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Chapter 22- The Female Genital Tract Flashcards

1
Q

What epithelium lines the genital tract and ovarian surface?

A

Mesothelium/coelomic epithelium

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2
Q

What infectious organisms cause pain but no pathological condition?

A

Candida

Trichomonas

Gardnerella

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3
Q

What tissues are most affected by HSV?

A

Cervix > vagina > vulva

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4
Q

What organism is caused by a pox virus and appears as pearly, dome-shaped applies with a dimpled centre?

A

Molluscum contagiosum

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5
Q

How are fungal infections diagnosed?

A

Psuedospores or hyphae in wet KOH mounts

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6
Q

What is a characteristic finding in trichomonas vaginalis infections?

A

Fiery red vaginal and cervical mucosa

“Strawberry cervix”

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7
Q

What is the primary cause of bacterial vaginitis?

A

Gardnerella vaginalis

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8
Q

Ureaplasma urealyticum and Mycoplasma hominis are involved in some cases of what disorders?

A

Vaginitis

Cervicitis

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9
Q

What is pelvic inflammatory disease (PID)?

A

An infection that begins in the vulva or vagina and spreads upwards to involve most of the genital structures

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10
Q

What is the difference between PID due to gonococcal infections and non-gonococcal infections?

A

Gonococcal- involve mucosal surfaces and spread upwards (involve ovaries and tubes)

Non-gonococcal- spreads via lymphatics and venous channels

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11
Q

What is the effect of PID on fallopian tubes?

A

Lumen can dilate and full with purulent exudate (pyosalpinx)

Scar formation, fimbriae fuse (hydrosalpinx)

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12
Q

How can pyosalpinx effect the ovaries?

A

Tubo-ovarian abscesses from exudate collecting in the ovary

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13
Q

What benign lesions are associated with the vulva?

A

Bartholin cysts

Leukoplakia

Lichen sclerosus

Squamous cell hyperplasia

Exophytic/wart-like lesions

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14
Q

What are the characteristics of Bartholin cysts?

A

Obstruction of the ducts (inflammation)

Lined with transitional or squamous epithelium

Pain, local discomfort

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15
Q

What are the differences between leukoplakia and lichen sclerosus?

A

Leukoplakia- white plaques, many causes

LS- smooth white plaques that may enlarge/coalesce (porcelain surface), increased risk of SCC, thinning of epidermis, dermis sclerosis, inflammation of deeper dermis

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16
Q

What does squamous cell hyperplasia result from?

A

Skin rubbing/scratching

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17
Q

Where is squamous cell hyperplasia sometimes found?

A

The margins of vulvar cancers

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18
Q

What are some examples of benign exophytic/wart-like lesions of the vulva and their characteristics?

A

Condyloma acuminatum- atypical nuclei (syphilitic condyloma with perinuclear halos), HPV 6 and 11

Vulvar fibroepithelial polyps (skin tags)

Vulvar squamous papillomas- nonkeratinized squamous epithelium

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19
Q

What is the most common histological type of vulvar cancer?

A

SCC

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20
Q

What are the two types of vulvar SCC?

A
  1. Basaloid/warty- high risk HPV, younger ages, immature basaloid cells, central necrosis, classic VIN is precursor
  2. Keratinizing- older (~80), malignant squamous epithelium with prominent keratin pearls, long standing lichen sclerosus or squamous hyperplasia, differentiated VIN is precursor
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21
Q

How are classic and differentiated VIN different?

A

Classic- little differentiation from the basal layer (immature cells at surface), nuclear enlargement, hyperchromasia

Differentiated- basal layer atypical, superficial layers differentiated

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22
Q

Where does vulvar cancer initially spread?

A

Inguinal, iliac and periaortic nodes

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23
Q

What body part do glandular neoplastic lesions affect?

A

Modified apocrine sweat glands of the vulva

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24
Q

What are the characteristics of papillary hidradenoma?

A

Sharply circumscribed module of the vulva

Histological appearance identical to intraductal papilloma of breast

Columnar secretory cells cover myoepithelium

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25
What malignancy can papillary hidradenoma be confused with?
Carcinoma
26
Where does extramammary Paget disease primarily occur?
Labia majora
27
What are the characteristics of extramammary Paget disease?
Pruritic, red, crusted, map-like area Pale cytoplasm with mucopolysaccharide Apocrine, eccrine and keratinocyte differentiation
28
What is the pathology of extramammary Paget disease?
Cells spread laterally within the epidermis (single file or small clusters)
29
What is the epithelium of the vagina?
Columnar, endocervical type initially, replaced with squamous
30
What are examples of developmental anomalies of the vagina?
Septate/double (with double uterus) Vaginal adenosis- remnants of endocervical type (columnar) epithelium
31
What benign lesions are found in the vagina?
Gartner duct cysts- remnants of mesonephric ducts Mucous cysts- derived from müllerian epithelium
32
What are the locations of Gartner duct cysts and mucous cysts in the vagina?
Gartner- lateral walls Mucous- proximal vagina
33
What ages do benign vaginal tumours primarily occur in?
Reproductive
34
Almost all primary vaginal tumours are what type?
Squamous carcinomas from high risk HPV
35
What is a rare, highly malignant, primary vaginal tumour in infants?
Embryonal rhabdomyosarcoma
36
The serosa of the cervix extends furthest in which direction?
Posteriorly
37
How are the ecto and endocervix differentiated?
Ecto- external vaginal portion, covered by mature squamous epithelium Endo- internal canal, columnar, mucous-secreting epithelium
38
What is the squamocolumnar junction/transformation zone?
Point where the epithelium of the ecto and endocervix meet
39
What are endocervical polyps composes of?
Loose, fibromyxomatous stroma covered by mucous secreting glands
40
What is the main significance of endocervical polyps?
Irregular bleeding
41
What is the most important factor in developing cervical cancer?
High risk HPVs (16 and 18)
42
What are the different forms of cervical intraepithelial neoplasia (CIN)/squamous epithelial lesions?
CIN1- low grade SIL (lower third), mild dysplasia CIN2- high grade SIL (upper two thirds), moderate dysplasia CIN3- high grade SIL, severe dysplasia
43
What staining is highly correlated with HPV?
Ki-67 and p16
44
What are the types of carcinomas associated with the cervix and how common are they?
Squamous (80%) Adenocarcinoma (15%) Adenosquamous and neuroendocrine (5%)
45
How do cervical carcinomas manifest?
Fungating/exophytic or infiltrating massesy
46
What does the prognosis of cervical cancer depend on?
Stage at diagnosis and histological subtype (microinvasive better survival)
47
What are the stages of cervical cancer?
0- CIS I- confined to cervix II- extends beyond cervix but doesn’t involve the pelvic wall, doesn’t involve the lower vagina third III- extends to pelvic wall, involves lower vaginal third IV- involves bladder or rectal mucosa, metastatic dissemination
48
What is the difference between endo and myometrium?
Endo- glands embedded in cellular stromal, epithelial lining Myo- bundles of smooth muscle
49
What defines dysfunctional uterine bleeding?
Abnormal bleeding without the presence of an organic lesion
50
What is the most common cause of DUB?
Hyperestrogenic states (anovulatory cycle)
51
What is endometriosis?
Presence of endometrial tissue outside the uterus
52
What is the form of endometriosis that occurs specifically in the myometrium?
Adenomyosis
53
What is the morphology of adenomyosis?
Cystic holes Trabeculae
54
What are the pathogenesis theories of endometriosis?
1. Regurgitation (retrograde flow) 2. Benign metastasis (tissue spread) 3. Metaplastic- epithelium or remnants differentiate 4. Extrauterine stem cells differentiate
55
What is the morphology of endometriosis?
Red-blue/yellow-brown nodules on/beneath the mucosal and/or serosal surface Hemorrhage can cause extensive fibrosis Chocolate cysts in ovaries (endometriomas)
56
What are chocolate cysts composes of?
Fluid from previous hemorrhage
57
What is the morphology of endometrial polyps?
Exophytic masses of endometrial glands and stroma projecting into the endometrial cavity
58
What can cause endometrial polyps?
Elevated estrogen or tamoxifen therapy
59
What malignancy can endometrial polyps occasionally develop into?
Adenocarcinoma
60
What is endometrial hyperplasia?
Increased proliferation of endometrial glands
61
Endometrial hyperplasia is an important cause of what?
Uterine bleeding
62
What is endometrial hyperplasia associated with?
Prolonged estrogen stimulation
63
Endometrial hyperplasia is a precursor lesion to what malignancy?
Endometrial carcinoma
64
What are the two WHO classifications of endometrial hyperplasia?
1. Nontypical | 2. Atypical
65
Which WHO classification is associated with a higher cancer risk?
Atypical
66
What gene is mutated in 20% of endometrial hyperplasia cases?
PTEN tumour suppressor gene
67
What are the different types of endometrial malignancies?
Carcinoma Malignant mixed müllerian tumours (MMMT) Tumours of stroma
68
What are the differences in the two types of endometrial carcinomas?
Type I- well differentiated, arise in cases of endometrial hyperplasia, polyploid or diffuse/spreading Type II- poorly differentiated, arise in cases of endometrial atrophy (later years), large, bulky and deeply invasive
69
What is the most common subtype of type II endometrial carcinomas?
Serous
70
What are the characteristics of MMMTs?
Endometrial adenocarcinoma with concurrent malignant stroma Highly malignant Bulky, fleshy and polypoid
71
What are the types of endometrial stromal tumours and their characteristics?
1. Adenosarcomas- stromal neoplasia with benign glands, polypoid growth 2. Endometrial stromal sarcomas (ESS)- malignant stroma between myometrial bundles, invasion (diffuse and lymphatic)
72
What are the types of myometrial tumours and what are their characteristics?
1. Leiomyomas (fibroids)- benign masses of smooth muscle, circumscribed, white whorls 2. Leiomyosarcomas- bulky, fleshy mass, aggressively metastasizes
73
What is the most common tumour in women?
Leiomyomas
74
What lesions are associated with the fallopian tubes?
Paratubal cysts (benign) Adenomatoid tumours (mesothelial) Adenocarcinomas
75
Larger versions of paratubal cysts located near the fimbriae are known as what?
Hydatids of Morgagni
76
What mutations can adenocarcinomas of the fallopian tubes be associated with?
BRCA mutations
77
What are the most common nonneoplastic ovarian lesions and their characteristics?
1. Cystic follicles- multiple with clear, serous fluid 2. Luteal cysts- rim of yellow tissue, maybe with hemorrhagic centre, normal 3. PCOS- endocrine disorder
78
PCOS can increase the risk of developing what malignancies?
Endometrial hyperplasia Carcinoma
79
What are the three types of ovarian tumours?
1. Müllerian epithelial 2. Germ cell 3. Sex cord stromal cell
80
Ovarian tumours are mostly benign in what age group?
20-45
81
What are the types of benign Müllerian epithelial tumours?
Cystadenomas Cystadenofibromas Adenofibromas
82
What are the modes of pathogenesis for Müllerian epithelial tumours?
Type I- progress from benign to borderline, low grade Type II- arise from inclusions/cysts/STIC cells (fallopian tube precursors), high grade
83
Müllerian epithelial carcinomas are categorized as what?
Type I Type II
84
What are the forms of Müllerian epithelial tumours?
Serous Mucinous Endometrioid Brenner tumours
85
What is the most common ovarian malignancy?
Serous adenocarcinoma
86
What are the different types of serous Müllerian epithelial tumours?
Benign- serous cystadenoma/cystadenofibrom Borderline- serous borderline tumour High grade- TP53 and BRCA mutations
87
The majority of serous Müllerian epithelial tumours are benign, borderline or malignant?
Benign/borderline
88
What is the morphology of the different types of serous Müllerian epithelial tumours?
Benign- smooth wall, no thickening or projections Borderline- increased number of papillary projections Malignant- larger, solid/papillary masses, nodularity in capsule Smooth inner lining, lack papillary masses Multiloculated Multicystic or projectile mass
89
Which form of serous Müllerian epithelial tumour is most commonly bilateral?
Malignant
90
The majority of mucinous Müllerian epithelial tumours are benign, borderline or malignant?
Benign/borderline
91
Smoking is a risk factor for what form of Müllerian epithelial tumour?
Mucinous
92
What is the morphology of mucinous Müllerian epithelial tumours?
Large, cystic masses Multiloculated, filled with sticky gel Mostly unilateral
93
What is the morphology of endometrioid Müllerian epithelial tumours?
Epithelium resembles endometrium Solid and cystic areas of growth Majority are unilateral
94
15-20% of endometrioid Müllerian epithelial tumours are associated with what disorder?
Endometriosis
95
What is an uncommon variant of endometrioid Müllerian epithelial tumours?
Clear cell carcinoma
96
What type of tumour is a Brenner tumour?
Solid adenofibroma (dense stroma with nests of epithelium resembling urothelium)
97
What are the forms of germ cell tumours?
Teratomas Dysgerminomas Yolk sac/endodermal sinus tumours Choriocarcinomas
98
Where do teratomas arise from?
Ovum
99
What karyotype are teratomas commonly?
46xx
100
What are the categories of teratomas and their characteristics?
1. Mature/dermoid cysts- benign, greasy hair and calcifications 2. Monodermal- differentiate along single tissue line 3. Immature/malignant- embryonic elements
101
What is an example of a monodermal teratoma?
Struma ovarii (entirely thyroid tissue)
102
What male tumour is similar to dygerminoma?
Testicular seminoma
103
What are the characteristics of dysgerminoma?
All are malignant and chemosensitive Solid, yellow-white/grey-pink, fleshy Most are unilateral
104
What is the characteristic histological feature of yolk sac tumours?
Schiller-Duval bodies- central blood vessel enveloped by tumour cells within a tumour cell-lined space
105
What is the malignant potential of yolk sac tumours?
Aggressive but chemoresponsive
106
What are the characteristics of choriocarcinomas?
Extraembryonic differentiation of malignant germ cells In combo with other germ cell tumours Highly malignant, more resistant to chemo
107
Where do sex cord stromal cell tumours originate from?
Ovarian stroma
108
What are the forms of sex cord stromal tumours?
1. Granulosa-theca cell tumours 2. Fibromas, thecomas and fibrothecomas 3. Sertoli-Leydig cell tumours
109
What hormone is produced in large quantities in granulosa-theca cell tumours?
Estrogen (endometrial hyperplasia)
110
What are the characteristics of granulosa-theca cell tumours?
Unilateral Solid, white-yellow Primitive follicle structures Call-Exner bodies- gland-like structures with acidophilic material
111
What are the characteristics of fibromas, thecomas and fibrothecomas?
Composes of fibroblasts or plump spindle cells with lipid droplets Unilateral Solid/hard, grey-white (yellow is thecoma portion present) Majority are benign
112
What are the characteristics of Sertoli-Leydig cell tumours?
Recapitulate cells of the testes (masculinization) Solid, grey/golden brown Heterologous elements may be present
113
Metastatic ovarian tumours normally arise from which organs?
Uterus Fallopian tubes Cotralateral ovary or pelvic peritoneum
114
What is the most common location of extra-Müllerian mets?
Mucinous signed cell tumours from the stomach

Pathology (25 decks)

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