Flashcards in 4c.pathology Gynecological tumor epidemiology Vaginal tumors Cervical pathology Premature ovarian failure Most common causes of anovulation Polycystic ovarian syndrome (Stein-Leventhal syndrome) Ovarian cystsOvarian neoplasms Deck (62)
What fetal malformations are associated with polyhydramnios (greater than 1.5–2 L of amniotic fluid)?
Esophageal/duodenal atresia and anencephaly, both causing an inability of the fetus to swallow amniotic fluid
List these cancers in order of worsening prognosis: cervical, endometrial, ovarian.
Ovarian, cervical, endometrial
A woman is concerned about her risk of gynecologic cancers. List incidence in the U.S. from most to least common. How about worldwide?
In U.S. = endometrial, ovarian, cervical; worldwide = cervical cancer is the most common due to lack of HPV screening or HPV vaccine access
What vaginal cancer develops secondary to cervical carcinoma?
Vaginal squamous cell carcinoma develops from cervical squamous cell carcinoma (primary vaginal cancer is rare)
A female patient presents with clear cell adenocarcinoma of the vagina. What drug was she likely exposed to in utero?
A 3-year-old girl presents with a clear, grape-like, polypoid mass emerging from her vagina. Diagnosis?
Sarcoma botryoides (rhabdomyosarcoma variant), which are spindle-shaped cells on histology, desmin positive, & typically affect girls
On histology, where would you expect to see the initial stages of cervical dysplasia or carcinoma in situ?
At the basal layer of the squamocolumnar junction (dysplasia begins basally and progressively extends to the apical surface)
A 19-year-old woman receives the HPV vaccine. It protects against which two carcinogenic HPV strains? How do they cause cervical cancer?
16 and 18 (E6 gene product inhibits p53 suppressor gene, E7 gene product inhibits RB suppressor gene)
What characteristics of cervical cancer make it amenable to screening and effective intervention?
Slow development and identifiable precursor lesions, which can be located and removed at an early stage
Name four risk factors for cervical cancer.
Multiple sexual partners (largest risk factor), early sexual intercourse, HIV infection, and smoking
A 40-year-old woman with a history of cervical carcinoma now has oliguria and a creatinine of 4.0 mg/dL (elevated). What is likely cause?
Lateral invasion by the carcinoma, resulting in obstruction of the ureters
What is the classification system for cervical intraepithelial neoplasia (CIN)?
CIN I is mild dysplasia, CIN 2 is moderate dysplasia, CIN 3 is severe dysplasia or carcinoma in situ
A woman has invasive cervical carcinoma due to HPV infection. The carcinoma is more likely of ____ (squamous/glandular) cell origin.
A 24-year-old woman presents with postcoital bleeding. She has a history of smoking and several sexual partners. How would you diagnose her?
She is at high risk for cervical dysplasia, which is typically asymptomatic but can present with abnormal bleeding (do a Pap smear)
What distinguishes premature ovarian failure from menopause?
Menopause occurs after age 40 years, premature ovarian failure occurs before age 40, and both are caused by ovarian follicle atresia
A 40-year-old woman has hot flashes, and you suspect premature ovarian failure. What do you expect to see on blood laboratory results?
Decreased estrogen and increased follicle-stimulating and luteinizing hormones
Name two causes of anovulation, other than pregnancy, that are due to increased levels of circulating estrogens.
Polycystic ovarian syndrome and obesity
Name four endocrine abnormalities that can cause anovulation.
Thyroid disorders, Cushing syndrome, adrenal insufficiency, hyperprolactinemia
What might cause anovulation in a 30-year-old woman who is experiencing hot flashes, irregular menstrual cycles, and dyspareunia?
Premature ovarian failure
Disrupting what endocrine signaling system may cause anovulation?
The hypothalamic-pituitary-ovarian (HPO) axis (such as in Kallmann syndrome, where there is a failure of gonadotrope cells in the pituitary)
Which of the following conditions is not a common cause of anovulation: pregnancy, being a competitive athlete, eating disorders, or HPV?
HPV infection (other three conditions are common causes of anovulation)
An obese woman has amenorrhea/oligomenorrhea and dark hair above her lips. Pregnancy test is negative. What is the cause of her infertility?
Polycystic ovarian syndrome, which causes anovulation due to elevated luteinizing hormone levels (common cause of subfertility in women)
A woman is diagnosed with Stein-Leventhal syndrome. What is the etiology of the increased serum testosterone level?
Deranged steroid synthesis by theca cells results in hyperandrogenism (it is also known as polycystic ovarian syndrome)
How does polycystic ovarian syndrome affect luteinizing (LH) and follicle-stimulating (FSH) hormones, and androgen levels?
LH is increased; FSH is increased, LH:FSH ratio is increased, and androgens are increased
A woman with polycystic ovarian syndrome is at increased risk for what type of cancer?
Endometrial cancer secondary to unopposed estrogen from repeated anovulatory cycles
A woman has hirsutism, infertility, oligomenorrhea, and enlarged cystic ovaries bilaterally. Diagnosis and treatment options?
Polycystic ovarian syndrome—treated with weight loss, oral contraceptives, clomiphene citrate, ketoconazole, and spironolactone
What causes the increased luteinizing hormone (LH) levels in polycystic ovarian syndrome?
Increased LH due to pituitary/hypothalamus dysfunction secondary to hyperinsulinemia/insulin resistance
What is an ovarian cyst that consists of an unruptured, distended graafian follicle called?
A follicular cyst (most common ovarian mass in women)
A woman with endometrial hyperplasia and anovulatory cycles is found to have an ovarian cyst. What is the most likely type?
A follicular cyst, which can be associated with endometrial hyperplasia and elevated estrogens