Female Reproduction (path) - genitalia Flashcards
Herpes infection
STD from Herpes Simplex Virus 1 or 2,
Histo: multinucleated cells w/ “ground glass” nuclear inclusions
Tx: acycylovir (not curable)
Molluscum Contagiosum
Pox virus that replicates in cytoplasm, usually Asymptomatic;
HIsto: eosinophilic intracytoplasmic inclusion bodies
* esp. widespread if immunocompromised.
Condyloma Acuminatum
HPV types 6 & 11 –> genital warts (30% w/ Sx);
Histo: dark, enlarged “raisinoid” nuclei
Tx: cryoTx, etc. to eliminate symptomatic lesions
Bartholin Cyst/Abscess
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
Lichen Sclerosis
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
Vulvar Intraepithelial Neoplasia (VIN)
NONinvasive precursor of sq. carcinoma;
Histo: mitotic activity, nuclear englarge & dark
grades I-III
*risk carcinoma esp. if immunosuppr. or age>45
2 types of vulvar Squamous Cell Carcinoma
1) NO assoc. w/ VIN or HPV, in older F, well-diff. *w/ keratinization!!
2) Assoc. w/ basaloid/warty VIN & HPV & smoking.
Paget’s Disease of the vulva
SLOWly progressing, superficial disease assoc. w/ adjacent anal/rectal/etc. adenocarcinoma;
HIsto: atypical, glandular cells
*recurrence after excision common
Melanoma
relatively common primary vulvar malignancy (5-10%); *with brown melanin in histo!
Sx: vulvar bleeding, mass, ulceration, pruritis
Tx: wide excision
Bacterial Vaginosis
overgrowth of flora –> gardnerella & anaerobic; assoc. w/ sexual activity.
Sx: fishy/musty odor, gray-white vaginal discharge
trichomonas infection
vaginal infection, = anaerobic flagellate protozoan;
affects M and F!
Sx: frothy discharge, erythema, edema, prurritis, (“strawberry cervix”)
Tx: metronidazole, tinidazole
candida infection (vaginal)
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!
mesodermal stroma polyp
benign, asymptomatic.
mean age 40, often w/ pregnancy
Embyronal Rhabdomyosarcoma
90% before age 5 (avg. age 2)
tumor w/ polypoid mass extruding from vagina
Tx: surgery & chemo
Common causes of infectious cervicitis
Chlamydia, mycobacterium TB, Neisseria gonorrhea, Group B strep, gardnerella, trichomonas
Cervical microglandular hyperplasia
benign proliferation of endocervical glands,
Sx: postcoital bleeding/spotting
Cause: Hx of recent progesterone exposure
benign endocervical polyp
most common in multiparous F age 40-50;
single smooth & soft polyp, bleeds easily.
High risk vs. low risk HPV
High risk: types 16, 18, 31, 33… assoc. w/ cancer
Low risk: types 6 & 11, assoc. w/ condyloma acuminatum
Risk factors for cervical cancer & SIL (squamous intrepithelial lesions)
1: HPV infection, abnormal PAP
- early age at 1st sex or pregnancy
- # sexual partners, # pregnancies
- Hx of smoking
- use of oral contraceptives
- immunosuppresion
pathophysiology of high risk HPV infection
- HPV infects basal cells
- gets integrated into host chromosomal DNA
- => unregulated expression of E6 & E7
effects of E4 protein (from HPV)
disrupts keratinocyte intermediate filaments
–> koilocytosis & viral particle release
effects of E7 protein (from HPV)
interacts with Rb gene products
–> inactivates inhibition of proliferation
==> abnormal cells replicate
effects of E6 protein (from HPV)
inhbits p53 & apoptosis signal proteins
=> blocks DNA repair & apoptosis
Squamous cell carcinoma of cervix
common, wide age range.
Sx: abnormal bleeding/brown discharge
* may spread to vagina, bladder, rectum, etc.
** prognosis based on depth, tumor size, lymph nodes
Adenocarcinoma In Situ (of cervix)
from infection of glandular epithelium by HPV 18,
Histo: enlarged, overlapping, hyperchromatic nuclei
* can become invasive adenocarcinoma!
Dysfunctional Uterine Bleeding
bleeding by no identifiable underlying condition;
*diagnosis of exclusion (but may be assoc. w/ anovulatory cycles from insuffic. estrogen)
Chronic endometritis
inflammation of the endometrium,
assoc. w/ salpingitis & PID, IUD, Hx of douching
orgs: N. gonorrhea, C trachomatis, trichomonas
Tx: oral antibiotics
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
Endometrial hyperplasia
- simple or complex architecture,
a) No atypia: disordered, abnormal shape glands
b) Atypical: neoplastic, large round nuclei *risk carcinoma
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
Type 2 Endometrial Carcinoma
Serous or Clear-cell carcinomas,
in older women (60s), NOT assoc. w/ estrogen;
1 hit muts: p53 (or LOH) ** aggressive!
Genetic muts for type 1 endometrial carcinoma
Slow accumulation of muts: PTEN, B-catenin, kRAS, microsatellite instability
Risk factors for endometriOID carcinoma
high estrogen exposure
- nulliparity, late menopause, obesity, DM, estrogen Tx, tamoxifen
- atypical endometrial hyperplasia
Serous (endometrial) carcinoma path
Histo: papillary or solid, high grade atypia, large nucleoli, many mitotic figures
* ER & PR negative (usually)
Clear cell (endometrial) carcinoma path
Histo: cystic, papillary or solid; clear/eosin. cytoplasm, large “monstrous” nuclei
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
adenomyosis
benign global enlargement of the uterus, w/ holes throughout (= endometrium in uterine wall)
* mostly asymptomatic, or dyspareunia
Tx: GnRH agonists, hysterectomy
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
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%)
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!)
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
Germ cell ovarian neoplasms
- most common ovarian tumors in children!
1. Teratoma
2. Dysgerminoma
3. Endodermal Sinus tumor
4. Choriocarcinoma
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
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
Endometriosis
= deposits of endometrial epithelium & stroma OUTside of endometrium
(ie: ovary, fallopian tubes, pelvic peritoneum… lung, brain, etc.)
- -> mass, menstrual irregularities, etc
Benign Serous Ovarian tumor
Most common ovarian tumor, avg age 20-45;
gross: unilocular, cystic, unilateral (usually)
* single cell layer, minimal mitotic activity
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
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
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
Ovarian Mucinous adenocarcinoma
rare, malignant, +/- K-ras mut. *rule out mets!
gross: multiple cysts, w/ solid areas & necrosis
Histo: intestinal-type, endocervical or mixed
*pseudomyxoma peritonei”
disseminated intra-abdominal mucin/carcinoma
usually = intestinal or apendiceal origin
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)
metastatic ovarian neoplasms
5% of all ovarian tumors, usually bilat.
mostly from breast & GI, also hematopoeitic
*often mets before primary tumor Sxs
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
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
Granulosa cell tumors (pathology)
Gross: cystic/hemorrhagic, large +/- rupture
Histo: varied w/ grooved nuclei (coffee beans!) & “Call-Exner” bodies, does NOT predict malignancy
Juvenile ovarian Granulosa Cell tumor
usually BEFORE reproductive age.
histo: larger nuclei & more atypia (than adult form)
Sertoli-Leydig tumor (“androblastoma”)
avg age 20, unilateral, rarely malignant or recurrent; usually virilizing. +/- heterologous.
Teratoma (ovarian)
most common germ cell tumor, duplicates body tissues (any kind!). +/- bilat.
- overgrowth of 1 element, neural tissue common
a) benign
b) malignant
Ovarian Dysgerminoma
undifferentiated, mimics primitive oocyte
* similar to seminoma
w/ gonadal dysgenesis, expresses c-kit +/- hcg
Embryonal carcinoma
primitive ovarian carcinoma, poorly differentiated
Choriocarcinoma
resembles trophoblast (placenta), * 2 elements:
1) multinucleate syncitiotrophoblast
2) single cell cytotrophoblast
* * very aggressive. often w/ other germ cell tumors.
Ovarian Yolk sac carcinoma
recreates extra-embryonic structures,
** excretes AFP (alpha feto protein)!
