Female pathology

Question 1

proliferative endometrium normal

Answer 1

Test tube shaped glands, abundant stroma, mitosis in the glands and stroma

Follicular phase

Question 2

Secretory endometrium

Answer 2

Wiggly jiggly , cleared out stroma, spacing of the nuclei

Question 3

Progestin effect on endometrium

Answer 3

inactive endometrium, stroma>glands, pseudodecidualized stroma

Question 4

Endometritis

Answer 4

inflammation of endometrium (acute- neutrophils, chronic- plasma cells)

PID, Retained products of conception, intrauterine device (IUD), Mass lesion (leiomyoma, polyps)

Question 5

Endometrial polyps

Answer 5

Benign biphasic neoplastic growths, proliferation of glands and stroma, dysfunctional bleeding

Most common with menopause

HMGIC or HMGIY- 12 q 15, or 6 p 21 rearrangement

Question 6

Leiomyoma

Answer 6

mosst common benign tumors in females, Blacks> whites

asymptomatic, abnormal bleeding, ussually multiple, sharply demarcated tumors, submucosal, intramural, and subserosal, monoclonal proliferation of benign smooth muscle cells, complex genotypes

Question 7

Adenomyosis

Answer 7

Growth of endometrium in the myometrium, often seen with endometriosis, enlarged, nodular myometrium with cysts, may be hemorrhagic, abnormal uterine bleeding infertility

Question 8

Endometriosis

Answer 8

Presence of endometrial glands and stroma outside of uterus, cyclic bleeding, can become blood filled cysts (chocolate cyst), discharge of blood leads to reactive changes, fibrosis and adhesions, histology (endometrial glands and stroma with hemosiderin)

Question 9

Endometrial disorders

Answer 9

Hyperplasia (Glandular proliferation, Gland/Stroma >50%, abnormal Glandular Architure, )
Without atypia lower risk of carcinoma

With atypia- higher rist of carcinoma- endometrial intraepithelial neoplasia (EIN)

Question 10

Unopposed Estrogen

Answer 10

Prolonged excess estrogen
Obesity (peripheral estrogen production by adipocytes), anovulation (Polycustic ovariaan Syndrom, perimenopause)
Estrogen producing tumors (Granulosa cell tumor of ovary), exogenous hormones

Question 11

Endometrial Adenocarcinoma Type 1

Answer 11

In a background of endometrial hyperplasia (estrogen dependent, Lots of mutations)
Low grade endometrioid and mucinous adenocarcinoma, hyperplasia- carcinoid sequence, Genetic alterations (mutation in Mismatch repair sporadic- hereditary cdanncers 90% survival for low stage tumors
PIK3CA, PTEN, KRAS, ARID 1a, CTNB1

Back to back glands`

Question 12

Endometrial adenocarcinoma type2

Answer 12

usually atrophic background, independent of endometrial hyperplasia (TP53 mutations)
Older women- more aggressive, high grade endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated/dedifferentiated carcinoma, carcinosarcoma

Some nuclei are huge and very high not basal

very aggressive, 50%

Question 13

Leiomyomasarcoma

Answer 13

Denovo from myometrial mesenchymal cells, post menopausal, solitary, soft, hemorrhagic, necrotic mass, pathological diagnostic features (tumor necrosis cytologic atypia and mitosis
Recurrence and mets are common, pelvic organs, soft tissue and bondes

Question 14

Ovary normal structure

Answer 14

surface epithelium/ specialized mesothelium (coelemic epithelium), serum, mucinous, transitional, endometriod, clear cell tumors
Cortex- follicles, oocyte (germ cell), sex cord (granulosa cells), stromal cells (give rise to thecomas and fibromas)

Medulla/hilum (hilar/leydig cells), adrenal cortical rest, rete ovaril (mesonephric tubules), stromal cells/smooth muscle/fat, thick walled vessels

OOcyte in the middle, cortex is granulosa cells/sex cord cells making estrogen, and theca cells

Question 15

functional cysts

Answer 15

inclusion cysts (cortical cyst), follicular cyst in follicles), luteal cyst (corpus luteum), hemorrhagic (corpus luteum)

Question 16

PCOS

Answer 16

hyper androgenism, menstrual abnormalities, polycystic ovaries, chronic Anovualtion, decreased fertility, enlarged ovaries, thickened fibrotic capsule, innumerable cystic follicles, absence of corpora lutea

Question 17

Risk factors for ovarian epithelial neoplasms

Answer 17

most common neoplasms of the ovary,

Things that reduce risk: high parity, use of oral contraceptives

Increased risk: obesity, estrogen usage for>10 y
Family history (germline mutations in tumor suppressor gene

Family history- 5-10% of b=ovarian cancers are familial, BRCA1 and BRCA2 tumor suppressor genes, 30% lifetime risk of ovarian cancer in BRCA 1 carriers, Slightly lower risk for BRCA 2

lynch syndrome- mismatch repair gene mutation
Lifraumeni- Tp53 mutation

Somatic mutations in tumor suppressor genes- BRCA1 and 2 inn 8-10% of sporadic ovarian cancers, tp53

type 2 starts at the fimbrae

Question 18

high grade serous carcinoma

Answer 18

poor prognosis, even after surgery and chemotherapy, prognosis depends heavily on the stage of the disease at diagnosis, the 5 yr survival for women with carcinoma confined to one ovary is about 90%, falls to less than 40% with high stage

Question 19

Endometrioid Tumors

Answer 19

Solid/cystic, may be associated with endometriosis, usually malignant, bilateral 30%, concurrent endometrial carcinoma 15-30%
Mutation of PTEN suppressor gene and genes that upregulate PI3K AKT signaling

Question 20

Brenner tumors

Answer 20

Uncommon, solid usually unilateral , incidental finding, nests of transitional type epithelium, mostly benign, borderline and malignant extremely rare