REPRODUCTIVE Flashcards
(262 cards)
1
Q
What is a theca-lutein cyst?
A
They are cysts due to gonadotropin (hCG) stimulation and may be associated with choriocarcinoma and moles
1
Q
T/F: both cervical SCC and adenocarcinoma are related to HPV
A
true
2
Q
Discuss how estrogen is synthesized in the ovaries
A
GnRH leads to LH and FSH secretion. LH stimulates desmolase in theca cells to convert cholesterol to androsteinedione; Androstienedione goes from theca cell to granulosa cell where FSH stimulates aromatase to convert androsteinedione to estrogen
2
Q
Differentiate the lining of a mucinous cystadenoma from that of a serous cystadenoma
A
Serous = more like fallopian tube; Mucinous = more like intestine (both are ovarian tumors)
2
Q
What is the most common overall of a “breast lump”?
A
Fibrocystic change
2
Q
Which testicular cancer has Reinke crystals?
A
Leydig cell tumor
3
Q
What is the way to tell by biopsy that there is endometrial hyperplasia?
A
The glands are numerous and they are jam-packed together
3
Q
2 causes of acute prostatitis in young adults; 2 in old adults; WHAT SHOULD YOU PROBABLY PICK???
A
Young = C. trachomatis and N. gonorrhea; Old = E. coli and P. aeruginosa; In general, probably E. coli
4
Q
What is the age group for benign and malignant surface epithelial tumors of ovary?
A
Benign i.e. serous and mucinous adenomas more in young women; Malignant i.e. serous and mucinous cystadenocarcinomas more in older women
5
Q
Which ovarian tumor increases the risk of endometrial carcinoma?
A
Granulosa cell tumor because it secretes estrogen
5
Q
Which breast cancer is often bilateral with lesions in the same location?
A
Invasive lobular carcinoma (indian filing)
5
Q
Secondary amenorrhea due to loss of basalis from scarring? Most likely cause?
A
Asherman Syndrome; overaggressive D/C
6
Q
Which 4 structures is testosterone responsible for the differentiation of?
A
Seminal Vesicles; Epididymis; Ejaculatory duct; Ductus deferens
6
Q
What is the classic finding in the blood vessels of maternal-fetal interface in ecclampsia?
A
Fibrinoid necrosis
7
Q
What gene mutations increase the risk for malignancies of breast?
A
BRCA1 and BRCA2; tumor suppressor genes
7
Q
What is the precurosor lesion of DCIS?
A
Ductal hyperplasia
8
Q
Which testicular tumor can cause precocious puberty? Which 2 cause gynecomastia?
A
Leydig cell; Choriocarcinoma and Leydig cell
9
Q
What does E7 do?
A
Inhibits Rb (mostly from HPV 17)
9
Q
Name 6 ovarian cysts
A
Follicular cyst, Theca-Lutein Cyst, Corpus luteum cyst, Endometrioid cyst, Hemorrhagic cyst, and Dermoid cyst (mature teratoma)
9
Q
Name 2 pathologies of breast stroma
A
Fibroadenoma, Phyllodes tumor
10
Q
What are the expected findings for LH, FSH, Testosterone, and Estrogen in PCOS?
A
LH increased, FSH decreased, Testosterone increased (because more LH than FSH), Estrogen increased from adipocyte aromatization (increased risk of endometrial CA)
11
Q
Which forms of estrogen are from 1) ovary 2) placenta 3) adipose (rank strength)
A
1) 17-beta estradiol 2) estriol 3) estrone (Estradiol > Estrone > Estriol)
12
Q
This is SCC in situ on the penis presenting as leukoplakia on shaft or scrotum
A
Bowen disease
13
Q
What reproductive pathology is treated with gentamycin, clindamycin and possible ampicillin?
A
Endometritis? This is inflammation of the endometrium assoc. with retained products of conception and possibly from the intestinal tract (bacteroides)
13
Which is a risk factor for endometrial carcinoma, nulliparity or multiparity?
Nulliparity
13
What is the general key risk factor for ectopic pregnancy?
SCARRING i.e. endometriosis or PID
14
What effects can cocaine have on a fetus?
Placental abruption (squeezing of vessels) and intrauterine growht restriction
16
Discuss the relationship between estrogen and prolactin in pregnancy
Estrogen is high in pregnancy (most from placental estriol), this leads to secretion of prolactin; however, the action at the breast is blocked. So the idea is to get prolactin out but to wait unti after pregnancy is done to really get milk production going!
17
Anemia in leiomyoma
Fe deficient anemia due to bleeding
17
What is a hydrocele
failed closure of processus vaginalis
18
What are the levels of testosterone and LH if there is a testosterone secreting tumor or use of exogenous steroids?
LH decreased; test increased
19
What is oligomenorrhea and polymenorrhea?
Oligomenorrhea is when there are long cycles (more than 35 d); Polymenorrhea is when there are short cycles (less than 21 d)
19
Signet ring adenocarcinoma of the ovary
Krukenberg tumor from GI met
21
T/F: testosterone production is temperature dependent
False; Leydig cells continue to produce testosterone but Sertoli cells are temperature sensitive and decrease sperm production because they will secrete less ABP
21
What are the levels of testosterone and LH if there is hypogonadotropic hypogonadism?
Both decreased
21
Which breast cancer has indian filing?
Invasive lobular carcinoma (often bilateral in same location)
22
What causes a complete mole vs. partial mole?
Complete mole = 2 sperm fertilizing an empty egg; Partial mole = 2 sperm fertilizing 1 egg
23
What is the histology of ectocervix and endocervix? What if there is endocervix in the vagina?
Ecto = SSNKE; Endo = simple columnar; Vaginal adenosis prob from DES exposure in utero, increases risk of clear cell CA of vagina
23
Where does the lower vagina come from? Upper?
Lower = urogenital sinus; Upper = paramesonephric ducts
25
What effect does progesterone have on gonadotropins?
Inhibits LH and FSH, and decreases estrogen receptor expressivity
25
Name 1 pathology of the terminal duct of breast
Tubular carcinoma
26
When does implantation occur? When is hCG first detectable?
6 days after fertilization; hCG is detectable essentially at the same time, i.e. within a week of fertilization
27
Which hormone is maintained by hCG?
Progesterone
28
Why is obesity a risk factor for endometrial carcinoma
Estrone can be produced in adipose tissue
29
Which structure contains the artery of sampson?
Round ligament of the uterus
29
Whorled pattern of smooth muscle bundles
Leiomyoma
29
What is SCC of penis associated with?
HPV (failure to circumcise)? Africa, Asia, South America
29
What is the sequelae of lymphogranuloma venereum in the asshole?
Rectal stricture (L1-L3)
29
Why can choriocarcinoma lead to hyperthyroidism?
Alpha subunit of hCG is same as TSH (and LH and FSH)
31
Which cells secrete inhibin? Function?
Inhibin is secreted by sertoli cells and inhibits FSH release; this does not affect testosterone synthesis by Leydig cells but will decrease spermatogenesis since FSH stimulates Sertoli cells
32
What are 2 indications that a ovarian teratoma may be malignant?
If either it is an immature teratoma which may have a neural malignancy OR if it is mature but one of the tissues it formed became cancerous i.e. SCC
33
Tumor marker for dysgerminoma?
LDH
34
4 risk factors for endometrial hyperplasia
Anovulatory cycles (unopposed estrogen), Hormone replacement (excess estrogen), PCOS (excess estrogen from aromatization of testosterone), and granulosa cell tumor (produces estrogen)
35
Where in the female reproductive tract will you find simple cuboidal epithelium?
Germinal epithelium of the ovary
35
What is the long name for HER2 neu?
c-erbB2
35
What is the worst cancer of testes?
Embyronal cell carcinoma
36
What is vagina adenosis? What is adenomyosis?
adenosis is endocervical tissue (simple columnar) in vagina (DES); Adenomyosis is endometrium in myometrium
36
What 2 stains can be used for rhabdomyoblasts in sarcoma botryoides?
Desmin, myogenin
37
What is the histology of testicular choriocarcinoma? Mets to where?
Distinguished cytotrophoblastic and syncytiotrophoblastic elements; mets to lungs
38
What are the 4 general types of ovarian germ cell tumors?
Dysgerminomas (Turner), Choriocarcinoma, Yolk Sac tumor, Teratomas (mature, immature, struma ovarii)
39
Why is FSH elevated in Klinefelter's?
There is fibrosis of seminiferous tubules so there is less inhibin
40
What causes the increase in temperature during ovulation?
Progesterone
41
Which ovarian tumor can cause precocious puberty?
Granulosa cell tumor because it secretes estrogen (Call Exner bodies pathognomonic)
42
What is the pathognomonic feature of endodermal sinus tumors? Tumor marker?
Schiller duval body (glomeruloid structure); AFP
43
What is pseudomyxoma peritonei? What cancer is associated?
intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor; mucinous cystadenocarcinoma
44
How is emission different from ejaculation?
Emmision involves contracting seminal vesicles and internal structures and is sympathetic-mediated (hypogastric nerve)? Ejaculation is from SKM contraction via the pudendal nerve
44
What is the cause of preeclampsia and ecclampsia?
Placental ischemia due to impaired vasodilation of spiral arteries that leads to increased vessel tone
44
Yolk sac tumors are common in the ovaries and testes of children, where else might they be found?
Sacrococcygeal area (AFP, also in hepatocellular carcinoma)
44
What is a phyllodes tumor?
bulky mass of connective tissue and cysts, rarely can become malignant
45
Yellow-brown gunpowder nodules
endometriosis implants
45
What are the 3 cell types (BASIC) of ovaries?
Cell surface, Germ cells (oocyte, PGC), and sex-cord stroma
46
What should you think for a histology of "fried egg" in 1) Brain 2) Heme 3) Testicle
1) oligodendrocyte 2) neoplastic plasma cell in multiple myeloma 3) seminoma
46
Germ cell tumors produce things that germ cells would normally make! What is it called when there is 1) Fetal tissue 2) Oocyte 3) Yolk sac 4) Placental tissue? Which MALIGNANCY has the best prognosis and why?
1) Cystic teratoma 2) Dysgerminoma 3) Endodermal sinus tumor 4) choriocarcinoma (Dysgerminoma is the most like oocyte = well differentiated = best prognosis)? Cystic teratoma not malignant usually
46
What cysts may form in the presence of a choriocarcinoma? Why?
Theca lutein cysts since it is malignant trophoblast it is secreting B-hCG which is normally meant to maintain the corpus luteum, this causes a large corpus leteum = theca lutein cyst
47
How do you Dx varcocele? Tx?
US; Tx is varicocelectomy or embolization
48
During which 2 female surgeries is the ureter at risk?
Oopherectomy when ligating the ovarian arteries in the suspensory ligament of the ovary; In hysterectomy when ligating the uterine arteries in the cardinal ligament
48
What happens to a leiomyoma in pregnancy?
Gets bigger because it is estrogen sensitive
48
10 common causes of anovulation
Pregnancy, PCOS, Obesity, HPO axis abnormality, premature ovarian failure, hyperprolactinemia (CT of head); thyroid disorder; eating disorder (anorexia shuts down GnRH), Cushing's, and adrenal insufficiency
48
What is a serous cystadenocarcinoma?
A malignant non germ cell tumor of ovaries with psammoma bodies
48
What is the worst and most common breast cancer?
Invasive ductal carcinoma (worst one)
49
What is retained placental tissue?
exactly what it fucking sounds like; increases risk of hemorrhage and infection
50
How much of the epithelium is involved in CIN 1; CIN2; CIN 3?
1) less than one third 2) 2 thirds 3) almost full thickness? Full thickness is carcinoma in situ
51
Name 5 drugs that cause gynecomastia
Ketoconazole, Alcohol, Spironolactone, Digitalis, and Cimetidine (Marijuana and Heroin as well)
52
What increases the risk of placenta previa and why?
C section and multiparity because it cant find a good spot higher up in the uterus to implant due to scarring etc.
53
What determines the prognosis of a mixed germ cell tumor?
The worst component
54
What is the most common type of invasive cervical carcinoma?
SCC
55
What causes endometrial hyperplasia?
Excess (unopposed) estrogen stimulation
55
Why is metformin often given to PCOS pts?
Because it is associated with insulin resistance
56
What is the most common pathogen in acute mastitis?
S. aureus (however, supposedly if it spreads far then S. pyogenes because that is basically cellulitis, but if it is more abscess-like, think S. aureus)
58
What is the deal with ambiguous genitalia in 5 alpha reductase deficiency?
They are ambiguous until puberty because 5 alpha reductase is responsible for their initial development, but testosterone is responsible for the growth spurt of puberty; Thus, they will be essentially normal after puberty
59
Menorrhagia, dysmenorrhea, dyspareunia with normal sized uterus
Endometriosis
61
What should you consider if there is menopause before age 40?
Premature ovarian failure
63
How can cervical cancer cause renal failure?
It can invade laterally into the ureters leading to post-renal azotemia with hydronephrosis and renal failure
63
Which is associated with an increased risk of SCC: lichen simplex chronicus or lichen sclerosis? Which is post-menopausal?
Lichen sclerosis involves increased risk of SCC (non-HPV vulvar SCC)and is post-menopausal, the epidermal thinning is due to the hormonal changes (i.e. atrophy)
64
Most common site of endometriosis
ovary
66
How can you Dx ectopic pregnancy based on hCG?
The hCG is lower than that expected for dates
67
What is the most common casue of acute prostatitis? Chronic?
E. coli; chronic abacterial prostatitis is the most common type of chronic prostatitis
68
How do you treat adenomyosis?
Hysterectomy (endometrial glands in myometrium)
69
Which testicular tumors have elevated hCG?
Choriocarcinoma (gynecomastia); and teratomas (has hCG and or AFP), embryonal carcinomas when pure
69
What is an endodermal sinus tumor trying to do?
It is a germ cell tumor that is "trying" to make yolk sac! AFP levels checked and there are Schiller Duval bodies
70
Which testicular tumor has placental alkaline phosphatase?
Seminoma, though, you would think it would be choriocarcinoma (radiosensitive, fried egg appearance)
72
What is the best test to confirm that a person is in menopause?
Elevated FSH due to loss of negative feedback from estrogen, which is decreased
73
What are the 3 major non-germ cell tumors you find in testes?
Leydig cell tumor; Sertoli cell tumor; Testicular lymphoma
75
What is the major risk of placenta accreta after delivery?
Often placenta does not dissociate from endometrium and causes a massive bleed
76
How do you know if a testicular embryonal cell carcinoma is mixed or pure?
Mixed has both hCG and AFP; pure is hCG only? pure ones are rare
77
No detachement of placenta after birth
Likely a placenta accreta
78
Where will you find an intraductal papilloma? Risk?
Beneath the areola in the lactiferous ducts; increased risk of carcinoma
80
What is the function of the suspensory ligament of the ovary?
anchors the ovaries to the pelvic walls and contains the ovarian artery
82
How does testosterone close the epiphyseal plates?
It doesnt, it is converted to estrogen which closes the epiphyseal plates (note precocious puberty can ultimately lead to earlier closure of epiphyseal plates despite a quick growth spurt)
83
What does E6 do?
Inhbits p53 (mostly from HPV 16)
85
What are the expected estrogen, LH, and FSH levels in premature ovarian failure? What is the age criteria?
Low estrogen with high FSH and LH; signs of menopause before 40
86
What is a Call-Exner body? What CA?
small follicles filled with eosinophilic inclusions; non germ cell tumor of ovary = Granulosa cell tumor
87
Which phase of the menstrual cycle is a constant 14 days?
Luteal phase
89
Which cells form the blood-testis barrier?
Sertoli cells
90
How quickly does fertilization occur after ovulation?
In the ampulla within 24 hrs
90
What are the major associations of serous cystadenocarcinomas and mucinous cystadenocarcinomas?
Serous = psammoma bodies; Mucinous = pseudomyxoma peritonei
90
What is the prognosis for chemotherapy in choriocarcinoma arising as a germ cell tumor? As a hydatidiform mole? (IN WOMEN)
If as a germ cell tumor it is poor prognosis; If from hydatid mole it is excellen prognosis
92
Which female cells are stimulated by LH and FSH for estrogen synthesis?
LH = theca cell (desmolase convert cholesterol to androsteinedione); FSH = granulosa cell (aromatase converts androsteinedione to estrogen)
93
Which ovarian tumor is most likely to have psammoma bodies?
Cystadenocarcinoma (non-germ cell)
94
What is Meig's syndrome?
ovarian fibroma, ascites, and hydrothorax
96
What cancer is associated with Turner's?
Dysgerminoma
96
What are the testosterone and LH levels if there is a defective androgen receptor in a male?
Both increased
97
What is Mittelschmerz? Which hormone would most directly cause it?
Mittelschmerz is when blood from a ruptured follicle causes pain in the peritoneum? LH is responsible for follicular rupture (ovulation)
98
What aspect of HPV determines whether the lesion is high grade or low grade?
DNA sequence? The nomenclature of HPV types is based on DNA sequence
100
What is the most common type of ovarian germ cell tumor? 3 subtypes?
Mature teratoma (dermoid cyst); immature teratoma (more malignant); Struma ovarii has functional thyroid tissue and presents with hyperthyroidism
101
What are the sex cord stromal tumors of men?
Leydig cell tumors (Reinke crystals); Sertoli cell tumor (androblastoma)
103
What is the Tx of endometriosis (4)
Oral contraceptives, continuous leuprolide, NSAIDs and danazol (acts as partial agonist at androgen receptors)
104
Which testicular tumor causes precocious puberty in males? Which ovarian tumor causes precocious puberty in girls? What inclusions will you find (HIGH YIELD)
Leydig cell tumor (Reinke crystals); Granulosa cell tumor (Call-Exner bodies)
105
Where are meiosis I and II arrested in oogenesis?
Meiosis I = prophase I; Meiosis II = metaphase II
106
Name 3 tumors of vagina
SCC (usually from extension of cervical SCC), Clear cell (from DES), Rhabdomyosarcoma botyroides (in young girls, desmin positive)
107
Which 3 vulvar lesions present as leukoplakia, which increases risk of non-HPV vulvar carcinoma?
Vulvar carcinoma most often from HPV; Lichen simplex chronicus; Lichen sclerosis increases risk of non-HPV vulvar CA
108
Name 3 pathologies of the lactiferous sinus
Intraductal papilloma, breast abscess, mastitis
109
What is the inhibin level in cryptorchidism?
low because Sertoli cells are temperature dependent. FSH is high as are LH and test. However, if bilateral, test is low
110
Painful bleeding in 3rd trimester
likely abruptio placentae
111
Which breast CA has a classic stellate morphology?
Invasive ductal carcinoma (worst one)
111
Treatment of which testicular cancer with chemotherapy may result in differentiation into another cancer?
Embryonal cell carcinoma
112
Why is estriol an important marker of fetal wellbeing?
Estriol is the estrogen produced by the placenta; high estriol indicates that the placenta is developing properly!
113
Which mole has fetal parts?
Partial mole because it has 2 sperm and 1 egg; since complete mole is just 2 sperm with empty egg, no fetal parts develop
114
If endometritis is particularly foul smelling what is the probable organism?
Bacteroides; this is the most common organism in endometritis
115
What is the cause of peau d orange?
Neoplastic cells of breast invade lymphatics
116
Define Preeclampsia and eclampsia
Preeclampsia = hypertension, proteinuria, edema; Ecclampsia = hypertension, proteinuria, edema AND SEIZURES
117
What is a Brenner tumor?
Benign ovarian tumor that looks like bladder and has coffee bean nuclei
118
Meig's syndrome involves an ovarian tumor made of \_\_\_\_\_\_\_\_\_\_
fibroblasts; fibroma
120
Name 2 pathologies of the major duct (in breast)
Fibrocystic change, ductal cancer
121
Best way to differentiate a mucinous cystadenocarcinoma from a Krukenberg tumor on clinical exam?
Krukenbergs are usually bilateral
123
What happens after delivery if a woman has uterine atony?
BLEEDING because the uterus doesnt clamp down on the spiral arteries
124
Name 2 noninvasive breast cancers
DCIS and comedocarcinoma (subtype of DCIS with caseous necrosis)
125
What is conspicuously absent from ovarian choriocarcinoma?
Chorionic villi
126
Which bacteria cause orchitis in young adults? Old adults? Which virus can do it? What other visceral problem?
Young = C. trachomatis (D-K) and N. gonorrhea; Old = E. coli, P. aeruginosa; Virus = mumps can also cause pancreatitis
127
Differentiate the layers affected by lichen sclerosis and lichen simplex chronicus
lichen sclerosis is thinning of epidermis with fibrosis of dermis; Lichen simplex chronicus is thickening of epidermis
128
What is the Tx of a hydatidiform mole?
D/C with methotrexate
130
How do you treat preeclampsia/ecclampsia?
DELIVER BABY AS SOON AS IT IS VIABLE; until then you can treat siezures with MAGNESIUM SULFATE
132
What hormonal changes occur in menopause for 1) Estrogen 2) FSH 3) LH 4) GnRH
1) decreased 2) heavily increased 3) increased 4) increased
133
What is the function and control of desmolase in theca cells?
Under control of LH, desmolase converts cholesterol into androsteinedione which then goes to granulosa cells to be aromatized to estrogen under FSH control
134
How do ovarian epithelial tumors spread?
locally into peritoneum (monitor with CA-125, makes sense)
136
Where are the testes found in androgen insensitivity syndrome? Levels of LH and testosterone?
in the labia majora; both are elevated
137
Name 2 tumor markers for prostatic adenocarcinoma?
Prostate specific antigen; Prostatic acid phosphatase
138
What is DHT responsible for later in life?
Balding, Prostate growth, sebaceous glands
138
Which ovarian tumor has bundles of spindle shaped fibroblasts?
Fibroma (assoc. with Meig's syndrome)
139
Which testicular tumor is also called an androblastoma?
Sertoli cell tumor
141
What other syndrome is often associated with preeclampsia?
HELLP; Hemolysis, elevated liver enzymes, low platelets
143
What is the pathognomonic feature of granulosa cell tumors?
Call Exner bodies (these are non germinomas)
144
What is another name for CIN 3?
Carcinoma in situ
145
What is a Paget Cell?
large cell in epidermis with clear halo (suggests underlying DCIS)
147
What are the general effects of estrogen and progesterone on the endometrium, i.e. what is the point?
Estrogen stimulates growth of the endometrium for pregnancy and progesterone maintains it and allows for thick mucus and spiral artery development
148
What 2 prophylactic surgeries are often done in BRCA1 carriers?
Salpingoopherectomy and prophylactic mastectomy (no hysterectomy!!!)
149
What is the most common germ cell tumor overall in women? #2?
Cystic teratoma (benign usually), Dysgerminoma (good prognosis)
150
How is a Brenner tumor classified?
Benign (usually) tumor of ovarian surface epithelium (bladder like epithelium)
152
What are the tumor markers for choriocarcinoma, dysgerminoma and yolk sac tumors?
Choriocarcinoma = hCG; Dysgerminoma = LDH and hCG; Yolk sac tumor = AFP
154
What effect does estrogen have on lipoprotein levels?
Increases HDL and lowers LDL which is why they are protected from atherosclerosis
156
What is a corpus luteum cyst?
Hemorrhage into a persistent corpus luteum
157
What is seen on endometrial Bx in ectopic pregnancy?
decidualized endometrium without chorionic villi! These can only be present in an intrauterine pregnancy
158
Name 5 germ cell tumors of the testes
Seminoma (like dysgerminoma in female), Embryonal carcinoma, Choriocarcinoma, Teratoma, Yolk sac tumor
159
What is the most common cause of a theca lutein cyst?
usually a mole or choriocarcinoma due to excessive hCG stimulation of the corpus luteum
160
What is the purpose of the following in PCOS 1) Medroxyprogesterone or OCPs 2) Spironolactone 3) Clomiphene 4) Metformin
1) decreases LH and therefore androgenesis 2) decreases acne and hirsutism by inhibitng steroid binding 3) a SERM for women who want to become pregnant 4) because there is often insulin resistance
161
Which hormone drives the growth of the endometrium?
Estrogen (progesterone just "prepares" it and maintains it, and the loss of progesterone support = death of corpus luteum = menstruation)
162
T/F: cervical carcinoma is an AIDS defining illness
true
163
What disinhibits lactation after pregnancy?
The drop in progesterone
164
What are the expected LH and FSH levels in Turner's?
Both elevated due to a low estrogen from streak ovaries
166
What causes a fibroadenoma to grow? To cancer?
Estrogen; there is no increased risk of converting to cancer, it is not a precursor
167
What is a follicular cyst?
Distention of an unruptured Graafian follicle (assoc. with hyperestrinism and endometrial hyperplasia)
168
What is a spermatocele?
Dilated epididymal duct
169
What is the difference between spontaneous abortion and intrauterine fetal demise?
SA = before 20 weeks IUFD = after 20 weeks
170
Which chromosomal abnormality increases the risk of male germ cell tumors?
Klinefelter (XXY)
171
Why are there cysts in PCOS?
Because the high estrone produced in adipose from aromatization of androgens to estrone decreases FSH, since FSH stimulates granulosa cells this leads to a cystic degeneration of follicles
172
What is the issue in Kallman syndrome?
Defective migration of GnRH cells and a lack of olfactory bulb development
174
What is the most common gynecologic cancer in the U.S.? Worldwide? Why?
Endometrial CA; Cervical CA; we use the pap smear
174
Which breast cancer has a good prognosis?
Medullar carcinoma
175
Which ovarian germ cell tumor contains sheets of uniform cells and is the equivalent of the male seminoma? Tumor markers (2)?
Dysgerminoma (LDH, hCG); this is a more common tumor in males (seminoma, that is)
176
Name 2 pathologies of the nipple
Breast abscess, Paget's disease of breast (assoc. with underlying DCIS)
177
What is comedocarcinoma?
subtype of DCIS (therefore, noninvasive) that has caseous necrosis
178
Where is aromatase found in a male? 2 inhibitors of?
It is found in Leydig cells and adipose and converts test and androsteinedione into estrogen; exemestane and anastrazole
179
What (specifically) is a pap smear trying to scrape?
Transformation zone between the ectocervix and endocervix
181
Which HPV has E6 which has E7? What do these do?
16 has E6 = inhibits p53; 17 has E7 = inhibits Rb
182
Which androgens are produced by the testis? The adrenals?
Testosterone and Dihydrotestosterone; Androsteinedione
182
Which tumor has coffee bean nuclei?
Brenner tumors of the ovary (bening bladder like tumor)
183
Elevation of what hormone is indicative of ovulation?
Progesterone
184
What is the most common ovarian mass in young women?
Follicular cyst? this is distention of an unruptured Graafian follicle
185
What are the two pathways that lead to endometrial carcinoma?
Hyperplasia pathway = arises from endometrial hyperplasia; Sporadic = arises from atrophic endometrium and has psammoma bodies (usually papillary and serous)
187
Which testiculuar tumor is radiosensitive? Marker?
Seminoma (placental alkaline phosphatase)
188
What are the 3 sex cord stromal tumors? Buzz words?
1) Granulosa-Theca cell tumor (Call-Exner bodies) 2) Sertoli-Leydig cell (Reinke crystal in Leydig) and 3) Fibroma (Meig's syndrome)
190
What genetic disease can cause priapism?
Sickle cell anemia, sickled RBC's get stuck in vascular channels
191
What effects can phenytoin have on a fetus?
Digital hypoplasia and cleft lip and palate
192
Why does anovulatory cycle lead to bleeding?
You never ovulate = never get a corpus luteum = no progesterone. So you just get growth on top of growth and that leads to overgrowth of blood supply
194
Which type of malignant breast cancer can cause CASEOUS NECROSIS?
Comedocarcinoma (a noninvasive one)
195
What determines prognosis of endometrial carcinoma?
how far into the myometrium it has invaded
196
What is the most common trisomy leading to spontaneous abortion?
Trisomy 16
197
Which testicular tumor has Schiller Duval bodies? Marker?
Yolk sac tumor; AFP
199
How do you treat endometritis?
Gentamycin and Clindamycin with possible ampicillin
200
Bacterial infection due to retained products of conception
Acute endometritis (bacteroides very common)
202
Name 2 pathologies of the lobules of the breast
Lobular carcinoma and sclerosing adenosis
203
What is a serous cystadenoma?
A bening tumor of ovaries lined by fallopian tube-like lining
204
What is BPH?
Benign prostatic HYPERPLASIA (NOT hypertrophy)
205
Which cervical cancer is not picked up by pap smear?
Cervical adenocarcinoma
206
What is the function and control of aromatase in granulosa cells?
Androstiendione formed in the theca cells enters the granulosa cell and under FSH control upregulates aromatase to aromatize androsteinedione into estrogen
207
Which ovarian tumor is pale and looks like bladder tissue?
Brenner tumor
208
What occurs 14 days after ovulation?
menstruation
210
What lines the vulva?
Squamous epithelium
211
Two places Paget's disease may be (aside from bone)
Vulva (no underlying CA) and Breast (underlying DCIS)
212
Which basic type of ovarian tumors have no correlate in men?
Surface epithelial tumors (men have germ cells and sex-cord stroma)
213
Pseudomyxoma peritonei represents massive amounts of mucus in the peritoneum from metastasis of a _______________ tumor to the ovary
Mucinous tumor of the appendix
215
What is the difference in prognosis for a mature teratoma in males vs. females?
Males more often malignant
216
What is Asherman Syndrome?
Secondary amenorrhea due to loss of basalis and scarring from D/C (without basalis there is no way to grow an endometrium)
217
Painless bleeding in any trimester
Placenta previa
218
Smooth muscle tumor in uterus with areas of necrosis and hemorrhage
Leiomyosarcoma
220
What are 3 benign breast tumors?
Fibroadenoma, Phyllodes tumor (both of stroma), and Intraductal papilloma (lactiferous sinus)
221
Which cells are NOT affected by cryptorchidism?
LEYDIG CELLS!!! Although sertoli cells depend on temp, testosterone synthesis is NOT affected by temp. Spermatogenesis is though because there is no ABP; However, for whatever reason, testosterone is LOW in BILATERAL cryptorchidism
223
What is Peyronie's disease
Bent penis due to acquired fibrous tissue
224
Which 2 structures in the female are derivatives of the gubernaculum?
Ligament of the ovary (attaches medial ovary to lateral uterus); Round ligament of uterus (from uterine fundus to labia majora, contains artery of Sampson)
226
What is a dermoid cyst of the ovary?
Mature teratoma, has all kinds of tissue in it
227
What is the screening test and confirmatory test for cervical carcinoma?
Pap smear; Colposcopy
228
What cells are necessary for a Dx of chronic endometritis?
PLASMA CELLS since lymphocytes are normally present
229
Which tumor in ovaries produces estrogen? Signs in young girl? Repro age? Post menopause?
Granulosa-Theca cell tumor? Young girl = precocious puberty, Repro age = menorrhagia/metrorrhagia; Old = uterine bleeding
230
What are the 4 histologic types of fibrocystic breast disease?
Fibrosis (stromal hyperplasia), Cystic (blue dome), Sclerosing adenosis (calcifications confused with CA), Epithelial hyperplasia (increases risk of CA)
231
What is Bowen disease?
SCC in situ on the penis presenting as leukoplakia
232
What is a common cause of endometrial polyps?
Tamoxifen due to partial agonist activity on estrogen receptors of endometrium (antagonist at breast)
233
Which structure contains the uterine vessels? Ovarian vessels?
Cardinal ligament; suspensory ligament of the ovary
235
What structure is at risk when ligating the suspensory ligament of the ovary in oopherectomy?
ureter
237
Which testicular tumors can have AFP?
Yolk sac tumor; teratoma (AFP and or hCG), embryonal carcinoma when mixed
239
What are the levels of testosterone and LH if there is primary hypogonadism (Klinefelter's)?
Testosterone decreased, LH increased
240
Which mole causes choriocarcinoma?
Complete mole; partial moles are unlikely to convert to choriocarcinoma
242
What happens when there is hemorrhage into a corpus luteum?
Hemorrhagic corpus luteal cyst (especially in early pregnancy)
243
What is the risk that DES proposes for the mother taking it?
Breast cancer; Diethylstilbestrol is an estrogen drug
244
What tests indicate osteoblastic mets from prostate?
high PSA and elevated alk phos (prob with a negative GGT as well to r/o liver)
245
What is the histology of 1) medullary carcinoma of breast 2) invasive lobular carcinoma 3) invasive ductal carcinoma
1) flesshy, cellular, lyphocytic invasion 2) indian filing 3) stellate
246
Which sleeping position is a risk factor for sudden infant death?
Sleeping on the stomach!!! Should sleep on the back
247
Roughly where on the right side of a clock are Skenes glands and Bartholins glands located?
Skenes = 1 o clock; Bartholins = 5 oclock (i.e. lower vestibule)
248
Which strains are covered by gardasil (4)?
6, 11 (warts); 16 and 18 (CA)
249
What maintains the glands and stroma of the prostate?
androgens (i.e. DHT)
250
What is the grading system for prostatic adenocarcinoma? What is it based on?
Gleason grading system; based on architecture ALONE not based at all on atypia
251
Which germ cell tumors are non-seminomas? What is the counterpart in the female for a seminoma?
Choriocarcinoma, Endodermal sinus tumor, Embryonal carcinoma and teratoma; Seminoma = Dysgerminoma in female
252
What is the cause of ovulation?
Estrogen is building up during the follicular phase and then it will increase GnRH receptors on the ant pit which will cause the paradoxical LH surge and the LH surge is responsible for ovulation
253
Differentiate Paget cells and melanoma by 1) PAS 2) S-100 and 3) Keratin
Melanoma = PAS negative, Keratine negative, S-100 positive; Paget cells = PAS positive, Keratin positive; and S100 negative
254
Which 2 diseases represent SCC in situ presenting as erythroplakia of the penile glans?
Bowenoid papulosis (younger); Erythroplasia of Queyrat
255
Why is endometrial hyperplasia more likely in an obese woman?
There is the ability of fat tissue to aromatize DHEA and weak androgens from zona reticularis into estrogens
256
What are the 2 most common types of surface epithelial tumors of ovaries?
Serous and mucinous (adenomas and adenocarcinomas)
257
Ovarian fibroma, ascites, and hydrothorax
Meig's syndrome
258
What is the most common cause on non-HPV related vulvar carcinoma?
Long standing lichen sclerosis
259
What are 2 fairly uncommon tumors of the ovarian surface epithelium?
Endometrioid tumor (may arise from endometriosis!!!), Brenner tumor (looks like bladder)
260
Which general type of ovarian malignancies have the worst prognosis?
Surface epithelial tumors
261
What is an endometrioid ovarian cyst?
This is endometriosis within the ovary, it is a chocolate cyst? Not the same as endometriosis on the outside of ovary
262
What is the most important prognostic indicator regarding the conversion of endometrial hyperplasia into carcinoma?
cellular atypia
