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Reproductive: 4/21-4/29 > Reproductive- PATHOMA > Flashcards

Reproductive- PATHOMA Flashcards

1
Q

Where does bartholin cyst occur?

A

LOWER vestibule adjacent to vaginal canal
usually UNILATERAL

*examiners like to ask anatomy: where is bartholin gland? => lower vestibule
* what is embryological origin of bartholin gland?
=> urogenital sinus

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2
Q

Histologic finding of HPV on Pap smear?

A

koilocytes

: wrinkled nucleus that looks like raisin

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3
Q

Lichen sclerosis vs. Lichen simplex chronicus

  • gross description
  • risk for squamous cell carcinoma
A

Lichen sclerosis
- thinning of epidermis and fibrosis of dermis of vulva
=> parchment like vulvar skin
- slight increase risk for SCC

Lichen simplex chronicus
-hyperplaisa of vulva skin
=> thick, leathery vulvar skin
- NO risk for SCC

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4
Q

How to distinguish extramammary paget disease on vulva vs. metastatic melanoma on vulva

A
  • paget disease: S100 negative, keratin positive

- metastatic melanoma: S100 positive, keratin negative

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5
Q

Major difference between nipple paget disease vs. extramammary paget disease on vulva?

A
  • nipple: alway associated with underlying carcinoma
  • vulva: no underlying carcinoma
  • they both show neoplastic cells in EPIDERMIS
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6
Q

Vaginal adenosis

  • definition
  • associated with in utero exposure to what?
A
  • columnar epithelium in upper 1/3 vagina
  • normally it is squamous
  • DES (diethylstilbestrol)
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7
Q

Embryonal rhabdomyosarcoma

  • what is another name?
  • age group
  • gross appearance
  • two histologic markers
A
  • sarcoma botryoides
  • <4 yrs old
  • grape like mass emerging from vagina
  • desmin and myogenin
    (rhabdomyosarcoma= stirated muscle)
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8
Q

What is the key feature that distinguish CIN (cervical intraepithelial neoplasia) 1,2,3 and CIS (carcinoma in situ)?

A
  • reversibility

CIN 1, 2, and 3: dysplasia => reversible
: partial, but not full thickness of epithelium

CIS: carcinoma => NOT reversible
: involves full thickness of epithelium

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9
Q

Is HPV related to HIV defining illness? If so, what is CD4 cut off?

A

YES.

CD4 <500: cervical carcinoma by HPV happens early!

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10
Q

Common cause of death in cervical carcinoma?

A

post-renal failure due to hydronephrosis

: tumor invade through bladder, obstructing ureter

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11
Q

Vaccine against HPV covers what subtypes (4)?

A

HPV, 6, 11, 16, 18

NO coverage to 31 and 33, another subtypes high risk for cervical cancer
=> even with vaccination, Pap smear is still required! (high yield)

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12
Q

Asherman syndrome

  • what is it
  • what test can be used to rule out
A
  • secondary amenorrhea due to lack of BASALIS (regenerative stem cells in endometrium)
  • > no further regeneration, but rather scarring
  • > no further shedding
  • positive bleeding test after progestrin withdrawal can rule out Asherman syndrome
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13
Q

What is diagnostic histologic finding of chronic endometritis?

A

lymphocytes and plasma cells

  • remember normally plasma cells reside only in bone marrow. It does NOT circulate peripheral blood. so seeing plasma cells is not a good sign
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14
Q

Most common site of endometriosis?

A

ovary

  • it is called endometrioma
  • high yield: chocolate cyst= accumulation of blood (chocolate) as a result of mensturation (endometrial tissue) within ovaries
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15
Q

What is “gun powder” nodules?

A

endometriosis involving soft tissue

: yellow-brown hemorrhagic regions as result of mesnturation (endometrial tissue) within soft tissue

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16
Q

Endometrial carcinoma: sporadic vs. hyperplasia

  • histology
  • risk factor or associated gene
A

sporadic
- associated with loss of p53

  • histology: psammoma bodies, papillary sturcutres
  • psammoma bodies also seen in serous cystadenocarcinoma (ovary)

hyperplasia
- endometrial carcinoma as a consequence of hyperplasia

  • histology: endometrioid (normal hyperplastic endometrium)
  • risk factor is hyper-estrogen
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17
Q

Leiomyoma

  • benign or malignant?
  • neoplastic proliferation of what cell?
  • what is another name
A

benign neoplastic proliferation of smooth muscle

also called fibroid

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18
Q

Leiomyoma: most commonly affected age group?

A

pre-menopausal: 20-40 yrs

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19
Q

Leiomyoma: symptoms?

A

mostly ASYMPTOMATIC

but it can present as abnormal uterine bleeding or infertility

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20
Q

Leiomyoma: histologic findings?

A

MULTIPLE, well demarcated WHITE, WHORLED masses

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21
Q

Leiomyosarcoma is arised from what?

A

it is usually sporadic

Leiomyosarcoma does NOT arise from leiomyoma
* leimyoma is benign with no chance to progress to cancer

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22
Q

Leiomyosarcoma: histologic finding?

A

SINGLE lesion (vs. leiomyoma which is multiple) with areas of NECROSIS and HEMORRHAGE

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23
Q

Follicle consists of oocytes surrounded by granulosa and theca cells. which one is inner and which one is outer?

A

SGLT
- Sertoli, Granulosa, Leydig, Theca

Just like sperm, where leydig is periphery and sertoli is in inside of semitubule,
Granulosa is inside and Theca is outside

  • oocyte middle, granulosa next, and Theca
24
Q

ovarian cancer: surface epithelial tumors

  • benign (3)
  • malignant (2)
A

Benign

  • serous cystadenoma
  • mucinous cystadenoma
  • Brenner tumor

Malignant

  • serous cystadenocarcinoma
  • mucinous cysadenocarcinoma
25
Q

Brenner tumor

  • what unique type of cell
  • histologic finding
A

Bladder cell: transitional epithelium

Coffee bean nuclei

  • three Bs
    Brenner tumor, Bladder epithelium, coffee Bean nuclei
26
Q

Which gene is associated with serious cystadenocarcinoma?

A

BRCA1

27
Q

Ovarian cancer: germ cell tumors
Name and tumor marker?
- benign (1)
- malignant (4)

A

Benign

  • mature cystic teratoma, no tumor marker
  • hyperthyroidism for struma ovarii

Malignant

  • immature cystic teratoma
  • yolk sac tumor (AFP)
  • dysgerminoma (beta-hCG, LDH)
  • choriocarcinoma (beta-hCG)
28
Q

Ovarian cancer: sex cord stromal tumors

  • benign (1)
  • malignant (1)
A

Benign
- Fibroma

Malignant
- theca-granulosa cell tumor

29
Q

What is Meigs syndrome? triad?

A

variant form of fibroma

triad

  • pleural effusion
  • ascities
  • ovarian fibroma
30
Q

What is common cause of sudden infant death syndrome?

A

smoking

31
Q

Choriocarcinoma can happen via two pathways: what are they? how are they different?

A

gestational: arise from mole => responds well to chemotherapy

spontaneous germ cell tumor => do NOT respond to chemotherapy

  • think in this way: spontaneous germ cell tumor is spontaneous arise of cancer, which is bit aggressive (vs. gestational requires preceding step, mole). More aggressive, no response to chemotherapy
32
Q

What is lymphogranulaoma venereum?

A

STD by chlamydia L1-L3

painful inguinal lymph node

33
Q

What are three precursor lesions for squamous cell carcinoma of penis?

A
  • Bowen disease: leukoplakia, penile shaft
  • Erythroplasia of Queyrat: erythoplakia, glands
  • Bowenoid papulosis: multiple reddish papules, wart like looking
34
Q

Physical exam findings of testicular torsion?

A

sudden testicular pain

absent cremasteric reflex

  • cremasteric reflex (L1-L2, ilioinguinal nerve): stroking inner thigh with tongue blade normally retracts scrotum. Absent cremasteric reflex is diagnostic physical exam finding of testicular torsion
35
Q

What malignancy is associated with varicocele?

A

renal cell carcinoma in left renal vein

36
Q

Why testicular tumor should not be biopsied?

A
  • risk for seeding tumor on scrotum in the process of biopsy
37
Q

seminoma

  • histologic finding
  • gross apperance
A
  • histology: fried egg appearance- clear cytoplasm
  • gross appearance: homogenous mass with NO HEMORHAGE OR NECROSIS
  • think about clean uniform white mass in scrotum
38
Q

What is female equivalent form of embryonal carcinoma in male?

A

none

embryonal carcinoma is unique entity to male

39
Q

Why chemotherapy can be risky for treating embryonal carcinoma?

A

chemotherapy may cause differentiation of embryonal carcinoma to other type of malignancy (ex: teratoma)

  • think like this: embryonal carcinoma sounds young. It can become other cancers with stimulation of chemotherapy
40
Q

embryonal carcinoma

  • Histologic finding
  • gross appearance
A
  • glands or papillary

- hemorrhagic mass with necrosis (vs. seminoma)

41
Q

How to make diagnosis of prostate adenocarcinoma?

A
  • PSA
  • digital rectal exam
  • also, BIOPSY
  • even with elevated PSA and positive DRE, biopsy is still required for diagnosis
    => this makes sense: PSA means prostate is there, and DRE can be subjective
42
Q

What is histologic finding of prostate adenocarcinoma biopsy?

A

prominent nucleoli (just like other cancers)

43
Q

What two medications are indicated for prostate cancer?

A
  • leuprolide (continuous)
  • flutamide
  • finasteride is NOT indicated for prostate cancer, it is only indicated for BPH
  • prostate cancer relies on androgen for growth, not DHT.
44
Q

Mammary lobules and ducts are lined by what two layers of epithelium? function of each?

A
  • luminal cell layer (epithelium): protection and milk production
  • myoepithelial layer: basement, contractile
45
Q

Which drug is used to treat acute mastitis?

A

dicloxacillin

: broad spectrum, penicilinase resistant penicilin

46
Q

periductal mastitis: how vitamin A deficiency can cause it?

A

vitamin A is required for normal development of specialized epithelium
: vitamin A deficiency
-> squamous metaplasia of duct (not normal epithelium) -> plugging of duct
-> inflammation and periductal mastitis

47
Q

Gross apperance of periductal mastitis?

A

nipple retraction: fibrotic tissue pulling nipple

* nipple retraction can also be seen in many other breast cancer

48
Q

green brown nipple discharge: diagnosis? pathophysiology?

A

mammary duct ectasia

: dilation of mammary duct due to inflammation

49
Q

What metaplasia does NOT have increased risk for cancer? What hyperplasia does NOT have increased risk for cancer?

A
  • apocrine metaplasia: fibrocystic change of breast
  • BENIGN prostatic hyperplasia
  • BOTH have no increased risk for cancer
50
Q

How to distinguish between intraductal papilloma vs. intraductal papillary carcinoma? (Two ways)

A
  1. age
    - intraductal papillma: premenopausal
    - intraductal papillary carcinoma: postmenopausal
    * elderly gets cancer
  2. histology
    - intraductal papillma: both epithelial layers- luminal cell layer and myoepithelial layer
    - intraductal papillary carcinoma: absence of myoepithelial layer
51
Q

What is them most common breast cancer in premenopausal female?

A

fibroadenoma

  • benign, NO increased risk of carcinoma
52
Q

Breast pathologies that shows calcification on mammogram?

A
  • fat necrosis
  • sclerosing adenosis
  • ductal carcinoma in situ
53
Q

Which subtype of invasive ductal carcinoma has high association with BRCA1 mutation?

A

medullary carcinoma

54
Q

lobular carcinoma in situ shows dyscohesive cells in histology? why is this?

A

lack of E-cadherin

  • on histology, carcinoma cells present apart from each other => dyscohesive
  • this also applies to invasive lobular carcinoma
  • Anything lobular: think about E-cadherin
55
Q

Male breast cancer: what gene mutation? which chromosome?

A

BRCA2

chromosome 13

Reproductive: 4/21-4/29 (5 decks)

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