Reproductive + pregnancy Flashcards

Question

What happens to undescended testes over time in cryptorchidism?

Answer 1

Testes become atrophic. Tubular atrophy evident by age 5-6. Hyalinization present by puberty. Foci of intratubular germ cell neoplasia may be present.

Answer 2

Increased risk of infertility. Increased risk of developing testicular cancer, affecting both testes even in unilateral cases.

Answer 3

- Germ cell tumors - ~95% of cases, all malignant, usually occur between ages 15-40. - Sex cord-stromal tumors (Sertoli or Leydig cells) - uncommon, usually benign.

Answer 4

Cryptorchidism (3-5 fold increase). Testicular dysgenesis (e.g., testicular feminization and Klinefelter syndrome). Caucasians > African Americans. Family history. Isochromosome of the short arm of chromosome 12 in germ cell tumors.

Answer 5

Intratubular germ cell neoplasm (in-situ lesion).

Answer 6

Firm, painless testicular mass

Answer 7

Account for 50% of testicular neoplasms. Remain confined to the testis for a long time. Spread mainly to para-aortic nodes. Distant spread is rare.

Answer 8

Tend to spread earlier by both lymph and blood vessels.

Answer 9

Radical orchiectomy and chemotherapy.

Answer 10

60% of germ cell tumors are mixed and contain more than one component, arising from pluripotent neoplastic germ cells.

Answer 11

Seminoma. Good prognosis with late metastasis and responsiveness to treatment.

Answer 12

Soft, well-demarcated, gray-white tumor. Homogenous cut surface with no hemorrhage or necrosis.

Answer 13

Large polygonal, uniform cells with distinct borders. Clear, glycogen-rich cytoplasm. Round nuclei and visible nucleoli. Arranged in small lobules separated by fibrous septae with possible lymphocytic infiltrate.

Answer 14

Spermatocytic seminoma. Affects older men. Lacks lymphocytic infiltrate and syncytiotrophoblasts. Not associated with intralobular germ cell neoplasm and does not metastasize.

Answer 15

Present in 10% of cases. Source of minimally elevated serum hCG concentration.

Answer 16

Rare (2-3%). Poor prognosis with early metastasis and poor reaction to treatment. Common in ages 20-30. Malignant tumor with immature, primitive cells. Gross: Mass with hemorrhage and necrosis. Micro: Large primitive cells with basophilic cytoplasm, indistinct borders, and large hyperchromatic nuclei with prominent nucleoli. Tumor markers: Negative for pure embryonal carcinoma but can show markers if mixed with choriocarcinoma or yolk sac tumor cells.

Answer 17

Gross: Mass with hemorrhage and necrosis. Micro: Large primitive cells with basophilic cytoplasm, indistinct borders, large hyperchromatic nuclei with prominent nucleoli, and pleomorphic cells in cords, sheets, or gland-like arrangements.

Answer 18

Highly malignant with early hematogenous metastases, commonly to liver and lung. Common in ages 20-30. Tumor comprised of trophoblastic (placenta-forming) cells. Gross: Often small, non-palpable lesions with hemorrhage. Micro: Proliferation of syncytiotrophoblasts (large eosinophilic multinucleated cells) and cuboidal cytotrophoblasts. Tumor marker: hCG.

Answer 19

Gross: Small, non-palpable lesions with hemorrhage on cut surface. Micro: Syncytiotrophoblasts (large eosinophilic multinucleated cells) intermingle with small cuboidal cytotrophoblasts.

Answer 20

Embryonal carcinoma: Negative for pure form, but mixed tumors may show markers from choriocarcinoma or yolk sac tumors. Choriocarcinoma: hCG is a significant marker.

Answer 21

Most common germ cell tumor in children younger than 3. Good prognosis in children.In adults, often mixed with embryonic carcinoma. Tumor marker: alpha-fetoprotein (AFP).

Answer 22

Macro: Large and may be well demarcated. Micro: Low cuboidal to columnar epithelial cells forming microcysts and lace-like (reticular) patterns. Schiller-Duval bodies (resemble developing glomeruli) are characteristic.

Answer 23

Alpha-fetoprotein (AFP) is a significant marker for yolk sac tumors.

Answer 24

Schiller-Duval bodies are structures resembling developing glomeruli and are characteristic of yolk sac tumors (endodermal sinus tumors).

Answer 25

A germ cell tumor with neoplastic cells differentiating along somatic cell lines. Majority are malignant in males and benign in females. Contains tissues from two or three embryonic layers (ectoderm, endoderm, and mesoderm).

Answer 26

A germ cell tumor with neoplastic cells differentiating along somatic cell lines. Majority are malignant in males and benign in females. Contains tissues from two or three embryonic layers (ectoderm, endoderm, and mesoderm).

Answer 27

Gross: Often cystic masses that may contain cartilage. Micro: Composed of mature fetal tissue derived from multiple embryonic layers in a haphazard arrangement (e.g., cartilage, neural tissue, glandular/squamous epithelium).

Answer 28

More common and benign in young age. Rare and malignant in older age. Rarely, non-germ cell tumors may arise in teratoma (teratoma with malignant transformation).

Answer 29

90% of patients have elevated hCG and AFP.

Answer 30

Most common germ cell tumor in children younger than 3. Good prognosis in children. In adults, often mixed with embryonic carcinoma. Tumor marker: alpha-fetoprotein (AFP).

Answer 31

Macro: Large and may be well demarcated. Micro: Low cuboidal to columnar epithelial cells forming microcysts and lace-like (reticular) patterns. Schiller-Duval bodies (resemble developing glomeruli) are characteristic.

Answer 32

Alpha-fetoprotein (AFP) is a significant marker for yolk sac tumors.

Answer 33

Schiller-Duval bodies are structures resembling developing glomeruli and are characteristic of yolk sac tumors (endodermal sinus tumors).

Answer 34

Lies at the base of the bladder, encircling the urethra (prostatic urethra). Sits anterior to the rectum; posterior aspect palpable by digital rectal exam. Divided into peripheral and transition zones: hyperplastic lesions common in transition zone; carcinoma common in peripheral zone.

Answer 35

Contains glands with two cell layers: a flat basal layer and an overlying columnar secretory cell layer. Surrounding prostatic stroma contains a mixture of smooth muscle and fibrous tissue.

Answer 36

Secretes an alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.

Answer 37

Maintained by androgens. Predominantly regulated by dihydrotestosterone (DHT), a metabolite of testosterone.

Answer 38

Acute bacterial prostatitis. Chronic bacterial prostatitis. Chronic prostatitis / chronic pelvic pain syndrome. Granulomatous prostatitis.

Answer 39

Acute infiltrate seen in prostatic acini and stroma. Clinically associated with fever, chills, and dysuria. Rectal examination: prostate is tender. Common pathogens: Chlamydia and Gonorrhea in young men; E. coli in older men.

Answer 40

Associated with recurrent UTI.Presents as dysuria with pelvic or low back pain. Culture may come negative, but prostate shows infiltrate of lymphocytes, plasma cells, and macrophages.

Answer 41

Difficult to diagnose. Clinically similar to chronic bacterial prostatitis with persistent pain, especially after ejaculation. No bacteria cultured from expressed prostatic secretions. Excessive white blood cells (WBC) may be present or absent.

Answer 42

An inflammatory condition of the prostate with granulomas. Most common cause: instillation of Bacillus Calmette-Guérin (BCG) for bladder cancer treatment. Histologically indistinguishable from tuberculosis. Fungal granulomatous prostatitis seen in immunocompromised hosts. Nonspecific granulomatous prostatitis is a reaction to secretions from ruptured prostatic ducts and acini.

Answer 43

Benign proliferation of stromal and epithelial elements, not leading to cancer. Very common, starts at age 40, and affects 90% of men by age 80.

Answer 44

Excessive androgen-dependent growth/trophic glandular hyperplasia. Central role of Dihydrotestosterone (DHT) synthesized in the prostate from circulating testosterone by enzyme 5α-reductase. DHT binds to nuclear androgen receptors, regulating gene expression for growth and survival of prostatic epithelium and stromal cells.

Answer 45

Occurs in the inner, transitional zone of the prostate. Enlarged prostate with well-demarcated nodules; nodules may be solid or contain cystic spaces. Adenomatous nodules composed of proliferating fibromuscular stroma surrounding proliferated glandular epithelium, maintaining distinct basal and tall columnar layers. Nodules create papillary infolding into cystic lumens containing proteinaceous secretory material (Corpora Amylacea).

Answer 46

Lower urinary tract obstruction in only 10% of men. Difficulty starting urine stream and intermittent interruptions. Presence of residual urine in the bladder increases the risk of UTI. Symptoms may be mediated by alpha-1 adrenergic receptors on smooth muscle.

Answer 47

Most prostate cancers (95%) are adenocarcinomas. Prostate adenocarcinoma is the most common form of cancer in men, usually seen in older age (99% with clinical disease are age 50+). It is the 2nd most common cancer-related death in men.

Answer 48

Androgens are crucial as cancer does not develop in males castrated before puberty. Tumor resistance to anti-androgen therapy often involves mutations that allow androgen receptors to activate target genes without hormones.

Answer 49

Increased risk among first-degree relatives. Higher prevalence in African origin, lower in Asian origin. Mutations in BRCA1, BRCA2, and HOXB13 genes increase risk. People inherit an increased risk of cancer, not the disease itself.

Answer 50

Variant near MYC oncogene on chromosome 8 (African males). Susceptibility locus on chromosome 1q24-q25 (American men). Gene rearrangements creating fusion genes with ETS family transcription factors. Mutations activating PI3K/AKT pathway, inactivating PTEN tumor suppressor gene. Loss of PTEN, TMPRSS2–ERG chromosome fusion, p53 mutations, overexpression of MYC.

Answer 51

Aging and diet contribute to the risk. Incidence increases in Japanese immigrants to the USA.

Answer 52

Usually arises from the peripheral zone (posterior and lateral). Most carcinomas detected clinically are not visible grossly. Advanced lesions appear as ill-defined, firm, gray-white masses infiltrating adjacent gland.

Answer 53

Moderately differentiated adenocarcinoma producing well-defined glands. Glands are smaller than benign glands in a back-to-back pattern with scant to moderate stroma. Complete absence of basal cell layer around malignant glands. Tumor cells have darker stained cytoplasm, enlarged nuclei, and prominent nucleoli. Presence of perineural invasion and abundant intraluminal mucin.

Answer 54

May be palpable in rectal examination as irregular hard nodules. Can only identify tumors that are big enough to feel.

Answer 55

Clinically silent and don't press the urethra. Discovered by routine serum PSA level checks in older males. PSA levels rise with prostate cancer and serve as a warning that the prostate gland has gone awry.

Answer 56

PSA (prostate-specific antigen) is a protein produced by cells of the prostate gland. Levels of circulating PSA rise with prostate cancer. A serum level of 4 ng/mL is the cutoff between normal and abnormal. PSA is used for follow-up treatment and recurrence detection, not diagnosis.

Answer 57

Based on architectural growth pattern rather than nuclear features. Identifies five grading patterns from 1 to 5, with predominant and second-most predominant grades yielding a combined score. Grade 1: Most well-differentiated tumors. Grade 5: No glandular differentiation, higher score suggests worse prognosis.

Answer 58

Gleason grade 1: Single and separate rather uniform acini with little intervening stroma, well demarcated. Gleason grade 2: Moderate amounts of intervening stroma, not sharply delineated, tumor acini lined by a single layer of columnar epithelial cells, no basal cells.

Answer 59

Gleason grade 3: Small, separate, round to irregular glands with moderate to abundant intervening stroma, most common pattern. Gleason grade 4: Tumor glands show gland fusion, small to indistinct lumens, complex, cribriform and confluent glands almost without any intervening stroma.

Answer 60

Solid tumor with little gland formation. Poorly differentiated single cells in an infiltrative or sheet-like pattern.

Answer 61

May present with lower back pain secondary to bone metastases. Spread to lumbar spine or pelvis is common, causing osteoblastic (bone-producing) lesions.

Answer 62

Inflammation of the cervix, often associated with a purulent vaginal discharge. Common pathogens include Chlamydia trachomatis (most common), Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans, HSV-2, and certain types of HPV.

Answer 63

Hyperemia (increased blood flow). Leukorrhea: flow of a whitish, yellowish, or greenish vaginal discharge.

Answer 64

Chronic inflammation with regeneration of epithelium. Epithelium may show hyperplasia and squamous metaplasia of the columnar epithelium.

Answer 65

Acute cervicitis: Rare, typically postpartum, and caused by staphylococci or streptococci. Chronic cervicitis: More common, showing inflammation, regeneration, hyperplasia, and squamous metaplasia.

Answer 66

Local trauma (e.g., cervical irritation caused by tampons). Chemical irritation or inflammation (e.g., Behçet syndrome).

Answer 67

Chlamydia trachomatis (most common). Neisseria gonorrhoeae. Trichomonas vaginalis. Candida albicans. HSV-2.Certain types of HPV.

Answer 68

Most tumors are of epithelial origin, caused by oncogenic strains of HPV. Common types: Squamous cell carcinoma (SCC) and adenocarcinoma. Key risk factor: High-risk HPV infection (types 16, 18). Secondary risk factors: Smoking and immunodeficiency.

Answer 69

Exocervix: Visible on vaginal exam, lined by nonkeratinizing squamous epithelium. Endocervix: Lined by a single layer of columnar cells. Transformation zone: Transition point between the exocervix and endocervix.

Answer 70

High-risk HPV infection is the primary cause. Persistent HPV infection can lead to cervical intraepithelial neoplasia (CIN), a precursor to invasive cervical carcinoma. HPV oncoproteins E6 and E7 inactivate tumor suppressors p53 and Rb. Somatic mutations in the LKB1 gene (20%).

Answer 71

High-risk HPV: Types 16 and 18. Low-risk HPV: Types 6 and 11, which typically lead to condyloma (benign neoplastic lesion).

Answer 72

CIN can progress from dysplasia to carcinoma in situ and eventually to invasive carcinoma if left untreated.

Answer 73

HPV infects the lower genital tract, particularly the transformation zone of the cervix. HPV E6 protein binds and inactivates p53. HPV E7 protein binds and inactivates Rb. These actions lead to uncontrolled cell growth and progression to neoplasia.

Answer 74

Peak age incidence of CIN: ~30 years. Peak age incidence of carcinoma: ~45 years.

Answer 75

Koilocytotic change. Loss of cellular maturation. Nuclear atypia (cell pleomorphism). Parakeratosis/dyskeratosis. Increased mitotic activity within the cervical epithelium.

Answer 76

CIN I: Involves < 1/3 of the thickness of the epithelium. CIN II: Involves < 2/3 of the thickness of the epithelium. CIN III: Involves slightly less than the entire thickness of the epithelium. Carcinoma in situ (CIS): Involves the entire thickness of the epithelium

Answer 77

Dysplasia is reversible.Carcinoma in situ is not reversible. The higher the grade of dysplasia, the more likely it is to progress to carcinoma and the less likely it is to regress to normal.

Answer 78

LSIL (Low-grade squamous intraepithelial lesion): Includes HPV, mild dysplasia, CIN 1. HSIL (High-grade squamous intraepithelial lesion): Includes moderate and severe dysplasia, carcinoma in situ, CIN 2, and CIN 3.

Answer 79

Squamous cell carcinomas (75%). Adenocarcinomas and mixed adenosquamous carcinomas (20%). Small cell neuroendocrine carcinomas (less than 5%).

Answer 80

In the transformation zone of the cervix. They can range from microscopic foci of stromal invasion to grossly conspicuous exophytic tumors.

Answer 81

A condition where tumors encircle the cervix and penetrate into the underlying stroma, producing a barrel-like appearance of the cervix, often identified by direct palpation.

Answer 82

Hydronephrosis with postrenal failure due to the tumor invading through the anterior uterine wall into the bladder and blocking the ureters.

Answer 83

Very effective. Cells are scraped from the transformation zone using a brush and analyzed under a microscope to detect neoplastic changes.

Answer 84

Endometrial mucosa. Underlying smooth muscle myometrium.

Answer 85

Inflammation of the endometrium, classified as acute or chronic based on the type of inflammatory infiltrate present.

Answer 86

Bacterial infection (e.g., N. gonorrhoeae) of the endometrium. Usually due to retained products of conception acting as a nidus for infection.

Answer 87

Fever. Abnormal uterine bleeding. Pelvic pain.

Answer 88

Presence of plasma cells (necessary for diagnosis). Lymphocytes are normally found in the endometrium but plasma cells indicate chronic inflammation.

Answer 89

Retained products of conception or intrauterine devices. Chronic pelvic inflammatory disease (e.g., Chlamydia). Tuberculosis (granulomatous endometritis).

Answer 90

Abnormal uterine bleeding. Abdominal pain. Infertility.

Answer 91

Endometriosis is the abnormal presence of endometrial glands and stroma outside the endomyometrium.

Answer 92

Affects 10% of women in their reproductive years. Found in nearly half of women with infertility.

Answer 93

Ovaries (most common). Pouch of Douglas (pain in defecation/rectovaginal septum). Uterine ligaments (pelvic pain/peritoneum). Fallopian tubes (may cause scarring and infertility, provide area for ectopic pregnancy implantation). Rarely in the lung/skeletal muscle.

Answer 94

Regurgitation theory: Menstrual backflow through the fallopian tubes leads to implantation of endometrial tissue. Metaplastic theory: Endometrial dysplastic differentiation of coelomic epithelium (of Mullerian duct). Vascular or lymphatic dissemination theory.

Answer 95

Yes, endometriotic tissue almost always contains functioning endometrium.

Answer 96

Increased levels of inflammatory mediators, particularly prostaglandin E2. Increased estrogen production due to high aromatase activity of stromal cells. These changes enhance the survival and persistence of the endometriotic tissue within a foreign location.

Answer 97

Endometriosis almost always contains functioning endometrium, which undergoes cyclic bleeding, while adenomyosis does not typically contain functioning endometrium.

Answer 98

They appear as red-brown nodules or implants lying on or just under the affected serosal surface.

Answer 99

The lesions may form large, blood-filled cysts that turn brown, known as "chocolate cysts."

Answer 100

The presence of two out of the following three features: endometrial glands, endometrial stroma, and hemosiderin pigment.

Answer 101

Dysmenorrhea (painful menstruation). Pelvic pain resulting from intrapelvic bleeding and periuterine adhesions. Specific signs depend on the location of the endometriotic implants.

Answer 102

Pelvic pain in endometriosis is caused by intrapelvic bleeding and the formation of periuterine adhesions.

Answer 103

Adenomyosis is the presence of endometrial tissue within the myometrium.

Answer 104

The endometrial tissue in adenomyosis is nonfunctioning and derives from the stratum basalis, hence it does not undergo cyclic bleeding, unlike the functioning endometrial tissue in endometriosis.

Answer 105

Adenomyosis induces reactive hypertrophy of the myometrium, resulting in an enlarged, globular uterus with a thickened uterine wall.

Answer 106

The glands in adenomyosis derive from the stratum basalis of the endometrium, which does not undergo cyclic bleeding.

Answer 107

Dysfunctional uterine bleeding is abnormal bleeding from the uterus in the absence of a primary organic uterine lesion.

Answer 108

Menorrhagia: Intense or prolonged bleeding at the time of the period. Metrorrhagia: Irregular bleeding between periods. Postmenopausal bleeding.

Answer 109

Common causes include endometrial polyps, leiomyomas, endometrial hyperplasia, endometrial carcinoma, and endometritis.

Answer 110

The probable primary cause of uterine bleeding depends somewhat on the age of the patient.

Answer 111

Failure of ovulation Inadequate luteal phase Contraceptive-induced bleeding Endomyometrial disorders

Answer 112

Failure of ovulation, which results in an excess of estrogen relative to progesterone.

Answer 113

The endometrium goes through a proliferative phase not followed by the normal secretory phase, may develop mild cystic changes, appear disorderly, and have scarce stroma, making it prone to breakdown and abnormal bleeding.

Answer 114

Hypothalamic-pituitary axis, adrenal, or thyroid dysfunction Functional ovarian lesions producing excess estrogen Malnutrition, obesity, or debilitating disease Severe physical or emotional stress

Answer 115

The corpus luteum may fail to mature normally or regress prematurely, leading to a relative lack of progesterone.

Answer 116

Older oral contraceptives.

Answer 117

Chronic endometritis, endometrial polyps, and submucosal leiomyomas.

Answer 118

Endometrial hyperplasia is a growth adaptation lesion produced by hyperestrinism, leading to glandular and stromal proliferation of the endometrium. It results from prolonged estrogen excess without progesterone, conditions like failure of ovulation, prolonged estrogen administration, estrogen-producing ovarian lesions, and obesity.

Answer 119

Failure of ovulation (e.g., perimenopause) Prolonged administration of estrogenic steroids without progestin Estrogen-producing ovarian lesions (e.g., polycystic ovary disease, granulosa-theca cell tumors) Obesity (adipose tissue converts steroid precursors into estrogens)

Answer 120

Endometrial hyperplasia is classified based on: Architectural crowding: Simple (diffuse, cystic dilation) or Complex (patchy, crowded branching glands)Presence or absence of atypia: Without atypia or with atypia

Answer 121

Simple or complex hyperplasia without atypia: Less than 5% risk Complex hyperplasia with atypia: 20% to 50% risk

Answer 122

Inactivating mutations in the PTEN tumor suppressor gene are often associated with endometrial hyperplasia. PTEN mutations are believed to be a key step in the transformation of hyperplasia to endometrial carcinoma.

Answer 123

Thickened endometrium with increased gland/stroma ratio, gland cystic lining from simple ciliated columnar to pseudostratified appearance, and glandular crowding, either simple (Swiss cheese morphology) or complex (patchy crowded glands).

Answer 124

Symptoms include metrorrhagia (irregular uterine bleeding) and menorrhagia (excessive menstrual bleeding).

Answer 125

Malignant proliferation of endometrial glands, known as endometrial carcinoma, is the most frequent cancer occurring in the female genital tract in the US, primarily affecting women aged 55-65.

Answer 126

Endometrioid carcinoma (80% of cases) Serous carcinoma (15% of cases)

Answer 127

Associated with estrogen excess and endometrial hyperplasia in perimenopausal women. Risk factors: obesity, infertility, exposure to unopposed estrogen. Mutations in mismatch repair genes and the tumor suppressor gene PTEN. Histology: Similar to endometrium, atypical tumor cells forming irregular glands with multiple lumens and reduced stroma.

Answer 128

Endometrioid carcinoma is graded I to III based on the degree of differentiation. Better prognostic features are associated with moderate differentiation and superficial invasion.

Answer 129

Arises in an atrophic endometrium with no evident precursor lesion in older postmenopausal women (~70 years old). Nearly all cases have mutations in the P53 tumor suppressor gene. Histology: Serous pattern with papillary features, high mitotic rate, small tufts, and significant cytological atypia and cellular pleomorphism.

Answer 130

Serous carcinoma has poorer prognostic features due to poor differentiation and greater invasiveness compared to endometrioid carcinoma.

Answer 131

An endometrial polyp is a protruding outgrowth from the endometrial lining, ranging from 0.5 to 3 cm, usually hemispheric and sessile.

Answer 132

Endometrial polyps are most frequently detected around the time of menopause.

Answer 133

Endometrial polyps are composed of endometrial tissue, often with cystically dilated glands, monoclonal stromal cells (with rearrangement of chromosomal region 6p21, indicating a neoplastic component), and frequently with small muscular arteries.

Answer 134

Can cause abnormal uterine bleeding. They have very low malignant potential.

Answer 135

Leiomyoma is a benign neoplastic proliferation of smooth muscle cells, commonly known as fibroids, and is the most common benign tumor in females.

Answer 136

Leiomyomas are found in 30% to 50% of women of reproductive age and are stimulated by estrogens, often shrinking postmenopausally.

Answer 137

Leiomyomas are often asymptomatic but can cause abnormal bleeding and infertility if they block the opening of the fallopian tubes.

Answer 138

Leiomyomas are sharply circumscribed, firm, gray-white masses with a characteristic whorled cut surface, often appearing as multiple tumors scattered within the uterus.

Answer 139

Leiomyomas are characterized by bundles of smooth muscle cells that mimic the appearance of normal myometrium.

Answer 140

Leiomyosarcoma is a malignant neoplastic tumor of smooth muscle that arises de novo from mesenchymal cells of the myometrium, not from preexisting leiomyomas.

Answer 141

Leiomyosarcomas usually present as solitary lesions in postmenopausal women.

Answer 142

Leiomyosarcomas typically appear as soft, hemorrhagic, and necrotic masses.

Answer 143

The diagnostic features of leiomyosarcoma include tumor necrosis, cytologic atypia, and high mitotic activity. The tumor is much more cellular with significant pleomorphism and hyperchromatism compared to benign leiomyoma.

Answer 144

Leiomyosarcomas have a high recurrence rate after removal and often metastasize to the lungs, with a 5-year survival rate of about 40%.

Answer 145

The most common disorder of the fallopian tubes is inflammation (salpingitis), usually as part of pelvic inflammatory disease (PID).

Answer 146

Common microbial origins of fallopian tube infections include gonorrhea, Chlamydia, Mycoplasma hominis, tuberculosis, coliforms, and streptococci and staphylococci (especially in the postpartum setting).

Answer 147

Complications from fallopian tube infections can include adherence of the inflamed tube to the ovary and adjacent structures forming a tuboovarian abscess complex, tubal scarring increasing the risk for ectopic pregnancy, and in severe cases, permanent sterility.

Answer 148

Clinical manifestations of fallopian tube infections include fever and lower abdominal pain.

Answer 149

Primary tumors of the fallopian tubes are usually serous or endometrioid adenocarcinomas and are often associated with BRCA1 mutation patients. They are usually discovered at a later stage after spreading to the peritoneum.

Answer 150

Follicular cysts in the ovaries result from the degeneration of ovarian follicles, including the oocyte, theca, and granulosa cells.

Answer 151

Follicular cysts originate from unruptured Graafian follicles or from follicles that have ruptured and then become immediately sealed.

Answer 152

Follicular cysts are typically small (1 to 1.5 cm in diameter), situated just under the serosal covering of the ovary, filled with clear serous fluid, and lined by granulosa cells or luteal cells.

Answer 153

Large follicular cysts (4 to 5 cm in diameter) can produce palpable masses and pelvic pain. If these cysts rupture, they can cause intraperitoneal bleeding and peritoneal symptoms (acute abdomen).

Answer 154

When follicular cysts rupture, they produce intraperitoneal bleeding and peritoneal symptoms, leading to an acute abdomen.

Answer 155

Polycystic Ovarian Disease is a condition characterized by multiple ovarian follicular cysts due to hormone imbalance, affecting roughly 5% of women of reproductive age.

Answer 156

Polycystic Ovarian Disease is characterized by increased LH and low FSH, leading to excess androgen production from theca cells and subsequent estrone conversion in adipose tissue.

Answer 157

Increased LH induces excess androgen production, resulting in hirsutism (excess hair in a male distribution) and contributing to the hormone imbalance seen in Polycystic Ovarian Disease.

Answer 158

Classic presentation includes a young woman with oligomenorrhea, hirsutism, later infertility, and sometimes obesity. Some patients also develop insulin resistance and may develop type 2 diabetes mellitus 10-15 years later.

Answer 159

Estrone feedback decreases FSH, leading to cystic degeneration of follicles as granulosa cells can't produce estrogen from androgen released by theca cells.

Answer 160

The surface (coelomic) epithelium gives rise to the most varied group of ovarian tumors.

Answer 161

The three main groups of ovarian tumors are surface epithelial tumors, germ cell tumors, and sex cord-stromal tumors.

Answer 162

Ovarian tumors can arise from the multipotent surface (coelomic) epithelium, totipotent germ cells, and sex cord–stromal cells.

Answer 163

Metastatic tumors can also occur in the ovary, originating from other primary sites in the body.

Answer 164

Ovarian tumors are varied due to the presence of three different cell types (coelomic epithelium, germ cells, and sex cord-stromal cells) and the potential for metastasis from other parts of the body.

Answer 165

Ovarian tumors are varied due to the presence of three different cell types: the multipotent surface (coelomic) epithelium, totipotent germ cells, and sex cord–stromal cells, in addition to metastatic tumors from other parts of the body.

Answer 166

The three main groups of ovarian tumors are: Surface epithelial tumors Germ cell tumors Sex cord-stromal tumors

Answer 167

Metastatic tumors, originating from primary cancers in other parts of the body, can also affect the ovaries.

Answer 168

Surface epithelial tumors are the most common type of ovarian tumor, accounting for 70% of cases, typically found in women over 40.

Answer 169

Surface epithelial ovarian tumors are derived from the coelomic epithelium that lines the ovary.

Answer 170

The two most common subtypes are serous (filled with watery fluid) and mucinous (filled with mucus-like fluid) tumors.

Answer 171

Benign tumors are usually cystic (cystadenoma) and more common in pre-menopausal women, while malignant tumors may be cystic (cystadenocarcinoma) or solid (carcinoma) and are more common in post-menopausal women. Borderline tumors have features in between benign and malignant.

Answer 172

Risk factors include nulliparity, family history, and germline mutations in tumor suppressor genes such as BRCA1 and BRCA2. Prolonged use of oral contraceptives somewhat reduces the risk.

Answer 173

The prognosis is generally poor, and these tumors tend to spread locally, especially to the peritoneum.

Answer 174

CA-125 is a useful serum marker to monitor treatment response and screen for recurrence in surface epithelial ovarian carcinomas.

Answer 175

Serous tumors are the most common ovarian epithelial tumors, with most being benign but they account for the highest frequency of malignant ovarian tumors.

Answer 176

The two types are low-grade (associated with KRAS, BRAF, or ERBB2 mutations) and high-grade (96% have mutations in TP53).

Answer 177

Serous tumors are large, spherical to ovoid cystic structures up to 30-40 cm in diameter, often with multiple compartments. Benign forms have smooth walls, while malignant forms (cystadenocarcinoma) show nodular irregularities, serosal penetration, and solid growth areas. The cystic spaces are filled with clear serous fluid.

Answer 178

Benign serous tumors contain a single layer of tall columnar epithelial cells that line the cyst or cysts, and these cells may be ciliated.

Answer 179

Serous carcinomas exhibit complex, multilayered papillary formations, nests, or undifferentiated sheets of malignant cells invading the axial fibrous tissue. Psammoma bodies (concentrically laminated calcified concretions) are often present.

Answer 180

Tumors of low malignant potential exhibit less cytologic atypia and typically have little or no stromal invasion.

Answer 181

The essential difference is that mucinous tumors consist of neoplastic epithelium made up of mucin-secreting cells.

Answer 182

80% of mucinous ovarian tumors are benign.

Answer 183

Mucinous tumors produce cystic masses with mucinous contents. They are more likely to be larger and multicystic compared to serous tumors.

Answer 184

The cysts in mucinous tumors are lined by mucin-producing epithelial cells.

Answer 185

Mucinous tumors are much less likely to be bilateral compared to serous tumors.

Answer 186

A Krukenberg tumor is a metastatic mucinous tumor that involves both ovaries, most commonly due to metastatic gastric carcinoma (diffuse type).

Answer 187

Pseudomyxoma peritonei is the implantation of mucinous tumor cells in the peritoneum with production of massive amounts of mucin. It is most commonly caused by metastasis from the gastrointestinal tract, primarily the appendix, to the ovary.

Answer 188

Endometrioid tumors are composed of endometrial-like glands and are usually malignant.

Answer 189

Endometrioid tumors may arise from endometriosis.

Answer 190

15% of endometrioid carcinomas of the ovary are associated with an independent endometrial carcinoma.

Answer 191

Mutations in the PTEN tumor suppressor gene are often found in endometrioid tumors of the ovary.

Answer 192

Endometrioid tumors are bilateral in about 30% of cases.

Answer 193

Brenner tumors are composed of bladder-like epithelium and are usually benign.

Answer 194

Brenner tumors may arise from the surface epithelium or from urogenital epithelium trapped within the germinal ridge.

Answer 195

Brenner tumors are solid, usually unilateral ovarian tumors that are smoothly encapsulated and gray-white on cut section.

Answer 196

Brenner tumors have an abundant stroma containing nests of transitional-type epithelium resembling that of the urinary tract.

Answer 197

Germ cell tumors account for 15% of ovarian tumors and usually occur in young women of reproductive age.

Answer 198

Fetal tissue—cystic teratoma and embryonal carcinoma Oocytes—dysgerminoma Yolk sac—endodermal sinus tumor Placental tissue—choriocarcinoma

Answer 199

Benign (mature) cystic teratomas are composed of mature tissues derived from all three germ cell layers (ectoderm, endoderm, and mesoderm). They are the most common germ cell tumor in females and are often bilateral (10% of cases). They may contain sebaceous secretion, hair, bone, cartilage, and other tissues.

Answer 200

A struma ovarii is a teratoma composed primarily of thyroid tissue.

Answer 201

The presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential.

Answer 202

Malignant (immature) teratomas are found early in life (average age 18), are predominantly solid with areas of necrosis, and uncommonly contain cystic foci with sebaceous secretion. They show immature elements or minimally differentiated tissue on microscopic examination.

Answer 203

A dysgerminoma is a tumor composed of cells with clear cytoplasm and central nuclei, resembling oocytes. Its testicular counterpart is called seminoma.

Answer 204

Dysgerminomas present as solid gray masses with sheets or cords of large clear cells separated by scant fibrous strands. The stroma may contain lymphocytes and occasional granulomas. They are all malignant but have a good prognosis and respond well to radiotherapy.

Answer 205

A yolk sac tumor (endodermal sinus tumor) is a malignant tumor that mimics the yolk sac. Serum AFP (alpha-fetoprotein) is often elevated.

Answer 206

Schiller-Duval bodies (glomerulus-like structures) are classically seen in yolk sac tumors.

Answer 207

A choriocarcinoma is a malignant tumor composed of trophoblasts and syncytiotrophoblasts, mimicking placental tissue but without villi. It presents as a small, hemorrhagic tumor with early hematogenous spread, producing larger metastatic masses. High beta-hCG levels are characteristic

Answer 208

Choriocarcinomas of germ cell origin have a poor response to chemotherapy, unlike gestational choriocarcinomas, which respond well.

Answer 209

The amnion consists of a single layer of cuboidal epithelium, its basement membrane, and a collagen layer. Deep to the amnion lies the fibrous chorion, which is fetal in origin. Beneath the chorion is the decidual layer, which is maternal in origin and contains decasualized maternal cells, vessels, fibrin, and often some degree of hemorrhage.

Answer 210

The outer surface of the umbilical cord is covered by amniotic epithelium. Normally, it contains 3 vessels: 2 arteries and 1 vein, embedded in Wharton's jelly.

Answer 211

The chorionic plate (fetal surface) consists of a single layer of cuboidal amniotic epithelium overlying a collagenous matrix (chorion) containing numerous large vessels of fetal origin. Beneath this are the villi, separated by clear or blood-containing spaces (the intervillous space), where maternal blood circulates around the fetal villi. The villi consist of syncytiotrophoblasts and cytotrophoblasts cells, along with macrophages and fibroblasts. Terminal villi increase gas and nutrient exchange without a significant increase in placental mass. The basal plate (maternal surface) consists of intermediate trophoblast cells, decasualized maternal cells, and maternal vessels, which are invaded by extravillous trophoblast cells and remodeled for better circulation.

Answer 212

Infections may reach the placenta either through ascension through the birth canal or hematogenous (transplacental) spread.

Answer 213

Infections ascending through the birth canal are more common and are typically bacterial. They are associated with premature rupture of the fetal membranes. Major causative organisms include Mycoplasma, Candida, and various bacteria from the vaginal flora. Microscopically, chorioamnionitis shows neutrophilic infiltration associated with edema and congestion. In severe cases, the infection may involve the umbilical cord and placental villi, resulting in acute vasculitis of the cord (funisitis).

Answer 214

Infections spreading hematogenously primarily affect placental villi, resulting in villitis. Causative agents include syphilis, tuberculosis, listeriosis, toxoplasmosis, and various viruses such as rubella, cytomegalovirus, and herpes simplex virus. Transplacental infections can affect the fetus, leading to the TORCH complex (toxoplasmosis, other infections, rubella, cytomegalovirus infection, herpes).

Answer 215

Ectopic pregnancy is defined as the implantation of a fertilized ovum in any site other than the uterus.

Answer 216

In more than 90% of cases, implantation occurs in the fallopian tube (tubal pregnancy).

Answer 217

Early development of ectopic pregnancies proceeds normally in all sites, with formation of placental tissue, the amniotic sac, and decidual changes. In tubal pregnancies, the invading placenta eventually burrows through the wall of the oviduct, causing intratubal hematoma (hematosalpinx). The tube is usually distended by freshly clotted blood containing bits of gray placental tissue and fetal parts. Intraperitoneal hemorrhage is a major risk, leading to sudden intense abdominal pain and blood loss, requiring surgical emergency. The histologic diagnosis depends on visualization of placental villi or, rarely, of the embryo.

Answer 218

Gestational trophoblastic disease has been divided into three overlapping morphologic categories: hydatidiform mole, invasive mole, and choriocarcinoma, ranging from benign to highly malignant tumors.

Answer 219

A typical hydatidiform mole is characterized by edematous swollen chorionic villi, appearing grossly as grapelike structures. The swollen villi are covered by varying amounts of normal to highly atypical chorionic epithelium (proliferating trophoblasts).

Answer 220

There are two distinctive subtypes of hydatidiform moles: complete and partial.

Answer 221

An invasive mole is a complete mole that is more locally invasive but lacks the aggressive metastatic potential of choriocarcinoma.

Answer 222

Microscopically, the epithelium of the villi in an invasive mole shows atypical changes, with proliferation of both trophoblastic and syncytial components.

Answer 223

Invasive mole presents similarly to hydatidiform mole, with the uterus expanding as if a normal pregnancy is present. However, the uterus is much larger, and hCG levels are higher than expected for the gestational age. It typically presents in the second trimester with the passage of grape-like masses through the vaginal canal. Fetal heart sounds are absent, and a 'snowstorm' appearance is seen on ultrasound.

Answer 224

Invasive mole presents similarly to hydatidiform mole, with the uterus expanding as if a normal pregnancy is present. However, the uterus is much larger, and hCG levels are higher than expected for the gestational age. It typically presents in the second trimester with the passage of grape-like masses through the vaginal canal. Fetal heart sounds are absent, and a 'snowstorm' appearance is seen on ultrasound.

Answer 225

Treatment for invasive mole involves curettage. Subsequent monitoring with serial hCG measurements is important to ensure adequate mole removal and to screen for the development of choriocarcinoma. In some cases where scraping is insufficient, prolonged hCG elevation may necessitate chemotherapy.

Answer 226

Gestational choriocarcinoma is a very aggressive malignant tumor that arises either from gestational chorionic epithelium or within the gonads as a germ cell tumor.

Answer 227

Gestational choriocarcinomas usually appear as hemorrhagic, necrotic uterine masses. Unlike hydatidiform moles and invasive moles, choriocarcinomas do not have formed chorionic villi. Instead, the tumor is composed of anaplastic cuboidal cytotrophoblasts and syncytiotrophoblasts.

Answer 228

Gestational choriocarcinoma often manifests with a bloody, brownish discharge. β-hCG titers are typically much higher than those associated with a mole.

Answer 229

Gestational choriocarcinoma commonly metastasizes to the lungs (50%), vagina (30% to 40%), brain, liver, or kidneys.

Answer 230

These tumors are remarkably sensitive to chemotherapy, and nearly 100% of affected patients are cured. However, response rates are relatively poor for choriocarcinomas that arise in the gonads (ovary or testis).

Answer 231

Preeclampsia is pregnancy-induced hypertension, proteinuria, and edema, usually arising in the third trimester, and seen in approximately 5% of pregnancies.

Answer 232

Hypertension in Preeclampsia may be due to abnormality of the maternal-fetal vascular interface in the placenta. It typically resolves with delivery.

Answer 233

Eclampsia is Preeclampsia with seizures.

Answer 234

HELLP syndrome is Preeclampsia with thrombotic microangiopathy involving the liver. It is characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets.

Answer 235

Both Eclampsia and HELLP syndrome usually warrant immediate delivery.

Answer 236

Fibrocystic changes in the breast consist predominantly of cyst formation and fibrosis. They are non-neoplastic.

Answer 237

Fibrocystic changes are the most common breast abnormality seen in premenopausal women.

Answer 238

Fibrocystic changes tend to arise during reproductive age and are most likely a consequence of the cyclic breast changes that occur normally in the menstrual cycle.

Answer 239

Non-proliferative fibrocystic change is characterized by an increase in fibrous stroma associated with dilation of ducts and formation of variably sized cysts, primarily affecting the terminal duct lobular unit, not the large duct.

Answer 240

Macroscopically, changes are usually multifocal and often bilateral. The cysts range from less than 1 cm to up to 5 cm in diameter. Unopened cysts may appear brown to blue (blue dome cysts) and are filled with watery, turbid fluid.

Answer 241

Microscopically, the epithelial lining of larger cysts may be flattened or even totally atrophic. Apocrine metaplasia, a variant of non-proliferative fibrocystic change, is characterized by large, polygonal lining cells with abundant granular, eosinophilic cytoplasm and small, round, deeply chromatic nuclei.

Answer 242

Apocrine metaplasia, a variant of non-proliferative fibrocystic change, does not increase the risk for neoplastic change.

Answer 243

The stroma surrounding all types of cysts usually consists of compressed fibrous tissue that has lost the delicate, myxomatous appearance of normal breast stroma.

Answer 244

Epithelial hyperplasia is a variant of proliferative fibrocystic change characterized by more than the normal two lining epithelial layers of the duct in the breast.

Answer 245

Microscopically, the ducts or lobules may be filled with orderly cuboidal cells within which small gland patterns (called fenestrations) are seen. The proliferating epithelium projects as multiple small papillary excrescences into the ductal lumen, a condition known as ductal papillomatosis.

Answer 246

Atypical ductal/lobular hyperplasia is used to describe hyperplasias that exhibit changes starting to resemble those of carcinoma in situ.

Answer 247

Both atypical ductal and lobular hyperplasia are associated with an increased risk of invasive carcinoma.

Answer 248

Sclerosing adenosis is a hyperplastic process involving an increased number of glandular components (adenosis) plus stromal proliferation that creates a hard palpable mass (sclerosis).

Answer 249

Sclerosing adenosis may mimic the clinical and morphologic features of carcinoma. The lesion typically has a hard, rubbery consistency, similar to that of breast cancer.

Answer 250

Microscopically, sclerosing adenosis shows enlarged terminal ductal lobular units (TDLU) with preservation of luminal lining epithelium and myoepithelial layer, helping to distinguish it from invasive ductal carcinoma. Surrounding dense stromal fibrosis may compress and distort the proliferating glands.

Answer 251

Fibroadenoma is the most common benign neoplasm of the female breast. It does not increase the risk of carcinoma.

Answer 252

Fibroadenoma is a biphasic slow-growing tumor composed of fibroblastic stroma and epithelium-lined glands. Only the stromal cells are clonal and truly neoplastic.

Answer 253

Fibroadenomas are typically solitary, mobile masses with a firm consistency, ranging in size from a few millimeters to several centimeters. They may grow during pregnancy and may be painful during the menstrual cycle. They peak in appearance in the 3rd decade of life, and after menopause, they may regress and calcify.

Answer 254

On cut section, fibroadenoma shows a uniform grayish-white color punctuated by softer yellow-pink specks representing the glandular areas.

Answer 255

Microscopically, fibroadenoma exhibits epithelial proliferation appearing as duct-like spaces of various shapes and sizes surrounded by a loose fibroblastic stroma. Depending on the proportion and relationship between these two components, two main histological features are observed: intracanalicular and pericanalicular fibroadenomas. Often, both types are found in the same tumor.

Answer 256

A Phyllodes tumor is a fibroadenoma-like tumor with a more cellular and abundant stromal element, often forming epithelium-lined leaflike projections (phyllodes is Greek for "leaflike").

Answer 257

Phyllodes tumors are less common than fibroadenomas and arise de novo, not from preexisting fibroadenomas.

Answer 258

Changes suggesting malignancy in a Phyllodes tumor include increased stromal cellularity, anaplasia, high mitotic activity, rapid increase in size, and infiltrative margins. However, most Phyllodes tumors remain localized and are cured by excision.

Answer 259

An intraductal papilloma is a benign neoplastic papillary growth most often seen in premenopausal women.

Answer 260

Intraductal papillomas are typically solitary and found within the principal lactiferous ducts or sinuses.

Answer 261

The clinical presentation of intraductal papilloma may include serous or bloody nipple discharge, the presence of a small subareolar tumor a few millimeters in diameter, and nipple retraction.

Answer 262

Microscopically, intraductal papillomas are composed of multiple papillae, each having a connective tissue core covered by epithelial cells that are double-layered, with an outer luminal layer overlying a myoepithelial layer. The presence of a double-layered epithelium helps to distinguish intraductal papilloma from intraductal papillary carcinoma.

Answer 263

The lifetime risk of developing breast cancer is 1 in 8 for women in the United States, with a mortality rate of 20-30%.

Answer 264

Age Geographic variations Family history Age at menopause greater than 55 First pregnancy after the age of 35 or nulliparity Benign breast diseases such as proliferative atypical hyperplasia Prolonged exposure to exogenous estrogens postmenopausally, hormone replacement therapy, oral contraceptivesIonizing radiation exposure, especially before the age of 30 Obesity Alcohol consumption Diet high in fat

Answer 265

The risk of breast cancer increases after the age of 30, especially after menopause.

Answer 266

The risk of breast cancer is significantly higher in North America and northern Europe compared to Asia and Africa. These differences seem to be environmental rather than genetic in origin.

Answer 267

- Overexpression of the HER2/NEU proto-oncogene, which undergoes amplification in approximately 30% of invasive breast cancers. - Amplification of RAS and MYC genes has also been reported in some human breast cancers. - Gene expression profiling has identified four molecular subtypes with distinct natural histories and clinical behavior, based on the presence or absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).

Answer 268

- Luminal A (estrogen receptor–positive, HER2/NEU-negative), associated with a good prognosis and older age. - Luminal B (estrogen receptor–positive, HER2/NEU overexpressing), associated with a less favorable prognosis. - HER2/NEU positive (HER2/NEU overexpressing, estrogen receptor–negative), more aggressive and appearing at younger ages. - Basal-like (estrogen receptor–negative and HER2/NEU-negative), also called triple negative, associated with poor prognosis and younger age, more common in African American women.

Answer 269

Approximately 10% of breast cancer cases are hereditary, with manifestations including a premenopausal appearance, occurrence in first-degree relatives, and bilateral tumors or tumors in other related organs such as the ovaries. - Roughly one third of women with hereditary breast cancer have mutations in BRCA1 or BRCA2, which function in a common DNA repair pathway

Answer 270

Less common genetic diseases associated with breast cancer include Li-Fraumeni syndrome, Cowden syndrome (caused by germline mutations in PTEN), and carriers of the ataxia-telangiectasia gene.

Answer 271

Estrogen excess leads to hormonal imbalance, stimulating the production of growth factors such as TGF-α, PDGF, and FGF, which may promote tumor development through paracrine and autocrine mechanisms.

Answer 272

Environmental variables include factors such as geographic location, treatments, alcohol consumption, obesity, etc.

Answer 273

The most common location of breast tumors is in the upper outer quadrant (50%), followed by the central portion (20%).

Answer 274

Breast cancers are classified into two categories based on whether they have penetrated the limiting basement membrane: A. Noninvasive - Ductal carcinoma in situ (DCIS) - Lobular carcinoma in situ (LCIS) B. Invasive (infiltrating) Invasive ductal carcinoma (most common subtype) Invasive lobular carcinoma Medullary carcinoma Colloid carcinoma (mucinous carcinoma) Tubular carcinoma Other types

Answer 275

Ductal carcinoma in situ (DCIS) and Lobular carcinoma in situ (LCIS)

Answer 276

DCIS tends to fill and expand the ductal lumen with proliferating ductal cells and necrosis.

Answer 277

LCIS usually expands but does not alter the acini of lobules.

Answer 278

DCIS has a wide variety of histologic patterns, often mixed, including comedo (large central zone of necrosis resembling toothpaste), cribriform, papillary, etc.

Answer 279

The nuclear appearance tends to be uniform in a given case and ranges from monotonous to pleomorphic (high nuclear grade).

Answer 280

Calcifications are frequently associated with DCIS, making it highly detectable in mammography, and they carry a very good prognosis.

Answer 281

DCIS may develop into invasive carcinoma if left untreated, usually in the same breast and quadrant as the earlier DCIS.

Answer 282

LCIS has a uniform appearance with cells that are monomorphic, having round nuclei, and occurring within the lobules. They preserve lobular architecture and expand acini.

Answer 283

Intracellular mucin vacuoles, which may result in the appearance of signet ring cells, are a common finding in LCIS.

Answer 284

LCIS is rarely associated with calcifications and cannot be detected on mammography.

Answer 285

One third of women with LCIS will eventually develop invasive carcinoma.

Answer 286

Unlike with DCIS, LCIS is associated with an increased risk of carcinoma in both breasts and is a direct precursor of some cancers.

Answer 287

Paget Disease of the Nipple is caused by the extension of Ductal Carcinoma in Situ (DCIS) up the lactiferous ducts and into the contiguous skin of the nipple, resulting in a unilateral crusting exudate over the nipple and areolar skin.

Answer 288

Yes, in almost all cases of Paget Disease of the Nipple, an underlying carcinoma is present.

Answer 289

Approximately 50% of the time, the underlying carcinoma in cases of Paget Disease of the Nipple is invasive.

Answer 290

The prognosis of Paget Disease of the Nipple is based on the underlying carcinoma, and it is not affected by the presence of Paget disease.

Answer 291

The most common type of invasive carcinoma in the breast is invasive ductal carcinoma, accounting for 70% to 80% of cases.

Answer 292

Invasive ductal carcinoma is usually associated with Ductal Carcinoma in Situ (DCIS) and, rarely, Lobular Carcinoma in Situ (LCIS).

Answer 293

Most ductal carcinomas produce a desmoplastic response, which replaces normal breast fat, resulting in a mammographic density and forming a palpable mass.

Answer 294

The microscopic appearance of invasive ductal carcinoma is quite heterogeneous, ranging from tumors with well-developed tubule formation and low-grade nuclei to tumors consisting of sheets of anaplastic cells. The tumor margins typically are irregular.

Answer 295

About two-thirds of invasive ductal carcinomas express estrogen or progesterone receptors.

Answer 296

About one-third of invasive ductal carcinomas overexpress HER2/NEU.

Answer 297

Invasive lobular carcinoma originates from neoplastic cells within the lobules and morphologically appears identical to the cells of Lobular Carcinoma in Situ (LCIS).

Answer 298

Two-thirds of cases of invasive lobular carcinoma are associated with adjacent Lobular Carcinoma in Situ (LCIS).

Answer 299

The cells of invasive lobular carcinoma invade individually into the stroma and are often aligned in "single-file" or "indian file" strands or chains.

Answer 300

Invasive lobular carcinoma is associated with mutations in E-cadherin.

Answer 301

Yes, most invasive lobular carcinomas exhibit a desmoplastic reaction, leading to the formation of a palpable mass.

Answer 302

Lobular carcinomas have a unique pattern of metastases among breast cancers; they more frequently spread to cerebrospinal fluid, serosal surfaces, gastrointestinal tract, ovary, uterus, and bone marrow.

Answer 303

Almost all invasive lobular carcinomas express hormone receptors.

Answer 304

No, HER2/NEU overexpression is rare in invasive lobular carcinomas.

Answer 305

Medullary carcinoma is a rare subtype of breast carcinoma characterized by cohesive sheets of highly pleomorphic cells with well-circumscribed, "pushing" borders. It is associated with prominent infiltration of lymphocytes and plasma cells.

Answer 306

Medullary carcinomas occur with increased frequency in women with BRCA1 mutations.

Answer 307

Medullary carcinoma is typically triple-negative, meaning it does not express estrogen receptor (ER), progesterone receptor (PR), or HER2/neu.

Answer 308

Colloid carcinoma, also known as mucinous carcinoma, is a rare subtype of breast carcinoma where tumor cells produce abundant extracellular mucin into the surrounding stroma. Like medullary carcinomas, they often present as well-circumscribed masses and can be mistaken for fibroadenomas.

Answer 309

On gross evaluation, colloid carcinomas usually appear soft and gelatinous.

Answer 310

Most colloid carcinomas express hormone receptors.

Answer 311

Invasive cancers often become adherent and fixed to the pectoral muscles or deep fascia of the chest wall and overlying skin, leading to skin or nipple retraction. Involvement of lymphatic pathways may result in localized lymphedema, giving rise to the appearance of peau d’orange (“orange peel”).

Answer 312

Tumor Invasion and Size: In situ carcinomas and invasive carcinomas less than 2 cm in size carry a good prognosis. Extent of Lymph Node Involvement: The number of involved lymph nodes significantly impacts survival rates. Distant Metastases: Hematogenous spread indicates poor prognosis. Histologic Grade: Evaluates tubule formation, nuclear grade, and mitotic rate. Histologic Type of Carcinoma: Specialized types like tubular, medullary, and mucinous have a slightly better prognosis. Presence of Hormone Receptors: Estrogen or progesterone receptor positivity confers a slightly better prognosis. Overexpression of HER2/NEU: Associated with a poorer prognosis but helps predict response to targeted therapy like trastuzumab (Herceptin).