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IC 1.0 > Reproductive Pathology > Flashcards

Reproductive Pathology Flashcards

1
Q

What two duct systems are in place in both males and females prior to one or the other involuting?

A
  • mesonephric ducts involute in women

- Mullerian ducts involute in men

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2
Q

What pathology is associated with mesonephric remnants in women?

A

remnants may persist and form cyst if epithelium remains

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3
Q

Acute Endometritis

A
  • 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
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4
Q

Chronic Endometritis

A
  • an infection of the uterus
  • most common presenting symptom is irregular bleeding
  • endometrial aspiration biopsy will find plasma cells and this is diagnostic
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5
Q

What is the most common presenting symptom of chronic endometritis?

A

irregular vaginal bleeding

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6
Q

Acute endometritis is most commonly associated with what other conditions?

A

abortion or pregnancy

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7
Q

Endometriosis

A
  • 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
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8
Q

What are the two theories for the pathogenesis of endometriosis?

A
  • metastatic: through hematogenous spread, lymphatic spread, or retrograde menstruation
  • metaplastic theory: transformation of the coelomic epithelium
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9
Q

What is the coelomic epithelium?

A

the epithelium lining the peritoneal cavity and overlying the ovaries

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10
Q

What is an endometrioma?

A
  • a cyst formed from endometriosis of the ovaries

- often referred to as a “chocolate cyst”

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11
Q

Describe the epithelium of the cervix.

A
  • 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
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12
Q

Squamous Cell Carcinoma of the Cervix

A
  • 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
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13
Q

Cervical Intraepithelial Neoplasia

A
  • 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
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14
Q

Low-Grade Squamous Intraepithelial Lesion

A
  • 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
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15
Q

High-Grade Squamous Intraepithelial Lesion

A
  • 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
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16
Q

Small Cell Carcinoma of the Cervix

A
  • 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
17
Q

What is the most common invasive cancer of the female genital tract? What is the most common tumor?

A
  • cancer: endometrial carcinoma

- tumor: leiomyoma (aka “fibroid”)

18
Q

Endometrial cancers arise mainly in which population?

A

post-menopausal women

19
Q

Endometrioid Adenocarcinoma

A
  • 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
20
Q

Leiomyoma of the Uterus

A
  • 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
21
Q

Leiomyosarcoma of the Uterus

A
  • 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
22
Q

Where do ovarian carcinomas often spread?

A

they often seed the peritoneum, leading to a phenomenon known as mental caking

23
Q

What are the first and second most common malignant tumors of the female genital tract?

A
  • 1st: endometrial carcinoma

- 2nd: ovarian carcinoma

24
Q

Corpus Luteum Cyst

A
  • 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
25
Q

Are germinomas more common in men or women?

A

much more common in men

26
Q

What is the most common primary benign tumor of the ovary?

A

serous cystadenoma

27
Q

Most ovarian tumors are of what origin?

A

germinal epithelium origin from the fallopian tube

28
Q

What is the strongest genetic risk factor for ovarian cancer?

A

BRCA1 and BRCA2 carry a 20% and 60% risk by the age of seventy, respectively

29
Q

Serous Cystadenocarcinoma of the Ovary

A
  • 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
30
Q

Granuloma

A
  • 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
31
Q

What are the components of Meigs syndrome?

A
  • ovarian fibroma
  • hydrothorax
  • ascites
32
Q

Dysgeminoma

A
  • 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
33
Q

What is a dermoid cyst?

A

a benign teratoma

IC 1.0 (24 decks)

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