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359 Cards in this Set
- Front
- Back
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Describe the path the sperm takes from the seminiferous tubule.
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Seminiferous tubule-->tubuli recti-->rete testis-->efferent ducts-->epididimyis-->vas deferens-->seminal vesicle-->prostate-->bulbourethral gland
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What secretes flavin?
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seminal vesicle
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What is secreted by the seminal vesicle?
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Flavin & prostaglandins
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What is secreted by the prostate?
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glycoproteins & fibrinolytic enzymes
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What is secreted by the bulbourethral gland?
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alkalinizing pH & mucoproteins
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What forms the BBB in the testis?
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tight junctions between Sertoli cells
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What produces inhibin in the male?
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Sertoli cells
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What is the function of inhibin?
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Inhibition of FSH & LH release by the anterior pituitary
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What mediates the GnRH-stimulated release of FSH/LH from the anterior pituitary?
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PI pathway: IP3
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What mediates the FSH/LH-stimulated synthesis of testosterone?
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cAMP
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What forms of testosterone are considered active?
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Free & albumin-bound
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What causes PDE5 & what is the result of this inhibition?
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Sildenfil inhibits PDE5
This causes prolonged erection d/t increased amounts of cGMP |
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What mediates erection at the blood vessel level?
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cGMP
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What is the most common cause of hypergonadotropic hypogonadism in males?
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Klinefelter syndrome
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What is the most common cause of hypogonadotropic hypogonadism in males?
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Kallman syndrome
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What is the largest of the sperm progenitor cells?
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primary spermatocyte
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What sperm progenitor cell is distinguished by thread-like chromatin?
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Primary spermatocyte
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What sperm progenitor cell is distinguished by dense chromatin & a higher N/C ratio than other sperm progenitor cells?
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Secondary spermatocyte
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What sperm progenitor cell is distinguished by small with a very round nuclei & granular appearance?
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Primary spermatid
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Aromatase is responsible for what reaction?
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androstenedione-->estrone
testosterone-->estradiol |
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5alpha-reductase is responsible for what reaction?
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Testosterone-->DHT
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BCG is related to what illness?
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Granulomatous prostatitis
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What mediates BPH?
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DHT
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What ranges of PSA are considered normal, abnormal, and borderline?
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Normal<4
Borderline: 4-10 Abnormal>10 |
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What binds PSA?
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alpha1-antichymotrypsin
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What hormonal treatments may be used to treat prostate cancer?
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Orchiectomy
Estrogen administration LHRH analogs (Leuprolide) Androgen blockade (Flutamide) |
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What group is at the highest risk for developing testicular cancer?
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Testicular feminization
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What are the labs associated with a seminoma of the prostate?
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Normal AFP
High hCG |
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What age groups are most commonly affected by a testicular seminoma?
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40s, 30s
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What age groups are most commonly affected by a testicular embryonal carcinoma?
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20s
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What age groups are most commonly affected by a testicular yolk sac tumor?
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Infants & children<3
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What age groups are most commonly affected by a testicular choriocarcinoma?
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Quesitonable
Source of hCG |
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What testicular tumor cells often express PLAP and/or CD30?
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Embryonal carcinoma
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Schiller-Duval bodies are found in what testicular tumors?
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Yolk sac tumor
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What types of cells are found in choriocarcinomas?
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Small columnar cytotrophoblasts & large, eosinophilic, hCG-positive syncytiotrophoblasts
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What tumor is particularly radiosensitive & has an excellent prognosis?
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Seminoma
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What is leuprolide?
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GnRH analog that inhibits gonadotropin secretion
Suppresses steroidogenesis by genitalia Used in palliative treatment of prostate cancer |
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What is a Type II 5alpha-reductase inhibitor?
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Finasteride
Used to treat alopecia & BPH |
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What is a Type I & II 5alpha-reductase inhibitor?
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Dutasteride
BPH use |
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What 5alpha reductase inhibitor is used for palliative prostate cancer treatment?
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Finasteride
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What are the antiandrogen drugs used for prostate cancer treatment?
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Flutamide, bicalutamide, nilutamide
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Spironolactone reduces the activity of what enzyme?
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17alpha-hydroxylase
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How do androgens affect HDL?
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Decreased HDL
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How do androgens affect RBC synthesis?
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stimulate erythropoietin synthesis by kidneys-->increased RBCs
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What cells are responsible for the synthesis of follicular fluid?
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granulosa cells
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What is found in the follicular fluid?
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Steroids (ESTROGEN), inhibin, OMI
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A follicle has 1 layer of flattened granulosa cells. What kind of follicle is it?
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Promordial follicle
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A follicle has 1 layer of cuboidal granulosa cells. What kind of follicle is it?
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Primary follicle
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A follicle has multiple layers of cuboidal granulosa cells. What kind of follicle is it?
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Secondary follicle.
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A follicle has both mural granulosa cells & cumulus granulosa cells. What kind of follicle is it?
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Antral or graafian follicle
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What produces the follicular fluid?
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Granulosa cells
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What is the theca interna?
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A layer of theca cells separated from the mural granulosa cells by the basal lamina
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Where can a primary oocyte be found?
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All stages of follicular growth up to Graafian follicle
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What triggers the completion of meiosis I by primary oocytes?
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LH surge
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What arrests primary oocytes?
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OMI
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What stage of oocyte is arrested in meiosis I?
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primary oocyte
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What stage of oocyte is arrested in meiosis II?
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Secondary oocyte
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What triggers the completion of meiosis II by an oocyte?
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Fertilization
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What causes the LH surge?
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Drop in estrogen caused by the negative feedback
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What is produced by the corpus luteum?
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Progesterone & some estrogen
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What rescues the corpus luteum in pregnancy?
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hCG
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What provides the blood supply to the zona functionalis?
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Spiral/helical arteries
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What provides the blood supply to the zona basalis?
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Straight/radial arteries
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What provides the blood supply to the myometrium?
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Arcute arteries
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Straight, tubular glands are found in the endometrium in what phase of the menstrual cycle?
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Proliferative phase
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Tortuous, dilated glands are found in the endometrium in what phase of the menstrual cycle?
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Secretory phase
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What is the origin of activin, inhibin, and follistatin in the female?
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Ovary
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What is the action of follistatin?
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Inhibition of FSH & LH release by the anterior pituitary
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What is the action of activin?
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Stimulation of FSH/LH secretion by the anterior pituitary
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What causes the transformation of the proliferative endometrium to the secretory endometrium?
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Progesterone
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What cell in the female produces testosterone & androstenedione?
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theca cell
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What cell in the female produces estradiol?
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granulosa cell
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What prevents granulosa cells from producing testosterone & androstenedione?
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Deficiency of CYP17
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What are the major actions of estrogen on female tissue?
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Increases watery cervical mucus
Pyknotic index Causes endometrial proliferation |
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What increases basal body temperature in the female?
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Progesterone
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What are sources of circulating estrogen in the postmenopausal female?
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Increased LH in ovarian stroma-->androstenedione production
Increased androstenedione is convertes to estrone by aromatases (largely peripheral) |
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Most common cause of hypogonadotropic hypogonadism in females?
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Menopause
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When is an early thecal layer visible in the developing follicle?
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Secondary follicle
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What are the two major synthetic estrogens?
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Mestranol
Ethinyl estradiol |
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How does estrogen help prevent osteoporosis?
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decrease rate of bone resorption by antagonizing PTH
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What are the absolute contraindications for estrogen replacement therapy (ERT)?
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Hormone-responsive neoplasms
Active thrombosis Pregnancy Breast cancer Vaginal bleeding of unknown cause |
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What are the severe side effects of ERT?
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Increased risk of blood clot, stroke, invasive breast cancer
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What are the "minor" side effects of ERT?
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nausea
breast tenderness hyperpigmentation migraine headahches gallbladder disease |
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Does ERT decrease the risk of any diseases?
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Osteoporosis & colon cancer
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What synthetic progestin has antimineralocorticoid activity & what OCP is it found in?
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Drospirenone
Found in Yasmin |
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What synthetic progestin is found in DepoProvera?
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Medoxyprogesterone acetate
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What synthetic progestin has a particularly increased risk of DVT?
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Desogestrel
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What are some adverse effects of progestins?
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Increased HTN
Reduced HDL Depression |
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What effect do the progestins in OCPs have on the estrogens in OCPs?
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Reduce the activity of the estrogen component
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The risk of what cancers are decreased by the use of OCPs?
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Ovarian cysts & ovarian cancer
Endometrial cancer & endometriosis FCC in breast Uterine fibromas |
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What are absolute contraindications for OCPs?
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Known or suspected pregnancy
Abnormal genital bleeding Hx of cholestative jaundice of pregnancy Hx of:thromboembolic disorders, cerebrovascular disease, CAD, known or suspected breast CA, endometrial CA, known or suspected estrogen-dependent neoplasm, hepatic adenomas or malignant liver tumors |
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A non-pregnant patient comes in with loss of vision & proptosis. What has happened & what medication is she likely taking?
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Retinal artery thrombosis
OCPs |
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A 29-year-old woman taking OCPs comes in with abdominal tenderness in the RUQ. What might she have?
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Liver neoplasm
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Chloasma is related to which component of OCPs?
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Estrogen
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Edema is related to which component of OCPs?
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Estrogen
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Decreased libido is related to which component of OCPs?
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Progestin
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Hypertension & hyperlipidemia is related to what component of OCPs?
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Progestin
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DCT is related to which component of OCPs?
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Estrogen
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Depression is related to which component of OCPs?
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Progestin
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A woman on OCPs comes in with complaints of nausea. Assuming it is a side effect of her OCP, which component is it related to & how can you manage it?
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Estrogen
Take OCP @ night w/food Switch to OCP w/less estrogen effect. |
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A woman on OCPs comes in with complaints of weight gain. Her appetite has increased. Assuming it is a side effect of her OCP, which component is it related to & how can you manage it?
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Progestin
Switch to less progesin |
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A woman on OCPs comes in with complaints of weight gain but denies any change in appetite. Assuming it is a side effect of her OCP, which component is it related to & how can you manage it?
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Estrogen
Switch to less estrogen effect |
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A woman on OCPs comes in with spotting & breakthrough bleeding. Assuming it is a side effect of her OCP, which component is it related to & how can you manage it?
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Too little progestin
Recommend backup protection Increase progestin componentn |
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What may cause depression in a woman on combined OCPs?
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Progestin-induced B6 deficiency
Supplement B6 |
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A woman on OCPs has a change in her corneal curvature. Assuming it is a side effect of her OCP, which component is it related to & how can you manage it?
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Estrogen excess
Switch to less estrogen |
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YAZ is approved for what non-contraceptive uses?
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PMDD
Acne |
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Which medication is approved for PMDD & acne treatment: YAZ or Yasmin?
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YAZ
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What drugs reduce the efficacy of OCPs?
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Rifampin
Anticonvulsants Abx Clotrimazole Griseofulvin Benzodiazepines St. Johns wort |
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What drugs have increased effects on OCP users?
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Cyclosporine
Meperidine Benzodiazepines Beta-blockers Theophylline Corticosteroids Phenothiazines Tricyclic antidepressants |
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What drugs have decreased efficacy in OCP users?
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Anticoagulants
Betamimetics Clofibrate Apomorphine |
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What are the approved uses of raloxifene?
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Treatment of osteoporosis in postmenopausal women
Prevention of invasive breast cancer in women w/osteoporosis or are @ high risk of developing invasive breast cancer |
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What are the effects of raloxifene?
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Estrogen-like effects on bone & lipid metabolism but NOT on uterus or breast tissue
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What are the qualities of the perfect SERM?
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Estrogen effects on vagina, CNS, bone, liver
Antiestrogen effects on breast & uterus |
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What is mifepristone?
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Progesterone antagonist
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What are the effects of danazol?
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Suppression of ovarian function
FSH suppression & LH surge suppression |
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What are the uses of danazol?
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Endometriosis treatment, hereditary angioedema, FCC in breast (rarely)
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What is clomiphene?
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partial estrogen agonist
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What is the mechanism of action of aromatase inhibitors?
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Block estrogen production in peripheral tissues-->reduce estrogen in body
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What is the use of aromatase inhibitors?
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Breast cancer treatment in postmenopausal women
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What are the aromatase inhibitors?
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Anastrazole
Exemestane Letrozole |
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What is anastrazole?
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Aromatase inhibitor used to treat breast cancer in postmenopausal women
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What is exemestane?
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Aromatase inhibitor used to treat breast cancer in postmenopausal women who have been treated w/tamoxifen
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What is letrozole?
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Aromatase inhibitor used to treat breast cancer in postmenopausal women
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What is danazole?
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Drug that suppress ovarian function by inhibiting LH & FSH release
Used to treat endometriosis |
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What is a contraceptive for men & what is a major side effect of it?
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Gossypol
S/E: hypokalemia |
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Where are stellate myoepithelial cells found?
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In the lobules of the breast between the epithelial cells & the basal lamina
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What is the intralobular stroma & what does it contain?
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Delicate tissue surrounding the acini w/in the TDLU
Contains lymphocytes, macrophages, plasma cells |
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What happens to the stellate myoepithelial cells during the menstrual cycle?
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become vacuolated during luteal phase of cycle
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What is the most common benign breast tumor?
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Fibroadenoma
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What is the etiology of the most common benign breast tumor?
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Hyperestrogenism
Tumor=fibroadenoma |
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What is the age range of fibroadenoma?
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20s-40s
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What is the microscopic morphology of fibroadenoma of the breast?
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Proliferation of intralobular stromal cells w/epithelial-lined glandular spaces & cysts that are compressed by stroma into slit-like spaces
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What is the age range of phyllodes tumor?
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40s-60s
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What is the microscopic morphology of phyllodes tumor?
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Hypercellular stromal proliferation
Increased mitotic figures |
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What is the etiology of fibrocystic change?
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Hyperestrogenism
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What is the increase in cancer risk related to fibrocystic change?
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NONE
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What is the gross morphology of fibrocystic change?
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Cystic dilation of ducts
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What is the microscopic morphology of fibrocystic change?
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Epithelial hyperplasia (up to 2 cell layers thick)
Apocrine metaplasia (large eosinophilic cells w/apical snout) |
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Describe mild ductal hyperplasia.
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3-4 levels of cells
No ductal distension |
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Describe moderate ductal hyperplasia.
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>4 layers of cells in TDLU
No distension of ducts |
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Describe florid hyperplasia.
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Extensive moderate ductal hyperplasia that distends ducts
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Describe atypical ductal hyperplasia.
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Multicentric or bilateral
Monomorphic, hyperchromatic cells w/ovoid nuclei admixed w/hyperplastic epithelial cells Sharp punched-out spaces |
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What is the change in breast cancer risk associated with fibrocystic change?
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None.
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What is the change in breast cancer risk associated with mild hyperplasia w/o atypia?
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None
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What is the change in breast cancer risk associated with moderate or florid hyperplasia?
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1.5-2x
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What is the change in breast cancer risk associated with atypical ductal hyperplasia?
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5x
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What is the increase in breast cancer risk associated with nulliparity?
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1-2x
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What are the preventable risk factors for breast cancer?
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Diet
EtOH Nicotine Lack of physical activity |
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What is the major identification factor used to find DCIS on mammography?
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Microcalcifications
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What is the morphology of low-grade DCIS?
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Ductal distension by monomorphic neoplastic cells
May be arranged in cribriform pattern, papillary projections NO necrosis |
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What is the morphology of high-grade DCIS?
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Ductal distension by pleomorphic neoplastic cells
Central necrosis Fibrosis of adjacent interlobular stroma |
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What is the morphology of LCIS?
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May be multicentric or bilateral
Filling of terminal acini in a lobule by small, monomorphic, loosely cohesive evenly-spaced neoplastic cells |
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What is the microscopic morphology of Paget's disease of the breast?
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Large neoplastic cells w/clear cytoplasm in small clusters
Do NOT penetrate basement membrane (CIS of the nipple) |
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What is the morphology of infiltrating ductal carcinoma-NOS?
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Cells in cords, nests, tubules, glands and/or anastomosing masses that infiltrate stroma & fat
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What is minimally invasive infiltrating ductal carcinoma?
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DCIS with <1mm of invasive carcinoma
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What is the the microscopic appearance of inflammatory ductal carcinoma?
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Vascular & lymphatic invasion by high grade tumor cells
Little actual inflammation |
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What ductal carcinoma tends to be bilateral and/or multicentric?
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Lobular carcinoma
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A breast tumor appears microscopically as a single-file line of tumor cells infiltrating the stroma. What is it?
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Lobular carcinoma
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What are common metastases of lobular carcinoma?
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Abdominal & peritoneal serosal surfaces
Ovaries uterus |
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What is the morphology of tubular carcinoma?
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At least 75% infiltrating small angulated glands or tubules lined by single layer of low-grade malignant cells in dense collagenized stroma
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What type of breast tumor is particularly associated with hypermethylation of BRCA1?
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Mucinous carcinoma
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What is the morphology of medullary carcinoma?
|
syncytium-like sheets of large cells w/pleomorphic nuclei, prominent nucleoli, LOTs of mitotic figures
Lots of T cell infiltration |
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Which breast cancers have the worst prognoses?
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DIC-NOS
Inflammatory carcinoma |
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What is the most significant indicator of patient survival in breast cancer?
|
Lymph node status
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ER/PR status is important for what treatment?
|
Tamoxifen
Aromatase inhibitors |
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Her2/Neu status is important for what treatment?
|
trastuzumab (herceptin)
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How does triple-negative breast cancer appear on mammograms?
|
No microcalcifications
|
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What is the morphology of triple-negative breast cancer?
|
IDC-NOS or medullary carcinoma
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What are common metastases of triple-negative breast cancer?
|
Spinal cord
Meninges Liver Brain Lung |
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Luminal subtypes of breast cancer are found in what classifications of breast cancer?
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ER-positive
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What is the worst subtype prognosis?
|
Basal-like
|
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What type of treatment is particularly good for TNBC?
|
Classical chemotherapy
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How does doxorubicin work?
|
Intercalates DNA
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How does cyclophosphamide work?
|
alkylating agent that crosslinks DNA
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How does methotrexate work?
|
Inhibits DHR reductase->inhibits folic acid metabolism
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How does paclitaxel work?
|
Binds to tubulin-->MT arrest
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How does vinorelbine work?
|
Inhibits MT assembly
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CYP2D6 is important for the metabolism of what drug?
|
Tamoxifen to active metabolite
|
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What is the active metabolite of tamoxifen?
|
endoxifen
|
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What gene & syndrome is related to ionizing radiation repair?
|
ATM
ataxia telangiectasia |
|
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What gene & syndromes are related to homologous recombination repair?
|
FANC-->Fanconi anemia
BRCA2/FANCD1-->hereditary breast ovarian cancer/Fanconi anemia BLM: Bloom syndrome |
|
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What gene & syndrome is related to genome surveillance?
|
BRCA1/2
|
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What mutation is particularly associated with male breast cancer?
|
BRCA2
|
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What morphology of breast cancer is related with BRCA1 cancers?
|
80% basal subtype
|
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What morphology of breast cancer is related to BRCA2 cancers?
|
normal distribution
|
|
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What type of ovarian carcinomas are rleated to BRCA mutations?
|
Papillary serous adenocarcinoma
|
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What mutation is related to Li-Fraumeni?
|
TP53
|
|
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What cancers are seen in Li-Fraumeni?
|
Breast
Children: bone & soft tissue sarcomas, brain, adrenocortical, leukemia Multiple primary cancers |
|
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What mutation is related to Cowden syndrome?
|
PTEN
|
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What is PTEN?
|
Inhibitor of PI3K pathway
|
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What is the inheritance pattern of Cowden syndrome?
|
AD
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What syndrome is related to hamartomas?
|
Cowden syndrome
|
|
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Differentiate primary & secondary breast cancer prevention in patients w/BRCA1/2 mutations?
|
Primary: mastectomy, early oophorectomy, chemoprevention
Secondary: surveillance!!! |
|
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What lines the ectocervix?
|
Non-keratinizing squamous epithelium
Visible from vagina |
|
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What lines the endocervix?
|
Endocervical glands lined by a layer of mucin-producing epithelial cells
|
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Small glandular structures are noticed at the 3 & 9 o'clock positions on the stroma of the cervix. What do they represent?
|
Remnants of mesonephric ducts
|
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What characterizes acute inflammation of the cervix?
|
PMNs, erosions
|
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What characterizes chronic inflammation of the cervix?
|
lymphocytes, macrophages, plasma cells
|
|
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What is acanthosis?
|
Thickening of mucosal epithelium that appears as a white area
Related to chronic cervical inflammation |
|
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What is nabothian cyst?
|
Dilated endocervical glands secondary to obstruction of glandular openings d/t inflammation
|
|
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What pathogens may cause cervical infection?
|
Strep, Enterococcus, E. coli, Staph
|
|
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Ground glass nuclei indicate what?
|
HSV infection
|
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Lymphoid germinal centers in a lesion on the cervix indicates what?
|
Chlamydia
|
|
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How do endocervical polyps present?
|
Irregular vaginal bleeding
|
|
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What cells to HPVs infect?
|
Immature basal cells in squamocolumnar junction
Can replicate in maturing squamous cells |
|
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What are some less-known risk factors for cervical neoplasia development?
|
High parity
OCP use Nicotine use |
|
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What are the features of a koilocyte?
|
Nuclear enlargement
Hyperchromasia Cytoplasmic perinuclear halos |
|
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Describe CIN I.
|
Lower 1/3 of full mucosal thickness has increased N/C ratio & mitotic activity
|
|
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Describe CIN II.
|
Lower 2/3 of full mucosal thickness has increased N/C ratio & mitotic figures
|
|
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Describe CIN III.
|
Full epithelial thickness shows increased N/C ratio & mitotic figues, lacks orderly cellular maturation pattern
|
|
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What lesion is most commonly associated with invasivce cervical carcinoma?
|
CIN II
|
|
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What is the most common type of cancer of the cervix?
|
Squamous cell carcinoma
|
|
|
What is the morphology of cervical cancer?
|
Nest of polygonal cells
Eosinophilic cytoplasm May have keratin pearls |
|
|
What is the treatment for cervical cancer?
|
Surgical excision & radiation
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What are the types of cancer found in the cervix?
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Squamous cell carcinoma
Adenocarcinoma (15%) Adenosquamous carcniomas |
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What likely precedes adenocarcinoma of the cervix?
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AIS
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An ovarian lesion has a "powder burn" appearance. What is it?
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Endometriosis
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Chocolate cyst is a form of what disease?
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Endometriosis
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What are the 2 theories of endometriosis?
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Metastatis: regurgiation of endometrial epithelium
Metaplastic: from embryonic precurosrs |
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What is the microscopic appearance of endometriosis?
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Endometrial glands & stroma w/varying amounts of hemorrhage
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Hematochezia can be a complication of what?
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Endometriosis
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Differentiate cystic follicles& follicular cysts.
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Follicular cysts>2cm
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What is the morphology of cystic follicles/follicular cysts?
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Smooth-walled cysts lined by granulosa cells
Theca cells on outer aspect |
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What is the most common cause of delayed puberty & heavy anovulatory bleeding in adolescent females?
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PCOS
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What is the microscopic appearance of PCOS lesions?
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Superficial cortex thickened
Cystic follicles have hyperplasia of theca interna Absent corpus luteum |
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What are the risk factors for developing malignant ovarian tumors?
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Nulliparity
FHx of ovarian cancer Heritable mutations (BRCA1/2) Gonadal dysgenesis |
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What are the 4 basic categories of ovarian neoplasms?
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Surface epithelium
Germ cell Ovarian Stromal metastasis |
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Surface epithelial ovarian tumors are derived from what?
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Coelemic epithelium
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Germ cell ovarian tumors are derived from what?
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yolk sac
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What are the features that may indicate that an ovarian tumor is benign?
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Cystic
Lined w/bland epithelium |
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What are the features that may indicate that an ovarian tumor is malignant?
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Solid and/or cystic
More solid growth of malignant epithelial cells Invasion itno stroma |
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Serous surface epithelial carcinoma resembles what?
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Fallopian tube lining
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What may be preliminary lesions to surface epithelial ovarian carcinomas?
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Surface epithelial inclusions
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What is the most common malignant ovarian tumor?
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Serous cystadenocarcinoma
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What is the most common benign ovarian tumor?
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Serous cystadenoma
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What is the morphology of a serous cystadenocarcinoma?
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Very smooth lining w/few cilia appearing from pseudostratified epithelium
Psammoma bodies May have papillary apperance |
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What does a mucinous surface epithelial tumor resemble?
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Some resemble endocervical lining
Some resemble GI epithelium |
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What is the pattern of spread of surface epithelial-stroma ovarian tumors?
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Along peritoneal surfaces
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What is the treatment for surface epithelial-stroma ovarian tumors?
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Surgical resection
Chemo |
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Which women get mature cystic teratomas?
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Young women
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What is a dermoid cyst?
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Mature cystic teratoma
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Who gets immature teratomas?
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Younger patients
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Name 1 monodermal teratoma.
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Struma ovarii
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What kind of tumor is a granulosa cell tumor?
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Sex cord-stromal tumor of the ovary
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What ovarian tumors may produce estrogen?
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GCTs
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What are the 2 variants of granulosa cell tumors?
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Adult & juvenile
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Call-Exner bodies are characteristic of what cancer?
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Adult-variant granulosa cell tumors
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Describe adult-variant granulosa cell tumor.
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95% of GCTs
More common in menopausal & postmenopausal patients 10-20 years for metastasis or recurrence Call-exner bodies, cells w/nuclear grooves |
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Differentiate adult & juvenile morphology of GCTs.
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Adult: Call-Exner bodies, nuclear grooves, various patterns
Juvenile: pleomorphism & mitotic activity increased |
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Describe the juvenile-variant granuolsa cell tumor.
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Most common under age 30
Recurrence in 3 years |
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What is the ovarian counterpart of the male seminoma of the testes?
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Dysgerminoma
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What kind of tumor is a dysgerminoma?
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Germ cell tumor
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What is the morphology of a dysgerminoma?
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Unilateral
Nest of large cells w/clear cytoplasm, large nuclei & prominent nucleoli Fibrous stroma infiltrated by lymphocytes May have granulomas |
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Differentiate a fibroma from a thecoma.
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Fibroma=from fibroblasts, uniform spindle-shaped cells
Thecoma=from theca cells, spindle-shaped cells w/cytoplasmic clearing |
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Describe Meig's syndrome.
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Ovarian fibroma
Ascities Right-sided hydrothorax |
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Describe Basal Cell Nevus syndrome.
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AD
Multiple basal carcinomas of skin Ovarian fibroma |
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What are the most common metastatic tumors to the ovary?
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Mullerian origin: cervix, uterus, fallopian tube
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What are the most common extra-mullerian metastatic tumors to the ovary?
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Breast
Colon Stomach (signet ring) |
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Define Functional Endometrial Disorders/Dysfunctional Uterine Bleeding.
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uterine bleeding not caused by any underlying organic (structural) abnormality
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What is menorrhagia?
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excessive bleeding during menstrual cycle
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What is metrorrhagia?
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excessive bleeding between menstrual cycles
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What results from an anovulatory cycle?
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Excessive & prolonged estogenic stimulation of endometrium w/o development of secretory phase
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What is "inadequate luteal phase"?
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Inadequate function of the corpus luteum
See interfertility w/increased bleeding or amenorrhea Low estrogen levels Secretory endometrium lags in secondary characteristics w/respect to expected date |
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What endometrial pattern is related with OCPs?
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Discordant appearance between glands & stroma
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What is the most common cause of abnormal uterine bleeding in prepubertal girls?
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precocious puberty
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What is the most common cause of abnormal uterine bleeding in adolescents?
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Anovulatory cycle, coagulation disorders
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What is the most common cause of abnormal uterine bleeding in reproductive age women?
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Pregnancy
Organic lesions Dysfunctional uterine bleeding |
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What is the most common cause of abnormal uterine bleeding in perimenopausal women?
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DUB
Organic lesions |
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What is the most common cause of abnormal uterine bleeding in postmenopausal women?
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Organic lesions
Endometrial atrophy |
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What pathogens are related to acute endometritis?
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alpha-hemolytic strep
staph |
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What is the morphology of chronic endometritis?
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infiltrate of plasma cells in endometrial stroma, macrophages & lymphoid aggregates
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What is adenomyosis?
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Downgrowth of endometrial tissie into & between smooth muscle fascicles of the uterus
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A globoid uterus in a nonpregnant woman with pelvic pain is indicative of what?
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Adenomyosis
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What are the 3 types of endometrial polyps?
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Functional
Hyperplastic Atrophic |
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What is the importance of endometrial polyps?
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Adenocarcinomas may arise in them
Associated w/Tamoxifen use |
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Define endometrial hyperplasia.
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Increased proliferation of endometrial glands relative stroma-->increased gland:stroma ratio
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Name a genetic alteration associated with endometrial hyperplasia.
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PTEN inactivation on chromosome 10q23.3
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Simple/complex descriptors of endometrial hyperplasia relate to what?
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gland architecture
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Atypical/non-atypical descriptors of endometrial hyperplasia relate to what?
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cytologic features of the epithelium
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What is the risk of progression to endometrial carcinoma of simple hyperplasia w/o atypia?
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<5%
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What is the risk of progression to endometrial carcinoma of simple hyperplasia w/atypia?
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8%
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What is the risk of progression to endometrial carcinoma of complex hyperplasia w/o atypia?
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3%
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What is the risk of progression to endometrial carcinoma of complex hyperplasia w/atypia?
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23-48%
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List the risk factors linked to development of endometrial carcinoma linked to high estrogen levels.
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Obesity
DM HTN Infertility Endometrial hyperplasia |
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What is Type I endometrial carcinoma?
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Associated w/increased estrogen levels
Well-differentiated & of endometroid type |
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What is Type II endometrial carcinoma?
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Associated w/normal estrogen elvels in background of endometrial atrophy
Older age Less differentiated, more aggressive p53 mutations |
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What are the criteria for diagnosis of endometroid endometrial carcinoma?
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Cribriform growth: confluent glands w/o intervening stroma
Extensive intraglandular papillary growth Desmoplastic stromal response |
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Clear cell endometrial carcinoma resembles what?
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Pregnant endometrium
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What types of endometrial carcinoma are always considered Grade II neoplasms?
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Clear or papillary serous
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What histologic type of endometrial carcinoma has p53 mutations in 90% of lesions?
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Serous
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Define "malignant mixed mullerian tumor."
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Ovarian tumor.
Mixed tumor w/epithelial & stromal components likely derived from same endometrial precursor cell |
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How do malignant mixed mullerian tumors present?
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Postmenopausal bleeding
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What is the histology of a malignant mixed mullerian tumor?
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2 malignant components:
Epithelial: high grade adenocarcinoma (endometroid, serous, squamous) Mesenchymal: homologous (stromal sarcoma, leiomyosarcoma) and/or heterologous (rhabdomyosarcoma, chrondrosarcoma) |
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What is the clinical behavior of malignant mixed mullerian tumors?
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Aggressive
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What predicts the outcome of malignant mixed mullerian tumors?
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depth of myometrial invasion
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What is a "fibroid"?
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Leiomyoma
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Call-Exner bodies are characteristic of what cancer?
|
Adult-variant granulosa cell tumors
|
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Describe adult-variant granulosa cell tumor.
|
95% of GCTs
More common in menopausal & postmenopausal patients 10-20 years for metastasis or recurrence Call-exner bodies, cells w/nuclear grooves |
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|
Differentiate adult & juvenile morphology of GCTs.
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Adult: Call-Exner bodies, nuclear grooves, various patterns
Juvenile: pleomorphism & mitotic activity increased |
|
|
Describe the juvenile-variant granuolsa cell tumor.
|
Most common under age 30
Recurrence in 3 years |
|
|
What is the ovarian counterpart of the male seminoma of the testes?
|
Dysgerminoma
|
|
|
What kind of tumor is a dysgerminoma?
|
Germ cell tumor
|
|
|
What is the morphology of a dysgerminoma?
|
Unilateral
Nest of large cells w/clear cytoplasm, large nuclei & prominent nucleoli Fibrous stroma infiltrated by lymphocytes May have granulomas |
|
|
Differentiate a fibroma from a thecoma.
|
Fibroma=from fibroblasts, uniform spindle-shaped cells
Thecoma=from theca cells, spindle-shaped cells w/cytoplasmic clearing |
|
|
Describe Meig's syndrome.
|
Ovarian fibroma
Ascities Right-sided hydrothorax |
|
|
Describe Basal Cell Nevus syndrome.
|
AD
Multiple basal carcinomas of skin Ovarian fibroma |
|
|
What is the most common uterien tumore?
|
leiomyoma
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What is hte histology of a leiomyoma?
|
fascicles of spindled cells w/oval nucleus & few mitotic figures
cells resemble myometrium but are more numerous |
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Who gets leiomyosarocmas?
|
women 40-60
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How does a leiomyosarcoma spread?
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Hematogenously (lungs, liver, bone)
Few lympho nodes involved |
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List the cardinal movements of labor in order.
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Engagement
Descent Flexion Internal rotation Extension External rotation Expulsion |
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What marks the beginning & end of the 1st stage of labor?
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Begins w/contractions reaching sufficient strength, etc. to initiate cervical dilation & effacement
Ends when cervix=10cm |
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What is normal duration of the 1st stage of labor?
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Nulliparous=20
Multiparous=14 hours |
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What are the 2 phases of the 1st stage of labor?
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Latent & active
Latent=contractions are infrequent & cause slow dilation Active=strong progressive cervical dilation |
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What is "prolonged latent phase"?
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Greater than 20 hours in nulliparous
Greater than 14 hours in multiparous |
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What is "prolonged active phase"?
|
Primigravida<1.2cm/hr
Multigravida<1.5cm/hr |
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What is the second stage of labor?
|
begins w/complete cervical dilation
ends w/delivery of infant |
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What is average duration of second stage of labor?
|
Nulliparous: 50 minutes
Multiparous: 20 minutes Can last up to 2 hours w/o concern |
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How does an epidural affect the 2nd stage of labor?
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add 1 hour
|
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What is the advantage of a midline episiostomy?
|
Easier to repair
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What is a disadvantage of a midline episiostomy?
|
Increased risk of extension through anal sphincter
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What is an advantage of a mediolateral episiostomy?
|
Decreased risk of extension through anal sphincter
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What is the 3rd stage of labor?
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Begins w/delivery of infant
Ends w/delivery of placenta |
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What is the duration of the 3rd stage of labor?
|
15 minutes
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|
How is oxytocin administered?
|
IV or IM
|
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|
What is hypotonic uterine dysfunction?
|
Uterine contractions have normal gradient pattern but decreased pressure during contraction
|
|
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What type of uterine dysfunction during labor can be corrected by oxytocin administration?
|
Hypotonic uterine dysfunction
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What type of uterine dysfunction during labor can be corrected by sedation?
|
Hypertonic uterine dysfunction
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|
What is hypertonic uterine dysfunction?
|
Uterine contractions have abnormal gradient
Painful contractions w/o cervical dilation |
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What is a 1st degree birth canal laceration?
|
Does NOT involve fascia or muscle
|
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What is a 2nd degree birth canal laceration?
|
Does NOT involve rectal sphincter
|
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What is a 3rd degree birth canal laceration?
|
Involves rectal/anal sphincter but does not expose rectal lumen
|
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What is a 4th degree birth canal laceration?
|
Exposes rectal lumen
|
|
|
What are the 3 most common obstetrical causes of morbidity & mortality?
|
Hemorrhage
PIH Infection |
|
|
What is the etiology of placenta abrupto?
|
Trauma
short cord sudden decomp of uterus Uterine anomaly Compression of IVC HTN |
|
|
Where does the hemorrhage appear in placenta abrupto?
|
Decidua basalis
|
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|
A 32yo G1P0 comes in complaining of painful uterine bleeding. There are decreased fetal heart tones & her uterus is tender. What has happened?
|
Placental abruption
Baby will not survive |
|
|
Define placenta previa.
|
Placenta implanted near or over the cervical os
|
|
|
What is the etiology of placenta previa?
|
Multiparity
Advancing age Defective vascularization of the decidua Large placenta |
|
|
What are the post-partum causes of hemorrhage?
|
Uterine atony
Unrecognized laceration Coagulation defects Placenta accreta |
|
|
What is placenta accreta?
|
placenta invades the myometrium
|
|
|
What are risk factors for PIH?
|
Nulliparity
FHx Obesity Multiple gestation Previous pregnancy preeclampsia Previous pregnancy poor outcome Hx of vasoactive disease |
|
|
PIH is most like in women who...
|
Are exposed to chorionic villi for the first time
|
|
|
Describe mild preeclampsia.
|
BP=160/110
Proteinuria<300mg/day Platelets>100,000 NO symptoms |
|
|
Describe severe preeclampsia.
|
BP>160/110
Proteinuria>5g/day Oliguria<400ml/day Platelets<100,00 Epigastric pain, nausea, vomiting Pulmonary edema |
|
|
What is HELLP?
|
Hemolytic anemia
Elevated LFTs Low Platelet count |
|
|
What pathogens are found in the vagina & cervix?
|
Anaerobes: bacteroides peptostreptococcus
Aerobes: Gram positive cocci, E. coli |
|
|
What are predisposing conditions for ectopic pregnancy?
|
PID associated w/chronic salpingitis
Previous abdominal surgery Endometriosis |
|
|
What is a circumvallate placenta?
|
Chorion lavae: reflected membranes, insets inside the normal margin of placenta insertion
Circumvallate: amnion folds onto itselt forming a rim |
|
|
What is placenta accreta?
|
Partial or complete absence of decidua w/placenta adhering directly to myometrium
|
|
|
What are terms for placental inflammation?
|
Placentitis
Villitis |
|
|
What are terms for fetal membrane inflammation?
|
Chorioamnionitis
|
|
|
What is the term for umbilical cord inflammation?
|
Funisitis
|
|
|
What is TORCH?
|
Toxoplasma
Rubella CMV HSV |
|
|
What is the most common source of placenta infections?
|
Ascending infection from birth canal
|
|
|
What is the appearance of CMV placentitis?
|
giant cells
inclusions |
|
|
What is the appearance of Listeria?
|
neutrophilic invasion
|
|
|
What is the appearance of Candida?
|
neutrophil invasion
wormy things |
|
|
Define gestational trophoblastic disease (GTD).
|
Spectrum of tumors & tumor-like conditions characterized by proliferation of placenta tissue (villous or trophoblast) that can have progressive malignant potential
|
