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Reproductive > Pathology > Flashcards

Pathology Flashcards

1
Q

Klinefelter syndrome

A

Male (47,XXY) – testicular atrophy, tall/long estremities, gynecomastia, female hair distribution, azoospermia, increased FSH (dysgenesis of seminiferous tubules) and increased LH/estrogen, decreased testosterone (abnormal Leydig cell function)

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2
Q

Turner syndrome

A

Female (45, XO) – short stature, streak ovaries, no breast development, bicuspid aortic valve, preductal coarctation (femoral less than brachial pulse), lymphatic defects (webbed neck, cystic hygroma, edema in hands/feet), horseshoe kideny — MCC primary amenorrhea (no barr body) – MENOPAUSE BEFORE MENARCHE —Normal pubic hair but no breast development or menarche — missing SHOX gene (decreased bone growth) — decreased estrogen leads to increased LH and FSH — MC is paternal meiotic nondisjunction

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3
Q

Double Y males

A

XYY - very tall, severe acne, learning disability, antisocial personality disorder (extreme anger) – paternal meiosis II issue

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4
Q

True hermaphroditism

A

46XX or 47XXY – Ovarian and testicular tissue present

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5
Q

Female pseudohermaphrodite

A

XX - ovaries present but external genitalia are virilized or ambiguous – inappropriate exposure to androgenic steroids

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6
Q

Male pseudohermaphrodite

A

XY - testes present but external genitalia are female or ambiguous – MC form is androgen insensitivity syndrome

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7
Q

Aromatase deficiency

A

Masculinization of female, ambiguous genitalia, increased serum testosterone – can have maternal vilirzation (deep voice, etc.)

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8
Q

Androgen insensitivity syndrome

A

XY – defect in androgen receptor in normal appearing female – female external genitalia, rudimentary vagina, no uterus/fallopian tubes, have testes, increased testosterone/estrogen/LH, normal FSH levels

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9
Q

5a reductase deficiency

A

Autosomal recessive – no testosterone to DHT – ambiguous genitalia until puberty then testosterone can cause masculinzation – normal internal genitalia

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10
Q

Kallmann syndrome

A

Failure to complete puberty (hypogonadotropic hypogonadism) – defective migration of GnRH cells and formation of olfactory bulb – decreased GnRH synthesis in hypothalamus, anosmia – decreased GnRH/FSH/LH/test – infertility – mutation in KAL-1 gene

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11
Q

Complete hydatidiform mole

A

46XX or 46XY (complete paternal origin) – HUGE HUGE hCG levels – increased uterine size – enucleated egg with single sperm – risk for malignant trophoblastic disease (20%) – first trimester bleeding, enlarged uterus, hyperemesis, pre-eclampsia — “snow storm”, “grape clusters”, “honeycombed”

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12
Q

Partial hydatidiform mole

A

69XXX, 69XXY, or 69XYY – contains 2 sperm and 1 egg – has fetal parts – low risk of malignancy – vaginal bleeding, abdominal pain

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13
Q

Gestational hypertension

A

BP > 140/90 AFTER WEEK 20 – Tx: (a-methyldopa, labetalol, hydralazine, nifedipine)

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14
Q

Preeclampsia

A

New onset HTN with PROTEINURIA or END ORGAN DAMAGE after WEEK 20 — d/t abnormal placental spiral arteries — can cause placental abruption, coagulopathy, renal failure, eclampsia – Tx: antiHTNs, IV MgSulfate, delivery at 34 weeks

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15
Q

Eclampsia

A

Preeclampsia + SEIZURES – death d/t stroke, intracranial hemorrhage, or ARDS — IV Mg Sulfate and anti-HTNs to stabilize then IMMEDIATE DELIVERY

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16
Q

HELLP Syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets – schistocytes on blood smear – IMMEDIATE DELIVERY

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17
Q

Triple test (16-18 weeks gestation)

A

AFP - increased in dating error (MC), NTDs, abdominal wall defects - decreased in Downs —- Estriol - decreased in placental insufficiency —- hCG - increased in choriocarcinoma, hydaditiform mole

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18
Q

Placental abruption

A

Separation of placenta from uterine wall — caused by trauma, smoking, HTN, cocaine – ABRUPT, PAINFUL bleeding in THIRD trimester – possible DIC, maternal shock, fetal distress

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19
Q

Placenta accreta/increta/percreta

A

Defective decidual layer causes attachment after delivery — risk factors (prior C-section, inflammation) – accreta (attaches to myometrium), increta (into myometrium), percreta (perforates through myometrium into uterine serosa and bladder/rectum) — Postpartum bleeding (Sheehan syndrome)

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20
Q

Placenta previa

A

Attachment of placenta over internal cervical os — risk factors (prior C section, multiparity) – PAINLESS third trimester bleeding — DON’T DO A GYN EXAM!!!! (Extreme bleeding)

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21
Q

Vasa previa

A

Fetal vessels run over cervical os – vessel rupture – presents with membrane rupture, painless bleeding, fetal bradycardia — emergency C section

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22
Q

Ectopic pregnancy

A

MC in ampulla of fallopian tube (decidual endometrium with NO CHORIONIC VILLI) — history of amenorrhea, lower than expected hCG rise, sudden lower abdominal pain – commonly mistaken for appendicitis — risks (infertility, PID, ruptured appendix, prior tubal surgery)

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23
Q

Polyhydramnios

A

Fetal malformations (duodenal atresia, anencephaly – inability to swallow amniotic fluid), maternal diabetes, multiple gestations

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24
Q

Oligohydramnios

A

Placental insufficiency, bilateral renal agenesis, posterior urethral valves — Potter sequence

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25
Q

Vaginal tumors

A

SCC (secondary to cervical SCC), clear cell adenocarcinoma (exposure to DES in utero), Sarcoma botryoides (girls less than 4, spindle shaped cells and desmin +)

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26
Q

Cervical dysplasia

A

Disorder growth begins at basal layer of SC junction (transition zone) — HPV 16/18 – E6 (inhibits p53) and E7 (inhibits RB) – asymptomatic or abnormal vaginal bleeding – risks (multiple sexual partners, smoking, sex at young age, HIV infection)

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27
Q

Cervical SCC

A

Pap smear can catch koilocytes before it progresses to invasive – diagnose with colposcopy and biopsy – lateral invasion can block ureters and cause renal failure

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28
Q

Anovulation causes

A

PREGNANCY, PCOS, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, competitive athletes, Cushing syndrome, adrenal insufficiency

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29
Q

PCOS (Polycystic ovarian syndrome)

A

Hyperinsulinemia increases LH:FSH, increases androgens, and decreases rate of follicular maturation –> unrupturee follicles (cysts) and anovulation – amenorrhea/oligomenorrhea, hirsutism (hyperandrogens), acne – obesity, increased risk of endometrial cancer/atherosclerosis – MCC INFERTILITY — Tx: lose weight, OCPs, clomiphene citrate, ketoconazole, spironolactone

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30
Q

Ovarian neoplasm general info

A

MC adnexal mass in women > 55 – most malignant tumors are epithelial – increased risk with age, infertility, endometriosis, PCOS, BRCA, HNPCC – decreased risk with pregnancies, breastfeeding, OCPs, tubal ligation – CA 125 LEVELS (monitor, not screening)

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31
Q

Serous cystadenoma

A

Benign - MC ovarian neoplasm - fallopian tube like epithelium, BILATERAL

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32
Q

Mucinous cystadenoma

A

Benign - Multioculated, LARGE – lined with mucus secreting epithelium

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33
Q

Endometrioma

A

Benign - Endometriosis within ovary with cyst formation – pelvic pain, chocolate cyst, symptoms vary with menstrual cycle

34
Q

Mature cystic teratoma

A

Benign - MC in ages 20-30 – germ cell tumor – cystic mass with elements from all 3 germ layers – pain secondary to ovarian enlargement or torsion – functional thyroid tissue (hyperthyroidism)

35
Q

Brenner tumor

A

Benign - looks like Bladder – pale yellow/tan and encapsulated – coffee Bean nuclei

36
Q

Fibromas

A

Benign - bundles of spindle shaped fibroblasts – associated with Meigs syndrome

37
Q

Thecoma

A

Benign - may produce estrogen – abnormal uterine bleeding in postmenopausal women

38
Q

Immature teratoma

A

Malignant - AGGRESSIVE - contains fetal tissue, neuroectoderm

39
Q

Granulosa cell tumor

A

Malignant – MC malignant stromal tumor – women in 50s – make estrogen/progesterone and have abnormal uterine bleeding, breast tenderness – Call Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid)

40
Q

Serous cystadenocarcinoma

A

Malignant - psammoma bodies - BILATERAL

41
Q

Mucinous cystadenocarcinoma

A

Malignant - Pseudomyxoma peritonei-intraperitoneal accumulation of mucinous material

42
Q

Dysgerminoma

A

Malignant - MC in adolescents – uniform fried egg cells – hCG and LDH (tumor markers)

43
Q

Choriocarcionoma

A

Malignant - during/after pregnancy in mom or baby – trophoblastic tissue (no chorionic villi) – abnormal increase in BhCG, shortenss of breath, hemoptysis – spreads to lungs

44
Q

Yolk sac tumor

A

Malignant - AGGRESSIVE - MC tumor in male infants (in ovaries/testes) – yellow, friable mass – Schiller-Duval bodies (look like glomeruli) – AFP tumor marker

45
Q

Endometrial polyp

A

Well circumscribed - endometrial tissue in uterine wall

46
Q

Leiomyoma (fibroid)

A

MC tumor in females (increased in blacks) – often have multiple discrete tumors – BENIGN smooth muscle tumor – increase size with pregnancy, decrease with menopause – MC in age 20-40 – asymptomatic, uterine bleeding, or miscarriage – can cause iron deficiency anemia – WHORLED smooth muscle bundles

47
Q

Adenomyosis

A

Endometrial tissue in uterine myometrium – hyperplasia of basal layer of endometrium – dysmenorrhea, menorrhagia – Tx: GnRH agonist, hysterectomy

48
Q

Endometriosis

A

Endometrial tissue outside endometrial cavity – MC sites (ovary, pelvis, peritoneum) – chocolate cyst in ovary – d/t retrograde flow, or metaplastic transformation – cyclic pelvic pain, dyspareunia, infertility, dyschezia – Tx: NSAIDs, OCPs, progestins, GnRH agonists, danazol, lap removal

49
Q

Endometritis

A

Endometrial inflammation – retained products of conception or foreign body – infection by bacterial flora from vagina or GI tract (mixed flora - Bacteroides) – Tx: Gentamicin plus clindamycin

50
Q

Endometrial hyperplasia

A

Abnormal endometrial gland proliferation d/t excess estrogen – increases cancer risk – PM vaginal bleeding – risks (anovulatory cycles, PCOS, hormone replacement, granulosa cell tumor)

51
Q

Endometrial carcinoma

A

MC gyn malignancy – peak at age 55-65 – vaginal bleeding — preceeded by endometrial hyperplasia – risks (prolonged estrogen use, obesity, DM, HTN, nulliparity, late menopause, Lynch)

52
Q

Fibroadenoma

A

Benign - small, mobile, firm mass with sharp edges in breast stroma – MC tumor in women less than 35 — increase size and tenderness with increased estrogen – NOT PRECANCEROUS

53
Q

Intraductal papilloma

A

Benign - small tumor in lactiferous ducts – MCC bloody nipple discharge

54
Q

Phyllodes tumor

A

Benign – large, bulky tumor with leaf like projections in stroma of breast

55
Q

Proliferative breast disease

A

Lumpy, bumpy breast from age 25 to menopause – fluctuation in size of mass – common in upper outer quadrant – can be fibrosis, cystic, sclerosing adenosis (calcification), or epithelial hyperplasia (terminal duct lobule, increased risk of cancer)

56
Q

Lactational mastitis

A

During breastfeeding – infection through cracks in nipple - S. aureus is most common - Tx: Dicloxacillin

57
Q

Fat necrosis

A

Benign, painless lump – injury to breast tissue – abnormal calcifications on mammography – necrotic fat and giant cells

58
Q

Gynecomastia

A

Hyperestrogenism in males, Kleinfelter, drugs — Some Drugs Create Awesome Knockers (Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole)

59
Q

Malignant breast tumor general info

A

Mostly postmenopausal – terminal duct lobular unit — ER or PER receptors, HER2/neu (c-erbB2) receptor – Triple negative is most aggressive (more in African Americans) – axillary lymph node involvement is most important prognostic factor – upper outer quadrant – risks (increased estrogen exposure, increased total menstrual cycles, older age at 1st birth, obesity, BRCA) — nipple retraction (infiltration of suspensory ligaments), orange skin (blocked lymphatics)

60
Q

Ductal carinoma in situ

A

Fills ductal lumen – microcalcifications on mammography

Comedocarcinoma is subtype of DCIS – ductal, central necrosis

61
Q

Paget disease

A

Underlying DCIS or invasive breast cancer – eczematous patches on nipple – large cells in epidermis with clear halo

62
Q

Invasive ductal carcinoma

A

Firm, fibrous, rock hard mass with sharp margins – “stellate” infiltration) – MC (worst and most invasive)

63
Q

Invasive lobular carcinoma

A

Orderly row of cells (Indian file) – decreased E-cadherin expression – often bilateral

64
Q

Medullary breast carcinoma

A

Lymphocytic infiltrate – GOOD PROGNOSIS

65
Q

Inflammatory breast carcinoma

A

Dermal lymphatic invasion – peau d’orange

66
Q

Peyronie disease

A

Fibrous plaque in tunica albuginea so abnormal curvature of penis – surgical repair

67
Q

Priapism

A

Painful sustained erection lasting > 4 hours – trauma, sickle cell disease, medications – Tx: corporal aspiration, intracavernosal phenylephrine, or surgery

68
Q

Squamous cell carcinoma of penis

A

Precursors are Bowen disease (shaft leukoplakia), erythroplasia of Queyrat (glans), Bowenoid papulosis (reddish papule) — associated with HPV, lack or circumcision

69
Q

Cryptorchidism

A

Undescended testis – impaired spermatogenesis d/t temperature damage of sertoli cells – normal testosterone levels (Leydig cells unaffected) – increased risk of germ cell tumors – decreased inhibin, increased FSH/LH

70
Q

Varicocele

A

Dilated veins in pampiniform plexus due to incrased venous pressure – on LEFT SIDE – “bag of worms” – infertility d/t increased temperature – Tx: varicocelectomy

71
Q

Hydrocele

A

Congentital (scrotal swelling in infants d/t incomplete obliteration of processus vaginalis) — Acquired (scrotal fluid collection d/t infection, trauma, tumor) – TRANSILLUMINATE

72
Q

Spermatocele

A

Cyst due to dilated epididymal duct

73
Q

Testicular germ cell tumor risks

A

MC in young men – risks are cryptorchidism and Klinefelter syndrome — TESTICULAR MASS THAT DOESN’T ILLUMINATE = CANCER!!!! (95% germ cell)

74
Q

Seminoma

A

Malignant, painless, homogenous testicular enlargement — MC tumor – large cells in lobules with watery cytoplasm and fried egg cells — increased placental ALP – RADIOSENSITIVE!

75
Q

Yolk sac tumor

A

Yellow, mucinous – Schiller Duval bodies – increased AFP – MC in boys less than 3

76
Q

Choriocarcinoma

A

Malignant, increased hCG (abnormal syncytiotrophoblasts and cytotrophoblasts) – hematogenous mets to lungs and brain – gynecomastia and hyperthyroidism in men (testicular germ cell) or vaginal bleedinga nd uterine enlargement in women (common after hydaditiform mole, abortion, or pregnancy)

77
Q

Teratoma

A

Mature teratoma in adult males can be malignant, benign in children – increased hCG and/or AFP

78
Q

Embryonal carcinoma

A

Malignant, hemorrhagic mass with necrosis, painful – glandular/papillary morphology – MC mixed with other tumor types – increased hCG and normal AFP levels when pure

79
Q

Non-germ cell tumors

A

Leydig cell (Reinke crystals, produce androgens, golden brown color) – Sertoli cell (androblastoma) – testicular lymphoma (MC testicular cancer in older men)

80
Q

Benign prostatic hyperPLASIA

A

Men > 50 – firm nodular enlargement of PERIURETHRAL lobes (compress urethra into vertical slit) – NOT A PRECURSOR TO CANCER – increased frequency of urination, dysuria, distention and HYPERTROPHY of bladder – Tx: a-antagonists (terazosin, tamsulosin), 5a reductase inhibitors (finasteride), PDE-5 inhibitors (sildenafil)

81
Q

Prostatitis

A

Dysuria, frequency, urgency, low back pain – young (Chlamydia or gonorrhea) – old (pseudomonas)

82
Q

Prostatic adenocarcinoma

A

Men > 50 – POSTERIOR LOBE (peripheral zone) – increased PSA – OSTEOBLASTIC to vertebrae, ribs, and pelvis – increased serum ALP and decreased Calcium

Reproductive (5 decks)

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