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Gen Path Final > Gyn and Breast > Flashcards

Gyn and Breast Flashcards

1
Q

Diseases of the vulva and vagina are most often

A

inflammatory, rendering them more uncomfortable than serious. Malignant neoplasia is uncommon.

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2
Q

Vulvitis, inflammation of the vulva, can be caused by

A

infection, contact irritant, allergic reaction, or traumatic injury.

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3
Q

Vulvitis

A variety of pathogens has been associated and often

A

sexually transmitted.

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4
Q

Vulvitis

In addition, the moist environment supports

A

fungal infections (Candida albicans).

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5
Q

Vulvitis

Contact irritation or allergic reaction may be related to a number of

A

agents, including soaps, perfumes, deodorants, clothing textiles, etc.

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6
Q

Vulvitis

Scratching-induced trauma secondary to

A

associated pruritus (itching) may exacerbate the primary condition.

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7
Q

Vaginitis, inflammation of the vagina, is relatively common and results in production of

A

vaginal discharge (leukorrhea).

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8
Q

Vaginitis

A variety of organisms have been associated, including

A

bacteria, fungi, and parasites.

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9
Q

Vaginitis

Many associated orgs are normal commensal organisms that become

A

pathogenic under certain circumstances, such diabetes, systemic antibiotic therapy (which disrupts normal microbial flora), or immunodeficiency.

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10
Q

Vaginitis

Candida albicans and Trichomonas vaginalis are

A

frequent offenders.

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11
Q

The cervix must act as a

A

barrier to prevent entrance of air and microflora into the uterus but at the same time permit escape of menstrual flow and be capable of dilation to accommodate childbirth. This location represents the site of one of the most common cancers in women.

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12
Q

Cervicitis is inflammation of the

A

cervix, is extremely common and is associated with purulent vaginal discharge.

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13
Q

Cervicitis

The process may be secondary to

A

specific infections such as candida, trichomonas, chlamydia, gonorrhea, syphilis, HPV, or herpes; but more commonly, it arises from nonspecific infections and is seen in virtually every multiparous woman.

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14
Q

Cervicitis

It may be

A

acute or chronic.

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15
Q

Cervicitis

In severe lesions, it is difficult to

A

clinically distinguish from carcinoma and biopsy is required for diagnosis.

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16
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

At one time, this cancer was the

A

leading cause of cancer deaths in women; but currently, it ranks 14th (12,820 cases and 4,200 deaths predicted in the US in 2017).

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17
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix
In contrast, the discovery of preinvasive intraepithelial cervical neoplasia has

A

increased significantly.

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18
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

The Papanicolaou cytologic test (Pap smear, 1940) is responsible for the

A

increased discovery of these earlier lesions, most of which are cured by effective therapy.

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19
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Exfoliated cells collected from the cervix are processed with a

A

special stain (Papanicolaou stain). This allows identification of precancerous (dysplastic) cytological features. This test is inexpensive, however, false positives/negatives are recognized and additional HPV testing is now standard with abnormal Pap tests.

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20
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Several factors tend to increase the prevalence; the four most important are

A

early onset of coitus, multiple sexual partners, a male partner with multiple previous sexual partners, and persistent infection with “high-risk” HPV (16, 18).

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21
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

HPV is present in

A

85-90% of cervical neoplasia.

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22
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

In spite of this correlation, research has shown that

A

something more than viral action must be involved in the evolution of invasive cervical carcinoma.

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23
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Approximately 75-95% of cervical cancers present as

A

squamous cell carcinoma.

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24
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Most (perhaps all) invasive cervical carcinomas arise from

A

precursor lesions termed cervical intraepithelial neoplasia (CIN).

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25
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Not all CIN progress to

A

cancer.

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26
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

The cancer is now known to be the end stage of a continuum of

A

progressively more dysplastic changes in which one slowly progresses on to the next stage; this progression evolves slowly over the course of many years.

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27
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Cervical intraepithelial neoplasia is

A

graded I (Mild) – III (Carcinoma in situ); the higher the grade, the greater the likelihood of progression to carcinoma.

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28
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Although probable in many instances, progression to

A

carcinoma is not inevitable, even in higher-grade lesions.

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29
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Screening for cervical neoplasia via cytology (Pap smear) and cervical examination (colposcopy) remaining the

A

standard approach.

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30
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Abnormalities revealed during a

A

colposcopy examination following application of acetic acid appear as white patches.

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31
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Upon discovery of a high-grade lesion,

A

biopsy always is necessary to confirm the cytologic findings and to evaluate for invasion.

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32
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

CIN typically is

A

asymptomatic.

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33
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Once invasive, the main symptoms of the carcinoma are

A

irregular vaginal bleeding, leukorrhea, painful coitus and dysuria.

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34
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Treatment of cervical carcinoma is

A

surgery and/or radiation and chemotherapy; in situ lesions have a 100% survival rate, while the prognosis of invasive lesions correlates directly with the stage.

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35
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Deeply invasive stage 4 carcinomas have only a

A

10% survival.

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36
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Recent reports indicate that chemotherapy may

A

improve survival in advanced cases.

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37
Q

Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix

Introduction of HPV vaccines (now available: Gardasil-9: 6, 11, 16, 18, 31, 33, 45, 52, 58) have been shown effective in decreasing the frequency of genital warts, condylomas (low-risk HPV types 6, 11) and CIN and are expected to decrease cancers associated with these

A

HPV serotypes, possibly including oropharyngeal/tonsillar cancers in both men and women.

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38
Q

• Uterine corpus is responsible for majority of female

A

reproductive tract diseases

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39
Q

Uterine • Disorders often

A

chronic and recurrent

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40
Q

Structure of Uterus

A 
•	Myometrium
o	Muscular wall of the uterus
o	Composed of interlacing bundles of smooth muscle
•	Endometrium
o	Glandular lining of the uterus
o	Changes under hormonal influence
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41
Q

• Myometrium

A

o Muscular wall of the uterus

o Composed of interlacing bundles of smooth muscle

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42
Q

• Endometrium

A

o Glandular lining of the uterus

o Changes under hormonal influence

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43
Q

By far, the most common complaints related to disorders of the uterus are

A

pelvic pain and abnormalities in menstrual function: menorrhagia (profuse or prolonged bleeding), metrorrhagia (irregular bleeding between periods), and dysmenorrhea (unusually painful menstrual bleeding).

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44
Q

Uterine disorders;

Common causes include, but are not restricted to

A

endometriosis, endometrial hyperplasia, leiomyomas, and endometrial carcinoma.

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45
Q

Endometriosis is the presence of endometrial glands and/or stroma in locations

A

other than the uterine lining (10% women in reproductive years, 50% of women with infertility).

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46
Q

Endometriosis

The most common site is in the

A

pelvis (ovaries, uterine ligaments, tubes and rectovaginal septum).

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47
Q

Endometriosis

Less common sites include the

A

peritoneal cavity, umbilicus, lymph nodes, lungs and even heart or bone.

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48
Q

Endometriosis

Although the causation is unknown, the most accepted

A

“regurgitation” theory proposes that menstrual endometrium backflows through the fallopian tubes and also somehow enters the local venous and lymphatic systems.

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49
Q

Endometriosis

Sites of endometriosis are

A

functional and undergo cyclic bleeding.

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50
Q

Endometriosis

With long-standing disease,

A

seepage and organization of the blood leads to widespread fibrosis and adherence of pelvic structures; severe dysmenorrhea (painful menstruation), dyspareunia (painful intercourse), dysuria, pain upon defecation, and pelvic pain may occur secondary to intrapelvic bleeding and periuterine adhesions.

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51
Q

Endometriosis

Large blood-filled cysts on the ovaries transform to

A

“chocolate” cysts as the blood ages.

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52
Q

Endometriosis;

Involvement of the oviducts and ovaries may result in

A

sterility.

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53
Q

Endometrial hyperplasia refers to

A

hyperplasia of the epithelial lining of the uterus that is thought secondary to an excess of estrogen.

54
Q

Endometrial hyperplasia

The process often arises in

A

perimenopausal women from obesity (estrogen synthesis in fat deposits), failure of ovulation, administration of estrogen or from estrogen-secreting tumors.

55
Q

Endometrial hyperplasia

Endometrial hyperplasia produces

A

abnormal bleeding; but more importantly, it is a forerunner to endometrial carcinoma.

56
Q

Endometrial hyperplasia

It progresses through stages of

A

mild, moderate and atypical hyperplasia which often then progresses to carcinoma.

57
Q

Endometrial hyperplasia

D & C is required to control the

A

bleeding and to rule out carcinomatous transformation.

58
Q

Endometrial hyperplasia

In addition, any correctable underlying

A

causation should be resolved.

59
Q

Uterine Tumors

• May arise from

A

endometrium or myometrium

60
Q

Uterine Tumors

• All produce

A

abnormal uterine bleeding

61
Q

Uterine Tumors

• Most common:

A

o Endometrial polyps
o Smooth muscle tumors
o Carcinomas

62
Q

Leiomyomas are benign tumors of

A

myometrial smooth muscle origin.

63
Q

Leiomyomas

When arising in the uterus, these neoplasms historically have been called

A

fibroids.

64
Q

Leiomyomas

These arise from the ——— in 30-50% of women during active reproductive life; this makes leiomyoma the most common benign tumor in females.

A

myometrium

65
Q

Leiomyomas

Although the cause is unknown, they seem to be

A

estrogen dependent, as evidenced by their rapid growth during pregnancy and the tendency to regress after menopause.

66
Q

Leiomyomas

Uterine leiomyomas are often

A

asymptomatic and discovered during routine pelvic exams.

67
Q

Leiomyomas

Occasionally, they produce

A

menorrhagia.

68
Q

Leiomyomas

Multiple leiomyomas are

A

not rare.

69
Q

Endometrial Carcinoma:

Carcinoma of the endometrium arises from the

A

uterine lining and is the most frequent cancer of the female genital tract in the Western world (due to decreased prevalence of cervical carcinoma secondary to PAP test).

70
Q

Endometrial Carcinoma

Most cases are diagnosed between the ages of

A

55-65 and are very uncommon prior to the age of 40.

71
Q

Endometrial Carcinoma

The cancer tends to arise in

A

two clinical settings, each associated with a specific type of endometrial carcinoma: perimenopausal women with evidence of estrogen excess (endometrioid carcinoma, more common type) and in older women with endometrial atrophy (serous carcinoma).

72
Q

Endometrial Carcinoma

The majority of these cancers appear to be associated with

A

increased estrogen stimulation with similar risk factors as endometrial hyperplasia.

73
Q

Endometrial Carcinoma

The most common early symptoms are

A

leukorrhea and irregular bleeding, a red flag in postmenopausal women.

74
Q

Endometrial Carcinoma

Fortunately, these are

A

late-metastasizing cancers, but dissemination can occur to regional nodes and more distant sites like the liver and lungs.

75
Q

Endometrial Carcinoma

Radiotherapy and surgery are the

A

standard of care with the addition of antiestrogen chemotherapy for disseminated cases.

76
Q

Endometrial Carcinoma

If localized to the body of the uterus, 5-year survival is

A

90%, but this drops to 20% once it has spread outside of the uterus (Stage III and IV).

77
Q

DISORDERS OF THE OVARIES

Solitary non-neoplastic cysts of the ovaries are common, but generally

A

not serious.

78
Q

Disorders of the ovaries

polycystic ovarian disease causes

A

significant problems for many women.

79
Q

Polycystic ovarian disease is a common

A

hormonal disorder affecting 5-10% of females of reproductive age.

80
Q

Polycystic ovarian disease

It is generally diagnosed after

A

menarche in teenage girls or young adults.

81
Q

Polycystic ovarian disease

The condition was named due to the presence of

A

multiple cystic follicles in ovaries, resulting in increased size of ovaries and excess production of androgens and estrogens.

82
Q

Polycystic ovarian disease

While there seems to be a genetic influence, the cause of this disorder is

A

incompletely understood.

83
Q

Polycystic ovarian disease

Patients may present with

A

delayed or absent menstruation, oligomenorrhea, hirsutism (increased body hair), acne, fertility problems, and obesity.

84
Q

Polycystic ovarian disease

These women are also at increased risk fo

A

r type II diabetes and cardiovascular disease.

85
Q

Polycystic ovarian disease

——– is the most significant disease with carcinoma of the ovaries accounting for more deaths than cancers of the cervix and endometrium combined. This is the fifth leading cause of cancer deaths in women

A

Neoplasia

86
Q

Ovarian Carcinoma

Ovarian cancers come in a wide variety of

A

histogenic types.

87
Q

Ovarian Carcinoma

The surface epithelial variants account for

A

90% of ovarian cancers, with less common varieties also produced by the germ cells and sex-cord stroma.

88
Q

Ovarian Carcinoma

Several risk factors for ovarian cancer have been recognized, with the two most prominent being

A

nulliparity and family history (5-10% of cases → Mutations of BRCA genes (BRCA1, BRCA2 = increase risk for breast and ovarian cancer).

89
Q

Ovarian Carcinoma

Use of oral contraceptives appears to

A

reduce the risk somewhat.

90
Q

Ovarian Carcinoma

The clinical presentation of these tumors is remarkably similar. Most are

A

asymptomatic until they become large enough to cause local pressure symptoms.

91
Q

Ovarian Carcinoma

The prognosis of invasive ovarian tumors depends heavily on the

A

stage of the disease at the time of diagnosis.

92
Q

Ovarian Carcinoma

For those cancers that have penetrated the capsule, the 10-year survival is less than

A

15%.

93
Q

Ovarian Carcinoma

Approximately 22K new cases of ovarian cancer will be diagnosed in the US

A

in 2017; of these patients, close to 14K will die of their disease.

94
Q

Teratomas of the ovary are tumors which develop from

A

differentiation of totipotential germ cells into mature tissues which represent all three germ layers: ectoderm, mesoderm, and endoderm.

95
Q

Teratomas

These tumors have a tendency to arise in the

A

first two decades of life, and the earlier onset the greater the likelihood of malignancy.

96
Q

Teratomas

Fortunately, at least 90% of these germ cell neoplasms are

A

benign mature cystic teratomas.

97
Q

Teratomas

Usually, these cysts contain an

A

epidermal appearing cyst lining with adnexal skin appendages (hair follicles, sebaceous glands, sweat glands), hence the common designation of dermoid cysts.

98
Q

Teratomas

Most are discovered incidentally in young women on

A

abdominal scans or radiography.

99
Q

Teratomas

These tumors often contain

A

hair, bone, cartilage, bronchial or gastrointestinal epithelium, and even teeth!

100
Q

BREAST DISORDERS
Disorders of the female breast are extremely common. In a large study of patients with breast complaints, 30% had no breast disease, 40% had fibrocystic disease, 10% had carcinoma, 7% had fibroadenomas and the remainder had a

A

miscellany of benign lesions. The discussion will be limited to the three most frequent abnormalities of the breast.

101
Q

BREAST DISORDERS

Fibrocystic changes apply to

A

breast alterations which arise as an exaggeration and distortion of the cyclic breast changes that occur normally in the menstrual cycle.

102
Q

BREAST DISORDERS

Fibrocystic changes consist of

A

overgrowths of the fibrous stroma, the epithelial elements or a proliferation of both.

103
Q

BREAST DISORDERS

All tend to arise during

A

reproductive life but may persist after menopause.

104
Q

BREAST DISORDERS

The lesions frequently are

A

bilateral and/or multiple.

105
Q

BREAST DISORDERS

They sometimes produce masses requiring

A

differentiation from cancer.

106
Q

BREAST DISORDERS

The great majority of these lesions do not

A

predispose to cancer.

107
Q

BREAST DISORDERS

However, there is a slightly increased risk with

A

florid ductal hyperplasia; and if the hyperplasia is atypical, there is a significant increased risk.

108
Q

BREAST DISORDERS

Fibroadenoma is the most common

A

benign tumor of the female breast and usually appears in prepubertal girls and young women, with the peak prevalence in the third decade.

109
Q

BREAST DISORDERS

They result from increased

A

estrogen.

110
Q

BREAST DISORDERS

These tumors are

A

encapsulated and comprised of both glandular epithelium and fibrous tissue.

111
Q

BREAST DISORDERS

They usually appear as a

A

solitary, discrete, freely movable nodule (1-10 cm in diameter).

112
Q

BREAST DISORDERS

Biopsy is mandatory to verify its

A

benign nature.

113
Q

Carcinoma of the breast:

Carcinoma of the breast arises from the

A

glandular (and ductal) structures of the breast, and many histologic variants are seen.

114
Q

Carcinoma of the breast

Breast carcinoma was the number one cause of cancer deaths in women until

A

1986, when the increased prevalence of smoking caught up with females and lung cancer became number 1.

115
Q

Carcinoma of the breast

Of those women that develop breast cancer (253,00 US cases in 2017), approximately

A

one fourth will die of their disease.

116
Q

Carcinoma of the breast

It is the 2nd leading cause of

A

cancer related death in women (41,000 deaths in US for 2017).

117
Q

Carcinoma of the breast

Genetic factors, environmental influences (e.g. Exposure to ionizing radiation, diet, reproductive patterns, nursing habits, etc.) and hormonal influences (e.g. Prolonged exposure to exogenous estrogens) have been i

A

mplicated in the etiology.

118
Q

Carcinoma of the breast

About 10% of breast cancers are thought to be related to

A

specific inherited mutations.

119
Q

Carcinoma of the breast

In those cases related to specific inherited mutations (Majority seen with BRCA1, BRCA2 genes), the cancers appear in women under

A

40 years of age and more often are bilateral.

120
Q

Carcinoma of the breast

The lifetime risk of female breast cancer is

A

one in eight with 75% occurring in individuals over the age of 50

121
Q

Carcinoma of the breast

Early lesions are

A

freely movable, discrete, non-tender masses and most are found by self-examination.

122
Q

Carcinoma of the breast

Much less often, an occult lesion is detected by a

A

routine mammogram (Calcification or soft tissue density).

123
Q

Carcinoma of the breast

Most are identified in the

A

upper outer quadrant but lower inner quadrant and central lesions have lowest 5 yr survival (tumors tend to be larger by the time of detection).

124
Q

Carcinoma of the breast

The tumor has a tendency to become adherent to the body wall with

A

fixation of the lesion.

125
Q

Carcinoma of the breast

Adherence to the overlying skin results in

A

retraction or dimpling of the nipple (often the first indication of a lesion).

126
Q

Carcinoma of the breast

Tumor blockage of the lymphatics can result in

A

thickened skin which resembles the surface of an orange (peau d’orange).

127
Q

Carcinoma of the breast can be classified as

A

ductal carcinoma (arising from ductal epithelium) or lobular carcinoma (arising from glandular acini).

128
Q

Carcinoma of the breast

Both have noninvasive precursor stages, termed ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS), in which the

A

neoplasm has not penetrated the basement membrane and thus has not invaded or infiltrated the connective tissue stroma.

129
Q

Carcinoma of the breast

Current therapeutic approaches include combinations of

A

simple mastectomy or segmental resection of the mass (lumpectomy) with or without lymph node dissection, postoperative irradiation and/or chemotherapy.

130
Q

Carcinoma of the breast

The prognosis is

A

variable and dependent on several factors, including tumor stage.

131
Q

Carcinoma of the breast

While metastases may occur many years after apparent therapeutic control of the primary lesion, the prognosis

A

improves with each passing year free of disease.

132
Q

Carcinoma of the breast

Overall, the 10-year survival is

A

still no more than 50%.

Gen Path Final (18 decks)

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