Exam 2 - Female Flashcards
When is breast cancer common and uncommon
Uncommon <40, MC when >50
What are some of the causes of breast cancer
Hormonal, genetic, environmental
Who is most likely to get breast cancer
> 50, white, family Hx, geography
Why would someone <30 have breast cancer
Nulliparous or chest irradiation
What are hormonal, and genetic risks for breast cancer
Increased estrogen, BRCA1/2, benign lesion
When breast cancer penetrates the BM what is it called
Invasive, infiltrating
When breast cancer does not invade the BM what is it called
In situ
Where is breast cancer most commonly located
In superolateral quadrant
What form of breast cancer is characterized by small “mixed” cells with necrosis and calcification
Ductal carcinoma in situ (DCIS)
If left untreated what would happen to a patient with DCIS
1/3 turn into invasive CA
If a female that was diagnosed with DCIS (underlying cancer) comes in showing manifests on skin near the areola that looks like eczema what is the disease
Paget disease of the nipple
A women comes in with a form of breast cancer with uniform cells, mucin vacuoles, and you incidentally diagnosed that left untreated would turn into CA on both breasts
Lobular carcinoma in situ
Patient comes in with breast cancer that has invaded and adhered to the pectorals what is it
Invasive (infiltrating) carcinoma
What type of breast cancer has possible lymphedema and lymphatic mets that shows as dimpling of skin and nipple inversion after it invaded/adheres to the pectorals
Invasive/infiltrating carcinoma
What type of breast cancer extends from DCIS making up 75% of all breast CA with heterogenous cells, irregular borders that also has firm/ fibrotic and palpable lumps
Invasive ductal carcinoma
What breast CA is from LCIS that has multiple masses that are palpable and when aggressivecan mets to GI, ovary, uterus, CSF, marrow
Invasive lobular carcinoma
What type of breast cancers lack 3 main receptors (ER,PR,HER2) and are linked to mutations on BRCA1/2
Triple negative breast Ca’s
What type of pathology report deals with estrogen receptors and progesterone receptors where if both + indicates 80%. Response
Hormone receptors
HER2 breast cancer pathology report indicates from what and is 30% of all breast Ca’s
Gene amplification
What breast cancer has solitary painless mass detected during palpation
Invasive breast cancer
Where is invasive breast cancer usually mets to
Lymphatic
What does the location of invasive breast cancer more lateral/central indicate
Route through axillary nodes
What does the location of invasive breast cancer more medial
Internal mammary arteries
What brings on poorer prognosis of invasive breast cancer
Anaplasia, increase in size, invasion or distant mets, overexpression of HER2/neu
What brings about better prognosis of invasive breast cancer
Estrogen receptors, and progesterone receptors
Patient comes in with enlarged male breast tissue that is non cancerous, you notice increased estrogen and going through puberty
Gynecomastia
Who is most likely to get male breast cancer
Mc in elderly
Where is male breast cancer likely to go to
Rapidly invades thorax, 50% mets at dx
Patient comes in with bilateral button like subareolar swelling what is it
Gynecomastia
Patiet has increase connective tissue, ductal hyperplasia, and is not lobule
Gynecomastia
What type of vulvitis produces erythema, oozing/crust, itching commonly caused form soaps, lotions and other things
Allergic contact dermatitis vulvitis
What type of vulvitis is caused by HPV/HSV, trep pallidum, gonorrheae, c albicans
Infectious vulvitis
Patient comes in and is dx with an obstruction/dilation of a bartholin gland what is the condition
Bartholin cyst
What is a co-infecx with a barhtolin cyst
Bartholin abscess
What condition is produced from hyperplasia/hyperkeratosis of epithelium due to chronic irritation
Lichen simplex chronicus
What epithelial disorder is from atrophy due to an AI whitening near the minora
Lichen sclerosus
Patient age 8 and patient age 60 comes in with dermal fibrosis around the minora what do you suspect is the cause
Lichen sclerosus
What type of CA is produced from lichen sclerosus
5% SCC
What do lichen simplex chronicus and lichen sclerosus resemble
Leukoplakia
What type of condyloma is a causitive of secondary syphilis
Condylomata lata
What type of condyloma is caused by HPV 6/11 (genital warts)
Condylomata acuminata
What type of neoplasia usually impacts >60 years, 90% SCC and has late lymph mets
Vulvar carcinoma
What hpv-related SCC deals with precancerous lesion of the vulva
Vulvar intraepithelial neoplasia
What type of vulvar carcinoma is the mc type and impacts older women with symptoms of lichen sclerosus (no VIN)
Non-HPV related SCC
What is the cause usually for vaginitis
Infections = fungi, protozoan (C.albicans, trichomonas)
What are risks of vaginitis
Diabetes,immunodeficiency, antibiotics
What of the vagina is benign/transient and has leukorrhea, pain, itching
Vaginitis
What type of vaginal cancer is rare, but mc in the elderly
Squamos cell carcinoma
What vaginal cancer is a pre-cancerous vaginal intraepithleial neoplasia
Squamos cell carcinoma
What are the risks of squamos cell carcinoma vaginal cancer
HPV, early intercourse, multiple partners
What type of vaginal cacer has symptoms of rare red/granular foci
Clear cell adenocarcinoma
What vaginal cancer is a 40x risk from mothers who took DES
Clear cell carcinoma
What type of vaginal cancer is rare but is characterized by embryonal rhabdomyosarcoma
Sarcoma botryoides
What type of vaginal cancer is mc <5 years, soft/polypoid mass
Sarcoma botryoides
What skeletal muscle tumor usually affects the head and neck and is mc pediatric soft tissue sarcoma
Rhabdomyosarcoma
Is cervicitis benign or malignant
Benign
What prompts a pelvic exam due to leukorrhea, pain, itching, bleeding, fever
Cervicitis
What is the mc cause of cervicitis
Infectious = chlamydia
What are the 2 types of non infectious cervicitis
Acute and chronic
Chronic cervicitis is common in who
Reproductive age women due to estrogen fluctuations or trauma
What type of cervicitis deals with postpartum
Non infectious acute cervicitis
Most cases of cancer in the cervix are from what
HPV 16 - 18
Most hpv infections last months and if they persist they can become what
Cervical intraepithelial neoplasia
What cervical neoplasia has columnar cells undergoing squamos metaplasia
Puberty = eversion
What darker stain indicates cervical intraepithelial neoplasia
Koilocytosis
What neoplasia of the cervix starts as HPV producing dysplasia and eventually precancerous
Cervical intraepithelial neoplasia
When is CIN most commonly diagnosed
Age 30 and peaks 15 years later
What CIN needs observation
Low grade CIN 1
What CIN needs excision
CIN 2/3
Why do we do screenings for CIN
It is asymptomatic
What neoplasia is dx in mid 40’s and is usually SCC from HPV infection
Invasive carcinoma of the cervix
Where is cervical cancer located
Transformation zone
What size determines cervical cancer mets
1% if <3 mm, 10% if >3mm
Who is most likely going to get cervical cancer
Mc in women who lack screening
Invasion of cervical cancer results in what mc cause of death
Renal failure = mc cause of death
What is associated with barrel cervix
Invasive cervical cancer
What is endometrial inflammation in its normal location
Endometritis
What can endometritis left untreated from gonorrhea, chlamydia, TB produce
Pelvic inflammatory disease (PID)
What type of enometritis needs a removal of an item for resolutin
Retained products
What is a chocolate cyst associated with
Endometriosus
What is extrauterine endometrial tissue with multiple masses causing bleeding and fibrosis
Endometriosus
What is the cause of half of female infertility
Endometriosus
What abnormal uterine bleeding is profuse/prolonged menstruation
Menorrhagia
What abnormal uterine bleeding is irregular, between periods
Metorrhagia
What is an inadequate luteal phase
Anovulatory cycle
What can cause an anovuluntary cycle
Retained endometrium = prone to breakdown/bleeding
What is an overgrowth of endometrial cells due to increased estrogen or failed ovulation
Endometrial hyperplasia
What is the most common female genital tract cancer
Endometrial carcinoma
Who is most impacted by endometrial carcinoma
Age 55-65
What are symptoms of endometrial carcinoma
Enlarged uterus, leukorrhea, metorrhagia
How does endometrial carcinoma mets
Late lymphatic mets
What type of endometrial carcinoma is mc and deals with endometrial hyperplasia, increased estrogens, diabteses HTN
Endometrioid
What type of endometrial carcinoma deals with endometrial atrophy, post menopausal and is aggressive
Serous
What type of proliferative lesions is mc around menopause and causes bleeding, cancer risk
Enometrial polyps
What smooth muscle tumore is bening, multiple, reproductive age women, and is fibroid
Leiomyoma
Who is likely to get leiomyoma
Repro age women, increased estrogens, african americans
What smooth muscle tumore is malgnant, solitary
Leiomyosarcoma
What smooth muscle tumor is postmenopausal and mets to lungs mc
Leiomyosarcoma
What is a microbial infection of the fallopian tubes
Salpingitis
What else can cause salpingitis
Ectopic pregnancy, endometriosis, tumor
What is an adenocarcinoma mc on fimbriae
Fallopian tube carcinoma
What does fallopian tube carcinoma invade
Peritoneal cavity
What are risks of fallopian tube carcinoma
BRCA 1/2
What are ovarian cysts from
Graffian or ruptured follicles
How big are ovarian cysts
Serous filled cysts 1-4 cm
Patient comes in with multiple cystic follicles enlarged to 2x size
Polycystic ovarian disease
Why does PCOD cause hirsutism and obesity
Increased androgens, estorgens, LH and decrease FSH
Both PCOD and ovarian cysts are what genetically
Familial
Increase the size of ovarian cyst increases the what
Complications
What is the fifth mc cause of CA related death
Ovarian tumors
What are risks of ovarian tumors
> 20 years, nulliparity, family hx, BRCA 1/2
What can decrease the risk of ovarian tumors
Oral contraception
Surface epithelial tumors of ovarian tumors are benign or malig
Benign
What is 90% of ovarian cancers
Surface epithelial tumors
Ovulation creates what in surface epithelial tumors
Metaplasia
What are the mc surface epithelial tumors
Serous tumores
95% of surface epithelial tumors have what
Mutated TP53
When are most serous tumors benign
30-40 years old
When are most surface epithelial tumors malignant
45-65 years old
What are characteristics of serous tumors
Large = 40cm, 25% bilateral
What type of surface epithelial tumor is malignant
Endometrioid tumors
What are enometrioid tumors associated with
Endometrial CA and endometriosus
Wha type of endometrioid tumor increases CA risk
Solid no cystic
What is cancer of the GI tract that has spread to the ovaries with signet ring cells
Krukenburg tumore
What type of mets goes with krukenburg tumor
Lymphatic
Who is most likley to get krukenburg tumor
45 years old
What is signet ring cells originally a characteristic of before spread to ovaries
Gastric adenocarcinoma
Is ovarian teratomas benign or malignant
Benign, younger = increased cancer risk
What disease of pregnancy is mc
Ascending
What disease of pregnancy is from premature ruptrue of membranes sending neutrophils and edema there to combat mc bacteria
Ascending
What type of disease of pregnancy has the acronym TORCH
Transplacental
What is TORCH stand for
Toxoplasmosis, other, rubella, CMV, HSV
Where do most ectopic pregnancies take place
Most are tubal
When can ectopic pregnancies rupture
During 1st trimester
Why would ectopic pregnancy have acute abdominal pain
Salpingitis
What is a group of tumors resulting from abnormal fertilization
Gestational trophoblastic disease
What can mimic early pregnancy and increases hCG
Gestational trophoblastic disease
What is a benign tumor cystic mass that is grape like gestiational trophoblastic disease
Hydatidiform mole
When is there a risk for invasive hatidiform mole
Complete 2 sperm
What type of gestational trophoblastic disease is benign but locally invasive, from complete moles and can have possible life threatening hemorrhage
Invasive mole
What type of gestational trophoblastic disease is malignant, from complete mole, causing severe uterine bleeding extreme hCG increase (blood/urine
Choriocarcinoma
Choriocarcinoma commonly mets to where and is called what
Mc to the lungs, aka “cannonball metastasis”
What other cancers may produce a “cannonball” appearance
Testicular choriocarcinoma, renal cell carcinoma, prostatic adenocarcinoma
What is preeclampsia
Toxemia of pregnancy
What are symptoms of preeclampsia
HTN (>20 wks gestation), proteinuria, edema in face or periphery
What happens in preeclampsia around 3rd tirmester that can result in organ damage and placental hypoxia
Maternal endothelial dysfunx
Who is at risk for preeclampsia
1st pregnancy, material age> 35 years old
After preeclampsia what can develop due to endothelial damage that leads to clotting
DIC
What are the main issues with eclampsia
Onset of seizures and possible coma
What are the symptoms of eclampsia
Continued BP elevation, HA, diplopia, epigastric pain
How does eclampsia affect the kidneys and liver
Maternal end organ failure
What do 10% of cases of eclampsia develop (hint: what syndrome can develop)
HELLP syndrome
What does HELLP syndrome stand for
Hemolysis, elevated liver enzymes, low platelets
What type of minor abnormalities can happen in the breast
Supernumerary nipple, inverted nippled, galactocele
What takes place in the later stages of nursing and can produce a possible cyst due to an obstructed mammary gland duct
Galactocele
What can be common in the breast due to menstrual hormonal fluctuations
Fibrocystic changes
Who is most likely to have fibrocystic changes
Reproductive age females
Patient comes in with a fibrotic, cystic mass in the superolateral quadrant of the breast, what do you think it is
Fibrocystic changes
How does oral contraceptive impact fibrocystic changes
Decreases the risk
What are the categories of fibrocystic changes and which is mc
Nonproliferative (MC) and proliferative
What type of fibrocystic change has dilated ducts, multiple/bilateral cysts (<5cm), and has fibrotic/calcific densities
Non proliferative fibrocystic changes
What type of fibrocystic changes deals with ductal epithelial hyperplasia
Proliferative
Where does ductal epithelial hyperplasia of proliferative fibrocystic changes take place
Extra layer of cells in ducts/lobules (>2 cell layers)
What are the two types of proliferative fibrocystic changes and how are they categorized
Mild = orderly hyperplasia, atypical = dysplastic hyperplasia
Which type of fibrocystic change has an increased risk of breast CA
Atypical = 5x risk
What inflammatory breast lesion is indicated by small, chalky white painful mass
Fat necrosis
What is fat necrosis inflammatory breast lesion most likely caused by
Alcoholism/trauma= pancreatitis
What inflamm breast lesion is mc a S. Aureus infx in the ducts due to early nursing
Acute mastitis
Patient comes in age 40-60 wiith a non bacterial inflamm breast lesion with nipple retraction, what is it
Mammary duct ectasia
What inflamm breast lesion has chronic inflamm due to lymphocytes and plasma cells and is caused by ductal dehydration
Mammary duct ectasia
What are tumors of the breast mc from
Epithleia (fibrotic and glandular)
What is the mc benign breast tumor
Fibroadenoma
Who is likely to get fibroadenoma tumor of the breast
Younger women 20-30
What tumor of the breast is mostly bening but still has rapid growth with late mets
Phyllodes tumor
What tumor of the breast has a leaf like appearance
Phyllodes tumor
