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USMLE 1 > Reproductive- Phatology (2) > Flashcards

Reproductive- Phatology (2) Flashcards

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USMLE® Step 1 flashcards
1
Q

Ovarian Surface epithelium tumors (benign)

  • Serous cystadenoma
  • Mucinous cystadenoma
A

Most common ovarian neoplasm. Lined with fallopian tube–like epithelium. Often bilateral

Multiloculated, large. Lined by mucus-secreting epithelium

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2
Q

Ovarian Surface epithelium tumors (benign)

- Endometrioma

A

Endometriosis within ovary with cyst formation

pelvic pain, dysmenorrhea, dyspareunia; symptoms may vary with menstrual cycle

“Chocolate cyst”—endometrioma filled with dark, reddish-brown blood. Complex mass on ultrasound.

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3
Q

Ovarian Germ cell tumors (benign)

- Mature cystic teratoma (dermoid cyst)

A

most common ovarian tumor in females 10–30 years old. Cystic mass containing elements from all 3 germ layers

Can present with pain 2° to ovarian enlargement or torsion

A monodermal form with thyroid tissue (struma ovarii) uncommonly presents with hyperthyroidism

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4
Q

Ovarian Sex cord stromal tumor (benign)

  • Fibroma
  • Thecoma
A

Bundles of spindle-shaped fibroblasts. Meigs syndrome—triad of ovarian fibroma, ascites, hydrothorax.

Like granulosa cell tumors, may produce estrogen. Usually presents as abnormal uterine bleeding in a postmenopausal woman.

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5
Q

Ovarian Brenner tumor

A

Resembles bladder epithelium. Solid tumor that is pale yellow-tan and appears encapsulated. “Coffee bean” nuclei on H&E stain. Usually benign.

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6
Q

Ovarian Surface epithelium tumors (malignant)
- Serous cystadenocarcinoma
-

A

Most common malignant ovarian neoplasm, frequently bilateral. Psammoma bodies.

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7
Q

Ovarian Surface epithelium tumors (malignant)

- Mucinous cystadenocarcinoma

A

May be metastatic from appendiceal or other
GI tumors.

Can result in pseudomyxoma peritonei intraperitoneal accumulation of mucinous material.

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8
Q

Germ cell tumors (malignant)

- Dysgerminoma

A

in adolescents. Equivalent to male seminoma. 1% of all ovarian tumors; 30% of germ cell tumors

Sheets of uniform “fried egg” cells.

hCG, LDH = tumor markers.

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9
Q

Germ cell tumors (malignant)

- Immature teratoma

A

Commonly diagnosed before age 20. Typically

represented by immature/embryonic-like neural tissue.

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10
Q

Germ cell tumors (malignant)

- Yolk sac tumor (ovarian endodermal sinus tumor)

A

Aggressive, in ovaries or testes and sacrococcygeal
area in young children. Most common tumor in male infants.

Yellow, friable (hemorrhagic), solid mass. 50% have Schiller-Duval bodies (resemble glomeruli).

AFP = tumor marker.

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11
Q

Sex cord stromal tumors (malignant)

- Granulosa cell tumor

A

women in their 50s. Produces estrogen and/or progesterone.

Presents with postmenopausal bleeding, sexual precocity (in pre-adolescents), breast tenderness.

Shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles)

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12
Q

Krukenberg tumor

A

GI malignancy that metastasizes to ovaries Ž mucin-secreting signet cell adenocarcinoma

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13
Q

Endometrial conditions

A

Pag. 630

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14
Q

Asherman syndrome

A

Adhesions and/or fibrosis of the endometrium.

Presents with infertility fertility, recurrent pregnancy
loss, abnormal uterine bleeding, pelvic pain

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15
Q

Endometrial

carcinoma

A

Most common gynecologic malignancy.

Peak occurrence at 55–65 years old. Presents with
vaginal bleeding

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16
Q

Breast Fibrocystic changes (< 35 years old)

  • Sclerosing adenosis
  • Epithelial hyperplasia
A

acini and stromal fibrosis, associated with calcifications. Slight (1.5–2 ×) risk for cancer.

cells in terminal ductal or lobular epithelium. risk of carcinoma with atypical cells.

*premenstrual breast pain or lumps; often bilateral and multifocal

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17
Q

Breast Inflammatory processes

  • Fat necrosis
  • Lactational mastitis
A

benign, usually painless, lump due to injury to breast tissue. Calcified oil cyst on mammography; necrotic fat and giant cells on biopsy.

risk of bacterial infection through cracks in nipple. S aureus is most common pathogen

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18
Q

Breast Benign tumors

- Fibroadenoma

A

< 35 years old. Small, well-defined, mobile mass.

inncrease size and tenderness with estrogen.

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19
Q

Breast Benign tumors

- Intraductal papilloma

A

small fibroepithelial tumor within lactiferous ducts, typically beneath areola.

Most common cause of nipple discharge (serous or bloody). Slight (1.5–2 ×) risk for cancer

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20
Q

Breast Benign tumors

- Phyllodes tumor

A

large mass of connective tissue and cysts with “leaf-like” lobulations.

Most common in 5th decade. Some may become malignant.

21
Q

Gynecomastia

- Causes

A

Physiologic in newborn, pubertal, and elderly males.

Other causes:
cirrhosis, hypogonadism, testicular tumors, and drugs (Spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole)

22
Q

Malignant breast tumors

A

Usually arise from terminal duct lobular unit.

triple negative (ER ⊝, PR ⊝, and Her2/Neu ⊝) more aggressive

Axillary lymph node involvement indicating metastasis is the most important prognostic factor in early-stage
disease

23
Q

Non invasive breast cancer

  • Ductal carcinoma in situ
  • Comedocarcinoma
A

Fills ductal lumen. Arises from ductal atypia. Often seen early as microcalcifications on mammography.

Ductal, central necrosis. Subtype of DCIS.

24
Q

Non invasive breast cancer

- Paget disease

A

Results from underlying DCIS or invasive breast cancer. Eczematous patches on nipple.

Paget cells = intraepithelial adenocarcinoma cells.

25
Q

Invasive breasr cancer

- Invasive ductal carcinoma (most common)

A

Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.

Tumor can deform suspensory ligaments Ž dimpling of skin. Classic morphology: “stellate” infiltration

26
Q

Invasive breasr cancer

- Invasive lobular carcinoma

A

Orderly row of cells due to decreased E-cadherin expression

Often bilateral with multiple lesions in the same location

27
Q

Invasive breasr cancer

- Medullary carcinoma

A

Fleshy, cellular, lymphocytic infiltrate.

Good prognosis.

28
Q

Invasive breasr cancer

- Inflammatory breast cancer

A

Dermal lymphatic invasion by breast carcinoma. Peau d’orange. neoplastic cells block lymphatic drainage.

Poor prognosis (50% survival at 5 years). Often mistaken for mastitis or Paget disease.

29
Q

Peyronie disease

A

Abnormal curvature of penis due to fibrous plaque within tunica albuginea. Associated with erectile dysfunction

30
Q

Ischemic priapism

  • Definition
  • Causes
  • Treatment
A

Painful sustained erection lasting > 4 hours.

Associated with sickle cell disease, medications (eg, sildenafil, trazodone).

Treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia.

31
Q

Penile Squamous cell carcinoma

- Precursor in situ lesions:

A
  • Bowen disease (in penile shaft, presents as leukoplakia),
  • erythroplasia of Queyrat (carcinoma in situ of the glans, presents as erythroplakia),
  • Bowenoid papulosis (carcinoma in situ of unclear malignant potential, presenting as reddish papules).
32
Q

Cryptorchidism

A

associated with risk of germ cell tumors. Prematurity high risk of cryptorchidism

33
Q

Testicular torsion

  • Definition
  • CLinical manifestations
  • Treatment
A

Rotation of testicle around spermatic cord and vascular pedicle. Commonly presents in males 12–18 years old.

Characterized by acute, severe pain, high-riding testis, and absent cremasteric reflex

Treatment: surgical correction (orchiopexy) within 6 hours, manual detorsion

34
Q

Varicocele

- Diagnosis

A

Standing clinical exam/Valsalva maneuver (distension on inspection and “bag of worms” on palpation; augmented by Valsalva) or ultrasound with Doppler A ; does not transilluminate.

35
Q

Extragonadal germ cell tumors

A

Arise in midline locations.

In adults, most commonly in retroperitoneum, mediastinum, pineal, and suprasellar regions.

In infants and young children, sacrococcygeal teratomas are most common.

36
Q

Congenital hydrocele

A

Common cause of scrotal swellingi n infants, due to incomplete obliteration of processus vaginalis.

Most spontaneously resolve by 1 year old.

37
Q

Spermatocele

A

Cyst due to dilated epididymal duct or rete testis.

Paratesticular fluctuant nodule.

38
Q

Testicular germ cell tumors

- Seminoma

A

Malignant; painless, homogenous testicular enlargement; most common testicular tumor. Does not
occur in infancy

Large cells in lobules with watery cytoplasm and “fried egg” appearance. ALP. Highly radiosensitive. Late metastasis, excellent prognosis

39
Q

Testicular germ cell tumors

- Yolk sac tumor (testicular endodermal sinus tumor)

A

Yellow, mucinous. Aggressive malignancy. Schiller-Duval bodies resemble primitive glomeruli.

AFP is highly characteristic. Most common testicular tumor in boys < 3 years old.

40
Q

Testicular germ cell tumors

- Choriocarcinoma

A

Malignant,  hCG

Hematogenous metastases to lungs and brain. May produce gynecomastia, symptoms of hyperthyroidism

41
Q

Testicular germ cell tumors

- Teratoma

A

Unlike in females, mature teratoma in adult males may be malignant. Benign in children

42
Q

Testicular germ cell tumors

- Embryonal carcinoma

A

Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma. Often glandular /papillary morphology

hCG and normal AFP levels when pure (high AFP when mixed).

43
Q

Testicular non–germ cell tumors (5% of all testicular tumors)
- Leydig cell tumor

A

Golden brown color; contains Reinke crystals.

Produces androgens or estrogens Ž gynecomastia in men, precocious puberty in boys

44
Q

Testicular non–germ cell tumors (5% of all testicular tumors)
- Sertoli cell tumor

A

Androblastoma from sex cord stroma

45
Q

Testicular non–germ cell tumors (5% of all testicular tumors)
- Testicular lymphoma

A

Most common testicular cancer in older men. Not a 1° cancer; arises from metastatic lymphoma to testes. Aggressive

46
Q

Benign prostatic hyperplasia

A

men > 50 years old

Enlargement of periurethral (lateral and middle) lobes.

Presents with frequency of urination, nocturia, difficulty starting and stopping urine stream, dysuria

47
Q

Prostatitis

  • Clinical presenation
  • Acute bacterial prostatitis
  • Chronic prostatitis
A

dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate.

in older men most common bacterium is E coli; in young males consider C trachomatis, N gonorrhoeae

either bacterial or nonbacterial (eg, 2° to previous infection, nerve problems, chemical irritation).

48
Q

Prostatic adenocarcinoma

A

> 50 years old. Arises most often from posterior lobe (peripheral zone).

diagnosed by  PSA and subsequent needle core biopsies.

Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and serum ALP and PSA.

USMLE 1 (73 decks)

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