Witrak Part 1: OBGYN Pathology

Question 1

What are some causes of abnormal vaginal bleeding?

Answer 1

Endometrial atrophy (post-menopausal), endometrial hyperplasia/carcinoma, structural disorders of endometrium/myometrium: endometrial polyps, abnormal gestation

Question 2

what are the most malignant primary ovarian neoplasms?

Answer 2

epithelial: serous vs. mucinous

Question 3

are germ cell tumors in men benign or malignant? what about women?

Answer 3

malignant for men. benign for women.

Question 4

adnexal mass in post-menopausal female = ______ until proven otherwise?

Answer 4

CANCER

Question 5

what is an early trimester gestational disorder example

?

Answer 5

miscarriage, ectopic gestation

Question 6

post-menopausal vaginal bleeding is _____ until proven otherwise?

Answer 6

cancer

Question 7

almost all of the infections of the vulva and vagina are _____________, except ____.

Answer 7

largely sexually transmitted, except candidiasis and post-partum types.

Question 8

infections with clinical manifestations typically limited to _______ genital tract

Answer 8

lower (vulva, vagina, cervix).

candidiasis, trichomonas, gardnerella (bacterial
vaginosis), HSV, HPV, molluscum, and tropical
STDs (lymphogranuloma venereum, granuloma
inguinale, chancroid)

Question 9

what two bugs can progress to Pelvic Inflammatory Disease (asymptomatic usually) and what does it put the female at risk for?

Answer 9

Chlamydia and gonococcus. Ectopic pregnancy and infertility.

Question 10

What infectious agents are potentially fatal sequelae?

Answer 10

HIV, Syphillis, viral hepatitis.

Question 11

What STDs are notable for risk to fetus/newborn?

Answer 11

HSV, Chlamydia, gonorrhea, syphilis, HIV,

hepatitis B and C

Question 12

what is a common complication leading to obstetrical infection in the third world? from what organism?

Answer 12

retained placenta doesnt allow uterus to contract. Group B strep.

Question 13

Classically, but can be subclinical: Sexually active female with lower abdominal pain, purulent endocervical discharge, chandelier sign (pain with movement of cervix). Name that disorder!

Answer 13

PID. subclinical could be first evidence of tubal infertility.

Question 14

Dx is largely a clinical one:
one recommendation: sexually active young women with lower abdominal, adnexal, and cervical motion tenderness – should receive WHAT?

Answer 14

receive empiric antibiotic RX.

Question 15

what is the commonest cause of vaginal discharge (40-50%) in reproductive age women?

Answer 15

Bacterial vaginosis- results from disturbed vaginal flora (Gardnerella vaginalis)

Question 16

How does Gardnerella vaginalis present? Inflammation?

Answer 16

malodorous (fishy), gray-white discharge usually WITHOUT signs of INFLAMMATION. Clue CELLS

Question 17

What is the commonest curable STD in the world?

Answer 17

Trichomoniasis due to flagellated protozoan T. vaginalis

Question 18

Are Candida albicans usually sexually transmitted?

Answer 18

NO. often normally present as a commensal in small numbers, due to IMMUNOSUPPRESSION (antibiotics, HIV)

Question 19

Sexually active female presents with multiple, shallow, painful genital ulcers (preceding vesicles), inguinal adenopathy. What is this infection?

Answer 19

HSV-2

Question 20

T or F: HSV is sexually transmitted and may occur during asymptomatic/sub-clinical viral shedding (even without genital lesions)

Answer 20

True!

Question 21

HSV-2 is the most common cause of sporadic _______

Answer 21

MENINGITIS!!!

Question 22

Tzanck smear is used to see what infectious agent? what would you see?

Answer 22

HSV. multinucleated giant cells, intranuclear inclusions.

Question 23

what do you see on a histologic slide for HPV?

Answer 23

papillomatous proliferation w/ koilocytotic atypia/mild dysplasia (low grade squamous intraepithelial lesion).

Question 24

what type of cervical cancer, due to HPV, is the most common?

Answer 24

Squamous cell carcinoma! Adenocarcinoma is the next (if it infects endocervical glandular mucosa).

Question 25

______ disease usually presents with non-specific pruritus, soreness, or dyspareunia

Answer 25

non-neoplastic

Question 26

what is the commonest tumefaction of vulva (either infection with abscess or inflammatory duct obstruction with cyst formation)?

Answer 26

Bartholin gland disease

Question 27

90% of vulvar malignancies are ________

Answer 27

squamous carcinoma

Question 28

what is the principal cause of vulvar carcinoma in older/post-menopausal women?

Answer 28

'differentiated type': typically seen arising in relation to LICHEN SCLEROSUS or LICHEN SIMPLEX CHRONICUS

Question 29

what can present as abnormal coloration: usually white but also may be red or dark/pigmented. symptomatically: vulvar itch, burning, pain

Answer 29

Squamous vulvar neoplasia

Question 30

what does the whiteness of the vulvar skin represent?

Answer 30

- lichen simplex chronicus – chronically irritated/hyperplastic skin. - lichen sclerosus et atrophicus = atrophic epidermis with subepidermal edema OR Pre-invasive cancer. -> NEED BIOPSY TO TELL THE DIFFERENCE

Question 31

what benign lesion is associated with the 'milk line' and a lump of the vulva?

Answer 31

Papillary hidradenoma. benign labial neoplasm which may ulcerate- hypothesized as originating from ectopic-breast tissue (axilla to groin = milk line)

Question 32

can have cancer have condyloma like features?

Answer 32

YES. biopsy to make sure. 90% benign condylomatous disease

Question 33

a post-menopausal white woman has a non-squamous malignancy on her clitoris, what type of cancer is it?

Answer 33

melanoma (5-10%). HIGH mortality rate if > 1 mm thickness. favors clitoris and labia minora

Question 34

what vulvar carcinoma presents as a 'rodent' ulceration, usually non-metastasizing?

Answer 34

Basal Cell Carinoma (2% of vulvar CA)

Question 35

____ _____: locally aggressive/non-metastasizing neoplasm relatively unique to vulva/perineum/female pelvis

Answer 35

Deep angiomyxoma

Question 36

in adults, commonest malignancies involving the vagina come from where?

Answer 36

direct extension from cervical, vulvar or endometrial CANCER or hematogenous spread from breast, ovary, kidney

Question 37

Vagina CA symptom?

Answer 37

bleeding or discharge

Question 38

who does largerly aggressive embryonal rhabdomyosarcoma effect?

Answer 38

infants/young children

Question 39

______ from HPV is the commonest cancer worldwide of female genital tract

Answer 39

invasive cervical carcinoma

Question 40

_____ is more vulnerable to HPV infection than any other genital tract site.

Answer 40

Cervix.

Question 41

Which area of the cervix does carinoma usually develop?

Answer 41

transformation zone (ecto-cervix squamous -> endo-columnar)

Question 42

what are the 3 early symptoms of Cervical CA?

Answer 42

irregular or heavy vaginal bleeding, post-coital bleeding (after sex), or non-bloody vaginal discharge

Question 43

what are 3 late symptoms of cervical cancer?

Answer 43

invasion of parametrium (pain), direct invasion of vagina with secondary malignant fistulas into bladder or rectum

Question 44

how do most women die of cervical cancer?

Answer 44

NOT GETTING SCREENED IN TIME!

Question 45

why do we NOT screen most individuals before age 21?

Answer 45

low risk dysplasia that will go away! regresses

Question 46

what are two paramount concerns with abnormal uterine bleeding?

Answer 46

1. chronic or acute hemorrhage sufficient to cause anemia | 2. is endometrial cancer present

Question 47

what are indications for endometrial biopsy?

Answer 47

1. age > 45 yrs 2. younger than 45yrs: history of unopposed estrogen exposure (obesity, chronic anovulation), tamoxifen, Lynch

Question 48

what is a syndrome of anovulation that is characterized by oligomenorrhea, hyperandrogenism, obesity and insulin resistance?

Answer 48

Polycystic ovary syndrome.

Question 49

what are the two chief causes of vaginal bleeding in postmenopausal women?

Answer 49

endometrial atrophy (59%) & endometrial polyps (12%). hyperplasia (10%), carcinoma (10%)

Question 50

what type of cancer is the commonest GYN cancer in developed world? average age of diagnosis?

Answer 50

Endometrial carcinoma. 61 yrs. 25% cases in pre-menopausal women.

Question 51

what do you give obese women with complex atypical hyperplasia and want to remain fertile?

Answer 51

give progestational agents! reversible if remains superficial in patient, but still varies on success.

Question 52

major risk factor for endometrial carcinoma?

Answer 52

CHRONIC UNOPPOSED ESTROGEN STATES: obesity, chronic anovulation, nulliparity (sad), tamoxifen (antagonist in BREAST, agonist in endometrium)

Question 53

What tends to be higher stage, poor prognosis tumor and can be a serous carcinoma?

Answer 53

type 2 endometrial CA

Question 54

_____ = ectopic endometrial glands and stroma (outside of uterine cavity)

Answer 54

endometriosis

Question 55

what does endometriosis present as on a histological section?

Answer 55

ovaries may be markedly enlarged and cystic (CHOCOLATE CYST)

Question 56

what are specific types of disorders in myometrial pathology?

Answer 56

***LEIOMYOMAS, * adenomyosis, leiomyosarcoma

Question 57

what is the commonest visceral tumor in women (15-20%)?

Answer 57

Uterine leiomyomas (fibroid tumors)

Question 58

Main Sx in reproductive age women: pelvic pressure/pain, urinary frequency, difficult defecation, abnormal uterine bleeding with dysmenorrhea, impaired fertility, or adverse pregnancy outcomes. Name that type of tumor!

Answer 58

Uterine leiomyomas

Question 59

who is uterine leiomyomas most common in

Answer 59

african-american women. Think- Lions (leio) live in Africa

Question 60

on a pathology report, what presents as a circumscribed white/rubbery nodules with bland smooth muscle proliferation?

Answer 60

Leiomyomas

Question 61

what cancer usually presents as typically large tumors with soft/fleshy cut surfaces showing hemorrhage and necrosis?

Answer 61

Uterine leiomyosarcoma. RARE. Distorted uterus.

Question 62

what pathologies are associated with fallopian tubes?

Answer 62

endometriosis, tubal infertility, ectopic pregnancy.

Question 63

what percent of women have PCOS?

Answer 63

6-8%*

Question 64

what is the most FEARED cancer of the female genital tract?

Answer 64

ovarian cancer

Question 65

what is the MOST common ovarian neoplasia?

Answer 65

epithelial (mullerian) tumors: 67% of all primary ovarian neoplasia, 95% of ovarian CA

Question 66

epithelial ovarian tumors: serous are most often ____ (unilateral, bilateral), mucinous ____ (unilateral, bilateral)

Answer 66

bilateral. unilateral.

Question 67

USA: what is the second most common GYN malignancy but commonest cause of GYN cancer death?

Answer 67

Ovarian carcinoma. majority of patients: diagnosed at advanced stage and are high grade serous type.

Question 68

what do you use the CA-125 marker for?

Answer 68

NOT used for screening. used to follow for tumor recurrence if initially elevated

Question 69

what are the mass majority of ovarian germ cell tumors?

Answer 69

Mature cystic teratoma- dermoid cyst- skin, hair, bone, etc. benign!!!

Question 70

where are the major areas that metastasize to ovary?

Answer 70

non-OBGYN: *colorectum, appendix, stomach, breast.

Question 71

what is the most common pathology you see in a first trimester woman?

Answer 71

spontaneous abortion with symptoms of abdominal pain, amenorrhea, vaginal bleeding. pregnancy loss < 20 wks

Question 72

what is the major risk for retaining a dead fetus over 4wks?

Answer 72

the mother Disseminated Intravascular Coagulation. can be completely calcified.

Question 73

what does HELLP syndrome stand for?

Answer 73

hemolysis, elevated liver enzymes, low platelets (usually associated with severe preeclampsia)

Question 74

____ = presence of placental tissue extending over or just proximal from the internal cervical os

Answer 74

placenta previa

Question 75

when would you suspect placenta previa?

Answer 75

in patients > 20wks gestation with painless vaginal bleeding

Question 76

_____= morbidly adherent/suck placenta

Answer 76

placenta accreta. due to defective/thin decidual layer at implantation site

Question 77

what can an ascending infection (from vagina/cervix)?

Answer 77

premature membrane rupture (PROM). usually polymicrobial

Question 78

what is the most common cause of life-threatening newborn infection?

Answer 78

GROUP B STREPTOCOCCUS

Question 79

what will be elevated in HYDATIDIFORM MOLE?

Answer 79

increase serum HCG

Question 80

______ ____: fertilization of an empty ovum by either a single sperm which duplicates or two separate sperm= 46 XX or XY (DIPLOID)

Answer 80

Complete MOLE

Question 81

___ ___: fertilization of ordinary ovum (23X) by two separate sperm= 69 XXX, XXY, XYY (TRIPLOID)

Answer 81

PARTIAL mole

Question 82

____ ___ = diffuse vesicular enlargement of villi (gross vesicles) without fetal sac/fetus

Answer 82

COMPLETE mole

Question 83

___ __ = variable vesicular enlargement of villi w/ fetal sac/fetus

Answer 83

PARTIAL mole

Question 84

____ ___= neoplasitc villi penetrate myometrium

Answer 84

invasive mole

Question 85

why is HCG associated with hyperthyroidism

Answer 85

some thyroid stimulating properties

Question 86

_____ = hemorrhagic/necrotic tumor w/ mixtures of syncytiotrophoblastic and cytotrophoblastic cells (w/o villus formation)

Answer 86

choriocarcinoma

Question 87

____ = 'intermediate' cytotrophoblastic cells (w/o villi) diffusely infiltrating myometrium

Answer 87

PSTT