Brs- Female Reproductive/breast

Front 1

Follicular cyst
location
pathophys
complications

Back 1

ovary
distention of unrupture graafian follicles, can be assoc w hyperestrinism and endometrial hyperplasia
can rupture --> peritonitis

Front 2

Pathophys of corpus luteum cyst

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results from hemorrhage into eristent mature corpus luteum
assoc with menstrual irreg and sometimes intraperitoneal hemorrhage

Front 3

Pathophys of theca-lutein cyst
disease association
morph

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gonadtropin stimulation
also assoc with choriocarcinoma and hydatidiform mole
multiple and bilateral cysts, lined by luteinized theca cells

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Pathophys of PCOS

Back 4

excess LH and androgens

Front 5

Relationship between DM adn PCOS

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there is increased insulin R and increased risk of DM
hyperinsulinemia --> increased ovarian androgen production --> increased LH

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morphology of PCOS (cell types?)

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markedly thickened ovarian capsule
multiple small follicular cysts containing granulosa cell alyer and luetinized theca interna
cortical stromal fibrosis, with islands of focal leutinization

Front 7

What are the different classes of ovarian tumors

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sumors of surface epi origin
tumors of germ cell origin
tumors o fovarian sex cord-stromal origins
mets to ovary

Front 8

what are the different types of ovarian tumors of surface epi origins?

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serous tumors
mucinous tumors
endometrioid tumors
clear cell tumors
Brenner tumros

Front 9

demographics of surface epi tumors of ovaries

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women older than 20 yo
these tumors are 75% of all tumors

Front 10

what are the different types of serous tumor s

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serous cystadenoma (benign)
serous cystadenocarcinoma (malig)

Front 11

morph of serous cystadenoma

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lined with cells sim to fallophian tube epi
usually bilat

Front 12

which cancer accounts for 50% of ovarian carcinomas?

Back 12

serous cystadenoma

Front 13

types of mucinous tumors

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mucinous cystadenoma (benign)
mucinous cystadenocarcinoma (malig)

Front 14

morph of mucinous cystadenoma

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multilocular cysts lined by mucous secreting columnar epi filled with mucinous material

Front 15

consequence of mucinous cystadenocarcinoma

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pseudomyxoma peritonei --> production of intraperitoneal muncinous material

Front 16

causes of pseudomyxoma peritoei

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mucinous cystadenocarcino (most common cause)
mucinous cystadenoma
carcinomatous mucocele of appendix

Front 17

are endometrioid tumors benign or malig?
clear cell tumors?
Brenner tumors?

Back 17

malig
malig
benign

Front 18

morph of brenner tumors

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small islands of epi cells resembling bladder transitional epi interspersed w/i fibrous stroma

Front 19

tumor in women analagous to testiular seminoma? benign/malig?

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dysgerminoma (malig, but good prog)

Front 20

morphology of endodermal sinus tumor?
biochem markers?

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resembles extraembryonic yolk sac
produces AFP

Front 21

types of teratomas (behaviour)

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immature teratoma (aggressive, malignant)
mature teratoma (benign)
monodermal (benign?)

Front 22

pathophys of dermoid

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reduplication of meiotic maternal chromosomes --> 46XX cells of maternal origin

Front 23

most common type of monodermal teratoma

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struma ovarii (consists of thyroid tissue --> hyperthyroidism)

Front 24

What are the tumors of ovarian sex cord-stromal origin

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thecoma-fibroma
thecoma
granulosa cell tumor
sertoli-leydig cell tumor

Front 25

morph of ovarian fibroma?
association?

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consists of bundles of spindle shaped fibroblasts
meig's syndrome (triad of ovarian fibroma, ascites, and hydrothorax)

Front 26

morph of thecoma
biology of thecoma

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round lipid containing cells in addition to fibroblasts
secretes estrogen (occassionally)

Front 27

what do theca cells normally do?
GC?

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produce testosterone and androstenedione (test diffuses to nearby granulosa cells and converts testosterone into 17B estradiol)
granulosa lutein cells make progesterone
pre-ovulatory GC converts testosterone to 17B estradiol via aromatase (and stim by FSH)

Front 28

activity of granulosa cell tumor
association?

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secretes estrogen --> precocious puberty
associated with endometrial hyperplasia or endometrial carcinoma

Front 29

morph of GC tumor? what helps wiht dx?

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small cuboidal deeply staining granulosa cells arranged in anastomotic cords
Call-Exner odies are small follicles filled with eosinophilic secretion (used to dx)

Front 30

activity of Sertoli-Leydig cell tumor

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androgen secreting tumor associated with virilism

Front 31

Krukenberg tumor

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ovaries are replaced bilaterally by mucin=secreting signet ring cells from mets of carcinoma of the stomach

Front 32

what is abruptio placentae

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premature separation of placenta
associed with DIC

Front 33

what is placenta accreta
causes
presentation

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attachment of placenta directly to myometrium, defective decidual layer
predisposed by endometrial inflammation and old scars from prior cesarian sections/other surgeries
impaired placental separation after delivery, sometimes w massive hemorrhage

Front 34

placenta previa: definition
clinical presentation

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attachment of placenta to lower uterine segmnet, partially or completely covering cervical os
can co-exist with placental accreta
manifest by bleeding

Front 35

predisposition ofo ectopic pregnancy

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chronic salpingtis (often gonorrheal)
endometriosis
post-op adhesions
some occur in normal ppl

Front 36

what does ectopic pregnancy cause

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hematosalpinx
tubal rupture --> acute abdomen/shock

Front 37

when does toxemia of preganancy normally occur?

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1st preg
3rd trimester

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types of toxemia of pregnancy

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pre-ecampsia
eclampsia

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clinical presentation of pre-eclampsia

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HTN
albuminuria
edema

HELLP syndrome is variant (hemolysis, elevated liver enzymes, low platelets)

Front 40

clinicla presentation of eclampsia

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DIC and convulions
reverses rapidly on termination of pregnancy, but can be fatal

Front 41

cause of amniotic fluid embolism
presentatioin
progression

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tear in placental membranes and rupture of maternal veins
peripartal respiratory difficulty --> chock and death
--> DIC

Front 42

morph of amniotic fluid emobolism

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masses of debris adn epi squamous cells in maternal pulm microcirculation

Front 43

what is amniotic fluid aspiration syndrome
morph

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inability to expel amniotic fluid at birth (prob of neonate)
assoc with prematurity
squamous epithelial cells of amniotic origin in fetal terminal air spaces and larger bronchi

Front 44

chorioamnionitis

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follows premature ROM
caused by ascending infection from vagina or cervix

Front 45

morph of hydatidiform mole

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enlarged edematous placental villi in loose stroma, resemblingn a bunch of grapes

Front 46

biochem marker of hydatidiform mole

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sig increase in hcg

Front 47

when does hydatidiform mole occur?
what cna it progress to?
clincal presentation

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early in regnancy
choriocarcinoma
vaginal bleeding and rapdi increase in uterine size.. can be mistaken for a normal pregnancy, but uterus too large for supposed state of gestation

Front 48

what are the different types of hydatidiform mole?

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complete (no embryo present, 46XX karyotype of paternal derivation)
partial: (embryo present, triploidy and rarely tetrapoidy can occur- thought to be d/t fertilization of ovum by 2+ spermatozoa, usually 2 sets of chromosomes from dad, 1 set from mom)

Front 49

biochem dx of gestational choriocarcinoma
biology of tumor (whwere does it spread to?)
demographics

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increased serum hCG
early hematogenous spreaed to lungs
responsive to chemo
asia/african

Front 50

what can precede gestational choriocarcinoma

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hydatifidiform mole
abortion of ectopic pregnancy
normal-term preg

Front 51

clinical presentation of gestational choriocarcinoma

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vaginal bleeding

Front 52

which is the most common d/o of breast
clinical presentation

Back 52

fibrocystic dz
palpable breast mass in pts between 25-50 yo
lumpy breast with midcycle tenderness
usually bilateral

Front 53

which types of fibrocystic breast disease are associated with increased risk of breast cancer?

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epithelial hyperplasia (w atypia)
sclerosing adenosis
any time hyperplastic epi has atypia

Front 54

which fibrocystic dz of breast are not associated with increased risk of breast ca

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stromal fibrosis
cyst frmation

Front 55

morph of fibrocystic dz

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fibrosis
cysts
epi lining may be flattened, show apocrine metaplasia or be hyperplastic
in adenosis: small ducts and myoepithelial cells (in adenosis w fibrosis = sclerosing adenosis)

Front 56

what is the most common breast tumor in women younger than 25 yo
benign/malig
morph

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fibroadenoma
benign
rubbery, firm, painless, well-circumscribed
well demarcated from adjacent breast tissue
stromal cells are neoplastic and ductal epi cells are reactive

Front 57

types of fibroadenomas

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intracanalicular fibroadenoma (stroma compresses and distrots glands into slitlike spaces)
pericanalicular (gland maintains round shape)

Front 58

Phyllodes tumor
morph

Back 58

large, bulky
variable malig
has ulceration of overlying skin
cystic spaces contain leaf-like projections from cyst walls and myxoid contents are characteristic

Front 59

presentation of adenoma of nipple

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tumor presents with serous or bloody discharge and palpable mass
can be mistaken for malignancy

Front 60

presentation of intraductal papilloma

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serous or bloody discharge
(benign tumor of major lactiferous ducts that must be disting from carcinoma)

Front 61

another name for intraductal carcinoma in situ
characteristics

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tumr cells fill ducts
tumor cell necrosis --> cheese like consistancy

Front 62

most common form of breast carcinoma
morph

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invasive ductal carcinoma (scirrhous carcinoma)
tumor cells arrangd in cords, islands, and glands, embedded in dense fibrous stroma
abundant fibrous tissue --> firm consistency

Front 63

morph of Paget dz of breast

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eczematoid lesion of nipple or areola
neoplastic Paget cells (large cells surrounded by clear halo-like area) invade epidermis
underlying ductal carcinoma always present

Front 64

morph of lobular carcinoma in situ

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clusters of neoplastic cells fill intralobular ductules and acini
--> invasive carcinoma in same/contralateral breast

Front 65

morph of medullary carcinoma

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cellular with scant stroma
soft, fleshy consistency
lymphocytic infiltrate
good prognosis compared to invasive ductal carcinoma

Front 66

morph of mucinous carcinoma
prognosis

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pools of extracellular mucous surrounding clusters of tumor cells
gelatinous consteny
good prognosis

Front 67

morph of inflammatory carcinoma

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lymphatic involvment of skin by underlying carcinoma
--> red swollen hot skin
POOR PROGSNOSI S

Front 68

which genetics are associated with a poor prognosis for breast carcinoma

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c-erB2 (Her2/Neu)

Front 69

Gross appearance of cervicitis?

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red cervix

Front 70

#1 cause of cervicitis in sexually active women

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chlamydia trachomatis

Front 71

discharge from candidiasis?

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scant, curdlike, milky

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discharge from trichomonas

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frothy, yellow/green

Front 73

discharge from garnerella

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fishy, thin

Front 74

gross appearance of uterus in adenomyosis

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2-4x bigger, from myometrial thickening
enlargement is symmetrical
no focal masses/lesions

Front 75

gross appearance of uterus in leiomyoma

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asymmetrical

Front 76

does endometrial hyperplasia lead to increased uterus size

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no

Front 77

when does endometrila hyperplasia usually occcur?
association with other dzs?

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during menopuase (also associated with germ line ovarian tumors)
25% --> endometrial carcinoma

Front 78

pathology of pre-eclampsia

Back 78

decidual arterioles show acute atherosis and fibrinoid necrosis

Front 79

what does a decrease in estriol in a pregnant woman indicate

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incipient abortion

Front 80

biochem markers for NTD

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high AChE and MSAFP

Front 81

which gene has association with ovarian ca

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brca 1

Front 82

how do GC-theca cell tumors --> endometrial hyperplasia

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they produce estrogens

Front 83

Clinical presentation of embryonic rhabdomyosarcoma

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vaginal bleeding and grape like protrusion from vagina of a child

Front 84

Histology of endometriosis

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red/blue brown .3 cm implants on uterine serosa

Front 85

how to treat cin 1?

Back 85

no tx necessary

Front 86

causes of salpingitis

Back 86

chlamydia
gonorrhea
mycolplasma

Front 87

Presentation of choriocarcinoma

Back 87

bloody, brown vaginal discharge
masses in lungs --> SOB
mass in vagina
synctiotrophoblasts
hihg hCG from synctiotrophoblasts

Front 88

clue cells found when?

Back 88

Pap smear of pt with Garnerella vaginosis

Front 89

pathophys of gardnerella

Back 89

loss of normal vaginal lactobacilli --> overgrowth of anaerobes --> superficial polymicrobial infection

Front 90

What bacteria are associated with Bartholin cysts?

Back 90

N. gonorrheae
Staph
both grow after Bartholin ducts are obstructed

Front 91

histo forms of vulvar dystrophies

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lichen sclerosus/hyperplastic dystrophy (both benign )
atypical hyperplastic dystrophy (malig)

Front 92

clinical features of vulvar dystrophy

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pruritis
leukoplakia

Front 93

most common causes of PID

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gonorrhea
chlamydia
enteric bacteria

Front 94

which STD causes opthalmia neonatorum

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gonorrhea

Front 95

what causes lymphogranuloma venereum?
sx?

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C. trachomatis
small papule or ulcer followed by superficial ulcers and enlarged lymph nodes that can get matted together --> rectal stricture from scarring and inflammation

Front 96

cellular changes associated with cervical erosion

Back 96

columnar epi replacing stratified squamous epi --> erythematous area