Gynecologic and Obstetrical Pathology - Witrak Flashcards
What are the acute signs/symptoms of STDs?
vulvar/vaginal pain/discomfort, discharge, or erythema, ulceration
What are the chronic or delayed signs/symptoms of STDs?
pelvic inflammatory disease (pelvic pain, sterility, ectopic pregnancy)
condyloma/squamous intraepithelial neoplasia/carcinoma
AIDS
chronic viral hepatitis
2°/3° syphilis
More than 95% of abnormal vaginal bleeding is due to what female reproductive origin?
Endometrial
What is dysfunctional uterine bleeding? Etiologies?
Disorders of ovulatory cycle (anovulation):
either idiopathic, perimenarchal, perimenopausal,
OR due to primary ovarian disease (PCOS, sex cord/stromal tumors), primary endocrine disorders, or systemic disease
Post-menopausal vaginal bleeding is due to what condition until proven otherwise?
Cancer
What are some of the various etiologies of abnormal vaginal bleeding?
Endometrial atrophy (post-menopausal)
Endometrial hyperplasia/carcinoma
Structural disorders of endometrium/myometrium: endometrial polyps, submucosal leiomyomas, adenomyosis, endometriosis
Abnormal gestation: early trimester miscarriage, ectopic gestation, mid/late trimester bleeding
Cervical or vaginal neoplastic disease
What are the major considerations in the setting of an Adnexal Mass?
Non-neoplastic ovarian/tubal disease: Pelvic inflammatory disease, Ectopic gestation
Cysts: paratubal, ovarian follicle and corpus luteal.
Endometriosis
Neoplastic disease (ovary dominant, tube rare)
Primary ovarian neoplasms
Tumors secondarily involving ovary
- adjacent GYN CA vs. other: appendix, colon, breast, stomach
What are the primary ovarian neoplasms to consider in the setting of an Adnexal Mass?
- epithelial: benign vs. malignant vs.
“borderline”; serous vs. mucinous vs.
endometrioid vs. clear cell vs. transitional cell - sex cord/stromal tumors (± estrogen or
testosterone secretion) - germ cell: esp. dermoid cyst
An adnexal mass in a post-menopausal female is what condition until proven otherwise?
Cancer
What conditions can cause pelvic floor insufficiency?
uterine prolapse, cystocele, rectocele with associated dysfunctional bladder or bowel symptoms
What is Urogynecology?
OBGYN specializing in hysterectomy with pelvic floor reconstruction
What are the clinical signs and symptoms of Pelvic Inflammatory Disease?
-classically: lower abdominal pain, purulent
endocervical discharge, deep dyspareunia,
cervical motion and adnexal tenderness on bi-
manual exam ± fever and abnormal vaginal bleeding
- Many cases are sub-clinical: first evidence of
PID may be tubal infertility
What patient population is commonly affected by Candida albicans infections?
overgrowth and infection usually ages 20-40:
especially if diabetes, on antibiotics, pregnancy,
immunosuppression
What is the terminology in HPV-related neoplasms? (e.g. CIN, VIN, VAIN, AIN, PAIN)
HPV: pre-invasive disease terminology by region
CIN: cervical intraepithelial neoplasia
VIN: vulvar intraepithelial neoplasia
VAIN: vaginal intraepithelial neoplasia
AIN: anal intraepithelial neoplasia
PAIN: perianal intraepithelial neoplasia
- grade 1 = low grade dysplasia; grade 2-3 = high grade dysplasia
- all above are squamous in type.
HPV also infects endocervical glandular mucosa
- can cause adenocarcinoma-in-situ (AIS)
with subsequent risk of invasive cervical adenocarcinoma
What are the early and late symptoms of Cervical Cancer?
- early Sx: irregular or heavy vaginal
bleeding, post-coital bleeding, or non-
bloody vaginal discharge - late Sx: invasion of parametrium
(pain), cervical stenosis (pyometra),
direct invasion of vagina with secondary
malignant fistulas into bladder (± ureteral
obstruction/hydronephrosis) or rectum; sacral
plexus invasion (sciatic pain)
What are the various squamous cell epithelial cell abnormalities that can be found on Pap?
- Atypical squamous cells of undetermined
significance (ASCUS) - ASCUS – cannot exclude high grade
dysplasia (ASC-H) - Low grade squamous intraepithelial lesion
(LSIL) = cellular changes consistent with
HPV (koilocytotic atypia/mild dysplasia/CIN1) - High grade squamous intraepithelial lesion (HSIL): includes moderate dysplasia (CIN2) and severe dysplasia/CIS (CIN3)
What are the various glandular cell abnormalities that can be found on Pap?
Atypical glandular cells of undetermined significance
- further qualify if possible
Adenocarcinoma
- further qualify if possible
What is the most common cause of cancer in the female reproductive tract worldwide?
Invasive Cervical Carcinoma (due to HPV)
What is the most common cause of cancer in the femal reproductive tract in the USA?
Endometrial carcinoma (due to chronic unopposed estrogen states)
What is the most common presenting symptom in Endometrial Carcinoma?
abnormal uterine bleeding
What are the two types of Endometrial Carcinoma?
- Endometrioid
2. SEROUS/clear cell carcinoma
What is the treatment for Endometriosis?
medical hormonal manipulation (progestins, combined BCPs, GnRH analogues) and laparoscopic ablation with adhesion lysis vs. salpingo-oophorectomy (removes estrogenic stimulation) ± hysterectomy
What is the commonest visceral tumor in women?
Uterine leiomyomas (fibroid tumors)
most prominent in African-American women
What is the treatment for Leiomyomas?
- for women with impaired fertility or adverse pregnancy
outcomes: myomectomy - all other symptomatic patients: usually hysterectomy
What population of women most commonly get Leiomyosarcomas?
usually seen in middle-aged/older women with vaginal
bleeding/pelvic pressure symptoms
Primary tubal carcinoma is historically a rare tumor except in what patients?
BRCA 1, 2 mutation patients
What are the clinical or biochemical signs associated with PCOS?
hyperandrogenism: hirsutism, acne, male pattern balding.
- typically associated with: enlarged ovaries with
polycystic features (by transvaginal ultrasound), obesity, and insulin resistance/diabetes.
What is the percentage of Epithelial tumors, Sex cord/stromal tumors, and Germ cell tumors in ovarian cancer?
Epithelial tumors = 67% of all primary ovarian neoplasia and 95% of ovarian CA: usually high grade/high stage carcinomas
Sex cord/stromal tumors = 5-10% of ovarian neoplasms and 1% of ovarian CA (usually low grade and surgically curable)
Germ cell tumors = 20-25% of ovarian neoplasms and 3-5% of ovarian CA (spectrum of readily curable to aggressive/fatal)
What are the types of Epithelial ovarian tumors?
serous (often bilateral), mucinous (typically unilateral), endometrioid, clear cell, Brenner/transitional cell, and undifferentiated
Benign (adenoma) vs. malignant (carcinoma) vs. “borderline” (principally serous vs. mucinous)
What are the triggers for DIC in pregnancy?
severe preeclampsia/abruption, retained dead fetus (> 4 wks), septic abortion, amniotic fluid embolism, acute fatty liver of pregnancy, and also precipitated by a massive hemorrhage event (previa, accreta, uterine atony/rupture)
What are the Hematogenous infections that can be spread from the mother transplacentally to fetus?
malaria, syphilis, HIV (usually perinatal transmission),
toxoplasmosis, TB, rubella, listeriosis, hepatitis B and
C, and CMV (most common congenital viral infection)
What are the Fetal infections acquired via birth canal passage?
- HSV (if active ulceration present)
- group B streptococcus: most common cause of life-
threatening newborn infection: 20% of 3rd trimester
women = carriers - chlamydia and gonococcus: conjunctivitis
