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REGUB > L15, 16 + 17: Female Reproductive Tract Pathology > Flashcards

L15, 16 + 17: Female Reproductive Tract Pathology Flashcards

1
Q

What is a Bartholin Cyst?

A
  • vulvular cyst
  • caused by blockage of Bartholin gland
  • a retention cyst
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2
Q

What is another term for vestibular adenitis?

A

vulvar vestibulitis

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3
Q

What is vulvar vestibulitis?

A
  • inflammation of vulvar vestibule
  • ulceration of glands and mucosa
  • a/w pain during sex + tenderness of vestibule
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4
Q

Leukoplakia (white plaques) may occur in the vulva. List some of the possible causes of leukoplakia of the vulva

A
  • vitiligo
  • inflammatory conditions
  • neoplastic conditions
  • lichen sclerosus
  • lichen simplex chronicus
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5
Q

What is vitiligo?

A
  • skin loses its pigment cells (melanocytes)

- can cause leukoplakia of vulva

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6
Q

What are 2 vulvular dystrophies?

A
  1. Lichen Sclerosus

2. Lichen Simplex Chronicus

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7
Q

What is lichen sclerosus? (pop. target, associated with…)

A
  • vulvular dystrophy
  • occurs in women 30 - 50s
  • inflammatory condition
  • a/w subsequent malignancy (esp. SCC)
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8
Q

What are the histological features of lichen sclerosus?

A
  • subepithelial fibrosis
  • atrophy
  • scarring
  • thinning of epidermis
  • flat white lesions
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9
Q

What is lichen simplex chronicus?

A
  • vulvular dystrophy
  • chronic dermatitis
  • due to repeated scratching/rubbing of skin
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10
Q

What are the histological features of lichen simplex chronicus?

A
  • acanthosis (increased # of squamous cells)
  • hyperkeratosis (increased keratin = thickening of skin)
  • inflammatory infiltrate of dermis
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11
Q

What is acanthosis?

A

increased number of squamous cells; thickening of epithelium

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12
Q

What is hyperkeratosis?

A

increased keratin; leads to thickening of skin

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13
Q

What are the 2 types of benign vulval neoplasms?

A
  1. Papillary Hidradenoma

2. Condyloma Acuminatum

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14
Q

What is condyloma acuminatum? Can it progress to cancer?

A

genital warts from HPV types that do NOT cause cancer (e.g. HPV 6 + 11)

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15
Q

What is a papillary hidroadenoma?

A
  • benign vulval tumour

- tumour of apocrine (sweat) glands on labia majora

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16
Q

What is the most common type of malignant neoplasm of the vulva?

A

squamous cell carcinoma

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17
Q

What are the 2 types of malignant neoplasms of the vulva?

A
  1. Carcinoma (esp. SCC)

2. Melanoma

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18
Q

What are the histological features of condyloma accuminatum?

A
  • acanthosis
  • parakeratosis
  • hyperkeratosis
  • koilocytosis (koilocytes aka halo cells appear)
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19
Q

What does parakeratosis look like?

A

epithelial cells appear flattened

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20
Q

In HPV-related squamous cell carcinoma of the vulva, what precedes it?

A

Vulval Intraepithelial Neoplasia (arising from infection w/ high risk HPV - e.g. 16/18)

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21
Q

In NON-HPV-related squamous cell carcinoma of the vulva, what may precede it?

A

Lichen Sclerosus

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22
Q

What malignancy can arise from paget’s disease of the vulva?

A

adenocarcinoma

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23
Q

What is the common presentation and histology of paget’s disease of the vulva?

A
  • red, crusted skin lesion
  • irritated and sore
  • Paget cells replace most of epidermis
  • clusters/nests of tumour cells
  • clear halo
  • granular cytoplasm (PAS positive)
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24
Q

What immunohistochemistry stain can be used in paget’s disease of the vulva?

A

PAS stain

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25
Q

Give an example of a congenital anomaly of the vagina

A

failure of fusion of the mullerian ducts

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26
Q

What is the most common type of tumour of the vagina?

A

squamous cell carcinoma

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27
Q

What is a possible cause of squamous cell carcinoma of the vagina?

A

HPV-associated

- progression to vaginal intraepithelial neoplasia (VaIN)

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28
Q

Give 3 types of cancer that may occur in the vagina

A
  1. Squamous Cell Carcinoma
  2. Adenocarcinoma
  3. Embryonal Rhabdomyosarcoma
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29
Q

What is another name for Sarcoma Botryoides?

A

embryonal rhabdomyosarcoma

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30
Q

What is a possible cause of an adenocarcinoma of the vagina

A

daughters of pregnant women that took DES

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31
Q

Embryonal Rhabdomyosarcoma of the vagina occurs in which age group typically?

A

children (usually less than 5 years)

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32
Q

Where in the cervix does cervical cancer normally occur?

A

zone of transformation/squamocolumnar junction

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33
Q

What 2 types of cervical cancers can HPV cause?

A
  1. Adenocarcinoma (from ACIS/CGIN as it affects glandular cells)
  2. Squamous Cell Carcinoma (from CIN as it affects squamous cells)
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34
Q

What is the most common type of cancer of the cervix?

A

squamous cell carcinoma

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35
Q

List the 4 types of cancer that may arise from the cervix

A
  • squamous cell carcinoma
  • adenocarcinoma
  • neuroendocrine carcinoma
  • adenosquamous carcinoma
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36
Q

What is the primary prevention of cervical cancer?

A

HPV vaccination (e.g. Gardasil)

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37
Q

Peutz-Jeghers Syndrome is associated with which type of cervical cancer?

A

adenocarcinoma

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38
Q

What is Peutz-Jegher’s Syndrome?

A
  • AD genetic disorder
  • usually benign harmatomatous polyps in GIT
  • a/w adenocarcinoma of the cervix
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39
Q

An adenocarcinoma of the cervix may be associated with which hereditary cancer syndrome?

A

Peutz-Jegher’s Syndrome

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40
Q

What is endometritis?

A
  • inflammation of the endometrium
  • can be acute or chronic
  • ascending or haematogenous route of acquisition
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41
Q

What are some possible causes of an acute endometritis?

A

a/w delivery or miscarriage (and presence of retained products)

42
Q

What are some possible causes of chronic endometritis?

A
  • a/w delivery or miscarriage
  • IUCD
  • PID (from chlamydia, mycoplasma, neisseria…)
  • TB
43
Q

What is a characteristic histological feature of chronic endometritis?

A

plasma cells in stroma

44
Q

What is endometriosis?

A

presence of endometrial tissue outside of endometrium

- a/w cyclical pain

45
Q

What is an adenomyosis?

A
  • specific form of endometriosis
  • endometrial tissue pushes into myometrium (a “diverticulum”)
  • a/w dysmonorrhea (painful periods)
46
Q

What is dysmenorrhea?

A

painful periods

47
Q

Endometrial hyperplasia is a pre-malignant condition of the endometrium.

What are 2 factors that may cause endometrial hyperplasia?

A
  1. Increased Estrogen Production

2. Inactivation of PTEN (tumour suppressor gene - increases sensitivity to estrogen)

48
Q

What is PTEN? Why is it associated w/ endometrial hyperplasia?

A
  • tumour suppressor gene

- loss of this gene increases sensitivity to estrogen

49
Q

What is the most common type of cancer of the endometrium?

A

adenocarcinoma

50
Q

List the 4 types of cancer that may arise in the uterus/endometrium

A
  1. endometrioid adenocarcinoma
  2. serous carcinoma
  3. mucinous carcinoma
  4. squamous cell carcinoma
51
Q

What is the name of the gene a/w PTEN?

A

10q23

52
Q

What endometrial cancer is Lynch syndrome associated with?

A

adenocarcinoma

53
Q

What are the histological features of a endometrial serous carcinoma?

A
  • papillary architecture
  • high grade pleomorphic nuclei
  • smudge cells
54
Q

What is a possible treatment option for endometrial cancer?

A
  • total abdominal hysterectomy
  • bilateral salpingo-oophorectomy
  • w/ lymph node dissection
55
Q

What is a bilateral salpingo-oophorectomy?

A

removal of the fallopian tubes

56
Q

What is another name for a leiomyoma?

A

fibroid

57
Q

What is a leiomyoma? (definition)

A
  • fibroid
  • benign smooth muscle tumour (of myometrium)
  • estrogen dependent
  • does NOT transform to become a leiomyosarcoma
58
Q

What hereditary syndrome is associated with the development of leiomyomas?

A
  • autosomal dominant

- hereditary leiomyomatosis and renal cancer syndrome (HLRCC)

59
Q

What are the features of a leiomyoma?

A
  • round
  • well-circumscribed
  • unencapsulated
  • occur anywhere in uterus
  • NO haemorrhage
  • NO necrosis
  • appears homogenous
60
Q

What is a leiomyosarcoma?

A
  • malignant tumour of the smooth muscle of the uterus (myometrium)
61
Q

What are the features of a leiomyosarcoma?

A
  • round
  • intramural
  • haemorrhage
  • necrosis
  • mitoses and atypia
62
Q

Leiomyosarcomas can recurr and metastasize. List 3 organs in which they can metastasize to

A
  1. lungs
  2. bone
  3. brain
63
Q

What is an adenosarcoma of the endometrium?

A
  • benign glands

- malignant stroma

64
Q

What is a carcinosarcoma of the endometrium? (definition, main pop. and possible cause)

A
  • malignant glands
  • malignant stroma
  • malignant mixed mullerian tumour
  • affects elderly pts
  • usually have history of radiation treatment
65
Q

A secondary serious carcinoma in the uterus may have metastasized from…

A

the fallopian tubes

66
Q

Where do ectopic pregnancies normally occur?

A

in the fallopian tubes (causes inflammation)

67
Q

What is the most common benign tumour of the fallopian tubes?

A

adenomatoid tumour

68
Q

List the 4 types of benign neoplasms of the fallopian tube

A
  1. adenomatoid tumour
  2. paratubal cysts
  3. salpingitis isthmica nodosa
  4. endosalpingiosis
69
Q

What is the most common type of malignant neoplasm of the fallopian tube?

A

serous carcinoma

70
Q

List 2 types of malignant neoplasms of the fallopian tubes

A
  1. serous carcinoma (adenocarcinoma)

2. endometrioid carcinoma (adenocarcinoma)

71
Q

Most of fallopian tube carcinomas are associated with which type of mutations

A

BRCA 1 or BRCA 2

72
Q

What is the most common type of cancer to spread from the fallopian tubes to the ovary?

A

Serous Adenocarcinoma

73
Q

What is the second most common type of cancer to spread from the fallopian tubes to the ovary?

A

Endometrioid/Clear Cell

74
Q

List some of the clinical features of polycystic ovarian syndrome

A
  • multiple cysts
  • oligomenorrhea (infrequent periods)
  • subfertility
75
Q

What is oligomenorrhea?

A

infrequent periods

76
Q

List some masses that may cause ovarian torsion

A
  • functioning cysts
  • benign neoplasms
  • malignant tumours
77
Q

What are the 3 main categories of ovarian neoplasms?

A
  1. Surface/Epithelial (most common)
  2. Germ Cell
  3. Sex Cord Stromal
78
Q

Ovarian neoplasms that occur in younger women are typically….

A

benign

79
Q

Ovarian neoplasms that occur in older women are typically….

A

malignant

80
Q

List the 7 common types of surface-epithelial stromal tumours

A
  1. Serous
  2. Mucinous
  3. Endometrioid
  4. Clear Cell
  5. Transitional Cell = Brenner’s Tumour
  6. Squamous Cell
  7. Mixed Cell
81
Q

What is the most common invasive ovarian tumour?

A

high grade serous carcinoma

82
Q

What are some risk factors for developing ovarian cancer?

A
  • increasing age
  • nulliparous or having a child late
  • family history
  • oncogenes/tumour suppressor genes (BRCA 1, BRCA 2, HER2, P53)
  • taking hormone therapy after menopause
83
Q

What does nulliparous mean?

A
  • woman that has never given birth

- a/w risk of ovarian cancer

84
Q

Give 3 examples of benign ovarian epithelial/surface neoplasms

A
  1. cystadenoma
  2. cystadenofibroma
  3. adenofibroma
85
Q

What are some histological features of serous epithelial neoplasms of the ovary?

A
  • papillary growth patterns

- psamomma bodies*

86
Q

In which type of ovarian cancer is psamomma bodies seen in?

A

serous epithelial ovarian neoplasms

87
Q

Mucinous epithelial ovarian tumours usually metastasize from which 2 common primary sites?

A
  1. Appendix/Colon

2. Pancreas

88
Q

What are some histological features of mucinous epithelial neoplasms of the ovary?

A
  • bilaterality (affects both ovaries)

- pseudomyxoma peritoneii or ovarii (mucinous appearance in abdomen or the ovaries)

89
Q

Cytokeratin 7- can help localize a mucinous primary tumour to which part of the abdomen?

A

a/w GIT (e.g. pancreas)

90
Q

Cytokeratin 20+ can help localize a mucinous primary tumour to which part of the abdomen?

A

a/w colonic tumours

91
Q

What are the 2 most common ovarian tumours associated with endometriosis?

A
  1. Clear Cell - most common

2. Endometrioid

92
Q

What are 2 specific characteristics of an endometrioid adenocarcinoma?

A
  • has squamous morules

- “hobnail boot appearance” on histology

93
Q

What is a Brenner Tumour?

A
  • transitional cell tumour of the ovary
  • benign
  • can be hormone-producing (estrogen)
94
Q

What is the most common germ cell tumour of the ovary?

A

benign cystic teratoma

95
Q

List some of the clinical presentations/symptoms of a germ cell tumour of the ovary

A
  • young ppl
  • acute symptoms (e.g. due to torsion)
  • chronic symptoms (e.g. pain/abdominal mass)
  • isosexual precocity (due to early HCG production)
96
Q

What is isosexual precocity? Why does it occur?

A
  • secondary sexual feature development in young girls

- due to early HCG production

97
Q

List the 4 types of ovarian germ cell tumours

A
  1. teratoma
  2. dysgerminoma
  3. yolk sac
  4. choriocarcinoma
98
Q

List 2 histological features of teratomas of the ovary

A
  • multilocular (have cavities)

- dermal papilla - Rockitansky protruberance

99
Q

Which type of ovarian tumour is associated with a Rockitansky protruberance?

A

teratoma (a germ cell tumour)

100
Q

Are dysgerminomas (a germ cell tumour) benign or malignant?

A

all malignant

101
Q

What specific type of cells are present in Krukenberg tumours?

A

signet ring cells

102
Q

What is a krukenberg tumour?

A
  • secondary ovarian tumour

- usually arises from GIT tumour

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