Female reproductive system and Gestational pathology Flashcards
1
Q
Bartholin cyst
A
- Cystic dilation of Bartholin gland
- Results from an obstruction of gland - can become secondary infected, most often by N. gonorrrhoeae, or less often by Staphylococcus.
- Usually occurs in women of reproductive age
- Risk of adenoid cystic carcinoma in older women
2
Q
Lichen sclerosis
A
- Thinning of epidermis and fibrosis of dermis
- White plaques and atrophic skin with a parchment-like vulvar skin - “paper-like” skin
- Most commonly seen in postmenopausal women
- Squamous cell hyperplasia (keratosis)
- Squamous cell carcinoma develops in a minority of patients
3
Q
Candidiasis
A
- Most common form of vaginitis
- Cause: Candida albicans, a normal component of the vaginal flora.
- Associated with DM, pregnancy, broad-spectrum antibiotic therapy, oral contraceptive use, and immunosuppression
4
Q
Trichomoniasis
A
- Second most common type of vaginitis
- Cause: Trichomonas vaginalis
- Most often transmitted by sexual contact
5
Q
Bacterical vaginosis
A
- Most common cause of vaginal discharge
- Cause: loss of normal vaginal lactobacilli, a consequent overgrowth of anaerobes, and a resultant superficial polymicrobial vaginal infection
- Associated with increased numbers of the facultative anaerobe Gardnerella vaginalis
- Characteristically appearance of “clue cells”
6
Q
Toxic shock syndrome
A
- Cause: exotoxin produced by Staphylococcus aureus, which grows in the tampon.
- Characteristic features include fever, vomiting, and diarrheah, sometimes followed by renal failure and shock
7
Q
Papillary hidradenoma
A
- Most common benign tumor of the vulva
- Originates from apocrine sweat glands
- Presents as a labial nodule that may ulcerate and bleed
8
Q
Condyloma acuminatum
A
- Benign squamous cell papilloma
- Caused by HPV, most frequently 6 or 11
- Multiple wart-like lesions, venereal warts, in the vulvovaginal and perianal regions
- Characterized by koilocytes
9
Q
Squamous cell carcinoma (vulva)
A
- Most common malignant tumor of the vulva (95%)
- Presents as leukoplakia
- May be HPV related or non-HPV-related
- HVP: due to types 16 and 18, arises from vulvar intraepithelial neoplasia; often basaloid or warty histology with VIN of similar histology
- Non-HPV: arises from long-standing lichen sclerosis, chronic inflammation and irritation eventually lead to carcinoma
10
Q
Extramammary paget disease
A
- Malignant epithelial cell in the epidermis of the vulva
- Represent carcinoma in situ (70-85% of cases), sometime associated with underlying adenocarcinoma of the apocrine sweat glands
- Crusting, weeping, oocing lesion; may be erythematous
11
Q
Squamous cell carcinoma (vagina)
A
- 95% of all vaginal carcinomas
- Most often due to extension of squamous cell carcinoma of the cervix
- Usually related to high-risk HPV
- Usually upper posterior vagina
- Regional LN spread: lower 2/3 of vagina goes to inguinal nodes, upper 1/3 of vagina goes to regional iliac nodes
12
Q
Clear cell adenocarcinoma
A
- Rare malignant tumor
- Greatly increased incidence in daughters of women who received diethylstilbestrol (DES) therapy during pregnancy
13
Q
Sarcoma botryoides
A
- Rare variant of embryonal rhabdomyosarcoma
- Present with bleeding and grape-like mass protruding from vagina or penis of child
- Occurs in children younger than 5 years of age
14
Q
Cervicitis
A
- Most often involves the endocervix
- Causes: ataphylococci, enterococci, G. vaginalis, T. vaginalis, C. albicans, and C. trachomatis
- Most often asymptomatic
15
Q
Cervical carcinoma
A
- Invasive carcinoma that arises from cervical epithelium
- Presents as vaginal bleeding
- Risk factors: High-risk HPV infection, smoking and immunodeficiency
- Most often squamous cell carcinoma; adenocarcinoma 5% of cases (endocervical type - 70-90% of adenocarcinomas)
- Advanced tumors - often invade through anterior uterine wall into bladder
- Dysplastic cells frequently demonstrate koilocytosis
16
Q
Endometritis
A
- Acute endometritis: Most often caused by S. aureus or Streptococcus. Related to intrauterine trauma from instrumentation, intrauterine contraceptive devices, or complications of pregnancy - retained products of conception
- Chronic endometritis: Most often caused by tuberculosis, PID, postpartum, post-abortion, IUD, symptomatic bacterial vaginosis. Also from retained products of conception
17
Q
Endometriosis
A
- Presence and proliferation of ectopic endometrial tissue
- Causes: Retrograde dissemination of endometrial fragments through fallopian tubes during menstruation, or blood-born or lymphatic-born dissemination of endometrial fragments.
- Ovary is the most common site, followed by uterine ligaments, rectovaginal septum, pelvic peritoneum.
- Presents with menstrual-related pain, infertility
18
Q
Adenomyosis
A
- Islands of endometrium within myometrium.
- Causes menorrhagia, pelvic pain during menstruation; rarely causes rupture during pregnancy
19
Q
Endometrial hyperplasia
A
- Abnormal proliferation of endometrial glands, relative to stroma
- Cause is usually excess estrogen stimulation
- Most often presents with postmenopausal bleeding
- Sometimes a precursor lesion of endometrial carcinoma; the risk of carcinoma varies with the degree of cellular atypia
20
Q
Leiomyoma
A
- Most common uterine tumor and the most common of all tumors in women
- Benign proliferation of smooth muscle arising from myometrium
- Related to estrogen exposure, often increase in side during pregnancy, and they almost always decrease in size following menopause
- Multiple, well-defined white whorled masses
21
Q
Leiomyosarcoma
A
- Malignant proliferation of smooth muscle arising from the myometrium
- Arises the novo (leiomyoma does not become leiomyosarcoma
- Usually seen in postmenopausal women
- Single lesion with necrosis and hemorrhage
- Necrosis, mitotic activity, and cellular atypic
- Tend to recur, 50% metastasize to lung, bone, brain, other; lymph node involvement unusual
22
Q
Endometrial carcinoma
A
- Most common gynecologic malignancy
- Type I (endometrioid): more common (80%); arises from endometrial hyperplasia; risk factors are related to estrogen exposure
- Type II (non-endometrioid): occur in older age group and have poor prognosis; arises in atrophic endometrium; serous papillary and clear cell carcinoma
23
Q
Salpingitis
A
- Most often associated with inflammation of the ovaries and other adjacent tissue
- Causes: most often N. gonorrhoeae, various anaerobic bacteria, C. trachoma tis, streptococci, and other pyogenic organisms
- Can be caused by trauma, such as surgical manipulation
- Pyosalpinx - tube filled with pus
- Hydrosalpinx - tube filled with watery fluid
24
Q
Follicular cyst
A
- Cyst due to distention of the unruptured graafian follicle
- Sometime associate with hyperstrinism and endometrial hyperplasia
25
Q
Theca-lutein cyst
A
- Result from gonadotropin stimulation
- Can be associated with choriocarcinoma and hydatidiform mole
- Often multiple and bilateral and lined by luteinized theca cells
26
Q
Chocolate cyst
A
- Blood-containing cyst resulting from ovarian endometriosis with hemorrhage
27
Q
Polycystic ovary syndrome
A
- Multiple follicular cysts in ovary due to hormone imbalance
- Causes may include excess LH and androgens, and low FSH; LH:FSH>2
- Presents with amenorrhea, infertility, obesity, and hirsutism
- Markedly thickened ovarian capsule, multiple small follicular cysts, cortical stromal fibrosis
28
Q
Serous cystadenoma
A
- Group: Surface epithelial tumor
- Benign cystic tumor lined with cells similar to fallopian tube epithelium
- Accounts for approximately 20% of all ovarian tumors and is frequently bilateral
29
Q
Serous borderline tumor
A
- Group: Surface epithelial tumor
- Tumor of intermediate malignant potential
- Typically comprised of papillary fronds with moderate atypia and some mitotic activity, and lacks significant invasion
30
Q
Serous cystadenocarcinoma
A
- Group: Surface epithelial tumor
- Malignant tumor
- Accounts for approximately 50% of ovarian carcinomas
- Frequently bilateral
31
Q
Mucinous cystadenoma
A
- Group: Surface epithelial tumor
- Benign tumor characterized by multilocular cysts lined by mucus-secreting columnar epithelium and filled with mucinous material
32
Q
Mucinous borderline tumor
A
- Group: Surface epithelial tumor
- Typically occur in younger women and are confines to the ovary
33
Q
Mucinous cystadenocarcinoma
A
- Group: Surface epithelial tumor
- Malignant tumor
- Through rupture or metastasis, can result in pseudomyxoma peritonei with multiple peritoneal tumor implants
34
Q
Endometrioid adenocarcinomas
A
- Group: Surface epithelial tumor
- Often, synchronous endometrial primaries are identified in patients with ovarian tumors of this histologic type
35
Q
Clear cell carcinomas
A
- Group: Surface epithelial tumor
- High grade malignancies
- Most common tumors seen in association in with endometriosis
36
Q
Brenner tumors
A
- Group: Surface epithelial tumor
- Rare, benign tumors
- Characterized by small islands of epithelial cells resembling bladder transitional epithelium interspersed within a fibrous stroma
37
Q
Dysgerminoma
A
- Group: Tumors of germ cell origin
- Most common malignant germ cell tumor
- Analogous to testicular seminoma
- Composed of large cells with clear cytoplasm and central nuclei
38
Q
Endodermal sinus (yolk sac) tumor
A
- Group: Tumors of germ cell origin
- Resembles extraembryonic tolk sac structures
- Produces alpha-fetoprotein
- Most common germ cell tumor in children
- Schiller-Duval bodies
39
Q
Teratomas
A
- Group: Tumors of germ cell origin
- Derived from two or three embryonic layers
- Most common germ cell tumor in females
- Three distinct forms:
(1) Immature teratoma - includes immature cellular elements, which are most often primitive neural elements
(2) Mature teratoma (dermoid cyst) - accounts for 20% of ovarian tumors and 90% of germ cell tumors, consist of many elements; skin, hair, bone, tooth, cartilage, etc.
(3) Monodermal teratoma - contains only a single tissue element, most common is strum ovarii which consist entirely of thyroid tissue
40
Q
Ovarian choriocarcinoma
A
- Group: Tumors of germ cell origin
- Agressive malignant tumor
- Composed of trophoblasts and syncytiotrophoblasts
- Small, hemorrhagic tumor with early hematogenous spread
- Secretes beta-hCG
41
Q
Fibroma
A
- Group: Sex cord-stromal tumors
- Benign tumor consisting of bundles of spindle-shaped fibroblasts
- May be associated with Meigs syndrome: triad of ovarian fibroma, ascites, and hydrothorax
42
Q
Thecoma
A
- Group: Sex cord-stromal tumors
- Round lipid-containing cells in addition to fibroblasts
- Occasionaly estrogen-secreting
43
Q
Granulosa cell tumor
A
- Group: Sex cord-stromal tumors
- Estrogen-secreting tumor - causes precocious puberty
- In adults: associated with endometrial hyperplasia or endometrial carcinoma
- Call-Exner bodies, small follicles filled with eosinophilic secretion, are an important diagnostic feature
44
Q
Sertoli-Leydig cell tumor
A
- Group: Sex cord-stromal tumors
- Sertoli cells from tubules
- Leydig cell contain characteristic Reinke crystals
- Androgen-secreting tumor - associated with virilism (masculinization) or hirsutism
45
Q
Tumors metastatic to the ovary
A
- Account from approximately 5% of all ovarian tumors
- Frequently of GI tract, breast, or endometrial origin
- Krukenberg tumors = ovaries replaced bilaterally by mucinus-secreting signet-ring cells - often stomach origin
46
Q
Ectopic pregnancy
A
- Most often located in the fallopian tubes. Can also occur in the ovary, abdominal cavity, or cervix
- Most often predisposed by chronic salpingitis, often gonorrheal.
- Other predisposing factors are endometriosis and postoperative adhesions
- Frequently no obvious cause
- Most common cause of hematosalpinx
47
Q
Placental abruption
A
- Premature separation of the placenta
- Important cause of antepartum bleeding and fetal death
- Often associated with disseminated intravascular coagulation (DIC)
48
Q
Placenta accreta
A
- Attachment of the placenta directly to the myometrium; the decidual layer is defective
- Predisposed by endometrial inflammation and old scars from prior cesarean sections or other surgery
- Clinically: impraired placental separation after delivery, sometimes with massive hemorrhage
49
Q
Placenta previa
A
- Attachment of the placenta to the lower uterine segment, partially or completely covering the cervical os
- May coexist with placenta accreta
- Presents as third-trimester bleeding
- Often requires delivery of fetus by C-section
50
Q
Preeclampsia
A
- Milder form of toxemia
- Pregnancy-induced HTN, proteinuria, and edema
- Arises in 3rd trimester
- Due to abnormality of maternal-fetal vascular interface in placenta
51
Q
Eclampsia
A
- Severe form of toxemia
- Preeclampsia with seizures
- Reverse rapidly on termination of pregnancy, but can be fatal
52
Q
Hydatidiform mole
A
- Proliferation of throphoblasts
- Enlarged, edematous placental villi in a loose stroma, grossly resembling a bunch of grapes
- Increase in hCG
- Uterus expand as if normal pregnancy is present
- Fetal heart sound are absent - “snow-storm” appearance on ultrasound
(1) Complete hydatidiform mole: no embryo is present; 46,XX karyotype
(2) Partial hydatidiform mole: embryo is present; triploidy and rarely tetraploidy occur. Due to fertilization of the ovum by two or more spermatozoa
53
Q
Gestational choriocarcinoma
A
- Aggressive malignant neoplasm that occur more frequently than ovarian choriocarcinoma
- May arise as a complication of gestation or as a spontaneous germ cell tumor
(1) Hydatidiform mole - 50% of cases
(2) Abortion of ectopic pregnancy - 20% of cases
(3) Normal-term pregnancy - 20-30% of cases - Increase in hCG is an important diagnostic sign
- Characteristic include early hematogenous spread to the lungs
- Respond well to chemotherapy
54
Q
Vaginal cysts
A
- Epithelial inclusion cyst: lined by squamous epithelium; may occur post-surgery or trauma
- Gartner duct cyst: rare, in lateral vaginal wall, non-mucin secreting
- Mullerian/mucous cyst: mucin secreting columnar cells, focal squamous metaplasia
- Urothelial cysts: rare, from periurethral and Skene’s glands
