Female Genital System and Gestational Pathology Flashcards Preview

Pathoma > Female Genital System and Gestational Pathology > Flashcards

Flashcards in Female Genital System and Gestational Pathology Deck (67):
1

Bartholin Cyst

Cystic dilation of Bartholin Gland (mucus secreting gland on each side of vaginal canal. Due to inflammation and obstruction of gland. Usually unilateral and painful at site of lower vestibule adjacent to vaginal canal

2

Condyloma

Warty neoplasm of vulvar skin. Due to HPV 6 or 11, secondary syphillis.
Displays koilocytes (raisin like nucleus)
Rarely progress to carcinoma

3

High Rish HPV

16, 18
31, 33

4

Low Risk HPV

6, 11

5

Lichen Sclerosis

Thinning of the epidermis and fibrosis (sclerosis) of the dermis.
Leukoplakia (white patch) and "parchment like" vulvar skin
See in postmenopausal women. Slight increase risk of squamous cell carcinoma

6

Lichen Simplex Chronicus

Hyperplasia if vulvar squamous epithelium
Leukoplakie (white patch) with thick, leathery skin
Totally benign due to chronic irritation and scratching

7

Vulvar Carcinoma
HPV vs Non HPV etiology

Carcinoma arising from squamous epithelium.
Rare. Presents as leukoplakia so need to do a biopsy.

HPV 16 and 18. Arises from vulvar intraepithelial neoplasia (VIN). See in younger women.

Non HPV due to long standing lichen sclerosis. See in elderly

8

Extramammary Paget Disease
How to distinguish between paget and melanoma

Malignant epithelial cells in epidermis of vulva.
Erythematous, pruritic, ulerated vulvar skin
Represents carinoma in situ with no underlyin carnimoa unlike paget in other areas of body

Paget cells are PAS+, KERATIN+, S100-
Melanoma cells PAS -, KERATIN -, S100+

9

Adenosis

Persistance of columnar epithelium in the upper vagina
At birth lower 1/3 derived from urogenital sinus is stratified squamous and it grows upward to completely displace the upper 2/3 that was derived from mullerian duct and columnar.
Increased risk of clear cell adenocarcinoma
See in girls whose mothers took diethylstilbesterol (DES)

10

Clear Cell Adenocarcinoma

Malignant proliferation of glands with clear cytoplasm
Rare complication of DES

11

Emrbyonal Rhabdomyosarcoma/ Sarcome Botryoides

Malignant Mesenchymal proliferation of immature skeletal muscle.
Present with bleeding and grape like mass on young child (<5) on vagina or penis.
Rhabdomyoblast = cytoplasmic cross-striations, Desmin+, Myogenin+

12

Vaginal Carcinoma
Lymph node involvement of lower 1/3 vs upper 2/3

Carcinoma of squamous epithelium lining vaginal mucosa.
Related to high risk HPV (16, 18, 31, 33)
Precursor lesion is vaginal intraepithelial neoplasia (VAIN)
Lower 1/3 spread to inguinal nodes
Upper 2/3 spread to iliac nodes

13

How does HPV lead to Cervical Intraepithelial Neoplasia (CIN)

High risk HOV produces E6 and E7 proteins that destroy p53 and Rb. Loss of these tumor supressor proteins increases risk for CIN

14

Grading of Cervical Intraepithelial Neoplasia

Characterized by koilocytic change, disordered cellular maturation, nuclea atypia, increased mitotic activity
CIN I (CIN II ( CIN III (less than entire thickness) -> Carinoma in Situ -> invasive squamous cell carcinoma (enitre. I-III are reversible. Takes many many years so usually don't see carcinoma until middle aged women.

15

Cervical Carcinoma

Common in middle aged women. Presents as vaginal bleeding especially after sex.
Risk factors include high rish HPV (16, 18, 31, 33), smoking, and AIDS!!!!
Usually invades anterior uterus and blocks ureters causing lethal hydronephrosis with postrenal failure

16

Pap Smear

MUST sample at transition zone (stratified squamous to simple columnar). Follow up with colposcopy and biopsy.
Good screening for progression from CIN to carcinoma
Not effective in screening for adenocarcinoma

17

HPV Vaccine

Vaccinates agasint 6, 11, 16, and 18 which are hte most common. Still need pap smears cus can have one of the other more rare HPVs that can still cause cancer.

18

Asherman Syndrome

Secondary amenorrhea due to loss of the basalis and scarring. Basalis is the regenerative layer of the endometrium (site of stem cells) and can be damaged during overagressive dilation and curettage

19

Anovulatory Cycle

Lack of Ovulation. Get an estrogen driven proliferative phase but lack the progesterone driven secretory phase so bleed. Often seen during menarche and menopause

20

Acute Endometriosis

Bacterial infection of endometirum caused by retained products of conception. Fever, uterine bleeding, pelvic pain.

21

Chronic Endometriosis

Chonic inflammation of the endometrium. See PLASMA cells especially in addition to lymphocytes. results from retained products of conception, chronic pelvic inflammatory disease (chlamydia), IUD, and TB.
Have bleeding, pain, and infertility

22

Endometrial Polyp

Hyperplastic protrusion of the endometrium that presents as abnormal uterine bleeding. Can be a side effect of tamoxifen which has anti-estrogenic effects on breast but weak pro-estrogenic effects on endometrium

23

Endometriosis

Endometrial Glands and stroma outside of uterine lining (most likely due to retrograde menstruation).
Presents as Dymenorrhea (pain during period) and pelvic pain, maybe infertility.
Most common site is ovary (chocolate cyst), if occurs in fallopian tube then increase chance of ectopic pregnancy.
Sites have increased risk of carcinoma.
Appear as yellow-brown "gun powder" nodules

24

Adenomyosis

Endometriosis that involves uterine myometrium

25

Endometrial Hyperplasia

Hyperplasia of glands relative to stroma due to unopposed estrogen (obesity, estrogen replacement, polycystic ovary). Get postmenopasual bleeding.
Most important predictor for progression to carcinoma is presence of cellular atypia

26

Endometrial Carcinoma (hyperplasia vs sporadic)

Malignant proliferation of endometrial glands.
Hyperplasia = 75%of cases. Risk increases with time exposed to estrogen. Cells are endometriod (look normal)
Sporadic = carcinoma arises in atrophic endometrium with no evident precursor legion. Serous cells characterized by papillary structure that can calcify and layer to become psammoma body. P53 mutation is most common and is very aggressive.

27

Leiomyoma (fibroids)

Benign neoplastic proliferation of smooth muscle. Often multiple occur, common post menopause, enlarge during pregancy. Usually asymptomatic
Tumors are multiple, well defined, white, whorled masses

28

Leiomyosarcoma

Malignant proliferation of smooth muscle of myometrium. Arises de novo usually in postmenopausal women.
Usually just a single tumor with areas of necrosis and hemorrhage, cellular atypia.

29

Polycystic Ovarian Disease

LH:FSH >2. Obese, hirsutism, and oligomenorrhea.
Increased LH induces excess androgen production from thecal cells leading to hirsutism (male hair distribution). The androgen is converted to estrone in adipose tissue. Estrone negatively feedbacks to decrease FSH so granulosa cells cant convert androgen to to estradiol and so all follicles degenerate. The high levels of estrone increase risk of enodmetrial carcinoma as wel.
Patients tend to develop insulin resistance and get type 2 diabetes 10-15years later.

30

Ovarian surface epithelial tumors

Most common ovarian tumor (70%)
Serous- water vs mucinous = mucous
B= cystadenomas M=Cystadenocarcinomas Borderline
Present late with vague abdominal pain or urinary frequency, as a result prognosis tends to be poor.
Tend to spread locally into peritoneum = omental caking

31

BRCA1 susceptible to what kind of ovarian tumor?

Surface epithelial tumors of serous nature. Serous carcinoma of ovary or fallopian tube (commonly elect for salpingo-oophorectomy)

32

Surface Epithelial Tumor of ovary - endometrioid tumors

endometrial-like glands that are malignant and proably arise from retrograde menstraution. 15% have independent endometrial cancer so need to check every patient's endometrium

33

Brenner Tumors

Surface Epithelial Tumor of ovary composed of bladder like epithelium.

34

Germ Cell Tumors of Ovary

Present in women of reproductive age and 2nd most common ovarian cancer. Includes cystic teratoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma, embryonal carcinoma

35

cystic teratoma,

germ cell tumor of ovary. Composed of fetal tissues derived from two or three embyologic layers (skin, hair, bone, cartilage, gut, and thyroid)
Bilateral in 10% of cases.
Typically benign but immature tissue (neuroectoderm most common) or somatic malignancy of the cells inside (squamous cell carcinoma of skin most common) indicates malignant potential

36

dysgerminoma

germ cell tumor of ovary. Composed of large cells with clear cytoplasm and central nuclei. Serum LDH may be elevated. Good prognosis since responds to radiotherapy

37

endodermal sinus tumor

germ cell tumor of ovary. Most common germ cell tumor in children. Malignant. Serum AFP is elevated. Notice Schiller-duval bodies (glomerulus-like structures) seen on histology

38

choriocarcinoma

germ cell tumor of ovary. Malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts mimicking placental tissues but lacking vili. Early hematogenous spread. High beta-hCG. Poor prognosis and response to chemo

39

embryonal carcinoma

germ cell tumor of ovary. Malignant with large primitive cells. Agressive with early mets

40

Struma Ovarii

germ cell tumor of ovary. Special cystic teratoma composed primarily of thyroid tissue. Can get hyperthyroidism as a result

41

Granulosa Thecal cell tumor

Neoplastic proliferation of granulosa and thecal cells.
Prior to puberty - see precocious puberty
reproductive age = see menorrhagia (heavy periods) or metrorrhagia (bleed at irregular intervals)
postmenopause = enometrial hyperplasia eith uterine bleeding when not expected

42

Sertoli-Leydig Cell Tumor

Characteristic Reinke Crystals. May produce androgens leading to hirsutism (male hair patterns) and virilization.

43

Fibroma

Benign tumor of fibroblasts. Can be associated with pleaural effusions and ascites (meigs syndrome)

44

Meigs Syndrome

Benign tumor of ovarian fibroblasts. Get tumor, ascites, and pleural effusions

45

Krukenberg tumor

metastatic mucinous tumor that involves BOTH ovaries and usually mets from gastric carcinoma

46

Pseudomyxoma Peritonei

Massive amounts of mucous in peritoneum due to mucinous tumor of appendix and usually mets to ovary

47

Ectopic Pregnancy

Implantation of a fertilized ovum into a place other than than uterus. Fallopian tube is most common.
Key risk factor is scarring (pelvic inflammatory disease, endometriosis). Surgical emergency

Presents as lower quadrant abdominal pain, few weeks after a missed period.

48

Spontaneous abortion

Miscarriage of fetus before 20weeks gestation.
Presents as vaginal bleeding, cramping pain, passage of fetal tissues
Usually due to chromosomal abnormalitis but also hypercoaguable states, lupus, congenital inection

49

Placenta Previa

Implantation of placenta in lower uterine segment, overlies the cervical os. Presents as 3rd trimester bleeding. Have to do C-Section usually

50

Placental Abruption

Seperation of Placenta from the decidua prior to delivery. Common cause of still birth. Blood clots on maternal surface of placenta

51

Placenta Accreta

Improper implantation of placenta into the myometrium. Leads to difficult delivery of the placentaand postpartum bleeding. Often requires a hysterectomy

52

Teratogens Alcohol

Most common cause of mental retardation. Also leads to facial abnormalities and microcephaly

53

Teratogens Cocaine

Growth retardation and placental abruption

54

Teratogens Thalidomide

Limb defects

55

Teratogens Cigarette Smoke

Growth retardation

56

Teratogens Isotretinoin

Spontaneous abortion. Hearing and visual impairment

57

Teratogens Tetracyclin

Discolored teeth

58

Teratogens Warfarin

Fetal bleeding

59

Teratogens Phenytoin

Digital Hypoplasia and cleft lip/palate

60

Preeclampsia

Pregnancy induced hypertensions (can be so severe it causes headaches and visual problems), proteinuria, and edema all occuring in 3rd trimester and resolves with delivery. Myah ave fibrinoid necrosis in vessels of the placenta

61

Eclampsia

Preeclampsi (hypertension, proteinuria, edema) + seizures. Needs immediate delivery

62

HELLP

Preeclampsia with thrombotic microangiopathy involving the liver.
Hemolysis (shearing of RBCs,) Elevated Liver enzymes (small infarcts in liver), Low Platelets (all used up to clot). Requires immediate delivery

63

SIDS

Sudden infant death syndrome = death of healthy infant 1month-1yr. Die in sleep and risks include sleeping on stomach, cigarette smoke, and prematurity

64

Hydatidiform Mole

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts.
Can have a partial or complete mole
Uterus expands much larger and Beta - hCG is much higher than expected for date of gestation
Classically presents with passage of grape like masses through vagina if no prenatal care, or absent heart sounds and snowstorm appearance on ultrasound when get prenatal care
Treat with suction curettage
Need to monitor Beta-hCG to make sure that you removed all cells and screen for development of choriocarcinoma

65

Partial Mole

Genetics = normal ovum fertilized by 2 sperm
Fetal tissue = present
Villous edema = some are hydropic
Trophoblastic focal proliferation around hydropic vili
Risk for choriocarcinoma = minimal

66

Complete Mole

Genetics = Emtpy ovum fertilized by two sperm (compeltely dads genes)
Fetal tissue = absent
Villous edema = most/all are hydropic (completely hydropic)
Trophoblastic Proliferation = diffuse, circumferential proliferation. (vili compeltely covered in trophoblasts)
Risk for choriocarcinoma = 2-3%

67

Choricarcinoma of gestation vs spontaneous

Gestatoinal complication = spontaneous abortion, normal pregnancy, hydatidiform mole. Respond well to chemo

Spontaneous germ cell tumor = does not respond well to chemo