Female GU, Breast, & Gestation Flashcards
Condyloma = warty neoplasm of vulvar skin, often large. Most commonly due to HPV types ___ or ____ and characterized by _______ change. These rarely progress to carcinoma
6; 11; koilocytic
Thinning of epidermis and fibrosis of dermis characterized by leukoplakia with parchment-like vulvar skin; most commonly seen in postmenopausal women
Lichen sclerosis
Lichen sclerosis of the vulva is benign, but associated with slightly increased risk of _______
SCC
Hyperplasia of vulvar squamous epithelium characterized by leukoplakia with thick, leathery vulvar skin; associated with chronic irritation and scratching
Lichen simplex chronicus
T/F: Lichen simplex chronicus is associated with increased risk for SCC
False — lichen simplex chronicus is benign and there is NO increased risk of SCC
Vulvar cancer arises from the squamous epithelium of the vulva and is relatively rare. It presents as leukoplakia, so biopsy may be required to distinguish carcinoma from other causes of this lesion. What are the 2 pathways by which this type of cancer can develop?
HPV-related — types 16, 18, 31, 33 —> Vulvar intraepithelial neoplasia (VIN) [can occur at younger ages]
Non-HPV-related — long-standing lichen sclerosis [typically older age >70]
Disease characterized by malignant epithelial cells in the epidermis of the vulva presenting as erythematous, pruritic, ulcerated skin that represents carcinoma in situ, usually with no underlying carcinoma
Extramammary Paget Disease
[Contrast with Paget disease of the breast which typically represents underlying carcinoma]
Extramammary paget disease of the vulva must be distinguished from melanoma. What cellular markers allow this differentiation?
Paget cells: PAS+, keratin+, and S100-
Melanoma: PAS-, keratin-, S100+
Focal persistence of columnar epithelium in the upper vagina
Adenosis
Adenosis is focal persistence of the columnar epithelium in the upper vagina. There is increased incidence of this condition in females exposed to ______ in utero
DES
[Diethylstilbesterol — also causes increased risk of breast cancer in mom]
Rare complication of DES-associated vaginal adenosis characterized by malignant proliferation of glands with clear cytoplasm (discovery of this and other complications led to cessation of DES usage)
Clear cell adenocarcinoma
Rare, malignant mesenchymal proliferation of immature skeletal muscle presenting as bleeding and grape-like mass protruding from vagina or penis of child, usually <5 yrs of age
Embryonal rhabdomyosarcoma
[aka sarcoma botryoides]
Key cell of rhabdomyosarcoma is rhabdomyoblast, which is characterized by cytoplasmic cross-striations and stains positive for _____ and ______ on immunohistochemistry
Desmin; myogenin
Vaginal carcinoma arises from squamous epithelium lining the vaginal mucosa and is usually related to high-risk HPV. The precursor lesion is vaginal intraepithelial neoplasia (VAIN).
This type of carcinoma spreads to regional LNs depending on location. Cancer from the lower 1/3 of the vagina goes to the _____ nodes, while cancer from the upper 2/3 goes to the _______ nodes
Inguinal; regional iliac
The cervix is divided into the exocervix and endocervix, what is the difference in their epithelial lining?
Exocervix = squamous epithelium
Endocervix = columnar epithelium
[division between the two is the transformation zone]
HPV is a sexually transmitted DNA virus that infects the lower genital tract, especially the cervix in the transformation zone. Persistent infection leads to risk for CIN. High risk HPV factors E6 and E7 increase destruction of _____ and _____, respectively
p53; Rb
CIN is characterized by ________ change, nuclear atypia, and increased mitotic activity. It is divided into grades based on extent of immature, dysplastic cells. CIN progresses stepwise from I to II to III to carcinoma in situ to invasive carcinoma. This is not inevitable, as up to _______ still has some potential for regression/reversibility.
Koilocytic; CIN III
[Note that carcinoma in-situ has lost potential for reversibility]
Cervical carcinoma is an invasive carcinoma that arises from cervical epithelium, most commonly seen in middle-aged women (age 40-50) and presents as vaginal bleeding. What are some key risk factors for cervical carcinoma?
Key risk factor = HIGH RISK HPV!
Secondary risk factors include SMOKING and IMMUNODEFICIENCY
What are the most common subtypes of cervical carcinoma?
Squamous cell carcinoma
Adenocarcinoma
[note that BOTH types are related to HPV]
Advanced cervical cancer often invades through what?
Often invades through anterior uterine wall into bladder
[presents as hydronephrosis and post-renal failure — common cause of death in late cervical cancer!]
An abnormal pap smear is followed by confirmatory _____ and ______
Colposcopy; biopsy
2 major limitations of pap smear
Inadequate sampling of transformation zone resulting in false negative screening
Limited efficacy in screening for adenocarcinoma
Quadrivalent vaccine against HPV cover which 4 subtypes?
6, 11, 16, 18
The endometrium is hormonally sensitive and growth is ______ driven. Preparation of the endometrium for implantation is ______-driven. Shedding occurs with loss of _______ support
Estrogen; progesterone; progesterone
Secondary amenorrhea due to loss of basalis (regenerative layer) and scarring; often the result of overaggressive dilation and curettage (D and C)
Asherman syndrome
[loss of basalis = loss of stem cells, can regenerate endometrium]
Anovulatory cycle is a lack of ovulation. This results in estrogen-driven proliferative phase without progesterone-driven _______ phase. This is a common cause of dysfunctional uterine bleeding, especially during menarche and menopause
Secretory
Bacterial infection of endometrium usually due to retained products of conception; presents as fever, abnormal uterine bleeding, and pelvic pain
Acute endometritis
Chronic endometritis is chronic inflammation of the endometrium characterized by _____ cells (these cells are required to classify as chronic!!). Common causes include retained products of conception, chronic PID, IUD, and TB. This presents as abnormal uterine bleeding, pelvic pain, and infertility
Plasma
Endometrial polyps are hyperplastic protrusions of endometrium which present as abnormal uterine bleeding. These can arise as a side effect of the drug _____
Tamoxifen
[tamoxifen is antiestrogenic on breast, but weakly pro-estrogenic on endometrium]
Endometriosis = endometrial _____ and ______ outside the uterine endometrial lining; presents as dysmenorrhea and pelvic pain and may cause infertility
Glands; stroma
Common sites of involvement of endometriosis
Ovary — chocolate cyst
Uterine ligaments — pelvic pain
Pouch of douglas — pain with defecation
Bladder wall — pain with urination
Bowel serosa — abdominal pain and adhesions
Fallopian tube mucosa — scarring (increased risk of infertility and ectopic pregnancy)
_______ = Endometrial glands and stroma within the uterine myometrium
Adenomyosis
T/F: there is increased risk of carcinoma at the site of endometriosis
True! — especially the ovary
Endometrial hyperplasia = hyperplasia of endometrial _____ relative to the _____. This is often a consequence of unopposed _______ and presents as postmenopausal uterine bleeding
Glands; stroma; estrogen
Endometrial hyperplasia is classified histologically, based on architectural growth and cellular atypia. What is the most important predictor for progression to carcinoma in this condition?
Cellular atypia
Endometrial carcinoma is a malignant proliferation of endometrial glands that typically presents as postmenopausal bleeding. This arises via what 2 distinct pathways?
Pathologic hyperplasia d/t unopposed estrogen —> endometrioid carcinoma [resembles normal endometrium, average age is 60 yrs]
Sporadic — cancer results from atrophic endometrium (no evident precursor lesion) —> papillary serous carcinoma [typically occurs in the elderly; driven by p53 mutations, psammoma bodies present]
Benign proliferation of smooth muscle arising from myometrium related to estrogen exposure; presents as multiple, well-defined white whorled masses [grow during pregnancy, shrink during menopause]
Leiomyoma
[important that there are multiple, because distinguishes from leiomyosarcoma which would be single lesion. White whorled masses are also benign features, because malignant would show necrosis, hemorrhage, etc.]
Leiomyomas are usually asymptomatic, however what are some ways in which pts may present?
Abnormal uterine bleeding
Infertility
Pelvic mass
Malignant proliferation of smooth muscle arising from the myometrium. This tumor arises de novo, usually in postmenopausal women. Commonly appears as single lesion with necrosis and hemorrhage, mitotic activity, and cellular atypia
Leiomyosarcoma
The functional unit of the ovary is the follicle, which consists of an _____ surrounded by ______ and ______ cells
Oocyte; granulosa; theca
After ovulation, the residual follicle becomes the _____ _____, which primarily secretes ________. This prepares the endometrium for maintenance of a possible pregnancy
Corpus luteum; progesterone
[hemorrhage into corpus luteum can result in hemorrhagic luteal cyst]
Degeneration of follicles results in follicular cysts. Multiple follicular cysts results in polycystic ovarian syndrome, which is an issue of hormone imbalance. PCOS is characterized by increased ____ and low ______
LH; FSH
[LH:FSH ratio > 2]
The classic presentation of PCOS is an obese young woman with infertility, oligomenorrhea, and hirsutism. Some patients have insulin resistance as well. Pts with high circulating _____ levels are at an increased risk for endometrial carcinoma
Estrone
The ovary is composed of what 3 cell types?
Surface epithelium
Germ cells
Sex-cord stroma
[tumor can arise from any of these cell types or from metastasis]
What is the most common type of ovarian tumor?
Surface epithelial tumors
Surface epithelial tumors of the ovary are derived from coelomic epithelium that lines the ovary. The 2 most common subtypes of surface epithelial tumors are _____ and _____, both are usually cystic
Serous; mucinous
Benign tumors (cystadenoma) are composed of a single cyst with simple, flat lining and most commonly arise in premenopausal women (30-40 y/o).
How does the benign form differ from a malignant cystadenocarcinoma?
Malignant cystadenocarcinomas are composed of complex cysts with THICK SHAGGY lining and most commonly arise in POST-menopausal women (60-70 y/o)
______ mutation carriers have increased risk for serous carcinoma of the ovary and fallopian tube
BRCA1