Reproductive- PATHOMA Flashcards
Where does bartholin cyst occur?
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
Histologic finding of HPV on Pap smear?
koilocytes
: wrinkled nucleus that looks like raisin
Lichen sclerosis vs. Lichen simplex chronicus
- gross description
- risk for squamous cell carcinoma
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
How to distinguish extramammary paget disease on vulva vs. metastatic melanoma on vulva
- paget disease: S100 negative, keratin positive
- metastatic melanoma: S100 positive, keratin negative
Major difference between nipple paget disease vs. extramammary paget disease on vulva?
- nipple: alway associated with underlying carcinoma
- vulva: no underlying carcinoma
- they both show neoplastic cells in EPIDERMIS
Vaginal adenosis
- definition
- associated with in utero exposure to what?
- columnar epithelium in upper 1/3 vagina
- normally it is squamous
- DES (diethylstilbestrol)
Embryonal rhabdomyosarcoma
- what is another name?
- age group
- gross appearance
- two histologic markers
- sarcoma botryoides
- <4 yrs old
- grape like mass emerging from vagina
- desmin and myogenin
(rhabdomyosarcoma= stirated muscle)
What is the key feature that distinguish CIN (cervical intraepithelial neoplasia) 1,2,3 and CIS (carcinoma in situ)?
- reversibility
CIN 1, 2, and 3: dysplasia => reversible
: partial, but not full thickness of epithelium
CIS: carcinoma => NOT reversible
: involves full thickness of epithelium
Is HPV related to HIV defining illness? If so, what is CD4 cut off?
YES.
CD4 <500: cervical carcinoma by HPV happens early!
Common cause of death in cervical carcinoma?
post-renal failure due to hydronephrosis
: tumor invade through bladder, obstructing ureter
Vaccine against HPV covers what subtypes (4)?
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)
Asherman syndrome
- what is it
- what test can be used to rule out
- 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
What is diagnostic histologic finding of chronic endometritis?
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
Most common site of endometriosis?
ovary
- it is called endometrioma
- high yield: chocolate cyst= accumulation of blood (chocolate) as a result of mensturation (endometrial tissue) within ovaries
What is “gun powder” nodules?
endometriosis involving soft tissue
: yellow-brown hemorrhagic regions as result of mesnturation (endometrial tissue) within soft tissue
Endometrial carcinoma: sporadic vs. hyperplasia
- histology
- risk factor or associated gene
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
Leiomyoma
- benign or malignant?
- neoplastic proliferation of what cell?
- what is another name
benign neoplastic proliferation of smooth muscle
also called fibroid
Leiomyoma: most commonly affected age group?
pre-menopausal: 20-40 yrs
Leiomyoma: symptoms?
mostly ASYMPTOMATIC
but it can present as abnormal uterine bleeding or infertility
Leiomyoma: histologic findings?
MULTIPLE, well demarcated WHITE, WHORLED masses
Leiomyosarcoma is arised from what?
it is usually sporadic
Leiomyosarcoma does NOT arise from leiomyoma
* leimyoma is benign with no chance to progress to cancer
Leiomyosarcoma: histologic finding?
SINGLE lesion (vs. leiomyoma which is multiple) with areas of NECROSIS and HEMORRHAGE
Follicle consists of oocytes surrounded by granulosa and theca cells. which one is inner and which one is outer?
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
ovarian cancer: surface epithelial tumors
- benign (3)
- malignant (2)
Benign
- serous cystadenoma
- mucinous cystadenoma
- Brenner tumor
Malignant
- serous cystadenocarcinoma
- mucinous cysadenocarcinoma
Brenner tumor
- what unique type of cell
- histologic finding
Bladder cell: transitional epithelium
Coffee bean nuclei
- three Bs
Brenner tumor, Bladder epithelium, coffee Bean nuclei
Which gene is associated with serious cystadenocarcinoma?
BRCA1
Ovarian cancer: germ cell tumors
Name and tumor marker?
- benign (1)
- malignant (4)
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)
Ovarian cancer: sex cord stromal tumors
- benign (1)
- malignant (1)
Benign
- Fibroma
Malignant
- theca-granulosa cell tumor
What is Meigs syndrome? triad?
variant form of fibroma
triad
- pleural effusion
- ascities
- ovarian fibroma
What is common cause of sudden infant death syndrome?
smoking
Choriocarcinoma can happen via two pathways: what are they? how are they different?
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
What is lymphogranulaoma venereum?
STD by chlamydia L1-L3
painful inguinal lymph node
What are three precursor lesions for squamous cell carcinoma of penis?
- Bowen disease: leukoplakia, penile shaft
- Erythroplasia of Queyrat: erythoplakia, glands
- Bowenoid papulosis: multiple reddish papules, wart like looking
Physical exam findings of testicular torsion?
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
What malignancy is associated with varicocele?
renal cell carcinoma in left renal vein
Why testicular tumor should not be biopsied?
- risk for seeding tumor on scrotum in the process of biopsy
seminoma
- histologic finding
- gross apperance
- histology: fried egg appearance- clear cytoplasm
- gross appearance: homogenous mass with NO HEMORHAGE OR NECROSIS
- think about clean uniform white mass in scrotum
What is female equivalent form of embryonal carcinoma in male?
none
embryonal carcinoma is unique entity to male
Why chemotherapy can be risky for treating embryonal carcinoma?
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
embryonal carcinoma
- Histologic finding
- gross appearance
- glands or papillary
- hemorrhagic mass with necrosis (vs. seminoma)
How to make diagnosis of prostate adenocarcinoma?
- 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
What is histologic finding of prostate adenocarcinoma biopsy?
prominent nucleoli (just like other cancers)
What two medications are indicated for prostate cancer?
- 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.
Mammary lobules and ducts are lined by what two layers of epithelium? function of each?
- luminal cell layer (epithelium): protection and milk production
- myoepithelial layer: basement, contractile
Which drug is used to treat acute mastitis?
dicloxacillin
: broad spectrum, penicilinase resistant penicilin
periductal mastitis: how vitamin A deficiency can cause it?
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
Gross apperance of periductal mastitis?
nipple retraction: fibrotic tissue pulling nipple
* nipple retraction can also be seen in many other breast cancer
green brown nipple discharge: diagnosis? pathophysiology?
mammary duct ectasia
: dilation of mammary duct due to inflammation
What metaplasia does NOT have increased risk for cancer? What hyperplasia does NOT have increased risk for cancer?
- apocrine metaplasia: fibrocystic change of breast
- BENIGN prostatic hyperplasia
- BOTH have no increased risk for cancer
How to distinguish between intraductal papilloma vs. intraductal papillary carcinoma? (Two ways)
- age
- intraductal papillma: premenopausal
- intraductal papillary carcinoma: postmenopausal
* elderly gets cancer - histology
- intraductal papillma: both epithelial layers- luminal cell layer and myoepithelial layer
- intraductal papillary carcinoma: absence of myoepithelial layer
What is them most common breast cancer in premenopausal female?
fibroadenoma
- benign, NO increased risk of carcinoma
Breast pathologies that shows calcification on mammogram?
- fat necrosis
- sclerosing adenosis
- ductal carcinoma in situ
Which subtype of invasive ductal carcinoma has high association with BRCA1 mutation?
medullary carcinoma
lobular carcinoma in situ shows dyscohesive cells in histology? why is this?
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
Male breast cancer: what gene mutation? which chromosome?
BRCA2
chromosome 13
