Female Flashcards

1
Q

The central pathologic abnormality of PCOS is?

A

Numerous cystic follicles or follicle cysts

In reproductive age women

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2
Q

Common S/Sx of PCOS

A
  • Persistent anovulation
  • Obesity (40%)
  • Hirsutism (50%)
  • Virilism (rare)
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3
Q

Recent studies link PCOS to {{…}}

A

Insulin resistance

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4
Q

Unlike PCOS, ovarian stroma, display…

A
  • Post-menopausal women
  • B/L symmetrical enlargement of ovaries
  • Similar S/Sx: hirsutism, obesity

PCOS: cysts; pre-menopausal

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5
Q

What is the earliest sign of an endometrial cancer?

A

Post-menopausal bleeding

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6
Q

Why are ovarian neoplasms related to a higher rate of mortality when compared to cervical or other female reproductive tract cancers?

A
  • Hard to detect early
  • Not many S/Sx
  • Most are benign & occur 20-45 yo (80%)
  • Malignant tumors: 40-65 yo
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7
Q

What is the main risk factor for cervical cancer?

A

HPV infection

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8
Q

What is the main risk factor for endometrial cancer?

A

Estrogen excess

Exogenous estrogen; early menarche

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9
Q

What are the most common S/Sx of ovarian neoplasms?

A
  • Abdominal pain
  • Abdominal distention
  • Urinary & GI Sx

General Sx due to non-functional nature of neoplasms

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10
Q

{{…}} are the origin of most ovarian cancers

A

Surface epithelial cells

90% malignant

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11
Q

What are the most common types of surface epithelial cell ovarian cancers?

A
  • Serous tumor
  • Mucinous tumor
  • Endometroid tumor
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12
Q

The risk of malignancy of ovarian cancers is directly propertional to {{…}}

A

Solid mass

Not fluid –> solid mass only

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13
Q

{{…}}, are concentric calcifications that are frequently seen in serous ovarian neoplasms

A

Psamomma bodies

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14
Q

A cancer features the following histopathology image. What type of ovarian tumor do you suspect?

A

Serous ovarian tumor

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15
Q

The {{…}} type of ovarian tumors are more likley to grow in large size with less surface inolvement

A

Mucinous tumors

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16
Q

Upon exploratory laporotomy, it is found that a patient suffering from a large ovarian tumor and has a large quantity of mucin within their peritoneal cavity. What type of tumor do you suspect they suffer from?

A

Mucinous

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17
Q

{{…}} type of ovarian tumors are mostly carcinomas that involve the endometrium and can coexist with endometriosis

Usually found in 50-70 yo

A

Endometrioid

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18
Q

What biomarker may be used to evaluate for ovarian neoplasm in BRCA1 or BRCA2 patients?

Only used for those at risk or to monitor treatment

A

CA-125

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19
Q

What procedure(s) can be used to reduce the risk of ovarian cancer in those with BRCA mutations?

A
  • Tubal ligation
  • Oral contraceptive therapy
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20
Q

{{…}} are benign tumors that can undergo malignant transformation of any of the components

A

Teratomas

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21
Q

Teratomas are most commonly found in women of {{…}}

A

Reproductive years

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22
Q

Are dermoid cysts can be used to desribe benign cancerous lesions called {{…}}

A

Teratomas

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23
Q

The karyotype of all teratomas will be {{…}}

A

46,XX

Same # as female has

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24
Q

A {{…}} type of teratoma is composed almost of entirely mature thyroid tissue that can hyperfunction and cause hyperthyroidism

Tachycardia, exothalmos, etc

A

Struma ovarii

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25
Q

{{…}} is the most common germ cell tumor in children and can elaborate α-FP

Can contain schiller-duval bodies (glomerulus-like structures)

A

Endodermal sinus tumors

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26
Q

{{…}} produce large amounts of estrogen linked to endometrial hyperplasia, endometrial carcinoma, and breast carcinoma (breast cancer)

A

Granulosa-theca cell tumor

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27
Q

Krukenberg or metastatic tumors of the ovaries are highly related to {{…}} cancers

Signet ring histologic pattern

A

GIT

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28
Q

A {{…}} type of cancer is associated with right-sided hydrothorax known as Meign’s syndrome

A

Fibrothecoma

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29
Q

The {{…}} tumors can be masculinizing or defeminizing but are not as common as PCOS

A

Sertoli-Leydig cell tumors

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30
Q

The most common site of ectopic pregnancy is?

A

Fallopian tubes (90%)

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31
Q

The most common risk factor for ectopic pregnancy?

A

PID (w/ chronic salpingitis)

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32
Q

Diethylstilbestrol (DES) exposure increases the risk of what type of cancer?

A

Vaginal clear cell adenocarcinoma

In utero exposure

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33
Q

{{…}} is the Dx procedure of choice along with β-hCG testing to evaluate for ectopic pregnancy

A

Transvaginal ultrasound

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34
Q

A normal rise in {{…}} is not seen in ectopic pregnancy

A

β-hCG

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35
Q

First trimester bleeding is typically associated with?

A

Normal implantation

2nd/3rd trimester assoc. w/ abnormal implantation

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36
Q

A sudden onset of pain during 27-32 weeks gestation w/ or w/o vaginal bleeding you should suspect & rule out {{…}}

A

Abruptio placentae

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37
Q

In {{…}} the placenta is near the internal os of the cervix and can lead to significant hemorrhaging during delivery

Adv maternal age, multiple gestations, previous C-section, etc.

A

Placenta previa

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38
Q

In {{…}} there is partial or complete absence of the decidua of the endometrium w/ adherence of the placenta directly to the myometrium

Can be a cause of obstetric bleeding

A

Placenta accreta

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39
Q

S/Sx of preeclampsia

A
  • HTN
  • Proteinuria

Both must be present

After 20 weeks gestation; if < 20 weeks then chronic HTN

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40
Q

{{…}} is similar to preeclampsia (proteinuria & HTN) with new onset of seizures

A

Eclampsia

Can occur before & after delivery

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41
Q

What is the main mechanism behind preeclampsia?

A

Reduced placental perfusion

Maternal antioxidants & endothelial dysfunction –> reduced perfusion

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42
Q

What arteries display abnormal remodeling in the mechanism behind preeclampsia & eclampsia?

A

Remodeling of Spiral Arteries

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43
Q

What are some risk factors for preeclampsia/eclampsia?

A
  • FMH of preeclampsia
  • Preeclampsia w/ a previous pregnancy (man or woman)
  • Fetus w/ a karyotypic abnormality
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44
Q

β-hCG level is much higher than that seen in pregnancy in what type of diseases?

A

Gestational trophoblastic disease
* Hydatidiform mole
* Invasive mole
* Choriocarcinoma

More hCG more malignant

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45
Q

{{…}} are a gestational trophoblastic disease characterized as “grape-like” swellings of the chorionic villi

A

Hydatidiform mole

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46
Q

Complete hydatidiform moles are genotypically {{…}}

A

Dilpoid (46,XX or 46,XY)

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47
Q

Partial hydatidiform moles are genotypically {{…}}

A

Triploid (69,XXY or 69,XXX)

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48
Q

Which type of hydatidiform mole will not display fetal parts?

A

Complete hydatidiform moles

Maternal egg is absent of DNA; All genes from paternal origin (sperm)

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49
Q

Which type of hydatidiform mole can produce fetal parts w/ a viable embryo maintained for up to weeks?

A

Partial mole (sperm has diploid DNA or 2 sperm fertilize the egg)

Maternal egg (DNA) is normal; Sperm or action of sperm is abnormal

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50
Q

A complete hydatidiform mole is completely a {{…}}

A

Cystic/villous mass

no fetal parts

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51
Q

Which type of hydatidiform mole is most likely to become a choriocarcinoma?

A

Complete hydatidiform mole (46,XX or 46,XY)

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52
Q

How are hydatidiform moles identified?

A
  • Ultrasound at 12-14 weeks (too large for dates)
  • Cystic appearance upon ultrasound
  • Detected earlier via β-hCG
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53
Q

What are the risk of not removing all of the hydatidiform mole?

A
  • Invasion of myometrium
  • Rupturing & life-threatening hemorrhaging
  • Embolization

Can spread to broad ligament & vagina; monitor via hCG

54
Q

Months after a normal pregnancy, a patient comes in complaining of bloody, brown discharge with high levels of hCG still in their laboratory work. What do you suspect?

A

Choriocarcinoma

Necrotic mass –> brown; roughly 100% cure rate

55
Q

Why is bacterial vaginosis important to treat during pregnancy?

A

Can lead to premature rupture of the membrane (premature birth)

56
Q

What is the Dx criteria for bacterial vaginosis?

Amsel’s criteria

A
  • Clue cells
  • Fishy odor upon KOH
  • Vaginal pH > 4.5
  • Thin homogenous discharge

3 of the above

57
Q

S/Sx of PID

A
  • Pelvic pain
  • Adnexal tenderness (implies infection)
  • Fever
  • Vaginal discharge

Adnexa = appendages of organ

58
Q

A patient comes into your office complaining of a greenish-yellow vaginal discharge along with a fever of 101F. You perform a vaginal swab which indicates WBCs on wet mount. What is your preliminary Dx?

Pt has no other S/Sx pointing to other cause

A

PID

59
Q

In gonococcal PID, it is common for the {{…}} to be involved in disease

A

Cervix

60
Q

Acute suppurative salpingitis that spares the endometrium can be a sign of {{…}} PID

A

Gonococcal PID

61
Q

How does a salpingo-oophoritis develop in gonococcal PID?

A
  • Tubal fimbriae leak exudate w/ fibrin
  • Fimbriae seal to ovaries leading to combining of tubes with ovaries

An abscess can develop

62
Q

Why is post-partum and post-abortion PID important to treat? Especially after pregnancy?

A
  • The sequelae are bad: salpingo-oophoritis & abscess formation
  • In post-partum & post-abortion, lymphatic/blood spread is more common leading to bacteremia

Tx before comfirmation to avoid sequelae

63
Q

Lichen sclerosus leads to…

A
  • Atrophy of epidermis (labia; rete peds)
  • Subepithelial (dermal) fibrosis
  • Narrowing of introitus
  • Bandlike lymphocytic infiltrate

Most commonly occurs after menopause

64
Q

{{…}} is a non-specific condition that results from rubbing or scratching the skin to relieve pruritus

Characterized by acanthosis & hyperkeratosis

A

Lichen simplex chronicus

Itching can be due to various conditions (e.g., bacterial vaginosis)

65
Q

Lichen simplex chronicus is different from lichen sclerosis as there can be {{…}} of the epithelium

A

thickening

Hyperkeratosis & Acanthosis (thickening of epidermis)

66
Q

How & why do you treat lichen sclerosis?

A
  • Tx with steroids
  • Prevents cancer development (increased cell turnover)

No cancer risk in lichen simplex chronicus – no constant turnover

67
Q

Benign venereal warts (condyloma acuminatum) are typically caused by HPV {{…}} & {{…}}

A

HPV 6 and HPV 11

68
Q

What are the major pathohistologic features of condyloma acuminatum?

A
  • Koilocytes
  • Acanthosis
  • Parakeratosis
  • Hyperkeratosis

Frequently regress spontaneously

69
Q

You perform a biopsy of a condyloma along a female patients perineum and note the following cells in the image attached. What is the etiology?

A

Koilocytes; HPV

70
Q

most carcinoma & vulvar intraepithelial neoplasia (VIN) are {{…}}

A

Squamous cell carcinomas

2 groups: HPV-assoc. or VNED

71
Q

What is the most common vulvar intraepithelial neoplasia (VIN)?

A

Type I (HPV-assoc.)

Most frequent in younger patients

72
Q

What are the more oncogenic types of HPV?

A

HPV types 16 & 18

73
Q

What are the strongest risk factors for Type I VIN (vulvar intraepithelial neoplasia)?

A
  • HPV infection (16 & 18)
  • Hx of Condyloma (warts)
  • Hx of STD
  • Cigarette smoking
74
Q

What are the most common S/Sx of Vulvar intraepithelial neoplasia (VIN)?

A
  • Long hx of pruritus
  • Vulvar bleeding discharge
  • Dysuria
  • Pain
  • Vulvar lump or mass most common on labia majora

Mass can be leukoplakic, ulcerated, fleshy, warty

75
Q

Vulvar carcinoma is dangerous as it likes to…

A
  • Spread early in inguinal and femoral nodes
  • Metastasis occurs early
76
Q

Dx of vulvar carcinoma is based on?

A

Biopsy

77
Q

You treat a patient with a vaginal condyloma and it comes back and is resistant to further treatment. What do you suspect to be the possible cause?

A

Verrucous carcinoma
* Appears as a condyloma acuminatum but it is resistant to Tx

Biopsy any condyloma that doesn’t respond to Tx as you would expect

78
Q

What are Dx features of extramammary paget disease?

A
  • Large tumor cells (Paget cells)
  • Distinguished by other cells by a “Halo”
  • Mucopolysaccharide within cells
  • Keratin-positive
79
Q

What is the major difference between malignant melanoma of the vulva versus extramammary paget disease of the vulva?

A

Paget Disease
* S100 negative
* Mucopolysaccharide positive
* Keratin positive

80
Q

Why is marsupialization of the bartholin gland preferred over excision in bartholin cyst treatment?

A

In excision, recurrence is likely

81
Q

What is the greatest risk factor for vaginal intraepithelial neoplasia (VIN) and squamous cell carcinoma?

A

HPV

Greatest risk factor in cervical & vulvar cancers

82
Q

VIN & squamous cell carcinoma are dangers regarding vaginal cancers because…

A
  • Clinically silent until urinary or rectal fistulas develop (grows/spreads)
  • Irregular spotting & leukorrhea may occur
83
Q

Adenocarcinoma (clear cell carcinoma) has the highest risk factor for presentation in young women of?

A

DES (diethylstilbestrol) administration to their mothers during gestation

84
Q

The attached image displays what type of cells associated with clear cell carcinoma?

A

Adenocarcinoma

85
Q

What type of staining is used to Dx embryonal rhabdomyosarcoma (Sarcoma Botryoides)?

A
  • Desmin
  • Myogenin
86
Q

A 3 yo female patient presents with vaginal masses that have grapelike clustering that are projecting out of the vaginal opening. What neoplasm is suspected?

A

Embryonal rhabdomyosarcoma (Sarcoma Botryoides)

87
Q

In cervicitis, atypical cells can be indicative of?

A

Normal inflammatory processes and will likely regress spontaneously within the next few months

88
Q

Endocervical polyps, a benign inflammatory tumor of the cervix, are more likely to occur due to?

A

Pregnancy
* due to hormone exposure

Can occur during pregnancy & rupture or tear during parturition (bleed)

89
Q

Which type of CIN lesion (I, II, or III) is a cancer?

CIN = cervical intraepithelial neoplasia

A

None
* I = mild dysplasia
* II = moderate dysplasia
* III = severe dysplasia (carcinoma in situ)

Basement Membrane (BM) remains intact -when it escapes- CIN IV (cancer)

90
Q

What does ASC-H or ASC-US on a pap smear?

A
  • ASC-US: atypical squamous cells w/ undetermined significance
  • ASC-H: atypical squamous cells w/ high risk HPV infection (e.g., HPV 16 or 18)

ASC – will typical go away

91
Q

T/F: All CIN lesions progress orderly regarding intensity of dysplasia

A

False, CIN lesions can enter into any stage w/o beginning or entering the previous stage

92
Q

T/F: most CIN lesions, especially in younger women, will progress to cancer

A

False, most will spontaneously regress

50-80% will regress; lower chance if CIN II or CIN III

93
Q

{{…}} DNA is present in 99.7% of cervical cancer cases

A

HPV

94
Q

Regarding HPV, what is the role of HPV E7?

A
  • Inhibition of p21
  • Increased CDK4/Cyclin D
  • Inhibition of RB-E2F
95
Q

Regarding HPV, what is the role of HPV E6?

A
  • Increased telomerase expression
  • Inhibition of p53
96
Q

What are the risk factors for cervical cancer?

A
  • HPV
  • Cigarette smoking
  • Increased parity/oral contraceptives
  • Vitamin A or C deficiency
  • Host factors (e.g., immunodeficiency)

Parity/OC is only correlated via increased sexual activity

97
Q

The most common invasive cancers of the cervix are?

Also, vulva & vagina

A

Squamous cell carcinomas

98
Q

How long does it take cervical cancer (invasive carcinoma) to progress from precancerous to cancer?

A

~10-15 years

Precancer ~30 yo, cancer presents 40-45 yo

99
Q

What type of spread is related to invasive cervical carcinoma mortality?

A

Direct/Local extension
* peritoneum, urinary bladder, ureters, rectum, and vagina

Not distant metastasis

100
Q

The cytologic screening for cervical cancer should begin around {{…}} since HPV lesions can spontaneously regress & CIN lesions progress slowly

A

25 yo
* HPV testing every 5 years
* Cytology alone every 3 years
* Stop at 65 yo if negative last 10 years & no Hx of ≥ CIN II last 25 years

101
Q

What type of biopsy confirm abnormalities (CIN lesions) of cytologic investigation of pap smear?

A

Punch biopsy

CIN II or CIN III lesions

102
Q

Most commonly, uterine and endometrial disorders are due to?

A

Endocrine abnormalities

103
Q

A rise of {{…}} occurs in the later half of the menstrual cycle post-ovulation.

A

Progesterone

104
Q

In anovulatory cycles, there is prolonged excessive {{…}} stimulation leading to endometrial proliferation

A
  • Estrogen
  • No progesterone rise (due to LH) to decrease endometrium
105
Q

Why is endometrial cancer a higher risk for anovulatory cycle patients?

A

Prolonged estrogen mediated hyperplasia of endometrium

106
Q

An inadequate luteal phase can be due to an inadequate corpus luteum that maintains a low {{…}} output

A

Low progesterone output

107
Q

Acute endometritis is uncommon and is limited to bacterial infections that arise after?

A
  • post-parturition
  • post miscarriage
108
Q

Where is endometrial tissue found in adenomyosis?

A

Deeper into the uterine wall

Occurs in up to 20% of uteri

109
Q

Where is endometrial tissue located in endometriosis?

A
  • Outside of uterus
  • Sites: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, umbilicus, vagina, vulva, or appendix

An important cause of infertility, dysmenorrhea, pelvic pain

110
Q

Endometriosis is typically Dx during…

A

20-30s

111
Q

A chocolate cyst is indicative of {{…}} (disease)

A

Endometriosis

111
Q

In endometriosis, there is bleeding, why?

A
  • Hormone sensitive
  • Bleeds during normal menstrual cycle
111
Q

A 38 yo woman developed recurrent right-sided chest pain synchronously with her menses. What is the most likely diagnosis?

A

Meig’s syndrome

Endometrial tissue implanted in chest cavity leading to pneumothorax

112
Q

What is surprising regarding risk factors for endometriosis?

A

Decreased risk with:
* Obesity
* Smoking

113
Q

What are some things that can increase risk for endometriosis?

A
  • FMH
  • EtOH consumption
114
Q

What are the most common S/Sx of endometriosis?

A
  • Severe dysmenorrhea
  • Dyspnareunia
  • Pelvic pain
  • Intrapelvic bleeding
  • Periuterine adhesions
  • Menstrual irregularities
  • Infertility

Dysuria = affects bladder, Rectal blood = rectum, etc

115
Q

Endometrial polyps are associated with {{…}}

A

Tamoxifen

116
Q

Endometrial polyps come in {{…}} endometrium and {{…}} endometrium

A
  • Functional
  • Functional but hyperplastic
117
Q

{{…}} is characterized by increased gland to stroma ratio and abnormalities in epithelial growth

A

Endometrial intraepithelial neoplasia (EIN)

118
Q

Endometrial intraepithelial neoplasia (EIN) is linked to prolonged exposure to {{…}}

A

Estrogen

Can be a drug, anovulatory, etc.

119
Q

The most common mutation seen in transformation of benign to precancerous endometrial intraepithelial neoplasia (EIN) is?

A

PTEN

120
Q

In endometrial intraepithelial neoplasia (EIN) there will be glands colored?

Normal = brown

A

Pale blue

121
Q

What is the most common invasive cancer of the female genital tract?

A

Endometrial carcinoma

122
Q

You should be suspicious of {{…}} for post-menopausal vaginal bleeding.

A

Endometrial carcinoma

123
Q

What are common patient characteristics for someone with endometrial carcinoma?

A

Hx of Estrogen stimulation (excess)
* Hx of anovulation
* No Hx of children (nulliparous)
* Hx of breast cancer
* Obesity

Sometimes it does not relate to estrogen

124
Q

Individuals with endometrial carcinoma (adenocarcinoma) can be asymptomatic for a prolonged epriod of time; however, they will likely present to your office for?

A

Abnormal vaginal bleeding

Excessive leukorrhea

125
Q

{{…}} are perhaps the most common tumor in humans

A

Leiomyomas

3/4 of reproduction age women have ~6.5 tumors

126
Q

{{…}} of the myometrium are benign tumors of smooth muscle of the uterus that appear as sharply circumscribed, discrete, round, gray-white

A

Leiomyomas

127
Q

Most commonly, leiomyomas are asymptomatic, but they can cause what S/Sx?

A
  • Abnormal vaginal bleeding
  • Bladder compression
  • Sudden pain
  • Infertility (compression of fallopian tube)

Note treated unless need to (e.g., infertility)

128
Q

Leiomyosarcomas have a peak incidence of {{…}} age

A

40-60 yo

Very aggressive: lung, brain, bone