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
2
Q
lichen sclerosis
A
- THINNING epidermis with FIBROUS dermis
- “parchment paper” skin with leukoplakia
- postmenopausal women
- slight increase risk for SCC
3
Q
lichen simplex chronicus
A
- hyperplasia of vulvar squamous epi
- LEATHERY skin + leukoplakia
- chronic irritation and scratching
- NO increased risk of SCC
4
Q
condyloma acuminatum
A
- verrucous neoplasm of vulvar skin
- caused by HPV 6/11
- koilocytic change
- hyperkeratosis and parakeratosis
5
Q
molluscum contagiosum
A
- pearly skin lesions
- endophytic growth
- eosinophilic inclusions
- self limited/ benigng
6
Q
tricomonas
A
- flagellated protozaon infx
- frothy yellow discharge
- “strawberry cervix”
7
Q
Name examples of Squamous dysplasia and carcinoma of the vulva
A
- VIN
- vulvar carcinoma
- extramammary pagets dz
- malignant melanoma
8
Q
Vulvar Carcinoma (rare)
A
- squamous epithelium lining
- presents with leukoplakia
- can be HPV associated or INFLAMMATORY
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
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
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
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
13
Q
Pathology of the Vagina (list 4)
A
- embryonal rhabdomyosarcoma
- adenosis
- clear cell adeno
- vaginal carcinoma
14
Q
embryonla rhabdomyosarcoma (aka sarcoma botyroides)
A
- malignant mesenchymal prolif of immature skeltal muscle
- presents with bleeding
- GRAPE LIKE MASS
- usu < 5 yo
15
Q
characteristics of a rhabdomyoblast
A
- characteristic cell of Embryonal blah blah
- cytoplastmic corss striations
- desmin+
- myogenin +
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
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
18
Q
vaginal carcinoma
A
- squamous epi ining of vaginal mucosa
- related to high risk HPV
- arise from VIN (vaginal intraepithelial neoplasia)
19
Q
describe the regional lymph node spread of vaginal carcinoma
A
- upper 2/3 –> regional iliac nodes
- lower 1/3 –> inguinal nodes
20
Q
name path of the cervix (4)
A
- endocervical polyps
- CIN
- cervical squamos cell carc
- adenocarc in situ (AIS)
21
Q
endocervical polyps
A
- cause spotting
- can be cured via curettage
- see inflamm and dilated mucus secreting glands
22
Q
Cervical intraepithelial neoplasia (CIN)
A
- koilocytic change
- disordered cellular maturation
- nuclear atypia
- increased mitotic activity
- PRECURSOR to SCC
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
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
25
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
26
adenocarcinoma in situ (AIS)
15% of cerical cancers
HPV related
-hisot: hyperchromasia, mucin deplation, luminal mitosis
27
endometrial polyps
- hyperplastic protrusion of endometrium
- presents with abnormal uterine bleeding
- dense pink stroma with hapazardly arranged glands
- can be side effect of tamoxifan
28
Endometreitis clinically = PID
cool.
29
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
30
CHRONIC endometritis
- plasma cell + lympho infiltrates
- caused by: retained products of conception, chronic PID, IUD, TB
- present: abnl uterine bleeding, pain, INFERTILITY
31
endometriosis
- endometrioal glands and stroma OUTSIDE THE ENDOMETRIAL LINING HOLY SHIT
- can cause pelvic pain, dysmennorrhea
- can cause infertility
32
adenomyosis
endometrial glands and stroma WITHIN THE UTERINE WALL
33
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
34
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
35
Endometrial hyperplasia
hyperplasia of endometrial glands relative to stroma
- due to UNOPPOSED ESTROGEN
- presents as postmenopausal bleeding
- can be simple or complex
36
What are some causes of unopposed estrogen?
obesity
PCOS
estrogen replacement tx
37
Simple (endometrial) hyperplasia
- increased gland to stroma ratio
- rarely progresses to CA
- treat with PROGESTINS
38
complex (endometrial) hyperplasia
+/- cytologic atypia
-gland crowding
5-30% progress to CA
39
name two types of mesenchymal/ stromal tumors
leiomyoma
| leiomyosarcoma
40
leiomyoma (fibroids)
BENIGN
- non neoplastic prolif of smooth musc
- related to est exposure
- WHITE WHORLED well circumscribed lesions
- most common uterine tumor
41
whats the tx for leiomyomas?
surgery
embolization
GnRH agonist
nothing.
42
leiomyomasarcoma
- arises DE NOVO
- malginant prolif of smooth muscle
- usu in post menopasual women
- single, necrotic, hemmorhagic
- increased mitotic activity with cellular atypia
43
leiomyosarcoma vs leiomyoma
lieomyoma has MULTIPLE, well circumscribed lesion
leioSARC has single, necrotic and hemmorragic mass
44
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
45
What are the risk factors for TYPE I endometrial carc?
- HNPCC --> MLH1 and MSH2 gene mutations (typically somatic)
- colon ca
- unopposed estrogen
46
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
47
Risk factors for PRIMARY OVARIAN TUMORS
-infertility
-unopposed estrogen > 10 eyars
-fam hx
-nulliparity
-BRCA1
BRCA2
48
Epithelial neoplasms (of the ovary)
=65-70 ovarian tumors
| -derived from coelomic epithelium --> embryological derivative for lining of fallopian tube, endo, endocervix
49
Types of Epithelial ovarian neoplasms
- cystadenoma (benigng, borderline, malignant)
- serous
- mucinous
- endometrioid
- clear cell
50
talk about cystadenomas
bening--> single, simple, flat lining. usu PREMNOPAUSE
borderline --> exactly what it sounds.
malignant --> CYSTADENOCARCINOMAS
51
talk more about malignant cystadenomas (aka cystadenocarcinomas)
- complex cyst with thick, shaggy, lining
- hemorrhage, nec, rapidly increasing adb girth
- usu post menopausal women
52
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
```
53
mucinous epithelial ovarian neo
full of mucus obvi
- YUUUGE tumors
- goblet cells
54
endometrioid epithelial ovarian neo
- resemble nl endometrial glands
* ***excluse metastasis from uterine tumor
- usu malignant :(
55
Clear cell epi ovarian neo
RARE but AGGRESSIVE
- assoc with endometriosis
- "hobnail" cells --> nuclei bulging into cystic space without cytoplasm
56
Name the sex cord stromal neos
- granulosa cell tumors
- fibromas and thecomas
- sertoli-leydig cell tumors
57
granulosa cell tumors
- neoplastic prolif of granulosa cells
- produce est
- present with signs of estrogen xs
- Call-Exner bodies (resemble primitive follice)
- nuclear grooves
58
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
59
fibromas
benign
| "meig's syndrome" --> associated with pleural effusions and ascites that resolve with removal
60
sertoli-leydig cell tumors
- recapitulates developing testis
- sertoli cells form tubules
- leydig cells with REINKE CRYSTALS
- may cause hirsutism and virilization
61
describe basic mech of ovary
functional unit= follice
| follicle has oocyte surrounded by granulosa cells and those are surounded by theca cells
62
LH act on _____ cells which produce ____
theca, androgens
63
FSH acts on _____ cell in the ovarian follice, which helps convert _____ to ____
Granulosa cells, androgens, estradiol
64
NAme the types of germ cell tumors
- teratomas
- dysgerminoma
- yolk sac tumors
- choriocarcinoma
65
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
66
struma ovarrii
teratoma composed mostly of thyroid tissue
67
whats an immature teratoma like
- malignant
- microscopic ID of immature neuroepi
- graded based on ammount of immature neural tissure
68
dysgerminoma
- large cells with clear cytoplasm and central nuclei --> resemble oocytes
- bilat
- good prognosis
* ***female counterpart to seminoma
69
yolk sac tumor (endometrial sinus tumor)
- malig, mimics ylk sac
- most common germ cell of children
- High AFP
- Schiller-duval bodies (look like gloms)
70
choriocarcinoma
- malignant tumor made of cytotrophoblasts and syncytiotrophoblasts
- mimics placental tissue BUT W/O VILLI
- HIGH BhCG
- poor chemo response :(
71
does choriocarcinoma respond well to chemo?
no :(
72
what tumor has high AFP? high bhcg?
yolk sac, chorio
73
krukenberg tumor
metastatic mucinous tumor that involves both avaries
- most comonly metastatic gastric carc
- signet ring cells!!!!
74
pseudomyxoma peritonei
"jelly belly"!
- mucin throughout abd
- can be due to mucinous tumor of appendix with mets to ovary
75
What type of path do we see in fallopian tubes?
intraepithelial carcinoma (TIC)
76
TIC
- precursor lesion to most ovarian high grade serous carcinomas
- derived from fimbriated end of fallopian tubes
- typically p53 mutations
77
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
78
ok, what is hematosalpinx?
bleeding into the fallopian tubes.
