Test 3 Flashcards
What is the only finding in fibrocystic condition of the breast that has an increased risk of having carcinoma?
Atypical Epithelial Hyperplasia
What is the most common benign breast tumor? Also seen most commonly in young women?
Fibroadenoma
Describe 2 key features of a fibroadenoma
- Well Encapsulated (2-5 cm in diameter)
2. Freely Movable
Name 2 components of a fibroadenoma
- Fibrous Stroma (resembles normal intralobular stroma enclosing glandular and cystic spaces lined by epithelium)
- Glandular Epithelium
Where area of the breast of fibroadenomas found?
Upper outer quadrant
What breast disease usually affects both breasts, and because the changes are symmetrical, patients may complain mostly of pain, nodularity, and sensitivity on palpation. Small lumps may fluctuate, corresponding to the fluid filled cysts, and even areas of calcification.
Fibrocystic disease - mammography may reveal condensed areas, cysts and even areas of calcification -> indistinguishable from those seen in cancer, biopsy exam needed. Usually no tx necessary unless hyperplasia is found ->lumpectomy
Name for neoplastic papillary growth within a duct.
Intraductal papilloma -> usually solitary and are found with the principle lactiferous ducts or sinuses.
How does an intraductal papilloma present?
with serous or bloody discharge from the nipple, with a small subareolar mass, and sometimes nipple retraction
Multiple papillomas are associated with an __________ risk of papillary carcinomas. Solitary ones are _______.
Increased
Benign
What 3 breast diseases have fibrous tissue?
- Chronic mastitis
- Fibroadenomas
- Gynecomastia/Carcinoma
What disease is characterized by blue-domed cysts?
fibrocystic change of the breast
What is the term for when tumor cells infiltrating the tissue are surrounded by dense CT that is produced by the HOST in response to the tumor.
Desmoplasia
What is the #1 cause of fat necrosis of the breast?
Trauma
What happens over time to the area of trauma in the breast after fat necrosis?
Grossly there is hemorrhage with central fat necrosis which later forms a nodule of gray-white firm tissue with foci of chalk-white debris
Possible confusion with cancer when fibrotic
Name 2 breast conditions what mimic cancer in appearance
- Fat necrosis of the breast
2. Chronic Mastitis
Name for male breast enlargement associated hormonal changes at puberty and its process
Gynecomastia- enlargement is caused by proligeration of the excretory ducts that surround CT. Forms a fibrous cap directly under the areola.
Why would gynecomastia occur in adulthood?
due to an excess of estrogen as from cirrhosis or tumors.
Why does male breast cancer spread more rapidly?
Less adipose tissue to impede the cancer growth
8 Risk factors related to breast cancer
Most importantly -> hormonal and genetic etiologies
- Sex - Females 100x more likely
- Age - incidences rise over 35
- Race - most common in caucasians
- Genetics
- Hormonal- exposed to estrogen for prolonged periods
- Presence of other cancers
- Premalignant Fibrocystic changes and multiple intraductal papilloamtosis
- Obesity, high fat diets, mod alcohol consumption
What is the main difference from invasive and in-situ, is breachment of?
Basement membrane
What is the process called when a biopsy is needed and the sample is too small to establish a definitive diagnosis and the procedure must be repeated? done at initial screening
FNA - fine needle aspiration
________ ______ requires incision of the skin and is usually performed under general anesthesia. Confirms diagnosis of cancer.
Surgical Biopsy (incisional)
Mammogram : Specialized ______ technique that allows detailed examination of the breast with _____ _______ radio graphs. ______ masses can be detected in _____ stages of development even before they are _________ seen as increased density with frequent ________. Smallest tumor can be less than____cm
x-ray low density Tumor early palpable calcification 0.5cm
______: most conservative surgical procedure as it is limited to resection of the tumor with surrounding fat tissue.
Lumpectomy
_______________: removal of breast tissue, skin, areola, nipple, pectoralis, and most of underarm lymph nodes
Modified radical mastectomy
What route do breast cancers metastasize via?
Lymphatics - bc most lymph ducts drain into the axillary lymph nodes, it is expected that most metastases are found in the axillary area
Most common metastases sites?
Lungs, liver, BONES, brain, and adrenals
What is the other name for sertoli cells?
Sustenticular Cells
What is the function of sertoli cells?
Support and nutrition of the spermatozoa, located between the germ cells. “inside”
Which 3 male glands produce the largest amount of seminal fluid?
- Seminal Vesicles 60%
- Prostate 13-30%
- Cowpers (bulbourethral) gland 7-10%
________: lined with ciliated pseudostratified columnar epithelium and their walls contain smooth muscle
Epididymis
____________: Lined by pseduostratified epithelium with a heavy coat of three muscle layers that propel the sperm towards the urethra by peristalsis
Vas Deferens
A congenital malpositioning of the testes outside of their normal scrotal location - it is the most important of the congentital abnormalities.
Crytorchidism
If crytorchidism is left untreated, it can cause what malignant and non malignant complications?
Non malignant -> infertile
Malignant -> Seminomas and Embryonal Carcinomas
Type of surgery done on babies born with crytorchidism before the age of 2. Generally prevents any future complication
orchiopexy
What 2 types of cancers are 10-35 times more likely in untreated cases of cryptorchidism?
- Seminoma
2. Embryonal Carcinoma
At what week in utero do fetal testes descend and reach the scrotum
33 weeks
Most common karyotype of a man with Klinefelter’s syndrome?
47 XXY - 50/50 maternal and paternal disjunction (unique bc usually its maternal)
Klinefelter’s Syndrome is best defined as male ________. It is rarely diagnosed before _______ bc the testicular abnormality hasnt manifested. Most patients have a _______ body with long legs, small _______ testes, a small ______, and lack of _________ sex characteristics. The plasma FSH levels are _________ and the testosterone levels are ________. This pathology relates to reduced ________ and male _______. The testicular tubules are totally ________ and replaced by pink hyaline collagen. The Leydig cells appear _______.
Hypogonadism puberty elongated atrophic penis secondary elevated reduced spermatogenesis infertility atrophied larger
________: collection of serous fluid in the scrotal sac between the 2 layers of the tunica vaginalis.
Hydrocele - most common benign condition. Long standing hydroceles may cause testicular atrophy or compression of the epididymis
How is diagnosis of a hydrocele made?
- Ultrasound
2. Transillumination
How is a congenital hydrocele formed?
Usually in infants due to inguinal hernia or being born breach
How is an acquired hydrocele formed?
In adults, and secondary to some other disease, tumor, or infection
__________: A cystic mass formed from the protrusions of widened efferent ducts of the epididymis or rete testis.
Spermatocele
How does a spermatocele manifest? Clinically and histologically
As a paratesticular nodule or soft mass filled with milky fluid - Histologically, the cyst is lined by cuboidal epithelium that contains spermatozoa in various stages of development.
What is the most common etiology of torsion of the testes?
Torsion of the spermatic cord, if complete, produces severe pain and infarction of the testicular germ cells within a few hours. Common after vigorous exercise
What type of cancer is cancer of the penis?
Squamous cell carcinoma - presents as an ulcerated and hemorrhagic mass on the glans or prepuse. It may be ulcerated or exophytic-fungating grossly
5 risk factors for penis squamous cell carcinoma
- Middle/older aged man
- Uncircumcised
- HPV
- Keratin debris through prolonged contact
- Smegma
What is the most common male condition of the male reproductive system related to a herpes infection?
Herpes Genitalis can cause initial vesicular lesions on the glans and shaft of the penis
(CMV- cytopathic effect on cells which becomes multinucleated giant cells with intranuclear inclusion cells will be BLUE
HSV-2 Inctranuclear inclusions have a red color)
What disease has an unknown etiology characterized by focal asymmetric, fibrous in duration of the shaft of the penis resulting in penile curvature and pain during erection?
Peyronie’s Disease -
Presents as ill defined fibrous nodule in young or middle aged males with no change in overlying skin. Dense dermal fibrosis with a non specific chronic inflammatory infiltrate and the collagen slowly replaces the muscle
Characteristics of primary vs secondary vs tertiary SYPHILIS
Primary -> @ inoculation site, spirochetes multiply and CHANCRE is formed. Heals spontaneously
Secondary -> Maculopapular rash usually on palms and soles, moist lesions on the genitals -> condylomata lata. May become meningitis, nephritis, hepatitis, lymphadenopathy, arthritis, and fever
Tertiary -> aorta aneurysm, neurosyphilis to chronic meningitis to Tabes Dorsalis, general paresis, dementia, GUMMAS
Gonorrhea aka _________. ______ most common STD behind venereal warts and chlamydia. Causes disease only in humans. Symptomatic in ______ asymptomatic in __________.
Gonococcus (GC)
3rd
Males
Females
Virulence factors of Gonorrhea (2)
- Pili
2. IgA protease
2 common symptoms of gonorrhea is men
- painful urination
- purulent urethral discharge
Due to urethritis
Where does GC cause inflammation in women?
columnar epithelium of the cervix - becomes reddened and friable with purulent exudate
Can progress to PID, endometritis, salpingitis, and oophoritis
If woman is symptomatic with GC infection what are her 3 symptoms?
- Lower abdominal discomfort
- Pain with sexual intercourse
- purulent vaginal discharge
Trichomonas vaginalis is a sexually transmitted ________. It is pear-shaped with central nucleus and ____ anterior flagella. Worldwide it is one of the most _______ infections. In women, causes watery, foul _____, greenish discharge with _____ and ______. In men usually _________. Diagnosis is done with ______ _______ ______ of vaginal or prostatic secretions for moving trophozoites.
protozoan 4 common smelling itching burning asymptomatic wet mount prep
What is the Tzanck smear used for?
Test for chickenpox (VZV) or herpes simplex
Used for molding of the nuclei with characteristic intranuclear inclusions
Affects of herpes simplex 1
Herpes Labialis - fever blisters, cold sores, keratitis, encephalitis
Transmission of herpes simplex 1
Saliva, direct contact with the virus from the vesicle
Latency location of herpes simplex 1
sensory ganglia (trigem)
Affects of herpes simplex 2
Herpes genitalis, oral/skin/eye disease, genital herpes, aseptic meningitis. congenital infection (TORCH) acquired during passage in an infected birth canal
Latency location of herpes simplex 2
sensory ganglia (lumbar or sacral)
Is there a cross re activity between herpes viruses?
Yes HSV1 can cause genital herpes and HSV2 can cause cold sores
What is the ovarian homologue to seminoma?
Dysgerminoma
Seminomas are the most ______ testicular tumor. Seen in ages ___- ___. Stromal invasion of _____ cells that gives rise to _________ germ cell tumor. Presents as firm intratesticular poorly demarcated mass that bulges from the cut surface. Entire testes replaced but tumor ______ -________ with rare focal areas of __________ and necrosis. Display _____ nests of proliferating tumor cells. Cells have well defined _______ with glycogen rich clear cytoplam and _____ appearing nuclei with coarse granular chromatin.
common 25-55 germ undifferentiated yellow-white hemorrhage solid borders normal
2 key characteristics of a seminoma
- sensitive to radiation 85-95% 5 year survival rate
2. no serological tumor markers
What tumor marker does the yolk sac tumor of infancy produce?
Alpha fetoprotein - AFP
What is the second most common germ cell tumor of the testes, most are found between the ages of 20-35. More aggressive and lethal. Grossly the tumor is small, and does replace the entire testis, on sectioning it is gray-white, poorly demarcated, and bulging, with varying degrees of hemorrhage and necrosis
Embryonal Carcinoma
Testicular teratoma is what homologue in females?
Dermoid cyst of the ovaries
What is the most important predictor of biological behavior of a testicular teratoma?
AGE
Adults - malignant
Children- benign
Germ cell tumors characterized by tissue from all ____ germ layers comprise almost _____ of the germ cell tumors in infants and children but less than ____% of tumors in adults.
3
half
5%
What are the 3 classifications of testicular teratomas?
- Mature teratomas (young)
- Immature teratomas (middle age)
- Malignant teratomas (elderly)
Name the haphazard arrangement of cell types histologically found in testicular teratomas
neural, skeletal bone, cartilage, thyroid, respitatory epithelium, squamous epithelium, GI tract epithelium adn other tissues within a fibrous or myxoid matirx.
What do the Leydig cell tumors produce? (intersitial cell tumor)
Androgens/estrogens
What do Sertoli cell tumors produce?
Androgen/estorgens
Name tumor markers for:
Embryonal Carcinomas:
Yolk Sac Tumor:
Choriocarcinoma:
EC - beta HCG and AFP
YST - AFP
C - HCG
What is the name of a highly malignant germ cell testicular tumor which causes no testicular enlargement and detected only as a small painless nodule. Contains syncytiotrophoblasts which are large multinucleated giant cells with abundant vacuolated cytoplasm which contain HCG.
Choriocarcinoma
What cancer represents the most common urinary tract neoplasm?
Bladder - transitional cell - carcinoma
Usually men 60-80
What parasite is involved in causing bladder cancer that is endemic to Egypt?
Schistosoma haematobium -parasite that lays eggs inside of urinary bladder wall and causes squamous cell carcinoma
What tumor marker (antigen) is released in both malignant and normal prostate cells but released in high concentrations by tumor cells into circulation. It may be detected immunochemically in the blood and tissue. Diagnosis is confirmed by needle biopsy of the prostate done transrectally.
PSA - Prostate Specific Antigen
PSA level in blood should be 0 in non cancerous men
High PSA after prostatectomy suggests persistent local and metastatic disease
What tumor marker is a blood enzyme that is released by osteoblasts when prostatic carcinoma cells meet bone and evoke an osteoblastic reaction.
Bone Alkaline Phosphatase
What type of cancer makes up 98% of prostate cancers?
Adenocarcinomas - usually posterior lobe, initially bound by basement membrane but can metastasize.
Name for Nodular Hyperplasia of the Prostate. It is a common reactive benign hyperplastic lesion that may obstruct flow of urine related to male hormonal changes that occurs with aging (decrease in testosterone)
BPH - Benign Prostate Hyperplasia
seen in blacks, USA/Europe, and 70 years of age most common
does not progress to cancer
What is TURP?
Transurethral Resection of the Prostate - tx for BPH
What cancer is the most common cancer in men, 3rd most common cause of cancer related deaths in males, tumor in older men, highesy in US/scandinavia, Blacks, familial/high fat diets/exposure to cadmium rubble textiles increases risk. Risk decrease with consumption of green/yellow veggies
Prostate Cancer
9 characteristics about the prostate gland
- donut shaped, inferior to bladder surrounds urethra
- Size of chestnut
- secretes alkaline fluid (13-33% of semen)
- Has 3-50 individual compound tubuoalveolar glands
- each gland has a duct that delivers secretory product to prostatic urethra
- developmet at puberty only in presence of male sex hormones
- Homologue to skeens gland
- prostate glands lined by simple to pseudostratified columnar epithelium
- lumen of glands house round to oval prostatic concentrations composed of calcified glycoproteins
What prostate infection expresses with intense discomfort with urination, fever, chills, peritinneal pain and high presence of PMNs? What causes this?
Acute prostatitis due to gram negative bacteria, E. coli, chlamydia, mycoplasma, trichomonas, and previous UTI due to reflux of infected urine into prostate.
What prostate infection expresses with suprapubic, perineal and low back pain, dysuria, nocturia and high presence of lymphocytes, plasma cells, and macrophages.
Chronic prostatitis due to previous episodes of acute prostatitis
What is caused by mycobacterium tuberculosis and histoplasma capsulatum?
Granulomatous prostatitis
What is the gleason score?
Grading system to classify prostate cancers based on 5 histologic patterns of tumor gland formation and infiltration. Numbered 1-5 each Best =2 Worst prognosis =10 Most common 4-7
