CH22 2nd

Question 1

What are the morph’s of cVIN and VINs? What are the morphs of BW and KSCC?

Answer 1

CVIN: white or raised pigmented lesions, epi thickening, HPV-16
VINs: basal atypia only (no HPV)
Basaloid: nests, no cell maturation, necrosis
Warty: exophytic, papillary architecture, atypia
KSCC: nests and tongues, keratin pearls, malignant epi

Question 2

What dx process is associated w/ Bowen Syndrome?

Answer 2

Classic VIN (cVIN)

Question 3

What stimulates cVIN and VINs progression?

Answer 3

CVIN: HPV-16
VINs: TP53 + pt w/ h/o leukoplakias

Question 4

Where do glandular neoplastic lesions of the vulva rise from?

Answer 4

Modified apocrine sweat glands also seen in he breast

Question 5

What are the glandular neoplastic lesions of the vulva?

Answer 5

Hidradenoma

Extramammary Paget dx

Question 6

What do Paget cell stains target?

Answer 6

Mucopolysaccharides

Question 7

Is extramammary Paget dx associated w/ CA?

Answer 7

NO

Question 8

Is primary CA of the vagina very rare? What is it? Is it associated w/ HPV?

Answer 8

YES

SCC of the vagina

YES, high risk

Question 9

What’s another name for Embryonal Rhabdomyosarcoma?

Answer 9

Sarcoma Botryoides

Question 10

What is lactobacilli associated w/? What is lactobacilli’s morph?

Answer 10

Cervicitis

G+ rod

Question 11

What in the cervix has fibromyxomatous stroma covered in endocervical glands?

Answer 11

Endocervical polyps

Question 12

What are the 3 types of cervical carcinoma?

Answer 12

Squamous cell, adenocarcinoma, neuroendocrine

Question 13

What does CSIL stand for?

Answer 13

Cervical squamous intra-epi lesion

Question 14

What is the HPV associated w/ cervical carcinoma?

Answer 14

HPV-16

Question 15

What is stained for in HSIL to confirm diagnosis?

Answer 15

P-16 and Ki-67

Question 16

What’s the staging for cervical carcinoma?

Answer 16

Stage 0: CIS (CINIII + HSIL)
Stage 1: carcinoma confined to cervix
Stage 2: carcinoma extends beyond cervix but NOT to pelvic wall or lower third of vagina
Stage 3: carcinoma extends to pelvic wall and lower third of vagina
Stage 4: distant metastases

Question 17

What type of tissue is seen in the different cervical carcinomas?

Answer 17

SCC = keratinizing squamous epi
Adenocarcinoma = glandular epi w/ mucin-depletion
Neuroendocrine = looks like lung CA

Question 18

What dx of the Uterus and Endometrium involves an under-dev vagina and uterus? What else is involved?

Answer 18

Mayer-RKH syndrome

Kidneys can be abnormally formed or positioned, hearing loss, heart defect, 46, XX

Question 19

In the anovulatory cycle, what are the hormone levels likely to be?

Answer 19

Inc estrogen

No progesterone (d/t no ovulation and thus no corpus luteum)

Question 20

What a striking characteristic of the Inadequate luteal phase dx?

Answer 20

Endometrial development over the course of a cycle lags behind where it should be

Question 21

What’s a striking feature of chronic endometritis?

Answer 21

Presence of plasma cells

Question 22

red/blue/yellow/brown, think of?

Answer 22

Endometriosis

Question 23

Increased gland:stroma ratio, think of?

Answer 23

Endometrial hyperplasia

Question 24

What mutation is associated w/ Cowdren syndrome (endometrial carcinoma)?

Answer 24

PTEN

Question 25

What CA deals w/ T1 vs T2?

Answer 25

Endometrial carcinoma

Question 26

What is associated w/ Lynch syndrome?

Answer 26

Endometrial carcinoma T1 (DNA mis-match repair HNPCC)

Question 27

What has a broad based polypoid growth and may respond to estrogen?

Answer 27

Adenosarcoma of the endometrial stroma

Question 28

What are the tumors of the endometrail myometrium?

Answer 28

Leiomyomas (fibroids) Leiomyosarcomas

Question 29

What's associated w/ MED12?

Answer 29

Tumors of the myometrium

Question 30

What are the attributes of a fibroid?

Answer 30

``` Nickname - leiomyoma, tumor of myometrium Small to large Benign smooth m neoplasm Whorled pattern of smooth m MED 12, HMGIC (12) and HMGIY (6) No CA risk ```

Question 31

Where do paratubular cysts arise from?

Answer 31

Mullerian/paramesonephric remnants

Question 32

What does leutinization mean?

Answer 32

Increased amounts of pale cytoplasm

Question 33

Acanthosis nigricans is associated w/ what dx?

Answer 33

Stromal hyperthecosis of the ovaries

Question 34

What percentage of ovarian tumors are benign?

Answer 34

80%

Question 35

What is psuedomyxoma peritonei associated w/? What is it?

Answer 35

Mucinous epithelial tumors of the ovary Mucinous ascites, adhesions, metastases

Question 36

What is the third class of Ovarian Germ Cell Teratomas?

Answer 36

Monodermal

Question 37

If a tumor of the ovaries is described as "rapidly-growing", what might it be?

Answer 37

Yolk sac tumor (especially if inc a-fetoprotein is involved)

Question 38

Which germ cell ovarian CA has a placental origin? What does it excrete?

Answer 38

Choriocarcinoma Chorionic gonadotropins

Question 39

What are the most common malignant ovarian tumors?

Answer 39

Serous carcinoma Dysgerminoma Granulosa Cell tumor

Question 40

What are Call-Exner bodies?

Answer 40

Small gland-like structures w/ acidophilic material

Question 41

What's Stein-Levanthal syndrome associated w/?

Answer 41

PCOS

Question 42

What dxs can present w/ ascites?

Answer 42

Mucinous epi tumor of the ovary | Fibromas/Thecomas/Fibrothecomas (sex cord tumors of the ovaries)

Question 43

Where is the most common location of an ectopic pregnancy? What is the most common predisposing condition of an ectopic pregnancy? Do ovums develop normally where they rest? What does a tubal pregnancy cause? What can it lead to? What lab is performed to help diagnose? When might a pt present w/ these sorts of sxs?

Answer 43

``` Fallopian tube PID (causes intra-tubal scarring) Yes Hematosalpinx Intraperitoneal hemorrhage d/t fallopian tube wall rupture HCG titer (human chorionic gonadotropin) 6-8 weeks after last menstrual period ```

Question 44

What situation can produce twin-twin transfusion syndrome?

Answer 44

Monochorionic twin pregnancy, one baby receives too much and the other too little

Question 45

Placental previa vs placental accreta. What inc accreta risk?

Answer 45

Previa: placental implants in lower uterine segment or cervix > bleeding in 3rd trimester > cesarean section Accreta: failed placental separation from myometrium at birth > bleeded post-partum H/o placenta previa and cesarean sections

Question 46

Placental infection most likely?

Answer 46

Bacterial

Question 47

What does preeclampsia present as? Eclampsia?

Answer 47

HTN, edema, proteinuria More severe form, illness w/ convulsions > HELLP

Question 48

What does HELLP stand for?

Answer 48

Hemolysis, elevated liver enzymes, low platelets

Question 49

Does anti-HTN medication work in preeclampsia?

Answer 49

No, only delivery txs the sxs

Question 50

Difference between invasive mole and choriocarcinoma?

Answer 50

Invasive moles encompass the entire uterus making it larger, choriocarcinomas are more focal lesions and arise d/t spotting/brown fluid coming from the vagina

Question 51

Chemo of choriocarcinoma leads to what?

Answer 51

WONDERFUL prognosis (nearly 100% remission)

Question 52

What does PSTT (placental site trophoblastic tumor) have that choriocarcinomas don't?

Answer 52

Polygonal mononuclear cells w/ abundant cytoplasm that produce human placental lactogen