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211 Cards in this Set
- Front
- Back
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what are the two cell layers present in the terminal ducts and lobules of the breast?
|
myoepithelial cells
epithelial cells |
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what portion of the breast is responsive to hormones: the interlobular stroma or the intralobular stroma?
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intralobular stroma
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during pregnancy and lactation, an increase is seen in what breast portion?
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increase in lobules
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what is the most common breast-related clinical symptom that women come in to the doctor for?
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breast pain
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treatment (if indicated) for "cyclical breast pain?"
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hormonal regulation
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two synonyms for breast pain?
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mastalgia
mastodynia |
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in general, how large must a breast lump be in order to palpate it?
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2 cm
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compare a lump/cyst found in a young woman vs. an older woman (what it most likely is)
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young woman - most likely benign
older (post-menopausal) woman - most likely malignant |
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what would be more concerning:
discharge that is unilateral or bilateral? |
unilateral
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what would be more concerning: milky discharge or bloody, serous discharge
|
bloody serous discharge
(milky is almost never associated with a malignancy) |
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what could cause milky breast discharge? (5)
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*could be "normal"*
*prolactin increase *hypothyroidism *anovulatory cycles *some drugs |
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why is mammography more sensitive in older women?
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decreased breast density
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what size lesions can be detected by mammography?
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1 cm
(remember, expert palpation can only detect 2cm masses) |
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when is acute mastitis most commonly seen?
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in lactating women
|
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MC causative agent of acute mastitis?
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Staph epi
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which breast cancer presents similarly to acute mastitis?
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inflammatory carcinoma
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which breast disease is mainly restricted to smokers?
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periductal abscess
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is there an association between a periductal abscess and lactation or menses?
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NO
|
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pathogenesis of a periductal abscess?
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squamous epithelium extends deeper than normal - traps keratin in ductal system - this produces cysts - cysts rupture - causes granulomatous response
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which breast disorder am I?
- usually painless - peri-areolar mass - skin retraction - thick, white discharge - squamous metaplasia is rare |
mammary duct ectasia
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two causes of fat necrosis of the breast?
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trauma
surgery |
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between the proliferative and non-proliferative breast diseases, which has an increased risk of breast carcinoma?
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proliferative
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three components of fibrocystic disease?
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1. cysts
2. fibrosis 3. adenosis (increased # of acini in a lobule) |
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do proliferative breast lesions commonly have cell atypia?
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NO
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how do most proliferative breast lesions without atypia present?
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as a mass detected by mammography
(vs. non-proliferative breast disease presenting as a breast mass) |
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what type of lesion am I?
- a variant of FCD in which proliferation and adenosis dominate - characterized by fibrosis around the lobular unit -radiologically and pathologically resembles breast carcinoma |
sclerosing adenosis
|
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describe a breast papilloma
|
a benign tumor attached to lactiferous duct by a fibrovascular core
|
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are papillomas associated with an increased risk of breast carcinoma?
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No
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what breast lesion am I?
- hormonally responsive - tumor of terminal duct lobular unit - MC benign neoplasm of the breast |
fibroadenoma
|
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what happens to a fibroadenoma in pregnancy?
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grows rapidly
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which drug is associated with fibroadenoma development?
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cyclosporin
(more than 1/2 of women on cyclosporin develop fibroadenomas) |
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compare the cancer risk between proliferative lesions with and without atypia
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with atypia: 2-5x increased risk of carcinoma
without atypia: 1-2x increased risk |
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define an in-situ breast carcinoma
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malignant cells that haven't penetrated the basement membrane
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what are the two types of ductal carcinoma in situ (DCIS)
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1. DCIS, comedo type
2. DCIS, non-comedo type |
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treatment for DCIS?
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lumpectomy
tamoxifen if ER (+) |
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which is harder to pick up on mammography: DCIS or LCIS?
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LCIS
(no calcifications, no mass effect) |
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treatment for LCIS?
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tamoxifen (almost always ER (+))
some opt for bilateral prophylactic mastectomy |
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when LCIS is found, why is a contralateral biopsy also performed?
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LCIS often has bilateral involvement
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what is Pagets disease a variation of?
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ductal carcinoma of the breast (DCIS or invasive)
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how does Pagets disease present?
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eczema
see malignant cells in epidermis |
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women with the BRCA1 gene have what chance of developing breast cancer?
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75% chance
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BRCA1 is also associated with what other cancer?
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ovarian
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women with the BRCA2 gene have what chance of developing breast cancer?
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30-40% (smaller chance than BRCA1 mutation)
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which gene is associated with an increased risk of breast cancer in men?
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BRCA2
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what is Li-Fraumeni syndrome
|
germline mutation in p53
*increases risk of breast, brain and adrenal cancer* |
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along with an increasted risk of breast cancer, what is Peutz-Jeghers syndrome known for?
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intestinal polyposis REMEMBER?!?
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PTEN mutations are known to precipitate which syndrome?
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Cowden syndrome
(multiple hamartomas, 20-50% increased risk of breast cancer) |
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what is the most common histologic type of breast cancer?
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(Usual) Ductal Carcinoma
(70-80% of all breast carcinomas) |
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what term is used in a ductal carcinoma when stroma dominates?
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scirrous carcinoma
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second most common kind of breast carcinoma?
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lobular carcinoma
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characteristic histology of lobular carcinoma?
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"indian filing"
single lines of cells infiltrating stroma |
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three most common sites of metastases in lobular carcinoma?
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leptomeninges
retroperitoneum ovaries |
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describe the hormone receptor status and Her-2-neu status of lobular carcinoma
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most are E/P (+)
most are her-2-neu (-) |
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prognosis of a ductal carcinoma presenting as an inflammatory carcinoma?
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poor
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what type of involvement is usually seen in inflammatory carcinoma?
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lymphatic and vessel involvement
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which type of tumor is ALWAYS hormone receptor positive?
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tubular carcinoma
|
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prognosis of tubular carcinoma?
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excellent
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prognosis of "uncommon histologic types" of breast cancer vs. ductal or lobular carcinoma?
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in general, uncommon types have better prognosis
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what is by far the most important prognostic factor for a lobular or ductal breast carcinoma?
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stage (clinical spread) at diagnosis
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what three factors are taken into account in breast cancer staging?
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size of tumor
location of spread extent of spread |
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a stage 4 breast cancer has a <15% 5 year survival. what would be seen in this advanced stage?
|
involvement of:
- skin - chest wall - supraclavicular nodes - arm edema - distant mets |
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what is taken into account in breast cancer grading?
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- tubule formation
- nuclear grading - mitotic rate |
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in breast carcinoma, how do survival rates correlate with vessel and lymphatic involvement?
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survival decreases when vessel or lymphatic invasion is detected
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her-2-neu receptors are looked for to see if what therapy will be effective?
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Herceptin
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what are the two general methods of looking for the her-2-neu gene?
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1. immunostaining
2. FISH |
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is a phyllodes tumor most commonly benign or malignant?
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benign (rarely becomes malignant)
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gynecomastia is usually due to a dominance of what hormone?
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estrogen
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hormonal receptor status of male breast carcinoma?
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usually ER (+)
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what are the two stromal tumors of the breast?
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1. fibroadenoma
2. phyllodes tumor *stromal tumors are most commonly benign* |
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what are the four anatomically recognizable zones of the prostate?
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1. peripheral
2. central 3. periurethral 4. transitional |
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in which zones do hyperplasia and hypertrophy tend to be in?
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transitional, central and periurethral
(best accessed with TURP) |
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in which zone is carcinoma most likely to be in?
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peripheral zone
(best palpated by DRE) |
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how many layers are normal glands of the prostate lined by?
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two
(basal layer and overlying mucous secreting epithelium) |
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what effect does a lack of testosterone have on the prostate?
|
atrophy
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which cells produce PSA?
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acinar cells in the prostate
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besides PSA, what other thing do the acinar cells of the prostate make?
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PAP -> prostatic acid phosphatase
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two reasons for the PSA test being so controversial?
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1. some prostate CAs don't produce PSA
2. PSA can be elevated for other reasons than CA |
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what are three other reasons besides CA for the PSA to be elevated?
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1. infarction
2. inflammation 3. post-manipulation |
|
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what are the three types of inflammation that can be seen in the prostate?
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1. acute bacterial prostatitis
2. chronic bacterial prostatitis 3. chronic abacterial prostatitis |
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which type of prostatitis would present as an extremely tender prostate on exam and fever, chills and dysuria?
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acute bacterial prostatitis
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why is chronic bacterial prostatitis so difficult to treat?
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antibiotics penetrate the prostate poorly
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what is the most common form of prostatitis?
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chronic abacterial prostatitis
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BPH is most commonly seen in what age group?
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men over 50
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BPH is seen earlier in which race?
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blacks
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which part of the prostate participates in BPH?
|
periurethral area
|
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effect of hormones on BPH?
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androgens and estrogens influence BPH development
(BPH does not occur in castrated males) |
|
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two types of nodular hypertophy seen in BPH?
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stromal
glandular (or both) |
|
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describe the epithelium of BPH
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it is intact
|
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is cytological atypia seen in BPH?
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NO
|
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MOA of using 5-a-reductase to treat BPH?
|
inhibits dihydrotestosterone (DHT) formation -> no more promotion of stromal growth
|
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besides DHT, what is the other most likely candidate to be promoting prostate growth?
|
17b-estradiol
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T/F: it is well established that BPH progresses to prostate CA.
|
FALSE
no support for the progression of BPH to carcinoma. |
|
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complications of BPH?
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urinary retention
increased incidence of UTIs, pyelonephritis |
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what is the process considered to be a precursor to malignant prostate carcinoma?
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PIN
Prostatic Intraepithelial Neoplasia |
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is cytologic atypia seen in low grade PIN?
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minimal to none
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clinically, would we be worried about a paitent with low grade PIN?
|
Dr. Sens told us "not to really worry about this one too much"
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is cytologic atypia seen in high grade PIN?
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yes, significant atypia may be seen
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is the basal cell layer intact in high grade PIN?
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YES
|
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in high grade PIN, describe the size and shape of the glands
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normal
(just increased number and stratification of cells lining the glands) |
|
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connection between high grade PIN and cancer?
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>50% of men with high grade PIN develop cancer within 5 yrs
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clinical action/treatment of high grade PIN?
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close monitoring with PSA, DRE and prostatic biopsies
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MC prostate cancer in US?
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adenocarcinoma of the prostate
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prostatic adenocarcinoma is most common in what race?
|
blacks
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does prostatic adenocarcinoma have an intact basal cell layer?
|
NO
just a single layer of epithelium is seen |
|
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what type of invasion characterizes prostatic adenocarcinoma?
|
perineural invasion
|
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what is the name of the grading system in prostate cancer that is evidence based and very valuble for predicting prognosis?
|
Gleason score
(range of 2-10) |
|
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compare stage A and stage D prostate cancer
|
stage A - confined to prostate
stage D - pelvic node or other mets (grave prognosis) |
|
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at what stage is prostate cancer when it becomes symptomatic?
|
Stage D
|
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where does prostate cancer like to metastasize to?
|
bone
(therefore osteoblastic vertebral lesions in males are virtually diagnostic for prostate CA) |
|
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four options in prostate CA treatment?
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1. surgery
2. castration 3. radiation 4. hormonal treatment |
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which 2 types of prostate cancer have a better prognosis than prostate adenocarcinoma?
|
1. prostatic duct adenocarcinoma
2. endometroid carcinoma |
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how does atypical adenomatous hyperplasia (AAH) differ from BPH?
|
AAH - smaller glandular proliferations
BPH - branching large nodular lesions |
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in a hypospadia the meatus is found on which side of the penis?
|
ventral
|
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in an epispadia the meatus is found on which side of the penis?
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dorsal
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which is more common: and epispadia or a hypospadia?
|
hypospadia
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what is phimosis?
|
when the prepuce opening is too small for retraction
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what is paraphimosis?
|
forcible retraction of the prepuce over the glans penis -> causes constriction and swelling -> painful -> may cause urethral and urinary obstruction
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nonspecific infection and inflammation of the glans is called?
|
balantitis
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nonspecific infection and inflammation of the prepuce is known as?
|
balanoprosithitis
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in a patient that presents with balantitis or balanoprosithitis what else should we consider working them up for?
|
occult diabetes
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what is the MCC of balatitis or balanoprosthitis?
|
poor personal hygiene
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when are condylomata lata seen?
|
late stage syphillis
|
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what is Fournier's gangrene?
|
necrotizing, subcutaneous, gas-producing infection starting in the scrotum. 40% mortality
|
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what is Peyronie's disease?
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plastic induration of the penis that causes painful curvature towards the lesion
|
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what types of tissue may be found in Peyronie's disease?
|
cartilage
bone |
|
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Peyronie's disease may be related to?
|
chronic urethritis
|
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what is retrograde ejaculation?
|
ejaculation of semen into the bladder instead of through the urethra
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condyloma acuminatum is caused by?
|
HPV (types 6 and 11)
|
|
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is condyloma acuminatum a precancerous lesion?
|
NO
|
|
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all types of penile carcinoma in situ are related to what causative agent?
|
HPV type 16
|
|
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three types of penile CIS?
|
1. erythroplasia of Queyrat
2. Bowen's disease 3. Bowenoid papulosis |
|
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which type of CIS occurs in sexually active young adults?
|
bowenoid papulosis
|
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which type of CIS is associated with occult visceral malignancy in 1/3 of cases?
|
Bowen's disease
|
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progression rate of erythroplasia of Queyrat?
|
5-10% develop SCC
|
|
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how is bowenoid papulosis distinguished from bowen's disease?
|
bowenoid papulosis - multiple lesions
bowens disease - single lesion |
|
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progression of bowenoid papulosis to invasive carcinoma?
|
very rare
|
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is a giant condyloma (bushchle-lowenstein tumor) benign or malignant?
|
benign
|
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what is the MC penile cancer worldwide?
|
SCC
|
|
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SCC is related to?
|
uncircumcised males
(cleanliness issue) |
|
|
at what age does SCC MC occur?
|
40-70 (mid to late life)
|
|
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which hormone do Sertoli cells produce?
|
estrogen like hormones
|
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which hormone do Leydig cells produce?
|
testosterone
|
|
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the condition in which the testes are undescended is called?
|
cryptorchidism
|
|
|
is cryptorchidism usually unilateral or bilateral?
|
unilateral
|
|
|
three most common places for the undescended testicle to lie?
|
abdomen
inguinal canal upper scrotal sac |
|
|
what are the two phases of descent of the testes?
|
1. transabdominal phase
2. inguinalscrotal phase |
|
|
what types of substances govern the transabdominal phase of testicle descention?
|
mullerian inhibiting substance
|
|
|
what types of substances govern the inguinoscrotal phase of testicle descention?
|
androgens
|
|
|
in cryptorchidism: what 3 changes are seen in the testicle by age 2?
|
1. hyaline deposition
2. failure of germ cell maturation 3. tubular atrophy |
|
|
two possible consequences of untreated cryptorchidism?
|
1. sterility (if bilateral)
2. 7-10x increase in testicular cancer |
|
|
if cryptorchidism is surgically corrected, is there still a risk for testicular cancer?
|
yes
(in that testicle and the contralateral testicle) |
|
|
current treatment protocol for cryptorchidism?
|
1. surgical correction by age 2
2. monitor throughout middle age for testicular cancer |
|
|
where is inflammation more common: in the testis proper or in the epididymis?
|
epididymis
|
|
|
in gonorrhea which is inflammed first: the epididymis or the testes?
|
epididymis
|
|
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in syphilis which is inflammed first: the epididymis or the testes?
|
testes, then epididymis
|
|
|
in which age group is orchitis seen with a mumps infection?
|
puberty and adulthood
|
|
|
in which infection of the testes is "perivascular cuffing" seen?
|
SYPHILLIS
|
|
|
is TB more likely to be seen in the epididymis or the testes?
|
epididymis
|
|
|
what causes torsion of the testicles?
|
twisting of the spermatic cord -> blocks venous drainage -> get hemorrhagic infarct
|
|
|
10 predisposing conditions to testicular atrophy?
|
1. increased age
2. atherosclerosis 3. cryptorchidism 4. hypopituitarism 5. malnutrition 6. obstruction of seminal outflow 7. high FSH levels 8. radiation 9. administration of female sex hormones 10. genetic (ie. Klienfelters) |
|
|
a benign cystic accumulation of sperm (usually near the epididymis) is called?
|
spermatocele
|
|
|
95% of testicular neoplasms come from what cell type?
|
germ cells
|
|
|
most testicular neoplasms are found in what age range?
|
15-35
(small peaks in early childhood and old age) |
|
|
how does testicular cancer usually present?
|
painless mass in testicle
|
|
|
in general, what is the character of most testicular neoplasms?
|
very aggressive
(but good therapies exist) |
|
|
which histologic type of testicular cancer has a very good prognosis?
|
seminomas
|
|
|
3 tumor markers used to evaluate testicular seminomas?
|
1. AFP (alpha fetoprotein)
2. HCG (human chriogonadotrophin) 3. PLAP (placental-specific isozyme of Alkaline Phosphatase) |
|
|
AFP is ALWAYS seen in what type of testicular tumors?
|
yolk sac tumors
|
|
|
AFP is NEVER seen in what type of testicular tumor?
|
choriocarcinoma
|
|
|
hCG is ALWAYS seen in what type of testicular cancer?
|
choriocarcinoma
|
|
|
hCG is NEVER seen in what type of testicular cancer?
|
yolk sac tumors
|
|
|
PLAP is seen in what tumors?
|
in 50-60% of all testicular tumors
|
|
|
which group of lymph nodes does testicular cancer spread to first?
|
peri-aortic (retroperitoneal)
|
|
|
testicular cancer usually metastasizes to?
|
lung
(may also go to brain, liver, bones) |
|
|
connection between Intratubular Germ Cell Neoplasia (ITGCN) and cancer?
|
ITGCN is considered a precursur lesion to testicular germ cell tumors
|
|
|
does testicular cancer have a genetic component?
|
yes
see familial clustering: siblings may have 10x increased risk |
|
|
which race is testicular cancer virtually unheard of?
|
blacks
|
|
|
common genetic mutation seen in testicular germ cell tumors?
|
isochromosome of the short arm of chromosome 12.
|
|
|
which two germ cell tumors are considered not to be a result of ITGCN?
|
1. Spermatocytic seminoma
2. Pediatric yolk sac tumor |
|
|
3 major nonseminomatous germ cell tumors?
|
1. embryonal carcinoma
2. immature teratoma 3. choriocarcinoma |
|
|
what is the most common type of germ cell tumor?
|
seminoma
|
|
|
peak age at diagnosis of a seminoma?
|
40
|
|
|
prognosis of testicular seminoma?
|
excellent if confined locally or to retroperitoneum
(responsive to radiation) |
|
|
age at diagnosis of a spermatocytic seminoma?
|
65+
OLD MEN |
|
|
when an elderly man presents with a testicular mass, what two types of cancer is it most likely to be?
|
1. testicular lymphoma
-if not that, then - 2. spermacytic seminoma |
|
|
is a spermacytic seminoma benign or malignant?
|
benign
(on rare metastasis -> very aggressive) |
|
|
is ITGCN a precursur to spermacytic seminoma?
|
NO!
(spermacytic seminoma is not related to intratubular germ cell tumors) |
|
|
is spermacytic seminoma PLAP (+)?
|
NO! it is PLAP (-)
(spermacytic seminoma is not related to intratubular germ cell tumors) |
|
|
do non-seminomatous germ cell tumors have ITGCN as a precursur?
|
Yes
|
|
|
What are the three non-seminomatous germ cell tumors Dr. Sens gave us?
|
1. Embryonal Carcinoma
2. Immature Teratoma 3. Choriocarcinoma |
|
|
age at diagnosis of an embryonal carcinoma?
|
20-30 yrs
|
|
|
compare the "personality" of an embryonal carcinoma as compared to a seminoma
|
embryonal carcinoma more aggressive and lethal; tends to metastasize hematogenously
|
|
|
which tumor marker does embryonal carcinoma produce?
|
AFP
|
|
|
two components of a choriocarcinoma?
|
1. cytotrophoblast
2. syncitiotrophoblast |
|
|
choriocarcinoma makes what tumor marker?
|
hCG
|
|
|
"personality" of choriocarcinoma?
|
highly malignant
(hematogenous metastasis) |
|
|
does a yolk sac tumor have a ITGCN precursor?
|
NO
|
|
|
age at diagnosis of a yolk sac tumor?
|
infancy and childhood
|
|
|
prognosis of a yolk sac tumor?
|
excellent (in the young age group)
|
|
|
tumor marker for a yolk sac tumor?
|
AFP
|
|
|
age group at diagosis of a mature teratoma?
|
infants and children
|
|
|
prognosis of a mature teratoma?
|
benign in children
(most likely malignant if found in adult=rare) |
|
|
two sex-cord/stromal derived tumors?
|
1. Leydig cell tumors
2. Sertoli cell tumors |
|
|
crystalloids of Reinke are seen in what tumor?
|
Leydig cell tumor
|
|
|
are most Leydig and Sertoli cell tumors benign or malignant?
|
benign
(~10% malignant) |
|
|
age group at diagnosis of a testicular lymphoma?
|
elderly
|
|
|
progosis of a testicular lymphoma?
|
VERY POOR, usually metastatic
|
|
|
what other type of cancer prefers to spread to the testes?
|
leukemia
(called testicular leukemia) |
|
|
is an adenomatoid tumor benign or malignant?
|
benign
|
|
|
where does an adenomatoid tumor commonly arise?
|
epididymis
|
|
|
an adenomatoid tumor presents alot like a yolk sac tumor. how can they be telled apart?
|
adenomatoid tumor stains with keratin, yolk sac doesn't
|
