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ENRP Exam 1 > Female GU Pathology > Flashcards

Female GU Pathology Flashcards

1
Q

from what embryonic tissue is the upper third of the vagina, the cervix, fallopian tubes, and uterus derived?

A

paramesonephric duct (mullerian duct)

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2
Q

What is Mayer-Rokitansky-Hauser syndrome

A

Normal external genitalia, chromosomal and ovary function BUT

underdeveloped/absent vagina and uterus

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3
Q

How can antibiotic use predispose a woman to infection

A

destruction of normal flora shifts commensal bacteria populations which maintain the normal physiology of vagina. this may make vagina more susceptible to colonization

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4
Q

Is HSV-2 infection more common in men or women?

A

Women

also more common in non-hispanic blacks

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5
Q

list the parts of the female GU tract in order of frequency of HSV infection

A

Cervix, Vagina, Vulva

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6
Q

you suspect a patient of having herpes, what test is likely to confirm that suspicion

A

Tzanck Smear

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7
Q

You and your wife are having a mutherfucking gin and tonic down in the minican and swinging with locals. 5-7 days after you get back, you develop a fever, tender lymph nodes and your wife has red papules on her vulva. What infection did she likely pick up in the minican

A

Herpes

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8
Q

what is the prognosis of vertical transmission of HSV

A

high mortality, poor prognosis

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9
Q

What does HHV-8 cause

A

Kaposi Sarcoma

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10
Q

In congenital CMV, 95% of the patients are asymptomatic but in the case of primary maternal infection, that disease develops and what does it resemble

A

Cytomegalic inclusion disease which resembles

erythroblastosis fetalis

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11
Q

In the case of a neonate who was infected with CMV and developed cytomegalic inclusion disease, what does the disease process look like.

A 
Intrauterine Growth Restriction
Jaundice
hepatosplenomegaly 
anemia 
bleeding

also have microcephaly

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12
Q

what are the two forms chlamydia exists in

A

elementary body - infectious, inactive form
reticular body - metabolically active

Most common bacterial STI in the world

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13
Q

What is the serotype of chlamydia associated with urogenital and conjunctivitis

A

D-H

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14
Q

what is the serotype of chlamydia associated with lymphogranuloma venereum serotypes

A

L1, L2, L3

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15
Q

What is the serotype of chlamydia associated with ocular infections in children/trachoma

A

A, B, C

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16
Q

What is the best test to use for chlamydia infection

A

Nucleic Acid Amplification Test (NAAT)

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17
Q

What is a complication of PID that is characterized by peritonitis and peri-hepatitis. SX include URQ pain, Fever, chills, malaise and maybe adhesions? (slide 41)

A

Fitz-Hugh-Curtis Syndrome

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18
Q

if someone describes a non-tender chancre on their vulva or scrotum. and show endarteritis on histology, what organism has likely infected them

A

Treponema Pallidum (syphilis)

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19
Q

A 24 year old man presents to the free clinic on an LGBTQ free screening day. His history seems normal, he is sexually active but only with a couple of people. During the interview, you notice and ulcer on the back of his hand. When you ask about it, he says it doesn’t hurt. What infection should you be thinking of

A

Syphilis

included because he made a point that ulcers can appear anywhere on the body. This would be epidermal syphilis

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20
Q

Describe Chancroid disease

A

Caused by Haemophilus ducreyi (look out in tropics)
Painful!
yellow/gray exudate
buboes can erode -> chronic draining ulcers

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21
Q

Describe Granuloma Inguinale

A

Cause by Klebsiella granulomatis
painless ulcers
Rare in the west
Untreated -> elephantiasis

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22
Q

describe lymphogranuloma venereum

A

L serotypes
starts as small papule on genital mucosa or skin
2-6 weeks draining swollen nodes

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23
Q

A woman presents with vulvovaginal pruritus,, erythema, and swelling in her hooha. She also describes cottage cheese like discharge. On pap smear you notice pseudohyphae. what is the organism she is infected with

A

Vulvovaginal candidiasis

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24
Q

What are the hallmarks of trichomonas vaginalis

A 
Large flagellated ovoid protozoan
frothy yellow discharge 
dysuria
dyspareunia 
strawberry cervix
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25
Q

What is the most common cause of bacterial vaginosis

A

Garderella Vagnialis

gives you dat fish puss, treat with metronidazole

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26
Q

What is the classic tetrad of congenital toxoplasmosis

A

Cerebral Calcifications
Micro or hydrocephalus
Chorioretinitis
Convulsions

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27
Q

What is a complication of listeria in pregnancy

A

can lead to SAB, stillbirth, or neonatal sepsis due to chorioamnionitis

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28
Q

Parvo B19 can cause what disease in immunocompetent children

A

fifths disease

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29
Q

What are adverse outcomes of parvo B19 infection in seronegative women

A

SAB (second trimester)
Stillbirth
Hydrops
Congenital anemia

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30
Q

What is lichen sclerosis

A

smooth white plaque or macules that coalesce into a surface that resembles parchment

occurs in all ages but most common in postmenopausal women

increases chance of squamous cell carcinoma

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31
Q

describe squamous cell hyperplasia

A

nonspecific localized, well circumscribed area of lichenification resulting from repeated itching and scratching

not considered premalignant

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32
Q

What is condyloma cuminatum

A

genital warts
solitary but more likely multifocal
from HPV 6 and 11 (low risk)

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33
Q

What is condyloma latum

A

painless superficial lesions to skin and mucosa

associated with secondary syphilis (2-10 weeks after primary chancre)

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34
Q

What are the two types of squamous neoplasia of the vulva and their associated

A

A. HPV related - Classic VIN

B. Non HPV related - differentiated VIN

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35
Q

What are the two tumor types of the vulva that have counterparts in the breasticles

A

Papillary hidradenoma

extramammary paget disease

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36
Q

how does extramammary Paget disease presetn

A

pruritic, red, crusted, map-like area on Labia Majora

distinctive intraepithelial proliferation of cells

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37
Q

What is the treatment for vulvar paget disease

A

wide local excision

if malignancy does develop, prognosis is poor

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38
Q

What are gartner duct cysts

A

cysts on the walls of vagina left over from wolffian duct rests

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39
Q

If a young female presents with a vaginal tumor composed of malignant embryonal rhabdomyoblasts, what is the diagnosis

A

Embryonal Rhabdomyosarcoma

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40
Q

what is the predominant protective bacterium in the vagina

A

Lactobacilli

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41
Q

What are the high risk and the low risk HPV strains

A

High Risk - 16, 18

Low risk - 6, 11

42
Q

What are the two proteins associated with the high risk strains of HPV that lead to cancer

A

E6 - p53 degradation

E7 - RB inactivation

43
Q

What percent of HPV infections are cleared by a normal immune system in 24 months

A

90%

44
Q

Describe Low Grade Squamous Intraepithelial Lesions

A
  • high level of viral replication
  • not treated like premalignant lesion
  • 80% associated with serotype HPV-16
  • does NOT progress directly to invasive carcinoma
45
Q

Describe High Grade Squamous Intraepithelial Lesions

A
  • low replication but high proliferation
  • Irreversible derangements
  • high risk progression to SCC
46
Q

what is the average age of cervical carcinoma and what type of carcinoma is present

A

45-50

SCC

47
Q

what endometrial characteristics could be used to determine that the woman is in day 1-5 (menstrual phase) of their cycle

A
  • Dissolution of corpus luteum

- functionalis layer degenerates/sheds

48
Q

what endometrial characteristics could be used to determine that the woman is in the proliferative phase of her cycle

A
  • rapid growth of glands and stroma

- glands are straight tubular structures

49
Q

What is the key histologic feature of they secretory phase

A

subnuclear vacuoles

50
Q

What are histologic features of the 21-22 day phase of the secretory phase

A

Prominent spiral arterioles
Increased ground substance and edema
Cytoplasmic eosinophilia

51
Q

what is the most common cause of dysfunctional uterine bleeding

A

Anovulatory cycle

other causes include
MEtabolic disorders
ovarian lesions
endocrine disorders

52
Q

Failure of what process would cause in excessive endometrial stimulations by estrogen that is unopposed by progesterone

A

Ovulation

53
Q

Name some of the disorders that are associated with endometritis

A 
Chronic pelvic inflammatory disease
Retained gestational tissue
intrauterine contraceptive devices 
TB 
No cause 15%
54
Q

Describe endometriosis

A

presence of ectopic endometrial tissue outside of uterus. This leads to infertility, dysmenorrhea, dyspareunia, pelvic pain

55
Q

What are the locations of ectopic endometrial tissue in endometriosis

A

Ovaries
Uterine ligaments
Rectovaginal septum
Rectouterine pouch

56
Q

What is adenomyosis

A

presence of endometrial tissue within the myometrium

57
Q

What are the 4 theories of endometriosis

A
  1. Regurgitation theory
  2. Benign metastasis theory
  3. Metaplastic theory
  4. Extrauterine stem/progenitor cell theory
58
Q

What are conditions that cause increased estrogen

A 
anovulation
obesity
menopause 
prolonged administration of estrogenic substances 
PCOS 
tumors
59
Q

Inactivation of what gene in endometrial hyperplasia is common

A

PTEN

60
Q

What is cowden syndrome

A

germline PTEN mutation and high incidence of endometrial and breast cancer

61
Q

loss of PTEN leads to secondary activation of what pathway

A

PI3K/AKT

62
Q

What is the cardinal feature of typical hyperplasia

A

increased gland to stroma ratio

rarely progress to cancer

63
Q

Describe Atypical hyperplasia

A

AKA EIN
Complex patterns of proliferating glands displaying nuclear atypia
Glands back to back and branching

Conspicuous nuclei
overlap with well differentiated cancer

64
Q

What is the most common invasive cancer of the female genital tract and what is the peak age

A

Endometrial carcinoma

peak age is 55-65

65
Q

Describe type 1 - endometrioid endometrial carcinoma

A

most common type of endometrial carcinoma

  • Well differentiated
  • obesity
  • Diabetes
  • HTN
  • Unopposed estrogen
66
Q

What is the main morphology of type II endometrial carcinoma

A

serous (compared to type I endometrioid)

  • pts are older and it is more aggressive
  • associated with TP53
67
Q

What are mixed mullerian tumors

A

endometrial adenocarcinomas with a malignant mesenchymal component

68
Q

Define carcinosarcoma

A

malignant glandular and mesenchymal elements

69
Q

what are the two types of stromal tumors

A

adenosarcoma = benign glands and malignant stroma

pure stromal tumors = B-9 vs stromal sarcoma

70
Q

what are microscopic features of leiomyoma

A

bundles of smooth muscle cells
uniform in size and shape, oval nucleus
rare mitoses
can degenerate

71
Q

How does most leiomyosarcoma come to be

A

arise from myometrium or stromal precursor cells, NOT from leiomyoma

more than half metastasize

72
Q

what are key features of leiomyosarcoma on histo

A

nuclear atypia
mitotic index is >10
zonal necrosis

mets to lungs

73
Q

What infectious agent is most likely to attack fallopian tubes

A

N. gonorrhea 60%

rest is chlamydia

74
Q

how common are adenocarcinomas of the fallopian tubes?

A

super rare
Post menopausal caucasians
sinister disease with 40% dead to 5 yrs

75
Q

When does a cystic follicle become a follicle cyst

A

when it grows from <2 cm to greater

76
Q

Describe PCOS

A

multiple ovarian cysts combined with

  • hyperandrogenism
  • menstrual irregularity
  • Chronic Anovulation
  • decreased fertility
77
Q

What are common comorbidities with PCOS

A

Obesity
T2DM
Premature Atherosclerosis

78
Q

Why do ovarian tumors account for a disproportionate high number of deaths from female GU cancer

A

metastasis by the time of diagnosis

79
Q

what are the most common symptoms of ovarian tumors

A

Abdominal pain/distention
urinary and gastrointestinal tract symptoms
vaginal bleeding

80
Q

From what tissue do most primary ovarian neoplasms arise

A

Mullerian Epithelium

81
Q

What are the three types of epithelial ovarian neoplasms

A

Serous
Mucinous
Endometrioid

82
Q

How do mucinous epithelial ovarian tumors differ from the serous types

A

Surface of ovary is rarely involved

Mutation of KRAS is consistent mutation

83
Q

How can specialized teratomas cause problems

A

they can be fully functional differentiated tissues that can cause hypersecretion of a hormone

84
Q

If someone has a dysgerminoma and during testing you find elevated levels of HCG. what type of cell would you be expected to find on histology

A

syncytiotrophoblastic cells

tumor associated with gonadal dysgenesis

85
Q

What are the germ cell tumors

A

Teratomas - mature, immature, specialized
Dysgerminoma
Yolk sac
Choriocarcinoma

*he says focus on key concepts boxes and morphology in robbins

86
Q

How does an adult granulosa cell tumor present

A 
DUB
Endometrial hyperplasia 
Endometrial Carcinoma 
Proliferative breast disease 
Masculinization if androgens
87
Q

how would a juvenile granulosa cell tumor present clinically

A

Precocious puberty
Early breasts
early menarche
pubic or underarm hair

Pseudohermaphroditism if androgen

88
Q

What are the two associations with fibromas

A

ascites

basal cell nevus syndrome

89
Q

What are the hallmarks of sertoli-leydig cell tumors

A

masculinization or defeminization

90
Q

What is the definition of spontaneous abortion

A

pregnancy loss prior to 20 weeks

91
Q

what are the main causes of spontaneous abortion

A

fetal chromosomal abnormalities
maternal endocrine factors
physical defects in the uterus
infections

92
Q

What is the predisposing condition of 35-50% with ectopic pregnancy

A

chronic salpingitis secondary to PID

93
Q

What are the 2 pathways associated with infection

A

Ascending infection

hematogenous spread

94
Q

What is placenta previa

A

placenta covering cervical opening which can cause bleeding

95
Q

what causes placenta accretia

A

partial or complete absence of the decidua

96
Q

what is the triad of preeclampsia

A

HTN
edema
proteinuria

97
Q

describe the pathology of preeclampsia

A

failure of the remodeling of the maternal endothelial cells with placental endothelial cells so when more blood is demanded the placenta becomes ischemic

98
Q

What are the halmarks of HELLP

A

Hemolysis
Elevated Liver Enzymes
Low platelets

99
Q

what makes a complete mole

A

sperm fertilizes an empty ovum
or
2 sperm fertilize one empty ovum

100
Q

what makes a partial mole

A

2 sperm fertilize a normal ovum

101
Q

which type of mole is likely to develop into carcinoma

A

complete mole

partial mole has NO risk

102
Q

What is the clinical presentation of a gestational choriocarcinoma

A

Irregular vaginal bleeding
Enlarged uterus
May present with mets
hCG very high

ENRP Exam 1 (20 decks)

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