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ENRP Exam 1 > Female Reproductive Tract Pathology > Flashcards

Female Reproductive Tract Pathology Flashcards

1
Q

Describe the embryologic development of the female GU tract

A

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

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2
Q

What is uterine didelphys?

A

When there are two separate uterine cavities with two separate cervices; caused by failure of fusion of the Müllerian ducts during embryologic development

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3
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome (Mullerian agenesis)?

A

Uterine/vaginal absence or underdevelopment due to Mullerian agenesis; leads to amenorrhea but normal breast, pubic hair and vulvar development

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4
Q

When does Pap smear screening start?

A

21 years

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5
Q

What are the guidelines for a Pap smear for ages 21-29?

A

Cytology every 3 years

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6
Q

What are the Pap smear guidelines for ages 30-65?

A

Co-testing with high risk HPV (molecular test) every 5 years if normal is an option; if HPV+ take cytology at 6-12mo

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7
Q

When can Pap test screening stop?

A

When >65 years old if not at high risk (3 consecutive negative Pap tests; negative hrHPV last 10 years)

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8
Q

What are reasons for abnormal uterine bleeding in adolescence?

A

Anovulatory cycle, coagulation disorders

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9
Q

What are reasons for abnormal uterine bleeding in reproductive age women?

A

Dysfunctional uterine bleeding (anovulatory cycle, ovulatory dysfunctional bleeding), anatomic lesions (Leiomyoma, adenomyosis, polyps, endometrial hyperplasia, carcinoma), complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy)

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10
Q

What are reasons for abnormal uterine bleeding in perimenopausal women?

A

Dysfunctional uterine bleeding due to anovulatory cycle; anatomic lesions (carcinoma, hyperplasia, polyps)

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11
Q

What are reasons for abnormal uterine bleeding in postmenopausal women?

A

Endometrial atrophy; anatomic lesions (need to exclude carcinoma)

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12
Q

What is the most common reason for an anovulatory cycle?

A

Hormonal imbalances during menarche (initiation of messes) and perimenopausal period

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13
Q

What are some conditions that can cause an anovulatory cycle?

A

Ovarian lesions (PCOS, functioning ovarian tumor), generalized metabolic disorder (obesity, malnutrition, chronic systemic dz), specific endocrine disorders (thyroid, adrenal, pituitary disease)

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14
Q

What are the factors resulting in persistence and survival of endometriotic tissue?

A

Release of proinflammatory and inflammatory factors; increased aromatase enzyme production causing increased estrogen; mutations in tumor suppressors/oncogenes

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15
Q

What are the RF for endometrial hyperplasia/carcinoma?

A

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)

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16
Q

Early menarche, late menopause and nulliparity (lack of child bearing) also increase the risk of what?

A

Endometrial hyperplasia/carcinoma

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17
Q

What is the 4th MC cancer in women?

A

Endometrial cancer

18
Q

In which population is endometrial carcinoma most often seen in?

A

Post menopausal women

19
Q

What is the MC finding in endometrial carcinoma?

A

Abnormal uterine bleeding

20
Q

What is the malignant glandular component of MMMT?

A

Serous, endometrioid

21
Q

What is the malignant sarcomatous component of MMMT?

A

Homologous (leiomyosarcoma, stromal sarcoma) or heterologous (chondrosarcoma, rhadbomyosarcoma)

22
Q

What age group is affected by type I endometrial carcinoma?

A

55-65

23
Q

What is the clinical setting for type I endometrial carcinoma?

A

Obesity, DM, HTN

24
Q

What is the morphology of type I endometrial carcinoma?

A

Endometrioid

25
Q

What is the precursor to type I endometrial carcinoma?

A

Hyperplasia

26
Q

What are the major molecular/genetic abnormalities seen in type I endometrial carcinoma?

A

PTEN, P13K/AKT, MSI (esp in Lynch syndrome)

27
Q

What is the prognosis for type I endometrial carcinoma?

A

Indolent, favorable prognosis

28
Q

What age group is affected by type II endometrial carcinoma?

A

65-75

29
Q

What are RFs for type II endometrial carcinoma?

A

Age

30
Q

What is the clinical setting for type II endometrial carcinoma?

A

Atrophy (postmenopausal), increased in AA

31
Q

What is the morphology for type II endometrial carcinoma?

A

Serous and MMMT

32
Q

What are the major molecular/genetic abnormalities seen in type II endometrial carcinoma?

A

TP53

33
Q

What is the prognosis for type II endometrial carcinoma?

A

Aggressive, poor prognosis

34
Q

What is the MC ovarian malignancy?

A

Serous carcinomas

35
Q

Malignant ovarian tumors are often what?

A

Bilateral esp serous and metastatic tumors; exception = mucinous tumors which are unilateral

36
Q

What are the general clinical features of ovarian tumors?*

A

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

37
Q

What are the general clinical features seen with malignant ovarian tumors?

A

Wt loss, ascites (with involvement of peritoneum), metastases

38
Q

What is the pathogenesis for type I ovarian tumors?

A

Begin as benign precursors lesion which turns into a borderline tumor and finally a low grade carcinoma

39
Q

Which ovarian tumors are considered to be type I?

A

Low grade serous, mutinous, endometrioid, clear cell and Brenner tumors

40
Q

What is the pathogenesis of type II ovarian tumors?

A

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

41
Q

What are examples of type II ovarian tumors?

A

High grade serous carcinoma (derived from a fallopian tubal precursor termed serous tubal intraepithelial carcinoma, STIC)

42
Q

Many sex cord stromal tumors are positive for what?

A

Inhibin, especially granulosa cell tumor

ENRP Exam 1 (10 decks)

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