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Pathology for repro exam > Female path (robbins) > Flashcards

Female path (robbins) Flashcards

1
Q

Vulvar mucosa showing Thinned epidermis, Hydropic degeneration of Basal cells, Sclerotic stroma, Dermal inflammation? Benign white plaques?

A

Lichen Sclerosus

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2
Q

Condylomata lata or flat, moist minimally elevated lesions occur in what disease?

A

2nd syphilis

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3
Q

Cells showing perinuclear cytoplasmic vacuolization and wrinkled nuclear contours?

A

Koliocytes

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4
Q

An intraepithelial proliferation of malignant cells that occur in the skin, vulva, or nipple?

A

Paget disease

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5
Q

Vulvar red, scaly plaque caused by proliferation of malignant epithelial cells within the epidermis, positive PAS scan?

A

Paget disease

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6
Q

Curdy white vaginal discharge?

A

Candidiasis

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7
Q

Watery, copious gray-green discharge with infested parasites?

A

Trichomonas

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8
Q

Associated with females whose mothers took Diethylstilbestrol during pregnancy to avoid abortions?

A

vaginal adenosis–> Clear cell carcinoma

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9
Q

embryonal Rhabdomysarcoma in infants or < 5yo manifesting as soft polypoid masses in vagina?

A

Sarcoma Botryoides

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10
Q

What is the MCC of cervicitis?

A

Chlamydia trachomatis

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11
Q

Postpartum patient with acute cervicitis. MCC?

A

Staph or strep

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12
Q

What is gene has been linked to 20% of cervical cancers (also hamartomatous GI polyps)?

A

LKB1

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13
Q

What is required to diagnose chronic endometritis?

A

Plasma cells

**Lymphocytes are normally present in the endometrium

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14
Q

What is seen on Histology of endometritis caused by either Ct or GC?

A

PMN infiltrate in superficial endometrium and glands coexisting with a stromal lymphoplasmacytic infiltrate

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15
Q

Growth of basal layer of endometrium down into the myometrium?

A

Adenomyosis

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16
Q

What is the consequence on myometrium in adenomyosis?

A

hypertrophym + enlarged, globular uterus

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17
Q

Adenomyosis causes what signs and symptoms?

A

Menorrhagia
Dysmenorrhea
pelvic pain
Before onset of menstruation

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18
Q

Presence of endometrial glands and stroma in location outside the endomyometrium?

A

Endometriosis

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19
Q

What are the 3 theories for Pg of Endometriosis?

A

regurgitation->backflow through fallopian tube
Metaplastic-> differentiation of coelomic epi
Vascular or lymph dissemination

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20
Q

Unlike adenomyosis, Endometriosis tissue is?

A

Functional–> undergoes cyclic bleeding

c

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21
Q

Blood collects in aberant tissue causing Red-Brown nodules or implants, as in “Chocolate cysts” in the ovaries?

A

Endometriosis

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22
Q

Severe dysmenorrhea, pelvic pain from intrapelvic bleeding, and periuterine adhesions?

A

Endometriosis

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23
Q

MCC of Abnormal bleeding in prepubertal patient?

A 
Precocious puberty 
(hypothalamic, pituitary, ovarian origin)
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24
Q

MCC of abnormal bleeding in adolescence?

A

anovulatory cycles

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25
Q

MCC of abnormal bleeding in reproductive age?

A

Complications of pregnancy
Proliferations (leiomyomas, adenomyosis, polyps)
Anovulatory cycles
Ovulatory dysfxn (inadequate luteal phase)

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26
Q

MCC of abnormal bleeding in perimenopausal women?

A

Anovulatory cycles
Irregular shedding
Proliferations (carcinoma, hyperplasia, polyps)

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27
Q

MCC of abnormal bleeding in Postmenopausal women?

A

Proliferations

Endometrial atrophy

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28
Q

MCC of anovulatory cycles?

A

Hypo-Pit-Adrenal- thyroid dysfxn
Functional ovarian lesion producing Estrogen
Malnutrition, obesity, disease
Severe physical or emotional stress

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29
Q

Excess Estrogen with little progesterone causes endometrium to appear?

A

Gland hyperplasia= estrogen
Stroma scarce= progesterone

**prone to breakdown and bleeding

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30
Q

How does inadequate luteal phase cause abnormal bleeding?

A

Corpus luteum fails to mature= lack of progesterone

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31
Q

Endometrial hyperplasia is associated with what genetic abnormality?

A

PTEN inactivation

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32
Q

Endometrial neoplasm associated with excess estrogen + endometrial hyperplasia in perimenopausal women?

A

Endometrioid cancer

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33
Q

Endometrial neoplasm arising from endometrial atrophy in postmenopausal women?

A

Serous cancer

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34
Q

What syndrome is associated with development of endometrioid carcinoma?

A

Cowden syndrome= PTEN mutation

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35
Q

Endometrial neoplasm showing tufts and papillae rather than glands with positive immunohistochemistry for p53?

A

Serous carcinoma

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36
Q

What are some risk factors for Endometrial hyperplasia?

A 
Anovulatory cycles
Polycystic ovarian syndrome
Estrogen producing tumor
obesity
estrogen without progestin
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37
Q

Most common benign tumor in females or reproductive age, > in blacks, FIRM, hormone responsive?

A

Leiomyoma

**aka= Fibroids because “firm”

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38
Q

Sharply circumscribed, firm, gray-white masses with characteristic “Whorled cut surface.” often multiple occurring in premenopausal women?

A

Leiomyomas

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39
Q

Soft, hemorrhagic, necrotic mass in post menopausal women?

A

Leiomyosarcoma

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40
Q

What are the organisms that can cause transplacental fetal infections?

A 
TORCH
toxoplasmosis
other infections
rubella
CMV
herpes
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41
Q

What pregnancy conditions are associated with elevated hCG?

A

Hydatidform mole
Invasive mole
Choriocarcinoma

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42
Q

Cystically dilated, chorionic villi, appearing grossly as grape like structures?

A

Hydatidiform mole

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43
Q

What is the difference btwn complete and partial hydatidiform mole?

A

Complete: not compatible with embryogenesis and never contain fetal parts (villi are diploid)
Partial: compatible with embryo formation, contain fetal parts, Triploid

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44
Q

Lesion arising from Hydatidiform mole manifesting as bloodym brownish discharge accompanied by rising Beta hCG in blood and urine?

A

Choriocarcinoma

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45
Q

What cells are seen in microscopic choriocarcinoma?

A

Anaplastic cuboidal cytotrophoblasts and syncytiotrophoblasts

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46
Q

Indolent, tumor of intermediate trophoblasts that produce HPL and do not respond to chemo well?

A

Placental site trophoblastic tumor

47
Q

Pt in 3rd trimester (24-25wk) with HTN, proteinuria, and edema?

A

Pre-eclampsia

48
Q

What makes pre-eclampsia –> eclampsia?

A

addition of seizures or convulsions

49
Q

Disease triggered by Insufficient maternal blood flow to placenta secondary to inadequate remodeling of spiral arteries of uteroplacental vascular beds?

A

Pre-eclampsia

50
Q

Caused by impaired vascular remodeling by trophoblasts, where the musculoelastic walls are retained, and channels remain narrow?

A

pre-eclampsia

51
Q

What are the consequences associated with Pre-eclampsia?

A

Placental infarction= chorionic hypoperfusion
HTN=reduced PGs and increased TxA2
Hypercoag= endothelial dysfuxn
End organ failure= Kidney + liver
HELLP syndrome= elevated Liver enzymes + low platelets

52
Q

Placental consequences of Pre-eclampsia?

A

Infarcts
Retroplacental hemorrhage
Premature maturation of placental villi
Fibrinoid Necrosis= Foam cells in vessels

53
Q

What are the MC reasons women seek evaluation of breast lumps?

A 
40%= Fibrocystic change 
7%= fibroadenoma 
10%= cancer
54
Q

MC breast abnormality in premenopausal women, multifocal, ill defined, diffusely increased densities and discrete nodules on mammography. Usually appearing as Brown or Blue domed cysts +- micro calcifications?

A

Non-proliferative Fibrocystic change

55
Q

Epithelial hyperplasia in breasts in recognized by the presences of what?

A

2+ cell layers (epithelial layer + myoepi cells)

56
Q

Fibrocystic change marked by intralobular fibrosis and proliferation of small ductules and acini?

A

Sclerosing adenosis

**increased risk for cancer

57
Q

Hard rubbery lesion, with proliferation of luminal spaces lined by epithelial cells and myoepithelial cells. Glands are back to back, stromal fibrosis which compresses the ducts/acini and appears similar to carcinoma?

A

Sclerosing adenosis

**differentiated from carcinoma by PRESENCE of myoepithelial cells

58
Q

Features of fibrocystic change that is associated with 1.5-2x and 5x increased risk for Breast Carcinoma in BOTH breasts?

A

1.5-2–> ductal papillomatosis, sclerosing adenosis

5x–> atypical hyperplasia (ductal or lobular)

59
Q

Acute mastitis acquired during early weeks of nursing is MCC by?

60
Q

Non-bacterial chronic inflammation of breasts associated with insipissation of breast secretions in main excretory ducts. Ducts ruptures= masses and nipple retractions in women 40-60 yo?

A

Mammary duct ectasia (plasma cell mastitis)

61
Q

Ducts filled with granular debris, PMNs, foam cells, Prominent Lymphoplasmocytic infiltrate and occasional Granuloma in periductal stroma?

A

Mammary duct ectasia

62
Q

Sharply localized, tender mass, with necrosis surrounded by PMNs, giant cells, and may develop calcifications?

A

Fat necrosis= trauma

63
Q

30yo with solitary, discrete, mobile breast mass that enlarges during menstrual periods?

A

Fibroadenoma

64
Q

Breast mass with loose fibroblastic stroma containing ductlike, epithelium lined spaces of various shapes and sizes. Tissue lined by epithelial and myoepithelial cells?

A

Fibroadenoma

65
Q

Neoplastic growth of epithelial covered glands and leaflike stromal elements?

A

Phyllodes tumor

66
Q

Premenopausal women with solitary mass found in lactiferous ducts of sinuses causing BLOODY nipple discharge, nipple retractions?

A

Intraductal Papilloma

**Benign= covered by both epi & myoepi layers

67
Q

What are some of the risk factors for breast cancer?

A 
Age
FHx/ Genetics 
Menstrual Hx: early menarche or late menopause
Pregnancy: early/ late 1st, Nulliparous 
Benign breast lesions 
Obesity 
Exogenous estrogens
Cigarettes
68
Q

What genetic factors are associated with Breast cancer?

A 
HER2/NEU
BRCA 1/2
Li Fraumeni syndrome
Cowden syndrome
Ataxia telangiectasia
69
Q

What are the MC locations of breast tumors? (Specific)

A

Upper Outer Quadrant (50%)

Central (20%)

70
Q

MC invasive breast cancer?

A

Invasive Ductal carcinoma

71
Q

DCIS with high grade nuclei and Extensive Central Necrosis + calcifications?

A

Comedo subtype DCIS

72
Q

Breast mass causing ductlike spaces, central necrosis, and calcifications?

73
Q

Extension of DCIS up the lactiferous duct into skin of nipple?

A

Paget disease of nipple

**50% signify underlying Carcinoma

74
Q

Uniform breast mass, loosely cohesive clusters, intracellular mucin vacuoles, NO calcifications, may lead to invasive carcinoma in Either breast?

75
Q

Process by which invasive ductal carcinomas replace normal breast tissue and form hard, palpable mass?

A

Desmoplastic response

76
Q

Invasive breast cancer more likely to spread to Cerebrospinal fluid, serosal surfaces, GI, ovary, uterus, and Bone marrow?

A

Invasive Lobular carcinoma

77
Q

Invasive breast cancer with cells producing abundant quantities of extracellular mucin. Often appear as wll circumscribed soft/ gelatinous masses?

A

Colloid carcinoma

78
Q

Breast lesion showing highly pleomorphic cells growing in cohesive sheets and are associated with prominent reactive infiltrates of Lymphocytes and Plasma cells?

A

Medullary breast carcinoma

79
Q

What are the implications for a breast tumor with HER2/Neu over expression?

A

Poor prognosis

Trastuzumab therapy

80
Q

Male with breast lesion showing epithelial hyperplasia of ducts, NO lobules, Button-like subareolar swelling. MCC?

A 
Gynecomastia= Hyperestrinism 
MMC= Cirrhosis--> inability to metabolize estrogen
Klinefelter syndrome
Anabolic steroids
Old age
81
Q

MC disorder of fallopian tubes is inflammation caused by?

82
Q

MCC of salpingitis?

A

GC (declining)
Non GC (Rising)
Ct + Staph + Strep (postpartum)

83
Q

What is a complication of PID related to fallopian tubes?

A

Inflammation= adherence = tuboovarian abscess

Adhesion of tubal plicae = Increased Risk of ECTOPIC pregnancy

Sterility

84
Q

Primary adenocarcinoma of the fallopian tubes in increased in women with what?

A

BRCA mutation

85
Q

Multiple small cysts, develop subjacent to serosal covering of ovary. Caused by non-rupured follicle?

A

Follicle or luteal cysts

86
Q

WHat is Stein Leventhal syndrome?

A

Polycystic ovarian disease caused by Excess androgens and estrogens

87
Q

Teenage girls or young adults present with Oligomenorrhea, hirsutism, infertility, Obesity?

A

PCOD= Stein Leventhal sydnrome

88
Q

Large ovaries, gray/white, smooth outer cortex, studded subcortical cysts?

89
Q

Ovary histology showing: thickened, fibrotic ovarian capsule overlying innumerable cystic follicles lined by Granulosa cells + hyperplastic theca interna?

90
Q

What is the principle biochemical abnormalities in PCOD?

A

HIGH Androgens
High LH
LOW FSH

91
Q

What causes hormonal imbalances in PCOD?

A

Ovaries makes excess androgens= converted to Estrogen Peripherally by ADIPOSE= inhibit FSH

92
Q

MCC ovarian tumor?

A

Suface epithelial tumors= 65-70%
Germ cell= 15-20%
Sex cord/stomal = 5-10%
Metastasis= 5%

93
Q

Pg of ovarian surface epithelial tumors?

A

Repeated ovulation and scarring= epithelial cells form cysts= metaplasia= dysplasia

94
Q

What are the important risk factors for Ovarian cancer?

A

Nulliparity
FHx
Germline mutations of suppressor genes
**prolonged oral contraceptives may lower Risk

95
Q

MC tumor of Ovarian epithelial?

A 
Serous
Mucinous 
Endometrioid 
Clear cell
Brenner 
Cystadenofibroma
96
Q

MC germ cell tumors?

A

Teratomas
Dysgerminoma
Endodermal sinus tumor
Choriocarcinoma

97
Q

Benign Serous ovarian tumors are associated with what genetics?

A

KRAS
BRAF
ERBB2 mutations

98
Q

Serous ovarian carcinomas are 96% associated with what genetics?

A

TP53 mutations

99
Q

Ovarian biopsy: Bilateral, spherical, cystic structures lined by Columnar cells, and Psammoma bodies?

A

Benign serous ovarian tumor

100
Q

What is the Krukenberg tumor?

A

metastatic mucinous adenocarcinoma from GI

101
Q

Ruptured ovarian cysts causes pseudomyxoma peritonei?

A

Mucinous tumor

102
Q

Ovarian cyst showing formation of tubular glands lining the space with PTEN mutations?

A

Endometrioid tumors

103
Q

Ovarian tumor in 2-3rd decades, with Gonadal Dysgenesis, solid gray masses, with Sheets or cords Clear Cells separated by scant fibrous stands?

A

Dysgerminoma

** may contain Lymphocytes + Granulomas

104
Q

Ovarian tumor that is Small, hemorrhagic focus with two types of epithelium: cytotrophoblasts and synctiotrophoblasts?

A

Choriocarcinoma= Malignant

**early/ wide mets + primary focus may degenerate

105
Q

Ovarian tumor MC in post-menopauasal, gray/yellow, with mixed cells in cords or sheets and CALL-EXNER BODIES?

A

Granulosa-theca cell tumor

106
Q

Ovarian tumor elaborating large amounts of estrogen and may promote breast or endometrial cancer?

A

Granulosa- theca cell tumor

107
Q

Dermoid cyst found on routine radiographs with foci of calcification, may produce infertility, and can undergo torsion?

A

Benign Cystic Teratomas

108
Q

Ovarian tumor that is Bulky, solid, necrotic with foci of neuroepithelial differentiation and metastasize widely?

A

Immature Malignant Teratoma

109
Q

Immature thyroid tissue located in ovary, that can produce signs of hyperthyroidism?

A

Struma ovarii

110
Q

Surface epithelial ovarian tumors usually present as?

A

Pain
GI complaints
Urinary frequency

111
Q

What is the marker protein for tracking epithelial ovarian tumors?

112
Q

Asherman syndrome?

A

2nd amenorrhea due to loss of Basal layer of Endometrium

113
Q

Dysfunctional uterine bleeding during Menarche and Menopause caused by presence Estrogen without Progesterone?

A

Anovulatory cycle

Pathology for repro exam (6 decks)

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