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Repro/GU by Minnie (she/her) > 212/215/216 - Histology, Pathology of Female Reproductive System > Flashcards

212/215/216 - Histology, Pathology of Female Reproductive System Flashcards

1
Q

Vulvar Lichen simplex chornicus

  • Cause
  • Pathologic changes:
  • Prognosis:
A
  • Cause: Chronic irritation (ex: itching)
  • Pathologic changes: Squamous cell hyperplasia; hyperkeratosis in reaction to itching
  • Prognosis: benign; resolves when the irritating agent is taken away
  • Note: Lichen sclerosus IS itchy, SCC may arise*
  • Lichen simplex chronicus is CAUSED BY itching; no cancer risk*
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2
Q

What is histologic difference between endometrial hyperlasia with atypia vs. atypical hyperplasia?

How do their prognoses differ?

A
  • Hyperplasia without atypia
    • No nuclear changes
    • Stroma present between glands
    • May rarely progress to carcinoma
  • Atypical hyperplasia
    • Nuclear changes: round, clear chromatin, prominent nucleolus
    • May progress to carcinoma up to 48% of the time
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3
Q

Is the following characteristic of usual or differentiated vulvar squamous cell carcinoma?

p53 Mutation

A

Differentiated

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4
Q

What kind of lesion does this describe:

“Crusted, red vulvar or perianal lesion”

What are to possible processes that it may represent?

A

Vulvar paget’s disease

  • Usually a neoplasm of sweat glands or skin adenexae
  • Somtimes represents an internal malignancy
    • Colon cancer, urothelial carcinoma
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5
Q

What makes the “high-risk” HPV serotypes so high risk?

A

They integrate into the host chormosome

High risk = 16, 18, 31, 33

Low-risk serotypes (6, 11) do NOT integrate into the host chromosome, will cause warts

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6
Q

Is the following characteristic of usual or differentiated vulvar squamous cell carcinoma?

HPV-driven

A

Usual

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7
Q

What is the histological marker of chronic endometritis?

A

Plasma cells

Not normally in the endometrium; if they are there, implies chronic endometritis

Acute endometritis is less common, will see neutrophils

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8
Q

List the 4 theories for the origin of endometriosis

A
  • Regurgitation
    • ​Retrograde menstruation
  • Benign metastases
    • ​Lymph/vascular spread
  • Metaplasia
  • Extrauterine stem-progenitor cells

Most likely a combination of some or all of these

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9
Q

Is the following characteristic of usual or differentiated vulvar squamous cell carcinoma?

Arises from lichen sclerosus

A

Differentiated

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10
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

PTEN mutation

A

Endometroid

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11
Q

What is the defining cell type present in a Syphilis chancer?

A

Plasma cells

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12
Q

Inactivation of which tumor suppressor is associated with endometrial hyperplasia?

A

PTEN

  • And this is associated with endometroid (type 1) endometrial carcioma
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13
Q

What kind of epithelium is found in the fallopian tube?

A

Simple collumnar epithelium

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14
Q

What are the characteristic histological findings of endometriosis?

How many are needed for diangosis?

A

2/3 of the following in an ectopic location

  • Endometrial glands
  • Endometrial stroma
  • Hemosiderin-laden macrophages (evidence of hemorrhage)
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15
Q

What is the most common type of cancer in the cervix?

A

Squamous cell carcinoma

Develops in the transformation zone in the background of dysplasia

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16
Q

What is the major function of the simple cuboidal epithelium (germinal epithelium) of the ovary?

  1. Projects inward to form glands
  2. Forms the capsule of the ovary
  3. Is a serous, peritoneal membrane
  4. Is the source of primordial oocytes
A

c. Is a serous, peritoneal membrane
* Stupid name - turns out eggs come from the hindgut, not the germinal epithelium lmao*

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17
Q

What is the histologic feature of vaginal epithelium?

A

Pyknotic nuclei

  • Small, focal, condensed
  • Spaces in between = cells swelling with glycogen in response to rising estrogen (before menstruation)
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18
Q

What in which stage of meiosis are oocytes arrested during fetal development?

A

Prophase I

As the follicle matures, continues until Mataphase II; only progresses from here if fertilized

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19
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Papillary or glandular growth pattern

A

Serous

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20
Q

Histologic differences between leiomyosarcoma and leiomyoma? (3)

A

Leiomyosarcomas may have:

  • Nuclear atypia
  • Mitoses
  • Necrosis

Need 2/3 to diagnose

If none are present = leiomyoma (fibroid)

If 1 is present it falls into some weird category - if we are ever tested on it may the power of Dr. Wolniak be with us all <3

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21
Q

What is the difference between the corpus albicans vs. atretic follicles?

A
  • Corpus albicans comes from a mature follicle
    • ​After ovulation, follicul becums corpus luteum
    • No pregnancy -> corpus luteum dies, becomes corpus albicans
  • Atretic follicle = all follicles that were never selected to become mature follicles
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22
Q

Which cells does HPV infect?

A

Basal cells of the transformation zone

  • Transformation zone: squamous mucosa of the ectocervix -> glandular mucosa of the endocervix
  • These cells ar vulnerable because they are naturally metaplastic
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23
Q

List 4 risk factors for cervical cancer

A
  • Multiple sexual partners
  • Early initiation of sexual activity
    • There is more transformation zone epithelium during adolescent hormonal states
  • High parity
  • Smoking
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24
Q

At what stage of follicular develpent is the follicle 10mm or greater in size?

A

Mature follicle (ready to pop out)

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25
Q

Which one of the following changes the least in morphology during the menstrual cycle?

A. Uterine glands

B. Ovarian follicles

C. Uterine tube epithelium

D. Vaginal epithelium

E. Cervical histology

A

E. Cervical histology

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26
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

p53 mutation

A

Serous

27
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Fused glands with stroma in between (cribiforming)

A

Endometroid

28
Q

Which normal cell function is disrupted by HPV’s E6 protein?

A

p53-mediated Apoptosis

Viral protein E5 marks p53 for degradation

-> p53 cannot use p21 ot arrest the cell cycle

=> cells with DNA damage that would normally die or be repaired get to progress through the cell cycle and proliferate

29
Q

What is a major role of the theca interna of a secondary follicle?

A. Forms a connective tissue capsule

B. Protective layer of the ovulated ovum

C. Site of entry of estrogen into the bloodstream

D. Produces progesterone

E. Metabolic support of the egg

A

C. Site of entry of estrogen into the bloodstream

30
Q

At what stage of follicular development does the follicle develop a cavity?

A

Secondary (aka antral) follicle

31
Q

What are the roles of glycogen and low pH in the vaginal epithelium?

A
  • Glycogen = favorable environment for sperm
    • Spaces between cells fill with glycogen in response to estrogen, which rises pre-ovulation
  • Low pH = protection against infection
32
Q

List the two types of endometrial stromal tumors

A
  • Endometrial stromal nodule
    • Benign, well-circumscribed
  • Endometrial stromal sarcoma
    • Infiltrative
    • May recur, late distant mets are uncommon but can happen
33
Q

List 2 histopalologic hallmarks of cervical squamous cell carcinoma

A

Keratinization

Intracellular bridges

  • Note: hallmark of HPV infection = koliocyte; koliocytes do NOT mean SCC; they just mean HPV infection*
  • Another note: Adenocarcinoma of the cervix is rare, will see glands*
34
Q

When you are looking at a PAP smear, can you determine if dysplasia is mild, moderate, or severe?

A

No!

  • PAP smear looks at cells only
    • Can only tell if they’re low grade or high grade (LSIL or HSIL)
  • Need biopsy to determine the thickness of the displasia
    • Mild = bottom 1/3
    • Moderate = involves middle 1/3
    • Severe = involves full thicknes
35
Q

List 3 key histologic characteristics of HSV-2

A
  • Multinucleation
  • Molding - Nuclei fit and shape to one another
  • Margination - Chromatin pushed to the edge of the nucelus

Also pink nuclear inclusions - Cowdry A

36
Q

Descrive the pattern of proliferation of atypical cells in the epithelium in Paget’s disease

A

Atypical cells spread in the epithelium without invasion

Proliferate and grow between layers of skin cells

Pagetoid pattern

37
Q

What are the respective drivers of usual-type and differentiated vulvar squamous cell carcinoma?

A
  • Usual
    • HPV-driven (like cervical cancer)
    • Usually seen in pre-menopausal women
  • Differentiated
    • HPV-independent
    • Associated with lichen sclerosus
    • Typically seen in older women
38
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Indolent, lymphatic spread

A

Endometroid

39
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Arises in the setting of unopposed estrogen

A

Endometroid

40
Q

What gene is most frequently mutated in uterine serous carcinomas?

Describe the “typical patient”

A

p53

Older (65-75), in a background of atrophic endometrium

Serous carcinoma = Type 2 endometrial carcioma

The other type (Type 1, endometroid) occurs in younger pts, backgorund of endometrial hyperplasia

41
Q

Which layer fo the uterine corpus is most responsive to hormones?

A

Functionalis

(Basalis doesn’t really change much in response to hormones)

42
Q

What type of epithelium is present in the vagina?

A

Stratified squamous (non-keratinized)

Note: no glands! lubrication is from the cervix and greater vestibular glands

43
Q

How does the epithelium of the fallopian tube change during the menstrual cycle?

A
  • Estrogen (folliclular phase) -> more ciliated cells
  • Less estrogen (in luteal phase) -> more peg cells

Very few ciliated cells in menopause

44
Q

At what stage of follicular development do cells become stratified?

A

Primary follicle

45
Q

Which cell types are found in tthe theca interna of a follicle?

A

Theca cells: produce androgens

Granulosa cells: aromatize androgens to estrogen

46
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Arises in the setting of an atropic endometrium

A

Serous

47
Q

Describe the key histoligic features of the endometrium during each phase:

  • Menstrual phase:
  • Proliferative phase:
  • Secretory phase:
A
  • Menstrual phase:
    • Stratum functionale has shed
    • Prominent basal glands
    • Low estrogen, low progesterone
  • Proliferative phase:
    • ​Stratum functionale is rebuilding
    • Glands are straight
    • High estrogen, low progesterone
  • Secretory phase:
    • ​Sratum functionale has wavy glands
    • Dilated with glycogen-rich fluid (due to progesterone)
    • High estrogen, high progesterone
48
Q

What are koliocytes?

A

Cells infected with HPV

  • Large w/expanded halo around cells
  • Large, crinkled nuclei
  • Represent dysplasia, NOT cancer

Koliocytes will be present in any HPV infection: includes high and low risk

49
Q

Vulvar Lichen sclerosus

  • Typical presentation:
  • Typical patient:
  • Pathologic changes:
  • Prognosis:
A
  • Typical presentation: Itchy, whitis scaly plaques
  • Typical patient: Older patients
  • Pathologic changes: Thinning (atrophy) of epithelium with stromal hyalinization
  • Prognosis: SCC (differentiated type) may arise
50
Q

Which endometrial phase is characterized by vacuoles?

A

Early secretory

  • Early secretory = vacuoles
  • Mid-secretory = coiled vessels
  • Late secretory = spiral arteries
51
Q

Which of the following is a characteristic of primary follicles?

A. Has a stratified epithelium

B. Has a cavity

C. Is 10 mm in diameter

D. Has a simple squamous epithelium

E. Has a cumulus oophorus

A

A. Has a stratified epithelium

  • B = secondary follicle
    • Secondary follicle = more mature than primary
  • D = primordial follicle
  • C, E = mature follicle
52
Q

Which of the following is an important effect of progesterone?

A. Secretory phase of the endometrium

B. Triggers ovulation

C. Follicle development

D. Maintenance of the corpus luteum

E. Initiation of menstruation

A

A. Secretory phase of the endometrium

53
Q

List the parts fo the fallopian tube, from the part closest to the ovary to the uterus

A
  • Infundibulum
  • Ampulla
  • Isthmus
  • Intramural segment (inserts into the wall of the uterus)
54
Q

Which of the following is characteristic of the vagina?

A. Elaborate, branched mucous glands

B. Washed out epithelial cells with pyknotic nuclei

C. Vascular submucosa

D. Serosa with a high fat content

E. Muscularis externa with an inner longitudinal layer and outer circular layer

A

B. Washed out epithelial cells with pyknotic nuclei

55
Q

Which part of the uterus is retroperitoneal?

A

Cervix

The rest is peritonealized

  • Broad ligament = transverse mesentery of the uterus
    • All peritonealized organs have mesenteries?
56
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Extremely atypical cells

A

Serous

  • High nucleus:cytoplasm ratio
  • Large, darkly stained nuclei w/ prominent nucleoli
  • Many atypical mitoses
57
Q

Characteristic of Endometroid (type 1) or Serous (type 2) enometrial carcinoma?

Aggressive, lymphatic and intraperitoneal spread

A

Serous

58
Q

What endometrial changes occur in adenomyosis?

A

Endometrial glands in the stroma within the myometrium

Essentially, endometriosis confined to the myometrium

59
Q

Which normal cell protein is disrupted by HPV’s E7 protein?

What is the result?

A

Rb-E2F complex

  • Normally, Rb is bound to the trasncription factor E2F
    • Prevents E2F from aberrently upregulating transcription
  • Also, Rb provides positive feedback to p16
    • p16 also inhibits phosphorylation (and activation) of E2F

Degradation of Rb by viral protein E7 results in uncontrolled cell division, accumulation of DNA damage

Also, p16 builds up: surrogate marker for high-risk HPV

60
Q

What histologic features characterize proliferative endometrium? (3)

How do these features change in secretory edometrium? (3)

A
  • Proliferative (estrogen, no progesterone)
    • Tubular/straight glands
    • Pseudostratified columnar epithelium
    • Mitoses
  • Secretory (estrogen + progesterone)
    • Cytoplasmic vacuoles (early)
    • Coiled glands (mid-secretory)
    • Decidualized stroma, spiral arterioles (late)
61
Q

Which HPV serotypes are most likely to lead to dysplasia? (4)

What is the natural course of infection with these serotypes?

A

16, 18, 31, 33

These are high-risk serotypes BUT:

  • Most infections will resolve (without progressing to dysplasia)
  • Most cases of dysplasia will resolve (without progressing to invasive carcinoma)
  • Cases that do progress take years to go from low-grade to high grade, and then years to go from high-grade to invasive

KEY: we can prevent invasive carcinoma with screening!

62
Q

Which layer of the uterine mucosa is shed during menstruation?

Describe the changes to the mucosa that result in shedding

A

Stratum functionale

  • During proliferation and differentiation, a spiral artery ascends into the striatum functionale from the stratum basale
  • When progesterone drops, this artery constricts, cutting off the blood supply to the functionale
  • This causes cell death and shedding of the stratum functionale

The rest of the spiral artery stays behind in the stratum basale

63
Q

What kind of vulvar lesion does this describe:

“Finger-like projections with a fibrovascular core”

What usually causes this lesion?

A

Condyloma acuminatum

Usually caused by low-risk HPV serotypes (6, 11)

NOT pre-malignant

(Will still see koliocytes)

64
Q

Which cell protein is a surrogate marker of high-risk HPV infection?

A

P16

  • Increases in high-risk HPV infection because viral protein E7 binds Rb, resulting in overexpression of p16

Repro/GU by Minnie (she/her) (31 decks)

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