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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
Causes of dysfunctional bleeding (2)
anovulatory cycle - excess estrogen with lack of ovulation inadequate luteal phase - low progesterone with early menses and is often associated with infertility
26
prepuberty abnormal bleeding
precocious puberty (HPA or ovarian origin)
27
adolescence abnormal bleeding
anovulatory cycle, coag disorders
28
reproductive age abnormal bleeding
complications of pregnancy, organic lesions, anovulatory cycle, ovulatory dysfunctional bleeding
29
perimenopausal abnormal bleeding
dysfunctional uterine bleeding (anovulatory cycle, irregular shedding), organic lesions
30
postmenopausal abnormal bleeding
organic lesions, endometrial atrophy
31
Endometritis (acute and chronic)
acute - uncommon, bacterial infections after delivery or miscarriage from conception chronic - abnormal bleeding, pain, discharge, infertility, endometrial plasma cell and macro infiltration
32
Endometriosis
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
Adenomyosis
Nests of endometrial tissue in myometrium
34
Endometrial polyps
exophytic masses of endometrial glands and stomra project into endometrial cavity - associated with estrogens or tamoxifen therapy - possible to adenocarcinoma
35
Endometrial hyperplasia
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
Carcinoma of endometrium
Genetics: 7% of all invasive cancers Age: 55-65 years Types: Type I and Type II
37
Type I endometrial CA
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
Type II endometrial CA
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
Malignant Mixed Mullerian tumors (MMMT)
Endometrial adenocarcinomas with malignant stroma changes from neoplastic precursor Morph: gross - tumors are bulky, fleshy, polypoid Micro: malignant glandular and stromal elements
40
Adenosarcoma
Estrogen sensitive tumors exhibit stromal neoplasia with benign glands - large polypoid growths generally low grade malignancies
41
Stromal tumors
Benign stromal nodules - discrete lumps of stromal neoplasia with myometrium Endometrial stromal sarcomas - lesions composed of malignant stroma interposed between myometrial bundles
42
Leiomyoma (fibroids)
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
Leiomyosarcoma
Uncommon malignancies that form bulky, fleshy masses, in uterine wall or project into lumen - wide range of atypia - metastasize and disseminate widely
44
Suppurative salpingitis
Component of PID; gonococcal infections, chlamydia also factor Tuberculous salpingitis - rare in US cause of infertility
45
polycystic ovarian disease and stromal hyperthecosis
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
Surface epithelium tumors - serous
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
Surface epithelial tumors - mucinous
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
Surface epithelial tumors - endometrioid
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
Surface epithelial tumor - clear cell adenocarcinoma
Uncommon, variant of endometrioid adenocarcinoma | - cystic or solid
50
Surface epithelial tumor - brenner
variably sized solid tumor by dense fibrous stroma and nests of epi resembling urinary transiational or columnar epithelium - unilateral
51
Teratoma
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
Dysgerminoma
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
Endodermal sinus tumor (yolk sac)
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
Choriocarcinoma
highly malignant, metastasize widely, resistant to chemotherapy than placentral counterparts
55
Granulosa-theca cell tumors
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
Fibromas, thecomas, fibrothecomas
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
Sertoli- Leydig cells
Masculinization or defeminization | - unilateral and consist of tubules
58
Spontaneous abortion
Pregnancy before 20 weeks | Causes: maternal, fetal, uterine defects, maternal vasculature disorders, infections, idiopathic
59
Ectopic pregnancy
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
placenta previa
placental implamantation in lower uterine segment or cervix, third trimester bleeding - C section necessary or death
61
Placenta accreta
absence of decidua and placenta adheres to myometrium, life threatening hemorrhage
62
Preeclampsia and eclampsia
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
Hydatidiform mole
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
Invasive mole
penetrates and perforates uterine wall, proliferating cytotrophoblastas and syncytiotrophoblasts - villi can embolize to distant sites
65
Choriocarcinoma (not germ cell)
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
Placental site trophoblastic tumor
neoplastic proliferation of extravillous trophoblasts, syncytio and cytotrophoblasts absent, lower hCG

Pathology (12 decks)

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