and mitotic figures

A

proliferative phase (estrogen driven)

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24
Q

Menstrual cycle histo:

“piano key” vaculoles

A

early secretory phase (progesterone driven)

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25
Q

Menstrual cycle histo:

tortuous serrated glands

A

late secretory phase (progesterone driven)

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26
Q

Menstrual cycle histo:

tight clusters of stromal cells, ischemia and hemorrhage

A

menses (dec. estrogen and progesterone)

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27
Q

Diagnosis? (endometritis)

  • after giving birth, pt has fever, uterine tenderness and abdominal pain due to bacterial infection (GAS, staph)
  • Histo: neutrophil infiltration w/ microabscesses
A

Acute endometritis

*contrast with chronic endometritis (maybe no sxs, plasma cells, later after giving birth)

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28
Q

Diagnosis? (endometritis)

  • may be asymptomatic, abn bleeding, abd pain
  • many causes (retained fetal products, IUD, chronic PID)
  • Histo: plasma cell infiltration
A

Chronic endometritis

*contrast with acute endometritis (acute symtoms, neutrophils, right after giving birth)

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29
Q

Diagnosis?

  • woman with painful menses
  • inspection shows “powder burn” lesions and blood filled cysts
  • ectopic tissue present in ovaries, pelvis, GI, bladder
  • Histo: endometrial glands, endometrial stroma, hemosiderin laden macrophages
A

Endometriosis

***survival of ectopic tissue driven by inflammation

inflammation => VEGF=> angiogenesis
increased aromatase increases estrogen, proliferation
mutations in tumor suppressor genes

*contrast with adenomyosis (endometrial tissue in myometrium), same clinical presentation

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30
Q

Diagnosis?

  • exophytic benign hyperplastic polypoid mass of the endometrium
  • woman taking Tamoxifen
A

Endometrial polyp

*tamoxifen is proestrogenic in endometrium

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31
Q

Type of endometrial hyperplasia?

  • glandular crowding w/ NO atypia
  • small carcinoma risk
A

Typical endometrial hyperplasia

*both types caused by chronic unopposed estrogen

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32
Q

Type of endometrial hyperplasia?

  • glandular proliferation w/ atypia
  • HIGH carcinoma risk
A

Atypical endometrial hyperplasia

*both types caused by chronic unopposed estrogen

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33
Q

What are these risk factors for?

Obesity
PCOS
Estrogen replacement tx
Tamoxifen tx
Estrogen producing tumor (granulosa or thecoma)
A

Endometrial hyperplasia/ carcinoma

*unopposed estrogen drives proliferation!!!

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34
Q

Secretory products of what tumors can lead to endometrial hyperplasia/carcinoma?

A

Granulosa cell tumor and Thecoma

*both release estrogen!!!

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35
Q

Endometrial carcinoma:

  • Setting of unopposed estrogen
  • Mutations in PTEN, PI3K/AKT, MSI
  • Indolent course, more favorable prognosis
  • Histo: endometrioid morphology
  • younger age of onset
A 
Endometrioid carcinoma
(Type 1 endometrial carcinoma)
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36
Q

Endometrial carcinoma:

  • Setting of endometrial atrophy in African American
  • Mutations in TP53
  • Aggressive, poor prognosis
  • Histo: papillary growth with atypia
  • older age of onset
A

Serous carcinoma of the uterus

Type 2 endometrial carcinoma

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37
Q

Endometrial carcinoma:

  • Setting of endometrial atrophy in African American
  • Aggressive, poor prognosis
  • Histo: malignant glands and stroma
  • older age of onset
A

Malignant Mixed Mullerian Tumor (MMMT)
(Type 2 endometrial carcinoma)

*contrast with adenosarcoma of the uterus (benign glands and malignant stroma)

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38
Q

Diagnosis?

  • endometrioid carcinoma + colorectal/ovarian cancer
  • AD inheritance
  • mut in mismatch repair gene (MLH1 or MSH2) leading to microsatellite instability (MSI)
A

Lynch Syndrome

*MSI + unopposed estrogen increases risk for endometrial hyperplasia/carcinoma

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39
Q

Diagnosis?

Endometrial tumor composed of benign glands and malignant stroma

A

Adenosarcoma

*contrast with MMMT (malignant glands AND stroma)

40
Q

Diagnosis?

  • Malignant endometrial stroma
  • Invades myometrium +/- lymph/vascular
  • Histo: small blue cell tumor
  • JAZF1 mutation
A

Low Grade Endometrial Stromal Sarcoma

*differentiate from endometrial adenosarcoma and MMMT (mixed tumors)

41
Q

Diagnosis?

  • Benign smooth muscle tumor of the uterus
  • White circumscribed nodules
  • MED12 mutation
42
Q

Diagnosis?

  • Malignant smooth muscle tumor of the uterus
  • Bulky fleshy mass
  • Aggreessive with likelihood of metz
  • Histo: atypia, mitoses, necrosis
A

Leiomyosarcoma

43
Q

Fallopian tube lesions:

Paratubal cyst derived from mullerian remnants near fimbriae

A

Hydatid cyst of Morgagni

44
Q

Fallopian tube lesions:

Benign tumor of mesothelial origin

A

Adenomatoid tumor

45
Q

Diagnosis?

  • Hyperandrogenism (inc testosterone, hirsutism)
  • Hormonal imbalance (high LH, low FSH)
  • Insulin resistance
  • Polycystic ovaries
A

PCOS

*increased risk of endometrial hyperplasia/carcinoma

46
Q

Epithelial ovarian tumors:

Papillary growth pattern, cystic with tubal-like epithelium

A

Low grade serous tumor of the ovary

47
Q

Epithelial ovarian tumors:

  • Solid tumor with marked atypia
  • p53 mutation
  • BRCA1/2 mutations (breast cancer risk/assoc.)***
A

High grade serous tumor of the ovary

***BRCA1/2 mutations predispose to breast cancer!!!

48
Q

Epithelial ovarian tumors:

  • Tumor of columnar epithelium, cystic lesion filled with mucinous fluid
  • Unilateral, malignant
  • KRAS mutation
A

Ovarian mucinous tumor

49
Q

Epithelial ovarian tumors:

  • Endometrial tissue can be precursor lesion
  • Carcinoma
A

Endometrioid ovarian tumor

50
Q

Epithelial ovarian tumors:

  • Histo: large epithelial cells with clear cytoplasm
  • Carcinoma
A

Clear cell ovarian tumor

*NOT associated with DES, that is for clear cell carcinoma of the VAGINA

51
Q

Epithelial ovarian tumors:

  • Tumor comprised of urothelial-type transitional epithelium
  • Benign (unilateral)
A

Brenner tumor (ovarian transitional cell tumor)

52
Q

Germ cell ovarian tumor:

-comprised of mature tissues from all embryonic layers (hair, teeth, muscle, fat, etc.)

A

Mature cystic teratoma

53
Q

Germ cell ovarian tumor:

  • prepubertal female or young woman
  • malignant immature neuroepithelium
A

Immature malignant teratoma

54
Q

Germ cell ovarian tumor:

  • comprised of one tissue type
  • mature thyroid tissue => hyperthyroidism
  • or carcinoid tumor (flushing, diarrhea, hypotension)
A

Monodermal (specialized) teratoma

55
Q

Germ cell ovarian tumor:

  • ovarian counterpart to testicular seminoma
  • KIT mutation
A

Dysgerminoma

56
Q

Germ cell ovarian tumor:

  • Tumor cells secrete alpha-fetoprotein
  • Schiller-Duval body (glomerulus-like structure) on histo
A

Yolk sac tumor

57
Q

Germ cell ovarian tumor:

  • Malignant trophoblastic tumor
  • High B-hCG levels
  • Widespread metz common
  • assoc w/ complete mole
  • chemotherapy has high cure rate
A

Choriocarcinoma

58
Q

Ovarian sex cord stromal tumors:

  • “coffee bean” nuclei on histo
  • release estrogen (endometrial hyperplasia risk)
  • stain positive for inhibin
A

Granulosa cell tumor

  • hormonally active tumors are yellow, increased risk for endometrial hyperplasia (adults)
  • hyperestrogenism can cause precocious puberty in juvenile tumor
59
Q

Ovarian sex cord stromal tumors:

  • benign tumor of fibroblasts and theca cells
  • release estrogen (endometrial hyperplasia risk)
A

Fibrothecoma (fibroma + thecoma)

*can also exist as individual parts

60
Q

Diagnosis?***

Ascites
Pleural effusion
Benign ovarian tumor (fibroma most common)

A

Meigs Syndrome***

61
Q

Ovarian sex cord stromal tumor:

  • Secretes testosterone (defeminization, virilization)
  • DICER1 mutation
A

Sertoli-Leydig cell tumor

*sertoli cells and leydig cells on histo

62
Q

Metastatic tumor to the ovary:

  • mucin rich “signet ring” cells on histo
  • Metz from GI tract (colon or stomach)
  • Bilateral metz
A

Krukenberb tumor

63
Q

Metastatic tumor to the ovary:

  • Mucinous ascites (jelly belly)
  • Metz from appendiceal mucinous tumor
  • Acellular mucin on histo
A

Pseudomyxoma peritonei

64
Q

Diagnosis?

  • abdominal pain and bleeding 6-8 weeks after LMP
  • # 1 risk factor is PID from chlamydia/gonorrhea infection
A

Ectopic pregnancy

  • fetal implantation outside uterus (fallopian tube most common)
  • rupture can lead to severe pain and hemorrhagic shock
65
Q

Diagnosis?

  • New onset HTN and proteinuria in pregnancy
  • HA and visual changes
A

Preeclampsia

+seizure = eclampsia

66
Q

Preeclampsia/eclampsia pathogenesis

A
  1. abnormal placental vasculature leads to placental ischemia
  2. endothelial dysfunction leads to factor release, causing maternal vasoconstriction (HTN)
  3. resultant hypercoagulable state (fibrin thrombi)
67
Q

The following are pathological findings for what disease process?

  • Infant: abnormal decidual vessels (placental infarcts)
  • Mother: fibrinoid necrosis, fibrin thrombi in organs
A

Preeclampsia/eclampsia

68
Q

Diagnosis?

Hemolysis, microangiopathic anemia (schistocytes)
Elevated liver enzymes
Low platelets

A

HELLP syndrome

69
Q 
Gestational trophoblastic disease: findings for
Complete Molar Pregnancy
1. Fetal parts?
2. villi involvement?
3.genetic derivation?
4. choriocarcinoma/invasive mole risk?
  • multi-cystic mass lesion with “snow storm” US
  • cystic swelling of chorionic villi
  • abnormally elevated B-hCG
A
  • NO fetal parts
  • abnormal villi SURROUND specimen
  • Paternally derived (46 XX)
  • risk for both choriocarcinoma/ invasive mole

*also p57 negative

70
Q 
Gestational trophoblastic disease: findings for
Partial Molar Pregnancy
1. Fetal parts?
2. villi involvement?
3.genetic derivation?
4. choriocarcinoma/invasive mole risk?
  • multi-cystic mass lesion with malformed fetus on US
  • cystic swelling of chorionic villi
  • abnormally elevated B-hCG
A
  • YES fetal parts
  • abnormal villi involve small part of specimen
  • Maternally and Paternally derived (69 XXX or XXY)
  • low risk for invasive mole

*also p57 positive

71
Q

Gestational trophoblastic disease:

  • malignant tumor of INTERMEDIATE trophoblasts
  • uterine mass following normal pregnancy or spontaneous abortion
  • elevated B-hCG
A

Placental site trophoblastic tumor

72
Q

Inflammatory disorders of the breast:

Diagnosis?

  • red erythematous breast in breastfeeding mother
  • caused by S. aureus (abscess) or GAS (cellulitis)
  • infection is secondary to tissue damage
A

Acute bacterial mastitis

73
Q

Inflammatory disorders of the breast:

Diagnosis?

  • subareolar mass
  • smoker (relative vit A deficiency)
  • inverted nipple
  • keratinizing squamous metaplasia causes duct blockage and abscess formation
A

Squamous metaplasia of the lactiferous ducts (SMOLD)

74
Q

Inflammatory disorders of the breast:

Diagnosis?

  • inflammation and dilation of the subareolar ducts
  • palpable periareolar mass
  • thick white (or brown-green) nipple secretion
  • multiparous postmenopausal women
  • histo markers for chronic inflammation (plasma cells)
A

Duct ectasia

75
Q

Inflammatory disorders of the breast:

Diagnosis?

  • mass with abnormal calcification on mammogram (due to saponification)
  • history of trauma
  • necrotic fat and calcifications seen on biopsy
A

Fat necrosis of breast

76
Q

Inflammatory disorders of the breast:

Diagnosis?

  • granulomatous inflammation in the breast
  • systemic granulomatous disease (sarcoid, GPA, TB)
A

Granulomatous mastitis

77
Q

Benign epithelial breast lesion prognosis:

cystic change
fibrosis
adenosis

*fibrocystic changes

A

Non-proliferative changes, no increased risk of invasive carcinoma

these are fibrocystic changes

78
Q

Benign epithelial breast lesion prognosis:

epithelial hyperplasia
sclerosing adenosis
complex sclerosing lesion
intraductal papilloma
gynecomastia
A

Proliferative changes w/o atypia, 2x increased risk of invasive carcinoma

79
Q

Benign epithelial breast lesion prognosis:

atypical ductal hyperplasia
atypical lobular hyperplasia

A

Proliferative changes w/ atypia, 5x increased risk of invasive carcinoma

80
Q

Inflammatory disorders of the breast:

Diagnosis?

  • palpable breast mass with lymphocytic infiltrate
  • associatted with autoimmune dz (T1DM, autoimmune thyroid dz)
A

Lymphocytic mastopathy

81
Q

Benign epithelial breast tumors:

  • tumor of fibrous tissue and glands
  • well circumscribed mobile mass distorts ducts
  • estrogen sensitive
  • MED12 mutation
A

Fibroadenoma of breast

82
Q

Benign epithelial breast tumors:

  • fibroadenoma-like tumor
  • papillary “leaf like” projections on biopsy
  • higher cellularity, mitoses, pleomorphism than fibroadenoma (therefore higher risk of malignancy)
  • MED12 mutation
A

Phylloodes tumor

83
Q

Male breast cancer associations (invasive ductal carcinoma)

A

BRCA2 mutation and Kleinfelter (XXY)

84
Q

Greatest risk factor for developing breast carcinoma

A

lifetime estrogen exposure

85
Q

Familial ER+ luminal breast cancers are associated with

A

BRCA2 mutation

*sporadic assoc. w/ PIK3A or TP53

86
Q

Familial HER2+ breast cancers are associated with

A

TP53 mutation, Li Fraumeni syndrome

*SBLA = sarcoma, breast, leukemia, adrenal gland

87
Q

Familial TNBC are associated with

A

BRCA1 mutation

*sporadic due to TP53 mutation

88
Q

ER+ breast cancer prognosis and tx

A

best prognosis, low risk of metz

Tx with tamoxifen

89
Q

HER2+ breast cancer prognosis and tx

A

moderate prognosis, bimodal risk of metz (early and late)

Tx with trastuzumab

90
Q

TNBC prognosis

A

worst prognosis, likely early metz

91
Q

Breast neoplasm diagnosis:

  • palpable mass with calcification on mammo
  • confined to ductal system
  • central necrosis of tumor
  • may present with inflammation at the nipple
A

DCIS (comedo type due to necrosis)

*inflammation at the nipple = Paget disease of the nipple and is indicative of underlying DCIS that has invaded the skin (HER2+)

92
Q

Breast neoplasm diagnosis:

  • no palpable mass, incidental finding
  • bilateral
  • loss of E-cadherin (discohesive, linear growth pattern of lobular tissue)
  • most commonly ER+ and PR+
A

LCIS

*E-cadherin loss = CDH1 mutation, therefore diffuse type gastric cancer assoc.

93
Q

Special type breast cancers:

  • TNBC subtype with better prognosis
  • BRCA1 assoc.
  • Tumor has lymphocyte and plasma cell infiltrate
A

Medullary pattern carcinomas

94
Q

Special type breast cancers:

  • soft, rubbery
  • malignant cells floating in mucus
A

Mucinous (colloid) carcinoma

95
Q

Special type breast cancers:

  • dimpling of the skin of the breast (peau d’ orange)
  • tumor observed in dermal lymphatics
  • poor prognosis
A

Inflammatory carcinoma of the breast

96
Q

Most useful staging metric for breast cancer

A

Node involvement (N), migration to sentinel nodes worsens prognosis

*most important prognostic metric is metz (M), but since metz are not common at dx, N is more useful

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