Repro Pathoma (Not in FA) Flashcards
Lichen Sclerosis?
thinning of epidermis and fibrosis/sclerosis of the dermis. Presents as a white patch (leukoplakia) and parchment skin in vulva. Postmenopausal women. Benign
What type of skin is the vulva?
squamous epithelium
Lichen simplex chronicus?
hyperplasia and thickening of the vulva skin. Leukoplakia. Benign
Vulvar carcinoma?
Can be HPV or non-HPV related. VIN (vulvar intraepithelial neoplasia) is the dysplastic precursor lesion with koilocytic change. Non-HPV related arise due to long-standing lichen sclerosis (>70yo)
Extramammary Paget disease of vulva?
malignant epiethelial cells in teh epidermis of the vulva. No association with underlying carcinoma (differs from breast which is almost always associated with an underlying carcinoma)
How to distinguish extramammary paget disease from melanoma?
Paget cells: PAS+, keratin+, S100-
Melanoma: PAS-, keratin-, S100+
What type of epithelium lines the vagina?
non-keratonized squamous epithelium
Adenosis of the vagina?
persistance of columnar epithelium in upper vagina. Increased incidence in females exposed to diethylstilbestrol (DES). Squamous epithelium from the urogenital sinus is supposed to grow up and replace the columnar epithelium lining of the upper 2/3 of the vagina (derived from mullerian ducts)
What is the biggest risk factor for clear cell adenocarcinoma of the vagina?
DES
Embryonal rhabdomyosarcoma?
malignant mesenchymal prolif of immature skeletal muscle. Sarcoma botryoides. Grape like mass. Desmin and myogenin +
Vaginal carcinoma?
from squamou epithelium lining of vaginal mucosa. High risk HPV. From VAIN.
Where does vaginal carcinoma spread?
Lower 1/3 of vagina spreads to inguinal nodes and upper 2/3 goes to regional iliac nodes
Precursor lesion to cervical dysplasia?
CIN= cervical intraepithelial neoplasia
Role of E6 and E7 in HPV? (super high yield)
E6 and E7 are produced by high risk HPV infections. E6 promotes destruction of p53 and E7 promotes destruction of Rb. Loss of tumor suppressor genes increases the risk for CIN.
How does cervical carcinoma present?
vaginal bleeding, especially postcoital bleeding, or cervical discharge. HPV infection in early 20s then carcinoma in 40-50s.
Is cervical carcinoma an AIDS-definining illness?
YES
What is a common cause of death in cervical carcinoma patients?
really advanced tumors can invade through anterior uterine wall into the bladder, blocker the ureters resulting in hydronephrosis with postrenal failure.
What is a limitation of the pap smear?
false negative screening and it cannot detect adenocarcinoma, only squamous (which are the majority)
What is in the quadrivalent vaccine for HPV?
types 6, 11, 16, 18. Protects against CIN, VIN, VAIN, and condyloma
Asherman Syndrome?
secondary amenorrhea due to loss of basalis (stem cells). Due to overaggressive dilation and curettage
Presentation of anovulatory cycle?
no progesterone phase since no ovulation, just get estrogen driven proliferation of glands until they have to shed. Dysfunctional uterine bleeding
Acute endometritis?
retained fetal products. fever, abnormal uterine bleeding, pelvic pain
Chronic Endometritis?
**Plasma cells necessary for diagnosis. **Due to PID, IUD, and TB
ENdometrial polyp?
Due to side effect of tamoxifen, which has antiestrogenic effects on the breast but weak pro-estrogenic effect on the endometrium
Endometriosis?
Due to retrograde menstruation. Dysmenorrhea, dyschezia (painful defecation). Chocolate cyst in the ovary. Can cause scaring of the fallopian tubes leading to ectopic pregnancy, gun-powder nodules yellow-brown
What is adenomyosis?
Endometriosis that spreads to involve the myometrium.
Is there an increased risk for carcinoma in endometriosis?
Yes, especially in the ovary
Buzz word for endometrial hyperplasia?
Unopposed estrogen! (obesity, Polycystic ovarian syndrome, estrogen replacement)
What is the most common invasive carcinoma of the female genital tract?
Endometrial carcinoma
What are the 2 types of endometrial carcinoma?
Endometriod and serous papillary
Characterisitcs of endometriod carcinoma?
Hyperplasia precursor, risk factors are unopposed estrogen, nulliparity, obesity. 60 yo @ presentation. Histology looks normal.
Characteristics of serous papillary carcinoma?.
Sporadic, psammoma bodies, p53 mutation common, 70 yo @ presentation, aggressive behavior
What enlarges during pregnancy and shrinks after menopause?
Fibroids aka leiomyoma
What causes fibroids and what is the histology?
related to estrogen exposure. Arise from myometrium. Gross exam shows multiple, well-defined white whorled masses
Leiomyosarcoma?
malignant prolif of SM from myometrium, de novo, not from leiomyomas, postmenopausal women (70-80yo), single lesion with areas of necrosis and hemorrhage.
What tumors will have elevated alkaline phosphatase?
Metastases to bone, liver, Paget disease of bone, seminoma (placental ALP)
What tumors will have elevated alpha-fetoprotein?
HCC, hepatoblastoma, yolk sac (endodermal sinus) tumor, testicular cancer, mixed germ cell tumor (co-secreted with hCG)
What tumors will have elevated B-hCG?
Hydatidiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer
What tumors will have elevated CA-15-3/CA-27-29?
Breast cancer
What tumors have elevated CA-19-9?
pancreatic adenocarcinoma
What tumors have CA-125?
Ovarian cancer–good for monitoring response and screening for recurrence
What tumors have elevated calcitonin?
Medullary thyroid carcinoma
What tumors have elevated CEA?
Non-specific, but produced by 70% of colorectal and pancreatic cancers, also produced by gastric, breast ,and medullary thyroid carcinoma
What tumors have elevates PSA?
prostate adeocarcinoma. May also be elevated in BPH and prostatitis
What tumors have S-100?
Neural crest origin (melanomas, neural tumors, schwannomas, Langerhans cells histiocytosis)
What cells have TRAP?
Hairy cell leukemia, B-cell neoplasm
What ovarian tumor is associated with BRCA1 mutations?
serous carcinoma of the ovary and fallopian tube
What is the most common ovarian tumor?
cystic teratoma
The presence of what two types of tissue indicate that a cystic teratoma may have malignant potential?
immautre tissue, usually neural, and somativ malignancy, usually squamous cell carcinoma of the skin
What ovarian tumor is associated with Turner’s Syndrome?
Dysgerminoma
