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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
Key to prognosis of Endometrial Cancer
-stage
26
Endometrial Cancer
-bleed earlier in cervical
27
Tumors of Uterine Corpus: Benign
- leiolyoma (smooth muscle) | - endometrial stromal nodule
28
Tumors of Uterine Corpus: Malignant
- adenocarcinoma of endometrium (endometrioid, serous papillary) - mixed mullerian tumors - leiomyosarcoma - endometrial stromal sarcoma
29
Leiomyoma
- circumscribed nodules in myometrium - white whorled surface - cigar-shaped nuclei (smooth muscle)
30
Abnormal Uterine Bleeding
Baby girl: maternal estrogen | Post Menopause: tumor
31
Adenomyosis
-presence of benign endometrial glands and stroma within the myometrium
32
Endometriosis
- most common site is on ovary, then around ovary | - presence of benign endometrial glands and stroma outside the uterus
33
Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-
34
Serous Tumors
Ovarian Neoplasms/Surface Epithelial Stromal Tumors -cystadenoma -cystadenocarcinoma MOST COMMON 75%
35
Mucinous Tumors
Ovarian Neoplasms/Surface Epithelial Stromal Tumors - cystadenoma - cystadenocarcinoma
36
Endometrioid
Ovarian Neoplasms/Surface Epithelial Stromal Tumors - adenocarcinoma - epithelial-stromal tumor (mixed Mullerian tumor)
37
Transtional Cell Tumor
Ovarian Neoplasms/Surface Epithelial Stromal Tumors | -Brenner tumor
38
Benign Serous Cystadenoma
- large simple cyst, thin wall and serous fluid content | - epithelium is cuboidal-low columnar, ciliated
39
Serous papillary cystadenocarcinoma, gross
-tan-yellow-white with papillary projections and solid areas
40
Serous Carcinoma of Ovary
- invasive cell nests forming papillary fronds | - psammoma bodies are common
41
Ovarian neoplasma/sex cord-stromal tumors
- granulosa cell timors - tumors of thecoma-fibroma group - sertoli cell tumor - sex cord tumors
42
Granulosa cell tumor, gross
-mustard-yellow with areas of necrosis
43
Granulosa cell tumor, microscopic
- coffee-bean shaped nuclei, nuclear grooves | - call-exner bodies (circular arrangement around a sparsely cellular space recapitulating ovarian follicle)
44
Mature cystic teratoma, gross pathology
-cystic mass with sebaceous content, hair, teeth
45
Mature cystic teratoma, microscopy
-keratin, skin, skin appendages and subcutaneous fat tissue
46
Placenta
-temporary organ connecting fetus and mother providing equivalent of respiratory services
47
Amnion
membranous sac surrounding fetus containing serous fluid essential for fetal development
48
Chorion
-plate-shaped tissue under part of amniotic sac containing fetal blood vessels that branch into villi projecting into space filled with maternal blood
49
Trophoblast
outter layer of blastocyst (from fertilized ovum) that implants in uterus and forms placenta
50
Decidua
outer layer of placenta that normally peels off myometrium and sheds with placenta
51
Syncytiotrophoblast
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
First Trimester Chorionic Villi
covered by double layer | inner cytotrophoblast layer and outer syncytiotrophoblast layer
53
Third Trimester Chorionic Villi
more efficient | -more blood vessels, less interstitium, thinner trophoblast covering
54
Ectopic Pregnancy
-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
Presentation of Ectopic Pregnancy
acute severe abdominal pain due to fallopian tube rupture and pelvic hemorrhage (6 weeks agter last menses) -hemorrhagic shock, death
56
Diagnosis of Ectopic Pregnancy
-history, physical (signs of peritonitis), ultrasound, pregnancy test
57
Treatment/Prognosis of Ectopic Pregnancy
surgery, good with proper treatment
58
Spontaneous Abortion
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
Cause of Spontaneous Abortion in First Trimester
-Genetic | 1/2 with chromosomal abnormalities
60
Causes of Spontaneous Abortion in Second Trimester
-Infectious | acute chorioamnionitis
61
Causes of Spontaneous Abortion in Third Trimester
-Vascular | uteroplacental insufficiency, commonly associated with pre-eclampisa
62
Recurrent Spontaneous Abortion
``` >/= 3 immunologic (25%) (antiphospholipid syndrome) anatomic (22%) endocrinologic (20%) microbiologic genetic unknown ``` -recurrent stillbirth associated with hypercoagulable states
63
Placenta Previa
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
Diagnosis/Treatment of Placenta Previa
ultrasound | C-section
65
Placenta Accreta
defective decidua, with adherence of villous tissue to myometrium 80%
66
Placenta Increta
defective decidua, with penetration of villous tissue into myometrium 15%
67
Placenta Percreta
defective decidua, with penetration of villous tissue through entire uterine wall 5%
68
Treatment of Placenta Accreta, Increta, Percreta
persistent postoartum | -hysterectomy, resection or oversewing
69
Hydatidiform Moles
- 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
Complete Moles
diploid
71
Partial Moles
triploid
72
Morphology of Hydatidiform Moles
- cystic swelling of chorionic villi makes them resemble grapes - trophoblast hyperplasia more prominent in complete moles (all the way around villi)
73
Diagnosis/Treatment of Hydatidiform Moles
- 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
Types of Twin Placentas
- Dichorionic Diamnionic - Dichorionic Diamnionic (fused) - Monochorionic Diamnionic - Monochorionic Monoamnionic
75
Dichorionic Diamniotic Twin Placenta
-69% of twins | 80% of these twins are dizygotic
76
Monochorionic Diamniotic Twin Placenta
- 30% of twins | - all twins are monozygotic
77
Monochorionic Monoamniotic Twin Placenta
- 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
Twin-Twin Transfusion Syndrome
-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
Placental Infections: Hematogenous
``` TORCH T-Toxoplasm gondii O-Other (syphillis, HIV) R-Rubella (german measles) C-Cytomeglovirus H-Herpes Simplex Virus ``` ascending from vagina: acute chorioamnionitis
80
Toxoplasma gondii
-protozoan from cat feces, causes microcephaly, fever, rash, seizures in noenates
81
Other
-rare in US with prenatal care
82
Rubella
causes deafness, neurologic defects, cardiac malformations
83
Cytomegalovirus
- most common infection | - deafness and neurological defects, & jaundice
84
Herpes Simplex Virus
gotten from birth - skin infection - prevent with C-section
85
Acute Chorioamnionitis
-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
Funisitis
-extensive tan exudate (areas of congestion) on the amniotic surface, exudate and congestion of cord
87
Acute Chorioamnionitis: Infection
- 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
Acute Chorioamnionitis Syndrome
-fever, tachycardia (fetal/maternal), uterine tenderness, foul smelling amniotic fluid and leukocytosis
89
Acute Chorioamnionitis Diagnosis/Treatment
- Diagnosis is clinical - Treatment: antibiotics and delivery - Prognosis: usually good, but can cause fetal sepsis, cerebral palsy, endometritis
90
Acute Abdomen (surgical emergencies) Causes
1. ruptured ectopic pregnancy 2. corpus luteum rupture & hemorrhage 3. pelvic inflammatory disease 4. appendicitis 5. ovarian torsion
91
Ovarian Torsion
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
Ovarian Torsion Symptoms/Treatment
- acute onset of moderate-severe pelvic pain, often with nausea and vomiting - treat with surgery
93
Appendicitis
- 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
Volvulus
-twisting with intermittent cramping lower abdominal pain, progressive abdominal distension, passing no stool or flatus, with marked abdominal distension and tympany
95
Treatment of Volvulus
-untwisting by inserting tube
96
Diverticulitis
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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