What is the difference between hermaphroditism and pseudohermaphroditism?
True = both male and female gonads (ovotestis)
male pseudo = genetically male with female features
female pseudo = genetically female with male features
What is PID?
Inflammation of the entire reproductive tract
Most often chlamydia and gonorrhea. 1/3 have no preexisting STD. Fallopian tubes bear the brunt of infection. Typically have severe abdominal pain, fever, nausea, vaginal discharge, bleeding. Predisposes to ectopic pregnancy b/c inflamed folds of fallopian tube may entrap fertilized ovum.
List the most common STDs
genital herpes: HSV2: painful, recurrent, blisters
HPV: HPV: labial, vaginal, cervical warts (condyloma)
infectious vaginitis: trichomonas/gardnerella/candida: vaginitis with discharge
chlamydial infection: chlamydia: urethritis, cervicitis with discharge, PID
gonorrhea: gonorrhea: urethritis, cervicitis with discharge, PID
syphilis: treponema: vulvar ulcers
Discuss the pathogenesis of endometrial hyperplasia
With an an-ovulatory cycle, the endometrium continues to proliferate because of continuous estrogenic stimulation unopposed by progesterone. Finally the endometrium outgrows it's own blood supply and sheds superficial layers 2-3 weeks after expected menstruation. Can be caused by hyperestrinism.
How is endometrial hyperplasia classified, and how does it relate to endometrial cancer?
Simple hyperplasia = benign
complex hyperplasia = more glands
complex hyperplasia without atypia = 2-3% cancer
complex hyperplasia with atypia = 25-30% cancer >> endometrial adenocarcinoma
How common is gynecologic neoplasia, and what are the most common tumors in this anatomic location?
Most common > 35yrs
Most common = uterus > ovary > cervix
Correlate the pathologic and clinical features of carcinoma of the vulva.
- Cancer of older women
- wartlike, macular lesion or ulceration
- symptoms = itching, discomfort, pain, bleeding, 1/5 are asymptomatic
What is the significance of the diagnosis of leukoplakia and erythroplasia?
These are white or red patches that are precursors to cancer in the vulva. Preneoplastic lesions "carcinoma in situ"
What is the significance of clear cell adenocarcinoma of the vagina?
squamous cell carcinoma
What are the risk factors for carcinoma of the cervix?
- early sexual intercourse
- multiple sex partners
- evidence of HPV infection
- other STDs
- smoke tobacco
Explain the evolution of carcinoma of the cervix from cervical intraepithelial neoplasia
The preinvasive lesions may be mild/moderate/severe dysplasia or as carcinoma in situ or cervical intraepithelial neoplasia. Compare the lack of epithelial maturation in CIN with the normal epithelium that shows distinct basal, suprabasal, and superficial layers. The basement membrane is intact in all forms of CIN but is breached in invasive cancer.
Describe the colposcopic features of cervical neoplasia
Described as mosaic or punctate. Cervix changes from smooth pattern to pathologic with abnormal cells, irregular maturation of cells, and ingrowth of new blood vessels in the tumor zone.
Will then become endo or exophytic.
How is carcinoma of the cervix staged
Stage 0: no gross lesion, CIN III limited to mucosa
Stage 1: invasive carcinoma, confined to the cervix
Stage 2: beyond cervix but not reaching the pelvic wall or below upper vagina
Stage 3: reaches pelvic wall and invading lower 1/3 of vagina
Stage 4: spread beyond pelvis
What is the significance of Pap smears in the diagnosis of cervical cancer?
Because the abnormal cells of CIN are shed into the vagina, can be scraped off and studied.
Most CIN lesions contain HPV (types 16/18 cause 70% of cervical cancer); Koilocytes, vacuolated cells
What is the most common tumor of the body of the uterus?
How is adenocarcinoma of the uterus related to endometrial hyperplasia?
Arises from the epithelial cells lining the endometrial glands
What is the most common malignant tumor of the body of the uterus?
What are the risk factors for endometrial adenocarcinoma?
- taking exogenous estrogen
- have estrogen producing tumors
- obese and form estrogen at an increased rate
- nulliparous and have early menarche or late menopause
How is adenocarcinoma of the endometrium graded and staged, and how are these findings related to the prognosis of this cancer?
Stage 1: confined to endometrium, 90%
Stage 2: extends to cervix and invating myometrium, 50%
Stage 3: extends through wall of uterus but not outside true pelvis, 20%
Stage 4: extends outside true pelvis, infiltrate bladder or rectum, 5%
Describe the gross and microscopic pathologic features of endometrial AC.
Gross: most are exophytic, but can become endophytic
Microscopic: most resemble endometrial glands = endometrioid; less often resembel clear-cell or serous
What are the clinical features of EAC?
- most common presenting symptom is bleeding
- most remain clnically inapparent
Compare the features of submucosal, intramural, and subserosal leiomyomas.
Leiomyomas originate from the smooth muscle of the myometrium
submucosal and subserosal >> may be pedunculated and may protrude from the uterine surface or into the uterine cavity (respectively)
intramural >> throughout the wall
What is endometriosis?
= foci of endometrial tissue that form tumorlike nodules outside the uterus
Discuss the pathogenesis and the complications of endometriosis
Likely occurs due to retrograde menstrual flow >> shedding into peritoneal cavity
- the foci are composed of uterine glands and stroma
- respond to estrogenic stimuli
- lesions grow during proliferative phase, and dont stop growing
- eventually destroys glands and become fibrotic scars, with hemosiderin
What is the significance of ovarian cysts, and how are these cysts classified?
Cysts are common
- follicles that have not ruptured may remain with follicular fluid and enlarge
Most are solitary; but bilateral, with follicular cysts = PCOS
What is the pathogenesis and clinical sig of POS?
These women have complex hormonal disturbances that prevent ovulation, despite high output of gonadotropins from the pituitary. Persisten follicles also contribute to hormonal imbalance. May have masculinization and infertility.
How common are ovarian tumors and how are they classified?
Ranked 2nd most common GYN cancer, but 1st for death. 4th most common cause of cancer in women.
- serous cystadenoma
- mucinous cystadenoma
- serous tumor
- mucinous tumor
- serous cystadenocarcinoma
- mucinous cystadenocarcinoma
- endometrioid adenocarcinoma
Compare the patho and pathology of ovarian tumors originating from the ovarian surface epithelium.
Serous tumor secrete clear fluid, wherease mucinous secrete mucin. Endometrioid to not secrete.
Serous and mucinoid are cystic; Endometrioid are solid.
All endometrioid tumors are malignant.
What are the most important tumors originating from the ovarian surface epithelium?
Serous tumors are the most common.
Compare serous and mucinous cystic tumors of the ovary.
Serous: nodular surface correlates wth cysts filled with fluid, cysts are lined by serous cuboidal epithelium and the same cell line the papillae that project into the lumen, calcifications common
Mucinous: Cysts filled with mucin, a jelly-like substance, mucinous cells are filled with clear material and have basally located nuclei
How do ovarian malignant tumors spread?
What is the most common germ cell tumor of the ovary?
Most common = benign cystic teratoma
lined with hairy skin, dermoid cysts
Compare benign and malignant ovarian germ cell tumors.
When teratomas are left in place, the skin and other tissues of its wall may gradually undergo malignant transformation.
List the most common sex cord stromal tumors of the ovary.
Compare granulosa cell tumors with thecomas and Sertoli-Leydig cell tumors.
Granulosa: solid tumor, hormonally inactive or produce estrogen, small (benign) or large (malignant), slow growth
Thecoma: always benign, solid tumors, secrete estrogens
SL: solid tumors, secrete androgens and cause virilization, benign or malignant
What is Krukenberg tumor?
Metastasis from carcioma of the stomach that produces bilateral enlargement of the ovaries
Explain the various forms of infertility.
Ovum-related: immature, inferior quality
Sperm-related: varying quality, no living sperm, or not enough, not mobile
Genital organ-related: PID
Systemic factors: antibodies to sperm or ova, etc
What are the most common sites of implantation in ectopic pregnancy?
Fallopian tube is the most common site, but can occur ont he ovary or the peritoneal surface.
Compare placenta accreta and placenta previa.
Accreta >> deep penetration of the placental villi into the wall of the uterus
Previa >> implantation of the zygote in the lower segment of the uterus
What is the difference between complete and incomplete abortion?
complete = fetus and placenta are expulsed
incomplete = expulsion of some fetal parts and placenta, while retaining others
Describe the pathologic features of gestation trophoblastic disease.
An abnormality of placentation, leading to tumor-like changes.
The trophoblast (epithelial lining) consists of two cell types: cytotrophoblastic and syncytiotrophoblastic
Benign = hydatidiform mole
Malignant = choriocarcinoma
Compare complete and incomplete hydatiform mole.
Incomplete: two sperms fertilize oocyte
What is choriocarcinoma, and which hormone does it secrete?
In 50% of cases arises from preexisting complete mole
Highly invasive and secrete HCG
*if invades the veins, mets to lung, liver, and brain
RESPONDS to methotrexate
Discuss the pathogenesis and list clinical features of toxemia of pregnancy