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STEP 8: EndoRepro PATHOMA FA > Female Genital System Pathology_PATHOMA > Flashcards

Female Genital System Pathology_PATHOMA Flashcards

1
Q

Name the high risk HPV.

A

HPV 16, 18, 31, 33

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2
Q

What histological change is seen in ALL HPV infections (Any risk, Any location)

A

KOILOCYTIC Nuclei (rasinoid nuclear envelope)

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3
Q

What is the most common cause of CONDYLOMAS of the lower genital tract (vulva + vaginal canal + cervix)?

A

HPV LOW RISK - 6/11

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4
Q

What is the main clinical feature that distinguishes between LICHEN SCLEROSIS and LICHEN SCLEROSIS CHRONICUS?

A

LICHEN SCLEROSIS: Parchment-like vulvar skin

LICHEN SCLEROSIS CHRONICUS: Thick, leathery vulvar skin

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5
Q

What is the main clinical feature that is shared between LICHEN SCLEROSIS and LICHEN SCLEROSIS CHRONICUS?

A

LEUKOPLAKIA (white patch)

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6
Q

Does LICHEN SCLEROSIS infer any increased risk of developing squamous cell carcinoma? What about LICHEN SCERLOSIS CHRONICUS?

A

Both are BENIGN itself
Lichen sclerosis - slightly increased risk
Lichen sclerosis chronicus - NO increased risk at all

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7
Q

What are the two possible pathways of developing VULVAR CARCINOMA. Name the most common cause of each pathway.

A
  1. HPV-related: HPV 16,18,31, 33 infection = most common cause in age 40-50yo
  2. NON-HPV-related: Long-standing LICHEN SCLEROSIS in age>70yo POST-menopausal woman
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8
Q

Name the 3 Paget diseases.

A

SKIN ORIGIN: Vulva + Breast

Bone

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9
Q

What is the main difference in terms of etiology between PAGET DISEASE OF THE BREAST and of the VULVA (EXTRAMAMMARY)?

A

Breast - YES underlying carcinoma [DCIS]

Vulva - NO underlying carcinoma

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10
Q

Ddx of intraepithlial malignant proliferation within the epidermis on biopsy:

A
  1. CARCINOMA (Paget disease of the vulva)

2. MELANOMA

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11
Q

How does one distinguish between MELANOMA and PAGET DISEASE OF THE VULVA?

A

STAINS:
PAGET DISEASE = CARCINOMA (Epithelial) = PAS + [mucus prdn], KERATIN + [Epithelial cell IMF], S100-
MELANOMA (Non-epithelial) = S100+ [specific to melanoma], PAS-,Keratin-

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12
Q

What drug is there an associated increased incidence of ADENOSIS?

A

DIETHYLSTILBESTROL (DES) exposure in utero

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13
Q

What does DES do to result in VAGINAL ADENOSIS?

A

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

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14
Q

What is feared complication of VAGINAL ADENOSIS?

A

CLEAR CELL ADENOCARCINOMA

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15
Q

Name the LOW RISK HPV.

A

HPV 6, 11

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16
Q

What are the feared complications (2) of a DES daughter? (crossed through placenta by DES mom)

A
  1. Vaginal Adenosis -> Can become clear cell carcinoma
  2. Abnormality in formation of smooth muscle of uterus + tubes -> Increased risk of gestational problems (e.g. ectopic pregnancy, pregnancy losses)
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17
Q

What are the feared complications of a DES son? (crossed through palcenta by DES mom)

A

NONE

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18
Q

What does a DES mom have a slightly increased risk of?

A

BREAST CARCINOMA

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19
Q

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)

A

EMBRYONAL RHABDOMYOARCOMA

CONFIRMATORY TESTS: Based on presence of RHABDOMYOBLAST

  1. Histology: Cytoplasmic striations
  2. Immunohistochemistry: DESMIN + (IMF in skeletal muscle) + MYOGENIN + (immature skeletal muscle)
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20
Q

What is the most classic cause of VAGINAL CARCINOMA?

A

HPV HIGH RISK 16, 18, 31, 33

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21
Q

Which local lymph node does the cancer from the upper 2/3 of the vagina spread to?

A

REGIONAL ILIAC NODES

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22
Q

Which local lymph node does the cancer from the lower 1/3 of the vagina spread to

A

INGUINAL NODES

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23
Q

What is the molecular basis of HPV HIGH RISK 16,18,31,33?

A

Produces E6 - p53 destruction
Produces E7 - Rb destruction
Promotes dysplasia -> increases risk of carcinoma

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24
Q

What are the 2 classic clinical features of CERVICAL CARCINOMA?

A

VAGINAL BLEEDING

POST-COITAL BLEEDING: Bleeding after sexual intercourse

25
Q

What are the 2 types of cervical carcinoma?

A
  1. SQUAMOUS CELL CARCINOMA - Ectocervix (stratified squamous)
  2. ADENOCARCINOMA - Endocervix (simple columnar)
26
Q

Which subtype of cervical carcinoma is related to HPV?

A

BOTH

27
Q

What are the risk factors of CERVICAL CARCINOMA?

A
  1. HPV HIGH RISK
  2. SMOKING
  3. IMMUNODEFICIENCY: Cervical carcinoma = AIDS defining illness (one of the series of illnesses that determines the HIV pt as now having AIDS)
28
Q

What is a classic complication of an ADVANCED cervical carcinoma (i.e. that has metastasized)

A

HYDRONEPHROSIS

29
Q

What is the most common cause of death in pts with ADVANCED CERVICAL CARCINOMA?

A

POST-RENAL AZOTEMIA (kidney failure) due to HYDRONEPHROSIS (blockage of ureters)

30
Q

What is the screening test for cervical carcinoma?

A

PAP SMEAR

31
Q

What are the confirmatory tests for cervical carcinoma?

A
  1. COLPOSCOPY

2. BIOPSY

32
Q

Are the screening tests good for both the squamous cell cervical carcinoma (ectocervix) + adenocarcinoma (endocervix)

A

NO

Only good for SQUAMOUS CELL CERVICAL CARCINOMA

33
Q

What is the immunization vaccine against HPV? How often does pt need to be vaccinated?

A

QUADRIVALENT VACCINE - HPV 6, 11, 16, 18

Every 5yrs

34
Q

Why do pts who are HPV vaccinated already have to get PAP smears every 3 years?

A

Bec HPV vaccine doesn’t cover the high risk HPV 31, 33 organisms that can also cause cervical carcinoma

35
Q

What is ASHERMAN SYNDROME? What is a common cause of ASHERMAN SYNDROME?

A

Secondary amenorrhea due to LOSS OF ENDOMETRIAL BASALIS (stem cell layer) + scarring
Common cause = D&C (dilation + curettage)

36
Q

When is ANOVULATORY CYCLE generally seen?

A

MENARCHE + MENOPAUSE - Dysfunctional uterine bleeding

37
Q

What is a common cause of DYSFUNCTIONAL UTERINE BLEEDING?

A

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

38
Q

What are possible causes of CHRONIC ENDOMETRITIS?

A
  1. Chronic PID
  2. IUD
  3. TB
  4. Retained products of conception
39
Q

Abnormal Uterine Bleeding + Pelvic Pain + Fever = ?

Abnormal Uterine Bleeding + Pelvic Pain + Infertility = ?

A

ACUTE ENDOMETRITIS

CHRONIC ENDOMETRITIS

40
Q

What is the histologic diagnosis of CHRONIC ENDOMETRITIS?

A

PLASMA CELLS

41
Q

What is a common side effect of TAMOXIFEN in terms of the endometrium?

A

ENDOMETRIAL POLYP (hyperplasia) - Even though it is anti-estrogenic in the breast, it is PRO-estrogenic on the endometrium

42
Q

What is ENDOMETRIOSIS? What is the most common site of endometriosis?

A

Placement of endometrial GLANDS + STROMA outside of the endometrial mucosal lining
OVARY = most common site of involvement

43
Q

CHOCOLATE CYST = ??

A

Endometriosis of the OVARY

44
Q

BROWN GUN POWDER LESIONS = ??

A

Endometriosis of SOFT TISSUE

45
Q

ENDOMETRIOSIS within the MYOMETRIUM = ??

A

ADENOMYOSIS

46
Q

What are the 3 common causes of ENDOMETRIAL HYPERPLASIA?

A

UNOPPOSED ER: Obesity + Polycystic ovary syndrome + ER replacement therapy

47
Q

What is the most important predictor for progression to CARCINOMA?

A

CELLULAR ATYPIA

48
Q

What are the 2 pathways of ENDOMETRIAL CARCINOMA? What are the associated histologic features?

A
  1. HYERPLASIA PATHWAY - ENDOMETRIOID LIKE

2. SPORADIC PATHWAY - PAPILLARY SEROUS + PSAMMOMA BODIES

49
Q

What is the age population of both HYPERPLASIA PATHWAY ENDOMETRIAL CARCINOMA and SPORADIC PATHWAY ENDOMETRIAL CARCINOMA? Which one is more aggressive?

A
  1. HYERPLASIA - 50-60s

2. SPORADIC - 70s **more aggressive

50
Q

Which genetic mutation is associated with SPORADIC PATHWAY ENDOMETRIAL CARCINOMA?

A

P53

51
Q

Ddx of PSAMMOMA BODIES (calcifications on top of papillary projections) on HISTOLOGY:

A

PAPILLARY SEROUS SPORADIC ENDOMETRIAL CARCINOMA + PAPILLARY SEROUS OVARIAN CARCINOMA
MEDULLARY CARCINOMA OF THE THYROID + MENINGIOMA + MESOTHELIOMA

52
Q

What is the most common tumor in females?

A

UTERINE FIBROIDS - LEIOMYOMA

53
Q

What are 3 distinguishing features between benign LEIOMYOMA (UTERINE FIBROIDS) and malignant LEIOMYOSARCOMA?

A

LEIOMYOMA - Pre-menopausal + Multiple masses + Well-defined, white whorled masses

LEIOMYOSARCOMA - Post-menopausal + Single mass + Necrotic/Hemorrhagic/irregularities

54
Q

What is the most common Sx of LEIOMYOMA

A

NO SX - usually asymptomatic

55
Q

If symptomatic, what are the sx of LEIOMYOMA?

A
  1. Abnormal uterine bleeding -> Leiomyoma stretches endometrial lining
  2. Pelvic Mass
  3. Infertility - Block uterine cavity -> Fertilized ovum can’t implant on uterine wall
56
Q

What is the cause of LEIOMYOSARCOMA?

A

DE NOVO

LEIOMYOMA DOES NOT RESULT IN LEIOMYOSARCOMA!

57
Q

What is the main lab finding of POLYCYSTIC OVARY DISEASE?

A

INCREASED LH, DECREASED FSH (LH:FSH>2)

58
Q

Young obese woman presents to the clinic with hirsuitism + infertility + oligomenorrhea. Her blood Glc is 200. What does she have?

A

POLYCYSTIC OVARY DISEASE
Hirsutism - ANDROGEN EXCESS
Infertility/Oligomenorrhea - Androgen -> Estrone -> Negative feedback onto AP -> Decreased ER -> Follicular degeneration -> Cysts

59
Q

What does a young POLYCYSTIC OVARY DISEASE pt have an increased risk of ?

A

ENDOMETRIAL CANCER

STEP 8: EndoRepro PATHOMA FA (7 decks)

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