exam3 guide female Flashcards
Describe signs/symptoms of breast cancer
Focal lesions can extend in all directions and may become adherent to deep fascia of chest wall and become fixed in position
Skin dimpling
Lymphatic blockage can cause lymphedema and skin thickening => peau d’ orange
Nipple retraction (if tumor involves main excretory duct)
breast cancer and diagnostic modalities
80-90% of breast carcinoma is detected by self-exam, palpation in clinician’s office, or mammography
Complete PX must include palpation of breast with biopsy of suspicious masses or nodules.
-Mammography: can detect early growth of tumors, <0.5 cm
-FNA: accuracy rate >95%. Sample can be too small for dx. May need surgical biopsy
-Breast biopsy: more tissue, more appropriate final dx.
Cancer risk factor increase of fibrocystic condition and intraductal papillomas
Fibrocystic conditions: Increased risk only if atypical epithelial hyperplasia
Intraductal papillomas: Increased risk only if there are multiple
Know the general risk factors for breast cancer
Most important: hormonal and genetic, as well as poss. Environmental or carcinogenic viruses
- Sex: females 100x > men
- Age: rarely before puberty; unusual in YW. Incidence rises after age 35 and peaks in postmenopausal women ~60
- Genetics: more common in some families. Increased risk with first degree relatives. History of familial cancer increases risk 5-10 (higher in some families)
- Hormones: women exposed to estrogens for prolonged period develop more frequently. More common in women with early menarche and late menopause. Nulliparous women at greater risk. >90-95% tumors are estrogenic positive
- Other cancers: incidence increased in women who have cancer in other breast, or other hormonal cancers (ovarian and endometrial)
- Race: uncommon in Japanese, Chinese. MC in Caucasians, esp. Jews
- Premalignant fibrocystic changes and multiple intraductal papillomatosis: with atypical epithelial hyperplasia, multiple intraductal papillomas, can progress to invasive carcinoma over years if not removed
Fat necrosis
- Tends to occur as solitary, sharply localized process in one breast. Almost all patients give a history of previous trauma, prior surgical intervention, or radiation therapy.
- Grossly: hemorrhage with central fat necrosis. Later forms nodule of grey-white firm tissue with foci of chalk-white debris.
- Possibly confused with cancer when fibrotic
Fibrocystic Changes of Breast
- Most common condition of female breast
* Describes fibrosis and cysts with reactive and degenerative changes that occur in breast of older women.
Fibrocystic Changes of Breast Pathology
- estrogen and progesterone stimulate proliferation of cells in excretory ducts of breast and intralobar stroma
- Imbalance may cause irregularity in ducts, lobules, and stroma
- Change include: dense fibrosis (most consistent feature), cystic dilation of ducts, ductal proliferative changes
- Loose intralobar connective tissue replaced by dense connective tissue – has lots of collagen but don’t listen much to them hormones
- Ductal epithelium continues to proliferate in response to hormones. Dilated ducts can become entrapped in dense connective tissue and lead to cysts.
- Epithelial hyperplasia always present
- When this becomes multilayerd with atypical nuclear change, it’s called Atypical Epithelial Hyperplasia – only change related to development of carcinoma
- Etiology: Associated with hormones, increased age
blue domed cyst a/w ?
Fibrocystic Changes of Breast
Fibrocystic Changes of Breast Etiology
Associated with hormones, increased age
• Does NOT occur before puberty. Unusual to diagnosis onset clinically in postmenopausal women
Fibrocystic Changes of Breast s/s
- Produces palpable lumps in breast substance
- Typically affects both breasts – patients may complain of pain, nodularity, sensitivity to palpation
- Lumps are easily palpable, may fluctuate, correspond to fluid-filled cysts
Fibroadenomas of the Breast
- MC of benign breast tumors
- Etiology: common in young women; occurs MC in upper outer quadrant
- Tx: do not recur or undergo malignant changes. Easily removed.
Locations for breast cancer
- 45% occur in upper outer quadrant, 25% are central (underneath areola)
- Tend to met via lymph, most mets found in axillary area
General infections of the male and female external genitalia o Bacteria
▪ Common. Gonorrhea, gardnerella vaginalis, Treponema pallidum (syphilis), granuloma inguinale, cancroid, mycoplasma
General infections of the male and female external genitalia
viral
▪ HSV, HPV, CMV, Mollascum contagiosum
▪ Typically affect vulva, vagina, cervix
General infections of the male and female external genitalia fungal
▪ Candida albicans
▪ Typically cause vulvovaginitis, does not invade into deeper tissue
General infections of the male and female external genitalia ▪ Typically cause vulvovaginitis, does not invade into deeper tissue
o Chlamydial infection
▪ Obligate intracellular organisms that share features of bacteria and viruses. Causes cervicitis and urethritis
General infections of the male and female external genitalia o Protozoan
▪ Typically limited to vagina.
▪ Trichomonas is most important pathogen
General infections of the male and female external genitalia
CP
o Local: Itching, pain, ulcers, blisters, chancres
o Systemic: fever, malaise, poss. Peritonitis & sepsis if bacteria enters abd. cavity (gonorrhea)
choriocarcinoma pahto
Placental origin, Forms bulky hemorrhagic nodules in the placental bed that invades through the wall of the uterus and often implants in the vagina.
-secretes hcg
choriocarcinoma Grossly
No testicular enlargement and is small painless nodule.
marked hemorrhage and necrosis on cut surface
choriocarcinoma Histology
Trophoblastic tissues found in areas of hemorrhage
Synctiotrophoblasts = large multinucleated giant cells with abundant cytoplasm that contains HCG
Cytotrophoblastsa = polygonal cells with hyperchromatic nuceli and sparse cytoplasm
choriocarcinoma Tx/Prognosis
The tumor responds well to chemo with
Methotrexate, and cure rates of 80-100% have been achieved, but only in those patients who do not have metastases.
choriocarcinoma clinically
Highly malignant
Pure tumors are rare – mostly component of mixed germ cell tumor
Complications of pelvic inflammatory disease
- Rupture of tubovarian abscess
- Infertility from scarring of tube
- Increased rate of ectopic pregnancies
Describe the metaplastic process involved in the cervical transformation zone
- As women age, mucinous columnar epithelium undergoes squamous metaplasia – thus columnar epithelium is transformed into stratified squamous epithelium
- “new” squamocolumnar junction now located at internal os
- Area between original junction on exocervix and new junction at internal os = “transformation zone”
