dr. barone kaplan pathology notes part 1

7/25/2019 Dr. Barone Kaplan Pathology Notes Part 1

http://slidepdf.com/reader/full/dr-barone-kaplan-pathology-notes-part-1 1/47

DR. JOHN BARONE KAPLANLECTURES POST-MINI 1

Monday, March 1, !"1#

• LIVERo

Free Radicals/Fenton reaction: H2O2 via catalase O2 + H2O If high levels of iron/copper? H2O2 OH-

• Leads to Heochroatosis/!ilsons diseaseo "irrhosis: acro vs icronod#lar

$lcoholic cirrhosis % ost coon ca#se of icronod#lar cirrhosis in&'

• (() increases * alcohol and iliar, ostr#ction icro: . nod#les:

• B$%$ary &rac& o'(&r)c&$on* 01" or 0'"

• M+&a'o%$c* alcoholic liver cirrhosis !ilsons diseaseHeochroatosis $3-$) def

acro: 4 nod#les:

• $r)(: Hepatitis

To$n: acetainophen dr,cleaner 5caron tetrachloride6 ""L7 via "8079 ""L; halothane

o Eval of Liver <isease:

ar=ers for h+a&ocy&+ $n/)ry: AST, ALT, L<H 5nonspeci>c;

$lost all Liver diseases: ALT 0 AST

ar=ers for h+a&ocy&+ )nc&$on: ser# al#in6 prothroin tie50);6 ser# aonia 5green top t#e;

55Heatolog,/p#rple t#es: che panel 5red; @ cc 5p#rple; ABeed VitC for gaa caroD,lation of factors 26663 @ protein" @ ' A need "a2+ to *or=G;; (aa caroD,lation creates"a2+ inding site

!hen liver doesnt *or= 55IB"RE$'E< 0) d/t liver fail#re )R$B'0L$B);;

ar=ers of '$%$ary )nc&$on2$n/)ry: ser# ilir#in6 $L0 55speci>car=er for iliar,;;6 (() 5&';6 9-n#cleosidase 5E#rope;

1one diseases also increases $L0: $L0 increased therefore <<J:1OBE @ 1ILI$R8

I 33T nor4a%, Bon+5 $ 33T $ncr+a(+d* B$%$ary

L$6+r '$o(y 78o%d (&andard9

o Ka#ndice: IB"RE$'E< total ilir#inGG 5&ncon#gated or "on#gated?;

"on#gated: 5ost d/o; &ncon#gated:

Heol,tic aneiaso Increased R1" t#rnover increased ilir#ino ie 'ic=le cell 'pheroc,tosiso Increased ris= of $84+n&+d ilir#inate stones

0h,siologic 5ne*orn; a#ndice: &() not read,GGo )ransient ild increases in #ncon#gated ilir#in d/t

iat#rit, of liver

3



o Ka#ndice occ#rs 27-7M hrs a&+r '$r&h

o 0reat#rit, and heol,tic aneias *ill eDacerateo High levels of )ncon/)8a&+d ilir#in a, cro((

$44a&)r+ BBBo K+rn$c&+r)(* 1asal ganglia t#rns ,ello* )D:

ho&o&h+ray:: ech: Pho&o$(o4+r$;a&$onGG a=ingilir#in *ater sol#le 5#ncon#gated;

Hereditar, h,perilir#ineias: child/ad#lt Nstress

a#ndiceo UNCONJU3ATED*

(ilert 55PROMOTER r+8$on;;

PQ of &' pop

$R #t in prooter region of &<0gl#c#ron,ltransferase 5&(); gene

"rigler-Baar 55CODIN3 r+8$on;;

#t of &<0 gl#coron,ltransferase 5&(); gene

),pe 3: $R A BO &() activit, A F$)$L d/t=ernicter#s

o 0henoarital does BO) *or=G

),pe 2: $< A red#ced &() activit, A lesssevere

o 0henoarital *or=sGGo CONJU3ATED*

<#in-Kohnson:

$R A #t in hepatoc,te ilir#in gl#coronidetransport protein

<ecreased ilir#in eDcretion

(ross: 1L$"C liver 5d/t catecholaineetaolites;

Rotor s,ndroe:

$R A #t in #pta=e and storage? <efectiveeDcretion?

BO liver pigentation B$%$ary o'(&r)c&$on* ost coon ca#se % stones in ile d#ct 7#

<(95 "ancer " senensis A $sian liver #=e strict#re fro >rosis Asclerodera 01" 0'"

S* a#ndice 5con#g ilir#in; itching d/t ile salts Danthoasd/t cholesterol ado pain <$RC #rine d/t decreased or BO#roilinogen c of high/increased con#g ilir#in 0ale stool d/tdecreased stercoilinogen

IB"RE$'E<: con#g ilir#in

IB"RE$'E< 5s=, high; $L0

IB"RE$'E< (()/9-n#cleosidase

PBC* chronic progressive cholestatic disease characteriSed ,intrahepatic ile d#cts6 inaation and scarring d/t8ran)%o4a( '%oc=$n8 '$%+ d)c&::

o $#toi#ne disease A aTects *oen in reprod#ctive,ears

o Initiall, asD6 discovered , elevated $L0 progression toostr#ctive a#ndice6 pr#ritis

2



o $ssoc * other a#toi#ne diseases 5sogren6sclerodera;

o <D: An&$-4$&ochondr$a% A'(>>> iops, sho*ing Noridd#ct lesion % d#ct destr#ction , l,phoplasac,ticinaation *ith 8ran)%o4a(

o )D: oral #rsodeoD,cholic acid A iproves disease co#rseand slo*s progression Liver transplant

PSC* chronic cholestatic disease characteriSed , >rosis and

destr#ction of intra and eDtrahepatic ile d#ctso 2-,o 4Fo Initiall, asD6 and discovered , elevated $L0 later6

ostr#ctive a#ndiceo Increased ris= of ac#te cholangitiso assoc *ith ULCERATIE COLITIS 7"?9

o <D: cholangiogra: @'+ad+d a+aranc+ iops,sho*ing concentric @on$on (=$n 'ro($( aro#nd iled#cts -ANCA A'(

o 0rognosis: increased ris= of cirrhosis andcho%an8$ocarc$no4a 5d/t 0'" or thorotrast; 53-39Q;

&": p-$B"$ as

"rohns: $'"$ 5$nti-saccharo,ces cerevisiae $s;

Hashiotoss: anti-icrosoal as

C$rrho($(* chronic +nd-(&a8+ %$6+r d$(+a(+ characteriSed , d$)(+

destr#ction of noral architect#t#re , 'and( o 'r$d8$n8 'ro($(and nod#les of r+8+n+ra&$on h+a&ocy&+(

"a#ses: alcohol6 viral hep 5H1V6 H"V;

ech: h+a&$c (&+%%a&+ c+%% 7$&o c+%%9 is sti#lated , RO'",to=ines 5il-3;tnf; and gro*th factors transfors into,o>rolast prod#ces tgf-eta s,nthesis of increased E"5collagen 3@;

• Vit$ def: 55toDicit, vs def;; A stored in ito 5hepatic stellate; cellso night lindness 5rhodopsin A rods;o increased intracranial press#re i#node>cienc,o hair follicles lined , specialiSed c#oidal cells U

s#ao#s etaplasia of hair follicleso 1itot spotso )(F-eta GGG ost po*erf#l sti#lator of >rosisGGGo )RI"HROE % FI1RO'I'GGG

Con(+)+nc+( o c$rrho($(*o Por&a% h&n* ascites portal caval sh#nts 5heorrhoids6

esoph varices - W36 cap#t ed#sae; splenoegal, Uh,persplenis

o

Lac= o d+&o$ca&$on* hepatic encephalopath, A BHh,perestrogenis: g,necoastia6 h,pogonadis A ales6spider angioa6 palar er,thea

o Lac= o (yn&h+($(* coag#lopath, h,poal#ineiahepatorenal s,ndroe % renal fail#re *o priar,anoralities of =idne,s

o (IVE O")REO)I<E )O LO!ER 0OR)$L 0RE''&REGG 55*henalcoholic coes in *ith lood in voit d/t r#pt#redvarices;;



• FE"$L )R$B'0L$B)GG If all dr#gs fail for tD of c diXcilepse#doeraneo#s colitisGG Helps to restore noral oraGG55also *or=s for severe I1<;;

VIR$L HE0$)I)I':

• "linical s,ndroes

• $sD infection: H$V6 H"Vo Fo#nd incidentall, c of elevated transainases or Ave $

serolog,

• $c#te viral hepatitiso Inc# periodo 'D preicteric phase

alaise6 fatig#e6 na#sea6 loss of appetite !t loss6 lo* grade fever6 headache6 #scle and

oint aches ildl, enlarged liver and elevated transainases

o 'D icteric phase: "on#g ilir#in <ar= #rine 0r#ritis 5ile salts;

o "onvalescence• F#linant hep: #ncoon ac#te liver fail#re d/t assive

hepatic necrosis• "hronic hep:

o 'D/la anoralities 4Yoso Fatig#e6 alaise6 loss of appetite6 o#ts of a#ndiceo Hv/hcv a, for i#ne copleDes prod vasc#litis and

gloer#lonephritis Hv % erano#s gloer#lonephritis Hcv % erano-proliferative gloer#lonephritis

o "hronic carrier state: asD #t haror vir#s and a,

transit it• O') "OOB 5in &'; to LE$') "OOB: $6 16 "6 <6 E

o $ll RB$ EJ"E0) A 1o )rans:

$ @ E % Fecal-Oral 55$@1 via 1O!EL';; 16"6< % parenteral 55'EJ @ BEE<LE';;

o H"V % 0RI'OB @ 0O')-transf#sionGGo $LL % $"&)E HepatitisG )herefore6 need serolog,GG

"hronic: 4Yos % onl, 16 "6 <G therefore all atris= for "irrhosis @ H""

$&)OI&BE HE0: F4

• $B$+6 SMA

• CI<BE8: "OB(EBI)$L $BO$LIE':o B$%a&+ra% r+na% a8+n+($( 7NO KIDNEFS9*

O%$8ohydra4n$o(* Po&&+rG( S+)+nc+* 0otters facies: N0arrot ea=deforit,6 Nlord voldeort

Er,o: ilateral degeneration of #reteric #ds leads to ilateral renalagenesis

<ie shortl, after irthG 1c l#ngs do BO) at#re 5d/t p#l hyo%a($a; &nilateral renal agenesis: can live on 3G

o HORSESHOE KIDNEF* st#c= in pelvis on IMA a& LGG

7



BOR$L renal fDnGG 1#t predisposes for &)Is @ Cidne, stones c oftort#ro#s #reters

o ",stic diseases: 3 or 2 c,sts % $B8OBE can haveG SIMPLE RETENTION CFSTS

",sts in ed#lla % M+d)%%ary Son8+ K$dn+y

• '0OB(E1O1 I' (OO< % E<&LL$R8 '0OB(E I' (OO< 1EBI(B Po%ycy(&$c =$dn+y d$(+a(+ 7PKD9 AR

• &s#all, infantile *ith aggressive and fatal renal fail#re

• If dont die of renal fail#re6 die of hepatic >rosis

• ",sts in 1O)H liver @ =idne,

• (ene: 0CH<3 5pol,c,stic Cidne, @ Hepatic disease 3;

• 0rotein: 'rocy(&$n ro&+$n 5leads to >rosis @ c,sts;

• !hats aTected? 0roteins involved in cilia of renal t##le

• ",sts % ever,*here 5corteD @ ed#lla; and RADIATIN3 CFSTS PKD AD >>>>

• (ene: 0C<3 0C<2

• 0rotein: o%ycy(&$n 15 o%ycy(&$n ! 5for copleD together;o "opleD iportant for connective tiss#e adhesion A if

*o? asD #ntil iddle-aged @ have proles ever,*hereGG55ie arfans;;

• "OOB 3 in 3 aTected 5(eorge LopeS;

• Boral renal fDn till id life *hen present *ith HTN,

HEMATURIA, RENAL INSU<<ICIENCF 51&B/"reatinineincrease; and event#all, need dial,sis

• 3s of c,sts ilaterall,GG A &'/RI/")

• Ro#nd6 heorrhagic6 HU3E-ASS cy(&(::

• >>HATS RON3 ETRA-RENALLF >>o "ircle of !illis: BERRF ANEURFSM:: h+n r)&)r+,

SUBARACHNOID HEMORRHA3E @or(& h+adach+o 4y %$+

o Liver: ore c,stso Hear on a#sc#ltation of heart? MP 7@4$d (y(&o%$c

c%$c=9o "olon: d$6+r&$c)%o($( 7'r$8h& r+d '%ood co4$n8 o)& o

r+c&)49T)+(day, March 1, !"1#

• High hepicidin A aneia of chronic disease

• Iportant las:o 1&B 5-3M; 5P3;: eDcreted , =idne, and reasoredo "reatinine 5"r % P3;: eDcreted , =idne, #t BO) reasoredo 1&B/"r ratio 5P3:3;

o $Soteia: increased 1&B and "r d/t decreased (FR 5$ $ncr+a(+d (&$c=(&o 1"*1 ra&$o, Pr+r+na%5 $ on+ $ncr+a(+( 4or+ &han o&h+r5 R+na% ;

o Pr+r+na% A;o&+4$a: h,poperf#sion of =idne, d/t decreased "O6h,povoleia6 renal arter, stenosis6 etc

o R+na% A;o&+4$a: intrinsic renal diseaseo Po(&r+na% A;o&+4$a: #rine o* ostr#ction d/t stones 5PAIN<UL:;6 10H6

t#orso &reia % $Soteia + "linical sD

• 3LOMERULONEPHRITIS* N$s st#c= in =idne,

9



o icroal#in#ria % one of earliest signs of < 5<: s#gar a=e ,o# lose negcharge of aseent erane ca#sing loss of al#in dipstic= *ill iss itG;

o S)'+ndo&h+%$a% $44)n+ co4%++(* ver, large or highl, chargedo I#ne copleDes activate copleent 5"9a; ca#sing ne#trophils to coe

in and ca#se inaationo S)'odocy&+ $44)n+ co4%++(

o In&ra4+4'rano)( $44)n+ co4%++( 7into aseent erane9

o If #st daage podoc,tes6 get 4a(($6+ rO&+$n)r$a n+hrO&$c

(yndro4+

EVER8 BE0HRO)I" <I'E$'E &') H$VE <$$(E )O 0O<O"8)E'Go $&$(* if inaed6 lood lea=s o#t HEMATURIA:

Ndar=-colored Nso=e, Ntea-colored Ncoca-cola-colored #rine

3st step: <ipstic= 5 or 7+ % aDi#; &rinal,sis #nder icroscope

<<J of heat#ria:

1leed fro #retha6 ladder6 prostate6 #reter6 =idne,

If =idne, leeding6 see red cell castsG 5CASTS KIDNEF ;

If *hite cell casts6 =idne,G 5pol,nephritis;

Eosinophil casts? Cidne,G

If inaed? <E"RE$'E< (FRG H)B6 Olig#ria

BE0HRO)I" vs BE0HRI)I" ',ndroesG 55)$1LE;;o W3: &rinal,siso W2: 1iops, of =idne,o BE0HRO)I": @MM <AN*

ME1R$BO&'

MIBI$L "H$B(E

<O"$L 'E(EB)$L ('

A8LOI<O'I'

NO<&L$R ('o 0odoc,te % epithelial cell

o esangial cell % s#pporting cell

R+na% ar&+ry (&+no($( a(c)%ar d2o*

o 2-,of A <IBROMUSCULAR DFSPLASIA A in angiogra NBEADEDAPPEARANCE

o 49,o 4f A ATHEROSCLEROSIS A on a#sc#ltation of ado hear ABDOMBRUIT

=idne, releases reninGG HTN::

3OLDBLATT KIDNEF : narro*ing arter, ore and ore get oreand ore H)B

o Opposite =idne, % h,perplasia/h,pertroph,

HFALINE ARTERIOLOSCLEROSIS

o Renal vein renin levelo <o NOT give $"EI in this case c =idne, can infarct if drop 10 too #chGG

CHRONIC 3LOMERULONEPHRITIS* ESRD*

o "" % <6 H)B Zd/t salt @ *ater retention[6 @ gloer#lar dSGo Final end stage of all gloer#lar and t##lar diseaseso "/F: aneia 7NO KIDNEF, NO EPO ro4 r+na% +r$&)')%ar $n&+r(&$&$a%

c+%%(:9, anoreDia6 alaise6 protein#ria6 H)B6 aSoteia 5noral ratio thereforeRenal aSoteia; #rine sho*s BROAD, AF CASTS 5t##les dilatedatrophic;

HFPER-K $&h 4+&a'o%$c ac$do($(>>

Y



H80O-"a2+ d/t <E" 3-alpha-h,droD,lation of vit< , 0") @ H80O-0O7 Osteitis >rosa c,stica

o 0athologic eDa: =idne,s grossl, sall and shr#n=eno icro: h,aliniSation of gloer#li6 interstitial >rosis6 atroph, of t##les6 and

l,phoc,tic in>ltrateo )D: dial,sis * renal transplant

<iseases of )##les:o ACUTE TUBULAR NECROSIS, ATN 7ACUTE TUBULAR INJURF, ATI9

$c#te renal fail#re - W3 ost coon ca#se in &' A 0O)EB)I$LL8REVER'I1LE c proDial t##le cells can regenerate if tie

SUDDEN ONSET O< OLI3URIA RENAL AQOTEMIA:: M+&a'o%$c

ac$do($(, +%+c&ro%y&+ $4'a%anc+ 7+( HFPER=a%+4$a PT a6+(%+ad$n8 &o $d+n$n8 o RS arrhy&h4$a( DEATH:9

'tep 3: 'ee h,per=aleia * EC( changes6 IE<I$)EL8 giveCA! 73LUCONATE9 to stailiSe/protect the heartGGG

'tep 26 lo*er C+ 5ove fro intracell#lar to eDtracell#lar; ,:$n()%$n d+&ro(+ '$car'>> 5helps to shift C+ and etaolicacidosis; or B+&a-! a8on$(&>>>

'tep : reove C+ fro od,: 5ost eTective; =+ 5loop; *asting

di#retic li=e f#roseide

EER(EB"8 5if all else fails;: <I$L8'I'G "a#se: 5ost coon; I'"HEI$: 5h,poDia6 h,potension6 shoc=6

decreased "O;

Renal epithelial casts degenerate dirt,/#dd, ro*n gran#larcasts

BephrotoDin $)B:

<r#gs: $ll '#lfa dr#gs6 ainogl,cosides 5esp genta,cin;6 $D5esp ethicillin;

o ethicillin: $c#te interstitial necrosis 5$IB; fever6 rash6eosinophils

<r,cleaners: "aron tetrachloride 5activated , "8079 in liverinto free radical;

Eth,lene gl,col 5antifreeSe;

'#icide pts drin=ing antifreeSeo Eth,lene gl,col converted to oDalate 5oDalic acid;

5envelope-shaped cr,stals;o N'&I"I<E BO)E IB &RIBE

,ogloin A cr#sh in#r,G )herefore give #idsG

$LL HE$V8 E)$L' "$&'E $)BG (OO< 0RO(BO'I' IF <O <I$L8'I' @ )J )HE "$&'EG

o PFELONEPHRITIS*

A(c+nd$n8 infection fro ladder6 travels #p #reters and into =idne, W3 ladder infection % ( neg E coli 5via pili;

W2 A E faecalis

W - Clesiella

Renal pelvis t##le interstit#

ost infections6 gloer#li are sparedG

IB" ris= *ith Vesico-#reteral re#D ZV&R[

F44 c of short #rethra

R/F:

Ostr#ction



Re#D 5#rine o*s *rong *a, ZV&R[; A ch$%dr+n *ith p,eloGG

0regnant *oen d/t horones @ #ter#s p#shing #p against#reters 5+ever,thing else;

<iaetes 5ne#rogenic ladder6 ne#ropath,;

10H

'tones

)#ors

High fever6 chills6 high !1" co#nt 5ne#trophils and ands % LE<T

SHI<T therefore acterial infection;6 #nilateral 5ost; costoverteral5"V$; tenderness 50$IBGG *hen tapping on =idne,s;

&rine: acteria6 !1"s6 !1" casts Z!$J8[

HI3H <EER, CHILLS, CA TENDERNESS, BC CASTS

1road depressed scars 5healing;: CHRONIC PFELO:: Zd/t #ltipleo#ts of ac#te p,elo[

<ilated t##les >lled *ith colloid-LICE aterial Zeosinophilc[o THFROIDIQATION

Interstitial >rosis and atroph, of t##les

K$dn+y S&on+(* o Co%$c=y a$n $&h h+4a&)r$a UNILATERAL an= a$n>>

o Ca! oa%a&+ 5or "a2+ phosphate; d/t s#persat#ration 5"% EB;

High "a2+: 3° h,perparath,roidis etastatic t#or of one il=-al=ali s,ndroe: have peptic #lcer therefore ta=e in antacids and il=to coat #ild #p of "a2+ stones

3° tD: stop antacid/"a2+ inta=e and prescrie 00I and chec= forH p,lori

high oDalate: foods6 I1< stone seen on Dra,6 ct in #rine6 envelope-shaped cr,stals " stones A )J *ith H,drochlorothiaSide A "a2+ sparing di#retic

o 2nd " % A44on$)4 M8! Pho(ha&+* d/t &)I * #rease + organis5prote#s6 #reaplasa6 etc;

#rea via #rease BH+ 5aoni#; 5#rine sells li=e aoni#; F4

BH+ *ill increase pH6 therefore6 g and 0hosphate *ill s#persat#rate*ith BH+

STRUITE STONE: g + 0hosphate + BH+

BI3:: Fill #p pelvisG

STA3HORN CALCULUS 5o#tline of renal cal,ces;

'een on Dra,6 ct

)D: 3[ stop gro*th of stone , acidif,ing #rine 5ascoric acid; 2[ =illprote#s

Beed to copletel, reove stoneGG 1c ig6 need to do:

0ER"&)$BEO&' BE0HROLI)HO)O8 then\$DG

0rote#s ca#ses N#, coXn cr,stals and s*ars plateo Cy(&+$n+ (&on+(* NheDagon-shaped

0ts *ith c,stein#ria 5$R; 'een on Dra,6 ct

CI<'GGo Ur$c ac$d (&on+(

CANNOT see on Dra,6 #t can see on ") 0ts *ith 3OUT 7N+8 '$r+r$n8+4+n& n++d%+(9

P(+)do8o)& 7o( o%y8on(9

M



'een *ith High grade le#=eias 5$L/$LL/1#r=itts l,phoa; A )&OR L8'I' '8B<ROE 5)L';

&rate nephropath,

0re-)D 1EFORE "HEO: IV #ids and allop#rinol c *ill inhiitDanthine oDidase 5prevents prod of #ric acid

RASBURICASE A rea=s do*n #ric acid

T)4or( o &h+ =$dn+y:o 1EBI(B:

RENAL PAPILLARF CORTICAL ADENOMA

In corteD . 5sall; papillar, str#ct#re

&s#all, fo#nd at a#tops, 5incidental % coon;

>>RENAL AN3IOMFOLIPOMA>>

proliferation of lood vessels6 fat and #scle

not a t#or6 #t a HAMARTOMA:

$ssoc *: TUBEROUS SCLEROSIS: AD

o )'"3 OR )'"2 gene A a=e t#erin + haartin proteins% copleD

o "oposed of haartoas thro#gho#t the od, 55geneticdisease *here ,o# get haartoas\ost coonl, in

rain;;o In CNS: CORTICAL TUBER 5ne#rons6 oligodendroc,tes; A

proliferation of Nscraled rain ost coon periventric#larGG can get enign proliferation of astroc,tes:

a(&rocy&o4a 7()'++ndy4a% 8$an& c+%%a(&rocy&o4a9 55can ecoe alignant;;

(et ne* onset seiS#res 5P3-33,o Pschool age; ,ao#t late childhood to adolescence

<evt of ental dela,s A grades in school declineo In =$dn+y* $ngio,olipoas A proliferation/t#or of

lood vessels6 #scle6 fat li=e *ils #t fatt,o $n h+ar&: rhado,oa A striated #scle t#or can

give arrh,thiaso $n %)n8(: haartoas of l#ngso $n (=$n: SHA3REEN PATCH 5#p, li=e orange peel;

ASH LEA< PATCH A loo=s li=e leaf @h,popigentation

• $n,one can get itG

• <J: !oodslap 5&V-$ light; A lesion#orescesG

$ngio>roas of face A loo=s li=e acneo D TRIAD* SEIQURES, RETARDATION, ACNE-LIKE

LESIONS O< <ACE

• ONCOCFTOMA* 1enign t#or fro INTERCALATED CELLS O<COLLECTIN3 DUCTSo 3ro((* encaps#lated6 hoogeno#s6 TAN-MAHO3ANF

BRON MASS 5d/t to itochondrial pigents; * centralstellate scar

o M$cro* large cells * a#ndant gran#lar EOSINOPHILICCFTOPLASM 7MITOCHONDRIA; * enign appearing n#clei* proinent n#cleoli



!ednesda,6 arch 36 237o RENAL CELL CARCINOMA RCC 7HFPERNEPHROMA9 73RAITQ TUMOR9

o Overall6 M0< V"-"yo 5feales increasing incidence;o 0resentation:

55not ver, classic A 3Q onl,;;: "lassic )riad:

• painless heat#ria

• palpale ass

• an= pain 55real life;;: #st painless heat#ria A YQ cases left varicocele of testes Zrare association[ etastasis #s#all, F$)$L6 1&)\

• od, can =ill itGG )herefore6 part of tD no* is to sti#late i#nes,ste to help >ght oT t#or

on eDa: li=e 'all cell carcinoa of l#ng: PARANEOPLASTIC

SFNDROME 55assoc * t#or #t not ca#sed , invasion nor etastasis;;55can %oo= %$=+ any&h$n8;;

• ie t#or a=es E0O pol,c,theia

• renin H)B

• $")H "#shings s,ndroe

• $<H 'I$<H• (onadotropin 5H"(; feiniSation/asc#liniSation

• Eosinophilia $,loidosis high *hite co#nt 5le#=eoid rDn;

• 0)H-related peptide increased "a2+ 'toneso R2<* W1 ca)(+* SMOKIN3 B'$I< a#se 5esp phenactin; c,clophosphaide

ac#ired c,stic disease 5d/t long-ter dial,sis; @ 6on H$)% d$(+a(+ 7ADgerline #t in VHL gene on chr p A =noc= o#t #t;

VHL 5norall,; inhiits h,poDia-ind#cile factor 5HIF that ca#ses vesselsto gro*; Hee angiolastoa 5H$1 retina6 cereell#6 rainste6spinal cord;

H$1 in cereell# a=es E0O pol,c,theia vera * ass in cereell#

!hen see #ltiple ilateral renal cells Elevated V$ in #rine 55chec= adrenal ed#lla for pheochrooc,toa;; VHL HIF H$1 E0O R"" V$ 0HEO >>(r+ad( h+4a&o8+no)(%y ro4 =$dn+y r+na% 6+$n IC $n&o

r$8h& ($d+d h+ar& &o %)n8( 77(++ HU3E, CANNONBALL-SIQEDMETASTASES99

• once in l#ngs its ever,*here % <ATAL:

• R"" @ H"" % heatogeno#s spread In en: fro left renal vein can aTect left testes V$RI"O"ELEG 55ag of

*ors;; I"RO: CLEAR CELL CARCINOMA 7CCC9: 55clear c,toplas;;

•!h, is it clear??? ",toplas f#ll of lipids and gl,cogenGG !h, grosst#or is ,ello* and loo=s li=e fatG

CCC % " 5Y9Q;

• $rise fro proDial t##lar epithelial cells

• Loss of HL 8+n+ 5p29;

• "ells * clear c,toplas d/t gl,cogen andlipid

Pa$%%ary RCC % 39Q

• $rise fro proDial t##lar epithelial cells

R""

'poradicHereditar,- W3 R/F: -,o#nger

3



• 0apillar, gro*th pattern

• Often #ltifocal and ilateral

• #t in MET 8+n+ % hepatoc,te gro*th factor Chro4oho'+ RCC % 9Q

• $rise fro intercalated cells of collecting d#cts

• (rossl, ro*n tan

• EDtree h,poploid,

•

(ood prognosis Sarco4a&o$d chan8+( % indicate a poor prognosis

• 'arcoatoid % 1$<GG <ont respond to an,thing 1&) s#rger,GGGo 1$18 1ORB ! $BIRI<I$?? ILMS TUMOR::: 77NEPHROBLASTOMA99 A )#or of

etanephric nephroso !)3 @ !)2 5)'(s; on chr 33 right neDt to gene for devt of iris 50$JY PAired

Hoeoo gene;

>>A3R (yndro4+* $%4(, ANIRIDIA, 3+n$&a%(, R+&arda&$on 5ental@ otor;

• <elete K&') 0$JY6 $niridia

• 'ince !)3 and 0$JY neDt to each other A 1O)H deleted can get*ils t#or + aniridia

D+ny(-Dra(h (yndro4+ 7DDS9

HI(H RI'C 5Q; for !ils t#or + Renal anoalies + gonadald,sgenesis

DOMINANT NE3 IB$")IV$)IOB &) OF !)3o <oinant disease *here #t protein =noc=s o#t *ildt,pe

eTect 55li=e arfans6 osteogenesis iperfect;;

B+c=$&h-+$d+4ann (yndro4+ 7BS9 % T! 4)&::

Enlargeent of organs or od, parts 7h+4$hy+r&rohy9o H$LF of od, gets H&(EGG )herefore6 Ris= of !ils t#or of

=idne, on H&(E half of od,G

3ross: *hite tan t#or

icro: adrenal c,toegal, % enlarged adrenal cortical cells

Loss of iprinting of aternal allele o6+r+r+(($on o I3<-!

o (et assive gro*th of one side of od, @ N+ona&a%

HFPO8%yc+4$a 55#sed , aies;;o I(F-3: ca#ses gro*th li=e acroegal, @ H80ERgl,ceia

55#sed , ad#lts;;

"/F: " % age 2-9,o #nilateral palpale ado ass fever6heat#ria6 intestinal ostr#ction

o Other lastoa palpale ass co#ld e: BE&RO1L$')O$ Acan <<J via ,prod#ct oth alignant6 #t BE&ROlastoacan cross idline and calcif,

M$cro: Ntriphasic t#or1. B%a(&+4a 5sall ro#nd l#e cells;!. Epithelial 5t##les and gloer#lar str#ct#res;. 'troao Iportant for prognosis % 1$< % Ana%a($a % h,perchroatic

pleoorphic n#clei * anoral itosis

"orrelates * p9 #t and resistance to cheotDo 0rognosis ITHOUT $naplasia % (OO<G Q 9,r c#re rateGo Be#rogenic rests 55?0rec#rsor?;;

)J *ith s#rger,6 radiation

33



o S&+r$%+ Py)r$a*o 0,#ria *ith BE($)IVE #rine c#lt#re s#ggests #rethritis d/t " trachoatis or

B gonorrheaeo CFSTITIS: inaation of ladder d/t:

o W1* $n+c&$o)( cy(&$&$(: F444 d/t shorter #rethra 55d/t E coli;; #rgenc,6 #rning6 s#prap#ic pain/tenderness 55BO fever6 sha=ing chills if

so? In =idne,;;o W2: Radiation to ladder

o W: cheo RD: esp ",clophosphaide 55Heorrhagic c,stitis;; "HEO via "8079 in liver Bitrogen #stard + $crolein

"8079 activates c,clophosphaide 55active etaolite % nitrogen#stard A al=,lating agent daages <B$; + ,dprod#ct 5$crolein;

*ith c,clophosphaide6 give E'B$ to ind $crolein to preventheorrhagic c,stitis

o 1ladder cancer: W1 MCC* TRANSITIONAL CELL CARCINOMA TCC 7AKA UROTHELIAL

CARCINOMA9

involves ladder @ renal pelvis

2 *a,s can loo=: either li=e papillar, or at

o papillar,: #ltifocal @ tends to rec#r therefore tD:trans#rethral resection @ if =eeps rec#rring6 +i#notherap, 5inect 1"( into ladder 5intravesic#lar 1"(; inaation/gran#loas =ills t#or;

o once t#or invades #scle of ladder % ",stecto,

CE8 () <E"I'IOB: has it invaded #scle of ladder,et?

R/F: W3: 'OCIB(GGo !or=ing *ith d,es/r#ers 5eta-naph,laine;

oth alls % p#re eta-naph,laine W! SCC

'*iing in the Bile 'chistosoiasis 5heatoi# or ansoni;o Interediate host % fresh *ater snailo Leaves snail6 and penetrates intact s=ino Man(on$ intestines and liver and la,s eggs 5L$)ER$L

spine; L$6+r* @PIPE STEM 'ro($(

Intestines: gastroenteritis6 etco H+4a&o'$)4 to ladder and la,s eggs 5terinal Ntoe-

nail spine;o aor asic protein 55li=e copleent for parasites;;

therefore al*a,s see eosinophilia

'#ao#s etaplasia '#ao#s "ell "arcinoa 5P9Q;

chronic inaationo ' heatoi#o Infectionso 'tones

)ransitional cells s#ao#s etaplasia d,splasia '""

presents as painless heat#ria W* 77RARE::99 ADENOCARCINOMA O< BLADDER

DOME o '%add+r

32



arising fro renant of URACHUS Zlined , gland#lar cells d#ctthat connects fetal ladder *ith ,ol= sac allo*s ladder to drain*aste into ,ol= sac[

o if patent #rach#s? 0ee o#t of ell, #ttono if econi# o#t of ell, #tton? 0atent vitelline d#ct >st#lao if vitelline d#ct oliterates6 #t little it left? ec=els

divertic#l#o ass neDt to #ilic#s? 'ister ar, oseph nod#le 55peri-

#ilical nod#le;;o 3ENITAL SFSTEM*

o <EMALE 3ENITAL SFSTEM <3T*

ULA*

ULITIS* inaation of v#lvao "a#ses:

"ontact IRRITANT deratitis

RDn to $rr$&an&( $n )r$n+, (oa(,d+&+r8+n&(, d+odoran&(

Er,theato#s *eeping and cr#stingpap#les and pla#es

"ontact ALLER3IC deratitis

RDn to A8( $n +r)4+(, cr+a4(,%o&$on(

Er,theato#s *eeping and cr#stingpap#les and pla#es

Infectio#s

')<s

H0V6 H'V6 gonorrhea6 etco BARTHOLIN CFST* Z#s#all, d/t previo#s infD

coon[

"oplic of v#lvitis

Inaation ca#ses ostr#ction of eDcretor,d#cts of 1artholin glands

",stic ass in o(&+r$or %a&+ra% aspect ofvesti#le -9c in diaeter lined ,s#ao#s or etaplastic s#ao#s epitheli#

Pa$n)%6 large c,st re#ires 4ar()$a%$;a&$on Zor eDcision[

o <iscofort d#ring seD and d#ringinsertion of tapon

o BEHCETS DISEASE*

Ophthalic inaation6 genital #lcers6 oral#lcers

@CANGT SEE: CANGT PEE: CANGT EAT SPICF:

"OB8LO$:

CONFLOMA ACUMINATA* 1EBI(B eDoph,tic lesion of v#lva*art, lesions in anogenital region ZVERR&"O&'[

o H0V t,pes Y @ 33 Z')<[o H0V viral eTect % Ko$%ocy&o($( % perin#clear

c,toplasic vac#oliSation and *rin=led n#clearconto#rs

o Lo* ris= of alignant transforation

3



o )D:0odoph,llin6 trichloroacetic acid 5)"$;

I4$)$nod 7A%dara9 ac&$6a&+( $44)n+

(y(&+4

"O2 laser/"r,otherap,0revent? (ardasil H0V vaccine A t,pes Y6 336 3Y63M

0ro? <oesnt cover all t,pesGGo HI(H RI'C )80E' of H0V: 3Y6 3M6 36 55all Ws over

Ns*eet 3Y;; Insert theselves into <B$ and ecoe latent

@ start a=ing viral oncogenes 5EY6 E;

EY inds and inhiits p9

E inds and inhiits R 1efore cancer6 get dy(%a($a* Z0RE-

$LI(B$B)[:

In cerviD: CERICAL INTRAEPITHELIALNEOPLASIA 7CIN9

o BO) cancer ,et6 isnoerGG

In v#lva: ULAR INTRAEPITHELIALNEOPLASIA 7IN9

'#ao#s etaplastic lesion

Old nae: o*ers dS/"a-in-sit#

B#clear at,pia

IB" itoses

BO at#ration of cells

Reprod#ctive age grp

Zsae R/F as cervical "$[

H0V 3Y+ D$+r+n&$a&+d IN* H0V

BE($)IVE chronic epithelialirritation in Lichen sclerosis ZR/F[

In vagina: A3INAL INTRAEPITHELIAL

NEOPLASIA 7AIN9

I )n&Gd "an progress to '""GGo LO! RI'C )80E' of H0V:

Y @ 33 5Ngo to heaven;: genital *arts 3-7 5Nget fro the oor;: plantar *arts 72 @ 77

o cond,loa aro#nd the an#s?? 0t engaging in analinterco#rse and at ris= for HIV

CONDFLOMATA LATA*

o 2° s,philis 7 DRL5 RPR5 <TA9

o <%a&6 oist6 iniall, elevated lesions LEUKOPLAKIA* *hite patches6 opa#e6 *hite6 #cosal

thic=ening6 pr#rit#s6 scalingo ZLI"HEBOI< LE'IOB': $00E$R' as Nle#=opla=ia[

Ma/or DD* BEE< )O 1IO0'8 )O R/O "$B"ERGGo L$ch+n (c%+ro($(

'ooth *hite pla#es 5le#=opla=ia;

" in postenopa#sal feales

37



0ossile a)&o$44)n+ etiolog,

May ro8r+(( &o SCC in 3-9Q

icro: &h$n +$d+r4$(6 loss of rete pegs6h,dropic degeneration6 deral >rosis6 scantperivasc#lar inaation

o L$ch+n ($4%+ chron$c)( Za=a s#ao#s cellh,perplasia[

'ooth *hite pla#es 5le#=opla=ia;

d/t chron$c $rr$&a&$on ro4 (cra&ch$n8

BO increased rs= of cancr #t often fo#nd neDtto '""

icro: &h$c= +$d+r4$( 5esp strat#gran#los#;6 h,per=eratosis6 no at,pia6 deralinaation

o VIBo V#lvar '""

Carc$no4a o )%6a* ZBOB-H0V-related =eratiniSing '""[:o SCC* !oen 4Y,o preceded , lichen sclerosis

*ell-diTerentiated and =eratiniSingo

$vg age % Y,oo H0V BE($)IVEo In6a($6+ n+(&( o &)4or c+%%( $&h =+ra&$n +ar%(

HP-r+%a&+d SCC: less coon foro assoc * hgh ris= H0V 3Y @ 3M6 @3o iddle-ages so=ers and i#node>cienc,o prec#rsor: VIBo (RO'': egins as discrete6 *hite6 esh-colored or

pigented6 slightl, raised lesions ZVIB[o 1$'$LOI<:

Iat#re cells resele asal cells ofepitheli#

H0V+ !$R)8:

EDoph,tic papillar, *ith =oiloc,tic at,pia

H0V+

1$'$LOI< @ !$R)8:

"arcinoa

1egins as "L$''I" VIB

"/F:o VIB @ carcinoa a, present as le#=opla=ia6

eDoph,tic t#ors6 or #lcerative endoph,tic t#orso ost coonl, located on laia aora also laia

inora @ clitoriso a, reain localiSed for long period efore event#all,

spreadingo Ris= of etastasis correlates * siSe and depth of

invasionoetastasis to regional LBs:

LABIA SUPER<ICIAL $n8)$na% nod+(

CLITORIS DEEP $n8)$na% nod+(

oETRAMAMMARF PA3ET DISEASE* $LI(B$B)G

t#ors siilar to those seenn reast:

E&ra4a44ary Pa8+&(Pa$%%ary H$drad+no4a*

1EBI(B

(land#lar

$rises fro odi>edapocrine s*eat glands'harpl, circ#scried nod#le

On laia aora or interlaialfolds )ends to #lcerateGG Zconf#sed*/ carcinoa[

icro: papillar, t#or lined

, do#le la,er of cells

39



Ce, feat#res: In&ra+$d+r4a% spread of alignant epithelial cells in s=inof v#lva aorit, of classes have BO &B<ERL8IB( )&OR Zadeno"$[

o EL$BO$:o 0oor prognosis

Yth-th decadeo <<J 0agets dS Zin

IBI)I$L phase*hen con>ned to

epitheli#[o Origin:

ost cases tho#ght to arise fro epideralprogenitor cells

'all W of cases fro s*eat glands

icro: epideris in>ltrated , %ar8+ +$&h+%o$d c+%%( a')ndan&cy&o%a(4 *hich occ#r as single cells and cl#sters cells contain#cin 0$'+ a, resele elanoa 55elanoa is 0$'-;;

"/F: red6 scal, cr#sted or ooSing pla#e that a, resele aninaator, deratitis con>ned to epideris6 good prognosis #ta, rec#r invasion of deris a, lead to etastasis

A3INA*

3ardn+rG( d)c& cy(&* 3-2c6 #id >lled c,stso In lateral vaginal *allso Renant of *ol>an d#ct 5esonephric d#ct;o Bon-#c#s secreting

a8$n$&$(*o Vaginal discharge 5le#corrhea;o Boral coensal organiss a, ecoe pathogenic *:

<iaetes

',ste $D therap,

I#node>cienc,

0regnanc, Recent aortion

o Tr$cho4ona( 6a8$na%$( 55otileNcor=scre* otilit,;; A protoSoa

Fo#nd in 3Q of $sD *oen 'D infection d/t R/F or

s#perinfection * ne* oreaggressive strain

ATERF, COPIOUS 3RAF

3REEN DISCHAR3E STRABERRF CERI

o Cand$da% 7Mon$%a%9 6a8$n$&$(*

,east 0art of noral ora in 9Q or

feales

'D infection d/t R/F or s#perinfection * ne* oreaggressive strain

CURDF HITE DISCHAR3E

<D: 0$0 sear COH prep

TUMORS o A3INA*

o 3$ard$a La4'%$a: falling otilit, fro streas ANeaver fever

o L$(&+r$a 4onocy&o8+n+

t#ling otilit, fro socheeses or irth canal se

M)%%+r$an 55FE$LE';;:1. <allopian t#e!. Uter#s. CerviD#. Upper 3/ of vagina 55lo*er

2/ fro #rogenital sin#s;;

o MULLERIAN A3ENESIS 7a=aROKITANSKF-KUSTER-HAUSER Syndro4+9* BOF&"& 'tr#ct#resGG

o U()a%%y r+(+n&(

X1yo 7NOMENSES9

o !nd MCC o 1

A4+norrh+a 71(& MCC $( T)rn+r(9

o DES6 given for threatenedaortion 1&) esses #p#llarian d#cts 5ca#sesc+r6$ca% (&+no($(; infertilit, of a, 7T-(ha+d)&+r$n+ ca6$&y9 get glands

o%an 55$LE';;: testesa=e #llerian inhiitor,factor 5IF; fro 'ertoli cells@ ales need to a=e )E')O')EROBE to a=e!ol>an str#ct#res:1. Epidid,is!. as 5d#ct#s; deferens. Seinal vesicle#. E ac#lator, d#cto Beed 9-alpha-red#ctase to

a=e <H) *hich a=esgenitalia ale and getsrid of &rogenital sin#s

o <INESTERIDE* inhiits 9-

alpha-red#ctase tD for10H '/E of enopa#se

need to e on for Yos-

3Y

Cy&o=+ra&$n

PAS S1"" HMB-#V

PA3ET 55red lesion;; - -

MELANOMA 55lac=lesion;;

- -



o SCC 5R$RE Z3Q[;: 0riar, Vag "$ d/t H0V 3Y @ 3M V$IB % prec#rsor cervical '"" eDtending do*n to vagina

o " $LI(B$B) )&OR OF V$( % E)' "$ FRO "ERVIJGGo CLEAR CELL ADENOCARCINOMA*

<E' eDpos#re $denosis adenocarcinoa

)eens/,o#ng ad#lts

R+d 8ran)%ar oc$ &ha& donG& (&a$n $&h L)8o%G(

$od$n+ (o%Gn 6a8$na% ad+no($( and c%+ar c+%%ad+nocarc$nona

o EMBRFONAL RHABDOMFOSARCOMA*

A=a SARCOMA BOITRFOIDES

1oitr,oides 5gree=: grapes; alignant striated #scle t#or 0ol,poid6 ro#nded6 #l=, asses that >ll and proect

fro vagina

<ro4 4)(c%+ o 6a8$na a( +%% a( 4)(c%+ o

'%add+r, and h+ad n+c= r+8$on Infants to 3 ,r ZZ.9,o[[

(rape-li=e lesions/t#ors coing o#t of vagina "$1I& L$8ER: la,er #nder #cosa *here all t#or

cells gro*ing• Nstrap Ntadpole

• soe cells have cross striations 5tr,ing to e#scle;

o Ntennis rac=et-li=e c,toplas

• alignant rhado,olasts

• ar=er for #scle cells:o $ctin+o >>D+(4$n

o

,o<3+o ,ogenin+

<<J: inaator, pol,psGo CERI*

Inaator, conditions

CERICITIS* inaation of cerviD 1EBI(BGo 0#r#lent vaginal dischargeo $"&)E or "HROBI"

$t enarche6 estrogen at#ration of cervical/vags#ao#s epitheli# *ith intracell#lar gl,cogenvac#oles in s#ao#s cells

0$0 'E$R

In+c&$o)(: ')<so esp chla,dia @ gonorrhea 55tD together;;

P+%6$c Ina44a&ory D$(+a(+ 7PID9o D*

1. 0$0 'ear!. (ra stain/c#lt#re. 1lood: IB" E'R/"R0

o !hen infection ascends Zfro v#lva/vag[ involves ost str#ct#res of F()

3



o ca#sative organiss: B gonorrheae Z(onococc#s[ A infD a, egin *ith

artholin glands

ar=ed ac#te inaation 2-da,s afterinoc#lation

" site of initial involveent A endocervical#cosa

Endoetri# #s#all, spared

'preads to t#o-ovarian regions fro an, ofaove locations Zretrograde[

BOB-(onococcal InfD spread via l,phatics or veno#schannels

" trachoatis 0ol,icroial infD A staph6 strep6 colifor act6 "

perfringenso NP#ss In Dereo PID Endo4+&r$&$( idline ado pain Fallopian

)#es 5Sa%$n8$&$(; 0eritoneal cavit, 5g#arding6 rigidit,6reo#nd tenderness; P+r$&on$&$( P+r$h+a&$&$(

5ascesses neDt to liver; R&] pain $dhesions 5Nviolinstrings <$&;-H)8h(-C)r&$( Syndro4+ Zfor of 0I<[;o T)'o-O6ar$an A'(c+((* ascess t*n fallopian t#e @

ovar,o Co4%$c* W3: Infertilit, 5if do get pregnant; +c&o$c &)')%+

r+8nancy 55W3 ca#se for ectopic pregnanc, is scarringfro prior 0I< W3 location in a4)%%a;;

o CANCERS o Lo+r <+4a%+ 3+n$&a% Sy(&+4*

o Incidence: 5top ;

W3: Endoetrial cancer 55ost coon;;

W2: Ovarian cancer

W: "ervical cancero ortalit,:

W3: O6ar$an Canc+r>>>

W2: Endoetrial "ancer

W: "ervical "ancer 55in &'6 W rest of *orld6 W3;;

etastasis:o <irect spread: #reia % ost fre ca#se of death in stage IVo Local @ distant LBso <istant etastasis: to LIVER6 L&B('6 and 1OBE $RRO!G %

cervical "$

c *e do ,earl, 0ap 'earsGGo NORMAL a (4+ar: 'all ro#nd n#clei lots of c,toplas

o Paan$co%ao) 7PAP9 (4+ar* ost s#ccessf#l screening test ever developed icro eDa of scraped cells fro transforation Sone

o CERICAL CANCER*

R/F: HP 7H)4an Pa$%%o4a $r)(9 1Y,1> W1 Mo(& I4 R2< $n

c+r6$ca% onco8+n+($(>

H0V has tropis for $44a&)r+ ()a4o)( 4+&a%a($a o&ran(or4a&$on ;on+

Endocervical: col#nar gland#lar cells

3M



!hat a=es pap sear ade#ate? Have oth s#ao#s andcol#nar cells on sear

Other R/F:o Earl, age of interco#rseo #ltiple seD partnerso $I<' Zi#nos#ppressed[o #ltiple ')< eDpos#reo "ertain HL$ s#t,peso O"0s Bicotine

R/F: 'o=ingG

CIN* prec#rsor lesion

0ea= incidence of "IB: P,o

0ea= incidence of invasive '"": P79,o

CIN I* Lo*-grade s#ao#s intraepithelial lesion 5ild d,splasia;o Coiloc,tic at,piao ost regress spontaneo#sl,o $t,pical6 iat#re cell la,er con>ned to LOER 12 of

epitheli#o T* oserve and re do pap sear

CIN II* oderate d,splasia 5high grade s#ao#s intraepitheliallesion;

o $t,pical6 iat#re cells occ#p, 2/ of epitheli#o 0rogression dereg#lates cell c,cle

>>CIN III* severe d,splasia 5high grade s#ao#s intraepitheliallesion;

o at,pical6 d,splastic cells in 42/ Zor entire thic=ness[ C2<*

Vaginal leeding fro interco#rse le#corrhea d,spare#nia d,s#ria

" in *oen *ho have not een screened *ith 0$0 sear

If tr#l, invasive6 recoend h,sterecto,G

If icro invasive Zin>ltrates stoa #st elo* aseent erane[6 insit#6 or d,splasia: LO"$L )HER$08 A coat it6 freeSe it6 etc 55an,thing to getit o#tGG;;

"an proliferate anteriorl, ipacting #reters at trigone ca#sing dilation of#reters 5h,dro#reters;6 ac=ing #p to =idne,6 ca#sing HFDRONEPHROSIS COMPLIC* KIDNEF <AILURE::

PELIC EONERATION<J:

H0V <B$ detection via H,ridiSation

I#no stain *ith Ci-Y Zprolif ar=er[ @ p3Y Zcell c,cle inhiitor[o POLFPS*

ENDOCERICAL POLFPS* tD % s#rgical eDcision

1enign pol,poid ass arising fro endocervical #cosa

(ross: soft sooth glistening s#rface *ith #nderl,ing c,stic spacescontaining #co#s

icro: #cin-secreting lining *ith edeato#s stroa

"/F: a, leed Zspotting[6 protr#des thro#gh vagina

NO MALI3NANT POTENTIAL::

ENDOMETRIAL POLFPS* sessile6 occasionall, ped#nc#lated

MALI3NANT POTENTIAL

3



"oposed of endoetrial glands and stroa

Estrogen eTect: h,perplastic pol,pso UTERUS*

Z1IFI<[ 1icorn#ate &ter#s:

• anoral 8-shaped #terine cavit, ZR$RE[

• can ca#se hait#al aortions fre d/t Leio,oaso res#lts in defective placental iplantation *ith spontaneo#s

aortion6 #s#all, in 2nd triester $noral #terine leeding Z$&1[:

MENORRHA3IA* prof#se or prolonged leeding at reg#lar intervals

METROHHA3IA* irreg#lar leeding t*n periods

OLI3OMENORRHEA* leeding at intervals 4-9 da,s

AMENORRHEA* BO #terine leeding 4Yos

o 1

* )#rner ',ndroe #llerian agenesis

o !

* 0regnanc,

POSTMENOPAUSAL BLEEDIN3* #terine leeding afterenopa#se

o )D: dilation + iops,/c#rettage

"oon ca#ses:o Endoetrial pol,pso Endoetritiso Leio,oas 5>roids;o Endoetrial h,perplasiao Endoetrial carcinoa

<,sfDnal &terine leeding Z<&1[:

$noral leeding fro #ter#s $&ho)& a (&r)c&)ra% or or8an$c)&+r$n+ a&ho%o8y

o R/O ca#ses of $noral #terine leeding

<J of eDcl#sion

1. Ano6)%a&ory cyc%+: fail#re of ov#lation 5"" in PQ cases;

2 Inade l#teal phase

O"0s

7 enopa#sal and postenopa#sal changes

ASHERMAN SFNDROME

ENDOMETRITIS*

Fever6 idline ado pain6 enstr#al irreg#larities

)D: $DGG 0revents se#elae li=e salpingitis

ACUTE*o Be#trophilic in>ltrates and icroascesseso 0ost deliver, or iscarriage

CHRONIC* o $l*a,s secondar, to #nderl,ing ca#se:

I&"<

"hronic 0I< 0ostpart# or postaortal states

)1 A ilitar, spread or fro t#erc#lo#s salpingiitiso 0resence of PLASMA CELLS>>> in endoetri#o "onse#ence of 0I<o In&ra)&+r$n+ d+6$c+ 7IUD9* ta=e o#t6 send for c#lt#re of

$ctino,ces 5s#lf#r gran#les;

2



ADENOMFOSIS*

(ro*th of asal la,er of endoetri# do*n into ,oetri#o + of endoetrial tiss#e DEEP *ithin #terine *all

Z,oetri#[

icro:o B+n$8n a+ar$n8 +ndo4+&r$a% 8%and( and (&ro4a

$&h$n 4yo4+&r$)4o 'ince coposed of strat# asalis the gland <O BO)

&B<ER(O "8"LI" 1LEE<IB(o R+ac&$6+ HFPERTROPHF O< MUSCLE +n%ar8+d

8%o')%ar )&+r)( &h$c=+n+d TRABECULATED UTERINEALL

"/F: enorrhagia <,senorrhea Zcolic=,[ 0elvic pain prior to onsetof enses

>>>>>ENDOMETRIOSIS>>>>>*

o Pr+(+nc+ o +ndo4+&r$a% 8%and( and (&ro4a OUTSIDE

UTERUSo <e>nitive <D Z2 of [:

Endoetrial glands in ectopic lesion

'troa in ectopic lesion

Heosiderin pigent in ectopic lesiono H,potheses:

Reg#rgitation theor, A retrograde enstr#ationthro#gh fallopian t#es even in noral feale

etaplastic theor, A endoetri# co#ld arise directl,fro coelic epitheli#

Vasc#lar/l,phatic disseinated theor, Adisseination thro#gh pelvic veins and l,phatics*o#ld eDplain endoetriotic lesions in l#ngs or LBs

o ech of ailit, for endoetrial tiss#es to s#rvive:

P3E!, IL(, TN<, +&c. d/t profo#nd sti#lation of

inaation

"OJ-2 inhiitors good to tD pelvic pain in thesepts

aro4a&a(+ estrogen prod#ction

BO) in noral endoetri#

"an tD *ith $roatase inhiitorso FDning endoetri# #ndergoes cyc%$c '%++d$n8

o icro: endoetrial glands stroa h+4o($d+r$n $84+n&

o Loca&$on(*

" site: OV$R8: Choco%a&+ cy(& 7+ndo4+&r$o4a9

Large6 -9c *ith ro*n #id

&terine ligaents and fallopian t#es 0o#ch of do#glas 0eritoneal cavit,: red-ro*n areas 5Nod+r ')rn(; Rectovaginal sept# and c#l-de-sac

o*els/appendiD/etco "/F:

"an develop alignanc,6 #t &BcoonG "oon

P3Q *oen of reprod#ctive age

23



ca#ses P9Q $n+r&$%$&y c of scarring

lo*er ado discofort pelvic pain severed,senorrhea 5pain d#ring c,cle;

#terine serosa d,spare#nia 5pain d#ring interco#rse; ladder serosa d,s#ria 5pain on #rination;

rectal *all pain on defecationo orph:

Red-l#e to ,ello*-ro*n nod#les Firo#s adhesions

o LEIOMFOMA* a=a <IBROIDS*

MC &)4or $n +4a%+(:

'ooth #scle t#or Zt#or of ,oetri#[

"an lead to $n+r&$%$&y and if n#ero#s chronic pelvic pain Zif intr#de#terine cavit,[

1EBI(BGG "oon in $frican $erican Feales

ost have noral =ar,ot,pes

7Q % siple chroosoal anoralit, A li=e alanced translocationt*n 3237

E')RO(EB-RE'0OB'IVE

Locations *ithin #ter#s:

'##cosal

Intra#ral

'#serosal+%%-c$rc)4(cr$'+d, hor%+d, &ra'+c)%a&+d, ($nd%+-(ha+d

(4oo&h 4)(c%+ c+%%(:

!hat ca#ses these to gro*? ESTRO3EN-d++nd+n& &)4or(:

(ro* ost d#ring reprod#ctive ages @ t,picall, #ltiple

Old $frican $erican *oan A Jra, #ltiple calci>ed ascesses

(RO! R$0I<L8 d#ring pregnanc, and can ca#se spontaneo#s aortionG

'J:$noral leeding

"opression of ladder #rinar, fre

'#dden pain Zdisr#ption of lood s#ppl,[

Infertilit,o LEIOMFOSARCOMA* UNco44on:

$LO') BEVER FRO LEIO8O$'GG

0ea= age % 7-Y,o

HI(H rec#rrence rateG

$LI(B$B) arises 0O')EBO0$&'$LL8 'IB(LE

<e novo fro ,oetri# OR fro endoetrial stroal prec#rsor

cells

Heorrhagic #l=,6 esh, asses that invade #terine *all pol,poidasses that proect into #terine ligaent

icro: *ide range of $)80I$ eDtreel, *ell-diTerentiated anaplasticlesions

#ch ore cell#lar ore itoses Ho* do all sarcoas spread? Heatogeno#sl,G )herefore *here does this

go 3st? L&B('GG

*a,s t#or can spread:1. thic= *all arter,

22



!. thin *all veina. portal veins: in (I Liver'. vena cava veins: in rest of od, IV"/'V"

L#ngs. thin *all l,phatic channel 5O') )&OR' spread to

regional LBs;o ECEPTIONS*

ALL SARCOMAS SPREAD HEMATO3ENOUSLF

1!

R""/H""

Follic#lar th,roid cancer

alignant ger cell t#or 5"HORIO"$R"IBO$;

Ovarian t#ors seed ell,

$ppendiceal adenocarcinoa seeds ell, >llsell, * #c#s 5PSEUDOMFOMA PERITONIAE;

(allladder cancer seed ell,o ENDOMETRIAL HFPERPLASIA* prec#rsor of endoetrial carcinoa

IB" prolif of glands IB" gland:stroa ratio Ip ca#se of <&1 ech: +c+(($6+ +(&ro8+n

R/F: 55d/t eDcessive estrogen;;

fail#re to ov#lation

#nopposed estrogens

oesit,

0ol,c,stic ovarian s,ndroe Z0"O'[

Estrogen-prod ovarian t#ors 5gran#losa-thecal cell t#or;

0ts *ith "O0LEJ H80ER0L$'I$ ITH $)80I$ have 29Q chance ofevent#all, developing endoetrial carcinoa d/t HI(H itotic activit,6disorganiSation6 and n#clear at,pia

0ts *ith "O0LEJ H80ER0L$'I$ ITHOUT $)80I$ have 9Q chance ofdeveloping endoetrial carcinoa

M$cro* severit, of h,perplasia corresponds to ao#nt and d#ration

$rchitect#ral cro*ding A siple vs copleD

0resence or asence of ATFPIA: presence of at,pia increases ris= of cancer

(enetics: INACTIATION O< PTEN TS3

0)EB is ra=e on 0I- =inase/$)C signaling path*a,

On chr 3

Leads to prostate t#ors and endoetrial cancers

"o*den ',ndroe A $< #t in 0)EBo H$$R)O$' aro#nd od,

S$4%+ H,perplasia: irreg#larit, or c,stic dilation of glands Ns*iss cheese appearance

ITHOUT $t,pia A irreg#lar6 c,stic glands stroal h,perplasia

ITH $t,pia A &Bcoon progression to "$ is HI(HL8 &nli=el,GG

Co4%+ H,perplasia: cro*ding or #dding of glands55#t in LH3 @ 'H2 5<B$ isatch repair genes;

HB0"" "olon6 Endoetrial6 Ovarian cancer;;

2



Co4%+ A&y$ca% H,perplasia: cell strati>cation6 t#fting6 loss of n#clear polarit,6enlarged n#clei6 itosis 2-7MQ have h,sterecto,

55CR$' #t 0)EB #t;;

In6a($6+ 7+ndo4+&ro$d9 carcinoa* eta-catenin @ 0IC"$ #t

)h#rsda,6 arch 26 237

ENDOMETRIAL CANCER*

o " cancer of F()GGo "/F:

" in postenopa#sal *oen 99-Y9,o6 #s#all, in n#lliparo#sG Le#corrhea or postenopa#sal leeding Invades local str#ct#res Late in co#rse etastasis to regional LBs and distant sites )J: s#rger,/radiation prognosis depends on stage6 grade6 and t,pe

o 2 fors: ),pe I @ II: ENDOMETROID 5MQ; A ),pe I A indolent ehavior

• R/F:o Oesit,

o <iaeteso H)Bo Infertilit,o &nopposed +(&ro8+n( 7ERT2&a4o$+n 7'r+a(& canc+r

R9 )(+9o Endo4+&r$a% hy+r%a($a

• (enetics:o #t in 4$(4a&ch r+a$r 8+n+( 7hMLH1, hMSH!

4$cro(a&+%%$&+ $n(&a'$%$&y9o #t in PTEN, '+&a-ca&+n$n, KRAS

• (ross: localiSed6 pol,poid ass or diT#se ass

• icro: reseles noral endoetri#

• 'pread:o Via ,oetrial invasion and then to peri-#terine

str#ct#reso Into road ligaent Zpalpale ass[o ets to regional LBs then to l#ngs6 liver6 ones

• <J: c#rettage or iops, and histopatholog,

• "o#rse:o BO screening tests availaleGo $sDG

o step grading s,ste *ell-diTerentiated % grade 3 % *ell-de>ned glands oderatel,-diTerentiated % grade 2 % glands iDed *ith solid sheets

of alignant cells poorl,-diTerentiated % grade % solid sheets arel, recogniSale

glands

SEROUS 539Q; A ),pe II Zgrade [

27



• R/F:o O%d+r a8+, postenopa#salo $rise fro a&roh$c +ndo4+&r$)4

o #t in Vo For sall t#fts and papillaeo ore c,tologic at,piao ore a88r+(($6+

o a, spread via fallopian t#e into peritoneal cavit, 'eeds ell, li=e ovarian cancer

) A alignant iDed #llerian )#or

• Endoetrial adenoca *ith alignant changes in stroa carcinocarcinoa

• HI(HL8 aggressiveGG

• In elderl,6 postenopa#sal *oen

• 0OOR prognosisGG

• $sherans s,ndroe: adhesions in endoetri# after rigoro#s <@"

• "hronic endoetritis: plasa cells+ in endoetri#

• $ctino,ces gro*ing on I&<

• $deno,osis: asal la,er gro*th of endoetri# do*n into ,oetri#

• Endoetriosis: endoetrial glands+ and stroa o#tside #ter#s

• "hocolate c,st: appearance of ovar, in endoetriosis

• "opleD endoetrial h,perplasia: increased Ws of endoetrial glands * cro*dingor #dding of glands

• POLFCFSTIC OARIAN SFNDROME 7PCOS9* a=a S&+$n-L+6$n&ha%

o N'tring of 0earlso cy(&$c o%%$c%+( that aorted ov#lation

n#ero#s *ithin corteDo ,o#ng6 reprod#ctive age 5avg A teen;o coonl, present *: NOHIO

Oligo#ria Hirs#tis Infertilit, Oesit, 5have aroatase: peripheral conversion of androgens to

estrogen;o O&h+r c2*

Oligoenorrhea $novol#tar, c,cles Vir#lis Zrare[

o LH +thecal cells to start developing follicles 5then gets aorted d/tandrogens; +androstenedione 5often presents * hirs#tis Zneed for laserhair reoval[ acne; estrogen

o gross: ovaries 2D the noral siSe sooth gra,-*hite o#ter corteD st#dded*ith c,sts 9-39c in diaeter

NO8')ER OV$RIE'o icro: thic=ened corteD #ltiple s#cortical follic#lar c,sts *ith follic#lar

h,perthecosis % h,perplasia of theca internao LIBC to IB'&LIB RE'I')$B"E soeties tD of 0"O' leads to res#ption of

ov#lation )hese pts at IB" ris= for <G

o Variet, of enS,es involved in androgen s,nthesis are poorl, reg#lated in0"O'

29



LH / F'H

+)heca cells

+$ndrogensZ$ndrostenedione[

Estrogen ZEstrone[

o O') "OOB EB<O"RIBE </OG

o F'H 5.2;o (ive pt "loiphene for ov#lation 5pro? Ov#late #ltiple eggs and get

#ltiple irths;o Ho* to control LH? (ive O"sG

• OARIAN TUMORS*o categories:

3 1enign A MQ - 2-79,o

2 1orderline A slightl, older pts alignant A 79-Y9,o

o 'oe ilateral6 soe non-fDnal6 others are horonall, activeo 'D: ado pain6 progressive distention6 #rinar, and (I) sD6 vaginal leedingo Epitheli#6 stroa6 and ger cells can all t#rn alignanto EPITHELIAL ()rac+ &)4or( MC MC MALI3NANT

$=a #llerian epithelial t#ors

d/t inaation of s#rface irritation can get trapped in c,st5trapped epithelial incl#sion *ithin ovar,; can t#rn alignant

present as ig c,stic ovaries A3UE SI3NS2S:

77CFSTADENOMAS991. SEROUS TFPE* MC MOST LETHAL:

0apillar,

"lear #id prod cells Zc,stic[

29Q ilateral

orderline % Nt#or of lo* alignant potentialo ore intricate papillae BO stroal invasionG

alignant % c,stadenocarcinoa % has to invade stroaGGo ore solid than c,stic6 esh,6 n#ero#s6 irreg#lar

papillae6 >Dation6 nod#larit, of caps#leo if lined , sero#s cells % 'ero#s ",stadenocarcinoa %

ost coon SEROUS PAPILLARF CFSTADENOCARCINOMA A

line papillaries

la,ered *hirled calci>cation % P(a44o4a 'od$+(

ar=er: "$-329 to follo* these t#orso lined , #cino#s cells % #cino#s c,stadenocarcinoao R/F:

B#lliparit,

(onadal d,sgenesis in =ids

Fa HD

#t in 1R"$3/26 CR$'6 1R$F6 p9

BE(FEE<1$"C

2Y



o <E" ris= *ith O"0s t#al ligationGG

gross: copleD6 #ltiloc#lar c,sts * nod#les and solid area

icro:o tall6 col#nar epithelial cells Zciliated and non-ciliated[

often foring a$%%ary (&r)c&)r+(o (a44o4a 'od$+(

lo* grade: CR$'6 1R$F or ER112 #t

high grade: p9!. MUCINOUS TFPE Zless coon than sero#s[

"an e enign6 orderline6 or invasiveo alignant in 39Q

&s#all, aTects in iddle ad#lt life

R/F: 'o=ingG Ver, fe* olec#lar alterations I<d #t 3consistent >nding % CR$' #t

!ith signet ring cells

#cino#s lining thats invading % "8')$<EBO"$R"IBO$

"opared to sero#s:o Less li=el, to e enign ilateral 5#s#all, #nilateral;o &s#all, larger and #ltic,stic 5therefore ore easil,

noticed;o 1etter prognosis

Rarel, ca#se (+)do4yo4a +r$&on+$ 55Nell, ell, A ":adenocarcinoa of appendiD;;

o EDtensive #cino#s ascites6 c,stic epithelial iplants onperitoneal s#rfaces6 adhesions A if eDtensive6 leads tointestinal ostr#ction and death

o 2ar, to: appendiceal #cino#s t#or *ith 2ar, ovarian and

peritoneal spread

ovarian #cino#s t#ors

o icro: #cin prod#cing epitheli# and glands free#cin+

#st e <<J fro etastatic stoach cancer KRUCKENBER3&)4or 5#s#all, ilateral;

. ENDOMETROID CARCINOMA

d/t etaplasia

ostl, alignant

ilateral in Q 39Q coeDist *ith endoetriosis

a, e solid or c,stic glands resele endoetrial glands Zlo*grade[

1V-"? a%(o ha6+ +ndo4+&r$a% carc$no4a::

#t in 0)EB6 CR$'6 eta-catenin6 icrosatellite instailit,6 p9Zpoorl, diT[#. CLEAR CELL TUMORV. BRENNER TUMOR* adeno>roas

ostl, enign

can e seen *ith #cino#s c,stadenoa or *ith teratoa

c,stic or 'olid #nilateral ovarian t#or ,ello*ish color .3c toassive Z2-c[

$#ndant stroa *ith n+(&( o &ran($&$ona%-&y++ndo&h+%$)4

2



o NcoTee-ean n#clei

$rise fro s#rface epitheli# or #rogenital epitheli# trapped*ithin the gerinal ridge

Ovarian ass + ascites % 1$<G

T* 4)%&$%+ r+(+c&$on(:

"an develop #ltiple adhesions fro #ltiple s#rgeries or eveno*el ostr#ction *hich #ltiatel, ca#ses death

R/F: 55Lots of OV&L$)IOB';;o BO 0RE(B$B"8o 1R"$3/2o L,nch ',ndroe 55"EO;;

o 3ERM CELL TUMORS !nd MC 7$lso in en ger cells of tests;

In en: SEMINOMA // in *oen: DFS3ERMINOMA Zalignant[

Occ#rs in 2nd and rd decade of life 539-9,o;

$ssoc *ith 8onada% dy(8+n+($( o <8'(ERIBO$ % assoc * )#rners ',ndroeo 'EIBO$ % assoc * Cleinfelters

icro:o large clear cells c lots of gl,cogen 55"LE$R "ELL

"$R"IBO$;;o 'troa * l,phoc,tes and gran#loas

',nc,tial tropholasts can a=e eta-H"(

Rad$o(+n($&$6+ 55 *a,s to =ill it: cheo6 radiation6 andresection % (OO< 0RO(BO'I';;

alignant 5MQ c#red; CHORIOCARCINOMA

FOLK SAC

EMBRFONAL CARCINOMA

TERATOMA 5Nscraled a,;: a=a D+r4o$d Cy(&

<D: #ltraso#nd of ovar, c dont *ant to radiate gonads

In *oen6 PQ 1EBI(B in en A $LO') $LL $LI(B$B)5#ntil proven other*ise;

Occ#r in ,o#ng *oen 53st 2 decades of life;

" ger cell t#or

BENI3N 7MATURE9 CFSTIC TERATOMAS

o 0resence of at#re tiss#e fro all ger la,ers:ectoder6 endoder6 esoder

o (ross: Cy(&( con&a$n$n8 (+'ac+o)( (+cr+&$on(, ha$r,

and &++&ho "/F: infertilit, ovarian torsion6

LIMBIC ENCEPHALITIS* paraneoplastic s,ndroe

* teratoras containing at#re ne#ral tiss#e

Ina of liic s,ste

'#ac#te onset 5.32*=s; of seiS#res6 shortter eor, loss6 conf#sion6 and ps,chiatric

An&$-NMDAR &+ra&o4a( con&a$n$n84a&)r+ n+)ra% &$(()+

An&$-Ma! 8+r4 c+%% &)4or( o &+(&+(

An&$-H) (4a%% c+%% carc$no4a o %)n8

SPECIALIQED TERATOMA* STRUMA OARII

2M



o "oposed alost copletel, of at#re &hyro$d &$(()+

o a, ca#se h,perth,roidis 55* NO goiter;;o &nilateral solid ro*n ass

MALI3NANT 7IMMATURE9 TERATOMA

o HI(HER RI'C OF "$B"ER'GGo (ross: #l=, solid ass * areas of necrosiso icro: presence of iat#re eleents foci of

n+)ro+$&h+%$a% d$+r+n&$a&$on 5a, e aggressive

and etastasiSe *idel,;o SE CORD STROMAL TUMORS*

<IBROMA

THECOMA-<IBROMA*

o &nilateralo Fir gra, *hite asso M+$8( (yndro4+*

Ovarian >roa

$scites

Right sided h,drothoraDo 1enign

o "hief coplaint: ass in aneDa *ith ascites 55iicsdeath sentence of seeding;;

3RANULOSA CELL TUMOR

Often prod large ao#nts of +(&ro8+n

"/F: depends on ageo 0rep#ertal: precocio#s p#ert,o Reprod#ctive life: irreg#lar c,cleso 0ostenopa#sal: postenopa#sal leeding

(ross: #nilateral solid gra, ,ello* ovarian ass

icro: coposed of gran#losa cells in cords or sheets Ca%%-

En+r Bod$+( 5gran#losa cells prod sall follicle-li=e str#ct#res

>lled * eosinophilic aterial;

a, ca#se +ndo4+&r$a% and 'r+a(& h,perplasia and cancers55t#or ca#sing t#ors;;

'ER)OLI-LE8<I( "ELL )&OR: ovaries a=ing androgensGG'ae gross appearanceGG

o Hirs#tis6 deep voice6 etco If pregnant? 0se#do-heraphroditis if feale a,

CONNECTIE TISSUE TUMORS

o METASTASIS* C%a(($c*

3ASTRIC CANCER* S$8n+& r$n8 c+%%(* KRUKENBER3 TUMOR

BREAST CANCER 7+( LOBULAR CANCER9

9-3Q reast cancer % hereditar,

1R"$3 A chr 3 A ost coon for reast and ovar, cancer @prostate cancer

o Esp sero#s $B< #cino#s epithelial t#ors

1R"$2 A chr 3 A reast cancer in EB $B< !OEB in 3 fail,

<B$ 1rea= $) 1R"$3/2 OR p9 tells R to stop cellc,cle at (3/'

o 4)& ATM $taDia6 telangiectasia6 alignanc, @ icroialinfections c i#ne s,ste cannot repair itself

o 4)& V $ll cancers

2



o 4)& R' ostl, retinolastoa @ osteolastoa

CANCER A3S*

o "$ 39-: for FOLLO!IB( 5BO) <J; 1reast cancero "$ 3-Z: pancreatic cancero "$ 3!V: ovarian cancer

D2O o Pr+8nancy*o ASCENDIN3 IN<ECTIONS

$ssoc * preat#re r#pt#re of eranes Ac)&+ chor$oa4n$on$&$(* ne#trophils6 edea6 congestion <)n$($&$(* ac#te vasc#litis of cord Myco%a(4a, cand$da, 6a8$na% ora

o HEMATO3ENOUS IN<ECTION

$%%$&$(* inaation of placental villi Syh$%$(, TB, L$(&+r$o($(, TORCH

o TRANSPLACENTAL IN<ECTION O< <ETUS

)OR"H "opleD:

ToDoplasosis

Other

R#ella

CV

Herpes

ECTOPIC PRE3NANCF* iplanted fertiliSed ov# in an, site O&)'I<E #terinecavit,

o P3Q of pregnancieso 'ites:

Ovid#cts: &)'a% r+8nancy

" PQ cases

" site: ap#lla Ovar, $do cavit,

o R/F: dela,ed passage of ov#

Chron$c (a%$n8$&$( and (carr$n8

Endoetriosis

^ have BO I<ale ca#seo icro: placental villi and fetal tiss#eso t#al pregnancies invade *all leading to $n&ra&)'a% h+4orrha8+

7h+4a&o(a%$n9 and intraperitoneal heorrhageo r#pt#re % ed eergenc,: ac#te ado shoc= eDsang#ination

MCC O< <ETAL LOSS IN 1ST TRIMESTER Chro4o(o4a% A'nor4a%$&$+( 7$.+.&r$(o4$+(9 &h+r+or+, a%ay( %oo= or &ran(%oca&$on(

3ESTATIONAL TROPHOBLASTIC DISEASES % t#ors of placentao "oplete ole 53Q <$<; % "opletel, t#oro 0artial ole % 0art 1a, + 0art )#or

Par&$a% 4o%+ Co4%+&+ 4o%+Karyo&y

+Tr$%o$d 7YZ, y9

D$%o$d 7#Y, y97a%% a&+rna%9

$%%o)(+d+4a

So4+ 6$%%$ A%% 6$%%$



Troho'%a(&

ro%$+ra&$on

<oca%5 (%$8h& D$)(+5 4ar=+d

S+r)4and

&$(()+hC3

<+&a%&$(()+

Pr+(+n& a'(+n&

o ),pes:

HFDATIDI<ORM MOLE* 5$=a olar 0regnanc,;

Incidence:o In &': P3-39 per 2 pregnancieso ore coon in $siao " in ages .2 and 47o ris= of having another in f#t#re

"/F:eta-H"( +0regnanc, )est &ltraso#nd BO vialefet#s6 BO Hearteat see s*ollen chorionic villi 5loo= li=e grapes;% N'no*stor

o 1efore #ltraso#nd: 'iSe of #ter#s 44 <ate of conception @lood + grapes

icro:o h,dropic s*ollen chronic villi 5Ngrapes;o Virt#al asence of vasc#lariSation of villio 0roliferation of c,totropholasts and s,nc,tiotropholasts

5-h"(;

)J: dilatation and c#rettage 5<@"; onitor h"( cheo5ethotreDate; if h"( doesnt go do*n INASIE MOLE: have grapesG

P3Q of coplete oles are invasive

h,dropic villi invade ,oetri#

a, lead to #terine r#pt#re and life-threatening heorrhage

at,pical changes in c,totropholasts and s,nc,tiotropholasts

does not etastasiSe #t a, eoliSe

CHORIOCARCINOMA>>>: BO grapesG

ost alignant ger cell t#or 5highl,; of K&') tropholasts5BO VILLI;

o BO #terine enlargeent6 BO grapeso 'ee heorrhage and necrosis

Earl, spread , heatogeno#s ro#tes therefore goes to l#ngs6liver6 one6 rain6 s=in6 etc

1-h"( is t,picall, IB"

2 fors:o 3+(&a&$ona%*

ost of tie after coplete ole

after spontaneo#s aortion

3



after noral preg 5rare;

X1""? c)r+ ra&+ $&h ch+4o::

Highl, responsive to "heo

)#or is ^ o6 ^ dad A foreign $gstherefore i#ne s,ste =ic=s in to >ghtdads foreign $gs

(OO< 0RO(BO'I'Go 3onada%*

fro ger cells of ovar,/testes

0OOR 0RO(BO'I'

Responsive to cheo

BO i#ne response e BO foreign $gs

)estes: good dD test % +preg testo $ll prod elevations of h)4an chor$on$c 8onado&ro$n 7hC39 5therefore

+pregnanc, test;o Response to therap, is critical

PLACENTAL SITE TROPHOBLASTIC TUMOR

o <erived fro placental site $n&+r4+d$a&+ &roho'%a(&

o $rise a fe* onths after a pregnanc,o =ar,ot,pe: diploid 57Y6 JJ;o prod h)4an %ac+n&a% %ac&o8+n

o no& a( (+n($&$6+ &o ch+4o as other tropholastic t#orso prognosis:

con>ned to #ter#s: favorale spread e,ond #ter#s: poor

PREECLAMPSIA2ECLAMPSIA* a=a &o+4$a o r+8nancyo In 9-3Q of pregnancieso " * 3st pregnancies in *oen 49,oo 0reeclapsia:

H)B

0rotein#ria Edea

o 0reeclapsia in 3st triester orning sic=ness % t#or6 BO a,G

55#s#all, in 2nd-rd triester;;o Eclapsia % 0reeclapsia + 'eiS#reso HELLP Syndro4+* 55on the *a, to <I";;

In P3Q 5severe preeclapsia;

Heol,sis liver enS,nes

Lo* platelets

o ech: $n()[c$+n& 4a&+rna% '%ood o &o &h+ %ac+n&a !

&o

$nad+)a&+ r+4od+%$n8 o ($ra% ar&+r$+(o d/t altered placentation decreased perf#sion to placenta ')O0 a=ing

O(I26 0(E26 increased renin/$)II6 increased )J$26 endothelial d,sfDn arterial vasoconstriction6 endothelial in#r,6 + of intravasc#lar coag#lation s,steic H)B6 <I"

o 0ath:

0lacental infections

H)B d/t red#ced vasodilators increase vasoconstrictors

H,percoag#lailit,: endothelial d,sfDn and release of tiss#e factor5+Factor ; to start clotting fro ischeic p#rp#ra

2



End organ ircroangiopath and fail#re of =idne,6 livero )D: deliver, is OBL8 c#reGGo 1-h"( responsile for orning sic=nessG

BREAST*o 55pic in roins;;o >>>ALL BREAST LESIONS MUST BE DD <ROM CANCER:::>>>>>

o age: 49,o favor alignanto palpale ass or not?

In sit# lesions #s#all, do not have a palpale ass *hile an invasiveone a,

o Ca)(+( o 'r+a(& %)4(*

1. <$'rocy(&$c chan8+ 55"" for l#p in reast;;!. Nor4a% 'r+a(&. O&h+r '+n$8n#. Canc+r

o 0attern of calci>cation

Favor enign

"o#rse or Npopcorn-li=e MACROca%c$ca&$on( A enign>roadenoa

Egg-shell or ri-li=e A fat necrosis or c,sts

ore *orrisoe

$orpho#s coarse heterogeno#s

Fine pleoorphic cl#stered MICROca%c$ca&$on(

Fine linear ranching calci>ed d#cts

0attern of calci>cations a, e s#ggestive #t onl, iops, is de>nitiveo 0resence of ,oepithelial la,er

Pr+(+nc+ cr$&$ca% or d+&+r4$n$n8 $n6a($on

Nan intact ,oepithelial cell 5E"; la,er is seen in oth enign and insit# lesions6 *hereas loss of E" la,er is considered the 8o%d(&andard for the dD of invasive cancer

o

nor4a% ana&o4y* 2 cell la,ers for d#cts @ lo#lesGG

'#rface % epithelial 5l#inal; cello "ells that a=e il= 55respond to 0rolactin;;

,oepithelial 5asal; cello #scle: eect the il= to a, 55respond to OD,tocin;;

o BENI3N reast lesions

'#pern#er, 5#ltiple; nipples or reast tiss#e

a, occ#r an,*here along the er,onic ridge 54$%= %$n+;

a, develop reast patholog,

"ongenital inversion of nipple

Bipple is p#lled in*ard , >ro#s ands

a, iic reast cancer and interfere *ith n#rsing

3a%ac&oc+%+

In lactating *oen

Ostr#cted d#ct develops c,stic dilation

0ainf#l l#p

R#pt#re prod inaation and res#lts in a scar iic=ingreast cancer

Ac)&+ 4a(&$&$(



" organis: S. a)r+)(

In *oen reastfeeding d/t crac=s or >ss#res in nipple

Er,theato#s6 *ar reast * p#r#lent nipple discharge

a, progress to ascess foration and >st#la tract to areola

"linicall, a, r+(+4'%+ $na44a&ory carc$no4a

)D: $D and contin#ed eDpression of il= fro reasto If does BO) get etter * $D6 1IO0'8GG

aar, d#ct ectasia 5plasa cell astitis;

Bon acterial chronic inaation of reast * inspissatedsecretions

$ssoc * lactation 5occ#rs fe* ,rs after cessation;

D$%a&+d d)c&(

<#ct r#pt#re leads to reactive inaator, changes iic=ingreast cancer

Fir periareolar ass * nipple discharge and retraction

)ra#atic fat necrosis

S++n $n yo)n8 +4a%+(

a, or a, not have hD of antecedent tra#a to reast

Earl, lesions are sharpl, localiSed * central fat necrosiss#rro#nded , ne#trophils and acrophages

Late lesions are coposed of ca%c$+d (car(

a, iic reast cancer

3a%ac&orrh+a

M$%=y n$%+ d$(char8+ in non-%ac&a&$n8 *oan

• "a#ses:o EDcessive nipple sti#lationo >>Pro%ac&$no4a of anterior pit#itar,o <r#gs 5antips,chotic eds antidopainergic eTects;

Frida,6 arch 236 237

77con&Gd99 THE BREASTo <IBROCFSTIC CHAN3ES 7<C9: 1EBI(B

Old nae: Firoc,stic disease " in reprod#ctive ages ),picall, #ltifocal and often ilateral Nl#ps @ #ps $lost ever, *oan has a little it F" vs "ancer

• F": #ltiple6 ilateral6 changes * enses6 calci>cation 5diT#se6large;

• "ancer: single6 #nilateral6 doesnt change * enses 5slo*l,enlarges;6 calci>cation 5local6 icro;

Boral reast tiss#e % ,ello* and fatt, A "hange: *hite >rosis @'%)+

do4+ cy(&( F" is ade of:

• BOB-0ROLIFER$)IVE coponent % BO ris= of reast cancerGo "alci>cationso Firosiso ",sts 5l#e ro*n c,sts * *ater, t#rid #id;o $pocrine etaplasia 5ig6 #ic, cells % ig @ pin=; A large

pol,gonal cells

• 0ROLIFER$)IVE coponent % ris= of reast cancerG

7



o Epithelial h,perplasia: 42 cell la,erso >>ATFPICAL H,perplasia

A&y$ca% D)c&a% Hy+r%a($a* soe spaces arero#nd and reg#lar others ore slit-shaped

A&y$ca% Lo')%ar Hy+r%a($a: onoorphicro#nd loosel, cohesive cells >ll soe of lo#les

Lo')%ar Carc$no4a $n ($&) A $LL RO&B<G 5$lllo#les >lled *ith cells BO ore slit-shaped;

o <#ctal 0apilloatosis - sall papillar, proections in d#ctso SCLEROSIN3 ADENOSIS 55lots of gland proliferating in

ver, dense >ro#s stroa;; iics reast cancer Fir consistenc, icro:

• Sc%+ro($n8* >rosis distorts the proliferatingeptheli#

• Ad+no($(* proliferation of sall d#ct#lesand acini lined , epithelial and,oepithelial cells

• )o <<J fro invasive cancer6 do #scle stainc still contains ,oepithelial la,er

o 0resent? 'clerosing adenosiso Bot present? cancer

" site: #pper o#ter #adrant of reast 55" site for alost all lesionsof reast;;

• 1c contains O') ao#nt of reast tiss#e @ c of TAIL O<

SPENCE goes all the *a, into aDilla BO ris= of reast cancer

• 55non-proife changes;; 'lightris= 539-2D;

• od to orid h,perplasia *o at,pia

• <#ctal papilliatosis

• 'clerosing adenosis 'I(BIF ris= 59D;

• $)80I"$L d#ctal or lo#lar h,perplasiao RADIAL SCAR* "O0LEJ '"LERO'IB( LE'IOB

in center6 loo=s li=e cancerGG JR$8: irreg#lar densit, (ross: >r >rotic scar icro: 55can <<J fro cancer;;

• "entral nid#s of (4a%% &)')%+( &ra+d $n d+n(+%y 'ro&$c(&ro4a

• '#rro#nded , rad$a&$n8 ar4( of epitheli# * cy(&( andhy+r%a($a

o <IBROADENOMA*

MC BENI3N TUMOR IN BREAST IN OMEN \"FO:

+(&ro8+n a, pla, role in devt

• Enlarge late in enstr#al c,cle and d#ring pregnanc,

• Regress and calcif, after enopa#se SOLITARF, <IRM, RUBBERF, MOBILE MASS 55Nreast o#se;; JR$8: heav, coarse calci>cations 55NPOPCORN;;

9



icro: *ell-circ#scried proliferation of >rosis and d#cts 55ore so>rosis therefore ore of a stroal t#or than d#ctal t#or;;

1enign iphasic t#or

• Epithelial coponent

• N+o%a(&$c 'ro%a(&$c (&ro4a <$'road+no4a&o($(* #ltifocal disease is assoc * CFCLOSPORIN A

#sed for =idne, transplants• alignant version: PHFLLODES TUMOR 77a=a Cy(&o(arco4a

Phy%%od+(99o )echnicall, alignant #t #s#all, ehaves in 1enign

fashiono $rise de novo rather fro >roadenoaso &s#all, enign iphasic t#or

Epithelial coponent A')ndan& c+%%)%ar n+o%a(&$c 'ro'%a(&$c

(&ro4a or4 %+a-%$=+ (&r)c&)r+( 77hy%%od+( %+a-%$=+ $n 3r++=99

o 'ign of alignan,: Inc stroal cell#larit,

$naplasia High itotic co#nt In>ltrative argins May r+c)r and rar+%y 4+(&a(&a($;+

o $Tects ostl, older6 peri- or postenopa#sal *oeno 'iilar to leio,osarcoa

o INTRADUCTAL PAPILLOMA*

1EBI(B 1&) '"$R8 papillar, gro*th IB'I<E d#ctsG &nilateral lood, nipple discharge &s#all, occ#rs in %ac&$+ro)( d)c&( or ($n)(+( )nd+r n$%+

"/F: sero#s or '%oody n$%+ d$(char8+ sall s#areolar t#or

icro: papillae * a >rovasc#lar stal=s *ithin large d#cts lined ,4yo+$&h+%$a% and epithelial cells )ends to occ#r in ,o#nger6 preenopa#sal *oen 55-7s;;

• If 49,o6 Invasive d#ctal cancer ca#sing lood, nippledischargeGG

o >>BREAST CANCER>>*

" cancer in *oen 5lifetie ris=: 3 in M *oen; 2nd " ca#se of cancer of deaths in *oen 55L&B( is W3 for en and

*oen;; R/F:

<+4a%+ 8+nd+r 77W1 R2<::99

• $ge: ris= * age

• Fail, hD of reast cancer in 1(& d+8r++ r+%a&$6+

• &' 44 $sia or $frica

• " in *hite *oen6 #t earl, and ore aggressive in lac=s andHispanics

• 0rolonged eDpos#re to +(&ro8+n

o Horone replaceent therap,o Earl, age of enarcheo Late enopa#seo B#lliparit,

Y



o Oesit,o Estrogen prod ovarian t#ors 55ie gran#losa cell

t#ors;;• IoniSing radiation

(enetics:

• >>O6+r+r+(($on o HER!-n+)>> 77@H+r ! n+9Go H#an Epideral gro*th factor receptor 2 A ne#ronal

),rosine-=inase receptorGG (ene Er-12 AMPLI<ICATION:::

• $pli>cation

of R$' and 8" genes

• #t in R1 and p9

• Hereditar, reast cancer genes BRCA12BRCA! 559-3Q ofcases;;

• SERM* (+%+c&$6+ +(&ro8+n r+c+&or 4od)%a&or( A loc=estrogen receptors if cancer d/t overeDpression of these

• HERCEPTIN* onoclonal $ A intercepts HER2-ne#o On eDa: TRASTUQUMAB 55generic nae;; 77@! T$&(99

• "/F:o " in #pper o#ter #adranto 'all lesions 5P3c; detected , aograph, 539Q

LB etastasis;o Larger lesions 52-c; prod >r palpale painless ass

59Q LB etastasis;o N$%+ r+&rac&$on and d$4%$n8 o (=$no $dherent to pectoral #scles or chest *allo Involveent of deral l,phatics: $na44a&ory 'r+a(&

canc+r

P+a) dGoran8+ 7oran8+ ++% a+aranc+9

0oor prognosiso L,phatic spread:

#pper o#ter #adrant aDillar, LB edial #adrants internal aar, arter, LB

o <istant spread to l#ngs6 one6 liver6 adrenal6 raino 0rognosis:

)#or invasion and siSe EDtent of LB involveent <istant etastasis Histo grade Histo t,pe Receptor stat#s: ER/0R6 HER2-ne#

NONINASIE IN SITU CARCINOMA*

D)c&a% carc$no4a $n ($&) 7DCIS9o &s#all, detected , ca%c$ca&$on( on aograph,o Rarel, prod a palpale ass or ass on radiograph,o EDcellent prognosis: Q long ter s#rvivalo >>Co4+do ()'&y+>>* high grade n#clei * central

necrosiso )J:

Eradication * s#rger, and radiation $ntiestrogenic agents 5taoDifen and aroatase;

a, ris= of rec#rrence



o Lo#lar carcinoa in sit# 5L"I';o &s#all, detected $nc$d+n&a%%y

o Rarel, prod calci>cations6 palpale ass6 or ass onradiograph,

o R$(= o $n6a($6+ carc$no4a 4ay occ)r $n EITHER

'r+a(&::

Mo%+c)%ar ()'&y+( E(&ro8+n r+c+&orPro8+(&+ron+

r+c+&orH+r!-n+)

o6+r+r+((

L)4$na% A 773OOD99 - 7&a4o$

L)4$na% B @Tr$%+ 7&a4o

&ra&);)4

H+r!-n+) - - 7&ra&);)4

Ba(a%-%$=+ @Tr$%+ @7BRCA12!9 77BAD canG& do SHIT:99

- - - 7N2A

o Un$or4 4ono4orh$c a+aranc+ %oo(+%ycoh+($6+ c+%%( &h+ %o')%+(

INASIE CARCINOMA* BO 8OE0I)HELI$L L$8ERGG

In6a($6+ D)c&a% Carc$no4a*o !hite color c lots of desoplasia/>rosis A good c can

feel itGo <esoplastic response >r ass

o " t,pe 5-MQ;o In>ltrating glands * var,ing degrees of diTerentiation

>>In6a($6+ Lo')%ar Carc$no4a>>*o $cco#nts for P2Q of reast cancero a, prod palpale ass or calci>cationo a, e clinicall, occ#lto ore fre BILATERAL MULTI<OCALo #t in E-cadh+r$n loss of cell#lar cohesion 55*h, dont

stic= together;;o L"I'o icro:

$ssoc * adacent L"I' in 2/ cases "ells identical to L"I' )#or cells $n6ad+ (&ro4a $n @($n8%+-%+

a&&+rn 'ee soe signet ring cells6 tooG

o Receptor stat#s: ost are ER0R positive HER2-ne# overeDpression is rare

o 0attern of spread:

M



ore fre spread to CS<, (+ro(a% ()rac+, (I)6o6ary, #ter#s6 one arro*

• M+d)%%ary carc$no4a*o $cco#nts for P3Q of reast cancero a, e conf#sed * >roadenoa c of eing *ell-

circ#scriedo Occ#r * IB" fre * BRCA1 4)&

o icro: 'heets of large anaplastic cells * *ell-

circ#scried p#shing orders '#rro#nded , a d+n(+ %y4ho%a(4acy&$c

$n%&ra&+o Receptor stat#s: @Tr$%+ N+8a&$6+

ost are ER/0R negative Her2-ne# overeDpression is rare

• Co%%o$d 7M)c$no)(9 carc$no4a*o a, e conf#sed * >roadenoa of eing *ell-

circ#scriedo 'oft gelatino#s ass

o icro: cl#ster of t#or cells *ithin oo%( o+&rac+%%)%ar 4)c$n

o Receptor stat#s: ost ER/0R+ Her2-ne# overeDpression rare

T)')%ar carc$no4a*o 'all t#ors fo#nd on aographic screeningo In>ltrating +%%-or4+d 8%and( %o 8rad+ n)c%+$o ER/0R + HER2-ne# overeDpression rareo LB etastasis rare EJ"ELLEB) prognosis

Ina44a&ory carc$no4a*o Involveent of deral l,phatics therefore also in

aDillar, nodeso Bipple retraction and dipling of s=ino P+a) dGoran8+ a+aranc+* sall pin siSe holes are

attachent sites for C#per-s#spensor, ligaents 55sp?;;o 0oor prognosis

Pa8+&G( d$(+a(+ 7o &h+ n$%+9*o Inaed red ooSing cr#sted nipple that does NOT get

etter * $DGo $ssoc * )nd+r%y$n8 DCIS or $n6a($6+ &)4or in alost

all caseso "/F: >ss#ring6 #lcerated ooSing s=in reseles ecSeao icro:

In sit# carcinoa In&ra+$d+r4a% (r+ad

a, e + for 4)c$n 7PAS9

Cy&o=+ra&$n CK5 S1""5 HMB#V

• K#st s3+ @ H179+ % elanoao 0rognosis: depends on #nderl,ing t#or

MALE REPRO*

o MALE BREAST*



3FNECOMASTIA* enlargeent of ale reast d/t relative eDcess ofestrogens

• d/t:o cirrhosis: inailit, to etaoliSe estrogeno =linefelters s,ndroeo anaolic steroidso ph,siologic: p#ert, and eDtree old ageo paraneoplastic: l#ng6 =idne,6 choriocarcinoa6 le,dig cell

t#or• "/F: #nilateral or ilateral @')&&on or d$(c %$=+ ()'ar+o%ar

(+%%$n8o In 3,of A noral p#ert, the reast #d

• icro:o IB" connective tiss#eo E$&h+%$a% hy+r%a($a o d)c&(o 0roliferation of d#cts *o lo#les

CARCINOMA*

• Rare in en .3Q

• Rapidl, invades overl,ing s=in and #nderl,ing thoracic *all

• ost have spread to regional LBs or distal sites at dD• IB" ris= in failial #t of BRCA! K%$n++%&+r(

o Con8+n$&a% 4a%or4a&$on(*

Epi-6 h,pospadiaso Inaator, conditions

Ba%an$&$( % ina of glans penis Ba%anoo(&h$&$( % ina of prep#ce

• R/F: poor h,giene in #ncirc#scried ales leads toacc##lation of (4+8na % des#aated epithelial cells6 s*eat6deris

• "oon organiss: candida6 anaeroic acteria6 garnerella

• "oplic: scarring a, lead to Ph$4o($( % prep#ce cannot eretracted easil, over the glans penis

P+yron$+G( d$(+a(+*

• Firosis of penis leading to painf#l c#rved erections

• a, e assoc * >rosis in other areas s#ch as foot or hand5D))y&r+nG( con&rac&)r+;

• $ssoc * phen,toin 5<,lantin; A seiS#re RD Condy%o4a&a ac)4$na&a*

• !art, lesion occ#rring on anogenital region

• H0V t,pes Y@33

• H0V viral eTect % =o$%ocy&o($( % perin#clear c,toplasic

vac#oliSation and *rin=led n#clear conto#rs• Lo* ris= of alignant transforation

o )#orsGG P+n$%+ canc+r*

• #ch " in developing co#ntries

• " in &Bcirc#siSed ales 47,o

• R/F: poor h,giene 5carcinogens in sega; so=ing H0V3Y@3M

• 0rec#rsor: '"" in sit#

7



o !hite pla#e on shaft of penis or scrot# 5Bo4+n(d$(+a(+;

o Red pla#es on glans or fores=in 5Ery&hro%a($a o

)+yra&;o alignant cells *o invasiono 0rogression to invasion in 3Q

In6a($6+ SCC*

• " on glans penis or prep#ce

• Often #lcerated6 ind#rated ass• etastasis to ing#inal nodes prognosis

+rro)( carc$no4a*

• Variant of '"" 'crot#:

Scro&a% Canc+r*

o '""o 3st h#an alignanc, assoc * environental eDpos#reo 'ir 0ercival 0ott noted '"" in English chine, s*eeps

• 'crotal Enlargeent:o 3st thing to do6 shine light thro#gh it A if transill#inates?

1enignGo Hydroc+%+*

"" of scrotal enlargeent $cc##lation of sero#s #id in &)n$ca 6a8$na%$(

• d/t patent process vaginalis !ill transill#inate

o ar$coc+%+*

<ilated veins of papinifor veno#s pleD#s ofscrot#

Feels li=e @'a8 o or4(

<ragging sensation6 feeling of heaviness6

$n+r&$%$&y !ill NOT transill#inate6 therefore do &ltraso#ndG

o S+r4a&oc+%+* 0ainless c,stic ass at head of epidid,is that

con&a$n( (+r4a&o;oa !ill transill#inate

o E%+han&$a($(* Filariasis d/t l,phatic ostr#ction

E$d$dy4$&$(*

• 0ain in #pper ac= of testes * scrotal redness and *arth

• "reasteric reeD present

•d/t:

o .9,o and seD#all, active: chla,dia6 Beisseriao 49,o: e coli

• icro: ne#trophil in>ltrate

• a, 2°l, involve testes 5orchitis;

• other:o )1 a, also ca#se epidid,itis and orchitiso (ran#loato#s ina * caseo#s necrosis

M)4( orch$&$(*

73



o $d#lt ales P2Q develop orchitiso icro: edeato#s testes * l,phoplasac,tc in>ltrateo 'evere cases a, ca#se sterilit, 5#n#s#al c #s#all,

#nilateral; T+(&$c)%ar &or($on*

• )*isting of speratic cord cas#es veno#s copression

• Intense engorgeent of testes leading to infarction

• Ris=: @'+%% c%a+r a'nor4a%$&y testic#lar oilit,

• "/F:o " in adolescentso '#dden onset of testic#lar paino Fir s*ollen elevated testicleo >>Lo(( o cr+4a(&+r$c r++>> 5on 0/E;

• <#pleD #ltraso#nd

• )D:o &rological eergenc,: #st e #nt*isted *ithin Yhr( to

aintain viailit,o Ho*? an#al detorsion Nopen oo= techni#e edial

to lateralo If an#al detorsion fails '#rgical eDploration 58o%d

(&andard;o Once #nt*isted A tie it do*n 5orch$o+y* s#rger, to

ove an #ndescended testicle into the scrot# andperanentl, >D it there;

Cry&orch$d$(4*

• Fail#re of testic#lar descent into the scrot#

• $Tects 3Q of ales

• P3Q ilateral

• #ndescended testes ecoe atrophic leading to sterilit,

• icro:

o )##lar atroph, proceeding to h,aliniSationo Foci of intrat##lar ger cell neoplasia a, e present

• IB" ris= 5-9D; of testic#lar cancer in either testes

• Orch$o+y efore p#ert, li=elihood of atroph,6 sterilit, andcancer

TESTICULAR TUMORS*

• " ages 39-9,o

• !hites 4 lac=s

• P3Q ilateral

• R/F:o "r,ptorchidis

o InterseD s,ndroes 5androgen insensitivit, s,ndroe6testic#lar d,sgenesis;

o Fail, hD of testic#lar cancer

• 0rec#rsor: intrat##lar ger cell neoplasia

ALL TESTICULAR 3ERM CELL TUMORS HAE ANISOCHROMOSOME O< SHORT ARM O< CHR 1!::

• "/F:o "" of pain%+(( testic#lar enlargeent 55large #l=,

asses;;

72



0ain)% enlarging testes % infectiono !ill NOT transill#inate c 'OLI< ass in testes6 then to

dD do &ltraso#nd

>>NEER BIOPSF TESTES I< ORRIED ABOUT CANCER:: Bc$%% ca)(+ (r+ad o canc+r:>>

• )#or ar=er assa,so LDH 5nonspeci>c ar=er of cell death; correlates * t#or

#rden Higher it is6 the ore t#or present eas#re 1EFORE @ $F)ER s#rger,

o >S+4$no4a* %ac+n&a% a%=a%$n+ ho(ha&a(+

7PLALP9

P3Q haveeta-h"(

o >Chor$ocarc$no4a:B+&a-hC3

"an get g,necoastiaGG

o >Fo%= (ac carc$no4a:a%ha-+&oro&+$n

o T+ra&o4a: 55BO $RCER;; A In *oen6 enign//in en6can e alignant

• )J: radical orchiecto,

• >>SEMINOMA>>*o " ger cell t#or 5539-9,o;;o (ross:

Large #l=, ass !ell-circ#scried $reas of necrosis a, e seen

o icro: Lar8+ )n$or4 c+%%( c%+ar 8%yco8+n-r$ch

cy&o%a(4

• "LE$R "ELL "$R"IBO$ 5"""; Ro#nd n#clei and n#cleoli

L,phoc,tic in>ltrate a, have gran#loato#s rDn and

s,nc,tiotropholasts 5in P3Q - eta-h"(;o Rad$o(+n($&$6+2ch+4o-(+n($&$6+o Often sta,s con>ned to the testes for long periods of tieo EDcellent prognosiso S+r4a&ocy&$c (+4$no4a(*

Older en 4Y9,o 'ae #st in older g#,s

EMBRFONAL CARCINOMA*o !OR'EGGG ore aggressiveGGo

(ross: Ill-de>ned invasive ass * heorrhage and

necrosis icro:

• Large priitive cells * asophilic c,toplas

• Large n#clei and proinent n#cleoli

• a, for sheets or priitive glands

• a, have other coponents iDed ino ar=ers: $F0 or -h"(

7



• >>FOLK SAC TUMOR>>* 5a=a ENDODERMAL SINUS TUMOR9

o " ger cell t#or in =$d( \yo 558OLC '$" % 8O&B(;; Cids do *ell $d#lts often have other coponents iDed * it

o (ross: large *ell dearcated asso icro:

Lo* c#oidal to col#nar epithelial cells Fors icroc,sts6 retic#lar patterns6 sheets6

glands6 and papillae >>Sch$%%+r-D)6a%% 'od$+(>>* resele priitive

gloer#li Eosinophilic h,aline glo#les coposed of $F0 or

$3-$) a, e seeno 'er# t#or ar=er % A<P

CHORIOCARCINOMA>>>: BO grapesGo ost alignant ger cell t#or 5highl,; of K&')

tropholasts 5BO VILLI;

BO #terine enlargeent6 BO grapes

'ee heorrhage and necrosis

o Earl, spread , heatogeno#s ro#tes therefore goes tol#ngs6 liver6 one6 rain6 s=in6 etc

o 1-h"( is t,picall, o 2 fors:

3+(&a&$ona%*

ost of tie after coplete ole

after spontaneo#s aortion

after noral preg 5rare;

X1""? c)r+ ra&+ $&h ch+4o::

o Highl, responsive to "heoo )#or is ^ o6 ^ dad A foreign $gs

therefore i#ne s,ste =ic=s in to>ght dads foreign $gso (OO< 0RO(BO'I'G

3onada%*

fro ger cells of ovar,/testes

0OOR 0RO(BO'I'o Responsive to cheoo BO i#ne response e BO foreign

$gs

T+(&+(* 8ood d &+(& r+8 &+(&

TERATOMAS 5Nscraled a,;: a=a D+r4o$d Cy(&o <D: #ltraso#nd of ovar, c dont *ant to radiate gonadso In *oen6 PQ 1EBI(B in en A $LO') $LL

$LI(B$B) 5#ntil proven other*ise;o Occ#r in ,o#ng *oen 53st 2 decades of life;o " ger cell t#oro BENI3N 7MATURE9 CFSTIC TERATOMAS

0resence of at#re tiss#e fro all ger la,ers:ectoder6 endoder6 esoder

(ross: Cy(&( con&a$n$n8 (+'ac+o)( (+cr+&$on(,

ha$r, and &++&h

77



"/F: infertilit, ovarian torsion6

LIMBIC ENCEPHALITIS* paraneoplastics,ndroe * teratoras containing at#rene#ral tiss#e

o Ina of liic s,steo '#ac#te onset 5.32*=s; of seiS#res6

short ter eor, loss6 conf#sion6and ps,chiatric

o An&$-NMDAR &+ra&o4a(con&a$n$n8 4a&)r+ n+)ra% &$(()+

o An&$-Ma! 8+r4 c+%% &)4or( o&+(&+(

o An&$-H) (4a%% c+%% carc$no4a o%)n8

o SPECIALIQED TERATOMA* STRUMA OARII "oposed alost copletel, of at#re &hyro$d

&$(()+

a, ca#se h,perth,roidis 55* NO goiter;;

&nilateral solid ro*n asso MALI3NANT 7IMMATURE9 TERATOMA

HI(HER RI'C OF "$B"ER'GG

(ross: #l=, solid ass * areas of necrosis

icro: presence of iat#re eleents foci ofn+)ro+$&h+%$a% d$+r+n&$a&$on 5a, eaggressive and etastasiSe *idel,;

PROSTATE*

o BPH* BENI3N PROSTATIC HFPERPLASIA

(ross:

• Enlarged prostate * an, *ell circ#scriednod#les

• ),picall, occ#rs in inner transitional Sone

• &rethra a, e copressed into a slit-shape If see nod#le in peripheral Sone % cancer <H) is R/F for enlarged prostate "/F:

• Fre #rination

• Feeling of never f#ll, ept,ing ladder icro:

• H,perplastic nod#les containing proliferationglands and >ro#sc#lar stroa

• (lands are dilated and have papillar,infolding

• (lands are lined , &a%% co%)4nar+$&h+%$a% c+%%( 'a(a% c+%% %ay+r

• "orpora a,lacea: inspissated proteinaceo#saterial *ithin gland l#ens

)D:

• 9-alpha-red#ctase inhiitors: Finesteride Ainhiit <H) foration

• alpha-adrenergic receptor loc=ers 5relaDsooth #scle;

79



• s#rger, A trans#rethral resection of prostate5)&R0;

o PROSTATE CANCER*

" for of cancer in en 49,o (EBE: PTEN 4)&

Hard to see6 #t eas, to feel "oes for peripheral Sone #s#all, posterior

peripheral Sone 0rec#rsor: high grade prostatic intraepithelial

neoplasia 50IB; icro:

• 'aller cro*ded glands

• Lac= ranching and papillar, infolding

• Lined , single la,er

• Lac= 'a(a% c+%% %ay+r::

• Enlarged n#clei and n#cleoli 3LEASON 3RADIN3 SFSTEM*

• (rade 3-9 ased on diTerentiationo 3 % good // 9 % ad

• $dd 2 ost doinant patterns together toget (leason score

• !ill e W t*n 2-3o Higher the W6 the *orst prognosisGG

(ro*s aro#nd nerves "/F:

• Often $sD: detected as >r nd#le on <RE @elevated 0'$

• a, present as lo*er ac= pain:o(&+o'%a(&$c 4+&a(&a($( can e seen onradion#cleotide one scans elevated $L0

0rostatic speci>c $g 50'$;:• Organ speci>c #t not cancer speci>c

• a, e elevated *ith 10H6 prostatitis6prostate infarcts6 instr#entation andeac#lation

• 0rod#ct of prostatic epitheli# secreted inseen

Local invasion

• $dvanced cancers a, invade seinalvesicles or thr# caps#le into ladder/rect#

• 0eri#rethral Sone involveent a, prod

#rinar, ostr#ction )J:

• Local: prostatecto, or radiation or actives#rveillance

• etastatic: androgen deprivation 5palliative6not c#rative;

o Orchiecto, or l#teinSing horone5LH;

o L&0ROB + Fl#taide

7Y



!hen >rst give L#pron6 LH >rstIB" then <E"

)o loc= initial IB"6 loc= it *ithFl#taide

dr. barone kaplan pathology notes part 1

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