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***MS 2 Unit 1 Pathology > Female Genital System and Gestational Pathology > Flashcards

Female Genital System and Gestational Pathology Flashcards

(68 cards)

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1
Q

Bartholian Cyst

A

unilateral dilation of <b>lower vestibule</b> due to obstruction and consequential inflammation (caused by infection or STD)

<b>*gland abscess is often causes by N. gonorrhoeae</b>

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2
Q

Condyloma

A

warty neoplasm of vulvar skin due to HPV (6, 11) causing koilocytic change

*rarely progresses to carcinoma

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3
Q

HPV categories

A

<b>low risk</b>: 6, 11; condyloma

<b>high risk</b>: 16, 18, 31, 33; dysplasia–> carcinoma

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4
Q

Lichen Sclerosis

A

benign thinning of epidermis and fibrosis or dermis causing leukoplakia with <b>parchment-like</b> vulvar skin

  • occurs in postmenopausal women
  • slighly increases risk for squamous cell carcinoma
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5
Q

Lichen Simplex Chronicus

A

benign squamous cell hyperplasia causing leukoplakia with <b>leathery</b> vulvar skin

  • <b>chronic irritation and scratching</b>
  • no increased risk of squamous cell carcinoma
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6
Q

Vulvar Carcinoma etiology

A

<b>HPV-related</b>: high risk HPV 16 and 18 in 40-50 year olds; from vulvar intraepithelial neoplasia (VIN)

<b>non-HPV-related</b>: long-standing Lichen Sclerosis in >70 year olds

*keratin squamous pearls on histology

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7
Q

Extramammary Paget Disease

A

malignant epithelial cells in epidermis causing erythematous, pruritic (itchy) and ulcerated skin <b>without underlying carcinoma</b> (unlike Paget Disease of the breast)

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8
Q

Vulvar Carcinoma vs. Vulvar Melanoma

A

<b>Carcinoma</b>: PAS +, keratin +, S100 -

<b>Melanoma</b>: PAS -, ketain -, S100 +

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9
Q

Adenosis

A

when upper 2/3 of vaginal canal remains columnar when it should actually transition to squamous (<b>residual columnar cells</b>)

  • related to DES in utero
  • <b>Complication= Clear Cell Adenocarcinoma</b>
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10
Q

Clear Cell Adenocarcinoma

A

malignant proliferation of glands with clear carinoma

  • complication of DES-associated Adenosis
  • DES inhibits Mullerian differentiation
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11
Q

Embryonal Rhabdomyosarcoma

A

malignant mesenchymal proliferation of immature skeletal muscle causing <b> grape-like mass</b> protrusion in children

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12
Q

Rhabdomyoblast

A

has cytoplasmic cross-striations and + IHC staining for desmin and myogenin

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13
Q

Vaginal Carcinoma (& lymph node spread)

A

related to high risk HPV with vaginal intraepithelial neoplasia (VAIN) as the precursor lesion

lower 1/3–> spreads to inguinal nodes
upper 2/3–> spreads to regional iliac nodes

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14
Q

Cervix anatomy

A

endocervix (mucus-secreting columnar cells), transformation zone, exocervix (squamous)

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15
Q

proteins made by high-risk HPV

A

<b>E6</b>- increased destruction of p53

<b>E7</b>- increased destruction of Rb

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16
Q

Cervical Intraepithelial Neoplasia: CIN (definition and grades)

A

koilocytic change, nuclear atypia and increased mitotic activity

<b>Grades</b>:

  • CIN 1 (lower 1/3 of epithelium), 2 (lower 2/3 of epithelium), 3 (full thickness of the epithelium) are reversible
  • CIN in situ is irreversible (involves full thickness of epithelium)
  • progression from CIN 1 to CIN 3 takes ~10 years
  • progression from CIN 3 to invasive cancer ~10 years
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17
Q

Cervical Carcinoma (definition, risk factors, types)

A

invades basement membrane in women aged 40-50 years old presenting as <b>vaginal bleeding</b>

<b>Risk factors</b>: high-risk HPV, smoking, immunodeficiency (since majority of the time, HPV is eliminated by the immune system)

<b>Types</b>: squamous cell and adenocarcinoma

**postrenal azotemia leading to renal failure is a common cause of death

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18
Q

Limitations of Pap smears

A
  1. inadequate transformation zone sampling

2. limited efficacy in screening adenocarcinoma

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19
Q

Asherman Syndrome

A

secondary amenorrhea due to loss of basalis (regenerative layer of endometrium) <b>from overaggressive dilation and curettage</b>

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20
Q

Anovulatory Cycle

A

estrogen proliferative phase <b> without progesterone-driven secretory phase</b> causing dysfunctional uterine bleeding

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21
Q

Endometritis (Acute and Chronic)

A

<b>Acute</b>: bacterial infection fro retained products of conception causing <b>fever</b>, uterine bleeding and pelvic pain

<b>Chronic</b>: inflammation of endometrium from placenta retention characterized by plasma cells causing uterine bleeding, pelvic pain and <b>infertility</b>

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22
Q

Endometriosis

A

glands and stroma outside of the uterine endometrial lining from retrograde menstruation commonly involving <b>ovary (chocolate cyst)</b>

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23
Q

Adenomyosis

A

endometriosis involving the myometrium increasing risk for carcinoma

  • uterus becomes enlarged, menorrhagia, dysmenorrhea, pelvic pain
  • <b>treatment: hysterectomy</b>
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24
Q

Endometrial Hyperplasia

A

hyperplasia of glands due to unopposed estrogen causing postmenopausal bleeding

<b>Simple</b>: increased number of cystically dilated glands without glandular crowding
<b>Complex</b>: increased number of dilated glands with branching and glandular crowding
<b>Atypical</b>: glandular crowding and dysplastic epithelium

*atypia is an important predictor for progression to carcinoma

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25
Endometrial Carcinoma (pathways)
malignant proliferation of endometrial glands causing postmenopausal bleeding Hyperplasia--> CA--> Endometrioid * 50 year-olds * related to estrogen exposure Sporatic p53 mutation--> Serous--> Papillary * elderly * no evident precursor lesion *lungs are a common site of metastasis
26
Leiomyoma/Fibroids (definition, possible symptoms, what happens to the tumors)
benign proliferation of smooth muscle (myometrium) due to estrogen exposure causing multiple, well-defined white whorled masses * usually asymptomatic or cause uterine bleeding, infertility and pelvic mass * never leads to Leiomyosarcoma *tumors undergo degeneration, dystrophic calcification and hyalinization
27
Leiomyosarcoma
malignant proliferation of smooth muscle (myometrium) arising denovo in postmenopausal women causing single lesion with necrosis and hemorrhage
28
Hormone flow in oocytes:
LH stimulates Theca cells to produce androgens which then in the Granulosa cells they can turn into estradiol with the help of FSH allowing for maturation of the oocyte
29
Polycystic Ovarian Disease: PCOD
hormone imbalance (high LH and low FSH) leading to multiple follicular cysts (hyperplasia of ovarian theca cells around ovarian follicles) high LH causes increased androgen synthesis leading to infertility, oligomenorrhea and hirtuism
30
Cell types that make up the ovary:
1. Surface epithelium 2. Germ cells 3. Sex-cord stroma
31
Surface Epithelial Tumors of the Ovary
presents late with vague abdominal symptoms and urinary frequency and tend to spread locally with poor prognosis 1. Cystadenoma: benign, simple cyst with flat lining, premenopausal (30-40 years old) 2. Cystadenocarcinoma: malignant, complex cyst with thick shaggy lining, postmenopausal, presence of psammoma bodies (60-70 years old) 3. Borderline: still carries metastatic potential 4. Endometrioid 5. Brenner: urothelium; contains Walthard cell rests
32
Germ Cell Tumors of the Ovary
occurs in women of reproductive age 1. Cystic Teratoma: benign, composed of 2-3 embryonic layers of fetal tissue, bilateral in 10% of cases 2. Struma Ovarii: cystic teratoma composed of thyroid tissue 3. Dysgerminoma: malignant, large cells with clear cytoplasm and central nuclei with elevated LDH but a good prognosis 4. Endodermal Sinus Tumor: malignant, resembles yolk sac, elevated seum AFP, Schillar-Duval bodies 5. Choriocarcinoma: composed of trophoblasts and syncytiotrophoblasts, early hematogenous spread, high beta hCG, chorionic villi are not present 6. Embryonal Carcinoma: large primitive cells, aggressive with early metastasis
33
Sex Chord Stromal Tumors of the Ovary
1. Granulosa-Theca Cell Tumor: produces estrogen, contains Call-Exner bodies 2. Sertoli-Leydig Cell Tumor : Sertoli cells form tubules and Leydig cells contain Reinke crystals; production of androgens thus associated with hirtuism or virulization 3. Fibroma: benign fibroblast tumor associated with pleural effusion and ascites (Meigs Syndrome) 4. Metastasis: Kruckenberg tumor (hematogenous spread of gastric cancer) and Pseudomyxoma peritonei
34
Ectopic Pregnancy risk factor
scarring
35
What are spontaneous abortions usually due to?
chromosomal anomalies, congenital infections, exposure to teratogens or hypercoaguable states
36
Placenta Previa
implantation of placenta in lower uterine segment overlying cervical Os *presents as painless 3rd trimester bleeding without fetal distress
37
Placenta Abruption
separation of placenta from decidua due to retroplacental clot cutting off O2 supply *presents as painful 3rd trimester bleeding and fetal insufficiency
38
Placenta Accreta
improper implantation of placenta into myometrium without intervening decidua requiring a hysterectomy since it cannot be properly removed
39
Preeclampsia and Ecclampsia
Preeclampsia: pregnancy-induced hypertension, proteinuria and edema (and placental hypoperfusion) due to abnormality of maternal-fetal vascular interface and increase in vasoconstrictors and sensitivity to ANGII Ecclampsia: Preeclampsia + Seizures
40
HELLP
Hemolysis, Elevated Liver enzymes, Low Platelets *preeclampsia with thrombotic microangiopathy involving liver
41
Hyaditidiform Mole
- benign tumors of the chorionic villus - abnormal conception - swollen and edematous villi with trophoblast proliferation - passage of grape-like masses - complete vs. partial - high beta hCG - risk of Choriocarcinoma - snow storm appearance on ultrasound Treatment= dilatation and curettage
42
Gardnerella vaginalis
gram negative rod that adheres to squamous cells thus producing "clue cells" * due to alteration in the microenvironment of the vagina * treatment: metronidazole
43
What happens to cells when they undergo koilocytic change?
they have wrinkled pyknotic nuclei surrounded by a clear halo
44
Klebsiella granulomatis
STD; gram negative coccobacillus causing granuloma inguinale in which the organism is phagocytized by macrophages (Donovan bodies) * creeping, raised sore * treatment: doxycycline
45
Trichomonas vaginalis
produces vaginitis, cervicitis, urethritis, green-frothy discharge *treatment: metronidazole
46
Rokitansky-Kuster-Hauser (RKH) Syndrome
underdeveloped or absent vagina and uterus | *ovaries are usually present and functional
47
Gartner Duct Cyst
remnant of wolffian/mesonephric duct presenting as cyst on lateral wall of vagina
48
Nabothian cysts
obstruction of the outflow of mucus due to blockage by metaplastic squamous cells
49
Cervicitis (Acute, Chronic, Follicular)
Acute: Chlamydia, Gonorrhea, Trichomonas vaginalis, Candida or HPV will cause discharge, pain during sex (dyspareunia) and pelvic pain Chronic: when acute cervicitis persists Follicular: Chlamydia infects metaplastic squamous cells causing profound lymphoid infiltrate with germinal centers
50
Different cells that are noticed on Pap smear
Superficial squamous cell: estrogen Intermediate squamous cells: progesterone Parabasal cells: lack of estrogen and progesterone
51
hCG
made by the syncytiotrophoblast lining the chorionic villus in the plascenta acting as LH by maintaining the corpus luteum so it can produce progesterone to keep the pregnancy
52
Estradiol vs. Estrone vs. Estriol
Estradiol: made by ovaries and present primarily in non-pregnant women allowing for development of reproductive system Estrone: weak estrogen made during menopause Estriol: primary estrogen of pregnancy
53
Androgen origins that cause hirtuism
1. Ovarian origin--> testosterone | 2. Adrenal origin--> DHEA-S and testosterone
54
Types of Dysfunctional Uterine Bleeding (DUB)
Menorrhagia: regular but excessive flow Hypomenorrhea: regular but decreased flow Metrorrhagia: irregular with excessive flow Menometrorrhagia: irregular or excessive between periods
55
rectal pouch of Douglas (lol such a royal sounding name)
area anterior to rectum but posterior to uterus that can be palpated *common site for blood, malignant cells, pus and endometrial implants
56
CA-125
- excellent sensitivity, poor specificity (increased false positive results) - increased in surface-derived ovarian cancers - useful in excluding endometriosis when it returns negative
57
What causes an endometrial polyp to enlarge?
estrogen stimulation
58
2 common causes of PID
N. gonorrhoeae and C. trachomatis causing pus filled fallopian tube lumen
59
Salpingitis Isthmica Nodosa (SIN)
invagination of the mucosa into the muscle of fallopian tubes producing nodules
60
Most common risk factor for ectopic pregnancy
scarring from previous PID
61
Stromal Hyperthecosis
hypercellular ovarian stroma causing bilateral ovarian enlargement * vacuolated/lutenized stromal hilar cells synthesize extra androgens * hirsutism or virilization
62
What decreases the risk for surface-derived ovarian cancers?
Pregnancies since this would mean a decreased number of ovulatory cycles
63
Two sides of the placenta (and layers of the chorionic villi)
Baby's view: chorion covered by aminon (chorionic villi vessels converge with the umbilical cord) *chorionic villi are lined by trophoblastic tissue: outside layer is syncytiotrophoblast and inside layer is cytotrophoblast Mother's view: decidua basalis
64
Funisitis, Placentitis and Chorioamnionitis
Funisitis: infection of umbilical cord Placentitis: infection of placenta Chorioamnionitis: infection of fetal membranes (danger of neonatal sepsis and meningitis
65
Velamentous insertion
umbilical cord inserts away from placental edge causing increased risk for hemorrhage *vessels pass through the membranes between amnion and chorion
66
What can lead to the development of an enlarged placenta?
DM, Rh hemolytic disease, congenital syphilis
67
amniotic fluid (and disorders where it is increased or decreased)
-made of fetal urine that is recycled Polyhydramnios: excess Oligohydramnios: decreased
68
alpha-fetoprotein
increased--> open neural tube defect or folic acid deficiency decreased--> Down syndrome (would also show decreased urine estriol and increased B-hCG)

***MS 2 Unit 1 Pathology (3 decks)

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