Male and Female Genital Tract, Breast Flashcards
Most common cause of
hydronephrosis in infants
and children
Ureteropelvic junction
obstruction
Most common and serious
congenital anomaly of the
urinary bladder
Vesicoureteral reflux
Sequelae of bladder
exstrophy
Infections, Colonic
glandular metaplasia, ↑
risk of Adenocarcinoma
Partial patency of the
urachus result in the
formation of
Urachal cyst
Cancer associated with
urachal cyst and intestinal
metaplasia of the urinary
bladder
Adenocarcinoma
Most common cause of acute
cystitis
Coliforms (E. coli, Proteus,
Klebsiella, Enterobacter)
Viruses associated with
hemorrhagic cystitis
Adenovirus, BK virus
Commonly associated drug
with hemorrhagic cystitis
Cyclophosphamide
Polypoid cystitis is
commonly associated with
Indwelling catheter use
Type of urinary bladder
cancer linked to Schistosoma
haematobium infection
Squamous cell carcinoma
Most common bladder tumor
Urothelial tumors
Most important risk factor
for urothelial tumor
formation
Smoking
A 4-year-old female presents
with painless hematuria,
frequency and recurrent UTI.
Imaging revealed
hydronephrosis and a grapelike
lesion inside the urinary
bladder. What is the most
likely initial diagnosis?
Embryonal
rhabdomyosarcoma
(Sarcoma botyroides)
Most common urinary
bladder sarcoma in adults
Leiomyosarcoma
Non-infectious urethritis
associated with
conjunctivitis and arthritis
Reactive arthritis (Reiter
syndrome)
Common infectious etiology
of urethritis
N. gonorrhoeae, C.
trachomatis, Ureaplasma
urealyticum
Type of carcinoma seen in
the proximal urethra
Urothelial carcinoma
Type of carcinoma seen in
the distal urethra
HPV-related Squamous cell
carcinoma
Abnormal opening on the
ventral shaft of the penis
Hypospadia
Associated disease with
hypospadia
Cryptorchidism
Abnormal opening on the
dorsal shaft of the penis
Epispadia
Associated disease with
epispadia
Exstrophy of the bladder
Long-term consequence of
phimosis and balanoposthitis
↑ risk for penile cancer
Etiology of condyloma
acuminatum or genital warts
Low-risk HPVs (HPV 6 >
HPV 11)
Perinuclear cytoplasmic
vacuolization of squamous
epithelial cells; indicative of
HPV infection
Koilocytosis/Koilocytic
change
HPV-related penile
intraepithelial neoplasia
(PeIN)
Bowen disease, Bowenoid
papulosis
PeIN associated with older
men. Lesion is solitary.
Bowen disease
PeIN associated with
younger men. Lesions are
multiple..
Bowenoid papulosis
High-risk HPV types
HPV 16, 18, 31, and 33
HPV oncogenic viral product
that inactivates p53
E6
HPV oncogenic viral product
that inactivates RB and
increases p16
E7
Surrogate marker of HPV
infection
p16
Most common site of arrest
in cryptorchidism
Inguinal canal
Type of cancer associated
with cryptorchidism
Testicular germ cell tumors
on BOTH testes
Common etiology of
epididymitis and orchitis in
childhood
Gram-negative rods
Common etiology of
epididymitis and orchitis in
childhood
E. coli, Pseudomonas
Epididymo-orchitis pattern
of involvement in
tuberculosis
Epididymis→Testis
Epididymo-orchitis pattern
of involvement in syphilis
Testis→Epididymis
Adolescents with a bell
clapper deformity of the
testis is at risk for this
urologic emergency
Testicular torsion
Most common cause of
painless testicular
enlargement
Tumors
Most common testicular
tumor
Germ cell tumors (GCT)
Most common GCT
Seminoma
Prognosis of seminomatous
GCTs
Favorable (radio- and
chemosensitive)
Primary route of metastasis
of non-seminomatous GCTs
Hematogenous
Tumor marker used to assess
testicular tumor burden
Lactate dehydrogenase
(LDH)
Most common testicular GCT
in infants and children up to
3 years
Yolk sac tumor
Central capillary surrounded
by tumor cells within a space
lined by tumor cells; seen in
yolk sac tumor
Schiller-Duval bodies
Elevated tumor marker in
choriocarcinoma
Human chorionic
gonadotropin (hCG)
Most important predictor of
biologic behavior of teratoma
Age (prepubertal male -
benign; postpubertal -
malignant)
Sex-cord stromal tumor that
can elaborate androgens and
estrogens
Leydig cell tumor
Eosinophilic, rod-shaped
inclusions seen in the
microscopy of Leydig cell
tumors
Crystalloids of Reinke
Most common testicular
tumor in men > 60 years
Testicular lymphoma
A 50-year-old male presents
with fever, chills, dysuria. PE
showed tender, boggy
prostate on DRE. What is the
most likely diagnosis?
Acute bacterial prostatitis
Most common form of
prostatitis
Chronic abacterial
prostatitis
Most common benign
prostatic disease in men > 50
years old
Nodular prostatic
hyperplasia (NPH)
Ultimate mediator of
prostatic growth formed by
Type 2 5-α-reductase
Dihydrotestosterone (DHT)
Most common site of nodular
prostatic hyperplasia
Transition zone, Inner
periurethral zone
Risk factors for prostatic
adenocarcinoma
Advancing age, androgen
excess, race (African
Americans, family history
in 1st degree relatives,
inherited mutations,diet
(Charred meats, animal fat)
Most common site of
prostatic adenocarcinoma
Peripheral zone
Gleason pattern with discrete
prostatic glands
Gleason pattern 3
Gleason pattern with no
gland formation observed
Gleason pattern 5
Computation of Gleason
score
Most dominant pattern +
2nd most dominant pattern
Prostatic adenocarcinoma
produce blastic lesions on
the bones by spreading
hematogenously via the
Batson plexus
Sites of distant metastasis of
prostate cancer in decreasing
order of frequency
(hematogenous route)
Lumbar spine, proximal
femur, pelvis, thoracic
spine, ribs
Screening for prostate
cancers starts at age
45
Morphologically normal
spermatozoa percentage less
than reference value
Teratozoospermia
Sperm motility less than
reference value
Asthenozoospermia
Recommendation for a >75
y.o. patient with PSA >4
ng/mL and suspicious DRE
Biopsy
Reference range of PSA
0-4 ng/mL
Most serious complication of
gonorrhea in women
Pelvic inflammatory
disease (PID)
Risk factors associated with
polymicrobial cause of PID
Induced abortion,
dilatation and curettage,
and surgical procedures
Complications of chronic PID
Infertility and tubal
obstruction, ectopic
pregnancy, pelvic pain,
and intestinal
obstruction
Age at which a Bartholin cyst is
biopsied to rule out malignancy
> 40 years
Stage of syphilis where
condyloma lata appear
Secondary syphilis
Most common histologic type
of carcinoma in the vulva
Squamous cell carcinoma
Etiology of septate vagina
Failure of Mullerian duct
fusion
Septate vagina and vaginal
adenosis are associated with in
utero exposure to which drug
Diethylstilbestrol (DES)
Most common malignant
tumors of the vagina originate
from the
Cervix
Most common site of primary
squamous cell carcinoma of the
vagina
Posterior wall at
ectocervicovaginal
junction
Vaginal mass with grape-like
clusters protruding from the
vaginal orifice of an infant
Sarcoma botyroides
Most common site of squamous
intraepithelial lesion (SIL)
Transformation zone
Basaloid cells and mitosis
within lower 1/3 of epithelium,
Koilocytic atypia
Low-grade SIL/Cervical
Intraepithelial Neoplasia
(CIN) 1
A 50-year-old female presents
with post-coital bleeding. On
examination, a finger-like mass
was seen on the cervical
introitus. Biopsy showed
fibrovascular stroma lined by
endocervical epithelium. What
is the most likely diagnosis?
Endocervical polyp
Basaloid cells and mitosis to
upper 2/3 of epithelium
CIN 2
Full thickness basaloid cell
proliferation and mitosis
CIN 3
CIN classified as high-grade SIL
CIN 2, 3
80% of cervical carcinomas are
of this histologic type
Squamous cell carcinoma
Most common cause of death cervical ca
Complications of urinary
tract obstruction
Cellular infiltrates identified in
chronic endometritis
Plasma cells
Ectopic endometrial tissue
outside the uterus
Endometriosis
Endometrial tissue in deep
myometrium
Adenomyosis
Cyst filled with old menstrual
blood due to ectopic
endometrial implants in the
ovaries
Chocolate cyst or ovarian
endometrioma
A patient on tamoxifen
presents with AUB. D&C was
performed. Pathology report
showed cystically dilated
glands in fibrous stroma.
Endometrial polyp
Etiology of endometrial
hyperplasia without atypia
Prolonged estrogen
stimulation
Etiology of atypical
endometrial hyperplasia and
endometrioid carcinoma
PTEN loss/mutation
Most common invasive cancer
of the FGT
Endometrial carcinoma
Type I endometrial carcinoma
histologic type/s
Endometrioid
Type II endometrial carcinoma
histologic type/s
Serous, Clear cell,
Carcinosarcoma
Most common histologic type
of endometrial carcinoma
Endometrioid carcinoma
Endometrioid carcinoma
associations
Age 55-65 years, ↑
Estrogen, Hypertension,
DM, Obesity
Serous carcinoma associations
Age 65-75 years,
Atrophic uterus, Thin
physique
Most common tumor in women
Leiomyoma
Diagnostic triad for uterine
leiomyosarcoma
Marked cell atypia,
tumor cell necrosis,
increased mitosis
Most common site of tubal
pregnancy
Ampulla
Serous tubal intraepithelial
carcinoma (STIC) is a precursor
to
Ovarian high-grade
serous carcinoma
A 30-year-old patient
complains of menstrual
irregularities, hirsutism and
acne. TVS showed bilaterally
enlarged ovaries with multiple
small follicles. What is the most
likely diagnosis?
Polycystic ovarian
syndrome or Stein-
Leventhal syndrome
Most common ovarian tumors
Surface epithelial tumors
Most commonly benign surface
epithelial tumors
Serous, mucinous
Most commonly malignant
surface epithelial tumors
Endometrioid
Elevated tumor markers in
surface epithelial tumors
CA-125 and HE4
Most common histologic type
of ovarian cancer
High-grade serous
carcinoma
Mutated genes associated with
ovarian serous carcinoma
BRCA1, BRCA2
Protective factors for ovarian
serous carcinoma
40-59 years with OCP
intake or tubal ligation
Ovarian tumor with
transitional/urothelial-like
epithelium in a fibrous stroma
Brenner tumor
Tumors associated with
dermoid cysts and Brenner
tumor
Mucinous carcinoma
Accumulation of mucinous
material within the
abdominopelvic cavity due to
mucin-secreting tumor cells
Pseudomyxoma
peritonei
Ovarian counterpart of
seminoma
Dysgerminoma
GCT predominant in children
and young women
Immature teratomas,
Yolk sac tumor
GCT predominant in
reproductive age
Mature cystic teratomas,
Dysgerminomas
Most common ovarian GCT
Mature cystic teratoma
A subtype of teratoma
characterized by a cystic mass
lined by skin-like structures
Dermoid cyst
Grading of immature teratoma
is based on the amount of
Neuroepithelium
A patient with mature cystic
teratoma presents with
psychosis and seizures. What is
the paraneoplastic syndrome
associated with this tumor?
Anti-NMDA receptor
encephalitis
A postmenopausal woman
presents with AUB and a large
adnexal mass. She
consequently underwent
surgery. Pathology report
showed round/oval cells with
scant cytoplasm and nuclear
grooves (coffee bean nuclei).
Granulosa cell tumor
Most metastatic tumors to the
ovary come from primary
tumors of
Mullerian origin (uterus,
fallopian tube,
contralateral ovary,
pelvic peritoneum)
Signet ring cell carcinoma from
GIT metastatic to both ovaries
Krukenberg tumor
Abnormal gestations
characterized by hydropic villi
chorionic villi with
trophoblastic proliferation
Hydatidiform mole
Karyotype of partial mole
Triploid (Diandric
triploidy - 2 Sperm + 1
Ovum)
Karyotype of complete mole
Paternal-only diploidy
Embryo/fetus, amnion, and
fetal RBCs are only present in
Partial Mole
Uterine size larger for dates,
hCG levels >100,000 mIU/mL
and higher rate of subsequent
gestational trophoblastic
neoplasia
Complete Mole
Ovarian cysts associated with
hydatidiform mole due to
elevated hCG
Theca-lutein cysts
Most common gestational
trophoblastic neoplasm
Gestational
choriocarcinoma
Distant sites of metastasis of
gestational choriocarcinoma
Lungs > Vagina > Brain >
Liver > Bone > Kidney
Cells that are histologically
absent in invasive carcinomas
of the breast
Myoepithelial cells
A postpartum, nursing mother
developed fever accompanied
by pain and erythema of her
right breast. What is the most
likely diagnosis?
Acute mastitis
Fat necrosis of the breast
occurs following a
History of breast
trauma/surgery
Fat necrosis occurs due to the
saponification of fat by this
enzyme
Tissue/blood lipase
A patient with Hashimoto’s
thyroiditis complains of a
palpable left breast mass.
Biopsy showed lymphocytic
infiltrates and ductal and
lobular atrophy.
Lymphocytic mastopathy
Proliferative breast diseases
without atypia
Usual ductal hyperplasia,
sclerosing adenosis,
complex sclerosing
lesion
Cell adhesion molecule absent
in atypical lobular hyperplasia
or lobular neoplasia
E-cadherin
Papillary fronds covered by
epithelial and myoepithelial
cells, growing within a dilated
duct; presents with bloody
nipple discharge
Intraductal papilloma
Histologic subtype of ductal
carcinoma in-situ (DCIS) that
has abundant central luminal
necrosis
Comedo DCIS
Malignant epithelial cells in the
nipple-areola epidermis;
presents with eczematous
nipple lesion; associated with
invasive cancer or DCIS
Paget Disease of the
Breast
Most common and deadly
malignancy of women globally
Invasive Breast
Carcinoma
Most common genes implicated
for single gene familial breast
cancers (80-90%)
BRCA1, BRCA2
Gene more associated with
ovarian cancer and triplenegative
breast cancer
BRCA1
Gene associated with male
breast cancer
BRCA2
Overexpression of this gene
implies poorer prognosis but is
more amenable to treatment
with trastuzumab
HER2
Most common type of invasive
breast carcinoma (IBC)
Invasive breast
carcinoma of no special
type
Special type of IBC with
discohesive cells assuming a
single file or ‘Indian filing’
Invasive lobular
carcinoma
Type of breast carcinoma
where tumor cells plug dermal
lymphatics producing a peau
d’orange appearance
Inflammatory carcinoma
Most important prognostic
factor of IBC in the absence of
distant metastasis
Lymph node metastasis
Most common benign tumor of
the female breast
Fibroadenoma
Breast tumor composed of the
proliferation of both epithelial
and stromal components with
leaf-like fronds protruding into
cystically dilated spaces
Phyllodes tumor
Most common breast sarcoma
Angiosarcoma
Excess estrogen in males
produces this
unilateral/bilateral swelling of
the areola
Gynecomastia
Most important cause of
gynecomastia
Liver cirrhosis
Chromosomal disorder
associated with male breast
cancer
Klinefelter syndrome
Germ Cell Neoplasia in Situ associated mutation
Isochrome 12p
(KIT mutation also)
Michaelis Gutmann Bodies
Malakoplakia
Cystitis Cystica vs. glandularis: precursor to adenocarcinoma
Cystitis glandularis
(Colonic/cuboidal-columnar epithelium)
Keratinizing vs. Non keratinizing squamous metaplasia: squamous cell ca of bladder (S. haematobium)
Keratinizing squamous metaplasia
Non-invasive urothelial papillary tumor mutations
RAS
FGFR3
Non-invasive urothelial flat tumor mutations
TP53
Rb
Urothelial carcinoma in situ has a ____________ spread
Pagetoid
*scattered malignant cells in normal epithelium
2ndary urothelial tumors usually arise from these sites
CUPL
*Cervix
*Uterus
*Prostrate
*Lymphomas
Smegma in uncircumcised males precipitate this condition
Balanoposthitis (inflamed glans and prepuce)
HPV oncogenic viral product E6 inactivates ________ and stimulates ___________
p53; telomerase
HPV oncogenic viral product E7 increases ________ and inactivates ___________
p16; Rb
Bell-clapper deformity
Inc testicular mobility —> inc risk for testicular torsion
Golden period for testicular torsion
6 hours
Seminoma IHC
(+) KIT
(+) Oct 3/4
(-) cytokeratin
Nonseminoma (Embryonal) IHC
(+) Oct 3/4
(+) Cytokeratin
(+) CD30
(-) KIT
Schiller Duval Bodies
Yolk Sac tumor of testis
Crystalloids of Reinke
Leydig cell tumor of testis
Hormonally silent testicular tumor, only shows testicular enlargement
Sertoli cell tumor of testis
Corpora amylacea is seen in
Nodular Prostatic Hyperplasia
Most common genetic alteration in prostatic (acinar) adenocarcinoma
ETV1-TMPRSS2
Subepithelial condensation of tumor cells in sarcoma botryoides
Cambian layer
Cells susceptible to HPV infection
*Immature squamous basal cells
*Endometrial glandular epithelial cells
Mutations in endometrial glands
*physiologic peculiarity
KRAS
PIK3CA
ARID1A
Atypical endometrial hyperplasia mutations
PTEN loss —> PIK3K/AKT pathway disinhibition
Serous carcinoma mutation
TP53 loss
Lynch syndrome is characterized by, and mutation is
*microsatellite instability
*MLH1 loss
Serous tubal intraepithelial carciboma (STIC) mutation
BRCA1
Serous carcinoma risk factors and morphology
Nulliparity, fam hx, BRCA1 and BRCA2 gene
(+) Psamomma bodies
Mucinous adenocarcinoma usually arise from
Dermoid cyst
Brenner tumor
Pseudomyxoma peritonei (mucinous carcinoma) can happen in these organ involvements
Ovary
Appendix
Ovarian carcinomas associated with endometriosis
Clear cell
Endometroid
Neuroepithelial rosette
Immature teratoma
Psychiatric natured disorder in Immature teratoma
Anti-NMDA receptor encephalitis
Monodermal teratoma that has thyroid tissue, thus can cause hyperthyroidism
Struma ovarii
Call exner bodies & coffee bean nuclei
Granulosa cell tumors
Characteristic UTZ finding in Complete H-mole
Snowstorm appearance
Meigs syndrome components
Ovarian fibroma
Ascites
Pleural effusion
Blue dome cyst
Fibrocystic changes
