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77 Cards in this Set
- Front
- Back
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What is a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal?
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Bartholin cyst - women of reproductive age, produces mucous-like fluid that drains via ducts into the lower vestibule
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What is condylmona? Due to? Characterized by?
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- warty neoplasm
- due to HPV 6 and 11 - characterized by koilocytes |
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What is lichen sclerosis?
Presentation? When is it seen? |
thinning of epidermis and fibrosis (sclerosis of the dermia
white patch (leukoplakia) with "parchment-like" vulvar skin post-menopausal women |
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What is Lichen Simplex Chronicus?
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1. hyperplasia of vulvar of squamous epithelium
2. leukoplakia with thick, leathery vulvar skin 3. Due to chronic irriation and scratching 4. completely benign |
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What is vulvar carcinoma presentation? Etiology? Presentation? Risk Factors? 3
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- rare
- presents as leukoplakia - HPV related or not - HPV related = due to high risk types 16 and 18 - Multiple partners, early first age of intercourse, generally occurs in women of reproductive age - koilocytic change |
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1. What is extramammary paget disease?
2. Presents as? 3 3. Represents? 4. Where else can it be found? |
1. malignant epithelial cells in epidermis of the vulva
2. erythematous pruritic ulcerated vular skin 3. Represents carcinoma in situ 4. Nipple with an underlying carcinoma |
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How do you distinguish Pagets disease of the nipple and melanoma?
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Paget cells are PAS + keratin + S100-
Melanoma PAS- keratin- S100+ |
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Mucosa of the vagina?
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non-keratinizing squamous epithelium
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What is a focal persistence of columnar epithelium in the upper 1/3 of the vagina?
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Adenosis
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Where does squamous epithelium from the lower 2/3 of the vagina come from? And what does it do?
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- urogenital sinus
- grows upward to replace the columnar epithelium lining of the upper 1/3 of the vagina |
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Where does the columnar epithelium lining of the upper 1/3 of the vagina come from?
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Mullerian ducts
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What inc the incidence of Adenosis? What is a complication of this?
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females who are exposed to diethylstibestrol (DES) in utero
- Clear cell adenocarcinoma |
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1. What is Embryonal rhabdomyosarcoma?
2. What is the characteristic cell? |
1. The malignant mesenchymal proliferation of immature of skeletal muscle
2. Rhabdomyoblast, the characteristic cell, exhibits cytoplasmic cross-striations and pos immunohistochemical staining for desmin and myoglobin |
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A pt presents with bleeding and a grape-like mass protruding from the vagina or penis of a child under 5yrs?
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Embryonal rhabdomyosarcoma
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1. What vaginal cancer can develop from HPV 16,18,31,or33?
2. Precursor lesion? 3. Where does cancer from the lower 2/3 of the vagina goes? 4. Where does cancer from the upper 1/3 goes where? |
1. Vaginal Carcinoma
2. Vaginal intraepithelial neoplasia (VAIN) 3. inguinal 4. regional iliac nodes |
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How is the cervix divided?
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1. Exocervix - nonkeratinizing squamous epithelium
2. Endocervix - single layer of columnar cells 3. Junction between the two = transformation. |
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1. Where does HPV esp infect?
2. Leads to increase risk for what? |
1. Transitional zone in the cervix
2. cervical dysplasia |
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What are the high risk strains of HPV for CIN (cervical intraepithelial neoplasia)? What makes them "high risk"?
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16,18,31,33
- produce E6 and E7 proteins which result in inc destruction of p53 and Rb, respectively |
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What are the low risk strains of HPV for CIN (cervical intraepithelial neoplasia)?
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6 and 11
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What is Cervical intraepithelial neoplasm characterized by? 4
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1. koilocytic change
2. disordered cellular maturation 3. nuclear atypia 4. inc mitotic activity |
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What are the different grades of Cervical intraepithelial neoplasm? How long does progression take?
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CIN I - <1/3 thickness of the epithelium
CIN II < 2/3 CIN III slightly less than the entire thickness Carinoma in situ entire thickness progresses through these to become invasive squamous cell carcinoma average progress from cIN to carcinoma is 10-20 yr |
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A middle aged woman (40-50) presents with vaginal bleeding esp postcoital or cervical discharge...what must you rule out? What are the risk factors for this disease?
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Cervical Carcinoma
1. high-risk HPV 2. Smoking 3. Immunodeficiency |
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What is a common cause of death with cervical carcinoma?
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advance tumors invade through the anterior uterine wall into the bladder blocking the ureters.
- Hydronephrosis with postrenal failure is a common cause of death. |
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What is the gold standard for screening and prevention of cervical carcinoma? What form of cancer was not effected by this test?
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Pap Smear
- cells scraped from the transformation zone - an abnormal Pap smear is followed by confirmatory colposcopy and biopsy Adenocarcinomas were not effected |
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What are the stages of the hormonally sensitive endometrium?
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1. Proliferative - growth is estrogen driven
2. Secretory stage - preparation for implantation is progesterone driven 3. Menstrual - Shedding occurs with loss of progesterone |
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What is Asherman syndrome? How does this occur?
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secondary amenorrhea due to los sof the basalis and scarring
- result of overaggressive dilation and curettage |
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What is an anovulatory cycle?
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lack of ovulation b/c no pergesterone-driven secretory phase
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A pt presents after delivery with a fever, abnormal uterine bleeding, and pelvic pain...What could she have?
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Acute endometritis - a bacterial infection of the endometrium due to the retained products of conception
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Chronic Endometritis:
1. What is it characterized by? 2. What is required for dx? 3. Causes? 4 4. Presentation? 3 |
1. lymphocytes and plasma cells
2. plasma cells 3. Retained products of conception Chronic pelvic inflammatory disease IUD TB 4. bleeding, pain, and inferitily |
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What is a hyperplastic protrusion of endometrium that presents with abnormal uterine bleeding? What is a possible cause?
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Endometrial polyp
- Side effect of Tamoxifen with anti-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium |
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Endometriosis
1. What is it? 2. Presentation? 3. Most common site of involvement? 4. How do implants present? 5. Inc risk for what? |
1. Endometrial glands and stroma outside the uterine endometrial lining
2. Dysmenorrhea and pelvic pain => may cause infertility 3. Ovary - 'chocolate cyst' 4. yellow-brown gunpowder nodule 5. carcinoma esp at ovary |
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What is it called when endometriosis involves the uterine myometrium?
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adenomyosis
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A female pt presents with pelvic pain, dysmenorrhea, and a chocolate cyst on her ovary...what does she most likely have?
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Endometriosis
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Unopposed estrogen such as in obesity or polycystic ovarian syndrome could lead to what syndrome that accompanies postmenopausal uterine bleeding? What is the most important predictor of carcinoma?
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Endometral hyperplasia
- cellular atypia |
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What is the most common invasive carcinoma of the female genital tract? How does it present?
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Endometrial carcinoma
- postmenopausal bleeding |
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What are the 2 ways that endometrical carcinoma develops?
1. causes? 2. presentation age? 3. histology? |
1. Hyperplasia - carcinoma from hyperplasia
- Related to estrogen exposure - 50/60 yo - Histology is endometrioid 2. Sporadic - arises in atrophic endometrium - 70 yo - Histology is serous and papillary with psammoma body formation - p53 |
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Smooth m arising from myometrium related to estrogen exposure that enlarges during pregnancy describes what?
- usually symptomatic but may cause uterine bleeding, inferility, or a pelvic mass? What does gross exam show? |
Leiomyoma (fibroids)
- multiple, well-defined, white "whorled masses" |
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What is the malignant proliferation of smooth m arising from the myometrium that arises de novo in postmenopausal women? What are the gross and histo features?
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Leiomyosarcoma
1. Gross - single lesion with necrosis and hemorrhage 2. Histo - necrosis, mitotic activity, and cellular type |
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What does the follicle (the functional unit of the ovary) consist of? What acts on the different parts of it?
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Oocyte surrounded by granulosa then theca cells
1. LH acts on theca cells to induce androgen production 2. FSH stimulates granulosa cells converts androgen to estradiol => drives proliferation phase => esterdiol surge induces LH surge and ovulation |
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Polycystic Ovarian Disease:
1. Due to? 2. Characterized by ? 3. Classic presentation? 6 |
1. hormonal imbalence
2. Inc LH and low FSH (LH:FSH >2) 3. Obese young female infertile oligomenorrhea hirsutism Some develop diabetes mellitus 10-15 yrs later |
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What results from inc LH and low FSH in Polycystic ovarian disease?
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Hirsutism = inc LH induces excess androgen production from theca cells resulting in hirsutism
Androgen is converted to estrone in adipose syndrome, dec FSH, degrades follicles, and inc circulating estrone inc risk for endometrical carcinoma |
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What are the 3 types of ovarian tumors?
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1. Surface epithelial tumor - most common
- Serous => watery fluid - Mucinous => mucous - Endometroid => endometrial - Brenner => bladder 2. Germ cell tumor - cystic teratoma - dysgerminoma - endodermal sinus tumor - choriocarcinoma - embryonnal carcinoma 3. Sex cord-stromal tumors - Granulosa theca cell tumor - Sertoli-Leydig tumor - Fibroma |
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Surface epithelial tumors of the ovary
1. Derived from? 2. 3 types of tumors |
1. Coelomic epithlium
2. Benign = cystadenomas, single cyst with simple flat lining, premenopausal women Malignant = cystadenomcarcinomas, complex cysts w/ thick shaggy lining, postmenopausal women Borderline = |
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Surface epithelial tumor (Serous) have what mutation? What is a useful serum marker to monitor treatment?
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BRCA 1 - carriers often prophylactic salpingo oophorectomy
- CA-125 |
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What are the types of ovarian cell tumors that are part of germ cells? Who gets them?
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premenopausal women
1. Fetal tissue => cystic teratoma and embryonal carcinoma 2. Oocytes => dysgerminoma 3. Yolk sac => endodermal sinus tumor 4. Placental => Choriocarcinoma |
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What is a cystic teratoma? Ovarian germ cell tumor
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derived from many layers (hair, cartilage, bone ,etc)
- most common germ cell tumor in females - benign but presents of neuronal tissue may give it potential - thyroid tissue = Struma ovarii |
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Ovarian germ cell tumor: Dysgerminoma
1. Composition? 2. Testicular counterpart? 3. Prognosis? 4. What may be elevated? |
Dysgerminoma!
1. large cells with clear cytoplasm and central nuclei => Most common malignant germ cell tumor 2. Seminoma 3. Good prognosis due to radiotherapy 4. LDH may be elevated |
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Ovarian germ cell tumor: Endodermal sinus tumor
1. What does it mimic? 2. Who is it found in? 3. What is elevated in the serum? 4. What is classically seen on histology? |
1. yolk sac
2. Children 3. Serum AFP is often elevated 4. Schiller-Duval bodies |
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Ovarian germ cell tumor: Choriocarcinoma
1. What is it composed of? 2. What does it mimic? 3. What is high in the serum? 4. What may it lead to? 5. Response to chemo? |
1. trophoblasts and syncytiotrophoblasts
2. mimics placental tissue, villi are absent 3. High beta-hCG 4. Thecal cysts in the ovary 5. poor response to chemo |
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Ovarian germ cell tumor: Embryonal carcinoma
1. What is it composed of? 2. What is its behavior? |
1. composed of large primitive cells
2. aggressive with early metasis |
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What are the types of Sex cord-stromal tumors? 3 (ovarian)
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1. Granulosa-theca cell tumor
2. Sertoli-Leydig cell tumor 3. Fibroma |
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Ovarian Sex cord-stromal tumors: Granulosa-theca cell tumor
1. What does it produce? 2. What does it cause at every age? |
often produces estrogen
1. Prior to puberty - precocious puberty 2. Reproductive age - menorrhagia or metrorrhagia 3. Postmenopause - endometrial hyperplasia |
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Ovarian Sex cord-stromal tumors: Sertoli-Leydig cell tumor
1. What is it composed of? 2. What does it produce? 3. What is it characteristic? |
1. Composed of Sertoli and Leydig cells
2. Androgens => hirsutism and virilization 3. Reinke crystals |
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Ovarian Sex cord-stromal tumors: Fibroma
1. benign or malignant? 2. What is it associated with? |
1. benign tumor of fibroblasts
2. assoc w/ pleural effusions and ascites (Meigs syndrome) but resolves with removal of tumor |
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What are the two metastatic conditions of the ovary? 2
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1. Krukenberg tumor - metastatic mucinous tumor involves both ovaries and is most likely due to gastric carcinoma
2. Pseudomyxoma peritonei - massive amounts of mucous in the peritoneum due to a mucinous tumor of the appendix usually with metastasis to the ovary |
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A pt presents with lower abdominal pain a few wks after a missed period...what could it be?
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ectopic pregnancy
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1. What is a spontaneous abortion defined as?
2. Presentation? 3 3. What is it due to? 4 |
1. miscarriage before 20 wks gestation
2. vaginal bleeding, cramp-like pain, and passage of fetal tissues 3. Chromosomal anomalies Hypercoagulable Congenital infection Exposure to teratogens |
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What is a placenta previa?
Presentation? |
implantation of the placenta in the lower uterine segment
- placenta overlies cervical os - third trimester bleeding - often requires delivery of fetus by c-section |
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What is a placental abruption? What is this a common cause of? How does it present and when?
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- separation of placenta from the decidua prior to delivery of the fetus
- common cause of still birth - presents w/ 3rd trimester bleeding and fetal insufficiency |
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What is a placenta accreta? presentation? what may it require?
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- improper implantation of placenta into the myometrium with little or no intervening decidua
- presents with difficult delivery of placenta and postpartum bleeding - may require hysterectomy |
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TERATOGEN: Alcohol
Effect? 3 |
most common cause of mental retardation
facial abnormalities Microcephaly |
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TERATOGEN: Cocaine
Effect? 2 |
Intrauterine growth retardation
Placental abruption |
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TERATOGEN: Thalidomide
Effect? 1 |
Limb defects
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TERATOGEN: Cigarette Smoke
Effect? 1 |
Intrauterine growth retardation
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TERATOGEN: Isotretinoin
Effect? 3 |
Spontaneous abortion
hearing and visual impairments |
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TERATOGEN: Tetracycline
Effect? 1 |
Discolored teeth
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TERATOGEN: Warfarin
Effect? 1 |
Fetal bleeding
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TERATOGEN: Phenytoin
Effect? 2 |
Digit hypoplasia
Cleft lip and palate |
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1. What is preclampsia and what the sx?
2. What is it due to? |
1. Pregnancy induced HTN
2. Proteinuria 3. Edema 4. Usually in the 3rd trimester 5. Headaches 6. Visual disturbances Due to abnormal maternal-fetal vascular interface in the placenta that resolves with delivery |
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What is Eclampsia?
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Preclampsia with seizures - needs immediate delivery
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What is HELLP?
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preclampsia with thrombotic microangiopathy involving the liver characteristized by
H - Hemolysis E - elevated liver enzymes L - liver enzymes L - low platelets P - platelets warrants immediate delivery |
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What is sudden infant death syndrome? Risk Factors? 3
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1 month to 1 year old
usually during sleep risk factors: Sleeping on stomach Exposure to cigarette smoke prematurity |
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What is an abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts ?
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Hydatiform mole
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PARTIAL MOLE:
1. Genetics: 2. Fetal Tissue: 3. Villous edema: 4. Trophoblastic proliferation: 5. Risk for choriocarcinoma: |
1. Genetics: normal ovum fertilized by two sperm; 69 chromosomes
2. Fetal Tissue: Present 3. Villous edema: Some villi are hydropic and are normal 4. Trophoblastic proliferation: Focal proliferation present around hydropic villi 5. Risk for choriocarcinoma: Minimal |
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COMPLETE MOLE:
1. Genetics: 2. Fetal Tissue: 3. Villous edema: 4. Trophoblastic proliferation: 5. Risk for choriocarcinoma: |
1. Genetics: Empty ovum fertilized by two sperm; 46 chromosomes
2. Fetal Tissue: Absent 3. Villous edema: Most villi are hydropic 4. Trophoblastic proliferation: Diffuse, circumferential proliferation around hydropic villi 5. Risk for choriocarcinoma: 2-3% |
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What happens with a Hydatiform mole?
Presentation? Dx? |
Uterus expands as if in a normal pregnancy is present, but the uterus is much faster and beta-hCG much higher than expected for date of gestation
second trimester: grape-like masses through vaginal canal often dx by routine ultrasound in the first trimester absent heart sounds are absent "snowstorm appearance" is ultrasound |
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Hydatiform mole Tx?
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subsequent beta-hCG is needed for monitoring and to screen for the development of choriocarcinoma
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