STEP1_Repro/LC Flashcards
Biopsy of the endometrium showing neutrophils with in the endometrial glands indicated what disease pathology?
Acute (early-onset) Endomteritis
A Lab positive for Desmin indicates what?
Sarcoma botryoides: malignant mesenchymal prolif of immature skeletal muscle.
this diz is in kids <4 years old
Adenosisof the vaginais the focal persistence of _________ epithelium in the upper vagina.It is a precursor of vaginal clear cell carcinoma.
columnar epithelium
What are the risk factors/cause of increase and unopposed estrogen: (8)
- early menarche; late menopause
- Nulliparity
- Anovulatory cycle
- PCOS
- Obesity
- Estrogen-secreting tumors (Granulosa cell tumors)
- Tamoxifen
- Used of drugs that increase estrogen without progesterone in the replacement therapy
Clear Cell Adenocarcinoma is ~w/ the side effects of what drug?
Diethlstilbestrol (DES); used to be given to women who were at risk for miscarriages/
For endometrial, cervical and ovarian cancers, list them best/greatest to worst/least in terms of incidence and prognosis.
Prognosis (best to worst):
cervical > endometrial > ovarian
Incidence (greatest to least):
endometrial > ovarian > cervical
What is the most common ob/gyn cancer in women?
Endometrial cancer
what ob/gyn cancer in women has the WORST progX?
Ovarian
what ob/gyn cancer in women has the BEST progX?
Cervical
____1____ is hyperplasia of the theca interna of the ovary. It is when an area of luteinization occurs along with stromal hyperplasia. The luteinized cells produce ____2____ , which may lead to hirsutism and virilization (or masculinization).
- Hyperthecosis
2. androgens
Psammoma bodies are ~w/ what ob/gyn cancer?
Serous cystadenocarcinoma (& invading papilary structures are also seen.
What are the two major genetic risk factors for surface epithelia ovarian tumors?
BRAC1
Lynch Synd. (HNPCC)
They occur in mainly older pt.
Histology of a Krukenberg tumor will show what type of cells? and what are these cells ~w/?
Signet ring cells are ~w/ mainly stomach cancers, but can be from any GI cancers.
also will show mucin-secreting cells.
Granulosa cells tumors are ________0secreting tumors and pt. will present differently base on age.
Granulosa cell tumors produce estrogen!
A pt. with the following has what diz?
Ovarian fibroma \+ Ascities \+ Pleural effusion
Meigs syndrome
Sx = “pulling sensation in the groin”
Where is the loc. of yolk sac tumors in males?
testes
Choriocarcinoma and hydatifrom moles are ~w/ what tumors?
Theca-lutein cysts
Reinke crystal = ?
sertoli-leydig cell tumor
they are in the leydig cells
A thecoma is a ____1____ tumor of the theca cells that are typically ____2____-producing.
- Benign
2. estrogen-producing
What is the most common malignant germ cell tumor in females
Dysgerminoma
increases in oth hCG and LDH!
On H&E, you see “coffee bean” nuclei, you should be thinking…?
Brenner tumor; benign surface epit tumor of the ovaries. plae yellow-tan and looks encapsulated.
You see “Call-Exner bodies”, what should be at the top of your differential?
Granulosa Cells Tumors.
You see Psammoma Bodies on histology, what should you be thinking?
Serous cystadenocarcioma
Psammoma Bodies are (distrophic calcification)
What is the most common malignant stromal tumor (commonly seen in women in their 50s)?
Granulosa Cell Tumor
_____1_____ are benign cystic tumors lined with cells similar to fallopian tube epithelium.
- Serous cystadenomas
__________________ are malignant tumors usually found in the ovaries
Serous cystadenocarcinomas
Mucinous cystadenomas are benign tumors characterized by ____________, lined by mucus-secreting columnar epithelium and filled with mucinous material.
multilocular cysts
___________________________ are malignant tumors, which can result through rupture or metastasis in pseudomyxoma peritonei with multiple peritoneal tumor implants, all producing large quantities of intraperitoneal mucinous material.
Mucinous cystadenocarcinomas
______________ are rare, benign tumors characterized by small islands of epithelial cells, resembling bladder transitional epithelium, interspersed within a fibrous stroma.
Brenner tumors
Serous cystadenomas are benign cystic tumors lined with cells similar to what?
fallopian tube epithelium
_____1_____ is a rare form of monodermal teratoma that is mostly comprised of thyroid tissue, and often leads to symptoms of hyperthyroidism. They are usually unilateral, and most commonly seen in _____2_____.
- Struma ovarii
2. mature teratomas
What should be the LH:FSH ratio be to dX PCOS?
LH:FSH >2.0 (or >2.5, depends on texts)
hematosalpinx:?
Bleeding into fallopian tube
Inhibin A - important in _____1_____
Inhibin B - important in ______2______ phase of menstrual cycle
- luteal phase
2. follicular
When testing for menstrual cycle abnormallities, what do you NOT need to do/test?
DO NOT need to test for androgen or do a GnRH stimulation test.
What time should you test a women for her LH and FSH?
day 3, 4, 5 of her cycle.
should be: LH=FSH
What type of drug is Raloxifene? what is its agonist and antagonist activ`ity?
Raloxifene is a SERM.
Agonist @ bone & liver
antagonist @ uterine and breast!
Raloxifene has NO EFFECTS on breast of endometrial tissues
What is Tamoxifen used for?
Tx and prevention of breast cancers.
ADRs Tamoxifen = 5x increase in endometrial cancer, hot flashes, Thromboembolic events.
What are the 3 methods of EMERGENCY contraceptives?
- Plan B; progestin only (75% effective)
- Cupper IUD (99% effective)
- Ella: ulipristal acetate = progesterone receptor modulator. better efficacy then Pnan B.
What ob/gyn hyperplasia has NO increase risk of cancer?
Lichen Simplex Chronicus
What is the focal persistence of columnar epithelium of the upper vaginal called?
Adenosis
~w/ moms getting DES
What is the precursor lesion to SCC?
CIN,
Koilocytic change seen on histo
Meiotic division which gives rise to secondary oocyte occurs in ____1____ follicle just before ____2____
- Graafian cells
2. ovulation
What are the func. of Sertoli cells? (6)
1) Form blood-testis barrier (tight junctions)
2) Nurture developing sperm
3) Secrete androgen binding protein (APB) → maintain high local level of testosterone
4) Convert androgens to estrogen (via aromatase)
5) Secrete inhibin and other growth factors
6) Respond to FSH through GPCR
What makes hPL during in a prego?
Human Placental Lactogen (hPL) is made by Syncytiotrophoblast
What are the actions of hPL?
hPL modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus.
The metabolic functions of hPL include:
- decreased maternal insulin sensitivity
- decreased maternal glucose utilization
- increased lipolysis
On breast examination, a painless, firm, and rubber-like in texture nodule is found, what is it?
Fibroadenomas are the most common benign tumors of the breast.
What is Fibrocystic breast disease (FBD)?
Fibrocystic breast disease (FBD) is a disorder commonly seen in women of childbearing age that results in tender swollen breasts. FBD is most commonly seen with hormonal changes during a woman’s menstrual cycle and tends to improve towards the completion of their menstrual cycle. On examination, patient’s breasts are often tender to touch and can present with several small tender nodules throughout their breast tissue. These nodules are actually inflamed swollen breast lobules that results from a spike in estrogen levels during the menstrual cycle. This patient can most likely be observed for now given her current presentation and young age. If her breast lumps do not subside after a few weeks, she will likely require ultrasonography for further evaluation. Most FBD patients are treated with over-the-counter non-steroidals such as ibuprofen or naproxen, ice packs, or oral contraceptives.
What creates the blood-testis barrier?
Tight junction between Sertoli Cells.
What is Lichen simplex chronicus?
Lichen simplex chronicus is a chronic skin condition caused by a trigger, such as an irritant or infection, that causes pruritus, which leads to scratching. The scratching leads to skin damage which, in turn, leads to further itching. This itch-scratch cycle continues and leads to thickening of the skin. This patient has pruritus which began after exposure to a trigger (a new scented body wash) and has persisted, along with evidence of skin thickening on exam.
___________ is a chronic autoimmune condition that leads to thinning of the vulvar skin. Patients primarily complain of itching. Physical exam demonstrates “cigarette-paper” skin that is thin and wrinkled. The labia may be attenuated or obliterated, as may the clitoris. Skin changes often occur in an hourglass or figure-of-eight distribution.
Lichen sclerosus
Physical exam demonstrates “cigarette-paper” skin that is thin and wrinkled, what is the Disease?
Lichen sclerosus;
chronic autoimmune condition that leads to thinning of the vulvar skin.
a rare breast cancer characterized by scaly, vesicular, or ulcerated lesions that begin on the nipple and spread to the areola.
What is the patho?
Paget disease of the nipple/breast.
Other symptoms include bloody nipple discharge, nipple retraction, and sensations of pain, burning and/or pruritus. In 80 to 90% of Paget cases, there is an underlying breast cancer.
Pt. with Sx of enlarged, boggy uterus on exam is suggestive of what?
Adenomyosis
Adenomyosis occurs when islands of endometrial tissue grow within the uterine myometrium and is associated with dysmenorrhea (secondary dysmenorrhea), and menorrhagia.
Ectopic growth of endometrial tissue outside of the uterus is indicative of what?
Endometriosis
Bimanual exam of a patient with endometriosis might reveal adnexal masses (“chocolate cysts” on the ovaries), areas of tenderness, or nodularity of the uterosacral ligaments. The uterus would be expected to be a normal size and contour.
What would be the size and contour of the uterus in a pt. with endometriosis.?
The uterus would be expected to be a normal size and contour.
Dysregulated growth of smooth muscle within the myometrium describes what?
Uterine leiomyomas, or fibroids.
This describes uterine leiomyomas, or fibroids. Fibroids may also present with heavy and painful periods, but physical exam will reveal a “lumpy-bumpy” uterus with an irregular contour. The symmetrically enlarged, boggy uterus described here is more characteristic of adenomyosis.
A physical exam with a “lumpy-bumpy” uterus with an irregular contour ==??
Uterine leiomyomas, or fibroids.
The American College of Obstetricians and Gynecologists suggest against what type of exercise for a pregnant woman?
No hot-yoga. No off-road cycling.
patient should discontinue hot yoga and off-road cycling because these are considered unsafe during pregnancy due to heat stress and the risk of falling, respectively
Pregos can running all they want. This ligament contains the ovarian artery, vein, and nerves. The ovarian artery is the primary blood supply of the ovaries and forms anastomoses with the uterine artery.
What ligament of the uterus attaches the lateral aspect of the cervix to the abdominal wall?
cardinal (or transverse) ligament
What does the cardinal ligament contain?
uterine artery and uterine vein.
During hysterectomy, the cardinal ligament is often ligated to cut off blood flow to the uterus.
What is the difference between fibrocystic change and Fibroadenoma?
fibrocystic breasts sometimes present with breast tenderness that can usually be treated effectively with non-steroidal anti-inflammatory drugs. Increased breast pain or lumpiness often occurs just prior to a menstrual period.
Fibroadenoma is another benign condition; it is usually identified by a solitary lump, rather than bilateral changes.
During implantation, What structures secretes the hormones that keep the endometrium prepared for implantation of a developing embryo?
Corpus luteum;
synthesizes and secretes Progesterone. Progesterone increases vascularization and glandular secretion from the endometrial lining to help prepare the endometrium for receipt of a developing embryo.
No fertilization ==> decrease in progesterone and start of menses.
What is the regressed form of the corpus luteum that can no longer secrete hormones?
Corpus albicans
What is the regressed form of the corpus luteum that can no longer secrete hormones?
Corpus albicans
During the First Trimester:____ stimulates the production of progesterone by the corpus luteum.
hCG
hCG peaks during the first trimester.
What hormone stimulates peripheral insulin resistance in the mother during pregnancy.
Human placental lactogen stimulates peripheral insulin resistance in the mother. While this may benefit the infant by ensuring that adequate levels of glucose reach the placenta, it also contributes to gestational diabetes mellitus in the mother.
sildenafil is used to Tx erectile dysfunction, what is its MOA?
sildenafil exert their vasodilatory effects via inhibition of the enzyme phosphodiesterase (PDE5), which normally acts to break down cGMP in vascular smooth muscle. The smooth muscle cells produce cGMP in response to stimulation by nitric oxide, which in turn promotes smooth muscle relaxation.
What is a malformation of the venous plexus and is not a firm mass, that typically disappears when seated or lying down, secondary to improved venous drainage.
varicocele
What is a hydrocele?
hydrocele is a collection of peritoneal fluid that accumulates between the parietal and visceral layers of the tunica vaginalis and surround the testis and spermatic cord. The fluid in scrotal sac transilluminates distinguishing it from other scrotal masses includes hematocele,
What syndrome should you suspect in a patient with an ovarian mass (usually a benign fibroma) with hydrothorax and ascites.
Meigs syndrome
The combo of Hydrothorax (often right sided), ascites, and ovarian tumor (of a benign fibroma) is what syndrome?
Meigs Syndrome
What causes cervicitis and pelvic inflammatory disease, and is the most common bacterial STD in the U.S?
Chlamydia trachomatis.
Early signs and symptoms of a chlamydial infection in women tend to be mild and include pain during urination, frequent urination, and low-grade fever.
What is the most significant risk factor for breast caner in females?
Positive Family History
What nerve innervated the perineum?
Pudendal nerve
What anatomical landmark is used to located the pudendal nerve for a block?
Ischial spine
What is the origin of the Krukenberg tumors, and what is the associated cell type?
Krukenberg tumors are gastric mucinous adenocarcinomas that have metastasized to the ovary.
Usually, both ovaries are involved.
Signet ring cells: cytoplasmic mucin droplet pushes aside the nucleus of an adenocarcinoma cell
What is the most worrisome complication of Crytorchidism?
Testicular carcinoma
Also, infertility, but ain’t as bad as cancer.
What neoplasm is a surface-derived ovarian tumor that represents about 40% of all ovarian tumors.
Serous cystadenocarcinoma
What do Serous cystadenocarcinomas look like?
filled with clear fluid and is lined up my epithelia cells forming papilaary fronds.
2/3 are bilateral and tend to occur between 40-65 years of age.
What drug is indicated for Tx of initial and recurrent mucosal and cutaneous infectons causes by HSV-1 & 2?
Acyclovir; which is NOT a bone-marrow suppressant, vs. Gancyclovir, which is.
germ-tube test that demostates psudohyphae == ?
Candida
itching and soreness, pain on intercourse, findings of pseudohyphae in vaginal secretions, vaginal discharge with a “cottage cheese-like” consistency, a normal vaginal pH (4.0–4.5), and absence of a particular odor.
Candida
What are Diabetics prone to vaginal canadiasis?
The increased vulnerability in diabetes may reflect increased glucose concentrations in vaginal secretions and relative immunosuppression. Treatment is typically with an “-azole” such as fluconazole.
What is an oxytocic?
a drug that causes uterine contractions
What is the use and MOA of Dinoprostone?
Dinoprostone is a synthetic PGE2 preparation that is administered vaginally for oxytocic (uterine contractions) use.
It also promotes cervical ripening by increasing proteoglycan content and changing the properties of collagen.
When given as a vaginal insert, what drug, induces cervical softening and effacement, and causes the cervix to dilate and the uterus to contract.
dinoprostone (prostaglandin E2)
What is the use and MOA of Alprostadil?
Alprostadil. or prostaglandin E1, is a vasodilator used to treat erectile dysfunction. It can be administered via intracavernous injection or with an intraurethral pellet.
What is the use and MOA of Epoprostenol?
Epoprostenol, which is used to treat pulmonary hypertension, is a formulation of prostaglandin I2 , which causes vasodilation of pulmonary blood vessels.
Administration of synthetic form of what hormone is a proven method of labor induction?
oxytocin.
Intravenous administration of this drug produces periodic uterine contractions. Although it is indicated for labor induction or augmentation, it is not a prostaglandin analog.
Oxytocin (choice E) is a polypeptide hormone produced in the hypothalamus and secreted from the posterior lobe of the pituitary gland.
Describe the histological appearance of a Seminoma.
Seminoma histologically presents as nests or lobules of malignant cells surrounded by lymphocytic infiltrate.
Seminoma is radiosensitive and the prognosis is better than for other nonseminomatous germ cell tumors.
Does does Actinomyces israelii, gram-positive, branching, anaerobic rod, associated with female reproductive pathology?
Actinomyces israelii is a gram-positive anaerobic rod that can cause cervicofacial, female reproductive, or gastrointestinal mycetomas with sulfur granules.
In a pt. with an IUD and experiencing unusual vaginal discharge, what should you be thinking?
Actinomyces israelii;
which is an anaerobic normal flora organism that lives in the GI and female reproductive tract.
Actinomyces is commonly associated with______________ when it invades from the gingival crevices into the tissues near the jawline.
cervicofacial mycetoma (lumpy jaw)
PID is most commonly associated with infection of Neisseria gonorrhoeae and Chlamydia trachomatis.
But what other bug can also cause PID?
Actinomyces israelii
What is the most common breast mass in men, especially in men under 25 years of age?
Gynecomastia, which is a benign proliferation of ductal and stromal elements of the breast. It is generally an idiopathic condition, probably related to pubertal hormonal changes, specifically an increase in estrogen activity compared to testosterone activity.
Gynecomastia can involve either one or both breasts and, if it arises during adolescence, will often resolve spontaneously with time. It can present either as a diffuse enlargement or as an isolated mass. In adolescents, pain is usually associated with this condition though not always. Nipple discharge may or may not be present.
Other than puberty, what are other causes of gynecomastia?
- Liver cirrhosis (due to decreased estrogen breakdown).
- Testicular tumors (increased aromatase activity)
- alcohol, certain medications; (spironolactone, digoxin, cimetidine, and ketoconazole)
- Hyperthyroidism, and Klinefelter syndrome (XXY karyotype).
_____?_____ tumors produce a yellow, mucinous mass that histologically shows endodermal sinus formation and presence of hyaline droplets.
Yolk-sac tumors
What is use as a tumor marker for yolk-sac tumors?
α-Fetoprotein (AFP) can be used both to mark the tumor in histologic sections and as a serum tumor marker for metastatic pure yolk-sac tumor or mixed non-seminomatous germ cell tumors.
What are immunohistochemical stains for seminomas?
CD117 and Placental Alkaline Phosphatase (PLAP)
hCG can be used as a serum marker to detect what two pathologies in men?
choriocarcinoma and seminoma?
Prostate-specific antigen (PSA) is a serum marker that may be elevated in what? (3)
- prostatic carcinoma
- a cute prostatitis
- benign prostatic hypertrophy.
Currently, it is not considered a screening or diagnostic test, but it may be helpful for patient monitoring regarding cases of prostate cancer recurrence or metastasis.
What is the most serious complication of a hydatidiform mole? Why?
Choriocarcinoma
Rapid trophoblastic proliferation in complete moles heightens the potential for malignant transformation into choriocarcinoma.
Choriocarcinoma has a significant propensity for hematogenous spread, particularly to the lungs and brain. If a complete mole has progressed to choriocarcinoma, usually the chorionic villi are obliterated and replaced
What would a pathogist call densely packed epithelial cells with large, dark nuclei and markedly increased nuclear/cytoplasmic ratio?
Severe cervical dysplasia (CIN 3), also considered as carcinoma in situ (CIS) or high grade squamous intraepithelial lesion (HSIL).
Iodine-staining intraepithelial inclusion bodies == ???
Chlamydia trachomatis
Intracellular, non-gram staining organism that is defective in ATP production
List the Possible precursors of squamous cell carcinoma of the penis: (5)
- Bowen disease
- Bowenoid papulosis
- Erythroplasia of Queyrat
- Condyloma acuminatum
- Giant condyloma
__________ : form of carcinoma in situ that presents as a gray-white plaque.
Bowen disease
____________: form of carcinoma in situ that presents as multiple reddish-brown papular lesions
Bowenoid papulosis
Bowenoid papulosis: ???
form of carcinoma in situ that presents as multiple reddish-brown papular lesions
____________: form of carcinoma in situ that presents as a soft red plaque
Erythroplasia of Queyrat
Erythroplasia of Queyrat: ???
form of carcinoma in situ that presents as a soft red plaque
_____________ : HPV-related lesion that resembles a common wart that (rarely) develops into invasive squamous cell carcinoma
Condyloma acuminatum
Condyloma acuminatum: ???
HPV-related lesion that resembles a common wart that (rarely) develops into invasive squamous cell carcinoma
___________ : large, locally aggressive version of condyloma acuminatum; usually does not metastasize (but also has a small potential for developing into squamous cell carcinoma)
Giant condyloma
Giant condyloma: ???
large, locally aggressive version of condyloma acuminatum; usually does not metastasize (but also has a small potential for developing into squamous cell carcinoma)
Bowen disease: ???
form of carcinoma in situ that presents as a gray-white plaque.
The bulk of oocytes in babies, girls, and premenopausal women are arrested at what phase?
prophase of the first meiotic division (meiosis I).
What is the processus vaginalis?
The processus vaginalis is an evagination of the parietal peritoneum that descends through the inguinal canal.
If a part of the processus vaginalis does not fuse, the resulting cystic structure called what?
Hydrocele
what type of neoplasms include Bowen disease (solitary whitish plaque), bowenoid papulosis (multiple reddish-brown papules), and erythroplasia of Queyrat (single or multiple shiny red plaques).
penile squamous cell carcinoma in situ
What pathology usually produces a raised papillary lesion, and is related to infection with human papillomavirus (HPV).
Condyloma acuminatum.
What is a chronic inflammatory condition of the skin that produces white plaques, usually on or near the genitals, but also in other locations.
Lichen sclerosis;
It histologically shows an inflammatory infiltrate at the dermal-epidermal junction and a significantly thinned epidermis. The dermis shows edema, then eventually fibrosis.
What is a disorder causing fibrosis in the tunica albuginea of the penis, causing curvature of the penis and painful erections.?
Peyronie disease;
The fibrotic plaques show abnormal elastic fibers and excessive collagen deposition.
What disease process takes the form of a painless, button-like mass called a chancre, which could be present in the genital area, including the penis?
Primary syphilis
what does Primary syphilis look like microscopically?
Microscopically, there would be chronic inflammation with abundant plasma cells.
Vacuoles with reticulate bodies in epithelial cells = ?
C. trachomatis
Infants who acquire infection from what pathogen during vaginal birth usually present with conjunctivitis and pneumonia.
C. trachomatis
Conjunctivitis precedes the pneumonitis. Tachypnea, hypoxemia, crackles, wheezing, and mild to moderate eosinophilia > 400 cells/mm3 or > 5% are evident at approximately 6 weeks.
Chlamydia pneumonia may present with a “staccato cough” (inspiration between each single cough).
Chest x-ray may show scattered infiltrates and hyperinflation of the lungs.
What are mitotically active 2n cells that serve as the stem cells for spermatogenesis.
Spermatogonia
What should you suspect in a 3rd trimester prego who develops;
- Edema
- Hypertension
- Proteinuria
- Elevated AST & ALT
- Low Platelets
Preeclampsia
HELLP syndrome.
A systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg and proteinuria is diagnostic.
Iodine-staining intraepithelial inclusion bodies == ??
Chlamydia trachomatis:
Intracellular, non-gram staining organism that is defective in ATP production. Because it is an intracellular organism, it can only be visualized inside epithelial cells with iodine, Giemsa, or fluorescent-antibody strains.
Intranuclar inclusion bodies surrounded by halos ==> ??
CMV
those are “Owl eyes”
Pt. will have monoculeosis-like Sx, but neg horse serum tests
Lactose-fermenting, Gram-neg bacilli == >
E. coli
Pear-shaped, flageelated protozoa == ?
Trichomonas vaginalis
malodorous, green-yellow discharge, and “strawberry” cervix
Pleomorhpic, gram-neg rod and painful, soft genital lesion ==>
Haemophilus ducreyi
What are the epithelial type ovarian neoplasms?
- serous cystadenocarcinoma
- Mucinous Cystadenocarinoma
What are the germ cell type ovarian neoplasms?
- Dysgerminoma
- Endodermal sinus tumor (yolk sac)
What are the stroma (sex-cord) type ovarian neoplasms?
- Granulosa cell
- Setoli-Leydig cells tumor
- Most common ovarian neoplasm
- often bilateral
- HISTO: Psammoma bodies
Serous Cystadenocarinoma
epithelial ovarian neoplasm
~w/ Pseufomyxoma pertonei
- mucin-producing epithelial cells
Mucinous Cystadenocarinoma
epithelial ovarian neoplasm
- Adolescents
- increase beta-hCG
- increase LDH
HISTO: “fried egg cells”
Dysgerminoma
Germ cell ovarian neoplasm
- increase AFP
- Aggressive
- Schiller-Duval bodies that resemble glomeruli
Endodermal Sinus Tumor;
aka: Yolk Sac tumor
(Germ cell ovarian neoplasm)
- increase estrogen (eg. endrometrial hyperplasia)
- increase Inhibin
HISTO: Call-Exner bodies, coffee-bean nuclei
Granulosa cell tumor
stroma [sex-cord] ovarian neoplasm
- increase Androgens (eg. hirsutism, clitoromegaly)
Sertoli-Leydig cell tumor
stroma [sex-cord] ovarian neoplasm
tumor with a golen-brown color on gross histo.
pale-staining rod-shaped inclusions == ???
Leydig cell tumor;
pale-staining rod-shaped inclusions = Reinke crystals
_________ tumors are gray-white to yellow, and microscopically form cordlike structures resembling seminiferous tubules. They do not show Reinke crystals
Sertoli cell tumors
Germ Cell
Most common in infants and younger children. Presents with several different types of tissues, such as nerves, muscles, cartilage, and hair.
Benign during childhood; variable duringadulthood.
Teratoma
Germ Cell
Rare overall, but more common in infants and children. Aggressive tumor. Elevated alpha-feto-protein is present.
Yolk-sac tumor
Germ Cell
Men 15-25 years old. Malignant.
May have gynecomastia and Testicular enlargement.
Elevated hCG levels.
Choriocarcinoma
Germ Cell
Men 20-30 years old. Aggressive.
Testicular enlargement with metastasis often at time of presentation.
Elevated serum alpha-fetoprotein.
Embryonal carcinoma
Germ Cell
Peak in men in their 50s. Nuclear atypia present.
Seminoma
Germ Cell
Unilateral.
Produces estrogens or
androgens.
Produces clinical symptoms of masculinization or Feminization in children, gynecomastia in adults.
Often benign
Leydig cell tumor
Non-germ cell
Unilateral.
Small amounts of estrogens or androgens produced; not enough to
cause clinical symptoms.
Over 90% are benign.
Sertoli cell tumor
Non-germ cell
Most common in the elderly; often
disseminated.
Lymphoma
Non-germ cell
Pleomorphic, gram-negative rod that displays a characteristic pattern (“school of fish”) on Gram-stained slides. It grows on chocolate agar or on whole blood agar with a satellite phenomenon (around Staphylococcus aureus).
Haemophilus ducreyi
Epithelial cells with intranuclear inclusion bodies are found withwhat infections?
herpes simplex infections (HSV).
HSV vesicles (individually, up to 0.5 cm in diameter) evolve to shallow ulcers on an erythematous base, with vesicular lesions being, painful and recurring.
Diagnostic confirmation of HSV infection includes demonstration of HSV DNA in lesion scrapings.
List of the organisms causing genital ulcers: (5)
Herpes simplex virus (HSV)
Treponema pallidum (causes syphilis)
Haemophilus ducrey (causes chancroid)
Chlamydia trachomatis serovars L1-3 (causes lymphogranuloma venereum)
Klebsiella granulomatis (causes granuloma inguinale)
What organism causes granuloma inguinale?
Klebsiella granulomatis
Unopposed estrogen contributes to the endometrial hyperplasia and increases the risk for what?
endometrial carcinoma, specially, granulosa cell tumors.
What levels of what hormone can cause repeated early pregnancy losses?
Low Progesterone
low progesterone –> atrophy of the endometrium
what are:
- Are benign masses composed of whorls of smooth muscle cells
- May cause abnormal uterine bleeding and anemia, more often in premenopausal patients
- Show immunoreactivity for smooth muscle actin
Uterine leiomyomas
Stimulation of what receptors causes uterine contraction?
Stimulation of what receptors causes uterine relaxation?
Stimulation of α1 causes uterine contraction;
stimulation of β2 receptors causes uterine relaxation.
Stimulation of what receptors causes uterine contraction?
Stimulation of α1 causes uterine contraction;
Stimulation of what receptors causes uterine relaxation?
stimulation of β2 receptors causes uterine relaxation.
Epi has high affinity for what receptor?
α1 > β2
What causes epinephrine to subsequently act as a pure α agonist, causing robust uterine contraction.
When beta receptors are blocked with propranolol,
_____________ are a common cause of first trimester pregnancy loss.
Chromosomal abnormalities
what is an important cause of both second and third trimester losses?
Chorioamnionitis
Abruptio placentae and placenta previa can cause what?
third trimester pregnancy losses
Vesicular lesions localized to the penis is a classic example of an infection by what?
HSV-2
B-cells are the site of latency for what?
EBV
EBV does NOT cause vesicular lesion on the penis.
EBV ==> monoculeosis Sx; fever, sore throat, fatigue, splenomegaly.
Polyhydramnios is associated with what fetal abnormalities: (4)
- Anencephaly
- Esophageal, duodenal atresia.
- Tracheoesophageal fistula.
- Fetal anemia
What type of breast neoplasm does not usually produce a mass, but is often detected as calcification on mammography?
DCIS
Ductal Carcinoma in-situ
Lesions that are scaly, vesicular, or oozing start in the nipple then spread to the areola.
Sometimes a bloody discharge is also present. Patients may complain of pain, burning, or pruritus before the lesions appear.
Immunohistochemical stain confirms the cells in question are epithelial cells with a positive cytokeratin stain.
Paget disease of the breast.
Histologically, malignant (in situ or invasive), mucin-containing cells (Paget cells) extend intraepidermally within the large ductal system into the nipple skin without crossing the basement membrane.
Breast cancer with postivie positive cytokeratin stain on immunohistochemical stain is suggestive of what?
Paget disease of the breast.
What is a papillary mass arising within the large ducts, usually presents as a single subareolar tumor that may produce a bloody or serous nipple discharge.
Intraductal papilloma.
Most intraductal papillomas are benign and are cured with complete excision.
What is a tumor of the terminal ductules of the breast. It presents as a poorly circumscribed, rubbery breast mass, comprised of invasive single-filing arrangement of tumor cells.
Invasive lobular carcinoma.
In contrast, invasive ductal carcinoma tends to appear as a hard, stellate, and fibrous tumor.
Lobular carcinoma does not produce Paget disease since it does not invade along large duct epithelium.
What tumors usually present in older patients as a large, firm, circumscribed breast tumor.
Microscopically, there is stromal and epithelial proliferation.
Phyllodes tumor.
The tumors tend to be benign, but a small number may have malignant transformation. There is no nipple involvement.
Cervicofacial myceoma ~w/?
Actinomyces israelli
Elevation of androgens, virilization, hypertension, and hypokalemia all suggest a CAH syndrome with what enzyme deficiency.
11β-hydroxylase deficiency
since this is the only enzyme defect that would increase 11-DOC (which has mineralocorticoid activity) and androgen production.
All the forms of congenital adrenal hyperplasia (CAH) results in a decrease in what?
CAH = decrease cortisol
BPH can be a cause of what renal dysfunction?
Post-Renal Azotemia.
BPH blocks the outflow of the kidneys. ==> high BUN/Cr. ratio
nuclear homegenatization (“ground-glass” nuclei) intranuclear inclusions (Cowdry type A bodies). and the formation of multinucleated giant cells ==>
HSV infection
What do you need to keep monitoring after a removal of a complete hydatidiform mole?
Beta-hCG
Communicating hydroceles and indirect inguinal hernia are caused by what?
The incomplete obliteration of the process vaginalis.
