Female path (robbins) Flashcards
1
Q
Vulvar mucosa showing Thinned epidermis, Hydropic degeneration of Basal cells, Sclerotic stroma, Dermal inflammation? Benign white plaques?
A
Lichen Sclerosus
2
Q
Condylomata lata or flat, moist minimally elevated lesions occur in what disease?
A
2nd syphilis
3
Q
Cells showing perinuclear cytoplasmic vacuolization and wrinkled nuclear contours?
A
Koliocytes
4
Q
An intraepithelial proliferation of malignant cells that occur in the skin, vulva, or nipple?
A
Paget disease
5
Q
Vulvar red, scaly plaque caused by proliferation of malignant epithelial cells within the epidermis, positive PAS scan?
A
Paget disease
6
Q
Curdy white vaginal discharge?
A
Candidiasis
7
Q
Watery, copious gray-green discharge with infested parasites?
A
Trichomonas
8
Q
Associated with females whose mothers took Diethylstilbestrol during pregnancy to avoid abortions?
A
vaginal adenosis–> Clear cell carcinoma
9
Q
embryonal Rhabdomysarcoma in infants or < 5yo manifesting as soft polypoid masses in vagina?
A
Sarcoma Botryoides
10
Q
What is the MCC of cervicitis?
A
Chlamydia trachomatis
11
Q
Postpartum patient with acute cervicitis. MCC?
A
Staph or strep
12
Q
What is gene has been linked to 20% of cervical cancers (also hamartomatous GI polyps)?
A
LKB1
13
Q
What is required to diagnose chronic endometritis?
A
Plasma cells
**Lymphocytes are normally present in the endometrium
14
Q
What is seen on Histology of endometritis caused by either Ct or GC?
A
PMN infiltrate in superficial endometrium and glands coexisting with a stromal lymphoplasmacytic infiltrate
15
Q
Growth of basal layer of endometrium down into the myometrium?
A
Adenomyosis
16
Q
What is the consequence on myometrium in adenomyosis?
A
hypertrophym + enlarged, globular uterus
17
Q
Adenomyosis causes what signs and symptoms?
A
Menorrhagia
Dysmenorrhea
pelvic pain
Before onset of menstruation
18
Q
Presence of endometrial glands and stroma in location outside the endomyometrium?
A
Endometriosis
19
Q
What are the 3 theories for Pg of Endometriosis?
A
regurgitation->backflow through fallopian tube
Metaplastic-> differentiation of coelomic epi
Vascular or lymph dissemination
20
Q
Unlike adenomyosis, Endometriosis tissue is?
A
Functional–> undergoes cyclic bleeding
c
21
Q
Blood collects in aberant tissue causing Red-Brown nodules or implants, as in “Chocolate cysts” in the ovaries?
A
Endometriosis
22
Q
Severe dysmenorrhea, pelvic pain from intrapelvic bleeding, and periuterine adhesions?
A
Endometriosis
23
Q
MCC of Abnormal bleeding in prepubertal patient?
A
Precocious puberty (hypothalamic, pituitary, ovarian origin)
24
Q
MCC of abnormal bleeding in adolescence?
A
anovulatory cycles
25
MCC of abnormal bleeding in reproductive age?
Complications of pregnancy
Proliferations (leiomyomas, adenomyosis, polyps)
Anovulatory cycles
Ovulatory dysfxn (inadequate luteal phase)
26
MCC of abnormal bleeding in perimenopausal women?
Anovulatory cycles
Irregular shedding
Proliferations (carcinoma, hyperplasia, polyps)
27
MCC of abnormal bleeding in Postmenopausal women?
Proliferations
| Endometrial atrophy
28
MCC of anovulatory cycles?
Hypo-Pit-Adrenal- thyroid dysfxn
Functional ovarian lesion producing Estrogen
Malnutrition, obesity, disease
Severe physical or emotional stress
29
Excess Estrogen with little progesterone causes endometrium to appear?
Gland hyperplasia= estrogen
Stroma scarce= progesterone
**prone to breakdown and bleeding
30
How does inadequate luteal phase cause abnormal bleeding?
Corpus luteum fails to mature= lack of progesterone
31
Endometrial hyperplasia is associated with what genetic abnormality?
PTEN inactivation
32
Endometrial neoplasm associated with excess estrogen + endometrial hyperplasia in perimenopausal women?
Endometrioid cancer
33
Endometrial neoplasm arising from endometrial atrophy in postmenopausal women?
Serous cancer
34
What syndrome is associated with development of endometrioid carcinoma?
Cowden syndrome= PTEN mutation
35
Endometrial neoplasm showing tufts and papillae rather than glands with positive immunohistochemistry for p53?
Serous carcinoma
36
What are some risk factors for Endometrial hyperplasia?
```
Anovulatory cycles
Polycystic ovarian syndrome
Estrogen producing tumor
obesity
estrogen without progestin
```
37
Most common benign tumor in females or reproductive age, > in blacks, FIRM, hormone responsive?
Leiomyoma
| **aka= Fibroids because "firm"
38
Sharply circumscribed, firm, gray-white masses with characteristic "Whorled cut surface." often multiple occurring in premenopausal women?
Leiomyomas
39
Soft, hemorrhagic, necrotic mass in post menopausal women?
Leiomyosarcoma
40
What are the organisms that can cause transplacental fetal infections?
```
TORCH
toxoplasmosis
other infections
rubella
CMV
herpes
```
41
What pregnancy conditions are associated with elevated hCG?
Hydatidform mole
Invasive mole
Choriocarcinoma
42
Cystically dilated, chorionic villi, appearing grossly as grape like structures?
Hydatidiform mole
43
What is the difference btwn complete and partial hydatidiform mole?
Complete: not compatible with embryogenesis and never contain fetal parts (villi are diploid)
Partial: compatible with embryo formation, contain fetal parts, Triploid
44
Lesion arising from Hydatidiform mole manifesting as bloodym brownish discharge accompanied by rising Beta hCG in blood and urine?
Choriocarcinoma
45
What cells are seen in microscopic choriocarcinoma?
Anaplastic cuboidal cytotrophoblasts and syncytiotrophoblasts
46
Indolent, tumor of intermediate trophoblasts that produce HPL and do not respond to chemo well?
Placental site trophoblastic tumor
47
Pt in 3rd trimester (24-25wk) with HTN, proteinuria, and edema?
Pre-eclampsia
48
What makes pre-eclampsia --> eclampsia?
addition of seizures or convulsions
49
Disease triggered by Insufficient maternal blood flow to placenta secondary to inadequate remodeling of spiral arteries of uteroplacental vascular beds?
Pre-eclampsia
50
Caused by impaired vascular remodeling by trophoblasts, where the musculoelastic walls are retained, and channels remain narrow?
pre-eclampsia
51
What are the consequences associated with Pre-eclampsia?
Placental infarction= chorionic hypoperfusion
HTN=reduced PGs and increased TxA2
Hypercoag= endothelial dysfuxn
End organ failure= Kidney + liver
HELLP syndrome= elevated Liver enzymes + low platelets
52
Placental consequences of Pre-eclampsia?
Infarcts
Retroplacental hemorrhage
Premature maturation of placental villi
Fibrinoid Necrosis= Foam cells in vessels
53
What are the MC reasons women seek evaluation of breast lumps?
```
40%= Fibrocystic change
7%= fibroadenoma
10%= cancer
```
54
MC breast abnormality in premenopausal women, multifocal, ill defined, diffusely increased densities and discrete nodules on mammography. Usually appearing as Brown or Blue domed cysts +- micro calcifications?
Non-proliferative Fibrocystic change
55
Epithelial hyperplasia in breasts in recognized by the presences of what?
2+ cell layers (epithelial layer + myoepi cells)
56
Fibrocystic change marked by intralobular fibrosis and proliferation of small ductules and acini?
Sclerosing adenosis
**increased risk for cancer
57
Hard rubbery lesion, with proliferation of luminal spaces lined by epithelial cells and myoepithelial cells. Glands are back to back, stromal fibrosis which compresses the ducts/acini and appears similar to carcinoma?
Sclerosing adenosis
**differentiated from carcinoma by PRESENCE of myoepithelial cells
58
Features of fibrocystic change that is associated with 1.5-2x and 5x increased risk for Breast Carcinoma in BOTH breasts?
1.5-2--> ductal papillomatosis, sclerosing adenosis
5x--> atypical hyperplasia (ductal or lobular)
59
Acute mastitis acquired during early weeks of nursing is MCC by?
S. aureus
60
Non-bacterial chronic inflammation of breasts associated with insipissation of breast secretions in main excretory ducts. Ducts ruptures= masses and nipple retractions in women 40-60 yo?
Mammary duct ectasia (plasma cell mastitis)
61
Ducts filled with granular debris, PMNs, foam cells, Prominent Lymphoplasmocytic infiltrate and occasional Granuloma in periductal stroma?
Mammary duct ectasia
62
Sharply localized, tender mass, with necrosis surrounded by PMNs, giant cells, and may develop calcifications?
Fat necrosis= trauma
63
30yo with solitary, discrete, mobile breast mass that enlarges during menstrual periods?
Fibroadenoma
64
Breast mass with loose fibroblastic stroma containing ductlike, epithelium lined spaces of various shapes and sizes. Tissue lined by epithelial and myoepithelial cells?
Fibroadenoma
65
Neoplastic growth of epithelial covered glands and leaflike stromal elements?
Phyllodes tumor
66
Premenopausal women with solitary mass found in lactiferous ducts of sinuses causing BLOODY nipple discharge, nipple retractions?
Intraductal Papilloma
**Benign= covered by both epi & myoepi layers
67
What are some of the risk factors for breast cancer?
```
Age
FHx/ Genetics
Menstrual Hx: early menarche or late menopause
Pregnancy: early/ late 1st, Nulliparous
Benign breast lesions
Obesity
Exogenous estrogens
Cigarettes
```
68
What genetic factors are associated with Breast cancer?
```
HER2/NEU
BRCA 1/2
Li Fraumeni syndrome
Cowden syndrome
Ataxia telangiectasia
```
69
What are the MC locations of breast tumors? (Specific)
Upper Outer Quadrant (50%)
| Central (20%)
70
MC invasive breast cancer?
Invasive Ductal carcinoma
71
DCIS with high grade nuclei and Extensive Central Necrosis + calcifications?
Comedo subtype DCIS
72
Breast mass causing ductlike spaces, central necrosis, and calcifications?
DCIS
73
Extension of DCIS up the lactiferous duct into skin of nipple?
Paget disease of nipple
| **50% signify underlying Carcinoma
74
Uniform breast mass, loosely cohesive clusters, intracellular mucin vacuoles, NO calcifications, may lead to invasive carcinoma in Either breast?
LCIS
75
Process by which invasive ductal carcinomas replace normal breast tissue and form hard, palpable mass?
Desmoplastic response
76
Invasive breast cancer more likely to spread to Cerebrospinal fluid, serosal surfaces, GI, ovary, uterus, and Bone marrow?
Invasive Lobular carcinoma
77
Invasive breast cancer with cells producing abundant quantities of extracellular mucin. Often appear as wll circumscribed soft/ gelatinous masses?
Colloid carcinoma
78
Breast lesion showing highly pleomorphic cells growing in cohesive sheets and are associated with prominent reactive infiltrates of Lymphocytes and Plasma cells?
Medullary breast carcinoma
79
What are the implications for a breast tumor with HER2/Neu over expression?
Poor prognosis
| Trastuzumab therapy
80
Male with breast lesion showing epithelial hyperplasia of ducts, NO lobules, Button-like subareolar swelling. MCC?
```
Gynecomastia= Hyperestrinism
MMC= Cirrhosis--> inability to metabolize estrogen
Klinefelter syndrome
Anabolic steroids
Old age
```
81
MC disorder of fallopian tubes is inflammation caused by?
PID
82
MCC of salpingitis?
GC (declining)
Non GC (Rising)
Ct + Staph + Strep (postpartum)
83
What is a complication of PID related to fallopian tubes?
Inflammation= adherence = tuboovarian abscess
Adhesion of tubal plicae = Increased Risk of ECTOPIC pregnancy
Sterility
84
Primary adenocarcinoma of the fallopian tubes in increased in women with what?
BRCA mutation
85
Multiple small cysts, develop subjacent to serosal covering of ovary. Caused by non-rupured follicle?
Follicle or luteal cysts
86
WHat is Stein Leventhal syndrome?
Polycystic ovarian disease caused by Excess androgens and estrogens
87
Teenage girls or young adults present with Oligomenorrhea, hirsutism, infertility, Obesity?
PCOD= Stein Leventhal sydnrome
88
Large ovaries, gray/white, smooth outer cortex, studded subcortical cysts?
PCOD
89
Ovary histology showing: thickened, fibrotic ovarian capsule overlying innumerable cystic follicles lined by Granulosa cells + hyperplastic theca interna?
PCOD
90
What is the principle biochemical abnormalities in PCOD?
HIGH Androgens
High LH
LOW FSH
91
What causes hormonal imbalances in PCOD?
Ovaries makes excess androgens= converted to Estrogen Peripherally by ADIPOSE= inhibit FSH
92
MCC ovarian tumor?
Suface epithelial tumors= 65-70%
Germ cell= 15-20%
Sex cord/stomal = 5-10%
Metastasis= 5%
93
Pg of ovarian surface epithelial tumors?
Repeated ovulation and scarring= epithelial cells form cysts= metaplasia= dysplasia
94
What are the important risk factors for Ovarian cancer?
Nulliparity
FHx
Germline mutations of suppressor genes
**prolonged oral contraceptives may lower Risk
95
MC tumor of Ovarian epithelial?
```
Serous
Mucinous
Endometrioid
Clear cell
Brenner
Cystadenofibroma
```
96
MC germ cell tumors?
Teratomas
Dysgerminoma
Endodermal sinus tumor
Choriocarcinoma
97
Benign Serous ovarian tumors are associated with what genetics?
KRAS
BRAF
ERBB2 mutations
98
Serous ovarian carcinomas are 96% associated with what genetics?
TP53 mutations
99
Ovarian biopsy: Bilateral, spherical, cystic structures lined by Columnar cells, and Psammoma bodies?
Benign serous ovarian tumor
100
What is the Krukenberg tumor?
metastatic mucinous adenocarcinoma from GI
101
Ruptured ovarian cysts causes pseudomyxoma peritonei?
Mucinous tumor
102
Ovarian cyst showing formation of tubular glands lining the space with PTEN mutations?
Endometrioid tumors
103
Ovarian tumor in 2-3rd decades, with Gonadal Dysgenesis, solid gray masses, with Sheets or cords Clear Cells separated by scant fibrous stands?
Dysgerminoma
** may contain Lymphocytes + Granulomas
104
Ovarian tumor that is Small, hemorrhagic focus with two types of epithelium: cytotrophoblasts and synctiotrophoblasts?
Choriocarcinoma= Malignant
**early/ wide mets + primary focus may degenerate
105
Ovarian tumor MC in post-menopauasal, gray/yellow, with mixed cells in cords or sheets and CALL-EXNER BODIES?
Granulosa-theca cell tumor
106
Ovarian tumor elaborating large amounts of estrogen and may promote breast or endometrial cancer?
Granulosa- theca cell tumor
107
Dermoid cyst found on routine radiographs with foci of calcification, may produce infertility, and can undergo torsion?
Benign Cystic Teratomas
108
Ovarian tumor that is Bulky, solid, necrotic with foci of neuroepithelial differentiation and metastasize widely?
Immature Malignant Teratoma
109
Immature thyroid tissue located in ovary, that can produce signs of hyperthyroidism?
Struma ovarii
110
Surface epithelial ovarian tumors usually present as?
Pain
GI complaints
Urinary frequency
111
What is the marker protein for tracking epithelial ovarian tumors?
CA-125
112
Asherman syndrome?
2nd amenorrhea due to loss of Basal layer of Endometrium
113
Dysfunctional uterine bleeding during Menarche and Menopause caused by presence Estrogen without Progesterone?
Anovulatory cycle
