Reproductive - Pathology (2) Flashcards
1
Q
Fibromas
- Type of tumor
- Findings
A
- Type of tumor
- Benign ovarian neoplasm
- Findings
- Bundles of spindle-shaped fibroblasts.
- Meigs syndrome—triad of ovarian fibroma, ascites, and hydrothorax.
- Pulling sensation in groin.
2
Q
Thecoma
- Type of tumor
- Findings
A
- Type of tumor
- Benign ovarian neoplasm
- Findings
- Like granulosa cell tumors, may produce estrogen.
- Usually present as abnormal uterine bleeding in a postmenopausal woman.
3
Q
Immature teratoma
- Type of tumor
- Definition
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Aggressive
- Contains fetal tissue, neuroectoderm.
- Findings
- Mature teratoma are more likely to contain thyroid tissue.
- Immature teratoma is most typically represented by immature/embryonic-like neural tissue
4
Q
Granulosa cell tumor
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Most common sex cord stromal tumor.
- Predominantly women in their 50s.
- Findings
- Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness.
- Histology shows Call-Exner bodies (resemble primordial follicles).
5
Q
Serous cystadenocarcinoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Most common ovarian neoplasm
- Frequently bilateral.
- Findings
- Psammoma bodies.
6
Q
Mucinous cystadenocarcinoma
- Type of tumor
- Definition
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Pseudomyxoma peritonei–intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.
7
Q
Dysgerminoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Most common in adolescents.
- Equivalent to male seminoma but rarer.
- 1% of all ovarian tumors; 30% of germ cell tumors.
- hCG, LDH = tumor markers.
- Findings
- Sheets of uniform “fried egg” cells [D]
8
Q
Choriocarcinoma
- Type of tumor
- Definition
- Findings
- Treatment
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Rare
- Can develop during or after pregnancy in mother or baby.
- Malignancy of trophoblastic tissue [E] (cytotrophoblasts, syncytiotrophoblasts)
- Findings
- No chorionic villi present.
- Increased frequency of theca-lutein cysts.
- Presents with abnormal β-hCG, shortness of breath, hemoptysis.
- Hematogenous spread to lungs.
- Treatment
- Very responsive to chemotherapy.
9
Q
Yolk sac (endodermal sinus) tumor
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children.
- Most common tumor in male infants.
- Findings
- Yellow, friable (hemorrhagic), solid mass.
- 50% have Schiller-Duval bodies (resemble glomeruli) [F].
- AFP = tumor marker.
10
Q
Krukenberg tumor
- Type of tumor
- Definition
A
- Type of tumor
- Malignant ovarian neoplasm
- Definition
- GI malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma.
11
Q
Vaginal tumors
- Squamous cell carcinoma (SCC)
- Clear cell adenocarcinoma
- Sarcoma botryoides (rhabdomyosarcoma variant)
A
- Squamous cell carcinoma (SCC)
- Usually 2° to cervical SCC
- 1° vaginal carcinoma rare.
- Clear cell adenocarcinoma
- Affects women who had exposure to DES in utero.
- Sarcoma botryoides (rhabdomyosarcoma variant)
- Affects girls < 4 years old
- Spindle-shaped tumor cells that are desmin (+).
12
Q
Breast pathology (584)
- Stroma
- Lobules
- Terminal duct
- Major duct
- Lactiferous sinus
- Nipple
A
- Stroma
- Fibroadenoma
- Phyllodes tumor
- Lobules
- Lobular carcinoma
- Terminal duct
- Tubular carcinoma
- Major duct
- Fibrocystic change
- DCIS
- Invasive ductal carcinoma
- Lactiferous sinus
- Intraductal papilloma
- Abscess / mastitis
- Nipple
- Paget disease
- Breast abscess
13
Q
Fibroadenoma
- Type of tumor
- Characteristics
- Epidemiology
- Notes
A
- Type of tumor
- Benign breast tumor
- Characteristics
- Small, mobile, firm mass with sharp edges.
- Epidemiology
- Most common tumor in those < 35 years old.
- Notes
- Increased size and tenderness with increased estrogen (e.g., pregnancy,
prior to menstruation). - Not a precursor to breast cancer.
- Increased size and tenderness with increased estrogen (e.g., pregnancy,
14
Q
Intraductal papilloma
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Benign breast tumor
- Characteristics
- Small tumor that grows in lactiferous ducts.
- Typically beneath areola.
- Notes
- Serous or bloody nipple discharge.
- Slight (1.5–2×) increase in risk for carcinoma.
15
Q
Phyllodes tumor
- Type of tumor
- Characteristics
- Epidemiology
- Notes
A
- Type of tumor
- Benign breast tumor
- Characteristics
- Large bulky mass of connective tissue and cysts.
- “Leaf-like” projections.
- Epidemiology
- Most common in 6th decade.
- Notes
- Some may become malignant.
16
Q
Malignant breast tumors
- Definition
- Due to…
- Prognosis
- Risk factors
A
- Definition
- Commonly postmenopausal.
- Usually arise from terminal duct lobular unit.
- Most often located in upper-outer quadrant of breast
- Due to…
- Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common
- Triple negative (ER (-), PR (-), and Her2/Neu (-)) more aggressive
- Prognosis
- Type affects therapy and prognosis
- Axillary lymph node involvement indicating metastasis is the single most important prognostic factor.
- Risk factors
- Increased estrogen exposure, increased total number of menstrual cycles, older age at 1st live birth, obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone), BRCA1 and BRCA2 gene mutations, African American ethnicity (increased risk for triple (-) breast cancer).
17
Q
Ductal carcinoma in situ (DCIS)
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Noninvasive malignant breast tumor
- Characteristics
- Fills ductal lumen.
- Arises from ductal atypia [A].
- Often seen early as microcalcifications on mammography
- Notes
- Early malignancy without basement membrane penetration.
18
Q
Comedocarcinoma
- Type of tumor
- Characteristics
A
- Type of tumor
- Noninvasive malignant breast tumor
- Characteristics
- Ductal, caseous necrosis [B].
- Subtype of DCIS.
19
Q
Paget disease
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Noninvasive malignant breast tumor
- Characteristics
- Results from underlying DCIS.
- Eczematous patches on nipple.
- Paget cells = large cells in epidermis with clear halo [C].
- Notes
- Suggests underlying DCIS.
- Also seen on vulva, though does not suggest underlying malignancy.
20
Q
Invasive ductal tumor
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Invasive malignant breast tumor
- Characteristics
- Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.
- Grossly, see classic “stellate” infiltration.
- Notes
- Worst and most invasive.
- Most common (76% of all breast cancers).
21
Q
Invasive lobular tumor
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Invasive malignant breast tumor
- Characteristics
- Orderly row of cells (“Indian file”).
- Notes
- Often bilateral with multiple lesions in the same location.
22
Q
Medullary tumor
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Invasive malignant breast tumor
- Characteristics
- Fleshy, cellular, lymphocytic infiltrate.
- Notes
- Good prognosis.
23
Q
Inflammatory tumor
- Type of tumor
- Characteristics
- Notes
A
- Type of tumor
- Invasive malignant breast tumor
- Characteristics
- Dermal lymphatic invasion by breast carcinoma.
- Peau d’orange (breast skin resembles orange peel)
- Neoplastic cells block lymphatic drainage.
- Notes
- 50% survival at 5 years.
24
Q
Proliferative breast disease
- Definition
- Findings
- Histologic types
- Fibrosis
- Cystic
- Sclerosing adenosis
- Epithelial hyperplasia
A
- Definition
- Most common cause of “breast lumps” from age 25 to menopause.
- Findings
- Presents with premenstrual breast pain and multiple lesions, often bilateral.
- Fluctuation in size of mass.
- Usually does not indicate increased risk of carcinoma.
- Histologic types
-
Fibrosis
- Hyperplasia of breast stroma.
-
Cystic
- Fluid filled, blue dome.
- Ductal dilation.
-
Sclerosing adenosis
- Increased acini and intralobular fibrosis.
- Associated with calcifications.
- Often confused with cancer.
- Increased risk (1.5–2×) of developing cancer.
-
Epithelial hyperplasia
- Increase in number of epithelial cell layers in terminal duct lobule.
- Increased risk of carcinoma with atypical cells.
- Occurs in women > 30 years old.
-
Fibrosis
25
Q
Common breast conditions
- Acute mastitis
- Definition
- Treatment
- Fat necrosis
- Definition
- Findings
A
- Acute mastitis
- Definition
- Breast abscess
- During breast-feeding, increased risk of bacterial infection through cracks in the nipple
- S. aureus is the most common pathogen.
- Treatment
- Treat with dicloxacillin and continued breast-feeding.
- Definition
- Fat necrosis
- Definition
- A benign, usually painless lump
- Forms as a result of injury to breast tissue.
- Up to 50% of patients may not report trauma
- Findings
- Abnormal calcification on mammography
- Biopsy shows necrotic fat, giant cells.
- Definition
26
Q
Gynecomastia
- Definition
- Results from…
A
- Definition
- Common breast condition
- Occurs in males [A].
- Results from…
- Hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
- Klinefelter syndrome
- Drugs (Spironolactone, marijuana [Dope], Digitalis, Estrogen, Cimetidine, Alcohol, Heroin, Dopamine D2 antagonists, Ketoconazole).
- “Some Dope Drugs Easily Create Awkward Hairy DD Knockers.”
27
Q
Prostate pathology
- Prostatitis
- Acute
- Chronic
A
- Prostatitis
- Dysuria, frequency, urgency, low back pain.
- Acute
- Bacterial (e.g., E. coli)
- Chronic
- Bacterial or abacterial (most common).
28
Q
Benign prostatic hyperplasia
- Definition
- Findings
- Treatment
A
- Definition
- Common in men > 50 years old.
- Hyperplasia (not hypertrophy) of the prostate gland.
- Not considered a premalignant lesion.
- Findings
- Characterized by a smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit.
- Often presents with increased frequency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria.
- May lead to distention and hypertrophy of the bladder, hydronephrosis, and UTIs.
- Increased free prostatespecific antigen (PSA).
- Treatment
- α1-antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle
- Finasteride.
29
Q
Prostatic adenocarcinoma
- Definition
- Findings
- Due to…
- Diagnosis
A
- Definition
- Common in men > 50 years old.
- Findings
- Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA
- Due to…
- Arises most often from the posterior lobe (peripheral zone) of the prostate gland [A]
- Diagnosis
- Most frequently diagnosed by increased PSA and subsequent needle core biopsies.
- Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increased total PSA, with decreased fraction of free PSA).
30
Q
Cryptorchidism
- Definition
- Findings
- Associations
A
- Definition
- Undescended testis (one or both)
- Findings
- Impaired spermatogenesis (since sperm develop best at temperatures < 37°C)
- Can have normal testosterone levels (Leydig cells are unaffected by temperature)
- Decreased inhibin, increased FSH, and increased LH
- Testosterone decreased in bilateral cryptorchidism, normal in unilateral
- Associations
- Associated with increased risk of germ cell tumors.
- Prematurity increases the risk of cryptorchidism.
31
Q
Varicocele
- Definition
- Findings
- Diagnosis
- Treatment
A
- Definition
- Dilated veins in pampiniform plexus as a result of increased venous pressure
- Most common cause of scrotal enlargement in adult males
- Can cause infertility because of increased temperature
- Findings
- Most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein
- “Bag of worms” appearance
- Diagnosis
- Diagnosed by ultrasound with Doppler [A].
- Treatment
- Varicocelectomy, embolization by interventional radiologist.
32
Q
Testicular germ cell tumors
- Definition
- Risk factors
- Findings
- Differential diagnosis for testicular mass that does not transilluminate
A
- Definition
- ~95% of all testicular tumors.
- Most often occur in young men.
- Risk factors
- Cryptorchidism, Klinefelter syndrome.
- Findings
- Can present as a mixed germ cell tumor.
- Differential diagnosis for testicular mass that does not transilluminate
- Cancer.
33
Q
Seminoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Testicular germ cell tumor
- Definition
- Malignant
- Painless, homogenous testicular enlargement
- Most common testicular tumor
- Most common in 3rd decade, never in infancy.
- Late metastasis, excellent prognosis
- Findings
- Painless, homogenous testicular enlargement
- Large cells in lobules with watery cytoplasm and a “fried egg” appearance.
- Increased placental ALP.
- Radiosensitive.
34
Q
Yolk sac (endodermal sinus) tumor
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Testicular germ cell tumor
- Definition
- Aggressive malignancy of testes, analogous to ovarian yolk sac tumor.
- Most common testicular tumor in boys < 3 years old.
- Findings
- Yellow, mucinous.
- Schiller-Duval bodies resemble primitive glomeruli.
35
Q
Choriocarcinoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Testicular germ cell tumor
- Definition
- Malignant
- Disordered syncytiotrophoblastic and cytotrophoblastic elements.
- Findings
- Increased hCG
- Hematogenous metastases to lungs and brain
- May present with “hemorrhagic stroke” due to bleeding into the metastasis
- May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog).
36
Q
Teratoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Testicular germ cell tumor
- Definition
- Unlike in females, mature teratoma in adult males may be malignant.
- Benign in children.
- Findings
- Increased hCG and/or AFP in 50% of cases.
37
Q
Embryonal carcinoma
- Type of tumor
- Definition
- Findings
A
- Type of tumor
- Testicular germ cell tumor
- Definition
- Malignant, hemorrhagic mass with necrosis
- Worse prognosis than seminoma
- “Pure” embryonal carcinoma is rare
- Most commonly mixed with other tumor types
- Findings
- Painful
- Often glandular/papillary morphology.
- May be associated with increased hCG and normal AFP levels when pure (increased AFP when mixed)
38
Q
Testicular non–germ cell tumors
- Definition
- Leydig cell
- Sertoli cell
- Testicular lymphoma
A
- Definition
- 5% of all testicular tumors.
- Mostly benign.
- Leydig cell
- Contains Reinke crystals
- Usually androgen producing, gynecomastia in men, precocious puberty in boys.
- Golden brown color.
- Sertoli cell
- Androblastoma from sex cord stroma.
- Testicular lymphoma
- Most common testicular cancer in older men.
- Not a primary cancer, arises from lymphoma metastases to testes.
- Aggressive.
39
Q
Tunica vaginalis lesions
- Definition
- Hydrocele
- Spermatocele
A
- Definition
- Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs. testicular tumors).
-
Hydrocele
- Increased fluid 2º to incomplete obliteration of processus vaginalis
-
Spermatocele
- Dilated epididymal duct
40
Q
Penile pathology:
Squamous cell carcinoma
- Geography
- Precursor in situ lesions
- Associations
A
- Geography
- More common in Asia, Africa, and South America.
- Precursor in situ lesions
- Bowen disease (in penile shaft, presents as leukoplakia)
- Erythroplasia of Queyrat (cancer of glans, presents as erythroplakia)
- Bowenoid papulosis (presents as reddish papules).
- Associations
- Associated with HPV, lack of circumcision.
41
Q
Penile pathology:
Priapism
- Definition
- Associations
A
- Definition
- Painful sustained erection not associated with sexual stimulation or desire.
- Associations
- Associated with trauma, sickle cell disease (sickled RBCs get trapped in vascular channels), medications (anticoagulants, PDE-5 inhibitors, antidepressants, α-blockers, cocaine).
