MOD 1 Flashcards
Male genital SCC risks and hygeine/ pop? features?
- middle/elderly
- keratin pearls, big
- risks are poor hygiene, lack of circumcision, HPV, smoking, etc
- doesn’t usu involve bleeding
Testicular tumors
- pop
- 3 types
- 6 assocations with testicular cancer
- dx/biomarkers
- pop: most common malig in young men, second peak in elderly, more common in right testis, caucasians
- 3 types: germ cell tumors (seminoma/ embryonal/ yolk sac/ choriocarc/ teratoma/ mixed), stromal tumor (leydig, sertoli), and lymphoma
- 6 assoc: crypotorchidism, prior history, prior fam history, intersex, infertility, intratubular germ cell neopl
- dx: dont biopsy bc can contaminate, markers like AFP and B-HCG
Seminoma
gross
histo
px
- large bulky homogen mass replacing testis, white surface WITHOUT necr/hemorr, most common
- histo sheets of cells, polyhedral with pink clear cyto, central nuclei
- grow slowly, 4th decade, rare gynecom and BHCG
- HIGHLY CURABLE, good px, radio tx
Embryonal carcinoma
- histo/gross
- px
- poorly demarcated tumor WITH necrosis/hem
- immature primitive cells (lost of mitoses, large syncytial cells MAY be present that express BHCG and AFP), middle age, more aggro than seminoma, pain
- nuclear atypia
Yolk sac tumor (endodermal sinus)
histo, elev, pop, px
-SCHILLER DUVAL body that looks like prim glom, hyaline globules that represent AFP elev, px good in kids
Choriocarcinoma
histo
elev
px
- Most malig
- made of syncytiotrophoblast growing around cytotropho, with absent chorionic villi, produces HCG (which causes hyperthyroidism and gynecomastia)
Teratoma
- MAY have increased AFP of BHCG
- Malig in males, benign in females
- may contain other tissues
Leydig cell tumor
-gross/histo
- stromal tumor, yellow or brown in color, REINKE CRYSTALS
- may have testicular swelling, gynecom
Sertoli cell tumor
-stromal tumor, secr estro/andros can cause masc/fem or gynecom
Gonadoblastoma
stromal, arise in pts with gonadal dysgenesis
Lymphoma
Gray-white homogenous in appearance, infilitrate between sem tubules, usu diffuse large B cell type
- most common in elderly, often bilateral
- part of sys disease
Hypospadia/epispadia
Phimosis
Complications of cryptorchidism and tx
Assoc with torsion of spermatic cord
- hypo- urethral opening on ventral surface, epi- dorsal; both assoc with undescended testes
- phimosis-cant retract foreskin
- sterility of bilat, higher risk of cancer, tx with orchiopexy
- torision of test assoc with bell clapper deformity (incr mobility of testes in scrotum)
Biggest disease assoc with cervical cancer?
HPV!
Cervical cancer involves
squamous or adeno, invasvive SCC is T1B+
Which is worse px/aggro between cervical and adeno
adenocarcinomas of cervix are worse!
Pap smear
cervical brush at transition zone for women 30+
What cell type is pathognomic for HPV?
KOILOCYTES!
squamous cell with halo around a raisinoid/grooved nucleus darker than normal staining
What test do you do after seeing an abnormality from a pap smear? and then what?
If you see an abnormality on the pap smear, do a colposcopy (visualization of mucosa), and if still abnormal do a biopsy
procedures for high grade SIL (squamous intraepith neo aka CIN or cervical neo) vs low grade?
Low grade– survey with colposcopy and watch for change
High grade– cryosurgery or LEEP (removal of tissue) or surge
Cervical cancer risk factors besides HPV
multiple partners, HIV, long term oral contraceptive use, smoking
HPV virus type high risk serotypes proteins vaxx what cancers is it assoc with
dsDNA virus high risk serotypes are 16 and 18 protein E6 and E7 vax is gardasil hpv assoc with cervical cancer--both SCC AND adenocarc
what cells line the ecto and endocervix?
ecto- strat squam
endo- simple colum
trans zone is in between
HPV early genes that contribute to pathogenesis of cervical cancer caused by hpv?
E6 which binds to p53
and E7 which binds Rb
(tumor suppressor genes etc)
vax for hpv in US
Gardasil 9, recommended for all kids
precursor lesion to SCC and adeno?
SCC- SIL/CIN (squamous or cervical intraepith, low or high grade)
which cancer is obesity vs smoking a risk for?
obesity- adeno
smoking- scc
oral contraceptive use is both!
What is the usual cause of death in SCC patients?
Uremia due to obstruction
what did DES increase risk for
adeno (clear cell) in daughter
how often should females have pap?
every 3 yr starting at age 21 etc
fxnl unit of breast?
what are the 2 cells involved?
the TDLU (terminal duct lobular unit), small duct coming from lobule surr by fibrous stroma -2 cell types: luminal epith cells and myoepith cells
Mastitis
inflammat changes in breasts, shouldnt be biopsied due to bact or virus (eg staph), would give neutros (chronic woudl show up as lymphos/plasma cells)
silicone granulomas can also happen, would show foamy histiocytes with silicone granules
Fat necrosis
cause and histo
trauma or prior surg which can mimic carc
-fibrosis and EGG SHELL CALCIFICATIONS with FOAMY MACROPHAGES and LIPID-FILLED CYSTS, can be from seatbelt, sports, etc (tender and lumpy)
Fibrocystic breast changes - 2 forms
Nonprolif and prolif (+/- cellular atypia)
nonprolif fibrocystic breast change
stromal fibrosis, cyst, apocrine metaplasia, and adenosis (of myometrium?) (DONT incr risk for BC dev)
prolif fibrocystic breast change
epith hyperplasia, sclerosing adenosis, small duct papilloma, and clerosing lesions– all incr risk for BC and cellular atypia increases it even more, carc in situ has highest risk of dev into invasive carc
Fibrocystic BREAST changes are found in which pathologies?
1 Atypical ductal hyperplasia
2 Fibroadenoma
3 Phyllodes tumor
4 Intracellular papilloma
Atypical ductal hyperplasia
lesion w SOME features of low grade ductal carc in situ (not DCIS)
-when hyperplasia incl 2 types of cells (normal), if only one cell found its more worrisome
Fibroadenoma gross appearance features pop sx
Benign tumor with CT and epith prolif, most common breast tumor in young ppl, more in AA pts
- well circumscribed FREELY MOVABLE nonpainful mass
- CAN ENLARGE WITH PREG AND REGRESS as it responds to estrogen
- tubular and lactating adenomas most common
Phyllodes tumor
gross/histo
-etc
Fleshy tumor with leaflike pattern
- made of CT and epith, more CT than fibroadenomas tho, uncommon
- can be benign borderline OR malig–> if malig spreads thru blood
Intraductal papilloma
appearance
sx
- discrete benign pap tumor from mammary duct
- periductal inflamm and sclerosis
- often have BLOODY NIPPLE DISCHARGE or serious (mimics carcinoma of breast!)
- fibrosis, infarct, and metaplasia
Breast Cancer types
1 DCIS 2 Infiltrating ductal carcinoma, NOS 3 Tubular carcinoma 4 Mucinous carcinoma 5 Medullary carcinoma 6 Papillary carcinoma 7 Paget's disease of the nipple 8 Lobular carcinoma in situ (LCIS) 9 Invasive lobular carcinoma
risk of developing or dying from BC
survival rate
- 1/8 risk , 1/35
- second leading cause of cancer death among women
- 5 year survival rate is 90%
Breast Cancer risk factors
older, f hx, mutations like brca, AA, estrogen exposure like early menarche, late menopause, nullparity etc, obesity and western diet, radiation etc
BRCA-1 vs BRCA-2 mutations
- BRCA-1 BC risk increases in elderly, ovarian prostate pancreas and fall tube neoplasms also
- BRCA-2 is ovarian and male BC in addition
signs of BC
breast mass, asymmetric thickening, bloody nipple discharge/scaling(pagets/ dimpling, erythema/ pain etc
subtyes of bc
in situ and INVASIVE
- most is invasive- mostly DUCTAL
- rest is in situ carc- mostly ductal (rest is lobular)
DCIS of breast
and four growth patterns
intraductal carcinoma in situ (of mammary ducts) which doesnt invade surr stroma
-4 patterns: micropapillary, cribiform, solid, and CAMEDO
Camedo of the Breast
DCIS that includes CALCS around neoplasm with CENTRAL NECROSIS
Infiltrating ductal carc, NOS
-gross appearance, hormones, px
most common mamm carc, in mid-late 50s
- gross: stellate white and firm with desmoplasia in background
- dep on estro and progest
- aggro and will often mets
Tubular carcinoma
- levels/genetics
- histo
- ductal carc with FAVORABLE px, background of low grade DCIS with FLAT ATYPIA
- ER/PR+, low Ki-67, her2-
- histo: looks like random TUBES placed in breast stroma
Mucinous carcinoma
-histo, genetics, px
tumor w malig clusters of cells floating in POOLS OF EC MUCIN (v distinguishable appearance)
- can involve ax node, well circumscribed, can mimic adenocarc
- most ER/PR+ with FAVORABLE px
Medullary carcinoma
-genetics, px/mets, histo, pop, gross
- ER/PR-HER2-, (TRIPLE NEG) but includes diffuse lymphoplasmocytic inflitrate which STOPS IT FROM MESTASIZING!
- syncytial growth pattern with high mitotic rate, circumscribed
- younger pts with BRCA-1 mutation
Papillary carcinoma
-histo, sx, px, pop
- cancer with fingerlike projections, postmenopause, many have papillary DCIS and can have BLOODY NIPPLE DISCHARGE
- good px, low rate of mets
Paget’s disease of the nipple
-sx, histo
- pain/itching/scaling/redness of nipple which may have ulceration, crusting, and serious/bloody discharge
- mistaken for ECZEMA
- pale staining malig cells within the epidermis
LCIS (Lobular carcinoma in situ)
carc of intralobular ductules which are damaged by loosely aggregated cells without stromal invasion, usually bilateral
Invasive lobular carcinoma
- levels
- mets
- histo
Invasive carcinoma of uniform cells resembling LCIS, low mitotic rate
- can be bilateral, can mets to csf, body cavities and ovaries
- E-cadherin negative
- cells line up in single file line
which cancers have favorable, unfavorable, and poor px based on levels
ER/PR+, HER2- favorable
ER/PR-, HER2+ unfavorable and harder to tx
Triple negative ER/PR/HER2- has v poor px (Basal-like cancers)
which cancers are BRCA2/DCIS
which cancers are HER2+
Which cancers are tBRCA1 basal like
- luminal!
- germline p53 and atypical apocrione adenosis
- triple neg
Gynecomastia
- apperance
- assoc
- type of carc
Subareolar mass, soemtimes bilateral
- assoc with cirrhosis, RF, pulm dis, hormones /drugs
- carc is DCIS (bc no lobular components in male breast)
***go thru clicker q’s and pathoma for this lecture!
