Pathology of the Uterus, Vagina, and Vulva Flashcards
Vulvar malignancies will drain to the ___________ lymph nodes.
inguinal
Cervical malignancies will drain to the ____________ lymph nodes.
iliac (first) and then para-aortic (second)
Trace the types of epithelium from vulva to uterus.
Vulva: keratinizing squamous
Vagina: non-keratinizing squamous
Cervix: non-keratinizing squamous to glandular
Uterus: glandular
Tumor growth into a tissue is called ___________, while tumor growth outward is ____________.
endophytic; exophytic
Single cells growing into an organ is called ___________.
pagetoid
Histologic exam of HSV-2 lesions will show ______________.
eosinophilic intranuclear inclusions
If a woman in labor has an active HSV-2 recurrence, _____________ is indicated.
caesarean section
Molluscum contagiosum is _____________.
a benign, self-limited endophytic lesion
Verrucous means ___________.
cauliflower-like
Hyperparakeratosis is ____________.
too much stratum corneum with nuclei (diagnostic of HPV infection)
What kind of organism causes strawberry cervix?
Flagellated protozoa (being Trichomonas)
What can cause vaginal candida?
Diabetes
Antibiotics
Pregnancy
Vaginal candida is described as ___________.
curd-like discharge
Actinomyces causes _____________.
nothing usually
Vulvar SCC is _________ as common as cervical cancer.
1/8
Most high-grade vulvar/cervical lesions do not ____________.
invade
What increases the risk of vulvar/cervical SCC?
Smoking, HPV, immunosuppression, and chronic inflammation
Describe inflammatory SCC.
Usually HPV-negative and occurring in women older than 70
What is lichen sclerosis?
A pre-malignant diffuse lesion that presents with “parchment paper” vulva and collagenous fibrosis of the stratum spinosum
Extramammary Paget’s disease in the vulva, unlike in the breast, is not associated with _____________.
underlying malignancy
Note: because of this, extramammary Paget’s presents in the epidermis.
Histologically, extramammary Paget’s disease presents with _____________.
marked hyperkeratosis and pale basal cells with gland formation
____________ presents with S100 staining.
Melanoma (Me10nom0)
Girls exposed to DES (an old form of estrogen thought to prevent miscarriages from low estrogen levels) will develop _____________.
embryonal rhabdomyosarcoma, a malignant proliferation of skeletal muscle cells just below the surface of the epithelium
Note: this is also called sarcoma botryoides
Note #2: this presents with a “grape-like” protrusion from the vagina
__________ also presents in women exposed to DES and will display patches of red, glandular tissue in the vagina.
Adenosis
____________ is like a worse form of adenosis.
Clear cell carcinoma
Another DES exposure disorder
What stain identifies HPV?
p16
The classic histologic description of the proliferative phase uterus is _____________.
“test-tube” like with basal nuclei and occasional mitoses
Secretory phase uterus has this appearance: _____________.
S-shaped glands with secretory glands that look like piano keys
Exogenous hormones will cause ____________ appearance of the uterus.
decidualized stromal cells (fluffy cells)
In response to hCG and progesterone, the endometrium develops a ____________ appearance.
Arias-Stellar Response (ASR) with “crazy-looking” nuclei and decidualized stroma
Menopausal uterus looks like _____________.
atrophic endometrium, cystic glands, and decreased mucus glands
_________ is the pathologic term for PID.
Endometritis
What is curettage?
Scraping out the uterus
____________ presents with PMNs in the uterine glands.
Endometritis
What is endometriosis?
Endometrial glands where they should not be (e.g., in the ovary or myometrium)
Note: when endometriosis occurs in the uterus (such as the myometrium) it is called adenomyosis.
What are the three locations that a leiomyoma can present?
Subserosal, intramural, and submucosal
Outer, middle, and inner
The histologic buzzwords for leiomyoma are _______________.
well-circumscribed mass with cells containing cigar-shaped nuclei
How are leiomyomas treated?
They are usually hormonally responsive, so they shrink with menopause. In many cases, however, nothing is done.
______________ are the most common uterine sarcoma.
Leiomyosarcomas
The 5-year survival for endometrial carcinoma is ____________.
81%
The three most common genes for type I endometrioid carcinoma are ______________.
PTEN, KRAS, and beta-catenin
What genes are mutated in Lynch syndrome (that can also present with endometrial cancer)?
MSH2 and MLH1
Note: these are the MMR proteins that lead to microsatellite instability if impaired.
Of endometrial hyperplasias, ____________ rarely progress to cancer while about 30% of __________ do.
simple hyperplasias; complex hyperplasias
Endometrioid carcinoma sometimes has ____________ metaplasia.
squamous
Which demographic is more typical for type II endometrial cancer?
Older (i.e., post-menopausal) women
Type II endometrial cancer is frequently driven by mutations in _________.
p53
Lecturer: “You have to know that.”
What kind of cancer is type II endometrial carcinoma?
Serous papillary adenocarcinoma
Mixed Müllerian tumors can present as either ______________.
homologous (in which they recapitulate multiple tissue types that are normally found in the uterus, like epithelium) or heterologous (in which they recapitulate tissues not normally found in the uterus, like cartilage)
Which kind of Müllerian tumor is worse?
Heterologous
Type I endometrioid cancer is more common in ______________.
obese perimenopausal women
Molluscum contagiosum is what kind of organism?
Pox virus
The most common cause of abnormal uterine bleeding in a perimenopausal woman is _____________.
endometrial polyp
Histologically, what’s the best way to distinguish between endometrioid polyp and endometrial adenocarcinoma?
Endometrial carcinoma will not have stroma between glands, whereas polyps will.
If you see keratin pearls in the vagina, the patient will likely test positive for _______________.
hrHPV
What lesion is itchy and pearly in appearance?
Molluscum contagiosum
Endocervical polyps can be cured by ____________.
curettage
Which phase is characterized by straight tubules and which is S-shaped tubules?
Straight: proliferative
S-shaped: secretory
Remember, endometriosis is glands and ________.
stroma
Which endometrial cancer is more aggressive?
Type II
