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138 Cards in this Set
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- Back
- 3rd side (hint)
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Egg cell count at birth |
2 million |
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Normal position of the uterus |
Anteflexed and anteverted |
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Location of round ligament |
lateral border of the uterus |
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Reason for anterversion of the uterus |
Round ligament |
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Most immature follicle |
Primordial follicle |
Respond to the hormone by the pituitary gland |
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Oocyte will be released on the |
14th day |
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More constant in menstration |
Secretory phase |
Used in family planning |
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Main hormone in secretory phase |
progesterone |
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Layer of the endometrium that is shed during menstration |
stratum spongiosum |
Also known as the functional layer |
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14 days, remains constant |
Secretory phase |
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The major hormone in proliferative phase |
Estrogen |
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Endometrial histologic characteristic in prolifereative phase |
Tubular, psuedostratified |
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Life span of the oocyte |
24-36 hours |
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Phase with presence of sub nuclear vacules |
Early Secretory phase |
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Phase with Supra nuclear vacules plus edema |
mid secretory phase |
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Pre decidual changes with development of arteriols in the stroma |
Late secretory phase |
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The remains of the dominant follicle |
Corpus luteum |
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All pituitary and ovarian hormones should be released at the proper time in the right amounts
Any disturbances will lead to |
Dysfunctional uterine bleeding |
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Most common cause of dysfunctional uterine bleeding |
Anovulatory cycle (failure to ovulate)* - endocrine, ovarian (PCOS or granulosa cell tumor), metabolic (obesity, malnutrition)
2nd cause is inadequate luteal phase - ovulation occurs but lags due to LOW progesterone |
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Caused by Infections after delivery or miscarraige
Retained products of conception
Causative agents: group A strep, staph aureus
With neutrophils |
Acute endometritis |
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Treatment of acute endometritis |
Removal of retained POC by curretage, antibiotic therapy |
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With lymphocytes and plasma cells in stroma
Chronic Pelvic inflammatory disease
Intrauterine contraceptive devices
Tuberculosis (from miliary spread or from TB in fallopian tubes)
No obvious cause |
Chronic endometritis |
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Presence of endometrial tissues, both glands and stroma, outside the uterine cavity
Pre menopausal 3rd-4th decade |
Endometriosis |
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Dysmenorrhea, dyschezia, dysparenuria 3D |
Endometriosis |
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4 theories of development of endometriosis |
Retrograde menstration Metaplasia of coelomic epithelium Immunologic theory Vascular or lymphatic dissemination |
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Most common site of endometriosis |
Ovary
2nd uterine ligaments |
30-40% associated with infertility |
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Treatment of endometriosis |
Oral contraceptive pills |
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Laparoscopy will show Mulberry spots: dark blue/ brownish black Chocolate cyst (ovarian surface) Poweder burn (peritoneal) |
Endometriosis |
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Biopsy/ histology will show Endometrial tissue (glands and stroma) and Hemosiderin laden macrophages |
endometriosis |
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First line for treatment for endometriosis |
Oral contraceptive pills (estrogen and progesterone) |
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Surgical management of endometriosis |
TAHBSO (defenitive)
Conservative: oophorocystectomy, excision (consider the age please) |
Best time to become pregnant: immediately after conservative surgery |
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Presence of Endometrial tissue within the myometrium
Halban sign (uterus is usually tender and slightly softened on bimanual exam ) |
adenomyosis |
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Uterus is assymetrically bulky, mobility not restricted, no associated adnexal pathology |
Adenomyosis |
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Metromenorrhagia, colicky dysmenorrhea, dysparenuria, pelvic pain |
adenomyoma |
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Tender, soften premenstrual uterus uterus is usually tender and slightly softened on bimanual exam |
halban sign |
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Treatment of adenomyosis |
Hysterectomy |
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Exophytic masses projecting into endometrial cavity
Multiple and sessile or large and pedunculated |
Endometrial polyp |
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Glands may be hyperblastic and atrophic or can undergo secretory changes |
Endometrial polyp |
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Treatment for endometrial polyp |
dilatation and curettage |
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Rearrangement of HMGIC and HMGIY genes
Mutations of the med12 genes |
Leiomyoma |
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Subtype of leiomyoma with bleeding |
submucosal |
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Subtype of leiomyoma that is asympotmatic |
subserosal |
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Diagnostic for leiomyoma |
Ultrasound |
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Treatment for leiomyoma/fibroid uterine |
Conservative: watch and wait
Medical: OCP, GNRH agonist
Surgical: hysterectomy, myomectomy |
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Rubbery Mass with world cut cervix |
Leiomyoma |
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70 year old woman passed blood for a month. What diagnostic procedure? |
Tansvaginal ultrasound |
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Most common gynecologic malignancy in the developed countries |
Endometrial carcinoma |
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Most common gynecologic malignancy in developing countries |
Cervical cancer |
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Mean age for endometrial carcinoma |
60 |
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Most common cause of abnormal uterine bleeding more than 60 yrs old |
Atrophy
2nd endometrial cancer |
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Most common cause if within the reproductive age group of abnormal uterine bleeding |
PCOS |
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Increased estrogen production of endometrial carcinoma |
Type 1 endometrial cancer |
ObesityPCOSunbalanced HRTnulliparityLate menopauseEstrogen produxing tumor (granulosa cell tumor, most common) |
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Type of endometrial cancer not estrogen related |
type 2 |
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Increase in the glands stroma
Absence of stromal invasion
Inactivation of PTEN tumor |
Endometrial hyperplasia |
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Precursor to endometrial carcinoma
Increase proliferation of endometrial glands relative to stroma, increase gland to stroma ratio
Associated with prolonged estrogenic stimulation
Inactivation of PTEN tumor suppressor gene |
Endometrial hyperplasia |
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Most common symptoms of endometrial hyperplasia |
bleeding |
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Classification of endometrial hyperplasia |
non atypical endometrial hyperplasia
atypical endometrial hyperplasia/ endometrial intraepithelial carcinoma |
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1-3% progressed to cancer
Increase gland to stroma ratio with intervening stroma
Follow up monitoring (every 3 months until regression) |
non atypical endometrial hyperplasia |
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Endometium is Crowded glands with intervening stroma |
atypical endometrial hyperplasia |
Treatment is surgery hysterectomy |
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Endrometriod morophology in endometrial carcinoma |
Type 1 endometrial carcinoma |
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Aggresive type of endometrial cancer
Intraperitoneal |
Type 2 endometrial carcinoma |
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Most common maligant tumor of the endometrium |
Endometrioid adenocarcinoma |
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Diagnostics for endometriod adenocarcinoma |
Biopsy Curettage (both diagnostic and curative) |
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Most common uterine sarcomas |
Carcinosarcomas / malignant mixed mullerian tumor |
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Large broad based endometrial polypoid growth
Malignant stroma with abnormally shaped benign glands |
Adenosarcoma |
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Treatment for adenosarcoma |
Early: TAHBSO late: radiation and chemotherapy |
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Hemorrhage and necrosis
Rapidly enlarging pelvic mass, pain or vagibal bleeding |
Leiomyosarcoma |
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Treatment of leiomyosarcona |
TAHBSO, Radiation therapy and chemotherapy as adjuvant |
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Fusion of JAZFI and SUZ12 genes
High rate of recurrence
10% or uterine sarcoma |
Endometrial stromal tumors |
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Consist of epithelia and mesenchymal elements native or foreign to the uterus
Mutations of PIK3CA, PTEN, TP53
postmenopausal bleeding with enlarged uterus, Bulky and polypoid, protrudes to the cervical os |
Carcinosarcoma |
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Most common site of cervical malignancy (HPV 16 and 18 related) |
Metaplastic squamous epithelium or transformation zone. |
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Lining of the endocerival epithelium |
Single layer mucinus columnar |
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Only cancer that has screening (pap smear) |
Cervical cancer |
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HPV strain related to cervical cancer |
High risk: 16 and 18, 31 and 33
Low risk: 6 and 11 |
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Most common type of cancer of the cervix |
Squamous cell carcinoma |
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Types of cervical cancer |
squamous cell carcinoma Adenocarcinoma Small cell carcinoma(hpv18)
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Recommended guidelines for cervical screening |
Start if >21 years of age who are or have been sexually active
21-29: if negative, every 2 years
30 and older: annually, if negative for 3 consecutive, every 3 years
HIV patients: twice in the first year then annually thereafter |
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Screening will discontinue if |
Age 70 yrs old Total hysterectomy |
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Non enveloped, double stranded, Dna virus
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Human pallimoma virus |
Onco 16,18,31,33
Non onco 6 and 11 |
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Early changes in the infection of HPV is seen in the |
Superficial layer |
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Will inhibit p53 |
E6 |
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Associated with retinoblastoma |
E7 |
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Pathognomonic histolgicaly for HPV infection |
Koilocytes E5 |
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Watery discharge (often offensive) and blood stained discharge or bleeding , after coitus |
Early cervical cancer |
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Exophytic of fungating type of cervical cancer |
squamous cell carcinoma |
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Pelvic pain Bladder and bowel problems |
Late cervical cancer |
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Most common cause of mortality in cervical carcinoma |
renal failure |
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ASCUS (Atypical Squamous Cells of Undetermined Significance) |
repeat pap smear after 6 months |
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AGUS (atypical glandular cells of undetermined significance) |
Colposcopy with endometrial currettage |
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Vaccine for hov 6,11,16,18 IM 0, 2, 6 mo |
Gardasil |
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Vaccine for hpv 16 and 18 IM 0, 1, 16 |
Cervarix |
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Prepares the endometrium for possible emplantation |
Corpus luteum |
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Distention of unruptured graafian follicle
>2.5cm
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Follicular cyst |
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Multiple follicular cyst due to hormonal imbalance
Increased LH and decreased FSH
Obese young woman with infertility, oligomenorrhea and hirsutism
Insulin resistance (give metformin) |
polycystic ovarian syndrome |
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Most common primary ovarian tumor |
surface epithelial tumors |
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Most common type of ovarian tumor |
Metastatic |
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Treatment of epithelial ovarian cancer |
Surgery |
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Most common symptom of epithelial ovarian cancer |
abdominal pain and enlarging mass |
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Extragonadal sites are less common In the mediastinum and retroperitoneum
Majority arise in the gonad from undifferenciated germ cell
Pediatrics |
Germ cell tumors
Dysgerminoma (seminoma in males) Embryonal carcinoma |
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Fried egg cells
Only germ cell tumor that is radio sensitive |
dysgerminoma |
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Most common tumor found in pediatric population |
yolk sac tumor |
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Most common malignant germ cell tumor
Most common spread: lymphatics Retroperitonial nodes and near structures
75% are stage 1 |
Dysgerminoma |
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Treatment for dysgerminoma |
Surgical: conservative Radiation: very sensitive Chemotherapy: adjuvant |
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Aggressive, contains fetal tissue, neuroectoderm.
Typical represented by immature like neural tissue |
Immature teratoma |
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Treatment for immature teratoma |
Surgery and chemotherapy |
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Most common immature component found in immature teratoma |
neuroepithelium |
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Most common germ cell tumor
Squamous Cell CA- most common somatic transformation |
mature teratoma |
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Type of Yolk sak tumor that has Abdominal /pelvic pain and secretes AFP, rarely alpha antitrypsin |
Endometrial yolk sac tumor |
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Very young median 14 years
Secrets AFP and HCG |
Embryonal carcinoma |
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Non gestational and extremely rare
Secrete HCG
treatment : surgery then chemotherapy
Poor prognosis if its pure form |
Choriocarcinoma |
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Embryoid bodies |
Polyembryoma |
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Derived from the sex cords (granulosa and sertoli cells) and the ovarian stroma or mesenchyme (theca, lutein and leydic cells
Most common: granulosa stromal cell tumor |
Sex cord stromal tumors |
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Carl-Exner bodies Low grade malignancy, late relapse Secretes estrogen aand may secrete androgen No endocrine function in some |
Granulosa cell tumor |
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Granulosa cell tumor marker |
Inhibin |
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Most common sex cord stromal tumor |
Adult tyoe |
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Metastatic ca to the ovaries, from GI
Mucin secreting signet cell adenocarcinoma
More on the left |
Krukenberg tumor |
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BRCA1 Least commin site for carcinima female reproductive sysstem 80-90% metastatic |
Fallopian tube cancer |
4th to 5th decade life |
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Watery discharge (most common and most specific ) Vaginal bleeding Crampy abdominal pain |
Fallopian cancer |
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Mucoid clear, translucent liquid
Lined by transitional epithelium or squamous low cuboidal mucinous epithelium
Marsupilization |
Bartholin cyst |
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lichen sclerosis Lichen simplex chronicus |
Leukoplakia |
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Marked thinning of epidermis, degeneration of basal cells, hyperkeratosis bandlike lymphocytic infiltrates in the dermis
Activated t cell
Not more malignant but high chance of malignancy |
Lichen sclerosis |
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Hyperplastic dystrophy
From rubbing/ scratching
Thickening of epidermis acanthosis and hyperkeratosis |
Lichen simplex chronicus (squamous hyperplasia) |
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HPV 6 and 11 |
Condyloma accuminata |
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Most common vaginal cancer |
Squamous cell carcinoma |
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Refers to a spextrun if proliferqtive abnormalities of the throphoblast Primipara |
Gestational throphoblastic disease |
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Most common type of H mole |
Complete |
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No fetal tissues or membranes, diffuse
Competely paternal 46XX/XY
Snow storm pattern |
Complete H mole |
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With fetus XXY |
Partial H mole |
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Pap smear: 3M margination molding and multinucleation |
HSV infection |
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Treatment of HSV |
Acyclovir 400mgs TID Famcyclovir 250 |
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Poxvirus infection of skin and mucous |
Molluscum contangiosum
Mcv 1 - most prevalent Mcv 2 - sexually transmitted |
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Most common fungal infection |
Candida glabrata
Txt metronidazole |
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whitish mucoud frothy |
Trichomonas vaginalis
Metronidazole |
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Clue cells
Whiff test positive
Thin green maloderous vaginal discharge |
Gardnerella vaginalis |
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Second most common
Black pigment irregular borders 2cm margin excision |
Melanoma |
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red lesion
Extramammary
80% intraepithelial adenocarcinoma cells
In situ
Most common site of spread: inguinal lymph nodes |
Pagets disease |
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Symptoms of pagets disease |
pruritus and vulvar soreness |
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Painless vaginal bleeding most common Due to T shpaed uterus, small/hypoplastic cervix (incompetent cervix) Due to DES Metastatic from cervix |
Vaginal cancer |
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