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UGS Pathology Final
Pathology of the RS
| Question | Answer |
|---|---|
| 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
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