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Endo/Repro > Female Pathology > Flashcards

Female Pathology Flashcards

1
Q

Infections of lower gyn tract

A

don’t miss chlamydia or gonococcus (intracellular gram (-) diplococci) -> can cause PID
- can be treated well, are commonest STDs in USA
Systemic -> HIV, syphilis, hepatits
Fetus/Newborns -> HSV, chlamydia, gonorrhea, syphilis, HIV, hep B/C

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2
Q

Obstetrical infections

A

staph, strep, gram (-), clostridia

  • retained placenta = BAD
  • colonization with sepsis risk to fetus = group B strep
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3
Q

Pelvic Inflammatory Disease

A

acute/frequent chronic infection of upper genital tract
- spectrum from mild to infertile
Exam = lower ab pain, discharge, dyrpareunia, tenderness with cervical motion
MANY cases are subclinical
- sexually active women with lower ab pain –> empiric Rx

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4
Q

Bacterial Vaginosis

A

commonest cause of vaginal discharge –> disturbed vaginal flora
- gardnerella vaginalis –> malodorous gray-white discharge –> clue cells (elevated pH)

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5
Q

Trichomoniasis

A

flagellated protozoa –> commonest curable STD

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6
Q

Candida

A

not STD –> usually a commensal, results from overgrowth after disturbed by Rx

  • hyphae/yeast on wet mount
  • cottage-cheese or curdled milk
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7
Q

Genital Herpes

A

HSV 2 - below the waist

  • subclinical usually
  • painful genital ulcers -> not curable
  • can reactivate from DRG
  • Tzanck smear –> multinucleated giant cells
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8
Q

Solitary genital ulcer/wart in sexually active young person

A

syphilis until proven otherwise

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9
Q

HPV

A

non-genital skin warts, genital warts, anogenital cancer

- lots of people infected and some don’t know it (100s of serotypes)

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10
Q

Condyloma

A

warty neoplasm of vulvar skin –> HPV 6, 11 (low risk)
Hallmark Cells –> koilocytes
- rarely progress to carcinoma

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11
Q

Pre-invasive HPV terminology

A 
ALL ARE SQUAMOUS TYPE
CIN - cervical intraepithelial neoplasia
VIN - vulvar intraepithelial neoplasia
VAIN - vaginal intraepithelial neoplasia
AIN - anal intraepithelial neoplasia
PAIN - perianal intraepithelial neoplasia
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12
Q

Low grade HPV vs High grade HPV

A

low grade is 6, 11 –> 90% regress
high grade is 16, 18 –> won’t regress
vaccine –> 6, 11, 16, 18 –> very promising

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13
Q

Lichen sclerosis

A

thinning of epidermis and fibrosis of dermis

  • presents as leukoplakia with parchment-like vulvar skin
  • post-menopausal women
  • increased risk of squamous cell cancer
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14
Q

Lichen Simplex Chronicus

A

hyperplasia of vulvar squamous epithelium

  • presents as leukoplakia with thick leathery skin
  • chronic irritation and scratching
  • no increased risk of squamous cancer
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15
Q

Bartholin Cyst

A

cystic dilation of Bartholin gland -> due to inflammation and obstruction of gland
- unilateral, painful cystic lesion at lower vestibule adjacent to vaginal canal

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16
Q

Vulvar Carcinoma

A

arises from squamous epithelium lining the vulva
- presents as leukoplakia
HPV caused –> arises as VIN -> dysplastic precursor lesion characterized by koilocytic change
Non-HPV caused -> arises from long-standing lichen sclerosis (older women)

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17
Q

Vulvar non-squamous carcinoma

A

Melanoma - post-menopausal women, pigmented, fatal
- PAS (-), keratin (-), S100 (+)
Basal Cell - post-menopausal women, “rodent” ulceration, non-metastasizing

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18
Q

Extramammary Paget Disease

A

malignant epithelial cells in epidermis of vulva
- erythematous, pruritic, ulcerated vulvar skin
PAS (+), keratin (+), S100 (-)

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19
Q

Vaginal Carcinoma

A

carcinoma arising from squamous epithelium lining vaginal mucosa –> commonly due to HPV 16, 18, 31, 33
- precursor is VAIN
lower 1/3 of vagina –> inguinal nodes
upper 2/3 of vagina –> regional iliac nodes (para-aortic)

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20
Q

Embryonal Rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle

  • bleeding and grape-like mass protruding from vagina
  • rhabdomyoblasts –> characteristic cells
  • cytoplasmic cross-striations and (+) stain for desmin and myogenin
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21
Q

Adenosis

A

focal persistance of columnar epithelium in upper vagina

  • during development, lower 1/3 of vagina is from urogential sinus, but upper 2/3 is from mullerian ducts (columnar)
  • increased incidence in women exposed to diethylstilbestrol
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22
Q

Cervical Carcinoma

A

invasive carcinoma –> ALMOST ALL HPV RELATED

  • presents as postcoital bleeding, cervical discharge
  • squamous cell carcinoma (85%) or adenocarcinoma (15%)
  • advanced tumors can cause hydronephrosis with postrenal failure
  • increased risk with smoking and immunodeficiency
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23
Q

Cervical Intraepithelial Neoplasia

A 
KOILOCYTIC CHANGE --> stepwise fashion through stages (higher risk HPV more likely to progress)
CIN 1 - < 1/3 of thickness
CIN 2 - < 2/3 of thickness
CIN 3 - almost entire thickness
CIS - entire thickness
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24
Q

Pap Smears

A

goal = catch dysplasia before it develops into carcinoma
- progression take 10-20 years (start at 21 y.o. every 3 years)
- GOLD STANDARD -> cells scraped from SCJ and analyzed under microscope
High grade dysplasia = hyperchromatic nuclei and high nuclear to cytoplasm ratio
- abnormal pap smear followed by colposcopy
- pap smear doesn’t pick up adenocarcinoma

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25
Q

Asherman Syndrome

A

secondary amenorrhea due to loss of basalis and scarring

- due to overaggressive D&C

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26
Q

Anovulatory Cycle

A

Lack of ovulation –> estrogen-driven proliferative phase without subsequent progesterone driven secretory phase
- can lead to hyperplasia of endometrium

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27
Q

Endometrial Polyps

A

hyperplastic protrusion of endometrium -> presents as abnormal bleeding
- can be due to tamoxifen (agonistic effect on uterus)

28
Q

Endometrial Hyperplasia

A

hyperplasia of endometrial glands relative to stroma
- unopposed estrogen (obesity, PCOS, replacement)
- classified histologically based on architectural growth and if there is cellular atypia
Cellular Atypia - most important predictor for progression to carcinoma

29
Q

Endometrial Carcinoma

A

commonest form of GYN carcinoma

  1. Hyperplasia pathway (60s) - from endometrial hyperplasia -> unopposed estrogen therapy
    - endometrioid histology
  2. Sporadic pathway (older women) - from atrophic endometrium
    - serous histology (papillary structures with psammoma bodies) – p53 mutation is common
30
Q

Endometriosis

A

endometrial glands and stroma outside uterine endometrial lining –> retrograde menstruation –> cycles just like normal endometrium!!!

  • presents as dysmenorrhea and pelvic pain
  • most common site = ovary (chocolate cyst)
  • increased risk of carcinoma at site of endometriosis
31
Q

Adenomyosis

A

endometriosis involving uterine myometrium

32
Q

Leiomyomas (fibroids)

A

benign neoplastic proliferation of smooth muscle arising from myometrium –> related to estrogen exposure

  • PREmenopausal women, multiple, enlarge during pregnancy
  • multiple, well-defined, white, whorled masses
  • asymptomatic –> can cause abnormal uterine bleeding, infertility, pelvic mass
33
Q

Lieomyosarcoma

A

malignant proliferation of smooth muscle arising from myometrium –> arises de novo
- no risk of leiomyoma causing leiomyosarcoma
- POSTmenopausal women, single lesion with necrosis and hemorrhage
histologically - necrosis, mitotic activity, cellular atypia

34
Q

Fallopian tube pathology

A

generally non-neoplastic –> more PID

  • salpingitis –> PID bugs
  • endometriosis
  • tubal infertility and ectopic pregnancies
35
Q

Tubal Neoplasia

A

adenomatoid tumor –> benign mesothelioma

tubal carcinoma - historically rare, BRCA 1 or 2 mutations

36
Q

Polycystic Ovarian Syndrome

A

multiple ovarian follicular cysts due to hormonal imbalance

  • increased LH -> excess androgen production resulting in hirtuism
  • androgens converted to estrone in adipose tissue
  • estrone feedback decreases FSH –> cystic degeneration of follicles
  • increased risk of endometrial carcinoma
  • highly associated with obesity and diabetes
37
Q

Surface Epithelial Tumors

A

most common type of ovarian tumor - derived from coelomic epithelium that lines ovary
2 subtypes - can be benign or malignant or borderline
1. Serous - watery fluid
- BRCA-1 mutation carry higher risk -> may elect to have prophylactic oophorectomy and mastectomy
2. Mucinous - mucus like fluid (HUGE!)

38
Q

Benign surface epithelial tumors

A

cystadenomas -> composed of single cyst with simple, flat lining (premenopausal women)

39
Q

Malignant surface epithelial tumors

A

cystadenocarcinoma -> complex cysts with thick, shaggy lining (postmenopausal women)

40
Q

Borderline surface epithelial tumors

A

features of both benign and malignant

- better prognosis than malignant but carry metastatic potential

41
Q

Clinical Diagnosis of Ovarian Neoplasm

A
  1. Incidental adnexal mass
  2. Chronic pelvic/ab compression
  3. Acute/subacute presentations
  4. Signs of chronic sex steroids
  5. Atypical glandular cells
42
Q

Ovarian Germ Cell Tumors

A

usually occur in women of reproductive age
Fetal tissue - cystic teratoma and embryonal carcinoma
Oocytes - dysgerminoma
Yolk Sac - endodermal sinus tumor
Placental Tissue - choriocarcinoma

43
Q

Cystic teratoma

A

cystic tumor composed of fetal tissue dervied from 2 or 3 embryologic layers (skin, hair, bone)

  • most common germ cell tumor in females (99% benign)
  • struma ovarii - teratoma composed of thyroid tissue
44
Q

Dysgerminoma

A

tumor composed of large cells with clear cytoplasm and central nuclei (oocytes)
- same as seminoma in males
- responds to radiotherapy - good prognosis
LDH may be elevated

45
Q

Endodermanl Sinus Tumor

A

malignant tumor that mimics yolk sac -> most common in children
- serum AFP elevated, Schiller-Duval bodies

46
Q

Choriocarcinoma

A

malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts –> mimics placental tissue

  • small, hemorrhagic tumor with early hematogeneous spread
  • high beta-hCG
  • poorly responsive to chemo –> worst prognosis
47
Q

Embronal Carcinoma

A

malignant tumor composed of large primitive cells

- aggressive with early metastasis

48
Q

Sex-cord Stromal Tumors

A

resemble sex-cord-stromal tissue
Granulosa-Theca cells - produces estrogen (malignant but low metastasis)
- precocious puberty, menorrhagia, or postmenopausal bleeding
Sertoli-Leydig cell - composed of sertoli cells that form tubules and leydig cells with Reinke crystals
Fibroma - benign tumor of fibroblasts (pleural effusions and ascites)

49
Q

Kruckenberg tumor

A

metastatic mucinous tumor that involves both ovaries

  • most commonly with metastatic gastric carcinoma
  • bilaterally = distinguish from metastases of primary mucinous carcinoma of ovary (unilateral)
50
Q

Pseudomyxoma peritonei

A

massive amounts of mucus in peritoneum

- due to mucinous tumor of appendix –> usually with metastasis to ovary

51
Q

Spontaneous Abortion

A

miscarriage of fetus before 20 weeks gestation

  • presents as ab pain, vaginal bleeding, passage of fetal tissues
  • chromosomal abnormalities, uterine abnormalities, previous PID
  • retained dead fetus = high risk for DIC (rich in thromboplastin)
52
Q

Ectopic Pregnancy

A

implantation of fertilized ovum at site other than uterine wall (most common in tubes)
- key risk factor = previous PID
presents with = lower quandrant pain - after missed period (6-8 weeks)
- diagnose with hCG (less than 50% increase) and transvaginal ultrasound
-surgical emergency

53
Q

Preeclampsia

A

pregnancy induce HTN, proteinuria, edema (3rd trimester)
- HTN can be severe and lead to symptoms (fibrinoid necrosis of placental vessels)
- abnormal maternal-fetal vascular interface (maternal endothelium malfunction)
- primary risk factor = 1st pregnancy
HELLP syndrome
- hemolysis, elevated liver enzymes, low platelets

54
Q

Eclampsia

A

preeclampsia with new onset seizures

- CNS hemorrhage, acute renal failure, pulmonary edema, DIC, hepatic failure, death

55
Q

Placenta previa

A

implantation of placenta in lower quandrant of uterus -> overlies the cervical os (marignal, partial, complete)

  • often requires c-section
  • associated with placenta accreta
56
Q

Placental abruption

A

separation of placenta from decidua prior to delivery of fetus

  • 1% maternal mortality….12% fetal mortality
  • vaginal bleeding, contractions, and fetal insufficiency
57
Q

Placental accreta

A

improper implantation of placenta into myometrium
- difficulty delivering the placenta -> postpartum bleeding
- often require hysterectomy
RISK FACTOR - placenta previa w/ prior c-section

58
Q

Postpartum hemorrhage

A

most commonly due to uterine atony

  • retained placenta
  • defined as causing hypovolemic symptoms
  • can be delayed
59
Q

Acute DIC in pregnancy

A

avalanche of systemic coagulation factors
TRIGGERS:
- preeclampsia/abruption, retained dead fetus, amniotic fluid embolus, massive hemorrhage
Corollary fact - unprovoked DVT/PE = underlying coag disorder

60
Q

Placental/maternal infections

A

ascending infections = bacterial, polymicrobial

- can cause premature rupture of membranes

61
Q

Infections from mom->fetus

A 
Toxoplasmosis/TB
Rubella
CMV
Herpes/HIV/HBV
Syphilis
62
Q

Infections from birth canal

A

HSV
Group B strep
Chlamydia/Gonococcus

63
Q

Hydatiform Mole

A

abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts (abnormal placental tissue)

  • higher beta-hCG than expected
  • passage of grape-like mass through vaginal canal
  • “snow-storm” appearance on ultrasound
64
Q

Complete hydatiform mole

A
  • empty ovum fertilized by 2 sperm (46 chromos)
  • absent fetal tissue (completely dad)
  • most villi are hydropic
  • lots of trophoblastic proliferation (high beta-hCG)
  • risk of choriocarcinoma (use beta-hCG as serum marker)
65
Q

Partial hydatiform mole

A
  • normal ovum fertilized by 2 sperm (69 chromos - triploid)
  • present fetal tissue
  • some villi are hydropic
  • low trophoblastic proliferation
  • low risk of choriocarcinoma

Endo/Repro (34 decks)

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