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144 Cards in this Set

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Bartholin cyst
- obstruction of Bartholin ducts
- can become secondarily infected by N. gonorrhoeae (common) or Staphlococcus (less common)
Vulvular dystrophies
- disorders of epithelial growth
- present with leukoplakia
2 histologic forms:
1. Lichen sclerosis and hyperplastic dystrophy (bening)
2. atypical hyperplastic dystrophy (premalignant)
- clinical char: pruritis and leukoplakia
what are the two histologic forms of valvular dystrophy?
1. lichen sclerosus and hyperplastic dystrophy
2. atypical hyperplastic dystrophy
List the infectious disorders of the vulva and vagina
1. Cnadidiasis
2. Trichomoniasis
3. Bacterial vaginosis
4. TSS
5. Gonorrhea
6. Chlamydia
7. HSV
8. Syphilis
9. Chancroid
10. Granuloma inguinale
Candidasis (moniliasis)
- most common form of vaginitis
- caused by candida albicans- normal component of vaginal flora
- associated conditions: DM, pregnancy, broad spectrum antibiotics, OCPs, immunosuppression
- white, patch-like mucosal lesion
- thick white discharge
- vulvovaginal pruitis
Trichomoniasis
- second most common type of vaginitis (after candidasis)
- caused by trichomonas vaginalis
- transmitted by sexual contact
Bacterial vaginosis (Gardnerella vaginitis)
- most common cause of vaginal discharge
- fishy odor, esp with 10% KOH
- overgrowth of anaerobes (Prevotella bivia, mobiluncus spp, peptostreptococcus spp) -> superficial polymicrobial infection
- associated with increased Gardnerella vaginalis growth
which organisms cause bacterial vaginosis?
- anaerobes:
- prevotella bivia
- mobiluncus spp
- peptostreptococcus spp
- bacterial/Gardnerella vaginitis is also associated with increased numbers of gardnerella vaginalis (facultative anaerobe)
what do you see on the Pap smear to diagnose bacterial/Gardnerlla vaginitis?
- 'clue cells' (epithelial cells w/ a stippled appearance) due to adherent coccobacilli
TSS
- tampon use
- caused by exotoxin produced by Staph aureus
- fever, vomiting, diarrhea, sometimes renal failure and shock
- generalized rash followed by desquamation
Gonorrhea
- caused by N. gonorrhoeae, which frequently causes PID
- STD
- can be asymptomatic and infectious
- can ascend to endocervix, uterine canal, and fallopian ubes
- purulent acute inflammation, initially in urethra, paraurethral and bartholin glands and skene ducts
what organisms cause PID?
- N. gonorrhea
- Chlamydia trachomatis
- enteric bacteria
what are skene glands?
glands located on the upper wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening- possibly female ejaculation
which extragenital infections can be caused by gonorrhea?
- pharyngitis (orogenital contact)
- proctitis (anal intercourse)
- purulent arthritis
- ophthalmia neonatorum
describe the purulent arthritis derived from gonorrhea infection
- monoarticular, large joint (knee)
- from blood borne infection
describe ophthalmia neonatorum derived from gonorrhea infection
- neonatal conjnctival infection acquired at delivery
chalmdial infetions (2 types)
1. chlamydial cervicitis (most common STD)
2. lymphogranuloma venereum
chlamydial cervicitis
- most common STD
- caused by C. trachomatis
- frequent cause of PID
- often asymptomatic
lymphogranuloma venereum
- occurs in tropics
- caused by C. trachomatis L1, L2, or L3 serotypes
- seen as small papule or ulcer, followed by superficail ulcers and enlargement of lymph nodes
- can lead to rectal stricture from inflammation and scarring
HSV
- HSV2 causes genital herpes
- small vesicles and shallow ulcers that can involve the cervix, vagina, clitoris, vulva, urethra, and perianal skin
- cytology: multinucleated giant cells with viral inclusions
syphilis
- caused by treponmea pallidum
- STD
- firm painless chancre (no clincial sig) -> secondary syphilis (condyloma lata)
- spirochetes can cross placenta -> fetal malformation
what is condyloma lata
- gray, flattened, wart-like lesions
- seen in secondary syphilis
- do not confuse with condyloma acuminatum
Chancroid
- caused by Haemophilus ducreyi
- STD
- common in tropics; rare in US
- soft and painful ulcerated lesion (not like a chancre in syphilis)
granulom inguinale
- caused by Calymmatobacterium (Donovania) granulomatis- gram neg rod
- STD
- Donovan bodies: multiple organisms filling large histoiocytes
- papule that becomes superficially ulcerated -> large genital or inguinal ulcerations sometimes w/ lymphatic obsruction or genital distortion
Donovan bodies
- seen in granuloma inguinale
- multiple organisms filling large histoiocytes
- important diagnostic feature
list the neoplasms of the vulva
1. Papillary hidradenoma
2. Condyloma acuminatum
3. Squamous cell carcinoma
4. Paget disease of the vulva
5. Malignant melanoma
Papillary hidradenoma
- most common benign tumor of the vulva
- originates from apocrine sweat glands
- labial nodule that can ulcerate or bleed
- cure: excision
condyloma acuminatum
- bening squamous cell papilloma caused by HPV (6 & 11)
- STD
- wart like lesions, venereal warts, the the vulvovaginal and perianal regions, and sometimes cervix
- histology: koilocytes (expanded epith cells with perinuclear clearing)
what are koilocytes?
cell found in precancerous cervical lesions. They have the following characteristics:

* Nuclear enlargement(2x-3x)
* Irregularity in the nuclear contour
* Hyperchromasia
* Perinuclear clearing
Squamous cell carcinoma of the vulva
- most common malignant tumor of the vulva
- peaks in older women
- preceded by premalignant changes as vulvar intraepithelial neoplasia (VIN) 1-3
- can also be proceded by vulvar dystrophy
- HPV 16, 18, 31, 33 (same as in squamous cell carc of vagina and cervix)
paget disease of the vulva
- similar to paget disease of the breast
- sometimes associated with adenocarcinoma of the apocrine sweat glands
malignant melanoma of the vulva
- accounts for 10% of malignant tumors of the vulva
list the neoplasms of the vagina
- clear cell adenocar
- squamous cell carcinoma of cervix and vagina
- leiomyoma
- endometrail carcinoma
- cystadenoma, serous or mucinous
- mature teratoma (dermoid cyst)
- choriocarcinoma
- fibroma
- granulosa cel tumor
- krukenberg tumor
clear cell adenocarcinoma
- rare malignant tumor
- increased in daughters of women on DES during pregnancy
- can also appear with clear cell adenocarcinoma of teh cervix and vaginal adenosis
what is vaginal adenosis
- benign condition
- mucosal columnar epithelial-lined crypts in areas normally lined by stratified squamous epithelium
- precursor to clear cell adenocarcinoma
squamous cell carcinoma of the vagina
- due to extension of squamous cell carcinoma of cervix
- doesn't usually start at the vagina
Sarcoma botryoides
- rare variant of rhabdomyosarcoma
- occurs in children <5
- myltiple polypoid masses looking like a bunch of grapes projecting into the vagina, often protruding from the vulva
name some non-neoplastic disorders of the cervix
1. erosion
2. cervicitis
3. cervical polyps
cervical erosion
- columnar epithelium replacing squamous epitehilum -> erythematous area
- sometimes a manifestation of chronic cervicitis
cervicitis
- often involves the endocervix
- caused by staphlococci
- enterococci
- G. vaginalis
- T. vaginalis
- C. albicans
- C. trachomatis
- often asymptomatic; sometimes cervical discharge
cervical polyps
- inflammatory proliferations of cervical mucosa
- not true neoplasms
dysplasia and carcinoma in situ of the cervix
- most often involves sqamocolumnar jcn
- association with HPV 16, 18, 31, 33
- disordered epithelial growth: loss of polarity and nuclear hyperchromasia
- dysplasia can progress to carcinoma in situe and is classified as CIN w/ subtypes 1, 2, or 3
what is CIN 3?
- cervical intraepithelial neoplasia
- CIN 3: carciona in situ
- atypical changes extending through entire thickness of epithelium
describes the dysplasia that is seen in the cervix (HPV)
- disordered epithelial growth: loss of polarity and nuclear hyperchromasia
- begins at basal layer and extends outwards
invasive carcinoma of the cervix
- peaks in middle aged women
- most often squamous cell carcinoma
- carcinoma arises from preexisting CIN at teh squamocolumnar jcn
- dysplasia -> carcinoma in situ -> invasive carcinoma
what has changed the mortality associated with invasive carcinoma of the cervix?
- papanicolaou smear
what are the epidemiologic factors assocaited with invasive carcinoma of the cervix?
- early sexual activity
- multiple partners
- highest incidence in prostitues
- inreased incidence in poor
- increased incidence with smoking
describe HPV's role in invasive carcinoma
- dysplastic cells have koilocytosis (as seen in HPV condyloma acuminatum)
- HPV sequences are integrated inot the genomes of dysplatic cells
- 16, 18, 31, 33 most common (associated in >90% of cases)
- viral proteins E6 and E7 bind and inactivate p53 and Rb, respectively
Acute endometritis of the uterine corpus
- caused by S. aureus or streptococcus species
- related to intrauterine trauma from instrumentation, IUDs, or complications of pregnancy (retension of placental fragments after delivery)
chronic specific (granulomatous) endometritis of the uterine corpus
- of tuberculous etiology
endometriosis
- presence and proliferation of ectopic endometrial tissue
- caused by retrograde dissemination of endometrial fragments through fallopian tubes, or blood-borne or lymphatic-borne dissemination
- responsive to hormonal variation of menstrual cycle
- bleeding occurs into ectopic endometrium -> chocolate cysts
where does endometriosis most often occur?
- pelvic area, esp ovary
- uterine ligaments, rectovaginal septum, pelvic peritoneum
what are clincal manifestations of endometriosis?
- severe menstrual related pain
- can result in infertility
adenomyosis of the uterine corpus
- islands of endometrium within the myometrium
endometrial hyperplasia
- abnormal proliferation of endometrail glands
- caused by excess estrogen
- clinically manifested by postmenopausal bleeding
- sometimes a precurosr lesion of endometrail carcinoma
why might you get excess estrogen stimuation to cause endometrial hyperplasia?
- anovulatory cycles
- polycystic ovary disease
- estrogen-secreting ovarian tumors (e.g. granulosa cell tumor)
- estrogen replacement therapy
what is the risk of carcioma in endometrial hyperplasia correlated with?
- varies wtih degree of cellular atypia
- simple (cystic or mild) hyperplasias have low malignant potential
- higher grade (atypical or adenomatous with atypia) hyperplasias have greater potential
endometrial polyp
- bening lesion
- women > 40
- may result in uterine bleeding
leiomyoma (fibroid)
- most common uterine tumor
- increase in AA women
- benign neoplasm
- estrogen-sensitive. increase in size during pregnancy. shrink during menopause
- may lie in myometrium, subendometrium (can get menorrhagia), or subperitonal splace
menorrhagia
- increased menstrual bleeding
describe the locations of leiomyomas
- myometrium (intramural)
- subendometrial (submucous)
- subperitoneal (subserous)
- leiomyomas in subendometrial space can manifest as menorrhagia
leiomyosarcoma
- malignant tumor, rare
- arises de novo
- never caused by malignant transformation of a leiomyoma
endometrial carcinoma
- most common gynecologic malignancy
- increased incidence in nulliparity
- older women
- postmenopausal bleeding
- preceded by endometrial hyperplasia
- predisposing factors: prolonged estrogen stimulation, obesity, DM, hypertension
what are predisposing factors in endometrial carcinoma?
- prolonged estrogen stimulation (seen in exogenous estrogen therapy, estrogen producing tumors)
- obesity: estrone can be made in peripheral adipose tissue
- DM
- hypertension
salpingitis
- assocaited with inflammation of the ovaries and other adjacent tissue (PID)
- can be caused by trauma (surgery)
- caused by N. gonorrhoeae, anaerobic bacteria, C. trachomatis, streptococci
- can result in pyosalpinx, hydrosalpin
- can also cause tubo-ovarian abscess
hydrosalpinx
- fallopian tube filled wtih watery fluid
pyosalpinx
- fallopian tube filled with pus
hematosalpinx
- bleeding into fallopian tube
- caused by ectopic pregnancy
name the fallopian tube tumors
1. adenomatoid tumor: most freq benign tumor
2. adenocarcinoma: from extension or metastasis from another tumor
list the ovarian cysts
1. follicular cyst
2. corpus luteum cyst
3. Theca-lutein cyst
4. Chocolate cyst
5. Polycystic ovary syndrome
follicular cyst
- from distention fo the unrupture graafian follicle
- sometimes associated with hyperestrinism and endometrial hyperplasia
Corpus luteum cyst
- results from hemorrhage into persistent mature corpus luteum
- symptomatically assocaited wtih menstrual irregularity, occasionally with intraperitoneal hemorrhage
theca-lutein cyst
- results from gonadotropin stimulation
- associated with choriocarcinoma and hydatidiform mole
- often multiple and bilateral, and lined by luteinized theca cells
chocolate cyst
- blood containing cyst from ovarian endometriosis with hemorrhage
- the ovary is the most frequent site of endometriosis
polycystic ovary syndrome (Stein-Leventhal)
- seen in young women
- important cause of infertility
- amenorrhea, infertility, obesity, and hirsutism
- caused by excess LH and androgens
- associated with insulin resistance and increased risk for DM
what does hyperinsulinemia seen in polycystic ovary syndrome cause?
- increased ovarian androgen production -> increased LH production
what are the morphologic characeristics of polycystic ovary syndrome?
- markedly thickened ovarian capsule
- multiple small follicular cysts with granulosa cell layer and luteinized theca interna
- cortical stromal fibrosis with islands of focal luteinization
how are ovarian tumors categorized?
- according to the WHO, classified by the site of origin of the tumor: 1
1. tumors of surface epithelial origin
2. Tumors of germ cell origin
3. Tumors of ovarian sex cord-stromal origin
4. Tumors metastatic to the ovary
Ovarian tumors of surface epithelial origin
- 3/4 of ovarian tumors
- >20 yo
1. Serous tumors
2. Mucinous tumors
3. Endometrioid tumors
4. Clear cell tumors
5. Brenner tumors
Ovarian tumors of germ cell origin
- 1/4 of ovarian tumors
- <20
1. Dysgerminoma
2. Endodermal sinus (yolk sac) tumor
3. Teratomas
4. Ovarian choriocarcinoma
Ovarian tumors of the ovarian sex cord stromal origin
- rare
- affects all ages
1. Thecoma- fibroma group of tumors
2. Granulosa cell tumor
3. Sertoli-Leydic cell tumor
Tumors metastatic to the ovary
- 5% of all ovarian tumors
- from GI, breast, or endometrial origin
- called Krukenberg tumors when ovaries are bilaterally replaced by mucin-secreting signet-ring cells (met from stomach)
what are Krukenberg tumors?
- stomach tumor met:
when ovaries are bilaterally replaced by mucin-secreting signet-ring cells
Serous tumors of the ovary
- a surface epithelial origin tumor
1. Serous cystadenoma: bening cystic tumor lined with fallopian tube epithelium. Bilat. 20% of all ovarian tumors
2. Serous cystadenocarcinoma: malig. 50% of all ovarian tumors. bilat
Mucinous tumors
- a tumor of surface epithelial origin
1. Mucinous cystadenoma: bening. mmultilocular cysts lined by mucus-secreting columnar epithelium. filled with mucinous stuff
2. Mucinous cystadenocarcinoma: malig. usually caused by mucinous material. can cause pseudomyxoma peritonei
psuedomyxoma peritonei
- cuased by mucinous cystadenocarcinoma through rupture or metastatis.
- Psuedomyxoma peritonei can have multiple peritoneal implants that all make large amounts of intraperitoneal mucinous material
- can also be caused by mucinous cystadenoma, carcinomatous mucocele of the appendix, and other mucinoid tumors
endometrioid tumors
- a tumor of surface epithelial origin
- histologically resemble the endometrium
- usually malignant
clear cell ovarian tumors
- tumor of teh surface epithelial origin
- rare
- malignant
brenner tumor of the ovary
- rare, benign
- small islands of epithelial cells resembling bladder transitional epithelium interspersed in fibrous stroma
Dysgerminoma (ovary)
- tumor of germ cell origin
- malignant
- analogous to testicular seminoma
Endodermal sinus (yolk sac) tumor of ovary
- tumor of germ cell origin
* produces a-fetoprotein
- looks like extraembryonic yolk sac structures
- analogous to endodermal sinus tumor of testis
teratoma (ovary)
- germ cell tumor
- tissue elements from 2-3 embyonic layers
- three forms:
1. Immature teratoma
2. Mature teratoma
3. Monodermal teratoma
Immature teratoma of ovary
- aggressive malignant tumor
- has immature cellular elements
Mature teratoma (dermoid cyst) of ovary
- 20% of ovarian tumors
- 90% of germ cell tumors
* dermoid cyst is most frequent bening ovarian tumor
* cyst is lined by skin (incl. hair), and include bone, tooth, cartilage, and GI, neuro, pulm and thyroid gland tissues
- can see focal calcifications
- may arise from reduplication of meiotic maternal chromosomes, giving rise to 46XX cells of maternal origin
Monodermal teratoma of ovary
- has only a single tissue element
- e.g. struma ovarii which has only thyroid tissue; can be hyperfunctional -> hyperthyroidism
Ovarian choriocarcinoma
- a type of germ cell tumor
- agressive and malignant
- secretes hCG
Thecoma-fibroma group of tumors
- tumors of ovarian sex cord-stroma
1. Fibroma: solid; bundles of fibroblasts; associated with Meigs syndrome
2. Thecoma: lipd cells and fibroblasts; occasionally estrogen secreting
Meigs syndrome
- triad of ovarian fibroma, ascites, and hydrothorax
- associated with fibroma in the thecoma-fibroma group of tumors
Granulosa cell tumor of the ovary
- tumor of ovarian sex cord-stroma
- estrogen secreting that causes precocious puperty
- associatedw tih endometrail hyperplasia or endometrail carcinoma
- small cuboidal, deeply staining granulosa cells in anastomotic cords
- Call-Exner bodies are important diagnostic feature
Call-Exner bodies
- small follicles filled with eosinophilic secretion
- seen in granulos cell tumor of the ovary
Sertoli-leydic cell tumor (androblastoma, arrhenoblastoma)
- tumor of ovarian sex cord-stroma
- androgen secreting tumor associated with virilism
list the abnormalities of placental attachment
1. abruptio placentae (placental abruption)
2. placenta accreta
3. placenta previa
abruptio placentae (placental abruption)
- premature separation of placenta
- cause of antepartum bleeding and fetal death
- associated with DIC
placenta accreta
- attachment of placenta on mymetrium- the decidual layer is defective
* predisoed by endometrail inflammation and old scars from prior cesarean sections
- impaired placental separation after delivery, somtimes with massive hemorrhage
placenta previa
- attachment of placenta to lower uterine segment, partially or completely covering the cervical os
- may coexist with placenta accreta
* often manifested by bleeding
ectopic pregnancy
- most often in fallopian tubes
- can also occur in ovary, abdominal cavity, or cervix
- predisposed by chronic salpingitis (often gonorrheal), endometriosis and postoperative adhesions
- often idiopathic
- most common cause of hematosalpinx- tubal rupture can result
toxemia of pregnancy
- sever hypertension that occurs de novo during pregnancy or complicates preexisting hyertensive disease
- usually occurs in 3rd trimester and in 1st pregnancy
- affets the kidneys, liver, and CNS
1. Preeclampsia
2. Eclapsia
Preeclampsia
- milder form of toxemia
- hypertension
- albuminuria
- edema
- a variant of preeclampsia is the HELLP syndrome: Hemolysis, Elevated LIver enzymes, and Low Platelets
HELLP syndrome
- a variant of preeclampsia
- Hemolysis
- Elevated LIver enzymes
- Low Platelets
Eclampsia
- severe form of toxemia
- convulsions and DIC
- reverses on termination of pregnancy, but can be fatal
Amniotic fluid embolism
- caused by tear in placental membranes and rupture of maternal veins
- sudden peripartal respiratory difficulty, progressing to shock and death
* Amniotic fluid can cause DIC- marked by debris and epithelilal squamous cells in the maternal pulmonary circuation
- not the same as amniotic fluid aspiration syndrome
amniotic fluid aspiration syndrome
- inability to expel amniotic fluid at birth
- associated with prematurity
- characerized by squamous epithelial cells of amniotic origin in fetal terminal air spaces and larger bronchi
Sheeham syndrome (postpartum anterior pituitary necrosis)
- consequence of severe HYPOtension, most often from blood loss
- insidious onset, over weeks and months following delivery, of ant pit hypofunction
chorioamnionitis
- follows premature rupture of membranes
- usually cuased by ascending infection from the vagina or cervix
gestational trophoblastic disease
- degerative or neoplastic changes of trophoblastic tissue
1. Hydatidiform mole
2. Gestational choriocarcinoma
Hydatidiform mole
- enlarged, edematous placental villi in loose stroma (looks like grapes)
* increased hCG
* occurs in early months of pregnancy and transforms to choriocarcinoma in 2-3% of cases
* vaginal bleeding, increase in uterine size
- complete and partial moles
when do you see elevated hCG?
- trophoblastic disease (hydatidiform mole, gestational choriocarcinoma)
- normal or ectopic pregnancy
- germ cell tumors
complete hydatidiform mole
- no embryo
- 46 XX karyotype
- exclusively of PATERNAL derivation (androgenesis)
- from fertilization of an oocyte lacking a nucleus followed by duplication of the male chr to restore the diploid number
partial hydatidiform mole
- embryo present
- triploidy and rarely tetraploidy
- fertilization of ovum by 2 or more spermatozoa
- 69 chr derived from 2 paternal and 1 maternal haploid set
gestational choriocarcinoma
- type of gestational trophoblastic disease
- aggressive malignant neoplasm that occurs more frequently than ovarian choriocarcinoma
- increased hCG
- early heatogenous spread to lungs
- responsive to chemo
- increased incidence in Asia and Africa
- preceded by hydatidiform mole (50% of cases), abortion of ectopic preg (20%), normal-term preg (20-30%)
fibrocytic disease of the breast
- most common disorder of breast
- palpable mass in patients 25-50
- lumpy breasts with idcycle tenderness; usually bilateral
- results from increased activity of, or sensitivity to, estrogen or to decreased progesterone
which forms of fibrocytic disease of the breast increases the risk of breast cancer?
- nonproliferative forms: stromal fibrosis and cyst formation -> not associated with breast cancer
- epithelial hyperplasia (wth atypia) or sclerosing adenosis -> slightly decreased risk
- risk of cancer is clear when HYPERPLASTIC EPITHELIUM demonstrates atypia
what are the morphologic characteristics of fibrocystic disease of the breast?
- fibrosis of varying extent
- cysts are filled with fluid, and may look blue (blue dome cyst)
- lining of epithelium may be flattened, may show APOCRINE METAPLASIA or be hyperplastic
- hyperplastic epithelium can show celular atypia: adenosis
adenosis seen in fibrocystic disease of the breast
- proliferation of small ducts and myoepithelial cells
- called sclerosing adenosis when combined with fibrosis
list the tumors of the breast
1. Fibroadenoma
2. Phyllodes tumor
3. Adenoma of the nipple
4. Intraductal papilloma
5. Carcinoma of the breast
fibroademoa: tumor of the breast
- most common breast tumor in <25
- benign (not precursor for breast cancer)
- firm, rubbery, painles, and well circumscribed
- two types:
1. intracanalicular fibroadenoma: glands are slitlike
2. pericanalicular fibroadenoma: glands are round
what does fibroadenoma of the breast look like on histology?
- well-demarcated from adjacent breast tissue
- fibrous stroma encloses the epithelial component consisting of gland-like or duct-like spaces lined by cuboidal or columnar cells
- stormal cells are neoplastic
- ductal epithelal cells are thought to be reactive
Phyllodes tumor
- breast tumor
- large, bulky mass of variable malignancy with ulceration of overlying skin
- cystic spaces contain leaf-like projectsion from the cyst walls and myxoid contents are characteristic
Adenoma of the nipple
- serous or bloody discharge and a palpable mass
- can be mistaken for malignancy
intraductal papilloma of the breast
- bening tumor of the major lactiferous ducts
- serous or bloody discharge
list the types of breast carcinomas
1. intraductal carcinoma in situ (comedocarcinoma)
2. invasive ductal carcinoma (scirrhous carcinoma)
3. Paget disease of the breast
4. Lobular carcinoma in situ
5. Invasive lobular carcinoma
6. Medullary carcinoma
7. Mucinous (colloid) carcinoma
8. Inflammatory carcinomas
carcinoma of the breast (general)
- second most commmon malignancy in women after the lung
- most common cause of breast mass in postmenopausal patients
- most frequent in upper outer quadrant
- met sites: axillary lymph nodes, lung, liver, bone
- estrogen and progesterone receptors are found in some tumors
what correlates with better prognosis in breast cancer?
- presence of strogen and progesterone receptors is correlated with better prognosis and predictor of efficacy of antiestrogen therapy
- other prognostic indicators: type and size of tumor, extent of lymph node involvent, and DNA ploidy
- hyperexpression of c-erbB2 (HER-2/neu) has poorer prognosis
impact on OCPs and breast cancer
- not a predisposing factor
- may be slightly higher risk with high-dose postmenopausal estrogen therapy
what are the predisposing factors for breast cancer?
- age
- positive family history: esp first-degree female relatives. inherited p53, BRCA-1 or 2 tumor suppressor gene mutations
- history of breast cancer in one breast
- early menarch, late menopause
- obesity
- nulliparity, 1st preg >30
- high animal fat diet
- proliferative fibrocystic disease with atypical epithelial hyperplasia
what are BRCA-1 mutations associated with?
- breast and ovarian tumors
intraductal carcinoma in situ (comdocarcinoma) of the breast
- tumor cells fill ducts
- tumor cel necrosis results in cheesy consistancy
invasive ductal carcinoma (scirrhous carcinoma)
- most common type of breast cancer
- tumor cells aranged in cords, islands, and glands embedded in dense fibrous stroma
- abundant fibrous tissue -> firm consistency
Paget disease of the breast
- eczematoid lesion of the nipple or areola
- neoplastic paget cells, characteristic large cells surrounded by clear halo-like area, invade the epidermis
- underlying ductal carcinoma is almost always present
lobular carcinoma in situ
- clusters of neoplastic cells fill intralobular ductules and acini
- may lead to invasive carcinoma (sometimes many years later) in the same or contralateral breast
- often bilateral at time of inital diagnosis
invasive lobular carcinoma
- often multicentric or bilateral
- cells arranged in linear fashion ('indian-file' appearance)
- better prognosis than for invasive ductal carcinoma
medullary carcinoma
- cellular with scant stroma
- soft, fleshy consistency
- lymphocytic infiltrate
- prognosis better than that for invasive ductal carcinoma
mucinous (colloid) carcioma
- pools of extracellualr mucus surroudning clusters of tumor cells
- gelatinous consistency
- prognoss better than that for invasive ductal carcinoma
inflammatory carcinoma
- lymphatic involvement of skin by underlying carcinoma -> red, swollen, hot skin resembling inflammatory process
- poor prognosis