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Endo Repro Exam I > Female Reproductive Pathology > Flashcards

Female Reproductive Pathology Flashcards

1
Q

Bacterial cause of amnionitis that may result in abortion, stillbirth, or neonatal sepsis

A

Listeria monocytogenes

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2
Q

Cause of PID with rare complication of Fitz Hugh Curtis syndrome (violin string adhesions around diaphragm and/or liver)

A

Neisseria gonorrheae

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3
Q

STIs caused by chlaymida trachomatis serovars D-K and L1-L3

A

D-K = often present with watery vaginal or urethral discharge, may lead to PID, may be transmitted vertically causing conjunctivitis or PNA

L1-L3 = lymphogranuloma venereum — painful inguinal lymphadenopathy

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4
Q

Triad of Reiters syndrome associated with chlamydia trachomatis

A

Uveitis
Urethritis
Arthritis

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5
Q

Dx of tuberculous endometritis is based on identification of ____________ on biopsy

A

Plasma cells in the stroma (not seen in normal endometrium)

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6
Q

Clinical manifestations of Haemophilus ducreyi

A

Chancroid (soft chancre) — acute ulcerative STI most common in tropical and subtropical areas among lower SES groups

In females, most lesions occur in the vagina or periurethral area 4-7 days after inoculation as tender erythematous papule. Over several days, the surface of the primary lesion erodes to produce an irregular, painful ulcer (distinguish from primary chancre of syphilis because it is not indurated and multiple lesions may be present)

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7
Q

Clinical manifestations of Klebsiella granulomatis

A

Granuloma inguinale — begins as raised papular lesion on the moist stratified squamous epithelium of genitalia. Lesion eventually ulcerates and develops abundant granulation tissue, which manifests grossly as a protruberant, soft, painless mass. As the lesion enlarges, its borders become raised and indurated.

Untreated cases are characterized by extensive scarring, often associated with lymphatic obstruction and lymphedema of external genitalia, sometimes with associated strictures

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8
Q

Describe diagnostic steps for treponema pallidum

A

Dark-field microscopy for direct visualization

VDRL = screening test

Fluorescent treponemal Ab absorption test (FTA-ABS) = confirmatory test

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9
Q

Stages of syphilis

A

Primary syphilis — chancres (painless)

Secondary syphilis — systemic disease with maculopapular rash and condyloma lata

Tertiary syphilis — gummas, syphilitic aortitis, argyll robertson pupils

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10
Q

Describe bacterial vaginosis

A

Caused by gardnerella vaginalis

May present with thin, grey-white “fishy” smelling vaginal discharge with pH >4.5

Dx by the whiff test (KOH prep) or wet mount prep showing clue cells

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11
Q

Dx and clinical manifestations of HSV-2

A

Dx by Tzanck smear — used to visualize multinucleated giant cells infected with HSV

Presents with painful inguinal LAD; lies dormant in sacral ganglia

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12
Q

Actions of E6 and E7 protein associated with high risk HPV

A

E6 destroys p53 tumor suppressor protein

E7 destroys RB tumor suppressor protein

Both lead to unchecked cell replication

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13
Q

STI caused by HPV 6 and 11

A

Condyloma acuminata

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14
Q

Poxvirus that causes flesh-colored, dome-shaped, umbilicated skin lesions that may indicate immunosuppressed state when present diffusely on an adult

A

Molluscum contagiosum

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15
Q

What would you see on microscopic exam when diagnosing candida albicans via KOH mount?

A

Budding yeast and pseudohyphae

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16
Q

Clinical manifestations of trichomonas vaginalis

A

Cervicitis with “strawberry cervix” appearance

Symptoms may include genital burning, itching, and malodorous vaginal discharge that is frothy and yellow-green, usually pH >4.5

Dx based on motile organisms seen on wet mount with characteristic trophozoite shape

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17
Q

Compare classic VIN vs. differentiated VIN

A

Classic VIN = precursor lesion for basaloid/warty type of vulvar SCC — characterized as epidermal thickening, nuclear atypia, increased mitoses, and lack of cell maturation

Differentiated VIN = precursor lesion for keratinizing type of vulvar SCC — characterized by marked atypia of the basal layer and normal appearing differentiation of more superficial layers

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18
Q

Which type (basaloid/warty or keratinizing) of vulvar SCC is related to high risk HPV infection, is less common, and develops from classic VIN?

A

Basaloid/warty type

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19
Q

Which type (basaloid/warty or keratinizing) of vulvar SCC is unrelated to HPV, but is more common and usually results d/t long-standing lichen sclerosus or squamous cell hyperplasia, and may be associated with high frequency of TP53 mutations?

A

Keratinizing type

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20
Q

Clinical manifestations of extramammary paget disease (of the vulva)

A

Presents as pruritic, red, crusted, maplike area, usually on labia majora

NOT typically associated with underlying cancer, confined to the epidermis of vulvar skin

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21
Q

Clinical presentation of papillary hidradenoma

A

presents as sharply circumscribed nodule, most commonly on labia majora or interlabial folds, and has tendency to ulcerate

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22
Q

What is uterus didelphys?

A

Double uterus due to failure of mullerian duct fusion; may be caused by genetic syndromes or in utero exposure to DES

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23
Q

______ ______ presents clinically as red, granular areas that stand out from surrounding normal pale-pink vaginal mucosa d/t residual glandular epithelium in those areas

A

Vaginal adenosis

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24
Q

Vaginal adenosis is more common in women exposed to DES, some of whom go on to develop _________

A

Clear cell carcinoma

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25
Q

1-2 cm fluid-filled cysts that occur in submucosal location d/t remnants of mesonephric (wolffian) ducts in the cervix or vagina

A

Gartner duct cyst

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26
Q

3 types of benign vaginal tumors

A

Stromal tumors
Leiomyomas
Hemangiomas

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27
Q

Uncommon vaginal tumor usually found in infants and kids <5; tends to grow as polypoid, rounded, bulky masses that resemble grape clusters

A

Embryonal rhabdomyosarcoma [histologically characterized by small tumor cells with oval nuclei and small protrusions of cytoplasm that may show cross striations]

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28
Q

Histology of the cervix

A

Ectocervix = mature squamous epithelium

Endocervix = columnar, mucus-secreting epithelium

Between them = transformation zone — unique epithelial environment renders cervix highly susceptible to infections with HPV

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29
Q

Histology and clinical significance of endocervical polyps

A

Histo: loose fibromyxomatous stroma covered by mucus-secreting endocervical glands, often accompanied by inflammation

Main clinical significance is as source of irregular vaginal “spotting”

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30
Q

HPV infects the immature ____ cells of the squamous epithelium in areas of tissue breaks or immature metaplastic squamous cells present at the squamocolumnar junction. It matures in MATURE squamous cells

A

Basal

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31
Q

Both _____ and _____ staining are highly correlated wtih HPV infection and are useful for confirmation of the diagnosis in equivocal cases of squamous intraepithelial lesions

A

Ki-67; p16

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32
Q

Grading of CIN

A

CIN I = mild dysplasia

CIN II = moderate dysplasia

CIN III = severe dysplasia

CIN I has been renamed LSIL, while CIN II and III have been combined and are called HSIL

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33
Q

Compare features of LSIL vs. HSIL

A

LSIL reflects a productive HPV infection with high viral replication but only mild growth alterations of cells. If the immature squamous cells are confined to the lower 1/3 of the epithelium, the lesion is graded as LSIL. Only a small percentage progress to HSIL.

HSIL reflects a progressive deregulation of cell cycle by HPV but lower viral replication; All are considered high risk for progression to carcinoma

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34
Q

General staging of cervical carcinoma

A

Stage 0 = carcinoma in situ (CIN III/HSIL)

Stage I = carcinoma confined to cervix

Stage II = carcinoma extends beyond cervix but not to pelvic wall; involves vagina but not the lower 1/3

Stage III = carcinoma has extended to pelvic wall with no cancer-free space between; tumor involves lower 1/3 of vagina

Stage IV = carcinoma has extended beyond true pelvis or has involved mucosa of the bladder or rectum; also includes metastatic dissemination

35
Q

Histologic changes throughout menstrual cycle including menses, proliferative phase, and secretory phase

A

Menses: superficial (functionalis) layer of endomedtrium is shed

Proliferative: rapid growth of glands and stroma arising from endometrium basalis; numerous mitotic figures. Glands appear as straight tubular structures lined by regular tall pseudostratified columnar cells. Stroma consists of spindle cells with scant cytoplasm

Secretory: appearance of secretory vacuoles beneath nuclei in glandular epithelium, by week 4 the glands become tortuous and serrated (“sawtooth”). The late secretory phase is characterized by stromal changes including prominent spiral arterioles, stromal cell hypertrophy, eosinophilia, sparse infiltrate of lymphocytes and neutrophils (normal in this scenario)

36
Q

Most common cause of DUB and the associated DDx

A

Anovulation

Endocrine disorders: thyroid disease, adrenal disease, pituitary tumors

Ovarian lesions: functioning ovarian tumor (granulosa cell tumor), polycystic ovaries

Generalized metabolic dz: obesity, malnutrition, other chronic systemic dz

37
Q

Acute vs. chronic endometritis

A

Acute: uncommon and limited to bacterial infection arising after delivery or miscarriage, usually d/t retained products of conception. Inflammatory response is limited to stroma

Chronic: occurs in association with PID, retained gestational tissue, IUDs, or TB. May present with abnormal bleeding, pain, discharge, and/or infertility. Histology reveals plasma cells in stroma.

38
Q

Most common site of involvement for endometriosis

A

Ovary

39
Q

Histologic features of atypical endometriosis

A

Cytologic atypia of epithelium lining the endometriotic cyst

Glandular crowding d/t excessive epithelial proliferation

40
Q

____ = presence of endometrial tissue within uterine wall (myometrium)

A

Adenomyosis

41
Q

2 types of endometrial polyps

A

Hyperplastic polyps — arise in association with generalized endometrial hyperplasia and are responsive to estrogen (seen with tamoxifen use)

Atrophic polyps — postmenopausal women (likely represent atrophic remnants of previously hyperplastic polyps)

42
Q

______ inactivation is present in 20% of cases of endometrial hyperplasia. Its inactivation may stimulate estrogen-dependent gene expression leading to overgrowth of cells dependent upon estrogen (endometrium, mammary tissue)

A

PTEN

[pts with Cowden syndrome who have germline mutation in PTEN have high incidence of endometrial and breast carcinoma]

43
Q

Type I vs. type II endometrial carcinoma

A

Type I: mean age 55-65, occurs in the setting of unopposed estrogen, obesity, HTN, DM; Has precursor lesion of hyperplasia and endometrioid morphology; runs more indolent course

Type II: mean age 65-75, occurs in the setting of atrophy and thin physique, has serous endometrial intraepithelial lesion as precursor and serous clear cell morphology; runs more aggressive course

44
Q

Endometrial adenocarcinomas with malignant mesenchymal component, of which the vast majority are carcinosarcomas; morphologically bulky, polypoid, with elements of adenocarcinoma and sarcoma. occur in postmenopausal women and present with bleeding

A

Malignant mixed mullerian tumors (MMMT)

45
Q

Staging criteria for endometrial cancer

A

Stage I = carcinoma is confined to body of uterus

Stage II = carcinoma involves uterus and cervix

Stage III = carcinoma extends outside uterus but not outside true pelvis

Stage IV = carcinoma extends outside the true pelvis or involves the mucosa of the bladder or rectum

46
Q

2 types of tumors of endometrial stroma

A

Adenosarcomas — most commonly present as broad based endometrial polypoid growths but may prolapse through os; Dx based on malignant appearing stroma which coexists with benign endometrial glands. Estrogen-sensitive.

Stromal tumors — benign stromal nodules and endometrial stromal sarcomas (can be subdivided in to low grade [characterized by JAZF1-SUZ12 fusion] or high grade)

47
Q

Clinical presentation and morphology of leiomyoma

A

May be asymptomatic or present with abnormal bleeding, urinary frequency, sudden pain d/t infarct of large pedunculated tumor, and impaired fertility. In pregnancy, there is increased risk of spontaneous abortion, fetal malpresentation, uterine inertia, and postpartum hemorrhage

Morphology: sharply circumscribed, discrete, round, firm, gray-white tumors that vary in size; found in myometrium of corpus. Characteristic whorled pattern of smooth muscle bundles with low mitotic index (distinguishes them from leiomyosarcomas)

48
Q

Clinical presentation and morphology of leiomyosarcomas

A

Occur both before and after menopause, with peak incidence of 40-60y. Often recur, and metastasize hematogenously or via abdominal cavity. Typically arise de novo, not from leiomyomas

Morphology: grow in 2 patterns: bulky fleshy masses that invade uterine wall OR polypoid masses that project into uterine lumen. Display nuclear atypia, higher mitotic index, and zonal necrosis

49
Q

Pyogenic inflammation of the fallopian tube; usually a manifestation of PID caused by gonococcus or chlamydia

A

Suppurative salpingitis

50
Q

Cysts lined by serous epithelium found near fimbriated end of fallopian tube or in the broad ligaments; presumed to arise from mullerian remnants

A

Hydatid of morgagni

51
Q

Mesothelioma which occurs subserosally on the fallopian tube or sometimes in the mesosalpinx

A

Adenomatoid tumor

52
Q

Differentiate follicle cysts from luteal cysts clinically and morphologically

A

Follicle cysts — common, may be associated with increased estrogen production and endometrial abnormalities. Usually multiple, filled with serous fluid, and lined by gray glistening membrane, granulosa cells, and theca cells.

Luteal cysts — present in normal ovaries of women of reproductive age. Lined by bright yellow tissue containing luteinized granulosa cells; occasionally rupture and cause a peritoneal reaction

53
Q

Polycystic ovarian syndrome increases the risk for _______ hyperplasia and carcinoma due to increases in free _______ levels

A

Endometrial; estrone

54
Q

3 overall types of ovarian tumors

A

Surface epithelial tumors (most common)

Germ cell tumors

Sex-cord stromal tumors

55
Q

Surface epithelial tumors are derived from _____ epithelium that lines the ovary. The 2 most common subtypes are ______ and ______ — both are usually cystic, and can be further categorized as benign, malignant, or borderline

A

Coelomic; serous; mucinous

56
Q

Compare features of benign, malignant, and borderline tumors arising from surface epithelium in ovary

A

Benign = cystadenoma — compoased of single cyst with simple, flat lining. Most commonly arises in premenopausal women (age 30-40)

Malignant = cystadenocarcinoma — composed of complex cysts with thick, shaggy lining. Most commonly arises in postmenopausal women (age 60-70)

Borderline = features between benign and malignant. Better prognosis than malignant but still carry metastatic potential

57
Q

_____ mutation carriers have increased risk for serous carcinoma of the ovary and fallopian tube

A

BRCA1

58
Q

_______ is a type of surface epithelium ovarian tumor that is usually malignant and may be associated with endometriosis and a similar tumor located in the endometrium

______ is a type of surface epithelium ovarian tumor that usually contains urothelium

A

Endometrioid

Brenner

59
Q

Clinical presentation and prognosis of surface epithelial cancers of the ovary

A

Typically present LATE with vague abdominal symptoms (pain, fullness) and/or signs of compression (i.e., urinary frequency)

Since they present late, they have poor prognosis; tend to spread locally, especially to peritoneum — may see omental “caking”

60
Q

Useful serum marker for monitoring tx response and screening for recurrence

A

CA-125

61
Q

Germ cell ovarian tumors are the second most common type, usually occurring in women of reproductive age. Tumor subtypes mimic tissues normally produced by germ cells. What are the 5 primary types of germ cell ovarian tumors?

A 
Cystic teratoma
Dysgerminoma
Endodermal sinus tumor (yolk sac)
Choriocarcinoma
Embryonal carcinoma
62
Q

Features of cystic teratoma germ cell ovarian tumors

A

Cystic tumor composed of fetal tissue derived from 2-3 embryologic layers

Most common germ cell tumor in females

Bilateral in 10% of cases

Usually benign. Malignant potential is indicated by presence of immature tissue (usually neuroectoderm) or somatic malignancy (usually SCC in skin contained in tumor)

63
Q

Cystic teratoma in ovary composed primarily of thyroid tissue, possibly manifesting as hyperthyroidism

A

Struma ovarii

64
Q

Features of dysgerminoma germ cell tumor in ovary

A

Composed of large cells with clear cytoplasm and central nuclei

Most common malignant germ cell tumor

Good prognosis; responds to radiotherapy

Serum LDH may be elevated

65
Q

Features of endodermal sinus tumor

A

Malignant tumor that mimics the yolk sac; most common germ cell tumor in children

Serum alpha-fetoprotein is often elevated

Schillar duvall bodies seen on histology (glomeruloid appearance)

66
Q

Features of choriocarcinoma

A

Composed of trophoblasts and syncytiotrophoblasts (villi are absent)

Small hemorrhagic tumor with early hematogenous spread

High beta hCG

Poor response to chemotherapy

67
Q

3 types of sex cord-stromal tumors are granulosa-theca cell tumors, sertoli-leydig cell tumors, and fibromas.

What are features of granulosa-theca cell tumors?

A

Neoplasm of granulosa and theca cells

Often produces estrogen; elevated tissue and serum levels of inhibin; FOXL2 mutations

Presents with signs of estrogen excess (sx vary with age)

Associated with call-exner bodies

68
Q

Features of sertoli-leydig cell tumors of the ovary

A

Sertoli cells form tubules

Leydig cells contain characteristic Reinke crystals

May produce androgen; associated with hirsutism or virilization

Associated with DICER1 mutations

69
Q

Features of ovarian fibroma (sex cord-stromal tumor)

A

Benign tumor of fibroblasts

Associated with pleural effusion and ascites (Meigs syndrome)

70
Q

A ______ tumor of the ovary consists of a mucinous carcinoma from another site, they are often bilateral

A

Kruckenberg

71
Q

Classic primary site causing a kruckenberg tumor

A

Diffuse gastric carcinoma (signet ring cells)

Other primary sites include breast or colon cancer

72
Q

Condition resulting in abundent mucin in the abdomen, primary source is usually cancer of the appendix

A

Pseudomyxoma peritonei

73
Q

Type I vs type II ovarian carcinoma

A

Type I = low-grade tumors arise in association with borderline tumors or endometriosis

Type II = high-grade serous carcinomas that arise from serous intraepithelial carcinoma

74
Q

Condition in which placenta implants in lower uterine segment or cervix, often leading to serious 3rd trimester bleeding

A

Placenta previa [when complete/covering cervical os, it requires C section]

75
Q

Condition caused by partial or complete absence of decidua, such that placental villous tissue adheres directly to the myometrium —> failure of placental separation at birth

A

Placenta accreta

[important cause of severe life-threatening postpartum bleeding; common predisposing factors = placenta previa, hx of previous C section]

76
Q

Systemic syndrome characterized by widespread maternal endothelial dysfunction that presents during pregnancy with HTN, edema, and proteinuria

A

Preeclampsia (other complications include hypercoagulability, acute renal failure, pulmonary edema)

77
Q

10% of pts with preeclampsia develop ______

A

HELLP — hemolytic anemia, elevated liver enzymes, low platelets

78
Q

Eclampsia exhibits the features of pre-eclampsia + ________

A

Seizures (and/or coma)

79
Q

Role of placenta in pathogenesis of preeclampsia and eclampsia

A

Abnormal placental vasculature sets placenta up for ischemia

Endothelial dysfunction and imbalance of angiogenic and anti-angiogenic factors results in inadequate placental vascularization, vasoconstriction, HTN, and hypoperfusion (roles of sFlt1 and endoglin)

Coagulation abnormalities include hypercoagulability d/t inadequate production of PGI2

80
Q

Cystic swelling of chorionic villi, accompanied by variable trophoblastic proliferation

A

Hydatidiform mole

81
Q

Features of complete hydatidiform mole

A

Results from fertilization of egg that lost its female chromosomes — karyotype 46,XX

No fetal tissue present

Increased risk of choriocarcinoma

HCG greatly exceeds that of a normal pregnancy

82
Q

Features of partial hydatidiform mole

A

Results from fertilization of egg with 2 sperm — karyotype 69,XXY

Fetal tissue usually present

Not associated with choriocarcinoma

83
Q

Features of invasive hydatidiform mole

A

Mole penetrates or perforates uterine wall/myometrium; hydropic villi may embolize

Manifestations include vaginal bleeding and abnormal uterine enlargement with persistent elevation of HCG

Endo Repro Exam I (10 decks)

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