Reproductive Pathology Flashcards
What two duct systems are in place in both males and females prior to one or the other involuting?
- mesonephric ducts involute in women
- Mullerian ducts involute in men
What pathology is associated with mesonephric remnants in women?
remnants may persist and form cyst if epithelium remains
Acute Endometritis
- an infection of the uterus
- typically an infection that ascends from the cervix but occasionally through hematogenous spread
- highly associated with pregnancy or abortion
- most common organisms are hemolytic Strep, anaerobic Strep, Staph, Neisseria gonorrheae, or Clostridium welchii
Chronic Endometritis
- an infection of the uterus
- most common presenting symptom is irregular bleeding
- endometrial aspiration biopsy will find plasma cells and this is diagnostic
What is the most common presenting symptom of chronic endometritis?
irregular vaginal bleeding
Acute endometritis is most commonly associated with what other conditions?
abortion or pregnancy
Endometriosis
- the presence of endometrial glands or storm outside the uterus
- lead to infertility, dyspareunia, rectal pain, and constipation
- very common; found in 25% of all gynecologic laparotomies
- primarily found in women in their 20s-30s
- ovaries are the most common site followed by uterine ligaments, rectovaginal space of douglas, and laparotomy/C-section scars
- treat with progesterone
What are the two theories for the pathogenesis of endometriosis?
- metastatic: through hematogenous spread, lymphatic spread, or retrograde menstruation
- metaplastic theory: transformation of the coelomic epithelium
What is the coelomic epithelium?
the epithelium lining the peritoneal cavity and overlying the ovaries
What is an endometrioma?
- a cyst formed from endometriosis of the ovaries
- often referred to as a “chocolate cyst”
Describe the epithelium of the cervix.
- the endocervix is lined by mucous-secreting columnar epithelium
- the ectocervix is covered by a nonkeratinizing, stratified squamous epithelium
- the area between the two is referred to as a squamocolumar junction
Squamous Cell Carcinoma of the Cervix
- a neoplasm involving the stratified squamous epithelium of the ectocervix
- dysplasia usually begins at the squamocolumnar junction with CIN I/LSIL
- strongly associated with HPV infection
- presents with post-coital vaginal bleeding and a malodorous discharge
- may be exophytic or infiltrative
- metastasizes to the para-aortic lymph nodes
- mean age is about 50 but can range from 17-90
- no longer a leading cause of mortality due to the implementation of regular pap smears
Cervical Intraepithelial Neoplasia
- a classification scheme for precancerous dysplasia of the cervix
- currently divided into LSIL (low-grade squamous intraepithelial lesion) and HSIL
- most instance of LSIL regress on their own and don’t require immediate treatment
Low-Grade Squamous Intraepithelial Lesion
- a mild dysplasia of the cervical epithelium
- associated with productive HPV infection but without significant disruption or alteration of the host cell cycle
- histology reveals some cells with halos around enlarged, dark nuclei; the dysplasia is not full-thickness
- most regress spontaneously
High-Grade Squamous Intraepithelial Lesion
- a more severe dysplasia of the cervical epithelium
- associated with productive HPV infection that significantly disrupts or alters the host cell cycle
- histology reveals dark blue cells, with large nuclei, and a dysplastic change throughout the depth of the epithelium
- treated as a precancerous lesion
Small Cell Carcinoma of the Cervix
- a neuroendocrine cervical carcinoma
- resembles small cell carcinoma of the lung, but in contrast to the lung tumor, these are often positive for high oncogenic risk HPVs
- grow too fast too be screened for using Pap smears
What is the most common invasive cancer of the female genital tract? What is the most common tumor?
- cancer: endometrial carcinoma
- tumor: leiomyoma (aka “fibroid”)
Endometrial cancers arise mainly in which population?
post-menopausal women
Endometrioid Adenocarcinoma
- the most common invasive malignant tumor of the female genital tract
- risk factors are mostly tied to more estrogen exposure: age over 40, obesity, nulliparity, late onset menopause, or use of unopposed estrogen in post-menopausal women with a uterus
- most common presenting symptom is post-menopausal bleeding
Leiomyoma of the Uterus
- a benign, smooth-muscle tumor of the uterus also known as a fibroid
- the most common tumor of the female genital tract; seen in 20-30% of women over 30 and more common in AAs
- appear as well-circumscribed nodules of white, whorled fibrous-appearing tissue on gross examination with bundles of smooth muscle cells on histology
- estrogen-dependent and tend to increase in size with pregnancy or birth control pills and decrease in size during the post-menopausal period
- growth during pregnancy may lead to spontaneous abortion
- malignant transformation is extremely rare as is a benign, metastasizing variant
Leiomyosarcoma of the Uterus
- a malignant, smooth-muscle neoplasm that is quite rare
- gross examination usually reveals areas of hemorrhage or necrosis
- must be differentiated form a leiomyoma via histology and the presence of 10 or more mitotic figures per 10 high-power fields
Where do ovarian carcinomas often spread?
they often seed the peritoneum, leading to a phenomenon known as mental caking
What are the first and second most common malignant tumors of the female genital tract?
- 1st: endometrial carcinoma
- 2nd: ovarian carcinoma
Corpus Luteum Cyst
- cystic follicles in the ovary
- extremely common because ovaries naturally form cysts every month
- they originate from enraptured graafian follicles or follicles that have ruptured and then immediately re-sealed
- often confused with a neoplasm
Are germinomas more common in men or women?
much more common in men
What is the most common primary benign tumor of the ovary?
serous cystadenoma
Most ovarian tumors are of what origin?
germinal epithelium origin from the fallopian tube
What is the strongest genetic risk factor for ovarian cancer?
BRCA1 and BRCA2 carry a 20% and 60% risk by the age of seventy, respectively
Serous Cystadenocarcinoma of the Ovary
- a primary malignant tumor of the ovary
- half are bilateral
- associated with BRCA1 and BRCA2 mutations
- appear cystic or solid on gross examination; cystic neoplasms with a solid component within the cyst are highly suspicious for malignancy
- histology reveals papillary differentiation to solid sheets of tumor cells and psammoma bodies may be present
- CA125 serves as a tumor marker
- can be serous or mucinous
Granuloma
- a low grade tumor of granuloma cell origin
- produce estrogen and progesterone in most cases; may also produce inhibin
- as such, they manifest with precocious puberty if they arise before puberty, irregular bleeding or menses if they appear during reproductive years, or vaginal bleeding if they appear during the post-menopausal period
- appear solid with focal hemorrhages and cysts
- Call-Exner bodies are a pathognomonic feature found on histology: these cells resemble a normal follicle with a wide clearing around them
What are the components of Meigs syndrome?
- ovarian fibroma
- hydrothorax
- ascites
Dysgeminoma
- a germ cell tumor of the ovary
- typically asymptomatic or presenting with increasing abdominal pressure, a palpable mass, uterine bleeding
- usually identified in the early reproductive years
- appear as a large, solid, multi-lobular tumor on gross examination
- most are benign/mature/dermoid cyst teratomas (unilocular cysts lined by epidermis, containing hair and cheesy, sebaceous material)
- complications include torsion during pregnancy, rupture, and malignant transformation (1%)
- histology is indistinguishable from a seminoma with islands and nests of primordial germ cells with lymphocytes
- associated with congenital malformations of the genitals and Turner’s syndrome
What is a dermoid cyst?
a benign teratoma
