Gestation and Breast Flashcards
Implantation if fertilised ovum at site other than the uterine wall
Ectopic pregnancy
What is the most common site of ectopic pregnancy
Lumen of the Fallopian tube
What is the key risk factor for ectopic pregnancy
Pelvic inflammation disease and endometriosis
Presents with lower quadrant pain weeks after missed period and is a sergical emergency
Ectopic pregnancy
Miscarriage of fetus (20 weeks before gestation)
Pretty common and occurs in about 1/4 of pregnancies
Presents as vaginal pain bleeding and passage of feral tissue
Spontaneous abortion
What are the causes of spontaneous abortions
Most often due to chromosomal anomalies, also hyper coagulable state seen in lupus or congenital infection and teratogens
Implantation of placenta in lower uterine segment
Placenta overlies cervical
Requeuires deliver by C-section and presents as 3rd trimester bleeding
Placenta previa
Separation of placenta from decidua prior to delivery of fetus
Common cause of still birth
Causes 3rd trimester bleeding and feral insufficiency
Placental abruption
Improper implantation of placenta in to myometrium with little to no decidua
Presents with difficult delivery of placenta because placenta is stuck and post parturition bleeding
Placenta Accreta
- Abnormal eonception characterised by swollen and edmematous villi with proliferation of trophoblasts
- uterus expands as if it’s a normal pregnancy is present, but uterus will be bigger than normal and B-hcg (Human chorionic gonadotropin) is more than normal.
Hydatidiform mole
Hydatidiform mole without prenatal care
Classically presents in 2nd trimester, passage of grape like masses through the vaginal canal
(The large Edematous villi is what is passing)
Hydatidiform mole with prenatal care
Diagnosed by routine USG, fetal heart sounds are absent
SNOW STORM appearance on USG
Hydatidiform mole can be classified in to 2
Complete mole and partial mole
Is Hydatidiform mole caused by the father or the mother?
It is caused by the father
- when two sperms come in molar pregnancy so all genetic material is from the father)
(Complete mole -> completely from the dad)
No fetal tissue, since it is a complete mole all villi are edematous and complete proliferation of trophoblasts, in complete mole, B-HCG is way higher and complete has complete risk for chriocsrcinoma 2-3%
Complete mole (empty ovum with 2 sperms)
Normal ovum fertilised by two sperm (69 chrom) feral tissue is “partially”present some villi are edematous (hydropic) and focal proliferation of trophoblasts around hydropic villi also minimal risk of choriocarcinoma
Partial mole
•Proliferation of trophoblasts, villi are absent
- May arise as a complication of gestation or spontaneous germ cell tumour
- Gestational pathway responds well to chemotherapy-> can be due to molar pregnancy, spontaneous abortion or normal pregnancy
- Germ cell parhway doesn’t respond well to chemotherapy
Choriocarcinoma
What is breast derived from
Skin
What is the functional unit of the breast
Terminal duct lobule unit
The breast has two epithelial layers what are they
Luminal and myoepithelial
Milk out side of lactation
Galactorrhea
What causes galactorrhea
Nipple stimulation
Prolactioma
Drugs
- warm erythematous breast with purlent discharge
- due to S aureus infection due to breastfeeding
- treat with drainage and dicloxacillin
Acute mastitis
- Inflammation of subareolar ducts in smokers (vitamin A deficiency in specialised cells)
- subareolar mass and nipple retraction
Periductal mastitis
Subareolar dilation due to inflammation
Green brown nipple discharge and plasma cells in biopsy
Classically in multiparous(giving birth to more than 1 child), post menopausal women
Mammary duct ectasia (dilation)
Happens in the breast usually due to trauma, shows as a mass or calcification, and on biopsy it shows necrotic fat with giant cells
Fat necrosis
- no invasion of breast so no mass
- detected as calcification in mammography
Ductal carcinoma in situ DCIS
What’s the most important type DCIS
comedo type -> high grade nuclei and central necrosis and dysplastic calci
What is pager disease
When DCIS. Reaches skin of nipple
What is the most common invasive breast carcinoma
Invasive ductal carcinoma
Presents with rock hard mass with sharp borders
It invades through the basement membrane
Duct like structures in desmoplastic stroma on biopsy
Invasive ductal carcinoma
What are the subtypes of Invasive ductal carcinoma
Tubular
mucinous
Inflammatory (looks like acute mastitis) -> p’uedu orange
Medullary (Braca1) -> in sheets
What is a good distinguishing method for Invasive ductal carcinoma
Number of myoepithelial cells
- no invasion
- no mass or calcification so discovered incidently
- has dyscohesive cells (separated) since they lack E cadherin
- treat with Tamoxifen(antiestrogenic agent)
- risk factor if malignant cancer
Lobular carcinoma in situ (LCIS)
- invade in single files, not stuck ( NO E CADHERIN)
- prognosis by TNM - M most important factor but not many patients so for breast N is the most
- SENTINAL LYMPH NODE BIOPSY IS ISED TO assess the ancillary lymph nodes
- predictive factors - ER, PR, HER2 / neu genes
Invasive lobar carcinoma
BRCA 1
Breast and ovarian carcinoma
BRCA 2
Breast Carcinoma and breast in males
- most common premenopause
- blue domed appearance, lump in outer breast
- benign and doesn’t increase cancer risk
Fibrotic changes in the breast
What fibrotic changes increase cancer risk
Ductal hyperplasia, atypical hyperplasia and sclerosing adenosis
Does apocrine metaplasia increase cancer risk
No
- papillary lesion with bloody discharge
- lesion has both epithelium types
- most common cause of discharge
- similar to papillary carcinoma except for not having myoepithelium and is more seen in post menopausal
Intraductal papilloma
- Most common benign breast tumor
- Well circumscribed, mobile and marble like
- Has no risk
- estrogen sensitive
Fibroadenoma
- fibroadenoma like with some differences
- extra fibrous so it has leaflike projections
- more seen in post menopausal
- can be malignant
Phyllodes tumour
