Flashcards in 4dEndometrial conditionsBreast pathology Benign breast tumorsCommon breast conditionsMalignant breast tumors Deck (48)
An hour after giving birth, a woman develops abdominal pain, fever, and uterine tenderness. What is the likely causing her pain?
Endometritis (retained material [products of conception or a foreign body such as IUD] promotes infection from vagina or GI bacterial flora)
On laparoscopy, a woman with chronic pelvic pain has many lesions that appear like chocolate cysts in her ovaries. Does she have cancer?
Unlikely (chocolate cysts [endometriomas], classic for endometriosis, are caused by cyclic bleeding of ectopic endometrial tissue)
A woman has been unable to conceive for several years and has severe pain during periods and with sex. What diagnosis should you consider?
Endometriosis, which is nonneoplastic ectopic endometrial tissue (glands/stroma), most commonly found in the peritoneum, pelvis, or ovaries
What processes are thought to lead to the ectopic endometrial implantation in endometriosis?
Retrograde menstrual flow, transportation of endometrial tissue via the lymphatic system, metaplastic transformation of multipotent cells
A 35-year-old woman has dyschezia, dysmenorrhea, and dyspareunia. Her uterus is normal sized. How do you treat her?
Treat with OCPs, NSAIDs, GnRH agonists, progestins, danazol, laparoscopic removal (this is endometriosis)
Biopsy from a patient reveals extension of glandular endometrial tissue into the uterine myometrium. What is the diagnosis?
Adenomyosis, caused by hyperplasia of the endometrial basalis layer
A patient has dysmenorrhea and menorrhagia. She also has a soft, enlarged, and globular uterus. How do you treat her?
Treat with GnRH agonists or hysterectomy (this is likely adenomyosis)
Biopsy from a patient shows a collection of endometrial tissues that is well-circumscribed within the uterine wall. What is the diagnosis?
Polyp (may also contain smooth muscle cells)
Polyps can grow and extend into the ____.
What is the most common gynecologic malignancy?
A postmenopausal woman presents with vaginal bleeding. What two conditions should immediately come to mind?
Endometrial hyperplasia or the more worrisome endometrial carcinoma
Name four risk factors for endometrial hyperplasia.
Hormone replacement therapy, anovulatory cycles, granulosa cell tumors, and polycystic ovarian syndrome (think: increased estrogen exposure)
A young black woman presents with abnormal uterine bleeding. She has had several miscarriages. What benign neoplasm could be responsible?
Leiomyoma or fibroid (increased incidence in black women, most common tumor in women, and peak occurrence at 20–40 years of age)
Leiomyomas are sensitive to what hormone? What is the clinical significance?
Estrogen, meaning leiomyomas grow with pregnancy and shrink with menopause
A young woman has uterine bleeding and fatigues easily. She is anemic. Exam shows multiple uterine masses. What are you worried about?
Iron deficiency anemia secondary to severe bleeding from leiomyomas
A woman has had leiomyomas for many years. She wants screening, as she is worried about her leiomyomas progressing to cancer. Your reply?
There is no need to screen, as leiomyomas usually do not progress to cancer (specifically, leiomyosarcoma)
Name the most common location for each of the following: intraductal papilloma, fibrocystic change, lobular carcinoma, phyllodes tumor.
Intraductal papilloma = lactiferous sinus, fibrocystic change = major duct, lobular carcinoma = lobules, phyllodes tumor = stroma
Name the most common location for each of the following: breast abscess, tubular carcinoma, Paget disease, invasive ductal carcinoma.
Breast abscess = nipple/lactiferous sinus, tubular carcinoma = terminal duct, Paget disease = nipple, invasive ductal carcinoma = major duct
Name the most common location for each of the following: ductal carcinoma in situ (DCIS), fibroadenoma, mastitis.
DCIS = major duct. fibroadenoma = stroma, mastitis = lactiferous sinus
A woman complains of itchy breast skin and a bloody discharge from her nipples. What is the most commonly affected site?
What is the most common breast tumor among women younger than 35 years?
Fibroadenoma, a benign tumor
A 20-year-old woman has a small, mobile, firm breast mass with well-defined borders. What is the most likely etiology?
Fibroadenoma, the most common tumor in women younger than 35 years
A 24-year-old woman notes a breast mass that grows and is more tender during menstruation. Does she have breast cancer?
Unlikely (the age/description are consistent with a fibroadenoma from increased estrogen levels [e.g., pregnancy or prior to menstruation])
What neoplasm would be likely in a woman with serosanguineous discharge from her nipple but without a palpable breast mass?
Intraductal papilloma, a lactiferous duct tumor often seen below the areola that leads to a slightly increased risk for carcinoma (1.5–2×)
A large, bulky breast mass made up of connective tissue and cysts with leaf-like projections is taken from a 55-year-old woman. Prognosis?
Usually considered benign but may become malignant (this is a phyllodes tumor, most common in fifth decade)
Name four histologic types of proliferative breast disease.
Fibrosis, cystic, sclerosing adenosis, and epithelial hyperplasia
What diagnosis should you suspect in a woman who presents with a painless breast lump following trauma to her chest?
This is likely fat necrosis, a benign process that occurs after trauma (although up to 50% of patients may not recall an injury)
Name five non-drug-related conditions that can cause gynecomastia due to hyperestrogenism in males.
Puberty, old age, testicular tumors, cirrhotic liver disease, and Klinefelter syndrome
A male patient presents with abnormally enlarged breasts. What is this finding called, and which drugs could cause this?
Gynecomastia; Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole ("Some Drugs Create Awesome Knockers")