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STEP 1 Review > Reproductive Pathology > Flashcards

Reproductive Pathology Flashcards

1
Q

Klinefelter Syndrome

A

47 XXY. Testicular atrophy, eunuchoidal appearance, tall, slender gynecomastia. Presence of barr body in nucleus (electron dense area in nucleus). Common cause of hypogonadism and infertility.

Causes dysgenesis of seminiferous tubules. Decreased inhibin and increased FSH. Also abnormal leydig cell function. Decreased testosterone, increased LH, increased estrogen.

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2
Q

Turner Syndrome

A

45 XO. Short stature, webbed neck, shield chest. Streak ovary.

Preductal coarctation (Xoarctation of aorta). Horseshoe kidney.

Most common cause of primary amenorrhea. No barr body.

Decreased estrogen leads to increased FSH and LH. Can result for mitotic or meiotic error.

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3
Q

XYY males

A

Phenotypically normal. Increased antisocial behavior, normal fertility. Autism spectrum sometimes

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4
Q

True hermaphroditism

A

46 XX or 47 XXY. Ovotesticular disorder. Ovotestes present. Ambiguous genitalia. very rare.

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5
Q

Female pseudohermaphrodite

A

Ovaries present but ambiguous external genitalia. Due to excessive exposure to angrogenic steroids. Like CAH (21OH deficiency)

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6
Q

Male pseudohermaphrodite

A

XY testes present but external genitalia are ambiguous or female. Can be due to 5areductase deficiency or androgen insensitivity syndrome.

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7
Q

Male pseudohermaphrodite

A

XY testes present but external genitalia are ambiguous or female. Can be due to 5areductase deficiency or androgen insensitivity syndrome.

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8
Q

Kallman Syndrome

A

Failure of GnRH cells to migrate. Anosmia with decreased GnRH decreased LH and FSH. Low fertility.

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9
Q

Complete mole

A

46 XX or 46 XY, super high HCG, can convert to choriocarcinoma, no fetal parts, happens when sperm reached enucleated egg. Causes vaginal bleeding, increased uterine size, preeclampsia, hyperthyroidism.

Shows snowstorm appearance or bunches of grapes.

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10
Q

Partial mole

A

69 XXX 69 XXY 69 XYY, slightly increased HCG, has fetal parts, no choriocarcinoma. Causes vaginal bleeding, has fetal parts on imaging.

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11
Q

Gestational hypertension

A

Greater than 140/90 after 20th week. No proteinuria or end organ damage. Deliver at 39 weeks.

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12
Q

Preeclampsia

A

Fibrinoid necrosis of spiral arteries in placenta, hypertension >140/90 after 20th week. Causes edema and stuff. Severe features can include headache, thrombocytopenia.

Severe form is HELLP syndrome (hypertension, elevated liver enzymes, low platelets).

Give IV magnesium sulfate to prevent seizures deliver at 34 or 37 weeks

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13
Q

Eclampsia

A

Preeclampsia and maternal seizures. Maternal death from stroke sometimes.

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14
Q

HELLP syndrome

A

Hypertension, elevated liver enzymes, low platelets. Can cause thrombocytopenia, microthrombi in liver causing schistocytes.

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15
Q

How to treat hellp?

A

A-methyldopa, hydralazine

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16
Q

Placental abruption

A

Causes painful bleeding, often from cocaine. Causes premature separation of placenta from uterine wall. Usually occurs in third trimester.

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17
Q

Placenta accreta

A

Placenta touches wall of myometrium

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18
Q

Placenta increta

A

Placenta penetrates into myometrium

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19
Q

Placenta percreta

A

Placenta penetrates through myometrium. Can attach to rectum or bladder.

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20
Q

Risk factors for placenta accreta, increta, percreta? Presentation?

A

Prior c section, placenta previa. Presents with no separation of placenta after birth. Massive bleeding. Life threatening.

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21
Q

Placenta previa

A

Attachment of placenta to lower uterine segment. Lies near or covers the os. Risk factors include multiparity or prior c section.

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22
Q

Placenta previa

A

Attachment of placenta to lower uterine segment. Lies near or covers the os. Risk factors include multiparity or prior c section.

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23
Q

Ectopic pregnancy

A

Usually in ampulla. Risk increases with PID, ruptured appendix. Often mistaken for appendicitis. Often has lower HCG than expected.

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24
Q

Polyhydramnios

A

Associated duodenal/esophageal atresia, anencephaly. maternal diabetes. Treat with indomethacin to reduce fetal urine.

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25
Q

Endometritis

A

Inflammation of the endometrium associated with retained products of conception following delivery. Treat with gentamicin and clindamycin

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26
Q

Endometriosis

A

Non-neoplastic endometrial glands/stroma outside of the endometrium. Most commonly in ovary, pelvis, peritoneum.

Characterized by cyclic pelvis pain.

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27
Q

Adenomyosis

A

Where the endometrium dives down into the myometrial layer. Treat with hysterectomy

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28
Q

Endometrial hyperplasia

A

Abnormal gland proliferation usually caused by excess estrogen. Risk for endometrial carcinoma. Usually presents as postmenopausal menstrual bleeding.

Risk factors include PCOS, granulosa cell tumor, anything that increases estrogen

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29
Q

Endometrial carcinoma

A

Most common gynecologic malignancy usually at 55-65. can present with vaginal bleeding and is typically preceeded by endometrial hyperlasia.

Risk factors usually due to increased estrogen without progestins

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30
Q

Endometrial carcinoma

A

Most common gynecologic malignancy usually at 55-65. can present with vaginal bleeding and is typically preceeded by endometrial hyperlasia.

Risk factors usually due to increased estrogen without progestins

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31
Q

Leiomyoma

A

uterine fibroid. A benign smooth muscle tumor with rare malignant transformation. Estrogen sensitive. Can cause abnormal uterine bleeding

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32
Q

Incidence of gynecologic tumors

mortality of gynecologic tumors

A

Endometrial>Ovarian>cervical

Ovarian>cervical>endometrial

33
Q

Most common cause of anovulation?

A

PCOS, cushing syndrome

34
Q

PCOS (stein leventhal syndrome

A

Syndrome where there is increased activity of theca cells producing androgens, but aren’t converted by granulosa cells to estrogen. Signs of androgen excess (hirsuitism, amenorrhea, acne). Associated with obesity and insulin resistance. LH/FSH is 3:1.

Ultrasound shows many follicles in ovary due to low FSH

35
Q

How to treat PCOS

A

Oral contraceptives, Metformin, clomiphene (to block negative feedback of estrogen), cyclic progesterones

36
Q

Follicular cyst

A

Distension of unruptured graffian follicle. Has fallopian-like cells. Most common ovarian mass. Associated with increased estrogen.

37
Q

Corpus luteum cyst

A

Caused by rupture into corpus luteum.

38
Q

Follicular cyst

A

Distension of unruptured graffian follicle. Most common ovarian mass. Associated with increased estrogen.

39
Q

Corpus luteum cyst

A

Caused by rupture into corpus luteum.

40
Q

Endometrioid cyst

A

Chocolate cyst

41
Q

Characteristics of ovarian neoplasms

A

Most common adnexal mass in women. Often present late due to nonspecific GI symptoms. Most malignant neoplasms are epithelial, but others can be sex-cord or germ cell.

Increased risk with increase age, endometriosis, PCOS, BRCA1/2/ HNPCC.

Monitor symptoms with CA-125

42
Q

Serous cystadenoma

A

Most common benign ovarian neoplasm. Thin walled and multilocular. Associated with fallopian epithelium

43
Q

Serous cystadenoma

A

Most common benign ovarian neoplasm. Thin walled and multilocular. Associated with fallopian epithelium

44
Q

Mucinous cystadenoma

A

Filled with mucous

45
Q

Mature dermoid cyst

A

All three germ layers represented. Can produce functional thyroid tissue (struma ovarii).

46
Q

Brenner Tumor

A

Looks like bladder, has coffee bean nuclei.

47
Q

Fibromas/Meig’s Syndrome

A

Bundles of fibroblasts in ovaries, associated with Meig’s Syndrome: Fibroma, ascites and hydrothorax.

48
Q

Immature teratoma

A

Aggressive, contains fetal tissue. No thyroid tissue

49
Q

Granulosa Cell tumors

A

Most common sex-cord stromal tumor. Often produce estrogen or progesterone, present with AUB. Histology shows CALL-EXNER bodies which are primordial follicles.

CALL GRANNY

50
Q

Serous cystadenocarcinoma

A

Most common ovarian neoplasm. Frequently bilateral. Has psammoma bodies

51
Q

Mucinous cystadenocarcinoma

A

Can present with pseudomyxoma peritonei - accumulation of mucus in the peritoneum also seen with appendicitis.

52
Q

Dysgerminoma

A

Most common in adolescents. Equivalent to male seminoma. Fried egg appearance.

Markers hCG and LDH

53
Q

Choriocarcinoma

A

Rare, can develop during or after pregnancy. Trophoblastic tissue. Produces B-HCG. Hematogenous spread to lungs. Responds well to chemo

54
Q

Yolk Sac (endodermal sinus tumor)

A

Aggressive in ovaries or testes. In young children. Yellow mass. Schiller-Duvall Bodies resemble primative glomeruli.

55
Q

Yolk Sac (endodermal sinus tumor)

A

Aggressive in ovaries or testes. In young children. Yellow mass. Schiller-Duvall Bodies resemble primative glomeruli.

56
Q

Krukenberg tumor

A

Bilateral ovarian involvement from diffuse gastric cancer. Mucin secreting signet cell adenocarcinoma.

57
Q

Vaginal squamous cell carcinoma

A

usually secondary to cervical squamous cell carinoma

58
Q

Vaginal clear cell adenocarcinoma

A

Usually in response to women who were exposed to DES in utero.

59
Q

Sarcoma botryoides

A

Affects very young girls, spindle shaped tumor desmin postive. A type of rhabdosarcoma.

60
Q

Breast cancers

A

Review them

61
Q

Prostatitis

A

Dysuria, increased frequency of urination and urgency. Low back pain. Mostly from e.coli. Abacterial most common if chronic

62
Q

BPH

A

Driven by DHT. Common in men >50. In perirurethral zone. Presses urethra. Not premalignant but can increase PSA. Can also cause hydronephrosis.

63
Q

How to treat BPH

A 
Alpha antagonists (terazosin, tamulosin) -- relax smooth muscle.
Finasteride (5Areductase inhibitor)
64
Q

Prostatic adenocarcinoma

A

Men>50. Posterior lobe of peripheral zone. Increased PSA then needdle biopsy. PAP and PSA are important. Causes osteoblastic bone lesions.

65
Q

How to treat prostatic adenocarcinoma

A

Prostatectomy, leuprolide (GNRH agonist continuously), or flutamide (androgen receptor inhibitor).

66
Q

How to treat prostatic adenocarcinoma

A

Prostatectomy, leuprolide (GNRH agonist continuously), or flutamide (androgen receptor inhibitor).

67
Q

Cryptorchidism

A

Undescended testicle causes impaired spermatogenesis (since sertoli cells are affected by temp) testosterone normal. Increased risk of seminomas. Decreased inhibin, increased FSH and LH.

68
Q

Varicocele

A

Dilated veins in pampiniform plexus due to increased venous pressure.

69
Q

Varicocele

A

Dilated veins in pampiniform plexus due to increased venous pressure. Left side more common. Bag of worms. increased temp.

70
Q

Seminoma

A

Painless homogenous testicular enlargement. Most common testicular tumor occurs during 20s. Fried egg appearance. Increased placental ALP. Late mets with good prognosis

71
Q

Yolk Sac tumor

A

yellow mucinous, aggressive. Like ovarian yolk sac tumor Schiller-duval bodies look like primative glomeruli. Common in boys

72
Q

Choriocarcinoma

A

Poor prognosis with increased HCG. Causes mets with small primary tumor. Met to lungs and brain. Can cause gynecomastia or hyperthyroidism. Can bleed in brain

73
Q

Teratoma

A

Malignant in males. AFP up in most cases.

74
Q

Embyonal carcinoma

A

Early mets, primative cells that grow rapidly. usually mixed. increased HCG and normal afp when pure. Painful. Worse prognosis

75
Q

Leydig cell tumor

A

Contain Reinke crystals. Produce antrogens.

76
Q

Testicular lymphoma

A

Usually in older men from Diffuse large b cell lymphoma.

77
Q

Squamous cell carcinoma of the penis

A

Common is asia africa south amercia. precursos in situ lesions.Bowen disease (leukoplakia) erythroplasia of Queyrat (cancer of glands) . Associated with HPV lack of circumcision.

78
Q

Trazodone can cause…

A

Priapism

79
Q

How to reduce fetal urine in polyhydramnios?

A

Indomethacin

STEP 1 Review (21 decks)

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