Path: Female Genital

Question 1

What is the transformation zone?

Answer 1

zone between original squamocolumnar jxn of childhood and current one - where most cervical neoplasias arise

Question 2

What are the pre-invasive cervical lesions?

Answer 2

condyloma and squamous dysplasia

Question 3

What is cervical squamous dysplasia?

Answer 3

precancerous squamous lesions of transformation zone
can persist, regress, or proceed to cancer
almost all associated w HPV –> koilocytotic atypia = raisins in halos

Question 4

What type of cancers are cervical carcinomas?

Answer 4

mostly squamous cell, remaining are adeno

Question 5

What are risk factors for cervical cancer?

Answer 5

multiple partners (>4), beginning sex <16 yo, high risk partners, other STDs, smoking

Question 6

Which HPV strains are associated w cervical carcinoma?

Answer 6

16, 18, 31, 33, 35

Question 7

How does cervical carcinoma spread?

Answer 7

direct extension, lymph nodes, liver, lungs

Question 8

What are pathologies associated w the vagina?

Answer 8

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

Question 9

What are pathologies associated with the vulva?

Answer 9

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

Question 10

What is adenomyosis?

Answer 10

benign endometrial glands and stroma w/i myometrial wall resulting in adjacent smooth muscle hyperplasia
can cause menorrhagia, dysmenorrhea, dyspareunia
uterus looks like softball

Question 11

What is dysfunctional uterine bleeding?

Answer 11

abnormal bleeding due to functional disorder, not organic lesion in uterus
usually due to anovulatory cycles (metabolic problems, ovarian lesions, endocrine disorders)

Question 12

What is endometriosis?

Answer 12

benign endometrial glands and stroma outside endomyometrium

chocolate cyst!

Question 13

Where are the most common locations for endometriosis?

Answer 13

ovaries, uterine ligaments, rectovaginal septum, peritoneum

Question 14

What causes endometrial hyperplasia?

Answer 14

unopposed estrogen stimulation - get abnormal bleeding

Question 15

What is the relationship between endometrial hyperplasia and endometrial carcinoma?

Answer 15

hyperplasia can lead to endometrial adenocarcinoma (endometrioid carcinomas)

Question 16

What are the two types of endometrial carcinomas?

Answer 16

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

Question 17

What is polycystic ovarian dz?

Answer 17

numerous follicles beneath thickened cortex

due to unbalanced or asynchronous LH secretion

Question 18

What is Stein-Leventhal Syndrome?

Answer 18

PCOS w oligomenorrhea

also have anovulation, obesity, hirsutism, rarely virilism

Question 19

What kinds of ovarian tumors are there?

Answer 19

surface epithelial tumors - 70%
germ cell tumors - 20% (unlike testicles where these are most common)
sex cord-stromal tumors - 5%
metastases - 5%

Question 20

What are the different kinds of surface epithelial ovarian tumors?

Answer 20

serous, mucinous, endometrioid (mostly carcinomas that resemble endometrial), others

Question 21

What are serous surface epithelial tumors?

Answer 21

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)

Question 22

What are mucinous surface epithelial tumors?

Answer 22

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

Question 23

What germ cell tumors are seen in the ovary?

Answer 23

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

Question 24

What sex cord - stromal tumors are seen in the ovary?

Answer 24

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

Question 25

What are the most common metastases to the ovary?

Answer 25

uterus and other ovary

breast and GI tract

Question 26

What is Krukenberg tumor?

Answer 26

bilateral metastatic signet ring cell carcinoma from stomach