Reproductive Flashcards
1
Q
bartholin cyst
A
- obstruction of Bartholin gland
- infection in women of reproductive age
- in vestibule
- unilateral
2
Q
condyloma
A
- HPV 6 and 11
- koilocytic change
- rarely progresses to carcinoma
3
Q
HPV infects….
A
lower genital tract
4
Q
koilocytic change
A
HPV
5
Q
lichen sclerosis
A
- thinning of epidermis and fibrosis of dermis
- paper thin skin
- benign, but associated with SCC
6
Q
lichen simplex chronicus
A
- hyperplasia of epithelium
- leukoplakia with thick skin
- chronic irritation
- no risk for SCC
7
Q
vulvar carcinoma
A
- from squamous
- presents as leukoplakia
8
Q
two pathways of vulvar carcinoma
A
HPV (VIN, younger) vs non-HPV (long standing lichen sclerosus, post menopause)
9
Q
extramammary Paget disease
A
- malignant epithelial cells in epidermis
- erythematous, itchy, ulcerated skin
- underlying cancer only in breast, no in vulva
10
Q
differential in Paget disease
A
carcinoma vs melanoma (test PAS, keratin and S100)
11
Q
adenosis
A
- persistence of columnar epithelium in upper vagina
12
Q
derivations of vagina
A
upper 2/3 = mullerian duct
lower 1/3 urogenital sinus
13
Q
association with adenosis
A
DES increases incidence
14
Q
problem with adenosis
A
clear cell adenocarcinoma
15
Q
people at risk for DES
A
- daughters can get adenosis and smooth muscle problems
- moms at risk for breast carcinoma
16
Q
DES is derived from….
A
estrogen (at risk for breast cancer)
17
Q
embryonal rhabdomyosarcoma
A
- malignant mesenchymal proliferation of immature skeletal muscle
- presents with bleeding and grape like mass
- young kids
18
Q
rhabdomyoblast
A
- key cells in embryonal rhabdomyosarcoma
- shows cytoplasmic cross-striations
19
Q
staining in rhabdomyoblasts
A
- desmin (muscle)
- myogenin (in immature muscles cells)
20
Q
vaginal carcinoma
A
- of squamous epithelium
- high risk HPV
- precursor is VAIN
21
Q
lymph node spread of vaginal carcinoma
A
- lower 1/3 = inguinal nodes
- upper 2/3 = iliac nodes
22
Q
factors in HPV
A
E6 - p53
E7 - Rb
23
Q
CIN location
A
starts on bottom and raises
24
Q
irreversible step in CIN
A
carcinoma in situ (CIS)
25
risk factors for cervical cancer (high risk)
- HPV
| - smoking and immunodeficiency
26
two strange risks of smoking for cancer
- cervix and pancreas
27
two types of cervical cancer
SCC and adenocarcinoma (both from HPV)
28
one of the most common causes of death in cervical cancer
hydronephrosis from invasion into bladder (local invasion more than metastasis)
29
cellular changes in HPV
large nucleus, dark cytoplasm
30
limitations of pap smear
- limited to transformation zone
| - does not pick up adenocarcinoma
31
why do vaccinated individuals still need pap smears?
other high risk types
32
asherman syndrome
- loss of basalis due to scarring
- secondary amenorrhea
- from overaggressive dilation and curettage
33
anovulatory cycle
- lack of ovulation
- lack of progesterone secretory phase after proliferation
- seen in menarche and menopause
34
acute endometritis
- bacterial infection
- retained products of conception
- fever, bleeding and pain
35
chronic endomeritis
- inflammation
- plasma cells
- retained products, PID, IUD, TB
- bleeding and infertility
36
cell seen in chronic endometritis
plasma cell
37
endometrial polyp
- hyperplastic protrusion of endometrium
| - abnormal uterine bleeding
38
endometrial polyp can result from....
side effect of tamoxifen (weak pro estrogen effects on uterus)
39
endometriosis
- glands and stroma outside of uterus
| - presents with dysmenorrhea and pelvic pain
40
theories of endometriosis
- menstrual products go back
- metaplasia
- lymphatic dissemination
41
endometriosis in ovary
chocolate cyst
42
pain with defecation
endometriosis in pouch of douglas
43
adenomyosis
endometriosis in myometrium
44
risk in endometriosis
carcinoma, especially in ovary
45
endometrial hyperplasia
- many glands relative to stroma
- driven by estrogen
- in postmenopausal women (obese)
- presents as bleeding
46
most important predictor for progression to carcinoma in endometrial hyperplasia
cellular atypia
47
two pathways of endometrial carcinoma
- hyperplasia to carcinoma (endometrioid), younger
| - sporadic - cancer from an atrophic endometrium (serous or papillary), older
48
sporadic pathway driven by...
p53
49
leiomyoma
- benign mass of smooth muscle
- related to estrogen exposure
- *multiple, well-defined white whorrly masses (no necrosis/hemorrhage)
50
most common presentation of leiomyoma
no symptoms
51
leiomyosarcoma
- malignant proliferation of smooth muscle
- arises de novo
- seen in postmenopausal women
- single lesion with necrosis and hemorrhage
52
PCOS
- due to high LH and low FSH
- hirsutism
- degeneration of follicles
- obese, oligomenorrhea, insulin resistance
- risk for endometrial carcinoma
53
main problem in PCOS
high LH
54
most common type of ovarian tumor
epithelial
55
most common types of ovarian epithelial tumors
serous and mucous
56
characteristics of cystadenocarcinoma
- complex cyst with thick shaggy lining
| - in post menopausal women
57
classic tumor in BRCA1 mutation in ovary
serous carcinoma
58
endometrioid ovarian tumor
- usually malignant
- associated with endometriosis
- usually also in endometrium
59
Brenner tumor
- contains urothelium
60
marker for ovarian cancer
CA-125, good for treatment and recurrence
61
germ cell tumor in ovary
- women of reproductive age
- fetal = cystic teratoma or embryonal carcinoma
- yolk sac tumor
- germ cell = dysgerminoma
- placenta = choriocarcinoma
62
cystic teratoma
- most common germ cell tumor
- three embryologic tissues
- benign if mature
63
somatic malignancy
cancer in a teratoma, most commonly SCC of skin
64
struma ovarii
teratoma with thyroid tissue
65
dysgerminoma
- large cells with clear cytoplasm and central nuclei
- most common malignant
- serum LDH is high
66
endodermal sinus tumor
- most common germ cell tumor in kids (yolk sac)
- AFP
- Schiller Duval bodies (glomerular like)
67
choriocarcinoma
- malignant of placental like tissue
- proliferation of trophoblasts (no villi)
- high beta-HCG
- fast spreading
- poor response to chemo
68
embryonal carcinoma
- large primitive cells
| - can spread
69
granulosa-theca cell tumor
- produces estrogen
| - presents with signs of estrogen excess (precocious puberty or bleeding)
70
sertoli-leydig cell tumor
- tubles
- Reinke crystals
- may produce androgen
71
fibroma
- benign tumor of fibroblasts
| - pleural effusion and ascites (Meig)
72
Kruckenberg
metastatic ovarian cancer
| - classically from diffuse gastric cancer (signet ring)
73
pseudomyxoma peritonei
- abundant mucin in belly
- tumor in appendix
- can go to ovary (metastatic)
74
most common site of ectopic pregnancy
lumen of fallopian tube
75
HELLP
- hemolysis
- elevated liver enzymes
- low platelets
76
risks of SIDS
- sleeping on stomach and smoking
77
hydatidiform mole
- abnormal conception
- swollen and edematous ville with proliferation of trophoblasts
- higher than expected bHCG
78
classic presentation of mole
- grape like mass in 2nd trimester
79
presentation on ultrasound of mole
snow storm appearance
80
partial mole
- normal ovum by two sperm
- 69 chromosomes
- present fetal tissue
- some ville are hydropic
- focal proliferation around villi
- minimal risk for chroiocarcinoma
81
complete mole
- 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
how to screen for choriocarcinoma
b-HCG
83
two pathways for choriocarcinoma
- spontaneous germ cell (poor response to chemo)
| - from conception (good response to chemo)
84
hypospadias
- failure of urethral folds to close
85
epispadias
- abnormal positioning of genital tubercle
| - associated with bladder exstrophy
86
lymphogranuloma venereum
- chlamydia (L1-L3)
- lymphatics and lymph nodes
- healing with fibrosis
87
SCC of penis
high risk HPV
| - associated with lack of circumcision
88
precursor to SCC of penis
- Bowen disease (shaft)
- erythroplasia of Queyrat (glans)
- bowenoid papulosis (doesn't progress to invasion)
89
cyrptoorchidism
- failure to descend
- risk for seminoma
- surgery to lower temperature
90
orchitis
- chlamydia gonorrhoeae
- e coli, pseudomonas (UTIs)
- mumps
- autoimmune (granulomas of testicle)
91
torsion
- twisting leading to hemorrhagic infarction
| - acute testicular pain
92
varicocele
- scrotal swelling
- spermatic vein occlusion
- increased risk on left side
- associated with renal cell carcinoma
93
hydrocele
- fluid in tunica vaginalis
- incomplete closure of processus vaginalis
- can be transluminated
94
do you biopsy testicular tumors
no, dont want to seed
| - most are malignant
95
risk factors for germ cell tumors
- cryptorchidism and Klinefelter syndrome
96
seminoma in testicle
- large cell with clear cytoplasm
- no hemorrhage or necrosis
- good prognosis and responds well
97
embryonal carcinoma in testicle
- malignant
- hemorrhage mass with necrosis
- aggressive
- AFP or bHCG
- **can form glands
98
yolk sac tumor in testicle
- most common in children
| - Schiller Duvall body
99
choriocarcinoma in testicle
- trophoblasts
- bHCG from syncytiotrophoblasts
- hyperthyroidism because HCG is similar to thyroid hormone
- spreads early in blodd
100
teratoma
- mature fetal tissue
- malignant in males
- AFP and bHCG
101
mixed germ cell tumor
- represent most of testicular tumors
| - prognosis is based on worst one
102
sex cord stroma tissue
- usually benign
103
leydig cell tumor
- produces androgen
- Reinke crystals
- early puberty
104
testicular tumor in old male
lymphoma (usually diffuse large B cell)
105
BPH
- hyperplasia of stroma and glands
- related to DHT
- occurs in transitional zone
106
treatments for BPH
- alpha antagonist (also for hypertension)
| - 5A reductase inhibitor
107
requirement for prostate cancer diagnosis
biopsy
108
grading for prostate cancer
Gleason grading, only based on architecture (not atypia)
109
where does prostate cancer spread
to lumbar spine
| - osteoblastic metastasis
110
treatment of prostate cancer
```
GnRH analog (leuprolide)
androgen receptor inhibitor (flutamide)
```
111
milk line
from axilla to vulva, breast tissue can be anywhere along line
112
two layers of breast epithelium
- luminal cell layer
- myoepithelial cell layer
- both ducts and lobules
113
highest density of breast tissue
upper, outside quadrant
114
causes of galactorrhea
- nipple stimulation, prolactinoma or anterior pituitary and drugs
115
acute mastitis
- s aureus
- pus out of nipple
- continue drainage and give antibiotics
116
periductal mastitis
- inflammation of subareolar duct
- highly dependent on vitamin A (epithelium becomes squamous)
- seen in smoking
- myofibroblasts cause nipple contraction
117
non cancer nipple retraction
periductal mastitis
118
green brown nipple discharge
mammary duct ectasia
- in multiparous postmenopausal woman
- plasma cells
119
classic findings in fat necrosis
necrotic fat with calcifications and giant cells
120
fibrocystic change
- most common change in premenopausal woman
- vague irregularity to breast tissue
- blue domed cyst
121
increased risk for invasive breast carcinoma in either breast
- NOT fibrosis, cysts and apocrine metaplasia
- ductal hyperplasia and sclerosing adenosis- calcified (2)
- atypical hyperplasia (5)
122
intraductal papilloma
- bloody nipple discharge
- standard two cell layer
- in premenopausal woman
- must distinguished from papillary carcinoma
123
fibroadenoma
- most common benign tumor of breast
- premenopausal woman
- mobile and marble like
- sensitive to estrogen
124
phyllodes tumor
overgrowth of fibrous component
- leaf like projections
- older women
- can be malignant
- like fibroadenoma
125
main risk factor for breast cancer
estrogen
126
ductal carcinoma in situ
- malignant cells in duct
- detected as calcification
- comedo type has high grade necrosis and dystrophic calcification in center of ducts
127
paget disease
- DCIS to skin of nipple
- nipple ulceration and erythema
- usually has underlying cancer
128
invasive ductal carcinoma
- mass on physical exam or mammography
- dimpling of skin or retraction of nipple
- desmoplastic stroma
129
tubular carcinoma
- cancer produces tubules
- desmoplastic stroma
- no second cell type
130
mucinous carcinoma
- malignant cells in mucous
| - good prognosis
131
inflammatory carcinoma
- looks like mastitis but antibiotics dont work
- cancer in dermal lymphatics
- need clinical and pathology for diagnosis
- poor prognosis
- can seem like mastitis
132
medullary carcinoma
- high grade with inflammatory cells
| - increased in BRCA 1
133
LCIS
- discovered incidentally
- no mass of calcifications
- discohesive cells lacking E-cadherin
- multifocal and bilateral
134
treatment for LCIS
- tamoxifen
| - low risk of progression
135
invasive lobular carcinoma
- no e-cadherin
| - single file invasion
136
HER/neu
due to gene amplification
| - treated with antibody
137
risk for male breast cancer
- older male
| - associated with BRCA2 and Klinefelter syndrome
