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ENRP II > Female Reproductive Tract Pathology Part 2 > Flashcards

Female Reproductive Tract Pathology Part 2 Flashcards

1
Q

what two cysts are the most common submucosal cysts in reproductive aged women

A

gartner duct cyst

mullerian cyst

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2
Q

gartner duct cysts is derived from _ remnants

A

wolfian (mesonephric)

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3
Q

mullerian cysts are derived from _ duct remnants

A

mullerian/paramesonephric

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4
Q

both gartner duct cysts and mullerian cysts are found on the _ _ walls of the vagina somtimes protruding from the _

A

anterior lateral walls

ofifice

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5
Q

when gartner and mullerian cysts are symptomatic they can cause?

A

vaginal pressure or painful intercourse

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6
Q

histology of a gartner duct cysts and mullerian cyst

A

gartner: low cuboidal lining

mullerian: endocervial type lining: tubal, squamous etc.

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7
Q

in utero DES exposure predisposed women to develop _ _ _ (type of cancer)

A

vaginal clear cell adenocarcinoma

in daughters of mothers who took the drug

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8
Q

DES is a _ estrogen utilized clinically in the past to address pregnancy issues like miscarriage, preterm delivery etc.

A

non-steroidal

no longer given after 1971

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9
Q

females exposed to DES in utero have increased pathes of?

A

vaginal adenosis

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10
Q

vaginal adenosis

A

normal vaginal squamous mucosa contains or is replaced by glandular epithelium

benign change

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11
Q

what is a vaginal embryonal rhadomyosarcoma (sarcoma botryoides)

A

uncommon vaginal tumor in infants and young girls (less than 5)

it presents as a grape like bulky protruding mass or with mloody mucousy discharge

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12
Q

complications of a vaginal embryonal rhabdomyosarcoma

A

death if invasion of tumor into the peritoneum or if it obstructs the bladder

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13
Q

what is the cell type in a vaginal embryonal rhabdomyosarcoma

A

embryonal rhadbdomyoblasts (they are supposed to differentiated into mature muscle cells)

will see these cells on histology

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14
Q

pathogenesis of vaginal squamous cell carcinoma

A

starts as a premalignant lesion: VAIN- vaginal intraepithelial neoplasia caused by HPV 16, 18 (high risk strain)

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15
Q

how does vaginal SCC metastasize

lower 2/3 of vagina:

upper vagina:

A

lower: inguinal/femoral lymph nodes

upper vagina: regional iliac nodes, periaortic lymph nodes

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16
Q

almost all cervical and vaginal carcinomas are caused by high risk _

A

HPV (16 most common, but 18 as well)

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17
Q

HPV is a _ virus and is transmitted through?

A

DNA

sexual contact

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18
Q

HPV integrates into the squamous cells genome where the _ and the _ oncogenes create proteins that promote oncogenesis

A

E6 and E7

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19
Q

what role does E6 play in HPV

A

increase TERT which increases telomerase and gives the ceel immortality (infinite amount of divisions)

it also degrades P53 which is a tumor suppresor gene (recognized DNA damage)

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20
Q

what role does E7 play in HPV

A

it drives cellular proliferation from the G1/S checkpoint by inhibitng p21 and and binding to RB which allows for the E2F complex to displace and cause advancement through the cycle

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21
Q

what are the cervical squamous lesions? CIN vs SIL

A

mild dysplasia is CIN I which is also known as LSIL (low grade squamous intraepithelial lesion)

Moderate/Severe/Carcinoma insitu (CIN II, III) are also known as HSIL (high grade squamous intrapeithelial lesion)

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22
Q

what is the progression of LSIL and HSIL

A

10% of LSIL go on to be HSIL

10% of HSIL go on to be carcinoma

23
Q

human papilloma virus has a predilection for the _ zone which is the transition from ectocervical (Stratifiec squamous) to endocervical (columnar) mucosa

A

transformation zone

24
Q

what is the transformation zone in the cervix comprised of (type of epithelium)

A

metaplastic squamous epithelium

25
Q

infection by human papilloma virus occurs in the _ layer

A

basal

this means that cervical dyplasia is typed based on the maturation of the squamous epithelium (they clear as they reach the surface)

26
Q

in mild squamous dysplasia/LSIL what does the histology look like

A

there is a lack of maturation in the lower 3rd of the epithelium with kolicytes in the upper layers

remember koilyctes are squamous cells with hyperchromatic nuclei with perinuclear clearing ( halo appearance)

27
Q

as cervical dysplasia progresses to HSIL what is seen histologically

A

the progression of immature squamous cells (no cleared out) towards the top of the epithelium with mitotic figures (full thickness immaturity is the highest grade)

28
Q

how do we screen for a squamous intraepithelial lesion of the cervix

A

pap test

29
Q

pap tests are preformed at the _ zone

A

transformation

because this is where HPV has predileciton and most cervical dysplasia are caused by HPV

30
Q

pap smears are stained with?

A

papanicolau stain

screen for squamous lesions

31
Q

cytology of a low grade squamous intraepithelial lesion (LSIL)

A

bi nucleated kolicytes- hyperchromasia- perinuclear clearing

32
Q

cytology of high grade squamous intraepithelial lesion

A

high nuclear to cytoplasmic ratio (resembling basal cells)

33
Q

cytology of high grade squamous intraepithelial lesion

A

high nuclear to cytoplasmic ratio (resembling basal cells)

34
Q

what are the molecular techniques you can do to screen for cervical neoplasia?

A

PCR or hybrid capture (uses fluid from vial from pap test) if pap test cant place in category (reactive vs dysplastic)

used to check for high risk strains of HPV

35
Q

screening for pap smears start at age?

A

21

36
Q

age 21-29 should? (regarding screening guidlines for pap)

A

get cytology every 3 years

37
Q

at age 30, screening can occur every _ years with a pap test plus a molecular test to check for high risk HPV strains

- pap screening guidlines

A

5

38
Q

screening is no longer needed after the age of _ if there have been _ consecutive negative PAP tests and the molecular test has been negative for the previous _ years

pap testing screening guidlines

A

65

3

10

39
Q

If the pap tests picks up an abnormality a _ can be used to visualize the cervix and biopsy it. _ is applied to help visualize the cervix.

A

colposcope

acetic acid

40
Q

with dysplasia areas of the cervix stained with acetic acid are more likely to turn what color?

A

acetowhite

41
Q

low grade dysplasia the cervix turns what color when treated with acetic acid

high grade?

A

fine punctations

coarse punctations

42
Q

in an acetowhite positive (dyplastic ) cervix treated with acetic acid what do atypical vessels raise a concern for

A

carcinoma

43
Q

how do we treat h igh grade dyplasia of the cervix

A

cervical colonization and LEEP

cervical colonization is - removing the area of concern in a cone shape
LEEP- electric currents remove the area of concern

44
Q

HSIL and LSIL can both lead to invase squamous carcinoma. what are the 2 types

A

keratinizing SCC (with keratin pearls)
Non-Keratinizing SCC

45
Q

Sometimes HPV can infect the endocervical mucosa and cause a precursor lesion called _

which can progress to an invasive lesion called _

A

precursor lesion: cervical adenocarcinoma in situ (AIS)

invasive lesion: invasive adenocarcinoma

46
Q

AIS is characterized by?

A

hyperchromatic nuclear enlargement with psuedostratification

47
Q

invasive adenocarcinoma of the cervix looks like what?

histology

A

glandular tumor nests infiltrating the stroma

48
Q

can precursor lesions adenocarcinoma insitu (AIS) be seen on pap smear?

A

yes

49
Q

average age for cervical carcinoma

A

45-50 years old

50
Q

what are the vaccinations for HPV

A

Cevarix- not available in the US
Gardasil (high and low risk HPV protection)

51
Q

vaccination for the HPV vaccine is recommended a the age of _ for both males and females

A

11-12

52
Q

endocervical polyps are _ (benign/malignant)

they occur during _ (reproductive years/menopause)

they can present with _ or discharge

_ (procedure) is curative

A

benign

reproductive years

bleeding/spotting

simple excision (polypectomy)

53
Q

histology of an endocervical polyp

they arise from cervical _ epithelium

what causes them?

A

fibrovascular core with surface epithelium which is covered endocervical type dlands- benign glands and stroma

glandular

estrogen (postulated)

ENRP II (25 decks)

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