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Pathology 2-Systemic > Female Repro > Flashcards

Female Repro Flashcards

1
Q

PID

A
  • Ascending infection from cervix to fallopian tubes
  • Neisseria Gonorrhoeae (Cervix, Vagina, Uterus, Tubes)
    • <span><strong><u>Linked to ectopic pregnancy</u> (High b-HCG)<u>&amp; Septic Arthritis </u>(young adults)</strong></span>
  • Herpes (Vulva only)
  • Symptoms:
  • Cervicitis <strong>(inflammtion of cervix)</strong>-
    • White discharge & high risk for ectopic tubal pregers/Infertility
  • Endometritis (cells of uterus appear in other areas)-
    • Discharge w/mid-abdominal pain & High risk for <u>Ectopic tubal pregers</u>
  • Salpingitis (inflammation of fallopian tubes)-
    • Discharge, bilateral lower ab pain
  • Pelvic abscess + Peritonitis
  • Perihepatitis (inflammation of serous/periotoneal)
  • Associated w/**Neutrophils **
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2
Q

PID-Pathogens

A
  • Candidiasis-White surface patches
    • Leukorrhea & prutitus w/curd-like discharge
  • Trichomonas-Purulent discharge (pus like)
    • Discomfort & Fiery red appearance (strawberry red)
  • Herpes simplex-Painful vesicles
    • Coalescent ulcers w/severe leukorrhea (yellow discharge)
  • Chlamydia T-Lymphoid aggregates in tissue
    • White discharge
      • Affects Tubes = Salpingitis
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3
Q

Chronic PID

A
  • Chronic Cervicitis
  • Due chronic inflammatory cells
  • Nabothian cyst<em><strong> </strong></em>(mucus filled on surface of vervix)
  • Squamos metaplasia (<u>normal is columnar</u> in cervix)
  • Progress to cyctic tubo-ovarian mass
  • Bilateral w/long history & infertility
  • Mass due adhesion (GI obstruction)
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4
Q

Disease of Vagina

A
  • Sarcoma Bortholin:
  • Children 0-5 years
  • “Grape like mass protruding from child”
  • ​Malignancy assoc w/Embryonal rhabdomyosarcoma
    • Rhabdomyoblast-cytoplasmic cross striations
    • Desmin & myoglobulin ++
  • Clear cell carcinoma-Vagina:
  • Associated w/**DES **
  • Vaginal adenosis (presistance of columnar cells-upper part of vagina)
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5
Q

Vulval Disease

A
  • Extra Mammary Pagets Disease (malignant):
  • Intraepithelial adenocarcinoma cells from underlying source (carcinoma in-situ)
  • Sweat gland carcinoma from intraepidermal glands
    • Keratin + (epithelial cells), PAS +, S100 (-)<u><strong>(melanoma is +)</strong></u>
  • Symptoms:
  • Erythamtous (crusted rash)
  • Ulcerated skin
  • Condyloma acuminatum (wart like HPV 6 &11):
    • Koilocytic change w/Hyperkeratois-Dysplasia w/16&18
  • Histo: “Raisin like nucleus”
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6
Q

Cervical Dysplasia

A
  • Dysplasia @ Transformation zone (columnar/squamous)
  • Cervical intraepi neoplasia (CIN)
    • Arises from Squamos epi lining
  • CIN 1 (flat condyloma)-HPV 6, 11-Kolio change
    • Lower 1/3 of epi (does not progress)
    • Regional=Iliac nodes
  • CIN 2-Dysplasia starts here-HPV 16, 18
    • Lower 2/3 of epi can progress to CIN 3
    • Derived from <em><strong>urogenital sinus-can go to inguinal</strong></em>
  • CIN 3-HPV 16, 18
    • Full thickness of epi (intact basement membrane)
  • invasive basement membrane=Carcinoma In-situ
  • Diagnose: PAP smear
  • Prevention: Vaccine HPV 16, 18, 6, 11 (every 5 years)
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7
Q

Carcinoma of Cervix (Squamos)

A
  • Associated w/HPV 16, 18, 31, 33 <strong>(squamos/columnar)</strong>
  • High risk: Multiple sex partners, early age intercourse, Oral contraceptive, smoking, Chlamydia
  • Squamous cell carcinoma (HPV 16 & 18)-Most common
  • Viral oncogenes=E6 (TP53) & E7 (RB) cause inactivation
    • Exophytic <u>(outward growth)</u> & ulcerated
  • Symptoms-BAD prognosis w/Iliac nodes:
    • Dyspareunia (painful sexual intercourse)
    • Post coital bleeding
    • Leukorrhoea <u><strong>(yellow discharge)</strong></u>
  • Diagnose: Colposcopy(cervix, vagina, vulva),PAP, Cone biopsy
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8
Q

Carcinoma of cervix (Clear cell)

A
  • Clear cell adendocarcinoma (exposure to diethylstilbesterol)-DES
  • Rare malig prolif of glands in Columnar of endocervix
    • “Red, friable nodular mass”
  • PAP Does not detect adenocarcinoma accurately
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9
Q

Staging of Carcinoma/Cervix

A
  • 5 Year Survival
  • Stage 0=Carcinoma in situ CIN 3 (100% survival)
  • Stage 1=Carcinoma confined to cervix
  • 1A - micro invasive carcinoma (stromal invasion 3mm)
  • 1B - Histo invasive carcinoma 80-90% (Greater than 3mm)
  • Stage 2=Carcinoma involving vagina (<strong>Upper 2/3)</strong>-75%
  • Stage 3=Carcinoma extended to pelvic wall (entire vagina)
  • Stage 4=Involve mucosa of bladder (post-renal failure) & rectum bleeding
    • Metastatic dissemination (10% survival)
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10
Q

Disturbed Uterine Bleeding

A
  • Most common:
  • Polycystic ovary syndrome
  • Thyroid
  • Hyerprolactinemia/Prolactinoma
  • Anovulatory cycle (Starting period & Menopause):
  • Endometrium w/stromal breakdown (sloughing off)
    • <span>No secretion w/o progesterone phase over growth of estrogen phase</span>
  • Menstrual cycle chracterized by varying degrees of intervals & absence of ovulation @ luteal phase
    • Leads to infertility
  • Causes:
  • Primordial follicle NEVER matures
  • No formation of corpus luteum (Luteal Phase-Progesterone)
    • <strong>Leads to NO PROGESTERONE</strong>
  • Endometrium stays in prolif phase (tubular glands + compact stroma)
  • Diagnose: Biopsy endometrium on 20th day
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11
Q

Endometritis

A
  • Endometritis-
    • Acute: Bacterial infection after delivery or miscarriage
      • Histo: Neutrophils
    • Chronic: IUD or PID (chlamydia)
      • HIsto: Plasma cells
  • Both present-
  • Mid ab pain, infertility, dysmenorrhea, & fever
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12
Q

Endometriosis

A
  • Presence of endometrial tissue outside uterus
  • Sites of involvement:
    • Ovary (<strong><u>Chocolate cyst-high risk for carcinoma)</u></strong>
    • Uterine ligaments <u><strong>(pelvic pain-adenomyosis)</strong></u>
    • Laparoscopic scar <u><strong>(C-section)</strong></u>
    • Pouch of Douglas <u><strong>(pain w/defication)</strong></u>
  • Metaplasia, Blood/Lymph, regurgitation (endometrial fluid)
  • Morphology: Red-Blue nodule @ site (peritoneum)
    • Ovary=Chocolate cyst-<strong>Hemosiderin deposit</strong>
  • Symptoms:
  • Generalized pelvic pain,Dysmenorrhea,<strong><em>Dyspareunia</em> (painful sex)</strong>
    • **Infertility **
  • Can produce rectal bleeding (pouch of Douglas)
  • Treat: Aromatase inhibitors
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13
Q

Adenomyosis

A
  • Endometriosis invasion of smooth muscle
  • Endometrial tissue deep in myometrium of uterus
    • <strong>“Displacement of endometrial glands & stroma”</strong>
  • **Diffuse enlargement-Bilateral **of uterus (smooth)
  • Clinical:
    • Irregular profuse menstruation
    • Dysmenorrhea & menorrhagia
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14
Q

Hyperplasia of Endometrium

A
  • Endometrial Polyp-hyperplastic protrusion w/<u>abnormal uterine bleeding</u>
    • Made of-endometrial glands & fibrous stroma
    • Side effect of <strong>Tamoxfen <u>(anti-estrogenic on breast BUT pro-estrogen on endo)</u></strong>
  • Hyperplasia:
  • Builds up with prolonged estrogen LVLs (obese women)
    • <em><strong>More Glands</strong></em> to stroma ratio
    • <span>Presents w/<em><strong>DUB</strong></em></span>

Types (based on architecture):

  • Simple/Cyto-glandular- many cyctic endometrial glands, variable size
  • Atypical- Many complex glands, variable size & cell-atypia - leads to carcinoma (loss of Fnx PTEN)
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15
Q

Endometrial Carcinoma

A
  • Pathogenesis (malignant):
  • Atypical Endometrial Hyperplasia (cell atypia)
  • Prolonged estogenic stimulation
    • Tumor of ovary
    • Estrogen replacement therapy
  • Invasion in later stage =”Polypoid mass”
  • “50-60 yr Post-menopausal w/irregular bleeding”
  • High risk:
  • Obese women
  • Diabetes
  • HTN
  • Infertility (#1 sign)
  • Lynch syndrome/Hereditary nonpoly colorectal cancer<u><strong> (colon, endometrial &amp; overian)</strong></u>
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16
Q

Tumor of Endometrium

A
  • Stroma sarcoma-Malignant Tumor of endometrial stroma (PTEN gene)
    • Genetics: Chrom translocation t(7:17)(p15;q21)
  • Benign stromal nodules (asymptomatic)
    • Endometrial stromal sarcoma
      • Neoplastic-muscle bundles of myometrium
      • Diffuse infiltration of myometrial tissue OR penetration to <em><strong>lymph</strong></em>
  • Carcinosarcoma-Malignant mixed Mullerian tumor
    • malignant epi cells w/mesodermal comp
    • Muslce, Cartilage, osteoid
17
Q

Tumors of Uterus

A
  • Leiomyomata (Fibroid):
    • Estrogen & OCP stimulate growth
    • Can <em><strong>calcify in menopause</strong></em> <u><strong>(no estrogen for growth)-</strong></u>Psammoma body
  • Leiomyoma (benign prolif of smooth muscle):
    • <strong><u>Prolif origin=</u></strong>Sub mucosal, Intra mural, Sub serosal
    • Enlargement w/nodules &<strong> Dysfunctional Uterine bleeding (IRON def)</strong>
  • Symptoms: <strong>Bleeding w/infertility </strong>& pain w/ischemia necrosis
    • Morphology: <em><strong>Multiple</strong></em> Well circum of <em><strong>whorling mass</strong></em>
  • Leiomyosarcoma: Large malignant tumor (post-menopausal)
    • Arises de-novo NOT from Leiomyoma
    • Morphology: Single mass w/central necrosis
18
Q

Placenta Disorders

A
  • Placenta Previa (lower uterine cavity):
  • Marginal (side/bottom), complete (bottom), Low-lying (side)
    • Follows C-section
  • Placenta accreta (complication of previa):
  • ABNORMAL deep attachment of placenta through endometrium into myometrium
  • Absence of decidua (uterine lining-maternal surface)
  • Post-partum hemmorhage
  • Hystorectomy may be involved
19
Q

Ectopic Pregers

A
  • Location: Fallopian Tubes
  • High risk w/past scarring-due to endometritis/PID
  • Pathogenesis: PID (gonorrhea)
    • Caused by delyaed transfer of blastocyst
  • Symptoms: LQ pain after missed period
  • Morphology: Uterus empty w/Tubes containing placental tissue
    • Elevated Beta-hCG
    • Decidual change on endometrial stromal cells (progesterone) = Glandular hyperplasia
20
Q

Toxemia of Pregers

A
  • Symptoms:
    • HTN, Proteinuria, edema during pregers
  • Types: Preeclampsia & eclampsia
    • Fibrinoid necrosis vessels of placenta
  • High risk:
    • 1st pregers
    • Relatives who have had preclampsia
    • Multiple babies
    • Teenage mothers & Older women (40)
    • History of High BP or Renal issue
  • Preelampsia: HTN, Protenuria, edema-DIC
  • Eclampsia: Life threatening seizures w/above symptoms

Pathology 2-Systemic (15 decks)

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