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Female Reproductive System Flashcards

1
Q

This cell type is characteristic of what type of infxn?

A

HSV

  • Cell characteristics:
    • Multinucleated giant cell
    • eosinophilic inclusions
    • Ground-glass nuclei
  • Symptoms
    • inguinal lymphadenopathy
    • Red papule => vesicle => pustule => painful ulcer
    • Dysuria / urinary retention
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2
Q

The picture respresents what type of infxn?

A

Molluscum contagiosum type II (Pox virus)

  • Cell characteristics
    • Large intracytoplasmic viral inclusions
  • Gross appearance
    • Pearly, dome - shaped papules with dimpled center
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3
Q

The cell type is characteristic of what type of infxn?

A

Trichomoniasis

  • Organism: Trichomonas vaginalis
  • Cell characteristics:
    • flagellated protozoan
  • Symptoms
    • Strawberry cervix
    • Vaginal discharge
      • yellow-green / gray
      • Copious
      • Frothy
      • Fishy odor
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4
Q

The histology below shows what type of infxn?

A

Gardnerella vaginalis = bacterial vaginosis

  • Histo
    • epithelial cells from PAP smear
    • covered in organisms
  • Symptoms
    • Discharge
      • Gray / white
      • fishy odor
      • not frothy like trichomonos
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5
Q

Mycoplasma infection of the endometrium has been shown to cause what complications?

A
  • Infertility
  • Preterm delivery
  • Spontaneous abortion
  • Chorioamnionitis
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6
Q

The histology below indicates what disease? What is the most likely infectious cause?

A

PID

  • Cause:
    • Chlamydia
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7
Q

What organisms cause PID?

A
  1. Gonococcus
  2. Chlamydia
  3. Enteric bacteria
    • Strep
    • Staph
    • Clostridium perfringens
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8
Q

What is the progression of PID infxn (gonococcal)?

A
  1. Begins in Glands
    • Bartholin, vestibular or periurethral glands
  2. Acute suppurative salpingitis
    • may leak out of fimbriated end
  3. Salpingo-oophoritis
    • fibria seal or become plastered against ovary
      • abscess can form
  4. Pyosalpinx
  5. Hydrosalpinx (proteolysis of pus)
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9
Q

What is the progression of PID in non-gonococcal infxn?

A
  • Ascend thru lymphatics and veins rather than mucosa
  • Greater inflammatory response deep in tissue
    • less exudate and mucosal involvement
    • May spread to adjacent organs
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10
Q

What are the complications of PID?

A
  • Peritonitis
    • Intestinal obstruction from adhesion between bowel and pelvic organs
  • Bacteremia
  • Infertility
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11
Q

What is pictured below?

A

Bartholin cyst

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12
Q

The histology below shows what disease?

A

Lichen sclerosus

  • Characteristic:
    • Parchment-like skin
  • Histo
    • Epidermal thinning
    • Hyperkeratosis of upper layers
    • Basal degeneration
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13
Q

What is pictured below?

A

Squamous cell hyperplasia

(Lichen simplex chronicus)

  • Key feature:
    • No atypia
  • Clinical feature
    • pruritis
    • Gray-white or red with white plaques
    • Stenosis of vag opening not seen (as in lichen sclerosus)
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14
Q

The histology below is characteristic of what disease?

A

Condyloma acuminatum

  • Infxn by HPV 6 and 11
  • Histology
    • koilocytes
    • perinuclear clearing
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15
Q

Basaloid and Warty carcinomas

  • Type of cancer
  • Associated with infection by what?
  • Gross appearance
  • Microscopic appearance
A
  • Type of cancer
    • SCC of vulva
  • Associated with infection by what?
    • High risk HPV
      • 16, 18, 31
  • Gross Appearance
    • White or pigmented plaques
  • Microscopic appearance
    • Basaloid: poorly-differentiated
    • Warty: well-differentiated, koilocytic atypia
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16
Q

Keratinizing Squamous Cell Carcinoma

  • Associated with what medical conditions?
  • Gross appearance
  • Microscopic appearance
  • Cause
A
  • Association​
    • ​long standing squamous cell hyperplasia
    • Lichen sclerosis
  • Gross appearance
    • Nodules in background of inflammation
  • Microscopic appearance
    • atypia of basal layers
    • keratin pearls
  • Cause
    • Association w/ p53 mutation
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17
Q

What are the most common locations of lymph node involvement in keratinized SCC of the vulva? Of other metastasis?

A

Nodes:

  1. Inguinal
  2. Pelvic
  3. Iliac
  4. Periaortic

Mets:

  1. Lung
  2. Liver
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18
Q

Papillary hidradenoma

  • Origin
  • Associated with infection by what?
  • Gross appearance
  • Microscopic appearance
A
  • Origin
    • apocrine sweat gland
  • Associated with infection by what?
  • Gross appearance
    • dome shaped
    • well circumscribed nodule
  • Outcome:
    • benign course
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19
Q

What disease is pictured?

A

Extramammary Pagets disease

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20
Q

What disease is pictured?

A

Malignant melanoma

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21
Q

Markers for Paget vs melanoma

A
  • Paget
    • Keratin 7 (+)
    • PAS (+)
      • mucopolysaccharide stain
  • Melanoma
    • S-100 (+)
    • Lacks keratin and PAS staining
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22
Q

What disease process is pictured below?

A

Vaginal adenosis

  • Histo
    • Focal remnants of columnar, glandular epithelium of mullerian duct
    • mucous-secreting epithelium (like endocervix) or
    • tuboendometrial epithelium
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23
Q

What disease process is pictured below?

A

Vaginal adenocarcinoma

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24
Q

What disease process is pictured below?

A
  • Histo
    • Fibromyxomatous stroma
    • Mucus - secreting endocervical glands
  • Symptoms
    • vaginal spotting or bleeding
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25
Q

Changes in cervical epithelium throughout life

  • At birth
  • Young adult
  • Adult
A
  • at birth
    • SS nonkeratinized epithelium
  • Young adult
    • Simple columnar extends out of uterus and over cervix
  • Adult
    • Transformation zone with regrowth of squamous epithelium
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26
Q

What disease process is pictured below?

A

Nabothian cysts

  • During transformation, squamous epithelium covers and obstructs cervical gland opening
    • mucus accumulates in deeper glands
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27
Q

What percent of low grade cancers progress to high grade? What percent of high grade progress to invasive SCC?

A

10% for both

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28
Q

What markers identify a proliferating zone in upper 2/3 of cervical epithelium?

A

Ki-67

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29
Q

What markers are associated with intraepithelial lesions?`

A
  • Ki-67
    • marker of cell proliferation
  • HPV DNA
  • p16INK4
    • cyclin kinase inhibitor
    • associated with high-risk HPV
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30
Q

What is the CIN grade?

A

There is none! This is normal cervical epithelium

(SS, nonkeratinized)

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31
Q

What is the CIN grade?

A

CIN I

Low grade (LSIL)

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32
Q

What is the CIN grade?

A

CIN II

High grade (HSIL)

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33
Q

What is the CIN grade?

A

CIN III

High grade (HSIL)

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34
Q

How are CIN lesions visualized?

A

Application of acetic acid

Appears as white patches

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35
Q

What is the most common pattern of cervical SCC?

A

Fungating (or exophytic)

Others: ulcerating, infiltrative

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36
Q

What disease process is pictured below?

A

Microinvasive SCC of cervix

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37
Q

What disease process is pictured below?

A

Invasive SCC of cervix

Keratinization in some cells (keratin pearl on L)

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38
Q

What disease process is pictured below?

A

Adenocarcinoma

arise in endocervical glands

Association with HPV type 18

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39
Q

Describe the stages of SCC

A
  • Stage 0
    • CIS
  • Stage 1
    • confined to the cervix
    • Ia1: invasion < 3mm deep and 7mm wide
    • Ib: invasive but confined to cervix
  • Stage 2
    • Extends to upper 2/3 of vagina
  • Stage 3
    • Extends to pelvic wall and lower 1/3 of vagina
  • Stage 4
    • Extends beyond pelvis or involves bladder or rectum
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40
Q

What disease process is pictured below?

A

Anovulatory endometrium

  • Breaking down but glands match what should be proliferative phase
    • Estrogenic stimulation
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41
Q

What are some causes of Dysfunctional uterine bleeding?

A
  • Inadequate luteal phase
    • low protesterone output
    • corpus luteum not functioning correctly
  • OC
  • Menopausal or postmenopausal changes
    • ovarian failure and atrophy of endometrium
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42
Q

What disease process is pictured below?

A

Endometritis

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43
Q

What disease process is pictured below?

A

Endometrioma or “chocolate cyst”

Endometriosis

Location: ovary

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44
Q

What disease process is pictured below?

A

Endometriosis

See coming off colon (see surrounding glands)

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45
Q

What disease process is pictured below?

A

Atypical endometriosis

  • Single gland, some fluid inside
  • Little hemosiderin
46
Q

What disease process is pictured below?

A

Adenomyosis

  • Endometrial nests w/i myometrium
  • Produces hemorrhagic cysts in uterine wall
47
Q

What disease process is pictured below?

A

Endometrial polyp

48
Q

What disease process is pictured below?

A

Non-atypical endometrial hyperplasia

49
Q

What disease process is pictured below?

A

Atypical endometrial hyperplasia

  • More likely to progress to adenoCA
50
Q

Type I endometrial carcinoma

  • Associated mutations
  • Background of endometrial dysfunction
A
  • Mutations
    • PTEN
      • Pi3/AKT pathway
    • PIK3CA
    • KRAS activation
    • ARID1A loss of function
  • Endometrial dysfunction
    • Hypertrophy
    • Associated with hyperestrogenism
51
Q

Type II (serous) carcinoma

  • Associated mutations
  • Background of endometrial dysfunction
A
  • Mutations
    • TP53
  • Endometrial dysfunction
    • atrophy
    • Not associated with hyperestrogenism
  • Associated with extensive peritoneal spread
52
Q

Describe the staging system for Endometrial Adenocarcinomas

A
  • Stage I
    • confined to corpus
  • Stage II
    • corpus and cervix
  • Stage III
    • Outside uterus but not outside true pelvis
  • Stage IV
    • Outside true pelvis or involves mucosa of bladder or rectum
53
Q

What type of neoplasm of the endometrium shows focal differentiation of extrauterine tissues such as muscle, adipose, cartilage, and bone?

A

Malignant mixed Mullerian Tumors

54
Q

What disease process is pictured below?

55
Q

What determines malignancy in leiomyosarcoma?

A
  • 10 or more mitotic figures/high power view
  • 5 or more with cellular atypia
  • Necrosis present
56
Q

What disease process is pictured below?

A

Leiomyosarcoma

57
Q

What disease process is pictured below?

A

Pyosalpinx

58
Q

What is the origin of paratubal cysts?

A

Wolffian duct (mesenephric duct) remnants

59
Q

What is the origin of Hydatid cysts of Morgagni?

A

Mullerian (paramesenephric) duct remnants

  • Location
    • finbriated end of tube
    • broad ligament
  • Benign
60
Q

What mutation is associated with Adenocarcinoma of the fallopian tubes?

61
Q

What disease process is pictured below?

A

Adenomatoid tumor (benign)

62
Q

What disease process is pictured below?

A

Adenocarcinoma of the fallopian tubes

63
Q

What disease process is pictured below?

A

Polycystic ovarian disease

64
Q

What disease process is pictured below?

A

Stromal Hyperthecosis

  • Gross
    • white-tan ovary
  • Micro
    • hypercellular stroma with luteinization visible as discrete nests
  • Clinical presentation
    • virilization
65
Q

Describe the following:

  • Placenta accreta
  • Placenta increta
  • Placenta percreta
A
  • Placenta accreta
    • attachment into the myometrium
  • Placenta increta
    • penetration of myometrium
  • Placenta percreta
    • Penetration to serosa, may attache to adjacent organs
66
Q

How do the following twinning circumstances occur?

  • Dichorionic diamnionic
  • Dichorionic diamnionic (fused)
  • Monochorionic diamnionic
  • Monochorionic monoamnionic
A
  • Top: Two separate fertilizations, two implantation sites OR early separation of two implantation sites
  • Bottom left (MD): One fertilization, one ova, two inner cell masses (ICM)
  • Bottom right (MM): One fertilization, one ova, one ICM, two primitive streaks
67
Q

What type of infection is most likely to ascend through the birth canal?

A

Bacterial (often polymicrobial)

  • Strep
  • E coli
  • Ureaplasma
  • …
68
Q

What type of infection is most likely to spread hematogenously (transplacentally)?

A
  • TORCH
  • Toxoplasmosis
  • CMV
  • HSV
69
Q

What disease process is pictured below?

A

Acute amnionitis

  • Necrotic lesions
  • Inflammation
  • Neutrophils
70
Q

What disease process is pictured below?

A

Villitis

  • Some inflammatory cells
  • Fibrin (eosinophilic, associated with necrosis)
71
Q

What is the pathology of pre-eclampsia?

A
  • Early pregnancy
    • Failure of spiral arteries to change from resistance vessels to high capacity vessel
      • Normal job of intervillous trophoblasts
  • Late pregnancy
    • Vessels can’t handle demand
    • Placental hypoxia
    • Maternal endothelial dysfunction
    • Overproduction of sFlt1
      • Decoy receptor: VEGF and PlGF (placental)
      • (-) VEGF signaling
    • Overproduction of endoglin
      • (-) TGF receptors
    • Decreased PGI2 (normally antithrombotic)
  • Overall
    • decreased antithrombotic
    • decreased proangiogenic activity
72
Q

What is the role of fetal intervillous trophoblasts in placental development?

A
  • Invade spiral arteries
  • Replace smooth mm and endothelium
  • Ultimately:
    • converts high resistance to high capacity
73
Q

Placental hypoxia leads to maternal endothelial dysfunction and overproduction of what factors?

A
  • sFlt1
    • decoy VEGF receptor
    • also binds placental GF (PlGF)
    • (-) angiogenic activity
    • (-) NO induction by VEGF
  • Endoglin
    • decoy TGF-ß receptor
    • blocks TGF-ß activity
74
Q

Placental hypoxia leads to maternal endothelial dysfunction and underproduction of what factor?

A

PGI2

  • normally antithrombotic
  • Result: increased coagulability
75
Q

What disease process is pictured below?

A

Spontaneous pregnancy loss

  • Elevated HCG lvls
  • No viable embryo but pregnancy failed to terminate
  • Ultrasound: diffuse villous enlargement
76
Q

What disease process is pictured below?

A

Hydatidiform mole

(not specified)

77
Q

What disease process is pictured below?

A

Full hydatidiform mole

  • Villi enlarged, edematous
  • (-) p57
  • Only paternal genes
78
Q

What disease process is pictured below?

A

Partial hydatidiform mole

  • Only some villi are swollen / edematous
  • (+) p57
  • Triploid
79
Q

What disease process is pictured below?

A

Invasive hydatidiform mole

80
Q

What disease process is pictured below?

A

Choriocarcinoma

  • See trophoblastic cells
    • cytotrophoblasts = mononucleated
    • syncytialtrophoblast cells = multinucleated
81
Q

Most frequent mets of choriocarcinoma?

A
  1. Lungs
  2. Vagina
82
Q

What disease process is pictured below?

A

Placenta-Site Trophoblastic Tumor

  • Cell of origin
    • extravillus trophoblast
  • Invades myometrium
83
Q

What disease process is pictured below?

A

Serous Cystadenoma

84
Q

What disease process is pictured below?

A

Serous cystadenocarcinoma

  • papillary growth
  • solid tumor
85
Q
A

Serous cystadenoma

  • A: low grade
  • B: borderline tumor
  • C: low grade micropapillary serous carcinoma
  • D: Papillary serous cystadenocarcinoma (invasion of stroma)
86
Q

Mutations in what genes signal low-grade (well differentiated) serous tumors?

A
  1. KRAS
  2. BRAF
  3. ERBB2
  4. rarely p53
87
Q

Mutations in what genes signal high-grade (poorly differentiated) serous tumors?

A
  1. p53
  2. PIK3CA
  3. RB
88
Q

What mutation and serous tumor type is present in those with BRCA mutations?

89
Q

Most common mutation associated with mucinous tumors?

90
Q

What disease process is pictured below?

A

Mucinous cystadenoma

  • multicystic
  • Columnar cells with apical mucous accumulation
91
Q

What is pseudomyxoma peritonei?

A

Mucinous ascites due to mucinous tumor extention into peritoneal cavity

  • may obstruct intestines
    • death results
  • Usually extra-ovarian tumor that spreads to ovaries
92
Q

What disease process is pictured?

A

pseudomyxoma peritonei

93
Q

Endometrioid ovarian tumors

  • Histo
  • Gene Mutations
A
  • Histo
    • have tubular glands that resemble endometrial glands
  • Genes
    • PTEN
    • PIK3CA
    • ARID1A
    • KRAS
    • DNA mismatch repair (CTNNB1)
    • TP53
    • Similar to those in endometrial endometrioid carcinoma
94
Q

Clear Cell Adenoma

  • Histo
  • Gene mutations
A
  • Histo
    • large epithelial cells (hobnail)
    • abundant clear cytoplasm
  • Genes
    • PIK3CA
    • ARID1A
    • PTEN
    • TP53
    • Similar to those of endometrioid carcinoma
95
Q

What disease process is pictured below?

A

Brenner tumor

96
Q

What are the categories of transitional cell tumors?

A
  • Benign
  • Atypical proliferating Brenner tumor
    • Borderline
  • Malignant Brenner tumor
    • benign Brenner nest admixed with malignant cells
  • Transitional cell carcinoma
    • >50% malignant cells
97
Q

What disease process is pictured below?

A

Benign teratoma

98
Q

What disease process is pictured below?

A

Struma ovarii

99
Q

What disease process is pictured below?

A

Carcinoid teratoma

  • Carcinoid elements, origin probably GI
  • Typical pattern: organization of nests, these cells secrete 5-hydroxytryptamine
100
Q

What disease process is pictured below?

A

Strumal carcinoid teratoma

101
Q

What disease process is pictured below?

A

Immature teratoma

  • Regions of hemorrhage and necrosis
  • Less epithelial growth than mature
102
Q

What disease process is pictured below?

A

Dysgerminoma

  • Round nuclei
  • Uniform shape
  • Clear cytoplasm
  • Scant stroma, often with lymphocytes
103
Q

What transcription factors are common to dysgerminomas and seminomas?

A
  • OCT3
  • OCT4
  • NANOG
104
Q

What disease process is pictured below?

A

Yolk sac tumor

  • Histo: Schiller-Duval bodies
    • looks like glomerulus
105
Q

What disease process is pictured below?

A

Choriocarcinoma of ovaries

  • Cytotrophoblasts (mononucleated cells)
  • Syncytialtrophoblasts (multinucleated)
106
Q

What mutation is common in granulosa tumors?

107
Q

What disease process is pictured below?

A

Granulosa tumor with Call-Exner body shown

  • Below, stain for inhibin
108
Q

What disease process is pictured below?

A

Thecoma-fibroma

  • Front,
    • Large bisected fibroma of the ovary apparent as a white, firm mass .
  • Back,
    • Thecoma-fibroma composed of plump, differentiated stromal cells with thecal appearance.
109
Q

What disease process is pictured below?

A

Sertoli-Leydig cell tumor

110
Q

What is the effect of Sertoli-Leydig tumors in the following?

  • Children
  • Women
A
  • Children:
    • Block female sexual development
  • Women
    • defeminization
      • breast atrophy
      • amenorrhea
  • Virilization
111
Q

What disease process is pictured below?

A

Krukenberg tumor

  • Gastric origin
  • “signet-ring cell carcinoma”
112
Q
  • Hilus cell tumors
  • Pregnancy luteoma
  • Gonadoblastoma
A
  • •Hilus cell tumors (pure Leydig cells)
    • •Androgen producing
    • •Virulization less than in Sertoli/Leydig cell tumors
  • • Pregnancy luteoma
    • •Closely resembles corpus luteum
    • •Generally produces androgens
  • •Gonadoblastoma
    • •Immature Sertoli cells and granulosa cells
    • •80% phenotypic females
    • •20% phenotypic males with undecended testes and female internal secondary organs (pseudohermaphrodites)
    • •50% have coexistent dysgerminoma

Pathology (27 decks)

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