Pathology (Sections 21-) Flashcards
Clinically significant infectious etiology of endometritis
Chlamydia trachomatis
Infection that begins in the vulva/vagina that ascends to involve the upper reproductive tract
Presents as pelvic pain, adnexal tenderness, fever, and vaginal discharge
Pelvic Inflammatory Disease
Type of PID
Initial infection from endocervical mucosa
Ascends via direct mucosal spread
Gonococcal PID
Type of PID
Associated with uterine manipulation
Spreads lympohematogenously
Non-gonococcal PID
Non-neoplastic epithelial lesion of the vulva
Leukoplakia
Thinning of the epidermis
Not pre-malignant
Lichen sclerosus
Non-neoplastic epithelial lesion of the vulva
Acanthosis
Not pre-malignant
Squamous Hyperplasia of the Vulva
Most common type of Vulvar SCCA
Non-HPV related (70%)
Failure of Mullerian Duct fusion
Usually accompanied by uterine didhelphys
Associated wih DES exposure in utero
Septate Vagina
Remnant of the Wolffian/Mesonephric Duct
Gartner Duct Cyst
Most common vaginal malignancy
Direct spread from cervical carcinoma
Most common primary vaginal malgnancy
SCCA
Disease of the young (<5 years)
Grape-like clusters
Malignant embryonal rhabdomyoblasts
May cause urinary tract obstruction
Sarcoma Botryoides
Most important factor in developing cervical CA
HPV 16 (60%) and HPV 18 (10%) infection
MoA: E7 in Cervical CA
Inactivates Rb, p21, and p27;
Promotes cell proliferation
MoA: E6 in Cervical CA
Inactivates p53
Promotes cellular immortality
Grading of CIN
LSIL:
Confined to lower third of the epithelium
HSIL:
Expansion to upper 2/3 of the epithelium
Most common cause of death in cervical cancer
Uremia from renal spread of malignancy
Pap Smear Monitoring
Start at 21 or within 3 years of first coitus; repeat every 3 years until 30 years of age
Beyond 30, repeat every 5 years
If (+) HR HPV, repeat every 6-12 months
Quadrivalent (6, 11, 16, 18) vaccine for HPV
Gardasil
AUB Etiologies
PALM COEINS
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy Ovulatory dysfunction Edometrial Pathology Iatrogenic Not classified
Abnormal uterine bleeding without an organic/structural cause
Most common cause: Anovuatory Cycle (unopposed estrogen)
Dysfunctional Uterine Bleeding
Ectopic endometrial tissue
Infertility, dysmenorrhea, pelvic pain
Most common site: Chocolate Cysts (Ovary)
Mediated by elevated PGE2 (increases estrigen synthesis)
Endometriosis
Endometrial glands in the myometrium
AUB, colicky dysmenorrhea, dyspareunia
Symmetrically enlarged corpus with blood lakes
Adenomyosis
Regurgitation Theory (Endometriosis)
Implantation of ectopic endometrial tissue via retrogade menstruation
Benign endometrial mass associated with Tamoxifen use
Endometrial Polyp
Tumor suppressor gene found to be inactivated in cases of endometrial hyperplasia
PTEN
Most common malignancy of the female genital tract
Endometrial CA
Type of EM CA 50's-60's Unopposed Estrogen Endometroid Morphology PTEN Mutation Indolent, lymphatic spread
Type I (Endometroid)
Type of EM CA
60’s-70’s
Atrophic uterus, thin physique
Serous/Clear Cell/Mixed Mullerian Morphology
TP53 Mutation
Aggressive; intraperitoneal lymphatic spread
Type II
Serous
Most common tumor in women
Leiomyoma
Gene mutation involved in leiomyomas
MED 12
Most common type of Leiomyoma
Intramural
Most common pathogen seen in Salphingitis
Gonococcus
Lined by flattened granulosa cells in the ovary
Exhibit Luteinization
Hyperplasia of ovarian theca lutein (Hyperthecosis)
Cystic Follicles (if < 2cm) Follicular Cysts (if > 2cm)
Lined by luteinized granulosa cells in the ovary
May rupture and cause peritoneal reaction
Corpus Luteum Cysts
Stein-Leventhal Syndrome
Complex endocrine disorder characterized by:
- Hyperandrogenism
- Menstrual abnormalities
- Infertility
- Chronic Anovulation
- Polycystic ovaries
Associated with: T2DM, MS
Also known as Polycystic Ovarian Syndrome
Most common ovarian tumor
Mullerian Epithelium Type
Most common type of Surface Epithelial ovarian tumors
Serous
Tumor marker for Surface Epithelial ovarian tumors
CA 125
Type of serous tumor
Well-differentiated
Precursor lesion: Borderline Tumors
Mutations in KRAS. BRAF, ERBB22
Low-grade Serous Tumor
Type of serous tumor
Moderately- to poorly-differentiated
Precursor: Serous tubal intraepithelial carcinoma (STIC)
TP53, BRCA mutation
High-grade Serous Tumor
Surface epithelial ovarian tumor
Mostly benign
Primary type is rare; consider extraovarian primary
KRAS Mutation
Usually unilateral
Associated with Pseudomyxoma Peritonei (mucinous ascites)
Mucinous Tumor
Most common extraovarian source of mucinous ovarian tumors
Appendix
Surface epithelial ovarian tumor Coexists with endometriosis (15-20%) PTEN Mutation Hallmark: Tubular glands resembling endometrium Bilateral (40%)
Endometroid Tumor
Most common Germ Cell Tumor in females
Benign Cystic Teratoma
Type of GCT Dermoid Cyst-like architecture Reproductive age women Contain structures derived from > 1 germ cell layer Benign
Mature Teratoma
Type of GCT Solid architecture Young women, children Contains neuroepthelium Malignant
Immature Teratoma
Teratoma containing ectopic thyroid tissue
May cause hyperthyroidism
Struma ovarii
Teratoma that secretes serotonin
Carcinoid
rule-out primary intestinal carcinoid
Germ Cell Tumor Predominant tissue: Oogonia Nests of large, vesicular cells with central nuclei and clear cytoplasm KIT Mutation Favorable prognosis
Most common malignant GCT
Dysgerminoma
Seminoma in males
Germ Cell Tumor
Predominant tissue: Extraembryonic yolk sac
Central blood vessels enveloped by tumor cells within a space lined by tumor cells (Schiller-Duval Bodies)
AFP Mutation
Favorable prognosis
Second most common malignant GCT
Yolk Sac Tumor
Endodermal Sinus Tumor
Germ Cell Tumor
Predominant tissue: Placenta
HCG Mutation
Unfavorable prognosis
Ovarian Chriocarcinoma
Most common primary tumors in ovarian metastasis
Tumors of Mullerian Origin
Uterus, FT, contralateral ovary, pelvic peritoneum
Most common extra-mullerian primary in ovarian metastasis
Bone, GIT
Signet ring GIT carcinoma that frequently metastasizes to the ovaries
Krukenberg Tumor
Cystic swelling of the chorionic villi with trophoblastic proliferation
Differential for bleeding during the first trimester
Hydatidiform Mole
Triploid Karyotype
Beta-HCG < 100,000
(+) Fetal components, amnion
p57 positive
Partial Mole
Diploid Karyotype Beta-HCG > 100,000 (-) Fetal components, amnion p57 negative "Snowstorm" on TV UTZ
Complete Mole
Proliferation of cytotrophoblasts and syncitiotrophoblasts WITHOUT villi formation
Rapidly invasive, widely metastasizing
Gestational Choriocarcinoma
Character of nipple discharge consistent with malignancy
Unilateral, spontaneous
Most common pathogens associated with mastitis
Staphylococcus aureus
Streptococcus pyogenes
Benign breast lesion
> 2 cell layers in a duct
Distorted lumina at periphery
Mimics Ductal Carcinoma-in-situ
Epithelial Hyperplasia
Solid cords or double strand of cells in a densely fibrotic stroma, compressing ducts
Closely mimics Breast CA
Sclerosing Adenitis
Papillary fronds with fibrovascular cores
Bloody nipple discharge present in stalk infarcts
Papilloma
Central nidus of entrapped glands in a hyalinized stroma
Combination of epithelial hyperplasia, sclerosing adenosis, and papilloma of the breast
Complex Sclerosing Lesion
Breast neoplasia
Cribiriform pattern
“Cookie Cutter” Appearance
Loss of 16p function, gain of 17q function
Atypical ductal hyperplasia
Ductal Carcinoma-in-situ
complete ductal involvement
Breast neoplasia
Monomorphic, loosely cohesive cells
Loss of E-cadherin
Atypical lobular hyperplasia
Lobular Carcinomain-situ
>50% acini involved in a lobule
Most common non-skin malignancy in women
Breast CA
Female
BRCA1 (Ch17) and BRCA2 (Ch13) Mutation
Estrogen excess
Risk factors for Breast CA
Breast CIS Disrupted lobules Papillary, cribiriform patterns (+) Necrosis, calcifications Paget disease of the nipple Less likely to be bilateral (10-20%) Variable hormonal status
Ductal CIS
Breast CIS No disruption of lobules No papillary, cribiriform patterns No necrosis, calcifications No nipple involvement More likely to be bilateral (20-40%) ER (+), PR (+), HER2 (-)
Lobular CIS
Pagetoid Spread
Presence of malignant cells between basement membrane and overlying luminal cells
In situ breast disease + absence of intact myoepithelial layer
Haphazardly arranged cells with desmoplasia
Invasive Ductal Carcinoma, No Special Type
Components of Nottingham Histologic Score
- Tubule Formation
- Nuclear Pleiomorphism
- Mitotic Figures (per 10 hpf)
Used in grading Invasive ductal carcinoma
CDH1 (E-Cadherin) Loss
Tumor cells in single file (“Indian File”)
Scant desmoplasia
Mucin (+) signet rings
Most common breast cancer to present as occult primary (proven malignant but primary malignancy unknown)
Invasive Lobular Carcinoma
ER, HER (-)
Syncytium-like solid sheets of large cells with pleiomorphic nuclei in the breast
Lymphoplasmacytic infiltrates
Pushing Borders
Medullary CA
High-grade breast tumor
No particular molecular type
Peau d’orange
Inflammatory CA
Most common benign tumor of the female breast
Fibroadenoma
Characteristics of COMPLEX Fibroadenomas
Cysts larger then 0.3cm
Papillary apocrine change
sclerosing Adeosis
ePithelial Calcifications
(Mnemonic: CPAP)
Proliferation of intralobular stroma with epithelium
Ch1q gain Mutation
HOXB13 mutation suggests aggressive behavior
Leaf-like projections
Phyllodes Tumor
Characteristics of Male Breast CA
- Rare
- ER (+)
- Distant metastases are common on initial diagnosis
Most common cause of hyperpituitarism
Functional anterior pituitary adenoma