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Reproduction and Sexuality Extras > Pathologies > Flashcards

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

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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

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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.

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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

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5
Q

Hypogonadotropic hypogonadism

A

Dysfunction at the level of the hypothalamus or pituitary leading to testosterone deficiency
Also called secondary hypogonadism

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6
Q

Hypergonadotropic hypogonadism

A

Dysfunction at the level of the testes leading to testosterone deficiency
Also called primary hypogonadism

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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

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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

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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

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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

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11
Q

Urachal Sinus

A

Remnant of the urachus that connects to the umbilicus

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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

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13
Q

Epispadia

A

Opening of urethra on the dorsal surface of the penis

* very rare

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14
Q

Pseudohermaphroditism

A

external genitalia doesn’t match expected gonadal tissue present

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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25
Q

Urachal Cysts

A

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

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26
Q

Urge Incontinence

A

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

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27
Q

Stress Incontinence

A

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

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28
Q

Overflow Incontinence

A

Clinical Presentation: Constantly dribbling urine
MOA: bladder muscles no longer contract properly
Tx: α1-adrenergic blocking agents to relax smooth muscle contractions

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29
Q

Cystitis

A

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

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30
Q

Interstitial Cystitis

A

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

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31
Q

Malakoplakia

A

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

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32
Q

Polyploid Cystitis

A

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

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33
Q

Urothelial Papilloma of the Bladder

A

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

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34
Q

Low Grade Papillary Urothelial Carcinoma of the Bladder

A

Clinical Presentation: Painless hematuria, frequency, urgency, dysuria
Histo: orderly appearance, evenly spaced, cohesive cells, infrequent mitotic figures, minimal nuclear atypia

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35
Q

High Grade Papillary Urothelial Carcinoma of the Bladder

A

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

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36
Q

Flat Urothelial Carcinoma/CIS of the Bladder

A

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

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37
Q

Invasive Urothelial Carcinoma of the Bladder

A

Clinical Presentation: Painless hematuria, frequency, urgency, dysuria; associated with papillary urothelial cancer, usually high grade
MOA: Extent of spread to muscularis associated with prognosis

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38
Q

Squamous Cell Carcinoma of the Bladder

A

Clinical Presentation: Painless hematuria, frequency, urgency, dysuria; 3-7% of bladder cancers; nearly always associated with chronic bladder irritation and infection

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39
Q

Pelvic Fracture

A

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

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40
Q

Straddle Injuries

A

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

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41
Q

Internal Hemorrhoids

A

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

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42
Q

External hemorrhoids

A

Clinical Presentation: Painful, itchy rectum

MOA: Swollen veins in the anal canal due to increased venous pressure; are inferior to the pectinate line

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43
Q

Perianal abscess

A

Infection around the anus and rectum that can originate from breaks in the anal mucosal membrane

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44
Q

Pilonidal Cyst

A

Cyst near the coccyx

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45
Q

Chlamydia

A

Clinical Presentation: In females may be asymptomatic; epididymitis and prostatitis in males
MOA: Chlamydia bacteria
* most common STI in the world

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46
Q

Gonorrhea

A

Clinical Presentation: Urethritis in males; often asymptomatic in females

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47
Q

Genital Herpes

A

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

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48
Q

Chancroid

A

Clinical Presentation: Multiple genital ulcers, papules, lymphadenopathy in the groin
MOA: Seen in the tropics/subtropics

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49
Q

Granuloma inguinale

A

Clinical Presentation: Painless ulcers; lymphedema and scarring/stricture of the genitalia
MOA: Klebsiella Granulomatis (Coccobacillus) infection of the genitalia

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50
Q

Syphilis

A

Clinical Presentation: Solitary lesion at first; can progress to later stages if untreated
MOA: Spirochete infection of gram negative corkscrew shaped bacteria, Treponema Pallidum

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51
Q

Condyloma (genital warts)

A

Clinical Presentation: Very common STI

MOA: related to HPV 6 and 11

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52
Q

Klinefelter’s Syndrome

A

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

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53
Q

Turner’s Syndrome

A

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

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54
Q

Kallman Syndrome

A

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

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55
Q

Seminoma

A

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

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56
Q

Non-Seminomatous Germ Cell Tumor (NSGCT)

A

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

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57
Q

Leydig Cell Tumor

A

Sex Cord Stromal Tumor - BENIGN
MOA: abnormal proliferation of Leydig cells
Histo: lots of cytoplasm with crystalloids
90% benign, at least 50% hormonally active

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58
Q

Sertoli Cell Tumor

A

Sex Cord Stromal Tumor - BENIGN
MOA: Abnormal proliferation of Sertoli cells
Histo: Tubules full of Sertoli Cells
90% benign, at least 50% hormonally active

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59
Q

Yolk Sac Tumors

A

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

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60
Q

Choriocarcinoma of the Testes

A

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

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61
Q

Acute Bacterial Prostatitis

A

Clinical Presentation: fever, chills, dysuria

MOA: Caused by E. Coli and other gram negative bacteria via direct implantation, lymph nodes, or surgical manipulation

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62
Q

Chronic Bacterial Prostatitis

A

Clinical Presentation: Low back pain, dysuria, perineal and suprapubic discomfort; history of recurrent UTI

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63
Q

Chronic Abacterial Prostatitis

A

Clinical Presentation: Low back pain, dysuria, perineal and suprapubic discomfort
* most common form of prostatitis

64
Q

Granulomatous Prostatitis

A

MOA: Fungal or mycobacterial infections, non-infectious causes as well, in US BCG treatment is most common cause

65
Q

Benign Prostatic Hyperplasia

A

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
Q

Prostatic Carcinoma

A

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
Q

High-Grade Prostatic Intraepithelial Neoplasia (PIN)

A

MOA: Precursor lesion to prostatic adenocarcinoma

68
Q

Utero-Placental Vascular Insufficiency

A

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
Q

Pre-Eclampsia

A

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
Q

Eclampsia

A

High blood pressure (>140 systolic or >90 diastolic), protein in the urine, and seizures

71
Q

Follicular Ovarian Cyst

A

lined by inner layer of granulosa cells and outer layer of theca cells that are luteinizing

72
Q

Corpus Luteum Cysts

A

composed of large lutenized granulosa cells; outer layer of smaller lutenized theca cells; prominent inner layer of connective tissue

73
Q

PCOS (Stein-Leventhal Syndrome)

A

Clinical Presentation: Persistent anovulation; cortical cysts in ovaries, androgenic effects: amenorrhea, hirsutism, obesity
MOA: Excess androgen production. Decreased response to insulin

74
Q

Serous Cystadenoma of the Ovary

A

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
Q

Mucinous Cystadenoma of the Ovary

A

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
Q

Brenner Tumor

A

Usually incidentally found

Histo: nests of transitional-like (urothelial) epithelium; fibrous stroma, vary in size

77
Q

Serous Cystadenocarcinoma

A

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
Q

Mucinous Cystadenocarcinoma

A

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
Q

Endometroid Adenocarcinoma

A

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
Q

Clear Cell Carcinomas of the Ovary

A

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
Q

Borderline Ovarian Tumor

A

10-20% of ovarian epithelial tumors; occur more in 15-29 y.o.
Histo: no stromal invasion

82
Q

Pseudo-Myxoma Peritonei

A

Benign: appendix mucous, ovary source
Malignant: bowel or ovarian source
Histo: Numerous peritoneal implants; mucous secreting cells

83
Q

Immature Ovarian Teratoma

A

Germ Cell tumor
Malignant tumor
MOA: composed of 3 germ layers, predominant neural tissue
Seen in reproductive age women (<30y.o.)

84
Q

Endodermal Sinus Tumor (Yolk Sac Tumor)

A

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
Q

Dysgerminoma

A

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
Q

Choriocarcinoma of the Ovary

A

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
Q

Fibroma of the Ovary

A

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
Q

Thecoma of the Ovary

A

Sex Cord Tumor
Estrogen secretion, abnormal uterine bleeding, endometrial hyperplasia
MOA: proliferation of theca cells

89
Q

Granulosa Cell Tumor of the Ovaries

A

Sex Cord Tumor
Estrogen secretion
MOA: proliferation of granulosa cells

90
Q

Sertoli-Leydig Cell Tumor of the Ovaries

A

Sex Cord Tumor
Androgen secretion; hirsutism; average age is about 25y.o.
Histo: Rienke crystals

91
Q

Bartholin’s Duct Abscess

A

Clinical Presentation: unilateral, waxing and waning edema; tender and painful; can have abscesses

92
Q

Lichen Sclerosus

A

Clinical Presentation: Pruritic, burning, tearing, scarring; associated with autoimmune thyroiditis
MOA: Autoimmune thyroiditis

93
Q

Lichen Simplex Chronicus

A

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
Q

Lichen Planus

A

Clinical Presentation: Bleeding, severe pain, significant scarring and vaginal vault obliteration; associated with hepatitis C
MOA: Autoimmune disorder causing erosive mucositis

95
Q

VIN

A

HPV high-risk related (80-90% is type 16); pre-cancerous lesion
Risk of progression to cancer

96
Q

Paget’s DIsease

A

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
Q

Uterine Leiomyomas (fibroids)

A

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
Q

Hematometra

A

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
Q

Adenomyosis

A

Clinical Presentation: Dysmenorrhea, pelvic pain, menorrhagia
Histo: presence of endometrial glands and stroma in the myometrium

100
Q

Pelvic Organ Prolapse

A

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
Q

Abnormal Uterine Bleeding (AUB)

A

Structural: Polyp, andenomyosis, leiomyoma, malignancy and hyperplasia
Non-Structural: Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classifies

102
Q

Squamous Metaplasia of the Cervix

A

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
Q

Cervical Intraepithelial Neoplasia (CIN)

A

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
Q

Incompetent Cervix

A

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
Q

Phleboliths

A

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
Q

Hyperprolactinoma

A

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
Q

Progressive precocious puberty (females)

A

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
Q

Premature Ovarian Failure (POF)

A

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
Q

Ectopic Pregnancy

A

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
Q

Gestational Diabetes

A

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
Q

HELLP

A

Clinical Presentation: Hemolysis, elevated liver enzymes, low platelet counts; may not have antecedent HTN and proteinuria
MOA: variation of preeclampsia

112
Q

Acute Endometritis

A

Clinical Presentation: Bleeding, pelvic pain

MOA: Inflammation of endometrium; caused by ascending infection, abortion, and instrumentation

113
Q

Chronic Endometritis

A

Clinical Presentation: Bleeding, pelvic pain

MOA: Inflammation of endometrium; caused by IUD, PID, and abortion

114
Q

Endometrial Polyps

A

Clinical Presentation: Bleeding, pelvic pain
MOA: benign overgrowth of endometrium
Gross: overgrowth mostly in fundus
Tx: Curettage

115
Q

Endometrial Hyperplasia

A

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
Q

Leiomyosarcoma of the Uterus

A

MOA: Mesenchymal tumor
Gross: like a fibroid with hemorrhage and irregular border
Micro: mitoses, necrosis, increased cellularity, atypia

117
Q

Endometriosis

A

Clinical Presentation: Dysmenorrhea, pelvic pain

MOA: Endometrial glands and stroma outside of the uterine endometrial lining; may be due to retrograde menstruation

118
Q

Acute Mastitis

A

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
Q

Squamous Metaplasia of Lactiferous Ducts (SMOLD) aka Subareolar Abscess

A

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
Q

Duct Ectasia

A

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
Q

Fat Necrosis of the Breast

A

BENIGN

MOA: Trauma or surgery; commonly caused by seat belt in a car accident

122
Q

Fibrocystic Breast Changes

A

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
Q

Florid Epithelial Hyperplasia

A

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
Q

Sclerosing Adenosis

A

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
Q

Papilloma

A

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
Q

Atypical Ductal Hyperplasia (ADH)

A

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
Q

Atypical Lobular Hyperplasia (ALH)

A

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
Q

DCIS: Comedocarcinoma

A

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
Q

DCIS: Non-Comedocarcinoma

A

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
Q

Paget’s Disease of the Nipple

A

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
Q

Lobular Carcinoma In Situ (LCIS)

A

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
Q

Invasive Ductal Carcinoma

A

MALIGNANT
MOA: Stromal invasion by malignant cells. Palpable mass.
* most common form of breast cancer

133
Q

Invasive Lobular Carcnioma

A

MALIGNANT
Clinical Presentation: Often bilateral and multicentric
MOA: lobular invasion by malignant cells

134
Q

Medullary Carcinoma

A

MALIGNANT
Clinical Presentation: Most common in 60’s age group; BRCA1 associated
MOA: Subtype if invasive ductal carcinoma

135
Q

Colloid (mucinous) Carcinoma

A

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
Q

Tubular Carcinoma

A

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
Q

Inflammatory Breast Carcinoma

A

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
Q

Fibroadenoma of the Breast

A

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
Q

Angiosarcoma

A

MALIGNANT
MOA: Tumor that arises from interlobular stroma; is a complication of radiation therapy
* very aggressive

140
Q

Placenta Succenturiate

A

Accessory lobes of the placenta

141
Q

Placenta Circumvallate

A

Clinical Presentation: White ring around insertion of fetal membrane
MOA: abnormal insertion of fetal membranes

142
Q

Placenta Accreta

A

Chorionic villi attached to the myometrium in areas outside the decidua basalis
MOA: abnormal penetration of placenta into the uterine wall

143
Q

Placenta Increta

A

Placental villi invade into the myometrium aggressively

MOA: abnormal penetration of placenta into the uterine wall

144
Q

Placenta Percreta

A

Placenta invades deep into the uterine wall, and sometime through the wall
MOA: abnormal penetration of placenta into the uterine wall

145
Q

Placenta Previa

A

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
Q

Hydatidiform Mole

A

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
Q

Battledore Placenta

A

Marginal insertion of umbilical cord instead of at the center

148
Q

Placental Abruption

A

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
Q

Vasa Previa

A

Clinical Presentation: painless vaginal bleeding, non-reassuring fetal heart rate tracing
MOA: Fetal vessels of a velamentous cord insertion cover the cervical os

150
Q

Vaginismus

A

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
Q

Umbilical Cord Occult Prolapse

A

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
Q

Umbilical Cord Overt Prolapse

A

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
Q

Shoulder Dystocia

A

After delivery of the fetal head further expulsion of the infant in prevented by impaction of fetal shoulders within maternal pelvis

154
Q

Hypoactive Sexual Desire Disorder (HASDD)

A

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
Q

Female Sexual Arousal Disorder (FSAD)

A

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
Q

Embryonal Carcinoma

A

Non-Seminomatous Germ Cell Tumor - MALIGNANT
Malignant tumor of immature cells forming glands, hemorrhaging mass with necrosis, early hematogenous spread
elevated AFP

157
Q

Immature Teratoma

A

Non-Seminomatous Germ Cell Tumor - MALIGNANT
Tumor of fetal tissue
elevated AFP and/or hCG

Reproduction and Sexuality Extras (2 decks)

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