Female Flashcards
Which HPV serotypes cause female genital condyloma?
6 and 11
What histological structure is indicative of being infected by HPV?
Koilocyte
Lichen sclerosis is most often seen in what age group of women?
post-menopausal
What is Lichen Simplex Chronicus?
hyperplasia of (vulvar) squamous epithelium
Is Lichen Simplex Chronicus benign or premalignant? How does it present?
benign
leukoplakia
Which HPV isotypes would vulvar carcinoma be indicative of? What does this result in?
16 and 18
Vulvar Intraepithelial Neoplasia (VIN)
What is Extramammary Pagets Disease characterized by?
malignant epithelial cells in the epidermis
What would the two stains of Pagets Disease be?
Keratin +
PAS +
What is adenosis of the vagina?
focal persistence of columnar epithelium in the UPPER 2/3 of the vagina
What embryological layer is the lower 1/3 of the vagina derived from? Epithelial type?
Urogenital Sinus
squamous
What is the upper 2/3 of the vagina derived from? Epithelial type?
Mullerian Duct
columnar
What drug is associated with adenosis?
Diethylstilbestrol (DES)
What is the neoplastic concern for women with diethylstilbestrol associated adenosis?
clear cell ADENOcarcinoma
What is Embryonal Rhabdomyosarcoma?
malignant mesenchymal proliferation of immature skeletal muscle
WHat is another name for Embryonal Rhabdomyosarcoma?
Sarcoma Botryoiodes
How does Embryonal Rhabdomyosarcoma often present?
grape-like mass extending from vagina or penis
What two stains would be present in a Rhabdomyosarcoma?
Desmin and Myogenin
What is desmin?
intermediate filament of skeletal muscle
Where is myogenin usually found?
immature skeletal muscle
What type of epithelium lines the endocervix?
columnar
What type of epithelium lines the exocervix?
nonkeratinized squamous
Is HPV RNA or DNA?
DNA
What are the high risk HPV isotypes?
16/18/31/33
What are the low risk HPV isotypes?
6 and 11
What does CIN I involve?
1/3 thickness
What does CIN II involve?
2/3 thickness
What does CIN III involve?
almost all thick thickness
What does CIS involve?
all thickness
Cervical carcinoma often arises in what age group? What are two ways in which it often presents?
middle-aged women
vaginal bleeding or post-coital bleeding
What is a common cause of death in advanced cervical carcinoma? What type?
hydronephrosis
post-renal failure
What are the two high-yield secondary risk factors for the development of cervical carcinoma?
smoking and immunodeficiency
Antibodies against which HPV isotype protect against condylomas? Protect against CIN?
condyloma = 6 and 11
CIN = 16 and 18
What is Ashermann Syndrome? What does this result in?
loss of basalis of endometrium
amenorrhea
What is Acute Endometritis? What usually causes this?
bacterial infection of endometrium
retained pieces of placenta
The presence of what cell is required to diagnose chronic endometritis? Why?
Plasma cells
lymphocytes are normally present in the endometrium
What drug can cause an endometrial polyp?
Tamoxifen
What is perfect definition endometriosis?
endometrial GLANDS and STROMA outside of uterine endometrium lining
What is the most common site for endometriosis? What does this result in?
ovary
chocolate cyst
How does endometriosis outside of the ovary appear? Where?
yellow-brown ‘gunpowder’ nodules
fallopian tube
What is it called if the uterine myometrium is found to contain endometriosis?
Adenomysis
Endometriosis can cause what life-threatening outcome? Especially where?
carcinoma
ovary
What causes Endometrial Hyperplasia?
unopposed effects of ESTROGEN
How does endometrial hyperplasia commonly present? In what type of patient?
post-menopausal uterine bleeding
obese
What four cancers are Psamomma Bodies indicative of?
Papillary cancer of the thyroid
Meningioma
Papillary serous (ovarian or endometrial) carcinoma
mesothelioma
What protein is commonly deficient during Sporadic Endometrial Carcinoma?
p53
What is a Leiomyoma? What is another name for leiomyoma?
benign neoplastic proliferation of smooth muscle
fibroid
The development of a leiomyoma is related to what?
exposure to estrogen
What layer of the uterus does a Leiomyoma commonly arise from?
myometrium
What is a leiomyosarcoma?
malignant proliferation of smooth muscle cells arising from the myometrium
Do leiomyosarcomas arise from leiomyomas?
no
In what population of women does a leiomyosarcoma often arise in?
post-menopausal
How many lesions are usually present during a leiomyosarcoma?
single
LH acts on what cells? To produce what?
Theca
androgens
FSH acts on what cells? To produce what?
granulosa
estradiol from estrogens
The surge of what hormone causes an LH spike? What is the result?
estrogen
ovulation
What hormone does the corpus luteum secrete?
progesterone
What are the levels of LH and FSH during PCOD?
high LH
low FSH
What is the result of excessive LH production during PCOD? Why?
hirsutism
increased androgens from Theca cells
During PCOD, what does excessive androgen get converted into? Where?
estrone
peripheral fat
High estrone inhibits the release of what hormone? What does this result in?
FSH
cystic degeneration of the follicles
What are the four common presenting symptoms of a woman with Polycystic Ovary Disease?
Obese
Oligomenorrhea
Infertile
Insulin resistance
What are the three cellular layers of the ovary?
surface epithelium
germ cells
sex chord stroma
What is the most common type of ovarian tumor?
surface epithelial tumor
What are the two types of ovarian surface epithelium tumor? Both are usually?
mucinous and serous
cystic
What is the name for a benign surface epithelium ovarian tumor?
cystadenoma
Is a cystadenoma more common in a premenopausal or postmenopausal woman?
premenopausal
What is the name for a malignant surface epithelium ovarian tumor?
cystadenocarcinoma
Is a cystadenocarcinoma more common in a premenopausal or postmenopausal woman?
postmenopausal
BRCA1 mutations carry an increased risk of cancer regarding which two structures in the female genitalia?
serous carcinoma of ovary
serous carcinoma of fallopian tube
What kind of tumor is an endometrioid? Are endometrioid tumors more often benign or malignant?
ovarian surface epithelium
malignant
Are Brenner or Endometrioid tumors malignant? What kind of cancer are these?
Endometrioid = malignant
ovarian surface epithelium
What is the tumor marker for ovarian cancer?
CA-125
What type of ovarian tumor occurs in women of reproductive age?
Germ cell tumor
What are the two tumors of fetal tissue?
cystic teratoma and embryonal carcinoma
What germ cell tumor mimmics Oocytes?
Dysgerminoma
What germ cell tumor mimmics the yolk sac?
enodermal sinus tumor
What germ cell tumor mimmics the placenta?
choriocarcinoma
What is the name for a teratoma composed of ovarian tissue?
struma ovarii
What is the most common malignant germ cell tumor?
Dysgerminoma
What is the male counterpart of a dysgerminoma?
seminoma
What lab value may be elevated during a dysgerminoma?
LDH
What is the most common germ cell tumor in children?
endodermal sinus tumor
What lab may be elevated during a Endodermal Sinus tumor?
alpa-fetoprotein
Schiller-Duval bodies are indicative of what type of ovarian carcinoma? What do these structures look like?
Endodermal Sinus Tumor
‘Glomeruloid like’
What do Schiller-Duval bodies look like?
Glomerulus
What two blast cells compose a choriocarcinoma?
cytotrophoblasts and syncytiotrophoblasts
What is the preferred medium of metastisis for choriocarcinoma?
hematogenous
Granulosa-Thecal Tumors usually produce what hormone?
estrogen
Reinke crystals are indicative of what cancer? Which cell specifically?
Leydig-Sertoli tumor
Reinke = Leydig
What two findings on physical exam would be indicative of a Leydig-Sertoli tumor?
Hirsutism
Virilization
What is the triad of Meigs tumor?
ascites
pleural effusion
fibroma of ovary
What is Pseudomyxoma Peritonei?
massive amounts of mucus in peritoneum
What is the primary location for a tumor during Pseudomyxoma Peritonei? Where is the additonal location site of metastasis?
appendix
ovary
What is the classic presentation for an ectopic pregnancy?
lower abdominal pain a few weeks after a missed pregnancy
What are the three risk factors for a spontaneous abortion?
Trisomy 16
hypercoaguable state
teratogens
What is placenta previa?
When the placenta overlies the cervical os
How does placenta previa present?
3rd trimester bleeding
What is placenta accreta?
implantation of placenta into myometrium
What birth defects are caused by alcohol?
mental retardation and microcephaly
What two birth defects are caused by cocaine?
growth retardation
spontaneous abortion
What birth defect is caused by thalidomide?
limb defects
What birth defect is caused by cigarettes?
growth retardation
What three birth defects are caused by Isotretinoin?
spontaeous abortion
hearing
visual impairment
What birth defect is caused by phenytoin?
digit hypoplasia
cleft lip/palate
What cell proliferates during a hyaditiform mole?
tropholasts
What is a partial mole?
normal ovum fertilized by two sperm
How many chromosomes does a partial mole possess?
69
What is a partial mole?
empty ovum fertilized by two sperm
Is fetal tissue present in a partial mole?
yes
Is fetal tissue present in a complete mole?
no
What do the villi look like in a partial mole?
some are normal and some are edematous
What do the villi look like in a complete mole?
most are edematous
Which mole would have abnormally high βHCG? Lower βHCG?
high = complete
lower = partial
What type of cancer could a hyaditiform mole give rise to? Partial or complete mole?
choriocarcinoma
complete
How does a hyaditiform mole present on ultrasound?
‘snow storm’
Do condylomas progress to carcinoma?
no
How does Lichen Sclerosis present?
Leukoplakia
What is the key phrase for the presentation of lichen sclerosis?
“Parchment-like”
Other than HPV, what is the 2nd cause of vulvar carcinoma?
long standing lichen sclerosis
What is Extramammary Pagets Disease (vulva) characterized by?
malignant epithelial cells in the EPIDERMIS of the vulva
What causes vaginal carcinoma?
high risk HPV
Where does cancer from the lower 1/3 of the vagina spread?
inguinal nodes
Where does cancer from the upper 2/3 of the vagina spread?
iliac nodes
Where in the female genital tract does HPV like to infect the most?
transformation zone
What molecule does p53 use to initially begin apoptosis?
Bax
What is the function of bax?
inhibit bcl-2
What protein does E7 inhibit? What protein does this protein inhibit?
Rb
E2F
At what point is cervical epithelial dysplasia irreversible?
carcinoma in situ
Does HPV drive squamous cell or adenocarcinoma of he cervix?
both
What are the two limitations of the pap smear?
ineffective sampling of transformation zone
does not detect adenocarcinoma very well
What serotypes in the HPV vaccine effective against?
6/11
16/18
Do patients still need to get a pap smear after HPV vaccine?
yes
When are the two most common times for an anovulatory cycle to arise?
menarche and menopause
When does endometriosis often cause pain?
pain during menstruation
How does endometrial carcinoma most often present?
post-menopausal bleeding
What are the two pathways for the development of Endometrial Carcinoma?
hyperplastic and sporadic
What is the classic histology of hyperplastic endometrial carcinoma?
Endometrioid
What is the histology of Sporadic endometrial carcinoma?
Serous
Does sporadic endometrial carcinoma occur in the young or elderly?
elderly
What age group does hyperplastic endometrial carcinoma occur?
50-60
What are Psamomma bodies composed of?
concentric calcifications
What does gross examination of a leiomyoma reveal?
multiple well defined white whirled masses
How does a leiomyosarcoma arise?
De novo
High levels of estrone during PCOD correlates to an increased risk of what cancer?
endometrial carcinoma
Where do ovarian carcinomas like to spread?
peritoneum
What two types of tissue are most commonly found in an immature (malignant) Teratoma?
Neural
squamous cell
What is the most common malignancy to arise in a teratoma?
squamous cell carcinoma
Are villi present during a choriocarcinoma?
no
Do choriocarcinomas respond well or poorly to chemo?
poorly
Are embryonal carcinomas benign or aggressive?
aggressive
What is the biggest risk factor for ectopic pregnancy?
fibrosis
What is the presentation of an ectopic pregnancy?
lower quadrant abdominal pain weeks after a missed period
What type of necrosis can occur during pre-eclampsia? Where?
fibrinoid
vessels of placenta
Which cell type proliferates during a Hydatidiform Mole?
Trophoblasts
What is the most abnormal lab during a Hydatidiform Mole?
very high β-HCG
Choriocarcinoma is composed of what cell type?
trophoblasts
Which type of choriocarcinoma responds to chemo? Which does not?
chemo = gestation
poorly = germ cell tumor
What is the function of HPV E6 protein?
degrade p53
What type of cancer can endometriosis lead to? Where?
carcinoma
ovary
High levels of what hormone can drive endometrial carcinoma during Endometriosis?
Estrone
What are the two birth defects caused by phenytoin?
cleft lip/palate and digit hypoplasia
What is the second cause of a vulvar condyloma?
secondary syphillis
Does the epidermis thicken or thin during Lichen Sclerosis?
thin
Does the skin thicken or thin during Lichen Simplex Chronicus?
thicken
Does Pagets Disease of vulva represent an underlying carcinoma?
no
Does Pagets Disease of breast represent an underlying carcinoma?
yes
Does epithelium in the vagina grow from bottom-up or top-down?
bottum-up
Which female Genitourinary cancer is an AIDS defining illness?
cervical carcinoma
What follows an abnormal pap smear?
colposcopy
Which immune cell is usually present in the endometrium?
lymphocytes
What factor is the largest predictor of progression of Endometrial Hyperplasia to Endometrial carcinoma?
cellular atypia
‘Whorled’ refers to what mass?
leiomyoma
Do leiomyosarcomas have hemorrhage?
yes
Do leiomyosarcomas have necrosis?
yes
What produces a corpus luteum cyst?
hemorrhage into corpus luteum
Which epithelium is the surface epithelium of the ovary derived from?
coelemic epithelium
Coelomic epithelium gives rise to what three cell types of the female genitourinary tract?
fallopian
endometrium
endocervix
Which three cells comprise the sex chord stroma?
theca
granulosa
fibrocyte
Teratogens during which time period can cause abortion?
first two weeks
Teratogens during which time period can cause organ malformation?
3-8 weeks
Teratogens during which time period can cause organ hypoplasia?
3-9 weeks
During which trimester does placenta previa bleed?
third
What are the three risk factors for SIDS?
smoking
sleeping on stomach
prematurity
During which trimester can molar pregnancy pass grape like masses?
second
What happens to the dermis during lichen sclerosis?
sclerosis
Is Lichen Simplex Chronicus associated with the development of squamous cell carcinoma?
no
What is the main cause of non-HPV vulvar carcinoma?
long standing lichen sclerosis
What causes adenosis of the vagina?
DES
What is myogenin?
transcription factor in immature skeletal muscle
What is Desmin?
intermediate filament in muscle
What is the more common cancer of the cervix, adeno or squamous?
squamous
Which four isotypes are currently included in the cervical cancer vaccine?
6/11/16/18
Where in the endometrium are the stem cells present?
basalis
What can be the end outcome of endometriosis?
infertility
What is the definition of Endometrial Hyperplasia?
proliferation of endometrial glands relative to endometrial stroma
Does endometrial carcinoma involve stroma?
no
What are the two histological subtypes of endometrial carcinoma?
endometrioid
sporadic
Does leiomyoma occur in pre or post menopausal women?
pre
Is leiomyoma a single or multiple mass?
multiple
Are leiomyomas usually symptomatic or asymptomatic?
asymptomatic
The presence of what type of tissue in a teratoma signales that it is immature?
neuroectoderm
Does choriocarcinoma of the ovary respond to chemo poor or well?
poor
Is metastatic tumor of the ovary more often unilater or bilateral?
bilateral
Can endometriosis cause an ectopic?
yes
What is the age range for SIDS?
one month to one year
