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59 Cards in this Set
- Front
- Back
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How are breast masses evaluated?
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self/clinical breast exams: detect palpable masses only
mammogram: can detect non-palpable tumors, or tumors w/calcification needle biopsy: can do FNA for cytology, or core for histology. Need core for more definitive Dx. excisional biopsy: to remove mass completely |
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What are the key features of the following pathologies?
fibroadenoma phyllodes tumor intraductal papilloma |
fibroadenoma: most common benign tumor, more common in younger women. Mass is small, movable, well-circumscribed, often found in UOQ. No risk or potential for malignancy.
phyllodes tumor: large, bulky mass in older women. Recurrence is common, may become malignant. intraductal papilloma: occur in ductal system, cause bloody nipple discharge. Increased carcinoma risk. |
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What are the key features of the following breast conditions?
fibrocystic change fat necrosis |
fibrocystic change: common in younger women (25-45), get breast lumps. Bilateral, multiple lesions. No risk of carcinoma. Can be fibrotic, cystic, calcified, sclerosing, etc. Usually picked up on mammography.
fat necrosis: happens post-injury, can look like carcinoma. Benign and painless. |
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What are the key features of the following breast pathologies?
intraductal carcinoma invasive ductal carcinoma invasive lobular |
intraductal carcinoma: aka ductal carcinoma in situ. not palpable, microcalcifications. Cancer is confined to ducts.
invasive ductal carcinoma: most common BC, rock hard mass with sharp margins, stellate morphology invasive lobular: 2nd most common, multiple and bilateral |
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What is the progression of breast cancer from benign to malignant?
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1. non-proliferative changes: no increased risk of malignancy whatsoever, no expansion of the epithelium
2. proliferative disease: slight increased risk, have proliferation but no atypia 3. atypical hyperplasia: moderately increased risk, have atypia and proliferation 4. carcinoma in situ: malignancy is non-invasive, high risk of invasive carcinoma 5. invasive carcinoma: tissue invasion has occured |
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What factors influence the prognosis of breast cancer?
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Prognosis = grade, tumor size
Grade: looking at histological changes, can be 1.low/2.intermediate/3.high. Tumor size: the smaller, the better. 4 stages. Lymph node status: no lymph nodes best, 10 or more positive nodes worst. |
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What are the key features of the following breast pathologies?
inflammatory breast carcinoma Paget disease |
inflammatory breast carcinoma: breast is swollen, red, p'eau d'orange. There has been dermal invasion by the carcinoma.
Paget disease: crusting patches on the nipple, but no bloody discharge. Tumor cells have migrated to the epidermis |
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What biomarkers do we use to predict therapy response?
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estrogen and progesterone receptors (+ confers more survival), HER2neu status (overexpression is worse prognosis), Oncotype DXS recurrence score (high RS would benefit from chemo, low RS from hormones).
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What are leiomyomas?
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Found most often in myometrium, also seen in cervix/vagina. Well-circumscribed, firm, solid fibroids. Can be submucosal, intramural (most common), or subserosal (can become pedunculated). Bundles of smooth muscle on histology.
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What are leiosarcomas?
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Rare, malignant fibroids of smooth muscle origin. NOT a transformation of leiomyomas. Rare, older age, spread intraperitoneally. Irregular border, soft, different colors, atypical mitoses, necrotic.
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What are endometrial polyps?
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Very common, esp. over 40. Not premalignant. See inactive glands, large spaces, fibrotic stroma, thickened blood vessels on histology. Should resect due to low risk of malignancy, increases post-menopause.
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What pathology is found with endometriosis?
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Ovary: get chocolate cysts. In general see tissue with glands, stroma, and hemosiderin.
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What are the 3 theories endometriosis?
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regurgitation of menses, metastatsis of emboli in the blood, metaplasia of normal peritoneum into endometrium
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What is the pathology of adenomyosis?
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Same as endometriosis, but get endometrial tissue inside the myometrium. Grossly, see a thickened myometrium with glands and stroma. Uterus is symmetrically enlarged.
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What are the four types of endometrial hyperplasia?
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Need to consider glands (simple vs complex) and cytological atypia (present or not).
Simple = simple glands without atypia complex = complex glands without atypia simple atypical = simple glands with atypia complex atypical = complex glands with atypia Atypias most likely to progress to cancer. |
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What are the pathological features of endometrial carcinoma?
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See lots of glandular tissue that is closely packed together, no stroma to separate. Can be well differentiated, moderately, or poorly. Endometroid, serous, clear cell and mucinous are different types, endometrioid most common.
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How is type 1 endometrial carcinoma different from type 2?
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type 1: most common, younger women, associated hyperplasia, good prognosis, estrogen driven. Same risk factors as hyperplasia.
Type 2: less common, older women, driven by p53 mutation. Serous and clear cell type, poor prognosis. |
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What are the features of the following ovarian cysts of follicular origin?
Follicle cyst Corpus luteum cyst Theca lutein cyst |
Follicle cyst: reproductive age, solitary, most go away on their own. Size makes it pathological. Lined by follicle.
Corpus luteum cyst: reproductive age, normal corpus luteum don't resolve. Lined by luteinized granulosa cells. Yellow appearance. Theca lutein cyst: multiple, bilateral. Due to high HCG. Follicle cysts that have luteinization of theca interna. |
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What are the features of the following ovarian cysts?
endometriotic cyst surface epithelial inclusion PCOS |
endometriotic cyst: chocolate cyst due to thick blood inside. Glands, stroma, hemosiderin.
surface epithelial inclusion: PCOS: multiple cysts, anovulation, high androgens surface epithelial inclusion cyst: epithelium surface gets trapped/closed off, lined by single cuboidal epithelium layer. |
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What genital tract cancer has the worse prognosis? Why? What are the main categories/features of this cancer?
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Ovarian cancer. Not detected until late stage, ovaries are relatively hidden. Four categories are epithelial, germ cell, sex-cord stromal, and metastatic. In general most ovarian tumors are benign (80%).
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What are the features of surface epithelial tumors? Describe the following subtypes
serous mucinous endometrioid clear cell transitional cell/Brenner |
Vast majority of ovarian tumors are surface epithelial. Increased risk with more ovulation, BRCA, Lynch. Can be benign, borderline, malignant.
serous: benign includes cystadenomas and papillomas, containing clear fluid. Smooth lining. Borderline are more papillary, but no stromal invasion. Get peritoneal implants. Malignant are cystic or solid, atypia, stromal invasion. Psammoma bodies. mucinous: same groups as serous. No peritoneal implants, better prognosis than serous. endometrioid: malignant, from endometriosis clear cell: malignant transitional cell/Brenner: benign, solid |
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What is Pseudomyxoma peritonei ? DPAM vs PMCA?
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Mucinous ascites due to a tumor in the appendix, colon, or ovaries. Most often in appendix, men. Present with ascites and pain.
DPAM: lots of mucin, benign looking epithelium, better survival but death from adhesions/obstruction. PMCA: high grade metastatic adenocarcinoma, aggresive, high mortality. |
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What are the features of germ cell tumors? Describe the following subtypes
teratoma dysgerminoma edodermal sinus tumor embryonal carcinoma |
20% of all ovarian tumors, younger age group. Majority are mature cystic teratomas .
teratoma: tissue from 2+ embryonic layers. Mature is one of most common tumors, aka dermoid cyst. Hair/teeth/etc. Monodermal is single tissue type. Immature are solid, can met., younger age. dysgerminoma: most common malignant, but good prognosis. Raw salmon. Tumor cells & lymphocytes. endodermal sinus tumor: highly malignant, Schiller-Duval bodies & AFP increased. Yolk sac tumor. embryonal carcinoma: highly malignant, least differentiated. Varied appearance (hemorrhage, necrosis, soft, hard). |
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What are the features of sex-cord stromal tumors?
fibroma thecoma granulosa cell tumors sertoli-leydig cell tumors |
SCST: Sex cords are precursors of sertoli cells and granulosa cells. Fibroma is most common type, benign and look like fibroids.Part of Meig's syndrome. Thecoma are benign, functional, make estrogen, yellowish color. Granulosa cell tumors are malignant but rarely spread, seen in post-menopausal, functional and make estrogen. Call-Exner Bodies + coffee bean nucleus.
Sertoli Leydig tumors are very rare, benign, young women. Make androgen. |
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Features of metastatic carcinoma of the ovary?
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5-10% of malignant ovarian tumors are mets from endometrium (most common), breast, stomach, colon. Krukenberg tumor is classic, Signet cells.
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What are hyaditaform moles?
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Can be complete or partial.
Complete: lots of trophoblast, distended villi with fluid. No maternal DNA, empty ovum. 46XX or XY, but all from dad. Present with major symptoms and really high HCG. Partial: less trophoblast and more blood vessels, scalloped, still abnormal. Normal ovum fertilized with 2 sperm, get triploid amount. Present with abortion, HCG not as high. |
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What is choriocarcinoma?
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Malignant tumor derived from trophoblast. Can occur in moles, normal pregnancies, or abortions. Mets to brain, liver, lung, vagina, pelvis. Can't differentiate btw invasive mole and choriocarcinoma. Hemorrhage is a common complication.
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What is cryptochordism?
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Undescended testis (can be one or both), leads to impaired spermatogenesis. Increased risk of germ cell tumors. Histology shows fewer germ cells in seminiferous tubules. Can also see hyaline thickening of tubular basement membrane and stromal fibrosis. Eventually lose all spermatogenic cells.
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What are the various types of testicular tumors? What pathway do most start from? What are the exceptions/age groups to the rule?
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Can have germ cell tumors or non-germ cell tumors.
Germ cell tumors: 95% of all testicular cancer, mostly malignant. Think seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, or teratoma. Non-germ cell tumors: Leydig cell, Sertoli cell, or lymphoma. Most tumors start from a routine pathway orginating with ITGN, and are most common in young adults. Exceptions are spermatocytic seminoma (old men), yolk sac (infant), and tertoma (childhood). |
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What are some risk factors for testicular cancer? What serum markers are used to evaluate?
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cryptochordism, testicular feminization from androgen insensitivity, whites > blacks, i(12p) chromosomal change.
serum markers = AFP, HCG, LDH (prognostic indicator, conveys the bulk/size of the tumor). Stage using TNMS, s being serum markers. |
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What is Intratubular germ cell neoplasia in males?
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Found in some pts with cryptochordism, and many pts with malignancy. Starting point for cancer pathway for most testicular cancers, except the 3 previously mentioned. Histology shows large cells with clear cytoplasm, enlarged vesicular nuclei, and prominent nucleoli. There is no spermatogenesis. Thicken BM. Markers include PLAP, c-kit, OCT 3/4.
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What are the features of a seminoma?
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Malignant, painless, homogenous, white, solid. Most common tumor, germ cell. Think males in 30s. Same as dysgerminoma in females, called a germinoma if found outside of gonads. Histology shows sheets of large cells in lobules, clear cytoplasm, delicate fibrous septa with plasma cell and lymphocyte infiltrate.
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What are the features of embryonal carcinoma in males?
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Malignant, painful, worse prognosis than seminoma. Glandular morphology, primitive and non-specific.
Back to back irregular glands with nuclei containing prominent nucleoli |
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What are the features of a choriocarcinoma in males ?
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On gross, see hemorrhage! Malignant, hCG will be high. Usually seen as part of a mixed germ cell tumor. Most pts present with mets to lungs or brain. Contains syncytiotrophoblast and cytotrophoblast.
*Syncytiotrophoblast and cytotrophoblast arranged in sheets with extensive hemorrhage and necrosis |
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What are the features of a yolk sac tumor in males?
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Schiller-Duval bodies on histology that look like glomeruli. Most common tumor in children. Microcystic pattern seen, but many other varieties. No fibrous septa with infiltrate distinguishes it from a seminoma. Increased AFP.
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What are the features of a teratoma in males?
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2nd most common tumor in kids after yolk sac, see variety of tissue. If found in post-pubescent males, regarded as malignant.
*Islands of cartilage, squamous epithelial pearls and glands lined by tall columnar epithelium |
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What are the features of a Leydig cell tumors? Sertoli cell tumors?
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A type of non-germ cell tumor, contains Reinke crystals. Often produce androgens leading to gynecomastia. May also make estrogens, corticosteroids.
*Rounded cells with abundant granular eosinophilic cytoplasm containing crystalloids of Reinke Sertoli cell tumors are also non-germ cell tumors. |
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What spermatocytic seminoma?
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Rare germ cell tumor, not related to seminomas. Mix of small cells, intermediate, and giant cells. Old men, low potential for malignancy, no ITGCN precursor.
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How is testicular cancer treated?
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Need surgery to remove the primary tumor. The seminoma is highly radiosensitive. Can treat NSGCT with chemo. Both types have good prognoses.
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What are the pathological features of BPH? Prostatic adenocarcinoma?
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BPH: Hyperplasia of the prostate gland. Not premalignant.
PAC: blacks > whites. PIN is the precursor. Spreads to bone, especially lumbar spine. |
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What are the important non-path features of HPV?
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Common cause of cancer and death worldwide, but not in US because of screening (but still very common). HPV causes cervical cancer (16&18 cause 70% of cancer, but about 15 types total are high risk. E6 inhibits p53, E7 inhibits RB suppressor), and genital warts (types 6 & 11). Transmitted by skin or fluid, adolescents and young women more susceptible. RFs include standard stuff, plus smoking.
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How do we screen for cervical cancer? Guidelines? Why are coloposcopies done?
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Must have HPV to get cervical cancer. Takes 8-15 years to progress.
<21 no screen 21-29 every 3 yrs 30-65 pap and HPV every 5 yrs >65 no screening coloposcopy is magnification of the cervix, done to identify and biopsy specific areas |
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What cell types are found in the cervix? What types of dysplasia exist?
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Normally, cervix undergoes metaplasia at the squamocolumnar junction. Over time, the columnar epi gets replaced by squamous epi, and we call the area btw new and old the "transformation zone". 95% of cancers develop here.
HPV effect, CIN 1 (mild), CIN 2(moderate), and CIN3 (severe or CIS). |
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How do cells change in morphology with cervical dysplasia? How does gross morphology change?
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Progressively get larger nuclei, darker, more of a halo around the nuclei. Amount of cytoplasm compared to nuclei keeps dropping. Koliocytes are the classic cell.
Normal: pink tissue, flat, lacy vessels CIN1: white tissue, still flat, feathery border CIN2: white tissue, slightly raised, demarcated border CIN3: white tissue, coarse vessels, raised, sharp border Invasive: red/yellow/gray, ulcerated, rolled edges |
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What is the natural history of HPV infection?
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Vast majority of infections are transient, asymptomatic, and resolve on their own. Younger women better at clearing infection. If HPV is still around 2 yrs later, it is a persistent infection. In men, higher prevalence but even better at clearing it. Low risk of progression at early stages, can resolve at any point, highest risk (12%) at CIN3.
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How do we treat the stages of CIN and ICC?
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CIN1: observe with pap every 6 mos and coloposcopy, can use excision or ablation but may impact future pregnancy.
CIN2/3: excise with cone biopsy or LEEP, or ablate |
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What is the presentation and other features of invasive cervical carcinoma? Staging? Treatment?
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Post-coital bleeding, lack of screening, blacks > whites. Need biopsy to Dx.
Microinvasive has better prognosis, likelihood of LN + goes up with local spread. Most are squamous, 15% are adeno. Spreads locally then through lymphatics. Staging dependent on pelvic exam, most important prognostic factor. I: cervix only II: cervix and upper vagina III: lower vagina IV: adjacent or distant organs Early stage treat with radical hysterectomy, chemoradiation Advanced think chemorad only and palliative care |
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What does the HPV vaccine protect?
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16 & 18, 6&11. Both nearly 100% protection. L1 particles in the vaccine.
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What is clear cell adenoma?
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Associated with DES exposure during pregnancy.
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Pathology of LGV?
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Caused by different type of chlamydia, 3 types and 3 stages. Ulcerative, more common in developing countries.
1: herpetiform ulcer 2: tender inguinal nodes 3: fibrosis, lymphedema, etc Need to Dx with nucleic acid, send to CDC. RX is doxy or macrolide. |
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Pathology of chancroid?
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Caused by h. ducrei, presents 1 week post infection. Associated with low SES and poor hygeine. Rare. Tender papules, then ragged ulcers. Need to rule other diseases out. Treat with azithro.
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Pathology of granuloma inguinale?
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Painless large beefy ulceration. Papules at first then gets bigger, can get secondarily infected. No systemic symptoms, but can lead to fibrosis, lymphedema. Clinical diagnosis, treat with doxy and arizthro.
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Pathology of herpes?
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HSV1=oral, 2 - genital but can switch. Multiple painful, shallow lesions, systemic symptoms. 1st attack is the worst. Chronic disease, virus is latent in sensory nerve ganglion. Recurrence due to stress, trauma, menses. Diagnose with PCR, culture, antibody in serum, or Tzanck prep. Treat pain with lidocaine or narcotics, give acyclovir. May use suppressive therapy to reduce/prevent outbreaks.
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Pathology of syphilis?
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Caused by a spirochete. First get a painless ulcer that is highly infectious. Then maculopapular rash on hands and feet + systemic symptoms. Tertiary syphilis (if untreated) causes degenerative lesions called "gumma", cardiac complications, neuro problems. Diagnose with serology or darkfield testing. Treat with penicillin.
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Pathology of low risk HPV?
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From 6 & 11, get genital warts. More common in immunocompromised. Clinical diagnosis, treat with laser ablation or topicals.
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Pathology of molluscum contagiosum?
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DNA pox virus, get umbilicated lesions. Painless. Most common in kids, not a sign of abuse. Will resolve on their own.
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Pathology of scabies?
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Sexual, casual, and fomites can transmit. Really itchy, esp at night and between fingers. Very contagious, all SES. Rash is papular with linear burrows. Clinical diagnosis, treat with Nix.
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Pathology of pubic louse?
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Sexual contact or fomites transmit it, very contagious. Intense itchiness, can get constitutional symptoms. Treat with Nix.
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What is the staging system for testicular tumors? The grading system?
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Stage 1: tumor confined to the testis
2: distant spread to retoperitoneal nodes below the diaphragm 3: mets to nodes above the diaphragm Grading uses the Gleason Scoring system, based only on cell architecture. 2-4= well differentiated, good prognosis 5-6 = moderately differentiated 7-10= poorly differentiated, poor prognosis |
