Reproductive Pathology

Front 1

Describe carcinoma of the penis

Back 1

1) Uncircumscribed men, poor hygeine, smoking, HPV
2) Begins as CIS (Bowen's disease in adults). Restricted to epithelium, BM intact
3) Squamous cell carcinoma is crusted grey ulcerated papules of the glans which can affect the inguinal lymph nodes and metastasize

Front 2

What are the 3 penile congenital anomalies

Back 2

1) Hypospadias (ventral, aborted development of corpus spongiosum, often associated with cryptorchidism)
2) Epispadias (dorsal, bladder formation abnormality)
3) Phimosis but more commonly due to poor hygeine of uncircumcised penis. Risk of developing Bowen's disease, erectile dysfunction and vascular insufficiency.

Front 3

What are 4 important epidermal lesions of the penis

Back 3

1) Condyloma avvuminata (genital warts) - benign or cancerous depending on strain of HPV
2) Squampous cell carcinoma in-situ (paeds)
3) Bowen's disease due to poor hygeine and smegma toxins
4) Malignant SCC

Front 4

What are the histological features of penile SCC

Back 4

Keratin pearl surrounded by malignant epithelial cells and lymphocytes

Front 5

What are the complications of cryptorchidism

Back 5

Trauma and temperature causing
1) sterility
2) lack of androgen production
3) testicular atrophy
4) testicular cancer, bilateral risk

Front 6

What are the aetiologies of testicular atrophy

Back 6

1) atherosclerosis
2) inflammatory orchitis (usually infection)
3) hypopituitarism (eg androgen, anabolic steroid supplementation)

Front 7

A patient presents with enlarged testes. What are the DDx and what additional info is needed

Back 7

Chronic: Hydrocoele is not painful and transilluminates. Other "coeles" don't transilluminate. Haematocoele may be acute and associated with trauma.
Testicular tumour is non-acute and not painful
Acute (painful) testicular torsion of epididymo orchitis.
Need Hx of past episodes of torsion, cremasteric reflex and U/S
For orchitis need sexual Hx ( STI by chlamydia or gonnorrhoea) and discharge (puss, clear, blood) plus pain and possible systemic symptoms.

Front 8

A patient with a palpable mass in his teste is likely to have a tumour. What types of primary are there?

Back 8

Germ cell (carcinoma in situ, seminoma, teratoma, yolk sac, choriocarcinoma)
Sex cord stromal (leydig, sertoli, mixed)

Front 9

Describe the aetiology of the most common seminomatous germ cell tumours

Back 9

GS neoplasia arises from intratubular germ cells.
Seminoma most common cancer of tests. 30-40YO. Bulky homogenous mass, no necrosis or haemorrhage. Rapidly grows and metastasises to lungs but sensitive to chemo and radiation.
bHCG and LDH are markers

Front 10

Describe non-seminomatous germ cell tumours

Back 10

1) Embryonal carcinoma: 20-40YO with necrosis and haemorrhage. No serum marker (Dx by exclusion and histology)
2) Yolk Sac: Most common tumour up to 3YO. Dx by AFP. Curable in infants
3) Choriocarcinoma: highly malignant, small primary, rapid haematoginous spread. HCG is serum marker.
4) Teratoma: large, heterogenous made up of normal, embryonic or foetal tissue. Benign in infants but malignant in children. No markers.

Front 11

A 24 YO sexually active male suffers from epididymo ochhitis. What is the likely organism. What id he was 65

Back 11

<35YO - chlamydia, gonnorhoea
>45YO - extension of UTI caused by E.coli, Pseudomonas

Front 12

How is prostate cancer graded

Back 12

Gleeson score from 2 areas of the biopsy with neoplasia. Score based on glands and cellularity

Front 13

What are the possible ways endometrial tissue disseminates to other parts of the body

Back 13

1) Regurgitation - retrograde menstruation through the fallopian tubes deposits endometrial tissue into the abdomen
2) Coelomic metaplasia - peritoneal metaplasia of undifferentiated embryonic cells into endometrium
4) Via lymphatics and blood vessels

Front 14

What are common sites of endometriosis

Back 14

Ovaries, uterus, fallopian tubes, colon and appendix.

Front 15

What is the condition of endometrium deep in the myometrium. What are the symptoms and signs

Back 15

Adenomyoma
1) Severe menstrual pain
2) Enlargement of uterus up to 4x mass

Front 16

What are the sites of an ectopic pregnancy

Back 16

Fallopian tube
Ovary
Abdomen

Front 17

What are the symptoms or signs of an ectopic pregnancy and what risk factors are usually associated?

Back 17

Pain in right iliac fossa or massive haemorrhage. Risk factors are:
Salpingitis, PID, age, adhesions, endometritis, smoking, past Hx of ectopic

Front 18

What follow up should be done following an STI diagnosis

Back 18

Screen for other STI's, particularly HIV (10x risk)
Contact tracing

Front 19

What are the risk factors for STI

Back 19

Low socioeconomic status (homelessness, poverty)
Poor access to services (rural remote, indigenous)
Body image (teenagers developing, negative image)
IV drug use
Mental illness, developmental disorders
MSM

Front 20

What are the consequences of STI's

Back 20

Mortality and morbidity
Infertility
Vertical transmission
HIV risk

Front 21

What are common symptoms of Clamydia in men

Back 21

Discharge: watery, milky after several weeks
LGV: Proctatitis (DRE tenderness) with
lymph node enlargement (common in MSM)

Front 22

What are the signs and symptoms of gonnorhoea in men

Back 22

1) Copious prurulent urethral discharge
2) Intense dysurea within 2-8 days

Front 23

What are the sites of gonnorhoea infection

Back 23

Urethra
Rectum
Pharynx
Conjunctiva
Cervix
Dissemination and sepsis

Front 24

Describe the epidemiology and aetiology of syphylis

Back 24

1) Mostly MSM but spans all ages to 75+
2) Painless chancre is highly infective
3) High in indigenous
4) Oral, vaginal, anal and dermal transmission common

Front 25

How is syphilis diagnosed

Back 25

1) PCR of chancre swab in 1st deg disease
2) Serology in 2 deg disease

Front 26

What strains of HPV are targeted by Gardisil and how are men protected

Back 26

1) HPV 6, 11 (benign) and 16, 18 (oncogenic)
2) Herd immunity

Front 27

What are the infective disorders of the Fallopian tubes? complications?

Back 27

1) Pyosalpynx caused by gonnorhoea, chlamydia, staph, strep, coliforms due to salpingitis, IUD, abortion, products of conception
2) Hydrosalpynx: fusion of fimbriated end following PID
3) Salpingitis
4) Complications: oophoritis, endometritis, ovarian abcess, hydrosalpynx, pyosalpynx

Front 28

What are the benign ovarian cysts

Back 28

Functional:
Cystic follicle (< 2mm)
Follicular cyst (> 2mm anovulatory).
Luteal cysts (persistent corpus luteum)
Non Functional:
endometrioid
cystic teratoma

Front 29

What are the 4 diagnostic criteria of PCOS

Back 29

1) Polycystic ovaries (strings of pearls)
2) Hyperandrogenism: hirsutism, male-pattern balding, acne
3) obesity and insulin resistance
4) menstrual abnormality

Front 30

Describe the pathogenesis of PCOS

Back 30

1) Increased frequency and amplitude of LH due to hyperinsulinaemia (insulin resistance) resulting in
2) Theca cell hyperplasia resulting androgen overproduction
3) Granulosa cell defect causing excess oestrogen secretion and endometrial hyperplasia or, alternately, exogenous oestrogen production from excess androgens due to obesity

Front 31

What are the 3 classes of ovarian tumours

Back 31

1) Epithelial
2) Germ cell
3) Sex cord stromal

Front 32

What are the classifications of ovarian epithelial tumours

Back 32

Serous (cuboidal cells with cilia) and mucinous (columnar) which can be:
1) Benign (1 layer)
2) Borderline (> 1 layer with structural complexity. Can implant in the abdoment)
3) Invasive: invades the stroma

Front 33

What are the 3 epithelial tumours of the ovary

Back 33

1) Serous adenoma
2) Mucinous adenoma
3) Invasive adenocarcinoma

Front 34

What surface epithelial carcinoma of the ovary in young patients is associated with endometriosis

Back 34

Endometrioid carcinoma of the ovary

Front 35

What are the 4 germ cell tumours of the ovary

Back 35

1) Teratoma
2) Choriocarcinoma
3) Dysgerminoma
4) Yolk sac tumour

Front 36

What are 4 clinical signs of a possible germ cell tumour

Back 36

1) Dysmenorrhoea or precocious puberty due to increased hcg (choriocarcinoma)
2) Abdominal distension due to mass and/or ascites
3) Pain due to possible torsion
4) Symptoms of pregnancy (nausea, breast enlargement)

Front 37

What are the 3 types of teraoma

Back 37

1) Mature (contains mature tissue - benign)
2) Immature (1% go on to become SCC)
3) Stuma ovarii - thyroid tissue causing hyperthyroidism. Can develop thyroid cancer.

Front 38

What cancer is like a seminoma

Back 38

Dysgerminoma

Front 39

What type of ovarian cancer is found in children and how is it diagnosed

Back 39

Yolk sac - alpha-FP

Front 40

How does gestational choriocarcinoma arise

Back 40

Generally from a complete hydatidform mole

Front 41

Describethe aetiology of the 2 types of hydatidform mole

Back 41

1) Complete: egg loses DNA and is fertilised by one sperm. DNA replicates forming diploid, but paternally derived and non viable conceptus but placenta forms. Can become malignant (gestational choriocarcinoma from trophoblast cells)
2) Partial: 2 sperm fertilise the egg (triploid, quadriploid)

Front 42

What are the sex cord stromal tumours

Back 42

Granulosa-theca cell (high oestrogen; precocious puberty, oligomenorrhoea with menorrhagia, post menopausal bleeding)
Sertoli-leydig cell tumours (androgens), masculinisation, precocious puberty, delayed puberty and virilisation in girls

Front 43

What syndrome, involving the abdomen and thorax is caused by an ovarian fibroma

Back 43

Dissemination of an ovarian fibroma into the peritoneum and pleura results in Meigs syndroms: ascites, right sided pleural effusion and pain

Front 44

What type of metastatic cancer forms in the ovaries arising from the GI tract and breasts

Back 44

Krukenberg tumour: bilateral tumours of the ovaries from gastric adenocarcinoma and metastatic BC

Front 45

List 3 categories of vulval pathology

Back 45

1) Infective: HSVI and II, HPV (condyloma), trichomoniasis vaginalis, chlamydia, gonorrhoea, staph and strep
2) Obstructive: Bartholin gland cyst
3) Tumours: dysplastic (binucleated cells) condyloma -> VIN (vulval intraepithelial neoplasia) -> SCC
Melanoma and other skin cancers (BCC)
Extramamillary Paget's Disease

Front 46

Why are young women at risk of developing cervical cancer

Back 46

After puberty, columnar epithelium shifts transformation zone to exocervix, highly mitotic due to vaginal acidity and prone to infection by HPV.

Front 47

What are 4 ways in which an XY has a female phenotype

Back 47

1) No MIF (no Mullerian Inhibitory Factor causing Persistent Mullerian Duct Syndrome)
2) Inadequate testosterone or dihydrotestosterone (eg 5-alpha-reductase deficiency - external female genitalia with cryptorchidism)
3) No androgen receptors (Androgen Insensitivity Syndrome - 46XY female, cryptorchidism, testes produce testosterone and MIF so no uterus)
4) No gonads: Swyer's Syndrome - 46XY perpubertal female (no oestrogen) due to gonadal agenesis

Front 48

A female child approaches puberty but shows no 2ndary sexual characteristics and amenorrhoea. What two classifications of 46XY abnormalities may have occurred

Back 48

1) With uterus (ie MIF absent) then Swyer's (gonadal agenesis)
2) Without uterus (ie with MIF and testes) then androgen insensitivity syndrome

Front 49

Describe the pathogenesis of congenital adrenal hyperplasia

Back 49

1) Deficiecy of 21-hydroxylase
2) Decreased synthesis of cortisol and aldosterone with hyponatremia, hyperkalemia, dehydration
3) Decreased cortisol causing Addisonian symptoms
4) Raised ACTH increasing production of precursor proteins resulting in increased progesterone and testosterone production - virilisation and genital ambiguity in females (lpenis-like clitoris)

Front 50

What is this, what virus

Back 50

Condyloma accumenata, HPV (6, 11 are benign)

Front 51

An excematous malignancy of the vulval epithelium

Back 51

Extramammary Paget's Disease

Front 52

Describe the symptoms of progression of PID

Back 52

Begins wih vaginitis (pus in vagina), cervical inflammation (cervicitis), endometritis, salpingitis (and tuboovarian abcess causing fibrosis of Fallopian tube and ovary), oophoritis and peritonitis (guarding, rigidity, RT, adhesions, bowel obstruction)

Front 53

Where do ectopics mainly occur

Back 53

Ampulla (mid dilation) of the Fallopian tube

Front 54

Why are HPV 16 and 18 oncogenic

Back 54

Contain oncogenes for E6 (P53 knockout) and E7 (RBG)

Front 55

What are the stages of development of cervical carcinoma

Back 55

Dysplasia in epithelium:
1) CIN 1 - Basal region
2) CIN 2 - intermediate epihelium
3) CIN 3 - full thickness of epithelium
4) Carcinoma in situ (basement membrane intact)
5) Invasive SCC

Front 56

What are the complications of cervical carcinoma

Back 56

Invasion of the rectum (constipation), haemorrhagic necrosis within the tumour causing post coital bleeding, invasion of the bladder, compression of the ureters with renal failure and/or sepsis

Front 57

Age of precocious puberty

Back 57

< 8 for secondary sexual characteristics or eaely menarch < 10

Front 58

Define heterosexual

Back 58

Secondary characteristics of opposite sex

Front 59

What is measuring system for the stages of sexual development called and how is it different for boys and girls

Back 59

Tanner stages:
Boys - orchidometer
Girls - breasts and pubic hair

Front 60

What abnormalities are associated with precocious puberty

Back 60

1) Increased ICP (eg hydrocephaly)
2) Functional sex cord stromal tumours (granulosa cell and thecomas in girls, sertoli and leydig cell tumours in boys

Front 61

What are two types of functional ovarian tumours and their consequences

Back 61

1) Granulosa cell tumour, thecoma: secrete oestrogen and cause precocious puberty in girls and delayed puberty in boys

Front 62

I quit the pill 8 months ago and I'm still not pregnant. Am I infertile

Back 62

1) 12 months of unprotected sex without becoming pregnant is defined as infertility
2) Consider male infertility also

Front 63

What are fibroids originating from the myometrium. What are the complications and what if it's fast growing?

Back 63

Leiomyoma (uterine fibroids) causing menorrhagia (anaemia), dysmenorrhoea, constipation, bladder and ureter compression (urgency, hydronephrosis, UTI) infertility
If fast growing: possible leiomyosarcoma

Front 64

Risk factors for PID

Back 64

1) Previous PID
2) Younger age when sexually active
3) Low socioeconomic status
4) Multiple partners

Front 65

What are the signs and symptoms if PID

Back 65

Asymptomatic early on
Lower abdominal pain
Cervical, vaginal discharge
Nausea and vomiting. Irregular bleeding and fever each occur in up to one third of patients.
Cervical motion tenderness
Guarding, and rebound tenderness
Dyspareunia
Dysuria

Front 66

Complications of PID

Back 66

1) Tubo-ovarian abcess
2) Hydrosalpynx
3) Pyosalpynx
4) Fitz-Hugh-Curtis Syndrome (parahepatic fibrosis)

Front 67

What are the DDx of PID

Back 67

1) Adnexal torsion
2) Ectopic pregnancy