Gen Path Exam 4 - Female Reproductive Pathology

Question 1

Which disease?

Large anogenital warts; due to HPV 6 and 11

Answer 1

Condyloma acuminata

Question 2

Which disease?

Papillary, elevated or flat, rugose (wrinkled/creased)

Answer 2

Condyloma acuminata

Question 3

Which disease?

Key histologic feature is koilocytosis

Answer 3

Condyloma acuminata

Question 4

Angular nuclei with perinuclear clearing

Answer 4

Koilocytosis

Question 5

Which disease?

Not precancerous

Answer 5

Condyloma acuminata

Question 6

Which disease?

Tumors are from epithelium; caused by oncogenic strains of HPV

Answer 6

Cervical carcinoma

Question 7

Which disease has the following risk factors?

Persistent HPV infection w/ high risk subtypes (HRHPV)
Early age at first intercourse
Multiple sexual partners
Male partner with history of multiple partners
Smoking
Immunodeficiency

Answer 7

Cervical carcinoma

Question 8

What is the most important risk factor of Cervical carcinoma?

Answer 8

Persistent HPV infection with high risk HPV subtypes (HRHPV)

Question 9

Cervical cancer is caused by __________

Answer 9

HRHPV

Question 10

Tropic for immature squamous cells of the transformation zone

Answer 10

HRHPV

Question 11

Which zone of the cervix?

Squamocolumnar junction of the endocervix and exocervix

Answer 11

Transformation zone

Question 12

Which zone of the cervix?

Moves (everts) from endocervix at birth to exocervix in young adults

Answer 12

Transformation zone

Question 13

Which zone of the cervix?

Everted columnar cells undergo metaplasia into immature squamous cells

Answer 13

Transformation zone

Question 14

Which disease?

These infections are transient and eliminated within months by host immune response

Answer 14

HPV infection

Question 15

Which disease?

Low risk types remain as free episomal viral DNA and cause benign lesions, like condyloma

Answer 15

HPV infection

Question 16

What is the pathogenesis of persistent HPV infections with HRHPV types?

Answer 16

Viral integration -> viral oncoprotein E6 and E7 -> neoplasia

Question 17

What does E6 and E7 do?

Answer 17

E6 = inhibits p53
E7 = blocks CDKIs (cyclin-dependent kinase inhibitor)

Question 18

T/F: HPV infection alone is sufficient to cause cancer

Answer 18

FALSE; HPV infection alone is INSUFFICIENT to cause cancer

Question 19

Which disease?

Evolves from asymptomatic precancerous lesion that appears many years before invasive carcinoma

Answer 19

Cervical carcinoma

Question 20

What is the name of the precancerous cervical lesion?

Answer 20

Squamous intraepithelial lesion (SIL)

Question 21

Low or high grade SIL?

Does not progress directly to carcinoma; most regress; 10% progress to HSIL

Answer 21

Low grade SIL

Question 22

Low or high grade SIL?

Progress to carcinoma (10% over 10 yrs, so the majority don’t)

Answer 22

High grade SIL

Question 23

Early detection of SIL is done with what test?

Answer 23

Pap smear

Question 24

Most successful cancer screening test ever develop

Answer 24

Pap smear

Question 25

What are the cervical cancer screening guidelines?

Answer 25

21-65: pap smear every 3 yrs 30-65: can add HPV co-test or just HRHPV test every 5 yrs >65: stop pap smears, unless never been screened or high risk SIL is present

Question 26

What is done after an abnormal pap smear?

Answer 26

Biopsy/curettage during colposcopy

Question 27

Application of what makes affected areas in the cervix appear whiter to help guide biopsy?

Answer 27

Dilute acetic acid

Question 28

How are high risk SIL and persistent low risk SIL treated?

Answer 28

Surgical excision (cone biopsy)

Question 29

If HPV negative, there is a very low risk of harboring ________

Answer 29

SIL

Question 30

Which disease? May be invisible or exophytic

Answer 30

Cervical carcinoma

Question 31

Which disease? Requires HPV infection AND mutations in tumor suppressor and oncogenes

Answer 31

Cervical carcinoma

Question 32

What are most cervical carcinomas?

Answer 32

Squamous cell carcinoma

Question 33

Which disease? Surgery, radiation, and chemo may all be used depending on stage

Answer 33

Cervical carcinoma

Question 34

Which disease? Prognosis depends on clinical stage; even with positive nodes, 50% 5 yr survival

Answer 34

Cervical carcinoma

Question 35

How is cervical cancer prevented?

Answer 35

HPV vaccine for 11-12 yr old boys and girls

Question 36

Which vaccine prevents HPV 6 and 11, as well as high risk types like 16 and 18?

Answer 36

Gardasil 9

Question 37

Which disease? Usually small, develop below surface

Answer 37

Ovarian cysts

Question 38

Which disease? Large ones may be palpable/painful; rupture causes intraperitoneal bleeding

Answer 38

Ovarian cysts

Question 39

Which disease? Excess production of mostly androgens by multiple cystic follicles in ovaries

Answer 39

Polycystic ovarian syndrome

Question 40

Which disease? Hirsutism (male hair pattern), oligomenorrhea, infertility, enlarged ovaries w/ small subcortical cysts

Answer 40

Polycystic ovarian syndrome

Question 41

Which disease has the following risk factors? Nulliparity Low parity Family history BRCA1 mutation

Answer 41

Ovarian cancer

Question 42

Which disease has the following symptoms? Limited until widespread; may cause abdominal pain, swelling or ascites related to seeding of peritoneal cavity

Answer 42

Ovarian cancer

Question 43

What is a bloodmarker that has poor sensitivity and poor specificity as a screening test for ovarian cancer?

Answer 43

CA-125

Question 44

What is CA-125 valuable for monitoring in ovarian cancer?

Answer 44

Response to therapy