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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
Changes in cervical epithelium throughout life * At birth * Young adult * Adult
* at birth * SS nonkeratinized epithelium * Young adult * Simple columnar extends out of uterus and over cervix * Adult * Transformation zone with regrowth of squamous epithelium
26
What disease process is pictured below?
Nabothian cysts * During transformation, squamous epithelium covers and obstructs cervical gland opening * mucus accumulates in deeper glands
27
What percent of low grade cancers progress to high grade? What percent of high grade progress to invasive SCC?
10% for both
28
What markers identify a proliferating zone in upper 2/3 of cervical epithelium?
Ki-67
29
What markers are associated with intraepithelial lesions?`
* Ki-67 * marker of cell proliferation * HPV DNA * p16INK4 * cyclin kinase inhibitor * associated with high-risk HPV
30
What is the CIN grade?
There is none! This is normal cervical epithelium (SS, nonkeratinized)
31
What is the CIN grade?
CIN I Low grade (LSIL)
32
What is the CIN grade?
CIN II High grade (HSIL)
33
What is the CIN grade?
CIN III High grade (HSIL)
34
How are CIN lesions visualized?
Application of acetic acid Appears as white patches
35
What is the most common pattern of cervical SCC?
Fungating (or exophytic) Others: ulcerating, infiltrative
36
What disease process is pictured below?
Microinvasive SCC of cervix
37
What disease process is pictured below?
Invasive SCC of cervix Keratinization in some cells (keratin pearl on L)
38
What disease process is pictured below?
Adenocarcinoma arise in endocervical glands Association with HPV type 18
39
Describe the stages of SCC
* 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
40
What disease process is pictured below?
Anovulatory endometrium * Breaking down but glands match what should be proliferative phase * Estrogenic stimulation
41
What are some causes of Dysfunctional uterine bleeding?
* Inadequate luteal phase * low protesterone output * corpus luteum not functioning correctly * OC * Menopausal or postmenopausal changes * ovarian failure and atrophy of endometrium
42
What disease process is pictured below?
Endometritis
43
What disease process is pictured below?
Endometrioma or "chocolate cyst" Endometriosis Location: ovary
44
What disease process is pictured below?
Endometriosis See coming off colon (see surrounding glands)
45
What disease process is pictured below?
Atypical endometriosis * Single gland, some fluid inside * Little hemosiderin
46
What disease process is pictured below?
Adenomyosis * Endometrial nests w/i myometrium * Produces hemorrhagic cysts in uterine wall
47
What disease process is pictured below?
Endometrial polyp
48
What disease process is pictured below?
Non-atypical endometrial hyperplasia
49
What disease process is pictured below?
Atypical endometrial hyperplasia * More likely to progress to adenoCA
50
Type I endometrial carcinoma * Associated mutations * Background of endometrial dysfunction
* Mutations * PTEN * Pi3/AKT pathway * PIK3CA * KRAS activation * ARID1A loss of function * Endometrial dysfunction * Hypertrophy * Associated with hyperestrogenism
51
Type II (serous) carcinoma * Associated mutations * Background of endometrial dysfunction
* Mutations * TP53 * Endometrial dysfunction * atrophy * Not associated with hyperestrogenism * Associated with extensive peritoneal spread
52
Describe the staging system for Endometrial Adenocarcinomas
* 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
What type of neoplasm of the endometrium shows focal differentiation of extrauterine tissues such as muscle, adipose, cartilage, and bone?
Malignant mixed Mullerian Tumors
54
What disease process is pictured below?
Leiomyoma
55
What determines malignancy in leiomyosarcoma?
* 10 or more mitotic figures/high power view * 5 or more with cellular atypia * Necrosis present
56
What disease process is pictured below?
Leiomyosarcoma
57
What disease process is pictured below?
Pyosalpinx
58
What is the origin of paratubal cysts?
Wolffian duct (mesenephric duct) remnants
59
What is the origin of Hydatid cysts of Morgagni?
Mullerian (paramesenephric) duct remnants * Location * finbriated end of tube * broad ligament * Benign
60
What mutation is associated with Adenocarcinoma of the fallopian tubes?
BRCA
61
What disease process is pictured below?
Adenomatoid tumor (benign)
62
What disease process is pictured below?
Adenocarcinoma of the fallopian tubes
63
What disease process is pictured below?
Polycystic ovarian disease
64
What disease process is pictured below?
Stromal Hyperthecosis * Gross * white-tan ovary * Micro * hypercellular stroma with luteinization visible as discrete nests * Clinical presentation * virilization
65
Describe the following: * Placenta accreta * Placenta increta * Placenta percreta
* Placenta accreta * attachment into the myometrium * Placenta increta * penetration of myometrium * Placenta percreta * Penetration to serosa, may attache to adjacent organs
66
How do the following twinning circumstances occur? * Dichorionic diamnionic * Dichorionic diamnionic (fused) * Monochorionic diamnionic * Monochorionic monoamnionic
* 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
What type of infection is most likely to ascend through the birth canal?
Bacterial (often polymicrobial) * Strep * E coli * Ureaplasma * ...
68
What type of infection is most likely to spread hematogenously (transplacentally)?
* TORCH * Toxoplasmosis * CMV * HSV
69
What disease process is pictured below?
Acute amnionitis * Necrotic lesions * Inflammation * Neutrophils
70
What disease process is pictured below?
Villitis * Some inflammatory cells * Fibrin (eosinophilic, associated with necrosis)
71
What is the pathology of pre-eclampsia?
* 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
What is the role of fetal intervillous trophoblasts in placental development?
* Invade spiral arteries * Replace smooth mm and endothelium * Ultimately: * converts high resistance to high capacity
73
Placental hypoxia leads to maternal endothelial dysfunction and overproduction of what factors?
* 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
Placental hypoxia leads to maternal endothelial dysfunction and underproduction of what factor?
PGI2 * normally antithrombotic * Result: increased coagulability
75
What disease process is pictured below?
Spontaneous pregnancy loss * Elevated HCG lvls * No viable embryo but pregnancy failed to terminate * Ultrasound: diffuse villous enlargement
76
What disease process is pictured below?
Hydatidiform mole | (not specified)
77
What disease process is pictured below?
Full hydatidiform mole * Villi enlarged, edematous * (-) p57 * Only paternal genes
78
What disease process is pictured below?
Partial hydatidiform mole * Only some villi are swollen / edematous * (+) p57 * Triploid
79
What disease process is pictured below?
Invasive hydatidiform mole
80
What disease process is pictured below?
Choriocarcinoma * See trophoblastic cells * cytotrophoblasts = mononucleated * syncytialtrophoblast cells = multinucleated
81
Most frequent mets of choriocarcinoma?
1. Lungs 2. Vagina
82
What disease process is pictured below?
Placenta-Site Trophoblastic Tumor * Cell of origin * extravillus trophoblast * Invades myometrium
83
What disease process is pictured below?
Serous Cystadenoma
84
What disease process is pictured below?
Serous cystadenocarcinoma * papillary growth * solid tumor
85
Serous cystadenoma * A: low grade * B: borderline tumor * C: low grade micropapillary serous carcinoma * D: Papillary serous cystadenocarcinoma (invasion of stroma)
86
Mutations in what genes signal low-grade (well differentiated) serous tumors?
1. KRAS 2. BRAF 3. ERBB2 4. rarely p53
87
Mutations in what genes signal high-grade (poorly differentiated) serous tumors?
1. p53 2. PIK3CA 3. RB
88
What mutation and serous tumor type is present in those with BRCA mutations?
89
Most common mutation associated with mucinous tumors?
KRAS
90
What disease process is pictured below?
Mucinous cystadenoma * multicystic * Columnar cells with apical mucous accumulation
91
What is pseudomyxoma peritonei?
Mucinous ascites due to mucinous tumor extention into peritoneal cavity * may obstruct intestines * death results * Usually extra-ovarian tumor that spreads to ovaries
92
What disease process is pictured?
pseudomyxoma peritonei
93
Endometrioid ovarian tumors * Histo * Gene Mutations
* 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
Clear Cell Adenoma * Histo * Gene mutations
* Histo * large epithelial cells (hobnail) * abundant clear cytoplasm * Genes * PIK3CA * ARID1A * PTEN * TP53 * Similar to those of endometrioid carcinoma
95
What disease process is pictured below?
Brenner tumor
96
What are the categories of transitional cell tumors?
* Benign * Atypical proliferating Brenner tumor * Borderline * Malignant Brenner tumor * benign Brenner nest admixed with malignant cells * Transitional cell carcinoma * \>50% malignant cells
97
What disease process is pictured below?
Benign teratoma
98
What disease process is pictured below?
Struma ovarii
99
What disease process is pictured below?
Carcinoid teratoma * Carcinoid elements, origin probably GI * Typical pattern: organization of nests, these cells secrete 5-hydroxytryptamine
100
What disease process is pictured below?
Strumal carcinoid teratoma
101
What disease process is pictured below?
Immature teratoma * Regions of hemorrhage and necrosis * Less epithelial growth than mature
102
What disease process is pictured below?
Dysgerminoma * Round nuclei * Uniform shape * Clear cytoplasm * Scant stroma, often with lymphocytes
103
What transcription factors are common to dysgerminomas and seminomas?
* OCT3 * OCT4 * NANOG
104
What disease process is pictured below?
Yolk sac tumor * Histo: Schiller-Duval bodies * looks like glomerulus
105
What disease process is pictured below?
Choriocarcinoma of ovaries * Cytotrophoblasts (mononucleated cells) * Syncytialtrophoblasts (multinucleated)
106
What mutation is common in granulosa tumors?
FOXL2
107
What disease process is pictured below?
Granulosa tumor with Call-Exner body shown * Below, stain for inhibin
108
What disease process is pictured below?
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
What disease process is pictured below?
Sertoli-Leydig cell tumor
110
What is the effect of Sertoli-Leydig tumors in the following? * Children * Women
* Children: * Block female sexual development * Women * defeminization * breast atrophy * amenorrhea * Virilization
111
What disease process is pictured below?
Krukenberg tumor * Gastric origin * "signet-ring cell carcinoma"
112
* Hilus cell tumors * Pregnancy luteoma * Gonadoblastoma
* •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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