The Female Genital Tract Flashcards
Cystic dilation of the Bartholin gland due to duct obstruction; may be infected and may lead to abscess formation; occurrence in women >40 years old requires biopsy to rule out carcinoma.
Bartholin cyst
Lesion characterized by thinning of the epidermis, basal cell degeneration, hyperkeratosis, sclerotic changes of superficial dermis, dermal lymphocytic infiltrate; not premalignant, but symptomatic form has increased risk of vulvar cancer.
Lichen sclerosus
Lesion characterized by acanthosis, hyperkeratosis, dermal lymphocytic infiltrate with evident mitosis; not considered premalignant.
Squamous hyperplasia
Lesions of the anogenital area that may be papillary and distinctly elevated or may be somewhat flat and rugose; characteristic cellular morphology is the presence of cytoplasmic vacuolization with nuclear angular polymorphism and koilocytic atypia: hallmark of HPV infection; not precancerous.
Condyloma acuminata
HPV subtypes associated with condyloma acuminata.
HPV 6 and 11
Most common histology of vulvar carcinoma.
Squamous cell carcinoma (Note: most vulvar Cas are non-HPV related (70%))
Clinically presents as eczematoid lesion on the vulva; characterized by proliferation of malignant epithelial cells within the epidermis; usually not associated with underlying carcinoma, unlike its breast counterpart; PAS-positive (positive for mucin), unlike vulvar melanoma.
Vulvar Paget disease
Most common histology of vaginal carcinoma.
Squamous cell carcinoma
A soft polypoid mass, which is a rare form of primary vaginal cancer; Usually encountered in infants and children less than 5 y/o.
Sarcoma botryoides (Embryonal rhabdomyosarcoma)
Condition characterized by Areas of columnar mucinous epithelium (endocervical-like); 35-90% of patients with in utero exposure to DES; associated with clear cell CA of vagina.
Vaginal adenosis
Premalignant lesion of the cervix; can be low-grade (I; <1/3 of the entire epithelium), moderate (II; up to 2/3 of the entire epithelium), and severe (III or CIS; full-thickness of epithelium without invasion of the basement membrane).
Cervical intraepithelial neoplasia (CIN)
Another term for CIN I in the recent two-tiered classification system; regresses in 60% of cases.
Low-grade squamous intraepithelial lesion (LSIL)
Another term for CIN II and III in the recent two-tiered classification system; persists in 60% of cases, with 10% of cases progressing to carcinoma within 10 years.
High-grade squamous intraepithelial lesion (HSIL)
High-risk HPV implicated in the development of cervical carcinoma.
HPV 16, 18, 31 and 33
Viral oncoprotein responsible for koilocytic atypia in HPV-infected cells.
E5
HPV viral gene products that promote tumorigenesis and the tumor suppressor genes they inactivate.
E6 (inactivates p53) and E7 (inactivates Rb)
Most commonly develops in the transformation zone of the cervix; produces a “barrel cervix” if the tumor encircles the cervix and invades the underlying stroma; most common histology is squamous cell carcinoma (80%), followed by adenocarcinoma (15%) and neuroendocrine carcinoma (5%); all of the types are caused by HPV.
Invasive cancer of the cervix
Most common cause of death in cervical cancer.
Uremia
Most common cause of dysfunctional uterine bleeding.
Anovulatory cycle
Refers to the growth of the basal layer of the endometrium down to the myometrium; nests of endometrial stroma, glands or both are found in the myometrium, in between muscle bundles.
Adenomyosis
Characterized by the presence of endometrial glands and stroma in a location outside the myometrium.
Endometriosis
Exophytic masses that project into endometrial cavity; may be clinically silent or may cause abnormal uterine bleeding.
Endometrial polyp
Tumor suppressor gene commonly mutated in atypical endometriosis, endometrial hyperplasia and endometrial carcinomas; also mutated in endometrioid and clear cell carcinomas of the ovary.
PTEN
Precursor lesion of endometrial carcinoma secondary to prolonged and marked increased estrogen to progestin ratio; can be simple or complex, with or without atypia.
Endometrial hyperplasia
Atypical hyperplasia is now also called endometrial intraepithelial neoplasia (EIN).
Endometrial hyperplasia
Most common malignancy of the female genital tract.
Endometrial carcinoma
Most common histology of endometrial carcinoma found in 80% of cases; associated with atypical hyperplasia; maybe exophytic or infiltrative; histologically resembles endometrial glands to solid sheets, depending on differentiation; low-grade nuclei is a usual feature.
Endometrioid carcinoma (Type I)
Accounts for 15% of cases of endometrial carcinoma; forms small tufts and papillae with high nuclear grade.
Serous carcinoma (Type II)
Common gene mutated in leiomyomas and leiomyosarcomas.
MED12
Most common benign tumor in females; grossly appears as sharply circumscribed firm gray white masses with a characteristic whorled cut surface; histologically similar to normal smooth muscle cells.
Leiomyoma
Malignant counterpart of leiomyoma; grossly appears as soft, hemorrhagic, necrotic masses; diagnostic features include: tumor necrosis, cytologic atypia and mitotic activity; necrosis being the most important criterion among the three.
Leiomyosarcoma
Most common major type of ovarian tumors; 90% of which are malignant.
Surface epithelial-stromal tumors (65-70%)
Most common ovarian epithelial tumors; tumors with tubal-like epithelium; most are benign or borderline (70%).
Serous tumors
Grossly appears as large, spherical structures with smooth glistening serosal covering with less papillary projections; histologically, with a single layer of tall columnar epithelial cells without atypia and invasion; usually with Psammoma bodies.
Serous cystadenoma
Serous cystadenoma with micropapillary architecture and epithelial stratification, mild nuclear atypia but without invasion of stroma.
Bordeline serous tumor
Grossly appears as large, spherical structures with nodular serosal covering with prominent papillar projections; histologically, with layers of anaplastic epithelial cells and invasion; usually with Psammoma bodies; cancers are divided into low-grade (well-differentiated) or high-grade (moderately-differentiated or poorly-differentiated), based on general architecture, nuclear atypia and severity of stromal invasion.
Serous cystadenocarcinoma
Mutations associated with low-grade serous carcinomas.
KRAS, BRAF, ERBB2
Mutation associated with high-grade serous carcinomas.
TP53
Mucin-containing cystic masses; can be benign or malignant, but most of them are benign; tend to be larger, multicystic and unilateral; can rupture into the peritoneum and produce mucinous ascites (pseudomyxoma peritonei).
Mucinous tumors
Most consistent mutation in mucinous tumors.
KRAS
Tumors are usually malignant; 15-20% coexist with endometriosis; histologic hallmark is presence of tubular glands resembling benign or malignant endometrium.
Endometrioid tumors
Metastatic mucinous adenocarcinoma of the ovary from a gastrointestinal primary; often produces bilateral ovarian masses.
Krukenberg tumor
Cystic, lined by skin-like structures; usually occur in reproductive age women; histologically, derivatives from more than one germ layer can be seen; generally benign.
Mature teratoma
Solid masses that usually occur in younger women and children; histologically composed of neuroepithelium; generally malignant.
Immature teratoma
A type of teratoma that produces hyperthyroidism due to presence of mature thyroid tissue.
Struma ovarii
Ovarian tumor that may elaborate large amounts of estrogen; two thirds occur in post-menopausal women; potentially malignant; histologically composed of mixture of cuboidal granulosa cells in cords, sheets, or strands and spindled or plump lipid-laden theca cells; granulosa elements may recapitulate ovarian follicle as Call-Exner bodies.
Granulosa cell tumor
Sex cord tumor that recapitulates development of testis with tubules or cords and plump pink Sertoli cells; masculinizing and rarely malignant.
Sertoli-Leydig cell tumor
Sex cord stromal tumor composed of solid gray fibrous cells to yellow (lipid-laden) plump thecal cells; rarely malignant; associated with hydrothorax and ascites (Meig syndrome).
Thecoma-fibroma
A type of hydatidiform mole with the following features: diploid karyotype with diffuse villus edema and trophoblast proliferation; markedly elevated hCG with increased risk of developing subsequent choriocarcinoma.
Complete hydatidiform mole
A type of hydatidiform mole with the following features: triploid karyotype with focal villus edema and trophoblast proliferation; less elevated hCG with rare chance of developing subsequent choriocarcinoma.
Incomplete (Partial) hydatidiform mole
Complete moles that are more invasive locally but do not have the aggressive metastatic potential of a choriocarcinoma.
Invasive mole
Main difference between ovarian and gestational choriocarcinoma.
Ovarian chorioCAs are more difficult to treat
