Female GU Pathology Flashcards
from what embryonic tissue is the upper third of the vagina, the cervix, fallopian tubes, and uterus derived?
paramesonephric duct (mullerian duct)
What is Mayer-Rokitansky-Hauser syndrome
Normal external genitalia, chromosomal and ovary function BUT
underdeveloped/absent vagina and uterus
How can antibiotic use predispose a woman to infection
destruction of normal flora shifts commensal bacteria populations which maintain the normal physiology of vagina. this may make vagina more susceptible to colonization
Is HSV-2 infection more common in men or women?
Women
also more common in non-hispanic blacks
list the parts of the female GU tract in order of frequency of HSV infection
Cervix, Vagina, Vulva
you suspect a patient of having herpes, what test is likely to confirm that suspicion
Tzanck Smear
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
Herpes
what is the prognosis of vertical transmission of HSV
high mortality, poor prognosis
What does HHV-8 cause
Kaposi Sarcoma
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
Cytomegalic inclusion disease which resembles
erythroblastosis fetalis
In the case of a neonate who was infected with CMV and developed cytomegalic inclusion disease, what does the disease process look like.
Intrauterine Growth Restriction Jaundice hepatosplenomegaly anemia bleeding
also have microcephaly
what are the two forms chlamydia exists in
elementary body - infectious, inactive form
reticular body - metabolically active
Most common bacterial STI in the world
What is the serotype of chlamydia associated with urogenital and conjunctivitis
D-H
what is the serotype of chlamydia associated with lymphogranuloma venereum serotypes
L1, L2, L3
What is the serotype of chlamydia associated with ocular infections in children/trachoma
A, B, C
What is the best test to use for chlamydia infection
Nucleic Acid Amplification Test (NAAT)
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)
Fitz-Hugh-Curtis Syndrome
if someone describes a non-tender chancre on their vulva or scrotum. and show endarteritis on histology, what organism has likely infected them
Treponema Pallidum (syphilis)
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
Syphilis
included because he made a point that ulcers can appear anywhere on the body. This would be epidermal syphilis
Describe Chancroid disease
Caused by Haemophilus ducreyi (look out in tropics)
Painful!
yellow/gray exudate
buboes can erode -> chronic draining ulcers
Describe Granuloma Inguinale
Cause by Klebsiella granulomatis
painless ulcers
Rare in the west
Untreated -> elephantiasis
describe lymphogranuloma venereum
L serotypes
starts as small papule on genital mucosa or skin
2-6 weeks draining swollen nodes
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
Vulvovaginal candidiasis
What are the hallmarks of trichomonas vaginalis
Large flagellated ovoid protozoan frothy yellow discharge dysuria dyspareunia strawberry cervix
What is the most common cause of bacterial vaginosis
Garderella Vagnialis
gives you dat fish puss, treat with metronidazole
What is the classic tetrad of congenital toxoplasmosis
Cerebral Calcifications
Micro or hydrocephalus
Chorioretinitis
Convulsions
What is a complication of listeria in pregnancy
can lead to SAB, stillbirth, or neonatal sepsis due to chorioamnionitis
Parvo B19 can cause what disease in immunocompetent children
fifths disease
What are adverse outcomes of parvo B19 infection in seronegative women
SAB (second trimester)
Stillbirth
Hydrops
Congenital anemia
What is lichen sclerosis
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
describe squamous cell hyperplasia
nonspecific localized, well circumscribed area of lichenification resulting from repeated itching and scratching
not considered premalignant
What is condyloma cuminatum
genital warts
solitary but more likely multifocal
from HPV 6 and 11 (low risk)
What is condyloma latum
painless superficial lesions to skin and mucosa
associated with secondary syphilis (2-10 weeks after primary chancre)
What are the two types of squamous neoplasia of the vulva and their associated
A. HPV related - Classic VIN
B. Non HPV related - differentiated VIN
What are the two tumor types of the vulva that have counterparts in the breasticles
Papillary hidradenoma
extramammary paget disease
how does extramammary Paget disease presetn
pruritic, red, crusted, map-like area on Labia Majora
distinctive intraepithelial proliferation of cells
What is the treatment for vulvar paget disease
wide local excision
if malignancy does develop, prognosis is poor
What are gartner duct cysts
cysts on the walls of vagina left over from wolffian duct rests
If a young female presents with a vaginal tumor composed of malignant embryonal rhabdomyoblasts, what is the diagnosis
Embryonal Rhabdomyosarcoma
what is the predominant protective bacterium in the vagina
Lactobacilli
What are the high risk and the low risk HPV strains
High Risk - 16, 18
Low risk - 6, 11
What are the two proteins associated with the high risk strains of HPV that lead to cancer
E6 - p53 degradation
E7 - RB inactivation
What percent of HPV infections are cleared by a normal immune system in 24 months
90%
Describe Low Grade Squamous Intraepithelial Lesions
- high level of viral replication
- not treated like premalignant lesion
- 80% associated with serotype HPV-16
- does NOT progress directly to invasive carcinoma
Describe High Grade Squamous Intraepithelial Lesions
- low replication but high proliferation
- Irreversible derangements
- high risk progression to SCC
what is the average age of cervical carcinoma and what type of carcinoma is present
45-50
SCC
what endometrial characteristics could be used to determine that the woman is in day 1-5 (menstrual phase) of their cycle
- Dissolution of corpus luteum
- functionalis layer degenerates/sheds
what endometrial characteristics could be used to determine that the woman is in the proliferative phase of her cycle
- rapid growth of glands and stroma
- glands are straight tubular structures
What is the key histologic feature of they secretory phase
subnuclear vacuoles
What are histologic features of the 21-22 day phase of the secretory phase
Prominent spiral arterioles
Increased ground substance and edema
Cytoplasmic eosinophilia
what is the most common cause of dysfunctional uterine bleeding
Anovulatory cycle
other causes include
MEtabolic disorders
ovarian lesions
endocrine disorders
Failure of what process would cause in excessive endometrial stimulations by estrogen that is unopposed by progesterone
Ovulation
Name some of the disorders that are associated with endometritis
Chronic pelvic inflammatory disease Retained gestational tissue intrauterine contraceptive devices TB No cause 15%
Describe endometriosis
presence of ectopic endometrial tissue outside of uterus. This leads to infertility, dysmenorrhea, dyspareunia, pelvic pain
What are the locations of ectopic endometrial tissue in endometriosis
Ovaries
Uterine ligaments
Rectovaginal septum
Rectouterine pouch
What is adenomyosis
presence of endometrial tissue within the myometrium
What are the 4 theories of endometriosis
- Regurgitation theory
- Benign metastasis theory
- Metaplastic theory
- Extrauterine stem/progenitor cell theory
What are conditions that cause increased estrogen
anovulation obesity menopause prolonged administration of estrogenic substances PCOS tumors
Inactivation of what gene in endometrial hyperplasia is common
PTEN
What is cowden syndrome
germline PTEN mutation and high incidence of endometrial and breast cancer
loss of PTEN leads to secondary activation of what pathway
PI3K/AKT
What is the cardinal feature of typical hyperplasia
increased gland to stroma ratio
rarely progress to cancer
Describe Atypical hyperplasia
AKA EIN
Complex patterns of proliferating glands displaying nuclear atypia
Glands back to back and branching
Conspicuous nuclei
overlap with well differentiated cancer
What is the most common invasive cancer of the female genital tract and what is the peak age
Endometrial carcinoma
peak age is 55-65
Describe type 1 - endometrioid endometrial carcinoma
most common type of endometrial carcinoma
- Well differentiated
- obesity
- Diabetes
- HTN
- Unopposed estrogen
What is the main morphology of type II endometrial carcinoma
serous (compared to type I endometrioid)
- pts are older and it is more aggressive
- associated with TP53
What are mixed mullerian tumors
endometrial adenocarcinomas with a malignant mesenchymal component
Define carcinosarcoma
malignant glandular and mesenchymal elements
what are the two types of stromal tumors
adenosarcoma = benign glands and malignant stroma
pure stromal tumors = B-9 vs stromal sarcoma
what are microscopic features of leiomyoma
bundles of smooth muscle cells
uniform in size and shape, oval nucleus
rare mitoses
can degenerate
How does most leiomyosarcoma come to be
arise from myometrium or stromal precursor cells, NOT from leiomyoma
more than half metastasize
what are key features of leiomyosarcoma on histo
nuclear atypia
mitotic index is >10
zonal necrosis
mets to lungs
What infectious agent is most likely to attack fallopian tubes
N. gonorrhea 60%
rest is chlamydia
how common are adenocarcinomas of the fallopian tubes?
super rare
Post menopausal caucasians
sinister disease with 40% dead to 5 yrs
When does a cystic follicle become a follicle cyst
when it grows from <2 cm to greater
Describe PCOS
multiple ovarian cysts combined with
- hyperandrogenism
- menstrual irregularity
- Chronic Anovulation
- decreased fertility
What are common comorbidities with PCOS
Obesity
T2DM
Premature Atherosclerosis
Why do ovarian tumors account for a disproportionate high number of deaths from female GU cancer
metastasis by the time of diagnosis
what are the most common symptoms of ovarian tumors
Abdominal pain/distention
urinary and gastrointestinal tract symptoms
vaginal bleeding
From what tissue do most primary ovarian neoplasms arise
Mullerian Epithelium
What are the three types of epithelial ovarian neoplasms
Serous
Mucinous
Endometrioid
How do mucinous epithelial ovarian tumors differ from the serous types
Surface of ovary is rarely involved
Mutation of KRAS is consistent mutation
How can specialized teratomas cause problems
they can be fully functional differentiated tissues that can cause hypersecretion of a hormone
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
syncytiotrophoblastic cells
tumor associated with gonadal dysgenesis
What are the germ cell tumors
Teratomas - mature, immature, specialized
Dysgerminoma
Yolk sac
Choriocarcinoma
*he says focus on key concepts boxes and morphology in robbins
How does an adult granulosa cell tumor present
DUB Endometrial hyperplasia Endometrial Carcinoma Proliferative breast disease Masculinization if androgens
how would a juvenile granulosa cell tumor present clinically
Precocious puberty
Early breasts
early menarche
pubic or underarm hair
Pseudohermaphroditism if androgen
What are the two associations with fibromas
ascites
basal cell nevus syndrome
What are the hallmarks of sertoli-leydig cell tumors
masculinization or defeminization
What is the definition of spontaneous abortion
pregnancy loss prior to 20 weeks
what are the main causes of spontaneous abortion
fetal chromosomal abnormalities
maternal endocrine factors
physical defects in the uterus
infections
What is the predisposing condition of 35-50% with ectopic pregnancy
chronic salpingitis secondary to PID
What are the 2 pathways associated with infection
Ascending infection
hematogenous spread
What is placenta previa
placenta covering cervical opening which can cause bleeding
what causes placenta accretia
partial or complete absence of the decidua
what is the triad of preeclampsia
HTN
edema
proteinuria
describe the pathology of preeclampsia
failure of the remodeling of the maternal endothelial cells with placental endothelial cells so when more blood is demanded the placenta becomes ischemic
What are the halmarks of HELLP
Hemolysis
Elevated Liver Enzymes
Low platelets
what makes a complete mole
sperm fertilizes an empty ovum
or
2 sperm fertilize one empty ovum
what makes a partial mole
2 sperm fertilize a normal ovum
which type of mole is likely to develop into carcinoma
complete mole
partial mole has NO risk
What is the clinical presentation of a gestational choriocarcinoma
Irregular vaginal bleeding
Enlarged uterus
May present with mets
hCG very high
