Gynecologic and Obstetric Pathology STARRED ONLY Flashcards by Emily Prazak

What is the most common cause of abnormal vaginal bleeding?

Dysfunctional uterine bleeding - a disorder of the ovulatory cycle (anovulation)

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What are the common causes of this anovulatory bleeding?

IDIOPATHIC is the most common
perimenarchal
perimnopausal
PCOS
sex cord tumors
primary endocine disorders

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What is the most common reason for post-menopausal endometrial bleeding?

endometrial atrophy

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What are other endometrial problems that cause bleeding?

endometrial hyperplasia
endometrial carcinoma
endometrial polyps
submucosal leiomyomas
adenomyosis
endometriosis

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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

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Chief pearl: post-menopausal vaginal bleeding needs to be what until proven otherwise?

endometrial carcinoma

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If you feel an adnexal mass, what is the main NON-NEOPLASTIC source?

pelvic inflammatory disease

But also ectopic pregnancy, cysts, or endometriosis

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What are the primary ovarian neoplasms?

epithelial: serous vs. mucinous
sex cord/stromal
germ cell - dermoid cyst especially

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Tumors that are metastatic to the ovary tend to be from where?

adjacent gynecological tumors or appendix, colon, breast, stomach

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Chief pearl: adnexal mass in a post-menopausal female is what until proven otherwise

cancer

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What is the most common gestational disorder in the first trimester?

early trimester miscarriage

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Those were the stars from the overview….now on to the specifics….

……..

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Almost all of the vulvar infections are due to what?

sexually transmitted diseases (except for candida, GBS, etc)

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What is the most common cause of post-partum obstetrical infection in the US today?

retained placenta

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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

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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

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What is the most common cause of vaginal discharge?

bacterial vaginosis

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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

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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)

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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

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What are the two types of invasive cervical carcinoma due to HPV?

69% squamous carcinoma

25% adenocarcinoma

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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

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For reproductive women, dysfunctional uterine bleeding is the main consideration for what type of pathology?

endometrial pathology

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What are hormone issues with anovulation?

you have adequate estrgen, but lack of progesterone leading to non-cyclical bleeding

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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?

1. simple glandular enlargment wihtout atypia 2. complex enlargement without atypia 3. complex with atypia 4. 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?

1. 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?

1. PCOS 2. Chromosome abnormalities 3. structural uterine anomalies 4. cervical incompetence 5. 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?

1. hydatidiform mole 2. choriocarcinoma 3. placental site trophoblastic tumor

What is the most accurate tumor marker for these hydatidiform moles or choriocarcinoma?

increased serum hCG