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UGS Pathology Final

Pathology of the RS

What are the causes of endometritis? 1) Pelvic inflammatory disease 2) Miscarriage/Delivery 3) IUD
What are the consequences of endometritis? Fever, abdominal pain, menstrual abnormalities, infertility, and ectopic pregnancy
Where does adenomyosis occur? In the endometrial stroma, glands, or both embedded in myometrium
What are the clinical manifestations of adenomyosis? Menorrhagia, dysmenorrhea No cyclical bleeding
Where does endometriosis occur? Endometrial glands and stroma in a location outside the uterus Multifocal, multiple tissues in pelvis
What are the clinical manifestations of endometriosis? Dysmenorrhea, and pelvic pain Present as a pelvic mass filled with degenerating blood (chocolate cyst) Cyclic bleeding Fibrosis Sealing of fimbriated ends Distortion of ovaries
What are the three possible pathogeneses of endometriosis? 1) Regurgitation theory, proposes menstrual backflow through the fallopian tubes 2) Metaplastic theory --> endometrial differentiation of coelomic epithelium 3) Vascular or lymphatic dissemination
What are the 3 diagnostic criteria of endometriosis? 1) Endometrial glands 2) Endometrial stroma 3) Hemosiderin pigment
What are the causes of Dysfunctional Uterine bleeding? 1) Failure of ovulation - Due to hormonal dysfunction, malnutrition, obesity, and stress 2) Endomyetrial disorders- infection, polyps, hyperplasia, and cancer
What is the cause of endometrial hyperplasia? Excess of estrogen relative to progestin
How is severity of Endometrial hyerplasia staged? 1) Simple 2) Complex 3) Atypical --> leads to cancer
What are the manifestations of benign endometrial polyps? Sessile or pedunculated lesions that are 0.5 to 3 cm in diameter
What is the morphology of benign endometrial polyps? Endometrial cystically dilated glands, with small muscular arteries and fibrotic stroma
What are the types of endometrial carcinoma? 1) Endometroid 2) Serous
What are the two clinical settings in endometrial carcinoma? Perimenopausal women --> estrogen excess Older women -->endometrial atrophy
What is the most frequent cancer in the female genital tract? Endometrial carcinoma
What are the risk factors of Endometroid carcinoma? Obesity, DM, HT, Infertility, HRT, and Estrogen secreting ovarian tumors
What is the 5 year survival late for Stage 1, Stage 2, Stage 3 and 4 Endometroid carcinoma? Stage 1 --> 90% Stage 2 -->30-50% Stage 3 and 4--> 20%
What are the genetic mutations in Endometroid carcinoma? DNA mismatch repair genes PTEN
What are the genetic mutations in Serous endometrial carcinoma? p53 mostly
What is the most common benign tumor in females? Leiomyomas
What are the types of Leiomyomas? 1) Intramural 2) Submucosal 3) Subserosal
What is the morphology of Leimyomas? Circumscribed, firm gray-white masses with whorled cut surface Hemorrhage and cystic softening, and after menopause they may become calcified
What are the clinical manifestations of Leimyomas? Mostly asymptomatic Possible menorrhagia NEVER transform into sarcoma
What is the morphology of Leiomyosarcoma? Soft, hemorrhagic, and necrotic Have infiltrative borders
What are the diagnostic criteria of Leiomyosarcoma? Coagulative necrosis,cytologic atypia, and mitotic activity
What is the 5-year survival rate of Leiomyosarcoma? 40%
What are the clinical manifestations of Stein-Leventhal syndrome/Polycystic ovaries? Oligomenorrhea, hirsutism, infertility, and obesity
What is the pathogenesis of Stein-Leventhal syndrome/Polycystic ovaries? Excessive production of androgens; high concentrations of LH, and low concentrations of FSH
What is the morphology of Stein-Leventhal syndrome/Polycystic ovaries? Bilateral enlarged ovaries, fibrotic outer surface Subcortical cysts <1 cm
What is the 5th most common cancer deaths in women? Ovarian tumors
What are the causes of ovarian tumors? Nulliparity and family history BRCA-1 and BRCA-2 p53 MOSTLY HER2/NEU K-Ras
What are the types of surface epithelial ovarian tumors? 1) Serous 2) Mucinous 3) Endometroid 4) Clear cell 5) Brenner
What are the most frequent and most common malignant ovarian tumors? Serous tumors
What are the types of Ovarian tumors? 60% benign, 15% borderline, and 25% malignant Benign in 30 - 40 years Malignant in 45 - 65 years.
What are the genetic mutations in serous tumors? Borderline/Low grade --> KRAS and BRAF High-grade--> BRCA1 and p53
What is the general morphology of serous tumors? Psammoma bodies in the tips of papilla
What is the morphology of the different types of serous tumors? 1) Benign -->large, cystic, filled with fluid, and a single layer of columnar epithelium 2) Borderline -->Mild cytologic atypia, no stromal invasion 3) Malignant -->Anaplasia of cells and invasion of the stroma
What are the types and prevalence of Mucinous tumors? 80% benign. 10% low malignant potential (borderline) 10% malignant
What are the mutations in ovarian endometroid carcinoma? PTEN tumor suppressor gene
What are Benign (Mature) Cystic Teratomas? Tumor of totipotential germ cells into mature tissues of all three germ cell layers
What percentage of Benign Cystic teratomas are unilateral? 90%
What is the morphology of Benign Cystic teratomas? Cyst filled with sebaceous secretion and hair; bone and cartilage; epithelium, or teeth
Torsion occurs in what percentage of Benign Cystic teratomas? 10-15%
What are the clinical manifestations of Ovarian tumors? Pain, gastrointestinal complaints, urinary frequency, torsion producing severe abdominal pain, and Ascites
What are the causative agents of Salpingitis? Chlamydia, Mycoplasma , coliforms, (postpartum), strept. and staph.
What are the clinical manifestations of Salpingitis? Fever, lower abdominal or pelvic pain, tubo-ovarian abscess, adhesions of tubal plicae (risk of ectopic pregnancy), and permanent sterility
What is the most common tubal malignancy? Serous carcinoma
What are the risk factors of tubal malignanacy? BRCA mutations
Where does ectopic pregnancy occur? 90% -->fallopian tubes Ovaries and abdominal cavity
What are some predisposing factors for ectopic pregnancy? Tubal obstruction (50%) PID, tumors, endometriosis, and IUCD
What are the clinical manifestations of ectopic pregnancy? Intratubal hematoma (hematosalpinx) and intraperitoneal hemorrhage Acute abdomen
What are the two forms of Hydatid moles? 1) Complete --> an empty egg is fertilized by two spermatozoa --> diploid 2) Partial --> a normal egg is fertilized by two spermatozoa --> triploid
Which hydatid mole permits embryogenesis? Partial
What is the morphology of the hydatid mole? Cystically dilated chorionic villi (grapelike structures) with cytologic atypia
What is the incidence of hydatid moles? 1/2000 Higher in asian countries In women younger than 20 and older than 40
How is a hydatid mole diagnosed clinically? Elevations of hCG in the maternal blood and absence of fetal parts or fetal heart sounds
What is the prognosis for hydatid moles? complete moles: 80% to 90%--> no recurrence 10% --> invasive mole (invades myometrium) 2% to 3% --> choriocarcinoma. Partial moles --> better prognosis
What is a choriocarcinoma? very aggressive malignant tumor arises from gestational chorionic epithelium or from gonads
What is the incidence of choriocarcinoma? 1/30,000 Risk greater before age 20 and after age 40
What percentage of choriocarcinomas arise in complete hydatid moles? 50%
What percentage of choriocarcinomas arise after abortion? 25%
How is choriocarcinoma diagnosed? Bloody, brownish discharge and very high titer of hCG in blood and urine
What is the morphology of choriocarcinomas? Very hemorrhagic, necrotic masses within the myometrium Tumor is composed of anaplastic cytotrophoblast and syncytiotrophoblast
What is the prognosis of choriocarcinomas? Widespread dissemination via blood to lungs (50%), vagina, brain, liver, and kidneys. Good response to chemo
What is the most common cause of breast lumps? Fibrocystic changes
What may decrease the risk of fibrocystic changes? OCPs
Fibrocystic changes are found in what percentage of women in autopsy? 60-80%
What is the most common benign neoplasm of female breast? Fibroadenoma
When does fibroadenoma occur? In the third decade of life
What is the morphology of a fibroadenoma? A discrete, solitary, freely movable nodule Enlarges during pregnancy and late menstrual cycle Regresses and calcifies after menopause
What is the neoplastic element of Fibroadenoma? Stromal cells
What is the most common cancer in females? Carcinoma of the breast
What is the second most common cause of cancer death in females? Carcinoma of the breast
What percentage of patients with breast carcinoma are over 50? 75%
What is the pathogenesis of breast carcinoma? Familial --> BRCA Sporadic -->HER2/NEU Increased exposure to estrogen Environmental variables Premenopausal family history
What are the risk factors in breast carcinoma? Premenopausal and bilateral family history Increased age Prolonged exposure to exogenous estrogens Ionizing radiation in early life
What are the most common locations for breast carcinomas? Upper outer quadrant 50% Central portion 20% Lower outer quadrant, and upper and lower inner quadrant --> 10% each
What groups are breast cancers classified into: 1) Noninvasive (confined by a basement membrane and do not invade into stroma or lymphovascular channels) 2) Invasive (infiltrating)
What are the types of noninvasive breast cancers? Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS)
What are the types of invasive breast cancers? Invasive ductal carcinoma – NOS Invasive lobular carcinoma Medullary carcinoma Colloid (mucinous) carcinoma Tubular carcinoma
What is the morphology of Comedu DCIS? High-grade nuclei with extensive central necrosis Calcification is common
What is the prognosis of DCIS? Excellent 97% survival post mastectomy
How is DCIS treated? Surgery, radiation, and tamoxifen
What is the most common invasive breast carcinoma? Invasive ductal carcinoma - NOS Not otherwise specified
What is the precancerous lesion of invasive ductal carcinoma? DCIS
How does invasive ductal carcinoma present clinically? A hard mass on the mammogram Retraction of the nipple and fixation of the nipple to the chest wall in advanced stages
What receptors are expressed by invasive ductal carcinoma? 2/3 express ER or PR 1/3 overexpresses HER2/NEU
What percentage of all breast carcinoma does invasive lobular carcinoma make up? <20%
What is the precancerous lesion in most cases of invasive lobular carcinoma? LCIS
Invasive lobular carcinoma presents as multicentric and bilateral masses in: 10-20% of cases
How does invasive lobular carcinoma present clinically? As palpable masses or mammographic densities
What is the difference between receptors expression in Invasive lobular carcinoma and invasive ductal carcinoma? Almost all of these carcinomas express ER and PR, but HER2/NEU overexpression is usually absent in lobular
How does breast cancer spread? Lymph and blood Mostly to the lungs, skeleton, liver, and adrenals Less commonly, brain spleen pituitary
How do we screen for the spread of breast cancer? Mammographs and MRI
Which factors determine the prognosis of breast carcinomas? 1) Size 2) LN involvement 3) Distant met. 4) Grade 5) Histology 6) Presence/Absence of estrogen and progesterone receptors 7) Proliferation rate 8) Aneuploidy 9) HER2/NEU overexpression
What are the causes of gynecomastia in the male? 1) Physiologic --> with age and at puberty 2) Pathologic -->cirrhosis of the liver; Klinefelter syndrome; estrogen-secreting tumors; estrogen therapy; digitalis therapy.
What is the ratio of breast carcinomas in males to females? 1:125
Why is carcinoma of the male breast severe? Scant amount of breast substance in male, lead to the tumor rapidly infiltrating overlying skin and underlying thoracic wall Half have lymph node and distant metastasis by time of involvement
What are the most common tumors in men? Testicular neoplasms
What age group is most likely to be affected with testicular neoplasms? 15-24 tears of age
What are the two main types of testicular nsubclassifiedeoplasms? 1) Germ cell tumors (95%) --> Malignant 2) Sex cord stromal tumors --> Benign
What are the risk factors for testicular neoplasms? 1) White race 2) Cyptorchidism 3) Intersex syndromes 4) Family history 5) Cancer in one testes 6) i2p --> all germ cell tumors 7) Intratubular germ cell neoplasia 8)
The testicular germ cell tumors are sub-classified into: 1) Seminomas 2) Non Seminomas Or histologically: Pure (60%) and mixed (40%)
30-40% of testicular tumors are: Seminomas Most common
What are the clinical mainfestations of Seminomas? Progressive painless enlargement of the testis
What is the morphology of Seminomas? Soft, well-demarcated tumors Usually without hemorrhage
What is the morphology of Embryonal carcinoma? Ill-defined, invasive masses containing foci of hemorrhage and necrosis Microscopically: Large and primitive cells with a basophilic cytoplasm
The most common primary testicular neoplasm in children younger than 3 yr: Yolk sac tumors
What is the morphology of Yolk sac tumors? Composed of cells forming Microcysts, Lacelike patterns. A distinctive feature is the presence of Schiller-Duvall bodies
What substance is elevated in yolk sac tumors? AFP
What cells make up choriocarcinomas? Trophoblastic cells
What percentage of testicular neoplasms do choriocarcinomas make up? 5%
What is the morphology of choriocarcinoma? Composed of sheets of (cytotrophoblasts) irregularly intermingled with large multinucleated cells ( syncytiotrophoblasts)
What substance is elevated in choriocarcinoma? HCG
What is the second most common testicular neoplasm in children after yolk sac tumors? Teratomas
What is the difference between teratomas in adults and in children? Children --> Pure Adults --> Mixed
What is the prognosis of teratomas? Prepubertal males --> benign Postpubertal males --> Malignant
What are the clinical manifestations of all testicular germ cell neoplasms? 1) Painless mass 2) Contraindicated biopsy 3) Seminomas --> better prognosis than non-seminomas 4) Increased LDH --> Wider spread of tumor 5) Increased HCG --> Choriocarcinoma 6) Increased AFP --> Yolk sac tumor
How are testicular germ cell neoplasms treated? Seminomas --> radiosensitive Nonn-seminomas -->agressive chemotherapy Pure choriocarcinomas --> Likely deadly
At what age is the patient likely to have prostate glandular hyperplasia? 40
What is the cause of benign prostatic hyperplasia? Androgen-dependent proliferation of both stromal and epithelial elements, with enlargement of gland
What are the clinical manifestations of benign prostatic hyperplasia? Lower Urinary Tract obstruction (hesitancy; urgency, frequency, and nocturia) Increased risk of UTIs
What age group is affected with carcinoma of the prostate? Patients over50
What is the most common form of cancer in men? Carcinoma of the prostate
What is the pathogenesis of carcinoma of the prostate? 1) Androgens 2) Heredity 3) Geographical factors 4) Diet 5) TMPRSS 2-ETS (in 40-50%)
How is carcinoma of the prostate diagnosed? Hard peripheral glands palpated by digital PR exam Elevated PSA Osteoblastic regions on bone scan showing metastasis
Created by: Ulaisl