Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
325 Cards in this Set
- Front
- Back
|
What sexual development abnormality is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, and female hair distribution? Cause? |
Klinefelter Syndrome [male] (XXY)
- Inactivated X chromosome (Barr body) |
|
|
What are the effects of an extra X chromosome in a male?
|
Klinefelter Syndrome [male] (XXY)
- Extra X chromosome becomes inactivated forming a Barr body - Leads to dysgenesis of seminiferous tubules → ↓ inhibin → ↑ FSH - Leads to abnormal Leydig cell function → ↓ Testosterone → ↑ LH → ↑ Estrogen |
|
|
What are the physical findings in a male with an extra X chromosome?
|
- Testicular atrophy
- Eunuchoid body shape (indeterminate) - Tall with long estremities - Gynecomastia - Female hair distribution |
|
|
What is a common cause of hypogonadism seen in infertility work-up?
|
Klinefelter Syndrome (XXY)
|
|
|
What is the effect of an extra X chromosome in a male on the seminiferous tubules?
|
Dysgenesis of seminiferous tubules → ↓ inhibin → ↑ FSH
|
|
|
What is the effect of an extra X chromosome in a male on the Leydig cells?
|
Abnormal Leydig cell function → ↓ Testosterone → ↑ LH → ↑ Estrogen
|
|
|
What sexual development abnormality is associated with short stature, ovarian dysgenesis, shield chest, bicuspid aortic valve, preductal coarctation, lymphatic defects, and horseshoe kidney?
|
Turner Syndrome [female] (XO)
|
|
|
What are the effects of a missing X chromosome in a female?
|
Turner Syndrome (XO)
- Menopause before menarche (1° amenorrhea) - ↓ Estrogen → ↑ LH and FSH - No Barr body |
|
|
What is the physical appearance of a missing X chromosome in a female?
|
Turner Syndrome
- Short stature (if untreated) - Shield chest - Webbed neck (due to lymphatic defects) - Lymphedema in feet and hands (due to lymphatic defects) |
|
|
What are the effects of a missing X chromosome in a female on the organs?
|
- Ovarian dysgenesis (streak ovary)
- Bicuspid aortic valve - Preductal coarctation (femoral < brachial pulse, notched ribs) - Lymphatic defects - Horseeshoe kidney |
|
|
What are the consequences of a preductal coarctation? What is associated with this?
|
- Femoral < brachial pulse
- Notched ribs - Associated with Turner Syndrome (XO) |
|
|
What can cause Turner Syndrome?
|
- Can result from mitotic or meiotic error
- Can be complete monosomy (45,XO) or mosaicism (eg, 45,XO/46,XX) |
|
|
Can patients with Turner Syndrome become pregnant?
|
Possible in some cases
- Oocyte donation - Exogenous estradiol-17β and progesterone |
|
|
What is the most common cause of 1° amenorrhea?
|
Turner Syndrome (45,XO)
|
|
|
What sexual development abnormality is associated with phenotypically normal, ver tall, severe acne, antisocial behavior?
|
Double Y males [male] (XYY)
|
|
|
What are the effects of an extra Y chromosome in a male?
|
- Phenotypically normal
- Very tall - Severe acne - Antisocial behavior (1-2%) - Normal fertility - Small percentage diagnosed with autism spectrum disorders |
|
|
What chromosome disorder is associated with true hermaphroditism?
|
- 46,XX
- 47,XXY |
|
|
What is true hermaphroditism also known as? What are the signs?
|
Ovotesticular disorder of sex development:
- Both ovary and testicular tissue present (ovotestis) - Ambiguous genitalia - Very rare |
|
|
What disorder of sex hormones would cause ↑ Testosterone and ↑ LH?
|
Defective Androgen Receptor
|
|
|
What disorder of sex hormones would cause ↑ Testosterone and ↓ LH?
|
Testosterone-secreting tumor or exogenous steroids
|
|
|
What disorder of sex hormones would cause ↓ Testosterone and ↑ LH?
|
1° Hypogonadism
|
|
|
What disorder of sex hormones would cause ↓ Testosterone and ↓ LH?
|
Hypogonadotropic hypogonadism
|
|
|
What is the term for patients in which the phenotypic sex (external genitalia) does not match the gonads (testes vs ovaries)?
|
"Pseudohermaphrodite", "Hermaphrodite", or "Intersex"
|
|
|
What sexual development abnormality is associated with the presence of ovaries, but external genitalia are virilized or ambiguous? Cause?
|
Female Pseudohermaphrodite (XX)
- Due to excessive and inappropriate exposure to androgenic steroids during early gestation - Could be due to congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy |
|
|
What sexual development abnormality is associated with the presence of testes, but external genitalia are feminine or ambiguous? Cause?
|
Male Pseudohemaphrodite (XY)
- Most commonly due to androgen insensitivity syndrome (testicular feminization) |
|
|
What can cause masculinization of female (46,XX) infants, causing ambiguous genitalia, and maternal virilization during pregnancy?
|
Aromatase Deficiency
- Inability to synthesize estrogens from androgens - ↑ Serum testosterone and androstenedione → virilization - Fetal androgens can cross placenta → virilization of mother |
|
|
What can cause a normal appearing female with female external genitalia with a rudimentary vagina and absent uterus and fallopian tubes? Other findings?
|
Androgen Insensitivity Syndrome (46,XY)
- Defect in androgen receptor - Scant sexual hair appears - Patient develops testes that are often found in labia majora |
|
|
What are the findings in a 46,XY patient with androgen insensitivity syndrome due to a defect in the androgen receptor? How do you treat this patient?
|
- Normal appearing female with female external genitalia and a rudimentary vagina
- Absent uterus and fallopian tubes - Presence of testes in labia majora - Scant sexual hair - ↑ Testosterone, estrogen, LH *Must remove testes to prevent malignancy |
|
|
What sexual development abnormality is associated with ambiguous genitalia until puberty, when masculinization and growth of external genitalia begins (normal internal genitalia)? Cause?
|
5α-Reductase Deficiency
- Autosomal recessive, limited to genetic males (46, XY) - Inability to convert Testosterone to DHT - During puberty, ↑ T causes masculinization and growth of external genitalia - Testosterone, estrogen, and LH levels are norma |
|
|
What sexual development abnormality is associated with a failure to complete puberty and a low sperm count in males? Cause?
|
Kallmann Syndrome
- Form of hypogonadotropic hypogonadism - Defective migration of GnRH cells and formation of olfactory bulb - ↓ Synthesis of GnRH in hypothalamus → ↓ FSH, LH, T, and infertility - Anosmia |
|
|
What sexual development abnormality is associated with a failure to complete puberty and amenorrhea in females? Cause?
|
Kallmann Syndrome
- Form of hypogonadotropic hypogonadism - Defective migration of GnRH cells and formation of olfactory bulb - ↓ Synthesis of GnRH in hypothalamus → ↓ FSH, LH, T, and infertility - Anosmia |
|
|
What are the findings of Kallmann Syndrome? Cause?
|
- Form of hypogonadotropic hypogonadism
- Defective migration of GnRH cells and formation of olfactory bulb - ↓ Synthesis of GnRH in hypothalamus → ↓ FSH, LH, T, and infertility - In males: low sperm count - In females: amenorrhea - Anosmia |
|
|
What is the karyotype of a complete hydatidiform mole?
|
46,XX or 46,XY
|
|
|
What is the karyotype of a partial hydatidiform mole?
|
69,XXX or 69,XXY, or 69,XYY
|
|
|
What does a hydatidiform mole come from?
|
- Cystic swelling of chorionic villi
- Proliferation of chorionic epithelium (only trophoblast) |
|
|
How do you treat all types of hydatidiform moles?
|
- Dilation and curretage with methotrexate
- Monitor β-hCG until it returns to normal |
|
|
What is the relative amount of hCG in complete vs partial moles?
|
- Complete: ↑↑↑↑ hCG
- Partial: ↑ hCG |
|
|
What is the relative uterine size in complete vs partial moles?
|
- Complete: ↑ uterine size
- Partial: no change in size |
|
|
What is the relative rate of conversion to choriocarcinoma in complete vs partial moles?
|
- Complete: 2% convert
- Partial: rare |
|
|
What is the relative amount of fetal parts in complete vs partial moles?
|
- Complete: no fetal parts
- Partial: some fetal parts (PARTial = fetal PARTs) |
|
|
What are the components of a complete vs partial moles?
|
- Complete: enucleated egg + single sperm (subsequently duplicates paternal DNA) OR empty egg + 2 sperm (rare)
- Partial: 1 egg + 2 sperm (hence why fetal parts can form) |
|
|
What is the relative risk of complications in a complete vs partial moles?
|
- Complete: 15-20% malignant trophoblastic disease
- Partial: low risk of malignancy (<5%) |
|
|
What are the symptoms in complete vs partial moles?
|
- Both: vaginal bleeding
- Complete: enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism - Partial: abdominal pain |
|
|
What is the appearance on imaging of a complete vs partial moles?
|
- Complete: honeycombed uterus or "clusters of grapes", looks like a "snowstorm" on ultrasound
- Partial: fetal parts |
|
|
What pathology gives the uterus a "snowstorm" appearance on ultrasound? Cause?
|
Complete mole
- 46,XX or 46,XY - Enucleated egg + single sperm (subsequently duplicates paternal DNA) - OR more rarely, empty egg + 2 sperm |
|
|
What pathology gives the uterus an appearance of being "honeycombed" or as a "cluster of grapes"? Cause?
|
Complete mole
- 46,XX or 46,XY - Enucleated egg + single sperm (subsequently duplicates paternal DNA) - OR more rarely, empty egg + 2 sperm |
|
|
Which type of pathology leads to fetal parts in the uterus? Cause?
|
Partial mole
- 69,XXX or 69,XXY, or 69,XYY - 2 sperm + 1 egg |
|
|
How do you diagnose gestational hypertension (pregnancy-induced hypertension)?
|
BP > 140/90 mmHg after the 20th week of gestation
- No pre-existing HTN - No proteinuria or end-organ damage |
|
|
How do you treat gestational hypertension (pregnancy-induced hypertension)?
|
Anti-hypertensives:
- α-Methyldopa - Labetalol - Hydralazine - Nifedipine Deliver at 39 weeks |
|
|
How do you diagnose pre-eclampsia?
|
- Hypertension (>140/90 mmHg) AND
- Proteinuria (>300 mg/24 hours) After 20th week of gestation to 6 weeks post-partum |
|
|
What does hypertension (>140/90 mmHg) and proteinuria (>300mg/24 hours) before week 20 of pregnancy suggest?
|
Molar pregnancy
|
|
|
What does hypertension (>140/90 mmHg) and proteinuria (>300mg/24 hours) after week 20 of pregnancy suggest?
|
Pre-Eclampsia
|
|
|
What makes a pre-eclampsia diagnosis "severe"?
|
BP > 160/110 mmHg with or without end-organ damage (eg, headache, scotoma, oliguria, ↑ AST/ALT, thrombocytopenia)
|
|
|
What are some types of end-organ damage that may be associated with pre-eclampsia?
|
- Headache
- Scotoma (partial loss of vision or a blind spot in an otherwise normal visual field) - Oliguria - ↑ AST/ALT - Thrombocytopenia |
|
|
What can cause pre-eclampsia?
|
Abnormal placental spiral arteries → maternal endothelial dysfunction, vasoconstriction, or hyperreflexia
|
|
|
In what situations is there increased incidence of pre-eclampsia?
|
- Pre-existing HTN
- Diabetes - Chronic renal disease - Auto-immune disorders |
|
|
What are the potential complications of pre-eclampsia?
|
- Placental abruption
- Coagulopathy - Renal failure - Uteroplacental insufficiency - Eclampsia |
|
|
How do you treat a patient with pre-eclampsia?
|
- Anti-hypertensives (α-methyldopa, labetalol, hydralazine, nifedipine)
- Deliver at 34 weeks (severe) or 37 weeks (mild) - IV magnesium sulfate to prevent seizures |
|
|
How can you try to prevent seizures in mothers with pre-eclampsia?
|
IV magnesium sulfate
|
|
|
When should you deliver a baby to a mother with pre-eclampsia?
|
- If severe (BP >160/110): 34 weeks
- If mild (BP >140/90): 37 weeks |
|
|
How do you make a diagnosis of eclampsia?
|
Pre-eclampsia + Maternal seizures
|
|
|
What can cause maternal death in eclampsia?
|
Stroke → intracranial hemorrhage or ARDS (acute respiratory distress syndrome)
|
|
|
How do you treat mothers with eclampsia (seizures)?
|
- Anti-hypertensives
- IV magnesium sulfate *Immediate delivery |
|
|
What syndrome is a manifesation of severe pre-eclampsia, but may occur without hyperension?
|
HELLP Syndrome:
- Hemolysis - Elevated Liver enzymes - Low Platelets |
|
|
What diagnosis do you give to a mother with hemolysis, elevated liver enzymes, and low platelets? How do you treat?
|
HELLP Syndrome (manifestation of severe pre-eclampsia, but may occur without HTN)
*Immediate delivery |
|
|
What is the term for the premature separation (partial or complete) of the placenta from the uterine wall before delivery of infant? What increases the risk of this happening?
|
Placental Abruption (abruptio placentae)
Risk factors: - Trauma (eg, motor vehicle accident) - Smoking - Hypertension - Pre-eclampsia - Cocaine abuse |
|
|
How does a mother with placental abruption present? Risks?
|
- ABRUPT, painful bleeding (concealed or apparent) in 3rd trimester
- Possible DIC, maternal shock, and/or fetal distress - Life threatening for mother and fetus |
|
|
What is the term for an abnormal attachment of the placenta leading to an abnormal separation after delivery? What increases the risk of this happening?
|
Placenta Accreta / Increta / Percreta
Risk factors: - Prior C-section - Inflammation - Placenta previa |
|
|
What can go wrong if there is a defective decidual layer of the placenta? Types?
|
Abnormal attachment and separation of placenta after delivery
- Placenta accreta - Placenta increta - Placenta percreta |
|
|
What is the term for when the placenta attaches to the myometrium without penetrating it?
|
Placenta Accreta (most common type)
|
|
|
What is the term for when the placenta penetrates into the myometrium?
|
Placenta Increta
|
|
|
What is the term for when the placenta penetrates and perforates through the myometrium into the uterine serosa, invading the entire uterine wall? What can this lead to?
|
Placenta percreta - placenta can even attach to the rectum or bladder
|
|
|
What is the presentation of patients with placenta accreta, increta, or percreta? Risks?
|
- No separation of placenta after delivery → massive bleeding
- Life threatening for mother |
|
|
What is the difference between placenta accreta, increta, and percreta?
|
- Placenta accreta: placenta attaches to myometrium without penetrating it (most common)
- Placenta increta: placenta penetrates into myometrium - Placenta percreta: placenta penetrates through myometrium and into uterine serosa |
|
|
What are the risk factors for placenta accreta, increta, and percreta?
|
- Prior C-section
- Inflammation - Placenta previa |
|
|
What is the term for the attachment of the placenta to the lower uterine segment (lying near, partially covering, or completely covering the internal cervical os)?
|
Placenta Previa
|
|
|
What happens in Placenta Previa?
|
Attachment of the placenta to the lower uterine segment, with one of the following relationships to the internal cervical os:
- Lying near - Partially covering - Completely covering |
|
|
What are the risk factors for Placenta Previa?
|
- Multiparity
- Prior C-section |
|
|
What does a prior C-section increase your risk for?
|
- Placenta accreta / increta / percreta
- Placenta previa |
|
|
What can happen if there is retained placental tissue after pregnancy?
|
- May cause postpartum hemorrhage
- ↑ Risk of infection |
|
|
What is the most common location for an ectopic pregnancy?
|
Most often in the ampulla of the fallopian tube
|
|
|
When should you suspect an ectopic pregnancy? How do you confirm?
|
- Amenorrhea
- Lower than expected rise in hCG based on dates - Sudden lower abdominal pain with or without bleeding * Confirm with ultrasound |
|
|
What can an ectopic pregnancy be confused with?
|
Appendicitis
|
|
|
What can increase your risk of having an ectopic pregnancy?
|
- History of infertility
- Salpingitis (PID) - Ruptured appendix - Prior tubal surgery |
|
|
What are the types of amniotic fluid abnormalities?
|
- Polyhydramnios
- Oligohydramnios |
|
|
What is the definition of polyhydramnios? What is it associated with?
|
>1.5 - 2.0 L of amniotic fluid
Associated with: - Fetal malformations (eg, esophageal / duodenal atresia, anencephaly - inability to swallow amniotic fluid) - Maternal diabetes - Fetal anemia - Multiple gestations |
|
|
What is the definition of oligohydramnios? What is it associated with?
|
<0.5 L of amniotic fluid
Associated with: - Placental insufficiency - Bilateral renal agenesis - Posterior urethral valves (in males) and resultant inability to excrete urine |
|
|
What can oligohydramnios cause?
|
Potter sequence
|
|
|
What is an inability to swallow amniotic fluid associated with? Possible causes?
|
Polyhydramnios (>1.5 - 2.0 L of amniotic fluid)
- Associated with esophageal and duodenal atresia, as well as anencephaly |
|
|
What is an inability to produce/excrete urine in utero associated with? Possible causes?
|
Oligohydramnios (<0.5L of amniotic fluid)
- Associated with bilateral renal agenesis and posterior urethral valves in males |
|
|
What are the types of cervical pathology?
|
- Dysplasia and carcinoma in situ
- Invasive carcinoma |
|
|
What are the risk factors for developing cervical dysplasia and carcinoma in situ?
|
** Multiple sex partners
- Smoking - Early sexual intercourse - HIV infection |
|
|
What are the histologic changes associated with dysplasia and carcinoma in situ of the cervix?
|
- Disordered epithelial growth
- Begins at basal layer of squamoucolumnar junction (transition zone) and extends outward - Koilocytes in cervical condyloma: note wrinkled "raisinoid" nuclei, some of which have clearing or a perinuclear halo |
|
|
How do you classify cervical dysplasia and carcinoma in situ?
|
CIN 1, CIN 2, or CIN3 (severe dysplasia or carcinoma in situ)
|
|
|
What causes cervical dysplasia / carcinoma in situ?
|
HPV 16 and HPV 18
- Produce E6: inhibits p53 suppressor gene - Produce E7: inhibits RB suppressor gene |
|
|
What can happen if cervical dysplasia / carcinoma in situ is not treated?
|
Can progress slowly to invasive carcinoma
|
|
|
How do you diagnose cervical dysplasia / carcinoma in situ?
|
- Detected with Pap smear
- May present as abnormal vaginal bleeding (often post-coital) |
|
|
What is the function of the HPV 16 and 18 E6 gene product?
|
Inhibits p53 tumor suppressor gene
|
|
|
What is the function of the HPV 16 and 18 E7 gene product?
|
Inhibits RB tumor suppressor gene
|
|
|
What type of carcinoma is typically found on the cervix?
|
Invasive Squamous Cell Carcinoma
|
|
|
What can be the complications of Invasive Squamous Cell Carcinoma of the cervix?
|
Lateral invasion can block ureters, causing renal failure
|
|
|
What is the purpose of a Pap smear?
|
Catch cervical dysplasia (eg, koilocytes) before it progresses to invasive carcinoma
|
|
|
What kind of inflammation occurs with endometritis?
|
Plasma cell and lymphocyte inflammation
|
|
|
What is endometritis associated with?
|
Associated with:
- Retained products of conception following delivery (vaginal or C-section), miscarriage, or abortion - Foreign body such as IUD |
|
|
What are the potential complications of retained material in the uterus?
|
Promotes infection by bacterial flora from vagina or intestinal tract → endometritis
|
|
|
How do you treat endometritis?
|
Gentamicin + Clindamycin with or without Ampicillin
|
|
|
What occurs in Endometriosis?
|
Non-neoplastic appearance of endometrial glands and stroma outside of the endometrial cavity (can be found anywhere)
|
|
|
What are the most common sites for endometriosis?
|
- Ovary
- Pelvis - Peritoneum |
|
|
What is the appearance of endometriosis in the ovary?
|
Endometrioma: blood-filled "chocolate cyst"
|
|
|
What is wrong when you see a "chocolate cyst"?
|
Endometriosis of the ovary (filled with blood)
|
|
|
What can cause endometriosis?
|
Retrograde flow, metaplastic transformation of multipotent cells, or transportation of endometrial tissue via the lymphatic system
|
|
|
What are the characteristic symptoms of endometriosis?
|
- Cyclic pelvic pain
- Bleeding - Dysmenorrhea - Dyspareunia - Dyschezia (pain with defecation) - Infertility - Normal-sized uterus |
|
|
How do you treat endometriosis?
|
- NSAIDs
- OCPs - Progestins - GnRH agonists - Surgery |
|
|
What is the term for the extension of endometrial tissue (glandular) into the uterine myometrium (smooth muscle)?
|
Adenomyosis
|
|
|
What causes Adenomyosis?
|
- Hyperplasia of the basalis layer of the endometrium
- Causes endometrial tissue to extend into the uterine myometrium |
|
|
What are the symptoms of Adenomyosis?
|
Dysmenorrhea and Menorrhagia
|
|
|
What is the appearance of the uterus with Adenomyosis?
|
Uniformly ENLARGED, SOFT, globular uterus
|
|
|
How do you treat Adenomyosis (extension of endometrial tissue into the uterine myometrium)?
|
Hysterectomy (removal of uterus)
|
|
|
What is the term for a well-circumscribed collection of endometrial tissue within the uterine wall?
|
Adenomyoma (polyp)
|
|
|
What is an Adenomyoma? What does it contain?
|
- Well-circumscribed collection of endometrial tissue within the uterine wall
- May also contain smooth muscle cells - Can extend into the endometrial cavity in the form of a polyp |
|
|
What are the types of endometrial proliferations?
|
- Endometrial hyperplasia
- Endometrial carcinoma |
|
|
What is and causes endometrial hyperplasia?
|
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
|
|
|
What are the risks associated with endometrial hyperplasia?
|
At risk for endometrial carcinoma
|
|
|
If your patient has postmenopausal vaginal bleeding, what should you think of?
|
Endometrial hyperplasia or carcinoma
|
|
|
What are the risk factors for endometrial hyperplasia?
|
- Anovulatory cycles
- Hormone replacement therapy - Polycystic ovarian syndrome - Granulosa cell tumor |
|
|
What is the most common gynecologic malignancy? When is it most common?
|
Endometrial Carcinoma
- Peak occurrence at 55-65 years |
|
|
What typically precedes endometrial carcinoma?
|
Endometrial hyperplasia (which usually manifests as postmenopausal vaginal bleeding)
|
|
|
What are the risk factors for endometrial carcinoma?
|
- Prolonged use of estrogen WITHOUT progestins
- Obesity - Diabetes - Hypertension - Nulliparity - Late menopause |
|
|
What can decrease the prognosis for patients with endometrial carcinoma?
|
↑ Myometrial invasion
|
|
|
What is the most common tumor in females? When and in whom is it more common?
|
Leiomyoma (fibroid)
- More common from 20-40 years of age - More common in blacks |
|
|
What kind of tumor is a "fibroid"? Benign / malignant?
|
Leiomyoma
- Benign smooth muscle tumor - Malignant transformation is rare (does not progress to leiomyosarcoma) |
|
|
How do leiomyomas respond to estrogen?
|
Estrogen sensitive
- Tumor size increases in pregnancy - Tumor size decreases with menopause (hence why more common in women from 20-40 years) |
|
|
What are the possible complications of a leiomyoma?
|
- May be asymptomatic
- May cause abnormal uterine bleeding - May result in miscarriage - Severe bleeding may lead to iron deficiency anemia |
|
|
What is the appearance of a leiomyoma histologically?
|
Whorled pattern of smooth muscle bundles with well-demarcated borders
|
|
|
What are the most common types of gynecologic tumors?
|
Endometrial > Ovarian > Cervical in US
*Cervical cancer is the most common worldwide |
|
|
What are the types of gynecologic tumors with the worst prognosis?
|
Ovarian > Cervical > Endometrial
|
|
|
What diagnosis should you consider in a patient with signs of menopause after puberty but before age 40? Levels of hormones?
|
Premature Ovarian Failure
- Premature atresia of ovarian follicles in women of reproductive age - ↓ Estrogen and ↑ LH, FSH |
|
|
What are the most common causes of anovulation?
|
- Pregnancy
- Polycystic ovarian syndrome - Pbesity - Hypothalamic-Pituitary-Ovarian axis abnormalities - Premature ovarian failure - Hyperprolactinemia - Thyroid disorders - Eating disorders - Female athletes - Cushing syndrome - Adrenal insufficiency |
|
|
What are the hormonal causes of anovulation?
|
- Hypothalamic-Pituitary-Ovarian axis abnormalities
- Hyperprolactinemia - Thyroid disorders - Cushing syndrome - Adrenal insufficiency |
|
|
What is the most common cause of infertility in women? What is it associated with?
|
Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)
- Associated with obesity |
|
|
What is happening to the hormones in Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
Hyperandrogenism due to deranged steroid synthesis by theca cells and hyperinsulinemia
- Estrogen ↑ steroid hormone binding globulin (SHBG) and ↓ LH → ↓ free testosterone - Insulin and testosterone ↓ SHBG → ↑ free testosterone - Pituitary / hypothalamus dysfunction → ↑ LH |
|
|
What are the implications of the ↑ LH, ↑ FSH (LH:FSH, 3:1), ↑ Testosterone, and ↑ Estrogen (from aromatization) in Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
- Enlarged bilateral cystic ovaries
- Presents with amenorrhea / oligomenorrhea, hirsutism, acne, and infertility |
|
|
What does Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome) increase your risk of?
|
Increased risk of endometrial cancer 2° to ↑ estrogens from the aromatization of testosterone and absence of progesterone
|
|
|
How do you treat the hirsutism and acne associated with Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
- Weight reduction
- OCPs (estrogen ↑ SHBG and ↓ LH → ↓ free testosterone) - Anti-androgens |
|
|
How do you treat the infertility associated with Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
- Clomiphene Citrate (blocks negative feedback of circulating estrogen, ↓ FSH, LH)
- Metformin (↑ insulin sensitivity, ↓ insulin levels, results in ↓ testosterone; enables LH surge) |
|
|
How do you prevent endometrial hyperplasia / carcinoma in patients with Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
Cyclic progesterones (antagonizes endometrial proliferation)
|
|
|
What is the appearance of an ovary with Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)?
|
Multiple follicles
|
|
|
What are the types of ovarian cysts?
|
- Follicular cysts
- Corpus luteum cysts - Theca-lutein cysts - Hemorrhagic cysts - Dermoid cysts - Endometrioid cysts |
|
|
What is the most common ovarian mass in young women? Cause?
|
Follicular ovarian cyst:
- Distended unruptured graafian follicle - Associated with hyperestrogenism and endometrial hyperplasia |
|
|
What type of ovarian cyst is associated with hyperestrogenism and endometrial hyperplasia?
|
Follicular ovarian cyst
|
|
|
What happens in a corpus luteum ovarian cyst? Prognosis?
|
- Hemorrhage into persistent corpus luteum
- Commonly regresses spontaneously |
|
|
What type of ovarian cyst is commonly bilateral and multiple? Cause?
|
Theca-Lutein Cyst
- Due to gonadotropin stimulation |
|
|
What are Theca-Lutein ovarian cysts associated with?
|
- Choriocarcinoma
- Molar pregnancies |
|
|
What causes a hemorrhagic ovarian cyst? Prognosis?
|
Blood vessel rupture in cyst wall
- Cyst grows with ↑ blood retention - Usually self-resolves |
|
|
What is the name for a teratoma on the ovary? Contents?
|
Dermoid Cyst
- Cystic growth filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage |
|
|
What causes and endometrioid cyst? Contents?
|
Endometriosis within the ovary with cyst formation
- When filled with dark, reddish-brown blood it is called a "chocolate cyst" |
|
|
What type of ovarian cyst varies with the menstrual cycle?
|
Endometrioid Cyst
|
|
|
What is the most common adnexal mass in women >55 years old?
|
Ovarian neoplasms (benign or malignant)
|
|
|
What can ovarian neoplasms arise from?
|
- Surface epithelium
- Germ cells - Sex cord stromal tissue |
|
|
What are the characteristics of most ovarian neoplasms? Risk factors?
|
- Majority of malignant tumors arise from epithelial cells
- Majority (95%) are epithelial (serous cystadenocarcinoma most common) - Risk ↑ with advance age, infertility, endometriosis, Polycystic Ovarian Syndrome, genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history) |
|
|
What can increase the risk for ovarian neoplasms?
|
- Advanced age
- Infertility - Endometriosis - Polycystic Ovarian Syndrome (PCOS) - Genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history) |
|
|
What can decrease the risk for ovarian neoplasms?
|
- Previous pregnancy
- History of breastfeeding - OCPs - Tubal ligation |
|
|
How do ovarian neoplasms present?
|
- Adnexal mass
- Abdominal distention - Bowel obstruction - Pleural effusion |
|
|
How do you diagnose an ovarian neoplasm? How do you monitor?
|
- Diagnose surgically
- Monitor progression by measuring CA-125 levels |
|
|
What is the use of CA-125 measurements in relation to ovarian neoplasms?
|
Good for measuring progression but not good for screening
|
|
|
What are the types of benign ovarian neoplasms?
|
- Serous cystadenoma
- Mucinous cystadenoma - Endometrioma - Mature cystic teratoma (dermoid cyst) - Brenner tumor - Fibromas - Thecoma |
|
|
What are the types of malignant ovarian neoplasms?
|
- Immature teratoma
- Granulosa cell tumor - Serous cystadenocarcinoma - Mucinous cysadenocarcinoma - Dysgerminoma - Choriocarcinoma - Yolk sac (endodermal sinus) tumor - Krukenberg tumor |
|
|
What is the most common ovarian neoplasm?
|
Serous Cystadenoma (benign)
|
|
|
What is the histologic appearance of a serous cystadenoma?
|
- Thin-walled, uni- or multilocular (single or multiple chambered)
- Lined with fallopian-like epithelium - Often bilateral |
|
|
What type of ovarian neoplasm is lined by fallopian-like epithelium?
|
Serous Cystadenoma (benign)
|
|
|
What is the histologic appearance of a mucinous cystadenoma?
|
- Multiloculated (multiple chambers)
- Large - Lined by mucus-secreting epithelium |
|
|
What type of ovarian neoplasm is lined by a mucus-secreting epithelium?
|
Mucinous Cystadenoma (benign)
|
|
|
What type of ovarian neoplasm presents with pelvic pain, dysmenorrhea, dyspareunia and appears as a complex mass on ultrasound?
|
Endometrioma (benign)
|
|
|
What does an Endometrioma arise from?
|
Arises from growth of ectopic endometrial tissue
|
|
|
What type of ovarian neoplasm can present with hyperthyroidism? Cause?
|
Mature Cystic Teratoma (dermoid cyst)
- If it contains functional thyroid tissue it can cause hyperthyroidism = Struma Ovarii |
|
|
What type of benign ovarian neoplasm is a germ cell tumor?
|
Mature Cystic Teratoma (dermoid cyst)
|
|
|
What is the most common ovarian tumor in women 20-30 years old? Characteristics?
|
Mature Cystic Teratoma (dermoid cyst)
- Germ cell tumor, can contain elements from all 3 germ layers - May contain teeth, hair, sebum, or thyroid tissue (may cause hyperthyroidism / struma ovarii) - Can present with pain 2° to ovarian enlargement or torsion |
|
|
How does a Mature Cystic Teratoma (dermoid cyst) cause pain?
|
May cause ovarian enlargement or torsion
|
|
|
What type of ovarian tumor looks like a bladder? How so?
|
Brenner Tumor
- Solid tumor - Pale yellow-tan in color - Appears encapsulated |
|
|
What type of ovarian tumor has a "coffee bean" nuclei on H&E stain?
|
Brenner Tumor (the benign ovarian tumor that looks like a bladder)
|
|
|
What type of ovarian tumor has bundles of spindle-shaped fibroblasts? Typical symptom?
|
Fibromas (benign)
- Pulling sensation in groin |
|
|
What is Meigs Syndrome?
|
Triad of:
- Ovarian fibroma - Ascites - Hydrothorax |
|
|
What type of ovarian neoplasm can cause abnormal uterine bleeding in a post-menopausal woman?
|
Thecoma
|
|
|
What are the characteristics of a Thecoma?
|
- Benign ovarian neoplasm
- May produce estrogen (like a granulosa cell tumor, which is malignant) - Usually presents with abnormal uterine bleeding in a postmenopausal woman |
|
|
What type of ovarian neoplasm contains embryonic like neural tissue (neuroectoderm)?
|
Immature Teratoma
|
|
|
What is the difference between an Immature Teratoma and a Mature Teratoma of the ovary?
|
Immature Teratoma
- Aggressive / malignant - Contains fetal tissue (neuroectoderm) Mature Teratoma - Benign - Contains teeth, hair, sebum, and functional thyroid tissue |
|
|
What is the most common sex cord stromal tumor? When is it more common?
|
Granulosa Cell Tumor
- Predominantly in women in their 50s |
|
|
What does a Granulosa Cell Tumor produce? Symptoms?
|
- Often produces estrogen and/or progesterone
- Presents with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness |
|
|
What type of ovarian neoplasm presents with Call-Exner bodies (that resemble primordial follicles)?
|
Granulosa Cell Tumor
|
|
|
What is the histologic appearance of a Granulosa Cell Tumor?
|
Call-Exner bodies (resemble primordial follicles)
|
|
|
What is the most common malignant ovarian neoplasm?
|
Serous Cystadenocarcinoma
|
|
|
What type of ovarian neoplasm contains psammoma bodies?
|
Serous Cystadenocarcinoma
|
|
|
What are the characteristics of a Serous Cystadenocarcinoma?
|
- Most common ovarian neoplasm, malignant
- Frequently bilateral - Contains psammoma bodies |
|
|
What are the characteristics of a Mucinous Cystadenocarcinoma
|
- Malignant ovarian neoplasm
- Pseudomyxoma peritonei: intraperitoneal accumulation of mucinous material - Mucinous material from ovarian or appendiceal tumor |
|
|
What is the most malignant common ovarian neoplasm in adolescents?
|
Dysgerminoma (malignant germ cell tumor of ovary)
|
|
|
What is a Dysgerminoma similar to in males? Tumor markers?
|
- Equivalent to male seminoma (but more rare)
- Tumor markers = hCG and LDH |
|
|
What is the appearance of Dysgerminoma? How common?
|
- Sheets of uniformed "fried egg" cells
- 1% of all ovarian tumors, but 30% of germ cell tumors |
|
|
What type of ovarian neoplasm can develop during or after pregnancy in mother or baby?
|
Choriocarcinoma
|
|
|
What tissue becomes cancerous in Choriocarcinoma?
|
Malignancy of trophoblastic tissue (cytotrophoblasts, syncytiotrophoblasts)
- No chorionic villi present |
|
|
What is associated with Choriocarcinoma?
|
- Increased frequency of theca-lutein cysts
- Presents with abnormal β-hCG, shortness of breath, and hemoptysis |
|
|
Which type of ovarian malignancy can cause shortness of breath and hemoptysis? Why?
|
Choriocarcinoma - can spread hematogenously to the lungs
|
|
|
How do you treat Choriocarcinoma?
|
Chemotherapy - very responsive
|
|
|
What type of ovarian tumor is marked by alpha fetoprotein (AFP)?
|
Yolk Sac (Endodermal Sinus) tumor - aggressive, malignant ovarian neoplasm
|
|
|
Where does a yolk sac tumor appear?
|
Ovaries (girls) or testes (boys) and sacrococcygeal area in young children
|
|
|
What is the most common tumor in male infants?
|
Yolk Sac (Endodermal Sinus) tumor
|
|
|
What are the contents/appearance of a Yolk Sac tumor?
|
Yellow, friable (hemorrhagic), solid mass
|
|
|
What type of ovarian tumor has structures that look like glomeruli? What are these called?
|
Yolk Sac Tumor
- 50% have Schiller-Duval Bodies (resemble glomeruli) |
|
|
What is the tumor marker for Yolk Sac Tumors?
|
Alpha Fetoprotein (AFP)
|
|
|
What is the name for when a GI malignancy metastasizes to the ovaries? What type of tumors?
|
Krukenberg Tumor
- Causes mucin-secreting signet cell adenocarcinoma |
|
|
What type of malignancy is responsible for a Krukenberg Tumor?
|
- Caused by GI malignancy that metastasizes to the ovaries
- Characterized by mucin-secretin signet cell adenocarcinoma |
|
|
What are the types of vaginal tumors?
|
- Squamous cell carcinoma (SCC)
- Clear cell adenocarcinoma - Sarcoma boyryoides (rhabdomyosarcoma variant) |
|
|
What causes squamous cell carcinoma of the vagina?
|
- Often secondary to cervical squamous cell carcinoma
- Primary SCC in vagina is very rare |
|
|
What causes clear cell adenocarcinoma of the vagina?
|
Affects women who had exposure to DES (diethylstilbestrol) in utero
|
|
|
What is DES (diethylstilbestrol) treatment in pregnancy associated with?
|
Daughters who get clear cell adenocarcinoma of the vagina
|
|
|
What type of vaginal tumor affects girls <4 years old? Characteristics of tumor cells?
|
Sarcoma Botryoides (Rhabdomyosarcoma variant)
- Spindle-shaped tumor cells that are desmin (+) |
|
|
What type of of tumor should you diagnose in a <4 year old girl with spindle shaped tumor cells that are desmin (+)?
|
Sarcoma Botryoides (Rhabdomyosarcoma variant)
|
|
|
What type of breast pathologies affect the nipple?
|
- Paget disease
- Breast abscess |
|
|
What type of breast pathologies affect the lactiferous sinus?
|
- Intraductal papilloma
- Abscess / mastitis |
|
|
What type of breast pathologies affect the major duct?
|
- Fibrocystic change
- DCIS - Invasive ductal carcinoma |
|
|
What type of breast pathologies affect the terminal duct?
|
Tubular Carcinoma
|
|
|
What type of breast pathologies affect the lobules?
|
Lobular carcinoma
|
|
|
What type of breast pathologies affect the stroma?
|
- Fibroadenoma
- Phyllodes tumor |
|
|
What are the benign breast tumors?
|
- Fibroadenoma
- Intraductal papilloma - Phyllodes tumor |
|
|
What is the most common type of breast tumor in those <35 years old? Characteristics of tumor?
|
Fibroadenoma (benign)
- Small, mobile, firm mass, with sharp edges in stroma of breast - ↑ size and tenderness with ↑ estrogen (eg, pregnancy, prior to menstruation) - Not a precursor to breast cancer |
|
|
What type of breast tumor may cause serous or bloody nipple discharge? Risk for carcinoma?
|
Intraductal Papilloma (benign)
- Small tumor that grows in lactiferous ducts - Typically tumor is beneath areola - Slight (1.5-2x) ↑ risk for carcinoma |
|
|
What are the characteristics of an intraductal papilloma of the breast?
|
- Small tumor that grows in lactiferous ducts
- Typically found beneath areola - Serous or bloody nipple discharge - Slight (1.5-2x) ↑ in risk for carcinoma |
|
|
Which type of breast cancer has "leaf-like" projections? Characteristics of tumor?
|
Phyllodes tumor (benign)
- Large bulky mass of CT and cysts, located in stroma of breast - Most common in 6th decade - Some may become malignant |
|
|
Who is more likely to get malignant breast tumors?
|
Post-menopausal women
|
|
|
What do malignant breast tumors typically arise from?
|
Terminal duct lobular unit
|
|
|
What type of receptors on breast tumors can help guide treatment? What if there are none of these receptors?
|
- Estrogen receptor
- Progesterone receptor - c-erbB2 (HER-2, an EGF receptor) Triple negative: ER(-), PR(-), and Her2/Neu (-) is the most aggressive type |
|
|
What is the most important prognostic factor for breast cancer?
|
Axillary lymph node involvement - indicates metastasis
|
|
|
What is the most common location of breast cancer?
|
Upper-outer quadrant
|
|
|
What are the risk factors for malignant breast cancer?
|
- ↑ Estrogen exposure
- ↑ Total number of menstrual cycles (early menarche) - Older age at first live birth - Obesity (↑ estrogen exposure as adipose tissue converts androstenedione to estrone) - BRCA1 and BRCA2 gene mutations - African American ethnicity (↑ risk for triple (-) breast cancer) |
|
|
What are the types of malignant, non-invasive breast cancer?
|
- Ductal Carcinoma In Situ (DCIS)
- Comedocarcinoma - Paget Disease |
|
|
What are the types of malignant, invasive breast cancer?
|
- Invasive Ductal Carcinoma
- Invasive Lobular Carcinoma - Medullary Carcinoma - Inflammatory Carcinoma |
|
|
What type of malignant breast tumor often appears as microcalcifications on mammography? Other characteristics? What does it arise from?
|
Ductal Carcinoma in Situ
- Fills ductal lumen (neoplastic cells confined to duct) - Arises from ductal atypia - Early malignancy without basement membrane penetration |
|
|
What type of malignant breast tumor causes ductal and caseous necrosis?
|
Comedocarcinoma - subtype of Ductal Carcinoma In Situ (DCIS)
- Central necrosis surrounded by cancer cells within ducts |
|
|
What type of non-invasive malignant breast tumor arises causes changes to the nipple?
|
Pagets Disease
- Causes eczematous patches on nipple - Arises from underlying Ductal Carcinoma In Situ (DCIS) - Also seen on vulva, though does not suggest underlying malignancy |
|
|
What is the histologic appearance of Paget Disease?
|
Presence of Paget cells = large cells in epidermis with clear halo
|
|
|
What are the types of invasive malignant breast tumors?
|
- Invasive Ductal Carcinoma
- Invasive Lobular Carcinoma - Medullary Carcinoma - Inflammatory Carcinoma |
|
|
What type of breast tumor causes a firm, fibrous, "rock-hard" mass with sharp margins?
|
Invasive Ductal Carcinoma
|
|
|
What is the histologic appearance of Invasive Ductal Carcinoma? Gross appearance?
|
- Histologic: small, glandular, duct-like cells
- Gross: "stellate" infiltration; firm, fibrous, "rock-hard" mass with sharp margins |
|
|
What is the worst and most invasive type of breast cancer?
|
Invasive Ductal Carcinoma
|
|
|
What is the most common type of breast cancer? How common?
|
Invasive Ductal Carcinoma (76% of all breast cancers)
|
|
|
What type of breast tumor causes orderly rows of cells ("indian file")?
|
Invasive Lobular Carcinoma
|
|
|
What is the appearance of Invasive Lobular Carcinoma?
|
- Orderly row of cells ("Indian file")
- Often bilateral with multiple lesions in the same location |
|
|
What type of breast tumor causes a fleshy, cellular, lymphocytic infiltrate? Prognosis?
|
Medullary Carcinoma
- Good prognosis |
|
|
What type of breast tumor causes a "peau d'orange" appearance?
|
Inflammatory Carcinoma
|
|
|
What happens in Inflammatory Carcinoma of the breast? Appearance? Prognosis?
|
- Dermal lymphatic invasion by breast carcinoma
- Peau d'orange (breast skin resembles an orange peel) - Neoplastic cells block lymphatic drainage - 50% survival at 5 years |
|
|
What are common, non-malignant breast conditions?
|
- Proliferative breast disease
- Acute mastitis - Fat necrosis - Gynecomastia |
|
|
What are the histologic types of proliferative breast disease?
|
- Fibrosis
- Cystic - Sclerosing adenosis - Epithelial hyperplasia |
|
|
What is the most common cause of breast lumps from age 25 to menopause?
|
Proliferative Breast Disease
- Fibrosis - Cystic - Sclerosing adenosis - Epithelial hyperplasia |
|
|
What changes occur with Proliferative Breast Disease?
|
- Premenstrual breast pain
- Multiple lesions (bumps), often bilaterally - Fluctuation in size of mass |
|
|
Are proliferative breast diseases associated with carcinoma?
|
No increased risk of carcinoma
Except: Sclerosing Adenosis (1.5-2x increased risk) and Epithelial Hyperplasia if there are atypical cells present |
|
|
What type of proliferative breast disease is associated with hyperplasia of the breast stroma?
|
Fibrotic proliferative breast disease
|
|
|
What type of proliferative breast disease is associated with fluid filled blue domes?
|
Cystic proliferative breast disease
|
|
|
What type of proliferative breast disease is associated with calcification and is often confused with cancer? Other characteristics?
|
Sclerosing adenosis proliferative breast disease
- ↑ Acini and intralobular fibrosis - Often confused with cancer - ↑ Risk of developing cancer (1.5-2x ↑) |
|
|
What type of proliferative breast disease is associated with increased number of epithelial cell layers in the terminal duct lobule? Other characteristics?
|
Epithelial hyperplasia proliferative breast disease
- Occurs in women >30 years old |
|
|
What is and causes acute mastitis?
|
- Breast abscess
- During breast-feeding, increased risk of bacterial infection through cracks in the nipple |
|
|
What is the most common pathogen in Acute Mastitis? How do you treat?
|
S. aureus - treat with Dicloxacillin and continued breast-feeding
|
|
|
What can result from injury to the breast tissue?
|
Fat Necrosis - forms a benign, usually painless lump
(although remember, up to 50% of patients may not report trauma) |
|
|
What kind of changes occur in Fat Necrosis of the breast?
|
- Abnormal calcification on mammography
- Biopsy shows necrotic fat, giant cells |
|
|
What causes gynecomastia in males?
|
- Hyperestrogenism: cirrhosis, testicular tumor, puberty, old age
- Klinefelter syndrome - Drugs |
|
|
What drugs can cause gynecomastia?
|
"Some DOPE Drugs Easily Create Awkward Hair DD Knockers"
- Spironolactone - Marijuana (Dope) - Digitalis - Estrogen - Cimetidine - Alcohol - Heroin - Dopamine D2 antagonists - Ketoconazole |
|
|
What prostate pathology is the most common cause of dysuria, urinary frequency and urgency, and low back pain in males?
|
Abacterial chronic prostatitis
|
|
|
What are the types of prostatitis? Symptoms?
|
- Acute: bacterial (eg, E. coli)
- Chronic: bacterial or abacterial (most common) - Symptoms: dysuria, frequency, urgency, low back pain |
|
|
When is Benign Prostatic Hyperplasia more common?
|
In men >50 years old
|
|
|
What happens to the cells of the prostate in BPH?
|
Hyperplasia - more cells (not hypertrophy - not bigger cells)
|
|
|
What are the characteristics of BPH?
|
- Smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes
- Compresses the urethra into a vertical slit - Not considered a pre-malignant lesion |
|
|
What are the symptoms associated with BPH?
|
- ↑ Frequency of urination
- Nocturia - Difficulty starting and stopping the stream of urine - Dysuria |
|
|
What can BPH lead to?
|
- Distention and hypertrophy of bladder
- Hydronephrosis - UTIs - ↑ free Prostate-Specific Antigen (PSA) |
|
|
How do you treat BPH?
|
- α1-antagonoists (Terazosin and Tamsulosin) → relax smooth muscle
- Finasteride (5α-reductase inhibitor) |
|
|
What drugs are α1-antagonists used for BPH?
|
- Terazosin
- Tamsulosin |
|
|
What drugs are 5α-reductase inhibitors used for BPH?
|
Finasteride
|
|
|
What type of cancer is common in the prostate of men >50 years old?
|
Prostatic Adenocarcinoma
|
|
|
Where does Prostatic Adenocarcinoma most often affect?
|
Arises from the posterior lobe (peripheral zone) of the prostate gland
|
|
|
How do you diagnose Prostatic Adenocarcinoma?
|
- ↑ Prostate-Specific Antigen
- Subsequent needle core biopsy |
|
|
What tumor markers are indicative of Prostatic Adenocarcinoma?
|
- Prostatic Acid Phosphatase (PAP)
- Prostate-Specific Antigen (PSA) |
|
|
What other parts of the body may be affected in late stages of Prostatic Adenocarcinoma? How?
|
Osteoblastic metastases in bone may develop → lower back pain and ↑ in serum ALP and PSA
|
|
|
What is the term for undescended testis (or both)?
|
Cryptorchidism
|
|
|
What are the complications of Cryptorchidism?
|
- Impaired spermatogenesis (since sperm develop best at T <37°C)
- Increased risk of germ cell tumors - Normal testosterone levels (Leydig cells are unaffected by temperature) in unilateral condition, but may be decreased in bilateral Cryptorchidism |
|
|
What increases the risk of Cryptorchidism?
|
Prematurity
|
|
|
What are the hormone changes in Cryptorchidism?
|
- ↓ Inhibin
- ↑ FSH - ↑ LH - Normal T (if unilateral) or ↓ T (if bilateral) |
|
|
What is the most common cause of scrotal enlargement in adult males?
|
Varicocele
|
|
|
What causes and results from Varicocele?
|
- Caused by increased venous pressure (most often on L side because of resistance to flow from L gonadal vein)
- Dilated veins in pampiniform plexus |
|
|
What is the appearance of Varicocele? How do you make diagnosis?
|
- Looks like a "bag of worms"
- Diagnose based on ultrasound with Doppler |
|
|
How is fertility affected by a Varicocele?
|
Can cause infertility because of ↑ temperature (impairs spermatogenesis)
|
|
|
How do you treat a Varicocele?
|
- Varicocelectomy
- Embolization by interventional radiologist |
|
|
What are the types of testicular germ cell tumors?
|
- Seminoma
- Yolk sac (endodermal sinus) tumor - Choriocarcinoma - Teratoma - Embryonal carcinoma |
|
|
What are the types of testicular non-germ cell tumors?
|
- Leydig cell tumor
- Sertoli cell tumor - Testicular lymphoma |
|
|
What is the origin of ~95% of all testicular tumors?
|
Germ cells (can present as a mixed germ cell tumor)
|
|
|
Who is most likely to get testicular germ cell tumors? Risk factors?
|
Most often affects young men
Risk factors: - Cryptorchidism - Klinefelter syndrome |
|
|
If your patient has a testicular mass that does not transilluminate, what is the most likely cause?
|
Testicular Cancer
|
|
|
What is the most common testicular tumor? When is it most common?
|
Seminoma - common in 3rd decade, never in infancy
|
|
|
What is the histologic appearance of a testicular Seminoma? Gross appearance?
|
- Large cells in lobules with watery cytoplasm
- "Fried egg" appearance - Causes homogenous testicular enlargement |
|
|
What lab value is elevated with a testicular Seminoma?
|
Increased placental ALP
|
|
|
What is the prognosis of a testicular Seminoma?
|
- Late metastasis
- Excellent prognosis |
|
|
What type of testicular tumor is analogous to an ovarian yolk sac tumor? Histologic appearance?
|
Yolk Sac (Endodermal Sinus) Tumor
- Yellow, mucinous - Contains Schiller-Duval bodies that resemble primitive glomeruli |
|
|
What is the most common testicular tumor in boys <3 years old?
|
Yolk Sac (Endodermal Sinus) Tumor
- Aggressive malignancy |
|
|
What type of testicular tumor causes an ↑ in hCG?
|
Choriocarcinoma
- Testicular germ cell tumor |
|
|
What goes wrong in a testicular Choriocarcinoma?
|
- Disordered syncytiotrophoblastic and cytotrophoblastic elements
- ↑ in hCG |
|
|
What are the potential complications of a Choriocarcinoma?
|
- Hematogenous metastases to lungs and brain (may present with "hemorrhagic stroke" due to bleeding into metastasis
- May produce gynecomastia and symptoms of hyperthyroidism (hCG is an LH and TSH analog) |
|
|
When are testicular teratomas more likely to be malignant vs benign?
|
- Mature teratomas in adults may be malignant (unlike in females)
- Teratomas are usually benign in children |
|
|
What hormonal changes occur with a testicular teratoma?
|
↑ hCG and/or AFP in 50% of cases
|
|
|
What type of testicular tumor causes necrosis and has a poor prognosis?
|
Embryonal Carcinoma
|
|
|
How does an Embryonal Carcinoma present? Hormonal changes?
|
- Malignant, hemorrhagic mass with necrosis
- Painful - May be associated with ↑ hCG and normal AFP levels when pure (or ↑ AFP when mixed) - Pure embryonal carcinoma is rare, most commonly mixed with other tumor types |
|
|
What is the typical morphology of Embryonal Carcinoma?
|
Often glandular / papillary morphology
|
|
|
How common are non-germ cell testicular tumors? Benign or malignant?
|
5% of all testicular tumors
- Mostly benign |
|
|
What kind of testicular tumor contains Reinke crystals? Other characteristics of appearance
|
Leydig cell (non-germ cell) tumor
- Golden brown color |
|
|
What kind of testicular tumor is androgen producing? Symptoms?
|
Leydig cell (non-germ cell) tumor
- Gynecomastia in men - Precocious puberty in boys |
|
|
What type of testicular tumor forms from sex cord stroma?
|
Sertoli cell (non-germ cell) tumor
- Androblastoma |
|
|
What is the most common testicular cancer in older men?
|
Testicular lymphoma - not a primary cancer, arises from lymphoma metastases to the testes
- Aggressive |
|
|
What is the serous covering of the testis?
|
Tunica Vaginalis
|
|
|
What diagnosis should you consider if there is a testicular mass that can be transilluminated?
|
Lesion of the Tunica Vaginalis
- Hydrocele - Spermatocele |
|
|
What happens in a Hydrocele?
|
↑ Fluid 2° to incomplete obliteration of processus vaginalis
|
|
|
What happens in Spermatocele?
|
Dilated epididymal duct
|
|
|
What type of cancer can occur on the penis?
|
Squamous cell carcinoma of the penis
|
|
|
Where is penile squamous cell carcinoma more common?
|
- Asia
- Africa - South America |
|
|
What are the precursor lesions for penile squamous cell carcinoma?
|
- Bowen Disease
- Erythroplasia of Queyrat - Bowenoid Papulosis |
|
|
What is the name for leukoplakia of the penile shaft?
|
Bowen Disease - precursor for penile squamous cell carcinoma
|
|
|
What is the name for erythroplakia of the penile shaft?
|
Erythroplasia of Queyrat - cancer of glans - precursor for penile squamous cell carcinoma
|
|
|
What is the name for the reddish papules on the penile shaft?
|
Bowenoid Papulosis - precursor for penile squamous cell carcinoma
|
|
|
What is penile squamous cell carcinoma of the associated with?
|
- HPV
- Lack of circumcision |
|
|
What is the name for a painful sustained erection not associated with sexual stimulation or desire? What can cause this?
|
Priapism
- Trauma - Sickle cell disease (sickled RBCs get trapped in vascular channels) - Medications (anticoagulants, PDE-5 inhibitors, anti-depressants, α-blockers, cocaine) |
|
|
What drugs can cause a painful sustained erection not associated with sexual stimulation or desire?
|
- Anticoagulants
- PDE-5 inhibitors - Anti-depressants - α-Blockers - Cocaine |
