Repro- Pathology 2 Flashcards
What is the most common BENIGN ovarian neoplasm?
a serous cystadenoma, which is often bilateral
What is an endometrioma?
Endometriosis (ectopic endometrial tissue) within the ovary that results in cyst formation
How might an endometrioma present? Benign or malignant?
Presents with pelvic pain (can be chronic), dysmenorrhea, and commonly dyspareunia
Benign
What is this?
This is endometriosis in the ovaries that produces a characteristic chocolate cyst which is filled with reddish-brown blood
What is a teratoma? benign or malignant?
This is a tumor/growth that consists of tissue from all three embryonic layers- endo, meso, and ectoderm
How common are ovarian teratomas?
These make up roughly 15-20% of all ovarian tumors and can be classified as mature (benign) or immature (malignant)
What is a clue that a mass in the ovaries might be a teratoma?
teratomas, especially mature ones, might present with mature tissue from other organs including hair, bone, and teeth
What is strauma ovarii?
This is a monodermal teratoma presenting in the ovaries that consists of ectopic thyroid functional tissue, seen in cases of hyperthyroidism
What is a Brenner tumor?
A benign ovarian tumor of the ovaries histologically presents as nests of urothelium like tissue and are often multicystic and benign
Brenner looks like bladder
What are fibromas?
These are BENIGN sex-stroma tumors of the ovaries comprised of spindle-shaed fibroblasts.
NOTE: Fibromas and thecomas (and fibrothecomas) are indistinguishable typically
What are some syndromes associated with ovarian fibromas?
Meigs syndrome which has the triad of hydrothorax, ascites, and fibromas and
Basal cell nevus syndrome
How do fibromas classically present?
with a ‘pulling’ sensation in the groin
How do thecomas behave?
These, like ovarian granulomas, may produce estrogen, and may present classically as abnormal uterine bleeding in a postmenopausal woman
What is the most common malignant stromal tumor of the ovaries?
granulosa tumors
When are granulomas common in women?
In older (50s) women
Granulomas in grannys
T or F. Granulomas are classically known for producing estrogen
T. So they might tend to grow during the follicular phase and pregnancy and not be as resposnibel post-menopause
What are these?
Call-Exner bodies seen in Granulomas tumors of the ovaries- these occur when granulosa cells arrange haphazardly around collections of eosinophilic fluid
What is the most common overall MALIGNANT neoplasm of the ovaries?
Serous cystadenocarcinomas
What is a good histo tip that something is a Serous cystadenocarcinomas?
Psoammoma bodies
What are the other malignant tumors of the ovaries besides granulosa cell tumors and serous cystadenocarcinomas?
- mucinous cystadenocarcinoma
- immature teratomas
- dysgerminomas
- Yolk sac tumor
Krukenberg tumor
Describe mucinous cystadenocarcinomas
These are MALIGNANT tumors that typically arise in the ovaries secondary to pseudomyxoma peitonei, a tumor of appendiceal origin
When are dysgerminomas most common?
adolescence (these are the equivalent to the male seminoma)
How do dysgerminomas appear histologically?
These tumors, like male seminomas, have a characteristic fried egg appearance
What are good tumor markers for dysgerminomas?
hCG and LDH
What is the most common testicular tumor of male infants?
Yolk sac tumor
What characterizes yolk sac tumors in males and females histologically?
Schiller-Duval Bodies
What is a good serum marker for yolk sac tumors?
AFP
What is a Krukenberg tumor?
This is a secondary tumor of the ovaries that mets from the GI and classically produces mucin-secreting signel cell adenocarcinoma
What are the most common tumors of the endometrial wall?
- Endometrial polyps
- Adenomyosis
- Leiomyomas (fibroids)
- Endometrial hyperplasia
- Endometrial carcinoma
What is adenomyosis?
This is extension of the endometrium tissue down into the myometrium causing hypertrophy of the basal layer of the endometrium and a classic soft, **boggy***, enlarged uterus upon examination
What is the #1 most common tumor in females?
leiomyomas
What is a leiomyomas?
These are BENIGN tumors of the uterine smooth muscle that commonly appear in younger women (20-40)
Leiomyomas are more common in _____
AA
T or F. Leiomyomas are sensitive to estrogen
T. So they might enlarge during pregnancy and shrink after menopause
What are leiomyosarcomas?
These are the MALIGANT counterpart to benign leiomyomas
T or F. Most leiomyosarcomas arise from pre-existing leiomyomas
F. Malignant transformation is very rare
What causes endometrial hyperplasia?
This is most commonly associated with estrogen excess
What are some situations that might cause estrogen excess and lead to endometrial hyperplasia?
- nullparity
- obesity
- anovulatory cycles
- early age of menarche
- granulosa cell tumor
- PCOS
How is endometrial hyperplasia classified?
Based on the architechural complexity and the presence of cellular atypia
What is the most important indicator of potential to tranform endometrial hyperplasia into endometrial carcinoma?
cellular atypia
What is endometriosis?
Inflammation of the endometrium (can be acute or chronic)
What things typically cause endometriosis?
- retained products of conception (acute)
- IUDs, TB, miscarriage
What would you think of as the cause if chronic endometriosis presented due to IUDs?
Actinomyces
How is endometriosis treated?
gentamicin+ clindamycin +- amplicillin
What are the main suggested causes of endometriosis (i.e. ectopic endometrial tissue outside of the uterus)?
- retrograde flow during menses
- heme spread
- totipotential formation
Describe the anatomy of the breast lobular units?
Terminal duct lobular units surrounded by stroma filter into major ducts which lead to lactiferous ducts which expose to the surface of the nipple
What are the breast tumors of the stroma?
fibroadenoma and phyllodes tumors
What are the breast tumors of the terminal duct lobular units?
Fibrocystic changes
DCIS and LCIS
Ductal and Lobular carcinomas
What are the breast tumors of the lactiferous ducts?
Intraductal papilloma
Paget disease
mastitis/abscess
Describe fibroadenomas
These are BENIGN tumors most common in women under 35. They are biphasic and are composed of fibroblastic stroma and glands, but the stromal part is the only truly prolfierative part
What is this?
Fibroadenoma marked by slitlike glands with stroma proliferation
Do fibroadenomas carry any increased risk of carcinoma transformation?
No
Describe fibrocystic changes
These are considered normal parts of female physiology and typically result from unrupture graafian follicles that occur mostly in repsonse to rising estrogen levels
How do fibrocystic changes present?
These tend to worry women because they present as lumps that can grow during menstraul cycles (but then almost invaraibly shrink after) and can be associated with pain rarely
They are often bilateral and multifocal
Note that fibrocystic changes are characterized as proliferative or non-proliferative based on their potential to cause malignant transformation. What are some things that mark non-proliferative fibrocystic change?
Again, these can be singular but typically present as multi-focal illdefined lumps of the breast that histologically are marked by a classic fluid, filled dilation witha blue dome
What is another common finding associated with non-prolfierative fibrocystic change?
apocrine metaplasia, which is non malignant at all
What are the types of prolfierative fibrocystic change?
- usual ductal hyperplasia (below)
- atypical ductal hyperplasia
- atypical lobular hyperplasia
What is sclerosing adenosis marked by? Benign or malignant?
swirling of the ductal units of the breast in the center and retention of circular formation on the periphery of the tumor with calcifications in the middle
These are BENIGN
Can sclerosing adenosis turn into breast carcinoma?
Yes, there is about 1.5-2x increased risk
What is a phyllodes tumor?
This is another BENIGN growth of the breast STROMA like fibroadenoma, except that this tumor is markedby more leaf-like epithelium (below) and increased stroma cellularity.
Inflammation of the breast presents with localized pain and tenderness usually. What are some common causes?
- Acute mastitis
- Fat necrosis
- Mammary duct estasia
- Granulomatous mastitis
- Lymphocytic mastitis
What causes acute mastitis?
This typically presents as lateral breast pain in breastfeeding women most commonly caused by Staph aureus
What drugs are associated with the formation of gynecomastia in men?
Spironolactone
Hormones (estrogens)
Cimetidine
Keotconazole
Some Hormones Create Knockers
Describe malignant breast tumors
These typically arise postmenopausally from the terminal duct lobular unit. They most often arise in the upper outer quadrant of the breast
What are the risk factors for breast carcinoma?
Most of the risk factors are related to increased levels of estrogen in the body, as in the case of obesity and several anovulatory cycles.
What are the non-invasive malignant breast cancers?
-DCIS and LCIS
Comedocarcinoma
Paget disease
Describe DCIS
These commonly arise from ductal hypertrophy and are marked by the loss of the myometrial layer of cells around the berast glands
They often present with microcalcifications which allow them to be caught early by mammography (note that LCIS are less likely to produce these and thus are harder to screen for)
What is Paget disease of the breast?
This results from extension of DCIS from the terminal duct lobular unit to the lactiferous surface of the nipple and
What is this?
Paget cells as seen in Paget disease of the breast
What are the types of invasive carcinomas of the breast?
- Invasive ductal and lobular carcinomas
- medullary, tubular, and mucinous carcinomas
Invasive ductal carcinoma is more likely to arise from what in situ carcinoma?
DCIS
Invasive lobular carcinoma is marked by what?
Mutations in the CDH1 gene causing loss of cadherin-e causing to produce an ‘Indian-file’ orientation
tubular carcinoma of the beast- look at how angular the glands are
Medullary carcinoma of the breast- look at how the glands almost synctiousize
What is happening here?
Peau d-orange appearance of the breast, which commonly is associated with nipple retraction caused by an underlying invasive tumor causing tension on the supportive Copper ligaments of the breast
Inflammatory breast cancer- dermal lymphatic invasion by breast carcinoma that BLOCK lymph drainage. prognosis?
Prognosis is very bad
What is Peyronie disease?
This is the presence of unusual upward curvature of the penis during erection due to fibreous plaque within the tunica albuginea
How should priapism be treated?
corporal aspiration, intracavernosal phenylephrine, or surgical decompression
What are some precursor, in-situ lesions to a squamous cell carcinoma of the penis?
- Bowen disease
- erythroplasia of Queryat (cancer of glans)- below
- Bowenoid papulosis
What are the risk factors for squamous cell carcinoma of the penis?
-HPV, smegma, smoking
How would cyrptochidism affect a pt?
Since the testes are undescended, they remain at a constant higher temp and thus spermatogenesis (via Sertoli cell function) will be impaired, but testosterone levels will be normal (Leydig cells unaffected by temperature)
this places a pt at risk for testicular cancer
What cases congenital hydrocele?
incomplete obliteration of the processus vaginalis
remember: if it can be transilluminated, probably not a solid tumor
What are the risk factors for testicular cancer?
Klinefelter, testicular dysgenesis, cryptochidism
Describe seminomas
These are germ cell tumors of the testicle that present as a solid painless mass
Histo of seminomas
classic ‘fried-egg’ appearance
How do seminomas progress?
They tend to met late and have a very good prognosis
What is a yolk sac tumor of the testes
an aggressive germ cell tumor most common in boys under 3 yo
What histo clue is characteristic of yolk sac tumors?
Schiller-Duval bodies
What serum markers are suggestive of a yolk sac tumor?
elevated AFP (and anti-trypsin a1)
What is a choriocarcinoma?
This is a malignant non-seminoma germ cell tumor of the testes that is classically described as:
‘disordered synctiotrophoblast and cytotrophoblastic elements on a stroma of hemorrhage’ (below)
NOTE: These can arise from complete molar pregnancies
Testicular teratomas
Unlike in females, mature teratomas in adult males may be malignant. Benign in children
Where do choriocarcinomas like to MET to?
lungs and brain
What serum marker would be suggestive of a choriocarcinoma?
elevated hCG
How might a choriocarcinoma present?
potentially as gynecomastia OR
since hCG is stucturally anagalous to LH, FSH, and TSH, as signs of hyperthyroidism
What is the most common testicular cancer in older men?
metastatic lymphoma to the testes- aggressive
Buzzword for a leydig cell tumor of the testes
Reinke crystals (eosinophilic cytoplasmic inclusions)
Describe BPH
This is characterized as smooth, firm nodular enlargement (hyperplasia not hypertrophy) of periurethral lobes, most commonly in men over 50.
How might BPH present?
increased frequency of urination, nocturia, dysuria
How would BPH be treated?
a1-antagonists (terazosin, tamsulosin, etc.)
Describe prostatic adenocarcinomas
These arise more commonly in the peripheral zone (posterior lobe) of the prostate gland in men over 50
How is prostatic adenocaricnoma diagnosed?
increased PSA (combined with DEcreased fraction of free PSA) and subsequent needle core biopsy
What does prostatic adenocarcinoma classically like to do to nerve?
Wrap it self around nerve
Where does prostatic adenocarcinoma like to MET to?
bone to produce BLASTIC lesions
