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Step 1 > Life Cycles Pathology > Flashcards

Life Cycles Pathology Flashcards

1
Q

Condyloma Acuminatum

A

Anogenital warts caused by HPV 6 and 11

Will see koilocytes on histology

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2
Q

What causes priapism

A

Obstruction of the deep dorsal vein, causing pathologic congestion of the corpora cavernosa

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3
Q

Patient has abnormal curvature of the penis with pain and erectile dysfunction

A

Peyronie’s disease

Chronic fibrosis of the penile tunica albuginea

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4
Q

Penile Cancer

A

Squamous cell carcinoma (associated with HPV 16/18, smoking, lack of circumcision, Bowen disease)

Can present as a warty mass or an indurated ulcer

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5
Q

Bowen disease

A

Precursor to SCC of the penis

In situ carcinoma of the penis that presents as leukoplakia (associated with HPV 16)

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6
Q

Erythroplasia of Queyrat

A

Variant of Bowen disease, but presents as a erythroplakia on the glans

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7
Q

Bowenoid papulosis

A

In situ carcinoma that presents as multiple reddish papules, associated with HPV 16
Seen in younger males

Does not usually progress to invasive carcinoma

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8
Q

Congenital Hydrocele

A

Fluid collection within the tunica vaginalis

Due to incomplete closure of the processus vaginalis leading to communication of the testes with the peritoneal cavity

Transillumination

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9
Q

Varicocele

A

Dilation of the spermatic vein due to impaired drainage
“Bag of worms” appearance

Left>right

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10
Q

Testicular torsion blood flow

A

The veins are obstructed but the artery remains open: blood is able to collect in the testis but is unable to be drained out

EMERGENCY!

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11
Q

Infections that can cause orchitis

A

Viral: coxsackie B, mumps
Bacterial: N. gonorrhea, Chlamydia
TB
Syphilis

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12
Q

Biopsy of testicular tumors

A

DO NOT DO THIS
Risk of seeding the scrotum

Instead, remove via radical orchiectomy

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13
Q

Testicular tumor that stains for AFP?

What is seen on histo?

A

Yolk sac tumor

Histo shows Schiller-Duvall bodies (resemble primitive glomeruli)

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14
Q

Testicular tumor that stains for bHCG? What symptoms can this cause?

A

Choriocarcinoma – disordered syncytiotrophoblast and cytotrophoblast elements– NO VILLI

May produce gynecomastia or hyperthyroidism since hCG is structurally similar to LH, FSH, and TSH

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15
Q

Testicular tumor that stains for vimentin

A

Leydig cell tumor or Sertoli cell tumor

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16
Q

Intracytoplasmic eosinophilic inclusions seen in histology of a testicle

A

Reinke crystals = Leydig cell tumor

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17
Q

Child (age 3) presents with a testicular mass that cannot be transilluminated. What do you suspect?

A

Yolk sac tumor

Most common testicular mass in children

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18
Q

Risk factors for testicular germ cell tumor

A

Klinefelter syndrome

Cryptorchidism

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19
Q

What does it mean if you see basal cells on a sample from a patient’s prostate

A

Reassuring diagnosis - because invasive carcinoma has no basal cells

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20
Q

What is the most likely cause of chronic prostatitis?

A

Abacterial cause (>90%): will have negative cultures

Only about 5-10% of cases of chronic prostatitis are due to unresolved bacterial infection (most likely E. coli)

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21
Q

Causes of granulomatous prostatitis

A
  1. Specific organisms: TB, cocci, blastomycosis, cryptococcus
  2. Non specific: response to ruptured glands/ducts
  3. After treatment for bladder cancer with BCG (an attenuated form of TB)
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22
Q

Risk of prostate cancer with BPH

A

NO RISK: BPH is not a premalignant lesion

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23
Q

What causes BPH? How can you treat it?

A

DHT action – causes hyperplasia of glands and stroma (not always in equal amounts)

Treatment: a blockers (terazosin and tamsulosin) to cause relaxation of the smooth muscle, 5 a reductase inhibitors (finasteride) to reduce prostate size, and tadalafil (PDE-5 inhibitor)

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24
Q

What zone is involved in BPH? In prostate cancer?

A

BPH: transitional zone

Prostate CA: peripheral zone

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25
Q

What are the majority of prostate carcinomas?

A

Adenocarcinomas (95%)

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26
Q

Where do you see invasion of prostatic adenocarcinoma?

What is a complication of resection?

A

Perineural invasion

Erectile dysfunction is a complication of surgery

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27
Q

Gleason grading system

A

Used to grade invasive prostate carcinoma
1 = well differentiated
5= poorly differentiated

Give a grade for most common pattern seen, and then for second most common pattern seen, and add together

Sum >7 is poor prognosis

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28
Q

Prostate cancer metastases

A

Usually late
Lymph nodes: internal iliac
Distant: bone (vertebrae and pelvis), brain, lungs

** Bone lesions are osteoblastic

29
Q

PSA

A

Serine protease secreted by the prostate to mobilize the sperm and dissolve cervical mucus
Organ specific but is not sensitive or specific for carcinoma (elevated in BPH, infarct, prostatitis, and recent ejaculation)

30
Q

Who does testicular torsion occur in?

A

Neonates

Adolescents/young adults

31
Q

What procedure is done prophylactically in bellclappers deformity to prevent testicular torsion?

A

Orchiopexy: attach the testis to the tunica vaginalis

32
Q

Ovarian counterpart of a seminoma

A

Dysgerminoma

33
Q

Prognosis if a teratoma in found in a male infant vs a 17 year old male

A

Good prognosis in infants/children

All teratomas are considered malignant with risk of mets in post pubertal males

34
Q

Prognosis of a mixed embryonal carcinoma vs pure embryonal carcinoma

A

Mixed carcinoma has a better prognosis

35
Q

A non breast feeding woman presents with painful red swollen breast. Do you suspect acute mastitis or something else?

A

Since she is not breast feeding, consider inflammatory carcinoma

36
Q

What does Paget disease of the nipple suggest?

A

Underlying carcinoma (most often ductal carcinoma in situ)

37
Q

What are the major factors in breast cancer prognosis?

A 
Invasive vs in situ
Tumor size
Lymph node mets
Distant mets
Inflammatory carcinoma
38
Q

Theories of Endometriosis

A

Regurgitation theory: retrograde menstruation through the fallopian tubes

Metaplastic theory: de novo formation from coelmic epithelium through a metastatic process

Vascular or lymphatic dissemination theory: dissemination through the pelvic veins and lymphatics

39
Q

Where is the most common site of endometriosis?

A

Most common site = bilateral ovaries

Appear as endometrioma - blood filled “chocolate cyst”

40
Q

Type 1 vs Type 2 endometrial carcinomas

A

Type 1: estrogen-driven, in pre/postmenopausal women, endometrioid adenocarcinoma

Type 2: not related to estrogen, postmenopausal women, aggressive subtypes (clear cell, serous, carcinosarcoma)

41
Q

Risk factors for endometrial carcinoma

A

Excess estrogen, obesity, diabetes, HTN, infertility, late menopause, Lynch syndrome

42
Q

Carcinosarcoma

A

Endometrial adenocarcinoma in which there is malignant stromal differentiation (stroma can differentiate into malignant muscle, cartilage, and bone)
Not related to estrogen
HIGHLY MALIGNANT

43
Q

Where do the majority of serous cancers in the pelvis derive from?

A

Fallopian tubes

44
Q

Mutation that causes adenocarcinoma of the fallopian tube?

A

p53 –> dysplasia

45
Q

Ovarian tumor composed of bladder like epithlium. Cells have coffee bean nuclei.

A

Brenner tumor
(usually benign)

B = brenner, bladder, bean

46
Q

Meigs syndrome

A

Pleural effusions and ascites caused by an ovarian thecoma-fibroma tumor

Resolves with removal of the tumor

Women complain of “pulling” sensation in groin

47
Q

What is a leiomyoma?

What type of leiomyoma is most likely to cause menometorrhagia?

A

Caused by proliferation of myometrial smooth muscle cells. Causes heavy menstrual bleeding and the uterus is irregularly enlarged - estrogen sensitive
More common in African American women
Submucosal leiomyoma

48
Q

Adenomyosis

A

extension of glandular endometrial tissue into the uterine myometrium – presents with dysmenorrhea, menorrhagia, and uniformly enlarged globular uterus

49
Q

Where is vaginal SCC most commonly located?

A

Upper posterior vagina

50
Q

Where is vaginal adenocarcinoma more commonly located?

A

Upper anterior vagina

adenocarcinoma = anterior

51
Q

Child presents with multiple polypoid masses in the vagina. What is your diagnosis? What marker is positive/

A

Embryonal rhabdomyosarcoma (sarcoma botryoides)

(Malignant mesenchymal proliferation of immature skeletal muscle)

Desmin (+)

52
Q

What happens to women who had exposure to DES in utero?

A

Clear cell adenocarcinoma of the vagina

53
Q

What tumor marker is seen in ovarian tumors?

A

CA125

54
Q

Transformation Zone

A

Squamocolumnar junction of the cervix

Most common area for cervical cancer

55
Q

Blue mucin, prominent nucleoli, loss of basal cells, and ERG-TMPRSS2 is associated with what?

A

Prostate adenocarcinoma

56
Q

Fibroadenoma vs phyllodes tumor

A

Both have inc fibrous tissue and glands
Phyllodes tumor has overgrowth of fibrous stromal components and can be malignant – seen in postmenopausal women (whereas fibroadenoma is in premenopausal women)

57
Q

How does DCIS present on mammogram

A

Microcalcifications (due to necrosis of the tumor cells)

58
Q

Which breast cancer(s) lack E-cadherin?

A

Invasive lobular carcinoma

59
Q

What is the most common cause of nipple discharge (serous or bloody)?

A

Intraductal papilloma – small papillary tumor within the lactiferous ducts

Slight risk for cancer

60
Q

Breast feeding woman presents with a red and painful breast, what do you suspect?

A

Lactational mastitis – inc risk of bacterial infection (usually staph aureus) through cracks in nipple
Tx with antibiotics and continue breast feeding

61
Q

Granulosa cell tumor of the ovary

Signs and symptoms
Histology

A

Often produces estrogen and presents with precocious puberty in kids and endometrial hyperplasia/postmenopausal bleeding in older women.
Can also cause breast tenderness

Histo shows Call-Exner bodies (granulosa cels arranged haphazardly around colelctions of eosinophilic fluid)

62
Q

Histo of ovarian neoplasm shows psammoma bodies

A

Serous cystadenocarcinoma

63
Q

Pseudomyxoma peritonei

A

Mucinous cystadenocarcinoma

Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

64
Q

Inc AFP in ovarian tumorq

A

Yolk sac (endodermal sinus) tumor

May have schiller duval bodies on histo

65
Q

Krukenburg tumor

A

GI malignancy that metastasizes to ovaries

66
Q

What other conditions are ovarian tumors related to?

A

Lynch syndrome: polyposis syndrome caused by DNA mismatch repair mutation

Dermatomyositis

BRCA

67
Q

Which part of the urethra is most susceptible to injury due to pelvic fractures?

A

Membranous urethra – urine will leak into the retropubic space
o Perineal straddle injuries cause damage to the bulbar and penile urethra
o More common in males due to longer urethra

68
Q

Postmenopausal woman presents with breast mass and green-brown nipple discharge

A

Mammary duct ectasia – inflammation with dilation of the subareolar ducts

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