Spex1 Pink

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Syphillis

Back 1

Primary- plasma cell infiltrates, obliterative endearteritis begins, chancre
Secondary- hematogenous, rash palms and soles
Tertiary- endarteritis of Vasa Vasorum- aortitits: Aneurysm of the arch of the aorta.

Front 2

Chlamydia

Back 2

Sometimes Asymptomatic
Causes PID which leads to Infertility or Ectopic (tubal) pregnancy

Front 3

HPV low risk

Back 3

6,11 with Condylomata accuminata
Koilocytosis

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High Risk HPV

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16 and above
produces E6, E7 proteins which destroy Rb and p53

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CIN III

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Associated with both severe dysplasia and carcinoma in sittu
CIN III is the entire layer is dysplastic all the way to the top: Large Nuclei

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Low Grade SIL

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Associated with CIN I
High grades are II through III

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What is indicative of increased risk of squamous cell carcinoma of the transformation zone?

Back 7

Higher Grade CIN, NOT the # of infections a person has

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PAP tests for what carcinomas?

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Endocervical and Cervical, NOT Endometrial

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PAP and HPV tests

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PAP only show ABnormal cells- not dx of cancer
No need to test for HPV b/c included in annual pap

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Which group gets pap forever?

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Immunocompromised, Precious CIN II or >, Cervical CA, DES
normally pap retires at 65yo

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When do you start the pap?

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21 or 3yrs post vaginal intercourse, screen annually
Low risk women- every other year (21-29)

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DES

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Clear cell adinocarcinoma of the Vagina of the female child at puberty
Arises from vaginal adenosis

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Mullerian Duct abnormalities

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Didelphus-
Bicornnate- most common, infertile.
Unicornate-

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Mesonephric Duct abnormalities (wolfian)

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normally forms vasD and EpiD
Gartner duct cyst (mesonephric duct cyst)
- rests on the walls of the vagina

Front 15

Lichen Sclerosis

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Parchment Skin with narrowing of intrioitus, obstruction
obstruction--> squamous cell carcinoma
Dudes: Balantitis Xerotica Obliterans

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Lichen Simplex Chronicus

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SImplex- just irritation, it's simple. Pruritis
leads to hyperplasia

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PID

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pelvic pain, adnexal tenderness
Ascending gonococcal, chlamydia infection
Tubal PRegnancy

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COmplications of PID

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tubal pregnancy (chlamydia)
Perihepatitis: Fitzhugh curtis

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Fitzhugh Curtis

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Complicaiton of PID
14-16yo sexually active with RUQ pain/tenderness
Associated with chlamydia and PID
"violin String Adhesions

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Extramammary pagets

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lesions characterized by malignant epitthelial cells in the epidermis of the vulva
SEED
Skin, erythemattous, eroded, demarcated
Rarely with caracinoma
PAS+, Cytokeratin +

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Differentiate PAS, CytoK and S100 between Extramamm PPagets, VIN, and MM

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ExtraMammary ++-
VIN -+-
MM--+

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Imperforate Hymen

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Periumbilical pain with radiation to both flanks
Presents like a UTI
Hematocoplos- vagina fills with blood
Hematometra- Blood in the uterus

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Clear cell Adenocarcinoma of the vagina

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DES during pregnancy

Front 24

Nabothian Cysts

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Chronic Cervixitis
an obstructed endocervical gland- benign
Reparative Atypia- epithelial cells may be present and mimic CA on pap (but it is merely chronic cervicitis)
Inflammatory infiltrates are present- with sores on the cervix

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Endocervical Polyps

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Very common, benign
Inflammatory overgrowth that causes irregular vaginal bleeding
Tx- curettage and excision

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PCOD

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Multiple small subcapsular follicular cysts lined by granulosa cells- chain of pearls
Required components- excess androgens and amenorrhea/oligomenorrhea
Hyperglycemia, increased insulin, increased aromatiase, increased ovarian androgen, increased estrogen --> increased risk of endometrial carcinoma
LH high, low FSH

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Three categories of Surface Epithelial tumors

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Serous (most common)
Mucinous (second most common)
Endometrial

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What are the serous tumors

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Serous cystadenoma, carcinoma, cystadenocarcinoma

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What are the mucnious tumors?

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Mucinous Cystadenoma, Cystadenocarcinoma

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What are the Germ cell tumors?

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Teratoma
Dysgerminoma
Choriocarcinoma

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What are the Sex Cord Stromal tumors?

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Granulosa cell
Thecal cell
Fibroma
Sertoli-Leydig

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Serous cystadenoma

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smooth round surface, surgical excision is curative
good Px

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Serous Carciinoma

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The most common malignant ovarian tumor
Low grade- well differentiated BRAF pathway
High-grade: Arise denovo, P53 mutation

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Psammoma bodies

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occur in every papillary neoplasm
Serous neoplasms are all papillary

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Mucinous Cystadenoma

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Very large (30lbs, multilocular)
nonspecific sx: back and abdomen pain

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What is the origin of a huge mass, smooth surface tumor that is resected, with multiple cystic spaces with thick mucinous fluid

Back 36

Must be a mucnious cystadenoma, so, Surface epithelial, Which technically derived from the Mullerian Ducts

Front 37

Mucinous Cystadenocarcinoma

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Malignant mucinous tumor
smoking, endometriosis
Associated with pseudomyxoma peritonei

Front 38

Endometrioid Adenocarcinoma

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2nd most common ovarian malingancy
associated mainly with endometriosis, but also HNPCC

Front 39

Malignant tumors of the Surface epithelium

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Seed peritoneum
Have surface marker CA125

Front 40

Mature Teratoma

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Benign, Bilateral, Dermoid cyst
46xx
Skin, hair, teeth,"", cartilage
Immature is always malignant- contains fetal tissue

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Dysgerminoma

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Most common ovarian GERM cell tumor
polyhedral cells with clear cytoplasm
Males: Seminoma

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Choriocarcinoma

Back 42

Produce HCG in males and females
Brown foul smelling bloodyy mess.

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Granulosa Cell tumor

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Postmenopausal tumor in 2/3 of women leads to endometrial carcinoma
Also in young girls causes precocious puberty
INHIBIN

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Fibroma/thecoma

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Meig's syndrome
white bands of fibrosis from fibroblasts
a-Fibromas (unilateral)
b- Hydrothorax, pleural effushions from ascites
C-ascites
picture

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Sertoli-Leydig tumors:

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androgenblastoma
defeminization of ffemale

Front 46

Metastatic Germ Cell tumors female

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Krinkleburg- krinkle-chips go to the stomach and make you fat and make you succeptible to gastric carcinoma (signet ring cell)

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CA-125

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Surface epithelial tumors- monitors recurrence

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INhibin

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Tissue/serum marker for granulosa cell tumors

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HCG

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CHoriocarcinoma

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AFP

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Yolk sack/ endodermal sinus tumor

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Chronic endometriits

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Chronic PID due to infection-
plasma cell infiltrates for shure
Antibiotic treatment to prevent recurrence

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Uterus Adenomyosis

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presence of endometrium growing int o the myometrium (glands below the normal basalis)
Abnormally large uterus
Bleeding, pain

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Uterus Endometriosis

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endometrial glands/stroma outside the uterus
Chocolate cyst
Dysfunctional bleeding due to excess estrogen

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Endometrial Hyperplasia

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Can be caused by prolonged estrogen stimulation
postmenopausal bleeding

-->endometrial intraeptithelial neoplasia (EIN) --> loss of PTEN --> endometrioid carcinoma

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Endometrial polyyp

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your aunt calls you and says she has irregular bleeding
Endometrial polyp- benign

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Leiomyoma

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fibrous like uterine tumor
origin: smooth muscle cells
whorled pattern of smooth muscle found in myometrium

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Leiomyosarcoma

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Malignant proliferation of smooth muscle of the myometrium
high mitotic activity and has area of zonal necrosis
usually solitary lesion

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Breast feeding disadvantages

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Vitamin deficiencies transfer from mom to baby

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Mamography buzzword

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clustered, benign: fibrocystic, fat necrosis

Small, iregular linear, or Branching: ductal carcinoma in situ: malignant

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Periductal mastittis

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Subareolar abscess- squamous metaplasia of the lactiferous ducts
pt will be smoker, young, vit A deficient
NO lactation

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Breast Fat Necrosis

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Chalky white area, lipid laden macrophages- tend to calcify, skin retraction
due to trauma, radiation, abuse

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Fibrocystic changes

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benign non-proliferative change
Palpable mass, associated with estrogen stimulation
Clinically insignificant, No increased CA risk

Front 63

Fibrocystic lesions that are risk factors

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Atypical hyperplasia- risk of cancer (only one) 4-5x
Ductal Carcinoma in Situ (DCIS --> LCIS) 8-10x risk

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Fribroadenoma

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Stromal, benign tumor of the breast
Spherical nodlue, well circumscribribed, freely movable
no calcifications, responds to hormones PIC

Front 65

Large duct papilloma

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unilateral serous oor blood nipple discharge

Front 66

BRCAT risk factors

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Gender
Age
Menarchy
Delivery
Rellatives
(GAMe DR)

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BRCA1 and 2

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Mutation doesn't mean that you will have cancer but increases risk uup to 80%

Front 68

Comedocarcinoma

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COmer- orangge, duct, central necrosis, calcifications
sheets of high grade malignant cells

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Paget's disease

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Extends from the nipple ducts into contiguous skin of nipple and areola, localized
Epidermis involved by malignant cells

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INvasive ductal Carcinoma, no special type

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Most common
Firm hart with irregular border
Within center are sstreaks of chalky white stroma and calcificiations
Well differentiated- ERPR
Poorly differentiated- Her2Neu

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Basal Like

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a type of Invasive ductal NST
Triple Neg- ablsence of ER, PR, and Her2/neu
High grade , aggressive, viscera and brian mets

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Invasive ductal Medullary

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fleshy well circumscribed, 3-, prominent nucleoli

Front 73

Invasive ductal Mucinous/Colloid

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Gelatin, lakes of mucin
small islands of neoplastic cells

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INvasive ductal lobular

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Strands of infiltrating tumor cells lining up

Front 75

Invasive Ductal Tubular

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Speculated masses: Excellent prognosis

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Prognosis factors for invasive Carcinoma

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invasivee?
Distant mets
Lympoh nodes
Size

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Male breast cancer

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Brca2

Front 78

Salpingocyesis

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same thing as a tubal pregnancy

Front 79

Atherosis

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Placental pathology in eclampsia
spiral aarteries in the wall of the uterine arteries contract.
Remember fetal and maternnal pathology for eclampsia

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Hyatidiform mmole

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complication: choriocarcinoma

Elevated HCG much higher than expected for date of gestation
Uteruus i smuch larger than expected for date of gestation
Grape-like villi
SNOWSTORM on ultrasound
--- COmplete: increase risk of choriocarcinoma
--- Partial: No greater risk of choriocarcinoma (mild HCG increase as well)

Front 81

Choriocarcinoma

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invasion of the myometrium by a blood brown tuor that is HCG positive, metastases early and widely

Front 82

Utero-placental abnormalities

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Abrupto
Previa
Acrreta

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Twin placenta

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Mono= 1 of everything: NTK- identical twins- post implatnation blastocyst splits during the second week of gestation.
Di= 2 of everything

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Hypospadia

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Ventral surface do not circumcise
Fix to prevent UTI

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Cryptorchidism

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Inguinal 42%- worse prognosis
Upper scrotal 48%
Orchiopexis at 2yr
Removal at puberty
increased risk of cancer in all, infertility in puberty

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Testicular torsion

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Red infarct
Clapper
Emergency

Front 87

Male adenomatoid tumor

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most common tumor of the epididymis- benign neoplasm
small discrete round nodule of gray tissue

Front 88

Seminoma

Back 88

double neg AFP/BHCG
Germ cell tumor

Front 89

Yolk Sac tumor

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most common testicular tumor in children
Micro- shiller-duval bodies

Front 90

Embryonal tumor GSGCT

Back 90

MIXED tumors
immature primitive cells
form hemmorhage and encrosis
HCG and AFP positive
Chemo can cause differentiation of outer layer of cells

Front 91

Teratoma in males

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Mature- Malignant- if hemorrhagic= teratocarcinoma
AFP and HCG can be elevated
painless enllargment of scrotal mass, may test + on pregnancy test

Front 92

Sertoli and Leydig cell tumors dudes

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Sertoli- silent, comprised of tubules
Leydig cells- Big Balls, Boobs, Precocious pubes, Reinke

Front 93

Hydrocele

Back 93

Transilluminates

Front 94

Hematocele
Chylocele
Spermatocele
Varicocele

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Blood
Lymph accumulation
Cystic dilation of efferent ductules of rete testis
Dilated veins in spermatic cords "bag of worms"