Reproductive Ovarian and Testicular Cancer USMLE – Flashcards
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4 types of ovarian germ cell tumors?
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1. Dysgerminoma 2. Choriocarcinoma 3. Yolk Sac (Endodermal Sinus) Tumor 4. Teratoma
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Dysgerminoma Marker?
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1. hCG and LH
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Dysgerminoma prevalence in females?
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1% of germ cell tumors - associated with Turner's Syndrome
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Dysgerminoma pathologic appearance?
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Sheets of Uniform Cells
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Choriocarcinoma malignancy of?
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1. Trophoblastic cells occurring during or after pregnancy - chorionic villi not present - in mother or baby w/ early hematogenous spread to the lungs
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Choriocarcinoma marker?
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1. Elevated hCG
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Ovarian cyst associated with choriocarcinoma?
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1. Theca Lutein Cysts
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Yolk sac tumor appearance?
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1. Yellow, Friable, Solid mass
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Yolk sac tumor marker?
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1. AFP
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Other site besides testes and ovaries?
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1. Sacrococcygeal Tumor site
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Where is choriocarcinoma likely to spread?
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1. Hematogenous to the lungs
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What histology is associated with yolk sac tumors?
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1. Schiller Duval Bodies (Glomerulus Appearance)
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What is the most common female germ cell tumor?
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1. Teratoma
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What are the three main types of teratomas in the ovary?
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1. Mature (Dermoid Cyst_ Teratoma -> Genreally it is benign 2. Immature - aggressive malignant teratoma 3. Struma Ovari - Teratoma containing ectopic, functional thyroid tissue
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Non-Germ Cell Tumors of the ovary?
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1. Serous Cystadenoma/Cystadenocarcinoma 2. Mucinous Cystadenoma/Cystadenocarcinoma 3. Brenner Tumor 4. Fibroma 5. Kruckenberg Tumor 6. Granulosa Cell Tumor
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Serous Cystadenoma Characteristics?
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45% of all ovarian tumors, benign -> fallopian tube epithelial lining - bilateral
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Serous cystadenocarcinoma characteristics?
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45% of all Ovarian tumors - psammoma bodies - BRCA1,2, and HNPCC association. - bilateral
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Ovarian cancer marker?
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CA-125 -> not good for screening, only good for monitoring tumor progression
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Mucinous Cystadenoma?
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1. Mucous secreting GI like epithelium
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Mucinous Cystadenocarcinoma?
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1. Mucous secreting malignancy -> pseudomyxoma perotinei -> associated with mucous secreting appendix or ovarian tumors
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Brenner's Tumor?
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1. Benign unilateral encapsulated bladder like epithelium that is mostly unilateral.
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Granulosa Cell tumor? Kids/Adults? Histology?
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Estrogen secreting neoplasm of the granulosa cells -> leading to precocious puberty in kids and endometrial hyperplasia in adults (risk for carcinoma) - Call Exner Bodies present - small follicles filled with eosinophilic secretions.
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Fibroma tumor? Triad? sensation?
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1. Spindle Shaped fibroblast bundle - Ascites, Ovarian Fibroma, Hydrothorax - Pulling sensation in the pelvis
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What is a kruckenberg tumor?
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1. GI metastasis -> adenocarcinoma w/ signet ring cells
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Clear cell vaginal carcinoma?
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1. Associated with intrauterine exposure to DES
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What is sarcoma boytroides?
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1. Rhabdomyosarcoma variant -> girls <4yrs, spindle shaped tumor cells that are desmin positive (protruding from the vagina)
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3 types of benign breast tumors?
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1. Fibroadenoma 2. Intraductal Papilloma 3. Phyllodes Tumor
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What is the most common breast tumor in women<35?
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1. Fibroadenoma
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Fibroadenoma derived from what tissue?
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1. Breast Stroma
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Fibroadenoma predispose to malignancy?
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1. No
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Fibroadenoma change in size?
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1. Increases in size with increased estrogen -> i.e. preganncy
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Fibroadenoma palpation characteristics?
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1. Small, mobile, firm mass with sharp edges
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Location of intraductal papilloma?
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1. in the lactiferous duct, generally just below the aerola
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Intraductal papilloma presentation?
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1. Serous or Bloody discharge from the nipple
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Intraductal papilloma predispose to carcinoma?
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1. Slightly 1.5-2X
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Phyllodes tumor common in what population?
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1. 60+
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Phyllodes tumor location and appearance?
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1. Located in the breast stroma, a large bulky, cystic mass of connective tissue w/ leaf like projections
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Phyllodes tumor progression?
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1. Some can become malignant
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What pathology can occur at the nipple (2)?
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1. Paget's Disease 2. Breast Abscess
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WHat pathology can occur at the lactiferous duct (2)?
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1. Mastitis 2. Intraductal Papilloma, 3. Abscess
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What pathology can occur at the major duct? (2)
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1. Fibrocystic Change 2. Ductal Cancer
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What pathology can occur at the terminal duct? (1)
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1. Tubular Carcinoma
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What pathlogy can occur at the level of the lobules (2)?
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1. Lobular Carcinoma 2. Sclerosing Adenosis
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What pathology can occur in the stroma?
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1. Phyllodes Tumor 2. Fibroadenoma
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Malignant tumors of the breast most commonly arise from?
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1. Terminal duct lobular unit
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Receptor that is often overexpressed in breast cancer?
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1. HER-2 Receptor - estrogen receptor
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Single most important prognostic factor for breast malignancy?
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1. Axillary Lymph Node involvement
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Risk factors for breast cancer development? (5)
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1. Increased number of cycles 2. Late age at first pregnancy 3. Obesity (peripheral aromatization of androgens) 4. BRCA1/2 5. Increased Estrogen Exposure
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Two types of non-invasive breast cancer?
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1. Ductal Carcinoma in Situ 2. Comedo Carcinoma
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Ductal Carcinoma In Situ arises via?
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1. Ductal hyperplasia that fills in the ductal lumen-> no basement membrane penetration
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Characteristics of comedocarcinoma?
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1. DCIS subtype -> caseous necrosis w/ cancer cells at periphery
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5 types of invasive breast cancer?
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1. Invase Ductal Carcinoma 2. Invasive lobular carcinoma 3. Medullary 4. Inflammatory 5. Paget's Disease
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What is the most common and most destructive of all breast cancers?
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1. Invasive Ductal Carcinoma
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Appearance of invasive ductal carcinoma?
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1. Firm, Fibrous, and Rock Hard Mass w/ well demarcated margins and small glandular duct like cells.
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What is the classic morphology of invasive ductal carcinoma?
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1. Stellate morphology
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Invasive lobular carcinoma presentation? Unilateral or bilateral?
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1. Often bilateral with lesions in similar locations microscopic indian filing
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Invasive lobular carcinoma microscopic morphology?
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1. Indian filing of cells - orderly row
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Medullary carcinoma histologic appearance and prognosis?
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1. Fleshy, cellular, lymphocytic infiltrate w/ good prognosis
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Inflammatory carcinoma morphology/ appearance?
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1. Dermal lymphatic invasion by cancer cells leading to lymphatic obstruction and peu d' orange appearance of the breast
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Prognosis of inflammatory carcinoma?
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1. 50% survival @ 5 years
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Paget's disease gross and microscopic appearance?
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1. Eczematous patches on the nipples -> large cells in epidermis w/ clear halo = paget's cells
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What may paget's disease be suggestive of?
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1. Underlying ductal carcinoma in situ
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Typical presentation of fibrocystic change?
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1. Female aged 25-menopause w/ multiple/bilateral breast lumps that are painful premenstruation and change in size -> but are not associated with malignancy
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4 types of fibrocystic change?
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1. Fibrosis 2. Cystic 3. Sclerosing Adenosis 4. Epithelial Hyperplasia
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Which type of fibrocystic change is often confused with breast carcinoma and why?
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1. Sclerosing adenosis -> associated with calcifications - increaed acini and intralobular fibrosis
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What type of fibrocystic change is associated with blue dome cysts?
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1. Cystic
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Which type of fibrocystic change is associated with an increased number of epithelial cells in the terminal duct lobue?
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1. Epithelial hyperplasia - associated with increased risk of carcinoma
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Mastitis likely pathogen and cause?
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1. Associated with breast feeding, likely pathogen is S. Aureus, G+, coccus, catalase +, coagulase +
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Fat necrosis presentation and cause?
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1. Benign painless bump in breast tissue -> associated with breast trauma - saponification
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What causes gynecomastia?
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1. Hyperestroginism - (cirrhosis, drugs, tumor)
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Drugs causing gynecomastia?
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Some Drugs Create Awkward Knockers Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole
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What genetic abnormality is associated with gynecomastia?
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1. Klinefelter's Syndrome (XXY) -> decreased inhibin, increased FSH, LH, decreased testosterone and increased estrogen.
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BPH hyperplasia or hypertrophy?
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1. Hyperplasia!!!
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BPH lobes involved?
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1. Lateral and middle lobes -> direct compression of the urethra
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Complications from BPH?
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1. UTI, Bladder Distention/Hypertrophy, Hydronephrosis
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Acute prostatitis associated with what pathogen?
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1. E. Coli, Gram Negative, Encapsulated, Bacillus, lactose fermenter.
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Treatment for BPH?
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1. Alpha 1 Antagonists - Terazosin, Tamsulosin 2. Finasteride -> DHT leads to hyperplasia
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What lobe is typically involved in prostate cancer?
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1. Posterior lobe
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Prostatic adenocarcinoma histology?
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1. Small infiltrating glands with prominent nucleoli
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Tumor markers used for prostatic carcinoma?
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1. PSA and Prostatic Acid Phosphatase --> Look for increased total PSA w/ decreased fraction of free PSA
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What happens to PSA in BPH?
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1. Increased Free PSA
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Prostate cancer metastasis? Lab findings?
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1. To the spine -> osteoblastic metastasis -> Low back pain, elevated PSA, elevated bone alkaline phosphatase.
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FSH, LH, Testosterone, and INhibin levels in unilateral cryptorchidism?
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1. Sertoli Cell Dysfunction -> Decreased Inhibin -> Increased FSH; Normal Leydig function, Normal Testosterone, Increased LH
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Testosterone levels in bilateral cryptorchidism?
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1. Decreased, Thus there will be increase in both FSH and LH (LH because of decreased feedback inhibition from testosterone)
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What tumor type is increased in cryptorchidism?
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1. Germ cell tumors - reason why XY pseudohermaphrodites from androgen insensitivity system must have testicles removed.
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Differential diagnosis for a testicular mass that does not transilluminate?
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1. Cancer
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95% of testicular tumors are what type?
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1. Germ cell tumors
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Testicular germ cell tumors? (5)
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1. Seminoma (MCC) 2. Yolk Sac Tumor 3. Choriocarcinoma 4. Teratoma 5. Embryonal Carcinoma
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Seminoma presentation? microscopic pathology? Tumor marker?
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1. Painless testicular mass presenting in 18-35yr that does not transilluminate w/ lobules of large cells w/ watery cytoplasm and a fried egg appearance --> Awesome prognosis - Placental Alkaline Phosphatase (PLAP) elevated
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Yolk Sac Tumor gross pathology? Micropathology? Tumor Marker?
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Yellow friable appearance w/ shiller duval glomerular appearing structures - Elevated AFP present
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Choriocarcinoma cell types? Tumor marker? metastasis? Why might it produce gynecomastia?
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1. Cytotrophoblast and syncytiotrophoblastic cells 2. hCG elevated (may produce gynecomastia b/c is LH analog -> increased testosterone -> increased peripheral conversion to estrogen via aromatase. 3. Metastasis is hematogenous to the lungs
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Teratoma in males? Markers present?
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1. Usually malignant (in adults, benign in children) (multiple germ layers) 2. AFP and hCG elevated 50% of the time
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Embryonal Carcinoma presentation?
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1. Painful mass w/ glandular/papillary morphology - if pure hCG eleated only, hCG + AFP if mixed
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3 testicular non-germ cell tumors?
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1. Leydig Cell Tumor - golden brown 2. Sertoli Cell Tumor 3. Testicular Lymphoma (Metastatic)
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Leydig Cell tumor pathology? Findings in men vs. boys? Color of leydig cell tumor?
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1. Reinke Crystals usually producing androgen leading to gynecomastia in men and precocious puberty in boys? Golden brown color
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Sertoli cell tumor arises from?
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1. sex cord stroma
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Testicular lymphoma arises from?
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1. Metastasis from lymphoma - usually quite aggressive
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Transilluminated lesions? 2
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1. Tunica Vaginalis lesions - Hydrocele - Spermatocele (dilated epididymal duct)
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Peyronie's Disease?
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1. Bent penis due to acquired fibrous tissue formation
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Priapism associated with what causes?
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1. Sickle Cell Disease (vascular occlusion) 2. PDE5 Inhibitors, Antidepressants, Alpha Blockers, Cocaine, Anticoagulants
