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78 Cards in this Set
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Clomiphene
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partial ag at estrogen receptors in pit gland; prevent nl feedback inhib and incr release of LH and FSH from pit which stim ovulation
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Clomiphene use/tox
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tx of infertility, PCOS
tox: hot flashes, ovarian enlargement, multiple pregn, visual dist |
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Mifepristone (RU-486)
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comp inhib of progestins at progestin receptors
used for abortion tox: heavy bleeding, n/v/anorexia, ab pain |
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Tamoxifen
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increases risk of endomitrial carc
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Advantages of OC
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reliable, decr risk of endomit/ovarian cnacer, decr ectopic preg, decr pelvic infections (mucus change), regulation of menses, dysmenorrhea
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disadvantages of OC
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taken daily, no protection against STDs, incr TG, depression, weight gain, nausea, HTN, hepatic adenoma, hypercoag state
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HRT
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used for relief or prevention of meno sxs (hot flashes, vag atrophy) and OP (due to diminished estrogen levels)
unopposed ERT incr risk of endomitrial cancer must add progesterone |
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IUD
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risk of PID, perforation, infertility
copper- 10 yr progesteron- 5 yr good for stable monogamous relationships |
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Medroxyprogesterone (depo)
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assoc with bone mineral density loss esp if long term
ideal if > 2yrs good choice in pt with MR |
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bicornate uterus
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results from incomplete fusion of paramesonephric ducts
assoc with UT abnl and infertility |
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hypospadias
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abnl opening of penile urethra on infr side of penis due to failure of urethral folds to close
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epispadias
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abnl opening of penile urethra on superior side of penis due to faulty positioning of genital tubercle
extropy of bladder assoc |
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Klinefelters
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XXY: testicular atrophy, eunuchoid body shape, tall long extremities, gynecomastia, female hair dist
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incr FSH in Klinefelters
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dysgenesis of semiferous tublues--> decr inhibin
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incr estrogen in Klinefelters
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abnl Leydig cell function-->decr testo-->incr LH
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Turners
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XO: short stature, ovarian dysgenesis (streak ovary), webbing of neck, coarc of aorta, primary amenorrhea
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double males XYY
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phenotypically nl; very tall, severe acne, antisocial behavior
nl fertility |
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Pseudohermaphrodism
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disagreement between phenotypic and gonadal sex
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female pseudoherm (XX)
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ovaries present, but ext genitalia virilized/ambiguous
due to excessive and inappropirate exps to androgenic steroids during early gestation (21B hydroxylase def, 11b hydroxylase def) |
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male pseudoherm (XY)
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testes present, but ext genitalia are female/ambig
most common: androgen insensitivty snydrome |
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True hermaphrodite (XX or XXY)
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both ovary and testicular tissue present
ambig genitalia |
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AIS (XY)
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defect in androgen receptor resulting in nl appearing female; female ext genitalia, no uterus, testes present (often removed)
levels of testo, estrogen, LH all high |
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5alpha reductase def
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unable to convert testo to DHT, ambig genitalia until puberty when incr testo causes masculinization of genitalia
testo/estrogen levels nl, LH nl or high |
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abruptio placentae
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premature detachment of placenta from implanation site
painful uterine bleeding (3rd trimester), fetal death assoc with DIC incr risk with smoking, HTN, cocaine |
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placenta accreta
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defective decidual layer allows placenta to directly attach to myomitrium
predisposed by prior C section or inflam; massive hemorrhage after delivery tx: hysterectomy |
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placenta previa
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attachement of placenta to lower uterine segment
may occlude cervical os; painless bleeding in any trimester |
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ectopic preg
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most often in fallopian tube, predisposed by salpingitis
suspect with incr HCG and sudden lower ab pain confirm w/ U/S tx: MTX, surgical |
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polyhydraminos
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lots of amniotic fluid; assoc with eso/duodenal atresia, causing inability to swallow amniotic fluid and anencephaly
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oligohydraminos
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less amniotic fluid; assoc with bilateral renal agenesis or posterior urethral valves (in males), resultant inability ot excrete urine
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cervical dysplasia
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disordered epithelial growht; assoc with HPV 16, 18
may progress slowly to invasive carcinoma |
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invasive cervical carc
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often sq cell carc; pap smear can catch cervical dysplasia (kiolocytes) before it progresses to invasive carc
lateral invasion can block ureters causing renal failure |
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risk factors for cerv carc
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sex, HPV, smoking
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endomitrosis
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nonneoplastic endomitrial glands/stroma in abnl locations outside uterus
cyclic bleeding (menstrual type) from ectopic endomitrial tissue "chocolate cysts" severe menstrual related pain, often results in infertility |
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adenomyosis
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endomitriosis within myomitrium
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endomitrial hyperplasia
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abnl endomtiral gland prolif usually caused by excess estrogen stim
incr risk for endomitrial carc most commonly presents as vag bleeding |
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endomitrial carc
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most common gyn malignancy; peak age 55-65 y/o; clinically presents w/ vag bleeding
preceded by endomitrial hyperplasia |
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r/f for endomitrial carc
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prolonged use of estrogen without progestins, obesity (PCOS, estrone), HTN, diabetes, nulliparity, late menopause, early menarche
tx: hysterectomy |
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leiomyoma (fibroids)
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most common tumor in females; often presents with multiple tumors with well demarcated borders
benign SM tumor malig transformation is rare estrogen sens- incr size with preg, decr with meno tx: leuprolide infertility if obstruct fallopian tube |
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leiomyosarcoma
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bulky irreg shaped tumor with areas of necrosis and hemorrhage, typically arising de novo (not from leiomyoma); highly aggressive with tendency to recur
may protrude from cx and bleed |
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PCOS
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incr LH, decr FSH, incr testo
anovulation, hyperandreogenism c/f: amenorrhea, infertility, obesity, hirsutism tx: weight loss, OCP, gonadotropin analogs, surgery, metformin, clomiphene |
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PCOS hormones
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incr LH-->incr ovarian stromal stim-->incr ovarian androgens-->incr estrogen-->incr pit sensitivty to LRF-->incr LH release
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follicular cyst
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distention of unruptured graafian follicle
may be assoc with hyperestrinism and endomitrial hyperplasia |
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CL cyst
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hemorrhage into persistent CL; menstrual irreg
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Theca-lutein cyst
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often bilateral/multiple; due to gonadotropin stim
assoc with choriocarc and moles |
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chocolate cyst
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blood containing cyst from ovarian endomitrosis
varies with menstrual cycle |
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dysgerminoma
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malignant; eq to male seminoma
sheets of uniform cells incr hgc |
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yolk sac (endodermal sinus tumor)
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aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children
incr AFP Schiller Duval bodies (looks like a glomerulus) |
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choriocarc
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rare but malignant; can develop during preg in mother or baby; large, hyperchromatic syncytiotrophoblastic cells
incr hCG |
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teratoma
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contains 2-3 germ layers
mature- most freq benign ovarian tumor immature- aggressively malignant struma ovarii- contains functional thyroid tissue |
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serous cystadenoma
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freq bilat; lined with fallopian tube like epithelium
benign 20% of ovarian tumors |
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serous cystadenocarcinoma
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malig, freq bilat
psammoma bodies 50% of ovarian tumors |
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mucinous cystadenoma
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multilocular cyst lined by mucus secreting epithelium, benign
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mucinous cystadenocarcinoma
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malignant; pseduomyxoma peritonei- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
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Brenner tumor
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benign tumor that resembles bladder epithelium
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ovarian fibroma
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bundles of spindle shaped fibroblasts, Meig's syndrome- triad of ovarian fibroma, ascites, hydrothorax
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granulosa cell tumor
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secretes estrogen-->precocious puberty (kids)
can cause endomitiral hyperplasia or carcinoma in adults Call-Exner bodies-small follicles filled with eosinophilic inclusions |
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Sertoli Leydig cell tumor
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produces androgens (hirsutism)
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ovarian cancer R/F
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ovulation, no OCP, no early preg, no breast feeding
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germ cell tumors
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dysgerminoma, yolk sac (endodermal sinus tumor), choriocarc, teratoma
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epithelial tumors
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serous, mucinous, brenner
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ovarian stromal tumors
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ovarian fibroma, granulosa cell tumor, sertoli Leydig cell tumor
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fibrocystic disease
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most common cause of breast lumps ages 25-meno
presents with diffuse breast pain and multiple lesions, often bilat no incr risk of carcinoma |
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acute mastitis
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breast abscess, during breast feeding
incr risk of bacterial infection through cracks in nipple staph aureus is most common pathogen |
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fat necrosis
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benign painless lump
forms due to injury to breast tissue |
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gynecomastia
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results from hyperestrinism (cirrhosis, testicular tumor, puberty, old age), Klinefelters, drug induced (cimetidine, alcohol abude, marijuana, heroin, haloperidol, spironolactona, ketoconazole, dig)
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fibroadenoma
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benign- most common tumor <25 yrs; small mobile firm mass with sharp edges, incr size and tenderness with preg
not a precursor to breast cancer worsen with estrogen and caffeine |
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intraductal papilloma
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tumor of lactiferous ducts; presents with serous or bloody nipple dischage
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cystosarcoma phyllodes
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large bulky mass of CT and cysts; tumor may have leaflike projections
some are malignant |
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malignant breast tumors (general)
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common postmeno
arise from duct epithelium or lobular glands overexpression of E/P receptors or erb-B2 (HER-2) LN involvement is most improtant prognostic factor see nipple retraction, lactiferous duct involvement, dimpling |
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DCIS
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early malignancy without BM penetration
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invasive ductal, NST
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firm fibrous mass, MOST common
worst and most invasive |
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comedocarc
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ductal with cheesy consistency due to central necrosis
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inflammatory
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lymphatic involvement, poor prognosis
peau d'orange |
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invasive lobular
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often multiple, bilateral
loss of e-cadherin on chromo 16 signet ring cells |
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medullary
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fleshy, cellular lymphocytic infiltrate
good prognosis |
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Paget's disease of the breast
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eczematous patches on nipple; Paget's cells- large cells with clear halo; suggest underlying carc, also seen on vulva
any brca can present this way |
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R/F
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gender, age, early 1st menarche, delayed first preg, late meno, fam hx
not incr with fibroadenoma or nonhyperplastic cells |
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LCIS
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ER and PR +
mets to peritoneum |