HY - female and male path Flashcards
unilateral cystic lesion in vestibule
bartholin cyst
how do you determine if HPV infection is low or high grade?
DNA sequence b/c DNA virus - HR are 16, 18, 31, 33 with high risk of developing cancer
What do low risk HPV 6, 11 lead to?
condyloma
warty neoplasm with koilocytic change that rarely progresses to carcinoma
condyloma due to HPV 6 or 11
parchment-like vulvar skin in postmenopaulsal women
lichen sclerosis
white patch with thick, leathery vulvar skin
lichen simplex chronicus
hyperplasia due to chronic irritation of vulva
lichen simplex chronicus
patient has leukoplakia on vulva, what is your DDx?
lichen simplex chronicus, lichen sclerosis and vulvar carcinoma
what are two etiologies of vulvar carcinoma?
HPV related (16, 18, 31, 33) and non-HPV (lichen sclerosis, although rare)
erythematous, pruritic, ulcerated skin of vulva due to malignant epithelial cells in epidermis
extramammary paget disease
vulvar lesion that is PAS + keratin + and S100 -
paget cells, non-mamilly paget carcinoma
vulvar lesion that is PAS - keratin - and S100 +
melanoma of vulva
defining stain for melanoma
S100
keratin + means what type of cancer?
epithelial cells = carcinoma
when patient has paget’s disease of vulva, is there likely underlying malignancy?
no; this is unlike paget disease of nipple where there is certainly underlying malignancy
what is lower 1/3 vagina derived from
urogenital sinus
what is upper 2/3 vagina derived from
mullerian duct = columnar cells replaced by squamous cells of urogenital sinus
what do we call persistence of columnar cells in vagina?
adenosis; common in DES
what can adenosis lead to?
clear cell adenocarcinoma; associated with DES; malignant proliferation of glands with clear cytoplasm
embryonal rhabdomyosarcoma
bleeding grape-like mass protruding from vagina or penis of a child, usually child < 5 y/o
child with tumor protruding from vagina + cytoplasmic cross-striations on histo
rhabdomyoblast derived embryonal rhabdomyosarcoma
vaginal carcinoma in lower 1/3 will spread to what LN?
inguinal nodes
vaginal cancer that goes to iliac nodes is in what part of vagina?
upper 2/3
what does E6 of HPV do?
increases destruction of p53
what does E7 of HPV do?
increases destruction of Rb
what is key feature that differentiates dysplasia from carcinoma?
reversibility
middle-aged woman presenting with vaginal bleeding most likely has what
cervical carcinoma
risks of cervical carcinoma?
high risk HPV, smoking, immunodeficiency
what is an advanced finding of cervical carcinoma?
invasion through anterior wall into bladder with hydronephrosis
where must you take biopsy in pap?
transformation zone, where HPV is attracted to
is pap good for adenocarcinoma detection?
NO
what are you protecting against with quadrivalent HPV vaccination?
6, 11, 16, 18 - still need to do paps because could get disease from many others
loss of what hormone leads to shedding of endometrium
progesterone
uterus goes through 3 stages: growth, preparation, and shedding. which hormones are responsible for each phase?
growth = estrogen, preparation = progesterone, shedding = looss of progesterone
what can cause secondary amenorrhea due to loss of basalis and scarring?
over aggressive D&C; Asherman Syndrome
patient has bleeding from vagina and is taking tamoxifen, what should you be considering?
endometrial polyp
what does endometriosis look like when it involves soft tissues?
gun powder lesions
what is adenomyosis?
invovlement of uterine myometrium in endometriosis
unopposed estrogen can lead to _______ ______
endometrial hyperplasia
post-menopausal bleeding due to unopposed estrogen
endometrial hyperplasia or endometrial carcinoma
what is the most important predictor of endometrial hyperplasia profression to carcinoma?
cellular atypia
endometrioid histology
endometrial carcinoma from endometrial hyperplasia
serous/pappliary serous histology
> 70 years old, sporadic pathway due to P53 mutations leading to endometrial carcinoma
psammoma bodies
papillary carcinoma of thyroid, meningioma, papillary serous carcinoma, mesothelioma
multiple white-whorled masses
leiomyoma, benign (if single more likely leioyomysomacroma)
is a patient with leiomyoma more likely to be symptomatic or asymptomatic?
asymptomatic
arises de novo + postmenopausal women + single lesions with necrosis and hemorrhage
leiomyosarcoma
LH stimulates what cells?
theca
under the influence of LH, ______ cells make androstenedione which is then converted by _______ cells to estradiol
Theca cells make androstenedione which is then converted by granuolsa cells to estradiol
corpus luteum secretes ______ which prepares progesterone for implantation
progesterone prepares endometrium
obese woman with infertility, oligomennorhea, hirsutism + insulin resistance with risk of T2DM + risk for endometrial carcinoma
PCOD
PCOD is characterized by increased ____
luteinizing hormone, increases androgens
what are the three cell-types that ovarian tumors can arise?
surface epithelium, ger cells, sex-cord stroma
complex cysts of ovary with thick, shaggy lining
cystadenocarincoma; post menopausal women
BRCA 1
breast, serous carcinoma of ovary and fallopian tube
ovarian tumor with cells that resemble urothelium
brenner tumor
how do ovarian epithelium cancers like to spread?
locally, for example omental caking
useful serum marker to monitor tx response and screen for recurrence of epithelium ovarian tumor
CA 125
ovarian tumor that usually occurs in women of reproductive age
germ cell tumor
types of germ cell tumors
cystic teratoma, embryonal carcinoma, yolk sac tumor, dysgerminoma, choriocarcinoma
whats the most common type of malignancy that arises in cystic teratoma?
squamous cell carcinoma fof skin cells
dysgerminoma is the testicle is called _____
seminoma
increased serum LDH can be seen in _______
dysgerminoma
most common germ cell tumor in children
endodermal sinus tumor, malignang tumor that mimics yolk sac; serum AFP +
glomeruloid-like structures/ schiller-duval bodies
endodermal sinus tumor
reinke crystals are found in this ovarian tumor
sertoli-leydig tumor; reinke crystals found in leydig cells
kruckenberg tumor
metastasis to ovaries from gastric CA; mucinous tumors
how to differentiate between primary and secondary mucinous tumor of ovary?
if bilateral, likely metastasis from gastric carcinoma
pseduomyxoma peritonei
mucinous primary tumor of appendix
fibrinoid necrosis in vessels of placenta
pre-eclampsia, will go away with removal of placenta
risk factors of SIDS
sleeping on stomach, smoking in household, prematurity
age range of SIDS
1 month to 1 year
complete hyaditiform mole
COMPLETELY empty, dad, and sacry (risk of choriocarcinoma)
synciotrophoblasts produce ____
b-HCG
breast-feeding + s aureus + warm, erythematous, nipple discharge
mastitis; give dicloxacillin
smokers + subareolar mass + nipple retraction
periductal mastitis due to inflammation of subareolar ducts
mammary duct ectasia
green-brown discharge of nipple + subaerolar mass due to inflammation and dilation of subaerolar duct
fat necrosis of breast
trauma + mass or calcification + bipsy with necrotic fat, calcifications, and giant cells
blue-domed appearance on gross exam of breast
fibrocystic chances of breast, “lumpy’ breast in RUQ
bloody nipple discharge
papillary issue
DCIS that extend up ducts to skin of nipple and almost always associated with an underlying carcinoma
paget disease of the nipple
malignant cause of nipple retraction
invasive ductal carcinoma
a patient suspected of acute mastitis but does not improve with dicloxacillin rx. what are you concerned about?
inflammatory carcinoma, decreased lymphatic drainage due to tumor in dermal lymphatics
give rx for suspected acute mastitis. what is next step?
make sure to follow up 5 days later to mae sur resoled and eliminate concern for inlammatory carcinoma
breast malignancy discovered incidentally and cells are determine dyscohesive and lacking e-cadherin
lobular carcinoma in situ
LCIN risk factor for future invasive carcinoma so give patient ______
tamoxifen
if breast CA is determined to express ER and PR, what rx to give?
tamoxifen
if breast CA is Her2/neu +, what rx?
trastuzumab
