Reproductive Pathology Fact Stack

1. Reproductive Pathology Fact Stack Mike Ori

2. Disclaimer • Faculty has not reviewed or vetted the information contained herein. • If you think this material is any way accurate, you are mistaken. • Celebrity voices are impersonated

3. Which hormone is responsible for endometrial proliferation and which for increased gland development?

4. Estrogen is proliferative • Progesterone is responsible for gland maturation

5. Define dysfunctional uterine bleeding

6. Bleeding between menstrual cycles caused by abnormalities in the cycle or by systemic disease and not by organic abnormalities. • I.E. Hormone imbalances caused by PCOS, liver disease, etc

7. Define abnormal uterine bleeding

8. The occurrence of bleeding at times other than the expected menses.

9. Describe the structure of the endometrium

10. An epithelium composed of stroma and glands with a relatively constant stratum basalis and a variable stratum functionalis. The latter undergoes cyclic growth, maturation, and degeneration in response to estrogen and progesterone.

11. Define endometriosis

12. The presence of endometrial glands or stroma outside the uterine cavity.

13. Define adenomyosis

14. Endometrial tissue within the myometrium at a depth of 2+mm from the stratum basalis.

15. What are the common sx of endometriosis

16. Dysmenorrhea • Menstral irregularities • Recurrent pelvic pain • Infertility (30-40%)

17. What are the three theories of regarding the genesis of endometriosis

18. Menstrual regurgitation • Blood/lymphatic dissemination • Metaplasia

19. What is the most common organism for suppurative salpingitis

20. Neisseria Gonorrhea

21. Distinguish primary fallopian tube adenocarcinoma from secondary (ovarian origin).

22. Must have a dominant tubal mass involving the lumen of the tube that originates from tubal epithelium.

23. Define gestational trophoblastic disease

24. A variety of tumors and tumor-like conditions characterized by proliferation of pregnancy-associated trophoblastic tissue of increasing malignant potential.

25. Describe hydatidiform moles

26. Pathologic cystic swelling of the chorionic villi with variable degrees of associated trophoblastic proliferation. Resulting in high levels of HCG, large for gestational age uterus, and passage of small grape-like structures. The distribution is bimodal with peaks in teens and then forties.

27. Describe the three benign subclasses of moles

28. Complete – swelling of all or almost all villi with diffuse trophoblastic hyperplasia. These result from the fertilization of an empty ovum by two sperm (2x1n) or by a single 2n sperm. All genetic material is of paternal origin. There is absent or limited vascularization of the villi. • Partial – The fusion of a 1n ovum and 1x2n or 2x1n sperm resulting in a 3n fertilization. The fetus may be viable for weeks and thus fetal parts and an amniotic sac may be present. Both normal appearing and hydropic villi will be seen. HCG level are high but are less than with complete mole. • Invasive – invasion of the myometrium by hydropic villi. Responds well to chemotherapy.

29. Describe choriocarcinoma

30. A malignant neoplasm of the chorionic epithelium characterized by a large, bulky, soft, fleshy, yellow-white mass with areas of hemorrhage and necrosis that does not develop chorionic villi. • 50% arise from previous GTD • 25% from normal pregnancy • 25% follow abortion

31. List the benign ovarian cysts

32. Follicular cysts – serous > 2cm • Luteal cysts – Lined by layers of granulosa cells conveying bright golden yellow color. Usually regress spontaneously • Cystic follicles – serous < 2cm

33. List the sx associated with ovarian cancer

34. Pelvic or abdominal pain • Pelvic and abdominal swelling • Vague but persistent GI issues • Unexplained changes in bowel habits • Urinary urge and increased frequency • Ongoing unusual fatigue

35. Rank the incidence and prognosis for ovarian, endometrial, and cervical cancer from most common to least common and from most serious to least

36. Incidence (most common -> least common) • Endometrial > ovarian > cervical • Prognosis (worst -> best) • Ovarian > cervical > endometrial

37. Which blood test can you use to confirm ovarian cancer

38. There is no confirmatory blood test. CA-125 is used as a tracking test to monitor progression of the disease.

39. What are the risk factors for ovarian cancer?

40. Family hx (Ovarian, colon, prostate (?), breast) • Increasing age • Undesired infertility

41. What explains the prognostic difference between endometrial and ovarian cancer?

42. Endometrial cancer presents in post menopausal women with vaginal bleeding – an obvious sign. In contrast, ovarian cancer presents with vague signs that require clinical experience and judgment to recognize as part of a larger syndrome. Hence, ovarian cancer presents at a more advanced stage.

43. Which cancers is the pap smear diagnostic for?

44. The pap smear is not diagnostic for any cancer. It is a screening test. Any positive indicator must be followed by culposcopy and biopsy.

45. What is the average age of a patient diagnosed with breast cancer. What is the male:female ratio

46. 64 years • 1:100 M:F

47. Describe the structure of the lactating human breast and the importance of this structure for the development of cancer

48. Secretory lobules filled with alveoli lined with epithelial and surmounted by myoepithelium. Components are separated by connective tissue stroma and adipose tissue. Lobules connect to the nipple via ducts. Cancers typically arise in the ductal > lobular epithelium

49. Describe the clinical presentation of breast disease in broad terms

50. Pain • Palpable mass • Nipple discharge • Mammographic screenin abnormality