Roveda- Benign and Malignant Disorders of female GU tract Flashcards
Reactive inflammation of vulva in response to an exogenous stimulus
Vulvitis
HSV-2, N. gonorrhoeae, Treponema pallidum, and C. albicans, and M. contagiosum can cause what
vulvitis
causative agent of a genital ulcerative lesion in the vulva
Herpes simplex
causative agent of suppurative infection of vulva
N. gonorrhoeae
causative agent of syphilis
Treponema pallidum
fungus that causes a yeast infection in vulva
Candida albicans
a cutaneous or mucosal lesion caused by poxvirus. (present in eyes and in vulva)
Molluscum contagiosum
associated with condyloma acuminatum and vulvar intraepithelial neoplasia.
HPV
stiffened labial folds with smooth white plaques-leukoplakia
postmenopausal
Lichenoid sclerosis
epithelial THINNING
hyperkeratosis
classic for…
Lichen Sclerosis
with ______ there is an increased risk of developing SCC in vulva
Lichen Sclerosis
if you see leukoplakia in the mouth what are you trying to first exclude
SCC, then lichen lesions
area of leukoplakia
epithelial THICKENING
Lichen simplex chronicus
warty lesions
Condyloma
squamous cells which become infected with HPV have nuclear wrinkling with cleared cytoplasm
koilocytes
usually do not progress to invasive cancer; HPV subtypes 6 and 11 cause this
Condyloma acuminatum
“stuck on pieces of cauliflower”
Condyloma acuminatum
Marked thickening of epidermis; hyperkeratosis; turnover of cells
Condyloma
90% of vulvar carcinomas are _____
SCC
2 distinct forms of vulvar carcinoma (squamous cell carcinoma):
HPV subtypes 16 and 18
preceded by lichen sclerosis
Young age at first intercourse
Intercourse with multiple partners
Intercourse with a male partner who has had multiple partners
risk factors for HPV related diseases in vulva and cervix
HPV related vulvar carcinoma
lesion will look grossly like ______ due to the hyperkeratosis overlying the areas of squamous dysplasia
leukoplakia
normal on L side
vulva
vulvar intraepithelial neoplasia
vulva
vulvar squamous cell carcinoma
pretty good prognosis of vulvar _____ if you catch it while the lesion is small
vulvar carcinoma
Remember in Paget’s disease of the breast (which is referred to as mammary Paget’s), virtually 100% of patients have an underlying ______ ductal carcinoma of the breast.
invasive
About 30% of patients with perianal Paget’s have an underlying _____ carcinoma
invasive
Intraepithelial proliferation of malignant epithelial cells that can occur in the skin of the vulva (can also occur in the perianal area); most not associated with an underlying tumor
Extramammary Paget Disease
On gross image: red scaly crusted plaque
extramammary paget disease
red scaly crusted plaque
“area oozing, and see red scaly area, and frequently pruritic”
Extramammary Paget’s disease
disease- large pale cells with intracytoplasmic mucin which infiltrate the epidermis of the vulva
Extramammary Paget’s Disease
most people with ______disease do not have underlying invasive carcinoma
Extramammary Paget’s disease
pigmented lesion on labia
vulvar melanoma
what 2 things could this be if in vulva
Paget’s disease; vulvar melanoma
S-100 and HMB45 to stain for _____
melanoma
mucin stain to rule out_____
Paget’s
inflammatory, transient condition associated with discharge which is known as leukorrhea
vaginitis
causes curdy white discharge from vagina
Candida albicans
watery grey green frothy discharge – the cervix is grossly described as strawberry cervix
Trichomonas Vaginalis
Normal _____ of vagina can become pathogenic in the setting of diabetes, antibiotic therapy, pregnancy, or immunodeficiency
flora
uncommon in patients, but is the most common cancer of vagina occurring in patients older than 60
SCC
Usually preceded by vaginal intraepithelial neoplasia which is associated with HPV infection
SCC of vagina
The most significant risk factor for squamous cell carcinoma of the vagina is a previously diagnosed squamous cell carcinoma of the _____ or ______
cervix or vulva
1970s cluster of young women whose mothers took diethylstilbestrol to prevent threatened abortion got _____ adenocarcinoma of vagina
clear cell adenocarcinoma of vagina
Embryonal rhabdomyosarcoma—rare form of vaginal cancer that manifests as polypoid masses of tissue protruding from vaginal os (in young patients)
Sarcoma botryoides
mesenchymal sarcoma of vagina
sarcoma botryoides
Small round blue cell neoplasm with skeletal muscle differentiation
Sarcoma Botryoides
may express muscle specific marker desmin
Sarcoma Botryoides
results in epithelial metaplasia in the endocervical transformation zone: stratified squamous of ecto and merges into glandular of endo
cervicitis
the spread of this infection requires direct contact with the mucosa of an infected individual; infects cervix
Neisseria gonorrhoeae
most common bacterial cause of STD in the US, dx is made not thru culture but rather by nucleic acid amplification on voided urine; infects the cervix
Chlamydia
patients infected with ____ can get reactive arthritis known as Reiter’s syndrome
Chlamydia
will see Cowdry type A viral inclusions on pap smear
herpes
L: strawberry cervix
middle: grey green discharge
R: pap smear of organism
Trichomonas
____has a tropism for immature squamous cells of the transformation zone, basal layer at the squamocolumnar junction
HPV
where the ectocervical squamous mucosa meets the endocervical glandular mucosa
cervical transformation zone
if HPV infection persists, then can progress to SIL and CIN which are
squamous intraepithelial lesion
cervical intraepithelial neoplasia
Early age at first intercourse
Multiple sexual partners
Male partner with multiple previous sexual partners
Persistent infection with high risk strains of HPV
risk factors for squamous intraepithelial lesion
high risk strains of HPV for squamous intraepithelial lesions and cervical cancer
types 16 and 18
high risk subtypes of HPV______ into the host genome
integrate
low risk subtypes of HPV ___ and ___ are associated with condylomata and DO NOT integrate into the host genome
6 and 11
Persistent and long term infection of _____is what increases risk for developing SIL and cervical cancer
HPV
activation of E6 and E7 viral oncoproteins which inactivate p53 and Rb tumor suppressors resulting in uncontrolled cellular proliferation
high risk HPV
_____ usually precedes invasive carcinoma
squamous intraepithelial lesion
The higher grade of dysplasia, the greater the likelihood of progression to _____
cancer
grade for mild dysplasia
low grade SIL
grade for moderate, severe, in situ dysplasia
high grade SIL
full thickness dysplasia
carcinoma in situ
cervical transformation zone where what meets
endocervical glandular mucosa meets squamous mucosa
cervical squamous metaplasia (ecto and endo)
grade these
A. low grade
B and C: high grade
cervix—> how would you describe this
carcinoma in situ
in a pap smear, there is early detection of dysplastic changes in the cells scraped from the _____ zone
transformation
____ is usually asymptomatic and comes to attention because of an abnormal pap smear
SIL
cervical os (normal)
SIL patient (squamous metaplasia)
cervix
invasive SCC
L and R (squamous cells of cervical pap smear)
L: normal
R: HPV
____most common reason for having invasive carcinoma of cervix
HPV
most common type of invasive carcinoma of cervix
SCC
this type of cancer will not really be detected by pap smear due to being higher up than transition zone and tool can get
adenocarcinoma
Cone excision
Hysterectomy with or without lymph node sampling
Radiation and chemotherapy
treatment options for carcinoma of cervix
Most patients with advanced disease of carcinoma of cervix die as a result of ____ invasion rather than distant mets
local
cervix
invasive SCC
SCC
_____ phase endometrium- that which is prior to ovulation- this is the phase that can be of a variable length
proliferative
_____ phase endometrium is a fixed length of days which terminates in menses.
secretory
what phase of endometrium
proliferative
absence or suppression of menses
amenorrhea
Scanty or infrequent menstrual flow
oligomenorrhea
painful menses
dysmenorrhea
prolonged bleeding at menses
menorrhagia
irregular bleeding between menses
metrorrhagia
painful sexual intercourse
dyspareunia
Differential for abnormal uterine bleeding depends upon the _____ of the patient
age
Abnormal bleeding from the uterus in the absence of an organic uterine lesion
dysfunctional uterine bleeding
most common cause of dysfunctional uterine bleeding
anovulation
pre-puberty bleeding differential
precocious puberty
adolescence abnormal bleeding differential
Anovulation
reproductive age abnormal bleeding differential
complications of pregnancy
perimenopausal abnormal bleeding
dysfunctional uterine bleeding
postmenopausal abnormal bleeding
anatomic lesions
Most common at menarche and perimenopausal period
Anovulation
Corpus luteum fails to mature or may regress prematurely leading to a lack of progesterone
inadequate luteal phase
what happens if there is leftover placenta after giving birth
can lead to endometriosis, sepsis, or choriocarcinoma
Often a consequence of pelvic inflammatory disease
Infectious-N.gonorrhoeae, C.trachomatis, tuberculosis
IUD
genetic
causes of endometriosis
Refers to the growth of the basal layer of the endometrium downward into the myometrium
Adenomyosis
Induces reactive hypertrophy of the myometrium resulting in an enlarged uterus
Adenomyosis
reactive hypertrophy of myometrium in uterus
Adenomyosis
normal endometrial glands embedded in myometrium
Adenomyosis
Presence of endometrial glands and stroma in a location outside the endomyometrium
endometriosis
Adhesions can develop on fallopian tube, on ovary and cause fallopian tube to no longer float freely and grasp the egg at time of ovulation
endometriosis
ex. pt with _____didnt respond well to estrogen + progesterone COC so had to get ablation surgery (she had long and painful periods due to this)
endometriosis
chocolate cyst
endometriosis
“powder burns”
powder burns sign of
endometriosis
endometrial glands and stroma outside of uterus
endometriosis
Progestins and progesterone dominant oral contraceptives for this
endometriosis
precursor to some types of endometrial adenocarcinoma (endometrioid type)
endometrial hyperplasia
Excess of estrogen relative to progestin (unopposed estrogen)
endometrial hyperplasia
Failure of ovulation
Prolonged administration of therapeutic agents
Estrogen producing tumors (Granulosa-theca cell tumor) or syndromes (PCOS)
Obesity
can cause endometrial hyperplasia
Increased aromatase expression:
As ____ mass increases, so does the expression of aromatase, an enzyme complex that converts androgens into estrogens
fat
classified based upon presence of cytologic atypia
endometrial hyperplasia
endometrial hyperplasia may be associated with _____tumor suppressor gene inactivation
PTEN
normal what
endometrium
endometrial hyperplasia
If cytologic _____ is present on biopsy, up to 25% of those patients will harbor an unsampled endometrial carcinoma
atypia
In the US, the most frequent carcinoma of the genital tract in patients with a uterus; older population
endometrial adenocarcinoma
2 types of endometrial adenocarcinoma
endometrioid
serous
associated with estrogen excess and hyperplasia in the perimenopausal patient
endometrioid endometrial adenocarcinoma
associated with endometrial atrophy in the older postmenopausal patient
serous endometrial adenocarcinoma
accounts for 80% of ______ and msot risk factors are largely associated with increased estrogen
endometrioid adenocarcinoma
Association b/t mismatch repair gene who have HNPCC what other cancer do they develop
endometrioid adenocarcinoma
_____carcinoma-nearly all cases have mutations in the TP53 tumor suppressor gene
serous
P10 tumor marker for this adenocarcinoma
endometrioid
______ adenocarcinoma
endometrioid
_____ invading myometrium
endometrial adenocarcinoma
Microscopically-papillae with marked cytologic atypia
stain for p53
endometrial atrophy
serous adenocarcinoma
papillary tufts
endometrial atrophy
serous adenocarcinoma
”clinically referred to as fibroids”
Leiomyoma
Most common benign tumor of the uterus
Monoclonal with rearrangement of chromosomes 6 and 12
Leiomyoma
well circumscribed
Leiomyoma
Leiomyomata
fascicular pattern of smooth muscle cells
Leiomyoma
Leiomyomata
malignant; frequently metastasize to the lungs
Grossly-soft, hemorrhagic, and necrotic
Leiomyosarcoma
pronounced cytologic atypia
smooth muscle
Leiomyosarcoma
_____pregnancy is one of the most common findings in someone with pelvic inflammatory disease
ectopic
most common disorder of the fallopian tubes-occurs as a component of pelvic inflammatory disease (PID)
salpingitis
Clinically-present with fever, abdominal pain, pelvic pain, pelvic mass and cervical motion tenderness (Chandelier sign).
Salpingitis (fallopian tubes)
______carcinomas of the fallopian tube most frequently arise in the fimbriated end of the fallopian tube
serous
what kind of epithelium in fallopian tube
glandular
serous carcinomas of fallopian tube are associated with _____ mutation
BRCA
ectopic pregnancy
chorionic villi to the left and fallopian tube epithelium to the right.
ectopic pregnancy
2 types of physiologic ovarian cysts
follicular or luteal
produces excess estrogen and androgen (testosterone)
“string of pearls” on imaging
PCOS
Oligomenorrhea due to anovulation
Hirsutism-hyperandrogenism (facial hair)
Infertility
Obesity
Anemia
PCOS
PCOS
elevated _____stunt follicle growth which results in failure to trigger an LH surge resulting in failure to ovulate.
androgen (testosterone)
patients with PCOS can also experience _____ resistance
insulin
tumor that metastasized from GI tract to ovaries (bilateral)
Kruckenberg tumor
surface epithelial tumors of ovary can be what 3 things
benign
borderline
malignant
Positive family history- 5 to 10% of________cancers are familial (BRCA1 and BRCA2)
ovarian
most common of the ovarian epithelial tumors
serous tumors
Microscopically-benign tumors are lined by a single layer of columnar epithelial cells w/ cilia
serous tumors of ovary
_____cyst neoplasm
ovarian
see cilia
serous cystadenoma
low grade serous carcinomas associated with ____mutations
KRAS
high grade serous carcinomas associated with _____ mutations
TP53
_____ carcinoma; papillary tufts
serous carcinoma of ovary
____ carcinoma; papillary tufts
serous carcinoma of ovary
papillae and psamomma bodies
serous carcinoma of ovary
cyst with thick mucinous material
can be over 100 pounds
mucinous tumors (mucinous ovarian neoplasm)
mucinous ovarian neoplasm
mucinous ovarian neoplasm
mucinous cystadenoma (of ovary)
mucinous adenocarcinoma of ovary can look similar to what
colon cancer
implantation of tumor cells in the peritoneum with the production of copious amounts of mucin-jelly belly—most frequently caused by mets from the gastrointestinal tract-appendix
pseudomyxoma peritonei
metastatic ____ ring cell carcinoma of ovary
signet (Kruckenberg)
Of note Clear cell carcinoma of the ovary which is another high grade primary ovary carcinoma also is associated w/ _____
endometriosis
mutations in PTEN tumor suppressor gene
endometrioid tumors
germ cell tumor
mature are benign
all 3 germ cell layers
teratoma
Filled with sebaceous material, hair and teeth
teratoma
aka Dermoid cyst
teratoma
mature cystic teratoma (ovary)
teratoma
Foci of neuroepithelial differentiation are the aggressive components-these are the components which tend to metastasize
immature malignant teratoma
specialized teratoma composed entirely of mature thyroid tissue
Struma ovarii
thyroid tissue
Struma ovarii
may be asymptomatic
ascites; increasing abdominal girth
may have adb pain
ovarian tumors
most common malignant germ cell tumor in ovary
Elevated PLAP, LDH, hCG
Dysgerminoma
(looks similar to seminoma)
Dysgerminoma
elevated AFP
yolk sac tumor
Increased levels of hCG and AFP
May secrete estrogen and lead to precocious puberty
embryonal carcinoma
Cytotrophoblasts and syncytiotrophoblasts
Elevated levels of hCG
Choriocarcinoma
sex cord stromal tumor
granulosa cell tumor
serum markers for granulosa cell tumor
estrogen
inhibin
Call Exner bodies
Granulosa Cell Tumor
