FA Repro II Flashcards by G Thakur

What are the most common cause of anovluation

PCOS, obesity, Asherman’s, HPO axis defect, POF, hyperprolactinemia, thryoid, eating disorders, cushging’s, adrenal insuff

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hyperandrogenism due to deranged steroid synthesis by theca cells, inc LH leading to anovulation

PCOS

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what is the clinical manifestation of PCOS

enlarged bilateral cystic ovaries, amenorrhea, infertility, obesity, and hirsutism

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what metabolic disorder is assocaited with PCOS

insulin resistance

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What are the treatments for PCOS

weight loss, OCP, gonadotropin analogs, clomiphene, sprinolactone, surgery

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distention of unruptured graafian follicle

follicular cyst

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hemorrhage into persistent corpus luteum

corpus luteum cyst

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which cysts results from gonadotropin stimulation and is associated with choriocarcinoma and moles

theca-leutin cysts

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blood containing cyst from ovarian endometriosis that varies with menstrual cycle

chocolate cyst

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in what age group are ovarian germ cell tumors most common

adolescents

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equivalent to seminoma in the ovary and forms a sheet of uniform cells, marked by hCG and LDH

dysgerminoma

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large, hyperchromatic syncytiotrophoblasts cells, inc freq theca leutin cysts, develops during pregnancy in mom or baby, marked by hCG

choriocarcinoma

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malignancy in ovaries, testis, sacrococcygeal area of young children, yellow friable solid masses with 50% having schiller-duval bodies

yolk sace, endodermal sinus, tumor

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90% of ovarian germ cells tumors, contains cells from 2 or 3 germ layers

teratoma

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what is the most frequent benign ovarian tumor

mature teratoma

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how can struma ovarri present?

hyperthyroidism, contains functional thyroid tissue

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Which teratoma, mature or immature, is aggresively malignant

immature

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20% of ovarian tumors, benign, lined with fallopian tube like epithelium

serous cystadenoma

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50% of ovarian tumors, malignant and frequently bilateral

serous cystadenocarcinoma

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multilocular cyst lined by mucus secreting epi, benign, intestine like

mucinous cystadenoma

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malignant, pseudomyxoma pertonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

mucinous cystadenocarcinoma

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Benign, looks like bladder

brenner tumor

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bundles of spindle shaped fibroblasts, pulling sensation in the groin

fibromas

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triad of ovarian fibroma, ascites, hydrothorax

meigs syndrome

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can present as precocious puberty in kids, can cause endometrial hyperplasia/carinoma in adults, abnormal uterine bleeding

granulosa cell tumor

small follicles filled with eosinphilic secretions

call exner bodies

GI malignancy that metastasizes to ovaries causing a mucin secreting signet cell adenocarcinoma

Krukenburg tumor

Vaginal sqamous cell carcinoma is most often seconday from which site?

cervix

predisposing factor to clear cell adenocarcinoma of the vagina

DES in utero (DES is a sythetic estrogen)

vaginal carcinoma affecting girls < 4 spindle shaped tumors cells that are desmin positive

sarcoma botryoides, a rhabdomyosarcoma variant

small, mobile, firm breast mass with sharp edges, most common in <25

fibroadenoma

What occurs to a fibroadenoma during pregnancy and menstruation and why

inc size and tenderness with inc estrogen

is fibroadenoma a precursor to breast cancer

small breast tumor that grows in lactiferous ducts, typically beneath the areola with serous or bloody nipple discharge

intraductal papilloma

What is the risk for carcinoma among patients with intraductal papilloma

slight increase, 1.5 to 2

Large bulky breast mass of connective tissue and cysts with leaf like projections

phyllodes tumor

When are phyllodes tumors most common

in the 6th decade of life

In what group are malignant breast tumors most commonly seen

post menopausal

From what tissues to malignant breast tumors arise?

mammary duct epithelium or lobular glands

Overexpression of which receptors is common iwht malignant breast tumors

estrogen/progesterone receptors, erb-B2, HER2 an EGF receptrs

What is the single most important prognostic factor for malignant breast tumors

axillary node involvement

What are the associated risk factors for malignant breast tumors

inc estrogen, inc total nunmber of cycles, older age at 1st live birth, obesity

in postmenopausal women where is androstenedione converted to estrone

peripheral adipose tissue

tumor that fills ductal lumen, arises from ductal hyperplasia, early malignancy without BM penetration

DCIS

tumor with firm fibrous, "rock hard" mass with sharp margins and small glandular duct like cells, worst prognosis and most common

invasive ductal

tumor with orderly row of cells, often multiple and bilateral

invasive lobular

tumor is fleshy, cellular, with a lymphocytic infiltrate, good prognosis

medullary

tumor is ductal with caseous necrosis

comedocarcinoma

Dermal lymphatic invasion by breast carcinoma, peu d orange

inflammatory

Why does the skin resemble an orange peel in inflammatory type of maligantn breast tumor

neoplastic cells block lymphatic drainage

ecsematous patches on nipple and/or vulva, suggests underlying carcinoma

paget's disease

large cells in epidermis with clear halo,

paget cell

what is the most common cause of breast lumps from age 25 to menopause

fibrocystic disease

What is the presentation of fibrocystic dz

prementsrual breast pain and multiple lesions

histologic type of fibrocystic with hyperplasia of breast stroma

fibrosis

histologic type of fibrocystic with fluid filled, blue dome and ductal dilation

cystic

histologic subtype of fibrocystic with inc acini and intralobular fibrosis

sclerosing adenosis

What is associated with sclerosing adenosis?

calcifications

histological subtype of fibrocystic with inc number of epithelial cell lauers in terminal duct lobule, women over 30

epithelial hyperplasia

atypical cells in epithelial hyperplasia

inc risk for carcinoma

breast abscess, during breast feeding with increased risk of bacterial infxn through cracks in the nipple

acute mastitis

what is the most common pathogen in acute mastitis

s aureus

benign painless lump, forms as a result of injury to breast tissue, possible history of trauma

fat necrosis

What does gynecomastia result from?

hyperestrogenism

what are common causes of hyperestrogenism

cirrhosis, testicular tumor, puberty, old age, klinefelter's syndrome, drugs

Some drugs cause awesome knockers

sprinolactone, digitalis, cimetidine, alchohol, ketoconazole

Breast path, disease that occurs at the nipple

paget's disease, breast abscess

breast path, diseases of the lactiferous sinus

intraductal papilloma, breast abscess, mastitis

breast path, diseases of the major duct

fibrcystic change, ductal cancer

breast path, diseases of the terminal duct

tubular carcinoma

breast path, diseeases of the lobules

lobular carcinoma, sclerosing adenosis

breast path, diseases of the stroma

fibroadenoma, phyllodes tumor

what is the presentation of prostatitis

dysuria, frequency, urgency, low back pain

what bacteria is commone in acute prostatitis

e coli

in chronic prostatitis is bacterial or abacterial more common

abacterial

hyperplasia, not hypertrophy of the prostate gland

BPH

increases in which hormone are associated with BPH

estradiol and possible growth promoting effects of DHT

where is the enlargement found in BPH

periurethral lobes, lateral and middle

how does BPH present

inc freq of urination, nocturia, difficulty starting/stopping urination, dysuria

complications of BPH

distention and hypertrophy of bladder, hydronephrosis, UTIs, not premalignant

what is the serum marker for BPH

PSA

what are the treatments for BPH

alpha1 antagonists, terazosin, tamsulosin, finasteride

Where does prostatic adenocarcinoma arise from?

posterior lobe peripheral zone

How is prostatic adenocarcinoma diagnosed

DRE, hard nodule and biopsy

what are the useful tumor parkers in prostatic adenocarcinoma

Prostatic acid phosphatase and PSA

What changes are seen with total PSA and fraction of free PSA

inc in total, and dec in free fraction

What metastasis is most common with prostatic adenocarcinoma

osteoblastic in bone

What is the common presentation of metastasis in prostate cancer

low back pain with increased serum alk phos

what does the histo show for prostate cancer

small infiltrating glands with prominent nucleoli

what is a complication of cryptorchidism and why does it occur

lack of spermatogenesis due to inc temp of testis inside body and associated risk of germ cell tumors

what increases the risk of cryptorchidism

prematurity

malignant, painless homogenous testicular enlargement, most common testicular tumor, affecting males ages 15 to 3, large cells in lobules with watery cytoplasm and a "fried egg" appearnace,

seminoma

what is the prognosis for seminoma

good, late metastasis

malignant, painful, often glandular/papillary morphology testicular germ cell tumor that can differentiate into other tumors

embryonal carcinoma

What serum markers are associated with embyronal carcinoma

inc AFP and hCG

inc AFP, schiller duvel bodies, yellow mucinous

yolk sac, endodermal sinus, tumor

malignant, inc hCG, disordered syncytiotrophoblastic and cytotrophoblastic elements, hematogenous spread

choriocarcinoma

in males, are mature teratomas malignant? What is the case for females

malignant in males not in females

What percentage of testicular tumors are germ cell

95%

reinke crystals, androgen producing, gynecomastia in men, precocious puberty in boys, golden brown color

leydig cell tumor

androblastoma from sex cord stroma

sertoli cell tumor

most common testicular cancer in older men

testicular lymphoma

testicular masses that can be transilluminated

tunica vaginalis lesions

dilated vein in pampiniform plexus, bag of worms

varicocele

inc fluid secondary to incomplete fustion with processus vaginalis

hydrocele

dilated epididymal duct

spermatocele

gray, soliarty, crusty plaque, usually on the shaft of the penis or on the scrotum, peak incidence in 5th decade of life, can progress to invasive SCC in < 10% of cases

Bowen's dz, carcinoma in situ of the penis

Red velvety plaques, usually involving the glans, similar to Bowen's

erythroplasia of Queyrat, carcinoma in situ of penis

Multiple papular lesions on the penis, affects younger age group, usually does not become invasive

bowenoid papulosis, carcinoma in situ of the penis

Where is SCC of the penis more common and what is it associated with

Asia, Africa, S. America, HPV, lack of circumcision

Bent penis due to acquired fibrous tissue formation

Peyronie's dz