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Pathology > Female GU > Flashcards

Female GU Flashcards

1
Q

Herpes simplex virus

A

Morph: red papules which progress to vesicles and painful ulcers with fever, malaise, LAD
Path: 3-7 days after contact
- latent infection in lumbosacral nerve ganglia reactivated by stress, trauma, immunosuppression
- vertical transmission possible

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2
Q

Molluscum contagiosum

A

Poxvirus infection of skin and mucous membrane
Path: Type I most common, Type II sexually transmitted
Morph: dimpled dome-shaped lesions erupt, cells with viral inclusions

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3
Q

Trichomonas vaginalis

A

Flagellated protozoan by sexual contact

  • asymptomatic or present with yellow frothy vaginal discharge
  • vulvovaginal discomfort, dysuria, dyspareunia
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4
Q

Gardnerella vaginalis

A

Gram negative bacillus
- causes bacterial vaginitis
Sx: green-gray, fishy-smelling discharge

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5
Q

Pelvic Inflammatory Disease

A

Cause: infections in vulva or vagina and ascend to involve other genital structures
- gonococcus, chlamydia
Sx: pelvic pain, adnexal tenderness, fever, vaginal discharge
- chronic sequelae include tubal scarring and obstruction, infertility, increased ectopic pregnancy, pelvic pain, GI pelvic adhesions

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6
Q

Bartholin cyst

A

Occlusion of draining ducts by inflammation
- lined by flattened epithelium
Sx: painful, possible abscess formation

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7
Q

Lichen sclerosus

A

Path: papules or macules that coalesce into smooth, white parchment areas
- epidermal thinning, superficial hyperkeratosis, dermal fibrosis
Sx: labia atrophic and stiffened, constriction of vaginal orifice

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8
Q

Squamous cell hyperplasia/ Lichen simplex chronicus

A

Non specific response to recurrent rubbing or scratching to relieve pruritus

  • white plaques that have thickened epithelium, hyperkeratosis, dermal inflammation
  • no predisposition to malignancy
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9
Q

Papillomas

A

Benign exophytic proliferation lined by non-keratinizing squamous epithelium, single or numerous

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10
Q

Condyloma acuminatum

A

Verrucous lesions on vulva, perineum, vagina, cervix
Cause: sexually transmitted by HPV 6 or 11
Morph: sessile branching epithelial proliferation of squamous epithelium
- koilocytic atypia
- not precancerous

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11
Q

Vulvar intraepithelial neoplasia/ vulvar carcinoma

A

Uncommon, ~3% of genital CA
Age: older than 60
Morph: basaloid and warty carcinomas arise from precancerous in situ lesions (VIN)
- classic VIN –> discrete hyperkeratotic flesh colored or pigmented plaques
- basaloid carcinoma –> exophytic or indurated with ulceration
- varty carcinoma –> exophytic architecture with koilocytic atypia

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12
Q

Keratinizing sqamous cell carcinomas

A

long standing lichen sclerosus or squamous cell hyperplasia
- precursor differentated VIN with basal atypic
Morph: vulvar inflammation, infiltrating nests and tongues of malignant squamous epithelium with prominent keratin pearls

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13
Q

Papillary hidradenoma

A

Benign tumor

  • arises from apocrine sweat glands
  • sharply circumscribed nodule or tubular ducts
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14
Q

Extramammary paget disease

A

Malignant lesion
Morph: red, crusted, sharply demarcated map-like area
- large anaplastic mucin containing tumor cells lying singly or in small clusters within epidermis
- confined to epidermis and invasion rare

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15
Q

Malignant melanoma

A

Vulvar ~5% of all malignancy

Age: 60-80

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16
Q

Septate vagina

A

Double vagina with double uterus from failure of mullerian ducts
Cause: DES exposure or abnormalities of epi stromal signaling in fetal development

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17
Q

Vaginal adenosis

A

Red, granular patches of remnant endocervical type columnar epithelium replaced by normal squamous epithelium of adult vaginal mucosa

  • low frequency in normal women
  • exposure to DES
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18
Q

VIN and Squamous cell CA

A

Primary CA are rare, usually associated with HPV infection

  • arise from VIN which is analogous to malignant precursor lesion in cervical CA
  • upper posterior vagina
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19
Q

Embryonal rhabdomyosarcoma

A

Uncommon vaginal tumor in infants
Morph: polypoid, bulky asses composed of grape like clusers (sarcoma botyroides) that can protrude from vagina
- Small tumors cells, oval nuclei and eccentric cytoplasmic protrusions
Path: invade locally cause death by penetration into peritoneal cavity or obstructing urinary tract

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20
Q

Cervicitis

A

Acute: Overgrowth of pathogenic species over lactobacilli from sex, douche, bleeding
Chronic: gonorrhea, chlamydiae, mycoplasmas, HSV –> can lead to upper GI tract disease and/or complications or pregnancy

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21
Q

Endocervical polyps

A

Benign exophytic growths
Sx: present at irregular vaginal spotting
Morph: arise in endocervical canal and soft mucoid lesions composed of loose CT stroma

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22
Q

Premalignant and Malignant Neoplasms

A

Path: HPV caused 16, 18, 31, 33
- DNA virus infect immature basal cells of squamous epithelium
HSV - E6 and E7 with p53 and Rb

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23
Q

Cervical intraepithelial neoplasia

A

Associated with high risk HPV
- low grade squamous intraepithelial lesion –> mild dysplasia, involving basal layers
- high grade squamous intraepithelial lesion –> moderate to severe dysplasia, carcinoma in situ
Morph: distribution of cellular and nuclear atypia including nuclear enlargement, hyperchromasia, chromatin granularity, size variation, koilocytosis
- LSIL atypia confined to basal third of epi
- HSIL atypia extends to two thirds or more

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24
Q

Cervical carcinoma

A

sq cell CA - 80%
adenocarcinoma - 15%
- all associated with HPV
Age: 45 years
Morph: Grossly - exophytic or infiltrative
Microscopic - squamous lesions keratinizing or non-keratinizing adenoCA tend to be glandular
Tx: hysterectomy, lymph node dissection

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25
Q

Causes of dysfunctional bleeding (2)

A

anovulatory cycle - excess estrogen with lack of ovulation

inadequate luteal phase - low progesterone with early menses and is often associated with infertility

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26
Q

prepuberty abnormal bleeding

A

precocious puberty (HPA or ovarian origin)

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27
Q

adolescence abnormal bleeding

A

anovulatory cycle, coag disorders

28
Q

reproductive age abnormal bleeding

A

complications of pregnancy, organic lesions, anovulatory cycle, ovulatory dysfunctional bleeding

29
Q

perimenopausal abnormal bleeding

A

dysfunctional uterine bleeding (anovulatory cycle, irregular shedding), organic lesions

30
Q

postmenopausal abnormal bleeding

A

organic lesions, endometrial atrophy

31
Q

Endometritis (acute and chronic)

A

acute - uncommon, bacterial infections after delivery or miscarriage from conception

chronic - abnormal bleeding, pain, discharge, infertility, endometrial plasma cell and macro infiltration

32
Q

Endometriosis

A

Endometrial tissue outside of the uterus
- involves ovaries, uterine ligaments, rectovaginal septum, cul de sac, pelvic peritoneum, GI tract, mucosa of cx, vagina, fallopian tube, laparotomy scars
- undergo periodic bleeding but don’t slough off like endometrial lining
Morph: red-blue to yellow brown mucosal or serosal nodules
- organizing hemorrhage and fibrosis
- endometrial glands and stroma with or without hemosiderin
Sx: severe dysmenorrheal, pelvic pain, infertility

33
Q

Adenomyosis

A

Nests of endometrial tissue in myometrium

34
Q

Endometrial polyps

A

exophytic masses of endometrial glands and stomra project into endometrial cavity

  • associated with estrogens or tamoxifen therapy
  • possible to adenocarcinoma
35
Q

Endometrial hyperplasia

A

increased proliferation of endometrial glands relative to stroma
- cause of uterine bleeding
- precursor to carcinoma
Cause: prolonged estrogen exposure
- associated with PTEN tumor suppressor gene leading to enhanced AKT phosphorylation
Morph: simple hyperplasia without atypia - benign cystically dilated glands
simple hyperplasia with atypia - uncommon, cystically dilated glands
complex hyperplasia without atypia - apposed glands of size together into clusters, epi cytologically normal
complex hyperplasia with atypia - gland crowding and cyto changes, malignancy

36
Q

Carcinoma of endometrium

A

Genetics: 7% of all invasive cancers
Age: 55-65 years
Types: Type I and Type II

37
Q

Type I endometrial CA

A

Most common (80%), well differentiated from endometrial hyperplasia
Path: PTEN mutations seen in 30-80%, microsatellite instabliity, KRAS, p53
Morph: Gross - localized polypoid tumors or diffuse spreading lesions
Micro - endometrioid adenoca with epi resembling normal endometrium

38
Q

Type II endometrial CA

A

Age: occur later in life
Path: endometrial atrophy, poorly differentiated tumors, serous carcinoma
- p53 present
Morph: Gross - large and bulky, invasive
Micro - invasive lesions exhibit papillary or glandular growth pattern
Sx: ueterine bleeding or abnormal pap smear

39
Q

Malignant Mixed Mullerian tumors (MMMT)

A

Endometrial adenocarcinomas with malignant stroma changes from neoplastic precursor
Morph: gross - tumors are bulky, fleshy, polypoid
Micro: malignant glandular and stromal elements

40
Q

Adenosarcoma

A

Estrogen sensitive tumors exhibit stromal neoplasia with benign glands
- large polypoid growths generally low grade malignancies

41
Q

Stromal tumors

A

Benign stromal nodules - discrete lumps of stromal neoplasia with myometrium

Endometrial stromal sarcomas - lesions composed of malignant stroma interposed between myometrial bundles

42
Q

Leiomyoma (fibroids)

A

Benign masses of uterine smooth muscle
- most common tumor in women
Path: t(12;14) translocation
Sx: asymptomatic or present with abnormal uterine bleeding, pain, urinary bleeding, pain, urinary bladder disorders, impaired fertility
Morph: sharply circumscribed, discrete, round, firm, gray-white nodules in myometrium, beneath serosa, beneath endometrium
micro - whorled bundles of uniform smooth muscle cells with rare mitosis

43
Q

Leiomyosarcoma

A

Uncommon malignancies that form bulky, fleshy masses, in uterine wall or project into lumen

  • wide range of atypia
  • metastasize and disseminate widely
44
Q

Suppurative salpingitis

A

Component of PID; gonococcal infections, chlamydia also factor

Tuberculous salpingitis - rare in US cause of infertility

45
Q

polycystic ovarian disease and stromal hyperthecosis

A

Incidence: 3-6%
Path: numerous cystic follicles
Sx: oligomenorrhea, persistent anovulation, obesity, hirsuitism, insulin resistance

Stromal hyperthecosis - disorder of ovarian stroma in postmenopausal women
- stromal hypercellularity and luteinization visible

46
Q

Surface epithelium tumors - serous

A

Majority benign or borderline
- most common ovarian malignancy
Path: BRCA1
- low grade have KRAS and BRAF mutations
- high grade have p53 mutations
Morph: large cystic masses with serous fluid
- micro - tall, columnar, ciliated epi cells, mild atypia

47
Q

Surface epithelial tumors - mucinous

A

Majority are benign or borderline
Risk factor: smoking, KRAS
- pseudomyxoma peritonei extensive mucinous ascites
Morph: Gross - large multiloculated cystic masses with sticky gelatinous fluid
- micro - benign lesions lined by tall columnar epithelial cells non-ciliated

48
Q

Surface epithelial tumors - endometrioid

A

Account for 20& of all ovarian cancers
- resemble benign or malignant endometrium
Path: PTEN, KRAS, microsatellite instability, p53
Morph: Grossly - lesions are combo of solid and cystic masses
Micro - glandular patterns bear resemblane to endometrial adenocarcinoma

49
Q

Surface epithelial tumor - clear cell adenocarcinoma

A

Uncommon, variant of endometrioid adenocarcinoma

- cystic or solid

50
Q

Surface epithelial tumor - brenner

A

variably sized solid tumor by dense fibrous stroma and nests of epi resembling urinary transiational or columnar epithelium
- unilateral

51
Q

Teratoma

A

Mature - arise in young women during reproductive years

  • cystic masses lined by squamous with many germ cell layers
  • tumors are bilateral rarely

Monodermal or specialized - differentiate along one tissue, struma ovarii is composed of mature thyroid tissue, ovarian carcinoid variant

Immature - rare tumors of embryonic elements

52
Q

Dysgerminoma

A

Age: 20-40
Path: cKIT receptor tyrosine kinase
- malignant
Morph: grossly - solid, yellow-white to gray-pink, fleshy
- Micro - sheets and cords of large vesicular cells by scant fibrous stroma

53
Q

Endodermal sinus tumor (yolk sac)

A

Rare malignancy from differentiation of germ cells toward yolk sac structures
Path: schiller-duvall body (glomerulus like structures with a central vessel enveloped by germ cells)
- AFP elevated

54
Q

Choriocarcinoma

A

highly malignant, metastasize widely, resistant to chemotherapy than placentral counterparts

55
Q

Granulosa-theca cell tumors

A

Large estrogenic increase - precocious sexual development and endometral hyperplasia
- predispose to endometrial carcinoma
- malignant, most have indolent course with 10 year survival rates
Morph: grossly - unilateral, solid, white-yellow
Micro - small cuboidal to polygonal in cords, sheets or strands - CALL-EXNER bodies
- sheets of plump spindle cells often contain lipid droplets

56
Q

Fibromas, thecomas, fibrothecomas

A

Majority are benign

  • unilateral, solid, hard, gray-white masses
  • composed of well differentiated fibroblasts and scant collagenous connective tissue
  • associated with ascites and right sided hydrothorax (MEIGS SYNDROME)
57
Q

Sertoli- Leydig cells

A

Masculinization or defeminization

- unilateral and consist of tubules

58
Q

Spontaneous abortion

A

Pregnancy before 20 weeks

Causes: maternal, fetal, uterine defects, maternal vasculature disorders, infections, idiopathic

59
Q

Ectopic pregnancy

A

Embryo implantation at site other than uterus, usually fallopian tubes
- risk of PID with scarring, intrauterine devices, peritubal adhesions
Sx: hemorrhage with formation of hematosalpinx, rupture with hemorrhage, regression with resorption of products of contraception
- tubal ruptures

60
Q

placenta previa

A

placental implamantation in lower uterine segment or cervix, third trimester bleeding
- C section necessary or death

61
Q

Placenta accreta

A

absence of decidua and placenta adheres to myometrium, life threatening hemorrhage

62
Q

Preeclampsia and eclampsia

A

HTN, proteinuria, edema in 3rd trimester

  • eclamsia has association with seizure and coma
  • possible hypercoagulability, renal failure, pulmonary edema

HELLP - hemolysis, elevated liver enzymes, low platelets

Morph: small, periph infarcts

63
Q

Hydatidiform mole

A

Cystic swelling of chorionic villi with trophoblastic proliferation, can cause choriocarinoma
Morph: gross - translucent grape like structures
- micro - hydropic swelling of villi

Complete: egg fertilized by 1-2 sperm, empty ovum

  • karyotype is 46XX
  • all villi
  • diffuse trophoblast proliferation circumferential
  • atypia often present
  • elevated serum beta hCG
  • can go to choriocarcinoma

Partial: egg with two sperms

  • karyotype triploid
  • some villi edema
  • focal trophoblast proliferation
  • no atypia
  • not as high hCG
64
Q

Invasive mole

A

penetrates and perforates uterine wall, proliferating cytotrophoblastas and syncytiotrophoblasts
- villi can embolize to distant sites

65
Q

Choriocarcinoma (not germ cell)

A

Malignant tumor, half from hydatidiform moles

Morph: Grossly - large, soft, yellow-white tumors with necrosis and hemorrhage
Micro - mixed cytotrophoblasts and syncytiotrophoblast

Sx: vaginal bleeding and discharge after pregnancy

66
Q

Placental site trophoblastic tumor

A

neoplastic proliferation of extravillous trophoblasts, syncytio and cytotrophoblasts absent, lower hCG

Pathology (12 decks)

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