13 Flashcards
1
Q
What lines the vulva?
A
squamous epithelium
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
3
Q
MC cause Condyloma
A
HPV 6 and 11 (LOW RISK)…rarely progress to carcinoma
4
Q
Condyloma
A
warty neoplasm of vulvular skin
5
Q
histological appearance of HPV associated condylomas?
A
koilocytes
6
Q
White patch of parchment like vulvular skin seen in postmenopausal women
A
lichen sclerosis
benign, increased risk for SCC
7
Q
Chronic irritation/scratching> hyperplasia of vulvular sq epithelium> thick leathery vulvular skin
A
lichen simplex chronicus
NO risk of progression to SCC
8
Q
vulvular carcinoma
A
carcinoma from sq epithelium lining vulva
9
Q
vulvular carcinoma in F 40-50
A
HPV related> HR 16,18> VIN> carcinoma
10
Q
vulvular carcinoma in F >70
A
non-HPV related= lichen sclerosis
11
Q
VIN
A
vulvular intraepithelial neoplasia= dysplastic precursor lesion characterized by koilocytic change, nuclear atypia
12
Q
Erythematous, pruritic, ulcerated vulvar skin
A
extramammary paget disease
Malignant epithelial cells in the epidermis of the vulva
13
Q
Pas+, keratin+, S100-
A
Paget cells
14
Q
Pas-, keratin-, S100+
A
Melanoma
15
Q
mucosa that lines the vagina
A
non-keratinizing sq epithelium
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)
17
Q
DES in utero>
A
adenosis
18
Q
Malignant proliferation of glands w/ clear cytoplasm
A
clear cell adenocarcinoma
*rare but feared complication of DES associated vaginal adenosis
19
Q
Bleeding and grape like mass protruding from vagina or penis in child< 5
A
Embryonal rhabdomyosarcoma
Rhabdomyoblast + desmin and myogenin
20
Q
Where does vaginal carcinoma arise from?
A
sq epithelium lining vaginal mucosa
21
Q
spread of cancer from lower 1/3 of vagina
A
inguinal LN
22
Q
Spread of cancer from upper 2/3 of vagina
A
iliac nodes
23
Q
Exocervix vs endocervix
A
exo= nonkeratinizing sq epithelium endo= single layer of columnar cells
24
Q
junction between exocervix and endocervix
A
transformation zone (where HPV likes to infect)
25
Immune response to HPV
normally eradicated by acute inflammation
| persistent infection leads to increased risk cervical dysplasia (CIN)
26
high risk HPV types
16
18
31
33
27
low risk HPV types
6
| 11
28
High risk HPV E6 and E7 proteins
E6 > p53
E7> RB
Loss of TSG > increased risk for CIN
29
Koilocytic change (raisin), disordered cell maturation, nuclear atypia, increased mitotic activity
CIN
30
CIS can progresses to
invasive SCC
31
CIN I
<1/3 (reversible)
32
CIN II
<2/3 (reversible)
33
CIN III
less than entire thickness (reversible)
34
CIS
entire thickness of epithelium (irreversible)
35
Vaginal/postcoital bleeding in middle aged woman (40-50)
Cervical carcinoma
36
Key RFs for Cervical carcinoma
1. HPV
2. smoking
3. immunodeficiency (can't destroy preliminary infection)
37
Most common subtypes of cervical carcinoma
squamous cell
| adenocarcinoma
38
Common cause of advanced death in cervical carcinoma?
hydronephrosis
39
How long does it take for CIN to develop into carcinoma?
10-20 years
*screen at 21, every 3 years after
40
Pap smear
scrape cells from transformation zone
*confirm w/ colposcopy and biopsy
41
HPV immunization
LR: 6, 11
HR: 16, 18
*still do papas d/t limited number of HPV types
42
endometrium
mucosal lining of uterine cavity
43
myometriium
SM wall under the endometrium
44
3 phases of growth of endometrium
1. growth- estrogen driven proliferative phase
2. prep for implant- progesterone driven secretory phase
3. shedding- loss of progesterone (menstruation)
45
Secondary amenorrhea d/t loss of basalis and scarring
asherman syndrome
overaggressive D and C
46
Anovulatory cycle
estrogen driven proliferative phase without subsequent progesterone driven secretory phase>
proliferative glands break down and shed>
dysfunctional uterine bleeding during menarche and menopause
47
Fever
abnormal uterine bleeding
pelvic pain
Acute endometriosis
Retained products of conception lead to bacterial infection of endometrium.
48
abnormal uterine bleeding
pain
infertility
caused by products of conception, chronic pelvic inflammatory disease, IUD, TB
chronic endometriosis
49
necessary for diagnosis of endometriosis
plasma cells
50
abnormal uterine bleeding after taking tamoxifen
endometrial polyp (hyperplastic protrusion of the endometrium)
*weak pro-estrogenic effects on endometirum> polyp
51
retrograde menstruation leading to endometrial glands and stroma outside the uterine endometrial lining
endometriosis
52
dysmenorrhea (pain during menstruation) and pelvic pain
endometriosis
*endometriosis cycles like normal endometrium > pain
53
MC site of endometriosis
ovary = chocolate cyst
*increased risk of carcinoma at site of endometriosis
54
endometriosis and pain w/ defecation
pouch of douglass
55
endometriosis in the uterine myometrium
adenomyosis
56
Postmenopausal uterine bleeding related to UNOPPOSED estrogen (obesity, PCOS, estrogen replacement)
endometrial hyperplasia
57
most important predictor for progression of endometrial hyperplasia to carcinoma
cellular atypia
58
malignant proliferation of endometrial glands
endometrial carcinoma
59
Endometrial carcinoma caused by hyperplasia
50
```
increased estrogen>
increased endometrium>
hyperplasia>
carcinoma>
endomeTRIOD
```
60
Endometrial carcinoma caused by sporadic pathway
70 years
p53 mutation>
serous (papillary tumor)>
psamomma body formation
61
Benign neoplastic proliferation of SM arising from myometrium related to estrogen exposure
Leiomyoma
62
Asymptomatic tumor common in premenopausal women, often multiple, and on gross exam appears as a well defined white whorled mass
Leiomyoma
63
Malignant proliferation of SM from myometrium that arises de novo and is usually seen in POSTmenopausal women
leiomyosarcoma
| single lesion w/ area of necrosis and hemorrhage
64
follicle
oocyte surrounded by granulosa and theca cells
65
LH acts on theca cells>
androgen production
66
FSH stimulates granulosa cells>
converts androgen to estrodiol>
drives proliferative phase of endometrial cycle (1)>
induces LH surge>
ovulation
67
what marks the beginning of the secretory phase of the endometrial cycle
LH surge leading to ovulation
68
what happens to residual follicle after ovulation
becomes corpus luteum and secretes progesterone
69
what drives the secretory phase and prepares the endometrium for a possible pregnancy
corpus luteum which secretes progesterone
70
Hemorrhage into a corpus lutem
hemmorhagic corpus luteal cyst during early preganncy
71
follicular cysts
degeneration of follicles
| common and have no clincical significance
72
PCOD characterization
increased LH and LOW FSH
73
Hirsutism (excess hair in male distribution) + PCOD
increased LH>
excess androgen production from theca cells>
hirsutism
74
Affect of excess LH production on follicles?
increased LH>
excess androgen production from theca cells>
androgen converted to ESTRONE in adipose>
estrone DECREASES FSH>
dystic degeneration of follicles
75
high levels circulating estrone
endometrial cancer
76
Obese young woman w/ infertility, oligomenorrhea, hirsutiism
PCOD
May develop T2D 10-15 yrs later
77
MC type of ovarian tumor
surface epithelial tumor
78
origin of surface epithelial tumor
coelomic epithelium that lines the ovary
79
two most common subtypes of surface epithelial tumors
serous
mucinous
*both are usually cystic
Can be benign, borderline or malignant
80
serous tumors
filled with watery fluid
81
mucinous tumors
filled with mucus like fluid
82
single cyst w/ a simple flat lining
| arises in premenopausal women (30-40)
Benign tumors (cystadenomas)
83
complex cysts with thick shaggy lining
| arise in postmenopausal women (60-70)
Malignant tumors (cystadenomas)
84
Borderline tumors
better prognosis but still have metastatic potential
85
Mutation w/ increased risk for serous carcinoma of the ovary and fallopian tube
BRAC1 mutation
86
Endometriod tumor
subtype of surface epithelial tumor
endometrial like glands, malignant
can arise from endometriosis
*independent endometrial carcinoma is often associated with it
87
Brenner tumor
BLADDER-like epithelium
| benign
88
Tumor that presents late w/ vague abdominal sxs and signs of compression/fullnes
surface tumors
89
Epithelial carcinoma spread
locally, to peritoneum
90
Useful serum marker to monitor tx response and screen for recurrence
CA-125
91
Second MC type of ovarian tumor
GERM cell tumor
92
cystic tumor composed of fetal tissue from 2-3 embryological layers, often bilateral
cystic teratoma
93
cystic teratoma--benign or malignant?
benign
but have to hceck for presence of immature tissue (neural) or somatic malignancy (SCC of skin) can indicate malignant potential
94
Struma ovarii
teratoma composed of thyroid tissue
95
Tumor of large cells with clear cytoplasm and central nuclei
dysgerminoma
*increased LDH
96
MC germ cell tumor in children
endodermal sinus tumor
97
Increased AFP and schiller duval bodies
endodermal sinus tumor
98
malignant tumor of cytotrophoblasts and synctiotrophoblasts that mimics placental tissue but has ABSENT villi
choriocarcinoma
*high bHCG
99
small hemorrhagic tumor w/ early hematogenous spread
choriocarcinoma
100
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
Granulosa thecal cell tumor
neoplastic proliferation of granuolsa and theca cells
101
Tumor associated wtih hirsutism, virilization and Reinke crystals
Sertoli-Leydig tumor
102
mestatic mucinous tumor that involves both ovaries (often d/t gastric carcinoma)
krukenberg
103
massive amts of mucus in the peritoneum d/t mucinous tumor of hte appendix that often has metastasis to the ovary
Pseudomyxoma peritonei
