215, 216, 219 female pathology

Question 1

What is the cellular lining of the cervix?

Answer 1

glandular epithelium (upper portion) and squamous epithelium (lower portion)

• separated by a transformation zone*
• glandular surface replaced with squamous epithelium after onset of menarche*

Question 2

What is the main factor driving squamous dysplasia and invasive cervical carcinoma?

Answer 2

high risk HPV infection

Question 3

What is the carcinogenic mechanism of high risk HPV?

Answer 3

E6 accelerates p53 degradation

E7 disrupts E2F-Rb dimers

Question 4

What is the most common morphology of cervical cancer?

Answer 4

squamous cell carcinoma

Question 5

What is the gross and microscopic appearance of squamous cell cervical carcinoma?

Answer 5

gross: exophytic, friable mass
microscopic: nests of squamous cells infiltrating the stroma

key features: intracellular bridges between adjacent tumor cells, keratinization (bright orange/pink) inside or outside cytoplasm

Question 6

What are the histological features of squamous dysplasia?

Answer 6

high N:C ratios, enlarged/crowded nuclei with irregular contours, mitotic figures above the basal layer

no invasion of the underlying stroma

Question 7

When does cervical dysplasia become carcinoma in situ?

Answer 7

when it involves the full thickness of the epithelium

Question 8

What type of cell is pathognomonic for HPV infected squamous cells?

Answer 8

koilocytes

Question 9

What HPV serotypes cause condyloma?

Answer 9

6, 11

Question 10

What are the pathologic hallmarks of condyloma?

Answer 10

1) papillae
2) epithelial thickening
3) koilocytic change

Question 11

What are the pathologic features of lichen sclerosus?

Answer 11

1) epidermal thickening
2) sclerotic stroma
3) band like dermal lymphocytic infiltrate

Question 12

What can lichen sclerosus develop into?

Answer 12

vulvar squamous cell carcinoma

Question 13

What are the pathologic features of lichen simplex chronicus?

Answer 13

epithelial thickening and keratinization secondary to chronic scratching

Question 14

What are the major causes of vulvar squamous cell carcinoma?

Answer 14

HPV (30%), lichen sclrosis (older women)

Question 15

What is Paget’s disease?

Answer 15

pruritic, crusted, erythematous vulvar lesion

usually associated with benign neoplasms of sweat glands (or occasionally underlying malignancy)

Question 16

What are the 3 Ms of herpes simplex?

Answer 16

multinucleation, molding (nuclei shape each other), margination

Question 17

What is the histology of proliferative endometrium?

Answer 17

Question 18

What are the histological changes of secretory endometrium?

Answer 18

early: subnuclear vacuoles
mid: sawtooth glands with secretions and stromal edema
late: decidualized stroma, spiral arterioles, inflammation

Question 19

What are the histological characteristics of endometrial polyps?

Answer 19

fibrotic stroma

thick-walled vessels

irregular glands

Question 20

What are the histological characteristics of adenomyosis?

Answer 20

islands of endometrial glands and stroma in myometrium

Question 21

What are the histologic characteristics of chronic endometritis?

Answer 21

plasma cells in stroma with other stromal changes (e.g. spindling)

Question 22

What are the histological findings of endometriosis?

Answer 22

endometrial glands and stroma

hemosiderin-laden macrophages

Question 23

What features define hyperplasia with atypical features?

Answer 23

glandular crowding and irregularity + nuclear atypia

high rate of progression to carcinoma

Question 24

Compare the ages and causes (conditions and mutations) of type I and type II endometrial carcinoma.

Answer 24

type I: 55-65 yo, caused by unopposed estrogen/obesity/diabetes, associated with PTEN mutation and lynch syndrome

type II: 65-75 yo, caused by atrophy, associated with p53 mutations

Question 25

What are the histological findings of type I endometrial carcinoma?

Answer 25

fused glands, squamous metaplasia

Question 26

What are the histological findings of type II endometrial carcinoma?

Answer 26

papillary or glandular growth pattern, marked nuclear atypia can be serous carcinoma or carcinosarcoma

Question 27

What are the treatment options for endometrial carcinoma?

Answer 27

hysterectomy +/- adjuvant therapy some women of reproductive age may want to treat with progesterone at first to preserve fertility and then have a hysterectomy when finished with childrearing

Question 28

What are the histological findings of leiomyoma?

Answer 28

well-circumscribed, round masses made of bundles of spindled smooth muscle cells arranged at various angles

Question 29

What are the parameters that differentiate leiomyosarcoma from leiomyoma?

Answer 29

1) mitotic activity (\>10 per hpf) 2) tumor necrosis 3) atypia (moderate to severe)

Question 30

What is the most common type of type I endometrial carcinoma?

Answer 30

endometrioid carcinoma

Question 31

What are the histological findings of acute salpingitis, chronic salpingitis, and hydrosalpinx?

Answer 31

acute: distended plicae with abundant inflammatory cells chronic: fused plicae, cyst-like spaces hydrosalpinix: dilated fallopian tube lumen

Question 32

What are the histologic features of ectopic pregnancy?

Answer 32

chorionic villi and fetal tissue within tube lumen

Question 33

What mutations are associated with serous tubal intraepithelial carcinomas? What other malignancies are they associated with?

Answer 33

mutations: BRCA1, BRCA2, p53 associated with high-grade serous ovarian carcinomas

Question 34

What are the differences between type I and type II epithelial malignancies?

Answer 34

type I: low grade, slowly progressing, associated with many different mutations type II: high-grade serous carcinoma, aggressive, associated with p53 mutations

Question 35

What are the histologic features of clear cell carcinoma?

Answer 35

clear cytoplasm, hobnail cells

Question 36

What is the difference between mature and immature teratoma?

Answer 36

mature = benign, no embryonal tissue immature = malignant, embryonal/immature tissue present

Question 37

What histologic finding is associated with yolk sac tumors?

Answer 37

Schiller-duval body

Question 38

What are the histologic findings of granulosa cell tumors?

Answer 38

call-exner bodies (looks kinda like immature follicles)