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Pathoma > 13 > Flashcards

13 Flashcards

1
Q

What lines the vulva?

A

squamous epithelium

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2
Q

A woman of reproductive age presents with a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal.

A

Bartholin cyst

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3
Q

MC cause Condyloma

A

HPV 6 and 11 (LOW RISK)…rarely progress to carcinoma

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4
Q

Condyloma

A

warty neoplasm of vulvular skin

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5
Q

histological appearance of HPV associated condylomas?

A

koilocytes

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6
Q

White patch of parchment like vulvular skin seen in postmenopausal women

A

lichen sclerosis

benign, increased risk for SCC

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7
Q

Chronic irritation/scratching> hyperplasia of vulvular sq epithelium> thick leathery vulvular skin

A

lichen simplex chronicus

NO risk of progression to SCC

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8
Q

vulvular carcinoma

A

carcinoma from sq epithelium lining vulva

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9
Q

vulvular carcinoma in F 40-50

A

HPV related> HR 16,18> VIN> carcinoma

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10
Q

vulvular carcinoma in F >70

A

non-HPV related= lichen sclerosis

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11
Q

VIN

A

vulvular intraepithelial neoplasia= dysplastic precursor lesion characterized by koilocytic change, nuclear atypia

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12
Q

Erythematous, pruritic, ulcerated vulvar skin

A

extramammary paget disease

Malignant epithelial cells in the epidermis of the vulva

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13
Q

Pas+, keratin+, S100-

A

Paget cells

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14
Q

Pas-, keratin-, S100+

A

Melanoma

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15
Q

mucosa that lines the vagina

A

non-keratinizing sq epithelium

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16
Q

focal persistence of columnar epithelium in the upper vagina

A

adenosis

normally sq epithelium from lower 1/3 of vagina (UG Sinus) grows upward and replaces columnar epithelium (from mullerian ducts)

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17
Q

DES in utero>

A

adenosis

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18
Q

Malignant proliferation of glands w/ clear cytoplasm

A

clear cell adenocarcinoma

*rare but feared complication of DES associated vaginal adenosis

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19
Q

Bleeding and grape like mass protruding from vagina or penis in child< 5

A

Embryonal rhabdomyosarcoma

Rhabdomyoblast + desmin and myogenin

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20
Q

Where does vaginal carcinoma arise from?

A

sq epithelium lining vaginal mucosa

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21
Q

spread of cancer from lower 1/3 of vagina

A

inguinal LN

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22
Q

Spread of cancer from upper 2/3 of vagina

A

iliac nodes

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23
Q

Exocervix vs endocervix

A 
exo= nonkeratinizing sq epithelium
endo= single layer of columnar cells
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24
Q

junction between exocervix and endocervix

A

transformation zone (where HPV likes to infect)

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25
Q

Immune response to HPV

A

normally eradicated by acute inflammation

persistent infection leads to increased risk cervical dysplasia (CIN)

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26
Q

high risk HPV types

A

16
18
31
33

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27
Q

low risk HPV types

A

6

11

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28
Q

High risk HPV E6 and E7 proteins

A

E6 > p53
E7> RB

Loss of TSG > increased risk for CIN

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29
Q

Koilocytic change (raisin), disordered cell maturation, nuclear atypia, increased mitotic activity

A

CIN

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30
Q

CIS can progresses to

A

invasive SCC

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31
Q

CIN I

A

<1/3 (reversible)

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32
Q

CIN II

A

<2/3 (reversible)

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33
Q

CIN III

A

less than entire thickness (reversible)

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34
Q

CIS

A

entire thickness of epithelium (irreversible)

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35
Q

Vaginal/postcoital bleeding in middle aged woman (40-50)

A

Cervical carcinoma

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36
Q

Key RFs for Cervical carcinoma

A
  1. HPV
  2. smoking
  3. immunodeficiency (can’t destroy preliminary infection)
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37
Q

Most common subtypes of cervical carcinoma

A

squamous cell

adenocarcinoma

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38
Q

Common cause of advanced death in cervical carcinoma?

A

hydronephrosis

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39
Q

How long does it take for CIN to develop into carcinoma?

A

10-20 years

*screen at 21, every 3 years after

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40
Q

Pap smear

A

scrape cells from transformation zone

*confirm w/ colposcopy and biopsy

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41
Q

HPV immunization

A

LR: 6, 11
HR: 16, 18

*still do papas d/t limited number of HPV types

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42
Q

endometrium

A

mucosal lining of uterine cavity

43
Q

myometriium

A

SM wall under the endometrium

44
Q

3 phases of growth of endometrium

A
  1. growth- estrogen driven proliferative phase
  2. prep for implant- progesterone driven secretory phase
  3. shedding- loss of progesterone (menstruation)
45
Q

Secondary amenorrhea d/t loss of basalis and scarring

A

asherman syndrome

overaggressive D and C

46
Q

Anovulatory cycle

A

estrogen driven proliferative phase without subsequent progesterone driven secretory phase>
proliferative glands break down and shed>
dysfunctional uterine bleeding during menarche and menopause

47
Q

Fever
abnormal uterine bleeding
pelvic pain

A

Acute endometriosis

Retained products of conception lead to bacterial infection of endometrium.

48
Q

abnormal uterine bleeding
pain
infertility

caused by products of conception, chronic pelvic inflammatory disease, IUD, TB

A

chronic endometriosis

49
Q

necessary for diagnosis of endometriosis

A

plasma cells

50
Q

abnormal uterine bleeding after taking tamoxifen

A

endometrial polyp (hyperplastic protrusion of the endometrium)

*weak pro-estrogenic effects on endometirum> polyp

51
Q

retrograde menstruation leading to endometrial glands and stroma outside the uterine endometrial lining

A

endometriosis

52
Q

dysmenorrhea (pain during menstruation) and pelvic pain

A

endometriosis

*endometriosis cycles like normal endometrium > pain

53
Q

MC site of endometriosis

A

ovary = chocolate cyst

*increased risk of carcinoma at site of endometriosis

54
Q

endometriosis and pain w/ defecation

A

pouch of douglass

55
Q

endometriosis in the uterine myometrium

A

adenomyosis

56
Q

Postmenopausal uterine bleeding related to UNOPPOSED estrogen (obesity, PCOS, estrogen replacement)

A

endometrial hyperplasia

57
Q

most important predictor for progression of endometrial hyperplasia to carcinoma

A

cellular atypia

58
Q

malignant proliferation of endometrial glands

A

endometrial carcinoma

59
Q

Endometrial carcinoma caused by hyperplasia

A

50

increased estrogen>
increased endometrium>
hyperplasia>
carcinoma>
endomeTRIOD
60
Q

Endometrial carcinoma caused by sporadic pathway

A

70 years

p53 mutation>
serous (papillary tumor)>
psamomma body formation

61
Q

Benign neoplastic proliferation of SM arising from myometrium related to estrogen exposure

A

Leiomyoma

62
Q

Asymptomatic tumor common in premenopausal women, often multiple, and on gross exam appears as a well defined white whorled mass

A

Leiomyoma

63
Q

Malignant proliferation of SM from myometrium that arises de novo and is usually seen in POSTmenopausal women

A

leiomyosarcoma

single lesion w/ area of necrosis and hemorrhage

64
Q

follicle

A

oocyte surrounded by granulosa and theca cells

65
Q

LH acts on theca cells>

A

androgen production

66
Q

FSH stimulates granulosa cells>

A

converts androgen to estrodiol>
drives proliferative phase of endometrial cycle (1)>
induces LH surge>
ovulation

67
Q

what marks the beginning of the secretory phase of the endometrial cycle

A

LH surge leading to ovulation

68
Q

what happens to residual follicle after ovulation

A

becomes corpus luteum and secretes progesterone

69
Q

what drives the secretory phase and prepares the endometrium for a possible pregnancy

A

corpus luteum which secretes progesterone

70
Q

Hemorrhage into a corpus lutem

A

hemmorhagic corpus luteal cyst during early preganncy

71
Q

follicular cysts

A

degeneration of follicles

common and have no clincical significance

72
Q

PCOD characterization

A

increased LH and LOW FSH

73
Q

Hirsutism (excess hair in male distribution) + PCOD

A

increased LH>
excess androgen production from theca cells>
hirsutism

74
Q

Affect of excess LH production on follicles?

A

increased LH>
excess androgen production from theca cells>
androgen converted to ESTRONE in adipose>
estrone DECREASES FSH>
dystic degeneration of follicles

75
Q

high levels circulating estrone

A

endometrial cancer

76
Q

Obese young woman w/ infertility, oligomenorrhea, hirsutiism

A

PCOD

May develop T2D 10-15 yrs later

77
Q

MC type of ovarian tumor

A

surface epithelial tumor

78
Q

origin of surface epithelial tumor

A

coelomic epithelium that lines the ovary

79
Q

two most common subtypes of surface epithelial tumors

A

serous
mucinous

*both are usually cystic
Can be benign, borderline or malignant

80
Q

serous tumors

A

filled with watery fluid

81
Q

mucinous tumors

A

filled with mucus like fluid

82
Q

single cyst w/ a simple flat lining

arises in premenopausal women (30-40)

A

Benign tumors (cystadenomas)

83
Q

complex cysts with thick shaggy lining

arise in postmenopausal women (60-70)

A

Malignant tumors (cystadenomas)

84
Q

Borderline tumors

A

better prognosis but still have metastatic potential

85
Q

Mutation w/ increased risk for serous carcinoma of the ovary and fallopian tube

A

BRAC1 mutation

86
Q

Endometriod tumor

A

subtype of surface epithelial tumor
endometrial like glands, malignant
can arise from endometriosis

*independent endometrial carcinoma is often associated with it

87
Q

Brenner tumor

A

BLADDER-like epithelium

benign

88
Q

Tumor that presents late w/ vague abdominal sxs and signs of compression/fullnes

A

surface tumors

89
Q

Epithelial carcinoma spread

A

locally, to peritoneum

90
Q

Useful serum marker to monitor tx response and screen for recurrence

A

CA-125

91
Q

Second MC type of ovarian tumor

A

GERM cell tumor

92
Q

cystic tumor composed of fetal tissue from 2-3 embryological layers, often bilateral

A

cystic teratoma

93
Q

cystic teratoma–benign or malignant?

A

benign

but have to hceck for presence of immature tissue (neural) or somatic malignancy (SCC of skin) can indicate malignant potential

94
Q

Struma ovarii

A

teratoma composed of thyroid tissue

95
Q

Tumor of large cells with clear cytoplasm and central nuclei

A

dysgerminoma

*increased LDH

96
Q

MC germ cell tumor in children

A

endodermal sinus tumor

97
Q

Increased AFP and schiller duval bodies

A

endodermal sinus tumor

98
Q

malignant tumor of cytotrophoblasts and synctiotrophoblasts that mimics placental tissue but has ABSENT villi

A

choriocarcinoma

*high bHCG

99
Q

small hemorrhagic tumor w/ early hematogenous spread

A

choriocarcinoma

100
Q

Tumor that presents w/ signs of estrogen excess:
prior to puberty- precocious puberty
reproductive age- menorrhagia or metorrhageia
post meno- endometrial hyperplasia w/ postmeno uterine bleeding

A

Granulosa thecal cell tumor

neoplastic proliferation of granuolsa and theca cells

101
Q

Tumor associated wtih hirsutism, virilization and Reinke crystals

A

Sertoli-Leydig tumor

102
Q

mestatic mucinous tumor that involves both ovaries (often d/t gastric carcinoma)

A

krukenberg

103
Q

massive amts of mucus in the peritoneum d/t mucinous tumor of hte appendix that often has metastasis to the ovary

A

Pseudomyxoma peritonei

Pathoma (13 decks)

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