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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
Asherman Syndrome
secondary amenorrhea due to loss of basalis and scarring | - due to overaggressive D&C
26
Anovulatory Cycle
Lack of ovulation --> estrogen-driven proliferative phase without subsequent progesterone driven secretory phase - can lead to hyperplasia of endometrium
27
Endometrial Polyps
hyperplastic protrusion of endometrium -> presents as abnormal bleeding - can be due to tamoxifen (agonistic effect on uterus)
28
Endometrial Hyperplasia
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
Endometrial Carcinoma
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
Endometriosis
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
Adenomyosis
endometriosis involving uterine myometrium
32
Leiomyomas (fibroids)
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
Lieomyosarcoma
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
Fallopian tube pathology
generally non-neoplastic --> more PID - salpingitis --> PID bugs - endometriosis - tubal infertility and ectopic pregnancies
35
Tubal Neoplasia
adenomatoid tumor --> benign mesothelioma | tubal carcinoma - historically rare, BRCA 1 or 2 mutations
36
Polycystic Ovarian Syndrome
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
Surface Epithelial Tumors
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
Benign surface epithelial tumors
cystadenomas -> composed of single cyst with simple, flat lining (premenopausal women)
39
Malignant surface epithelial tumors
cystadenocarcinoma -> complex cysts with thick, shaggy lining (postmenopausal women)
40
Borderline surface epithelial tumors
features of both benign and malignant | - better prognosis than malignant but carry metastatic potential
41
Clinical Diagnosis of Ovarian Neoplasm
1. Incidental adnexal mass 2. Chronic pelvic/ab compression 3. Acute/subacute presentations 4. Signs of chronic sex steroids 5. Atypical glandular cells
42
Ovarian Germ Cell Tumors
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
Cystic teratoma
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
Dysgerminoma
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
Endodermanl Sinus Tumor
malignant tumor that mimics yolk sac -> most common in children - serum AFP elevated, Schiller-Duval bodies
46
Choriocarcinoma
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
Embronal Carcinoma
malignant tumor composed of large primitive cells | - aggressive with early metastasis
48
Sex-cord Stromal Tumors
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
Kruckenberg tumor
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
Pseudomyxoma peritonei
massive amounts of mucus in peritoneum | - due to mucinous tumor of appendix --> usually with metastasis to ovary
51
Spontaneous Abortion
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
Ectopic Pregnancy
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
Preeclampsia
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
Eclampsia
preeclampsia with new onset seizures | - CNS hemorrhage, acute renal failure, pulmonary edema, DIC, hepatic failure, death
55
Placenta previa
implantation of placenta in lower quandrant of uterus -> overlies the cervical os (marignal, partial, complete) - often requires c-section - associated with placenta accreta
56
Placental abruption
separation of placenta from decidua prior to delivery of fetus - 1% maternal mortality....12% fetal mortality - vaginal bleeding, contractions, and fetal insufficiency
57
Placental accreta
improper implantation of placenta into myometrium - difficulty delivering the placenta -> postpartum bleeding - often require hysterectomy RISK FACTOR - placenta previa w/ prior c-section
58
Postpartum hemorrhage
most commonly due to uterine atony - retained placenta - defined as causing hypovolemic symptoms - can be delayed
59
Acute DIC in pregnancy
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
Placental/maternal infections
ascending infections = bacterial, polymicrobial | - can cause premature rupture of membranes
61
Infections from mom->fetus
``` Toxoplasmosis/TB Rubella CMV Herpes/HIV/HBV Syphilis ```
62
Infections from birth canal
HSV Group B strep Chlamydia/Gonococcus
63
Hydatiform Mole
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
Complete hydatiform mole
- 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
Partial hydatiform mole
- 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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