Choriocarcinoma
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Choriocarcinoma is a highly malignant tumor that arises from chorionic epithelium. About 50% of cases develop after molar pregnancies or hydatidiform moles, while 30% occur after miscarriages and 20% after normal pregnancies. The primary site is usually anywhere in the uterus, though rarely it starts in the fallopian tubes or ovaries. It spreads rapidly through vascular erosion, commonly metastasizing to the lungs in 80% of cases, anterior vaginal wall in 30%, and brain and liver in 10% each. Symptoms include persistent ill health, irregular vaginal bleeding, and continued amenorrhea, as well as coughing, breathlessness, or headaches from metastatic sites.
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Choriocarcinoma
This document discusses choriocarcinoma, a type of gestational trophoblastic disease. It is a malignant neoplasm composed of atypical trophoblasts that develops after a molar pregnancy, abortion, or normal pregnancy. Key signs and symptoms include vaginal bleeding, abdominal pain, and metastases. Diagnosis involves elevated HCG levels and imaging. Treatment depends on the stage, with single-agent chemotherapy used for low risk early stages and multi-agent chemotherapy for advanced or high risk stages. Monitoring of HCG levels is important after treatment.
Ovarian tumors
Ovarian tumors can be primary (arise in the ovary) or secondary (spread from other sites). The most common primary ovarian tumor is epithelial ovarian cancer, which arises from ovarian surface cells. Germ cell tumors arise from egg-producing cells and are more common in children/teens. Stromal tumors produce hormones. Risk factors include nulliparity, family history of breast/ovarian cancer, and hereditary conditions. Epithelial tumors are classified as malignant, borderline, or benign. Staging involves assessing spread from ovaries to other pelvic/abdominal sites or distant metastasis. Treatment depends on stage but may include surgery and chemotherapy.
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Choriocarcinoma and its management
Gestational choriocarcinoma is a malignant neoplasm of the trophoblast that develops after pregnancy and can spread rapidly to distant organs like the lungs, brain and liver. Diagnosis involves testing serum hCG levels and imaging tests, while treatment primarily consists of combination chemotherapy like the EMACO regimen for high-risk cases. The prognosis is excellent even in metastatic disease, with cure rates approaching 100% for low-risk early stage choriocarcinoma. Careful long-term follow-up by monitoring serum hCG levels is important after treatment.
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1. The document discusses various types of ovarian tumours, including benign, borderline, and malignant surface epithelial tumours as well as germ cell tumours and sex cord-stromal tumours.
2. Etiological factors for ovarian tumours include nulliparity, heredity such as BRCA gene mutations, and genetic syndromes like Lynch syndrome.
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Ovarian tumors can be primary (arise in the ovary) or secondary (spread from other sites). The most common primary ovarian tumor is epithelial ovarian cancer, which arises from ovarian surface cells. Germ cell tumors arise from egg-producing cells and are more common in children/teens. Stromal tumors produce hormones. Risk factors include nulliparity, family history of breast/ovarian cancer, and hereditary conditions. Epithelial tumors are classified as malignant, borderline, or benign. Staging involves assessing spread from ovaries to other pelvic/abdominal sites or distant metastasis. Treatment depends on stage but may include surgery and chemotherapy.
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- It affects 5-15% of women and common symptoms include pelvic pain, painful periods, infertility.
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Ovarian cancer
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Molar pregnancy
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Gestational trophoblastic diseases
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
Leiomyomas
Uterine leiomyoma, commonly known as uterine fibroids, are benign smooth muscle tumors of the uterus that are sensitive to estrogen. They are quite common, affecting 20-30% of reproductive-aged women. Risk factors include being African American, nonsmoking, obesity, and perimenopausal age. While often asymptomatic, fibroids can cause symptoms like bleeding, pain, infertility, and pregnancy complications. Treatment options depend on symptoms and include expectant management, medical therapies, myomectomy, uterine artery embolization, hysterectomy, and potentially future gene therapies.
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Endometriosis- Easy explanation with Management...
Endometriosis- Easy explanation with Management...
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1) The uterine corpus is composed of endometrial mucosa and underlying myometrium. Inflammation of the endometrium is classified as acute or chronic endometritis, which can be caused by various bacteria or retained tissue/foreign bodies.
2) Adenomyosis is the growth of endometrial tissue into the myometrium, causing symptoms like heavy periods. Endometriosis is defined as endometrial tissue outside the uterus, commonly affecting ovaries and other pelvic structures.
3) Common proliferative lesions of the uterus include endometrial hyperplasia, which can progress to cancer, endometrial cancer itself, endometrial polyps, and
Invasive Mole
Invasive mole is a complication of molar pregnancy where abnormal villi grow into the myometrium or blood vessels. It occurs in approximately 15% of complete moles and can metastasize to other organs. Clinical features include persistent hemorrhage and uterine perforation. Microscopically, proliferating trophoblast tissue is seen invading the myometrium. Treatment involves chemotherapy, with single or combination drug regimens depending on the disease stage. The goals are to normalize hCG levels and administer additional "clean-up" courses of chemotherapy.
INVASIVE CERVICAL CANCER
Invasive cervical cancer is most commonly epidermoid (squamous cell) carcinoma, arising from the squamocolumnar junction. The risk factors are the same as for cervical intraepithelial neoplasia. Advanced disease spreads to nearby structures like the bladder, rectum, and lymph nodes. Distant metastases occur in organs like the lungs and liver. Histologically, squamous cell carcinoma is the most common type, followed by adenocarcinoma and other rare variants. Clinical staging uses the FIGO system to determine treatment and prognosis.
Gestational trophoblastic diseases
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.
Placental pathology
This document provides information about placental pathology. It describes the structure, development, functions and examination of the placenta. It discusses various anomalies and non-neoplastic lesions seen in placenta such as twin pregnancy, succenturiate lobes, membranacea and infarcts. It also covers tumors and tumor-like conditions including chorioangioma and gestational trophoblastic disease. Complete hydatidiform mole is described as a condition caused by abnormal gametogenesis resulting in trophoblastic hyperplasia and cistern formation.
Path anat(disease of the uterus body)
Cancer of the uterus is a common cancer that affects the female reproductive system. Abnormal vaginal bleeding is the most common symptom. Diseases that can affect the reproductive system include cancers of the prostate, breast, ovaries, penis, uterus, and testicles. The uterus is a major female reproductive organ located in the pelvis. Diseases of the uterus include prolapse, cancers of the cervix and uterus, fibroids, adenomyosis, infections, and uterine malformations. Benign lesions of the uterus include endometrial polyps and Asherman's syndrome. Uterine fibroids are a common benign tumor of the uterus that can cause heavy bleeding, pain, and infertility. Treatment options depend on symptoms
Gestational trophoblastic neoplasia
Pathophysiology, Classification,Gestational trophoblastic neoplasia, presentation, management, WHO scoring , FIGO staging
Gt ds
Gestational trophoblastic disease (GTD) forms a spectrum of tumors arising from placental tissue. Most GTDs are benign, but some can become malignant. The tumors include molar pregnancies, invasive moles, and choriocarcinoma. Molar pregnancies are categorized as complete or partial based on morphology and karyotype. Complete moles lack fetal tissue and have paternal chromosomes only. Partial moles contain fetal tissue and are usually triploid. Invasive moles and choriocarcinoma can metastasize and secrete hCG. Treatment involves surgery and multi-agent chemotherapy, with cure rates near 100% even in metastatic cases. Prognosis depends on factors like hCG
ENDOMETRIOSIS
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
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Uterine sarcomas are rare, aggressive cancers that arise from the muscular or connective tissues of the uterus. The main types are leiomyosarcomas, endometrial stromal sarcomas, and malignant mixed müllerian tumors. Uterine sarcomas commonly spread through the bloodstream to vital organs like the lungs and liver. Patients typically present with abnormal vaginal bleeding and abdominal pain. Diagnosis is made through histological examination of tissue samples obtained through procedures like uterine curettage.
Vulval carcinoma
Vulval carcinoma has pre-invasive and invasive types. Pre-invasive vulval intraepithelial neoplasia (VIN) is classified into three grades based on the thickness of the affected epithelial layer. Invasive vulval carcinoma commonly presents in postmenopausal white women as ulcerative or hypertrophic lesions on the labia or clitoris. It spreads locally through direct invasion or lymphatically to the inguinal and pelvic lymph nodes, and more rarely hematogenously to distant sites. Risk factors include HPV infection, chronic irritation, obesity, and lack of childbearing.
Vaginal & cervical carcinoma
Vaginal carcinoma is a rare type of cancer making up about 1% of genital malignancies. Risk factors include HPV, a history of cervical cancer, and exposure to diethylstilbestrol (DES) in utero. Symptoms may include abnormal vaginal bleeding, discharge, or asymptomatic growths. Diagnosis involves cytology, colposcopy, and biopsy of any abnormal cells or growths. Treatment depends on the type and stage but can include surgery, radiation, chemotherapy, or a combination. The most common type is squamous cell carcinoma arising from the upper third of the posterior vaginal wall. It typically spreads locally or via lymph nodes but can metastasize to distant organs in more advanced cases.
Endometrial carcinoma
The document discusses endometrial cancer. It notes that the incidence is highest among white populations in the US and lowest in India and Japan. Unopposed estrogen stimulation is the main risk factor. Risk increases with late menopause after age 52, obesity, family history of certain cancers, and nulliparity. Symptoms include postmenopausal bleeding, irregular bleeding, and abnormal discharge. Diagnosis involves endometrial biopsy and imaging tests. The cancer spreads locally within the uterus first and then can spread to lymph nodes or distant sites like lungs and liver.
Assisted reproductive technology
This document discusses Assisted Reproductive Technologies (ART) such as in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). It outlines the steps of an IVF cycle including down regulation, ovarian stimulation, oocyte retrieval, fertilization, embryo transfer, and luteal phase support. Key indications for IVF include tubal disease, endometriosis, male factor infertility, and others. Ideal patient selection criteria include age under 35, normal ovarian reserve, and screened partners. GIFT is a more invasive procedure that involves transferring eggs and sperm directly into the fallopian tubes for fertilization to occur in vivo.
SEXUALLY TRANSMITTED INFECTIONS
This document discusses several sexually transmitted infections (STIs), including gonorrhea, chlamydia, syphilis, and HIV/AIDS. It describes the causative organisms, sites of infection, clinical features, complications, diagnosis, and treatment for each STI. STIs can cause local and distant infections and lead to serious complications like infertility, ectopic pregnancy, and pelvic inflammatory disease if left untreated. Proper diagnosis and treatment of STIs and prevention of transmission are important for individual and public health.
Radiotherapy AND CHEMOTHERAPY
Radiotherapy and chemotherapy are important modalities for treating cancer alongside surgery. Radiotherapy can be curative for cervical cancer, while chemotherapy is curative for gestational trophoblastic neoplasia. Radiotherapy involves delivering high doses of radiation precisely to tumor volumes using techniques like CT, MRI, and brachytherapy to spare normal tissues. Radiation damages DNA in cells, inhibiting their ability to reproduce and survive. Chemotherapy aims to induce complete or partial remission and prevent recurrence, though it can cause side effects affecting many organ systems like the gastrointestinal tract, skin, heart, and immune system.
MEDICAL TERMINATION OF PREGNANCY
Medical termination of pregnancy can be performed for medical reasons to save the life of the mother, for social reasons such as an unplanned pregnancy in a woman with low socioeconomic status, or for eugenic reasons if abnormalities are found in the fetus. Termination is allowed up to 20 weeks and requires consent from the woman and in some cases her guardian. In the first trimester, termination can be performed through medical methods using mifepristone and misoprostol or through surgical vacuum aspiration. In the mid-trimester, prostaglandins or dilatation and evacuation are used. Complications can include cervical injuries, hemorrhage, infections, and future risks to pregnancy like preterm labor or ect
Ovarian tumours
This document discusses ovarian tumours, including their incidence, types, clinical features, and complications. It provides information on common varieties such as mucinous cyst adenoma, serous cyst adenoma, and dermoid cyst. For each variety, it describes origin, pathology, naked eye appearance, microscopic examination, and clinical features. It also discusses complications like torsion of the pedicle and covers differential diagnosis, investigations, and management of ovarian tumours.
Malignancies
Vulval carcinoma is a rare cancer that occurs more commonly in postmenopausal white women over age 60. It is associated with obesity, HPV infection, and other vulval disorders. Symptoms include a vulval ulcer or mass, pain, bleeding, and pruritus. The cancer spreads locally and via lymph nodes. Vaginal carcinoma is also rare, more common in younger women in India. Symptoms include vaginal discharge and bleeding. Endometrial carcinoma risk increases with prolonged, unopposed estrogen exposure and late menopause. Postmenopausal bleeding is the most common symptom. It spreads locally and via lymphatics, sometimes hematogenously.
Anemia in pregnancy
1. The document discusses various types of anemia that can occur during pregnancy including physiological anemia, iron deficiency anemia, megaloblastic anemia, and hemoglobinopathies like sickle cell anemia and thalassemia.
2. It provides details on the causes, signs and symptoms, complications, investigations, and management of these anemias.
3. Specific attention is given to megaloblastic anemia caused by folic acid deficiency which is a common form of anemia during pregnancy, as well as the effects and management of sickle cell anemia and thalassemia during pregnancy.
Physiological changes during pregnancy
This document describes the physiological changes that occur in a woman's body during pregnancy. It discusses changes in the vulva, vagina, uterus, breasts, skin, blood, metabolism, respiratory and cardiovascular systems, urinary system, alimentary system, nervous system, and weight gain. The major changes include increased blood volume and cardiac output, softening of tissues like the cervix, hypertrophy of organs like the breasts, and temporary changes to skin pigmentation and the distribution of weight gain.
Sexual dysfunctions
Sexual dysfunctions can manifest as vulval ulcers, which are predominantly caused by sexually transmitted diseases. Rarely, vulval ulcers may be due to nonspecific causes. Malignant ulcers are also a rare cause of vulval ulcers.
Puberty
Puberty in girls is a period of profound biological, morphological, and psychological changes between childhood and adulthood that leads to maturity and fertility. Key changes include breast development, pubic and underarm hair growth, increased height, and menstruation occurring between ages 10-16 with peak onset at 13 years. Precocious puberty refers to signs of secondary sex characteristics before age 8 or menstruation before 10. It can be central, involving normal progression of puberty starting too soon, or peripheral, caused by excess sex hormones from problems in ovaries, adrenal glands or pituitary gland. Diagnosis involves assessing growth, bone age, hormone levels and ruling out tumors or other lesions. Prognosis is generally good with
ENDOCRINOLOGY IN RELATION TO REPRODUCTION
Follicular maturation during the menstrual cycle is driven by the hormones FSH and LH. Estrogen is also necessary for continued FSH activity. Under FSH influence, around 20 follicles develop but only one will ovulate while the rest become atretic. The corpus luteum secretes progesterone and estradiol to prepare the uterus for implantation. During pregnancy, the placenta produces hormones including hCG, hPL, progesterone and estrogens that help maintain the corpus luteum, promote fetal growth and prepare maternal organs for the demands of pregnancy. These hormones have roles in immunoregulation, thyroid stimulation, angiogenesis and development of maternal breasts and the fetus.
Amenorrhoea PCOD
This document discusses various causes of delayed puberty and abnormal sexual development, including hypothalamic-pituitary dysfunction, Kallmann syndrome, central nervous system tumors, and chromosomal abnormalities. It then covers hypergonadotropic hypogonadism conditions like Turner's syndrome and primary ovarian failure. Treatment options are mentioned for specific conditions like vaginal reconstruction for vaginal agenesis or gonadectomy for androgen insensitivity syndrome. Postpartum pituitary necrosis is summarized as causing failing lactation, loss of pubic hair, and secondary amenorrhea due to low levels of hormones like growth hormone, prolactin, and gonadotropins.
Hirsutism
This document discusses the clinical approach and management of hirsutism and virilism. It defines hirsutism as excessive hair growth in androgen-dependent areas, while virilism is a more severe form involving additional masculine features. The clinical approach involves assessing a patient's history and examination findings to determine the severity and underlying cause. Management aims to remove excess hair, suppress androgens, and remove their source. Treatment options depend on the site of androgen overproduction and may include oral contraceptives, antiandrogens, cosmetic treatments like bleaching or laser, and surgery to remove tumors.
Abnormal puerperium
This document discusses several abnormalities that can occur during the postpartum period, known as the puerperium. It defines puerperal pyrexia as a temperature over 100°F occurring on two occasions within the first 10 days postpartum. Puerperal sepsis is defined as an infection of the genital tract occurring as a complication of delivery. Common causes of infection include bacteria like Staphylococcus and Streptococcus. Risk factors, signs and symptoms, treatments and management strategies are described for various postpartum infections and other issues like subinvolution, urinary tract infection, breast engorgement, and cracked nipples.
Post partum haemorrhage
This document defines postpartum hemorrhage as blood loss exceeding 500ml following childbirth. It occurs in 1% of hospital deliveries and can be primary (within 24 hours of delivery) or secondary (later). The main causes are an atonic uterus, trauma during delivery, or issues with blood coagulation. An atonic uterus accounts for 80% of cases as the uterus is unable to contract and retract fully after delivery. Risk factors include grand multiparity, overdistension of the uterus, malnutrition, prolonged labor, and mismanaged delivery of the placenta. Diagnosis involves visible vaginal bleeding and a flabby uterus that firms with massage. Prevention focuses on antenatal screening and care of high-
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2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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7. Discuss the placement and polarity of the leads of electrocardiograph
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Choriocarcinoma
- 2. • Choriocarcinoma is a highly malignant tumor arising from the chorionic epithelium. • About 50 percent of all patients with molar pregnancies/ hydatidiform mole develop choriocarcinoma. • 30 percent occur after a miscarriage or an ectopic pregnancy • 20 percent after an apparently normal pregnancy.
- 3. PATHOLOGY The primary site is - • Anywhere in the uterus. • Rarely, it starts in the tube or ovary.
- 4. NAKED EYE APPEARANCE • DIFFUSE AND LOCALIZED • The lesion is usually localized nodular type. The nodular type may be located deep in the myometrium with overlying endometrium intact. • It looks red, hemorrhagic and necrotic. • At times, the lesion is diffuse involving the entire endometrium.
- 5. MICROSCOPIC APPEARANCE • There are anaplastic sheets or columns of trophoblastic cells invading the uterine musculature. • Evidences of necrosis and hemorrhage. • Villus pattern is completely absent.
- 6. SPREAD • Local spread common • Vascular erosion takes place early and hence distant metastases occur rapidly. • The common sites of metastases are • lungs (80%), • anterior vaginal wall (30%), • brain (10%), • liver (10%)
- 7. CLINICAL FEATURES Symptoms : • Persistent ill health. • Irregular vaginal bleeding, at times brisk. • Continued amenorrhea. Other symptoms due to metastatic lesions are: • Lung: Cough, breathlessness, hemoptysis. • Vaginal: Irregular and at times brisk hemorrhage. • Cerebral: Headache, convulsion, paralysis or coma. • Liver: Epigastric pain, jaundice.
- 8. Signs: • Patient looks ill. • Pallor of varying degrees. • Bimanual examination reveals subinvolution of the uterus. • There may be a purplish red nodule in the lower-third of the anterior vaginal wall
- 9. FIGO STAGING