Neoplastic Path of F Repro Tract Flashcards
What are the low risk types of HPV? How is their DNA characterized?
6, 11 (episomal viral DNA)
What are the high risk types of HPV? How is their DNA characterized?
16, 18, 31, 33, 35, etc. (genomically integrated viral DNA, expression of viral oncogens)
What genes are important in development of high grade dysplasia and invasive cancer?
E6 and E7
What type of HPV has E6/E7?
16, 18
gene product binds to and causes degeneration of the p53
E6
gene product binds to and inactivates Rb protein
E7
How do E6 + E7 affect epithelial cells?
increase life span
found in 70% of invasive cervical cancers
HPV 16, 18
Allows up-regulation of Cyclin E and p16INK4 (prolif promoters)
E7 (occurs via binding to + inactivating Rb)
How is original squamous epithelium of cervix characterized (grossly)?
smooth, shiny and featureless
squamo-columnar junction separates the squamous epithelium from the villous endocervix
Application of ___ to cervix will identify CIN/SIL.
acetic acid
How is Invasive Squamous Cell Carcinoma
of cervix characterized (grossly)?
nodular, with bizarre vessels and areas of hemorrhage
How is CIN1characterized?
Flat Condyloma with Mild Atypia/dysplasia
basal layer slightly thickened
prominent koilocytes
How is CIN2 characterized?
moderate dysplasia
How is CIN3 characterized?
severe dysplasia»_space; carcinoma in situ
involves entire thickness of epithelium
What are the Features of Koilocytotic Changes in cervical epithelium?
Cytomegaly Nucleomegaly Perinuclear halo Irreg nuclear mem Stippled (coarse) chromatin Increased mitotic activity
Where do viral particles reside within cervical epithelium?
intermediate layer
Features of Intraepithelial Dysplasia/ CIN/SIL?
- Maturation arrest (decreased or missing superficial epithelial cells)
- Blurred or missing distinction of basal cell layer
- Loss of cellular orientation, polarity
- Increased nuclear/cytoplasmic ratio
- Hyperchromatic epithelium
This stain can be very helpful to differentiate between atypia associated with postmenopausal mucosal atrophy and true dysplasia:
Ki 67 immunostain
Histology of invasive squamous cell carcinoma demonstrates:
irregular tumor islands of sq cells
variable amount of keratinization
spindled cell stroma w/ inflmm cells
Survival of Cervical Invasive Squamous Cancer depends on:
clinical stage
Stages Cervical Squamous Cell Carcinoma: I involves... II involves... III involves... IV involves...
I = cervix II = upper vagina III = lower vagina, pelvic wall IV = bladder, rectum, beyond
CIN Risk Factors:
- Early age at 1st intercourse
- Multiple sexual partners
- male partner with multiple previous sexual partners
- High parity, family hx, other viruses
- Immune status
precursor of cervical cancer
CIN
Screening System for cervical cancer involves:
Exfoliative cytology of cervix
Bethesda nomenclature
Cervical cancer vaccine uses ____ to increase immunity.
Virus-like particles
Survival of Endometrial Cancer is related to:
Stage/Grade
age
progesterone R activity
depth of endometrial invasion
What factors correlate with a better prognosis in Endometrial Cancer?
High levels of estrogen and progesterone R in tumor
low levels of proliferative activity
Benign Tumors of the Uterine Corpus
leiomyoma (smooth muscle)
endometrial stromal nodule
Malignant Tumors of the Uterine Corpus
adenocarcinoma of endometrium (endometrioid, serous papillary)
mixed mullerian tumors
leiomyosarcoma
endometrial stromal sarcoma
most common tumor of the female genital tract
Leiomyoma
Epidemiology of leiomyoma?
> 30
Histopath of leiomyoma?
markedly elongated smooth muscle cells
eosinophilic cytoplasm
elongated, cigar-shaped nuclei
mitotic figures absent or sparse
Abnormal Uterine Bleeding can be caused by:
hormonal abnormality or can be intrinsic to the uterus
Abnormal Uterine Bleeding can lead to:
severe anemia
cause of ab uterine bleeding in baby girls?
Maternal estrogen
cause of ab uterine bleeding in kids?
trauma or tumors
cause of ab uterine bleeding in adolescents?
Hypothalamic immaturity
inadequate luteal function
psychological + nutritional problems
Adenomyosis is:
presence of benign endometrial glands and stroma within the myometrium
Endometriosis is:
presence of benign endometrial glands and stroma outside the uterus
Adenomyosis, histo?
glands are proliferative, but can show secretory changes leading to repeated bleeding and cystic changes
Causes of endometriosis?
retrograde menstrual implantation, vascular dissemination and metaplasia
Endometriosis can cause:
- infertility
- fibrous adhesions or strictures impairing fallopian tube function
- chocolate cysts” containing old altered blood, on the ovary
Why is ovarian cancer usually spread at time of dx?
Early detection is difficult
Classification of ovarian tissue is by:
tissue of origin
account for over 90% of ovarian neoplasms
Epithelial tumors
account for over 90% of ovarian neoplasms
Epithelial tumors
Large simple cyst, thin wall and serous fluid content
Benign Serous Cystadenoma
Large simple cyst, thin wall and serous fluid content
Benign Serous Cystadenoma
Histo of Serous Carcinoma of Ovary
Invasive cell nests forming papillary fronds; Psammoma bodies
types of Surface Epithelial Stromal Tumors
Serous
Mucinous
Endometrioid
Transitional cell
Granulosa cell tumor, gross pathology
tumor is mustard-yellow with areas of necrosis
most common ovarian cancers in kids
Germ cell tumors
tumor of germ cell origin that differentiates toward somatic structures
teratoma
highly malignant tumor of women under the age of 30 that histologically resembles the mesenchyme of the primitive yolk sac
yolk sac tumor (yeah, sorry)
Mature cystic teratoma, gross pathology
The cystic mass has sebaceous content, hair
Mature Cystic Teratoma, Microscopy
Keratin, skin, skin appendages and subcutaneous fat tissue
Mature Cystic Teratoma, Microscopy
Keratin, skin, skin appendages and subcutaneous fat tissue
Germ cell tumors tend to be malignant in:
children
types of germ cell tumors
Mature cystic teratoma Immature teratoma Dysgerminoma Endodermal sinus tumor (yolk sac tumor) Mixed germ cell tumor
Granulosa Cell Tumor: Microscopic Pathology
Coffee-bean shaped nuclei, nuclear grooves,
Call-Exner bodies (circular arrangement around sparsely cellular space recapitulating ovarian follicle)
When do most granulosa cell tumors occur?
after menopause
What do granulosa cell tumors secrete?
inhibin (+ associated w/ estrogen secretion)
types of sex cord-stromal tumors
Granulosa cell
Tumors of thecoma-fibroma group
Sertoli cell
Sex cord
Histology of benign serous cystadenoma
epithelium is cuboidal-low columnar, ciliated, single-celled layer
Serous papillary cystadenocarcinoma, gross pathology
Tan-yellow-white with papillary projections and solid areas.
Histo of Serous Carcinoma of Ovary
Invasive cell nests forming papillary fronds; Psammoma bodies
types of Surface Epithelial Stromal Tumors
Serous
Mucinous
Endometrioid
Transitional cell
Granulosa cell tumor, gross pathology
tumor is mustard-yellow with areas of necrosis
most common ovarian cancers in kids
Germ cell tumors
tumor of germ cell origin that differentiates toward somatic structures
teratoma
highly malignant tumor of women under the age of 30 that histologically resembles the mesenchyme of the primitive yolk sac
yolk sac tumor (yeah, sorry)
Mature cystic teratoma, gross pathology
The cystic mass has sebaceous content, hair
