Female Reproductive And Breast Flashcards
Name a disease of the cervix
Cervical intraepithelial neoplasia CIN
Congenital abnormalities
Name three
Bicornuate uterus
Uterine Didelyphys
Agenesis of various structures
Describe CIN
Epithelium changes sometimes lead to invasive carcinoma. Some regress, some do not go on to cancer. Dysplasia of the cervical epithelium. Is graded on severity of changes. Evaluated by cytologic or biopsy.
CLINICALLY-peak at 30 years. Intercourse at early age, multiple partners, persistence of HPV infection.
(Cervix)
HPV
Facts
- Can be detected and almost all cervical cervical intraepithelial neoplasias (CIN’s)
- High risk types are found in majority of carcinomas.
- Low risk types are associated with condylomas
(Cervix)
Biopsy classifications
name three
CIN I - mild dysplasia
CIN II - moderate dysplasia
CIN III - severe carcinoma and carcinoma in situ
(Cervix)
Cytologic classifications
Name the current system and describe
Current system is called Bethesda system.
Low grade squamous intraepithelial lesion (LGSIL)
-CIN I or flat condyloma
-50% likelihood of regression
- 1-5% likelihood of progression to invasive carcinoma
hi grade squamous intraepithelial lesion(HGSIL)
-CIN I
-CIN II
33% likelihood of regression
Studies 60- 74% likelihood of progression to carcinoma
(Cervix)
Invasive carcinoma of cervix
Name five points
-Most squamous cell carcinoma - about 75%
-Develop in the transformation zone
-Usually do not spread to lymph nodes or distant organs until later in their course.
-Most detected early stages
-Five-year survival rates
Stage 0 - 100%
Stage 1 - 90%
Stage 2- 82%
Stage 3- 35%
Stage 4- 10%
(Uterine body)
Endometriosis
-Presence of endometrial glands and stroma outside endometrial cavity.
-Effects 10% of women in reproductive years.
-50% of women with infertility.
-Can present anywhere and pelvis - frequently on surface of ovary.
-Can produce cystic areas - chocolate cysts.
-Possible causes of regurgitation of menstruated in the region, metaplasia, blood or lymphatic spread Pain.
Clinically -scarring, pain, dysuria, dysmenorrhea, infertility.
(uterine body)
Adenomyosis
- Presence of endometrium and stroma in myometrium
- causes enlargement of uterine wall
- consist of basal layer and do not respond cyclically
- still evoke reaction of muscle
- cause menorrhagia, dysmenorrhea, pelvic pain
Dysfunctional uterine bleeding
name three
- Menorrhagia is prolonged or heavy bleeding during menstruation
- Metrorrhagia is a regular bleeding between periods
- post menopausal bleeding
Endometrial hyperplasia
Describe the name types and associations
-Caused by excess estrogen relative to progestin
-Severity (tendency to develop cancer) based on microscopic experience
-three types 1)simple -negligible risk of developing cancer
2)complex without atypia.
3)complex with atypia 20% risk of developing cancer
Associated with failure of ovulation, prolonged unopposed estrogen therapy, ovarian lesions and some tumors, obesity
Endometrial carcinoma
Ages 55 to 65,
risk factors are obesity, diabetes, hypertension, infertility.
Occurs as endometriotic pattern or serous pattern
Endometria -usually Perry menopausal woman excess estrogen
Serous-Usually atropic or in polyps
Clinically depends on stage; Sirus can spread more extensively with minimal invasion of uterus.
Stage depends invasion of myometrium
Leomyomas
describe
- The nine smooth muscle tumors
- subserosal , intramural, submucosal
- bleeding, Infertility, pain, pressure
Leomyosarcomas
Malignant
aggressive
Fallopian tubes
Name three
-Ectopic pregnancy
Effects 1% of pregnancies, 90% are tubal
-primary tubal adenocarcinomas
- salpingitis- STD’s, coliforms
Ovaries
Name to pathologies
Polycystic ovary/Stein-Leventhal syndrome
-large ovaries with multiple sub cortical cyst,, excessively produce androgens, oligomenorrhea, hirsutism, infertility, obesity
Physiologic cysts - follicular or luteal
Surface epithelial tumors
Tumors that come from mesothelium on surface of ovary.
Can be: benign, borderline (tumors of low malignant potential), or malignant.
Serous tumors
Most common of surface epithelial tumors.
Peak 30 to 40 years; malignant 45 to 65.
60% benign, 15% borderline, 25% malignant, sizes vary; can be very large, complexity/presence of solid tissue, clinical depends on stage;
Names: serous cyst adenoma-benign, serous cyst adenocarcinoma-malignant.
Mucinous tumors
- Similar to serous tumors.
- Less likely to be malignant, 10% or malignant, more likely to be larger, mucinous cystadenoma or mucinous cystadenocarcinoma.
- Can rupture to peritonial cavity - pseudomyxoma peritonei. Most of these are from metastasis from G.I. tract-appendix.
Endometrioid tumors
Can be solid or cystic,
develop in background of endometriosis,
can be borderline; most or malignant.
Brenner tumors
Uncommon,
solid,
consists of transitional type epithelium,
most are benign; malignancies can occur.
Teratomas
15 to 20% of ovarian neoplasms,
first two decades of life,
younger the patient the more likely the malignancy,
most are benign,
–Benign (mature) Cystic Teratoma- 1)contains derivations of all three germ cell layers, 2)are cystic and contain skin/epidermal structures- “dermoid cyst”
–Immature Malignant Teratoma- average age of 18 years old, mostly solid
–Monodermal Teratomas- contain one cell line - example: struma ovaries -thyroid
Germ cell tumors
- Dysgerminoma-equivalent of seminoma and testicle.
- Choriocarcinoma
- Sex Chord stromal tumor’s are benign
- —Granulosa thecal cell produces estrogen’s
- —Thecoma fibroma usually hormonally inactive
- —Sertoli-Leydig cell are masculinizing
Diseases of pregnancy
Gestational trophoblast if disease
HYDATIDIFORM MOLE
-Chorionic villi are cystic ally dilated, grape like structures.
-Complete moles-diploid, usually 46XX - have no fetal development.
-Incomplete moles - triploid, 69XXY - may have a fetal development.
INVASIVE MOLE - complete moles that are locally but do not metastasize.
CHORIOCARCINOMA
Aggressive tumors that arise from trophoblastic tissue or from totipotent cells of gonads.
Placental pathologies
Name five
Chorioamnionitis - inflammation of membranes
Villitis- inflammation of chorionic villi
Funisitis-inflammation of umbilical cord
Abruption - premature separation of placenta from uterine lining
Previa-placenta overlies cervical opening
Breast pathologies
Name most significant
Mastitis
Hyperplasias
Neoplasms
Breast
Hyperplasias
Fibrocystic changes
Result of a variety of types of hyperplasia
Leads to presence of lumps and cysts in breast tissue
Often called fibrocystic disease
Actually a mixture of different pathologies
Breast
Cysts and fibrosis
Define
- Fibrous stroma of the breast increases
- Have associated dilation of ducts and formation of cysts
- No association with carcinoma
Epithelial hyperplasia/proliferative fibrocystic changes
ORDERLY Hyperplasia’s
- epithelium is increased but maintains normal geography and cellular appearance
ATYPICAL HYPERPLASIAS
-the architecture of the cells becomes abnormal.
-the cytology of the cells are altered
-can be found in ducal or lobular patterns.
CANCER RISKS
-hyperplasia without atypia - slightly increased (1.5-2 times)
-with atypia - significantly increased risk (five times)
Neoplasms
name two
Fibroadenoma
- most common benign neoplasm of breast
-peak incidence -3rd decade
-usually solitary a and discrete
-may enlarge w menstrual cycle and during pregnancy
PHYLLODES TUMOR-(formerly CYSTOSARCOMA PHYLLODES)
-much less common
-can grow very large
-usually benign
-malignant lesions new reoccur; usually do not metastasize
Carcinoma of the breast
name risk factors
More common in North America
uncommon women under 30,
5 to 10% related to specific inherited mutations, family history,
prolonged exposure to exogenous estrogens post menopausal,
ionizing radiation
Types of carcinoma of the breast
noninvasive types, (has not invaded basement membrane)
name invasive types
Noninvasive- Ductal carcinoma in situ Lobular or carcinoma in situ Invasive (invades out of ducts and lobules)- Is less common, medullary carcinoma, colloid carcinoma (mucinous), tubular carcinoma
Carcinoma of the breast
complications/variations
- Paget’s disease of the nipple-progress of DCIS into lactiferous ducts and the skin of nipple.
- inflammatory carcinoma-extensive invasive carcinoma throughout the breast with blockage of lymphatics-large swollen breast.
Carcinoma of the breast
clinically
Mammography for detection
Prognosis: size of primary lesion less than 1 cm favorable without evidence of metastasis,
lymph node involvement - if no involvement five years survival rate 90%
if 16 or more nodes less than 50% survival rate.
Distant metastasis-Seldom curable can respond to therapy.
Grade of carcinoma.
Histologic type.
Estrogen receptors presence or absence. Proliferative rate.
Aneuploidy worse. Overexpression of Her2/Neu - Poor prognosis
