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OMS II - Becom Exam 4 > Hef's Lectures > Flashcards

Hef's Lectures Flashcards

1
Q

what is the most common form of germ cell tumor?

A

seminoma

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2
Q

classical seminoma

A
  • 15-35 y/o and PAINLESS

- “fried egg” due to collagen -> large cells w/ clear cytoplasm and central nuclei

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3
Q

spermatocytic seminoma

A
  • 60 y/o

- NO fried egg appearance (no glycogen)

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4
Q

embryonal carcinoma

A
  • 20-30 y/o and PAINFUL
  • high hCG or AFP or both
  • HEMORRHAGE and NECROSIS -> Acute abdomen
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5
Q

yolk sac tumor

A
  • <4 y/o
  • high AFP
  • Schiller-Duval bodies
  • AFP and alpha 1 antitrypsin markers
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6
Q

choriocarcinoma

A
  • 20s and PAINFUL
  • mimic placental tissue
  • high hCG -> GYNECOMASTIA
  • blood metastasis to lungs
  • syncytiotrophoblasts and cytotrophoblasts
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7
Q

Teratoma

A
  • more than 1 of the 3 germline layers

- high hCG or AFP or both

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8
Q

Leydig cell tumors

A
  • 20-60 y/o
  • precocious puberty or gynecomastia
  • GOLDEN BROWN cholesterol nodules
  • crystalloids of Reinke
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9
Q

testicular lymphoma

A
  • men >60 y/o
  • metastis in testes
  • diffuse large B cell type
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10
Q

where do carcinomas arise from in prostate?

A

peripheral zone

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11
Q

where does BPH arise from in prostate?

A

transitional zone

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12
Q

what is the main androgen leading to BPH?

A

DHT

-formed by type 2 5a-reductase stromal cells

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13
Q

BPH

A
  • benign, men >50 y/o
  • NOT premalignant
  • DHT activates FGF and TGF-B
  • BRCA, HOXB13, PTEN, TP53 mutations
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14
Q

prostatic intraepithelial neoplasia (PIN)

A
  • cancer has NOT invaded BM

- can progress to prostatic adenocarcinoma

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15
Q

adenocarcinoma of the prostate

A
  • a-methylacyl-coenzyme A-racemase (AMACR) markers

- grading based on architecture alone, not nuclear atypia

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16
Q

are prostatic crystalloids a sign of good or bad prognosis?

A

-GOOD prognosis -> highly differentiated and less invasive

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17
Q

where does prostate cancer like to spread to?

A

-bone (osteoblastic), lungs, kidneys, Brain

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18
Q

prostatic biomarkers

A
  1. PAP
  2. PSA (>10 -> cancer)
  3. PCA3
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19
Q

what type of epithelium is the outside of the cervix compared to inside?

A

outside -> stratified squamous

inside -> columnar

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20
Q

acute vs. chronic cervicitis

A

acute -> neutrophil infiltrate

chronic -> lymphocytes, plasma cells, Mac infiltrate

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21
Q

squamous intraepithelial lesion (aka cervical intraepithelial neoplasia)…CIN

A

-NOT invading BM

  • CIN 1 -> <1/3
  • CIN 2 -> <2/3
  • CIN 3 -> full thickness (CIS)
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22
Q

cervical dysplasia

A
  • iodine stains of glycogen are BROWN
  • acetic acid stains WHITE (no glycogen)

test with Pap smear from the transformation zone

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23
Q

most common type of invasive cervical carcinoma?

A
  • SCC

- Adenocarcinoma is 2nd

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24
Q

when is dysfunctional uterine bleeding most worrisome?

A
  • post-menopausal women

- can indicate cancer

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25
endometriosis
- ectopic endometrial tissue OUTSIDE the uterus - usually due to retrograde menstruation - usually in ovaries -> CHOCOLATE CYSTS - gun powder nodules
26
adenomyosis
-endometrial tissue in myometrium
27
endometrial hyperplasia
- precursor to endometrial carcinoma - unopposed estrogen - associated w/ Cowden syndrome & PTEN mutations
28
endometrial carcinoma
- post-menopausal bleeding >40 y/o - unopposed estrogen - type I (endometrioid) -> PTEN mutations...less aggressive (high differentiation) and arises from endometrial hyperplasia - type II (serous) -> p53 mutations...more aggressive (poor differentiation) and arises from endometrial atrophy
29
Leiomyoma aka fibriod
- BENIGN - tumor of smooth muscle - "Whorled pattern" - Red degeneration -> ACUTE ABDOMEN - pre-menopause
30
Leiomyosarcoma
- MALIGNANT - tumor of smooth muscle - MED12 mutations - do NOT arise from leiomyomas - post-menopause
31
PCOS
- excess androgens -> hirsutism - associated w/ DM and obesity - hyperinsulinemia -> displace IGF
32
cystadenoma
- 30-40 y/o - benign - SINGLE layer, FLAT lining
33
brenner tumor
- bladder-like epithelium | - benign
34
borderline tumor
- low malignant potential | - MULTIPLE layers
35
cystadenocarcinoma
- JAGGED lining - Psammoma bodies - CA-125 marker
36
Dysgerminoma***
-ovarian counterpart of testicular seminoma - 20-30 y/o - "fried egg" appearance - all are MALIGNANT - high hCG and LDH
37
granulosa theca cell tumor
- Call-Exner bodies - coffee-bean nuclei - excess androgens and estrogen - FOXL2 gene mutations
38
fibroma
- benign tumor of fibroblasts - Meigs syndrome (ascites, effusion) - Gorlin syndrome
39
Sertoli-Leydig tumor
- mimics testicles - reinke crysals - produce androgens -> virulization and hirsutism
40
Krukenberg tumor
- metastatic mucinous tumor (GI/breast) -> spread to ovary - mucin -> SIGNET RING - bilateral
41
fibroadenoma
- benign | - MOBILE marble like mass (slippery)
42
intraductal papilloma
- benign - fibrovascular stalks -> BLOODY discharge from nipple - 2 layers (epith. + myoepith.)
43
Phyllodes tumor
- benign or malignant (based on STROMA) | - "leaf-like" due to overgrowth of fibrous part
44
mutations in what are at high risk for breast cancer?
- BRCA 1 and BRCA 2 | - p53
45
ductal carcinoma in situ (DCIS)
- NO invasion of BM - microcalcifications - NO mass 1. solid -> plugging 2. comedo** -> CHEESY necrotic debris in center w/ calcification 3. papillary -> lack fibrovascular stalk 4. cribriform -> fenestrations
46
Paget disease
if DCIS travels to the epidermis in the nipple | -always associated w/ carcinoma of breast
47
invasive ductal carcinoma
HAS MASS 1. NST - extensive FIBROSIS -> DESMOPLASIA - Peau d' Orange (dimpling) - form ducts - NO myoepithelial layer (single) 2. Medullary - SOFT & fleshy (encephaloid carcinoma) - most Anaplastic, BEST prognosis 3. Mucinous - islands of cells "floating" in mucin 4. tubular - no myoepith. layer - VERY good prognosis
48
Lobular carcinoma in situ
- NO invasion of BM - loosely cohesive cells (lack cadherin) - mucin -> SIGNET RING - ER+ and PR +, no HER2
49
invasive lobular carcinoma
- INDIAN FILE -> single file spread of cells | - bad prognosis
50
do ER/PR negative tumors have a good or bad prognosis?
BAD | -want ER+ and PR+ tumors to treat w/ anti estrogen therapy (ex. tamoxifen)
51
HER2
- receptor seen on some types of breast cancer | - respond to anti-HER2 Abs (trastuzumab/herceptin) if present
52
where does breast cancer 1st metastasize to?
AXILLARY lymph nodes | -disseminate to lung, liver, bone, brain
53
thyroid follicular adenoma
- benign & encapsulated - COLD nodule - Hurthle cell type -> seen in parathyroid lesions also - Atypical type -> indicate malignancy
54
thyroid carcinoma
- multiple types - COLD nodules - normal TSH values - FNA if nodules 1-4 cm (>4 -> surgery) - arise from follicular cells (except Medullary)
55
most common type of thyroid carcinoma
PAPILLARY thyroid carcinoma
56
Papillary thyroid carcinoma
- TRANSLOCATION/inversion of RET - gain of function mut. in BRAF - RADIATION is risk factor - fibrovascular core - ORPHAN ANNIE EYE nuclei - Pseudo-inclusion bodies - PSAMOMMA bodies
57
Follicular thyroid carcinoma
- q13;p25 translocation -> fusion of PAX8 w/ PPARG - IODINE DEFICIENCY is risk factor -> stimulate TSH - produces more T3, T4 -> suppress TSH - INFILTRATE through capsule - COLLOID follicles - HOT iodine scan
58
Anaplastic thyroid carcinoma
- undifferentiated - B-catenin activation mutation - WORSE PROGNOSIS -> aggressive - ELDERLY (65 y/o)
59
Medullary thyroid carcinoma
- arise from PARAFOLLICULAR C cells -> Calcitonin - high Calcitonin w/ NORMAL Ca2+ levels - point mutations in RET (sporadic) or germline mut. in RET (MEN-2A/B) - markers: CEA and CALCITONIN - AMYLOID deposits -> SOFT
60
Are most thyroid nodules malignant or benign?
BENIGN**
61
Adrenocortical Adenocarcinoma
-11C-metomidate-PET is diagnostic -> binds to 11B-hydroxylase
62
Pheochromocytoma
- BENIGN -> tumor of adrenal MEDULLA - ADULT (20-40)*** - dark brown in K+ dichromate*** - Zellballen Pattern*** - neuron-specific enolase (NSE) marker - HTN 90% of time - catecholamines in urine (Vanillylmandelic acid and Metanephrines)**
63
Neuroblastoma
- MALIGNANT - 4th most common childhood malignancy -> CHILD <5 y/o** - small blue tumor cells - Schwann cells** - Homer-Wright Pseudorosettes** - markers: NSE, neurofilaments, chromagranin - Raccoon eyes, Heterochromia iridis
64
Pituitary cancers
- BENIGN - FUNCTIONAL -> PRL, ACTH, GH - nm23 tumor suppressor mutation** - c-MYC activating mutation
65
MEN type 1 (Wermer syndrome)
- 3 ps -> parathyroid, pancreatic, pituitary adenomas** | - inactivating mutation in MEN-1 (chrom. 11)
66
Zollinger-Ellison syndrome
-gastrinomas (pancreatic tumor) w/ MEN1 mutations -> peptic/gastric ulcers
67
Carcinoid tumors
- MEN1 mutations - metastasize -> death - no cure - release Serotonin** -> 5-hydroxytryptamine metabolite in urine** - pallagra, flushing, diarrhea
68
MEN type 2A (Sipple syndrome)
- gain of function mut. in RET 1. Medullary thyroid carcinoma 2. Pheochromocytoma 3. Parathyroid hyperplasia
69
MEN-2B
- M918T variant of RET mut. - NO hyperparathyroidism 1. medullary thyroid carcinoma 2. pheochromocytoma 3. mucosal neuromas 4. Marfanoid Habitus
70
Von Hippel-Linau (VHL) disease
- benign - mut. in VHL - HEMANGIOBLASTOMAS*** and pheochromocytoma
71
Pancreatic Neuroendocrine Tumors (PanNETs)
- MEN1 and PTEN mutations - MONOTONOUS cells - AMYLOID deposits
72
pancreatic beta cells
- produce insulin by pro hormone convertase 1/3 (PC1/3) - ATP-regulated K+ channels - INSULINOMA
73
what drug blocks K+ efflux leading to an increase in insulin
SULFONYLUREA
74
pancreatic alpha cells
- secrete glucagon | - GLUCAGONOMA -> Necrolytic Migratory Erythema*** (AA and zinc deficiency)
75
pancreatic delta cells
- secrete Somatostatin | - SOMATOSTATINOMA -> low gastric acid, gallstones, steatorrhea
76
Gastrinoma (Zollinger-Ellison syndrome)
-increase acidity, ulcers, high serum gastrin
77
VIPoma (Verner-Morrison syndrome)
- diarrhea -> hypokalemia, dehydration | - treat and image w/ OCTREOTIDE
78
mutations that can cause DM
1. MODY - glucokinase mut. - hepatic nuclear factor mut. - insulin promotor factor 1 mut. 2. GATA6 3. DNA 3243
79
HbA1c
- glycated Hb from DM | - high levels -> retinopathy and CV problems
80
type I DM
- HLA-DR3 and HLA-DR4 class II antigens (higher w/ DQ8)*** - HLA-DQ5 and DQ6 -> protection from type 1 - hyperglycemia - increase risk for Candida - DIABETIC KETOACIDOSIS
81
type 2 DM
- insulin resistance due to obesity -> adipokines (resistin and RBP4)** - beta cell dysfunction -> AMYLOID deposits* - beta cell burnout - excess FAs
82
Hyperosmolar Hyperglycemic state
- seen in type 2 DM | - hyperglycemia, dehydrated, uremia, coagulability, rhabdomyolysis -> high mortality
83
AGE from DM
- ECM accumulation -> cross-link ECM type I collagen -> REDUCE ELASTICITY - trap LDL proteins -> cholesterol deposits (Kimmelstiel-Wilson Nodules)
84
activation of kinases and cytokines w/ DM
High glucose -> increase DAG -> increase PKCbeta -> increase TGFbeta and VEGF -> increase vascular permeability and angiogenesis -Avastin (VEGF antagonist) -> treat diabetic retinopathy

OMS II - Becom Exam 4 (8 decks)

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