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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
Q

Adenocarcinoma In Situ (of cervix)

A

from infection of glandular epithelium by HPV 18,
Histo: enlarged, overlapping, hyperchromatic nuclei
* can become invasive adenocarcinoma!

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26
Q

Dysfunctional Uterine Bleeding

A

bleeding by no identifiable underlying condition;

*diagnosis of exclusion (but may be assoc. w/ anovulatory cycles from insuffic. estrogen)

27
Q

Chronic endometritis

A

inflammation of the endometrium,
assoc. w/ salpingitis & PID, IUD, Hx of douching
orgs: N. gonorrhea, C trachomatis, trichomonas
Tx: oral antibiotics

28
Q

benign endometrial polyp

A

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
Q

Endometrial hyperplasia

A
  • simple or complex architecture,
    a) No atypia: disordered, abnormal shape glands
    b) Atypical: neoplastic, large round nuclei *risk carcinoma
30
Q

Type 1 Endometrial Carcinoma

A

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
Q

Type 2 Endometrial Carcinoma

A

Serous or Clear-cell carcinomas,
in older women (60s), NOT assoc. w/ estrogen;
1 hit muts: p53 (or LOH) ** aggressive!

32
Q

Genetic muts for type 1 endometrial carcinoma

A

Slow accumulation of muts: PTEN, B-catenin, kRAS, microsatellite instability

33
Q

Risk factors for endometriOID carcinoma

A

high estrogen exposure

  • nulliparity, late menopause, obesity, DM, estrogen Tx, tamoxifen
  • atypical endometrial hyperplasia
34
Q

Serous (endometrial) carcinoma path

A

Histo: papillary or solid, high grade atypia, large nucleoli, many mitotic figures
* ER & PR negative (usually)

35
Q

Clear cell (endometrial) carcinoma path

A

Histo: cystic, papillary or solid; clear/eosin. cytoplasm, large “monstrous” nuclei

36
Q

Malignant Mesodermal Mixed tumor (of endometrium)

A

biphasic tumor w/ malignant epithelial AND stromal differentiation (very poorly diff.)
Sx: postmenopausal bleeding & polypoid mass
* p53 mut –> very aggressive

37
Q

adenomyosis

A

benign global enlargement of the uterus, w/ holes throughout (= endometrium in uterine wall)
* mostly asymptomatic, or dyspareunia
Tx: GnRH agonists, hysterectomy

38
Q

Leiomyoma

A

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
Q

Leiomyosarcoma

A

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
Q

Endometrial Stromal Sarcoma

A

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
Q

Epithelial ovarian neoplasms

A

** 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
Q

Germ cell ovarian neoplasms

A
  • most common ovarian tumors in children!
    1. Teratoma
    2. Dysgerminoma
    3. Endodermal Sinus tumor
    4. Choriocarcinoma
43
Q

Stromal/Sex cord ovarian neoplasms

A
  • 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
Q

cystic follicles (ovary)

A

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
Q

Endometriosis

A

= deposits of endometrial epithelium & stroma OUTside of endometrium

(ie: ovary, fallopian tubes, pelvic peritoneum… lung, brain, etc.)
- -> mass, menstrual irregularities, etc

46
Q

Benign Serous Ovarian tumor

A

Most common ovarian tumor, avg age 20-45;

gross: unilocular, cystic, unilateral (usually)
* single cell layer, minimal mitotic activity

47
Q

Borderline Serous ovarian tumor

A

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
Q

Ovarian Serous Carcinoma

A

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
Q

ovarian mucinous cystadenomas

A

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
Q

Ovarian Mucinous adenocarcinoma

A

rare, malignant, +/- K-ras mut. *rule out mets!
gross: multiple cysts, w/ solid areas & necrosis
Histo: intestinal-type, endocervical or mixed

51
Q

*pseudomyxoma peritonei”

A

disseminated intra-abdominal mucin/carcinoma

usually = intestinal or apendiceal origin

52
Q

ovarian Endometrioid adenocarcinoma

A 
very rare, assoc. w/ endometriosis +/- borderline tumor. 
histo: flat along top of columnar layer, no nuclei
good prog (75% 5 yr survival)
53
Q

metastatic ovarian neoplasms

A

5% of all ovarian tumors, usually bilat.
mostly from breast & GI, also hematopoeitic
*often mets before primary tumor Sxs

54
Q

ovarian fibroma/thecoma/fibrothecoma

A

ovarian stromal tumors, foamy & eosinophilic.
fibroma = fibrous, thecoma = fat laden theca cells
*solitary fibroma assoc. w/ unilat. pleural effusion!
multiple fibromas => Gorlin syndrome

55
Q

adult ovarian granulosa cell tumor

A

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
Q

Granulosa cell tumors (pathology)

A

Gross: cystic/hemorrhagic, large +/- rupture
Histo: varied w/ grooved nuclei (coffee beans!) & “Call-Exner” bodies, does NOT predict malignancy

57
Q

Juvenile ovarian Granulosa Cell tumor

A

usually BEFORE reproductive age.

histo: larger nuclei & more atypia (than adult form)

58
Q

Sertoli-Leydig tumor (“androblastoma”)

A

avg age 20, unilateral, rarely malignant or recurrent; usually virilizing. +/- heterologous.

59
Q

Teratoma (ovarian)

A

most common germ cell tumor, duplicates body tissues (any kind!). +/- bilat.

  • overgrowth of 1 element, neural tissue common
    a) benign
    b) malignant
60
Q

Ovarian Dysgerminoma

A

undifferentiated, mimics primitive oocyte
* similar to seminoma
w/ gonadal dysgenesis, expresses c-kit +/- hcg

61
Q

Embryonal carcinoma

A

primitive ovarian carcinoma, poorly differentiated

62
Q

Choriocarcinoma

A

resembles trophoblast (placenta), * 2 elements:

1) multinucleate syncitiotrophoblast
2) single cell cytotrophoblast
* * very aggressive. often w/ other germ cell tumors.

63
Q

Ovarian Yolk sac carcinoma

A

recreates extra-embryonic structures,

** excretes AFP (alpha feto protein)!

HD 3 (8 decks)

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