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Pathology > Female Genital Tract > Flashcards

Female Genital Tract Flashcards

1
Q

What is uterine leiomyoma?

A
  • benign smooth muscle neoplasm
  • “fibroids”
  • may cause irregular bleeding (metrorrhagia)
  • painful intercourse (dyspareunia)
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2
Q

What are proliferative lesions of the endometrium?

A
  • hyperplasia& polyps
    – glandular epithelium
    – bleeding
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3
Q

What are the 2 major diseases of the endometrium?

A
  • endometriosis
  • adenocarcinoma
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4
Q

Describe edometriosis?

A
  • endometrial tissue outside of uterine cavity
  • ectopic endometrial tissue influenced by hormonal changes
  • recurring pelvic pain
  • symptoms depend on site & worsen with menstrual cycle
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5
Q

Typical locations for foci of endometriosis?

A
  • ovary, uterine tube, pelvic wall, myometrium
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6
Q

What is a chocolate cyst?

A

endometriosis of ovary filled with blood

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7
Q

Risk factors for endometrial carcinoma?

A
  • age (55-65), but seen in younger populations due to risk factors
  • obesity: synthesis of estrogen in fat
  • infertility: nulliparous increases risk
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8
Q

How to screen for cervical squamous cell carcinoma?

A

exfoliative cytologic screening for early detection (PAP smear)

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9
Q

Where is cervical squamous cell carcinoma often found?

A

squamo-columnar junction

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10
Q

What are the high risk HPV sub-types?

A

16 & 18 (31&33)

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11
Q

How to prevent cervical squamous cell carcinoma?

A

HPV vaccination

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12
Q

What are the sequence of events that may follow an HPV infection?

A

low risk (6,11) –> condyloma (mostly cleared)
high risk (16,18) –> CIN –> persists higher grade CIN –> invasive cancer –> metastasis

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13
Q

What does CIN mean? What are the types?

A

Cervical intraepithelial neoplasia
- LSIL: low grade
- HSIL: high grade

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14
Q

describe CIN I

A

transforming into dysplasia
– active changes in basal 1/3 (proliferation)

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15
Q

Describe CIN II

A

active changes spreading in basal 2/3

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16
Q

Describe CIN III

A

squamous cell carcinoma (changes in all layers)

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17
Q

What are you looking for in a pap smear?

A

koilocytes: nuclei abnormal, larger, abnormal chromatin

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18
Q

What is a teratoma?

A
  • tumor containing tissues from all 3 germ layers (ectoderm, mesoderm, endoderm)
    *2 layers is still diagnostic
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19
Q

Where are teratomas most common?

A

ovary
–generally arise in gonadal tissues

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20
Q

What is a dermatoid cyst?

A

benign cystic teratoma of ovary

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21
Q

What are complications of ectopic tubal pregnancy?

A

rupture

22
Q

What is gonorrhea?

A

Neisseria gonorrhea
pelvic inflammatory disease
tubal scarring
ectopic pregnancy
can have abscess, pain, and discharge

23
Q

Tissues of the breast?

A
  • glandular epithelium
  • ducts
  • lobules
  • interstitial tissue (mostly fat)
  • lymphatics (rich supply)
24
Q

What tissues of breast most commonly give rise to cancers?

A

ducts & lobules

25
Q

What are fibrocystic changes of breast tissue?

A
  • common as we age
  • ductal & stromal changes
  • lots of cysts
    *blue dome cyst: cystic spaces (fill with blood or cystic fluids)
26
Q

What is gynecomastia?

A
  • enlargement of male breast in response to estrogen
  • hyperestrinism
  • bilateral or unilateral
27
Q

Bilateral vs unilateral gynecomastia?

A

bilateral: rule out hormonal
unilateral: rule out tumor

28
Q

Causes of hyperestrinism?

A
  • cirrhosis of the liver (inability to metabolize estrogen)
  • klinefeller syndrome
  • estrogen- secreting tumor
  • estrogen therapy
29
Q

What is the most common benign neoplasm of the breast?

A
  • fibroadenoma
30
Q

What are fibroadenomas?

A
  • discrete, usually solitary, moveable nodule
  • typically young women
31
Q

What are factors that affect breast cancer?

A

genetics
hormonal influences
environmental variables

32
Q

Well established risk factors for breast cancer?

A
  • Genetics & family history: BRCA1/2 & p53
  • Menstrual hx: early start / later menopause (length of reproductive life)
  • Nulliparous
  • geographic
  • age
33
Q

What are the other “mild’ risk factors to breast cancer?

A
  • exogenous estrogens: hormone replacement
  • oral contraceptives
  • ionizing radiation during breast development
34
Q

What are some less well established risk factor to breast cancer?

A
  • alcohol
  • fatty diet
  • obesity
  • smoking
35
Q

Familial syndromes related to genetic changes (breast cancer) & the impairment

A
  • li fraumeni: p53 germline
  • cowden: PTEN germline
  • ataxia-telangiectasia: DNA repair gene
  • BRCA1/2: germline
  • HER2/NEU: proto-oncogene
  • estrogen/progesterone receptor positivity
36
Q

Why is HER2/NEU protooncogene important in breast cancer?

A
  • epidermal GF amplified in 30% of breast cancers
  • overexpression associated with poor prognosis
    TX: herceptin (trastuzumab)
37
Q

Therapeutic intervention for estrogen receptor positive?

A

Tamoxifen

38
Q

What leads to increased exposure to estrogen?

A
  • long reproductive life
  • nulliparity
  • late age at birth of first child
39
Q

How does obesity affect exposure to estrogen for breast cancer risk?

A

adipose tissue produces small amounts of estrogen
*pre-menopausal fat does not increase breast cancer risk

40
Q

Where on the breast is breast cancer most common?

A

upper outer quadrant = 50%
Central = 20%

41
Q

Invasive vs non-invasive breast cancer?

A
  • non: has not penetrated basement membrane
  • invasive: penetrated basement membrane
42
Q

Most common invasive breast cancer?

A

invasive ductal carcinoma

43
Q

What is the MOA of tamoxifen?

A

antiestrogen if estrogen receptor + (blocks estrogen receptor)

44
Q

What is the MOA for aromatase inhibotors?

A

post menopausal women (blocks estrogen formation)

45
Q

What is Paget’s disease of nipple?

A
  • clinical variant of DCIS
  • up to lactiferous ducts & into contiguous skin of nipple
  • crusting exudate over nipple & areolar skin
    *underlying invasive carcinoma in 50% –> serious and must biopsy
46
Q

How often do women with lobular carcinoma in situ (LCIS) develop invasive carcinoma?

A

1/3 of women

47
Q

70-80% of breast carcinomas are due to ?

A

invasive ductal carcinoma

48
Q

Describe appearance of invasive ductal carcinoma?

A
  • firm lesion with adipose tissue & lesion spreading into adipose tissue
49
Q

Clinical features common to all invasive carcinomas?

A
  • fixation secondary to adherence to pectoral muscles or deep fascia of chest wall
  • adherence to overlying skin with retraction or dimpling of skin or nipple
  • lymphatic involvement can cause lymphedema & skin thickened around hair follicles with peau d’ orange
50
Q

Describe the staging of breast cancer?

A

1: <2cm, no nodal involvement, no metastases
2: <5cm with <3 nodes & no metastases OR >5cm but no nodes
3: many categories; infiltration into skin, wall, nodes, NO disseminated metastases
4: disseminated metastases

51
Q

Prognostic factors for cancer?

A
  • size of primary carcinoma
  • lymph involvement / #
  • distant metastases
  • histological grade & type
  • estrogen / progesterone receptor
  • proliferative rate
  • aneuploidy
  • HER2/NEU expression
52
Q

Where is the drop off rate of 5 year survival for breast cancer?

A

stage 3 drops to 46%

in situ: 92%, 1: 87%, 2: 75%

all stages combined 50% relatively good 10 year survival rate

Pathology (9 decks)

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