Path: Female Genital Flashcards
What is the transformation zone?
zone between original squamocolumnar jxn of childhood and current one - where most cervical neoplasias arise
What are the pre-invasive cervical lesions?
condyloma and squamous dysplasia
What is cervical squamous dysplasia?
precancerous squamous lesions of transformation zone
can persist, regress, or proceed to cancer
almost all associated w HPV –> koilocytotic atypia = raisins in halos
What type of cancers are cervical carcinomas?
mostly squamous cell, remaining are adeno
What are risk factors for cervical cancer?
multiple partners (>4), beginning sex <16 yo, high risk partners, other STDs, smoking
Which HPV strains are associated w cervical carcinoma?
16, 18, 31, 33, 35
How does cervical carcinoma spread?
direct extension, lymph nodes, liver, lungs
What are pathologies associated w the vagina?
dysplasia (VAIN) and squamous CC: associated w HPV but less common than cervical
clear cell adenocarcinoma: slight increase risk if mother was treated w DES
Sarcoma boitryoides: embryonal rhabdomyosarcoma in kids <5, grapes sticking out of vagina
What are pathologies associated with the vulva?
condyloma accuminatum: low risk HPVs 6 and 11
vulvar squamous carcinoma: HPV 16, 18 - precursor is VIN-usual type, less common group associated w dermatoses (not HPV) is VIN-differentiated type
extramammary Pagets: intraepithelial adenocarcinoma, may persist for yrs w/o invasion
What is adenomyosis?
benign endometrial glands and stroma w/i myometrial wall resulting in adjacent smooth muscle hyperplasia
can cause menorrhagia, dysmenorrhea, dyspareunia
uterus looks like softball
What is dysfunctional uterine bleeding?
abnormal bleeding due to functional disorder, not organic lesion in uterus
usually due to anovulatory cycles (metabolic problems, ovarian lesions, endocrine disorders)
What is endometriosis?
benign endometrial glands and stroma outside endomyometrium
chocolate cyst!
Where are the most common locations for endometriosis?
ovaries, uterine ligaments, rectovaginal septum, peritoneum
What causes endometrial hyperplasia?
unopposed estrogen stimulation - get abnormal bleeding
What is the relationship between endometrial hyperplasia and endometrial carcinoma?
hyperplasia can lead to endometrial adenocarcinoma (endometrioid carcinomas)
What are the two types of endometrial carcinomas?
endometrioid carcinomas: related to endometrial hyperplasia, maybe obese, diabetic, infertile, spread directly to lymph nodes, lung, liver, bone
high grade serous and clear cell carcinomas: less commmon, not associated w unopposed estrogen, usually w endometrial atrophy, older pts, more aggressive
What is polycystic ovarian dz?
numerous follicles beneath thickened cortex
due to unbalanced or asynchronous LH secretion
What is Stein-Leventhal Syndrome?
PCOS w oligomenorrhea
also have anovulation, obesity, hirsutism, rarely virilism
What kinds of ovarian tumors are there?
surface epithelial tumors - 70%
germ cell tumors - 20% (unlike testicles where these are most common)
sex cord-stromal tumors - 5%
metastases - 5%
What are the different kinds of surface epithelial ovarian tumors?
serous, mucinous, endometrioid (mostly carcinomas that resemble endometrial), others
What are serous surface epithelial tumors?
cystic, often biliteral, lined by *fallopian tube-like epithelium, 1-3 locules
cystadenoma: benign
borderline tumor (LMP): increased atypia, no invasion yet
cystadenocarcinoma (may see psamomma bodies)
What are mucinous surface epithelial tumors?
multilocular (more than serous) cystic tumors with *endovercial or intestinal type epithelium
same classifications as serous
pseudomyxoma peritonei: most now thought to originate from primary appendiceal adenocarcinoma
What germ cell tumors are seen in the ovary?
mature cystic teratoma (dermoid cysts): benign, hair and sebum, mature tissues
immature teratomas: rare, malignant, mostly solid, mature and immature tissues, prognosis based on immature neural tissue
specialized teratomas = struma ovarii (mature benign thyroid tissue), carcinoid
also dysgerminoma (seminoma in ovary), EST, choriocarcinoma like in males
What sex cord - stromal tumors are seen in the ovary?
granulosa cell tumors: potential for hyperestrogenism that may lead to endometrial carcinoma, low grade malignant tumors, some recur or metastasize, solid and cystic
thecoma-fibroma: benign, thecoma component can be estrogenic, white and firm
sertolie-leydig cell tumors: produce masculinization, few malignant, yellow nodules
What are the most common metastases to the ovary?
uterus and other ovary
breast and GI tract
What is Krukenberg tumor?
bilateral metastatic signet ring cell carcinoma from stomach
