Female Repro Pathology Flashcards
lower abdominal pain and vaginal bleeding. In the setting of a positive pregnancy test (eg, detectable β-hCG) and an adnexal mass, her presentation is most concerning for
ectopic pregnancy
can occur in patients with a mature teratoma
Ovarian torsion
***Most common ovarian cancer *** Often bilateral ↑ CA-125 Histology: Psammoma bodies/ anaplasia/ invasion into the stroma/ papillary formations/ cellular atypia/ fibrous core
Serous cystadeno-carcinoma (epithelial) Ovarian Tumor
Pseudomyxoma peritonei Mucin-producing epithelial cells ↑ CA-125
Mucinous cystadeno-carcinoma (epithelial) Ovarian Tumor
Adolescents ↑ β-hCG, ↑ LDH Histology: “Fried egg cells”
Dysgerminoma (germ cell) Ovarian Tumor
↑ AFP Aggressive Schiller-Duval bodies resemble glomeruli
Endodermal sinus (yolk sac) Ovarian Tumor
↑ Estrogen (eg, endometrial hyperplasia, postmenopausal bleeding) ↑ Inhibin Histology: Call-Exner bodies, coffee bean nuclei
Granulosa cell Stroma (sex cord) Ovarian Tumor
↑ Androgens (eg, hirsutism, clitoromegaly) Stroma tumor
Sertoli-Leydig Stroma (sex cord) Ovarian Tumor
produce CA-125, which can be used as a serum marker for this condition.
Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma
Typically present with a: pelvic mass, ascites, peritoneal metastasis decreased appetite, abdominal distension, bowel or bladder changes (constipation, urinary frequency)
Patients with ovarian cancer Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma
Nulliparous women are at increased risk for ovarian cancer due to _____, resulting in continued disruption and repair of the ovarian epithelium.
frequent ovulation
Histologic findings of ______ include: anaplasia of epithelial cells with invasion into the stroma, multiple papillary formations with cellular atypia Psammoma bodies.
epithelial ovarian cancer Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma
Sertoli-Leydig cell tumors of the ovary are rare sex cord stromal neoplasms typically appear as ____ composed of Sertoli cells with interspersed ______ Leydig cells and surrounding _____ stroma.
tubules eosinophilic fibrous stroma
Human papillomavirus infection of ______ cells can progress from premalignant (Low/High grade CIN) to cancerous lesions (cervical carcinoma.
basal cervical
Expansion of immature basal cells to the epithelial surface
high-grade CIN
Expansion of immature basal cells to the epithelial surface and breaching the basement membrane below them
Cervical Carcinoma (aka Squamous cell carcinoma (SCC)) *koilocytes do not = carcinoma
Cervical intraepithelial neoplasia refers to atypical _____ cells and is classified as Low-grade squamous intraepithelial lesions (if extending ___ of the epithelium) High-grade squamous intraepithelial lesions (if extending ___ of the epithelium) Basement membrane breach signifies _____ Typically cause by ___ infection with strains __& ___
basal squamous cells <1/3 (less than half) >1/3 (half or more) invasive disease (cervical squamous cell carcinoma) HPV 16, 18
In most cases, ____ (cervical lesion) regress spontaneously
LSILs
HPV 1-4 =
Skin warts
HPV 6, 11 =
Genital warts (Condyloma accuminata)
HPV 16, 18, 31 =
Anal, cervical, vaginal, vulvar neoplasia
the most common type of cervical cancer, arises from the squamocolumnar junction of the endocervix.
Squamous cell carcinoma (SCC)
HPV 16, 18, 31 can lead to over expression of viral oncogenes __ & __
E6 and E7
E6 binds protein ___ and increases its ____
p53 degradation
E7 binds to ____ and displaces the ___
retinoblastoma (RB1) gene transcription factors normally bound by pRB *pRB= protein made by gene RB (tumor suppressor)
What is the most significant factor that predisposed most patients to cervical abnormalities?
Lack of barrier contraception use or Immunocompromised status
Nulliparity early menarche obesity increase the risk of ______ cancer due to increased estrogen stimulation of the tissue.
endometrial cancer
Nulliparity early menarche prolonged menses (no-contraception) are risk factors for
endometriosis
_____ responds to hormonal influences of the menstrual cycle in the same way as uterine endometrium. Bleeding and shedding of extrauterine endometrium leads to formation of blood collections and induces inflammation. Inflammation is then followed by ______, which in turn distorts organ’s structure and function.
Ectopic endometrium Adhesion formation
List 4 common implant sites for ectopic endometrial tissues and adhesion formation
Uterus bladder colon uteralsacral ligament (causes thickening)
Adhesions (from Endometriosis) may interfere with ovulation and fallopian tube function, resulting in ____. Shedding of the ectopic tissue causes ____.
infertility dysmenorrhea (painful menses)
Implants and adhesions (from Endometriosis involving the uterosacral ligament can result in a fixed, ____ uterus.
retroverted
Infiltration of the posterior cul-de-sac from ectopic endometrial tissues can result in painful ____ and tenderness with palpation of the posterior vaginal ____.
intercourse fornix
Polycystic ovary syndrome is characterized by: ____ levels excess androgen production ____ resistance
elevated LH insulin
Polycystic ovary syndrome clinical features include: obesity menstrual irregularities hirsutism _____ ovaries increased risk of (2):
enlarged ovaries DM and endometrial hyperplasia
Patients with polycystic ovary syndrome who desire fertility can be treated with Clomiphene which is an ______ that decreases _______ on the hypothalamus by high circulating estrogen. As a result, ____ production is increased for ovulation
estrogen receptor modulator negative feedback inhibition gonadotropin (FSH/LH)
PCOS patients who do not wish to become pregnant may also be started on _____ to minimize: endometrial proliferation androgenic symptoms (hirsutism, acne) unwanted pregnancy
dual estrogen-progestin oral contraceptive pills
____ is an androgen receptor antagonist used in the treatment of acne and hirsutism in PCOS if OCPs don’t work (do not use if they wanna get pregnant)
Spironolactone
Endometrial hyperplasia and cancer often present with _____ bleeding. A common risk factor is obesity due to the ____ which leads to chronic unopposed estrogen exposure and uncontrolled endometrial tissue proliferation.
postmenopausal peripheral aromatization of androgens to estrogens in adipose tissue
small and cuboidal in cells that grow in cords or sheets, and form follicle- or rosette-like structures with a gland-like appearance a pink eosinophilic center and coffee bean nuclei. ____ cells are plump with lipid contents, which give the mass a yellow color on gross inspection. Large Unilateral mass
Granulosa–Theca cell tumor *can cause precocious puberty in young girls
Large ovarian (adnexal) mass and signs of virilization: facial hair deepening voice clitoromegaly
Sertoli-Leydig tumor
Ovarian torsion typically occurs in reproductive-aged women due to rotation of the ovary around the _____ and _____ ligaments. Patients typically have SUDDEN-onset unilateral pelvic pain and a tender adnexal mass.
infundibulopelvic (suspensory) uteroovarian
___ sided ovarian torsion is more common because of the greater length of the uteroovarian ligament. Risk factors include: ___ & ___
Right-sided Pregnancy & Ovarian mass
E7 binds Rb and displaces bound transcription factors, promoting unregulated ___ and ___ mediated cell cycling.
DNA replication cyclin
The oncogenic capability of HPV is dependent on its ability to integrate into the host genome and subsequently produce _______ which interact with cell cycle regulatory proteins
viral proteins E6 and E7
E6 binds p53, leading to its ____ and subsequent ______. Without p53, the cell is unable to halt cell growth to repair____ or trigger ____ when DNA is damaged beyond repair.
ubiquination proteasomal degradation damaged DNA apoptosis
___ & ____ are proto-oncogenes that code for cytoplasmic signal transducer proteins which upregulate cellular proliferation and differentiation when activated. Mutations causing constitutive activation of these proteins are linked to development of _____ cancer and malignant ____.
RAS and BRAF pancreatic cancer (Ras) melanomas (BRAF)
The ovary is covered by a ____ epithelium involved in surface repair of defects from ovulation.
simple cuboidal
Simple columnar cells in the
Fallopian tube, uterus, endo-cervix
stratified squamous non-keratinized epithelium in the
ecto-cervix, vagina
sloughs off during menses
stratum functionalis
Risk factors for ectopic pregnancy include tubal scarring from, tobacco use, and in vitro fertilization.
prior pelvic surgery pelvic inflammatory disease
A Krukenberg tumor is a gastric tumor that has metastasized to the ____ and can present with unintentional weight loss, epigastric pain, and adnexal masses. Histologically, the metastatic tumor cells have large amounts of ____ with displaced nuclei, resulting in a ____ appearance.
ovary mucin signet ring
A ______ tumor is a gastric tumor that has metastasized to the ovary
Krukenberg
unintentional weight loss epigastric pain adnexal masse(s)
Gastric Krukenberg tumor
Combined oral contraceptives ______ Salpingo-oophorectomy ______ are protective factors against Epithelial ovarian cancer
Multiparity Breastfeeding
Family history Infertility/Nulliparity ________ Endometriosis _______ _______ Postmenopausal hormone therapy are risk factors for Epithelial ovarian cancer
BRCA1 or BRCA2 mutations Lynch syndrome Polycystic ovarian syndrome
The pathogenesis of ____ cancer is linked to the frequency of trauma and repair at the ovarian surface.
epithelial ovarian
obese patient with postmenopausal bleeding most likely has endometrial hyperplasia or cancer due to
peripheral aromatization of androgens
Endometriosis the ectopic implantation of endometrial glands and stroma, typically causes painful menses (ie, dysmenorrhea) due to inflamed tissue on the ____.
peritoneum
↑ Inhibin ↑ Estrogen (endometrial Hyperplasia/Precocious puberty) Large unilateral adnexal mass Thickened endometrium
Granulosa cell tumor of ovary
small cuboidal cells in sheets with gland-like structures containing acidophilic material. The cells are arranged in a microfollicular pattern around a pink, eosinophilic center & coffee bean nuclei *Yellow theca cells with lipid
Call Exner bodies Granulosa cell tumor of ovary
Cancer antigen ____ is elevated in epithelial carcinomas of the ovary (eg, serous, endometrioid, clear cell).
125 (CA-125)
Typically presents with a pelvic mass, ascites, and peritoneal metastasis that result in decreased appetite, abdominal distension, and bowel or bladder changes (eg, constipation, urinary frequency).
ovarian cancer
Leuprolide is a GnRH agonist used to treat symptomatic uterine fibroids causing __ GnRH __ Estrogen __ FSH
↓ ↓ ↓
Clomiphene, used for ovulation induction to treat infertility, acts on the hypothalamus by interfering with hypothalamic estrogen receptors __ GnRH __ Estrogen __ FSH
↑ ↑ ↑
An endodermal sinus (eg, yolk sac) tumor is a malignant germ cell ovarian tumor that typically presents with abdominal pain due to ovarian ___ without virilization. The neoplasm is characterized by Schiller-Duval bodies, which are glomerulus-like papillary structures with a central vessel
torsion
Risk factors for ectopic pregnancy include tubal scarring (eg, prior pelvic surgery, pelvic inflammatory disease), tobacco use, and ___.
in vitro fertilization
dyspareunia (ie, pain with intercourse) strong clue for what diagnosis?
endometriosis
Pelvic pressure + postcoital bleeding strong clue for what diagnosis?
Cervical cancer
Oral contraceptives, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation. Risk factors include BRCA mutation, nulliparity, and infertility.
Ovarian cancer
tamoxifen use increases risk for ____, a rare but aggressive malignant tumor arising from the uterine myometrium
uterine sarcoma
Myocytes and/or endometrial stromal cells with nuclear atypia, abundant mitoses, and areas of necrosis.
uterine sarcoma
Typical histologic features include ovarian stromal invasion by atypical cells (pleomorphic, large, irregular nuclei and prominent nucleoli) forming papillae and glandular spaces.
High-grade serous ovarian carcinoma *usually in older women
Struma ovarii is an ovarian ___ cell tumor composed of >50% mature thyroid tissue that can secrete thyroid hormone.
germ
Where in the female gential tract are simple cuboidal cells found?
Ovaries
Where in the female genital tract are simple columnar cells found? (3)
Fallopian Tube
Endometrium
endocervix
Old accumulated blood looks like “chocolate”-colored fluid inside an ovarian cyst
Diagnosis?
endometrioma
(endometriosis)
