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80 Cards in this Set
- Front
- Back
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structure of female reproductive system |
-vulva (labia majora, labia minora, clitoris, urethral orifice) -vagina -cervix -uterus -fallopian tubes -ovaries |
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histology of female reproductive system |
-stratified sqamous mucosa (vulva, vagina, ectocervix) -glandular epithelium (endocervix, endometrium, fallopian tube) -germ cells (ovary) |
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hermaphroditism |
developmental abnoramality -disconcordance between genotypic and phenotypic sex true hermaphroditism male pseudohermaphorditism female pseudohermaphroditism |
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true hermaphroditism |
have both male and female gonads
does not occur in humans (eg snails, worms) |
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male pseudohermaphroditism |
genotypically male phenotypically female testosterone insensitive -not acting on receptors |
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female pseudohermaphroditism |
genotypically fenale phenotypically male |
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STIs |
common (HSV, chlamydia, HPV) present w vaginal discharge, lesions, pelvic pain, dyspareunia |
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genital herpes |
herpes simplex virus 2 (HSV2) -vesicles on genitalia that coalesce and ulcerate -appear 3-7d after exposure (only 30% develop lesions) -remains dormant in nerves, reactivation -important to be aware b/c don't want vaginal delivery if active |
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human papilloma virus (HPV) |
-labial, vaginal and cervical warts (condyloma) -certain types associated w carcinoma -condyloma acuminatum is large vulvular wart (HPV 6, 11) |
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chlamydia |
chlamydia trachomatis -present with urethritis or cervicitis with discharge -PID |
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gonorrhea |
Neisseria gonorrheae -urethrits or cervicitis w discharge -PID |
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syphilis |
Treponema pallidum -vulvular ulcers |
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Vacterial vaginoses |
not all bacterial -Candida (fungus) -Trichomonas (parasite) -Gardnerella (bacteria) |
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pelvic inflammatory disease (PID) |
-chronic, extensive infection of upper reproductive tract -usually secondary to STD (Neisseria, Chlamydia) -salpingitis (inflammation of fallopian tube), tubo-ovarian abscess, peritonitis |
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complications of PID |
-chronic non-specific infection (fever, malaise, fatigue) -infertility secondary to scarring of fallopian tubes -pelvic mass w pain -spread of infection |
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endometrial hyperplasia |
-normal menstrual cycle requires normal fxning of hypothalamic-pituitary-ovarian axis -endometrial hyperplasia is thickening of endometrial mucosa due to continued estrogen stimulation w inadequate progesterone -anovulatory cycle (no ovulation , therefore no progesterone secretion) -complex vs simple hyperlasia -atypical hyperplasia (increased risk of endometrial adenocarcinoma) |
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causes of anovulation leading to endometrial hyperplasia |
functional causes: -puberty, anxiety, athlete organic: -excess estrogen (OCP, tumors) if no ovulation, no release of progesterone |
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neoplasms of lower reproductive tract |
carcinoma of vulva carcinoma of vagina carcinoma of cervix |
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carcinoma of vulva |
-squamous cell carcinoma -raised or ulcerated lesion -pre-neoplastic change may present as white or red patch (leukoplakia or erythroplakia) -biopsy to assess -surgical excision +/- adjuvant therapy |
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carcinoma of vagina |
squamous cell carcinoma clear cell carcinoma -women born to mothers on DES during pregnancy |
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carcinoma of cervix (risk factors) |
-sexual intercourse at early age, multiple partners, HPV infection (certain types), other venereal diseases (other STIs) -environmental component and other factors reduced mortality due to Pap test (early diagnosis) |
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carcinoma of cervix (appearance) |
squamous cell carcinoma -precursor lesion = dysplasia (cervical intra-epithelial neoplasia) -lack of normal maturation of squamous epithelium -occurs at transition zone -graded mild, moderate, severe -cells shed into vagina (Pap smear) -koilocytic change refers to characteristic changes due to HPV |
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HPV types that cause carcinoma |
16, 18, 31, 33, 34, 35 |
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neoplasia of uterus |
Leiomyoma (fibroid) Leiomyosarcoma Endometrial adenocarcinoma |
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Leiomyoma |
(fibroid) neoplasm of uterus -benign neoplasm derived from smooth muscle in wall of uterus -most common uterine neoplasm -responsive to estrogen, arise during reproductive age -usually asymptomatic -may produce sx due to mass effects, bleeding |
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Leiomyosarcoma |
neoplasm of uterus -malignant neoplasm derived from smooth muscle in wall of uterus -very rare (does not come from leiomyomas) |
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endometrial adenocarcinoma |
-malignant neoplasm derived from epithelial cells of endometrium -most common malignant tumor of female reproductive tract -elderly females, vaginal bleed |
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risk factors for endometrial adenocarcinoma |
related to increased estrogen (hyperestrinism)
-estrogen secreting tumor, exogenous estrogen -obesity (increased estrogen in periphery) -nulliparous or early menarche, late menopause |
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endometrial adenocarcinoma tx |
-stage most important prognostic feature (TNM) -grade also important (low, intermediate, high) -diagnosis: endometrial biopsy, dilation and curettage -therapy: hysterectomy +/- adjuvant therapy |
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ovarian cysts |
-fluid filled cavities lined by epithelium -usually arise from unruptured follicles (follicular cysts) -may also represent cystic corpora lutea or inclusions of surface cells -usually small, solitary, asymptomatic -if large, then further investigation to rule out neoplasm |
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polycystic ovary syndrome |
-multiple cysts in both ovaries due to complex hormonal disturbances of the hypothalamic-pituiatary-ovarian-adrenal axis -presents w menstrual irregularities -cause of infertility |
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ovarian neoplasms |
-second most common group of tumors of female reproductive tract tumors -malignant ovarian tumors are uncommon in young females -oral contraceptives not linked to ovarian neoplasms -surface epithelial tumors (serous, mucinous, endometrioid) -germ cell tumors (teratoma, immature teratoma) -fibroma -thecoma -granulosa cell tumor |
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3 major groups of ovarian neoplasms based on histogenetics |
-surface epithelial tumors -germ cell tumors -sex cord stromal tumors |
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risk factors for ovarian neoplasms |
not well defined -ovarian dysgenesis -BRCA1 and BRCA2 gene mutation |
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ovarian surface epithelial tumor |
-70% of ovarian neoplasms spectrum of histologic types: -serous, mucinous, endometrioid, clear cell and transitional cell types |
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ovarian serous epithelial tumor |
-most common ovarian surface epithelial tumor -typically cystic, filled w clear fluid -benign, borderline malignant, malignant -25% of benign tumors and 50% of malignant tumors are bilateral -distinction of benign vs malignant requires histologic examination |
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ovarian mucinous epithelial tumor |
-typically cystic, filled w viscous fluid -benign, borderline malignant, malignant -25% of benign, 50% of malignant tumors are bilateral -distinction of benign vs malignant requires histologic examination |
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endometrioid epithelial tumors |
ovarian neoplasm -typically solid -malignant |
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ovarian germ cell tumors |
20% of ovarian tumors -occur in young females Teratoma Immature teratoma |
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teratoma |
-most common ovarian neoplasm in young females -cystic, contain hair, sebaceous material (dermoid cysts) -may contain teeth, bone cartilage -benign (may undergo malignant transformation to malignant teratoma) |
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immature teratoma |
-teratoma that contains immature neural tissue -may behave malignantly |
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ovarian fibroma |
-benign neoplasm of fibroblasts |
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ovarian thecoma |
-benign solid and firm neoplasm of spindle cells (theca cells) |
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ovarian granulosa cell tumor |
-neoplasm of granulosa cells -benign or malignant, may produce estrogen |
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causes of infertility |
-ovum related -sperm related -genital organ factors (PID, Asherman's syndrome: remove basal layer and can't regenerate) -systemic factors |
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diseases of pregnancy |
ectopic pregnancy placenta accreta placenta previa toxemia of pregnancy preeclampsia eclampsia |
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ectopic pregnancy |
-implantation of fertilized ovum outside the uterine cavity -usually occurs in fallopian tube (rarely in peritoneal cavity) -trophoblast cells of placenta invade wall of tube, begins enlarging -may rupture (surgical emergency) |
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placenta accreta |
-abnormally deep penetration of placental villi into wall of uterus |
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placenta previa |
abnormal placental implantation site in lower uterine segment (block passage of fetus - do C-section) |
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toxemia of pregnancy |
-disease of pregnancy of unknown pathogenesis resulting in characteristic symptom complex in the mother |
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preeclampsia |
-presents w hypertension, edema, proteinuria -occurs in third trimester -may progress to eclampsia |
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eclampsia |
-hypertension, edema, proteinurea, seizures -life threatening, must tx seizures, deliver baby (induce delivery) |
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gestational trophoblastic disease |
-abnormalities of placentation resulting in tumor-like changes or malignant transformation Hydatidiform mole Choriocarcinoma |
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Hydatidiform mole |
-developmental abnormality of placenta -trophoblastic proliferation, hydropic degeneration of chorionic villi -enlarged uterus with no fetal movement, high HCG (stimulating uterus to grow, but no fetus) complete mole incomplete mole |
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complete hydatidiform mole |
no identifiable fetus abnormal fertilization (46XX, all paternal) |
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incomplete hydatidiform mole |
usually some fetal parts abnormal fertilization (69 chormosomes) -not viable |
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choriocarcinoma |
-rare highly malignant tumor of placental origin -tx w methotrexate |
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abortion |
-interruption of pregnancy prior to feta viability (< 500g, 20w) |
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spontaneous abortions |
-no identifiable cause (1/3 of all pregnancies) complete abortion incomplete abortion missed abortion threatened abortion |
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complete abortion |
fetus and placenta expelled normal fxn returns |
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incomplete abortion |
retention of some fetal or placental material |
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missed abortion |
death of fetus in utero passed several weeks later |
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threatened abortion |
cervical os clossed spotting of blood |
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endometriosis |
-endometrial tissue (uterine glands + stroma) located outside the uterus (ectopic tissue) -various locations, typically ovary, peritoneum -cycle in response to hormonal influences -common, may cause pain -may cause infertility (complete replacement of ovary by endometrial tissue) -benign condition -chocolate cyst of ovary (dry blood in center) |
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pathogenesis of endometriosis |
-retrograde flow -traumatic implantation (in surgical site of C-section) |
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breast fxn |
produce milk (nourish newborn) |
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structure of breast |
-modified apocrine sweat gland -lobules (ducts + terminal buds) drain into larger duct system hormonally influenced changes: -post-pubertal females (proliferation of ducts and early acini) -pregnant female (terminal buds develop into acini, prolactin released in response to infant's suck, milk produced) |
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acute mastitis |
-acute inflammation of the breast -lactating female -bacterial infection -abscess may develop |
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chronic mastitis |
-rare disease of unknown etiology -may mimic breast cancer |
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fibrocystic change of breast |
-benign changes in breast tissue due to various factors including hormonal influences and age -females of reproductive age -fibrosis of intralobular stroma -cystic dilation of epithelial ducts -epithelial hyperplasia -various sx |
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gynecomastia |
-increased proliferation of male breast due to various factors |
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fibroadenoma |
-benign neoplasm of breast epithelial and stromal elements -well circumscribed, firm, mobile mass (mobile is good b/c not attached to surrounding tissue, so not invasive) -young females |
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breast cancer |
-most common cancer in females -3rd most common cause of cancer-related deaths in females -there are different forms of breast cancer |
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causes of breast cancer |
hormonal, environmental and genetic influences -familial breast cancers -BRCA1, BRCA2 tumor suppressor genes -increased incidence of other cancers |
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risk factors of breast cancer |
-female sex (100x males) -genetic predisposition -hormonal factors -other malignancies (contralateral breast carcinoma, endometrial carcinoma) -premalignatn changes (carcinoma in situ, atypical hyperplasia) -age (increase w age) -race |
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hormonal factors related to breast cancer |
prolonged estrogen exposure -early menarche, late menopause -nulliparous (never had children) |
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most common form of breast cancer |
infiltrating ductal carcinoma
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infiltrating ductal carcinoma |
-adenocarcinoma -desmoplastic respnose of stroma -lymphatic spread (axillary nodes drain most of breast) -presents as mass -early detection (breast self-exam, mammography) -fine needle aspiration -incisional biopsy |
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breast cancer therapy |
1. surgical resection -lumpsectomy (if localized) -mastectomy -axillary dissection (if spread to lymph nodes) 2. radiation 3. chemotherapy -tamoxifen -herceptin |
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prognosis of breast cancer |
-staging most important -histologic subtypes -histological grading -estrogen receptor status |
