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47 Cards in this Set
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Patient with firm prostate on DRE. Incidece increases with age.
Gross: undescenrable unless cystic Micro: Low: acinar architectural distortion with basophilic appearance High: no nuclear atypia, but reduced cytoplasmic volume, crowded nuclei. Stromal fibrosis/sclerosis. Can have cystic (dilated) features, surround a dilated duct, or show "partial" features HMWCK (35bE12) or p63 is positive |
Prostatic atrophy
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Incidental finding in an elderly man, usually in TURP chips
Gross: not evident Micro: lobular proliferation of small glands with minimal infiltration into stroma. Cells have bland to clear cytoplasm with afragmented basal layer. Cells + for PSA and PSAP, P63/HMWK |
Atypical adenomatous hyperplasia (adenosis)
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Patient with elevated PSA levels, solitary nodule on prostate
Micro: proliferation of small, well-formed glands and single cells in edematous stroma. Cells have clear to eosinophilic cytoplasm. prominent basal cells that may be hyperplastic, particularly in sclerotic/hyalinized stroma. No atypia. glands likely to contain mucin. |
Sclerosing adenosis
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Elderly patient with clinical Dx of BPH, h/o androgen depravation therapy
Micro: lesion in transition zone, crowded complex cribiform glands without atypia, abundant cytoplasm, striking basal cell layer. |
Cribiform clear cell hyperplasia
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Elderly patient with clinical Dx of BPH, h/o androgen depravation therapy
Micro: nodular expansion of uniform, round glands with normal stroma. Cells show variants of solid nests of dark basophilic cells with scant cytoplasm. May have lamellar calcifications |
Basal cell hyperplasia
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What 8 pieces of information go in physician/adv nurse pract initial licensure applications?
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1-each school attended with dates
2-each hospital where privileges 3-address of primary place of practice 4-any specialty certificate 5-year began practicing 6-appt to any school as faculty in last 10 years 7-any criminal offense or disciplinary action in last 10 yrs 8-relevant prof qualifications Additional (optional) info: 1-publications in last 10 yrs 2-professional awards/community service 3-languages other than english that you practice in 4-whether participates in Medicaid program or not |
Section 2: Part G:
Health Professions & Occupations |
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Incidental lesion in patient with BPH symptoms
Micro: deeply pigmented, melanin-filled spindle cells, haphazardly dispersed in fibromuscular stroma. No cytologic atypia |
Blue nevus of the prostate
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AA man with prostate Bx
Micro: dark appearing glands at low power. HP- decreased N/C ratio, crowding, and stratification. nuclear pleomorphism. Basal cell layer is intact |
low grade PIN
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AA man with prostate Bx
Micro: dark appearing glands at low power. HP- decreased N/C ratio, crowding, and stratification. minimal nuclear pleomorphism, but all nuclei enlarged. Prominent nucleoli. clumpy chromatin. Basal cell layer is intact |
high-grade PIN
25% chance of CA if present in 4-10% of TURP in 85-100% of resections for CA incidence increases with age |
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Elderly man with elevated PSA
Micro:cribiform pattern of glands with cells showing nuclear enlargement, nucleoili, and a loss of basal cells. Crystaloids or mucin often present. IHC- negative for CK7/20/p63, positive for PSA, PLAP, AMACAR (not in b9). |
Prostate CA
Hereditary forms are present- mutations in MSR1, HPC2 implicated |
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man with elevated PSA or abnormal DRE
Gross:may have papillary mass projecting into urethra around verumontanum Micro: resembles endometrium- glands can be papillary or cribiform, expansive. c/o malignant glands with crowded/overlapping tall cells. May have desmoplasia. Papillary variant has true fibrovascular cores. |
Ductal adenocarcinoma of the prostate (old name: endometrial adenoCA of the prostate)
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elderly man with metastatic disease, usually normal PSA levels, h/o previous prostate CA treated with androgen depravation
Outcome is poor, median survival is 7-17 months Labs: show ACTH or ADH production Gross: prostate mass with extension into the seminal vesicles Micro:prosate CA with focal or diffuse areas of neuroendocrine differentiation. *May have bright eosinophillic granues IHC: + syn, chr, CD57, NSA; - for PSA, PSAP |
Neuroendocrine CA
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Middle aged man with urinary obstruction. PSA is normal.
Micro: peripheral pallisading dark cells in nests/sheets/cords. Can be cribiform. strong desmoplastic response. IHC: + HMWCK, p63, - PSA, PSAP |
Basaloid carcinoma
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65 YO man with urinary obstruction, abnormal DRE, bone pain. PSA is normal.
Patient h/o schistosomiasis. Gross: bulky tumor that involves SVs, extraprostatic tissues, or bladder Micro: epidermoid differentiation |
Squamous cell Ca;
Adenosquamous similar with both components, PSA is typically abnormal |
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middle-aged man with urinary obstruction, abnormal DRE, or hematuria.
Gross: lesion in posterior prostate, may be solid or cystic. Micro: hypercellular stroma with sometimes degenerated cells and normal glandular elements. May resemble phylloides tumor of breast. Atypical cells may be present without glandular elements. IHC: + vimentin, CD34, desmin, SMA, HHF-35, PR, ER. |
Stromal proliferation of uncertain malignant protential (STUMP)
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middle-aged man with urinary obstruction, abnormal DRE, or hematuria.
Gross: lesion in posterior prostate, may be solid or cystic. Micro: hypercellular stroma with sometimes degenerated cells and normal glandular elements. May resemble phylloides tumor of breast. Necrosis, mitoses, and cellular atypia present IHC: + vimentin, CD34 only. |
Prostatic stromal sarcoma (PSS)
NOT most common primary prostatic sarcoma- leiomyosarcoma is |
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incidental finding in a bladder bx.
Micro: solid nests of normal-appearing urothelium in the lamina propria. They may connect to the surface. Present in 85% of bladders. |
von brunn's nests
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incidental finding in a bladder bx.
Micro: nests of normal-appearing urothelium in the lamina propria. Nests have slit-like space or "cystic" appearance of a lumen. They may connect to the surface. Present in 60% of bladders. |
cystitis cystica
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incidental finding in a bladder bx.
Micro: nests of normal-appearing urothelium in the lamina propria. Nests have slit-like space or "cystic" appearance of a lumen. The lumen is lined by columnar epithelium. They may connect to the surface. Present in 71% of bladders. Intestinal metaplasia may be present. |
Cystitis glandularis
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Young male with incidental bladder lesion and history of previous bladder injury.
Micro: papillae/fungating/velvety lesion c/o dilated tubules with eosinophilic/basophilic secretions, cords, or single cells surrounded by hyalinized BM*. Commonly have inflammation in background. Epithelial cells have prominient nuclei, but no atypia. Hobnail cells present in tubules. IHC: cells + for CK7, PLAP, PSA, AMACAR, and PAX2. |
Nephrogenic adenoma/metaplasia
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middle aged woman (90%) with frequency/urgency, sterile urine.
Gross: petechial submucosal hemorrhages Micro: small mucosal hemorrhages, ulcerated (Hunner's ulcer). Perineural inflammation Is incurable. |
Interstitial cystitis
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Middle eastern/african male with frequency/dysuria/hematuria
Gross: erythematous, granular bladder with polyps Micro:eggs in bladder wall with numerous eos and intense granulomatous response. Later in disease, fibrosis and metaplasia (keratinizing), risk for SCC |
Schistosomiasis
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Drug use and effects on bladder:
1. Cytoxan 2. BCG 3. Thiotepa/mytomycin C |
1. cancer/autoimmune drug- causes Hemorrhaginc cystitis
2. for urethral CIS- causes granulomatous cystitis 3. for urothelial CIS- causes denudation of urothelium and atypia |
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50-60 year old patient with disuria, frequency, urgency, or hematuria
Gross: unremarkable or edematous mucosa Micro: flat lesion with severe cytological and architectural atypia (anaplasia, loss of polarity, crowding, mitoses), can be full thickness or isolated cells (pagetoid). denuded surface common IHC: CK20, p53 positive, CD44 negative. (normal CK20 is only positive on the surface, CD44 on the basal cells). |
Urothelial CIS
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clinically silent or middle aged men with irritative bladder symptoms
Gross: normal mucosa or erythema Micro: loss of cell polarity, cytologic atypia that is mild, with rare mitoses and minimal nuclear changes. Denuded surface rare. IHC: misexpression of CK20, p53 positive |
Urothelial dysplasia
Genetics: alterations of chr. 9 and p53 |
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Patient with papillary neoplasm of the bladder or microhematuria
Gross: Focal elevation in the bladder, can be sessile Micro: undulating urothelium arranged in narrow papillary folds. IHC is normal |
Papillary urothelial hyperplasia
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rare bladder lesion more commonly in middle aged men, presents with hematuria
Gross: papillary tumor up to 2cm Micro: Similar to a papilloma (no atypia, mitoses, preserved polarity), but with a thickened urothelium |
Papillary neoplasm of low malignant potential (PUNLMP)
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rare bladder lesion more commonly in middle aged men, presents with hematuria
Gross: papillary tumor A: Micro: Similar to a PUNLMP, but with cytologic atypia- architectural variation, enlarged nuclei, rare mitoses IHC rare p53 positivity B- similar to above with low-power evidence of cytologic and architectural atypia, fused paipllae, lots of mitoses, cell discohestion. IHC: diffuse CK20, p53 in 1/2 of cases. 40% chance to invade, can be seen along with invasive cancer |
A: Non-invasive low grade papillary carcinoma
B: high-grade papillary carcinoma |
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Gross hematuria in 85% of patients, more common in men. 7-9th leading cancer worldwide, 4th in US. Associated with smoking (66% assc with men, 30% women).
Somatic Genetic factors include numerous deletions, ERBB2 overexpression, HRAS, p53. One germiline described: GSTM1 Gross: mass (different types) Micro: by definition, dysplastic cells that invade below the basment membrane. T2 stage (II) when through the muscularis propria. Cells have eosinophilic cytoplasms and invoke desmoplastic reaction (can be hyperplastic- pseudosarcomatous stromal reaction). Can have clear cell, plasmacytoid, sarcomatoid, and microcystic variants. IHC: CK7/CK20, p63+ |
Invasive urothelial carcinoma
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Patient living in area endemic for schistosomiasis haematobium (rare otherwise; SE africa and Egypt), presents with irritative bladder symptoms
AND smoking. 50% are in a non-functioning bladder, 20% at diverticulae Gross: bulky, necrotic tumor Micro: keratinizing squamous metaplasia and pure tumor showing epidermoid differentiation. By definition, no urothelial component 5-yr survival only 56% |
Urothelial SCC
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A: middle aged man (6:1) with hematuria
Gross: exophytic or papillary mass with ulcerating or gelatinous appearance Micro: Clear glandular differentiation in an invasive tumor... signet ring, mucinous, enteric variants. IHC similar to enteric CA, CK20 positive, CK7 variable.. villin positive in the enteric variant. May be PSAP positive, but are PSA negative. These have a terrible outcome (5yr OS <20%) B: middle aged man or woman with lesion on anterior abdominal wall or bladder dome/anterior wall., often these recur Gross: similar to above Micro: similar to above, except location (anterior wall/apex), tumor usually restricted to bladder wall rather than luminal, sharp demarcation with normal surface without insitu component, exclusion of other primary andenocarcinomas |
Non-urachal adenocarcinoma of the bladder
B: Urachal carcinoma |
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rare bladder lesion presents in middle aged (69) men with hematuria, may also present with paraneoplastic syndromes (peripheral neuropathy, hypercalcemia, hypophosphotemia and ectopic secretion of ACTH)
Gross: large solid/nodular mass infiltrating into bladder wall Micro: small cells with stippled chromatin and scant cytoplasm. Frequent mitoses and necrosis. Can have areas of urothelial carcinoma, this Dx trumps it. IHC: NSE and CD56 positive, chr is also in 1/3 |
Small cell carcinoma of the bladder
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rare lesion in post-TUR bladders (<1cm), can also occur without surgery and are larger (<9 cm).
Gross: pedunculated or polypoid Micro: myofibtoblastic cells resembling tissue culture cells- fascicles or haphazard. small vessels in myxoid stroma. mitoses present but not atypical. Surface is typically ulcerated with acute inflammation. chronic inflammation and extravasated blood is present. IHC: CK, vimentin, actin, ALK positive, negative for caldesmon and EMA. |
Inflammatory myofibroblastic tumor
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FEMALE with urinary obstructive symptoms, most common B9 mesenchymal bladder neoplasm.
Gross: mostly submucosal, can be in the wall. Micro: fascicles of spindle cells with fusiform, blunt-ended nuclei, eosinohilic cytoplasm. NO invasion. |
Bladder Leiomyoma
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Most common malignant bladder mesenchymal neoplasm in children- 20-25% of these lesions arise in GU tract. mean age is 4, M:F=3:2.
Gross: polypoid and deep variants Micro:small round cells in a myxoid stroma, cells can condense under surface epithelium ("cambium layer") in the botryoid subtype. Striations typical, rhabdoid cells IHC: myogenin, MyoD1 in the nucleus, desmin and HHF-35 also positive, but nonspecific. |
Bladder rhabdomyosarcoma
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Most common mesenchymal bladder malignant tumor in adults, affects middle aged men 2:1 over women. Patients present with hematuria and a palpable mass.
Gross: large infitrative lesion with necrosis Micro: infitrative fascicles of spindle cells, low grade-high grade cytologic atypia. Low: less than 5 mitoses/10 HPF. IHC: SMA and HHF-35, desmin in less than 50%. CK and EMA +/- |
Leiomyosarcoma
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man in 30's with h/o cryptorcidism, intersex, or infertility.
Gross: none Micro: abnormal testes in background. Seminiferous tubules are small with thickened walls and have large cells with prominent nuclei, clear cytoplasm along the membrane. IHC: dysplastic cells stain for PLAP, CD117, PAS stain progress to germ cell tumor 90% of the time |
intratubular germ cell neoplasia, unspecified (IGCNU)
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white man with painless testicular mass. May have elevated serum hCG (mild), LDH
Gross: Mass 5cm mean, confined to testes- may be multicentric. Is gray. Micro: sheets/lobules of polygonal cells with sharp borders, enlarged nuclei with vescivular chromatin and prominent nucleoli, with mitoses. Cytoplasm is clear with glycogen. fibrous trabeculae with numerous lyphocytes, plasma cells, eos. Can have lots of scarring. Variant with syncytiotrophoblastic giant cells IHC: CD117, PLAP; STGCs stain for hGC |
seminoma
MC germ cell tumor (50%) Very good treatment/outcome, even if metastatic |
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30 YO man/woman with testicular/ovarian mass
Gross: variable, small, may be infiltrative Micro: 4 patterns: tubulopapillary, solid, glandular, embroid bodies. Irregular vsecicular neclei with prominent nucleoli. Cytoplasmic borders are INDISTINCT. frequent mitoses. Vascular invasion common. Seen mostly mixed with other epithelial tumor types (2.7% alone) IHC: PLAP, CK7, CAM5.2, CK, CD30. |
Embryonal carcinoma
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infant under 4 years with testicular mass
Gross: solid tan/gray mass with glistening cut surface Micro: microvescicular/cystic pattern/ reticular- numerous thin-walled cystslined by flattened cells with little cytoplasm; schiller-duvall bodies*. Also solid areas and alveolar areas. IHC: AFP, a1 antytripsin., PLAP, LMWCK. NO CD30 |
Yolk sac tumor
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Infant with testicular mass
Gross: solid and cystic areas of varying size. filled with heterologous elements. Micro: monodermal variants present, mostly B9 unless PNET. Can see mature or immature heterologous elements. |
Teratoma
B9 and "pure" in infants, in adults typically admixed with GCTs, or have 25% chance of metastasis. mixed GCTs with teratomas do better. If PNET, confirm with t(11,22) |
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man with h/o undescended testicle and testicular mass, high bhCG levels, gynecomastia, hyperthyroidism.
Gross: small, hemorrhagic mass. Micro: trophoblastic differentiation- syncytotrophoblasts and cytotrophoblasts. Grow in sheets to cytotrophoblasts (large polygonal cells with irregular nuclei and nucleoli) capped by syncytiotrophoblasts (sarcomatoid hyperchromatic spindle cells). IHC: SYN: hCG, EMA, HPL, SP1. CYTO: HPL, SP1 |
choriocarcinoma
Rare alone, present in 15% of mixed GCTs very poor prognosis |
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adult man with testicular mass, h/o undescended testes
Gross: variable, 1cm mean. Micro: combination of different histologic types of cells. |
mixed germ cell tumor
40-60% of GCTs Unfavorable signs: Embyonal and choriocarcinoma components |
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Patient with gonadal dysgenesis/intersex, incidental testicular/ovarian (streak gonad) mass with calcifications
Gross: variable, with calification, may be asociated with GCTs Micro: organoid aggregates of germ cells and sex cord stromal cells. Germ cells resemble IGCNUs. IHC: malignant germ component- CD117, PLAP, stromal- inhibin. |
Gonadoblastoma
MGD patients have high-risk of bilateral disease (25%), both testes removed |
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Man with testicular mass, may have precocity if before puberty, or mass/gynecomastia if after.
Gross: unencapsulated yellow or brown mass Micro: sheets/aggregates of ploygonal cells with single nucleolus, eosinophilic cytoplasm. Lipochrome pigmentation may be present, as well as Reinke's crystals*. ICH: Inhibin. melan A, calretinin, CK, S100 |
Leydig cell tumor
1-3% all testicular tumors, MC sex-cord stromal |
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man with painless testicular mass
Gross: small, unilateral, solid and cystic yellow/white mass Micro: Sharply demarcated unencapsulated tumor with solid/tubular structures mixed with spindle cells. cytoplasm may be lipid rich,variable. Charcot-Bottcher crystals* (microfillament bundles) IHC: CK, vimentin, inhibin, rarely S100. |
Sertoli Cell tumor
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boy less than 6 months old with ambiguous genitalia/intersex/ chr mosaicism, testicular tumor
Gross: enlarged teste with solid and cystic mass. Micro: solid and cystic mass pushing normal prepubertal testes to the side. Cysts are follicular with mucin. small epithelial cells without atypia compose solid areas. Lots of mitoses. IHC: vimentin, inhibin, S-100, SMA desmin positive. |
Juvenile granulosa cell tumor
Is B9. |
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