Flashcards in Witrak Deck (75):
What is the most common breast disease in adult females?
What is the most common breast change in premenopausal women > 35?
What is the most common breast disease in males?
What can cause gynecomastia in males?
Spironolactone, hormones, cimetidine, alcohol/anti-androgens, ketoconazole
Why does gynecomastia develop?
Increased estrogen compared to androgen activity
What is the appearance of the simple cysts seen in fibrocystic disease?
Blue dome appearance
What changes are seen in fibrocystic disease?
Simple cysts, papillary apocrine metaplasia, stromal fibrosis
What is the appearance of papillary apocrine changes in fibrocystic disease?
Large eosinophilic cells w/scalloping border
What is the most common breast tumor in females less than 30 years of age?
What is the appearance of a benign fibroadenoma?
Small, well-defined, mobile mass. Increased sized and tenderness with increased estrogen
30 yo pregnant F in 2nd trimester presents with firm, mobile mass in L breast. It is well defined, increasing with estrogen. What is it?
What is seen on gross examination of fibroadenoma?
Grey-white, rubbery nodule on gross examination
What is the treatment for lactational mastitis?
Dicloxicillin and continue breast feeding
What subtypes of fibrocystic disease have increased risk for cancer?
Sclerosing adenosis and epithelial hyperplasia
What are the two types of in-situ breast cancer?
Ductal in situ carcinoma and lobular in situ carcinoma
What in situ breast cancer is not seen on mammogram? Is there a mass present?
Lobular in situ carcinoma - no calcification seen, no mass
What is the pathogenesis of lobular in situ carcinoma?
Have decreased E cadherin expression, resulting in single file line of cells - cells don't stick together
Lobular in situ carcinoma has a risk of what?
Bilateral breast cancer over time
What is Paget disease of the breast?
Underlying DCIS that extends up the ducts to involve the skin of the nipple
How does Paget disease of the breast present?
Nipple ulceration with erythema
What family history is typical of hereditary breast cancer?
1st degree relatives with pre-menopausal bilateral breast cancer
BRCA 1 mutations are seen in what types of cancer?
Breast (medullary carcinoma) and ovarian serous carcinoma and fallopian carcinoma
In establishing degree of risk for a patient to develop invasive breast cancer, what is the first question to ask?
What patient population does preiductal mastitis present in? Why?
Smokers; smoking creates Vit A def which results in lactiferous duct squamous metaplasia; resulting in blockage and inflammation, nipple retraction and subareolar mass
What part of the breast does periductal mastitis occur in?
White discoloration on the vulva constitutes what DDx?
Lichen sclerosis, lichen simplex chronicus, squamous cell carcinoma
White patch with parchment-like skin on the vulva is seen in what disease?
Patient complains on chronic itching of the vulva; physical exam shows hyperplasia of vulvar epithelium with a thick, leathery appearance of the skin. What is the likely diagnosis?
Lichen simplex chronicus
Between lichen sclerosis and lichen simplex chronicus, which has an increased risk for squamous cell carcinoma?
How does lichen simplex chronicus present?
Chronic irritation, hyperplasia of vulvar epithelium; thick, leathery appearance of vulvar skin
How does lichen sclerosis present?
White patch with parchment-like skin on vulva
What are the most common causes of vaginal bleeding in post-menopausal women?
Endometrial atrophy (59%), endometrial poly (12%), endometrial hyperplasia (10%), carcinoma (10%)
What are the two types of endometrial carcinoma?
Type I: endometrioid; type II serous/clear cell
What type of endometrial cancer is related to chronic estrogen use?
Type I: endometrioid
What mutation is associated with endometrioid carcinoma?
What endometrial cancer is associated with precursor endometrial hyperplasia?
Endometrioid - type I
What type of endometrial cancer is associated with endometrial atrophy and no prior estrogen excess?
Type II: serous/clear cell
What population does type II serous/clear cell endometrial cancer present in?
Older women (70s +)
What mutation is associated with type II serous/clear cell endometrial cancer?
What are seen on histology in serous/clear cell endometrial cancer?
Papillary structures and psamomma bodies
Is type II serous clear cell endometrial cancer aggressive or more indolent?
What is endometriosis?
Endometrial glands and stroma outside of the uterus
What can be seen histologically in endometriosis?
What are potential sequelae of endometriosis?
Infertility; increased risk for carcinoma (esp at ovary)
What are the two most comon non-neoplastic tubal diseases? And their principal complications?
Salpingitis and endometriosis; can result in tubal infertility and ectopic pregnancy
What is the most common cause of abnormal vaginal bleeding in reproductive age females?
Dysfunctional anovulation = adequate estrogen but lack of progesterone
What is the most common cause of non-gestational uterine enlargement?
What are leiomyomas?
Benign, proliferations of smooth muscle arising from the myometrium
What is the most common tumor in females?
Why do leiomyomas enlarge during pregnancy and shrink after menopause?
Because they are related to estrogen exposure
What appears on gross examination of a leiomyoma?
Well-defined, white, whorled mass
What are the three categories of primary ovarian neoplasia?
Surface epithelium; ovarian stroma/sex cord; germ cell tumors
What category of primary ovarian tumors is most common? Responsible for the majority of ovarian cancer death?
Epithelial is most common overall and most common cause of ovarian cancer deaths
What is the most common germ cell tumor in women?
Mature cystic teratoma
What type of ovarian cancer do patients with BRCA1 mutations have an increased risk for?
PCOS is characterized by what hormone? Ratio?
Excess LH, leading to excess androgens; LH:FSH > 2
Patients with PCOS are at increased risk for what cancer?
What is the most common ovarian neoplasm in female 10 to 30 years of age?
Mature cystic teratoma
A mature cystic teratoma diagnosis can be strongly suggested by pelvic imaging studies, why?
Comprised of all 3 germ layers - some calcified (eg teeth); can be visualized on imaging
What is the ovarian tumor which holds the world record for neoplasm size?
Mucinous tumor of the ovary
What ovarian tumor category is most likely to present with either estrogenic or androgen excess?
Sex cord/stromal tumors
What ovarian tumor is most likely to behave in a recurrent/low-grade malignant fashion?
Granulosa cell tumor - causes estrogen excess (80% of all sex cord stromal tumor malignancy)
What sex cord tumors are usually non-functional and benign 90% of the time?
What is Meig syndrome?
When a ovarian fibroma becomes very large and produces pleural effusions and ascites
What is the major cause of first trimester maternal death?
Ectopic pregnancy, resulting in tubal rupture and hemoperitoneum/shcok
What is characterized by onset of maternal hypertension and proteinuria at >34 weeks gestation?
What placental disorder has a strong association with prior C section?
What is placenta accreta?
Absence of decidua basalis; placenta invade through/ is in contact with myometrium
What is placenta previa?
Placenta is over cervical os
What is placental abruption?
Premature separation of placenta
What is the most common cause of postpartum hemorrhage?
What is the second most common cause of postpartum hemorrhage?
What are the most common causes of postpartum hemorrhage?
1st - uterine atony; 2nd - retained placenta; others: trauma (laceration) and thrombin
What is the most common form of gestational trophoblastic neoplasia?
Complete hydatidaform mole