[08.29b] Patho Lab (ReGuGy) Female GU Pathologies Part 1 V2.pdf

Markedly dilated renal pelvis and calyces

What characterizes the internal surface of a hydronephrotic kidney?

Smooth

What is the appearance of the external surface of a hydronephrotic kidney?

Any obstruction along the urinary tract

What is the general cause of hydronephrosis?

Calculi, tumors, and ureteropelvic stricture

List three causes of hydronephrosis specifically involving the renal pelvis.

Calculi, tumors, clots, sloughed papillae, and inflammation

List five intrinsic causes of hydronephrosis occurring in the ureter.

Pregnancy, tumors, and retroperitoneal fibrosis

List three extrinsic causes of hydronephrosis affecting the ureter.

Calculi, tumors, and functional causes such as neurogenic bladder

List three causes of hydronephrosis in the bladder.

Hyperplasia, carcinoma, and prostatitis

List three prostatic causes of hydronephrosis.

Posterior valve stricture and tumors

List two rare urethral causes of hydronephrosis.

Clear cell carcinoma

What is the most common histological type of Renal Cell Carcinoma?

Yellow-orange

What is the characteristic color of RCC due to its lipid and glycogen content?

Angiomyolipoma

What benign lesion can be mistaken grossly for RCC due to its yellow fat tissue?

Blood vessels, muscle cells, and fat cells

What is the composition of an angiomyolipoma?

Nodular

What is the appearance of the external surface of a kidney affected by RCC?

Papillary, chromophobe, Xp11 translocation, and collecting duct or Bellini duct carcinoma

List four types of RCC besides clear cell.

70 percent

What percentage of the time is a large central renal tumor found to be RCC?

Transition zone

In which zone of the prostate does nodular prostatic hyperplasia usually occur?

Peripheral zone

In which zone does prostatic carcinoma usually occur?

20 grams

What is the normal weight of the prostate?

Increase in number of cells, proliferation of stroma, and proliferation of glands or acini

What three histological changes define prostatic hyperplasia?

Nodular arrangement

What is the characteristic histological and gross appearance of the prostatic acini in NPH?

Mixed form

How do germ cell tumors usually exist, as they are rarely pure?

Seminoma and yolk sac tumor or seminoma and embryonal tumor

Give an example of a common mixed germ cell tumor combination.

20 to 30 years old

What is the peak clinical age range for men to develop germ cell tumors?

Seminoma

What is the most common clinical diagnosis for a testicular mass in a man aged 20 to 30?

Ovoid and identifiable

How are the testes described in a case of seminoma despite the presence of an enlarging tumor?

Localized in the testes

What is the typical clinical stage of most seminomas at presentation?

Advanced clinical staging

What is the typical clinical stage of non-seminomas at presentation?

Lymph node metastasis with hematogenous spread

How do seminomas typically metastasize?

Hematogenous route with earlier metastasis

What is the characteristic metastatic route for non-seminomas?

Radiosensitive

What is the radiation sensitivity status of seminomas?

Radioresistant

What is the radiation sensitivity status of non-seminomas?

Better

How does the prognosis of a seminoma compare to that of a non-seminoma?

Fibroadenoma

What is the most common benign tumor of the female breast?

MED12

In which gene do two-thirds of fibroadenomas harbor driver mutations?

20 to 30 years old

What is the peak age range for women to develop fibroadenomas?

Multiple and bilateral

Are fibroadenomas more commonly solitary or multiple/bilateral?

Hormonally responsive

How does the epithelial compartment of a fibroadenoma react to hormonal secretions?

Increases in size

How does a fibroadenoma typically change during pregnancy?

Regress

What happens to a fibroadenoma after a woman reaches menopause?

Well circumscribed, rubbery, grayish white nodules

What is the characteristic gross appearance of a fibroadenoma?

Slit like spaces

What kind of spaces are often seen grossly within a fibroadenoma?

Freely movable

How is a fibroadenoma described during a physical examination regarding its mobility?

Infarction and inflammation

Which two complications can cause a fibroadenoma to mimic carcinoma clinically?

Myxoid stroma

What does the stroma of a fibroadenoma often resemble microscopically?

Pericanalicular pattern

What pattern is seen when stroma surrounds the epithelium in a fibroadenoma?

Intracanalicular pattern

What pattern is seen when stroma compresses and distorts the epithelium in a fibroadenoma?

Densely hyalinized stroma and atrophic epithelium

How does a fibroadenoma look microscopically in an older woman?

Fibroadenoma, fat necrosis, and duct ectasia

List three breast lesions that can be clinically mistaken for carcinoma.

Painless palpable mass and mammographic densities

What are the clinical and radiographic presentations of fat necrosis?

1.0 relative risk

What is the relative risk of developing malignancy from a fibroadenoma without complex features?

3 percent

What is the absolute lifetime risk of malignancy for a fibroadenoma without complex features?

2.17 times

By how many times do fibroadenomas increase the risk of invasive breast cancer according to some studies?

1.5 to 2.0 relative risk

What is the relative risk for a fibroadenoma that exhibits complex features?

Cysts larger than 0.3 cm, sclerosing adenosis, epithelial calcifications, and papillary apocrine change

List four complex features found in some fibroadenomas.

Nonproliferative changes, proliferative disease, and atypical hyperplasia

Name the three groups used to classify benign epithelial lesions of the breast.

Fibrocystic changes

What group of common morphologic alterations is grouped under the term nonproliferative changes?

Lumpy bumpy breast

What informal clinical term often describes fibrocystic changes?

No

Are nonproliferative fibrocystic changes associated with an increased risk of breast cancer?

Cystic change with apocrine metaplasia, fibrosis, and adenosis

List the three principal nonproliferative morphologic changes.

Dilation of the lobules

How do small cysts form in the breast?

Metaplastic apocrine cells

What type of cells typically line cysts in fibrocystic change?

Release of secretory material into adjacent stroma

What is the consequence of a breast cyst rupturing?

Chronic inflammation and fibrosis

What factors contribute to the palpable nodularity found in fibrocystic changes?

Increase in the number of acini per lobule

Define adenosis in the context of breast tissue.

Apocrine metaplasia

What is characterized by abundant pink-staining cytoplasm in tall columnar epithelial cells lining cysts?

Cystosarcoma phyllodes

What is the older, less accurate name for a phyllodes tumor?

Intralobular stroma

From what specific breast tissue does a phyllodes tumor arise?

MED12

What genetic mutation do phyllodes tumors share with the majority of fibroadenomas?

TERT

Which gene mutation, encoding telomerase, is more likely to be found in malignant phyllodes tumors?

Sixth decade

In which decade of life do most phyllodes tumors typically present?

Do not metastasize

Do low-grade or benign phyllodes tumors metastasize?

Wide excision or mastectomy

What is the required treatment for borderline and high-grade phyllodes tumors to prevent recurrence?

One-third

In what proportion of borderline or high-grade phyllodes cases do distant hematogenous metastases occur?

Rare

How common is lymphatic spread in phyllodes tumors?

Only the stromal component

Which component of a phyllodes tumor has the capacity to metastasize?

Higher cellularity, mitotic rate, nuclear pleomorphism, stromal overgrowth, and infiltrative borders

Name five characteristics that differentiate phyllodes tumors from fibroadenomas.

Leaf-like

What does the Greek word "phyllodes" mean?

Bulbous protrusions

What shape do larger phyllodes lesions often have due to nodules of proliferating stroma?

Invasive Carcinoma of No Special Type

What is the modern preferred name for Infiltrating Ductal Carcinoma?

Terminal lobular unit

From what specific part of the breast does Infiltrating Ductal Carcinoma arise?

Tends to form glands that resemble ducts

Why is the tumor called "ductal" despite not arising from the actual ducts?

Hard, irregular radiodense mass

How does IDC most commonly present on a mammogram?

Desmoplastic stromal reaction

What causes the characteristic grating sound when IDC is cut or scraped?

Chalky-white

What color is the desmoplastic stroma in IDC?

Inked basal margin

What is used to determine if a tumor has extension at the edge of the resection or if cells remain in the patient?

Nipple and areola

The presence of ulceration on the skin surface shows that a breast tumor has already involved which areas?

Gender

What is the most important risk factor for breast cancer?

First-degree relatives with breast cancer, race, age, age at menarche, age at first live birth, breast density, diet, obesity, and radiation exposure

List nine risk factors for breast cancer besides gender.

Estrogen and Progesterone receptors

Which two hormone receptors are commonly assayed for breast carcinoma prognosis?

80 percent

What percentage of cases that are both ER+ and PR+ respond to hormonal therapy?

40 percent

What percentage of cases respond to hormonal therapy if they are only positive for one receptor (ER+ or PR+)?

Less than 10 percent

What is the response rate to hormonal therapy for tumors that are ER- and PR-?

Chemotherapy

What therapy are ER- and PR- tumors more likely to respond to than hormonal therapy?

Predictor of response to targeted agents

What is the main importance of evaluating HER2 neu overexpression or amplification?

Angiosarcoma

What is the only sarcoma that occurs with any frequency in the breast?

Radiation therapy or chronic edema

In older women, breast angiosarcoma often arises as a complication of which two factors?

Non-Hodgkin lymphoma

What malignancy may arise primarily in the breast or secondarily due to systemic disease?

B-cell type

What is the most common cell type for primary breast lymphomas?

Breast implants

With what are rare T-cell lymphomas of the breast associated?