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DIT topics > vulva + vagina + cervix + uterine + ovarian > Flashcards

vulva + vagina + cervix + uterine + ovarian Flashcards

1
Q

round ligament of uterus terminates here

A

labia majora

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2
Q

skene glands are located around the

A

urethra

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3
Q

bartholin glands located

A

near vagina opening
ducts at 5 o’clock and 7 o’clock
obstruction of duct → cyst → infected cyst = abscess (I & D)
provide lubrication for intercourse

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4
Q

part of cervix in vagina

A

ectocervix

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5
Q

part of cervix closer to uterus is

A

endocervix

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6
Q

histology of vulva

A 
stratified squamous epithelium
labia majora (exposed): keratinized
labia minor (moist): non-keratinized
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7
Q

histology of vagina

A

stratified squamous epithelium (non-keratinized)

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8
Q

histology of ectocervix

A

stratified squamous epithelium (non-keratinized)

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9
Q

histology of endocervix

A

simple columnar epithelium (mucous-secreting cells prevent infection to uterus)

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10
Q

where does most cervical cancers occur

A

squamocolumnar junction of the transformation zone (transitions between ectocervix and endocervix)
HPV can infect and replicate well here

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11
Q

squmocolumnar junction is located in

A

transformation zone

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12
Q

metaplastic cells transform from columnar (endocervix) → squamous epithelium (ectocervix) here
depends on age + hormonal status of women

A

transformation zone

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13
Q

histology of body of uterus

A

simple columnar epithelium (ciliated or secretory, long tubular glands)

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14
Q

histology of fallopian tube

A

simple columnar epithelium (mostly ciliated, some secretory (peg) cells - nutrition to egg)

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15
Q

histology of ovary

A

simple cuboidal epithelium (germinal epithelium)

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16
Q

most ovarian cancer come from what epithelium

A

simple cuboidal epithelium

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17
Q

most common type of vulvar cancer

A

squamous cell carcinoma of vulva

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18
Q 
pre-pubertal or post-menopausal female
benign, inflammatory lesion of vulva
thinning of epidermis
smooth, white plaques
pruritic, pain, dyspareunia
A

lichen sclerosus

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19
Q

treatment of lichen sclerosus

A

topical corticosteroids

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20
Q

vulvar lesion associated with increased risk of squamous cell carcinoma of vulva

A

lichen sclerosus

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21
Q

most common type of vulvar cancer

A

squamous cell carcinoma of vulva

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22
Q

increased risk of squamous cell carcinoma of vulva if:

A 
HPV infection (koilocytes present) -30% cases
chronic inflammation (most cases) - like lichen sclerosus
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23
Q

HPV infection (oncogenic strains: 16, 18, 31) can cause

A 
squamous cell carcinoma of:
(vulvar and vaginal cancer are secondary to cervical SCC - have same risk factors)
cervical cancer
vulvar cancer
vaginal cancer
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24
Q

koilocytosis (enlarged nuclei, white cytoplasmic clearing)

A

squamous cells infected with HPV (viral replication occurring here)

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25
Q

intraepithelial cancer of vulva (occurs in skin)
can be associated with underlying malignancy of vulva or non-vulvar (breast, GI)
red, well-demarcated lesion
pruritic (like eczema)

A

Paget disease of vulva

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26
Q

intraepithelial cancer of vulva (occurs in skin)

can be associated with underlying malignancy

A

Paget disease of breast

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27
Q

types of vaginal cancers

A

squamous cell carcinoma
clear cell adenocarcinoma
sarcoma botryoides

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28
Q

vaginal cancer associated with high-risk HPV strains (16, 18, 31)

A

squamous cell carcinoma

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29
Q

vaginal cancer associated with in utero

diethylstilbestrol (DES) exposure

A

clear cell adenocarcinoma of women in utero during exposure:

DES was given in 40/50’s to prevent miscarriage

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30
Q

SE of DES exposure

A

clear cell adenocarcinoma of vagina of women in utero during exposure
mullerian duct anomalies: T-shaped uterus
vaginal adenosis (patches of columnar epithelium on ectocervix + vagina)

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31
Q

vaginal cancer in infants and children

A

sarcoma botryoides (embryonal rhabdomyosarcoma)

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32
Q

progression of cervical cancer

A 
infection of squamocolumnar junction of the transformation zone with high-risk HPV 16 and 18 have oncogenes E6 + E7 → mutated cells →
cervical dyplasia (screen for this) → cervical cancer
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33
Q

risk factors for cervical dysplasia + cancer

A

persistent infection with high-risk HPV strain (16 + 18 = 70% of cervical cancers)
early coitarche: ↑ risk of exposure to HPV
multiple sexual partners
immunosuppression (HIV): can’t clear infection
smoking: impairs immunity
OCP use: don’t protect against HPV infection
history of STDs

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34
Q

Rb is a tumor suppressor that

A

G1 → S checkpoint
binds to and inactivates E2F TF (transcribes genes for DNA replication)
at G1→S

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35
Q

E7 protein

A

binds and inactivates Rb → activated E2F TF → DNA replication (G1 →S)

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36
Q

p53 is a tumor suppressor that controls

A

senses DNA damage at G1→S or G2→M
stop cell-cycle for DNA repair
if no repair possible: p53 induces apoptosis of cell

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37
Q

E6 protein

A

binds to p53 →degradation of p53 →DNA damage → cancer

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38
Q

types of cervical cancer

A

squamous cell carcinoma (most common)

adenocarcinoma

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39
Q

CIN describes

A

how far dysplastic cells extend
CIN: bottom 1/3 of epithelium
CIN II: 2/3 or full thickness involvement

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40
Q

invasive cervical carcinoma

A

invasion through BM

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41
Q

more common grading scheme
low grade and high grade SIL
(squamous intraepithelial lesions)

A 
LSIL: = CIN I (mild dysplasia)
HSIL = CIN II (moderate dysplasia) /III (severe or CIS)
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42
Q

most LSIL’s

A

regress

tx: just monitor

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43
Q

most HSIL’s

A

are precancerous

tx: need excision

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44
Q

cervical cancer screening

A

Pap smear: catches cervical dysplasia (koilocytes, darkening of nuclei, ↑N/C) before progressive to invasive carcinoma
if >30 yo: HPV DNA test + Pap smear allows to space out the screening interval

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45
Q

HPV vaccines

A

prevent HPV infection and cervical dysplasia

bivalent: 16 + 18
quadravalent: 16 + 18, 6 + 11 (90% of genital warts)

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46
Q

abnormal vaginal bleeding (poist-coital) due to friable tissue in cervix
nonspecific vaginal discharge
pelvic or low back pain
bowel or bladder symptoms
ureteral obstruction → pyelonoephritis, uremia, renal failure

A

cervical cancer

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47
Q

staging and treatment of cervical cancer

A 
staged clinically (not surgically)
treatment depends on stage: surgery +/- chemoradiation
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48
Q

3 layers of uterus

A

perimetrium: outer serosal
myometrium: smooth muscle
endometrium: glandular, grows via estrogen

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49
Q

4 layers of endometrium

A 
stratum spongiosum + stratum compactum: sheds every month (due to low estrogen/progesterone)
stratum basale (base layer): doesn't shed with menstruation
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50
Q

estrogen causes the endometrium to

A

proliferate and become thicker during 1st have of cycle

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51
Q

excess estrogen can cause

A

endometrial hyperplasia and carcinoma

52
Q

risk factors for endometrial hyperplasia

A

unopposed estrogen state:
anovulation (PCOS): no CL forms (source of progesterone)
↑ estrogen production: granulosa cell tumor (secretes estrogen), obesity (estrone)
↑ exogenous estrogen with uterus (HRT without progesterone)

53
Q

most common gyn cancer in US

A

endometrial carcinoma

54
Q

55-65 yo women (post-menopausal)

irregular bleeding or post-menopausal bleeding

A

endometrial carcinoma

55
Q

diagnosis of endometrial cancer

A

endometrial biopsy

56
Q

inflammation of endometrium
caused by ascending vaginal infection (most common)
acute: postpartum (Csection), retained products of conception
chronic: due to PID, retained foreign bodies

A

endometritis

57
Q

plasma cell in endometrium

A

CHRONIC endometritis

58
Q

treatment of endometritis

A

broad spectrum antibiotic

post-partum endometritis: getamicin + clindamycin

59
Q

endometrial tissue outside uterus

tissue bleeds every month → irritation, pain → inflammation → fibrosis + adhesions

A

endometriosis

60
Q

possible causes of endometriosis

A

retrograde menstrual flow through fallopian tubes
metaplasia of coelomic epithelium (germinal epithelium)
vascular or lymphatic spread

61
Q

common areas of endometriosis

A 
ovaries (most common) → large ovarian cysts with blood → chocolate cyst
uterine ligaments
bowel, bladder
lungs
bone
heart
62
Q 
childbearing women with
dysmenorrhea
CYCLIC pelvic pain
dsypareunia
dysuria
dyschezia - pain with BM
NORMAL-SIZED uterus
A

endometriosis

63
Q

diagnosis of endometriosis

A

laparoscopy: biopsy + therapeutic (remove implants)

64
Q

treatment of endometriosis

A 
laparoscopy - remove lesions
NSAIDs
OCPs
progestins: inhibit growth of endometrial tissue
leuprolide: continous GnRH agonist
danazol
65
Q

hypeplasia of basalis layer of endometrium → endometrial tissue extends into myometrium (smooth muscle layer) → hypertrophy (thickened) uterine wall

A

adenomyosis

66
Q 
menorrhagia
dysmenorrhea
dyspareunia
pelvic pain
UNIFORMLY ENLARGED, SOFT globular uterus
uterus TENDER upon palpation
A

adenomyosis

67
Q

treatment of adenomyosis

A

hysterectomy

68
Q

benign tumor of smooth muscle of the myometrium
monoclonal (each arises from one cell)
hormone sensitive to estrogen/progesterone (bigger with pregnancy, ↓ in size with menopause)

A

leiomyoma

69
Q

most common benign tumor in women

A

leiomyoma

70
Q

round, firm, well-circumscribed tumors

“whorled pattern” of smooth muscle cells

A

leiomyoma

71
Q 
most asymptomatic
menorrhagia (most common sx)
dysmenorrhea
pelvic pressure/discomfort
acute pelvic pain (fibroid on stalk and twists itself → cuts of its blood supply) or (outgrow blood supply → becomes necrotic)
infertility, miscarriages
urinary frequency: compress bladder
non-tender, ENLARGED uterus with IRREGULAR contours
A

leiomyoma

72
Q

diagnosis of leiomyoma

A

physical exam followed by US (confirmation)

73
Q

treatment of leiomyoma

A

hysterectomy
myomectomy (only remove fibroid - can result in ↑ number of leiomyomas after surgery)
leuprolide pre-op: shrink fibroid

74
Q

can leiomyomas progress to leiomyosarcomas

A

no

75
Q

malignant tumor arising from myometrium de novo

A

leiomyosarcoma

76
Q

women with rapidly enlarging uterus and/or

vaginal bleeding

A

leiomyosarcoma

77
Q

SE of drug used to shrink leiomyoma pre-op and endometriosis

A

bone loss (produces a menopausal-like state)

78
Q

dominant (graafian) follicle fails to rupture at ovulation (after LH surge) → follicle continues to grow
regresses spontaneously

A

follicular cyst (type of functional cyst)

79
Q

corpus luteum does not degenerate (should involute after 2 weeks with no fertilization or after 6 wks if pregnancy ocrurs)
usually hemorrhagic cyst (broken blood vessel at time of ovulation)
regresses spontaneously

A

corpus luteum cyst

80
Q

ovarian cyst due to high hCG levels (multiple gestations, molar pregnancy, gestational trophoblastic disease, assisted reproductive techniques)
bilateral, multiples usually

A

theca-lutein cyst

81
Q

ovarian cyst with multiple tissue types from all 3 germ layers (endoderm, mesoderm, ectoderm)

benign: mature tissue
malignant: immature tissue (neuroectoderm)

A

teratoma (dermoid cyst)

82
Q

ovarian cyst that contains blood

A

hemorrhagic cyst

83
Q

endometriosis inside the ovary →cyclic bleeding in the ovary

A

endometriod cyst or

“chocolate cyst” or endometrioma

84
Q

twisting of supportive ligaments of ovary →↓ blood supply → ischemia, necrosis

A

ovarian torsion

greatest risk if >5 cm

85
Q

acute onset of severe (sharp, stabbing) pelvic pain with possible radiation to back or groin
+/- nausea and vomiting

A

ovarian torsion

86
Q

treatment for infertility

A

leuprolide: GnRH agonist (continuous - act like antagonist)
clomiphene: estrogen antagonist effect, induces ovulation

87
Q

inability to conceive after 1 year of unprotected intercourse

A

infertility

85% successful after 1 year

88
Q

female causes of infertility

A

PCOS: anovulation
endometriosis: affects tubes
uterine fibroids
PID: ascending infection of female reproductive tract, scar tubes
chromosomal abnormalities: turner syndrome (streak ovaries)
Ashermann syndrome: (intrauterine adhesions) after D&C

89
Q

work up for infertility

A

ovulating (cyclic menses, mittleschmertz - mid-cycle pelvic pain at ovulation, LH surge predictor kit, biphasic basal body temp (1 day after ovulation)?
reproductive anatomy (hysterosalpingography - see dye leave fallopian tubes)?
semen or sperm (get semen analysis)?

90
Q

symptoms of ovarian cancer

A 
usually symptoms once mets:
ascites
ab distention
ab pain → nausea, early satiety
vaginal bleeding
urinary sx (mets to bladder, ureter)
91
Q

ascites in otherwise healthy women

A

ovarian cancer

92
Q

risk factor of ovarian cancer

A

family history:
BRCA 1 or 2 mutation (associated with breast and ovarian cancer)
Lynch syndrome/hereditary nonpolyposis colon cancer (associated with colon, endometrial, ovarian cancer)
uninterrupted ovulatory cycles (nulliparity, infertility, early menarche, late menopause)

93
Q

protective against ovarian cancer

A

interrupt ovoluatory cycles
increase in parity
breastfeeding
OCP use

94
Q

CA-125 tumor marker

A

ovarian cancer
used to monitor disease progression and response to therapy
not used for screening: nonspecific (esp reproductive age, ↑ with peritoneal irritation)

95
Q

4 types of ovarian tumors

A

epithelial tumors (benign or malignant)
sex-cord stromal tumors
germ cell tumors
metastatic tumors

96
Q

most common type of ovarian neoplasm (majority of ovarian tumors, majority of malignant tumors)

A

epithelial tumor

97
Q

40-60 yo female
bilateral ovarian mass
poor prognosis if malignant (found late)

A

epithelial ovarian tumor

98
Q

types of serous epithelial ovarian tumors (most common type of epithelial tumor):

A

cystic, serous fluid-filled
ciliated columnar epithelium (fallopian tube-like)
Psammoma bodies (concentric calcifications)
benign: serous cystadenoma
malignant: serous cystadenocarcinoma

99
Q

psammoma bodies in ovary

A

concentric calcifications
found in serous epithelial tumors:
benign: serous cystadenoma
malignant: serous cystadenocarcinoma

100
Q

types of mucinous epithelial ovarian tumors

A 
multi-loculated
filled with mucin
can get up to 50 lbs
histology similar to GI tissue
benign: mucinous cystadenoma
malignant: mucinous cystadenocarcinoma
101
Q

abundant mucinous ascites (abdomen filled with gelatinous substance) caused by primary appendiceal cancer (not mucinous ovarian tumor as originally thought)

A

pseudomyxoma peritonei

102
Q

MALIGNANT epithelial ovarian tumor
look like endometrium (tubular glands)
some associated with endometriosis
30% coexist with endometrial cancer (cancers arise independently)

A

endometriod tumor

103
Q

variant of endometroid tumor (epithelial ovarian tumor)

cells with clear cytoplasm

A

clear cell ovarian tumor

104
Q

BENIGN epithelial ovarian tumor

epithelium is urinary tract-like

A

Brenner tumors

105
Q

germ cell tumors in female analagous to

A

testicular cancers in males

106
Q

unilateral usually
teens to 20 yo female
good prognosis (responsive to chemo)

A

germ cell ovarian tumor

107
Q

types of ovarian epithelial tumors

A 
Serious Epithelial Malignancies are Clearly Bad
Serous (most common type)
Endometroid
Mucinous
Clear cell
Brenner tumor
108
Q

types of ovarian germ cell tumors

A

teratomas (includes struma ovarii)
dysgerminoma (seminoma in males)
yolk sac tumor
ovarian choriocarcinoma

109
Q

ovarian mass with hyperthyroidism

A

struma ovarii: teratoma containing functional thyroid tissue → hyperthyroidism

110
Q

malignant ovarian tumor that produces hCG and LDH

sheets of large cells with clear cytoplasm + central nuclei (“fried egg cells”)

A

dysgerminoma ovarian tumor

111
Q 
malignant ovarian tumor that
produces AFP (tumor marker)
Shiller-Duval bodies (primitive glomeruli - central vessel surrounded by tumor cells)
A

yolk sac tumors (endodermal sinus tumors)

112
Q

malignant ovarian tumor that produces hCG
mets to LUNG (shortness of breath, hemoptysis)
not responsive to chemo (fatal)

A

ovarian
choriocarcinoma

–identical histology to choriocarcinoma that arise from placental tissue during or after pregnancy (but responsive to chemo)

113
Q

types of sex cords stromal tumors

A

granulosa cell tumors
sertoli-leydig tumors
fibroma
thecoma

114
Q

unilateral ovarian mass
women of any age
produce hormones
good prognosis (detected early due to hormonal changes)

A

sex-cord stromal tumors (hormones located in the stroma)

115
Q

potentially malignant ovarian tumor
produce ESTROGEN
child: precocious puberty
postmenopausal women (more common): abnormal vaginal bleeding, postmenopausal bleeding, endometrial hyperplasia/cancer
yellow: contain cholesterol needed for estrogen synthesis
call-exner body

A

granulosa cell tumors

116
Q

call-exner body in ovary

A

granulosa cell tumor

granulosa cells are trying to make ovarian follicles to surround the oocyte (make rosettes of tumor cells around eosinophilic lumen)

117
Q

Shiller-Duval bodies in ovary

A

yolk sac tumor

primitive glomeruli - central vessel surrounded by tumor cells in cystic space lined by tumor cells

118
Q

ovarian tumor that can resemble seminiferous tubules
possibly malignant (but detected early)
good prognosis
produce ANDROGENS → virilization (hirsutism, deepening of voice, clitoromegaly)
yellow: contain cholesterol

A

sertoli-leydig tumors

sertoli cells line the seminiferous tubules in males

119
Q

ovarian tumor that arise from fibroblast
form encapsulated, solid
NO HORMONES
associated with Meigs syndrome

A

fibroma

120
Q

ovarian tumor + ascites + hydrothorax (pleural effusion)

A

Meigs syndrome: associated with fibroma (ovarian tumor)

121
Q

ovarian tumor that arises from spindle cells
can be mixed with estrogen-producing cells →
CAN PRODUCE ESTROGEN: precocious puberty, postmenopausal bleeding, endometrial carcinoma (like granulosa cell tumors)

A

thecoma

122
Q

bilateral ovarian masses think of

A

metastasis to ovaries

123
Q

common causes of ovarian mets

A 
uterus
fallopian tube
other ovary
GI (krukenberg tumor)
breast
124
Q

metastatic gastroadenocarcinoma travels to the

A

bilateral ovaries

called Krukenberg tumor

125
Q

signet ring cells filled with mucin (nuclei pushed to side) in ovary

A

Krukenberg tumor (met gastroadenocarcinoma)

DIT topics (115 decks)

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