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Reproductive
FA complete review part 3 Pathology Neoplasia/Cancer
| Question | Answer |
|---|---|
| What are the most common adnexal masses in women >> 55 years old? | Ovarian neoplasms |
| What are the 3 main origins of Ovarian neoplasms? | Surface epithelium, germ cells, and sex cord stromal tissue |
| What is the origin of the majority of malignant ovarian neoplasms? | Epithelial |
| What is the most common malignant ovarian tumor? | Serous cystadenocarcinoma |
| List of common predispositions or risk factor for ovarian cancer | 1. Advanced age 2. Infertility 3. Endometriosis 4. PCOS 5. Genetic predisposition 6. BRCA1 or BRCA2 mutation 7. Lynch syndrome 8. Strong family history |
| What are actions known to decrease risk of developing Ovarian cancer? | Previous pregnancy, history of breastfeeding, OCPs, tubal ligation. |
| What are clinical symptoms of ovarian neoplasms? | Adnexal mass, abdominal distension bowel obstruction, and pleural effusion |
| What marker is used to monitor therapy and relapse of an ovarian tumor? | CA125 |
| Is CA125 good for screening? | No, it is only used for therapy and relapse of Ovarian tumors |
| Maker of ovarian tumors | CA125 |
| What are the 3 types of BENIGN Ovarian surface epithelial tumors? | 1. Serous cystadenoma 2. Mucinous cystadenoma 3. Endometrioma |
| What is the most common ovarian neoplasm? | Serous cystadenoma |
| Description of Ovarian serous cystadenoma: | Lined with Fallopian tube-like epithelium; Often bilateral; Benign Surface epithelium origin |
| Which ovarian benign neoplasm is known to be lined with fallopian tube-like epithelium? | Serous cystadenoma |
| Multiloculated, large. Lined by mucus-secreting epithelium. Benign ovarian neoplasm | Mucinous cystadenoma |
| Endometriosis within ovary with cyst formation. Dx? | Endometrioma |
| What classic signs of Endometrioma? | Pelvic pain, dysmenorrhea, and dyspareunia. |
| What is the classic "cyst" seen with Endometrioma? | "Chocolate cyst" |
| Endometrioma filled with dark, reddish-brown blood. | "Chocolate cyst" |
| Which is the benign Ovarian germ cell tumor? | Mature cystic teratoma |
| What is another name for Mature cystic teratoma? | Dermoid cyst |
| Benign germ cell tumor of the ovary | Mature cystic teratoma |
| What is the most common ovarian benign tumor in females 10-30 years old? | Mature cystic teratoma |
| What does the cystic mass of a dermoid cyst consist of? | Elements of all 3 germ layers (teeth, hair, sebum) |
| Ovarian mass filled with teeth, hair, and sebum. Benign. Dx? | Mature cystic teratoma |
| What tumor is present with pain secondary to ovarian enlargement or torsion? | Mature cystic teratoma |
| Struma ovarii is associated with which ovarian tumor? | Mature cystic teratoma |
| What is struma ovarii? | Monodermal form of dermoid cyst with thyroid tissue, that uncommonly presents with hyperthyroidism. |
| Young woman presents with hyperthyroidism, but her Hypothalamic studies are normal, and only complain is pelvic pain prior menses. Dx? | Struma ovarii |
| What are the most common benign sex cord stromal tumors of the ovaries? | Fibroma and Thecoma |
| What is an ovarian fibroma? | Bundles of spindle-shaped fibroblasts |
| What syndrome is associated with Ovarian fibroma? | Meigs syndrome |
| What is Meigs syndrome? | Triad of ovarian fibroma, ascites, and hydrothorax |
| "Pulling" sensation in groin in young woman. | Ovarian fibroma |
| Ovarian fibroma + Hydrothorax + Ascites. Dx? | Meigs syndrome |
| What is the most common form to describe sensation produced by an Ovarian fibroma? | "Pulling" session in groin |
| What hormone is commonly produced by Thecoma? | Estrogen |
| How does a Thecoma is similar to a Granulosa cell tumor? | Both produce estrogen |
| What is the most common presentation of Thecoma (clinically)? | Abnormal uterine bleeding in a postmenopausal woman |
| What is a Brenner tumor? | Benign ovarian tumor, that is not classified as surface epithelium, sex cord, or germ cell tumor of the ovaries. |
| Resembles a bladder epithelium (transition cell tumor). | Brenner tumor |
| A Brenner tumor is an _______________ tumor. | Ovarian |
| Solid tumor that is pale yellow-tan and appears encapsulated. | Brenner tumor |
| What is the classical description staining of Brenner tumor nuclei? | "Coffee bean" nuclei in H&E stain. |
| List of Malignant surface epithelial tumors of the ovary: | 1. Serous cystadenocarcinoma 2. Mucinous cystadenocarcinoma |
| What is the MC ovarian malignant neoplasm? | Serous cystadenocarcinoma |
| What is an important histological finding of ovarian serous cystadenocarcinoma? | Psammoma bodies |
| What is an important complication of a ovarian mucinous cystadenocarcinoma? | Pseudomyxoma peritonei |
| What is Pseudomyxoma peritonei? | Intraperitoneal accumulation of mucinous material in Ovarian Mucinous cystadenocarcinoma |
| What are the 3 main malignant Germ cell tumor? | 1. Dysgerminoma 2. Immature teratoma 3. Yolk sac tumor |
| Ovarian dysgerminoma is most common among _______________. | Adolescents |
| Ovarian dysgerminoma is equivalent to which male tumor? | Seminoma |
| What is the approximate percentage of dysgerminoma in relation to germ cell tumors? | Accounts for 30% |
| What i the histological description of ovarian dysgerminoma? | Sheets of uniform "fried egg" cells |
| What are the tumor markers used in specifically with Ovarian dysgerminoma? | hCG and LDH |
| Aggressive, contains fetal tissue, neuroectoderm. Malignant ovarian germ cell tumor. Dx? | Immature teratoma |
| Mature Ovarian teratoma is ______________________. | Benign |
| Immature Ovarian teratoma is ______________________. | Malignant |
| Immature ovarian teratoma is likely to be diagnosed before _______ of age. | 20 |
| What is the most common representation of Immature ovarian teratoma? | Immature/embryonic-like neural tissue |
| Ovarian neoplasm that contains fetal components of neural tissue origin? | Immature teratoma |
| How else is the Yolk sac tumor of the ovary known as? | Ovarian endodermal sinus tumor |
| Ovarian endodermal sinus tumor = | Yolk sac tumor or the ovary |
| What is the most common tumor in male infants? | Yolk sac tumor |
| Aggressive, in ovaries or testes and sacrococcygeal area in young children. Dx? | Yolk sac tumor |
| Description and features of Yolk sac tumor of ovary or testes: | - Yellow, friable (hemorrhagic) , solid mass - 50% have Schiller-Duval bodies - AFP = tumor marker |
| What is the tumor marker for Yolk sac tumors? | AFP |
| What is the key histological feature of 50% of all Yolk sac tumors? | Schiller-Duval bodies |
| What does the Schiller-Duval bodes tend to resemble? | Glomeruli |
| What is the malignant sex cord tumor of the Ovary? | Granulosa cell tumor |
| Granulosa cell tumor is of what origin? | Sex cord stromal tumor |
| Granulosa cell tumor is malignant or benign ovarian tumor? | Malignant ovarian tumor |
| What is the most common ovarian malignant stromal tumor? | Granulosa cell tumor |
| What is produced by Granulosa cell tumors? | Estrogen and/or progesterone |
| What is the clinical presentation of Granulosa cell tumors? | - Postmenopausal bleeding - Sexual precocity (in pre-adolescent) - Breast tenderness |
| What is a common sign of possible granulosa cell tumor in a pre-adolescent woman? | Sexual precocity |
| Key histological finding of Granulosa cell tumors of the ovaries? | Call-Exner bodies |
| What are the Call-Exner bodies? | Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles |
| What cells are arranged around eosinophilic fluid, and resemble primordial follicles? | Granulosa cells |
| (+) Call-Exner bodies. Dx? | Granulosa cell tumor |
| What type of ovarian neoplasm origin are Immature teratomas and Dysgerminomas? | Germ cell tumors |
| Malignant Sex cord stromal tumor of the ovary? | Granulosa cell tumor |
| GI malignancy that metastasizes to ovaires. Dx? | Krukenberg tumor |
| Mucin-secreting signet cell adenocarcinoma. | Krukenberg tumor |
| What is a Krukenberg tumor? | GI malignancy that goes to the ovaries, leading to development fo mucin-secreting signet cell adenocarcinoma |
| Which population of women are most likely to be affected b malignant breast tumors? | Postmenopausal |
| What is the most common location for malignant breast tumors to arise from? | Terminal duct lobular unit |
| Common characteristic (type) of malignant breast tumor | Amplification/overexpression of estrogen/progesterone receptors or c-erbB2 |
| Estrogen/Progesterone receptors or c-erbB2 = | HER-2, an EGF receptor |
| What are the triple negatives in malignant breast cancer? | ER (-) PR(-) Her2/Neu (-) |
| What is more aggressive breast tumor, a triple negative or a HER-2 (+) cancer? | Triple negative |
| What is the most important prognostic factor in early-stage malignant breast tumor? | Metastases to axillary lymph node |
| Which lymph node is associated with poor prognosis in breast cancer? | Axillary lymph node |
| Where is the most common location for malignant breast cancer? | Upper-outer quadrant |
| Common risk factors for malignant breast cancer: | 1. Increased estrogen exposure 2. Increased total number of menstrual cycles 3. Older age at 1st live birth 4. Obesity 5. BRCA1 or BRCA2 gene mutations 6. African American ethnicity |
| Which population is most likely to develop triple (-) breast cancer? | African American |
| What are the associated breast cancer gene mutations? | BRCA1 and BRCA2 |
| Which are the non-invasive malignant breast cancer tumors? | 1. Ductal carcinoma in situ of the breast 2. Comedocarcinoma 3. Paget disease of the breast 4. Lobular carcinoma in situ of the breast |
| Malignant breast cancer are divided into two featured categories: | Non-Invasive and, Invasive |
| Which breast cancer is seen with early microcalcifications on mammography? | Ductal carcinoma in situ of the breast |
| Breast ductal carcinoma in situ arises from: | Ductal atypia |
| DCIS of the breast | Fills ductal lumen |
| How is Early stage of DCIS of the breast seen? | Early malignancy without basement membrane penetration |
| Common subtype of DCIS of the breast | Comedocarcinoma |
| Ductal, central necrosis. Subtype of breast DCIS. Dx? | Comedocarcinoma |
| What is the cause of Paget disease of the breast? | Results from underlying DCIS or invasive breast cancer. |
| What are Paget cells? | Intraepithelial adenocarcinoma cells |
| What is the most important or key feature of Paget disease of the Breast? | Eczematous patches on nipple |
| What breast malignancy is presented with eczematous patches on nipple? | Paget disease of the Breast |
| Red rash on nipple. What is the most likely breast condition? | Paget disease of the Breast |
| What are the Invasive type of malignant breast tumors? | 1. Invasive ductal carcinoma 2. Invasive lobular carcinoma 3. Medullary carcinoma 4. Inflammatory breast cancer |
| Paget disease of the breast, is it invasive or non-invasive? | Non-invasive |
| DCIS is a non-invasive or invasive breast malignancy? | Non-invasive |
| Description of Invasive ductal carcinoma of the breast | Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells. |
| What ligaments are involved/affected in Invasive ductal carcinoma of the breast? | Suspensory ligaments |
| What causes the dimpling of skin seen in Invasive ductal carcinoma of the breast? | The deformation of the Suspensory ligaments by the tumor |
| What is the classic morphology seen in Invasive ductal carcinoma of the breast? | "stellate" infiltration |
| What is the most common type of malignant breast cancer? | Invasive ductal carcinoma of the breast |
| Which breast non-invasive carcinoma is seen with decreased E-cadherin expression? | Lobular carcinoma in situ of the breast |
| How is the risk of developing breast cancer differs from DCIS and LCIS? | LCIS increases cancer in either breast, while DCSI only on the same breast and quadrant. |
| Breast exam detects a firm, 'rock-hard" mass with well defined margins in the upper left outer quadrant. Most likely diagnosis? | Invasive ductal carcinoma of the breast |
| What kind of cells are found in Invasive Breast ductal carcinoma? | Duct-like cells in desmoplastic stroma |
| What is a shared feature of Invasive lobular breast carcinoma and Lobular carcinoma in situ of the breast? | Both have decreased E-cadherin expression |
| Which is the featured histological finding of Invasive lobular breast cancer? | Orderly row of cells ("single file") |
| Which invasive breast carcinoma lacks desmoplastic response? | Invasive lobular carcinoma of the breast |
| Medullary breast cancer: | Large, anaplastic cells growing in sheets with associated lymphocytes and plasma cells |
| Often bilateral with multiple lesions in the same location. What is the most likely breast cancer? | Invasive lobular carcinoma of the breast |
| Well-circumscribed breast tumor that can mimic a fibroadenoma. | Medullary breast cancer |
| What breast malignancy is associated with lymphocytes and plasma cells? | Medullary breast cancer |
| Anaplastic cells growing in sheets with WBCs and plasma cells. | Medullary breast cancer histological features |
| Which invasive breast cancer is seen with dermal lymphatic space invasion? | Inflammatory breast carcinoma |
| What are the clinical signs of Inflammatory breast cancer? | 1. Breast pain with warm 2. Swollen, erythematous skin around exaggerated hair follicles 3. Peau d' orange |
| Breast malignancy associated with "peau d' orange"? | Inflammatory breast carcinoma |
| Inflammatory breast cancer is often mistaken for: | Mastitis or Paget disease of the breast |
| What invasive breast malignancy, usually lacks a palpable mass upon physical exam or inspection? | Inflammatory breast carcinoma |
| What are the two types of Invasive breast carcinomas? | 1. Tubular subtype 2. Mucinous subtype |
| What is an invasive tubular breast cancer? | Well-differentiated tubules that lack myoepithelium |
| What is an Invasive Mucinous breast cancer featured with? | Abundant extracellular mucin and seen in older women |
| What are the main categories of testicular tumors? | Germ cell tumors and Non-germ cell tumors |
| List of Testicular Germ cell tumors | 1. Seminoma 2. Yolk sac tumor 3. Choriocarcinoma 4. Teratoma 5. Embryonal carcinoma |
| What type of testicular tumors account for nearly 95% of them? | Testicular germ cell tumors |
| What are two common conditions/risk factors for Testicular germ cell tumors? | 1. Cryptorchidism 2. Klinefelter syndrome |
| Do testicular germ cell tumors transilluminate? | No, they do not transilluminate |
| Why are testicular germ cell tumors not biopsy (usually)? | Risk of seeding scrotum |
| What is the most definite and common treatment for testicular germ cell tumors? | Radical orchiectomy |
| What is orchiectomy? | Surgical removal of one or both testicles. |
| What is the most common testicular tumor? | Seminoma |
| Seminoma is: | - Malignant - Painless - Homogenous testicular enlargement - Most common testicular tumor |
| Histology of a Seminoma (testicular tumor): | Large cells in lobules with watery cytoplasm and "fried egg" appearance |
| Which testicular tumor is seen with elevated placental ALP and is highly radiosensitive? | Seminoma |
| What is the female representation of a testicular seminoma (similar)? | Dysgerminoma |
| How is the prognosis in Seminoma? | Excellent |
| What is another name for testicular Yolk sac tumor? | Testicular endodermal sinus tumor |
| Yellow, mucinous; Aggressive malignancy of testes. (+) Schiller-Duval bodies. Dx? | Yolk sac tumor |
| What is a key serologic feature of testicular Yolk sac tumors? | Elevated AFP |
| What is the most common testicular tumor in children < 3 years old? | Yolk sac tumor |
| Description of a testicular Choriocarcinoma: | Malignant, increased hCG. Disordered syncytiotrophoblast and cytotrophoblast elements |
| Where does a testicular choriocarcinoma commonly metastasized to via blood? | Lungs and brain |
| What are some clinical symptoms associated with testicular Choriocarcinoma? | Gynecomastia and symptoms of Hyperthyroidism |
| Why does testicular choriocarcinoma is often seen with features fo hyperthyroidism? | Due to elevated levels of hCG, which shares the a-subunit with TSH. |
| What are the characteristic of testicular (male) teratoma? | Unlike females, mature teratoma in adult males is malignant and benign in children. |
| Which testicular tumor is malignant, in comparison to the same tumor but in females? | Mature teratoma |
| Testicular teratoma is benign in ___________________. | Children |
| Embryonal carcinoma characteristics: | Malignant Hemorrhagic mass with necrosis Painful |
| Which has a worse prognosis, seminoma or embryonal carcinoma? | Embryonal carcinoma |
| Which testicular germ cell tumor is painful? | Embryonal carcinoma |
| What is the common morphology of embryonal carcinoma of the testes? | Glandular/papillary |
| How is the most common presentation for an embryonal carcinoma? | Mixed with other tumors |
| Which is more likely to be seen, a "pure" embryonal carcinoma, or a mixed embryonal testicular carcinoma? | Mixed embryonal carcinoma |
| What are the associated levels of hCG and AFP in embryonal carcinoma? | Elevated hCG and normal AFP levels |
| When is a embryonal carcinoma seen with elevated AFP levels? | Mixed embryonal carcinoma |
| For what approximate percentage are testicular non-germ cell tumors accounted for? | 5% |
| Testicular non-germ cell tumors are mostly __________________. | Benign |
| Which are the 3 most common Testicular non-germ cell tumors? | 1. Leydig cell tumor 2. Sertoli cell tumor 3. Testicular lymphoma |
| What are key histological findings in Leydig cell tumors? | Reincke crystals |
| What are Reinke crystals? | Eosinophilic cytoplasmic inclusions |
| What type of testicular tumor is seen with Reinke crystals? | Leydig cell tumor |
| Golden-brown mass, (+) Reinke crystals on histology , Gynecomastia in male patient. Dx? | Leydig cell tumor |
| What is produced by Leydig cell tumor? | Androgens and estrogens which lead to gynecomastia in adults and precocious puberty in children. |
| Androblastoma from sex cord stroma. | Sertoli cell tumor |
| What is a Sertoli cell tumor? | Androblastoma from sex cord stroma |
| What is the most common testicular caner in older men? | Testicular lymphoma |
| How does testicular lymphoma most likely arises or develops? | From metastatic lymphoma to testes. Very aggressive |
| Prostatic adenocarcinoma is most common in men over _____ years old. | 50 |
| From which areas of the prostate, does prostatic adenocarcinoma, most commonly arises? | Posterior lobe (peripheral zone) of prostate gland |
| What is the most frequent way to diagnose Prostatic adenocarcinoma? | - Elevated PSA and, - Subsequent needle core biopsies. |
| What are the most useful prostate cancer tumor markers? | PAP and PSA |
| What is a common organ to which prostate cancer metastasizes to? | Bone |
| Which common male cancer is seen with Osteoblastic metastases in bone in its late stages? | Prostatic adenocarcinoma |
| How does Osteoblastic metastases from prostate cancer present clinically? | Lower back pin and increased serum ALP and PSA |
| Blood levels of a 62 year old male shoe elevated ALP and PSA. Suspected Dx? | Prostatic adenocarcinoma with Osteoblastic metastases to the bone. |
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rakomi
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