Reproductive Pathology Flashcards

Question

prostatic adenocarcinoma - grading (Gleason Score)

Answer 1

*architecture of glands from multiple (at least 2) zones *smaller glands = higher score from 1-5 ***higher score = worse prognosis**

Answer 2

*high-risk HPV types express oncoproteins which immortalize epithelial cells: 1. **E6: prevents apoptosis (degrades p53)**; activates telomerase 2. **E7:** allows progression in cell cycle; **binds RB and displaces E2F; blocks p21 and p27** *co-transfection with a mutated RAS gene results in full malignant transformation

Answer 3

*implicated in the genesis of several cancers: -benign squamous papillomas (warts) -**squamous cell carcinomas** (cervical, anogenitial, oropharynx) *low risk types = 6 and 11 *high risk types = **16, 18,** 31, 33, 35

Answer 4

***HPV; tropic for immature squamous cells in transformation zone** *squamous intraepithelial lesions (SIL): -precancerous epithelial changes -PAP smear = screening (cells scraped from transformation zone) -determines low-grade vs. high-grade SIL

Answer 5

*arises from cervical epithelium *usually from ectocervical squamous epithelium = squamous cell carcinoma (SCC) *some arise from endocervical glands = adenocarcinoma *4th most common cancer in women *9valent vaccine very effective in preventing HPV infection

Answer 6

*most commonly middle-aged women (40-50 years) **1. vaginal bleeding**, esp post-coital **2. cervical discharge** *risk factors: -high risk HPV (16, 18) -smoking -immunodeficiency

Answer 7

***fungating (exophytic) or infiltrative masses** 1. squamous cell carcinoma: -**nests/tongues of malignant squamous epithelium,** either keratinizing or nonkeratinizing, invading cervical stroma 2. adenocarcinoma: -**proliferation of malignant endocervical glands**

Answer 8

*benign endometrial **glands and stroma outside the uterus** *occurs in up to 10% of women in reproductive years and nearly half of women with infertility

Answer 9

*functional endometrial stroma and glands *undergo cyclic bleeding and appear as red-brown nodules or implants *may form large, blood filled **chocolate cysts**

Answer 10

*frequently multifocal *pelvic structures, eg. ovaries, uterine ligaments *dysmenorrhea and pelvic pain *scarring of fallopian tubes/ovaries → sterility

Answer 11

*benign hyperplasia of endometrial epithelial glands *prolonged/marked excess estrogen relative to progestin *clinically: **post-menopausal bleeding**

Answer 12

***estrogen excess**, due to: 1. obesity: adipose tissue converts steroids into estrogens 2. failure of ovulation (perimenopause) 3. estrogen therapy 4. estrogen-producing ovarian lesions

Answer 13

*crowded glands with increased gland:stroma ratio: 1. simple hyperplasia: -without cellular atypia -rarely progress 2. complex hyperplasia with atypia: -"back-to-back" glands; little to no stroma -progresses to carcinoma in 20-50% of cases

Answer 14

*malignant neoplasm of endometrial epithelial glands *most frequent cancer occurring in the female genital tract *manifests between the ages of 55 and 65 years *classically presents with **post-menopausal bleeding**

Answer 15

*mutations in PTEN tumor suppressor gene *background of **endometrial hyperplasia**

Answer 16

*mutations in TP53 tumor suppressor gene *background of **endometrial atrophy** in older women (>70)

Answer 17

*benign tumor of myometrial smooth muscle cells ("fibroid") *affect up to 50% of women of reproductive age ***estrogens stimulate growth;** tumors shrink post-menopause

Answer 18

*sharply circumscribed, firm gray-white masses *whorled cut surface *often multiple ***bundles of smooth muscle cells mimic normal myometrium**

Answer 19

*often asymptomatic and discovered incidentally *present with **menorrhagia +/- metrorrhagia**

Answer 20

***malignant tumor of myometrial smooth muscle cells** *arise de novo, NOT from leiomyoma (fibroids do not cause this) *complex, highly variable karyotypes, frequent chromosomal deletions

Answer 21

*usually solitary **hemorrhagic masses *marked necrosis *cytologic atypia *increased mitotic activity**

Answer 22

*most often occur in post-menopausal women *recurrence after surgical resection is common *many tumors metastasize to lung, bone, brain *prognosis: overall 5-year survival rate ~40%

Answer 23

*benign or malignant neoplasms derived from ovarian surface epithelium *most common type of ovarian neoplasm *TP53 mutations > 95% of cases *familial germline mutations in BRCA1 or BRCA2

Answer 24

1. serous = cuboidal epithelium with thin, watery fluid 2. mucinous = columnar epithelium with mucus 3. endometrioid = endometrial epithelium

Answer 25

*cystic, large to huge 1. benign tumors: -serous cystadenoma; mucinous cystadenoma -smooth cysts lined by simple epithelium layer 2. borderline tumors: -majority behave in a benign manner -can recur; some progress to carcinoma 3. malignant tumors: -serous cystadenocarcinoma; mucinous cystadenocarcinoma -markedly atypical **stratified** epithelium layer -exuberant papillary projections -epithelial invasion -spread by peritoneal implants and through lymphatics to regional lymph nodes

Answer 26

*usually present in first 2 decades of life *more than 90% are benign (typically malignant in very young pts)

Answer 27

*aka dermoid cyst *benign *ovarian mass or incidental imaging studies; infertility or ovarian torsion may be presenting sign ***mature tissues derived from ALL THREE germ layers:** -ectoderm, endoderm, and mesoderm -cysts lined by epidermis with skin adnexa -produce hair, teeth, bone, cartilage, and other tissues

Answer 28

*malignant *arise early in life (<18 years) *typically are bulky & solid, with areas of necrosis ***immature elements or minimally differentiated tissues**

Answer 29

*first-degree relatives with breast carcinoma *early menarche *late menopause *nulliparity *obesity *proliferative fibrocystic disease *inheritance of mutant copy tumor suppressor genes (TP53, BRCA1, BRCA2); individuals who inherit a mutation develop carcinomas at a younger age

Answer 30

*estrogen may bind to the receptors on the tumor cells and promote their growth -estrogen is not mutagenic, so it is a tumor promoter, not a tumor initiator *therapeutic strategies for estrogen receptor + breast cancer: 1. **tamoxifen** 2. aromatase inhibitors 3. oophorectomy

Answer 31

*HER2 is a growth factor receptor: -**gene amplification → increased overexpression of HER2 receptor and constitutive tyrosine kinase activity → promotion of growth and survival of tumor cells** *respond to treatment with drugs that block HER2 activity

Answer 32

*derived from proliferation of epithelial cells *majority incidental findings detected by mammography *major clinical significance is subsequent risk of malignant transformation

Answer 33

1. large duct papillomas: -lactiferous sinuses of the nipple -usually solitary -more than 80% with **nipple discharge (may be bloody)** 2. small duct papillomas: -multiple and located deeper in ductal system -clinically small palpable masses, or densities on imaging 3. multiple branching fibrovascular cores: -epithelial hyperplasia and apocrine metaplasia are frequently present

Answer 34

*most common change in **pre-menopausal breast** *vague, irregular breast tissue; "lumpy breast" *spectrum of morphology: 1. cysts: flattened atrophic epithelium or by metaplastic apocrine cells 2. fibrosis: cyst rupture → fibrosis; may calcify, leading to image detection 3. adenosis: increase in the number of acini per lobule

Answer 35

*proliferative disease *1.5-2x increased risk of malignancy *usually incidental finding ***increased NORMAL epithelial and myoepithelial cells:** -fill and distend ducts and lobules -cells maintain normal appearance -irregular peripheral lumers

Answer 36

*proliferative disease ***4-5x increased risk of malignancy** *both breasts are at increased risk ***increased ATYPICAL epithelial and myoepithelial cells:** -epithelial cell proliferation expands ductal/lobular spaces -resembles in situ carcinoma

Answer 37

*malignant neoplastic breast epithelial proliferation **limited by basement membrane** *may not produce palpable mass *detected as calcifications on mammography

Answer 38

*distorts lobules and ducts ***necrotic debris or secretory material produces Ca2+** (comedo necrosis)

Answer 39

*expands involved lobules *may be MULTIFOCAL *rarely produces Ca2+; usually incidental

Answer 40

*malignant neoplastic breast epithelial proliferation that **penetrates basement membrane**

Answer 41

***haphazard infiltrating tubules:** -no organized growth -lack myoepithelial cell layer ***induces a desmoplastic response:** -results in a mammographic density -eventually produces hard, palpable, irregular mass

Answer 42

*makes up 10-15% of invasive carcinomas *typically **infiltrate as discohesive SINGLE CELLS (single file), NOT tubules/ducts; E-cadherin negative** *may **FAIL to produce a desmoplastic response**; difficult to detect by palpation and imaging

Answer 43

*subtype of triple-negative cancer *well-circumscribed mass *pushing borders of large anaplastic cells *lymphocytic T-cell infiltrates

Answer 44

***"inflamed" reddening, thickening, and fine pitting edema of the skin (peau d'orange)** *lymphatic carcinomatosis

Answer 45

*neoplasms derived from proliferation of **intralobular fibroblasts** with entrapped non-neoplastic epithelial cells

Answer 46

*most common benign tumor in breast *typically presents in women < 30yrs *frequently multiple and bilateral *HORMONALLY RESPONSIVE (grow with menses and pregnancy) ***well-circumscribed, mobile, rubbery *fibroblasts distort/elongated slit-like ducts**

Answer 47

*typically post-menopausal *vary in size from small to huge ***fibroadenoma-like but more stromal overgrowth: -characteristic "phyllodes" (leaflike) growth pattern**