Goljans Flashcards
1
Q
What is the clinical presentation of lichen sclerosus?
A
Thinned epidermis of the vulva; parchment-like skin
2
Q
What is the clinical presentation of lichen simplex chronicus?
A
Leukoplakia (hyperplasia) of the vulva
3
Q
What is the clinical presentation of papillary hidradenoma?
A
Painful apocrine gland tumor; nodule on labia majora
4
Q
What causes vulvar intraepithelial neoplasia?
A
HPV 16
5
Q
What are the risk factors for squamous cell carcinoma of the vulva?
A
HPV 16
6
Q
What is extramammary Paget disease?
A
Intraepithelial adenocarcinoma; PAS positive
7
Q
What laboratory test can be used to differentiate extramammary Paget disease from vulvar melanoma?
A
PAS
8
Q
What is the clinical finding in Rokitansky-Küster-Hauster syndrome?
A
Vagina/uterus underdeveloped or absent
9
Q
What is a Gartner cyst?
A
Wolffian duct remnant in the lateral wall of the vagina
10
Q
What is the most common sarcoma in girls?
A
Embryonal rhabdomyosarcoma
11
Q
What is the clinical presentation of embryonal rhabdomyosarcoma?
A
Grape-like mass protruding from vagina
12
Q
What are the effects of diethylstilbestrol?
A
Inhibits müllerian differentiation; used to prevent spontaneous abortion
13
Q
What is the precursor lesion for clear cell adenocarcinoma?
A
Vaginal adenosis: red superficial ulcerations
14
Q
What female reproductive pathology is highly associated with exposure to diethylstilbestrol?
A
Clear cell adenocarcinoma in vagina/cervix
15
Q
What anatomical abnormalities are associated with intrauterine diethylstilbestrol exposure?
A
Incompetent cervix
16
Q
What is the most common cause of vaginal squamous cell carcinoma?
A
Extension of cervical squamous cell carcinoma
17
Q
What comprises the cervix?
A
Endocervix and exocervix
18
Q
What is the role of lactobacillus in the vaginal flora?
A
[Gram+ rod]
19
Q
What is the most common site of squamous dysplasia and squamous cell carcinoma in the cervix?
A
Transitional zone
20
Q
What is the most common cause of vaginal discharge?
A
Cervicitis
21
Q
What is the most common finding in acute cervicitis?
A
Vaginal discharge
22
Q
What is the most common cause of acute cervicitis?
A
C. trachomatis and N. gonorrhoeae account for >50% of cases
23
Q
What causes follicular cervicitis?
A
C. trachomatis
24
Q
What are reticulate bodies?
A
Produce elementary bodies, the infective particle of Chlamydia
25
What is opthalmia neonatorum?
Neonatal conjunctivitis contracted during delivery; vertical transmission of C. trachomatis, N. gonorrhoeae
26
What is the purpose of a cervical Pap smear?
Screen for dysplasia/cancer
27
What Pap smear finding indicates adequate estrogen?
Superficial squamous cells
28
What Pap smear finding indicates adequate progesterone?
Intermediate squamous cells
29
What Pap smear finding indicates lack of estrogen/progesterone?
Parabasal cells
30
What are the Pap smear findings in a normal nonpregnant female?
70% superficial squamous cells
31
What are the Pap smear findings in a normal pregnant female?
100% intermediate squamous cells
32
What are the Pap smear findings in an elderly female?
100% parabasal (atrophic); inflammatory cells
33
What are the Pap smear findings in a woman taking estrogen-only hormone replacement?
100% superficial squamous cells
34
What is the typical presentation of a cervical polyp?
Postcoital bleeding; vaginal discharge
35
Are cervical polyps cancerous?
Nonneoplastic; not precancerous
36
What are most cases of cervical intraepithelial neoplasia associated with?
HPV
37
What effect does HPV have on squamous cells?
Koilocytosis; clear halo containing a wrinkled, pyknotic nucleus
38
What is the primary complication of cervical dysplasia?
Precursor for squamous cell carcinoma
39
What is the classification of cervical intraepithelial neoplasia?
CIN I: mild
40
What is the average age of presentation for squamous cell carcinoma of the cervix?
~45 years
41
What are some general epidemiological features of cervical cancer?
Least common gynecologic cancer
42
What accounts for the decreased incidence and mortality of cervical cancer in the US?
Cervical pap smears
43
What is the most common sign of cervical cancer?
Abnormal vaginal bleeding
44
How does cervical cancer typically spread?
Spreads down and out
45
What is the most common cause of death in cervical cancer?
Renal failure
46
What are the steps in the sequence to menarche?
Breast budding
47
What is the most variable phase of the menstrual cycle?
Proliferative phase
48
What hormone mediates the proliferative phase of the menstrual cycle?
Estrogen
49
What hormonal changes lead to ovulation?
Estrogen surge → LH surge → ovulation
50
When does ovulation occur?
Between days 14 and 16 o the menstrual cycle
51
What is the best sign of ovulation?
Subnuclear vacuoles in endometrial cells
52
What is the least variable phase of the menstrual cycle?
Secretory phase
53
What hormone mediates the secretory phase of the menstrual cycle?
Progesterone
54
Where does fertilization typically occur?
Ampullary portion of fallopian tube
55
How long does it take for the fertilized egg to implant?
5 days
56
What is the Arias-Stella phenomenon?
Exaggerated secretory phase that occurs in pregnancy
57
What occurs in menses?
Drop in hormones initiates apoptosis
58
Why does vaginal bleeding occur in newborn girls?
Mother's estrogen causes endometrial hyperplasia; sudden drop following delivery induces bleeding
59
What changes are stimulated by FSH?
Prepares follicle
60
In what stage of division are unstimulated follicles arrested?
Meiosis I prophase
61
What is the function of LH in the proliferative phase?
Synthesis of testosterone for conversion by aromatase into estradiol in granulosa cells
62
What occurs when a follicle is stimulated by LH?
Follicle progresses to meiosis II metaphase
63
What happens after fertilization?
Fertilized follicle develops into mature oocyte with 23 chromosomes
64
What is the role of LH in the secretory phase?
Synthesizes 17-OH-progesterone
65
What is hCG?
LH analogue; synthesized in syncytiotrophoblast lining chorionic villus in the placenta
66
What is the function of hCG?
Maintains corpus luteum of pregnancy for 8-10 weeks
67
What is the mechanism of oral contraceptive pills?
Low estrogen prevents LH surge and ovulation; progestins cause gland atrophy and inhibit LH
68
What is the primary estrogen of non-pregnant women?
Estradiol
69
When is primary estrogen of post-menopausal women?
Estrone
70
How is estrone produced?
Adrenal androstenedione → estrone
71
What is the estrogen of pregnancy?
Estriol
72
Where is estriol produced?
Fetal adrenal/liver
73
Where is DHEA-sulfate synthesized in women?
Almost exclusively synthesized in adrenal cortex
74
Where is testosterone synthesized in women?
Synthesized in ovary/adrenals
75
Where is sex hormone-binding globulin synthesized?
Liver
76
What is the relative affinity of sex hormone-binding globulin?
Higher binding affinity for testosterone than estrogen
77
What hematologic changes occur in pregnancy?
↑RBC mass/↑↑plasma volume = ↓Hb/RBC count
78
What renal changes occur in pregnancy?
↑↑plasma volume causes ↑GFR/CCr
79
What respiratory changes occur in pregnancy?
Respiratory alkalosis
80
What is the mechanism of respiratory alkalosis in pregnancy?
Estrogen/progesterone stimulation of respiratory center
81
How do cortisol and thyroxine levels change in pregnancy?
↑total serum T₄/cortisol; ↑in binding proteins, no change in free hormones
82
What is the definition of menopause?
No menses for 1 year after age 40
83
What is the average age of menopause?
51 years [genetically determined]
84
What are the symptoms of menopause?
Hot flushes
85
What testosterone changes occur in menopause?
↑testosterone levels in menopause; leads to ↑libido in some women
86
What are the laboratory findings in menopause?
↑FSH best marker
87
What is the clinical presentation of hirsutism?
Excess hair in normal hair-bearing areas
88
What features define virilization?
Hirsutism + male secondary sex characteristics
89
What is the underlying mechanism of hirsutism and virilization?
↑ androgens of ovarian, adrenal, or drug origin
90
What is the mechanism of ovarian-mediated hirsutism?
↑testosterone
91
What is the mechanism of adrenal-mediated hirsutism?
↑DHEA-S, testosterone
92
What is the most common cause of hirsutism?
Polycystic ovary syndrome
93
Polycystic ovary syndrome is associated with an increased incidence of which conditions?
Insulin-resistance
94
What is the key pathogenic factor underlying polycystic ovary syndrome?
LH/FSH ratio >3
95
What is the pathogenesis of polycystic ovary syndrome?
↑secretion of LH → follicular hyperthecosis (hyperplasia of ovarian theca cells) → ↑production of testosterone, androstenedione → hyperandrogenicity (e.g., hirsutism)
96
What are the effects of polycystic ovary syndrome?
Chronic anovulation
97
What is the mechanism of anovulation in polycystic ovary syndrome?
Less aromatization of androgens to estrogen
98
What happens to the excess androstenedione generated in polycystic ovary syndrome?
↑conversion of androstenedione to estrone → ↑endometrial hyperplasia/cancer, breast cancer risk
99
What are the clinical findings in polycystic ovary syndrome?
Oligomenorrhea
100
What are the laboratory findings in polycystic ovary syndrome?
LH/FSH ratio >3
101
What is the definition of menorrhagia?
Loss of blood >80 mL per period
102
What findings should raise suspicion for menorrhagia?
Staining sheets at night
103
What is the definition of dysmenorrhea?
Painful menses
104
What is the mechanism of primary dysmenorrhea?
Due to PGF₂α; ↑uterine contractions
105
What is the most common cause of secondary dysmenorrhea?
Endometriosis
106
What is the definition of dysfunctional uterine bleeding?
Abnormal bleeding unrelated to an anatomic cause
107
What is the most common cause of abnormal bleeding?
Menorrhagia
108
What characterizes hypomenorrhea?
Regular normal intervals with decreased blood flow
109
What characterizes metrorrhagia?
Irregular intervals with excessive flow and duration
110
What characterizes menometrorrhagia?
Irregular or excessive bleeding during menstruation and between periods
111
What characterizes oligomenorrhea?
Menses at intervals >35 days
112
What characterizes polymenorrhea?
Menses at intervals
113
When do most cases of dysfunctional uterine bleeding occur?
Menarche and perimenopausal period
114
What is the most common type of dysfunctional uterine bleeding?
Anovulatory dysfunctional uterine bleeding
115
What is the mechanism of anovulatory dysfunctional uterine bleeding?
Excessive estrogen stimulation; occurs at the extremes of reproductive life
116
What is the mechanism of ovulatory dysfunctional uterine bleeding?
Inadequate luteal phase; irregular shedding of the endometrium
117
What is the pathogenesis of inadequate luteal phase in ovulatory dysfunctional uterine bleeding?
Inadequate maturation of corpus luteum; delayed secretory phase due to ↓17-OH progesterone synthesis
118
What is the pathogenesis of irregular endometrial shedding in ovulatory dysfunctional uterine bleeding?
Persistent luteal phase with continued secretion of progesterone; mixture of proliferative/secretory gland
119
What is the definition of primary amenorrhea?
No menses by age 16
120
What is the most common cause of primary amenorrhea?
Constitutional delay
121
What is the definition of secondary amenorrhea?
No menses for >6 months
122
What is the most common cause of secondary amenorrhea?
Pregnancy
123
What hormonal findings are associated with hypothalamic/pituitary causes of amenorrhea?
↓FSH, LH, estrogen
124
What are some examples of hypothalamic/pituitary disorders causing amenorrhea?
Anorexia nervosa
125
What hormonal findings are associated with ovarian causes of amenorrhea?
↑FSH, LH; ↓estrogen
126
What syndrome should be suspected with the combined findings of primary amenorrhea with poor secondary sex characteristics?
Turner syndrome
127
What hormonal findings are associated with end-organ causes of amenorrhea?
Normal FSH, LH, estrogen
128
What are some examples of end-organ defects causing amenorrhea?
Imperforate hymen
129
What is Asherman syndrome?
Removal of stratum basalis by excessive curettage
130
What is acute endometritis?
Uterine infection following delivery or abortion
131
What is the most common pathogen associated with acute endometritis?
Group B streptococcus
132
What are the clinical findings in acute endometritis?
Fever
133
What pathogen causes infections associated with intrauterine devices?
Actinomyces
134
What is the key histological finding in chronic endometritis?
Plasma cells in biopsy
135
What is adenomyosis?
Functioning glands/stroma in myometrium
136
What are the clinical findings in adenomyosis?
Menorrhagia
137
What is endometriosis?
Functioning glands/stroma outside the confines of the uterus
138
What is the most common cause of endometriosis?
Reverse menses
139
What is the pathogenesis of endometriosis?
Reverse menses
140
What site is most commonly involved in endometriosis?
Ovaries
141
What is the clinical significance of the rectal pouch of Douglas?
Site for collection of blood, malignant cells, pus, endometrial implants
142
What is the triad of symptoms in endometriosis?
Dysmenorrhea
143
How can endometriosis be diagnosed and treated?
Laparoscopy
144
What are the implications of an endometrial polyp?
Common cause of menorrhagia; no risk of endometrial cancer
145
What is the pathogenesis of endometrial hyperplasia?
Prolonged estrogen stimulation
146
What are the common risk factors associated with endometrial hyperplasia?
Early menarche/late menopause
147
What type of endometrial hyperplasia has the greatest risk for endometrial cancer?
Atypical hyperplasia (glandular crowding and dysplastic epithelium)
148
What is the main clinical finding in endometrial hyperplasia?
Postmenopausal bleeding
149
What is the most common gynecologic cancer?
Endometrial carcinoma
150
What is the effect of oral contraceptives on cancer risk?
↓risk of endometrial cancer
151
What is the most common type of endometrial carcinoma?
Well-differentiated adenocarcinoma (vs papillary)
152
What is the characteristic spread of endometrial carcinoma?
Spreads down and out
153
What is the most common clinical finding in endometrial cancer?
Postmenopausal bleeding
154
What is the most common benign connective tissue tumor in women?
Leiomyoma
155
In which population are leiomyomas more common?
Blacks > whites
156
What are the clinical findings of leiomyomas?
Menorrhagia
157
What is the most common uterine sarcoma?
Leiomyosarcoma
158
What are the histological characteristics of leiomyosarcoma?
Atypical mitotic spindles; ↑mitosis
159
What gynecologic tumor is strongly associated with previous irradiation?
Carcinosarcoma (malignant mixed müllerian tumors)
160
What are hydatid cysts?
Cystic müllerian remnant; may undergo torsion
161
What is the most common cause of female infertility and ectopic pregnancy?
Pelvic inflammatory disease
162
What is the most common cause of pelvic inflammatory disease?
N. gonorrhoeae and C. trachomatis; both present in 45% of cases
163
What is one of the common findings of pelvic inflammatory disease?
Hydrosalpinx (tube fills with clear fluid after pus resorbs)
164
What is the pharmacologic treatment of pelvic inflammatory disease?
Ceftriaxone (for N. gonorrhoeae)
165
What occurs in salpingitis isthmica nodosa?
Tubal diverticulosis
166
What complications are associated with salpingitis isthmica nodosa?
Infertility
167
What is the most common cause of ectopic pregnancy?
Previous pelvic inflammatory disease
168
What risk factors are associated with ectopic pregnancy?
Pelvic inflammatory disease
169
What is the most common location of ectopic pregnancy?
Ampullary portion of fallopian tube
170
When does an ectopic pregnancy present?
Usually presents ~6 weeks after previous normal menses
171
What is the classic triad of symptoms associated with ectopic pregnancy?
Vaginal bleeding
172
What are the complications of ectopic pregnancy?
Intraperitoneal hemorrhage and shock
173
What term describes the presence of blood in the fallopian tube?
Hematosalpinx (usually due to ectopic pregnancy)
174
How can an ectopic pregnancy diagnosed?
hCG is the best screening test; vaginal ultrasound is the confirmatory test
175
What is the most common ovarian mass?
Follicular cyst (nonneoplastic)
176
What is the most common ovarian mass in pregnancy?
Corpus luteum cyst (nonneoplastic)
177
What causes oophoritis?
May be a complication of mumps or pelvic inflammatory disease
178
What are the clinical findings of stromal hyperthecosis?
Hirsutism/virilization
179
What age group is at highest risk for ovarian cancer?
Risk increases with age
180
What risk factors are associated with the development of surface-derived ovarian tumors?
Genetic factors
181
Patients with Turner syndrome are at increased risk for what neoplasm?
Dysgerminoma
182
OCPs/pregnancy are associated with decreased risk for what type of malignancy?
Surface-derived ovarian tumors
183
What is the most common group of ovarian tumors?
Surface-derived tumors
184
What is the most common ovarian cancer?
Serous cystadenocarcinoma
185
What are some key findings associated with serous cystadenocarcinoma?
Bilateral
186
What is a complication of malignant surface-derived ovarian cancers?
Commonly seed the abdominal cavity
187
What is the most common benign germ cell tumor?
Teratoma
188
What is the most common malignant germ cell tumor?
Dysgerminoma
189
What are sex cord-stromal tumors?
Hormone-producing tumors (estrogen/testosterone); most are benign
190
What are Krukenberg tumors?
Metastasis to ovaries with signet ring cells
191
What is the most common sign of ovarian cancer?
Abdominal enlargement due to fluid
192
What causes malignant ascites?
Seeding
193
What are the clinical signs of malignant ascites due to seeding?
Induration in rectal pouch
194
What should be suspected in a postmenopausal woman with palpable ovaries?
Ovarian cancer
195
What is a common site for ovarian metastasis?
Pleural cavity
196
What clinical findings are associated with cystic teratomas?
Torsion with infarction
197
What clinical findings are associated with sex cord-stromal tumors?
↑estrogen (granulosa cell)/↑androgens (Sertoli-Leydig cell)
198
What is the tumor marker for surface-derived ovarian tumors?
↑CA125
199
What covers the fetal surface of the placenta?
Chorionic plate
200
What is found on the maternal surface of the placenta?
Cotyledons
201
What is the function of chorionic villi?
Extract O₂ from maternal blood
202
What type of tissue lines the chorionic villi?
Trophoblast: made up of outer layer of syncytiotrophoblast (synthesizes hCG, HPL) and inner layer of cytotrophoblast
203
What is the function of human placental lactogen?
Anti-insulin activity; similar to human growth hormone
204
What forms the umbilical vein?
Vessels in chorionic villi
205
What structures are found within the umbilical cord?
Two arteries
206
What are the implications of a single umbilical artery?
Increased incidence of congenital anomalies
207
What is the most common cause of placental infection?
Ascending broup B streptococcus from vagina
208
What is the definition of funisitis?
Infection of the umbilical cord
209
What is the definition of placentitis?
Infection of the placenta
210
What is chorioamnionitis?
Infection in fetal membranes; danger of neonatal sepsis/meningitis
211
What is placenta previa?
Implantation over cervical os
212
What risk factor is associated with placenta previa?
Previous C-section
213
How does placenta previa present?
Painless vaginal bleeding
214
What is the appropriate management of placenta previa?
Diagnose by ultrasound
215
What causes abruptio placentae?
Retroplacental clot
216
What is the most common cause of late pregnancy bleeding?
Abruptio placentae
217
What is the greatest risk factor for abruptio placentae?
Hypertension
218
What is the triad of clinical findings in abruptio placentae?
Painful vaginal bleeding
219
What is the appropriate management of abruptio placentae?
No pelvic exam
220
What are the implications of placenta increta/percreta?
Implantation into muscle; danger of hemorrhage at delivery
221
What are the implications of velamentous insertion?
Cord inserts away from placental edge; danger of tearing vessels
222
What are the implications of an accessory placental lobe?
↑risk of hemorrhage if detached
223
What causes an enlarged placenta?
Rh hemolytic disease of newborn
224
What type of twins form a monochorionic placenta?
Identical twins from a single fertilized egg
225
What type of twins form a dichorionic placenta?
Identical or fraternal (separate fertilized eggs)
226
When does preeclampsia occur?
Usually occurs after the 20th week of pregnancy
227
What risk factors are associated with preeclampsia?
Young/advanced age
228
What is the pathogenesis of preeclampsia?
Placental hypoperfusion
229
What pathologic findings are associated with preeclampsia?
Hypertension
230
What is eclampsia?
Preeclampsia + seizures
231
What is the treatment for preeclampsia?
Delivery is the treatment of choice; methyldopa for hypertension
232
What is a hydatidiform mole?
Benign tumor in chorionic villus; look like grapes
233
What are the characteristics of a complete molar pregnancy?
All villi are neoplastic; dilated neoplastic villi with no fetal parts
234
What causes a complete molar pregnancy?
Fertilization of empty ovum by 46XX/XY sperm or two separate 23X/Y sperm
235
How does a complete molar pregnancy appear on ultrasound?
snowstorm appearance; too large for gestational age
236
What are the characteristics of a partial molar pregnancy?
Normal villi intermixed with neoplastic villi; fetal parts intermixed with neoplastic villi
237
What causes a partial molar pregnancy?
Fertilization of a 23X/Y ovum by two sperm
238
What clinical findings are associated with a partial molar pregnancy?
Incomplete/missed abortion
239
What is a choriocarcinoma?
Malignancy of trophoblastic tissue; no chorionic villi
240
What risk factors are associated with choriocarcinoma?
Complete mole > spontaneous abortion > normal pregnancy > partial mole
241
What are the common sites of metastasis associated with choriocarcinoma?
Lungs, vagina; lesions are hemorrhagic
242
What is the composition of amniotic fluid?
Predominantly fetal urine
243
Why does amniotic fluid cause "ferning" when dried on a glass slide?
High salt content
244
What are the causes of polyhydramnios?
Tracheoesophageal fistula
245
What is the main cause of oligohydramnios?
Juvenile polycystic kidney disease
246
What underlying defect is implicated by ↑AFP?
Open neural tube defect; inadequate folic acid before pregnancy
247
What underlying defect is implicated by ↓AFP?
Down syndrome
248
What is indicated by an L/S ratio >2?
Adequate surfactant
249
What factors influence surfactant synthesis?
↑ with glucocorticoids/thyroxine
250
What is the source of urine estriol in pregnancy?
Fetal adrenal gland/liver
251
What causes ↓estriol?
Sign of fetal-maternal-placental dysfunction
252
What triad of laboratory findings is associated with Down syndrome?
↓urine estriol
253
What is the most common location of breast cancer?
Upper outer quadrant
254
What effect does estrogen have on breast tissue?
Stimulates ductal/alveolar growth, fat, stroma
255
What effect does progesterone have on breast tissue?
Stimulates alveolar proliferation/lobule differentiation; breast swelling
256
What is the role of prolactin in lactation
Stimulates/maintains lactogenesis and secretion
257
What is the role of oxytocin in lactation?
Released by suckling; expulsion of milk into ducts
258
Where do outer quadrant breast cancers drain?
Axillary nodes
259
Where do inner quadrant breast cancers drain?
Internal mammary nodes
260
What is the most common physiologic cause of galactorrhea?
Mechanical stimulation of the nipple
261
What is the most common pathologic cause of galactorrhea?
Prolactinoma
262
What is the most common nonpituitary cause of galactorrhea?
Primary hypothyroidism: ↑TRH stimulates prolactin release
263
What drugs commonly cause galactorrhea?
Oral contraceptive pills
264
What pathologies cause bloody nipple discharge?
Intraductal papilloma
265
What causes purulent nipple discharge?
Acute mastitis during breast-feeding
266
What causes greenish nipple discharge?
Mammary duct ectasia
267
What is the most common cause of breast pain?
Fibrocystic change
268
What is Mondor disease?
Superficial thrombophlebitis overlying breast
269
What are some examples of benign calcifications in mammograms?
Popcorn calcifications
270
What is the most common breast mass in women
Fibrocystic change
271
How does fibrocystic change feel on breast examination?
Lumpy bumpy due to cysts and fibrosis
272
Sclerosing adenosis is associated with what finding on mammogram?
Often contain microcalcifications
273
What complication is associated with atypical ductal hyperplasia?
↑risk of breast cancer
274
How does mammary duct ectasia present?
Greenish brown nipple discharge; common in menopause
275
What is the presentation of traumatic fat necrosis?
Usually presents as a painless indurated mass; associated with trauma to breast tissue
276
What happens if a silicone breast implant ruptures?
Silicone produces foreign body giant cell reaction
277
What is the most common breast tumor in women
Fibroadenoma
278
What drug is highly associated with the development of fibroadenomas?
Cyclosporine; 50% of women taking cyclosporine post renal transplantation develop fibroadenomas
279
What is a fibroadenoma?
Benign tumor derived from stroma
280
What are the characteristics of a Phyllodes tumor?
Benign, borderline, or malignant stromal tumor; depends on stromal cellularity
281
What is the most common cause of bloody nipple discharge in women
Intraductal papilloma
282
What is the most common cancer in women?
Breast cancer
283
What is the most common breast mass in women >50 years old?
Breast cancer
284
What factors increase the risk for breast cancer?
Prolonged estrogen stimulation
285
What percent of breast cancers have a genetic basis?
286
What risk factors are associated with breast cancer?
Unopposed estrogen
287
What factors reduce the risk of breast cancer?
Breast-feeding
288
What are the clinical findings of breast cancer?
Painless mass; skin/nipple retraction
289
What is the purpose of mammography?
Screening to test for nonpalpable masses
290
What causes microcalcifications in breast tissue?
Ductal carcinoma in-situ
291
What are some features that can be used to distinguish malignant microcalcifications on mammography?
Clustered punctate, microlinear, or branching
292
Breast cancer is the most common source of metastasis in which two sites?
Lungs and bone
293
How can pain in bone metastasis be relieved?
Radiation
294
What determines the staging of breast cancer?
Extranodal spread has greater significance than nodal metastasis alone
295
Which node sampled in sentinel node biopsy?
Initial node draining the tumor
296
What receptor assay confers better prognosis for breast cancer?
Positive assay for estrogen and progesterone receptors (ERA-PRA)
297
What is the significance of ERBB2?
Oncogene; if positive in breast tissue, poor prognosis
298
What physical finding is caused by damage to the long thoracic nerve?
Winged scapula
299
What is the relative survival rate of breast conservation vs mastectomy?
Breast conservation therapy has similar survival rate as modified radical mastectomy
300
What is the definition of gynecomastia?
Benign glandular proliferation of male breast tissue due to estrogen stimulation
301
What are the sources of estrogen in males?
Peripheral aromatization of androgens
302
When does physiological gynecomastia occur?
Gynecomastia is normal in newborns, adolescence, and elderly
303
What is the most common pathologic cause of gynecomastia?
Cirrhosis (via hyperestrinism)
304
What are some genetic causes of gynecomastia?
Klinefelter syndrome
305
What drugs are associated with gynecomastia?
Spironolactone
306
What malignancy causes gynecomastia?
Choriocarcinoma of testis (via production of hCG)
307
What disorders cause gynecomastia via ↓androgens?
Leydig cell dysfunction
308
What risk factors are associated with the development of breast cancer in men?
Klinefelter syndrome
