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DT4 Exam 1 > Male and Female Repro > Flashcards

Male and Female Repro Flashcards

1
Q

zones of prostate

A

peripheral
central
transitional
periurethral

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2
Q

cell layers prostate

A

basal layer of low cuboidal epithelium

inner columnar secretory cells

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3
Q

acute bacterial prostatitis etiology

A

same bacteria that cause UTI
E. coli, enterococci staph
implanted via reflux

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4
Q

clinical presentation acute bacterial prostatitis

A

fever, chills, dysuria
prostate tender and boggy on DRE
leukocytes and bacterial cultures

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5
Q

clinical presentation chronic bacterial prostatitis

A

mild symptoms or asymptomatic
history of recurrent UTI with same organism
leukocytes and bacterial cultures

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6
Q

chronic abacterial prostatitis clinical presentation

A

most common form
same presentation as chronic bacterial
<10 leukocytes/HPF and bacterial culture negative

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7
Q

etiology granulomatous prostatitis

A

from BCG in bladder to treat superficial bladder cancer

insignificant

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8
Q

etiology BPH

A

increased number of epithelial cells

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9
Q

role of DHT

A

testosterone to DHT by type 2 5 alpha reductase in stromal cells
binds androgen receptor on stromal and epithelial cells
increases proliferation of stromal cells and decreases death of epithelial cells

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10
Q

morphology BPH

A

originates in transition zone (periurethral)
early nodules-stromal
later-epithelial

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11
Q

microscopic BPH

A

lined by 2 layers

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12
Q

work up BPH

A

do not do biopsy-nodules hard to appreciate

not premalignant lesion

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13
Q

clinical presentation BPH

A

urethral obstruction-impinge on urethra
bladder hypertrophy and distension
sudden acute urinary retention

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14
Q

treatment BPH

A

decrease fluids, caffeine, and alcohol
timed voiding
alpha blockers and 5 alpha reductase inhibitors
TURP

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15
Q

most common cancer in men

A

prostate adenocarcinoma

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16
Q

genetics prostate adenocarcinoma

A 
BRCA2 mutations
overexpression of ETS
PTEN deletions
MYC amplications
alterations of GSTP1 (most common)
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17
Q

risks for development of prostate adenocarcinoma

A

high fat diet

androgens

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18
Q

prostate intraepithelial neoplasia

A

precursor lesion

seen in peripheral zone (same as cancer)

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19
Q

morphology PIN

A

larger glands with branching and infolding

surrounded by patchy layer of basal cells and intact BM

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20
Q

histology prostate adenocarcinoma

A

little or no stroma=back to back glands
single layer of cuboidal (outer basal layer absent)
mitotic figures uncommon

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21
Q

local extension prostate adenocarcinoma

A

periprostatic tissues, seminal vesicles, base of bladder

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22
Q

mets prostate adenocarcinoma via lymphatics

A

obturator nodes

para-aortic nodes

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23
Q

mets prostate adenocarcinoma via blood

A

lumbar spine

osteoblastic lesions

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24
Q

Gleason staging

A

scored by most prominent pattern and second most prominent

or most prominent and highest grade pattern

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25
Q

factors that elevate PSA

A

cancer, prostatitis, infarct, instrumentation of the prostate, ejaculation, UTI

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26
Q

use of PSA

A

organ specific
useful in diagnosis and management of prostate cancer
lacks specificity and sensitivity

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27
Q

refinements of PSA for screening

A

density
velocity
age specific reference ranges
bound to free (lower free in cancer)

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28
Q

treatment prostate adenocarcinoma

A

surgery
radiation
hormone manipulation-orchiectomy, LH-releasing hormone agonist

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29
Q

etiology of follicular and luteal cysts

A

unruptured Graafian follicle or one that immediately seals

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30
Q

histology follicular and luteal cyst

A

grnaulosal cell lining

outer thecal cell

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31
Q

rim of yellow in luteal cyst

A

from corpus luteum
luteinized granulosal cells
may rupture and cause peritoneal reaction

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32
Q

clinical presentation polycystic ovaries

A

oligomenorrhea
obesity
hirsutism
virilism

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33
Q

risk factors ovarian tumors

A

nulliparity

family history-BRCA1, BRCA2, p53, her2/neu

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34
Q

clinical presentation ovarian tumors

A

abdominal pain and distention
urinary and GI symptoms
bleeding

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35
Q

serous tumors origin

A

tubal epithelium

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36
Q

benign serous tumor gross morphology

A

cystic with few papillary projections

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37
Q

borderline serous tumor gross morphology

A

increasing papillary projections

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38
Q

malignant serous tumor gross morphology

A

solid with nodularity

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39
Q

benign serous histology

A

columnar cilia and intercalated cells

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40
Q

borderline serous histology

A

increased papillae with nuclear stratification and atypia

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41
Q

malignant serous cystadenocarcinoma histology

A

effacement of stroma and atypical nuclei

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42
Q

gross appearance mucinous tumors of ovary

A

filled with sticky, gelatinous material rich in glycoproteins

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43
Q

histology benign mucinous tumor

A

tall columnar with apical mucin and no cilia

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44
Q

histology borderline mucinous tumor

A

complex glanduar structures

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45
Q

histology malignant mucinous tumor

A

more solid growth with atypia and necrosis

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46
Q

pseudomyxoma peritonea

A

ovarian tumor with extensive mucinous ascites and cystic epithelial implants
can cause intestinal obstruction and death
also caused by appendiceal mucinous tumors

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47
Q

gross morphology endometrioid tumors

A

combination solid and cystic

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48
Q

histology endometrioid tumors

A

glands resembling endometrium

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49
Q

characteristics of clear cell adenocarcinoma

A

association with endometriosis

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50
Q

histology clear cell adenocarcinoma

A

looks like clear cell adenocarcinoma of endometrium

large cells with abundant clear cytoplasm

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51
Q

Brenner tumor

A

adenofibroma with transitional type epithelium

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52
Q

histology Brenner tumor

A

fibrous stroma with nests of epithelium resembling urothelium with central mucinous cysts

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53
Q

cystadenofibroma

A

variant with proliferation of fibrous stroma

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54
Q

metastasis of surface epithelial tumors

A

regional nodes, liver, lungs and GI

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55
Q

screening for serous and endometrioid tumors

A

CA-125

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56
Q

gross morphology mature teratomas

A

unilocular containing hair and cheesy material

areas of calcification

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57
Q

histology mature teratomas

A

mostly squamous epihtelium with underlying skin adnexae

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58
Q

specialized teratomas

A

most common struma ovarii and carcinoid

can result in hyperthyroidism or carcinoid syndrome producing 5HIAA

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59
Q

immature malignant teratoma

A

resembles embryo

found in adolescents and young women

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60
Q

gross morphology immature malignant teratoma

A

smooth external surface

solid with areas of necrosis and hemorrhage

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61
Q

dysgerminoma

A

increased HCG
usually in childhood
can occur with gonadal dysgenesis
radiosensitive

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62
Q

gross morphology dysgerminoma

A

unilateral

soft and fleshy

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63
Q

histology dysgerminoma

A

vesicular cell with well defined cell border

fibrous stroma with lymphocytes

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64
Q

yolk sac tumor

A

rich in alpha fetoprotein and alpha 1 antitrypsin
children or young women
chemo has improved prognosis

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65
Q

histology yolk sac tumor

A

Schiller-Duval body (glomerular like)

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66
Q

choriocarcinoma histology

A

cytotrophoblasts and syncytiotrophoblasts

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67
Q

choriocarcinoma

A

invades blood vessels and mets to lungs, liver, bone and viscera
high levels HCG
unresponsive to chemo

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68
Q

histology granulosa-theca cell tumors

A

granulosal cells with many components (Call-Exner)

theca are plump and spindled (stain Oil-Red-O)

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69
Q

clinical presentation of granulosa-theca cell tumors

A

large estrogen-precocious sexual development, endometrial hyperplasia or carcinoma, cystic breast

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70
Q

thecoma-fibroma

A

fibroblasts and thecoma (plump spindle cells with lipid)

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71
Q

Meigs syndrome

A

ascites, pleural effusion (right) and ovarian tumor

thecoma fibroma

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72
Q

fibrosarcoma

A

increased mitosis and nuclear/cytoplasmic ratio

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73
Q

histology Sertoli-Leydig cell tumor

A

tubules of Sertoli cells with interspersed Leydig cells

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74
Q

Kruckenberg tumor

A

bilateral, mucin producing signet ring

cancer of stomach

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75
Q

histology nipple and areola

A

stratified squamous epithelium

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76
Q

contractile cells of breast

A

myoepithelial

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77
Q

interlobular stroma

A

fibroconnective tissue with adipose

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78
Q

intralobular stroma

A

loose, myomatous stroma and lymphocyte

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79
Q

change to breast at menarche

A

terminal ducts give rise to lobules and interlobular stroma

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80
Q

milk line remnants

A

persistence of epidermal thickening along milk line

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81
Q

accessory axillary breast tissue

A

mastectomy may not remove all breast tissue

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82
Q

congenital inversion of nipple

A

nursing difficulties

can be confused with inversion due to carcinoma or inflammation

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83
Q

acute mastitis

A

mostly staph aureus (abscess)
strep-spreading
in nursing mother, scarring and retraction of nipple

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84
Q

periductal mastitis

A

painful erythematous subareolar mass

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85
Q

morphology periductal mastitis

A

keratinizing squamous to abnormal depth

keratin accumulates

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86
Q

risk of periductal mastitis

A

smoking

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87
Q

mammary duct ectasia

A

50s to 60s

poorly defined mass, skin retraction, cheesy discharge

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88
Q

morphology mammary duct ectasia

A

ductal dilation

periductal and interstitial chronic granulomatous inflammation

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89
Q

gross appearance fat necrosis

A

early hemorrhage

late liquefaction necrosis

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90
Q

histology fat necrosis

A

central necrotic fat cells surrounded by lipid laden macrophages and intense neutrophilic infiltrate
later walled off by fibroblastic

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91
Q

etiology granulomatous mastitis

A

systemic granulomatous disease-Wegeners
infections
only affects parous women (HSR?)

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92
Q

morphology granulomatous mastitis

A

granulomas in lobular epithelium

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93
Q

lymphocytic mastopathy

A

single or multiple hard palpable masses

collagenized stroma surrounding atrophic ducts and lobules

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94
Q

non-proliferative breast changes

A

peaks at menopause

hormonal imbalance-increased estrogen or decreased progesterone

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95
Q

patterns non-proliferative breast changes

A

cyst
fibrosis
adneosis

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96
Q

cysts of breast

A

can calcify

apocrine metaplasia-lining cells have abundant eosinophilic cytoplasm

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97
Q

fibrosis of breast

A

from rupture of cyst and release of contents resulting in inflammation

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98
Q

adenosis of breast

A

increase in number of acinar units per lobule

calcifications can be seen

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99
Q

lactational adenomas

A

palpable masses in pregnant or lactating women

exaggerated response to hormones

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100
Q

epithelial hyperplasia (w/o atypia)

A

more than 2 layers of hyperplasia

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101
Q

sclerosing adenosis

A

number of acini increased

myoepithelial cells prominent

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102
Q

complex sclerosing adenosis

A

stellate with central nidus of entrapped glands

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103
Q

papillomas

A

branching fibrovascular cores

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104
Q

risk factors breast carcinoma

A 
age
age at menarche
age at first birth
relative with breast cancer 
breast biopsies 
race (lower in AA)
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105
Q

other risk factors for breast carcinoma

A

estrogen exposure
radiation
carcinoma of contralateral breast or endometrial
geography
diet-decreased with B carotene, increase with alcohol
obesity-decrease at young age, increase at high age
exercise
breast feeding
organochloride pesticides

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106
Q

all carcinomas arise from

A

terminal duct lobular unit

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107
Q

ductal carcinoma in situ

A

limited to basement membrane

myoepithelial cells can be present but decreased

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108
Q

comedocarcinoma

A

solid sheets of pleomorphic cells

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109
Q

non-comedocarcinoma

A

cribiform-cookie cutter spaces
solid
papillary
micropapillary

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110
Q

paget disease

A

unilateral erythematous eruption with scale crust
extension of DCIS into surface epithelium
can have underlying invasive carcinoma

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111
Q

lobular carcinoma in situ

A

lack E-cadherin

small cells with oval or round nuclei

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112
Q

peau d’orange

A

larger carcinoma fixed to chest wall

lymphatic involvement blocking skin drainage

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113
Q

NST invasive carcinoma

A

majority of carcinomas

induce fibrotic reaction

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114
Q

invasive lobular carcinoma

A

seen in older women

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115
Q

morphology invasive lobular carcinoma

A

single infiltrating tumor cells
signet ring cell
concentric rings around normal ducts

116
Q

mets invasive lobular carcinoma

A

peritoneum, retroperitoenum, leptomeninges, GI tract, ovaries, uterus

117
Q

medullary carcinoma histology

A

large cells with vesicular nuclei and prominent nucleoli
frequent mitoses
pushing border

118
Q

histology mucinous carcinoma

A

tumor cells as clusters of cells in lakes of mucin

119
Q

clinical mucinous carcinoma

A

diploid

better prognosis than invasive ductal

120
Q

tubular carcinoma histology

A

tubules

absence of myoepithelial cells

121
Q

clinical tubular carcinoma

A

diploid

excellent prognosis

122
Q

major prognostic factors

A 
invasive carcinoma 
distant mets
lymph node mets 
tumor size
locally advanced
inflammatory carcinoma
123
Q

minor prognostic factors

A 
histologic subtype
tumor grade
receptors
lymphovascualr invasion
proliferative rate 
DNA content
124
Q

fibroadenoma

A

fibrous clonal and epithelial is polyclonal
more common before age 30
hormonally responsive

125
Q

phylloides tumor

A

in 60s
low grade that recurs
leaf like protrusions from nodules of proliferating stroma

126
Q

diagnosis HSV

A

purulent exudate-CPE on culture
NAA test
anti-HSV antibodies

127
Q

detection of antibodies to HSV

A

indicative of recurrent or latent infection

128
Q

most common cause of molluscum contagiosum

A

MCV-2

poxvirus

129
Q

clincial appearance of molluscum contagiosum

A

pearly, dome shaped papules with dimpled center

intracytoplasmic viral inclusions

130
Q

risk factors candidiasis

A

diabetes, pregnancy, OCP

131
Q

clinical presentation candidiasis

A

snow-ball to crotch

vulvovaginal pruritis, erythema, swelling and curdlike vaginal discharge

132
Q

clinical presentation trichomonas

A

from large ovoid protozoan with flagella

vaginal discharge, fishy odor on exam, strawberry cervix

133
Q

identification trichomonas

A

wet mount
pap smear
molecular test-more sensitive

134
Q

presentation gardnerella

A

thin, gray-green, malodorous (fishy) vaginal discharge

135
Q

causes follicular cervicitis, endometritis, slapingo-oophoritis

A

chlamydia trachomitis

136
Q

causes PID

A

gonococci (most common)
chlamydia, enteric bacteria
D and C or surgical procedure

137
Q

puerperal infection

A

PID following normal delivery

138
Q

gonococcal infection leading to PID

A

begins in Bartholin glands

inflammation confined to superficial mucosa and submucosa

139
Q

spread non gonococcal infection leading to PID

A

lymphatics or venous channels

140
Q

layers non gonococcal infection leading to PID

A

deeper layers

causes acute suppurative salpingitis

141
Q

complications non gonococcal infection

A

peritonitis, intestinal obstruction due to adhesions, bacteremia, infertility

142
Q

presentation leukoplakia

A

white plaques

143
Q

lichen sclerosis

A

parchment like white plaques on vulva and labial atrophy
more common after menopause
thinning of epidermis, dense dermal collagen
leads to atrophy, fibrosis, scarring

144
Q

lichen simplex chronicus

A

non-specific
thickening of epidermis, hyperkaratosis, dermal inflammation
slight increased risk of cancer development

145
Q

sites of HPV infection

A

vulva, vagina, cervix

146
Q

condyloma acuminatum

A

wart like benign lesions
caused by HPV (6 and 11)
koilocytosis-halo around cell

147
Q

basaloid and warty carcinomas

A

associated with high risk HPV (16, 18, 31)
preceded by VIN
presents as white patches
multicentric, lesions on vagina or cervix

148
Q

keratinizing squamous cell carcinoma

A

from women with long standing lichen sclerosus or squamous cell hyperplasia
average age 76

149
Q

extramammary paget disease

A

common in white postmenopausal women
pruritic red crusted lesion
not associated with cancer

150
Q

morphology extramammary paget disease

A

intraepithelial growth pattern

PAS or mucin stain

151
Q

malignant melanom

A

6th and 7th decades

may mimic paget disease

152
Q

vaginal squamous cell carcinoma

A

most associated with HPV

often results from spread of cervical lesion

153
Q

vaginal adenocarcinoma

A

DES during pregnancy (babies from mothers who received this)
clear cell type
much more common association with vaginal adenosis

154
Q

vaginal adenosis

A

red granular foci in vagina

squamous replaced by columnar mucosa

155
Q

embryonal rhabdomyosarcoma

A

child less than 5
malignant embryonal rhabdomyoblasts
project out of the vagina, grapelike mass

156
Q

cervical change at menarche

A

increased estrogen causes increased glycogen uptake

provides substrate for bacteria (drop in pH)

157
Q

ectocervix histology

A

squamous epithelium

158
Q

endocervix histology

A

columnar epithelium

159
Q

endocervical polyp

A

can cause vaginal bleeding
soft, mucoid polypod mass
may protrude from os

160
Q

testing of HPV in adolescents

A

may lead to over treatment
especially vulnerable
most are able to clear infections within 2 years

161
Q

slow to clear

A

HPV 16

162
Q

risk factor for development of cervical cancer

A

persistence of HPV

163
Q

mode of infection HPV

A

infects immature basal cells

especially immature metaplastic squamous cells at transformation zone

164
Q

HPV in vulva and vagina

A

must have damage for HPV to have access to immature cells deep in epithelium

165
Q

E6 and E7 in HPV

A

interact with tumor suppressor genes Rb and p53

166
Q

test for primary HPV

A

cobas

do HPV test first then pap

167
Q

screening molecular tests for HPV

A

3 for DNA

1 for RNA

168
Q

CIN 1

A

low grade dysplasia

confined to lower 1/3 of epidermis

169
Q

CIN 2

A

moderate dysplasia
more often associated with HPV
involves 2/3 of epidermis

170
Q

CIN 3

A

most likely to progress to cervical cancer

change to entire epidermal layer

171
Q

squamous cell carcinoma

A

at 40-45 yo

exophytic or infiltrative lesions

172
Q

treatment of cervical dysplasia

A

excision-crypotherapy, laser vaporization, conization biopsy

173
Q

treatment cervical cancer

A

complete hysterectomy with lymph node dissection

174
Q

bleeding in older women

A

rule out endometrial hyperplasia or carcinoma

175
Q

anovulatory cycles

A

most common cause of dysfunctional bleeding

excessive estrogen stimulation without progesterone

176
Q

inadequate luteal phase

A

corpus luteum does not put out adequate progesterone
increased bleeding, amenorrhea
biopsy-endometrium lags behind expected at date

177
Q

causes of chronic endometritis

A

chronic PID
postpartum/postabortion
intrauterine contraceptive devices
patients with TB

178
Q

histology chronic endometritis

A

plasma cells in endometrium

179
Q

most common sites endometriosis

A

ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum

180
Q

theories about endometriosis

A

regurgitation-retrograde menses spread to peritoneum
metaplastic-coelomic epithelium
lymphvascular-spread through pelvic vessels

181
Q

morphology endometriosis

A

little red to brown nodules
powder burn marks
chocolate cyst in ovary

182
Q

adenomyosis

A

endometrial glands within uterine wall

nests are functional-hemorrhagic nests within the myometrium

183
Q

two forms of endometrial polyps

A

functional endometrium-adjacent endometrium

hyperplastic endometrium-mostly cystic

184
Q

cause of endometrial hyperplasia

A 
prolonged estrogen stimulation, unopposed estrogen
menopause
PCOS
excessive cortical function
prolonged estrogen replacement therapy
185
Q

genetic alterations endometrial hyperplasia

A

inactivation of PTEN

186
Q

non-atypical endometrial hyperpalsia

A

increased gland to stromal ratio
cystic formation
results from excessive estrogen stimulation

187
Q

atypical endometrial hyperplasia

A

increased glands with crowding, enlargement and irregular shape
risk of adenocarcinoma

188
Q

type 1 endometrial adenocarcinoma

A

most common
prolonged estrogen stimulation and endometrial hyperplasia
endometrioid carcinoma, PTEN associated

189
Q

type 2 endometiral adenocarcinoma

A

may be asymptomatic

thickened endometrium on ultrasound

190
Q

malignant mixed mullerian tumors

A

malignant stromal differentiation with endometrial adenocarcinoma
highly malignant

191
Q

leiomyomas

A

unique clonal neoplasm (most normal karyotype)

most common tumor in humans

192
Q

morphology leiomyomas

A

well circumscribed masses
white whorled cut surface
whorled bundles of smooth muscle
low mitotic index

193
Q

clinical course leiomyomas

A

can cause abnormal bleeding, urinary frequency, pain, impaired fertility
malignant transformation rare

194
Q

leiomyosarcoma

A

arise de novo from myometrium

complex karyotypes with chromosomal abnormalities

195
Q

morphology leiomyosarcoma

A

bulky fleshy mass iwthin myometrium or polypoid mass

>10 mitoses per HPF

196
Q

mets leiomyosarcoma

A

lungs, brain and bone

197
Q

cause suppurative salpingitis

A

most often from gonococcus

198
Q

primary adenocarinoma of fallopian tubes

A

watery discharge or bleeding

associated with germline BRCA mutations

199
Q

placenta composition

A

chorionic villi

sprout from the chorion

200
Q

outer cells of placenta

A

syncytiotrophoblast

201
Q

inner cells of placenta

A

cytotrophoblast

202
Q

spontaneous abortion causes

A

defective implantation and death of ovum or fetus
chromosomal abnormalities
trauma
infectious agents

203
Q

predisposing factor for ectopic pregnancy

A

PID

204
Q

most common location ectopic pregnancy

A

fallopian tube

205
Q

presentation ectopic pregnancy

A

pain 6 weeks after normal menses

206
Q

biopsy ectopic pregnancy

A

ill not show chorionic villi

207
Q

rupture of tubal pregnancy

A

medical emergency

208
Q

placenta accreta

A

adherence of placenta to myometrium due to partial or complete absence of deciduas

209
Q

postpartum hemorrhage

A

sequela of placenta acreta
can result in hysterectomy
lack of placental separation

210
Q

placenta previa

A

implants in lower uterine segment or cervix
antepartum bleeding and premature labor
can occur in women with previous c-section scar

211
Q

two ova

A

dizygotic

212
Q

one ova

A

monozygotic

213
Q

dichorionic diamnionic

A

separate placentas or fused

214
Q

twin twin transfusion syndrome

A

occurs in monochorionic-monoamionic placentas

abnormal sharing of fetal circulatiosn

215
Q

ascending pathway for infection

A

most common bacterial
sexual intercourse can enhance ascending infection
can cause premature rupture of membranes

216
Q

hematogenous infection

A

spread of bacteria to placenta

villi most often affected

217
Q

most likely for pre-eclampsia

A

primiparas

218
Q

pre-eclampsia

A

endothelial dysfunction, presents with HTN, proteinuria, and edema

219
Q

eclampsia

A

seizures and DIC

220
Q

placenta role in toxemia

A

endothelial dysfunction
vasoconstriction leading to HTN
increased permeability resulting in proteinuria and edema

221
Q

abberations in toxemia

A 
abnormal placental vasculaure-leads to shallow implantation and placental ischemia
endotheial dysfunction and imbalance of angiogenic and anti-angiogenic factors
hypercoagulable state (thrombosis in liver, kidneys, brain, pituitary)
222
Q

morphology placenta toxemia

A

infarcts in wall of uterine vessels, decidual vessels show thrombosis and fibrinoid necrosis

223
Q

hydatidiform mole

A

swelling of chorionic villi with trophoblastic proliferation

uterus larger than due date in 4th or 5th month

224
Q

complete mole

A 
egg lost chromosomes-all paternally deerived 
all villi are edematous 
46XX or XY
rare fetal parts 
uterine cavity-grape like structures
225
Q

partial mole

A

some villi are edematous
69xxx,xxy
fetal parts more common

226
Q

mole with elevated hcg

A

complete mole

227
Q

invasive mole

A

penetrates and may even perforate the uterine wall
myometrium is invaded by hydropic chorionic villi
locally destructive and can embolize to liver and brain

228
Q

clinical presentation invasive mole

A

vaginal bleeding and irregular uterine enlargement
elevated hcg
responds well to chemo
can result in uterine rupture/hysterectomy

229
Q

morphology gestational choriocarcinoma

A

soft fleshy tumor with areas of necrosis

proliferation of cytotrophoblasts and syncytiotrophoblasts

230
Q

clinical course gestational choriocarcinoma

A

irregular spotting following miscarriage

tumor mets by time of diagnosis-lungs, vagina, liver, kidney

231
Q

treatment gestational choriocarcioma

A

chemo

232
Q

hydrospadias

A

abnormal opening of the urethra along ventral aspect of penis

233
Q

epispadias

A

abnormal opening of the urethra along the dorsal aspect of the penis

234
Q

phimosis

A

orifice of prepuce too small for retraction

predisposed to infection, carcinoma

235
Q

balanoposthitis

A

infection of glans and prepuce

non-specific and not sexually transmitted

236
Q

Peyronie’s disease

A

circumscribed fibrous thickening of connective tissue
painful curvature of penis toward lesion
may be related to chronic urethritis

237
Q

condyloma acuminatum

A

HPV related

histology-acanthosis, hyperkeratosis, koilocytosis

238
Q

giant condyloma

A

large, cauliflower like

usually in older individuals

239
Q

dysplastic lesions of penis

A

associated with high risk HPV especially 16

240
Q

Bowen’s disease

A

lesion on skin of shaft, plaque like

potential for malignant transformation

241
Q

Bowenoid papulosis

A

seen in young
multiple papules
rare malignant transformation

242
Q

cancer of penis, scrotum

A

squamous cell most common (related to HPV 16)
melanoma, soft tissue sarcomas, lymphomas
mets rare from GU

243
Q

clinical course squamous cell carcinoma of penis

A

occurs in older

circumcision confers protection, age of circumcision, hygiene

244
Q

appearance squamous cell carcinoma

A

slow growing, plaque, ulceration or verrucous growth

245
Q

mets squamous cell carcinoma

A

inguinal lymph nodes

246
Q

cryptorchid testis

A

undescended testis
inguinal canal or abdomen
usually unilateral and idiopathic
increased risk of injury and cancer, bilateral-sterility

247
Q

pathology of cryptorchid testis

A

increased hyaline deposition
failure of germ cell maturation
increased or normal Leydig cells
tubular atrophy-increases with age

248
Q

causes of atrophy of testis

A

atherosclerosis, perivascular inflammation, cryptorchidism, malnutrition, hypo-pituitarism, obstruction, radiation, hormonal, Klinefelters

249
Q

histology atrophic testis

A

increased interstitial scarring, tubular basement membrane thickening, loss of spermatogenesis, fibrosis, decreased or absent germ cells

250
Q

gonorrhea in males

A

in epididymis

251
Q

mumps in males

A

heavy mononuclear inflammation, edema

neutrophils and abscesses

252
Q

syphilis in males

A

testis first then epididymis

gummas or diffuse inflammation of lymphocytes, plasma cells, obliterative endarteritis, perivascular cuffing

253
Q

chronic orchitis

A

usually non-specific and chronic inflammation

254
Q

tuberculosis in males

A

epididymis then testis

caseating granulomas

255
Q

torsion

A

twisting of spermatic cord and blockage of venous drainage
hemorrhagic infarction of testis
leads to acute pain and swelling

256
Q

adenomatoid tumor

A

usually in epididymis, mesothelial in nature
cuboidal/flat cells in cords, cytoplasmic vacuole
benign

257
Q

germ cell tumor origin

A

most from intratubular germ cell neoplasia

258
Q

genetics intratubular germ cell neoplasia

A

12p

germ cell tumors express OCT3/4 and NANOG

259
Q

testicular dysgenesis syndrome

A

cryptorchidism, hydrospadias, poor sperm quality

germ cell tumors association

260
Q

seminomas genetics

A

25% KIT activation

261
Q

AFP

A

elevated in yolk sac tumors

262
Q

HCG

A

elevated in choriocarcinoma

263
Q

characteristics of seminoma

A

average age 30
10% hcg+, PLAP+ 50%
radiosensitive, preceded by ITGCN, confined to testes

264
Q

histology seminoma

A

thin septa, large cells, prominent nucleoli, sparse lymphocytes

265
Q

histology spermatocytic seminoma

A

small cells, intermediate cells, large cells

266
Q

characteristics spermatocytic seminoma

A

sarcomatous component-aggressive
seen in older population
never originates outside testes

267
Q

characteristics embryonal carcinoma

A

more aggressive, 20-30 yo
tubular/alveolar/papillary pattern
large undifferentiated cells
PLAP+, CD30+

268
Q

Schiller Duvall bodies

A

resemble primitive glomeruli

seen in yolk sac tumor

269
Q

characteristics yolk sac tumor

A

pure form in infants, young adults
positive for AFP
excellent prognosis

270
Q

cells in choriocarcinoma

A

syncytiotrophoblast-large cells with irregular nuclei

cytotorphoblast-small cells with clear cytoplasm

271
Q

characteristics choriocarcinoma

A

malignant
mets to liver and lung
hemorrhage and necrosis common
hcg+

272
Q

mature teratoma components

A

ectoderm-neural and epidermis
endoderm-GI, respiratory, mucous glands
mesoderm-bone, cartilage, muscle

273
Q

common types of mixed germ cell tumor

A

teratoma, embryonal carcinoma, yolk sac
seminoma with embryonal
teratoma with embryonal

274
Q

testicular lymphatic spread

A

retroperitoneal para-aortic nodes

275
Q

testicular hematogenous spread

A

lungs, liver, brain, bones

276
Q

characteristics of NSGCT

A

mets hematogenous
radioresistant
poorer prognosis

277
Q

characteristics of SGCT

A

localized to testis longer
mets lymph nodes
radiosensitive
better prognosis

278
Q

stage 1 testicular tumors

A

confined to testis, epididymis, or spermatic cord

279
Q

stage 2 testicular tumors

A

retroperitoneal nodes below diaphragm

280
Q

stage 3 testicular tumors

A

mets outside retroperitoneal nodes or above diaphragm

281
Q

LDH serum marker

A

tumor burden/volume

282
Q

characteristics Leydig cell tumor

A

20-60 yo

may secrete androgens, may have gynecomastia

283
Q

histology Leydig cell tumor

A

large, round, polygonal granular cytoplasm

rod-shaped crystalloids of Reinke

284
Q

histology Sertoli cell tumors

A

distinctive trabeculae with cordlike structures and tubules

hormonally silent

285
Q

testicular lymphoma

A

most common testicular neoplasm in men over 60

diffuse large cell most common

DT4 Exam 1 (5 decks)

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