Male/Female Repro + Breast buzzwords (FA/Uworld/Pathoma)

Peyronie disease

Abnormal *curvature* of penis due to *fibrous plaque* in tunica albuginea; causes ED, pain, or anxiety Not a penile fracture (that's rupture of coprora cavernosa)

Endometrial hyperplasia

Abnormal *proliferation of glands relative to stroma* caused by *excess estrogen* with increased risk of endometrial carcinoma; no increase in uterus size Presents as *postmenopausal bleeding* Risks = *anovulatory cycles*, hormone replacement therapy, polycystic ovarian, and granulosa cell tumor Anvoluatory can be due to obesity (increased estrone from adipose), eating disorders, and intense exercise (among other things)

Testicular torsion

Acute, severe pain, and *absent cremasteric reflex* (no elevation of scrotum when touching inner thigh) Due to failure of testes to attach to inner lining of processus vaginalis and rotation of testicle around spermatic cord Obstructs the thin veins and may cause conjestion/hemorrhagic infarct Orchiopexy (fix testis in scrotum) should be bilateral b/c contralateral testis is at increased risk

Adenosis and clear cell adenocarcinoma of the vagina

Adenosis = persistence of columnar epi in the upper 2/3 of the vagina which leads to clear cell columnar Clear cell = *malignant proliferation of glands* due to woman who had exposure to *DES* which crosses the placenta

Asherman Syndrome

Adhesions or *fibrosis* of endometrium associated with *curettage* of intrauterine cavity Scraping of the uterus leads to loss of the basalis layer (which is the regenerative later) Normally, progesterone withdrawal causes bleeding but NOT with this syndrome b/c it's basically just scar tissue

Immature teratoma

Aggressive *malignant* ovarian neoplasm that contains *fetal neuroectoderm* Diagnosed beofre age 20 with embryonic neural tissue

Placenta previa

Attachment of placenta to *lower uterine segment* so that you can see it from cervix Risk = multiple births, prior C section *painLESS third-trimester bleeding* Requires C section b/c baby can't get through w/o compromising blood supply

Primary cilliary dyskinesia

Auto R defect in ciliary function = *Kartagener Syndrome* Upper/lower *respiratory infections* and *bronchiectasis* (signet ring sign, dilated airways* May have situs inversus (heart on wrong side) and infertility

Fetal alcohol syndrome

Retardation, *microcephaly*, *small palpebral fissures*, smooth philtrum, thin upper limb, heart-lung defects, and holoprosencephaly Due to failure of cell migration

Congenital hydrocele and acquired hydrocele

Scrotal swelling in infants due to *incomplete obliteration of processus vaginalis* See fluid in the tunica vaginalis (serous membrane that covers testes/internal surface of scrotum) Acquired = due to *trauma*, infection, or tumor that blocks lymphatic ducts Both *transillumate*

Septate uterus, bicornuate uterus, and uterus didelphys

Septate = incomplete resorption of septum Bicornuate = incomplete fusion of mullerian ducts Uterus didelphys = complete failure of fusion (double uterus, cervix, and vagina)

Sclerosing adenosis

Subtype of fibrocystic change Central acini and stromal fibrosis w/ peripheral ductal dilations Often with *calcifications* and slight increase risk of cnacer

Complete hydatidiform mole

Swelling of chorionic villi and trophoblasts 46 XX or 46 XY (enucleated egg with single sperm that duplicates or 2 sperm) *no* fetal parts, *large increase in hCG*, *grapes/snowstorm* on ultrasound Increased risk of malignancy and choriocarcinoma (no p57 from maternal genome available) Vaginal bleeding and pelvic pressure

Partial hydatidiform mole

Swelling of chorionic villi and trophoblasts 69XXX, 69XXY, or 69XYY due to 2 sperm + 1 egg *fetal parts present* with slightly increased hCG Partial proliferation of trophoblasts with low risk of malignancy due to presence of *p57* from maternal genome Vaginal bleeding and pelvic pressure

46 XY DSD (disorder of sex devleopment)

Testes present but external genitalia are female Most common form is androgen insensitivity syndrome/testicular feminization (see next card)

Hypospadias and epispadia

Hypo = ventral (lower) surface of penis opening due to *failure of urethral folds to fuse* Epi = dorsal (upper) surface of penis opening due to *faulty positioning of genital tubercle* Epi is associated with bladder exstrophy (protrusion of bladder through abdominal wall)

Amniotic Fluid Embolism

Hypoxemic respiratory failure (dyspnea), DIC, and cardiogenic shock Occurs *abruptly after delivery*; Tissue factor/thromboplastin causes the DIC Findings: *fetal squamous cells in maternal pulmonary artery* at autopsy

Placental aromatase deficiency

Inability so make estrogen from androgens *Masculinization of female* (46 XX DSD) with *increased testosterone and androsteneidone* Presents with *maternal virilization* during pregancy (fetal androgens cross the placenta)

Periductal mastitis

Inflammation of subareolar ducts Think a *smoker* causing a *Vitamin A deficiency* Would see squamous metaplasia of lactiferous ducts leading to fibrosis and blockage Mass with *nipple retraction* *uncommon --> remember that smoking normally doesn't increase the risk for breast changes

Serous cystadenoma

Most common ovarian neoplasm; *benign* Lined with fallopian-tube like epithelium; often *bilateral* Premenopausal women; can have cauliflower like inclusions

Mucinous cystadenoma

Mulitloculated and large *benign* ovarian cyst lined by mucus-secreting epithelium

Invasive carcinoma of cervix

Often *squamous cell carcinoma* that is diagnosed via colposcopy (magnification) or biopsy Lateral invasion may block ureters and lead to *hydronephrosis/renal failure* Presents with postcoital bleeding and discharge Goes *through basement membrane* in a middle age woman; atypical cells are present in subepithelial stroma Immunodeficiency (HIV) is a big risk

46 XX DSD (disorder of sex development)

Ovaries but external genitalia virilized Excessive exposure to *androgenic steroids* (due to CAH or exogenous to mom when pregnant)

Placental abruption

Premature *separation* of placenta from uterine wall *before delivery* = painful bleeding in *third trimester* Due to trauma, smoking, HTN, cocaine; can cause DIC, shock, and fetal distress or still birth

DiGeorge syndrome

*22q11 deletion* with poor development of *3rd/54th branchial pouch* T cell deficiency (thymic aplasia) and hypocalcemia (bad parathyroids) Also has cardiac defects

5a reductase deficiency

*Auto Recessive* limited TO 46 XY males. Inability to convert testosterone to DHT. Ambiguous genitalia *until puberty* (testosterone increases) Tetosterone/estrogen levels are normal, LH is normal, and internal genitalia are normal Type 1 occurs in skin Type 2 occurs in genitals (small phalus, hypospadias, undescended testes)

Mature cystic teratoma/dermoid cyst

*Benign* germ cell tumor of ovary in a woman *10-30 years old* Contains *teeth, hair, sebum*; if of thyroid origin = *struma ovarrii* which causes *hyperthyroidism* + an ovary mass Can be bilateral; may have *keratin* with sebaceous glands

Thecoma

*Benign* ovarian neoplasm that may produce *estrogen* (like a granulosa stumor) Presents with *bleeding* in a *post-menopausal woman*

Brenner tumor

*Benign* ovarian tumor that appears *yellow and encapsulated* and looks like *bladder* (urothelium) Has *coffee-bean nuclei*

Fibromas and Meigs syndrome

*Benign* ovarian tumor with *spindle-shaped fibroblasts* Meigs syndrome = triad of ovarian fibroma, *ascites*, and *hydrothroax* (pleural effusions)

Fibroadenoma

*Benign* tumor (no LAD) of breast in woman <35 y/o Well defined *mobile* mass *without* irregular borders or lymphadenopathy *increased size/tenderness* with estrogen (i.e. with pregnancy or right before period) Tumor of myxoid stroma, fibrous tissue, and glands

Phyllodes tumor

*Benign* tumor of breast (no LAD) that is a *large mass* (usually >4cm) of connective tissue, stroma, and cysts *Leaf like* lobulations common; usually in a *post menopausal* woman; May see *protrusions* as a key word Similar to a fibroadenoma (i.e. *from breast stroma*) but has more fibers; can also *recur* or be malignant

Intraductal papilloma

*Benign* tumor of breast (no LAD) within lacteriferous ducts that is usually *unilateral* and beneath areola in a premenopausal woman Most common cause of *BLOODY or serous nipple discharge* *Fibrovascular fingers* lined with luminal cells/myoepitherial cells Slight increase risk of cancer

Polycystic Ovarian syndrome/Stein-Levethal syndrome

*Bilateral enlarged cystic ovaries* with amenorrhea/oligomenorrhea, *ACNE*, *hirsutism,* and decreased fertility (increased steroid enzymes) Associated with *obesity* and can increase risk of *endometrial cancer* due to anovulatory cycles Due to *Hyperinsulinemia* or *insulin resistance* (think Type 2 DM) which alters feedback response and leads to *increased LH* relative to FSH and *increased androgens* from theca-interna; low progesterone Androgens are converted to estrone in adipose tissue which feedback inhibits FSH further = *increased degeneration of follices* Treat with weight reduction, OCPS (prevent endometrial hyperplasia due to unopposed estrogen), clomiphene and metformin (induce ovulation), and spironolactone/ketoconazole to treat hirutism

Androgen insensitivity syndrome

*Defect in androgen receptor* results in normal appearing female but is *46 XY DSD* Female external genitalia (scant pubic hair) but *absent uterus and fallopian tubes* *Normal testes* (found in labia majora) with *increased testosterone, estrogen, and LH*

Placenta accreta/increta/percreta

*Defective/absent decidual layer* (endometrium that placenta attaches to) which yields abnormal *attachment/separation after delivery* Accreta - attaches to myometrium Increta = penetrates myometrium Percetra - penetrates through myometrium into serosa Presents with *post-partum bleeding* and difficult delivery; usually detected on ultrasound beforehand so look out for someone whose *previous pregnancy records are unavailable* Risks = C section (scar tissue), inflammation, and placenta previa

Varicocele

*Dilated veins* in pampiniform plexus; most often on *left side* Increase chance of infertility; bag of worms that increases with Valsalva *Does not transilluminate* Associated with renal cell carcinoma b/c it invades the renal vein --> check for signs of *renal failure*

Krukenberg tumor

*GI Malignancy* (diffuse type) metastasizes to ovaries *bilaterally* Shows *signet ring* adenocarcinoma

Leydig cell tumor

*Golden brown*; mostly benign; Has *Reinke crystals* (eosinohpillic/pink cytoplasm) Makes *estrogens/androgens* = gyncomastia in men or precocious puberty in boys

HELLP Syndrome

*H*emolysis, *E*levated *L*iver enzymes, *L*ow *P*latelets due to severe preeclampsia *Schistocytes* on blood smear; can lead to hepati hematomas with *severe HYPOtension* Thrombotic microangioatphy involves the liver and leads to infarct to increase liver enzymes and use up platelets in the thrombi

Embryonal carcinoma

*Hemorrhagic mass with necrosis that is painful* Bad prognosis; glandular and papillary Most often mixed with other things (look for elevations of AFP - yolk sac mix) May rarely have increased hCG and normal AFP if pure Chemo may cause it to differentiate to another tumor

Endometritis

*Inflammation* of endometrium due to *retained products of conception* (placenta left over from delivery, miscarriage, abortion, or IUD) *fever*, bleeding, and pelvic pain Bacterial flora promoted; treat with gentamicin + clindamycin or ampicillin Chronic type = plasma cells and lymphocytes; can cause infertility

Medullary carcinoma

*Invasive* tumor of the breast with a *fleshy* appearance and moderated *lymphocytic infiltrate* Usually has plasma cells and *BRCA1* carriers affected; well circumsized mass = good prognosis

Malignant breast tumor (overview)

*Lymphadenopathy*; masses with *irregular borders* Estrogen/Progesterone and HER2 + breast cancers are better b/c we have treatments for those *Triple negative* = more aggressive and affects African Americans Risks = *increased estrogen*, increase number of cycles (early menarche, late menopause), obesity (increase estrogen/estrone from adipose tissue); 1st degree relative,

Serous cystadenocarcinoma

*Malignant* ovarian neoplasm that is *bilateral* with *psammoma bodies*; usually *unilocular* Complex cysts with shaggy lining; occurs in post-meno women that invades into the CT *BRCA 1* is a risk; may need prophylactic salpingo-oophronectomy to prevent fallopian tube complications

Granulosa cell tumor

*Malignant* ovarian stromal cell tumor that affects women in their 50s. *Unliateral mass* that has *coffee bean nuclei* and thick endometrium. Produces *estrogen* and sometimes progesterone; presents with *postmenopausal bleeding* or early secondary sex characteristics and breast tenderness Shows *Call Exner bodies* = simple cuboidal cells around *eosinophilic* fluid with some yellow theca cells (lipids)

Dysgerminoma

*Malignant* ovarian tumor that is a proliferation of oocytes; most common in *adolescents* *Fried egg cells* with elevated *LDH and hCG* Rapidly growing tumor that may also develop during pregnancy

Yolk sac/endodermal sinus tumor

*Malignant* ovarian tumor that is in ovaries, testes, or sacrococcygeal area in children. Most common in *male infants* *Hemorrhagic* yellow *solid mass* that has *Schiller Duval bodies* (resemble GLOMERULI) Elevated *AFP* is a tumor marker

Endometrial carcinoma (adenocarcinoma)

*Malignant* proliferation of glands in a woman *55-65 years old* with vaginal bleeding Risks = estrogen w/o progesterone, obesity, diabetes, HTN, late menopause, early menarche, and no prior births (early menarche/late menopause = more cycles = more estrogen = more opportunity for endometrial cells to migrate) Sporadic type has papillary/finger-like structures, psammoma bodies, and p53 mutations

Leiomyoma/fibroid

*Multiple benign* tumors in endometrium that is common in African Americans that are *20-40 years old* Estrogen sensitive = * (increases with pregnancy and decreases with menopause)* May cause bleeding or miscarriage (blockage of implantation) Bleeding may lead to *iron deficiency anemia*; histologically shows *whorled pattern of SMC* RARELY transforms to leiomyosarcoma

Lymphogranuloma Venereum

*Necrotizing granulomas* of inguinal lymphatics and nodes Due to *Chlamydia trachomatis* (L1-L3 type) that is obligate intracellular Heals w/ fibrosis and may cause *rectal strictures* due to perianal involvement

Benign prostatic hyperplasia

*Nodular enlargement* of prostate with urinary problems; increased risk for infection, *hydronephrosis*, hematuria; but *normal part of aging* May cause slightly increased PSA (4-10 ng/mL); always *recheck* for increases (cancer) Treat with a1 antag (terazosin/tamsulosin); 5a reductase inhibitors (finasteride); PDE5 inhibitors

Paget disease of the breast

*Noninvasive* *intraepithelial adenocarcinoma* (glands and clear cytoplasm) tumor of the breast resulting from underlying cancer Extends up the duct and involves the nipple *Scaly nipple* that may be *crusty* and ooze or bleed

Ductal carcinoma in situ

*Noninvasive* malignant proliferation of ducts; usually *no mass* or a small mass Will see *microcalcifications without basement membrane invasion* Rarely metastasizes; may come from sclerosing adenosis or fat necrosis

Comedocarcinoma

*Noninvasive* subtype of DCIS Shows dystrophic calcifications and *central necrosis* May extrude a *white pus* from the ducts if you squeeze them (due to the necrosis)

Fat necrosis of breast

*Painless lump* due to *trauma/injury* to breast (think of a scar tissue mass basically) - patient may forget to initially report the trauma WIll see calcified oil cyst on mammogram; necrotic fat and *giant cells*; macrophages and neutrophils may be present

Seminoma

*Painless* teticular enlargement without hemorrhage, necrosis, and does not transilluminate. *Fried egg* or cells with *clear cytoplasm* *Highly response to radiotherapy*; metastasize late Increased *ALP*; may make small amounts of B-hCG (large amounts point towards a mixed tumor/choriocarcinoma) If high AFP, consider mixed with yolk sac

Mucinous cystadenocarcinoma

*Pseudomyxoma peritonei-intraperitoneal* accumulation of mucinous material from ovarian or *appendiceal* tumor; usually *multilocular* May cause a "jelly belly" and is usually unliateral - look for mass extending to *peritoneum* (endometriosis can also go here)

Sertoli-Leydig tumor of ovary

*Reinke crystals* which are eosinophilic --> produce *androgen* and lead to hirtutism (male hair) and virillization of female

Invasive ductal carcinoma

*Rock hard* or firm fibrous *irregular* bordered mass with *duct like cells* that can cause *dimpling of the skin* with LAD *Stellate* infiltration with desmoplastic stroma Type 1 = tubular = lack myoepithelial cells (good prognosis) Type 2 = mucinous/*colloid type* = tumor floating in mucinous pool (older women; good prog) Most common of all breast cancers

Invasive lobular carcinoma

*Single file* row of cancer cells due to *decreased E-cadherin* that may have signet ring cells Usually an asymptomatic breast mass with occasional discharge Often *bilateral* with *multiple lesions* and LAD

Cryptorchidism

*Undescended testis* with *normal testosterone* (usually) b/c leydig are affected by the increased temperature but *Sertoli cells affected* *Decreased inhibin B* with increased FSH and LGH; increased risk of cancer and infertility testosterone is only decreased if bilateral

Condyloma accuminata in males

*Warty* neoplasm due to HPV 6/11 with koilocytic change; due to sexual intercourse

Endometrial polyp

*Well-circumsized* collection within uterine wall that may contain *SMC*; may present with *painless uterine bleeding* Common side effect of *Tamoxifen* since it's anti-estrogenic on breast but weakly pro-estrogenic on endometrium

Yolk sac (endodermal sinus) tumor in males

*Yellow* tumor that is highly aggressive; usually in boys less than 3; no transillumination *Schiller Duval bodies* resemble *glomeruli* *high AFP* is characteristic; may mix with other tumors

Turner Syndrome

45 XO with a shield chest, *bicupsid aortic valve*, *coarctation of aorta* (brachial pulses stronger than femoral pulses), webbed neck/lymphedema, *horseshoe kidney* *Menopause* very early (before menarche) Decreased estrogen = *increased LH and FSH*

Klinefelter syndrome

47 XXY with testicular atrophy, *gynecomastia*, *small firm testes*, tall/long extremities May have inactivated X chromsome (Barr body) *increased FSH and LH* (steroli damage and abnormal leydig) = low testosterone and inhibin B which reduces negative feedback

Congenital Torticollis *Uworld only

Baby 2-4 weeks hold has a palpable *neck mass* with a *head tilt to affected side* Due to birth trauma --> SKM fibrosis and injury May have other MSK deformities (hip dysplasia, adducted foot, club foot) Resolves with stretching

Phimosis and balantis *From Robbins Pathology

Balantitis = *inflammation* of *glans/penis* Phimosis = balantitis that recurs and *prevents retraction of foreskin* in an uncircumsized male

Vulva pathology (multiple listed in this card) (cysts, condyloma cuminata, lichen scelrosis, carcinoma)

Bartholin cyst: *unlitateral painful cystic lesion* adjacent to vaginal canal in woman of repro age Condyloma cuminata: "warty" neoplasm of sq epi due to *HPV 6/11* with koilocytes --> rarely can transform to carcinoma Lichen sclerosis et atrophicus: *thinning* of epidermis/fibrosis with *leukoplakia* in a *post-menopausal woman* that can be autoimmune; benign; slight increase risk of carcinoma Lichen simplex chronicus: hyperplastic/*thick* sq epi of vulva with *leathery leukoplakia* from chronic irritation/scratching but no chance of carcinoma Vulva carcinoma: Due to *HPV 16/18* and arises from vulvar intraepi neoplasm with koilocytic dysplasia; non-HPV types can be due to lichen sclerosis in an elderly woman >70

Prostatitis (two types)

Dysuria, low back pain, and *warm, tender, boggy* prostate with a *fever* Acute bacterial = E. coli/pseudomonas in older guy; C trachomatis and gonorrhoea in young male Chronic = bacterial or nonbacterial; *cultures usually negative*; may have lymphocyte invasion; can be due to previous infection, nerve problem, or chemical irritation

Sarcoma botryoides

Embryonal *rhabdomyosarcoma* Spindle cells that are *desmin positive* due to presence of immature SKM Presents with *grape like masses emerging through vagina* Shows *cross-striations* in cytoplasm (similar to SKM striations)

Endometriosis

Endometrial glands/stroma *outside of endometrial cavity* with hemosiderin deposits. Can present with *flesh colored nodules* in pelvis; can also go to ovary or peritoneum In ovary --> presents as *chocolate covered cysts* = endometrioma. May be due to retrograde flow or transport via lymphatic system Cyclic pelvic pain, pain during periods, pain with sex, pain with defection, infertility, but *normal sized uterus*

Gynecomastia

Enlargement in males due to increased estrogen Can be due to cirrhosis, hypogonadism, testicular tumors, and drugs Think *Spironolactone* (HTN), *Hormones* (prolactinoma), *Cimetidine* (GERD treatmenet), or *Ketoconazole* (anti-steroidal)

Cervical dysplasia/carcinoma in situ

Exo = NKSq and Endo = Single columnar epi Dysplasia begins at *basal layer* and extends out. Associated w/ *HPV 16/18* which has E6 (inhibits p53) and E7 (inhibits Rb) *koilocytes* or raisin cells are pathognomnoic; may present as *postcoital bleeding* High grade = hyperhcomatic/dark nuclei that has a high N:C ratio Risk = multiple parteners, smoking, first sex young, and HIV NO genetic component; may progress to invasive

Adenomyosis

Extension of endometrial tissue into *uterine myometrium* caused by hyperplasia. Presents with painful and heavy periods *Enlarged, soft, uterus*; treat with GnRH or hysterectomy

Kallman syndrome

Failure to complete puberty due to *defective migration of GnRH releasing neurons* and failure of olfactory bulbs to development *decreased GnRH* with *ANOSMIA* (lose sense of smell) Decreased GnRH, LH, FSH, and testosterone = *low sperm count or amenorrhea* May have cleft lip and a small testicular volume

Vasa previa

Fetal vessels in close proximity to cervical opening Presents with *membrane rupture, painless bleeding, and feta bradycardia* C section required due to rupture, blood loss, and fetal death Often has *velmanetous umbilical cord insertion* (goes into chorioamniotic membrane first rather than directly into placenta) = *unprotected by wharton jelly*

Gestational HTN

HTN after 20th week *with no proteinuria* May be due to MODY (glucokinase defect) Treat w/ hydralazine, a-methyldopa, lebetalol, nifedipine

Preeclampsia vs. eclampsia

HTN in pregnancy after 20th week with *proteinuria* and *end-organ dysfunction* (headaches, visual changes, pain in abdomen (liver damage)) Caused by *abnormal placental spiral arteries* leading to endothelial dysfunction, vasoconstriction, and ischemia = *fibrinoid necrosis* in placental vessels Resolves with delivery; HTN, diabetes, renal disease, and autoimmune disorders are risk factors Can cause placental abruption, renal failure, *Eclampsia* is the same thing * + maternal seizures* (can cause stroke, hemorrhage, or ARDS Treat both with *magnesium sulfate,* delivery, and anti-hypertensives

Orchitis

Inflammation of testicle May be due to Chlamydia D-K serotypes in Gonorrhea in young males (libido intact b/c Leydig cells are fine but increase sterility) E coli/psuedomonas in older adults with UTI Mumps (affect teenage/young adult) = *patchy atrophy* with increase infertility Autoimmune type = *granulomas in seminiferious tubules*

Mamillary Duct Ectasia

Inflammation/dilation (ectasia) of subareolar ducts Mass in a post-menopausal woman with multiple births *Green-brown* nipple discharge due to chronic inflammation with *plasma cells and granulomas*

Lactational mastitis

Inflammatory process of breast that occurs during *breast feeding* Bacterial infection risk is increased through *cracks* and is usually due to *Staph Aureus* Give antibiotics and continue breastfeeding

Inflammatory breast cancer

Invasive; not a cancer itself (describes an above cancer that is *infiltrating dermal lymphatics* *Peau d'orange* appearance due to blocked lymphatic drainage with *poor prognosis* Mistaken for mastitis or Pagets; distinguish by seeing *no response to antibiotics*

Choriocarcinoma

Malignancy of trophoblasts with *no chorionic villi present* Abnormally increased B-hCG, *dyspnea*, and *hemoptysis* due to lung metastasis = *cannoballs* on CXR Masses are *necrotic and hemorrhagic* with a small mass in ovary but larger masses in body Increase frequency of theca-lutein cysts Can arise due to spontaneous abortion, normal pregnancy, or a hydatidiform mole or could just be a sponatenous germ cell tumor

Leiomyosarcoma

Malignant and *DE NOVO* (not from leiomyoma) *SINGLE* lesion with *hemorrhage and necrosis* in a post-menopausal woman; enlarged uterus

Extramammary Paget Disease

Malignant epithelium in the epidermis of vulva Erythematus, pruritic, and ulcerated vulva (carcinoma in situ) w/o an underlying carcinoma will be *PAS+, keratin +, and S100-* Distinguish from melanoma (PAS-, keratin -, S100+)

Lobular carcinoma in situ

Malignant proliferation of lobules that is *noninvasive of basement membrane* No mass or calcifications usually (normally incidental finding) May see cells that lack E-cadherin --> can be *bilateral* Treat with tamoxifen to prevent carcinoma

Choriocarcinoma in males

Malignant tumor with large elevations in *b-hCG* Disordered trophoblastic elements without villi and with *hematogenous spread to lungs and brain* May cause gynecomastia or hyperthyroidism (hCG similar to LH, FSH, and TSH)

Squamous cell carcinoma (Bowen, Queyrat, or Bowenoid papulosis types)

Malingant dysplasia of skin common in Asia, Africa, and South america Bowen = dyplasia and *leukoplakia* in full-thickness of *shaft* Erythroplasia of Queryrat = cancer of *glans* with erthroplakia Bowenoid papulosis = *reddish papules* usually in a younger patient All are associated with *HPV* and *uncircumcision*

Teratoma in males

Mature teratoma is *highly malignant* in males (unlike in females); benign in children Multiple cell types May see increased AFP (yolk sac) or hCG (choriocarcinoma) mixed tumors

Male breast cancer

Usually a subareolar mass in an *older* male adult May have nipple discharge; usually an invasive ductal carcinoma Can be associated with *BRCA2* and Klinefelter's syndrome

Prostatic adenocarcinoma

Usually older men; most often in *posterior lobe* Diagnosed by *large increased PSA* (>10) but *decreased free PSA* (cancer binds to free stuff); and *increased PAP* Osteoblastic metastases may occur = *lower back pain* and *increased ALP*; lower spine and pelvis too Small glands with *prominent nucleoli*; higher in AA>Cauc>Asian with high saturated fat diets Treat w/ Leuprolide (GnRH continuous analog to decrease FSH/LH) or Flutamide (competitive inhibitor at androgen R) Robbins detail = GSTP1 gene mutated

Fibrocystic changes

Woman <35 y/o; *cyclic* breast pain or lumps before period Usually *bilateral*; simple cysts that may have *blue dome* and due to *papillary apocrine change/metaplasia* and stromal fibrosis May give breast a *lumpy* or "rope-like* texture Epithelial hyperplasia = subtype whereas terminal ductal or lobular epithelium are hyperplastic; greater increased risk of cancer

Double Y males

XYY = phenotypically normal but *very tall* with normal fertility *acne, learning disability, autism*