Flashcards in Female Genital System and Gestational Pathology Deck (67):
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
Warty neoplasm of vulvar skin. Due to HPV 6 or 11, secondary syphillis.
Displays koilocytes (raisin like nucleus)
Rarely progress to carcinoma
High Rish HPV
Low Risk HPV
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
Lichen Simplex Chronicus
Hyperplasia if vulvar squamous epithelium
Leukoplakie (white patch) with thick, leathery skin
Totally benign due to chronic irritation and scratching
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
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+
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)
Clear Cell Adenocarcinoma
Malignant proliferation of glands with clear cytoplasm
Rare complication of DES
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+
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
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
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.
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
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
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.
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
Lack of Ovulation. Get an estrogen driven proliferative phase but lack the progesterone driven secretory phase so bleed. Often seen during menarche and menopause
Bacterial infection of endometirum caused by retained products of conception. Fever, uterine bleeding, pelvic pain.
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
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
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
Endometriosis that involves uterine myometrium
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
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.
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
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.
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.
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
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)
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
Surface Epithelial Tumor of ovary composed of bladder like epithelium.
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
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
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
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
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
germ cell tumor of ovary. Malignant with large primitive cells. Agressive with early mets
germ cell tumor of ovary. Special cystic teratoma composed primarily of thyroid tissue. Can get hyperthyroidism as a result
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
Sertoli-Leydig Cell Tumor
Characteristic Reinke Crystals. May produce androgens leading to hirsutism (male hair patterns) and virilization.
Benign tumor of fibroblasts. Can be associated with pleaural effusions and ascites (meigs syndrome)
Benign tumor of ovarian fibroblasts. Get tumor, ascites, and pleural effusions
metastatic mucinous tumor that involves BOTH ovaries and usually mets from gastric carcinoma
Massive amounts of mucous in peritoneum due to mucinous tumor of appendix and usually mets to ovary
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.
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
Implantation of placenta in lower uterine segment, overlies the cervical os. Presents as 3rd trimester bleeding. Have to do C-Section usually
Seperation of Placenta from the decidua prior to delivery. Common cause of still birth. Blood clots on maternal surface of placenta
Improper implantation of placenta into the myometrium. Leads to difficult delivery of the placentaand postpartum bleeding. Often requires a hysterectomy
Most common cause of mental retardation. Also leads to facial abnormalities and microcephaly
Growth retardation and placental abruption
Teratogens Cigarette Smoke
Spontaneous abortion. Hearing and visual impairment
Digital Hypoplasia and cleft lip/palate
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
Preeclampsi (hypertension, proteinuria, edema) + seizures. Needs immediate delivery
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
Sudden infant death syndrome = death of healthy infant 1month-1yr. Die in sleep and risks include sleeping on stomach, cigarette smoke, and prematurity
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
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
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%