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Pathoma > Reproductive > Flashcards

Reproductive Flashcards

1
Q

bartholin cyst

A
  • obstruction of Bartholin gland
  • infection in women of reproductive age
  • in vestibule
  • unilateral
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2
Q

condyloma

A
  • HPV 6 and 11
  • koilocytic change
  • rarely progresses to carcinoma
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3
Q

HPV infects….

A

lower genital tract

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4
Q

koilocytic change

A

HPV

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5
Q

lichen sclerosis

A
  • thinning of epidermis and fibrosis of dermis
  • paper thin skin
  • benign, but associated with SCC
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6
Q

lichen simplex chronicus

A
  • hyperplasia of epithelium
  • leukoplakia with thick skin
  • chronic irritation
  • no risk for SCC
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7
Q

vulvar carcinoma

A
  • from squamous

- presents as leukoplakia

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8
Q

two pathways of vulvar carcinoma

A

HPV (VIN, younger) vs non-HPV (long standing lichen sclerosus, post menopause)

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9
Q

extramammary Paget disease

A
  • malignant epithelial cells in epidermis
  • erythematous, itchy, ulcerated skin
  • underlying cancer only in breast, no in vulva
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10
Q

differential in Paget disease

A

carcinoma vs melanoma (test PAS, keratin and S100)

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11
Q

adenosis

A
  • persistence of columnar epithelium in upper vagina
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12
Q

derivations of vagina

A

upper 2/3 = mullerian duct

lower 1/3 urogenital sinus

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13
Q

association with adenosis

A

DES increases incidence

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14
Q

problem with adenosis

A

clear cell adenocarcinoma

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15
Q

people at risk for DES

A
  • daughters can get adenosis and smooth muscle problems

- moms at risk for breast carcinoma

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16
Q

DES is derived from….

A

estrogen (at risk for breast cancer)

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17
Q

embryonal rhabdomyosarcoma

A
  • malignant mesenchymal proliferation of immature skeletal muscle
  • presents with bleeding and grape like mass
  • young kids
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18
Q

rhabdomyoblast

A
  • key cells in embryonal rhabdomyosarcoma

- shows cytoplasmic cross-striations

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19
Q

staining in rhabdomyoblasts

A
  • desmin (muscle)

- myogenin (in immature muscles cells)

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20
Q

vaginal carcinoma

A
  • of squamous epithelium
  • high risk HPV
  • precursor is VAIN
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21
Q

lymph node spread of vaginal carcinoma

A
  • lower 1/3 = inguinal nodes

- upper 2/3 = iliac nodes

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22
Q

factors in HPV

A

E6 - p53

E7 - Rb

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23
Q

CIN location

A

starts on bottom and raises

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24
Q

irreversible step in CIN

A

carcinoma in situ (CIS)

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25
Q

risk factors for cervical cancer (high risk)

A
  • HPV

- smoking and immunodeficiency

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26
Q

two strange risks of smoking for cancer

A
  • cervix and pancreas
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27
Q

two types of cervical cancer

A

SCC and adenocarcinoma (both from HPV)

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28
Q

one of the most common causes of death in cervical cancer

A

hydronephrosis from invasion into bladder (local invasion more than metastasis)

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29
Q

cellular changes in HPV

A

large nucleus, dark cytoplasm

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30
Q

limitations of pap smear

A
  • limited to transformation zone

- does not pick up adenocarcinoma

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31
Q

why do vaccinated individuals still need pap smears?

A

other high risk types

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32
Q

asherman syndrome

A
  • loss of basalis due to scarring
  • secondary amenorrhea
  • from overaggressive dilation and curettage
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33
Q

anovulatory cycle

A
  • lack of ovulation
  • lack of progesterone secretory phase after proliferation
  • seen in menarche and menopause
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34
Q

acute endometritis

A
  • bacterial infection
  • retained products of conception
  • fever, bleeding and pain
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35
Q

chronic endomeritis

A
  • inflammation
  • plasma cells
  • retained products, PID, IUD, TB
  • bleeding and infertility
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36
Q

cell seen in chronic endometritis

A

plasma cell

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37
Q

endometrial polyp

A
  • hyperplastic protrusion of endometrium

- abnormal uterine bleeding

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38
Q

endometrial polyp can result from….

A

side effect of tamoxifen (weak pro estrogen effects on uterus)

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39
Q

endometriosis

A
  • glands and stroma outside of uterus

- presents with dysmenorrhea and pelvic pain

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40
Q

theories of endometriosis

A
  • menstrual products go back
  • metaplasia
  • lymphatic dissemination
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41
Q

endometriosis in ovary

A

chocolate cyst

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42
Q

pain with defecation

A

endometriosis in pouch of douglas

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43
Q

adenomyosis

A

endometriosis in myometrium

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44
Q

risk in endometriosis

A

carcinoma, especially in ovary

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45
Q

endometrial hyperplasia

A
  • many glands relative to stroma
  • driven by estrogen
  • in postmenopausal women (obese)
  • presents as bleeding
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46
Q

most important predictor for progression to carcinoma in endometrial hyperplasia

A

cellular atypia

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47
Q

two pathways of endometrial carcinoma

A
  • hyperplasia to carcinoma (endometrioid), younger

- sporadic - cancer from an atrophic endometrium (serous or papillary), older

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48
Q

sporadic pathway driven by…

A

p53

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49
Q

leiomyoma

A
  • benign mass of smooth muscle
  • related to estrogen exposure
  • *multiple, well-defined white whorrly masses (no necrosis/hemorrhage)
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50
Q

most common presentation of leiomyoma

A

no symptoms

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51
Q

leiomyosarcoma

A
  • malignant proliferation of smooth muscle
  • arises de novo
  • seen in postmenopausal women
  • single lesion with necrosis and hemorrhage
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52
Q

PCOS

A
  • due to high LH and low FSH
  • hirsutism
  • degeneration of follicles
  • obese, oligomenorrhea, insulin resistance
  • risk for endometrial carcinoma
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53
Q

main problem in PCOS

A

high LH

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54
Q

most common type of ovarian tumor

A

epithelial

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55
Q

most common types of ovarian epithelial tumors

A

serous and mucous

56
Q

characteristics of cystadenocarcinoma

A
  • complex cyst with thick shaggy lining

- in post menopausal women

57
Q

classic tumor in BRCA1 mutation in ovary

A

serous carcinoma

58
Q

endometrioid ovarian tumor

A
  • usually malignant
  • associated with endometriosis
  • usually also in endometrium
59
Q

Brenner tumor

A
  • contains urothelium
60
Q

marker for ovarian cancer

A

CA-125, good for treatment and recurrence

61
Q

germ cell tumor in ovary

A
  • women of reproductive age
  • fetal = cystic teratoma or embryonal carcinoma
  • yolk sac tumor
  • germ cell = dysgerminoma
  • placenta = choriocarcinoma
62
Q

cystic teratoma

A
  • most common germ cell tumor
  • three embryologic tissues
  • benign if mature
63
Q

somatic malignancy

A

cancer in a teratoma, most commonly SCC of skin

64
Q

struma ovarii

A

teratoma with thyroid tissue

65
Q

dysgerminoma

A
  • large cells with clear cytoplasm and central nuclei
  • most common malignant
  • serum LDH is high
66
Q

endodermal sinus tumor

A
  • most common germ cell tumor in kids (yolk sac)
  • AFP
  • Schiller Duval bodies (glomerular like)
67
Q

choriocarcinoma

A
  • malignant of placental like tissue
  • proliferation of trophoblasts (no villi)
  • high beta-HCG
  • fast spreading
  • poor response to chemo
68
Q

embryonal carcinoma

A
  • large primitive cells

- can spread

69
Q

granulosa-theca cell tumor

A
  • produces estrogen

- presents with signs of estrogen excess (precocious puberty or bleeding)

70
Q

sertoli-leydig cell tumor

A
  • tubles
  • Reinke crystals
  • may produce androgen
71
Q

fibroma

A
  • benign tumor of fibroblasts

- pleural effusion and ascites (Meig)

72
Q

Kruckenberg

A

metastatic ovarian cancer

- classically from diffuse gastric cancer (signet ring)

73
Q

pseudomyxoma peritonei

A
  • abundant mucin in belly
  • tumor in appendix
  • can go to ovary (metastatic)
74
Q

most common site of ectopic pregnancy

A

lumen of fallopian tube

75
Q

HELLP

A
  • hemolysis
  • elevated liver enzymes
  • low platelets
76
Q

risks of SIDS

A
  • sleeping on stomach and smoking
77
Q

hydatidiform mole

A
  • abnormal conception
  • swollen and edematous ville with proliferation of trophoblasts
  • higher than expected bHCG
78
Q

classic presentation of mole

A
  • grape like mass in 2nd trimester
79
Q

presentation on ultrasound of mole

A

snow storm appearance

80
Q

partial mole

A
  • normal ovum by two sperm
  • 69 chromosomes
  • present fetal tissue
  • some ville are hydropic
  • focal proliferation around villi
  • minimal risk for chroiocarcinoma
81
Q

complete mole

A
  • empty ovum with two sperm
  • 46 chromosomes
  • all villi are edematous
  • trophoblasts all along villus
  • high b-HCG (made by trophoblast)
  • higher risk for choriocarcinoma
82
Q

how to screen for choriocarcinoma

A

b-HCG

83
Q

two pathways for choriocarcinoma

A
  • spontaneous germ cell (poor response to chemo)

- from conception (good response to chemo)

84
Q

hypospadias

A
  • failure of urethral folds to close
85
Q

epispadias

A
  • abnormal positioning of genital tubercle

- associated with bladder exstrophy

86
Q

lymphogranuloma venereum

A
  • chlamydia (L1-L3)
  • lymphatics and lymph nodes
  • healing with fibrosis
87
Q

SCC of penis

A

high risk HPV

- associated with lack of circumcision

88
Q

precursor to SCC of penis

A
  • Bowen disease (shaft)
  • erythroplasia of Queyrat (glans)
  • bowenoid papulosis (doesn’t progress to invasion)
89
Q

cyrptoorchidism

A
  • failure to descend
  • risk for seminoma
  • surgery to lower temperature
90
Q

orchitis

A
  • chlamydia gonorrhoeae
  • e coli, pseudomonas (UTIs)
  • mumps
  • autoimmune (granulomas of testicle)
91
Q

torsion

A
  • twisting leading to hemorrhagic infarction

- acute testicular pain

92
Q

varicocele

A
  • scrotal swelling
  • spermatic vein occlusion
  • increased risk on left side
  • associated with renal cell carcinoma
93
Q

hydrocele

A
  • fluid in tunica vaginalis
  • incomplete closure of processus vaginalis
  • can be transluminated
94
Q

do you biopsy testicular tumors

A

no, dont want to seed

- most are malignant

95
Q

risk factors for germ cell tumors

A
  • cryptorchidism and Klinefelter syndrome
96
Q

seminoma in testicle

A
  • large cell with clear cytoplasm
  • no hemorrhage or necrosis
  • good prognosis and responds well
97
Q

embryonal carcinoma in testicle

A
  • malignant
  • hemorrhage mass with necrosis
  • aggressive
  • AFP or bHCG
  • **can form glands
98
Q

yolk sac tumor in testicle

A
  • most common in children

- Schiller Duvall body

99
Q

choriocarcinoma in testicle

A
  • trophoblasts
  • bHCG from syncytiotrophoblasts
  • hyperthyroidism because HCG is similar to thyroid hormone
  • spreads early in blodd
100
Q

teratoma

A
  • mature fetal tissue
  • malignant in males
  • AFP and bHCG
101
Q

mixed germ cell tumor

A
  • represent most of testicular tumors

- prognosis is based on worst one

102
Q

sex cord stroma tissue

A
  • usually benign
103
Q

leydig cell tumor

A
  • produces androgen
  • Reinke crystals
  • early puberty
104
Q

testicular tumor in old male

A

lymphoma (usually diffuse large B cell)

105
Q

BPH

A
  • hyperplasia of stroma and glands
  • related to DHT
  • occurs in transitional zone
106
Q

treatments for BPH

A
  • alpha antagonist (also for hypertension)

- 5A reductase inhibitor

107
Q

requirement for prostate cancer diagnosis

A

biopsy

108
Q

grading for prostate cancer

A

Gleason grading, only based on architecture (not atypia)

109
Q

where does prostate cancer spread

A

to lumbar spine

- osteoblastic metastasis

110
Q

treatment of prostate cancer

A 
GnRH analog (leuprolide)
androgen receptor inhibitor (flutamide)
111
Q

milk line

A

from axilla to vulva, breast tissue can be anywhere along line

112
Q

two layers of breast epithelium

A
  • luminal cell layer
  • myoepithelial cell layer
  • both ducts and lobules
113
Q

highest density of breast tissue

A

upper, outside quadrant

114
Q

causes of galactorrhea

A
  • nipple stimulation, prolactinoma or anterior pituitary and drugs
115
Q

acute mastitis

A
  • s aureus
  • pus out of nipple
  • continue drainage and give antibiotics
116
Q

periductal mastitis

A
  • inflammation of subareolar duct
  • highly dependent on vitamin A (epithelium becomes squamous)
  • seen in smoking
  • myofibroblasts cause nipple contraction
117
Q

non cancer nipple retraction

A

periductal mastitis

118
Q

green brown nipple discharge

A

mammary duct ectasia

  • in multiparous postmenopausal woman
  • plasma cells
119
Q

classic findings in fat necrosis

A

necrotic fat with calcifications and giant cells

120
Q

fibrocystic change

A
  • most common change in premenopausal woman
  • vague irregularity to breast tissue
  • blue domed cyst
121
Q

increased risk for invasive breast carcinoma in either breast

A
  • NOT fibrosis, cysts and apocrine metaplasia
  • ductal hyperplasia and sclerosing adenosis- calcified (2)
  • atypical hyperplasia (5)
122
Q

intraductal papilloma

A
  • bloody nipple discharge
  • standard two cell layer
  • in premenopausal woman
  • must distinguished from papillary carcinoma
123
Q

fibroadenoma

A
  • most common benign tumor of breast
  • premenopausal woman
  • mobile and marble like
  • sensitive to estrogen
124
Q

phyllodes tumor

A

overgrowth of fibrous component

  • leaf like projections
  • older women
  • can be malignant
  • like fibroadenoma
125
Q

main risk factor for breast cancer

A

estrogen

126
Q

ductal carcinoma in situ

A
  • malignant cells in duct
  • detected as calcification
  • comedo type has high grade necrosis and dystrophic calcification in center of ducts
127
Q

paget disease

A
  • DCIS to skin of nipple
  • nipple ulceration and erythema
  • usually has underlying cancer
128
Q

invasive ductal carcinoma

A
  • mass on physical exam or mammography
  • dimpling of skin or retraction of nipple
  • desmoplastic stroma
129
Q

tubular carcinoma

A
  • cancer produces tubules
  • desmoplastic stroma
  • no second cell type
130
Q

mucinous carcinoma

A
  • malignant cells in mucous

- good prognosis

131
Q

inflammatory carcinoma

A
  • looks like mastitis but antibiotics dont work
  • cancer in dermal lymphatics
  • need clinical and pathology for diagnosis
  • poor prognosis
  • can seem like mastitis
132
Q

medullary carcinoma

A
  • high grade with inflammatory cells

- increased in BRCA 1

133
Q

LCIS

A
  • discovered incidentally
  • no mass of calcifications
  • discohesive cells lacking E-cadherin
  • multifocal and bilateral
134
Q

treatment for LCIS

A
  • tamoxifen

- low risk of progression

135
Q

invasive lobular carcinoma

A
  • no e-cadherin

- single file invasion

136
Q

HER/neu

A

due to gene amplification

- treated with antibody

137
Q

risk for male breast cancer

A
  • older male

- associated with BRCA2 and Klinefelter syndrome

Pathoma (11 decks)

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