1. What is this? What is the male counterpart called? Is it radiosensitive? In what age bracket are these usually found? What are histological characteristics of this tumor?

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    • Dysgerminoma of the ovary (a germ cell tumor)
    • Male counterpart: Testicular seminoma (the two have identical histologies)
    • Age bracket: 2nd-3rd decades of life
    • Histo char: malignant cells with "fried egg" appearance (clear cytoplasm with enlarged nuclei and prominent nucleoli) and infiltration by mature lymphocytes (T cells)
  2. What is fibrocystic change in the breast? Why is it important for physicians to recognize it? Is the process usually unilateral or bilateral? What changes are associated with it histologically?
    • Fibrocystic change: a lumpy bumpy breast on palpation (clinician), a desne breast with cysts (radiologist), and benign histological findings (pathologist); three main morphological changes are cystic change, fibrosis, and adenosis
    • Important because: it can simulate or obscure clinical, radiographic, gross, and microscopic appearances of breast carcinoma
    • Most commonly seen in women between ages 25-50
    • Although hormones play a role in its development, the pathogenesis is unclear
    • Process is usually bilateral
    • Histological changes: cyst formation (from small and large ducts), apocrine metaplasia in some cysts, stromal fibrosis, epithelial hyperplasia in many of the ducts, and microcalcifications (what often prompts biopsy)
    • Note that microcalcifications can be seen in breast carcinomaa
  3. What is this? What can you see in the low power? What can you see in the high power?
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    • Fibrocystic change in breast
    • Low power: cysts and dense fibrous tissue (dense pink strips)
    • High power: columnar cells with dark pink cytoplasm and bulbous extensions (called apical snouts) lining the cysts; this is apocrine metaplasia and has no real significance
  4. From what two sources are breast neoplasms derived?
    • 1. Stromal elements (fibroadenomas)
    • 2. Epithelial elements of terminal duct lobular unit (TDLU)
  5. What is this? Is it benign or malignant? How is it usually dx?
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    • Breast fibroadenoma: Focal proliferation of glandular and stromal elements that results in a circumscribed, firm nodule of tissue within the breast
    • Benign: the most common benign tumor of the breast, seen in 10% of women usually ages 20-30
    • Dx: via breast exam because of their firm, mobile circumscribed nature
    • Note that the tumor is sharply circumscribed from surrounding tissue and is composed of an overgrowth of spindle shaped cells and collagen of the stroma; the enclosed ducts and alveoli appear stretched becauase of this overgrowth
  6. How are epithelial neoplasms of the breast categorized?
    • In two ways: either in-situ or invasive tumors
    • In-situ ductal tumors: confined to one ductal system and thought to be a clonal population of malignant cells that lack the ability to invade the basement membrane surrounding the epithelium of the ducts/lobules (rarely metastasize but can become an invasive tumor)
    • Invasive tumors: have breached the basement membrane and can metastasize via the lymphatic or vascular channels
  7. What is this? What is desmoplasia? How are these tumors graded?
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    • Invasive ductal carcinoma of the breast: tumor is composed of irregular clusters of cells that are infiltrating the stroma
    • Desmoplasia: When the tumor induces the surrounding stroma to become very dense and firm
    • Close up of the tumor shows malignant cells with large, irregularĀ  nuclei, prominent nucleoli, and scant cytoplasm; there is no evidence of a basal membrane
    • Tumor grading based on three features: 1) tubule formation 2) mitotic activity 3) nuclear pleomorphism
  8. What is this? What can you see here?
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    • Lymph node with metastatic breast carcinoma
    • Notable: dark blue, small lymphocytes forming a sheet in part of the tissue and the metastatic carcinoma in the LN (solid pink clusters)
  9. What are the main sources of testicular tumors? How does this differ from ovarian tumors?
    • Primarily from: germ cells
    • May also be from: sex cord stormal type (rare)
    • Not from: epithelium
    • Ovarian tumors: mostly epithelial in origin (rarely germ cell or stromal origin)
  10. What are germ cell tumors? In what age group are they most common? How are they divided? How do they arise? What is a pure vs mixed tumor? Do these tumors needed to be tx? How do testicular tumors present? What type of testis is at particular risk for developing a tumor?
    • Germ cell tumor: most common malignant tumor of young men between 15-34
    • Divided into two groups based on incidence and response to therapy: Seminoma and Non-seminomatous Germ Cell Tumors (NSGCT)
    • Arise from: germinal epithelium (spermatogonia) but differentiate along embryonic cell lines
    • Pure tumors: of one particular cell type
    • Mixed tumors: of more than one cell type; more frequence than pure
    • Tx?: Yes, because these tumors are aggressive, lymphadenectomy, radiation, and chemotherapy are required
    • Presentation: painless mass that may grow slowly or astonishingly rapid
    • Risk: cryptochid testis
  11. What is a Seminoma? Are they radiosensitive? What is the female counterpart?
    • Seminoma: account for 30-40% of testicular tumors and are a tumor of undifferentiated germ cells
    • Are exquisitely radiosensitive and respond to radation therapy
    • Female counterpart: dysgerminoma (fried egg cell appearance and lymphocyte infiltration)
  12. What are non-seminomatous Germ Cell Tumors (NSGCT)? What are examples of them?
    • NSGCT: germ cell tumors involving some differentitaion of an embryo and/or its associated structures
    • Examples: Choriocarcinoma, embryonal carcinoma, mature and immature teratomas, yolk sac tumors or endodermal sinus tumor
  13. What is a choriocarcinoma?
    • A non-seminomatous germ cell tumor that contains syncytiotrophoblast and cytotrophoblast
    • It resembles the placenta
  14. What is an embryonal carcinoma?
    A non-seminomatous germ cell tumor that resembles primitive cells of the embryo with little or no differentiation
  15. What is a teratoma?
    A non-seminomatous germ cell tumor that has multiple tissue types (endodermal, mesodermal, and ectodermal)
  16. What is a yolk sac or endodermal sinus tumor?
    A non-seminomatous germ cell tumor that contains extraembryonal ectoderm and mesoderm and so resembles the yolk sac
  17. What is this? What features here are important? What are they indicating? What is composing the tumor?
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    • Seminoma of the testis
    • Features that are important: small, atrophic seminiferous tubules with few or no spermatogonia and thickened fibrous tissue surroudnign the tubules, all typical of a cryptorchid testis
    • Tumor composition: nests of cells separated by fibrovascular septa
    • Note the fried egg appearance of tumor cells and infiltration of small mature lymphocytes
  18. What is this?
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    • Mixed germ cell tumor of testis with yolk sac, embryonal, and teratoma elements
    • Notice the well differentiated, glandular structures that look like normal GI, respiratory, and squamous epithelium, just in the wrong place
    • Also notice the enlarged anaplastic and hyperchromatic nuclei with prominent nucleoli
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