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***MS 2 Unit 1 Pathology > Female Genital System and Gestational Pathology > Flashcards

Female Genital System and Gestational Pathology Flashcards

1
Q

Bartholian Cyst

A

unilateral dilation of <b>lower vestibule</b> due to obstruction and consequential inflammation (caused by infection or STD)

<b>*gland abscess is often causes by N. gonorrhoeae</b>

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2
Q

Condyloma

A

warty neoplasm of vulvar skin due to HPV (6, 11) causing koilocytic change

*rarely progresses to carcinoma

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3
Q

HPV categories

A

<b>low risk</b>: 6, 11; condyloma

<b>high risk</b>: 16, 18, 31, 33; dysplasia–> carcinoma

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4
Q

Lichen Sclerosis

A

benign thinning of epidermis and fibrosis or dermis causing leukoplakia with <b>parchment-like</b> vulvar skin

  • occurs in postmenopausal women
  • slighly increases risk for squamous cell carcinoma
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5
Q

Lichen Simplex Chronicus

A

benign squamous cell hyperplasia causing leukoplakia with <b>leathery</b> vulvar skin

  • <b>chronic irritation and scratching</b>
  • no increased risk of squamous cell carcinoma
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6
Q

Vulvar Carcinoma etiology

A

<b>HPV-related</b>: high risk HPV 16 and 18 in 40-50 year olds; from vulvar intraepithelial neoplasia (VIN)

<b>non-HPV-related</b>: long-standing Lichen Sclerosis in >70 year olds

*keratin squamous pearls on histology

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7
Q

Extramammary Paget Disease

A

malignant epithelial cells in epidermis causing erythematous, pruritic (itchy) and ulcerated skin <b>without underlying carcinoma</b> (unlike Paget Disease of the breast)

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8
Q

Vulvar Carcinoma vs. Vulvar Melanoma

A

<b>Carcinoma</b>: PAS +, keratin +, S100 -

<b>Melanoma</b>: PAS -, ketain -, S100 +

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9
Q

Adenosis

A

when upper 2/3 of vaginal canal remains columnar when it should actually transition to squamous (<b>residual columnar cells</b>)

  • related to DES in utero
  • <b>Complication= Clear Cell Adenocarcinoma</b>
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10
Q

Clear Cell Adenocarcinoma

A

malignant proliferation of glands with clear carinoma

  • complication of DES-associated Adenosis
  • DES inhibits Mullerian differentiation
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11
Q

Embryonal Rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle causing <b> grape-like mass</b> protrusion in children

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12
Q

Rhabdomyoblast

A

has cytoplasmic cross-striations and + IHC staining for desmin and myogenin

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13
Q

Vaginal Carcinoma (& lymph node spread)

A

related to high risk HPV with vaginal intraepithelial neoplasia (VAIN) as the precursor lesion

lower 1/3–> spreads to inguinal nodes
upper 2/3–> spreads to regional iliac nodes

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14
Q

Cervix anatomy

A

endocervix (mucus-secreting columnar cells), transformation zone, exocervix (squamous)

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15
Q

proteins made by high-risk HPV

A

<b>E6</b>- increased destruction of p53

<b>E7</b>- increased destruction of Rb

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16
Q

Cervical Intraepithelial Neoplasia: CIN (definition and grades)

A

koilocytic change, nuclear atypia and increased mitotic activity

<b>Grades</b>:

  • CIN 1 (lower 1/3 of epithelium), 2 (lower 2/3 of epithelium), 3 (full thickness of the epithelium) are reversible
  • CIN in situ is irreversible (involves full thickness of epithelium)
  • progression from CIN 1 to CIN 3 takes ~10 years
  • progression from CIN 3 to invasive cancer ~10 years
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17
Q

Cervical Carcinoma (definition, risk factors, types)

A

invades basement membrane in women aged 40-50 years old presenting as <b>vaginal bleeding</b>

<b>Risk factors</b>: high-risk HPV, smoking, immunodeficiency (since majority of the time, HPV is eliminated by the immune system)

<b>Types</b>: squamous cell and adenocarcinoma

**postrenal azotemia leading to renal failure is a common cause of death

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18
Q

Limitations of Pap smears

A
  1. inadequate transformation zone sampling

2. limited efficacy in screening adenocarcinoma

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19
Q

Asherman Syndrome

A

secondary amenorrhea due to loss of basalis (regenerative layer of endometrium) <b>from overaggressive dilation and curettage</b>

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20
Q

Anovulatory Cycle

A

estrogen proliferative phase <b> without progesterone-driven secretory phase</b> causing dysfunctional uterine bleeding

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21
Q

Endometritis (Acute and Chronic)

A

<b>Acute</b>: bacterial infection fro retained products of conception causing <b>fever</b>, uterine bleeding and pelvic pain

<b>Chronic</b>: inflammation of endometrium from placenta retention characterized by plasma cells causing uterine bleeding, pelvic pain and <b>infertility</b>

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22
Q

Endometriosis

A

glands and stroma outside of the uterine endometrial lining from retrograde menstruation commonly involving <b>ovary (chocolate cyst)</b>

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23
Q

Adenomyosis

A

endometriosis involving the myometrium increasing risk for carcinoma

  • uterus becomes enlarged, menorrhagia, dysmenorrhea, pelvic pain
  • <b>treatment: hysterectomy</b>
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24
Q

Endometrial Hyperplasia

A

hyperplasia of glands due to unopposed estrogen causing postmenopausal bleeding

<b>Simple</b>: increased number of cystically dilated glands without glandular crowding
<b>Complex</b>: increased number of dilated glands with branching and glandular crowding
<b>Atypical</b>: glandular crowding and dysplastic epithelium

*atypia is an important predictor for progression to carcinoma

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25
Q

Endometrial Carcinoma (pathways)

A

malignant proliferation of endometrial glands causing postmenopausal bleeding

<b>Hyperplasia</b>–> CA–> Endometrioid

  • 50 year-olds
  • related to estrogen exposure

<b>Sporatic p53 mutation</b>–> Serous–> Papillary

  • elderly
  • no evident precursor lesion

*lungs are a common site of metastasis

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26
Q

Leiomyoma/Fibroids (definition, possible symptoms, what happens to the tumors)

A

benign proliferation of smooth muscle (myometrium) due to estrogen exposure causing <b>multiple, well-defined white whorled masses</b>

  • usually asymptomatic or cause uterine bleeding, infertility and pelvic mass
  • <b>never</b> leads to Leiomyosarcoma

*tumors undergo degeneration, dystrophic calcification and hyalinization

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27
Q

Leiomyosarcoma

A

malignant proliferation of smooth muscle (myometrium) arising <b>denovo</b> in postmenopausal women causing <b>single lesion with necrosis and hemorrhage</b>

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28
Q

Hormone flow in oocytes:

A

LH stimulates Theca cells to produce androgens which then in the Granulosa cells they can turn into estradiol with the help of FSH allowing for maturation of the oocyte

29
Q

Polycystic Ovarian Disease: PCOD

A

hormone imbalance (<b>high LH and low FSH</b>) leading to multiple follicular cysts (hyperplasia of ovarian theca cells around ovarian follicles)

high LH causes increased androgen synthesis leading to <b>infertility, oligomenorrhea and hirtuism</b>

30
Q

Cell types that make up the ovary:

A
  1. Surface epithelium
  2. Germ cells
  3. Sex-cord stroma
31
Q

Surface Epithelial Tumors of the Ovary

A

presents late with vague abdominal symptoms and urinary frequency and tend to spread locally with poor prognosis

  1. <b>Cystadenoma</b>: benign, simple cyst with flat lining, premenopausal (30-40 years old)
  2. <b>Cystadenocarcinoma</b>: malignant, complex cyst with thick shaggy lining, postmenopausal, presence of psammoma bodies (60-70 years old)
  3. <b>Borderline</b>: still carries metastatic potential
  4. <b>Endometrioid</b>
  5. <b>Brenner</b>: urothelium; contains Walthard cell rests
32
Q

Germ Cell Tumors of the Ovary

A

occurs in women of reproductive age

  1. <b>Cystic Teratoma</b>: benign, composed of 2-3 embryonic layers of fetal tissue, bilateral in 10% of cases
  2. <b>Struma Ovarii</b>: cystic teratoma composed of thyroid tissue
  3. <b> Dysgerminoma</b>: malignant, large cells with clear cytoplasm and central nuclei with elevated LDH but a good prognosis
  4. <b>Endodermal Sinus Tumor</b>: malignant, resembles yolk sac, elevated seum AFP, Schillar-Duval bodies
  5. <b>Choriocarcinoma</b>: composed of trophoblasts and syncytiotrophoblasts, early hematogenous spread, high beta hCG, chorionic villi are not present
  6. <b>Embryonal Carcinoma</b>: large primitive cells, aggressive with early metastasis
33
Q

Sex Chord Stromal Tumors of the Ovary

A
  1. <b>Granulosa-Theca Cell Tumor</b>: produces estrogen, contains Call-Exner bodies
  2. <b>Sertoli-Leydig Cell Tumor </b>: Sertoli cells form tubules and Leydig cells contain Reinke crystals; production of androgens thus associated with hirtuism or virulization
  3. <b>Fibroma</b>: benign fibroblast tumor associated with pleural effusion and ascites (Meigs Syndrome)
  4. <b>Metastasis</b>: Kruckenberg tumor (hematogenous spread of gastric cancer) and Pseudomyxoma peritonei
34
Q

Ectopic Pregnancy risk factor

A

scarring

35
Q

What are spontaneous abortions usually due to?

A

chromosomal anomalies, congenital infections, exposure to teratogens or hypercoaguable states

36
Q

Placenta Previa

A

implantation of placenta in lower uterine segment <b>overlying cervical Os</b>

*presents as painless 3rd trimester bleeding without fetal distress

37
Q

Placenta Abruption

A

separation of placenta from decidua due to <b>retroplacental clot</b> cutting off O2 supply

*presents as painful 3rd trimester bleeding and <b>fetal insufficiency</b>

38
Q

Placenta Accreta

A

improper implantation of placenta into <b>myometrium without intervening decidua</b> requiring a hysterectomy since it cannot be properly removed

39
Q

Preeclampsia and Ecclampsia

A

<b>Preeclampsia</b>: pregnancy-induced hypertension, proteinuria and edema (and placental hypoperfusion) due to abnormality of <b>maternal-fetal vascular interface</b> and increase in vasoconstrictors and sensitivity to ANGII

<b>Ecclampsia</b>: Preeclampsia + Seizures

40
Q

HELLP

A

Hemolysis, Elevated Liver enzymes, Low Platelets

*preeclampsia with thrombotic microangiopathy involving liver

41
Q

Hyaditidiform Mole

A
  • <b>benign tumors of the chorionic villus</b>
  • abnormal conception
  • <b>swollen and edematous villi with trophoblast proliferation</b>
  • passage of grape-like masses
  • complete vs. partial
  • <b>high beta hCG</b>
  • <b>risk of Choriocarcinoma</b>
  • snow storm appearance on ultrasound</b>

<b>Treatment</b>= dilatation and curettage

42
Q

Gardnerella vaginalis

A

gram negative rod that adheres to squamous cells thus producing <b>“clue cells”</b>

  • due to alteration in the microenvironment of the vagina
  • <b>treatment: metronidazole</b>
43
Q

What happens to cells when they undergo koilocytic change?

A

they have wrinkled pyknotic nuclei surrounded by a clear halo

44
Q

Klebsiella granulomatis

A

STD; gram negative coccobacillus causing granuloma inguinale in which the organism is phagocytized by macrophages (<b>Donovan bodies</b>)

  • <b>creeping, raised sore</b>
  • treatment: doxycycline
45
Q

Trichomonas vaginalis

A

produces vaginitis, cervicitis, urethritis, green-frothy discharge

*treatment: metronidazole

46
Q

Rokitansky-Kuster-Hauser (RKH) Syndrome

A

underdeveloped or absent vagina and uterus

*ovaries are usually present and functional

47
Q

Gartner Duct Cyst

A

remnant of wolffian/mesonephric duct presenting as cyst on lateral wall of vagina

48
Q

Nabothian cysts

A

obstruction of the outflow of mucus due to blockage by metaplastic squamous cells

49
Q

Cervicitis (Acute, Chronic, Follicular)

A

<b>Acute</b>: Chlamydia, Gonorrhea, Trichomonas vaginalis, Candida or HPV will cause discharge, pain during sex (dyspareunia) and pelvic pain

<b>Chronic</b>: when acute cervicitis persists

<b>Follicular</b>: Chlamydia infects metaplastic squamous cells causing profound lymphoid infiltrate with germinal centers

50
Q

Different cells that are noticed on Pap smear

A

<b>Superficial squamous cell</b>: estrogen
<b>Intermediate squamous cells</b>: progesterone
<b>Parabasal cells</b>: lack of estrogen and progesterone

51
Q

hCG

A

made by the syncytiotrophoblast lining the chorionic villus in the plascenta acting as LH by maintaining the corpus luteum so it can produce progesterone to keep the pregnancy

52
Q

Estradiol vs. Estrone vs. Estriol

A

Estradiol: made by ovaries and present primarily in non-pregnant women allowing for development of reproductive system

Estrone: weak estrogen made during menopause

Estriol: primary estrogen of pregnancy

53
Q

Androgen origins that cause hirtuism

A
  1. Ovarian origin–> testosterone

2. Adrenal origin–> DHEA-S and testosterone

54
Q

Types of Dysfunctional Uterine Bleeding (DUB)

A

<b>Menorrhagia</b>: regular but excessive flow
<b>Hypomenorrhea</b>: regular but decreased flow
<b>Metrorrhagia</b>: irregular with excessive flow
<b>Menometrorrhagia</b>: irregular or excessive between periods

55
Q

rectal pouch of Douglas (lol such a royal sounding name)

A

area anterior to rectum but posterior to uterus that can be palpated

*<b>common site for blood, malignant cells, pus and endometrial implants</b>

56
Q

CA-125

A
  • excellent sensitivity, poor specificity (increased false positive results)
  • increased in surface-derived ovarian cancers
  • <b>useful in excluding endometriosis when it returns negative</b>
57
Q

What causes an endometrial polyp to enlarge?

A

estrogen stimulation

58
Q

2 common causes of PID

A

N. gonorrhoeae and C. trachomatis causing pus filled fallopian tube lumen

59
Q

Salpingitis Isthmica Nodosa (SIN)

A

invagination of the mucosa into the muscle of fallopian tubes producing nodules

60
Q

Most common risk factor for ectopic pregnancy

A

scarring from previous PID

61
Q

Stromal Hyperthecosis

A

hypercellular ovarian stroma causing <b>bilateral ovarian enlargement</b>

  • vacuolated/lutenized stromal hilar cells synthesize extra androgens
  • <b>hirsutism or virilization</b>
62
Q

What decreases the risk for surface-derived ovarian cancers?

A

Pregnancies since this would mean a decreased number of ovulatory cycles

63
Q

Two sides of the placenta (and layers of the chorionic villi)

A

<b>Baby’s view</b>: chorion covered by aminon (chorionic villi vessels converge with the umbilical cord)

*chorionic villi are lined by trophoblastic tissue: outside layer is syncytiotrophoblast and inside layer is cytotrophoblast

<b>Mother’s view</b>: decidua basalis

64
Q

Funisitis, Placentitis and Chorioamnionitis

A

<b>Funisitis</b>: infection of umbilical cord
<b>Placentitis</b>: infection of placenta
<b>Chorioamnionitis</b>: infection of fetal membranes (danger of neonatal sepsis and meningitis

65
Q

Velamentous insertion

A

umbilical cord inserts away from placental edge causing increased risk for hemorrhage

*<b>vessels pass through the membranes between amnion and chorion</b>

66
Q

What can lead to the development of an enlarged placenta?

A

DM, Rh hemolytic disease, congenital syphilis

67
Q

amniotic fluid (and disorders where it is increased or decreased)

A

-made of fetal urine that is recycled

<b>Polyhydramnios</b>: excess
<b>Oligohydramnios</b>: decreased

68
Q

alpha-fetoprotein

A

increased–> open neural tube defect or folic acid deficiency
decreased–> Down syndrome (would also show decreased urine estriol and increased B-hCG)

***MS 2 Unit 1 Pathology (3 decks)

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