pearls 1

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#0000CC" TEXT="#080000" background="0443f783.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>USMLE PEARLS</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="USMLE PEARLS"><U><B>home</B></U></A></div> <div> <B>pearls 1</B>   |   <A HREF="id31.htm" TARGET="_top" TITLE="pearls 2"><U>pearls 2</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="pearls3"><U>pearls3</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="pearls 5"><U>pearls 5</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="pearls4"><U>pearls4</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="photo"><U>photo</U></A>   |   <A HREF="id30.htm" TARGET="_top" TITLE="pth"><U>pth</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="cardiac disease in pregnancy"><U>cardiac disease in pregnancy</U></A>   |   <A HREF="id32.htm" TARGET="_top" TITLE="Features of chromosomal defects "><U>Features of chromosomal defects </U></A>   |   <A HREF="id29.htm" TARGET="_top" TITLE="Ultrasound of Fetal Biometrics and Growt"><U>Ultrasound of Fetal Biometrics and Growth</U></A>   |   <A HREF="id28.htm" TARGET="_top" TITLE="FEMALE MASS"><U>FEMALE MASS</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE=" testicular feminization syndrome "><U> testicular feminization syndrome </U></A>   |   <A HREF="id27.htm" TARGET="_top" TITLE="GENYCOMASTIA"><U>GENYCOMASTIA</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="FSH"><U>FSH</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Fragile X Syndrome"><U>Fragile X Syndrome</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Mental Retardation "><U>Mental Retardation </U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Substance Abuse"><U>Substance Abuse</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Infertility"><U>Infertility</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Treatments for Coagulation Disorders in"><U>Treatments for  Coagulation Disorders in Pregnancy </U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="Friedrieichs Ataxia"><U>Friedrieich's Ataxia</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#660066" TEXT="#080000" background="0f7d2c00dkblmu.png"> <div>  <img src="HTMLobj-76/aniGif.gif" border="0" align="bottom" width="120" height="114">   <img src="HTMLobj-75/aniGif.gif" border="0" align="bottom" width="300" height="383">  <IMG SRC="058b4580.jpg" border=0 width="436" height="600" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </td> <td valign="top" height=390 BGCOLOR="#A6CAF0" TEXT="#080000"> <div> <I>pearls 1</I></div> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">most commonly associated with bladder rupture=</B><FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>Blunt trauma with a full bladder [ as don't drive with a full bladder]</B></FONT></div> <bR> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">following groups of predisposing factors is most likely to be associated with carcinoma of the colon:=</B><FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>High-fat diet; ulcerative colitis; diet low in vitamins A, E, C and selenium; Crohn's disease</B></FONT></div> <div> <B>A low-fiber diet, not a high-fiber diet, is associated with an increased incidence of colon cancer and diverticular disease.</B></div> <div> <B>Additional predisposing or risk factors for colon cancer are a</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> high-fat diet,</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> familial polyposis syndromes, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ulcerative colitis, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Crohn's disease, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and a diet low in antioxidant vitamins (i.e., A, C, E) </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and selenium.</B></div> <bR> <bR> <bR> <bR> <bR> <div> =========================================================================================================================</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Primary amenorrhea can be classified into four groups based on the presence or absence of normal breast development and a palpable uterus. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> woman, with <B>normal breast development but without a uterus,</B> has either:</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> testicular feminization syndrome </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">or congenital uterine absence.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">a genetic male has a congenital lack of androgen receptors, and so the normal male levels of testosterone are unrecognized</B>. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Normal female hormonal status is associated with congenital uterine absence, including low levels of testosterone. Thus, measurement of serum testosterone would be the most useful test </B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Follicle-stimulating hormone (FSH)  is helpful for <B><U>differentiating the etiology of primary amenorrhea with absent breasts but uterus present.</U></B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">An<B> elevated FSH level indicates absence of functional follicles, whereas a low FSH level indicates a hypothalamic-pituitary problem.</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Luteinizing hormone (LH) is not helpful because it normally fluctuates significantly during a normal menstrual cycle. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Prolactin  and progesterone  levels do not contribute to the work-up of primary amenorrhea.</div> <bR> <div> <FONT SIZE="3" COLOR="#003333" FACE="Arial" ><B>woman comes to the physician's office stating that she has never had a menstrual period. Physical examination reveals normal breast development, but no uterus can be palpated on pelvic examination.- tests for serum levels would be most helpful in identifying the cause of her amenorrhea</B></FONT><B>:</B><B>Testosterone</B></div> <bR> <div> <B>Externally, she looks like the perfect woman: voluptuous, tall, clear complected, luxuriant hair. Internally, however, things get a little more complicated. Because of Androgen Insensitivity </B><B>Syndrome</B><B> (AIS), on the outside she appears as a woman, but on the inside she has testes instead of ovaries and a uterus. AIS is the inability to utilize the androgens produced by the embryonic testes, so the fetus develops as male (XY) until it is time for the sex organs to mature further. The external genitalia appear female, but internally the testes produce another hormone which inhibits the development of female organs. Because she has no ovaries or uterus, she cannot menstruate or have children</B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="515" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" BGCOLOR=#FF0000 > <tR> <tD VALIGN=TOP HEIGHT= 151 WIDTH="503"><div> <B>Testicular</B><B>-</B><B>Feminization</B><B> </B><B>Syndrome</B></div> <div> <B>- XY individuals </B></div> <div> <B>- female with few traces of masculinity </B></div> <div> <B>- sterile </B></div> <div> <B>- mutation on X chromosome </B></div> <div> <B>- due to inability of embryonic tissue to respond to testosterone</B></div> <bR> </tD> </tR> </TABLE></B></div> <bR> <div> <B>====================================================================================================================================</B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="772" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" BGCOLOR=#FFFFFF > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Classification</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>Definition</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Normospermia</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>Normal ejaculate as defined in Table 2</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Oligozoospermia</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>Sperm concentration <20 x 106/ml</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 39 WIDTH="219"><div> <B>Asthenozoospermia</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>Fewer than 50% spermatozoa with forward progression or fewer than 25% spermatozoa with rapid linear progression</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Teratozoospermia</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>Fewer than 30% spermatozoa with normal morphology</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 39 ><NOBR><div> <B>Oligoasthenoteratozoospermia</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="538"><div> <B>Signifies disturbance of all three variables (combination of only two prefixes may also be used)</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Azoospermia</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>No spermatozoa in the ejaculate</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="219"><div> <B>Aspermia</B></div> </tD> <tD VALIGN=TOP WIDTH="538"><div> <B>No ejaculate</B></div> </tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="072f5f10.png" border=0 width="757" height="497" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B><IMG SRC="07301090.png" border=0 width="769" height="521" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>================================================================================================================================</B></div> <div> <B>FEMALE PELVIC MASS AS CASE PRESENTATION [see my </B><A HREF="http://pathologylectures.homestead.com" TARGET="_top" TITLE="http://pathologylectures.homestead.com"><U><B>pathology lectures </B></U></A><B>female]</B></div> <div> 1/ </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">23-year-old woman, gravida 2, para 1, at <B><U>14 weeks' gestation has a 6-cm unilateral, unilocular pelvic mass.</U></B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The mass is<B><U> separate from the uterus and has been confirmed by serial sonograms. </U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">However, it is <B><U>variable in location, being noted anterior, posterior, and lateral to the uterus</U></B></div> <div> <B>= </B><A HREF="id28.htm" TARGET="_top" TITLE="FEMALE MASS"><U><B>Paraovarian cyst of Morgagni</B></U></A></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </B><B>The case scenario describes a hydatid cyst of Morgagni, also known as a paraovarian cyst.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> They are thin-walled, pedunculated, benign cysts attached to the tubal fimbria.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> They are of</B><B><U> paramesonephric origin</U></B><B> and are usually small, but they can grow to 10 cm in size and can be very mobile.</B></div> <bR> <bR> <bR> <div> <FONT SIZE="3" COLOR="#BF0000" FACE="Arial" ><B>2/</B></FONT><B>34-year-old woman, gravida 1, para 0, at 18 weeks' gestation with </B><B><U>severe hyperemesis</U></B><B> </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f066000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">has a blood pressure of</B><B><U> 150/95 mm Hg, 2+ proteinuria,</U></B><B> </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f066000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and</B><B><U> bilateral adnexal masses</U></B><B> that are 8 cm in diameter and are</B><B><U> multiloculated on a sonogram</U></B></div> <bR> <div> <B>=</B><A HREF="id28.htm" TARGET="_top" TITLE="FEMALE MASS"><U><B>Theca-lutein cyst</B></U></A></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The case scenario describes theca-lutein cysts, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">which occur as a </B><B><U>response of normal ovaries</U></B><B> to excessively high</B><B><U> </U></B><FONT SIZE="3" COLOR="#000000" FACE="Symbol" ><B><U>b</U></B></FONT><B><U>-human chorionic gonadotropin (HCG) titers</U></B><B> </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">which, in this case, are a</B><B><U> result of a molar pregnancy associated with preeclampsia before 20 weeks' gestation.</U></B><B> </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The cysts are bilateral and fluid-filled, growing to massive size. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They disappear when the source of the increased </B><FONT SIZE="3" COLOR="#000000" FACE="Symbol" ><B>b</B></FONT><B>-HCG levels is resolved.</B></div> <bR> <bR> <div> <B>3/</B><B>An 18-year-old woman, gravida 1, now para 1, just delivered a 3500-g (7 lb 12 oz) healthy male neonate without complications. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At </B><B><U>8 weeks' gestation, </U></B><B>she was noted to have a 5-cm</B><B><U> right adnexal cystic mass</U></B><B> that </B><B><U>spontaneously disappeared and was no longer seen on sonogram at 16 weeks' gestation.</U></B></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="FEMALE MASS"><U><B>=Corpus luteum cyst</B></U></A></div> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The case scenario describes a classic corpus luteum cyst of pregnancy that resolved spontaneously when the placenta took over the function of progesterone production. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These cysts are generally unilateral. </B></div> <bR> <bR> <bR> <div> <B>4/</B><B>A 29-year-old woman had her last menses 9 weeks ago.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> She is noted to have a 9- to 10-cm soft, midline pelvic mass.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> She has experienced morning nausea, but no vomiting</B></div> <div> <B>= pregnancy</B></div> <bR> <div> <B>The case scenario describes a normal intrauterine pregnancy.</B></div> <div> <B> This is the most common cause of an enlarged pelvic mass in the reproductive years. </B></div> <bR> <div> <B>5/</B><B>A 5-year-old girl, who shows signs of isosexual complete precocious puberty, is found to have a 4-cm unilateral, solid pelvic mass</B></div> <div> <B>=</B><A HREF="id28.htm" TARGET="_top" TITLE="FEMALE MASS"><U><B>Granulosa cell tumor</B></U></A></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </B><B>The case scenario describes a child undergoing precocious puberty with the finding of a unilateral pelvic mass. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This must be assumed to be a hormonally functional ovarian tumor producing estrogen,</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> such as a granulosa cell tumor, until proved otherwise. </B></div> <bR> <bR> <bR> <div> <B>6/</B><B>A 55-year-old postmenopausal woman shows evidence of </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">temporal balding, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">clitoromegaly, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and increased facial hair. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">She is noted to have a 5-cm unilateral, solid pelvic mass.</B></div> <div> <B>=</B><FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>Sertoli-Leydig cell tumor</B></FONT></div> <div> <B>balding + hair think men think androgen think tumor like men do have = sertoli</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </B><B>The case scenario describes a postmenopausal woman with virilization and a unilateral pelvic mass.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> This must be assumed to be a hormonally functional ovarian tumor producing androgens, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">such as a Sertoli-Leydig cell tumor, until proved otherwise. </B></div> <bR> <div> <B>7/</B><B>28-year-old nulligravid woman is found on routine annual examination to have a 6-cm unilateral pelvic mass. </B></div> <div> <B>On sonogram, the mass is partially solid and partially </B><B><U>cystic with foci of calcifications. </U></B></div> <div> <B>=Benign cystic teratoma</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The case scenario describes a benign cystic teratoma.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Because these tumors derive from primordial germ cells, they may contain any combination of </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">well-differentiated ectodermal,</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> mesodermal, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and endodermal elements.</B></div> <div> <B><U><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Foci of calcification, even the presence of teeth, are common. </U></B></div> <bR> <div> <B>8/</B><B>A 32-year-old infertile, obese nulligravida is noted to have an asymptomatic 7-cm right adnexal mass. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">She has uterosacral ligament nodularity and a fixed retroverted uterus.</B></div> <bR> <div> <B>=endometrioma</B></div> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The case scenario is characteristic for endometriosis.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Endometriomas are </B><B><U>cysts on the ovary that result from accumulation of menstrual-like detritus from endometriosis. </U></B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These </B><FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B><U>"chocolate cysts</U></B></FONT><B>'' can enlarge to many centimeters in size.</B></div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> <a href="HTMLobj-131/USMLE1.htm"><u>USMLE1.htm</u> </a>  </B></div> </td> </tr></table></body>