REPRODUCTIVE Flashcards
What is a theca-lutein cyst?
They are cysts due to gonadotropin (hCG) stimulation and may be associated with choriocarcinoma and moles
T/F: both cervical SCC and adenocarcinoma are related to HPV
true
Discuss how estrogen is synthesized in the ovaries
GnRH leads to LH and FSH secretion. LH stimulates desmolase in theca cells to convert cholesterol to androsteinedione; Androstienedione goes from theca cell to granulosa cell where FSH stimulates aromatase to convert androsteinedione to estrogen
Differentiate the lining of a mucinous cystadenoma from that of a serous cystadenoma
Serous = more like fallopian tube; Mucinous = more like intestine (both are ovarian tumors)
What is the most common overall of a “breast lump”?
Fibrocystic change
Which testicular cancer has Reinke crystals?
Leydig cell tumor
What is the way to tell by biopsy that there is endometrial hyperplasia?
The glands are numerous and they are jam-packed together
2 causes of acute prostatitis in young adults; 2 in old adults; WHAT SHOULD YOU PROBABLY PICK???
Young = C. trachomatis and N. gonorrhea; Old = E. coli and P. aeruginosa; In general, probably E. coli
What is the age group for benign and malignant surface epithelial tumors of ovary?
Benign i.e. serous and mucinous adenomas more in young women; Malignant i.e. serous and mucinous cystadenocarcinomas more in older women
Which ovarian tumor increases the risk of endometrial carcinoma?
Granulosa cell tumor because it secretes estrogen
Which breast cancer is often bilateral with lesions in the same location?
Invasive lobular carcinoma (indian filing)
Secondary amenorrhea due to loss of basalis from scarring? Most likely cause?
Asherman Syndrome; overaggressive D/C
Which 4 structures is testosterone responsible for the differentiation of?
Seminal Vesicles; Epididymis; Ejaculatory duct; Ductus deferens
What is the classic finding in the blood vessels of maternal-fetal interface in ecclampsia?
Fibrinoid necrosis
What gene mutations increase the risk for malignancies of breast?
BRCA1 and BRCA2; tumor suppressor genes
What is the precurosor lesion of DCIS?
Ductal hyperplasia
Which testicular tumor can cause precocious puberty? Which 2 cause gynecomastia?
Leydig cell; Choriocarcinoma and Leydig cell
What does E7 do?
Inhibits Rb (mostly from HPV 17)
Name 6 ovarian cysts
Follicular cyst, Theca-Lutein Cyst, Corpus luteum cyst, Endometrioid cyst, Hemorrhagic cyst, and Dermoid cyst (mature teratoma)
Name 2 pathologies of breast stroma
Fibroadenoma, Phyllodes tumor
What are the expected findings for LH, FSH, Testosterone, and Estrogen in PCOS?
LH increased, FSH decreased, Testosterone increased (because more LH than FSH), Estrogen increased from adipocyte aromatization (increased risk of endometrial CA)
Which forms of estrogen are from 1) ovary 2) placenta 3) adipose (rank strength)
1) 17-beta estradiol 2) estriol 3) estrone (Estradiol > Estrone > Estriol)
This is SCC in situ on the penis presenting as leukoplakia on shaft or scrotum
Bowen disease
What reproductive pathology is treated with gentamycin, clindamycin and possible ampicillin?
Endometritis? This is inflammation of the endometrium assoc. with retained products of conception and possibly from the intestinal tract (bacteroides)
Which is a risk factor for endometrial carcinoma, nulliparity or multiparity?
Nulliparity
What is the general key risk factor for ectopic pregnancy?
SCARRING i.e. endometriosis or PID
What effects can cocaine have on a fetus?
Placental abruption (squeezing of vessels) and intrauterine growht restriction
Discuss the relationship between estrogen and prolactin in pregnancy
Estrogen is high in pregnancy (most from placental estriol), this leads to secretion of prolactin; however, the action at the breast is blocked. So the idea is to get prolactin out but to wait unti after pregnancy is done to really get milk production going!
Anemia in leiomyoma
Fe deficient anemia due to bleeding
What is a hydrocele
failed closure of processus vaginalis
What are the levels of testosterone and LH if there is a testosterone secreting tumor or use of exogenous steroids?
LH decreased; test increased
What is oligomenorrhea and polymenorrhea?
Oligomenorrhea is when there are long cycles (more than 35 d); Polymenorrhea is when there are short cycles (less than 21 d)
Signet ring adenocarcinoma of the ovary
Krukenberg tumor from GI met
T/F: testosterone production is temperature dependent
False; Leydig cells continue to produce testosterone but Sertoli cells are temperature sensitive and decrease sperm production because they will secrete less ABP
What are the levels of testosterone and LH if there is hypogonadotropic hypogonadism?
Both decreased
Which breast cancer has indian filing?
Invasive lobular carcinoma (often bilateral in same location)
What causes a complete mole vs. partial mole?
Complete mole = 2 sperm fertilizing an empty egg; Partial mole = 2 sperm fertilizing 1 egg
What is the histology of ectocervix and endocervix? What if there is endocervix in the vagina?
Ecto = SSNKE; Endo = simple columnar; Vaginal adenosis prob from DES exposure in utero, increases risk of clear cell CA of vagina
Where does the lower vagina come from? Upper?
Lower = urogenital sinus; Upper = paramesonephric ducts
What effect does progesterone have on gonadotropins?
Inhibits LH and FSH, and decreases estrogen receptor expressivity
Name 1 pathology of the terminal duct of breast
Tubular carcinoma
When does implantation occur? When is hCG first detectable?
6 days after fertilization; hCG is detectable essentially at the same time, i.e. within a week of fertilization
Which hormone is maintained by hCG?
Progesterone
Why is obesity a risk factor for endometrial carcinoma
Estrone can be produced in adipose tissue
Which structure contains the artery of sampson?
Round ligament of the uterus
Whorled pattern of smooth muscle bundles
Leiomyoma
What is SCC of penis associated with?
HPV (failure to circumcise)? Africa, Asia, South America
What is the sequelae of lymphogranuloma venereum in the asshole?
Rectal stricture (L1-L3)
Why can choriocarcinoma lead to hyperthyroidism?
Alpha subunit of hCG is same as TSH (and LH and FSH)
Which cells secrete inhibin? Function?
Inhibin is secreted by sertoli cells and inhibits FSH release; this does not affect testosterone synthesis by Leydig cells but will decrease spermatogenesis since FSH stimulates Sertoli cells
What are 2 indications that a ovarian teratoma may be malignant?
If either it is an immature teratoma which may have a neural malignancy OR if it is mature but one of the tissues it formed became cancerous i.e. SCC
Tumor marker for dysgerminoma?
LDH
4 risk factors for endometrial hyperplasia
Anovulatory cycles (unopposed estrogen), Hormone replacement (excess estrogen), PCOS (excess estrogen from aromatization of testosterone), and granulosa cell tumor (produces estrogen)
Where in the female reproductive tract will you find simple cuboidal epithelium?
Germinal epithelium of the ovary
What is the long name for HER2 neu?
c-erbB2
What is the worst cancer of testes?
Embyronal cell carcinoma
What is vagina adenosis? What is adenomyosis?
adenosis is endocervical tissue (simple columnar) in vagina (DES); Adenomyosis is endometrium in myometrium
What 2 stains can be used for rhabdomyoblasts in sarcoma botryoides?
Desmin, myogenin
What is the histology of testicular choriocarcinoma? Mets to where?
Distinguished cytotrophoblastic and syncytiotrophoblastic elements; mets to lungs
What are the 4 general types of ovarian germ cell tumors?
Dysgerminomas (Turner), Choriocarcinoma, Yolk Sac tumor, Teratomas (mature, immature, struma ovarii)
Why is FSH elevated in Klinefelter’s?
There is fibrosis of seminiferous tubules so there is less inhibin
What causes the increase in temperature during ovulation?
Progesterone
Which ovarian tumor can cause precocious puberty?
Granulosa cell tumor because it secretes estrogen (Call Exner bodies pathognomonic)
What is the pathognomonic feature of endodermal sinus tumors? Tumor marker?
Schiller duval body (glomeruloid structure); AFP
What is pseudomyxoma peritonei? What cancer is associated?
intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor; mucinous cystadenocarcinoma
How is emission different from ejaculation?
Emmision involves contracting seminal vesicles and internal structures and is sympathetic-mediated (hypogastric nerve)? Ejaculation is from SKM contraction via the pudendal nerve
What is the cause of preeclampsia and ecclampsia?
Placental ischemia due to impaired vasodilation of spiral arteries that leads to increased vessel tone
Yolk sac tumors are common in the ovaries and testes of children, where else might they be found?
Sacrococcygeal area (AFP, also in hepatocellular carcinoma)
What is a phyllodes tumor?
bulky mass of connective tissue and cysts, rarely can become malignant
Yellow-brown gunpowder nodules
endometriosis implants
What are the 3 cell types (BASIC) of ovaries?
Cell surface, Germ cells (oocyte, PGC), and sex-cord stroma
What should you think for a histology of “fried egg” in 1) Brain 2) Heme 3) Testicle
1) oligodendrocyte 2) neoplastic plasma cell in multiple myeloma 3) seminoma
Germ cell tumors produce things that germ cells would normally make! What is it called when there is 1) Fetal tissue 2) Oocyte 3) Yolk sac 4) Placental tissue? Which MALIGNANCY has the best prognosis and why?
1) Cystic teratoma 2) Dysgerminoma 3) Endodermal sinus tumor 4) choriocarcinoma (Dysgerminoma is the most like oocyte = well differentiated = best prognosis)? Cystic teratoma not malignant usually
What cysts may form in the presence of a choriocarcinoma? Why?
Theca lutein cysts since it is malignant trophoblast it is secreting B-hCG which is normally meant to maintain the corpus luteum, this causes a large corpus leteum = theca lutein cyst
How do you Dx varcocele? Tx?
US; Tx is varicocelectomy or embolization
During which 2 female surgeries is the ureter at risk?
Oopherectomy when ligating the ovarian arteries in the suspensory ligament of the ovary; In hysterectomy when ligating the uterine arteries in the cardinal ligament
What happens to a leiomyoma in pregnancy?
Gets bigger because it is estrogen sensitive
10 common causes of anovulation
Pregnancy, PCOS, Obesity, HPO axis abnormality, premature ovarian failure, hyperprolactinemia (CT of head); thyroid disorder; eating disorder (anorexia shuts down GnRH), Cushing’s, and adrenal insufficiency
What is a serous cystadenocarcinoma?
A malignant non germ cell tumor of ovaries with psammoma bodies
What is the worst and most common breast cancer?
Invasive ductal carcinoma (worst one)
What is retained placental tissue?
exactly what it fucking sounds like; increases risk of hemorrhage and infection
How much of the epithelium is involved in CIN 1; CIN2; CIN 3?
1) less than one third 2) 2 thirds 3) almost full thickness? Full thickness is carcinoma in situ
Name 5 drugs that cause gynecomastia
Ketoconazole, Alcohol, Spironolactone, Digitalis, and Cimetidine (Marijuana and Heroin as well)
What increases the risk of placenta previa and why?
C section and multiparity because it cant find a good spot higher up in the uterus to implant due to scarring etc.
What determines the prognosis of a mixed germ cell tumor?
The worst component
What is the most common type of invasive cervical carcinoma?
SCC
What causes endometrial hyperplasia?
Excess (unopposed) estrogen stimulation
Why is metformin often given to PCOS pts?
Because it is associated with insulin resistance
What is the most common pathogen in acute mastitis?
S. aureus (however, supposedly if it spreads far then S. pyogenes because that is basically cellulitis, but if it is more abscess-like, think S. aureus)
What is the deal with ambiguous genitalia in 5 alpha reductase deficiency?
They are ambiguous until puberty because 5 alpha reductase is responsible for their initial development, but testosterone is responsible for the growth spurt of puberty; Thus, they will be essentially normal after puberty
Menorrhagia, dysmenorrhea, dyspareunia with normal sized uterus
Endometriosis
What should you consider if there is menopause before age 40?
Premature ovarian failure
How can cervical cancer cause renal failure?
It can invade laterally into the ureters leading to post-renal azotemia with hydronephrosis and renal failure
Which is associated with an increased risk of SCC: lichen simplex chronicus or lichen sclerosis? Which is post-menopausal?
Lichen sclerosis involves increased risk of SCC (non-HPV vulvar SCC)and is post-menopausal, the epidermal thinning is due to the hormonal changes (i.e. atrophy)
Most common site of endometriosis
ovary
How can you Dx ectopic pregnancy based on hCG?
The hCG is lower than that expected for dates
What is the most common casue of acute prostatitis? Chronic?
E. coli; chronic abacterial prostatitis is the most common type of chronic prostatitis
How do you treat adenomyosis?
Hysterectomy (endometrial glands in myometrium)
Which testicular tumors have elevated hCG?
Choriocarcinoma (gynecomastia); and teratomas (has hCG and or AFP), embryonal carcinomas when pure
What is an endodermal sinus tumor trying to do?
It is a germ cell tumor that is “trying” to make yolk sac! AFP levels checked and there are Schiller Duval bodies
Which testicular tumor has placental alkaline phosphatase?
Seminoma, though, you would think it would be choriocarcinoma (radiosensitive, fried egg appearance)
What is the best test to confirm that a person is in menopause?
Elevated FSH due to loss of negative feedback from estrogen, which is decreased
What are the 3 major non-germ cell tumors you find in testes?
Leydig cell tumor; Sertoli cell tumor; Testicular lymphoma
What is the major risk of placenta accreta after delivery?
Often placenta does not dissociate from endometrium and causes a massive bleed
How do you know if a testicular embryonal cell carcinoma is mixed or pure?
Mixed has both hCG and AFP; pure is hCG only? pure ones are rare
No detachement of placenta after birth
Likely a placenta accreta
Where will you find an intraductal papilloma? Risk?
Beneath the areola in the lactiferous ducts; increased risk of carcinoma
What is the function of the suspensory ligament of the ovary?
anchors the ovaries to the pelvic walls and contains the ovarian artery
How does testosterone close the epiphyseal plates?
It doesnt, it is converted to estrogen which closes the epiphyseal plates (note precocious puberty can ultimately lead to earlier closure of epiphyseal plates despite a quick growth spurt)
What does E6 do?
Inhbits p53 (mostly from HPV 16)
What are the expected estrogen, LH, and FSH levels in premature ovarian failure? What is the age criteria?
Low estrogen with high FSH and LH; signs of menopause before 40
What is a Call-Exner body? What CA?
small follicles filled with eosinophilic inclusions; non germ cell tumor of ovary = Granulosa cell tumor
Which phase of the menstrual cycle is a constant 14 days?
Luteal phase
Which cells form the blood-testis barrier?
Sertoli cells
How quickly does fertilization occur after ovulation?
In the ampulla within 24 hrs
What are the major associations of serous cystadenocarcinomas and mucinous cystadenocarcinomas?
Serous = psammoma bodies; Mucinous = pseudomyxoma peritonei
What is the prognosis for chemotherapy in choriocarcinoma arising as a germ cell tumor? As a hydatidiform mole? (IN WOMEN)
If as a germ cell tumor it is poor prognosis; If from hydatid mole it is excellen prognosis
Which female cells are stimulated by LH and FSH for estrogen synthesis?
LH = theca cell (desmolase convert cholesterol to androsteinedione); FSH = granulosa cell (aromatase converts androsteinedione to estrogen)
Which ovarian tumor is most likely to have psammoma bodies?
Cystadenocarcinoma (non-germ cell)
What is Meig’s syndrome?
ovarian fibroma, ascites, and hydrothorax
What cancer is associated with Turner’s?
Dysgerminoma
What are the testosterone and LH levels if there is a defective androgen receptor in a male?
Both increased
What is Mittelschmerz? Which hormone would most directly cause it?
Mittelschmerz is when blood from a ruptured follicle causes pain in the peritoneum? LH is responsible for follicular rupture (ovulation)
What aspect of HPV determines whether the lesion is high grade or low grade?
DNA sequence? The nomenclature of HPV types is based on DNA sequence
What is the most common type of ovarian germ cell tumor? 3 subtypes?
Mature teratoma (dermoid cyst); immature teratoma (more malignant); Struma ovarii has functional thyroid tissue and presents with hyperthyroidism
What are the sex cord stromal tumors of men?
Leydig cell tumors (Reinke crystals); Sertoli cell tumor (androblastoma)
What is the Tx of endometriosis (4)
Oral contraceptives, continuous leuprolide, NSAIDs and danazol (acts as partial agonist at androgen receptors)
Which testicular tumor causes precocious puberty in males? Which ovarian tumor causes precocious puberty in girls? What inclusions will you find (HIGH YIELD)
Leydig cell tumor (Reinke crystals); Granulosa cell tumor (Call-Exner bodies)
Where are meiosis I and II arrested in oogenesis?
Meiosis I = prophase I; Meiosis II = metaphase II
Name 3 tumors of vagina
SCC (usually from extension of cervical SCC), Clear cell (from DES), Rhabdomyosarcoma botyroides (in young girls, desmin positive)
Which 3 vulvar lesions present as leukoplakia, which increases risk of non-HPV vulvar carcinoma?
Vulvar carcinoma most often from HPV; Lichen simplex chronicus; Lichen sclerosis increases risk of non-HPV vulvar CA
Name 3 pathologies of the lactiferous sinus
Intraductal papilloma, breast abscess, mastitis
What is the inhibin level in cryptorchidism?
low because Sertoli cells are temperature dependent. FSH is high as are LH and test. However, if bilateral, test is low
Painful bleeding in 3rd trimester
likely abruptio placentae
Which breast CA has a classic stellate morphology?
Invasive ductal carcinoma (worst one)
Treatment of which testicular cancer with chemotherapy may result in differentiation into another cancer?
Embryonal cell carcinoma
Why is estriol an important marker of fetal wellbeing?
Estriol is the estrogen produced by the placenta; high estriol indicates that the placenta is developing properly!
Which mole has fetal parts?
Partial mole because it has 2 sperm and 1 egg; since complete mole is just 2 sperm with empty egg, no fetal parts develop
If endometritis is particularly foul smelling what is the probable organism?
Bacteroides; this is the most common organism in endometritis
What is the cause of peau d orange?
Neoplastic cells of breast invade lymphatics
Define Preeclampsia and eclampsia
Preeclampsia = hypertension, proteinuria, edema; Ecclampsia = hypertension, proteinuria, edema AND SEIZURES
What is a Brenner tumor?
Benign ovarian tumor that looks like bladder and has coffee bean nuclei
Meig’s syndrome involves an ovarian tumor made of __________
fibroblasts; fibroma
Name 2 pathologies of the major duct (in breast)
Fibrocystic change, ductal cancer
Best way to differentiate a mucinous cystadenocarcinoma from a Krukenberg tumor on clinical exam?
Krukenbergs are usually bilateral
What happens after delivery if a woman has uterine atony?
BLEEDING because the uterus doesnt clamp down on the spiral arteries
Name 2 noninvasive breast cancers
DCIS and comedocarcinoma (subtype of DCIS with caseous necrosis)
What is conspicuously absent from ovarian choriocarcinoma?
Chorionic villi
Which bacteria cause orchitis in young adults? Old adults? Which virus can do it? What other visceral problem?
Young = C. trachomatis (D-K) and N. gonorrhea; Old = E. coli, P. aeruginosa; Virus = mumps can also cause pancreatitis
Differentiate the layers affected by lichen sclerosis and lichen simplex chronicus
lichen sclerosis is thinning of epidermis with fibrosis of dermis; Lichen simplex chronicus is thickening of epidermis
What is the Tx of a hydatidiform mole?
D/C with methotrexate
How do you treat preeclampsia/ecclampsia?
DELIVER BABY AS SOON AS IT IS VIABLE; until then you can treat siezures with MAGNESIUM SULFATE
What hormonal changes occur in menopause for 1) Estrogen 2) FSH 3) LH 4) GnRH
1) decreased 2) heavily increased 3) increased 4) increased
What is the function and control of desmolase in theca cells?
Under control of LH, desmolase converts cholesterol into androsteinedione which then goes to granulosa cells to be aromatized to estrogen under FSH control
How do ovarian epithelial tumors spread?
locally into peritoneum (monitor with CA-125, makes sense)
Where are the testes found in androgen insensitivity syndrome? Levels of LH and testosterone?
in the labia majora; both are elevated
Name 2 tumor markers for prostatic adenocarcinoma?
Prostate specific antigen; Prostatic acid phosphatase
What is DHT responsible for later in life?
Balding, Prostate growth, sebaceous glands
Which ovarian tumor has bundles of spindle shaped fibroblasts?
Fibroma (assoc. with Meig’s syndrome)
Which testicular tumor is also called an androblastoma?
Sertoli cell tumor
What other syndrome is often associated with preeclampsia?
HELLP; Hemolysis, elevated liver enzymes, low platelets
What is the pathognomonic feature of granulosa cell tumors?
Call Exner bodies (these are non germinomas)
What is another name for CIN 3?
Carcinoma in situ
What is a Paget Cell?
large cell in epidermis with clear halo (suggests underlying DCIS)
What are the general effects of estrogen and progesterone on the endometrium, i.e. what is the point?
Estrogen stimulates growth of the endometrium for pregnancy and progesterone maintains it and allows for thick mucus and spiral artery development
What 2 prophylactic surgeries are often done in BRCA1 carriers?
Salpingoopherectomy and prophylactic mastectomy (no hysterectomy!!!)
What is the most common germ cell tumor overall in women? #2?
Cystic teratoma (benign usually), Dysgerminoma (good prognosis)
How is a Brenner tumor classified?
Benign (usually) tumor of ovarian surface epithelium (bladder like epithelium)
What are the tumor markers for choriocarcinoma, dysgerminoma and yolk sac tumors?
Choriocarcinoma = hCG; Dysgerminoma = LDH and hCG; Yolk sac tumor = AFP
What effect does estrogen have on lipoprotein levels?
Increases HDL and lowers LDL which is why they are protected from atherosclerosis
What is a corpus luteum cyst?
Hemorrhage into a persistent corpus luteum
What is seen on endometrial Bx in ectopic pregnancy?
decidualized endometrium without chorionic villi! These can only be present in an intrauterine pregnancy
Name 5 germ cell tumors of the testes
Seminoma (like dysgerminoma in female), Embryonal carcinoma, Choriocarcinoma, Teratoma, Yolk sac tumor
What is the most common cause of a theca lutein cyst?
usually a mole or choriocarcinoma due to excessive hCG stimulation of the corpus luteum
What is the purpose of the following in PCOS 1) Medroxyprogesterone or OCPs 2) Spironolactone 3) Clomiphene 4) Metformin
1) decreases LH and therefore androgenesis 2) decreases acne and hirsutism by inhibitng steroid binding 3) a SERM for women who want to become pregnant 4) because there is often insulin resistance
Which hormone drives the growth of the endometrium?
Estrogen (progesterone just “prepares” it and maintains it, and the loss of progesterone support = death of corpus luteum = menstruation)
T/F: cervical carcinoma is an AIDS defining illness
true
What disinhibits lactation after pregnancy?
The drop in progesterone
What are the expected LH and FSH levels in Turner’s?
Both elevated due to a low estrogen from streak ovaries
What causes a fibroadenoma to grow? To cancer?
Estrogen; there is no increased risk of converting to cancer, it is not a precursor
What is a follicular cyst?
Distention of an unruptured Graafian follicle (assoc. with hyperestrinism and endometrial hyperplasia)
What is a spermatocele?
Dilated epididymal duct
What is the difference between spontaneous abortion and intrauterine fetal demise?
SA = before 20 weeks IUFD = after 20 weeks
Which chromosomal abnormality increases the risk of male germ cell tumors?
Klinefelter (XXY)
Why are there cysts in PCOS?
Because the high estrone produced in adipose from aromatization of androgens to estrone decreases FSH, since FSH stimulates granulosa cells this leads to a cystic degeneration of follicles
What is the issue in Kallman syndrome?
Defective migration of GnRH cells and a lack of olfactory bulb development
What is the most common gynecologic cancer in the U.S.? Worldwide? Why?
Endometrial CA; Cervical CA; we use the pap smear
Which breast cancer has a good prognosis?
Medullar carcinoma
Which ovarian germ cell tumor contains sheets of uniform cells and is the equivalent of the male seminoma? Tumor markers (2)?
Dysgerminoma (LDH, hCG); this is a more common tumor in males (seminoma, that is)
Name 2 pathologies of the nipple
Breast abscess, Paget’s disease of breast (assoc. with underlying DCIS)
What is comedocarcinoma?
subtype of DCIS (therefore, noninvasive) that has caseous necrosis
Where is aromatase found in a male? 2 inhibitors of?
It is found in Leydig cells and adipose and converts test and androsteinedione into estrogen; exemestane and anastrazole
What (specifically) is a pap smear trying to scrape?
Transformation zone between the ectocervix and endocervix
Which HPV has E6 which has E7? What do these do?
16 has E6 = inhibits p53; 17 has E7 = inhibits Rb
Which androgens are produced by the testis? The adrenals?
Testosterone and Dihydrotestosterone; Androsteinedione
Which tumor has coffee bean nuclei?
Brenner tumors of the ovary (bening bladder like tumor)
Elevation of what hormone is indicative of ovulation?
Progesterone
What is the most common ovarian mass in young women?
Follicular cyst? this is distention of an unruptured Graafian follicle
What are the two pathways that lead to endometrial carcinoma?
Hyperplasia pathway = arises from endometrial hyperplasia; Sporadic = arises from atrophic endometrium and has psammoma bodies (usually papillary and serous)
Which testiculuar tumor is radiosensitive? Marker?
Seminoma (placental alkaline phosphatase)
What are the 3 sex cord stromal tumors? Buzz words?
1) Granulosa-Theca cell tumor (Call-Exner bodies) 2) Sertoli-Leydig cell (Reinke crystal in Leydig) and 3) Fibroma (Meig’s syndrome)
What genetic disease can cause priapism?
Sickle cell anemia, sickled RBC’s get stuck in vascular channels
What effects can phenytoin have on a fetus?
Digital hypoplasia and cleft lip and palate
Why does anovulatory cycle lead to bleeding?
You never ovulate = never get a corpus luteum = no progesterone. So you just get growth on top of growth and that leads to overgrowth of blood supply
Which type of malignant breast cancer can cause CASEOUS NECROSIS?
Comedocarcinoma (a noninvasive one)
What determines prognosis of endometrial carcinoma?
how far into the myometrium it has invaded
What is the most common trisomy leading to spontaneous abortion?
Trisomy 16
Which testicular tumor has Schiller Duval bodies? Marker?
Yolk sac tumor; AFP
How do you treat endometritis?
Gentamycin and Clindamycin with possible ampicillin
Bacterial infection due to retained products of conception
Acute endometritis (bacteroides very common)
Name 2 pathologies of the lobules of the breast
Lobular carcinoma and sclerosing adenosis
What is a serous cystadenoma?
A bening tumor of ovaries lined by fallopian tube-like lining
What is BPH?
Benign prostatic HYPERPLASIA (NOT hypertrophy)
Which cervical cancer is not picked up by pap smear?
Cervical adenocarcinoma
What is the function and control of aromatase in granulosa cells?
Androstiendione formed in the theca cells enters the granulosa cell and under FSH control upregulates aromatase to aromatize androsteinedione into estrogen
Which ovarian tumor is pale and looks like bladder tissue?
Brenner tumor
What occurs 14 days after ovulation?
menstruation
What lines the vulva?
Squamous epithelium
Two places Paget’s disease may be (aside from bone)
Vulva (no underlying CA) and Breast (underlying DCIS)
Which basic type of ovarian tumors have no correlate in men?
Surface epithelial tumors (men have germ cells and sex-cord stroma)
Pseudomyxoma peritonei represents massive amounts of mucus in the peritoneum from metastasis of a _______________ tumor to the ovary
Mucinous tumor of the appendix
What is the difference in prognosis for a mature teratoma in males vs. females?
Males more often malignant
What is Asherman Syndrome?
Secondary amenorrhea due to loss of basalis and scarring from D/C (without basalis there is no way to grow an endometrium)
Painless bleeding in any trimester
Placenta previa
Smooth muscle tumor in uterus with areas of necrosis and hemorrhage
Leiomyosarcoma
What are 3 benign breast tumors?
Fibroadenoma, Phyllodes tumor (both of stroma), and Intraductal papilloma (lactiferous sinus)
Which cells are NOT affected by cryptorchidism?
LEYDIG CELLS!!! Although sertoli cells depend on temp, testosterone synthesis is NOT affected by temp. Spermatogenesis is though because there is no ABP; However, for whatever reason, testosterone is LOW in BILATERAL cryptorchidism
What is Peyronie’s disease
Bent penis due to acquired fibrous tissue
Which 2 structures in the female are derivatives of the gubernaculum?
Ligament of the ovary (attaches medial ovary to lateral uterus); Round ligament of uterus (from uterine fundus to labia majora, contains artery of Sampson)
What is a dermoid cyst of the ovary?
Mature teratoma, has all kinds of tissue in it
What is the screening test and confirmatory test for cervical carcinoma?
Pap smear; Colposcopy
What cells are necessary for a Dx of chronic endometritis?
PLASMA CELLS since lymphocytes are normally present
Which tumor in ovaries produces estrogen? Signs in young girl? Repro age? Post menopause?
Granulosa-Theca cell tumor? Young girl = precocious puberty, Repro age = menorrhagia/metrorrhagia; Old = uterine bleeding
What are the 4 histologic types of fibrocystic breast disease?
Fibrosis (stromal hyperplasia), Cystic (blue dome), Sclerosing adenosis (calcifications confused with CA), Epithelial hyperplasia (increases risk of CA)
What is Bowen disease?
SCC in situ on the penis presenting as leukoplakia
What is a common cause of endometrial polyps?
Tamoxifen due to partial agonist activity on estrogen receptors of endometrium (antagonist at breast)
Which structure contains the uterine vessels? Ovarian vessels?
Cardinal ligament; suspensory ligament of the ovary
What structure is at risk when ligating the suspensory ligament of the ovary in oopherectomy?
ureter
Which testicular tumors can have AFP?
Yolk sac tumor; teratoma (AFP and or hCG), embryonal carcinoma when mixed
What are the levels of testosterone and LH if there is primary hypogonadism (Klinefelter’s)?
Testosterone decreased, LH increased
Which mole causes choriocarcinoma?
Complete mole; partial moles are unlikely to convert to choriocarcinoma
What happens when there is hemorrhage into a corpus luteum?
Hemorrhagic corpus luteal cyst (especially in early pregnancy)
What is the risk that DES proposes for the mother taking it?
Breast cancer; Diethylstilbestrol is an estrogen drug
What tests indicate osteoblastic mets from prostate?
high PSA and elevated alk phos (prob with a negative GGT as well to r/o liver)
What is the histology of 1) medullary carcinoma of breast 2) invasive lobular carcinoma 3) invasive ductal carcinoma
1) flesshy, cellular, lyphocytic invasion 2) indian filing 3) stellate
Which sleeping position is a risk factor for sudden infant death?
Sleeping on the stomach!!! Should sleep on the back
Roughly where on the right side of a clock are Skenes glands and Bartholins glands located?
Skenes = 1 o clock; Bartholins = 5 oclock (i.e. lower vestibule)
Which strains are covered by gardasil (4)?
6, 11 (warts); 16 and 18 (CA)
What maintains the glands and stroma of the prostate?
androgens (i.e. DHT)
What is the grading system for prostatic adenocarcinoma? What is it based on?
Gleason grading system; based on architecture ALONE not based at all on atypia
Which germ cell tumors are non-seminomas? What is the counterpart in the female for a seminoma?
Choriocarcinoma, Endodermal sinus tumor, Embryonal carcinoma and teratoma; Seminoma = Dysgerminoma in female
What is the cause of ovulation?
Estrogen is building up during the follicular phase and then it will increase GnRH receptors on the ant pit which will cause the paradoxical LH surge and the LH surge is responsible for ovulation
Differentiate Paget cells and melanoma by 1) PAS 2) S-100 and 3) Keratin
Melanoma = PAS negative, Keratine negative, S-100 positive; Paget cells = PAS positive, Keratin positive; and S100 negative
Which 2 diseases represent SCC in situ presenting as erythroplakia of the penile glans?
Bowenoid papulosis (younger); Erythroplasia of Queyrat
Why is endometrial hyperplasia more likely in an obese woman?
There is the ability of fat tissue to aromatize DHEA and weak androgens from zona reticularis into estrogens
What are the 2 most common types of surface epithelial tumors of ovaries?
Serous and mucinous (adenomas and adenocarcinomas)
Ovarian fibroma, ascites, and hydrothorax
Meig’s syndrome
What is the most common cause on non-HPV related vulvar carcinoma?
Long standing lichen sclerosis
What are 2 fairly uncommon tumors of the ovarian surface epithelium?
Endometrioid tumor (may arise from endometriosis!!!), Brenner tumor (looks like bladder)
Which general type of ovarian malignancies have the worst prognosis?
Surface epithelial tumors
What is an endometrioid ovarian cyst?
This is endometriosis within the ovary, it is a chocolate cyst? Not the same as endometriosis on the outside of ovary
What is the most important prognostic indicator regarding the conversion of endometrial hyperplasia into carcinoma?
cellular atypia
