Path of female reproductive tract Flashcards
name NON neoplastic and infectious pathologies of the vulva
lichen sclerosus lichen simplex chronicus condyloma acuminatum molluscum contagiosum thrichomonas candida
lichen sclerosis
- THINNING epidermis with FIBROUS dermis
- “parchment paper” skin with leukoplakia
- postmenopausal women
- slight increase risk for SCC
lichen simplex chronicus
- hyperplasia of vulvar squamous epi
- LEATHERY skin + leukoplakia
- chronic irritation and scratching
- NO increased risk of SCC
condyloma acuminatum
- verrucous neoplasm of vulvar skin
- caused by HPV 6/11
- koilocytic change
- hyperkeratosis and parakeratosis
molluscum contagiosum
- pearly skin lesions
- endophytic growth
- eosinophilic inclusions
- self limited/ benigng
tricomonas
- flagellated protozaon infx
- frothy yellow discharge
- “strawberry cervix”
Name examples of Squamous dysplasia and carcinoma of the vulva
- VIN
- vulvar carcinoma
- extramammary pagets dz
- malignant melanoma
Vulvar Carcinoma (rare)
- squamous epithelium lining
- presents with leukoplakia
- can be HPV associated or INFLAMMATORY
HPV assoc SCC
HPV 16/18 –> VIN precurosr lesion –> present with leukoplakia 10-20 years after infection
-infiltrating irregular nests of malignant squamous cells
Inflammatory assoc SCC of the vulva
- HPV neg
- arise from longstanding lichen sclerosis
- prominent keratin pearls
- well diff carcinoma
- pink cytoplasm
- increased mitosis
Extramammary Paget Dz
- malignant epithelial cells invading epidermis
- carcinoma IN SITU w/o underlying CA because isolated to epidermis
- presents as erythematous, pruritic, ulcerated vulvar skin
how do you distinguish melanoma from extramammary pagets dz?
EPD: PAS +, keratin+, S100-
Melanoma: PAS-, keratin -, S100+!!!!!
—–> S100 is specific to melanoma
Pathology of the Vagina (list 4)
- embryonal rhabdomyosarcoma
- adenosis
- clear cell adeno
- vaginal carcinoma
embryonla rhabdomyosarcoma (aka sarcoma botyroides)
- malignant mesenchymal prolif of immature skeltal muscle
- presents with bleeding
- GRAPE LIKE MASS
- usu < 5 yo
characteristics of a rhabdomyoblast
- characteristic cell of Embryonal blah blah
- cytoplastmic corss striations
- desmin+
- myogenin +
adenosis
- 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
clear cell adenocarcinoma
- malignant prolif of glands with clear cytoplasm
- rare complication from DES exposed fetus
- -> can have increased risk of breast CA
vaginal carcinoma
- squamous epi ining of vaginal mucosa
- related to high risk HPV
- arise from VIN (vaginal intraepithelial neoplasia)
describe the regional lymph node spread of vaginal carcinoma
- upper 2/3 –> regional iliac nodes
- lower 1/3 –> inguinal nodes
name path of the cervix (4)
- endocervical polyps
- CIN
- cervical squamos cell carc
- adenocarc in situ (AIS)
endocervical polyps
- cause spotting
- can be cured via curettage
- see inflamm and dilated mucus secreting glands
Cervical intraepithelial neoplasia (CIN)
- koilocytic change
- disordered cellular maturation
- nuclear atypia
- increased mitotic activity
- PRECURSOR to SCC
CIN grades
graded based on epithelial involvement I- < 1/3 thickness epi II= <2/3 thickness III= slightly less than entire thickness CIS= entire thickness
how does CIN grading relate to ability to regress/progress?
I= most likely to regress, 33% II= 66% regress III= does NOT regress, more likely to progress
Cervical Squamous Cell Carcinoma
- 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
adenocarcinoma in situ (AIS)
15% of cerical cancers
HPV related
-hisot: hyperchromasia, mucin deplation, luminal mitosis
endometrial polyps
- hyperplastic protrusion of endometrium
- presents with abnormal uterine bleeding
- dense pink stroma with hapazardly arranged glands
- can be side effect of tamoxifan
Endometreitis clinically = PID
cool.
ACUTE endometritis
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
CHRONIC endometritis
- plasma cell + lympho infiltrates
- caused by: retained products of conception, chronic PID, IUD, TB
- present: abnl uterine bleeding, pain, INFERTILITY
endometriosis
- endometrioal glands and stroma OUTSIDE THE ENDOMETRIAL LINING HOLY SHIT
- can cause pelvic pain, dysmennorrhea
- can cause infertility
adenomyosis
endometrial glands and stroma WITHIN THE UTERINE WALL
What is the most common side of endometriosis?
ovary –> CHOCOLATE CYST
-will have increased risk of carcinoma at site of involvement, but esp when ovary is the site
Other typical sites of endometriosis besides ovary (most common)?
uterine ligaments –> pelvic pain
pouch of douglas –> pooping pain
bladder wall –> dysuria
bowel serosa –> abd pain + adhesions
Endometrial hyperplasia
hyperplasia of endometrial glands relative to stroma
- due to UNOPPOSED ESTROGEN
- presents as postmenopausal bleeding
- can be simple or complex
What are some causes of unopposed estrogen?
obesity
PCOS
estrogen replacement tx
Simple (endometrial) hyperplasia
- increased gland to stroma ratio
- rarely progresses to CA
- treat with PROGESTINS
complex (endometrial) hyperplasia
+/- cytologic atypia
-gland crowding
5-30% progress to CA
name two types of mesenchymal/ stromal tumors
leiomyoma
leiomyosarcoma
leiomyoma (fibroids)
BENIGN
- non neoplastic prolif of smooth musc
- related to est exposure
- WHITE WHORLED well circumscribed lesions
- most common uterine tumor
whats the tx for leiomyomas?
surgery
embolization
GnRH agonist
nothing.
leiomyomasarcoma
- arises DE NOVO
- malginant prolif of smooth muscle
- usu in post menopasual women
- single, necrotic, hemmorhagic
- increased mitotic activity with cellular atypia
leiomyosarcoma vs leiomyoma
lieomyoma has MULTIPLE, well circumscribed lesion
leioSARC has single, necrotic and hemmorragic mass
Type I endometrial carcinoma
PTEN –> KRAS –> b-catenin
- hyperplasia pathway arises from endometrial hyperplasia
- endometrioid histology (looks like nl endo)
- minimal invasion/spread
- perimenopausal –> age 60
What are the risk factors for TYPE I endometrial carc?
- HNPCC –> MLH1 and MSH2 gene mutations (typically somatic)
- colon ca
- unopposed estrogen
Type II endometrial carcinoma
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
Risk factors for PRIMARY OVARIAN TUMORS
-infertility
-unopposed estrogen > 10 eyars
-fam hx
-nulliparity
-BRCA1
BRCA2
Epithelial neoplasms (of the ovary)
=65-70 ovarian tumors
-derived from coelomic epithelium –> embryological derivative for lining of fallopian tube, endo, endocervix
Types of Epithelial ovarian neoplasms
- cystadenoma (benigng, borderline, malignant)
- serous
- mucinous
- endometrioid
- clear cell
talk about cystadenomas
bening–> single, simple, flat lining. usu PREMNOPAUSE
borderline –> exactly what it sounds.
malignant –> CYSTADENOCARCINOMAS
talk more about malignant cystadenomas (aka cystadenocarcinomas)
- complex cyst with thick, shaggy, lining
- hemorrhage, nec, rapidly increasing adb girth
- usu post menopausal women
Serous epithelial ovarian neo
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
mucinous epithelial ovarian neo
full of mucus obvi
- YUUUGE tumors
- goblet cells
endometrioid epithelial ovarian neo
- resemble nl endometrial glands
- ***excluse metastasis from uterine tumor
- usu malignant :(
Clear cell epi ovarian neo
RARE but AGGRESSIVE
- assoc with endometriosis
- “hobnail” cells –> nuclei bulging into cystic space without cytoplasm
Name the sex cord stromal neos
- granulosa cell tumors
- fibromas and thecomas
- sertoli-leydig cell tumors
granulosa cell tumors
- neoplastic prolif of granulosa cells
- produce est
- present with signs of estrogen xs
- Call-Exner bodies (resemble primitive follice)
- nuclear grooves
If granulosa cell tumors present with signs of estrogen xs, what does it look like at different age ranges?
prior to puberty –> precocious puberty
reproductive age –> menorrhagia, metorrhagia
postmenopausal –> endometrial hyperplasia with postmenopausal uterine bleeding
fibromas
benign
“meig’s syndrome” –> associated with pleural effusions and ascites that resolve with removal
sertoli-leydig cell tumors
- recapitulates developing testis
- sertoli cells form tubules
- leydig cells with REINKE CRYSTALS
- may cause hirsutism and virilization
describe basic mech of ovary
functional unit= follice
follicle has oocyte surrounded by granulosa cells and those are surounded by theca cells
LH act on _____ cells which produce ____
theca, androgens
FSH acts on _____ cell in the ovarian follice, which helps convert _____ to ____
Granulosa cells, androgens, estradiol
NAme the types of germ cell tumors
- teratomas
- dysgerminoma
- yolk sac tumors
- choriocarcinoma
whats a mature teratoma
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
struma ovarrii
teratoma composed mostly of thyroid tissue
whats an immature teratoma like
- malignant
- microscopic ID of immature neuroepi
- graded based on ammount of immature neural tissure
dysgerminoma
- large cells with clear cytoplasm and central nuclei –> resemble oocytes
- bilat
- good prognosis
- ***female counterpart to seminoma
yolk sac tumor (endometrial sinus tumor)
- malig, mimics ylk sac
- most common germ cell of children
- High AFP
- Schiller-duval bodies (look like gloms)
choriocarcinoma
- malignant tumor made of cytotrophoblasts and syncytiotrophoblasts
- mimics placental tissue BUT W/O VILLI
- HIGH BhCG
- poor chemo response :(
does choriocarcinoma respond well to chemo?
no :(
what tumor has high AFP? high bhcg?
yolk sac, chorio
krukenberg tumor
metastatic mucinous tumor that involves both avaries
- most comonly metastatic gastric carc
- signet ring cells!!!!
pseudomyxoma peritonei
“jelly belly”!
- mucin throughout abd
- can be due to mucinous tumor of appendix with mets to ovary
What type of path do we see in fallopian tubes?
intraepithelial carcinoma (TIC)
TIC
- precursor lesion to most ovarian high grade serous carcinomas
- derived from fimbriated end of fallopian tubes
- typically p53 mutations
ectopic pregnancy
- implantation in the wrong site…….
- most common in fallopian tube
- risk scarring –> PID
- can cause hematosalpinx
- presents with lower abdominal pain after missed period
ok, what is hematosalpinx?
bleeding into the fallopian tubes.
