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Reproductive Ovarian and Testicular Cancer USMLE

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4 types of ovarian germ cell tumors?
1. Dysgerminoma
2. Choriocarcinoma
3. Yolk Sac (Endodermal Sinus) Tumor
4. Teratoma
Dysgerminoma Marker?
1. hCG and LH
Dysgerminoma prevalence in females?
1% of germ cell tumors - associated with Turner's Syndrome
Dysgerminoma pathologic appearance?
Sheets of Uniform Cells
Choriocarcinoma malignancy of?
1. Trophoblastic cells occurring during or after pregnancy - chorionic villi not present - in mother or baby w/ early hematogenous spread to the lungs
Choriocarcinoma marker?
1. Elevated hCG
Ovarian cyst associated with choriocarcinoma?
1. Theca Lutein Cysts
Yolk sac tumor appearance?
1. Yellow, Friable, Solid mass
Yolk sac tumor marker?
1. AFP
Other site besides testes and ovaries?
1. Sacrococcygeal Tumor site
Where is choriocarcinoma likely to spread?
1. Hematogenous to the lungs
What histology is associated with yolk sac tumors?
1. Schiller Duval Bodies (Glomerulus Appearance)
What is the most common female germ cell tumor?
1. Teratoma
What are the three main types of teratomas in the ovary?
1. Mature (Dermoid Cyst_ Teratoma -> Genreally it is benign
2. Immature - aggressive malignant teratoma
3. Struma Ovari - Teratoma containing ectopic, functional thyroid tissue
Non-Germ Cell Tumors of the ovary?
1. Serous Cystadenoma/Cystadenocarcinoma
2. Mucinous Cystadenoma/Cystadenocarcinoma
3. Brenner Tumor
4. Fibroma
5. Kruckenberg Tumor
6. Granulosa Cell Tumor
Serous Cystadenoma Characteristics?
45% of all ovarian tumors, benign -> fallopian tube epithelial lining - bilateral
Serous cystadenocarcinoma characteristics?
45% of all Ovarian tumors - psammoma bodies
- BRCA1,2, and HNPCC association. - bilateral
Ovarian cancer marker?
CA-125 -> not good for screening, only good for monitoring tumor progression
Mucinous Cystadenoma?
1. Mucous secreting GI like epithelium
Mucinous Cystadenocarcinoma?
1. Mucous secreting malignancy -> pseudomyxoma perotinei -> associated with mucous secreting appendix or ovarian tumors
Brenner's Tumor?
1. Benign unilateral encapsulated bladder like epithelium that is mostly unilateral.
Granulosa Cell tumor? Kids/Adults? Histology?
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.
Fibroma tumor? Triad? sensation?
1. Spindle Shaped fibroblast bundle
- Ascites, Ovarian Fibroma, Hydrothorax
- Pulling sensation in the pelvis
What is a kruckenberg tumor?
1. GI metastasis -> adenocarcinoma w/ signet ring cells
Clear cell vaginal carcinoma?
1. Associated with intrauterine exposure to DES
What is sarcoma boytroides?
1. Rhabdomyosarcoma variant -> girls <4yrs, spindle shaped tumor cells that are desmin positive (protruding from the vagina)
3 types of benign breast tumors?
1. Fibroadenoma
2. Intraductal Papilloma
3. Phyllodes Tumor
What is the most common breast tumor in women<35?
1. Fibroadenoma
Fibroadenoma derived from what tissue?
1. Breast Stroma
Fibroadenoma predispose to malignancy?
1. No
Fibroadenoma change in size?
1. Increases in size with increased estrogen -> i.e. preganncy
Fibroadenoma palpation characteristics?
1. Small, mobile, firm mass with sharp edges
Location of intraductal papilloma?
1. in the lactiferous duct, generally just below the aerola
Intraductal papilloma presentation?
1. Serous or Bloody discharge from the nipple
Intraductal papilloma predispose to carcinoma?
1. Slightly 1.5-2X
Phyllodes tumor common in what population?
1. 60+
Phyllodes tumor location and appearance?
1. Located in the breast stroma, a large bulky, cystic mass of connective tissue w/ leaf like projections
Phyllodes tumor progression?
1. Some can become malignant
What pathology can occur at the nipple (2)?
1. Paget's Disease
2. Breast Abscess
WHat pathology can occur at the lactiferous duct (2)?
1. Mastitis
2. Intraductal Papilloma, 3. Abscess
What pathology can occur at the major duct? (2)
1. Fibrocystic Change
2. Ductal Cancer
What pathology can occur at the terminal duct? (1)
1. Tubular Carcinoma
What pathlogy can occur at the level of the lobules (2)?
1. Lobular Carcinoma
2. Sclerosing Adenosis
What pathology can occur in the stroma?
1. Phyllodes Tumor
2. Fibroadenoma
Malignant tumors of the breast most commonly arise from?
1. Terminal duct lobular unit
Receptor that is often overexpressed in breast cancer?
1. HER-2 Receptor - estrogen receptor
Single most important prognostic factor for breast malignancy?
1. Axillary Lymph Node involvement
Risk factors for breast cancer development? (5)
1. Increased number of cycles
2. Late age at first pregnancy
3. Obesity (peripheral aromatization of androgens)
4. BRCA1/2
5. Increased Estrogen Exposure
Two types of non-invasive breast cancer?
1. Ductal Carcinoma in Situ
2. Comedo Carcinoma
Ductal Carcinoma In Situ arises via?
1. Ductal hyperplasia that fills in the ductal lumen-> no basement membrane penetration
Characteristics of comedocarcinoma?
1. DCIS subtype -> caseous necrosis w/ cancer cells at periphery
5 types of invasive breast cancer?
1. Invase Ductal Carcinoma
2. Invasive lobular carcinoma
3. Medullary
4. Inflammatory
5. Paget's Disease
What is the most common and most destructive of all breast cancers?
1. Invasive Ductal Carcinoma
Appearance of invasive ductal carcinoma?
1. Firm, Fibrous, and Rock Hard Mass w/ well demarcated margins and small glandular duct like cells.
What is the classic morphology of invasive ductal carcinoma?
1. Stellate morphology
Invasive lobular carcinoma presentation? Unilateral or bilateral?
1. Often bilateral with lesions in similar locations microscopic indian filing
Invasive lobular carcinoma microscopic morphology?
1. Indian filing of cells - orderly row
Medullary carcinoma histologic appearance and prognosis?
1. Fleshy, cellular, lymphocytic infiltrate w/ good prognosis
Inflammatory carcinoma morphology/ appearance?
1. Dermal lymphatic invasion by cancer cells leading to lymphatic obstruction and peu d' orange appearance of the breast
Prognosis of inflammatory carcinoma?
1. 50% survival @ 5 years
Paget's disease gross and microscopic appearance?
1. Eczematous patches on the nipples -> large cells in epidermis w/ clear halo = paget's cells
What may paget's disease be suggestive of?
1. Underlying ductal carcinoma in situ
Typical presentation of fibrocystic change?
1. Female aged 25-menopause w/ multiple/bilateral breast lumps that are painful premenstruation and change in size -> but are not associated with malignancy
4 types of fibrocystic change?
1. Fibrosis
2. Cystic
3. Sclerosing Adenosis
4. Epithelial Hyperplasia
Which type of fibrocystic change is often confused with breast carcinoma and why?
1. Sclerosing adenosis -> associated with calcifications - increaed acini and intralobular fibrosis
What type of fibrocystic change is associated with blue dome cysts?
1. Cystic
Which type of fibrocystic change is associated with an increased number of epithelial cells in the terminal duct lobue?
1. Epithelial hyperplasia - associated with increased risk of carcinoma
Mastitis likely pathogen and cause?
1. Associated with breast feeding, likely pathogen is S. Aureus, G+, coccus, catalase +, coagulase +
Fat necrosis presentation and cause?
1. Benign painless bump in breast tissue -> associated with breast trauma - saponification
What causes gynecomastia?
1. Hyperestroginism - (cirrhosis, drugs, tumor)
Drugs causing gynecomastia?
Some Drugs Create Awkward Knockers

Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole
What genetic abnormality is associated with gynecomastia?
1. Klinefelter's Syndrome (XXY) -> decreased inhibin, increased FSH, LH, decreased testosterone and increased estrogen.
BPH hyperplasia or hypertrophy?
1. Hyperplasia!!!
BPH lobes involved?
1. Lateral and middle lobes -> direct compression of the urethra
Complications from BPH?
1. UTI, Bladder Distention/Hypertrophy, Hydronephrosis
Acute prostatitis associated with what pathogen?
1. E. Coli, Gram Negative, Encapsulated, Bacillus, lactose fermenter.
Treatment for BPH?
1. Alpha 1 Antagonists - Terazosin, Tamsulosin
2. Finasteride -> DHT leads to hyperplasia
What lobe is typically involved in prostate cancer?
1. Posterior lobe
Prostatic adenocarcinoma histology?
1. Small infiltrating glands with prominent nucleoli
Tumor markers used for prostatic carcinoma?
1. PSA and Prostatic Acid Phosphatase
--> Look for increased total PSA w/ decreased fraction of free PSA
What happens to PSA in BPH?
1. Increased Free PSA
Prostate cancer metastasis? Lab findings?
1. To the spine -> osteoblastic metastasis
-> Low back pain, elevated PSA, elevated bone alkaline phosphatase.
FSH, LH, Testosterone, and INhibin levels in unilateral cryptorchidism?
1. Sertoli Cell Dysfunction -> Decreased Inhibin -> Increased FSH; Normal Leydig function, Normal Testosterone, Increased LH
Testosterone levels in bilateral cryptorchidism?
1. Decreased, Thus there will be increase in both FSH and LH (LH because of decreased feedback inhibition from testosterone)
What tumor type is increased in cryptorchidism?
1. Germ cell tumors - reason why XY pseudohermaphrodites from androgen insensitivity system must have testicles removed.
Differential diagnosis for a testicular mass that does not transilluminate?
1. Cancer
95% of testicular tumors are what type?
1. Germ cell tumors
Testicular germ cell tumors? (5)
1. Seminoma (MCC)
2. Yolk Sac Tumor
3. Choriocarcinoma
4. Teratoma
5. Embryonal Carcinoma
Seminoma presentation? microscopic pathology? Tumor marker?
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
Yolk Sac Tumor gross pathology? Micropathology? Tumor Marker?
Yellow friable appearance w/ shiller duval glomerular appearing structures
- Elevated AFP present
Choriocarcinoma cell types? Tumor marker? metastasis? Why might it produce gynecomastia?
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
Teratoma in males? Markers present?
1. Usually malignant (in adults, benign in children) (multiple germ layers)
2. AFP and hCG elevated 50% of the time
Embryonal Carcinoma presentation?
1. Painful mass w/ glandular/papillary morphology
- if pure hCG eleated only, hCG + AFP if mixed
3 testicular non-germ cell tumors?
1. Leydig Cell Tumor - golden brown
2. Sertoli Cell Tumor
3. Testicular Lymphoma (Metastatic)
Leydig Cell tumor pathology? Findings in men vs. boys? Color of leydig cell tumor?
1. Reinke Crystals usually producing androgen leading to gynecomastia in men and precocious puberty in boys? Golden brown color
Sertoli cell tumor arises from?
1. sex cord stroma
Testicular lymphoma arises from?
1. Metastasis from lymphoma - usually quite aggressive
Transilluminated lesions? 2
1. Tunica Vaginalis lesions
- Hydrocele
- Spermatocele (dilated epididymal duct)
Peyronie's Disease?
1. Bent penis due to acquired fibrous tissue formation
Priapism associated with what causes?
1. Sickle Cell Disease (vascular occlusion)
2. PDE5 Inhibitors, Antidepressants, Alpha Blockers, Cocaine, Anticoagulants