GU/Breast Flashcards
what are the two types of epithelium that line the glandular tissue and ducts in the breast
inner: luminal
outer: myoepthelial
What is the commonest type of congenital breast abnormality
ectopic/heterotopic breast tissue
what is breast hypoplasia associated with
ulnar-mammary syndrome, polands syndrome, turners syndrome and congenital adrenal hyperplasia
what are the two types of stromal overgrgowth
juvenile hypertrophy and gestational hypertrophy
two strains of inflammatory infections
infective and non-infective
acute mastitis
a cellulitis associated with breast feeding, the skin fissuring may let the bacteria in and the milk stasis favours their growth which leads to the infection of the breast tissue
granulomatous inflammation
can occur is systemic diseases including sarcoidosis, and infections including tuberculosis
recurrent subareolar abscesses
these can be associated with maxillary fistula and is said to be associated with squamous metaplasia of lactiferous ducts and smoking
periductal mastitis/duct ectasia
dilation of the central lactiferous ducts, periductal chronic inflammation and scarring
CALCIFIED LUMINAL SECRETIONS SEEN ON MAMOGRAM
adenosis
increase in glandular breast tissue
Radial scars
benign lesions characterised by a fibrotic core with elastic fibres, trapped glands and a pseudo-infiltrative appearance
intraduct papilloma
benign tumour of the epithelium lining the mammary ducts
Phyllodes Tumour
they are like fibroadenomas, combine epithelium and mesenchyme, but with more celullar stroma, mitotic activity, cytological atypic and an infiltrative border
Phyllodes Tumour
they are like fibroadenomas, combine epithelium and mesenchyme, but with more celullar stroma, mitotic activity, cytological atypic and an infiltrative border
When is axillary clearance necessary
if the sentinel node biopsy is positive (but sometimes not even then)
what would you treat breast tumours with if they were ER/PR-positive carcinomas
response to endocrine treatment with tamoxifen (predominantly an ER antagonist)
what are aromatase inhibitors used for
postmenopausal women are given this to prevent oestrogen stimulation of tumour growth as it blocks the conversion of adrenal (androgens) to oestrogen’s, a process which usually occurs within adipose tissue (link between obesity and breast cancer?)
HER2 Positive cancers
worse prognosis and are treated with monoclonal antibody Trastuzymab (Herceptin) AND others
this reduces risk of relapse and prolongs survival
what is breast cancer grading based off of
- nuclear pleomorphism
- the number of mitosis per mm2
- the degree of gland formation by the cancer cells
grade 1 = well differentiated and slow growing
grade 3 = poorly differentiated and fast growing
what are the three main imaging modalities used in imaging of the pelvis in relation to female anatomy
MRI
CT
US - requires a full bladder as it opens up a good window to the uterus as the fluid does not reflect the beams
why is US less effective in people with obesity
the sonar beam gets reflected by the fat, this means there is less beam to penetrate deeper tissues
what can you see on a normal MRI in terms of pelvic imaging
in terms of T2 imaging it shows water and fat as bright areas and junctional zones as dark with the myometrium in the middle
what are some examples of benign ovarian pathology
ovarian follicle
dermoid cysts
haemorrhage cysts
endometriosis
polycystic ovarian syndrome
ovarian torsion
what size do follicles have to exceed to be diagnosed as cysts
above 2.5cm - these appear with completely dark centres
hemorrhagic cysts
the US would not appear just dark it would also show internal echos that appear like speckles and this is a sign its blood
mostly symptomatic but can present with pain
endometrioma
this is also known as the chocolate cyst
it appears much more dense on US as it also has haemorrhage debris and won’t go away after 6 weeks
dermoid cysts
this is usually incidentally found in young women and is a very common benign neoplasm
this contains elements from multiple germ cells laters (teeth/calcification) and appear dark due to its fat content (on US its got a variable appearance on CT it appears well defined and dark with calcification)
PCOS
this is a syndrome associated with excess androgens - on US it would present with multiple immature follicles (they often lack a central oocyte) as development has been prematurely stopped
- patients have irregular periods and androgen excess leading to hirsutism, acne and weight gain
can also result in fertility problems
ovarian torsion
this is when he ovary twists on its vascular pedicle - young women present with abdominal/pelvic pain, nausea and vomitting and its mostly associated with an ovarian mass such as a dermoid cyst
symptoms of ovarian cancer
feeling the need to urinate urgently or often
trouble eating or feeling full quickly
pelvic or abdo pain
bloating persistently
how do you calculate the RMI (risk of malignancy index)
ultrasound score x menopausal score x CA 125
Premenopausal = 1
post menopausal = 3
ultrasound abnormalities:
0 = 0
1 = 1
3 = two or more
more than 200 is concerning
what are some features of malignancy on an US
irregular solid or multi-lobulated cystic mass
solid components on the cyst wall
bilateral ovarian less
ascites, peritoneal nodules, or other evidence of metastases
staging of endometrial cancer
1 = carcinoma in the uterus
2 = spread to the cervix
3 = outside the uterus but is still within the pelvis
4 = beyond the pelvis such as the bladder or bowel
parametrium
this is a fibrous band that separates the cervic from the bladder
this is often invaded in stage 2b and above
if its invaded then surgery is not an option and it must be treated with chemo or radiation
what is the metastatic theory of endometriosis
retrograde menstruation or surgical procedures introduce endometrium to sites outwit the uterine cavity
what is the metaplastic theory of endometriosis
endometrium arises directly from the coelomic epithelium (i.e the peritoneum) of the pelvis
leiomyoma
benign smooth muscle tumour of the myometrium
leiomyosarcoma
malignant smooth muscle tumour of the myometrium
most common cause of enlarged ovaries in post-menopausal women
ovarian stromal hyperplasia
inflammation of the fallopian tube
salpingitis
what is the presentation of PID
abdominal/pelvic pain, adnexal tenderness, fever and vaginal discharge
REQUIRES ANTIBIOTICS
aggregates of neutrophils are present
molecular abnormalities in low grade serous carcinomas
BRAF and KRAS
there is an absence of the p53 mutation
molecular abnormalities in high grade serous carcinomas
can be associated with the BRCA mutation in younger patients but this condition usually effects peri-menopausal and post-menopausal women. it is also associated with the p53 mutation
SURGERY AND CHEMO
thought to originate from the Fallopian tube as a STIC
epithelial clear cell carcinomas
these are associated with endometriosis but can also occur in women without this
resistant to platinum based chemotherapy
NO P53 MUTATION
this is what can differentiate between high grade serious and clear cell
