Exam 3 Gynecological and Breast Diseases

Question 1

Define vulvitis.

Answer 1

inflammation of the external female genitalia

Question 2

Etiology of vulvitis

Answer 2

contact irritation, allergic reaction, infection, trauma

Question 3

Define vaginitis.

Answer 3

inflammation of the vaginal canal

Question 4

What is a result of vaginitis?

Answer 4

leukorrhea - vaginal discharge

Question 5

Etiology of vaginitis.

Answer 5

bacteria, fungi, parasites, diabetes, antibiotics

Question 6

What is the histology of the cervix?

Answer 6

NON-keratinized - should be no white changes in epithelium

Question 7

Define cervicitis

Answer 7

inflammation of the cervix - can result in purulent vaginal discharge

Question 8

Etiology of cervicitis.

Answer 8

Can represent a specific infection, like an STD, but often non-specific infection

Question 9

What is often required in a patient with cervicitis to rule out cancer or precancer?

Answer 9

biopsy - always

Question 10

What is the most common type of cervical cancer?

Answer 10

squamous cell carcinoma

Question 11

Why has the prevalence of cervical cancer decreased?

Answer 11

papanicolaou (pap) smears (1940) - detects precancerous cells

Question 12

Define/describe CIN.

Answer 12

cervical intraepithelial neoplasia –> this is preinvasive

Question 13

What stain is used in a pap smear?

Answer 13

papanicolau stain

Question 14

What cell types are screened in pap smears?

Answer 14

exfoliated cells collected from the cervix

Question 15

What does a colposcopy examine?

Answer 15

it is a direct view of the cervix where abnormalities will appear white after washed in acetic acid

Question 16

What is the precursor epithelial change that indicates squamous cell carcinoma in the cervix?

Answer 16

cervical intraepithelial neoplasia (CIN)

Question 17

What is the peak age for CIN?

Answer 17

30 yrs

Question 18

What is the peak age for squamous cell carcinoma in women?

Answer 18

45 yrs

Question 19

Do all CINs progress into cancer?

Answer 19

no

Question 20

What needs to be done if there is an atypical pap smear?

Answer 20

colposcopy or biopsy

Question 21

What is epithelial dysplasia?

Answer 21

cytologic and maturational disturbances of epithelium seen microscopically

Question 22

Explain the different grades of CIN.

Answer 22

CIN I - mild dysplasia
CIN II - moderate dysplasia
CIN III - Carcinoma in situ
higher grade = more likely to be cancer

Question 23

What is the major factor in cervical neoplasia?

Answer 23

human papillomavirus

Question 24

How is HPV transmitted?

Answer 24

direct contact

Question 25

What are the high risk types of HPV?

Answer 25

16 and 18 - associated with cancer

Question 26

What are the low risk types of HPV?

Answer 26

6 and 11 -- associated with condyloma

Question 27

What are risk factors for HPV/squamous cell carcinoma?

Answer 27

early age at first intercourse multiple sex partners male partner with multiple previous sexual partners prolonged infection with high-risk HPV *risk factors are secondary since there is an HPV vaccine

Question 28

What is the treatment for squamous cell carcinoma?

Answer 28

laser vaporization or excisional biopsy of CIN Surgery radiation chemotherapy

Question 29

What vaccine is safe and effective in preventing HPV infection?

Answer 29

Gardasil 9

Question 30

Describe the endometrium of the uterus.

Answer 30

glandular lining that changes under hormonal influence. (menstrual cycle)

Question 31

Describe the myometrium of the uterus.

Answer 31

muscular wall composed of interlacing bundles of smooth muscle

Question 32

Define menorrhagia.

Answer 32

abnormally heavy menstrual bleeding

Question 33

Define metrorrhagia.

Answer 33

bleeding between menstrual cycles

Question 34

Define dysmenorrhea

Answer 34

unusually painful menstrual bleeding

Question 35

True or False- | Most endometrial diseases do not present with abnormal uterine bleeding.

Answer 35

False. they do present with abnormal bleeding

Question 36

Describe endometriosis.

Answer 36

functional endometrium is located outside the uterus and undergoes cyclic bleeding (still has hormonal response)

Question 37

What percentage of women with infertility also have endometriosis?

Answer 37

50%

Question 38

What can occur with endometriosis?

Answer 38

widespread fibrosis and periuterine adhesions --> severe dysmenorrhea and pelvic pain

Question 39

What is a chocolate cyst?

Answer 39

large blood filled cyst on the ovary - turns a brown color as blood ages

Question 40

What is endometrial hyperplasia?

Answer 40

an overgrowth of endometrium

Question 41

Name some risk factors for endometrial hyperplasia.

Answer 41

obesity, hormone intake, failure to ovulate, estrogen producing ovarian tumors

Question 42

What causes endometrial hyperplasia?

Answer 42

excess exposure to estrogen (exogenous or endogenous)

Question 43

What can result from endometrial hyperplasia?

Answer 43

adenocarcinoma

Question 44

How do you treat endometrial hyperplasia?

Answer 44

D&C , correct/tx underlying cause (like readjust medication dosage)

Question 45

Are there different stages of endometrial hyperplasia?

Answer 45

yes 3 stages: mild moderate atypical hyperplasia

Question 46

From what tissues do uterine tumors arise?

Answer 46

endometrium or myometrium

Question 47

What are the most common uterine tumors?

Answer 47

endometrial polyps smooth muscle tumors carcinomas

Question 48

What is a leiomyoma (fibroids)

Answer 48

benign tumor of the myometrial smooth muscle

Question 49

What age group is leiomyoma common?

Answer 49

30-50% of women in reproductive age

Question 50

What stimulates the growth of a leiomyoma?

Answer 50

estrogens; so they can regress after menopause

Question 51

What are common symptoms of leiomyoma?

Answer 51

some are asymptomatic menorrhagia palpable pelvic mass infertility

Question 52

What is the most common female genital tract cancer in the US?

Answer 52

endometrial carcinoma

Question 53

What age group usually does endometrial carcinoma usually affect?

Answer 53

55-65 yr olds

Question 54

What are some symptoms of endometrial carcinoma?

Answer 54

leukorrhea or irregular bleeding

Question 55

Describe treatment for endometrial carcinoma.

Answer 55

surgery and radiation or chemo

Question 56

Is there a good 5 year prognosis for endometrial carcinoma?

Answer 56

yes, 90% 5 yr survival rate

Question 57

Describe polycystic ovarian disease.

Answer 57

hormonal disorder in 5-10% of young females (reproductive age)

Question 58

What is the etiology of polycystic ovarian disease?

Answer 58

there isn't a complete understanding; possible genetic influence

Question 59

What is being produced by the cysts in polycystic ovarian disease?

Answer 59

androgens and estrogens

Question 60

Describe some symptoms of polycystic ovarian disease.

Answer 60

oligomenorrhea, hirsuitism (male hair growth pattern in women), acne, fertility issues, obesity

Question 61

Who is at increased risk for polycystic ovarian disease?

Answer 61

type II diabetics, individuals w/ hypertension and cardiovascular disease

Question 62

What type of tissue does a majority of ovarian carcinomas arise? What are the other tissue types they arise from?

Answer 62

90% are from surface epithelial | Can arise from germ cells or stroma

Question 63

What are risk factors for ovarian carcinoma?

Answer 63

nulliparity (woman who has never given birth) or family history

Question 64

What gene mutations are a concern for ovarian carcinoma?

Answer 64

BRCA gene | BRCA 1 & 2 - increase risk for breast and ovarian cancer

Question 65

Are there symptoms associated with ovarian carcinoma?

Answer 65

most are asymptomatic until they are large

Question 66

What is the prognosis for ovarian carcinoma?

Answer 66

10 yr survival is less than 15% if cancer is spreads outside ovary

Question 67

What is a teratoma?

Answer 67

a tumor in all three germ layers: ectoderm, mesoderm, endoderm

Question 68

What age group do teratomas arise?

Answer 68

in someones first 2 decades of life

Question 69

Are benign or malignant teratomas more common?

Answer 69

90% are benign | malignant are seen in younger patients

Question 70

Is there a screening for a teratoma?

Answer 70

no, they are usually incidental findings during a routine pelvic exam/ultrasound

Question 71

What is seen in the microscopic pathology of a teratoma?

Answer 71

skin, hair, teeth, bone, respiratory epithelium, cartilage (remember all germ layers are represented)

Question 72

Describe a fibrocystic change in breast pathology?

Answer 72

overgrowth of fibrous stroma and/or glandular elements

Question 73

Describe a fibroadenoma in breast tissue.

Answer 73

solitary, freely movable nodule 1-10 cm

Question 74

What usually causes a fibroadenoma?

Answer 74

increased estrogen

Question 75

What age group is usually affected by fibroadenomas?

Answer 75

prepubertal girls, young women | peaks in 3rd decade

Question 76

Are fibroadenomas of the breast typically benign or malignant?

Answer 76

benign

Question 77

What is usually shown in the biopsy of fibroadenomas?

Answer 77

proliferation of stroma and glands

Question 78

What tissue does most breast cancer arise?

Answer 78

glandular elements of the breast

Question 79

What is the 2nd leading cause of cancer deaths in women?

Answer 79

breast cancer

Question 80

What age group is mostly affected from breast cancer?

Answer 80

women over 50 (75%)

Question 81

What are some risk factors related to breast carcinoma?

Answer 81

genetics hormonal influences (prolonged exposure to estrogen) environmental (radiation, diet, nursing habits, reproductive patterns)

Question 82

What genes are related to inheritable breast carcinoma?

Answer 82

BRCA 1 and BRCA 2 genes - typically occurs at a younger age

Question 83

What quadrant of the breast is breast carcinoma located in that has the highest mortality?

Answer 83

inner lower quadrant

Question 84

How is breast carcinoma detected?

Answer 84

clinically - non-tender mass, nipple retraction, thickened overlying skin -->surface of an orange Mammography

Question 85

What is mammography detecting?

Answer 85

calcifications or soft tissue density

Question 86

How do you diagnose breast carcinoma?

Answer 86

biopsy

Question 87

What are the two types of breast carcinoma we discussed?

Answer 87

ductal carcinoma | lobular carcinoma

Question 88

Are there preinvasive stages with ductal or lobular carcinoma?

Answer 88

yes, ductal carcinoma in-situ | lobular carcinoma in-situ

Question 89

Describe ductal carcinoma.

Answer 89

arises from ductal epithelium - most common

Question 90

Describe lobular carcinoma.

Answer 90

arises from glandular acini - more terminal regions (?)

Question 91

How do you treat carcinoma of the breast?

Answer 91

surgery, radiation, chemo, tamoxifen (anti-estrogen therapy)

Question 92

What is the prognosis for someone with breast carcinoma?

Answer 92

10 yr survival - 50% | metastases can occur years after therapeutic control of primary lesion