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Pathology > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

What is a Bartholin Cyst and what part of the genital tract is it located in?

A

Cystic dilation of Bartholin gland due to inflammation and obstruction of gland
Located on vulva

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2
Q

What age group does a Bartholin Cyst affect?

A

Women of reproductive age

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3
Q

How does a Bartholin Cyst present?

A

Unilateral, painful cystic lesion on lower vestibule

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4
Q

What is the histologically defining characteristic of a Condyloma?

A

Koilocytes

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5
Q

What is the major and minor causes of condylomas?

A

Major - HPV types 6 or 11

Minor - secondary syphilis

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6
Q

Where is a condyloma located?

A

Vulva

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7
Q

What is Lichen Sclerosis?

A

Thinning of epidermis and sclerosis of dermis on vulva

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8
Q

How would you describe the skin of Lichen Sclerosis?

A

Parchment-like, white patch

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9
Q

Age group associated with Lichen Sclerosis

A

Postmenopausal women

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10
Q

What presents as hyperplasia of the vulvar squamous epithelium?

A

Lichen Simplex Chronicus

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11
Q

HPV-Related vulvular carcinoma is due to which HPV types?

A

16 and 18

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12
Q

What does HPV-related vulvular carcinoma arise from?

A

VIN - vulvular intraepithelial neoplasia

Characterized by koilocyte change, increased mitotic activity, disordered cell maturation, and nuclear atypia

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13
Q

What does non-HPV-related vulvular carcinoma arise from?

A

Long standing Lichen Sclerosis

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14
Q

What disease is characterized by malignant epithelial cells in epidermis of vulva?

A

Extramammary Paget Disease

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15
Q

What is vaginal adenosis?

A

Persistence of columnar epithelium in upper vagina

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16
Q

Risk factor for Vaginal Adenosis

A

Exposure to DES in utero

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17
Q

Besides adenosis, other effect of DES exposure in utero

A

Clear Cell Adenocarcinoma

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18
Q

Grape-like mass protruding from vagina or penis of child, usually less than 5 years old

A

Embryonal Rhabdomyosarcoma

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19
Q

Cancer from lower 1/3 of vagina goes to ____ nodes, cancer from upper 2/3 of vagina goes to _____ nodes

A

Inguinal; iliac

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20
Q

Persistent HPV infection can lead to increased risk for _____ ____ ______

A

Cervical Intraepithelial Neoplasia (CIN)

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21
Q

High risk HPV types

A

16, 18, 31, 33

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22
Q

Which tumor suppressor proteins are destroyed during a high risk HPV infection and how?

A

p53 and Rb

Through production of E6 and E7 proteins

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23
Q

4 histological characteristics of Cervical Intraepithelial Neoplasia

A

Koilocyte change
Disordered cell maturation
Nuclear atypia
Increased mitotic activity

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24
Q

What age group is cervical carcinoma most often seen in?

A

Middle aged women (40-50 years)

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25
Q

Primary and secondary risk factors for cervical carcinoma

A

Primary - High risk HPV infection

Secondary - smoking, immunodeficiency (AIDs)

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26
Q

Common cause of death in advanced cervical carcinoma

A

Hydronephrosis with postrenal failure

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27
Q

How long does it take to progress from CIN to carcinoma?

A

10 - 20 years

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28
Q

Disease defined by secondary amenorrhea due to loss of basalis and scarring, usually from overaggressive D&C (abortion)

A

Asherman Syndrome

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29
Q

What is an anovulatory cycle?

A

Estrogen-driven proliferative phase without a progesterone-driven secretory phase

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30
Q

How does acute endometritis present?

A

Fever, abnormal uterine bleeding, pelvic pain

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31
Q

What are the characteristic cells of chronic endometritis?

A

Plasma cells (lymphocytes always present)

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32
Q

What are the four main causes of chronic endometritis?

A

Retained products of conception
Chronic Pelvic Inflammatory Disease
IUD
TB

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33
Q

What is an endometrial polyp and what drug can it be a side effect of?

A

Hyperplastic protrusion of endometrium

Tamoxifen

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34
Q

Most common site and presentation of endometriosis?

A

Ovary - chocolate cyst

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35
Q

What is endometrial hyperplasia?

A

Hyperplasia of endometrial glands relative to stroma

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36
Q

What causes endometrial hyperplasia?

A

Unopposed estrogen (obesity, polycystic ovarian syndrome, estrogen replacement)

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37
Q

Two pathways for endometrial carcinoma & which is most common

A 
Hyperplasia pathway (75%) - arises from endometrial hyperplasia
Sporadic pathway (25%) - little bit older population (70 years)
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38
Q

Which type of endometrial carcinoma is more aggressive and what is the histological characteristics of it?

A

Sporadic type

Papillary structures with psammoma body formation

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39
Q

Benign neoplastic proliferation of smooth muscle arising from myometrium; most common tumor in females

A

Leiomyoma (Fibroids)

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40
Q

Malignant proliferation of smooth muscle arising from myometrium

A

Leiomyosarcoma

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41
Q

Characteristic hormone imbalance of Polycystic Ovarian Disease

A

Increased LH – excess androgen production = excess hair

Low FSH due to feedback

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42
Q

Classic presentation for Polycystic Ovarian Disease

A

Obese young woman with infertility, oligomenorrhea, and hirsutism

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43
Q

Most common type of ovarian tumor

A

Surface Epithelial Tumor

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44
Q

Benign ovarian tumors have a ____ lining, whereas malignant ovarian tumors have a ____ lining

A

SImple, flat lining

Thick, shaggy lining

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45
Q

Two common subtypes of surface epithelial ovarian tumors and two less common subtypes of surface epithelial ovarian tumors

A

Serous tumors and mucinous tumors

Endometroid tumors and Brenner tumors (bladder-like epithelium, usually benign)

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46
Q

BRCA1 mutation carriers have increased risk for ____ carcinoma of ovary and fallopian tube

A

Serous

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47
Q

Useful serum marker used to monitor the treatment response of surface epithelial ovarian tumors and screen for recurrance

A

CA-125

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48
Q

2nd most common type of ovarian tumor

A

Germ Cell Tumor

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49
Q

Benign germ cell ovarian tumor composed of fetal tissue from two or three embryological layers

A

Cystic Teratoma

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50
Q

Most common malignant germ cell ovarian tumor composed of large cells with clear cytoplasm and central nuclei

A

Dysgerminoma

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51
Q

Most common malignant germ cell ovarian tumor in children; Schiller-Duval bodies

A

Endodermal Sinus Tumor (Yolk Sac Tumor)

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52
Q

Malignant germ cell ovarian tumor that mimics placental tissue, hemorrhagic with early hematogenous spread

A

Choriocarcinoma

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53
Q

Malignant germ cell ovarian tumor that is composed of large, primitive cells that metastasizes early

A

Embryonal Carcinoma

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54
Q

3 types of Sex-Cord Stromal Ovarian Tumors

A

Granulosa-Theca cell tumor
Sertoli-Leydig cell tumor
Fibroma

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55
Q

_____ Tumor is a metastatic mucinous tumor that involves both ovaries (bilateral), commonly due to metastatic gastric carcinoma

A

Krukenberg Tumor

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56
Q

Key risk factor for ectopic pregnancy

A

Scarring (PID or endometriosis)

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57
Q

Implantation of placenta in lower uterine segment so it overlies cervical opening

A

Placenta Previa

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58
Q

Characteristics of Pre-Eclampsia

A

Hypertension, proteinuria, edema

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59
Q

Eclampsia is pre-eclampsia + _____

A

Seizures

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60
Q

What does HELLP stand for?

A

Hemolysis, Elevated Liver enzymes, Low Platelets

Preeclampsia + thrombotic microangiopathy

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61
Q

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts; can be complete or partial

A

Hydatidiform Mole

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62
Q

Classic presentation of mole

A

Passage of grape-like masses through vaginal canal in second trimester

63
Q

What is acute mastitis and what organism is it commonly caused by?

A

Bacterial infection of breast

Staph Aureus

64
Q

How does acute mastitis present?

A

Erythematous breast with purulent nipple discharge

65
Q

Inflammation of subareolar ducts seen in smokers

A

Periductal Mastitis

66
Q

Presentation of Periductal Mastitis

A

Subareolar mass with nipple retraction

67
Q

Inflammation of subareolar ducts + dilation

A

Mammary Duct Ectasia

68
Q

Presentation of Mammary Duct Ectasia

A

Periareolar mass with green-brown nipple discharge

69
Q

What is fat necrosis usually caused by?

A

Trauma

70
Q

What can you see on fat necrosis breast biopsy?

A

Necrotic fat with calcifications and giant cells

71
Q

Most common change in premenopausal breast

A

Fibrocystic change

72
Q

Fibrocystic Change associated with:
2X Increased risk for invasive carcinoma
5X increased risk for invasive carcinoma

A

2X - Ductal Hyperplasia & Sclerosing Adenosis

5X - Atypical Hyperplasia

73
Q

Papillary growth in breast, usually into large duct

A

Intraductal Papilloma

74
Q

Classic histological characterization and clinical presentation of Intraductal Papilloma

A

Histo - fibrovascular projections lined by epithelial and myoepithelial cells (2 cell layers)

Clinical - bloody nipple discharge in premenopausal woman

75
Q

Most common benign neoplasm in breast

A

Fibroadenoma

76
Q

What is a Phyllodes Tumor and what is defining about it?

A

Fibroadenoma-like tumor with overgrowth of fibrous component

Defining leaf-life projections on biopsy

77
Q

Risk factors for breast cancer

A

Female, postmenopausal, early menarche/late menopause, obesity, atypical hyperplasia, 1st degree relative with breast cancer

78
Q

How does Ductal Carcinoma In Situ present?

A

Calcifications on mammography (biopsy needed to distinguish from benign conditions)
No masses

79
Q

What is Paget Disease of the breast?

A

DCIS that extends up the ducts to involve skin of nipple

Presents as nipple ulceration and erythema

80
Q

Most common type of invasive cancer of the breast

A

Invasive Ductal Carcinoma

81
Q

Presentation of Invasive Ductal Carcinoma

A

Mass with possible skin dimpling or nipple retraction

82
Q

4 Subtypes of Invasive Ductal Carcinoma and descriptions

A

Tubular Carcinoma - well-differentiated tubules that lack myoepithelial cells

Mucinous Carcinoma - abundant extracellular mucin

Medullary Carcinoma - large, high grade cells growing in sheets with lymphocytes and plasma cells

Inflammatory Carcinoma - carcinoma in dermal lymphatics, poor prognosis, can be mistaken for acute mastitis

83
Q

What is characteristic of Lobular Carcinoma In Situ and Invasive Lobular Carcinoma Cells?

A

Lack E-Cadherin (form single file pattern in invasive)

84
Q

Most important factor in breast cancer staging and most useful factor

A

Important - metastasis

Useful - spread to axillary lymph nodes

85
Q

Receptor status on poorest prognostic breast cancer and population most at risk

A 
Triple Negative (negative for ER, PR, and HER2/Neu)
African American women
86
Q

Most common histological subtype of breast cancer in males

A

Invasive ductal carcinoma

87
Q

Risk factors for males to develop breast cancer

A

BRCA2 mutation and Klinefelter’s Syndrome

88
Q

Impaired cartilage proliferation in the growth plate - common cause of dwarfism

A

Achondroplasia

89
Q

Achondroplasia is due to ______

A

Activating mutation in fibroblast growth factor receptor 3 (FGFR3)

90
Q

What is osteogenesis impefecta?

A

Congenital defect of bone formation resulting in structurally weak bone

91
Q

Common cause of osteogenesis imperfecta

A

Autosomal dominant defect in Collagen Type I synthesis

92
Q

Clinical features of osteogenesis imperfecta

A

Multiple fractures of bone, blue sclera, hearing loss

93
Q

Inherited defect of bone resorption; results in abnormally thick, heavy bone that fractures easily

A

Osteopetrosis

94
Q

What is the cause of Osteopetrosis and a common mutation that leads to it?

A

Poor osteoclast function

Carbonic Anhydrase II mutation leads to loss of acidic microenvironment required for bone resorption

95
Q

Clinical features of Osteopetrosis

A 
Bone fractures
Anemia/thrombocytopenia/leukopenia
Vision and hearing impairment
Hydrocephalus
Renal Tubular Acidosis - seen with Carbonic Anhydrase II Mutation
96
Q

What is Ricketts/Osteomalacia and what is the difference between the two?

A

Defective mineralization of osteoid due to low Vit D

Ricketts = children, Osteomalacia = adults

97
Q

Clinical features of Ricketts

A 
Pigeon-breast deformity
Frontal Bossing (enlarged forehead)
Rachitic Rosary (osteoid deposition at costochondral junction)
Bowing of legs
98
Q

What is Osteoporosis and what are the consequences?

A

Reduction in trabecular bone mass

Results in porous bone with increased risk for fracture

99
Q

How can you differentiate between osteoporosis and osteomalacia?

A

Labs - serum calcium, phosphate, PTH, and alkaline phosphate are normal in Osteoporosis
Osteomalacia - low calcium & phosphate, high PTH

100
Q

Disease caused by imbalance between osteoblast and osteoclast activity

A

Paget Disease of Bone

101
Q

Three Stages of Paget Disease of Bone

A

Osteoclastic
Mixed Osteoblastic/Osteoclastic
Osteoblastic

102
Q

Clinical Features and Complications of Pagets Disease of Bone

A 
Bone Pain
Increasing hat size
Hearing loss
Lion-like facies
Isolated elevated alkaline phosphate

Complications: high-output cardiac failure, osteosarcoma

103
Q

Treatment for Paget Disease of Bone

A

Calcitonin and Bisphosphonates

104
Q

What is Osteomyelitis and what population does it normally occur in?

A

Infection of marrow and bone, children

105
Q

What part of the bone is affected in Osteomyelitis in kids vs. adults?

A

Kids - metaphysis

Adults - epiphysis

106
Q

How does osteomyelitis present on X Ray?

A

Lytic focus (sequestrum, abscess) surrounded by sclerosis (involucrum)

107
Q

Common bacterial causes of Osteomyelitis and which is most common?

A

Staph Aureus - most common cause
N gonorrhoeae - sexually active young adults
Salmonella - sickle cell disease
Pseudomonas - diabetics, IV drug users
Pasteurella - cat, dog bites or scratches
TB - Pott disease

108
Q

What are common causes and complications of Avascular Necrosis of bone?

A

Causes - trauma/fracture, steroids, sickle cell anemia, caisson disease
Complications - osteoarthritis, fracture

109
Q

What is an Osteoma and what is it associated with?

A

Benign tumor of bone

Associated with Gardner Syndrome (GI)

110
Q

Benign tumor of osteoblasts surrounded by a rim of reactive bone

A

Osteoid Osteoma

111
Q

Where does Osteoid Osteoma arise and in what patient population?

A

Cortex of long bones

Young adults, males more commonly

112
Q

Difference between Osteoid Osteoma and Osteoblastoma

A

Osteoid Osteoma pain is relieved with Aspirin

113
Q

Most common benign tumor of bone

A

Osteochondroma

114
Q

Benign tumor of bone with overlying cartilage cap

A

Osteochondroma

115
Q

Malignant proliferation of osteoblasts

A

Osteosarcoma

116
Q

Where does Osteosarcoma arise and what are some risk factors?

A

Metaphysis of long bone

Familial Retinoblastoma, Paget Disease, Radiation exposure

117
Q

Imaging characteristics of Osteosarcoma

A

Sunburst appearance, lifting of periosteum (Codman Triangle)

118
Q

What is a Giant Cell Tumor?

A

Bone tumor comprised of multinucleated giant cells and stromal cells

119
Q

Where does a Giant Cell Tumor arise?

A

Epiphysis of long bone (only one to do so)

120
Q

What is the characteristic appearance of a Giant Cell Tumor on xray?

A

Soap Bubble appearance

121
Q

Malignant proliferation of poorly-differentiated cells derived from neuroectoderm

A

Ewing Sarcoma

122
Q

Where does Ewing Sarcoma normally arise and what is its appearance on xray?

A

Diaphysis of long bone

Onion skin appearance

123
Q

What is the characteristic translocation of Ewing Sarcoma?

A

11;22

124
Q

Benign tumor of cartilage

A

Chondroma

125
Q

Malignant cartilage-forming tumor

A

Chondrosarcoma

126
Q

Which is more common in bone, metastatic tumors or primary tumors?

A

Metastatic tumors

127
Q

What does metastatic bone cancer usually result in physically?

A

Osteolytic lesions (punched out)

128
Q

Most common type of arthritis

A

Degenerative Joint Disease/Osteoarthritis

Progressive degeneration of articular cartilage

129
Q

Major risk factor for osteoarthritis + minor ones

A

Major - age (greater than 60)

Minor - obesity, trauma

130
Q

Classic presentation of osteoarthritis

A

Joint stiffness in the morning that worsens during the day

131
Q

Important pathological features of Osteoarthritis

A 
Disruption of cartilage that lines articular surface - fragments in joint space are called joint mice
Eburnation (polishing) of subchondral bone
Osteophyte formation (bony outgrowths) in DIP and PIP joints of fingers classically
132
Q

What is Rheumatoid Arthritis and what population is it associated with?

A

Autoimmune disease associated with HLA-DR4

Arises in women of late childbearing age

133
Q

What is the hallmark pathology of Rheumatoid Arthritis?

A

Synovitis leading to formation of pannus (inflamed granulation tissue)

134
Q

How to differentiate Rheumatoid Arthritis from Osteoarthritis clinically?

A

Joint stiffness improves with activity in RA

DIP is spared in RA (unlike OA)

135
Q

Clinical features of Rheumatoid Arthritis

A

Fever, malaise, weight loss, myalgias
Vasculitis, rheumatoid nodules
Baker Cyst (knee)
Pleural effusions, lymphadenopathy, interstitial lung fibrosis

136
Q

Lab findings in Rheumatoid Arthritis

A

IgM autoantibody against Fc portion of IgG (rheumatoid factor)
Neutrophils and high protein in synovial fluid

137
Q

Group of joint disorders characterized by lack of rheumatoid factor, axial skeleton involvement, and HLA-B27 involvement

A

Seronegative Spondyloarthropathies

138
Q

3 disease included in Seronegative Spondyloarthropathies

A

Ankylosing Spondyloarthritis - sacroiliac joints & spine, young adults, fusion of vertebrae (bamboo spine)

Reiter Syndrome - arthritis, urethritis, conjunctivitis, young adults, GI or chlamydia infection

Psoriatic Arthritis - axial and peripheral joints, DIP joints of hands and feet often involved (sausage fingers/toes)

139
Q

Common causes of infectious arthritis

A 
N gonorrheae (most common)
S aureus
140
Q

What is Gout?

A

Deposition of monosodium urate (MSU) crystals in tissue, especially the joints

141
Q

What are some causes of secondary gout?

A

Leukemia/myeloproliferative diseases - hyperurecemia due to increased cell turnover

Lesch-Nyhan Syndrome - X linked deficiency of HGPRT

Renal Insufficiency

142
Q

What is the presentation of acute gout?

A

Podagra - painful arthritis of big toe

143
Q

Chronic gout can lead to _____ and _____

A

Development of tophi; renal failure

144
Q

Inflammatory disease of the skin and skeletal muscle

A

Dermatomyositis

145
Q

Clinical features of dermatomyositis

A

Bilateral proximal muscle weakness
Rash of upper eyelids, malar rash
Red papules on elbows, knuckles, knees

146
Q

Difference between Dermatomyositis and Polymyositis

A

Polymyositis only involves skeletal muscle, not skin

147
Q

Disorder characterized by muscle wasting and replacement of muscle tissue with adipose tissue

A

X-Linked Muscular Dystrophy

148
Q

Benign tumor of adipose tissue

A

Lipoma

149
Q

Malignant tumor of adipose tissue

A

Liposarcoma

150
Q

Characteristic cell of Liposarcoma

A

Lipoblast

151
Q

Benign tumor of skeletal muscle

A

Rhabdomyoma

152
Q

What is a Rhabdomyosarcoma?

A

Malignant tumor of skeletal muscle

153
Q

What is the most common malignant soft tissue tumor in children?

A

Rhabdomyosarcoma

154
Q

Characteristic cell in Rhabdomyosarcoma and cell is ____ positive

A

Rhabdomyoblast; desmin positive

Pathology (4 decks)

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