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Obstetrics and Gynecology > Female Genital System > Flashcards

Female Genital System Flashcards

1
Q 
Thinned epidermis
Hydropic degeneration at basal layer
Sclerotic stroma
Dermal inflammation
Dermal fibrosis
Atrophic epithelium
A

Lichen sclerosus

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2
Q

Thickened epidermis (acanthosis)
Hyperkeratosis
Dermal inflammation

A

Lichen simplex chronicus

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3
Q

Carries a slightly increased risk for development of SCC

A

Lichen sclerosus

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4
Q

Flat, moist, minimally elevated in secondary syphilis

A

Condyloma lata

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5
Q

Papillary, distinctivelt elevated or flat and rugose
Anywhere on anogenital surface
Strongly associated with HPV

A

Condyloma acuminata

6 & 11 (low risk of malignant transformation)

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6
Q

Characteristic cellular feature of HPV
Perinuclear cytoplasmic vacuolization
Wrinkled nuclear contours

A

Koilocytosis

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7
Q 
Less common 
Related to HPV:
Middle aged women
Cigarette smokers 
Preceded by precancerous changes termed VIN (valvular intraepithelial neoplasia)
Progresses to greater degree of atypia
Immunodeficiency
A

HPV related VULVAR SCC

16 and 18

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8
Q

Older women with reactive epithelial changes like lichen sclerosus
Lacks cytologic changes of VIN
but with atypia of basal layer and keratinization
Invasive is well differentiated and keratinizing

A

Non HPV related VULVAR SCC

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9
Q

Leukoplakia -> exophytic or ulcerative endophytic tumors -> HPV + are multifocal -> poorly diff SCC whereas negative are unifocal and manifest as well differentiated keratinizing SCC

A

SCC of Vulva

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10
Q

Red scaly plaque caused by prolif of malignant epithelial cells within epidermis
No underlying carcinoma unlike that of nipple

A

Paget disease of the vulva

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11
Q

This differentiates Paget disease cells from melanoma

A

Positive staining PAS lacks mucin

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12
Q

Watery copious discharge gray green in which parasites are identified with microscopy

A

Trichomonas vaginalis vaginitis

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13
Q

Uncommon, older than 60 yrs
Similar risk factors as in vulvar CA
Precursor lesion is vaginal IN assoc with HPV

A

SCC of Vagina

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14
Q

Very rare tumor

Identified in young women whose mothers took diethylstilbestrol to prevent threatened abortion

A

Clear cell Adenocarcinoma of VAGINA

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15
Q

Agent associated with elevated risk of cancer when exposed

1/3 will present with small glandular or microcystic inclusions appearing in mucosa

Red, granular appearing foci lined by mucus-secreting ciliated columnar cells called
where clear cell adenocarcinoma arises

A

Diethylstilbestrol

Vaginal adenosis

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16
Q

Rare form of primary vaginal cancer manifesting as soft polypoid masses
Infants and children <5
Also in bladder and bile duct

A

Sarcoma botryoides

Embryonal rhabdomyosarcoma

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17
Q

Most common infection of cervix 40%

A

C trachomatis cervicitis

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18
Q

Acute form of cervicitis is usually in women

by

A

postpartum

staph or strep

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19
Q

Cervicits comes to attention because of

A

leukorrhea

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20
Q

During puberty, SC junction of cervix undergoes eversion causing columnar epithelium visibility in exocervix called

A

transformation zone

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21
Q

HPV has tropism for this site on cervix

A

immature squamous cells of transformation zone

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22
Q

Rf for cervical ca

A 
HPV exposure
Early coitarche
Multiple sexual partners
Male with multiple sexual partners
Persistent infection of HPV
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23
Q

HPV infected squamous cells do not usually replicate but expression of two potent oncogenes encoded in HPV genome enable this

A

E6

E7

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24
Q

E6 and E7 genomes bind and INactivate two critical TSG namely

that promote growth and inc susceptibility to additional mutations leading to carcinogenesis

A

E6 - p53

E7 - Rb

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25
Q

Most important risk factor for development of CIN and carcinoma

A

HIGH RISK HPV 16 and 18
70%
Also 31, 33

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26
Q

Serine threonine kinase phosphorylating and activating AMPK, a metab sensor
AMPK regulates cell growth through mTOR
Somatic mutations in this protein (loss) is related to cervical ca, Peutz Jhegers and inactivated lung CA

A

LKBI

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27
Q

Episomal infection

A

HPV 6 and 11

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28
Q

Viral integration

A

HPV 16 and 18

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29
Q

Two tiered grading system for CIN

A 
LSIL previously (CIN I)
HSIL previously (CIN II and III)
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30
Q

Rationale for Pap smear

Most successful cancer screening test ever developed

A

Early detection of DYSPLASTIC changes

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31
Q

Dysplastic changes in lower third of squamous epithelium and koilocytic change in superficial layers of epithelium

A

CIN I

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32
Q

Dysplasia extending to middle third of epithelium
Delayed keratinocyte maturation
Assoc with variation in nuclear and cell size
Heterogeneity of chromatin
Presence of mitoses above basal layer

A

CIN II HSIL

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33
Q 
Complete loss of maturation with greater variation in cell and nuclear size 
Chromatin hererogeneity
Disorderly orientation of cell 
Normal/abnormal mitoses
Affects ALL layers of epithelium 
ABSENT koilocytic change
A

CIN III HSIL

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34
Q

Abnormal pap smear -> colposcopy with acetic acid test
LSIL positive:

HSIL:

A

Observation

Cone biopsy

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35
Q

HPVs can cause these types of cervical ca

A

SCC 75%
Adeno
Adeno squamous 20%
Small cell neuroendocrine 5%

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36
Q

Invasive carcinomas of cervix develop in

A

transformation zone

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37
Q

Tumors encircling cervix and penetrate underlying stroma produce

A

barrel cervix

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38
Q

Growth of basal layer of endometrium down to myometrium inducing reactive hypertrophy (enlarged, globular uterus with thickened uterine wall)
No bleeding bec infiltrative glands come crom basalis

A

Adenomyosis of endometrium

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39
Q

Ectopic endometrial glands and stroma

A

Endometriosis

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40
Q

3 hypotheses for endometriosis

A

1 regurgitant theory (menstrual backflow through fallopian tubes)
2 metaplastic theory (endomentrial differentiation of coelomic epithelium)
3 vascular or lymphatic dissemination (extrapelvic or intranodal implant)

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41
Q

Ectopic endometrial glands are abnormal bec of

A

Inc inflammatory mediators (PGE2)
Inc estrogen production due to aromatase

enhancing persistence of endometrial tissue in foreign locations

42
Q

Endometriosis contains this type of endothelium

Grossly red brown implants coalescing to form large masses

In ovaries, they are called

A

functional hence bleed

Chocolate cyst

43
Q

Hx diagnosis of endometriosis involves

A

2/3 structures

Endometrial glands
Endometrial stroma
Hemosiderin pigment

44
Q

AUB due to precocious puberty (hypothalamic, pituitary, ovarian)

A

Prepuberty

45
Q

AUB in anovulatory cycle

A

Adolescence

46
Q

AUB in complications of pregnancy (abortion, tropho, ectopic)
Proliferation (leiyomyoma, adenomyosis)
Anovulatory cycle
Ovulatory dysfunctional bleeding inadequate luteal phase

A

Reproductive age

47
Q

AUB due to anovulatory cycle
Irregular shedding
Proliferation

A

Perimenopause

48
Q

AUB due to proliferation

Endometrial atrophy

A

Postmenopause

49
Q

Induces exaggerated endometrial proliferation or hyperplasia and risk for carcinoma

A

Prolonged excess estrogen relative to progesterone

50
Q

Estrogen excess rf

A

1 ovulatory failure
2 exogenous estrogen without progestin
3 PCOS or estrogen producing tumor like granulosa theca cell of ovary
4 obesity

51
Q

Hyperplasia of endometrium is classified based on

A

1 architectural crowding (simple vs complex)

2 cytologic atypia (normal vs atypical) -related to risk of carcinoma

52
Q

Endometrial Hyperplasia progression to carcinoma is related to inactivating mutation of

which acts as brake on PI-3kinase/AKT pathway

A

PTEN tumor supressor gene

53
Q

Most frequent cancer occuring in genital tract

A

Endometrial CA

54
Q

Arise in setting of endometrial hyperplasia and estrogen excess in perimenopausal
80%
Mutations in PTEN
May be mucinous, tubal, squamous or adenosquamous
Infiltrates myometrium in cribriform pattern

A

Endometriod cancer

55
Q

Arises fr endometrial atrophy in postmenopausal
Forms small tufts and papillae not glands with greater atypia
Aggressive
IHC demonstrates hig levels of mutant

A

Serous endometrial CA

p53

56
Q

Endometriod CA rf

A 
Obesity
DM
HTN
Infertility
Exposure to unopposed e
57
Q

Women with germline mutations in PTEN are known as

and have inc risk for endometrioid CA

A

Cowden syndrome

58
Q

15% of endometrial tumors

All have mutations to:

A

Serous endometrial CA

TP53

59
Q

Most common benign tumor in women
Sharply circumscribed
Whorled cut surface

A

Leiomyoma

Fibroid

60
Q

Leiomyosarcomas arise from and not from
Solitary on postmenopausal
Soft hemorrhagic necrotic masses
Tumor necrosis, atypia and mitotic activity
Recurrence and mets are common typically:

A

De novo mesenchymal cells
leiomyosarcoma

Lung

61
Q

Most common disorder of fallopian tube

A

Salphingitis from PID

62
Q

Primary adenoCa of fallopian tubes may be:

A

Serous

Endometrioid

63
Q

Serous adenoca of fallopian tube are related with mutations of

AdenoCa of FP occur in

A

BRCA

fimbriae

64
Q

Multiple cystic follicles in ovaries producing excess androgen and estrogen with high LH and low FSH (Pituitary inhibition through hypothalamus)

A

Polycystic ovarian disease

Stein-Leventhal Syndrome

65
Q

Three cell types in ovary:

A

Multipotent coelomic epithelium
Totipotent germ cells
Sex cord stromal cells

66
Q 
65-70%
Malignant ovarian proportion: 90%
Age group: 20+ years
Types:
Serous, Mucinous, Endometrioid, Clear cell, Brenner, Cystadenofibroma
A

Surface epithelial stromal cell tumors of ovary

67
Q 
15-20%
Proportion of malig: 3-5%
Age group: 0-25+ years
Types:
Teratoma, dysgerminoma, endoderm sinus tumor, choriocarcinoma
A

Germ cell tumors of ovary

68
Q 
5-10%
Malignancy proportion: 2-3%
Onset: all ages
Types:
Fibroma, Granulosa-theca cell, Sertoli-leydig cell
A

Sex cord-stroma tumors of ovary

69
Q

5%
Malignancy proportion: 5%
Onset: variable age

A

Metastases to ovary

70
Q

Most common form of ovarian epithelial tumor

Borderline and malignant: 60%

A

Serous carcinoma of

Ovary

71
Q

Arise from borderline lesions

Assoc with KRAS, BRAF or ERBB2 mutation

A

Low grade serous of ovary

72
Q

Develop rapidly from TUBAL intraepithelial carcinoma with mutations in TP53 and FOXM1

A

High grade serous of ovary

73
Q

25% of serous carcinoma of ovary are

74
Q

Tall columnar epithelial cells with cilia
Psamomma bodies in tips of papillae

If carcinoma, anaplasia and stromal invasion with complex papilla and multilayered nests of undiff malignant cells

In between: less atypia with little or no stromal invasion but seeds peritoneum

A

Benign cystadenomas

Cystadenocarcinoma

Tumors of low malig potential

75
Q

Similar to serous but epithelium consists of mucin
80% benign
Larger, multicystic
Serosal penetration and solid areas of growth suggestive of malig
Less likely bilat

A

Mucinous tumor of ovary

76
Q

BILATERAL

Mucinous adenocarcinoma tumor of GI metastasizing to ovary

A

Krukenberg tumor

77
Q

Implantation of mucinous tumor in peritoneum producing mucin

Usually from appendix

A

Pseudomyxoma peritonei

78
Q

Solid or cystic sometimes assoc endometriosis
Tubular glands within lining of cyst
Usually malignant
Bilateral and with concomitant endometrial CA
Mutations in:

A

Endometrioid carcinoma of ovary

PTEN

79
Q

Uncommon, solid unilateral with abdundant stroma with nests of transitional type endothelium resembling URINARY TRACT
Most are benign

A

Brenner tumors

80
Q

15-20% of ovarian tumors
Common in first two decades of life
The younger the greater risk of malignancy
90% benign

81
Q

Hallmark of benign mature cystic teratomas

90% uni, Right side

A

Presence of MATURE tissues from all 3 GERM CELL LAYERS (ecto, endo, meso)

82
Q

Cysts lined by epidermis replete with adnexal appendage

A

dermoid cyst

83
Q

Complication of benign mature cystic teratoma

84
Q

Rare paraneoplastic complication benign mature cystic teratomas
With mature neural tissue and remits with tumor resection

A

Limbic encephalitis

85
Q

Bulky, solid punctuated areas of necrosis
Cystic foci with sebaceous secretion, hair and other similar to mature
IMMATURE ELEMENTS (minimally diff cartilage, bone, muscle, nerve)
Neuroepithelial diff

A

Immature malignant teratoma

86
Q

Rare subtype of teratoma
Specialized tissue
Most common eg: Struma ovarii

A

Specialized teratoma

87
Q

Mature thyroid tissue producing hyperthyroidism in ovary

Small solid brown unilateral

A

Struma ovarii teratoma

88
Q

Marker of ovarian ca
Elevated in 75-90% of ovarian ca
Greatest value is of determinance to therapy response

89
Q 
2nd-3rd decade
Gonadal dysgenesis
Unilateral 80-90%
Counterpart of testicular SEMINOMA
Solid large to small gray
Sheets or cords of large cells separated by scant fibrous strands
Contain lymphocyte and granuloma
All malignant but 1/3 are aggressive and spread
All radiosensitive, 80% cure rate
A

Dysgerminoma

Germ cell

90
Q 
First 3 decades
Unilateral
Identical to placental tumor
Small, hemorrhagic focus with two types: cytotrophoblast and syncio
Mets early, widely
Ovarian primies resistant to therapy
A

Choriocarcinoma

Germ cell

91
Q 
Postmenop but sometimes any 
Unilateral
Tiny, large gray cystic space
Cuboidal granulosa in cords, sheets or strands or spindles or plump lipid laden theca cell
Elements may recapitulate ovarian follicle as Call-Exner bodies
Large amounts of ESTROGEN from theca
Promotes endometrial or breast ca
Granulosa malignant 5-25%
A

Granulosa-theca cell

Sex-cord tumor

92
Q 
Any age
Unilateral
Solid gray fibrous cell to yellow lipid laden plump theca cell
Hormonally INactive
Ascites and hydrothorax 40%
Rarely malignant
A

Thecoma-fibroma

Sex-cord tumor

93
Q 
All ages
Unilateral
Small, gray to yellow brown, solid
Recapitulates testes with tubules or cords and plump pink Sertoli cell
Masculinizing or defeminizing 
Rarely malig
A

Sertoli-Leydig Cell

Sex-cord tumor

94
Q

Older age
Mostly bilateral
Solid gray white mass large
Anaplastic tumor cells, cords, glands, dispersed through fibrous background
Signet ring or mucin-secreting
Primaries of GI aka Krukenberg, breast, lung

A

Metastases to ovary

95
Q

Hallmark of granulosa theca cell carcinoma

Recapitulate ovarian follicles

A

Call-Exner bodies

96
Q 
46XX, XY
All villi edematous
Diffuse circumferential trophoblast prolif
Elevated HCG
\++++ Tissue HCG
Choriocarci risk: 2%
All chromosomes paternal
No fetal tissue
A

Complete mole

97
Q 
Triplod karyotype
Some villi are edematous
Focal slighr trophoblast prolif
Less elevated HCG
\+ Tissue HCG
Rare subsequent choriocarcinoma
Two sets of paternal chromosomes
With fetal tissue
A

Partial H mole

98
Q

Highly invasive freq metastatic tumor responsive to chemotherapy and curable

A

Gestational choriocarcinoma

Vs ovarian germ cell

99
Q

Indolent immediate trophoblasts that produce HPL and doesn’t respond well to chemotherapy

A

Placental site trophoblastic tumor

100
Q

Insufficient maternal blood flow to placenta secondary to inadequate remodelling of spiral arteries

A

Preeclampsia (toxemia of pregnancy)

101
Q

Placental abnormality in preeclampsia:

A

Infarcts
Retroplacental hemorrhage
Premature maturation of placental villi with villous edema, hypovascularity, inc production of syncytial epithelial knots
Fibrinoid necrosis

102
Q

Preeclampsia clinical features

A

Edema
Proteinuria
HTN

Seizure - eclampsia with multi organ damage

Obstetrics and Gynecology (18 decks)

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