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Repro First Aid > pathoma female repro pathology > Flashcards

pathoma female repro pathology Flashcards

1
Q

what does the vulva include? lined by what type of epithelium?

A

the skin and mucosa of the female genitalia external to the hymen (labia majora, minora, mons pubis, and vestibule) lined by squamous epithelium

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2
Q

bartholin cyst

A

cystic dilation of the bartholin gland due to inflammation and obstruction of the gland presents as a unilateral, painful cyst at the lower vestibule adjacent to the vaginal canal

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3
Q

bartholin gland

A

one is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the lower vestibule

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4
Q

condyloma

A

sexually transmitted warty neoplasm of vulvar skin, often large either condyloma acuminatum (HPV 6 or 11) or secondary syphilis (condyloma latum) —HPV associated is characterized by koilocytes —low risk, rarely progresses to carcinoma

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5
Q

lichen sclerosis

A

thinning of the epidermis and fibrosis(sclerosis) of the dermis; presents as a white patch (leukoplakia) with parchment like vulvar skin usually in postmenopausal women benign but slight increased risk for sq. cell carcinoma

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6
Q

lichen simplex chronicus

A

hyperplasia of the vulvar squamous epithelium; presents as leukoplakia with thick leathery vulvar skin; associated with chronic irritation and scratching –benign

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7
Q

vulvar carcinoma

A

arises from vulva squamous epithelium; RARE; may be due to high risk HPV 16 or 17 or non-HPV cause(long standing lichen sclerosis) presents as leukoplakia **use biopsy to distinguish from other causes of leukoplakia

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8
Q

risk factors for vulvar carcinoma

A

HPV exposure, multiple partners, early first age of sex, women of reproductive age

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9
Q

VIN

A

vulvar intraepithelial neoplasia a dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity **leads to vulvar carcinoma

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10
Q

which type of vulvar carcinoma is seen in elderly women?

A

non-hpv related due to long standing lichen sclerosis (chronic inflammation and irritation)

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11
Q

extramammary paget disease

A

malignant epithelial cells in the vulva epidermis; presents as erythematous, pruritic, ulcerated vulvar skin **carcinoma in-situ (no underlying cancer) must distinguish from melanoma!! paget cells are PAS+, keratin +, and S100-

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12
Q

what type of paget disease DOES have underlying carcinoma?

A

paget disease of the nipple

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13
Q

melanoma vs paget disease

A

M = PAS -, keratin -, S100 + P = PAS +, keratin +, S100-

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14
Q

vagina mucosa is lined by…

A

non-keratinizing squamous epithelium

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15
Q

adenosis

A

focal persistence of columnar epithelium in the upper vagina mech: during development, sq. epithelium from the lower 1/3 vagina grows upward to replace the columnar epithelium lining the upper 2/3 **increased incidence in females who were xposed to DES (diethylstilbestrol) in utero

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16
Q

clear cell adenocarcinoma of vagina

A

malignant proliferation of glands with clear cytoplasm; RARE but FEARED complication of DES-associated vaginal adenosis

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17
Q

what can adenosis due to DES progress to?

A

clear cell adenocarcinoma

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18
Q

embryonal rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle -presents as bleeding and grape-like mass protruding from the vagina or penis of a child (

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19
Q

desmin + and myogenin +

A

characteristic of rhabdomyoblasts –> embryonal rhabdomyosarcoma

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20
Q

vaginal carcinoma

A

arises from sq. epithelium lining the vagina mucosa; usually related to high risk HPV precursor lesion is VAIN (vaginal intraepithelial neoplasia)

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21
Q

where does vaginal carcinoma spread when it spreads to regional lymph nodes?

A

lower 1/3 of vagina –> inguinal nodes upper 2/3 –> iliac nodes

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22
Q

exocervix vs endocervix epithelium

A

exo = nonkeratinizing sq epithelium endo = single layer of columnar cells

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23
Q

HPV

A

sexually transmitted DNA virus that infects the lower genital tract, especially the cervix in the transformation zone infection is usually eradicated by acute inflammation; persistence leads to risk for cervical dysplasia (CIN) high risk HPV = 16, 18, 31, 33 low risk = 6, 11

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24
Q

high risk hpv vs low risk hpv

A

high = 16, 18, 31, 33 low = 6, 11

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25
Q

CIN

A

cervical intraepithelial neoplasia caused by high risk HPV characterized by koilocytic change, disordered maturation, atypia, and mitoses –progresses stepwise through 4 different grades (1 –>2–>3–>CIS) to become invasive sq. cell carcinoma

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26
Q

high risk HPV produces….

A

E6 and E7 proteins that result in increased destruction of p53 (by E6) and Rb (by E7), respectively loss of these tumor suppressor genes increases the risk for CIN

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27
Q

CIN1 CIN2 CIN3 CIS

A

1 - involves less than 1/3 of epithelium thickness; often regresses 2 - involves less than 2/3 of epi thickness 3 - slightly less than the entire thickness Carcinoma in situ - involved entire epithelial thickness

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28
Q

cervical carcinoma

A

invasive; arises in cervical epithelium; common in middle aged women (40-50) presents as vaginal bleeding, especially postcoital bleeding, or cervical discharge squamous cell is 80% of cases; adenocarcinoma is less common

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29
Q

risk factors for cervical carcinoma

A

high risk HPV, smoking, immunodeficiency (Cervical carcinoma is AIDS defining)

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30
Q

advanced cervical carcinoma often…

A

invades through the anterior uterine wall into the bladder, blocking the ureters –> hydronephrosis with postrenal failure can cause death

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31
Q

screening and prevention of cervical carcinoma

A

catch CIN before It progresses –> usually takes 10-20 yrs so screening begins at 21, every 3 years pap smear is gold standard (cells from transformation zone) abnormal pap smear is followed by confirmatory colonoscopy and biopsy immunization with quadrivalent HPV vaccine (for 6, 11, 16, 18)

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32
Q

asherman syndrome

A

secondary amenorrhea due to loss of the basalis and scarring; due to overaggressive D&C (dilation and curettage)

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33
Q

anovulatory cycle

A

lack of ovulation; results in estrogen-driven proliferatory phase without a subsequent progesterone driven secretory phase –proliferative glands break down and shed resulting in uterine bleeding

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34
Q

acute endometritis

A

bacterial infection of the endometrium; due to retained products of contraception (after delivery or miscarriage) presents as fever, abnormal uterine bleeding and pelvic pain

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35
Q

chronic endometritis

A

chronic inflammation of the endometrium; characterized by lymphocytes and plasma cells —since lymphocytes are normal in the endometrium, plasma cells are necessary for diagnosis causes: IUD, TB, contraception products, chronic disease (chlamydia) presents as abnormal uterine bleeding, pain, and infertility

36
Q

endometrial polyp

A

hyperplastic protrusion of endometrium; presents as abnormal uterine bleeding can be a side effect of tamoxifen, which has an anti-estrogenic effect of breast but pro-estrogenic effects on endometrium

37
Q

drug that can cause endometrial polyp?

A

tamoxifen (pro estrogen on endometrium; anti estrogenic on breasts)

38
Q

endometriosis

A

endometrial glands and stroma outside of the uterine endometrial lining due to retrograde menstruation with implantation at ectopic site ***common site is the ovary (“chocolate cyst”) presents as dysmenorrhea(pain during menstruation) and pelvic pain; can cause infertility endometriosis cycles just like normal endometrium risk of carcinoma

39
Q

“chocolate cyst”

A

endometriosis of the ovary

40
Q

“gunpowder nodules”

A

endometriosis

41
Q

adenomyosis

A

endometriosis with involvement of the uterine myometrium

42
Q

endometrial hyperplasia

A

hyperplasia of endometrial glands relative to stroma; due to unopposed estrogen (obesity, polycystic ovary syndrome, estrogen replacement) presents as postmenopausal uterine bleeding most important predictor for carcinoma progression is the presence of cellular atypia!

43
Q

endometrial carcinoma

A

malignant proliferation of endometrial glands; most common invasive carcinoma of the female genital tract presents as postmenopausal bleeding arises through two different pathways: hyperplasia (most cases) and sporadic

44
Q

hyperplasia pathway for endometrial carcinoma

A

arises from hyperplasia; average age is 60 risk factors: related to estrogen exposure, early menarche/late menopause, nulliparity, anovulatory cycles, obesity histology is endometrioid (normal endometrial like)

45
Q

sporadic pathway for endometrial carcinoma

A

carcinoma arises in an atrophic endometrium with no precursor lesion; aggressive! average age is 70; p53 mutation is common histology is serous with papillary structures and psammoma body formation

46
Q

leiomyoma (fibroids)

A

benign; smooth muscle proliferation arising from myometrium; related to estrogen exposure common in premenopausal women, often multiple, enlarge during pregnancy and shrink after menopause multiple, well defined white whorled masses that may distort the area; usually asymptomatic, but can present with bleeding, infertility, and a pelvic mass

47
Q

leiomyosarcoma

A

malignant proliferation of smooth muscle arising from myometrium; de novo (DO NOT arise from leiomyoma) usually in postmenopausal women a single lesion with areas of necrosis and hemorrhage; histology shows necrosis, mitotic activity and cellular atypia

48
Q

PCOD (polycystic ovarian disease)

A

-multiple ovarian follicular cysts due to hormone imbalance; women of reproductive age -characterized by increased LH and low FSH (LH:FSH>2) –increased LH induces excess androgen from theca cells –> hirsutism (excess hair in male distribution) –androgen is converted to estrone in adipose tissue –> estrone feedback decreases FSH –> cystic degeneration of follicles **high circulating estrone increases risk of endometrial carcinoma

49
Q

classic presentation of PCOD

A

obese young woman with infertility, oligomenhorrhea, and hirsutism; sometimes have insulin resistance and may develop diabetes 10-15 years later

50
Q

small number of follicular cysts are…

A

common and have no clinical significance

51
Q

ovarian tumor: surface epithelial tumor

A

most common type; derived from the coelomic epithelium that lines the ovary –serous tumors are full of watery fluid –mucinous tumors are full of mucus-like fluid both can be benign, borderline, or malignant present late with vague abdominal pain and fullness, and urinary frequency (sign of compression) POOR prognosis; ca125 is a serum marker

52
Q

what is a benign surface epithelial tumor called? describe?

A

cystadenoma single cyst with a simple flat lining; usually in premenopausal women (30-40)

53
Q

what is a malignant surface epithelial ovarian tumor called?

A

cystadenocarcinoma complex cysts with thick shaggy lining; usually in postmenopausal women (60-70)

54
Q

BRCA1 mutation has increase risk for what? what can they opt for?

A

risk of serous carcinoma of the ovary and fallopian tube and breast cancer prophylactic salpingo-oophorectomy and mastectomy

55
Q

endometrioid tumor

A

tumor of endometrial-like glands; usually malignant may arise from endometriosis

56
Q

Brenner tumor

A

composed of bladder like epithelium and are usually benign

57
Q

ca125

A

serum marker for surface epithelial tumors

58
Q

ovarian tumors: germ cell tumor

A

women of reproductive age; tumor subtypes mimic tissues produced by germ cells normally –cystic teratoma and embryonal carcinoma = fetal tissue –dysgerminoma = oocytes –endodermal sinus tumor = yolk sac –chariocarcinoma = placental tissue

59
Q

cystic teratoma

A

germ cell tumor composed of fetal tissue derived from 2 or 3 embryologic layers; can be uni or bilateral benign but malignant potential if there is immature/neural tissue or somatic malignancy (sq cell carcinoma of skin)

60
Q

struma ovarii

A

a teratoma composed of thyroid tissue

61
Q

dysgerminoma

A

germ cell tumor composed of large cells with clear cytoplasm and central nuclei (resemble oocytes) —if testicular, call a seminoma good prognosis; responds to radiotherapy

62
Q

endodermal sinus tumor

A

germ cell tumor that is malignant and resembles the yolk sac; common in children serum AFP is elevated histology shows schiller-duval bodies

63
Q

schiller-duval bodies

A

glomerulus like structures seen in endodermal sinus tumors

64
Q

choriocarcinoma

A

malignant germ cell tumor composed of cytotrophoblasts and syncytiotrophoblasts; mimics placental tissue but villi are absent small hemorrhagic tumor with early hematogenous spread high B-hCG (made by syncytiotrophoblasts)

poor response to chemo

65
Q

embryonal carcinoma

A

malignant germ cell tumor composed of large primitive cells; aggressive with early metastasis

66
Q

sex cord-stromal tumors (3)

A

tumors that resemble sex cord-stromal tissues of the ovary

1) granulosa-theca cell tumor
2) sertoli-leydig cell tumor
3) fibroma

67
Q

granulosa-theca cell tumor

A

malignant proliferation of granulosa and theca cells

often produces estrogen -> signs of estrogen excess like:

  • precocious puberty (pre-puberty)
  • menorrhagia or metrorrhagia (reproductive age)
  • endometrial hyperplasia with postmenopausal uterine bleeding (postmenopause)**most common
68
Q

sertoli-leydig cell tumor

A

composed of sertoli cells that form tubules and leydig cells between the tubules with characteristic Reinke crystals

may produce androgen; associated with hirsutism and virilization

69
Q

fibroma

A

benign tumor of fibroblasts; associated with pleural effusions and ascites (Meigs syndrome); syndrome resolves with removal of tumor

70
Q

krukenberg tumor

A

metastatic mucinous tumor that involves BOTH ovaries; most commonly due to metastatic gastric carcinoma (diffuse type)

**bilateral - helps distinguish it from a primary mucinous carcinoma of the ovary which is usually unilateral

71
Q

pseudomyxoma peritonei

A

massive amount of mucus in the peritoneum due to a mucinous tumor of the appendix; usually with metastasis to ovary

72
Q

ectopic pregnancy

A

implantation of fertilized ovum anywhere else than uterine wall; common in the lumen of the fallopian tube

risk factor is scarring

presents as lower quadrant abdominal pain a few weeks after a missed period – SURGICAL EMERGENCY – major complications are bleeding into fallopian tube (hematosalpinx) and rupture

73
Q

spontaneous abortion

A

miscarriage of fetus occuring before 20 weeks gestation

presents as vaginal bleeding, crampy pain, and passage of fetal tissues

usually due to chromosomal anomalies (trisomy 16) or hypercoagulable states, congenital infection, or exposure to teratogens

74
Q

effects of teratogens in

1- first two weeks of gestation

2-weeks 3-8

3 - months 3-9

A

1 - spontaneous abortion

2 - organ malformation

3 - organ hypoplasia

75
Q

placenta previa

A

implantation of the placenta in the lower uterine segment; placenta overlies cervical os (opening)

presents as third trimester bleeding and requires C-section

76
Q

placental abruption

A

separation of the placenta from the decidua prior to delivery of the fetus; causes still birth

presents with third trimester bleeding and fetal insufficiency

77
Q

placenta accreta

A

improper implantation of placenta into the myometrium with little or no intervening decidua

presents with difficult delivery of the placenta and postpartum bleeding

often requires hysterectomy

78
Q

effects of these teratogens?

1 - alcohol

2- cocaine

3- thalidomide

4 - cigarette smoke

5- isotretinoin

6- tetracycline

7- warfarin

8- phenytoin

A

1 - mental retardation, facial abnormalities, microcephaly

2 - intrauterine growth retardation and placental abruption

3 - limb defects

4 - intrauterine growth retardation

5 - spontaneous abortion, hearing/visual impairment

6 - discolored teeth

7 - fetal bleeding

8 - digit hypoplasia and cleft lip/palate

79
Q

preeclampsia

A

pregnancy induced hypertension, proteinuria, and edema in third trimester; if HTN is severe it can cause headaches and visual abnormalities

-due to abnormal maternal-fetal vascular interface in the placenta; resolves with delivery

80
Q

eclampsia

A

preeclampsia with seizures

warrants immediate delivery

81
Q

HELLP

A

preeclampsia with thrombotic microangiopathy involving the liver; characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets

warrants immediate delivery

82
Q

sudden infant death syndrome

A

death without obvious cause (1 month to 1 year old); usually during sleep

risk factors: sleeping on stomach, exposure to cigarette smoke, and prematurity

83
Q

hydatidiform mole

A

abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts

  • uterus expands as if normal pregnancy, but the uterus is much larger and B-hCG is higher than expected
  • classically presents in 2nd trimester as passage of grape like masses through vaginal canal (diagnosed by routine ultrasound–> no fetal heart sounds and “snowstorm” appearance)
  • either partial or complete
  • treat with suction curettage
84
Q

partial mole

genetics?

fetal tissue?

villous edema?

trophoblastic proliferation?

risk for choriocarcinoma?

A

normal ovum fertilized by two sperm (or one that duplicates chromosomes); 69 ch

fetal tissue is present

some villi are hydropic, some are normal

focal proliferation present around hydropic villi

minimal risk

85
Q

complete mole

genetics?

fetal tissue?

villous edema?

trophoblastic proliferation?

risk for choriocarcinoma?

A
  • empty ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 46 ch
  • fetal tissue absent
  • most villi are hydropic (grapelike)
  • diffuse circumferential proliferation around hydropic villi
  • 2-3% risk for choriocarcinoma

Repro First Aid (8 decks)

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