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114 Cards in this Set
- Front
- Back
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define benign hyperplasia/hypertrophy of the prostate |
benign enlargement of the prostate tissue, esp around the urethra. |
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what is the cause of benign hyperplasia/hypertrophy of the prostate |
ageing causes hormone alteration
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is some enlargement common before 40? what are the symptoms |
yes
often asymptomless |
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how does enlargement obstruct the urethra |
elargemtn of median and lateral lobes --> elongation and tortuosity of prostatic urethraand enlargement of median lobe may act like a ball valve --> obstruction
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what does partial obstruction mean? |
1/ bladder is never fully emptied --> frequency and nocturia
2. stagnant urine --> increased risk of infection 3. poor urinary stream 4. bladder hypertrophy to push urine past obstruction - diverticulae - infection - claculi 5. back pressure to ureters --> progressive hydonephrosis --> renal failure |
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what are the clinical features of BPH? |
1. hesitancy 2. terminal dribbling 3. poor urine stream 4. frequency and noctura 5. signs of secondary infection 6. lateral lobes are enlarged (SMOOTH AND FIRM, NOT HARD) |
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DEFINE carcinoma of the prostate |
malignancy of the prostate gland |
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who is carcinoma of the prostate common in |
elderly males
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who is carcinoma of the prostate rare in |
below 50
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where is the tumour usually |
posterior part of prostate beneath the capsule |
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what dooes arcinoma of the prostate look like histoloigcally |
adenocarcinoma usually well differentiated and occasionally anaplastic
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how does carcinoma of the prostate spread locally |
to bladder, urethra and seminal vesicle
rare = rectum |
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how does carcinoma of the prostate spread lymphatically |
iliac and para aortic nodes
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gow does carcinoma of the prostate spread through bone |
bone - osteosclerotic or osteolytic lesions especially pelvis, spine and skull
liver lungs |
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what are the clinical features of carcinoma of the prostate? |
may be identical to BHP 2. signs of secondaries - ESP BACK PAIN 3. genreral of malignancy - weight loss - anaemia - fatigue |
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define carcinoma of the penis |
malignancy of the penis |
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who is it common in? what is it associated with? what race rarely gets it? why? |
elderly
presence of reatined sebum Jews, circumcission |
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what does it look like histologically? |
well differentiated squamous cell carcinoma
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how does carcinoma of the penis spread locally |
fungates through ulceration. spread proximally to destroy penis
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how is carcinoma of the penis spread lymphatically |
inguinal nodes (often bilateral)
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how is carcinoma of the pensi spread haematogenically |
late and unusual
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what are the clinical features of carcinoma of the penis |
ulcer on glans
purulent blood stained discharge from non retractile prepuce death from haemorrhage from fungating groin nodes |
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define tumours of the testes |
neoplastic gorwth of testes, often malignant
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what are the two main types of tumours of the testes |
1. seminomas
- 30 to 40 YO 2. teratoma - 20 to 30 YO |
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is a seminoma fast or slow growing?1 what does it feel like of palpation what doesit look like histologically |
slow
solid well differentiated to undifferentiated |
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where do teratomas orginate what might it contain |
unkown
cartilage, bone, muscle, fat, other tissue |
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how do tumours of the testes spread locally |
teste destroyed by tumour and may ulcerate
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how do tumours of the testes spread lymphatically |
para-aortic nodes
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how do tumours of the testes spread haematogenically |
from teratoma to lunga and liver early
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what are the clincal features of tumours of the testes |
1. hard lump in testis 2. with hydrocoele 3. rarely = painful, rapidly enlargming swelling which may be mistaken for orchitis 4. secondary deposits - lung - mass in ab - lymphadenopaty |
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what are disorders of growth and differentation of the breast |
1. chronic mastitis/fibroadenosis/fibrocystic disease of the breast 2. fibroadenoma of the breast (benign) 3.carcinoma of the breast (malignant) |
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define chronic mastitis/fibroadenosis/fibrocystic disease of the breast |
extremely common disorder ranging from 'physioloigcal variants' to potentially precancer. Characterised by fibrocystic changes in the breast |
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what is the cause of chronic mastitis/fibroadenosis/fibrocystic disease of the breast |
excessive breast responsiveness to estrogen levels in the body |
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what are the changes to breast that occur in chronic mastitis/fibroadenosis/fibrocystic disease of the breast |
1. areas of fibrosis (stromal) 2. cystic changes (from numerous tiny cysts to solitary large cysts) 3. hyperplasia of stromal and eithelial tissue 4. atypical hyperlasia of epithelia tissue 5. cystic dysplasia |
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what are the clinical features of chronic mastitis/fibroadenosis/fibrocystic disease of the breast |
1. often bilateral 2. lump(s) in breast 3. pain esp pre-menstrually 4. discharge (yellow, brown or green) |
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define fibroadenoma of the breast |
firm and encapuslated benign tumour of fibroustissue surroudnding epithelial duct proliferatio |
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what is the pathology of fibroadenoma of the breast |
ncapsulated mass of fibrous stroma and proliferating ducts |
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what is the size of a fibroadenoma of the breast |
3cm |
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what are the clinical features of fibroadenoma of the breast |
1. breast mouse (mobile lump in breast) 2. painless 3. no discharge |
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define carcinoma fo the breast |
common malgnancy of the breast |
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what is the leifetime risk of developing breast cancer what age group has lowest risk |
10% 0-39 (.5%) |
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incidence of breast cancer increases with age? 75% of women over --- |
yes 50 |
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relatedness first degree relatives (parent, sibling, child) = distant no history |
2-3x slight increase 80% develop |
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women with early menarche, late menopause and late first preganancy are at increased risk because women whos first friegancy after 30 are at more risk than women who are |
prolonged estrogen exposure nullparous |
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there is a slight increased risk with what disordered growth? |
fibrocystic disease - ductal proliferation must be present (moderate risk) - atypical hyperplasia (higher risk) |
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women with multiple breast lumps but no histological confirmation of high risk pattern are considered what risk |
not at high risk |
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when has use of contraceptive pill been confirmed to increase risk of developing carcinoma of the breast |
prolonged use of contraceptive pill before first preganncy |
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the se of postmenopausal oestrogen replacement increases the risk of breast cancer by ---- after --- years |
less than two fold after 10-20 years |
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there is evidence that --- prmotes or causes carcnioma of breast but there is no conlcusive evidence |
diet |
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why is obesity a risk factor for developing ccarcinoma of the breast |
exrta fat increases production of oestrogen by adrenal androgens |
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radiation before --- increases risk |
30 |
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carcinoma of breast is common in --- cultures and rare in ---- cultures |
western oriental |
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people who smoke havea higher incidence |
true |
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BRCA 1 (breast cancer 1) gene is on chromosome --- it is associated with increased risk of --- or --- carcinma. BRCA 2 gene is on chromosome --- and is associated with increased risk of --- |
17 breast or ovarian 13 breast |
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carcinoma of the breast and its macroscopic appearance sirrhous atrophic scirrhous encephaloid papillary lactational pagets disease of the nipple |
hard and unencapsulated scar like tumur in the shrivelled breast of te elderly large, soft, brain like intraduct or intracyst fulminating type occuring in or after pregnany (mastitis carcinomatosa) tumour and eczematous skin lesion |
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carcinoma of the breast and its microscopic apprearance |
range from 1. adenocarcinoma (well differentiated and common) 2. carcinoma simplex (anaplastic) 3. squamous cell carcinoma |
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what are the ways carcinom of the breast spreads |
1. direct extension 2. lymphatic spread 3. haematogenous spread 4. transcoelomic spread |
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direct extension: skin or subcutaneous involvement --> spread to deep tissue --> ----- ---> |
skin dimpling, retraction of nipple, eventual ulceration pec major, serratus anterior --> chest wall |
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lymphatic spread: blockage of dermal lymphatics --> daughter skin nodules --> whole chest wall becoming a -- --- of tumour tissue main lymphatic channels ---> eventually --> |
vuteaneous oedema pitted b sweat gland orifice (peau d'orange) cancer en cuirasse firm mass axillary and internal mammary lymph nodes supraclavicular, abdominal, mediastinal, groin, cervical, oppostite axillary nodes |
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haematogenous spread results in spread to |
1. lungs 2. lver . bones (red bone marrow = skull, vertebrae, pelvis, ribs, sternum, upper femur and humerus) 3. brain, ovaries and adrenals |
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trancoleomic spread to |
1. pleura and preritoneum in adavancef disease causes plueral effuion ascities |
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what are the clinical features of carcinoma of breast 80% found as less common mass of lump that is ---- from surrounding tissue advanced involvemnt of --- nodes, supre/infraclavicular --- in advanced stages ---- breast cancer (diffuse inflamamtion and enlargement of breast without mass) nipple ---- signs and symptoms of --- spread |
lump by patient H of chest pain and no mass, enlargemtn or thickening different inoperable, fixation of cancer to chest wall or skin, satellite nodules/ulcers of skin, lymphoedema (p'eau do'raonge) fixed axillary nodes, lymphadenopathy inflammatory discharge metastatic |
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what are the disorders of growth and differentiation of the uterus and cervix (5) |
1. cervical carcinoma 2. endometrial carcinoma 3. endometriosis 4. adenomyosis 5. uterine fibromas/fibromyoma/fibroids |
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define cervical carcinoma |
a malignancy of the cervix. common gential tract malignancy in Aus |
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what is te cause of carcinoma of the cervix |
1. SEX RELATTED - rare in nuns, common in prostitutes 2. being black 3. being of low socioeconomic class 4. starts around 30 and increases with age 5. correlated with HPV 6. possibly with HSV 2 |
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the majority of carcinomas of the caervix are of ---- histological appearnce. the rest are ---- |
squamous cell carcinomas adenocarcinomas |
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most carcinomas of the cerix arise from the ---- zone |
transitional |
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what are the 4 stages of carcinoma of the cervix |
CIN1 (cervical intraepithelial neoplasia) = mild dysplasia CIN2 CIN3 = poor;y dfferentiated invasive cancer stages 1-4 (breach in basement membrane) |
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where does carcinoma of the cervix spread directly |
uterus vagial walls bladder broad lig rectum |
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where does carcinoa of the cerix spread lymphatically |
internal iliac nodes obturator nodes |
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is haematogenous spread common in carcinoma of the cervix where will it spread |
no bone, brain and lung |
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what are teh clinical features of carcinoma of the cervix? |
1. earyl = symptomless 2. post coital bleeding 3. vaginal spotting/beleeding after urination 4. foul vaginal discharge 5. leakage of urien of faeces from vagina 6. weight loss and anorexia 7. signs of mets 8. palpiatation of cervix = hard, fribale, fixed position that bleeds easily |
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what are the complications and causes of death in carcinoma fo the cervix (4) |
1. obstructed cervical canal --> pyometra 2. direct spread --> fistulae 3. ureteric obstruction --> hydonephosis, pyonnephrosis and renal failre 4. uraemia causes 50% of deaths. - other causes are cachexia, haemorrhage, intestinal obstrucition, peritonitis and mets |
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define endometrial carcinoma |
malignancy of the endometrium. MOST COMMON GYNAGOLOIGICAL MALIGNANCY IN AUS MOST COMMON POST MENOPAUSE |
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any ccondition that increases estrogen levels ill increase the risk of endometral carcinoma. name six. |
1. obesity 2. polycystic ovarian syndrome 3. late menopause 4. estrogen replacement therapy 5. anovulation 6. oligo-ovulation |
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family history increases the risk of endometrial carcinoma? high intake of fat inreases the risk of endometrial carcinoma? obesity, HT, DM also increase the risk of endometrial carcinoma? |
T T T |
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endometrial carcinoma is ofen preceeded by |
hyperplasia |
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most endometrial carcinomas have an ----- histological appearance |
adenocaarcinoma |
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what are the clinical features of endometrial carcinoma |
1. irregular bleeding (esp post menopause) - 1/3 of post menopausal menstual bleeds due to endometrial carcinoma 2. mucoid watery discharge precedes bleed ing by several weeks 3. not severe hypogastiric pain at about the same time each day |
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define endometrosis |
presence of functional endometrial tissue in abnormal location |
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in endometriosis there is a ---- tendency |
famialial
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the cause of endometriosis is due to either viable endometrial cells being transported by 1. 2. |
1. lymphatics
2. retrograde mestrual folow |
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possible sites for implantation include (7) |
1. ovaries
2. ducts 3. ligamanets 4. colon 5. cervix 6. bladder 7. umbilicus |
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the endometrial cells of endometriosis respond to ---- stimulation thus bleed when ---- fall. this results in the foramtion of ---- cysts. ---- tissue can cause --- to surrounding tissue |
hormonal
estrogen levels chocolate fibrous adhesions |
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the most common age group for endometrisos is and is more common in --- socioeconomic groups due to ? |
30-45
higher later marriage na d pregnancy |
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what are the clinical features of endometriosis |
1. H of infertility and may cause infertility 2. Dysnmonorrhoea - gradual worsening - increases in severeity 2-3 days before menstrualtion - most severe on day 1 and 2 of menstruation 3. abnormal menstuation 4. dyspareunia 5. associated symptoms - malaise - intestinal/ureteric obstruction - frequency - haematuria or acute ab pain when cysts burst spectrum (asymptomatic --> crippling) |
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define adenomyosis |
common and benign endometrium infiltrates in to myometrium |
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what are the clincal features of adenomyosis (2) |
1. menorrhagia 2. intermentrural bleeding |
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define uterine fibroma/fribromyoma/fibroids |
tumours composed of fibrous CT and muscle |
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are they the most common tumour the the reproductive system |
yup |
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pathology of utereine fibromas/fibromyoma/fibroids i) number? ii) size iii) shape and feel iV) sites commonly found - - - |
i) single or multiple ii) up to 30 cm! iii) hard and spherical iv) - subserous (under parametrium) - intramural (within uterine wall) - submucous (under endometrium) |
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what are the clnical eatures of uterine fibromas/fibromyomas/fibroids |
1. increased menstrual flow 2. colicky uterine pain 3. obstructive signs (esp subserous) - distended ab - aching pain - frequency - varicose veins 4. dull draggin ache during menses 5. anaemia |
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what is the pathogenseis of intreased mentrsual flow in fibroids |
submucous and intramural fibroids cause an increase in endometrial surface area |
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what is the pathogenesis of colicky uterine pain in fibroids |
uterus attempts to dispel tumour |
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what is the pathogenesis of urinary frequency in fibroids |
fibroids --> increased pressure on bladder --> frequency |
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what is the pathogeneis of varicose veins in fibroids |
fibrids --> obstruction o pelvic veins --> distension --> varicose veins |
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what are disorders of growth and differentiation of the ovary (2) |
1. benign tumours/cysts of the ovary 2. ovarian malignancy |
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define benign tumours/cysts of the ovary |
singele or multiple cystic masse within or attached to one or both ovaries |
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what are the 5 ways to classify benign tumour/ cyst of the ovary |
1. functional cystss 2. serous cysts 3. pesudomucinous cystadenoma 4. teratoma (dermoid cyst) 5. endometrial cyst (chocolate cysts) |
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which are the most relevant? |
teratomas (dermoid cysts) endometrial cysts (chocolate cysts) |
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what are the functional cysts they are a result of ?? |
1. follicular cysts - 5 to 6 cm - from distension of graafian follicle (lack of resorption or faiure of ovum to release) - normal women, self limitng - asymtpomatic or menstrual irregularites from estrogen 2. corpus luteum cysts - corpus luteum that doesnt degenerate hormal change |
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serous carcinomas contain a --- and --- sectrion are --- cm in diaemter pitental for malignancy? |
thin and watery 10 YES |
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pseudomucinous cystadenomas common? contain a ---- substance are --- in diameter chance of bein g bilateral ??? |
VERY mucinous (clear, brown or green if there are blood pigments) 50! 10% |
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teratoma (dermoud cyst) is benign??? peak age ?? constains --- cause ovarian enlargement hich is really ---- |
YES 20-30 YO many kinds of tissues endometriosis |
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endometrial cysts (chocolate cysts) are part of ? |
endometriosis |
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what are the clincal featutes of neign tumours/cysts of the oovaries |
1. asymtpomatic 2. menstrual irregularities |
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the 5 complications of benign tumours/cysts of the ovary: |
1. torsion of the pedical - gangren if untrated - symtoms 4-5 days before patient presents - iliac fossa pain, vomting and nausea - signs of pelvic mass and local tenderness and peritonism 2. haemorrhage - into or from cysts --> pain and tenderness 3. rupture - small follicular cysts at ovulation = mittlechmertz - large ovarian cysts = ab pain and vomiting 4. infection (may follow torsion) 5. malignant change into cystadenomas |
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define ovarian malignancy |
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inreased risks for ovarinan malignancy 1. type of diet? 2. parity?? 3. familial hisoty of 4. genetics? 5. estrogen therapy 6. fertility status |
1. high fat 2. nulliparity or late child bearing 3. uterine, breat or colon 4. BRCA 1 and XY gonadal dysgenesis 5. without progesterone 6. infertility |
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the histological appeaance of ovarian malignancy is one of |
arising from epithelium (cystadenocarcnioma) |
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spread of ovarian malignancy direct? intraperitoneal implantation (seeding)? lymphatic? haemtogenous? |
YES YES YES less comon (liver and lung) |
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what are the symtpoms of ovarian malignancy |
- develop late 1. vague ab discomfort with dyspepsia 2. bloating 3. back pain 4. anorexia 5. dull aching pelvis pain, frequency and ankle swelling 6. post menopausal bleeding or irrgular bleeding |
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what are the sings of ovarian malignancy |
1. ovarian enlargement (soid, may be bilateral and multinodular) 2. rapid growth of ovary 3. rapab swelling 4. ascites |
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vulval malignancy, vaginal malgnacy and tubal malignacy all occur? |
post menopuuse 50 years + |
