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USMLE Pathoma > Breast pathoma > Flashcards

Breast pathoma Flashcards

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USMLE® Step 1 flashcards
1
Q

What is a Bartholin cyst?

A

Inflammation of the Bartholin glands causes a painful unilateral cystic lesion in the lower vestibule adjacent to the vagina (usually in women of reproductive age)

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2
Q

Inflammation of the Bartholin glands causes a painful unilateral cystic lesion in the lower vestibule adjacent to the vagina (usually in women of reproductive age)

Describes which condition?

A

Bartholin cyst

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3
Q

What is a condyloma acuminatum?

A

A large warty neoplasm of the vulva due to an HPV 6 or 11 infection that is characterized by koilocytes it very rarely progresses to cancer

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4
Q

A large warty neoplasm of the vulva due to an HPV 6 or 11 infection that is characterized by koilocytes it very rarely progresses to cancer

A

condyloma acuminatum

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5
Q

What is a condyloma latum?

A

A large warty neoplasm of the vulva due to an secondary syphilis infection that very rarely progresses to cancer

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6
Q

A large warty neoplasm of the vulva due to an secondary syphilis infection that very rarely progresses to cancer

A

condyloma latum

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7
Q

What is lichen sclerosis?

A

Benign thinning of the dermis & fibrosis (aka sclerosis) of the vulva dermis.

Signs:
1) leukoplakia
2) parchment-like vulva

Causes:
1) menopause (#1)
2) autoimmune diseases.

Complication:
higher risk of progressing to squamous cell carcinoma

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8
Q

Thinning of the dermis & fibrosis (aka sclerosis) of the vulva dermis. It presents as leukoplakia & parchment-like vulvar skin. It’s usually from post menopause (#1) or autoimmune diseases. Though it is benign it has a higher risk of progressing to squamous cell carcinoma

A

lichen sclerosis

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9
Q

What is lichen simplex chronicus?

A

Hyperplasia of the vulva’s squamous epithelium that presents as leukoplakia & a thick/leathery vulvar skin. It’s usually because of chronic irritation & scratching. It is benign and doesn’t have a cancer risk

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10
Q

Hyperplasia of the vulva’s squamous epithelium that presents as leukoplakia & a thick/leathery vulvar skin. It’s usually because of chronic irritation & scratching. It is benign and doesn’t have a cancer risk

A

lichen simplex chronicus

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11
Q

What is the form vulvar carcinoma that typically presents in younger women?

A

A rare cancer of the squamous epi lining the vulva that is caused by HPV 16 or 18 infection it starts as a dysplastic precursor lesion called vulvar intraepithelial neoplasia which has:

1) leukoplakia
2) koilocytic change
3)disordered cellular maturation
4) nuclear atypia
5) more mitotic activity

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12
Q

What is the form vulvar carcinoma that typically presents in elderly women? (>70yrs)

A

A rare cancer of the squamous epi lining the vulva that is caused by Long-standing lichen sclerosis (chronic inflammation/irritation) eventually leads to carcinoma. It presents only as leukoplakia

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13
Q

A rare cancer of the squamous epi lining the vulva that is caused by Long-standing lichen sclerosis (chronic inflammation/irritation) eventually leads to carcinoma. It presents only as leukoplakia

A

vulvar carcinoma that typically presents in elderly women? (>70yrs)

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14
Q

A rare cancer of the squamous epi lining the vulva that is caused by HPV 16 or 18 infection it starts as a dysplastic precursor lesion called vulvar intraepithelial neoplasia which has:

1) leukoplakia
2) koilocytic change
3)disordered cellular maturation
4) nuclear atypia
5) more mitotic activity

A

vulvar carcinoma that typically presents in younger women?

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15
Q

What is Extramammary pagets disease?

A

Malignant epithelial cells in the vulvar epidermis. It presents as erythematous, pruritic, & ulcerated vulvar skin that stains PAS+ve, Keratin +ve, & S100-ve. It represents carcinoma in situ but it is usually not associated with underlying carcinoma EXCEPT for pagets disease of the nipple

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16
Q

Malignant epithelial cells in the vulvar epidermis. It presents as erythematous, pruritic, & ulcerated vulvar skin that stains PAS+ve, Keratin +ve, & S100-ve. It represents carcinoma in situ but it is usually not associated with underlying carcinoma EXCEPT for pagets disease of the nipple

A

Extramammary pagets disease

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17
Q

What is paget’s disease of the nipple ?

A

Pretty much the same thing as the extramammary Paget’s disease except it is ALWAYS associated with an underlying carcinoma. It has ulcerated vulvar skin that stains PAS+ve, Keratin +ve, & S100-ve.

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18
Q

Pretty much the same thing as the extramammary Paget’s disease except it is ALWAYS associated with an underlying carcinoma. It has ulcerated vulvar skin that stains PAS+ve, Keratin +ve, & S100-ve.

A

paget’s disease of the nipple

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19
Q

What is a vaginal adenosis?

A

The focal persistence of columnar epithelium in the upper vagina (derived from the Mullerian ducts) because of failure of the squamous epithelium of the lower vagina (derived from the urogenital tract) that grows up to replace the columnar epithelium

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20
Q

The focal persistence of columnar epithelium in the upper vagina (derived from the Mullerian ducts) because of failure of the squamous epithelium of the lower vagina (derived from the urogenital tract) that grows up to replace the columnar epithelium.

A

vaginal adenosis

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21
Q

Females in utero exposed to Diethylstilbestrol (DES) are at higher risk of developing what condition?

A

Vaginal adenosis

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22
Q

Exposure to what in utero can lead to the development of vaginal adenosis?

A

Diethylstilbestrol (a synthetic estrogen)

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23
Q

What is vaginal clear cell carcinoma?

A

Malignant proliferation of the glands that have cells with clear cytoplasm it is a rare complication of DES associated vaginal adenosis

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24
Q

Malignant proliferation of the glands that have cells with clear cytoplasm it is a rare complication of DES associated vaginal adenosis

A

vaginal clear cell carcinoma

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25
Q

What is vaginal embryonal rhabdomyosarcoma

A

also known as a sarcoma of Botryoides. It is a rare malignant mesenchymal proliferation of immature skeletal cells. It’s usually seen in children <5yrs

It presents as bleeding & a grape-like mass protruding from the vagina.

The rhabdoblast has cytoplasmic cross-striations & stains +ve for Desmin & Myogenin

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26
Q

A rare malignant mesenchymal proliferation of immature skeletal cells. It’s usually seen in children <5yrs

It presents as bleeding & a grape-like mass protruding from the vagina.

The rhabdoblast has cytoplasmic cross-striations & stains +ve for Desmin & Myogenin

A

Vaginal embryonal rhabdomyosarcoma/ sarcoma of Botryoides.

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27
Q

What is vaginal carcinoma?

A

Cancer of the squamous epithelium lining the vaginal mucosa. It is usually caused by HPV 16 or 18 infection.

It presents as a precursor lesion called Vaginal Intraepithelial Neoplasia (VAIN)

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28
Q

Cancer of the squamous epithelium lining the vaginal mucosa. It is usually caused by HPV 16 or 18 infection.

It presents as a precursor lesion called Vaginal Intraepithelial Neoplasia (VAIN)

A

vaginal carcinoma

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29
Q

What can vaginal carcinoma progress to & how?

A
  1. It can spread to the regional LN causing cancer in the lower 1/3rd of the vagina.
  2. Then it can move to the inguinal LN causing cancer of the upper 2/3rds of the vagina
  3. Lastly it can spread to the inguinal LNs to further metastasize
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30
Q

What is HPV & how does it affect the cervix?

A

An STD of the lower genital tract that targets the cervical transformation zone. Normally acute inflammation can eradicate it, but if infection persists it can lead to cervical dysplasia (CIN)

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31
Q

An STD of the lower genital tract that targets the cervical transformation zone. Normally acute inflammation can eradicate it, but if infection persists it can lead to cervical dysplasia (CIN)

A

HPV

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32
Q

Which types of HPV are considered low risk?

A

HPV 6 & 11 which usually cause oral herpes or condyloma Acuminatum

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33
Q

Which types of HPV are considered high risk?

A

HPV 16, 18, 31, & 33, they produce two proteins:
E6 (Destroys P53)
E7 (Destroys Rb)

Loss of these tumor suppressors increases the risk of developing Cervical Intraepithelial Neoplasia (CIN)

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34
Q

What is Cervical Intraepithelial Neoplasia?

A

Dysplasia of the cervix aka cancer that has koilocytic change, nuclear atypia, disordered cell maturation, & high mitotic activity in the cervical epithelium

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35
Q

Dysplasia of the cervix aka cancer that has koilocytic change, nuclear atypia, disordered cell maturation, & high mitotic activity in the cervical epithelium

A

Cervical Intraepithelial Neoplasia

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36
Q

What does a CIN 1 grade indicate?

A

It involves 1/3 of the cervical epithelial thickness (good prognosis that usually regresses)

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37
Q

It involves 1/3 of the cervical epithelial thickness (good prognosis that usually regresses)

A

CIN 1

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38
Q

What does a CIN 2 grade indicate?

A

It involves 2/3rds of the cervical epithelium

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39
Q

It involves 2/3rds of the cervical epithelium

A

CIN 2

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40
Q

What does a CIN 3 grade indicate?

A

It involves ALMOST all of the cervical epithelium

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41
Q

It involves ALMOST all of the cervical epithelium

A

CIN 3

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42
Q

What does a CIS grade indicate?

A

Cervical Invasive Squamous cell carcinoma, it involves ALL of the cervical epithelium (WORST!)

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43
Q

Cervical Invasive Squamous cell carcinoma, it involves ALL of the cervical epithelium (WORST!)

A

CIS grade

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44
Q

What is cervical carcinoma? & What are the subtypes?

A

An invasive carcinoma that arises from the cervical epithelium. It is most common in middle aged women (40-50yrs) & it presents with vaginal bleeding (especially after sex) or cervical discharge.

The #1 cause is HPV (16,18,31, & 33)

The subtypes of cervical cancer include Squamous cell cervical carcinoma (80%) & Cervical Adenocarcinoma (15%)

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45
Q

An invasive carcinoma that arises from the cervical epithelium. It is most common in middle aged women (40-50yrs) & it presents with vaginal bleeding (especially after sex) or cervical discharge.

The #1 cause is HPV (16,18,31, & 33)

A

cervical carcinoma

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46
Q

What are the subtypes of cervical cancer?

A

The subtypes of cervical cancer include

Squamous cell cervical carcinoma (80%)

Cervical Adenocarcinoma (15%)

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47
Q

What is a major complication of cervical carcinoma?

A

Advanced cervical carcinoma can invade the anterior wall of the uterine wall & block the ureters causing hydronephrosis & post renal failure

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48
Q

What is a key complication & major cause of death in patients with advanced cervical cancer?

A

hydronephrosis & post renal failure

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49
Q

hydronephrosis & post renal failure are complications of which type of cancer?

A

advanced cervical cancer

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50
Q

What are the other secondary causes of cervical carcinoma?

A

Smoking & Immunodeficiency (AIDS)

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51
Q

How long does it usually take for CIN 1 to progress to & what age does screening typically start?

A

it tends to take 10-20yrs & screening starts at 25yrs of age

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52
Q

What is the gold standard for cervical cancer screening & what is the follow up diagnostic test if a PAP is abnormal?

A

PAP smear is the gold standard that samples the transformation zone

If the PAP is abnormal a confirmatory colposcopy (visualize the cervix) & biopsy

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53
Q

What is Asherman Syndrome?

A

It is secondary amenorrhea due the loss of the basalis & scarring causing adhesions & fibrosis) of the endometrium. That is caused by overaggressive dilation & curettage (surgery)

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54
Q

It is secondary amenorrhea due the loss of the basalis & scarring causing adhesions & fibrosis) of the endometrium. That is caused by overaggressive dilation & curettage (surgery)

A

Asherman Syndrome

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55
Q

What is an anovulatory cycle?

A

Lack of ovulation that results in an estrogen-driven proliferative phase without a subsequent progesterone driven secretory phase.

The proliferative glands break down & shed causing uterine bleeding.

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56
Q

What is a common cause of dysfunctional uterine bleeding, especially during menarche & menopause?

A

Anovulatory cycle

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57
Q

What is acute endometritis?

A

A bacterial infection of the endometrium that is usually due to retained products of conceptions (delivery or miscarriage). It presents as:
1) Fever
2) Abnormal uterine bleeding
3) Pelvic pain

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58
Q

A bacterial infection of the endometrium that is usually due to retained products of conceptions (delivery or miscarriage). It presents as:
1) Fever
2) Abnormal uterine bleeding
3) Pelvic pain

A

acute endometritis

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59
Q

What is chronic endometritis?

A

Chronic inflammation of the endometrium that is characterized by lymphocytes & plasma cells.

It can be caused by retained products of conception (delivery/miscarriage), chronic inflammatory disease (chlamydia), IUD, or TB

It presents as:
1) Abnormal uterine bleeding
2) Pain
3) Infertility

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60
Q

Chronic inflammation of the endometrium that is characterized by lymphocytes & plasma cells.

It can be caused by retained products of conception (delivery/miscarriage), chronic inflammatory disease (chlamydia), IUD, or TB

It presents as:
1) Abnormal uterine bleeding
2) Pain
3) Infertility

A

chronic endometritis

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61
Q

What is a Endometrial polyp?

A

A hyperplastic protrusion of the endometrium that presents as abnormal uterine bleeding.

It can be caused by medication side effects like Tamoxifen

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62
Q

A hyperplastic protrusion of the endometrium that presents as abnormal uterine bleeding.

It can be caused by medication side effects like Tamoxifen

A

Endometrial polyp

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63
Q

What is endometriosis? What are the symptoms?

A

Endometrial glands & stoma outside of the uterine endometrial lining. It is usually caused by retrograde menstruation with implantation at an ectopic site

It presents as:
1) Dysmenorrhea
2) Pelvic pain
3) Infertility

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64
Q

Endometrial glands & stoma outside of the uterine endometrial lining. It is usually caused by retrograde menstruation with implantation at an ectopic site

It presents as:
1) Dysmenorrhea
2) Pelvic pain
3) Infertility
4) Chocolate cysts (ovary involvement)
5) Gunpowder nodules (Fallopian tube involvement)

A

endometriosis

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65
Q

What is the most common site of involvement of endometriosis?

A

The ovaries which is characterized by the formation of chocolate cysts

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66
Q

What are the lesser common sites of involvement in endometriosis?

1) (Pelvic pain)
2) (Pain with defecation)
3) (Pain with urination)
4) (Abdominal pain with adhesions)
5) (gunpowder nodules)
6) (adenomyosis)

A

1) Uterine ligaments

2) Pouch of Douglas

3) Bladder wall

4) Bowel serosa

5) Fallopian tube mucosa

6) Uterine myometrium

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67
Q

1) Uterine ligaments (Pelvic pain)
2) Ouch of Douglas (Pain with defecation)
3) Bladder wall (Pain with urination)
4) Bowel serosa (Abdominal pain with adhesions)
5) Fallopian tube mucosa (gunpowder nodules)
6) Uterine myometrium (adenomyosis)

Are all sites of what condition?

A

Endometriosis

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68
Q

What is a possible complication of endometriosis?

A

It has a higher risk of endometriosis.

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69
Q

What is Endometrial hyperplasia?

A

Endometrial hyperplasia is caused by excess estrogen and can lead to abnormal growth of the endometrial tissue outside the uterus, causing pain, inflammation, and potential infertility. It can be simple or complex and may present as post-menopausal uterine bleeding.

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70
Q

Endometrial hyperplasia is caused by excess estrogen and can lead to abnormal growth of the endometrial tissue outside the uterus, causing pain, inflammation, and potential infertility. It can be simple or complex and may present as post-menopausal uterine bleeding.

A

Endometrial hyperplasia

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71
Q

What findings in endometriosis are indicative of endometrial cancer as a major complication?

A

Cellular atypia alone or cellular atypia with simple hyperplasia

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72
Q

What is endometrial cancer?

A

Malignant proliferation of the endometrial glands that presents as post-menopausal bleeding that can arise by either the hyperplasia pathway or the sporadic pathway.

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73
Q

Which cancer is the most common invasive carcinoma of the female genitalia?

A

Endometrial cancer

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74
Q

Which is the most common pathway would endometrial cancer arise in ~60yr old females?

A

The hyperplasia pathway (75%) where the carcinoma arises from endometrial hyperplasia. Histology will show endometrioid tissue (endometrium outside the uterus)

Risks:
1) Estrogen exposure (obesity, diethylstilbestrol etc.)
2) Early menarche
3) Late menopause
4) Nulliparity infertility with anovulatory cycles

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75
Q

The carcinoma arises from endometrial hyperplasia. Histology will show endometrioid tissue (endometrium outside the uterus)

Risks:
1) Estrogen exposure (obesity, diethylstilbestrol etc.)
2) Early menarche
3) Late menopause
4) Nulliparity infertility with anovulatory cycles

A

The hyperplasia pathway (75%)

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76
Q

Which is the less common pathway would endometrial cancer arise in older females (~70yr old females?)

A

The sporadic pathway (25%)

1) Arises in an atrophic endometrium without precursor lesions

2) serous type with is papillae that have psammoma bodies

3) An aggressive tumor due to P53 mutations

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77
Q

the carcinoma arises in an atrophic endometrium with no evident precursor lesions. The histology is usually serous & is characterized by papillary structures with psammoma bodies. The tumor is typically aggressive & it is usually caused by P53 mutations

A

The sporadic pathway (25%),

78
Q

What is are leiomyoma (fibroids)?

A

Common benign smooth muscle neoplastic proliferation in females arising from the myometrium, linked to elevated estrogen levels. (Tends to be more than one)

1) Common in premenopausal women
2) Enlarge during pregnancy (shrink during menopause)

79
Q

What are the possible symptoms of leiomyomas (fibroids)?

A

Asymptomatic or it presents with:
- Abnormal uterine bleeding
- Infertility
- Pelvic mass

80
Q

Common benign smooth muscle neoplastic proliferation in females arising from the myometrium, linked to elevated estrogen levels. (Tends to be more than one)

1) Common in premenopausal women
2) Enlarge during pregnancy (shrink during menopause)

A

leiomyoma (fibroids)

81
Q

What is a leiomyosarcoma?

A

Malignant proliferation of smooth muscle that arises from the myometrium. It arises de novo (they don’t arise from leiomyomas) usually in post menopausal women.

82
Q

Malignant proliferation of smooth muscle that arises from the myometrium. It arises de novo (they don’t arise from leiomyomas) usually in post menopausal women.

A

leiomyosarcoma

83
Q

A single lesion with areas of necrosis & hemorrhage (necrosis, mitotic activity, & cellular atypia)

A

Leiomyosarcoma

84
Q

What are the histological findings of leiomyosarcoma?

A

A single lesion with areas of necrosis & hemorrhage (necrosis, mitotic activity, & cellular atypia)

85
Q

Which cells does LH act on?

A

It acts on theca cells to induce androgen production.

86
Q

Which cells does FSH act on?

A

It stimulates granulosa cells to convert androgen to estradiol’s (it drives the proliferative phase of the endometrial cycle)

87
Q

What does an estradiol surge induce?

A

it induces an LH surge which leads to ovulation (the beginning of the secretory phase of the endometrial cycle)

88
Q

What is Polycystic Ovarian Disease (PCOD)?

A

There is multiple ovarian follicular cysts due to hormone imbalance that effects ~5% of repro-aged women that is characterized by HIGH LH & LOW FSH

89
Q

There is multiple ovarian follicular cysts due to hormone imbalance that effects ~5% of repro-aged women that is characterized by HIGH LH & LOW FSH

A

Polycystic Ovarian Disease (PCOD)

90
Q

What are the symptoms of PCOD?

A

1) Hirsutism (high LH)
2) Obesity (androgens are converted into estrone in fat)
3) Infertility
4) Oligomenorrhea
5) Insulin resistance (some)

91
Q

1) Hirsutism (high LH)
2) Obesity (androgens are converted into estrone in fat)
3) Infertility
4) Oligomenorrhea
5) Insulin resistance (some)

A

symptoms of PCOD

92
Q

What are the complications of Polycystic Ovarian Disease (PCOD)?

A

1) Higher risk of endometrial cancer (high levels of estrone)

2) Cystic degeneration of the follicles (estrogen feedback reduced FSH)

3) Patients with insulin resistance can develop type 2 diabetes

93
Q

1) Higher risk of endometrial cancer (high levels of estrone)

2) Cystic degeneration of the follicles (estrogen feedback reduced FSH)

3) Patients with insulin resistance can develop type 2 diabetes

Are all complications of which condition?

A

Polycystic Ovarian Disease (PCOD)

94
Q

What are surface epithelial ovarian tumors?

A

It’s the most common (70%) that is derived from the coelomic epithelium (lines the ovary). It has both serous (watery) & mucinous (Mucus) subtypes that can present as benign, malignant, or borderline tumors.

95
Q

It’s the most common (70%) that is derived from the coelomic epithelium (lines the ovary). It has both serous (watery) & mucinous (Mucus) subtypes that can present as benign, malignant, or borderline tumors.

A

surface epithelial ovarian tumors

96
Q

What is a benign surface epithelial ovarian tumor (serous/or/mucous)?

A

Also known as a cystadenoma, it is a single cyst with simple & flat lining that is usually seen in premenopausal women (30-40yrs)

97
Q

Also known as a cystadenoma, it is a single cyst with simple & flat lining that is usually seen in premenopausal women (30-40yrs)

A

benign surface epithelial ovarian tumor (serous/or/mucous)

98
Q

What is a malignant surface epithelial ovarian tumor (serous/or/mucous)?

A

Also known as cystadenocarcinoma, it is made up of complex cysts with thick & shaggy lining that is usually seen in postmenopausal women (60-70rs)

99
Q

Also known as cystadenocarcinoma, it is made up of complex cysts with thick & shaggy lining that is usually seen in postmenopausal women (60-70rs)

A

malignant surface epithelial ovarian tumor (serous/or/mucous)

100
Q

What is coelomic epithelium? What pathology is it seen in?

A

Tissue that normally lines the ovary it embryologically produces the epithelial lining of the fallopian tube (serous cells), endometrium, & endocervix (mucinous cells).

Seen in surface epithelial ovarian tumors

101
Q

What is a Borderline surface epithelial ovarian tumor (serous/or/mucous)?

A

A tumor in-between benign & malignant, it has a good prognosis but still has the potential to metastasize

102
Q

A tumor of the ovary in-between benign & malignant, it has a good prognosis but still has the potential to metastasize

A

Borderline surface epithelial ovarian tumor (serous/or/mucous)

103
Q

What is a risk factor for developing a serous ovarian/fallopian tube carcinoma?

A

BRACA1 gene mutation usually have a prophylactic mastectomy & oophorectomy

104
Q

What is an endometroid surface epithelial ovarian tumor?

A

A malignant subtype of surface epithelial ovarian tumor that is made of endometrial glands & it can arise from endometriosis.

It presents with:
1) Vague abdominal signs (pain & fullness)
2) Signs of compression (urine frequency)

105
Q

A malignant subtype of surface epithelial ovarian tumor that is made of endometrial glands & it can arise from endometriosis. Marked by CA-125 serum marker.

It presents with:
1) Vague abdominal signs (pain & fullness)
2) Signs of compression (urine frequency)

A

endometroid surface epithelial ovarian tumor

106
Q

What is an Brenner surface epithelial ovarian tumor?

A

A benign subtype of surface epithelial ovarian tumor that is made of bladder-like epithelium.

It presents with:
1) Vague abdominal signs (Pain & Fullness)
2) Signs of compression (urine frequency)

107
Q

What is the surface marker for surface epithelial ovarian tumors?

A

CA-125 serum marker

108
Q

What is the prognosis of surface epithelial ovarian tumors?

A

They generally have a prognosis (it’s the worst female genital tract cancer) that tends to spread locally to the peritoneum

109
Q

What is a cystic teratoma?

A

A benign cystic tumor made from fetal tissues that are derived from 2-3 embryological layers (skin, bone, thyroid etc.)

110
Q

A cystic tumor made from fetal tissues that are derived from 2-3 embryological layers (skin, bone, thyroid etc.)

A

A cystic teratoma

111
Q

Which is the most common germ cell tumor?

A

cystic teratoma

112
Q

the presence of which type of tissue is indicative of malignancy in cystic teratomas?

A

Immature tissue (usually neural) or somatic malignancy (squamous cell carcinoma) often indicate malignancy in these typically benign tumors

113
Q

What is Dysgerminoma?

A

A germ cell tumor made of large cell with clear cytoplasm & central nuclei (resembles oocytes) with elevated LDH.

It has a good prognosis that responses to radiotherapy

114
Q

A germ cell tumor made of large cell with clear cytoplasm & central nuclei (resembles oocytes) with elevated LDH.

It has a good prognosis that responses to radiotherapy

A

A Dysgerminoma

115
Q

What is the female counterpart of a seminoma?

A

A Dysgerminoma

116
Q

What is an endodermal sinus tumor?

A

A malignant tumor that mimics a yolk sac tumor, it has elevated serum AFP with Schiller-Duval bodies (glomeruli-like)

117
Q

A malignant tumor that mimics a yolk sac tumor, it has elevated serum AFP with Schiller-Duval bodies (glomeruli-like)

A

Endodermal sinus tumor

118
Q

What Choriocarcinoma?

A

A small hemorrhagic & malignant with early hematogenous spread. It is made up of cytotrophoblasts & syncytiotrophoblast that mimics placental tissue without the villi.

It has elevated B-hCG levels

It has a very poor response to chemotherapy

119
Q

A small hemorrhagic & malignant with early hematogenous spread. It is made up of cytotrophoblasts & syncytiotrophoblast that mimics placental tissue without the villi.

It has elevated B-hCG levels

It has a very poor response to chemotherapy

A

Choriocarcinoma

120
Q

What can a choriocarcinoma progress into?

A

it can progress into thecal cysts in the ovary

121
Q

What is an embryonal carcinoma?

A

An aggressive & malignant cancer made up of primitive cells that has early metastasis

122
Q

An aggressive & malignant cancer made up of primitive cells that has early metastasis

A

embryonal carcinoma

123
Q

What is a granulosa-theca cell tumor of the ovary?

A

A malignant sex-cord stromal tumor of the ovary. It is made up of neoplastic proliferation of the granulosa & theca cells leading to excessive estrogen

It presents:
1) Endometrial hyperplasia with post menopausal uterine bleeding (most common!!)

2) Precocious puberty (in pre-puberty kids)
3) Menorrhagia (reproductive age)

124
Q

A malignant sex-cord stromal tumor of the ovary. It is made up of neoplastic proliferation of the granulosa & theca cells leading to excessive estrogen

It presents:
1) Endometrial hyperplasia with post menopausal uterine bleeding (most common!!)

2) Precocious puberty (in pre-puberty kids)
3) Menorrhagia or Menorrhagia (reproage)

A

granulosa-theca cell tumor of the ovary

125
Q

What is a Sertoli-Leydig ovarian cell tumor?

A

A sex cord stromal tumor made from Sertoli cells from tubules & Leydig cells (In-between the tubules) with characteristic Reinke crystals

They can make excess androgens causing
1) Hirsutism
2) Virilization

126
Q

A sex cord stromal tumor made from Sertoli cells from tubules & Leydig cells (In-between the tubules) with characteristic Reinke crystals

They can make excess androgens causing
1) Hirsutism
2) Virilization

A

Sertoli-Leydig ovarian

127
Q

What is a fibroma?

A

An aggressive but benign stromal cell tumor made up of large primitive cells that has early metastasis

128
Q

An aggressive but benign stromal cell tumor made up of large primitive cells that has early metastasis

A

fibroma

129
Q

What are metastatic Kruckenberg tumors?

A

A metastatic bilateral ovarian tumor that is due to the metastasis of a gastric carcinoma

130
Q

A metastatic bilateral ovarian tumor that is due to the metastasis of a gastric carcinoma

A

metastatic Kruckenberg tumors

131
Q

What is a primary ovarian tumor?

A

a unilateral ovarian tumor that tends to metastasize

132
Q

a unilateral ovarian tumor that tends to metastasize

A

primary ovarian tumor

133
Q

What is a pseudomyxoma peritonei?

A

A massive collection of mucus in the peritoneum due to a mucus tumor in the appendix that tends to metastasize to the ovary

134
Q

A massive collection of mucus in the peritoneum due to a mucus tumor in the appendix that tends to metastasize to the ovary

A

pseudomyxoma peritonei

135
Q

What is ectopic pregnancy?

A

Implantation of the ovum at any site other than the uterine wall (usually the fallopian tubes). Scarring is the major risk factor from secondary PID or endometriosis. It is considered a surgical emergency requiring removal of the fetus

136
Q

Implantation of the ovum at any site other than the uterine wall (usually the fallopian tubes). Scarring is the major risk factor from secondary PID or endometriosis. It is considered a surgical emergency requiring removal of the fetus

A

ectopic pregnancy

137
Q

What are the risk factors for having an ectopic pregnancy?

A

Main cause:
Scarring (from secondary PID or from endometriosis

138
Q

How does ectopic pregnancy classically present as?

A

Lower quadrant abdominal pain a few weeks after a missed period

139
Q

What are the complications of an ectopic pregnancy?

A

Hematosalpine (Bleeding into the fallopian tubes)
&
Rupture

140
Q

Hematosalpine (Bleeding into the fallopian tubes)
&
Rupture

Are complications of which condition?

A

Ectopic pregnancy

141
Q

What is a spontaneous abortion? & what does it typically present as?

A

When a miscarriage happens before 20wks (usually during the first trimester)

It presents as:
1) Vaginal bleeding
2) Crampy pain
3) Passing fetal tissues

142
Q

When a miscarriage happens before 20wks (usually during the first trimester)

It presents as:
1) Vaginal bleeding
2) Crampy pain
3) Passing fetal tissues

A

spontaneous abortion

143
Q

What is the main cause of a spontaneous abortion?

What are some other causes of spontaneous abortion?

A

Chromosomal defects (XXX16!)

Other:
1) Hypercoagulable states (antiphospholipid syndrome)
2) Congenital infections
3) Teratogens (first 2wks of embryogenesis)

144
Q

1 Chromosomal defects (XXX16!)

Other:
1) Hypercoagulable states (antiphospholipid syndrome)
2) Congenital infections
3) Teratogens (first 2wks of embryogenesis)

A

Causes of spontaneous abortion

145
Q

Teratogens in the first 2wks usually cause what?

A

Spontaneous abortion

146
Q

Teratogen exposure in the 3-8wks of pregnancy put the fetus at risk for developing what?

A

Organ malformation

147
Q

Teratogen exposure in the 3-9 months of pregnancy put the fetus at risk for developing what?

A

Organ hypoplasia

148
Q

What is placenta previa?

A

When the placental implants into the lower uterus causing it to overlie the cervical opening

Presents with 3rd trimester bleeding

149
Q

When the placental implants into the lower uterus causing it to overlie the cervical opening

Presents with 3rd trimester bleeding

A

placenta previa

150
Q

How do you handle a case of placenta previa?

A

Caesarian delivery

151
Q

What is a placental abruption?

A

When the placenta separates from the decidua BEFORE delivery usually causing stillbirth

Presents with 3rd trimester bleeding & fetal insufficiency

152
Q

When the placenta separates from the decidua BEFORE delivery usually causing stillbirth

Presents with 3rd trimester bleeding & fetal insufficiency

A

placental abruption

153
Q

Alcohol teratogenic effect?

A

FAS

154
Q

Cocaine teratogenic effect?

A

1) Growth retardation
2) Placental abruption

155
Q

Thalidomide teratogenic effect?

A

Phocomelia (flipper limb syndrome)

156
Q

Isotretinoin teratogenic effect?

A

1) Spontaneous abortion
2) Ear & Eye issues

157
Q

Tobacco teratogenic effect?

A

1) ADHD
2) Growth retardation

158
Q

TCA teratogenic effect?

A

Yellow/discolored teeth

159
Q

Warfarin teratogenic effect?

A

1) Fetal bleeding
2) Hypoplastic nose
3) Stippled epiphyses
4) Skeletal anomalies

160
Q

Phenytoin teratogenic effect?

A

1) Digit hypoplasia
2) Cleft palate

161
Q

What is placenta accreta?

A

Improper implantation of the placenta into the myometrium with little or no intervening decidua

Presents with difficult delivery of the placenta & postpartum bleeding

162
Q

Improper implantation of the placenta into the myometrium with little or no intervening decidua

Presents with difficult delivery of the placenta & postpartum bleeding

A

Placenta accreta

163
Q

What intervention does placenta previa often require?

A

Hysterectomy

164
Q

What is preeclampsia ?

A

It is pregnancy induced HTN, proteinuria, & edema that usually arises in the 3rd trimester.
(severe headaches can cause headaches & visual disturbances)

165
Q

What are the 2 major complications of preeclampsia?

A

1) Preeclampsia with thrombotic microangiopathy

2) Eclampsia

Both require immediate delivery

166
Q

What is eclampsia?

A

Preeclampsia & seizures

167
Q

Preeclampsia & seizures describes which condition?

A

Eclampsia

168
Q

What is Preeclampsia with thrombotic microangiopathy “HELLP”

A

Hemolysis
Elevated Liver enzymes
Low Platelets

169
Q

Hemolysis
Elevated Liver enzymes
Low Platelets

Is the presentation of a complication of which complication of birthing?

A

Preeclampsia with thrombotic microangiopathy “HELLP”

170
Q

It is pregnancy induced HTN, proteinuria, & edema that usually arises in the 3rd trimester.
(severe headaches can cause headaches & visual disturbances)

A

Preeclampsia

171
Q

What is SIDS (Sudden Infant Death Syndrome)?

A

Unexplainable death of an infant between 1 month-to-1yrs of age. It usually happens during sleep

172
Q

Unexplainable death of an infant between 1 month-to-1yrs of age. It usually happens during sleep

A

SIDS :(

173
Q

1) Sleeping on the stomach
2) Expose to cigarette smoke
3) Prematurity

Are all risk factors of which condition?

A

SIDS

174
Q

What are the risk factors fir SIDS?

A

1) Sleeping on the stomach
2) Expose to cigarette smoke
3) Prematurity

175
Q

What is a hydatidiform mole?

A

Abnormal ovum with 69X made from swollen/edematous villi & proliferating trophoblasts. It usually appears in the 2nd trimester & can be partial (normal) or complete (empty)

It presents as an abnormally large uterus with crazy high B-hcG levels

176
Q

Abnormal ovum with 69X made from swollen/edematous villi & proliferating trophoblasts. It usually appears in the 2nd trimester & can be partial (normal) or complete (empty)

It presents as an abnormally large uterus with crazy high B-hcG levels

A

Hydatidiform mole

177
Q

What is a complication of gestation
(Spontaneous abortion, normal preggos, or Hydatidiform moles)?

A

Choriocarcinoma it has a good response to chemotherapy

178
Q

Dilation & curettage with B-hCG monitoring to ensure complete removal & screening for choriocarcinoma

Is the treatment regime for…

A

Hydatidiform mole

179
Q

What are the treatment options for Hydatidiform mole?

A

Dilation & curettage with B-hCG monitoring to ensure complete removal & screening for choriocarcinoma

180
Q

Women in her 2nd trimester & passes grape-like masses through the vaginal canal

A

Hydatidiform

181
Q

If a Hydatidiform is caught early in the 1st trimester, what would the ultrasound findings be?

A

Absent heart sounds with a snowstorm appearance on ultrasound

182
Q

Absent heart sounds with a snowstorm appearance on ultrasound

A

Hydatidiform

183
Q

What is a partial Hydatidiform mole?

A

A normal ovum that is fertilized by 2 sperm (or one sperm that duplicated chromosomes) causing 69 chromosomes total.

It is made of fetal tissue & has normal & hydrophobic villi with surrounding focal proliferation

It has a minimal risk of choriocarcinoma

184
Q

A normal ovum that is fertilized by 2 sperm (or one sperm that duplicated chromosomes) causing 69 chromosomes total.

It is made of fetal tissue & has normal & hydrophobic villi with surrounding focal proliferation

It has a minimal risk of choriocarcinoma

A

A partial Hydatidiform mole

185
Q

Which type of mole has minimal risk for choriocarcinoma Partial or Complete hydatidiform mole?

A

A partial mole because it only has focal trophoblastic proliferation around some hydropic villi

186
Q

1) Normal ovum with 69 chromosomes
2) Fetal tissue
3) Some hydropic & normal villi
4) Focal trophoblastic proliferation around hydropic villi
5) Minimal risk of choriocarcinoma

A

Partial hydatidiform mole

187
Q

What is a complete Hydatidiform mole?

A

An empty ovum fertilized by 2 sperm (or one with duplicate chromosomes X69)

There are NO fetal tissues & most villi are hydropic with diffuse & circumferential trophoblastic proliferation around the hydropic villi

Higher risk of choriocarcinoma

188
Q

An empty ovum fertilized by 2 sperm (or one with duplicate chromosomes X69)

There are NO fetal tissues & most villi are hydropic with diffuse & circumferential trophoblastic proliferation around the hydropic villi

Higher risk of choriocarcinoma

A

complete Hydatidiform mole

189
Q

1) Empty ovum (69x)
2) Absent fetal tissues
3) Mostly hydropic villi
4) Diffuse & circumferential trophoblastic proliferation
5) Higher risk of choriocarcinoma

A

Complete Hydatidiform mole

190
Q

What is a complication of a hydatidiform mole?

A

Choriocarcinoma (a gestational complication)

USMLE Pathoma (20 decks)

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