Danil hammoudi.md

Sinoe medical association

Usmle step 1 and 2

pathology

 

Pathology open question

 

 

1/ what are the most common sites of heterotopic [ectopic ] pancreas?

 

2/what is the inheritance pattern of familial pancreatitis

 

3/ what is a cystic ductal complex in the pancreas?

 

4/what is the association of non papillary ductal hyperplasia and papillary ductal hyperplasia with pancreatic carcinoma?

 

5/which hormone , produced in the duodenum , is responsible for stimulation of water and bicarbonate secretion by the duct cells of the pancreas?

 

6/What is the most common clinical associations of acute pancreatitis?

 

7/What is the most common congenital disorder of the pancreas?

 

8/tuner’s and cullen’s signs?

 

9/ clinical sign of acute pancreatitis?

 

10/systemic signs of acute pancreatitis?

 

11/Which enzyme amylase or lipase is the first to rise in acute pancreatitis

 

12/ The four major types of cells IN THE PANCREAS AND THERE PRODUCTIONare:

 

 

 

01/CONDITION OF ENDOMETRIAL THICKENING?

 

02/Ascherman's Syndrome?

 

03/GARTNER'S DUCT CYST?

 

 

04/ENDOMETRIAL CARCINOMA AND RISK FACTOR?

 

05/

 

1.The leading cause of death among American women ages 40-45 is?
a. Heart disease.
b. Breast cancer.
c. Car accidents.

2.The best way to detect possible breast cancer in its early stages?
a. An annual pap smear.
b. An annual mammogram.
c. A monthly self breast exam.

3.What time of the month should you perform a monthly breast exam?
a. Right before your period.
b. Right after your period.
c. During your period.

4.At what age should a women have her first mammogram?
a. 30
b. 35
c. 40
d. Over 40

5.How often should a woman get a mammogram?
a. Once a year
b. Twice a year
c. Every other year
d. Every three years

6.What should you do if you detect anything unusual during your monthly exam?
a. Notify your primary care physician immediately.
b. Go to the nearest emergency room.
c. Ignore it and it will go away.

What are the causes and risks of the breast cancer?

Invasive Carcinomas of the Breast?

Non-invasive Carcinomas of the Breast?

Immunoperoxidase Techniques?

The location of breast cancers?

The stage of a breast cancer is based upon its size and degree of spread. The staging system goes from stage I to stage IV as follows:?

 

general guidelines as to the potential biologic behavior of a breast carcinoma. In general, a better prognosis will accompany cancers:?

 

Figure 1

Figure 2

 

 

 

Figure 3

 

Dysfunctional uterine bleeding has several causes?

 

Male pathology

1. The most common congenital abnormality affecting the testis is:

A. anorchia

B. polyorchidism

C. microorchidism

D. monorchia

E. cryptorchidism

2. Early carcinoma of the prostate is usually located in the:

A. median lobe

B. peripheral portions

C. anterior lobe

D. median bar

E. periurethral portion of the prostate

3. Precocious puberty in a 8-year old boy is most likely caused by:

A. seminoma

B. yolk sac carcinoma

C. Leydig cell tumor

D. pheochromocytoma

E. craniopharyngioma

4. Bone metastases with elevated acid and alkaline phosphatate in serum

A. carcinoma of the prostate

B. urinary bladder cancer

C. renal cell carcinoma

D. embryonal carcinoma

E. Wilm's tumor

5. Has the highest incidence in the 25-40 year age

A. carcinoma of the prostate

B. urinary bladder cancer

C. renal cell carcinoma

D. embryonal carcinoma

E. Wilm's tumor

6. Increased frequency among workers in aniline dye industry

A. carcinoma of the prostate

B. urinary bladder cancer

C. renal cell carcinoma

D. embryonal carcinoma

E. Wilm's tumor

7. Which of the following conditions or diseases predisposes the LEAST to urinary tract infection?

A. pregnancy

B. diabetes mellitus

C. prostatic hyperplasia

D. diabetes insipidus

E. cystoscopy

8. Benign prostatic hyperplasia may cause all EXCEPT:

A. trabeculation of bladder wall

B. hyperplasia of bladder wall cells

C. hypertrophy of smooth muscle cells in the bladder

D. increased incidence of cystitis

E. increased incidence of prostatic cancer

9. Which of the following malignant neoplasms most frequently metastasizes to inguinal lymph nodes?

A. carcinoma of the prostate

B. carcinoma of the vulva

C. carcinoma of the ovary

D. carcinoma of the colon

E. seminoma of the testis

10. Early carcinoma of the prostate is usually located in the:

A. median lobe

B. external part of the prostate

C. anterior lobe

D. median bar

E. periurethral portion of the prostate

11. Leydig cell tumors of the testis may present with:

A. prostatism

B. gynecomastia

C. ascites

D. early metastases

E. positive pregnancy test

12. Each of the following are true regarding seminoma EXCEPT

A. produces androgens

B. is the most frequent tumor in undescended testes

C. is typically found in 30-40 year old men

D. is radiosensitive

E. has a good prognosis

13. Isolated metastases to the lumbar periaortic lymph nodes are most characteristic of:

A. Carcinoma of the vulva

B. Carcinoma of the penis

C. Pheochromocytoma

D. Endometrioid carcinoma of the ovary

E. Seminoma

14. A 60-yearold woman was referred to a urologist because of hematuria. Cystoscopy revealed a mass in the dome of bladder. A biopsy showed tumor cells with enlarged eccentric nuclei, prominent nucleoli, abnormal mitoses and cytoplasmic vacuoles. Special stains demonstrated the presence of mucin in the cytoplasm of tumor cells. The diagnosis is:

A. Carcinoma in situ

B. Adenocarcinoma

C. Transitional cell carcinoma grade 3

D. Squamous cell carcinoma

E. Inverted papilloma

15. A 72-year-old man presents with painless hematuria. Cystoscopy shows a 2 cm papillary tumor in the posterior wall. A biopsy shows finger-like papillary structures covered by benign-appearing urothelial cells. The diagnosis is:

A. Villous adenoma

B. Inverted papilloma

C. Papillary adenocarcinoma

D. Papillary transitional cell carcinoma, grade 1

E. Papillary transitional cell carcinoma, grade 3

16. A 52-year old woman with a long history of intermittent urinary symptoms underwent a cystoscopy. A biopsy of the yellow mucosal plaques revealed the presence of chronic inflammatory cells with numerous histiocytes, some of which contained small intracytoplasmic spherical structures. The most likely diagnosis is:

A. Cystitis cystica

B. Polypoid cystitis

C. Malacoplakia

D. Eosinophilic cystitis

E. Transitional cell carcinoma

17. The most common presenting symptom of transitional cell carcinoma of the bladder is:

A. Frequency

B. Urgency

C. Fever

D. Dysuria

E. Hematuria

18. Each of the following has been linked to bladder cancer EXCEPT

A. Radiation

B. Extrophy of the bladder

C. Schistosomiasis

D. Industrial carcinogens

E. Tobacco smoking

19. Which of the following bladder tumors occurs most commonly in 60-80 year old American males?

A. Transitional cell carcinoma

B. Adenocarcinoma

C. Squamous cell carcinoma

D. Wilms' tumor

E. Rhabdomyosarcoma

20. Which of the following bladder tumors can be treated by local cystoscopic resection?

A. Flat transitional cell carcinoma in situ

B. Papillary transitional cell carcinoma, grade 1

C. Papillary transitional cell carcinoma, grade 3

D. Squamous cell carcinoma

E. Adenocarcinoma

21. The most common site of metastasis from bladder carcinoma is

A. Kidney

B. Liver

C. Lymph nodes

D. Lung

E. Bone

22. The most common cause of death in patients with bladder carcinoma is:

A. Metastasis to the brain

B. Massive hemorrhage

C. Pulmonary embolus

D. Uremia

E. Pulmonary insufficiency secondary to metastases

23. The type of bladder cancer most commonly seen in countries with endemic schistosomiasis is:

A. Papillary transitional cell carcinoma

B. Carcinoma in situ

C. Squamous cell carcinoma

D. Adenocarcinoma

E. Leiomyosarcoma

24. The type of bladder cancer most commonly seen in workers of the dye, rubber and organic chemical industries is:

A. Transitional cell carcinoma

B. Squamous cell carcinoma

C. Adenocarcinoma

D. Small cell carcinoma

E. Leiomyosarcoma

25. A 66-year old man develops a sudden episode of painless hematuria. No other symptoms are present. All blood tests and urinalysis are normal EXCEPT for the presence of blood in the urine. Which of the following is the most likely cause?

A. Glomerulonephritis

B. Cystitis cystica

C. Urinary stone

D. Malacoplakia

E. Bladder cancer

26. A 67-year old man who had an indwelling catheter in his bladder during and after prostate surgery three months previously, continued to have urinary symptoms after the removal of the catheter. At cystoscopy exophytic mucosal projections were found. Biopsy of the lesions revealed broad-based papillary structures with fibrous stalks which were infiltrated by inflammatory cells and covered by normal appearing urothelium. The most likely diagnosis:

A. Cystitis glandularis

B. Polypoid cystitis

C. In situ transitional cell carcinoma

D. Inverted papilloma

E. Papillary transitional cell carcinoma, grade 3

27. Penile squamous cell carcinoma is characterized by each of the following, EXCEPT:

A. Chemical carcinogens are the most frequently implicated etiologic agent.

B. Frequency of occurrence shows significant geographic variation.

C. Most patients with enlarged inguinal lymph nodes do not have metastases in the nodes.

D. Most commonly arises on the glans penis.

E. Most patients present in their 6-7 decades.

28. A patient with prostatic carcinoma with bone metastases has typically each of the following, EXCEPT:

A. Osteosclerotic vertebral x-ray lesions

B. Elevated serum alkaline phosphatase

C. Elevated serum acid phosphatase

D. Hard and enlarged prostate

E. Prolactinemia

29. The frequency of prostatic carcinoma is accurately described in all the following statements, EXCEPT:

A. American males exceed Japanese males

B. American white males exceed American black males

C. Peripheral subcapsular prostate exceeds the peri-urethral prostatic tissue

D. 80 year old males exceed 60 year old males

E. The incidence of prostate carcinoma in U.S. males exceeds lung carcinoma in U.S. males

30. The spread of prostatic carcinoma is characterized by all of the following, EXCEPT

A. Perineural invasion through the prostatic capsule

B. Direct invasion of the seminal vesicles

C. Lymphatic spread to nodes in the pelvis

D. Common spread to the brain

E. Hematogenous spread to bone

31. Which of the following is typical of Klinefelter syndrome?

A. Anorchia

B. Cryptorchidism

C. Polyorchidism

D. Testicular atrophy

E. Hyperandrogenism

32. Each of the following are characteristic of cryptorchidism EXCEPT:

A. It is most frequently unilateral.

B. Infertility is associated only with untreated bilateral cryptorchidism.

C. Most cases of cryptorchidism are isolated congenital anomalies.

D. Surgically-uncorrected cryptorchidism is associated with an increased risk of germ cell neoplasms.

E. Histologic changes present in cryptorchid testes include abnormal and decreased intralobular germ cells, and decreased mean diameter of seminiferous tubules.

33. Most testicular tumors that secrete chorionic gonadotropin are classified as:

A. Leydig cell tumors

B. Sertoli cell tumors

C. Nonseminomatous germ cell tumors

D. Seminomas

E. Yolk sac carcinoma

34. Condyloma acuminatum of the penis is typically caused by:

A. Herpesvirus

B. Treponema pallidum

C. Leptospira

D. Human papilloma virus

E. Borellia recurrentis

35. The stroma of which tumor is characteristically infiltrated with lymphocytes:

A. Seminoma

B. Teratoma

C. Embryonal carcinoma

D. Mixed germ cell tumor

E. Leydig cell tumor

 

Figure 4

 

1/ stomach, duodenum, jejunum

 

2/autosomal dominant inheritance

acute pancreatitis beginning at a young age

chronic pancreatitis

high risk of pancreatic carcinoma

 

3/group of simple cysts that are lined by a single layer of variable epithelium  with underlying fibrous wall

the lumen may or may not contain secretions

4/none

 

5/ secretin

 

6/alcoholism and cholelithiasis

 

7/ pancreas divisum

 

8/ signs of acute hemorrhagic pancreatitis

discoloration around the umbilicus = cullen’s sign

in the loin = turner’s sign

 

9/ mid epigastric pain radiating to the back, nausea, vomiting, fever

 

10/leukocytosis

hemolysis

dic

ards

shock

 

11/ first day amylase

72 hours lipase

 

12/ The four major types of cells are:

1.)     Beta (70%) producing Insulin,

2.)     2.) Alpha (20%) producing Glucagon,

3.)     3.) Delta (5-10%) producing Somatostatin

4.)      4.) PP (1-2%) producing Pancreatic Peptide.

 

 

 

ENDOMETRIAL THICKENING:

Resulting from- early IUP, pregnancy related complications, endometrial hyperplasia, secretory endometrium, polyps, endometrial cancer

Postmenopausal females with vaginal bleeding- endometrial hyperplasia or endometrial carcinoma

GARTNER'S DUCT CYST:

caudal remnants of mesonephric duct' (Berman 99), common cystic lesion, incidental finding

ENDOMETRIAL CARCINOMA:

• obesity
• young patients with chronic anovulation
• HRT
• early menarche
• late menopause

 

breast

1.       B. Breast cancer kills over 40,000 American women each year.

2.       C. You know your body better than anyone else and can find any irregularities. Examine yourself every month.

3.       B. Do a self-exam after your period each month.

4.       C. The American Cancer Society suggests beginning annual 
mammograms at age 40.

5.       A. The American Cancer Society suggests annual mammograms.

6.       A. Make an appointment with your primary care physician and let him/her 
know what you have found

What are the causes and risks of thebreast cancer?

	started their periods early,
	delayed childbearing to later in life,
	never had children,
	have been treated for other cancers using radiation to the chest
	have close blood relatives, like a mother or sister, who develop breast cancer before menopause.

There may be other risk factors for developing breast cancer, but they are controversial. They include:

	drinking a moderate amount of alcohol
	eating a high-fat diet
	obesity
	using hormones such as estrogen and progesterone

Risk Factors for Breast Cancer

Although a specific cause for breast cancer has not been identified, there are risk factors that increase the likelihood that a woman will develop a breast cancer. These risks include:

·         Maternal relative with breast cancer. Women whose mother or sister or aunt had breast cancer, particularly at a younger age, have a greater risk.

·         BRCA1 and BRCA2 genes. The incidence of the BRCA1 gene on chromosome 17 may be 1 in 800 women. The BRCA2 gene on chromosome 13 is less frequent but associated with early onset breast carcinomas. The presence of these genes may explain some of the familial cases, and may be the etiology for about 1% of breast cancers overall.

·         Longer reproductive span. Women who have an earlier menarche and/or a later menopause, increasing the length of reproductive years, are at greater risk.

·         Obesity. Women who are overweight are at increased risk. In addition, increased dietary fat intake is a risk.

·         Nulliparity. Women who have never borne children are at greater risk, while women who have been pregnant are at a lower risk.

·         Later age at first pregnancy. Women who had their first child over age 30 are at greater risk.

·         Atypical epithelial hyperplasia. Although fibrocystic changes that produce benign breast "lumps" are not premalignant, the presence of atypical changes in ductular epithelium does increase the risk.

·         Previous breast cancer. Women who have had breast cancer in the opposite breast are at increased risk for cancer in the remaining breast.

·         Previous endometrial carcinoma. Women who have had adenocarcinoma of the endometrium are at increased risk for breast cancer.

Aside from the genetic predisposition, the common factor in many of these risks is increased endogenous estrogen exposure over a long time.

Invasive Carcinomas of the Breast

 

Non-invasive Carcinomas of the Breast

 

Immunoperoxidase Techniques

1.       Estrogen receptor positivity

2.       Progesterone receptor positivity

3.       Cathepsin D positivity

4.       HER2 (C-erb B2) positivity

The location of breast cancers

·         Upper outer quadrant: 50%

·         Central area: 20%

·         Lower outer quadrant: 10%

·         Upper inner quadrant: 10%

·         Lower inner quadrant: 10%

The stage of a breast cancer is based upon its size and degree of spread. The staging system goes from stage I to stage IV as follows:

Stage	Definition	5-year Survival (%)	7-year Survival (%)
I	Tumor 2 cm or less in greatest diameter and without evidence of regional (nodal) or distant spread	96	92
II	Tumor more than 2 cm but not more than 5 cm in greatest dimension, with regional lymph node involvement but without distant metastases, OR > a tumor of more than 5 cm in diameter without regional (nodal) and distant spread	81	71
III	Tumors of any size with possible skin involvement, pectoral and chest wall fixation, and axillary or internal mammary nodal involvement, fixed, but without distant metastases	52	39
IV	Tumor of any size with or without regional spread but with evidence of distant metastases	18	11

 

general guidelines as to the potential biologic behavior of a breast carcinoma. In general, a better prognosis will accompany cancers:?

·         Less than 2 cm in size

·         Without axillary lymph node involvement

·         That are non-invasive ductal carcinoma and LCIS

·         With ER and PR positivity

·         Which lack of aneuploidy

This irregular tan mass in the breast is a carcinoma. The gross appearance seen here is a cut section from a mastectomy specimen. Microscopically this neoplasm proved to be an infiltrating ductal carcinoma. In the microscopic view seen here from the dermis overlying the breast, there is perineural invasion. The risk for breast cancer lifetime for women living in the U.S. is at least 1 in 10. Breast self-examination, physical examination by health care workers, and mammography can aid in identifying these tumors, hopefully before they have reached the size seen here, when metastases are much more likely to have occurred.

 

 

Figure 5 Note the small nests and infiltrating strands of neoplastic cells with prominent bands of collagen between them in this ductal carcinoma of the breast. It is this marked increase in the dense fibrous tissue stroma that produces the characteristic hard "scirrhous" appearance of the typical infiltrating ductal carcinoma. Note the nerve surrounded by the neoplasm at the lower left.

 

 

Figure 6 breast carcinoma

 

 

Male pathology

1) The correct answer is: E
Explanation: Cryptorchidism is the most common congenital disorder of the testis.

2) The correct answer is: B
Explanation: Carcinoma of the prostate usually originates in the peripheral areas of the prostate.

3) The correct answer is: C
Explanation: Leydig cell tumors may secrete male sex hormones and cause precocious puberty.

4) The correct answer is: A
Explanation: Prostatic carcinoma secretes acid phosphatase. If it metastasizes to bone and induces osteoblastic change it also causes elevation of alkaline phosphatase.

5) The correct answer is: D
Explanation: Peak incidence of embryonal carcinoma is at 30 years.

6) The correct answer is: B
Explanation: Aniline dye industry workers have higher than average incidence of urinary bladder cancer.

7) The correct answer is: D
Explanation: Diabetes insipidus does not predispose to urinary track infection.

8) The correct answer is: E
Explanation: Benign prostatic hyperplasia (BPH) does not cause increased incidence of prostatic cancer.

9) The correct answer is: E
Explanation: Sorry, explanation is not available at this time

10) The correct answer is: B
Explanation: Sorry, explanation is not available at this time

11) The correct answer is: B
Explanation: Leydig cell tumors may secret sex hormones that cause gynecomastia.

12) The correct answer is: A
Explanation: Seminomas do not secrete androgens.

13) The correct answer is: E
Explanation: Isolated periaortic abdominal lymph node metastases are typical of seminoma and all other malignant tumors of the testis.

14) The correct answer is: B
Explanation: Malignant neoplasm of the bladder (as evidenced by nuclear atypia, prominent nucleoli and abnormal mitoses) which produces mucin is an adenocarcinoma.

15) The correct answer is: D
Explanation: Papillary transitional cell carcinoma, grade 1 is characterized by papillary projections with vascular connective tissue cores which are covered by benign-appearing urothelial cells without cytologic atypia.

16) The correct answer is: C
Explanation: Malacoplakia is chronic inflamatory coondition of the bladder characterized by the presence of numerous histiocytes, some of which contain small intracytoplasmic inclusions called Michaelis-Gutmann bodies.

17) The correct answer is: E
Explanation: Hematuria is the most common presenting symptom of transitional cell carcinoma of the bladder.

18) The correct answer is: A
Explanation: Carcinoma of the bladder has been linked to tobacco smoking, certain industrial carcinogens, Schistosoma hematobium infection and bladder exotrophy. There is no evidence that radiation causes bladder cancer.

19) The correct answer is: A
Explanation: Transitional cell carcinoma is the most common mallignant tumor in any age group.

20) The correct answer is: B
Explanation: Grade 1 papillary transitional cell carcinoma of the bladder is a low grade malignant tumor, usually non-invasive, which can be treated by local cystoscopic resection.

21) The correct answer is: C
Explanation: Regional lymph nodes are the most common sites of metastasis from bladder carcinoma.

22) The correct answer is: D
Explanation: Uremia is the most common cause of death in patients with bladder carcinoma.

23) The correct answer is: C
Explanation: Squamous cell carcinoma is the most common type of bladder cancer seen in countries with endemic schistosomiasis.

24) The correct answer is: A
Explanation: Workers of the dye, rubber and organic chemical industries who are exposed to chemical carcinogens are at a high risk for development of transitional cell carcinoma of the bladder.

25) The correct answer is: E
Explanation: The most common symptom of bladder cancer is painless hematuria.

26) The correct answer is: B
Explanation: Polpoid cysts is an inflamatory lesion characterized by broad based papillary mucosal projections which contain inflammatory cells within the lamina propria. Most cases are associated with indwelling catheters.

27) The correct answer is: A
Explanation: Smegma and viral causation are the most probable etiologic agents.

28) The correct answer is: E
Explanation: Prolactin secretion has no relationship with prostate cancer.

29) The correct answer is: B
Explanation: The frequency of prostatic carcinoma in black American males exceeds that in American white males.

30) The correct answer is: D
Explanation: Prostatic carcinoma typically metastisizes to lung via lymphatics, thence via blood stream to bone, etc. The brain is an infrequent site of metastasis.

31) The correct answer is: D
Explanation: Testicular atrophy is characteristic of Klinefelter syndrome.

32) The correct answer is: B
Explanation: Unilateral cryptorchidism is associated with infertility, abeit at lower frequency than in bilateral cases.

33) The correct answer is: C
Explanation: Testicular tumors that secrete chorionic gonadotropin are classified as nonseminomatous germ cell tumors.

34) The correct answer is: D
Explanation: Condyloma acuminatum of the penis is typically caused by human papilloma virus.

35) The correct answer is: A
Explanation: Seminoma is characteristically infiltrated with lymphocytes.

) The correct answer is:
Explanation:

Figure 7pus from orchitis

 

 

Figure 8

Figure

This is the microscopic appearance of normal proliferative endometrium in the menstrual cycle. The proliferative phase is the variable part of the cycle. In this phase, tubular glands with columnar cells and surrounding dense stroma are proliferating to build up the endometrium following shedding with previous menstruation.

 

Dysfunctional uterine bleeding has several causes?

• Anovulatory cycles are common around menarche and menopause
• A granulosa and/or theca tumor in an ovary producing estrogens and/or progesterone
• Endocrine disease elsewhere (especially the pitutiary or thyroid)
• Massive obesity (too much estrogen being converted)

All of these will give "unopposed estrogen effect" on bipsy, with a thick endometrium with long glands but without decidual-type change. The endometrium starts breaking down early in patches, hence the bleeding.

• Too little body fat (too little estrogen being converted)
• Severe chronic disease ("something with the interleukins")
• Inadequate luteal phase (i.e., the corpus luteum doesn't form properly and the second half of the cycle may be abnormally long if the corpus luteum develops slowly, or short if it doesn't develop at all) -- the pathologist will make the diagnosis by discovering that the date of the endometrium is less than the chronologic date
• Persistent luteal phase (i.e., the corpus luteum doesn't regress as it should) -- there is still obvious decidual change in the menstrual endometrium, and the periods are long and heavy.