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Female genital tract > Robbins > Flashcards

Robbins Flashcards

1
Q

gives rise to the epithelium and stroma of the ovary

A

mesoderm

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2
Q

these mature into the fallopian tubes

A

unfused upper portions of the müllerian ducts

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3
Q

these develop into the uterus, cervix, and upper vagina

A

fused lower portion of the müllerian ducts

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4
Q

forms the lower part of the vagina and the vestibule of the external genitalia

A

urogenital sinus

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5
Q

in embryology, which of the ducts regress in the female?

A

mesonephric ducts (wolffian ducts)

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6
Q

In females, remnants of the mesonephric ducts may persist into adult life as epithelial inclusions adjacent to the ovaries, tubes, and uterus called

A

Gartner duct cyst

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7
Q

infection shows characteristic colposcopic appearance of strawberry cervix.

A

Trichomonas vaginalis

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8
Q

the most serious complication of gonorrhea in women

A

Pelvic inflammatory disease

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9
Q

tubal plicae, denuded of epithelium, adhere to one another and slowly fuse in a reparative, scarring process that forms glandlike spaces and blind pouches, referred to as

A

chronic salpingitis

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10
Q

marked thinning of the epidermis, degeneration of the basal epithelial cells, excessive keratinization (hyperkeratosis), sclerotic changes of the superficial dermis, and a bandlike lymphocytic infiltrate in the underlying dermis

A

Lichen sclerosus

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11
Q

Clinically it presents as leukoplakia, and histologic examination reveals thickening of the epidermis (acanthosis) and hyperkeratosis. Lymphocytic infiltration of the dermis is sometimes present. The hyperplastic epithelium may show mitotic activity but lacks cellular atypia

A

squamous cell hyperplasia

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12
Q

___ are benign genital warts caused by low-risk HPV, mainly types __ and __

A

Condyloma acuminata, 6 and 11

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13
Q

characteristic viral cytopathic changes seen in condyloma acuminata which manifest as nuclear enlargement, hyperchromasia, and a cytoplasmic perinuclear halo

A

koilocytic atypia

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14
Q

T/F Condylomata acuminata are precancerous lesions

A

False

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15
Q

most common histologic type of vulvar cancer

A

Squamous cell carcinoma

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16
Q

This vulvar squamous cell carcinoma subtype is related to infection with high-risk HPVs, most commonly HPV-16. These are less common (30% of cases) and occur in younger women (average 60 years of age)

A

Basaloid and warty carcinoma

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17
Q

This vulvar squamous cell carcinoma subtype is unrelated to HPV infection. These are more common (70% of cases) and occur in older women (average 75 years of age)

A

Keratinizing squamous cell carcinoma

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18
Q

precursor lesion of vulvar Basaloid and warty carcinomas

A

classic vulvar intraepithelial neoplasia (VIN)

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19
Q

risk of progression to invasive carcinoma of vulvar intraepithelial neoplasia (VIN) is higher in women who are older than ___ years of age or who are_______.

A

45, immunosuppressed

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20
Q

precursor lesion of vular Keratinizing squamous cell carcinoma

A

differentiated vulvar intraepithelial neoplasia (differentiated VIN)

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21
Q

Vulvar Keratinizing squamous cell carcinoma occurs most often in individuals with

A

long-standing lichen sclerosus or squamous cell hyperplasia

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22
Q

sometimes found to be mutated in VIN

A

TP53

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23
Q

this vulvar precursor lesion is microscopically characterized by epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation, features analogous to those seen in cervical squamous intraepithelial lesions

A

Classic VIN

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24
Q

this vulvar precursor lesion is microscopically characterized by marked atypia of the basal layer of the squamous epithelium and normal-appearing differentiation of the more superficial layers

A

Differentiated VIN

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25
Q

sharply circumscribed nodule, most commonly on the labia majora or interlabial folds, it consists of papillary projections covered by two cell layers, an upper layer of columnar secretory cells and a deeper layer of flattened myoepithelial cells

A

Papillary hidradenoma

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26
Q

T/F Vulvar Paget like it’s counterpart in the nipple, is typically associated with underlying cancer

A

False

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27
Q

a failure of müllerian duct fusion and is accompanied by a double uterus

A

uterus didelphys

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28
Q

Vaginal adenosis is found in only a small percentage of adult women, but has been reported in 35% to 90% of women exposed to

A

diethylstilbestrol (DES)

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29
Q

most common and 2nd most common malignant tumors to involve the vagina are

A

carcinoma spreading from the cervix, followed by primary squamous cell carcinoma of the vagina

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30
Q

Virtually all primary carcinomas of the vagina are squamous cell carcinomas associated with infection with

A

high-risk HPV infection

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31
Q

Squamous cell carcinoma of the vagina arises from a premalignant lesion called

A

vaginal intraepithelial neoplasia

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32
Q

found in infants and children younger than 5 years of age. These tumors tend to grow as polypoid, rounded, bulky masses that have the appearance and consistency of grapelike clusters

A

Embryonal Rhabdomyosarcoma (sarcoma botryoides)

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33
Q

HPV- susceptible cells in the cervix

A

immature basal squamous cells and endocervical glandular cells

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34
Q

most susceptible to HPV infection in the cervix

A

Immature squamous cells

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35
Q

stimulates maturation of the cervical and vaginal squamous mucosa and formation of intracellular glycogen vacuoles in the squamous cells

A

production of estrogens by the ovary

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36
Q

dominant microbial species in the normal vagina

A

Lactobacilli

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37
Q

Lactobacilli produce lactic acid, which maintains the vaginal pH at _____

A

below 4.5

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38
Q

fourth most common cancer in women

A

cervical cancer

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39
Q

this infection is most important factor in the development of cervical cancer

A

High-risk HPV infection

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40
Q

This high-risk HPV subtype alone accounts for almost 60% of cervical cancer cases

A

HPV-16

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41
Q

This high-risk HPV subtype alone accounts for another 10% of cervical cancer cases

A

HPV-18

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42
Q

50% of HPV infections are cleared within

A

8 months

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43
Q

90% of HPV infections are cleared within

A

2 years

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44
Q

The ability of HPV to act as a carcinogen depends on these viral proteins (2)

A

viral E6 and E7 proteins

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45
Q

viral protein E6 interferes with____ and E7 with____

A

p53, RB

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46
Q

How does the viral E7 protein of high-risk HPV promote cancer?

A

It binds the hypophosphorylated (active) form of RB and promotes its degradation via the proteasome pathway and also binds and inhibits p21 and p27

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47
Q

How does the viral E6 protein of high-risk HPV promote cancer?

A

it binds p53 and promote its degradation by the proteasome and upregulates the expression of telomerase

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48
Q

represents a productive HPV infection in which there is a high level of viral replication

A

LSIL

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49
Q

represents an HPV infection in which there is a low level of viral replication

A

HSIL

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50
Q

At an ultrastructural level, these “halos” consist of perinuclear vacuoles, a cytopathic change created in part by an HPV-encoded protein

A

E5

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51
Q

T/F The progression time from in situ to invasive adenosquamous and neuroendocrine carcinomas is shorter than in squamous cell carcinoma

A

TRUE

52
Q

most common cause of dysfunctional uterine bleeding which results in excessive endometrial stimulation by estrogens that is unopposed by progesterone

A

Failure of ovulation/ anovulation

53
Q

diagnosis of chronic endometritis rests on the identification of _______ in the stroma

A

plasma cells

54
Q

likely precursor to endometriosis-related ovarian carcinoma

A

Atypical endometriosis

55
Q

defined as the presence of endometrial tissue within the uterine wall (myometrium)

A

adenomyosis

56
Q

It is defined as an abnormal proliferation of the endometrial glands relative to the stroma, resulting in an increased gland-to-stroma ratio when compared with normal proliferative endometrium.

A

Endometrial hyperplasia

57
Q

Inactivation of the this tumor suppressor gene is a common genetic alteration in both endometrial hyperplasias and endometrioid endometrial carcinoma

A

PTEN

58
Q

increased gland-to- stroma ratio. The glands show variation in size and shape and may be dilated. Although there may be back-to-back glands focally, some intervening stroma is usually retained

A

Typical hyperplasia

59
Q

composed of complex patterns of proliferating glands displaying nuclear atypia.The glands are commonly back- to-back and often have complex outlines due to branching structures. Individual cells are rounded and lose the normal perpendicular orientation to the basement membrane. In addition, the nuclei have open (vesicular) chromatin and conspicuous nucleoli.

A

atypical hyperplasia

60
Q

Endometrial hyperplasia is most commonly caused by

A

unopposed estrogen stimulation

61
Q

most common invasive cancer of the female genital tract

A

Endometrial carcinoma

62
Q

When PTEN function is lost, the _______ pathways becomes overactive

A

phosphatidylinositol 3-kinase (PI3K)/AKT pathway

63
Q

Endometrial carcinoma molecular subtype that has an exceptionally high burden of somatic mutations

A

Ultramutated/POLE tumors

64
Q

Endometrial carcinoma molecular subtype defined by mutations in or epigenetic silencing of mismatch repair genes, also leading to genomic instability and a high burden of somatic mutations

A

Hypermutated/MSI (microsatellite instability) tumors

65
Q

Endometrial carcinoma molecular subtype associated with endometrioid morphology that is frequently associated with mutations that upregulate signaling through the PI3K/AKT pathway

A

Copy number low/MSS (microsatellite stable) tumors

66
Q

Endometrial carcinoma molecular subtype with aggressive tumors with serous or high-grade endometrioid morphology that are often associated with TP53 mutations and numerous genomic copy number variants

A

Copy number high/ serous-like tumors

67
Q

most common type of endometrial carcinoma

A

Endometrioid Endometrial Carcinoma

68
Q

Endometrioid Endometrial Carcinoma falls under what type category?

A

type 1

69
Q

hallmark of the endometrioid endometrial carcinoma tumor type is that the most common mutations present act to increase signaling through what pathway?

A

PI3K/AKT pathway

70
Q

this signaling pathway augments expression of estrogen receptor–dependent target genes in endometrial cells

A

PI3K/AKT pathway

71
Q

mutations that impact the PI3K/AKT pathway in endometrial carcinomas are (4)

A

PTEN
PIK3CA
KRAS
ARID1A

72
Q

mutations in endometrioid carcinoma disrupt genes that are required for the maintenance of genomic stability (3)

A

MMR (MSH1, MLH2)
POLE
TP53

73
Q

Tumors with these mutations or defects are frequently associated with large numbers of infiltrating T cells (2)

A

POLE and MMR

74
Q

Serous Endometrial Carcinoma falls under what type category?

A

type 2

75
Q

All serous carcinomas belong to which molecular category?

A

copy number high / serous-like

76
Q

Serous endometrial carcinoma is highly associated with disruptive mutations in what gene?

A

TP53

77
Q

precursor lesion of Serous endometrial carcinoma

A

serous endometrial intraepithelial carcinoma

78
Q

T/F All of the tumors in the category of Serous endometrial caracinoma are classified as grade 3 irrespective of architectural pattern

A

True

79
Q

T/F Carcinosarcoma (Malignant Mixed Müllerian Tumors) are carcinomas that have acquired the capacity for mesenchymal differentiation

A

True

80
Q

Usual mutations found in carcinosarcomas (malignant mixed mullerian tumos) (3)

A

PTEN, PT53, PIK3CA

81
Q

endometrial stromal tumor which presents as a large broad-based polypoid growth that has malignant-appearing stroma, which coexists with benign but abnormally shaped endometrial glands

A

adenosarcoma

82
Q

Endometrial stromal neoplasms are divided into two categories which are

A

benign stromal nodules and endometrial stromal sarcoma

83
Q

fusion gene usually found in Low-grade endometrial stromal sarcoma

A

JAZF1-SUZ12 fusion

84
Q

mutation that occurs in roughly 70% of uterine leiomyomas that appears to be virtually unique to uterine smooth muscle tumors

A

MED12

85
Q

well circumscribed monotonous proliferation of bland endometrial stromal cells with expansive growth pattern at the margins but not infiltrating. If protrusions present must be <3mm and <3 protrusions

A

Endometrial stromal nodule

86
Q

mutation in endometrial stromal nodule

A

JAZF1-SUZ12

87
Q

Distinction between leiomyomas and leiomyosarcomas are based on (3)

A

Nuclear atypia, mitotic index, and tumor necrosis

88
Q

cystic follicle size

A

> /= 2 cm

89
Q

follicle cyst size

A

> 2cm

90
Q

ovarian cyst lined by a rim of bright yellow tissue containing luteinized granulosa cells and are prone to rupture

A

luteal cyst / corpus luteum

91
Q

Most primary ovarian neoplasms arise from

A

müllerian epithelium

92
Q

three major ovarian tumor histologic types based on the differentiation of the neoplastic epithelium

A

serous, mucinous, and endometrioid tumors

93
Q

inherited germline mutations in both these 2 genes increase susceptibility to both ovarian cancer and breast cancer

A

BRCA1 and BRCA2

94
Q

recently thought to be the precursor lesion for sporadic high-grade serous ovarian cancers

A

serous tubal intraepithelial carcinoma (STIC)

95
Q

What is the origin of high-grade serous carcinomas that involve the ovary, without concomitant involvement of the fallopian tube?

A

cortical inclusion cysts or implantation of detached fallopian tube epithelium at ovary

96
Q

Low-grade ovarian tumors arising in serous borderline tumors
have mutations in ___________(3) and usually have ____ type Tp53 genes

A

KRAS, BRAF, or ERBB2 oncogenes,
and usually have wild-type TP53 genes

97
Q

High-grade ovarian serous tumors have a high frequency of what mutation?

A

TP53

98
Q

Almost all ovarian carcinomas arising in women with BRCA1 or BRCA2 mutations are

A

high-grade serous carcinomas with TP53 mutations

99
Q

In serous, mucinous, or seroumucinous ovarian tumors, if intracystic epithelial proliferation accounts for < 10% of the tumour, the neoplasm should be classified as

A

cystadenoma with focal epithelial proliferation

100
Q

T/F Bilaterality is an uncommon finding in, benign serous cystadenomas, serous borderline tumors, serous carcinomas.

A

False. Bilaterality is common, occurring in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approximately 66% of serous carcinomas.

101
Q

Stromal microinvasion in ovarian serous tumors is defined as

A

invasion < 5 mm in
greatest dimension in any single focus

102
Q

The term “implant” is used in the context of extraovarian disease associated with SBT of the ovary. Implants of serous borderline are, by definition,_______; if there is invasion, a diagnosis of ______should be made

A

non-invasive, LOW GRADE SEROUS CARCINOMA

103
Q

precursor to low-grade ovarian serous carcinoma

A

micropapillary carcinoma

104
Q

ovarian serous tumor subtype that has elongated micropapillae without stromal cores (at least 5 times longer than wide) that directly emanate from large papillae (the so-called Medusa head appearance) and/or small punched-out cribriform spaces. An area of pure growth measuring > 5 mm is required for the tumour to be classified as the this subtype

A

micropapillary/cribriform

105
Q

a consistent genetic alteration in mucinous tumors of the ovary, including the majority of benign mucinous cystadenomas (58%), mucinous borderline tumors (75% to 86%), and ovarian mucinous carcinomas (85%)

A

KRAS

106
Q

T/F In ovarian mucinous tumors, the surface of the ovary is rarely involved, and only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilateral

A

T

107
Q

is marked by mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, and frequent involvement of the ovaries, if extensive, may result in intestinal obstruction and death.

A

pseudomyxoma peritonei

108
Q

T/F Because the majority of primary mucinous ovarian tumors are unilateral, bilateral presentation of mucinous tumors always requires exclusion of metastasis from a non-ovarian primary tumor.

A

True

109
Q

sometimes a precursor lesion to ovarian endometrioid carcinoma

A

ovarian endometriosis

110
Q

Molecular studies have found similarities of ovarian endometrioid carcinoma to endometrial endometrioid carcinoma; shared features include mutations in _____ pathway and _____

A

mutations that increase PI3K/AKT pathway (PTEN, PIK3CA, ARID1A, and KRAS) and MMR

111
Q

an uncommon variant ovarian tumor in which there is pronounced proliferation of the fibrous stroma that underlies the columnar lining epithelium, usually small and multilocular and have simple papillary processes that are not as complicated and branching as those found in the ordinary cystadenoma

A

Cystadenofibroma

112
Q

contain neoplastic epithelial cells resembling urothelium and are usually benign

A

Transitional cell tumors / Brenner tumors

113
Q

karyotype of almost all benign ovarian teratomas is

A

46,XX

114
Q

teratoma composed entirely of mature thyroid tissue, which may be functional and cause hyperthyroidism

A

Struma ovarii

115
Q

how do you deyermine the histologic grading (I to III) of an ovarian immature malignant teratoma

A
116
Q

yolk sac tumor is also known as

A

endodermal sinus tumor

117
Q

characteristic histologic feature of yolk sac tumor

A

Schiller-Duval body

118
Q

undifferentiated gonadal mesenchyme eventually produces specific types of cells in male (___________) and female (_________)

A

Sertoli and Leydig

granulosa and theca

119
Q

small, distinctive, glandlike structures filled with an acidophilic material recall immature follicles in Granulosa cell tumors

A

Call-Exner bodies

120
Q

The most common driver mutation found in granulosa cell tumors

A

FOXL2 gene

121
Q

syndrome with these combination of findings: ovarian tumor, hydrothorax, and ascites

A

Meigs syndrome

122
Q

3 Tumors arising in the ovarian stroma

A

Fibromas,Thecomas, and Fibrothecomas

123
Q

in one-half of cases, Sertoli-Leydig Cell Tumors have mutations in

A

DICER1

124
Q

metastatic gastrointestinal carcinoma involving the ovaries characterized by bilateral metastases composed of mucin- producing cancer cells with a “signet-ring” appearance, most often of gastric origin

A

Krukenberg tumor

125
Q
A

Female genital tract (1 decks)

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