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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
Acute endometritis cause ? Presentation ?
Due to retained products of conception which acts as a nidus for infection Presents as : fever , abnormal uterine bleeding and pelvic pain
26
Chronic endometritis characterized by ? Causes ? Presentation ?
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
27
Endometrial polyp mechanism ? Presentation ? Cause ?
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
28
Mast common site of endometriosis ? Results in formation of ?
Ovary | Chocolate cyst
29
Sites of involvement in endometriosis ? Appearance of the implants ?
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
30
Endometrial hyperplasia mechanism ? Cause ? Presentation ? Classification ?
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
31
Most important predictor for progression of endometrial hyperplasia into carcinoma ?
The presence of cellular atypia
32
Most common invasive carcinoma of female genital tract ?
Endometrial carcinoma
33
Hyperplasia pathway of endometrial carcinoma risk factors ? Age ? Histology ?
``` 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
34
Sporadic pathway of endometrial carcinoma ? Age ? Histology ? Associated mutation ?
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
Most common tumor of females ?
Leiomyoma ( Fibroids )
36
Characters of leiomyoma ? Gross ? Presentation ?
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
Leiomyosarcoma source ? Seen in ? Gross ? Micro ?
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
Hemorrhagic corpus luteal cyst arises when ?
In early pregnancy
39
PCOD mechanism ? Presentation ?
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
Most common type of ovarian tumor ?
Surface epithelial tumors ( 70% of cases )
41
Coelomic epithelium embryologically lines ?
1- Ovary 2- Fallopian tubes ( serous cells ) 3- Endometrium 4- Endocervix ( mucinous cells )
42
Most common subtypes of surface epithelial tumors ?
Serous : full of watery fluid | Mucinous : full of mucus-like fluid
43
Types of serous and mucinous tumors ? Composition ? Age ?
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
Which mutation carries increased risk for serous carcinoma of the ovary and fallopian tubes ? Prophylaxis ?
BRCA1 mutation Prophylaxis : salpingo-oophorectomy with mastectomy ( due to increased risk for breast cancer )
45
Less common subtypes of surface epithelial tumors ?
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
Presentation of surface epithelial tumors ?
Present late with vague abdominal symptoms ( pain or fulness ) or signs of compressions ( urinary frequency )
47
Worst prognosis of female genital tract cancer is seen in ?
Surface epithelial tumors
48
Serum marker for surface epithelial tumors ?
CA-125
49
Most common germ cell tumor in females ?
Cystic teratoma
50
Cystic teratoma composed of ? Characteristics ?
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
Most common malignant germ cell tumor ?
Dysgerminoma
52
Dysgerminoma composed of ? Prognosis ? Labs ?
Large cells with clear cytoplasm and central nuclei Good prognosis , responds to chemotherapy Labs : serum LDH maybe elevated
53
Most common germ cell tumor in children ?
Endodermal sinus tumor
54
Endodermal sinus tumor marker ? Histology ?
AFP is often elevated Histology : Schiller-Duval bodies ( glomerulus like structures )
55
Choriocarcinoma composed of ? Spread ? Labs ? Response to chemotherapy ?
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
Embryonal carcinoma composed of ? Characteristics ?
Large primitive cells Aggressive with early metastasis
57
Granulosa theca cell tumor produces ? Presentation ? Benign or malignant ?
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
Sertoli Leydig cell tumor produces ? Presentation ? Leydig cell characteristic ?
Androgen Presents with hirsutism and virilization Leydig cells with characteristic Reinke Crystals
59
Meigs syndrome ?
Ovarian fibroma Pleural effusion Ascites
60
How to distinguish Krukenberg tumor from primary mucinous carcinoma of the ovary ?
Bilaterality in krukenberg while in mucinous carcinoma its often unilateral
61
Krukenberg tumor is metastasis of ?
Gastric carcinoma ( diffuse type )
62
Pseudomyxoma peritonei is metastasis of ?
Mucinous tumor of the appendix
63
Key factor of ectopic pregnancy ? Presentation ?
Scarring for example secondary to : Pelvic inflammatory disease Endometriosis Presents as lower quadrant abdominal pain a few weeks after a missed period
64
Spontaneous abortion time ? Presentation ? Causes ?
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
Effects of teratogens according to time exposure ?
First two weeks of gestation —> spontaneous abortion Weeks 3-8 —> risk of organ malformation Months 3-9 —> risk of organ hypoplasia
66
Alcohol teratogenic effect ?
Most common cause of mental retardation Facial abnormalities Microcephaly
67
Cocaine teratogenic effect ?
Intrauterine growth retardation | Placental abruption
68
Thalidomide teratogenic effect ?
Limb effects
69
Cigarette smoking teratogenic effect ?
Intrauterine growth retardation
70
Isotretinoin teratogenic effect ?
Spontaneous abortion | Hearing and visual impairment
71
Tetracycline teratogenic effect ?
Discolored teeth
72
Warfarin teratogenic effect ?
Fetal bleeding
73
Phenytoin teratogenic effect ?
Digit hypoplasia | Cleft lib/palate
74
Placenta previa presentation ?
Third trimester bleeding
75
Placental abruption mechanism ? Presentation ?
Separation of the placenta from decidua prior to delivery of the fetus Presents with third trimester bleeding and fetal insufficiency
76
Placenta accreta mechanism ? Presentation ? Ttt ?
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
Preeclampsia ? Time ? Mechanism ?
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
Eclampsia ?
Preeclampsia with seizures
79
HELLP syndrome ?
Preeclampsia with thrombotic microangiopathy involving the liver Hemolysis Elevated Liver enzymes Low Platelets
80
Sudden infant death syndrome time ? Risk factors ?
1 month to 1 year old Risk factors : Sleeping on stomach Exposure to cigarette smoke Prematurity
81
Hydatidiform mole differs from pregnancy in what ?
The uterus is much larger | Beta-hCG is much higher
82
Diagnosis of hydatidiform mole ?
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
Importance of Beta-hCG monitoring after removal of hydatidiform mole ?
Ensure adequate mole removal | Screen for the development of choriocarcinoma

Pathology (18 decks)

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