1.
1. Acute and Chronic endometritis, risk and micro findings?
2. Endometriosis- Endometrioma
3. Adenomyosis and sympt?
4. Most common tumor of female genital tract? population? hormonal changes?: 1.1. Acute: pregnancy or abortions
1.2. Chronic: Pelvic Inflammatory disease, IUD (actinomyces). Plasma cells in endometrium.
2. End. tissue anywhere else-End tissue in ovary
3. End tissue in myometrium, menorrhage, dysmenorrhea.
4. Leiomyomas, african, Estrogen rcpt, Pregnacy enlarges.
2.
1. Bartholin Gland Abscess, Bact? presentation?
2. Lichen sclerosis, clinical presentation, micro? cancer?
3. Liquen Simplex Chronicus. Cause, gross and micro?
4. Vaginal Adenosis, micro, associated disease and risk factor?: 1. Gonococcus. Painful gland.
2. White patch in elderly, epidermal thinning. smalllll risk of squamous cell carcinoma.
3. Chronic scratching, white patch, squamous cell hyperplasia and dermal scarring.
4. Glands in vagina: Clear cell Adenocarcinoma, DES in utero
3.
1. Causes of amenorrhea?: 1. Pregnancy, Polycystic ovarian syndr.
Premature Ovarian menopause
Prolactinoma, Hypothyroidism (high prolactin), Kallman syndrome
Exercise, stress, eating disorders
4.
1. Causes of Placental Abruption
2. Names of Progesterone phase in menstrual cycle?
3. When does luteal phase start?: 1. HTN, smoking, cocaine, older maternal age
2. secretory, luteal phase
3. 24-36 hrs BEFORE OVULATION when granulosa cell LH rcp (lutinizing ovary)
5.
1. Common bact in Acute Mastitis?
2. Most common cause of Breast lumps?
3. Years of fribocystic changes?: 1. Staph a.
2. Fibrocystic changes>Normal Breast>Cancer: Fibroadenoma (<35yo) Invasive ductal adenocarcinoma (>50yo)
3. reproductive years.
6.
1. Embryonal Rhabdomyosarcoma (Sarcoka Botryoides) population, gross and micro findings. Stains?
2. PRIMARY Vag Squamous Cell carcinoma.
3. SECONDARY Vag Squamous Cell carcinoma.
4. Rhabdomyoma
5. Gartner Duct cyst
6. Rokitansky-Kuster-Hauser Syndrome.: 1. < 4yo, polyps grape-like. Spindle-shaped tumor cell with cross striations. Cambium layer (under epidermis). Desmin-actin-vimectin +
2. HVP infection
3. From cervical cancer
4. Skeletal muscle tumor
5. Cyst lateral wall (wolffian duct)
6. No upper vagina and uterus. (1ry amenorrhea)
7.
1. Fibroadenoma, population? micro findings? gross?
2. Phyllodes Tumor, name? population? prognosis?
3. Intraductal papilloma, presentation, micro findings?: 1. most common benign if <35yo. increase normal stroma+diffuse fibrosis. round, movable, cleft like spaces on gross.
2. Cystosarcoma phyllodes, fibroadenoma variant, >50yo, rarely metastasize.
3. unilateral bloody nipple discharge. papillary growth within lactiferous ducts or sinuses.
8.
1. Hirsutism
2. Virilization clinical findings?
3. Causes of virilization?
4. How to ID origin?
5. Treatment?: 1. Male pattern hair
2. clitoromegaly, increased muscle bulk, breast atrophy.
3. Congenital adrenal hyperplasia, P. Ovarian Synd
4. DHEAS and dexamethasone suppression test
5. Dexamethasone, Spirinolactone (antiandrogenic)
9.
1. How the increased prolactin during pregnancy doesn't produce lactation before parturition.
2. Parturition hormonal start?: 1. high blood prolactin but estrogen blocks prolactin rcp in breasts. After birth, drop estrogen, free rcp, lactation.
2. Descended head + relaxin (soften cervix). high PGlandins and oxitocin (plus more oxitocin rcp).
3. Lysosomal action on fetal proteins>toxic proteins>high PGlandins
10.
1. Human Chorionic Somatomammotropin (hCS) or Human placental lactogen (hPL) from placenta, Effect? Marker of?
2. Modern fasting risk of?
3. Excessive hCS causes?
4. Worst cardiac disease during pregnancy?: 1. similar GH, high lipolysis and ketogenesis (energy for mother), low glucose uptake (more for baby). Hyperinsulinemia. Placental well being
2. ketosis
3. Gestational Diabetes, risk of Diabetes type II
4. Pulmonary hypertension with Eisenmenger disease.
11.
1. If no fertilization, end of corpus leteum?
2. Excreted form of estradiol and progesterone?
3. 17 beta estradiol? Estrone? Estriol?
4. Androgens types found in women and origin?
5. Best days for intercourse for fertilization: 1. Low LH, low progesterone: Menses
2. Estrone or estriol. Pregnanediol glucuronide.
3. Adult life. Menopause, from fat tissue (androgens+aromatase). Placenta
4. testosterone to DHT but skin 5alpha reductase.
5. 11th to 14th day (3 days prior ovulation)
12.
1. Inflammatory carcinoma.
2. Causes of Gynecomastia? and micro findings?: 1. skin's lymphatics infiltration, by invasive ductal carcinoma. Worst prognosis. Peau d'orange.
2. Physiologic (any age), Klineffelter, prolactinoma. Drugs (spirinolactone or ketoconazole). Ductal epith hyperplasia, Ductal elongation-branching, increase periductal fibroblasts, high vascularity,
13.
1. Low sperms account?
2. Preimplantation and until 2nd month of gestation progesterone source?
3. 3rd month to term progesterone and estrogen source?: 1. < 20 million/ml
2. Pituitary LH> Progesterone. Placental hCG (similar to LH)> 17-OHprogesterone (measure for corpus luteum function).
3. LDL in placenta>Progesterone. Fetal adrenals in placenta> aromatase> estriol (marker placental fx)
14.
1. Mother with normal parturition, with <24hrs without lactation?
2. Lactation hormones status?: 1. first time parturition, high estrogen level for 24 hrs.
2. low PIF(dopamin): high prolactin milk production, low FSH, LH, high oxytocin (milk eyection).
15.
1. Names of Follicular phase of menstrual cycle?
2. Granulosa cell and theca cell activity.
3. Estrogen fase at this fase? from negative to positive feedback.: 1. Estrogenic, mitotic phase, preovulatory.
2. High FSH>aromatase>Estradiol (stimulate own follicle and inh FSH-LH production: Dominant follicle). Inhibin-activins production
- High LH>Cholesterol>androgens (to granulosa)
3. Early: inh LH-FSH. Preovulatory: Stim LH surge.
4. Thick mucus, endometr proliferation, female features,
16.
1. Ovulation, Hormonal status?
2. Effects of LH surge?
3. Special condition for granulosa cell transformation? production?
4. Progesterone effects?: 1. LH surge + Estrogen fall
2. Follicular rupture after 24-36 hr of starting + completed 1rst meiosis + formation luteal cells (before rupture), corpus luteum (after rupture)
3. Estrogen+FSH: stop aromatase-estradiol> LH rcp + progesterone (negative feedback on LH surge).
4. Inh LH, thin mucus, secretory endometrium, increase Tº 0,5(close ovulation) -1ºF, apetite (cachexia in cancer patient)
17.
1. Pap Smear features?
2. Cause of death in cervical cancer
3. Cervical polyps, symptoms?
4. Acute Cervicitis, bact cause: 1. high nuclei/cytoplasm ratio, membr varies, dark nuclei, different sizes.
2. ureters obstruction
3. Postmenopause bleeding.
4. Chlamydia (Follicular cervicitis-newborn conjunctivitis or pneumonia), gonococcus, trichomonas vag, candida, Herpes Simplex II.
18.
1. Papillary hidradenoma, type of tumor, localization? gross and micro findings?
2. Extramammary paget Disease of Vulva, localization, micro findings, related disease?
3. Squamous cell Carcinoma of vulva, Clinical presentation, micro, risk factors?
4. Melanoma of vulva, stains?: 1. Apocrine sweat gland labia majora benign. Milkline mimicks carcinoma (ulcerate). Intraductal papilloma.
2. Labia majora paget cells in epidermis, no underlying tumor. PAS +
3. Elderly with itching and bleeding of vulva. Keratin pearls, desmosomes. Smoking, HIV, HPV 16
4. PAS-, S100+ similar to paget disease.
19.
1. Polycystic ovarian DIsease
2. Cystadenoma.
3. Cystadenocarcinoma, gross, and micro findings?
4. if running in family, cause? tumor marker? spreading?: 1. high LH and testosteron, low FSH. Oligoovulation (1ry-2ry amenorrhea), hirsutism, infertility, obesity.
(severed aromatase in granulosa cells)
2. most common benign in ovary, one big cyst.
3. common malignant in ovary, multicystic, stratified lining, papillary structures with psammoma body.
4. Seeding, BRCA-1, Lynch syndrome. CA 125.
20.
1. Sites of Ovarian metastasis?
2. Epithelial cell ovarian tumor? >20 yo: 1. Breast, colon, endometrium, gastric "signet ring cell" cancer (Krukenberg)
2. Serous-mucinous tumor, Endometrioid Cancer, Brenner tumor, clear cell tumor, cystadenocarcinoma
21.
1. Types of Fibrocystic changes? and cancer risk
2. differences of fibrocystic changes from breast cancer.: 1.1. Nonproliferative (no cancer risk): Fibrosis, cysts, microcalcification, apocrine metaplasia.
1.2. Proliferative (risk); Ductal hyperplasia (if with atypia highest risk), sclerosing adenosis, small duct papilloma.
2. bilateral, multiple nodules, menstrual variation, cyclic pain, regress during pregnancy.
22.
Breast Carcinoma: 1. age, early menarche, nulliparuty, obesity, exog estrogens, atypical hyperplasia of fibrocystic changes. 10% BRCA1 chrom17 (repairing), BRCA2 chrom 13. Li-fraumeni syndrome.
2. painless, fixed mass, nipple retraction , skin dimpling.
3. Axillary node, Size-type, ER/PR rcpt? (tamoxifen), c-erbB2(HER2/neu). Flow cytometry Sphase.
23.
Breast Carcinoma
Stellate, white-tangritty mass.
Treatment?
1. Local (surgery)
2. metastasis?: 
2. Tamoxifen, chemotherapy
24.
Breast Carcinoma.
1. Preinvasive Lesion
2. Invasive (infiltrative) ductal Carcinoma80% 3. Invasive (infiltrative) lobular Carcinoma10%
4. Mucinous (colloid) carcinoma
5. Tubular Carcinoma
6. Medullary Carcinoma: 1. Ductal or Lobular Carcinoma in situ, Paget Disease
2. elderly+bloody discharge+mass. Moss common carcinoma, ducts+fibrosis (desmoplastic stroma)
3. Small bland tumor (like lymph node), high risk of bilateral tumor. Single file pattern.
4. Best prognosis, flowing cells in mucin.
5. no metastasize, good prognosis.
6. Pleomorphic syncytial cells surrounded by dense lymphocytic layer. good Prognosis.
25.
Choriocarcinoma
1. type of tumor
2. gross and micro findings
3. Spreading? treatment?
4. Causes of enlarged placenta?: 1. Malignant germ cell.
2. Necrotic-hemorrhagic mass with cyto and syncytiotrophoblasts.
3. Hematogenous Spreading. Chemotherapy
4. Diabetes, siphilis, Rh hemolytic disease.
26.
Classification of Cervical Carcinoma
CIN Cervical Intraepithelial Neoplasia
SIL Squamous Intraepithelial Lesion
- Symptoms?: 1. CIN I (Mild Dysplasia) low grade SIL
2. CIN II (Moderate dysplasia) high grade SIL
3. CIN III (Severe dysplasia) high grade SIL
4. CIS (in situ) (local resection)
5. Invasive Sq Cell Carcinoma and keratin pearls
- Postcoital bleeding, dyspareunia, malodorous discharge.
27.
Endometrial Carcinoma
1. % of cancer
2. population, risk factors?
3. gross, prognosis, micro type?: 1. Most common malignancy in female genital tract.
2. Postmenopausal bleeding. Estrogen use, HTN, Diabetes, Obesity, Granulosa cell tumor, Tamoxifen, Endometrial Hyperplasia, Lynch Syndrome.
3. Polyypoid mass, worst if invating myometrium. Endometroid adenocarcinoma.
28.
Follicular Phase
- Early: low LH, slow rising Estrogen
- Late: low LH, rapid rising Estrogen
- Ovulation: high but going down estrogen + LH surge. Progesterone increasing.: 
29.
Granulosa cell tumor
Yellow because of cholesterol.: 
30.
Hormones during Pregnancy
- hCG
- hPL
- Prolactin
- Progesterone
- Estriol, estradiol, estrone: 
31.
Hydatidiform Mole
1. Complete, chromosomes? fetal tissue? Prognosis?
2. Partial, chromosomes? fetal tissue? Prognosis?
3. clinical findings? Diagnosis, micro.
4. If after curettage still high bHCG?: 1. only father chromosomes (46 XX), no fetal tissue. 2% risk of choriocarcinoma.
2. 69XXY, fetal tissue, rare choriocarcinoma.
3. High bHCG, excessive uterine enlargement, vaginal bleeding and grapelike tissue. Swollen chorionic villi, trophoblasts and fetal tissue.
4. Invasion to myometrium (10% cases in both types), or choriocarcinoma (2% in complete type)
32.
Leiomyoma symptoms:
1. menorrhagia, abd mass or pain, infertility, abortion.
2. Leiomyosarcoma (HEMATOGENOUS spreading): 
33.
Ovarian Fibroma
Most common sex cord stromal tumor: 
34.
Paget Disease of breast.: 
35.
Paget Disease of breast.
1. gross findings?
2. associated disease?
3. micro findings?: 1. Ulceration, oozing crusting, fissuring of nipple and areola.
2. Associated with invasive - in situ ductal carcinoma.
3. intraepidermal solitary tumor cells (paget cells with perinuclear halo)
36.
Pelvic Inflammatory disease
1. Bact?
2. Violin String adhesions?
3. symptoms?
4. complications?
5. Types of Cervical cancer? HPV MOA? risks?: 1. Gonococcus, Chlamydia.
2. Perihepatitis (fitz-hugh-Curtis syndrome).
3. Cervicitis (discharge), bleeding, endometritis, salpingitis.
4. Tubal obstruction or abscess, intestinal obstruction
5. Squamous cell, Adenocarcinoma, Small cell neuroendocrine carcinoma. 16, 18, 31, 33. E6 oncog (p53), E7 (Rb), multipary, smoking, early age sex.
37.
Pregnancy changes
Uterus. Cardiac, TPR, RBC, Kidney, Endocrin?: 1.- increase myometrium, all breast tissues.
- high CO, low TPR (parallel circuit placenta), low BP at beginning.
- 25% more RBC mass, 40% plasma vol (dilutional anemia)
- Low renal glucose threshold. Glucosuria NORMAL.
- High T4 total, normal free T4
- increase size pituitary (estrogen)-Sheehan: No lactation>hypothyroidism>hypocortisolism
38.
SEX CORD STROMAL all ages
1. Ovarian Fibroma, gross, complication?
2. Sertoli-Leydig Cell tumor (androblastoma)
3. Granulosa cell tumor, symptoms, secretion
4. Complications, micro findings?: 1. firm white mass, Meigs Syndrome: Fibroma+ascities+pleural effusion (right sided)
2. Androgen producer, risk female pseudohermaphroditism.
3. Estrogen producer, Precocious puberty, irregular menses, postmenop vaginal bleeding.
4. Endometrial hyperplasia and ductal invasive breast cancer. Follicular like structures (call-exner bodies)
39.
Teratoma (Dermoid Cyst) (0-25yo)
1. micro findings?
2. prognosis and malignancy?
3. complications?
4. Struma ovarii
Dysgerminoma(0-25yo)
5. Similar to? related disease? treatment? prognosis?
6. Other Germ cell tumors?: 1. female benign, ectoderm (skin, hair, neural), mesodeerm (bone, cartilage), endoderm (thyroid...).
2. Squamous cell carcinoma
3. torsion, rupture, malignant (1%)
4. mainly thyroid tissue.
5. Seminoma, Turner syndrome, Pseudohermaphrodites. Radiation. good prognosis
6. Yolk sac tumor (endodermal sinus tumor), choriocarcinoma
