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Gyn. Flashcards

1
Q

Squamous cell carcinoma of the labia majora

A

Note the ulcerated lesion on the labia minora. HPV 16 and 18 are the primary causes. (Neo091)

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2
Q

Vulvar leukoplakia

A

Note the white discoloration of the thin epidermis. This patient has lichen sclerosis (Gyn224)

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3
Q

Lichen sclerosis of vulva

A

Note the thinning of the epidermis and hypocellular area in the superficial dermis. It is not a precursor for cancer (Gyn225)

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4
Q

Squamous hyperplasia of vulva

A

Clinically, this would have looked like leukoplakia. Note the increased stratum corneum, increased thickness of the epidermis, and underlying inflammation. This is a precursor for squamous cancer. (Gyn226)

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5
Q

Vulva with Paget’s disease

A

Note the large cells surrounded by a clear halo in the epidermis. These are malignant glandular cells (mucin positive, S100 antigen negative). Paget’s is a cancer limited to the epithelium. (Gyn294)

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6
Q

Paget’s disease of the vulva

A

This slide shows large cells with clear appearing cytoplasm present in the lower portion of the epidermis. These represent Paget’s cells and would stain positive for mucin. (Gyn016)

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7
Q

Paget’s disease of the vulva

A

Notice that there are several nests of large clear cells present in the owner portion of the epidermis. These represent Paget’s cells. (Gyn017)

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8
Q

Gartner’s duct cyst

A

Note the cyst in the lateral wall of the vagina. Remnant of Wolffian duct (mesonephric duct). (Gyn227)

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9
Q

Rokitansky-Kuster-Hauser syndrome (Mullerian agenesis)

A

Note absence of the vagina. The uterus is often absent as well. The patient has primary amenorrhea due to an end-organ defect. (Gyn228)

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10
Q

Herpes genitalis on labia

A

Note the grouping of the areas of ulceration on the labia. (Gyn310) 765

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11
Q

Herpes genitalis on shaft of penis

A

Note the ulcers and vesicular lesions. (Gyn201)

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12
Q

Tzanck prep of Herpes genitalis lesion

A

Note the multinucleated squamous cell and the dark red intranuclear inclusions surrounded by a halo. (Gyn309)

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13
Q

Herpes genitalis cervicitis

A

Note the erosive nature of the inflammation (Gyn202)

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14
Q

Herpes genitalis proctitis

A

Note the vesiculoulcerative nature of the lesions (Gyn203)

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15
Q

Condyloma acuminata (“venereal wart”)

A

Note the fern-like appearance of the lesion on the shaft of the penis. It is caused by HPV 6 or 11. (Derm012)

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16
Q

Chlamydia trachomatis urethritis

A

Note the watery exudate exuding from the meatus of the penis. Gram stain reveals neutrophils but no visible organisms (sterile pyuria). Symptoms occur the second week after sexual exposure. (Gyn204)

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17
Q

Chlamydia trachomatis in cervical Pap smear

A

Note the cytoplasmic inclusions with the vacuoles (lysosomes) and centrally located elementary bodies. (Gyn308)

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18
Q

Chlamydia trachomatis conjunctivitis in a newborn (ophthalmia neonatorum)

A

Conjunctivitis is usually bilateral and occurs during the second week after delivery. Infection occurs from contamination of the eyes on passage through an infected endocervical canal. Chlamydia trachomatis pneumonia also commonly occurs at the same time. (Gyn205)

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19
Q

Neisseria gonorrhoeae urethritis/ cervicitis

A

Note the thick exudate from the penis and surrounding the external os of the cervix. Symptoms appear within the first week after sexual exposure. (Gyn206)

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20
Q

Neisseria gonorrhoeae gram stain

A

Note the neutrophil on the right of the screen. It contains numerous gram negative diplococci. The gram negative rods are Lactobacilli. (Gyn311)

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21
Q

Pelvic inflammatory disease due to Neisseria gonorrhoeae

A

Note the inflamed fallopian tubes and enlarged ovaries (contain abscesses). (Gyn208)

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22
Q

Pelvic inflammatory disease due to Neisseria gonorrhoeae

A

Note the pus in the lumens of both fallopian tubes and the multiloculated abscesses in both ovaries. (Gyn307)

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23
Q

Fitz-Hughes-Curtis syndrome

A

Note the adhesions between the parietal peritoneum and the capsule of the liver. Pus from pelvic inflammatory disease due to Neisseria gonorrhoeae and/or Chlamydia trachomatis may produce these adhesions. Patients complain of chronic pain in the RUQ. (Gyn209)

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24
Q

Vulvar lymphedema secondary to lymphogranuloma venereum

A

LGV is due to a variant of Chlamydia trachomatis. Unlike other STDs, this STD has papular lesions (not visible) rather than ulcers and granulomatous microabscesses in the inguinal lymph nodes. Obstruction of lymphatics leads to localized lymphedema. Rectal strictures are also common in women. (Gyn314)

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25
Q

Chancroid (Hemophilus ducreyi)

A

Note the ulcer on the shaft of the penis. Unlike syphilis, it is painful. Gram stain demonstrates a school of fish orientation of the gram negative organisms. (Gyn306)

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26
Q

Granuloma inguinale (Calymmatobacterium granulomatis)

A

Note the serpiginous ulcers. Unlike other STDs, there is no lymphadenopathy. (Gyn217)

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27
Q

Donovan bodies in macrophages in granuloma inguinale

A

Note the phagocytosed organisms. They are very similar in appearance to Histoplasma yeasts and leishmanial forms in leishmaniasis. (Gyn312)

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28
Q

Clue cell in bacterial vaginosis due to Gardnerella vaginalis

A

Note the granular material (adherent bacteria) covering the surface of the superficial squamous cell. These are called clue cells. (Gyn304)

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29
Q

Dark field of Treponema pallidum

A

Note the tightly wound spirochete. Dark field is considered the gold standard for diagnosing syphilis. (Gyn210)

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30
Q

Clear cell carcinoma of the vagina

A

This lesion is found in the daughters of women who took DES. Daughters are predisposed to vaginal adenosis (benign Mullerian epithelium), which is the precursor for clear cell adenocarcinoma. It occurs in the age group of 17-22 and occurs on the anterior wall of the upper third of the vagina where Mullerian epithelium joins with the urogenital sinus. Notice that the tumor forms glandular structures on the left or sheets of clear staining cells on the right. (Gyn022)

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31
Q

Embryonal rhabdomyosarcoma

A

This slide shows a classic feature of the embryonal rhabdomyosarcoma (skeletal muscle sarcoma), mainly cross striations. (Neo205)

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32
Q

Cervical pap smear with endocervical cells

A

Note the glandular appearing endocervical cells on your left. These indicate that there is adequate sampling of the transformation zone, the primary site for squamous dysplasia and cancer. (Gyn231)

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33
Q

Cervical pap smear with superficial squamous cells

A

Note the eosinophilic cytoplasm (may be blue) and pyknotic nucleus. These cells indicate estrogen stimulation. (Gyn315)

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34
Q

Cervical pap smear with intermediate squamous cells

A

Note the blue cytoplasm (may be eosinophilic) and less dense appearing nuclei. These indicate progesterone stimulation. (Gyn316)

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35
Q

Cervical pap smear with parabasal cells:

A

parabasal cells indicate the absence of estrogen and progesterone stimulation. (Gyn317)

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36
Q

Nabothian cysts

A

Nabothian cysts arise in endocervical glands where the gland duct has been blocked by squamous epithelium that has replaced endocervical epithelium. Nabothian cysts are a feature of chronic cervicitis. (Gyn038)

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37
Q

Carcinoma-in-situ (CIN III) of the cervix

A

Note the full thickness dysplasia of the epidermis and lack of surface maturation. HPV 16 or 18 are the MC causative agent. (Neo093)

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38
Q

Koilocytosis of cervix

A

Note the squamous cells with the pyknotic nuclei surrounded by a clear space (called koilocytosis). These cells have been infected by HPV. (Gyn318)

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39
Q

Cervical dysplasia mosaic pattern

A

This pattern is associated with dysplasia of the cervix. It is produced when acetic acid is applied to the surface of the cervix. This application coagulates the proteins of the nucleus and cytoplasm of the cervical cells and makes the proteins opaque and white. The term referring to this change is called acetowhite epithelium. The mosaic pattern is caused by terminal capillaries surrounding roughly circular or polygonal shaped blocks of acetowhite epithelium crowded together which causes the mosaic pattern similar to mosaic tile. The vessels form a basket around the blocks of abnormal epithelium. (Gyn047)

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40
Q

Invasive cervical squamous carcinoma

A

The rectal vault is to your left. A portion of distal vagina and ulcerated cervix, representing squamous cancer, is in the middle. The urinary bladder is on your right. Note the white appearing cancer extending through the wall of the cervix into the wall of the subjacent urinary bladder. Although not visible, the ureterovesical junction is in this area and is most likely blocked by the cancer. This explains why renal failure is the MC cause of death. (Gyn319)

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41
Q

Endometrial cycle

A

This slide shows the early proliferative phase which is evidenced as elongation of the endometrial glands. The cells lining the glands show scattered mitotic figures. There is no obvious stratification at this time. (Gyn051)

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42
Q

Endometrial cycle

A

This slide shows a gland that is representative of a later stage of the proliferative phase. The nuclei within the gland demonstrate stratification and there are scattered mitotic figures present. (Gyn052)

43
Q

Endometrium-ovulation

A

The presence of subnuclear vacuoles is consistent with the ovulatory phase of the cycle. The secretory products will then progress toward the lumen as the glands enter the secretory phase. The subnuclear vacuoles typically appear around cycle day 16. (Gyn053)

44
Q

Early secretory phase-endometrium

A

This slide demonstrates several vacuoles which are on the luminal side of the glands. This is consistent with the migration of the vacuole toward the lumen. This usually occurs by cycle day 19-20. (Gyn054)

45
Q

Secretory phase-endometrium

A

This slide demonstrates a slightly later stage of the secretory phase in the previous slide. Notice the marked vacuolization projecting toward the lumen and the presence of secretory material within the lumen of the glands. (Gyn055)

46
Q

Late secretory phase of the menstrual cycle

A

Note the prominent tortuosity of the glands. (Gyn242)

47
Q

Decidualized stroma

A

Decidualization of stromal cells is a sign of pregnancy. (Gyn243)

48
Q

Arias-Stella phenomenon

A

An exaggerated secretory phase as evident in this slide is a sign of pregnancy. (Gyn244)

49
Q

Endometrial mucosa in a patient on birth control pills

A

Note the atrophy of the endometrial glands (progesterone effect) and prominent pseudodecidualized stroma. (Gyn246)

50
Q

Hirsutism

A

Note the increase in hair in normal hair bearing areas. Virilization is hirsutism + signs of male secondary sex characteristics (e.g., clitoromegaly). (Gyn320)

51
Q

Ovary with subcortical cysts in polycystic ovarian syndrome

A

Note the cysts that are devoid of follicles. Constant suppression of FSH causes the follicles to degenerate. (Gyn321)

52
Q

Turner’s syndrome

A

Patient is XO. Note the poor female secondary sex characteristics and prominent webbed neck. (Gyn248)

53
Q

Chronic endometritis

A

Both of the microscopic sections represented on this slide show sulfur granules associated with Actinomyces israelii. This organism is associated with the presence of an IUD. The diagnosis of endometritis of the chronic type is based on finding plasma cells in the stroma. The sulfur granules represent tangles of organisms which are filamentous. (Gyn060)

54
Q

Endometrial polyp

A

The vagina is at the top and uterus on the bottom. A polyp is noted in the lumen of the uterus. Polyps are not precursors for cancer, however, they are a common cause of bleeding. (Gyn251)

55
Q

Simple hyperplasia of endometrial mucosa

A

Note the enlarged gland with secretions in the center. (Gyn257)

56
Q

Complex hyperplasia of endometrial mucosa

A

Note the glandular crowding with outpouching of glandular lumens. It is a precursor for adenocarcinoma. (Ci048A)

57
Q

Uterus with adenomyosis

A

Note the enlarged uterus with coarse trabeculation of the myometrial tissue. (Gyn254)

58
Q

Adenomyosis

A

This slide shows the presence of endometrial glands and stroma within the wall of the uterus and not connected to the overlying endometrium. It is not endometriosis, since endometriosis is the presence of functioning glands and stroma outside the confines of the uterus. (Gyn062)

59
Q

Endometrial adenocarcinoma

A

The rectal ampulla is to your right (note the pouch of Douglas between the rectum and posterior wall of the uterus). The entire vagina, cervix, and uterus is in the middle. The bladder is on your left. Note the fungating cancer in the top portion of the body of the uterus. The tumor extends through the wall and out to the serosa. (Neo095)

60
Q

Endometrial adenocarcinoma

A

Note the crowding of the neoplastic glands and necrotic debris in the gland lumens. (Neo096)

61
Q

Leiomyomas of the uterus

A

Note the white swirling masses in the body of the fundus. An invasive cervical squamous cancer is present in the underlying cervix (white material). (Neo094)

62
Q

Leiomyomas of the uterus

A

Note the large pedunculated leiomyoma originating from the serosa. They do not predispose to leiomyosarcoma. (Gyn252)

63
Q

Leiomyosarcoma

A

Note the anaplastic appearing nuclei. The mitosis count is the key to diagnosing these sarcomas. (Neo097)

64
Q

Ruptured ectopic pregnancy

A

Note the embryo within the blood clot. (Gyn322)

65
Q

Follicular cyst of the ovary

A

These commonly rupture and produce localized sterile peritonitis. They are the MC ovarian mass in young women. (Gyn323)

66
Q

Serous cystadenocarcinoma

A

This slide shows a large cystic structure with solid areas. The presence of the solid tissue is consistent with the malignant form of serous tumor. Microscopic exam would show ciliated epithelium. This is the most common primary malignant ovarian tumor. Sixty-six percent of the cases are bilateral. The marker for this tumor is CA125. It is one of the tumors of the ovary that calcify. The calcified structures are called psammoma bodies. (Gyn099)

67
Q

Serous cystadenocarcinoma

A

This is an additional section of the serous malignant tumor showing the papillary structures and psammoma bodies (apoptotic tumor cells with dystrophic calcification). (Gyn101)

68
Q

Brenner’s tumor with a Walthard’s rest

A

These are benign tumors derived from surface epithelium. They are commonly associated with benign mucinous cystadenomas. The epithelium of a Walthard rest has a transitional cell appearance. (Gyn265)

69
Q

Mucinous cystadenocarcinoma

A

This slide is a gross specimen of a mucinous tumor which has been opened showing solid areas and cystic areas. Presence of solid areas is characteristic of the malignant variant of the cystadenocarcinoma. These tumors commonly seed the omentum and produce pseudomyxoma peritoneii. They are the largest of all ovarian tumors. (Gyn112)

70
Q

Cystic teratoma (mature teratoma)

A

This slide is a gross specimen of a tumor that demonstrates severeal characteristics of the benign teratoma. This tumor is derived from all 3 germ cell layers, but the ectodermal component is the most commonly represented or is the component that is the most dominant as far as appearance of the tumor. Notice that there is hair protruding from the tumor. There are also tooth-like structures present. This tumor is the most common germ cell tumor and the mature variant or cystic variant is benign. It is also called a dermoid cyst. This tumor originates from a single germ cell after its first meiotic division. The tumor occurs in young women in the 20-40 year age range. Occasionally it can contain a malignant component and that would be most typically a squamous cell carcinoma. (Gyn124)

71
Q

Cystic teratoma, benign

A

This specimen shows a large ovarian mass attached to the uterus which you can appreciate on the left side of the slide. The tumor has been opened and shows a keratin-like material filling the cyst. There is quite a lot of hair also associated with the tumor. (Gyn125)

72
Q

Histologic section of a cystic teratoma (germ cell tumor)

A

Note the squamous epithelium, sebaceous glands, and cartilage. (Gyn268)

73
Q

Dysgerminoma

A

This shows large cells surrounded by stroma with a lymphocytic infiltrate. These malignant germ cell tumors are the female counterpart of seminomas in males. They are associated with Turner’s syndrome. (Gyn134

74
Q

Ovarian fibromas

A

Note the bilateral nodular masses in both ovaries. These are the MC stromal tumor of the ovary and are benign. Fibromas are not typically hormone-producing unless they contain thecal cells. This patient may have had Meigs syndrome which refers to the presence of a right-sided pleural effusion, an ovarian fibroma, and ascites. (Gyn146)

75
Q

Granulosa theca cell tumor

A

This is a microscopic appearance of the granulosa/thecal cell tumor. The nests of cells resemble the follicle of the ovary. The clear spaces are called Call-Exner bodies, which are a diagnostic feature of the granulosa cell tumor. These tumors are the MC tumor to secrete estrogen. (Gyn141)

76
Q

Hilar cell tumors (steroid cell tumors)

A

These tumors are benign and secrete androgens. They are unilateral. A characteristic feature is the elongated eosinophilic rod-like crystal which is called a Reinke crystalloid. (Gyn274)

77
Q

Metastatic adenocarcinoma to ovary

A

This slide shows mucin-positive signet ring cells which is called a Krukenberg tumor. It is most commonly a mucin producing adenocarcinoma from the stomach which metastasizes to both ovaries. (Gyn275)

78
Q

Normal chorionic villus

A

The surface is lined by trophoblastic tissue (syncytiotrophoblast on the outside and cytotrophoblast underneath). Note the myxomatous stroma and small vessels with nucleated RBCs. These vessels coalesce to form 2 umbilical veins, which carry the greatest concentration of oxygen. (Gyn324)

79
Q

Abruptio placenta

A

This slide shows multiple sections through placenta with a retroplacental clot. Abruptio placenta will present with painful vaginal bleeding and it represents a premature separation of the placenta producing a retroplacental clot. It’s a complication of pre-eclampsia and any cause of hypertension. It is associated with cocaine addiction. (Gyn154)

80
Q

Abruptio placenta

A

This is an additional specimen showing a placenta with retroplacental clot. Notice the umbilical cord in the central portion of the specimen. When hematomas form involving a third or more of the maternal surface of the placenta, this can result in fetal demise. There is a 30 to 65% mortality rate of the fetus associated with abruptio placenta. Recall that this is a complication of pre-eclampsia, hypertension, and cocaine addiction. (Gyn155)

81
Q

Placenta accreta

A

Note the chorionic villi on the left of the histologic section directly implanting on myometrial tissue without any intervening decidua. The uterus must be removed (gross specimen) or the patient will bleed to death. (Gyn279)

82
Q

Accessory lobe and velamentous insertion of the umbilical cord along the margin of the placenta

A

Both pose a risk for hemorrhage. (Gyn281)

83
Q

Hydatidiform (complete) mole

A

Note the grape like masses representing neoplastic chorionic villi lined by trophoblastic tissue. They present as preeclampsia in the first trimester and a uterus too large for gestational age. Ultrasound demonstrates a “snowstorm” effect. They may progress into a choriocarcinoma if not adequately removed. (Neo105)

84
Q

Choriocarcinoma

A

This slide illustrates the two populations of cells composing a choriocarcinoma. You notice that the central portion of the nests contain cells with clear vacuolated looking nuclei. Surrounding these little chords or nests of cells are the syncytotrophoblasts (hormone producing cells) which are groups of nuclei within a large mass of cytoplasm. The cells in the central portion are the cytotrophoblasts. (Gyn162)

85
Q

Fibrocystic change

A

Note the large cyst surrounded by a fibrous stroma within which are smaller bluish-discolored cysts. FCC is the MCC of a breast mass in women under 50 years old. (Gyn325)

86
Q

Fibroadenoma

A

This is a microscopic appearance of a fibroadenoma showing the slit-like duct spaces surrounded by stroma. It is a well circumscribed tumor. Fibroadenoma is the most common benign breast tumor and it occurs in women younger than age 35. It most commonly occurs in the left upper quadrant of the breast and presents as a firm rubbery painless well-circumscribed mass. It is due to an increased sensitivity to estrogen. (Gyn178)

87
Q

Carcinoma of the breast

A

This patient has been asked to raise her arms. Note the retraction of the skin in the left lower quadrant associated with an underlying invasive ductal carcinoma. (Gyn192)

88
Q

Infiltrating ductal carcinoma The infiltrating ductal carcinoma is the most common type of breast cancer.

A

Grossly, it appears as a stellate area of firm tissue which is described as being stony hard. Another name applied to this tumor is a scirrhous carcinoma. The fixed nature of the tumor is due to desmoplastic response as the individual tumor cells invade surrounding tissues. This causes fixation to overlying structures as the skin and the dimpling affect or retraction that is noted with infiltrative cancers. (Gyn195)

89
Q

Infiltrating ductal carcinoma

A

This is another gross specimen demonstrating a stellate-appearing firm nodule. (Gyn196)

90
Q

Gross of infiltrating ductal cancer

A

Note the stellate appearance of the indurated mass. (Gyn286)

91
Q

Infiltrating ductal carcinoma

A

This slide is quite classic for the typical pattern of an infiltrating ductal cancer. Notice that the tumor cells are in next and cords and they are infiltrating through the surrounding tissue. There is an intense desmoplastic response to this infiltration which gives the name scirrhous carcinoma to this type of invasive cancer of the breast. (Gyn197)

92
Q

Comedocarcinoma variant of DCIS

A

Note the necrotic centers of the ducts surrounded by malignant ductal cells. (Gyn288)

93
Q

Infiltrating ductal carcinoma with vessel invasion

A

Note the vessel in the middle of the slide has a plug of tumor. Nests of malignant cells are infiltrating the stroma around the vessel. (Gyn289)

94
Q

Mammogram showing densities in both breasts

A

A fine needle aspiration is necessary to determine whether these lesions are benign or malignant. (Gyn284)

95
Q

Paget’s disease of breast

A

Notice that the nipple surrounded by an eczematoid rash. This characteristic is associated with Paget’s disease, which is a ductal carcinoma that is infiltrating the epithelium of the nipple and areola. Microscopic appearance would show clear cells in the epidermis, similar to those noted in extramammary Pagets of the vulva. (Gyn1904)

96
Q

Paget’s disease of the breast

A

Note the eczematous appearing rash and nipple inversion on the left. (Gyn290)

97
Q

Paget’s disease of the breast

A

Note retraction of the bottom portion of the nipple. The tip of the nipple has an abnormal discoloration, probably representing malignant cells infiltrating the epidermis. (Gyn291)

98
Q

Carcinoma of the breast peau d’ orange.

A

Notice the dimpling of the skin having the appearance of an orange. This is due to obstruction of subcutaneous lymphatics causing localize lymphedema. (Gyn193)

99
Q

Peau d’orange appearance of inflammatory carcinoma of the breast

A

Note the enlarged erythematous right breast with the dimpling effect on the surface. (Gyn295)

100
Q

Lobular carcinoma in-situ

A

Note the terminal acini filled with monomorphic appearing cells. This neoplasm has the greatest incidence of bilaterality. (Gyn297)

101
Q

Infiltrating lobular carcinoma

A

In the middle of the slide you see individual tumor cells that are lined up behind one another infiltrating through the tissue. This is called the Indian file pattern of infiltration of an invasive lobular carcinoma. (Gyn298)

102
Q

Cystosarcoma phyllodes or phyllodes tumor

A

This is a gross specimen showing in a massively enlarged left breast which has been replaced by large, bulky tumor tissue. Most patients who develop this lesion are older than 40. This tumor has benign glandular tissue and a malignant stroma. It resembles the fibroadenomas but the stromal elements tend to be more hypercellular. It is best to view this tumor as having a low grade malignant potential. (Gyn185)

103
Q

Lymphedema following radical mastectomy

A

This slide demonstrates extensive lymph stasis in the right arm in a patient who had a radical mastectomy. This treatment removes all of the pectoralis major and minor and the axillary lymph node chain which renders the dependent extremity enable to drain lymphatic fluid. The patients are susceptible to having extensive swelling of that dependent extremity, and the potential for lymphangiosarcoma. (Gyn1909)

104
Q
A

Imperforate hymen with blood behind the membrane (Gyn229)

Histo- Goljian (3 decks)

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