Pathologie (Fach) / Geschlechtsorgane (Lektion)
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6. SJ.
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- Breast cancer Most breast cancers are adenocarcinomas, arising from ductal tissue (80%) or lobular tissue (20%). Non-invasive:1. Ductal carcinoma in situ (DCIS)∼25% of all newly diagnosed breast cancers- Localization: unifocal- Frequently has a pattern of grouped microcalcifications- Can travel along the lactiferous duct, through the pore, onto the skin → Paget disease of the nipple- Obligate precancerous lesion → surgical therapy2. Lobular carcinoma in situ (LCIS)- 1-5% of all newly diagnosed breast cancers- Localization: multifocal- Microcalcifications are rare3. Comedocarcinoma (subtype of DCIS)- Central necrosis Invasive:1. Invasive ductal carcinoma (most common)- 70-80% of all invasive breast carcinomas- Unilateral localization- Mostly unifocal tumors- More aggressive, early metastases2. Invasive lobular carinoma- 10-15% of all invasive breast carcinomas- Unilateral or bilateral- Frequently multifocal- Less aggressive than ductal carcinoma3. Mucinous breast carcinoma (<5%)4. Medullary (5%, gute Prognose)5. Inflammatory breast cancer - Peau d'orange- Tenderness, burning sensation, blood-tinged nipple discharge- Differential: Mastitis, Paget disease of the breast, abscess6. Paget disease of the breast- A ductal carcinoma that infiltrates the nipple and areola- Erythematous, scaly, or vesicular rash affecting the nipple and areola- Pruritus, burning sensation, nipple retraction- The lesion eventually ulcerates → blood-tinged nipple discharge- Differential: Mammary eczema
- Benign breast conditions - Supranumerary nipples- Fat necrosis- Mastitis- Fibrocystic changes (Mastopathie)- Gynecomastia Neoplasmas: - Fibroadenoma- Phyllodes tumor- Intraductal papilloma
- Fibroadenom - Häufigste Mammatumor der jungen Frau- Meist solitär, gut abgrenzbar, adolent, mobil 1. Mischtumor: Mesenchymale (Stroma, fibrös) und epitheliale (glandulär) Komponente 2. Gutartiger Tumor: Scharf begrenzt, keine Zeichen der Malignität 3. Kapsel Diagnose:- Ultraschall: gut definierte Masse- Mammogramm: gut definierte Masse, möglicherweise popcorn-like calcifications- Falls Bildgebung inkonklusiv → Feinnadelaspiration mit glandulärem und fibrösem Parenchym
- Mastopathie (= Fibrozystische Veränderungen) Vielzahl proliferativer oder degenerativer Umbauprozesse des Brustdrüsen-Parenchyms, die meist durch hormonelle Dysbalancen zwischen Östrogenen und Progesteron verursacht sind. 1. Fibrose des Zwischengewebes 2. Zysten 3. Epithelmetaplasien (v. Saar Epithel): Zweischichtige Epithelauskleidung (Epithel- und Myoepithelzellen) 4. Apokrine Metaplasie: Zahlreiche Drüsenstrukturen mit intraluminalen, pseudopapillären, hell eosinophilen Epithelien Subgruppen:- Sklerosierende Adenosis- Duktale Hyperplasie- Radiäre Narbe
- Invasives dukales Karzinom - Fibrolipomatös umgebautes Mammagewebe - Stromale Invasion - Tumorknoten aus schalen soliden Strängen und vereinzelten Drüsenstrukturen - Immer wieder in situ Komponente (DCIS) mit Nekrosen und Verkalkungen - Diffuse Infiltration ins umgebende Fettgewebe
- Invasives lobuläres Mammakarzinom - Tumorwachstum vorwiegend in schmalen, soliden Strängen, meist in Einerreihen - 'Zieltarget' Strukturen - Monotone Zellen diffus verteilt
- Germ cell ovarian cancer Germ layers: Ectoderm; mesoderm; endoderm; Some don't differentiate and remain pluripotent → head to ovary or testes and eventually turn into egg/sperm. 4 Types:1. Teratoma: Comes from any of the germ layers- Mature cystic teratoma: Most common ovarian tumor in young woman. Eg, struma ovarii.- Immature teratomas: From neuroectoderm. Often malignant and metastasize quickly.2. Yolk sack tumor (endodermal sinus tumor)- Most common germ cell tumor in children- Can be very aggressive- Schiller-Duval bodies (rings of cells around a central blood vessel)3. Choriocarcinoma- Made of germ cells that turn into syncytiotrophoblast cells- Usually small, bleed easily, spread beyond ovaries- Secrete β-HCG → ovarian cysts4. Dysgerminoma- Made of germ cells that form oocytes (normal pattern) but grow uncontrollably- Most common malignant ovarian tumor- Central nuclei with clear cytoplasm5. Embryonal carcinoma
- Ovarian cancer types 1. Epithelial cell cancer (most common)- Serous- Mucinous- Endometroid- Transitional (Brenner) 2. Germ cell cancer- Teratoma- Yolk sac tumor (endodermal sinus tumor)- Choriocarinoma- Dysgerminoma 3. Sex cord-Stromal cell cancer: From follicular cells or connective tissue cells- Granulosa-theca cell- Fibroma- Sertoli-Leydig cell
- Epithelial ovarian cancer Serous: Fluid-filled cysts (typically small)- Benign serous cystadenoma: Most common→ Bilateral- Borderline serous cystadenoma- Malignant serous cystadenocarcinoma: → Psammoma bodies: Plaques with calcium & cellular debris Mucinous: Mucous-filled cysts (typically large & multiloculated)- Benign mucinous cystadenomas: → One ovary- Borderline mucious cystadenoma- Malignant mucinous cystadenocarcinoma: → Pseudomyxoma peritonei: mucinous material collects in peritoneal cavity Endometroid:- Endometrium-like cells, ectopic - Benign cysts filled with dark blood ("chocolate cysts")- Can spread to fallopian tubes and peritoneal cavity Clear cell:- Highly malignant- Clear cells filled with glycogen- 25% associated with endometriosis or endometrial carcinomaTransitional (Brenner tumors):- Transitional cells, resembling the lining of the bladder- Solid tumor with pale yellow-tan and appears encapsulated- “Coffee bean” nuclei on H&E stain- Usually benign
- Sex cord-Stromal tumors of the ovary Granulosa-Theca cell tumor:- Most common malignant stromal tumor- Middle-aged women- Produce estradiol → uterine bleeding, breast tenderness, early puberty in young girls- Fluid pocks throughout tissue = Call-Exner bodies Fibroma:- Fibroblast cells- Thin, needle-like strands- Associated with ascites and pleural effusion (Triad = Meigs syndrome)- Pulling sensation in groin when it compresses the round ligament of the uterus Sertoli-Leydig cells:- Primitive gonadal stroma that look like Sertoli/Leydig cells found in men- Can produce androgens like testosterone → hirsutism- Reinke crystals: Pink, rod-like crystals
- Benigne Prostatahyperplasie - Knoten - Hyperplasie und Hypertrophie der Drüsen (zystisch dilatierte Drüsen mit Sekretretention) - Papilläres Epithel - Stromaproliferation und muskuläre Hyperplasie - Corpora amylacea (Prostatakonkremente)
- Leiomyom - Häufister Tumor der Frau, insb. Afroamerikaner- Assoziiert mit MED12 Gen, Steroidhormone, Hereditary Leiomyomatosis, Renal cell carcnioma syndrome (Reed's syndrome)- Intramural (häufigste), subserosal, submucosal, zervikal - Glatte, monoklonale Tumoren (aus einer einzelnen Zelle aus dem Myometrium), grau-weisse Farbe 1. Spindelzelliger Tumor 2. Keine Malignitätszeichen 3. Fibrose
- Prognosefaktor Mammakarzinom - Tumorgrösse- Lymphknotenstatus- Histologischer Subtyp- Grading (BRE Score)- Gefässinvasion Prädiktive Faktoren, Biomarkers- Östrogen Rezeptoren (IHC)- Progesteron Rezeptoren (IHC)- HER2 Status (IHC + FISH)- Proliferationsfraktion (Ki-67, IHC)(nur das invasive Karzinom darf beurteilt werden) Genexpressionstests:- Multigen Tests (Luminal B Tumoren)
- Brustkarzinome Morphologie Invasiv duktales Karzinom- Knoten in der Brust- Häufig assoziiert mit Mikrokalk Invasiv lobuläres Karzinom- Kein Knoten, nur Architekturstörung- Keine Verkalkung intratumoral- Diffuser Tumor- Häufig multizentrisch- Bilateral (10-20%)
- Histologische Subtypen des invasiven Mammakarzinoms Gute Prognose:- Tubuläres Karzinom- Rein muzinöses Karzinom- Tubulo-lobuläres Karzinom- Kribriformes Karzinom- Papillares Karzinom- Sekretorisches Karzinom (<30 Jahre) Schlechte Prognose:- Pleomorphes lobuläres Karzinom- Mikropapilläres Karzinom- Kleinzelliges Karzinom- Apokrines Karzinom- Inflammatorisches Karzinom- Glykogenreiches Karzinom Intermediat: - Medulläres Karzinom- Grosszelliges neuroendokrines Karzinom- Invasiv duktales Karzinom- Sekretorisches Karziom (>30 Jahre)- Klassisches lobuläres Karzinom
- Grading des Mammakarzinoms: BRE Score BRE Score (Bloom & Richardson, Elston & Ellis) Kriterien: - Glanduläre Differenzierung (1-3)- Kernpolymorphie (1-3)- Mitosen (1-3) 3-5 Score: G1, gut differenziert6-7 Score: G2, mässig differenziert8-9 Score: G3, wenig differenziert
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- Männliche Brust Nur Drüsengänge, keine Azini. - Gynäkomastie - Mammakarzinom → selten (<1% aller Mammakarzinome)→ DCIS oder invasiv duktales Mammakarzinom
- Risikofaktoren für Brustkrebs Familienanamnese (1-3x)Regelanamnese (1-2x)Schwangerschaft (2-3x) Proliferative Läsionen:- Mastopathie (0-1x)- Duktale Hyperplaise (1-2x)- Sklerosierende Adenose (1-2x)- Radiäre Narbe (bis 4.5x)- In situ Karzinome (bis 12)
- Intraduktale papilläre Läsion Benigne Brustneoplasie Periphere papilläre Läsionen und zentrale papilläre Läsionen sind histologisch identisch. - Periphere papilläre Läsionen: Okkult, Verkalkung, Assoziation mit ADH (atypical duct hyperplasia), DCIS- Zentrale papilläre Läsion: Klinisch manifest als Nippelausfluss (serös oder blutig) Histologie:- Papillom- Papillom mit ADH/DCIS- 'Encapsulated papillary carcinoma' = Papilläres DCIS
- Zervixkarzinome Subtypen Plattenepithelkarzinom der Zervix (80%)- Subtypen:→ Large cell keratinizing→ Large cell nonkeratinizing→ Small cell → Papillary - IHC: p63, p40 Adenokarzinom der Zervix (20%)- Subtypen:→ Mucinous→ Endometrioid→ Clear cell→ Endocervical- IHC: p16, CEA, vimentin, TP53
- Plattenepithelkarzinom der Zervix - 80% der Zervixkarzinome- High risk HPV Infektion: HPV 16, 18 - Altersgruppe 40-55. Lebensjahr Makroskopie:- Polypoid, ulzeriert Mikroskopie:- Non-keratinizing- Keratinizing: Hornperlen, Keratohyalingranula- Basaloid: hohe Mitoserate, Komedonekrosen- Verrukös: hochdifferenziert, pushing border- Kondylomatös, papillär, transitionalzellig, lymphoepitheliomartig
- Keratinisierendes Plattenepithelkarzinom der Zervix - Irregulär geformte Zellverbände mit Keratinperlen - Grosse Tumorzellen, reichlich Zytoplasma, Interzellularbrücken - Mitosen, Nekrosen, Stromadesmoplasie, Entzündung - IHC: p63, p40- IH: HPV
- Adenokarzinom der Zervix - 20% der Zervixkarzinome, steigende relative Inzidenz- 94% Assoziation zu HPV 16, 18, 45 Makroskopie: 50% mit polypoidem Wachstum Mikroskopie:- Drüsenstrukturen mit Atypien und Invasion- Zahlreiche varianten: muzinös, gastrisch, intestinal, siegelringzellig, endometroid, klarzellig, ... Immunhistochemie: p16, CEA, Vimentin, ER, TP53Molekularbiologie: In-situ Hybridisierung HPV
- Endometriale intraepitheliale Neoplasie (EIN), atypische Endometriumhyperplasie (AIN) Ätiologie:- Hormonelle Dysregulation (exogener oder endogener Hyperöstrogenismus)→ Adipositas, anovulatorische Zyklen, Hormontherapie, PCOS- Molekulare Aberrationen→ PTEN Mutationen am häufigsten→ Mikrosatelliteninstabilität (20-25%), Lynch-Syndrom Epidemiologie:- 6. Lebensdekade, 15-45x erhöhtes Karzinomrisiko Histomorphologie:- Corpuspolyp1. Schleimhauthyperplasie (Stroma + Drüsen)2. Drüsenlichtungen stark ausgeweitet 3. Durchblutungsstörung: Fibrinthromben, Blutungen, abgestossene EndometriumstückeBei der AIN:- Back-to-back glands mit zytologischen Atypien- Keine Drüsenkonfluenz
- Endometrial cancer Type I endometrial cancer: endometrioid adenocarcinomas derived from atypical endometrial hyperplasiaType II endometrial cancer: tumors of nonendometrioid histology 1. Type 1 endometrial carcinoma: Tumors look like normal endometrial glands.- Mutations in PTEN → ↑ signaling in the PI3K/AKT pathway → ↑ estrogen- Risk factors: Obesity, tamoxifen, postmenopausal estrogen thearpy without progestin, nulliparity, early menarche, late menopause, chronic anovulation, Lynch syndrome2. Type 2 endometrial carcinoma: Several subtypes, most commonly serous carcinoma- Not linked to estrogen- Affect women who have endometrial atrophy and lower body weight, ↑ women of African descent- More aggressive Clinical features:- Abnormal vaginal bleeding- Enlargement of the uterus (abdominal discomofort, cramping) Diagnosis:- Transvaginal ultrasound to determine if endometrium is abnormally thick (>4 mm) → Biopsy/Dilation and curretage to confirm diagnosis Therapy: - Surgery: Hysterectomy and bilateral salpingo-oophorectomy and removal of lymph nodes ± radiation/chemotherapy Complications: Pyometra (purulent infection of the endometrium)
- Benign prostatic hyperplasia Common in men >50, considered a normal part of aging. 5α-reductase increases with age. - Covered by a capsule of connective tissue and smooth muscle- Peripheral zone: Largest zone, 70% of glandular tissue- Central zone: 25% of glandular tissue and ejaculatory ducts that join with the prostatic urethra- Transitional zone: 5% of the glandular tissue, portion of the prostatic urethra Macroscopic:- Enlargement of the entire gland- Hyperplastic nodules in the periurethral zone Microscopic:- Glands are surrounded by a basement membrane.- Sitting in basement membrane are basal cells, neuroendocrine cells, luminal (columnar) cells that secrete sustances that into the prostatic fluid that are alkaline, containe nutrients for sperm and help it survive in the acidic environment of the vagina, as well as prostate specific antigen (helps liquefy semen after ejaculation) Ejaculation: Sperm leave testes → vas deferens → ejaculatory ducts → prostatic urethra → urethra (joins sperm & semen from seminal vesicles) Symptoms: Dribbling, hesitancy, dysuria, nocturia, feeling of bladder fullness Treatment: Finasteride (5α-reductase inhibitor), α1-antagonists (eg, phenoxybenzamine), TURP (transurethral resection of the prostate)
- Prostatakarzinom Gleason Score: Prognostischer Score- Primär und sekundär vorherrschendes Wachstumsmuster- Je nach Wachstum mit Punkten von 1 bis 5 bewertet- Addition zu einem Gesamtscore aus häufigstem und zweithäufigstem Muster- Architekturkriterien: Drüsenform, - grösse, - abstand, Herdgrenze Gut differenziert:- Uniforme mittelgrosse oder kleine glanduläre Formationen- Einschichtiges Epithel neoplastischer kubischer/zylindrischer Zellen- Keine Basalzellschickt (DD normales/hyperplastisches Gewebe)- Wenig Stroma, Drüsen stehen "dos-à-dos" Undifferenziert:- Abortive Drüsen- Solide Stränge oder Nester, unregelmässige Grenzen- Nekrosen im Tumor und Prostatagewebe - Erhebliche Vermehrung des Stromas- Invasives Wachstum mit Einbruch in: Kapsel, Lymphgefässe, perineurale Scheiden Zellen:- Grosser Zellkern, ein oder zwei prominente Nukleoli- Cytoplasma vakuolisiert, erscheint hell
- Intraductal papilloma Solitary or multiple benign lesions that arise from the epithelium of breast ducts.- Peak incidence: 40-50 years Clinical features:- Most common cause of unilateral bloody nipple discharge- Large, central lesion- Palpable breast tumor close to or behind the nipple Diagnosis:- If lesion is palpable: Core needle biopsy is confirmatory and rules out malignancy → Shows fibrovascular tissues surrounded by epithelial cells within lactiferous ducts.→ Papillary structure; can have multiple atypical cells but still benign- Otherwise: Ductogram Treatment: surgical excision of the affected duct
- Endometriosis Disease in women of reproductive age that is characterized by the occurrence of endometrial tissue outside the uterus. Age of onset: 20-40 yearsIncidence: 2-10% of all women Location: Ovaries, fallopian tubes, cervix or less commonly, the extrapelvic organs (e.g., lung or diaphragm) Clinical features:- Up to one-third of patients are asymptomatic.- Chronic pelvic pain that worsens before the onset of menses- Dysmenorrhea- Pre- or postmenstrual bleeding- Dyspareunia- Infertility- Dyschezia (difficult or painful defecation) Diagnostics:- Patient history- Physical examination→ Rectovaginal tenderness→ Adnexal masses- Transvaginal ultrasound (best initial test)→ The uterus is generally not enlarged. → Evidence of ovarian cysts (chocolate cysts)→ Nodules in bladder or rectovaginal septum- Laparoscopy (confirmatory test) - MRI, coloscopy, cystoscopy, or other interventions are potentially indicated if endometrial cells are suspected. Pathology:- Yellow-brown (sometimes reddish-blue) blebs, islands, or pinpoint spots.- Gunshot lesions or powder-burn lesions: black, brown, or bluish nodules or cystic structures seen on the serosal surfaces of the ovaries and peritoneum- Chocolate cysts: cyst-like structures that contain blood, fluid, and menstrual debris- Histology: Normal architecture, preponderance of hemosiderin laden macrophages due to cyclic hemorrhages into endometriomas Treatment:- Mild to moderate pain: NSAIDs and continuous OPCs- Severe pain: GnRH agonists (e.g., buserelin, goserelin) and continuous OCPs- Surgical therapy: Laparoscopic excision and ablation of endometrial implants
- Endometrial hyperplasia Etiology:- Anovulatory cycles- PCOS- Estrogen-producing ovarian tumors (e.g., granulosa cell tumors, theca cell tumors)- Hormone replacement therapy without progestin administration Clinical features:- Constant bleeding- Intermenstrual bleeding- Postmenopausal bleeding Diagnostics:- Ultrasonography: endometrial thickening (> 1 cm in premenopausal women and > 5 mm in postmenopausal women) - Hysteroscopy with fractional curettage- Clinical chemistry: FSH, estradiol, testosterone Classification: based on histology- Simple endometrial hyperplasia→ Histology: both stromal and glandular cells. Enlarged, dilated mucous membrane glands (Swiss cheese pattern) are located between abundant stromal tissue.- Complex endometrial hyperplasia→ Histology: pronounced proliferation of glandular tissue. The glands are positioned, in part, back-to-back ("dos-à-dos") with no separating stroma→ Grades I-II: no nuclear atypia→ Grade III: additional cell atypia such as extensive mitosis and loss of cell polarity
- Uterine leiomyoma Benign, hormone-sensitive uterine neoplasms. The most common tumor of the female genital tract. Predisposing factors:- Nulliparity- Early menarche (< 10 years old)- Age: 25-45 years- Race: Black women are at increased risk.- Obesity- Family history Classification1. Intramural leiomyoma (most common)2. Subserosal leiomyoma3. Submucosal leiomyoma4. Diffuse uterine leiomyomatosis Clinical features:- Abnormal menstruation: Hypermenorrhea, menorrhagia, metrorrhagia (possibly associated anemia)- Enlarged, firm and irregular uterus during bimanual pelvic examination- Back or pelvic pain/discomfort- Urinary tract or bowel symptoms (e.g., urinary frequency/retention, constipation, features of hydronephrosis) Reproductive abnormalities: Infertility, dyspareunia Diagnostics: Ultrasound, MRI Pathology:- Macroscopic→ Grayish-white surface→ Homogenous; tissue bundles on cross section partly in a whorled pattern→ Some leiomyomas may involve regressive changes: scar formation, calcification, and cysts- Microscopic: Smooth muscle tissue, consisting of monoconal cells interspersed with connective tissue Treatment:- Medical: Hormone therapy, NSAIDs, antifibrinolytics- Surgical therapy: Myotomy, hysterectomy
- Cervical cancer Etiology:- Infection with high-risk HPV types: 16, 18Risk factors:- Early onset of sexual activity; multiple sexual partners (strongest risk factors)- High parity- Immunosuppression (e.g., HIV infection) - History of sexually transmitted infections (e.g., herpes simplex, chlamydia)- Cigarette smoking and/or exposure to second-hand smoke (for squamous cell cancer types only)- Oral contraceptives- Low socioeconomic status Clinical features:- Abnormal vaginal bleeding: menometrorrhagia, postcoital spotting, irregular vaginal bleeding- Abnormal vaginal discharge: blood-stained or purulent malodorous discharge- Cervical ulceration- Hydronephrosis Diagnosis:- Pap smear→ Cervical intraepithelial neoplasia (CIN) classification- HPV testing- Colposcopy- Conization Pathology:- Cervical carcinoma most commonly arises from metaplastic squamous cell epithelium in the transformation zone.- Squamous cell carcinoma (∼80% of cases):→ Subtypes include large cell keratinizing, large cell nonkeratinizing, small cell, and papillary → Histology: irregular cell morphology; hyperchromatic cells with nonspherical nuclei, mitotic activity, and prominent nucleoli; loss of basal membrane- Adenocarcinoma (∼20% of cases; increasing incidence)→ Subtypes include mucinous, endometrioid, clear cell, and serous adenocarcinoma. The most common is the endocervical mucinous subtype.→ Histology: atypical columnar epithelium with elongated nuclei
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- Fibrocystic changes Benign changes characterized by the formation of fibrotic and/or cystic tissue.- Most common benign lesion of the breast- Up to 50% of women are affected during their lifetime Etiology: unknown Clinical features:- Premenstrual bilateral breast pain- Tender or nontender breast nodules- Clear or slightly milky nipple discharge Diagnosis:- Physical exam- First-line: ultrasound and mammogram- Fine-needle aspiration- Biopsy:→ Stromal fibrosis→ Cysts→ Papillary apocrine changes→ Mild epithelial hyperplasia → Calcifications Treatment:- If mild: none- If severe symptoms: oral contraceptives, tamoxifen or progesterone
- Mastitis Inflammation of the breast parenchyma that is frequently seen in nursing mothers two to four weeks postpartum.- Incidence: up to 10% of nursing mothers (particularly 2-4 weeks postpartum) Etiology: Staphylococcus aureus (most common) Clinical features:- Tender, firm, swollen, erythematous breast (generally unilateral)- Pain during breastfeeding- Reduced milk secretion- Flu-like symptoms, malaise, fever, and chills- Possible reactive lymphadenopathy Diagnosis: Clinical - Breast milk cultures or imaging may be required if there is no response to initial treatment. Treatment:- In nursing mothers: frequent emptying of the breast; breastfeeding with both breasts is recommended every 2–3 hours. - Analgesics (e.g., ibuprofen)- Cold compresses- Antibiotic treatment: Oral penicillinase-resistant penicillin or cephalosporin (e.g., dicloxacillin or cephalexin)
- Fibroadenoma Benign breast tumor with fibrous and glandular tissue. Etiology: unknown, but a hormonal relationship has been established (growth may occur in parallel to increasing estrogen, e.g., during pregnancy or before menstruation) Epidemiology:- The leading cause of breast tumor in women < 35 years of age- Peak incidence: 15-35 years Clinical features: - Mostly solitary, well-defined, non-tender, rubbery and mobile mass Diagnosis:- Ultrasound: well-defined mass- Mammogram: well-defined mass with possibly popcorn-like calcifications- If imaging is inconclusive: fine-needle aspiration showing fibrous and glandular tissue Treatment: regular check-ups
- Phyllodes tumor Rare fibroepithelial tumor with histology similar to that of fibroadenoma. Epidemiology:- 1% of all breast tumors- Most commonly benign- Peak incidence: 40-50 years Clinical features:- Painless, smooth, multinodular lump in the breast- Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern- Average size 4-7 cm Diagnosis:- Ultrasound and mammogram findings are similar to fibroadenoma, but phyllodes tumors tend to be larger and grow faster than fibroadenoma- Despite typically being a benign lesion, a suspected phyllodes tumor should be considered a suspicious mass until proven otherwise.- When phyllodes tumor is suspected (based on clinical or imaging findings) → core biopsy → Leaf-like architecture with papillary projection of epithelium-lined stroma and varying degrees of atypia and hyperplasia Treatment: Surgical excision- In case of recurrence: total mastectomy
- Testicular tumors - Subtypes Germ cell tumors (95%):- Seminoma→ Radiosensitive- Embryonal carcinoma- Teratoma- Choriocarcinoma- Yolk sac tumor→ Most common prepubertal testicular tumor→ Schiller-Duval bodies→ ↑ AFP- Mixed germ cell tumor Non germ cell tumors:- Leydig cell tumor→ Androgen excess features, like prominent external genitalia, pubic hair growth, accelerated skeletal and muscle development, and mature masculine voice- Sertoli cell tumor- Lymphoma Extragonadal germ cell tumors:- Primary germ cell tumors that arise outside of the gonads, anywhere along the body's midline from the pineal gland to the coccyx
- Prostate cancer - Second most common cancer in men following skin cancer- Second leading cause of cancer deaths in American men (after lung cancer) Risk factors:- Advanced age (> 50 years)- Family history- African-American race- Genetic disposition (BRCA-2, Lynch syndrome)- Obesity and diet high in animal fat Clinical features:- Fatigue- Loss of appetite → weight loss- Urinary retention- Hematuria: especially blood at the end of the urine stream (terminal hematuria) indicates damage to the vessels of the bladder or prostate by the tumor. - Incontinence- Hydronephrosis- Erectile dysfunction- Bone pain (bone metastasis, especially lumbosacral spine) Screening:- Digital rectal examination (DRE) - Prostate-specific antigen levels → Interpretation: a total PSA > 4 ng/mL suggests malignancy→ ↑ Alkaline phosphatase in bone metastases→ ↑ Prostatic acid phosphatase (PAP)- Confirmatory test: Prostate biopsy- Staging: Abdominal ultrasound and CT/MRI of the abdomen/pelvis Pathology:- Most common type: adenocarcinoma expressing PSA- Most common localization: peripheral zone (posterior lobe) of prostate
- Tumor markers AFP:- Hepatocellular carcinoma- Yolk sac tumor- Mixed germ cell tumors β-hCG:- Choriocarcinoma- Seminoma ALP:- Seminoma- Paget disease of the bone
- Testicular tumors Stage I: Limited to the testicles without lymph node involvement Stage II: Retroperitoneal (beneath the diaphragm) lymph node involvement- Stage IIa: affected lymph nodes < 2 cm- Stage IIb: affected lymph nodes 2–5 cm- Stage IIc: affected lymph nodes > 5 cm Stage III: Distant metastases or nonregional lymph node involvement, or retroperitoneal lymph node involvement with moderately to highly elevated tumor markers Seminoma: c-KIT staining Treatment:- Surgery→ Prior to surgery: sperm cryopreservation→ Radical inguinal orchiectomy- Seminoma: Radiation therapy ± BEP (= chemotherapy with cisplatin, etoposide, and bleomycin)- Nonseminoma: RPLND = retroperitoneal lymph node dissection ± cisplatin