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Discussion Starter · #1 ·
A 16 year old female presents to your clinic because she is concerned about not having her first period. She is 5'5 and 120 lbs. On physical exam, she has normal breast development but scanty pubic hair and her vagina is short and ends in a blind pouch. Karyotyping reveals that she is 46 XY. The malignancy associated with this patient's condition is most likely to first metastasize to which of the following?

  • Lung
  • Liver
  • Prostate
  • Inguinal Lymph Nodes
  • Para-aortic Lymph Nodes
  • Breast
 

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Discussion Starter · #6 ·
Correct!

You guys are all over it!

This is a case of androgen insensitivity. Here is a full explanation if you would like to know more:

This patient presents with Androgen Insensitivity Syndrome. This disorder is associated with an increased risk of germ cell tumors because of undescended testes. The most common germ cell tumor associated with AIS is a seminoma (good prognosis because it responds well to treatment). Recall that germ cell tumors metastasize via lymphatics. Knowing this, you can narrow down your answer choices to D and E because the question asks about first metastasis. To come up with the final answer, you have to think about the development of the testes. They first developed in the abdomen (retroperitoneal) and then descended at about 7-8 months of gestation so the first site of metastasis would most likely be Para-aortic lymph nodes (recall that the aorta is retroperitoneal). Inguinal lymph nodes drain the skin of the penis, the scrotum, vulva, etc. (superficial structures) but not the testes.
 
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