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180 Cards in this Set
- Front
- Back
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What is the disorder with the sex chromosomes XXY?
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Klinefelter's
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Name the common findings of Klinefelter's
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Testicular atrophy, fibrosis of seminiferous tubules leading to absence of spermatogenesis and loss of Sertoli cells, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
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Kleinfelter's is associated with significant mental retardation: TRUE OR FALSE
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FALSE
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What are the FSH, LH and T level's in Klinefelter's
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Increased FSH, Increased LH, Decreased T
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What is the karyotype for Klinefelter's
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XXY
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Why is there increased FSH in Klinefelter's?
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Absence of sertoli cells --> Decreased inhibin --> Inc FSH
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Why is there increased LH in Klinefelter's?
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inc FSH --> inc Aromatase in Leydig --> convert T to estradiol --> low testosterone --> inc LH
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What leads to increased estrogen in Klinefelter's?
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Abnormal leydig fx --> dec testosterone --> Inc. LH --> Inc estrogen
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What are some common findings of Turner's?
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Short stature, ovarian dysgenesis (streak ovary), devoid of oocytes by 2 yrs, webbing of neck, preductal coarctation of aorta, lymphedema in hands and feet of infants
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What is the most common cause of primary amenorrhea?
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Turner's
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Karyotype for Turner's
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XO
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What are estrogen, FSH, LH levels in Turners?
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Dec estrogen, Inc LH and Inc FSH
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What is the pathophysiology of webbed neck in Turner's
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Dilated lymphatic channels
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What is Turner's associated with?
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Horseshoe kidney, hypothyroidism, coarctation of the aorta, and bicuspid aortic valve
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What is the cause of XYY karyotype?
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Paternal nondysjunction
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What are clinical findings in XYY double Y males?
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Phenotypically normal, very tall, severe acne, antisocial behavior. Normal fertility
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Fertility is abnormal or normal in XYY males?
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Normal
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What are some causes of female psuedohermaphrodite?
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Excessive and inappropriate exposure to androgenic steroids during early gestation (congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)
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What condition occurs when ovaries are present but external genitalia are virilized or ambiguous?
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Female pseudohermaphrodite (XX)
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What condition occurs when testes are present but external genitalia are female or ambiguous?
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Male pseudohermaphrodite (XY)
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What is the most common form of male pseudohermaphrodite?
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Androgen insensitivity syndrome
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What could be the cause of sudden respiratory peripartal difficulty?
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Amniotic fluid embolism
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What causes amniotic fluid embolism and what is a hematologic complication?
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Tear in placental membrane and rupture of maternal veins, infusing of amniotic fluid and procoagulants. . DIC in pulmonary microcirculation --> DIC
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What is amniotic fluid aspiration syndrome?
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When a neonate is unable to expel amniotic fluid at birth
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What is a true hermaphrodite (46, XX or 47 XXY)
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Both ovary and testicular tissue present; ambiguous genitalia
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Pathophys of androgen insensitivity syndrome; findings
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Defect in androgen receptor resulting in normal-appearing female; female external genitalia with rudimentary vagina; uterus and uterine tubes generally absent; develops testes (inguinal herniae), primary amenorrhea in adulthood.
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How are the levels of T, estrogen, and LH in Androgen insensitivity syndrome?
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All high or varying depending on degree of insensitivity
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What condition is there ambiguous genitalia until puberty?
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5a-reductase deficiency
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What is the problem in 5a-reducatse deciiency and what happens as a result?
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Unable to convert testosterone to DHT --> Inc. testosterone @ puberty causes masculinization/ increased growth of external genitalia.
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How are the levels of T/estrogen/LH in 5a-reductase deficiency?
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Normal
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What is the pathophysiology of a hydatidiform mole?
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Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast)
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Hydatidiform moles are the most common precursor of
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Choriocarcinoma
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What are some descriptions of appearance for hydatidiform moles?
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"Honey-combed uterus" "cluster of grapes"
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The uterus is enlarged abnormally in partial hydatidiform moles: true or false
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False, only in complete hydatidiform moles
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Moles can lead to what complication of the uterine
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Uterine rupture
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Karyotype for two different classes of moles
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Complete: 46,XX(90%) and 46,XY. Partial: 69, XXY
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What are some differences between complete and partial hydatidiform moles
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Complete: entire placenta neoplastic, markedly increased hCG, 2% convert to choriocarcinoma, No fetal parts seen Partial: not all villi are neoplastic or dilated, somewhat increased hCG, rare conversion to choriocarcinoma, fetal parts present
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What are the components of a complete and partial hydatidiform mole
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Complete: 2 sperm and empty egg. Partial: 2 sperm and 1 egg
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With which hydatidiform mole do you see a snowstorm pattern on ultrasound?
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Complete mole
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What is a common cause of recurrent miscarriages in the 1st weeks?
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low progesterone levels (no response to B-hCG
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Leiomyomas have an increased incidence in what race
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Blacks
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Peak occurance of leiomyoma at what age
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20-40
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Leiomyomas are sensitive to what and increase and decreases in what stages for female
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Estrogen sensitive, Tumor size increases with pregnancy and decreases with menopause
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Benign smooth muscle tumor of the myometrium, malignant transformation rare
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Leiomyoma (fibroid)
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What is the histological finding of leiomyomas?
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Whorled pattern of smooth muscle bundles
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What are the clinical manifestations of leiomyomas?
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May be asymptomatic or may cause abnormal uterine bleeding. Severe bleeding may lead to iron deficiency anemia
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Describe a leiomyosarcoma
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Bulky, irregularly shaped tumor with areas of necrosis and hemorrhage, typically arising de novo. Hihgly aggressive tumor with tendency to bleed. May protude from cervix and bleed.
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Bulky, irregularly shaped tumor of myometrium with areas of necrosis and hemorrhage, typically arising de novo. Hihgly aggressive tumor with tendency to bleed. May protude from cervix and bleed.
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Leiomyosarcoma
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What is the order of gynecological tumor incidence?
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Endometrial > ovarian > cervical
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What is the order of gynecological tumors for worse prognosis?
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Ovarian > cervical > endometrial
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What are the levels of estrogen, LH, and FSH in premature ovarian failure?
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Decreased estrogen, Increased LH and FSH
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First hormone irregularity to think of when thinking of PCOS
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Increased LH
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Enlarged, bilateral cystic ovaries manifest clinically with amenorrhea, infertility, obesity, and hirsuitism
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Polycystic ovarian syndrome
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How does increased LH lead to the abnormalities in PCOS
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Inc LH --> Inc. androgen and increased estrogen --> Increase LH and decrease FSH --> follicle degeneration and fluid accumulation. Extra estrogen and androgen cause hirsutism and increase risk of endometrial cancer
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What are the treatments for PCOS?
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weight loss, OCPs, gonadotropin analogs, clomiphene (SERM), or surgery
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What is a follicular cyst?
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Distention of unruptured graafian follicle
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Distention of unruptured graafian follicle
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Follicular cyst
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What is follicular cyst associated with?
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Hyperestrinism and endometrial hyperplasia
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What is a corpus luteum cyst? Associated with
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Hemorrhage into persistent corpus luteum. Associated with menstrual irregularity
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Hemorrhage into persistent corpus luteum. Associated with menstrual irregularity
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Corpus luteum cyst
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What is the cause of a theca-lutein cyst and what is it associated with?
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Due to gonadotropin stimulation. Associated with choriocarcinoma and moles
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What ovarian tumor is equivalent to a male seminoma and is malignant?
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Dysgerminoma
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Which ovarian tumor is the most common malignant germ cell tumor?
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Dysgerminoma
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What ovarian tumor has a characteristic increase in serum LDH and has sheets of uniform cells?
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Dysgerminoma
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What is the tumor marker for a dysgerminoma?
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hCG
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What ovarian tumor is an aggressive malignancy in ovaries that is also seen in testes in boys and the sacrococcygeal area of young children? It also has a tumor marker of alpha-fetoprotein
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Yolk sac (endodermal sinus tumor)
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What is another name for a yolk sac tumor of the ovary?
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Endodermal sinus tumor
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What area can yolk sac tumors be found in young children?
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Sacrococcygeal area
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Teratoma is a non germ cell or germ cell tumor?
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Germ cell tumor
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What is another name for a mature teratoma?
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Dermoid cyst
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What is the most frequent benign ovarian tumor?
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Mature tgeratoma
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Teratomas are how many eprcent of all ovarian germ cell tumors?
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90.%
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Which of the teratomas is aggressively malignant? Mature or immature
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Immature
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What is struma ovarii?
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A teratoma that contains functional thyroid tissue and can present as hyperthyroidism
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What ovarian tumor has Schiller-Duval bodies?
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Yolk sac tumor
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Name the different germ cell tumors of the ovary
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Teratoma, dysgerminoma, Yolk sac tumor
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Name the different non-germ cell tumors of the ovary
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Serous cystadenoma, serous cystadenocarcinoma, mucinous cystadenoma, mucinous cystadenocarcinoma, Brener tumor, Fibromas, Granulosa cell tumor, Krukenberg tumor
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Serous cystadenomas are what percentage of ovarian tumors?
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20.%
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What are risk factor genes for ovarian cancer?
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BRCA-1, HNPCC
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Serous cystadenocarcinomas are what percentage of ovarian tumors?
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50.%
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Frequently bilateral ovarian tumor, lined with fallopian tube-like epithelium. Benign
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Serous cystadenoma
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Frequently bilateral ovarian tumor, lined with epithelium resembling fallopian tube, malignant
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Serous cystadenocarcinoma
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Which ovarian tumor has psammoma bodies?
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serous cystadencarcinoma
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Multilocular ovarian cyst lined by mucus-secreting epithelium. Benign
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Mucinous cystadenoma
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What is the name of the condition when mucinous cystadenocarcinomas form multiple intraperitoneal accumulations because of rupture or metastases?
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Pseudomyxoma peritonei
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Small islands of transitional epithelium within fibrous stroma of an ovarian tumor
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Brenner tumor
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Brenner tumors are benign/malignant and look like what organ's cells?
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Benign. Bladder
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What are fibromas and what syndrome are they associated with?
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Budnles of spindle-shaped fibroblasts. Meigs syndrome - triad of ovarian fibroma, ascites, and hydrothroax
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With what ovarian tumor do you get a pulling sensation in the groin?
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Fibroma
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What ovarian tumor secretes estrogen and causes precocious puberty in kids?
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Granulosa cell tumor
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What problems can granulosa cell tumors cause clinically?
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Estrogen secreting --> precocious puberty (kids). Cause endometrial hyperplasia or carcinoma in adults because of unoppossed estrogen secreting tumor which can then cause vaginal bleeding as well
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What is the common pathological finding in Granulosa cell tumors and what are they?
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Call Exner bodies - small follicles filled with eosinophilic secretions
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What is a Krukenberg tumor?
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GI malignancy that metastasizes to ovaries, causing a mucin-secreting signet cella denocarcinoma
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GI malignancy that metastasizes to ovaries, causing a mucin-secreting signet cella denocarcinoma
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Krukenberg tumor
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Vaginal squamous cell carcinoma is usuallly secondary to
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Cervical squamous cell carcinoma
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What type of vaginal carcinoma affects women who have had exposure to DES in utero?
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Clear cell adenocarcinoma
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What vaginal carcinoma affects girls <4 years old and consist of spindle shaped tumor cells that are desmin positive?
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Sarcoma botryoides
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Multiple polypoid masses "a bunch of grapes" projecting into vagina, protuding from vulva
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Sarcoma botryoides
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Characteristics of a fibroadenoma in breast
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Small, mobile, firm mass with sharp edges
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What breast tumor is the most common tumor in those <25 years old
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Fibroadenoma
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What happens to fibroadenomas with increased estrogen and are they malignant?
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Increase size and tenderness with increased estrogen; not a precursor to breast cancer
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Characteristics of intraductal papilloma in breast
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Small tumor that grows in lactiferous ducts. Typically beneath areola. Serous or bloody nipple discharge
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Small tumor that grows in lactiferous ducts. Typically beneath areola. Serous or bloody nipple discharge
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Intraductal papilloma
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Are intraductal papillomas malignant or benign
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Slight increase in risk for carcinoma
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Characteristics of Phyllodes tumor
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Large bulky mass of connective tissue and cyssts. "Leaf-like" projections from cyst wall ulceration of overlying skin.
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Phyllodes tumor: when most common for pts and malignant or benign
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Most common in 6th decade. Some may become malignant
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What is vaginal adenosis?
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Precursor lesion to clear cell adenocarcinoma. Mucosal columnar epithelium lined crypts in areas normally stratified squamous
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Precursor lesion to clear cell adenocarcinoma. Mucosal columnar epithelium lined crypts in areas normally stratified squamous
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Vaginal adenosis
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What is a papillary hidradenoma of the vulvar?
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Most common benign neoplasm of vulvar. Origniate from apocrine sweat glands. Labial nodule that ulcerates and bleeds. Rx - excision
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Most common benign neoplasm of vulvar. Origniate from apocrine sweat glands. Labial nodule that ulcerates and bleeds. Rx - excision
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Papillary hidradenoma of vulvar
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Vulvar squamous carcinoma is associatedw ith which viruses?
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HPV 16, 18
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What is the single most important prognostic factor for malignant breast tumors?
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Axillary lymph node inolvement
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What tumor fills breast ductal lumen?
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Ductal carcinoma in situ (DCIS)
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Early malignancy without basement membrane penetration that fills ductal lumen of breast
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Ductal carcinoma in situ (DCIS)
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Early malignancy that fills intralobular ductules and acini without basement membrane penetration
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Lobular carcinoma in situ (LCIS)
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What malignant breast tumor is the worst and most invasive?
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Invasive ductal
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What malignant breast tumor is the most common?
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Invasive ductal
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What are the characteristic of an invasive ductal tumor?
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Firm, fibrous mass. Small, glandular, duct-like cells
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What are the characteristics of invasive lobular breast tumors?
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Orderly row of cells "Indian file"
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Which malignat breast tumor has often multiple present bilaterally and has orderly row of cells.
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Invasive lobular
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What malignant breast tumor is ductal and has central areas of caseous necrosis?
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Comedocarcinoma
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Characteristics of an inflammatory breast tumor
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Dermal lymphatic invasion by breast carcinoma. Peau d'orange . 50% survival in 5 yrs
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Dermal lymphatic invasion by breast carcinoma. Peau d'orange . 50% survival in 5 yrs
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Inflammatory breast tumor
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Describe Paget's disease and Paget cells
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Disease = eczematous patches on nipple. Cells = largecells in epidermis with clear halo
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Paget's disease suggests what and is seen in what two parts of the female
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Suggest underlying carcinoma. Breast and vulva
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Describne a mucinoid (colloid) carcinoma
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Pools of extracellular mucus surrounding clusters of tumor cells. Having a gelatinous consistency
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What is the most common cause of "breast lumps" from age 25 to menopause?
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Fibrocystic disease
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When do you get pain with fibrocystic disease? Bilateral or unilateral?
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Premenstrual; bilateral
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What are the four different types of fibrocystic disease?
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1. Fibrosis 2. Cystic 3. Sclerosing adenosis 4. Epithelial hyperplasia
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Describe the features of fibrosis type fibrocystic disease
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Hyperplasia of breast stroma
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Describe the features of cystic type fibrocystic disease
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Fluid filled, blue dome
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Describe the features of sclerosing adenosis fibrocystic disease. What is it often confused with?
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Increasing acini and intalobular fibrosis; microcalcifications; proliferation of small ductules/acini in lobule - pattern often confused with infiltrating ductal cancer
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Describre the features of epithelial hyperplasia fibrocystic disease. Who does it occur in ?
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Increase in number of epithelial cell layers in terminal duct lobule. Ducts are estrogen sensitive. Increase risk of carcinomna with atypical cells. Occurs in women > 30 years of age
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Describe features of fat necrosis in the breast and how it occurs typically?
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A benign painless lump; lipid laden macrophages, mammographic calcifications may be present; forms as a result of injury to breast tissue.
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What is acute mastitis, when and how does it happen, and what is the most common pathogen?
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Breast abscess; during breast-feeding, increased risk of bacterial infection through cracks in the nipple; S. aureus is the most common pathogen
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Breast abscess; during breast-feeding, increased risk of bacterial infection through cracks in the nipple; S. aureus is the most common pathogen
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Acute mastitis
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What drugs cause gynecomastia?
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psychoactive drugs, Spironolactonee, Digitalis, Cimetidine, Alcohol, Ketoconazole (Some Drugs Creat Awesome Knockers)
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What are two pathologic conditions that lead to gynecomastia
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Hyperestrogenism (cirrrhosis, testicular tumor, puberty, old age), Klinefelter's syndrome
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Dysuria, frequency, urgency, low back pain are symptoms of what in a male
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Prostatitis
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The prostate gland undergoes _________ in BPH
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Hyperplasia (not hypertrophy)
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Why does the prostate gland undergo hyperplasia in BPH?
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Age-related increase in estradiol with possible sensitization of the prostate to the growth-promoting effects of DHT
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BPH is characterized by a nodular enalargement of what lobes?
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Periurethral (lateral and middle) lobes
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BPH leads to what complications of the urinary tract
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Distention and hypertrophy of the bladder, hydronephrosis and UTIs
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Is BPH a premalignant lesion
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No
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What is the lab finding associated with BPH
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Increased prostate specific antigen (PSA)
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Where do prostatic adenocarcinomas arise from typically?
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Posterior lobe (peripheral zone)
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How are prostatic adenocarcinomas most frequently diagnosed
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By digital rectal examination (hard nodule) and prostate biopsy
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What are useful tumor markers of prostatic adenocarcinoma
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Prostatic acid phosphatase (PAP) and PSA (increased total PSA, with DECREASED fraction of free PSA)
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What does lower back pain and an increase in serum alkaline phosphatase and PSA indicate?
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Prostatic adenocarcinoma osteoblastic metastases
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What is the histological finding in prostatic adenocarcinoma
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Small infiltrating glands with prominent nucleoli
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Name of condition for undescended testis (one or both)
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Cryptorchidism
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What increases the risk of cryptorchidism and what does cryptoorchidism increase the risk of
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Prematureity increases risk of cryptorchidism; Increased risk of germ cell tumor
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What is the most common testicular tumor
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Seminoma
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Seminomas affect males mainly in the age range
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15-35
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Describe the histological findings of a seminoma
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Large cells in lobules with watery cytoplasm and a "fried egg" appearance
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Which testicular germ cell tumor is malignant, presents with painless testicular enlargement, is radiosensitive, and has late metastasis and excellent prognosis?
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Seminoma
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Which testicular tumor is malignant, pianful, and has a glandular/papillary morphology, and can differentiate to other tumors?
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Embryonal carcinoma
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What is the morphology of an embryonal testicular carcinoma?
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Glandular/papillary morphology
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What testicular tumor has Schiller-Duval bodies and what do these bodies resemble?
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Yolk sac (endodermal sinus) tumor, resembles primitive glomeruli
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What is the tumor marker for yolk sac testicular tumor?
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Increased alpha-fetoprotein
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What testicular tumor has an increase in hCG levels and is malignant?
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Choriocarcinoma
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What is differnet about male teratomas?
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Mature teratoma in males is most often malignant
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What percentages of testicular tumors are germ cell tumors and what percentage are non-germ cell
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95% germ cell. 5% non-germ cell
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Name the testicular germ cell tumors
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Seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma
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Name the testicular non-germ cell tumors
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Leydig cell, Sertoli cell, Testicular lymphoma
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What are some common findings in Leydig cell tumors
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Benign, contains Reinke crystals; usually androgen producing, gynecomastia in men, precocious puberty in boys
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Benign, androblastoma from sex cord stroma in testicle
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Sertoli cell tumor
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What is the most common testicular cancer in older men?
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Testicular lymphoma
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How are varicoceles caused?
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Dilated vein in pampiniform plexus (can be caused by blockage of left renal vein - renal cell carcinoma) or blockage of right spermatic vein (retroperitoneal fibrosis)
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How are hydroceles caused?
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Increased fluid secondary to incomplete fusion of processus vaginalis --> peritoneal fluid can travel down patent processus vaginalis
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How are spermatoceles caused?
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Dilated epididymal duct
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What are features of Bowen's disease? In what percent can it progress to invasive SCC?
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Gray, solitary, crusty plaque, usually on shaft of penis or on scrotum; 10%
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When is the peak incidence of Bowen's disease
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5th decade of life
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What are features of Erythroplasia of Queyrat?
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Red velvety plaques, usually nvovling the glans, precursor to invasive SCC
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Red velvety plaques, usually nvovling the glans, precursor to invasive SCC of penis
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Erythroplasia of Queyrat
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Multiple papular lesions of penis; affects younger age group than other subtype; suually does not become invasive
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Bowenoid papulosis
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What virus is Bowen's disease, Erythroplasia of Queyrat, and Bowenoid papulosis associatd with
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HPV 16
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What is the biggest risk factor for SCC of the penis
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Not being circumcised
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What is peyronie's disase
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bent penis due to acquired fibrous tissue formation
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Paget's cells: large cells in epidermis with clear halo
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