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pathology > gyn path- female > Flashcards

gyn path- female Flashcards

1
Q

what type of HSV typically involves genital mucosa and skin?

A

hsv 2

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2
Q

during acute infection of HSV virus migrates to

A

regional nerve ganglia to establish lastent infection

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3
Q

is candidiasis an STD

A

no

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4
Q

symptoms of candidiasis

A

severe itching, erythema, swelling and curdlike thick, white discharge

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5
Q

in HSV what can trigger reactivation of virus and recurrence of lesions

A

any decrease in immune system

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6
Q

symptomatic candidiasis is typically a result of what?

A

disturbance in the patients vaginal microbial ecosystem

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7
Q

coloscopic appearance of trichomonas vaginalis

A

strawberry cervix

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8
Q

what are the symptoms of trichomoniasis?

A

STD - pts may be asymptomatic or present with yellow frothy vaginal discharge, discomfort, dysuria, and painful intercourse

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9
Q

main cause of bacterial vaginosis is

A

gardnerella vaginalis

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10
Q

is gardnerella vaginalis an STD

A

no

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11
Q

symptom of gardnerella vaginalis

A

Thin, green-gray, malodorous (fishy) vaginal discharge

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12
Q

PID is

A

an infection that begins in the vulva or vagina and spreads upward

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13
Q

infections after abortions and deliveries spread ___ and are inflammation of ___

A

upward from uterus through lymphatics or veins

deeper layers

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14
Q

what cell do you see microscopically in a gardnerella vaginalis infection?

A

clear cell

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15
Q

what types of infections can cause PID?

A

gonorrhoeae
chlamydia
infections after abortions and deliveries

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16
Q

chronic complications of PID

A 
Chronic salpingitis with scarring of the tubal lumen and fimbria
Infertility
Ectopic pregnancy
Pelvic pain
Intestinal obstruction due to adhesions
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17
Q

acute complications of PID

A

Bacteremia
Acute peritonitis
Endocarditis, meningitis, arthritis

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18
Q

bartholin cyst result from

A

obstruction of duct by inflammatory process

can be up to 5 cm

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19
Q

what is leukoplakia?

A

opaque, white plaque like epithelial lesions

itching and scaling

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20
Q

lichen sclerosis is most commonly seen in what population?

A

post-menopausal patients

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21
Q

what is lichen sclerosis?

A

gross: smooth white plaques resembling porcelain or parchment
micro: marked thinning of epidermis, degeneration of basal cells, hyperkeratosis, sclerotic changes of superficial dermis, bandlike lymphocytic infiltrate in underlying dermis

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22
Q

lichen sclerosis is slight increased risk of developing

A

squamous cell carcinoma

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23
Q

what is squamous cell hyperplasia?

A

nonspecific condition resulting from rubbing or scratching of the skin

micro: acanthosis thickening of epidermis and hyperkeratosis

**not considered premalignant

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24
Q

HPV types associated with benign genital warts (low risk)

A

6 and 11

most common

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25
Q

HPV types associated with carcinoma and its precursors

A

16, 18, 31, 33

high risk

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26
Q

what is a koilocyte?

A

an abnormal squamous cell that indicates HPV infection
perinuclear clearing
wrinkled, enlarged, and hyperchromatic nucleus
contains HPV DNA

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27
Q

what is condyloma acuminatum?

A

benign genital wart
HPV 6 & 11

papillary, exophytic cores of stroma covered by thickened squamous epithelium

koilocytosis
not precancerous lesion

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28
Q

what are the squamous neoplastic lesions of the vulva?

A

Vulvar Intraepithelial Neoplasia (VIN) and Vulvar Carcinoma

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29
Q

how do vulvar carcinomas appear grossly?

A

basaloid and warty carcinomas 30%
keratinizing SCC 70%

related to high risk HPV - most commonly 16

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30
Q

what are the risk factors for classic VIN?

A

young age at first intercourse
multiple sexual partners

grades high VIN 2-3
low VIN 1

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31
Q

Keratinizing squamous cell carcinomas occurs most often in individuals with

A

long-standing lichen sclerosus

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32
Q

Keratinizing squamous cell carcinomas arises from

A

differentiated VIN or VIN simplex
tp53 mutations; 8th decade
unrelated to HPV

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33
Q

differentiated VIN is

A

Marked atypia of the basal layer of the squamous epithelium and normal-appearing differentiation of the more superficial layers

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34
Q

what are the types of glandular neoplastic lesions?

A

papillary hidradenoma

extramammary pagets disease

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35
Q

is papillary hidradenoma benign or malignant?

and what does it look like

A

benign
small tumors of the tubular ducts (apocrine sweat gland tumors)
histologically identical to intraductal papilloma of the breast

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36
Q

what is extramammary paget disease?

A

itchy, red, crusted, sharply demarcated, maplike area
confined to the epidermis

typically seen in isolation

Ddx: melanoma in-situ

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37
Q

what is septate

A

double vagina that arises from failure of mullerian duct fusion
also double uterus

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38
Q

what effects were caused when women were exposed to diethylstilbestrol?

A

non-neoplastic and neoplastic changes (clear cell carcinoma) liked to in-utero exposure

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39
Q

what is VAIN?

A

vaginal intraepithelial neoplasia

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40
Q

what can VAIN lead to?

A

squamous cell carcinoma

virtually all primary carcinomas of the vagina are squamous cell carcinomas associated with high risk HPVs, arises from VAIN

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41
Q

what is the greatest risk factor for VAIN and squamous cell carcinoma?

A

previous carcinoma of the cervix or vulva

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42
Q

where do vaginal lesions metastasize to?

A

lesions in the lower 2/3 metastasize to the inguinal nodes

lesions in the upper vagina spread to regional iliac nodes

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43
Q

what is embryonal rhabdomyosarcoma?

who is it frequent in

how do you treat it

A

bulky polypoid mass that can project out of vagina

composed of malignant embryonal rhabdomyoblasts

most frequently in children under age five

tx with surgery and adjuvant chemotherapy

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44
Q

what types of cells are found in the cervix?

A

exocervix - mature squamous epithelium
endocervix - columnar, mucus-secreting epithelium
transformation zone: area where the columnar epithelium abuts the squamous epithelium (HPV tends to affect this area)

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45
Q

what causes acute and chronic cervicitis?

A

bacteria - primarily lactobacilli

estrogen stimulates glycogenation of vaginal and cervical squamous cells
shedding provides glycogen substrate for endogenous bacteria

lactobacilli produce lactic acid which maintains the vaginal pH below 4.5 suppressing growth of other organisms

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46
Q

what are endocervical polyps?

A

Benign exophytic growth of fibromyxomatous stroma covered by mucus-secreting endocervical glands

Irregular vaginal bleeding

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47
Q

what are the most important factors in the development of cervical cancer?

A

high risk HPVs (16 and 18)

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48
Q

most HPV infections are transient and eliminated by

A

immune response

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49
Q

the ability of HPV to act as a carcinogen depends on what viral proteins?

A

E6 and E7

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50
Q

E7 binds to what and promotes its degradation?

A

Rb

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51
Q

E6 binds to what and promotes its degradation?

A

p53

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52
Q

what is HSIL and LSIL

A

High grade intraepithelial lesion and low grade

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53
Q

LSILS are how many times more common than HSILs?

A

10 times

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54
Q

all HSILS are considered to be what?

A

at high risk for progression to carcinoma

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55
Q

almost all cervical carcinomas caused by

A

high risk HPV

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56
Q

what is the treatment for cervical carcinoma?

A

most invasive cancers managed by hysterectomy with lymph node dissection and radiation and chemotherapy

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57
Q

what do most patients with advanced cervical cancer die of?

A

the consequences of local tumor invasion rather than distant metastases

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58
Q

when should a woman get her first pap smear?

A

at age 21 or within 3 years of onset of sexual activity and every 3 years after

after age 30 every 5 years if negative for HPV

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59
Q

what is the uterine endometrium?

A

glands embedded in a cellular stroma

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60
Q

glands embedded in a cellular stroma

A

bundles of smooth muscle that form the wall of the uterus

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61
Q

proliferative phase in endometrium

A

estrogen driven endometrium grows

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62
Q

secretory phase in endometrium

A

progesterone driven endometrium prepares for implantation

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63
Q

menstrual phase phase in endometrium

A

endometrium falls due to loss of progesterone

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64
Q

what can cause abnormal uterine bleeding?

A

lesions of endometrium or uterus (leiomyoma, adenomyosis, polyps, endometrial hyperplasia, endometrial carcinoma)
complications of pregnancy (ectopic, abortion trophoblastic disease)

65
Q

what is dysfunctional uterine bleeding (DUB)?

A

due to hormonal disturbances, no morphologic cause

the most frequent cause of DUB is anovulation results in excessive endomentrial stimulation by estrogens that is unopposed to progesterone

66
Q

why are the myometrium and endometrium relatively resistance to infections?

A

because of cervical barrier

67
Q

what is acute endometritis

A

Uncommcon
Bacterial infection occurring after delivery, abortion or miscarriage
Often related to retained products of conception

68
Q

what is chronic endometritis

and what causes it

A

plasma cells in stroma

Pelvic inflammatory disease 
Intrauterine devices
Retained gestational tissue
Tuberculosis (very rare)
Idiopathic (about 15% of cases)
69
Q

what is endometriosis

A

presence of ectopic endometrial tissue at a site outside of the uterus

70
Q

most common sites endometriosis found

A

within the abdominal cavity (ovary), but occasionally it is found at distant sites

71
Q

endometriosis is associated with which types of ovarian cancers?

A

endometrioid and clear cell types

72
Q

how do you identify endometriosis grossly?

A

ovarian chocolate cysts (endometriomas)

subseroal and/or submucosal red-blue to yellow brown nodules
fibrous adhesions

need to see: endometrial glands, stroma, and hemosiderin

73
Q

adenomyosis is

A

presence of endometrial tissue within uterine wall (myometrium)

can coexist with endometriosis

74
Q

what are endometrial polyps?

A

masses of endometrium protruding into the endometrial cavity

may cause abnormal uterine bleeding

may contain functional or hyperplastic endometrium

endometrial carcinoma can arise within a polyp

75
Q

what is endometrial hyperplasia and what can it lead to?

A

defined as an increased proliferation of the endometrial glands relative to the stroma

increased gland to stroma ratio

most commonly caused by unopposed estrogen stimulation

precursor to most common type of endometrial carcinoma

hyperplasia with and without atypia

76
Q

what is the most common invasive cancer of female genital tract

A

carcinoma of endometrium

77
Q

what are the two types of carcinoma of the endometrium?

A

type 1 - endometrioid

type 2 - serious, clear cell, MMMT - malignant mixed mullerian tumor

78
Q

what are the characteristics of a type I endometrial carcinoma

A

endometrioid
80% of cases
55-65
unopposed estrogen stimulation obesity, diabetes, HTN, infertility

indolent, spreads via lymphatics

79
Q

what are the characteristics of a type II endometrial carcinoma?

A

serous, clear cell, MMMT
65-75
endometrial atrophy
aggressive, intraperitoneal and lymphatic spread

80
Q

endometrial carcinoma is often preceded by atypical hyperplasia and commonly has mutations in what genes?

A

MC mutations act to increase signaling through the PI3K/AKT pathway

PTEN
PIK3CA
KRAS
ARID1A

81
Q

what are the most common mutations seen in serous carcinoma of the endometrium?

A

TP53

82
Q

what is MMMT

malignant mixed mullerian tumor

A

carcinosarcoma

endometrial adenocarcinomas with a malignant mesenchymal component biphasic

clinically aggressive, 5 year survival 25-30%

83
Q

what is true of both low and high grade stromal sarcomas of the endometrium?

A

both prone to late recurrences

84
Q

low grade stromal sarcomas associated with what genes

A

JAZF1 and SUZ12

85
Q

what is leiomyoma of the endometrium?

A

fibroids

benign smooth muscle neoplasn that can occur anywhere smooth muscle is normally found

about 25% of women of repro age have them

86
Q

what is leiomyosarcoma?

A

malignant tumor of the endometrial smooth muscle

uncommon
40-60 y/o

mets to lungs bone brain

87
Q

malignant neoplasms of fallopian tubes are metastases from

A

ovarian or uterine primaries

88
Q

what is STIC?

A

serous tubal intraepithelial carcinoma

(tubal carcinoma in situ - p53)

precursor of ovarian high grade serous carcinoma

89
Q

what are the most common lesions of the ovarian?

A

benign follicular cysts

90
Q

what are follicular cysts?

A

unruptured graafian follicles or follicles that have ruptured and immediately sealed

91
Q

what do luteal cysts look like?

A

bright yellow/orange luteal tissue, hemorrhage and fibrin in the center (may be confused with endometriosis)

92
Q

what is PCOS?

A

complex endocrine disorder characterized by hyperandrogenism, menstrual abnormalities, polycystic ovaries, chronic anovulation, and decreased fertility

**dysregulation of enzymes involved in androgen biosynthesis and excessive androgen production

93
Q

why is there a disproportionate number of deaths from cancer of female genital tract?

A

bc most ovarian cancers have spread beyond the ovary by the time of diagnosis

fifth most common cause of cancer death in women

94
Q

what are the different classifications of ovarian tumors?

A

surface epithelial tumors
germ cell tumors
sex cord stromal tumors
metastatic tumors

95
Q

what are the three major types of surface epithelial tumors in women?

A

serous
mucinous
endometrioid

(classified as benign, borderline, and malignant)

96
Q

what determines the stage of ovarian tumors?

A

extent of spread outside the ovary

97
Q

ovarian tumors associated with BRCA1 and 2 mutations are almost always associated with what?

A

serous carcinoma and TP53 mutations

98
Q

low and borderline serous tumors have associations with what mutations?

high grade serous tumors have associations with what mutation?

A

low and borderline - KRAS, BRAF, HER2

high - TP53

99
Q

serous carcinomas have a spread where?

A

peritoneal surfaces and omentum
ascites

5 year survival does not mean cure

100
Q

what is the consistent genetic alteration in mucinous tumors?

A

KRAS

101
Q

what does mucinous tumors look like

A

Large cystic masses; multiloculated filled with sticky, gelatinous fluid

102
Q

only ___ of primary mucinous cystadenomas and mucinous are bilateral

A

5% *****

103
Q

what is pseudomyxoma peritonei?

A

extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, frequent involvement of ovaries

(related to mucinous ovarian tumors)

104
Q

endometrioud ovarian tumors resemble

A

endometrious adenocarcinoma of endometrium

105
Q

clear cell carcinoma

A

rare
aggressive, extremely poor diagnosis
in association with endometriosis

106
Q

brenner tumor

A

uncommon

neoplastic epithelial cells resembling urothelium

107
Q

the majority of female germ cell tumors are of what type?

A

mature cystic teratomas in women of reproductive age

108
Q

what are the three catagories of teratomas?

A

mature (benign)
immature (malignant)
monodermal or highly specialized

109
Q

what is another name for a mature teratoma?

A

dermoid cyst (almost always lined by skin-like structures)

110
Q

in mature teratomas you see unilocular cyst containing

A

hair, sebaceous debris, teeth, and mature brain tissue

111
Q

immature malignant teratomas is presence of

A

immature elements, most often consisting of primitive neuroepithelium

112
Q

struma ovarii and carcinoid in

A

immature elements, most often consisting of primitive neuroepithelium

113
Q

struma ovarii compossed entirely of

A

mature thyroid tissue that may be functional (hyperthyroidism)

114
Q

carcinoid may arise from

A

intestinal epithelium in a teratoma, can also be functional (carcinoid syndrome)

115
Q

dysgerminoma is ovarian counterpart of

A

testicular seminoma

116
Q

is dysgerminoma response to chemo

A

yes

117
Q

yolk sac tumor affects

A

children and young adults

118
Q

tumor cells in yolk sac tumor produce

A

AFP

119
Q

yolk sac tumor feature

A

shiller duval bodies

120
Q

sex cord stromal tumors are derived from

A

ovarian stroma which is derived from sex cords of embryonic gonad

121
Q

granulosa cell tumors are mostly in which women

A

post menopausal

122
Q

granulosa cell tumors are composed of cells that resemble granulosa cells of

A

developing ovarian follicle

123
Q

granulosa cell tumors associated with elevated tissue and serum levels of

A

inhibin

124
Q

Mutations of the ___ gene in 97% of adult granulosa cell tumors

A

FOXL2

125
Q

granulosa cell tumors unilateral or bilateral

A

unilateral

126
Q

histological features of granulosa cell tumors

A

call exner bodies

grooved (coffee bean) nuclei

127
Q

what are fibromas, thecomas, and fibrothecomas?

A

tumors of ovarian stroma composed of fibroblasts (fibromas) or spindle cells with lipid droplets (thecomas)

tumors that contain a mixture of these cells are termed fibrothecomas

***the thecoma portion can produce estrogen

128
Q

fibromas, thecomas, and fibrothecomas as associated with what two syndromes?

A

meigs syndrome (ovarian tumor, hydrothorax - R, ascites)

basal cell nevus syndrome (Gorlin syndrome)

129
Q

what is meigs syndrome?

A

ovarian tumor, hydrothorax (R side), ascites

130
Q

sertoli-leydig cell tumor is ovarian tumor that resembles cell of

A

male testis: capable of androgen production

Unilateral solid tumors
Histologically, Sertoli-like tubules and interspersed large Leydig-like cells

131
Q

most common metastatic ovarian tumor

A

Müllerian origin most common

-Uterus, contralateral ovary, fallopian tube, pelvic peritoneum

132
Q

Extra-Müllerian metastatic ovarian tumors

A
  • Breast

- Gastrointestinal tract (stomach, colon, biliary tract, pancreas, appendix)

133
Q

what is a krukenberg tumor?

A

bilateral mets composed of mucin producing signet ring cancer cells, most often gastric origin

134
Q

spontaneous abortion/ miscarriage is

A

pregnancy loss before 20 weeks of gestation

About 50% show fetal chromosomal abnormalities

135
Q

ectopic pregnany is

A

Implantation of fetus outside of the uterus including fallopian tube (90%), ovary, abdominal cavity, intrauterine portion of the tube (cornual pregnancy)

136
Q

what is the predisposing condition of ectopic pregnancy?

A

previous PID with chronic salpingitis

scarring & adhesions from appendicitis, endometriosis, prior surgery
IUD

137
Q

Placenta previa is

A

placenta implants to low uterine segment or cervix

serious 3rd trimester bleeding

138
Q

what percentage of spontaneous abortions show fetal chromosomal abnormalities?

A

50%

139
Q

what is placenta acreta?

A

partial or complete absence of the decidua - the placental villous tissue adhere directly to the myometrium

(failure of placental separation can cause severe postpartum bleeding)

140
Q

what is chorioamnionitis

A

inflammation of fetal membrane

141
Q

what is funisitis

A

inflammation of umbilical cord

142
Q

hematogenous (transplacental) infection examples

A

TORCH group (toxoplasmosis and others [syphilis, TB, listeriosis], rubella, cytomegalovirus, herpes simplex): chronic villitis, congenital anomalies

143
Q

what are ascending infections through birth canal caused by

A

bacteria

144
Q

what is preeclampsa

A

widespread maternal endothelial dysfunction that presents with hypertension, edema and proteinuria

eclampsia: if convulsions occur

145
Q

what is HELLP syndrome?

A

microangiopathic hemolytic anemia
elevated liver enzymes
low platelets

146
Q

management of preeclampsia depends on

A

gestational age and severity of disease

definitive treatment is delivery

147
Q

what type of disease is caused by a hydatidiform mole?

A

gestational trophoblastic disease

cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation

abnormal vaginal bleeding sometimes with passage of bits of tissue

148
Q

how do you measure hydatidiform mole?

A

** measure B-hCG for diagnosis

persistently elevated beta-hCG may be indicative of persistent or invasive mole

149
Q

treatment of hydatidiform mole?

A

curettage of hysterectomy

150
Q

complete mole is fertilization of an egg that __

A

has lost its female chromosomes

46 chromosomes

151
Q

is there edema in complete mole

A

almost all villi are edematous

152
Q

are there fetal parts in complete mole

A

no

153
Q

partial mole is fertilization of egg with

A

two sperm

69 chromosomes

154
Q

is there edema in partial mole

A

mixture of edematous villi and normal sized villi

155
Q

which mole has more risk for choriocarcinoma

A

complete

156
Q

what are the differences between a complete and partial hydatidiform mole?

A 
complete:
fertilization of egg that has lost its female 
diploid
all villi edematous
diffuse trophoblastic hyperplasia
no fetal parts
serum B-hCG markedly elevated
partial:
triploid
edematous villi and normal-sized villi
focal trophoblastic proliferation
fetal parts often present
serum b-hCG less elevated than with complete mole
157
Q

what is invasive mole

A

a mole that penetrates or even perforates the uterine wall

158
Q

what is a choriocarcinoma in females?

A

gestational malignant neoplasm of trophoblastic cells derived from a previously normal or abnormal pregnancy

159
Q

clinical symptoms of choriocarcinoma in females

A 
presentation:
irregular spotting of bloody brown fluid
hCG markedly elevated
proliferation sync and cytotrophoblasts
widespread metastasis
nearly 100% remission with chemo

pathology (8 decks)

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