Female Genital System II Flashcards
Ovarian Neoplasms are called (umbrella term for all three)
Surface Epithelial-Stroma Cell Tumors
Surface Epithelial-Stroma Cell Tumors
-What?
-Ovarian neoplasm that arises especially in cases of never giving birth or family Hx
Surface Epithelial-Stroma Cell Tumors
-Types (3)
- Serous tumors of the ovary
- Cystadenoma
- Cystadenocarcinoma
Surface Epithelial-Stroma Cell Tumors
-Genes
- Familial types associated with BRCA
- BRCA only in 10% of sporadic cases
- Overexpression of HER2/NEU will lead to a poor prognosis
Serous tumors of the ovary
- A type of Surface Epithelial-Stroma Cell Tumor
- Most frequent ovarian tumor
- Large and round
Cystadenoma
A type of Surface Epithelial-Stroma Cell Tumor
- Benign
- Cystic lesions
- single layer of tall columnar epithelium lining cysts
- younger age (30-40)
Cystadenocarcinoma
- What
- Who does it affect
A type of Surface Epithelial-Stroma Cell Tumor
-Malignant
-Affects older women (45-65)
Cystadenocarcinoma
- Dx
- Histo
- Metastasis
Dx:
-CA-125 used as a marker
Histo:
-cyst lined with anaplastic epithelium (as opposed to cystadenoma which is lined with___?)
Mets:
-spread by seeding
Breast Cancer
-Gene factors
BRCA1*:
-involved in 20% of breast cancer cases
BRCA2*
- involved in 20% of breast cancer cases
- common in ashkenazi jewish women
- Men who have BRCA2 at increased risk of breast cancer
*These mutations not detected frequently in sporadic breast cancers
p53
- Li Fraumeni syndrome: all young women will develop breast cancer
- Germline mutations involved in 1% of breast cancer cases for women <40 yrs old
Breast Cancer
-Hormonal/other factors
Women who never give birth or who have their first pregnancy at >35 yrs have 2-3X the risk of those who have first baby at <25 yrs of age
Breast cancer
-Genetic changes
overexpression of HER2/NEU IN 30% of invasive breast cancers
HER2/NEU is involved in epidermal growth factor receptors, and overexpression is associated with poor prognosis
Ductal Carcinoma in Situ (DCIS)
-Histopathology
DCIS is the most common form of in situ breast cancer
histopathology:
- arises from terminal duct lobular units
- involves ductlike spaces
- wont penetrate basement membrane
- Calcifications are associated with DCIS (ducts=milk=Calcium)
Ductal Carcinoma in Situ (DCIS)
-Clinical
- Rarely presents as palpable or radiologically detectable mass
- if develops into carcinoma, will develop in the same breast and quadrant
- Non-comedo subtype unlikely to produce desmoplastic (hardening) response
Ductal Carcinoma in Situ (DCIS)
-Comedo High-Grade Subtype
- Gross appearance is a duct-like structure with white, necrotic material that looks like comedos (a clogged hair follicle)
- Induces desmoplastic (hardening) response
Lobular Carcinoma in Situ (LCIS)
-histopathology
- arises in terminal duct lobular units
- wont penetrate basement membrane
- these lobules produce mucus
- mucin vacuoles that produce signet ring cells are common
Lobular Carcinoma in Situ (LCIS)
-Clinical
- Always found incidentally
- Does not form masses or calcifications
- 1/3 of women with LCIS will have an invasive carcinoma, appearing in either breast at a significant frequency
- Thus, LCIS is used as a marker for breast cancer
Invasive Ductal Carcinoma
-What
- Breast cancers that cant be categorized into any particular specialized subtype
- Associated with DCIS
Invasive Ductal Carcinoma
-histopathology
- may see dimpling of the skin
- irregular margins
- Invades tissues (nerves and/or lymph-vascular spaces)
Invasive Ductal Carcinoma
-Clinical
Hard palpable mass because normal breast fat is replaced due to a desmoplastic response
Breast Cancer: clinical manifestations
-nodules
- small nodules can be felt through palpation
- 2-3 cm diameter means regional lymph nodes in 50% of cases
- 1 cm diameter means nodal metastasis in 15% of cases
Breast Cancer: clinical manifestations
-Superficial signs
- nipple retraction
- nipple discharge
- breast inflammation
- lymph node enlargement
- maybe some paraneoplastic syndrome like hypercalcemia
Breast cancer: clinical manifestations
-radiologic findings
Calcification from the hypercalcemia
Breast Cancer: prognosis
- Size
- Lymph node involvement
Size:
- 12 involved, survival rate decreases to <50%
Breast Cancer: prognosis
- Histologic type
- Hormone receptor status
histologic type:
-specialized types of breast carcinomas are better than no special type (invasive ductal carcinoma)
Hormone receptor status:
- overexpression of HER2/NEU is not good
- on the other hand, the anti-tumor antibody, Herceptin, which targets the HER2/NEU gene product, is good
