Pathology Exam 3

Front 1

The abnormal opening of the urethra along the ventral aspect of the penis. It can be constricted and lead to an inc. chance of a UT infection.

Back 1

Hypospadias

Front 2

The abnormal opening of the urethra along the dorsal aspect of the penis. Can lead to UT obstruction and urinary incontinence.

Back 2

Epispadias

Front 3

Neoplasms of the penis are all associated with HPV infections of this type

Back 3

Types 16 and 18

Front 4

Bowen disease

Back 4

Carcinoma in-situ of the penis

Front 5

Erythroplasia of Queyrat

Back 5

When penile lesions present as an erythematous patch on the glans

Front 6

Bowenoid Papulosis

Back 6

Mulitiple reddish brown papules on the glans, epithelial dysplasia with histologic features of HPV

Front 7

Occurs in uncircumcised men over 40, HPV associated, distant metastasis is relatively uncommon, 5 yr survival rate is 70%

Back 7

Squamous cell carcinoma of the penis

Front 8

Presents as a crusted papule that usually develops with ulcerations and irregular margins

Back 8

Squamous cell carcinoma of the penis
- surgical excision

Front 9

Happens by inflammatory process or fungal infection. Neoplasms of ___are rare, but squamous cell carcinoma mostly.

Back 9

Scrotum

Front 10

Cryptochidism

Back 10

- Incomplete descent of the testis
- 1% of 1 yr old males
- Bilateral (and some unilateral) is associated w/ sterility
- 3-5 fold increased risk of testicular cancer arising from intratubular germ cell neoplasia w/in the atrophic tubules
- Orchiopexy reduces risk of sterility and cancer

Front 11

When do the the testis descend 1) from the body cavity and 2) into the scrotum?

Back 11

1) Third month of gestation
2) Last 2 months of intrauterine life
- Cryptorchidism cannot be diagnosed until 1 yr of age

Front 12

Orchitis (inflammation of the testis)

Back 12

- Begins primarily as a UTI
- Frequently caused by STD
- Swelling and tenderness and includes nonspecific orchitis and tuberculosis
- Complication of mumps in adults is 20%

Front 13

2 Groups of testicular tumors

Back 13

1- Seminomas
2- Nonseminomas

Front 14

Seminomas

Back 14

- Remain confined to the testis for a long time
- May eventually spread via lymphatics
- Respond well to chemotherapy; radiosenitive

Front 15

Nonseminomas

Back 15

- Tend to spread earlier via lymphatics and BV
- Lung and liver frequent metastatic sites
- Prognosis improved w/ newer chemo regimens

Front 16

Tumor markers for nonseminomas

Back 16

Alpha-fetoprotein (AFP) and human chorionic gonadotropin (HGC)

Front 17

95% of testicular tumors arise from what?

Back 17

Germ cells

Front 18

Most common cause of painless testicular enlargement; 5 per 100,000 males; peak incidence of 20-34 yr; <400 die of disease

Back 18

Testicular tumors

Front 19

The most important categories of prostate disease (3)

Back 19

1- inflammatory lesions (prostatitis)
2- nodular hyperplasia
3- carcinoma

Front 20

Prostatitis

Back 20

- Often caused by bacteria assoc. w/ UTI
- Acute or chronic
- May present w/ dysuria, frequency, low back pain, and pelvic pain
- Often clinically silent

Front 21

Important cause of recurrent UTI in men

Back 21

Prostatitis

Front 22

Generally affects the inner periurethral zone of the prostate and compresses the prostatic urethra; proliferation of stromal and glandular elements (obstruction)

Back 22

Nodular Hyperplasia

Front 23

Nodular Hyperplasia

Back 23

- Clinical symptoms include: hesitancy, urgency, nocturia, and poor urinary stream
- Chronic obstruction predisposes to recurrent UTI
- Etiology isn't completely understood but can be assoc. w/ local androgens
- Can be treated w/ drugs mostly or surgical treatment in 10%

Front 24

Carcinoma of the prostate

Back 24

- Metastasis to lymph nodes and bone may be seen
- Mot commonly arises in the outer (peripheral) glands of the prostate; palpable
- Pathogenesis: hormones, genes, and environment

Front 25

Elevated serum prostate specific antigen (PSA); treatment includes surgery, radiation, hormone manipulation; 10 yr survival rate of 10-40% for disseminated disease

Back 25

Carcinoma of the prostate

Front 26

Microscopic feature of prostate carcinoma

Back 26

- Neoplastic glands
- Adenocarcinoma

Front 27

Syphilis is caused by what bacteria?

Back 27

Treponema pallidum (spirochete)

Front 28

Painless chancre develops at site of inoculation 9-90 days after infection; resolves spontaneously in 4-6 weeks; Ab are produced as organism spreads

Back 28

Primary syphilis

Front 29

Approx. 2 months following resolution of chancre; generalized lymphadenopathy and mucocutaneous lesions; macular rash, condyloma lata, and mucous patches affect muscosa; patient enters latent phase ofter several weeks

Back 29

Secondary syphilis

Front 30

Develops after latent period of 5+ years; patient less likely to be infectious

Back 30

Tertiary syphilis

Front 31

Cardiovascular Syphilis

Back 31

- 80%
- Proximal aortitis, aortic insufficiency, and aneurysms

Front 32

Neurosyphilis

Back 32

- 10%
- Involvement of the brain, meninges, and spinal cord

Front 33

Benign tertiary syphilis

Back 33

- Focal granulomatous lesions called gummas develop in bone, skin, and mucous membranes of the upper airway and mouth

Front 34

Congenital syphilis

Back 34

- Maternal transmission across the placenta
- Stillbirth
- Infantile syphilis: infants w/ clinical manifestations at birth or w/in first few months of life
- Late congenital syhilis (untreated, > 2 yrs duration)

Front 35

Hutchinson's Triad

Back 35

1- Hutchinson's teeth
2- Interstitial keratitis of eyes
3- Eighth cranial nerve deafness
* from late congenital syphilis

Front 36

Diagnosing syphilis

Back 36

The infection produces two types of antibodies: a nonspecific antibody, syphilitic reagin, and a specific antibody, treponemal antibody. The reagin can be detected by several simple screening serologic tests (VDRL: venereal disease research laboratory, RPR: rapid plasma reagin), but these are not specific for syphilis. Up to 15% of positive screening tests for syphilis reagin are biologic false-positive results. The more difficult and expensive specific treponemal antibody tests (FTA: fluorescent treponemal antibody absorption test) should be performed following positive screening tests. The specific treponemal tests remain positive for life, even following successful treatment

Front 37

Syphilis is treated w/ ___

Back 37

Penicillin

Front 38

Hallmark of syphilis

Back 38

The histopathologic hallmark of syphilis is a lymphoplasmacytic infiltrate associated with obliterative endarteritis, a specific type of vasculitis

Front 39

Gonorrhea

Back 39

Gonorrhea is a frequent sexually transmitted disease caused by Neisseria gonorrhoeae, a gram-negative diplococcus. An estimated 650K cases occur annually in the U.S., and this is complicated by the emergence of strains which are resistant to multiple antibiotics. Humans are the only natural reservoir, and spread requires direct contact with the mucosa of an infected person. Sites of entry include the urethra, oropharynx, eyes and the anorectum

Front 40

Symptoms of gonorrhea

Back 40

The diplococcus evokes a neutrophilic inflammatory reaction which produces copious amounts of pus. Two to seven days after exposure, symptomatic males exhibit dysuria, urinary frequency and mucopurulent exudation from the urethra; the main symptoms in females are dysuria, lower pelvic pain and vaginal discharge.

Front 41

How to diagnose gonorrhea

Back 41

Culture of the exudates

Front 42

Most common STD caused by Chlamydia trachomatis; clinically similar to gonorrhea but milder w/ less complications; treated w/ ceftriaxone and doxycycline

Back 42

Nongonococcal urethritis and cervicitis

Front 43

Initial (primary) infection of herpes

Back 43

- Many primary infections are asymptomatic; the remainder develop painful focal lesions with dysuria, fever, lymphadenopathy, headache and malaise. The glans penis or surrounding areas in men and the cervix in women are the usual sites. Involvement of the vagina, vulva and labia may also be seen. The lesions are small vesicles that quickly ulcerate.
- Without treatment, the clinical manifestations may last 3-6 weeks

Front 44

Recurrent lesions of herpes

Back 44

Recurrent herpes presents with periodic vesiculo-erosive lesions that heal in 7-10 days. More than 80% of the patients with HSV Type II genital herpes have one or more recurrences yearly for several years.

Front 45

Herpes

Back 45

Genital herpes simplex (herpes genitalis) is a common STD that affects an estimated 50 million individuals in the U.S. and occurs from infection by herpes simplex virus. Most are caused by
HSV Type II, with a small percentage related to Type I. Spread is possible when the virus comes in contact with a mucosal surface or broken skin. The clinical manifestations vary considerably, depending on whether the infection is primary or recurrent

Front 46

Exfoliative cytology/biopsy reveal viral cytopathic effect (ballooning degeneration of epi cells w/ large, often multinucleate, purple staining nuclei)

Back 46

Herpes diagnosis

Front 47

The most common form of HPV, condyloma acuminatum, is caused by what?

Back 47

HPV types 6 and 11

Front 48

HPV Infections

Back 48

- Proliferative lesions (benign or malignant) on the genital mucosa
- Benign papillary nodules that frequently appear in clusters

Front 49

Histology: Papillary proliferation of shamus epithelium exhibiting koilocytic change
Treatment: Surgical excision, lasers, cryotherapy, imiquimod

Back 49

Condyloma Acuminatum

Front 50

Diseases of the cervix can be ___or ___

Back 50

Inflammatory (cervitis) or neoplatic

Front 51

Inflammation of the cervix, is extremely common and is associated with purulent vaginal discharge. The process may be secondary to specific infections such as candida, trichomonas, chlamydia, gonorrhea, syphilis, HPV, or herpes; but more commonly, it arises from nonspecific infections and is seen in virtually every multiparous woman. It may be acute or chronic

Back 51

Cervicitis

Front 52

Colposcopy

Back 52

- Medical diagnostic procedure to view a magnified cervix
- Abnormalities appear as white patches following application of acetic acid

Front 53

Risk factors for squamous cell carcinoma (cervix)

Back 53

Early onset of coitus, multiple sexual partners, a male partner with multiple previous sexual partners, and persistent infection with “high-risk” HPV. HPV being present in 85-90% of cervical neoplasia

Front 54

High risk HPV types _and _ are associated with __. Low risk HPV types _and_ are associated with __.

Back 54

16 and 18, cancer
6 and 11, condyloma

Front 55

13th leading cause of female cancer mortality in the US; 10,500 new cases w/ 3,900 annual deaths; >50,000 precancerous conditions diagnosed annually

Back 55

SCC of cervix

Front 56

Pap Smear

Back 56

- Detects precancerous cells
- Exfoliated cells collected and stained
- Ids dysplastic cytological features
- Inexpensive but gives both false positives and false negatives

Front 57

Cytologic and maturational disturbances of epithelium seen microscopically

Back 57

Dysplasia

Front 58

Approximately 75-95% of cervical cancers present as squamous cell carcinoma. Most (perhaps all) invasive cervical carcinomas arise from precursor lesions termed ___.

Back 58

Cervical intraepithelial neoplasia

Front 59

___ ___ is responsible for the majority of female reproductive tract diseases and they are either chronic or recurrent

Back 59

Uterine corpus

Front 60

The myometrium is composed of what type of muscle?

Back 60

Smooth

Front 61

The endometrium changes due to what?

Back 61

Hormonal changes
- glandular lining of the uterus

Front 62

This is a benign tumor arising from smooth m. of the myometrium and is the most common benign tumor in females (30-50% repro ages)

Back 62

Leiomyoma (fibroids)

Front 63

Growth of leiomyoma is stimulated by what? What are the symptoms and complications?

Back 63

- Estrogens; regress after menopause
- May be asymptomatic; can cause menorrhagia, a palpable pelvic mass, or infertility

Front 64

Most frequent female tract cancer in the US; diagnosed between 55-65; present in setting estrogen excess (exo/endogenous) or endometrial atrophy

Back 64

Endometrial carcinoma

Front 65

Symptoms include leukorrhea and irregular bleeding; treatment includes surgery and radiation +-chemo; 90% 5 yr survival for stage 1 and 20% 5 yr for stage 3 and 4

Back 65

Endometrial carcinoma

Front 66

T/F Non-neoplastic cysts of the ovaries are not common and are a serious problem

Back 66

False, they are common and not a serious problem

Front 67

This is the 5th leading cause of cancer death in women, has a wide variety of histological types, and risk factors include nulliparity and family history

Back 67

Ovarian carcinoma

Front 68

Surface epithelial variant accounts for 70% of these
- less commonly arise from germ cell or stroma

Back 68

Ovarian carcinoma

Front 69

Mutations of these genes are linked to ovarian and breast cancers

Back 69

BRCA genes
-BRCA 1 and 2 for ovarian and breast
- Familial in 5-10% of cases

Front 70

Most endometrial diseases present w/ abnormal what?

Back 70

Uterine bleeding

Front 71

Menorrhagia

Back 71

Abnormally heavy menstrual bleeding

Front 72

Metorrhagia

Back 72

Bleeding between menstrual cycles

Front 73

Dysmenorrhea

Back 73

Unusually painful menstrual bleeding

Front 74

Endometriosis

Back 74

- Functional endometrium (glands and stroma) located outside the uterus which undergoes cyclic bleeding
- 10% women in repro yrs
- 50% women w/ infertility

Front 75

Intrapelvic bleeding and organization of blood leads to widespread fibrosis and periuterine adhesions=> severe dysmenorrhea and pelvic pain

Back 75

Endometriosis

Front 76

Chocolate cysts of the ovaries are large blood filled sacs on the ovaries and related to what?

Back 76

Endometriosis

Front 77

Endometrial hyperplasia

Back 77

This is an overgrowth of endometrial glands and stroma resulting from excess exposure to estrogen (ex/endogenous)

Front 78

Risk Factors for endometrial hyperplasia

Back 78

- obesity
- hormone intake
- failure to ovulate
- estrogen producing ovarian tumors

Front 79

This may progress to adenocarcinoma w/ stages that are mild, moderate, or atypical hyperplasia

Back 79

Endometrial hyperplasia

Front 80

Tumors of the uterus

Back 80

- may arise from endometrium or myometrium
- all produce uterine bleeding
- most common neoplasms are endometrial polyps, smooth m. tumors, and carcinomas

Front 81

T/F Most ovarian cancers are asymptomatic until they become large

Back 81

True

Front 82

Teratoma

Back 82

Differention of totipotential germ cells into mature tissues representing all three germ layers

Front 83

Happens in first 2 decades of life; often an incidental finding on examination; 1% chance of malignancy in younger patients

Back 83

Teratoma

Front 84

Dermoid cyst

Back 84

90% benign mature cystic teratoma

Front 85

Micro pathology of teratoma includes

Back 85

- Multiple mature elements
=> skin, hair, teeth, bone, resp epi, cartilage

Front 86

__% of breast pathologies are fibrocystic changes while __% are actually cancerous, __% had no disease and __% are fibroadenomas

Back 86

40%, 10%, 30%, and 7%

Front 87

Fibrocystic changes

Back 87

- Very common
- Arises during repro yrs
- Exaggeration and distortion of normal cyclic breast changes occurring w/ menstruation
- Overgrowth of fibrous stroma and/or glandular elements
- May increase risk for cancer

Front 88

T/F Fibrocystic changes are generally innocuous but may cause breast lumps that must be differentiated from cancer

Back 88

True

Front 89

Fibroadenoma

Back 89

- Most common benign neoplasm of the breast
- In prepubertal girls, peak prevalence in 3rd decade
- Results from increased estrogen
- Discrete, solitary freely movable nodule 1-10 cm
- Biopsy for diagnosis

Front 90

2nd leading cause of cancer in women; 1 in 8 US women; 75% occurs after age of 50; 5-10% are inherited mutations

Back 90

Breast carcinoma

Front 91

Breast carcinoma

Back 91

- Arises from glandular and ductal structures of the breast (both have pre invasive stages)
- Majority arises from mutated BRCA1 and BRCA2 genes

Front 92

Breast carcinoma treatment and prognosis

Back 92

Combo of surgery, radiation, chemo, tamoxifen (anti-estrogen therapy). Prognosis is variable and dependent on stage
- overall 10 yr survival is around 50%

Front 93

Detecting breast cancer

Back 93

- Clinical exam
=> non-tender mass, nipple retraction, thickened overlying skin that resembles surface of an orange
- Mammography
=> calcification of soft tissue density
- Diagnosis
=> Biopsy

Front 94

T/F Bowen's disease is specific for the penis and cannot occur at other site such as the vulva or mouth

Back 94

False, not specific

Front 95

This cancer tends to arise in those over 40 and may be preceded by Bowen’s disease

Back 95

Carcinoma of the penis

Front 96

__ penetrate the prostate poorly, and the most common cause of recurrent urinary tract infections is the ___.

Back 96

Antibiotics; surviving bacteria

Front 97

T/F Androgen supplementation is good for prostate cancers

Back 97

False, androgens are an associated cause

Front 98

T/F Both the incipient and clinically evident cancers usually begin in the peripheral zones of the posterior lobe of the prostate; therefore, dysuria is not frequently an early sign of prostate cancer

Back 98

True

Front 99

T/F PSA levels are only useful in detecting prostate cancer

Back 99

False, elevated levels also seen w/ prostatitis and nodular hyperplasia

Front 100

T/F PSA is not important in staging of the neoplasm and judging response to treatment.

Back 100

False, it is

Front 101

Humans are the only natural host in this STD

Back 101

Syphilis

Front 102

T/F The specific treponemal tests remain positive for life, even following successful treatment.

Back 102

True

Front 103

T/F Serological tests for syphilis are often negative in the early stages

Back 103

True

Front 104

T/F Treatment within the first three months of pregnancy will generally prevent clinical complications of congenital syphilis

Back 104

False, four months

Front 105

Humans are the only natural reservoirs in this STD

Back 105

Gonorrhea

Front 106

These HPV types are found more frequently in epithelial neoplasias

Back 106

HPV 16, 18, 31, 33, 35

Front 107

Menorrhagia, metrorrhagia, and dysmenorrhea can be caused by what?

Back 107

Endometriosis, endometrial hyperplasia, leiomyomas, and endometrial carcinoma.

Front 108

Complications of long-standing endometriosis

Back 108

Widespread fibrosis and adherence of pelvic structures; severe dysmenorrhea, dyspareunia (painful intercourse), dysuria, pain upon defecation, and pelvic pain may occur secondary to intrapelvic bleeding and periuterine adhesions. Involvement of the oviducts and ovaries may result in sterility

Front 109

___ women with evidence of estrogen excess have endometrioid carcinoma and in __ women with endometrial atrophy have serous carcinoma

Back 109

Perimenopausal; older

Front 110

This bacteria is linked to prostatitis

Back 110

E. coli

Front 111

Primary syphilis chancres take how long to heal?

Back 111

4-6 weeks

Front 112

T/F Non-syphilic spirochetes are found in the oral cavity so dark-field microscopy has limited use in the initial stages

Back 112

True