Female Genital System Pathology_PATHOMA Flashcards
Name the high risk HPV.
HPV 16, 18, 31, 33
What histological change is seen in ALL HPV infections (Any risk, Any location)
KOILOCYTIC Nuclei (rasinoid nuclear envelope)
What is the most common cause of CONDYLOMAS of the lower genital tract (vulva + vaginal canal + cervix)?
HPV LOW RISK - 6/11
What is the main clinical feature that distinguishes between LICHEN SCLEROSIS and LICHEN SCLEROSIS CHRONICUS?
LICHEN SCLEROSIS: Parchment-like vulvar skin
LICHEN SCLEROSIS CHRONICUS: Thick, leathery vulvar skin
What is the main clinical feature that is shared between LICHEN SCLEROSIS and LICHEN SCLEROSIS CHRONICUS?
LEUKOPLAKIA (white patch)
Does LICHEN SCLEROSIS infer any increased risk of developing squamous cell carcinoma? What about LICHEN SCERLOSIS CHRONICUS?
Both are BENIGN itself
Lichen sclerosis - slightly increased risk
Lichen sclerosis chronicus - NO increased risk at all
What are the two possible pathways of developing VULVAR CARCINOMA. Name the most common cause of each pathway.
- HPV-related: HPV 16,18,31, 33 infection = most common cause in age 40-50yo
- NON-HPV-related: Long-standing LICHEN SCLEROSIS in age>70yo POST-menopausal woman
Name the 3 Paget diseases.
SKIN ORIGIN: Vulva + Breast
Bone
What is the main difference in terms of etiology between PAGET DISEASE OF THE BREAST and of the VULVA (EXTRAMAMMARY)?
Breast - YES underlying carcinoma [DCIS]
Vulva - NO underlying carcinoma
Ddx of intraepithlial malignant proliferation within the epidermis on biopsy:
- CARCINOMA (Paget disease of the vulva)
2. MELANOMA
How does one distinguish between MELANOMA and PAGET DISEASE OF THE VULVA?
STAINS:
PAGET DISEASE = CARCINOMA (Epithelial) = PAS + [mucus prdn], KERATIN + [Epithelial cell IMF], S100-
MELANOMA (Non-epithelial) = S100+ [specific to melanoma], PAS-,Keratin-
What drug is there an associated increased incidence of ADENOSIS?
DIETHYLSTILBESTROL (DES) exposure in utero
What does DES do to result in VAGINAL ADENOSIS?
Crosses the placenta -> Prevents the 1/3 Urogenital sinus derived stratified squamous epithelial cells from extending upward/displacing the upper 2/3 mullerian duct derived columnar cells -> Prevents proper vaginal canal dvlm
What is feared complication of VAGINAL ADENOSIS?
CLEAR CELL ADENOCARCINOMA
Name the LOW RISK HPV.
HPV 6, 11
What are the feared complications (2) of a DES daughter? (crossed through placenta by DES mom)
- Vaginal Adenosis -> Can become clear cell carcinoma
- Abnormality in formation of smooth muscle of uterus + tubes -> Increased risk of gestational problems (e.g. ectopic pregnancy, pregnancy losses)
What are the feared complications of a DES son? (crossed through palcenta by DES mom)
NONE
What does a DES mom have a slightly increased risk of?
BREAST CARCINOMA
Pt is a 5yo girl with a grape-like mass protruding from the vagina. She complains of bleeding. What does she most likely have?
What confirmatory tests can be done (hint: defining cell)
EMBRYONAL RHABDOMYOARCOMA
CONFIRMATORY TESTS: Based on presence of RHABDOMYOBLAST
- Histology: Cytoplasmic striations
- Immunohistochemistry: DESMIN + (IMF in skeletal muscle) + MYOGENIN + (immature skeletal muscle)
What is the most classic cause of VAGINAL CARCINOMA?
HPV HIGH RISK 16, 18, 31, 33
Which local lymph node does the cancer from the upper 2/3 of the vagina spread to?
REGIONAL ILIAC NODES
Which local lymph node does the cancer from the lower 1/3 of the vagina spread to
INGUINAL NODES
What is the molecular basis of HPV HIGH RISK 16,18,31,33?
Produces E6 - p53 destruction
Produces E7 - Rb destruction
Promotes dysplasia -> increases risk of carcinoma
What are the 2 classic clinical features of CERVICAL CARCINOMA?
VAGINAL BLEEDING
POST-COITAL BLEEDING: Bleeding after sexual intercourse
What are the 2 types of cervical carcinoma?
- SQUAMOUS CELL CARCINOMA - Ectocervix (stratified squamous)
- ADENOCARCINOMA - Endocervix (simple columnar)
Which subtype of cervical carcinoma is related to HPV?
BOTH
What are the risk factors of CERVICAL CARCINOMA?
- HPV HIGH RISK
- SMOKING
- IMMUNODEFICIENCY: Cervical carcinoma = AIDS defining illness (one of the series of illnesses that determines the HIV pt as now having AIDS)
What is a classic complication of an ADVANCED cervical carcinoma (i.e. that has metastasized)
HYDRONEPHROSIS
What is the most common cause of death in pts with ADVANCED CERVICAL CARCINOMA?
POST-RENAL AZOTEMIA (kidney failure) due to HYDRONEPHROSIS (blockage of ureters)
What is the screening test for cervical carcinoma?
PAP SMEAR
What are the confirmatory tests for cervical carcinoma?
- COLPOSCOPY
2. BIOPSY
Are the screening tests good for both the squamous cell cervical carcinoma (ectocervix) + adenocarcinoma (endocervix)
NO
Only good for SQUAMOUS CELL CERVICAL CARCINOMA
What is the immunization vaccine against HPV? How often does pt need to be vaccinated?
QUADRIVALENT VACCINE - HPV 6, 11, 16, 18
Every 5yrs
Why do pts who are HPV vaccinated already have to get PAP smears every 3 years?
Bec HPV vaccine doesn’t cover the high risk HPV 31, 33 organisms that can also cause cervical carcinoma
What is ASHERMAN SYNDROME? What is a common cause of ASHERMAN SYNDROME?
Secondary amenorrhea due to LOSS OF ENDOMETRIAL BASALIS (stem cell layer) + scarring
Common cause = D&C (dilation + curettage)
When is ANOVULATORY CYCLE generally seen?
MENARCHE + MENOPAUSE - Dysfunctional uterine bleeding
What is a common cause of DYSFUNCTIONAL UTERINE BLEEDING?
ANOVULATORY CYCLE - YES estrogen-driven proliferative phase, no ovulation, no secretory phase -> Proliferation of glands on top of previous growth -> Overgrowth of blood supply -. Degeneration
What are possible causes of CHRONIC ENDOMETRITIS?
- Chronic PID
- IUD
- TB
- Retained products of conception
Abnormal Uterine Bleeding + Pelvic Pain + Fever = ?
Abnormal Uterine Bleeding + Pelvic Pain + Infertility = ?
ACUTE ENDOMETRITIS
CHRONIC ENDOMETRITIS
What is the histologic diagnosis of CHRONIC ENDOMETRITIS?
PLASMA CELLS
What is a common side effect of TAMOXIFEN in terms of the endometrium?
ENDOMETRIAL POLYP (hyperplasia) - Even though it is anti-estrogenic in the breast, it is PRO-estrogenic on the endometrium
What is ENDOMETRIOSIS? What is the most common site of endometriosis?
Placement of endometrial GLANDS + STROMA outside of the endometrial mucosal lining
OVARY = most common site of involvement
CHOCOLATE CYST = ??
Endometriosis of the OVARY
BROWN GUN POWDER LESIONS = ??
Endometriosis of SOFT TISSUE
ENDOMETRIOSIS within the MYOMETRIUM = ??
ADENOMYOSIS
What are the 3 common causes of ENDOMETRIAL HYPERPLASIA?
UNOPPOSED ER: Obesity + Polycystic ovary syndrome + ER replacement therapy
What is the most important predictor for progression to CARCINOMA?
CELLULAR ATYPIA
What are the 2 pathways of ENDOMETRIAL CARCINOMA? What are the associated histologic features?
- HYERPLASIA PATHWAY - ENDOMETRIOID LIKE
2. SPORADIC PATHWAY - PAPILLARY SEROUS + PSAMMOMA BODIES
What is the age population of both HYPERPLASIA PATHWAY ENDOMETRIAL CARCINOMA and SPORADIC PATHWAY ENDOMETRIAL CARCINOMA? Which one is more aggressive?
- HYERPLASIA - 50-60s
2. SPORADIC - 70s **more aggressive
Which genetic mutation is associated with SPORADIC PATHWAY ENDOMETRIAL CARCINOMA?
P53
Ddx of PSAMMOMA BODIES (calcifications on top of papillary projections) on HISTOLOGY:
PAPILLARY SEROUS SPORADIC ENDOMETRIAL CARCINOMA + PAPILLARY SEROUS OVARIAN CARCINOMA
MEDULLARY CARCINOMA OF THE THYROID + MENINGIOMA + MESOTHELIOMA
What is the most common tumor in females?
UTERINE FIBROIDS - LEIOMYOMA
What are 3 distinguishing features between benign LEIOMYOMA (UTERINE FIBROIDS) and malignant LEIOMYOSARCOMA?
LEIOMYOMA - Pre-menopausal + Multiple masses + Well-defined, white whorled masses
LEIOMYOSARCOMA - Post-menopausal + Single mass + Necrotic/Hemorrhagic/irregularities
What is the most common Sx of LEIOMYOMA
NO SX - usually asymptomatic
If symptomatic, what are the sx of LEIOMYOMA?
- Abnormal uterine bleeding -> Leiomyoma stretches endometrial lining
- Pelvic Mass
- Infertility - Block uterine cavity -> Fertilized ovum can’t implant on uterine wall
What is the cause of LEIOMYOSARCOMA?
DE NOVO
LEIOMYOMA DOES NOT RESULT IN LEIOMYOSARCOMA!
What is the main lab finding of POLYCYSTIC OVARY DISEASE?
INCREASED LH, DECREASED FSH (LH:FSH>2)
Young obese woman presents to the clinic with hirsuitism + infertility + oligomenorrhea. Her blood Glc is 200. What does she have?
POLYCYSTIC OVARY DISEASE
Hirsutism - ANDROGEN EXCESS
Infertility/Oligomenorrhea - Androgen -> Estrone -> Negative feedback onto AP -> Decreased ER -> Follicular degeneration -> Cysts
What does a young POLYCYSTIC OVARY DISEASE pt have an increased risk of ?
ENDOMETRIAL CANCER
