Life Cycles Pathology Flashcards
Condyloma Acuminatum
Anogenital warts caused by HPV 6 and 11
Will see koilocytes on histology
What causes priapism
Obstruction of the deep dorsal vein, causing pathologic congestion of the corpora cavernosa
Patient has abnormal curvature of the penis with pain and erectile dysfunction
Peyronie’s disease
Chronic fibrosis of the penile tunica albuginea
Penile Cancer
Squamous cell carcinoma (associated with HPV 16/18, smoking, lack of circumcision, Bowen disease)
Can present as a warty mass or an indurated ulcer
Bowen disease
Precursor to SCC of the penis
In situ carcinoma of the penis that presents as leukoplakia (associated with HPV 16)
Erythroplasia of Queyrat
Variant of Bowen disease, but presents as a erythroplakia on the glans
Bowenoid papulosis
In situ carcinoma that presents as multiple reddish papules, associated with HPV 16
Seen in younger males
Does not usually progress to invasive carcinoma
Congenital Hydrocele
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
Varicocele
Dilation of the spermatic vein due to impaired drainage
“Bag of worms” appearance
Left>right
Testicular torsion blood flow
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!
Infections that can cause orchitis
Viral: coxsackie B, mumps
Bacterial: N. gonorrhea, Chlamydia
TB
Syphilis
Biopsy of testicular tumors
DO NOT DO THIS
Risk of seeding the scrotum
Instead, remove via radical orchiectomy
Testicular tumor that stains for AFP?
What is seen on histo?
Yolk sac tumor
Histo shows Schiller-Duvall bodies (resemble primitive glomeruli)
Testicular tumor that stains for bHCG? What symptoms can this cause?
Choriocarcinoma – disordered syncytiotrophoblast and cytotrophoblast elements– NO VILLI
May produce gynecomastia or hyperthyroidism since hCG is structurally similar to LH, FSH, and TSH
Testicular tumor that stains for vimentin
Leydig cell tumor or Sertoli cell tumor
Intracytoplasmic eosinophilic inclusions seen in histology of a testicle
Reinke crystals = Leydig cell tumor
Child (age 3) presents with a testicular mass that cannot be transilluminated. What do you suspect?
Yolk sac tumor
Most common testicular mass in children
Risk factors for testicular germ cell tumor
Klinefelter syndrome
Cryptorchidism
What does it mean if you see basal cells on a sample from a patient’s prostate
Reassuring diagnosis - because invasive carcinoma has no basal cells
What is the most likely cause of chronic prostatitis?
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)
Causes of granulomatous prostatitis
- Specific organisms: TB, cocci, blastomycosis, cryptococcus
- Non specific: response to ruptured glands/ducts
- After treatment for bladder cancer with BCG (an attenuated form of TB)
Risk of prostate cancer with BPH
NO RISK: BPH is not a premalignant lesion
What causes BPH? How can you treat it?
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)
What zone is involved in BPH? In prostate cancer?
BPH: transitional zone
Prostate CA: peripheral zone
What are the majority of prostate carcinomas?
Adenocarcinomas (95%)
Where do you see invasion of prostatic adenocarcinoma?
What is a complication of resection?
Perineural invasion
Erectile dysfunction is a complication of surgery
Gleason grading system
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
Prostate cancer metastases
Usually late
Lymph nodes: internal iliac
Distant: bone (vertebrae and pelvis), brain, lungs
** Bone lesions are osteoblastic
PSA
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)
Who does testicular torsion occur in?
Neonates
Adolescents/young adults
What procedure is done prophylactically in bellclappers deformity to prevent testicular torsion?
Orchiopexy: attach the testis to the tunica vaginalis
Ovarian counterpart of a seminoma
Dysgerminoma
Prognosis if a teratoma in found in a male infant vs a 17 year old male
Good prognosis in infants/children
All teratomas are considered malignant with risk of mets in post pubertal males
Prognosis of a mixed embryonal carcinoma vs pure embryonal carcinoma
Mixed carcinoma has a better prognosis
A non breast feeding woman presents with painful red swollen breast. Do you suspect acute mastitis or something else?
Since she is not breast feeding, consider inflammatory carcinoma
What does Paget disease of the nipple suggest?
Underlying carcinoma (most often ductal carcinoma in situ)
What are the major factors in breast cancer prognosis?
Invasive vs in situ Tumor size Lymph node mets Distant mets Inflammatory carcinoma
Theories of Endometriosis
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
Where is the most common site of endometriosis?
Most common site = bilateral ovaries
Appear as endometrioma - blood filled “chocolate cyst”
Type 1 vs Type 2 endometrial carcinomas
Type 1: estrogen-driven, in pre/postmenopausal women, endometrioid adenocarcinoma
Type 2: not related to estrogen, postmenopausal women, aggressive subtypes (clear cell, serous, carcinosarcoma)
Risk factors for endometrial carcinoma
Excess estrogen, obesity, diabetes, HTN, infertility, late menopause, Lynch syndrome
Carcinosarcoma
Endometrial adenocarcinoma in which there is malignant stromal differentiation (stroma can differentiate into malignant muscle, cartilage, and bone)
Not related to estrogen
HIGHLY MALIGNANT
Where do the majority of serous cancers in the pelvis derive from?
Fallopian tubes
Mutation that causes adenocarcinoma of the fallopian tube?
p53 –> dysplasia
Ovarian tumor composed of bladder like epithlium. Cells have coffee bean nuclei.
Brenner tumor
(usually benign)
B = brenner, bladder, bean
Meigs syndrome
Pleural effusions and ascites caused by an ovarian thecoma-fibroma tumor
Resolves with removal of the tumor
Women complain of “pulling” sensation in groin
What is a leiomyoma?
What type of leiomyoma is most likely to cause menometorrhagia?
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
Adenomyosis
extension of glandular endometrial tissue into the uterine myometrium – presents with dysmenorrhea, menorrhagia, and uniformly enlarged globular uterus
Where is vaginal SCC most commonly located?
Upper posterior vagina
Where is vaginal adenocarcinoma more commonly located?
Upper anterior vagina
adenocarcinoma = anterior
Child presents with multiple polypoid masses in the vagina. What is your diagnosis? What marker is positive/
Embryonal rhabdomyosarcoma (sarcoma botryoides)
(Malignant mesenchymal proliferation of immature skeletal muscle)
Desmin (+)
What happens to women who had exposure to DES in utero?
Clear cell adenocarcinoma of the vagina
What tumor marker is seen in ovarian tumors?
CA125
Transformation Zone
Squamocolumnar junction of the cervix
Most common area for cervical cancer
Blue mucin, prominent nucleoli, loss of basal cells, and ERG-TMPRSS2 is associated with what?
Prostate adenocarcinoma
Fibroadenoma vs phyllodes tumor
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)
How does DCIS present on mammogram
Microcalcifications (due to necrosis of the tumor cells)
Which breast cancer(s) lack E-cadherin?
Invasive lobular carcinoma
What is the most common cause of nipple discharge (serous or bloody)?
Intraductal papilloma – small papillary tumor within the lactiferous ducts
Slight risk for cancer
Breast feeding woman presents with a red and painful breast, what do you suspect?
Lactational mastitis – inc risk of bacterial infection (usually staph aureus) through cracks in nipple
Tx with antibiotics and continue breast feeding
Granulosa cell tumor of the ovary
Signs and symptoms
Histology
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)
Histo of ovarian neoplasm shows psammoma bodies
Serous cystadenocarcinoma
Pseudomyxoma peritonei
Mucinous cystadenocarcinoma
Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
Inc AFP in ovarian tumorq
Yolk sac (endodermal sinus) tumor
May have schiller duval bodies on histo
Krukenburg tumor
GI malignancy that metastasizes to ovaries
What other conditions are ovarian tumors related to?
Lynch syndrome: polyposis syndrome caused by DNA mismatch repair mutation
Dermatomyositis
BRCA
Which part of the urethra is most susceptible to injury due to pelvic fractures?
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
Postmenopausal woman presents with breast mass and green-brown nipple discharge
Mammary duct ectasia – inflammation with dilation of the subareolar ducts
