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System Path II > Female > Flashcards

Female Flashcards

1
Q

what is the acinus?

A

what the functional unit of the breast, the terminal duct lobular unit, is called during lactation

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2
Q

explain the normal epithelium of the lobules and ducts of the breast (location, shape, and function)

A

2 layers: inner cuboidal - milk production

outer myoepithelial - contractile function to move milk down duct

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3
Q

what is an important change in the epithelium of the breast that indicates malignancy?

A

loss of myoepithelial cells in the ducts

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4
Q

define polythelia

A

accessory nipples - can be anywhere along milk line from axilla to vulva

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5
Q

define polymastia - significance?

A

accessory breast tissue anywhere along milk line - can have any breast pathology

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6
Q

what is induration of the breast?

A

hardening

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7
Q

Mother is breast feeding her child and notices a painful lump in her right breast. Diagnosis? Pathogenesis?

A

Galactocele

cystic dilation of obstructed duct during lactation

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8
Q

32 year old woman presents with a lump in her breast that shows vague nodularity, is bilateral, and gets bigger before mensus. There is no skin change or axillary LN involvement. Diagnosis? Pathogenesis? Relationship to oral contraception?

A

Fibrocystic change (FCC)
exaggerated response to normal hormones of menstrual cycle
oral contraction REDUCES risk of FCC

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9
Q

42 year old woman presents with cysts of her breast and you see related calcifications on X-ray. On biopsy you find them filled with a bloody, watery substance. Explain her condition. Should you be concerned?

A

These are blue domed cysts of FCC and are completely benign

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10
Q

35 year old woman presents with lumps that are lined by large polygonal cells with abundant granular, eosinophilic cytoplasm with small, round, deeply chromatic nuclei. You also see lymphomononuclear infiltration. Disease? Name of this histology?

A

FCC

apocrine metaplasia

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11
Q

How do you tell the difference between simple FCC and proliferative FCC?

A

Proliferative FCC will have epithelial hyperplasia of ducts and ductules

Proliferative FCC also has nipple discharge

Both hyperplasia and nipple discharge are absent in simple

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12
Q

40 year old woman presents with lump in her breast and nipple discharge. On biopsy you see the lumen of a duct is filled with heterogenous cells of different morphologies. You also see fenestrations around the edges of the duct lumen. What is this condition, specifically. What is the prognosis?

A

Cribiform pattern of proliferative FCC

ductal hyperplasia carries at 2x increased risk of invasive carcinoma

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13
Q

40 year old woman presents with lump in her breast and nipple discharge. On biopsy you see the lumen a duct is less than 50% filled with monomorphic, hyperplastic cells. What is this condition specifically. What is the prognosis?

A

Atypical hyperplasia subtype and proliferative FCC

5x increased risk of invasive carcinoma

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14
Q

35 year old woman presents with a hard, rubbery, irregular lump with ill defined borders in the upper outer quadrant of her right breast. On x-ray you see calcifications and on biopsy you find a dense, fibrous stroma with masses of proliferated ducts in a back to back arrangement. Diagnosis? What is an important test to do on this biopsy sample?Prognosis?

A

Sclerosing adenosis subtype of proliferative FCC

Must stain for myoepithelial cells, if present, not carcinoma!

Sclerosing adenosis only has a 2x increased risk for invasive carcinoma (very small!) so good prognosis, benign condition

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15
Q

27 year old woman nursing her baby suddenly experiences enlargement and pain in her left breast. The entire breast became reddish and the nipple cracked. Diagnosis? Explain how this condition resolves.

A

Acute mastitis with Strep infection

Strep causes infection of the whole breast and heals WITHOUT scaring

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16
Q

27 year old woman nursing her baby suddenly experiences enlargement and pain in her left breast. You notice a reddish area under her left nipple. Diagnosis? Explain how this condition resolves.

A

Acute mastitis with Staph infection

Staph infection remains localized, usually under nipple but can heal with indurated scar

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17
Q

65 woman presents with an indurated mass close to her areola, nipple retraction, and green-brown nipple discharge. On histo you see plasma cells, foamy histiocytes, and granulomas. Diagnosis? Pathogenesis? Prognosis?

A 
Duct Ectasia (dilation)
obstruction of large duct leading to dilation and rupture
benign, but mimics carcinoma (mass in postmenopausal woman usually cancer)
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18
Q

Patient with macromastia presents with a painful mass and shows calcifications on mammography. On histo you see neutrophils, fibrosis, giant cells and cholesterol clefts. Diagnosis? Pathogenesis? Prognosis?

A

Fat necrosis
Usually traumatic
benign condition - mimics carcinoma but presents with painFUL lump

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19
Q

18 year old presents with a 2cm lump in her right breast that is well delineated and mobile and difficult to palpate. Skin is normal, no LN involvement, no signs of inflammation. Diagnosis? Pathogenesis? Prognosis?

A

Fibroadenoma - most common benign tumor of breast
Grows with excess estrogen
Benign, no risk of malignancy

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20
Q

24 year old presents with a 4cm lump in her left breast and large, popcorn calcifications on mammography. On biopsy you see loose edematous myxoid fibroblastic stroma containing glandular/duct-like epithelial lined spaces. Diagnosis? Type of tumor? Prognosis?

A

Fibroadenoma
tumor of stroma cells
Benign, no malignant potential

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21
Q

Name 2 benign stromal tumors of the breast. How can they be differentiated?

A

Fibroadenoma: teens and 20s

Phylloides tumor: 40s-50s (much less common)

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22
Q

45 year old woman presents with firm, palpable, 12 cm mass that is growing quickly. On histo you see mild atypia of stromal cells and hypercellular projections with slits and clefts. Diagnosis? Prognosis? Should you be concerned about the axillary lymph nodes? why or why not

A 
Phylloides tumor (stromal tumor)
usually benign (15% malignant)
invasion is usually only local, but if it does metastasize, it does so via blood, so no need to remove axillary LNs
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23
Q

45 year old woman presents with firm, palpable, 12 cm mass that is growing quickly. On histo you see hypercellularity, atypical stromal cells, stromal overgrowth, mitosis, and infiltrative borders. Diagnosis? Prognosis?

A

Phylloides tumor (malignant - usually only 15%)

Malignant, usually only invades locally, can spread via BLOOD

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24
Q

“leaf like projections”

A

Phylloides tumor

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25
Q

29 year old female presents with serous, bloody discharge from her right nipple which is retracted. No signs of inflammation but a 1cm subareolar lump is palpable. Diagnosis? Prognosis?

A

Intraductal papilloma

benign condition

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26
Q

29 year old female presents with serous, bloody discharge from her right nipple which is retracted. No signs of inflammation but several 1cm subareolar lumps are palpable. Diagnosis? Prognosis? Treatment?

A

Intraductal papilloma
benign condition, but multiple lumps carry a higher risk of malignancy
Excise the whole duct system

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27
Q

35 year old woman presents for her biannual mammogram. You find a small area of calcification but can palpate no mass. Should you be concerned?

A

Further testing is needed, could be malignant or benign. Important: not all cancers present with a lump!!!!

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28
Q

name 4 commons sites of metastasis of breast cancer

A

lungs, bone, liver, adrenals

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29
Q

Woman presents with thick nipple discharge that can be squeezed out with gentle pressure. Histo shows necrosis and dystrophic calcifications in center of ducts. Diagnosis? Prognosis?

A

DCIS comedo type

60% become invasive carcinomas

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30
Q

Name the 4 subtypes of invasive ductal carcinoma of the breast

A

Tubular
Mucinous (colloid)
Medullary
Inflammatory

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31
Q

70 year old woman presents with soft, gelatinous mass in her right breast. Biopsy stains PAS+. Diagnosis? Prognosis?

A

Mucinous (colloid) carcinoma
subtype of invasive ductal carcinoma

study hint: tumor cells “stuck” in mucus, can’t spread -> good prognosis

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32
Q

Female presents with well-circumscribed mass in her right breast. Histo shows large sheets of large oval cells and little stroma with lymphocytic infiltration. Diagnosis? Pathogenesis? Prognosis? Important differential?

A

Medullary carcinoma
subtype of invasive ductal carcinoma

increased incidence in BRCA1 carriers

good prognosis

commonly mistaken for fibroadenoma

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33
Q

Pregnant woman in her last trimester presents with an inflamed, swollen, red breast. You see stippling of the skin over the affected area but cannot palpate a mass. Diagnosis? Pathogenesis? Treatment? Prognosis?

A 
Inflammatory carcinoma (common in pregnancy)
subtype of invasive ductal carcinoma

carcinoma in dermal lymphatics

commonly mistaken for acute mastitis, treat with antibiotics, if they don’t work -> carcinoma

bad prognosis (already in lymph)

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34
Q

which type of breast carcinoma is more common? How often can carcinomas present bilaterally?

A

ductual 90% lobular 10%

both can present bilaterally 10-20%

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35
Q

This tumor is usually multifocal and bilateral and is characterized by loss of E-cadherin adhesion proteins. Usually does not produce a mass or calcifications.

A

Lobular carcinoma in situ (LCIS)

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36
Q

Patient presents with a hard, fibrous mass in their left breast. On histo you see well-differentiated tubules and nests of cells with small monomorphic nuclei that are invading the surrounding stroma. This tumor is characterized by a desmoplastic response. Diagnosis? Prognosis? What is a desmoplastic response?

A

Infiltrating Ductal Carcinoma NOS
worst prognosis and most invasive

desmoplastic response is growth of stroma surrounding tumor that leads to fibrosis (why it appears hard)

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37
Q

single file line of cells is characteristic of what? why are they in a line?

A

Invasive lobular carcinoma

cannot form ductal structures due to lack of E-cadherins

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38
Q

This breast tumor is estrogen receptor + and shows tumor cells surrounding normal acini and ducts. Diagnosis? Name the buzzword for this description and give 2 other common findings on microscopy.

A

Invasive lobular carcinoma
“bull’s eye pattern”
also see indian file pattern and signet ring morphology

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39
Q

Patient presents with eczema, hyperemia, edema and fissuring of the nipple with no palpable mass. On biopsy you see cells with large hyperchromatic nuclei with a clearing around them. Diagnosis? Prognosis? How will these cells stain?

A

Paget’s disease of the breast
ALWAYS associated with an underlying ductal carcinoma - find it! Prognosis is based on the tumor you find

Paget cells are PAS+

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40
Q

explain how obesity can be a risk factor for breast cancer

A

Adipose cells take up androgens and convert it to estrogen. High estrogen levels are associated with many breast carcinomas

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41
Q

What is the most important factor when giving prognosis for breast cancer? What is the most useful? Why?

A

Most important is metastasis, but most people present before metastasis so axillary lymph node involvement is more useful.

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42
Q

How long can breast tissue sit out before being placed in fixative? How long should it be fixed for?

A

1 hour or less

fixed for at least 6 hours but no longer than 72

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43
Q

how does tomoxifen work?

A

it is an antiestrogenic agent - many cancers are associated with excess estrogen

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44
Q

how does trastuzumab work?

A

aka Herceptin

It is a designer antibody targeted to the HER2 growth factor receptor leading to decreased growth of the tumor

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45
Q

what % of breast cancers express estrogen receptor? why is this important?

A

60% - can treat with anti-estrogens like Tomoxifen

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46
Q

explain the treatment and outcome of ER+/PR+ vs ER-/PR- tumors

A

ER+/PR+ tumors respond well to endocrine treatment with anti-estrogens (tomoxifen)

tumors without these receptors have a very low response to this kind of treatment and need to be treated preferentially with chemo

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47
Q

explain the significance of 17q21

A

loci for the HER2/neu oncogene

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48
Q

How does the prognosis of ER+/PR+ tumors different from HER2/neu tumors?

A

ER+/PR+ tumors have a better prognosis and respond well to treatment. HER2/neu tumors metastasize quickly

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49
Q

Explain the downside of herceptin

A

herceptin works well for treatment of tumors with HER2/neu, but it cannot cross the BBB so if there is metastasis there, the therapy won’t work

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50
Q

high cathepsin D is found in a tumor - how does this affect the prognosis and what does it do?

A

Cathepsin D degrades basement membrane and connective tissue - indicates metastatic potential -> poor prognosis

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51
Q

What group of women has higher incidence of BRCA1 and BRCA2 mutations? What is significant about these mutations (2 things)?

A

Ashkenazi Jews

  1. higher risk of breast AND ovarian cancer
  2. breast cancer appears 15-20 years earlier than sporadic cancers
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52
Q

ER/PR/HER2 receptor analysis is important in what stage tumor?

A

Important in stage 1

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53
Q

which mutation carries the higher risk of ovarian cancer?

A

BRCA1

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54
Q

which mutation increases the chance of breast cancer in a male?

A

BRCA2

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55
Q

Male with Klinefelter’s syndrome is at higher risk for what disease?

A

Breast cancer

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56
Q

what type of breast carcinoma is more common in males? why?

A

invasive ductal carcinoma - male breast develops very few lobules

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57
Q

Name the functional unit of the ovary and describe the basic histology

A

functional unit: follicle

a follicle is an oocyte surrounded by granulosa and theca cells

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58
Q

What acts on theca cells to induce them to do what?

A

LH acts on theca to produce androgens

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59
Q

What acts on granulosa cells to induce them to do what?

A

FSH acts on granulosa cells to convert androgen to estradiol

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60
Q

What marks the beginning of the secretory phase of the menstrual cycle? What hormonal changes precede its beginning?

A

ovulation marks beginning of secretory phase

estrogen induces an LH surge which leads to ovulation

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61
Q

what is the corpus luteum and what does it produce and for how long?

A

residual follicle - produces progesterone until menstruation or for the 1st trimester if pregnancy occurs

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62
Q

how do ovarian diseases commonly present?

A

usually silent for a long time until they get big enough to cause mass effect -> pressure, pelvic discomfort, frequent micturition

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63
Q

what is the relationship between oral contraception and ovarian cancer?

A

oral contraception is usually protective against ovarian cancer

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64
Q

you find a thin walled cyst filled with clear fluid in an ovary. Diagnosis? What is the etiology? common symptoms?

A

follicular cyst

ovulation doesnt occur, egg is not released, follicle grows until it becomes a cyst

sharp, one-sided pain usually during ovulation

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65
Q

you find a mass on an ovary filled with a dark fluid. Histology shows lipid accumulation in the theca cells. Diagnosis? Etiology? Complication?

A

corpus luteum cyst
hemorrhage into persistent corpus luteum
can undergo torsion -> rupture -> internal bleeding

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66
Q

on inspection of the ovaries you find multiple, bilateral, yellow/hemorrhagic cysts that show hyperplasia of theca interna cells. Diagnosis? Pathogenesis? List 2 associated disease

A

Theca lutein cyst
excess stimulation of theca interna cells due to high circulating hCG
associated with choriocarcinoma and moles (both increase hCG - also pregnancy)

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67
Q

On inspection of an ovary, you find a cyst filled with a dark fluid. Biopsy shows normal glands, stroma, RBCs and hemosiderin. Diagnosis? Etiology? Important association?

A

Chocolate cyst
caused by endometriosis (hence endometrial glands)
associated with infertility

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68
Q

explain how hyperinulinemia can lead to high levels of LH

A
  1. Hyperinsulinemia -> inc GnRH -> inc LH relative to FSH (see below)
  2. persistently high LH stimulates theca cells in ovary to produce excess androgens leading to anovulation
  3. excess androgens are converted to estrogen by adipose tissue. Excess estrogen inhibits release of FSH, but stimulates release of GnRH
  4. GnRH acts on pituitary to release LH (and FSH but FSH is inhibited by estrogen)
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69
Q

An obese 26 year old woman with hirsutism and oligomenorrhea presents complaining of infertility. Diagnosis? Cause of infertility and explain

A

Polycystic ovarian disease

infertility caused by anovulation due to persistently high LH levels but no spike to induce release of oocyte

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70
Q

Ovary shows thickened capsule with multiple large cysts inside. Surface of ovary is uniform. Diagnosis? long term complication?

A

polycystic ovarian disease

insulin resistance leading to type 2 diabetes

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71
Q

name the 3 cell types of the ovary

A

surface epithelium
germ cells (eggs)
sex cord-stroma

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72
Q

sex cord stromal tumors of the ovary can arise from what cells?

A

granulosa, theca, or fibroblasts

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73
Q

what is the clinical significance of cystic ovarian tumors vs solid ovarian tumors?

A

cystic tumors are generally benign whereas malignant tumors are generally solid

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74
Q

name the 4 subtypes of surface epithelial tumors of the ovary and the type of epithelium of each and where else that epithelium is found

A

serous: ciliated columnar (fallopian tube)
mucinous: tall mucin secreting cells (endocervix)
endometrioid: non-ciliated columnar (endometrium)
brenner: transitional (bladder)

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75
Q

What are the 3 possible designations that can be given to an ovarian surface epithelial tumor? What is important to remember about these designations?

A

Benign, borderline, malignant

NOT a continuum (one doesnt necessarily lead to the next)

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76
Q

Increased CA125 is indicative of what? what can it be used for?

A

ovarian tumor

used to monitor response to therapy and recurrence… diagnostic aid is debatable

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77
Q

Name the 4 types of germ cell tumors of the ovary and what tissues they produce

A

teratoma (fetal tissue)
dysgerminoma (oocytes)
endodermal sinus tumor (yolk sac)
choriocarcinoma (placental tissue)

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78
Q

you find bilateral ovarian cysts lined by tall columnar ciliated cells filled with watery fluid. What type of tumor is this? How likely is it to be malignant and what is this called? benign and what is this called?

A

serous surface epithelial tumor
2/3rds of malignant serous tumors are bilateral (cystadenocarcinoma)
only 20% of benign serous tumors are bilateral (cystadenoma)

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79
Q

papillae, polyps, psammoma bodies are found in what type of tumor? malignant or benign?

A

serous surface epithelial tumors of the ovary

seen in both benign and malignant (malignant has more papilla/polyps and solid nodules)

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80
Q

what is important about the presence of a fibrovascular core?

A

means its not malignant

81
Q

On histo of a fluid filled ovarian tumor you see finger-like papillae with a fibrovascular core, Multilayering, moderate mitosis, nuclear atypia - diagnosis? prognosis?

A

borderline serous surface epithelial tumor

10 year survival 75%

82
Q

BRCA1 mutation increases a female’s risk for what type of ovarian cancer?

A

serous carcinoma

83
Q

psammoma bodies are more likely to be seen in benign or malignant serous epithelial tumors?

A

malignant

84
Q

you find a glistening tumor of the ovary that shows tall columnar cells with basal nuceli and graffian follicles in the stroma - diagnosis? How likely is it found bilaterally if it is malignant? benign?

A

mucinous surface epithelial tumor
only 15% of malignant mucous tumors are bilateral (unlike serous where 2/3rds were)
only 5% of benign mucous tumors are bilateral

85
Q

Patient presents with abdominal distension, digestive difficulties, and weight changes. On biopsy of the patients ovaries, you find mucinous material bilaterally. Describe the possible pathogenesis of this condition

A

mucinous tumors are rarely bilateral and digestive problems and wt. changes suggests pseudomyxoma peritonei which is due to a primary carcinoma of the appendix which seeded the peritoneum and metastasized to the ovaries

86
Q

Mass in the ovary appears cystic, small, has papillae and a velvety surface. Micro shows non-ciliated columnar cells. Diagnosis? Pathogenesis? Prognosis? Clinical significance?

A

Endometroid surface epithelial tumor
caused by endometriosis
usually malignant
15% are associated with an independent endometrial carcinoma

87
Q

what cancer has the worst prognosis of the female genital tract cancers?

A

surface epithelial carcinomas

88
Q

concentric laminated calcified concretions describe what histological feature?

A

psammoma bodies

89
Q

A solid tumor of the ovary shows multiple small nodules made of dense fibrous tissue. The cells appear to be stratified with domed surfaces. Diagnosis? Prognosis?

A 
Brenner's surface epithelial tumor
usually benign (even though its solid with nodules) and clinically silent
90
Q

coffee bean nuclei can be found in what 3 pathologies?

A

brenner’s tumor
adult granulosa cell tumor
thyroid papillary carcinoma

91
Q

how likely is a germ cell tumor of the ovary likely to be malignant? in what age group?

A

95% are benign

5% of malignant ones are in kids and young adults

92
Q

15 year old girl presents with a mass in her right ovary that contains neuroepithelium. Possible diagnosis? Prognosis?

A

Immature teratomas have immature tissues (usually neural), common in children and young women, and are malignant

93
Q

30 year old woman presents with a mass in her right ovary and complains of sterility. On biopsy of the mass, you find various embryological tissues. Diagnosis? Rare but important complication?

A

Mature teratoma

1% of the time, the fetal skin tissue inside the teratoma can develop squamous cell carcinoma

94
Q

patient presents with heat intolerance, weight loss, agitation, and tremor. There are no abnormal neck masses. What could be a possible explanation of her condition? How would this appear grossly?

A

Stuma ovarii: teratoma with mature, hyperfunctional thyroid tissue

small, unilateral, brown ovarian masses

95
Q

dermoid cyst is another name for what?

A

mature ovarian teratoma that only has ectodermal tissue

96
Q

Patient presents with flushing, diarrhea, abdominal cramps, wheezing, salivation, nausea and vomiting. These are symptoms of what? Caused by what? Found in what disease?

A

carcinoid syndrome (flushing!)
serotonin
can be related to a mature teratoma

97
Q

layers of epithelial cells around blood vessels resembling glomeruli describes what histological finding? This is seen in what pathology?

A

Schiller Duval bodies

Endodermal sinus tumor (yolk sac) germ cell tumor of the ovary

98
Q

A 6 year old female presents with a mass in her ovary that contains cytoplasmic pink inclusions. Diagnosis? What are the inclusions? Prognosis?

A

Endodermal sinus tumor (yolk sac) germ cell tumor of the ovary

inclusions: alpha feto protein

malignant and aggressive

99
Q

What two blood tests should you order for a woman with an endodermal sinus tumor? What is the origin of this tumor?

A

AFP and alpha 1- AT

germ cell tumor

100
Q

you find a malignant germ cell tumor in the ovary, what is it most likely to be?

A

dysgerminoma (most common malignant tumor of the ovary)

101
Q

Patient presents with a unilateral solid tumor of the ovary. It is a soft, fleshy tumor that shows lymphocytic infiltration. Serum LDH levels are noted to be high. Diagnosis? What is the origin of this tumor? Prognosis?

A

Dysgerminoma
germ cell tumor
good prognosis, all malignant but only 1/3 aggressive, most respond to radiotherapy

102
Q

30 year old patient presents with unilateral solid tumor in her ovary. On microscopy you see large, uniform, round cells with clear cytoplasm and central regular nuclei and little stroma. Diagnosis? Origin of the tumor? Where else is this histology seen (2 places)

A

Dysgerminoma
germ cell tumor
testicular seminoma and medullary carcinoma of the breast

103
Q

24 year old woman has a small, hemorrhagic tumor in her ovary. You see areas of necrosis, pleomorphism, multi nucleation, and giant cells. Levels of beta-HCG and CGT are high but she says she has not had sex recently. Diagnosis? Prognosis?

A

nongestational choriocarcinoma

very bad prognosis, early and widespread metastasis - resistant to therapy

104
Q

A 25 year old woman presents with cachexia, wt loss, and a cough. On chest X-ray you see multiple nodules in her lungs. On biopsy you see trophoblasts, but no villi. Diagnosis? How does it spread? Prognosis?

A

nongestational choriocarcinoma that has metastasized to the lung

EXCEPTION: it is a carcinoma that spreads hematogenously

prognosis is very bad

105
Q

A 25 year old woman who is short in stature, has swelling of her hands and feet and a webbed neck presents with abdominal pain, vaginal bleeding, and a palpable abdominal mass. Diagnosis?

A

Dysgerminoma - associated with gonadal dysgenesis like the streak ovaries associated with Turner’s syndrome

106
Q

“Gland/follicle-like structures formed by the tumour cells aligning themselves around a central space that is filled with acidopilic material” describes what histological structure? where do you find it?

A

Call-Exner bodies

Granulosa cell tumor - ovary

107
Q

this ovarian tumor presents with polygonal cells with pale, uniform nuclei that contain grooves, commonly post-menopausal

A

Granulosa cell tumor (with coffee bean nuclei - grooves)

108
Q

65 year old woman presents with uterine bleeding and signs of endometrial hyperplasia. You find a mass in her ovary - diagnosis? risk of metastasis? why is she bleeding?

A

granulosa cell tumor
malignant but minimal risk of metastasis
tumor is producing estrogen which causes the endometrial hyperplasia which sheds as it outgrows its blood supply

109
Q

ovarian tumor biopsy stains (+) for inhibin - diagnosis? complication in adolescents? increased risk of what? why?

A

granulosa cell tumor
precocious puberty/irregular menses
inc. risk of breast cancer due to inc estrogen

110
Q

what is important to note about the theca cells in a granulosa-theca cell tumor?

A

only the granulosa cells can become malignant, not the theca cells

111
Q

this ovarian tumor stains positive for red oil O

A

fibrothecoma of ovary

112
Q

Unilateral ovarian tumor shows intersecting bundles of polygonal cells and spindle cells producing collagen - diagnosis? risk of metastasis?

A

fibrothecoma of ovary

none - almost always benign

113
Q

woman presents with fluid in her abdomen and right sided rales. There is no sign of liver damage. diagnosis? what is the name of this condition?

A

Fibrothecoma of ovary

Meig’s syndrome

114
Q

18 year old patient has just had her 3rd skin carcinoma removed in the past 5 years. On examination you notice bifid ribs and jaw abnormalities. What is the name of this condition? What is it associated with?

A

Nevus/Gorlin syndrome

fibroma of the ovary

115
Q

which cells over-proliferate in a fibroma of the ovary?

A

fibroblasts

116
Q

A 13 year old girl presents with excess facial hair and a hypertrophied clitoris. Diagnosis? should you be concerned?

A

Sertoli Leydig cell tumor of the ovary

usually benign

117
Q

12 year old girl presents with a unilateral mass in her ovary. On histo you see Reinke crystals - diagnosis?

A

Sertoli Leydig cell tumor of the ovary

118
Q

you find signs of tumor metastasis to the ovary. Name the 3 most common sites of origin

A

intestine, appendix, stomach

119
Q

what % of bilateral tumors of metastatic?

A

10% - low

120
Q

you find a multi-nodular solid metastatic tumor in an ovary - name 2 possible sites of origin

A

breast

stomach

121
Q

you find a cystic/solid metastatic tumor in an ovary - name a possible site of origin

A

intestine

122
Q

you find a cystic metastatic tumor in an ovary - name a possible site of origin

A

pancreas/biliary tract

123
Q

you find a metastatic tumor in an ovary containing signet ring cells - diagnosis? give 2 specific tumors of origin and which is most common?

A

Krukenberg tumor

gastric carcinoma (most common 70%)
lobular carcinoma of breast
124
Q

you find a tumor of the ovary with signet ring cells - what is the most important factor for correct diagnosis? why?

A

whether it is bi or unilateral

krukenberg is bilateral and primary mucinous carcinoma is unilateral

125
Q

sertoli leydig cell tumor has another name, what is it?

A

androblastoma

126
Q

what is the breakdown product of serotonin? When would you see this in ovarian tumors?

A

5-HT

carcinoid syndrom from dermoid cyst aka mature teratoma

127
Q

during which phase does the endometrium have coiled glands? conspicuous arterioles? cuboidal cells? which hormones drive which part of the cycle?

A

secretory
secretory
proliferative

estrogen: proliferative (1-14)
progesterone: secretory (15-28)

128
Q

Menorrhagia - definition and common cause

A

Excessive amount of regular (cyclical) bleeding

Cause: Submucosal Leiomyoma

129
Q

Metrorrhagia - definition

A

irregular noncyclical bleeding

130
Q

Menometrorrhagia - definition and 2 causes

A

excessive AND noncyclical bleeding

Causes: cervical polyps, cervical/endometrial carcinoma

131
Q

Oligomenorrhoea - definition and 2 causes

A

Infrequent (greater than 35 days) bleeding

Causes: polycystic ovarian syndrome, low body weight

132
Q

Dysmenorrhoea - definition and association

A

painful menses - high levels of prostaglandin F

133
Q

what is the luteal phase?

A

another name for secretory phase

134
Q

patient presents with early menses and increased bleeding. what hormonal changes are responsible for this?

A

inadequate corpus luteum - low progesterone, FSH, LH

135
Q

patient presents with excessive bleeding and prolonged periods (10+ days) - what hormonal changes are responsible for this?

A

persistent luteal phase - due to continued low level production of corpus luteum after onset of menstruation

136
Q

what causes the onset of menstruation?

A

abrupt cessation of progesterone secretion by corpus luteum

137
Q

patient presents with pelvic pain and dysmenorrhea. on examination you find blood-filled cysts in her ovary and histo shows large amounts of hemosiderin - diagnosis? this is associated with an increased risk of what?

A 
endometriosis
ovarian carcinoma (or carcinoma at site of endometriosis)
138
Q

on examination of a uterus you see diffuse deposition of endometrial tissue in the myometrium - 2 names for this condition?

A

endometriosis - adenomyoma

139
Q

define pyometrum - what can it lead to?

A

obstruction of cervical os by neoplasm or fibrosis

endometritis (infection of endometrium)

140
Q

patient presents with pain on defecation and lower back pain. she also notes bleeding - diagnosis?

A

endometriosis in the rectovaginal pouch (pouch of Douglas)

141
Q

most common site of endometriosis? what is this called? what do you see on histo?

A

ovary - chocolate cyst

endometrial glands and stroma and blood clots

142
Q

on examination of a uterus you see a focal deposition of endometrial tissue in the myometrium - 2 names for this condition?

A

endometriosis - adenomyosis

143
Q

on examination of the endometrium you see an increased gland to stroma ratio - what is this called? what causes it? what is most important when looking for high risk factors? what can high risk factors predict?

A

endometrial hyperplasia
high estrogen
cellular atypia -> carcinoma

144
Q

55 year old woman presents with metrorrhagia and on exam you find a 2cm protrusion of the endometrium of her uterus - diagnosis? cause? should you be concerned?

A

endometrial polyp
extreme response to hyperplasia (from increases estrogen)
malignant transformation is very rare

145
Q

57 year old woman presents with vaginal bleeding despite having been through menopause several years earlier. On exam of her uterus you find a protruding mass and asymmetric enlargement of her uterus. Diagnosis? Cause? list 3 risk factors?

A

Endometrial carcinoma
unopposed estrogen and is preceded by hyperplasia
obesity, type II diabetes, nulliparous

146
Q

on biopsy of a mass from a uterus you find a tumor with 50% glands and 50% solid mass - diagnosis and stage. List identifying factors of the other stages

A

endometrial carcinoma - stage II
stage I: all glands “back to back”
stage III: mostly solid, few glands

147
Q

list 3 conditions where you see psammoma bodies

A

papillary carcinoma of the thyroid
endometrial carcinoma
ovarian carcinoma

148
Q

70 year old woman with an atrophic endometrium has a tumor in her uterus. Histo is mostly serous with papillary structures and psammoma bodies - diagnosis? how common? associated mutation?

A

endometrial carcinoma
25% are sporadic (as opposed to 75% that are linked to hyperplasia and present 10 years earlier, 60)
p53

149
Q

on biopsy of 58 year old uterus you find a large, fleshy mass with hemorrhage and necrosis. you find evidence of epithelial growth as well as some muscle tissue - diagnosis? why is it named this? prognosis?

A

mixed mullerian (mesodermal) tumor
has both epithelial and mesenchymal tissues
poorly differentiated tumor with poor prognosis

150
Q

long term use of IUD can lead to what condition?

A

chronic endometritis

151
Q

how do you differentiate between acute and chronic endometritis? give 2 causes of each

A

acute has PMNs and chronic has plasma cells

acute: postpartum sepsis, gonococcal infection
chronic: IUD and TB

152
Q

to make a diagnosis of leiomyoscarcoma what 3 factors must be present?

A

nuclear atypia
tumor necrosis
mitotic index > 10

153
Q

a 30 year old woman pregnant with her 3rd child experiences sudden acute, severe pain and has to be treated with strong pain killers - diagnosis? name of this condition and what is it?

A

leiomyoma

red degeneration: rapidly growing fibroid (due to increased estrogen from pregnancy) outgrows blood supply and necrosis

154
Q

on exam of uterus you find multiple unencapsulated growths that are white and whorled - diagnosis? what tissue is involved? should you be concerned?

A

leiomyoma
myometrium
no, NO malignant potential does NOT lead to leiomyosarcoma!!!!!

155
Q

best way to differentiated between leiomyoma and leiomyosarcoma? second best?

A

leiomyomas are multiple and leiomyosarcomas are singular

age of onset: myomas premenopausal and go away after menopause
sarcomas usually in postmenopausal women

156
Q

name 3 conditions that can lead to uterine bleeding

A

endometriosis, endometrial carcinoma, leiomyoma

157
Q

epithelium of the ectocervix?

A

non-keratinized stratified squamous

158
Q

epithelium of the endocervix?

A

simple columnar

159
Q

where is the normal squamo-columnar junction in the cervix?

A

external cervical os

160
Q

patient presents with several firm, mucous filled cysts on her cervix. diagnosis? how does it occur?

A

retention (Nabothian) cyst

squamous cells grow over cervical crypts and lead to retention of the secretions

161
Q

on examination you notice that the squamo-columnar junction of your patient has moved closer to the inner cervical os. Should you be concerned? what is this called?

A

no, no malignant potential and reversible

squamous metaplasia

162
Q

you notice several polyps on your patient’s endocervix. should you be concerned?

A

no, no malignant potential

163
Q

increased nuclear to cytoplasmic ratio on a pap smear is indicative of what?

A

dysplasia

164
Q

explain the Schiller test

A

paint the cervix with iodine and look for unstained pale patches (these areas don’t have glycogen which is what the iodine stains) which can indicate cervical dysplasia or inflammation, not specific but shows areas to be biopsied
(keep in mind this is not Schilling’s test for B12 absorption)

165
Q

most common cause of acute cervicitis?

A

chlamydia

166
Q

perinuclear halo, large hyperchromatic nuclei - in what cells is this seen? in what disease?

A

koilocytes

HPV infection

167
Q

what site can get metastasis from all other cancers of the female genital tract?

A

vagina

168
Q

on routine vaginal exam you find small asymptomatic cysts on the lateral wall of the vagina - diagnosis? how are they formed?

A

gartner’s duct cyst

remnants of mesonephric ducts

169
Q

on vaginal exam of a preteen girl you find areas of columnar epithelium in the upper 1/3 of the vagina. Her mother tells you that she took diethyl stilbesterol (DES) while pregnant to prevent abortion - diagnosis? should you be worried?

A

vaginal adenosis

its a benign condition but 10-35 years later, many develop clear cell adenocarcinoma

170
Q

on a vaginal biopsy you see proliferation of glands with non-staining cytoplasm - history of DES use in pt.’s mother - diagnosis? prognosis?

A

clear cell adenocarcinoma

malignant, poor prognosis

171
Q

4 year old child presents with vaginal bleeding and large, nodular mass protruding from vagina - diagnosis? what type of tissue is involved? prognosis?

A

embryonal rhabdomyosarcoma (sarcoma botryoides (grapes))
immature skeletal muscle
highly malignant and aggressive

172
Q

these glands are located on either side of the vaginal canal and drains into the lower vestibule - name? complication?

A

bartholin

inflammation and unilateral cyst formation

173
Q

these glands are located around the urethral opening

A

Skene’s glands

174
Q

60 year old woman presents with white patch on her vulva. On exam you find scaly plaques with thinning of the epidermis - diagnosis? should you be concerned?

A

Lichen sclerosus (Kraurosis vulvae)
very low malignant potential but can be associated with squamous cell carcinoma (another cause thats not HPV!!!)
buzz phrase: “parchment like” vulva

175
Q

63 year old woman presents with severe itching in the vaginal area and has a thickened, leathery vulva - diagnosis? should you be concerned?

A

Lichen simplex chronicus

no malignant potential

176
Q

patient presents with reddish brown plaque on vulva - diagnosis? should you be concerned?

A

Bowen’s disease (VIN III) (carcinoma in situ)

yes, needs to be excised, can lead to squamous cell carcinoma

177
Q

40 year old patient presents with flat, gray-white papule on vulva. she smokes and had a kidney transplant 3 years prior - diagnosis?how to treat? should you be worried? pathogenesis?

A

vulval intraepithelial neoplasia (VIN)
treat with resection - but often multifocal, many recur
even after treatment, can progress to carcinoma
associated with high risk HPV (16, 18, 31, 33)

178
Q

If something stains PAS+ what cell type must it be?

A

only epithelial cells make mucin

179
Q

If something stains positive for keratin, what cell type must it be?

A

only epithelial cells produce keratin

180
Q

25 weeks of gestation, you see nucleated RBCs in the embryonic vessels of the placenta, should you be concerned?

A

Yes, nucleated red cells should disappear after 20 weeks of gestation, if they persist suggests ischemic disease of the fetus

181
Q

name the inner and outer cells of the placenta

A

inner: cytotrophoblasts
outer: syncitiotrophoblasts

182
Q

pelvic inflammatory disease is associated with increased risk of what? why?

A

tubal pregnancy

fibrosis blocks the passage of fertilized ovum

183
Q

female patient presents with acute onset, RLQ abdominal pain. Two differentials

A

acute appendicitis

ruptured ectopic pregnancy

184
Q

cowdry bodies are found in what pathology? what stain do you use?

A

Herpes

Tzanck

185
Q

biopsy of the uterus shows hypersecretory glands but no chorionic villi - diagnosis? name of this condition?

A

ectopic pregnancy - can’t be spontaneous abortion because that would show chorionic villi

arias stella reaction

186
Q

when does an embryo become considered a fetus and when does a fetus become a premature baby?

A

embryo: up to 8 weeks
fetus: up to 20 weeks
premature: 20-40 weeks

187
Q

pregnant woman presents with vaginal bleeding in her third trimester - diagnosis? etiology? how to treat?

A

placenta previa
placenta implants in lower uterine segment and overlies cervical os
caesarian section is necessary

188
Q

a woman in her 3rd trimester presents with vaginal bleeding, premature labor, and shock. No fetal heart beat can be auscultated - diagnosis? cause? complication?

A

abruptio placenta
sudden, incomplete separation of placenta from implantation site prior to delivery of fetus
still birth

189
Q

after delivery of her newborn, mother experiences severe postpartum bleeding and difficulty delivering the placenta - diagnosis? cause? how to treat?

A

placenta accreta
no decidua, villi directly invade the myometrium
requires hysterectomy (removal of uterus)

190
Q

a pregnant woman in her third trimester presents with edema, proteinuria and headaches - diagnosis? what causes the headaches? etiology?

A

preeclampsia
headaches causes by severe HTN
ischemic placenta

191
Q

30 year old Asian woman presents with highly elevated BetaHCG and a greatly expanded uterus as compared to normal in second trimester. Diagnosis? what do you see on histo? ultrasound?

A

hydatiform mole

histo: proliferation of trophoblasts
ultrasound: “snowstorm”

192
Q

give the genotypes of both a complete and partial mole. which one has fetal parts? Someone with this condition has an increased risk of developing what?

A

complete: 46XX (two sperm)
partial: 69XXY (fetal parts seen)

choriocarcinoma

193
Q

patient presents with positive pregnancy test, amenorrhea, excessive symptoms of morning sickness and vaginal bleeding at 3 months gestation - diagnosis?

A

partial mole

194
Q

salpingitis is another name for what?

A

pelvic inflammatory disease

195
Q

after giving birth, patient presents with friable, hemorrhagic mass in their uterus found after complaining of bloody discharge from the vagina. No chorionic villi are seen on histo, but beta-HCG levels are elevated - diagnosis? what cells are involved? prognosis?

A

gestational choriocarcinoma
malignant cyto and syncitiotrophoblasts
good prognosis with chemo (better than non-gestational type)

196
Q

following pregnancy, patient presents with mass in uterus but shows no fetal parts and low levels of beta-HCG. Cells are positive for placental lactogen - diagnosis? prognosis? why is beta-HCG low?

A

placental type trophoblastic tumor
prognosis good if confined to uterus (cured by curettage), bad if it spreads
its a tumor of cytotrophoblasts only, and syncitiotrophoblasts produce beta-HCG

197
Q

common sites of metastasis for gestational choriocarcinoma? how does this affect prognosis?

A

lungs and vagina

even with metastasis, still good prognosis, very responsive to chemo

198
Q

What disease does the following histo describe? Cystic swelling of chorionic villi, large edematous vascular villi, degeneration of stroma, proliferation of chorionic epithelial trophoblasts (all kinds)

A

hydatidiform mole

System Path II (3 decks)

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