GYN Benign & Malignant

Question 1

Fibrocystic changes to breast that carries high risk of cancer

Answer 1

ATtypical hyperplasia (“likely to ATurn into cancer”)

(epithelial hyperplasia is a proliferative breast disorder and is benign)

Question 2

proliferative breast disorders are benign. what are 3 examples?

(slightly increased risk of cancer)

Answer 2

1. epithelial hyperplasia (increased luminal & myoepithelial cells)
2. sclerosing adenosis (calcification, compressed acini)
3. intraductal papilloma (“finger-like” projections, myoepithelium)

Question 3

location of intraductal papillomas

(“finger-like”)

Answer 3

under areola

(serous or bloody discharge; increased risk for cancer although benign)

Question 4

ALL breast cancer comes from which location?

Answer 4

terminal duct lobular unit (ductal & terminal)

(ductal & lobular get their name from the appearance of the cells, NOT the location w/in the breast!)

Question 5

breast cancer tumors can be classified by which 3 predictive markers

Answer 5

1. estrogen (ER+)
2. progesterone (PR+)
3. HER-2 (cell surface tyrosine kinase receptor)

(this gives us info about prognosis & therapy)

Question 6

breast cancer in men always presents as a mass located…

Answer 6

subareolar/near nipple

(intraductal papilloma also located under/near the nipple)

Question 7

male breast cancer is a/w… (2 conditions)

Answer 7

klinefelter (~10%)
BRCA2 gene mutation (15%)

Question 8

breast cancer a/w BRCA1 mutation

Answer 8

medullary breast carcinoma (MBC)

(10% of BRCA1 have this)

Question 9

histologic findings of medullary breast cancer

a/w BRCA1 mutations

Answer 9

1. syncytial growth pattern high nuclear atypia
2. dense lymphohistiocytic infiltration

Question 10

3 Rx that tx ER-positive breast cancer

Answer 10

1. tamoxifen
2. anastrozole
3. letrozole

(-“zole” = aromatase inhibitor)

Question 11

Rx for HER-2 positive breast cancer

Answer 11

Trastuzumab (“Her two (HER2) breasts can be treated with trastwozumab.”)

(AE: dilated cardiomyopathy: If you trust trustuzumub, it might break your heart.)

Question 12

how is the pathophysiology different in inflammatory breast cancer vs. paget’s disease of the breast

Answer 12

breast cancer: malignant migration through lymph vessels
paget’s: neoplastic cells migrate through mammary ducts

Question 13

best prognosis of the 3 gynecologic tumors?

(ovarian, endometrial, cervical)

Answer 13

1. Cervical (<45 y/o)
2. Endometrial (55 y/o)
3. Ovarian (>65 y/o)

(“CEOs often go from best to worst as they get older”)

Question 14

PCOS is a/w obesity, acanthosis nigricans and an increased risk of endometrial cancer d/t…

Answer 14

unopposed estrogen from repeated anovulatory cycles

Question 15

leiomyoma is considered a …

Answer 15

fibroid (mostly submucosal polyp, like a lipoma or fibroma, but depends on location)

(adnexal mass w/hypertrophied myometrial tissue. leiomyosarcoma is malignant)

Question 16

2 sx of leiomyoma (benign fibroid)

Answer 16

1. abnormal uterine bleeding
2. pelvic pressure/pain

(reproductive dysfunction also)

Question 17

why are post-menopausal women at a higher risk for endometrial cancer?

Answer 17

unopposed estrogen levels (no progesterone to stop it)

(especially in obese women bc they have more estrogen)

Question 18

which Rx are used to prevent endometrial cancer is post-menopausal women w/uteruses?

Answer 18

progestin added to estrogen

(endometrial cancer is d/t unopposed estrogen)

Question 19

MC finding in papillary necrosis

Answer 19

gross hematuria (clumps of blood reported by patient)

(no intrinsic renal failure; MCC diabetes and sickle cell)

Question 20

MCC of papillary necrosis

Answer 20

sickle cell

(also diabetes, NSAIDs)