Male and Female Reproductive Tract, TBP Flashcards
1
Q
Germ cells vs epithelial cells: Majority of testicular tumors derived from
A
Germ cells
2
Q
Germ cells vs epithelial cells: Majority of ovarian tumours are derived from
A
Epithelial cells
3
Q
T/F All masses of the testes are considered malignant unless proven otherwise
A
T
4
Q
Seminomas vs nonseminomatous neoplasms: Remain localized in the testis for a longer period
A
Seminomas
5
Q
Seminomas vs nonseminomatous neoplasms: Radiosensitive
A
Seminomas
6
Q
Seminomas vs nonseminomatous neoplasms: Metastasize sooner
A
Nonseminomatous
7
Q
Seminomas vs nonseminomatous neoplasms: Radioresistant
A
Nonseminomatous
8
Q
Seminomas vs nonseminomatous neoplasms: Metastasize via lymphatic route
A
Seminomatous
9
Q
Seminomas vs nonseminomatous neoplasms: Metastasize via hematogenous route
A
Nonseminomatous
10
Q
Classic presentation of testicular cancer
A
Painless testicular mass
11
Q
Sites of metastases from testicular neoplasms: Lymph nodes (3)
A
1) Para-aortic
2) Mediastinal
3) Supraclavicular
12
Q
Sites of metastases from testicular neoplasms: Hematogenous
A
1) Lungs
2) Liver
3) Brain
4) Bone
13
Q
Most common type of testicular neoplasm
A
Germ cell
14
Q
Risk factors for development of testicular neoplasms (3)
A
1) Cryptorchidism
2) Syndromes with testicular dysgenesis such as Klinefelter syndrome
3) Family history and history of tumor in the collateral testis
15
Q
Tumor with 1 histologic pattern vs Mixed germ cell tumor: More common
A
Mixed germ cell tumor
16
Q
Non-seminomatous germ cell neoplasms (4)
A
CYTE
1) Choriocarcinoma
2) Yolk sac tumor
3) Teratoma
4) Emrbyonal carcinoma
17
Q
Neoplasm-associated protein secreted: Seminoma
A
hCG
18
Q
Neoplasm-associated protein secreted: Emrbyonal CA
A
hCG and AFP
19
Q
Neoplasm-associated protein secreted: Yolk sac tumor
A
AFP
20
Q
Neoplasm-associated protein secreted: Choriocarcinoma
A
hCG
21
Q
Neoplasm-associated protein secreted: Teratoma
A
None
22
Q
Preneoplastic proliferation of germ cells within seminiferous tubules
A
Intratubular germ cell neoplasia
23
Q
Main risk factor for intratubular germ cell neoplasia
A
Cryptorchidism
24
Q
Seminoma: Ovarian correlate
A
Dysgerminoma
25
Seminoma: 3 characteristic microscopic features
1) Large mononuclear cells with clear cytoplasm
2) Fibrous septae
3) Lymphocytes
26
Seminoma: Characteristic gross appearance
Homogeneous and tan
27
Seminoma: Cell component that secretes hCG
Syncytiotrophoblast
28
Seminoma: Prognosis
Excellent
29
Seminoma: Cure rate for Stage I and II disease
100%
30
Embryonal CA: Mostly pure vs part of mixed tumor
Mixed
31
Embryonal CA: Gross morphology
Hemorrhagic and necrotic
32
Embryonal CA: Microscopic
Ugly cells
33
Yolk sac tumor: Pure vs mixed in young males at about 3 y/o
Pure
34
Yolk sac tumor: Pure vs mixed in adults
Mixed
35
Yolk sac tumor: Characteristic microscopic feature
Schiller-Duval bodies
36
Yolk sac tumor: Description of Schiller Duval bodies
Core capillary surrounded by visceral and parietal layer
37
Schiller-Duval bodies resemble
Primitive glomerulus
38
Choriocarcinoma: Almost always pure vs mixed
Mixed
39
Choriocarcinoma: Primary route of metastasis
Hematogenous
40
Choriocarcinoma: Response to chemotherapy
Good
41
Choriocarcinoma: Prognosis
Good
42
Choriocarcinoma: Gross
Hemorrhagic mass
43
Choriocarcinoma: Microscopic
Syncytiotrophoblasts and cytotrophoblasts
44
Tumor derived from all 3 germ cell layers
Teratoma
45
T/F Teratomas are always benign
F
46
Pure teratomas: Young vs adult
Young
47
Teratoma part of a mixed germ cell tumor: Young vs adult
Adult
48
Mature teratoma: Benign vs malignant in adult
Assumed to be malignant
49
Mature teratoma: Benign vs malignant in young
Benign
50
T/F Immature teratomas are always malignant
T
51
Mature vs immature vs malignant transformation teratoma: Fully differentiated from all 3 germ lines
Mature
52
Mature vs immature vs malignant transformation teratoma: Areas of tumor have appearance of fetal or embryonic tissue
Immature
53
T/F Extragonadal (outside of testis) teratomas are common
F
54
Classic extragonadal presentation of a teratoma
1) Sacrococcygeal
| 2) Anterior mediastinal
55
Sacrococcygeal teratoma is more common in: Males vs females
Females
56
Most common testicular mass in men older than 60
Lymphoma
57
Testicular mass in men >60: Unilateral vs bilateral
Bilateral
58
Testicular mass in men >60: T/F Most have disseminated at diagnosis
T
59
Collection of fluid in the tunica vaginalis
Hydrocele
60
Hydrocele: Tender vs nontender
Nontender
61
Testicular varicocele is dilation of veins of
Pampiniform plexus
62
Testicular varicocele: Right vs left
Left
63
Testicular varicocele: Classic presentation
Testicular pain worse when standing
64
Testicular varicocele: Texture on palpation
Bag of worms
65
T/F If untreated, varicocele may cause infertility
T
66
Testicular torsion: Arterial vs venous
Venous
67
Testicular torsion: Type of infarct
Hemorrhagic
68
Testicular torsion: Classic presentation
Sudden excruciating testicular pain with tender, swollen high-riding testicle
69
SCC of penis: Circumcised vs uncircumcised male
Uncircumcised
70
SCC of penis: T/F associated with HPV infection
T
71
SCC of penis: Risk factors
1) Uncircumcised
| 2) HPV 16 and 18 infection
72
Carcinoma in situ of penile shaft
Bowen disease
73
Carcinoma in situ of penis presenting as erythematous patch on the glans
Erythroplasia of Queyrat
74
Causative agents of acute prostatitis in men older than 35 y/o
1) E. coli
2) Enterobacter
3) Other urinary tract pathogens
75
Causative agents of acute prostatitis in men younger than 35 y/o
1) N. gonorrheae
| 2) Chlamydia
76
Complication of acute prostatitis
1) Chronic prostatitis
| 2) Recurrent UTI
77
Important consideration in treatment of prostatitis
Antibiotics poorly penetrate the prostate
78
Acute prostatitis: PE of prostate
Boggy, tender
79
T/F PSA is commonly elevated in prostatitis
T
80
BPH: Usual location
Transitional zone (around urethra)
81
BPH: Results from action of
Androgens
82
BPH: Complication
Urinary obstruction
83
Prostatic CA: Location
Peripheral zone
84
Prostatic CA: Common site of metastasis
Osteoblasts in lumbar spine, proximal femur, and pelvis
85
Prostatic CA: Elevated in prostatic CA in addition to PSA secondary to common metastasis
ALP
86
Prostatic CA: Precursor lesion
High-grade prostatic intraepithelial neoplasia (PIN)
87
Prostatic CA: Grading system
Gleason
88
Prostatic CA: Prostatic PE
Nodular, hard
89
Prostatic CA: Microscopic
Small glands, back-to-back
90
PSA levels: Gray zone
4-10 ng/mL
91
PSA levels: Rarely cancer
92
PSA levels: Most likely cancer
>10 ng/mL
93
PSA levels: Uncertain etiology
4-10 ng/mL
94
Test done to evaluate patients with PSA level within 4-10 ng/mL
Free PSA
95
Normal free PSA level
96
Causes of elevated PSA besides prostatic CA (6)
1) BPH
2) Prostatitis
3) Prostate massage
4) Cystoscopy
5) TURP
6) Prostate biopsy
97
PSA density is calculated by
PSA divided by weight of gland
98
PSA density suggestive of CA
>0.15
99
PSA velocity suspicious for carcinoma
>0.75 ng/mL/year
100
Precursor lesion of clear cell adenoCA
Vaginal adenosis
101
Dysplastic changes in cervical epithelium that are a precursor to malignancy (2)
1) CIN
| 2) SIL
102
CIN grade: 1/3 from basement membrane to surface of cervical mucosa
I
103
CIN grade: 2/3 from basement membrane to surface of cervical mucosa
II
104
CIN grade: From basement membrane to surface of cervical mucosa
III
105
SIL is based on
Appearance of ells in Papanicolaou smears
106
Dramatically increases the risk of cervical cancer in women
HIV infection
107
Risk factors for progression to squamous cell CA of cervix, low risk
1) Low-grade SIL
2) CIN I
3) HPV 6, 11, 42, 44
108
Risk factors for progression to squamous cell CA of cervix, high risk
1) High-grade SIL
2) CIN II-III
3) HPV 16, 18, 31, 33
109
Protein produced by HPV that induces degradation of p53
E6
110
Protein produced by HPV that induces degradation of Rb
E7
111
Viral change associated with CIN I found in the upper portion of the mucosa
Koilocytes
112
Characteristic appearance of koilocytes
Raisinoid nucleus with clear halo
113
Most common presenting symptom in cervical CA
Abnormal vaginal bleeding or postcoital spotting
114
Most common cause of death in cervical CA
Uremia from ureteral obstruction
115
T/F Papsmear is used to diagnose cervical CA
F
116
Findings on colposcopic exam that indicate cervical CA (3)
1) Acetowhite change
2) Color change
3) Corkscrew and hairpin vessels
117
Causative agents of PID in non postpartum or postabortion
1) Chlamydia
| 2) N. gonorrhea
118
Causative agents of PID in postpartum or postabortion
1) Strep
| 2) Staph
119
PID triad
1) Fever
2) Elevated WBC
3) Purulent cervical discharge
120
Characteristic sign on IE indicative of PID
Chandelier sign (cervical motion tenderness)
121
Syndrome associated with PID
Fitz-Hugh-Curtis
122
Fitz-Hugh-Curtis syndrome is characterized by
RUQ pain in gonococcal or chlamydial perihepatitis
123
Primary amenorrhea is defined as absence of menarche by the age of
16
124
Secondary amenorrhea is defined as
Lack of menstrual period > 6 months after menarche has occurred
125
Acquired syndrome associated with amenorrhea
Asherman syndrome
126
What is Asherman syndrome
Adhesions in the uterus and/or cervix
127
Most common cause of primary amenorrhea
Turner syndrome
128
First step in evaluation of primary amenorrhea
Rule out pregnancy
129
Most common cause of secondary amenorrhea
Pregnancy
130
LH/FSH ratio suggestive of PCOD
> 2:1
131
Progesterone challenge involves
Administering progestins for 7-10 days and awaiting withdrawal bleeding
132
Progesterone challenge: Withdrawal bleeding indicates
Estrogen-primed endometrium and anovulatory but otherwise normal ovaries
133
Progesterone challenge: Absence of withdrawal bleeding is followed up with
Combined estrogen and progesterone challenge
134
Combined estrogen and progesterone challenge: Lack of withdrawal bleeding indicates
Anatomic obstruction to menstruation
135
Combined estrogen and progesterone challenge: Withdrawal bleeding indicates
Low estrogen due to nonfunctional ovaries or dysfunctional HPO axis
136
Microscopic finding in adenomyosis that indicates that it is NOT an invasive endometrial adenoCA
Presence of both glands and stroma
137
Microscopic finding in endometrial adenoma that differentiates it from adenomyosis
Presence of glands only
138
Acute infection of the endometrium caused by polymicrobial infection with vaginal flora
Acute endometritis
139
Most common cause of postpartum fever in patients following CS
Acute endometritis
140
Microscopic morphology of chronic endometritis
Plasma cells in endometrium
141
Presence of normal endometrial tissue within the myometrium of the uterus
Adenomyosis
142
Adenomyosis: Gross
Grossly enlarged uterus
143
Leiomyoma: Gross
Nodularly enlarged uterus
144
Endometrial tissue in abnormal location outside of uterus
Endometriosis
145
Extrapelvic locations of endometriosis
1) Intestine
| 2) Lungs
146
3 theories of mechanisms of endometriosis
1) Regurgutation into peritoneum
2) Metaplastic differentiation of coelomic epithelium
3) Vascular/lymphatic dissemination
147
Endometriosis: Gross
Chocolate cyst
148
Endometriosis: Microscopically, 2 of the following must be present
1) Endometrial glands
2) Endometrial tissue
3) Hemosiderin
149
Profuse or prolonged bleeding during menstruation
Menorrhagia
150
Profuse or prolonged bleeding between menstrual cycles
Metrorrhagia
151
Encompasses menorrhagia and metrorrhagia
AUB
152
Most common cause of AUB
Anovulation
153
Mutation in endometrial hyperplasia
Inactivation of PTEN gene
154
Outcome of PTEN inactivation in endometrial cells
More sensitive to oestrogen stimulation
155
3 microscopic morphology of endometrial hyperplasia
1) Simple
2) Complex w/o atypia
3) Complex with atypia
156
Endometrial hyperplasia: Cystic
Simple
157
Endometrial hyperplasia: Crowded back to back glands, 50% of tissue is glands
Complex w/o atypia
158
Endometrial hyperplasia: Crowded back to back glands with nuclear pleomorphism and mitotic figures
Complex with atypia
159
Most common endometrial CA
Endometrial adenoCA
160
Most common tumour of the uterus
Leiomyoma
161
Most important risk factor for development of endomterial adenoCA
Increased estrogen levels
162
Estrogen levels in OBESITY: Increased vs decreased
Increased
163
How estrogen level is increased with obesity
Peripheral conversion of androstenedione to estrone via aromatase in adipose tissue
164
Less commonly related to increased estrogen and hyperplasia: High-grade vs low-grade endometrial adenoCA
High-grade
165
High-grade variants of endometrial adenoma (2)
1) Clear cell adenoma
| 2) Papillary serous adenoCA
166
Associated with microsatellite instability or p53 mutation: High-grade vs low-grade endometrial adenoCA
High-grade
167
Sites of endometrial adenoma metastases
1) Lungs
2) Liver
3) Bone
168
Sentinel symptom of endometrial CA
Vaginal bleeding in postmenopausal women
169
T/F Endometrial CA are usually diagnosed at an early stage
T
170
Tumors that are uncommon causes of endometrial hyperplasia due to oestrogen secretion
Granulosa cell tumors
171
Leiomyoma: Single vs multiple
Multiple
172
T/F Leiomyoma commonly develops into leiomyosarcoma
F
173
Most important risk factor for malignant degeneration of leiomyoma to leiomyosarcoma
Prior pelvic irradiation
174
PCOD: AKA
Stein-Leventhal syndrome
175
PCOD: Mechanism
Multiple cysts in ovary result in excessive production of estrogen and androgens that are converted to estrone. Estrone inhibits FSH.
176
4 general categories of ovarian tumors
1) Surface epithelial
2) Germ cell
3) Sex cord-stromal
4) Metastatic
177
5 categories of surface epithelial tumors
1) Serous
2) Mucinous
3) Brenner
4) Endometrioid
5) Clear cell
178
Benign vs borderline vs malignant: MOST surface epithelial tumors
Benign
179
T/F Benign ovarian tumors are more common in the younger age group and malignant ovarian tumours are more common in the older age group
T
180
Most important tumour marker for ovarian CA
CA-125
181
Most common type of all ovarian tumors
Serous
182
Serous ovarian tumor: Unilocular vs multilocular
Unilocular
183
Serous ovarian tumor: Bilateral vs unilateral
Bilateral
184
Serous ovarian tumor: Microscopic
Fallopian tube-like epithelium
185
Serous ovarian tumor: Characteristics that increase the chance that a malignant component is present (3)
1) Solid areas
2) Papillary projections
3) Friable tissue
186
Mucinous tumors: MOST benign vs malignant
Benign
187
Mucinous tumors: Unilocular vs multilocular
Multilocular
188
Mucinous tumors: Unilateral vs bilateral
Unilateral
189
Complication of mutinous tumour characterised by ascites, adhesions, and cystic peritoneal implants
Pseudomyxoma peritonei
190
Mucinous tumors: Microscopic
Lined by glandular-like epithelium
191
Brenner tumor: MOST benign vs malignant
Benign
192
Ovarian tumor that microscopically appears like endometrial adenocarcinoma
Endometrioid tumor
193
Mature cystic teratoma in females: Pure vs mixed
Pure
194
A monodermal ovarian teratoma composed entirely of thyroid epithelium
Stroma ovarii
195
Dysgerminoma is the female counterpart of male
Seminoma
196
T/F All dysgerminomas are malignant
T
197
Ovarian germ cell tumor associated with Meigs syndrome
Fibroma
198
Triad of Meigs syndrome
1) Ovarian fibroma
2) Ascites
3) Hydrothorax
199
Granulosa cell tumor: MOST benign vs malignant
Benign
200
Granulosa cell tumor: Hormone production
Estrogen
201
Granulosa cell tumor: Characteristic
Call-Exner
202
Hormone produced by Call-Exner bodies
Inhibin
203
Brenner tumor: Characteristic microscopic finding
Nest of transitional epithelium-like cells admixed with fibrous stroma
204
Bilateral metastatic ovarian tumor composed of signet ring cells, usually GI in origin
Krukenberg tumor
205
Most common organism associated with acute mastitis
S. aureus
206
Fibroadenoma vs fibrocystic change: >35 y/o
Fibrocystic change
207
Fibroadenoma vs fibrocystic change:
Fibroadenoma
208
T/F Fibroadenoma carries a risk for development of CA
T
209
Fibroadenoma: Characteristic PE
Painless, firm, movable, rubbery nodule
210
Leafy architecture
Phyllodes tumor
211
Important consideration in phyllodes tumor excision
Perform wide local excision to prevent recurrence
212
Bloody nipple discharge
Intraductal papilloma
213
2 types of carcinoma in situ of breast
1) DCIS
| 2) LCIS
214
DCIS vs LCIS: Greatly increased risk for development of invasive ductal CA
DCIS
215
T/F DCIS can be detected as a density on mammogram
F
216
Characteristic microscopic morphology of high-grade DCIS
Comedo (has central necrosis)
217
Erythematous eruption of the nipple with scaling and crust
Paget disease of the nipple
218
Paget disease of the nipple: Location of neoplastic cells
Epidermis
219
DCIS vs LCIS: Greatly increased risk for development of invasive breast CA, either lobular or ductal
LCIS
220
DCIS vs LCIS: Marker of future risk of developing invasive CA
LCIS
221
DCIS vs LCIS: May be associated with calcifications
DCIS
222
Substance deficient in LCIS and lobular CA
e-cadherin
223
T/F Majority of LCIS progress to invasive carcinoma
F
224
Type of breast CA associated with peau d'orange
Inflammatory carcinoma
225
Good vs bad prognosis: ER-positive, PR-positive
Good
226
Good vs bad prognosis: Her2-neu +
Poor
227
Her2-neu is what type of receptors
EGFR receptor
