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Reproductive
FA complete review part 3 Pathology Endometrial, Penile and Breast diseases
| Question | Answer |
|---|---|
| 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 albugínea. |
| 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 |
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