(BQ) Part 2 book Lange pathology flash cards presentation of content: Reproductive system, nervous system, musculoskeletal system, the skin, immune system, chromosomal disorders. Invite you to consult.
Disorders of the Female Reproductive System Disorders of the Breast Fibrocystic Disease of the Breast Benign Tumors of the Breast Breast Carcinoma Disorders of the Ovaries Disorders of the Cervix and Uterus Ovarian Cysts Endometritis Polycystic Ovarian Syndrome Endometriosis Ovarian Tumors of Surface Epithelium Origin Leiomyoma Ovarian Tumors of Germ Cell Origin Ovarian Tumors of Sex Cord-Stromal Origin Endometrial Carcinoma Dysplasia, Carcinoma in Situs, and Squamous Cell Carcinoma of the Cervix 176 Disorders of Pregnancy Other Disorders Placental Attachment Abnormalities Neoplasms of the Vagina Preeclampsia and Eclampsia Pelvic Inflammatory Disease Hydatidiform Mole and Gestational Choriocarcinoma Female Reproductive System Differential Features of Ovarian Masses Ovarian Mass Years Affected Menstrual Irregularity Malignancy Follicular cysts Menstrual years Anovulation No Corpus luteum cysts Menstrual years Delayed period No Theca-lutein cysts Menstrual years Amenorrhea, hCG elevation No Dysgerminoma Kids, young adults None Yes Yolk sac tumor Kids, young adults None Yes Choriocarcinoma Premenstrual None, hCG elevation Yes Benign teratoma All years None No Malignant teratoma Kids, young adults None, hCG elevation Yes Cystadenocarcinoma Menstrual years None Yes Endometrioid tumor Postmenopausal None Yes Granulosa cell tumor Premenarche or postmenopausal Irregular/excessive bleeding Sometimes Ovarian thecoma All years Irregular Rarely Sertoli-Leydig cell tumor All years Amenorrhea No 176 Disorders of the Male Reproductive System Tumors of the Testes Disorders of the Prostate Disorders of the Penis Testicular Germ Cell Tumors Benign Prostate Hyperplasia Penile Diseases Testicular Sex CordGonadal Stroma Tumors Prostate Carcinoma Penile Cancers 177 Male Reproductive System Ovarian and Testicular Tumor Analogues Ovarian Tumors Testicular Tumor Analogs Dysgerminoma Seminoma Yolk sac tumor Endodermal sinus tumor Ovarian choriocarcinoma Testicular choriocarcinoma Ovarian teratoma (benign) Testicular teratoma (malignant) Sertoli-Leydig ovarian tumor Leydig cell (interstitial) tumor, Sertoli cell tumor (androblastoma) 177 A 30-year-old woman presents to your clinic complaining of bilateral, diffuse breast pain Her last menstrual period was weeks ago and she says that she has felt several painful masses in both breasts during her self-examination in the shower She is very concerned because she has a sister-in-law, who was recently diagnosed with breast cancer On physical examination, you notice multiple, palpable masses on both breasts but no changes to the overlying skin After taking a detailed history, you learn that the patient does not drink or smoke, has no immediate family members with a history of breast cancer, and there has been no nipple discharge You order a fine needle aspiration cytology, which reveals an aspirate suggestive of a cyst You reassure the patient that the lesion is benign and recommend that she avoid trauma to the affected regions and wear a brassiere that gives good support and protection 178 Fibrocystic Disease of the Breast Etiology and Epidemiology Caused by hormonal imbalance (increased estrogens and/or decreased progesterones) Pathology Several histologic types: (1) Cystic: multiple fluid-filled cysts appear blue (blue-dome cyst), cysts lined by polygonal cells with eosinophilic granular cytoplasm that are similar to apocrine epithelium (apocrine metaplasia), may see papillary projections of cystic epithelium; (2) Epithelial hyperplasia of breast duct: increase in number of epithelial layers in terminal duct lobules resulting in irregular lumens; (3) Stromal fibrosis: hyperplasia and fibrosis of breast stroma; (4) Sclerosing adenosis: increased number of acini, stromal fibrosis Clinical Manifestations Presents with diffuse breast pain (midcycle tenderness) and multiple, palpable lesions, often bilateral; no changes in overlying skin or nipple; rapid fluctuation in size of masses is common Treatment Symptom management with pain control Notes Fibrocystic disease is the most common breast disorder Cystic and stromal fibrosis represent no increased risk for carcinoma, but epithelial hyperplasia and sclerosing adenosis carry a mildly increased risk Peak incidence is between 25 and 50 years old 178 A 21-year-old African American woman presents to the clinic complaining of a large mass in her left breast She has no immediate family members with breast cancer On physical examination, you notice that the mass is round, rubbery, mobile, and nontender It is approximately cm in diameter You order a needle biopsy that shows a combination of connective tissue and cystic spaces taking on a leaflike appearance You inform the patient that this lesion is most often benign, but nevertheless you suggest that she be treated with a local excision to remove the growth 179 Benign Tumors of the Breast Epidemiology Fibroadenoma (FA): Occurs in women < 40; tends to occur more frequently and at a younger age in African American women Phyllodes tumor (PT): Occurs most commonly after the age of 50 Intraductal papilloma (IP): Occurs in middle-aged women Pathology FA: Gross: small, mobile, rubbery, firm mass with sharp, well-circumscribed edges Microscopic: fibroblastic stroma surrounding cystic and glandular spaces; may regress after menopause and demonstrate calcifications PT: Gross: large, bulky mass of connective tissue and cysts Microscopic: cystic spaces on cut section of stroma contains leaflike projections from cyst walls; leaflike appearance on breast surface; 5%–10% undergoes malignant change with atypia (cystosarcoma phyllodes) IP: Gross: arising from major lactiferous ducts Microscopic: proliferation of ductal epithelial tissue in papillary growth manner; apocrine metaplasia Clinical Manifestations FA and PT: Increased size and tenderness of mass with pregnancy or menstrual cycle; no overlying skin changes; no lymphadenopathy; no nipple retraction IP: Presents with nipple discharge Treatment FA: No treatment or simple excision PT: Local excision with wide margin; can recur after resection IP: Simple excision Notes Phyllodes tumor and intraductal papilloma carry a mildly increased risk of breast carcinoma 179 A 50-year-old woman presents to your clinic after finding a mass on the upper outer quadrant of her left breast After taking a thorough history, you learn that her mother died from breast cancer and her maternal aunt was also diagnosed with breast cancer at an early age The patient started her period at age 11, did not bear any children, and has not been through menopause On physical examination, she is markedly obese and you notice retraction of the skin and the nipple on her left breast You locate the mass in question during your breast examination and find that it is fixed, hard, and nontender The mass was not present on her last mammogram dating back years You also feel palpable axillary lymph nodes You schedule the patient for an immediate mammography and needle biopsy to confirm your suspicions 180 Breast Carcinoma (Part I) Etiology and Epidemiology Risk factors include family history of first-degree relative with breast cancer at young age (highest risk), autosomal dominant inheritance of mutations in BRCA1 or BRCA2 gene, female gender, increased age, early first menarche, delayed first pregnancy, nulliparity, late menopause, radiation, and exogenous estrogen use Incidence increases with age Pathology Infiltrating ductal carcinoma: Tumor cells arranged in cords, islands, or glands embedded in dense fibrous stroma; may arise from ductal carcinoma in situ (DCIS) Intraductal comedocarcinoma: Sheet of tumor cells confined within duct; central necrosis; periductal fibrosis with inflammation Inflammatory: Lymphatic involvement of overlying skin Paget disease: Paget cells (large cells with clear halo of pale cytoplasm) extend from ducts and invade epidermis of nipple; underlying ductal adenocarcinoma within subareolar excretory ducts always present Infiltrating lobular: Often multiple and bilateral; cells line up (Indian file) with tumor cells surrounding lobule in target fashion; signet ring cells; may arise from lobular carcinoma in situ (LCIS) after many years Medullary: Solid sheets of cells with large nucleoli in scant stroma; lymphocytic infiltrate Mucinous (colloid): Pools of extracellular mucin surrounding tumor cell clusters; gelatinous consistency Notes Breast carcinoma is the second most common cause of cancer death among women 180 ... mutations in BRCA1 and BRCA2 genes and high expression of the HER2/neu oncogene Occurs most commonly in children and young adults (except for teratomas, which can occur at all ages) Pathology Dysgerminoma:... family history of ovarian cancer, mutations in BRCA1 and BRCA2 genes, and high expression of the HER2/neu oncogene Affects all age groups Pathology and Pathophysiology Ovarian fibroma-thecoma (OFT):... disappears with 2- month regimen of oral contraceptives; follow with serial ultrasounds; laparoscopic removal if persistent CL and TL: Cyst removal or unilateral oophorectomy Notes 1 82 A 30-year-old