What is the premalignant lesion for Cervical Squamous Cell Carcinoma?
Cervical Intraepithelial Neoplasia (CIN)
Female - vulvar skin is pale gray and parchment-like
Lichen Sclerosus/Chronic Atrophic Vulvulitis
What is the premalignant lesion for Vulular Carcinoma?
Vulvular Intraepithelial Neoplasia (VIN)
What is the premalignant lesion for Squamous Cell Carcinoma of the Vagina?
Vaginal Intraepithelial Neoplasia (VAIN)
Location of Squamous Cell Carcinoma of the Vagina?
Upper posterior vagina
Location of Clear Cell Adenocarcinoma of the Vagina?
Upper anterior vagina
What is the premalignant lesion for Clear Cell Adenocarcinoma of the Vagina?
Atypical vaginal adenosis
Absence of bleeding for at least 3 cycles
Bleeding that occurs at an interval of >35 days
Bleeding that occurs at an interval of
Excessive, prolonged, heavy bleeding
Bleeding at irregular intervals
Heavy bleeding at irregular intervals
Painful menstruation with abdominal cramps
Difference between ectopic endometrium and eutopic endometrium?
Ectopic has aromatase P450 enzyme.
Eutopic does not have that enzyme.
What is the premalignant lesion for Endometrial Adenocarcinoma?
Endometrial Intraepithlial Neoplasm (EIN)/ Complex endometrial hyperplasia with atypia
Adenocarcinoma of the Fallopian Tube mutation?
p53 mutation -> dysplaisa
Invasive Ductal Carcinoma mets locally and distant
local = axillary LN distant = lung, brain
Invasive Lobular Carcinoma mets locally and distant
local = axillary LN distant = bone, GI, uterus, ovary, serosa
Origin of ovarian epithelial tumors?
Fallopian tube fimbrae
Endodermal sinus/Yolk sac tumors (female and male) stain for?
Alpha-fetoprotein positive (AFP +)
Which ovarian tumors are hormonally active?
Sex cord stromal tumors
Area of the prostate involved in BPH?
transitional zone, periurethral
Area of the prostate involved in prostatic neoplasms?
What is the premalignant lesion for Prostate Adenocarcinoma?
Prostatic Intraepithelial Neoplasia (PIN) - still has outer basal cell layer
Prostate Adenocarcinoma mets - local and distant
local = early - obturator; late - para-aortic distant = bone, brain, lungs
Bell Clapper Deformity?
cause of testicular torsion in adolescents. lack of posterior attachment of the scrotum and testicle due to tunica vaginalis wrapping all the way around the testicle.
Male germ cell tumor mutation
Isochromosome of Chr 12 - loss of long arm with duplication of the short arm
Characteristics of Seminomatous type germ cell tumors in males (5)
- older patients
- low tumor marker expression
- late mets
- met via lymphatics
Characteristics of Non-seminomatous type germ cell tumors in males (5)
- younger patients
- elevated tumor marker expression
- early met
- met via hematogenous and lymphatics
Schiller-Duval bodies are found in what male tumor?
Yolk Sac Tumor
Reinke Crystals are found in what male tumor?
Leydig cell tumor
What is the premalignant lesion for Squamous Cell Carcinoma of the Penis?
Bowen Disease caused by HPV 16
Thick, leathery vulvar skin?
Lichen simplex chronicus
What 3 conditions present as leukoplakia in females?
- Lichen Sclerosis
- Lichen Simplex Chronicus
- Vulvar Carcinoma
Paget’s disease stains? PAS, Keratin, S100
Melanoma stains? PAS, Keratin, S100
Vaginal CA from the lower 1/3 of the vagina locally mets to?
Superficial Inguinal LN
Vaginal CA from the upper 2/3 of the vagina locally mets to?
High risk HPV produces what proteins (2) and what are their functions?
E6 -> inhibits p53 (Normally, p53 regulates G1->S transition and monitors for DNA mutations/damage. Without p53, DNA mutations are allowed to continue through the cell cycle.)
E7->inhibits Rb (Normally, Rb holds onto E2F which regulates when cells move into G2. Without Rb, E2F just allows everything to go into G2 whether it is normal DNA or damaged DNA.)
Desmin is what?
Intermediate filament for muscle cells
Myogenin is what?
Nuclear transcription factor in immature skeletal muscle
Seen in sarcoma botryoides (rhabdosarcoma variant)
- girls under 4 yo
- spindle shaped cells
- clear, grape-like polypoid mass emerging from vagina
Proliferation phase is driven by? What is happening during this phase?
Growth of the endometrium (functionalis layer)
Secretory phase is driven by? What is happening during this phase?
Preparation of the endometrium for implantation (secretion of products from the functionalis layer glands)
Menstrual phase is driven by? What is happening during this phase?
Decline of progesterone.
Shedding of the functionalis layer of the endometrium
What 3 conditions show up as calcifications on mammography?
- Ductal Carcinoma In Situ
- Fibrocystic change - Sclerosing Adenosis
- Fat Necrosis
BRCA1 mutation predisposes to (2)
- Female IDC - Medullary CA type
- Serous CA of the ovary or fallopian tube
BRCA2 mutation predisposes to (1)
Mutation found in LCIS and ILC?
Inhibition of E-cadherin
Retraction of the nipple is found in what 2 conditions?
- Invasive ductal carcinoma
- Periductal mastitis
2 types of choriocarcinoma and their treatments?
- Gestational Choriocarcinoma - complication of a complete mole, chemotherapy is effective
- Germ Cell Choriocarcinoma of the Ovary - malignant tumor of trophoblast cells, no villi, chemotherapy is NOT effective
Leukoplakia in males?
How does elevated beta-hCG cause hyperthyroidism and gynecomastia in males?
The alpha subunit of LH, FSH, TSH and beta-hCG is all the same
ovarian tumor marker
Positive beta-hCG in a male (3) =
- embryonal carcinoma germ cell tumor
- teratoma germ cell tumor
- choriocarcinoma germ cell tumor
What type of leiomyoma is worst?
Submucosal leiomyoma -> menometrorrhagia
Choriocarcinoma CAN/CANNOT follow a normal pregnancy?
Most important risk factor for ectopic pregnancy?
History of PID
CAH - XX with no secondary sexual characteristics
17-alpha hydroxylase deficiency
CAH - XY with salt wasting and increased 17-hydroxyprogesterone
21 hydroxylase deficiency
CAH - XX with virilization and increased 17-hydroxyprogesterone
21 hydroxylase deficiency
CAH - XX with virilization and hypertension
11-beta hydroxylase deficiency
increased beta-hCG in males = (3)
- Embryonal testicular CA (Germ cell tumor)
- Choriocarcinoma (Germ cell tumor)
- Teratoma (Germ cell tumor)
How is Leuprolide administered for infertility vs prostate cancer?
Infertility = Pulsatile
Prostate cancer = Continuous
GnRH is released from where?
Pre-optic nucleus in the hypothalamus
Cri-du-chat syndrome mutation?
Terminal deletion of the short arm of chromosome 5
Holoprosencephaly, small head, absent eyebrows, cleft lip or palate, dysplastic ears, polydactyly, decreased viability
Trisomy 13 (Patau syndrome)
Low birth weight, small mouth/jaw, shield chest, prominent occiput, dysplastic ears, clenched hand with overlapping fingers, life expectancy 1 week
Trisomy 18 (Edward’s Syndrome)
What is a robersonian translocation and what chromosomes can be affected?
Rearrangement in acrosomic chromosomes (13, 14, 15, 21, 22). Results in a centric fusion of the two long arms and the loss of the short arms. Balanced = 45 chromosomes; Unbalanced = 46 chromosomes.
female phenotype, short stature, broad chest, streak gonads, aortic constriction, bicuspid aortic valve =
Turner Syndrome (45, XO)
Male phenotype, tall stature, gynecomastia, small testis =
Kleinfelter Syndrome (47, XXY)
What is noticed first in female pubertal development?
What is noticed first in male pubertal development?
Central precocious puberty is caused by?
Premature reactivation of the HA axis. Increased secretion of GnRH results in increased sex steroids.
Peripheral precocious puberty is caused by?
Non-GnRH stimulated sex steroid secretion.
Fallopian tube epithelium = ? What are the names and functions of those cells?
Simple columnar epithelium.
Ciliated cells - beat towards the uterus
Peg cells - secrete nutrients, carbohydrates, enzymes for capacitation of sperm
Basal body temperature drops right before _
Blood supply to ovary travels in?
Suspensory ligament of the ovary (ovarian artery and vein)
Blood supply to the uterus (5)
Uterine artery -> arcuate artery (perimetrium) -> radial artery (myometrium) -> straight artery (stratum basalis - endometrium) -> spiral artery (stratum functionalis - endometrium)
Location of the cervical squamocolumnar junction 1) pre-puberty 2) post-pubrty/post-partum
1) inside the cervical os
2) outside the cervical os
Path of sperm (starting from seminiferous ducts ->-> exit)
Seminiferous tubules -> Straight tubles -> Rete testes -> Efferent tubules -> Epididymis -> Ductus Deferens -> Prostatic urethra -> Membranous urethra -> Spongy urethra -> exit
What are in seminal vesicle secretions? (3)
Which placental cells are in direct contact with maternal blood?
Which placental cells invade maternal spiral arteries?
Monozygotic twins -
1) split at 0-4 days
2) split at 4-8 days
3) split at 8-12 days
1) 2 chorions, 2 amnions
2) 1 chorion, 2 amnions
3) 1 chorion, 1 amnion
How do fraternal/dizygotic twins occur?
Two eggs are ovulated in the same cycle and are fertilized by two different sperms.
Painless bleeding the 2nd-3rd trimester?
Painful bleeding the 2nd-3rd trimester? (2)
- Placental abruption
- Uterine rupture
increase in GnRH, LH
increase in LH -> increase in androgens -> hair + acne
increased LH -> increased E
Preeclapmsia vs Eclampsia?
Preeclampsia = HTN post 20 weeks gestation + proteinuria + edema
Eclampsia = preeclampsia + seizures
epithelium of the epididymis? what are the cell types (2)?
pseudostratified columnar epithelium
When does the baby begin producing its own IgM?
Female labia majora = Male _
Male ventral shaft of penis + penile urethra = Female _
Primary oocytes are arrested in _ I/II?
Remain here until ovulation
Secondary oocyes are arrested in _ I/II?
Remain here until fertilization
Bloody nipple discharge with no associated breast changes?
- Proliferation of papillary cells in a duct/cyst with a fibrovascular core
What hormone ensures that lactation does not occur during pregnancy even though prolactin levels are rising?
Female (46 XX) newborn with ambiguous genitalia and clitoromegaly with elevated levels of androstenedione. Mother had virilization during pregnancy.
Aromatase deficiency (AR)
- Increased T, Decreased E
- Normal female internal genitalia
- Virilized external genitalia
- As she grows up, due to the lack of estrogen: primary amenorrhea, osteoporosis, tall stature
- Maternal virilization is due to the androgens crossing the placenta and affecting the mother
Similar presentation to 21 hydroxylase deficiency except for the lack of estrogen symptoms as she grows up and the lack of maternal virilization
Genetics of a partial mole
69XXX, 69 XXY, 69 XYY
Normal egg + sperm + sperm
Will see some fetal tissue
Genetics of a complete mole
Most common: 46 XX - empty egg + X sperm that duplicates
Less common: 46 XY - empty egg + X sperm + Y sperm
No fetal tissue will be present
Most common pathogen found in septic abortions?
Also might be found: E coli, Group B Strep
Septic abortion = retained products of conception in uterine cavity
Pulmonary artery branches with swirls of fetal squamous cells seen on autopsy
Amniotic fluid embolism
Often this is fatal
What cells in female ovaries secrete androgens?
Theca interna cells
-Stimulated by LH
What cells in female ovaries secrete estrogen?
Granulosa cells (contain aromatase) -Stimulated by FSH
Perineal straddle injury in men injures the _ urethra. Urine leaks into the _.
Anterior urethra - bulbar and penile
Deep fascia of Buck or Superficial perineal space
Pelvic fracture in men injures the _ urethra. Urine leaks into the _.
Posterior urethra - prostatic + membranous
ovarian mass that looks like the bladder and has coffee bean nuclei on H&E
mass of spindle shaped cells in the ovary. creates a “pulling” sensation.
Ovarian fibroma + Ascites + Hydrothorax
adolescent with an ovarian mass. sheets of uniform fried-egg looking cells on LM. increased LDH and beta-hCG.
What male testicular tumor is radiosensitive?
- never seen in infancy
- fried egg appearance of cells
- increased ALP
Proliferation of ducts in hyalinized fibrous tissue with periductal edema
Ovarian tumor: Call exner bodies + positive inhibin stain
Granulosa cell tumor
Cells found in chronic endometritis?
Plasma cells are diagnostic
Superficial inguinal ring is made out of
Deep inguinal ring is made out of
Malformation vs Deformation
Malformation = primary intrinsic defect that results in downstream effects
Deformation = structural anomalies that occur due to extrinsic forces
What 4 things does human placental lactogen do in the second half of pregnancy?
- Increases insulin resistance - increases blood glucose
- Increases proteolysis
- Increases lipolysis
- Increases insulin secretion
Painless scrotal mass + increased heat intolerance + elevated T4/T3 + normal TSH
Germ cell tumor - secretes beta-hCG
When do the syncytiotrophoblasts begin secreting beta-hCG?
Implantation and secretion begin around day 6-7 post-fertilization
@day 8 the levels can be detected in serum
@day 14 the levels can be detected in urine
CA-125 is a marker for?
Epithelial ovarian tumors
- Failure of the uterus to contract adequately post-delivery
- Most common cause of postpartum hemorrhage
- If uterus does not respond to uterotonic agents, then do surgery to ligate the internal iliac a bilateral (-> uterine artery)
There is enough collateral supply to all things that internal iliac artery gives rise to
Uncomplicated delivery 9 weeks prior. Woman presents with shortness of breath. Uterus is enlarged and beta-hCG is elevated. Chest x-ray shows multiple lung nodules bilaterally.
- Malignant proliferation of cytotrophoblasts and syncytiotrophoblasts
- Hematogenous spread to lungs - pulmonary symptoms are usually the presenting symptoms
- No villi present
Vitamin A supplementation during pregnancy - yes or no?
- In well developed countries, mothers get enough vitamin A from diet
- Excess vitamin A is teratogenic
First line treatment for vomiting and nausea in pregnancy
Vitamin B6 supplementation
4 causes of hydrops fetalis
- Parvovirus B19
- Alpha-thalassemia - HbBarts (no viable alpha gene)
Heavy menstrual bleeding + anemia + enlarged uterus + pelvic heaviness + premenopausal woman