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Endo/Repro II Block 1 > Vulva/Vagina/Cervix/Uterus/Endometrium Path > Flashcards

Vulva/Vagina/Cervix/Uterus/Endometrium Path Flashcards

1
Q 
Embryological Derivatives
Mullerian Duct (4) Urogenital Sinus, Mesonephric Duct
A

Unfused Mullerian: Fallopian tubes
Fused Lower Mullerian: Uterus, Cervix, Upper vagina

Urogenital sinus becomes Lower Vagina

Mesonephric duct regresses

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2
Q

Bartholin Gland Cyst

Etiologies (2) and Clinical Features (2)

A

Obstruction of gland via infectious inflammation
Neisseria gonorrhoeae

3-5 cm cyst on vulva
Local pain

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3
Q

Lichen Sclerosis

Pathogenesis, Morphology (4) and Clinical Features (3)

A

Likely autoimmune etiology

Smooth white plaques on vulva
Thinning of epidermis
Hyperkeratosis
Band-like T cell infiltrate (lymphocytosis)

Postmenopausal women
Not premalignant
Associated with autoimmune conditions

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4
Q

Vulvar Squamous Hyperplasia

Etiology, Morphology (2), Clinical Features (2)

A

Caused by scratching skin to relieve pruritis

Thickened epidermis (acanthosis)
Hyperkeratosis

Presents as leukoplakia
Not premalignant

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5
Q

Condyloma Latum

Etiology and Morphology

A

Syphillis (Treponema pallidum)

Benign raised skin lesion

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6
Q

Condyloma Accuminatum

Etiology (2), Morphology (3) and Clinical Features (2)

A

HPV 6 and 11

Koilocytic atypia of surface epithelium
Papillary exophytic tree like cores of stroma
Thickened epithelium

Not premalignant
Multifocal genital warts involving vulva, perineum, perianal region

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7
Q

Classic Vulvar Intraepithelial Neoplasia
Population (2), CVIN Morphology (2)
Complications with Morphology (2)

A

Younger patients with HPV 16 infection

White hyperkeratotic lesion or
Slightly raised pigmented lesion

Basaloid Carcinoma Precursor:
Nests and cords of small tightly packed cells resembling normal basal layer

Warty Carcinoma Precursor:
Exophytic, papillary, koilocytic atypia

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8
Q

Differentiated Vulvar Intraepithelial Neoplasia
Population (3), DVIN Morphology
Complication with Morphology

A

Older patients with long standing lichen slerosis or squamous hyperplasia

Basal layer atypia with normal superficial layers

Invasive Keratinizing Squamous Cell Carcinoma
Central keratin pearls

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9
Q

Extramammary Paget Disease

Staining (3), Morphology (3) and Clinical Features (2)

A

PAS, Alcian blue, Mucicarcmine

Pruritc, red, crusted area on labia majora

Not associated with underlying cancer
Malignant process but unlikely to invade (poor prognosis if it does)

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10
Q

Papillary Hidradenoma

Morphology (4)

A

Sharply circumscribed nodule on labia majora or interlabial folds
Papillary projections covered in two layers:
Columnar secretory cells
Flat myoepithelial cells

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11
Q

Vaginal Developmental Anomalies

Examples with Descriptions (3)

A

Uterus didelphys: Double uterus, associated with septate (double) vagina

Vaginal Adenosis: Persistence of glandular columnar, endocervical-type epithelium, from DES exposure

Gartner Duct Cyst: Persistence of mesonephric duct

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12
Q

Embryonal Rhabdomyosarcoma

Presentation, Morphology (4) and Prognosis

A

Infants and children < 5 years old

Polypoid, grapelike mass
Small cells with oval nuclei with small protrusions
Tumor cells found in cambium layer
(+) for Desmin intermediate filaments

Malignant tumors that require excision and chemotherapy

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13
Q

Cervix
Histological Regions (3)
Transformation Zone Significance (2)

A

Ectocervix is squamous epithelium and ends at external os
Endocervix is columnar epithelium
Meeting point between endo/ecto is squamocolumnar junction (transformation zone)

Squamocolumnar Junction is most susceptible to HPV infection
Cervical precursor lesions develop at junction

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14
Q

Endocervical Polyps

Morphology and Significance

A

Loose fibromyxomatous stroma covered by glands

Source of irregular vaginal spotting or bleeding

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15
Q

Cervical Intraepithelial Neoplasia

Pathogenesis (3), Morphology (5)

A

Persistent infection with high risk HPV strains (mostly 16)
E6 protein blocks p53
E7 protein breaks up Rb

Nuclear Atypia: Nuclear enlargement, Hyperchromasia, Chromatin granules
Koilocytic atypia
p16 overexpression

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16
Q

Cervical Intraepithelial Neoplasia

Classifications (2) with Associated Natural Histories and Morphology (1/2)

A

Low Grade Squamous Intraepithelial Lesion (LSIL)
CIN I
60% regress, 30% persist and 10% progress to HSIL
Epithelial atypia in lower 1/3

High Grade Squamous Intraepithelial Lesion (HSIL)
CIN II and CIN III
30% regress, 60% persist and 10% progress to carcinoma
Full thickness epithelial atypia
Ki67 (+) staining

17
Q 
Mestrual Cycle Tissue Changes
Menstrual Phase (2) Proliferative Phase (3) Secretory Phase (4)
A

Menstrual Phase
Decreased progesterone
Stratum functionalis shedding

Proliferative Phase
Increased estrogen causes:
Straight tubular glands
Stromal cell proliferation and mitotic figures present

Secretory Phase
Increased progesterone causes:
Sawtooth shaped glands
Subnuclear vacuoles progress to supranuclear vacuoles
Prominent arterioles present
18
Q

Abnormal Uterine Bleeding Differential By Age Group

Prepuberty (1) Adolescence (2) Reproductive Age (4) Perimenopausal (2) Postmenopausal (2)

A

Precocious puberty

Anovulatory cycle, Coagulation disorders

Pregnancy complications, Lesions, Anovulatory cycle, Ovulatory dysfunctional bleeding

Anovulatory cycle, Lesions

Endometrial atrophy, Lesions

19
Q

Dysfunctional Uterine Bleeding

Most Common Cause and Differential Diagnosis(3)

A

Anovulatory Cycles

Differential:
Endocrine Disorders
Ovarian Lesions
Metabolic Disturbances

20
Q

Endometritis Etiologies and Features

Acute (1/2) and Chronic (4/2)

A

Acute:
Bacterial infection after delivery or miscarriage

Stromal inflammation
Treat with antibiotics and gestational material removal

Chronic:
Chronic PID
Retained gestational material
IUD use
Tuberculosis

Diagnosed via plasma cells in stroma
Treat with antibiotics

21
Q 
Endometriosis
Common Sites (8), Pathogenesis
A 
Ovaries
Uterine Ligaments
Rectovaginal septum
Cul de sac
Pelvic peritoneum
Large/Small bowel and Appendix
Mucosa of cervix, vagina, fallopian tubes
Laparotomy scars

Regurgitation Theory:
Endometrial tissue travels through fallopian tube and out into abdominal cavity

22
Q

Endometriosis

Molecular Abnormality, Morphology (3) Presentation (5)

A

Increased aromatase which increases estrogen levels

Red/blue or yellow brown nodules on mucosa/serosa
Fibrous adhesions
Chocolate cysts in ovaries (endometriomas)

Menometrorrhagia
Severe dysmenorrhea
Dyspareunia
Pelvic pain
Small bowel obstruction (if adhesions present)
23
Q

Adenomyosis

Definition, Morphology and Presentation (4)

A

Presence of endometrial tissue in uterine wall

Nests of endometrial stroma within myometrium

Menometrorrhagia
Severe dysmenorrhea
Dyspareunia
Pelvic pain

24
Q

Endometrial Hyperplasia
Etiologies (4), Genetics (2)
Classifications (2) with Characteristic Features (2/3)

A 
Prolonged Estrogen exposure from:
Anovulation
Obesity
Menopause
Estrogen only therapy for Menopause
PTEN inactivation (Cowden syndrome)
Causes overactivation of PI3K/AKT pathway

Non-Atypical: Increased gland to stroma ratio
Rarely progresses to cancer

Atypical: Conspicuous nucleoli
Back to back glands with little stroma
More often associated with cancer

25
Q

Type I Endometrial Adenocarcinoma

Precursor, Presentation (5) Mutations (6) and Morphology (2)

A

Precursor is endometrial hyperplasia

Ages 55-65
Unopposed estrogen
Type 2 Diabetes
HTN
Obesity
PTEN*
Microsatellite instability (Lynch syndrome)
ARID1A
KRAS
FGF2
CTNNB1

Well differentiated
Mimic endometrial glands (endometrioid carcinoma)

26
Q

Type II Endometrial Adenocarcinoma

Precursor, Presentation (2) Mutations (6) and Subtypes (3)

A

Serous endometrial intraepithelial carcinoma

Ages 65-75
Endometrial atrophy
Thin physique

TP53*
Aneuploidy
PI3K
FBXW7
CHD4
PP2A

Serous carcinoma*
Clear cell tumors
Mixed Mullerian tumors

27
Q

Carcinosarcoma

Description, Presentation, Prognosis

A

Malignant adenocarcinoma with mixed mesenchymal components

Present with postmenopausal bleeding

Prognosis bad if mesenchymal component is heterologous

28
Q

Leiomyoma

Morphology (3) and Clinical Features (4)

A

Whorled Pattern of smooth muscle bundles
Found in myometrium of the corpus
Sharply circumscribed firm grey-white masses

Often multiple masses
Benign, not mitotically active
Abnormal bleeding
Urinary frequency

29
Q

Leimyosarcoma

Morphology (3), Clinical Features (2) and Mutation

A

Mitotic figures*
Nuclear atypia
Zonal necrosis

Most metastasize before presentation
40-60 years old peak age

MED12 mutations

Endo/Repro II Block 1 (6 decks)

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