Female Pathologies Flashcards
1
Q
Bartholin cyst obstructs what kind of ducts?
A
Bartholin ducts- which are a pair of ducts leading from the Bartholin’s glands to the surface of the vulva.
2
Q
What are Bartholin’s glands? What do they secrete?
A
They are two pea sized compound racemose glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.
3
Q
Bartholin cyst happens most commonly in who?
A
women of reproductive age (2% are affected)
4
Q
How do these bartholin cysts become obstructed so a cyst forms?
A
trauma or non-specific inflammation
5
Q
How big is a bartholin cyst?
A
1-3 cm
6
Q
What are the symptoms of a bartholin cyst?
A
most often- they are asymptomatic, but they may be associated with dyspareunia
7
Q
What is dyspareunia?
A
painful sexual intercourse
8
Q
What is the secondary infection of a bartholin cyst?
A
bartholin abscess-bigger than 3 cm
9
Q
What are the symptoms of a bartholin abscess?
A
progressive pain the vulva, signs of inflammation, usually a polymicrobial culture- not related to STD’s
10
Q
In post-menopausal women, progressive enlargement of a bartholin cyst could mean what?
A
adenocarcinoma
11
Q
Group of female disorders involving epithelial growth
A
vulvar dystrophies
12
Q
The BENIGN type of lichen sclerosis is what kind of disease?
A
vulvar dystrophy- chronic inflammatory process
13
Q
What are the symptoms of lichen sclerosis?
A
white, itchy, polygona papules that coalesce into plaques, obliteration of labia minora and obstruction of the introitus, hyperplastic dystrophy, lichen simplex chronicus
14
Q
What are the symptoms and signs of MALIGNANT lichen sclerosis?
A
atypical hyperplastic dystrophy- pruritis, leukoplakia
15
Q
How do discover malignancy in lichen sclerosis?
A
biopsy
16
Q
What is the most common tumor of the vulva?
A
papillary hydradenoma
17
Q
Is papillary hydradenoma benign or malignant?
A
benign
18
Q
Where does a papillary hydradenoma originate from?
A
apocrine sweat gland
19
Q
What are the symptoms of a papillary hydradenoma?
A
painless labial nodule, may ulcerate and bleed
20
Q
How do you treat a papillary hydradenoma?
A
surgical excision is curative
21
Q
Is condyloma acuminatum benign or malignant?
A
benign- it is a common genital wart
22
Q
Which types of HPV is condyloma acuminatum usually associated with?
A
HPV 6 and 11- belongs to STDs
23
Q
What are the large epithelial cells with peripheral clearing called in condyloma acuminatum?
A
koilocytes
24
Q
What is the most common malignancy of the vulva?
A
squamous cell carcinoma
25
What commonly precedes squamous cell carcinoma?
premalignant changes graded as VIN 1 through 3
26
What sometimes precedes squamous cell carcinoma?
vulvar dystrophy
27
What types of HPV is squamous cell carcinoma associated with?
HPV 16, 18, 31, 33
28
What does paget's disease of the vulva look like?
persistent scaly appearance of the skin
29
What is paget's disease of the vulva sometimes associated with?
adenocarcinoma of the sweat gland
30
Malignant melanoma accounts for ______% of malignant lesions of the vulva
10%
31
What drug is linked to clear cell adenocarcinoma?
diethylstibestrol therapy
32
What group of people had high prevalence of clear cell carcinoma in the 1960's?
In daughters of mothers who had
diethylstibestrol therapy during
pregnancy. This drug was used to prevent miscarriages.
33
What is the histology of clear cell carcinoma?
Columnar cell lined tubular glands
where normally stratified squamous
epithelium should be
34
What type of cancer is sarcoma botryoides?
a type of rhabdomyosarcoma
35
What is rhabdomyosarcoma?
A type of connective tissue cancer (sarcoma) in which the cancer cells are thought to arise from skeletal muscle progenitors.
36
What does sarcoma botryoides look like?
"bunch of grapes" protruding from introitus
37
In who does a sarcoma botryoide seen in?
pediatrics- it is a pediatric tumor
38
What is an introitus?
entrance or opening to a hollow organ or tube (especially the vaginal opening); "the introitus of the vagina"
39
What is the histological pathology of erosion of the uterine cervix?
columnar epithelium metaplasia
40
How does erosion of the uterine cervix present?
erythematous area- could be a manifestation of chronic cervicitis
41
What does a KOH test for?
used to detect fungus
42
What are the different kinds of cervicitis?
They are all most likely infectious- gardnerella vaginalis (bacterial vaginosis), trichomona vaginalis, candida albicans,chlamidya trachomatis,
43
What is most likely involved in cervicitis?
most likely involved is endocervix
44
What are the symptoms of cervicitis?
often asymptomatic, but could present with cervical discharge
45
Where does cervical dysplasia carcinoma likely present?
most likely occurs on squamo-columnar junction at transformational zone
46
What types of HPV are associated with cervical dysplasia carcinoma?
HPV 16, 18, 31, 33
47
What does cervical dysplasia carcinoma look like?
disordered growth, mitotic figures, loss of polarity, nuclear hyperchromasia
48
What is nuclear hyperchromasia?
growth that begins at basal level and extends outwards- hyperchromasia is is the hyperchromatic state of the nucleus (elevated chromatin), where there is an abundance of DNA that stains darkly when stained for histological viewing. The hyperchromatic state of the nucleus suggests malignancy.
49
What is dysplasia (abnormal development) progressing into carcinoma in situ called?
Cervical Intraepithelial Neoplasia
CIN 1 progressing to CIN 3- is the potentially premalignant transformation and abnormal growth (dysplasia) of squamous cells on the surface of the cervix. CIN is not cancer, and is usually curable. Most cases of CIN remain stable, or are eliminated by the host's immune system without intervention. However a small percentage of cases progress to become cervical cancer, usually cervical squamous cell carcinoma (SCC), if left untreated.
50
What type of cancer is invasive carcinoma of the cervix most commonly?
squamous cell carcinoma- it could be adenocarcinoma
51
Who gets invasive carcinoma most commonly?
middle aged women
52
What are the risk factors for invasive carcinoma of the cervix?
smoking, early onset of sex life, multiple sex partners
53
When does endometritis happen?
dilation and curette complications- retention of placenta
54
What two bacteria cause endometritis?
staph and strep are most common agents
55
What is endometriosis happen?
presence of ectopic endometrium in the ovaries, palvic cavity, vagina, non-neoplastic
56
Does endometriosis increase risks of endometrial cancer?
no
57
What is endometriosus closely related to?
Closely related to Adenomyosis = “endometriosis of the uterine muscular wall”
58
What are the three theories on why endometriosis occurs?
retrograde seeding through fallopian tube, metaplasia of any mullerian-duct derived tissue, lymphatic spread
59
What are common symptoms of endometriosis of the ovary?
chocolate cyst, infertility, menstrual related pain
60
Why does endometrial hyperplasia occur?
abnormal proliferation of endometrial glands because of excess stimulation by estrogen, anovulatory cycle (menstrual cycle characterized by varying degrees of menstrual intervals and the absence of ovulation and a luteal phase. In the absence of ovulation, there will be infertility), estrogen secreting ovarian tumors
61
What is a symptom of endometrial hyperplasia?
post-menopausal bleeding
62
Does endometrial hyperplasia increase the risk of cancer?
Yes, increases risk of endometrial carcinoma- the higher the degree of cellular atypia, the higher the risk of cancer
63
Are endometrial polyps benign?
yes, but may cause profuse bleeding
64
In who do endometrial polyps most commonly occur in?
women over 40
65
What are the characteristics of an endometrial polyp?
Sessile (relatively flat, mushroom-like), some arise in context of hyperplasia
66
What are the two main types of endometrial polyps?
the two main types are functional epithelium and hyperplastic epithelium- they respond to estrogen but not progesterone (Uterine polyps are estrogen-sensitive, meaning that they respond to estrogen in the same way that the lining of your uterus does — growing in response to circulating estrogen).
67
What is the most common malignancy of the female reproductive organs?
endometrial cancer
68
What are the risk factors for endometrial cancer? Who is risk lower with?
Obesity, diabetes, hypertension- risk is lower with child bearing women
69
If a post-menopausal woman is bleeding, what should you suspect?
endometrial cancer
70
What is inflammation of the fallopian tubes called?
salpingitis
71
What diseases does salpingitis happen in?
in the context of pelvic inflammatory disorder (PID) and N. gonorrhea (most commonly gonorrhea)
72
What are the symptoms of salpingitis?
pain, malaise, and systemic symptoms
73
What could salpingitis result in?
pyosalpinx (pus in the tube), hydrosalpinx (watery fluid in the tube), tubo-ovarian abscess
74
Hematosalpinx (blood filled tube) occurs most commonly because of?
ectopic pregnancy
75
What is the most common form of vaginitis?
candidiasis-infectious disease- caused by overgrowth of candida albicans
76
What pathologies increase the chance of getting candidiasis?
diabetes, pregnancy, broad spectrum antibiotic therapy, OCP, immunosuppression
77
What does candidiasis look like?
white patches on mucosa, thick white discharge, pruritis in perineal and vulvovaginal area
78
What does trichomoniasis look like and what are the symptoms?
Vaginal itching and burning, it's worse with intercourse. Yellow-green frothy, foul smelling discharge, strawberry cervix, symptoms occur 5-28 days after transmission
79
What does the infectious disease, Gardnerella vaginitis (bacterial vaginosis) look like and present as?
Thin, white or clear discharge with "fishy" odor.
80
What does gardnerella vaginitis look like on a wet mount?
"clue cells" on a wet mount- bacterial studded epithelial cells with indistinct borders- less than expected WBCs
81
Can gardnerella vaginitis be sexually transmitted?
yes
82
What is one of the common causes of PID?
Gonorrhea
83
What are the symptoms of gonorrhea?
May be asymptomatic, it can present as acute purulent inflammation of the vagina, urethra, bartholine and skene glands
84
What are skene's glands?
glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening and may be near or a part of the G-Spot. These glands are surrounded with tissue (which includes the part of the clitoris) that reaches up inside the vagina and swells with blood during sexual arousal.- They are remnants of prostate gland
85
What are clue cells?
They are a medical sign of bacterial vaginosis. They are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria. The etymology behind the term "clue" cell derives from the original research article from Gardner and Dukes describing the characteristic cells. The name was chosen for its brevity in describing the sine qua non of bacterial vaginosis.
86
What kind of cyst is the most common ovarian cyst?
follicular cyst
87
What does a follicular cyst look like?
4-6 cm in size, thin-walled, contains clear fluid, endometrial hyperplasia
88
What hormone is often elevated when a follicular cyst is present?
estrogen
89
What are the symptoms of a follicular cyst if it ovulates/ruptures?
sharp pain, mittelschmerz
90
What the fuck is mittelschmerz?
medical term for ovulation pain
91
What does clomid (the fertility drug) increase the risk of?
corpus luteum cyst and ovarian torsion
92
How big can a corpus luteum cyst grow to be?
10 cm- these are heavy and can cause ovarian torsion
93
In who do you see corpus luteum cysts?
pre-menopausal women
94
What is a corpus luteum cyst often associate with?
menstrual irregularity and intraperitoneal hemorrhage- it can hemorrhage into a persistent, mature corpus luteum
95
What kind of cyst contains blood due to ovarian endometriosis?
chocolate ovarian cyst
96
What kind of cyst is often bilateral, multiple in each ovary, and is associated with a molar pregnancy?
theca-lutein cyst
97
In a molar pregnancy, which hormone stimulates the production of theca lutein cysts?
hCG
98
How do you treat a theca lutein cyst?
resolve completely upon resolution of underlying cause
99
Who commonly gets polycystic ovary (stein leventhal syndrome) and what are the symptoms?
Young women, most commonly at menarche. The symptoms are amenorrhea, obesity, hirsutism and infertility. (only 50% become obese)
100
What hormone is SOMETIMES elevated in polycystic ovarian disease?
androgens- testosterone, androstenedione, and DHEA-sulfate- some women with PCOS will have normal androgen levels though
101
What will happen from hirsutism in polycystic ovarian syndrome?
hair on the chin, linea alba, chin- it also may present with male pattern baldness
102
What other hormone is affected in POCS?
Insulin- 40% of women will have elevated levels of insulin
103
What will high insulin levels do to women with PCOS regarding their ovaries?
potentiates gonodatropic effect on ovaries (FH and LSH)
104
What hormone level is low in women with PCOS?
Adiponectin- which is involved in regulating glucose levels as well as fatty acid breakdown.
105
What skin pathology will present in women with PCOS?
acanthosis nigricans
106
How do the ovaries present in a woman with PCOS?
Large ovaries (bilaterally), smooth, thickened, avascular capsules. On cut surface, multiple follicles in different stages of maturation and atresia. There are lutenized theca cells surrounding generated follicles. Thickened and hyperplastic stroma theca cell layers.
107
How can women get pregnant when they have PCOS?
Cut capsule to allow for ovulation, many women achieve pregnancy after this is done.
108
What other pathologies can be mistaken for PCOS?
cushings, metabolic syndrome, prolactinoma
109
2/3 criteria must be present in someone with PCOS. What is the criteria?
1.) Oligo-ovulation or anovulation (oligomenorrhea or amenorrhea). 2.) Either hyperandrogenism (clinical features) or hyperandrogenemia (measured elevated androgens)
Best measured as free androgen index, as single androgens might be normal
3.) Polycystic ovary- ovary>10 cm3 volume. At least 12 cysts, measuring 2-9 mm each.
110
What kind of ovarian tumor counts for 75% of all ovarian tumors?
epithelial
111
What is a BENIGN SEROUS EPITHELIAL ovarian tumor you see in women?
serous cystadenoma-20% of all ovarian tumors
112
What is the histology of a serous cystadenoma?
cysts lined with fallopian tube epithelium-flat or columnar ciliated epithelium
113
What is a MALIGNANT SEROUS EPITHELIAL ovarian tumor seen in women?
serous cystadenocarcinoma-50% of all malignant tumors of the ovaries- frequently bilateral
114
How does a BENIGN MUCINOUS cystadenoma present?
multiocular cysts lined by columnar epithelium- they secrete mucous
115
Where does a malignant mucinous cystadenocarcinoma (20% of all malignant tumors of the ovaries) metastasize?
rupture spreads metastases throughout peritoneal cavity
116
What is a malignant tumor of germ cell origin that is homologous to seminoma?
dysgerminoma
117
What is the clinical name of a yolk sac tumor in females?
endodermal sinus tumor- homologous to yolk sac tumor of the testis
118
What protein does an endodermal sinus tumor produce?
alpha-fetoprotein
119
What is the kind of tumor with tissues that originate from 2 or more embryonic layers?
teratoma
120
What can a MATURE teratoma contain?
They are covered by skin, contain skin vestiges, teeth, neural cells, thyroid gland tissue- could contain cells with replication of maternal DNA- 46 XX of entire maternal origin
121
How aggressive is an IMMATURE teratoma?
Aggressive!
122
What kind of tissue does a monodermal teratoma have?
struma ovarii- ectopic thryroid tissue in the ovaries
123
What pathology could you see in someone with a struma ovarii?
hyperthyroidism- results FROM the tumor
124
What hormone does a ovarian choriocarcinoma secrete?
hCG
125
Which tumors are of sex cord origin?
fibroma-thecoma tumors, granulosa cell tumors, sertoli-leydig cell tumors
126
A solid fibroblast contains which type of tumor?
fibroma-thecoma type of tumor
127
When do granulosa cell tumors occur?
precocious puberty- puberty occurring at an unusually early age
128
How do granulosa cell tumors present in adults?
endometrial hyperplasia
129
What type of tumor presents with virilization?
sertoli-leydig cell tumor- virilization occurs from androgen secretion
130
What is a metastatic signet cell carcinoma of the stomach that spreads to the ovary?
krukenberg tumor presents in the ovaries- gastric adenocarcinoma spreads these to the ovaries
131
How does endometriosis occur?
bleeding (menses) can lead to inflammation in the pelvic cavity (which is why women who do not get pregnant have a higher rick of developing endometriosis)
132
In endometriosis, what kind of endometrial cyst bleeds inwards?
chocolate cyst
133
What is adenomyosis?
medical condition characterized by the presence of ectopic glandular tissue found in muscle. Previously named as endometriosis interna, adenomyosis actually differs from endometriosis and these two disease entities are found together in only 10% of the cases.
134
What are the symptoms of adenomyosis?
asymptomatic to severe symptoms- The Endometrial implants that grow into the wall of the uterus bleed during menstruation, (the same as endometrial tissue bleeds) is discharged vaginally as menstrual bleeding. The vaginal pressure can be severe enough to feel like the uterus is trying to push out through the vagina, like the last stage of labor when the baby's head pushes into the cervix.
135
How do trichomoniasis men present? (not sure if this is important, but she said it during lecture relating to women, nevertheless it's interesting)
They can have intra urethral discomfort and mild discharge- If untreated symptoms disappear this leaves men as an asymptomatic reservoir of infection
136
How do you differentiate between a corpus luteum cyst and theca lutein cyst? (they often get confused)
theca lutein cysts are bilateral, unlike corpus luteum
137
What hormone is usually low in women with PCOS?
Sex hormone binding globulin- although not a part of diagnostic test- it is usually low in PCOS women. It might be measured to support diagnosis.
138
When it comes to teratomas, are they usually malignant in men? What about women?
Men-malignant potential, Women-usually benign
139
How early can granulosa cell tumors present?
As early a pediatric age, but can resolve during precocious puberty
