Reproductive Pathology Flashcards
Vaginal tumors (malignant) (3)
Squamous cell carcinoma
Clear cell adneocarcinoma
Sarcoma botryoides
Squamous cell carcinoma- vagina
Usually secondary to cervical SCC
Associated with HPV 16, 18, 31, and 33
Clear cell adenocarcinoma- vagina
Affects women who had DES exposure in utero
Sarcoma botryoides- vagina
Affects girls <4
Grape-like mass emerging from vagina
Desmin +
Tumor of immature skeletal muscle
Cervical tumors
Dysplasia and carcinoma in situ
Invasive carcinoma
Dysplasia and carcinoma in situ- cervix
Classified as CIN 1-3 (koilocytes see on histology)
Associated with HPV 16 and 18
E6 –> affects p53 (inhibits apoptosis)
E7 –> affects RB
Risk factors: multiple sex partners, smoking, early sex, HIV
Invasive carcinoma- cervix
Often SCC (see kilobytes) Presentation: Post-menopausal/ post-coital bleeding
Ovarian neoplasms- benign (7)
Serous cystadenoma Mucinous cystadenoma Endometrioma Cystic teratoma (dermoid cyst) Brenner tumor Fibroma Thecoma
Serous cystadenoma- ovaries
Most common ovarian neoplasm
Lined with fallopian-tube like epithelium
Mucinous cystadenoma- ovaries
lined by mucus secreting epithelium (single layer)
Endometrioma-ovaries
Ectopic endometrial tissue in ovaries (endometriosis)
Chocolate cyst
Presentation: pelvic pain, dysmenorrhea, dyspareunia
Mature cystic teratoma (dermoid cyst)- ovaries
Germ cell tumor
Most common ovarian tumor in 10-30
Monodermal form: ectopic thyroid tissue- struma ovarii (presentation: hyperthyroidism)
Generally contains elements from all 3 germ layers (e.g. teeth, hair, sebum)
Brenner tumor- ovaries
Looks like bladder (transitional epithelium)
Fibromas- ovaries
Bundles of fibroblasts
Complication: Meigs syndrome: triad of ovarian fibromas, ascites, and hydrothorax (pleural effusion)
Thecoma- ovaries
May produce estrogen (??- don’t know why not androgens, b/c theca cells don’t have aromatase)
Presents with post-menopausal bleeding (PMB)
Ovarian neoplasms- malignant (7)
Note: often CA-125 is elevated with ovarian neoplasms
Granulosa cell tumor Serous cystadenocarcinoma Mucinous cystadenocarcinoma Immature teratoma Dysgerminoma Yolk sac (endodermal sinus tumor) Krukenberg tumor
Granulosa cell tumor- ovaries
Most common malignant stromal tumor
Histology: Call-Exner bodies (granulosa cells arranged around eosinophilic fluid)
Presentation: PMB, sexual precocity (in pre-adolescents)
Serous cystadenocarcinoma- ovaries
Most common malignant ovarian neoplasm, frequently bilateral Psammoma bodies (others with psammoma bodies include: Papillary thyroid cancer, Meningioma, and Mesothelioma)
Mucinous cystadenocarcinoma- ovaries
Pseudomyxoma peritonei (jelly belly)- due to accumulation of mutinous material from ovarian or appendices tumor
Immature teratoma- ovaries
Typically immature/ embryonic-like neural tissue
Dysgerminoma- ovaries
Mass of malignant germ cells (oocytes)
Fired egg cells
hCG and LDH are high
Yolk sac (endodermal sinus tumor)
Germ cell tumor (uncontrolled oocyte or spermatocyte proliferation)
Schiller-Duval bodies (resemble glomeruli)
Increased AFP
Krukenberg tumor
GI malignancy (adenocarcinoma) that mets to ovaries
mucin-secreting
Histology: signet cells
General bilateral mets
Endometrial conditions (7)
Polyp Adenomyosis Leiomyoma Endometrial hyperplasia Endometrial carcinoma Endometritis Endometriosis
Polyp- endometrial
Well-circumscribed
Can arise with use of tamoxifen
Presentation: painless, abdominal uterine bleeding
Adenomyosis- endometrial
Endometrial tissue in myometrium
“Boggy” uterus ( uniformly enlarged)
Tx: GnRH agonists, hysterectomy
Leiomyoma (fibroid)- endometrial
Benign mass of smooth muscle Lumpy, bumpy uterus Change in size with changes in estrogen (increase with pregnancy, decreases with menopause) Histology: whorled masses Tx: continuous GnRH agonist
Endometrial hyperplasia
Abnormal endometrial gland proliferation
Increase risk of endo. cancer
Increased gland to stromal ratio
RF: HRT, PCOS, granulosa cell tumor, nuclear atypia»_space; architecture
Endometrial carcinoma
Most common gynecologic malignancy
Presentation: Vaginal bleeding and generally preceded by endometrial hyperplasia
RF: Unopposed estrogen, nulliparity, diabetes, obesity, Lynch syndrome
Note: smoking appears to decrease risk
Endometritis
Inflammation of endometrium
May be due to retained products of conception
Tx: gentamicin + clinda +/- ampicillin
Endometriosis
Endometrial glands/stroma outside endometrial cavity
Most common sites: ovary, pelvis, peritoneum
Presentation: cyclic pelvic pain, bleeding, dysmenorrhea, infertility
Tx: NSAIDs, OCPs, progestins, GnRH agonists
Vulvar complications (3)
Lichen Sclerosis
Lichen Simplex Chronicus
Vulvar Carcinoma
Lichen Sclerosis
Leukoplakia with parchment-like vulvar skin
Increases risk of SCC
Lichen Simplex Chronicus
Leukoplakia with leather-like vulvar skin
No increased risk of cancer
Presentation: consistent itching of vulva that causes hyperplasia
Vulvar carcinoma
SCC (squamous cell cancer); presents with leukoplakia
Can be HPV-related (precursor- HPV infection with strains 16, 18, 31, 33) –> seen in 40-50 year old women
Can be HPV-unrelated (increased risk with long-standing lichen sclerosis) –> seen in >70 year old women
Penile Squamous Cell Cancer
Precursor in situ lesions-
Bowen disease- cancer of penile shaft, presents as leukoplakia
Erythroplasia of Queyrat- cancer of glans, presents as leukoplakia
Associated with HPV and lack of circumcision
Cryptorchidism
Undescended testes (one or both)
Impaired spermatogenesis
Can have normal testosterone levels
Increased risk of germ cell tumors (specifically seminoma)
Prematurity increases risk of crytorchidism
Varicocele- testicular
Dilated veins in pampiniform plexus
Most often on left side due to increased resistance (left gonadal vein drains into left renal vein before IVC)
Can cause infertility due to increased temp
Does not transilluminate
Tx: varicocelectomy, embolization
Hydrocele- testicular
Can be transilluminated (vs. solid testicular tumors)
Congenital- incomplete closure of processus vaginalis
Acquired- generally secondary to infection, trauma, tumor
Hematocele- if bloody (similar causes to acquired)
Testicular germ cell tumors (5)
Note: 95% of all testicular tumors, does not transilluminate
Seminoma Yolk sac (endodermal sinus tumor) Choriocarcinoma Teratoma Embryonal carcinoma
Seminoma- testicular
Most common testicular tumor Germ cell tumor Homogenous mass Histology: Fried egg appearance of cells Increased placental ALP
Yolk sac (endodermal sinus) tumor- testicular
Increased AFP
Schiller-duval bodies (glomeruloid)
Most common testicular tumor in boys < 3yo
Chriocarcinoma- testicular
Placental tissue, but no villi
Increased hCG
Disordered syncytiotrophoblastic and cytotrophoblastic elements
Hematogenous mets to lung and brain
hCG can cross react with other receptors- TSH, LH, FSH (cause hyperthyroidism)
Teratoma- testicular
Benign in females, malignant in males
Generally benign in children
Embryonal carcinoma- testicular
Malignant, hemorrhagic mass with necrosis
Painful; worse prognosis than seminoma
Most commonly mixed
Generally high hCG and high placental ALP
Testicular non-germal tumors (3)
Leydig cell tumor
Stromal cell tumor
Testicular lymphoma
Leydig cell tumor- testicular
Reinke crystal (eosinophilic cytoplasmic inclusions)- not to be confused with Call-Exner bodies in granulosa cell tumors in ovaries
Produce androgens or estrogens
Gynecomastia in men, precocious puberty in boys
Stromal cell tumor- testicular
Androblastoma from sex cord stroma
Testicular lymphoma
Most common testicular cancer in older men
Arises from metastatic lymphoma to testes
Generally seen in men over 60
Benign prostatic hyperplasia
Most often affects transitional (peri-urethral) zone (vs. adenocarcinoma which affects peripheral zone)
Presents with difficulty starting and stopping urination, increased frequency of urination, nocturne, and dysuria
May lead to distention and hypertrophy of bladder, hydronephrosis
Tx: alpha-1 antagonists (-zosin), or finAsteride (5A-reductase inhibitor)
Note: no increased risk of cancer
Prostatis
Presents with dysuria, frequency, urgency, low back pain; DRE: warm, tender, enlarged prostate
Low back pain- associated with chronic prostatitis
Acute prostatitis: bacterial generally (E.coli, chlamydia, gonorrhea, pseudomonas)
Chronic prostatitis: Bacterial or abacterial
Prostatic adenocarcinoma
Common in men > 50
Most often affects peripheral zone or prostate gland
Dx via increased PSA and needle core biopsies
Can metastasize to back
Serum markers: increased PSA and ALP
Gleeson grading: based on ARCHITECTURE not nuclear atypic
Tx: prostatectomy (local dz), GnRH analogs (continuous), GnRH antagonists, androgen receptor inhibitor (flutamide/ biscalutamide)
