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167 Cards in this Set
- Front
- Back
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Most common benign tumor of the breast
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Fibroadenoma
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Breast tumor that varies with menstrual cycle
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Fibroadenoma
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Breast tumor from intralobular stroma, in 6th decade, cellularity, high mitotic rate, nuclear pleomorphism, overgrowth and infiltrative bodies, leaf like
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Phyllodes Tumor
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Benign breast tumor more common in men
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Myofibroblastoma
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Irregular clonal proliferation of fibroblasts, NO METS
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Fibromatosis
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Arises in response to radiation, bulky palpable masses
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Angiosarcoma
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Papillary growth w/in major ducts near nipple, serous/bloody discharge, covered by epithelium, no nipple retraction
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Large Duct Papilloma
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6 BCRAT Risks
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Age, age @ menarche, 1st live birth age, 1st degree relatives c BRCA, breast biopsy #'s, race (whites*)
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4 Mutated genes of breast CA
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BRCA 1 (52%), BRCA 2 (32%), p53 (3%), CHEK2 (5%, post radiation)
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2 Gene mutations seen in Li Fraumani
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p53 and CHEK
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Rare very aggressive breast cancer, peau-d-orange is the pathologic basis, CA spreads through breast quickly
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Inflammatory carcinoma
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Neoplastic cells limited by basement membrane, may extend to overlying skin (pagets), NO METS
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Breast cacrinoma in situ
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Sheets of highly malignant cells c central necrosis
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Comedocarcinoma
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Extends from nipple ducts to the skin of the nipple --> fissured / ulcerated skin
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Paget's disease of the nipple
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Incidental finding in the breast, bilateral in 20-40%,
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Lobular CIS
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Most common breast tumor
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Invasive ductal carcinoma
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Difference in Her-2-Nu in well-differentiated vs poorly differentiated invasive ductal carcinoma
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Well - no overexpression of H2N, poor - overexpression of H2N
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Class of invasive NST that is ER+ and responsive to hormone tx
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Luminal A
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Class of Invasive NST that is ER+, H2N+ and is very aggressive
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Luminal B
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Class of invasive NST that is ER+, H2N- and well differentiated
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Normal Breast-Like Type
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Class of invasive NST that is ER/H2N-, triple -, high grade, BRCA1 carcinoma
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Basal-like
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Class of invasive NST that is ER-, H2N+, poorly differentiated, high frequency of brain METS
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Her 2 Nu + class
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Most common in 6th decade, better prognosis than NST, soft/fleshy/well circumscribed, solid sheet of large cells c pleomorphic nuclei + lymphoplasmocytic infiltrate + non-infiltrating border
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Medullary Carcinoma
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Older women, grows slowly, has small islands of neoplastic cells in mucin
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Colloid/Mucinous Carcinoma
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Hard to detect, very infiltrative, single file formation, LCIS+, overexpresses H2N
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Invasive Lobular Carcinoma
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Late 40's, well formed tubules, + hormone receptors, excellent prognosis, mamographic spiculated masses
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Tubular Carcinoma
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Most important prognostic factor for breast cancer
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Axillary Node Status
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Most breast carcinomas drain into ______ ________?
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Sentinal Nodes
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Most valuable factor to predict response to treatment of breast cancer
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E/P receptors
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Basis of gynecomastia
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Hyperestrinism, very rare, BRCA 2
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3 Conditions related to Gynecomasita
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Kleinfelters, Testicular neoplasm, Liver Cirrhosis
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Hypospadia vs Epispadia
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Hypo - urethra on bottom, ass'd c cryptorchid testes, Epi - urethra on top, ass'd c exstrophy of bladder
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Small orifice of foreskin that prevents retraction over glans, tx c circumcision
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Phimosis
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Inability to reduce foreskin back over glans, results in swelling
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Paraphimosis
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Subcutaneous fibrosis of dorsum of penis, results in curve in older males, WNT pathway mutations
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Peyronies Disease
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Continuous erection unrelated to sex, may be caused by venous thrombosis of sicle cell
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..
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Inflammation involving glans / prepuce, from phimosis / poor hygiene, can be sexually transmitted
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Balanoposthitis
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Inflammation involved by sclerosis of prepuce, usually in older men
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Balanitis Xerotica Obliterans
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Sq Cell CA of penis involving HPV 16/18
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Penile Intraepithelial Neoplasia
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Bowen's vs Bowenoid Papulosis
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Bowens - older pts / immunocompromised, high risk of progression to SCC, Bowenoid - younger pts, good immune status, sharply demarcated, no CA risk
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Red lesion on glans / foreskin
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Erythroplasia of Queyrat
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Very rare, esp in circumcised pts, higher risk c smoking, HPV 16/18
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SCC of Penis
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Slow warty growth, good prognosis
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Verrucas Carcinoma
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Complete/Incomplete failure of testes to descend into scrotum, can cause azospermia and infertility and germ cell CA, tx c surgery (orchipexy)
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Cryptorchidism
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Loss of spermatagonia, sparing of Leydig cells, results in sterility
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Testicular Atrophy
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Nonspecific or contenital, can be from an STI or infection, or autoimmune, or TB, involved epididimis
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Epididimitis
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Burning on urination, epididimitis + orchitis, ascends to prostate, can abscess / sterility / stricture
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Gonorrhea
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Testicular involvement, postpubertal, patchy interstitial infiltrate of MONONUCLEAR CELLS
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Mumps orchitis
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Testes involved first, shows Gummas and obliterative endarteritis and plasma cells
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Syphillis
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Sharp immediate pain in genitals from trauma, too much motility or bell-clapper abnormality
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Testicular Torsion
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Found in Hernias, not a true tumor
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Lipoma of spermatic cord
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Most common tumor of epididimis, round nodules of grey tissue
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Adenomatoid tumor of scrotum
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3 Malignant tumors of Scrotum
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Liposarcoma, Mesothelioma, Rhabdomyosarcoma
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Most common malignant testicular tumors, curable, isochromosome p12, from intralobular germ cell neoplasia
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Germ Cell Tumors
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Precurser lesion of germ cell tumors of adults, expresses OCT 3/4 + NANOG + PLAP and has atypical nuclei, tx c prophylactic orchidectomy
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Intratubular Germ cell neoplasia
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Germ Cell Tumor locations (8)
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Testes, Ovaries, Ant. Mediastinum, Thyroid, Retroperitonium, Sacral Region, Pineal Gland Region, Nasopharynx
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3 High Hormones in Germ Cell Tumors
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hCG, aFP, LDH
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Most common germ cell tumor, single cell type, localized for a long time, good prognosis, -aFP/hCG, large polyhedral cells c watery cytoplasm + prominent lymphocytic infiltrates
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Seminoma
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Mixed tumors, not radiosensitive, high serum tumor markers, slow growing, excellent prognosis
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Non Seminomatous Germ Cell Tumors
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20-30yo, aggressive, hemorrhagic surface c irregular border, sheet like cells, hCG + aFP +
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Embryonal Carcinoma
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Endodermal sinus tumor, young males >3yo, very good pronosis, aFP+
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Yolk Sac Tumor
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Schiller Duval Bodies
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Yolk Sac Tumor
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Highly malignant testicular tumor, METs early, HCG+
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Choriocarcinoma
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Derived from more than 1 cell layer, mature and immature both malignant in men, only immature malignant in kids
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Teratoma
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Produces androgens / estrogen, testicular enlargement, gynecomastia, precocious puberty
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Leydig Cell Tumor
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Crystals of Reinke
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Leydig Cell Tumor
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Hormonally silent, majority benign, arranged in tubular structures
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Sertoli Cell Tumors
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Most common testicular tumor over 60yo, diffuse large B-cell type, poor prognosis
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Testicular Lymphoma
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Accumulation of fluid in sac proximal to epididymis + testes, ID c transillumination
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Hydrocele
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Blood in tunica vaginalis from direct trauma/torsion
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Hematocele
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Cystic dilation of efferent ductules or rete testis c acumulation of sperm, milky fluid in cyst
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Spermatocele
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Dilated veins in spermatic cord, bag of worms on palpation
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Varicocele
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3 Weeks post syphillis infection
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Primary syphillis
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Dark Field dx, plasma cell infiltrates, obliterative endarteritis, CHANCRE
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Syphillis
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Gummas (coagulated, necrotic center, surrounded by macros/fibroblasts/plasma cells)
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tertiary syphillis
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Rash on palms and soles, condyloma lata, orchitis, white oral patches
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Secondary Syphillis
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Can cause aneurysm of aorta from endarteritis of vasa vasorum
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Aortitis of Syphillis
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This STD readily crosses the placenta, causes late abortion/stillbirth, hutchinson teeth, interstitial keratitis, 8th nerve deafness, saddle nose
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Congenital Syphillis
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Intracellular, infects columnar epithelial cells, causes lymphogranuloma venereum, venereal urethritis, cervicitis/PID, mucopurulent cervicitis
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Chlamydia
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DNA virus, low/high risk types, affects both men and women
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HPV virus
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HPV 6, 11
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Low Risk
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HPV 16, 18, 31, 33
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HPV High Risk
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HPV warts on hand/feet
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Verruca Vulgaris
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Other name for condyloma accuminatum
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Venereal Warts
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Papillary Architecture and cells with Koilocytosis
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Condyloma Accuminatum
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How does HPV affect E2?
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Causes loss of E2 Repression, so E2 is expressed and E6/E7 are not inhibited
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What does E6 normally do, and what happens with HPV?
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E6 --> blocks p53 which causes a block of apoptosis
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What does E7 normally do, and what happens with HPV?
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E7 blocks Rb in HPV which blocks growth arrest
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Precancer HPV lesion
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VIN, VAIN, VIN, PIN, AIN, Intraepithelial Neoplasias, loss of polarity, nuclear atypia, BM INTACT
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Which CIN is low grade?
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CIN 1 only
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Which CIN's are high grade?
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CIN 2, 3, In Situ
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Where is the pap smear taken from?
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Transformation zone
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What must a pap smear sample contain?
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Metaplastic cells, columnar cells
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What do you do if you see any squamous cell abnormalities on a pap smear?
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Surgical evaluation and biopsy
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What HPV types does Gardasil prevent?
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6, 11, 16, 18
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What is the majority cell type that causes carcinoma of the cervix?
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Squamous cells
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What is Clear Cell Carcinoma associated with?
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DES use in the mother
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What is important about stage 4 cervical carcinoma?
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Extends beyond pelvis, leads to death from UREMIA
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What is a Gartner Duct Cyst / Mesonephric Duct Cyst?
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Failure of regression of the Mesonephric duct
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Double Uterus
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Didelphus
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Pelvic pain, discharge, fever, adnexal tenderness
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PID
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Causes Bartholinitis, sexually transmitted, ascends tract --> vulvovaginitis in kids, causes cervicitis / supporative infection in adults (vulva --> cervix --> PID)
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Gonococcal PID
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Fever, acute suppurative salpingitis, salpingo-oophritis, can lead to abscess or bacteremia --> infective endocarditis, septic arthritis
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Staph/Strep/Coliforms/Anerobes like clostridium PID
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Obstructed gland duct/ bartholinitis, local pain/discomfort
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Bartholin Cyst
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Inflammation of glands in the posterior introitus, can lead to ulceration
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Vulvar Vestibulitis
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Loss of pigment, inflammation, vitilligo, inflammatory dermatoses, CIS, Pagets, vulvular dystrophy, lichen sclerosis, squamous hyperplasia all can cause what?
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Vulvular Leukoplakia
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Chronic vulvulitis, occurs post-menopause, labial atrophy + narrow introitus + thin epithelium
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Lichen Sclerosis
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Squamous hyperplasia, hyperkeratosis, thickened epidermis, white vulvular plaques
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Lichen Simplex Chronicus
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Nodule of the vulva, benign tumor of apocrine glands, tends to ulcerate, tubular ducts c myoepithelial cells
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Papillary Hidradenoma
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Wart-like tumors, condylomata latum, condylomata accuminatum, HPV 6,11
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Verrucas Tumors
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Related to high risk HPV + lichen sclerosis, high p16, no PAS / S-100
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VIN
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Exophytic growth, pain, local discomfort, good prognosis
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Sq. Cell Carcinoma of Vulva
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Pruritic, red crusted skin, sharply demarcated, +PAS and +cytokeratin
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Extramammary Paget's Disease
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5% of vulvar malignancies, poor prognosis + low survival, S100+ and cytokeratin -
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Malignant Melanoma
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Most common vaginal congenital abnormality
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Imperforate Hymen
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Ass'd c double ureters, failed fusion of mullerian ducts
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Double Vagina
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Kids <5yo, polypoid tumor that extends out of vagina, grape bunch shaped
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Sarcoma Botryoides (embryonal Rhabdomyosarcoma)
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Presents in nullparas and multiparas, little consequence
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Chronic cervicitis
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Obstructed endocervical glands, mimics cancer
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Nabothian cysts
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Inflammatory overgrowths of the cervix --> bleeding
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Cervical polyps
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Cysts from mullerian remnants
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Hydatids of Morgani
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Cysts lined by granulosa cells, unruptured or resealed graffian follicles, source of ESTROGEN --> endometrial hyperplasia
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Follicular cysts
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Leutinization of follicle by LH, maintains 1st 4 months of pregnancy, yellow rim of tissue around cyst
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Corpus Luteum Cyst
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Hemorrhagic cyst from ovarian endometriosis --> leads to infertility, ovarian failure, adhesions
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Endometrial / Chocolate Cyst
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Infertility in young women, inc risk for endometrial CA, thick capsule, multiple small subcapsular collicular cysts lined by granulosa cells, leads to excess androgen, ass'd c amenorrhea / infertility / hirsutism / polycystic ovaries
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Polycystic Ovarian Disease
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Premature expulsion from uterus prior to 20 weeks
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Abortion
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Abortion prior to 12 weeks
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Spontaneous abortion
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Prior PID, Endometriosis, IUD, salpingocyesis
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Causes of ectopic pregnancy
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Most common in 1st pregnancy in the 3rd trimester, consists of HTN, edema, proteinuria
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Preeclampsia
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Preeclampsia + convulsions
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Eclampsia
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Fibrin in glomeruli / hepatic sinusoids, infarcts /hemorrhage in brain / heart / ant pit / liver --> bilateral renal cortical necrosis, infarcts and atherosis of uterine vessels
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Cause of preeclampsia
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Cystic swelling of chorionic villi into grape like clusters, disease of trophoblast
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Hydatiform mole
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ALL chorionic villi are grape like, enlarged, 2 sperm or X sperm (male only genes), causes vaginal bleed in 4-5th month, passage of grape-like masses, uterus larger than gestational date
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Complete Mole
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One or 2 sperm + egg, so 69 XXX or 69 XXY, fetus may be present but dies by week 10, some villi enlarged, looks like a missed abortion
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Partial Mole
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Trophoblast invades myometrium, may invade vessels and embolize to the lungs, HIGH HCG, persistant bleeding
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Invasive Mole
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50% from Hydatidiform moles, 25% from previous abortions, irregular spotting of bloody, brown, foul smelling fluid following pregnancy, HIGH HCG, widespread METS
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Gestational Choriocarcinoma
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Placental abruption or premature separation of placenta, increased in smokers --> bleeding, fetal death, risk of maternal death, DIC
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Abrupto Placenta
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Placenta implanted in lower uterine segment, may cover cervical os --> abnormal bleeding, ass'd c placenta accreta
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Placenta Previa
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Adherence of placenta directly to myometrium c absence of decidua --> severe postpartum hemorhage from failed separation
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Placenta Accreta
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Most common twin placenta
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Diamniotic dichorionic
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External Fetal Membrane Inflammation
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Chorionitis
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External and internal fetal membrane inflammation
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Chorioamnionitis
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Placental Chorionic Villi Inflammation
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Villitis, Placentitis
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Umbilical cord inflammation
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Funisitis
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>20yo surface epi based, <20yo germ cell based
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Ovarian Tumors
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Most common ovarian tumor type, 60% benign, most common malignant type, lined by tubal type epithelium + papillary processes, cystadenoma or cystadenocarcinoma
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Serous Ovarian Tumors
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Benign, 20-45yo, bilateral, risks of nullparity/low parity, family hx, BRCA, smooth outer surface + broad papillary processes, decrease risk with OCP's and tubal ligation
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Papillary Serous Carcinoma
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Low malignant potential, complex branching papillae, NOT RELATED TO BRCA
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Borderline Papillary Serous Tumor
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40-65yo, most common malignant ovarian tumor, ovaries + peritoneum, low grade = well differentiated (KRAS/BRAF), high grade = poorly differentiated (p53)
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Serous Carcinoma
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Primary and Secondary types, primary arises from peritoneum, secondary implants and invades peritoneum
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Peritoneal Serous Carcinoma
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Cystic --> solid with higher grades, complex papillary processes + Psammoma Bodies
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Serous Carcinoma / Cystadenocarcinoma
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Benign, multilocular, very large, lined by mucous secreting columnar cells
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Mucinous Tumors
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Uncommon, related to smoking/endometriosis, KRAS, ass'd c pseudomyxoma peritonei (malignant peritoneal implants producing mucin)
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Mucinous Cystadenocarcinoma
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Glands resemble endometrial tissue, HNPCC/PTEN mutations, good prognosis, may arise from pelvic peritoneum, ass'd c endometriosis
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Endometrioid Adenocarcinoma
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Rare, ass'd c endometriosis, abundant clear cytoplasm, related to DES exposure
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Clear Cell Adenocarcinoma
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Uncommon, benign, abundant fibrous stroma, resembles bladder transitional cells
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Brenner Tumor
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What is elevated in ovarian tumors but is not a screening test, it is used to follow progress of tumors
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CA 125
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Common, 90% of germ cell tumors, benign, 46XX composition, also called dermoid cyst
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Mature teratoma (female)
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Teratoma with single tissue element, what is the one with thyroid tissue and the one with intestinal tissues called?
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Monodermal Teratomas, struma ovarii - thyroid tissue (leads to hyperthyroid sx), Carcinoid - intestinal tissue (leads to high levels of serotonin and carcinoid syndrome)
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Rare teratoma type in females, malignant, aggressive, resembles fetal tissue
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Immature teratoma
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Most common malignant germ cell tumor, equivalent to seminoma of testes
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Dysgerminoma
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Malignant and trophoblastic differentiation, HIGH HCG, highly aggressive, poor chemo response
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Choriocarcinoma
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2/3 in postmenopausal women, potentially malignant, HIGH INHIBIN leads to FSH release, produces estrogen --> precocious puberty in kids, irregularity/bleeding in mature females, has CALL-EXNER BODIES
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Granulosa cell tumors
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Bundles of spindle shaped cells, may cause Meig's syndrome
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Fibroma-Thecomas
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Pleural Effusion, Ascites, Ovarian Fibroma
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Meig's Syndrome Sx
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Androblastoma, produces androgens, decrease sexual development in kids, virilization of adults
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Sertoli-Leydig Cell Tumors
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Signet Ring Cell Carcinoma metastatic to bilateral ovaries, most common MET's from uterus/ovary/peritoneum
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Krukenberg Tumor
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