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
Terminal lobules
Lobular carcinoma - BILATERAL!
Most common mass in breast < 50
Fibrocystic change. Cysts, fibrosis, sclerosing adenosis.
Most common mass in breast > 50
Infiltrative ductal carcinoma.
35 movable mass, gets bigger during cycle, painful
Fibroadenoma. Stroma is neoplastic.
PAINLESS OVER 50
cancer; outer quadrants are most common b/c most amount of tissue.
Stellate appearing, white mass
Invasive cancer. On mammography with spicules.
Comedocarcinoma
ERb2 oncogene. Pus stuff.
Paget’s disease
Rash on the nipple. Cancer of the duct underneath that has spread into the skin.
Inflammatory carcinoma
Dimpled skin b/c LYMPHATICS are plugged w/ tumor. Peau d’ orange.
Mod radical mastectomy
Leaving behind pectorals major. Axillary resection. Take away pectoralis minor. WINGED scapular b/c cut LONG thoracic nerve is common complication.
Lumpectomy
Removes underlying tumor w/ border. A few nodes of axillary chain. Then radiation.
ERA, PRA Assay
Women that are young, USUALLY ER, PR negative (b/c estrogen down regulate receptor synthesis). Postmenopausal often get up-regulation of receptors -> ER, PR +. ER, PR + tumors req. get rid of estrogen effect. Tamoxifen is a weak estrogen (risk of endometrial cancer, prevent osteoporosis)
