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Bloc I - Reproduction > Sept7 M1,2-Gynecological Pathology > Flashcards

Sept7 M1,2-Gynecological Pathology Flashcards

1
Q

ecto vs endocervix

A 
endocervix = columnar mucinous epithelium
ectocervix = squamous epithelium
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2
Q

TZ def

A

junction of ecto and endo cervix

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3
Q

where cervical cancer can be

A

TZ (most likely so pap smear done there)

ecto or endocervix

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4
Q

steps of cervical cancer dev

A
  • oncogenic HPV infection
  • persistence of infection
  • progression to precancer (asx, above BM, detected by screening)
  • dev of invasive CA (below BM, can metastasize, may be sx)
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5
Q

pap smear looks at what

A

dysplastic changes in cells of TZ

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6
Q

colposcopy is done when + bx what

A

specific cases if pap test +. bx lesions if see any + bx TZ + bit of endo and exocervix

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7
Q

3 precursor lesions of cervical cancer (all above BM)

A
  • low grade squamous intraeptih lesion (LSIL) (CIN1 and CIN2. cervical intraepith neoplasm)
  • high grade squamous intraepith lesion (HSIL) (CIN3)
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8
Q

(imp?) how HPV infection is detected in LSIL

A

see specific cell type called koilocytes

  • cytoplasmic vacuole
  • large and dark nucleus
  • coiled nuclear membrane
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9
Q

CIN1 vs CIN2 vs CIN3

A 
CIN1: = koilocytes in bottom, near BM
CIN2 = koilocytes going up, in middle but still the top cells are mature and pink
CIN3 = koilocytes all the way
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10
Q

specific changes in CIN3

A

high NC ratio, big nuclei, more cells (increased cellularity), more mitotic figures

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11
Q

cervical adenocarcinoma in situ (AIS) def + grading

A

see glandular lesions (glands) = AIS present.

no grading**

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12
Q

AIS charact

A
  • glandular
  • high NC ratio
  • mtiotic figures
  • crowding
  • stratification
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13
Q

end point of cervical AIS

A

invasive adenoCA

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14
Q

low risk HPV types (leading to external genitalia lesions)

A

6, 11, etc.

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15
Q

high risk HPV types (LSIL and HSIL)

A

16, 18, etc.

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16
Q

tx of LSIL

A

conservative (regresses often)

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17
Q

tx of HSIL and AIS

A

surgical excision (LEEP)

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18
Q

sx of invasive CA of the cervix

A
  • early = asx

- late = abnormal vaginal bleeding (typically postcoital) and abnormal vaginal discharge

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19
Q

RFs for invasive cervical CA

A
  • many partners
  • high risk partners
  • early age intercourse
  • other STDs
  • immunosuppression
  • smoking
  • high parity
  • low SES
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20
Q

macroscopic lesion charact of invasive squamous CA

A

red exophytic lesion irregular

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21
Q

what’s below the BM of cervix, where do cervical invasive CA cells invade

A

stroma. get an inflammatory desmoplastic response in the stroma

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22
Q

how to define invasive adenoCA of the cervix

A
  • glands fused and formed a clear architecture
  • high NC ratio, high cellularity, mitotic figures, crowding, stratification
  • NOT based on BM bc hard to tell if went below BM or not*
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23
Q

tx of cervical invasive CA early vs late

A
  • early = radical hysterectomy or chemo radiation

- advanced = radiation and chemo

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24
Q

classif of vulva pathologies

A
  • HPV related lesions (same morpho as cervix and now caled VIN for vulvar)
  • non HPV related
  • note: vulva = squamous epith
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25
Q

VIN3 charact on histo

A
  • red
  • slightly raised
  • dysplastic cells
  • mitotic figures
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26
Q

non HPV related lesions in vulva + charact

A
  • lichen simplex chronicus
  • lichen sclerosus
  • chronic inflam
  • setup for squamous cell CA (SCC)
  • especially older pts
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27
Q

(important) what to do when see vulvar lesion

A

biopsy (bc can’t guess if dysplastic)

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28
Q

paths of the endo

A
  • endo hyperplasia with or without atypia

- endo CA

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29
Q

benign paths of the myometrium

A
  • leiomyoma (fibroids)

- adenomyosis

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30
Q

malignant paths of the myometrium

A

leiomyosarcoma (malignant counterpart of fibroids. DOESN’T arise from fibroid)

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31
Q

endo hyperplasia def and cause

A

overgrowth of endo caused by persistent stim by estrogens

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32
Q

common cause of endo hyperplasia

A

granulosa cell tumor

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33
Q

RFs for endo hyperplasia and CA

A
  • obesity
  • diabetes
  • htn
  • infertility
  • estrogen secreting ovarian tumor (like GC tumor)
  • tamoxifen use
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34
Q

sx of endo hyperplasia

A

abnormal vaginal bleeding (usually postmenopausal)

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35
Q

endo hyperplasia without atypia def

A
  • no clonal growth, not neoplstic yet, no cytological atypia*
  • glandular crowding (meaning glands cover >50% of surface)
  • irregular shape of glands
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36
Q

when to tx endo hyperplasia wo atypia and how

A

ALWAYS if dx

-progesterone

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37
Q

atypical endo hyperplasia other name

A

endometrial intraepithelial neoplasia (EIN)

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38
Q

EIN charact

A
  • glandular crowding (meaning glands cover >50% of surface)

- cyto atypia and alteration

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39
Q

most common invasive tumor of the female genital tract

A

CA of the endometrium

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40
Q

clinical pres of CA of endo

A

abnormal vaginal bleeding (PMB = premenopausal bleeding, menometrorrhagia)

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41
Q

2 types of endo CA

A

type 1: estrogen dependent (endometrioid CA and variants)

type 2: unrelated to sustained E stim. (serous CA or clear cell CA)

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42
Q

Lynch syndrome pt: screen for what gyn paths

A

endometrial CA

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43
Q

type 1 vs type 2 endo CA

A
  • type 1 assoc with endometrial hyperplasia. type 2 with atrophy
  • type 1 low grade. type 2 high grade
  • type 1 good prognosis. type 2 bad prognosis.
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44
Q

type 1 endo CA grading

A
  • gade 1 = normal glands, normal endo
  • grade 2 between 1 and 3
  • grade 3 = no glands, undiff. only solid sheaths of cells
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45
Q

type II endo CA serous

A
  • high NC ratio, no cyto
  • shed cells in lumen that travel in tube to get spread
  • more likely lymphovascular spread
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46
Q

type II endo CA clear cell

A
  • clear cytoplasm

- high grade atypical nuclear features and architecture

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47
Q

T1a endo CA def (in TNM staging)

A
  • confined to endo
  • NO myometrium invasion
  • tumor is a raised growth
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48
Q

T1b endo CA def (in TNM staging)

A
  • invasion deep in myometrium
  • almost reached serosa
  • invaded into the outer half of the myometrium
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49
Q

fibroids content

A

benign tumor from smooth muscle, no atypia, spindle cells,, no mitotic figures

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50
Q

fibroids sx

A
  • often asx

- abnormal uterine bleeding

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51
Q

pedunculated fibroid def

A

= out of external os

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52
Q

parasitic fibroid def

A

free floating in pelvic cavity

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53
Q

leiomyosarcoma macro charact

A
  • large
  • solitary
  • hemorrhagic
  • necrosis
  • variegated color
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54
Q

leiomyosarcoma origin

A

arises de novo from SM

55
Q

when to suspect a leiomyosarcoma

A

see a leiomyoma (fibroid) growing a lot after menopause as a single lesion (not supp to happen)

56
Q

leiomyosarcoma charact

A
  • malignant
  • sarcoma
  • not arising from fibroid
  • SM origin
  • grows fast
57
Q

leiomyosarcoma on histo

A
  • spindly like SM
  • atypica cells
  • mitotic figures
58
Q

adenomyosis def

A

abnormal localisation of endometrial stroma and glands within deep myometrium

59
Q

sx of adenomyosis

A

menorrhagia, pelvic pain

60
Q

consequence of adenomyosis

A
  • bleeding in myometrium
  • causes pain + myometrial reaction (hyperplasia)
  • forms tumor like mass
61
Q

adenomyosis on macro

A
  • thick

- trabeculated

62
Q

adenomyosis on micro

A
  • SM
  • stroma
  • endometrial glands
63
Q

types of ovary paths

A
  • non neoplastic lesions
  • borderline lesions (atypical proliferative with potential malignancy)
  • neoplastic lesions
64
Q

non neoplastic lesions of ovaries

A
  • benign cysts

- endometriosis

65
Q

neoplastic lesions of ovaries

A
  • primary (surface epithelial origin which can be benign, borderline or malignant, germ cell tumor or sex-cord stromal tumor)
  • metastatic
66
Q

benign cysts of ovary characteristic progression

A
  • transient
  • physiologic
  • spontaneous regression
  • common in young pts
  • may look like ovarian neoplasm
67
Q

2 types of benign ovarian cysts

A
  • follicular cyst

- corpus luteum cyst

68
Q

benign cysts of ovary charact

A
  • smooth wall
  • unolocular
  • no papillary excresence
  • no solid component
69
Q

when to worry about an ovarian lesion

A
  • liquid
  • solid
  • cystic
  • multicomponent
70
Q

endometriosis and myometriosis def

A

endometrial glands and stroma (or myometrium for myometriosis) present outside endometrial cavity

71
Q

clinical pres of endometriosis

A
  • pelvic pain
  • infertility
  • can mimic a tumor mass (‘‘endometrioma’’)
72
Q

consequences of endometriosis and why have symptoms

A
  • cycles and bleeds in ectopic location

- can cause adhesion and twisting of uterine tube (Fall)

73
Q

endometrioma def

A

endometriosis that formed a tumor mass with bleeding and fibrosis

74
Q

endometriosis macro

A
  • raised, red to brown, can deposit anywhere (skin to lung)

- can deposit on ovaries (cyst dilated ovary)

75
Q

most common area of endometriosis

A

serosa of pelvic area

76
Q

diff names for endometriotic cyst

A
  • cystic endometriosis

- chocolate cyst (one with old hemorrhage)

77
Q

chocolate cyst def

A

benign lesion that can develop endometrioid lesions (atypical hyperplasia and adenoCA are possible in endometriosis)

78
Q

how age helps for ovarian tumor prognosis

A
  • young = likely benign

- older = likely malignant

79
Q

4 categories of ovarian neoplasms

A
  • surface epithelial or stromal cells
  • germ cells
  • sex-cord stroma
  • metastasis to ovaries
80
Q

most common ovarian neoplasm

A

surface epithelial tumors

81
Q

important thing to know about germ cell tumors of ovaries

A
  • develop in young patients (under 25). pelvic mass or ovarian mass.
  • important ddx
  • serum markers help to dx
82
Q

3 types of surface epithelial tumors of ovaries

A
  • serous (tubal)
  • mucinous (endocervical)
  • endometrioid (endometrial type)
83
Q

most common ovarian neoplasm

A

high grade serous surface epithelial CA

84
Q

3 classifications that each epithelial tumor type of ovary can have depending on prognosis

A
  • benign
  • atypical, borderline
  • malignant
85
Q

diff categories of benign epithelial tumors of ovaries

A
  • cystadenoma
  • cystadenofibroma
  • adenofibroma
  • name depending on if see lot of fibroid, cystic component
86
Q

diff categories of malignant epithelial tumors of ovaries

A

-adenoCA
-cystadenoCA
(not really imp if cyst present or not tho..)

87
Q

dx features of epithelial tumors of ovaries

A
  • cell prolif
  • nuclear atypia
  • stromal invasion
88
Q

2 most common gynecologic malignant tumors

A 
#1 endometrial CA
#2 ovarian carcinoma
89
Q

leading cause of death in gyn cancers

A

ovarian cancer

90
Q

sx of ovarian CA

A
  • often asx until spread

- non specific, vague sx = urinary symptoms, GI, etc.

91
Q

causes classif for ovarian CA

A
  • sporadic (de novo) (90%): no precursor lesion.

- hereditary (10%): BRCA1, BRCA2, HNPCC (Lynch)

92
Q

2 things protective against ovarian CA

A
  • high parity

- use of OCP

93
Q

diff types of serous tumors of ovary

A
  • serous cystadenoma
  • serous cystadenofibroma
  • serous borderline tumor
  • low grade serous CA (uncommon)
  • high grade serous CA (more common)
94
Q

how do you grade a serous tumor of ovary found in the uterine tube

A

high grade by def

95
Q

steps of pathophgy of low grade serous CA of ovary

A
  • tubal type of epith
  • get serous cystadenoma
  • Kras and BRAF mutation = epith prolif
  • serous borderline tumor is the result
  • stromal invasion (mutations)
  • LGSC is the result
96
Q

steps of pathophgy of HGSC

A
  • tubal type epith
  • p53 mutation
  • result = HGSC
97
Q

theory (almost accepted) regarding origin of HGSC

A
  • originates in end of fall tube as serous tubal intraepithelial CA (STIC)
  • goes to ovaries
98
Q

(important) precursor lesion that causes most high grade serous CA of ovaries

A

serous tubal intraepithelial CA of the Fallopian tube

99
Q

serous cystadenoma histo

A

-single layer of tubal epith. smooth wall. genign

100
Q

serous borderline ovarian CA histo

A
  • epithelial prolif

- grape like growth in the lumen, tree like branches, papillary projections with epith cells

101
Q

LGSC of ovaries on histo

A

stromal invasion

102
Q

HGSC of ovaries on histo

A
  • big nucleoli

- papillary growth pattern

103
Q

diff types of mucinous tumors of ovaries

A
  • benign mucinous cystadenoma
  • mucinous borderline tumor
  • invasive mucinous CA
104
Q

mucinous cystadenoma histo

A
  • smooth wall
  • cystic
  • looks like cervix
105
Q

mucinous borderline histo

A
  • solid growth

- prolif of epith

106
Q

mucinous CA histo

A
  • obvious solid component
  • stroma
  • neoplastic epith in the stroma
107
Q

important thing about INVASIVE mucinous tumors of ovary (mucinous CA)

A

80% are metastatic and come from another source particularly GIT

108
Q

imp thing to do if suspect mucinous CA of ovaries

A

G scope and C scope to rule out GI cancer

109
Q

endometrioid CAs assoc with what conditions

A
  • ovarian or pelvic endometriosis (makes sense bc can then become neoplastic)
  • endometrioid CA of the endometrium (sometimes can’t tell which is metastasis of the other)
110
Q

how to dx ovarian cancer

A

at time of laparotomy (for staging), bc late detection. by bx of omentum or peritoneum

111
Q

tumor marker of ovarian CA

A

C25

112
Q

screening tests for ovarian CA

A

none

113
Q

2 categories of germ cell tumors of ovaries

A
  • benign dermoid cyst (97%)

- malignant (3%): dysgerminoma and non dysgerminoma

114
Q

4 types of non dysgerminoma germ cell tumors of ovaries

A
  • endodermal sinus (yolk sac tumor)
  • immature teratoma
  • embryonal carcinoma
  • choriocarcinoma
115
Q

sx of malignant germ cell tumors of ovaries

A
  • young people
  • abd pain, pelvic mass, rapidly enlarging
  • highly aggressive
  • highly chemosensitive
116
Q

tumor markers of dysgerminoma germ cell tumors of ovaries

A
  • LDH
  • EST
  • alpha FP
  • chorio:hCG
117
Q

dermoid cyst germ cell tumors of ovaries other name

A

mature cystic teratoma (dermoid cyst)

118
Q

mature cystic teratoma histo

A
  • sebaceous glands
  • cartilage
  • neural tissue
  • from endo, meso or ecto derm embryonically
119
Q

most common ovarian tumor

A

dermoid cyst (mature cystic teratoma)

120
Q

sex cord stromal tumors of ovaries composition

A
  • sex cord derivatives (GCs and Sertoli cells)

- stromal derivatives (theca and Leydig cells)

121
Q

most common sex cord stromal tumors of ovaries

A
  • fibroma
  • thecoma
  • granulosa cell tumor
122
Q

how to determine the type of sex cord stromal tumors of ovaries a patient has

A
  • the tumor may be functioning or not, meaning secreting estrogen or androgen or not)
  • if secreting estrogen, see feminization so know it’s thecoma
  • if secreting androgens, see masculinization so know it’s Sertoli cell tumor (Sertoli-Leydig cell)
123
Q

what to worry about in estrogen producing sex cord stromal tumors of ovaries like thecomas

A

high estrogen so have to check if endometrium is fine

124
Q

general features of metastatic tumors of the ovaries

A
  • bilateral
  • surface deposit
  • multinodular
  • lymphovascular invasion (more commonly)
  • IHC help dx
125
Q

how definite dx of metastatic tumor of ovaries is done

A

IHC

126
Q

3 most common metastatic tumor of ovaries

A
  • Colorectal ca
  • breast ca
  • Krukenberg ca
127
Q

krukenberg ca def

A
  • signet ring cell CA from GIT
  • most often gastric stromal CA
  • SIGNET RING CELLS*
128
Q

most common breast cancer to metastasize to ovaries

A

invasive lobular CA (bc tends to invade abdominal and pelvic cavities)

129
Q

paths of the fall tube

A
  • PID (inflammatory disorder of upper GIT most often secondary to bacterial infection)
  • tumor (STIC): precursor of lot of peritoneal, pelvic, high grade CA
130
Q

complications of PID

A
  • hydrosalpinx (infalmmation overtime, reactive changes, adhesions, fibrosis. twisted, tender, lumen blocked, cystic lesion like.
  • prob of higher incidence of ectopic pregnancy + INFERTILITY
  • tubo-ovarian abscess. (can get misdx as a tumor), is painful
131
Q

what’s the prophylactic tx for ovarian cancer in BRCA carriers

A

removal of fallopian tubes

132
Q

diagnostic features of STIC when see it when bx it from removed fallopian tubes in BRCA carrier

A
  • significant atypia
  • p53 mutation
  • increased Ki67 prolif mix
133
Q

tubal intraepith CA (TIC) often assoc with what

A

invasive serous CA in the tube

134
Q

pelvic HGSC different theories for organ of origin

A
  • ovarian
  • tubal
  • tubo-ovarian
  • peritoneal

Bloc I - Reproduction (57 decks)

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