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190 Cards in this Set

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What hormone is known as the "pregnancy maintenance hormone"? What secretes it?
Progesterone. Granulosa cells of the corpus luteum.
What spikes around the time of ovulation?
LH, FSH (a day before). Body temperature (a day or more after).
What is the most common site of involvement of endometriosis? Other sites?
The ovary. Abdomen, pelvis, bowel, bladder, "posterior cul de sac".
Powder-burn lesions?
Endometriosis.
How does pain related to endometriosis present?
Dyspareunia and worsening pain during the luteal phase, improving upon menses.
What women are more likely to suffer from endometriosis?
Women in their 30's without prior pregnancy.
Chocolate cyst?
Endometriosis of ovary.
What are the medical therapies available for a young woman with endometriosis?
GnRH analogs/agonists (Leuprolide) and androgenic agents (Danazol) to induce a hypoestrogenic state, oral contraceptives (Depo-Provera) to disrupt the estrogen cyclic secretion.
T/F: Fibroids and adenomyosis are not associated with race or obesity.
False, fibroids are inc in prevalence in blacks and obese.
T/F: Endometriosis, adenomyosis, and fibroids shrink or depart entirely after menopause.
True, bc they are all estrogen-dependent conditions.
Patients presenting with abnormal uterine bleeding or amenorrhea should have what condition ruled out?
Pregnancy!
Asherman's syndrome?
Synechiae of the uterus - adhesions and/or fibrosis due to scarring, often in the setting of D&C following miscarriage/abortion.
Stein-Leventhal syndrome? Symptoms?
Polycystic ovary syndrome. Classic triad of hyperandrogenism (acne hirsutism, deep voice, clitoromegaly), anovulation (oligo- or amenorrhea), obesity. Also acanthosis nigricans and hyperinsulinemia.
Increasing rates of infertility with increasing maternal age are due to what primary cause?
Decreasing quality of eggs.
What is the most common etiological cause of infertility for females?
Chronic anovulation due to PCOS or other pathology. Diagnose by oligo-amenorrhea.
What is the most common cause of pelvic inflammatory disease? Others?
STD's (GC, chlamydia) leading to LoF or occlusion. Previous tubal or pelvic surgery, endometriosis, ruptured appendicitis, septic abortion leading to peri-tubular/pelvic adhesions.
What is the best diagnostic tool to assess tubal factor infertility?
Hysterosalpingogram (HSG) to make sure the tube is patent. Laparoscopy with chromopertubation is the gold standard.
Clomiphene citrate has what effect?
Weak estrogen receptor modulator that blocks E2 binding to gonadotropes, stimulating GnRH and subsequent FSH release from the pituitary. Used for ovarian stimulation in women trying to get pregnant.
Metformin has what use in OB/gyn?
Corrects insulin resistance by sensitizing the body to insulin, helps women overcome PCOS to become fertile.
What are some age related risk factors for breast cancer?
Early menarche (12), late menopause (55), young (18) or old (30) age during first pregnancy.
What pharmacotherapies pose inc risk of developing breast cancer?
Estrogen replacement for postmenopausal women and long term oral contraceptive use esp prior to first pregnancy.
Where are BRCA-1 and BRCA-2 located in the genome? Associated with what cancers?
BRCA-1: Chr 17, familial breast and ovarian cancer.
BRCA-2: Chr 13, breast and prostate cancer.
Most important prognostic factor for breast cancer?
Axillary node involvement.
T/F: The presence of estrogen receptor positivity in breast cancer signifies a worse prognosis.
False. Better. Progesterone receptor too.
T/F: The presence of HER-2/NEU amplification in a breast tumor signifies a worse prognosis.
True. Codes for the epidermal growth factor receptor.
Cathepsin D?
Proteolytic enzyme, lyses basement membranes and plays a role in breast cancer invasiveness, its presence signifies worse prognosis.
What are the sites of distant metastasis for breast cancer?
Bone, liver, lungs, abdominal carcinomatosis, brain parenchyma/meninges, skin.
What tumor marker is elevated in 70-80% of metastatic breast cancer?
CA 15-3.
Tamoxifen? Application?
Estrogen receptor antagonist. Breast cancer (ER+).
Fulvestrant (Faslodex)? Application?
Estrogen receptor downregulator, degrader, for ER+ breast cancer.
Megesterol (Megace)?
Progesterone derivative used to treat advanced carcinoma of breast and endometrium, can also be used to inc appetite in pts with cachexia or treat perimenopausal symptoms (hot flushes).
Trastuzumab (Herceptin)?
HER/NEU2 monoclonal antibody, treats breast cancer (esp metastatic).
Fluoxymesterone (Halostetin)?
Anabolic steroid, used in tx of male hypogonadism and also breast cancer due to its competitive inhibition of estrogen/prolactin receptors.
Anastrozole (Arimidex) and Letrozole (Femara)?
Aromatase inhibitors, block conversion of androgens to estrogen and treat ER+ breast cancer.
Popular chemotherapy regimens with activity in metastatic breast cancer?
FAC (5-FU, adriamycin, cyclophosphamide) and CMF (cyclophosphamide, methotrexate, 5-FU).
Bevacizumab (Avastin)?
Monoclonal antibody against VEGF, used in many metastatic cancers esp colon, non-small cell lung, and breast.
Climacteric?
The physiologic period in a woman's life when there is a regression of ovarian function.
Perimenopause?
The time between the onset of irregular menses and permanent cessation of menstruation.
What is the duration of time without periods after which diagnosis of menopause can be certainly established?
2 years.
What is the first index of declining ovarian function?
Fall of inhibin levels. This correlates with a rise in FSH which can be used as a clinical marker of perimenopausal transition.
What produces inhibin, where does inhibin act, how does production change with age?
Granulosa cells in the ovaries, it inhibits pituitary FSH production, and levels fall during the climacteric when approaching menopause.
What levels can be tested to confirm menopause?
Elevated FSH and low estradiol (FSH should stimulate estradiol production but in the absence of follicles it cannot).
What is the best indication of treatment of menopause with estrogen replacement therapy?
Control of perimenopausal symptoms, not FSH levels.
What are the peri- and post-menopausal symptoms?
Hot flushes, dysphoric mood, mild memory impairment, interrupted sleep, arthralgia, mastalgia, paresthesias, palpitations, HA.
What causes hot flushes?
Decrease in circulating estrogen levels.
What are the two most common types of breast cancer?
Infiltrating lobular (70%) and then infiltrating ductal (10-15%) carcinoma.
Which forms of breast cancer have the best prognosis?
Tubular, medullary, and colloid (mucinous).
What is Paget's disease of the breast characterised by?
Eczema of the nipple in the setting of breast cancer (3-4%), sometimes with bleeding, with tumorous infiltration of the nipple's epithelium. A form of superficial DCIS w/o BM brakhage.
What are the potential manifestations of breast cancer metastasis to the lung?
Pleural effusions, pulmonary nodules, and lymphangitic spread.
What chemotherapeutic drug is herceptin contraindicated with? Why?
Adriamycin bc both can cause cardiomyopathies or induce congestive heart failure. Monitor the EF when pts are on herceptin.
What are some pharmacologic therapies for mid post-menopausal urinary incontinence?
Estrogen, alpha-agonists, and anticholinergic agents to increase smooth muscle tone of the urethral sphincter.
Oxybutynin (Ditropan)?
Anticholinergic indicated for urinary incontinence (inc muscle tone of urethral sphincter).
Tolterodine (Detrol)?
Muscarinic receptor antagonist indicated for stress and urge urinary incontinence (inc urethral sphincter tone).
Imipramine?
Alpha agonist and anticholinergic drug indicated for urinary incontinence (inc urethral sphincter tone).
Capsaicin?
C-fiber neurotoxin which can densensitize the blader to "urge" sensations, indicated for urge incontinence (overactive bladder).
Hormone replacement therapy has been proven to decrease the risk of:
Colon cancer, osteoporosis.
Hormone replacement therapy has been proven to increase the risk of:
Cardiovascular dz, CVA (like strokes), VTE, breast cancer, dementia.
The only sure method of contraception is:
Abstinence. All other methods involve some possibility for pregnancy!
Oral contraceptive use decreases risk for what cancer and increases risk for what cancer?
Ovarian cervical and endometrial decreased. Breast cancer inc with longterm use before first pregnancy.
Barrier and intrauterine contraceptives decrease the risks of what cancers?
Cervical and endometrial, respectively.
What is the most common indication for use of progestin-only contraceptives?
Hypertension (all conditions where estrogen therapy is contraindicated).
How do progestin-based OCP's relieve dysmenorrhea?
1. Inhibition of ovulation and subsequent progesterone-based prostaglandin secretion of the endometrium.
2. Reduction in menstrual flow which contains prostaglandins.
OCP's are contraindicated in women over 35 who:
Smoke.
How do OCP's improve acne and hirsutism?
1. Dec ovarian and adrenal androgen secretion.
2. Inc SHBG to bind androgens.
3. Dec 5alpha-reductase activity.
Net effect: less free testosterone.
Lybrel?
First continuous oral contraceptive (no placebo pills) released in the market.
Seasonale/Seasonique?
Extended cycle oral contraceptives (84 actives 7 placebos).
Advantages and disadvantages of extended use oral contraceptives?
Adv- fewer or no periods, prevention of endometriosis. Good for migraines.
Disadv- more breakthrough bleeding during early cycles.
Two main side effects of Implanon? What is its primary mode of action?
Irregular bleeding and headaches. Inhibition of ovulation. Ridiculously effective.
What non-cardiovascular contraindications to estrogen-based OCP's are out there?
Acute liver disease, SLE, past hx of breast cancer.
How does Mirena (Levornogestrel IUD) act as a contraceptive?
Inhibiting fertilization, makes life hard on sperm. Thickens cervical mucus, also inhibits tubal mobility.
What is the most widely used form of reversible contraception worldwide?
IUD's.
What are the main non-contraceptive benefits of IUD's?
Prevention of endometrial cancer and reduction of blood loss by menses.
T/F: Plan B acts within 72hr after unprotected intercourse by aborting the conceived fetus.
False, it acts by preventing ovulation and thus fertilization.
Levonorgestrel?
Synthetic gonane progestin used in oral contraceptives, including the IUD Mirena.
Yuzpe regimen?
Combination of estrogen and progestogen pills taken 12 hours apart within 72hrs after unprotected intercourse with the objective of "emergency contraception".
Mifepristone?
Progesterone analog that competitively inhibits activation of progesterone and glucocorticoid receptors to permit follicle maturation and endometrial development. Can be used either as an emergency contraceptive or abortive agent.
What is the most widely used form of contraception in the US?
Sterilization.
T/F: Obesity is protective against hot flushes.
True, because adipose tissue induces peripheral conversion of testosterone to estrogen which counteracts the dec levels responsible for hot flushes. Also dec SHBG's bc of the fat.
What is the best reducer of hot flushes?
Exercise.
In estrogen replacement therapy (ie for perimenopausal symptomatic relief) what also must be administered and why?
Progesterone in order to offset the stimulatory effects of estrogen.
Between complete and partial hydatiform moles and choriocarcinoma, what is the order of inc in beta-HCG serum level?
Partial mole < complete mole < choriocarcinoma.
Fertilization occurs within the _____ structure at what point during the woman's menstrual cycle?
Fallopian tubes, 3-4d after ovulation.
Between the amnion, the placental disc, the chorion, the umbilical cord, the villi, and the embryo, which come from the outer cell layer of the morula at 4d post-ovulation and which from the inner?
Inner - embryo, amnion, umbilicus.
Outer - placental disc, chorion, villi.
When does hCG peak in the course of pregnancy?
Around 8-10wks gestation, first becoming measurable at 8-10 days after fertilization.
Modified form of the endometrium that has been hormonally influenced by pregnancy, acting as a physical and immunologic barrier btw placenta and uterus?
Decidua appearing 28d post-menstruation.
Where the majority of ectopic pregnancies occur?
Fallopian tubes.
Abnormal deep implantation onto/into/through the myometrium?
Onto - Placenta accreta
Into - Placenta increta
Through - Placenta percreta
Abnormally low implantation of the fetus inducing blockage of the cervical os?
Placenta previa.
What two umbilical cord insertion patterns into the uterus are problematic?
Marginal and velamentous insertion, expose vessels w inc risk vascular compression, rupture, or thrombosis.
In what direction does the umbilical cord spiral, and what are its components?
Left at 7:1 CCW rotation, two umbilical arteries and one umbilical vein.
Umbilical arteries differ from large peripheral vascular arteries how?
No vaso vasorum and no peripheral nerves (no pain upon clamping).
What layer of cells forms the outside of the trophoblast and infiltrate into the endometrial stroma to enable implantation during embryogenesis? These cells secrete what hormone to keep what other hormone level high and sustain pregnancy?
Syncytiotrophoblasts secreting hCG to maintain high progesterone levels during pregnancy.
Chorionic plate sharing in twin embryos means that the twins are monozygotic or dizygotic?
Monozygotic.
Twin embryos that are monoamnionic have a risk of suffering what complications?
Twin transfusion syndrome (and occur in all monochorionics) and cord entangling and strangulation.
Pregnant woman with hypertension and proteinuria +/- edema?
Preeclampsia arising after 20wks gestation (usu after 32wks).
Preeclampsia + epigastric pain mandates ruling out what disease?
HELLP syndrome (hemolytic anemia, elevated liver enzymes, low platelets).
Fibrinoid necrosis with atheroma formation in the decidua?
Classic pathologic change for preeclampsia. Also small placenta with multiple large infarcts and accelerated maturation of villi.
Vaginal bleeding in a late term pregnant woman with uterine pain or tenderness?
Beware of abruptio placenta (antepartum hemorrhage or retroplacental hematoma) inducing fetal distress or death.
What are some fetal complications of gestational diabetes?
Fetal overgrowth (macrosomia), cardiomyopathy, hypoglycemia at birth due to excess fetal insulin production, inc risk resp distress.
What is the most common gynecological cancer? What is the most common cause of non-infectious uterine pain?
Uterine cancer. Ovarian endometriosis.
What is the leading diagnostic test for evaluation of ovarian tumors?
Pelvic ultrasonography.
Between benign and malignant ovarian tumors, which ones tend to be bilateral, cystic, mobile, smooth, fast-growing, and assoc with ascites or cul-de-sac nodules?
Benign- cystic, mobile, smooth.
Malignant- bilateral, solid, fixed, fast growing, assoc w ascites and cul-de-sac nodules.
Most common ovarian mass in women of reproductive age?
Functional (follicular) cyst - benign, 70% of all masses.
What ovarian mass can induce an intraabdominal hemorrhage and is often confused with a ruptured tubal pregnancy?
Corpus luteum cyst.
Dermoid cysts (benign cystic teratomas) tend to sit in what area of the uterus?
Anteriorly unlike most cysts which sit posteriorly or to the side of the uterus.
Endometrioma of the ovary is also called?
Chocolate cyst.
What type of cancer are 90% of ovarian cancers? What is the most common epithelial neoplasm of the ovary?
Epithelial = 90% malignant ovarian cancers, but the benign serous cystadenoma is actually the most common epithelial neoplasia of the ovary. Both benign and malignant show psammoma bodies.
Ovarian benign mass more common in older women showing spindle cells and fibrous bands on histo?
Ovarian fibroma (thecoma).
Define the staging criteria for ovarian cancer.
Region of spread. I - ovary. II - pelvis, peritoneum, uterus, Fallopian tubes. III - Abd cavity, most commonly omentum, then LN, aorta. IV - Liver, spleen, or extraabdominal.
Older women without any past history of pregnancy (nulligravid) have an inc risk of getting what cancer?
Ovarian cancer, uterine cancer, even breast cancer. Not being pregnant defies a woman's natural chronological physiology.
What tumor marker is assoc with ovarian cancer and what are some common causes of false positives?
CA-125. Endometriosis, uterine fibroids, pregnancy.
What are the types of malignant ovarian cancers of epithelial origin and what tissue does each resemble?
1. Serous cystadenocarcinoma - Fallopian tube epithelium;
2. Mucinous "" - Endocervical mucus;
3. Endometrioid carcinoma - Endometrioid-type glands;
4. Clear cell; 5. Brenner's tumor
What malignant neoplasm is an immature form of the benign cystic teratoma?
Immature teratoma which usu contains neural tissue.
Call-Exner body?
Granulosa cell tumor. Rosette arrangement of cells around a small fluid-filled space.
Which sex cord stromal malignancies secrete estrogen and testosterone?
Granulosa cell tumor/thecoma - estrogen; Sertoli-Leydig cel tumor - testosterone.
What are the most important protective factors against ovarian cancer?
Pregnancies, current or former use of OCPs, breast feeding, tubal ligations, oophorectomies.
What is the most common type of uterine adenocarcinoma?
Endometrioid.
Which two uterine adenocarcinomas spread early and behave like ovarian carcinomas (and are thus treated as one)?
Clear cell and papillary serous adenocarcinoma.
What is usually the presentation of uterine cancer?
Abnormal bleeding presenting early in the course of the disease allowing for early evaluation and appropriate treatment.
What are the differences between type I and II endometrial cancer of the uterus?
Type I - 90%, estrogen related, younger perimenopausal women, low grade, often due to exogenous estrogen use.
Type II - 10%, aggressive, no relation to estrogen, older and thinner women, genetic basis often (ex: Lynch- breast, uterine, then colon).
Obesity is a risk factor for which main gynecologic cancers and why?
Breast and uterine cancer, bc it exposes the body to more estrogen via extraglandular aromatization. Also remember nulliparity, early menarche, late menopause, DM, hypertension are risk factors.
Why do PCOS patients have an inc risk for getting uterine cancer?
PCOS induces anovulatory cycles due to unopposed estrogen, without progesterone present to intermittently relieve the endometrial hyperplasia induced by estrogen.
Rough 25% of females with granulosa cell tumors get what concomitant cancer and why?
Uterine adenocarcinomas bc of overproduction of estrogen.
Pipelle?
A quick and easy way to get an endometrial biopsy to screen for uterine cancer. Other catheters/curettes - Novak and Sharp curette.
Define staging for uterine/endometrial cancer?
Region of spread. I - confind to uterus. II - cervix involved. III - uterine serosa, adnexae, vaginal mets, pelvic/periaortic LN mets. IV - bladder, bowel, inguinal node, distant mets ie lung.
At what period in the menstrual cycle will the endometrium display a "blue donut" pattern?
Proliferative or follicular phase.
At what period in the menstrual cycle will the endometrium display a "piano key" pattern?
At ovulation or just after it (beginning of the luteal/secretory phase).
What signal in the endometrium is inhibited in the proliferative phase, activated in the secretory phase, and becomes responsible for menstrual breakdown?
M30.
What are some proliferative factors that are activated during the proliferative/follicular phase of endometrial growth?
RNA, EGFR, bcl-2, Ki67.
Why do anovulatory cycles occur and what age group do they usually demonstrate abnormal menstrual bleeding in?
Due to dysregulation of the menstrual cycle via excess estrogen and insufficient progesterone, occurring in adolescents just entering menarche and perimenopausal women.
What are the most common reasons for abnormal menstrual bleeding in reproductive age women?
Abortions/miscarriages, ectopic pregnancies, leiomyomas, and polyps.
What are the most common causes of abnormal menstrual bleeding in postmenopausal women?
Endometrial atrophy and uterine cancer/hyperplasia.
Tamoxifen is indicated for treatment of what cancer but can conversely give rise to tumors where?
Breast cancer, but can give rise to uterine polyps and endometrial adenocarcinoma bc it's pro-estrogenic in the uterus and anti-estrogenic in the breast.
Leiomyomas of what uterine location will produce bleeding? Others have what complications?
Submucosal leiomyomas can put pressure on the endometrial lining and cause bleeding. Outer fibroids can produce cramping and abd pain upon menstrual contractions, also pelvic distress due to being heavy.
What are risk factors for endometrial adenocarcinoma?
Post-menopause. High estrogenic states: HRT, Tamoxifen, ovarian cancer, obesity, reproductive factors.
"Fish flesh" appearance on uterine biopsy?
Atypical spindle cells of leiomyosarcoma.
Uterine malignant cancer involving both the glands and the stroma with heterologous formation by stem cells of chondrosarcomas, osteosarcomas, or rhabdomyosarcomas?
Malignant Mullerian tumor.
What are the assay tests performed to diagnose hydatiform moles?
Complete moles - androgenic diploid;
Partial moles - Triploid;
Both - p57 immunostain+, very high B-hCG.
Histologic difference btw complete and partial hydatiform moles? Choriocarcinoma?
Complete - large villi only, trophoblastic proliferation, no fetal tissue;
Partial - large and small villi, less trophoblastic proliferation, may contain fetal tissue.
Choriocarcinoma - no villi.
Dilatation of breast ducts due to obstruction, leading to a chronic inflammatory response and inspissation of secretion, perilobulitis?
Duct ectasia.
What is the most common tumorous growth in the breast in younger patients, is it benign or malignant?
Fibroadenoma, benign. If you leave it alone, it will dec in size w age.
Higher grade form of fibroadenoma in breast?
Phyllodes tumor, can be benign or malignant.
What are the types of proliferative breast dz with atypia (premalignant)? What carcinomas can they look like/give rise to?
Atypical ductal hyperplasia (ADH) - Ductal Carcinoma In Situ (DCIS), Atypical lobular hyperplasia (ALH) - Lobular Carcinoma In Situ (LCIS).
What histologic feature is classic for atypical lobular hyperplasia of the breast and why is this?
Small cells, round nuclei that do not adhere to each other bc no E-cadherin expression.
T/F: Patients with hereditary breast cancer respond well to chemotherapy.
True.
Nulliparity increases the risk of what cancers?
Breast cancer, ovarian and uterine.
Microcalcifications most often form in which type of carcinoma in situ of the breast?
DCIS (ductal).
"Comedo necrosis"?
Frequently seen in rapidly growing ductal carcinomas in situ of breast.
What do luminal A and B cancers have in common? What differentiates them?
Both are ER+, but luminal B is less responsive to therapy and proliferates faster.
Ovarian cancer positive for WT-1?
Serous adenocarcinoma.
Ovarian cancer positive for inhibin?
Granulosa cell sex cord stromal tumor.
What are the markers for the malignant germ cell tumors forming in the ovaries?
Dysgerminoma - PLAP
Yolk sac tumor - AFP
Chriocarcinoma - beta-HCG.
Female correlate of the male seminoma?
Dysgerminoma.
Schiller-Duval bodies?
Yolk sac tumors.
What etiologies can cause irritative voiding symptoms (dysuria, urgency, frequency, nocturia, urge incontinence)?
BPH, DM, neurogenic bladder, carcinoma in situ, overactive bladder.
Treatment for BPH? Mechanisms?
Alpha-blockers (___zosin), relaxation of bladder sphincter or prostatic region. 5-alpha reductase inhibitors, prevent conversion of testosterone to dihydrotestosterone to shrink bladder.
Contraindications for Sildenafil use?
Any patients on nitrates (for heart dz or otherwise).
Alprostadil?
Intraurethral suppository, prostaglandin E1 to be used 10min before an erection is desired.
What are methods to enable the visualization or palpation of a varicocele?
Ask patient to stand up and perform the valsalva.
At what point during the woman's menstrual cycle is conception likeliest to occur if intercourse takes place?
48hrs before ovulation.
What are the criteria for diagnosing varicoceles on duplex ultrasound?
Testicular vein must be greater than 3mm wide and reversal of flow must occur.
Sertoli cells secrete what factor to provide feedback inhibition to the anterior pituitary?
Inhibin (only inhibits FSH release).
What hormone levels would you check to monitor Sertoli cell function in a male?
FSH (recall Sertoli cells responsible for spermatogenesis and secrete inhibin to feed back to FSH secretion).
What hormone levels would you check to monitor Leydig cell function?
LH and testosterone (recall Leydig cells produce testosterone which feeds back to inhibit LH).
Evidence of small round cells in a semen sample of an infertile male?
1. Stain with CD45 Ab to make sure its' WBC and not immature sperm.
2. Suspect autoimmunity, Ab to sperm, NOT infection.
Between adult and infantile, which polycystic kidney disease is medullary? Autosomal dominant? Parallel?
Infantile - medullary, autosomal recessive, parallel;
Adult - throughout, autosomal dominant, big.
What kidney disease shows fibrinoid necrosis of arterioles with high levels of renin?
Malignant hypertension.
What are the most common acute and chronic causes of renal artery stenosis?
Acute - Thrombus formation;
Chronic - Atherosclerosis or fibromuscular dysplasia in women.
Which stones most commonly cause urolithiasis?
Calcium oxalate and phosphate.
Which kidney stones are characteristic for staghorn calculi?
Struvite (ammonium magnesium phosphate).
What are the acquired and genetic associated factors for renal cell carcinoma?
Acquired - tobacco, obesity, unopposed estrogen. Genetic - von Hippel Lindau gene.
What are the diseases associated with a mutaiton in the von Hippel Lindau (VHL) gene?
1. Hemangioblastomas in the cerebellum, spinal cord, kidney and retina.
2. Renal cell carcinoma.
3. Pheochromocytoma.
Most common type of renal cell carcinoma? How do you identify this grossly and histologically?
Clear cell carcinoma. Very yellow, round, pushing not infiltrating borders, variegated surface, cells look cleared of cytoplasmic contents.
Grossly how do you differentiate a clear cell carcinoma and renal oncocytoma?
Both are round with pushing borders but the clear cell will be yellow with necrosis + hemorrhage where the oncocytoma will be red with a central scar.
What gives the oncocytoma its appearance on microscope?
Red appearance due to proliferation of mitochondria.
Which renal tumors do not derive from the parenchyma?
Urothelium - Papillary transitional cell carcinoma.
Stroma- angiomyolipoma.
How is interstitial cystitis diagnosed in women?
Clinical dx as a persistent, painful, treatment resistant inflammation of bladder in women. If biopsy is performed, inc mast cells seen.
Is the vesicoureteric reflux more common in males or females? What disease results from this?
Females, UTI's.
Persistent damage to the bladder wall can lead to these formations of tiny glandular structures with outpouchings throughout the bladder wall.
Cystitis cystica et glandularis.
What are the two types of transitional cell carcinomas (cancer of the urothelium)?
Papillary TCC and carcinoma in situ.
What part of the prostate proliferates in BPH? Cancer?
Transition zone. Peripheral zone.
Scoring system for defining prostate cancer differentiation?
Gleason score (1 = well differentiated, 5 = no visible glands).
What tumor marker are seminomas positive for?
LDH and PLAP.
Choriocarcinoma has a predilection for what tissue type? Prostate cancer loves what tissue?
Choriocarcinoma - blood vessels.
Prostate - nerves.
Intratubular germ cell neoplasia is characteristic of what tumor?
Seminoma.
The majority of tumors in the testicles are:
Mixed germ cell tumors.
What cancer is assoc with schistosoma hematobium found in N. Africa?
Bladder cancer.
What is the one drug of the two drug regimen that serves as the gold standard for bladder cancer chemotherapy?
Cisplatin.
Sites of metastasis for bladder cancer?
Lung, liver, bone.
Classic triad of presenting sx in renal cancer?
Hematuria, flank pain, and palpable abd mass.