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Pathology > Chapter 22- The Female Genital Tract > Flashcards

Chapter 22- The Female Genital Tract Flashcards

1
Q

What epithelium lines the genital tract and ovarian surface?

A

Mesothelium/coelomic epithelium

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2
Q

What infectious organisms cause pain but no pathological condition?

A

Candida

Trichomonas

Gardnerella

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3
Q

What tissues are most affected by HSV?

A

Cervix > vagina > vulva

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4
Q

What organism is caused by a pox virus and appears as pearly, dome-shaped applies with a dimpled centre?

A

Molluscum contagiosum

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5
Q

How are fungal infections diagnosed?

A

Psuedospores or hyphae in wet KOH mounts

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6
Q

What is a characteristic finding in trichomonas vaginalis infections?

A

Fiery red vaginal and cervical mucosa

“Strawberry cervix”

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7
Q

What is the primary cause of bacterial vaginitis?

A

Gardnerella vaginalis

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8
Q

Ureaplasma urealyticum and Mycoplasma hominis are involved in some cases of what disorders?

A

Vaginitis

Cervicitis

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9
Q

What is pelvic inflammatory disease (PID)?

A

An infection that begins in the vulva or vagina and spreads upwards to involve most of the genital structures

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10
Q

What is the difference between PID due to gonococcal infections and non-gonococcal infections?

A

Gonococcal- involve mucosal surfaces and spread upwards (involve ovaries and tubes)

Non-gonococcal- spreads via lymphatics and venous channels

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11
Q

What is the effect of PID on fallopian tubes?

A

Lumen can dilate and full with purulent exudate (pyosalpinx)

Scar formation, fimbriae fuse (hydrosalpinx)

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12
Q

How can pyosalpinx effect the ovaries?

A

Tubo-ovarian abscesses from exudate collecting in the ovary

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13
Q

What benign lesions are associated with the vulva?

A

Bartholin cysts

Leukoplakia

Lichen sclerosus

Squamous cell hyperplasia

Exophytic/wart-like lesions

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14
Q

What are the characteristics of Bartholin cysts?

A

Obstruction of the ducts (inflammation)

Lined with transitional or squamous epithelium

Pain, local discomfort

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15
Q

What are the differences between leukoplakia and lichen sclerosus?

A

Leukoplakia- white plaques, many causes

LS- smooth white plaques that may enlarge/coalesce (porcelain surface), increased risk of SCC, thinning of epidermis, dermis sclerosis, inflammation of deeper dermis

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16
Q

What does squamous cell hyperplasia result from?

A

Skin rubbing/scratching

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17
Q

Where is squamous cell hyperplasia sometimes found?

A

The margins of vulvar cancers

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18
Q

What are some examples of benign exophytic/wart-like lesions of the vulva and their characteristics?

A

Condyloma acuminatum- atypical nuclei (syphilitic condyloma with perinuclear halos), HPV 6 and 11

Vulvar fibroepithelial polyps (skin tags)

Vulvar squamous papillomas- nonkeratinized squamous epithelium

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19
Q

What is the most common histological type of vulvar cancer?

A

SCC

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20
Q

What are the two types of vulvar SCC?

A
  1. Basaloid/warty- high risk HPV, younger ages, immature basaloid cells, central necrosis, classic VIN is precursor
  2. Keratinizing- older (~80), malignant squamous epithelium with prominent keratin pearls, long standing lichen sclerosus or squamous hyperplasia, differentiated VIN is precursor
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21
Q

How are classic and differentiated VIN different?

A

Classic- little differentiation from the basal layer (immature cells at surface), nuclear enlargement, hyperchromasia

Differentiated- basal layer atypical, superficial layers differentiated

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22
Q

Where does vulvar cancer initially spread?

A

Inguinal, iliac and periaortic nodes

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23
Q

What body part do glandular neoplastic lesions affect?

A

Modified apocrine sweat glands of the vulva

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24
Q

What are the characteristics of papillary hidradenoma?

A

Sharply circumscribed module of the vulva

Histological appearance identical to intraductal papilloma of breast

Columnar secretory cells cover myoepithelium

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25
Q

What malignancy can papillary hidradenoma be confused with?

A

Carcinoma

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26
Q

Where does extramammary Paget disease primarily occur?

A

Labia majora

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27
Q

What are the characteristics of extramammary Paget disease?

A

Pruritic, red, crusted, map-like area

Pale cytoplasm with mucopolysaccharide

Apocrine, eccrine and keratinocyte differentiation

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28
Q

What is the pathology of extramammary Paget disease?

A

Cells spread laterally within the epidermis (single file or small clusters)

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29
Q

What is the epithelium of the vagina?

A

Columnar, endocervical type initially, replaced with squamous

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30
Q

What are examples of developmental anomalies of the vagina?

A

Septate/double (with double uterus)

Vaginal adenosis- remnants of endocervical type (columnar) epithelium

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31
Q

What benign lesions are found in the vagina?

A

Gartner duct cysts- remnants of mesonephric ducts

Mucous cysts- derived from müllerian epithelium

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32
Q

What are the locations of Gartner duct cysts and mucous cysts in the vagina?

A

Gartner- lateral walls

Mucous- proximal vagina

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33
Q

What ages do benign vaginal tumours primarily occur in?

A

Reproductive

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34
Q

Almost all primary vaginal tumours are what type?

A

Squamous carcinomas from high risk HPV

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35
Q

What is a rare, highly malignant, primary vaginal tumour in infants?

A

Embryonal rhabdomyosarcoma

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36
Q

The serosa of the cervix extends furthest in which direction?

A

Posteriorly

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37
Q

How are the ecto and endocervix differentiated?

A

Ecto- external vaginal portion, covered by mature squamous epithelium

Endo- internal canal, columnar, mucous-secreting epithelium

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38
Q

What is the squamocolumnar junction/transformation zone?

A

Point where the epithelium of the ecto and endocervix meet

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39
Q

What are endocervical polyps composes of?

A

Loose, fibromyxomatous stroma covered by mucous secreting glands

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40
Q

What is the main significance of endocervical polyps?

A

Irregular bleeding

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41
Q

What is the most important factor in developing cervical cancer?

A

High risk HPVs (16 and 18)

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42
Q

What are the different forms of cervical intraepithelial neoplasia (CIN)/squamous epithelial lesions?

A

CIN1- low grade SIL (lower third), mild dysplasia

CIN2- high grade SIL (upper two thirds), moderate dysplasia

CIN3- high grade SIL, severe dysplasia

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43
Q

What staining is highly correlated with HPV?

A

Ki-67 and p16

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44
Q

What are the types of carcinomas associated with the cervix and how common are they?

A

Squamous (80%)

Adenocarcinoma (15%)

Adenosquamous and neuroendocrine (5%)

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45
Q

How do cervical carcinomas manifest?

A

Fungating/exophytic or infiltrating massesy

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46
Q

What does the prognosis of cervical cancer depend on?

A

Stage at diagnosis and histological subtype (microinvasive better survival)

47
Q

What are the stages of cervical cancer?

A

0- CIS

I- confined to cervix

II- extends beyond cervix but doesn’t involve the pelvic wall, doesn’t involve the lower vagina third

III- extends to pelvic wall, involves lower vaginal third

IV- involves bladder or rectal mucosa, metastatic dissemination

48
Q

What is the difference between endo and myometrium?

A

Endo- glands embedded in cellular stromal, epithelial lining

Myo- bundles of smooth muscle

49
Q

What defines dysfunctional uterine bleeding?

A

Abnormal bleeding without the presence of an organic lesion

50
Q

What is the most common cause of DUB?

A

Hyperestrogenic states (anovulatory cycle)

51
Q

What is endometriosis?

A

Presence of endometrial tissue outside the uterus

52
Q

What is the form of endometriosis that occurs specifically in the myometrium?

A

Adenomyosis

53
Q

What is the morphology of adenomyosis?

A

Cystic holes

Trabeculae

54
Q

What are the pathogenesis theories of endometriosis?

A
  1. Regurgitation (retrograde flow)
  2. Benign metastasis (tissue spread)
  3. Metaplastic- epithelium or remnants differentiate
  4. Extrauterine stem cells differentiate
55
Q

What is the morphology of endometriosis?

A

Red-blue/yellow-brown nodules on/beneath the mucosal and/or serosal surface

Hemorrhage can cause extensive fibrosis

Chocolate cysts in ovaries (endometriomas)

56
Q

What are chocolate cysts composes of?

A

Fluid from previous hemorrhage

57
Q

What is the morphology of endometrial polyps?

A

Exophytic masses of endometrial glands and stroma projecting into the endometrial cavity

58
Q

What can cause endometrial polyps?

A

Elevated estrogen or tamoxifen therapy

59
Q

What malignancy can endometrial polyps occasionally develop into?

A

Adenocarcinoma

60
Q

What is endometrial hyperplasia?

A

Increased proliferation of endometrial glands

61
Q

Endometrial hyperplasia is an important cause of what?

A

Uterine bleeding

62
Q

What is endometrial hyperplasia associated with?

A

Prolonged estrogen stimulation

63
Q

Endometrial hyperplasia is a precursor lesion to what malignancy?

A

Endometrial carcinoma

64
Q

What are the two WHO classifications of endometrial hyperplasia?

A
  1. Nontypical

2. Atypical

65
Q

Which WHO classification is associated with a higher cancer risk?

A

Atypical

66
Q

What gene is mutated in 20% of endometrial hyperplasia cases?

A

PTEN tumour suppressor gene

67
Q

What are the different types of endometrial malignancies?

A

Carcinoma

Malignant mixed müllerian tumours (MMMT)

Tumours of stroma

68
Q

What are the differences in the two types of endometrial carcinomas?

A

Type I- well differentiated, arise in cases of endometrial hyperplasia, polyploid or diffuse/spreading

Type II- poorly differentiated, arise in cases of endometrial atrophy (later years), large, bulky and deeply invasive

69
Q

What is the most common subtype of type II endometrial carcinomas?

A

Serous

70
Q

What are the characteristics of MMMTs?

A

Endometrial adenocarcinoma with concurrent malignant stroma

Highly malignant

Bulky, fleshy and polypoid

71
Q

What are the types of endometrial stromal tumours and their characteristics?

A
  1. Adenosarcomas- stromal neoplasia with benign glands, polypoid growth
  2. Endometrial stromal sarcomas (ESS)- malignant stroma between myometrial bundles, invasion (diffuse and lymphatic)
72
Q

What are the types of myometrial tumours and what are their characteristics?

A
  1. Leiomyomas (fibroids)- benign masses of smooth muscle, circumscribed, white whorls
  2. Leiomyosarcomas- bulky, fleshy mass, aggressively metastasizes
73
Q

What is the most common tumour in women?

A

Leiomyomas

74
Q

What lesions are associated with the fallopian tubes?

A

Paratubal cysts (benign)

Adenomatoid tumours (mesothelial)

Adenocarcinomas

75
Q

Larger versions of paratubal cysts located near the fimbriae are known as what?

A

Hydatids of Morgagni

76
Q

What mutations can adenocarcinomas of the fallopian tubes be associated with?

A

BRCA mutations

77
Q

What are the most common nonneoplastic ovarian lesions and their characteristics?

A
  1. Cystic follicles- multiple with clear, serous fluid
  2. Luteal cysts- rim of yellow tissue, maybe with hemorrhagic centre, normal
  3. PCOS- endocrine disorder
78
Q

PCOS can increase the risk of developing what malignancies?

A

Endometrial hyperplasia

Carcinoma

79
Q

What are the three types of ovarian tumours?

A
  1. Müllerian epithelial
  2. Germ cell
  3. Sex cord stromal cell
80
Q

Ovarian tumours are mostly benign in what age group?

A

20-45

81
Q

What are the types of benign Müllerian epithelial tumours?

A

Cystadenomas

Cystadenofibromas

Adenofibromas

82
Q

What are the modes of pathogenesis for Müllerian epithelial tumours?

A

Type I- progress from benign to borderline, low grade

Type II- arise from inclusions/cysts/STIC cells (fallopian tube precursors), high grade

83
Q

Müllerian epithelial carcinomas are categorized as what?

A

Type I

Type II

84
Q

What are the forms of Müllerian epithelial tumours?

A

Serous

Mucinous

Endometrioid

Brenner tumours

85
Q

What is the most common ovarian malignancy?

A

Serous adenocarcinoma

86
Q

What are the different types of serous Müllerian epithelial tumours?

A

Benign- serous cystadenoma/cystadenofibrom

Borderline- serous borderline tumour

High grade- TP53 and BRCA mutations

87
Q

The majority of serous Müllerian epithelial tumours are benign, borderline or malignant?

A

Benign/borderline

88
Q

What is the morphology of the different types of serous Müllerian epithelial tumours?

A

Benign- smooth wall, no thickening or projections

Borderline- increased number of papillary projections

Malignant- larger, solid/papillary masses, nodularity in capsule

Smooth inner lining, lack papillary masses

Multiloculated

Multicystic or projectile mass

89
Q

Which form of serous Müllerian epithelial tumour is most commonly bilateral?

A

Malignant

90
Q

The majority of mucinous Müllerian epithelial tumours are benign, borderline or malignant?

A

Benign/borderline

91
Q

Smoking is a risk factor for what form of Müllerian epithelial tumour?

A

Mucinous

92
Q

What is the morphology of mucinous Müllerian epithelial tumours?

A

Large, cystic masses

Multiloculated, filled with sticky gel

Mostly unilateral

93
Q

What is the morphology of endometrioid Müllerian epithelial tumours?

A

Epithelium resembles endometrium

Solid and cystic areas of growth

Majority are unilateral

94
Q

15-20% of endometrioid Müllerian epithelial tumours are associated with what disorder?

A

Endometriosis

95
Q

What is an uncommon variant of endometrioid Müllerian epithelial tumours?

A

Clear cell carcinoma

96
Q

What type of tumour is a Brenner tumour?

A

Solid adenofibroma (dense stroma with nests of epithelium resembling urothelium)

97
Q

What are the forms of germ cell tumours?

A

Teratomas

Dysgerminomas

Yolk sac/endodermal sinus tumours

Choriocarcinomas

98
Q

Where do teratomas arise from?

A

Ovum

99
Q

What karyotype are teratomas commonly?

A

46xx

100
Q

What are the categories of teratomas and their characteristics?

A
  1. Mature/dermoid cysts- benign, greasy hair and calcifications
  2. Monodermal- differentiate along single tissue line
  3. Immature/malignant- embryonic elements
101
Q

What is an example of a monodermal teratoma?

A

Struma ovarii (entirely thyroid tissue)

102
Q

What male tumour is similar to dygerminoma?

A

Testicular seminoma

103
Q

What are the characteristics of dysgerminoma?

A

All are malignant and chemosensitive

Solid, yellow-white/grey-pink, fleshy

Most are unilateral

104
Q

What is the characteristic histological feature of yolk sac tumours?

A

Schiller-Duval bodies- central blood vessel enveloped by tumour cells within a tumour cell-lined space

105
Q

What is the malignant potential of yolk sac tumours?

A

Aggressive but chemoresponsive

106
Q

What are the characteristics of choriocarcinomas?

A

Extraembryonic differentiation of malignant germ cells

In combo with other germ cell tumours

Highly malignant, more resistant to chemo

107
Q

Where do sex cord stromal cell tumours originate from?

A

Ovarian stroma

108
Q

What are the forms of sex cord stromal tumours?

A
  1. Granulosa-theca cell tumours
  2. Fibromas, thecomas and fibrothecomas
  3. Sertoli-Leydig cell tumours
109
Q

What hormone is produced in large quantities in granulosa-theca cell tumours?

A

Estrogen (endometrial hyperplasia)

110
Q

What are the characteristics of granulosa-theca cell tumours?

A

Unilateral

Solid, white-yellow

Primitive follicle structures

Call-Exner bodies- gland-like structures with acidophilic material

111
Q

What are the characteristics of fibromas, thecomas and fibrothecomas?

A

Composes of fibroblasts or plump spindle cells with lipid droplets

Unilateral

Solid/hard, grey-white (yellow is thecoma portion present)

Majority are benign

112
Q

What are the characteristics of Sertoli-Leydig cell tumours?

A

Recapitulate cells of the testes (masculinization)

Solid, grey/golden brown

Heterologous elements may be present

113
Q

Metastatic ovarian tumours normally arise from which organs?

A

Uterus

Fallopian tubes

Cotralateral ovary or pelvic peritoneum

114
Q

What is the most common location of extra-Müllerian mets?

A

Mucinous signed cell tumours from the stomach

Pathology (25 decks)

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