PATHOMA Flashcards
1
Q
describe the anatomy of the vulva
A
skin and mucosa outside hymen
1- labias
2- mons pubis
3- vestibule
2
Q
describe the histology of the vulva, vagina, cervix (lining)
A
vulva: lined by keratinized squamous epithelium
vagina: lined by NONkeratinized squamous epithelium
exocervix: lined by NONkeratinized squamous epithelium
endocervix: lined by SINGLE layer of columnar cells
(note: junction is the TRANSFORMATION ZONE SOS)
3
Q
women in reproductive age
presents with
unilateral pain and cystic dilatation on the vulva
what is it?
where do you expect to see the dilatation?
pathogenesis?
A
bartholyn cyst
in the LOWER vestibule adjacent to the vaginal canal
d/t inflammation, the duct gets obstructed —> leading to dilatation of the bartholin gland —> cyst maybe abscess too
4
Q
what is condyloma
A
painless genital warts
warty neoplasm of squamous epithelium
5
Q
how to differentiate between high risk and low risk HPV?
A
based on DNA sequencing
low: 6,11 (leads to condyloma)
high: 16,18,31,33 (leads to dysplasia then ca)
6
Q
what is the HALLMARK of HPV infected cells?
A
KOLIOCYTES ! (nucleus look WRINKLED)
7
Q
where do we see :
condyloma acuminatum
condyloma latum:
A
acuminatum: HPV
latum: syphilis
8
Q
differentiate between lichen sclerosis and lichen simplex chronicus in terms of:
- women age
- presentation and cause
- benign vs malignant
- risk of SCC
A
-women age
lichen sclerosis: POSTMENOPAUSAL
lichen simplex chronicus: any age, usually young
-presentation and cause
lichen sclerosis: LEUKOPLAKIA (PARCHMENT-LIKE VULVAR SKIN)
note: EPIDERMIS thins and DERMIS fibrosis (sclerosis) —AU usually
lichen simplex chronicus: LEUKOPLAKIA (THICK LEATHERY VULVAR SKIN
HYPERPLASIA)
note: hyperplasia d/t chronic irritation and scratching
-benign vs malignant
lichen sclerosis: BENIGN
lichen simplex chronicus: BENIGN
-risk of SCC
lichen sclerosis: INCREASED RISK
lichen simplex chronicus: NO RISK
9
Q
2 causes of vulvar carcinoma with age
A
1- HPV 16, 18 (40-50 usually)
2- Non-HPV (long-standing lichen sclerosis) - age >70 yrs
10
Q
leukoplakia DD 3
A
1- lichen sclerosis
2- lichen simplex chronicus
3- vulvar carcinoma (need biopsy)
11
Q
pathophysi of HPV cases vulvar carcinoma
A
arises from vulvar intraepithelial neoplasia (VIN) -neoplasia limited to epithelium -dysplasia characterised by: 1- koliocytic change 2- disordered cellular maturation 3- nuclear atypia
12
Q
presence of malignant epithelial cells in epidermis of vulva (carcinoma in situ)
A
extramammary paget disease
usually no underlying malignancy
13
Q
extramammary paget dx vs paget dx of the nipple, which one has underlying malignancy?
A
paget dx of nipple
14
Q
diagnose
erythematous, pruritic, ulcerated vulvar skin
A
extramammary paget dx
15
Q
DD b/w paget cells (extamammary paget dx) and melanoma (similar there is malignant cells in the epidermis)
1- KERATIN
2- S100
3- PAS
A
paget cells
1- KERATIN +ve (epithelial)
2- S100 -ve
3- PAS + ve
melanoma
1- KERATIN -ve
2- S100 +ve
3- PAS -ve
16
Q
reminder embryological origin of the vagina
A
upper 2/3: mullerian duct
lower 1/3: urogenital sinus
17
Q
what is vaginal adenosis? and pathophys
A
persistence of COLUMNAR epithelial cells in UPPER VAGINA
-During development, squamous epithelium from lower 1/3rd of vagina (derived
from urogenital sinus) grows up to replace columnar cells (derived from
Mullerian ducts)
18
Q
cause of vaginal adenosis?
A
use of DES !! (diethylstilbestrol) in utero
19
Q
complication of vaginal adenosis? sos
A
progression to clear cell adenocarcinoma of vagina
-> MALIGNANT proliferation of glands with clear cytoplasm
20
Q
bleeding with grape like mass protruding from vagina OR penis (seen <5 yrs)
- diagnosis?
- what is the mass called?
A
-embryonal rhabdomyosarcoma
(rare cancer)
- SARCOMA BOTRYOIDES !!!
21
Q
what does a biopsy of embryonal rhabdomyosarcoma show (2)
A
1- rhabdomyoblast (malignant proliferation of immature skeletal muscles) sos: cytoplasm shows CROSS STRIATIONS similar to muscle fibers
2-POSITIVE IMMUNOHISTOCHEMISTRY for DESMIN and MYOGENIN !!
22
Q
what is vaginal carcinoma?
A
malignant proliferation of SQUAMOUS epithelium lining vaginal canal
23
Q
cause of vaginal carcinoma?
what is the precursor lesion called?
A
HPV 16 18 31 33
VAIN (vaginal intraepithelial neoplasia)-dysplasia in epithelium
24
Q
lymph spread of vaginal carcinoma 2
A
1- upper 2/3 (from MD) spread to ILIAC NODES
2- lower 1/3 (from UGS) spread to INGUINAL LYMPH NODES
25
3 characteristics of CIN
1- koliocytic change
2- nuclear atypia
3- increased mitotic activity
26
CIN grades of dysplasia 4 then develops into …..
| what stages are reversible ?
```
CIN I (1/3 epithelium thickness)
CIN II (2/3 epithelium thickness)
CIN III (almost complete thickness)
CIS (carcinoma in situ): (entire thickness) NO INVASION OF BM
```
into invasive SCC (and not ADENOCARCINOMA —> cells of the endocervix)
CIN I II III are REVERSIBLE , CIS is IRREVERSIBLE
27
main difference b/w dysplasia and carcinoma
reversibility
28
what region in the lower genital tract is especially infected with HPV ?
transformation zone of the cervix
29
remember
- Infection usually eradicated by acute inflammation
| - PERSISTENT !! infection can lead to cervical dysplasia and cervical intraepithelial neoplasia (CIN)
30
most common cause of SCC of genitourinal tract
HPV
31
SOSOSOOSOS
| pathophysio of HPV infection leading to cancer 2
produces proteins:
1- E6 (inactivates p53)
tumor suppressor gene regulate G1 to S phase (looks at damaged DNA), if little damage fix it by repair enzymes. if too much damage: induce apoptosis calls BAX (bcla-2 decrease) thus loss of mitoch membrane stability, cytochrome C leaks leading to apoptosis
2- E7 (inactivates Rb)
Rb holds ETF another tumor suppressor gene essential for cell cycle
32
```
HPV vaccination (QUADRIVALENT)
each type prevents what?
protects for how long?
is it necessary to do a pap smear after?
```
-HPV 6 11 prevents against condylamata accuminata
HPV 16 18 prevents against CIN and cervical cancer
- 5years
- necessarily incase of infection from other subtypes 31 33
33
HPV can lead to what types of cancers (esp in cervix)?
SCC
| ADENOCARCINOMA
34
middle aged women 40-50 yrs
present with postcoital bleeding and vaginal bleeding
what to think of?
cervical carcinoma
| probably got infected with HPV 25 years ago :) and didnt perform any pap smears
35
sos 3 main risk factors for cervical carcinoma:
1- HPV infection
2- IMMUNOSUPPRESSION (it is an AIDS defining illness)
3- SMOKING
36
smoking leads to what 2 cancers that are not directly affected (i.e lungs pharynx etc,,,) ?
1- cervix
| 2- pancreas
37
sos
| complication of cervical cancer
if the tumor invades through anterior uterine wall to the bladder and blocks the ureters: leads to HYDRONEPHROSIS and post RENAL FAILURE (common cause of death)
38
gold standard screening for cervical cancer, to screen for what type?
```
pap smear
(note only for SCC type)
```
39
how long it takes CIN to develop to carcinoma?
10-20 years
40
how frequent should women do pap smear?
| cells are scraped using the brusher from where?
- every 3 years >21 yrs
| - transformation zone
41
what is the confirmatory test after positive screening test (pap smear) foor cervical ca?
Colposcopy + biopsy !!
42
2 limitations of pap smear ?
1- ONLY for SCC (not for adenocarcinoma)
| 2- FALSE -ve if transformation zone is not sampled :)
43
review histology of abnormal pap smear
| and comment on 3 abnorma findings
features of dysplasia
1- hyperchromatic dark nucleus
2- large nucleus
3- high nucleus to cytoplasm ratio
44
hormone cycle of the endometrium 3 (phase name, hormone, physio)
1- proliferative phase, estrogen, endo grows
2-secretory phase, progesterone, endo prepares for implantation
3- menstrual phase, loss of progesterone, endo falls
45
secondary amenorrhea
d/t loss of BASALIS (stem cell) and scarring
diagnose
asherman syndrome
46
overagressive dilatation and curettage (D&C) can cause ..
asherman syndrome
47
what is a common cause of dysfunctional uterine bleeding during MENARCHE and MENOPAUSE ?explain how?
```
anovulatory cycle (lack of ovulation)
b/c of no ovulation, corpus luteum doesn’t develop thus no progesterone is made.
endo develops by estrogen but not maintained by proges, so falls off
```
48
```
after delivery or miscrriage:
fever
abnormal uterine bleeding
pelvic pain
diagnose? how?
```
acute endometriris
| -retained products of conception serves as the nidus of infection
49
```
abnormal uterine bleeding
pain
INFERTILITY
w/ (retained products of infection, IUD, TB, PID (gonorrhea, CHLAMYDIA)
diagnose:
```
chronic endometritis
50
acute vs chronic endometritis
| type of inflammation?
- acute: BACTERIAL infection of endo
| - chronic: PLASMA CELLS (and lymphocytes) in biopsy sos
51
MoA of TAMOXIFEN?
| can lead to?
- ANTI-estrogenic effect on BREAST
- PRO-estrogenic effect on endome
thus can lead to ENDOMETRIAL POLYP
52
abnormal uterine bleeding after the use of tamoxifen (for breast ca), what is it???
endometrial polyp (d/t HYPERPLASTIC protrusion of endometrium)
53
what is endometriosis ? definition
GLANDS and STROMA !!outside uterine endometrial lining (note that the glands follow normal menstruation cycle)
54
what are the 3 theories in order for the causes of endometriosis?
1- RETROGRADE menstruation with implantation at an ectopic site
2-Mullerian ducts lead to endometrial METAPLASIA
3- LYMPHATIC dissemination
55
what is the most common site of endometriosis?
OVARY (makes hemorrhagic- chocolate cyst !!!!)
56
remember: common sites of endometriosis and symptoms
-Ovary (most common) - makes hemorrhagic (aka chocolate) cyst
-Uterine ligament - cause pelvic pain
-Pouch of douglas - pain with defecation
-Bladder wall - pain with urination
-Bowel serosa - abdominal pain and adhesions
-Fallopian tube mucosa - scarring increases risk for ectopic tubal pregnancy
-Adenomyosis - if endometriosis occurs in myometrium of uterus
when soft tissue is involved: Sites classically appear as yellow-brown 'gun powder' nodules
57
if endometriosis occurs in the myometrium. what is it called?
ADENOMYOSIS
58
- pain before/after/during menstruation
- pain during sex, urinating or bowel movements
- severe disabling pain or chronic pain
endometriosis
59
IMPORTANT complication of endometriosis? special location?
increased risk of carcinoma at site of endometriosis !!!
| esp in ovary: ENDOMETOID TUMOR
60
postmenopausal uterine bleeding could indicate: … which is …
endometrial HYPERPLASIA , hyperplasia of endometrial GLANDS! relative to STROMA
or endometrial carcinoma (if theres cellular atypia)
61
what is the cause of endometrial hyperplasia
UNOPPOSED ESTROGEN
1- obesity
2- PCOS
3- estrogen replacement
62
most important predictor for progression from hyperplasia to carcinoma?
CELLULAR ATYPIA !
63
what is the most common incasive carcinoma of female genital tract?
endometrial carcinoma (malignant proliferation of endometrial GLANDS!)
64
endometrial carcinoma 2 causes
1- hyperplasia 75%
| 2- sporadic 25%
65
differentiate b/w hyperplasia vs sporadic pathways leading to endometrial cancer:
1- age
2- histology
3- risk factors/cause
1- age:
- hyperplasia: 50-60 yrs
- sporadic: 70 yrs
2-histology
- hyperplasia: endometrOID (normal)
- sporadic: SEROUS (characterized by PAPILLARY structures with psammoma bodies)
3-RF/cause
- hyperplasia: increased estrogen exposure
- sporadic: P53 mutation -aggressive
66
list 4 causes for increased estrogen exposure
1- early menarche/late menopause
2- nulliparity (no babies)
3- inferitility with anovulatory cycle
4- obesity
67
DD for psammoma bodies 4
| sos sos sos
1- papillary ca of the thyroid
2- meningioma
3- papillary serous ca of the endometrium/ovary
4- mesothelioma (ca of the pleura)-related to asbestos
68
most common tumor in females
| is it benign or malignant
leiomyoma/ fibroma
| benign (prolifeation of SM in myometrium)
69
what is the cause for leiomyoma (fibroma)
estrogen exposure
70
```
differentiate between leiomyoma (fibroma) and leimyosarcoma in terms of:
1-age
2-size
3-characteristics
4- cause
```
1-age:
leiomyoma: premenopausal
leiomyosarcoma: postmenopausal
2- size
leiomyoma: multiple lesions
leiomyosarcoma: single lesion
3- characteristics:
leiomyoma: well defined WHITE whorled masses
leiomyosarcoma: areas of necrosis and hemorrhage
4- cause:
leiomyoma: estrogen exposure
leiomyosarcoma: DE NOVO
71
how does leiomyoma/fibroma usually present
asymptomatic!!!!
| or abnormal uterine bleeding, infertility, pelvic mass
72
how does leiomyoma size change over time?
enlarges during pregnancy
| shrinks after menopause
73
can leiomyoma progress to leimyosarcoma
NOO
74
functional unit of the ovary
follicle
75
follicle consists of 3 parts
oocyte
granulosa
theca cells
76
describe the follicle process of maturation starting from theca cells until end of secretory phase
- theca cells produces androgen (stimulated by LH)
- granulosa cells convert androgen to estrogen (estradiol) (stimulated by FSH)
- then estrogen leads to the estadiol surge —> LH surge leading to ovulation
- after ovulation, follicle become corpus luteum (very big and yellow) secretes progesterone and prepares endometrium for possible conception
77
what are the 2 cysts that can occir in the follicle
1- hemorrhagic corpus luteal cyst
| 2- follicular cyst
78
how is hemorrhagic corpus luteal cyst caused ?
| when is it common?
formed when the CL fails to disintegrate and instead persist
-commonly found during early phase of pregnancy
79
how follicular cysts are caused?
| is it dangerous?
d/t degeneration of follicles
| normal in women (if few)
80
main cause of polycystic ovarian disease (PCOD)
| sosoosso
hormonal imbalance
LH:FSH >2
sosososos
81
what is PCOD
presence of multiple ovarian FOLLICULAR cysts
| -affects 5% of women of reproductive age
82
explain the pathophysiology of PCOD starting with the main finding
main finding: LH:FSH ratio >2
- high LH stimulates theca cells to produce LOTS of androgen
imp: when androgen goes to blood leads to hirsuitism
- androgen is converted to estrone in adipose tissue (thus gives NEGATIVE feedback for FSH secretion)
- thus granulosa cells and eventually follicle degenerates making a cyst :)
83
obese young women with: -infertility
-oligomenorrhea
-hirsuitism
and explain the symptoms
PCOD
- infertility d/t degenerated follicles
- hirsuitism d/t excess androgen
84
pt with PCOD is at risk of what cancer and why
ENDOMETRIAL cancer (d/t high estrone) unopposed effect
85
what is a v impo complication for a women with PCOD after 10-15 yrs?
insulin resistance and T2D
86
what are the 3 types of ovarian tumors? and 4- metastasis
1- surface epithelium
2- germ cells (from oocyte)
3- sex-cord stroma (granulos,theca,fibroblast)
87
most common ovarian tumors types (2 in order)
1- surface epithelium 70%
| 2- germ cells 15%
88
surface epithelium ovarian tumors is divided into 2*2 and 2*2
```
1- common (with cyst)
a- serous tumor (filled with water)
b- mucinos tumor (filled with mucin)
2- less common (metaplasia)
a-endometroid tumor
b- brenner tumor
```
89
what is the worst prognosis of all female genital tract cancer
surface epithelium ovarian cancer!! its the most common as well!!
90
what is the surface epithelium of the ovary?
coelomic epithelium (has the ability to produce multiple cell types)
91
which ovarian tumor is detected LATE (thus has poor prognosis):
presents as:
-vague abdominal discomfort
-urinary frequency (compress on the bladder)
surface epithelium
92
How are serous and mucinous tumor (surface epithelial tumors of the ovary) classified into benign, borderline, and malignant?
- name
- describe the cyst (since serous and mucinous are common and have cysts)
- age
```
1- name
benign: cystadenoma
borderline: -
malignant: cystadenocarcinoma
2- description
benign: SINGLE cyst with SIMPLE FLAT lining
borderline: has malignant potential
malignant: COMPLEX cyst with THICK SHAGGY lining
3- age
benign: premenopausal 30-40
borderline: —
malignant: postmenopausal 60-70
```
93
What ovarian cancer is BRCA1 mutation associated with?
BRCA1 associated with increased risk of cancer where?
what is done prophylactically?
- Serous carcinoma (serous cystadenocarcinoma)
- breast and ovary
- salpingo-oophroectomy (fallopian tube has risk as well!!) along with bilateral mastectomy
94
what are the 2 surface epithelial tumors of the ovary with NO CYST? are they mostly malignant or benign?
remember: tumors with cyst: cystadenoma, borderline, cystoadenocarcimoa
sos
1- endometroid tumor mostly malignant
| 2- brennor tumor mostly benign
95
women with ENDOMETRIOSIS may develop what type of ovarian tumor? sos
```
surface epithelium (ENDOMETROID tumor)
made of endometrial like gland
```
96
women with an ovarian tumor that contains cells resembling UROTHELIUM (bladder like epithelium) sos
```
BRENNOR TUMOR (surface epithelial tumor)
remmeber: Bladder Brennor Benign
```
97
if a women presents with endometroid carcinoma tumor of the ovary, it is imp to check what?
check for ENDOMETRIAL CARCINOMA !!! (15% have independent ca)
98
what is the distant metastasis of SURFACE epithelial tumors of the ovary?
spread LOCALLY to the PERITONEUM (via direct contact)
| sosososos: OMENTAL CAKING !!!!!!
99
CA-125 marker in what type of ovarian tumors? used to do what?
surface epithelial tumors
| mostly to: 1- monitor tx response 2- screen for RECURRENCE 3-not so useful in screening
100
what 4 tissues are made by germ cells, thus leading to what tumors 5?
1-Oocyte —> dysgerminoma
2- Placental tissue —> choriocarcinoma
3- Fetal tissue —> Embryonal ca, Cystic teratoma
4- Yolk sac —> endometril sinus (yolk sac) tumor
101
all germ cells are MALIGNANT except —— is BENIGN?
cystic teratoma
102
- what is the most common MALIGNANT germ cell tumor?
- what is the most common germ cell tumor? also, it is BEINGN!
- what is the most common germ cell tumor in KIDS? is it benign or malignant?
- dysgerminoma
- cystic teratoma
- yolk sac tumor (endodermal sinus tumor)-malignant
103
schiller-duval bodies are seen in what tumor ?
endodermal sinus (yolk sac) tumor
104
DD women presents with an ovarian tumor, if age is — what is the most likely diagnosis?
15-30
35-40
60-70
15-30: germ cell tumor
35-40: BENIGN surface epithelial tumor
60-70: MALIGNANT surface epithelial tumor
105
```
malignant tumor with cells that resemble oocytes:
-large cells
-clear cytoplasm
-central nuclei
—> FRIED egg appearance
```
Dysgerminoma
106
what is the male counterpart of dysgerminoma? how do we distinguish histologically?
seminoma (histologically indistinguishable)
107
serum LDL is elevated in what OVARIAN tumor?
prognosis?
response to radiotherapy?
dysgerminoma
- good prognosis
- responds to radiotherapy
108
malignant tumor composed of cytotrophoblast and sycytiotrophoblast is called? does it spread?
choriocarcinoma - trophoblasts are VERY invasive
| SPREADS HEMATOGENEOUSLY EARLY !!! it is small and hemorrhagic
109
remember:
villi (fxnl unit of placenta) are absent in choriocarcinoma
110
ovarian tumor with HIGH BETA HCG ?
| response to chemotherapy?
choriocarcinoma
| poor response to chemotherapy
111
choriocarcinoma may lead to —- cysts in ovary
thecal
112
embryonal carcinoma are malignant aggressive germ cell tumors that are composed of what type of cells?
LARGE PRIMITIVE CELLS (almost embryo-like)
113
what is cystic teratoma?
tumor made up of fetal tissue derived from >2 embryonic layers (skin, hair, cartilage, thyroid, etc… )
114
20 years old female presents with hyperthyroidism and mass in her ovary
STRAUMA OVARII (TERATOMA mainly composed of thyroid tissue !!!)
115
cystic teratoma is mostly BENIGN but have malignant potential if what is present?
soso
1- immature tissue (esp neural ectoderm !!!)
| 2- somatic malignancy (SCC!!! of the skin of the TERATOMA)
116
a female kid with serum AFP elevated and the biopsy shows glumeruloid structures on ovarian mass biopsy ?
-what are these glumeruloid strctures known as?
```
endodermal sinus (yolk sac) tumor
-schiller-duval bodies
```
117
what are the 3 sex cord stroma tumors?
1- granulosa-theca tumor
2- sertoli-leydig cell tumor
3- fibroma
118
Fibroma is a tumor of what cells? and what type of ovarian tumor is it?
- fibroblast
| - sex-cord stromal tumors
119
```
female presents with:
-ovarian tumor (what is it? benign or malignant?
-pleural effusion
-ascites
sosososososososo diagnose?
```
MEIGS syndrome
| -ovarian tumor: fibroma !!!!!!! BENIGN
120
granulosa-theca tumor is presented based on excess —— production? and presentation varies with age (how?)
1- prior to puberty
2 reproductive age
3- postmenopause
malignant or benign ?
EXCESS ESTROGEN PRODUCTION
1- precious puberty
2- menorrhagia and metrorrhagia
3- postmenopausal uterine bleeding with endometrial hyperplasia
malignant (min risk metastasis)
121
young girl present with precious puberty and ovarian tumor? what is it?
granulosa-theca cell tumor (excess estrogen production)
122
what ovarian tumor leads to hirsuitism and virilization (more masculine) and high androgens!!???
what is an SOS histological characteristic?
sertoli-leydig cell tumor (sex cord stromal tumors)
| -intracytoplasmic REINKE CRYSTALS !!!!!!!!!
123
2 common tumor metastasis to ovary
1- krukenberg tumor
| 2- pseudomyxoma peritonei
124
a female with gastric carcinoma (what type?why?) is at risk of metastasis to what part of the genital tract? what is the tumor called?
```
DIFFUSE type (not intestinal) since it has MUCUS:::
remember: diffuse type has signet ring cell (nucleus is pushed to side and cell is filled with mucus)
METASTASIS to OVARY: KRUKENBERG tumor-MUCINOUS TUMOR!!!
```
thus note: metastasis could come from breast, colon, anywhere with MUCUS!!!!
125
- bilateral ovarian mucinous carcinoma we think of?
| - unilateral / / / / ?
```
BILATERAL !!
krukenberg tumor (metastasis of mucus ca (e.g diffuse gastric ca) leading to mucinous carcinoma in the ovary)
```
UNILATERAL: primary mucinous carcinoma of ovary
126
what is jelly belly ?
| it is found with what tumor?
huge amount of mucus in peritoneum
| -mucinous tumor of APPENDIX metastasizing to the OVARY: leading to PSEUDOMYXOMA PERITONEI
127
primary source of pseudomyxoma peritonei (metastasis tumor to the ovary) ?
mucinous tumor of appendix
| -REMEMBER: jelly belly :)
128
key risk of ectopic pregnancy
tube scarring (secondary to pelvic inflammatory disease or endometriosis)
129
lower quadrant pain a few wks after a missed period
ectopic pregnancy
130
tx of ectopic pregnancy
surgical emergency
131
spontaneous abortion is :
<20 weeks of gestation (usually 1st trimester)
132
vaginal bleeding with passage of fetal tissue
| cramp like pain
spontaneous abortion
133
most common cause of spontaneous abortion 4
- chromosomal abnormalities (e.g trisomy 16) !!!
- hypercoaguable states (antiphospholipid syndrome)
- congenital infection
- exposure to teratogens )first 2 wks)
134
timewise effect of teratogen exposure
0-2 wks spontaneous abortion
3-8 wks organ malformation
3-9 mo organ hypoplasia
135
effect of alcohol as a teratogen?
MOST COMMON CAUSE OF MENTAL RETARDATION… FACIAL ABORMALّّITIES, MICROCCEPHALY
136
limb defects is caused by what teratogen
thalidomide
137
discolored teeth caused by what teratogen
tetracycline
138
effect of warfarin as a teratogen?
fetal bleeding
139
DIGIT HYPOPLASIA AND CLEُFT LIP/PALATE cause by what teratogen ?? sos
phenytoin
140
-hearing and visual impairment
-spontaneous abortion
is caused by what teratogen ?
isotretinoin
141
cocaine and cig smoking if taken during pregnancy can lead to ..
IUGR
| +cocaine: placental abruption
142
most common cause of spontaneous abortion 4
- chromosomal abnormalities (e.g trisomy 16) !!!
- hypercoaguable states (antiphospholipid syndrome)
- congenital infection
- exposure to teratogens )first 2 wks)
143
DD:
1- painless 3rd trimester bleeding
2- painful 3rd trimester bleeding (and fetal insufficiency)
3- postpartum bleeding and difficulty to deliver the placenta
1- placenta previa
2- placenta abruption
3- placenta accreta
144
what is placenta previa? tx?
placenta implants and closes cervical os
| tx: requires C-section delivery
145
what is placenta abruption? tx?
separation of placenta from decidua, prior to delivery of fetus
146
what placental dx is a common cause of stillbirth
placental abruption
147
when placenta implants to myometrium (with little or no decidua) it is called : differentiate based on the extent of invasion:
if superficially implanted/grows into/completely through (invade bladder/bowel) myometrium is called?
tx?
placenta accreta , increta, percreta
HYSTERECTOMY
148
what is eclampsia
preeclampsia + seizures
149
what is HELLP ?
preeclampsia + thrombotic MAHA (in liver)
Hemolysis
Elevated Liver enzyme
Low Platelets
150
HELLP and Eclampsia require what tx ???
IMMEDIATE DELIVERY
151
preeclampsia characteristics
-pregnancy induced HTN (headache, visual abnormality)
-proteinuria
-edema
usually arise in 3rd trimester
152
what is the cause of preeclampsia ? tx?
caused due to abnormality in maternal-fetal vascular interface in placenta
resolves with delivery
remember: increased BP: fibrinoid necrosis)
153
SIDS is ….., infants often expire during ….
death of infant (1mo - 1yr) with NO obvious cause
| during sleep
154
RF for SIDS 3 sos
1- EXPOSURE TO CIG smoking
2- sleeping on stomach
3- prematurity
155
what is hydatidiform mole (molar pregnancy) ?
```
abnormal conception (grow of abnormal placental tissue)
; benign tumor, d/t genetic error (abnormal fertilized egg)
```
156
what is hydatidiform mole (molar pregnancy) ?
```
abnormal conception (grow of abnormal placental tissue)
; benign tumor, d/t genetic error (abnormal fertilized egg)
```
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how is molar pregnancy detected?
if prenatal care present:
- routine US (early 1st trimester)
- no fetal heart sounds
- ‘SNOW-STORM’ appearance (grape like masses filled w/ fluid)
if no prenatal care:
-pass of grapes-like masses (LARGE VILLI pass through vagina in 2nd trimester)
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-> uterus is much larger and
-> B-HCG is much higher
(than expected for date of gestation)
hydatidiform mole (molar pregnancy)
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tx of hydatidiform mole ? how is it monitored after?
D&C
| monitor B-HCG to ensure mole is completely removed and CHECK for CHORIOCARCINOMA
160
how can choriocarcinom arise?4
| SOSOSOS how to differentiate between the major 2 types?
- after spontaneous abortion
- normal pregnancy
- hydatidiform mole
- spontaneous germ cell tumor
Choriocarcinoma that arise from gestational pathway respond well to
chemotherapy; those from germ cell pathway don't.
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how to differentiate between partial and complete mole?
- genetics
- fetal tissue
- villous edema
- trophoblastic proliferation
- risk for choriocarcinoma
- genetics
partial: normal ovum + 2 sperms = 69 chromosome
complete: empty ovum + 2 sperms =46 chromosome
- fetal tissue
partial: present
complete: absent
- villous edema
partial: some villi are hydropic, some normal
complete: most villi are hydropic
- trophoblastic proliferation
partial: focal proliferation present around hydropic villi
complete: diffuse proliferation around hydropic villi
- risk for choriocarcinoma
partial: minimal risk
complete: 2-3%
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spontaneous abortion is :
<20 weeks of gestation (usually 1st trimester)
