Term
|
Definition
| hormone secreted by gonads that is inhibitory at pituitary but activating in paracrine effects (similar to inhibin) |
|
|
Term
| What phase are oocytes arrested in until puberty? then what do they become? |
|
Definition
1. Arrest in Prophase I (primary oocyte) until puberty
2. Arrest in Metaphase II (ovum) until fertilization |
|
|
Term
| cells of the indifferent gonad (germ cells, coelomic epithelium, mesenchymal cells) form what structures in either male or female? |
|
Definition
1. Germ cells: forms spermatogonia OR oogonia.
2. Coelomic epithelium: forms Sertoli cells OR Granulosa cells (‘nurse’).
3. Mesenchymal cells: forms Leydig cells OR Theca cells (‘hormone’). |
|
|
Term
| what is the most common cause of primary amenorrhea? |
|
Definition
|
|
Term
| undescended testes with female habitus |
|
Definition
|
|
Term
| eunuchoid body, no spermatogenesis or seminiferous tubules |
|
Definition
|
|
Term
| most common form of primary testicular failure? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| where is the level of disorder in Kallmann's? |
|
Definition
| tertiary -- at the hypothalamus (no GnRH production because the GnRH neurons never migrated from the nose to the brain) |
|
|
Term
| what is the main cause of female pseudohermaphroditism? |
|
Definition
| prenatal exposure to androgens |
|
|
Term
| spermiogenesis vs spermiation? |
|
Definition
Spermiogenesis- final stage of spermatogenesis, cellular remodeling of spermatids into spermatozoa (nuclear condensation, shrinkage of cytoplasm, formation of acrosome, development of flagella)
Spermiation- extrusion of flagellated spermatozoa from sertoli cells into the lumen of the tubule. 'residual body' is formed. |
|
|
Term
| where do sperm mature/gain motility? |
|
Definition
|
|
Term
| what does the seminal vesicle do? |
|
Definition
| Secretions of prostaglandins – contractions of uterus and fallopian tubes considered important in sperm movement |
|
|
Term
| DHT causes both BPH and prostatic carcinoma growth-- how do the treatments differ? |
|
Definition
Finasteride (5a-reductase inhibitor) for BPH
Flutamide (DHT receptor blocker) for Prostatic carcinoma OR long-term GnRH agonist |
|
|
Term
| summarize the steps of Leydig/Sertoli cell interactions starting with FSH stimulation |
|
Definition
1. FSH stimulates Sertoli cells to secrete inhibin/activin, which act on Leydig cells.
2. Inhibin: stimulates testosterone secretion from Leydig; activin: inhibits testosterone secretion from Leydig.
3. Leydig cell testosterone has positive paracrine effects on Sertoli cells. (T increase inhibin which further increases T production) |
|
|
Term
| what is the mucopolysaccharide layer immediately around the oocyte formed by granulosa cells? |
|
Definition
|
|
Term
| what menstrual phase is responsible for the differences in cycle lengths among ovulating women? |
|
Definition
|
|
Term
| describe how E2 conc change throughout the menstrual phases |
|
Definition
follicular phase - E2 has neg feedback on FSH secretion and E2 conc continues to increase
ovulatory phase - E2 conc crosses a threshold and switches to positive feedback and there is and LH surge. Rupture of follicle causes a dec in E2 which in turn dec LH
luteal phase - corpus luteum makes E2 which becomes inhibitory again, causing decreased FSH/LH/GnRH secretion |
|
|
Term
| what female cells make androgen out of cholesterol? which cells convert androstenedione to estradiol? |
|
Definition
theca cells make androstenedione
granulosa cells have aromatase to convert it to estradiol |
|
|
Term
| What is the definition of secondary amenorrhea and what are some common causes? |
|
Definition
Secondary amenorrhea: cessation of menstruation for LONGER than 6 months.
causes-- Pregnancy, lactation, menopause; hyperprolactinemia (pituitary tumors; inhibits GnRH, LH, and FSH). |
|
|
Term
| What is the definition of oligomenorrhea and what are some common causes? |
|
Definition
Oligomenorrhea: infrequent periods (cycle length >35 days)
Changes due to functional abnormalities in CNS mechanisms that regulate GnRH releases (stress/illness).
Changes in body fat composition (female runners); intense exercise, weight loss, anorexia…etc. |
|
|
Term
| Steps of acrosomal reaction? |
|
Definition
Triggered when spermatozoan encounters glycoproteins on egg (ZP3 receptor).
Binding leads to increased IP3 /Ca2+, triggers fusion of outer/inner membrane |
|
|
Term
| What is the Cortical or Zona Reaction? |
|
Definition
Exocytosis of oocyte’s internal vesicles to prevents polyspermy ...
The inc Ca2+ inside the egg from the acrosomal rxn causes fusion of cortical granules with membrane that then release enzymes that harden glycoproteins of zona pellucida so a second sperm cannot bind |
|
|
Term
| Where does fertilization most often take place? |
|
Definition
| ampulla of fallopian tube |
|
|
Term
| What day does the morula enter the uterine cavity? |
|
Definition
|
|
Term
| What day does the blastocyst implant? |
|
Definition
|
|
Term
| how soon can hCG be detected in the urine after conception? |
|
Definition
|
|
Term
| where is hCG made in the placenta? |
|
Definition
| Produced by syncytiotrophoblasts under control of GnRH from cytotrophoblasts |
|
|
Term
|
Definition
1. Signals to ovary that implantation has occurred (maternal recognition of pregnancy)
2. rescues corpus luteum and stimulates secretion of progesterone and estradiol
3. negative feedback effects on maternal pituitary to prevent LH/FSH secretion |
|
|
Term
| What is Human placental lactogen (HPL) – aka Human Chorionic Somatomammotrophin (HCS)? |
|
Definition
| HPL is a hormone produced by syncytiotrophoblasts that is structurally similar to GH. In response to hypoglycemia, HPL stimulates lipolysis and has anti-insulin actions on maternal carbohydrate metabolism (leads to an increase in plasma glucose and free fatty acids to maintain continuous flow of nutrients to the fetus). |
|
|
Term
| hormone produced by CL and placenta to inhibit myometrial contractions and relaxes pelvic bones and ligaments? |
|
Definition
|
|
Term
| what inhibits the effects of prolactin during pregnancy? |
|
Definition
| high levels of progesterone and E2 |
|
|
Term
| what hormone promotes mammogenesis during pregnancy? |
|
Definition
progesterone stimulates alveolar pouches and increase their capacity to secrete milk;
estrogen promotes growth of ductal system |
|
|
Term
| how do the concentrations of estrogen and progesterone change when it is time for delivery? |
|
Definition
Progesterone >> estrogen
maintains uterine quiescence and sustenance of fetus
Estrogen >> progesterone
may play an essential role in parturition |
|
|
Term
| what is an oocyte with one single layer of granulosa cells? |
|
Definition
|
|
Term
| When the granulosa cells surrounding the primordial follicle become enlarged and cuboidal, the oocyte is called...? when does this occur? |
|
Definition
| primary follicle; occurs at puberty |
|
|
Term
| When a primary follicle enlarges, there are several layers of granulosa cells with theca layers, and fluid filled vesicles begin forming, the oocyte is called a... |
|
Definition
|
|
Term
| when the fluid filled vesicles form a single antrum, the oocyte is called... |
|
Definition
|
|
Term
| what is the cumulus oophorus? |
|
Definition
| a cluster of cells (called cumulus cells) that surround the oocyte both in the ovarian follicle and after ovulation. In the antral follicle, it may be regarded as an extension of the membrana granulosa. The innermost layer of these cells is the corona radiata |
|
|
Term
| what are the secretory cells in the fallopian tube called? |
|
Definition
|
|
Term
| High and low risk types of HPV? |
|
Definition
high risk = 16, 18, 31, 33
low risk = 6, 11 |
|
|
Term
|
Definition
| it expresses oncoproteins E6 and E7 that bind and neutralize p53 and Rb tumor suppressor genes, respectively |
|
|
Term
| Where does HPV replicate its DNA? |
|
Definition
|
|
Term
| What is the characteristic cell of a condyloma? |
|
Definition
koilocyte --
A koilocyte's nucleus is enlarged compared to normal mature squamous cells from which they derive. Nucleus is more wrinkly/raisin-like. The nucleus appears hyperchromatic/more basophilic. Perinuclear halo. |
|
|
Term
| What fraction of the cervical epithelium is dysplastic in CIN1-3 and CIS? |
|
Definition
CIN 1 = less than 1/3
CIN 2 = ~2/3
CIN 3 = nearly full thickness
CIS = full thickness but BM has not been breached |
|
|
Term
| What percentage of LSIL and HSIL regress? persist? progress? |
|
Definition
LSIL = 60% regress, 30% persist, 10% progress to HSIL
HSIL = 30% regress, 60% persist, 10% progress to carcinoma <10 yrs |
|
|
Term
| Management of LSIL? HSIL? |
|
Definition
LSIL - observation
HSIL - surgical excision, long-term follow-up |
|
|
Term
|
Definition
bivalent -- against types 16 and 18
quadrivalent -- against types 16, 18, 6, 11
*women can get both, men only quadrivalent |
|
|
Term
| What is the major type (75%) of invasive carcinoma of the cervix? What is the minor type? |
|
Definition
major type = squamous cell carcinoma
minor type = adenocarcinoma |
|
|
Term
| peak age of incidence of invasive carcinoma of the cervix? |
|
Definition
|
|
Term
| histology of squamous cell carcinoma of the cervix? |
|
Definition
| Nests of malignant squamous cells. Presence of keratin pearls. |
|
|
Term
| what percentage of female genital cancers are vulva squamous cell carcinoma? vaginal SqCC? |
|
Definition
3% are vular SqCC
vaginal SqCC is extremely rare |
|
|
Term
| How do the risk factors for vulva vs. vaginal squamous cell carcinoma differ? |
|
Definition
high risk HPV a risk for both
non-HPV lichen sclerosis a risk for ONLY vulva |
|
|
Term
| presentation of vulvar cancer vs vaginal cancer? |
|
Definition
vulvar = leukoplakia
vaginal = vaginal bleeding, discharge |
|
|
Term
| what population does lichen sclerosis of the vulva mainly affect? etiology? |
|
Definition
postmenopausal women
autoimmune |
|
|
Term
| what is lichen simplex chronicus? |
|
Definition
| hyperplasia of vulvar squamous epithelium assoc with chronic irritation/scratching. NO inc risk for SqCC. |
|
|
Term
| what is the name for intra-epitermal proliferation of malignant cells in the vulva? presents as RED, scaly, crusted plaque |
|
Definition
Paget Disease of the Vulva
*remember: no underlying tumor |
|
|
Term
| tests to differentiate Paget disease of vulva from Melanoma? |
|
Definition
Paget: keratin (+), PAS (+), S-100 (-)
Melanoma: keratin (-), PAS (-), S-100 (+) |
|
|
Term
| persistence of columnar epithelium in upper 2/3 of the vagina ? |
|
Definition
|
|
Term
| vaginal cancer related to DES exposure in utero? |
|
Definition
| clear cell adenocarcinoma of the vagina |
|
|
Term
| vaginal cancer in children <5 |
|
Definition
| embryonal rhabdomyosarcoma aka sarcoma botryoides |
|
|
Term
| what is a common cause of death in advanced cervical carcinoma? |
|
Definition
|
|
Term
| what cancer does Pap smear screen for? |
|
Definition
| squamous cell carcinoma; it does NOT detect adenocarcinoma |
|
|
Term
| What is the difference in cellularity between acute and chronic endometritis? |
|
Definition
acute endometritis = PMNs
chronic endometritis = plasma cells*, lymphocytes
*necessary for diagnosis since lymphocytes are normally found in the endometrium |
|
|
Term
| Infection that causes endometritis in endemic countries and immunocompromised? |
|
Definition
| mycobacterium tuberculosis |
|
|
Term
| Criteria for endometriosis? |
|
Definition
2/3 must be present
-endometrial glands
-endometrial stroma
-hemosiderin pigment |
|
|
Term
| What does endometriosis of the ovary look like? |
|
Definition
| 'chocolate cysts' of the ovary |
|
|
Term
| what is growth of basalis layer endometrial glands/stroma WITHIN myometrium called? |
|
Definition
adenomyosis
eg. dysmenorrhea, uterus is 3x size, symmetrically englarged, preg test neg |
|
|
Term
| how does estrogen excess affect the endometrium? |
|
Definition
causes hyperplasia
gland>stroma |
|
|
Term
| What is the most important predictor for progression of endometrial hyperplasia to carcinoma? |
|
Definition
cellular atypia
ie, if simple hyperplasia becomes...
simple hyperplasia with atypia = 30%
complex hyperplasia without atypia = <5%
complex hyperplasia with atypia = 50% |
|
|
Term
| what are the two distinct pathways that endometrial carcinoma arises from ? avg ages? |
|
Definition
1. hyperplasia pathway/endometrioid type (80%) = 60
2. sporadic pathway/serous type (25%) = 70 yo |
|
|
Term
| What type of mutation are endometrioid cancers of the endometrium assoc with? |
|
Definition
|
|
Term
| What type of mutation are serous cancers of the endometrium assoc with? |
|
Definition
|
|
Term
| Which type of endometrial carcinoma is more aggressive and has a worse prognosis? |
|
Definition
|
|
Term
| Which type of endometrial carcinoma has papillary structures? |
|
Definition
|
|
Term
| What risk factor are endometrial polyps associated with? |
|
Definition
| Tamoxifen use for tx and prevention of breast cancer. Tamoxifen has anti-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium |
|
|
Term
| compare leiomyoma vs. leiomyosarcoma |
|
Definition
leiomyoma - pre-menopausal, benign, grows with estrogen, gross appearance = white, whorled masses
leiomyoma - arises de novo from mesenchymal cells of myometrium (NOT from leiomyomas), postmenopausal, gross = single lesion with necrosis and hemorrhage |
|
|
Term
| clinical scenario: obese young woman, infertility, oligomenorrhea, hirsutism (ovarian hyperandrogenism) and insulin-resistance? |
|
Definition
|
|
Term
| Androgen is converted in adipose tissue to estrone resulting in what long-term potential complication of PCOD? |
|
Definition
| Uterine endometrioid endometrial cancer |
|
|
Term
| what is the most common type (origin) of ovarian neoplasm? |
|
Definition
| surface epithelial cell tumors |
|
|
Term
| What are the types of surface epithelial ovarian tumors? |
|
Definition
most common:
Serous (30% are malignant)
Mucinous (10% are malignant)
less common:
Endometrioid (usually malignant)
Brenner (usually benign) |
|
|
Term
| What is the age group for surface epithelial ovarian tumors? |
|
Definition
|
|
Term
| What type of ovarian cancer does BRCA1 put a woman at risk for? |
|
Definition
|
|
Term
| what tumor marker is used to monitor surface epithelial cell response to tx and recurrence? |
|
Definition
|
|
Term
What age group are benign ovarian cystadenomas seen in?
What age group are cystadenocarcinomas seen in? |
|
Definition
cystadenoma = 30-40
cystadenocarcinoma = 45-60 |
|
|
Term
| what type of surface epithelial ovarian tumor forms papillary structures, sometimes with psamomma bodies? |
|
Definition
| serous cystadenocarcinoma |
|
|
Term
| are bilateral tumors more common with serous or mucinous cystadenomas? |
|
Definition
|
|
Term
| are multicystic/multiloculated tumors more common with serous or mucinous cystadenomas? |
|
Definition
|
|
Term
| what type of ovarian tumor has transitional-type epithelium resembling that of the urinary tract? |
|
Definition
|
|
Term
| What tumor suppressor gene mutation is associated with endometrioid ovarian carcinoma? |
|
Definition
|
|
Term
| What underlying condition is associated with endometrioid ovarian carcinoma? |
|
Definition
|
|
Term
| What is the second most common type of ovarian neoplasm? |
|
Definition
|
|
Term
| What are the different types of ovarian germ cells tumors? what are their malignant potentials? |
|
Definition
-Teratoma (90% benign, presence of neural or some other immature tissue indicates malignant potential)
-Dysgerminoma (malignant but radiosensitive)
-Endodermal Sinus Tumor/Yolk Sac Tumor (malignant)
-Choriocarcinoma (malignant, early metastasis and often fatal)
-Embryonal Carcinoma (malignant, aggressive) |
|
|
Term
| What type of tumor category is struma ovarii (thyroid tissue)? |
|
Definition
|
|
Term
| Which type of ovarian germ cell tumor spreads hematogenously? |
|
Definition
choriocarcinoma
*weird because carcinomas usually spread via lymphatics |
|
|
Term
| What age group do ovarian germ cell tumors occur in? |
|
Definition
|
|
Term
| Which ovarian germ cell tumor has large cells with clear cytoplasm and central nuclei that resemble oocytes? |
|
Definition
|
|
Term
| Which ovarian germ cell tumor has Schiller-Duvall Bodies? |
|
Definition
Endodermal Sinus/Yolk Sac Tumor
(SD bodies look like glomeruli) |
|
|
Term
| Which ovarian germ cell tumor has placenta like tissue without villi? |
|
Definition
|
|
Term
| Which ovarian germ cell tumor has large primitive cells? |
|
Definition
|
|
Term
| Tumor marker for dysgerminoma? |
|
Definition
|
|
Term
| Tumor marker for yolk sac tumor? |
|
Definition
|
|
Term
| Tumor marker for choriocarcinoma? |
|
Definition
|
|
Term
| What type of ovarian tumors originate from undifferentiated gonadal mesenchyme? |
|
Definition
|
|
Term
| what type of ovarian tumors occur at any age, have low malignant potential, are unilateral, and hormonally active? |
|
Definition
|
|
Term
| What are the types of ovarian sex-cord stromal tumors? What hormones do they produce? |
|
Definition
-granulosa-theca (estrogen)
-sertoli-leydig (testosterone)
-thecoma-fibroma (none) |
|
|
Term
| Which type of ovarian tumor has "Call-exner bodies"? |
|
Definition
granulose-theca cell tumor
*Call-Exner bodies = gland like structures filled with eosinophilic material & Recapitulate ovarian follicle
"Call Exner Cook Estrogen" |
|
|
Term
| Which type of ovarian tumor can present with hirsutism and virilization? |
|
Definition
| sertoli-leydig cell tumor |
|
|
Term
|
Definition
1. Right sided pleural effusion
2. ascites
3. ovarian mass (thecoma-fibroma) |
|
|
Term
| Which type of ovarian tumor has Reinke crystals? |
|
Definition
| sertoli-leydig cell tumor |
|
|
Term
| What type of gastric carcinoma metastasizes to both ovaries? What is the ovarian tumor called? |
|
Definition
-Diffuse type (signet ring cells)
-Krukenberg tumor |
|
|
Term
| What type of ovarian cancer is related to pseudomyxoma peritonei (disseminated gelatinous ascites and multifocal peritoneal epithelial implants, secreting copious globules of extracellular mucin)? |
|
Definition
ovarian mucinous cystadenocarcinoma
from metastasis of an appendiceal mucinous cystadenocarcinoma |
|
|
Term
| What is the most common germ cell tumor in children? |
|
Definition
| endodermal sinus/yolk sac tumor |
|
|
Term
| Are the amnion (inner layer) and chorion (outer layer) derived from the mother’s tissue or fetal tissue? |
|
Definition
|
|
Term
| What does the chorion attach to? |
|
Definition
| The decidua = endometrium of pregnancy |
|
|
Term
| What are the two layers of the chorionic villi epithelium? |
|
Definition
| Syncytiotrophoblast and cytotrophoblast |
|
|
Term
| Where do maternal and fetal blood mix? |
|
Definition
| they shouldn't under normal circumstances |
|
|
Term
| How many umbilical arteries/veins are there? |
|
Definition
|
|
Term
| How does deoxygenated fetal blood enter the placenta? |
|
Definition
| Through the umbilical arteries that branch to form chorionic arteries then they branch again as they enter the chorionic villi |
|
|
Term
| How does oxygenated blood in the placenta return to the fetus? |
|
Definition
| Through the single umbilical vein |
|
|
Term
| What is a spontaneous abortion? |
|
Definition
| Miscarriage before 20 weeks due to chromosomal abnormalities (over half), defective implantation, fetal abnormalities, or maternal causes (inflammation, uterine deformity, DM, luteal-phase defects) |
|
|
Term
| Where do most ectopic pregnancies occur? |
|
Definition
|
|
Term
| What are the three types of twin placentas? |
|
Definition
1. Dichorionic, Diamnionic (monozygotic and dizygotic)
2. Monochorionic, Diamnionic (monozygotic)
3. Monochorionic, Monoamnionic (monozygotic) |
|
|
Term
| If one egg divides between days 0-4, what kind of placenta will it form? |
|
Definition
|
|
Term
| If one egg divides between days 4-8, what kind of placenta will it form? |
|
Definition
| Monochorionic, Diamnionic |
|
|
Term
| If one egg divides between days 8-12, what kind of placenta will it form? |
|
Definition
| Monochorionic, monoamnionic |
|
|
Term
| If one egg divides between after day 13, what kind of placenta will it form? |
|
Definition
| Monochorionic, monoamnionic with conjoined twins |
|
|
Term
| What types of placentas will always result in identical twins? |
|
Definition
|
|
Term
| Term for attachment of placenta to lower uterine segment or cervix? |
|
Definition
|
|
Term
| How do placenta previas present? |
|
Definition
| serious third trimester bleeding |
|
|
Term
| Term for partial or complete absence of decidua with adherence of placental villous tissue directly to myometrium? |
|
Definition
|
|
Term
| Premature separation of the placenta prior to delivery with painful maternal bleeding? |
|
Definition
|
|
Term
| What are the three main theories behind preeclampsia-eclampsia? |
|
Definition
1. abnormal placental vasculature – cytotrophoblastic cells do not invade the myometrium in preeclampsia and uterine spiral artery does not remodel
2. endothelial dysfunction and imbalance of angiogenic and anti-angiogenic factors
3. coagulation abnormalities – hypercoagulable |
|
|
Term
| When do the symptoms of preeclampsia-eclampsia go away? |
|
Definition
| after delivery of the placenta |
|
|
Term
| What organ systems are affected in a mother with preeclampsia-eclampsia? |
|
Definition
| Liver (fibrin thrombi, hemorrhage, necrosis), kidney (fibrin in glomeruli and capillaries, renal cortical necrosis), brain (hemorrhage and thrombosis), heart and anterior pituitary |
|
|
Term
| What happens to the placenta in preeclampsia-eclampsia? |
|
Definition
| Infarcts, retroplacental hematoma, villous ischemia, acute atherosis** of uterine vessels (fibrinoid necrosis, MAC inflammation) |
|
|
Term
| HTN + edema + proteinuria? |
|
Definition
|
|
Term
| Preeclampsia + headaches and vision changes? |
|
Definition
|
|
Term
| Preeclampsia + convulsions? |
|
Definition
|
|
Term
|
Definition
| Severe preeclampsia + hemolysis, elevated liver enzymes, low platelets |
|
|
Term
| Management of pre-eclampsia/eclampsia if baby is preterm? |
|
Definition
If mild, expectant management
If severe, delivery regardless of fetal age |
|
|
Term
| Long term maternal sequelae after preeclampsia? |
|
Definition
20% develop HTN and microalbuminemia within 7 years
2x increase in heart and brain vascular disease |
|
|
Term
| How can the placenta become infected? |
|
Definition
Ascending bacterial infection (more common) – eg. Acute chorioamnionitis
Hematogenous spread – transplacental + TORCH organisms |
|
|
Term
| What are the TORCH organisms? |
|
Definition
Toxoplasma gondii
Others – Parvovirus B19, syphilis, TB, listeria
Rubella
CMV
HSV, HIV |
|
|
Term
| What do TORCH infection cause? |
|
Definition
| Neonate fever, encephalitis, chorioretinitis, hepatosplenomegaly, pneumonitis, myocarditis, hemolytic anemia, and vesicular or hemorrhagic skin lesions |
|
|
Term
| Term for cystic swelling of chorionic villi with trophoblastic proliferation? |
|
Definition
|
|
Term
| Are hydatiform moles benign or malignant? |
|
Definition
| Benign but we want to know and distinguish them with regard to increased risk of invasive mole or choriocarcinoma |
|
|
Term
| What hormone levels may indicate the presence of a hydatiform mole? |
|
Definition
| elevated hCG beyond normal for pregnancy |
|
|
Term
| what is the most common route of hydatiform mole formation? how else are moles formed? |
|
Definition
1. Partial mole = filled ovum fertilized by two sperm
2. Complete mole = one sperm fertilizes an empty egg than duplicates (90%); two sperm fertilize an empty ovum (10%) ('completely' dad's fault) |
|
|
Term
| which type of mole has an increased risk of choriocarcinoma? |
|
Definition
|
|
Term
| which type of mole has fetal tissue present? |
|
Definition
|
|
Term
| which type of mole has some villi hydropic and some normal? |
|
Definition
|
|
Term
| what are two risks assoc with invasive moles? |
|
Definition
-a part may break off and embolize to distant sites
-uterine rupture |
|
|
Term
| what are risk factors for gestational choriocarcinoma? |
|
Definition
50% derived from complete moles
25% in person with previous abortion
22% in normal pregnancy |
|
|
Term
| what type of cancer presents as vaginal bleeding with brown fluid spotting during pregnancy, after a miscarriage or even months after curretage? |
|
Definition
| gestational choriocarcinoma |
|
|
Term
| is chemo more effective in gestational choriocarcinoma or ovarian choriocarcinoma? |
|
Definition
| chemo is extremely effective in gestational choriocarcinoma; poor prognosis with ovarian choriocarcinoma (spontaneous germ cells tumor) |
|
|
Term
| Where do most breast cancers arise from? |
|
Definition
| Upper outer quadrant and in terminal duct lobular units |
|
|
Term
| What patients are most likely to develop acute mastitis? |
|
Definition
| Breast-feeding women, caused by S. Aureus |
|
|
Term
| What may mimic breast cancer? |
|
Definition
Fat necrosis – generally associated with trauma
Confusion with cancer due to palpable mass or calcification on mammogram |
|
|
Term
| What is the most common benign breast condition? |
|
Definition
Non-proliferative fibrocystic changes--no increased risk of cancer
Other type of fibrocystic change = proliferative (worse – increase risk of getting cancer)
*NOTE: fibroadenoma is the most common benign neoplasm in premenopausal women but fibrocystic change is the most common benign condition overall |
|
|
Term
| What are the histologic components of fibrocystic changes? |
|
Definition
1. Cysts with apocrine metaplasia – Dilated lobules; coalesce and form “blue-dome” cysts grossly
2. Dense fibrosis – Reaction to cyst rupture
3. Adenosis – Increase in the number of acini per lobule. |
|
|
Term
| Compare and contrast fibroadenoma (most common benign tumor) and phyllodes tumor. |
|
Definition
Fibroadenoma = most common benign tumor, usually small, <30, palpable mass, gross: sharply circumscribed nodule, micro: delicate stroma around compressed, distorted slit-like glandular spaces (stroma proliferates and compresses the ducts)
Phyllodes tumor = most are benign but can be borderline or malignant, larger than fibroadenoma, 60s, larger lesions often have bulbous protrusions (pyllodes: leaflike), distinguished from fibroadenomas on the basis of cellularity, mitotic rate, nuclear pleomorphism, stromal overgrowth and infiltrative borders. Phyllodes tumors are hypercellular, invasive into adjacent tissue, mitotically active |
|
|
Term
| What is the most common cause of bloody nipple discharge in younger women? |
|
Definition
| Intraductal papilloma (side note: papillomas are benign and have luminal and myoepithelial cells, whereas papillary carcinomas lack myoepithelial cells). |
|
|
Term
| Describe the mechanism of Paget’s disease and its association with underlying cancer |
|
Definition
| Paget Disease of the breast is DCIS that extends up the ducts to involve the skin of the nipple. It presents as nipple ulceration and erythema. It is almost always associated with an underlying carcinoma. |
|
|
Term
| Rank the following lesions (fibroadenoma, ADH, DCIS, and LCIS) in terms of developing invasive carcinoma after diagnosis. |
|
Definition
Nonproliferative breast changes (fibroadenoma without complex features) (1x)
Proliferative disease without atypia (fibroadenoma with complex features) (1.5-2.0x)
Proliferative disease with atypia (ADH = atypical ductal hyperplasia) (4-5x)
Carcinoma in situ (LCIS, DCIS) (8-10x) |
|
|
Term
| What is the most common breast cancer histologic type? |
|
Definition
|
|
Term
| What are the breast cancers with better prognosis? |
|
Definition
| Medullary, tubular and mucinous types |
|
|
Term
| Which BRCA mutation is associated with higher ovarian cancer risk |
|
Definition
|
|
Term
| Which BRCA mutation is associated with triple negative breast tumors? |
|
Definition
|
|
Term
| Which BRCA mutation is associated with higher male breast cancer risk? |
|
Definition
|
|
Term
| Recognize 4 molecular types of breast cancers (Luminal A, Luminal B, Basal-like and HER2/neu positive carcinoma) |
|
Definition
LUMINAL A: ER+, PR+, HER2/neu-
LUMINAL B: ER+, PR+, HER2/neu+
HER2/NEU : ER-, PR-, HER2/neu+
BASAL-LIKE: Triple negative (ER, PR, HER2/Neu negative), express basal keratins. Carcinomas arising in women with BRCA1 mutations cluster with this group (Poor prognosis). Poorly differentiated, have a syncytial growth pattern with pushing margins, have a lymphocytic response. |
|
|
Term
| what is the single most important factor in predicting breast cancer prognosis? what else is predictive of therapy benefit? |
|
Definition
single most important factor = LN involvement
also predictive = ER and HER2 Neu status |
|
|
Term
| How effective is chemo for breast cancer? what chemo agents are used? |
|
Definition
Administration of chemotherapy reduces recurrence rates by 30%, decrease mortality by 20%. Optimal duration of adjuvant chemo is 3 – 6 months.
Typical agents: Adriamycin, cyclophosphamide, taxanes, trastuzumab if HER2+ |
|
|
Term
| What are some side effects of chemotherapy for breast cancer? |
|
Definition
Short term toxicities: Hair loss, N/V
Anemia, risk of infection
Premature menopause
Cognitive dysfunction
Cardiac dysfunction
Acute leukemia/MDS |
|
|
Term
| What populations can aromatase inhibitors and tamoxifen be used on for treating breast cancer? |
|
Definition
AIs work only in postmenopausal women.
Tamoxifen works in pre and postmenopausal women |
|
|
Term
| what is the inheritance pattern of BRCA1 and BRCA2? |
|
Definition
| Autosomal dominant inheritance, passed via maternal or paternal allele |
|
|
Term
| What are some features that indicate increased likelihood of having BRCA mutations? |
|
Definition
Multiple cases of early onset breast cancer (<50 years)
Ovarian cancer (with family history of breast or ovarian cancer)
Breast and ovarian cancer in the same woman
Bilateral breast cancer
Ashkenazi Jewish heritage
Male breast cancer |
|
|
Term
| What should you do next when you suspect a patient of have a hereditary breast/ovarian syndrome (besides treat them obvi)? |
|
Definition
| refer for genetic counseling |
|
|
Term
| What is the fate of a pt with metastatic breast cancer? |
|
Definition
MBC is incurable. 22% are alive at 5 years.
median survival = 2 years. |
|
|
Term
| What are the most common cancers that metastasize to the breast? |
|
Definition
| bone, lungs, liver, brain |
|
|
