Reproduction Final Flashcards
Name the 2 risk factors for cancer among the benign lesions of the Breast.
Atypical Epithelial Hyperplasia
Multiple Intraductal Papillomas
(underneath nipple in dilated lactiferous sinuses)
Who is more likely to get a Fibrocystic Change in the breast?
Older women
The pathogenesis of Fibrocystic Change in the breast is related to what?
Sex Hormones
*why improvement after menopause
Are Fibrocystic Changes to the breast generally bilateral or unilateral?
Bilateral
*symmetrical, usually affecting both breasts
Fibrocystic Changes of the breast are seen between what ages?
Onset of puberty to menopause
*Sex hormone related
How does the progesterone/estrogen imbalances that cause the pathogenesis in Fibrocystic breast changes affect the tissue?
What 3 areas are affected?
Stimulates proliferation of cells
Excretory ducts, Lobules, and Intralobular stroma
What is the only risk factor that occurs in Fibrocystic breast change that leads to cancer?
Atypical Epithelial Hyperplasia
*more atypical, greater risk
**Atypical = multilayered
T/F
The most constant feature of fibrocystic change in the breast is Fibrosis
True
T/F
10-15% women between 20-50 have fibrocystic change
True
What are the presenting clinical features of Fibrocystic changes to the breast?
(5 things)
Blue-Domed Cysts
Both breasts
Pain, nodularity, palpation sensitivity
Easily palpated
Calcification (difficult to distinguish from cancer)
What is the most common presenting feature of Intraductal Papillomas?
Bloody/Serous nipple discharge
*secondarily sub-areolar mass
Non-pregnant woman with Bloody or Serous discharge from the nipple…
Intraductal Papilloma
Multiple papillomas are associated with an increased risk of ________. ______ are benign.
Papillary carcinomas
Solitary
What is the most common benign tumor of the breast?
Fibroadenoma
A fibroadenoma is made up of what two components?
Fibrous stroma
Glandular epithelium
T/F
Fibroadenomas are well-encapsulated, spherical, and freely moveable (which distinguishes them from cancers).
True
Fibroadenoma is most often seen in what demographic?
Young women
Fibroadenoma is most often in what location?
this is also the most common location for breast cancer
Upper Outer quadrant
Fibrosis and Blue-Domed cysts are seen in _______, NOT ______.
Fibrocystic disease
Fibroadenoma
What is the most common etiology behind fat necrosis of the Breast?
Trauma
What is the term for male breast cancer?
Gynecomastia
Gynecomastia is a ductile cancer because what is absent?
Lobules
What is Gynecomastia associated with?
2 things
Hormonal changes/puberty
Excess Estrogen (tumors/cirrhosis)
How does Gynecomastia present?
Fibrous cap under areola
T/F
Sex, Age, and Race are all risk factors for Breast Cancer
True
*peaks at 60
What ethnic bias does Breast cancer have?
Uncommon Japanese and Chinese, most common Caucasians and Jews
Other than Sex, Age, and Race, what are 5 risk factors for Breast Cancer?
Genetics (5-10 fold)
Hormonal (Estrogen - Tamaxaphen)
Other cancers (ovarian/endometrial)
Atypical Epithelial Hyperplasia/Multiple Intraductal Papillomas
Obesity, high fat diet, moderate EtOH consumption
What is the most common location for breast cancer?
Upper Outer quadrant (45%)
25% central, under areola
2/3 of Breast Cancers are of what type?
Invasive Ductal Carcinomas
*Desmoplastic rxn host response
What defines the difference between an In Situ lesion and and Invasive/Infiltrating lesion?
Breaching of Basement Membrane
T/F
90% of breast cancers metastasize via the lymphatics
True
Where does Breast cancer generally drain?
Axillary lymphatics
Distant breast metastases are common in what 5 areas?
Lungs
Liver
Bone
Brain
Adrenals
Lumpectomy is limited to resection of the tumor and what?
Mastectomy removes the entire breast and what?
Surrounding fat tissue
Axillary lymph node resection
In a Mammography, aside from looking for a Mass, what else are we looking for?
Calcification around the mass
*Spicules
Where are the primordial germ cells?
In the wall of yolk sac near the allantois
After the primordial germ cells leave the yolk sac and migrate to the gonadal ridges and penetrate into the primitive gonad, what do they become?
Cells that create spermatagonia, and eventually, sperm cells.
The epithelium of the genital ridge proliferates and penetrates the underlying mesenchyme to form what?
Primitive Sex cords
In the presence of the SRY gene, the primitive sex cords differentiate into what?
Medullary cords
Testicular seminiferous tubules
The medullary cords created from the Primitive Sex Cords further differentiate into what 4 structures?
Testicular seminiferous tubules
Rete testis
Efferent ducts
Vas deferens
What fibrous connective tissue separates the testes cords from the epithelium?
Tunica Albuginea
What is the function and location of Sertoli cells?
Leydig cells?
Support, nutrition - between germ cells
Testosterone secretion - between seminiferous tubules
Mesonepheric Ducts aka…
Paramesonephric Ducts aka…
Wolffian
Mullerian
What type of epithelium histologically allows for the propulsion of sperm from the Efferent ducts > Epididymis > Vas Deferens?
Ciliated Pseudostratified Columnar Epithelium
*surrounded by smooth muscle
What is the term for the congenital malpositioning of the testes outside normal scrotal location?
(most important congenital abnormality relating to testes)
Crytorchidism
T/F
Descent of testes may stop at any point and 4% newborns have condition
True
*also unilateral common, 1/4 bilateral
In Cryptorchidism, what % arrest in the High Scrotal Sac?
% inguinal canal?
% abdominal cavity?
60%
25%
15%
T/F
Most crytorchid children have testes descend within the 1st year, and condition in adults is less than 0.4%.
True
T/F
The decreased diameter of seminiferous tubules along with the decrease in germ cells can lead to Infertility in Cryptochidism
True
What 2 types of tumors are increased 10-35 times in untreated cryptorchidism?
Seminoma
Embryonal Cercinoma
(Germ Cell Tumors)
What are the 2 most feared complications of Cryptorchidism?
Infertility
Germ Cell Tumors
Most testicular tumors are ______, and a small % are ______.
Seminomas
Embryonal Carcinomas
Malignant transformation into Seminomas or Embryonal Carcinomas can happen in what 2 cases/states of Cryptochidism?
Non-descended testis
Delayed normally descended testis
What is defined by male hypogonadism?
Klinefelter Syndrome
Klinefelter’s Syndrome occurs when there is what pairing of chromosomes?
2 or more X
1 or more Y
**XXY most common
T/F
Klinefelter’s is rarely diagnosed before puberty
True
Gynocemastia, lack of beard/body hair, female hips, long arms, testicular/penile atrophy, long legs, and lack of pubic hair all are physical characteristics of what?
Klinefelter’s Syndrome
*lack all secondary sex characteristics
**mean IQ somewhat lower, retardation uncommon
T/F
plasma FSH is increased and testosterone is decreased in Klinefelter’s
True
What is the reproductive status of Klinefelters?
Infertile
*testicular tubules totally atrophied with hyaline
What is the classic Karyotype of Klinefelter?
Results from paternal or maternal nondisjunction?
47 XXY
50/50 split maternal/paternal
Hydrocele, Spermatocele, and Hematocele are different flavors of what?
Cystic Scrotal Masses
A Hydrocele is a clear serous accumulation between what 2 layers?
(spontaneous)
Tunica Vaginalis
Testis or Epididymis
Spermatocele is a cystic accumulation of semen in what 2 possible places?
Dilated efferent ductules
Ducts of rete testis
A Hematocele accumulates blood where?
What causes?
Between Tunica Vaginalis layers
Trauma
Histologically, what is the Spermatocele cyst lined with?
Cuboidal epithelium
*contains spermatozoa in various developmental stages
What can result from testicular torsion, tumors, or infections?
Hematocele
Phimosis =
Strangulation
T/F
Hydrocele can be either congenital or acquired, and the compression can lead to atrophy
True
If torsion of the Testes is severe enough, what can it cause?
Infarction (obstruction) of testicular Germ Cells
How doe testicular Torsion present?
Severe pain, usually a few hours after vigorous exercise
Then swelling
*once Tunica Albuginea black - amputation
Dysplastic lesions (Bowen Disease) on the glans and prepuce are known as what?
This occurs only in ______.
Erythroplasia of Queyrat
Uncircumcised
What is a major risk factor in penile cancer?
Smegma
HPV 16 and 18
Since penile cancer is an extension of the skin, it is…
Squamous Cell Carcinoma
*presents as ulcerated hemorrhagic mass on glans/prepuce
**most well-differentiated
Buzzwords:
Herpes:
Chancre:
Koilocytosis
Vescicles
Syphylis
HPV
What is the Etiology of Peyronie Disease?
Unknown
- focal, asymmetric, penile curvature
- collagen slowly replaces muscle
**question mark
What far advanced disease results in General Paresis (brain spirochetes), Gummas (granulomas), and Tabes Dorsalis (spirochetal damage to sensory nerves)
Tertiary Syphilis
What are the 2 most common organisms that cause PID?
Gonococcus
Chlamydia
What are the 2 most common complications of PID?
Sterility and Ectopic Pregnancy
Chondylomata Lata:
Maculopapular Rash:
Secondary Syphylis
Secondary Syphyllis
Why do many women get PID?
GC and Chlamydia are asymptomatic in women
What agar would one use to plate a GC swab?
Chocolate/Thayer-Martin
T/F
Trichimonas vaginalis is only seen in a trophozoite form
True
**no cyst form
What type of organism is Trichomonas vaginalis?
Protozoan
Describe Trichomonas vaginalis
Pear shaped protozoan, anterior flagella
Who is most likely to get Trichomonas vaginalis?
Least likely?
Sexually active women
Postmenopausal women
Herpes symplex I or II has what 2 characteristics?
Latency
Cytopathic effect (inclusion bodies)
Herpes simplex type I or II stains what color?
CMV stains what color?
Pink acidophilic nuclear inclusions
Basophilic/blue inclusion bodies
What is the homologue to Seminoma?
What is the homologue to the Yolk sac tumor?
Dysgerminoma
Endodermal Sinus Tumor
Lobular Carcinoma In-Situ is a marker for what?
Invasive Ductal or Lobular carcinoma
What is the tumor marker for the Prostate?
PSA
What is the serologic marker for Seminoma?
None
Over 90% of testicular tumors are of what origin?
Is it the same in the ovary?
Germ Cell
No - surface epithelial most common (75%)
4 Risk factors for Germ cell Tumors of the testes
Cryptorchidism
Klinefelters
Family History
Testicular Tumor on the opposite testis
When considering a Teratoma, what factor is most important in predicting whether it will be malignant or benign?
Age
What is another name for Leydig Cell Tumors?
Interstitial Cell Tumors
What is the only Germ Cell Tumor that doesn’t metastasize via the lymphatics?
How does it metastasize?
Choriocarcinoma
Hematogenous routes
***this is if originate in either testes/ovaries
What is the most common tumor of the Urinary Tract?
Urinary Bladder tumors
What is the parasite that lays eggs in the Bladder?
What type of cancer does this cause?
Schistosoma haemotobium
Squamous Cell Carcinoma
What marker in used for both diagnosis and monitoring of Yolk Sac Tumors?
AFP
What is the most important risk factor (increases 4 fold) for Bladder Cancer?
What are some secondary risk factors?
(3 things)
Smoking
Azo dyes, Drugs, Radiation to area
*Cyclophosphamide
What does PSA stand for?
What is it?
How is it used as a tumor marker?
Prostate Specific Antigen
Antigen that is only released into blood by Tumor Cells (but made always)
If detectable after radical prostatectomy, metastasis persists
Explain Bone Alkaline Phosphate’s relationship to Prostate Cancer
Marker that Prostate Cancer has metastasized to bone
*proliferation of osteoblasts increases Alk Phos in blood
T/F
Prostatic Cells produce Alkaline Phosphatase
False
*only osteoblasts produce
T/F
Prostate normally secretes PSA, but the tumor puts it in the bloodstream
True
T/F
BPH leads to Prostate Cancer
False
BPH doesn’t lead to Prostate Cancer, but they are both under the influence of what hormone?
Testosterone
What does TURP stand for?
What is the surgical procedure?
Trans Urethral Resection of Prostate
Stent, Prostatic Chips
What does BPH stand for?
Benign Prostatic Hyperplasia
What ethnic group has the highest incidence of BPH in the US?
In what region of the world is it most common?
Least common?
Blacks
Western Europe/US
Asia (the orient?)
T/F
1/3 males over 65 have some degree of BPH, and 75% over 80 years have some degree of it.
True
Which cells are present in Acute Prostatitis?
Which are present in Chronic Prostatitis
E. coli with acute inflammatory infiltrate (PMN’s, etc)
Lymphocytes, Plasma cells, Macrophage
How can Acute and Chronic Prostatitis be diagnosed?
Recovery organism on Urine Culture
What 2 organisms can cause granulomatous Prostatitis?
Mycobacterium tuberculosis
Histoplasma capsulatum
What % of the semen is secreted by the prostate?
13-33%
T/F
30-50 tubuloalveolar glands are in the prostate and they each secrete into the urethra through its own duct
True
What histologically makes up the Prostate Gland?
2 things
Pseudostratified Columnar Cells
Glandular Cells
What is the classification of Prostate Cancers based on 5 histologic patterns of tumor gland formation and infiltration?
Gleason score
Each Gleason score is given a ______ pattern score and _____ pattern score.
Majority
Minority
What is the best Gleason Score?
What is the histologic state?
2 (1 for each)
Well differentiated
What is the worst Gleason Score?
What is the histologic state?
10 (5 majority, 5 minority)
Undifferentiated
T/F
The Gleason score is strictly for the Grading and done by the Pathologist. The Oncologist will use that to stage the pt. with prostate cancer.
True
