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HD 3 > Female Reproduction (path) - genitalia > Flashcards

Female Reproduction (path) - genitalia Flashcards

1
Q

Herpes infection

A

STD from Herpes Simplex Virus 1 or 2,
Histo: multinucleated cells w/ “ground glass” nuclear inclusions
Tx: acycylovir (not curable)

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2
Q

Molluscum Contagiosum

A

Pox virus that replicates in cytoplasm, usually Asymptomatic;
HIsto: eosinophilic intracytoplasmic inclusion bodies
* esp. widespread if immunocompromised.

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3
Q

Condyloma Acuminatum

A

HPV types 6 & 11 –> genital warts (30% w/ Sx);
Histo: dark, enlarged “raisinoid” nuclei
Tx: cryoTx, etc. to eliminate symptomatic lesions

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4
Q

Bartholin Cyst/Abscess

A

infection of mucinous glands on either side of vaginal orifice, bc of obstruction.
Histo: inflamed granulation tissue
Tx: marsupialization of cyst
* biopsy if age >40 to exclude carcinoma

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5
Q

Lichen Sclerosis

A

autoimmune disease, esp. post-menopause;
=> thin, whitened epithelium -> labial fusion, etc.
Histo: hyperkeratosis, no rete ridges, dermal edema, chronic inflamm.
*SOME risk of sq. cell carcinoma

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6
Q

Vulvar Intraepithelial Neoplasia (VIN)

A

NONinvasive precursor of sq. carcinoma;
Histo: mitotic activity, nuclear englarge & dark
grades I-III
*risk carcinoma esp. if immunosuppr. or age>45

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7
Q

2 types of vulvar Squamous Cell Carcinoma

A

1) NO assoc. w/ VIN or HPV, in older F, well-diff. *w/ keratinization!!
2) Assoc. w/ basaloid/warty VIN & HPV & smoking.

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8
Q

Paget’s Disease of the vulva

A

SLOWly progressing, superficial disease assoc. w/ adjacent anal/rectal/etc. adenocarcinoma;
HIsto: atypical, glandular cells
*recurrence after excision common

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9
Q

Melanoma

A

relatively common primary vulvar malignancy (5-10%); *with brown melanin in histo!
Sx: vulvar bleeding, mass, ulceration, pruritis
Tx: wide excision

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10
Q

Bacterial Vaginosis

A

overgrowth of flora –> gardnerella & anaerobic; assoc. w/ sexual activity.
Sx: fishy/musty odor, gray-white vaginal discharge

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11
Q

trichomonas infection

A

vaginal infection, = anaerobic flagellate protozoan;
affects M and F!
Sx: frothy discharge, erythema, edema, prurritis, (“strawberry cervix”)
Tx: metronidazole, tinidazole

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12
Q

candida infection (vaginal)

A

opportunistic, w/ pregnancy, menstruation, obesity, DM, etc.
Sx: pruritis, vulvar burning, cottage cheese-like discharge; w/ satellite lesions
Tx: topical azole/oral fluconazole * high recurrence!

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13
Q

mesodermal stroma polyp

A

benign, asymptomatic.

mean age 40, often w/ pregnancy

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14
Q

Embyronal Rhabdomyosarcoma

A

90% before age 5 (avg. age 2)
tumor w/ polypoid mass extruding from vagina
Tx: surgery & chemo

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15
Q

Common causes of infectious cervicitis

A

Chlamydia, mycobacterium TB, Neisseria gonorrhea, Group B strep, gardnerella, trichomonas

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16
Q

Cervical microglandular hyperplasia

A

benign proliferation of endocervical glands,
Sx: postcoital bleeding/spotting
Cause: Hx of recent progesterone exposure

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17
Q

benign endocervical polyp

A

most common in multiparous F age 40-50;

single smooth & soft polyp, bleeds easily.

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18
Q

High risk vs. low risk HPV

A

High risk: types 16, 18, 31, 33… assoc. w/ cancer

Low risk: types 6 & 11, assoc. w/ condyloma acuminatum

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19
Q

Risk factors for cervical cancer & SIL (squamous intrepithelial lesions)

A

1: HPV infection, abnormal PAP

  • early age at 1st sex or pregnancy
  • # sexual partners, # pregnancies
  • Hx of smoking
  • use of oral contraceptives
  • immunosuppresion
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20
Q

pathophysiology of high risk HPV infection

A
  1. HPV infects basal cells
  2. gets integrated into host chromosomal DNA
  3. => unregulated expression of E6 & E7
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21
Q

effects of E4 protein (from HPV)

A

disrupts keratinocyte intermediate filaments

–> koilocytosis & viral particle release

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22
Q

effects of E7 protein (from HPV)

A

interacts with Rb gene products
–> inactivates inhibition of proliferation
==> abnormal cells replicate

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23
Q

effects of E6 protein (from HPV)

A

inhbits p53 & apoptosis signal proteins

=> blocks DNA repair & apoptosis

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24
Q

Squamous cell carcinoma of cervix

A

common, wide age range.
Sx: abnormal bleeding/brown discharge
* may spread to vagina, bladder, rectum, etc.
** prognosis based on depth, tumor size, lymph nodes

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25
Adenocarcinoma In Situ (of cervix)
from infection of glandular epithelium by HPV 18, Histo: enlarged, overlapping, hyperchromatic nuclei * can become invasive adenocarcinoma!
26
Dysfunctional Uterine Bleeding
bleeding by no identifiable underlying condition; | *diagnosis of exclusion (but may be assoc. w/ anovulatory cycles from insuffic. estrogen)
27
Chronic endometritis
inflammation of the endometrium, assoc. w/ salpingitis & PID, IUD, Hx of douching orgs: N. gonorrhea, C trachomatis, trichomonas Tx: oral antibiotics
28
benign endometrial polyp
single OR multiple, avg age 40-49; assoc. w/ high estrogen (ie: tamoxifen) Histo: fibrovascular stroma w/ thick walled vessels Rel. risk carcinoma: x2
29
Endometrial hyperplasia
* simple or complex architecture, a) No atypia: disordered, abnormal shape glands b) Atypical: neoplastic, large round nuclei *risk carcinoma
30
Type 1 Endometrial Carcinoma
low grade, estrogen-related "endometrioid," * preceded by atypical hyperplasia Histo: fused glands w/ inflam. stroma ("desmoplastic") Tx: surgery or high dose progesterone if young age
31
Type 2 Endometrial Carcinoma
Serous or Clear-cell carcinomas, in older women (60s), NOT assoc. w/ estrogen; 1 hit muts: p53 (or LOH) ** aggressive!
32
Genetic muts for type 1 endometrial carcinoma
Slow accumulation of muts: PTEN, B-catenin, kRAS, microsatellite instability
33
Risk factors for endometriOID carcinoma
high estrogen exposure - nulliparity, late menopause, obesity, DM, estrogen Tx, tamoxifen - atypical endometrial hyperplasia
34
Serous (endometrial) carcinoma path
Histo: papillary or solid, high grade atypia, large nucleoli, many mitotic figures * ER & PR negative (usually)
35
Clear cell (endometrial) carcinoma path
Histo: cystic, papillary or solid; clear/eosin. cytoplasm, large "monstrous" nuclei
36
Malignant Mesodermal Mixed tumor (of endometrium)
biphasic tumor w/ malignant epithelial AND stromal differentiation (very poorly diff.) Sx: postmenopausal bleeding & polypoid mass * p53 mut --> very aggressive
37
adenomyosis
benign global enlargement of the uterus, w/ holes throughout (= endometrium in uterine wall) * mostly asymptomatic, or dyspareunia Tx: GnRH agonists, hysterectomy
38
Leiomyoma
benign smooth muscle neoplasms in uterus, * most common pelvic tumor in F, esp. Afr.Amer. Gross: LARGE, firm, white whorled masses - cystic/calcified & red infarction if degen. * risk uterine artery embolization
39
Leiomyosarcoma
rare uterine malignancy, NOT from leiomyomas. Histo: spindle cell prolif, necrosis, high gr. nuclear atypia NOT well-circumscribed --> Tx: total hysterectomy ** recurrence w/in 2 years common (50%)
40
Endometrial Stromal Sarcoma
very rare, endometrial stroma tumor -- invades myometrium. esp. age 40-50. gross; soft, tan/yellow, messy looking Histo: ovoid nuclei, little cytoplasm, many sm. blood vessels *recurrence likely (up to 30 yrs after hysterectomy!)
41
Epithelial ovarian neoplasms
** most common of all ovarian neoplasms (90%) #1. Serous tumor - assoc. w/ BRCA 1 & 2 2. Mucinous tumor *always rule out metastasis 3. Endometrioid tumor - assoc. w/ Lynch s. 4. Clear cell tumor - assoc. w/ Lynch s 5. Brenner tumor
42
Germ cell ovarian neoplasms
* most common ovarian tumors in children! 1. Teratoma 2. Dysgerminoma 3. Endodermal Sinus tumor 4. Choriocarcinoma
43
Stromal/Sex cord ovarian neoplasms
* assoc. w/ Peutz-Jeghers s. (STK11/LKB1) 1. Fibroma - assoc. w/ Gorlin s. (PTCH gene) 2. Granulosa-Theca cell tumor 3. Sertoli-Leydig cell tumor
44
cystic follicles (ovary)
normal occurence in ovary -- NOT neoplastic. DO follow if large/dominant cysts, may persist at center of corpus luteum -- any age (esp. reproductive), usually ASx
45
Endometriosis
= deposits of endometrial epithelium & stroma OUTside of endometrium (ie: ovary, fallopian tubes, pelvic peritoneum... lung, brain, etc.) - -> mass, menstrual irregularities, etc
46
Benign Serous Ovarian tumor
Most common ovarian tumor, avg age 20-45; gross: unilocular, cystic, unilateral (usually) * single cell layer, minimal mitotic activity
47
Borderline Serous ovarian tumor
malignant, age range 30-55+; Gross: mixed cystic & solid, 30% bilat. Histo: high grade atypia, papillae w/ fibrous cores, No stromal invasion *local recurrence common, "implants" may spread outside ovary
48
Ovarian Serous Carcinoma
avg age 55, no Sxs --> 80% LATE stage @ Dx; Gross: cystic or solid, 70% bilat. Histo: calcifications & psammoma bodies, high grade atypia, poorly diff. *at tips of fimbria if BRCA muts
49
ovarian mucinous cystadenomas
30% of ovarian tumors, +/- K-ras mut; Gross: LARGE, bilat, multiloculated Benign - single layer of columnar cells Borderline - "intestinal type" --> goblet cells, complex papillae & extracell. mucin
50
Ovarian Mucinous adenocarcinoma
rare, malignant, +/- K-ras mut. *rule out mets! gross: multiple cysts, w/ solid areas & necrosis Histo: intestinal-type, endocervical or mixed
51
*pseudomyxoma peritonei"
disseminated intra-abdominal mucin/carcinoma | usually = intestinal or apendiceal origin
52
ovarian Endometrioid adenocarcinoma
``` very rare, assoc. w/ endometriosis +/- borderline tumor. histo: flat along top of columnar layer, no nuclei good prog (75% 5 yr survival) ```
53
metastatic ovarian neoplasms
5% of all ovarian tumors, usually bilat. mostly from breast & GI, also hematopoeitic *often mets before primary tumor Sxs
54
ovarian fibroma/thecoma/fibrothecoma
ovarian stromal tumors, foamy & eosinophilic. fibroma = fibrous, thecoma = fat laden theca cells *solitary fibroma assoc. w/ unilat. pleural effusion! multiple fibromas => Gorlin syndrome
55
adult ovarian granulosa cell tumor
avg age 55, 90% unilateral & stage I, often produce steroids (#1 estrogen, or androgen) -- high estrogen => endometrial hyperplasia/adenocarcinoma * recurrences 10-20 yrs after
56
Granulosa cell tumors (pathology)
Gross: cystic/hemorrhagic, large +/- rupture Histo: varied w/ grooved nuclei (coffee beans!) & "Call-Exner" bodies, does NOT predict malignancy
57
Juvenile ovarian Granulosa Cell tumor
usually BEFORE reproductive age. | histo: larger nuclei & more atypia (than adult form)
58
Sertoli-Leydig tumor ("androblastoma")
avg age 20, unilateral, rarely malignant or recurrent; usually virilizing. +/- heterologous.
59
Teratoma (ovarian)
most common germ cell tumor, duplicates body tissues (any kind!). +/- bilat. * overgrowth of 1 element, neural tissue common a) benign b) malignant
60
Ovarian Dysgerminoma
undifferentiated, mimics primitive oocyte * similar to seminoma w/ gonadal dysgenesis, expresses c-kit +/- hcg
61
Embryonal carcinoma
primitive ovarian carcinoma, poorly differentiated
62
Choriocarcinoma
resembles trophoblast (placenta), * 2 elements: 1) multinucleate syncitiotrophoblast 2) single cell cytotrophoblast * * very aggressive. often w/ other germ cell tumors.
63
Ovarian Yolk sac carcinoma
recreates extra-embryonic structures, | ** excretes AFP (alpha feto protein)!

HD 3 (8 decks)

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