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2nd U1 Path > Robbins Ch 22 Female genital tract > Flashcards

Robbins Ch 22 Female genital tract Flashcards

1
Q

Patient presents with mucopurulent vaginal discharge for 1 week. upon pelvic examination a reddened cervical os is found. Pap smear is performed and numerous neutrophils are found. Marked follicular cervicitis is found on biopsy. What is the most likely diagnosis for this patient and what is she at an increased risk of developing?

A

Chlamydia Trachomatis

PID

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2
Q

This condition produces scant, white, curd-like vaginal discharge and can cause vaginitis or cervicitis with exudate and erythema…

A

Candidiasis

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3
Q

This condition produces a profuse homogeneous, frothy, and adherent yellow/green vaginal discharge…

A

Trichomonas

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4
Q

What is found in bacterial vaginosis and produces a moderate, homogeneous, low-viscosity, adherent vaginal discharge–white/gray with a characteristic fishy odor.

A

Gardnerella

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5
Q

Manifest as clear vesicles on the skin in the perineal region…

A

Herpetic infections

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6
Q

An infection associated with condylomata, dysplasias, and carcinoma.

A

HPV

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7
Q

What does a biopsy taken of a person infected with HPV show?

A

Prominent perinuclear vacuolization (Koilocytosis) and angulation of nuclei

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8
Q

What is the lesion seen in infections with HPV and what types is this associated with?

A

Condylomata acuminate

Associated with HPV infection type 6 and 11

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9
Q

Infection shows presence of budding cells with pseudohyphae?

A

Candida albicans

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10
Q

Gram (-) diplococcus that can lead to salpingitis and PID with scarring of the fallopian tube? what is this patient at an increased risk of?

A

Neisseria gonorrhoeae

Predisposes to ectopic pregnancy

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11
Q

What glands can become obstructed, inflamed and cystic due to abscess formation?

A

Bartholin glands

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12
Q

A type of cyst that can form in the lateral vaginal wall from the remnant of a wolffian duct…

A

Gartner duct cyst

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13
Q

Postmenopausal woman with pale parchment-like areas of the skin–especially on labia major and minora. Is associated with malignancy.

A

Lichen sclerosus et atrophicus

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14
Q

Appears grossly as leukoplakia from squamous hyperplasia and is NOT associated with malignancy…

A

Lichen simplex chronicus

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15
Q

Produces reddish areas of scaling and is caused by the presence of adenocarcinoma-like cells at the dermal-epidermal junction, is NOT associated with underlying malignancy…

A

Extramammary Paget disease

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16
Q

Patient presents with a red, pruritic lesion on labia. No abnormal findings on Pap smear. Large atypical cells lying singly or in small clusters are within the epidermis, seen on microscopic exam. There is abundant cytoplasm that stains with PAS…

A

Extramammary paget disease

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17
Q

Pelvic inflammatory disease can rest from what infections of the internal genital organs?

A

Neisseria gonorrhoeae

Chlamydia trachomatis

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18
Q

40 y/o female patient presents with Leukoplakia, pruritic patches and scaly plaques on the vulva. Epidermal thickening with hyperkeratosis and intense dermal inflammation is seen. There is no dysplastic changes presents and there is no predisposition to cancer..

A

Lichen simplex chronicus (squamous cell hyperplasia)

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19
Q

Produces red patches and vesicles with intense round cell infiltrates..

A

Contact dermatitis

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20
Q

Neoplasia marked by dysplastic squamous epithelial changes. Pale area of discoloration on labia. Biopsy–dysplastic cells that occupy half the thickness of the squamous epithelium. Can progress to invasive cancer and is associated with HPV-16…

A

Vulvar intraepithelial neoplasia

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21
Q

infectious agent of syphilis… characterized by the gross appearance of a hard chancre.

A

Treponema pallidum

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22
Q

Associated with exposure of the patients mother to diethylstilbestrol (DES) during pregnancy?

A

Vaginal clear cell carcinomas

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23
Q

25 y/o patient presents with dyspareunia followed by vaginal bleeding. A red, friable nodular mass is found on the anterior wall of the upper third of the vagina.

A

Vaginal clear cell carcinomas

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24
Q

What can congenital adrenal hyperplasia produce in early childhood girls?

A

Masculinization

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25
Q

Uncommon vaginal tumor that can be found in girls younger than 5 yrs?

A

Embryonal rhabdomyosarcoma

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26
Q

4 year old patient presents with vaginal discharge of polypoid, grape like mass. Upon histological examination, small round blue cell tumors that show skeletal muscle differentiation are seen. with eosinophilic strap-like cytoplasm. The mass is Desmin/Vimentin/Myogenin positive. What is the most likely diagnosis?

A

Embryonal Rhabdomyosarcoma

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27
Q

What are the risk factors for cervical intraepithelial neoplasia I (CIN I) and describe its prognosis…

A

Early age at first intercourse
multiple sex partners
Male partner with multiple previous sex partners

Minimal dysplasia and is potentially reversible process

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28
Q

What is a major risk factor for the development of cervical intraepithelial neoplasia III?

A

HPV 16 and 18–high risk of displasias and carcinomas of the cervix

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29
Q

Cervical intraepithelial neoplasia (CIN ) II may progress to what if not treated and what is it associated with?

A

May progress to invasive carcinoma

High risk subtype of HPV–> 16, 18, 31, 33

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30
Q

What are the risk factors for the development of cervical squamous cell carcinoma?

A

Multiple sex partners
Documented infection of the cervix with high-risk HPV-16/18/31/33
Dx of high grade squamous intraepithelial lesion

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31
Q

Prolonged estrogenic stimulation that is not followed by secretion of progesterone causes what?

A

Anovulatory cycle

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32
Q

1 week postpartum women presents to the ED with a foul smelling vaginal discharge and abdominal pain. Upon ultrasound it was found that the mother had retained products of conception. What is the most likely cause of the patients symptoms?

A

Acute endometritis

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33
Q

Hypomethylation of what two genes can lead to overproduction of prostaglandins and estrogens and what is used for the treatment in order to suppress estrogen production?

A

NR5A1 and ESR2 genes

Aromatase inhibitor

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34
Q

Endometrial gland extend from the endometrium down into the myometrium–enlarging the uterus 2-4x normal size due to thickening of myometrium. Symmetrical enlargement…

A

Adenomyosis

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35
Q

Myometrial tumor mass–can produce an asymmetric uterine mass..

36
Q

functional endometrial glands found outside the uterus…

A

Endometriosis

37
Q

What are the common sites for endometriosis to occur?

A

Ovaries
Uterine ligaments
Rectovaginal septum
Pelvic peritoneum

38
Q

Patient presents with cyclic abdominal pain that coincides with menstruation and has unable to conceive for over 3 yrs. What is the most likely diagnosis?

A

Endometriosis

39
Q

Results from excessive estrogenic stimulation, usually occurs with failure of ovulation around the time of menopause and a D&C will stop bleeding…

A

Endometrial hyperplasia with numerous crowded glands

40
Q

Perimenopausal patient presents with abnormal bleeding. A hysteroscopy is performed and a smooth, soft mass is found protruding into the endometrial cavity. What is the diagnosis?

A

Endometrial polyp

41
Q

Endocervical glands with squamous metaplasia…

A

Chronic cervicitis

42
Q

Multiple benign uterine masses with no evidence of necrosis or hemorrhage.. enlarge during repro years and can cause chronic blood loss leading to iron deficient anemia.

43
Q

Estrogen-producing tumors of the ovary–sex cord tumors

A

Granulose-Theca cell tumor/thecoma-fibroma

Produce estrogen leading to endometrial hyperplasia

44
Q

Postmenopausal woman presents with vaginal bleeding. Patient is obese and has DM II and HTN. What is the most likely diagnosis?

A

Adenocarcinoma

Postmenopausal vaginal bleeding is a RED FLAG for endometrial carcinoma

45
Q

What mutation is associated with endometrioid carcinoma?

A

Mutations of the PTEN tumor suppressor gene

46
Q

Arises de novo in the uterine corpus and is a large irregular mass composed of pleomorphic spindle cells with many mitoses. Most often seen in postmeno women…

A

Leiomyosarcoma—DOES NOT arise from leiomyoma

47
Q

Anaplastic cytophoblasts are characteristic of what abnormality?

A

Choriocarcinomas

48
Q

What carcinoma arises from glandular epithelium?

A

Adenocarcinomas

49
Q

What are the major causes of postmenopausal uterine bleeding?

A

Endometrial atrophy
Carcinoma
Hyperplasia
Polyps

50
Q

What is the most common cause of inflammation of the fallopian tube?

A

STDs

N. Gonorrhoeae
Chlamydia
Mycoplasma

51
Q

Patient presents with severe lower abdominal pain. Negative pregnancy test was obtained. What will most likely be found on ultrasound examination?

A

Follicule cyst or lutein cyst

52
Q

Disorder associated with oligomenorrhea, obesity, hirsutism, and enlarged ovary with multiple round cysts found on imaging…

53
Q

What are the two types of cystadenocarcinomas?

A

Serous (unilocular)–more common and is associated with the homozygous loss of the BRCA1 gene

Mucinous (multilocular)

54
Q

What mutation is the serous cystadenocarcinoma associated with?

A

homozygous loss of the BRCA1 gene

55
Q

Patient presents with large abdomen and thinks she is pregnant. Pregnancy test is performed and is negative. Abdomen is dissented and has a fluid wave. Psammoma bodies are present. What is the most likely diagnosis?

A

Cystadenocarcinoma

56
Q

What is the origin of mucinous cystadenocarcinoma?

A

Epithelial origin

Multioculated

57
Q

What is common with surface epithelial neoplasms of the ovary and is suggestive of metastases?

58
Q

Solid tumor of germ cell origin?

A

Dysgerminomas

59
Q

Contain abundant hair and gooey sebaceous fluid within the cystic cavity…

A

Mature cystic teratoma

60
Q

A rare tumor that has a yellow-brown appearance, is a solid mass, and may secrete androgens or estrogens…

A

Sertoli-leydig cell tumors

61
Q

ERbB2 gene overexpression is best known for its association with breast carcinomas. What other cancer is this overexpression seen in?

A

Ovarian cancers

62
Q

What two mutations are associated with serous tumors of the ovary?

A

KRAS and BRAF mutations

63
Q

A papillary projection into the cyst lumen, associated with peritoneal implants and has NO hormonal effect…

A

Serous tumor of the ovary

64
Q

Can a serous tumor of the ovary cause endometrial hyperplasia or androgenic driven masculinization?

65
Q

Cystic tumor with a mass of hair in the lumen..filled with hair and sebum derived from well-differentiated ectodermal structures…

A

Cystic teratoma (dermoid cyst)

66
Q

Papillary structures with psammoma bodies is characteristic of what?

A

Cystadenocarcinoma

67
Q

Tissues derived from multiple germ cells layers and has at least one immature tissue element–often neuroectodermal tissue…

A

Immature teratomas

68
Q

A patient presents with pelvic discomfort. A large, nontender adnexal mass is palpated. Imaging shows a solid circumscribed mass. The mass is removed and is solid, white and has small areas of necrosis. Upon microscopic examination there is mostly primitive mesenchymal cells found. What is this mass?

A

Immature teratoma

69
Q

Uncommon solid tumors that contain epithelial nests resembling transitional cells of the urinary tract and may be associated with endometrial hyperplasia…

A

Brenner tumors of the ovary

70
Q

Female equivalent of male testicular seminomas…

A

Dysgerminomas

71
Q

Solid tumors of smooth muscle origin that are found mostly in the myometrium?

A

Leiomyosarcomas

72
Q

What is Meigs syndrome and what does it have an associated with?

A

Ovarian tumor with ascites and right pleural effusion

Association with Fibromas and thecomas–which are sex cord-stromal tumors that may be hormonally active and secrete estrogens leading to endometrial hyperplasia and carcinomas

73
Q

What are condyloma acuminatums associated with and who are most susceptible?

A

Related to infection with HPV

More likely to occur in younger, sexually active women on external genitalia and perineum

74
Q

Uncommon form of gestational trophoblastic dz with a triploid karyotype

Only occurs in reproductive-aged women

A

Partial mole

75
Q

Female patient presents with masculinizing signs and symptoms–hirsutism, acne, breast atrophy, amenorrhea. A well-circumscribed, lobulated, firm, yellow mass lesions are found on her ovaries. Microscopy of the lesions reveal plump pink cells that are positive for inhibin. What is the most likely diagnosis?

A

Sterol cell ovarian neoplasm

76
Q

What infection is most likely to cause preterm premature rupture of membranes and premature labor?

A

Group B streptococcus

77
Q

What are the risk factors for the development of an ectopic pregnancy?

A

Chronic salpingitis–caused by gonorrhea or chlamydia
Intrauterine tumors
Endometriosis

78
Q 
HTN 
Proteinuria
Edema
Small placenta
Infarcts and retroplacental hemorrhages can occur

Microscopy shoes decidual arterioles with acute athetosis and fibrinoid necrosis

A

Preeclampsia

79
Q

Most often due to ascending bacterial infections and leads to or follows premature rupture of membranes…

A

Chorioamnionitis

80
Q

Enlarged, grapelike villi that form the tumor mass in the endometrial cavity.

A

Hydatidiform mole

81
Q

Trophoblastic tumor that secretes large amounts of hCG–resulting from abnormal fertilization–only paternal chromosomes present…

A

Hydatidiform mole

82
Q

What is the acetylcholinesterase test used for?

A

to distinguish neural tube defect from other fetal defects

83
Q

Fetus that develops from triploidy and may contain some grape-like villi and is usually malformed, often having 3.4 syndactyly…

A

Partial hydatidiform mole

84
Q

An aggressive, malignant trophoblastic tumor that can metastasize in the vaginal wall and lungs. Characteristic appearance is hemorrhagic. And a positive b-hCG is obtained. What is the disorder and what cells are causing the elevated hCG?

A

Choriocarcinoma

Syncytiotrophoblastic cells are causing elevated hCG

85
Q

What is the treatment for choriocarcinoma?

A 
Etoposide
Methotrexate
Actinomycin D
Cyclophosphamide
Vincristine
86
Q

The rarest of all forms of gestational trophoblastic disease. Produces human placental lactogen (hPL)

A

Placental site trophoblastic tumor

2nd U1 Path (6 decks)

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