215, 216, 219 female pathology Flashcards
What is the cellular lining of the cervix?
glandular epithelium (upper portion) and squamous epithelium (lower portion)
- separated by a transformation zone*
- glandular surface replaced with squamous epithelium after onset of menarche*
What is the main factor driving squamous dysplasia and invasive cervical carcinoma?
high risk HPV infection
What is the carcinogenic mechanism of high risk HPV?
E6 accelerates p53 degradation
E7 disrupts E2F-Rb dimers
What is the most common morphology of cervical cancer?
squamous cell carcinoma
What is the gross and microscopic appearance of squamous cell cervical carcinoma?
gross: exophytic, friable mass
microscopic: nests of squamous cells infiltrating the stroma
key features: intracellular bridges between adjacent tumor cells, keratinization (bright orange/pink) inside or outside cytoplasm
What are the histological features of squamous dysplasia?
high N:C ratios, enlarged/crowded nuclei with irregular contours, mitotic figures above the basal layer
no invasion of the underlying stroma
When does cervical dysplasia become carcinoma in situ?
when it involves the full thickness of the epithelium
What type of cell is pathognomonic for HPV infected squamous cells?
koilocytes
What HPV serotypes cause condyloma?
6, 11
What are the pathologic hallmarks of condyloma?
1) papillae
2) epithelial thickening
3) koilocytic change
What are the pathologic features of lichen sclerosus?
1) epidermal thickening
2) sclerotic stroma
3) band like dermal lymphocytic infiltrate
What can lichen sclerosus develop into?
vulvar squamous cell carcinoma
What are the pathologic features of lichen simplex chronicus?
epithelial thickening and keratinization secondary to chronic scratching
What are the major causes of vulvar squamous cell carcinoma?
HPV (30%), lichen sclrosis (older women)
What is Paget’s disease?
pruritic, crusted, erythematous vulvar lesion
usually associated with benign neoplasms of sweat glands (or occasionally underlying malignancy)
What are the 3 Ms of herpes simplex?
multinucleation, molding (nuclei shape each other), margination
What is the histology of proliferative endometrium?
What are the histological changes of secretory endometrium?
early: subnuclear vacuoles
mid: sawtooth glands with secretions and stromal edema
late: decidualized stroma, spiral arterioles, inflammation
What are the histological characteristics of endometrial polyps?
fibrotic stroma
thick-walled vessels
irregular glands
What are the histological characteristics of adenomyosis?
islands of endometrial glands and stroma in myometrium
What are the histologic characteristics of chronic endometritis?
plasma cells in stroma with other stromal changes (e.g. spindling)
What are the histological findings of endometriosis?
endometrial glands and stroma
hemosiderin-laden macrophages
What features define hyperplasia with atypical features?
glandular crowding and irregularity + nuclear atypia
high rate of progression to carcinoma
Compare the ages and causes (conditions and mutations) of type I and type II endometrial carcinoma.
type I: 55-65 yo, caused by unopposed estrogen/obesity/diabetes, associated with PTEN mutation and lynch syndrome
type II: 65-75 yo, caused by atrophy, associated with p53 mutations
What are the histological findings of type I endometrial carcinoma?
fused glands, squamous metaplasia
What are the histological findings of type II endometrial carcinoma?
papillary or glandular growth pattern, marked nuclear atypia
can be serous carcinoma or carcinosarcoma
What are the treatment options for endometrial carcinoma?
hysterectomy +/- adjuvant therapy
some women of reproductive age may want to treat with progesterone at first to preserve fertility and then have a hysterectomy when finished with childrearing
What are the histological findings of leiomyoma?
well-circumscribed, round masses made of bundles of spindled smooth muscle cells arranged at various angles
What are the parameters that differentiate leiomyosarcoma from leiomyoma?
1) mitotic activity (>10 per hpf)
2) tumor necrosis
3) atypia (moderate to severe)
What is the most common type of type I endometrial carcinoma?
endometrioid carcinoma
What are the histological findings of acute salpingitis, chronic salpingitis, and hydrosalpinx?
acute: distended plicae with abundant inflammatory cells
chronic: fused plicae, cyst-like spaces
hydrosalpinix: dilated fallopian tube lumen
What are the histologic features of ectopic pregnancy?
chorionic villi and fetal tissue within tube lumen
What mutations are associated with serous tubal intraepithelial carcinomas? What other malignancies are they associated with?
mutations: BRCA1, BRCA2, p53
associated with high-grade serous ovarian carcinomas
What are the differences between type I and type II epithelial malignancies?
type I: low grade, slowly progressing, associated with many different mutations
type II: high-grade serous carcinoma, aggressive, associated with p53 mutations
What are the histologic features of clear cell carcinoma?
clear cytoplasm, hobnail cells
What is the difference between mature and immature teratoma?
mature = benign, no embryonal tissue
immature = malignant, embryonal/immature tissue present
What histologic finding is associated with yolk sac tumors?
Schiller-duval body
What are the histologic findings of granulosa cell tumors?
call-exner bodies (looks kinda like immature follicles)
