Pathologies Flashcards
1
Q
Androgen Insensitivity Syndrome (AIS)
A
XY individual harbors mutations that knock out function of the androgen receptor on the X chromosome, so even though androgens are present the androgenizing effect on the genitalia will be lost. Has testicles in the labia majora, so the testes will produce MIS causing lack of internal female genitalia and short/blind vagina
2
Q
Congenital Virilizing/Adrenal Hyperplasia (CVH/CAH)
A
Clinical Presentation: Masculinization of external genitalia in genetic females; poor weight gain, dehydration, vomiting, circulatory collapse
MOA: defect in cortisol pathway in adrenal gland, usually 21-hydroxylase deficiency, leading to excess ACTH production in anterior pituitary and excess androgen production
3
Q
Cryptorchidism
A
Undescended testes
MOA: congenital malposition resulting in retention of the testes anywhere along the route of the descent
Tx: hCG treatment to stimulate Leydig cells to produce androgens may stimulate descent. Surgery also an option
* Increased incidence of testicular germ cell cancers in these patients
* Must fix by 2 y.o.
4
Q
5α-reductase deficiency
A
Lack of 5α-reductase, which converts testosterone to DHT
Clinical Presentation: can have normal male external genitalia, ambiguous, or normal female external genitalia; have epididymis and vas deferens
5
Q
Hypogonadotropic hypogonadism
A
Dysfunction at the level of the hypothalamus or pituitary leading to testosterone deficiency
Also called secondary hypogonadism
6
Q
Hypergonadotropic hypogonadism
A
Dysfunction at the level of the testes leading to testosterone deficiency
Also called primary hypogonadism
7
Q
Polycystic Ovarian Syndrome (PCOS)
A
Clinical Presentation: hirsutism, obesity, and insulin resistance, cycle changes (amenorrhea or frequent menses), elevated LH:FSH ratio
Histo: Many antral follicles
8
Q
Varicocele
A
Associated with reduced fertility; found more in men aged 15-25
MOA: insufficient or congenital absence of valves within the spermatic veins causing blood reflux within the pampiniform plexus
Tx: Surgical removal of veins
*more common on left b/c L testicular vein anastomosing with L renal vein which is compressed by SMA
9
Q
Hydrocele
A
Scrotum that rapidly fills with fluid when child/patient strains or tries to sit up
Congenital MOA: processes vaginalis remains open to peritoneal cavity
Acquired MOA: abnormal accumulation of serous fluid in the sac of the tunica vaginalis; usually doesn’t communicate with peritoneal cavity
* most spontaneously resolve w/in the first year of life
10
Q
Extrophy of the Bladder
A
Protrusion of the anterior portion of the bladder wall through the lower abdominal wall
MOA: failure of the abdominal wall to close during fetal development
Tx: surgery
11
Q
Urachal Sinus
A
Remnant of the urachus that connects to the umbilicus
12
Q
Hypospadia
A
Opening of the urethra on the ventral surface of the penis
MOA: failure of fusion of the urogenital fold to meet in the midline
* very common
13
Q
Epispadia
A
Opening of urethra on the dorsal surface of the penis
* very rare
14
Q
Pseudohermaphroditism
A
external genitalia doesn’t match expected gonadal tissue present
15
Q
46, XX intersex
A
Clinical Presentation: Chromosomes of a women, ovaries of a woman, external genitalia appears male
MOA: Usually due to female fetus being exposed to excess male hormones before birth
16
Q
46, XY intersex
A
Clinical Presentation: Chromosomes of a male, but the external genitalia are incompletely formed, ambiguous, or clearly female
MOA: testes not forming properly (therefore low testosterone level), problem with testosterone receptor
17
Q
Torsion of the Testes
A
Clinical Presentation: Sudden unilateral testicular pain
MOA: Sudden twisting of the spermatic cord resulting in strangulation of the blood vessels serving the testis and epididymis; gubernaculum remnant normally prevents testicular torsion
Dx: via US; must be treated within 4 hours
18
Q
Balanoposthitis
A
Infection of the glans and prepuce (foreskin); caused by STIs (syphilis, gonorrhea, chancroid, herpes) and also by poor local hygiene in uncircumcised males
19
Q
Priapism
A
2 types
Low Flow: persistent erection lasting 4+ hours; painful, glands is soft, may stutter
High Flow: persistent erection lasting 4+ hours; not painful, not a full erection, glans full
MOA: incorrect use of intra-cavernosum agents, sickle cell dz, trazodone, neoplastic processes, TPN
20
Q
Erectile Dysfunction
A
Clinical Presentation: persistent inability to achieve or maintain an erection sufficient for intercourse
MOA: arteriogenic/vasculogenic, neurologic, venous outflow, psychogenic causes
21
Q
Condyloma Acuminatum
A
Clinical Presentation: occurs on any moist mucocutaneous surface of external genitalia
MOA: benign, sexually transmitted tumor caused by HPV 6 and 11
22
Q
Bowen Disease
A
Clinical Presentation: Solitary lesion involving the skin of the penis shaft and scrotum; found in patient >35 y.o.
MOA: Related to HPV 16; is a carcinoma in situ
* 10% of cases transform into squamous cell carcinoma
23
Q
Bowenoid Papulosis
A
Clinical Presentation: Multiple penile lesions found in younger patients
MOA: Related to HPV 16; is a carcinoma in situ
* Doesn’t transform into squamous cell carcinoma
24
Q
Squamous Cell Carcinoma of the Penis
A
Clinical Presentation: Slow growing and locally invasive; non-painful lesion, early metastasis to inguinal lymph nodes
MOA: Related to HPV 16 and 18
Slow growing and locally invasive
25
Urachal Cysts
Clinical Presentation: often don't cause issues, but can get infected
MOA: small fluid filled cyst superior to the bladder and inferior to the umbilicus
26
Urge Incontinence
Clinical Presentation: Need to urinate 7+ x/day or 2+ x/night
MOA: low smooth muscle tone in the bladder, high number of bladder contractions (detrusor muscle)
Tx: anticholinergic drugs that inhibit parasympathetic stimulation of detrusor muscle contractions
27
Stress Incontinence
Clinical Presentation: Almost exclusively female problem; involuntarily leaking urine while sneezing, coughing, laughing, or lifting heavy weights
MOA: weakening of external urethral sphincter
Tx: kegel exercises; α-adrenergic agonists to increase contraction of the smooth muscle at the neck of the bladder
28
Overflow Incontinence
Clinical Presentation: Constantly dribbling urine
MOA: bladder muscles no longer contract properly
Tx: α1-adrenergic blocking agents to relax smooth muscle contractions
29
Cystitis
Clinical Presentation: Urinary frequency, lower abdominal pain, dysuria; more common in females
MOA: Uropathogens gain access via urethra; bacteria (E. coli, proteus, kelbsiella, and enterobacter) is the most common cause; also caused by chemo or radiation
30
Interstitial Cystitis
Clinical Presentation: Found more in women aged 30-70; intermittent pelvic pain, frequency, dysuria, urgency, hematuria
MOA: Chronic inflammation of unknown cause
Two forms: non-ulcerous and chronic with Hunner's Ulcers
31
Malakoplakia
Clinical Presentation: Seen in immune compromised patients and in people with chronic bacterial infections
MOA: Acquired defect in phagocytic function; get inflammatory reaction in GU tract that causes yellow, mucosal plaques
Histo: Michaelis-Gutmann bodies, foamy macrophages, multinucleated giant cells
32
Polyploid Cystitis
Clinical Presentation: Doesn't present with dysuria or polyuria; usually symptom-less
MOA: Inflammatory lesion caused by chronic irritation of the urethra, often due to an indwelling catheter
33
Urothelial Papilloma of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria;
1% or less of bladder tumors
Found in younger patients
Histo: structures superficially attached to the mucosa by a stalk with exophytic configuration
34
Low Grade Papillary Urothelial Carcinoma of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria
Histo: orderly appearance, evenly spaced, cohesive cells, infrequent mitotic figures, minimal nuclear atypia
35
High Grade Papillary Urothelial Carcinoma of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria
Histo: dys-cohesive cells with large, hyperchromatic nuclei, frequent mitotic figures, loss of cells polarity, higher incidence of invasion into muscular layer
36
Flat Urothelial Carcinoma/CIS of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria
Histo: Malignant cells within a flat urothelium; lack of cohesivness that causes shedding of malignant cells in urine, involves most of bladder surface
50-70% progress to muscle-invasive cancer if untreated
37
Invasive Urothelial Carcinoma of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria; associated with papillary urothelial cancer, usually high grade
MOA: Extent of spread to muscularis associated with prognosis
38
Squamous Cell Carcinoma of the Bladder
Clinical Presentation: Painless hematuria, frequency, urgency, dysuria; 3-7% of bladder cancers; nearly always associated with chronic bladder irritation and infection
39
Pelvic Fracture
From automobile accidents: displacement of pubic symphysis posteriorly, breaking superior and/or inferior rami; from jumping: displacement of the head of the femur through the acetabulum
40
Straddle Injuries
Damage to external genitalia that causes bleeding into superficial perineal space; blood is limited by the superficial perineal membrane where it attaches to deep fascial planes
41
Internal Hemorrhoids
Clinical Presentation: usually painless, often grow quite large before they are noticed
MOA: Swollen veins in the anal canal due to increased venous pressure; are superior to pectinate line
42
External hemorrhoids
Clinical Presentation: Painful, itchy rectum
| MOA: Swollen veins in the anal canal due to increased venous pressure; are inferior to the pectinate line
43
Perianal abscess
Infection around the anus and rectum that can originate from breaks in the anal mucosal membrane
44
Pilonidal Cyst
Cyst near the coccyx
45
Chlamydia
Clinical Presentation: In females may be asymptomatic; epididymitis and prostatitis in males
MOA: Chlamydia bacteria
* most common STI in the world
46
Gonorrhea
Clinical Presentation: Urethritis in males; often asymptomatic in females
47
Genital Herpes
Clinical Presentation: Multiple vesicles on genitalia; when disseminated can cause blindness and encephalopathy
MOA: HSV-2 infection; viral replication in skin and mucous membranes
Histo: viral inclusion bodies, margination, excess chromatin
48
Chancroid
Clinical Presentation: Multiple genital ulcers, papules, lymphadenopathy in the groin
MOA: Seen in the tropics/subtropics
49
Granuloma inguinale
Clinical Presentation: Painless ulcers; lymphedema and scarring/stricture of the genitalia
MOA: Klebsiella Granulomatis (Coccobacillus) infection of the genitalia
50
Syphilis
Clinical Presentation: Solitary lesion at first; can progress to later stages if untreated
MOA: Spirochete infection of gram negative corkscrew shaped bacteria, Treponema Pallidum
51
Condyloma (genital warts)
Clinical Presentation: Very common STI
| MOA: related to HPV 6 and 11
52
Klinefelter's Syndrome
Clinical Presentation: Decreased testosterone levels, small penis, usually azoospermia, ~50% have some breast development at puberty, high FSH and LH levels, difficulties reading and writing
MOA: XXY hypogonadism
* usually not detected until puberty unless tested for at birth
53
Turner's Syndrome
Clinical Presentation: Typically sterile, short stature, lymphedema, webbed skin behind the neck, low hairline, small breast development, ovarian failure, coarctation of the aorta, bicuspid aortic valve, aortic dissection
MOA: XO in females; 2/3 of cases is maternal origin
* about 95% are spontaneously aborted in the first trimester
54
Kallman Syndrome
Clinical Presentation: Ansomia (lack of sense of smell) and hypogonadism
MOA: Genetic disorder (can be X-linked, autosomal, recessive, or dominant); failure of GnRH neurons to migrate and enter the proper location during development
55
Seminoma
Germ Cell Tumor - MALIGNANT
Clinical Presentation: Testicular mass or enlargement, dull pain or minor discomfort
Gross: yellow-gray discoloration of the testis
* 90% cure rate
56
Non-Seminomatous Germ Cell Tumor (NSGCT)
Non-Seminomatous Germ Cell Tumor - MALIGNANT
Clinical Presentation: Testicular mass; elevated hCG and/or AFP
MOA: Proliferating stem cells
* an metastasize to paraaortic lymph nodes, lungs, liver, and brain
Includes: Yolk Sac Tumor, Choriocarcinoma, Embryonal Carcinoma, and Immature Teratoma
57
Leydig Cell Tumor
Sex Cord Stromal Tumor - BENIGN
MOA: abnormal proliferation of Leydig cells
Histo: lots of cytoplasm with crystalloids
90% benign, at least 50% hormonally active
58
Sertoli Cell Tumor
Sex Cord Stromal Tumor - BENIGN
MOA: Abnormal proliferation of Sertoli cells
Histo: Tubules full of Sertoli Cells
90% benign, at least 50% hormonally active
59
Yolk Sac Tumors
Non-Seminomatous Germ Cell Tumor - MALIGNANT
Clinical Presentation: 99% occur in children younger than 4 y.o.; Elevated AFP
Histo: Schiller-Duval bodies; tissue resembles yolk sac
60
Choriocarcinoma of the Testes
Non-Seminomatous Germ Cell Tumor - MALIGNANT
Clinical Presentation: Elevated hCG in serum and urine.
MOA: autonomous trophoblastic proliferation; type of gestational trophoblastic disease
very rare
61
Acute Bacterial Prostatitis
Clinical Presentation: fever, chills, dysuria
| MOA: Caused by E. Coli and other gram negative bacteria via direct implantation, lymph nodes, or surgical manipulation
62
Chronic Bacterial Prostatitis
Clinical Presentation: Low back pain, dysuria, perineal and suprapubic discomfort; history of recurrent UTI
63
Chronic Abacterial Prostatitis
Clinical Presentation: Low back pain, dysuria, perineal and suprapubic discomfort
* most common form of prostatitis
64
Granulomatous Prostatitis
MOA: Fungal or mycobacterial infections, non-infectious causes as well, in US BCG treatment is most common cause
65
Benign Prostatic Hyperplasia
Clinical Presentation: Enlarged prostate with multiple nodules; urgency, frequency, nocturia, dysuria, hesitancy, weakening of stream, terminal dribbling, incomplete evacuation
MOA: Periurethral and transition regions of the prostate have hyperplasia of stromal or epithelial cells causing the formation of large nodules
Tx: α-1-adrenergic receptor antagonists, 5-α reductase inhibitors, transurethral resection of the prostate (TURP)
66
Prostatic Carcinoma
Clinical Presentation: When localized is asymptomatic; difficulty in starting or stopping the stream, dysuria, frequency, or hematuria in advanced disease; mostly affects men aged 70-80
MOA: originates in the peripheral zone of the prostate; multifactorial causes
67
High-Grade Prostatic Intraepithelial Neoplasia (PIN)
MOA: Precursor lesion to prostatic adenocarcinoma
68
Utero-Placental Vascular Insufficiency
Clinical Presentation: hypoxia and re-oxygenation injury; syncytial knots may fragment and be shed into maternal blood; potential cause of pre-eclampsia
MOA: Extra-villous cytotrophoblasts less successful in invading maternal decidua or may be removed by immune system; get narrower, disease, atherosclerotic distal spiral arteries; hypoxia and re-oxygenation injury
69
Pre-Eclampsia
High blood pressure (>140 systolic or >90 diastolic) and protein in the urine; RBC breakdown, low blood platelet count, impaired liver or kidney dysfunction, swelling, SOA, visual disturbances
Tx: delivery of the baby
70
Eclampsia
High blood pressure (>140 systolic or >90 diastolic), protein in the urine, and seizures
71
Follicular Ovarian Cyst
lined by inner layer of granulosa cells and outer layer of theca cells that are luteinizing
72
Corpus Luteum Cysts
composed of large lutenized granulosa cells; outer layer of smaller lutenized theca cells; prominent inner layer of connective tissue
73
PCOS (Stein-Leventhal Syndrome)
Clinical Presentation: Persistent anovulation; cortical cysts in ovaries, androgenic effects: amenorrhea, hirsutism, obesity
MOA: Excess androgen production. Decreased response to insulin
74
Serous Cystadenoma of the Ovary
Surface Epithelial Tumor
Clinical Presentation: 15% are bilateral. Seen in 30-40 y.o.
MOA: Serous benign lesion of the surface epithelium
Gross: cystic, clear serous fluid
Histo: single layer of cuboidal ciliated tubal-type epithelium
75
Mucinous Cystadenoma of the Ovary
Surface Epithelial Tumor
MOA: Mucinous benign lesion of the surface epithelium. Seen in 30-40 y.o.
Gross: vary in size, cystic, multilocular ovaries, filled with thick mucinous fluid
Histo: tall columnar epithelium
76
Brenner Tumor
Usually incidentally found
| Histo: nests of transitional-like (urothelial) epithelium; fibrous stroma, vary in size
77
Serous Cystadenocarcinoma
Surface Epithelial Tumor
Most common malignant tumor of the over; 30% of ovarian cancers. CA-125 used to monitor. Seen in postmenopausal women
Gross: cystic, multilocular, papillary like epithelium inside the cyst
Histo: adenocarcinoma, papillary bodies, psammoma bodies, mitotic figures, atypical nuclei, necrosis
78
Mucinous Cystadenocarcinoma
Surface Epithelial Tumor
10% of a ll ovarian cancers; large tumors. CA-125 used to monitor. Seen in postmenopausal women
Histo: Mucin-producing, adenocarcinoma, stromal invasion; can have tall columnar epithelium invading the stroma; back to back glands
79
Endometroid Adenocarcinoma
10-25% of primary ovarian carcinomas; 15% co-exists with endometriosis; 15-30% of patients have endometrial hyperplasia or carcinoma
MOA: tumors may arise with endometriotic cysts
80
Clear Cell Carcinomas of the Ovary
Clinical Presentation: very aggressive epithelial neoplasm; early metastasis, peritoneal implants
MOA: associated with vascular thrombotic events with para-neoplastic hypercalcemia
Histo: solid and fibrous thick walled cysts with yellow beige nodules protruding into the cyst lumen
81
Borderline Ovarian Tumor
10-20% of ovarian epithelial tumors; occur more in 15-29 y.o.
Histo: no stromal invasion
82
Pseudo-Myxoma Peritonei
Benign: appendix mucous, ovary source
Malignant: bowel or ovarian source
Histo: Numerous peritoneal implants; mucous secreting cells
83
Immature Ovarian Teratoma
Germ Cell tumor
Malignant tumor
MOA: composed of 3 germ layers, predominant neural tissue
Seen in reproductive age women (<30y.o.)
84
Endodermal Sinus Tumor (Yolk Sac Tumor)
Germ Cell tumor
Second most common malignant ovarian germ cell tumor; found more in kids; elevated AFP
Histo: Schiller-Duval bodies
Seen in reproductive age women (<30y.o.)
85
Dysgerminoma
Germ cell tumor
Most common malignant germ cell tumor of the ovary
Seen in reproductive age women (<30y.o.)
Histo: tumor cells filled with glycogen; unilateral found/oval solid tumor that varies in size
86
Choriocarcinoma of the Ovary
Germ cell tumor
Found in young girls with precocious sexual development. May see vaginal bleeding and discharge. Elevated hCG
Histo: has syncytiotrophoblast and cytotrophoblast. Solid hemorrhagic tumor.
87
Fibroma of the Ovary
Sex Cord Tumor
Most common stromal/sex cord tumor; peak incidence around menopause; associated with Gorlin syndrome and Meig's syndrome
Benign tumor with no ridk for cancer
88
Thecoma of the Ovary
Sex Cord Tumor
Estrogen secretion, abnormal uterine bleeding, endometrial hyperplasia
MOA: proliferation of theca cells
89
Granulosa Cell Tumor of the Ovaries
Sex Cord Tumor
Estrogen secretion
MOA: proliferation of granulosa cells
90
Sertoli-Leydig Cell Tumor of the Ovaries
Sex Cord Tumor
Androgen secretion; hirsutism; average age is about 25y.o.
Histo: Rienke crystals
91
Bartholin's Duct Abscess
Clinical Presentation: unilateral, waxing and waning edema; tender and painful; can have abscesses
92
Lichen Sclerosus
Clinical Presentation: Pruritic, burning, tearing, scarring; associated with autoimmune thyroiditis
MOA: Autoimmune thyroiditis
93
Lichen Simplex Chronicus
Clinical Presentation: Intense pruritis and scratching that can go on for years, can significantly interfere with daily living; associated with OCD
MOA: Starts as contact irritant dermatitis or allergic dermatitis
"leather-like" labia majora
94
Lichen Planus
Clinical Presentation: Bleeding, severe pain, significant scarring and vaginal vault obliteration; associated with hepatitis C
MOA: Autoimmune disorder causing erosive mucositis
95
VIN
HPV high-risk related (80-90% is type 16); pre-cancerous lesion
Risk of progression to cancer
96
Paget's DIsease
Vulva: Malignant epithelial cells in the epidermis of the vulva. Represents CIS.
Often of the breast, external genitalia UG canal, and GI
Cytology: PAS+, keratin+, and S100-. Must distinguish from melanoma (PAS-, keratin-, S100+)
MOA: Associated with underlying adenocarcinoma; epithelial disease
97
Uterine Leiomyomas (fibroids)
Clinical Presentation: multiple masses on ovaries that have fibrous consistency due to lots of collagen; found in 20-25% of women; bleeding, anemia, pelvic discomfort, sometimes infertility
MOA: benign smooth muscle neoplasm from the myometrium
98
Hematometra
Clinical Presentation: cyclic midline pain, sometimes amenorrhea; enlarged and tender soft pelvic mass on exam
MOA: menstrual outflow obstruction at the level of cervix or higher traps blood and distends uterus; caused by congenital abnormalities, scarring, or neoplasm blocking flow
99
Adenomyosis
Clinical Presentation: Dysmenorrhea, pelvic pain, menorrhagia
Histo: presence of endometrial glands and stroma in the myometrium
100
Pelvic Organ Prolapse
Clinical Presentation: vaginal wall protrusion or bulge; urinary incontinence, constipation, vaginal bleeding, sometimes are painful
MOA: downward displacement of a pelvic organ from its normal location
101
Abnormal Uterine Bleeding (AUB)
Structural: Polyp, andenomyosis, leiomyoma, malignancy and hyperplasia
Non-Structural: Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classifies
102
Squamous Metaplasia of the Cervix
Clinical Presentation: Conversion of columnar epithelium into squamous epithelium; generally in/adjacent to the transformation zone
MOA: Rising estrogen levels in puberty causes glycogenation of squamous epithelium of the lower genital tract; glycogen nourishes lacotbacilli (predominant vaginal flora) which lowers the pH of the vaginal tract causing metaplasia
103
Cervical Intraepithelial Neoplasia (CIN)
Clinical Presentation: Initially asymptomatic, post-coital bleeding, abnormal vaginal bleeding, vaginal discharge
MOA: Pre-malignant change in cervical epithelium
Histo: cells have altered nuclei with at least some features of neoplastic process
104
Incompetent Cervix
Clinical Presentation: Minimal symptoms; results in pregnancy loss by spontaneous passage of pregnancy, ROM, or spontaneous labor
MOA: "silent" cervical dilation without uterine contractions
Tx: Cerclage aka stitching the cervix closed; progesterone therapy
105
Phleboliths
Clinical Presentation: Cause few problem, uncommon in children, seen in adults with low fiber diets
MOA: Calcifications of the wall or thrombus of veins, often in pelvic veins
106
Hyperprolactinoma
MOA: prolactin inhibits reproduction at the hypothalamus and ovary
Can lead to amenorrhea
Prolactin feedback inhibits GnRH production in the hypothalamus and the activity of steroidogenic enzymes at the ovarian level
107
Progressive precocious puberty (females)
Clinical Presentation: accelerated growth velocity; advanced bone age (>1 year), falling off growth curve, progression between Tanner stages within 3-6 months; estradiol within pubertal range
Treatment: GnRH agonist will result in regression or cessation of pubertal development; early initiation of treatment will preserve growth
108
Premature Ovarian Failure (POF)
Clinical Presentation: Before age 40, elevated FSH
MOA: Autoimmune ovarian failure - Ab to the ovaries; associated with genetic mutations: mosaic 45X, monosomy X, Turner's syndrome, FMR1 gene, FOXL2
Tx: Sequential estrogen/progesterone or oral contraceptives
109
Ectopic Pregnancy
Clinical Presentation: Unilateral lower abdominal pain, vaginal bleeding, positive hCG test; can have tubal rupture and hemorrhage
MOA: Implantation of conceptus at a site other than the endometrial lining of the uterus; caused by chronic salpingitis, congenital uterine tube abnormalities, extrinsic tube compression, and transmigration of the ovum.
Tx: Methotrexate, salpingectomy, salpingostomy, watch hCG and wait
110
Gestational Diabetes
Clinical Presentation: Elevated blood glucose and insulin resistance
MOA: elevate estrogen levels stimulate beta cell hyperplasia and increased insulin secretion in first trimester; in 2nd and 3rd trimester insulin resistance increases due to increased placental lactogen and prolactin and basal hepatic glucose production increases
111
HELLP
Clinical Presentation: Hemolysis, elevated liver enzymes, low platelet counts; may not have antecedent HTN and proteinuria
MOA: variation of preeclampsia
112
Acute Endometritis
Clinical Presentation: Bleeding, pelvic pain
| MOA: Inflammation of endometrium; caused by ascending infection, abortion, and instrumentation
113
Chronic Endometritis
Clinical Presentation: Bleeding, pelvic pain
| MOA: Inflammation of endometrium; caused by IUD, PID, and abortion
114
Endometrial Polyps
Clinical Presentation: Bleeding, pelvic pain
MOA: benign overgrowth of endometrium
Gross: overgrowth mostly in fundus
Tx: Curettage
115
Endometrial Hyperplasia
Clinical Presentation: Abnormal bleeding
MOA: increase in number of glands relative in the stroma of the endometrium; PCOS, obesity, estrogen therapy, and tumors may predispose
Tx: high dose progestins, hysterectomy
116
Leiomyosarcoma of the Uterus
MOA: Mesenchymal tumor
Gross: like a fibroid with hemorrhage and irregular border
Micro: mitoses, necrosis, increased cellularity, atypia
117
Endometriosis
Clinical Presentation: Dysmenorrhea, pelvic pain
| MOA: Endometrial glands and stroma outside of the uterine endometrial lining; may be due to retrograde menstruation
118
Acute Mastitis
BENIGN
Clinical Presentation: Unilateral, erythematous, painful abscess; usually during lactation period
MOA: caused mostly by staph aureus or strep
Tx: antibiotics and complete drainage of milk
119
Squamous Metaplasia of Lactiferous Ducts (SMOLD) aka Subareolar Abscess
BENIGN
Clinical Presentation: Painful, erythematous subareolar mass
MOA: Squamous metaplasia of lactiferous ducts leads to keratin trapped within the duct; duct dilates and ruptures causing intense inflammatory reaction
Tx: surgical excision
*strong association with cigarette smoking
120
Duct Ectasia
BENIGN
Clinical Presentation: Poorly defined, palpable, periareolar mass; thick, cheesy nipple secretion; seen mostly in 50-60 year olds
MOA: Inspissation of breast secretions which leads to dilation of ducts and periductal and interstitial chronic granulomatous inflammatory reaction
* no association with cigarette smoking
121
Fat Necrosis of the Breast
BENIGN
| MOA: Trauma or surgery; commonly caused by seat belt in a car accident
122
Fibrocystic Breast Changes
BENIGN
Clinical Presentation: palpable lumps, mammographic densities, calcifications, nipple discharges; most common breast disorders in ages 20-40
MOA: Hormonal imbalances between estrogen and progesterone
Histo: Cysts, fibrosis, adenosis (increase in # of lobular units per lobule)
* confers no increased risk of developing carcinoma
123
Florid Epithelial Hyperplasia
Type of Proliferative Breast Disease Without Atypia
BENIGN
MOA: Proliferation of ductal epithelium and/or stroma without cellular abnormalities
Histo: more than 2 cell layers; florid but architecturally and cytologically benign cells
* 1.5x increased risk of cancer
124
Sclerosing Adenosis
Type of Proliferative Breast Disease Without Atypia
BENIGN
MOA: Proliferation of ductal epithelium and/or stroma without cellular abnormalities
Histo: Increased # of acini per TDLU, acini are compressed and distorted by surrounding dense stroma; well-circumscribed outer border; calcifications are common
* 1.5x increased risk of cancer
125
Papilloma
Type of Proliferative Breast Disease Without Atypia
BENIGN
Clinical Presentation: Most common cause of bloody nipple discharge
MOA: proliferation of ductal epithelium and/or stroma without cellular abnormalities
* 1.5x increased risk of cancer
126
Atypical Ductal Hyperplasia (ADH)
BENIGN
MOA: Proliferation of ductal epithelium with cellular and architectural abnormalities
Histo: monomorphic cell population, regular cell placement and round lumina, short of DCIS
* 4-5x increased risk of breast cancer
127
Atypical Lobular Hyperplasia (ALH)
BENIGN
MOA: Proliferation of ductal epithelium with cellular and architectural abnormalities
Histo: monomorphic small round cells that partially fill a lobule - when completely fills the lobule it is LCIS
* 4-5x increased risk of breast cancer
128
DCIS: Comedocarcinoma
MALIGNANT
Clinical Presentation: Extrusion of cheese material
MOA: A type of DCIS; arises in TDLU and distorts/distends the ducts without invading basement membrane to stroma
129
DCIS: Non-Comedocarcinoma
MALIGNANT
MOA: A type of DCIS; arises in TDLU and distorts/distends the ducts without invading basement membrane to stroma
* Cribiform, solid, micropapillary, and papillary patterns
130
Paget's Disease of the Nipple
MALIGNANT
Clinical Presentation: Skin of the nipple and areola is often fissured, ulcerated, and oozing
MOA: A type of DCIS that extends from nipple ducts into contiguous skin of the nipple and areola
Histo: Cells with large pleomorphic nuclei, prominent nucleoli, abundant clear cytoplasm
131
Lobular Carcinoma In Situ (LCIS)
MALIGNANT
MOA: Arises in TDLU; proliferation of monotonous population of cells that expands the terminal duct and lobule; loss of cellular adhesion due to dysfunction of E-cadherin
132
Invasive Ductal Carcinoma
MALIGNANT
MOA: Stromal invasion by malignant cells. Palpable mass.
* most common form of breast cancer
133
Invasive Lobular Carcnioma
MALIGNANT
Clinical Presentation: Often bilateral and multicentric
MOA: lobular invasion by malignant cells
134
Medullary Carcinoma
MALIGNANT
Clinical Presentation: Most common in 60's age group; BRCA1 associated
MOA: Subtype if invasive ductal carcinoma
135
Colloid (mucinous) Carcinoma
MALIGNANT
Clinical Presentation: Found in older women; slow growth of tumor
MOA: Subtype of invasive ductal carcinoma
Gross: soft, pale grey-blue gelatinous tumor
136
Tubular Carcinoma
MALIGNANT
Clinical Presentation: Younger age; multifocal or bilateral
MOA: Subtype of invasive ductal carcinoma
Histo: well formed tubules; myoepithelial layer is absent; apocrine snouts and luminal calcification
137
Inflammatory Breast Carcinoma
MALIGNANT
Clinical Presentation: Thickened, erythematous, rough skin surface with appearance of orange peel
MOA: Dermal lymphatic invasion of carcinoma
* this is a descriptive term and not a histological subtype
138
Fibroadenoma of the Breast
BENIGN
Clinical Presentation: Common benign tumor of female breast; occurs at reproductive age - mostly before 30 y.o.
MOA: Growth of fibrous and glandular tissue
Gross: round, sharply demarcated rubbery tumor; freely moveable
139
Angiosarcoma
MALIGNANT
MOA: Tumor that arises from interlobular stroma; is a complication of radiation therapy
* very aggressive
140
Placenta Succenturiate
Accessory lobes of the placenta
141
Placenta Circumvallate
Clinical Presentation: White ring around insertion of fetal membrane
MOA: abnormal insertion of fetal membranes
142
Placenta Accreta
Chorionic villi attached to the myometrium in areas outside the decidua basalis
MOA: abnormal penetration of placenta into the uterine wall
143
Placenta Increta
Placental villi invade into the myometrium aggressively
| MOA: abnormal penetration of placenta into the uterine wall
144
Placenta Percreta
Placenta invades deep into the uterine wall, and sometime through the wall
MOA: abnormal penetration of placenta into the uterine wall
145
Placenta Previa
Clinical Presentation: post or ante-partum bleeding, blocks delivery of the baby
MOA: Implantation of blastocysts over the internal cervical os; associated with placenta accreta
* requires c-section if it doesn't move
146
Hydatidiform Mole
Clinical Presentation: vaginal bleeding and discharge, elevated hCG in serum and urine
MOA: autonomous trophoblastic proliferation; type of gestational trophoblastic disease
Gross: graph-like cysts
147
Battledore Placenta
Marginal insertion of umbilical cord instead of at the center
148
Placental Abruption
Clinical Presentation: Painful contractions or hypertonic contractions; non-reassuring fetal heart rate tracing
MOA: Separation of placenta from the wall of the uterus prior to delivery of the fetus
149
Vasa Previa
Clinical Presentation: painless vaginal bleeding, non-reassuring fetal heart rate tracing
MOA: Fetal vessels of a velamentous cord insertion cover the cervical os
150
Vaginismus
Clinical Presentation: difficult or impossible penetration of the vagina; typically described as ripping or burning sensation
MOA: involuntary muscle spasm of the outer third of the vagina
151
Umbilical Cord Occult Prolapse
Clinical Presentation: cord is lying beside the presenting part
MOA: Umbilical cord descends in advance of the presenting fetal part
Risk Factors: low birth weight, preterm baby, breech presentation, multiple gestations, hydramnios, obstetrical interventions
152
Umbilical Cord Overt Prolapse
Clinical Presentation: cord is protruding through the cervix and sometimes escaping from the vagina
MOA: Umbilical cord descends in advance of the presenting fetal part
Risk Factors: low birth weight, preterm baby, breech presentation, multiple gestations, hydramnios, obstetrical interventions
153
Shoulder Dystocia
After delivery of the fetal head further expulsion of the infant in prevented by impaction of fetal shoulders within maternal pelvis
154
Hypoactive Sexual Desire Disorder (HASDD)
Clinical Presentation: Persistent or recurring deficiency of sexual fantasies/thoughts and/or receptivity to sexual activity
MOA: menopause, agine, endocrine abnormality (i.e. diabetes), medications, psychogenic
155
Female Sexual Arousal Disorder (FSAD)
Clinical Presentation: Persistent or recurring inability to attain or maintain sufficient sexual excitement; decreased lubrication or labial sensation
MOA: menopause, neuro disease, vascular disorder, HTN, psychological factors
156
Embryonal Carcinoma
Non-Seminomatous Germ Cell Tumor - MALIGNANT
Malignant tumor of immature cells forming glands, hemorrhaging mass with necrosis, early hematogenous spread
elevated AFP
157
Immature Teratoma
Non-Seminomatous Germ Cell Tumor - MALIGNANT
Tumor of fetal tissue
elevated AFP and/or hCG
