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Block 10 Week 3 > Fung: Gyn Pathology > Flashcards

Fung: Gyn Pathology Flashcards

1
Q

Anatomically includes the moist hair bearing skin & mucosa of the female genitalia external to the hymen
Lined by squamous epithelium

A

vulva

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2
Q

Most disorders of the vulva are (blank). List some examples of disorders of the vulva.

A

inflammatory;

contact dermatitis, eczymatous dermatitis, infections

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3
Q

Characterized by thinning of the epidermis & fibrosis of the dermis
Presents as a white patch with parchment-like vulvar skin

A

lichen sclerosis

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4
Q

Who gets lichen sclerosis?

A

postmenopausal women, who get a thinning of the dermis

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5
Q

Is lichen sclerosis benign or malignant?

A

benign, but associated with a slight increased risk for squamous cell carcinoma

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6
Q

Characterized by hyperplasia of the vulvar squamous epithelium
Presents as leukoplakia with thick, leathery vulvar skin
Associated with chronic irritation & scratching

A

Lichen simplex chronicus

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7
Q

Is lichen simplex chronicus benign or malignant?

A

benign

no increased risk of squamous cell carcinoma

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8
Q

Warty neoplasm of the vulvar skin, often very large
Most commonly due to HPV 6 & 11
Secondary syphilis is a less common cause
Rarely progresses to carcinoma

A

condyloma

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9
Q

What is vulvar intraepithelial neoplasia? What is it related to?

A

dysplasia of the epithelium lining the vulva, which progresses to vulvar carcinoma;
associated with HPV 16 & 18, 31 & 33 (high risk)

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10
Q

What are the levels of vulvar intraepithelial neoplasia?

A

VIN 1-3 –> carcinoma

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11
Q

What are the two etiologies of vulvar carcinoma?

A

HPV related - occurs in women ages 40-50, begins as dysplasia, which progresses to cancer

non-HPV related - occurs in women greater than 70yo - reactive changes - lichen sclerosis

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12
Q

Characterized by malignant epithelial cells in the epidermis of the vulva
Presents as erythematous, pruritic, ulcerated vulvar skin
Represents carcinoma in situ with no underlying carcinoma

A

Extramammary paget’s disease

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13
Q

How can you distinguish extramammary paget disease from a melanoma, which can rarely occur on the vulva?

A

Paget cells are PAS +, keratin +, and S100-

Melanomas are PAS-, keratin -, and S100+

**PAS is a marker of mucous in epithelial cells, keratin is also found in epithelial cells

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14
Q

Malignant proliferation of glands with clear cytoplasm

Rare, but feared complication of DES-associated vaginal adenosis

A

clear cell adenocarcinoma

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15
Q

Focal persistence of columnar epithelium in the upper vagina
During development, squamous epithelium from the lower 1/3 of the vagina grows upward to replace the columnar epithelium of the upper 2/3 of the vagina

A

adenosis

**increased incidence in females who were exposed to DES in utero

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16
Q

This kind of epithelium lines the mucosa of the vagina

A

non-keratinizing squamous epithelium

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17
Q

What are the two division of the cervix? What is each lined by?

A

endocervix - lined by a single layer of columnar cells

exocervix - lined by nonkeratinizing squamous epithelium

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18
Q

The junction between the exocervix & the endocervix is called the (blank) zone

A

transformation

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19
Q

Circular double-stranded DNA virus
Over 200 known types which are species specific and tissue specific
Infects the lower genital tract, especially the cervix in the transformation zone
Cause epithelial proliferations: warts to carcinoma

A

HPV

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20
Q

Persistent infection with HPV leads to an increased risk for (blank)

A

cervical intraepithelial neoplasia (CIN)

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21
Q

What are the high risk HPV types? Low risk?

A

high risk: 16, 18, 31, 33

low risk: 6, 11

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22
Q

High risk HPV produces E6 & E7 proteins which result in destruction of tumor suppressor genes (blank) and (blank) respectively

A

p53; Rb

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23
Q

Characterized by koilocytic change, disordered cellular maturation, nuclear atypia, & increased mitotic activity w/i the cervical epithelium

A

cervical intraepithelial neoplasia

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24
Q

What are the four grades of cervical intraepithelial neoplasia?

A

CIN 1: involves less than 1/3 of the thickness of the epithelium

CIN 2: involves less than 2/3 of the thickness of the epithelium

CIN 3: involves slightly less than the entire thickness of the epithelium

Carcinoma in situ: involves the full thickness of the epithelium

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25
Q

CIN classically progresses in a stepwise fashion through CIN 1, 2, 3, and carcinoma in situ to become (blank)

A

invasive squamous cell carcinoma

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26
Q

Is progression to invasive squamous cell carcinoma inevitable?

A

nooo
CIN often regresses
the higher the grade of dysplasia, the more likely it is to progress to carcinoma & the less likely it is to regress to normal

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27
Q

Who gets cervical carcinoma?

A

middle aged women (ages 40-50)

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28
Q

How does cervical carcinoma present?

A 
vaginal bleeding (esp after sex)
cervical discharge
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29
Q

Key risk factors for cervical carcinoma?

Secondary risk factors?

A

HPV infection

secondary: smoking & immunodeficiency

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30
Q

What are the most common subtypes of cervical carcinoma?

A

squamous cell carcinoma (80%)

adenocarcinoma (15%)

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31
Q

This is a common cause of death in advanced cervical carcinoma

A

hydronephrosis with postrenal failure

**advanced tumors often invade thru the anterior uterine wall into the bladder

32
Q

What are the recommendations for pap screening?

A

21+, cytology alone every 3 yrs
30-65, HPV & cytology cotesting every 5 yrs
greater than 65 - no screening if adequate negative prior screening

33
Q

(blank) is the mucosal lining of the uterine cavity

(blank) is the smooth muscle wall underlying the endometrium

A

endometrium; myometrium

34
Q

The endometrium is hormonally sensitive. Growth of the endometrium is (blank) driven, while preparation of the endometrium for implantation (secretory phase) is (blank) driven. Shedding occurs with loss of (blank) support.

A

estrogen; progesterone; progesterone

35
Q

Bacterial infection of the endometrium
Usu due to retained products of conception, which act as a nidus for infections
Presents as fever, abnormal uterine bleeding & pelvic pain

A

acute endometritis

36
Q

Chronic inflammation of the endometrium
Characterized by lymphocytes & plasma cells (plasma cells are necessary for the diagnosis)
Caused by retained products of conception, pelvic inflammatory disease, IUD, & TB
Presents as abnormal uterine bleeding, pain, & infertility

A

chronic endometritis

37
Q

What is endometriosis?

A

endometrial glands & stroma outside of the uterine endometrial lining

38
Q

What kinds of things can cause abnormal bleeding?

A

anovulatory cycles
polyps
hyperplasia
carcinoma

39
Q

Lack of ovulation
Results in estrogen-driven proliferative phase w/o a subsequent progesterone-driven secretory phase
Proliferative glands break down & shed resulting in uterine bleeding

A

anovulatory cycle

40
Q

Hyperplastic protrusion of the endometrium
Presents as abnormal uterine bleeding
Can be a result of tamoxifen which has weak pro-estrogenic effects on the endometrium

A

endometrial polyp

41
Q

What is endometrial hyperplasia?

A

hyperplasia of the endometrial glands relative to stroma

occurs as a consequence of unopposed estrogen

42
Q

What causes endometrial hyperplasia? What are the different kinds?

A

unopposed estrogen - obesity, PCOS, estrogen replacement

simple vs complex & cellular atypia

43
Q

What is the most important predictor for progression of endometrial hyperplasia to carcinoma?

A

cellular atypia

44
Q

How does endometrial hyperplasia present?

A

postmenopausal uterine bleeding

45
Q

Malignant proliferation of endometrial glands

Most common invasive carcinoma of the female genital tract

A

endometrial carcinoma

46
Q

There are two pathways for endometrial carcinoma. What are they?

A
  1. hyperplasia –> carcinoma arises from endometrial hyperplasia - histology is endometrioid, average age is 60yo
  2. sporadic –> carnoma arises in an atrophic endometrium with no evident precursor lesion - histology shows papillary structures with psammoma bodies - p53 mutation is common
47
Q

Endometrioid carcinoma is related to precursor (blank). It is graded by (blank). Associated with mutations in (blank) and (blank)

A

hyperplasia; FIGO; PTEN and DNA mismatch repair gene

48
Q

This type of endometrial carcinoma is not related to endometrial hyperplasia; it occurs in the fallopian tube & ovary; occurs in postmenopausal women usu; associated with p53 gene mutations

A

serous carcinoma

sporadic - papillary pathway

49
Q

Benign neoplastic proliferation of smooth muscle arising from myometrium
Most common tumor in females
Gross exam shows multiple, well-defined, white whorled masses

A

leiomyoma (fibroids)

50
Q

Leiomyomas are related to (blank) exposure

A

estrogen

**premenopausal women, enlarged during pregnancy

51
Q

How does leiomyoma present?

A

usu asymptomatic;

when present, symptoms include abnormal uterine bleeding, infertility, & a pelvic mass

52
Q

Malignant proliferation of smooth muscle arising from the myometrium
Arises de novo, NOT from leiomyoma
Gross exam often shows a single lesion with areas of necrosis & hemorrhage

A

leiomyosarcoma

53
Q

Do leiomyosarcomas come from leiomyomas?

A

nooo! they arise de novo

54
Q

What things can cause salpingitis?

A

**gonorrhea
chlamydia
pelvic inflammatory disease

55
Q

Implantation of fertilized ovum at a site other than the uterine wall

A

ectopic pregnancy

56
Q

Where is the most common site of ectopic pregnancy implantation? What is the key risk factor for ectopic pregnancy?

A

lumen of fallopian tube;

key risk factor is scarring

57
Q

How does an ectopic pregnancy present?

A

lower quadrant abdominal pain after a missed period

**surgical emergency

58
Q

The functional unit of the ovary is the (blank)

A

follicle

59
Q

Discuss the contents of an ovarian follicle

A

consists of an oocyte surrounded by granulosa (inside) & theca cells (outside)

60
Q

(blank) acts on the theca cells to induce androgen production
(blank) stimulates granulosa cells to convert androgen to estradiol
(blank) surge induces an LH surge, which leads to ovulation

A

LH; FSH; estradiol

61
Q

After ovulation, what happens to the residual follicle?

A

it becomes the corpus luteum - which secretes progesterone to prepare the endometrium for a possible pregnancy

62
Q

Degeneration of follicles

Small number are common in women & have no clinical significance

A

follicular cysts

63
Q

What is a luteal cyst?

A

hemorrhage into the corpus luteum - this can occur especially during pregnancy

64
Q

Multiple ovarian follicular cysts due to hormone imbalance
Increased LH causes increased androgen production - hirsutism
Androgen is converted to estrone in adipose tissue, which decreases FSH via negative feedback –> results in cystic degeneration of follicles

A

PCOS

65
Q

What is the classic presentation of PCOS?

A

obese young woman with infertility, oligomenorrhea, and hirsutism

66
Q

What are the 3 cell types of the ovary that can lead to tumors?

A

surface (germinal) epithelium
germ cells
sex cord stroma

67
Q

Most common ovarian tumor

Derived from coelomic epithelium that lines the ovary

A

surface epithelial tumors

68
Q

What are the two most common subtypes of surface epithelial tumors?

A

serous - full of watery fluid

mucinous - full of mucus-like fluid

69
Q

Mucinous and serous epithelial tumors of the ovary can be benign, borderline, or malignant. How are these different?

A

benign - composed of a single cyst with simple flat lining - most commonly arise in premenopausal women

malignant - composed of complex cysts with a thick, shaggy lining - most commonly in postmenopausal women

borderline - features in between benign & malignant, some malignant potential

70
Q

Less common subtype of epithelial tumor of the ovary
Composed of bladder-like epithelium
Usu benign

A

Brenner tumors

71
Q

A multilocular, usually benign, tumor produced by ovarian epithelial cells and having mucin-filled cavities.

A

mucinous cystadenoma

72
Q

Abnormal conception characterized by swollen & edematous villi with proliferation of trophoblasts
Uterus expands as if a normal pregnancy is present, but the uterus is larger, b-HcG is higher, no heart sounds, and snowstorm appearance on ultrasound

A

hydatidiform mole

73
Q

What are the differences between a complete mole & a partial mole in the following realms?

Genetics
Fetal tissue
villous edema
trophoblast proliferation
risk for choriocarcinoma
A

genetics: complete mole is when an empty ovum is fertilized by two sperm (46 chromosomes), while a partial mole is a normal ovum fertilized by two sperm (69 chromosomes)

fetal tissue: absent in complete mole, while present in partial mole

villous edema: most villi are hydropic in complete mole, while only some villi are hydropic in partial

diffuse trophoblastic proliferation around hydropic villi in complete mole, focal proliferation of trophoblasts in partial mole

minimal risk for choriocarcinoma in partial, increased risk for complete

74
Q

How does a mole present?

A

second trimester

passage of grape-like masses thru the vaginal canal

75
Q

Malignant tuumor composed of cytotrophoblasts & syncytiotrophoblasts
Mimics placental tissue, but no villi
Small, hemorrhagic tumor w/ early hematogenous spread
High b-hCG

A

choriocarcinoma

76
Q

Neoplastic proliferation of granulosa & theca cells
Often produces estrogen, presents with signs of estrogen excess
Malignant, but minimal risk for mets

A

Granulosa-theca cell tumor

77
Q

Who is Gardasil recommended for?

Who is Cervarix recommended for?

A

Gardasil: females & males - protects against types 6, 11, 16, & 18

Cervarix: females only, protects against types 16 & 18

Block 10 Week 3 (6 decks)

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