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FA complete review part 3 Pathology Endometrial, Penile and Breast diseases

Disordered epithelial growth of the cervix. Cervical dysplasia
What are the classifications of Cervical dysplasia? CIN 1, CIN 2, and CIN 3
Cervical carcinoma in situ is associated with HPV serotypes? HPV-16 and HPV-18
HPV-16 serotype produces which gene? E6 gene
What is inhibited by E6 gene product of HPV-16? TP53
E7 gene product is known to inhibit Rb
What cells are pathognomonic of HPV infection? Koilocytes
Koilocytes are seen in what type of viral infection? HPV
(+) for koilocytes. Dx? HPV infection
What are known risk factors for HPV infection? 1. Multiple sexual partners 2. HPV 3. Smoking 4. Early coitarche 5. DES exposure 6. Immunocompromised (HIV, transplant)
Cervical invasive carcinoma is most often of what type? Squamous cell carcinoma
What is a possible complication of lateral invasion of Cervical Invasive carcinoma? Hydronephrosis leading to renal failure
What is another way to refer to Primary Ovarian insufficiency? Premature Ovarian failure
Premature atresia of ovarian follicles in women of reproductive age. Dx? Primary ovarian insufficiency
What type of conditions are most associated with development of Primary ovarian insufficiency in women less than 30 y.o.? Chromosomal abnormalities
A patient with signs of menopause after puberty but before the age of 40, with a diagnosed chromosomal abnormality. Dx? Primary ovarian insufficiency
List of MCC of ANOVULATION: 1. Pregnancy 2. PCOS 3. Obesity 4. HPO axis abnormalities/immaturity 5. Premature ovarian failure 6. Hyperprolactinemia 7. Thyroid disorders 8. Eating disorders 9. Competitive athletes 10. Cushing syndrome 11. Adrenal insufficiency, 12. Chromosomal abnormalities (Turner syndrome)
Another name of functional hypothalamic amenorrhea Exercise-induced amenorrhea
What are some common causes/activities that cause functional hypothalamic amenorrhea? Severe caloric restriction, increase energy expenditure, and/or stress.
What does the first affection of Functional hypothalamic amenorrhea? Functional disruption of pulsatile GnRH secretion leading to decrease levels of LH, FSH, and estrogen.
"female athlete triad" is associate with what condition? Functional hypothalamic amenorrhea
Pathogenesis of functional hypothalamic amenorrhea: 1. Functional disruption of pulsatile GnRH secretion --> Decrease LH, FSH, estrogen. 2. Decrease in leptin due to decrease fat 3. Increase cortisol (stress, excessive exercise)
What is another name for Polycystic Ovarian syndrome (PCOS)? Stein-Leventhal syndrome
What is the main disruption in PCOS that lead to hormonal changes? Hyperinsulinemia and/or insulin resistance alter the hypothalamic hormonal feedback response
Are LH:FSH ratio increased or decreased in PCOS? Increased
What is the result of the increased levels of LH:FSH and androgens in PCOS? Unruptured follicles (cysts) + anovulation
What is a common cause of decreased fertility in women? Polycystic ovarian syndrome
Enlarged, bilateral cystic ovaries; amenorrhea/oligomenorrhea, hirsutism, acne, and decreased fertility. Dx? Polycystic ovarian syndrome
How is PCOS related to Endometrial cancer? Increased risk of Endometrial cancer secondary to UNOPPOSED estrogen from repeated anovulatory cycles
What is the effect on estrogen due to recurrent anovulatory cycles in a PCOS patient? Unopposed estrogen leads to its incrase and higher riks of endometrial cancer.
What are the non-medication life modifications used for treating PCOS? 1. Weight reduction to decrease periphear estrone formation 2. OCPs
What is the medical (chemical) treatment for PCOS? 1. Clomiphene, metformin to induce ovulation 2. Spironolactone 3. Ketoconazole (antiandrogenic) to treat hirsutism
Which antibiotic is usually used to treat hirsutism in PCOS patient? Ketoconazole
Reason for Spironolactone use in PCOS treatment Anti-androgenic; treating hirsutism
1. Hyperglycemia 2. Hirsutism 3. Infertility Common triad of symptoms seen in PCOS
What are the two main types of Ovarian cysts? 1. Follicular cysts 2. Theca-lutein cysts
What is an Follicular ovarian cyst? Distension of unruptured graafian follicle
Associations of Follicular ovarian cyst? - Hyperestrogenism - Endometrial hyperplasia
What is the most common ovarian mass in young women? Follicular ovarian cyst
Description of ovarian Theca-Lutein cyts? Often bilateral and multiple
Ovarian Theca-Lutein cysts are due to: Gonadotropin stimulation
What are common associations of Ovarian Theca-Lutein cysts? Choriocarcinoma and Hydatidiform moles
List of common Endometrial pathologies: 1. Polyp 2. Adenomyosis 3. Asherman syndrome 4. Leiomyoma (fibroid) 5. Endometrial hyperplasia 6. Endometrial carcinoma 7. Endometritis 8. Endometriosis
An endometrial polyp is: Well-circumscribed collection of endometrial tissue within uterine wall.
What kind of cells are found in endometrial polyps? Smooth muscle cells
An endometrial polyp can extend to the: Endometrial cavity in the form of a polyp
An endometrial may be asymptomatic, or if symptomatic it presents with: Painless abnormal uterine bleeding.
"Sac-like structure" of endometrial tissue within the uterine wall. Dx? Endometrial polyp
What is adenomyosis? Extension of endometrial tissue (glandular) into uterine myometrium
What is the most common cause fo Adenomyosis? Hyperplasia of basal layer of endometrium.
What is the result (pathology) caused by the hyperplasia of the basal layer of endometrium? Adenomyosis
What is the clinical presentation of Adenomyosis? Dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus.
What is the treatment of Adenomyosis? GnRH agonists, hysterectomy or excision of an organized adenomyoma.
What type of endometrial tissue is affected or extended in Adenomyosis? Glandular endometrial tissue
Adhesions and /or fibrosi of the endometrium. Dx? Asherman syndrome
Patient with Hx of recent dilation and curettage of intrauterine cavity, presents with abnormal uterine bleeding, pelvic pain, and Hx of infertility and recurrent pregnancy loss 2x? Asherman syndrome
Leiomyoma = Fibroid
Fibroid is also known as ___________________. Leiomyoma
What is the most common tumor in females? Leiomyoma
Description of a Leiomyoma: 1. Benign smooth muscle tumor 2. Estrogen sensitive 3. Peak occurrence - women 20-40 years old
What ethnic population have higher levels of Leiomyoma recurrence? African American women
What does an "Leiomyoma is Estrogen-sensitive" means? Tumor size increase with pregnancy and decreases with menopause
Whorled pattern of smooth muscle cells bundles with well-demarcated borders. Which is the possible endometrial condition? Leiomyoma
What is an hematologic adverse condition that may be a consequence of severe Leiomyomas? Iron deficiency anemia
Medical procedures that are directed to check/treat the uterus may lead to development of? Asherman syndrome
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. Dx? Endometrial dysplasia
What is the most characteristic symptom of Endometrial hyperplasia? Postmenopausal vaginal bleeding
What are associated risk factor of Endometrial hyperplasia? Anovulatory cycles, hormone replacement therapy, PCOS, and granulosa cell tumor
What is a higher risk factor for Endometrial hyperplasia, nuclear atypia or complex architecture? Nuclear atypia
What is the MC gynecologic malignancy with peak at 55-65 years old? Endometrial carcinoma
Postmenopausal vaginal bleeding. is a features of which malignancy? Endometrial carcinoma
What is the most typical preceding condition of Endometrial carcinoma? Endometrial hyperplasia
What are some associated risk factors that lead to development of Endometrial carcinoma? 1. Prolonged use of estrogen without progestins, 2. Obesity 3. Diabetes 4. Hypertension 5. Nulliparity 6. Late menopause 7. Early menarche 8. Lynch syndrome
Which GI condition is often associated with Endometrial carcinoma? Lynch syndrome
What is Endometritis? Inflammation f endometrium associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (IUD).
How does retain material in uterus lead to Endometritis? It promotes infection by bacterial flora from vaginal or intestinal tract
What a histological feature of chronic endometritis? Presence of plasma cells on histology
Which condition is associated with (+) plasma cell on histology? Chronic endometritis
What is the most common or usual treatment for Endometritis? Gentamicin + clindamycin +/- ampicillin
Non-neoplastic endometrium-like glands/stroma outside endometrial cavity. Dx? Endometriosis
Endometrial tissue outside of endometrium. Dx? Endometriosis
What is the most common site for Endometriosis? Ovary (frequency bilateral)
What are 3 common places for endometriosis to develop? BIlateral ovaries, pelvis, and peritoneum
What is the description of endometriosis in the ovary? Endometrioma
What is endometrioma? Endometriosis in the ovary
Blood-filled "chocolate cysts" . Dx? Ovarian endometriosis
What are some possible causes of Endometriosis? 1. Retrograde blood flow 2. Metaplastic transformation of multipotent cells 3. Transportation of endometrial tissue via the lymphatic system
What are common clinical signs and symptoms of endometriosis? Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility.
How is the size of uterus with a women with Endometriosis? Normal sized uterus
Treatment of Endometriosis? -NSAIDs - Continuous OCPs - Progestins - GnRH agonists - Danazol - Laparoscopic removal
Danazol is used int the treatment of ____________________. Endometriosis
What is a common features of Endometriosis to describe the cysts? "Chocolate cysts"
What are the two subtypes of Fibrocystic changes of the breast? 1. Sclerosing adenosis 2. Epithelial hyperplasia of the breast
What are the types of benign breast diseases (general)? 1. Fibrocystic changes 2. Inflammatory processes 3. Benign tumors 4. Gynecomastia
Fibrocystic changes of the breast are most common what type of women? Premenopausal women < 35 years old
Description of fibrocystic changes of the breast: - Pre-menstrual pain or lumps - Often bilateral and multifocal
What are the cystic changes of the breast (definition)? Non-proliferative lesions that include simple cysts, papillary aprocine change/metaplasia, and stromal fibrosis.
Sclerosing adenosis is a subtype of: Fibrocystic changes of the breast
What is Sclerosing adenosis of the breast? Acini and stromal fibrosis, associated with calcifications; minimal increase for cancer
Breast cells in terminal ductal or lobular epithelium with increased risk of carcinoma with atypical cells. Subtype of Fibrocystic breast changes. Dx? Epithelial hyperplasia of breast
What are the two main benign breast inflammatory processes that cause disease? 1 Fat necrosis 2 Lactational mastitis
How is Fat necrosis of the breast defined? Benign, usually painless, lump due to injury to breast tissue
What is a typical finding of Fat necrosis on mammography? Calcified oils cyst
What is Lactational mastitis? Occurs during breastfeeding. Increased risk of bacterial infection through cracks in nipple
What i the most common pathogen that causes Lactational mastitis? S. aureus
What are the benign tumors of the breast? - Fibroadenoma - Intraductal papilloma - Phyllodes tumor
Fibroadenoma of the breast is a benign or malignant tumor? Bening
Intraductal breast papilloma is a benign or malignant tumor? Benign
What is the most common benign breast tumor in women under the age of 35? Fibroadenoma
Description and features of Breast fibroadenoma? - Small, defined, mobile mass, - Increases size and tenderness with increases levels of estrogen, such as in pregnancy an prior to menstruation
What type of benign tumor is usually seen with increased levels of tenderness and size few days prior to menstruation? Breast fibroadenoma
Small fibroepithelial tumor within lactiferous ducts, typically beneath areola. Dx? Intraductal papilloma of the breast
What is the most common cause of bloody or soeurs nipple discharge? Intraductal papilloma of the breast
What is the Phyllodes tumor? Large mass of connective tissue and cysts with "leaf-like" lobulations
Which benign breast tumor has changes of one day becoming malignant? Phyllodes tumor
What decade of life is most commonly a Phyllodes tumor to develop? 5th decade
"leaf-like" lobulations. Dx breast tumor? Phyllodes tumor
Bloody nipple. MC benign breast tumor? Intraductal papilloma of the breast
What is Gynecomastia? Breast enlargement in males due to increased levels of estrogen compared with androgen activity.
What are some causes of Gynecomastia? 1. Cirrhosis 2. Hypogonadism 3. Testicular tumors 4 . Drugs
What drugs/medications are known to cause gynecomastia? Spironolactone, Hormones, Cimetidine, Finasteride, and Ketoconazole.
Abnormal breast growth in males. Gynecomastia
What is an "embarrassing" condition in males, due to increased estrogen compared to androgen activity? Gynecomastia
Which ducts have the presence of Intraductal adenoma growth? Lactiferous ducts, beneath the areola.
What is Peyronie disease? Abnormal curvature of penis due to fibrous plaque within tunica albugĂ­nea.
What is the distinction between Peyronie disease and Penis fracture? Penis fracture is the ruprus of corpora cavernosa due to forced bening
Which type of conditions is likely due to practicing rough coitus? Penile fracture
When is surgical repair of Peyronie disease recommended? Once curvature stabilized
What are symptoms or associations of Peyronie disease? Erectile dysfunction, pain, and anxiety.
Painful sustained erection lasting > 4 hours. Dx? Ischemic priapism
What are common associative-causes of Priapism? Sickle cell disease and medications (viagra)
Why is Sickle cell disease associated with development of Priapism? Sickled RBCs block venous drainage of corpus cavernosum vascular channels
Treatment for ischemic priapism Immediate corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia
Intracavernosal phenylephrine is used for: Treatment of priapism
Which parts of the world ar most affected by Squamous cell carcinoma of the penis? Asia, Africa, and South America
What are the precursor in situ lesions for Squamous cell carcinoma of the penis? 1. Bowen disease 2. Erythroplasia of Queyrat 3. Bowenoid papulosis
What penile pathology is associated with uncircumcised males and HPV? Penile squamous cell carcinoma
Leukoplakia in the penis shaft. Bowen disease
What is Bowen disease? Precurus in situ lesion for Penile SCC that presents as leukoplakia in the shaft of penis
What is Erythroplasia of Queyrat? Carcinoma in situ of the glans of the penis, that presents as erythroplakia.
What is Bowenoid papulosis? Carcinoma in situ of unclear malignant potential, presented as reddish papules; precursor condition of Penile SCC.
Reddish papules in penis, which later gave rise to development Penile SCC? Bowenoid papulosis
What is Cryptorchidism? Undescended testis (one or both)
Medical term for undescended testis (one or both). Cryptorchidism
Why does cryptorchidism cause impaired spermatogenesis? Since sperm develop besta at temperatures < 37 degrees.
What type of tumors are most associated with Cryptorchidism? Germ cell tumors
What is a common risk for Cryptorchidism? Prematurity
How important hormonal levels affected in Cryptorchidism? Decreased inhibin B, and increased LH and FSH. Testosterone Is normal in unilateral but decreased in bilateral cases of cryptorchidism
How does the levels of testosterone differ in bilateral cryptorchidism vs unilateral cryptorchidism? Bilateral --> low testosterone leves Unilateral ---> normal levels
Rotation of testicle round the spermatic cord and vascular pedicle. Dx? Testicular torsion
What is the definition of testicular torsion? Rotation of testicle around the spermatic cord and vascular pedicle
In testicular torsion, the testicle is around which important stricture? Spermatic cord
Testicle around the spermatic cord. Dx? Testicular torsion
What is the clinical presentation of Testicular torsion? Acute, severe pain, high-riding testis, and absent cremastic reflex
An absent cremasteric reflex in a 15 year old male, that present with sudden testicular pain. Dx? Testicular torsion
Orchiopexy? Surgical correction of Testicular torsion within the first 6 hours.
What is the treatment or procedure in Testicular torsion with a < 6 hours from event? Orchiopexy
What is a varicocele? Dilated veins in pampiniform plexus due to increased venous pressure
Dilated veins in pampiniform plexus due to increased venous pressure. Dx? Varicocele
What plexus is associated or affected in Varicocele? Pampiniform plexus
What is the most common cause of scrotal enlargement in adult males? Varicocele
Which side is most common to develop a Varicocele, right or left? Left side
Why is the left side of a male most prone to develop a varicocele? Increase resistance to flow from left gonadal vein drainage into left renal vein
How is Varicocele diagnosed? By standing clinical exam/Valsalva maneuver or US with Doppler
What is "felt" by doctor in inspecting a Varicocele? "bag of worms" on palpation of testicule
Does a varicocele transilluminate? No, it does not
"bag of worms" Varicocele
What is the treatment for Varicocele? Surgical ligation or embolization if associated with pain or infertility.
Benign scrotal lesions present as testicular masses that can be transilluminated. Scrotal masses
Definition of scrotal masses. Benign scrotal lesions present as a testicular masses that transilluminated.
Does scrotal masses or solid testicular tumors, transilluminate? Scrotal masses
What are the most common forms of Scrotal masses? 1. Congenital hydrocele 2. Acquired hydrocele 3. Spermatocele
Reason of congenital hydrocele development? Incomplete obliteration of processus vaginalis
What is a very common cause of scrotal swelling in infants? Congenital hydrocele
Failed obliteration of processus vaginalis leads to development of: Congenial hydrocele
Which feature in development is failure that leads to Congenital Hydrocele? Processus vaginalis
Scrotal fluid collection usually secondary to infection, trauma, or tumor. Dx? Acquired hydrocele
Bloody acquired hydrocele Hematocele
If the hydrocele is filled with blood, it is known as ______________. Hematocele
What is a Spermatocele? Cyst due to dilated epididymal duct or rete testis
Cyst formed by dilation of the epididymal duct or rete testis. Dx? Spermatocele
Paratesticular fluctuant nodule. Dx? Spermatocele
Common hyperplastic condition of the prostate in men over 50 years of age. Benign prostatic hyperplasia
What are the characteristics of BPH? Smooth, elastic, firm nodular enlargement of periurethral lobes, which compresses the urethra into a vertical slit.
What parts of the prostate gland are comprised in BPH? Periurethral lobes (lateral and middle lobes)
If compresses the lateral and middle lobes of prostate, suspect conditions? Benign prostatic hyperplasia
If the prostatic enlargement compressor arises from the posterior lobe, which is the suspected dx? Prostatic adenocarcinoma
Is BPH premalignant? No, it is not considered a premalignant condition
What are clinical symptoms or presenting conditions of BPH patients? - Increased frequency of urination - Nocturia - Difficulty starting and stopping urine stream - Dysuria
What are possible complications of severe BPH? Distension And hypertrophy of bladder, hydronephrosis, and UTIs.
What antigen is seen elevated in BPH? Free PSA
What are the common drugs to treat BPH? 1. Alpha-1 antagonists (tamsulosin) 2. 5a-reductase inhibitors (finasteride) 3. PDE-5 inhibitors (tadalafil) 4. Surgical resection /ablation
What is a common alpha-1 antagonist used in treating BPH? Terazosin and Tamsulosin
What type of drugs are Terazosin and Tamsulosin? Alpha-1 antagonists
What are the general characteristics of Prostatitis? Dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate
What are the two types of Prostatitis? 1. Acute bacterial prostatitis 2. Chronic prostatitis
What is the most common pathogen that causes bacterial prostatitis in older men? E. coli
Acute bacterial prostatitis in young men is most likely caused by: C. trachomatis or N. gonorrhoeae infection.
What type of prostatitis may be bacterial or non-bacterial? Chronic prostatitis
Common causes of chronic prostatitis: - Secondary to previous infection - Nerve problems - Chemical irritation
Created by: rakomi



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