Female Reproductive Tract Pathology Flashcards
Describe the embryologic development of the female GU tract
Germ cells migrate to the genital ridge to form gonads; Mullerian (paramesonephric) and Wolffian ducts (mesonephric) form; lack of SRY gene leads to ovary formation of the gonads; presence of estrogen leads to female anatomical differentiation
What is uterine didelphys?
When there are two separate uterine cavities with two separate cervices; caused by failure of fusion of the Müllerian ducts during embryologic development
What is Mayer-Rokitansky-Kuster-Hauser syndrome (Mullerian agenesis)?
Uterine/vaginal absence or underdevelopment due to Mullerian agenesis; leads to amenorrhea but normal breast, pubic hair and vulvar development
When does Pap smear screening start?
21 years
What are the guidelines for a Pap smear for ages 21-29?
Cytology every 3 years
What are the Pap smear guidelines for ages 30-65?
Co-testing with high risk HPV (molecular test) every 5 years if normal is an option; if HPV+ take cytology at 6-12mo
When can Pap test screening stop?
When >65 years old if not at high risk (3 consecutive negative Pap tests; negative hrHPV last 10 years)
What are reasons for abnormal uterine bleeding in adolescence?
Anovulatory cycle, coagulation disorders
What are reasons for abnormal uterine bleeding in reproductive age women?
Dysfunctional uterine bleeding (anovulatory cycle, ovulatory dysfunctional bleeding), anatomic lesions (Leiomyoma, adenomyosis, polyps, endometrial hyperplasia, carcinoma), complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy)
What are reasons for abnormal uterine bleeding in perimenopausal women?
Dysfunctional uterine bleeding due to anovulatory cycle; anatomic lesions (carcinoma, hyperplasia, polyps)
What are reasons for abnormal uterine bleeding in postmenopausal women?
Endometrial atrophy; anatomic lesions (need to exclude carcinoma)
What is the most common reason for an anovulatory cycle?
Hormonal imbalances during menarche (initiation of messes) and perimenopausal period
What are some conditions that can cause an anovulatory cycle?
Ovarian lesions (PCOS, functioning ovarian tumor), generalized metabolic disorder (obesity, malnutrition, chronic systemic dz), specific endocrine disorders (thyroid, adrenal, pituitary disease)
What are the factors resulting in persistence and survival of endometriotic tissue?
Release of proinflammatory and inflammatory factors; increased aromatase enzyme production causing increased estrogen; mutations in tumor suppressors/oncogenes
What are the RF for endometrial hyperplasia/carcinoma?
Chronic unopposed estrogen seen with obesity (often with DM), PCOS, estrogen replacement therapy, Tamoxifen therapy, estrogen producing tumors (granulosa cell tumor and thecoma of ovary)
Early menarche, late menopause and nulliparity (lack of child bearing) also increase the risk of what?
Endometrial hyperplasia/carcinoma
What is the 4th MC cancer in women?
Endometrial cancer
In which population is endometrial carcinoma most often seen in?
Post menopausal women
What is the MC finding in endometrial carcinoma?
Abnormal uterine bleeding
What is the malignant glandular component of MMMT?
Serous, endometrioid
What is the malignant sarcomatous component of MMMT?
Homologous (leiomyosarcoma, stromal sarcoma) or heterologous (chondrosarcoma, rhadbomyosarcoma)
What age group is affected by type I endometrial carcinoma?
55-65
What is the clinical setting for type I endometrial carcinoma?
Obesity, DM, HTN
What is the morphology of type I endometrial carcinoma?
Endometrioid
What is the precursor to type I endometrial carcinoma?
Hyperplasia
What are the major molecular/genetic abnormalities seen in type I endometrial carcinoma?
PTEN, P13K/AKT, MSI (esp in Lynch syndrome)
What is the prognosis for type I endometrial carcinoma?
Indolent, favorable prognosis
What age group is affected by type II endometrial carcinoma?
65-75
What are RFs for type II endometrial carcinoma?
Age
What is the clinical setting for type II endometrial carcinoma?
Atrophy (postmenopausal), increased in AA
What is the morphology for type II endometrial carcinoma?
Serous and MMMT
What are the major molecular/genetic abnormalities seen in type II endometrial carcinoma?
TP53
What is the prognosis for type II endometrial carcinoma?
Aggressive, poor prognosis
What is the MC ovarian malignancy?
Serous carcinomas
Malignant ovarian tumors are often what?
Bilateral esp serous and metastatic tumors; exception = mucinous tumors which are unilateral
What are the general clinical features of ovarian tumors?*
Often asx or vague sx early on; findings include adnexal mass on palpation, vaginal bleeding, abd pain/distention, urinary tract sx, GI sx; often asx until large
What are the general clinical features seen with malignant ovarian tumors?
Wt loss, ascites (with involvement of peritoneum), metastases
What is the pathogenesis for type I ovarian tumors?
Begin as benign precursors lesion which turns into a borderline tumor and finally a low grade carcinoma
Which ovarian tumors are considered to be type I?
Low grade serous, mutinous, endometrioid, clear cell and Brenner tumors
What is the pathogenesis of type II ovarian tumors?
Derived from tubal and/or ovarian surface epithelial abnormalities which give rise to a high grade aggressive tumor; tend to be associated with p53 mutations
What are examples of type II ovarian tumors?
High grade serous carcinoma (derived from a fallopian tubal precursor termed serous tubal intraepithelial carcinoma, STIC)
Many sex cord stromal tumors are positive for what?
Inhibin, especially granulosa cell tumor
