Gyn1 Flashcards
Virilization
Hirsuitism + male secondary sex characteristics (zits, deeper voice, clitoromegaly - pathognomonic)
Most testosterone in a woman is predominantly diagnosed in the ovary. DHEA sulfate is 95% from adrenal
Tests are testosterone lvl (fractionate) and DHEA sulfate. If predominantly testosterone - ovary origin. DHEA up, then adrenal origin (hydroxyls deficiencies, etc.)
PCOS
Hypothalamic-pituitary abnormality. FSH suppressed but LH is increased. LH -> hormone synthesis around follicle (theca interna) –> DHEA, androstendione –> testosterone -(across into granulosa cells w/ aromatase)-> estradiol. Good percentage of PCOS has obesity. Aromatase (adipose). Hirsuitism, acne BUT being converted in estrogens -> endometrial hyperplasia/ca risk. Both increased. Estrogens –> suppress FSH but INC LH -> cycle. Tx = birth control pills. Cysts develop b/c FSH suppressed and follicle degenerates.
Dysmenorrhea
Painful menses. Primary - too much PGF. Inc. contractions of uterine musculature. Secondary - endometriosis is most common.
Dysfunctional uterine bleeding
It’s not bleeding abnormality from anatomical or organic cause. HORMONE imbalance causing an abnormality in bleeding. 1. Anovulatory cycles. 2 and 3 - inadequate luteal phase and irregular shedding of endometrium
Anovulatory cycles
Menarche to age 20. Usual cause. Persistent estrogen w/o enough progesterone –> hyperplasia -> sloughs
Primary amenorrhea
Hypothalamus or pituitary? Is it ovarian problem? End-organ problem (Anatomical)?
Secondary amenorrhea
Asherman (too many D&C’s, scrape to muscle).
Turner syndrome
XO. No Barr body. Defects in lymphatics - swelling of hand and feet. 4th metacarpal decreased. Webbed neck 2/2 cystic hygromas (dilated lymphatics in neck). Preductal coarctations. No ID. Sometimes mosaics. Menopause before menarche. All their follicles gone = streak gonad -> dysgerminomas.
Adenomyosis vs. endometriosis
Adenomyosis = glands and stroma within the myometrium. Dysmenorrhea, dyspauerenia. No predisposition to cancer. Endometriosis = functioning gland and stroma outside of the uterus. Ovary is common. Bleeding in ovary -> chocolate cysts. Tube, Pouch of Douglas -> hurts when defecates during period.
Endometrial hyperplasia
Unopposed estrogen -> risk for endometrial cancer. PCOS. Early menarche. Late menopause. Obesity.
45, 55, 65
Cervical, endometrial ca, ovarian ca. Anyone over age 55 with palpable ovarian mass = ca until proven otherwise.
Leiomyoma vs leiomyosarcoma
Leiomyoma is NOT precursor for leiomyosarcoma
Ovarian masses
Derived from lining of ovary - surface-derived. Germ-cell types (yolk sacs, teratomas). Sex-chord stromal tumors - can make estrogens (granulsoma), sertoli/leydig cell (testosterone). 35 yrs cutoff for malignancy
Surface-derived (most common)
Serous cystadenoma - benign. Serous cysadenocarcinoma - malignant, PSAMOMMA bodies (apoptosis -> dystrophic Ca). Most commonly b/l.
Cystic teratoma
Most common overall germ-cell tumor. Cartilage, glands, tooth, thyroid.
Sex chord stromal tumors
Fibromas most common. MEIG syndrome ( ).
Granulosa cell tumor
Low-grade. Normally aromatizes test -> Estrogen producing.
Chorionic villus
syncitiotrophoblast (outside - bcg and hpl), cytotrophoblast (middle). Myxomatous stroma. Vessels -> umbilical vein (highest o2 content)
Hydaditiform mole
Complete, partial. Complete = 46XX (both from dad). Partial = triploid 69. Complete more malignant (choriocarcinoma - malignancy of trophoblastic tissue. NO chorionic villi -> lungs; responds well to chemo)
Breast lesions
Nipple, lactiferous duct, major duct, terminal lobules, stroma.
Nipple
Paget’s disase
Lactiferous duct
Intraductal papilloma - most common cause of bloody nipple discharge < 50y/o. Benign papillary tumor.
Major ducts
Invasive, medullary carcinoma, mucinous
