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life cycles test 1 > path of vagina vulva and uterus > Flashcards

path of vagina vulva and uterus Flashcards

1
Q

Describe lymphatic drainage of vulvar, cervical and uterine lesions

A

VULVAR lesions: drains to inguinal, pelvic, periaortic nodes. Cervical lesions: pelvic (internal/external iliac) and periaortic nodes. Uterine lesions: pelvic (external iliac/ lumbar) and periaortic nodes

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2
Q

Define endophytic, exophytic and pagetoid

A

enDophytic =growing DOWN into the tissue. exOphytic =growing OUT from the surface. Pagetoid = Single cells/clusters PERCOLATING through the epithelium

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3
Q

Ddx for vulvar pruritis and papules

A

HSV, molluscum contagiosum, HPV

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4
Q

HSV pathology/ Sx

A

eosinophilic intranuclear inclusions. Painful red lesions 3-7 days after exposure (red papules > vesicle > coalescent ulcer)

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5
Q

Molluscum contagiosum pathology/ Sx

A

Flesh colored, pearly skin lesions. Genital in adults, extremities in children (sharing towels). Path: Endophytic growth with eosinophilic inclusion bodies

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6
Q

Condyloma acuminatum pathology

A

branching treelike cores of stroma covered by squamous epithelium with viral cytopathic change (koilocytic atypia- perninuclear clearing). Hyperparakeratosis: thickened stratum corneum with ghost nuclei. Elongated rete ridges and hypergranulosis

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7
Q

Trichomonas infection Sx and pathology

A

flagellated protozoan; frothy yellow d/c, dysuria, dyspareunia; “strawberry cervix” on colposcopy

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8
Q

Actinomyces

A

“sulfur granule” with clublike projections; non-copper IUD, non-pathogenic

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9
Q

Vulvar intraepithelial neoplasia pathology

A

Nuclear atypia (koilocytes with perinuclear clearing) and lack of maturation

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10
Q

VIN III/ squamous cell carcinoma in situ pathology

A

Grossly: Discrete white hyperkeratotic raised lesions. Increased mitoses, full thickness dysmaturity (cells at the surface look the same as those near the base)

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11
Q

HPV associated squamous cell carcinoma pathology

A

Infiltrating irregular nests of malignant squamous cell eliciting a desmoplastic stromal response (tissue with low cellularity, hyalinization, myxoid or sclerotic stroma and disorganized blood vessel infiltration). Basaloid (poorly differentiated) small dark cells infltrating in cords and nests

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12
Q

Inflammatory associated squamous cell carcinoma path

A

Prominent keratin “pearls” in well-differentiated carcinoma. Increased mitoses, pink cytoplasm

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13
Q

Lichen sclerosus

A

Itching, fissures/bleeding/pain, dyspareunia. Increased risk (not specified) for developing SCC. Possibly autoimmune related: activated T cells in subepithelial inflammatory infiltrate and increased frequency of autoimmune disorders.

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14
Q

Lichen sclerosus pathology

A

Smooth white plaques/papules, resembles parchment. Dermal fibrosis (top, solid pink) w/ perivascular mononuclear infiltrate . Thinned epidermis w loss of rete pegs, hydropic degeneration of basal cells & superficial hyperkeratosis.

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15
Q

Extramammary Paget disease pathology

A

Form of adenocarcinoma. Red, crusted sharply demarcated map like area on vulva. Marked hyperkeratosis and “pale” basal epidermis. Tumor cells with halo in epidermis, occasional gland formation

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16
Q

Malignant melanoma of vulva

A

rapid vertical growth.

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17
Q

List conditions associated with in utero DES exposure

A

DES is diethylsilbestrol, a synthetic estrogen prescribed to prevent miscarriage until 1971. Can cause adenosis, clear cell carcinoma

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18
Q

embryonal rhabdomyosarcoma pathology

A

Gross: Polypoid, rounded, bulky masses which fills and protrude from vagina, resembling grape-like clusters (sarcoma botryoides). Histology: Cambium layer: Dense zone of rhabdomyoblast present beneath the surface epithelium. Small spindle-shaped cells with abundant mitoses. Elongated spindle cells have striations with eosinophilic cytoplasm (rhabdomyogenic differentiation)

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19
Q

Adenosis pathology

A

Glandular tissue in vagina, mucinous epithelium. Red granular spots and patches. Can have overlying squamous metaplasia as healing phenomenon.

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20
Q

Clear cell carcinoma pathology

A

Affects anterior upper 1/3 of vagina, with discontinuous areas (kissing lesion). Occurs in women under 30. Tubulocystic pattern of growth with dense hyaline stroma; clear cytoplasm with bland nuclei

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21
Q

Endocervical polyps pathology and treatment

A

Polyp inside the OS of cervix. Loose fibromyxomatous stroma w dilated, mucus-secreting glands and inflammation. Eosinophilic stroma. Curettage is curative

22
Q

Most common form of cervical cancer and the most common cause

A

squamous cell carcinoma- HPV. Adenocarcinoma is 15% of cervical cancer cases and is also caused by HPV

23
Q

Squamous cell carcinoma pathology

A

Increased mitoses, full thickness dysmaturity. Infiltrating irregular nests of malignant squamous cells, eliciting a desmoplastic stromal response

24
Q

Adenocarcinoma in situ pathology

A

Hyperchromasia, mucin depletion, luminal mitoses, high N: C ratio

25
Q

Describe histology of proliferative phase of menstrual cycle

A

straight tubular glands, mitoses, nuclear stratification

26
Q

Describe histology of secretory phase of menstrual cycle

A

“S-shaped” tortuous, coiling glands, secretory activity. Subnuclear vacuoles (piano keys)

27
Q

Describe histology of menstrual phase of menstrual cycle

A

stromal/glandular breakdown, inflammation, intravascular fibrin

28
Q

describe the histological effects of exogenous hormones on the uterine lining

A

Hypersecretory glands (short term), decidualized stromal cells, inactive glands (chronic) and incomplete response

29
Q

Endometrial histology during pregnancy

A

stromal decidualization, Arias-Stella Reaction: hypersecretory glands with nuclear enlargement, no mitoses

30
Q

endometrial histology during menopause

A

Thin endometrium w/o mitoses. Decreased Cervical mucous and glycogenation. Cystic atrophy

31
Q

Causes of menometrorrhagia

A

aka heavy, irregular periods. Polyps, endometritis, mesenchymal neoplasm (adenomyosis, leiomyoma, leiomyosarcoma)

32
Q

endometrial polyps pathology

A

Dense pink stroma, haphazardly arranged glands. Cystic dilatation, hormonally unresponsive.

33
Q

Endometritis path and Sx

A

Sx: PID, infertility if chronic. Acute: increased PMNs in stroma and glands. Chronic: plasma cells.

34
Q

adenomyosis vs endometriosis

A

adenomyosis: endometrial glands and stroma in uterine wall. Endometriosis: endometrial glands and stroma in abnormal exrauterine location. Both cause infertility and dysmenorrhea

35
Q

Leiomyoma path

A

Can have single or multiple. Spherical, firm, white, whorled, well circumscribed masses of smooth muscle. Central ischemic necrosis or calcification common. Cigar shaped nuclei

36
Q

Most common uterine tumor

A

leiomyoma

37
Q

Leiomyoma Sx, treatment

A

Menometrorrhagia, infertility, mass. Treatment: surgery, embolization, GnRH agonist, nothing

38
Q

Leiomyosarcoma path

A

Malignant smooth muscle tumor. Infiltrating polypoid mass. Hemorrhage, necrosis. Hypercellular, pleomorphic nuclei, mitoses

39
Q

Leiomyosarcoma behavior

A

rapid increase in size, mets to lungs, low survival if high grade (15%)

40
Q

Risk factors for endometrial cancer

A

unopposed estrogen supplements, later menopause, low parity, PCOS, obesity, ovarian lesions

41
Q

simple endometrial hyperplasia pathology and progression and treatment

A

rarely progesses to cancer. Increased gland to stroma ratio- crowded hyperchromatic glands. Thickened, fluffy endometrium. Treated with progestins

42
Q

Complex endometrial hyperplasia pathology, progression

A

nuclear atypia, glandular crowding and architectural complexity. Diffuse involvement of endometrial cavity. 5-30% progress to cancer

43
Q

endometriod adenocarcinoma grade 1 path

A

Exophytic (protruding) mass of tightly packed glands without intervening stroma. Squamous metaplasia

44
Q

endometriod adenocarcinoma grade 2-3 path

A

solid pattern of growth. Severe nuclear atypia and mitoses

45
Q

Endometrod adenocarcinoma prognosis

A

Stage1: 96% survival at 5 years. Stage III: 23%

46
Q

Serous carcinoma path

A

type II adenocarcinoma cancer. Papillary growth (fibrovascular stromal cores), atypia, disseminated at presentation.

47
Q

Malignant Mixed Müllerian Tumor (Carcinosarcoma)

A

biphasic tumor. Can be Homologous = cell types of tissue normally found in the uterus (smooth muscle, fibroblasts) OR Heterologous = cell types of tissue NOT normally found in the uterus (cartilage, fat, bone, skeletal muscle)

48
Q

compare type I vs type II endometrial cancers

A

Both are adenocarcinomas. Type I endometrial cancers occur in younger women and are estrogen-dependent with a generally good prognosis, while Type II endometrial cancers occur in older women, have higher grade histology and poorer prognosis
Both are adenocarcinomas. Type I endometrial cancers occur in younger women and are estrogen-dependent with a generally good prognosis, while Type II endometrial cancers occur in older women, have higher grade histology and poorer prognosis

49
Q

genes involved in type I endometrial cancer

A

mutations in PTEN > MLH1 > KRAS > beta catenin

50
Q

genes involved in type II endometrial cancer

A

p53 aneuploidy

life cycles test 1 (19 decks)

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