Witrak Part 1: OBGYN Pathology Flashcards
What are some causes of abnormal vaginal bleeding?
Endometrial atrophy (post-menopausal), endometrial hyperplasia/carcinoma, structural disorders of endometrium/myometrium: endometrial polyps, abnormal gestation
what are the most malignant primary ovarian neoplasms?
epithelial: serous vs. mucinous
are germ cell tumors in men benign or malignant? what about women?
malignant for men. benign for women.
adnexal mass in post-menopausal female = ______ until proven otherwise?
CANCER
what is an early trimester gestational disorder example
?
miscarriage, ectopic gestation
post-menopausal vaginal bleeding is _____ until proven otherwise?
cancer
almost all of the infections of the vulva and vagina are _____________, except ____.
largely sexually transmitted, except candidiasis and post-partum types.
infections with clinical manifestations typically limited to _______ genital tract
lower (vulva, vagina, cervix).
candidiasis, trichomonas, gardnerella (bacterial
vaginosis), HSV, HPV, molluscum, and tropical
STDs (lymphogranuloma venereum, granuloma
inguinale, chancroid)
what two bugs can progress to Pelvic Inflammatory Disease (asymptomatic usually) and what does it put the female at risk for?
Chlamydia and gonococcus. Ectopic pregnancy and infertility.
What infectious agents are potentially fatal sequelae?
HIV, Syphillis, viral hepatitis.
What STDs are notable for risk to fetus/newborn?
HSV, Chlamydia, gonorrhea, syphilis, HIV,
hepatitis B and C
what is a common complication leading to obstetrical infection in the third world? from what organism?
retained placenta doesnt allow uterus to contract. Group B strep.
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!
PID. subclinical could be first evidence of tubal infertility.
Dx is largely a clinical one:
one recommendation: sexually active young women with lower abdominal, adnexal, and cervical motion tenderness – should receive WHAT?
receive empiric antibiotic RX.
what is the commonest cause of vaginal discharge (40-50%) in reproductive age women?
Bacterial vaginosis- results from disturbed vaginal flora (Gardnerella vaginalis)
How does Gardnerella vaginalis present? Inflammation?
malodorous (fishy), gray-white discharge usually WITHOUT signs of INFLAMMATION. Clue CELLS
What is the commonest curable STD in the world?
Trichomoniasis due to flagellated protozoan T. vaginalis
Are Candida albicans usually sexually transmitted?
NO. often normally present as a commensal in small numbers, due to IMMUNOSUPPRESSION (antibiotics, HIV)
Sexually active female presents with multiple, shallow, painful genital ulcers (preceding vesicles), inguinal adenopathy. What is this infection?
HSV-2
T or F: HSV is sexually transmitted and may occur during asymptomatic/sub-clinical viral shedding (even without genital lesions)
True!
HSV-2 is the most common cause of sporadic _______
MENINGITIS!!!
Tzanck smear is used to see what infectious agent? what would you see?
HSV. multinucleated giant cells, intranuclear inclusions.
what do you see on a histologic slide for HPV?
papillomatous proliferation w/ koilocytotic atypia/mild dysplasia (low grade squamous intraepithelial lesion).
what type of cervical cancer, due to HPV, is the most common?
Squamous cell carcinoma! Adenocarcinoma is the next (if it infects endocervical glandular mucosa).
______ disease usually presents with non-specific pruritus, soreness, or dyspareunia
non-neoplastic
what is the commonest tumefaction of vulva (either infection with abscess or inflammatory duct obstruction with cyst formation)?
Bartholin gland disease
90% of vulvar malignancies are ________
squamous carcinoma
what is the principal cause of vulvar carcinoma in older/post-menopausal women?
‘differentiated type’: typically seen arising in relation to LICHEN SCLEROSUS or LICHEN SIMPLEX CHRONICUS
what can present as abnormal coloration: usually white but also may be red or dark/pigmented. symptomatically: vulvar itch, burning, pain
Squamous vulvar neoplasia
what does the whiteness of the vulvar skin represent?
- 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
what benign lesion is associated with the ‘milk line’ and a lump of the vulva?
Papillary hidradenoma. benign labial neoplasm which may ulcerate- hypothesized as originating from ectopic-breast tissue (axilla to groin = milk line)
can have cancer have condyloma like features?
YES. biopsy to make sure. 90% benign condylomatous disease
a post-menopausal white woman has a non-squamous malignancy on her clitoris, what type of cancer is it?
melanoma (5-10%). HIGH mortality rate if > 1 mm thickness. favors clitoris and labia minora
what vulvar carcinoma presents as a ‘rodent’ ulceration, usually non-metastasizing?
Basal Cell Carinoma (2% of vulvar CA)
____ _____: locally aggressive/non-metastasizing neoplasm relatively unique to vulva/perineum/female pelvis
Deep angiomyxoma
in adults, commonest malignancies involving the vagina come from where?
direct extension from cervical, vulvar or endometrial CANCER or hematogenous spread from breast, ovary, kidney
Vagina CA symptom?
bleeding or discharge
who does largerly aggressive embryonal rhabdomyosarcoma effect?
infants/young children
______ from HPV is the commonest cancer worldwide of female genital tract
invasive cervical carcinoma
_____ is more vulnerable to HPV infection than any other genital tract site.
Cervix.
Which area of the cervix does carinoma usually develop?
transformation zone (ecto-cervix squamous -> endo-columnar)
what are the 3 early symptoms of Cervical CA?
irregular or heavy vaginal bleeding, post-coital bleeding (after sex), or non-bloody vaginal discharge
what are 3 late symptoms of cervical cancer?
invasion of parametrium (pain), direct invasion of vagina with secondary malignant fistulas into bladder or rectum
how do most women die of cervical cancer?
NOT GETTING SCREENED IN TIME!
why do we NOT screen most individuals before age 21?
low risk dysplasia that will go away! regresses
what are two paramount concerns with abnormal uterine bleeding?
- chronic or acute hemorrhage sufficient to cause anemia
2. is endometrial cancer present
what are indications for endometrial biopsy?
- age > 45 yrs 2. younger than 45yrs: history of unopposed estrogen exposure (obesity, chronic anovulation), tamoxifen, Lynch
what is a syndrome of anovulation that is characterized by oligomenorrhea, hyperandrogenism, obesity and insulin resistance?
Polycystic ovary syndrome.
what are the two chief causes of vaginal bleeding in postmenopausal women?
endometrial atrophy (59%) & endometrial polyps (12%). hyperplasia (10%), carcinoma (10%)
what type of cancer is the commonest GYN cancer in developed world? average age of diagnosis?
Endometrial carcinoma. 61 yrs. 25% cases in pre-menopausal women.
what do you give obese women with complex atypical hyperplasia and want to remain fertile?
give progestational agents! reversible if remains superficial in patient, but still varies on success.
major risk factor for endometrial carcinoma?
CHRONIC UNOPPOSED ESTROGEN STATES: obesity, chronic anovulation, nulliparity (sad), tamoxifen (antagonist in BREAST, agonist in endometrium)
What tends to be higher stage, poor prognosis tumor and can be a serous carcinoma?
type 2 endometrial CA
_____ = ectopic endometrial glands and stroma (outside of uterine cavity)
endometriosis
what does endometriosis present as on a histological section?
ovaries may be markedly enlarged and cystic (CHOCOLATE CYST)
what are specific types of disorders in myometrial pathology?
***LEIOMYOMAS, * adenomyosis, leiomyosarcoma
what is the commonest visceral tumor in women (15-20%)?
Uterine leiomyomas (fibroid tumors)
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!
Uterine leiomyomas
who is uterine leiomyomas most common in
african-american women. Think- Lions (leio) live in Africa
on a pathology report, what presents as a circumscribed white/rubbery nodules with bland smooth muscle proliferation?
Leiomyomas
what cancer usually presents as typically large tumors with soft/fleshy cut surfaces showing hemorrhage and necrosis?
Uterine leiomyosarcoma. RARE. Distorted uterus.
what pathologies are associated with fallopian tubes?
endometriosis, tubal infertility, ectopic pregnancy.
what percent of women have PCOS?
6-8%*
what is the most FEARED cancer of the female genital tract?
ovarian cancer
what is the MOST common ovarian neoplasia?
epithelial (mullerian) tumors: 67% of all primary ovarian neoplasia, 95% of ovarian CA
epithelial ovarian tumors: serous are most often ____ (unilateral, bilateral), mucinous ____ (unilateral, bilateral)
bilateral. unilateral.
USA: what is the second most common GYN malignancy but commonest cause of GYN cancer death?
Ovarian carcinoma. majority of patients: diagnosed at advanced stage and are high grade serous type.
what do you use the CA-125 marker for?
NOT used for screening. used to follow for tumor recurrence if initially elevated
what are the mass majority of ovarian germ cell tumors?
Mature cystic teratoma- dermoid cyst- skin, hair, bone, etc. benign!!!
where are the major areas that metastasize to ovary?
non-OBGYN: *colorectum, appendix, stomach, breast.
what is the most common pathology you see in a first trimester woman?
spontaneous abortion with symptoms of abdominal pain, amenorrhea, vaginal bleeding. pregnancy loss < 20 wks
what is the major risk for retaining a dead fetus over 4wks?
the mother Disseminated Intravascular Coagulation. can be completely calcified.
what does HELLP syndrome stand for?
hemolysis, elevated liver enzymes, low platelets (usually associated with severe preeclampsia)
____ = presence of placental tissue extending over or just proximal from the internal cervical os
placenta previa
when would you suspect placenta previa?
in patients > 20wks gestation with painless vaginal bleeding
_____= morbidly adherent/suck placenta
placenta accreta. due to defective/thin decidual layer at implantation site
what can an ascending infection (from vagina/cervix)?
premature membrane rupture (PROM). usually polymicrobial
what is the most common cause of life-threatening newborn infection?
GROUP B STREPTOCOCCUS
what will be elevated in HYDATIDIFORM MOLE?
increase serum HCG
______ ____: fertilization of an empty ovum by either a single sperm which duplicates or two separate sperm= 46 XX or XY (DIPLOID)
Complete MOLE
___ ___: fertilization of ordinary ovum (23X) by two separate sperm= 69 XXX, XXY, XYY (TRIPLOID)
PARTIAL mole
____ ___ = diffuse vesicular enlargement of villi (gross vesicles) without fetal sac/fetus
COMPLETE mole
___ __ = variable vesicular enlargement of villi w/ fetal sac/fetus
PARTIAL mole
____ ___= neoplasitc villi penetrate myometrium
invasive mole
why is HCG associated with hyperthyroidism
some thyroid stimulating properties
_____ = hemorrhagic/necrotic tumor w/ mixtures of syncytiotrophoblastic and cytotrophoblastic cells (w/o villus formation)
choriocarcinoma
____ = ‘intermediate’ cytotrophoblastic cells (w/o villi) diffusely infiltrating myometrium
PSTT
