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FA complete review part 3 Pathology Neoplasia/Cancer

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.
Created by: rakomi
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