1. What is this?

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    Normal breast tissue
  2. What is this?

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    Normal breast nodule
  3. 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 adenosisImportant 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
  4. 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
  5. From what two sources are breast neoplasms derived?
    1. Stromal elements (fibroadenomas)2. Epithelial elements of terminal duct lobular unit (TDLU)
  6. What are all of these?

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    Examples of fibrocystic change in breast
  7. 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
  8. What is this?

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    Breast fibroadenoma (benign)
  9. What is this?
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    Breast fibroadenoma (benign)
  10. What is this?
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    Breast fibroadenoma (benign)
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    Breast fibroadenoma (benign)
  12. 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
  13. 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)
  14. What is this?
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    Metastatic breast cancer in lymphatic space
  15. What is this?
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    Invasive ductal carcinoma of the breast (malignant)
  16. What is this?
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    Invasive ductal carcinoma of the breast (malignant)
  17. What is this?
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    Invasive ductal carcinoma of the breast (malignant)
  18. What is this?

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    Metastatic breast carcinoma in lymph node
  19. 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
  20. 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 cellsAre exquisitely radiosensitive and respond to radation therapyFemale counterpart: dysgerminoma (fried egg cell appearance and lymphocyte infiltration)
  21. 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
  22. What is this?

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  23. What is this? With what is it associated? Are they limited to the penis? What do we see microscopically? What evidence do we see of the pathogen's influence?

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    • Condyloma acuminatum of the penis: a benign epithelial tumor
    • Associated with: HPV types 6 and 11 infection
    • Can be found anywhere on external genitalia and perineal areas in both men and women
    • Considered low risk with low probability of progression to high grade dysplasia or carcinoma
    • Microscopically: branching of papillary architecture with marked epithelial hyperplasia and hyperkeratosis
    • Evidence of viral cytopathic effect: koilocytosis (clear vacuolization or halos in the cytoplasm of squamous cells)
  24. With what disease is this associated?

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    condyloma acuminatum (from HPV infection)
  25. What is this?

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    Condyloma acuminatum
  26. What is this?
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    Condyloma acumenatum
  27. What is this?
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    Condyloma acumentum
  28. What is it?

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    Condyloma acumenatum
  29. What is this? Where is it typically found? What can you see in the image?
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    • Squamous cell carcinoma in-situ of the penis: aka Bowen's disease
    • Typically found: on the penis shaft and scrotum
    • Note: features of disordered maturation of squamous epithelium with nuclear crowding, enlarged nuclei, hyperchromasia, and mitotic figures that extends from base to surface of epithelium
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