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Pathology > Chapter 13 ( Female Genital System And Gestation ) > Flashcards

Chapter 13 ( Female Genital System And Gestation ) Flashcards

1
Q

In which part of the vaginal canal does the Bartholin gland drain ?

A

Into the lower vestibule

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2
Q

Presentation of bartholin cyst ?

A

Unilateral painful cystic lesion at the lower vestibule adjacent to the vaginal canal

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3
Q

Vulva condyloma cause ? Histological characteristic ?

A 
HPV types 6 , 11 ( Condyloma acuminatum )
Secondary syphilis ( Condyloma latum )

HPV associated condylomas are characterized by koilocytes ( Hallmark of HPV infected cells )

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4
Q

Lichen sclerosis of the vulva histology ? Presentation ?

A

Thinning of the epidermis and fibrosis of the dermis

Presents as a white patch ( leukoplakia ) with parchment-like valvular skin
Most commonly in postmenopausal women

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5
Q

Lichen simplex chronicus histology ? Presentation ?

A

Hyperplasia of the valvular squamous epithelium

Presents as leukoplakia with thick leathery vulvlar skin associated with chronic itching and scratching

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6
Q

Vulvar carcinoma etiology ?

A 
1- HPV related vulvar carcinoma :
Exposure to high risk HPV
Multiple partners 
Early first age of intercourse 
Seen in women of reproductive age 
Arises from vulvar intraepithelial neoplasia

2- Non HPV related vulvar carcinoma :
Most often from long standing lichen sclerosis
Seen in elderly women >70

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7
Q

Vulvar intraepithelial neoplasia ( VIN ) ?

A 
Dysplastic precursor lesion charcterized by : 
Koilocytic change 
Disordered cellular maturation 
Nuclear atypia
Increased mitotic activity
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8
Q

Extramammary Paget disease histology ? Presentation ?

A

Malignant epithelial cells in the epidermis of the vulva

Presents as erythematous pruritic ulcerated vulvar skin

Represents carcinoma in situ with no underlying malignancy

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9
Q

How to distinguish extramammary paget disease from melanoma ?

A

Paget disease : PAS+ , Keratin+ , S100-

Melanoma : PAS- , Keratin- , S100+

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10
Q

Adenosis of vagina mechanism ? Cause ?

A

Focal persistence of columnar epithelium in the upper vagina

Increased incidence in females who were exposed to Diethylstilbestrol (DES) in utero

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11
Q

Clear cell adenocarcinoma of the vagina mechanism ? Cause ?

A

Malignant proliferation of glands with clear cytoplasm

Complication of DES-associated vaginal adenosis

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12
Q

Embryonal rhabdomyosarcoma of vagina mechanism ? Presentation ? Characteristic cell ?

A

Malignant mesenchymal proliferation of immature skeletal muscle

Presents as Bleeding and Grape-like mass protruding from the vagina or penis of a child > 5 y

Characteristic cell : Rhabdomyoblast

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13
Q

Rhabdomyoblasts exhibit ?

A

1- Cytoplasmic cross-striations

2- Positive immunohistochemical staining for Desmin and Myogenin

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14
Q

Another name for rhabdomyosarcoma ?

A

Sarcoma botryoids

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15
Q

LN spread of vaginal carcinoma ?

A

Lower 2/3 of vagina —> inguinal LNs

Upper 1/3 of vagina —> regional iliac LNs

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16
Q

Exocervix and endocervix are lined by ?

A

Exocervix : non keratinizing squamous epithelium

Endocervix : a single layer of columnar cells

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17
Q

HPV infects ?

A

The lower genital tract especially the cervix in the transformation zone

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18
Q

Mechanism of increased risk for CIN in case of high risk HPV infection ?

A

High risk HPV produce :
1- E6 : results in increased destruction of p53 gene
2- E7 : results in increased destruction of Rb gene

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19
Q

Grades of CIN ?

A

Grade l : < 1/3 of the thickness of epithelium
CIN ll : < 2/3 of the thickness of epithelium
CIN lll : slightly less than the entire thickness of epithelium
CIS : the entire thickness of epithelium

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20
Q

Cervical carcinoma presentation ? Risk factors ? Most common types ? Invasion ?

A

In middle aged woman presents as vaginal bleeding ( postcoital bleeding ) or cervical discharge

Risk factors :
High risk HPV
Smocking
Immunodeficiency

Most common types:
Squamous cell carcinoma 80%
Adenocarcinoma 15%

Invades through the anterior uterine wall into the bladder blocking the ureter , hydronephrosis os a common cause of death

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21
Q

Screening for cervical carcinoma ?

A

Pap smear from the transformation zone followed by confirmatory colposcopy and biopsy

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22
Q

Limitations of the pap smear ?

A

1- inadequate sampling of the transformation zone

2- limited efficacy in screening for adenocarcinoma

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23
Q

Asherman syndrome ? Cause ?

A

Secondary amenorrhea due to loss of the basalis and scarring

Cause : overaggressive dilation and curettage

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24
Q

Anovulatory cycle results in ?

A

Estrogen driven proliferative phase without a subsequent progesterone driven secretory phase —> proliferative glands break down —> uterine bleeding

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25
Q

Acute endometritis cause ? Presentation ?

A

Due to retained products of conception which acts as a nidus for infection

Presents as : fever , abnormal uterine bleeding and pelvic pain

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26
Q

Chronic endometritis characterized by ? Causes ? Presentation ?

A

Characterized by : Lymphocytes and Plasma cells

Causes : 
Retained products of conception 
Chronic pelvic inflammatory disease ( as chlamydia )
IUD
TB

Presents as : abnormal uterine bleeding , pain and infertility

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27
Q

Endometrial polyp mechanism ? Presentation ? Cause ?

A

Hyperplastic protrusion of the endometrium

Presents as abnormal uterine bleeding

Cause : as a side effect of Tamoxifen ( has anti estrogenic effects on the breast but weak pro estrogenic effects on the endometrium

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28
Q

Mast common site of endometriosis ? Results in formation of ?

A

Ovary

Chocolate cyst

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29
Q

Sites of involvement in endometriosis ? Appearance of the implants ?

A

1- ovary
2- uterine ligaments ( pelvic pain )
3- pouch of Douglas ( pain with defecation )
4- bladder wall ( pain with urination )
5- bowel serosa ( abdominal pain and adhesions )
6- fallopian tube mucosa ( scarring increasing risk for ectopic pregnancy and infertility )

Appearance of implants : yellow-brown gun-powder nodules

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30
Q

Endometrial hyperplasia mechanism ? Cause ? Presentation ? Classification ?

A

Hyperplasia of endometrial glands relative to stroma

Cause : unopposed estrogen ( obesity , polycystic ovary syndrome , estrogen replacement )

Presents as postmenopausal bleeding

Classified based on architectural growth pattern into Simple and Complex
And based on the presence of absence of cellular atypia

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31
Q

Most important predictor for progression of endometrial hyperplasia into carcinoma ?

A

The presence of cellular atypia

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32
Q

Most common invasive carcinoma of female genital tract ?

A

Endometrial carcinoma

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33
Q

Hyperplasia pathway of endometrial carcinoma risk factors ? Age ? Histology ?

A 
From endometrial hyperplasia related to estrogen exposure :
Early menarche
Late menopause 
Nulliparity
Infertility with anovulatory cycles 
Obesity

Average age of presentation : 60 y

Histology is Endometrioid

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34
Q

Sporadic pathway of endometrial carcinoma ? Age ? Histology ? Associated mutation ?

A

Arises in an atrophic endometrium with no evident precursor lesion

Average age at presentation : 70 y

Histology is usually serous and characterized by papillary structures with psammoma body formation

Commonly associated with p53 mutation

35
Q

Most common tumor of females ?

A

Leiomyoma ( Fibroids )

36
Q

Characters of leiomyoma ? Gross ? Presentation ?

A

Related to estrogen exposure :
1- common in premenopausal women
2- often multiple
3- enlarge during pregnancy and shrink after menopause

Gross : multiple ,well defined ,white whorled masses

Asymptomatic , when presents : abnormal uterine bleeding , infertility and a pelvic mass

37
Q

Leiomyosarcoma source ? Seen in ? Gross ? Micro ?

A

Arises DE NOVO , NOT from leiomyomas

Seen in postmenopausal women

Gross : single lesion with areas of hemorrhage and necrosis

Micro : necrosis , cellular atypia , mitotic activity

38
Q

Hemorrhagic corpus luteal cyst arises when ?

A

In early pregnancy

39
Q

PCOD mechanism ? Presentation ?

A

Multiple ovarian follicular cysts due to hormonal imbalance ( ⬆️ LH and ⬇️ FSH , LH : FSH ratio > 2 )

⬆️ LH —> theca cells release excess androgens —> converted to estrone in adipose tissue —> feedback ⬇️ FSH —> cystic degeneration of follicles

Presentation : obese young woman with infertility , oligomenorrhea and hirsutism , some patients have insulin resistance and may develop type 2 DM 10-15 years later

40
Q

Most common type of ovarian tumor ?

A

Surface epithelial tumors ( 70% of cases )

41
Q

Coelomic epithelium embryologically lines ?

A

1- Ovary
2- Fallopian tubes ( serous cells )
3- Endometrium
4- Endocervix ( mucinous cells )

42
Q

Most common subtypes of surface epithelial tumors ?

A

Serous : full of watery fluid

Mucinous : full of mucus-like fluid

43
Q

Types of serous and mucinous tumors ? Composition ? Age ?

A

1- Benign tumors ( Cystadenomas ) : composed of single cyst with a simple flat lining
Most common in premenopausal women

2- Malignant tumors ( cystadenocarcinomas ) : composed of complex cysts with a thick shaggy lining
Most common in postmenopausal

3- Borderline tumors : have features in between benign and malignant tumors

44
Q

Which mutation carries increased risk for serous carcinoma of the ovary and fallopian tubes ? Prophylaxis ?

A

BRCA1 mutation

Prophylaxis : salpingo-oophorectomy with mastectomy ( due to increased risk for breast cancer )

45
Q

Less common subtypes of surface epithelial tumors ?

A

Endometrioid tumors : composed of endometrial like glands , usually malignant and may arise from endometriosis

Brenner tumors : composed of bladder-like epithelium and usually are benign

46
Q

Presentation of surface epithelial tumors ?

A

Present late with vague abdominal symptoms ( pain or fulness ) or signs of compressions ( urinary frequency )

47
Q

Worst prognosis of female genital tract cancer is seen in ?

A

Surface epithelial tumors

48
Q

Serum marker for surface epithelial tumors ?

A

CA-125

49
Q

Most common germ cell tumor in females ?

A

Cystic teratoma

50
Q

Cystic teratoma composed of ? Characteristics ?

A

Fetal tissue derived from two or three embryologic layers

Bilateral in 10%

Benign but presence of immature tissue ( neural ) or somatic malignancy ( squamous cell carcinoma of skin ) indicates malignant potential

51
Q

Most common malignant germ cell tumor ?

A

Dysgerminoma

52
Q

Dysgerminoma composed of ? Prognosis ? Labs ?

A

Large cells with clear cytoplasm and central nuclei

Good prognosis , responds to chemotherapy

Labs : serum LDH maybe elevated

53
Q

Most common germ cell tumor in children ?

A

Endodermal sinus tumor

54
Q

Endodermal sinus tumor marker ? Histology ?

A

AFP is often elevated

Histology : Schiller-Duval bodies ( glomerulus like structures )

55
Q

Choriocarcinoma composed of ? Spread ? Labs ? Response to chemotherapy ?

A

Cytotrophoblasts and syncytiotrophoblasts but villi are absent

Small hemorrhagic tumor with early hematogenous spread

High Beta hCG ( produced by syncytiotrophoblasts ) is characteristic which may leads to thecal cysts in ovary

Poor response to chemotherapy

56
Q

Embryonal carcinoma composed of ? Characteristics ?

A

Large primitive cells

Aggressive with early metastasis

57
Q

Granulosa theca cell tumor produces ? Presentation ? Benign or malignant ?

A

Estrogen

Presents with signs of excess estrogen :
Precocious puberty
Menorrhagia or metrorrhagia
Postmenopause endometrial hyperplasia or uterine bleeding

Malignant but minimal risk for metastasis

58
Q

Sertoli Leydig cell tumor produces ? Presentation ? Leydig cell characteristic ?

A

Androgen

Presents with hirsutism and virilization

Leydig cells with characteristic Reinke Crystals

59
Q

Meigs syndrome ?

A

Ovarian fibroma
Pleural effusion
Ascites

60
Q

How to distinguish Krukenberg tumor from primary mucinous carcinoma of the ovary ?

A

Bilaterality in krukenberg while in mucinous carcinoma its often unilateral

61
Q

Krukenberg tumor is metastasis of ?

A

Gastric carcinoma ( diffuse type )

62
Q

Pseudomyxoma peritonei is metastasis of ?

A

Mucinous tumor of the appendix

63
Q

Key factor of ectopic pregnancy ? Presentation ?

A

Scarring for example secondary to :
Pelvic inflammatory disease
Endometriosis

Presents as lower quadrant abdominal pain a few weeks after a missed period

64
Q

Spontaneous abortion time ? Presentation ? Causes ?

A

Before 20 weeks of gestation

Presents as vaginal bleeding , cramp like pain and passage of fetal tissue

Causes :
Chromosomal abnormalities ( most common )
Hypercoagulable state ( antiphospholipid syndrome )
Congenital infection
Exposure to teratogens

65
Q

Effects of teratogens according to time exposure ?

A

First two weeks of gestation —> spontaneous abortion
Weeks 3-8 —> risk of organ malformation
Months 3-9 —> risk of organ hypoplasia

66
Q

Alcohol teratogenic effect ?

A

Most common cause of mental retardation
Facial abnormalities
Microcephaly

67
Q

Cocaine teratogenic effect ?

A

Intrauterine growth retardation

Placental abruption

68
Q

Thalidomide teratogenic effect ?

A

Limb effects

69
Q

Cigarette smoking teratogenic effect ?

A

Intrauterine growth retardation

70
Q

Isotretinoin teratogenic effect ?

A

Spontaneous abortion

Hearing and visual impairment

71
Q

Tetracycline teratogenic effect ?

A

Discolored teeth

72
Q

Warfarin teratogenic effect ?

A

Fetal bleeding

73
Q

Phenytoin teratogenic effect ?

A

Digit hypoplasia

Cleft lib/palate

74
Q

Placenta previa presentation ?

A

Third trimester bleeding

75
Q

Placental abruption mechanism ? Presentation ?

A

Separation of the placenta from decidua prior to delivery of the fetus

Presents with third trimester bleeding and fetal insufficiency

76
Q

Placenta accreta mechanism ? Presentation ? Ttt ?

A

Improper implantation of placenta into the myometrium with little or no intervening decidua

Presents with difficult delivery of the placenta and postpartum bleeding

Often requires hysterectomy

77
Q

Preeclampsia ? Time ? Mechanism ?

A

Pregnancy induced Hypertension , Proteinuria and Edema

Usually in the third trimester

Due to abnormality of the maternal fetal vascular interface in the placenta , resolves with delivery

78
Q

Eclampsia ?

A

Preeclampsia with seizures

79
Q

HELLP syndrome ?

A

Preeclampsia with thrombotic microangiopathy involving the liver

Hemolysis
Elevated Liver enzymes
Low Platelets

80
Q

Sudden infant death syndrome time ? Risk factors ?

A

1 month to 1 year old

Risk factors :
Sleeping on stomach
Exposure to cigarette smoke
Prematurity

81
Q

Hydatidiform mole differs from pregnancy in what ?

A

The uterus is much larger

Beta-hCG is much higher

82
Q

Diagnosis of hydatidiform mole ?

A

Presents in the second trimester as passage of grape like masses through the vaginal canal

With prenatal care : diagnosed in the first trimester by routine ultrasound as :
Absent fetal heart sounds
Snowstorm appearance

83
Q

Importance of Beta-hCG monitoring after removal of hydatidiform mole ?

A

Ensure adequate mole removal

Screen for the development of choriocarcinoma

Pathology (18 decks)

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