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ENRP > Week 1 (Exam 1) > Flashcards

Week 1 (Exam 1) Flashcards

1
Q

How do phyllodes tumor usually present?

A

Palpable mass, can be massive

High grade can recur and some high grade stromal components metastasize

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2
Q

Fetus papyraceus

A

Mummified fetus associated with multiple gestations where one fetus dies and is flattened between membranes of living fetus and uterine wall

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3
Q

How is endometriosis tissue different from regular endometrium?

A

Proinflammatory and angiogenic factors
Produces increased estrogen from increased aromatase
Mutated ts and oncogenes (KRAS, PIK3CA, PPP2R1A, deeply infiltrating ARID1A)

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4
Q

Major complications of ascending cervical infections

A

Bartholin gland abscess (vulvo-vaginal)
Ectopic pregnancy (from salpingitis, stricture)
Sterility (hydrosalpinx, tubo-ovarian abscess, PID)
Fitz-Hugh-Curtis Syndrome (from PID)

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5
Q

E1

A

Estrone: menopausal estrogen from aromatizing androstenedione in peripheral fatty tissue
Less potent than E2 estradiol

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6
Q

What correlation exists in a patient with a dysgerminoma and elevated chorionic gonadotropin?

A

Syncytiotrophoblastic giant cells

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7
Q

Histology of lichen sclerosis

A

Hyperkeratosis with thinned epidermis

Hyaline zone in superficial dermis from edema and degeneration of collagen and elastic fibers of dermis

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8
Q

Rokintanksy’s Protuberance

A

Solid prominence at the junction between the teratoma and normal ovarian tissue
Rupture can lead to chemical peritonitis

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9
Q

Surgical treatment for different kinds of leiomyomas

A

Submucosal: Hysteroscopic Myomectomy

Pedunculate, subserosal, intramural: Lap/robot

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10
Q

Granulosa cells

A

Become granulose lutein cells

Secrete progesterone and estrogen

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11
Q

What breast carcinoma is associated with calcifications?

A

DCIS

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12
Q

How to rapidly diagnose ruptured ectopic pregnancy

A

hCG titers, pelvic sonography, endometrial biopsy, laparoscopy

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13
Q

Common feature of Atypical lobular hyperplasia and LCIS

A

Loss of E-cadherin expression (associated with p120 catenin and b-catenin)

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14
Q

Trichomoniasis

A

Strawberry Cervix, pH below 4.5, Green-yellow froth
Half ASx, irritation, painful sex
Tx w/ Metronidazole 2g single dose
Sexually transmitted

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15
Q

How is endometrial proliferation suppressed post-ovulation?

A

Secretory vacuoles appear in the glandular epithelium

Secretory-phase progesterone down-regulates estrogen receptors in glands and stroma, and that does it

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16
Q

Type I endometrial carcinoma

A 
55-65 y.o., endometrioid
Hyperplasia precursor
PTEN mutation (among others)
Indolent, spreads via lymphatics
Clinical setting: Unopposed E, Obestity, HTN, DMII
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17
Q

Classic Histology features of complete hyatidiform mole

A

Hydropic villi with cisterns
Circumferential trophoblastic proliferation
Often have cytologic atypia

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18
Q

Clinical features of VIN III

A

Pruritus, most are elevated, many different colors
20% have warty appearance
Tx w/ surgery

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19
Q

Features of low-proliferation type luminal breast cancer

A

Major type in older women and in men (40-50%)
Mets to bone after a long time
Responds well to antiestrogenic drugs

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20
Q

Most common metastatic tumors of the ovary

A

Derived from Mullerian origin: uterus, Fallopian tube, contralateral ovary, pelvic peritoneum

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21
Q

Microscopic features of leiomyoma

A

Bundles of smooth muscle cells (whorled appearance)
Uniform in size and shape, oval nucleus, long bipolar processes
Rare mitosis
Can degenerate

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22
Q

Lymphogranuloma Venereum

A

L serotypes, ulcerative
Small papule that progresses to draining, swollen nodes
Can cause fibrosis and strictures in anogenital tract
Sporadic in US, endemic to Asia, Africa, SA, Caribbean

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23
Q

E3

A

Estriol: Placental estrogen from fertal adrenal gland as DHEA and converted in placenta. Least potent.

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24
Q

Glomerulus-like structure of central blood vessel enveloped by tumor cells within a space also lined by tumor cells

A

SCHILLER-DUVAL BODY, found in YOLK SAC TUMOR

Hyaline droplets usually there, some stain for a-FETOPROTEIN

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25
Q

Major complications of Listeria in pregnant women

A

Ascending infection, can cause SAB, stillbirth, neonatal sepsis

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26
Q

Most common tumors of the vagina

A

SCC: mostly in post-menopausal women (~65yo)

Often have Hx of chronic vulvar pruritus

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27
Q

Presentation of vulvovaginal candidiasis

A

Curd-like / cottage-cheese-like
Psyeudohyphae on histology
Dx by KOH test, inspection, Pap smear

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28
Q

How to treat labial agglutination

A

Estrogen cream and massage to separate the labia majora

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29
Q

Type II vulvar CA (differentiated VIN)

A

55-85 y.o.
Low associations, only cofactor is vulvar atypia
Ass’d w/ pre-existing lichen sclerosis, vulvar inflammation, squamous cell hyperplasia

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30
Q

Hills cell tumors

A 
Pure Leydig: Lipid laden w/ cytoplasmic Reinke CRYSTALLOIDS
Milder MASCULINIZATION (predominantly testosterone)
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31
Q

Presentation of fat necrosis in the breast

A

Painless palpable mass, skin thickening or retraction, or mammography densities or calcification
about half of patients had breast trauma or surgery

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32
Q

Histology of proliferative phase endometrium cycle

A

Glands are straight and tubular, lined by regular, tall, pseudo stratified columnar cells

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33
Q

Krukenberg tumor

A

GI METASTASIS to ovary

Bilateral metastases of MUCIN-producing cancer cells with SIGNET RING appearance

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34
Q

10% of preeclampsia associations

A

microangiopathic hemolytic anemia, Elevated liver enzymes, low platelets (this is HELLP syndrome)

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35
Q

How do polycystic ovarian cysts come about?

A

Increased LH levels promote androgen secretion from ovarian theca cells, giving elevated T and androstenedione
Peripheral conversion of androgen to estrogen suppresses FSH from pituitary gland

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36
Q

Brenner tumor

A

Small, smooth, solid ovarian neoplasm
Usually benign, fibrotic encasing TRANSITIONAL-LOOKING cells
33% associated with MUCINOUS epithelial elements

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37
Q

Uterine and cervical abnormalities caused by DES

A

Small T-shaped endometrial cavity

Cervical collar deformity

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38
Q

Main risk factors for progression of ductal carcinoma in situ (DCIS)

A

Nuclear grade and necrosis

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39
Q

Desquamation

A

Sloughing of skin on palms and soles (usually)

Characteristic of Staph Aureus

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40
Q

Pemphigus

A

Auto-immune blistering involving vulvovaginal and conjunctival areas
Auto-Abs to DESMOGLOBIN
Usually starts in the mouth

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41
Q

Hemorrhagic cysts

A

Functional
More often symptomatic
From hemorrhage in corpus luteum cyst 2-3 days after ovulation

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42
Q

When should groid nodes be included in the treatment of of vagina CA?

A

When lower 1/3 is involved

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43
Q

What happens to the umbilical arteries, ductus venosus / arteriosus, foramen ovale?

A

Umbilical arteries become Medial Umbilical Ligaments
Ductus Venosus becomes Ligamentum Venosum
Ductus Arteriosus becomes Ligamentum Arteriosum
Foramen oval become fossa ovalis

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44
Q

What hormones are produced by the placenta?

A

hCG, progesterone, hPL

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45
Q

What are uterine fibroids derived from?

A

Smooth muscle cells of myometrium, stimulated by estrogen (40% during pregnancy)
Sympomatic ones are most common cause for hysterectomy

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46
Q

What normal (stepwise) process is interrupted to cause eclampsia?

A

Fetal extravillous trophoblastic cells at the implantation site invade maternal decidua, destroy vascular SM
Maternal endothelial cells replaced fetal trophoblastic cells
Decidual spiral arteries convert from small-caliber resistance vessels to large capacity uteroplacental vessels without SM coat

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47
Q

Sarcoma Botryoides

A

Grape-like polyps protruding from Introits
Histologically embryonal rhabdomyosarcoma
2-3 y.o.

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48
Q

Chlamydia presentatioon

A

Women: usually asx (can cause bleeding, discharge)

Pelvic Inflammatory Disease (major complication)

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49
Q

Tetrad of congenital toxoplasmosis

A

Cerebral calcification
Cephaly (micro/hydro)
Chorioretinitis
Convulsions

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50
Q

Twin-Twin transfusion syndrome

A

Placental blood shuts disproportionally

One can get heart failure, one can get anemia

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51
Q

Myofibroblastoma

A

Interlobular stroma lesion EQUALLY COMMON in males

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52
Q

Most common site of ectopic pregnancy

A

extrauterine Fallopian tube

This is the most common cause of hematosalpinx (blood-filled Fallopian tube)

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53
Q

CA-125

A

Used to monitor recurrence and progression of ovarian cancer

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54
Q

Presentation of Hyatidiform mole

A

spontaneous miscarriage or curettage b/c US findings
Abnormal villous enlargement
hCG way higher and rise way faster than in pregnancy

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55
Q

Difference between Paget disease of the nipple and vulva

A

Of the nipple: 100% have underlying ductal breast CA

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56
Q

Types of female genital mutilation

A

I: Partial removal of the clitoris / prepuce
II: Partial/total removal of clitoris and minora
III: Narrowing of vaginal orifice w/covering seal
IV: All other harmful non-medical procedures

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57
Q

Strong Inhibin Ab positivity

A

Granulosa cell tumor

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58
Q

(5) sex cord-stomal ovarian tumors

A 
Granulosa tumors
Fibromas / thecomas
Steroli-Leydig cell tumors
Hills (Leydig) cell tumor
Gonadoblasoma
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59
Q

HPV infection alone is not sufficient for malignant transformation. What else contributes?

A

Mutated RAS gene

Environmental factors

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60
Q

Imperforate hymen

A

After birth a bulging membrane-like structure may be noticed in vaginal opening and blocking mucus
If not detected until after menarche, it can look thin, dark, bluish structure entrapping menstrual flow

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61
Q

Endometrial hyperplasia

A

Too many glands (crowded), abnormal shape
Usually from unopposed estrogen
Causes abnormal vaginal bleeding
Atypical causes endometrial CA
20% have PTEN (phosphate and tensin homologue) ts gene mutation

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62
Q

Condyloma latum

A

2-10 weeks after primary chancre in most untreated
often on palms/soles, most areas of skin
broad-based elevated plaques (condylomata)
May be scaly, pustular, or maculopapular

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63
Q

What do stromal tumors arise from and what unique characteristic does this confer?

A

Intralobular stroma

Biphasic: also include non-neoplastic epithelial component

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64
Q

Biopsy findings of lichen simplex chronicus (squamous cell hyperplasia)

A

Elongated rete ridges

Hyperkeratosis of the keratin layer

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65
Q

Transverse vaginal septum

A

Usually in upper and middle thirds of vagina

Often small sinus tract or perforation will let menstrual flow through, hiding it until sex is impeded

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66
Q

Presentation of Eclampsia

A

systemic syndrome of endothelial dysfunction
[HTN + Edema + Proteinuria] + Seizure
Sx disappear with delivery of placenta

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67
Q

Type II endometrial carcinoma

A

II: 65-75 y.o., serous/clear/mixed mullerian
Serous endometrial intraepithelial CA precursor
p53 mutation (among others)
Agressive, intraperitoneal and lymphatic spread
Clinical setting: Atrophy, thin plaque

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68
Q

How does clitoral agenesis come about?

A

Failure of the genital tubercle to form

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69
Q

Vulvar vestibulitis

A

Infection of 1+ minor vestibular glands, super tender
Introital dypareunia
Topical estrogens/hydrocortisone

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70
Q

Adenosis

A

Increase in number of acini per lobule (breast)
Vagina: columnar cell islands within normal squamous
Seen in women exposed to DES (diethylstilbestrol) in utero

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71
Q

Features of high proliferation luminal breast cancer

A

Increased nuclear staining for Ki67
Most common form associated with BRCA2 mutation
10% of breast cancers, 10% of them respond to chemo

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72
Q

Histological key feature of secretory phase endometrium

A

Subnuclear Vacuoles

Progressively go apical, glands look serrated by week 4

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73
Q

Characteristic pattern of Lobular carcinoma metastasis

A

Peritoneum and retroperitoneum
Leptomeninges
GI tract
Ovaries (Krukenberg) and uterus

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74
Q

Histological findings of sclerosing adenosis

A

Terminal duct lobular unit is enlarged
Acini are compressed and distorted by dense stroma
Calcifications
Unlike CA: Swiring pattern acini, outer border is well circumscribed

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75
Q

What tumor characteristically elaborates a-fetoprotein?

A

yolk sac tumor (aka endodermal sinus tumor)

Also has schiller-duval body

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76
Q

Associated with Guillain Barre and Microcephalus

A

Zika

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77
Q

HSIL (High-Grade Squamous Intraepithelial Lesion)

A

Lower viral replication rate, more cellular proliferation
Most come from LSIL, may become irreversible
100% high grade HPV (16), transform to SCC

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78
Q

Poland syndrome

A

Unilateral muscle absence, often presents early in hand

Breast asymmetry is common, can include axilla web

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79
Q

What causes the menstrual phase of endometrium cycle?

A

Dissolution of corpus lute and subsequent drop in progesterone. This functionalis layer then sheds

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80
Q

Call-Exner bodies

A

Small, distinctive gland like structures filled with acidophilic material
Sometimes in Granulosa cell tumors

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81
Q

Most significant features of late secretory phase of endometrium cycle

A

Prominent spiral arterioles: increased ground substance and edema, stroll cell hypertrophy, increased cytoplasmic eosinophilia. Pre-Decidual
Decidual change: increase stromal mitoses

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82
Q

Presentation of Lobular Carcinoma in Situ

A

Always an INCIDENTAL finding (nothin on mammogram)
Bilateral 20-40% of the time
Risk factor for invasive lobular carcinoma (either breast)

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83
Q

Characteristic histology finding of all stages of syphilis

A

Proliferative ENDARTERITIS affecting small vessels with a surrounding plasma cell-rich infiltrate

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84
Q

Recurrence rates of triple negative breast cancer

A

Almost all occur within the first 8 years, after which it is rare

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85
Q

Risk factors for PCOS

A

Obesity (altered adipose tissue deposition)
DMII (altered insulin release)
Premature atherosclerosis
Increased free serum estrone (E1)

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86
Q

Gonadoblastoma

A

Germ cells and sex-cord derivatives
Resembles immature sertoli and granulosa cells
Abnormal sexual development
80% F, 20% M w/ female internal organs / undescended testicles
Think 45, XO (turner) and Denys Drash

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87
Q

What is the significance of Endoglin antagonizing TGFb?

A

TGFb induces NO production
NO activates guanylate cyclase, making cyclic guanosine monophosphate, activating kinases that block Ca entry to cell, causing them to be stored, resulting in vasodilation

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88
Q

Histology of SMOLD

A

Keratinizing SQUAMOUS METAPLASIA up to nipple duct
dilation and rupture of duct
Intense, chronic granulomatous inflammatory response
secondary anaerobic bacterial infection may supervene and cause inflammation/abscess in recurrences

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89
Q

Placental Site Trophoblastic Tumor (PSTT)

A

Produces human placental lactose (hPL) aka human chorionic somatomammotripin
Localized has excellent Px, 10-15% die of disseminated dz

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90
Q

Presentation of SMOLD (squamous metaplasia of lactiferous ducts)

A

Painful, red, subareolar mass (mimics bacterial abscess)
Often a fistula onto the skin, maybe nipple inverts
90%+ are smokers, deficient in vitamin A

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91
Q

Fibromatosis

A

Interlobular stromal lesion that can involve muscle and does not metastasize

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92
Q

Presentation of polycystic ovarian cyst

A

Chronic an-ovulation, hyper-androgenism, insulin R

Makes enlarged ovaries w/ small, inactive follicles arrested in astral stage

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93
Q

Best tests to identify chlamydia

A

Urine or swabs for NAAT

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94
Q

Congenital syphillis presentation

A

Infantile: Rash, osteochondritis, periostitis, fibrosis
Childhood: Hutchinson teeth, CNVIII deafness, interstitial keratitis

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95
Q

What is endometriosis?

A

Presence of ectopic endometrial tissue outside of the uterus. Most commonly ovaries, but also uterine ligaments, rectovaginal septum, rectouterine pouch, etc.

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96
Q

Most common stromal malignant breast lesion

A

Angiosarcoma
Sporadic in women ~35
Prior radiation or in setting of Stewart Treves

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97
Q

Staging of Cervical CA

A

I: confined to the cervix
II: Beyond cervix, not to pelvic wall, upper 2/3 vagina
III: To the pelvic wall without space, lower 1/3 vagina
IV: Beyond true pelvis, mucosa of bladder or rectum
Metastatic dissemination

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98
Q

Corpus luteum cysts

A

Functional

If corpus lute becomes larger than 3cm and doesn’t regress normally after 14 days

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99
Q

HSV-8

A

Kaposi Sarcoma

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100
Q

Most common symptoms of ovarian tumors

A

Abdominal pain and dissension, GI/GU tract sx (from compression by tumor/invasion)
Vaginal bleeding

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101
Q

Molluscum contagioum presentation and virus

A

Poxvirus
Adults is usually sexually transmitted and on genitals
Children its usually on trunk and extremities

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102
Q

How to treat polycystic ovarian cysts

A

ASx and premenopausal: OCPs (suppress hCG and prevent development of other cysts) and repeat US
Sx and premenopausal: Rule out ectopic pregnancy, etc

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103
Q

Endocervical polyps

A

small bumps to large masses, can protrude through external os
Benign, can cause spotting. Easily removed

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104
Q

How does atrophic vaginitis come about?

A

Loss of estrogen: menopause, surgery (oophorectomy)
Presents with closure of vaginal hole, labia and rugae start flattening out
Treat with topical estrogen, maybe give oral estrogen

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105
Q

Fitz-Hugh-Curtis Syndrome

A

Complication of PID in women

Causes liver adhesions and pain, general illness

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106
Q

Risk associated with submucosal fibroid

A

Can be pedunculate and come through the cervical os

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107
Q

Verrucous carcinoma

A

variant of SCC, rarely mets
Cauliflower-like and often confused w/ condyloma
Radiation is contraindicated - may induce anaplastic transformation

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108
Q

Sx of adenomyosis

A

Menometrorrhagia (irregular and heavy menses), Coclicky dysmenorrhea, dyspareunia, pelvic pain (esp during premenstrual period)

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109
Q

Recurrence rate of luminal (ER+) breast cancer

A

Lowest rate in the first 10 years

Recurrences continue steadily over long periods

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110
Q

Sx of PCOS

A

Menstrual disorder / amenorrhea
Infertility
Hirsutism / male pattern baldness / acne
Obesity / metabolic syndrome / diabetes

111
Q

What is the significance of the modified apocrine sweat glands contained in the vulva?

A

Similar to the breast, confers two similar tumors:
Papillary hidradenoma and Extramammary Paget Disease
Histologically identical to intraductal papilloma of breast

112
Q

Primary carcinoma of the vagina

A

Pretty much all are SCC ass’d w/ high risk HPVs

113
Q

Presentation of Lymphocytic Mastopathy (sclerosing lympocytic lobulitis)

A

Breast nodules / hardened mass / ductal atrophy / lobules surrounded by thick BM
Ass’d w/ DMI, auto-immune thyroid disease

114
Q

Presentation of Paget Disease of the nipple

A

Erythematous eruption with a scale crust
Palpable mass 50-60%
Almost all are invasive ER- HER2 overexpressing

115
Q

Bartholin gland carcinoma

A

1-2%, painless vulvar mass, no Hx of Bartholin shit
Women over 40 should get biopsy
Tx w/ radical vulvectomy and lymphadenecomy
Common recurrence, 85% survival rate

116
Q

Sx of endometriosis

A

Infertility (30-40%), Dysmenorrhea, dyspareunia, pelvic pain, others.

117
Q

Inflammatory carcinoma

A

Higher in African Americans
Very poor prognosis (3 year survival 3-10%)
Peau d’orange from plugging lymph-vascular spaces of dermis with carcinoma cells

118
Q

Lining of breast cysts

A

Either flattened atrophic epithelium or metaplastic apocrine cells (granular, eosinophilic cytoplasm and look like normal apocrine epithelium of sweat glands)

119
Q

When do disorders relate to maturing placenta occur?

A

3rd trimester

Complete interruption of blood through umbilical cord from any cause can be lethal

120
Q

MED12

A

Somatic mutations on this create both stromal tumors (FIBROADENOMA AND PHYLLODES tumor)

121
Q

Treatment of different types of endometrial hypertrophy

A

NO atypia: Progestin, resample in 3 mos

Atypia: Hysterectomy

122
Q

Parvovirus B19 presentation

A 
Fifths disease (Erythema infectiosum) in children
Pregnant women: SAB, Stillbirth, hydrops, congenital anemia
123
Q

MOA of Paget Disease of the Nipple

A

Malignant Paget cells extend from DCIS in the ductal system to the nipple skin via the lactiferous sinuses
Does not cross the BM
Tumor cells disrupt the normal epithelial border
Fluid seeps out onto the nipple

124
Q

Clinical presentation of Gestational Choriocarcinoma

A

Irregular vaginal bleeding (bloody, brown)
Enlarged uterus
Maybe mets (mostly lung, vagina)
hCG very high (unless tumor is necrotic)

125
Q

LSIL (Low-Grade Squamous Intraepithelial Lesion)

A

High viral replication, mild growth alteration
10x more common than High grade
Most regress, doesn’t progregress directly to CA
80% are associated with high risk HPV (mostly 16)

126
Q

Hydradenoma

A

Rare lesion arising from sweat gland of the vulva

127
Q

Staging of endometrial adenocarcinoma (I and II) and malignant mixed mullein tumors

A

I: confided to the corpus uteri
II: involves both the corpus and the cervix
III: extends outside uterus but not to true pelvis
IV: extends outside true pelvis or involves bladder or rectal mucosa

128
Q

HER2 (ERBB2) cancers

A

Mostly poorly differentiated

Most common subtype in patients with P53 gremlin mutations (Li-Fraumeni syndrome)

129
Q

Granuloma Inguinale

A

(Donovanosis) caused by Klebsiella
Rare in the US, more in rural developing nations
Scarring, lymphedema

130
Q

Ovarian torsion

A

Often presents as acute lower abdominal pain
Fallopian tube is often involved
If missed, can lead to vascular compromise of adnexa

131
Q

How to treat epithelial benign ovarian tumors

A

Usually unilateral salpingo-oophorectomy

Mucinous cystadenoma: APPENDECTOMY secondary to possible coexistence of appendices mucocele

132
Q

HSV-5

A

CMV (beta)

133
Q

Clinical findings of endometriosis

A

Red/blue to yellow/brown nodules on or beneath mucosa or serosa (powder-burn marks)
Extensive can cause fibrous adhesions
Can cause small bowel obstruction

134
Q

Decubitus ulcer

A

Develops with chronic pressure or from moisture associated with urinary incontinence

135
Q

What is the significance of fetal tissue present in a hyatidiform mole?

A

No maternal DNA or fetal tissue? 2.5% risk of subsequent choriocarcinoma, 15% risk of persistent and invasive mole
Fetal tissue present? increased risk of persistent mole, NO risk of choriocarcinoma

136
Q

Presentation of congenital CMV

A

95% Asx

Microcephaly! encephalitis, thrombocytopenia cause: jaundice, hepatosplenomegaly, anemia, bleeding, IUGR

137
Q

How does female pseudohermaphroditism come about/?

A

Congenital adrenal hyperplasia
Ingestion of exogenous hormones
Androgen secreting tumors of mothers adrenal or ovaries

138
Q

Trichomonas vaginalis

A

Large, flagellated ovoid protozoan
Asx or frothy yellow discharge, dysuria, dyspareunia
Strawberry cervix

139
Q

Cowden Syndrome

A

Multiple hamartoma sydome, gremlin PTEN mut

High incidence of endometrial and breast CA

140
Q

Abruptio Placentae

A

Retroplacental hemorrhage at the interface of placenta and myometrium
Threatens both mother and fetus

141
Q

Risk associated with subserosal fibroids

A

can attach to blood supply of the omentum or bowel mesentery, lose connection to the uterus, and become parasitic

142
Q

Aromatase

A

Gets granulosa cells to convert androstenedione to estradiol

143
Q

Follicular cyst

A

Functional
Lined by 1+ layers of granulose cells
Develops when ovarian follicle fails to rupture
Clinically significant if its large enough to be painful

144
Q

Vulvar intraepithelial III (VIN III) aka SCC in Situ

A

Linked to vulvar cancer
Vin-Usual type: HPV-16, Smoking, Immunocompromise
Diff’n-type VIN: Not associated, get Lichen and stuff

145
Q

Most common type of breast cancer to present as an occult primary

A

Lobular carcinoma

146
Q

What can happen as a result of mullerian duct formation failure?

A

Unicornate uterus

147
Q

Lichen sclerosis

A

Smooth, white, crinkly plaques over vulva
Can become atrophic and agglutinated, orifice constricts
Most common in post-menopausal women
Slight increase in SCC

148
Q

HSV-4

A

EBV (gamma)

149
Q

Atypical endometrial hyperplasia

A

Nuclear atypia - glands back to back and branching
Conspicuous nucleoli
Overlap with well differentiated cancer

150
Q

How does androgen insensitivity come about?

A

Usually X-linked

Mullerian inhibiting substance (produced by 46xy) causes lack of mullerian duct development

151
Q

Histology of Intraductal papilloma of the breast and valvular counterparts

A

papillary projections covered by upper layer of columnar secretory cells and deeper layer of flattened my-epithelial cells
(characteristic of sweat glands and their tumors)

152
Q

(3) germ cell ovarian neoplasms

A

Teratoma, dysgerminoma, yolk sac tumor

153
Q

Dermatology of vaginal atrophy

A

After menopause the vaginal rogation flatten and the epithelium becomes thin, pale, inelastic
Vaginal pH rises

154
Q

US focal thickening of endometrial stripe

A

Endometrial polyp

most are benign

155
Q

Histology of duct ectasia

A

Ducts filled with secretions and lipid-laden MO
Rupture, inflammation, maybe granulomas
Fibrosis produces irregular mass with skin and nipple RETRACTION!

156
Q

Most common and other causes of Dysfunctional Uterine Bleeding (DUB)

A

Most common: Anovulatory cycle (excessive endometrial stimulation by estrogens unopposed by progesterone)
Other: General metabolic disturbances, ovarian lesions, endocrine disorders

157
Q

Criterion for spontaneous abortion

A

pregnancy loss before 20 weeks gestation (most occur before 12 weeks)

158
Q

HPV vaccines

A

Gardasil: 6, 11, 16. 18
Gardasil 9: adds 31, 33, 45, 52, 58
Cervarix: 16, 18

159
Q

Second most common vulvar cancer

A

Malignant melanoma
Usually on minora and clitoris
Overall survival rate 30%

160
Q

CMV histology

A

Enlarged w/ intranuclear basophilic inclusions: span half of the nucleus diameter, set off from nuclear membrane by clear halo
Causes focal necrosis w/ little inflammation

161
Q

Galactocele

A

Infected milk ducts

162
Q

Staph vs Strep infection of the breast

A

Staph: Single or multiple abscesses
Strep: cellulitis

163
Q

LH

A

Stimulates Theca cells to make androstenedione
It is then given to Granulosa cells
FSH then stimulates Granulose cells to convert it to estradiol via Aromatase

164
Q

Histology of Lichen Simplex Chronicus

A

Hyperkeratosis and parakeratosis w/ prominent granular layer
Acanthosis with elongated rete ridges
Dense infiltrate of chronic inflammatory cells

165
Q

Complete androgen insensitivity syndrome / testicular feminization (46XY)

A

Lack androgen receptors, phenotypically Female, functioning testes that are need removing after puberty because of malignant potential

166
Q

Main differences between mucinous and serous tumors

A

Mucinous: surface is rarely involved, almost never bilateral, mutated KRAS

167
Q

4 pathogenesis of endometriosis

A

Regurgitation of menstrual endometrium through tubes
Benign metastasis through of tissue through vessels
Metaplasia of coelomic mesothelium or remnants
Extrauterine stem/progenitor cell differentiation

168
Q

Carcinoma in Situ

A

Clonal proliferation confined to ducts and lobules
No extension beyond basement membrane
Myoepithelial cells preserved
Detected mammographically as micro Ca++
70% have stromal invasion by the time its detected

169
Q

How does a septate uterus come about?

A

Incomplete dissolution of the midline fusion of paramesonephric ducts

170
Q

Worst cervical carcinoma

A

Mixed Aden-squamous or NE
Shorter progression from in situ to invasive
More likely advanced disease, less favorable Px

171
Q

2 cell theory of ovarian follicular development and estrogen production

A

LH stimulates theca cells to produce androgens

FSH stimulates granulose cells to convert them to estrogens E1 and E2

172
Q

Immature malignant teratomas

A

like benign teratomas but component tissues resemble embryonal and immature fetal tissue
Found chiefly in prepubertal adolescents and young women (mean age 18)

173
Q

How do most ovarian cancers present?

A

Systemic sx beyond the ovary
Weakness, weight loss, cachexia
Peritonieal disease, ascites
Mets to liver, lungs, GI, opposite ovary (if surface)

174
Q

Breast tumors that are usually well differentiated and slow-growing

A

ER+ and PR+

175
Q

dysgerminoma

A

ovarian counterpart of testicular seminoma
mostly in 10-30 year olds
Sometimes in pts with gonadal dysgenesis (including pseudo-hermaphroditism)

176
Q

Presentation of ovary fibroma

A

Usually pelvic mass

Sometimes have pain and Meigs syndrome (ascites, hydrothorax on right) or Basal cell nevus syndrome

177
Q

What does lichen planus look like?

A

Purple-ish polygonal papule maybe in erosive form

Can involve vulvar-vaginal-gingival syndrome

178
Q

Urethral caruncles

A

Small fleshy red outgrowth at distal edge of urethra
Children: spontaneous prolapse of urethral epithelium
Post menopausal women: Secondary to contraction of hypoestrogenic vaginal epithelium - everting of the urethral epithelium

179
Q

Most common epithelial ovarian tumor

A 
Serous cystadenoma:
PSAMMOMA bodies (more common in malignant)
180
Q

Turner syndrome and gonad development

A

Small rudimentary streaked ovaries

Develop secondary sexual characteristics but enter menopause shortly after

181
Q

What are the consequences of functional carcinoid tumors from GI tissue found in teratomas?

A

They can produce 5-Hydroxytryptamine to cause CARCINOID SYNDROME
Even in the absence of hepatic metastases because ovarian veins connect directly to systemic circulation

182
Q

HSIL cellular findings

A

Ki-67 proliferation marker usually in basal layer only (E6/7 prevent cell cycle arrest so its seen in upper levels)
Overexpression of P16 (increased CDK4)

183
Q

Bartholin’s cyst

A

most common vulvovaginal tumor
Less than 3cm is usually Asx
Usually unilateral swelling
Biopsy in women 40+ for Bartholin CA

184
Q

Bartholin Gland Abscess

A

From blockage / accumulation of purulent material
Painful mass arises
Tx w/ word catheterization or Marsupialization (New ductal opening by everting the cyst wall onto the epithelial surface where its sutured with absorbable interrupte)

185
Q

How does Male pseudohermaphroditism come about?

A

Mosaicism

186
Q

HSV-3

A

Zoster (Alpha, like 1 and 2)

187
Q

Cervical CA metastasis

A

Primary pelvic nodes, then para-aortic nodes
Distant to lung, other nodes liver, bone
Death from local tumor invasion (not distant mets)

188
Q

Diagnostic features of ADH (atypical ductal hyperplasia)

A

Absence of Cytokeratin 5/6 and diffuse positivity for ER

189
Q

Vulvovaginal Candidiasis

A

Can have clumpy, cottage-cheese like discharge
Increased estrogen levels, pH below 4.5
Tx w/ Diflucan 150mg x1, imidazoles

190
Q

SCC of the vulva

A

90% of vulvar cancers, presents with a lump
Itchy, red, ulcerated, pigmented or warty on majora
Direct extension to adjacent structures
Lymphatic embolization to LN
Hematogenous spread

191
Q

Luteoma of pregnancy

A

Functional
Caused by hyperplastic reaction of ovarian theca cells secondary to prolonged hCG stimulation
Regress spontaneously

192
Q

Huge size cyst filling the entire pelvis and abdomen

A

Mucinous Cystadenoma
Mostly benign, associated with mucocele of APPENDIX
Rarely, leads to pseudomyxoma peritonei (numerous benign implants are seeded onto surface of bowel and other peritoneal surfaces, producing lots of mucous)

193
Q

Presentation of Duct Ectasia

A

Palpable periareolar mass
often associated with thick, white nipple secretions and maybe skin retraction
Occurs in middle age, often multiparous women

194
Q

Two forms of Chlamydia

A

Elementary body: Inactive infectious form in endoscope

Reticulate body: Metabolically active form

195
Q

(3) metastatic, non-ovarian neoplasms of the ovary

A

Appediceal, gastric, breast

196
Q

In eclampsia, what factors are released by the ischemic placenta?

A

FMS-like tyrosine kinase (sFltl): antagonizes VEGF

Endoglin: antagonizes angiogenic TGFb

197
Q

Bartholin Cyst

A

On the Labia Majora, from obstructed duct doing inflammation, can cause abscess

198
Q

Key features of leiomyosarcoma

A

Nuclear atypia
Mitotic index 10+ (malignant)
Zonal NECROSIS

199
Q

Chancroid

A

Caused by H. DUCREYI
Cofactor in HIV transmission
Painful, irregular, un-indurated, may be multiple
Base has shaggy, yellow-gray exudate
Regional LN enlargement (buboes) skin may erode

200
Q

Stages of Syphillis

A

Primary: Chancre
Secondary: Palm rash, lymphadenopathy Condyloma L.
Tertiary: Neuro, Aortitis, Gummas

201
Q

Typical endometrial hyperplasia

A

Typical is increased glad:stroma. intervening storm remains, rarely progresses to cancer

202
Q

Nabothian cyst

A

from SQUAMOUS METAPLASIA (entraps a layer of COLUMNAR, which keep secreting mucous)

203
Q

Cystic neutrophilic granulomatous mastitis

A

Rare, Coryndebacteria disease

Similar to Granulomatous lobar mastitis

204
Q

Basal cell carcinoma of the vulva

A

Rolled edge ulceration

Does not Mets, wide local excision is adequate

205
Q

Positive Tzanck smear

A

Multinucleation, means you have HSV

206
Q

Paget disease of the vulva

A

postmenopausal white, 10-20% have underlying CA

Itching and tenderness, well demarcated and eczematoid with fiery red background and white plaque-like lesions

207
Q

Pseudomyxoma peritonei

A

Ovarian metastasis FROM APPENDIX tumors

Mucin in the abdominal cavity

208
Q

Treatment of gestational choriocarcinoma

A

Chemo cures nearly 100%
Many cured have had normal subsequent deliveries
Nongestational choriocarcinomas that arise OUTSIDE of the uterus are more resistant

209
Q

PTEN mutation

A

Overactivation of MI3K/AKT pathway
Upregulates glucose transporters and enzymes
Promotes lipid and protein synthesis
Implicated in Cowden/ENDOMETRIAL HYPERPLASIA

210
Q

ER2+ breast cancer recurrence rate

A

Mixed pattern with early and late peaks

211
Q

MOA of lobular carcinoma

A

Biallelic loss of CDH1 (loss of E-cadherin): discohesive tumor

212
Q

Placenta Accreta

A

Partial or complete absence of the decidua
Placental villous tissue adheres directly to the myometrium
Leads fo failure of placental separation at birth
Important cause of severe, life threatening postpartum bleeding

213
Q

Treatment of leiomyomas

A

Estrogen + Progesterone, Progesterone-only, GnRH

214
Q

Precursor to endometrial cancer

A

Endometrial hyperplasia (4+mm lining)

215
Q

What two anomalies can happen from failure of mullerian duct fusion?

A 
Bicornuate uterus (split halfway down)
Uterus didelphys (fully split into two w/ cervix/tube/vag)
216
Q

Midline longitudinal vaginal septum

A

Double vagina: septum attaches to lateral wall and creates a blind vaginal pouch
Associated with duplication anomalies of the uterine fundus

217
Q

Difference between DCIS and LCIS

A

DCIS is local with invasive carcinomas at same site

LCIS confers bilateral risk

218
Q

BRCA 1/2

A

Tumor suppressor proteins
Repair dsDNA via homologous recombination
80-90% of single gene familial breast cancers, 3% of all

219
Q

Gartner duct cysts

A

pretty common lesions along lateral walls of vagina
derived from Wolffian / mesonephric duct rests
1-2 cm fluid-filled submucosal cysts

220
Q

What is the composition of the first-trimester chorionic villi?

A

Delicate mesh of central stroma surrounded by two discrete epithelial layers
Outer layer: syncytiotrophoblast
Inner layers: Cytotrophoblast

221
Q

Fox Fordyce disease

A

Severe itchy raised yellow cyst in the ARMPIT, labia major, labia minor.
From keratin-plugged inflammation of apocrine glands

222
Q

Triple Negative Breast cancer MOA

A

Estrogen and HER2 independent
Gene expression normally in basal myoepithelial cells
More likely to have palpable mass
Treated with cytotoxic + anti-BRCA1/Homologous recombination defect drugs

223
Q

Masculinizing tumor

A

Sertoli Leydig Tumor

224
Q

Squamous cell hyperplasia

A

Thickened (lichenified) skin from scratching
Mitotic activity without cellular atypia
Sometimes at bargains of vulvar cancers

225
Q

Most common palpable malignant lesion of the breast

A

Invasive ductal carcinomas

226
Q

Most common benign tumor of the female breast, and what drug is it associated with?

A

Fibroadenoma

Cyclosporine A

227
Q

E2

A

Estradiol: predominates in reproductive years
Most potent estrogen
Produced my aromatization of testosterone in Graafian follicle

228
Q

hCG

A

produced by trophoblasts, maintains corpus lute (progesterone producer)
Usually double about every 2 days for the first 4 weeks of pregnancy
Also a tumor marker

229
Q

Two types of SCC of the vulva

A

HPV-related: 30%, classic VIN (Bowen disease)

Non-HPV: 70%, Differentiated VIN

230
Q

Main mutation found in mucinous tumors of the ovary

A

KRAS

231
Q

Condyloma acuminatum

A

Genital warts - solitary but probs multifocal

Low risk HPV types 6 and 11

232
Q

Theca cells

A

Become Theca lutein cells

Secrete progesterone and androgens

233
Q

Where is GnRH secreted from and what does it do?

A

Arcuate nucleus
Responsible for synthesis and release of LH and FSH
Estradiol enhances its release and induces LH surge
Inhibited by Gonadotropins

234
Q

MOA of Lobular carcinoma in situ

A

Clonal proliferation of cells that grow in discohesive way

Mutated CDH1 means loss of tumor suppressor adhesion protein E cadherin

235
Q

Gestational Choriocarcinoma

A

Rapidly invasive malignant neoplasm of syncytio- and cytotrophoblasts from previously normal or abnormal pregnancy that metastasizes widely
50% arise in complete mole, 25% previous abortion, 22% after normal pregnancy, rest are from ectopic pregnancy

236
Q

Associations of Gonorrhea

A

Women often Asx, can lead to PID
Invasion of non-ciliated epithelial cells
Aerobic with stringent growth requirements
Can also infect anus, rectum, pharynx

237
Q

Sertoli-Leydig cell tumors

A

Often functional, masculinize / defeminize
A few have estrogenic effects
Mostly in teens and 20’s

238
Q

Major corresponding factor to ectopic pregnancy

A

Chronic salpingitis secondary to PID

Also IUD, smoking, scarring/adhesions from appendicitis, endometriosis, prior surgery

239
Q

Characterizatioin of ruptured ectopic pregnancy

A

moderate to severe abdominal pain and vaginal bleeding 6-8 weeks after last menstrual period
May rapidly develop hemorrhagic shock
Medical emergency

240
Q

Gardnerella vaginalis

A

Thin, green-gray fishy-smelling discharge

Superficial and intermediate squamous cells covered with shaggy coat of coccobacilli (clue cells)

241
Q

Type I vulvar CA (usual)

A

35-65 yo

Ass’d w/ cervical neoplasia, HPV, Hx of Condyloma, STD, smoking, pre-existing VIN, age, immune status, viral

242
Q

Extramammary Paget disease

A

Itchy, red, crusted, manlike area usually on labia majora

Distinctive intraepithelial proliferation of malignant cells

243
Q

Where does most of the progesterone come from during different phases of the ovarian cycle?

A

Follicular development: Peripheral adrenal conversion
Before ovulation: Unruptured luteinizing Graafian follicle
5-7 days after ovulation: corpus luteum

244
Q

Presentation of adult granulose cells tumor

A 
DUB
Endometrial hyperplasia
Endometrial carcinoma
Proliferative breast dz
Masculinization (if androgens are involved)
245
Q

Granulomatous lobar mastitis

A

Rare, only in porous women

Granulomas ass’d with lobules, may have lipid vacuoles surrounded by neutrophils

246
Q

Where does vaginal malignant melanoma usually occur?

A

Distal anterior wall

247
Q

Lymph drainage of vulva

A

Vulva and distal 1/3 of vagina drain to inguinal nodes
Proximal 2/3 of vagina and uterus to internal nodes
(lower vagina and vulva develop from urogenital sinus)

248
Q

Most common subtype of type II endometrial carcinoma

A

serous carcinoma

249
Q

Histology of lymphocytic mastopathy

A

Densely collagenized stroma
Atrophic ducts and lobules w/ thickened BMs
Surrounded by prominent lymphocytic infiltrate

250
Q

T vs B cell breast lymphomas

A

Most primary lymphomas are B-Cell

T cell are associated with breast implants

251
Q

Features of both ADH and ALH

A

High expression of estrogen receptor
Low rate of proliferation
Maybe 16q / 17p loss, gain of 1q (also in low-grade carcinoma in situ and ER+ invasive breast CA

252
Q

Chlamydia disease by serotype

A

D-H: Urogenital infection and inclusion conjunctivitis
L1-3: Lymphogranuloma Venereum
A,B,C: Ocular infections in kids

253
Q

Vaginal inclusion cyst

A

From infolding of the vaginal epithelium
In the posterior or lateral wall in the lower third of vagina
Often associated with surgery or birthing lacerations

254
Q

Association between preeclampsia and hyper coagulable state

A 
thrombi formation (esp in liver, kidneys, brain, pituitary)
Related to reduced endothelial PGI2 (antithrombotic produced by VEGF - antagonized by sFlt1)
255
Q

Embryonal Rhabdomyosarcoma

A

Malignant embryonal rhabdomyoblasts
Usually in children younger than 5 y.o.
Tumors invade locally, kill by penetrating peritoneal cavity or obstruction of urinary tract (surgery)

256
Q

Mayer-Rokintansky-Kuster-Hauser syndrome

A

Mullerian Agenesis
vagina and uterus are underdeveloped or absent
External genitalia, ovaries, tubes are spared

257
Q

Presentation of juvenile granulose cell tumor

A

Peripheral type: precocious puberty (before 8)
Early breast (thelarche) development
Early menarche
Pubic or underarm hair
Pseudo-hermaphroditism if there’s androgens

258
Q

Syringoma

A

Eccrine gland tumor

259
Q

Pregnancy leutoma

A

rare tumor that closely resembles corpus luteum of pregnancy

May produce virilization

260
Q

BV

A

Most commonly Gardnerella Vaginalis, Clue Cells
KOH+ Whiff test
Thin milky discharge
Tx w/ Metronidazole

261
Q

VAIN

A

HPV related, ASx, abnormal pap in woman post hysterectomy or no demonstrable cervical lesion
Colposcopic direct vaginal biopsy

262
Q

PCOS = multiple cysts + what 4 clinical combinations

A

Hyperandrogenism
Menstrual irregularities
Chronic anovulation
Decreased fertility

263
Q

How does preeclampsia cause hepatic failure?

A

Periportal sinusoids contain fibrin deposits associated with hemorrhage into space of Disse
Causes coagulative necrosis, dissection of blood under Glisson capsule
May lead to catastrophic hepatic rupture

264
Q

Most common invasive cancer of female genital tract

A

Endometrial carcinoma: often presents with irregular or postmenopausal vaginal bleeding

265
Q

Chancre

A

Primary syphillis

Nontender, slightly elevated, firm, reddened papule that erodes into a clean-based shallow ulcer

266
Q

What is Adenomyosis?

A

Presence of endometrial tissue within the uterine wall (myometrium)

267
Q

Dermatology of urethral diverticula

A

Small sac like projections in the anterior vagina along the posterior urethra
Can cause UTI, dysuria, maybe leaking
Tx with dilation or excision

268
Q

Herceptin (trastuzumab)

A

MoAb that binds and inhibits HER2

not all respond, some become resistant

269
Q

Cervical HPV target

A

Immature basal cells of squamous epithelium in breaks
Immature metaplastic squamous cells
(usually at the transformation zone)
Cannot infect mature superficial squamous cells covering the cervix, vagina, or vulva
Basal Keratinocytes (stem cells)

270
Q

What is the composition of the third trimester chorionic villi?

A

Stroma with dense network of dilated capillaries surrounded by markedly thinned out syncytiotrophoblast and cytotrophoblast

271
Q

What breast change occurs after the third decade of life?

A

Lobules and their specialized stroma start to involute

/Interlobular stroma converted from fibrous to adipose

272
Q

Theca-Lutein Cyst

A

Functional
Usually bilateral, may develop w/ high hCG
Often regresses when it falls

273
Q

ERBB2

A

proto-oncogene (over expressed)
Encodes RTK: proliferation/anti-apoptosis
(Stimulates RAS and PI2k-AKT signaling, gene amplification)

274
Q

Grading of immature malignant teratomas

A

Proportion of tumor comprised of immature neuroepithelium

ENRP (4 decks)

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