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Reproductive > Vaginal, cervical and ovarian pathology (not malignant tumors) > Flashcards

Vaginal, cervical and ovarian pathology (not malignant tumors) Flashcards

1
Q

Gynecologic tumor epidemiology - incidence

A

US: 1. endometrial 2. ovarian 3. cervical
Worldwide: cervical is more common (Lack of screening or HPV vaccination)

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2
Q

Gynecologic tumor epidemiology - worst prognosis

A
  1. ovarian
  2. endometrial
  3. cervical
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3
Q

vaginal tumors

A
  1. Squamous cell carcinoma
  2. Clear cell adenocarcinoma
  3. Sarcoma botryoides (embryonal rhabdomyosarcoma variant)
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4
Q

vaginal tumors - types and characteristics

A
  1. SCC: usually 2ry to cervical SCC (rare 1ry)
  2. clear cell adenocarcinoma: Women who had exposure to DES in utero
  3. Sarcoma botryoides: girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina
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5
Q

vaginal tumors - SCC

A

usually 2ry to cervical SCC (rare 1ry)

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6
Q

vaginal tumors - clear cell adenocarcinoma

A

Women who had exposure to DES in utero

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7
Q

Sarcoma botryoides (embryonal rhabdomyosarcoma variant) - epidemiology and appearance

A

girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina

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8
Q

Cervical dysplasia and carcinoma - definition, location

A

Disordered epithelial growth. Begins at basal layer of Squamocolumnar Junction (transformation zone) and extends outward

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9
Q

Cervical dysplasia and carcinoma - Classification

A

CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extend of dysplasia

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10
Q

cervical dysplasia and carcinoma - pathogenesis

A

HPV 16, 18 –> both produce E6 (inh p53) and E7 (inh RB)

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11
Q

cervical dysplasia and carcinoma - May progress

A

slowly to invasive carcinoma i left untreated

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12
Q

cervical dysplasia and carcinoma - presentation

A
  1. typically asymptomatic (detected with Pap smear - koilocytes)
  2. presents as abnormal vaginal bleeding (often postcoital - after sexual intercourse)
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13
Q

cervical dysplasia and carcinoma - Risk factors (MC?)

A
  1. Multiple sexual partners (MC)
  2. Smoking
  3. Starting sexual intercourse at young age
  4. HIV infection
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14
Q

Koilocyte

A

squamous epithelial cell that has structural changes, as a result of infection HPV

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15
Q

Koilocyte - structural changes

A
  1. Nuclear enlargement
  2. Irregularity of the nuclear membrane contour
  3. darker nucleus (Hyperchromasia)
  4. perinuclear halo.
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16
Q

cervical invasive carcinoma - type

A

often SCC

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17
Q

cervical invasive carcinoma - Diagnosis

A

colposcopy and biopsy

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18
Q

cervical invasive carcinoma - complication

A

lateranl invasion –> block ureters –> renal failure

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19
Q

Premature ovarian failure - definition

A

premature atresia of ovarian follicles in women of reproductive age

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20
Q

Premature ovarian failure - presentation and endocrine profile

A

signs of menopause after puberty but before 40

endocrine profile: low estrogen, high LH, FSH

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21
Q

Polysystic ovarian syndrome is AKA

A

Stein-Leventhal syndrome

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22
Q

Polysystic ovarian (Stein-Leventhal) syndrome - mechanism

A

hyperinsulinemia and/or insulin resistance is hypothesized to alter hypothalamic hormonal feedback response –> high LH/FSH –> increased androgen production from theca cells (LH) (–> hirsutism) but low estrogen (no FSH on granulosa), low rate of follicular maturation –> unruptured follicles (cysts) + anovulation

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23
Q

Polysystic ovarian (Stein-Leventhal) syndrome - risk factors

A

obesity

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24
Q

Polysystic ovarian (Stein-Leventhal) syndrome - image

A

enlarged, bilateral cystic ovaties

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25
Q

Polysystic ovarian (Stein-Leventhal) syndrome - presentation

A
  1. amenorrhea/oligomenorrhea
  2. hirsutism
  3. acne
  4. low fertility
26
Q

Polysystic ovarian (Stein-Leventhal) syndrome - estrogen levels (mechanism)

A
  1. low 17β -estradiol (low FSH –> no aromatization granulosa cells)
  2. high estrone (aromatization of androgen on adiposse tissue)
27
Q

Polysystic ovarian (Stein-Leventhal) syndrome - increased risk of … (and mechanism)

A
  1. endometrial cancer 2ry to unopposed estrogen from repeated anovulatory cycles
  2. Ovarian neoplasm
28
Q

Polysystic ovarian (Stein-Leventhal) syndrome - treatment

A
  1. weight loss,
  2. OCP
  3. clomiphene citrate
  4. ketoconazole
  5. spironolactone
29
Q

MCCs of anovulation (11)

A

pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, competitive athletics, Cushing syndrome, adrenal insuficiency

30
Q

MC ovarian mass in young women

A

follicular cysts

31
Q

Ovarian cysts - types

A
  1. follicular cysts

2. Theca lutein cyst

32
Q

ovarian follicular cysts

A

distention of unruptured graafian follicle

33
Q

graafian follicle?

A

Tertiary vesicular follicles or mature vesicular follicles

34
Q

ovarian follicle cyst may be associated with

A
  1. hyperestrogenism

2. endometrial hyperplasia

35
Q

Theca-lutein cyst - definition/mechanism

A

often bilateral/multiple due to gonadotropin stimulation

36
Q

Theca-lutein cyst - associated with

A
  1. choriocarcinoma

2. hydatidiform moles

37
Q

Most common adnexal mass in women over 55

A

Ovarian neoplasm

38
Q

Ovarian neoplasms arises from

A
  1. surface epithelium
  2. germ cells
  3. sex cord stromal tissue
39
Q

Majority of malignant ovarian neoplasms

A

epithelial (serous cystedocarcinoma MC)

40
Q

increased risk for ovarian neoplasm

A
  1. advanced age
  2. infertility
  3. endometriosis
  4. Polysystic ovarian syndrome
  5. genetics (BRCA1/2 Lynch syndrome, family history)
41
Q

genetic predisposition for ovarian neoplasm

A

BRCA1/2 Lynch syndrome, family history

42
Q

decreased risk for ovarian neoplasm

A
  1. previous pregnancies
  2. history of breastfeeding
  3. OCPs
  4. tubal ligation
43
Q

ovarian neoplasm - presentation

A
  1. adxenal mass
  2. abdominal distention
  3. bowel obsruction
  4. pleural effusion
44
Q

ovarian neoplasm - marker and characteristics

A

CA-125 –> monitor to response to therapy/relapse

not good for screening

45
Q

Benign ovarian neoplasms

A
  1. serous cystadenoma
  2. mucinous cystadenoma
  3. endometrioma
  4. mature cystic teratoma (dermoid cyst)
  5. Brenner tumor
  6. fibromas
  7. thecoma
46
Q

MC ovarian neoplasm

A

Serous cystadenom

47
Q

Serous cystadenoma - histology/characteristics

A
  • lined with fallopian tube-like epithelium

- often bilateral

48
Q

Mucinous cystadenoma - histology/characteristics

A
  • Multiloculated (many small covities), large

- lined by mucus-secreting epithelium

49
Q

ovarian endometrioma - definition

A

endometriosis (ectopic endometrial tissue) within ovary with cystic formation

50
Q

ovarian endometrioma - presentation

A
  1. pelvic pain
  2. dysmenorrhea
  3. dyspareunia
    symptoms may vary with menstrual cycle
51
Q

ovarian endometrioma - appearance

A
  1. “chocolate cyst” - endometrioma filled with dark, redish-brown blood.
  2. Complex mass on US
52
Q

MC ovarian tumor in females 10-30

A

Mature teratoma of ovary (dermoid cyst)

53
Q

Mature teratoma of ovary is AKA

A

dermoid cyst

54
Q

Mature teratoma of ovary (dermoid cyst) - origin/appearance

A

germ cell tumor - cystic mass contating elements all 3 germ layers (eg. teeth, hair, sebum)

55
Q

Mature teratoma of ovary (dermoid cyst) - presentation

A
  1. pain 2ry to ovarian enlargement or torsion

2. a monodermal form with thyroid tissue (stroma ovari) uncommonly presents with hyperthyroidism

56
Q

A struma ovarii is

A

a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism

57
Q

Brenner tumor - appearance

A

like bladder

  • solid tumor that is pale-yelllow tan and appearns encapsulated
  • coofee been nuclei on hemotaxelin-eosin stain
58
Q

ovarian fibromas - definition/histology/presentation

A

bundles of spindle-shape fibroblasts

pulling sensation in groin

59
Q

Meig syndrome

A

triad of

  1. ovarian fibroma
  2. ascites
  3. hydrothorax
60
Q

Thecoma - characteristic, presentation

A

like granulosa cell tumors –> may produce estrogen

usually presents as abnormal uterine bleeding in postmenopausal women

Reproductive (20 decks)

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