Ch 13 Pathoma - Female Genital System and Gestational Pathology Flashcards

1
Q

<p>Anatomically includes the skin and mucosa of the female genitalia external to the hymen (labia major and minor, mons pubis, and vestibule) and is lined by \_\_\_\_\_ epithelium.</p>

A

<p>Vulva; squamous</p>

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2
Q

<p>A Bartholin cyst arises from obstruction of the \_\_\_\_\_\_\_\_, (present on each side of the vaginal canal and drains a mucus like fluid in to the lower vestibule). Usually occurs in \_\_\_\_\_\_ and presents as a \_\_\_\_ and \_\_\_\_ cystic lesion.</p>

A

<p>Bartholin gland; women of reproductive age; unilateral; painful</p>

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3
Q

<p>\_\_\_\_\_ is a warty neoplasm of vulvar skin, most commonly due to \_\_\_\_\_. Histologically characterized by \_\_\_\_\_.</p>

A

<p>Condyloma; HPV 6 or 11 (less commonly secondary syphilis); koilocytes</p>

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4
Q

<p>\_\_\_\_\_\_ is characterized by thinning of the epidermis and fibrosis of the dermis. Presents as a \_\_\_\_\_\_ with parchment like vulvar skin. Most commonly seen in \_\_\_\_\_ women. Yes/No increased risk for SCC.</p>

A

<p>Lichen sclerosis; white patch (leukoplakia); postmenopausal; Yes</p>

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5
Q

<p>\_\_\_\_\_\_ is characterized by hyperplasia of the vulvar squamous epithelium. Presents as \_\_\_\_\_\_\_ with thick, leathery vulvar skin. Associated with \_\_\_\_\_\_\_. Yes/No increased risk of SCC.</p>

A

<p>Lichen simplex chronicus; leukoplakia; chronic irritation/scratching; No</p>

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6
Q

<p>Three potential causes of leukoplakia of the vulva</p>

A

<p>lichen sclerosis, lichen simplex chronicus, vulvar carcinoma</p>

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7
Q

<p>Vulvar carcinomas presents as \_\_\_\_\_\_. It can be related or not related to \_\_\_\_. When it is related, it arises from \_\_\_\_\_. When it is not related, it arises most often from \_\_\_\_. Age difference</p>

A

<p>leukoplakia; HPV; VIN (vulvar intraepithelial neoplasia); lichen sclerosis; HPV related seen in women of reproductive age; HPV non related seen in women >70 yrs</p>

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8
Q

<p>\_\_\_\_\_\_ is characterized by malignant epithelial cells in the epidermis of the vulva. Presents as \_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_ vulvar skin. It represents carcinoma in situ usually with no underlying carcinoma (different from \_\_\_\_\_). Must be distinguished from melanoma, done with these three stains.</p>

A

<p>Extramammary paget disease; erythematous; pruritic; ulcerated; paget disease of the nipple;

~~~
paget = PAS+, keratin+, S100-
melanoma = PAS-, keratin-, S100+</p>

~~~

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9
Q

<p>Adenosis; Increased incidence in females who were exposed to \_\_\_\_\_ in utero</p>

A

<p>focal persistence of columnar epithelium in upper vagina (lower 1/3 of vag is sq epith derived from urogenital sinus, which during development overtakes the columnar epith of the upper 2/3 derived from Mullerian ducts); diethylstilbestrol (DES)</p>

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10
Q

_______ is a malignant proliferation of glands with clear cytoplasm. It is a rare complication of ___-associated vaginal adenosis

A

Clear cell adenocarcinoma; DES

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11
Q

Embryonal rhabdomyosarcoma is a malignant ______ proliferation of ______. It presents as ______ and a ____ mass protruding from the vagina or penis of a child (usually

A

mesenchymal; immature skeletal muscle; bleeding; grape-like; sarcoma botryoides; cross-striations; desmin; myogenin

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12
Q

Vaginal carcinoma’s precursor lesion is ______. When spread to regional lymph nodes occur, cancer from lower 1/3 spreads to _____, and cancer from upper 2/3 goes to _____.

A

VAIN (vaginal intraepithelial neoplasia); inguinal nodes; iliac nodes

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13
Q

Vulvar intraepithelial neoplasia (VIN), CIN, VAIN are dysplastic precursor lesions characterized by these 4 things.

A

koilocytic change, disordered cellular maturation, nuclear atypia (high nuclear to cytoplasmic ratio, with hyper chromatic nuclei), and increased mitotic activity

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14
Q

Exocervix is lined by ______ and endocervix is lined by _____. The junction between the two is the ______.

A

nonkeratinizing stratified squamous epithelium; columnar epithelium; transformation zone

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15
Q

HPV is a sexually transmitted ___ virus that infects the _____, especially the ____.

A

DNA; lower genital tract; cervix (transformation zone)

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16
Q

High risk HPV types are _____. Low risk HPV types are _____. High risk HPV produces ___ and ___, which result in destruction of ____ and ____ respectively

A

16, 18, 31, 33
6 and 11
E6 and E7
p53 and Rb

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17
Q

p53 recruits ___, which inactivates ____, which normally stabilizes the mitochondrial membrane, so ____ can escape and cause apoptosis

A

BAX; bcl2; cytochrome c

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18
Q

Rb holds ____, which is needed to progress to the cell cycle.

A

E2F (transcription factor)

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19
Q

CIN I involves ___ of the thickness of the epithelium (also answer CIN II and CIN III, and CIS)

A
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20
Q

Cervical carcinoma is invasive carcinoma that arises in the cervical epithelium most commonly in _____ women, and presents as _____ or _____. Key risk factor is ____; 2ndary risk factors include ___ and ____. 80% of cases are ____ and 15% are ____.

A

middle aged; vaginal bleeding (especially post coital) or cervical discharge; HPV; smoking and immunodeficiency (AIDS defining illness); squamos cell carcinoma; adenocarcinoma

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21
Q

In advanced stages of cervical carcinoma, tumors often invade through the ____ into the _____ and blocking the _____. Common cause of death is _____ due to _____.

A

anterior uterine wall; bladder; ureters; postrenal failure; hydronephrosis

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22
Q

The goal of the pap smear is to catch ____ before it develops in to ____. An abnormal pap is followed by ______ and _____. There is limited efficacy in screening for _____.

A

dysplasia (CIN); carcinoma; confirmatory colposcopy; biopsy; adenocarcinoma

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23
Q

The quadrivalent vaccine is effective in preventing HPV types _____.

A

6, 11, 16, and 18

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24
Q

Endometrium

A

mucosal lining of the uterine cavity (it is hormonally sensitive)

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25
______ is the smooth muscle wall underlying the endometrium
myometrium
26
Growth of endometrium is ____ driven (proliferative phase), preparation for implantation is ____ driven (secretory phase), and shedding occurs with loss of _____ support (menstrual phase)
estrogen; progesterone; progesterone
27
_______ is secondary amenorrhea due to loss of the basalis (basal endometrial layer) and scarring. It is a result of overaggressive _____.
Asherman syndrome; dilation and curettage (D&C)
28
________ is the lack of ovulation resulting in an estrogen driven proliferative phase without a _______ phase. Results in dysfunctional ______, especially during menarche and menopause
Anovulatory cycle; progesterone driven secretory phase; uterine bleeding
29
Acute endometritis is a _____ infection of the endometrium, usually due to _____, which presents with these three symptoms.
bacterial; retained products of conception (after delivery/miscarriage); fever, abnormal uterine bleeding, and pelvic pain
30
Chronic endometritis is chronic _____ of the endometrium characterized by the presence of ____ and most importantly _____, and presents with these three symptoms.
inflammation; lymphocytes; plasma cells (lymphocytes are normally found in endometrium); abnormal uterine bleeding, pain, and infertility
31
Name four causes of chronic endometritis.
retained products of conception (same as in acute), chronic PID (e.g. chlamydia); IUD; TB (would also see granulomas)
32
______ is a hyperplastic protrusion of endometrium, which presents as _____. Can arise as a side effect of ______, a drug with anti-estrogenic effects of the breast, but weak pro-estrogenic effects on the endometrium
endometrial polyp; abnormal uterine bleeding; tamoxifen
33
Endometriosis is when ______ and _____ are found outside of the uterine endometrial lining, most likely due to ______. It presents as _____ and _____ and may cause ____.
endometrial glands and stroma; retrograde menstruation; dysmenorrhea (pain during menstruation); pelvic pain; infertility
34
The most common site of involvement of endometriosis is the _____, which results in formation of a _______.
ovary; chocolate cyst
35
Aside from the ovary, name the 5 other sites of endometriosis and how they present. These implants typically appear as _____ nodules.
-uterine ligaments (pelvic pain); -pouch of Douglas (pain with defecation); -bladder wall (pain with urination); -bowel serosa (abd pain and adhesions); -fallopian tube mucosa (scarring --> ectopic) yellow-brown/gun powder
36
_____ is endometriosis with involvement of the uterine myometrium
adenomyosis
37
Yes/No to an increased risk of carcinoma at the site of endometriosis
Yes - especially in the ovary
38
Endometrial hyperplasia is hyperplasia of endometrial ____ relative to _____. Occurs as a consequence of unopposed _____ (obesity, PCOD, replacement) and classically presents as ______. Histologically, the growth pattern can be ____ or _____ with the presence or absence of _____.
glands; stroma; estrogen; postmenopausal uterine bleeding; simple or complex; cellular atypia Cellular atypia is the most important predictor of progression to carcinoma
39
Endometrial carcinoma is a malignant proliferation of endometrial _____. It presents as ______. It can arise from two distinct pathways: _____ and _____
glands; postmenopausal bleeding; hyperplasia (75%) and sporadic (25%)
40
What is the most common invasive carcinoma of the female genital tract?
endometrial carcinoma
41
In the hyperplasia pathway of endometrial carcinoma, it arises from ______ (due to unopposed estrogen). Average age of presentation is ____. Histology is _____. Risk factors are related to ____ exposure.
endometrial hyperplasia; 60; endometrioid; estrogen (early menarche/late menopause, nulliparity, infertility with anovulatory cycles, obesity)
42
In the _____ pathway of endometrial carcinoma, it arises in an _____ endometrium with no evident precursor lesions. Avg age of onset is ____, and histology is usually ____ and characterized by ____ with ____ formation
sporadic; atrophic; 70; serous; papillary structures; psammoma body formation
43
Which pathway of endometrial carcinoma (hyperplasia/sporadic) is associated with a p53 mutation and aggressive tumor behavior?
sporadic
44
Name the four types of cancers with which you see psammoma bodies
- papillary carcinoma of the thyroid - meningioma - papillary serous carcinoma - mesothelioma
45
_____ are concentric lamellated calcified structures seen in certain types of cancer.
Psammoma body
46
______ are benign neoplastic proliferation of smooth muscle arising from myometrium. They are related to ____ exposure. Gross exam shows ____, ______, _____, _____ masses. Usually asymptomatic, but symptoms include these three.
Leiomyoma; estrogen; multiple, well defined, white, whorled; abnormal uterine bleeding, infertility, pelvic mass common in premenopausal women
47
What is the most common tumor in females?
Leiomyoma
48
Leiomyoma/Leiomyosarcoma - which one presents as single/multiple, white/whorrly vs hemorrhagic/necrotic, premenopausal/postmenopausal
leiomyoma: multiple, white/whorrly, premenopausal leiomyosarcoma: single, hem/nec, post
49
______ is a malignant proliferation of smooth muscle from the myometrium; on gross exam shows a single lesion with _____ and _____. Histological features include ____, _____, _____.
leiomyosarcoma; areas of necrosis and hemorrhage; necrosis, mitotic activity, cellular atypia
50
True/False: leiomyosarcomas arise from leiomyomas
False - they always arise de novo
51
_____ is the functional unit of the ovary and consists of an oocyte surrounded by ___ and ___ cells.
follicle; granulosa; theca
52
____ acts on theca cells to induce ____ production; ____ acts on granulosa cells to convert _____ to _____. A ____ surge induces a ____ surge, which leads to ovulation.
LH; androgen; FSH; androgen; estradiol; estradiol; LH
53
After ovulation, the residual follicle becomes a _____, which secretes _____. Hemorrhage in to it results in a ______, especially during early pregnancy. Degeneration of follicles results in ____.
corpus luteum; progesterone; hemorrhagic corpus luteal cyst; follicular cysts (which are common and have no clinical significance)
54
Polycystic ovarian disease (PCOD) is characterized by increased ____ and low ____.
LH; FSH (LH:FSH>2)
55
In this disease, increased LH induces excess androgen causing _____. Androgen can be converted to estrone in ____ tissue, causing feedback and subsequent decrease of ____, resulting in cystic degeneration of follicles
Polycystic ovarian disease (PCOD); hirsutism; adipose; FSH
56
PCOD increases/does not effect/decreases the risk for endometrial carcinoma
increases
57
Which disease classically presents as an obese young woman with infertility, oligomenorrhea, and hirsutism; and is often associated with insulin resistance.
Polycystic ovarian disease (PCOD)
58
Ovary is composed of these three cell types, and tumors can arise from any of them
surface epithelium (70%), germ cells (15%), sex-cord stroma
59
Name the four subtypes of surface epithelial ovarian tumors
serous and mucinous (most common 2), endometrioid, Brenner tumor
60
Cystadenomas are benign/malignant tumors composed of a ____ cyst with a ___, ___ lining and most commonly arise in ____ women.
benign; single; simple, flat; pre menopausal (30-40) | these are mucinous or serous surface epithelial ovarian tumors
61
Cystadenocarcinomas are benign/malignant tumors composed of _____ cysts with a ___, ___ lining and most commonly arise in ____ women.
malignant; complex; thick, shaggy; postmenopausal (60-70) | these are mucinous or serous surface epithelial ovarian tumors
62
BRCA1 mutation carriers have an increased risk for ____ of the ovary and fallopian tube
serous carcinoma
63
Endometrioid tumors are usually benign/malignant; brenner tumors are usually benign/malignant, and are composed of ____ epithelium
malignant; benign; bladder-like
64
True or False: 5% of endometrioid carcinomas of the ovary are associated with an independent endometrial carcinoma (endometrioid type)`
False - 15% are
65
Surface tumors (ovary) clinically present early/late with _____ symptoms or signs of _____.
late; vague abdominal (pain/fullness); compression (urinary frequency)
66
How cancers typically like to spread: Carcinomas --> Sarcomas --> Ovary -->
lymphatics hematogenously locally to peritoneum
67
Which type of cancer has the worst prognosis of female genital tract cancers?
Surface epithelial carcinoma (ovary)
68
Germ cell tumors usually occur in ______. Name the four tumor subtypes and the name of the tumor
WOCBP; (1) fetal tissue (cystic teratoma and embryonal carcinoma); (2) oocytes (dysgerminoma); (3) yolk sac (endodermal sinus tumor); (4) placental tissue (choriocarcinoma)
69
Cystic teratoma is a cystic tumor composed of ____ derived from ____. It is benign, though the presence of ___ or ____ indicates malignant potential. ____ is a teratoma composed of thyroid tissue
fetal tissue; 2 or 3 embryologic layers (skin, hair, bone, cartilage, gut, thyroid); immature tissue (usually neural); somatic malignancy (usually sq cell carcinoma of the skin); Struma ovarii
70
Dysgerminoma is a tumor composed of ____ cells, with ____ cytoplasm, and ____ nuclei (resemble oocytes). It is the most common malignant germ cell tumor; it's testicular counterpart is called _____. It has a good/poor prognosis and serum ___ may be elevated
large; clear; central; seminoma; good (responds to radiotherapy); LDH
71
______ is a malignant tumor that mimics the yolk sac. It is the most common germ cell tumor in children. Serum ___ is often elevated, and ______ are classically seen on histology.
Endodermal sinus tumor; AFP; Schiller-Duval bodies (glomerulus like structures)
72
Choriocarcinoma is a malignant tumor composed of _____ and ______; it mimics placental tissue but ____ are absent. It is a small, hemorrhagic tumor with ____ spread. High ____ is characteristic. And it may cause ___ in the ovary
cytotrophoblasts and syncytiotrophoblasts; villi; hematogenous; B-hCG; thecal cysts Poor response to chemo
73
Embryonal carcinoma is a malignant tumor composed of large ____ cells. It is aggressive with early mets
primitive; not surprising it's aggressive as primitive embryo cells have the ability to grow/spread
74
Name the three types of sex cord-stromal tumors (ovary)
Granulosa-theca cell tumor; Sertoli-Leydig cell tumor; Fibroma
75
Granulose-Theca cell tumors presents with signs of _____. Name these symptoms in a pt prior to puberty, in reproductive age, and postmenopausal, and which one is most common. They are malignant but with minimal risk for mets
estrogen excess; precocious puberty; menorrhagia (heavy bleeding) or metrorrhagia (abn bleeding from uterus); endometrial hyperplasia with postmenopausal bleeding; post menopausal
76
Sertoli Leydig cell tumor is composed of sertoli cells that form tubules and leydig cells (btwn tubules) with characteristic ____. May produce ____ and associated ___ and ___
Reinke crystals; androgen; hirsutism and virilization
77
Meig's syndrome is a triad of a _____, ____ and ____
ovarian tumor; pleural effusions and ascites
78
____ is a benign tumor of fibroblasts often associated with Meig's syndrome
fibroma
79
Name two metastatic tumors you see in the ovary
Krukenberg tumor and Pseudomyxoma peritonei
80
Krukenberg tumor is a metastatic ____ tumor that invovles BOTH ovaries; most commonly due to metastatic ____.
mucinous; gastric garcinoma (diffuse type)
81
_____ is massive amounts of mucus in the peritoneum due to a mutinous tumor of the _____. "Jelly Belly"
pseudomyxoma peritonei; appendix
82
_____ is implantation of the placenta in the lower uterine segment where it overlies the ______. It presents as ______ and often requires delivery of fetus by c-section
Placenta previa; cervical os; 3rd trimester bleeding
83
____ is separation of placenta from the decidua (uterine wall) prior to delivery of the fetus. It is a common cause of _____, and presents with _____ and _____.
Placental abruption; still birth; 3rd trimester bleeding and fetal insufficiency
84
_____ is improper implantation of the placenta (can be in the myometrium) with little or no intervening decidua. It presents with _____ and _____. Often requires ____
Placenta accreta; difficult delivery of the placenta and postpartum bleeding; hysterectomy (increta = in the myometrium)
85
Preeclampsia is pregnancy induced ____, ____, and ____ usually in 3rd trimester (seen in 5% of pregnancies). Due to abnormality of the _____ in the placenta. Eclampsia is preeclampsia + _____.
HTN (can cause headaches and visual abnormalities), proteinuria, edema; maternal-fetal vascular interface; seizures
86
HELLP is preeclampsia with _____ involving the ____. It stands for: It warrants immediate delivery (as dose eclampsia)
thrombotic microangiopathy; liver | Hemolysis, Elevated Liver enzymes, Low Platelets
87
Sudden Infant Death Syndrome is when healthy infant age _____ dies without obvious cause (usually during ____). Name three risk factors
1 month to 1 year; sleep; sleeping on stomach, exposure to cigarette smoke, prematurity
88
_____ is an abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
Hydatidiform mole
89
With a hydatidiform mole, the uterus is larger/smaller than in normal pregnancy and the B-hCG is higher/lower. It classically presents in the ____ trimester as passage of ____ through the vaginal canal. On US, fetal heart sounds are absent and a ____ appearance is seen. Tx is ____.
larger; higher; 2nd; grape-like masses; snowstorm; suction curettage (also need to monitor B-hCG to ensure adequate removal and to screen for development of choriocarcinoma) can be complete or partial
90
Choriocarcinoma may arise as a _____ (spontaneous abortion, normal pregnancy, hydatidiform mole) or as a _____. Which one responds well to chemo?
complication of gestation; spontaneous germ cell tumor gestational pathway
91
_____ mole has an empty ovum fertilized by two sperm (46 chromosomes), absent fetal tissue, edematous villi, proliferation of trophoblasts around all vili, and a 2-3% risk for choriocarcinoma
Complete mole Partial has 69 chromosomes (ovum fertilized by 2 sperm or one sperm that duplicates chromosomes) - has fetal tissue; some of everything else (instead of all); minimal risk
92
Name the teratogen effect: alcohol, thalidomide, cocaine, cigarette smoke
most common cause of mental retardation, also facial abnormalities and microcephaly; limb defects; intrauterine growth retardation and placental abruption; intrauterine growth retardation
93
Name the teratogen: spontaneous abortion, hearing and visual impairment; discolored teeth; fetal bleeding; digit hypoplasia and cleft lip/palate
isotretinoin; tetracycline; warfarin; phenytoin
94
Spontaneous abortion (before 20 weeks) presents with these 3 symptoms.
vaginal bleeding, cramp-like pain, passage of fetal tissue
95
Spontaneous abortion is most often due to these 4 causes
chromosomal anomalies (esp trisomy 16); hyper coagulable states (antiphospholipid syndrome seen in lupus); congenital infxn; exposure to teratogens (esp during first two weeks)
96
Effect of teratogen based on time of exposure First 2 weeks --> weeks 3-8 --> months 3-9 -->
spontaneous abortion organ malformation organ hyoplasia
97
____ is a polypoid inflammatory lesion near the female urethral meatus which elicits pain and bleeding - occurs in women, most frequently after menopause.
Caruncle presents as an exophytic, often ulcerated polypoid mass of 1-2 cm diameter