Gyn Path (Samuelson) Flashcards
this is the most important risk factor for development of cervical cancer, and results in transient infections
human papilloma virus (particularly HPV16 and 18)
how often should pap testing be done for women age 21-29? what about for women who are 30-65?
21-29: every 3 years
30-65: every 3 years, or 5 years with HPV co-testing
*only good for detecting/preventing cervical cancer, not other cancers
what is the follow up procedure for low grade squamouos intraepithelial lesions (LSIL) with +/-HPV?
colposcopy
what are the histological findings in high grade squamous intraepithelial lesions (HSIL)?
basal layer of cells = the total epithelial thickness and high nucleus:cytoplasm ratio with clumped chromatin (almost no cytoplasm evident)
procedure performed to excise a cervical lesion that involves using a hot loop to remove a square or rectangular piece of affected cervical tissue
LEEP (aka, low electrocautery procedure)
procedure in which a large area of tissue around the cervix is excised for examination
cold knife cone (not as common as it can cause cervical problems that may translate to problems during pregnancy)
most common type of cervical cancer
squamous cell carcinoma; may have no symptoms or present with post-coital spotting, vaginal bleeding or discharge
staging of a carcinoma is used to assess ____ of damage, predict ____, and plan therapy
extent; survival
a cervical carcinoma that extends to the bladder or rectal mucosa is given what stage classification?
stage IV
a cervical carcinoma that extends beyond the cervix but not to pelvic sidewall or lower third of the vagina is given what stage classification?
stage II
what is the survival rate of stage IA cervical cancer (microscopic disease)?
95%
benign growths composed of fibrous stroma, irregular-shaped, dilated glands and abnormal vessels; thought to be due to unopposed estrogen secretion
endometrial polyp
a spectrum of morphologic alterations ranging from benign to premalignant disease often related to loss of hormonal control of the endometrium
hyperplasia
up to 29% of hyperplasias with cytologic ____ progress to cancer
atypia
All of the following are risk factors for endometrial carcinoma EXCEPT:
A. Multi-parity
B. Late menopause
C. Lynch syndrome
D. Obesity
E. Poly cystic ovarian syndrome
A. Nulliparity is an endogenous risk factor for endometrial adenocarcinoma.
an autosomal dominant genetic condition in which inherited mutations in DNA mismatch repair lead to high risk of colon, endometrial and various other types of cancer
Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer )
most common type of endometrial carcinoma associated with excess estrogen and atypical hyperplasia in pre-menopausal women
endometrioid *important to know for exam
second most common type of endometrial carcinoma associated with atrophic endometrium and intraepithelial carcinoma in older women
serous carcinoma *important to know for exam
what are the histological features of the 3 grades of endometrioid type carcinoma?
grade 1: highly grandular
grade 2: 5-50% solid tumor, mostly making glands
grade 3: nearly all solid tumor, >50%
common benign uterine mesenchymal neoplasm that can cause bleeding and may present as pelvic pain or mass
leiomyomata (aka, leiomyoma)
malignant mesenchymal tumors that are uncommon, account for about 3% of all uterine malignancies
uterine sarcomas (ie, leiomyosarcoma, endometrial stromal sarcoma, etc)
type of uterine sarcoma that is characterized by spindle cells with high mitotic rate on histology, and are treated with resection and maybe chemo/RT; poor prognosis
leiomyosarcoma
type of uterine sarcoma that is characterized by invasive growth into vessels and is low grade and indolent; high risk of recurrence but can often be treated with hormone therapy
endometrial stromal sarcoma (ESS)
in adults, the most common type of ovarian tumors involve this cell layer
epithelial cell layer. In adults, 65% of all ovarian tumors, and ~91% of all malignant primary tumors involve the epithelial cell layer.
*In the pediatric population, germ cell tumors are most common
___ tumors are the most common type of ovarian epithelial tumors, accounting for nearly 50%, and are often bilateral, especially when malignant
serous
about 1/3 of epithelial tumors are ____ tumors, and usually occur unilaterally
mucinous
malignant serous epithelial carcinomas are usually stage ___ when detected during surgery, with large nodules in the peritoneum
3;
5 year surival rates for ovarian epithelial malignancy are:
Stage 1: 80-85%
Stage 2: 60-70%
Stage 3: 30-50%
Stage 4: 15%
Which of the following germ cell tumors is incorrectly matched with its cell morphology?
A. Teratoma: resembles any of the 3 embryonic layers
B. Dysgerminoma: resembles germ cells
C. Yok sac tumor: heterogenous, resembles any ectodermal structure
D. Embryonal: resembles embryonic disc
E. Choriocarcinoma: resembles placenta
C. Yolk sac tumors are heterogenous and resemble any ENDOdermal structure
type of rare germ cell tumor shown below that has malignancy potential, and on histology shows many small round cells with high NC ratio that form rosettes around a central core
immature teratoma
*note: mature teratomas are the most common germ cell tumors, and are usually benign
type of tumor shown below, that resembles fallopian tube epithelium and has complex internal structure with visible friable papillary growth pattern (papillary “excrescences”)
borderline serous tumor
type of tumor shown histologically below, with sheets of germ-like cells that have a nucleous surrounded by clear cytoplasm and prominent nucleoli; lymphocytes are also seen mixed in with cells
dysgerminoma; gross image shows homogenous solid tan tumor
____ and _____ are benign ovarian sex cord stromal neoplasms that are usually solid masses composed of swirling spindled stromal cells
fibromas and thecomas
type of estrogen-producing sex cord/stromal tumor that has malignant potential and is notorious for recurring many years after initial resection; histo shows “coffee-bean nuclei”
granulosa cell tumor
* another classic but uncommon histologic finding are small light colored patches called Call-Exner bodies (shown below)
_____ cell tumors generally produce androgens and are associated with virilization.
Sertoli-Leydig
Vaginal bleeding is likely to be a presenting symptom in each of the following EXCEPT:
A. spontaneous miscarriage
B. carcinoma-in-situ of the uterine cervix
C. adenocarcinoma of the endometrium
D. invasive squamous cell carcinoma of uterine cervix
E. complex hyperplasia, with atypia, of endometrium
B
You perform a routine Pap test on a 32 year old woman. The Pap shows scattered cells with a low nuclear:cytoplasm ratio but enlarged, irregular nuclei with perinuclear haloes. You have sent a concurrent molecular test for HPV, the results of which show the presence of HPV16. What is the appropriate management?
A. Follow-up with repeat Pap in 3 years
B. Follow-up with repeat Pap in 1 year
C. Excisional procedure
D. Colposcopy
C.
An 82-year-old woman comes to your clinic for new-onset vaginal bleeding. She has been postmenopausal for 30 years. You perform an endometrial biopsy which shows complex papillary structures lined by pleomorphic hobnail-type cells and background atrophic endometrium. The diagnosis is:
A. High grade endometrioid carcinoma (FIGO grade 3)
B. Complex hyperplasia with atypia
C. Serous carcinoma (FIGO grade 3)
D. Atrophic endometrium with papillary metaplasia
C.
Which inherited (germline) genetic abnormality is NOT associated with an increased risk of developing ovarian carcinoma?
A. Lynch Syndrome
B. BRCA 1 mutation
C. BRCA 2 mutation
D. p53 mutation
D.
A 50 year old woman has a right ovarian mass removed. It is enlarged (20 cm), multicystic, and contains septations with many papillary excrescences. The most likely diagnosis is:
A. Granulosa cell tumor
B. Mature cystic teratoma
C. Metastatic adenocarcinoma
D. Serous borderline tumor
E. Thecoma with cystic degeneration
D.
Where do we sample the cervix for a pap smear?
squamo-columnar junction; this site is ideal for getting a sample of HPV which tends to hang out in the basal layer of the squamous layer at first and gradually works its way up to the surface of the squamous layer
condition in which benign endometrial tissue is found outside of the uterine cavity, and affects 5-15% of women of reproductive age
endometriosis
Generally, the term “endometriosis” refers to the external version - but if there are benign endometrial glands/stroma within the uterine myometrium, it is referred to as _______ (diffuse) or______ (discrete lesion).
adenomyosis; adenomyoma
what is the treatment for organ torsion?
removal of the organ
All of the following are sources of secondary infection EXCEPT:
A. Mycoplasma
B. E. Coli
C. Bacteroides
D. Anaerobes
A. Mycoplasma, gonorrhea and chlamydia are all primary infections.
Pelvic abscesses, tubal obstruction/scar, infertility and hydrosalpinx (marked fluid-dilated fallopian tubes) are all problems associated with what disease?
pelvic inflammatory disease
The most common site of ectopic pregnancy implantation is:
A. Ovary
B. Cervix
C. Fallopian tube
D. Abdomen
E. Wall of the uterus
C
All of the following are true about gestational trophoblastic neoplasia (GTN) EXCEPT:
A. GTN arises from proliferation of placental tissue
B. Complete hydatidiform moles have marked edema of the villi and have no fetus
C. Invasive mole invades the myometrium of the uterus
D. Choriocarcinoma is a histologic finding of atypical trophoblast growth without the formation of villi and is known to have aggressive behavior
E. Partial variant mole is diploid with both sets of chromosomes paternal in origin
E. This is the definition of a complete variant hydatidiform mole. Partial variant is triploid and has two sets of paternal chromosomes and one set of maternal chromosomes. In a partial mole, there often may be fetal tissue present
Note: below are the hallmarks of complete mole. cistern formation (left) and villi trophoblastic proliferation (right) can be seen
condition which may result as a metastasis of a molar pregnancy, in which there are NO villi present, just malignant-appearing trophoblast
choriocarcinoma (CCC)
malignant GTN that occurs after a normal pregnancy is associated with _____ prognosis.
poor; prognosis is also poor if HcG is high (>40,000) or there is metastasis to brain/liver (risk of tumor ingrowth into vascular structures –> hemorrhage)
A 30 year old woman presents to your Infertility Clinic. She has been off of birth control and trying to get pregnant for the last year, but has not been successful. Her menses are regular. She has been seen in your clinic and treated for chlamydia and gonorrhea several times in the past, but has not had any pelvic pain for a few years. You suspect the most likely culprit for her infertility is:
A. Complications of endometriosis
B. Complications of excisional procedures for cervix dysplasia
C. Complications of pelvic inflammatory disease.
E. Complications of hyperestrogenism
C
