Glossary of Block VII, Week VIII
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- what are the two cell layers present in the terminal ducts and lobules of the breast?
- myoepithelial cells
- what portion of the breast is responsive to hormones: the interlobular stroma or the intralobular stroma?
- intralobular stroma
- during pregnancy and lactation, an increase is seen in what breast portion?
- increase in lobules
- what is the most common breast-related clinical symptom that women come in to the doctor for?
- breast pain
- treatment (if indicated) for "cyclical breast pain?"
- hormonal regulation
- two synonyms for breast pain?
- in general, how large must a breast lump be in order to palpate it?
- 2 cm
- compare a lump/cyst found in a young woman vs. an older woman (what it most likely is)
- young woman - most likely benign
older (post-menopausal) woman - most likely malignant
- what would be more concerning:
discharge that is unilateral or bilateral?
- what would be more concerning: milky discharge or bloody, serous discharge
- bloody serous discharge
(milky is almost never associated with a malignancy)
- what could cause milky breast discharge? (5)
- *could be "normal"*
- why is mammography more sensitive in older women?
- decreased breast density
- what size lesions can be detected by mammography?
- 1 cm
(remember, expert palpation can only detect 2cm masses)
- when is acute mastitis most commonly seen?
- in lactating women
- MC causative agent of acute mastitis?
- Staph epi
- which breast cancer presents similarly to acute mastitis?
- inflammatory carcinoma
- which breast disease is mainly restricted to smokers?
- periductal abscess
- is there an association between a periductal abscess and lactation or menses?
- pathogenesis of a periductal abscess?
- squamous epithelium extends deeper than normal - traps keratin in ductal system - this produces cysts - cysts rupture - causes granulomatous response
- which breast disorder am I?
- usually painless
- peri-areolar mass
- skin retraction
- thick, white discharge
- squamous metaplasia is rare
- mammary duct ectasia
- two causes of fat necrosis of the breast?
- between the proliferative and non-proliferative breast diseases, which has an increased risk of breast carcinoma?
- three components of fibrocystic disease?
- 1. cysts
3. adenosis (increased # of acini in a lobule)
- do proliferative breast lesions commonly have cell atypia?
- how do most proliferative breast lesions without atypia present?
- as a mass detected by mammography
(vs. non-proliferative breast disease presenting as a breast mass)
- what type of lesion am I?
- a variant of FCD in which proliferation and adenosis dominate
- characterized by fibrosis around the lobular unit
-radiologically and pathologically resembles breast carcinoma
- sclerosing adenosis
- describe a breast papilloma
- a benign tumor attached to lactiferous duct by a fibrovascular core
- are papillomas associated with an increased risk of breast carcinoma?
- what breast lesion am I?
- hormonally responsive
- tumor of terminal duct lobular unit
- MC benign neoplasm of the breast
- what happens to a fibroadenoma in pregnancy?
- grows rapidly
- which drug is associated with fibroadenoma development?
(more than 1/2 of women on cyclosporin develop fibroadenomas)
- compare the cancer risk between proliferative lesions with and without atypia
- with atypia: 2-5x increased risk of carcinoma
without atypia: 1-2x increased risk
- define an in-situ breast carcinoma
- malignant cells that haven't penetrated the basement membrane
- what are the two types of ductal carcinoma in situ (DCIS)
- 1. DCIS, comedo type
2. DCIS, non-comedo type
- treatment for DCIS?
tamoxifen if ER (+)
- which is harder to pick up on mammography: DCIS or LCIS?
(no calcifications, no mass effect)
- treatment for LCIS?
- tamoxifen (almost always ER (+))
some opt for bilateral prophylactic mastectomy
- when LCIS is found, why is a contralateral biopsy also performed?
- LCIS often has bilateral involvement
- what is Pagets disease a variation of?
- ductal carcinoma of the breast (DCIS or invasive)
- how does Pagets disease present?
see malignant cells in epidermis
- women with the BRCA1 gene have what chance of developing breast cancer?
- 75% chance
- BRCA1 is also associated with what other cancer?
- women with the BRCA2 gene have what chance of developing breast cancer?
- 30-40% (smaller chance than BRCA1 mutation)
- which gene is associated with an increased risk of breast cancer in men?
- what is Li-Fraumeni syndrome
- germline mutation in p53
*increases risk of breast, brain and adrenal cancer*
- along with an increasted risk of breast cancer, what is Peutz-Jeghers syndrome known for?
- intestinal polyposis REMEMBER?!?
- PTEN mutations are known to precipitate which syndrome?
- Cowden syndrome
(multiple hamartomas, 20-50% increased risk of breast cancer)
- what is the most common histologic type of breast cancer?
- (Usual) Ductal Carcinoma
(70-80% of all breast carcinomas)
- what term is used in a ductal carcinoma when stroma dominates?
- scirrous carcinoma
- second most common kind of breast carcinoma?
- lobular carcinoma
- characteristic histology of lobular carcinoma?
- "indian filing"
single lines of cells infiltrating stroma
- three most common sites of metastases in lobular carcinoma?
- describe the hormone receptor status and Her-2-neu status of lobular carcinoma
- most are E/P (+)
most are her-2-neu (-)
- prognosis of a ductal carcinoma presenting as an inflammatory carcinoma?
- what type of involvement is usually seen in inflammatory carcinoma?
- lymphatic and vessel involvement
- which type of tumor is ALWAYS hormone receptor positive?
- tubular carcinoma
- prognosis of tubular carcinoma?
- prognosis of "uncommon histologic types" of breast cancer vs. ductal or lobular carcinoma?
- in general, uncommon types have better prognosis
- what is by far the most important prognostic factor for a lobular or ductal breast carcinoma?
- stage (clinical spread) at diagnosis
- what three factors are taken into account in breast cancer staging?
- size of tumor
location of spread
extent of spread
- a stage 4 breast cancer has a <15% 5 year survival. what would be seen in this advanced stage?
- involvement of:
- chest wall
- supraclavicular nodes
- arm edema
- distant mets
- what is taken into account in breast cancer grading?
- - tubule formation
- nuclear grading
- mitotic rate
- in breast carcinoma, how do survival rates correlate with vessel and lymphatic involvement?
- survival decreases when vessel or lymphatic invasion is detected
- her-2-neu receptors are looked for to see if what therapy will be effective?
- what are the two general methods of looking for the her-2-neu gene?
- 1. immunostaining
- is a phyllodes tumor most commonly benign or malignant?
- benign (rarely becomes malignant)
- gynecomastia is usually due to a dominance of what hormone?
- hormonal receptor status of male breast carcinoma?
- usually ER (+)
- what are the two stromal tumors of the breast?
- 1. fibroadenoma
2. phyllodes tumor
*stromal tumors are most commonly benign*
- what are the four anatomically recognizable zones of the prostate?
- 1. peripheral
- in which zones do hyperplasia and hypertrophy tend to be in?
- transitional, central and periurethral
(best accessed with TURP)
- in which zone is carcinoma most likely to be in?
- peripheral zone
(best palpated by DRE)
- how many layers are normal glands of the prostate lined by?
(basal layer and overlying mucous secreting epithelium)
- what effect does a lack of testosterone have on the prostate?
- which cells produce PSA?
- acinar cells in the prostate
- besides PSA, what other thing do the acinar cells of the prostate make?
- PAP -> prostatic acid phosphatase
- two reasons for the PSA test being so controversial?
- 1. some prostate CAs don't produce PSA
2. PSA can be elevated for other reasons than CA
- what are three other reasons besides CA for the PSA to be elevated?
- 1. infarction
- what are the three types of inflammation that can be seen in the prostate?
- 1. acute bacterial prostatitis
2. chronic bacterial prostatitis
3. chronic abacterial prostatitis
- which type of prostatitis would present as an extremely tender prostate on exam and fever, chills and dysuria?
- acute bacterial prostatitis
- why is chronic bacterial prostatitis so difficult to treat?
- antibiotics penetrate the prostate poorly
- what is the most common form of prostatitis?
- chronic abacterial prostatitis
- BPH is most commonly seen in what age group?
- men over 50
- BPH is seen earlier in which race?
- which part of the prostate participates in BPH?
- periurethral area
- effect of hormones on BPH?
- androgens and estrogens influence BPH development
(BPH does not occur in castrated males)
- two types of nodular hypertophy seen in BPH?
- describe the epithelium of BPH
- it is intact
- is cytological atypia seen in BPH?
- MOA of using 5-a-reductase to treat BPH?
- inhibits dihydrotestosterone (DHT) formation -> no more promotion of stromal growth
- besides DHT, what is the other most likely candidate to be promoting prostate growth?
- T/F: it is well established that BPH progresses to prostate CA.
no support for the progression of BPH to carcinoma.
- complications of BPH?
- urinary retention
increased incidence of UTIs, pyelonephritis
- what is the process considered to be a precursor to malignant prostate carcinoma?
Prostatic Intraepithelial Neoplasia
- is cytologic atypia seen in low grade PIN?
- minimal to none
- clinically, would we be worried about a paitent with low grade PIN?
- Dr. Sens told us "not to really worry about this one too much"
- is cytologic atypia seen in high grade PIN?
- yes, significant atypia may be seen
- is the basal cell layer intact in high grade PIN?
- in high grade PIN, describe the size and shape of the glands
(just increased number and stratification of cells lining the glands)
- connection between high grade PIN and cancer?
- >50% of men with high grade PIN develop cancer within 5 yrs
- clinical action/treatment of high grade PIN?
- close monitoring with PSA, DRE and prostatic biopsies
- MC prostate cancer in US?
- adenocarcinoma of the prostate
- prostatic adenocarcinoma is most common in what race?
- does prostatic adenocarcinoma have an intact basal cell layer?
just a single layer of epithelium is seen
- what type of invasion characterizes prostatic adenocarcinoma?
- perineural invasion
- what is the name of the grading system in prostate cancer that is evidence based and very valuble for predicting prognosis?
- Gleason score
(range of 2-10)
- compare stage A and stage D prostate cancer
- stage A - confined to prostate
stage D - pelvic node or other mets (grave prognosis)
- at what stage is prostate cancer when it becomes symptomatic?
- Stage D
- where does prostate cancer like to metastasize to?
(therefore osteoblastic vertebral lesions in males are virtually diagnostic for prostate CA)
- four options in prostate CA treatment?
- 1. surgery
4. hormonal treatment
- which 2 types of prostate cancer have a better prognosis than prostate adenocarcinoma?
- 1. prostatic duct adenocarcinoma
2. endometroid carcinoma
- how does atypical adenomatous hyperplasia (AAH) differ from BPH?
- AAH - smaller glandular proliferations
BPH - branching large nodular lesions
- in a hypospadia the meatus is found on which side of the penis?
- in an epispadia the meatus is found on which side of the penis?
- which is more common: and epispadia or a hypospadia?
- what is phimosis?
- when the prepuce opening is too small for retraction
- what is paraphimosis?
- forcible retraction of the prepuce over the glans penis -> causes constriction and swelling -> painful -> may cause urethral and urinary obstruction
- nonspecific infection and inflammation of the glans is called?
- nonspecific infection and inflammation of the prepuce is known as?
- in a patient that presents with balantitis or balanoprosithitis what else should we consider working them up for?
- occult diabetes
- what is the MCC of balatitis or balanoprosthitis?
- poor personal hygiene
- when are condylomata lata seen?
- late stage syphillis
- what is Fournier's gangrene?
- necrotizing, subcutaneous, gas-producing infection starting in the scrotum. 40% mortality
- what is Peyronie's disease?
- plastic induration of the penis that causes painful curvature towards the lesion
- what types of tissue may be found in Peyronie's disease?
- Peyronie's disease may be related to?
- chronic urethritis
- what is retrograde ejaculation?
- ejaculation of semen into the bladder instead of through the urethra
- condyloma acuminatum is caused by?
- HPV (types 6 and 11)
- is condyloma acuminatum a precancerous lesion?
- all types of penile carcinoma in situ are related to what causative agent?
- HPV type 16
- three types of penile CIS?
- 1. erythroplasia of Queyrat
2. Bowen's disease
3. Bowenoid papulosis
- which type of CIS occurs in sexually active young adults?
- bowenoid papulosis
- which type of CIS is associated with occult visceral malignancy in 1/3 of cases?
- Bowen's disease
- progression rate of erythroplasia of Queyrat?
- 5-10% develop SCC
- how is bowenoid papulosis distinguished from bowen's disease?
- bowenoid papulosis - multiple lesions
bowens disease - single lesion
- progression of bowenoid papulosis to invasive carcinoma?
- very rare
- is a giant condyloma (bushchle-lowenstein tumor) benign or malignant?
- what is the MC penile cancer worldwide?
- SCC is related to?
- uncircumcised males
- at what age does SCC MC occur?
- 40-70 (mid to late life)
- which hormone do Sertoli cells produce?
- estrogen like hormones
- which hormone do Leydig cells produce?
- the condition in which the testes are undescended is called?
- is cryptorchidism usually unilateral or bilateral?
- three most common places for the undescended testicle to lie?
upper scrotal sac
- what are the two phases of descent of the testes?
- 1. transabdominal phase
2. inguinalscrotal phase
- what types of substances govern the transabdominal phase of testicle descention?
- mullerian inhibiting substance
- what types of substances govern the inguinoscrotal phase of testicle descention?
- in cryptorchidism: what 3 changes are seen in the testicle by age 2?
- 1. hyaline deposition
2. failure of germ cell maturation
3. tubular atrophy
- two possible consequences of untreated cryptorchidism?
- 1. sterility (if bilateral)
2. 7-10x increase in testicular cancer
- if cryptorchidism is surgically corrected, is there still a risk for testicular cancer?
(in that testicle and the contralateral testicle)
- current treatment protocol for cryptorchidism?
- 1. surgical correction by age 2
2. monitor throughout middle age for testicular cancer
- where is inflammation more common: in the testis proper or in the epididymis?
- in gonorrhea which is inflammed first: the epididymis or the testes?
- in syphilis which is inflammed first: the epididymis or the testes?
- testes, then epididymis
- in which age group is orchitis seen with a mumps infection?
- puberty and adulthood
- in which infection of the testes is "perivascular cuffing" seen?
- is TB more likely to be seen in the epididymis or the testes?
- what causes torsion of the testicles?
- twisting of the spermatic cord -> blocks venous drainage -> get hemorrhagic infarct
- 10 predisposing conditions to testicular atrophy?
- 1. increased age
6. obstruction of seminal outflow
7. high FSH levels
9. administration of female sex hormones
10. genetic (ie. Klienfelters)
- a benign cystic accumulation of sperm (usually near the epididymis) is called?
- 95% of testicular neoplasms come from what cell type?
- germ cells
- most testicular neoplasms are found in what age range?
(small peaks in early childhood and old age)
- how does testicular cancer usually present?
- painless mass in testicle
- in general, what is the character of most testicular neoplasms?
- very aggressive
(but good therapies exist)
- which histologic type of testicular cancer has a very good prognosis?
- 3 tumor markers used to evaluate testicular seminomas?
- 1. AFP (alpha fetoprotein)
2. HCG (human chriogonadotrophin)
3. PLAP (placental-specific isozyme of Alkaline Phosphatase)
- AFP is ALWAYS seen in what type of testicular tumors?
- yolk sac tumors
- AFP is NEVER seen in what type of testicular tumor?
- hCG is ALWAYS seen in what type of testicular cancer?
- hCG is NEVER seen in what type of testicular cancer?
- yolk sac tumors
- PLAP is seen in what tumors?
- in 50-60% of all testicular tumors
- which group of lymph nodes does testicular cancer spread to first?
- peri-aortic (retroperitoneal)
- testicular cancer usually metastasizes to?
(may also go to brain, liver, bones)
- connection between Intratubular Germ Cell Neoplasia (ITGCN) and cancer?
- ITGCN is considered a precursur lesion to testicular germ cell tumors
- does testicular cancer have a genetic component?
see familial clustering: siblings may have 10x increased risk
- which race is testicular cancer virtually unheard of?
- common genetic mutation seen in testicular germ cell tumors?
- isochromosome of the short arm of chromosome 12.
- which two germ cell tumors are considered not to be a result of ITGCN?
- 1. Spermatocytic seminoma
2. Pediatric yolk sac tumor
- 3 major nonseminomatous germ cell tumors?
- 1. embryonal carcinoma
2. immature teratoma
- what is the most common type of germ cell tumor?
- peak age at diagnosis of a seminoma?
- prognosis of testicular seminoma?
- excellent if confined locally or to retroperitoneum
(responsive to radiation)
- age at diagnosis of a spermatocytic seminoma?
- when an elderly man presents with a testicular mass, what two types of cancer is it most likely to be?
- 1. testicular lymphoma
-if not that, then -
2. spermacytic seminoma
- is a spermacytic seminoma benign or malignant?
(on rare metastasis -> very aggressive)
- is ITGCN a precursur to spermacytic seminoma?
(spermacytic seminoma is not related to intratubular germ cell tumors)
- is spermacytic seminoma PLAP (+)?
- NO! it is PLAP (-)
(spermacytic seminoma is not related to intratubular germ cell tumors)
- do non-seminomatous germ cell tumors have ITGCN as a precursur?
- What are the three non-seminomatous germ cell tumors Dr. Sens gave us?
- 1. Embryonal Carcinoma
2. Immature Teratoma
- age at diagnosis of an embryonal carcinoma?
- 20-30 yrs
- compare the "personality" of an embryonal carcinoma as compared to a seminoma
- embryonal carcinoma more aggressive and lethal; tends to metastasize hematogenously
- which tumor marker does embryonal carcinoma produce?
- two components of a choriocarcinoma?
- 1. cytotrophoblast
- choriocarcinoma makes what tumor marker?
- "personality" of choriocarcinoma?
- highly malignant
- does a yolk sac tumor have a ITGCN precursor?
- age at diagnosis of a yolk sac tumor?
- infancy and childhood
- prognosis of a yolk sac tumor?
- excellent (in the young age group)
- tumor marker for a yolk sac tumor?
- age group at diagosis of a mature teratoma?
- infants and children
- prognosis of a mature teratoma?
- benign in children
(most likely malignant if found in adult=rare)
- two sex-cord/stromal derived tumors?
- 1. Leydig cell tumors
2. Sertoli cell tumors
- crystalloids of Reinke are seen in what tumor?
- Leydig cell tumor
- are most Leydig and Sertoli cell tumors benign or malignant?
- age group at diagnosis of a testicular lymphoma?
- progosis of a testicular lymphoma?
- VERY POOR, usually metastatic
- what other type of cancer prefers to spread to the testes?
(called testicular leukemia)
- is an adenomatoid tumor benign or malignant?
- where does an adenomatoid tumor commonly arise?
- an adenomatoid tumor presents alot like a yolk sac tumor. how can they be telled apart?
- adenomatoid tumor stains with keratin, yolk sac doesn't
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