Neoplastic Pathology of the female Reproductive Tract and PATHOMA FEMALE GENITAL SYSTEM

Question 1

Human Papilloma Virus is what type of virus?

Answer 1

DNA

Question 2

Low risk HPV

Answer 2

6, 11 (episomal DNA)

Question 3

High Risk HPV

Answer 3

16,18,31, 33 ( genomically integrated viral DNA, Expression of viral oncogenes)

Question 4

High Risk HPV associated with what two harmful genes?

Answer 4

E6 and E7

Question 5

E6 gene product does what that is bad?

Answer 5

Binds to and causes degeneration of p53 tumor suppressor

Question 6

E7 does what that is bad?

Answer 6

binds to and inactivates Rb gene which then allows upregulation of Cyclin E and p16INK4… KNOW…Cyclin E and P16INK4 are proliferation promoters

Question 7

HPV nearly always affects what area of the cervix?

Answer 7

Transformation zone

Question 8

What even is the transformation zone

Answer 8

It is the area where exocervix joins endocervix. Exocervix consists mostly of squamous epithelium whereas endocervix is columnar cells. The transformation zone exists between these layers and is most commonly affected by HPV

Question 9

CIN

Answer 9

Cervical Intraepithelial Neoplasia

Question 10

CIN is characterized by?

Answer 10

KOILOCYTIC change, disordered maturation, nuclear atypia, increased mitotic activity…pretty much all of that is pretty routine for neoplasia except maybe the koilocytic change

Question 11

CIN 1

Answer 11

less than 1/3 of the thickness of the epithlium is involved. Koilocytes near the top

Question 12

CINII

Answer 12

less than 2/3 the thickness of the epithelium

Question 13

CIN III

Answer 13

Just barely less than the entire thickness

Question 14

What is koilocytic change?

Answer 14

Raisinoid nuclei

• You see large cytoplasm (cytomegaly) the virus particles live here, large nucles (nucleomegaly), perinuclear halo, irregular nuclear membrane (raisin appearance), stippled coarse chromatin, increased mitotic activity as well

Question 15

What are the most common subtypes of cervical carcinoma

Answer 15

Squamous cell (80%) and adenocarcinoma (15%)…both related to HPV

Question 16

Best prognostic indicator for survival in cervical cancer?

Answer 16

clinical stage
Stage 1- 85-90% 5 year survival
stage 2- 75%
Stage 3- 35%
stage 4- 10%

Question 17

CIN risk factors?

Answer 17

Early age at first intercourse
multiple partners
male partner with multiple partners
high parity, family history, other viruses

Question 18

HPV vaccines use ….. to create HPV specific immunity

Answer 18

Virus Like Particles

Question 19

Most common tumor of the female genital tract

Answer 19

Leiomyoma present in 75% of women over 40

Question 20

Adenomyosis

Answer 20

presence of benign endometrial glands and stroma within the myometrium

Question 21

Asherman’s syndrome

Answer 21

secondary amenorrhea due to loss of basalis and scarring

Question 22

What is the cause of an anovulatory cycle

Answer 22

No progesterone driven secretory phase

Question 23

Endometrial glands and stroma outside of the endometrial lining

Answer 23

endometriosis

Question 24

Theories of Endometrioosis…

Answer 24

1) Retrograde menstruation- most popular
2) Menoplastic theory- mullerian duct metaplasia leads to endometriosis
3) Lymphatic dissemination: Endometriosis goes through the lymphatics and migrates to other regions.

Question 25

Adenomyosis

Answer 25

endometriosis in the myometrium

Question 26

Remember that there is increased risk of carcinoma at the site of endometriosis, especially the ovary

Answer 26

ok

Question 27

Adenocarcinoma of the endometrium

Answer 27

Remember, it is a malignant proliferation of endometrial GLANDS. So you will see tons of glands to less less stroma.

Question 28

What are the two pathways of endometrial carcinoma?

Answer 28

1) Hyperplasia- due to unobstructed estrogen which causes the endometrim to grow unopposed
2) Sporadic- no evident precursor lesion- average age at presentation is 70

Question 29

What is the histological appearance of endometrial adenocarcinoma of the hyperplastic pathway called?

Answer 29

endometrioid because it looks like normal endoemtrium

Question 30

Leiomyoma

Answer 30

smooth muscle mass arising from myometrium

Question 31

Leiomyomas are dependent on what for growth

Answer 31

ESTROGEN….enlarge during pregnancy and shrink after menopause

Question 32

When doing a colposcopy and a pap smear, it is standard practice to do what?

Answer 32

apply dilute acetic acid which turns displastic areas. If its still hard to see you add iodine which will turn the normal endocervical epithelium a brown color and leave the displastic area white

Question 33

CIN is now called what

Answer 33

SIL (squamous intrepithelial lesion)

Also important to note that high grade SIL covers CIN 2 and 3

Question 34

Explain the staging of cervical squamous cell carcinoma

Answer 34

Stage 1- confined to the cervix (85% five yr survival)
Stage 2- Local invasion to areas like the vag (75%)
Stage 3- deeper (35%)
Stage 4- distant mets (10%)

Question 35

What would the histology of a leiomyoma look like?

Answer 35

Markedly elongated, eosinophilic cytoplasm, Cigar shaped nuclei…..THIS IS THE DESCRIPTION OF A SMOOTH MUSCLE CELL

Question 36

Most common ovarian tumors are of what type

Answer 36

Surface epithelial (65-70%)
afer that
- Germ Cell
- Sex cord/Stromal
- Metastases to ovaries

Question 37

Benign serous cystadenoma is what type of ovarian tumor

Answer 37

surface epithelial