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ENR Biweekly 1 > Roveda- Benign and Malignant Disorders of female GU tract > Flashcards

Roveda- Benign and Malignant Disorders of female GU tract Flashcards

1
Q

Reactive inflammation of vulva in response to an exogenous stimulus

A

Vulvitis

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2
Q

HSV-2, N. gonorrhoeae, Treponema pallidum, and C. albicans, and M. contagiosum can cause what

A

vulvitis

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3
Q

causative agent of a genital ulcerative lesion in the vulva

A

Herpes simplex

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4
Q

causative agent of suppurative infection of vulva

A

N. gonorrhoeae

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5
Q

causative agent of syphilis

A

Treponema pallidum

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6
Q

fungus that causes a yeast infection in vulva

A

Candida albicans

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7
Q

a cutaneous or mucosal lesion caused by poxvirus. (present in eyes and in vulva)

A

Molluscum contagiosum

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8
Q

associated with condyloma acuminatum and vulvar intraepithelial neoplasia.

A

HPV

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9
Q

stiffened labial folds with smooth white plaques-leukoplakia
postmenopausal

A

Lichenoid sclerosis

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10
Q

epithelial THINNING
hyperkeratosis
classic for…

A

Lichen Sclerosis

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11
Q

with ______ there is an increased risk of developing SCC in vulva

A

Lichen Sclerosis

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12
Q

if you see leukoplakia in the mouth what are you trying to first exclude

A

SCC, then lichen lesions

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13
Q

area of leukoplakia
epithelial THICKENING

A

Lichen simplex chronicus

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14
Q

warty lesions

A

Condyloma

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15
Q

squamous cells which become infected with HPV have nuclear wrinkling with cleared cytoplasm

A

koilocytes

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16
Q

usually do not progress to invasive cancer; HPV subtypes 6 and 11 cause this

A

Condyloma acuminatum

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17
Q

“stuck on pieces of cauliflower”

A

Condyloma acuminatum

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18
Q

Marked thickening of epidermis; hyperkeratosis; turnover of cells

A

Condyloma

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19
Q

90% of vulvar carcinomas are _____

A

SCC

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20
Q

2 distinct forms of vulvar carcinoma (squamous cell carcinoma):

A

HPV subtypes 16 and 18
preceded by lichen sclerosis

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21
Q

Young age at first intercourse
Intercourse with multiple partners
Intercourse with a male partner who has had multiple partners

A

risk factors for HPV related diseases in vulva and cervix

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22
Q
A

HPV related vulvar carcinoma

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23
Q

lesion will look grossly like ______ due to the hyperkeratosis overlying the areas of squamous dysplasia

A

leukoplakia

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24
Q

normal on L side
vulva

A

vulvar intraepithelial neoplasia

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25
Q

vulva

A

vulvar squamous cell carcinoma

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26
Q

pretty good prognosis of vulvar _____ if you catch it while the lesion is small

A

vulvar carcinoma

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27
Q

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.

A

invasive

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28
Q

About 30% of patients with perianal Paget’s have an underlying _____ carcinoma

A

invasive

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29
Q

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

A

Extramammary Paget Disease

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30
Q

On gross image: red scaly crusted plaque

A

extramammary paget disease

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31
Q

red scaly crusted plaque
“area oozing, and see red scaly area, and frequently pruritic”

A

Extramammary Paget’s disease

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32
Q

disease- large pale cells with intracytoplasmic mucin which infiltrate the epidermis of the vulva

A

Extramammary Paget’s Disease

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33
Q

most people with ______disease do not have underlying invasive carcinoma

A

Extramammary Paget’s disease

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34
Q

pigmented lesion on labia

A

vulvar melanoma

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35
Q

what 2 things could this be if in vulva

A

Paget’s disease; vulvar melanoma

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36
Q

S-100 and HMB45 to stain for _____

A

melanoma

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37
Q

mucin stain to rule out_____

A

Paget’s

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38
Q

inflammatory, transient condition associated with discharge which is known as leukorrhea

A

vaginitis

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39
Q

causes curdy white discharge from vagina

A

Candida albicans

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40
Q

watery grey green frothy discharge – the cervix is grossly described as strawberry cervix

A

Trichomonas Vaginalis

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41
Q

Normal _____ of vagina can become pathogenic in the setting of diabetes, antibiotic therapy, pregnancy, or immunodeficiency

A

flora

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42
Q

uncommon in patients, but is the most common cancer of vagina occurring in patients older than 60

A

SCC

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43
Q

Usually preceded by vaginal intraepithelial neoplasia which is associated with HPV infection

A

SCC of vagina

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44
Q

The most significant risk factor for squamous cell carcinoma of the vagina is a previously diagnosed squamous cell carcinoma of the _____ or ______

A

cervix or vulva

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45
Q

1970s cluster of young women whose mothers took diethylstilbestrol to prevent threatened abortion got _____ adenocarcinoma of vagina

A

clear cell adenocarcinoma of vagina

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46
Q

Embryonal rhabdomyosarcoma—rare form of vaginal cancer that manifests as polypoid masses of tissue protruding from vaginal os (in young patients)

A

Sarcoma botryoides

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47
Q

mesenchymal sarcoma of vagina

A

sarcoma botryoides

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48
Q

Small round blue cell neoplasm with skeletal muscle differentiation

A

Sarcoma Botryoides

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49
Q

may express muscle specific marker desmin

A

Sarcoma Botryoides

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50
Q

results in epithelial metaplasia in the endocervical transformation zone: stratified squamous of ecto and merges into glandular of endo

A

cervicitis

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51
Q

the spread of this infection requires direct contact with the mucosa of an infected individual; infects cervix

A

Neisseria gonorrhoeae

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52
Q

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

A

Chlamydia

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53
Q

patients infected with ____ can get reactive arthritis known as Reiter’s syndrome

A

Chlamydia

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54
Q

will see Cowdry type A viral inclusions on pap smear

A

herpes

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55
Q

L: strawberry cervix
middle: grey green discharge
R: pap smear of organism

A

Trichomonas

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56
Q

____has a tropism for immature squamous cells of the transformation zone, basal layer at the squamocolumnar junction

A

HPV

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57
Q

where the ectocervical squamous mucosa meets the endocervical glandular mucosa

A

cervical transformation zone

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58
Q

if HPV infection persists, then can progress to SIL and CIN which are

A

squamous intraepithelial lesion
cervical intraepithelial neoplasia

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59
Q

Early age at first intercourse
Multiple sexual partners
Male partner with multiple previous sexual partners
Persistent infection with high risk strains of HPV

A

risk factors for squamous intraepithelial lesion

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60
Q

high risk strains of HPV for squamous intraepithelial lesions and cervical cancer

A

types 16 and 18

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61
Q

high risk subtypes of HPV______ into the host genome

A

integrate

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62
Q

low risk subtypes of HPV ___ and ___ are associated with condylomata and DO NOT integrate into the host genome

A

6 and 11

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63
Q

Persistent and long term infection of _____is what increases risk for developing SIL and cervical cancer

A

HPV

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64
Q

activation of E6 and E7 viral oncoproteins which inactivate p53 and Rb tumor suppressors resulting in uncontrolled cellular proliferation

A

high risk HPV

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65
Q

_____ usually precedes invasive carcinoma

A

squamous intraepithelial lesion

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66
Q

The higher grade of dysplasia, the greater the likelihood of progression to _____

A

cancer

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67
Q

grade for mild dysplasia

A

low grade SIL

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68
Q

grade for moderate, severe, in situ dysplasia

A

high grade SIL

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69
Q

full thickness dysplasia

A

carcinoma in situ

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70
Q

cervical transformation zone where what meets

A

endocervical glandular mucosa meets squamous mucosa

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71
Q
A

cervical squamous metaplasia (ecto and endo)

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72
Q

grade these

A

A. low grade
B and C: high grade

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73
Q

cervix—> how would you describe this

A

carcinoma in situ

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74
Q

in a pap smear, there is early detection of dysplastic changes in the cells scraped from the _____ zone

A

transformation

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75
Q

____ is usually asymptomatic and comes to attention because of an abnormal pap smear

A

SIL

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76
Q
A

cervical os (normal)

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77
Q
A

SIL patient (squamous metaplasia)

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78
Q

cervix

A

invasive SCC

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79
Q

L and R (squamous cells of cervical pap smear)

A

L: normal
R: HPV

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80
Q

____most common reason for having invasive carcinoma of cervix

A

HPV

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81
Q

most common type of invasive carcinoma of cervix

A

SCC

82
Q

this type of cancer will not really be detected by pap smear due to being higher up than transition zone and tool can get

A

adenocarcinoma

83
Q

Cone excision
Hysterectomy with or without lymph node sampling
Radiation and chemotherapy

A

treatment options for carcinoma of cervix

84
Q

Most patients with advanced disease of carcinoma of cervix die as a result of ____ invasion rather than distant mets

A

local

85
Q

cervix

A

invasive SCC

86
Q
A

SCC

87
Q

_____ phase endometrium- that which is prior to ovulation- this is the phase that can be of a variable length

A

proliferative

88
Q

_____ phase endometrium is a fixed length of days which terminates in menses.

A

secretory

89
Q

what phase of endometrium

A

proliferative

90
Q

absence or suppression of menses

A

amenorrhea

91
Q

Scanty or infrequent menstrual flow

A

oligomenorrhea

92
Q

painful menses

A

dysmenorrhea

93
Q

prolonged bleeding at menses

A

menorrhagia

94
Q

irregular bleeding between menses

A

metrorrhagia

95
Q

painful sexual intercourse

A

dyspareunia

96
Q

Differential for abnormal uterine bleeding depends upon the _____ of the patient

A

age

97
Q

Abnormal bleeding from the uterus in the absence of an organic uterine lesion

A

dysfunctional uterine bleeding

98
Q

most common cause of dysfunctional uterine bleeding

A

anovulation

99
Q

pre-puberty bleeding differential

A

precocious puberty

100
Q

adolescence abnormal bleeding differential

A

Anovulation

101
Q

reproductive age abnormal bleeding differential

A

complications of pregnancy

102
Q

perimenopausal abnormal bleeding

A

dysfunctional uterine bleeding

103
Q

postmenopausal abnormal bleeding

A

anatomic lesions

104
Q

Most common at menarche and perimenopausal period

A

Anovulation

105
Q

Corpus luteum fails to mature or may regress prematurely leading to a lack of progesterone

A

inadequate luteal phase

106
Q

what happens if there is leftover placenta after giving birth

A

can lead to endometriosis, sepsis, or choriocarcinoma

107
Q

Often a consequence of pelvic inflammatory disease
Infectious-N.gonorrhoeae, C.trachomatis, tuberculosis
IUD
genetic

A

causes of endometriosis

108
Q

Refers to the growth of the basal layer of the endometrium downward into the myometrium

A

Adenomyosis

109
Q

Induces reactive hypertrophy of the myometrium resulting in an enlarged uterus

A

Adenomyosis

110
Q

reactive hypertrophy of myometrium in uterus

A

Adenomyosis

111
Q

normal endometrial glands embedded in myometrium

A

Adenomyosis

112
Q

Presence of endometrial glands and stroma in a location outside the endomyometrium

A

endometriosis

113
Q

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

A

endometriosis

114
Q

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)

A

endometriosis

115
Q

chocolate cyst

A

endometriosis

116
Q
A

“powder burns”

117
Q

powder burns sign of

A

endometriosis

118
Q

endometrial glands and stroma outside of uterus

A

endometriosis

119
Q

Progestins and progesterone dominant oral contraceptives for this

A

endometriosis

120
Q

precursor to some types of endometrial adenocarcinoma (endometrioid type)

A

endometrial hyperplasia

121
Q

Excess of estrogen relative to progestin (unopposed estrogen)

A

endometrial hyperplasia

122
Q

Failure of ovulation
Prolonged administration of therapeutic agents
Estrogen producing tumors (Granulosa-theca cell tumor) or syndromes (PCOS)
Obesity

A

can cause endometrial hyperplasia

123
Q

Increased aromatase expression:
As ____ mass increases, so does the expression of aromatase, an enzyme complex that converts androgens into estrogens

A

fat

124
Q

classified based upon presence of cytologic atypia

A

endometrial hyperplasia

125
Q

endometrial hyperplasia may be associated with _____tumor suppressor gene inactivation

A

PTEN

126
Q

normal what

A

endometrium

127
Q
A

endometrial hyperplasia

128
Q

If cytologic _____ is present on biopsy, up to 25% of those patients will harbor an unsampled endometrial carcinoma

A

atypia

129
Q

In the US, the most frequent carcinoma of the genital tract in patients with a uterus; older population

A

endometrial adenocarcinoma

130
Q

2 types of endometrial adenocarcinoma

A

endometrioid
serous

131
Q

associated with estrogen excess and hyperplasia in the perimenopausal patient

A

endometrioid endometrial adenocarcinoma

132
Q

associated with endometrial atrophy in the older postmenopausal patient

A

serous endometrial adenocarcinoma

133
Q

accounts for 80% of ______ and msot risk factors are largely associated with increased estrogen

A

endometrioid adenocarcinoma

134
Q

Association b/t mismatch repair gene who have HNPCC what other cancer do they develop

A

endometrioid adenocarcinoma

135
Q

_____carcinoma-nearly all cases have mutations in the TP53 tumor suppressor gene

A

serous

136
Q

P10 tumor marker for this adenocarcinoma

A

endometrioid

137
Q

______ adenocarcinoma

A

endometrioid

138
Q

_____ invading myometrium

A

endometrial adenocarcinoma

139
Q

Microscopically-papillae with marked cytologic atypia
stain for p53
endometrial atrophy

A

serous adenocarcinoma

140
Q

papillary tufts
endometrial atrophy

A

serous adenocarcinoma

141
Q

”clinically referred to as fibroids”

A

Leiomyoma

142
Q

Most common benign tumor of the uterus
Monoclonal with rearrangement of chromosomes 6 and 12

A

Leiomyoma

143
Q

well circumscribed

A

Leiomyoma

144
Q
A

Leiomyomata

145
Q

fascicular pattern of smooth muscle cells

A

Leiomyoma

146
Q
A

Leiomyomata

147
Q

malignant; frequently metastasize to the lungs
Grossly-soft, hemorrhagic, and necrotic

A

Leiomyosarcoma

148
Q

pronounced cytologic atypia
smooth muscle

A

Leiomyosarcoma

149
Q

_____pregnancy is one of the most common findings in someone with pelvic inflammatory disease

A

ectopic

150
Q

most common disorder of the fallopian tubes-occurs as a component of pelvic inflammatory disease (PID)

A

salpingitis

151
Q

Clinically-present with fever, abdominal pain, pelvic pain, pelvic mass and cervical motion tenderness (Chandelier sign).

A

Salpingitis (fallopian tubes)

152
Q

______carcinomas of the fallopian tube most frequently arise in the fimbriated end of the fallopian tube

A

serous

153
Q

what kind of epithelium in fallopian tube

A

glandular

154
Q

serous carcinomas of fallopian tube are associated with _____ mutation

A

BRCA

155
Q
A

ectopic pregnancy

156
Q

chorionic villi to the left and fallopian tube epithelium to the right.

A

ectopic pregnancy

157
Q

2 types of physiologic ovarian cysts

A

follicular or luteal

158
Q

produces excess estrogen and androgen (testosterone)
“string of pearls” on imaging

A

PCOS

159
Q

Oligomenorrhea due to anovulation
Hirsutism-hyperandrogenism (facial hair)
Infertility
Obesity
Anemia

A

PCOS

160
Q
A

PCOS

161
Q

elevated _____stunt follicle growth which results in failure to trigger an LH surge resulting in failure to ovulate.

A

androgen (testosterone)

162
Q

patients with PCOS can also experience _____ resistance

A

insulin

163
Q

tumor that metastasized from GI tract to ovaries (bilateral)

A

Kruckenberg tumor

164
Q

surface epithelial tumors of ovary can be what 3 things

A

benign
borderline
malignant

165
Q

Positive family history- 5 to 10% of________cancers are familial (BRCA1 and BRCA2)

A

ovarian

166
Q

most common of the ovarian epithelial tumors

A

serous tumors

167
Q

Microscopically-benign tumors are lined by a single layer of columnar epithelial cells w/ cilia

A

serous tumors of ovary

168
Q

_____cyst neoplasm

A

ovarian

169
Q

see cilia

A

serous cystadenoma

170
Q

low grade serous carcinomas associated with ____mutations

A

KRAS

171
Q

high grade serous carcinomas associated with _____ mutations

A

TP53

172
Q

_____ carcinoma; papillary tufts

A

serous carcinoma of ovary

173
Q

____ carcinoma; papillary tufts

A

serous carcinoma of ovary

174
Q

papillae and psamomma bodies

A

serous carcinoma of ovary

175
Q

cyst with thick mucinous material
can be over 100 pounds

A

mucinous tumors (mucinous ovarian neoplasm)

176
Q
A

mucinous ovarian neoplasm

177
Q
A

mucinous ovarian neoplasm

178
Q
A

mucinous cystadenoma (of ovary)

179
Q

mucinous adenocarcinoma of ovary can look similar to what

A

colon cancer

180
Q

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

A

pseudomyxoma peritonei

181
Q

metastatic ____ ring cell carcinoma of ovary

A

signet (Kruckenberg)

182
Q

Of note Clear cell carcinoma of the ovary which is another high grade primary ovary carcinoma also is associated w/ _____

A

endometriosis

183
Q

mutations in PTEN tumor suppressor gene

A

endometrioid tumors

184
Q

germ cell tumor
mature are benign
all 3 germ cell layers

A

teratoma

185
Q

Filled with sebaceous material, hair and teeth

A

teratoma

186
Q

aka Dermoid cyst

A

teratoma

187
Q
A

mature cystic teratoma (ovary)

188
Q
A

teratoma

189
Q

Foci of neuroepithelial differentiation are the aggressive components-these are the components which tend to metastasize

A

immature malignant teratoma

190
Q

specialized teratoma composed entirely of mature thyroid tissue

A

Struma ovarii

191
Q

thyroid tissue

A

Struma ovarii

192
Q

may be asymptomatic
ascites; increasing abdominal girth
may have adb pain

A

ovarian tumors

193
Q

most common malignant germ cell tumor in ovary
Elevated PLAP, LDH, hCG

A

Dysgerminoma

194
Q

(looks similar to seminoma)

A

Dysgerminoma

195
Q

elevated AFP

A

yolk sac tumor

196
Q

Increased levels of hCG and AFP
May secrete estrogen and lead to precocious puberty

A

embryonal carcinoma

197
Q

Cytotrophoblasts and syncytiotrophoblasts
Elevated levels of hCG

A

Choriocarcinoma

198
Q

sex cord stromal tumor

A

granulosa cell tumor

199
Q

serum markers for granulosa cell tumor

A

estrogen
inhibin

200
Q

Call Exner bodies

A

Granulosa Cell Tumor

ENR Biweekly 1 (11 decks)

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