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Embryology and CAH > Reproductive Pathology > Flashcards

Reproductive Pathology Flashcards

1
Q

Vaginal tumors (malignant) (3)

A

Squamous cell carcinoma
Clear cell adneocarcinoma
Sarcoma botryoides

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2
Q

Squamous cell carcinoma- vagina

A

Usually secondary to cervical SCC

Associated with HPV 16, 18, 31, and 33

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3
Q

Clear cell adenocarcinoma- vagina

A

Affects women who had DES exposure in utero

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4
Q

Sarcoma botryoides- vagina

A

Affects girls <4
Grape-like mass emerging from vagina
Desmin +
Tumor of immature skeletal muscle

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5
Q

Cervical tumors

A

Dysplasia and carcinoma in situ

Invasive carcinoma

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6
Q

Dysplasia and carcinoma in situ- cervix

A

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

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7
Q

Invasive carcinoma- cervix

A 
Often SCC (see kilobytes)
Presentation: Post-menopausal/ post-coital bleeding
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8
Q

Ovarian neoplasms- benign (7)

A 
Serous cystadenoma
Mucinous cystadenoma
Endometrioma
Cystic teratoma (dermoid cyst)
Brenner tumor
Fibroma
Thecoma
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9
Q

Serous cystadenoma- ovaries

A

Most common ovarian neoplasm

Lined with fallopian-tube like epithelium

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10
Q

Mucinous cystadenoma- ovaries

A

lined by mucus secreting epithelium (single layer)

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11
Q

Endometrioma-ovaries

A

Ectopic endometrial tissue in ovaries (endometriosis)
Chocolate cyst
Presentation: pelvic pain, dysmenorrhea, dyspareunia

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12
Q

Mature cystic teratoma (dermoid cyst)- ovaries

A

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)

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13
Q

Brenner tumor- ovaries

A

Looks like bladder (transitional epithelium)

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14
Q

Fibromas- ovaries

A

Bundles of fibroblasts

Complication: Meigs syndrome: triad of ovarian fibromas, ascites, and hydrothorax (pleural effusion)

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15
Q

Thecoma- ovaries

A

May produce estrogen (??- don’t know why not androgens, b/c theca cells don’t have aromatase)

Presents with post-menopausal bleeding (PMB)

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16
Q

Ovarian neoplasms- malignant (7)

A

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
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17
Q

Granulosa cell tumor- ovaries

A

Most common malignant stromal tumor
Histology: Call-Exner bodies (granulosa cells arranged around eosinophilic fluid)
Presentation: PMB, sexual precocity (in pre-adolescents)

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18
Q

Serous cystadenocarcinoma- ovaries

A 
Most common malignant ovarian neoplasm, frequently bilateral
Psammoma bodies (others with psammoma bodies include: Papillary thyroid cancer, Meningioma, and Mesothelioma)
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19
Q

Mucinous cystadenocarcinoma- ovaries

A

Pseudomyxoma peritonei (jelly belly)- due to accumulation of mutinous material from ovarian or appendices tumor

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20
Q

Immature teratoma- ovaries

A

Typically immature/ embryonic-like neural tissue

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21
Q

Dysgerminoma- ovaries

A

Mass of malignant germ cells (oocytes)
Fired egg cells
hCG and LDH are high

22
Q

Yolk sac (endodermal sinus tumor)

A

Germ cell tumor (uncontrolled oocyte or spermatocyte proliferation)
Schiller-Duval bodies (resemble glomeruli)
Increased AFP

23
Q

Krukenberg tumor

A

GI malignancy (adenocarcinoma) that mets to ovaries
mucin-secreting
Histology: signet cells
General bilateral mets

24
Q

Endometrial conditions (7)

A 
Polyp
Adenomyosis
Leiomyoma
Endometrial hyperplasia
Endometrial carcinoma
Endometritis
Endometriosis
25
Q

Polyp- endometrial

A

Well-circumscribed
Can arise with use of tamoxifen
Presentation: painless, abdominal uterine bleeding

26
Q

Adenomyosis- endometrial

A

Endometrial tissue in myometrium
“Boggy” uterus ( uniformly enlarged)
Tx: GnRH agonists, hysterectomy

27
Q

Leiomyoma (fibroid)- endometrial

A 
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
28
Q

Endometrial hyperplasia

A

Abnormal endometrial gland proliferation
Increase risk of endo. cancer
Increased gland to stromal ratio
RF: HRT, PCOS, granulosa cell tumor, nuclear atypia&raquo_space; architecture

29
Q

Endometrial carcinoma

A

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

30
Q

Endometritis

A

Inflammation of endometrium
May be due to retained products of conception
Tx: gentamicin + clinda +/- ampicillin

31
Q

Endometriosis

A

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

32
Q

Vulvar complications (3)

A

Lichen Sclerosis
Lichen Simplex Chronicus
Vulvar Carcinoma

33
Q

Lichen Sclerosis

A

Leukoplakia with parchment-like vulvar skin

Increases risk of SCC

34
Q

Lichen Simplex Chronicus

A

Leukoplakia with leather-like vulvar skin
No increased risk of cancer
Presentation: consistent itching of vulva that causes hyperplasia

35
Q

Vulvar carcinoma

A

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

36
Q

Penile Squamous Cell Cancer

A

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

37
Q

Cryptorchidism

A

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

38
Q

Varicocele- testicular

A

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

39
Q

Hydrocele- testicular

A

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)

40
Q

Testicular germ cell tumors (5)

A

Note: 95% of all testicular tumors, does not transilluminate

Seminoma
Yolk sac (endodermal sinus tumor)
Choriocarcinoma
Teratoma
Embryonal carcinoma
41
Q

Seminoma- testicular

A 
Most common testicular tumor
Germ cell tumor
Homogenous mass
Histology: Fried egg appearance of cells
Increased placental ALP
42
Q

Yolk sac (endodermal sinus) tumor- testicular

A

Increased AFP
Schiller-duval bodies (glomeruloid)
Most common testicular tumor in boys < 3yo

43
Q

Chriocarcinoma- testicular

A

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)

44
Q

Teratoma- testicular

A

Benign in females, malignant in males

Generally benign in children

45
Q

Embryonal carcinoma- testicular

A

Malignant, hemorrhagic mass with necrosis
Painful; worse prognosis than seminoma
Most commonly mixed
Generally high hCG and high placental ALP

46
Q

Testicular non-germal tumors (3)

A

Leydig cell tumor
Stromal cell tumor
Testicular lymphoma

47
Q

Leydig cell tumor- testicular

A

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

48
Q

Stromal cell tumor- testicular

A

Androblastoma from sex cord stroma

49
Q

Testicular lymphoma

A

Most common testicular cancer in older men
Arises from metastatic lymphoma to testes
Generally seen in men over 60

50
Q

Benign prostatic hyperplasia

A

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

51
Q

Prostatis

A

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

52
Q

Prostatic adenocarcinoma

A

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)

Embryology and CAH (11 decks)

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