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PLE 2017: Pathology > Pathology (Sections 16-20) > Flashcards

Pathology (Sections 16-20) Flashcards

1
Q

Most common form of intestinal atresia

A

Imperforate anus

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2
Q

Most common type of tracheoesophageal fistula

A

Distal TEF with proximal esophageal atresia

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3
Q

Posterolateral diaphragmatic hernia

A

Bochdalek

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4
Q

Anteromedial diaphragmatic hernia

A

Morgagni

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5
Q

Pathophysiology: Omphalocoele

A

Failure of bowel to return during physiologic herniation (6th to 10th week AOG)

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6
Q

Pathophysiology: Gastroschisis

A

Abnormal closure of the abdominal wall, usually to the right of the umbilicus

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7
Q

True diverticulum, antimesenteric
Failed involution of vitelline/omphalomesenteric duct

Rule of 2's:
2% of population
2ft from ileocecal valve
2x in males
Symptomatic by 2 years of ages
A

Meckel’s Diverticulum

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8
Q

Teratogens associated with pyloric stenosis

A

Erythromycin, Azithromycin

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9
Q

Types of Esophageal Diverticula

A

Zenker (Pharyngoesophageal)
(Above the UES)

Epiphrenic
(Above the LES)

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10
Q

Iron deficiency Anemia
Glossitis
Cheilosis
Esophageal Webs

A

Plummer-Vinson Syndrome

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11
Q

Circumferential narrowng of the esophagus brought about by thickening of mucosa and muscle

A

Schatzki Ring

Type A:
Above Gastroesophageal Junction

Type B:
Squamocolumnar Junction of lower esophagus

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12
Q

Triad of Achalasia

A
  1. Incomplete LES Relaxation
  2. Increased LES Tone
  3. Esophageal Peistalsis
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13
Q

Longitudinal tears near GEJ from retching

A

Mallory-Weiss

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14
Q

Vascular anastomosis involved in esophageal varices

A

Esophageal branch of Left Gastric Vein

And

Azygos Vein

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15
Q

Intestinal metaplasia of the squamous esophageal epithelium

Complication of chronic GERD

A

Barrett Esophagus

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16
Q

Common site of SCCA in the esophagus

A

Middle third

versus AdenoCA: Distal Third

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17
Q

Proximal duodenal ulcers associated with severe burns and trauma

A

Curling Ulcers

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18
Q

Esophageal, gastric, or duodenal ulcers in patients with elevated ICP (direct vagal stimulation and increased acid secretion)

A

Cushing Ulcers

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19
Q

Most common cause of diffuse, acute chronic gastritis

A

Autoimmune gastritis

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20
Q

H. Pylori virulence factors

A
  1. Lophotrichus flagella
  2. Adhesins
  3. Urease
  4. CagA Toxin
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21
Q

Type 4 HSR causing destruction of gastric parietal cells directed against the H/K ATPase Pump

Spares the Antrum

A

Autoimmune Gastritis

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22
Q

Histologic change associated with autoimmune gastritis

A

Endocrine Cell Hyperplasia

versus Intestinal Metaplasia in H. pylori

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23
Q

Most common complication of PUD

A

Bleeding

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24
Q

Most common form of PUD

A

Antral/Duodenal

H. pylori associated

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25
Q 
Mucosal atrophy
Corpus-predominant
Decreased gastric acid secretion
Pain with meals
No nocturnal awakening
A

Gastric Ulcer

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26
Q

Triad of Zollinger-Ellison Syndrome

A
  1. Pancreatic Cell Tumor
  2. Gastric Hypersecretion
  3. Peptic Ulcer Disease
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27
Q

Hypertrophic gastropathy with resulting hypoproteinemia due to protein-losing enteropathy

A

Menetrier Disease

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28
Q

Type of gastric polyp
Lined with flattened chief/parietal cells
Absent a nflammation
No dysplasia

A

Fundic gland polyp

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29
Q

Most common type of gastric polyp

A

Inflammatory/Hyperplastic (85%)

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30
Q

Most common malignancy of the stomach

A

Adenocarcinoma

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31
Q

Most common site of extranodal lymphomas

A

Stomach

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32
Q

Most common abdominal mesenchymal tumor

A

Gastrointestinal stromal tumor

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33
Q

Most common site of gastric adenocarcinoma

A

Antral, Lesser Curvature

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34
Q

Gastric adenocarcinoma
Abnormality in WNT signalling
Exophytic, ulcerative lesions

A

Intestinal Type

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35
Q 
Gastric adenocarcnoma
Loss of E-Cadherin
Infiltrative lesions with desmoplasia
Leather bottle appearance (lintis plastica)
Poorly cohesive cells
A

Diffuse Infiltrative

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36
Q

Most common inducer of MALT lymphoma

A

H. pylori Infection

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37
Q

Most important prognosticating factor for GI Carcinoids

A

Location

*Midgut tumors often multiple and aggressive

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38
Q

Most common site of GI Carcinoids

A

Small Intestine (40%)

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39
Q 
Arise from Cajal Cells
cKIT Mutation (75-80%)
A

Gastrointestinal Stromal Tumor

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40
Q

Most common cause of intestinal obstruction

A

Hernias

*in less than 2 years: intussusception

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41
Q

Most common sites of ischemic bowel disease

A

Splenic Flexure
Sigmoid
Rectum

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42
Q

Hallmark of malabsorptive syndromes

A

Steatorrhea

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43
Q

Cell-mdiated immune reponse to gliadins
CD8+ T-Cells in villi
Diagnostic: Transglutaminase antibodies
Increased risk of Enteropathy-associated T-Cell Lymphoma

A

Celiac Disease

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44
Q

Most common bacterial enteric pathogen

A

Campylobacter jejuni

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45
Q

Associated with Whipple Disease

Ssx of GITB, but AFB (-)

A

Trophyrema whippeli

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46
Q

Common cause of severe childhood diarrhea; associated with diarrheal mortalities worldwide

A

Rotavirus

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47
Q

Causes almost half of gastroenteritis outbreaks worldwide

A

Norwalk Virus

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48
Q

Inflammatory bowel disease
Transmural involvement
Any part of the GIT
Hallmark: Non-caseating granuloma

A

Crohn’s Disease

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49
Q

Inflammatory bowel disease
Mural Involvement
Involves colon and rectum

A

Ulcerative Colitis

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50
Q

Most common site of diverticular disease

A

Sigmoid

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51
Q

Absent in False Diverticula

A

Muscularis propria

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52
Q

Single most important factor that relates to malignancy risk in GIT adenomas

A

Size

> 4cm

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53
Q

Elephant-feet Glands

A

Sessile serrated adnoma

high malignant potential

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54
Q

Multiple hamartomatous polyps, mucocutaneous hyperpigmentation along GIT
Arborizing networks of smooth muscle
Autosomal Dominant

A

Peutz-Jegher Polyps

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55
Q

Multiple (at least 100) colorectal adenomas during teenage years

APC Mutation
Pathgenesis: Hyperactive WNT signalling

A

Familial Adenomatous Polyposis

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56
Q 
Familial clustering of the following tumors:
Colorectal
Endometrial
Ovarian
GIT, HBT
Neurologic
Skin

Pathogenesis: Defective DNA Repair

A

Hereditary nonpolyposis colon cancer

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57
Q

Diagnostic criteria used for HNPCC

A

Amsterdam Criteria

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58
Q

Drug considered protective against GIT adenocarcinoma

A

NSAID

decreased PGE2

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59
Q

Most common site of metastases for GIT malignancies

A

Liver

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60
Q

Gross description of colon cancers

A

Proximal: Exophytic, Bulky

Distal: Annular

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61
Q

Vascular plexuses involved in hemorrhoid formation

A

Internal:
Superior Hemorrhoidal Plexus

External:
Inferior Hemorrhoidal Plexus

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62
Q

Most common cause of appendiceal obstruction

A

Children:
Lymphoid Hyperplasia

Adults:
Fecalith

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63
Q

Mucinous ascites due to peritoneal seeding of mucinous tumors

A

Pseudomyxoma Peritonei

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64
Q

Most common appendiceal tumor

A

Carcinoid

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65
Q

Pathophysiology: Ormond Disease

A

IgG mediated retroperitoneal sclerosis

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66
Q

Functions of hepatic stellate cells

A

Vitamin A Storage

Scar formation in hepatic injury

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67
Q

Etiology of rapid hepatic necrosis in ALF without evidence of repair

A

Drug-induced

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68
Q

Pathophysiology: Hepatorenal Syndrome

A

Decreased GFR due to afferent arteriole vasoconstriction (c/o RAAS) from renal hypoperfusion

Initiating Event: Systemic Vasodilation

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69
Q

Most common cause of portal hypertension

A

Cirrhosis

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70
Q

Pathologic derangements of portal hypertension

A

Sinusoidal remodelling and intrahepatic shunting

Hyperdynamic pulmonary circulation

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71
Q

Councilman Bodies

A

Eosinophilic inclusions in viral hepatitis

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72
Q

Autoimmune hepaitis
Middle aged and older
ANA, Anti-SMA autoantibodies
Better prognosis

A

Type 1

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73
Q

Autoimmune hepatitis
Children and teenagers
Anti-LKM-1 autoantibody
Less favorable prognosis

A

Type 2

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74
Q

Drugs that trigger an immune response via binding of large molecules

A

Hapten

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75
Q

Alcohol consumption associated with ALD

A

80g/day

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76
Q

Morphologic patterns of ALD

A

Hepatocellular steatosis
(Lipid droplets; reversible)

Alcoholic steatohepatitis
(Swelling and necrosis)

Steatofibrosis
(Chicken-wire Fibrosis)

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77
Q

Mallory-Denk Bodies

A

Amorphous, eosinophilic material seen in ALD

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78
Q

Most common metabolic liver disease

A

Non-alcoholic fatty liver disease

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79
Q

Triad of Hemochromatosis

A
  1. Micronodular cirrhosis
    (mediated by activation of stellate cells by iron)
  2. DM
    (pancreatic fibrosis)
  3. Skin pigmentation
    (Slate gray skin)
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80
Q

Impaired copper excretion in bile
ATP7B mutation
Putaminal atrophy (movement disorders)
Kayser-Fleisher Ring (corneal limbus)

A

Wilson Disease

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81
Q 
Autosomal ecessive
PiZZ genotype
Panlobular emphysema (elevated elastase)
Liver damage (misfolded CHON accumulation)
A

Alpha-1-antitrypsin Deficiency

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82
Q

Conditions associated with impaired uridine diphosphate glucoronyltransferase

A

Criggler-Najar Type 1
(AR, absent activity)

Criggler-Najar Type 2
(AD, decreased activity)

Gilbert
(AR, decreased activity)

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83
Q

Conjugated hyperbilirubinemia
MRP2 Mutation
Impaired biliary excretion

A

Dublin-Johnson Syndrome

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84
Q 
Conjugated hyperbilirubinemia
Mechanism unknown
#PinoyPride
A

Rotor Syndrome

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85
Q

Most common cause of bilde duct obstructions

A

Adults:
Gallstones

Children:
Biliary Atresia

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86
Q

Charcot Triad

A
  1. Fever
  2. Jaundice
  3. RUQ Pain
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87
Q

Complete or partial obstruction of the extrahepatic BT within first 3 months of life

Single most common cause of hepatic mortality in early childhood

A

Extrahepatic biliary atresia

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88
Q

Types of Biliary Atresia

A

Fetal
(Malformation)

Perinatal
(Postnatal destruction)

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89
Q 
Median age 50
Female
Associated with Sjogren Syndrome (70%)
AMA positive (95%)
Loss of small ducts

Florid duct lesion
Mallory-Denk Bodies

A

Primary Biliary Cirrhosis

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90
Q 
Median Age 30
Male
Associated with IBD (70%)
ANCA positive(65%)
Involvement of all sizes of hepatic ducts
A

Primary Sclerosing Cholangitis

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91
Q

Triad of Choledochal Cysts

A
  1. Pain
  2. Jaundice
  3. Abdominal Mass
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92
Q

Congenital cystic dilatation of intrahepatic bile ducts

Associated with choledochal cysts

A

Caroli disease

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93
Q

Congenital bile duct hamartomas

Associated with polycystic kidney disease

A

Von Meyenbrg Complex

94
Q

Infarct of Zahn

A

Intrahepatic thrombosis

95
Q

Sinusoidal dilatation due to impediment in hepatic blood outflow

A

Peliosis hepatis

96
Q

Thrombotic obstruction of more than 2 hepatic veins

Hemorrhagic centrilobular necrosis

A

Budd-Chiari Syndrome

97
Q

Sinusoidal remodelling secondary to toxic endothelial injury

A

Sinusoidal Obstruction Syndrome

98
Q

Components of Nutmeg Liver

A

Centrilobular Congestion
(RSHF)

Centrilobular Ischemic Coagulative Necrosis
(LSHF)

99
Q

Centrilobular fibrosis in long-standing congestion

A

Cardiac sclerosis

100
Q

Most common benign hepatic tumor

A

Cavernous Hemangioma

101
Q

Most common liver tumor in early childhood

A

Hepatoblastoma

102
Q

Most common tumor of the liver

A

Metastasis

103
Q

Most common primary malignant tumor pf the liver

A

Hepatocellular Carcinoma

104
Q

Second most common primary malignancy of the liver

A

Cholangiocarcinoma

105
Q

Tumor marker for HCC

A

Alpha-fetoprotein

106
Q

Pattern and site of metastasis for HCC

A

Hematogenous to the Lungs

107
Q

HCC Variant
Oncocytes in clusters
Parallel lamellae of dense connective fiber

A

Fibrolamellar HCC

108
Q

Common location of Cholangiocarcinoma

A

Perihilar (Klatskin Tumor)

109
Q

Most common congenital anomaly of the gallbladder

A

Folded fundus

Phrygian Cap

110
Q

Most common biliary tract disease

A

Cholelithiasis

111
Q

Types of acute cholecystitis

A

Acute calculous (90%)

Acute acalculous (ischemic)

112
Q

Rochitansky-Aschoff Sinuses

A

Mucosal outpouching of the gallbladder

113
Q

Extensive, dystrophic calcification of the gallbladder

A

Porcelain Gallbladder

114
Q

Atrophic, dilated GB with clear secretions

A

Hydrops

115
Q

Failure of fusion of fetal pancreatic duct systems

Most common congenital anomaly of the pancreas

A

Pancreatic divisum

116
Q

Most common site of ectopic pancreatic tissue

A

Stomach, Duodenum

117
Q

Mutation involved in pancreatic agenesis

A

PDX1

118
Q

Most frequntly mutated oncogene in pancreatic cancer

A

KRAS

119
Q

Most common location of pancreatic cancer

A

Head

120
Q

Tumor marker for pancreatic cancer

A

CA 19-9

121
Q

Common site of metastasis for pancreatic cancer

A

Liver, Lungs

122
Q

Acute Kidney Injury

A
  1. Increase in SCr by 0.3 in 48 hrs
  2. Increase in SCr by 1.5x baseline within 7 days
  3. Urine < 0.5mL/kg/hr for 6 hrs
123
Q

Nephritic Syndrome
Type 3 HSR
EM: Subepithelial bumps
IF: IgG, C3 positve

Most common cause of nephritic syndrome in children

A

PSGN

124
Q

Histologic hallmark of RPGN

A

Crescent formation

125
Q

Electron Microscopy and Immunofluorescence in RPGN

A

Type I
EM: Ruptured GBM
IF: Linear deposits

Type II
EM: Lumpy-Bumpy deposits
IF: Granular deposits

Type III
EM, IF: No deposits

126
Q

Males in their 20’s
Smokers
Hemoptysis and Renal Failure

Antibodies against Collagen type 4

A

Goodpasture Syndrome

127
Q

Nephrotic Syndrome
EM: Effaced foot processes
Responsive to steroids

Most common cause in children

A

Minimal Change Disease

128
Q

Nephrotic Syndrome
EM:”Spike and Dome” subepithelial deposits
IF: Granular deposits

Second most common cause in adults

A

Membranous Nephropathy

129
Q 
Nephrotic Syndrome
Associated with HIV, Heroin
LM: Mesangial proliferation, hyalinosis
EM: Effacement of foot processes
IF: Non-specific trapping in hyalinosis

Most common cause in adults

A

Focal Segmental Glomerulonephritis

130
Q

Difference between MPGN Type 1 and 2

A

Type 1
Classical and alternative complement activation
WITH Immune Complex Deposition

Type 2
Also known as Dense Deposit Disease
Alternative complement activation
WITHOUT Immune Complex Deposition

131
Q

Nephrotic Syndrome
IgA deposition localized to kidneys (mesangial)
Gross hematuria post-infection (GI, Pulmo)
IF: Mesangial deposit of IgA

Most common GN worldwide

A

IgA Nephropathy

Berger Disease

132
Q

Nephrotic Syndrome
Systemic IgA Deposition
Purpuric skin lesions, GI Bleed, Arthralgias
IF: Mesangial deposit of IgA

A

Henoch-Schonlein Purpura

133
Q

Defective assembly of Type 4 Collagen
Isolated Hematuria
EM: Diffuse thinning of GBM

A

Thin Basement Membrane Lesion

134
Q 
Defective assembly of Type IV collagen
Posterior Lens dislocation
Hearling Loss
Hematuria
EM: Basket-Weave Appearance
A

Alport Syndrome

135
Q

Top causes of AKI

A
  1. Pyelonephritis

2. Drug-induced TIN

136
Q

Pathophysiology: Adult Polycystic Kidney Disease

A

PKD1 (85%, more severe) and PKD2 (15%) Mutations

137
Q

Pathophysiology: Childhood Polycystic Kidney Disease

A

PKHD1 Mutation

138
Q

Most commn stones in urolithiasis

A

Calcium Oxalate, Calcium Phosphate (70%)

139
Q

Types of Renal Stones

A

Calcium Oxalate
(Acidic, Opaque)

Struvite
(Basic, Opaque)

Uric Acid
(Acidic, Lucent)

Cystine
(Acidic, Opaque)

140
Q

Renal tumor associated with Tuberous Sclerosis

A

Angiomyolipoma

141
Q

Benign renal tumor arising from the intercalated cells of the collecting duct

A

Oncocytoma

142
Q

Benign renal tumor arising fr, tubular epithelial cells in a palm frond configuration

A

Renal Papillary Adenoma

143
Q

Most common renal malignancy

A

Renal Cell Carcinoma

144
Q

Second most common renal malignancy

A

Wilms Tumor

145
Q

Third most common renal malignancy

A

Urothelial carcinoma of the pelvocalyceal system

146
Q

Common in:
Males
60’s-70’s
Smoker

Most common renal malignancy

A

Renal Cell Carcinoma

147
Q

Sites of predisposition: Renal Cell Carcinoma

A

Renal Cell:
Proximal Tubule

Papillary:
Distal Tubule

Chromophobe:
Intercalated cells of the Collecting Ducts

148
Q

Triad of Renal Cell Carcinoma

A
  1. Hematuria
  2. Flank Pain
  3. Palpable Mass
149
Q

Renal malignancy associated with Lynch Syndrome and Analgesic Nephropathy

A

Urothelial Carcinoma of the Renal Pelvis

150
Q

Metastatic spread by Renal Cell Carcinoma

A

Hematologic to the Lungs, Bones

151
Q

Most common cause of hydronephrosis in children

A

Ureteropelvic Junction Obstruction

152
Q

Most common primary malignancy in the Ureters

A

Urothelial Carcinoma

153
Q

Most common and serious congenital anomaly of the ureters

A

Vesicoureteral Refux

154
Q

Consequences of a patent Urachus

A

Fistula between umbilicus and urinary bladder (total patency)

Urachal Cyst (partial patency)

155
Q

Most common bacterial pathogens of acute cystitis

A

Escherichia coli
Klebsiella
Proteus
Enterobacter

156
Q

Viral cause of hemorrhagic cystitis

A

Adenovirus

157
Q

Cytotoxic drug associated with hemorrhagic cystitis

A

Cyclophosphamide

158
Q

Triad of Acute Cystitis

A
  1. Frequency
  2. Lower abdominal pain’
  3. Dysuria
159
Q

Common in women
Intermittent, severe suprapubic pain
Frequency, urgency, hematuria, dysuria
Cystoscopy: Punctate hemorrhages, fissures, Hunner Ulcers

May mimic carcinoma-in-situ

A

Chronic Pelvic Pain Syndrome

Interstitial Cystitis

160
Q

Hunner Ulcers

A

Chronic mucosal ulcers found in patients with Interstitial Cystitis

161
Q

Seen in cases of chronic E. coli and Proteus infections
Defect of phagocyte function
Michaelis-Guttman Bodies

A

Malakoplakia

162
Q

Michaelis-Guttman Bodies

A

Macrophages with abundant lysosomal calcium deposits

Seen in Malakoplakia

163
Q

Form of cystitis that mimics Urothelial carcinoma both clinically and histologically

Arises from irritation secondary to catheterization

A

Polypoid Cystitis

164
Q

Brunn nests (urothelial cells) grow downward into lamina propria; presents as glandular metaplasia or cyst formation

A

Cystitis Cystica et Glandularis

165
Q

Implantation of renal tubular cells at sites of injured urothelium

A

Nephrogenic Adenoma

166
Q 
Males
Smokers
5th to 8th decade of life
Mediated by 9p and 9q deletions/monosomy
Presents as painless hematuria, frequency, urgency

Most common histologic type: Urothelial

A

Bladder Cancer

167
Q

Infectious cause of SCCA in the bladder

A

Schistosoma haematobium

168
Q

Denuding Cystitis

A

Few malignant cells on a largely denuded basement membrane with inflamed stroma.

Seen in carcinoma-in-situ of the urinary bladder

169
Q

Intravesically administered vaccine used as treatment for non-invasive urothelial carcinomas

Attenuated strain of Mycobacterium bovis

A

Bacille-Calmette-Guerin

170
Q

Most important prognostic factor in invasive urothelial carcinoma of the bladder

A

Staging

171
Q

Most common benign tumor of the bladder

A

Leiomyoma

172
Q

Most common sarcoma in children

A 
Embryonal Rhabdomyosarcoma
(Sarcoma Botryoides)
173
Q

Most common sarcoma in adults

A

Leiomyosarcoma

174
Q

Most common cause of urinary bladder obstruction in males

A

Nodular prostatic hyperplasia

175
Q

Most common cause of urinary bladder obstruction in females

A

Cystocoele of the bladder

176
Q

Non-infectious cause of urethritis

A

Reiter Syndrome

177
Q

Inflamed granulation tissue in the urethra, covered by a friable mucosa

A

Urethral Caruncle

178
Q

Distribution of Urethral Malignancies

A

Proximal:
Urothelial Carcinoma

Distal:
Squamous Cell Carcinoma

179
Q

Pathophysiology:

Hypospadias, Epispadias

A

Malformation of the urethral groove

180
Q

Most common cause of phimosis

A

Scarring from infection

181
Q

Infection of the glans and the prepuce

A

Balanoposthitis

182
Q

Pathogen responsible for Condyloma Acuminatum

A

HPV 6, HPV 11

183
Q

HPV 16 Infection
Solitary gray-white, opaque plaque

Progresses to SCCA in 10% of cases

A

Bowen Disease

184
Q

HPV 16 infection

Solitary, shiny, red, velvety plaque

A

Erythroplasia of Queyrat

185
Q

HPV 16 Infection
Multiple reddish-brown papules

Does not progress to SCCA

A

Bowenoid Papulosis

186
Q

Locally invasive, but rarely metastatic verrucous tumor of the penis

A

Buschke-Lowenstein Tumor

Giant Condyloma Acuminatum

187
Q

Most important prognostic factor in penile malignancy

A

Staging

188
Q

Most common site of cryptorchidism

A

Inguinal Canal

189
Q

Most common phase of arrest in Cryptorchidism

A

Inguinoscrotal

4th to 7th month AOG

190
Q

Anatomic predisposition of the various patholog processes in male gonads

A

Epididymis:
Inflammation, Gonorrhea (initially), EPTB (initially)

Testes:
Tumors, Syphilis (initially)

191
Q

Pathogenesis of orchitis and epidydimitis

A

Ascending or lymphatic spread of UTI

192
Q

Testicular mass with or without fever

Non-caseating granulomas in spermatic tubules

A

Granulomatous / Autoimmune Orchitis

193
Q

Acute interstitial orchitis following a previous PAROTITIS
Unilateral testicular involvement
Not associated with infertility

A

Mumps Orchitis

194
Q

Urologic emergency
Hemorrhagic infarction from twisting of the spermatic cord
Golden period: 6 hours

A

Testicular Torsion

195
Q

Adult-type testicular torsion results from this bilateral anatomic defect in adolescents

A

Bell-clapper Deformity

increased mobility of testes

196
Q

Most common cause of painless testicular enlargement

A

Testicular neoplasia

197
Q

Histologic types of Testicular Tumors

A

Germ Cell (95%, aggressive)

Sex cord-stromal (5%, less aggressive)

198
Q

Prescursor lesion of most Testicular Germ Cell Tumors

A

Intratubular germ cell neoplasia

199
Q

Most common route of lymphatic spread by Germ Cell Tumors

A

Retroperitoneal para-aortic lymph nodes

200
Q

Most common route of hematogenous spread by Germ Cell Tumors

A

Lungs
Liver
Brain
Bones

201
Q 
Clinical division of GCT
Diagnosed at Stage I (70%)
Lymphatic Spread
Radiosensitive
Cells resemble primordial germ cells
A

Seminomatous

202
Q 
Clinical division of GCT
Diagnosed at Stage II or III (60%)
Hematogenous spread
Radioresistant
Undifferentiated Cells
A

Non-seminomatous

203
Q

Staging of GCT

A

Stage I
Confined to testes, epididymis, or spermatic cord

Stage II
Spread to subdiaphragmatic LN

Stage III
Spread to retroperitoneal LN or those above diaphragm

204
Q 
Seminomatous GCT
Occurs after puberty
Precursor lesion: ITGCN
Ovarian equivalent: Dysgerminoma
Gray-white, lobulated mass

Most common GCT

A

Seminoma

205
Q 
Seminomatous GCT
Occurs at 6th decade of life and beyond
No precursor lesion
No ovarian equivalent
Well-circumscribed, pale-gray, multinodular mass
A

Spermatocytic Seminoma

206
Q

Types of Seminoma

A

Typical/Classic
(Large polyhedral cells, clear cytoplasm, central nucleus)

Anaplastic
(Same as typical, with atypia)

207
Q 
20's to 30's
Precursor lesion: ITCGN
Common component of Mixed GCT's (80%)
More aggressive than Seminomas
Small, poorly demarcated masses with foci of hemorrhage
A

Embryonal Carcinoma

208
Q

<3 years old
No precursor lesions
Excellent prognosis
Non-encapsulated, solid, homegnous, yellow-white mass
Schiller-Duval Bodies, Hyaline-like Globules
(+) AFP is highly characteristic

Most common testicular tumor in children less than 3 years

A

Yolk Sac Tumor

Infantile Embryonal Carcinoma, Endodermal Sinus Tumor

209
Q

Highly malignant
Hematogenous Spread with Brain metastases
Clinically, normal sized testes and/or small nodule
Tumor Marker: HCG
Histology: Cytotrophoblasts and Syncytiotrophoblasts

A

Choriocarcinoma

210
Q

Complex tumor with various components derived from more than 1 germ cell layer

Second most common testicular tumor in infants and children

A

Teratoma

211
Q

Best prognostic factor for Teratomas

A

Age

Post-puberty: All considered malignant

212
Q

Differentiates Immature from Mature Teratomas

A

Degree of Differentiation

Less in Immature

213
Q

Malignant transformation of a Teratoma

A

Non-germ cell malignancy arising from within a teratoma
Usually chemoresistant
Retains i(12p) Mutation from Teratoma precursors

214
Q

Schiller-Duval Bodies

A

Central blood vessels enveloped by tumor cells within a space lined by tumor cells

Seen in Yolk Sac Tumors

215
Q

Second most common GCT in adults (60%)

A

Mixed GCT

216
Q 
Sex Cord-Stromal Tumor
2nd to 6th decade of life
Gynecomastia, Precocious Puberty
Benign
Well-differentiated polygonal cells with abundant granular cytoplasm; with Crystalloids of Reinke (rod-shaped)
A

Leydig Cell Tumor

217
Q 
Sex Cord-Stromal Tumor
First 4 decades of life
Hormonally silent
Most are benign
Trabeculae and cords recemble seminiferous tubules
A

Sertoli Cell Tumor

218
Q

Most common form of testicular neoplasm in males greater than 60 years of age

A

Testicular Lymphoma

219
Q 
Fever, chills, and dysuria
Tender, boggy prostate on DRE
Caused by E. coli, Enterococci, Staphylococci
Chronic: History of recurrent UTI
Prostatic secretions: >15 WBC/hpf
A

Bacterial Prostatitis

220
Q

Painful ejaculation
Caused by Chlamydia, Trichomonas, Ureaplasma, and Mycoplasma
Prostatic secretions: >10 WBC/hpf
(-) Bacterial Cultures

A

Abacterial Prostatitis

221
Q

Most common site of prostatic intraepithelial neoplasia (PIN), and prostatic malignancy

A

Peripheral Zone

222
Q

Most common site of nodular prostatic hyperplasia (NPH)

A

Transitional Zone

223
Q

Prostatic neoplasia
Mediated by Dihydroxytestosterone (DHT)
Fibromuscular and glandular hyperplasia leading to nodule formation

NOT a premalignant lesion

A

Nodular Prostatic Hyperplasia

224
Q 
> 50 years
High fat diet, Obesity, Alcoholism
Adenocarcionoma without basal layer
Presents as dysuria (most common)
Direct local extension to seminal vesicles and bladder
Hematogenous spread to Lumbar Spine

Diagnostics: PSA (Non-specific)

A

Prostatic Adenocarcinoma

225
Q

PTEN Mutation in Prostatic CA

A

Gives resistance to anti-androgen therapy

226
Q

ERG-ETV1-TMPRSS2 Mutation in Prostatic CA

A

Associated with invasiveness; very common mutation

227
Q

Diagnostic used in the context of elevated PSA given a normal prostate biopsy

A

PCA3

228
Q

Prostate CA scoring system based on the two most dominant glandular patterns on histology

A

Gleason Scoring System

229
Q

Best prognostic factor for Prostate CA

A

Stage and Grade

230
Q

Most common cause of renal artery stenosis

A

Atherosclerosis

PLE 2017: Pathology (4 decks)

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