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Pathology > Repro-Endo: Female Genitals > Flashcards

Repro-Endo: Female Genitals Flashcards

1
Q
  • Cystic dilation on the side of the Vaginal canal
  • Mucus-like fluid
  • Inflammation and Obstruction of the gland
  • Women of Reproductive age (infections, STDs)
  • Unilateral
  • Painful cystic lesion @ Lower Vestibule adjacent to the Vaginal canal
  • Can become an Abcess if untreated - most often caused by *Neisseria gonorrhoeae*
A

Bartholin Cyst

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2
Q
  • Warty neoplasm of Vulvar skin (Large)
  • HPV 6 and HPV 11 (Condyloma acuminatum)
    • Koilocytes - “Crinkled Raisen nuclei”
      • Cytoplasmic Vacuolization - Koilocytosis
    • Vulvar Skin, Vaginal canal, Cervix
  • Secondary Syphilis (Condyloma latum)
  • Rarely progresses to Carcinoma
A

Condyloma

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3
Q
  • Thinning of the Epidermis ‘paper thin skin’
    and Fibrosis (sclerosis) of the dermis
  • Benign - small risk of SCC
  • Leukoplakia (white patch)
  • “Parchment-like” Vulvar skin
  • Postmenopausal women
  • Possibly Autoimmune etiology
A

Lichen Sclerosis

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4
Q
  • Hyperplasia of the Vulvar Squamous epithelium
  • White Leukoplakia (due to squamous cell hyperplasia)
    w/ Thick, Leathery Vulvar skin
  • Chronic irritation
  • Scratching
  • Benign
  • NO Risk of SCC
A

Lichen Simplex Chronicus

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5
Q
  • Leukoplakia
  • Req’s Biopsy
  • (2) HPV related and Non-HPV related
  • HPV 16 and HPV 18 –> Koilocytic change
    • Multiple partners, Early first age of intercourse
    • Women of Reproductive age
    • arises from Vulvar Intraepithelial Neoplasia (VIN)
  • Non-HPV a/w Long-standing Lichen Sclerosis
    • evetually Carcinoma, Elderly women > 70 y.o.
  • Vulvar Squamous epithelium lining –> Carcinoma
A

Vulvar Carcinoma

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6
Q
  • Malignant epithelial cells in the Epidermis of Vulva
  • Red, crusted, Vulvar lesion –> Adenocarcinoma
  • Primitive Epithelial Progenitor cells
  • Erythematous, Pruritic, Ulcerated skin, Rarely invades
  • Must be distinguished from Melenoma
    • PAS+, Keratin +, S100- –> Paget cells
      • Mucin is Periodic acid-Schiff Positive (PAS+)
    • PAS -, Keratin -, S100+ –> Melanoma
      • Keratin is an intermediate filament in Epi cells
  • -> epithelial carcinoma
A

Extramammary Paget Disease

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7
Q
  • Focal persistence of Columnar Epithelium
    of Upper Vagina
  • Exposure to Diethylstilbestrol (DES) in utero
  • Lower 1/3 - Squamous Epithelium (Urogenital sinus)
  • Upper 2/3 - Columnar Epithelium (Mullerian ducts)
A

Adenosis

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8
Q
  • Malignant proliferation of Glands w/ Clear Cytoplasm
  • Complication of DES-associated Vaginal Adenosis (rare)
  • Dx during the Late Teenage years
  • Discovery lead to cessation of DES usage
    • Diethylstilbestrol (DES) was used to prevent a Threatened abortion
    • DES inhibits Mullerian Differentiation
      • Fallopian tubes, Uterus, Cervix, Upper 1/3 of the Vagina
    • Abnormally shaped Uterus
    • Cervical Impotence
A

Clear Cell Adenocarcinoma

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9
Q
  • Malignant Mesenchymal Proliferation of Immature Skeletal muscle (rare)
  • Rhabdomyoblasts w/ Striations
  • Spindle-shaped Tumor cells
  • Expresses muscle-specific proteins (Desmin)
  • Bleeding - Wall of Bladder, Wall of Vagina
  • Grape-like mass protruding from Vagina or Penis
    • “Sarcoma Botryoides”
  • Child < 5 y.o.
A

Embryonal Rhabdomyosarcoma

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10
Q
  • Cytoplasmic Cross-striations
  • Positive immunohistochemical staining for:
    • Desmin - intermediate filament of muscle cells
    • Myogenin - Nuclear transcription factor Pos.
A

Rhabdomyoblast

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11
Q
  • Squamous epithelium lining the Vaginal mucosa
  • -> Carcinoma
  • High Risk HPV 16, 18, 31, 33
  • Vaginal Intraepithelial neoplasia (VAIN)
  • -> Precursor lesion
  • When it spread to Regional Lymph Nodes:
    • Lower 1/3 of Vagina –> Inguinal Nodes (primary)
    • Upper 2/3 of Vagina –> Regional Iliac Nodes
A

Vaginal Carcinoma

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12
Q

What kind of tissue lines the Exocervix?

A

Nonkeratinizing Squamous Epithelium

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13
Q

What kind of tissue lines the Endocervix?

A

Single layer of Mucus-secreting Columnar cells

Endocervical epithelium normally
migrates down to the Exocervix

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14
Q

What is the Junction between the
Exocervix and the Endocervix called?

A

Transformation Zone

TZ -Squamous dysplasia and Cancer develop

TZ- sampled when performing a cervical Papanicolaou smear (Pap smear)

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15
Q
  • DNA Virus that Infects Lower Genital tract
  • Cervix and Transformation Zone
  • Infection usually eradicated by Acute Inflammation
  • Persistant infection –> Cervical dysplasia
  • *(Cervical Intraepithelial Neoplasia (CIN)**
  • CIN Risk:
  • HPV 6, 11 –> Low Risk
  • HPV 16, 18, 31, 33 –> High Risk
  • High-risk HPV produces E6 (p53) and E7 (Rb)
A

HPV

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16
Q

What produces the acidic pH of the Vagina?

A

Lactobacilli (gram + rod)

produce Lactic acid –> maintains pH of Vagina

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17
Q
  • Low Risk 6, 11 and High Risk HPV 16, 18
  • Koilocytic - Raisen wrinkled pyknotic nucleus, Disordered Cellular maturation, Nuclear atypia, Increased Mitiotic activity w/in Cervical Epithelium
  • Divided into Grades: Extent of Epithelial involvement
    • CIN I - < 1/3 thickness of epithelium, 66% reverse
    • CIN II - < 2/3 thickness of epithelium, 33% reverse
    • CIN III - slightly less than entire thickness, unlikely
    • Carcinoma in situ - entire thickness
  • Stepwise progression –> SCC (10 yrs per stage, 45 y.o.)
  • CIN I often regresses, Higher grade –> more likely SCC
A

Cervical Intraepithelial Neoplasia (CIN)

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18
Q
  • Vaginal Bleeding (Postcoital or Cervical discharge)
  • Malodorous discharge
  • Cervical Epithelium –> Invasive Carcinoma
  • Middle aged women (40 - 50 y.o.)
  • HPV –> key High risk factor
  • 2nd factors –> Smoking and Immunodeficiency (AIDS)
  • Squamous cell carcinoma (80%)
  • Adenocarcinoma (15%)
  • Both types are related to HPV infection
  • **Anterior Uterine wall invasion –> Bladder –> Blocking Ureters –> Hydronephrosis w/ Postrenal Failure
  • -> Death in Advanced cases SCC (75% - 80%)**
A

Cervical Carcinoma

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19
Q

How do you Screen for Cervical Carcinoma?

A
  • Catch the Dysplasia (CIN) before –> Carcinoma
    • 10 years per step, avg. 10 - 20 years
    • Screening begins at age 21, every 3 years after
  • Pap Smear - Gold standard
    • cells scraped from Transformation zone w/ Brush
    • Low Grade (CIN I) or High Grade (CIN II and III)
    • High Grade = Hyperchromatic (dark) nuclei and High nuclear to Cytoplasmic ratios
  • Abnormal Pap Smear –> Confirmatory Colposcopy and Biopsy, Limited by Inadequate sampling and Efficacy
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20
Q

Discuss effectiveness of preventing
HPV infections through Immunization?

A
  • Quadrivalent vaccine; HPV 6, 11 and HPV 16, 18
  • Ab-HPV 6, 11 –> Protect against Condylomas
  • Ab-HPV 16, 18 –> Protect against CIN and Carcinoma (VIAN, and VIN)
  • Pap smears are still necessary due to the limited number of HPV types covered by the Vaccine
    • Does not protect against 31, 33, other subtypes
  • Protection lasts for ~5 years
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21
Q

Types of Dysmenorrhea?

A
  • Primary Type
    • Only occurs in Ovulatory cycles
    • Dut to Increased Prostaglandin F2α (PGF2α)
      • Increases Uterine Contractions
  • Secondary Type
    • Endometriosis (most common)
    • Adenomyosis
    • Leiomyomas
    • Cervical stenosis
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22
Q

Menorrhagia?

A

Regular normal intervals w/ excessive flow and duration

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23
Q

Hypomenorrhea?

A

Regular normal intervals w/ decreased amount of bleeding

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24
Q

Metrorrhagia?

A

Irregular intervals w/ excessiv flow and duration

Loss of blood > 80 mL per period

Excessive passage of Clots –> Plasmin does not have enought time to Dissolve clot

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25
Q

Menometrorrhagia?

A

Irregular or excessive bleeding during menstruation and between periods

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26
Q

Oligomenorrhea?

A

Menses at Intervals > 35 days

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27
Q

Polymenorrhea?

A

Menses at interval < 21 days

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28
Q
  • Overaggressive Dilation and Curettage (D&C)
  • -> Scrap away all the Uterine wall
  • -> Loss of the Basalis and Scarring
  • -> Secondary Amenorrhea
  • Basalis = regenerative layer of Stem cells
A

Asherman Syndrome

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29
Q
  • Lack of Ovulation w/ Uterine Bleeding
  • -> Estrogen-driven Proliferative phase w/out a subsequent Progesterone-driven Secretory phase
  • Estrogen Grow –> No Progesterone –> Estrogen Grow
  • -> Eventual overgrowth of the Blood supply
  • **Proliferative glands break down and shed
  • -> Uterine Bleeding**
  • Common cause of Dysfunctional Uterine Bleeding, especially during Menarch and Menopause
A

Anovulatory Cycle

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30
Q
  • Fever, Inflammation w/ Plasma cells and Lymphocytes
  • Abnormal Uterine Bleeding
  • Pelvic pain, Utherine tenderness
  • Purulent or Foul Vaginal Discharge
  • Bacterial infection of the Endometrium following Delivery or Miscarriage
  • Group B Streptococcus agalactiae
  • Group A Strep, S. aureus, Bacteroides, C. trachomatis, N. gonorrhoeae, E. coli
  • A/w Retained products of Conceptions
    • Products act as a Nidus for Infection
A

Acute Endometritis

Tx: Gentamicin + Clindamycin + Ampicillin

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31
Q
  • Abnormal Uterine Bleeding
  • Pain
  • Infertility
  • Chronic inflammation of the Endometrium
  • Lymphocytes and Plasma cells*
    • Lymphocytes normally found in the Endometrium
    • Plasma cells are necessary for Dx
  • A/w Retained products of conception, Chronic pelvic inflammatory disease (Chlamydia), IUD, and TB
A

Chronic Endometritis

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32
Q
  • Abnormal Uterine Bleeding
  • Menorrhagia (20 - 40 y.o.)
  • Hyperplastic protrusion of Endometrium
  • Benign Polyp that enlarges w/ Estrogen stimulation
  • Can protrude through the Cervix –> Vagina
  • A/w Tamoxifen
    • Anti-estrogenic effects on the Breast
    • Weak Pro-estrogenic effects on Endometrium
A

Endometrial Polyp

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33
Q
  • Dysmenorrhea (Pain during menstruation)
  • Abnormal bleeding, Premenstrual Spotting, Menorrhagia
  • Pelvic Pain, Painful stooling during menses
  • May cause infertility, Dyspareunia,
  • Blood-filled cysts, Englargment of Ovaries
  • Endometrial glands and Stroma outside of the Uterine endometrial lining
    • Retrograde menstruation w/ implantation at an Ectopic site
    • Metaplastic theory of Mullerian duct development
    • Lymphatic dessimination Theory
A

Endometriosis

Tx: Danazol, NSAIDs, OCPs, Progestins, GnRH agonists,

Sx: Bilateral Salpingo-oophorectomy

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34
Q

(5) Other sites of Endometriosis?

A
  • Uterine Ligaments (Pelvic pain)
  • Pouch of Douglas (Pain w/ Defecation)
  • Bladder wall (Pain w/ Urination)
  • Bowel Serosa (Abdominal Pain and Adhesion’s)
  • Fallopian Tube Mucosa (Scarring increases risk for Ectopic tubal pregnancy)
  • ‘Classically’ appear as Yellow-brown ‘Gun-powder’ nodules
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35
Q

Adenomyosis?

A
  • Uterine enlargment by 2x - 4x “Soft, Bulky, Uterus”
  • Menorrhagia, Dysmenorrhea, Pelvic pain
  • Invagination of the Stratum Basalis into Myometrium
  • Endometrial Glands and Stroma w/ Involvement of the Uterine Myometrium
  • Women mid to late 40’s
  • Tx: Hysterectomy
  • Extend from the Endometrium into the Myometrium
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36
Q
  • Anovulatory cycles, HRT, PCOS, Granulosa cell Tumor
  • Postmenopausal Uterine Bleeding
  • Hyperplasia of Endometrial glands relative to Stroma
  • Consequence of Unopposed Estrogen (excess)
    • Obesity*, DM2*, HTN*, Infertility*
  • *​–> Adenocarcinoma**
    • Polycystic Ovary Syndrome
    • Estrogen replacement w/out Progesterone
  • Achitecture Growth Pattern (Simple or Complex)
    • Cellular atypia: simple hyperplasia w/ atypia often progresses to cancer (30%)
    • Complex hyperplasia w/out atypia rarely (< 5%)
A

Endometrial Hyperplasia

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37
Q
  • 55 - 65 y.o.
  • Estrogen w/out Progestins
  • “HHONDA” - Hyperplasia, HTN, Obesity, Nullparity, DM, Anovulatory cycles
  • Postmeopausal Bleeding
  • Most common Invasive Carcinoma of the Female Genital Tract
  • Malignant proliferation of Endometrial glands
  • (2) Arises via two distinct pathways
    • Hyperplasia pathway (75%)
    • Sporadic pathway (25%)
A

Endometrial Carcinoma

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38
Q

Hyperplasia pathway of Endometrial Carcinoma?

A
  • 50 - 60 y.o.
  • Spreads down into the Endocervix
  • Spreads out of the Uterine wall
  • A/w Estrogen exposure (DONE-LATE)
    • Diabetes mellitus
    • Obesity
    • Nulliparity
    • Estrogen Replacement Therapy
    • Late menopause
    • Atypical endometrial Hyperplasia
    • Tamoxifen therapy for Breast Cancer
    • Early menarche
  • Endometroid on Histology
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39
Q

Sporadic pathway of Endometrial Carcinoma?

A
  • Arises from an Atrophic Endometrium w/ NO Evident precursor lesion
  • > 70 y.o.
  • Papillary structures w/ Psammoma body formation
  • Serous on Histology
  • p53 mutation is common
  • -> Finger like growths –> Psammoma bodies
  • Tumor exhibits Aggressive behavior
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40
Q
  • Usually asymptomatic, Cramping w/ Menses
  • Abnormal Uterine Bleeding, Menorrhagia
  • Infertility (Obstructive delivery)
  • Well-circumscribed ‘Gray-white’ Pelvic mass
  • Benign neoplastic Prolif., Smooth muscle arising from Myometrium - Monoclonal
  • Spindle-shaped cells w/ ‘Whorled bundles‘
  • Menometrorrhagia –> Iron def. Anemia
  • Estrogen exposure
    • Premenopausal women
    • Often multiple mass w/in the Uterine wall
    • Enlarge during Pregnany, Shrink during Menopause
A

Leiomyoma (Fibroids)

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41
Q
  • Numerous atypical Mitoses and Foci of Necrosis
  • Single lesion w/ Area of Necrosis and Hemorrhage
  • Postmenopausal women
  • Arisises de novo
  • Malignant proliferation of Smooth muscle arising from the Myometrium
  • Histological Features
    • Necrosis
    • Mitotic activity
    • Cellular atypia
A

Leiomyosarcoma

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42
Q

Ovarian Follicle functions?

A
  • The functional unit of the Ovary is the Follicle
  • Follicle = Oocyte surrounded Granulosa and Theca cells
  • LH –> Theca cells –> Androgen production
  • FSH –> stim. Granulosa cells –> convert Androgen to Estradiol (drives Proliferative phase of the Endometrial cycle)
  • Estradiol surge –> LH surge –> Ovulation (beginning of Secretory phase of the Endometrial cycle)
  • Residual Follicle –> Corpus Luteum –> Progesterone (drives Secratory phase –> prepares Endometrium for fertalized egg implantation)
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43
Q

Hemorrhage into a Corpus Luteum?

A

Results in a Hemorrhagic Corpus Luteal Cyst

Especially during pregnancy

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44
Q
  • Obese Young Woman w/ Infertility
  • Oligomenorrhea
  • Hirsuitism
  • Acanthosis nigricans
  • Insulin resistance –> may lead to DM2 (10-15 yrears later)
  • Hormone imbalance –> Multiple Ovarian Follicular cysts
  • ↑ LH and ↓ FSH –> LH:FSH > 2:1 (Imbalance)
  • LH –> excess Androgen (Theca cells) –> Hirsutism
  • Androgen –> Adipose tissue –> Estrone –> Negative feedback decreases FSH –> Cystic degeneration of Follicles
  • High Estrone –> Risk for Endometrial Carcinoma
A

Polycystic Ovarian Syndrome (PCOS)

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45
Q

(3) Cell Types of the Ovary?

A
  1. Surface Epithelium
  2. Germ Cells
  3. Sex Cord-stroma
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46
Q
  • Most common Ovarian Tumor (70%)
  • Derived from Coelomic epithelium (Lines the Ovary)
  • -> Produces Epithelial lining of the Fallopian Tube (serous cells), Endometrium and Endocervix (Mucinous cells)
  • -> Commonly Seed the Omentum
  • (4) Tumor Subtypes
    • Serous Tumors (Benign, Malignant, Borderline)
    • Mucinous Tumors (Benign, Malignant, Borderline)
    • Endometroid Tumor
    • Brenner Tumor
  • Present Late w/ Vague abdominal symptoms
  • CA-125 is a Serum marker for monitoring treatment
A

Surface Epithelial Tumors of Ovary

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47
Q

Tumors that are full of watery fluid?

A

Surface Epithelial Serous Tumor

Cysts are lined by ciliated cells, similar to Falloian tube

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48
Q

Tumor that are full of Mucus-like fluid?

A

Surface Epithelial Mucinous tumor

Lined by Mucus-secreting cells (like the Endocervix)

Seeding my produce Pseudomyxoma peritonei
(Mucinous tumors of the Appendix)

May be a/w Brenner tumor

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49
Q
  • Benign tumors are composed of a Single cyst w/ a Simple, Flat-Lining
  • Most commonly arise in Premenopausal women
  • *(30 - 40 y.o.)**
A

Cystadenomas - Benign Surface Epithelial Tumors

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50
Q
  • Malignant tumors composed of Complex cysts w/ Thick, Shaggy lining
  • Postmenopausal women (60-70 y.o.)
A

Cystadenocarcinomas - Malignant Surface Epithelial Tumors

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51
Q
  • Tumor w/ Features between Benign and Malignant
  • Better prognosis than Clearly Malignant tumors
  • Still carries Metastatic potential
A

Borderline - Surface Epithelial Tumors

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52
Q

Pts. w/ BRCA1 mutation?

A
  • Increased risk for Serous Carcinoma
  • Ovary
  • Fallopian tube
  • Often elect to have Prophylactic Salpingo-oophorectomy and Prophylactic Mastecomy due to increased risk of Cancer
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53
Q
  • Endometrial-like glands of Surface Epithelial
  • Usually Malignant a/w Edometrial carcinoma
  • May arise from Endometriosis
  • Commonly Bilateral
A

Endometrioid Tumor

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54
Q
  • Solid Tumor composed of Bladder-like Epithelium
  • “Pale Yellow-tan” in color
  • Appears Encapsulated
  • “Coffee Bean” nuclei on H&E stain
  • Usually Benign (Urothelium cells)
  • Contain Walthard cell rests (Transitional-like epithelium)
A

Brenner Tumors

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55
Q
  • Tumor in Woman of Reproductive age (15 - 30 y.o.)
  • 2nd most common type of Ovarian Tumor
  • Subtypes mimic tissues
    • Fetal Tissue –> Cystic Teratoma and Embryonal Carcinoma
    • Oocytes –> Dysgerminoma
    • Yolk sac –> Endodermal Sinus Tumor
    • Placental Tissue –> Choriocarcinoma
A

Germ Cell Tumors

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56
Q
  • Fetal tissue Tumor –> derived from 2 or 3 Embryologic layer
  • Skin, Hair, Bone, Cartilage, Gut, and Thyroid tissues
  • Most common germ cell tumor
  • 10% Bilateral
  • Benign, but presence of Immature Tissue or Somatic malignancy
  • Rokitansky tubercle - found in nipple-like structure in the cyst wall
A

Cystic Teratoma - Germ Cell Tumor

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57
Q

Cystic Teratoma Germ Cell tumor
comprised primarily of Thyroid tissue?

A

Struma Ovarii

Takes up Radioactive Iodine-123

58
Q
  • Tumor composed of Large cells w/ Clear cytoplasm and Central nuclei (resemble oocytes)
  • Sheets of uniform “Fried egg” cells
  • Serum hCG and LDH may be elevated
  • Most common malignant Germ cell tumor
  • A/w Streak glands** of **Turner syndrome
  • Testicular counterpart is called a Seminoma
  • A/w Turner Syndrome
  • Good Prognosis
  • Responds to Radiotherapy
A

Dysgerminoma - Germ Cell Tumor

59
Q
  • Tumor that mimics the Yolk sac
  • Yellow, Friable (hemorrhagic), Solid mass
  • Most common Germ cell tumor in Children
  • Elevated Serum AFP
  • Aggressive - Ovaries (Females) or Testes (Males) and Sacrococcygeal area in young Children
  • 50% have Schiller-Duval bodies (glomerulus-like structures) are classically seen on Histology
  • “Glomeruloid-like“
A

Endometrial Sinus Tumor - Germ Cell Tumor

(Yolk sac Tumor)

60
Q
  • Malignant Tumor –> Cytotrophoblasts and Syncytiotrophoblasts (Trophoblastic Tissue)
  • Mimics Placental Tissue, and NO Chorionic Villi
  • Small
  • Hemorrhagic Tumor
  • Hematogenous Spread
  • β-hCG produced by **Syncytiotrophoblasts
  • -> Theca-lutein cystsin theOvary**
  • Good response to Chemotherapy (Methorexate)
A

Choriocarcinoma - Germ Cell Tumor

61
Q
  • Malignant tumor of Large Prmitive cells
  • Aggressive
  • Early metastasis
A

Embryonal Carcinoma - Germ Cell Tumor

62
Q
  • **Estrogen Excess –> Feminizing Tumor
  • -> Call-Exner bodies (resemble Primordial follicles)**
  • Produces BOTH Estrogen and Progesterone
  • Breast tenderness
  • Prior to puberty - Precocious Puberty
  • Reproductive age - Menorrhagia or Metrorrhagia
  • Postmenopause (most common) - Endometrial Hyperplasia w/ Postmenopausal Uterine bleeding
  • Neoplastic proliferation of Graunlosa and Theca cells
  • Low-grade Malignant (minimal risk of metastasis)
A

Granulosa - Theca Cell Tumor - Sex Cord-stromal Tumor

(Thecoma)

63
Q
  • Angrogen production Tumor –> Masculinizing tumor
  • -> Hirsutism and Virilization
  • Sertoli cells –> Form Tubules
  • Leydig cells (between tubules) w/ Reinke crystals
  • A/w Peutz-Jeghers Syndrome
A

Sertoli-Leydig Cell Tumor - Sex Cord-stromal Tumor

64
Q
  • Tumor of Bundles of Spindle-shaped Fibroblasts
  • A/w Pleural Effusions and Ascites (Meigs syndrome)
    • ​Meigs Syndrome (Triad)
      • Ovarian fibroma
      • Ascites
      • Hydrothorax
  • ​Right-sided pleural effusion
  • Commonly calcify - “Pulling Sensation in Groin“
  • Resolves w/ removal of Tumor
A

Fibroma - Sex Cord-stromal Tumor

65
Q

(3) Sex Cord-Stromal Tumors?

A
  1. Granulosa - Theca Cell Tumor
  2. Sertoli-Leydig Cell Tumor
  3. Fibroma
66
Q
  • Metastatic Mucinous Tumor involves both Ovaries
  • Mucin-secreting Signet ring cells from Hematogenous spread of Adenocarcinoma
  • Outside Ovaries that spreads to the Ovaries
    • Intestinal cancer–> Ovaries
    • Breast cancer –> Ovaries (Lobular carcinoma)
    • Colon cancer –> Ovaries
  • A/w Metastatic Gastric Carcinoma (Diffuse type)
  • Bilaterally helps to distinguis metastases from Primary Mucinous Carcinoma of Ovary (Unilateral)
A

Krukenberg Tumor

67
Q
  • Massive amounts of Mucus in the Peritoneum
  • “Jelly-Belly”
  • Due to Mucinous Tumor of the Appendix
    • ​Appendiceal Tumor
    • Ovarian Tumor
  • Usually w/ Metastasis to the Ovary
A

Pseudomyxoma Peritonei

(Mucinous Cystadenocarcinoma)

68
Q
  • Lower Quadrant Abdominal Pain after a Missed Period
  • ~6 weeks after Previous Menses
  • Fertilized ovum at other than Uterine wall –> β-hCG*
  • Peritoneal signs (Rebound tenderness > 70%)
  • Lumen of the Fallopian Tube - Abnormal Bleeding
  • Chronic Salpingitis (may be caused by gonorrhea)
  • Intrauterine Tumors
  • Endometriosis
  • 1st: Scarring
  • 2nd: Pelvic Inflammatory Disease or Endometriosis
A

Ectopic Pregnancy

Tx: Methotrexate

69
Q
  • Miscarriage < 20 weeks Gestation (1/4 pregnancies)
  • A/w Chromosomal anomalies (Trisomy 16)
  • Hypercoagulable states (Antiphospholid Syndrome)
  • Congenital infection
A

Spontaneous Abortion

70
Q

Effects of Teratogens on Embryogenesis?

A
  • Exposure to Teratogens (< 2 weeks Embryogenesis)
  • 1 - 2 weeks –> Spontaneous Abortion
  • 3 - 8 weeks –> Risk of Organ Malformation
  • Months 3 - 9 –> Risk of Organ Hypoplasia
71
Q
  • 3rd Timester Bleeding - Painless
  • Requires delivery of Fetus by Caesarian section
    • Compression of the Placenta during birth can result in Fetal Distress
  • Implantation of the Placenta –> Lower Uterine Segment
  • Placenta overlies Cervical Os
A

Placenta Previa

Marginal (Lies near)

Partial (Partially covers)

Complete (Covers Cervical Os)

Vasa Previa - Fetal blood vessels covering the Cervix - can result in Fetal Blood loss and Death w/in minutes

72
Q
  • 3rd Trimester Bleeding and Fetal Insufficiency
    • ​Painful bleeding, Inflammation, Contractions
  • Seperation of Placenta from the Decidua prior to Delivery –> Still Birth
    • HTN
    • Smoking
    • Cocaine
    • Advanced maternal Age
    • Trauma, MVA, Chorioamnionitis
    • Premature Rupture
  • Dx: Kleihauer-Betke Test - Fetal RBCs w/in Mom’s Blood
A

Placenta Abruption

73
Q
  • Improper implantation of Placenta into the Myometrium
  • Little or No Intervening Decidua
  • Difficult Delivery of the Placenta
  • Postpartum Bleeding –> Massive –> Life-threatening
  • Often Requires Hysterectomy
A

Placenta Accreta (attaches strongly to the myometrium, but does not penetrate it)

Placenta Increta (invade into the myometrium)

Placenta Percreta (invade through the myometrium) –> can result in placental attachement to the Rectum or Bladder

74
Q

Teratogenic effects of Alcohol?

A
  • Most common cause of Mental Retardation
  • Leads to Facial abnormalities
  • Microcephaly
  • Fetal Alcohol Syndrome
75
Q

Teratogenic effects of Cocaine?

A
  • Intrauterine growth retardation (IUGR)
  • Abnormal fetal growth and Fetal addiction
  • Placental abruption
76
Q

Teratogenic effects of Thalidomide?

A
  • Limb Defects
    • Phocomelia - underdeveloped limbs
    • Micromelia - “flipper” limbs
  • Tha-limb-domide
77
Q

Teratogenic effects of Cigarette smoke?

A
  • Intrauterine growth retardation (IUGR)
  • Low Birth Weight
  • Preterm labor
  • Placental problems
  • ADHD
78
Q

Teratogenic effects of Isotretinoin?

(Accutane)

A
  • Spontaneous abortion
  • Hearing and Vision Impairment
79
Q

Teratogenic effects of Tetracycline?

A
  • Discolored teeth - “Teethracyclines”
80
Q

Teratogenic effects of Warfarin?

A
  • Fetal Bleeding and Hemorrhage
  • Bone deformities
  • Abortion
  • Ophthalmologic abnormalities
  • DO NOT wage Warfare on the baby; keep it Heppy w/ Heparin (does not cross the placenta)
81
Q

Teratogenic effects of Phenytoin?

A
  • Digit Hypoplasia
  • Fetal Hydantoin syndrome: Microcephaly, Dysmorphic craniofacial features, Hypoplastic nails and Distal phalanges, Cardiac defects, IUGR, Intelectual disability
  • Cleft Lip / Palate
82
Q
  • Pregnancy-induced Hypertension (Severe)
    • Headaches, Visual abnormalities (Scotoma), Chronic HTN, Oliguria (small amount of Urine)
  • After 20th week of Pregnancy
  • HTN > 140/90 mmHg
  • Proteinuria > 300 mg/24 hours after 20th week to 6 weeks Postpartum
  • Edema - Loss of Albumin in Urine
  • Weight gain > 4 lbs/wk
  • Renal Disease / Liver Disease (↑ AST / ↑ ALT)
  • Abnormalitiy of Maternal-Fetal Vascular Interface in the Placenta
    • Resolves w/ Delivery and Drug Tx?
A

Preeclampsia

  • IV Magnesium Sulfate to Prevent Seizure
  • Anti-hypertensives
    • α-methyldopa
    • Labetalol
    • Hydralazine
    • Nifedipine
83
Q

Eclampsia?

A

Preeclampsia + Seizures

  • IV Magnesium Sulfate to Prevent Seizure
  • Anti-hypertensives
    • α-methyldopa
    • Labetalol
    • Hydralazine
    • Nifedipine
84
Q

HELLP?

A
  • HELLP is Severe Preeclampsia w/ Thrombotic Microangiopathy Involving the Liver
  • **Microthrombi –> Schistocytes –> Anemia
  • -> Coagulation cascade –> Liver enzymes**
  • Tx: Immediate Delivery
  • Hemolysis
  • Elevated
  • Liver enzymes
  • Low
  • Platelets
85
Q
  • Death of a Healthy Infant
  • *1 Month to 1 year Old**
  • *w/out Obvious cause**
  • Sleeping on Stomach
  • Exposure to Cigarette smoke
  • Prematurity
A

Sudden Infant Death Syndrome (SIDS)

86
Q
  • Swollen and Edematous Villi w/ Proliferation of Trophoblastic Tumors (Chorionic villus) –> hCG
  • -> Abnormal conception
  • Ovum lacks Maternal Chom. / All Paternally derived
  • Uterus expansion –> much larger
  • β-hCG much higher than expected
  • 2nd Trimester w/ “Grape-like masses” through Vagina
  • Fetal Heart sounds absent
  • ‘Snowstorm’ appearnce on Ultrasound
  • Tx: D&C and Methotrexate
  • β-hCG monitoring for ensuring adequte mole removal
A

Hydatidiform Mole

87
Q
  • Genetics:
    • Normal ovum fertalize by 2 sperm –> 69 Chromo.
    • Chrom. 69 XXY 70%, Chrom. 69 XXX 27%
  • Fetal Tissue:
    • Present - Fetal parts are present on Imagining
  • Villous Edema:
    • Some vili are Hydropic, Some are Norma
  • Trophoblastic Proliferation:
    • Focal proliferation present around Hydropic vili
  • Risk for Choriocarcinoma
    • Minimal
A

Partial Mole

88
Q
  • Genetics:
    • Empty ovum fertalized by two sperm that duplicates –> 46 chromosomes
  • Fetal Tissue:
    • Absent
  • Villous Edema:
    • Most vili are Hydropic
  • Trophoblastic Proliferation:
    • Diffuse, Circumferential proliferation around Hydropic vili
    • “Honeycombed Uterus” or “Clusters of Grapes”
    • “Snowstorm”
  • Risk for Choriocarcinoma
    • 2% - 3% Choriocarcinoma risk
    • 15 - 20% Malignant Trophoblastic Disease - Worse
A

Complete Mole

89
Q
  • Benign Tumor of the Apocrine Sweat Gland
  • Painful nodule on the Labia Majora
A

Papillary Hidradenoma

90
Q
  • Vulvar Dysplasia
  • Mild to Carcinoma in-situ (CIS)
  • Strong a/w HPV 16
  • Precursor –> SCC
A

Vulvar Intraepithelial Neoplasia (VIN)

91
Q
  • Vagina and Uterus are Underdeveloped or Absent
  • Ovaries are usually present and functional
  • Primary Amenorrhea
  • Genetic and Environmental factors
  • Autosomal dominant
A

Rokitansky-Kuster-Hauser (RKH) Syndrome

92
Q
  • Cyst on the Lateral wall of the Vagina
  • Remnant of the Wolffian duct (Mesonephric)
A

Gartner Duct Cyst

93
Q
  • Vaginal discharge
  • Pelvic pain, Dyspareunia
  • Painful on palpation
  • Bleeds easily when obtaining cultures
  • Cervical Os is Erythematous, Covered in Exudate
  • Acute Inflammation in the Transformation Zone
  • Chlamydia, N. gonorrhoeae, Trichomonas, Candida,
    HSV-2, HPV
A

Acute Cervicitis

94
Q
  • Chronic Vaginal Discharge
  • Chronic Pelvic Pain, Dyspareunia
  • Pain on Palpation
  • Bleeds easily on Obtaining Cultures
  • Cervical Os is Erythematous, Covered in Exudate
A

Chronic Cervicitis

95
Q
  • Pronounced Lympoid infiltrate w/ Germinal centers
  • Vertical transmission of Infection to Newborn
  • -> Contact w/ Infected Cervix during Delivery
  • C. trachomatis infects Metaplastic Squamous cells
  • Phagosomes (Vacuoles) w/ Inclusions (Reticulate bodies)
  • Reticulate bodies divide into Elementary bodies
  • -> Infective particles of Chlamydia
A

Follicular Cervicitis

96
Q

(9) Causes of Hirsutism and Virilization?

A
  1. Polycystic Ovary Syndrome (PCOS)
  2. Idopathic
  3. Adrenogenital syndrome (congenital adrenal hyperplasia)
  4. Insulin resistance syndrome
  5. Drugs: Androgenic progestins, Phenytoin, Cyclosporin
  6. Ovarian Tumor: Leydic tumor, Sertoli-Leydig tumor
  7. Adrenal Tumor: Adenoma –> Cushing syndrome
  8. Obesity –> decreases SHBG –> increases Testosterone
  9. Hypothyroidism
97
Q

Amenorrhea?

A

Absence of Menses by 16 years of age

Family history of a delayed onset of mense

98
Q

Secondary Amenorrhea?

A

Absence of Menses for > 6 months in a Pt. who has had Normal menstrual cycles

Most cases are due to Pregnancy

99
Q
  • Cysts around the Fimbriated end of the Fallopian Tube
  • May undergo Torsion (> 25%) –> Abdominal pain
  • Cystic Mullerian Remnants
A

Hydatid Cysts of Morgagni

100
Q
  • Uterine bleeding, Vaginal discharge
  • Fever > 38.3 C (101 F)
  • Lower Abdominal pain (RUQ Pain 5%)
    • Perihepatitis (Fitz-Hughs-Curtis Syndrome)
  • Pain w/ Cervical motion, Palpation of Adnexa and Uterus
  • Mucopurulent discharge in Cervical Os
    • Fallopian tubes filled w/ Pus
    • Hydrosalpinx
  • N. gonorrhoeae and C. trachomatis
  • Other non-STD pathogens.
A

Pelvic Inflammatory Disease (PID)

101
Q
  • Fallopian Tubal Diverticulosis
  • Nodules in the Fallopian Tube that narrow the Lumen
  • Beading appearance in areas of Constriction
  • Postinfectious reaction
  • Infertility, Ectopic pregnancy
A

Salpingitis Isthmica Nodosa (SIN)

102
Q
  • Involuntary contraction of the muscles of the Pelvic floor
  • Pain and prevents Vaginal penetration, Sexual intercourse, and insertion of a Speculum
A

Vaginismus

103
Q
  • PID w/ RUQ tenderness
  • -> Perihepatitis (Infection of the Liver capsule) from Bacterial transmigration across the Peritoneum
A

Fitz-Hugh-Curtis Syndrome

104
Q

Teratogenic effects of ACE inhibitors?

A
  • Renal damage
105
Q

Teratogenic effects of Alkylating Agents?

A
  • Absence of Digits
  • Multiple anomalies
106
Q

Teratogenic effects of Aminoglycosides?

(-mycin)

A
  • CN VIII toxicity
  • A mean guy hit the Baby in the Ear.
107
Q

Teratogenic effects of Carbamazepine?

A
  • Neural tube defects
  • Craniofacial defects
  • Fingernail Hypoplasia
  • Developmental delay
  • IUGR (Intrauterine Growth Restriction)
108
Q

Teratogenic effects of DES (Diethylstilbestrol)?

A
  • Vaginal Clear Cell Adenocarcinoma
  • Congenital Mullerian anomalies
109
Q

Teratogenic effects of Folate antagonists?

A
  • Neural Tube defects
  • Methotrexate (ectopic pregnancies)
  • Anti-malarials
  • Anti-protozoals
110
Q

Teratogenic effects of Lithium?

A
  • Ebstein anomaly
  • (Atrialized Right Ventricle)
111
Q

Teratogenic effects of Methimazole?

A
  • Aplasia Cutis Congenita
  • “Congenital absence of skin”
  • Small to Large areas
112
Q

Teratogenic effects of Valproate?

A
  • Inhibition of Maternal Folate absorption
  • -> Neural tube defects
  • Valproate inhibits Folate absorption
113
Q

Teratogenic effects of Iodine?

A
  • Congenital Goiter or Hypothyroidism (Cretinism)
114
Q

Teratogenic effects of Maternal Diabetes?

A
  • Caudal Regression Syndrome (Anal atresia (not present or wrong location)
  • Sirenomelia (Fusion of legs))
  • Congenital Heart Defects
  • Neural Tube Defects
115
Q

Teratogenic effects of Vitamin A (excess)?

A
  • Spontaneous Abortions
  • Birth defects
  • Cleft palate
  • Cardiac Abnormalities
116
Q

Teratogenic effects of X-rays?

A
  • Microcephaly
  • Intelectual disability
117
Q

(3) Failure of the Urachus to Obliterate?

A
  1. Patent Urachus - Urine discharge from Umbilicus
  2. Urachal cyst - Partial failure of Urachus to Obliterate
    • Fluid-filled cavity lined w/ Uropithelium, Between Umbilicus and Bladder
    • Can lead to Infection
    • Adenocarcinoma
  3. Vesicourachal diverticulum - Outpouching of bladder
118
Q

(2) Failure of Vitelline duct to close results in?

A
  1. Vitelline Fistulla - Meconium discharge from Umbilicus
  2. Meckel diverticulum - Partial closure w/ Patent portion attached to Ileum (True Diverticulum)
    • May have Ectopic Gastric Mucosa and/or Pancreatic Tissue
      - -> Melena (dark sticky feces containing digested blood), Periumbilical Pain, and Ulcers
119
Q
  • Tall, Long extremities w/ Gynecomastia and Female Hair distribution
  • Reduced Androgens –> Developmental Delay
  • Testicular atrophy w/ Eunuchoid Body shape
  • Presence of Inactivated X Chromosome (Barr Body)
    • ​47: XXY
  • Hypogonadism –> Infertility work-up​
  • Dysgenesis of Seminiferous Tubules –> Decreased Inhibin –> Increased FSH
  • Abnormal Leydig cell function –>Decreased Testosterone –> Increased LH –> Increased Estrogen
A

Klinefelter Syndrome

120
Q
  • Short stature, Normal pubic hair, No Breasts, Amenorrhea
  • High LH and HIgh FSH
  • Narrow, High Arched Palate, Low Set Earys, Low Hairline
  • Webbed Neck
  • Broad Chest w/ widely spaced Nipples
  • Horseshoe Kidney
  • Pre-ductal Coarcation of Aorta / Bicuspid Aortic valve
  • Cubitus Valgus
  • Streak ovaries, Amenorrhea and Infertility
  • Lack of Paternal X Chromosomes –> Loss of Ovarian follicles by Age 2
  • Monosomy (45, X0) or Mosaicism (45, XO/46,XX)
A

Turner Syndrome

121
Q
  • Very Tall
  • Severe Acne
  • Antisocial behavior
  • Normal Fertility
  • Autism specrtum disorders (Criminals)
A

Double (XYY) Males

122
Q
  • Both Ovary and Testicular Tissue is present
  • Ovotestis
  • It can be caused by the division of one Ovum, followed by fertilization of each haploid ovum and fusion of the two zygotes early in development.
  • Ambiguous genitalia
  • Very Rare
A

True Hermaphroditism

(46,XX or 47,XXY)

123
Q
  • Ovaries present
  • External genitalia are Virilized or Ambiguous
  • Excessive / Inappropriate exposure to Androgenic steroids during early gestation
    • Congenital Adrenal Hyperplasia
    • Exogenous administration of Adrogens during pregnancy
A

Female Pseudohermaphrodite (XX)

124
Q
  • Testes present
  • External Genitalia are Female or Ambiguous
  • Androgen Insensitivity syndrome (Testicular feminization)
A

Male Pseudohermaphrodite (XY)

125
Q
  • Inability to Synthesize:
    Androgens –> into –> Estrogens
  • Masculilinization of Female Infants (46, XX)
    –> Ambiguous Genitalia
  • Increased Serum Testosterone and Androstendione
  • Fetal Angrogens cross the Placenta
    –> Maternal virilization during Pregnancy
A

Aromatase Deficiency

126
Q
  • **Female External Genitalia appears normal
  • -> Rudimentary vagina**
  • -> Uterus and Fallopian tubes generally **absent
  • ->**Does Not develop Paramesonephric ducts
  • Scant Sexual hair
  • Develops Testes (w/in Labia Majora, Sx removed)
  • Defect in Androgen receptor
  • -> Normal appearing Female
  • Increased Testosterone
  • Increased Estrogen
  • Increased LH
A

Androgen Insensitivity Syndrome (46, XY)

127
Q
  • Ambiguous genitalia until puberty
  • -> Increased Testosterone –> Masculinization
  • -> Growth of External genitalia
  • Inability Testosterone –> DHT
  • Autosomal recessive
  • Sex limited to genetic males (46, XY)
  • Testosterone / Estrogen lvls are Normal
  • LH normal or Increased
  • Internal genitalia are Normal
A

5α-reductase Deficiency

128
Q
  • Low Sperm count in Males
  • Amenorrhea in Females
  • Failure to complete Puberty
  • -> Hypogonadotropic Hypogonadism
  • Defective migration of GnRH cells
  • -> Lack of Formation of Olfactory bulb
  • -> Decreased syn. of GnRH in Hypothalamus
  • Anosmia (inability to percieve odor)
  • Decreased GnRH, FSH, LH, Testosterone, Infertility
A

Kallmann Syndrome

129
Q
  • BP > 140/90 mmHg after the 20th week of Gestation
  • No pre-existing HTN
  • No Proteinuria
  • No End-organ damage

What is it and what drugs are appropriate for Tx?

A

Gestational HTN

(Pregnancy Induced HTN)

  • Anti-hypertensives
    • α-methyldopa
    • Labetalol
    • Hydralazine
    • Nifedipine
130
Q
  • > 1.5 - 2 Liters of Amniotic Fluid
  • A/w Fetal malformations –> Inability to swallow fluid
    • Maternal diabetes
    • Fetal anemia
    • Multiple gestations
    • Esophageal atresia
    • Duodenal atresia
    • Anencephaly
A

Polyhydramnios

131
Q
  • < 0.5 L of Amniotic fluid
  • A/w Placental insufficiency
    • Bilateral Renal agenesis
    • Posterior Urethral valves (in males)
  • -> Inability to secrete Urine
  • Can cause Potter sequence
A

Oligohydramnios

  • Potter Sequence
    • ​Oligohydramnios
    • Limb and Facial deformaties
    • Pulmonary Hypoplasia
132
Q
  • Distention of Unruptured Graafian Follicle
  • A/w Hyperestrogenism and Endometrial Hyperplasia
  • Most common Ovarian mass in Young women
A

Follicular Cyst

133
Q
  • Hemorrhage into persistent Corpus Luteum
  • Regresses Spontaneously
A

Corpus Luteum Cyst

134
Q
  • Gonadotropin stimulation –> Bilateral/Multiple
  • -> Luteinization and Hypertrophy of Theca Interna layer of Ovary
  • Increased LH
  • Increased β-hCG
  • A/w Choriocarcinoma and Moles
A

Theca-lutein Cyst

135
Q
  • Cystic growths filled w/ various types of Tissue
    • Fat, Hair, Teeth, Bits of Bone, Cartilage
  • Mature Teratoma
A

Dermoid Cyst

136
Q
  • Endometriosis w/in the Ovary w/ Cyst Formation
  • Varies w/ Menstrual cycle
  • Filled w/ Dark, Reddish-brown Blood
A

Chocolate Cyst

137
Q
  • Thin-walled, Uni- or Multi- Locular
  • Lined w/ Fallopian-like Epithelium (Ciliated!)
  • Often Bilateral
A

Serous Cystadenoma

138
Q
  • Multiloculated, Large, Unilateral cyst lined by Mucus-secreting epithelium
  • Looks similar to Intestines.
A

Mucinous Cystadenoma

139
Q
  • Mass arising from growth of Ectopic Endometrial Tissue
  • Presents w/ Pelvic pain, Dysmenorrhea, Dyspareunia
A

Endometrioma

140
Q
  • Aggressive
  • Contains Fetal tissue
  • Neuroectoderm
  • Immature / Embryonic-like Neural Tissue
  • Mature Teratoma are more likely to contain Thyroid Tissue
A

Immature Teratoma

141
Q

Teratogenic effects of Fluoroquinolones?

A

Cartilage Damage

142
Q

Teratogenic effects of Chloramphenicol?

A

Gray Baby Syndrome

(Ash color, Low Tone)

Pathology (36 decks)

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