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Y2B3 - Reproductive 📘 > Pathology 🩺 > Flashcards

Pathology 🩺 Flashcards

1
Q

what are congenital anomalies of Male genital system?

A
  • Phimosis.
  • Hypospadias. (Most common)
  • Epispadias. (Least common)
  • Cryptorchidism

All corrected by surgery

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2
Q

what is the definition of Phimosis?

A
  • Narrowing of the opening of the prepuce which causes inability to retract foreskin over glans
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3
Q

what are the complications of Phimosis?

A
  • Balanitis (inflammations of glans penis).
  • Urinary tract obstruction.
  • Squamous cell carcinoma of penis (Due to no circumcision)
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4
Q

what is the definition of hypospadias?

A

Urethra opens at ventral surface of penis

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5
Q

what are the complications of hypospadias?

A
  • Urinary tract obstruction.
  • Sterility.
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6
Q

what is the definition of epispadias?

A

Urethra opens at dorsal surface of penis

(Usually associated with phimosis)

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7
Q

what are the complications of epispadias?

A
  • Urinary tract obstruction.
  • Sterility.
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8
Q

what is the definition of cryptochidism (Undescended testis)?

A

Arrest of one or both testicles in a point during their descent to scrotum

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9
Q

what are the causes of cryptochidism (Undescended testis)?

A
  • Deficiency of gonadotrophic hormone of pituitary.
  • Organic obstruction.
  • Testicular defect.
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10
Q

M/E of cryptochidism (Undescended testis)

A
  • Atrophy of seminiferous tubules. “Due to high tempertaure”
  • Fibrosis.

in most cases, people with one testicle can get someone pregnant. Remember, one testicle can provide enough testosterone for you to get an erection and ejaculate. This is also enough to produce adequate sperm for fertilization.

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11
Q

what are the complications of cryptochidism (Undescended testis)?

A
  • Infertility (in bilateral cases).
  • Malignancy (precancerous for seminoma).
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12
Q

what are inflammations related to male genital system?

A
  • Prostatitis. (swollen prostate)
  • Seminal vasculitis.
  • Funiculitis: inflammation of spermatic cord.
  • Orchitis: inflammation of testis.
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13
Q

what are the causes of orchitis?

A
  • Bacterial: syphilis. “sexual virus”
  • Viral: Mumps orchitis.
  • Traumatic orchitis.
  • Autoimmune orchitis
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14
Q

what is the definition of Benign prostatic hyperplasia?

A
  • Hyperplastic enlargement of prostate.
  • Senile prostatic hyperplasia.

some notes:

  • Treatment is TURP
  • A transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate. The prostate is a small gland in the pelvis only found in men.
  • One of the complications of TURP is postoperative retrograde ejaculation, which accounts for not only male infertility but also impaired sexual satisfaction [17]. The rate of retrograde ejaculation after TURP approximated 70–90% [18, 19].
  • https://youtu.be/nZxVvKw1IdU (The operation)
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15
Q

Incidence of Benign prostatic hyperplasia

A

Common in fifth decade of life and increase with age

All obes affected except posterior: BPH

Posterior lobe only affected: Prostatic cancer

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16
Q

what are the causes of Benign prostatic hyperplasia?

A

Absolute or relative increase of estrogen

absolute: increasedsecretion

Relative: decreased metabolism

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17
Q

N/E of Benign prostatic hyperplasia

A

Nodular, firm,greyish white with small cystic finely cystic C/S

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18
Q

M/E of Benign prostatic hyperplasia

A

Hyperplasia of both stroma and glands.

1) Glands:
* Increase in number.
* Variable in size and shape
* papillomatosis.
* Cysts contain corpora amylacea.

2) Stroma:
* Hyperplasia of smooth muscles and fibroblasts.

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19
Q

what are the complications of Benign prostatic hyperplasia?

A
  • Prostatism. (In 5-20% of patients)
  • Gradual urinary tract obstruction.
  • No relation to malignancy.
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20
Q

what characterizes prostatism?

A
  • Frequency (i.e., only small amounts are voided at a time)
  • Nocturia (urinating at night, same reason)
  • Difficulty starting and stopping urination
  • Incontinence (dribbling)
  • Dysuria (painful urination)
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21
Q

results of gradual urinary tract obstruction

A

1) Urethra: elongated, compressed to a mere slit.

2) Urinarybladder: trabeculations, diverticulations, cystitis, stones.

3) Bilateral hydroureter, pyoureter.

4) Bilateral hydronephrosis, pyonephrosis.

5) Chronic renal failure.

For more info: https://youtu.be/XyldGZdp0Sk

around 24:00

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22
Q

what is the incidence of Prostatic carcinoma?

A
  • One of commonest male cancers.
  • Age> 50 years
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23
Q

what are the causes of Prostatic carcinoma?

A
  • Genetic (Familial Predisposition)
  • Excess androgen
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24
Q

N/E of Prostatic carcinoma

A

Site: Posterior lobe

  • grayish white firm irregular mass
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25
M/E of Prostatic carcinoma
Adenocarcinoma
26
spread of Prostatic carcinoma
- Local - lymphatic - Blood: osteosclerotic bone metastasis with increased alkaline phosphatase. | (May cause sciatica) ## Footnote Blood spread to Bone, Lung, Adrenals, Brain & Liver
27
what are prostatic tumor markers?
✓ Prostate specific antigen (PSA). (very specific) ✓ Carcinoembryonic antigen (CEA). ✓ Acid phosphatase. ✓ Alkaline phosphatase. ## Footnote Most men without prostate cancer have PSA levels under 4 ng/mL of blood. When prostate cancer develops, the PSA level often goes above 4. Still, a level below 4 is not a guarantee that a man doesn't have cancer. About 15% of men with a PSA below 4 will have prostate cancer if a biopsy is done.
28
what are testicular tumors?
- Germ cell tumors (90%) - Non-germ cell tumors (3%) - Lymphoma (7%)
29
what are germ cell tumors?
30
what are non-germ cell tumors?
**Leydig cell tumor:** produce androgen (precocious puberty) **Sertoli cell tumor:** produce estrogen (feminizing characters as gynecomastia)
31
what is the definition of varicocele?
Varicosity of pampiniform plexus of veins around spermatic cord
32
N/E of varicocele
bag of worm-like mass in the scrotum
33
what are the causes of varicocele?
**Primary:** in young unmarried men. **Secondary:** - Renal tumor compressing on spermatic vein - Venous thrombosis. - RSHF
34
what are the complications of varicocele?
Defective spermatogenesis due to increased temp in scrotum (infertility)
35
what is the definition of Spermatocele?
Small cysts filled with clear or milky fluid containing sperms in relation to epididymis (spermatozoa + albumin)
36
site of Spermatocele
more related to head of epididymis, less often in body or tail
37
what are the causes of Spermatocele?
- Embryological remnants - Post inflammatory obstruction of epididymis
38
what is the definition of hydrocele?
Collection of serous fluid within Tunica vaginalis
39
what are the causes of hydrocele?
**Primary:** Unknown **Secondary:** - Diseases of testis, epididymis, spermatic cord - generalized edema
40
what are the complications of hydrocele?
1- Pressure atrophy of testis (infertility). 2- secondary infection (pyocele)
41
what is the definition of hematocele?
Collection of blood within Tunica vaginalis
42
what are the complications of hematocele?
1- Pressure atrophy of testis (infertility). 2- secondary infection (pyocele)
43
what are the causes of hematocele?
**Primary:** - Unknown **Secondary:** - Trauma - Blood disease - Malignant tumor
44
what is the definition of chylocele?
Collection of lymphatic fluid within tunica vaginalis
45
what are the causes of chylocele?
Lymphatic obstruction: e.g. filariasis
46
What are the diseases of vulva?
**Benign lesions:** 1. Condyloma Accuminata which is virus related (Low risk HPV 6, 11). 2. Squamous cell papilloma is not of viral origin. 3. Hydradenoma Papilliform: Benign glandular proliferation. **Malignant lesions:** 1. Squamous cell carcinoma. 2. Adenocarcinoma. 3. Malignant melanoma.
47
Hydradenoma Papilliform
Benign glandular proliferation.
48
what is Squamous cell carcinoma of the vulva related to?
It is related to (High risk HPV 16, 18).
49
Precursor lesion of Squamous cell carcinoma of the vulva
Vulvar Intraepithelial Neoplasia "VIN"
50
what are diseases of the Vagina?
- Squamous cell carcinoma - Clear cell carcinoma - Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
51
What is squamous cell carcinoma of the vagina related to?
These tumors are related to (High risk HPV).
52
what is the precursor lesion of squamous cell carcinoma of the vagina?
Vaginal Intraepithelial Neoplasia "VaIN"
53
what is the nature of clear cell carcinoma of the vagina?
This is a variant of adenocarcinoma.
54
what is the precursor lesion of clear cell carcinoma of the vagina?
Vaginal adenosis which is an area of vaginal mucosa not covered by squamous epithelium.
55
what causes clear cell carcinoma of the vagina?
- it is uncommon but is seen in patients exposed in utero to DES (Di-Ethyl Stilbestrol).
56
what is Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)?
It is uncommon tumor occurring in girls from birth to adolescence (90% under 5 years of age). It is the least malignant of Rhabdomyosarcomas.
57
N/E of Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Large - Polypoid - Reddish - Soft grape-like mass arising from submucosa.
58
M/E of Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Malignant embryonal cells (Small cells with oval nuclei) with Rhabdomyoblastic differentiation (Striated muscle) in a Myxoid stroma
59
what are the diseases of the cervix?
- Inflammations (Acute & Chronic Cervicitis) - Endocervical polyps - Micro-glandular hyperplasia
60
inflammation of cervix
Some degree of cervical inflammation may be found in virtually all women, and it is usually of little clinical consequence.
61
what organisms cause inflammation in cervix?
- Infections by Gonococci, Chlamydia, Mycoplasma & Herpes simplex virus may produce significant acute or chronic cervicitis. - Important is to identify their association with upper genital tract disease, complications during pregnancy, and sexual transmission.
62
what does cervical inflammation produce (Concerning the epithelium)?
Cervical inflammation produces reparative and reactive changes of the epithelium.
63
what is **Endocervical polyps**?
Benign exophytic growths that arise from the endocervix.
64
what do Endocervical polyps cause?
They can cause irregular vaginal bleeding.
65
N/E of Endocervical polyps
Soft Mucoid lesions.
66
M/E of Endocervical polyps
Fibrous stroma + Dilated Mucus-secreting Endocervical glands + Inflammation.
67
what is **Micro-glandular hyperplasia**?
It is benign condition of the cervix in which there is closely packed proliferation of endocervical glands.
68
What causes **Micro-glandular hyperplasia**?
Caused by Progesterone administration such as during pregnancy, postpartum period or oral contraceptive pills administration.
69
Incidence of Carcinoma of the cervix
- One of the commonest cancers in females especially in developing countries. - The age beak of incidence is 45 years.
70
what is the etiology of Carcinoma of the cervix?
Human Papilloma Virus (HPVI Is the most common in seyuallu active women
71
Pathogenesis of Carcinoma of the cervix
- High risk HPVs (16 & 18) are the single most important factor in cervical oncogenesis. - HPVs infect immature basal cells of the squamous epithelium in areas of epithelial breaks, or immature sauamous cells present at the squamo-columnar junction - Intearation Of HOV DNA interferes with the P53 & Rb genes.
72
what are the risk factors of Carcinoma of the cervix?
1. Smoking: Reduces local cervical immunity. 2. Multiple sexual partners - Early age at first intercourse. 3. Having a portner with sexually transmitted disease. 4. Presence of another sexually transmitted disease lke HIV & Genital herpes. 5. Long term Oral contraceotive pills - Multible pregnancies.
73
what are Precancerous lesions of carcinoma of the cervix?
- Cervical Intra-epithelial Neoplasia "CIN" - Adenocarcinoma in situ "AIS"
74
Cervical Intra-epithelial Neoplasia (CIN)
- The precancerous lesion of cervical squamous cell carcinoma. - It is classiled as CIN1 - CIN2 - CIN3 according to the upward extension or the abnormal cells in the epithelium. - The dysplastic cells show Loss of normal maturation, Increased Nuclear/Cytoplasmic ratio, Nuclear hyperchromatism, pleomorophism, frequent mitotic activity - CIN3 is the most severe where the atvoical cells involve the whole thickness of the epithelium
75
Adenocarcinoma in situ (AIS)
It is the precancerous lesion of invasive adenocarcinoma
76
CIN grading
77
Modified Simpler Bethesda classification of Carcinoma of the cervix
- Low-grade Squamous Intra-epithelial Lesion (LSIL) = CIN I - High-grade Squamous Intra-epithelial Lesion (HSIL) = CIN Il and CIN III
78
what are the types of carcinoma of the cervix?
The most common types are squamous cell carcinoma (80% & Adenocarcinoma 15%)
79
what are the sites of Carcinoma of the cervix?
1. Squamo-columnar junction. 2. Endocervix with Squamous metaplasia
80
what is the shape of carcinoma of the cervix?
1. **Carcinoma in situ:** Focal thickening. 2. **Invasive carcinoma**:- a) Fungating "Exophytic" b) Ulcerating "Malignant ulcer". c) Infiltrating "Endophytic" with induration & deformity of cervix.
81
Microscopic picture of carcinoma of the cervix
1) **Squamous cell carcinomas (80%):** Either Keratinizing or Non-keratinizing. 2) **Adenocarcinomas (15%):** Characterized by formation of irregular glandular structures. 3) **Other types (5%):** Adeno-squamous carcinoma - Neuroendocrine carcinoma
82
Spread of carcinoma of the cervix
1. **Local:** Peritoneum - Bladder - Rectum 2. **Lymphatic:** Regional LNs. 3. **Distant metastasis:** Lung - Liver - Bone
83
Prognosis of carcinoma of the cervix
- Because of screening programs, Most of patients are discovered in early stages. - Patients with stage 4 cancer die as a result of local extension of the tumor (e.g. Urethral obstruction - Pyelonephritis - Uremia) rather than Distant Metastases.
84
Prevention of Carcinoma of the cervix
1. Vaccination against HPV introduced to girls at school age hopefully may reduce the cervical cancer risk 2. Screening proarams:- - Aim: Detect precancerous lesions or abnormal cells early. - Method: PAP smear - HPV testing
85
what are the manifestations of uterine disease?
1. Abnormal Uterine Bleeding. 2. Pain Associated with Menstruation. 3. Infertility & Spontaneous Abortion. 4. Uterine Masses.
86
abnormal uterine bleeding
Any departure from a normal menstrual cycle pattern.
87
what are the key characteristics used in determination of abnormal uterine bleeding?
Regularity - Frequency - Heaviness - Duration of flow.
88
what are the causes of abnormal uterine bleeding?
**Organic (Structural) abnormality:** - Chronic endometritis - Submucosal leiomyoma - Endometrial polyp - Endometrial neoplasms. **Functional disturbances (Dysfunctional uterine bleeding):** - Result from abnormalities in the menstrual cycle or systemic diseases.
89
what are nonstructural causes of abnormal uterine bleeding?
1) Disorders of endometrial origin (Disturbances of the molecular mechanisms responsible for regulation of the volume of blood lost at menstruation). 2) Disorders of the hypothalamic-pituitary-ovarian axis. 3) Disorders of hemostasis (Coagulopathies).
90
FIGO classification for causes of abnormal uterine bleeding
91
what is endometritis?
Inflammation of the endometrial lining of the uterus.
92
what is what is endometritis divided into?
1. Pregnancy-related endometritis. 2. Endometritis unrelated to pregnancy (Pelvic inflammatory disease PID).
93
what causes acute endometritis?
Uncommon - Caused by bacterial infections after delivery or miscarriage
94
what are the predisposing factors of acute endometritis?
Retained products of conception are the usual predisposing factors.
95
what does progression of acute endometritis Lead to?
**Progression leads to puerperal sepsis**
96
what are the clinical characters of chronic endometritis?
Bleeding - Pain - Discharge - Infertility.
97
M/E of chronic endometritis
Plasma cells
98
what does chronic endometritis occur in?
It occurs in:- 1) Chronic PID. 2) In post-partum or post- abortion patients with retained gestational tissues. 3) Intrauterine contraceptive device. 4) TB - Syphilis.
99
what is endometriosis?
Presence of endometrial tissue at a site other than the lining of the uterine cavity.
100
what is the ectopic endometrial tissue Composed of?
The "Ectopic" endometrial tissue is usually composed of both epithelial and stromal cells.
101
What characterizes ectopic endometrial tissue?
It responds to ovarian hormones somewhat like the uterine endometrium.
102
what are the types of endometriosis?
**External Endometriosis:** Presence of endometrial tissue (Glands & Intervening Stroma) outside the uterus. **Internal Endometriosis (Adenomyosis):** Presence of endometrial tissue (Glands & Stroma) in the myometrium of uterine wall.
103
what is the definition of external endometriosis?
Presence of endometrial tissue outside the uterus.
104
site of external endometriosis
Pelvic organs - Laparotomy scar.
105
pathogenesis of external endometriosis
Suggested theories are: **Regurgitation theory:** - During menstruation, viable endometrial fragments pass via fallopian tube to implant on peritoneum **Metaplastic theory:** - Endometrial metaplasia of serosal cells leads to peritoneal lesions. **Vascular & Lymphatic dissemination theory:**
106
N/E of external endometriosis
- Hemorrhagic lesions (As the endometrial tissue undergoes cyclic menstrual bleeding. - It excites excessive fibrosis around it. - Ovarian Endometriosis (Chocolate Cysts) appears as cyst with dark red brown altered blood content. - The blood may organize leading to fibrous adhesion with surroundings.
107
ovarian endometriosis (Chocolate cyst)
appears as cyst with dark red brown altered blood content.
108
M/E of external endometriosis
- Lesion consists of endometrial glands and stroma with hemosiderin. - Fibrosis + Hemosiderin laden macrophage.
109
definition of adenomyosis
Presence of endometrial tissue in the myometrium of uterine wall.
110
Site of adenomyosis
Myometrium of body of uterus.
111
Pathogenesis of adenomyosis
The basal zone of endometrium dips into adiacent myometrium.
112
N/E of adenomyosis
- Uterus is symmetrically enlarged, Thick uterine wall - The lesions form dark red foci.
113
M/E of adenomyosis
Nests of endometrial glands and stroma in myometrium between muscle bundles.
114
What are the characters of endometrial polyp?
- Endometrial polyps are sessile masses that project into the endometrial cavity. - They may be single or multiple. - It may cause abnormal bleeding.
115
what are the types of endometrial polyp?
1. Functional endometrium. 2. Hyperplastic endometrium, in association with endometrial hyperplasia. 3. Endometrial polyps in association with the administration of tamoxifen, an anti-estrogen therapy of breast cancer.
116
what is the definition of endometrial hyperplasia?
- Increased proliferation of the endometrial glands relative to the stroma, resulting in an increased gland-to-stroma ratio when compared with normal proliferative endometrium.
117
what is endometrial hyperplasia considered as?
It is an important cause of abnormal uterine bleeding.
118
what are the causes of endometrial hyperplasia?
Prolonged unopposed estrogen stimulation:- 1. Repeated Anovulatory menstrual cycles. 2. Obesity. 3. Estrogen secreting tumors. 4. Polycystic ovarian disease.
119
N/E of endometrial hyperplasia
Endometrial hyperplasia appears as increased endometrial thickness.
120
M/E of endometrial hyperplasia
**Characterized by:** - Glandular proliferation and crowding. - Increased gland to stromal ratio. - Varying degree of atypia. **Can be divided based on:** - Architecture (Simple - Complex). - Cytologic features (With - Without atypia).
121
what is endometrial hyperplasia divided into?
1. Simple hyperplasia without atypia. 2. Simple hyperplasia with atypia. 3. Complex hyperplasia without atypia. 4. Complex hyperplasia with atypia.
122
what are the most common cancer of the female genital tract?
Endometrial carcinoma
123
compare between type I and type II endometrial carcinoma
124
what are precursor lesion of Type I carcinoma?
Atypical endometrial hyperplasia (Endometrial Intraepithelial Neoplasia, EIN).
125
what is the precursor lesion of type II carcinoma?
Surface endometrial lesion is called Endometrial Intraepithelial Carcinoma, EIC (Minimal Serous Carcinoma).
126
what are other tumors that affect the endometrium?
1. Carcino-Sarcoma (MMMT). 2. Adeno-Sarcoma. 3. Endometrial stromal tumors:- a) Benign: Stromal nodule. b) Malignant: Endometrial Stromal Sarcoma (ESS).
127
what are tumors of the myometrium?
**Benign:** Leiomyoma **Malignant:** Leiomyosarcoma
128
Etiology of leiomyoma "Fibroid"
The tumor is linked to prolonged Hyperestrinism.
129
site of leiomyoma "Fibroid"
- Commonly arise in the body of uterus and cervix. - May be (Intramural - Submucous - Subserous - Leiomyomatous polyp - Parasitic)
130
N/E of leiomyoma "Fibroid"
- Rounded mass. - Pseudo-capsulated (Compressed uterine muscles & Interstitial tissue) - C/S: Whorly appearance
131
M/E of leiomyoma "Fibroid"
- Interlacing bundles of (Smooth muscle cells + Fibroblasts) - Secondary changes: Hyaline degeneration - Cysts - Necrosis - Calcification - Red degeneration (Hemorrhagic infarction) occurs during pregnancy
132
what are the characteristics of Leiomyosarcoma?
Atypia - Increased mitotic figures - Coagulative necrosis
133
what are gestational trophoblastic disease?
Group of diseases characterized by:- 1. Proliferation of pregnancy-associated trophoblastic tissue. 2. Has a malignant potential.
134
classification of gestational trophoblastic diseases
135
compare between complete hyaditiform mole & Partial mole in terms of: - Etiology - N/E - M/E - Prognosis
136
What is another name of invasive mole?
(Chorio-adenoma Destruens)
137
what does invasive mole complicate?
complicates complete mole
138
what characterizes invasive mole?
Villi become more invasive to myometrium and blood vessels and spread to distant sites.
139
what is the definition of choriocarcinoma?
Malignant neoplasm of trophoblastic cells.
140
incidence of choriocarcinoma
1. 50% arise in hydatiform mole. 2. 25% in previous abortions. 3. 22% in normal pregnancies.
141
N/E of choriocarcinoma
- Uterus contains a soft, friable, fleshy mass invading the uterine wall - Very hemorrhagic & necrotic.
142
M/E of choriocarcinoma
- Tumor tissue consists of malignant Cytotrophoblasts & Syncytiotrophoblasts which do not keep their normal relation but occurs as separate large sheets.
143
what are the non-neoplastic cysts of the ovary?
- Polycystic ovary (Stein - leventhal syndrome) - Follicular cysts - Corpus luteum cysts - Theca lutein cysts - Endometriotic cyst (Chocolate cyst)
144
who does PCOS affect?
* Affects young women.
145
what is the most common cause of anovulatory infertility?
**PCOS**
146
what is PCOS associated with?
*Associated with irregular menstrual periods, hyperandrogenism, hirsutism, acne, obesity, and insulin resistance
147
what causes endometrial hyperplasia in PCOS?
- Elevated serum androgens are converted to estrogens, unopposed estrogen may lead to -›Endometrial hyperplasia.
148
morphology of PCOS
- Multiple cystic follicles covered by a dense fibrous capsule lined by luteinized theca cells
149
clinical picture of follicular cysts
- Usually asymptomatic and incidental. - May present with symptoms related to hyper-estrogenism
150
morphology of follicular cysts
- Bilateral, multiple (may be single) filled with clear fluid.
151
what are follicular cysts Lined by?
- Lined by inner granulosa cells and outer theca cells
152
what causes corpus luteum cysts?
- Dilatation of degenerated corpus luteum.
153
clinical picture of corpus luteum cysts
- Can be asymptomatic or present with menstrual irregularities, abdominal pain, mass (large cyst), acute abdomen and hemoperitoneum (ruptured cyst).
154
morphology of corpus luteum cysts
Usually single, large & filled with blood or serous fluid.
155
what are corpus luteum cysts lined by?
Lined by an inner luteinized granulosa cells and outer theca cells
156
what causes Theca lutein Cysts?
*Caused by elevated serum level of human chorionic gonadotropin (HCG)
157
what are Theca lutein Cysts Associated with?
High association with gestational trophoblastic disease.
158
morphology of Theca lutein Cysts
Bilateral, multiple, large cysts lined by luteinized theca cells
159
what is the definition of endometriotic cyst?
- Cystic changes of ovarian endometriosis.
160
morphology of endometriotic cyst
- Bilateral or unilateral. - Multiple small or single large cyst with fibrotic wall, and dark brown contents (chocolate cyst)
161
M/E of endometriotic cyst
- Characterized by endometrial glands, endometrial stroma and hemosiderin laden macrophages
162
what is another name of endometriotic cyst?
(Chocolate cyst)
163
what is another name of PCOS?
(Stein - leventhal syndrome)
164
what are types of ovarian tumors?
165
classification of tumors derived from surface epithelium of the ovary
166
what is the traditional pathogenic view of the cause of tumors derived from the surface epithelium of the ovary?
167
168
Classification of epithelial ovarian carcinomas
169
Compare between Begnin surface epithelium tumors Serous cystadenoma & Mucinous cystadenoma in terms of: - Age - Size - Shape - Surface - Pedicle - C/S (Wall - Lining - Content) - M/E - Complications
170
What are the characteristcs of borderline surface epithelium tumors?
171
What are the characteristcs of malignant surface epithelium tumors?
172
what are tumors derived from germ cells **(Totipotent cells)**?
- Undifferentiated Germ Cell Tumor (Dysgerminoma) - Differentiated along embryonic pathway (Teratoma) - Differentiated along Extra Embryonic Pathway
173
Charachteristcs of undiffrentiated germ cell tumor **(Dysgerminoma)**
Uncommon malignant non-functioning neoplasm.
174
Incidence of undiffrentiated germ cell tumor **(Dysgerminoma)**
Occurs in children & young adults.
175
Microscopic appearence of undiffrentiated germ cell tumor **(Dysgerminoma)**
**(Similar to Seminoma of testis)** - Formed of: Lobules of Large Polygonal cells with Hyperchromatic nuclei - Cytoplasm: Abundant - Rich in Glycogen - Separated by: Fibrous septa infiltrated by Lymphocytes
176
whata re types of tumors derived from germ cells that diffrentiated along embryonic pathway **(Teratoma)**?
- Mature Teratoma: Benign - Cystic **(Dermoid cyst).** - Immature Teratoma: Malignant - Solid. - Monodermal Teratoma
177
what charachterizes **Monodermal teratoma**? and give an example of it
One-sided development (One Tissue Line) **Example:** Struma Ovarii (Thyroid tissue)
178
what are types of tumors derived from germ cells that diffrentiated along extra-embryonic pathway?
- Choriocarcinoma - Endodermal Sinus Tumor "Yolk Sac Tumor" - Embryonal Carcinoma
179
Diffrentiation of choriocarcinoma
Differentiation towards Trophoblast (Placenta).
180
What does choriocarcinoma secrete?
HCG hormone.
181
Diffrentiation of Endodermal sinus tumor **(Yolk sac tumor)**
Differentiation towards yolk sac.
182
what does Endodermal sinus tumor **(Yolk sac tumor)** secrete?
secretes Alpha Feto-Protein (AFP).
183
what are types of tumors derived from sex cord and stromal cells?
- Pure sec cord tumors - Pure stromal tumors - Mixed sex cord-stromal tumors - Meig's syndrome
184
what are **(Pure sex cord tumors)**?
1) Adult Granulosa cell tumor: Secretes Estrogen 2) Juvenile Granulosa cell tumor 3) Sertoli cell tumor: Secretes Estrogen
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what are **Pure stromal tumors**?
1) Leydig cell tumor: Secrets Androgen 2) Theca cell tumor (Thecoma): Secretes Estrogen 3) Fibroma
186
what are **Mixed sex cord-stromal tumors**?
Sertoli-Leydig cell tumor: Secretes Both hormones
187
what is **Meig syndrome**?
Ovarian Fibroma + Ascites + Hydrothorax.
188
Are metastaticv ovary tumors unilateral or bilateral?
Usually bilateral.
189
How do tumors reach the ovary?
Direct - Lymphatic - Blood - **Transcoelomic spread**.
190
what are the sites of primary tumors that metastasize to the ovary?
**GIT** - Uterus - GB - Pancreas - Lung.
191
Charachters of **Krukenberg tumor**
- Bilateral ovarian metastatic tumor. - Showing signet ring cells in fibrous stroma. - The primary tumor is present in G.I.T, mainly Stomach. - It reaches through Trans-coelomic spread.
192
what are the methods of spread of ovarian cancers?
193
why does peritoneal dissemenation of ovarian tumors seem to be easy?
Peritoneal disseminated metastasis seems to be easier in ovarian cancer because of the lack of anatomical barriers around the primary ovarian tumor.
194
what is **Sister joseph's nodule**?
- Umbilical metastasis that may be first manifestation of disease.
195
what are the most common sites of involvment in the spread of ovarian cancer?
Contralateral ovary - Peritoneal cavity - Pelvic & Para-aortic LNs - Liver
196
what ismetastasis of ovarian cancer associated with?
Metastasis is associated with Malignant ascites - Intestinal obstruction - Ureteral involvement - Hydronephrosis
197
Structure of breast
198
Presentations of breast patient
* Lump * Pain * Discharge * Skin manifestations
199
what are common diseases of breast?
* Breast cancer * Traumatic fat necrosis * Fibrocystic disease of the breast * Fibroadenoma * Breast abscess * Miscellaneous
200
Diffrential diagnosis of breast lump
**Traumatic:** hematoma and traumatic fat necrosis. **Inflammatory:** breast abscess, mammary ductectasia and granulomatous as T.B. **Fibrocystic disease of the breast.** **Neoplastic mass:** Fibroadenoma, duct papilloma, phylloides tumor and breast cancer
201
what are the results of examintion of women seeking evaluation of breast lump?
* No disease - 30% * Fibrocystic changes - 40% * Miscellaneous(benign) - 13% * Fibroadenoma - 7% * Cancer - 10%.
202
Predisposing factors of **Breast abscess**
1. Ignorance of nipple hygiene 2. Nipple abrasion 3. Retained milk
203
Pathology of **Breast abscess**
- Acute, chronic. - Single, multiple. - Premammary, Intramammary, Retromammary.
204
what is another name of **Mammary Duct Ectasia**?
- Periductal plasma cell mastitis
205
Characters of **Mammary Duct Ectasia**
* Dilatation of mammary ducts. * Inspissation of breast secretion. * Periductal plasma cell infiltrate.
206
what is another name of **Fibrocystic disease of the breast**?
- Cystic Mammary Hyperplasia
207
Incidence of **Fibrocystic disease of the breast**
- The most common breast disease. - It affects over half the women during reproductive period
208
Prognosis of **Fibrocystic disease of the breast**
- It is not premalignant.
209
Etiology of **Fibrocystic disease of the breast**
- Hyperestrogenemia.
210
Pathogenesis of **Fibrocystic disease of the breast**
- Derangement of cyclic breast changes that occur normally during menstrual cycle.
211
N/E of **Fibrocystic disease of the breast**
- Unilateral or bilateral. - Single or multiple. - No-encapsulated, ill defined, rubbery in consistency. - Mobile. - Grey white in colour. - Firm to rubbery. - Show variable sized cyst containing serous or hemorrhagic fluid.
212
ME of **Fibrocystic disease of the breast**
1. Fibrosis. 2. Adenosis. 3. Epitheliosis. 4. Cystic formation.
213
Prognosis of **Fibrocystic disease of the breast**
- Epitheliosis increase incidence of breast cancer which is more evident with atypical hyperplasia
214
what are begnin tumors of the breast?
- Fibroadenoma - Phylloid tumor (Giant fibroadenoma) - Duct papilloma
215
what is the most common begnin tumor of the breast?
Fibroadenoma
216
Nature of **Fibroadenoma**
Mixed (fibrous and epithelial)
217
Peak incidence of **Fibroadenoma**
Peak incidence is in 3rd decade.
218
what causes **Fibroadenoma**?
estrogen stimulation
219
NE of **Fibroadenoma**
- Usually single, round or oval. - Encapsulated, well-defined. - Firm, freely mobile. - C/S: well circumscribed, encapsulated, greyish white
220
ME of **Fibroadenoma**
- Neoplastic acini and ducts separated by fibrous stroma. - Surrounded by true capsule. It may be: 1. Pericanalicular. 2. Intracanalicular 3. Mixed
221
Nature of **Phyloid tumor (Giant Fibroadenoma)**
Fibro-epithelial tumor of unpredictable behaviour
222
ME of **Phyloid tumor (Giant Fibroadenoma)**
- Intracanalicular but stroma is highly cellular. - Cysts may be present
223
Prognosis of **Phyloid tumor (Giant Fibroadenoma)**
- about 10% metastasize. - Metastasis consists of stromal cells only.
224
what is **Duct papilloma**?
- Intra-ductal growths.
225
what does **Duct papilloma** cause?
- Frequently causes nipple discharge or small sub-areolar mas
226
Incidence of **Duct papilloma**
- Usually occur in 4th or 5th decade.
227
Prognosis of **Duct papilloma**
* Involution. * Rarely change to papillary carcinoma.
228
what repesents 20% of all cancers in women?
Breast Carcinoma
229
what is the most common cause of death in women between 35-55 years?
Breast Carcinoma
230
Incidence of **Breast carcinoma**
* In UK 1 in 10-12 chances * 1 in 8 women in US * Less incidence in Asia * Very rare before age 25
231
where do majority of **Breast carcinomas** arise?
* Majority of cancers arise in the ducts.
232
Risk factors of **Breast carcinoma**
- Female sex - Age - Obesity, high fat diet - Maternal relative with breast cancer. - Longer reproductive span. - Nulliparity, Oral contraceptives - Later age at first pregnancy. - Atypical epithelial hyperplasia. - Previous breast cancer/Endometrial Ca. - Geographic factors - country - BRCA1 and BRCA2 genes
233
Clinical features of **Breast carcinoma**
- Physiologic vs Pathologic changes - Lump / lumps - Discharge in many conditions. - Hard, soft, inflammation - Skin fixation / Skin retraction
234
Diagnosis of **Breast carcinoma**
* Mammorgraphy * Ultrasound * Fine Needle Aspiration cytology * Core Biopsy * Excision Biopsy * Frozen section * IHC * Molecular techniques – Gene mutation detection.
235
what evidences Genetic & Familial presisposition in **Breast carcinoma**?
* Younger age * First degree relatives * Bilaterality * Associated with endometrial & ovarian carcinoma * Mutation; BRAC1& BRACA2 genes
236
Site of **Breast carcinoma**
* Upper outer quadrant. * Lt breast > Rt one. * Bilateral in 4 -10%, mostly in lobular carcinoma.
237
Incidence of different histologic types of **Breast carcinoma**
238
Types of Breast carcinoma
239
what is another name of **In-situ duct carcinoma**?
- Intraduct carcinoma
240
NE of **In-situ duct carcinoma**
* Small hard masses * Bloody or serous nipple discharge. * C/S: Dilated ducts containing papillae or necrotic tissues.
241
Prognosis of **In-situ duct carcinoma**
- Good with complete removal.
242
Definition of **In-situ duct carcinoma with paget's disease**
- Duct carcinoma extends along the main mammary duct to infiltrate the epidermis
243
NE of **In-situ duct carcinoma with paget's disease**
Nipple and areola show eczema.
244
ME of **In-situ duct carcinoma with paget's disease**
- Thickened epidermis. - Rounded large pale vacuolated cells in the epidermis (Paget’s cells).
245
what are the types of **Invasive duct carcinoma**?
- **Non-Otherwise Specified (NOS)** (65-80%) - **Otherwise Specified** 1. Medullary carcinoma. (1%-5%) 2. Mucinous (colloid) carcinoma. 3. Invasive duct carcinoma with paget’s disease.
246
Incidence of **Non-Otherwise specified carcinoma**
the most common (65%-80%)
247
NE of **Non-Otherwise specified carcinoma**
- Ill-defined mass greyish white. - Stony hard in consistency. - Fixed. - C/S: retracted hard with gritty sensation with hge and necrosis. - Skin covering shows peau d’orange.
248
ME of **Non-Otherwise specified carcinoma**
- small sheets of malignant cells, separated by abundant Collagenous stroma (Dysmoplasia)
249
Incidence of **Medullary carcinoma**
- 1-5% of all mammary carcinoma.
250
NE of **Medullary carcinoma**
- large fleshy mass. - C/S: soft fleshy with foci of hge and necrosis.
251
ME of **Medullary carcinoma**
- solid sheets of malignant cells separated by scanty stroma that shows excess lymphocytes
252
Prognosis of **Medullary carcinoma**
- is relatively good.
253
Characters of **Invasive duct carcinoma with paget's disease**
- The epidermis is thickened and infiltrated with Paget’s cells. - The dermis is infiltrated with masses of tumor cells.
254
what is another name of **In-situ lobular carcinoma**?
Intra-lobular carcinoma
255
How is **In-situ lobular carcinoma** usually discovered?
- Usually discovered incidentally
256
when does **In-situ lobular carcinoma** occur?
Occur near the menopause
257
NE of **In-situ lobular carcinoma**
hard breast mass
258
ME of **In-situ lobular carcinoma**
in one or more breast lobules all terminal ductules and acini are distented with malignant cells
259
Site of **Invasive lobular carcinoma**
- multicentric and bilateral
260
NE of **Invasive lobular carcinoma**
- Ill-defined breast mass.
261
ME of **Invasive lobular carcinoma**
- Strands of malignant cells of Indian file pattern separated by fibrous tissue stroma. - The cells are small, uniform with little pleomorphism
262
Prognosis of **Invasive lobular carcinoma**
- worse than invasive duct carcinoma
263
Incidence of **Mucinous (colloid) carcinoma**
- Occur in older women.
264
NE of **Mucinous (colloid) carcinoma**
- Slowly growing tumor forming large, soft gelatinous mass.
265
ME of **Mucinous (colloid) carcinoma**
- Lakes of mucin with scattered small islands of malignant cells
266
Prognosis of **Mucinous (colloid) carcinoma**
good
267
Spread of invasive carcinoma
* Direct spread * Lymphatic spread * Blood spread
268
Direct spread of invasive carcinoma
* Deep fascia, pect. Ms, pl.& chest wall. * Overlying skin causing cancer en cuirasse (thick, hard skin fixed to underlying structures).
269
Lymphatic spread of invasive carcinoma
- Common and early - It occurs by 2 ways: 1. Lymphaticembolization. 2. Lymphaticpermeation.
270
what does Lymphatic Embolization lead to?
It Leads to metastasis in: a) L.N., axillary, int. mammary, medias. &supraclav. b) Opposite breast. c) liver and peritoneum
271
what does Lymphatic permeation (skin lymphatic) lead to?
It Leads to: a) small malignant nodules under the skin. b) Cancer en cuirasse (widespread) c) Peau d‘orange due to lymphatic edema of the skin except at site of hair follicle.
272
what does blood spread of invasive carcinoma lead to?
* Occurs early or late. * Metastasis to lung, liver, bone, brain & adrenal gland.
273
5 & 7 year survival rates of different types of breast carcinoma
274
Skin manifestations of breast carcinoma
* Paget disease of nipple * Retraction of nipple * Peau-de Orange * Cancer en cuirasse. * Skin retraction
275
what is Estrogen Receptor expression proportional to?
- differentiation of tumor
276
what is used to treat tumors with estrogen receptor?
tamoxifen (receptor antagonist)
277
How are estrogen receptors demonstrated?
IHC stain
278
what does HER2 proto-oncogene encode?
- a cell surface receptor that is overexpressed in approximately 25%-30% of breast cancers
279
what is used to treat tumors with **extracelluar domain of the HER2 protein**?
- Trastuzumab (Herceptin®) is the first monoclonal antibody that targets the extracelluar domain of the HER2 protein - It inhibits growth of breast cancer cells that over express this protein.
280
what is Gynecomastia?
- enlargement of male breast
281
Etiology of Gynecomastia
**Physiological:** - at puberty. **Pathological:** - Increase estrogen level in: * Liver cirrhosis * Estrogen producing tumors * Estrogen therapy * Digitalis therapy. * Klienefilter syndrome.
282
NE of Gynecomastia
- Disc like subareolar mass - Unilaterl or bilateral
283
ME of Gynecomastia
- Variable degree of epithelial hyperplasia in ducts. - Prominent swollen stroma.
284
Incidence of Carcinoma of male breast
- Occurs in old age
285
what causes Carcinoma of male breast?
- Common with estrogen therapy
286
Prognosis of Carcinoma of male breast
- It has bad prognosis as the tumor infiltrate locally early due to small breast size
287
Definition of Gynecomastia
- It is enlargement or swelling of breast tissue in males
288
Causes of Gynecomastia
- High male estrogen level - Estrogen imbalance with testosterone levels. - Excess secretion of prolactin due to hypothalamic dysfunction or pituitary tumors.
289
Diagnosis of Gynecomastia
- By demonstrating a high prolactin level
290
Treatment of Gynecomastia
**Medical:** dopaminergic drugs→ ↓prolactin secretion. **Surgical:** removal of tumor.
291
Effect of prolactin on GTH
-ve feed-back on gonadotropins
292
what does the negative feed-back effect of prolactin on GTH cause?
293
Definintion of Hypogonadism
- It is diminished functional activity of the gonads (the testes or the ovaries) that may result in diminished production of sex hormones.
294
Types and causes of Hypogonadism
**Primary hypogonadism** - can result from abnormal ovaries or testes (genetically, surgically removed or destructed) **Secondary hypogonadism** - due to pituitary or hypothalamic disease. **(Both may be before puberty or after puberty)**
295
Types of Hypogonadism in females
- Prepubertal hypogonadism (Eunuchism) - Postpubertal hypogoandism
296
Manifestations of Hypogonadism in females
**Prepubertal hypogonadism (Eunuchism):** 1- Primary amenorrhoea and sterility. 2- Secondary sex organs remain infantile. 3- Secondary sex characters do not appear. 4- The patient becomes tall due to delayed union of the epiphyses of long bones, span > height. **Postpubertal hypogoandism:** 1- Secondary amenorrhoea and sterility. 2- The secondary sex organs regress. 3- The breasts atrophy and become pendulus. 4- The secondary sex characters regress. 5- Osteoprosis and muscle wasting.
297
Definition of Hypergonadism
- Is a condition where there is a hyperfunction of the gonads.
298
Causes of Hypergonadism
It is caused by abnormally high levels of testosterone or estrogen, crucial hormones for sexual development.
299
Causes and effects of Hypergonadism in females
300
Definition of **Subfertility**
- is a delay in conceiving , the possibility of conceiving naturally exists, but takes longer than average. - It generally describes any form of reduced fertility with prolonged time of unwanted non-conception.
301
Definition of **Infertility**
- Is the inability to conceive naturally.
302
Definition of Amenorrhea
- Absence of a menstrual period in a woman of reproductive age, most commonly during pregnancy and lactation (lactational amenorrhoea; method of contraception)
303
Types of Amenorrhea
- Primary amenorrhoea - Secondary amenorrhoea
304
1ry amenorrhoea
- absence of secondary sexual characteristics by age 14 with no menarche or normal secondary sexual characteristics but no menarche by 16 years of age.
305
2ry amenorrhoea (menstrual cycles ceasing)
- (menstrual cycles ceasing) - It is defined as the absence of menses for three months in a woman with previously normal menstruation.
306
Causes of 2ry amenorrhoea (menstrual cycles ceasing)
- hormonal disturbances from the hypothalamus and the pituitary gland, from premature menopause or intrauterine scar formation.
307
Definition of Oligomenorrhea
- Infrequent or very light menstruation. - More strictly, it is menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year.
308
Causes of Oligomenorrhea
1. Prolactinomas 2. Thyrotoxicosis 3. Hormonal changes in perimenopause. 4. Polycystic ovary syndrome (PCOS): a condition in which excessive androgens (male sex hormones) are released by the ovaries.
309
Definition of Virilism
- Development of male secondary sex characteristics in a female due to excessive secretion of adrenal androgens.
310
Causes of Virilism

Y2B3 - Reproductive 📘 (9 decks)

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