Female Repro Pathology Flashcards by Stephanie Escobar

lower abdominal pain and vaginal bleeding. In the setting of a positive pregnancy test (eg, detectable β-hCG) and an adnexal mass, her presentation is most concerning for

ectopic pregnancy

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can occur in patients with a mature teratoma

Ovarian torsion

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***Most common ovarian cancer *** Often bilateral ↑ CA-125 Histology: Psammoma bodies/ anaplasia/ invasion into the stroma/ papillary formations/ cellular atypia/ fibrous core

Serous cystadeno-carcinoma (epithelial) Ovarian Tumor

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Pseudomyxoma peritonei Mucin-producing epithelial cells ↑ CA-125

Mucinous cystadeno-carcinoma (epithelial) Ovarian Tumor

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Adolescents ↑ β-hCG, ↑ LDH Histology: “Fried egg cells”

Dysgerminoma (germ cell) Ovarian Tumor

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↑ AFP Aggressive Schiller-Duval bodies resemble glomeruli

Endodermal sinus (yolk sac) Ovarian Tumor

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↑ Estrogen (eg, endometrial hyperplasia, postmenopausal bleeding) ↑ Inhibin Histology: Call-Exner bodies, coffee bean nuclei

Granulosa cell Stroma (sex cord) Ovarian Tumor

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↑ Androgens (eg, hirsutism, clitoromegaly) Stroma tumor

Sertoli-Leydig Stroma (sex cord) Ovarian Tumor

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produce CA-125, which can be used as a serum marker for this condition.

Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma

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Typically present with a: pelvic mass, ascites, peritoneal metastasis decreased appetite, abdominal distension, bowel or bladder changes (constipation, urinary frequency)

Patients with ovarian cancer Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma

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Nulliparous women are at increased risk for ovarian cancer due to _____, resulting in continued disruption and repair of the ovarian epithelium.

frequent ovulation

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Histologic findings of ______ include: anaplasia of epithelial cells with invasion into the stroma, multiple papillary formations with cellular atypia Psammoma bodies.

epithelial ovarian cancer Epithelial ovarian tumors Serous/Mucinous cystadeno-carcinoma

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Sertoli-Leydig cell tumors of the ovary are rare sex cord stromal neoplasms typically appear as ____ composed of Sertoli cells with interspersed ______ Leydig cells and surrounding _____ stroma.

tubules eosinophilic fibrous stroma

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Human papillomavirus infection of ______ cells can progress from premalignant (Low/High grade CIN) to cancerous lesions (cervical carcinoma.

basal cervical

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Expansion of immature basal cells to the epithelial surface

high-grade CIN

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Expansion of immature basal cells to the epithelial surface and breaching the basement membrane below them

Cervical Carcinoma (aka Squamous cell carcinoma (SCC)) *koilocytes do not = carcinoma

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Cervical intraepithelial neoplasia refers to atypical _____ cells and is classified as Low-grade squamous intraepithelial lesions (if extending ___ of the epithelium) High-grade squamous intraepithelial lesions (if extending ___ of the epithelium) Basement membrane breach signifies _____ Typically cause by ___ infection with strains __& ___

basal squamous cells <1/3 (less than half) >1/3 (half or more) invasive disease (cervical squamous cell carcinoma) HPV 16, 18

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In most cases, ____ (cervical lesion) regress spontaneously

LSILs

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HPV 1-4 =

Skin warts

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HPV 6, 11 =

Genital warts (Condyloma accuminata)

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HPV 16, 18, 31 =

Anal, cervical, vaginal, vulvar neoplasia

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the most common type of cervical cancer, arises from the squamocolumnar junction of the endocervix.

Squamous cell carcinoma (SCC)

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HPV 16, 18, 31 can lead to over expression of viral oncogenes __ & __

E6 and E7

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E6 binds protein ___ and increases its ____

p53 degradation

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E7 binds to ____ and displaces the \_\_\_

retinoblastoma (RB1) gene transcription factors normally bound by pRB \*pRB= protein made by gene RB (tumor suppressor)

What is the most significant factor that predisposed most patients to cervical abnormalities?

Lack of barrier contraception use or Immunocompromised status

Nulliparity early menarche obesity increase the risk of ______ cancer due to increased estrogen stimulation of the tissue.

endometrial cancer

Nulliparity early menarche prolonged menses (no-contraception) are risk factors for

endometriosis

\_\_\_\_\_ responds to hormonal influences of the menstrual cycle in the same way as uterine endometrium. Bleeding and shedding of extrauterine endometrium leads to formation of blood collections and induces inflammation. Inflammation is then followed by \_\_\_\_\_\_, which in turn distorts organ's structure and function.

Ectopic endometrium Adhesion formation

List 4 common implant sites for ectopic endometrial tissues and adhesion formation

Uterus bladder colon uteralsacral ligament (causes thickening)

Adhesions (from Endometriosis) may interfere with ovulation and fallopian tube function, resulting in \_\_\_\_. Shedding of the ectopic tissue causes \_\_\_\_.

infertility dysmenorrhea (painful menses)

Implants and adhesions (from Endometriosis involving the uterosacral ligament can result in a fixed, ____ uterus.

retroverted

Infiltration of the posterior cul-de-sac from ectopic endometrial tissues can result in painful ____ and tenderness with palpation of the posterior vaginal \_\_\_\_.

intercourse fornix

Polycystic ovary syndrome is characterized by: ____ levels excess androgen production ____ resistance

elevated LH insulin

Polycystic ovary syndrome clinical features include: obesity menstrual irregularities hirsutism _____ ovaries increased risk of (2):

enlarged ovaries DM and endometrial hyperplasia

Patients with polycystic ovary syndrome who desire fertility can be treated with Clomiphene which is an ______ that decreases _______ on the hypothalamus by high circulating estrogen. As a result, ____ production is increased for ovulation

estrogen receptor modulator negative feedback inhibition gonadotropin (FSH/LH)

PCOS patients who do not wish to become pregnant may also be started on _____ to minimize: endometrial proliferation androgenic symptoms (hirsutism, acne) unwanted pregnancy

dual estrogen-progestin oral contraceptive pills

\_\_\_\_ is an androgen receptor antagonist used in the treatment of acne and hirsutism in PCOS if OCPs don't work (do not use if they wanna get pregnant)

Spironolactone

Endometrial hyperplasia and cancer often present with _____ bleeding. A common risk factor is obesity due to the ____ which leads to chronic unopposed estrogen exposure and uncontrolled endometrial tissue proliferation.

postmenopausal peripheral aromatization of androgens to estrogens in adipose tissue

small and cuboidal in cells that grow in cords or sheets, and form follicle- or rosette-like structures with a gland-like appearance a pink eosinophilic center and coffee bean nuclei. ____ cells are plump with lipid contents, which give the mass a yellow color on gross inspection. Large Unilateral mass

Granulosa–Theca cell tumor \*can cause precocious puberty in young girls

Large ovarian (adnexal) mass and signs of virilization: facial hair deepening voice clitoromegaly

Sertoli-Leydig tumor

Ovarian torsion typically occurs in reproductive-aged women due to rotation of the ovary around the _____ and _____ ligaments. Patients typically have SUDDEN-onset unilateral pelvic pain and a tender adnexal mass.

infundibulopelvic (suspensory) uteroovarian

\_\_\_ sided ovarian torsion is more common because of the greater length of the uteroovarian ligament. Risk factors include: ___ & \_\_\_

Right-sided Pregnancy & Ovarian mass

E7 binds Rb and displaces bound transcription factors, promoting unregulated ___ and ___ mediated cell cycling.

DNA replication cyclin

The oncogenic capability of HPV is dependent on its ability to integrate into the host genome and subsequently produce _______ which interact with cell cycle regulatory proteins

viral proteins E6 and E7

E6 binds p53, leading to its ____ and subsequent \_\_\_\_\_\_. Without p53, the cell is unable to halt cell growth to repair\_\_\_\_ or trigger ____ when DNA is damaged beyond repair.

ubiquination proteasomal degradation damaged DNA apoptosis

\_\_\_ & ____ are proto-oncogenes that code for cytoplasmic signal transducer proteins which upregulate cellular proliferation and differentiation when activated. Mutations causing constitutive activation of these proteins are linked to development of _____ cancer and malignant \_\_\_\_.

RAS and BRAF pancreatic cancer (Ras) melanomas (BRAF)

The ovary is covered by a ____ epithelium involved in surface repair of defects from ovulation.

simple cuboidal

Simple columnar cells in the

Fallopian tube, uterus, endo-cervix

stratified squamous non-keratinized epithelium in the

ecto-cervix, vagina

sloughs off during menses

stratum functionalis

Risk factors for ectopic pregnancy include tubal scarring from, tobacco use, and in vitro fertilization.

prior pelvic surgery pelvic inflammatory disease

A Krukenberg tumor is a gastric tumor that has metastasized to the ____ and can present with unintentional weight loss, epigastric pain, and adnexal masses. Histologically, the metastatic tumor cells have large amounts of ____ with displaced nuclei, resulting in a ____ appearance.

ovary mucin signet ring

A ______ tumor is a gastric tumor that has metastasized to the ovary

Krukenberg

unintentional weight loss epigastric pain adnexal masse(s)

Gastric Krukenberg tumor

Combined oral contraceptives ______ Salpingo-oophorectomy ______ are protective factors against Epithelial ovarian cancer

Multiparity Breastfeeding

Family history Infertility/Nulliparity ________ Endometriosis _______ \_\_\_\_\_\_\_ Postmenopausal hormone therapy are risk factors for Epithelial ovarian cancer

BRCA1 or BRCA2 mutations Lynch syndrome Polycystic ovarian syndrome

The pathogenesis of ____ cancer is linked to the frequency of trauma and repair at the ovarian surface.

epithelial ovarian

obese patient with postmenopausal bleeding most likely has endometrial hyperplasia or cancer due to

peripheral aromatization of androgens

Endometriosis the ectopic implantation of endometrial glands and stroma, typically causes painful menses (ie, dysmenorrhea) due to inflamed tissue on the \_\_\_\_.

peritoneum

↑ Inhibin ↑ Estrogen (endometrial Hyperplasia/Precocious puberty) Large unilateral adnexal mass Thickened endometrium

Granulosa cell tumor of ovary

small cuboidal cells in sheets with gland-like structures containing acidophilic material. The cells are arranged in a microfollicular pattern around a pink, eosinophilic center & coffee bean nuclei \*Yellow theca cells with lipid

Call Exner bodies Granulosa cell tumor of ovary

Cancer antigen ____ is elevated in epithelial carcinomas of the ovary (eg, serous, endometrioid, clear cell).

125 (CA-125)

Typically presents with a pelvic mass, ascites, and peritoneal metastasis that result in decreased appetite, abdominal distension, and bowel or bladder changes (eg, constipation, urinary frequency).

ovarian cancer

Leuprolide is a GnRH agonist used to treat symptomatic uterine fibroids causing __ GnRH __ Estrogen __ FSH

↓ ↓ ↓

Clomiphene, used for ovulation induction to treat infertility, acts on the hypothalamus by interfering with hypothalamic estrogen receptors __ GnRH __ Estrogen __ FSH

↑ ↑ ↑

An endodermal sinus (eg, yolk sac) tumor is a malignant germ cell ovarian tumor that typically presents with abdominal pain due to ovarian ___ without virilization. The neoplasm is characterized by Schiller-Duval bodies, which are glomerulus-like papillary structures with a central vessel

torsion

Risk factors for ectopic pregnancy include tubal scarring (eg, prior pelvic surgery, pelvic inflammatory disease), tobacco use, and \_\_\_.

in vitro fertilization

dyspareunia (ie, pain with intercourse) strong clue for what diagnosis?

endometriosis

Pelvic pressure + postcoital bleeding strong clue for what diagnosis?

Cervical cancer

Oral contraceptives, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation. Risk factors include BRCA mutation, nulliparity, and infertility.

Ovarian cancer

tamoxifen use increases risk for \_\_\_\_, a rare but aggressive malignant tumor arising from the uterine myometrium

uterine sarcoma

Myocytes and/or endometrial stromal cells with nuclear atypia, abundant mitoses, and areas of necrosis.

uterine sarcoma

Typical histologic features include ovarian stromal invasion by atypical cells (pleomorphic, large, irregular nuclei and prominent nucleoli) forming papillae and glandular spaces.

High-grade serous ovarian carcinoma \*usually in older women

Struma ovarii is an ovarian ___ cell tumor composed of \>50% mature thyroid tissue that can secrete thyroid hormone.

germ

Where in the female gential tract are **_simple cuboidal_** cells found?

Ovaries

Where in the female genital tract are **_simple columnar_** cells found? (3)

Fallopian Tube Endometrium endocervix

Old accumulated blood looks like "chocolate"-colored fluid inside an ovarian cyst Diagnosis?

endometrioma | (endometriosis)

Female Repro Pathology Flashcards

(78 cards)