PATH 375 Female Reproductive System Flashcards
Hermaphroditism
discordance between genotypic and phenotypic sex
a) True “: both male and female gonads
b) Male pseudo”: genotypically male
c) Female pseudo”:
STDs
3 common organisms
present (4)
common (HSV, Chlamydia, HPV) present with - vaginal discharge - lesions - pelvic pain - dyspareunia
Genital herpes (HSV2)
- def
- days
- dormant
- Dx impt
vesicles on genitalia that coalesce and ulcerate
- 3-7 days after exposure (30% dev lesions)
- dormant on nerves, recur
- Dx impt, prevent vaginal delivery if active
HPV
- condyloma (3 types)
- assoc
- labial, vaginal, and cervical warts (condyloma)
- condyloma acuminatum: large vulvar wart (HPV 6, 11)
- some types assoc with carcinoma
Chlamydia (trachomatis)
N. gonorrheae
urethritis or cervicitis with discharge, PID
Syphilis (T. pallidum)
vulvar ulcers
Bacterial vaginoses
Candida, Trichomonas, Gardnerella
PID
- def
- 2º to_
- present
- chronic, extensive infection of upper reprod tract
- usu 2º to STD (Chlamydia, Gonorrhea)
- salpingitis, tubo-ovarian abscess, peritonitis
PID complications (4)
- chronic non-specific infection (fever, malaise, fatigue)
- infertility (2º to fallopian tube scarring)
- pelvis mass + pain
- spread of infection
Endometrial hyperplasia
def
normal menstrual cycle req fn of hypothalamic-pituitary-ovarian axis
continued estrogen stimulation with inadequate progesterone => endometrial mucosa thickens
Endometrial hyperplasia
- present
- causes
- complex vs simple hyperplasia
anovulatory cycles: no ovulation => no progesterone sec)
- functional causes: puberty, anxiety, athlete
- organic causes: excess estrogen (OCT, tumors)
- atypical hyperplasia: incr risk of endometrial adenocarcinoma (from atypia)
Carcinoma of vulva
- type
- present (and colour)
- Dx
- Tx
squamous cell carcinoma
- raised or ulcerated lesion
- pre-neoplastic change present as white/red patch
- Dx: biopsy
- Tx: surgical +/- adjuvant Tx
Carcinoma of vagina (2 types)
squamous cell carcinoma
clear cell carcinoma: mother was on DES during pregnancy
Carcinoma of cervix
- Dx
- def
- lack of _
- loc
- HPV types
- grading
Pap test (early Dx) reduced mortality risk factors: sex early, multiple partners, HPV, other venereal diseases, env
squamous cell carcinoma: precursor lesion = dysplasia (cervical intra-epithelia neoplasia)
lack of normal maturation of squamous epith, occurs at transition zone
- cells shed into vagina (Pap smear)
- HPV types 16, 18, 33, 34, 35 assoc
- koilocytic change: characteristic changes due to HPV
graded mild (1/3), mod, severe
Leiomyoma (fibroid)
- def
- most common_
- responds to_
- symptoms
benign neoplasm der from smooth muscle in uterus wall
- most common uterine neoplasm
- responds to estrogen, arise dur reproductive age
- usu asymptomatic
- symptoms due to mass effects, bleeding
Leiomyosarcoma
malignant neoplasm der from smooth muscle
v rare
Endometrial adenocarcinoma
- def
- most common_
- present
- risk (6)
- prognosis
- Dx
- Tx
malignant neoplasm der from epith cells in endometrium
- most common malignant tumor of female reprod tract
- elderly females, vaginal bleed (PMB)
- risk related to incr estrogen (hyperestrinism): estrogen sec tumor, exogenous estrogen, obesity, nulliparous or early menarche, late menopause
- prognosis: stage most impt, grade (low intermed, high)
- Dx: endometrial biopsy, dilation and curettage
- Tx: hysterectomy +/- adjuvant Tx
Ovarian cysts
- def
- arise from_
- present
- if large
fluid filled cavities lined by epith
- arise from unruptured follicles (follicular cysts): may include cystic corpora lutea or inclusions of surface cells
- usu small, solitary, asymptomatic
- further investigation if large to rule out neoplasm
Polycystic ovary syndrome
- def
- cause
- present
- complications
multiple cysts in both ovaries
- caused by complex hormal disturbances of hypothalamic-pituitary-ovarian-adrenal axis
- menstrual irregularities
- infertility
Ovarian neoplasms
- common_
- mortality
- 3 types classification by_
- risk
second most common grp of tumors in female reprod tract
- highest mortality of femal reprod tract tumors
- 3 major grps based on histogenetics:
1. surface epith tumors
2. germ cell
3. sex cord stromal
malignant ovarian tumors uncommon in young females
not linked to OCP
- risk: ovarian dysgenesis, BRCA1 and BRCA2 gene mutations
Surface epith tumors
- histologic types
70% of ovarian neoplasms
- histologic types: serous, mucinous, endometrioid, clear cell, transitional cell
Serous epith tumors
Mucinous
most common
usu cystic, filled with clear fluid (serous) or viscous (mucinous)
types: benign, borderline malignant, and malignant (histology)
bilateral in 25% benign, 50% malignant
Germ cell tumors
20% ovarian tumors, occur in young females
teratoma: cystic, contain hair/seb material (dermoid cysts), teeth, bone, cartilage
- benign
immature teratoma: contains immature neural tissue
- may behave malignantly
Fibroma
Thecoma
benign neoplasm
- of fibroblasts
- of spindle (theca) cells (firm and solid mass), prod extrogens
Granulosa cell tumor
granulosa cells
benign or malignant
may prod estrogen
Infertility (4 factors)
ovum-related
sperm-related
genital organ factors: PID, Asherman syndrome (endometrium scar and close)
systemic factors
Ectopic pregnancy
- loc
- pathogenesis
implantation of fertilized ovume outside uterine cavity
usu fallopian tube trophoblast cells (of placenta) invade wall of tube, enlarge, may rupture => surgical emergency
Placenta accreta
abnormally deep penetration of placental villi into uterus wall
Placenta previa
abnormal placental implantation site in lower uterine segment
Toxemia of pregnancy
unknown pathogenesis
characteristic symptom complex in mother
Preeclampsia
- when
- present
occurs in 3rd trimester
may progress to eclampsia
present with hypertension, edema, proteinuria
Eclampsia
- present
- Tx
hypertension, edema, proteinuria, and seizures
life-threatening, must treat seizures
Tx: deliver baby asap
Gestational trophblastic disease
abnormalities of placentation => tumor-like changes or malignant transform
Hydatidiform mole
- def
- complete mole
- incomplete mole
abnormal placenta dev
trophoblastic prolif, hydropic degen of chorionic vili
enlarged uterus with no fetal movt , high HCG
complete mole: no identifiable fetus, abnormal fertilization (all paternal 46XX)
incomplete mole: some fetal parts, abnormal fertilization (69 chromosomes)
Choriocarinoma
rare
highly malignant tumor
placental origin
Tx: methotrexate
Abortion
interruption of pregnancy prior ot fetal viability
<500g, 20wks
Spont abortion
- complete
- incomplete
- missed
- threatened
1/3 all pregnancies, no identifiable cause
- complete: fetus and placenta expelled, normal fn returns
- incomplete: retain some fetal/placental mat
- missed: death of fetus in utero, passed after several wks
- threatened: cervical os closed, spotting of blood
Endometriosis
- def
- loc
- pathogenesis
- present
endometrial tissue (uterine glands + stroma) loc outside uterus (usu. ovary, peritoneum)
- common, may cause pain, infertility
- benign
- chocolate cyst of ovary
cycle in response to hormonal influences
- pathogenesis: retrograde flow, traumatic implantation
Mastitis
- def
- pop
- caused by
- present
acute inflamm of breast
- lactating female
- B. infection
- may dev abcess
chronic mastitis: unknown etiology, rare, may mimic BRCA
Fibrocystic change
- cause
- present
various factors including hormones, age
cause benign changes in breast tissue
fibrosis of intralobular stroma
cystic dilation of epith ducts
epith hyperplasia
- reprod age females
Gyneomastia
incr prolif of male breast, various factors
Fibroadenoma
benign neoplasm of breast epith and stroma
- well circumscribed, mobile mass
- young females
Breast cancer
most common_
2nd most common_
influences (3)
risk (7)
most common cancer in females
2nd most common cause of cancer-related death in females
influences: hormonal, env, genetic (familiar BRCA-1, -2 are TSG, incr inc of other cancers)
risk:
female (100x males)
genetics
hormones (prolonged estrogen exposure- nulliparous, early menarche, late menopause)
other malignancies (contralateral breast carcinoma, endometrial carcinoma)
premalignant changes (carcinoma in situ, atypical hyperplasia)
age
race
Infiltrating ductal carcinoma
- most common_
- type
- present
- pathogenesis
- Dx
- most common form of BRCA
- adenocarcinoma
- desmoplastic response of stroma
- lymphatic spread (axillary nodes)
- present as mass
- early detection (self-exam, mammogram)
- fine needle aspiration
- incisional biopsy
BRCA Tx (3)
surgical resection: lumpectomy, mastectomy, axillary dissection
radiation
chemo: tamoxifen, herceptin
BRCA prognosis (4 factors)
staging most impt
histologic subtypes
histological grading
estrogen receptor status (ER +/-)
