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Pathology > Cervix, vulva, vagina, cervix, fallopian tubes, ovaries > Flashcards

Cervix, vulva, vagina, cervix, fallopian tubes, ovaries Flashcards

0
Q

bacterial std

A

neisseria
treponema
haemophilia
calymmatpbacterium donovani

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1
Q

viral std

A 
HIV 1,2
HSV 1,2
chlamydia,mycoplasma
chlamydia trachomatis (L), lymphogranuloma venereum
c.trachomatis, ureaplasma
urelyticum
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2
Q

other stds

A

trichomonas

arthropod

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3
Q

oropharyngeal herpes serotype

A

HSV 1

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4
Q

genital, mucosal, skin HSV serotype

A

HSV2

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5
Q

herpes simplex gross

A

red papules ➡️ vesicles, pustules, ulcers

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6
Q

herpes simplex histo

A 
multinucleation
molding-kissing nuclei
margination
inclusion bodies
ground glass nuclei or perinculear halo
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7
Q

genital herpes s/sx

A

fever
malaise

cervical and vaginal:
pelvic pain
purulent discharge

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8
Q

complications of genital herpes simplex

A

latent infection 2/3 recurrences

neonatal transmission

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9
Q

genital herpes simplex diagnosis

A

immunologic
serology
biopsy

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10
Q

treatment for latent HSV

A

noooone

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11
Q

may shorten the length of the initial and recurrent assymptomatic phase

A

Acyclovir

Fancyclovir

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12
Q

lymphogranuloma venereum agent

A

Chlamydia trachomatis serotypes L1,2,3

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13
Q

lymphogranuloma venereum causes

A

cervisitis

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14
Q

cervitis by lymphogranuloma lesion

A
  1. painless genital ulcer
  2. swelling of inguinal lymph nodes - stellate abscesses surrounded by epitheloid cells
  3. scarring in chronic cases- elephantiasis of the vulva
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15
Q

lymphogranuloma venereum diagnosis

A

Frei test - chlamydial antigen

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16
Q

cause of vulvar condyloma acumintatum

A

HPV

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17
Q

low risk HPV types

A

6, 11

42, 44

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18
Q

high risk HPV

A

16, 18

31, 33

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19
Q

gross HPV

A

papillary or cauliflower outgrowth

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20
Q

HPV histo

A 
papillary overgrowth
hyperkeratosis
acanthosis
parakeratosis
hyperkeratosis
koilocytic
vacuolization
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21
Q

raisinoid nuclei and nuclear halo is seen in

A

HPV

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22
Q

cytopathic changes in pap smear of HPV inf

A

nuclear atypia
perinuclear halo
exfoliated squamous cells

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23
Q

vulvar chancre is caused by

A

Treponema pallidum

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24
Q

vulvar chancre gross

A

painless shallow ulcer

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25
Q

histo vulvar chancre

A

ulceration
chronic inflammation
vasculitis

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26
Q

diagnosis of vulvar chancre

A

darkfield microscopy
fluorescence
silver stain
serology

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27
Q

granuloma inguinale is caused by

A

Calymmatobcterium granulomatis

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28
Q

gross granuloma inguinale

A

painless ulcers with rolled borders and friable base- coalesce

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29
Q

granuloma inguinale histo

A

nonspecific
granulomatous rxn with no caseation
Donovan bodies

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30
Q

donovan bodies invade

A

cytoplasm of histiocytes

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31
Q

trichomoniasis agent

A

Trichomoniasis vaginalis

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32
Q

trichomoniasis lasts for

A

4 days to 14 weeks

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33
Q

trichomoniasis gross

A

copious purulent yellow frothy discharge

strawberry appearance
severe dilatation of mucosal vessels

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34
Q

strawberry cervix is seen in

A

trichomoniasis

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47
Q

crab louse infection

A

pediculosis pubis

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48
Q

main causative agent of bacterial vaginosis

A

Gardnerella vaginalis

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49
Q

Gardnerella vaginalis is a

A

G- coccobacilli

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50
Q

vaginitis or vaginosis s/sx

A

thin, gray fishy odor vaginal discharge

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51
Q

inflammation of the placenta caused by G. vaginalis

A

chorioamnionitis

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52
Q

G. vaginalis histo

A

clue cells

- individual sq cells covered by a layer of coccobacilli along the margin

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53
Q

pruritus, curdlike vaginal discharge caused by disturbance in vaginal microbial system

A

candidiasis

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54
Q

which disease is not considered an STD?

A

candidiasis

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55
Q

diagnosis of candida albicans

A

wet KOH mount

papsmear

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56
Q

candida albicans histo

A

nonseptated pseudopores or filamentous fungal hyphae in wet KOH

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57
Q

balls and spaghetti in microscopy is seen in

A

Candida albicans infection

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58
Q

ascending type of infection

most serious complication of gonorrhea in women

A

pelvic inflammatory disease

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59
Q

PID s/sx

A

pelvic pain
fever
adnexal tenderness

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60
Q

causative agents of PID

A

Gonococcus
Chlamydia trachomatis
Puerperal infections

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61
Q

GC in PID starts to appear

A

2-7 days after inoculation

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62
Q

puerperal infection microbes

A 
Strep
Staph
Coliform
Clostridium perfingens
Enteric
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63
Q

most common site of Gonococcal infection

A

endocervix

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64
Q

involvement of tubo-ovaria regions in PID leads to

A

tubo-ovarian abscess

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65
Q

non GC caused PID spread

A

uterus➡️lymphatics➡️venous channels

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66
Q

complications of PID

A

peritonitis
intestinal obstruction dt adhesions
infertility, ectopic pregnancy
bacteremia

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67
Q

non neoplastic epithelial disorders

A

bartholin duct cyst

vulvar dystrophy

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68
Q

Bartholin duct cysts s/sx

A 
adenitis
abscess
cystic dilatation at the posterior aspecr of labium majus
pain
discomfort
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69
Q

management of bartholin duct cust

A

marsupialization- open permanently

excision

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70
Q

bartholin glands are analogous to

A

Cowper’s gland

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71
Q

bartholin glands aka

A

greater vestibular glands

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72
Q

nonspecific inflammation characterized by white, scaly, plaquelike mucosal thickenings (leukoplakia)

A

vulvar dystrophy

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73
Q

2 categories of vulvar dystrophy

A

lichen sclerosis

squamous cell hyperplasia

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74
Q

lichen sclerosis histo (6)

A 
thinning of epidermis
disappearance of rete pegs
hydropic regeneration of basal cells
superficial hyperkeratosis
dermal fibrosis
scant perivascular mononuclear infiltrate
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75
Q

lichen sclerosis occurs

A

anywheeeere

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76
Q

lichen sclerosis is common in

A

menopausal women

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77
Q

clinical manifestation of lichen sclerosis

A

pale gray, parchment like appearance
atrophied labia
introitus narrowed

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78
Q

pathogenesis of lichen sclerosis

A

unknown

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79
Q

results from rubbing or scratching from skin due to pruritus associated with cancer

A

squamous cell hyperplasia

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80
Q

squamous cell hyperplasia histo

A

hyperplasia of vulvar squamous epithelium

hyperkeratosis

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81
Q

indicated in all vulvar lesions

A

BIOPSY

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82
Q

neoplastic tumors of the vulva- glandular neoplastic lesion

A

papillary hidradinoma

extramammary paget’s disease

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83
Q

neoplastic tumors of the vulva- benign vulvar tumors

A

condyloma acuminatum
fibroepithelial polyp
squamous papilloma
papillary hidradenoma

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84
Q

neoplastic tumors of the vulva- malignant vulvar tumors

A 
vulvar intraepithelial neoplasia VIN
vulvar carcinoma
vulvar scca
invasive scca
malignant melanoma
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85
Q

papillary hidradinoma involves

A

labia majora more than labia minora

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86
Q

papillary hidradinoma gross

A

small, well circumscribed nodules covered by normal skin

ulceration that may mimic carcinoma

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87
Q

papillary hidradinoma histo

A

similar to intraductal papilloma of the breast
- apocrine sweat glands

tubulopapillary glands lined by columnar cells and surrounded by myoepithelial cells

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88
Q

extramammary Paget’s disease gross

A

red sharply demarcated lesion on labia majora
epidermis, hair follicles, sweat glands
micropolysaccharide cells

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89
Q

prognosis of extramammary Paget’s disease

A

good!

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90
Q

not considered a precancerous lesion

A

condyloma acuminatum

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91
Q

Cancer cells are confined within the basement membrane of the entire thickness of the epithelium

A

VIN

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92
Q

VIN is multicentric meaning

A

may involve both majora and minora

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93
Q

VIN I

A

mild dysplasia

atypical proliferation <1/3

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94
Q

VIN II

A

Moderate dysplasia

<2/3 of thickness

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95
Q

VIN III

A

sever dysplasia in situ

entire thickness

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96
Q

uncommon, 3% of female genital cancers that occurs mostly in women of 60

A

carcinoma of the vulva

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97
Q

majority of vulva carcinoma are

A

SCCA

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98
Q

15% of vulva carcinoma

A

melanoma
adenoca
basal cell ca

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99
Q

prognosis of vulva ca

A

poor

65% have metastasized at time of dx

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100
Q

80% survival rate at lesions

A

<2cm

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101
Q

1st group or basaloid or warty vulvar scca is associated with

A

HPV infection of high oncogenic risk, 16,18/31

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102
Q

1st group or basaloid or warty vulvar scca is almost always preceded by

A

classic VIN

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103
Q

1st group or basaloid or warty vulvar scca occurs in

A

reproductive age women

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104
Q

vulvar intraepithelial lesion, Bowen’s dse is characterized by

A

nuclear atypia
increased mitoses
lack of cellular maturation

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105
Q

classic VIN is analogous to

A

cervical squamous intraepithelial lesions

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106
Q

second group or keratinizing scca is associated with

A

vulvar dystrophy- sq cell hyperplasia

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107
Q

second group or keratinizing scca is preceded by

A

Differentiated VIN

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108
Q

differentiated VIN is characterized by

A

marked atypia of basal layer

normal maturation and diff of superficial layers

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109
Q

more common group of vulvar scca

A

second group or keratinizing scca 70%

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110
Q

mean age for second group or keratinizing scca

A

76 y/o

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111
Q

gene features in second group or keratinizing scca

A

p53 mutations

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112
Q

vulvar scca with worse prognosis

A

second group or keratinizing scca

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113
Q

second group or keratinizing scca histo

A

keratin pearls

tonguelike masses of malignant cells infiltrating the stroma

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114
Q

invasive scca gross

A

exophytic fungating mass

endophytic ulcerating lesion

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115
Q

invasive scca histo

A

keratin pearls
intercellular bridges
frank stromal invasion

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116
Q

incidence of malignant melanoma of vulva

A

5% of vulvar cancers, rare

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117
Q

peak incidence of malignant melanoma of the vulva

A

60-70

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118
Q

malignant melanoma of the vulva histo

A

round, ovoid to spindly with large nuclei
hyperpigmentation
intracytoplasmic

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119
Q

immunostain specific for melanomas

A

HMB. 45

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120
Q

congenital vagina anomalies

A

Garthner’s duct cysts
Mucous cyst
Vaginal atresia
Double vagina

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121
Q

Garthner’s duct cysts are found in

A

anterooateral wall of vagina following mesonephric or Wolfian duct

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122
Q

Garthner’s duct cysts histo

A

low cuboidal non mucin secreting cells devoid of cytoplasmic mucicarmine or PAS + material

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123
Q

which vaginal congenital anomaly is common?

A

Garthner’s duct cysts

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124
Q

cyst derived from Mullerian epithelium

A

Mucous cyst

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125
Q

total absence of vagina

A

vaginal atresia

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126
Q

failure or total closure of the Mullerian ducts

A

double vagina

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127
Q

Vaginal intraepithelial neoplasia or VaIN gross

A

white reddish patch

raised

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128
Q

VaIN histo

A

loss of maturation
nuclear atypia
normal and abnormal mitotic figures

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129
Q

primary carcinoma of the vagina is

A

extremely uncommon

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130
Q

SCCA of vagina arises from vaginal intraepithelial neoplasia which is analogous to

A

cervical squamous intraepithelial lesions

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131
Q

SCCA of vagina most commonly found in

A

inv upper posterior

proximal 3rd

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132
Q

most common malignancy of vagina is

A

secondary to cervical or vulvar ca

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133
Q

vaginal ca gross

A

polypoid fungating indurated ulcerated lesions

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134
Q

vaginal CA histo

A 
intercellular bridges
central pearl formation
pigmenting
stratification
waxy cytoplasm
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135
Q

occurence of vaginal adenoca

A

raaaare

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136
Q

increased frequency of vaginal adenoca in

A

young women whose mothers were treated with DES

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137
Q

possible precursor of vaginal adenoca

A

vaginal adenosis

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138
Q

prognosis of vaginal adenoca

A

good upon surgery and radiation

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139
Q

vaginal adeno ca histo

A

clear cells of vacuolated, glycogen containing cells

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140
Q

very uncommon vaginal tumor seen in infants and children under 5

A

embryonal rhabdomyosarcoma or

sarcoma botryoides

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141
Q

sarcoma botryoides gross

A

soft, gray, tan, nodular tumors

polypoid lesions like a bunch of grapes

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142
Q

sarcoma botryoides histo

A

small round to spindle cells with cytoplasmic extensions from one end (tennis racket)
abundant pink cytoplasms

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143
Q

subepithelial dense zone in sarcoma botryoides

A

cambium layer

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144
Q

most cervical lesions are

A

benign

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145
Q

site where most cervical lesions arise

A

SCJ

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146
Q

acute and chronic cervicitis is common in

A

multiparous and nulliparous women

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147
Q

pathogenesis of acute and chronic cervicitis

A

glucogenated sq cells provide a substrate for endo bacteria causing acidic pH

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148
Q

lactobacilli produce

A

lactic acid to make pH of vagina less than 4.5

h2o2- bacteriotoxic

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149
Q

clinical manifestations of cervicitis

A

thick purulent discharge
fishy odor
itching
discomfort

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150
Q

diagnosis of cervicitis

A

clinical evaluation
culture
pap smear

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151
Q

replacement of mucus endocervical glands by stratified sq epithelium

A

squamous metaplasia of the endocervix

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152
Q

squamous epithelium in metaplasia of endocervix may also arise directly from

A

basal nerve cells of the endocervical mucosa

153
Q

cystic dilatation of endocervical glands or ducts with accumulation of secretory material within the cervical stroma

A

Nabothian cysts

154
Q

more common form of Nabothian cysts

A

multiple

155
Q

inflammatory, benign, nonneoplastic growth within the endocervical canal up to 5 cm

A

endocervical polyp

156
Q

symptom of endocervical polyp

A

vaginal bleeding or spotting

157
Q

management of endocervical polyp

A

simple curretage or excision

158
Q

endocervical polyp histo

A

soft, almost mucoid composed of loose fibromyxomatous stroma harboring dilated, mucus secreting endocervical glands often with inflammation

159
Q

HPV associated premalignant change in cervix

A

cervical intraepithelial neoplasia or CIN

160
Q

3 different classification systems for CIN

A

dysplasia- mild, mod, sev
CIN- 1-3
SIL or bethesda classification- LSIL, HSIL

161
Q

CIN 1

A

mild dysplasia

basal third of epithelium

162
Q

CIN 2

A

moderate dysplasia

lower and middle 3rd

163
Q

CIN 3

A

severe dysplasia and CIS

all layers

164
Q

CIN 1 renamed

A

LSIL

165
Q

CIN 2 and 3 renamed to

A

HSIL

166
Q

risk factors for cervical cancer

A 
persistent HPV 16,18
HPV 6, 11 : condylomas
early age at first intercourse
multiple sexual partners
high risk male sexual partners 
cigarette smoking
parity-multigravid
167
Q

cervical CA cocarcinogens

A

HLA subtypes
oral contraceptives
nicotine

168
Q

CIN begins at the

A

SCJ

169
Q

peak incidence for CIN is

A

30 years old

170
Q

CIN diagnosis

A

Schiller test
papsmear
colposcopy

171
Q

CIN is transient and can be cleared within

A

8 months to 2 years

172
Q

susceptible to CIN

A

immature basal cells

metaplastic squamous cells

173
Q

HPV inactivates

A

p53

RB

174
Q

nuclear alterations and perinuclear halo are termed

A

koilocytic atypia

175
Q

invasive cervical ca that spreads via direct extension or lymphatics

A

SCCA. of cervix

176
Q

most common complaint in SCCA. of cervix

A

postcoital bleed

177
Q

SCCA. of cervix complication

A 
obstruction
infection
ureteral compression
hydronephrosis
renal failure
178
Q

SCCA. of cervix gross

A

large fungating mass from posterior wall of cervix expanding laterally going inside

transformation zone palabas

179
Q

histologic grade of scca cervical

A

large keratinizing
large nonkeratinizing
small cell

180
Q

large keratinizing aka

A

invasive scca, large cell keratinizing

181
Q

most common histologic grade of cervical ca

A

large keratinizing

182
Q

large keratinizing histo

A

keratin pearls
dyskeratosis
well differentiated

183
Q

large cell nonkeratinizing histo

A

no intercellular bridges seen

moderately differentiated

184
Q

most aggressive grade of Cervical CA

A

small cell

185
Q

morphologically cannot diff from undifferentiated neuroendocrine ca with no keratin

A

small cell CA of cervix

186
Q

resembles endocervical mucinous glandular epithelium with atypia, pleomorphism, mitoses, invasion

A

cervical adenoca

187
Q

arrangement of cervical adenoca

A

gland
tubules
papillae

188
Q

cervical adenoca histo

A

tall columnar glands with basally oriented nuclei and apical cytoplasmic mucin

189
Q

cervical cancer stage 0

A

carcinoma in situ

190
Q

cervical cancer stage 1

A

confined to cervix

191
Q

stage 1A

A

microinvasive cancer

>5 mm in depth

192
Q

stage 1b

A

invasive cancer > 5mm in depth

193
Q

cervical cancer stage 2

A

extends beyond cervix into upper 1/3 of vagina

but not onto pelvic wall

194
Q

cervical cancer stage 3

A

extends to pelvic wall on lower 1/3 of vagina

195
Q

cervical cancer stage 4

A

extends beyond pelvis into bladder or rectum with distant metastases

196
Q

prognosis of cervical ca

A

5 year survival 60%

197
Q

cervical cancer screening and prevention

A

cytologic screening
histologic dx
HP vaccination program

198
Q

indications for CONE biopsy

A

lesions which are high in the endocervical canal
inconclusive or failed colposcopy
ca in situ on punch or coposcopic biopsy

199
Q

types of biopsy procedures

A

colposcopic directed biopsy
punch biopsy
cone biopsy

200
Q

most common disorder of the fallopian tubes

A

inflammations

201
Q

accounts for more than 60% of suppurative salphingitis

-usually more than one ha

A

Gonococcus

202
Q

almost always a part of PID

A

suppurative salphingitis

203
Q

important sequelae of suppurative salphingitis

A

infertility

ectopic pregnancy

204
Q

infection in fallopian tubes that is part of a systemic disease and is common in third world countries

A

tuberculous salphingitis

205
Q

bleeding due to ectopic pregnancy usually occurs

A

6 weeks after a menstrual period

206
Q

ectopic pregnancy gross

A

edema
congestion
fetus surrounded by blood clot

207
Q

occurs as a small round ovoid cyst attached by a pedicle to the fimbriated end of the tube

A

paratubal cyst

Cyst of Morgagni

208
Q

wall of paratubal cyst

A

paper thin

contain clear serous fluids

209
Q

paratubal cysts microscopy

A

lined by flat to ciliated columnar cells

210
Q

paraovarian cysts are lined by

A

flattened cuboidal epithelium

211
Q

which is more common, primary or secondary malignancy in fallopian tubes?

A

secondary

212
Q

secondary tumors are mistaken for lesions of

A

chronic salphingitis

pyosalpinx

213
Q

benign tumors of the fallopian tube are of what origin

A

mesoderm

214
Q

most frequent type of benign tubal tumor

A

adenomatoid tumor or benign mesothelioma

215
Q

adenomatoid tumor gross

A

nodular swelling beneath the tubal serosa or within the tubal wall
1-2 cm in diameter
grayish white or yellow in color

216
Q

adenomatoid tumor histo

A

multiple, slitlike or ovoid spaces

lined by single layer of low cuboidal or flattened epithelial cells

217
Q

adenomatoid tumor clinical sx

A

asymptomatic

218
Q

common malignant tumor of the fallopian tube

A

papillary adenoca

219
Q

fallopian malignant tumor are common in

A

post menopausal

60-70

220
Q

papillary adeno ca of the fallopian tube gross

A

enlarged, swollen

lumen is filled and dilated by papillary or solid tumor mass

221
Q

malignant tumor of fallopian tube histo

A

composed of fine branching papillae
covered by one or more epith
enlarged pleomorphic hyperchromatic nuclei

222
Q

primary tumor carcinoma of fallopian tube gross

A

main tumor is in the tube

ovary is intact and normal looking

223
Q

primary tubal carcinoma of the fallopian tube histo

A

mucosa invasion

papillary pattern

224
Q

tubal carcinoma may cause

A

paraneoplastic syndrome

225
Q

may prove useful in tx of malignancy of the fallopian tube

A

Ca-125 antigenic determination

226
Q

adenoca of the fallopian tube stage 0

A

carcinoma in situ

227
Q

adenoca of the fallopian tube stage 1

A

tumor extends into submucosa or muscularis, not serosa

228
Q

adenoca of the fallopian tube stage 2

A

tumor extends to serosa

229
Q

adenoca of the fallopian tube stage 3

A

tumor extends to ovary and/or endometrium

230
Q

adenoca of the fallopian tube stage 4

A

tumor extends beyond repro organs

231
Q

non neoplastic ovarian cyst

A 
inclusion (germinal cyst)
follicle cysts/ cystic follicle
lutein cyst/ corpus luteum cyst
polycystic (sclerocystic) ovary 
para-ovarian cyst
endometrial cyst
232
Q

usual location of inclusion cyst

A

surface or cortex

233
Q

inclusion cyst is filled with

A

serous or blood tinged fluid

234
Q

inclusion cyst lining

A

cuboidal or columnar of mullerian origin

235
Q

histogenesis of inclusion cyst

A

trapping of surface epithelium due to repeated ovulation and fibrosis

236
Q

incusion cyst histogenesis of cancer

A

serous cystadenoma
mucinous tumors
etc

237
Q

follicle cyst

A

abnormal cyst
>2.5 cm
granulosa-theca lining cells

238
Q

cystic follicle

A

physiologic cyst
<2.5 cm
granulosa theca-lining cells

239
Q

follicle cyst/cystic follicle occurence

A

common

considered normal

240
Q

histiogenesis of follicle cyst/cystic follicle

A

unruptured graafian follicle or ruptured follicle that immediately sealed

241
Q

follicle cyst/cystic follicle gross

A

single or multiple
filled with clear serous fluid
transparent gray membrane

242
Q

cells that secrete estrogen to stimulate the development of the follicle

A

granulosa cells

243
Q

granulosa cells histo

A

cuboidal with large centrally placed hyperchromatic nuclei

scanty cytoplasm

244
Q

theca cells nuclei

A

oval rather than round

245
Q

theca cells cytoplasm

A

pale

abundant

246
Q

usual diameter of corpus luteum cyst

A

> 2.5 cm

247
Q

occurence of corpus luteum cyst

A

very common

248
Q

corpus luteum cyst gross

A

bright yellow orange rim

249
Q

corpus luteum histo

A

granulosa lutein cells
luteinized theca cells
innermost layer of CT - foci of hemorrhage

250
Q

clinical significance of corpus luteum cyst

A

occasionally ruptures leading to intraperitoneal bleeding causing abdominal pain

251
Q

corpus luteum cyst rupture can mimic

A

appendicitis

pancreatitis

252
Q

extremely yellow cyst of a premenopausal ovary is regarded as

A

luteal in origin

253
Q

large follicular, bilateral, thin-walled cysts marked with luteinization of the theca interna layer

A

theca lutein cyst

254
Q

theca lutein cyst is associated with

A

high levels of HCG

  • H. mole
  • chorioCA
  • fetal hydrops
  • multiple gestation
255
Q

also known as Stein Leventhal syndrome

A

polycystic ovarian dse

256
Q

prevalence of polycystic ovarian dse

A

3-6%

young women

257
Q

associated syndromes of PCOD

A 
AUB with hyperestrenism
oligomenorrhea
anovulation
obesity
hirsutism
infertility
virilism- rare
258
Q

mechanism of PCOD

A

loss of hypothalamic control➡️unbalanced or asynchronous release of LH by pituitary gland

increased secretion of LH➡️stimulation of theca lutein cells of follicles➡️excess androgen➡️increase conversion to ESTRONE➡️inc ESTROGEN

neg feedback on FSH release

259
Q

PCOD gross

A

2x bigger than normal ovary
thick pearly white capsule
superficial cortex fibrotic and thickened

260
Q

PCOD histo

A

hyperplasia and luteinization of theca and granulosa cells
-follicular hyperthecosis
absent corpora albicantia
endometrial hyperplasia

261
Q

also known as chocolate cyst

A

endometriotic cyst

262
Q

endometriotic cysts are developed from

A

abnormal implants of endometrial gland and stroma in the ovary

263
Q

endometriotic cyst histo

A

old lesions with hemosiderin macrophages and fibrosis

264
Q

most common site of endometriosis

A

ovaries

broad ligament
peritoneum
large bowel
umbilicus
fallopian tubes 
laparatomy scars
265
Q

endometrial glands and stroma are within uterus- myometriumc

A

adenomyosis

266
Q

ectopic glands response to cyclical hormone in endometriosis

A

cyclical abdomina pain or pelvinc pain

267
Q

infertility caused by endometriosis is due to

A

serosal fibrosis of the fallopian tubes

anovulation of unknown etiology

268
Q

lining of endometriotic cyst wall

A

tall columnar endometrial cells

269
Q

incidence of cancer

A

endometrium>cervix>ovary

270
Q

ovarian cancer prevalence

A

6% in women excluding the skin

271
Q

80% of ovarian CA are benign, usually occur

A

25-45

272
Q

20% of ovarian ca are malignant, occuring between

A

45-65 years

273
Q

ovarian tumor symptoms secondary to the mass effect of the tumor

A

abdominal pain
mass distention
urinary or GI symptoms
vaginal bleeding

274
Q

cause of up to 50% cancer deaths of FGT because discovered late

A

ovarian tumors

275
Q

ovarian tumor markers

A

CA-125

osteopontin

276
Q

CA-125 is unspecific because it is high in benign ovarian condition but is negative in

A

mucinous ovarian cancer

277
Q

tumor marker better in screening ovaria ca

A

osteopontin

278
Q

ovarian ca risk factors

A

nulliparity
family history
genetic (hereditary) and host genes

279
Q

associated with breast cancer located at ch17q21

A

BRCA1&2

280
Q

high levels of HER2/neu oncogene means

A

poor prognosis

281
Q

K-ras protein is overexpressed in ovarian ca by

A

30%

282
Q

50% of carcinomas show mutations of this gene

A

p53 suppressor gene

283
Q

general classification of ovarian tumor

A

surface epithelial
germ cell
sex-cord stroma
metastatic tumors

284
Q

most frequent ovarian tumor

A

surface or mullerian epithelial tumor

285
Q

greatest proportion ovarian tumor

A

90%

286
Q

sex cord stroma ovarian ca age group

A

all ages

287
Q

surface epithelium cancer age group

A

20+

288
Q

surface epithelial tumors arises from

A

surface, coelomic germinal, mullerian epithelium

289
Q

mullerian tumors differentiate into

A

serous (tubal)
endometrioid(endometrium)
mucinous (endocervix)

290
Q

comprises 2/3 of ovarian tumors

comprises 90% of all ovarian cancers

A

mullerian epithelial tumor

291
Q

pathogenesis of mullerian epithelial tumor

A 
arises de novo
adeno ca sequence
surface epithelial dysplasias
endometrioses
incessant ovulation hypothesis
292
Q

incessant ovulation hypothesis

A

cortical inclusion cysts in which epithelial tumors can develop

293
Q

surface epithelial tumor classification

A 
serous
mucinous
endometrioid
clear (mesonephroid) cell
transitional or Brenner
mixed, squamous
294
Q

surface epithelial tumor:

recapitulate tubal mucosa (columnar ciliated)

A

serous

295
Q

surface epithelial tumor:

recapitulate endocervical enteric type of epithelial cells, tall columar mucus secreting

A

mucinous

296
Q

surface epithelial tumor:

recapitulate endometrial glands

A

endometrioid

297
Q

surface epithelial tumor:

mullerian

A

clear (mesonephroid) cell

298
Q

surface epithelial tumor:

cells are similar to the cells lining your urinary tract

A

transitional/ Brenner

299
Q

tumor is cystic and the lining epithelium differentiates into serous

A

serous cyst

300
Q

benign serous cyst

A

serous cystic adenoma

301
Q

parameter of classification of surface epithelial tumors

A

cell type
pattern
amt of fibrous stroma
atypia and invasiveness

302
Q

BENIGN surface epithelial tumor

A

single layer, nonpapillary
uniform,nonstratified
no stromal invasion

303
Q

BORDERLINE surface epithelial tumor

A

papillary architecture
❤️cell atypia
no stromal invasion

304
Q

MALIGNANT surface epithelial tumor

A

complex papillary, solid
marked cell atypia
❤️stromal invasion

305
Q

most widely accepted theory for the derivation of mullerian epithelial tumors

A

transformation of coelomic epithelium

306
Q

benign surface epithelial tumors are further classified based on components:
cystic areas

A

cystadenoma

307
Q

benign surface epithelial tumors are further classified based on components:
cystic, fibrous

A

cystadenofibroma

308
Q

benign surface epithelial tumors are further classified based on components:
predominantly fibrous

A

adenofibroma

309
Q

30% of ovarian tumors

A

serous tumors

310
Q

70% of serous tumors are

A

benign and borderline

311
Q

most common ovarian cancer

A

serous tumors

312
Q

histologic classification of serous tumors

A

benign serous tumors
serous tumors of borderline malignancy or APST
malignant serous tumors

313
Q

benign serous tumors

A

cystadenoma, papillary cystadenoma
surface papilloma
adenoma, cystadenofibroma

314
Q

APST

A

cystic and papillary cystic
surface papillary carcinoma
adenoca-fibroma/ cystadenocarcinofibroma

315
Q

malignant serous tumors

A

papillary cystadenocarcinoma
surface papillary carcinoma
adenocarcinoma-fibroma/ cystadenocarcinofibroma

316
Q

serous tumors general histo

A

lined by tall, columnar, ciliated and nonciliated epithelial cells
-tubal like epithelium
filled with clear serous fluid

317
Q

major group that arises in association with serous borderline tumors
mutations are in KRAS or BRAF oncogenes with mutation in p53

A

low grade serous ovarian CA (well differentiated)

341
Q

trichonomiasis s/sx

A

discomfort
dyspareunia
dysuria

342
Q

trichomoniasis diagnosis

A

wet mounts of vaginal discharge

pap smear

343
Q

Trichomona vaginalis microscopy

A

eccentrically located nuclei
flagellated, ovoid, pear shaped
cyanophilic
15-30 nm in size

344
Q

DNA poxvirus infection

common self-limiting viral dse of skin spread by direct contact

A

molluscum contagiosum

345
Q

most prevalent MCV

A

MCV 1

346
Q

sexually transmitted MCv

A

MCV 2

347
Q

direct contact infection of MCV is common in

A

children 2-12 y/o

348
Q

sexually transmitted MCV is common in

A

adults

349
Q

average incubation period of MCV

A

6 weeks

350
Q

molluscum contagiosum gross

A

pearly dome shaped papules with a dimpled center

351
Q

MCV lesions usually at the

A

trunk
anogenital
abdominal
face

352
Q

molluscum contagiosum histo

A

cup-like verrucous epidermal hyperplasia

eosinophilic intracytoplasmic inclusions

636
Q

major group that arise de novo without recognizable precursor lesion
has mutations in p53 but lacks mutations in KRAS or BRAF

A

high grade ovarian CA (poorly differentiated)

637
Q

benign serous ovarian tumor histo

A 
single, ciliated, flattened to cuboidal cells- reminiscent of TUBAL epithelium
fibrous stroma
no epithelial thickening
may contain focal papilae
Psamomma bodies in 15%
638
Q

benign serous ovarian tumor gross

A 
5-10 cm diameter or larger 30-40cm
smooth glistening outer membrane
paper thin wall
prominent BV
tensed tumor- filled with fluid
*small nodules or projections
639
Q

borderline malignancy or APST is common in

A

older patients

640
Q

borderline malignancy or APST histo

A

complex exophytic papillary projections
stratification: >1 cell layer but <3 layers
cellular atypia of columnar ciliated serous cells
-hyperchromasia
NO stromal invasion

641
Q

borderline malignancy or APST gross

A

multiple nodular growths protruding within the cyst wall
LARGE POPCORN on the surface of the inner cyst wall
irregularly thickened wall
clear serous fluid: blood-tinged

642
Q

(+) stromal invasion with 3 layers of cell

A

Serous cystadenoma

643
Q

(-) stromal invasion (+) cell atypia

A

APST or borderline malignancy

644
Q

borderline malignancy prognosis

A

5yr survival rate: 95-99%

645
Q 
(+) stromal invasion
extreme stratification >3 layers
pleomorphism
nuclear atypia 
mitoses
❤️PSAMOMMA bodies
A

malignant (serous cystadenoCA)

646
Q

Psamomma bodies are more common (not specific though) in benign serous or malignant serous?

A

malignant (serous cystadenoCA)

647
Q

malignant (serous cystadenoCA) gross

A

cystic lesion
papillary epithelium is contained within few fibrous walled cysts (intracystic)
large nodular yellow brown masses
extension of the tumor outside the capsule

648
Q

malignant (serous cystadenoCA) histo

A

cysts lined by columnar epithelium
more complex and branched
hyperchromasia
PSAMOMMA bodies

649
Q

mucinous tumors histologic class

A

mucinous cystadenoma
borderline mucinous tumor or APMT
mucinous cystadenoCA

650
Q

mucinous tumor histogenesis

A

surface epith with ENDOCERVICAL or panneth differentiation

651
Q

mucinous tumors are — of ovarian tumors

A

25%

652
Q

80% of mucinous tumors are

A

benign or borderline

653
Q

which tumors are less likely to be malignant?

serous or mucinous

A

mucinous

654
Q

mucinous or serous tumors are common in

A

older patients

655
Q

mucinous or serous?

larger

A

mucinous

656
Q

mucinous or serous?

sticky gelatinous material

A

mucinous

657
Q

mucinous or serous?

clear, straw colored

A

serous

658
Q

mucinous or serous?

tubal-like epithelium

A

serous

659
Q

after ovulation the ovarian follicles will transform into

A

corpus luteum

660
Q

without implantation of fertilized ovum in the uterus, corpus luteum will regress into

A

corpus albicans

661
Q

part of the ovary relatively free of developing follicles

rich in ct and bv

A

medulla

662
Q

gonadal differentiation that break up into a single layer of mesothelial follicular cells surrounding each germ cell

A

cortical sex cords

663
Q

differentiate to oogonia and undergo mitosis to increase their numbers

A

primordial germ cells

664
Q

connective tissue stroma for follicular support

A

mesenchym

665
Q

before birthm the oogonia enter

A

meiosis I prophase

666
Q

during meisois prophase the ovaries separate from the

A

mesonephros

667
Q

lost during meiosis prophase I

A

peritoneal covering of the ovary

Pathology (5 decks)

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