Pathology - repro Flashcards
Klinefelter syndrome (47, XXY)
hypogonadism! testicular atrophy, gynecomastia
abnormal seminiferous tubules and abnormal Leydig cell function (low inhibin, low testosterone), leads to increased FSH/LH, incr. estrogen
Barr body present
Turner syndrome (45, XO)
female, short stature w. primary amenorrhea (most common)
no Barr body
menopause before menarche, decr. estrogen leads to incr. FSH/LH
pregnancy is possible w/ oocyte donation and exogenous estradiol/progesterone
Aromatase deficiency
No estrogen synthesis
Masculinization of female infants, incr. serum testosterone, incr. serum androstenedione
Can present with maternal virilization during pregnancy
Androgen insensitivity syndrome (46, XY)
Defect in androgen receptor
Normal-appearing female with female external genitalia, no uterus/fallopian tubes
testes are surgically removed to prevent malignancy
incr. testosterone, estrogen and LH
5a reductase deficiency
no testosterone –> DHT
ambiguous genitalia until puberty, incr. testosterone causes masculinization
normal internal genitalia (testosterone intact)
Kallmann syndrome
defective migration of GnRH cells and defective development of olfactory bulb
decr. synthesis of GnRH in the hypothalamus, decr. FSH/LH/testosterone
infertility in males and females
Complete mole
46, very high hCG, enucleated egg + single sperm (duplicated paternal sperm), elevated risk of malignant disease, lots of maternal symptoms
honeycombed uterus (clusters of grapes)
Partial mole
69 chromosomes, fetal parts present, 2 sperm + 1 egg, low risk of malignancy
Treatment for gestational hypertension
alpha-methyldopa, labetalol, hydralazine, nifedipine
Cause of pre-eclampsia
Abnormal placental spiral arteries, leads to endothelial dysfunction, vasoconstriction, ischemia
Look for proteinuria or end-organ dysfunction after 20th week of pregnancy
Complications of pre-eclampsia
Placental abruption Coagulopathy Renal failure Uteroplacental insufficiency Eclampsia
Causes of death in eclampsia
stroke, intracranial hemorrhage, ARDS
HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets
Look for schistocytes
Rupture of subcapsular liver hematomas can lead to severe hypotension
Placenta accreta vs. increta vs. percreta
accreta - attachment to myometrium (no penetration)
increta - placenta penetrates into myometrium
percreta - placenta perforates through myometrium and into serosa
Vasa previa triad
Membrane rupture, painless vaginal bleeding, fetal bradycardia
HPV and cervical cancer
subtypes 16 and 18
produce E6 (flags p53 for ubiquitin degradation) and E7 (competitively inhibits RB)
lateral invasion of tumor can block ureters
PCOS pathophysiology
hyperinsulinism/insulin resistance
incr. LH:FSH ratio
incr. androgens from theca interna cells
decr. follicular maturation
ovarian cysts
follicular cyst - unruptured graffian cyst, most common ovarian mass
theca-lutein cyst - bilateral/multiple, due to gonadotropin stimulation, associated with choriocarcinoma/hydatidform moles
mitigating risk factors for ovarian cancer
previous pregnancies, breastfeeding, OCPs, tubal ligation
benign neoplasms
serous cystadenoma: lined with fallopian tube-like epithelium
mucinous cystadenoma: lined by mucus-secreting epithelium
endometrioma, mature teratoma (can present as hyperthyroidism), Brenner tumor (looks like bladder, coffee bean appearance), fibroma, thecoma
Meigs syndrome
ovarian fibroma, ascites, hydrothorax
dysgerminoma
most common ovarian tumor in adolescents
Krukenberg tumor
GI tumor that metastasizes to ovaries (mucin-secreting signet cell adenocarcinoma)
treatment of endometritis
gentamicin + clindamycin w/ or w/o ampillin
breast pathology by location
nipple: Paget dz, breast abscess
lactiferous sinus: intraductal papilloma, mastitis
major duct: fibrocystic change, DCIS, invasive ductal carcinoma
terminal duct: tubular carcinoma
lobules: lobular carcinoma
stroma: fibroadenoma, Phyllodes
phyllodes tumor
leaf-like projections, large bulky mass of connective tissue and cysts
may become malignant
Drugs that cause gynecomastia
Spironolactone Digoxin Cimetidine Alcohol Ketoconazole
Most important prognostic factor for breast cancer
Axillary node involvement
Paget disease histology
large cells in epidermis with clear halo
Invasive ductal vs. lobular
ductal - rock-hard with sharp margins, stellate infiltration
lobular - orderly row of cells, decr. E-cadherin
Effects of cryptorchidism
Impaired spermatogenesis w/ normal testosterone levels (unilateral) or low T (bilateral)
incr. risk of germ cell tumors (hCG)
loss of inhibin = incr. in FSH
Spermatocele
Cyst due to dilated epididymal duct or rete testis
BPH location
periurethral (lateral and middle) lobes, compresses urethra into a vertical slit
hyperplasia not hypertrophy
Prostate cancer location
posterior lobe (peripheral zone)
look for signs of bone mets
