GYN Malignancies (OB and Breast) Flashcards
HPV - Key Strains + Viral Proteins + Histology
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)
Vaginal Histology + Pathologic Change
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)
Vaginal Carcinoma - Precursor Lesion + Lymph Nodes
Precursor = VAIN =Vaginal Intraepithelial Neoplasia
Lymph Nodes - Lower 1/3 = Inguinal vs. Upper 2/3 = Illiac
Cervical Intraepithelial Neoplasia - Findings (4) + Grading
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
Cervical Carcinoma - Classic Presentation (5) + Secondary Risk Factors (2) + Screening Flaws (2)
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
Asherman’s Syndrome - Definition + Cause
Secondary amenorrhea due to basalis (stem cell) loss)
Due to excessive D&C and subsequent scaring
Acute Endometritis - Common Presentation (4) + Cause + Chronic Key
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)
Endometriosis - Definition + Common Locations and Associated Symptoms (5)
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
Endometrial Hyperplasia - Cause + Classic Presenation
Consequence of unopposed estrogen - Classically obesity/PCOS
Post-Menopausal Bleeding - Atypical Cells = Worst Prognostic Indicators
Endometrial Carcinoma - Key Presentation + 2 Types
Abnormal - POST-Menopausal Bleeding
Type 1 - Hyperplasia Progress (Endometriod)
Type II - Sporadic with Serous Histology
Type 1 Endometrial Carcinoma - Age Group + Histology + Risk Factors + Genetics
Age - 50-60
Histology = progressive hyperplasia (endometriod)
Risk Factors - Unopposed Estrogen (Obesity, HTN, Diabetes, Anolovulatory Cycles)
PTEN Genetics Positive
Type 2 Endometrial Carcinoma - Age Group + Histology + Risk Factors + Genetics
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
Leiomyoma - Description + Presentation + Histology
Uterine fibrosis - benign myometrium proliferation
Presentation - Pre-menopasual bleeding + estrogen exposure
Histology - Multiple, well defined, white, whorled masses
Leimyosarcoma - Description + Key findings (2)
Malignant myometrium tumor - arises de novo (not from leimyoma)
Key Findings
1) Single lesion with necrosis + hemorrhage
2) High Mitotic index > 10 HPF
Endometrial Polyp - Description + Pathophyisology
Hyperplastic protrusion of the endometrium with abnormal bleeding
Typically due to Tamoxifen - Tamoxifen inhibits breast E-Receptors but stimulates endometrial receptors triggering proliferation
Surface Epithelial Ovarian Tumors - Signs/Symptoms (3) + Major Types (4) + Biomarker for Remission
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
Cystadenoma - Common Presentation + Keys
Benign - Pre-Menopasual + Single Cyst
Serous more often bilateral
Mucinous - RAS Mutation
Cystadenocarcinoma - Common Presentation + Serous Keys (5)
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
Endometrioma - Definition + Findings
Ovarian surface tumor due to endometriosis Chocolate Cyst (Blood Products) + increased risk for both endometrial and ovarian cancer
Brenner Tumor - Definition + Findings
Surface epithelial ovarian tumor (benign)
Bladder epithelial tissue with coffee bean nuclei
Cystic Teratoma - Tissue + Age Group + Findings (4)
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
Dysgerminoma - Tissue + Age Group + Findings (3)
Oocyte Tumor
Reproductive Age Women
Findings
1) Histology = Clear cytoplasm and central nuclei (fried egg)
2) Male Version = Seminoma
3) LDH and bHCG Markers
Endodermal Sinus Tumor - Tissue + Age + Findings (4)
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
Choriocarcinoma - Tissue + Age + Findings (3)
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)
Granulosa/Theca Tumors - Systemic Effects + Tumor Markers (2)
Estrogen producing = S/Sx of estrogen excess (precious puberty, post-menopausal bleeding, endometrial hyperplasia etc)
Markers = Inhibin + FOXL2
Sertoli-Leydig Cell Tumor - Key Findings (2)
1) Androgen Producing - Hirtuism + Virilaization
2) Histology = Eosinophilic Reinke Crystals
Tumors with Psmammoa Bodies (6)
1) Papillay Thyroid Carcinoma
2) Serous Cystadenomcarcinoma
3) Prolactinoma
4) Endometrial Serous Carcinoma
5) Meningioma
6) Mesothelioma
Krukenberg Tumor - Key Findings (4)
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
