female Pathology Flashcards
1
Q
infections that cause vulvitis
A
HPV, HSV, gonococcal, syphilis, candida
2
Q
candida vulvitis, risk factor
A
pregnant ladies, diabetes mellitus
3
Q
most common vulvitis infectious agent
A
HPV
4
Q
HSV vulvitis presentation
A
vesicular eruption could be perioral or paranasal
5
Q
valvulitis complications
A
Bartholin glands ducts obstruction
cyst and abscess
Unilateral & painful dilation of the glands
6
Q
Lichen Sclerosis:
A
Fibrotic disorder & Presents as leukoplakia
7
Q
Lichen Sclerosis etiology
A
20% family history of AIDS or lichen sclerosis
8
Q
Lichen Sclerosis association
A
40% vulvar carcinoma
1%-5% SCC
9
Q
Lichen Sclerosis presention
A
pruritus, introital stenosis
10
Q
Lichen Sclerosis pathology
A
loss of rete ridges, thin epithelium, ecchymosis
11
Q
Lichen Sclerosis therapy
A
tropical testosterone or progesterone
12
Q
Lichen Simplex Chronicus
A
Thickening of the epithelium, Presents also as leukoplakia.
13
Q
Lichen Simplex Chronicus clinical presentation
A
pruritus, Thick gray white skin
14
Q
Lichen Simplex Chronicus pathology
A
Acanthosis & hyperkeratosis
15
Q
Lichen Simplex Chronicus treatment
A
Topical corticosteroids
16
Q
Leukopenia etiology
A
Nneds, vitiligo, inflammatory dermansses, cis, pager disease, invasive carcinoma
17
Q
HPV related to which cancers
A
Vulvar, vagina, cervical, head, neck & laryngeal
18
Q
HPV pathoognomonic
A
Koilocyres
19
Q
HPV low-risk
A
6 & 11
20
Q
HPV low risk association
A
Dm, pregnancy & immunosuppression
21
Q
HPV high risk
A
16, 18, 31, 45
22
Q
HPV high risk proteins
A
E6 & E7
23
Q
Low risk HPV may involve
A
Perineum, vulva, vagina, cervix, gnus
24
Q
VIN1
A
limited to the lower 1/3 of the epithelium
25
VIN2
limited to the lower 2/3, Mitoses are often seen
26
VIN3
beyond the lower 2/3 (whole thickness: CIS)
27
Vulvar malignant tumors incidence
Very rare: less than 1% of all tumors & 3% of FGT tumors
28
Vulvar malignant tumors median age
older than 60
high grade VIN if younger
29
Vulvar malignant tumors cancers
95%: SCC, 2% melanoma (Pigments), AdenoCA, Basal CC
30
Vulvar malignant tumor’s symptoms
pruritis, infections, bleeding, masses
31
frequent SCC type
older women (77), no HPV, well differentiated
32
frequent SCC associations
NNED (lichen Sclerosis), cigarette smoking & DM
33
less frequent SCC
younger (55), poorly differentiated, HPV
34
less frequent SCC associations
HPV 16, CIN, VIN & cigarette smoking.
35
SCC survival
less than 2cm 90% 5 years
larger 20% 10 years
36
Extra-mammary Paget’s disease
Intraepidermal adeno CA in vulva
37
Extra-mammary Paget’s disease association
underlying adeno CA in 1/3 of cases
38
Extra-mammary Paget’s disease origin
multipotential epidermal cells.
39
Extra-mammary Paget’s disease manifestion
red scaly crusted plaque, may mimic appearance of inflammatory dermatitis.
40
Congenital vaginal anomalies
uncommon
Total absence of vagina (vaginal agenesis)
Septate or double vagina
41
Vaginitis
common, transit
42
atrophic Vaginitis
postmenopausal women
43
vaginitis infectious agents
Gonorrhoeal, candida albicans, trichomonas vaginalis, STD
44
Vaginal tumors
Adenocarcinoma, melanoma, sarcoma & SCC (95%)
45
Most common vaginal tumor
SCC
46
Highly malignant vaginal tumor
Sarcoma
47
Comments vaginal childhood umm
Sarcoma, (below 5 average 3)
48
Embryonal rhabdomyosarcoma is seen in
sarcoma
49
Embryonal rhabdomyosarcoma
mimics skeletal MC rhabdomyoblasts
50
cambium
condensation of malignant cells under mucosal surface
51
Sarcoma grossly
polypoid grape like mass protrude out of the vagina.
52
Exocervix epithelium
Non kertanized stratified squamous
53
Endocervix epithelium
Columnar
54
Cervicitis
Common condition with purulent vaginal discharge
55
Pop smear reduced mortality by
99 %
56
LSIL
Koiolocytosis
57
CIN 1
Mild dysplasia, (lower1/3 of epithelium): LSIL
58
CIN2
Moder dysplasia (lower2/3):HSIL
59
CIN3
more than 2/3 or totally involved, sever dysplasia or carcinoma, HSIL
60
can be detected in ____ of precancerous lesions & invasive malignancies.
85-90%
61
pathogensis of latent HPV
Integrates its DNA → Intranuclear replication or episomal
62
pathogensis of chromosomal HPV
E6 inhibits P53
E7 inhibirs RB
63
endocervix CA it is an ____ CA unlike the Exocervix Which is _____ ca.
adeno, sc
64
most effective method of cancer prevention
Detection of precursor lesions by cytological examination & their eradication
65
(?) of the population might be exposed to HPV
75%
66
(?) exposed to high risk HPV
50%
67
(?) exposed to HPV-induced CIN
10%
68
microinvasive Cervical Carcinoma
<3mm
69
invasive Cervical Carcinoma
exophytic (papillary), ulcerative (infiltrative),, nodular
70
cervical carcinoma SCC: ___ Adenoca: ___
80%, 10%
71
cervical carcinoma complications
Hydronephrosis (causes obstruction), pyelonephritis
Renal failure.
Lymphatic spread to regional pelvic nodes.
Vascular to lungs and liver
72
Endometritis
inflammation of the uterus endometrium
73
acute Endometritis etiology
N. gonorrhea or C. trachomatis after delivery or miscarriages.
74
acute Endometritis symptoms
Higher grade fever, intense abdominal pain, menstrual abnormalities, ectopic pregnancy, infertility
75
Chronic endometritis etiology
Chronic gonorrheal pelvic disease
Tuberculosis
Postpartal or postabortal endometrial cavities
IUCDs: considered foreign bodies producing infection Spontaneously in 15% of patients.
76
Chronic endometritis symptoms
Lower grade fever & vague abdominal or pelvic pain
77
Chronic endometritis pathognomonic
plasma cells
78
Adenomyosis
Growth of basal cell layer of endometrium down into the myometrium (No cyclical bleeding).
79
Adenomyosis symptoms
Menorrhagia (interfere with vascularity), dysmenorrhea, pelvic pain before onset of menstruation
80
Adenomyosis complications
Reactive hypertrophy of myometriumm leading to thickened uterine wall (detected by US image).
81
Endometriosis
Presence of endo. tissue (functional: respond to cyclical changes) in remote sites:
82
where does Endometriosis occur
Ovaries (More common), Ovarian cyst might appear
Douglas pouch, uterine ligaments
tubes, peritoneal cavity, umbilicus
Uncommonly in LN, lungs, heart, & bone
83
Endometriosis: clinical symptoms
Pain on defecation / Infertility / Dyspareunia & Dysuria (pain induced by cyclical changes), severe dysmenorrhea, pelvic pain (In almost all cases) & Abdominal discomfort.
84
The favored theory
regurgitation of menstrual blood flow to fallopian tubes and ovaries.
85
Benign mets theory
that endometrium spread to different sites via blood vessels of lymphatics
86
Metaplastic theory
endometrium differentiation of coelomic epithelium is the real source
87
Extrautarine, extrapelvic theory
circulating stem cells from BM, differentiate into endometrial tissue.
88
Endometriosis grossly
Red blue to yellow brown implants, discoloration.
Variability in size & Chocolate cyst, as the blood ages, it turns brown.
Fibrosis, leading to adherence of pelvic structures, sealing of tubal fimbiriated ends (Infertility)
89
The most common problem for which women seek medical attention
Dysfunctional uterine bleeding:
90
Menorrhagia
profuse or prolonged bleeding at time of period
91
Metrorrhagia
irregular bleeding between the periods.
92
abnormal uterine bleeding common causes
polyps, leiomyomas, endometrial carcinoma, endometrial hyperplasia, and endometritis.
93
abnormal bleeding in the absence of organic uterine lesion
DUB
94
DUB causes
Anovulatory cycles (failure to ovulate) → excess of estrogen.
Inadequate luteal phase → delayed or underdevelopment of secretory phase.
Endomyometrial disorders; chronic endometritis, endometrial polyps, submucosal fibroids.
OCP
95
DUB causes in Prepuberty
Precocious puberty (hypothalamic, pituitary, or ovarian origin)
96
DUB causes in Adolescence
Abnormality within hormones -- Anovulatory cycle
97
DUB causes in Postmenopause
Endometrial atrophy (hormone loss), but should role
out Organic lesions first (carcinoma, hyperplasia, polyps).
98
DUB causes in Reproductive age
Complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy)
Organic lesions (leiomyoma, adenomyosis, polyps, endometrial hyperplasia, carcinoma)
Anovulatory cycles and Ovulatory dysfunctional bleeding (inadequate luteal phase)
99
you must role out _____ first to consider DUB in Reproductive age group
pregnancy
100
DUB causes in Perimenopause
might have Anovulatory cycle, irregular shedding or organic (CA, HP, polyps).
101
Endometrial hyperplasia etiology
Excess unopposed estrogen
102
Excess unopposed estrogen seen in
Anovulatory cycles, Polycystic ovarian disease
Prolonged administration of estrogenic steroids.
Estrogen producing tumors (granulosa-theca cell
tumors, cortical stromal hyperplasia)
Obesity.
103
Endometrial hyperplasia classified according to what
presence of atypia
104
incident of Endometrial hyperplasia with atypia
20%-50%
105
The most frequent CA of FGT
Endometrial adenocarcinoma
106
Endometrial adenocarcinoma median age
55-65 (menopausal and postmenopausal women)
107
Endometrial adenocarcinoma predisposing factors
estrogen stimulation due
endometrial hyperplasia, obesity, Infertility (single & nulliparous), late menopause, diabetes, HTN.
108
Endometrial adenocarcinoma types
Endometroid, Serous, clear cell, adenosquamous
109
common Endometrial adenocarcinoma
Endometroid
110
Endometrial adenocarcinoma Estrogen related, Associated with hyperplasia
endometroid
111
endometroid younger or older women
younger perimenpause
112
Microsatellite instability & PTEN gene mutations
endometroid
113
Endometrial adenocarcinoma Unrelated to estrogen, not associated with hyperplasia
Serous, clear cell, adenosquamous
114
Serous, clear cell, adenosquamous younger or older women
older
115
Endometrial adenocarcinoma mutation TP53
seros
116
Endometrial adenocarcinoma most aggressive type
adenosquamos
117
syndromes have increased risk to develop endometrium CANCERS
Cowden’s syndrome, HNPCC
118
HNPCC
Inherited genetic defect in DNA mismatch repair gene
119
Clinical course of endometrial adenocarcinoma
Irregular bleeding & marked leukorrhea (vaginal secretion) , Enlarged uterus & palpable, fixation to surroundings.
120
endometrial adenocarcinoma survival rate
stage 1 carcinoma has 90% 5 YSR
Stage 3 & 4 have less than 20% 5 YSR.
121
Most common benign tumor arising from uterine smooth muscle in females
Leiomyoma
122
Found in 30%-50% of women of reproductive age
leiomyoma
123
Leiomyoma common in which race
black
124
Leiomyoma grossly
Well circumscribed, round, often multiple, firm to hard, gray-white.
125
Monoclonal T with nonrandom chromosomal abnormalities in 40% of tumors
leiomyoma
126
leiomyoma symptoms
asymptomatic, menorrhagia &infertility
127
Leiomyoma shape
Sharply demarcated, Whorled cut surfaces (wrinkled), Single or multiple, Variably sized.
128
Leiomyosarcoma etilogy
denovo
129
Smooth muscle tumors of uncertain malignant potential
Leiomyosarcoma
130
Leiomyosarcoma features
tumor necrosis, cytologic atypia, mitotic activity.
131
Leiomyosarcoma survival rate
40% 5 years
132
most common disease; component of PID.
Salpingitis
133
Salpingitis symptoms
Fever, lower abdominal pain, or pelvic pain.
Pelvic mass, adherence leading to tubo-ovarian abscess.
134
Salpingitis complications
Increase risk of tubal pregnancy (Permanent sterility) – Dysfunctional cilia.
135
Acute Salpingitis etiology
MO: NG, C.trachomatis, Mycoplasma hominis, U.urealyticum
Sources of infections: VTD from the LGT.
Puerperal or post abortive, especially after IU instrumentation.
Intra-abdominal infections following peritonitis.
Hematogenous as in TB.
136
Primary adenocarcinoma origin
Papillary serous (derived from epithelium), or endometrioid (Mimic Endometrial Gland)
137
Primary adenocarcinoma common site
fimbria
138
Primary adenocarcinoma mutation
BRCA
139
Primary adenocarcinoma presention
advanced stage, with involvement of the peritoneal cavity.
140
Ovarian cysts origin
unruptured graffian follicles
141
Ovarian cysts placement
immediately subjacent to serosal covering
142
Ovarian cyst’s symptoms
Small, clear serous fluid, Pelvic pain, acute abdominal symptoms
143
Polycystic ovaries etiology
Oligomenorrhea, hirsutism, infertility, obesity.
144
Polycystic ovaries presention
Excessive estrogens & andorgens & some insulin resistant (Ovary twice the normal size).
Thickened fibrotic outer tunica, numerous cysts lined by granulosa
cells with hypertrophic and hyperplastic lutenized theca interna.
145
Absence of corpora lutea.
Polycystic ovaries
146
5th common CA in US & 5th leading cause of CA death in women.
Ovarian Tumors
147
Familial cases of ovarian tumors
Breast ovary syndrome related to BRCA 1
Ovary, endometrium and colon (Lynch II): DNA mismatch repair gene mutation
148
overian tumor rf
↑ risk: Nulliparity (1.5-3.2 folds), Drugs (induce ovulation but have not become pregnant)
OCP ↓ risk by 1/2
149
Surface epithelial stromal tumors origin
multipotential coelomic covering epithelium
150
Surface epithelial stromal tumors malignant or benign
90% malignant
151
recapitulate the components of the Mullerian ducts.
Surface epithelial stromal tumors
152
Serous Tumors median age
30-40
153
Serous Tumors incident
60% benign (25% are bilateral), 15% malignant, 25% LMP.
LMP & M serous account for 60% of all ovarian CAs.
154
most common malignant & bilateral tumour of the ovary
Serous cystadenocarcinoma
155
Psammoma bodies
Serous Tumors
156
Serous Tumors growth pattern
papillary
157
Serous Tumors size
large, 30-40cm
158
Serous Tumors borderline
Delicate papillary projections, Milder atypia, No or little stromal invasion.
159
Serous Tumors carcinoma
Large bulky tumor mass, Anaplasia & stromal invasion.
160
Mucinous Tumors median age
30-40
161
Mucinous Tumors incident
80% benign (5% bilateral), 10% malignant (20% bilateral), 10% LMP.
162
pseudomyxoma peritonei
Mucinous Tumors met to git
163
Mucinous Tumors met or rupture
pseudomyxoma peritonei
164
Krukenberg
mets of mucinous T of GIT
165
Krukenberg presention
bilateral, glands infiltrating ovarian stroma, dirty necrosis.
166
Teratomas incidence of ovarian tumors
15%-20%
167
Teratomas age group
first two decades
168
Teratomas incidence
>90% benign
90% unilateral
169
Commonest germ cell tumor in women
Mature cystic teratoma
170
Mature cystic teratoma differentiation
somatic
171
dermoid cysts found in
Mature cystic teratoma
172
placental infections predisposing conditions
Premature rupture of membranes (>18 hours),
173
placental infections mo
Mycoplasma, candida, vaginal flora
174
placental infection’s complications
congenital pneumonia, gastroenteritis, otitis media, meningitis.
175
placental infection’s pathogensis
ascending and hematogenous
176
Acute villitis etiology
maternal sepsis, Syphilis, TB, listeriosis, toxoplasmosis., viruses.
177
where does Ectopic pregnancy occure
ovaries (90%) , abdominal cavity, IU portion of the oviduct (interstitial pregnancy).
178
Ectopic pregnancy etiology
chronic inflammatory changes, IU tumors, or endometriosis.
50%; no anatomic cause identified.
179
Ectopic pregnancy complications
Hematosalpinx; intratubal hematoma.
Intense abdominal pain, can lead to shock.
180
trophoblastic diseases etiology
Empty (NO M.dna) ovum fertilized by either 2 sperms or one diploid sperm.
181
trophoblastic diseases histology
Large avascular villi with central edema & circumferential trophoblasts proliferation.
182
mass of grape like vesicles.
trophoblastic diseases
183
Choriocarcinoma age group
<20 & 40<
184
Choriocarcinoma etiology
50% follow complete mole, 25% follow abortions.
24% follow normal pregnancy, 1% follow ectopic pregnanc
185
Choriocarcinoma clinical
Very high titers of bhCG, Vaginal bleeding and discharge.
Hemorrhagic tumor with anaplasic sycytio and cytotrophoblasts, NO chorionic villi seen.
186
Choriocarcinoma met
lungs (50%), vagina (30-40%), brain, liver, kidneys.
