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Pathoma > Female Genital System and Gestational Pathology > Flashcards

Female Genital System and Gestational Pathology Flashcards

1
Q

What is the epithelium of the vulva?

A

Squamous epithelium

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2
Q

Bartholin cyst

A

cystic dilation of barthoin gland (on each side of the vaginal canal)

arises from inflammation and obstruction of gland

presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal

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3
Q

Condyloma

A

warty neoplasm of vulval skin, often large

most commonly due to HPV 6+11 (condyloma characterized by koilocytes), secondary syphilis (condyloma latum) is a less common cause

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4
Q

Lichen sclerosis

A

characterized by thinning of the epidermis and fibrosis (sclerosis) of the dermis

presents as a white patch (leukoplakia) with parchment-like vulvar skin

commonly seen in postmenopausal women; possible autoimmune etiology

benign but associated with slightly increased risk for squamous cell carcinoma

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5
Q

Lichen simplex chronicus

A

hyperplasia of the vulvar squamous epithelium

leukoplakia with thick, leathery vulvar skin

associated with chronic irritation and scratching

benign; no increased risk of squamous cell carcinoma

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6
Q

vulvar carcinoma

A

carcinoma arising from squamous epithelium lining the vulva

rare

leukoplakia

HPV (types 16 &18) or non HPV related (long-standing lichen sclerosis - chronic inflammation and irritation eventually lead to carcinoma)

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7
Q

extramammary paget disease

A

malignant epithelial cells in the epidermis of the vulva

presents as erythematous, pruritic, ulcerated vulvar skin

represents carcinoma in situ, usually with no underlying carcinoma

Paget disease of the nipple is also characterized by malignant epithelial cells in the epidermis of the nipple, but it is almost always associated with an underlying carcinoma

Must be distinguished from melanoma: paget cells are PAS+ (marking mucus - only epithelial cells make mucus), karatin +, and S100 - )

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8
Q

What is the epithelium lining the vagina?

A

non-keratinizing squamous epithelium

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9
Q

Adenosis

A

Focal persistence of columnar epitheliumin the upper vagina

during development, squamous epithelium from the lower 1/3 of the vagina (derived from the UG sinus) grows upward to replace the columnar epithelium lining of teh upper 2/3 of the vagina (derived from Mullerian ducts)

increased incidence in females exposed to DES in utero

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10
Q

clear cell adenocarcinoma

A

Malignant proliferation of glands with clear cytoplasm

complication of DES-associated vaginal adenosis

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11
Q

Embryonal rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle - rare

bleeding and a grape-like mass protruding from the vagina or penis of a child; also known as sarcoma botryoides

the characteristic cell - rhabdomyoblast - exhibits cytoplasmic cross-striations and positive immunohistochemical staining for desmin and myogenin

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12
Q

Vaginal carcinoma

A

carcinoma from squamous epithelium lining the vaginal mucosa

related to high risk HPV

precursor lesion is vaginal intraepitheliel neoplasia (VAIN)

lymph node spread - lower 1/3 of vagina through inguinal nodes, upper 2/3 cancer through regional iliac nodes

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13
Q

High risk HPV types

A

16,18,31,33

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14
Q

Low risk HPV types

A

6 + 11

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15
Q

Cervical Intraepithelial Neoplasia

A

Koilocytic change - disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium

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16
Q

Grades of cervical intraepithelial neoplasia

A

CINI - <2/3 thickness of epithelium - reverses 33% of time

CINIII - slightly less than entire thickness of epithelium - very rarely reverses

CIN classicallyprogresses in a stepwise fashion through CINI, CINII, CINIII and CIS to become invasive squamous cell carcinoma

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17
Q

Cervical Carcinoma

A

Invasive carcinoma arising from the cervical epithelium

Most commonly seen in middle-aged women

postcoital vaginal bleeding

risk factor = high risk HPV, smoking, immunodeficiency

Both squamous cell carcinoma dn adenocarcinoma

advnced tumors often invade through the anterior uterine wall into the bladder, blocking the ureters. Hydronephrosis with postrenal failure is a common cause of death in advanced cervical carcinoma

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18
Q

goal of screening

A

to catch dysplasia (CIN - cervical intraepithelial neoplasm) before it develops into carcinoma

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19
Q

colposcopy

A

visualization of cervix with a magnifying glass

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20
Q

What types of HPV does the vaccine cover?

A

6,11,16,18

antibodies generated against types 6 and 11 protect against condylomas

antibodies generated against 16 and 18 protect against CIN and carcinoma

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21
Q

Endometrium and myometrium

A

endometrium is the mucosal lining of the uterine cavity

myometrium is the smooth muscle wall underlying the endometrium

endometrium is hormonally sensitive

  • growth of endometrium is estrogen driven (proliferative phase)
  • preparation of the endometrium for implantation is progesterone driven (secretory phase)
  • Shedding occurs with loss of progesterone support (menstrual phase)
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22
Q

Asherman syndrome

A

secondary amenorrhea due to loss of the basalis (regenerative layer) and scarring

Result of overaggressive dilation and curettage (D&C)

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23
Q

Anovulatory Cycle

A

lack of ovulation

Estrogen-driven proliferative phase without a subsequent progesterone driven secretory phase

proliferative glands break down and shed resulting in uterine bleeding

Common cause of dysfunctional uterine bleeding, especially during menarche and menopause

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24
Q

Acute endometritis

A

bacterial infection of the endometrium

usually due to retained products of conception (e.g. after delivery or miscarriage); retained products act as a nidus for infection

Presents as fever, abnormal uterine bleeding, pelvic pain

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25
Q

Chronic endometritis

A

chronic inflammation of the endometrium

characterized by lymphocytes and plasma cells

plasma cells are necessary for diagnosis of chronic endometritis given that lymphocytes are normally found in the endometrium

cuases = retained products of conception, chronic pelvic inflammatory disease (Chlamydia), IUD, TB

Presents as abnormal uterine bleeding, pain, and infertility

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26
Q

Endometrial polyp

A

hyperplastic protrusion of endometrium

Presents as abnormal uterine bleeding

Side effect of tamoxifen, anti-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium

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27
Q

Endometriosis

A

Endometrial glands and stroma outside of the uterine endometrial lining

Due to retrograde menstruation with implantation at an ectopic site

Presents as dysmenorrhea (pain during menstruation) and pelvic pain; may cause infertility - endometriosis cycles just like normal endometrium

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28
Q

Most common site of involvement of endometriosis

A

Ovary - classically results in formation of ‘chocolate cyst’

Uterine ligaments - pelvic pin

Pouch of Douglas - pain with defecation

Bladder wall - pain with urination

Bowel serosa - abdominal pain and adhesion

Fallopian tube mucosa - scarring increases risk for ectopic tubal pregnancy

Implants appear as yellow-brown ‘gun-powder’ nodules

Involvement with uterine myometrium called adenomyosis

29
Q

Is there an increased risk of carcinoma at the site of endometriosis?

A

Yes, especially the ovary

30
Q

Endometrial hyperplasia

A

Hyperplasia of endometrial glands relative to stroma

A consequence of unopposed estrogen (obesity, polycystic ovary syndrome, estrogen replacement)

Presents as postmenopausal uterine bleeding

Presence of cellular atypia = most important predictor for progression to carcinoma - simple hyperplasia with atypia often progresses to cancer, complex hyperplasia without atypia rarely does

31
Q

Endometrial carcinoma

A

Malignant proliferation of endometrial glands

Most common invasive carcinoma of the female genital tract

Postmenopausal bleeding

Arises via hyperplasia and sporadic

32
Q

Hyperplasia pathway of endometrial carcinoma

A

75% of cases, carcinoma arises from endometrial hyperplasia

risk factors related to estrogen exposure and include early menarche/late menopause, nulliparity, infertility with anovulatory cycles, and obesity

Average age of presentation is 60

Histology is endometrioid (i.e., normal endometrium-like)

33
Q

Sporadic pathway of endometrial carcinoma

A

carcinoma arises in an atrophic endometrium with no evident precursor lesion

average age = 70

histology usually serous and characterized by papillary structures with psammoma body formation; p53 mutation common and tumor exhibits aggressive behavior

34
Q

Leiomyoma

A

Benign neoplastic proliferation of smooth muscle arising from myometrium

Related to estrogen exposure

  • common in premenopausal women
  • often multiple
  • enlarge during pregnancy; shrink after menopause

Gross exam shows multiple, well-defined white, whorled masses that may distort the uterus and impinge on pelvic structures

Usually asymptomatic; when present, symptoms include abnormal uterine bleeding, infertility, and a pelvic mass

35
Q

Leiomyosarcoma

A

Malignant proliferation of smooth muscle arising from the myometrium

Arises de novo; leiomyosarcomas do not arise from leiomyomas

Usually seen in postmenopausal women

Gross exam often shows a single lesion with areas of necrosis and hemorrhage; histological features include necrosis, mitotic activity, and cellular atypia

36
Q

LH

A

Acts on theca cells to induce androgen production

37
Q

FSH

A

Stimulates granulosa cells to convert androgen to estradiol (drives the proliferative stage of the endometrial cycle)

38
Q

What surge leads to ovulation?

A

Estradiol surge leads to LH surge, which leads to ovulation

39
Q

Corpus luteal cyst

Follicular cyst

A

Hemorrhage into a corpus luteum can result in a hemorrhagic corpus luteal cyst, especially during early pregnancy

Degeneration of follicles results in follicular cysts - small numbers of follicular cysts are common in women and have no clinical significance

40
Q

Polycystic Ovarian Disease

A

Multiple ovarian follicular cysts due to hormone imbalance

Increased LH induces excess androgen production (from theca cells) resulting in hirsutism (excess hair in a male distribution)

androgen is converted to estrone in adipose tissue

Estrone feedback decreases FSH resulting in cystic degeneration of follicles

High levels of circulating estrone increase risk for endometrial carcinoma

Some patients have insulin resistance and may develop type 2 diabetes mellitus

41
Q

Surface Epithelial Tumors of the Ovary

A

Most common type of ovarian tumor

derived from coelomic epithelium that lines the ovary (serous cells and mucinous cells)

most common types of surface epithelial tumors are serous (watery) and mucinous (mucus-like)

42
Q

Ovarian Cystadenoma (mucus or serous)

A

composed of a single cyst with a simple, flat lining, commonly arise in premenopausal women

43
Q

Ovarian Cystadenocarcinoma (mucus or serous)

A

Composed of complex cysts with a thick, shaggy lining; most commonly arise in postmenopausal women (30-40 yo)

44
Q

Borderline Ovarian Tumor (mucus or serous)

A

Features in between benign and malignant tumors

Better prognosis than clearly malignant tumors, but still carry metastatic potential

45
Q

What gene carries an increased risk for serous carcinoma of the ovary and fallopian tube?

A

BRCA1

46
Q

Endometrioid surface epithelial tumor

A

composed of endometrial-like glands and are usually malignant

May arise from endometriosis

47
Q

Brenner tumor

A

composed of bladder-like epithelium and are usually benign (urothelium)

48
Q

What do surface tumors present with and what is their prognosis?

A

Surface tumors present late with vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency)

Prognosis is generally poor for surface epithelial carcinoma (worst prognosis of female genital tract cancers)

Epithelial carcinomas tend to spread locally, especially to the peritoneum

CA-125 is a useful serum marker to monitor treatment response and screen for recurrence

49
Q

Germ cell ovarian tumor

A

2nd most common type of ovarian tumor

usually occurs in women of reproductive age

Tumor subtypes mimic tissues normally produced by germ cells:

fetal tissue - cystic teratoma and embryonal carcinoma

Oocytes- dysgermination

Yolk sac- endodermal sinus tumor

Placental tissue - choriocarcinoma

50
Q

Cystic teratoma

GST

A

cystic tumor composed of fetal tissue derived from two or three embryologic layers (e.g., skin, hair, bone, cartilage, gut, and thyroid)

most common germ cell tumor

benign, but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential

Struma ovarii is a teratoma composed primarily of thyroid tissue

51
Q

Dysgerminoma

GST

A

Tumor composed of large cells with clear cytoplasm and central nuclei. Most common malignant germ cell tumor

Testicular counterpart is called seminoma, which is relatively common germ cell tumor in males

Good prognosis; responds to radiotherapy

Serum LDH may be elevated

52
Q

Endodermal sinus tumor

GST

A

Malignant tumor that mimics the yolk sac; most common germ cell tumor in children

Serum AFP is often elevated

Schiller-Duval bodies (glomerulus-like structures) are classically sen on histology

53
Q

Choriocarcioma

GST

A

Malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts; mimics placental tissue, but villi are absent

Small, hemorrhagic tumor with early hematogenous spread

High Beta hCG is characteristic (produced by syncytiotrophoblasts); may lead to thecal cysts in the ovary

Poor response to chemotherapy

54
Q

Embryonal carcinoma

GST

A

Malignant tumor composed of large primitive cells

Aggressive with early metastasis

55
Q

Sex Cord-Stromal Tumors

A

tumors that resemble sex cord-stromal tissues of the ovary

56
Q

Granulosa-theca cell tumor

SCST

A

neoplastic proliferation of granulosa and theca cells

Often produces estrogen; presents with signs of estrogen excess

prior to puberty-precocious puberty

reproductive age-menorrhagia or metrorrhagia

postmenopause (most common setting for granulosa-theca cell tumors) - endometrial hyperplasia with postmenopausal uterine bleeding

malignant, but minimal risk for metastasis

57
Q

Sertoli-Leydig cell tumor

SCST

A

Composed of Sertoli cells that form tubules and leydig cells (between tubules) with characteristic Reinke crystals

May produce androgen; associated with hirsutism and virilization

58
Q

Fibroma

SCST

A

Benign tumor of fibroblasts

Associated with pleural effusions and ascites (Meigs syndrome); syndrome resolves with removal of tumor

59
Q

Krulenberg Tumor

A

A metastatic mucinous tumor that involves both ovaries; most commonly due to metastatic gastric carcinoma (diffuse type)

Bilaterality helps distinguish metastases from primary mucinous carcinoma of the ovary, which is usually unilateral

60
Q

Pseudomyxoma peritonei

A

massive amounts of mucus in the peritoneum sue to a mucinous tumor of the appendix, usually with metastasis to the ovary

61
Q

Placenta previa

A

Implantation of the placenta in the lower uterine segment; placenta overlies cervical os (opening)

Presents as third-trimester bleeding

Often requires delivery of fetus by caesarian section

62
Q

PLacental abruption

A

Separation of placenta from the decidua prior to delivery of the fetus

Common cause of still birth

Presents with third-trimester bleeding and fetal insufficiency

63
Q

Placenta Accreta

A

improper implantation of placenta into the myometrium with little or no intervening decidua

Presents with difficult delivery of the placenta and postpartum bleeding

Often requires hysterectomy

64
Q

Preeclapsia

A

Pregnancy-induced hypertension, proteinuria, and edema, usually arising in the third trimester; seen in approx 5% of pregnancies

hypertension may be severe, leading to headache and visual abnormalities

resolves with delivery

65
Q

Eclampsia

A

Preeclampsia with seizures

66
Q

HELLP

A

preeclampsia with thrombotic microangiopathy involving the liver; characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets

Eclampsia and HELLP warrant immediate delivery

67
Q

Hydatidiform mole

A

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts

Uterus expands as if a normal pregnancy is present, but the uterus is much larger and beta hCG much higher than expected for date of gestation

presents in the second trimester as passage of grape-like masses through the vaginal canal

With prenatal care, moles are diagnosed by routine ultrasound in the early first trimester. Fetal heart sounds are absent,and a ‘snowstorm; appearance is classically seen on ultrasound

Treatment is suction curretage - beta hCG monitoring is important to ensure adequate mole removal and to screen for the development of choriocarcinoma

Choriocarcinoma may arise as a complication of gestation (spontaneous abortion, normal pregnancy, or hydatidiform mole) or as a spontaneous germ cell tumor

Choriocarcinomas that arise from the gestational pathway respond well to chemotherapy; those that arise from the germ cell pathway do not

68
Q

Look up table comparing complete and partial moles

A

do it

Pathoma (3 decks)

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