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D2 - FALL - PAR 5 > PATH - Female GU > Flashcards

PATH - Female GU Flashcards

1
Q
  1. Sudden-onset RLQ pain
  2. Abd US shows enlargement of fallopian tube
  3. Mild erythema of pelvis
  4. Mmany neutrophils in pap smear
  5. N. gonorrhea from cervical culture
    What complication/disease? And what lab finding is most likely reported?
A

ECTOPIC PREGNANCY

& (+) Serum Pregnancy Test

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2
Q

In women, untreated gonorrhea can cause what?

A

Pelvic inflammatory disease (PID)

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3
Q

What are complications of PID?

A
  1. Formation of scar tissue that blocks fallopian tubes
  2. Ectopic pregnancy
  3. Infertility
  4. Long-term pelvic/abdominal pain
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4
Q

What are predisposing factors to Ectopic pregnancy?

A
  1. Salpinigitis (N. gonorrhea)
  2. Intrauterine tumors
  3. Endometriosis
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5
Q
  1. mucopurulent vaginal discharge
  2. “red” cervix near ox
  3. many neutrophils in pap smear
  4. cervical biopsy shows follicular cervicitis
    What infectious agent?
A

Chlamydia trachomatis

most common cause of Cervicitis

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6
Q

Scant, WHITE, CURD-like discharge?

A

Candida albicans

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7
Q

Mild vaginitis w/ a low viscous WHITE/GRAY, “FISHY-smelling” discharge w/ “clue-cells” seen on wet mount?

A

Gardnerella vaginalis

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8
Q

What are clue cells a diagnosing factor for?

A

Bacterial vaginitis

ex. Gardnerella vaginalis infxn

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9
Q
  1. menorrhagia
  2. pelvic pain
  3. hx of uncomplicated pregnancy 10 yrs ago
  4. only 1 sex partner
    5/ no dyspareunia
  5. symmetrically enlarged uterus
  6. (-) serum pregnancy test

Diagnosis?

A

Adenomyosis
(endometrial glands extend from endometrium down to myometrium, forming hemorrhagic cysts in uterine wall)
- uterus may enlarge due to reactive thickening of myometrium

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10
Q

What is endometriosis?

A

when endometrial glands are found outside the uterus (ovaries, uterine ligaments, scars, umbilicus, appendix, peritoneum)

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11
Q

Symptoms of endometriosis

A

dysmenorrhea (abnormally painful cramps during menstruation), dyspareunia (painful intercourse), pelvic pain

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12
Q

Which tumor is a myometrial tumor mass that if large enough can produce asymmetric mass?

A

leiomyoma (S.M. tumor)

*diff than chronic endometritis & endometrial hyperplasia bc these 2 conditions do NOT increase in uterus size; chronic endometritis also cannot extend to the myometrium.

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13
Q
  1. menometrorrhagia
  2. endometrial biopsy shows proliferative phase
  3. tx w/ Dilation and curettage (D&C) causes bleeding to stop

condition/diagnosis?

A

Failure of ovulation from ENDOMETRIAL HYPERPLASIA from excessive estrogenic stimulation

  • menometrorrhagia = prolonged/excessive uterine bleeding–irregularly & more frequently than normal
  • D&C = procedure in which cervix is dilated & uterine lining is scraped
  • this condition is usu in the proliferative phase w/ Mitosis
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14
Q

When does Endometrial Hyperplasia occur?

A
  1. failure of ovulation

2. around time of menopause

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15
Q
  1. dull constant abdominal pain
  2. adnexal mass
  3. well-circumscribed mass that involves ovary
  4. irregular calcifications

diagnosis?

A

MATURE CYSTIC TERATOMA
(aka Dermoid Cyst)

  • Benign Germ Cell tumor
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16
Q
  1. post-menopause
  2. pelvic heavines
  3. last menses 8 yrs ago
  4. enlarged nodular uterus
  5. CT scan shows solid uterine masses
  6. total abdominal hysterectomy performed

Diagnosis?

A

MULTIPLE LEIOMYOMAS

- Benign Neoplasm; often asymptomatic

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17
Q
  1. pap smears show abnormalities
  2. colposcopy & biopsy show dysplasia involving ENTIRE thickness of cervical epithelium.
  • What is the most likely factor contributing to development of this lesion?
A

Biopsy shows Cervical Intraepithelial Neoplasia (CIN-3)

*MUST KNOW the risk factors of CIN (on another card)

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18
Q

Risk factors for Cervical Intraepithelial Neoplasia?

A
  1. Early Age 1st Intercourse
  2. Multiple Sex partners
  3. HPV-16 & 18 infection
  4. Male partner w/ multiple previous sex partners
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19
Q
  1. obese
  2. nulliparous
  3. vaginal bleeding
  4. no uterine enlargement
  5. normal-looking cervix
  6. pap smear consistent w/ adenocarcinoma

What factor most likely contributed to the development of this malignancy?

A

ENDOMETRIAL HYPERPLASIA
-results from excess estrogen stimulation; can progress to endometrial carcinoma

Excess estrogen from

  1. anovulatory cycles
  2. nulliparity
  3. obesity
  4. exogenous estrogens
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20
Q

In Endometrial Hyperplasia, where can the excess estrogen come from?

A
  1. anovulatory cycles
  2. nulliparity
  3. obesity
  4. exogenous estrogens
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21
Q
  1. perimenopausal
  2. pelvic discomfort
  3. slightly enlarged uterus
  4. normal cervix & vagina
  5. total abdominal hysterectomy performed
  6. 2 well-circumscribed gray/white masses in myometrium w/ “spindle-shaped” cells in “whorled-bundles”
  7. cells are uniform in size & shape w/ few mitotic figures

What most likely was prevented by hysterectomy?

A

Iron Deficiency Anemia resulting from a LEIOMYOMA w/ Submucosal location

  • leiomyoma = Benign SM tumor
  • Often Asymptomatic, but if Submucosal in location, can produce Menometrorrhagia & Chronic Blood Loss leading to Iron Deficiency Anemia (which is prevented by Hysterectomy)
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22
Q
  1. childless; 62 yrs old
  2. blood-tinged vaginal discharge
  3. last menstrual period 14 yrs ago
  4. bimanual exam shoes normal sized uterus
  5. no palpable adnexal masses
  6. no cervical erosions or masses
  7. BMI = 33
  8. Hx of HTN & DM

Endometrial biopsy will most likely show what diagnosis?

A

ADENOCARCINOMA (Endometrial Carcinoma)

  • Post-Menopausal Vagina Bleeding is a “red flag” for Endometrial Carcinoma
  • Often arise in the setting of Endometrial Hyperplasia driven by excessive Estrogenic stimulation
  • Risk Factors include: Obesity, DM Type-2, HTN, & Infertility
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23
Q
  1. 54 yrs old
  2. weight loss
  3. abdominal enlargement
  4. family hx of ovarian carcinoma
  5. no lesions on cervix
  6. normal-sized uterus
  7. cystic left adnexal mass w/ scattered peritoneal nodules
  8. malignant cells consistent w/ cystadenocarcinoma in peritoneal fluid

what gene is most likely a factor in this neoplasm?

A

BRCA1
(tumor suppressor gene mutations)

  • RISK FACTOR FOR OVARIAN CANCER !!!! (others: family history, nulliparity)
  • Homozygous loss of BRCA1 is associated w/ Ovarian Carcinoma (usually Serous Cystadenocarcinoma)
  • BRCA1 mutations also play a role in Familial Breast Cancers
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24
Q
  1. 42 years old
  2. Menometrorrhagia
  3. NO Hx of irregular Menstrual bleeding
  4. has NOT yet reached Menopause
  5. NO Vaginal or Cervical lesions
  6. Uterus is normal in size
  7. Solid Right Adnexal Mass
  8. Endometrial Biopsy shows Hyperplastic Endometrium, but NO cellular atypia

Diagnosis?

A

GRANULOSA-THECA CELL TUMOR

  • Sex Chord Tumor which can produce excess Estrogen resulting in Endometrial Hyperplasia
  • Estrogen-producing Tumors of the Ovary are typically Sex Chord Tumors such as Granulosa-Theca Cell Tumor or Thecoma-Fibroma (the former is more often functional)
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25
Q

Endometrioma gives rise to what?

A

ADNEXAL MASS (Endometrioma) which enlarges over time; Endometrial glands are hormone sensitive, but do NOT produce hormones

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26
Q
  1. 19 yrs old
  2. pelvic pain
  3. mild erythema of ectocervix
  4. pap smear shows many neutrophils
  5. no dysplastic cells
  6. N/ gonorrhea in cervical culture

If infxn is NOT adequately treated, the pt will be at inc’d risk for what?

A

ECTOPIC PREGNANCY

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27
Q

Gonorrhea in terms of uterine bleeding, dysplasia, & endometrial hyperplasia??

A
  • Gonorrhea & other Genital Tract Infections do NOT cause dysfunctional Uterine bleeding
  • Gonorrhea does NOT carry the risk of dysplasia or carcinomas that HPV does
  • Gonorrhea & other Genital Tract Infections do NOT contribute to Endometrial Hyperplasia
28
Q
  1. 28 yrs old, sexually active
  2. takes oral contraceptives for 10 yrs
  3. NO abnormal findings on pelvic exam
  4. moderate dysplasia or CIN-2 in pap smear

Major significance of this finding?

A

Patient has increased risk of CERVICAL CARCINOMA

  • Dysplasias of the Cervix should NOT be ignored b/c they naturally progress to more severe dysplasias & invasive Carcinomas (although not all progress)
  • Dysplasias are strongly related to HPV infections & HPV DNA can be found in ~90% of cases; HPV produces Koilocytosis in squamous cells (Clear halo containing a wrinkled, pyknotic nucleus)
  • High Risk HPV Types-16 & 18
29
Q

HPV-assoc lesion caused by Low-Risk Types 6 & 11; pap smear showing CIN-1?

A

CONDYLOMA ACUMINATA

30
Q

usually due to Bacterial or Fungal infection & is NOT a significant risk for dysplasia or carcinoma?

A

CERVICITIS

31
Q
  1. 40 yrs old
  2. lower abdominal pain
  3. fever
  4. normal term infant 1 wk ago
  5. foul-smelling vaginal discharge

what pathological findings does she most likely have?

A

ENDOMETRIAL NEUTROPHILIC INFILTRATES

  • in this case: ACUTE ENDOMETRITIS results from retained products of conception after delivery
  • Endometritis may follow premature rupture of membranes w/ ascending infection to the Uterine Cavity
  • Often there is Polymicrobial Infection w/ organisms found in the Vagina
  • Some cases of Chronic Endometritis can be associated w/ Neisseria & Chlamydia infections & produce Lymphoplasmacytic inflitrates w/in the Endometrium
32
Q

What is the difference between endometriosis & endometritis?

A

Endometritis is an infection of the lining of the uterus ( endometrium) that can occur following prolonged labor or cs as well as uterine instrumentation eg: d&c, hysteroscopy. It can also be caused by stds.

Endometriosis is a chronic condition, where the hormone- responsive endometrial tissue grow outside the uterine cavity, mostly on the peritoneal cavity or within the ovaries–can cause infertility.

33
Q

a mass lesions resulting from continued hemorrhage into a focus of Endometriosis; However, this mass lesion is NOT associated w/ Pregnancy, & a possible cause for Infertility?

A

Ovarian endometrioma

34
Q

Vaginitis may produce Acute Inflammation w/ discharge, but Trichomonal Infections are associated w/ what type of discharge?

A

a Watery Gray/Green discharge

Trichomonas vaginalis

  • Flagellated Protozoan w/ jerky motility
  • causes Vaginitis, Cervicitis, & Urethritis
  • strawberry-colored cervix & fiery red vaginal mucosa
  • greenish, frothy discharge
35
Q
  1. 43 y/o Female
  2. Postcoital Bleeding (6 Mo)
  3. Menarche at age 11
  4. 12 Sexual Partners in lifetime
  5. regular Menstrual Cycles w/out abnormal intermenstrual bleeding
  6. Pelvic Exam shows focal, sightly raised area of erythema @ the 5 o’clock position of the Cervix
  7. Pap Smear shows High Grade CIN-3
    8/ In Situ Hybridization on Cervical Cells shows HPV Type-16 DNA

If her Cervical lesion is NOT treated, what malignancy is she at greatest risk for developing?

A

SQUAMOUS CELL CARCINOMA (of the cervix)

  • Risk factors include multiple sex partners, Cervical infection w/ High Risk HPV Type-16, & High Grade Squamous Intraepithelial neoplasia
36
Q

Risk factors for Squamous Cell Carcinoma?

A
  1. Multiple sex partners
  2. Cervical infection w/ High Risk HPV Type-16
  3. High Grade Squamous Intraepithelial neoplasia
37
Q
  1. 18 y/o Female
  2. Pelvic Discomfort
  3. Solid, Circumscribed & White Adnexal Mass
  4. Small areas of Necrosis
  5. Microscopic Exam shows mostly primitive Mesenchymal cells along w/ some Cartilage, Muscle, & foci of Neuroepithelial differentiation

diagnosis?

A

Immature TERATOMA

  • are NOT cystic like Mature Teratomas, but do contain tissues derived from multiple Germ Layers as in all Teratomas
  • presence of Neuroectodermal tissues is typical of Immature Teratomas; the Less differentiated & More numerous the Neuroepithelial elements, the Worse is the prognosis
  • “Immature teratoma of the ovary illustrating primitive neuroepithelium”
38
Q

solid tumors of SM Muscle origin usually found in the Myometrium?

A

LEIOMYOSARCOMA

39
Q

Female equivalent of Male Testicular Seminomas?

A

Dysgerminomas

40
Q

Tumors that have cells resembling those in Ovarian Follicles & may secrete Estrogen?

A

Granulosa Cell Tumors

41
Q
  1. 32 yrs old
  2. cyclic abdominal pain w/ her last menses
  3. failed attempts at pregnancy
  4. hemorrhagic lesions over peritoneal surfaces of uterus & ovaries

diagnosis?

A

ENDOMETRIOSIS
- functional endometrial glands located OUTSIDE the Uterus (ie. Ovaries, Uterine Ligaments, Rectovaginal Septum, & Pelvic Peritoneum)

  • the glands are responsive to ovarian hormones & can produce cyclic abdominal pain coinciding w/ menstruation
  • Recurrent Hemorrhages are followed by Scarring & the formation of Fibrous Adhesions in the Pelvis, which may cause distortion of the Ovaries & Fallopian Tubes, which may lead to Infertility
  • Endometrioma/Endometriotic Cyst (“Chocolate Cyst of Ovary”): common variation which represents a focus of Endometriosis that becomes a cystic lesions, its center filled w/ Chocolate/Brown sludge from the recurrent hemorrhages
42
Q
  1. 31 yrs old
  2. whitish, globular vaginal discharge
  3. erythematous cervix
  4. NO erosions or masses
  5. pap smear shows budding cells & pseudohyphae
  6. NO dysplastic cells

Infectious agent?

A

Candida albicans

  • presence of Pseudohyphae indicates a Fungal infection
  • Candidal (Monilial) Vaginitis is common; C. albicans is present in ~5-10% of women
  • Inflammation tends to be superficial w/ NO invasion of the underlying tissues
43
Q

This organism does produce a purulent Vaginal discharge, but the organism is Protozoan & does NOT produce Pseudohyphae. What is it?

A

TRICHOMONAS VAGINALIS

44
Q
  1. 57 y/o Female
  2. Pale/White area of discoloration on Labia Majora
  3. Biopsy shows Dysplastic cells that occupy ~1/2 the thickness of the Squamous Epithelium
  4. minimal underlying inflammation
  5. In Situ Hybridization shows HPV Type-16 DNA in the Epithelial Cells

Diagnosis?

A

Vulvar Intraepithelial Neoplasia (VIN)
- Precursor for developing Squamous Cell Carcinoma

(A) Classic VIN (HPV-positive) w/ diffuse cellular atypia, immaturity, nuclear crowding, & increased mitotic activity
(B) Differentiated VIN (HPV-negative) showing maturation of the superficial layers, hyperkeratosis, & basal cell atypia

45
Q
  1. 36 y/o
  2. Warty Vulvar lesions–increasing in size & number
  3. lesions are Red/Pink & Flat
  4. rough surfaces located on Vulva & Perineum

Infectious agent?

A

HPV
(infxn producing Condylomata Acuminata)

  • HPV infected Epithelium shows prominent Perinuclear Vacuolization (Koilocytosis) & angulation of Nuclei
  • Condylomata Acuminata lesions are associated w/ HPV Type-6 & 11 infections & may occur anywhere on the Anogenital surface; they are NOT pre-cancerous
    (B) “Condyloma Acuminatum showing Acanthosis, Hyperkeratosis, & Koilocytic atypia w/ enlarged, atypical nuclei & cytoplasmic vacuolation”
46
Q

What causes Urethritis, Cervicitis, & PID?

A

Chlamydia trachomastis

47
Q

What causes Syphilis, characterized by the appearance of a “Hard” Chancre?

A

Treponema pallidum

48
Q

What produces Vaginitis or Cervicitis w/ exudate & erythema?

A

Candida albicans

49
Q
  1. 20 y/o
  2. Oligomenorrhea & Hirsutism
  3. Menarche at age 14 w/ normal menstrual cycles for several years
  4. 10kg Weight Gain over the past 4 months
  5. NO Vaginal or Cervical lesions & Uterus is of normal size
  6. Ovary is 2X normal size

Diagnosis?

A

Polycystic Ovarian Syndrome

  • Unknown origin; associated w/ Oligomenorrhea, Obesity, & Hirsutism
  • thought to be caused by abnormal Androgen synthesis
  • Persistent anovulation (menstrual cycle during which the ovaries do not release an oocyte), menstrual irregularities
50
Q
  1. 28 y/o
  2. Fever, Pelvic Pain, & feelings of Pelvic Heaviness
  3. Pelvic Exam finds a palpable Left Adnexal Mass
  4. Laparoscopy shows an indistinct Fallopian tube that is part of a 5cm circumscribed, Red/Tan mass involving Adnexal region

Infectious agent?

A

Chlamydia trachomatis

51
Q

T/F? HPV infection can not be eradicated.

A

TRUE

52
Q
  1. 20 y/o Female
  2. Bloody, Brownish Vaginal discharge
  3. Shortness of Breath
  4. Red/Brown mass on Lateral Wall of Vagina
  5. Chest XR shows numerous Nodules in both Lungs
  6. Biopsy of Vaginal mass shows malignant cells resembling Syncytiotrophoblasts

What Protein is most likely to be elevated in her serum?

A

hCG

  • Highly malignant tumor composed of cytotrophoblastic and syncytiotrophoblastic cells (Rare)
  • KNOW: Tumor cells are hCG positive
  • metastasis in vaginal wall & lungs & hemorrhagic apperance
53
Q

What protein is elevated in Yolk Sac Tumors?

A

alpha-Fetoprotein

54
Q

What protein is elevated in Granulosa-Theca Cell tumors?

A

estrogens

55
Q

What is elevated in Leydig Cell tumors

A

androgens

56
Q
  1. 14 y/o
  2. began Menstruation 1 year ago
  3. has Abnormal Uterine Bleeding,
  4. Menstrual Periods 2-7 days long & 2-6 weeks apart
  5. Amount of Bleeding varies from minimal spotting to very heavy flow
  6. NO abnormalities on PE or Pelvic US Exam

What is most likely to produce these findings?

A

Anovulatory Cycles

  • common cause of dysfunctional uterine bleeding in both Young women who are beginning Menstruation, & Older women approaching Menopause
  • prolonged Estrogen stimulation that is NOT followed by secretion of Progesterone
57
Q
  1. 35 y/o
  2. increasing Abdominal enlargement (6 Mo)
  3. pregnancy tests are negative
  4. PE shows Abdominal Distension w/ a Fluid Wave
  5. Pelvic US shows Bilateral Cystic Ovarian Masses
  6. Excised masses are Unilocular Cysts filled w/ Clear Fluid
  7. Papillary projections extend into the Central Lumen of the Cyst;
  8. Microscopy shows the Papillae are covered w/ atypical Cuboidal Cells that invade the underlying Stroma
  9. Psammoma Bodies are present;

What is the most likely diagnosis?

A

Cystadenocarcinoma

  • common Ovarian tumors that are often BILATERAL
  • SEROUS Type occurs more frequently & is usually UNILOCULAR
  • Mucinous Type is less common & is usually Multilocular (“M” for Mucinous & Multi!)
  • Serous Cystadenocarcinomas account for more than 50% of Ovarian Cancers; They may be Benign, Borderline, or Malignant
  • Benign Tumors have a smooth cyst wall w/ small or absent papillary projections; Borderline have increasing amounts of papillary projections
58
Q
  1. 45 y/o
  2. small amount of Vaginal Bleeding
  3. Brownish, Foul-smelling discharge
  4. Pelvic Exam shows lesion on Ectocervix

Microscopic exam of the excised lesions is most likely to shows what diagnosis?

A

SQUAMOUS CELL CARCINOMA

  • lesion is large & ulcerative, & projects into the Vagina; it is most likely invasive Squamous Cell Carcinoma that has infiltrated into the Subepithelial region
    (A) microinvasive w/ invasive nest breaking through the basement membrane of High-grade squamous intraepithelial lesion (HSIL)
    (B) Invasive
59
Q

What condition shows Acanthosis, Hyperkeratosis, & Koilocytic atypia w/ enlarged, atypical nuclei & cytoplasmic vacuolation?

A

Condyloma Acuminatum

60
Q

Best known association b/w a faulty Tumor-suppressor gene & a Genital Tract Cancer is…?

A

BRCA1 gene & Ovarian Carcinoma

61
Q
  1. 40 y/o Female
  2. progressive enlargement of the Abdomen
  3. Diet has NOT changed
  4. Exercising more
  5. PE shows NO palpable masses
  6. Fluid Wave is present
  7. Paracentesis yields 500cc of slightly Cloudy fluid
  8. Cytologic Exam of the fluid shows Malignant cells
  9. US Exam shows 15cm Multilobular mass involving the Right Adnexal region
  10. Uterus is normal in size
  11. The mass is surgically removed

What is the most likely diagnosis?

A

Mucinous Cystadenocarcinoma of the Ovary

  • Epithelial in origin, less common than Serous Tumors, & tend to be Multiloculated
  • presence of a Ascites (ie. Fluid Wave) suggest metastases, which is most common w/ Surface Epithelial neoplasms of the Ovary
    (A) Mucinous Cystadenoma w/ its Multicystic appearance & delicate septa; Note the presence of glistening Mucin w/in the cysts
    (B) Columnar cell lining of Mucinous Cystadenoma
62
Q

What Neoplasm is most likely to have these characteristics:

  • Postmenopausal Uterine Bleeding
  • the Malignant Neoplasm arises from prior atypical hyperplastic lesions in some cases
  • Peak incidence is 55-65 y/o
  • More common in women w/ Obesity, HTN, &/or Diabetes
  • Most cases have mutations of the PTEN Tumor-Suppressor gene
  • the Malignancy tends to remain localized for years before spreading to local Lymphatics
A

ENDOMETRIAL CARCINOMA

  • Post-Menopausal Vagina Bleeding is a “red flag” for Endometrial Carcinoma
  • Often arise in the setting of Endometrial Hyperplasia driven by excessive Estrogenic stimulation
  • Risk Factors include: Obesity, DM Type-2, HTN, & Infertility
63
Q

What causes bacterial vaginosis?

A

Gardnerella vaginalis:

  • gram-Negative Rod
  • causes bacterial vaginosis (most common vaginitis)
  • malodorous vaginal discharge; vaginal pH > 4.5
  • organisms adhere to Squamous Cells producing “Clue Cells”
  • Increased incidence of Preterm delivery & low-birth-weight newborns

“Superficial squamous cells are covered by granular material representing bacterial organisms attached to the surface”

64
Q

What condition has red inclusions (Reticulate Bodies) in infected metaplastic squamous cells?

A

Chlamydia! (Chlamydia trachomatis)

  • Reticulate Bodies divide to form Elementary Bodies, which are the infective bodies producing infection
    FEMALES: Urethritis (sterile pyuria), Cervicitis, PID, PeriHepatitis (FHC syndrome -scar tissue between peritoneum & surface of liver from pus from PID), Proctitis, Bartholin Gland Abscess
65
Q

What does Chlamydia trachomatis cause in newborns?

A

Conjunctivitis (Ophthalmia Neonatorum), Pneumonia

66
Q

What does Chlamydia trachomatis cause in males?

A

Non-gonococcal Sterile Urethritis (NSU) (sterile pyuria), Epididymitis, Proctitis

D2 - FALL - PAR 5 (2 decks)

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