Chapter 18 (females) Flashcards
(150 cards)
1
Q
For the vulva what is the most common thing that occurs?
A
inflammation (neoplasia is rare)
2
Q
What are some symptoms for vulvitis?
A
pruritis, allergic contact dermatitis (eczema)
3
Q
What are some infections that occur in vulvitis?
A
HPV (condylomata acuminata), HSV (vesicles), treponema pallidum (chancre), n. gonorrhoeae, c. albicans
4
Q
What is bartholin’s cyst?
A
infection which obstructs the duct (vulvitis)
5
Q
What is lichen sclerosus?
A
epidermal thinning (atrophy); it is a smooth, white lesion near labia minora
6
Q
What age is lichen sclerosus most commonly seen in?
A
elderly (small cancer risk- 1-1.5% scc)
7
Q
What is lichen simplex chronicus?
A
epithelial hyperplasia (thickening) and hyperkeratosis;
8
Q
What type of cells are in lichen simplex chronicus?
A
leukocytes, no CA risk (chronic irritation)
9
Q
What is condyloma?
A
post infection, warty lesions
10
Q
What is condylomata lata?
A
secondary syphilis; flat, moist, and painless
11
Q
What is condylomata acuminata?
A
genital warts (HPV-6 and HPV-11)
12
Q
What is vulvar carcinoma?
A
rare, >60 years, late mets; 90% SCC, exophytic or ulerative; lymphatic mets
13
Q
What are the 2 types of vulvar carcinoma? which one is more common?
A
HPV-related SCC and non HPV-related SCC (MC)
14
Q
What is HPV-related SCC?
A
vulvar intraepithelial neoplasia (VIN); HPV-16 and HPV-18; middle aged, smokers, immunodeficiency, multifocal
15
Q
What is non-HPV-related SCC (MC)?
A
seen in older women, isolated, lichen sclerosis (precursor lesion), no VIN
16
Q
Are congenital malformations common or rare?
A
rare (agenesis, atresia, septate vagina)
17
Q
What is seen in vaginitis?
A
discharge (leukorrhea); inflammation of vaginal wall; pain, pruritus; commonly benign and transient (not life threatening)
18
Q
What are the 3 types of vaginal cancer? which one is most common?
A
squamous cell carcinoma (MC), clear cell adenocarcinoma and sarcoma botryoides
19
Q
Are vaginal cancers common or rare?
A
rare
20
Q
What is squamous cell carcinoma vaginal cancer?
A
pre-cancerous vaginal intraepithelial neoplasia (VIN); seen in those over 60 years old
21
Q
What are the risks of squamous cell carcinoma?
A
HPV (16 and 18), early intercourse and multiple partners
22
Q
What is clear cell adenocarcinoma?
A
red/granular foci; seen in children whose mothers took diethylstillbesterol (DES)- 40x increased risk of getting it
23
Q
What is sarcoma botryoides?
A
type of embryonal rhabdomyosarcoma; most common in young girls (under 5 years); soft polypoid
24
Q
In chapter 20 what was a rhabdomyosarcoma?
A
skeletal muscle tissue tumor (polyp-like mass); soft tissue sarcoma
25
What is cervitis?
inflamed cervix; common, benign, possibly asymptomatic
26
What are symptoms or cervitis?
leukorrhea, pain, pruritis, bleeding, fever (prompts pelvic exam)
27
What are the 2 types of cervitis?
infectious and non-infectious
28
What organisms are seen in infectious cervitis?
trichomonas vaginalis (MC), chlamydia trachomatis, candida, n. gonorrhoeae, HSV, HPV
29
What are the 2 types of non-infectious cervitis?
acute: postpartum and chronic: reproductive age women (common is estrogen fluctuation and trauma)
30
What are the risks of neoplasia in the cervix?
early 1st intercourse, multiple sex partners, male partner with several past partners, persistent infection with high risk HPV
31
What are the high risk HPVs?
16 and 18 (immature squamous cells; transformation zone)
32
Most HPV infections are _____
transient- lasting for only a short amount of time (months); few persist- cervical intraepithelial neoplasia (CIN), precursor to invasive carcinoma
33
Which type of epithelia is seen in cervical neoplasia?
endocervix: columnar and exocervix: squamous
34
What is cervical intraepithelial neoplasia (CIN)?
HPV to dysplasia= pre-cancerous lesion; most commonly diagnosed at age 30 years (cancer peaks about 15 years later; invasive carcinoma is about 45 years)
35
What are the 2 types of cervical intraepithelial neoplasia (CIN)?
low-grade (CIN 1) and high-grade (CIN 2-3)
36
What is low grade CIN?
observation; 60% regress; 10% progress to high-grade
37
What is high grade CIN?
excision; 30% regress; 10% progress to cancer
38
What is a cellular feature of cervical intraepithelial neoplasia (CIN)?
kollocytosis (HPV)
39
what is kollocytosis (HPV)?
enlarged nucleus, anaplasia, irregular (wrinkled) borders, dark (hyperchromasia)
40
Is CIN more symptomatic or asymptomatic?
asymptomatic
41
Invasive carcinoma of the cervix
SCC (75%); adenocarcinoma, carcinoid (HPV infection is a risk for all types); most commonly diagnosed in mid-40s
42
What zone is in the invasive carcinoma of the cervix?
transformation zone (variable size)
43
Local invasion in invasive carinoma of the cervix can lead to?
lymphatic mets
44
Uterus is composed of what to layers?
endometrium and myometrium
45
What is endometritis?
inflammation of the endometrium
46
What are the 2 types of endometritis?
acute (neutrophils) and chronic (plasma cells)
47
what is endometritis a risk for?
ectopic pregnancy or infertility
48
endometritis is most commonly secondary to _____ ____ ______
pelvic inflammatory disease (n. gonorrhea, c. trachomatis, TB)
49
Endometritis retained products are....
conception, abortion, intrauterine device (removal to resolution)
50
What is endometriosis?
extrauterine endometrial tissue (ectopic); outside of the ureters; causes pelvic pain
51
Where is endometriosis seen in?
10% of reproductive-age women, 50% of female infertility
52
What is abnormal uterine bleeding?
- menorrhagia
- metrorrhagia
- postmenopausal
53
What is menorrhagia?
profuse/prolonged menstruation
54
What is metrorrhagia?
irregular, between periods (spotting)
55
What is endometrial hyperplasia?
increase estrogen (obesity), PCOD, failed ovulation; precursor to endometrial carcinoma (atypia)
56
What is endometrial carcinoma?
most common female genital tract cancer, 55-65 years, endometrioid (80%); associated with endometrial hyperplasia (leukorrhea and metrorrhagia); favorable prognosis: 90% 5-year
57
What is endometrial polyps?
0.5-3cm sessile mass, cystic; any age, but most common around menopause (abnormal uterine bleeding, possible pre-cancerous)
58
What is smooth muscle tumors? What are the two types?
myometrium; leiomyoma and leiomyosarcoma
59
What is a leiomyoma?
"fibroids": benign, most commonly common during reproductive age (30-50%); african americans, increase estrogen
60
What is leiomyosarcoma?
malignant, postmenopausal (solitary, anaplastic, hemorrhagic/necrotic mass)
61
leiomyosarcoma most commonly metastasizes to
lungs (5-year survival: 40%)
62
In the fallopian tubes what are 2 pathologies that occur? which is more common?
salpingitis (MC) and fallopian tube carcinoma
63
What is salpingitis?
inflammation; STIs- chlamydia, gonorrhea, strep, staph (to PID); pyrexia, lower abdominal pain
64
Salpingitis is a risk factor for what?
ectopic pregnancy or sterility
65
What can you get salpingitis from?
ectopic pregnancy, endometriosis, tumor
66
What is fallopian tube carcinoma?
adenocarcinoma: BRCA1 and BRCA2 mutations
67
Where is fallopian tube carcinoma most commonly located?
on the fimbriae
68
When is fallopian tube carcinoma usually diagnosed?
in late stages; invades peritoneal cavity
69
What are the two pathologies associated with the ovaries?
ovarian cysts and polycystic ovarian disease?
70
What are ovarian cysts?
they may be normal, multiple, 1-4cm, filled with serous fluid
71
ovarian cysts can enlarge and eventually ______
rupture (hemorrhage, acute abdom.)
72
What is polycystic ovarian disease?
multiple cystic follicles (ovaries 2x size; produce androgens, estrogens, LH; decrease FSH)
73
Both ovarian cysts and polycystic ovarian disease are ______ understood
poorly (familial risks)
74
What are the differences between ovarian cysts and polycystic ovarian disease?
cysts: increase size increases risk of complications, bleeding, pelvic mass, pain, acute abdomen
polycystic disease: oligomenorrhea, infertility, hirsutism, obesity
75
Ovarian neoplasia is the ____ most common cancer in US women (___ most common cause of cancer related death)
8th; 5th
76
What are the various types of ovarian neoplasia? which is the most common?
surface epithelial tumors (MC), germ cell sex cord-stroma, can have metastasis to the ovaries
77
What is the overall frequency of the types of ovarian neoplasia?
surface epithelial tumors (65-70%); germ cell (15-20%); sex cord-stroma (5-10%); metastasis to ovaries (5%)
78
What is a surface epithelial tumor?
surface epithelia, repeated ovulation/scarring with leads to metaplasia; can be benign or malignant (represent 90% of ovarian cancer)
79
what are the types of surface epithelial tumors?
serous tumor, mucinous tumor, endometrioid tumor, clear cell tumor, brenner tumor, cystadenofibroma
80
What are the types of germ cell tumors?
teratoma, dysgerminoma, endometrial sinus tumor, choriocarcimona
81
What are the types of sex cord-stromas?
fibroma, granulosa-theca cell tumor, sertoli-leydig cell tumor
82
What ages do surface epithelial tumors occur?
20+ years
83
What ages do germ cell tumors occur?
0-25+ years
84
What ages do sex cord-stromas occur?
all ages
85
Which surface epithelial tumor type is most common?
serous tumors
86
How many serous tumors are benign? malignant?
60% benign (30-45 years), 25% malignant (45-65 years)
87
What are serous tumors?
large, 40 cm, bilateral (25%); 60% of all ovarian cancers (high-grade 15% 10 year survival)
88
What are endometrioid tumors associated with?
associated with endometriosis and endometrial cancer; most common are malignant (30% bilateral)
89
can both surface epithelial tumors be cystic or solid?
both may be cystic or solid
90
What is placental infection/inflammation types? Which is more common
ascending infections (MC) and transplacental
91
What are ascending infections?
bacterial, premature rupture of membranes, neutrophils (mycoplasma, candida, vaginal flora)
92
What is a transplacental infection/inflammation?
placental villitis (toxoplasmosis, rubella virus, CMV, HSV, TB, syphilis, HIV- TORCH)
93
What is an ectopic pregnancy?
non-uterine implantation (1%); occurs in the fallopian tube (90%), ovaries, abdominal cavity
94
What are the acute ruptures (1%) of ectopic pregnancy leading to?
possible hypovolemic shock
95
What are the types of gestational trophoblastic disease (tumor)?
hydatidiform mole, invasive mole, choriocarcinoma
96
What is a hydatidiform mole?
swollen chronic villi; abdominal fertilization (1.5: 1,000 pregnancies); benign, large, cystic, grape-like structure
97
What is an invasive mole?
benign, invasive, no mets; possible rupture: severe myometrial hemorrhage
98
What is a choriocarcinoma?
aggressive malignancy or gestational chorionic epithelium, hemorrhagic, discovered late
99
chemotherapy of choriocarcinoma gives _______ cure
~100%
100
Choriocarcinoma may mets to _____
lungs (cannon ball metastasis)
101
What is preeclampsia?
hypertension, proteinuria, edema in face and periphery (3rd trimester, 1st pregnancy)
102
preeclampsia is seen in what percentage of pregnancies?
5-10% (primigravida, >35 years)
103
In preeclampsia there is ___ of HELLP?
10% (hemolysis elevated liver enzyme platelets); hemolysis, increase liver enzymes, decreased platelets
104
What is eclampsia?
seizures, coma (toxemia of pregnancy); anti-angiogenesis, placental hypoxia/infarction (insufficient maternal blood flow to placenta)
105
What does possible eclampsia lead to?
possible end-organ failure (hypercoagulability, renal dysfunction)
106
What are types of minor breast lesion abnormalities?
supernumerary nipples (up to 5%), inverted nipples (MC congenital), galactocele (ductal obstruction, during lactation)
107
Breast lesions are most common among ______
females (most commonly benign, palpable mass)
108
breast lesions is the ____ cancer diagnosis; ____ most common cancer-related death
#1, 2nd (number 1 is lung)
109
What are the categories of fibrocystic changes? which is more common?
nonproliferative (MC) and proliferative
110
What are nonproliferative fibrocystic changes?
benign, increase fibrotic stroma, dilation of ducts
111
What are the size of nonproliferative cysts?
1-5 cm (multiple/bilateral cysts)
112
What are proliferative fibrocystic changes?
epithelial hyperplasia, additional cellular layer within ducts and lobules (>2 cell layers)
113
What are the types of proliferative fibrocystic changes?
mild: orderly hyperplasia
atypical: dysplastic hyperplasia (increased risk of breast cancer: 5x)
114
What is fat necrosis?
chalky, white mass (trauma: biopsy, irradiation, pedulous breasts)
115
What is acute mastitis?
early nursing: staph aureus (MC): via ducts; solitary or multiple, possible abscess
116
What is a mammary duct ectasia (plasma cell mastitis)?
ductal dehydration: most common at age 40-60 years
| nonbacterial, chronic inflammation (lymphocytes and plasma cells)
117
What can happen with mammary duct ectasia?
nipple retraction, nipple discharge, edema, tenderness, periareolar mass
118
What cells are usually seen in tumors of the breast?
most common epithelial cells (carcinomas)
119
What is a fibroadenoma?
most common benign breast tumor; mixed (neoplastic stroma, normal glands)
120
What age are fibroadenomas most commonly seen?
20-30 (young women)
121
What type of mass are fibroadenomas?
solitary, firm, mobile (1-10cm)
122
What is a phyllodes tumor?
benign or malignant (15%); metastasize late, good prognosis; leaflike projections, rapid growth
123
what type of cancer is breast cancer?
carcinoma
124
How many people a year get breast cancer?
200,000 per year, 40,000 lethal: 20% lethal
125
what are some influences on breast cancer?
hormonal, genetic, environmental
126
What are the risks of breast cancer?
age (>30 years), geography, caucasians, family history, nulliparous, benign lesions, obesity, high fat diet, alcohol, cigarettes, estrogens, chest irradiation (<30 years), BRCA1 and BRCA2
127
Where is most common areas of breast cancer?
most common superolateral quadrant (50%); 4% bilateral or multiple primary lesions
128
if breast cancer penetrates the _____ __________, it can be ________
basement membrane; invasive
129
if breast cancer does not penetrate the basement membrane, it can be ___-_______
non-invasive (in situ)
130
What are the 2 types of non-invasive breast cancers?
ductal carcinoma in situ (DCIS) and lobar carcinoma in situ (LCIS)
131
What is ductal carcinoma in situ?
mixed, possible necrosis, or calcification, rarely palpable (screening), great prognosis (97% survival)
132
What is lobar carcinoma in situ?
uniform cells, mucin vacuoles, rarely calcific (incidental diagnosis)
133
if lobar carcinoma in situ is untreated, 1/3 can lead to ____ ____
invasive cancer (either breast)
134
What is an invasive carcinoma?
lymphatic mets: lymphedema (dimpling of skin, nipple inversion)
135
What are the types of invasive ductal carcinoma?
invasive ductal carcinoma, invasive lobar carcinoma, medullary carcinoma, colloid carcinoma, tubular carcinoma
136
What is the invasive ductal carcinoma?
70-80%, from DCIS, firm/palpable mass, irregular borders, heterogenous mass, lymphatic mets
137
What is the invasive lobar carcinoma?
cells identical to LCIS, from LCIS, e-cadherin, palpable or occult, multiple (mets to CSF, GI, marrow, uterus)
138
What is medullary carcinoma?
<1%, BRCA1, anaplastic (triple negative)
139
What are colloid carcinomas?
rare, abundant mucin, soft
140
What is a tubular carcinoma?
<1cm, 10%, rarely palpable, irregular density, mets is rare, excellent prognosis
141
What is the mass type associated with invasive breast cancer?
solitary, painless, 2-3cm, ~mobile; mammography: 1cm
142
____ of invastive breast cancers have metastasized to lymph by diagnosis
50% (mammography: 15%)
143
When do you get a mammography?
50, every 2 years
144
Where are lesions for invasive breast cancer located?
lateral and central: axillary nodes; medial: internal mammary arteries
145
What are morphologic changes of the breast?
skin dimpling, visible lump, peau d'orange, surface erythema, surface ulceration, recent nipple inversion (not born with it), blood-stained nipple discharge, "eczema" around nipple (paget disease)
146
What is the prognosis of invasive breast cancer?
poorer prognosis (anaplasia, invasion, increase size, distant mets, overexpression of HER2)
147
What are some male breast pathologies?
gynecomastia and carcinoma
148
What is gynecomastia?
bilateral breast enlargement (~70% of pubescent males); increase connective tissue, ductal hyperplasia, lobule formation, subareolar swelling (button-like)
149
What is a male carcinoma of the breast?
rapidly invade (thorax); 50% lymphatic mets at diagnosis discharge
150
How many males get diagnosed with carcinoma of the breast cancer?
~2,000 cases/year, most common in elderly
