Female Genital Pathology 2

Question 1

Salpingitis

Answer 1

Inflammation of the fallopian tubes
Very common
Almost always a component of pid
Non gonococcal infections are more invasive
Increases risk of tubal ectopic pregnancy
All forms may produce fever, abdominal pain, pelvic masses

Question 2

Tubo ovarian abscesses and obstruction of tubal lamina may produce permanent sterility.

Answer 2

True my guy

Question 3

Physiologic cysts of the ovary include

Answer 3

Follicular cysts- Occurs when the follicle of the ovary doesn’t rupture or release its egg but instead grows until it becomes a cyst
Luteal cyst- Changes in the follicle of the ovary after an egg has been released can cause the eggs escape opening to seal off. Fluid builds up inside and a luteal cyst develops

Question 4

Polycyclic ovarian syndrome

Answer 4

Also known as Stein Leventhal syndrome.
Increased estrogen and androgen production due to presence of more than 9 tiny cysts less than 8mm in size.

Question 5

Features of POS

Answer 5

Clinically
H-hirsutism/hyperandrogenism
A- Amenorrhea/oligomenorrhea
P-polcyystic ovaries on ultrasound
I-infertility

Histological
Thickened outer tunica and hypertrophic luteinized theca interna and corpora lutea is absent

Biochemical
Excessive production of androgens
Increased Lh
Decreased Fsh

Question 6

The 5th most common cancer in U.S women

Answer 6

Ovarian cancer

Question 7

What are the 3 cell types that make up the ovary

Answer 7

The multipotential surface (coelomic) covering epithelium
The totipotential germ cells
Multipotential sex cord or stromal cells

Question 8

Two of the most common risk factors of ovarian cancer

Answer 8

Nulliparity and family history cuz it’s not FON to have ovarian cancers of course
Mutations of BRCA 1 and 2 genes
HER2/NEU is overexposed in 35%, poor prognosis
K-RAS in 30% , mostly mucinous cystadenocarcinoma
P53 is mutated in about 50% of all ovarian cancers

Question 9

About serous tumours

Answer 9

Most frequent , account for 60% of all ovarian cancers
Benign-30-40 yrs
Malignant 45-65 years
Poor prognosis in malignant cases

Question 10

About Mucinous tumors

Answer 10

Differ from mucinous tumors in that epithelium consists of mucin secreting cells similar to those of the endocervical mucosa
10% malignant, 10% of low malignant potential, 80% benign
Better prognosis

Question 11

About endometroid tumors

Answer 11

May be solid or cystic
Sometimes develop as a mass projecting from the wall of a cyst filled with chocolate coloured fluid.
15-30% of women with this tumor have a concomitant endometrial carcinoma
Also have mutations in PTEN gene

Question 12

What are brenners tumors

Answer 12

Typically unilateral transitional like epithelium seen in the ovary

Question 13

About teratomas

Answer 13

Neoplasms of germ cell origin
Constitute 15-20% of ovarian tumors
Arise in first 2 decades of life school that the younger the person is the greater the likelihood of malignancy

Question 14

Benign mature cystic teratomas

Answer 14

Differentiation of
T-totipotential germ cells, teeth
E- epidermis
R- representing
A-all
T- three germ layers
O- torsion occurs for unknown reason
M-mature tissue
A

Be -benign
Mature

Question 15

Immature malignant teratomas

Answer 15

Found early in life, mean age 18yrs
Rare
Differ from benign in that they are often bulky, solid or near solid on transection rather than producing secretions and are punctuated by areas of necrosis

Distinctive feature microscopically- immature areas of differentiation towards cartilage bone,muscle, nerve.

Question 16

Stroma ovarii

Answer 16

Specialised teratoma composed entirely of mature thyroid tissue that may hyperfunction and produce hyperthyroidism

Question 17

Torch syndrome

Answer 17

A group of infectious diseases that can be passed to a baby during pregnancy, at delivery or after birth
T- toxoplasmosis
O-other agents like varicella
R-rubella
C-CMV
H- HSV
S-Syphilis

Question 18

Gestational trophoblaatic diseases include

Answer 18

Hydatidiform mole
Invasive mole
Choriocarcinomas

Question 19

Hydatidiform mole

Answer 19

Also known as molar pregnancy
Abnormal form of pregnancy in which a non viable fertized egg implants in the uterus
Appears as a voluminous mass of swollen, sometimes cystically dilated chorionic villi, appearing like grape like structures.

Question 20

Types of hydatidiform moles

Answer 20

Complete hydatidiform- in which an enucleated egg is fertilised either by two sperms or more commonly a haploid sperms that endoreduplicates, resulting in expression of only paternal DNA.
Does not permit embryogenesis and thus never contains fetal parts
All the chorionic villi are abnormal and epithelial cells are diploid
(46XX or uncommonly 46XY)
Gives rise to choriocarciomas

Question 21

Partial hydatidiform mole

Answer 21

Here a haploid ovum either duplicatesand is fertilised by a normal sperm or a haploid ovum is fertilised by 2 sperms resulting in both the expression of maternal and paternal DNA
Compatible with early embryo formation
Have some normal chorionic villi almost always tripled (69,XXY)
Rarely gives rise to choriosarcomas

Question 22

Invasive mole

Answer 22

Complete moles
Hydropic villi
Aggressive locally but do not have Aggressive metastatic potential of a choriocarcinoma….rather embolism to distant organs
Difficult to remove by curettage and thus hCG levels remain elevated

Question 23

Choriocarcinoma

Answer 23

Very Aggressive malignant tumor
Arise from gestational chorionic epithelium or less frequently from totipotential cells within the gonads or elsewhere
50% arise in complete hydatidiform moles ,25% after abortion and the rest in normal pregnancy
Highest level of high
Due to chemo, nearly 100% of cases can be cured

Question 24

Why is it that choriocarcinomas originating from the gonads have a poor prognosis

Answer 24

May be due to presence of paternal antigens on placental choriocarcinoma but not gonadal lesion because maternal response against paternal antigens help by acting as an adjunct to chemo

Question 25

Placental Site trophoblastic tumors

Answer 25

Uncommon
Diploid often XX
Derived from placental site or intermediate trophoblast, typically arising a few months after pregnancy.
Intermediate trophoblasts do not produce large amount of high, rather human placental lactose
Poor prognosis if it spreads beyond the uterus

Question 26

Toxemia of pregnancy

Answer 26

Pre-eclampsia HTN+Proteinuria+edema in 3rd trimester
Occurs in 5-10% of pregnancies particularly in women older than age 35

Pre-eclampsia +seizures= eclampsia
Basic underlying feature is inadequate maternal blood flow to the placenta secondary to inadequate development of spiral arteries of the uteroplacental bed

Question 27

Fibrocystic changes of the breast could either be

Answer 27

Non proliferative- normal in 60-80%
Proliferative

Question 28

Mammary duct ectasia

Answer 28

Also known as periductal or plasma cell mastitis
A non bacterial chronic inflammation of the breast associated with inspiration of breast secretions in the main excretory duct
Encountered in women in their 40s and 50s who have borne children
Indication of breast substance mimicks carcinoma

Question 29

Breast duct dilatation and plasma cell infiltration are typically seen in

Answer 29

Mammary duct ectasia

Question 30

Tumors of the breast could be epithelial or more commonly connective tissue in origin. T/F

Answer 30

F…more commonly epithelial

Question 31

Most common benign tumor of the female breast ?

Answer 31

Fibroadenoma

Question 32

Peak incidence of fibroadenoma

Answer 32

3rd decade of life
Increase in estrogen activity.

Question 33

About phyllodes tumor

Answer 33

Less common
Arise from periductal stroma and preexisting fibroadenomas
On gross section, exhibit leaflike clefts and slits , thus are called phyllodes tumor
Remain localised

Question 34

About intraductal papilloma

Answer 34

Neoplastic papillary growth within a duct
Present clinically as a result of
*Appearance of serous or bloody nipple discharge
*presence of small subareolar tumor
*Nipple retraction
Mostly solitary and typically remain benign

Question 35

Intraductal papillomatoses

Answer 35

When there are multiple papillomas in several ducts
Sometimes become malignant unlike their solitary counterparts

Question 36

Breast carcinoma are common in younger people less than 40 years . T/f

Answer 36

F…only 5% are younger than 40
75% are older than 50yrs

Question 37

Tell me some Epidemiology and risk factors for breast cancer

Answer 37

Geographic distribution?
Age?
Genetics and family hx’ half of women with breast carcinoma have mutations in BRCA1 gene
One third have mutations in BRCA2
Li Fraumeni syndrome- mutations in p53, Cowden-PTEN
Oral contraceptives
Prolonged exposure to estrogen post menopausal
Ionising radiation

Question 38

Pathogenesis of breast cancer

Answer 38

Genetics: Overexpression of HER2/NEU gene in 30% of cases
Also Myc and RAS overexpression, Rb and p53

Hormonal:estrogen cuz it stimulates the production of growth factors by normal breast epithelial and cancer cells
Environmental

Question 39

American Joint Committee On Breast cancer staging

Answer 39

Stage 0: DCIS or LCIS 5yr survival rate 92%
1:invasive carcinoma 2cm without nodal involvement 87%
2:invasive carcinomas 5cm with up to 3 involved axillary nodes 75%
3:invasive carcinomas 5cm with 4 or more involved nodes 43%
4: breast cancer with distant metastases 13%

Question 40

Most important cause of gynecomastia

Answer 40

Liver cirrhosis