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
2
Q
What is another term for vestibular adenitis?
A
vulvar vestibulitis
3
Q
What is vulvar vestibulitis?
A
- inflammation of vulvar vestibule
- ulceration of glands and mucosa
- a/w pain during sex + tenderness of vestibule
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
5
Q
What is vitiligo?
A
- skin loses its pigment cells (melanocytes)
- can cause leukoplakia of vulva
6
Q
What are 2 vulvular dystrophies?
A
- Lichen Sclerosus
2. Lichen Simplex Chronicus
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)
8
Q
What are the histological features of lichen sclerosus?
A
- subepithelial fibrosis
- atrophy
- scarring
- thinning of epidermis
- flat white lesions
9
Q
What is lichen simplex chronicus?
A
- vulvular dystrophy
- chronic dermatitis
- due to repeated scratching/rubbing of skin
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
11
Q
What is acanthosis?
A
increased number of squamous cells; thickening of epithelium
12
Q
What is hyperkeratosis?
A
increased keratin; leads to thickening of skin
13
Q
What are the 2 types of benign vulval neoplasms?
A
- Papillary Hidradenoma
2. Condyloma Acuminatum
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)
15
Q
What is a papillary hidroadenoma?
A
- benign vulval tumour
- tumour of apocrine (sweat) glands on labia majora
16
Q
What is the most common type of malignant neoplasm of the vulva?
A
squamous cell carcinoma
17
Q
What are the 2 types of malignant neoplasms of the vulva?
A
- Carcinoma (esp. SCC)
2. Melanoma
18
Q
What are the histological features of condyloma accuminatum?
A
- acanthosis
- parakeratosis
- hyperkeratosis
- koilocytosis (koilocytes aka halo cells appear)
19
Q
What does parakeratosis look like?
A
epithelial cells appear flattened
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)
21
Q
In NON-HPV-related squamous cell carcinoma of the vulva, what may precede it?
A
Lichen Sclerosus
22
Q
What malignancy can arise from paget’s disease of the vulva?
A
adenocarcinoma
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)
24
Q
What immunohistochemistry stain can be used in paget’s disease of the vulva?
A
PAS stain
25
Give an example of a congenital anomaly of the vagina
failure of fusion of the mullerian ducts
26
What is the most common type of tumour of the vagina?
squamous cell carcinoma
27
What is a possible cause of squamous cell carcinoma of the vagina?
HPV-associated
| - progression to vaginal intraepithelial neoplasia (VaIN)
28
Give 3 types of cancer that may occur in the vagina
1. Squamous Cell Carcinoma
2. Adenocarcinoma
3. Embryonal Rhabdomyosarcoma
29
What is another name for Sarcoma Botryoides?
embryonal rhabdomyosarcoma
30
What is a possible cause of an adenocarcinoma of the vagina
daughters of pregnant women that took DES
31
Embryonal Rhabdomyosarcoma of the vagina occurs in which age group typically?
children (usually less than 5 years)
32
Where in the cervix does cervical cancer normally occur?
zone of transformation/squamocolumnar junction
33
What 2 types of cervical cancers can HPV cause?
1. Adenocarcinoma (from ACIS/CGIN as it affects glandular cells)
2. Squamous Cell Carcinoma (from CIN as it affects squamous cells)
34
What is the most common type of cancer of the cervix?
squamous cell carcinoma
35
List the 4 types of cancer that may arise from the cervix
- squamous cell carcinoma
- adenocarcinoma
- neuroendocrine carcinoma
- adenosquamous carcinoma
36
What is the primary prevention of cervical cancer?
HPV vaccination (e.g. Gardasil)
37
Peutz-Jeghers Syndrome is associated with which type of cervical cancer?
adenocarcinoma
38
What is Peutz-Jegher's Syndrome?
- AD genetic disorder
- usually benign harmatomatous polyps in GIT
- a/w adenocarcinoma of the cervix
39
An adenocarcinoma of the cervix may be associated with which hereditary cancer syndrome?
Peutz-Jegher's Syndrome
40
What is endometritis?
- inflammation of the endometrium
- can be acute or chronic
- ascending or haematogenous route of acquisition
41
What are some possible causes of an acute endometritis?
a/w delivery or miscarriage (and presence of retained products)
42
What are some possible causes of chronic endometritis?
- a/w delivery or miscarriage
- IUCD
- PID (from chlamydia, mycoplasma, neisseria...)
- TB
43
What is a characteristic histological feature of chronic endometritis?
plasma cells in stroma
44
What is endometriosis?
presence of endometrial tissue outside of endometrium
| - a/w cyclical pain
45
What is an adenomyosis?
- specific form of endometriosis
- endometrial tissue pushes into myometrium (a "diverticulum")
- a/w dysmonorrhea (painful periods)
46
What is dysmenorrhea?
painful periods
47
Endometrial hyperplasia is a pre-malignant condition of the endometrium.
What are 2 factors that may cause endometrial hyperplasia?
1. Increased Estrogen Production
| 2. Inactivation of PTEN (tumour suppressor gene - increases sensitivity to estrogen)
48
What is PTEN? Why is it associated w/ endometrial hyperplasia?
- tumour suppressor gene
| - loss of this gene increases sensitivity to estrogen
49
What is the most common type of cancer of the endometrium?
adenocarcinoma
50
List the 4 types of cancer that may arise in the uterus/endometrium
1. endometrioid adenocarcinoma
2. serous carcinoma
3. mucinous carcinoma
4. squamous cell carcinoma
51
What is the name of the gene a/w PTEN?
10q23
52
What endometrial cancer is Lynch syndrome associated with?
adenocarcinoma
53
What are the histological features of a endometrial serous carcinoma?
- papillary architecture
- high grade pleomorphic nuclei
- smudge cells
54
What is a possible treatment option for endometrial cancer?
- total abdominal hysterectomy
- bilateral salpingo-oophorectomy
- w/ lymph node dissection
55
What is a bilateral salpingo-oophorectomy?
removal of the fallopian tubes
56
What is another name for a leiomyoma?
fibroid
57
What is a leiomyoma? (definition)
- fibroid
- benign smooth muscle tumour (of myometrium)
- estrogen dependent
- does NOT transform to become a leiomyosarcoma
58
What hereditary syndrome is associated with the development of leiomyomas?
- autosomal dominant
| - hereditary leiomyomatosis and renal cancer syndrome (HLRCC)
59
What are the features of a leiomyoma?
- round
- well-circumscribed
- unencapsulated
- occur anywhere in uterus
- NO haemorrhage
- NO necrosis
- appears homogenous
60
What is a leiomyosarcoma?
- malignant tumour of the smooth muscle of the uterus (myometrium)
61
What are the features of a leiomyosarcoma?
- round
- intramural
- haemorrhage
- necrosis
- mitoses and atypia
62
Leiomyosarcomas can recurr and metastasize. List 3 organs in which they can metastasize to
1. lungs
2. bone
3. brain
63
What is an adenosarcoma of the endometrium?
- benign glands
| - malignant stroma
64
What is a carcinosarcoma of the endometrium? (definition, main pop. and possible cause)
- malignant glands
- malignant stroma
- malignant mixed mullerian tumour
- affects elderly pts
- usually have history of radiation treatment
65
A secondary serious carcinoma in the uterus may have metastasized from...
the fallopian tubes
66
Where do ectopic pregnancies normally occur?
in the fallopian tubes (causes inflammation)
67
What is the most common benign tumour of the fallopian tubes?
adenomatoid tumour
68
List the 4 types of benign neoplasms of the fallopian tube
1. adenomatoid tumour
2. paratubal cysts
3. salpingitis isthmica nodosa
4. endosalpingiosis
69
What is the most common type of malignant neoplasm of the fallopian tube?
serous carcinoma
70
List 2 types of malignant neoplasms of the fallopian tubes
1. serous carcinoma (adenocarcinoma)
| 2. endometrioid carcinoma (adenocarcinoma)
71
Most of fallopian tube carcinomas are associated with which type of mutations
BRCA 1 or BRCA 2
72
What is the most common type of cancer to spread from the fallopian tubes to the ovary?
Serous Adenocarcinoma
73
What is the second most common type of cancer to spread from the fallopian tubes to the ovary?
Endometrioid/Clear Cell
74
List some of the clinical features of polycystic ovarian syndrome
- multiple cysts
- oligomenorrhea (infrequent periods)
- subfertility
75
What is oligomenorrhea?
infrequent periods
76
List some masses that may cause ovarian torsion
- functioning cysts
- benign neoplasms
- malignant tumours
77
What are the 3 main categories of ovarian neoplasms?
1. Surface/Epithelial (most common)
2. Germ Cell
3. Sex Cord Stromal
78
Ovarian neoplasms that occur in younger women are typically....
benign
79
Ovarian neoplasms that occur in older women are typically....
malignant
80
List the 7 common types of surface-epithelial stromal tumours
1. Serous
2. Mucinous
3. Endometrioid
4. Clear Cell
5. Transitional Cell = Brenner's Tumour
6. Squamous Cell
7. Mixed Cell
81
What is the most common invasive ovarian tumour?
high grade serous carcinoma
82
What are some risk factors for developing ovarian cancer?
- 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
What does nulliparous mean?
- woman that has never given birth
| - a/w risk of ovarian cancer
84
Give 3 examples of benign ovarian epithelial/surface neoplasms
1. cystadenoma
2. cystadenofibroma
3. adenofibroma
85
What are some histological features of serous epithelial neoplasms of the ovary?
- papillary growth patterns
| - psamomma bodies*
86
In which type of ovarian cancer is psamomma bodies seen in?
serous epithelial ovarian neoplasms
87
Mucinous epithelial ovarian tumours usually metastasize from which 2 common primary sites?
1. Appendix/Colon
| 2. Pancreas
88
What are some histological features of mucinous epithelial neoplasms of the ovary?
- bilaterality (affects both ovaries)
| - pseudomyxoma peritoneii or ovarii (mucinous appearance in abdomen or the ovaries)
89
Cytokeratin 7- can help localize a mucinous primary tumour to which part of the abdomen?
a/w GIT (e.g. pancreas)
90
Cytokeratin 20+ can help localize a mucinous primary tumour to which part of the abdomen?
a/w colonic tumours
91
What are the 2 most common ovarian tumours associated with endometriosis?
1. Clear Cell - most common
| 2. Endometrioid
92
What are 2 specific characteristics of an endometrioid adenocarcinoma?
- has squamous morules
| - "hobnail boot appearance" on histology
93
What is a Brenner Tumour?
- transitional cell tumour of the ovary
- benign
- can be hormone-producing (estrogen)
94
What is the most common germ cell tumour of the ovary?
benign cystic teratoma
95
List some of the clinical presentations/symptoms of a germ cell tumour of the ovary
- young ppl
- acute symptoms (e.g. due to torsion)
- chronic symptoms (e.g. pain/abdominal mass)
- isosexual precocity (due to early HCG production)
96
What is isosexual precocity? Why does it occur?
- secondary sexual feature development in young girls
| - due to early HCG production
97
List the 4 types of ovarian germ cell tumours
1. teratoma
2. dysgerminoma
3. yolk sac
4. choriocarcinoma
98
List 2 histological features of teratomas of the ovary
- multilocular (have cavities)
| - dermal papilla - Rockitansky protruberance
99
Which type of ovarian tumour is associated with a Rockitansky protruberance?
teratoma (a germ cell tumour)
100
Are dysgerminomas (a germ cell tumour) benign or malignant?
all malignant
101
What specific type of cells are present in Krukenberg tumours?
signet ring cells
102
What is a krukenberg tumour?
- secondary ovarian tumour
| - usually arises from GIT tumour
