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82 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is structures are located in the cortex of the ovary? |
Germinal epithelium and follicles; which contain the oocytes |
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What structures are located in the tunica albuginea? |
Below the tunica is the medulla which contains nerves and connective tissue |
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What is contained in a mature follicle? |
Oocyte, granulosum cells, theca cells |
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What cells are responsible for producing estrogen and progesterone after ovulation? |
Granulosum and theca cells from corpus luteum |
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Most common causes of vaginal pain |
Trauma, infections, muscular spasms, mucosal allodynia, hyperalgesia, vaginismus, vestibulitis |
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Tear in anterior vaginal wall |
Bladder bulges out: Cystocele |
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Tear in posterior vaginal wall |
Rectum bulges out: Rectocele |
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Tear on superior part of vaginal wall |
Intestines bulge in: Enterocele |
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Cysts located on the openings of skene ducts amd bartholin glands |
Benign vulver cysts |
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Benign vulvar cysts are associated to which condition? |
Gonorreah, clamydia |
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What ligaments offer the most support for uterus? |
Round ligament + cardinal ligament |
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Affects women who had exposure to DES in utero |
Clear cell adenocarcinoma |
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Affects girls <4 years old, spindle-shaped tumor cells that are desmin + |
Sarcoma botryoides |
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Associated with HPV 16 and 18 |
Cervical and vaginal cancinoma |
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How do subtypes HPV 16 and 18 predispose to cervical carcinoma? |
They both produce the E6 gene product (which inhibits p53 suppressor gene) and E7 gene product (which inhibits RB suppressor gene) |
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How long does it take for HPV to induce cervical carcinoma? |
10 to 15 years |
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Risk factors for cervical pathology |
multiple sex partners, smoking, early sexual intercourse, HIV infections, other STDs
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Fried egg appearance |
Dysplastic cervical cells |
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cells with enlarged, dark nuclei |
Koilocytes |
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How is dysplasia and carcinoma in situ staged? |
NIC I, II, III (in situ) |
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How is invasive carcinoma staged? |
Clinically |
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How is cervical dysplasia most commonly diagnosed? |
Typically asymptomatic (detected by pap smear) or presents as postcoital vaginal bleeding |
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Non-neoplastic endometrial glands/stroma outside of the endometrial cavity |
Endometrosis |
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Most common site of endometrosis |
Ovary, pelvis and peritoneum |
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Blood-filled "chocolate cyst" |
Endometrosis |
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Most common causes of endrometrosis |
Retrograde menstrual flow, metaplastic transformation of multipotent cells, transportation of endometrial tissue via the lymphatic or hematologic system, or direct spread |
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Symptoms of endometrosis |
Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility, blood in urine or stool |
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Treatment for endometrosis |
- Continuous GnRH (Leuprolide) - Surgery (bilateral salpingo oophorectomy) - Danazol - NSAIDs - OCPs, progestins
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How is endrometrosis diagnosed? |
Laparoscopy + biopsy |
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Extension of glandular endometrial tissue into uterine myometrium |
Adenomyosis |
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Tender, boggy, uniformly enlarged uterus |
Adenomyosis |
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Pathology caused by hyperplasia of the basalis layer of the endometrium |
Adenomyosis |
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Symptoms of adenomyosis |
Focal pain during examination, dysmenorrhea, dyspareunia, menorrhagia |
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Mild androgenic that counteracts estrogen and is very effective in treating endometrosis but has many SE like balding, cliteromegaly, deepening of the voice |
Danazol |
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Treatment/diagnosis of adenomyosis |
Hysterectomy |
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Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation |
Endometrial hyperplasia |
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Clinically manifests as postmenopausal vaginal bleeding |
Endometrial hyperplasia, must do a endometrial biopsy to confirm |
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Risk factors for endometrial hyperplasia |
Everything that increases estrogen: Anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, granulosa cell tumor |
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Irregular bleeding, menorrhagia/metrorrhagia, in women over 35 |
Endometrial hyperplasia |
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Most common gynecologic malignancy and 4th cancer in women overall |
Endometrial carcinoma |
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Common age onset for endometrial carcinoma |
55-65 years old |
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Risk factors for endometrial carcinoma |
HHONDA: (Same as endometrial hyperplasia) PLUS: - HTN - Hyperplasia - Obesity - Nulliparity - Diabetes, - Anovulatory state |
HHONDA |
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Treatment for endometrial carcinoma |
Hysterectomy, removal of lymph nodes, +/- chemoradiation |
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Characteristics of leiomyosarcoma |
Bulky, irregularly shaped, areas of necrosis and hemorrhage |
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Risk factors for leiomyosarcoma |
Middle aged women, blacks, arises de novo (NOT bc of leiomyomas) |
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How does a leiomyosarcoma look histologically? |
spindle cells with mitotic figures |
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Desmine + |
Leiomyosarcoma, sarcoma botryoides |
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Most common tumor in females |
Leiomyoma |
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Benign tumor that often presents with multiple discrete tumors |
Leiomyoma |
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What is the average age onset of leiomyomas? |
20-40 years old |
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Suspect if uterus is enlarging rapidely |
Leiomyosarcoma |
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Leiomyoma locations |
Subserosal, intramural, submucosal |
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Most common leiomyoma location |
Intramural |
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Whorled pattern of smooth muscle bundles with well demarcated borders |
Leiomyoma |
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Estrogen sensitive tumor size, increases with pregnancy and decreases with menopause |
Leiomyoma |
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Leiomyoma treatment |
OCPs, continuous GnRH analog (leuprolide), embolization, ablation, myomectomy, hysterectomy |
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Gynecologic tumor epidemiology |
In U.S: Endometrial > Ovarian > Cervical Worldwide: Cervical is most common
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What gynecologic tumors have the worst prognosis |
Ovarian > cervical > endometrial |
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Most commonly administered estrogen |
Ethinyl estradiol, DES, mestranol |
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Clinical uses of estrogen |
Hypogonadism, menstrual abnormalities, in men with adrogen dependent prostate cancer, birth control |
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Contraindications for estrogen |
ER + breast CA, history of DVTs, uncontrolled HTN, migraine w/ aura, smokers >35 |
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GnRH analog with agonist and antagonist properties |
Leuprolide |
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How does the administration of GnRH affect the mechanism? |
It has agonist properties if given in a pulsatile fashion (increases GnRH) and antagonist properties if given in continuous fashion (decreases GnRH) |
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Premature atresia of ovarian follicles in women of reproductive age |
Premature ovarian failure |
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Patients present with signs of menopause after puberty but before age 40 |
Premature ovarian failure |
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Decreased estrogen, increased LH and FSH |
Premature ovarian failure |
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What are the most common causes of anovulation? |
Prenancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure |
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Hyperprolactinemia, thyroid disorders, cushing syndrome and adrenal insufficiency - are all common causes of? |
Anovulation |
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Hyperandrogenism due to deranged steroid synthesis by theca cells |
Polycystic ovarian syndrome |
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Most common cause of infertility in women |
Polycystic ovarian syndrome |
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Presents with amenorrhea or oligomenorrhea, hirsutism, acne, and infertility. |
Polycystic ovarian syndrome |
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Insulin resistance and androgens supress _______________. |
Sex hormone-binding globulin production |
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How does obesity cause polycystic ovarian syndrome? |
Fat cells increase androgen conversion to estrogen |
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Increased LH due to pituitary or hypothalamus dysfunction results in what ovaric affection? |
Enlarged, bilateral cystic ovaries |
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What are the treatments for hirsutism in PCOS? |
Weight reduction, OCPs, spironolactone. |
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What is the treatment for infertility in PCOS? |
Clomiphene citrate |
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What is the treatment for endometrial protection in PCOS? |
Cyclic progesterones |
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What criteria need to be met for DX of polycystic ovarian syndrome? |
2/3: oligo-anovulation hyperandrogenism polycystic ovaries
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Antagonist estrogen receptors in hypothalamus |
Clomiphene |
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Increases release of LH and FSH from pituitary |
Clomiphene |
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Used to treat infertility due to anovulation. |
Clomiphene |
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What are the SE of Clomiphene? |
Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances, GI and breast discomfort |
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