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160 Cards in this Set

  • Front
  • Back
With testicular cancer, how does mets spread?
para-aortic lymph nodes
Woman w/ previous cesarean section has a scar in her lower uterus clse to the opening of the os. What is she at increased risk for?
Placenta previa
Obese woman presents w/ hirsuitism and up levels of serum testosterone. What is the Dx?
Polycystic ovarian syndrome
Pregnant woman at 16 wks gestation presents w/ large abdomen. Whats teh Dx?
Hydatidiform mole
high hCG
55 y/o postmenopausal woman w/ tamoxifen. What is she at increased risk for?
endometrial carcinoma
How does the gonad drain?
Left-> renal vein-> IVC
Right-> IVC
Breakdown the following ligaments:
Suspensory ligament of the ovaries
Transverse cervical ligament
Round ligament of the uterus
Broad ligament
Suspensory- ovarian vessels
transverse cervical- uterine vessels
Round- no important structures
Broad- round ligaments; ovaries, and the uterine tubuels and vessels
How is the male sexual response stimmed?
Erection- paras
Emission- symps
Ejaculation- visceral and somatic

Point and Shoot
Where are the parts of the sperm located?
Acrosome from golgi, flagellum centriole
Middle has Mitochondria
sperm food is fructose
What are the stages of sperm development?
Spermatogonia (A and B)- diploid, 2N
1ry spermatocyte- diploid, 4N
2ry spermatocyte- haploid, 2N
Spermatid- haploid, N

Type A forms both A and B
Spermatogenesis occurs in the seminiferous tubules.
FSH stims sertoli cells to produce sperm
What are the functions of LH and FSH in men?
LH- stims testosterone release from Leydig cells
Testosterone- differentiates male genitalia, anabolic on protein metab, maintains gametogenesis, maintains libido, inhibs GnRH, fuses epiphyseal plates in bone.

FSH- stims ABP and Inhibin production from Sertolis
ABP- Androgen binding protein. Ensures that testosterone in seminiferous tubule is high
Inhibin- inhibits FSH
What are androgens?
Testosterone, DHT, androstenedione
made in teste and adrenal
acts on skin, prostate, seminal vesicles, epididymis, liver, muscle, brain

- differentiate wolffian duct system into internal gonadal structures
2ry sex characteristics and growth spurt during puberty
normal spermatogenesis
Anabolic- increase muscle size, increase RBC production
inicrease libido
What is the most potent androgen?
What si the difference between Genetic Sex, Gonadal sex, and Phenotypic sex?
Genetic- XY vs. XX
Gonadal- testes vs. ovaries
Phenotypic- internal and external genitalia
What is the role of AMH and T in developing the male phenotype?
AMH- suppresses meullarian grown
Testosterone stimis the wolffian duct regen.
what is cholesterol desmolase?
enzyme of the first reaction of testosterone synth
What part of the hypothalamus secretes GnRH?
Arcuate nuclei of the hypothalamus
What happens in puberty and GnRH?
pulsatile GnRH begins in puberty. FSH and LH are secreted in a pulsatile manner.
GnRH up-regulates its own receptor in the ant. pituitary
How does FSH and LH change throughout life?
FSH > LH in kids, but low levers
LH>FSH at puberty and reproductive years
FSH>LH in senescense
How is estrogen produced?
Desmolase triggers chol breakdown in the theca cells
Androstenedione is sent to the granulosa cell where aromatase converts the mofo. (Stimmed by FSH)
What is the role of FSH and LH in the female?
Steroidogenesis in teh ovarian follicle and corpus leuteum
Follicular development beyond the antral stage
What are the actions of estrogen?
maturation and maintenance of fallopian tubes, uterus, cervix, and vag
development of 2ry sex characteristics
up-regs egen, LH, and progerone receptors
prolif of ovarian granulosa cells
maintains pregnancy
Lowers the uterine threshold to contractile stimuli during pregs
stims PRL secretion; but blocks its action at the breast
+ feedback mid-cycle on LH for ovulation
- feedback all other times.
Fat distribution
Hepatic synth of transport proteins
increased myometrial excitability
increased HDL, lowers LDL
What's the word on hormone replacement therapy?
decreases hot flashes and postmenopausal bone loss
but can boost the risk of endometrial cancer, need progerone to keep this risk down.
What is the role of progerone?
Stims endometrial glandular secretions and spiral artery development
Maintenacne of pregs
decreases myometrial excitability
thick cervical mucus which inhibs sperm.
increases body temp
inhibs LH, FSH
uterine smooth muscle relaxation.
Go through the follicular phase of the menstrual cycle?
primordial follicle develops to the graafian stage w/ atresia of the neighboring follicles
LH and FSH receptors are up-regged in theca and granulosa cells
Estradiol levels increase and cause prolif of the uterus
FSH and LH levels are suppressed by the negative feedback effect of estradiol on the ant. pit.
low progerone

fastest growth in 2nd wk of proliferative phase

phase can change length
Breakdown ovulation?
14 days before menses
burst of estradiol synth at the end of the follicular phase causes an LH surge

egen goes down after ovulation, but goes up again in luteal phase

increased cervical mucus less viscous, more penetrable
What is teh luteal phase?
corpus luteum develops and synthesizes egen and progerone

vascularity and secretory activity of the endometrium increase
basal body temp increases becasue of the effect of progerone
w/o fertilization, luteum regresses w/ drop of progerone and egen
What is Mittleschmerz?
blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
Meiosis and ovulation, lets rock
1ry oocytes begin meiosis I during fetal life and complete meiosis I just prior to ovulation
arrested in prOphase til Ovulation
Meiosis II is arrested in METaphase til fertalizatio (an egg MET a sperm)
hCG: what is its source and function?
from the syncytiotrophoblast of the placenta
- maintains corpus luteum for 1st trimestor (acts like LH)
2nd and 3rd trimestor, synthes its own egen and progerone
hCG helps detect prggers; in urine 8 days after fertilization
Elevated hCG in hydatidiform moles or choriocarcinoma
What is the major placental egen?
What is the role of the fetal adrenal gland?
supplements placental egen w/ it's own DHEA
What is human placental lactogen?
produced throughout preggers. acts like GH and PRL
What is Parturition?
in pregs, progesterone increases the threshold for uterine contraction
near term, egen/progertone ratio increases- uterus is more sensitive
Egens and progerone stim growth and development of breasts in preggers
lactation does not occur during pregs becaseu egen and progerone block it.
after parturition, the levels decrease and lactation occurs.

Ovulation is suppressed w/ lactation.
PRL- inhibs GnRH and inhibs GnRH action on the pituitary, and antagonizes LH and FSH on the ovaries.
Cessation of egen w/ age linked delcine
smoking makes it earlier

Decreased egen, superincrease in FSH, increase in LH, increase in GnRH

Hot flashes
Atrophy of Vagina
Coronary artery disease
Abnl opening of penile urethra on ventral side
more common; fix to prevent UTIs
Abnl opening of penile urethra on dorsal side
from faulty genital tubercle
Extrophy of the bladder is associated with epispadia
Can't retract foreskin
Peyronie disease
old man fibrosis of dorsum of the penis
intractable painful erection
clot of corpus cavernosa
Inflam of the glans
poor hygeine
Treponema, dark-field exam
primary chancre, painless
superficially ulcerated, firm papule
Neisseria gonorrhea
acute purulent urethritis
can extend to prostate and smeinal vesicles
nongonococcal urethritis
Bowen Disease
single erythematous plaque on shaft or scrote
10% go invasive
visceral malig
Erythroplasia of Queyrat
single erythematous laque, glans or pepuce
uncircumcised men
median incidence in 5th decade
not associated w/ viseral maligs
Bowenoid papulosis
histo is similar to Bowen and erythroplasia
wart like
Penile carcinoma
squamous cell
far east, africa central america
poor personal hygiene and venereal disease
HPV 16, 18, 31, 33
What is XXY
small balls, eunuchoid, tall, long, gynecomastia, Barr body (inactive X)
What is XO
Short, ovarian dysgenesis (Streak ovary)
webbing of neck. Most common cause of 1ry amenorrhea
no barr body
Double Y
Normal phenotype
tall, severe acne
phenotypic (external) and gonadal (testes) aren't the same
Female- XX, Ovaries present, but external genitalia are virilized or ambiguous. CAH or exog androgens

Male- XY; testes, but external genitalia are female or ambiguous; androgen insensitivity
True hermaphrodite
46 XX
47 XXY
Both ovaries and testicular tissue are present; ambiguous genitalia. Rare
Androgen insensitivity
Defecct in androgen receptor -> normal-looking female
Testes in labia majora, surgically removed
Testosterone, Egen and LH are all high
Bicornuate uterus
incomplete fusion of the paramesonephric ducts
- bad urinary tract
- infertile
5alpha-reductase deficiency
can't convert testosterone to DHT
ambiguous genitalia til puberty
developmental failure of a testis to descend
increased incidence of germ cell tumros, seminoma and embryonal carcinoma
associated w/ testicular atrophy and sterility
Torsion of the spermatic cord
compromises blood supply
testicular gangrene
fluid fillilng and idstending the tunica vaginalis
congenital or persistence of continuity of the tunica w/ peritoneal cavity
can be 2ry to infection or lymph blockage
accumulation of blood distending the tunica vaginalis
varicose dilation multiple veins of the spermatic cord
Sperm-containing cyst
Testicular atrophy
Orchitis- mumps
Hormonal excess or dificieny- hypothalmus, pituitary, hormonal therapy, cirrhosis
chronic debilitating disease
old age
bacterial- epididymitis
viral- mumps
bilateral-> sterility form atrophy of sminiferous tubules. Testosterone is decreased, pituitary FSH, LH increased
more common
N. gonorrhoeae
C. trachomatis
E. coli
M. tuberculosis
dysgerminoma (ovary); Seminoma (teste)
40% of cancers
mid 30s peak
Sheets of uniform cells
Seminoma- painless enlargement of the testes
increased hCG
very radiosensitive

Increased risk of cryptorchidism
Embryonal carcinoma
malignant germ cell- yolk sack
2nd most common
presents w/ pain or mets
Glandular w/ papillary convolusions.
worse prognosis than smeinoma
often has increased hCG
Endodermal sinus
malignant germ cell tumor
occurs in testes, ovaries, sacrococcygeal area of young children.
Schiller-Duval bodies, primitive glomeruli
peak in infancy and early childhood. Most common for this age
increas in alpha fetoprotein
Most common ovarian germ cell tumor

germ cell from two or more embryonic layers
frequently malignant
Mature- always malignant (ovarian dermoid cyst is always benign)

Immature teratoma- malignant in women.

Taratoma w/ malignant transformation- contains malginant tissue such as squamous cell carcinoma
malignant germ cell tumor
analogous to choriocarcinoma of the ovary
can occur as an element of other germ cell tumors
peak incidence in the 2nd to 3rd decades
characterized histologically by cells resembling large syncytiotrophoblasts and cytotophoblasts
increased hCG
Mixed germ cell tumors
combinations of germ cell tumor
variable porgnois determined by the least mature element
can be teratocarcinoma
- Teratoma, embryonal carcinoma, and seminoma
- embryonal carcinoma and seminoma
Leydig cell tumor
non-germ cell tumor derived from testicular stroma
- similar to sertoli-leydig cell tumor of ovary
intracytoplasmic Reinke crystals
androgen producing but produces androgens and estrogens and sometimes corticos
- precocious w/ gynecomastia
Sertoli cell tumor
non-germ cell tumor derived from the sex cord-stroma
paucity of endocrine manifestations
what are the differences between the peripheral zone and the central/transitional/periurethral
Periurethral, transitional, and central zones are the areas of BPH
periperal zone drains into ducts of the urethral sinus close ot the verumontanum, site of carcinoma
urinary tract obstruction
common, universal in elderly
no relation to prostate cancer
(increase in egens)
hyperplasia of glandular and fibromuscular stromal elements
characterized by a rubbery nodular enlargement of the gland.
periurethral and transitional zones
- frequency, dysuria, hesitancy (difficulty starting), UTI
- incomplete bladder emptying
- distention and muscular hypertrophy of the bladder; long duration, bands of enlarged bladder muscle form characteristic trabeculae
- hydroureter and hydronephrosis
Prostate Cancer
very common
older age group
- indolend or aggressive course, which cna be predicted in part by the Gleason system of grading, based on differentiation
arise most often from the peripheral group of glands
PSA is increased
bony mets- increased alk phos
What is the most common teste cancer in old men?
Bartholin cyst
bostruction of Bartholin ducts
2ry infecion by N. gonorhea and staph
vulvar dystrophies
epitheliasl growth- leukoplakia, white patch-like lesion
Lichen sclerosus, hyperplastic dystrophy
atypical hyperplastic- premalignant

pruritus, leukoplakia
White, patch-like mucosal lesions, thick white discharge,and vulvovaginal pruritus.
Trichomoniasis and vaginas
second most common type of vaginitis
from trichomonas vaginalis
Gardnerella vaginitis
Gardnerella vaginalis
clue cells w dot-like organisms
Toxic Shcok syndrome and vaginas
staph toxin in the tampon
vomiting, fever, diarrhea, renal failure and shock; generalized rash
Gonorrhea and vaginas
purulent acute inflamm, initially of the urethra, paraurethral and Bartholin glands, adn skene ducts
- pharyngitis- oral
- proctitis- anal
- purulent arthritis- monoarticluar
- Ophthalmia neonatorum- neonatal conjunctival infection
Chlamydia and vaginas
Cervicitis- most common STD
PID; can be asymptomatic
Lymphogranulma venereum- tropics from C. trachomatis L1, L2 or L3
small papule or ulcer, followed by superficial ulcers and elnargement of regional lymph nodes
rectal stricture from inflamm.
HSV and vaginas
Type 2
spread by sex
vesicles and shallow ulcers that can involve the cervix, vag, clit, vulva, urethra, perianal skin
Multinucleated giant cells w/ viral inclusions found in cytologic smears
Syphilis and vaginas
treponema pallidum
firm, painless ulcer
canyloma lata in 2ry, gray, flattened wart-like
H. ducreyi
tropical areas
soft and painful ulcerated lesion.
Granuloma inguinale
Calymmatobacterium granulomatis, G- rod
Donovan bodies
Papule that becomes ulcerated
Papillary hidradenoma
benign tumor of the fvulva
apocrine sweat glands
labial nodule; may ulcerate and bleed.
Condyloma acuminatum
Benign squamous cell papilloma from HPV 6 and 11
venereal warts- vulvovag and perianal and cervical
koilocytes expanded epithelial cells w/ perinuclear clearing.
Squamous cell carcinoma of the vulva
most common malignant tumor of the vulva
peak occurrence in older women. preceded by premalignant changes graded as vulvar intraepithelial neoplasia 1-3
preceded by vulvar dystrophy
HPV 16, 18, 31, 33
Malignant melanoma of the vulva
10% of vag tumors
Clear cell adenocarcinoma of the vag
increased incidecne in daughters of women who took diethylstilbestrol (DES)
vaginal is a benign condition
mucosal columnar epithelial-lined crypts ina areas normally lined by stratified squamous epithellium, precursor of adenocarcinoma
Sarcoma botryoides
multiple polypoid masses resembling a "bunch of grapes" projecting into the vag, protrudes from the vulva.
Erosion of the cervix
columnar epithelium replaced by squamous epitheilum-> erythematous area
manifestation of chronic cervicitis
Staph, enerococci, gardenerella vaginalis, trich, candida, chlamydia
involves the endocervix
often asymptomatic
can cause cervical discharge
Cervical polyps
inflam porliferationso fthe cerivical mucosa
Carcinoma in situ of the cervix
squamocolumnar junction
HPV 16, 18, 31, 33
characterized by disordered epithelial growth manifest by loss of polarity and nuclear hyperchromasia, beginning a the the basal layer and extending outward
dysplasia can progress through mild, moderate and severe forms to carcinoma in situ and is classified as Cervical iNtraepithelial neoplasia
CIN3- Carcinoma in situ
Invasive carcinoma of cervix
peak in middle-age groups
most often squamous cell carcinoma
arises from CIN at the squamocolumnar junction

- early sex and multiple partners
prostitutes is common

HPV integrates into the genome
E6 and E7; p53 and Rb
from intrauterine trauma from instrumentation (IUD), or complications of pregs. Postpartum retention of placental fragments
caused by staph aureus or strep

Chronic endometritis is often related to TB
prolif of ectopic endometrial tissue
- retrograde dissemination of endometrial fragments during menses, or blood or lymphatic dissemination.
vaires w/ hormones.
causes "chocolate" cysts
occurs in the pelvic area; ovary is the most common site;
uterine ligaments, rectovag septum, pelvic peritoneum and other sites
Severe menstral pain
islands of endometrium in the myometrium
Endometrial hyperplasia
abnl prolif of endometrial glands
excess estrogen stimulation, anovulatory cycles, polycystic ovary disease, egen secreting ovarian tumors, granulosa cell tumor, egen replacement therapy
postmenopausal bleeding
can be a precursor lesion; depends on cellular atypia
Endometrial polyp
women >40
some uterine bleeding
most common uterine tumor and most common of all tumors.
increased in african lineage
benign neoplasm, putative malignant transformation is rare
occurs in multiple seperate foci
Egen sensitive. tumore often increases in size during preggers, almost always decreases in size after menopause.

can be intramural, in sumbendometrial or subperitoneal
can cause increased menstral bleeding
malignant tumor that is infrequent
arises de novo, not affiliated w/ leiomyoma
Endometrial carcinoma
increasing incidence
most common gyne malignancy
peaks in older age group
postmenopausal bleeding
- endometrial hyperplasia precedes it
prolonged egen stim, obesity, diabetes, hypertension (obesity may be the common link)
inflam of ovaries and adjacent tissue (PID)
n. gnorrhoeae, C. trachomatis, various anarobes, strep and other

pyosalpinx- pus filled
hydrosalpix- watery
tuboovarian abscess
bleeding in tubes
ectopic pregs etiology
What tumors occur in the fallopian tube?
adenomatoid tumor
- frequent bengin tumore of the fallpian tubes
- most often results from direct extension or mets from tumors originating elsewhere
Follicular cyst
distension of the unruptured grafian follicle
- hyperestrinism and endometrial hyperplasia
Corpus Luteum cyst
hemorrhage into a persistant mature corpus luteum
menstrual irregularity, occasionally w/ intraperitoneal hemorrhage
Theca-lutein cyst
Gonatotrop stim;
choriocarcinoma or hydatidiform mole
multiple and bilateral
lined by e luteinized theca cells
Chocolcate cysts
blood containing- usually from endometriosis
young women
amenorrhea, infertillity, obesity, hirsuitism
excess luteinizing hormone and androgens
insulin resistance w/ increased risk of DM

thickened ovarian capsule
multple small follicular cysts containing granulosa cell layer and luteinized theca interna
Cortical stromal fibrosis w/ islands of focal luteinization

Rx- weight loss, OCPs, gonatotropin analogues, surgery
Abruptio placentae
premature separation of the placenta
Painful antepartum bleeding and fetal death

Increased risk w/ smoking, HTN, cocaine use
Placenta accreta
attachment of the placenta to teh myometrium (defective decidual layer)
- predisposed by endometrial inflamm and old scars from cesarean
- impared placental separation after delivery/ w/ massive hemorrhage
Placenta previa
attachment of placenta to lower uterine segment.
may occlude cervical os.
Painless bleeding in any trimester
Ectopic pregs
Fallopian tube
also in the abdominal cavity, cervix or ovary
predisposed by salpingitis
predisposed by endometriosis and postoperative adhesions
- no obvious cause
most common cause of hematosalpinx-> tubal rupture
Toxemia of pregs
severe HTN
3rd trimester of 1st pregs
affects the kidneys, liver, and CNS
- Preeclampsia- milder form- HTN, albuminuria, and edema
- Eclampsia- severe form of toxemia, convulsions/seizures, DIC; reverses rapidly when pregs ends; can be fatal
What are some of the risk factors for preeclampsia/eclampsia?
pre-existing HTN, DM, autoimmune disease, chronic renal disease
Etiology- placental ischemia
Elevated LFTs
Low PLatelets
What are the clinical features of eclampsia?
headache, blurred vision, ab pain, edema of face and extremities, altered mental status, hyperreflexia; lab findigns of Tpenia, hyperuricemia
What is the Rx for eclampsia
delivery of fetus as soon asa viable
bed rest, salt restriciton, monitoring and Rx of HTN.
Eclampsia- medical emergency, IV magnesium sulfate and diazepam.
Hydatidiform Mole
enlarged edamatous placental villi in loos stroma, looks like grapes
increase in hCG
Honeycomb uterus
occurs in early months of pregs
vaginal bleeding, rapid increase in uterine size; can be mistaken for normal pregs, but uterus is too large
- can go to choriocarcinoma

Complete- 46 XX, all paternal
Partial- tiploidy, embryo is present; fertilization of the ovum by two or more sperm. 69; two paternal
Amniotic fluid embolism
tear in the placental membranes and rupture of maternal veins
sudden peripartal resp difficulty-> shock and death
can cause DIC
masses of debris and epi squamous cells in the maternal pulm microcirculation

amniotic fluid aspiration syndrome- disease of the neonate, not moms. can't expel amniotic fluid at birth (premature, squamous epi cells of amniotic origin in fetal terminal air space and larger bronchi)
Postpartum ant. pit. necrosis
Sheehan- severe hypotension from blood lost
insidious onset wks and months after birth that causes pit hypofunction
premature rupture of membranes
caused by ascending infection of vag or cervix
Gestational choriocarcinoma
aggressive malignant neoplasm
characterized by increased serum concentration of hCG. An important diagnostic sign
early hematogenous spread to teh lungs
responsive to chemotherapy
greatly increased in incidence in asia and africa
Preceded by:
- hydatidiform mole (50%)
- Abortion of ectopic (20%)
- Normal pregs (20-30%)
lots of amniotic fluid
esophageal/duodenal atresia
inability to swallow amniotic fluid,
little amniotic fluid
renal agenesis
posterior uretheral valves and inability to excrete urine
Serous cystadenoma of the ovary
benign cystic tumor lined w/ cells similar to fallopina tube epithelium
20% of tumors
Serous cystadenocarcinoma of the ovary
50% of ovarian carcinomas
Mucinous cystadenoma
benign tumor characterized by multilocular cysts lined by mucus-secreteinig columnar epithelium and filled w/ mucinous material
Mucinous cystadenocarcinoma
malignant tumor
rupture or mets in pseudomyxoma peritonei w/ multiple peritoneal tumor implants. Produces large amounts of intraperitoneal mucinous material.

Pseudomyxoma peritonei is also caused by mucinous cystadenoma, carcinomatous mucocele of th eappendix and other mucinous tumors
Endometrioid tumor
histo resemblest he endometrium
Clear cell tumor
rare tumor that is always malignant
Brenner tumor
rare, benign tumor
small islandss of epithelial cells; bladder transitional epithelium intersperse w/in a fibrous stroma
solid tumor of bundles of spindle-shaped fibroblasts
Meigs- fibroma, ascites, hydrothorax
demonstrates round lipid-containing cells in addition to fibroblasts
Granulosa cell tumor
egen secreting, precocious puberty
endometrial hyperplasia or endometrial carcinoma
small cuboidal, deeply staingin granulosa cells
Call-Exner bodies
What tumors mets to the ovaries
Krukenberg tumors- signet ring cells from teh stomach

also from the GI tract, breast, endometrial
strumo ovarii
monodermal teratoma
thyroid tissue-> hyperthyroidism
What is Fibrocystic Disease of the breast?
common disorder of the breast
most common cause of a palpable breast mass in pts of reproductive age
lumpy breasts w/ midcycle tenderness
postulated to be due to increased activeity of, or sensitivity to, egen or to decreased progesterone activity
- Nonproliferative forms (stromal fibrosis and cyst formation) have no increased risk of breast cancer
hyperplastic epithelium demonstrates atypia

- fibrosis
Cysts- grossly visible , or only histo; blue fluid?
apocrine metaplasia
hyperplastic epithelium- cellulaar atypia: adenosis- small ducts and myoepithelial cells- sclerosing adenosis (increased acini and intralobular fibrosis)
Most common breast tumor in women younger than 25
firm, rubbery, painless, well circumscribed
stromal cells are neoplastic
ductal epithelial cells are reactive
- intracanalicular- stroma compresses and distorts gland into slitlike spaces
- Pericanalicular - glands retain shape
Phyllodes tumor
large, bulky mass of variable malignancy w/ ulceration of overlying skin;
characterized by cystic spaces containing leaf-like projections from the cyst walls and myxoid contents
Adenoma of the nipple
serous or bloody discharge and palpable mass, not malig
Intraductal papilloma
benign tumor of the lactiferous duct
clincaly - bloody discharge
must be distinguished from carcinoma
Carcinoma of the breast
2nd most common malignancy of women
most common cause of mass in postmenopausal pts
upper outer quadrant
mets to axilla, lung, liver, bone
most often is invasive ductal carcinoma
Egen and progerone receptors in some tumors but not in others, presence is correlated w/ a better prognosis; can use anti-egen thereapy
Hyperexpression of C-erbB2(HER-2) is poorer prognosis
What are the risk factors of breast carcinoma?
FHx- p53, BRCA1,2
Hx of cancer in 1 breaset
early menarche, late menopause
First pregs after 30
High animal fat diet
Proliferative fibrocystic disease w/ atypical epithelial hyperplasia
What are the types of malignant breast cancers?
ductal insitu- early malig
invasive ductal- firm fibrous mass
Comedocarcinoma- ductal w/ cheesy consistency from central necrosis
Inflammatory- lymphatic involvement; poor prognosis
Invasive lobular- multiple, bilateral
Medullary- fleshy, cellular, lymphocytic infiltrate. Good prognosis
Paget's- eczematous patches on nipple; large cells w/ clear halo; underlying carcinoma
What is finasteride?
5alpha-reductase inhib- BPH
What is flutamide?
Non-steroidal inhib of agens at receptor
prostate carcinoma
Ketoconazole, spironolactone
inhibit steroid synth; for PCOS hirsutism
sildenafil, vardenafil
inhib cGMP phosphodiesterast-> increase cGMP,
smooth muscle relaxatoin in corpus cavernosum -> erection

SE- flushing, dyspepsia, blue-green color vision, risk of Hypotension w/ nitrates
GnRH analogue- agonist if pulsatile, antag if coninuous

agonist- infertility,
antag- prostate cancer, fibrinoids

tox- antiandrogen, nausea, vomiting
when continuous-> initial burst of LH, FSH
parial agonsit of egen receptors in the pituitary gland. prevents inhibition-> increased LH and FSH-> ovulation
Rx of infertility
Tox- Hot flashes, ovarian enlargement, mult simultaneous pregs, visual disturbances
Mifepristone (RU-486)
competative inhibitor of progestins
Abortifacient (prevents implantation)
TOx- heavy bleeding, GI (nausea, vomit, anorexia), ab pain
What are the advantages and disadvantages of OCs?
lower risk of endometrial, ovarian cancer
decreased ectopic pregs
decreased pelvic infections
regulation of menses

Taken daily
no protection against STDs
increased triglycerides
Depression, weigh gain, nausea, HTN