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Life cycles > Path of female reproductive tract > Flashcards

Path of female reproductive tract Flashcards

1
Q

name NON neoplastic and infectious pathologies of the vulva

A 
lichen sclerosus
lichen simplex chronicus
condyloma acuminatum
molluscum contagiosum
thrichomonas
candida
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2
Q

lichen sclerosis

A
  • THINNING epidermis with FIBROUS dermis
  • “parchment paper” skin with leukoplakia
  • postmenopausal women
  • slight increase risk for SCC
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3
Q

lichen simplex chronicus

A
  • hyperplasia of vulvar squamous epi
  • LEATHERY skin + leukoplakia
  • chronic irritation and scratching
  • NO increased risk of SCC
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4
Q

condyloma acuminatum

A
  • verrucous neoplasm of vulvar skin
  • caused by HPV 6/11
  • koilocytic change
  • hyperkeratosis and parakeratosis
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5
Q

molluscum contagiosum

A
  • pearly skin lesions
  • endophytic growth
  • eosinophilic inclusions
  • self limited/ benigng
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6
Q

tricomonas

A
  • flagellated protozaon infx
  • frothy yellow discharge
  • “strawberry cervix”
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7
Q

Name examples of Squamous dysplasia and carcinoma of the vulva

A
  • VIN
  • vulvar carcinoma
  • extramammary pagets dz
  • malignant melanoma
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8
Q

Vulvar Carcinoma (rare)

A
  • squamous epithelium lining
  • presents with leukoplakia
  • can be HPV associated or INFLAMMATORY
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9
Q

HPV assoc SCC

A

HPV 16/18 –> VIN precurosr lesion –> present with leukoplakia 10-20 years after infection
-infiltrating irregular nests of malignant squamous cells

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10
Q

Inflammatory assoc SCC of the vulva

A
  • HPV neg
  • arise from longstanding lichen sclerosis
  • prominent keratin pearls
  • well diff carcinoma
  • pink cytoplasm
  • increased mitosis
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11
Q

Extramammary Paget Dz

A
  • malignant epithelial cells invading epidermis
  • carcinoma IN SITU w/o underlying CA because isolated to epidermis
  • presents as erythematous, pruritic, ulcerated vulvar skin
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12
Q

how do you distinguish melanoma from extramammary pagets dz?

A

EPD: PAS +, keratin+, S100-
Melanoma: PAS-, keratin -, S100+!!!!!
—–> S100 is specific to melanoma

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13
Q

Pathology of the Vagina (list 4)

A
  • embryonal rhabdomyosarcoma
  • adenosis
  • clear cell adeno
  • vaginal carcinoma
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14
Q

embryonla rhabdomyosarcoma (aka sarcoma botyroides)

A
  • malignant mesenchymal prolif of immature skeltal muscle
  • presents with bleeding
  • GRAPE LIKE MASS
  • usu < 5 yo
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15
Q

characteristics of a rhabdomyoblast

A
  • characteristic cell of Embryonal blah blah
  • cytoplastmic corss striations
  • desmin+
  • myogenin +
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16
Q

adenosis

A
  • persistance of columnar epithelia in the UPPER 2/3
  • –> columnar epi should be replaced by squamous epi of lower 1/3 during development
  • DES exposed fetus
  • can lead to CCA
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17
Q

clear cell adenocarcinoma

A
  • malignant prolif of glands with clear cytoplasm
  • rare complication from DES exposed fetus
  • -> can have increased risk of breast CA
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18
Q

vaginal carcinoma

A
  • squamous epi ining of vaginal mucosa
  • related to high risk HPV
  • arise from VIN (vaginal intraepithelial neoplasia)
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19
Q

describe the regional lymph node spread of vaginal carcinoma

A
  • upper 2/3 –> regional iliac nodes

- lower 1/3 –> inguinal nodes

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20
Q

name path of the cervix (4)

A
  • endocervical polyps
  • CIN
  • cervical squamos cell carc
  • adenocarc in situ (AIS)
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21
Q

endocervical polyps

A
  • cause spotting
  • can be cured via curettage
  • see inflamm and dilated mucus secreting glands
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22
Q

Cervical intraepithelial neoplasia (CIN)

A
  • koilocytic change
  • disordered cellular maturation
  • nuclear atypia
  • increased mitotic activity
  • PRECURSOR to SCC
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23
Q

CIN grades

A 
graded based on epithelial involvement
I- < 1/3 thickness epi
II= <2/3 thickness
III= slightly less than entire thickness
CIS= entire thickness
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24
Q

how does CIN grading relate to ability to regress/progress?

A 
I= most likely to regress, 33% 
II= 66% regress
III= does NOT regress, more likely to progress
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25
Q

Cervical Squamous Cell Carcinoma

A
  • invasive
  • HPV related
  • middle aged women (40-50) –> takes 10-20 years to develop from HPV infx
  • presents with post coital bleeding and cervical discharge
  • **staging is based on clinical features
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26
Q

adenocarcinoma in situ (AIS)

A

15% of cerical cancers
HPV related
-hisot: hyperchromasia, mucin deplation, luminal mitosis

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27
Q

endometrial polyps

A
  • hyperplastic protrusion of endometrium
  • presents with abnormal uterine bleeding
  • dense pink stroma with hapazardly arranged glands
  • can be side effect of tamoxifan
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28
Q

Endometreitis clinically = PID

A

cool.

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29
Q

ACUTE endometritis

A

bacterial infection of endometrium usu due to RETAINED PRODUCTS OF CONCEPTION

  • present with fever, abnl bleeding, pelvic pain
  • increased PMNs in stroma and glands
  • **curretage curative
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30
Q

CHRONIC endometritis

A
  • plasma cell + lympho infiltrates
  • caused by: retained products of conception, chronic PID, IUD, TB
  • present: abnl uterine bleeding, pain, INFERTILITY
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31
Q

endometriosis

A
  • endometrioal glands and stroma OUTSIDE THE ENDOMETRIAL LINING HOLY SHIT
  • can cause pelvic pain, dysmennorrhea
  • can cause infertility
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32
Q

adenomyosis

A

endometrial glands and stroma WITHIN THE UTERINE WALL

33
Q

What is the most common side of endometriosis?

A

ovary –> CHOCOLATE CYST

-will have increased risk of carcinoma at site of involvement, but esp when ovary is the site

34
Q

Other typical sites of endometriosis besides ovary (most common)?

A

uterine ligaments –> pelvic pain
pouch of douglas –> pooping pain
bladder wall –> dysuria
bowel serosa –> abd pain + adhesions

35
Q

Endometrial hyperplasia

A

hyperplasia of endometrial glands relative to stroma

  • due to UNOPPOSED ESTROGEN
  • presents as postmenopausal bleeding
  • can be simple or complex
36
Q

What are some causes of unopposed estrogen?

A

obesity
PCOS
estrogen replacement tx

37
Q

Simple (endometrial) hyperplasia

A
  • increased gland to stroma ratio
  • rarely progresses to CA
  • treat with PROGESTINS
38
Q

complex (endometrial) hyperplasia

A

+/- cytologic atypia
-gland crowding
5-30% progress to CA

39
Q

name two types of mesenchymal/ stromal tumors

A

leiomyoma

leiomyosarcoma

40
Q

leiomyoma (fibroids)

A

BENIGN

  • non neoplastic prolif of smooth musc
  • related to est exposure
  • WHITE WHORLED well circumscribed lesions
  • most common uterine tumor
41
Q

whats the tx for leiomyomas?

A

surgery
embolization
GnRH agonist
nothing.

42
Q

leiomyomasarcoma

A
  • arises DE NOVO
  • malginant prolif of smooth muscle
  • usu in post menopasual women
  • single, necrotic, hemmorhagic
  • increased mitotic activity with cellular atypia
43
Q

leiomyosarcoma vs leiomyoma

A

lieomyoma has MULTIPLE, well circumscribed lesion

leioSARC has single, necrotic and hemmorragic mass

44
Q

Type I endometrial carcinoma

A

PTEN –> KRAS –> b-catenin

  • hyperplasia pathway arises from endometrial hyperplasia
  • endometrioid histology (looks like nl endo)
  • minimal invasion/spread
  • perimenopausal –> age 60
45
Q

What are the risk factors for TYPE I endometrial carc?

A
  • HNPCC –> MLH1 and MSH2 gene mutations (typically somatic)
  • colon ca
  • unopposed estrogen
46
Q

Type II endometrial carcinoma

A

serous adenocarcinoma

  • p53 driven
  • sporadic pathway –> arise in atrophic endo with no evidence of precursor lesion
  • > 70 y/o
  • aggressive –> disseminated at presentation
  • pappillary structures, psammomma bodies
47
Q

Risk factors for PRIMARY OVARIAN TUMORS

A

-infertility
-unopposed estrogen > 10 eyars
-fam hx
-nulliparity
-BRCA1
BRCA2

48
Q

Epithelial neoplasms (of the ovary)

A

=65-70 ovarian tumors

-derived from coelomic epithelium –> embryological derivative for lining of fallopian tube, endo, endocervix

49
Q

Types of Epithelial ovarian neoplasms

A
  • cystadenoma (benigng, borderline, malignant)
  • serous
  • mucinous
  • endometrioid
  • clear cell
50
Q

talk about cystadenomas

A

bening–> single, simple, flat lining. usu PREMNOPAUSE
borderline –> exactly what it sounds.
malignant –> CYSTADENOCARCINOMAS

51
Q

talk more about malignant cystadenomas (aka cystadenocarcinomas)

A
  • complex cyst with thick, shaggy, lining
  • hemorrhage, nec, rapidly increasing adb girth
  • usu post menopausal women
52
Q

Serous epithelial ovarian neo

A 
full of water/ cystic
-heirarchical branching of cuboidal cells --> resemble tubal epi w/o cilia
\+/- psamomma bodies
-most freq subtype
-increased CA-125
-BRCA1 increased risk
53
Q

mucinous epithelial ovarian neo

A

full of mucus obvi

  • YUUUGE tumors
  • goblet cells
54
Q

endometrioid epithelial ovarian neo

A
  • resemble nl endometrial glands
  • ***excluse metastasis from uterine tumor
  • usu malignant :(
55
Q

Clear cell epi ovarian neo

A

RARE but AGGRESSIVE

  • assoc with endometriosis
  • “hobnail” cells –> nuclei bulging into cystic space without cytoplasm
56
Q

Name the sex cord stromal neos

A
  • granulosa cell tumors
  • fibromas and thecomas
  • sertoli-leydig cell tumors
57
Q

granulosa cell tumors

A
  • neoplastic prolif of granulosa cells
  • produce est
  • present with signs of estrogen xs
  • Call-Exner bodies (resemble primitive follice)
  • nuclear grooves
58
Q

If granulosa cell tumors present with signs of estrogen xs, what does it look like at different age ranges?

A

prior to puberty –> precocious puberty
reproductive age –> menorrhagia, metorrhagia
postmenopausal –> endometrial hyperplasia with postmenopausal uterine bleeding

59
Q

fibromas

A

benign

“meig’s syndrome” –> associated with pleural effusions and ascites that resolve with removal

60
Q

sertoli-leydig cell tumors

A
  • recapitulates developing testis
  • sertoli cells form tubules
  • leydig cells with REINKE CRYSTALS
  • may cause hirsutism and virilization
61
Q

describe basic mech of ovary

A

functional unit= follice

follicle has oocyte surrounded by granulosa cells and those are surounded by theca cells

62
Q

LH act on _____ cells which produce ____

A

theca, androgens

63
Q

FSH acts on _____ cell in the ovarian follice, which helps convert _____ to ____

A

Granulosa cells, androgens, estradiol

64
Q

NAme the types of germ cell tumors

A
  • teratomas
  • dysgerminoma
  • yolk sac tumors
  • choriocarcinoma
65
Q

whats a mature teratoma

A

BENIGN IN FEMALES WOOOOOO
-fetal tissues from two or three embryo layers
-usu in reproductive years
-can be bilateral
-maybe assoc with anti-NMDA encephalitis
_“struma ovarii”= teratoma composed mostly of thyroid tissue

66
Q

struma ovarrii

A

teratoma composed mostly of thyroid tissue

67
Q

whats an immature teratoma like

A
  • malignant
  • microscopic ID of immature neuroepi
  • graded based on ammount of immature neural tissure
68
Q

dysgerminoma

A
  • large cells with clear cytoplasm and central nuclei –> resemble oocytes
  • bilat
  • good prognosis
  • ***female counterpart to seminoma
69
Q

yolk sac tumor (endometrial sinus tumor)

A
  • malig, mimics ylk sac
  • most common germ cell of children
  • High AFP
  • Schiller-duval bodies (look like gloms)
70
Q

choriocarcinoma

A
  • malignant tumor made of cytotrophoblasts and syncytiotrophoblasts
  • mimics placental tissue BUT W/O VILLI
  • HIGH BhCG
  • poor chemo response :(
71
Q

does choriocarcinoma respond well to chemo?

A

no :(

72
Q

what tumor has high AFP? high bhcg?

A

yolk sac, chorio

73
Q

krukenberg tumor

A

metastatic mucinous tumor that involves both avaries

  • most comonly metastatic gastric carc
  • signet ring cells!!!!
74
Q

pseudomyxoma peritonei

A

“jelly belly”!

  • mucin throughout abd
  • can be due to mucinous tumor of appendix with mets to ovary
75
Q

What type of path do we see in fallopian tubes?

A

intraepithelial carcinoma (TIC)

76
Q

TIC

A
  • precursor lesion to most ovarian high grade serous carcinomas
  • derived from fimbriated end of fallopian tubes
  • typically p53 mutations
77
Q

ectopic pregnancy

A
  • implantation in the wrong site…….
  • most common in fallopian tube
  • risk scarring –> PID
  • can cause hematosalpinx
  • presents with lower abdominal pain after missed period
78
Q

ok, what is hematosalpinx?

A

bleeding into the fallopian tubes.

Life cycles (16 decks)

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