Female Repro

bananas's version from 2015-06-26 17:31

Uterine cancer

Question Answer
Risk factors for endometrial hyperplasiaUnopposed estrogen (obese, PCOS, HRT)
PTEN mutation
Menstrual irregularities (meno/metrorrhagia)
Endometrial gland proliferationEndometrial hyperplasia
Is there a cancer risk with endometrial hyperplasia?YES! Endometrial adenocarcinoma
How do you treat endometrial hyperplasia?Progesterone, Hysterectomy
MC Gynecological malignancyEndometrial carcinoma
Peak age for endometrial adenocarcinoma55-65 y.o.
Excess unopposed estrogen is a risk factorEndometrial hyperplasia + Endometrial carcinoma
Rapid enlargement of uterus (post-menopause)Leiomyosarcoma
Unilateral proliferation of myometrial SMLeiomyosarcoma
What's the prognosis of LeiomyosarcomaMalignant! Aggressive mets to the lung, liver, abdomen. Hemorrhagic necrosis
Plasma cells in the endometriumChronic endometritis
Causes of Endometritis?Ascending infection: Retained products of conception, C section, IUD.
Treatment of EndometritisGentamycin + Clindamycin (usually polymicrobial)
Endometrial gland tissue outside the endometrium?Endometriosis
MC location of endometriosis?Ovaries! Usually bilateral
Chocolate cystEndometriosis in the ovaries
Gun-powder lesionEndometriosis
DyscheziaEndometriosis in the pooper (Pouch of Douglas)
Treatment of EndometriosisNSAIDs, OCP's, Progestins, Continuous GnRH
Is there a cancer risk with EndOmetriosis?YES! Carcinoma, especially Ovarian.
MC benign endometrial growth?Leiomyoma (aka fibroids)
Well-defined White Whorled massesLeiomyoma!!
Age group at risk for Leiomyoma20-40 y.o. aa.
Usually asymptomatic?Leiomyoma
Treatment for Leiomyoma?Hysterectomy
Cyclic pelvic pain +/- bowel or bladder symptoms?Endometriosis
Menorrhagia + nontender irregular uterus?Leiomyoma aka Fibroids
Memorrhagia + Tender, enlarged, globular uterusAdenomyosis
Endometrium in the myometrium?Adenomyosis

Ovarian cancer


Question Answer
MC group of ovarian cancer?Surface epithelial tumors
Surface epithelial tumorsCystadenoma (Serous and Mucinous), Cystadenocarcinomas (Serous and Mucinous), Endometrioid, Brenner's
Are germ cell tumors typically bilateral or unilateral?Bilateral
Which age group is affected in Epithelial tumors?40-60's
Which surface epithelial tumors are benign?Cystadenoma (Serous and Mucinous), Brenner
Which surface epithelial tumors are malignant?Cystadenocarcinoma (Serous and Mucinous), Endometrioid, Clear cell
Prognosis for surface epithelial tumors?Poor
MC ovarian cancer?Serous Cystadenoma/Cystadenocarcinoma
Fallopian tube-like epitheliumSerous Cystadenoma
BRCA-1Serous cystadenoma/cystadenocarcinoma
Multiloculated, huge mass?Mucinous cystadenoma (can be unilateral)
Chocolate cystEndometrioid
Associated with Endometrial CAEndometrioid (also Granulosa cell, Thecoma)
Bladder epithelium?Brenner tumor (Pale yellow-tan)
Coffee bean nuclei?Brenner tumor
Psammoma bodiesSerous cystadenocarcinoma!
[yo momma is a serious cystah]
Fallopian-tube like epitheliumSerous
Pseudomyxoma peritoneiMucinous cystadenocarcinoma: mucous collects in intraperitoneum (can be appendiceal)


Question Answer
Sex cord tumorsGranulosa cell, Sertoli-Leydig, Fibroma, Thecoma
What age group is affected with sex-cord?All
Sex cord tumors: unilateral or bilateral?Unilateral
Which sex cord tumors are benign?Thecoma, Fibroma
Which sex cord tumors are malignant?Granulosa, Sertoli
Prognosis of Sex-cord stromal tumors?Good! Tend to be found early
Ovarian tumor+Ascites+HydrothoraxMeig's syndrome: Fibroma
Meig's syndromeFibroma (benign)
Pleural effusion
Spindle shaped fibroblast bundlesFibroma (benign)
Precocious pubertyGranulosa cell tumor
Follicle-looking rosettes?Call-exner bodies: Granulosa cell tumor
Estrogen secretingGranulosa cell
- increased risk for Endometrial Carcinoma (Also Endometrioid)
Virilization (Hirsutism, Acne)Sertoli-Leydig
Estrogen secretingGranulosa and Thecoma
Reinke Crystals: Leydig tumor
Fibroma: spindle shaped fibroblasts
Call Exner bodies: Granulosa cell [Call your Grandma]


Question Answer
Germ cell tumorsCystic teratoma, Dysgerminoma, Yolk sac (endodermal sinus), Choriocarcinoma
What age group is affected with germ cell tumors?Teens to 20's
Germ cell tumors: unilateral or bilateral?Unilateral
Benign germ cell tumor?Mature teratoma
Malignant germ cell tumor?Immature teratoma, Dysgerminoma, Yolk sac, Choriocarcinoma
Prognosis of Germ cell tumorsExcellent response to chemo
Hyperthyroidism + ovarian massStruma ovarii: teratoma has functional thyroid tissue
Associated with Turner syndromeDysgerminoma
MC in adolescentsDysgerminoma
Fried egg cellsDysgerminoma
Tumor markers for Dysgerminoma?LDH
Cytotrophoblasts, syncytiotrophoblasts (without chorionic villi)Choriocarcinoma
Worst prognosisChoriocarcinoma: Hematogenous spread to the lungs
High B-hCGChoriocarcinoma
Embryonal carcinoma
MC in childrenYolk sac (endodermal sinus)
Glomeruloid bodiesSchiller-Duval bodies: Yolk sac tumor
AFPYolk Sac tumor
Schiller-Duval bodies: Yolk sac tumor
Dysgerminoma: fried egg


Question Answer
Bloody nipple dischargeIntraductal papilloma or Papillary carinoma
Phyllodes tumor:
- Fibrous overgrowth with leaf-like projections
Rubbery, mobile mass with sharp edgesFibroadenoma
Benign tumor that grows during pregnancyFibroadenoma
Milk productionNipple stimulation, Prolactinoma of anterior pituitary, Drugs (dopamine blockers)
Purulent nipple dischargeAcute mastitis from fissures. Most commonly staph aureus
Green/brown nipple dischargeMammary duct ectasia
Benign mass, post menopausal woman: Chronic inflammation and plasma cellsMammary duct ectasia
Lumpy breastFibrocystic change
Fluctuates with menstrual cycleFibrocystic change
Cysts or fibrosis that expand lobules and may cause painFibrocystic change
Changes that can occur with fibrocystic change?No risk: fibrosis, cystic, apocrine
2x Risk: Sclerosing adenosis
5x Risk: Atypical Hyperplasia
Nonlactational mastitis?Duct ectasia, fat necrosis, granulomatous mastitis (from TB or ruptured silicone implants), and inflammatory carcinoma
Trauma/injury to the breastFat necrosis
Abnormal calcification and soponofication on mammographyFat necrosis
Benign, painless lumpFat necrosis
Risks for malignant breast cancer?female gender, estrogen exposure, early menarche and late menopause, older age at first live birth, obesity, BRCA1 and 2 mutations, atypical hyperplasia, first degree relative with breast cancer
Dystrophic calcification on mammographyDCIS
Comedo type DCIS:
- central caseous necrosis and dystrophic calcification
Excematous patches on nipplePaget Disease. Extension of DCIS into the nipple
Paget cells: Large cells in epidermis with clear halo
- Underlying DCIS
Incidental benign findingLobular carcinoma in situ
Lack E-cadherinlobular carcinomas
Rock-hard mass with sharp marginsInvasive ductal carcinoma: Medullary
Stellate infiltrationInvasive ductal carcinoma
Dimpled skin or nipple retractionInvasive ductal carcinoma or periductal mastitis
Tubular Invasive ductal carcinoma
- Duct-like structures invading stroma
Invasive lobular carcinoma
- Single file row of cells
Carcinoma with lymphocytic infiltrate and good prognosisMedullary carcinoma (Invasive Ductal)
BRCA1 mutationsMedullary carcinoma
Dermal lymphatic invasion with peau d'orange skininflammatory carcinoma
Acute mastitis that is not responding to antibiotics?Inflammatory carcinoma
Good prognosis:medullary, mucinous, tubular, papillary, pagets
MC Breast changeFibrocystic changes
MC malignant breast cancerInvasive ductal carcinoma


Question Answer
Loss and scarring of endometrial basalisAsherman's syndrome
Cells with peripheral nucleusSignet ring cells: Krukenberg tumor from the GI
Risk factors for ovarian cancerHNPCC, BRCA-1, BRCA-2, PCOS
Tumor marker for Ovarian tumors?CA125 (not specific) -- used to monitor therapy