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90 Cards in this Set

  • Front
  • Back
causes of hypothalamic amenorrhea
deficiancy in GnRH secretion eg anorexia nervosa,Kallman's syndrome (congenital GnRH deficiancy)
pituitary causes of amenorrhea
destruction of pit such as prolactin adenoma or Sheehan's syndrome (acute necrosis)
invasive or persistant GTD
only occurs after pregnancy/mole in endo and myometrium, local invasion, excessive trophoblastic proliferation, villous pattern maintained, metastasis rare, dianosis based on stable or serially rising beta-hCG, will regress with time
risk for invasive or persistant GTD
long interval between the pregnancy and evacuation, large theca lutein cysts, mom over 40, history of GTD
complete molar pregnancy
hydropic degeneration and swelling of villous stroma, absence of blood vessels
gestational trophoblastic neoplasia - sheets of anaplastic (undifferentiated)trophoblast, no chorionic villi seen
mifepristone 8hrs
decidua begins to retract from uterine wall, pycnotic nuclei appear in the decidua, small hemmorhagic lakes are seen around the embryo
mifepristone 10 hrs
the decidua is necrotic and filled with a polymorphonuclear infiltrate and large areas of hemmorage, embryo partially disorganized
mifepriston 16hrs
the decidua is almost completely separated from the uterine wall and the degenerating embryo can be seen floating within hemmorrhagic lakes
causes uterine contractions
prostaglandins for cervical ripening
prepidil-intracervical with syringe
cervidil-vaginal insert
misoprostol-placed in posterior vagina, near cervix
E and P in the pill
E - supresses FSH, stabilizes the endometrium, induces progesterone receptors
P-supresses LH, decidualizes the endometrium, thickens cervical mucous
Copper T
MEch-steril inflammatory process, spermicidal
heavy menses, cramping, irregular bleeding
Mech - thickens cervical mucous, atrophy of endometrium
light periods
mastitis treatment
dicloxacillin, hydration, bedrest, acetominophen
decr production of E
fibrocystic change
cystic areas may enlarge rapidly, occasional spontaneous nipple discharge, epithelial and fibrous proliferation, fluid retention
treat - premenstrual diuretics, progestins, danazol, bromocriptine, tamoxifen, aspiration or excision of cysts
adolescents-20's, solitary, slow growing, mobile, painless, no change w/ menses, etiology may be determined by FNA cytology, imiging
duct ectasia
nipple retraction common
breast cancer - low grade
forms tubules, ER pos
(lobular tends to be low grade, can metastasize, multifocal/unifocal, risk for bilaterality, 10% lobular)
breast cancer - high grade
no tubules, ER neg
(ductal tends to be high grade, worse prognosis, unifocal, 80% ductal)
most imp factor in breast canger prognosis
precancerous lesions and squamous carcinomas develop...
in the transformation zone, including the squamocolumnar jct
condyloma accuminatum
branching tree-like proliferation of stratified squamous epi supported by a fibrous stroma
carcinoma of the vulva
85% are squamous cell carcinomas, either
1) associated w/ high risk HPV, and frequently coexists with or is preceded by VIN OR
2) associated with squamous cell hyperplasia and lichen sclerosis
2ndary)condyloma lata (moist confluent plaques), mucous patches, 6-8 wks after inital chancre, lasts 2-6wks
2 types of vulvar squamous carcinoma
2)p53,differntiated type/vulvar dystrophy/symplastic, assoc. w/ lichen sclerosis, worse prognosis
vaginal adenosis
DES, precursor to clear cell adenocarcinoma (vacuolated glycogen-containing cytoplasm), glandular columnar epithelium of mullerian type (endocervical appearance), appears beneath the squamous epi or replaces it
cambium layer
hypercellular zone beneath the vaginal epi - present in embryonal rabdomyosarcoma (sarcoma botryoides-spindled striated cells)
extramammory paget disease
large mucin-positive tumor cells within the epidermis, most frequently confined to the epidermis, may be accompainied by a palpable submucosal thickening or tumor, large tumor cells ingly or in small clusters within the epidermis, clear separation "halo" from surrounding epithelial cells
PAS, Alcian blue, or mucicarmine positive mucopolysaccharide
granuloma ingiunale
infiltrate of histiocytes and plasma cells, islands of necrosis (small abscesses)
lymphogranuloma venereum
LGV - ulcer painful on palpation
halo cells (clear zone around hyperchromatic nuclei), seen in condyloma accuminatum
HPV 18>16
often associated with CIN - cervical adenocarcinoma
anovulatory cycles
prolonged E stimulation w/o following progestational phase.
Common causes:endocrinee disorder, estrogenic ovarian lesion, metabolic disturbance (obesity, malnutrition)
atrophic/inactive glands and decidualized stroma
menopause can lead to
cystic atrophy, atrophic glands, resembles normal basalis, fewif an mitoses
infertility, dysmennorhea, pain
endometrial polyps
stromal cells clonal w/ 6p21 rearrangemant, funtional/proliferative or hyperplastic endometrium, fibrotic stroma, some associated with tamoxifen
endometrial carcinoma type I
herestrogenic, hyperplasia, endometroid, microsattelite instability, PTEN mutations
endometrial carcinoma type II
NOT hypperestrogenic, NOT hyperplastic, serous pappilary clear cell, p53 mutations, LOH, grade 3
endometrial stromal tumors
Benign: stromal nodule - well circumscribed, endometrail stromal cells in myometrium
Malignant: endometrial stromal sarcoma - invasive, low grade, or high grade, rich in blood vessels, invades myometrium, blood vessels, or lymphatics, t(7;17)
mixed epithelial-stromal neoplasms
adenosarcoma: benign glands and malignant stroma (periglandular cuffing), usually low grade polypoid mass
carcinosarcoma: MMMT, malignant mixed mullerian tumor, malignant glands and malignant stroma, homologous vs heterologous
arise from myometrium or endometrial stroma, complex karyotype, invade into uterine wall or project into lumen, patchy necrosis, nuclear pleomorphism, high mitotic index, 40-60yr
proliferative endometrium
coiling increases progressively, stromal cells with scant indistinct cytoplasm, mitoses
endometrium in pregnancy
hypersecretory endometrial glands, decidualized stromal cells
simple chromosomal abnormality, intersecting facies of bland spindle cells, degeneration common, may metastasize (benign metastasizing, disseminated peritoneal leiomyomatosis), variants (symplastic, cellular), edema
follicular cysts
graffian follicle origin, multiple, <2cm, may cause increased E
luteal cysts
rupture may cause peritoneal inflammation, corpus luteum of pregnancy: may appear as ovarian neoplasm
stein-leventhal syndrom
polycystic ovarian disease, enlarged thick smooth capsule
benign surface epithelial tumors (ovarian)
cystadenoma, cystadenofibroma
malignant surface epithelial tumors (ovarian)
cystadenocarcinoma, adenocarcinoma
surface epithelial stromal tumors
not enlarged ovary, ovary pouches in post ovulation
most common transitional type of surface epithelial stromal tumor
pseudostratified, tall cilliated, flat or with few pappilae
more solid, more papillae, more epi proliferation as tufting or multilayered arrangement
more solid, invasion into stroma, more proliferation, cytologic atypia and psammoma bodies (concentric calcifications)
serous may areise from...
ovary or ceolomic epi
mucinous tumors
intestinal-benign,LMP,or malignant(more solid)...stromal invasion more difficult to detect
pseudomyxoma peritonei has extensice mucinous ascites
progress along an adenoma-borderline tumor-carcinoma sequence involving mutations in KRAS
mucinous cystadenocarcinoma
lossof glandular architecture, necrosis
endometroid tumor
most often carcinoma, grossly solid and cystic neoplasms w/ tubular glands resembling endomerium, 15% show co-existing endometriosis, co-existing endometrial carcinoma in 15-30% of cases
Arise from endometriosis involving mutations of CTNNB1 (b-catenin gene) and PTEN
low grade serous carcinoma
adenoma-borderline tumor-carcinoma sequence ... mutaions in KRAS and BRAF
high grade serous
from surface epithelial inclusion glands invloving mutations of TP53, BRACA1 and/or BRACA2
Mature (cystic)-benign in ovary, not in testes-all 3 germ layers, dermoid cyst; struma avarii;carcinoid (derived from intestinal epi)
Immature: (soild)generally bulky,may grow rapidly, grading based on ammoutn of immature neuroepithelium
ovarian equivalent of seminoma, 90% unliateral, fleshy, 20-40yrs, sheets of large cells with clear cytoplasm, central nucleus
endodermal sinus
(yolk sac tumor)agressive, schiller duval body (glomerulous-like structure rich in AFP, A1-AT, forming hyaline droplets
agressive, early vascular metastasis, b-HCG, bilaminar combination of syncytiotrophoblasts and cytotrophoblasts, most exist in combination with other germ cell tumors
granulosa cell tumor
produle large amounts of E, post-menopausal, usually indolent course
juvenile form
call exner bodies- small gland-like spaces filled with eosinophillic material-resembles immature follicle
composed of fibroblasts(fibroma, plump lipid-containing spindle cells (thecoma), or mixture
90% unliateral solid firm grey white masses
Meigs syndrome: fibroma + ascites + R-sided hemothorax
NG,CT, T Pallidum, HSV
sterile pyuria, dissemites with fever, joint pain, rash
Chlamydia tests
gorwn in McCoy cells, DFA - direct flourescence antibody, EIA enzyme linked immuno assay, DNA RNA amplification tests by urine
Jarisch-Herxheimer reaction
fever, headache, muscle aches
in first 24hrs of syphillis treatment
bacterial vaginosis
malodorous white vaginal discharge, irritation, and itching
can lead to PID and premature labor
"clue cells"-vaginal epithelial cells coated with coccobacillary organisms
few PMNs in vaginal discharge
Hep B to fetus
transvaginal..prevent by active(hepatavax) and passive (HB immunoglobulin) immunotherapy of infant
HSV to baby
transvaginal...mucocutaneous/systemic/CNS disease, death...offered cesarian
STD highest incidence
1)HPV 2)Chlamydia
STD highest prevalence
pneumocystis pneumonia (PCP)
fungus, pneumocystis jiroveci, non-productive cough, labored breathing, fever, hypoxemia, elevated LDH, CXR bilateral diffuse interstitial infiltrates, CD4 <200
Disgnosis: induced sputum, broncoscopy w/ bronchiaveolar lavage.
disseminated MAC
fever, night sweats, anemia, weight loss abdominal pain, diarrhea, hepatosplenomegaly, intra-abdominal lymphadenopathy, elevated alkaline phosphatase
Diagnosis: bacteremia, AFB culture
Prophylaxis: azythromycin
Toxoplasma encephalitis
headache, confusion, lethargy, fever, neuro symptoms
Diagnosis: multifocal ring-enhancing lesions on CT or MRI w/ brain positive toxoplasma serology, response to empiric treatment, rarely biopsy
high CD4-upper lobe cavitary disease
low CD4-lower lobe, extrapulmonary, lymphadenopathy
cryptococcal meningitis
headache, stiff neck, confusion, fever, CSF may show lymphocytic pleocytosis, low glucose, or no WBCs
Diagnosis:CSF and serum antigen-titer correlates with prognosis and treatment response
retinits, enterocolitis, encephalitis, radiculopathy
Diagnosis: plasma DNA PCR suggests, retinits, blood cultire, colitis histopathology, CSF PCR
esophgitis, proctitis, perianal ulceration
herpes zoster, postherpetic neuralgia, encephalitis/myelitis
PML - progressive multifocal leukoencephalopathy
JC virus - ataxia, visual field cuts, multifocal demylenating lesions on brain MRI
Kaposi's sarcoma
cervical/anorectal carcinoma
non-Hodgkin's Lymphoma
primary CNS lymphoma usually EBV realted, 80% B cell, often polyclonal, extranodal disease is common