Week 3 + 4 Pathology Flashcards
Invasive: Hallmark(s)/Red Flags of Invasive Ductal Carcinoma
- (red flag) Desmoplasmic Reaction: Loose CT becomes Dense, thus it feels very hard.
- Nests are also a red flag word (but also seen in Invasive Lobular Carcinoma)
Invasive: Hallmark(s)/Red Flags of Invasive Lobular Carcinoma
- (red flag) Strands/Single file rows of malignant tumor cells.
- Targetoid pattern: Solid nests and sheets arranged in concentric rings
- Typically bilateral (more often than Ductal Carcinoma) and multicentric, rubbery.
Invasive: Hallmark(s)/Red Flags of Medullary Breast Carcinoma (doesn’t seem as focused on)
Epithelial Tumor = Large fleshy tumor masses > 5 cm
Histology: Foci of hemorrhage and necrosis
Invasive: Hallmark(s)/Red Flags of Colloid (Mucinous) Breast Carcinoma
DX: (red flag) Large gray-blue/purple lakes of mucin + small isalnds of neoplastic cells = tumor cells
Invasive: Hallmark(s)/Red Flags of Paget’s Disease of the Breast
Px: Causes ulcers, fissures, discharging oozing, edema, and inflammation around the nipple. Scaly.
Histology: (red flag) Pagets cells = malignant, large clear-staining cells.
Invasive: Causes of Peau d’Orange and Retraction of the Nipple
- Peau d’Orange = Obstructed Lymphatics => blockage of skin drainage.
- Retraction of the nipple = tumor involves main excretory duct.
Pathophysiology of Benign Breast Lumps: One Sentence
1) Acute Mastitis (also found in unilateral lect)
2) Chronic Mastitis
3) Fat Necrosis of the Breast (also found in Unilateral lect.)
4) Gynecomastia
1) Acute Mastitis:
- Stagnant milk in breasts, dilated milk ducts, and caused by Staph/Strep (Purulent) therefore possible pus in ducts.
2) Chronic Mastitis:
- Necrosis of Acute Mastitis, may mimic cancer (small lumps in breast)
3) Fat Necrosis of the Breast:
- HX of previous trauma, surgical intervention, or radiation therapy. Foci of chalk white debris. Possible confusion with cancer when fibrotic (need to remember this)
4) Gynecomastia:
- Dilated Ducts, no Lobules.
Benign + Bilateral: Fibrocystic Changes of Breast
Note: Different from Fibroadenoma + whole lecture dedicated to it (LG 3.21)
- Hormones (sex hormones) play a big role
(Usually DX in women after puberty, before menopause) - Red Flag: Blue-Domed Cyst + Epithelial Hyperplasia + ductal proliferative changes. Fibrosis (duh)
- Note: Atypical Epithelial Hyperplasia (multilayered) = ONLY factor that affects possibility of carcinoma development, roman arches/cribiforming a possible finding.
- Clinical: Symmetrical/Bilateral, painful, nodulatiry, sensitive to palpation and usually CYCLICAL
Benign: Breast Fibroadenoma
- Composed of fibrous stroma and glandular epithelium.
- DO NOT recur and DO NOT undergo malignant change.
- Smooth, oval, mobile
Benign: Phyllodes Tumor
- “Giant Fibroadenomas”
- DOES recur and DO undergo malignant change
- BIG tumor, affects entire breast.
Benign + Unilateral: Intraductal Papilloma
- Clinical: (Red Flag) serous or bloody discharge from the nipple, a small sub-areolar mass, and RARELY nipple retraction. (important!)
- May cause unilateral discomfort under the nibble.
- Note: Multiple = risk for breast cancer.
Non-invasive (In Situ, Malignant) Intraductal Carcinoma
- In situ: lack of capacity to invade through the basement membrane.
- AKA Comedocarcinoma
- White head
General: Ductal vs Lobular Carcinoma
Lobular = Multifocal + bilateral Ductal = Unilateral + only one area
Note: Most breast carcinoma are upper outer quadrant, then central underneath the areola.
Unilateral Breast: Non Cyclic Mastalgia vs Bilateral: Cyclic Mastalgia
Non Cyclic
- unrelated to menstrual cycle, can occur post menopausally
- often unilateral: sharp burning pain
- secondary to presence of fibroadeonma or cyst
Cyclic
- Most severe before menses, cyclic, bilateral.
- usually younger female generation
Unilateral Breast: Costochondral Chondritis
AKA Tietze’s Syndrome.
- Pain over one or more of the costochondral articulations.
Unilateral Breast: Mondor’s Disease
- thrombophlebitis of the thoracoepigastric vessels
- always pain/tenderness over the lateral and inferior breasts: subsides in 1-3 weeks.
Risk Factors for Germ Cell Tumors (90% of testicular tumors)
1) Prior Dx of germ cell tumor in contralateral testis
2) Prior Dx of testicular germ cell tumor in first degree family
3) Gonadal Dysgensis = Klinefelter Syndrome + Cryptochordism
Note: Testicular tumors = defect in chromosome 12, short arm
Seminoma = germ cell tumor, one cell type
- Entire testis is replaced by tumor
- Exquisitely sensitive to radiation (in localized tumor, radiation therapy = 85% - 95% 5 year survival rate)
- No serologic tumor markers
- (not sure if important): yellow-white, prominent nucleoli, solid nests of proliferating tumor cells. Well defined borders.
Embryonal Carconima (Includes Teratomas and Yolk Sac Tumor/Choricocarcinoma)
- Does not replace the entire testis
- (not sure if important): Grey-white, poorly demarcated
- chemo for local tumor with no mets = high cure rate
Embryonal Carcinoma: Teratomas (3 types)
Mature:
- Solid, multicystic lesion enlarges the testis: Exhibits mucinous cysts with solid cartilaginous and osseous foci.
- Haphazard arrangement of cells: neural, skeletal bone, cartilage, skin, etc.
Immature
- Same arrangement as mature teratoma but tissues are less differentiated and more primitive.
(IMPORTANT: Age of patient determines malignancy)
- Older the patient gets, the more likely it’s malignant regardless if its mature or immature.
Embryonal Carcinoma: Yolk Sac Tumor
- Endodermal Sinus Tumor in feamles
- most common germ cell tumor in children
- Schiller-Duval Body + AFP
Embryonal Carcinoma: Choriocarcinoma
- high malignant and aggressive
- Synctiotrophoblasts = hCG
- Mets to lungs via hematogenous route (usually lymph)
Leydig vs Sertoli Cell Tumor
Leydig
- larger endocrine effects
- sheets of polygonal cells with abundant eosinophilic cytoplasm
Sertoli
- trabecular arrangement with solid cords of cells with a fibrous trabecular network
TX for both = Orchiectomy
Torsion of Tests: Most common Hx.
Presents shortly after vigorous physical exercise
