Chapter 22: GYNE

Question 1

What are the features of hyperreactio luteinalis?

Answer 1

• Associated with high hCG levels including multiple pregnancies, GTN and ovulation induction
• Symmetric bilateral ovarian enlargement with multiple luteinized cysts

Question 2

What are the criteria for psammocarcinoma?

Answer 2

• No areas of solid growth >15 cells across
• Psammoma bodies in at least 75% of the papillae
• Invasive stromal growth

Question 3

What are histologic features of endocervical type borderline mucinous tumors?

Answer 3

• Hierarchical branching similar to serous tumors but with mucinous epithlium
• Often associated with acute inflammation and endometriosis

Question 4

What is intraepithelial carcinoma in a borderline mucinous tumor?

Answer 4

• Noninvasive areas with cytologic atypia, cribiforming, marked pleomorphism and prominent nucleoli
• Not associated with poorer prognosis

Question 5

What features of granulosa tumor are associated with poorer prognosis?

Answer 5

-High stage, large size, nuclear atypia, high mitotic count, sarcomatoid pattern

Question 6

Features of hypercalcemic small cell carcinoma of ovary

Answer 6

• Young women with poor prognosis
• Sheets of small cells with admixed follicle-like spaces filled with eosinophilic fluid
• Some tumor cells have globular hyaline inclusions
• IHC: CK, EMA, WT1, calretinin, CD10, p53 positive
• Less often positive for NSE, chromogranin and vimentin

Question 7

Facts about salpingitis isthmica nodosum

Answer 7

• Young women, associated with ectopic pregnancy, infertility, but uncertain pathogenesis
• 1-2 cm nodules in fallopian tube isthmus wall
• Outpouchings of tubal epithelium surrounded with thick smooth muscle

Question 8

What are features of placental implantation site?

Answer 8

• decidualized stroma infiltrated by intermediate trophoblast with hyperchromatic angulated nuclei and amphophilic cytoplasm
• often seen in curettage specimens for missed abortion

Question 9

What features would suggest endometrial origin as opposed to endocervical origin of an adenocarcinoma?

Answer 9

-Endometrial atypical hyperplasia, stromal foam cells, benign morular elements mixed with the tumor

Question 10

What features suggest an endocervical instead of endometrial origin of adenocarcinoma?

Answer 10

• Adjacent AIS or CIN
• positive for p16 and CEA, negative for ER, vimentin

Question 11

What translocation is associated with endometrial stromal tumors?

Answer 11

-t(7;17), JAZF1-JJAZ1

Question 12

What are features of endometrial stromal sarcoma?

Answer 12

• finger like projections into myometrium
• increased mitotic count and pleomorphism
• prominent stromal vascularity and areas of collagenized stroma
• extensive lymphatic invasion

Question 13

Features of undifferentiated endometrial sarcoma

Answer 13

• Sheets of pleomorphic undifferentiated cells with moderate cytoplasm and high mitotic rate
• lacks plexiform vascular network reminiscent of proliferative endometrium

Question 14

How are stromal tumors and smooth muscle tumors of the uterus staged?

Answer 14

T1a: 5 cm or less

T1b: greater than 5 cm, limited to uterus

T2a: involves adnexa

T2b: involves other pelvic tissues

T3a: one abdominal site involved

T3b: more than one abdominal site involved

T4: invades bladder or rectum

Question 15

What are cytologic features of repair?

Answer 15

• nuclear hyperchromasia and enlargement with multinucleation
• elongated cells with a streaming pattern
• smooth nuclear contours, lack of true atypia, and abundant cytoplasm remain

Question 16

What percentage of HPV infections are cleared in 8 months? What percentage in 2 years?

Answer 16

8 months: 50%

2 years: 90%

Question 17

Where does HPV infect and where does it replicate?

Answer 17

Infects immature squmous metaplastic cells or immature basal cells at sites of epithelial damage

Replicates in mature squamous cells (and produces koilocytic atypia)

Question 18

What are features of disordered proliferative endometrium?

Answer 18

• mild architectural distortion with cystic dilatation
• sometimes unscheduled stromal breakdown

Question 19

What mutations are found in low grade ovarian tumors arising from serous borderline tumors?

What mutations are found in the high grade ones?

Answer 19

Low grade: KRAS, BRAF mutations

High grade: p53 mutations, lack of KRAS and BRAF

Question 20

What mutation is found most consistently in mucinous ovarian tumors?

Answer 20

KRAS

Question 21

What are the principal aberrations in pre-eclampsia?

Answer 21

• abnormal placental vasculature (inadequate ability to perfuse placental bed with maternal vasculature)
• endothelial dysfunction and excess of antiangiogenic factors
• coagulation abnormalities (hypercoagulability)

Question 22

What are histologic findings in pre-eclampsia?

Answer 22

Placental infarcts

Increased syncytial knots

Retroplacental hematomas

Thrombosis, fibrinoid necrosis, or lipid deposition (acute atherosis) of decidual vessels

Mother may also have liver hematomas, glomerular lesions, brain hemorrhages and pituitary hemorrhages