Cancer of the female genital structures, major breast diseases, disorders of the breast, evaluation of male infertility, evaluation of primary/secondary amenorrhea

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Biomedical Science
BMS 460
D.Rao Veeramachaneni

13 December Cancer of the Female Genital Structures Endometrium Endometrial hyperplasia and adenoma Benign adenomas are not recognized clinically (as they may be discarded in the menstrual blood); if they present, they are indistinguishable from endometrial hyperplasia Hyperplastic glands may be with or without atypia; atypia may progress to adenocarcinoma Pathogenesis of endometrial cancer Considered an estrogen-induced malignancy 25% - 30% of women with complex hyperplasia may progress to atypia or adenocarcinoma Estrogen-induced hyperplasia and neoplasia might be related to the inactivation of a tumor suppressor gene, PTEN (phosphatase and tensin homologue) PTEN is also a target of DMRT1 Endometrial biopsy Dilation and curettage (D&C) Staging of endometrial cancer Most important prognostic feature Stage I – carcinoma confined to endometrium Stage II – carcinoma extending into cervix and invading myometrium Stage III – tumor extending through wall of the uterus but not outside pelvis Stage IV – carcinoma infiltrating the bladder or extending outside of pelvis 5-year survival (with therapy) Stage I: 90% Stage II: 50% Stage III: 20% Stage IV: 5% Ovary Ovarian tumors Complex group of benign and malignant lesions Surface epithelial origin – cystadenocarcinoma Germ cell origin – teratoma Sex cord stromal cell origin – granulosa cell tumor Non-specific or metastases from other organs Ovarian cancer Leading cause of death from gynecologic cancer Prophylactic oophorectomy and salpingo-oophorectomy in high risk women Major Breast Diseases Overview Breast diseases predominantly affect females Breast consists of cells and tissues that respond to hormones Each age group of women is affected by different breast diseases The functional status of the breast predisposes this organ to different diseases, e.g., mastitis Galactorrhea Spontaneous milk flow Mechanical stimulation of nipple; most common physiologic cause Prolactinoma; most common pathologic cause (i.e., spontaneous milk flow not associated with childbirth or nursing) Primary hypothyroidism; most common non-pituitary endocrine disease Fibroadenoma Occurs mostly in young women Freely movable, encapsulated masses delineated from surrounding breast tissue Exaggerated respond to sex hormones Usually do not recur Some hormonal and neoplastic diseases may be interrelated Disorders of the Breast Benign conditions Cyclic changes Estrogens and progesterone stimulate proliferation of cells in ducts and intralobular stroma During luteal (secretory) phase of the cycle fluid accumulates primarily because of hydration of loose connective tissue (CT) inside lobules, which is reversed at menses with hormonal withdrawal Fibrocystic disease Occurs mostly in middle-aged women Hyperplastic reactive and degenerative changes occur when hormonal cyclicity is perturbed Loose intralobular CT is replaced by dense CT that is rich in collagen but unresponsive to hormones – fibrosis The ductal epithelium, which retains its responsiveness to hormones, continues to proliferate – cysts develop Palpable masses that fluctuate with menstrual cycle – fibrosis and cysts Malignant conditions – carcinoma of the breast Hormonal, chemical and genetic influences Inherited forms account for only 20% of all cases of breast cancer BRCA-1 and 2 account for 80% familial cases but not involved in non-familial cases Women with an inherited defect in BRCA1 have ~85% risk of developing breast cancer and a 40 – 60% risk of ovarian cancer 80% invasive ductal carcinomas, 10% invasive lobular carcinomas; both are preceded by CIS The remainder is com
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