XIX - Female Genital System and the Breast Flashcards
Lesion of the female vulva characterized by thinning of the epidermis and disappearance of rete pegs, hydropic degeneration of basal cells, superficial hyperkeratosis, dermal fibrosis with scant perivascular, mononuclear inflammatory cell infiltrate. Occurs most commonly in postmenopausal women. SEE SLIDE 19.1
Lichen sclerosus(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 713
This disorder of the vulva is marked by epithelial thickening, expansion of the stratum granulosum, significant surface hyperkeratosis and pronounced leukocytic infiltrate. Appears clinically as an area of leukoplakia. SEE SLIDE 19.2
Lichen simplex chronicus(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 713
These are flat, moist, minimally elevated lesions that occur in secondary syphilis.
Condyloma lata(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 713
Lesions of the anogenital area which may be papillary and distinctly elevated or may be somewhat flat and rugose. Characteristic cellular morphology is the presence of cytoplasmic vacuolization with nuclear angular polymorphism and koilocytosis. SEE SLIDE 19.3. Hallmark of HPV infection.
Condyloma acuminata(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 713
Red, scaly plaque, microscopically characterized by the spread of malignant cells within the epithelium, occasionally with invasion of underlying dermis. May have underlying carcinoma of a vulvar or perineal gland.
Paget disease of the Vulva(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 715
A soft polypoid mass, which is a rare form of primary vaginal cancer. SEE SLIDE 19.4. Usually encountered in infants and children less than 5 y/o.
Sarcoma botryoides (embryonal rhabdomyosarcoma)(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 716
Most commonly develops in the transformation zone of the cervix. Produces a “barrel cervix” if the tumor encircles the cervix and invades the underlying stroma.
Invasive carcinoma of the cervix(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 719
Protruding polypoid masses which are inflammatory in origin, soft, yields to palpation, and have a smooth, glistening surface with underlying cystically dilated spaces filled with mucinous secretion.
Endocervical polyp(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 721
Refers to the growth of the basal layer of the endometrium down to the myometrium. Nests of endometrial stroma, glands or both are found in the myometrium, in between muscle bundles. SEE SLIDE 19.5.
Adenomyosis(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 721
Characterized by the presence of endometrial glands and stroma in a location outside the endomyometrium. Undergoes cyclic bleeding. Also called “chocolate cysts”. SEE SLIDE 19.6.
Endometriosis(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 722
These are sharply circumscribed, firm, gray-white masses of the uterus, with “whorled” cut surface. Histologically, it shows bundles of smooth muscle cells mimicking the appearance of normal myometrium.
Leiomyoma. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p 693
Solitary tumors of the uterus which arise de novo from the mesenchymal cells of the myometrium. Characterized by the presence of tumor necrosis, cytologic atypia and mitotic activity.
Leiomyosarcomas. (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 725
Type of endometrial carcinoma associated with estrogen excess and endometrial hyperplasia.
Endometroid carcinoma(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 727
Type of endometrial carcinoma which occurs in older women and is usually associated with endometrial atrophy.
Serous carcinoma(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 727
Small, fluid-filled cysts which originate from the unruptured graafian follicles or in follicles that have ruptured and immediately sealed.
Follicle and luteal cysts(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 728
Triad of oligomenorrhea, infertility and obesity in young women secondary to excessive production of estrogens and androgens.
Polycystic ovaries(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 728
Other name for polycystic ovary syndrome?
Stein-Leventhal syndrome(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 728
Two most important risk factors for development of ovarian cancer.
Nulliparity and family history(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 729
Mutation of this gene is associated in the development of both ovarian and breast cancers.
BRCA 1(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 729
Mutation of this gene is associated with the development of breast cancer only,
BRCA 2(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 729
Benign lesion of the ovary most commonly seen in women 30-40 years old. Most frequent of the ovarian tumors. Serosal covering is smooth and glistening. Characterized histologically by tall, columnar epithelium and the presence of Psammoma bodies. SEE SLIDE 19.7
Serous tumor of the ovary(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 730
Large, multilocular tumors of the ovaries, without psammoma bodies. Composed of mucin-producing epithelial cells.
Mucinous Tumors (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 731
Metastasis of mucinous tumor of the gastrointestinal tract to the ovaries is called?
Krukenberg tumor. SEE SLIDE 19.24. Usually bilateral, as opposed to mucinous tumors of primarily ovarian origin. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p 698
A rare, solid, unilateral ovarian tumor consisting of an abundant stroma containing nests of transitional-like epithelium resembling that of the urinary tract. SEE SLIDE 19.8
Brenner Tumor (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
Unilateral ovarian tumor composed of sheets or cords of large cleared cells separated by scant fibrous strands. Stroma may contain lymphocytes and occasional granuloma. Usually occur on the 2nd-3rd decade of life. SEE SLIDE 19.9
Dysgerminoma(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
Unilateral ovarian tumor which occur during the 1st 3 decades of life. Characterized by small, hemorrhagic focus with syncitiothrophoblast and cytotrophoblast. Metastasize early. SEE SLIDE 19.10
Choriocarcinoma(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
Sex cord tumor seen as small, gray to yellow-brown, and solid lesions. May resemble development of testis with tubules, or cords and plump pink Sertoli cells. May be masculinizing or defeminizing.
Sertoli-Leydig cell tumor(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
Microscopically, the distinguishing feature is a variety of immature or barely recognizable areas of differentiation toward cartilage, bone, muscle, nerve, and other structures. Found early in life.
Immature Malignant Teratomas (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 733
Tumor of the ovary composed entirely of mature thyroid tissue. May hyperfunction and produce hyperthyroidism. Appear as small, solid, unilateral brown ovarian masses. SEE SLIDE 19.11
Struma ovarii (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 733
A voluminous mass of swollen, sometimes cystically dilated, chorionic villi, appearing grossly as grapelike structures. SEE SLIDE 19.12
Hydatidiform Mole (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 735
This type of H. mole shows hydropic swelling of chorionic villi and virtual absence of vascularization of villi. No fetal parts seen.
Complete mole (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 736
This type of H. mole shows villous edema that involves only some of the villi and the trophoblastic proliferation is focal and slight, with characteristic irregular scalloped margin. Fetal parts/embryo may be seen.
Partial mole(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 736
These are complete moles that are more invasive locally but do not metastasize. Microscopically, the epithelium of the villi is marked by hyperplastic and atypical changes, with proliferation of both cuboidal and syncytial components.
Invasive Mole (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 736
Appear as very hemorrhagic, necrotic masses within the uterus. The tumor is purely epithelial, composed of anaplastic cuboidal cytotrophoblast and syncytiotrophoblast, chorionic villi are not formed. High propensity for metastasis. SEE SLIDE 19.10
Choriocarcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 737
Term used to describe hyperplasia that cytologically resemble lobular carcinoma in situ, but the cells do not fill or distend more than 50% of the acini within a lobule.
Atypical lobular hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 739
The lumen of the ducts, ductules, or lobules of the breast is filled with a heterogeneous population of cells of different morphologies. Irregular slit-like fenestrations are prominent at the periphery.
Epithelial Hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 739
Histology shows proliferation of luminal spaces (adenosis) lined by epithelial and myoepithelial cells, tielding masses of small glands within FIBROUS STROMA. Acini are arranged in a swirling pattern, and the outer border is well circumscribed.
Sclerosing Adenosis (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 741
A nonbacterial chronic inflammation of the breast associated with inspissation of breast secretions in the main excretory ducts.
Mammary duct ectasia (periductal or plasma cell mastitis) (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 742
The lesion is small, often tender, rarely more than 2 cm in diameter, and sharply localized, with a central focus of necrotic fat cells surrounded by neutrophils and lipid-filled macrophages. Caused by some antecedent trauma to the breast.
Traumatic fat necrosis (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 742
Small lobulated and cystic lesion of the breast that may grow rapidly. Exhibit “leaflike” clefts and slits on gross section. SEE SLIDE 19.13
Phyllodes Tumor (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 743
A neoplastic papillary growth within a duct, usually solitary and less than 1 cm in diameter, consisting of delicate, branching growths within a dilated duct or cyst.
Intraductal Papilloma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 743
A type of noninvasive carcinoma of the breast that tends to fill, distort, and unfold involved lobules and thus appears to involve ductlike spaces.
Ductal Carcinoma in Situ. SEE SLIDE 19.14 (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 745
A type of noninvasive carcinoma of the breast expands but does not alter the underlying lobular architecture. Cells are monomorphic with bland, round nuclei and occur in loosely cohesive clusters in ducts and lobules. Tend to be bilateral, and increases risk for development of breast CA.
Lobar Carcinoma in Situ(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 746
Caused by the extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple.
Paget disease of the nipple. SEE SLIDE 19.14 (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 746
This type of cancer produces a desmoplastic response, replacing normal breast fat and forms a hard, palpable mass. Advanced cancers may cause dimpling of the skin, retraction of the nipple, or fixation to the chest wall. SEE SLIDE 19.15
Invasive ductal carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
Breast cancer defined by the clinical presentation of an enlarged, swollen, erythematous breast, usually without a palpable mass. The blockage of numerous dermal lymphatic spaces by carcinoma results in the clinical appearance (e.g peau d’ orange)
Inflammatory carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
Breast cancer which consists of cells morphologically identical to the cells of LCIS. Occasionally they surround cancerous or normal-appearing acini or ducts, creating a so-called “bull’s-eye pattern.”
Invasive lobular carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
A rare subtype of carcinoma consisting of sheets of large anaplastic cells with pushing, well-circumscribed borders, with a pronounced lymphoplasmacytic infiltrate. SEE SLIDE 19.16
Medullary carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
A rare subtype of carcinoma which appear grossly as a soft and gelatinous mass which abundant quantities of extracellular mucin that dissects into the surrounding stroma.
Colloid (mucinous) carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
Usually present as irregular mammographic densities. Microscopically, the carcinomas consist of well-formed tubules with low-grade nuclei. Lymph node metastases are rare, and prognosis is excellent. SEE SLIDE 19.17
Tubular carcinomas (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 747
Grossly, appears as a button-like, subareolar swelling. in bilateral breasts of males.
Gynecomastia (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 750
Large, multilocular tumors of the ovaries, without psammoma bodies. Composed of mucin-producing epithelial cells.
Mucinous Tumors (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 731
Metastasis of mucinous tumor of the gastrointestinal tract to the ovaries is called?
Krukenberg tumor(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 731
Sex cord tumor characterized by solid gray fibrous cells to yellow (lipid-laden) plump thecal cells. Most hormonally inactive.
Thecoma-fibroma tumor(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
A cystic dilation of an obstructed duct that arises during lactation.
Galactocele (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 739
Multifocal, bilateral blue-brown cysts (“blue dome cysts”) of the breast, measuring 1-5 cm diameter, filled with serous turbid fluid. Occurs normally in the menstrual cycle.
Simple fibrocystic change of the breast(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 739
Term used to describe hyperplasia that cytologically resemble lobular carcinoma in situ, but the cells do not fill or distend more than 50% of the acini within a lobule.
Atypical lobular hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 739
The most common benign neoplasm of the female breast.
Fibroadenoma(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 742
A discrete, usually solitary, freely movable nodule, 1 to 10 cm in diameter, easily “shelled out” lesion of the breast. Histologically there is a loose fibroblastic stroma containing ductlike, spaces lined by a layer of epithelium that are regular and have a well-defined, intact basement membrane. SEE SLIDE 19.18
Fibroadenoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 742
Morphology: Large macrophages with granular PAS positive cytoplasm and several dense, round Michaelis Gutmann bodies. SEE SLIDE 19.19
Malacoplakia (TOPNOTCH)
In gonococcal infection of the female reproductive system, inflammatory changes will appear about how many days after the inoculation of the organism?
2-7 days (TOPNOTCH)
These cells are distinguised by a clear separation “halo” from the surrounding epithelial cells and a finely granular cytoplasm containing mucopolysaccharide that stains with PAS, Alcian Blue, and Mucicarmine
Paget cells. SEE SLIDE 19.14 (TOPNOTCH)
What is the probable precursor of vaginal adenocarcinoma?
Vaginal adenosis (TOPNOTCH)
What do you call the glandlike structures filled with an acidophilic material similar to immature follicles that are seen in Granulosa Theca Cell tumors?
Call Exner bodies. SEE SLIDE 19.20 (TOPNOTCH)
Presence of these structures characterize serous tumors of the ovaries
Psammoma bodies (TOPNOTCH)
These tumors are distinguished from serous and mucinous tumors of the ovaries by the presence of tubular glands that resemble the endometrium
Endometriod tumor (TOPNOTCH)
A key factor in the development of endometrial hyperplasia and related cancers is the inactivation of what tumor suppressor gene?
PTEN (TOPNOTCH)
What is the most common location of vaginal adenocarcinoma?
Anterior wall of the upper third of Vagina (TOPNOTCH)
This is a condition in which glandular columnar epithelium of mullerian type either appears beneath the squamous epithelium or replaces it
Vaginal Adenosis (TOPNOTCH)
Morphology: Presence of large tumor cells lying singly or in small lusters within the epidermis and its appendages
Extra mammary Paget Disease. SEE SLIDE 19.14 (TOPNOTCH)
Morphology: Tumor cells resemble tennis racket with small protrusions of cytoplasms from one end
Embryonal Rhabdomyosarcoma (TOPNOTCH)
Clustering of tumor cells in a so called “Cambium Layer” is seen in what type of rhabdomyosarcoma?
Embryonal Rhabdomyosarcoma (TOPNOTCH)
On histological examination of the cervix, epithelial spongiosis is associated with what type of infection?
T. vaginal infection (TOPNOTCH)
On histological examination of the cervix, epithelial ulcers with intranuclear inclusions within the epithelial cells and lymphocytic infiltration is associated with what type of infection?
HSV (TOPNOTCH)
Morphology: these are composed of dense fibrous stroma covered with endocervical columnar epithelium
Endocervical polyp (TOPNOTCH)
What is considered the most important agent in cervical oncogenesis?
HPV (TOPNOTCH)
Koilocytic atypia is considered what type of CIN lesion?
CIN I (TOPNOTCH)
What is the most common pattern seen in invasive cervical carcinoma?
Fungating (TOPNOTCH)
On histological examination of the endometrium, what is the earliest morphological evidence of ovulation?
Basal vacuolation (TOPNOTCH)
Morphology: ectopic endometrial glands and stroma with numerous macrophages containing hemosiderin
Endometriosis (TOPNOTCH)
The combination of ovarian tumor, hydrothorax, and ascites is designated as
Meigs Syndrome (TOPNOTCH)
What type of ovarian cancer is best considered as the counterpart of the seminoma of the testes?
Dysgerminoma (TOPNOTCH)
About 1% of the dermoids undergo malignant transformation of any one of the component elements present, but most commonly, they differentiate into what type of carcinoma?
Squamous Cell Carcinoma (TOPNOTCH)
Morphology: characterized by a lining of tall columnar epithelial cells with apical mucin and the absence of cilia, resembling cervical or intestinal epithelium
Mucinous tumors (TOPNOTCH)
Morphology: lined by a rim of bright yellow luteal tissue containing luteinized granulosa cells
Luteal cyst (TOPNOTCH)
Morphology: characterized chiefly by dilations of ducts, inspissation of breast secretions, and marked periductal and interstitial chronic granulomatous reaction
Mammary Duct Ectasia (TOPNOTCH)
What are the 3 principal patterns of morphologic changes seen in Fibrocystic Changes of the breast?
- Cyst formation with apocrine metaplasia2. Fibrosis3. Adenosis (TOPNOTCH)
Morphology: Proliferation of intralobular stroma surrounding and often pushing and distorting the associated epithelium. The border is sharply delimited from the surrounding tissue. SEE SLIDE 19.18
Fibroadenoma (TOPNOTCH)
What is the most important prognostic factor useful as a predictive factor for the response of therapy in patients with breast cancer?
Presence of estrogen and progesterone receptors (TOPNOTCH)
The histologic hallmark of this tumor is the pattern of single infiltrating tumor cells, often only one cell in width, or in loose clusters or sheets (Indian file) SEE SLIDE 19.21
Invasive lobular carcinoma (TOPNOTCH)
This is a rare manifestation of breast cancer and presents as a unilateral erythematous eruption with a scale crust
Paget disease (TOPNOTCH)
These are stellate lesions characterized by a central nidus of entrapped glands in a hyalinized stroma
Complex Sclerosing Lesion or Radial Scar (TOPNOTCH)
Morphology: composed of multiple branching fibrovascular cores, each having a connective tissue axis lined by luminal and myoepithelial cells
Papillomas (TOPNOTCH)
What is the most common clinical presentation of breast disease
Pain (TOPNOTCH)
The principal mammographic signs of breast carcinoma
Densities and calfications (TOPNOTCH)
Morphology: the main histologic feature is keratinizing squamous epithelium extending to an abnormal depth into the orifices of the nipple ducts
Periductal mastitis (TOPNOTCH)
Mammographic appearance: Large lobulated “popcorn” calcifications
Fibroadenoma (TOPNOTCH)
Morphology: Characterized by solid sheets of pleomorphic cells with high-grade nuclei and central necrosis detected mamographically as clusters or linear and branching microcalcifications
Comedocarcinoma (TOPNOTCH)
Morphology: Terminal ducts (without lobule formation) are lined by a multilayered epithelium with small papillary tufts and surrounding periductal hyalinization and fibrosis.
Gynecomastia (TOPNOTCH)
Morphology: Terminal duct lobular unit is enlarged, and the acini are compressed and distorted within the lumens. Calcifications are often present within the lumens.
Sclerosing adenosis(TOPNOTCH)
Morphology: central fibrovascular core extends from the wall of a duct. The papillae arborize within the lumen and are lined by myoepithelial and luminal cells
Intraductal papilloma(TOPNOTCH)
Cellular proliferation resembling ductal carcinoma in situ or lobular carcinoma in situ but lacking sufficient qualitative or quantitative features for a diagnosis of carcinoma in situ
Atypical hyperplasia(TOPNOTCH)
Recognized by its histologic resemblance to ductal carcinoma in situ, including a monomorphic cell population, regular cell placement, and round lumina. However, the lesions are characteristically limited in extend, and the cells are not completely monomorphic in type or they fail to completely fill ductal spaces
Atypical hyperplasia(TOPNOTCH)
What are the two major risk factors for breast carcinoma?
Hormonal and Genetics/family history(TOPNOTCH)
This is a subtype of DCIS which is recognized by bulbous protrusions without a fibrovascular core, often forming complex intraductal patents.
Micropapillary DCIS(TOPNOTCH)
Earliest lesions consist of red papules progressing to vesicles then to painful coalescent ulcers on the vulvar or vaginal area. Smears shows multinucleated squamous cellswith basophilic viral inclusion with a ground-glass appearance. This is caused by:
HSV (TOPNOTCH) Robbins Basic Pathologym 9th ed, p. 993
Manifests with vulvovaginal pruritus, erythema, swelling, and curdlike vaginal discharge. Wet KOH mount of discharge shows pseudospore or filamentous fungal hyphae.
Candidiasis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 994
Presents with yellow, frothy vaginal discharge, vulvovaginal discomfort, dysuria, and dyspareunia. The vaginal and cervical mucosa typically has a fiery red appearance, with marked dilatation of cervical mucosal vessels (“strawberry cervix”). The cause is:
Trichomonas vaginalis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 994
Presents with thin, green-gray, fishy vaginal discharge. Pap smear reveal squamous cells covered with a shaggy coating coccobacilli.
Bacteria vaginosis(caused by Gardnerella vaginalis)(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 994
This infection is characterized by marked acute inflammation of mucosa; smears of inflammatory exudate shows phagocytosed gram-negative diplococci within neutrophils.
Gonococcal infection(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 995
Most common site of vaginal carcinoma
Upper vagina, posterior wall at the junction with ectocervix(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1000
True or False: All HSILS are considered to be at high risk for progression to carcinoma.
True(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1003
Viral proteins implicated in the ability of HPV to act as carcinogen by interfering with the activity of tumor suppressor proteins.
E6 and E7(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1002
Most common histologic subtype of cervical carcinoma
Squamous Cell Carcinoma (TOPNOTCH)
Most common high-risk HPV type causing cervical precursor lesions and cervical carcinomas.
HPV-16 and 18. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1007
Most frequent cause of dysfunctional bleeding
Anovulation(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1009
Disease of women in active reproductive life; causes infertility, dysmenorrhea, pelvic pain. Endometrial glands and stroma outside of the uterus.
Endometriosis (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1012
An important cause of abnormal uterine bleeding; frequent precursor to endometrial carcinoma; most commonly caused by by unopposed estrogen stimulation.
Endometrial hyperplasia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1013
Most common invasive cancer of the female genital tract
Endometrial carcinoma(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1013
True or False. Malignant transformation of leiomyoma to leiomyosarcoma is rare.
True. Leiomyosarcoma arise DE NOVO. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1020
The majority of ovarian neoplasm arise from?
Mullerian epithelium(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1023
The most common primary malignant ovarian tumor
Serous adenocarcinoma(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1023
Most common germ cell tumor of the ovary in women of reproductive age
Mature cystic teratoma/dermoid cyst(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1031
Glomerulus-like structure composed of a central blood vessel enveloped by tumor cells within a space lined by tumor cells
Schiller-Duval body(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1031
Characteristic histologic feature of Yolk Sac Tumor
Schiller-Duval body(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1031
Ovarian tumor that may elaborate large amounts of estrogen; Two thirds occur in post-menopausal women; potentially malignant
Granulosa cell tumor(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1032
Biomarker useful for identifying granulosa an other sex cord-stromal tumors, and monitoring treatment.
Serum inhibin(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1032
Serum marker for ovarian carcinoma
CA-125(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1029
Ovarian tumor that often functional and commonly produce masculinization or defeminization; peak incidence 20-30 y/o; cut surface is usually solid, gray to golden brown in appearance.
Sertoli-Leydig cell tumor(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. `033
Most common extra-mullerian tumors metastatic to the ovary
Carcinoma of the breast and GIT(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1034
Systemic syndrome characterized by widespread maternal endothelial dysfunction that presents during pregnancy with hypertension, edema, and proteinuria.
Preeclampsia(TOPNOTCH) Robbins Basic Pathology, p. 1034
Morphology: placental infarcts, retroplacental hematoma, abnormal decidual vessels, fibrin thrombi in the portal capillaries and hemorrhagic necrosis of the liver, kidney glomeruli show marked swelling of endothelial cells, mesangial cell hyperplasia, amorphous dense deposits on the endothelial side of basement membrane.
Preeclampsia(TOPNOTCH) Robbins Basic Pathology, p. 1039
Choriocarcinoma is most often preceded by:
Complete H. mole(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1041
Most common cause of acute bacterial mastitis
Staphylococcus aureus(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1046
Most important risk factors of breast cancer
Estrogenic stimulation and age(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1057
Most common molecular subtype of invasive breast cancer
ER-positive, HER2-negative, low proliferation(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1060
Histologic hallmark: presence of discohesive infiltrating tumor cells, often including signet-ring cell containing mucin droplets.
Lobular carcinoma of the breast(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1065
Most important prognostic factor for invasive carcinoma of the breast in the absence of lymph node status.
Axillary lymph node status(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1066
A 44 year old G3P3 has a routine Pap smear, which reported “LSIL.” A colposcopy showed a reddish area in the posterior cervix. Biopsy showed an intact squamous epithelium with some cells showing dark, angulated nuclei surrounded by a clear cytoplasm. The biopsy will be read as (A) normal (B) CIN I (C) CIN II (D) CIN III
CIN I (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 718-719
A 38 year old G2P2 presents with dysmenorrhea and menorrhagia. Ultrasound shows a symmetrically enlarged uterus, with a 4 cm thick myometrium, and endometrium with normal thickness. She opts to have a hysterectomy. The histopathology showed nests of endometrial glands and stroma in the myometrium between the muscle bundles. SEE SLIDE 19.5. The endometrium is described as “proliferative.” She has (A) a leiomyoma (B) adenomyosis (C) endometrial stromal sarcoma (D) endometrial carcinoma
Adenomyosis(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 721
A 42 year old G4P4 has had a 20 year history of dysmenorrhea. An ultrasound shows a right adnexal cyst. She undergoes a right salpingoophorectomy. The right ovary has been converted to a 10 cm diameter brown cystic mass, filled with dark brown fluid. The internal surface is shaggy. Microscopic examination shows hemorrhage and hemosiderin deposits, and occasional endometrial glands and stroma. This lesion (A) contains nonfunctioning endometrium (B) probably originated from retrograde implantation of menstrual endometrium (C) is malignant (D) all of the above
probably originated from retrograde implantation of menstrual endometrium (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 722
Which of the following is associated with endometrial hyperplasia? (A) Stein-Leventhal syndrome (B) granulosa-theca cell tumors (C) obesity (D) all of the above
all of the above (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 723
Which of the following has the highest risk of developing endometrial carcinoma? (A) cystically dilated endometrial glands, with single layer of endometrial cells (B) crowded branched endometrial glands, with tall, columnar epithelium exhibiting stratification and nuclear atypia (C) nests of closely packed glands with single layer of endometrial cells (D) regularly spaced endometrial glands, with epithelium exhibiting supranuclear vacuoles, and stromal edema
crowded branched endometrial glands, with tall, columnar epithelium exhibiting stratification and nuclear atypia (complex hyperplasia with atypia) (A- disordered endometrium; C - hyperplasia without atypia; D - secretory endometrium) (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 723-724
A 48 year old G0P0 woman has menorrhagia. Ultrasound shows multiple sharply circumscribed myometrial and submucosal masses. She undergoes hysterectomy. Histopathology showed whorled bundles of smooth muscle cells, with rare mitoses, and no necrosis. These masses (A) commonly transform into sarcomas (B) may shrink postmenopausally (C) are polyclonal (D) all of the above are true
may shrink postmenopausally (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 724
Which of the following is a risk factor for endometrial carcinoma? (A) obesity (B) diabetes mellitus (C) hypertension (D) all of the above
all of the above (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 725
In endometrial carcinomas, which histologic pattern is associated with p53 mutations, arises in a background of endometrial atrophy, and has a poor prognosis? (A) serous (B) mucinous (C) endometrioid (D) adenosquamous
serous (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 726
A 22 year old presents with signs of acute abdomen. On history, she has been amenorrheic for 8 weeks. Pelvic examination showed a tender right adnexal mass. She undergoes emergency laparotomy with right salpingectomy. At histopathology, the fallopian tube is dilated with a point of rupture. The lumen is filled with blood clots. Which of the following histopathologic findings proves tubal pregnancy? (A) decidualized tubal epithelium (B) infiltrates of neutrophilic agreggates and necrosis (C) diffuse hemorrhage and fibrin deposition (D) chorionic villi
chorionic villi (TOPNOTCH) (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 734
Which of the following statements on ovarian cancer is true? (A) the risk is higher in BRCA 2 mutations than in BRCA1 (B) multiparity is a risk factor (C) oral contraceptives somewhat reduces the risk (D) all of the above
oral contraceptives somewhat reduces the risk (A - higher in BRCA1, B - nulliparity is a risk) (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 729
Epithelial tumors of the ovary can be benign, borderline, or malignant. Which histologic type is more likely to be malignant than benign? (A) serous (B) mucinous (C) endometrioid
endometrioid (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 731
A 17 year old female presents with a 10 cm left ovarian cyst and undergoes oophorectomy. On histopathology, the cyst is filled with sebum and hair. There is a solid area with a gritty cut surface. Which of the following histologic findings characterizes the tumor as immature? (A) islands of cartilage and bone (B) nests of pseudostratified epithelium (C) sheets of round cells with scant cytoplasm, some forming rosettes (D) foci of glial cells admixed with neuropil
Sheets of round cells with scant cytoplasm, some forming rosettes (neuroepithelial differentiation). SEE SLIDE 19.22. (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 733
Which of the following ovarian tumors can produce virilizing signs and symptoms? (A) granulosa cell tumor (B) thecoma (C) sertoli-leydig tumor (D) dysgerminoma
Sertoli-Leydig cell tumor(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 732
Which of the following trophoblastic lesions has a triploid karyotype? (A) complete mole (B) partial mole (C) invasive mole (D) placental site trophoblastic tumor
Partial mole(TOPNOTCH) Robbins Basic Pathology, 8th ed., p 735-736
Which of the following tumors is most responsive to chemotherapy? (A) gonadal choriocarcinoma (B) gestational choriocarcinoma (C) placental site trophoblastic tumor
gestational choriocarcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 737
A 32 year old female presents with a 5 year history of a right breast lump. A core needle biopsy is performed. Which of the following findings represents a lesion that can progress to ductal carcinoma? (A) small and large cysts with cuboidal to columnar epithelium and surrounding fibrous stroma (B) lymphocytes and plasma cells infiltrating the periductal stroma (C) loose fibroblastic stroma with compressed, slit-like epithelium lined spaces (D) expanded ducts with proliferating monomorphic epithelial cells, with rigid, round fenestrations
expanded ducts with proliferating monomorphic epithelial cells, with rigid, round fenestrations (atypical ductal hyperplasia) (A - fibrocystic changes; B - chronic mastitis; (C) - fibroadenoma) (TOPNOTCH) Robbins Basic Pathology, 8th ed., pp 739-743
A 39 year old female presents with bloody discharge from the right nipple. A subareolar lump is palpated. It is excised and submitted to histopathology, which showed multiple papillae with connective tissue cores and lined by an outer cuboidal epithelial layer, and an inner myoepithelial layer. This lesion (A) is also known as cystosarcoma phyllodes (B) is malignant (C) usually arises in a lactiferous duct (D) all of the above
usually arises in a lactiferous duct (intraductal papilloma) (TOPNOTCH) Robbins Basic Pathology, 8th ed., p743
A 45 year old female presents with a right breast lump. An excision is performed, showing an ill-defined firm mass. Histopathology shows cells invading individually into the stroma, some forming aligned strands or chains. Other cells encircle normal-appearing ducts, forming a bull’s eye pattern. This carcinoma (A) is almost always associated with HER2/NEU overexpression (B) frequently metastasizes into CSF, serosal surfaces and gastrointestinal tract (C) consists more than 80% of breast carcinomas (D) all of the above are true
frequently metastasizes into CSF, serosal surfaces and gastrointestinal tract (invasive lobular carcinoma) (A - Her2/Neu overexpression very rare; C - uncommon type,
Which of the following breast carcinomas has the worst prognosis? (A) pure medullary carcinoma (B) mucinous carcinoma (C) tubular carcinoma (D) ductal carcinomas of no special type
ductal carcinoma of no special type (TOPNOTCH) Robbins Basic Pathology, 8th ed., pp 748-749
How can one distinguish Paget disease of the vulva from a vulvar melanoma?
Positive PAS staining in Paget disease cells (TOPNOTCH) Robbins Basic Pathology, 9th ed., p684
Why is it important to get samples from the TRANSFORMATION ZONE of the cervix in Pap smears?
HPV has a tropism for the immature squamous cells in the transformation zone. Hence, most lesions start from there. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p685
CIN I, II or III: Dysplastic changes in the lower third of epithelium with koilocytic changes in the superficial layers LSIL.
CIN I. SEE SLIDE 19.23 (TOPNOTCH) Robbins Basic Pathology, 9th ed., p687
CIN I, II or III: Dysplasia extends to middle third with delayed keratinocyte maturation. Cells now have variation in size and how the nucleus looks. HSIL.
CIN II. SEE SLIDE 19.23 (TOPNOTCH) Robbins Basic Pathology, 9th ed., p687
CIN I, II or III: Marked by almost complete loss of maturation with disorderly cells affecting all layers of the epithelium. HSIL.
CIN III. SEE SLIDE 19.23 (TOPNOTCH) Robbins Basic Pathology, 9th ed., p687
Five risk factors for endometrioid type of endometrial carcinoma
Obesity, diabetes, hypertension, infertility, and exposure to unopposed estrogen. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p692
Most common origin of malignant ovarian tumors
Surface epithelial-stromal cells (90%) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p692
COMPLETE or PARTIAL MOLE: Usually triploid (ie., 69, XXY)
Partial Mole (TOPNOTCH) Robbins Basic Pathology, 9th ed., p702
COMPLETE or PARTIAL MOLE: Has more risk of subsequent choriocarcinoma
Complete Mole (TOPNOTCH) Robbins Basic Pathology, 9th ed., p702
COMPLETE or PARTIAL MOLE: Shows hydropic swelling of poorly vascularized chorionic villi with a loose stroma. Always with trophoblastic proliferation.
Complete Mole (TOPNOTCH) Robbins Basic Pathology, 9th ed., p702
COMPLETE or PARTIAL MOLE: Villi have a characteristic irregular, scalloped margin. Some fetal cells are present.
Partial Mole (TOPNOTCH) Robbins Basic Pathology, 9th ed., p702
Lining of cells are large and polygonal with abundant granular, eosinophilic cytoplasm and small, round, deeply chromatic nuclei.
Apocrine metaplasia, almost always benign. Seen in fibrocystic lesions of the breast. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p705
Most common location of breast tumors
Upper outer quadrant (TOPNOTCH) Robbins Basic Pathology, 9th ed., p710
DCIS subtype characterized by cells with high-grade nuclei, with extensive central necrosis that produces toothpaste-like necrotic tissue
Comedo DCIS (TOPNOTCH) Robbins Basic Pathology, 9th ed., p710
LCIS or DCIS: Intracellular mucin vacuoles, sometimes forming signet ring cells, are common. Only RARELY associated with calcifications, hence cannot be seen in mammography.
LCIS (TOPNOTCH) Robbins Basic Pathology, 9th ed., p710
Lobular or ductal carcinoma: Cells often aligned in single-file strands or chains. This is due to the presence of mutations that affect the function of E-cadherin. SEE SLIDE 19.21
Invasive lobular carcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p711
