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Flashcards in female reproductive Deck (108):
1

bartholin cyst

cystic dilation of bartholin gland; arises due to inflammation and obstruction of gland; usually occurs in reproductive age women

2

bartholin gland location

bottom of opening usually unilateral

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clinical presentation of bartholian cyst

unilateral painful cystic lesion

4

condyloma

warty neoplasm of skin; due to HPV 6/11; koilocytic change (raisen nucleus); rarely progress to carcinoma

5

HPV low risk/high risk subtypes

low risk = 6,11 cause condyloma
high risk = 16,18,31,33 cause dysplasia then can become carcinoma

6

lichen sclerosis

thinning of epidermis and fibrosis of dermis; presents with leukoplakia that is thin parchment like; commonly seen in post menopausal women; benign--slight inc. risk for SCC

7

lichen simplex chronicus

hyperplasia of vulvar squamous epithelium; leukoplakia with thick leathery skin; assoc with chronic irritation and scratching; benign, no risk for SCC

8

vulvar carcinoma

arised from squamous spi lining; rare

9

vulvar carcinoma presentation

presents as leukoplakia

10

2 pathway for vulvar carcinoma

HPV (high risk ones) and non-HPV

11

HPV type of vulvar carcinoma

infection then leads to vulvar intraepithelia neoplasia (dysplasia); 40-50 years old

12

non HPV type of vulvar carcinoma

think long standing lichen sclerosis; >70 or so; chronic irriation from the lichen sclerosis

13

extramammary paget disease

malignamt epi cell in the epidermis of vulva

14

extramammary paget disease presentation

erythematous, pruritic, ulcerated skin which represents carcinoma in situ; usually NO underlying carcinoma

15

extramammary paget disease stains

PAS +, Keratin +, S100 -; used to distinguish it from melanoma which is PAS -, keratin -, S100 +

16

Adenosis of vagina

focal persistence of columnar epi in upper 1/3 of vagina; inc. incidince in females exposed to DES in utero

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adenosis inc. risk for

clear cell carcinoma

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clear cell adenocarcinoma

malignant glands with clear cytoplasm; complication of the adenosis from DES;

19

embryonal rhabdomyosarcoma

malignant mesenchymal proliferation of immature skeletal muscle; rare

20

embryonal rhabdomyosarcoma presentaion

bleeding and grape like mass protruding from cagina or penis of child; < 5 y/o of age

21

maligant cell in embryonal rhabdomyosarcoma

rhabdomyoblast; has cytoplasmic cross striations, positive IHC staining for desmin and myoglobin

22

vaginal carcinoma

arising from squamous epi lining of vagina; related to high risk HPV; precursor lesion is vaginal intraepithelia neoplasia

23

cancer in lower 2/3 of vagina means spread to

inguinal nodes

24

cancer in upper 1/3 of vagina means spread to

regional iliac nodes

25

Asherman syndrome

secondary ammenorrrhea due to loss of basalis (regenerative layer) and scarring; resul;ts from overaggressive dilation and curettage

26

anovulatory cycle

lack of ovulation, results from estrogen driven growth phase but no progest driven secretory phase; common cause of dysfxn uterine bleeding especially during menarche and menopause

27

acute endometritis

bacterial infection; usually due to retained producst of conception

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acute endometritis presentation

fever, abnormal uterine bleeding, pelvic pain

29

chronic endometritis

characterized by plasma cells; causes retianed products of conception, chronic PID, IUD, TB

30

chronic endometritis presentation

abnormal uterine bleeding, pelvic pain, infertility

31

endometrial polyp

abnormal bleeding, can arise as SE from tamoxifen; hyperplastic protrusion of endometrium

32

endometriosis

abnormal placement of endometrial glands and stoma outside of the unterine endometrial lining

33

endometriosis presentation

dysmenorrhea, pelvic pain; may cause infertility

34

common sites of involvement of endometriosis

Ovary (chocolate cyst, most common); uterine ligaments (pelvic pain); pouch of douglas (pain with defacation); bladder wall (pain with urination); bowel serosa (abdom pain and adhesions); fallopian tube mucosa (scarring)

35

gun powder lesions

endometriosis inside of soft tissue

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involvement of uterine myometrium with endometriosis

adenomyosis

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endometriosis inc risk for

carcinoma especuially in ovary

38

endometrial hyperplasia

hyperplasia in relation to the stroma; consequence of unopposed strogen

39

endometrial hyperplasia presentation

post menopausal uterine bleeding; due to now loss of progesterone but some estrogen can still be around

40

endometrial hyperplasia classified by

architecture and cellular atypia; cellular atypia is most important factor for progression to carsinoma

41

endometrial carcinoma

proliferation of endometrial glands; arised from 2 distincgt pathways (hyperplasia or sporadic)

42

endometrial carinoma presentation

post menopasual bleeding

43

hyperplasia pathway of endometrial carcinoma

exess estro leading to endometrial to grow grow grow then leading to carcinoma; histo is endometriod (looks like endometrium tissue); age group is 50

44

sporadic pathway of endometrial carcinoma

cancer from atrophic endometrium; histology is a serous form (and is called also papillary growth); more often elderly; p53 mutations driven; no precursor lesion; may get psammoma bodies and very aggressive

45

leiomyoma

benign proliferation of the smooth muscle from the myometrium; related to estro exposure; pre-menopausal; usually asymptomatic

46

leiomyoma histo

multiple, well define white whorled masses

47

leiomyoma presentation

usually no Sx; but can have abnormal uterine bleeding, infertility, pelvic mass

48

leiomyosarcoma

malignant prolif. f smooth muscle of myometrium; arised de novo; POST-menopasual women; SINGLE lesion with necrosuis and hemorrhage

49

leimyosarcoma histo

necrosis, mitotic activity, cellular atypia

50

leiomyoma does nto become what

leiomyosarcoma

51

LH hits what? FSH hits what in ovary

LH hits THecal, and FSH hits granulosa

52

hemorrhagic luteal cyst

bleeding into corpus luteum

53

degeneration of follicle leads to

cystic degeration of the follicle

54

poly cystic ovarian disease

multiple follicular cysts in ovary due to horemone imbalance; LH:FSH >2; increase LH and lower FSH

55

PCOD clinical features

obese young women with inferility, oligomenorrhea, hirsutism; some will have insulin resistence; the high levels of estrone inc. risk for endometrial carcinoma

56

surface epithelia tumors of ovary

most common ovarian tumor; derived from coelomic epi that lines ovary;

57

2 most common subtypes of surface epi tumors of ovary

serous and mucinous which both are cystic; other less common types are endometrioid and brenner

58

benign surface epi. tumors of ovary

cystadenoma; single cyst with simple flat lining, premenopausal (30-40)

59

malignant tumor of ovarian surface epi

cystadenocarcinoma; complex cysts with think chaggy lining; POST menopausal women (60-70)

60

borderline tumors of ovarian surface epi cells

features of benign and malignant; still have malignant potenial

61

BRCA1 mutauion carriers with ovarian cancers

inc. risk for serous carcinoma of ovary and fallopian tubes

62

endometriod surface epi. tumor of ovary

looks like endometrial; malignant; may be assoc with endometriosis; assoc with seperate endometrioid carcinoma in endometrium

63

Brenner tumor of surfacve epi of ovary

has cells that are urothelium

64

surface epi tumors presentaion

usually present late; vague abdom Sx; signs of compression; poor prognosis; usually spread locally especially to peritoneum

65

surface epi tumor marker

CA-125, can monitor Tx response or screen recurrence

66

germ cell tumors of ovary

2nd most common; occer in reproductive age; subtypes mimic tissues by germ cells

67

cystic teratoma

cystic tumor comprised of fetal tissue derived from 2-3 embryologic layers; most common germ cell tumor in females; benign

68

cystic teratoma is

benign unless it has signs of immature tissue then it is considered malignant (most commonly malignant tissue is of neuroectooderm cells); the tumor by its self can have cancer (most common is SCC)

69

struma ovarii

cystic teratoma primarily of thyroid tissue

70

dysgerminoma

large cells with clear cytoplasm and central nuclei; most common malignant germ cell tumor; good prognosis, responds to radiotherapy; serum LDH may be elevated

71

dysgerminoma male counter part

seminoma

72

endodermal sinus tumor

malignant tumor that mimics yolk sac; most common germ cell tumor in children; serum AFP elevated; schiller-duval bodies seen

73

schiller duval bodies

glomeruloid type structure on histology

74

choriocarcinoma

malignant of trophoblasts and syncytiotrophoblasts; no villi present; small, hemorrhagic tumor that spreads early; HIGH B-hCG; poor response to chemo; genetically programmed to find blood vessels

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embryonal carcinoma

large primitive cells; aggressive with early metastasis

76

sex cord stromal tumors

granulosa cells, thecal cells, or sertoli-leydig cells

77

granulosa-theca cell tumor

often produces estrogen; Sx are of estrogen excess

78

sertoli-leydig cell tumor in ovary

leydig cells contain reinke crystals; sertoli cells form tubules; may produce androgens

79

fibroma

benign tumor of fibroblasts; assoc with pleural effusion and ascites (Meigs syndrome)

80

metastasis to ovary

kruckenburg tumor, psuedomyxoma peritonei

81

Kruckenburg tumor

mucinous carcinoma to ovary; classically from gastric carcinoma (diffuse type); signet ring cells; B/L

82

pseudomyxoma peritonei

term for excess muscin in the peritoneum; key tumor is a tumor in appendix (mucinous carcinoma of appendix); cuaes mucinous now onto ovary

83

ectopic pregnancy

implantation of fertilzed ovum at site other than uterine wall; most common site is fallopian tube

84

risk factor for ectopic pregnancy is

scarring

85

presentation of ectopic pregancy

LQ pain weeks after missing period; its a surgical mergency

86

spontaneuous abortion

miscarriage of fetus (20 weesk befor egestataion); common--1/4 of pregs

87

spontaneous abortion Sx

vaginal bleeding, cramp like pain, passage of fetal tissues

88

spontaneous abortion due to

chromosomal abnormalities; hypercoaguable states or exposure to teratogens or congenital infections are other causes

89

placenta previra

implantation of placenta on lower portion of cervical and overlys the Os; 3rd trimester bleeding; often requires fetus C-sextion delivery

90

placenta abruption

placenta abruptly seperaties prior ro delivery; common cause of still biurth;

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placenta abruiption presentation

3rd trimester bleeding and fetal insuffiency

92

placenta accreta

improper implantation of placenta into myometrium with little to no intervening deciua

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placenta accreta presentation

diff. delivery of placenta and post partum bleeding; often requires hysterctomy

94

preeclampsia

preg induced HTN, proteinuria and edema; arised in 3rd trimester; due to a maternal-fetal vascular interface in placenta

95

may see what in placenta in preeclampsia

fibrinoud necrosis

96

eclampsia

preeclamsia with seizures

97

HELLP

hemolysis, elevated liver enzymes, low plateles; thrombotic angiopathy involveing liver

98

SIDS

death of healthy infant (1 month to 1 year); usually during sleep;

99

SIDS risk factors

sleep on stomach, smoking in household, prematurity

100

hydatidiform mole

abnirmal conception characterized by swollen and edematous villie with proliferation of trophoblasts; uterus will expand as if the pregnancy is present

101

hydatidiform mole special Sx

uterus expands more than normal; B-hCG will be higher than normally expected; no prenatal care will cause pass of the grape like masses

102

hydatidiform mole presentation

2nd trimester with passage of grape lke masses from vaginal canal

103

hydatidiform mole presentation WITH prenatal care

Dx by routine ultrasound in early first trimester; absent fetal heart sounds; ''snow storm'' appearance on US

104

hydatidiform mole classifications

complete or partial

105

partial mole

normal ovum fertilized by 2 sperm; 69 chromosomes; fetal tissue present; hydropic and some normal villi; focal prolifeation of trophoblast around hydropic villie; minimal risk for choriocarcinoma

106

complete mole

empty ovum fertilized by 2 sperm; fetal tissue absent; most villi are hydropic; diffuse circumferential proliferation of trophoblast around hydropic villi; 2-3% inc chance for choriocarcinoma

107

Tx of molar pregnancy

D&C; monitor B-hCG to disceren if mole is gone

108

choriocarcinoma (gestational)

trophoblast tumor; no villi; gestation or germ cell tumor; gestation pathway responds well to chemotherapy while germ cell does not