Pathoma Female Reproductive Flashcards
1
Q
What type of epithelium does the vulva have?
A
squamous
2
Q
What does the vulva include?
A
skin and mucosa of the female genitalia external to the hymen (labia major, minora, mons pubis, vestibule)
3
Q
What presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal?
A
bartholin cyst
4
Q
What is the Bartholin gland?
A
present on each side of vaginal canal - produces mucus-like fluid that drains via ducts into the lower vestibule
5
Q
What presents as a warty neoplasm of vulvar skin?
A
condyloma
6
Q
What causes condylomas?
A
HPV types 6 or 11 and secondary syphilis
7
Q
What is characterized by thinning of the epidermis and fibrosis of the dermis of the vulva and presents as a white patch?
A
lichen sclerosis
8
Q
Who most commonly gets lichen sclerosis?
A
postmenopausal women
9
Q
Is lichen sclerosis benign or malignant?
A
benign, but associated with slight increased risk for squamous cell carcinoma
10
Q
What is characterized by hyperplasia of the vulvar squamous epithelium and presents as leukoplakia with thick, leather vulvar skin?
A
lichen simplex chronicus
11
Q
What is associated with lichen simplex chronicus?
A
chronic irritation and scratching
12
Q
Is lichen simplex chronicus benign or malignant?
A
bening with NO increased risk of squamous cell carcinoma
13
Q
What presents as leukoplakia (white patch)
A
lichen sclerosis and vulvar carcinoma
14
Q
What is a way to distinguish between HPV related vulvar carcinoma and non-HPV related vulvar carcinoma?
A
HPV related: high risk - get around age 40-50 non HPV: long standing lichen sclerosis in post menopausal women
15
Q
What type of carcinoma is vulvar carcinoma?
A
squamous
16
Q
What presents as erythematous, pruritic, ulcerated vulvar skin?
A
extramammary paget disease
17
Q
What is extramammary paget disease characterized by?
A
malignant epithelial cells in the epidermis of the vulva
18
Q
What is the difference between paget disease of the nipple as opposed to the vulva?
A
nipple: almost always associated with underlying carcinoma vulva: represents carcinoma in situ - no underlying carcinoma
19
Q
How is extramammary paget disease distinguished from melanoma?
A
melanoma = PAS-, keratin-, S100+ paget cells PAS+, keratin +, S100-
20
Q
What is PAS?
A
marks mucous (present in paget cells but not melanoma cells)
21
Q
What is S100?
A
defining stain of melanomas
22
Q
What is the mucosa of the vagina lined with?
A
non-keratinizing stratified squamous epithelium
23
Q
What has focal persistence of columnar epithelium in the upper vagina?
A
adenosis
24
Q
What do women who were exposed to diethylstilbestrol (DES) in utero have increased incidence of?
A
adenosis
25
What is a complication of DES-associated vaginal adenosis?
clear cell adenocarcinoma
26
What presents as bleeding and a grape-like mass protruding from vagina or penis of a child?
embryonal rhabdomyosarcoma
27
What is embryonal rhabdomyosarcoma?
malignant mesenchymal proliferation of immature skeletal muscle
28
What is the characteristic cell of embryonal rhabdomyosarcoma?
rhabdomyoblast which exhibits cytoplasmic cross-striations
29
What do rhabdomyoblast stain for?
desmin (intermediate filament in muscle cells) and myogenin (nuclear transcription factor present in immature skeletal muscle)
30
What is the precursor lesion for vaginal carcinoma?
vaginal intraepithelial neoplasia (VAIN)
31
What causes vaginal carcinoma?
high-risk HPV (16,18,31,33)
32
What type of cells are on the exocervix? endocervix?
exo: nonkeratinizing squamous epithelium endo: single layer of columnar transformation zone between the two
33
What typically infects the transformation zone?
HPV DNA virus
34
HPV infection
typically eradicated by acute inflammation - persistent infection is what leads to increased risk for cervical dysplasia (CIN)
35
What does high risk HPV produce?
E6 and E7 proteins E6 = increased destruction of p52 and E7 = increased destruction of Rb (both tumor suppressor proteins)
36
What is characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium?
CIN cervical intraepithelial neoplasia
37
What is the difference between dysplasia and carcinoma?
dysplasia is reversible
38
Who is cervical carcinoma most commonly seen in?
middle aged women (40-50 years)
39
How does cervical carcinoma typically present?
vaginal bleeding (esp post coital) and/or cervical discharge
40
What are the key risk factors for cervical carcinoma?
high-risk HPV, smoking, immunodeficiency (because immune system usually gets rid of viruses)
41
What are the two common subtypes of cervical carcinoma?
squamous cell and and adenocarcinoma
42
What happens with advanced tumors of cervical carcinoma?
invade anterior uterine wall into bladder, block ureters, cause hydronephrosis with postrenal failure (most common cause of death)
43
How are high-grade dysplastic cells characterized?
hyperchromatic (dark) nuclei and high nuclear to cytoplasmic ratios
44
What are abnormal Pap smears followed by?
colposcopy (visualization of cervix) and biopsy
45
What are the two limitations of the Pap smear?
inadequate sampling (false negatives) and limited efficacy in screening ADENOCARCINOMA
46
What does the HPV vaccine cover?
types 6, 11, 16, 18
47
What drives growth of the endometrium?
estrogen
48
What drives preparation of the endometrium for implantation?
progesterone
49
What drives shedding of the endometrium?
lack of progesterone
50
Secondary amenorrhea due to loss of the baseless (regenerative layer of the endometrium) and scarring is known as…….
asherman syndrome
51
What is an anovulatory cycle?
lack of ovulation resulting in an estrogen-driven proliferative phase without a subsequent progesterone-drive secretory phase
52
When do anovulatory cycles typically happen?
menarche and menopause
53
What are the most common cause of acute endometritis?
retained products of conception (after delivery/miscarriage) - retained products act as a nidus for the bacterial infection of the endometrium
54
How does acute endometritis typically present?
fever, abnormal uterine bleeding, pelvic pain
55
What is chronic endometritis characterized by?
lymphocytes and plasma cells (plasma cells most important!!!! bc lymphocytes are normally found in endometrium)
56
What are causes of chronic endometritis?
retained produced of conception, chronic pelvic inflammatory disease (eg chlamydia), IUD, TB (see granulomas)
57
How does chronic endometritis present?
abnormal uterine bleeding, pain, infertility
58
What is a side effect of tamoxifen? What are the effects on breast/endometrium?
endometrial polyp on breast: anti-estrogenic effects; on endometrium: pro-estrogenic effects
59
What is endometriosis?
endometrial glands and stroma outside of the uterine endometrial lining
60
How does endometriosis present?
dysmenorrhea (pain during menstruation), pelvic pain
61
What is the most common site of involvement in endometriosis?
ovary = chocolate cyst
62
What does involvement of the pouch of Douglas in endometriosis cause?
pain with defecation
63
What is adenomyosis?
involvement of the uterine myometrium with endometriosis
64
What is endometrial hyperplasia, and what causes it?
hyperplasia of endometrial glands relative to stroma caused by unopposed estrogen
65
What is the most common invasive carcinoma of the female genital tract?
endometrial carcinoma
66
How does endometrial carcinoma present?
postmenopausal bleeding
67
What are the two pathways that endometrial carcinoma can arise? Which is more common?
hyperplasia and sporadic - hyperplasia more common
68
What are the risk factors for the hyperplasia pathway of endometrial carcinoma?
estrogen exposure - early menarche/late menopause, nulliparity, infertility with anovulatory cycles, obesity (anything with unopposed estrogen)
69
What happens in the sporadic pathway of endometrial carcinoma?
carcinoma arises in an atrophic endometrium with no evident precursor - usually in women over 70
70
What are common characteristics of endometrial carcinoma?
histology: serous with papillary structures - psammoma (fluid) body formation also p53 mutation common aggressive tumor
71
What is a leiomyoma?
benign neoplastic proliferation of smooth muscle arising from myometrium *most common tumor in females*
72
What are characteristics of leiomyomas?
common in premenopausal women, often multiple masses, enlarge during pregnancy, shrink after menopause ***due to estrogen levels/exposure****
73
What is present in the gross exam of a leiomyoma?
multiple, well-defined, white, whorled masses that may distort the uterus (usually asymptomatic)
74
What are the differences between a leiomyoma and leiomyosarcoma?
leiomyosarcoma is malignant - always de novo NEVER from leiomyomas - usually seen in POSTmenopausal women - usually only a SINGAL lesion on exam with necrosis and hemorrhage (as opposed to multiple white, whirled masses)
75
What is the functional unit of the ovary?
follicle
76
What is the function of LH?
acts on theca cells to induce androgen production
77
What is the function of FSH?
stimulates granulosa cells to convert androgen to estradiol (drives the proliferative phase of the endometrial cycle)
78
What does estradiol do?
induces LH surge leading to ovulation (marks the beginning of the secretory phase)
79
What happens to the follicle after ovulation?
becomes the corpus lute which secretes progesterone (drive the secretory phase)
80
What is polycystic ovarian disease? (PCOD)
multiple ovarian follicular cysts due to hormone imbalance
81
What is PCOD characterized by?
increased LH and low FSH (LH:FSH >2) increased LH = increased androgen production causing hirsutism and the extra androgen is converted to estrone in adipose tissue - extra estrone = decreased FSH = cystic degeneration
82
What are the two types of surface epithelial tumors?
serous and mucinous
83
What is a cystadenoma?
benign surface epithelial tumor that is composed of a single cyst with a simple, flat lining (premenopausal women)
84
What is a cystadenocarcinoma?
malignant surface epithelial tumor - complex cysts with thick, shagge, lining (postmenopausal women)
85
What do BRCA1 mutation carrier have an increased risk for?
serous carcinoma of the ovary and fallopian tube
86
endometrioid tumor
surface epithelial tumor - composed of endometrial-like glands and usually malignant - may arise from endometriosis
87
brenner tumor
surface epithelial tumor composed of bladder-like epithelium - usually benign
88
How do surface tumors present clinically?
late with vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency)
89
Which cancer has the worst prognosis of the female genital tract cancers?
surface epithelial carcinoma = tend to spread locally esp to peritoneum
90
What sit eh serum marker used to monitor treatment response and screen for recurrence of a surface epithelial tumor?
CA-125
91
What are the four subtypes of germ cell tumors? When do they typically occur?
fetal tissue, oocytes, yolk sac, placental tissue occur during reproductive age typically
92
Cystic teratoma
germ cell tumor - cystic tumor composed of fetal tissue - most common, benign
93
Under what circumstances can cystic teratoma become malignant?
presence fo immature tissue (esp neural) or somatic malignancy (cancer within the teratoma)
94
Struma ovarii
teratoma composed primarily of thyroid tissue (causes hyperthyroid)
95
Dysgerminoma
germ cell tumor - composed of large cells with clear cytoplasma and central nuclei resembling OOCYTES - malignant - good prognosis responding to radiotherapy - high LDH
96
Endodermal sinus tumor
malignant tumor that mimics the YOLK SAC - most common germ cell tumor in children; serum AFP elevated
97
What tumor presents with schiller-ducal bodies in histology?
endodermal sinus tumor (schiller duval = glomerulus-like structures)
98
Choriocarcinoma
malignant tumor - composed of cytotrophoblasts and syncytiotrophoblasats mimicking PLACENTAL TISSUE - high b-hCG characteristic - poor response to chemotherapy
99
Embryonal carcinoma
malignant - composed of large primitive cells
100
Why is embryonal carcinoma so aggressive?
have the ability to move and spread easily since the cells are primitive
101
granulosa-theca cell tumor
sex cord-stromal tumor - neoplastic proliferation of granulosa and theca cell - often produces estrogen presenting with signs of estrogen excess - malignant but minimal risk for metastasis
102
What happens in a sertoli-leydig cell tumor?
mimics testicle because it is composed of sertoli cells that form tubules and leydig cells
103
What is characteristic of sertoli-leydig tumors?
reinke crystals
104
Fibroma
benign tumor of fibroblasts - associated with pleural effusions and ascites (meigs syndrome) - resolves with removal of tumor
105
Krukenberg tumor
metastatic mucinous tumor that involves both ovaries - most commonly due to metastatic gastric carcinoma
106
Pseudomyxoma peritonei
massive amounts of mucus in peritoneum - due to mutinous tumor of the appendix - usually has metastasis to the ovary
107
ectopic pregnancy
implantation of fertilized ovum at a site other than uterine wall - most common is fallopian tube
108
What is the key risk factor for ectopic pregnancy?
scarring (secondary to pelvic inflammatory disease or endometriosis)
109
What is the most common cause of spontaneous abortions?
chromosomal anomalies, hypercoagulable states, congenital infection, exposure to teratogens (esp first 2 weeks)
110
What most likely happens when a teratogen is introduced in weeks 3-8 of pregnancy?
risk of organ malformation
111
What most likely happens when a teratogen is introduced in months 3-9 of pregnancy?
risk of organ hypoplasia
112
What is placenta previa?
implantation of the placenta in the lower uterine segment; placenta overlies cervical os - presents as third-trimester bleeding
113
What is placental abruption?
separation of placenta from decidua prior to delivery of fetus - common cause of still birth
114
What is placenta accreta?
improper implantation of placenta into the myometrium with little or no intervening decide - presents with difficult delivery of placenta and postpartum bleeding
115
What is eclampsia?
preeclampsia with seizures (need to remove placenta)
116
What is HELLP?
preeclampsia with thrombotic microangiopathy involving the liver -characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets
117
What is hydatidiform mole?
abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
118
What are signs of a hydatidiform mole?
uterus is much larger and b-HCG is much higher than expected
119
How does hydatidiform mole classically present?
in the second trimester as passage of grape-like masses through vaginal canal - “snowstorm” appearance on ultrasound
120
What are the differences between a complete mole and a partial mole?
complete mole is “completely from dad” - empty ovum, two sperms - 46 chromosomes, no fetal tissue, hydraulic villi, risk for choriocarcinoma
121
Choriocarcinoma from which pathway respond well to chemotherapy?
gestational pathway (as composed to the germ cell pathway)
