Exam 21 - Gyn14,15 - Pathology Of Breast And Female Lower Genital Tract

Front 1

14 – breast pathology

Back 1

ok

Front 2

*Clinical Presentation of Breast Disease*

-... mass (often presents late)
-Pain
-Nipple ... (most are benign)
-Skin changes
-Lumpiness
-... abnormality (or mammogram)

Back 2

Palpable
discharge
Radiographic

Front 3

*Breast Lumps*

-Many breast diseases present as lumps
-Most lumps represent ... things
-A lump ... needs to be evaluated
-Ultrasound, mammography, ... (smaller sample), and biopsy (more material, more accurate) are the usual methods

Back 3

benign
always
fine needle aspiration

Front 4

*Acute Mastitis*

-Associated with ... and ... in nipple
-Most cases arise in ... month of nursing
-Occurs in 5-15% of post-partum primiparous women
-Postpartum infection usually due to ... (often MRSA)
-Nonpregnancy related infections are ...
-Gross: single or multiple abscesses
-Micro: central cavity with ... (early) and secretory material surrounded by inflammatory cells and eventually ...

Back 4

lactation and cracks
first
staphylococcus aureus
polymicrobial
neutrophils
fibrosis

Front 5

*Fibrocystic Change*

-Two kinds: ... (no risk of CA) and ... (carries risk of CA) change
-Cause: exaggeration of normal breast cycles
-Rarely associated with increased cancer risk
-Very common (present in most women at autopsy)
-Called fibrocystic change, not fibrocystic disease
-May produce a palpable mass or nodularity
-Often bilateral
-Menstrual ... (CA won’t present like this)
-Pain

Back 5

nonproliferative
proliferative
variation

Front 6

look at slide 23, lecture 14

Back 6

ok

Front 7

look at slide 25, lecture 14

Back 7

ok

Front 8

What is the most common benign breast tumor?

Back 8

fibroadenoma

Front 9

Fibroadenoma:

-Most common benign breast tumor
-Affect ~10% of women
-Presentation: palpable, round, ... rubbery mass
-Stimulated by ...
-Peak incidence in what age?
-Gross: ..., well circumscribed mass
-Microscopic: Fibrous tissue with ... ducts and lobules

Back 9

movable
estrogen
20s
Solitary
compressed

Front 10

look at slide 27-28, lecture 14

Back 10

ok

Front 11

*Breast Cancer Risk Factors*

-Increases with ...
-Family History – 1st degree relative
-... menarche
-... menopause
-Increased ... exposure
-Nulliparity
-Obesity
-High-fat diet
-Proliferative fibrocystic changes

Back 11

age
Early
Late
estrogen

Front 12

*Breast Cancer*

5-10% of all cases are hereditary

Worry if ... with breast cancer

Genetic testing

Most have ... or ... mutations
-Autosomal ...
-60-80% will get breast cancer
-Some pts elect to have prophylactic mastectomies

Back 12

first degree relative
BRCA-1 or BRCA-2
dominant

Front 13

look at slide 41, lecture 14

Back 13

ok

Front 14

*Invasive Carcinoma*

Invasive (infiltrating) ... carcinoma
-Most common ~80%
-... formation, desmoplastic stroma

Invasive (infiltrating) ... carcinoma
-5-10%
-Bland cells in ... pattern
-Often ... and multifocal

Back 14

Ductal
Duct
Lobular
single file
bilateral

Front 15

*... *

-Erythema and crusting of nipple and areola
-Pruritis
-May be mistaken for eczema
-Commonly associated with underlying invasive or insitu ... carcinoma
-Micro: cells are large, atypical and spread throughout epidermis; have abundant clear or light staining cytoplasm, abundant ...

Back 15

Paget’s disease
ductal
mucin

Front 16

lecture 15 – pathology of the female lower genital tract

Back 16

ok

Front 17

Condyloma acuminatum is associated w/ HPV type .. and ...

Back 17

6 and 11

Front 18

*Paget’s Disease*

-Malignant glandular tumor of ...
-Usually involves labia ...
-Either primary (70-85% of cases) or secondary (15-30% of cases and due to ... of anorectum, urothelium, prostate)
-Gross: Crusting, weeping, oozing lesion; may be erythematous
-Micro: large pale staining tumor cells, usually in lower epidermis, in nests, glandular spaces or continuously along basement membrane; contain ...

Back 18

vulva
majora
adenocarcinoma
mucin

Front 19

*... *

-Usually upper vagina or cervix of children or adults
-Mean age 17 years, rare before age 12 or after age 30
-2/3 have history of in utero DES exposure
-Gross: may involve most of vagina; usually polypoid and nodular but may be flat/ulcerated; usually only superficially invasive at diagnosis
-Micro: tubules, cysts, solid and papillary areas with clear cells that have abundant ... (glycogen, rarely fat), hobnail cells common

Back 19

Clear cell adenocarcinoma
cytoplasm

Front 20

*Botryoid (embryonal) Rhadomyosarcoma*

-Aka sarcoma botyroides
-Usually children < 5 years (2/3 under age ...)
-... vaginal wall
-Gross: grapelike clusters that fill and project out vagina
-Micro: ...-shaped tumor cells with occasional cross-striations, stain positively for ... and ... (muscle markers), have ... layer: tumor cells crowded beneath intact vaginal epithelium

Back 20

2
Anterior
spindle
desmin and actin
cambium

Front 21

*Cervical Carcinoma*

-Once the most common cancer in women – now not even in top 10
-Decreases due to ...
-At the same time, precursor lesions (dysplasias) are ... (early detection!)
-Peak incidence in women in their forties

Back 21

Pap smears
increasing

Front 22

*Cervical Intraepithelial Neoplasia (CIN)*

Precursor to ...

Almost all carcinomas arise in CIN; but not all cases of CIN progress to carcinoma

Progression:
-CIN I: ... squamous dysplasia (half regress, 20% progress)
-CIN II: ... squamous dysplasia
-CIN III: ... squamous dysplasia (30% regress, 70% progress)

The ... the grade, the more likely the lesion will progress to carcinoma in situ or invasive squamous cell carcinoma

Back 22

carcinoma
mild
moderate
severe
higher

Front 23

*Risk factors*

-Early age at first ...
-Multiple sexual partners
-... pregnancies
-A male partner with multiple previous partners
-Persistent infection with “high-risk” ...
-Oral contraceptive use
-STDs
-... (a cofactor)
-Immunodeficiency

Back 23

intercourse
Multiple
HPV
Smoking

Front 24

*HPV and Cervical Carcinoma*

... is detectable in almost all CIN and cancer

“High-risk” types:
-... and ... (MC), 45, 31
-Found in carcinomas
-Integrate into genome
-... p53, RB

“Low-risk” types:
-6,11
-Found in ... (benign lesions)
-... integrate into genome

Back 24

HPV
16, 18
Inactivate
condylomas
Do not

Front 25

*Invasive Cervical Carcinoma*

-Most cases are ..., arising from CIN
-Small number are adenocarcinomas
-Peak age: ... (10-15 years after CIN develops!)
-Presentation: may be asymptomatic, may have discharge, bleeding, dyspareunia
-Spreads ...
-Most cases are diagnosed early
-... is related to stage:
*stage 0 (preinvasive): 100% 5 year survival
*stage 4: 10% 5 year survival

Back 25

squamous
45
slowly
Mortality

Front 26

*Pelvic Inflammatory Disease*

... infection

STD -> ... (#1 cause) and/or chlamydia

Manifestations:
-... (uterus)
-... (previous + fallopian tubes)
-... abscess (prev + ovaries)
-... (prev + peritoneal cavity)
-... (Fitz-Hugh-Curtis syndrome) (prev + liver)

Back 26

Ascending
gonorrhea
Endometritis
Salpingitis
Tuboovarian
Peritonitis
Perihepatitis

Front 27

*Pelvic Inflammatory Disease*

Can lead to tubal ...
-Infertility
-Ectopic pregnancies

PID after abortions or deliveries is ...
-Staphylococci
-Streptococci
-Coliform bacteria
-Clostridium perfringens

Back 27

scarring
polymicrobial