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104 Cards in this Set
- Front
- Back
Where does the right ovary/testis venous drainage go?
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Right gonadal vein, then the IVC
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Where does the left ovary/testis venous drainage go?
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Left gonadal vein, left renal vein, IVC
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Where does the lymphatic drainage from the ovary/testis go?
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Para-aortic lymph nodes
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Where does the lymphatic drainage from the distal 1/3 of the vagina/vulva/scrotum go?
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Superficial inguinal nodes
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Where does the lymphatic drainage from the proximal 2/3 of the vagina/uterus go?
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Obturator, external iliac, and hypogastric lymph nodes
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Suspensory ligament of the ovaries
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Connects the ovaries to the lateral pelvic wall, contains the ovarian vessels
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Cardinal ligament
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Connects the cervix to the side wall of the pelvis, contains the uterine vessels
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Round ligament of the uterus
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Connects the uterine fundus to the labia majora. Derived from the gubernaculum and goes through the round inguinal canal.
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Broad ligament
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Connects the uterus, fallopian tubes, and ovaries to the pelvic wall. Contains the ovaries, fallopian tubes, and round ligaments. It is ligated during hysterectomy.
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Ligament of the ovary
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Connects the ovary to the lateral uterus
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What type of epithelium is present in the ovary
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Simple cuboidal
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What type of epithelium is present in the fallopian tube?
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Simple columnar, ciliated
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What type of epithelium is present in the uterus?
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Simple columnar, ciliated, tubular glands
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What type of epithelium is present in the endocervix
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Simple columnar
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What type of epithelium is present in the ectocervix
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Stratified squamous
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What type of epithelium is present in the vagina
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Stratified squamous, nonkeratinized, glycogen
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Where is the acrosome of sperm derived?
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Golgi apparatus
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What does the middle piece of the sperm contain?
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Mitochondria and feeds on fructose
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Where does the tail of the sperm come from (flagellum)
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Centrioles- 9+2
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What proteins do Sertoli cells secrete?
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Inhibit (inhibits FSH)
Androgen Binding Protein (maintains the levels of testosterone) AMH |
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What is contained in semen?
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60% seminal fluid (fructose, PGs)
20% prostatic fluid (phosphatases) 20% sperm |
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How does spermatogenesis proceed?
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Spermatogonium (Diploid-2N) ---> replication ----> primary spermatocyte (Diploid-4N) most common because prophase I lasts 22 days----> meiosis I ---> secondary spermatocyte (2N) haploid ----> meiosis II ---> spermatid (N)
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What are the sources of estrogen?
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Ovary (17B-estradiol), placenta (estriol), blood aromatization, fat (estrone)
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How should estrogen levels change in pregnancy?
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50-fold increase in estradiol and estrone
1000-fold increase in estriol (indicates fetal well-being) |
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What effects does estrogen?
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-Development of genitalia and breast, female fat distribution
-Follicle growth, endometrial proliferation, increased myometrial excitability -Upregulates estrogen, LH, and progesterone receptors -Feedback inhibition of FSH, LH, and LH surge -Stimulation of prolactin secretion, but blocks its action at the breast -Increases SHBG, increases HDL, decreases LDL, increases vitamin D |
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How do theca and granulosa cells interact?
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Theca cells convert cholesterol to androstenedione by desmolase/17alpha hydroxylase (under stimulation by LH). Androstenedione then goes to the granulosa cell to be converted to estrogen by aromatase (under stimulation by FSH)
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What does progesterone do?
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-Stimulates endometrial glandular secretions and spiral artery development
-Maintains pregnancy -Decreases myometrial excitability -Thick cervical mucus (inhibits sperm entry into uterus) -Increases body temperature -Inhibits gonadotropins -Uterine smooth muscle relaxation -Decreased estrogen receptor expressivity -Decreases HDL, increases insulin, increases fat deposition -Proliferation of mammary gland acini |
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What is Mittelschmerz?
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Blood from the ruptured follicle causes peritoneal irritation that can mimic appendicitis. Treat with OCPs and mild analgesics
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When is beta-hCG detectable?
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In the blood 1 week after conception (implantation occurs 6 days after fertilization), urine 2 weeks after conception
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What allows lactation after labor?
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Decrease in progesterone
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What hormonal changes take place during menopause?
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Decrease estrogen, increased FSH (a lot), increased LH (no surge), increased GnRH
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What occurs in Klinefelter's syndrome?
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-Testicular atrophy (hyalinzation and fibrosis of seminiferous tubules), long extremities, gynecomastia, female hair distribution, inactivated X chromosome (barr body) in neutrophils
-Dysgenesis of seminiferous tubules causes decreased inhibin and increased FSH -Abnormal Leydig cell function causes decreased testosterone, increased LH, and increased estrogen |
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What occurs in Turner's syndrome
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XO- No barr body, decreased estrogen due to ovarian dysgenesis causes increased LH and FSH
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What occurs in double Y males?
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Phenotypically normal, very tall, antisocial behavior, normal fertility
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Female pseudohermaphrodite?
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Ovaries present, but external genitalia is virilized or ambiguous. Due to innappropriate exposure to androgenic steroids early in gestation (CAH, exogenous administration during pregnancy)
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Male pseudohermaphrodite
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Testes present, but external genitalia are female or ambiguous
-Androgen insensitiviy: Appears female with external genitalia, rudimentary vagina (lower 2/3), no sexual hair, testes often in labia majora. Increased T, Increased E, increased LH -5a-reductase deficiency: AR; ambiguous genitalia until puberty when T increases; Normal T and E, normal LH or increased |
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Kallmann syndrome
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Decreased synthesis of gonadotropin in the anterior pituitary, anosmia. Decreased LH, T (hypogonadotropic hypogonadism), unilateral renal agenesis
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No Sertoli cell or lack of AMN
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Both male and female internal genitalia, male external genitalia (still have testosterone from the Leydig cells and DHT conversion)
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What are the features of a complete mole?
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46, XX or 46, XY (2 sperm + empty egg), HUGE increase in B-hCG, no fetal parts, increased uterine size, 2% convert to choriocarcinoma, 15-20% risk of malignant trophoblastic disease, described as bloody grapes
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What are the features of an incomplete mole?
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69, XXY or XXX
slight increase in B-hCG, no increase in uterine size, no conversion to choriocarcinoma, fetal parts present, low risk of malignancy |
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What is preeclampsia?
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-Hypertension, proteinuria, pitting edema. Occurs between 20 weeks - 6 weeks post partum (before 20 weeks indicates molar pregnancy). Probably autoimmune.
-Present with headache, blurred vision, abdominal pain (RUQ), edema of face and extremities, AMS, hyperreflexia, thrombocytopenia, hyperuricemia Treatment- IV Mg and diazepam |
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What is ecclampsia?
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Preeclampsia + seizures
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What is HELLP syndrome?
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Hemolysis, Elevated LFTs, Low Platelets. Die due to cerebral hemorrhage and ARDS
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What is abruptio placentae?
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Premature detachment of placenta from implantation site. Painful bleeding in 3rd trimester. A/w smoking, cocaine, hypertension
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What is placenta previa?
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Attachment of placenta to lower uterine segment and can occlude internal os. Painless uterine bleeding in any trimester. Multiparity and C-section predispose
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What is polyhydramnios associated with?
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Esophageal/duodenal atresia, anencephaly (see in DM)
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What is oligohydramnios associated with?
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Placental insufficiency, bilateral renal agenesis, posterior urethral valves
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What are the most common gynecologic tumors?
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endometrial > ovarian > cervical
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What is the order of prognosis for gynecologic tumors?
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Ovarian > cervical > endometrial
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What is the underlying cause of PCOS?
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Increased LH production, leading to anovulation, hyperandrogenism (enhanced steroid synthesis by theca cells). A/w infertility, obesity, hirsutism, insulin resistance, increased risk of endometrial cancer, long periods without bleeding followed by severe menorrhagia
-Se increased LH, decreased FSH, increased T and E |
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Follicular ovarian cyst
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Distention of unruptured graafian follicle. A/w hyperestrinism and endometrial hyperplasia
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Corpus luteum cyst
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Hemorrhage into persistent corpus luteum, regresses spontaneously
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Theca-lutein cyst
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BILATERAL/multiple; due to gonadotropin stimulation; A/w choriocarcinoma, moles, pregnancy related (due to increased B-hCG; a/w choriocarcinoma)
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Chocolate cyst
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Endometriosis cyst containing blood; varies with menstrual cycle.
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Ovarian dysgerminoma
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Malignant, equivalent to male seminoma, but much rarer. Sheets of uniform cells. Increased hCG, LDH
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Ovarian choriocarcinoma
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Rare, malignant, can occur pregnancy in mother or baby; Large, hyperchromatic syncytiotrophoblastic cells, increased frequency of theca-lutein cysts, mets to lung, increased hCG
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Ovarian yolk-sac tumor
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Aggressive; yellow, friable, solid mass; 50% have Schiller-Duvall bodies (look like glomeruli). AFP
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Ovarian teratoma
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90% of ovarian germ cell tumors are these
Mature- most frequent benign ovarian tumor Immature- aggressively malignant Struma ovarii- functional thyroid tissue |
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Ovarian serous cystadenoma
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20% ovarian tumors; Bilateral, FALLOPIAN-TUBE endothelium (ciliated).
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Ovarian serous cystadenocarcinoma
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50% ovarian tumors, malignant, bilateral, psamomma bodies
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Ovarian mucinous cystadenoma
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Multilocular cyst lined with mucus-secreting epithelium. Benign, intestine-like tissue (goblet cells)
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Ovarian mucinous cystadenocarcinoma
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Malignant. Pseudomyxoma peritonei- accumulation of mucinous material from ovarian or appendiceal tumor in the peritoneum
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Ovarian Brenner tumor
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Benign; looks like bladder
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Ovarian fibroma
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Meigs' syndrome: Ovarian fibroma, ascites, hydrothorax.
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Ovarian granulosa cell tumor
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Secretes estrogen- precocious puberty in kids, endometrial hyperplaisa or cacinoma in adults. Call-exner bodies (follicles with eosinophilic secretions), abnormal uterine bleeding
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Ovarian Krukenberg tumor
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GI malignancy met with signet cells; adenocarcinoma
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Fibroadenoma of breast
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Small, mobile, firm, sharp edges. MCC tumor in < 25 years; increases in size with estrogen; Histologically, it is a cellular stroma that encircles and compresses epithelium lined by glandular and cystic spaces. NOT PRECANCEROUS
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Intraductal papilloma of the breast
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Small, grows in lactiferous ducts, under areola. Serous or bloody nipple discharge, slight increased risk for carcinoma
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Phyllodes tumor
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Large, bulky connective tissue (stroma) mass and cysts; has leaf-like projections. Can become malignant; MC in 6th decade
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What is the most important prognastic factor in malignant breast tumors?
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Axillary lymph node involvement
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Ductal CIS of breast
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Fills ductal lumen, arises from ductal hyperplasia, early malignancy w/o BM penetration; can have comedonecrosis
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Invasive ductal carcinoma
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Fibrous, rock-hard mass (desmoplasia, scar like, scirrhous) with sharp margins, small, glandular duct-like cells. Worst, most invasive, common. Mets to peritoneum because inactivation of E-cadherin gene
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Invasive lobular carcinoma
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Orderly row of cells, multiple, bilateral
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Medullary carcinoma of the breast
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Fleshy, cellular, lymphatic infiltrate; good prognosis
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Inflammatory carcinoma of the breast
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Dermal lymphatic invasion, Peau d'orange due to blocked lymphatic drainage; nipple retraction occurs if cells infiltrate suspensory ligament of the breast, new retraction means lactiferous duct involvement
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Paget's disease of the breast
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Eczematous patches on nipple (also seen on the vulva) suggests underlying carcinoma. Paget cells are large with clear halos and are in the epidermis (DCIS can have this)
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Fibrocystic change
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MCC breast lumps from age 25-menopause, no increased risk of carcinoma, may fluctuate in size; Presents with premenstrual breast pain and often bilateral (as opposed to fibroadenoma!!)
-Hyperplasia of breast stroma (fibrosis), -Fluid filled blue domes (cystic), duct dilation, apocrine metaplasia. -Sclerosing adenosis- Increased acini and intralobular fibrosis. a/w calcifications (acini/lobule increases) -Epithelial hyperplasia- only increases risk of carcinoma if the cells are atypical. Occurs in women <30 years |
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Acute mastitis
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Breast abscess during breast feeding, MCC S. aureus
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Fat necrosis
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Painless lump due to trauma, but patients may not remember (seatbelt)
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Gynecomastia
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Hyperestrogenism, Klinefelter's, drugs
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What are the risk factors for ovarian non-germ cell tumors?
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Family history- Most important (BRCA-1, HNPCC)
CA-125 increased |
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What are the risk factors for malignant breast tumors?
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Increased estrogen exposure (more menses, older age at 1st live birth, obesity), Family history (erb-B2, HER-2)
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What breast pathology occurs at the nipple?
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Paget's disease, breast abscess
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What breast pathology occurs at the lactiferous duct?
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Intraductal papilloma, breast abscess, mastitis
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What breast pathology occurs at the major duct?
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Fibrocystic change, ductal cancer
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What breast pathology occurs at the lobules?
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Lobular carcinoma, sclerosing adenosis
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What breast pathology occurs at the stroma?
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Fibroadenoma, phyllodes tumor
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Where dose BPH occur?
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Hyperplasia of the lateral and middle lobes of the prostate (periurethral)
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Where does prostatic carcinoma occur?
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Posterior lobe of the prostate (peripheral zone)
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How do PSA levels differ between BPH and prostatic carcinoma?
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BPH- Increased FREE PSA
Prostatic carcinoma- Increased TOTAL PSA but DECREASED free PSA |
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Seminoma (testicular)
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Malignant, painless, homogenous enlargement, MCC testicular tumor, 15-35, large cells in lobules (fried egg), radiosensitive, late mets, good prognosis
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Embryonal carcinoma (testicular)
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Malignant, painful, glandular/papillary morphology, increased AFP and B-hCG
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Yolk sac (endodermal sinus) tumor of the teststicle
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Yellow, mucinous, Schiller-Duval bodies (look like glomeruli), increased AFP. MC in children < 3
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Choriocarcinoma (testicular)
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Malignant, increased hCG, disordered syncytiotrophoblastic and cytotrophoblastic elements, mets via blood
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Teratoma (testicular)
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MALIGNANT (unlike females)
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Leydig cell tumor (testicular)
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Reinke crystals, gynecomastia in men, precocious puberty in boys, golden brown (produces androgens)
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Sertoli cell tumor (testicular)
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Androblastoma from sex cord stroma; 90% benign
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Testicular lymphoma
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MCC testicular cancer in older men
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What causes a varicocele?
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Dilated vein in pampiniform plexus that can cause infertility; bag of worms, more common on left (left testicular vein drains into the left renal vein)
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What causes a spermatocele?
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Dilated epididymal duct
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Bowen's disease (CIS)
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Gray, solitary, crusty plaque on shaft or scrotum. 5th decade, < 10% progress to SCC
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Erythroplasia of Queyrat (CIS)
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Red, velvety plaques on glans. 10% progress to SCC
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Bowenoid papulosis (CIS)
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Multiple papular lesions in younger age group and does not become invasive
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SCC of penis
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Associated with HPV; mets to inguinal and iliac lymph nodes
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