Term
| In a Her2/Nu+ infultrating ductal carcinoma, what treatments are likely to be effective? |
|
Definition
| Positive C-erb B2 (HER2/neu) staining suggests that the monoclonal antibody traztuzumab may be effective. Radical mastectomies are rarely performed in pt with this type of cancer. |
|
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Term
| What treatment is likely to be effective in a tumor of the breast that stains positively for Estrogen or Progesterone receptors? |
|
Definition
| Tamoxifen (MAb to the estrogen receptor) and Aromatase inhibitors are frequently used. |
|
|
Term
| What are some key features of lobular carcinoma in situ? |
|
Definition
| Many areas of density with aspiration suggesting malignancy. Bilateral involvement is common. |
|
|
Term
| Paget's disease of the nipple is most commonly associated with which underlying neoplasm? |
|
Definition
|
|
Term
| What is virginal hypertrophy? |
|
Definition
| When gigantomastia occurs in young women during puberty (aka juvenile macromastia or juvenile gigantomastia). Along with the excessive breast size, other symptoms include red, itchy lesions and pain in the breasts. Dx is made when an adolescent's breasts grow rapidly and achieve great weight usually soon after her first menstrual period. The breasts rapidly develop, exceeding normal growth. Causes great physical discomfort. Women suffering VBH often experience an excessive growth of their nipples. In severe cases of VBH, hypertrophy of the clitoris occurs. |
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Term
| A solitary, firm, round mass in the breast of a 20 yo woman is most likely _________. |
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Definition
|
|
Term
| What are the most common causes of acute mastitis? |
|
Definition
| Staph aureus and streplococcal species. |
|
|
Term
| An irregular breast lesion with calcification and extensive fat necrosis was likely the result of _________? |
|
Definition
| Trauma. Often causes fat necrosis in the breast and can mimic a breast carcinoma. |
|
|
Term
| What breast lesions are highly associated with extended use of oral contraceptives? |
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Definition
| Galactoceles occurs secondary to obstruction of lactiferous ducts. It is a non-neoplastic process. Is a cystic tumor containing a milk-like substance within the mammary gland. |
|
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Term
| A very large, unilateral mass in the breast that on biopsy shows a cellular stromal component and an epithelial component. There may be cellular atypia or even frank malignancy. |
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Definition
| Phyllodes Tumor (cystosarcoma) - can grow to be quite large. |
|
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Term
| What are the most frequent complications of a leaking breast implant? |
|
Definition
| Pain and contracture (physical deformity) |
|
|
Term
| What feature of a breast tumor suggests poor prognosis? |
|
Definition
| Lymph node involvement, hormonal unresponsiveness. |
|
|
Term
| A focal lesion within the breast having both epithelial and stromal proliferation in a papillary pattern. |
|
Definition
|
|
Term
| Highly atypical disorganized cells within ductal lumens indicates what? |
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Definition
| Ductal Carcinoma In Situ (DCIS) |
|
|
Term
| Highly atypical cells filling and expanding lobules. |
|
Definition
| Lobular Carcinoma In Situ (LCIS) |
|
|
Term
| T/F : A biopsy showing ductal epithelial proliferation with ductal apocrine metaplasia, stromal fibrosis, and sclerosing adenosis indicates malignancy. |
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Definition
| FALSE: This describes the biopsy of someone with fibrocystic changes which may be accompanied by a mass effect. |
|
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Term
| Eczematous 1 cm diameter area on the skin of the right breast areola. Microscopic examination shows large cells at the dermal-epidermal junction that stain positively for mucin. What is the most likely diagnosis? |
|
Definition
| Paget disease of the breast is a skin lesion that appears grossly eczematous, but microscopically shows the presence of malignant cells. There is typically an underlying carcinoma that may be hard to locate. |
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Term
| What is implied by the term "inflammatory carcinoma"? |
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Definition
| Does not describe a type of carcinoma, rather it is a term that describes dermal lymphatic involvement by breast cancer. Implies poor prognosis (as does the description of a "signet ring" morphology). Infiltration of the overlying skin is often seen with "inflammatory carcinomas." |
|
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Term
| What is the only benign lesion of the breast with a presentation of bloody nipple discharge? |
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Definition
| Intraductal papilloma (Large Duct Papilloma). Can be malignant but benign lesions are not considered pre0malignant. Consist of multiple papillae covered by cuboidal or cylindrical epi cells, calcification is possible. |
|
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Term
| HPV infection increases the risk for what types of cancer? |
|
Definition
| Squamous epithelial dysplasias and carcinomas in the female genital tract, not the breast. |
|
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Term
| T/F: Multiparity tends to increase the overall risk for breast cancer. |
|
Definition
| FALSE: Multiparity tends to reduce the overall risk for breast cancer. |
|
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Term
| T/F: Smoking has no proven link to the development of breast cancers. |
|
Definition
| TRUE: Though it has been linked to urinary tract cancers. |
|
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Term
| Slow growing breast mass with no axillary lymphadenopathy. Grossly appears soft and fleshy. Microscopic exam shows a lymphoid stroma with little fibrosis surrounding sheets of large vesicular cells with frequent mitoses. What is the most likely diagnosis? |
|
Definition
| Medullary carcinoma is often bulky, with pushing margins. It lacks the desmoplasia typical of ductal carcinomas. It accounts for only about 1% of breast cancers. |
|
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Term
| T/F: Lobular Carcinomas of the breast typically present as a unilatera, large, well circumscribed mass. |
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Definition
| FALSE: does not form a large mass and is poorly circumscribed. It is bilateral about 20% of the time and they are often multicentric. Tumor cells are often aligned in strands or chains (Indian FIling). It makes up only 5 to 10% of breast cancers. |
|
|
Term
| In what type of breast cancer might cells be described as having an "Indian File" appearence? |
|
Definition
| Lobular Carcinoma (which is morphologically identical to LICS) |
|
|
Term
| What is the MC type of invasive carcinoma of the breast? |
|
Definition
| Ductal Carcinoma NOS (CT/desmoplastic response replaces normal tissue which creates a hard mass, dimpling of the skin and retraction of the nipple may occur. Cells typically have a high nuclear to cytoplasmic ration, nuclear pleomorphism, mitoses, and irregular nuclear membranes. |
|
|
Term
| What percentage of breast "lumps" turn out to be fibrocystic changes? |
|
Definition
|
|
Term
| Grossly white, solitary, well circumscribed, freely movable mass is most commonly what? |
|
Definition
| Fibroadenoma - the MC benign neoplasm of the female breast. Loose fibroelastic stroma with few cells, no atypia and myoepi cells present (naked nuclei). Are hormonally responsive* and can grow to be quite large. |
|
|
Term
| Increased stromal cellularity indicates what type of breast neoplasm? |
|
Definition
| Increased cellularity is typical for a phyllodes tumor. The greater the degree of anaplasia and number of mitoses, the more likely that the phyllodes tumor is malignant. |
|
|
Term
| What types of breast carcinomas (think location) have the best overall survival? |
|
Definition
| Intraductal Carcinomas (those that have not invaded out from the ducts); this is the lowest stage possible. |
|
|
Term
| A male with gynecomastia might have what karyotype? |
|
Definition
| 47 XXY, Klienfelter's males often display gynecomastia. |
|
|
Term
| T/F: A solitary well-circumscribed 1 cm firm nodule palpated in the lower outer quadrant of the breast is most likely malignant. |
|
Definition
| FALSE: Likely a fibroadenoma, especially if the pt is otherwise asymptomatic and/or younger. |
|
|
Term
| Name the cancer: A 3 cm area in left breast w/ microcalcifications and irregular densities. Needle biopsy shows ducts containing solid sheets of malignant cells, with central necrosis and calcification. No invasion. Immunohistochemical staining of the tumor cells shows them to be estrogen receptor and HER2 (c-erb B2) negative. |
|
Definition
| Ductal Carcinoma in Situ (DCIS), the most likely outcome for this pt following wide margin excision and radiation therapy is full recovery without relapse (note that recurrence in the opposite breast is a feature of Lobular NOT of Ductal carcinomas). |
|
|
Term
| What condition is described by the birth of a deformed fetus and placental triploidy with grape-like villi interspersed with normal appearing placenta. |
|
Definition
| A partial mole in a case of triploidy. Note that in most cases of triploidy the placenta is quite small without grape-like villi. |
|
|
Term
| Describe the difference between a complete and partial hydratidiform mole. |
|
Definition
Molar pregnancy is an abnormal form of pregnancy, wherein a non-viable, fertilized egg implants in the uterus, and thereby converts normal pregnancy processes into pathological ones.
It is characterized by the presence of a hydatidiform mole.
Molar pregnancies are categorized into partial and complete moles.
A complete mole is caused by a single (MC) or two (10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a "complete" 46 chromosome set). The genotype is typically 46,XX (diploid) due to subsequent mitosis of the fertilizing sperm, but can also be 46,XY.
A partial mole occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (quadraploid). Complete hydatidiform moles have a higher risk of developing into choriocarcinoma — a malignant tumor of trophoblast cells — than do partial moles. |
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|
Term
| Pt presents with an enlarged and firm L testis. The excised mass is grossly reddish-brown and soft, with areas of hemorrhage on sectioning. What would be the best laboratory test on his serum to aid in diagnosis and follow-up? |
|
Definition
| Based on location and gross appearance you suspect an embryonal/yolk sac tumor. Order Alpha fetal protein* which is elevated in these tumors. |
|
|
Term
|
Definition
| May be elevated in testicular cancers but is not specific for any one type. |
|
|
Term
| Peau d'Orange appearence of breast tissue suggests what underlying malignancy? |
|
Definition
| Infiltrating ductal carcinoma; a large infiltrating mass lesion with irregular borders. The infiltration of the tumor into the dermal lymphatics produces the gross 'peau d'orange' appearance of the overlying skin, described as 'inflammatory carcinoma' change. Infiltrating ductal carcinoma is the most common variety of breast cancer. |
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|
Term
| A 72 yo F has a 3 cm ulcerated mass that protrudes from the external urethral meatus, it is painful and occasionally bleeds. What is the most likely dx? |
|
Definition
| Squamous Cell Carcinomas (of the Urinary tract are rare but when they are seen it is on the external portion of the urethra of an older women and they tend to be locally aggressive). |
|
|
Term
| What is the most likely etiology of bladder hypertrophy with tribeculae? |
|
Definition
| Outlet obstruction - typically caused by prostate enlargement in an older male (hypertrophy or carcinoma). |
|
|
Term
| Prior schistosomiasis infx increases the risk for which neoplasm? |
|
Definition
| Schistosomiasis leads to chronic inflammation and scaring of the bladder and increases the risk of bladder cancer (which type?) |
|
|
Term
| What are the most frequent complications of adult polycystic kidney dz? |
|
Definition
| Hypertension and Infection (last assessment but I keep coming across it) |
|
|
Term
| What does a progressive loss of the ability to concentrate urine in a pt with a history of cancer suggest? |
|
Definition
| Neprhocalcinosis secondary to hypercalcemia. MCC of hypercalcemia in adults is metastatic disease. Hypercalcemia produces a chronic tubulointerstitial disease of the kidneys that initially presents as a loss of concentrating ability. If hypercalcemia is not corrected there will be a progressive loss of renal function. Calcium oxalate stones may also be present. |
|
|
Term
| What genetic mutations are associated with superficial papillary tumors of the bladder? |
|
Definition
| Deletions of portions of Chromosome 9 |
|
|
Term
| Which genetic mutations are associated with invasive bladder tumors? |
|
Definition
|
|
Term
| What does k-Ras activation tell you about a cancer? |
|
Definition
| That it is an adenocarcinoma (activation of k-ras is a feature of many different adenocarcinomas). |
|
|
Term
| Exposure to anyline dyes predisposes to which cancer(s)? |
|
Definition
| Transitional Cell Carcinomas (TCC)* |
|
|
Term
| T/F: Smoking is a risk factor for Renal Cell Carcinoma. |
|
Definition
| FALSE: Smoking is a risk factor for Transitional Cell Carcinomas of the bladder (TCCs). Appears as a sessile, papillary or In situ mass. |
|
|
Term
| List the risk factors for TCC (6) |
|
Definition
1) Drugs such as cyclophosphamide and phenacetin
2) Long-term usage of analgesics
3) Radiation exposure
4) Somatic mutation such as deletion of Chromosome 9p,9q,11p,17p,13q,14q or over expression of RAS (oncogene)/EGFR
5) Cigarette smoke
6) Naphthylamines and aniline dyes |
|
|
Term
|
Definition
| Mullarian Inhibiting Factor is active in embryogenesis of males. Controls testicular descent in the first abdominal phase, causing the testes to come to lie low in the abdomen, in the second stage of descent the testes descend under control of androgens down the inguinal canals to the scrotum. |
|
|
Term
| T/F: Androgens control the first phase of testicular descent. |
|
Definition
| FALSE: MIF controls the abdominal phase of testicular descent, while androgens control the second phase. |
|
|
Term
| What is a Sertoli-Cell Only Syndrome? |
|
Definition
| A disorder characterized by male sterility without sexual abnormality. The result of absent seminiferous tubules in the testes of germinal epithelium, while Sertoli cells are present. Pt have nl secondary sex charactaristics and normal to small sized testis. Testosterone and LH levels are normal, but due to lack of inhibin, FSH levels are increased. Such a syndrome is a cause for male infertility. A similar pattern would be present in a cryptorchid testis. Multifactorial cause. |
|
|
Term
| An elevated HCG in a male suggests the presence of __________________. |
|
Definition
| Testicular choriocarcinoma, a trophoblastic, germ cell tumor that is quite aggressive and also may be seen in the female with cells resembling the synctotrophoblasts of the placenta. Very Rare to see in the testes. |
|
|
Term
| An elevation of AFP suggests the presence of _____________________. |
|
Definition
| A testicular neoplasm with a yolk sac element. Seen in very young males (< 3 yrs). |
|
|
Term
| What is the most common form of pure testicular cancer? |
|
Definition
Seminoma, a germ cell tumor;
Is radiosensitive.
The tumor markers are not very elevated.
This form of testicular carcinoma has the best prognosis overall, when not mixed with other elements.
Gross appearance is tan and lobular on section without hemorrage or necrosis.
Testis are often enlarged. Undescended testis is at risk for development of seminomas. |
|
|
Term
| T/F : Leydig Cell Tumors are typically malignant |
|
Definition
| FALSE: Typically small and benign. |
|
|
Term
| What is the proper treatment for an undescended testis in an adult? |
|
Definition
| A cryptorchid testis that is not treated in early childhood no longer functions and presents a risk for subsequent development of seminoma and should therefore be removed. The earlier in life that an orchiopexy (putting it in the scrotum) is performed, generally under the age of 5, the more likely the testis will function properly |
|
|
Term
| A firm nodule palpable in the prostate of a 70 yoM via digital rectal examination. Prostate biopsies show small, crowded glands containing cells with prominent nucleoli within the nuclei. Which of the following is the most likely diagnosis? |
|
Definition
| Adenocarcinoma of the prostate. A nodule at that age strongly suggests carcinoma. Most carcinomas of the prostate arise in the posterior portion where they can be palpated on digital rectal exam. Microscopically, prostatic adenocarcinomas have irregular glands without intervening stroma. Large nucleoli are a characteristic microscopic feature. |
|
|
Term
| Phimosis predisposes to ____________. |
|
Definition
Penile squamous intraepithelial neoplasia (a precursor to Squamous Cell Carcinoma of the penis).
The chronic irritation from accumulation of secretions and smegma under the prepuce is the likely reason.
(Phimosis - the inability to retract the foreskin). |
|
|
Term
| T/F: HPV produces ulcerated lesions in males |
|
Definition
| FALSE: HPV infx in males typically produces genital warts and even cancers but does not typically produce ulcers. |
|
|
Term
| What pathology of the male reproductive system produces a spermatic cord that feels like a "bag of worms" on palpation? |
|
Definition
| Varicocele, an abnormal enlargement of the vein in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves/vein compression, can cause dilatation of the veins near the testis forming a varicocele. Warmth from the vascularity reduces sperm production (can lead to infertility). Spermatogenesis needs to occur at a temperature below that of the body as a whole (is why testes are in the scrotum). |
|
|
Term
|
Definition
| BPHyperplasia is a common finding in older males. The lateral lobes are typically involved (in contrast to carcinomas which are MC in the posterior lobe), and the hyperplasia tends to be nodular. Increasing prostatic urethral obstruction leads to the classic symptoms of frequency and hesitancy with urination. The PSA can be mildly elevated with hyperplasia, but the level tends not to increase significantly over time. |
|
|
Term
| What test can be useful in identifying testicular torsion? |
|
Definition
| Doppler Ultrasound can detect decreased blood flow to the affected testis. This condition is an emergency and must be treated within hours of onset to prevent hemorragic infarction of the testis. Acute onset with intense pain, inciting event usually unknown. |
|
|
Term
| What is a common complication of untreated Gonorrhea in males? |
|
Definition
| Epididymitis. When the testis is involved by gonorrhea, it is typically the epididymis. Many male gonorrheal infections are asymptomatic and not followed by significant complications. Urethritis with stricture is another possible complication. |
|
|
Term
| Sacroilitis is a complication of ________________. |
|
Definition
| Sacroiliitis is most often a feature of the spondyloarthropathies such as ankylosing spondylitis, or even Reiter syndrome resulting from a non-gonococcal urethritis such as Chlamydia trachomatis infection. |
|
|
Term
| What is prostatic intraepithelial neoplasia (PIN) and what does it indicate? |
|
Definition
| Seen on biopsy of a pt with BPH. Warrants monitoring of PSA levels as PIN can be a precursor of prostatic adenocarcinoma (is considered a carcinoma in situ of the glands of the prostate). |
|
|
Term
| Jock itch may lead to the development of what more serious condition? |
|
Definition
| Lichen planus chronicus. The chronic rubbing and scratching from this dermatophyte infection can result in epidermal hyperplasia and chronic inflammation. |
|
|
Term
| What is the MCC of prostatitis in young men? |
|
Definition
| C. trachomatitis (the leading cause of non-gonococcal urethritis) is the most frequent form of prostatitis (enlarged, tender prostates) in young adult men. There is typically no history of chronic urinary tract infection. |
|
|
Term
| Scant, pale yellowish urethral discharge with burning on urination in a male is most likely caused by __________. |
|
Definition
| C. trachomatitis (the leading cause of non-gonococcal urethritis). |
|
|
Term
| Physical examination of a newborn male reveals incomplete development of the dorsal aspect of the penile urethra, with the defect extending to the bladder, which is open on the lower abdominal wall. What is the most likely diagnosis? |
|
Definition
| Epispadias - a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly. |
|
|
Term
| What is a possible complication seen in pt receiving a vasectomy? |
|
Definition
| A sperm granuloma, also called vasitis nodosa, results from a foreign body granulomatous reaction to extravasated sperm at the vasectomy site. The granulomatous reaction is typically not florid. Hematomas and post-vasectomy pain syndrome are also possible complications. |
|
|
Term
| What can Mumps cause in infected males? |
|
Definition
| Patchy pattern of atrophy of testicular tubules. This was a very common childhood infection (when vaccinations are not done) resulting in orchitis as well as parotitis. The inflammation rarely causes enough damage to produce a significantly reduced sperm count therefore pts are typically still furtile. |
|
|
Term
|
Definition
| BD, also known as "squamous cell carcinoma in situ" is a neoplastic skin disease, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. Erythroplasia of Queyrat is a form of squamous cell carcinoma in situ arising on the glans or prepuce, possibly induced by HPV. |
|
|
Term
| On physical examination of a 17 yo M pearly penile papules are noted at the edge of the glans penis. What do these lesions most likely indicate? |
|
Definition
| Nothing! These are normal variation in some males. |
|
|
Term
| What diagnosis should be considered in males who have a hx of recurrent episodes of bacturia? |
|
Definition
| Chronic bacterial prostatitis. A chronically infected prostate can serve as the source of pathogens for recurrent UTIs. A pattern of relapsing UTIs in a middle-aged man strongly suggests chronic bacterial prostatitis. E. coli is a typical organism associated with urinary tract infection. The PSA can be slightly elevated with prostatic inflammation. |
|
|
Term
| Which laboratory method is most likely to be useful in diagnosis of C. trachomatis? |
|
Definition
| Enzyme Immunoassay. This is the easiest and most cost-effective method, since C. trachomatis cannot be cultured by routine methods. |
|
|
Term
| What complications are seen in infants born with hypospadias? |
|
Definition
| Opening of the urethra on the ventral/under side of the penis. Infection is a common complication, and partial urethral stricture may lead to urinary tract obstruction. |
|
|
Term
| What are the most common etiological agents of balanitis? |
|
Definition
| Staph aureus and Streplococcal agents. |
|
|
Term
| Most prostatic adenocarcinomas arise in the ______________ zone. |
|
Definition
| Peripheral Zone (posterior region, can be palpated on digital rectal exam). |
|
|
Term
| A 21-year-old man notes the presence of a lesion on his penis for the past week. On physical exam there is a solitary 0.7 cm diameter circumscribed area of ulceration on the dorsal aspect of his penis just proximal to the glans with a firm erythematous base containing minimal grey exudate. What is the most likely dx and what would be the most effective way to make this dx? |
|
Definition
| The findings suggest a chancre of primary syphilis, and a scraping of the lesion put on a glass slide and examined by darkfield microscopy will allow identification of spirochetes within minutes. |
|
|
Term
| Which if the testicular carcinomas is the most radiosensitive? |
|
Definition
|
|
Term
| Which hormone is implicated in the development of BPH? |
|
Definition
| Dihydrotestosterone (DHT) which is synthesized from circulating testosterone by the action of 5-alpha-reductase type 2. It is DHT which binds to nuclear antigen receptors to stimulate cell growth and proliferation in the prostate. |
|
|
Term
| 43-year-old w/ CC = a lesion on his penis for the past year. PE reveals a 0.9 cm diameter rough, tan, firm, slightly raised area at the right lateral base of the glans. He is uncircumcised, and there is difficulty in retracting the foreskin. What is the most likely diagnosis? |
|
Definition
| Bowen's Disease - This is squamous cell carcinoma in situ. If excised at this stage, it is curable. If not treated, it can progress to an invasive carcinoma. |
|
|
Term
| What testicular tumor may present as gynecomastia? |
|
Definition
| A Leydig cell tumor is most often seen in adult men. It may produce androgens and/or estrogens, leading to gynecomastia and/or feminization. It is histologically benign. Most are small in size. |
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