GYN Malignancies (OB and Breast)

Question 1

HPV - Key Strains + Viral Proteins + Histology

Answer 1

High Risk = 16. 18, 31, 33
Low Risk = 6, 11
E6 = p53 Suppressor
E7 = Rb Suppressor (prevents Rb from holding onto EF2 - Free EF2 induces G1-1)

Histology = Koilocytic Changes (raisin/coil nuclei)

Question 2

Vaginal Histology + Pathologic Change

Answer 2

Normal
Lower 1/3 = Urogenital Sinus = Non-Keratinizing Stratified Squamous
Upper 2/3 = Mullerian = Columnar –> Replaced in development

Pathologic = Adenosis = DES causes columnar persistence in the upper 1/3 = Risk of Adenocarcinoma (Clear Cells)

Question 3

Vaginal Carcinoma - Precursor Lesion + Lymph Nodes

Answer 3

Precursor = VAIN =Vaginal Intraepithelial Neoplasia

Lymph Nodes - Lower 1/3 = Inguinal vs. Upper 2/3 = Illiac

Question 4

Cervical Intraepithelial Neoplasia - Findings (4) + Grading

Answer 4

Findings

1) Koilocytic Change
2) Disordered Cellular Maturation
3) Nuclear Atypia
4) No BM Invasion

Low Grade = CIN 1 = Less than 30% of Epithelium = Monitor
High Grade = CIN 2/3 = Rest = Consider Excision

Question 5

Cervical Carcinoma - Classic Presentation (5) + Secondary Risk Factors (2) + Screening Flaws (2)

Answer 5

1) 40-50 y/o female
2) Vaginal Bleeding
3) Postcoital Bleeding
4) Cervical Discharge
5) 20-25 years after HPV Infection

Risk Factors

1) Immune-deficiency (can’t clear HPV)
2) Smoking

Pap Smear - Dysplactic Cell Analysis Hyperchromaitac Nuclei with limited cytoplasm (vs. pink and fluffy)

1) Not good for adenocarcinoma
2) Can miss transition zone = False Negative

Question 6

Asherman’s Syndrome - Definition + Cause

Answer 6

Secondary amenorrhea due to basalis (stem cell) loss)

Due to excessive D&C and subsequent scaring

Question 7

Acute Endometritis - Common Presentation (4) + Cause + Chronic Key

Answer 7

1) Fever
2) Abdominal Pain
3) Uterine Bleeding
4) Pelvic Pain

Due to bacterial infection of the endometrium due to retained foreign products of conception s/p miscarriage or delivery

Chronic - Plasma Cells (and lymphocytes)

Question 8

Endometriosis - Definition + Common Locations and Associated Symptoms (5)

Answer 8

Endometrial Glands and stroma outside of the endometrium (gun powder yellow-brown appearance

1) Ovary - Chocolate Cyst of Blood Products)
2) Uterine Ligament - Pelvic Pain
3) Pouch of Douglas - Pain of Deification
4) Bladder wall - Pain on Urination
5) Bowel Seroosa - Abdominal Pain

Question 9

Endometrial Hyperplasia - Cause + Classic Presenation

Answer 9

Consequence of unopposed estrogen - Classically obesity/PCOS

Post-Menopausal Bleeding - Atypical Cells = Worst Prognostic Indicators

Question 10

Endometrial Carcinoma - Key Presentation + 2 Types

Answer 10

Abnormal - POST-Menopausal Bleeding

Type 1 - Hyperplasia Progress (Endometriod)
Type II - Sporadic with Serous Histology

Question 11

Type 1 Endometrial Carcinoma - Age Group + Histology + Risk Factors + Genetics

Answer 11

Age - 50-60
Histology = progressive hyperplasia (endometriod)
Risk Factors - Unopposed Estrogen (Obesity, HTN, Diabetes, Anolovulatory Cycles)
PTEN Genetics Positive

Question 12

Type 2 Endometrial Carcinoma - Age Group + Histology + Risk Factors + Genetics

Answer 12

Age - 70+
Histology - Serous and fluid filled - Papillary structures with psammona bodies
Risk Factors - Sporadic (precursor lesion = endometrial intraepithelial carcinoma
Genetics - Linked to p53 Mutation

Question 13

Leiomyoma - Description + Presentation + Histology

Answer 13

Uterine fibrosis - benign myometrium proliferation
Presentation - Pre-menopasual bleeding + estrogen exposure

Histology - Multiple, well defined, white, whorled masses

Question 14

Leimyosarcoma - Description + Key findings (2)

Answer 14

Malignant myometrium tumor - arises de novo (not from leimyoma)

Key Findings

1) Single lesion with necrosis + hemorrhage
2) High Mitotic index > 10 HPF

Question 15

Endometrial Polyp - Description + Pathophyisology

Answer 15

Hyperplastic protrusion of the endometrium with abnormal bleeding
Typically due to Tamoxifen - Tamoxifen inhibits breast E-Receptors but stimulates endometrial receptors triggering proliferation

Question 16

Surface Epithelial Ovarian Tumors - Signs/Symptoms (3) + Major Types (4) + Biomarker for Remission

Answer 16

S/Sx not well defined - Late Detection

1) Pain/Fullness (Bloating)
2) Increased Urinary Frequency
3)

Major Types - Serous (Watery Fluid) + Mucinious (Mucus Like)

1) Serous - Cystadenoma
2) Mucinous - Cystadenoma
3) Serous - Cystadenocarinoma
4) Mucinous - Cystadenocarinoma

Marker = CA-125

Question 17

Cystadenoma - Common Presentation + Keys

Answer 17

Benign - Pre-Menopasual + Single Cyst

Serous more often bilateral
Mucinous - RAS Mutation

Question 18

Cystadenocarcinoma - Common Presentation + Serous Keys (5)

Answer 18

Malignant + Post-Menopausal

Serous Keys
Most common ovarian cancer
Serous more likely bilateral + with psammoma bodies
Serous Type II - p53 and Platinum Senstive (EXAM KEY)
BRAC1 - Increases Risk of Type II Serous
Serous Associated with Ascities

Question 19

Endometrioma - Definition + Findings

Answer 19

Ovarian surface tumor due to endometriosis 
Chocolate Cyst (Blood Products) + increased risk for both endometrial and ovarian cancer

Question 20

Brenner Tumor - Definition + Findings

Answer 20

Surface epithelial ovarian tumor (benign)

Bladder epithelial tissue with coffee bean nuclei

Question 21

Cystic Teratoma - Tissue + Age Group + Findings (4)

Answer 21

1) 2-3 Fetal Embryological Layers
2) Youngest (all germ line are pre-menopausal but this is < 20 y/o)
3) Neuro-ectoderm cells indicated malignant potential
4) Stuma ovarri - Thyroid tissue teratoma

Question 22

Dysgerminoma - Tissue + Age Group + Findings (3)

Answer 22

Oocyte Tumor
Reproductive Age Women

Findings

1) Histology = Clear cytoplasm and central nuclei (fried egg)
2) Male Version = Seminoma
3) LDH and bHCG Markers

Question 23

Endodermal Sinus Tumor - Tissue + Age + Findings (4)

Answer 23

Yolk Sac Tissue
Reproductive Age Women
1) AFP = Key Marker
2) Schiller-Duval Bodies = Glomerulus Like Structures
3) Yellow friable solid mass (with/without hemorrhage)
4) Male version = more aggressive + young children

Question 24

Choriocarcinoma - Tissue + Age + Findings (3)

Answer 24

Placental Tissue
Malignant tumor of trophbolast + syncythrophoblasts
Reproductive Age Women

Findings

1) Mimics placenta with absent villi
2) Rapid progression + massive METs (trophoblasts designed to invade blood vessesls
3) bHCG Marker (Syncythrophoblasts)

Question 25

Granulosa/Theca Tumors - Systemic Effects + Tumor Markers (2)

Answer 25

Estrogen producing = S/Sx of estrogen excess (precious puberty, post-menopausal bleeding, endometrial hyperplasia etc)

Markers = Inhibin + FOXL2

Question 26

Sertoli-Leydig Cell Tumor - Key Findings (2)

Answer 26

1) Androgen Producing - Hirtuism + Virilaization

2) Histology = Eosinophilic Reinke Crystals

Question 27

Tumors with Psmammoa Bodies (6)

Answer 27

1) Papillay Thyroid Carcinoma
2) Serous Cystadenomcarcinoma
3) Prolactinoma
4) Endometrial Serous Carcinoma
5) Meningioma
6) Mesothelioma

Question 28

Krukenberg Tumor - Key Findings (4)

Answer 28

1) GI Tumor with metastasis to the ovary
2) Bilateral
3) Histology = Signet Rings = Cytoplasm pushing nucleus to the side = mucous appearing
4) Will seem similar to mucinous cystadenocarcinoma but it is bilateral vs. mucinous = unilateral