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curdy white discharge
candida albicans vaginitis
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copious gray green discharge
trichonomas vaginalis vaginitis
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organisms causing purulent vaginal discharge in cervicitis
Chlamydia, trich, candida, HPV and HSV
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organism causing acute nonspecific form of cervicitis
staph or strep
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most common population in acute cervicitis
post partum women
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Chronic inflammatory obstruction of the cervical glands occuring over time
Nabothian cyst
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Soft masses that are few cm in diameter that protude from the cervix and may bleed
Endocervical polyps
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What is the prognosis of endocervical polyps?
No malignant potential
-
Pap smears have dramatically lowered the incidence of what type of cancer?
cervical
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Most invasive cervical SCC arise from?
CIN
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Pronosis of CIN
Some progress to invasive CA, some don't
-
Describe CIN I
mild dysplasia, generally involving lower 1/3 of cervical epithelium
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Describe CIN II
Moderate dysplasia, generally involving the lower 2/4 of the cervical epitheilium
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Describe CIN III
severe dysplasia and carcinoma in situ, involving the entire thickness of the epithelium
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What is the peak ageo f CIN?
30 years
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Peak age of invasive Ca?
45 years
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What are risk factors for CIN?
Early age at first intercourse, multiple sexual partners, or a male partner with multiple previous sexual partners
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Most common organism in precancerous cervical lesions and invasive neoplasms
HPV (85-90%)
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Which HPV types are associated with precancerous lesinos and invasive neoplasms?
16, 18, 31, 33
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Which HPV types are associated with benign condylomas?
6, 11, 42, 44
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Most invasive carcinomas of the cervix are of what type?
SCC
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Cauliflower like mass which may encircle the cervical os
fungating form of invasive carcinoma of the cervix
-
Sloughing of central surfce of the tumor
ulcerative form of invasive carcinoma of the cervix
-
Carcinoma grows downward into the underlying stroma
infiltrative invasive carcinoma of the cervix
-
Advanced lesions of invasive carcinomas of the cervix may extend into where?
LN, rectu, bladder, ureters
-
circulated lesion, beefy red
Advance invasive carcinoma of the cervix
-
What are the sx of carcinoma in situ?
They are usually asx
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What are the sx of invasive carcinoma?
irregular bleeding, dysuria, burning, vaginal discharge
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Mortality from invasive cervical carcinomas are usually from what?
local effects (obstruction of ureters, or penetration into the bladder or rectum)
-
How much time elapses in between the insitu and invasive stages of cervical carcinoma?
10 yeras
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Soft polypoid masses occring in infants and children under 5 years that may occur in bladder and bile ducts also
sarcoma botyroides
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Soft polypoid masses, coming from the vaginal orifice, that are large and grape like and can be aggressive
Sarcoma botyroides
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Sessile lesions, 0.5-3.0 cm in diameter
Endometrial polyps
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What are endometrial polyps made of?
They are covered with columnar cells and adenomatous stroma
-
What is the prognosis of endometrial polyps?
They may produce abnormal uterine bleeding, and may in rare cases give rise to cancer
-
Which type of female GU polyps don't have any malignant potential?
endocervical polyps
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Causes of DUB
- Any dysfunction of the hypothalamus, pituitary gland, thyroid
- Ovarian lesion
- Malnutrition (absence of building blocks needed to produce secretory phase)
- Obesity (makes more estrogen)
- Stress
-
What causes endometrial hyperplasia?
- excess of estrogen relative to progestin
- Excess estrogen can be caused by ovarian tumors or steroids
-
What cancer is associated with endometrial hyperplasia?
endometrial carcinoma
-
women in late teens whose mothers were exposed to DES
Vaginal clear cell adenoma
-
Glandular differentiation with cells with relatively clear cytoplasm, not forming normal glands, that are clumped
Vaginal clear cell adenoma
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What are the differences btewen adenomyosis and endometriosis?
- Tissue type: adenomyosis is glandular tissue, endometriosis is endometrium tissue
- Deposit location: adenomysis is muscle (myometrium), endometriosis is outside the uterus
- Cyclic bleeding: unusual in adenomyosis, common in endometriosis
-
What are common areas for endometriosis?
Ovaries, pouch of douglas, uterine ligaments, rectovaginal septum
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Red blue to yellow-brown nodule or implants that can markedly vary in size
endometriosis
-
blood filled cysts in the ovaries which may rupture and lead to fibrosis of pelvic structures
chocolate cysts, associated with endometriosis
-
growth of endometrial basal layer into the myometrium
adenomysosis
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Bilateral ovarian tumors
- SESTs-serous, mucinous
- GCTs-teratomas
-
unilateral ovarian tumors
- SESTs-Brenner tumor
- GCT-dysgerminoma
- SXSCT-Granulosa thecal cell, fibroma-thecoma, Sertoli leydig cell tumors
-
Which ovarian tumors may have a borderline, malignant, benign counterpart/subtype?
surfce epithelial stromal tumors (all types)
-
Serous ovarian tumors are usually (B/L or U/L?)
30-50% are B/L
-
Mucinous ovarian tumors are usually (B/L or U/L?)
10-20% B/L
-
Mostly multiloculated cysts containing mucinous material
mucinous tumors
-
Honey comb type of appearance, filled with thicker mucinous material
pseudomyxoma peritonei: implant on peritoneal structures, associated with mucinous ovarian tumors
-
What hormones do dysgernimonas produce?
Increase levels of gonadotrophin
-
What hormones do yolk sac tumors and endodermal sinus tumors produce?
increase levels of afp and A1AT
-
What hormones do granulosa tumors produce?
estrogen
-
What hormones do fibroma-thecomas produce?
may secrete estrogen
-
What homrones do sertoli-leydig cells produce?
may have estrogenic effects
-
Gestational trophoblastic dz produces what hormone?
HCG
-
What are risk factors for ectopic pregnancies?
PID
-
Which moles are triploid?
Partial hydatidiform
-
Which moles are diploid?
complete hydatidiform mole
-
Which moles have fetal parts?
partial hydatidiform moles
-
Which moles don't have fetal parts?
complete hydatidiform
-
Which moles are invasive?
- invasive mole (but not true metastasis)
- Choriocarcinomas (vascular invasion common)
-
Proliferative endometrium collapses and bleeds
DUB
-
Most common benign tumor in females
Leiomyoma
-
what stimulates the growth of leiomyomas?
estrogens
-
Well circumscribed gray white masses
Leiomyomas
-
Whils of smooth muscles (circular loops of smooth muscle)
leiomyoma
-
Uterine tumor that can result in abdominal enlargement
leiomyoma
-
May become hemorrhagic or calcified
leiomyoma
-
Solitary, infiltrating polypoid or discrete tumors
Leiomyosarcomas
-
Frequent mitoses, cellular, atypia
Leiomyosarcoma
-
Difference in gross appearance between leiomyomas and leiomyosarcomas
- Leiomyomas are small to very large, and may be multiple
- Leiomyosarcomas have a more loose appearance, are more hemorrhagic, and are often solitary
-
Age range affected by benign ovarian tumors
20-45 yo
-
Age range affected by malignant ovarian tumors
40-65 yo
-
Predisposing factors for ovarian cancer
nulliparity, FH, heritable mutations, gonadal dysgenesis, BRCA-1, BRCA-2, mutationsin p53
-
What decreases the incidence for ovarian cancer?
OCPs
-
What is the most common type of ovarian cancer?
serous cystadenocarcinomas, arising from surface epithelium
-
Her2/neu oncogene
Associated with a poor prognosis in adenocarcinomas, present in 30%
-
cystic spaces with papillary formations filled with clear fluid
serous ovarian tumor
-
multi loculated containing mucinous material
mucinous ovarian tumor
-
Large cystic mass with solide areas
Endometrioid tumors
-
Cystic nests of cells resembling transitional cells with grooved nuclei
Brenner tumor
-
Cyst wall wrinkled and gray
-
-
Bulky with smooth external surface; solid with necrosis and hemorrhage
Immature teratoma
-
solid, soft, fleshy, yellow white
dysgerminoma
-
Composed of large vesciular cells with clear cytoplasm, well defined borders, and a centrally located nucleus
dysgerminoma
-
Lymphocytic infiltrate
dysgerminoma
-
prognosis of dysgerminomas
All are malignant, but only 1/3 are aggressive and overall survival is good
-
Schiller duval body
Yolk sac tumor
-
Glomerulus structure with central blood vessel enveloped by germ cells within a space lined by germ cells
-
Schiller duval body, associated with yolk sac tumors
-
Call exner bodies
Granulosa-Theca cell tumors
-
Hemorrhagic tumor masses with vascular invasion
choriocarcinomas
-
Tetraploid mole
partial hydatidiform(only some though)
-
Bunch of grapes that distend the uterus
Complete hydatidiform mole
-
No identifiable embryo
Complete hydatidiform mole
-
Results from fertilziation of an egg that has lost its chromosomes by either one or two sperm
Complete hydatidiform mole
-
Complete mole in which the villi penetrate the myometrium of its vessels
invasive mole
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