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Pathophysiology > Female Pathologies > Flashcards

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.

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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.

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3
Q

Bartholin cyst happens most commonly in who?

A

women of reproductive age (2% are affected)

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4
Q

How do these bartholin cysts become obstructed so a cyst forms?

A

trauma or non-specific inflammation

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5
Q

How big is a bartholin cyst?

A

1-3 cm

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6
Q

What are the symptoms of a bartholin cyst?

A

most often- they are asymptomatic, but they may be associated with dyspareunia

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7
Q

What is dyspareunia?

A

painful sexual intercourse

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8
Q

What is the secondary infection of a bartholin cyst?

A

bartholin abscess-bigger than 3 cm

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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

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10
Q

In post-menopausal women, progressive enlargement of a bartholin cyst could mean what?

A

adenocarcinoma

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11
Q

Group of female disorders involving epithelial growth

A

vulvar dystrophies

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12
Q

The BENIGN type of lichen sclerosis is what kind of disease?

A

vulvar dystrophy- chronic inflammatory process

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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

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14
Q

What are the symptoms and signs of MALIGNANT lichen sclerosis?

A

atypical hyperplastic dystrophy- pruritis, leukoplakia

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15
Q

How do discover malignancy in lichen sclerosis?

A

biopsy

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16
Q

What is the most common tumor of the vulva?

A

papillary hydradenoma

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17
Q

Is papillary hydradenoma benign or malignant?

A

benign

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18
Q

Where does a papillary hydradenoma originate from?

A

apocrine sweat gland

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19
Q

What are the symptoms of a papillary hydradenoma?

A

painless labial nodule, may ulcerate and bleed

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20
Q

How do you treat a papillary hydradenoma?

A

surgical excision is curative

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21
Q

Is condyloma acuminatum benign or malignant?

A

benign- it is a common genital wart

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22
Q

Which types of HPV is condyloma acuminatum usually associated with?

A

HPV 6 and 11- belongs to STDs

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23
Q

What are the large epithelial cells with peripheral clearing called in condyloma acuminatum?

A

koilocytes

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24
Q

What is the most common malignancy of the vulva?

A

squamous cell carcinoma

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25
Q

What commonly precedes squamous cell carcinoma?

A

premalignant changes graded as VIN 1 through 3

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26
Q

What sometimes precedes squamous cell carcinoma?

A

vulvar dystrophy

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27
Q

What types of HPV is squamous cell carcinoma associated with?

A

HPV 16, 18, 31, 33

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28
Q

What does paget’s disease of the vulva look like?

A

persistent scaly appearance of the skin

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29
Q

What is paget’s disease of the vulva sometimes associated with?

A

adenocarcinoma of the sweat gland

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30
Q

Malignant melanoma accounts for ______% of malignant lesions of the vulva

A

10%

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31
Q

What drug is linked to clear cell adenocarcinoma?

A

diethylstibestrol therapy

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32
Q

What group of people had high prevalence of clear cell carcinoma in the 1960’s?

A

In daughters of mothers who had
diethylstibestrol therapy during
pregnancy. This drug was used to prevent miscarriages.

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33
Q

What is the histology of clear cell carcinoma?

A

Columnar cell lined tubular glands
where normally stratified squamous
epithelium should be

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34
Q

What type of cancer is sarcoma botryoides?

A

a type of rhabdomyosarcoma

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35
Q

What is rhabdomyosarcoma?

A

A type of connective tissue cancer (sarcoma) in which the cancer cells are thought to arise from skeletal muscle progenitors.

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36
Q

What does sarcoma botryoides look like?

A

“bunch of grapes” protruding from introitus

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37
Q

In who does a sarcoma botryoide seen in?

A

pediatrics- it is a pediatric tumor

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38
Q

What is an introitus?

A

entrance or opening to a hollow organ or tube (especially the vaginal opening); “the introitus of the vagina”

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39
Q

What is the histological pathology of erosion of the uterine cervix?

A

columnar epithelium metaplasia

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40
Q

How does erosion of the uterine cervix present?

A

erythematous area- could be a manifestation of chronic cervicitis

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41
Q

What does a KOH test for?

A

used to detect fungus

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42
Q

What are the different kinds of cervicitis?

A

They are all most likely infectious- gardnerella vaginalis (bacterial vaginosis), trichomona vaginalis, candida albicans,chlamidya trachomatis,

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43
Q

What is most likely involved in cervicitis?

A

most likely involved is endocervix

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44
Q

What are the symptoms of cervicitis?

A

often asymptomatic, but could present with cervical discharge

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45
Q

Where does cervical dysplasia carcinoma likely present?

A

most likely occurs on squamo-columnar junction at transformational zone

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46
Q

What types of HPV are associated with cervical dysplasia carcinoma?

A

HPV 16, 18, 31, 33

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47
Q

What does cervical dysplasia carcinoma look like?

A

disordered growth, mitotic figures, loss of polarity, nuclear hyperchromasia

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48
Q

What is nuclear hyperchromasia?

A

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.

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49
Q

What is dysplasia (abnormal development) progressing into carcinoma in situ called?

A

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.

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50
Q

What type of cancer is invasive carcinoma of the cervix most commonly?

A

squamous cell carcinoma- it could be adenocarcinoma

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51
Q

Who gets invasive carcinoma most commonly?

A

middle aged women

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52
Q

What are the risk factors for invasive carcinoma of the cervix?

A

smoking, early onset of sex life, multiple sex partners

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53
Q

When does endometritis happen?

A

dilation and curette complications- retention of placenta

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54
Q

What two bacteria cause endometritis?

A

staph and strep are most common agents

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55
Q

What is endometriosis happen?

A

presence of ectopic endometrium in the ovaries, palvic cavity, vagina, non-neoplastic

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56
Q

Does endometriosis increase risks of endometrial cancer?

A

no

57
Q

What is endometriosus closely related to?

A

Closely related to Adenomyosis = “endometriosis of the uterine muscular wall”

58
Q

What are the three theories on why endometriosis occurs?

A

retrograde seeding through fallopian tube, metaplasia of any mullerian-duct derived tissue, lymphatic spread

59
Q

What are common symptoms of endometriosis of the ovary?

A

chocolate cyst, infertility, menstrual related pain

60
Q

Why does endometrial hyperplasia occur?

A

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
Q

What is a symptom of endometrial hyperplasia?

A

post-menopausal bleeding

62
Q

Does endometrial hyperplasia increase the risk of cancer?

A

Yes, increases risk of endometrial carcinoma- the higher the degree of cellular atypia, the higher the risk of cancer

63
Q

Are endometrial polyps benign?

A

yes, but may cause profuse bleeding

64
Q

In who do endometrial polyps most commonly occur in?

A

women over 40

65
Q

What are the characteristics of an endometrial polyp?

A

Sessile (relatively flat, mushroom-like), some arise in context of hyperplasia

66
Q

What are the two main types of endometrial polyps?

A

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
Q

What is the most common malignancy of the female reproductive organs?

A

endometrial cancer

68
Q

What are the risk factors for endometrial cancer? Who is risk lower with?

A

Obesity, diabetes, hypertension- risk is lower with child bearing women

69
Q

If a post-menopausal woman is bleeding, what should you suspect?

A

endometrial cancer

70
Q

What is inflammation of the fallopian tubes called?

A

salpingitis

71
Q

What diseases does salpingitis happen in?

A

in the context of pelvic inflammatory disorder (PID) and N. gonorrhea (most commonly gonorrhea)

72
Q

What are the symptoms of salpingitis?

A

pain, malaise, and systemic symptoms

73
Q

What could salpingitis result in?

A

pyosalpinx (pus in the tube), hydrosalpinx (watery fluid in the tube), tubo-ovarian abscess

74
Q

Hematosalpinx (blood filled tube) occurs most commonly because of?

A

ectopic pregnancy

75
Q

What is the most common form of vaginitis?

A

candidiasis-infectious disease- caused by overgrowth of candida albicans

76
Q

What pathologies increase the chance of getting candidiasis?

A

diabetes, pregnancy, broad spectrum antibiotic therapy, OCP, immunosuppression

77
Q

What does candidiasis look like?

A

white patches on mucosa, thick white discharge, pruritis in perineal and vulvovaginal area

78
Q

What does trichomoniasis look like and what are the symptoms?

A

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
Q

What does the infectious disease, Gardnerella vaginitis (bacterial vaginosis) look like and present as?

A

Thin, white or clear discharge with “fishy” odor.

80
Q

What does gardnerella vaginitis look like on a wet mount?

A

“clue cells” on a wet mount- bacterial studded epithelial cells with indistinct borders- less than expected WBCs

81
Q

Can gardnerella vaginitis be sexually transmitted?

A

yes

82
Q

What is one of the common causes of PID?

A

Gonorrhea

83
Q

What are the symptoms of gonorrhea?

A

May be asymptomatic, it can present as acute purulent inflammation of the vagina, urethra, bartholine and skene glands

84
Q

What are skene’s glands?

A

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
Q

What are clue cells?

A

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
Q

What kind of cyst is the most common ovarian cyst?

A

follicular cyst

87
Q

What does a follicular cyst look like?

A

4-6 cm in size, thin-walled, contains clear fluid, endometrial hyperplasia

88
Q

What hormone is often elevated when a follicular cyst is present?

A

estrogen

89
Q

What are the symptoms of a follicular cyst if it ovulates/ruptures?

A

sharp pain, mittelschmerz

90
Q

What the fuck is mittelschmerz?

A

medical term for ovulation pain

91
Q

What does clomid (the fertility drug) increase the risk of?

A

corpus luteum cyst and ovarian torsion

92
Q

How big can a corpus luteum cyst grow to be?

A

10 cm- these are heavy and can cause ovarian torsion

93
Q

In who do you see corpus luteum cysts?

A

pre-menopausal women

94
Q

What is a corpus luteum cyst often associate with?

A

menstrual irregularity and intraperitoneal hemorrhage- it can hemorrhage into a persistent, mature corpus luteum

95
Q

What kind of cyst contains blood due to ovarian endometriosis?

A

chocolate ovarian cyst

96
Q

What kind of cyst is often bilateral, multiple in each ovary, and is associated with a molar pregnancy?

A

theca-lutein cyst

97
Q

In a molar pregnancy, which hormone stimulates the production of theca lutein cysts?

A

hCG

98
Q

How do you treat a theca lutein cyst?

A

resolve completely upon resolution of underlying cause

99
Q

Who commonly gets polycystic ovary (stein leventhal syndrome) and what are the symptoms?

A

Young women, most commonly at menarche. The symptoms are amenorrhea, obesity, hirsutism and infertility. (only 50% become obese)

100
Q

What hormone is SOMETIMES elevated in polycystic ovarian disease?

A

androgens- testosterone, androstenedione, and DHEA-sulfate- some women with PCOS will have normal androgen levels though

101
Q

What will happen from hirsutism in polycystic ovarian syndrome?

A

hair on the chin, linea alba, chin- it also may present with male pattern baldness

102
Q

What other hormone is affected in POCS?

A

Insulin- 40% of women will have elevated levels of insulin

103
Q

What will high insulin levels do to women with PCOS regarding their ovaries?

A

potentiates gonodatropic effect on ovaries (FH and LSH)

104
Q

What hormone level is low in women with PCOS?

A

Adiponectin- which is involved in regulating glucose levels as well as fatty acid breakdown.

105
Q

What skin pathology will present in women with PCOS?

A

acanthosis nigricans

106
Q

How do the ovaries present in a woman with PCOS?

A

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
Q

How can women get pregnant when they have PCOS?

A

Cut capsule to allow for ovulation, many women achieve pregnancy after this is done.

108
Q

What other pathologies can be mistaken for PCOS?

A

cushings, metabolic syndrome, prolactinoma

109
Q

2/3 criteria must be present in someone with PCOS. What is the criteria?

A

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
Q

What kind of ovarian tumor counts for 75% of all ovarian tumors?

A

epithelial

111
Q

What is a BENIGN SEROUS EPITHELIAL ovarian tumor you see in women?

A

serous cystadenoma-20% of all ovarian tumors

112
Q

What is the histology of a serous cystadenoma?

A

cysts lined with fallopian tube epithelium-flat or columnar ciliated epithelium

113
Q

What is a MALIGNANT SEROUS EPITHELIAL ovarian tumor seen in women?

A

serous cystadenocarcinoma-50% of all malignant tumors of the ovaries- frequently bilateral

114
Q

How does a BENIGN MUCINOUS cystadenoma present?

A

multiocular cysts lined by columnar epithelium- they secrete mucous

115
Q

Where does a malignant mucinous cystadenocarcinoma (20% of all malignant tumors of the ovaries) metastasize?

A

rupture spreads metastases throughout peritoneal cavity

116
Q

What is a malignant tumor of germ cell origin that is homologous to seminoma?

A

dysgerminoma

117
Q

What is the clinical name of a yolk sac tumor in females?

A

endodermal sinus tumor- homologous to yolk sac tumor of the testis

118
Q

What protein does an endodermal sinus tumor produce?

A

alpha-fetoprotein

119
Q

What is the kind of tumor with tissues that originate from 2 or more embryonic layers?

A

teratoma

120
Q

What can a MATURE teratoma contain?

A

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
Q

How aggressive is an IMMATURE teratoma?

A

Aggressive!

122
Q

What kind of tissue does a monodermal teratoma have?

A

struma ovarii- ectopic thryroid tissue in the ovaries

123
Q

What pathology could you see in someone with a struma ovarii?

A

hyperthyroidism- results FROM the tumor

124
Q

What hormone does a ovarian choriocarcinoma secrete?

A

hCG

125
Q

Which tumors are of sex cord origin?

A

fibroma-thecoma tumors, granulosa cell tumors, sertoli-leydig cell tumors

126
Q

A solid fibroblast contains which type of tumor?

A

fibroma-thecoma type of tumor

127
Q

When do granulosa cell tumors occur?

A

precocious puberty- puberty occurring at an unusually early age

128
Q

How do granulosa cell tumors present in adults?

A

endometrial hyperplasia

129
Q

What type of tumor presents with virilization?

A

sertoli-leydig cell tumor- virilization occurs from androgen secretion

130
Q

What is a metastatic signet cell carcinoma of the stomach that spreads to the ovary?

A

krukenberg tumor presents in the ovaries- gastric adenocarcinoma spreads these to the ovaries

131
Q

How does endometriosis occur?

A

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
Q

In endometriosis, what kind of endometrial cyst bleeds inwards?

A

chocolate cyst

133
Q

What is adenomyosis?

A

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
Q

What are the symptoms of adenomyosis?

A

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
Q

How do trichomoniasis men present? (not sure if this is important, but she said it during lecture relating to women, nevertheless it’s interesting)

A

They can have intra urethral discomfort and mild discharge- If untreated symptoms disappear this leaves men as an asymptomatic reservoir of infection

136
Q

How do you differentiate between a corpus luteum cyst and theca lutein cyst? (they often get confused)

A

theca lutein cysts are bilateral, unlike corpus luteum

137
Q

What hormone is usually low in women with PCOS?

A

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
Q

When it comes to teratomas, are they usually malignant in men? What about women?

A

Men-malignant potential, Women-usually benign

139
Q

How early can granulosa cell tumors present?

A

As early a pediatric age, but can resolve during precocious puberty

Pathophysiology (7 decks)

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