Kaplan Path Flashcards
Severe perimenstrual pain and nonfocal thickening of the myometrium. Ultrasound of pelvic organs shows nonfocal thickening of myometrium.
Adenomyosis
Characteristic histo of adenomyosis.
Characterizedby the presence of endometrial glands int he myometrium of the uterus.
What causes the pain and bleeding in adenomyosis?
Pain due to cyclic breaking down of glands and bleeding into the myometrium.
In a patient with amenorrhea, a very shallow vagina, and no obvious uterus and cervix, suspect ___ and look for ____ in the labia that might be abnormal testes?
Suspect testicular feminization (possibly due to presence of Mullerian Inhibitor Factor during early fetal life).
Look for palpable mass in labia that might be abnomral tests.
A 26 year old woman presents with hyperthyroid symptoms (normal TSH and inc T4)and a palpable abdominal mass. What does she have?
Monodermal teratoma form of mature teratoms of the ovary. This form (struma ovarii) produces abundant mature thyroid tissue, typically not under TSH control.
Most common form of mature teratoma?
Dermoid cyst
Suspects _____ in a breastfeeding pt who develops breast tenderness and swelling. Most likely etiology?
Acute mastoiditis. Staph aureus infection.
Suspect ___ in a pt with lower abdominal pain, vaginal discharge, adnexal tenderness, and tenderness with cervical motion.
PID
PID may be due to what four main infections?
N. gonorrhoeae, C. trachomatis, vaginal anaerobes, facultative gram(-) rods
Complications of PID.
Sterility, ectopic tubal pregnancy, bacteremia, peritonitis, intestinal obstruction.
In high grade dysplasia of the cervix, dysplastic cells show what?
- High nuclear:cytoplasmic ratio (big nucleus).
- Confined to epithelium
- Involve full thickness of surface epithelium
If a pt is lost to followup for 2 years following dx of high grade dysplasia of the cerivx, ___% persist and a small% possibly progress to ___.
60% persist and a small% possibly progress to invasive Ca.
Ca of breast that are positive for ER/PR have what prognosis and why? What do positive stains mainfest as?
Better because they may respond to tamoxifen - an ER antagonist.
(+)=brown stain
- Grading of breast cancer is based on ____.
- Staging is based on ____.
- HER2 and ER/PR have what value?
- Histologic features
- Distribution of disease
- Prognostic value (natural h of dz) and predictive value (response to therapy)
HER2 testing is done to decide whether pts will receive ___ therapy (and its MOA).
trastuzumab, a MOab (but they are aggressive tumors)
Name this: A patient presents with a whitish patch or plaque, lump, ulcer, or wart-like growth. Biopsy shows invasion of vulvar dermal-epidermal junction by disordered squamous epithelial cells.
Vulvar SCCa
Precursors to Vulvar SCCa
Vulvar intraepithelial neoplasia (VIN), condyloma, spontaneous
Most common predisposing factor for tubal pregnancy.
PID (also endometriosis, IUD, leiomyoma, and previous pelvic surgery)
Edema, HTN, proteinuria
Preeclampsia
What is HELLP?
Manifestation of severe Preeclampsia with: Hematuria, Elevated Liver enzymes, Low Platelets
Etiology of Preeclampsia
Develops secondary to placental ischemia.
A girl exhibits precocious sexual development. Suspect what?
Estrogen secreting tumor, like a Granulosa Cell tumor.
Name the male-hormone secreting tumor of the ovary.
Name the hCG-secreting tumor of the ovary.
- Sertoli-Leydig Cell Tumor
- Choriocarcinoma
Name conditions that increase risk of breast carcinoma by (2x) and (5x)
2x - Sclerosing Adenosis and Hyperplasia WITHOUT Atypia
5x - Atypical Ductal or Lobular Hyperplasia
Name this: An ulcerating lesion of or near the nipple with malignant glandular cells in the epidermis.
Paget Disease of the Breast
Name this: Nipple trauma that leads to acute inflammation and necrosis.
Actue mastitis (…i think it’s fat necrosis)
Name this: subareolar tumor in ducts that causes bloody or serous nipple dicharge.
Intraductal papilloma.
Name this: poorly circumscribed, rubbery breast mass. Signet cells lined single file or in loose clusters.
Invasive Lobular Carcinoma
Name this: tend to be benign, large, circumscribed, first breast mass, comprised of epithelial and stromal proliferation.
Phyllodes tumor
“leaf like”
Increased risk associated with developing invasive breast carcinoma?
- sclerosing adenosis
- apocrine metaplasia
- blue domed cysts
- duct ectasia
- fibroadenoma
- sclerosing adenosis - yes
- rest: no
What is this:
-Benign mass composed of whorls of smooth muscle cells. May cause abnormal uterine bleeding and anemia, more often in premenopausal women. May show immunoreactivity for smooth muscle actin.
Uterine leiomyomas
Gastric mucinous adenocarcinomas that have met to (both) ovaries.
Krukenberg tumors
What is this?
Resected ovarian tissue that shows numerous malignant cells containing cytoplasmic mucin droplets that push aside the nucleus of adenocarcinoma cell
Signet ring cells (Krukenberg tumors)
Discrete mass with calcifications on mammography. Biopsy shows chronic/prominent multinucleated giant cells, lipid laden histiocytes, and calcification.
Fat necrosis
Anovulatory cycles cause unopposed _____, leading to what?
- unopposed estrogen stimulation
- leading to AUB and disordered proliferative endometrium
Endometrial Ca develops in the background of ____, leading to malignant transformation of what?
unopposed estrogen –> endometrial hyperplasia and atypia –> malignant transformation –> endometrial Ca
What is this and karyotype: Grapelike, multicystic villous, no fetal tissue, 2% risk fo choriocarcinoma development, extremely high hCG levels (N/V).
Complete mole, 46XX
What is this and karyotype: wide range of villous sizes, often contain fetal tissue, no risk of choriocarcinoma , moderately high hCG levels (N/V).
Partial mole, 69XXY, 69XXX
Solid, yellow ovarian mass that can produce estrogens, leading to precocious puberty in girls and endometrial hyperplasia and abnormal uterine bleeding in older women.
Granulosa cell tumor (—> COT to endometrial Ca dt estrogen)
Suspect what? Ovarian mass (usually B9 fibroma), hydrothorax, and ascites
Meigs syndrome
Type of teratoma: development of Ca in a mature teratoma
solid mature teratoma with malignant transformation
Type of teratoma: almost always benign, cytstic, mature teratoma usually found in ovaries
dermoid cyst
Type of teratoma: B9 tumor forming multiple adult like tissue found in ovaries (all ages) and testes (prepubertal males)
Solid mature teratomas
Type of teratoma: contains tissue resembling embryonal tissues; considered to be potentially malignant
immature teratoma
40-65 years, bilateral (2/3rds of pts). Surface derived ovarian tumor that is filled with clear fluid and lined by epthelial cells forming papillary fronds.
Serous cystadenocarcinoma
Name this breast cancer: numerous small invasive glandular structures surrounded by desmoplastic stromal response
invasive ductal Ca
Name this breast cancer: malignant cells with abundant mucin secretion
colloid (mucinous) Ca
Name this breast cancer: single file distribution of invasive cancer cells
invasive lobular Ca
Name this breast cancer: sheets of tumor cells surrounded by abundant lymphoplasmacytic reaction
Medullary Ca
What is this infection: neonatal conjuctivitis in first 2 weeks of life, pneumonia (6wks-6mo), fever, tachypnea, crackles, wheezing, eosinophilia.
Chlamydia trachomatis/pneumonia - Sexually transmitted genital infection (mom to baby in vaginal canal)
Characteristic vacuoles containing reticulate bodies seen in epithelial cells
Chlamydia trachomatis
Women with complex hyperplasia with or without atypia have greater chance of developing endometrial Ca?
compelx hyeprplasia WITH ATYPIA have higher chance of developing endometrial Ca.
(high mitotic activity, disorganization, nuclear atypia)
Tumor marker for epithelial-derived ovarian Ca (i.e. serous or cystadenomCa). Useful for monitoring what?
CA-125 useful for monitoring disease recurrence in pts who have been treated with surgery or chemo.
A young woman with oligomenorrhea, infertility, and hirsutism. She has increased LH and low FSH.
Polycystic Ovarian Syndrome - multiple ovarial follicular cysts due to her hormone imbalance.
