Reproductive Pathology Flashcards Preview

USMLE Step 1 > Reproductive Pathology > Flashcards

Flashcards in Reproductive Pathology Deck (50):
1

Testicular atrophy, enuchoid body shape, tall, long extremities, gynecomastia, female hair distribution

Klinefelter Syndrome (47XXY). Presence of inactivation of X chromosome--Barr body. Infertility. Dygenesis of seminiferous tubules--decreased inhibin, increased FSH. Abnormal Leydig cell function--decreased testosterone, increased LH, increased estrogen.

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Short stature, streak ovary, shield chest, bicuspid aortic valve, preductal coarctation, webbed neck, cystic hygroma, lymphedema, horseshoe kidney

Turner (45XO or 45XO/46XX mosaic) syndrome. Most common cause of primary amennorhea. Menopause before menarche (decreased estrogen-->increased LH, FSH).

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phenotypically normal males, very tall, severe acne, with antisocial behavior, possible autism

Double Y males 47XYY

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true hermaphroditism

46XX or 47XXY--very rare

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ovaries present but external genitalia are virilized or ambiguous

Congenital adrenal hyperplasia, early and excessive exposure to androgens

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Testes present but external genitalia are female or ambiguous

most commonly androgen insensitivity syndrome

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masculinization of female (46XX) infants with increased serum testosterone and androsteonedione

Aromatase deficiency. Fetal androgens can cross placenta and cause maternal virilization

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normal appearing female, female external genitalia usually underdeveloped vagine, uterus/fallopian tubes generally absent, testes usually found in labia majora

Androgen insensitivity syndrome (46XY). Increased testosterone, estrogen, and LH (vs sex chromosome disorders).

9

male ambiguous genitalia until puberty

5alpha-reductase deficiency--autosomal recessive 46XY, cannot convert testosterone to DHT; normal testoterone/estrogen levels, LH is normal or increased, internal genitalia are normal

10

failure to complete puberty, anosmia, infertility

Kallman syndrome--form of hypogonadotropic hypogonadism; defective migration of GnRH cells and formation of olfactory bulb-->decreased synthesis of GnRH (hypothalamus)-->decreased FSH, LH-->decreased testosterone-->infertility (low sperm count, amenorrhea)

11

Complete Mole

46XX or 46XY, super high hCG, increased uterine size, can convert to choriocarcinoma, no fetal parts, enucleated egg+single sperm that subsquently duplicates, malignant trophoblastic disease, vaginal bleeding/large uterus/hyperemesis/pre-eclampsia/hyperthyroidism; honeycombed uterus/clusters of grapes/snowstorm on ultrasound

12

Partial Mole

69XXX/XXY/XYY; slightly high hCG; fetal parts; 2 sperm 1 egg; low risk of malignancy; vaginal bleeding/pain; see fetal parts on US

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treatment of gestational HTN

alpha-methyldopa, labetalol, hydralazine, nifedipine, deliver at 39 weeks

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hypertension > 140/90 with proteinuria after 20th week of gestation

Pre-eclampsia--abnormal placental spiral arteries (oliguria, elevated AST/ALT, thrombocytopenia)--Tx with antiHTN, deliver 34 weeks/37 weeks, IV MgSO4 to prevent seizures

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Pre-eclampsia < 20 weeks gestation

suggestive of molar pregnancy

16

Eclampsia

Preeclampsia + maternal seizures--death due to stroke, intracranial hemorrhage, ARDS

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HELLP syndrome

Hemolysis, elevated liver enzymes, low platelets--manifestation of severe preeclampsia

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history of amennorhea, lower than expected rise in hCG

ectopic pregnancy--RFs: hx of infertility, PID, ruptured appendix, prior tubal sugery

19

HPV types associated with cervical cancer

HPV 16/18 produce E6 and E7 gene products which inhibit p53 and Rb (tumor supressors) respectively

20

ectopic endometrial tissue surrounded by muscle fibers of abdominal wall

Endometriosis: cyclic pelvic pain, bleeding, dysmennorhea, dyspareunia, dyschezia, infertility, normal sized uterus; Tx with NSAIDS, OCPs, progestins, GnRH agonists, surgery

21

uniformly enlarged, soft, globular uterus w/ dysmenorrhea, menorrhagia

Adenomyosis: extension of endometrial tissue (glandular) into uterine myometrium (hyperplasia of basalis layer of endometrium); hysterectomy

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decreased estrogen, increased FSH/LH before age of 40

premature ovarian failure

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amenorrhea/oligomenorrhea, hirsutism, acne, infertility, obesity

PCOS: hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia; increased LH/FSH (3:1), increased testosterone, increased estrogen; most common cause of infertility in women

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Tx of PCOS

hirsutism/acne: weight reduction, OCPs, antiandrogens; infertility (clomiphene citrate, metformin); endometrial protection: cyclic progesterones

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ovarian neoplasm with call-exner bodies

Granulosa cell tumor (most common sex cord stromal tumor), primordial follicles

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ovarian neoplasm with psammoma bodies

serous cystadenocarcinoma

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ovarian neoplasm with sheets of uniform "fried egg" cells

dysgerminoma, hCG/LDH tumor markers

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abnormal bhCG, dyspnea, hemoptysis in pregnant woman

choriocarcinoma: develop during or after pregnancy, malignancy of trophoblastic tissue; no chorionic villi present; hematogenous spread to lungs

29

yellow, hemorrhagic, solid mass with histology that resemble glomeruli

Yolk sac (endodermal sinus) tumor--schiller duval bodies; elevated AFP

30

mucin secreting signet cell adenocarcinoma

Krukenberg tumor: GI malignancy mets to ovaries

31

exposure to DES in utero

clear cell adenocarcinoma of vagina

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spindle shaped tumor cells that are desmin+ in vagina

sarcoma botryoides (rhabdomyosarcoma variant)

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small, mobile firm mass that increases in size/tenderness with pregnancy/menstruation

fibroadenoma, most common tumor in those < 35 y/o

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serous or bloody nipple discharge

intraductal papilloma; slight increased risk for carcinoma

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large bulky mass of connective tissue and cysts with leaf-like projections

Phyllodes tumor

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microcalfications on mammography

ductal carcinoma in situ--early malignancy w/out basement membrane penetration, noninvasive

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ductal caseous necrosis (DCIS subtype)

comedocarcinoma, noninvasive

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Eczematous patches on nipple, large cells in epidermis with clear halo

Paget cells, Paget disease, results from underlying DCIS, noninvasive

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firm,fibrous rockhard mass with sharp margins and small glandular duct like cells, gross stellate infiltration

invasive ductal carcinoma, most common and worst/most invasive (76% of all breast Ca)

40

invasive breast Ca with orderly row of cells

Invasive lobular carcinoma, often bilateral with multiple lesions

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Fleshy, cellular, lymphocytic infiltrate, invasive breast Ca

medullary breast Ca, good prognosis

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Dermal lymphatic invasion by breast cancer, orange peel skin

inflammatory breast cancer, 50% survival at 5 years

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painless, homogeonous testicular enlargement; large cells in lobules with watery cytoplasm and a fried egg apperance

Seminoma; malignant testicular germ cell tumor; most common testicular tumor (never in infancy); increased placental ALP; late mets/good prognosis

44

elevated AFP, yellow, mucinous testicular tumor

Yolk sac (endodermal sinus) tumor, Schiller-duval bodies, most common testicular tumor in boys < 3 y/o

45

testicular tumor with increased hCG, dyspnea

Choriocarcinoma; hematogenous mets to lungs and brain; may produce gynecomastia or signs of hyperthyroidism (bHCG is analog of LH, FSH, TSH)

46

testicular tumor with increased hCG, increased AFP

teratoma--in males can be malignant

47

hemorrhagic testicular mass with necrosis, painful, glandular/papillary morphology

Embryonal carcinoma: maligant, often mixed with other tumor types, elevated hCG (pure) and AFP (mixed)

48

Reinke crystals, gynecomastia in men, precocious puberty in boys, golden brown color

Leydig cell non-germ cell testicular tumor; androgen producing

49

Leukoplakia on penile shaft

Bowen disease--squamous cell carcinoma, HPV associated

50

Erythroplakia on penile shaft

erythroplasia of Queyrat, squamous cell cancer of glans, associated with HPV