Pathology Flashcards
What is Bartholin’s Cyst
Unilateral dilation of the Bartholin gland
What virus usually cause Condyloma
HPV 6 or 11
What is koilocytic change
Hallmark for HPV infection (nucleus crinkles like a raisin)
What is lichen sclerosis
thinning of the skin
White patch/parchment like skin (super thin)
slightly higher risk for carcinoma
What is lichen simplex chronicus
the opposite of lichen sclerosis—>leather like skin—>due to itching and scratching
no risk for carcinoma
Hallmark for carcinoma?
Keratin
What is adenosis?
Persistent of columnar cell at upper 2/3 of vagina—>adenosis increases risks for clear cell adenocarcinoma
What is embryonal rhabdomyosarcoma?
malignant proliferation of immature skeletal muscle/defined by the presence of rhabdomyoblast
Can penetrate into peritoneal cavity
What are the types of high risk HPV virus?
16 (most common)/18/31/33
How does high risk HPV (DNA virus) cause CIN?
High risk HPV makes E6 (kills p53) and E7 (kills Rb)
What is CIN?
Dysplasia—>CIN I/II/III—>potential to reverse
CIS—>can’t reverse
2 risk factors for cervical carcinoma
Smoking and immunodeficiency
What is one of the common cause of death in advanced cervical carcinoma?
Hydronephrosis—>renal failure
Endometrium grows with?
Estrogen
Endometrium is prepared for implantation with?
Progesterone
What is Asherman syndrome lack of?
The basalis layer of the endometrium
What is the hallmark for chronic endometritis?
Plasma cells
Endometrial polyp can be the side effect of?
Tamoxifen (weak pro-esrogenic effect on endometrium)
What is adenomyosis?
Endometriosis of the myometrium
The most common site of involvement for endometriosis is?
Ovary (chocolate cyst….yum)
What is endometrial hyperplasia?
Hyperplasia of endometrial glands relative to stroma caused by unopposed estrogen
Most important predictor for progression to cancer?
Cellular atypia
Difference between leiomyoma and leiomyosarcoma?
Leiomyoma is benign and presents with white whorled masses (premenopause)
Leiomyosarcoma is malignant and presents with single lesion of necrosis/hemorrhage (post menopause)
What are the 2 pathways for endometrial carcinoma?
Hyperplasia—>expose to estrogen—>look for endometrioid (cancer looks like normal endometrium) (around 50-60 age)
Sporadic—>from atrophic endometrium—>serous papillary—>driven by p53 mutation—>can have psammoma bodies (layered calcification)
Hormone and cells in ovary
LH stimulates theca cells—>makes androgen—>androgen goes to granulosa cells—>FSH stimulates granulosa cells—>convert androgen to estrodial—>proliferative phase—>ovulation—>secretory phase
What is follicular cyst?
Degenerated follicles—>a few of them is normal
What is polycystic ovarian disease?
LH:FSH>2 (increase LH/decrease FSH)
multiple follicular cysts
What is the mechanism of PCOD?
Increase LH prompts theca cells to make more androgen—>hirsutism—>androgen is converted to estrone in fat—>estrone feedback inhibit FSH—>granulosa cannot convert androgen to estrodial—>follicle degenerates—>cyst
Where are the ovarian tumors derived from?
Surface epithelium (coelomic epithelium)/oocyte (germ cell)/sex cord stroma
Cystadenoma
Benign ovarian surface epithelial tumor (serous or mucinous)—>single cyst/flat lining
premenopausal woman
Cystadenocarcinoma
Malignant ovarian surface epithelial tumor—>complex cyst/thick shaggy lining/clear invasion of the cell
postmenopausal woman
BRCA1 mutation carrier have increase risk for
breast/ovarian cancer(serous cystadenocarcinoma)/fallopian tube serous carcinoma/medullary carcinoma of the breast
Ovarian surface epithelial endometrioid tumor
Malignant tumor/may raise from endometriosis
Brenner tumor
Ovarian surface epithelial tumor that has urothelium
How is the prognosis of surface epithelial ovarian tumor
Poor since they present late/ovarian carcinoma spread locally
Serum marker for monitoring treatment/recurrence for surface epithelial tumor?
CA-125
What is the most common malignant tumor of the vagina?
Carcinoma metastasize from cervix
What is ovarian cystic teratoma?
Benign tumor composed of fetal tissues (skin/hair and what not)/most common benign tumor
If there are immature tissues then it might be malignant/or somatic malignancy
Dysgerminoma
Malignant ovarian germ cell tumor that resembles oocytes
Elevated LDH
most common malignant tumor
Endodermal sinus tumor
Malignant ovarian germ cell tumor that resembles yolk sac
Most common in children
Elevated AFP (alpha fetal protein)
Schiller-Duval bodies (glomerulus like)
Choriocarcinoma
Malignant ovarian germ cell tumor that is from proliferation of trophoblast
Spread early (trophoblast look for blood vessel)
High beta-hCG
Poor response to chemo
Embryonal carcinoma
Composed of primitive cells
Invade aggressively
Granulosa-theca tumor
Malignant ovarian sex cord-stroma tumor that produce estrogen excess
Usually don’t metastasize
Sertoli-Leydig cell tumor
Sex ovarian sex cord-strome tumor (contain Reinke crystals)
Fibroma
Benign ovarian sex cord-stroma tumor can cause pleural effusion and ascites (entire complex is Meigs Syndrome)
Krukenberg tumor
Metastisized mucinous tumor at ovaries (gastric carcinoma)/if bilaterally then it is metastasized from other site/if unilaterally then it is a primary tumor
Pseudomyxoma pertionei
Abdomen fills with muscus/metastized from mucinous tumor of appendix
What are the key risk factor for ectopic pregnancy?
Scarring (from PID or endometriosis)
What are the causes of spontaneous abortion?
Chromosomal anomalies/hypercoagulable state (lupus)/infection/teratogen
Where is the placenta implanted for placenta previa?
Lower uterus blocking the os
What happened when the egg is implanted in myometrium of the uterus?
Placenta accreta—>placenta got stuck in there—>need hysterectomy
HELLP
Preeclampsia with Hemolysis/Elevated Liver enzyme/Low platelets
What is complete hydatidiform mole?
2 sperms fertilized an empty ovum—>no fetal tissues—>all villi are edematous and swollen—>trophoblast cover the whole of villi—>low risk for choriocarcinoma
beta-hCG is higher and the uterus is larger than normal
Does choricocarcinoma from the complication of mole response well to chemo?
Yes. The one from ovarian germ cell tumor does not response well to chemo
Is endocervical polyp benign or malignant?
Benign
What kind of cells can HPV infect?
Immature basal/metaplastic squamous epithelium (cervix)
Damage to the mature surface can give access to HPV infection
HPV can replicate in mature squamous cells
Rate ubiquity of cervical carcinoma
squamous cell carcinoma>adenocarcinoma>adenosquamous/neuroendocrine carcinoma (poor prognosis)
all caused by high risk HPV
When to start Pap smear and HPV test
Start Pap smear (scrape around the transformation zone) around 21 and testing for HPV under 30 is not recommended
What can granulosa-theca tumor/polycystic ovarian disease cause?
Anovulatory cycle
What is papillary hidradenoma?
Benign vulvar tumor from modified apocrine sweat gland
What is galactorrhea and what usually causes it?
Milk production outside of lactation. Can be caused by over stimulation of the nipple or prolactoma in AP. Or drugs
Which antibiotics is usually used to treat acute mastitis?
Dicloxacillin
What usually causes periductal mastitis?
Smoking—>vitamin A deficiency
What is the hallmark for mammary duct ectasia?
green-brown nipple discharge
What kind of change in breast is characterized by a blue-dome appearance on gross exam?
Fibrocystic change (benign)
How can you tell the difference between intraductal papilloma and intraductal carcinoma?
The finger like projection in intraductal papilloma (benign) is lined by both epithelial and myoepithelial cells, and it is usually common in premenopausal women. The projection in intraductal carcinoma is lined only by epithelial cells and th is common in postmenopausal women.
How can you tell phyllodes tumor from fibroadenoma?
Phyllodes tumor has the feature of fibrous component overgrowth that is leaf like, it is seen in postmenopausal women instead of premenopausal women in fibroadenoma.
What caused achondroplasia?
Activating mutation in FGFR3—>inhibit cartilage growth
What are the 3 features of osteogenesis imperfecta?
Multiple bone fractures/blue sclera/hearing loss
How does osetopetrosis cause anemia/thrombocytopenia/leukopenia?
Thickening of the bone (poor osteoclast function)—>replace medullary space—>no hematopoiesis
Why does alkaline phosphatase increase for osteomalacia?
Alkaline phosphatase makes alkaline environment—>which is necessary for osteoblast to lay down osteoid
What kind of environment is necessary for osteoclast function?
Acidic environment
Are serum Ca/phosphate/PTH/alkaline phosphatase normal in osteoporosis?
Yes
What are the 3 stages of for paget disease of bone?
Osteoclast goes crazy resorbing bone without the permission of osteoblast—>osteoblast then later come in to lay down more bone to counter osteoclast—>osteoclast burn out, leaving osteoblast to lay down as much bone as possible
In osteomyelitis, infection affect what part of the children/adult’s bone?
Children: metaphysis
Adult: epiphysis
What are the differences between osteoid osteoma and osteoblastoma?
Osteoblastoma is larger/arises in vertebrae/pain doesn’t respond to aspirin
What part of the bone does osteosarcoma usually take place?
Metaphysis of long bone
What is the only kind of tumor that arises from epiphysis of the bone?
Giant cell tumor
11;22 translocation is a characteristic of?
Ewing sarcoma
What is the location difference between chondroma and condrosarcoma?
Chondroma arises in small bones of hands and feet
Chondrosarcoma arises in pelvis or central skeleton
What is the ‘wear and tear’ disease that degenerate the articular cartilage?
Osteoarthritis
What is HLA-DR4 associated with?
Rheumatoid arthritis
What is the hallmark of Rheumatoid arthritis?
Synovitis leading to formation of pannus (granulation tissues)
Seronegative spondyloarthropathies lacks of?
Rheumatoid factor
What causes Lesch-Nyhan syndrome?
Deficiency of HGPRT—>which salvage hypoxanthine and guanine—>as a result high uric acid deposit—>mental retardation and self-mutilation
What is the characteristics of chronic gout?
Tophi/needle-shaped crystals with negative birefringence under polarized light
What is the difference between dermatomyositis and polymyositis?
Dermatomyositis involves skin—>perimysial inflammation
Polymyositis does not involve skin—>endomysial inflammation
What is the characteristic finding of Duchenne muscular dystrophy?
Calf pseudohypertrophy
What are the characteristic cells of liposarcoma and rhabdomyosarcoma?
Lipoblas/rhabdomyoblast
What are the two causes of vulvar carcinoma?
HPV 16/18 or long standing lichen sclerosis
What is extramammary paget disease?
Malignant carcinoma in situ of the vulva/PAS positive
What does DES put women at risk for?
Adenosis of the vagina and then clear cell adenocarcinoma/abnormally shaped uterus—>recurrent abortions
What causes Rokitansky-Kuster-Hauser syndrome?
Failure of mullerian duct to develop—>no uterus and upper vagina
What is Gartner duct cyst?
Benign cyst on the lateral wall of the vagina that is from the remnant of woffian duct
Is Nabothian cyst benign?
It is normal—>endocervical gland orifices got blocked by metaplastic squamous cells
What is the characteristics of acute cervicitis?
Vaginal discharge/pelvic pain/dyspareunia/caused by C. trachomatis, N. gonorrhea, trichomatis vaginalis, candida, HSV-2, HPV
Which bacteria causes follicular cervicitis?
C. trachomatis. Germinal center with large lymphoid cells
What are superficial/intermediate/parabasal cells from pap smear?
adequate estrogen (young nonpregnant women) /adequate progesterone (pregnant women) /lack of estrogen and progesterone (elderly)
What is cervical polyp and is it precancerous?
It is a benign polyp arises from endocervix. Need to be excised.
What is mittelschmerz?
Pain during mid cycle (blood from ruptured follicle irritate peritoneum)
What are the characteristics of preeclampsia?
HTN/proteinuria/edema
What is the characteristics of the placenta of the woman who is going to have preeclampsia?
Angiogenic changes of implantation does not occur (relative placenta ischemia)
What is the difference between hirsutism and virilization?
Hirsutism is excess hair in hair bare area and virilization is hirsutism + 2nd male sex characteristics (increase muscle mass/enlarged clitoris)
What causes anovulatory dysfunctional uterine bleeding?
Excess estrogen comparing to progesterone—>absent secretory phase
What causes ovulatory dysfunctional uterine bleeding?
Inadequate maturation of the corpus luteum/persistent luteal phase with continued secretion of progesterone
What might cause amenorrhea?
Hypogonadism/ovarian disorder—>decreased synthesis of estrogen and progesterone
What does leiomyoma depend on?
Estrogen. It usually go away during menopause
What is consists of carcinosarcoma?
Malignant gland and stroma tumor
What is Hydatid cyst?
Fallopian tube cyst from mullerian remnant
What is the gross finding of PID?
Hydrosalpnix (fluid filled fallopian tube)
What is the disease that is characterized by fallopian tube diverticulosis?
Salpingitis isthmica nodosa
What is the best screening test for ectopic pregnancy?
Beta-hCG with a lesser degree of elevation comparing with real pregnancy
What does stromal hyperthecosis cause?
Hyperplasia of the theca interna of the ovary increase androgen production—>hirsutism and virilization
Nulliparity increase risks of what kind of ovarian cancer?
Surface epithelium ovarian cancer
What is the name of the malignant tumor that has a mixture of germ cell and sex cord tumor?
Gonadoblastoma
What is the risk of velamentous insertion?
Umbilical cord plant from the placenta edge—>risk for hemorrhage
What drug is used to treat eclampsia seizure?
Magnesium sulfate
Increase/decrease maternal AFP is an indication of?
Open neural tube defect/Down syndrome
Lecithin/sphingomyelin ratio >2 indicates?
Adequate surfactant synthesis
What is Mondor’s disease of the breast?
Overlaying cord that is painful on the breast
What drug causes fibroadenoma in women?
Cyclosporine
When you see bloody discharge you think cancer, but one exception is?
Intraductal papilloma (breast and benign)
What is estrogen’s role for osteoblast/clast?
It promotes osteoblast and inhibit osteoblast
IL-1/6 TNF are osteoclast/osteoblast promoting?
increase RANKL/RANK—>promote Osteoblast
Osteoblast produces ___ to inhibit RANKL/RANK?
OPG
What age group does osteochondrosis affect?
Children
What is Legg-Calve-Perthes (limp) disease?
AVN of the femoral head ossification center
What becomes detached in osteochondritis dissecans?
The articular cartilage
What age group does Osgood-Schlatter disease affect?
Active boys from 11-15
Increase hat sized/alkaline phosphatase are markers for ___?
Paget disease of the bone
Paget disease of the bone increase risk for ___?
Osteosarcoma
What disease does polystotic bone involvement of firbrous dysplasia associated with?
Albright syndrome
Poor clot during mucin clot test means ___?
Sign of joint inflammation
What is the age group that osteoid osteoma and osteoblastoma affect?
10-20
Alkaptonuria can also cause ___?
osteoarthritis
What enzyme degrade proteoglycan and collage of the cartilage in osteoarthritis?
Metalloproteinase
Loss of proprioception and deep pain sensation is a result of ____ joint?
Charcot joint
What is the inflammatory mechanism of gout?
Uric acid activate complement system—>release C5/3a—>attract neutrophil—>inflammation
CPPD increase with ____ and ____
Hemochromatosis and hemosiderosis
What test is used to test De Quervain tenosynovitis?
Finkelstein test
What bone tumor is benign but locally aggressive?
Giant cell tumor
