Reproductive Pathology Flashcards
Most common male reproductive tumors are found in …….
testes, prostate, penis
Define cryptorchidism, and what could be the causes?
Failure of normal descent of intra abdominal testes into the scrotum
- Causes could be mechanical, hormonal, or just congenital
- Bilateral cryptorchidism causes infertility
Most of testicular tumors are …….. Most are caused by ……
germ cell tumors
- Most common in men 15-34 years of age (older than this, and it could be lymphoma)
- Caused by cryptorchidism, infection, trauma, genetic facors
- Usually painless enlargement, but with potential to disseminate
Leydig cell tumors are ……
benign
- In children, they cause feminization or musculinization. In adults, it caused gynecomastia
- Leydig cells produce androgens, estrogens, or corticosteroids
Sertoli cell tumors are mostly ……
benign (over 90%)
* Usually no endocrine changes with these tumors
Testicular lymphoma mostly occurs in …..
elderly men
* Rarely confined to the testes
Mumps rarely leads to sterility. T/F??
True
Gonorrhea may spread to …..
prostate, seminal vesicles, and epididymis
- Rarely to the testes
- Caused by Neisseria gonorrhea
Syphilis rarely leads to sterility. T/F??
False
* Testes involvement may occur, which leads to sterility
TB of the testes usually occur in the ……., with the classical finding being …..
epididymis
caseating granulomas
Non specific testicular inflammation usually caused by ……
Chlamydia trachomatis
Torsion of the spermatic cord causes …..
compromise of the arterial and venous supply
* If not corrected, it results in infarction
BPH (hyperplasia) is ……
formation of large nodules in the median lobe, that may cause obstruction of urethral canal
- Common after 45
- Causes secondary smooth muscle hypertrophy of bladder
Prostate cancer may present with …..
urinary problems, or a palpable mass on rectal exam
* Tumor is age and race related. Under endocrine and environmental influences
Prostate cancer usually spreads to …..
bone
* An elderly man with osteoblastic metastases should be screened for prostate cancer
Staging for prostate cancer depends on ……
size, degree of infiltration of local tissue, degree of metastases
High PSA with enlarged prostate is suggestive of …….
prostate cancer
Survival of prostate cancer is related to ….. & ……
stage and grade
* Most of patients present with advanced disease
Acute prostatitis is the result of ……
the extension of bacterial infection from the posterior urethra or bladder
Chronic prostatitis is the result of …..
recurrent UTI in men
* Could be bacterial or non bacterial (Ureaplasma & Chlamydia trachomatis)
Chancroid is caused by ………, while syphilis is caused by ………
Haemuphilus ducreyi
Tremponema pallidum
* Chancroid is different from chancers (of syphilis) although they share the same features
Breast cancer is …..
The main risk factor is ……..
the second most common cause of cancer death in women
- The most important risk factor is family history (A-D) of defective BRCA1 & 2 (tumor suppressor genes)
- Nulliparity is also a risk factor, but not like family history
Acute endometritis is usually caused by …..
Group A beta hemolytic streptococci and staphylococci
* Usually following childbirth of abortion
Chronic endometritis is associated with …..
use of intrauterine devices, TB, pelvic inflammation, or post abortion
Define endometriosis
What are the most common locations?
Ectopic endometrial tissue outside the uterine cavity
- Common in ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, vagina, vulva, and appendix
- Usually there is infertility (due to fibrosis of tubes and ovaries)
Endometriosis is characterized by ……..
- Cyclic bleeding from the ectopic endometrial tissue, resulting in brown filled spaces “chocolate cysts”
- Painful intercourse (dyspareunia)
- Pelvic pain
- Pain on defecation, dysuria, inability to conceive
Endometrial hyperplasia could be caused by …….., …….., ……
- Prolonged estrogen therapy (may cause a well differentiated adenocarcinoma, which regresses after stopping the therapy)
- Ovarian tumors
- Adrenocortical hyperfunction
- There could be excessive uterine bleeding
Endometrial polyps are …….., occur during …….
3 cm sessile/pedunculated masses
perimenopausal or postmenopausal period
* Usually present with uterine bleeding
Endometrial carcinoma is associated with …..
diabetes, obesity, hypertension, infertility, prolonged estrogen therapy
- There could be contiguous growth into the surrounding structure.
- Blood and lymph spread is possible
Endometrial carcinoma is seen (microscopically) as …….
adenocarcinomas showing glandular pattern with varying degree of differentiation
Myometrium fibroids (leiomyoma) are ….
benign smooth muscle neoplasms, occurring in the third and fourth decade
- There is hemorrhage, pain, excessive menstrual bleeding
- Malignant transformation is rare
Pelvic inflammatory disease (PID) is caused by …….
upward spread of infection from Bartholin or Skene glands, or may occur with postpartum or postabortion
- Caused by Neisseria gonorrhea, Staphylococcus, Streptococcus, coliforms, Clostridium perfringens, Mycoplasma, Chlamydia & anaerobes
- There is pelvic pain, dymenorrhea, fever
What are the complications of Pelvic inflammatory disease (PID)?
sepsis, peritonitis, infertility, intestinal obstruction, or tubo-ovarian abscess
Cervicitis is caused by ……
The symptoms are ……
infection following intercourse, childbirth, or gynecologic instrumentation
- Pathogens include E.coli, Staph, Streptococcus, enterococcus
- Asymptomatic, or with vaginal discharge (confirm with pap smear)
Cervical polyps are present with ……
vaginal bleeding
SCC of the cervix is highly associated with …..
HPV type 16 & 18
- SCC is high in HIV patients
- There is spread by contiguous growth, and blood/lymph dissemination
Cervical cancer is on the decline because of …….
pap smear
* every year for sexually active women, non active every 3 years
What are the most common vaginal infections?
- Trichomonas vaginalis: by protoza. Causes strawberry red vaginal mucosa with suppuration
- Monilia: cause thick white exudate
- Herpes simplex vaginitis: caused by HSV II
- Vulvovaginitis: by Neisseria gonorrhea. In children and adults
SCC of vagina may spread to ……..
rectum, cervix, bladder, or lymph/blood
* Rare
Diethylstilbestrol (DES) was used to treat ……. and usually causes ……
threatened abortions
adenocarcinoma of the cervix in young women (whose mothers were treated with DES)
* It is a synthetic estrogen
Most of ovarian tumors are …….
benign (80% of them)
What are the risk factors for ovarian cancer is ……
family history, early menarche, nulliparity
Most of the ovarian tumors are originated from ……
epithelium
* These are asymptomatic until they become quite large
Mature (benign) teratomas are …..
dermoid cysts (filled with sebaceous secretions and hair)
Immature (malignant) teratomas are …..
fast growing and invasive with blood/lymph spread
Sex cord tumors leads to …..
endocrinologic syndromes (because of steroids secretion)
Follicular cysts are usually located in ……
the cortex of the ovary
* They are unruptured fluid filled cysts that remain small
Luteal cysts are …..
benign cysts, composed of luteal tissue and large cells filled with SER
* Less common than follicular cysts
Polycystic ovaries are associated with ….
Hirsutism, infertility, amenorrhea, obesity
Define acute mastitis
fissures in the nipple during early nursing, caused by Staph aureus.
* Pus in the ducts
Mammary duct ectasia (plasma cell mastitis) is …….
Symptoms are ……..
Blockage of the lactiferous duct (mimics cancer).
- There is pain redness & swelling around the areola, thick secretion. Nipple is retracted, axillary lymphadenopathy
- Must be distinguished from malignancy
Fibrosis of the breast is ……, while fibrocystic disease is ……
not premalignant
predispose to malignancy
What is the difference between fibrocystic disease of the breast and breast cancer?
- Usually bilateral (cancer unilateral)
- Multiple nodules (cancer single)
- There is menstrual variation (cancer no variation)
- Cyclic pain and engorgement (no pain in cancer)
- May regress in pregnancy (cancer doesn’t regress)
Diagnosis of fibrocystic disease of the breast is important because …..
it is mistaken for cancer, and it may predispose to cancer
Breast epithelial hyperplasia has ……., while sclerosing adenosis has …….
increased cancer risk
no cancer risk
Gynecomastia is associated with …….
increased sensitivity to estrogen
* Occurs in Klinefelter syndrome, testicular tumors (sertoli-leydig), puberty, old age
Breast Fibroadenoma is
the most common benign tumor of the breast.
- Single movable nodule, not fixed to the skin. It is encapsulated
- Glandular epithelial lined spaces with fibroblastic stroma
Cystosarcoma phyllodes (Phyllodes tumor) is …….
fibroadenoma like tumors that became large and lobulated
* Distinguished from breast fibroadenoma by the nature of the stromal component
Breast cancer is rarely seen in ……
women under 25
What are the risk factors for breast cancer?
- Age 40+
- Nulliparity
- Family history
- Early Menarche, late menopause
- Fibrocystic disease
- Obestiy
- High fat diet
What are the possible clinical features of breast cancer?
- May grow into the thoracic fascia and become fixed
- May cause skin retraction and dimpling, peau d’orange
- May obstruct the subcutaneous lymphatics
- Invade Cooper ligament and causing nipple retraction
Metastatic tumors to the breast are ….
rare
What are the possible causes of breast cancer?
Family history, viral infection, radiation, unopposed estrogen for prolonged periods (leads to ductal hyperplasia)
Breast cancer can metastasize to …….
axillary, supraclavicular and internal thoracic nodes, or the nodes of the other side
Sixty percent of breast cancers have foci of ……
calcification
Define segmental mastectomy
The removal of the lump and some of the lymph nodes on the same side
* Also called partial mastectomy
Define simple mastectomy
The whole breast is removed
Define the modified radical mastectomy procedure
the removal of the whole breast, with the axillary lymph node & pectoralis fascia
Define the radical mastectomy procedure
The removal of the whole breast, the axillary lymph nodes, the pectoralis fascia and the pectoralis muscle (major & minor)
Tamoxifen is used as ……
an antiestrogen in breast tissue that shows positive estrogen receptor results.
* In the endometrium, Tamoxifen is an estrogen agonist. So it has a mixed agonist/antagonist action
