Reproductive Pathology

Question 1

Vaginal tumors (malignant) (3)

Answer 1

Squamous cell carcinoma
Clear cell adneocarcinoma
Sarcoma botryoides

Question 2

Squamous cell carcinoma- vagina

Answer 2

Usually secondary to cervical SCC

Associated with HPV 16, 18, 31, and 33

Question 3

Clear cell adenocarcinoma- vagina

Answer 3

Affects women who had DES exposure in utero

Question 4

Sarcoma botryoides- vagina

Answer 4

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

Question 5

Cervical tumors

Answer 5

Dysplasia and carcinoma in situ

Invasive carcinoma

Question 6

Dysplasia and carcinoma in situ- cervix

Answer 6

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

Question 7

Invasive carcinoma- cervix

Answer 7

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

Question 8

Ovarian neoplasms- benign (7)

Answer 8

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

Question 9

Serous cystadenoma- ovaries

Answer 9

Most common ovarian neoplasm

Lined with fallopian-tube like epithelium

Question 10

Mucinous cystadenoma- ovaries

Answer 10

lined by mucus secreting epithelium (single layer)

Question 11

Endometrioma-ovaries

Answer 11

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

Question 12

Mature cystic teratoma (dermoid cyst)- ovaries

Answer 12

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)

Question 13

Brenner tumor- ovaries

Answer 13

Looks like bladder (transitional epithelium)

Question 14

Fibromas- ovaries

Answer 14

Bundles of fibroblasts

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

Question 15

Thecoma- ovaries

Answer 15

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

Presents with post-menopausal bleeding (PMB)

Question 16

Ovarian neoplasms- malignant (7)

Answer 16

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

Question 17

Granulosa cell tumor- ovaries

Answer 17

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

Question 18

Serous cystadenocarcinoma- ovaries

Answer 18

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

Question 19

Mucinous cystadenocarcinoma- ovaries

Answer 19

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

Question 20

Immature teratoma- ovaries

Answer 20

Typically immature/ embryonic-like neural tissue

Question 21

Dysgerminoma- ovaries

Answer 21

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

Question 22

Yolk sac (endodermal sinus tumor)

Answer 22

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

Question 23

Krukenberg tumor

Answer 23

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

Question 24

Endometrial conditions (7)

Answer 24

Polyp
Adenomyosis
Leiomyoma
Endometrial hyperplasia
Endometrial carcinoma
Endometritis
Endometriosis

Question 25

Polyp- endometrial

Answer 25

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

Question 26

Adenomyosis- endometrial

Answer 26

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

Question 27

Leiomyoma (fibroid)- endometrial

Answer 27

``` 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 ```

Question 28

Endometrial hyperplasia

Answer 28

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

Question 29

Endometrial carcinoma

Answer 29

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

Question 30

Endometritis

Answer 30

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

Question 31

Endometriosis

Answer 31

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

Question 32

Vulvar complications (3)

Answer 32

Lichen Sclerosis Lichen Simplex Chronicus Vulvar Carcinoma

Question 33

Lichen Sclerosis

Answer 33

Leukoplakia with parchment-like vulvar skin | Increases risk of SCC

Question 34

Lichen Simplex Chronicus

Answer 34

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

Question 35

Vulvar carcinoma

Answer 35

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

Question 36

Penile Squamous Cell Cancer

Answer 36

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

Question 37

Cryptorchidism

Answer 37

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

Question 38

Varicocele- testicular

Answer 38

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

Question 39

Hydrocele- testicular

Answer 39

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)

Question 40

Testicular germ cell tumors (5)

Answer 40

Note: 95% of all testicular tumors, does not transilluminate ``` Seminoma Yolk sac (endodermal sinus tumor) Choriocarcinoma Teratoma Embryonal carcinoma ```

Question 41

Seminoma- testicular

Answer 41

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

Question 42

Yolk sac (endodermal sinus) tumor- testicular

Answer 42

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

Question 43

Chriocarcinoma- testicular

Answer 43

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)

Question 44

Teratoma- testicular

Answer 44

Benign in females, malignant in males | Generally benign in children

Question 45

Embryonal carcinoma- testicular

Answer 45

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

Question 46

Testicular non-germal tumors (3)

Answer 46

Leydig cell tumor Stromal cell tumor Testicular lymphoma

Question 47

Leydig cell tumor- testicular

Answer 47

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

Question 48

Stromal cell tumor- testicular

Answer 48

Androblastoma from sex cord stroma

Question 49

Testicular lymphoma

Answer 49

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

Question 50

Benign prostatic hyperplasia

Answer 50

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

Question 51

Prostatis

Answer 51

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

Question 52

Prostatic adenocarcinoma

Answer 52

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)