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pathology > Female Reporductive > Flashcards

Female Reporductive Flashcards

1
Q

The skin and mucosa external to the hymen, lined by squamous epithelium

A

Vulva

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2
Q
  • Cyctic dilation of batholin gland (secretes mucous to lubricate the vestibule)
  • there is inflammation due to infarction with an STD leading to an obstruction which leads to the dialation
A

Bartholin cyst

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3
Q

Presents with a unilateral painful cystic lesion at the lower vestibule adjacent to the vaginal canal

A

Bartholin cyst

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4
Q

Warty neoplasm of vulvar skin, most commonly due to HPV 6 and 11

A

Condyloma acuminata

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5
Q

What is Condyloma acuminata characteristized with

A

Kolycystic change ( raisin shaped nucleus)

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6
Q

What does HPV Infect

A

The lower genital tract (vulva, vaginal canal and cervix)

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7
Q

Characteristic of HPV infection

A

Koliocytic change

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8
Q

Risk of HPV - based on DNA sequencing

A

Low risk 6,11 - Condyloma acuminata

High risk 16,18,31,33 dysplasia -> carcinoma

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9
Q
  • thinning of epidermis and fibrosis of dermis
  • leukoplakia with parchment like vulvar skin (paper thin)
  • most commonly seen in post menopausal women (atrophy)
  • benign with slight risk scc
A

Lichen sclerosis

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10
Q

Squamous cell hyperplasia

-hyperplasia of vulvar squamous epithelium

A

Lichen simplex chornicus

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11
Q
  • Presents as leukoplakia with thick leathery vulvar skin
  • associated with chronic irritation and scratching
  • no risk of scc
A

Lichen simplex chronicus (hyperplasia of vulvar squamous epithelium)

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12
Q
  • presents with leukoplakia
  • can be HPV related or NON-HPV related(morecommon)
  • arise from squamous epithelium
A

Vulvar carcinoma - must be biopsied to rule out other causes of leukoplakia

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13
Q

What does HPV RELATED vulvar carcinoma present with?

A

A women 40-50 years old with vulvar leukoplakia, on biopsy she shows multifocal, warty and poorly differentiated cells. (Classic vulvar intraepithelial neoplasia)

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14
Q

What does NON HPV RELATED vulvar carcinoma present with

A

A women 70+ with vulvar leukoplakia and on biopsy it showed a unifocal well differentiated keratinising squamous eipithelium

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15
Q

What are the vaginas malignant neoplasms

A

Squamous cell carcinoma

Clear cell adenocarcinoma

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16
Q

What is clear cell adenocarcinoma

A

A begins malignant neoplasm which is the formation of small glands, red granular appearing foci

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17
Q

An uncommon malignant neoplasm that presents in women older than 60years of age
-VAIN is a precursor less ion almost always associated with HPV infection
-

A

Squamous cell carcinoma of the vagina

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18
Q

What is more than half invasive cell carcinoma associated with

A

HPV

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19
Q

Neck of the uterus

A

Cervix - divided into exocervix and endocervix

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20
Q

What is exoxervix lined with

A

Squamous epithelium

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21
Q

What is endocervix lined with

A

Columnar epithelium (transformation zone)

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22
Q
  • sexually transmitted DNA VIRUS
  • INFECTS Lowe genital tract especially the cervix in the transition formation zone
  • presistant infection leads to risk CIN
A

HPV INFECTION

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23
Q

What makes high risk HPV high risk?

A

Production of E6 and E7
E6 - increases destruction if P53
E7 - increases destruction of RB

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24
Q
  • Characterised by koliocytic change, nuclear pleomorphism and increased mitotic activity
  • Divides in to grades based on extent of immature dysplastic cells
A

CIN

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25
Q

Grades of CIN

A

CIN 1 / 2 / 3 -> CIS -> invasive carcinoma

1= 1/3 thickness 
2= 2/3 thickness 
3= most 
CIS = the Whole thickness
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26
Q

Is CIN reversible

A

Yes it is, may regress

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27
Q

Does CIS invade the basement membrane

A

No it doesn’t

28
Q

Does cervical carcinoma invade the basement membrane

A

Yes it does

29
Q

Most commonly seen in middle aged women and is seen as vaginal bleeding
With invading of the basement membrane

A

Invasive carcinoma - cervical carcinoma

30
Q

Low grade squamous intraepithelial lesion

A

Is CIN 1

31
Q

High grade squamous epithelium lesion

A

CIN 2 and 3

32
Q

What is the key risk factor for cervical carcinoma

A

High risk HPV infection #1

Smoking and immune deficiency #2

33
Q

What are the most common types of cervical carcinoma

A 
Squamous cell (more common) 
Adenocarcinoma 
(Both types are related to HPV)
34
Q

What happens in advanced tumors of the cervical carcinoma?

A

It invades the bladder through the anterior uterine wall, (hypdronephrosis)-> post renal failure

35
Q

What is the goal of screening

A

Catch dysplasia before it develops into carcinoma (20 years window)

36
Q

Gold standard screening (most successful)

A brush is used to scrape off cells from the transformation zone and check for dysplasia under the microscope

A

Pap smear

37
Q

How do dysplastic cells appear after papsmear

A

Cells with dark blue nuclei and cytoplasm and increased nuclear / cytoplasmic ratio

38
Q

What is done after an abnormal papsmear

A

Confirmatory colposcopy and biopsy

39
Q

What are the limitations of Pap smear

A

Inadequate sampling of the transformation zone results in a false negative
Limited efficacy in screening for adeno carcinoma

40
Q

An infective way to prevent HOV INFECTION

A

Immunisation
Vaccine covers hpv 6,11,16,18
Lasts 5 years
Pap smear still done due to 31 and 33 hpv

41
Q

Benign polyposis mass protruding from endocervical mucosa
A few cm in size with a smooth surface filed with mucinous scretiojs both the surface epithelium and epithelial lining the mucinous cavity is Columnar

A

Endocervical polyp
They can bleed
No malignant potential

42
Q

What does superimposed chronic inflammation do to endocervical polyp

A

Leads to squamous metaplasia and ulcers

43
Q

Endometrium is hormonal sensitive

A

Grow-> prepared-> shedding

44
Q

What drives the growth of the endometrium

A

Estrogen

45
Q

What drives the endometrium to be prepared for implantation

A

Progesterone

46
Q

When does shedding of the endometrium occur

A

With loss of the progesterone support

47
Q

Lack of ovulation
Results in esteogen driven proliferation without progesterone secretory phase
Common cause is dysfunction uterine bleeding especially during menarche and menopause

A

Anovultary cycle

48
Q

Bacterial infection of endometrium
Usually due to retained products of conception (eg piece of placenta remains behind)
Presents with fever abdominal uterinebleeding and pelvic pain

A

Acute endometrisis

49
Q

Chronic inflammation of the endometrium
Characterised by plasma cells (patho genomic for chronic endometriosis)
- Common cause retained products of conception, TB,
Chronic PID(chlamydia) and intrauterinedevice.
(With TB we get granulomas)
-presents with abdominal uterine bleeding, pelvic pain and infertility.

A

Chronic endometritis

50
Q

Hyperplastic protrusion of endometrium
Abnormal uterine bleeding
Usually due to side effects of TAMOXIFEN

A

Endometrial polyp

51
Q

Abnormal placement of endometrial glands and stromal outside the uterine cavity (endothelial lining)
- presents with dysmenorrhea( pain during menstral cycle) and pelvic pain , could cause infertility

A

Endometriosis

52
Q

Some menstral products go backwards through the tube in to the ovary and pelvis

A

Retrograde mensturation theory of endometriosis

53
Q

The mallee Ian duct from which the endometrial wall develops (and other cervical and begins epithelium develop from) -> endometrium metaplasia takes place

A

Metaplastic theory of endometriosis

54
Q

Endometrial epithelium spreading through lympatics( this theory proves how endometriosis for example reaches the lung)

A

Vascular or lymphatic dissemination theory of endometriosis

55
Q

What are the most common sites of involvement of endometriosis

A

1- ovary - chocolate cyst (most common site)
2- uterine ligament - pelvic pain
3- pouch if douglas- pain with deification
4- bladder wall- pain with urination
5- bowel serosa - abdominal pain
6- Fallopian tube mucosa - scarring -> can increase risk of infertility

56
Q
  • hyperplastic endothelial glands relative to stroke
  • consequences of unopposed esteogen (not followed by progesterone)
  • presents as post menopausal uterine bleeding
A

Endometrial hyperplasia

57
Q

Endometrial hyperplasia on biopsy

A

Based on architecture growth (simple or complex) and atypia(with or without)
Typical hyperplasia- no atypia
Atypical hyperplasia - atypia

58
Q

What is the most common predictor for progression of endometrial hyperplasia to carcinoma

A

Atypia

59
Q

Malignant proliferation of endometrial glands

Presents as post menopausal bleeding

A

Endometrial carcinoma

60
Q

What are the 2 types of endometrial carcinoma

A

Based on what they arise from
Hyperplasia (type 1 )
Sporadic (type 2)

61
Q

Type 1 Hyperplasia - endometrial carcinoma

A

Histologically - endometriod
Occurs in woman of 50-60 years
Risk factor is estrogen

62
Q

Sporadic endometrial carcinoma

A

Cancer from atrophic endometrium
Histologically serous with papillae (papiallry serous)
Occurs in elderly >70
Driven by p53 mutation
Pasmoma bodies can be present (calcification of papillary structures

63
Q

What are psammoma bodies present in

A

1- papillary carcinoma of of thyroid
2-papillary serous endometrial carcinoma
3- meningioma
4- mesothelioma

64
Q

Benign proliferation of smooth muscle arising from myometrium

  • related to esteogen exposure (premenopausal women)
  • multiple well defines white whirled masses with cigar chapped nucleus
  • usually asymptomatic, when present there is-> infertility, uterine bleeding and mass
A

Leiyimyoma

65
Q

Malignant proliferation of smooth muscle arising from myometrium

  • arises de novo (leiyomyoma does not become leiyosarcoma)
  • arises in post menopausal women
  • single lesion with necrosis and haemorrhage
  • necrotic mitotic activity and cellular atypia also with cigar shaped nucleus
A

Leiyomyosarcoma

pathology (15 decks)

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