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Life Cycle Unit 1 Flashcards

1
Q

Lichen Sclerosis

A
  • Porcelian white plaques with red or violet border = “parchment paper” vulva
  • itchy, fissures, painful sex = fragile skin/erosions
  • post-menopausal women
  • thinned epidermis with dermal fibrosis and/or superficial hyperkeratosis
  • may be autoimmune
  • increase risk of SCC
  • treat with steroids
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2
Q

Lichen Simplex Chronicus

A
  • -leathery thick skin with excoriations on the vulva

- benign, no increased SCC risk

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3
Q

Molluscum contagiosum

A
  • flesh colored pearly skin lesions, painless, on vulva
  • transmitted by kids sharing towels or genital contact
  • pox virus
  • endophytic growth with eosinophilic inclusions
  • self-limited
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4
Q

Vulvar carcinoma

A
  • vulva, mass from squamous cells, leukoplakia
  • rare
  • caused by high risk HPV -> reproductive age women
  • Non-HPV type think old and lichen sclerosis
  • increased risk with smoking and immunosuppression
  • “VIN”, “keratin pearls”, desmoplastic stromal response
  • 5 year survival good without nodes
  • 10-20y post infection -> tumor
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5
Q

Extramammary paget’s

A
  • pruritis, erythema, crusting, ulcers on vulva
  • intraepithelial adenocarcinoma
  • pale tumors with “halos” in epidermis
  • grows in pagetoid pattern
  • low risk underlying adenocarcinoma
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6
Q

Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

A
  • clear, grape-like polypoid mass that emerges from vagina
  • usually occurs in children less than 4
  • dense zone of rhabdomyoblasts below epithelium, “spindle/striations”
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7
Q

Vaginal Adenosis/Adenosarcoma Clear Cell

A
  • columnar epithelium in vagina (glandular)
  • DES exposure (1940-71)
  • “kissing lesions”
  • tubulocystic with dense hylain stroma and clear cytoplasm
  • increased risk of clear cell carcinoma
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8
Q

Vaginal Squamous Cell Carcinoma

A

-usually secondary to SCC

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9
Q

Endocervical Polyps

A
  • spotting, polyp on exam near os
  • common
  • dilated glands, dense eosinophilic stroma
  • curettage is curative
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10
Q

Cervical Dysplasia/Carcinoma In Situ/Carcinoma

A
  • asymptomatic or abnormal bleeding post-coital
  • Risk factors: unsafe sex, multiple partners, smoking, early coitarche, DES, immunocompromised
  • Most often seen in women who haven’t had regular paps
  • disordered epithelial growth pattern from transition zone
  • CIN 1, 2, 3 (severity classification)
  • associated with high risk HPV (E6 = p53; E7 = Rb)
  • “koilocytes”
  • usually squamous cell
  • slow progression to invasive cervical carcinoma
  • diagnosed by colposcopy
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11
Q

Endometrial Polyp

A
  • asymptomatic or painless AUB
  • well circumscribed, endometrial tissue within the uterine wall with/without muscle cells
  • hormonally unresponsive
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12
Q

Endometritis

A

associated with retained products of conception post delivery, miscarriage, abortion, and foreign body (IUD)

  • retained material -> bacterial infection
  • Acute = increase in polyps in stroma and glands
  • Chronic = plasma cells -> infertility
  • PID
  • treat with antibiotics and possible curretae if acute
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13
Q

Adenomyosis

A
  • dysmenorrhea/menorrhagia
  • uniformly enlarged, soft, globular uterus
  • associated with infertility
  • endometrial glands in the uterine myometrium
  • hyperplasia of basal layer of endometrium
  • treat with GnRH agonist and possible hysterectomy
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14
Q

Leiomyoma/Fibroids

A
  • most common uterine tumor
  • AUB or asymptomatic
  • multiple discrete tumors
  • miscarriage
  • anemia possible
  • increased risk in african american
  • more common in females 20-40y
  • benign smooth muscle tumor
  • estrogen sensitive
  • whorled pattern of smooth muscle bundles with well demarcated borders
  • rarely transitions to malignant leiomyosarcoma (check in older women)
  • Treatments: surgery, embolization, GnRH agonist
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15
Q

Asherman Syndrome

A
  • decreased fertility, recurrent miscarriages, AUB, pelvic pain
  • associated with D&C
  • adhesions/fibrosis of endometrium
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16
Q

Endometrial Hyperplasia

A

-post-menopausal AUB or asymptomatic
-associated with : anovulatory cycles, PCOS, hormone replacement therapy, granulosa cell tumor
-abnormal endometrial gland proliferation
often caused by excess estrogen
-simple = increased in glands:stroma ration, no atypia, PTEN mx
-Complex = nuclear atypia, much more glands, hMLH1 (lynch syndrome) associated
-increased risk of endometrial carcinoma
-Treatments: simple (just progestins), hormonal, curettage, surgery

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17
Q

Endometrial carcinoma

A

-most common gyn malignancy
-AUB (usually post-menopause)
-thickened endometrial stripe on US
-55-65 yr, hx of endometrial hyperplasia, OBESITY, prolonged unopposed estrogen, diabetes, HTN, nulliparity, late menopause, early menarche
-intercavitary solid mass that resembles endometrium +/- invasion into the muscle
-p53 most significant
Type II is more rare and worse than Type I
-Prognosis depends on stage
-Tx: surgery, radiation, chemotherapy

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18
Q

Endometriosis

A
  • cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility, normal sized uterus
  • non-neoplastic
  • endometrial tissue/glands outside of uterine cavity
  • common locations ovary (“chocolate cysts”), pelvis, and peritineum
  • may be due to retrograde flow, metaplastic transformation of multipotent cells, transport via lymphatic system
  • Tx: NSAIDs, continuous OCPs, progestins, GnRH agonist, danazole, laproscopy
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19
Q

Follicular Cyst

A
  • young females, +/- elevated E, PCOS

- distention unruptured follicle +/- endometrial hyperplasia

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20
Q

Theca-Lutein cyst

A
  • often b/l and multiple; associated with choriocarcinoma and hydratiform moles
  • due to gonadotropin stimulation
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21
Q

Serous cystadeonma

A
  • surface epithelial tumor ovary
  • most common ovarian neoplasm; often b/l
  • lined with fallopian tube like epithelium (cuboidal)
  • thin walled cysts
  • broad papilla with fibrovascular cores; no atypia or mitosis
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22
Q

Serous Borderline

A
  • Surface epithelial tumor ovary
  • 40-50s; asymptomatic; variable presentation
  • +Ca125
  • KRAS/BRAF mx
  • papillary excrescences
  • “hierarchical branching” & “tufting”
  • good prognosis
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23
Q

Serous cystadenocarcinoma

A
  • surface epithelial tumor of ovary
  • most common malignant neoplasm; often b/l
  • Gross: cysts contain straw like proteinaceous glands
  • Micro: psammoma bodies; stromal invasion
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24
Q

Mucinous cystadenoma

A
  • surface epithelial tumor ovary
  • most 35-50y
  • multilobulated, large, lined with mucous cells, NO BRANCHING
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25
Mucinous borderling
- surface epithelial tumor ovary - 60+ - stratified epithelium with atypia and mitosis - intestinal or endocervical type
26
Mucinous cystadenocarcinoma
- surface epithelial tumor ovary - rare; 60+; unilateral - destructive invasion: desmoplastic response (25% recurrence) - expansive invasion: pushing border without stromal response (5% recurrence) - can be metastatic from other tumors - pseudomyxoma peritonei = intraperitoneal accumulation of mucinous material
27
Endometrioma
- surface epithelial tumor ovary - endometriosus + cysts - chocolate cysts - complex mass on US
28
Endometrioid Tumor
- surface epithelial tumor ovary - 20% of ovarian cancer - 40% b/l - 15-30% synchronous with endometrial carcinoma - uterine adenocarcinoma; gland forming, atypia
29
Clear Cell (ovary)
- surface epithelial tumor ovary - vary rare, aggressive, associated with endometriosis - "Hob nail cells"; tubulocystic pattern
30
Mature Cystic Teratoma (dermoid cyst)
- germ cell tumor - most common ovarian tumor - asymptomatic - reproductive age - can be b/l - associated with NMDAR encephalopathy - cystic mass containing elements from all 3 germ layers - can cause hyperthyroidism = stroma ovarii - benign in females
31
Immature Teratoma
- germ cell tumor - <20y - contains fetal tissue/neural ectoderm (small dark nuclei) - malignant/aggressive
32
Dysgerminoma
- 50% of malignant germ cell tumors - can be b/l and in or out of ovary - common in teens - "fried eff cells"; sheets/nests; big nucleoli - good prognosis - sensitive to chemo/radiation - female counterpart to seminoma
33
Yolk Sac Tumor
- germ cell tumor - 10-20y - aggressive in young kids - Gross: yellow friable mass - Serum: elevated AFP - Micro: schiller-duval bodies - common extra-ovarian spread
34
Choriocarcinoma
- germ cell tumor - gestational or post-gestational - biphasic: mononuclear and multinucleated - +bHCG
35
Fibroma
- Sex chord stromal tumor - pulling sensation in groin - meig's syndrome: fibroma + ascitis + hydrothorax - bundles of spindle shaped fibroblasts - may have concurrent endometrial carcinoma
36
Thecoma
- sex cord stromal tumor - post-menopausal AUB - can make Estrogen - plump cells with increased cytoplasm and reticular cells - may have concurrent endometrial carcinoma
37
Granulosa Cell Tumor
- Sex cord stromal tumor - 50y; post-menopausal AUB; breast tenderness OR secually precocious adolescents - make progesterone and estrogen - "Call-Exner" bodies - like primitive follicle - "Give Granny a Call"
38
Sertoli-Leydig Cell Tumor
- sex cord stromal tumor - may have virilization - average age is 25y - rare - recapitulates developing testes - sertoli-leydig cells on histo
39
Tubal Intraepithelial Carcinoma
- precursor to most ovarian serous carcinoma | - at fimbrae; looks like cancer
40
Tubo-Ovarian Abscess
- late complication of PID - polymicrobial - reproductive age females - inflammatory mass - Tx: drain, surgery, antibiotics
41
Krukenberg Tumor
- b/l ovarian masses - GI malignancy -> ovaries - mucin secreting signet cells - adenocarcinoma
42
Brenner Tumor
- benign - resembles bladder epithelium - pale, yellow/tan, encapsulated - coffee bean on H&E
43
Peyronie Disease
- curvature of penis associated with ED (pain, anxiety) - fibrous plaque in tunica albuginea - Tx: surgical repair once curvature stabilizes - NOT a penile fx
44
Ischemic Priapism
- painful erection lasting longer than 4 hours - associated with sickle cell disease, and meds such as sildenafil/trazadone - due to blockage of veins - emergent tx: corporal aspiration, intra cavernosum phenylephrine or surgical decompression
45
Squamous Cell Carcinoma of Penis
-associations: uncircumsized & HPV -Types: 1-Bowen disease (penile shaft leukoplasia, carcinoma in situ), 2-Eryhtroplasia Queyrat (glans erythroplacia, carcinoma in situ), 3-Bowenoid Papulosis (reddish papules) -
46
Cyrptorchadism
- undescended testis, most are unilateral and resolve on own - risk factors: prematurity - low inhibin B, low T, high FSH & LH - treat with surgery if needed - complications: atrophy (>2y), impaired spermatogenesis (elevated T), and increased risk of germ cell tumors
47
Vericocele
- dilated pampiniform plexus due to increased venous pressure - most often on left side (b/c left renal vein), increases with valsalva maneuver - "bag of worms" - does NOT transiluminate - treatment = surgical ligation/embolization - complications = infertility
48
Congenital Hydrocele
- benign scrotal mass - infant - transilluminates - incomplete obliteration of procesus vaginalis
49
Acquired Hydrocele
- benign scrotal mass - transilluminates - caused by infection, trauma, or tumor
50
Spermatocele
- benign scrotal mass - transilluminates - paratesticular fluctuant nodule - cased by dilated epididymal duct or rete testis
51
Seminoma
- germ cell tumor - painless homogeneous testicular enlargement with large cells and lobules; fried egg appearance - Does NOT transilluminate - Increased placental ALP - treat with radiation - not in infants - good prognosis - equivalent to dysgerminoma in females
52
Yolk Sac Tumor (Testicular Endodermal Sinus Tumor)
- germ cell tumor - Does NOT transilluminate - yellow mucinous appearance with schiller duval bodies - Increased AFP - treat with radical orchiectomy - pure = kids - mixed = adults - okay prognosis, but aggressive - most common tumor in <3y
53
Choriocarcinoma
- Germ cell tumor - increased bHCG - disordered synctiotiphoblastic sytotrophoblastic elements - hematogenous mets to lungs and brain - may have gynecomastia and symptoms of hyperthyroidism - treat with radial orchiectomy - usually mixed, aggressive, chemo sensitive, but poor prognosis
54
Teratoma (testis)
- germ cell tumor - treat with radical orchiectomy - malignant in males
55
Embryonal carcinoma (testis)
- germ cell tumor - hemorrhagic mass with necrosis - painful - glandular papillary morphology - elevated bHCG - usually presents as part of mixed tumor - treat with radical orchiectomy - poor prognosis
56
Leydig Cell Tumor
- non-germ cell tumor of testis - golden brown color - ranke crystales (eosinophilic cytoplasm) - gynecomastia/precocious puberty
57
Sertoli Cell Tumor
- non-germ cell tumor of testis | - androblastoma from sex cord stroma
58
Testicular Lymphoma
- non-germ cell tumor of testis - old men - mets to testes/aggressive
59
Mumps orchitis
- pubertal/adult males - 1 week post-parotid involvement - 70% unilateral - no effect on fertility
60
Tuberculous orchitis
- epididymis -> testis - systemic disease - caseating granulomas
61
Benign Prostatic Hyperplasia
- common in males >50y - peeing problems, distended bladder, hydronephrosis, UTIs - elevated PSA - periurethral (lateral and middle) - smooth elastic firm nodule - not premalignant - treatment: alpha 1 antagonist )relax smooth muscle, -osin), 5 alpha reductase inhibitor (decrease DHT -> decrease prostate size, finasteride), PDE 5 inhibitor (smooth muscle relaxation, -afil), or surgical resection (TURP or ablation)
62
Prostatitis
- dysuria, frequency, urgency, low back pain - warm, tender, enlarged prostate - Acute: older men think E.Coli and younger men think STDs; PMNs for histo - Chronic: associated with atrophy, unclear etiology, infectious or not, mononuclear cells seen on histo
63
Prostate Adenocarcinoma
- common in M >50y - peeing problems & upstream problems - bone mets with low back pain (elevated ALP) - Elevated PSA and positive needle core biopsu - Prostatic Acid Phosphatase (PAP) tumor marker - Risk factors: age, race, genetics - Peripheral zone > transition zone - Screening issues - Diagnostic Criteria: uniform round glands, infiltrative pattern, single-cell layer (basal lost), Nuclear big and prominent, perineural invasion - high Gleason score is bad

Life Cycle (1 decks)

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