Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AP/CP > Female Reproductive Pathology > Flashcards

Female Reproductive Pathology Flashcards

1
Q

What stain is positive in hidradenoma papilliferum?

A

EMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between mammary and extramammary Paget’s?

A

Mammary has 95% chance of underlying cancer, underlying extramammary cancer is rare

Paget’s vulva: CK7+, CEA+, mucin+

Paget’s anus: CK20+, CEA+, mucin+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different kinds of vaginal cysts?

A

Mullerian: endocervical type

EIC: squamous epithelium (prior surgery or trauma)

Mesonephric / Gartner’s cyst: non mucinous cuboidal epithelial cells (lateral walls) but may have mucinous material in the lumen (they are CD10 positive)

Endometriotic cysts

Bartholin cysts: squamous or transitional or mucinous lining (located at 4 o’clock and 8 o’clock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BQ! Etiology of vaginal adenosis?

A

Exposure to DES

Vaginal adenosis: Upper 1/3 and anterior wall of vagina, 20% have gross congenital malformation of cervix (T shaped uterine cavity)

Benign glandular epithelium with metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Koilocytes in low grade cervical lesions are due to which types of HPV and to expression of what viral protein?

A

HPV 6 and 11

Viral E4 expression

its a productive infection (early and late gene expressed), non integration of viral DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

High grade cervical lesions are due to which types of HPV and to expression of what viral protein?

A

HPV 16 and 18

they are non productive infections

only early E6 and E7 genes expressed

there is integration of viral DNA, E6 binds P53, HPV E7 interacts with Rb protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is associated with microglandular hyperplasia?

A

oral contraceptives or pregnancy (hormonal stimulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stains to differentiate between endocervical and endometrial AIS?

A

Endocervical: CEA, p16

Endometrial: CD10, vimentin

From Dr. Speights:

Endocervical = CEA + and p16 + in cancer, ER negative in cancer, ER + in normal tissue

Endometrial = vimentin + and CD10 + in cancer, PTEN LOSS in cancer, ER negative in both cancer and normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which type of cervical cancer is associated with lots and lots of eosinophils (also seen in its metastasis)?

A

Glassy cell carcinoma (a variant of adenosquamous carcinoma)–very aggressive tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What virus is associated with small cell carcinoma of the cervix?

A

HPV18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When you see actinomycetes colony microscopically and there is a peripheral hot pink area, what is this called and what is the significance?

A

These are the sulfur granules and it’s called splendora hoeppli phenomenon and the significance is that it is the site of antigen antibody reaction (ie it’s invasive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What kind of diathesis do you see in endometrial carcinoma?

A

Watery diathesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Endometrial dating criteria

In the 28 day cycle, when is the menstrual, proliferative and secretory phases respectively?

A

Menstrual: Day 1-3

Proliferative: Day 4-14

Secretory: Day 14-28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the FIGO grades?

A

● FIGO 1: resembles microglandular hyperplasia; composed primarily of well formed glands; <5% nonsquamous solid component
● FIGO 2: 6-50% nonsquamous solid component
● FIGO 3: more than 50% nonsquamous solid component; lacks well formed glands, which differentiates it from serous endometrial carcinoma
● FIGO grading excludes serous or clear cell, which are considered high grade (grade 3)
● Raise grade from 1 to 2 or from 2 to 3 if notable nuclear atypia inappropriate for grade (particularly pleomorphism and prominent nucleoli)
● If marked atypia, tumor may be serous without typical papillary architecture (usually p53+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you call a endometrial polyp with smooth muscle in a younger patient with lots of squamous morules that is located in the lower uterine segment?

A

Atypical polypoid adenomyoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is your main differential with papillary serious endometrial carcinoma?

A

Villoglandular endometrial adenoCA

but this will not have hobnailing and the nuclei will be much lower grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What endometrial tumor is shown in the image and what are its features and staining pattern?

A

Low grade endometrial stromal sarcoma

Checkerboard type pattern, mitotic activity is increased, vasoinvasive (sometimes it looks like a bag of worms because it is so angioinvasive)

Staining: Vimentin +, CD 10 +, Actin – focally +, Desmin –, ER / PR +, Beta catenin overexpression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which type of breast cancer may metastasize to the uterus?

A

Lobular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What has happened to this leiomyoma?

A

Carneous (or red) degeneration

Carneous degeneration is a subtype of hemorrhagic infarction of leiomyomas that often occurs during pregnancy. On gross pathology, it is characterized by a red (hemorrhagic) appearance of the leiomyoma. Red degeneration primarily occurs secondary to venous thrombosis within the periphery of the tumor or rupture of intratumoural arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In MMMT (carcinosarcoma), what is the most common heterologous element and which part is most likely to metastasize?

A

Rhabdomyosarcoma is most common heterologous element and the carcinoma component is more likely to metastasize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the most common site of endometriosis in the GYN tract?

A

Ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name 3 tumors associated with endometriosis:

A

1) Endometroid
2) Clear Cell
3) Stromal sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common tumor associated with BRCA gene mutation?

A

Serous carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What gene mutation is found in high grade serous carcinoma? Low grade?

A

High grade: p53

Low grade: BRAF, KRAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which type of borderline tumor is more likely to be associated with endometriosis and be bilateral?

A

Mucinous muellerian (endocervical type)

The intestinal type is more common overall though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which syndrome is clear cell carcinoma of the ovary associated with?

A

Lynch Syndrome (HNPCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the only difference microscopically between a malignant Brenner tumor of the ovary and a primary urothelial carcinoma of the ovary (shown here)?

A

The Brenner tumor will have areas with the normal grooved nuclei (coffee bean nuclei shown here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If you see this picture of a cerebriform ovary, what tumor should you think about?

Stains?

Cytology appearance?

A

Dysgerminoma
Cytology: tigroid appearance on cytology and small lymphocytes
Stains: CD117, PLAP, OCT3/4, SALL4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What stain is positive in yolk sac tumor in addition to AFP?

A

Ovary​: Keratin, AFP (yolk sac elements, hepatic or intestinal epithelium in teratomas) and CD10

Testis: AFP (diffuse through cytoplasm and hyaline globules), cytokeratin, SALL4, Glypican3 (in hepatoid variant), PLAP (variable), CD117 (in solid pattern)

Yolk sac has red globules similar to clear cell (shown here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the entity shown of a peritoneal lesion that is associated with teratomas?

A

Gliomatosis peritonei

Thought to be a response to teratomas (WEIRD!)

ALSO associated with endometriosis and ventricular peritoneal shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

In the ovary, what is the most common heterologous element in a carcinosarcoma?

A

Cartilage

In uterus it is rhabdomyosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What placental lesion is shown here?

A

Amnion nodosum

Staghorn plaques on membranes, a condition characterized by yellow nodules of compressed squames and hair on the surface and membranes, is associated with severe, long-standing oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the different staining patterns of extramammary Paget’s disease regarding

1) primary vulvar Paget’s
2) vulvar Paget’s with underlying anorectal CA
3) vulvar Paget’s with underlying urothelial CA

A

Rare lesion of vulva/perianal skin, contrast to Paget’s disease of the nipple in that underlying adenocarcinoma may be rare. Mucin+, CEA+
1) Primary vulvar Paget’s: CK7, GCDFP-15 +; CK20-
2) Vulvar Paget’s secondary to anorectal carcinoma:
CK20+; CK7, GCDFP-15 –
3) Vulvar Paget’s secondary to urothelial carcinoma:
CK7, CK20, UPlakin-III +; GCDFP-15 -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the components of a pathology report that should be incluced in vulvar squamous cell carcinoma?

A

• Depth of invasion

  • Thickness of the tumor
  • Lymphovascular invasion
  • Margin status
  • Tumor grade (1, 2 or 3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What percentage of cervical SCC constitutes microinvasion and what are the stats on mets with these lesions?

A

< 5 mm (or 3mm depending on source) invasion is microinvasion
• < 1% of microinvasion of 3 mm metastasize
• < 10% of microinvasion of 3-5 mm metastasize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What percentage of adenoCA of the cervix has associated squamous intraepithelial lesions?

A

30-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the definition of microinvasive squamous cell carcinoma of the vulva? How does that differ from the cervix?

A

Vulva: Tumor depth less than 1mm as measured from the basement membrane of the nearest dermal papilla to the point of deepest invasion by tumor and less than 2cm in diameter

Cervix: Tumor depth less than 3mm as measured from the basal layer of overlying surface epithelium to the point of deepest invasion by the tumor, tumor diameter less than 7mm

*if invasion is present only adjacent to an involved gland, the measurement is from the top of the gland to the point of deepest invasion by tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Angiomyofibroblastoma (shown here) and aggressive angiomyxoma are very similar lesions. What stain is helpful in differentiating?

A

Smooth Muscle Actin

positive in angiomyofibroblastoma and negative in aggressive angiomyxoma (shown here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How are ovarian teratomas graded?

A

Grade 1 – neoplasms with embryonal tissue absent
or limited to a rare low magnification (X40) field
and not more than one such focus in any slide.
Grade 2 – embryonal tissue does not exceed three
low power microscopic fields in any slide.

Grade 3 – embryonal tissue occupies four or more
low magnification microscopic fields in at least one
slide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is being shown in this photo and what tumor is it associated with?

A

Azzopardi effect

Seen in small cell carcinomas when the necrotic tumor cells condense their chromatin material around blood vessels

*Only seen in lung small cells, NOT in ovarian!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What stain is an E-cadherin binding protein which is advocated by some experts for some E-cadherin equivocal cases?

A

p120

It will show membranous staining in DCIS and cytoplasmic staining in LCIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What stain is positive in almost 100% of lobular carcinoma (in situ and infiltrating)?

A

GCDFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Metaplastic breast carcinomas are frequently AE1/AE3 (pankeratin) and CAM5.2 negative. Therefore, what stains should always be used to rule it out?

A

CK903 and p63

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Paget’s disease of the breast ALWAYS has underlying DCIS and 50% of the time has underlying invasive carcinoma. Sometimes it can be hard to tell between Paget’s cell and Toker cells of the nipple. What stains can help?

A

Paget’s cells will be CK7, mucin, HER2 positive

Toker cells will be CAM5.2 positive but HER2 and mucin negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What unique translocation is seen in high grade endometrial stromal sarcomas and must be present to classify as high grade according to 2014 WHO?

A

t(10;17) (q22;p13) resulting in gene fusion YWAHAE-FAM22

The prognosis of this subset of HG-ESS is intermediate between LG-ESS and undiff uterine sarcoma.

About half of endometrial stromal sarcomas have the t(7;17) JAZF1/JJAZ1 gene fusion but recently a fusion associated with higher grades was discovered.

Tumors with YWHAE-FAM22 rearrangements constitute a distinct group of ESS, which is associated with high-grade morphology and aggressive clinical behavior compared to JAZF1 ESS. Thus, their distinction from typical JAZF1 ESS is important for prognostic and therapeutic purposes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What type of HPV is associated with Bowenoid papulosis of the vulva or penis?

A

HPV 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How often is extramammary Paget’s disease associated with underlying invasive carcinoma?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What vaginal lesion is shown and what would its location be?

A

The low cuboidal cells with hyaline material (resembles colloid) should be a clue that this is a mesonephric duct remnant (Gartner’s cyst) and they are located on the lateral vaginal wall

CD10 positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What vaginal lesion is shown and what causes it?

A

Vaginal adenosis

DES exposure

Can become clear cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Koilocytosis is related to ______ expression.

A

viral E4

Caused by low risk HPV (6, 11)

Productive infection (early and late gene expressed), non integration of viral DNA

15-30% associated with higher grade lesions

51
Q

Barrel shaped cervix should clue you into what kind of cervical cancer?

A

Glassy cell carcinoma!

Will be lots of eosinophils!

52
Q

In the western world, what is the most common GYN malignancy?

A

Endometrial adenoCA

53
Q

What ovarian tumor is shown, what will it stain for and what cytogenetic abnormality can it have?

A

Granulosa Cell Tumor

  • Inhibin
  • Calretinin
  • Vimentin
  • WT1
  • CD 99
  • S100
  • CD56
  • SF1 (steroidogenic factor)

FOXL2 gene abnormality on xsome 3

54
Q

Regarding MMMT, what is the most common heterologous element in:

1) EM
2) Ovary

A

1) Rhabdomyosarcoma
2) Cartilage

55
Q

What is the T staging for vulvar cancers?

A

T1: confined to vulva and peritoneum measuring 2cm or less in greatest dimension

T1a: stromal invasion less then 1mm

T1b: stromal invasion more than 1mm

T2: >2cm in greatest dimension and confined to vulva and peritoneum

T3: Evidence of invasion of the lower urethra, vagina or anus

56
Q

What is the staging for cervical squamous cell carcinoma?

A

Ia: confined to uterus and diagnosed only by microscopy with maximal stromal invasion depth of 5mm and a horizontal spread of 7mm or less

Ib: clinically visible confined to cervix, >5mm stromal invasion or >7mm horizontal spread

IIa: extend beyond the uterus but not the pelvic wall or lower one third of vagina and no evidence of parametrial invasion

IIIa: extend to the pelvic wall and involve the lower third of the vagina

IIIb: extend to the pelvic wall or cause hydronephrosis or nonfunctioning kidney

57
Q

What endometrial tumor occurs in young women, has excellent prognosis, associated with high risk HPV and oral contraceptives, are frequently associated with high grade squamous dysplasia or AIS, is the second most common variant of endometrioid CA, and are low grade tumors?

A

Villoglandular variant of endometrioid CA

58
Q

Peutz Jeghers is associated with development of what in the fallopian tubes?

A

Mucinous metaplasia

Single layer of mucinous epithelium replacing the usual ciliated-type epithelium of the fallopian tube

59
Q

What organism causes acute villitis with intervillous abscesses in the placenta?

A

Listeria

60
Q

What organism causes plasmacytic villitis with hemosiderin deposition and villous capillary thrombosis?

A

CMV

61
Q

What organism causes chronic villitis characterized by multinucleated giant cells?

A

Varicella

62
Q

What organism is associated with large, heavy pale placenta and microscopically demonstrates chronic villitis with prominent numbers of plasma cells and obliterative endarteritis?

A

Syphilis

63
Q

What is the most common maternal tumor to metastasize to the placenta or spread to the fetus?

A

Melanoma

64
Q

Florid epithelial hyperplasia, atypical lobular hyperplasia, atypical ductal hyperplasia and a family history of breast cancer give someone what increased risk for getting breast cancer?

A

4-5 times risk

65
Q

If you see a fibroadenoma with myxoid stroma, what syndrome should you think about?

A

Carney’s syndrome

*cardiac and cutaneous myxomas, myxoid FA, endocrine overactivity, pigmentation

66
Q

What is the most common non-invasive lesion seen in fibroadenomas?

A

Lobular carcinoma in situ

67
Q

Is it necessary to do an axillary lymph node dissection for a Phylllodes tumor?

A

NO

If these spread, they do so hematogenously

68
Q

What is the increased risk for invasive carcinoma with sclerosing adenosis, radial scar, columnar alteration, papilloma?

A

1.7 times

69
Q

What breast lesion shown is a mimicker of cancer, does not have a myoepithelial layer and contains PAS with diastase positive hyaline eosinophilic material in the lumens?

A

Microglandular adenosis

*No myoepithelial layer but there is intact basement membrane (positive with collagen IV stain)

70
Q

What is the increased risk of cancer with a radial scar?

A

1.8 times

71
Q

What is the increased cancer risk with moderate/florid epithelial hyperplasia, sclerosing adenosis and radial scar?

A

1.5-2 times

Family history increases risk

72
Q

What is the increased cancer risk with atypical ductal or lobular hyperplasia?

A

5X

73
Q

Atypical ductal hyperplasia and DCIS are negative for what stain and have what molecular alterations?

A

Both negative for CK5/6

UDH is positive for CK5/6!

16q-, 17p-, 1q+

They need close follow up and tamoxifen therapy

74
Q

If a patient just has high grade comedo DCIS (no evidence of invasive carcinoma), do you need to do axillary LN dissection?

A

YES

DCIS can go to nodes

If it’s a big lesion, they will do

75
Q

What markers are overexpressed in high grade DCIS?

A

Her2neu (50-60%)

p53

E-cadherin

76
Q

If a patient has LCIS, what is the risk that there is invasive cancer in either breast?

A

25% (10x risk)

77
Q

How much DCIS must be present in a cancer to classify it as extensive intraductal component (EIC)?

A

25%

78
Q

What is Rosen’s triad in breast lesions?

A

The histologic triad of tubular carcinoma (TC), columnar cell lesion (CCL), and lobular carcinoma in situ (LCIS)

*if you see any of these, look around carefully for the others

79
Q

What tumor is associated with tubular carcinoma of breast?

A

Cribiform carcinoma

*sometimes difficult to tell between cribiform DCIS. If it’s a large expansile mass, it’s CA

80
Q

What interesting staining pattern does micropapillary breast carcinoma show with stains?

A

REVERSE POLARITY

It will show staining opposite the lumen

*aggressive, don’t miss it!

81
Q

What is the staining pattern of PASH?

A

 Positive stains: vimentin, CD34, PR (intense)

 Negative stains: Factor 8, Ulex, CD31, ER, keratin

82
Q

How are breast tumors graded?

A

Tubule formation

– >75% = 1

– 10 – 75% = 2

– <10% = 3

Nuclear pleomorphism

– Small, uniform = 1

– Variable = 2

– Marked pleomorphism = 3

Mitotic count

– 0 – 5 = 1

– 6 – 10 = 2

– >11 = 3

Well, moderate and poorly differentiated

( I, II, III; 3 -5, 6 – 7, 8 – 9 points)

83
Q

What is Stewart Treves syndrome?

A

Also known as cutaneous angiosarcoma, refers to a lymphangiosarcoma, a rare complication that forms as a result of chronic, long-standing lymphedema.

84
Q

What is the role of BRCA1 and BRCA2 genes and what cancers are patients at risk for?

A

BRCA1: Tumor suppressor gene. Medullary and high grade tumors as well as ovary, prostate, colon

BRCA2: Possible role in DNA repair. Male breast, ovary, prostate, pancreas

85
Q

What disease is characterized by multiple hamartomas, 10q mutation and a family history of breast and thyroid cancers?

A

Cowden’s disease

86
Q

What is the oncotype DX and mammaprint?

A

Oncotype DX:

– 21 gene assay

– ER+ tumors

– Provides quantitative assessment of likelihood of distant metastases

– Assesses benefit from certain cancer chemotherapy

Mammaprint:

– Analysis of 70 genes

– Provides prognostic profile

87
Q

What mutation is seen in secretory (juvenile) carcinomas of the breast?

A

t(12;15) ETV6-NTRK3

Not seen in any other breast CA

88
Q

This tumor shown is an ovarian neoplasm and 80% occur in the first three decades and it is NOT generally associated with hormone production. The differential on morphology includes fibroma/thecoma however these are VERY rare after the age of 40 (age is very helpful).

A

Sclerosing stromal tumor of the ovary

These are usually unilateral and shows a pseudolobular pattern with cellular nodules separated by poorly cellular areas of dense collagen. They have prominent thin walled vessels within the nodules and may resemble a hemangiopericytoma.

89
Q

What is the translocation seen in EXTRAUTERINE endometrioid stromal sarcoma?

A

JAZF1-JJAZ1

t(7;17)

90
Q

When suspecting molar pregnancy on H&E, what TWO stains can you use to help make the diagnosis and how do they help?

A

p57: Differentiate between PARTIAL and COMPLETE mole (look for STROMAL staining in partial mole)

Ki67: Differentiates between MOLAR pregnancy and HYDROPIC pregnancy. >70% Ki67 staining around most villi is suggestive of MOLAR pregnancy

91
Q

What rare type of invasive pattern is seen in MUCINOUS ovarian neoplasms?

A

Expansile invasion

clue is when you see REALLY complex glands but no definite invasion

VERY subjective and difficult concept

92
Q

When you see a mucinous lesion in the ovary, what FOUR tumors should you be looking for in the background that can be associated with mucinous tumors?

A

Brenner Tumor

Carcinoid

Sertoli-Leydig

Teratoma

93
Q

In sertoli-leydig cell tumors of the ovary, what is the most important prognostic factor? What types of heterologous elements are seen in the different grades?

A

GRADE is the most important prognostic factor (whereas in granulosa cell tumor STAGE is the most important)

Sertoli-Leydig tumors are graded:

Well Diff: LOTS of sertoli tubules (NO HETEROLGOUS ELEMENTS)

Intermediate: Solid sheets of blue cells with interspersed leydig cells, possible tubules on periphery of sheets–heterologous elements 80% of the time will be mucinous epithelial

Poorly Diff: Sarcomatous features–heterologous elements usually skeletal mm and cartilage

94
Q

What stain is positive in thecoma and help differentiates it from fibroma?

A

Oil Red O

95
Q

What breast lesion is famous for arising in a fibroadenoma?

A

LCIS

96
Q

What is the recommended margin of excision with a Phyllodes tumor?

A

>5mm (0.5cm) margin

These tumors spread hematogenously

97
Q

What is this breast lesion?

A

PASH

98
Q

What is this breast lesion?

A

Myofibroblastoma

Note the alternating collagenous and spindle cell patterns. These tumors are CD34 positive/cytokeratin negative. In women they may have pseudoepithelioid features which can create diagnostic problems.

99
Q

What is this breast lesion?

A

Fibromatosis

100
Q

What is this breast lesion?

A

Angiosarcoma

101
Q

What is this breast lesion?

A

Adenomyoepithelioma

Basically this is mass producing sclerosing adenosis. It is myoepithelial rich as demonstrated by the biphasic pattern in this pic

102
Q

What is this breast lesion and what stain is positive?

A

Granular cell tumor

S100 positive

103
Q

What breast lesion is this?

A

Collagenous spherulosis

This is a fibrocystic change in which myoepithelial cells produce basal lamina-like material akin to that seen in adenoid cystic carcinoma. The cribriform like pattern resembles low grade ductal carcinoma in situ. The laminated appearance of the basal lamina-like material - and presence of myoepithelium in the population - however, are useful in distinguishing this lesion from ductal carcinoma in situ. Keep in mind that LCIS may arise in collagenous spherulosis.

104
Q

Papilloma or papillary cancer?

A

Papilloma

papilloma is more cohesive and more eosinophilic in character

105
Q

Papilloma or papillary cancer?

A

Papillary Cancer

papilloma is more eosinophilic

106
Q

Is this ADH or UDH?

A

UDH

*UDH is positive for CK5/6

107
Q

What is the T and N staging for invasive breast cancer?

A

pT1: Tumor ≤20 mm in greatest dimension

pT1mi: Tumor ≤1 mm in greatest dimension (microinvasion)

pT1a: Tumor >1 mm but ≤5 mm in greatest dimension

pT1b: Tumor >5 mm but ≤10 mm in greatest dimension

pT1c: Tumor >10 mm but ≤20 mm in greatest dimension

pT2: Tumor >20 mm but ≤50 mm in greatest dimension

pT3: Tumor >50 mm in greatest dimension

pT4: Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules). Note: Invasion of the dermis alone does not qualify as pT4.

pT4a: Extension to chest wall, not including only pectoralis muscle adherence/invasion

pT4b: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin which do not meet the criteria for inflammatory carcinoma

pT4c: Both T4a and T4b

pT4d: Inflammatory carcinoma

pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis greater than 2.0 mm

pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)

pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)

108
Q

High yield!

What lesion is this in the breast?

A

Micropapillary carcinoma of the breast

109
Q

What is simplex (differentiated) VIN?

A

A subset of VIN is un-related to HPV virus.

It occurs in older patients.

It is a histologically subtle lesion and may be underdiagnosed, especially in a superficial biopsy.

There is greater risk of progression to invasive squamous cell carcinoma than HPV-related VIN.

110
Q

How is depth of invasion measured in the cervix vs the vulva?

A

Vulva: Depth, measured from the uppermost dermal papillae (NOT basement membrane)

Critical Level: 1.0mm

Cervix: Depth, measured from the basement membrane of surface epithelium or endocervical gland.

FIGO Ia : depth width

Clinically visible tumors are stage Ib, regardless of size

111
Q

What is the difference between atypical leiomyoma and leiomyosarcoma?

A

Both have atypia but then count mitosis.

Atypical LM: Contains bizarre multinucleated tumor cells (moderate/severe atypia), less than 10 mitotic figures/10 HPF and NO tumor cell necrosis

If there is atypia AND necrosis, it is LMS regardless of mit count

>10 = LMS

112
Q

How is immaturity in a teratoma graded?

A

Grade 1: Rare foci of immature neural tissue

Grade II: 2-3 LPF

Grade III: 4 or more LPF

113
Q

What genetic alteration is consistently seen in juvenile granulonsa cell tumors?

A

Trisomy 12

114
Q

Lef Q:

A 54yo patient underwent resection of this ovarian mass. You would be MOST concerned about:

a) ascites
b) metastases
c) bilaterality
d) endometrial hyperplasia
e) intestinal obstruction

A

d) endometrial hyperplasia

This is a fibrothecoma of the ovary. The characteristic yellow hue reflects its potential endocrine function. These lesions may be estrogenic leading to unopposed estrogen stimulation to the EM with subsequent risk of HP or carcinoma

115
Q

What is the difference in measuring depth of invasion for vulvar melanoma and vulvar SCC?

A

Melanoma: from the surface of the epithelium discounting the acellular keratin layer

SCC: from the adjacent basement membrane of the closest dermal papilla

116
Q

In addition to Cowden’s syndrome, PTEN mutations are implicated in many other cancers. Regarding the immunostain, what are its main uses by pathologists?

A

LOSS OF NUCLEAR PTEN

(positive staining in almost all body tissues, similar to INI1 in that way)

  • seen in adenomatous thyroid nodules part of Cowden’s syndrome
  • distinguishes intraductal prostatic carcinoma from HGPIN
  • seen in EM hyperplasia and cancer (early marker)
117
Q

Lef Q:

The MOST COMMON malignancy arising out of a mature teratoma?

a) immature teratoma
b) adenoCA
c) carcinoid
d) SCC
e) melanoma

A

SCC

I personally would have thought immature teratoma but these DO NOT arise from mature teratomas and instead occur de novo

118
Q

What is this ovarian neoplasm and what is it associated with?

A

Gonadoblastoma

Most often seen in the context of mixed gonadal dysgenesis with Y chromosomal material being present as well as in patients with other intersex conditions (ie XO:XY mosaicism)

Composed of nests of both germ cells and sex cord cells.

Increased risk of developing dysgerminoma

This is different from POLYEMBRYOMA (shown here) which is a distinct pattern of mixed germ cell tumor that attempts to recapitulate embryonic architecture. In this image, three embryoid bodies are seen. Each is composed of a central portion of embryonal carcinoma between a ventral yolk sac tumor component and a dorsal amnion-like space.

119
Q

Lef Q:

The BEST diagnosis for this vaginal biopsy is:

a) squamous metaplasia
b) condyloma accuminatum
c) vaginal intraepithelial neoplasia
d) Bartholin’s cyst
e) adenosis

A

e) adenosis

The presence of subepithelial glandular tissue is the hallmark of adenosis. Although squamous metaplasia is part of the constellation of findings, it is the presence of the glands in a usually nonglandular tissue that is the major feature.

Associated with DES expoxsure in-utero although it can occur as an isolated finding.

120
Q

Lef Q;

This tissue was submitted after a surgical procedure on a vulvar cyst at the 4 o’clock position at the introitus. The MOST LIKELY diagnosis is:

a) Bartholin’s gland cyst
b) Endometriosis
c) EIC
d) Skene’s duct cyst
e) Gartner’s duct cyst

A

a) Bartholin’s gland cyst

In diagnosing these cysts, location and type of lining is important. This location is classic for Bartholin’s glands which are located at 4 o’clock and 8 o’clock at the introitus. The gland acini are mucinous and the duct epithelium usually is a mix of mucinous, transitional and squamous.

Skene’s ducts may be mucinous but occur in a periurethral location.

Gartner’s (Wollian) duct cyts occur in the anterolateral vaginal wall and may have a simple columnar lining

121
Q

Lef Q:

A 15yo girl is brought in for medical attention for a mass protruding out of the vagina with the histology shown. The MOST LIKELY diagnosis is:

a) sarcoma botyroides of the cervix
b) yolk sac of the vagina
c) sarcoma botyroides of the vagina
d) condyloma accuminatum
e) condyloma latum

A

a) sarcoma botyroides of the cervix

Sarcoma botyroides of the vagina is a rare tumor usually occuring in girls under the age of 5.

A histologically similar but less aggressive lesion is the sarcoma botyroides arising from the cervix which is more likely to occur in adolescents and early adulthood

122
Q

This is body in a cervical cytology specimen. What is this structure called and what is it associated with?

A

Donovan body from granuloma inguinale caused by Calymmatobacterium granulomatis

123
Q

What are the mitotic cutoffs for the uterine smooth muscle tumors?

A
124
Q

High Yield!

What lesion is this in the breast?

A

Micropapillary carcinoma of the breast

AP/CP (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions