Gynecologic and Obstetric Pathology STARRED ONLY Flashcards
What is the most common cause of abnormal vaginal bleeding?
Dysfunctional uterine bleeding - a disorder of the ovulatory cycle (anovulation)
What are the common causes of this anovulatory bleeding?
IDIOPATHIC is the most common perimenarchal perimnopausal PCOS sex cord tumors primary endocine disorders
What is the most common reason for post-menopausal endometrial bleeding?
endometrial atrophy
What are other endometrial problems that cause bleeding?
endometrial hyperplasia endometrial carcinoma endometrial polyps submucosal leiomyomas adenomyosis endometriosis
Any time you have abnormal bleeding in someone of reproductive age, what’s the first thing to think about?
abnormal gestation - early trimester miscarriage, ectopic gestation or mid/late trimester bleeding
Chief pearl: post-menopausal vaginal bleeding needs to be what until proven otherwise?
endometrial carcinoma
If you feel an adnexal mass, what is the main NON-NEOPLASTIC source?
pelvic inflammatory disease
But also ectopic pregnancy, cysts, or endometriosis
What are the primary ovarian neoplasms?
- epithelial: serous vs. mucinous
- sex cord/stromal
- germ cell - dermoid cyst especially
Tumors that are metastatic to the ovary tend to be from where?
adjacent gynecological tumors or appendix, colon, breast, stomach
Chief pearl: adnexal mass in a post-menopausal female is what until proven otherwise
cancer
What is the most common gestational disorder in the first trimester?
early trimester miscarriage
Those were the stars from the overview….now on to the specifics….
……..
Almost all of the vulvar infections are due to what?
sexually transmitted diseases (except for candida, GBS, etc)
What is the most common cause of post-partum obstetrical infection in the US today?
retained placenta
What is the clinical presentation of PID?
lower abdominal pain endocervical discharge deep dyspareunia acute cervical motion tenderness adnexal tenderness on bimanual exam fever
but…many cases are subclinical
Can the diagnosis of PID be clinical only?
yes - especially in the chronic form - you’r eunlikely to find evidence of the bug on tests
What is the most common cause of vaginal discharge?
bacterial vaginosis
How do we diagnose HSV
PCR for the HSV DNA
used to do viral culture or Tzanck smear, but PCR is so much better now
What are the two classic vulvar dermatoses?
lichen simplex chronicus
lichen sclerosus et atrophicus
both present with white leukoplakia - either thick skin (chronicus) or thin skin (atrophicus)
over 90% of the vulvar malignancies are what kind of carcinoma?
squamous (most related to HPV)
the other 10 percent are melanoma, basal cell carcinoma, soft tissue sarcoma, angiomyxoma, and extra-mammary paget’s disease
What are the two types of invasive cervical carcinoma due to HPV?
69% squamous carcinoma
25% adenocarcinoma
What does pap smear screening capitalize on?
the fact that CIN disease exofliates abnormal dysplastic cells for many years PRIOR to actually becoming invasive cancer
For reproductive women, dysfunctional uterine bleeding is the main consideration for what type of pathology?
endometrial pathology
What are hormone issues with anovulation?
you have adequate estrgen, but lack of progesterone leading to non-cyclical bleeding
What is a major cause of anovulation bleeding in reproductive age women?
PCOS
What are a major causes of vaginal bleeding in postmenopausal women?
endometrial atrophy or endometrial polyp
but nonetheless….it’s endometrial carcinoma until proven otherwise because you don’t want to miss it
Describe the sequence leading to endometrial cancer from chronic estrogen excess?
- simple glandular enlargment wihtout atypia
- complex enlargement without atypia
- complex with atypia
- carcinoma
For most post-menopausal endometrial hyperplasia, where is most of that estrogen coming from?
OBESITY
but could also be exogenous or an estrogen-producing tumors (ovarian vs adrenal)
How does endometrial carcinoma present?
75-90% present with abnormal vaginal bleeding early on in the disease course
Type 2 endometrial carcinoma is what kind?
serous/clear cell carcinoma
What is the precursor for serous/clear cell endometrial carcinoma?
endometrial intraepithelial carcinoma
Is the serous clear cell endo CA associatd with estrogen and hyperplasia?
no - associated with atrophy
What is the most common soft tissue tumor in women?
leiomyomas
What is adenomyosis?
when there are endometrial glands and stroma present within myometrium in up to 20% of the uteri (basically endometriosis of the myometrium)
this causes typically poorly circumscribed myometrial wall thickening
this can be associated with menstrual irregularity/dysmenorrhea/dyspareunia na dpelvic pain
Uterine leiomyomas are foudn in what percentage of hysterectomy specimens?
77%
WHat ethic group has the highest rate of leiomyoma?
african american
What are the main symptoms of leiomyomas?
pelvic pressure/pain, urinary frequency, difficult defectaion, abnormal uterine bleeding with dysmenorrhea, impaired fertility, or adverse pregnancy outcomes
True or false: uterine fibroids can develop into uterine leiomyosarcoma.
false - they arise on their own
What percentage of women are affected by PCOS?
6-8%
What hormones are elevated in PCOS?
hyperandrogenism
causation is uncertain
What is the most common ovarian neoplasm in young women?
teratoma - dermoid cyst
What are the two main types of epithelial ovarian tumors?
serous
mucinonus
can be benign (adenoma) or malignant (carcinoma) or borderline
Which one is often bilateral?
serous (mucinous is typically unilateral)
What is the most common germ cell ovarian tumor?
dermoid cyst
What is the most common tissue seen in dermoid cysts?
skin and hair
but also fat, brain, retina, bronchus, instestein, teeth, bone, cartilage, thyroid, etc.
99% of dermoid cysts are benign in women, but 1% are focally malignant with what type of cancer?
usually squamous CA
Dermoid cysts are usually asymptomatic, but why would they present acutely?
- torsion/infarction
2. rupture with chemical peritonitis
What is the most common source for a metastasis to the ovary?
colorectum
What is the most common pregnancy pathology?
first trimester miscarriage - in about 10-20% of diagnosed pregnancies
What are the two general categories of early miscarriage?
threatened vs inevitable
complete vs incomplete
missed vs recurrent
What are the major risk factors for early trimester miscarriage?
- PCOS
- Chromosome abnormalities
- structural uterine anomalies
- cervical incompetence
- systemic maternal disease like diabetes or thyroid disorders
What is the most common cause of post-partum hemorrhage?
uterine atony - 80%
other issues are retained placenta, drug effects, infection, coagulation defects
What are the two general types of placental/maternal infections?
ascending infections
hematogenous infections
Ascending infection from the vagina or cervix usually causes what?
chorioamnionitis
What does chorioamnionitis increase the risk for?
premature membrane rupture
preterm delivery
fetal sepsis
endomyometritis
Almost all of these infections are caused by what?
bacteria -polymicrobial with strep, e coli, ureaplasma, fusobacterium, anaerobes
What are the bugs that can cross the placenta as a hematogenos infection?
malaria, syphilis, HIV, toxo, TB, rubella, listeriosis, hep B, hep C, CMV
What are the bugs we really worry about for the baby crossing through the birth canal?
HSV if ulceration
group B strep
chlamydia
gonococcus
Why do we worry about group B strep?
it’s the most common cause of life-threatening bacterial sepsis in newborns
What are the three possible entities when the placenta basically comes a tumor?
- hydatidiform mole
- choriocarcinoma
- placental site trophoblastic tumor
What is the most accurate tumor marker for these hydatidiform moles or choriocarcinoma?
increased serum hCG
