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Reproductive > Pathology - Nichols 2 > Flashcards

Pathology - Nichols 2 Flashcards

1
Q

High Risk in HPV to cause cancer?

A

-16,18,31,33,35

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2
Q

Low Risk Cancer, High Warts for HPV?

A

-6,11

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3
Q

Is HVP a DNA or RNA virus?

A

DNA

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4
Q

Molecular Pathology of Cervical Dysplasia/CIN/SIL

A
  • high risk HPV E6 & E7 genes are important in development of high grade dysplasia and invasive cancer
  • E6 gene product binds to and causes degeneration of the p53 (tumor suppressor) protein
  • E7 gene binds/inactivates Rb protein, allowing up-regulation of Cyclin E and p16INK4
  • lifespan of epithelial cells increases
  • Koilocytotic changes (condyloma), dysplasia and cancer
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5
Q

Original Squamous Epithelium of Cervix

A
  • smooth, shiny, featureless
  • very fine vessels
  • sharp squamous columnar junction separates the squamous epithelium from villous endocervix
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6
Q

Appearance of Epithelium of CIN/SIL

A

-add acetic acid and it turns white

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7
Q

Appearance of Invasive Squamous Cell Carcinoma

A
  • nodular, with bizarre vessels and areas of hemorrhage
  • if endophytic: cervix is barrel-shaped
  • bleeds with acetic acid, does not stain with iodine
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8
Q

Features of Koilocytotic Change

A
  • Cytomegaly
  • Nucleomegaly
  • Perinuclear Halo
  • Irregular Nuclear Membrane
  • Stipples (coarse) chromatin
  • Increased mitotic activity
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9
Q

CIN I - Pap Smear

A
  • mild dysplasia

- changes are seen in basal third of squamous epithelium

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10
Q

CIN II - Pap Smear

A
  • moderate dysplasia

- lower and middle third of epithelium, still some epithelium differentiation

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11
Q

CIN III - Pap Smear

A
  • severe dysplasia

- minimal differentiation in superficial epithelium

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12
Q

Microscopic Koilocytotic Changes

A
  • epithelial cells with crisp, perimuclear intracytoplascmic halos
  • nuclear mem is irregular resulting in wrinkled nucleus w/viral particles
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13
Q

Flat Condyloma with Koilocytes

A
  • cells in intermediate layers are ballooned with copious clear cytoplasm in which viral particles reside
  • once cell binucleated
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14
Q

Features of Intraepithelial Dysplasia/CIN/SIL

A
  • maturation arrest (dec./missing superficial epithelial cells)
  • blurred or missing distinction of basal cell layer
  • loss of cellular orientation, polarity
  • increased nuclear/cytoplasmic ratio
  • hyperchromatic epithelium
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15
Q

Invasive Squamous Cell Carcinoma - Micro

A
  • invading irregular squamous cell nests

- dysmoplastic stroma, irregular squamous nests with keratinization (sometimes)

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16
Q

Cervical Invasive Squamous Cancer

A
  • predominately squamous cell carcinoma
  • leading cause of cancer deaths in women 50y/o
  • 8th cause of cancer deaths
  • survival depends on clinical stage
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17
Q

Stage I

A

confined to cervix

-85-90% 5 year survival

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18
Q

Stage II

A
  • local invasion

- 75% 5 year survival

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19
Q

CIN RIsk Factors

A
  • early age at first intercourse
  • multiple sexual partners
  • a male partner with multiple previous sexual partners
  • high parity, family history, other virusis
  • immune status
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20
Q

Screening for Cervical Cancer

A
  • Exfoliative cytology of cervix (pap smears)
  • Bethesda nomenclature: normal, benign changes, LSIS, HSIL, ASCUS (atypical squamous cells of undetermined significance), atypical glandular cells, other
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21
Q

Micro CIN I

A
  • large
  • nucleus is hyperchromatic
  • raisinoid and binucleated or multinucleated
  • low nuclear/cytoplasm ration
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22
Q

Micro CIN II

A

-high nuclear/cytoplasm ration

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23
Q

Micro CIN III

A
  • small cells

- very high nuclear/cytoplasmic ratio

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24
Q

Prevention of Cervical Cancer

A
  • virus-like particles can be used to create & increase host immunity against HPV
  • Increased immunity prevents HPV infection, dev of cervical dysplasia (precancerous condition) and cancer
  • decrease HPV infection
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25
Q

Key to prognosis of Endometrial Cancer

A

-stage

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26
Q

Endometrial Cancer

A

-bleed earlier in cervical

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27
Q

Tumors of Uterine Corpus: Benign

A
  • leiolyoma (smooth muscle)

- endometrial stromal nodule

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28
Q

Tumors of Uterine Corpus: Malignant

A
  • adenocarcinoma of endometrium (endometrioid, serous papillary)
  • mixed mullerian tumors
  • leiomyosarcoma
  • endometrial stromal sarcoma
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29
Q

Leiomyoma

A
  • circumscribed nodules in myometrium
  • white whorled surface
  • cigar-shaped nuclei (smooth muscle)
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30
Q

Abnormal Uterine Bleeding

A

Baby girl: maternal estrogen

Post Menopause: tumor

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31
Q

Adenomyosis

A

-presence of benign endometrial glands and stroma within the myometrium

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32
Q

Endometriosis

A
  • most common site is on ovary, then around ovary

- presence of benign endometrial glands and stroma outside the uterus

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33
Q

Ovarian Neoplasms/Surface Epithelial Stromal Tumors

A

-

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34
Q

Serous Tumors

A

Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-cystadenoma
-cystadenocarcinoma
MOST COMMON 75%

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35
Q

Mucinous Tumors

A

Ovarian Neoplasms/Surface Epithelial Stromal Tumors

  • cystadenoma
  • cystadenocarcinoma
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36
Q

Endometrioid

A

Ovarian Neoplasms/Surface Epithelial Stromal Tumors

  • adenocarcinoma
  • epithelial-stromal tumor (mixed Mullerian tumor)
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37
Q

Transtional Cell Tumor

A

Ovarian Neoplasms/Surface Epithelial Stromal Tumors

-Brenner tumor

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38
Q

Benign Serous Cystadenoma

A
  • large simple cyst, thin wall and serous fluid content

- epithelium is cuboidal-low columnar, ciliated

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39
Q

Serous papillary cystadenocarcinoma, gross

A

-tan-yellow-white with papillary projections and solid areas

40
Q

Serous Carcinoma of Ovary

A
  • invasive cell nests forming papillary fronds

- psammoma bodies are common

41
Q

Ovarian neoplasma/sex cord-stromal tumors

A
  • granulosa cell timors
  • tumors of thecoma-fibroma group
  • sertoli cell tumor
  • sex cord tumors
42
Q

Granulosa cell tumor, gross

A

-mustard-yellow with areas of necrosis

43
Q

Granulosa cell tumor, microscopic

A
  • coffee-bean shaped nuclei, nuclear grooves

- call-exner bodies (circular arrangement around a sparsely cellular space recapitulating ovarian follicle)

44
Q

Mature cystic teratoma, gross pathology

A

-cystic mass with sebaceous content, hair, teeth

45
Q

Mature cystic teratoma, microscopy

A

-keratin, skin, skin appendages and subcutaneous fat tissue

46
Q

Placenta

A

-temporary organ connecting fetus and mother providing equivalent of respiratory services

47
Q

Amnion

A

membranous sac surrounding fetus containing serous fluid essential for fetal development

48
Q

Chorion

A

-plate-shaped tissue under part of amniotic sac containing fetal blood vessels that branch into villi projecting into space filled with maternal blood

49
Q

Trophoblast

A

outter layer of blastocyst (from fertilized ovum) that implants in uterus and forms placenta

50
Q

Decidua

A

outer layer of placenta that normally peels off myometrium and sheds with placenta

51
Q

Syncytiotrophoblast

A

syncytium of cells forming outer covering of chorionic villi, which thin out their cytoplasm and let their clumped nuclei hang off villi in “syncytial knots” to minimize diffusion barrier

52
Q

First Trimester Chorionic Villi

A

covered by double layer

inner cytotrophoblast layer and outer syncytiotrophoblast layer

53
Q

Third Trimester Chorionic Villi

A

more efficient

-more blood vessels, less interstitium, thinner trophoblast covering

54
Q

Ectopic Pregnancy

A

-implantation of placenta anywhere besides normal intrauterine location
(1 in 150)
90% in fallopian tube
-scarring from previous infection of tube, adhesions from appendicitis, endometriosis or surgery

55
Q

Presentation of Ectopic Pregnancy

A

acute severe abdominal pain due to fallopian tube rupture and pelvic hemorrhage (6 weeks agter last menses)
-hemorrhagic shock, death

56
Q

Diagnosis of Ectopic Pregnancy

A

-history, physical (signs of peritonitis), ultrasound, pregnancy test

57
Q

Treatment/Prognosis of Ectopic Pregnancy

A

surgery, good with proper treatment

58
Q

Spontaneous Abortion

A

Pregnancy loss before 20 weeks

  • occurs in 15% of clinically recognized pregnancies but 22% more abort in first trimester
  • 11% in 22-24y/o to 51% in 40-44y/o
59
Q

Cause of Spontaneous Abortion in First Trimester

A

-Genetic

1/2 with chromosomal abnormalities

60
Q

Causes of Spontaneous Abortion in Second Trimester

A

-Infectious

acute chorioamnionitis

61
Q

Causes of Spontaneous Abortion in Third Trimester

A

-Vascular

uteroplacental insufficiency, commonly associated with pre-eclampisa

62
Q

Recurrent Spontaneous Abortion

A 
>/= 3
immunologic (25%)  (antiphospholipid syndrome)
anatomic (22%)
endocrinologic (20%)
microbiologic
genetic 
unknown

-recurrent stillbirth associated with hypercoagulable states

63
Q

Placenta Previa

A

implantation in lower uterus or cervix sometimes covering internal cervical os
-often results in severe bleeding, may result in placental rupture, massive bleeding, maternal death

64
Q

Diagnosis/Treatment of Placenta Previa

A

ultrasound

C-section

65
Q

Placenta Accreta

A

defective decidua, with adherence of villous tissue to myometrium
80%

66
Q

Placenta Increta

A

defective decidua, with penetration of villous tissue into myometrium
15%

67
Q

Placenta Percreta

A

defective decidua, with penetration of villous tissue through entire uterine wall
5%

68
Q

Treatment of Placenta Accreta, Increta, Percreta

A

persistent postoartum

-hysterectomy, resection or oversewing

69
Q

Hydatidiform Moles

A
  • Abnormal gestations due to two sperm fertilizing one egg or 1 or 2 sperm fertilizing an “empty egg” with absent or nonfunctional DNA
  • rare in US (1 in 1,000)
  • east (1 in 100)
  • women less than 20 or greater than 40
70
Q

Complete Moles

A

diploid

71
Q

Partial Moles

A

triploid

72
Q

Morphology of Hydatidiform Moles

A
  • cystic swelling of chorionic villi makes them resemble grapes
  • trophoblast hyperplasia more prominent in complete moles (all the way around villi)
73
Q

Diagnosis/Treatment of Hydatidiform Moles

A
  • average 8.5 weeks from abnormal ultrasound showing diffuse villous enlargement or rapid and high beta-HCG
  • Treated with curretage and monitoring beta-HCG to make sure its all out
74
Q

Types of Twin Placentas

A
  • Dichorionic Diamnionic
  • Dichorionic Diamnionic (fused)
  • Monochorionic Diamnionic
  • Monochorionic Monoamnionic
75
Q

Dichorionic Diamniotic Twin Placenta

A

-69% of twins

80% of these twins are dizygotic

76
Q

Monochorionic Diamniotic Twin Placenta

A
  • 30% of twins

- all twins are monozygotic

77
Q

Monochorionic Monoamniotic Twin Placenta

A
  • twin twin diffusion syndrome
  • unbalanced vascular anastomoses in monochorionic placentas can cause one twin to get to much blood and the other to get to little
78
Q

Twin-Twin Transfusion Syndrome

A

-death of deprived “donor” twin can send necrotic procoagulant material into the anastomoses threatening the life of the other twin and then the mother

79
Q

Placental Infections: Hematogenous

A 
TORCH
T-Toxoplasm gondii
O-Other (syphillis, HIV)
R-Rubella (german measles)
C-Cytomeglovirus
H-Herpes Simplex Virus

ascending from vagina: acute chorioamnionitis

80
Q

Toxoplasma gondii

A

-protozoan from cat feces, causes microcephaly, fever, rash, seizures in noenates

81
Q

Other

A

-rare in US with prenatal care

82
Q

Rubella

A

causes deafness, neurologic defects, cardiac malformations

83
Q

Cytomegalovirus

A
  • most common infection

- deafness and neurological defects, & jaundice

84
Q

Herpes Simplex Virus

A

gotten from birth

  • skin infection
  • prevent with C-section
85
Q

Acute Chorioamnionitis

A

-41% of women with premature rupture of membranes at <27 weeks and 15% at 28-36 weeks
-stages: maternal polys in intervillous space, then in chorion, then in amnion, then fetal polys in chorionic blood vessels (fetal vasculitis) where inflammation may lead to thrombosis b/c:
INFLAMMATION IS PROCOAGULANT

86
Q

Funisitis

A

-extensive tan exudate (areas of congestion) on the amniotic surface, exudate and congestion of cord

87
Q

Acute Chorioamnionitis: Infection

A
  • assends from vagina and cervix
  • mainly maternal neutrophils (so starts in intervillous space)
  • causes premature rupture of membranes (PROM) and premature labor and delivery
  • polymicrobial, with multiple vaginal flora bacteria
88
Q

Acute Chorioamnionitis Syndrome

A

-fever, tachycardia (fetal/maternal), uterine tenderness, foul smelling amniotic fluid and leukocytosis

89
Q

Acute Chorioamnionitis Diagnosis/Treatment

A
  • Diagnosis is clinical
  • Treatment: antibiotics and delivery
  • Prognosis: usually good, but can cause fetal sepsis, cerebral palsy, endometritis
90
Q

Acute Abdomen (surgical emergencies) Causes

A
  1. ruptured ectopic pregnancy
  2. corpus luteum rupture & hemorrhage
  3. pelvic inflammatory disease
  4. appendicitis
  5. ovarian torsion
91
Q

Ovarian Torsion

A

twisting on ligamentous support, cutting off venous outflow and then arterial inflow, causing ischemia and then infarction
-most common in women of childbearing age with ovarian mass or pregnancy (more in first trimester)

92
Q

Ovarian Torsion Symptoms/Treatment

A
  • acute onset of moderate-severe pelvic pain, often with nausea and vomiting
  • treat with surgery
93
Q

Appendicitis

A
  • inflammation of appendix due to overgrowth of normal flora trapped by occluding fecalith
  • 1 in 800 pregnancies (more in 2nd trimester)
  • periumbilical abdominal pain that migrates to right lower quadrant, anorexia, nausea, vomiting, fever with McBurney’s tenderness, rebound tenderness
94
Q

Volvulus

A

-twisting with intermittent cramping lower abdominal pain, progressive abdominal distension, passing no stool or flatus, with marked abdominal distension and tympany

95
Q

Treatment of Volvulus

A

-untwisting by inserting tube

96
Q

Diverticulitis

A

inflammation of transmural outpouching of colonic mucosa due to perforation +/- abscess

  • common in elderly
  • abdominal pain, often > day, left in 70% whites, right 75% asians, constipation 50%, nausea + vomiting, diarrhea, tenderness & leukocytosis

Reproductive (14 decks)

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