Repro Path Flashcards
Male Testicular atrophy Eunechoid body shape Gynecomastia Female Hair distribution
Klinefelter’s Syndrome
Klinefelter’s Syndrome Genotype
XXY
Barr body present
Hormonal effect of dysgenesis of seminiferous tubules in Klinefelter’s
Decreased inhibin –> decreased FSH
Hormonal effect of abnormal Leydig Cells in Klinefelter’s
increased LH –> increased Estrogen
Most common cause of 1º amenorrhea
Turner Syndrome
Turner Syndrome genotype
XO
No Barr Body
Short stature Ovarian dysgenesis shield chest defects in lymphatics --> webbed neck Lymphedema in hands and feet
Turner Syndrome
XO
Congenital defects associated with Turner Syndrome
Preductal Coarctation of Aorta
Horseshoe Kidney
Dysgerminoma
Hormone levels seen in Turner syndrome
Decreased Estrogen –> increased LH/FSH
Defective androgen receptor hormone levels
Increased T & LH
Testosterone secreting tumor or exogenous steroids hormone levels
increased T
Decreased LH
1º Hypogonadism hormone levels
Decreased T
Increased LH
Hypogonadotropic hypogonadism hormone levels
Decreased T and LH
Disagreement between phenotypic (external genitalia) and gonadal (testes/ovaries) sex
Pseudo-Hermaphoroditism
Female Pseudo-Hermaphoroditism (46 XX)
Ovaries but virulized/ambiguous genitalia
Exposure to androgens in utero
Male Pseudo-Hermaphoroditism (46 XY)
Testes present but female/ambiguous genitalia
Androgen insensitivity–most common cause
True Hermaphoroditism (46 XX or 47 XXY)
Both ovary and Testes
ambiguous genitailia
Rare
Increased E, T, and LH
Defect in Androgen Receptor
Genotypically male but Phenotypically female
Rudimentary vagina and no internal sex organs
Testes present in Labia
Androgen Insensitivity Syndrome
46 XY
Why do testicles need to be removed from labia in androgen insensitivity syndrome?
Prevent Malignancy
Male with ambiguous genitalia until puberty
Inability to convert T –> DHT
Autosomal Recessive
5alpha-reductase deficiency
Anosmia
Decreased Synthesis of GnRH
Decreased FSH, LH, T, and sperm count
Kallmann Syndrome
What causes Kallmann syndrome
failure of migration of GnRH cell and formation of olfactory bulb
Female presents with uterine bleeding, increased hCG, honeycomb uterus, and no fetus.
Hydatidiform Mole
Hydatidiform Mole is most common precursor of
Choriocarcinoma
Complete Hydatidiform Mole
VERY HIGH hCG 46 XX or XY Increased Uterine size Choriocarcinoma risk 2 sperm in empty egg
Partial Hydatiform Mole
69 XXX, XXY, XYY increased hCG (not as much as complete) normal uterus size 2 sperm 1 egg Composed of fetal parts RARELY becomes choriocarcinoma
Triad of preeclampsia
Edema
HTN
Proteinuria
Eclampsia
edema
HTN
Proteinuria
SEIZURES
HELLP Syndrome
Hemolysis
Elevated LV enzymes
Low Plts.
COD of pre-eclampsia
cerebral hemorrhage
ARDS
What causes pre-eclampsia?
placental ischemia due to compressed spiral aa. –> increased vascular tone
Tx for pre-eclmapsia
Delivery ASAP
Seizure Tx/prophylaxis during pregnancy (eclampsia)
Mg Sulfate
Watch for hyporeflexia
Painful bleeding in 3rd trimester
smoking, coke head mom
Hx of HTN
Abruptio placentae
detachment of placenta
Placenta accreta
Defective decidual layer allows placenta to attach to myometrium
Massive bleeding AFTER delivery
Increased risk of placenta accreta
prior C-section
inflammation
placenta previa
PAINLESS bleeding anytime during pregnancy
Placenta attached in lower part of Uterus
Near or over Os
Placenta previa
Retained placental tissue problems
post partum hemorrhage
infxn
Female presents with amenorrhea, RLQ pain, elevated hCG.
Endometrial Bx shows decidual endometrium but no chorionic villi
Ectopic pregnancy
Test of choice to Dx ectopic preg
ultrasound
Most common site for ectopic preg
fallopian tubes
Virus and genes associated with cervical CA
HPV 16–E6 inh. p53
HPV 18–E7 inh RB suppressor gene
complcation of invasive cervical CA
renal failure due to blocked ureters
Invasive cervical CA is usually what type of cell?
Squamous Cell CA
Inflammation of endometrium due to retained products of conception or foreign body (IUD)
Endometritis
Endometritis Tx
Gentamyxin + clindamycin
w/ or w/o ampicillin
Cyclic pelvic pain with menses--severe cyclic bleeding painful intercourse infertility Endometial tissue outside of uterus
Endometriosis
Non-neoplastic
Endometrium within myometrium
Adenomyosis
Endometrial CA precurser
Endometrial Hyperplasia
What causes endometrial hyperplasia?
excess estrogen stimulation
Most common gyn malignancy
Endometrial CA
Endometrial CA presentation
most menopausal bleeding
Most common tumor in females
Leiomyoma (fibroids)
Benign smooth mm. tumor Whorled pattern Age 20-40 Located in myometrium Black woman with anemia/vag bleeding
Leiomyoma (fibroids)
Bulky irregularly shaped tumor with areas of necrosis and hemorrhage in the uterus
black middle aged female
Leiomyosarcoma
Leiomyosarcoma arise from
de novo!!!!
Not from leiomyoma
Most common GYN tumor locations
endometrial > ovarian > cervical (US)
Cervical worldwide
GYN tumor locations with worst prognosis
Ovarian > cervical > endometrial
Menopause before 40
Low E,
High LH, FSH
atresia of ovarian follicles
Premature ovarian failure
Amenorrhea infertility (anovulation) obesity hirsutism Bilaterally enlarged ovaries NO PROGESTERONE High LH
Polycystic Ovarian Syndrome
why is there anovulation with Polycystic Ovarian Syndrome?
Increased LH –> anovulation –> NO PROGESTERONE
Why is there an increased risk of endometrial CA with Polycystic Ovarian Syndrome?
Incresaed E due to aromatization of T in FAT CELLS with NO PROGESTERONE opposition
Polycystic Ovarian Syndrome Tx
Weight loss OCP Spironolactone clomiphene (pregnancy desire) metformin
Distention of unruptured graafian follicle
Follicular cyst
Hemorrhage into persistent corpus luteum
Corpus luteum cyst
Bilater and multiple cysts
Gonadotropin stimulated
associated with chorio-CA and moles
Theca-Lutein cyst
Blood vessel rupture in cyst wall
Grows with blood retention
Hemorrhagic Cyst
Mature Teratoma
fat, hair, teeth, cartilage, bone
Dermoid Cyst
Endometriosis within ovary and cyst formation
blood accumulate–dark brown color
Endometrioid cyst
Chocolate Cyst
Malignant tumor in females
Sheets of uniform cells
Turner Syndrome
hCG and LDH markers
Dysgerminoma
Tumor that presents with hyperthyroidsim due to functional thyroid tissue in ovary
Struma ovarii
Most common ovarian germ cell tumor
benign
Mature teratoma
2-3 germ layers
Aggressively malignant ovarian germ cell tumor
Immature tertoma
Schiller Duvall bodies
yellow, friable, solid mass on ovary (testes)
Elevated AFP
Yolk Sac tumor
endodermal sinus tumor
Increased hCG
Malignant ovarian tumor of Trophoblastic tissue
No chorionic villi
Occurs during/after preg in mom or baby
Choriocarcinoma
increased frequency of choriocarcinoma with
theca-lutein cysts
How does choriocarcinoma spread?
Hematogenously to lungs
These 2 tumors account for 90% of ovarian tumors
Serous Cystadenoma (45%) Serous Cystadenocarcinoma (45%)
Bilateral benign ovarian tumor lined with fallopian tube-like epithelium
Serous Cystadenoma
malignant bilateral ovarian tumor
Psammoma bodies
Serous cystadenocarcinoma
Serous cystadenoma tumor marker for prognosis
CA-125
not for screening
Serous cystadenocarcinoma
BRCA-1
BRCA-2
HNPCC
Multilocular cyst line by mucus secreting epithelium
benign intestine like tissue on ovary
Mucinous Cystadenoma
Malignant mucus secreting ovarian tumor
causes pseudomyxoma peritonei
Mucinous cystadenocarcinoma
pseudomyxoma peritonei
intrapericoneal accumulatoin (acites) of thick mucinous material from ovarian or appendiceal tumors
mucinous adenocarcinoma
Ovarian tumor that is bladder like tissue bilateral or unilateral solid pale yellow tan color encapsulated Coffe bean nuclei
Brenner Tumor
B’s
Bean, bilateral, bladder
Bundles of spindle shaped fibroblasts
Ovarian tumor
causes Meig’s Syndrome
Fibromas
Meig’s Syndrome
ovarian fibroma
ascites
hydrothorax
caused by fibromas
Call-Exner Bodies
Secretes E –> presents with precocious puberty
Abnormal uterine bleeding
Ovarian tumor
Causes endometrial hyperplasia or CA in adults
Granulosa cell Tumor
GI Mets to ovaries (bilateral)
Mucin secreting signet cell adenocarcinoma
Krukenberg Tumor
Girls < 4
Spindle shaped tumor cells that are desmin +
Vaginal tumor
Sarcoma botryoides
(rhabdomyosarcoma variant)
looks like grapes coming out of vagina
Tumor associated with DES exposure in utero
Clear cell adenocarcinoma of the vagina
squamous cell CA of the vagina usually comes from
cervical SCC
Small mobile firm mass in breast–benign
Sharp edges
< 35 yrs
increase size and tenderness with E
Fibroadenoma
Small benign tumor in lactiferous ducts
usually bellow the areola
Serous/Bloody discharge
Intraductal papilloma
slight inc. risk of CA
Large bulky mass of CT and cysts in breast
Leaf like projections
6th decade
may become malignant
Phyllodes tumor
Single most important prognostic risk factor for malignant breast cancer
axillary lymph node involvement
Over expression of what 2 receptors is common in breast cancer?
Estrogen/Progesterone receptors
c-erbB2 (HER-2, EGF)
Risk factors of malignant breast cancer
Estrogen exposure increased total # menstrual cycles older age of 1st live birth obestiy BRCA 1 and 2
Breast tumor due to ductal hyperplasia that fills duct lumen
early malignancy w/o basement membrane penetration
Ductal CA in situ (DCIS)
Ductal and caseous necrosis
Subtype of DCIS
breast tumor
Comedocarcinoma
Most common of all breast cancers
Stellate morphology
Firm fibrous rock hard mass with sharp margins and small glandular duct-like cell
Invasice Ductal
Invasive breast cancer
Orderly row of cells
Bilateral with multiple lesions
Invasive lobular
Invasive breast cancer
Fleshy, cellular, lymphocytic infiltrate
Good prognosis
Medullary
Invasive breast cancer
Dermal lymphatic invasion by breast CA
blocked lymph drainage –> Peau d’orange
Inflammatory
Eczematous patches on nipple
large cells in epidermis with clear halo
suggestive of underlying DCIS
Paget’s disease of the nipple
Types of fibrocystic disease
Fibrosis
Cystic
Sclerosing Adenosis
Epithelial Hyperplasia
fibrocystic disease with hyperplasia of breast stroma
fibrosis
fibrocystic disease with increased # of epithelial cell layers in terminal duct lobule
inc. risk of CA
Epithelial Hyperplasia
fibrocystic disease with increased acinin and intralobular fibrosis
calcifications
Sclerosing adenosis
fibrocystic disease with fluid filled blue dome
ductal dilation
cystic
Breast abscess due to infection from cracked nipple during breast feeding
Acute Mastitis
Most common bug for acute mastitis
S. aureus
Post breast injury
benign
painless lumps
Fat necrosis
may not report trauma (sports)
Rx’s associated with Gynecomastia
Spironolactone Digitalis Cimetidine Alcohol Ketoconazole
Some drugs cause awkward knockers
Lobes in BPH
Lateral and middle
periurethral
BPH Tx
Alpha-1 antagonists (terazosin, tamsulosin)
Finasteride
BPH marker
PSA
Lower back pain
Incresaed Alk. Phos and PSA
Osteoblastic mets in bone from prostatic adenocarcinoma
Markers for Prostatic adenocarcinoma
PSA (inc. total, dec. free)
Prostatic Acid Phosphatase (PAP)
Lobe most common for prostatic adenocarcinoma
posterior lobe
peripheral zone
Varicocele Tx
Varicocelectomy
Empolization by interventional radiologist
95% of all testicular tumors
Germ Cell Tumors
Malignant, painless, homogenous testicular enlargment
Radiosensitive
15-35
Large cells in lobules with watery cytosol
FRIED EGG APPEARANCE
Seminoma
Seminoma Labs
increased placental alkaline phosphatatse (PLAP)
Yellow mucinous tumor of testicle
Increased AFP
SCHILLER DUVALL BODIES
Yolk Sac tumor
endodermal sinus
Malignant testicle tumor inc. AFP Disordered Syncytiotrophoblastci and cytotrophoblastic elements Gynecomastia Hematogentous spread
Choriocarcinoma
How are mature teratomas different in men than women?
they are malignant
Malignant, painful testicular mass
glandular/papillary morphology
Usually with another tumor type
Incresaed hCG and NORMAL AFP (pure)
Embryonal CA
AFP can be elevated if mixed (more common)
Reinke Crystals Androgen producing Gynecomastia in men Precocious puberty in boys Golden brown color
Leydig Cell
Androblastoma from sex cord stroma
Sertolli cell
Old men
Lymphoma mets to testes
Agressive
Testicular lymphoma
Hydrocele
increased fluid due ot incomplete fusion of processusu vaginalis
Illuminates
Spermatocele
Dilated epididymal duct
2 tunica vaginalis lesions
hydrocele
spermatocele
Squamous cell CA of penis
HPV and lack circumcision assoc.
Bent penis due to aqcuired fibrosis
Peyronie’s Disease
Painful sustained erections not due to sex
priapism
causes of priapism
Sickle cell boner Rx cocaine alpha blockers trauma Rx